From Bria McKenna-Nolta : A HUGE shout out to the AMAZING David Roer. I have the privilege of working for a very kind hearted man that would do anything for his team and their families. Everett cut his hand at work today. When I got home and saw it I knew he needed stitches. I sent a text with a picture to Dave and without hesitation he met us back at the office to suture his hand. This was after we worked a super busy Friday. What other Doctor do you know that would do this? He is seriously the best. Thank you doesn’t seem good enough but he wouldn’t let me buy him anything.😂 #facebookshoutout #7stitches #bestkiddoctor #igavemyhusbandashot 💉 Friends, if you don’t already bring your children to our office you should!! This says it ALL💗

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Talking to Children About Tragedies & Other News Events ​​After any disaster, parents and other adults struggle with what they should say and share with children and what not to say or share with them. The American Academy of Pediatrics (AAP) encourages parents, teachers, child care providers, and others who work closely with children to filter information about the crisis and present it in a way that their child can accommodate, adjust to, and cope with. Where to Start – All Ages No matter what age or developmental stage the child is, parents can start by asking a child what they’ve already heard. Most children will have heard something, no matter how old they are. After you ask them what they’ve heard, ask what questions they have. Older children, teens, and young adults might ask more questions and may request and benefit more from additional information. But no matter what age the child is, it’s best to keep the dialogue straightforward and direct. Avoiding Graphic Details & Exposure to Media In general, it is best to share basic information with children, not graphic details, or unnecessary details about tragic circumstances. Children and adults alike want to be able to understand enough so they know what’s going on. Graphic information and images should be avoided. Keep young children away from repetitive graphic images and sounds that may appear on television, radio, social media, computers, etc. With older children, if you do want them to watch the news, record it ahead of time. That allows you to preview it and evaluate its contents before you sit down with them to watch it. Then, as you watch it with them, you can stop, pause, and have a discussion when you need to. Children will generally follow good advice, but you have to give them some latitude to make decisions about what they’re ready for. You can block them from seeing the newspaper that comes to the door, for example, but not the one on the newsstand. Today, most older children will have access to the news and graphic images through social media and other applications right from their cell phone. You need to be aware of what’s out there and take steps in advance to talk to children about what they might hear or see. Talking to Very Young Children The reality is that even children as young as 4 years old will hear about major crisis events. It’s best that they hear about it from a parent or caregiver, as opposed to another child or in the media. Even the youngest child needs accurate information, but you don’t want to be too vague. Simply saying, “Something happened in a faraway town and some people got hurt,” doesn’t tell the child enough about what happened. The child may not understand why this is so different from people getting hurt every day and why so much is being said about it. The underlying message for a parent to convey is, “It’s okay if these things bother you. We are here to support each other.” Talking to Gradeschool Children & Teens After asking your child what they have heard and if they have questions about what occurred during a school shooting, community bombing, natural disaster, or even a disaster in an international country, a parent can say something such as: “Yes. In [city], [state]” (and here you might need to give some context, depending on whether it’s nearby or far away, for example, ‘That’s a city/state that’s pretty far from/close to here’), there was disaster and many people were hurt. The police and the government are doing their jobs so they can try to make sure that it doesn’t happen again.” A parent can follow-up as needed based on the child’s reactions and questions. Talking to Children with Developmental Delays or Disabilities Parents who have a child with a developmental delay or disability should gear their responses to their child’s developmental level or abilities, rather than their physical, age. If you have a teenage child whose level of intellectual functioning is more similar to a 7-year-old, for instance, gear your response toward her developmental level. Start by giving less information. Provide details or information in the most appropriate and clear way you can. Talking to Children with an Autism Spectrum Disorder (ASD) What’s helpful to a child with an ASD may be different. For instance, the child may find less comfort in cuddling than some other children. Parents should try something else that does calm and comfort their child on other occasions. Ask yourself, “Given who my child is, his personality, temperament, and developmental abilities, what might work for him?” Signs a Child Might Not Be Coping Well If children don’t have a chance to practice healthy coping, a parent may see signs that they’re having difficulty adjusting. Some of things to look for are: Sleep problems: Watch for trouble falling asleep or staying asleep, difficulty waking, nightmares, or other sleep disturbances. Physical complaints: Children may complain of feeling tired, having a headache, or generally feeling unwell. You may notice your child eating too much or less than usual. Changes in behavior: Look for signs of regressive behavior, including social regression, acting more immature, or becoming less patient and more demanding. A child who once separated easily from her parents may become clingy. Teens may begin or change current patterns of tobacco, alcohol, or substance use. Emotional problems: Children may experience undue sadness, depression, anxiety, or fears. Sometimes it can be hard to tell if a child is reacting in a typical way to an unusual event or whether they are having real problems coping, and might need extra support. If you are concerned, talk to your child’s pediatrician or a mental health professional or counselor. Don’t wait for the signs. Start the discussion early, and keep the dialogue going. Additional Information on HealthyChildren.org: Childhood Exposure to Violence How to Talk to Your Child After an Act of Terrorism School Safety during Emergencies: What Parents Need to Know How to Support Your Child's Resilience in a Time of Crisis Responding to Children's Emotional Needs During Times of Crisis​​ ​​Additional Resources: Promoting Adjustment and Helping Children Cope (AAP.org) Communicating with Children and Families: From Everyday Interactions to Skill in Conveying Distressing Information (AAP.org) Tips for Talking to Children After a Disaster (Substance Abuse and Mental Health Services Administration) Help in Times of Crisis ​(National Center for School Crisis and Bereavement) Catastrophic Mass Violence Resources (National Child Traumatic Stress Network) Tips for Talking to Children in Trauma (Substance Abuse and Mental Health Services Administration) How to Help Kids Cope After a Disaster (eHealthMD)

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10 important topics for new parents (long, but a good read) Bringing a new baby home can be nerve-wracking for any parent. If it's your first, the fear of making a mistake can be overwhelming. It's inevitable you won't do everything just right, but read on and you can cross these common mistakes off your list. 1. Car seat safety Some parents make the mistake of not practicing various baby care chores before the baby comes. While how to change a diaper many be intuitive for most, not everything is. Take car seats, for example. "Since hospitals require you to take baby home in an appropriate car seat, be sure you have it installed before delivering," said pediatrician Dr. Jennifer Shu, co-author of "Heading Home with Your Newborn." "Enlist the help of a child passenger safety technician, if needed." Strollers, car carriers send thousands of kids to ERs Figuring out how to correctly -- and safely -- install car seats can be a real challenge for many parents, so much so that many fire stations used to help parents with it. Today, fewer do so, but you can find a trained technician through the National Child Passenger Safety Certification site. But even while parents may have purchased the seat, and even learned how to install it properly, birth educator Polly Gannon finds that some haven't gone to the trouble of using it before the baby comes. "Some parents haven't even put a stuffed animal in there before the baby comes so they know how to get a newborn in there comfortably," said Gannon, who works at Calabasas Pediatrics in Calabasas, California. "Most hospitals, for legal reasons, cannot put the baby in the car seat for you, or even show you how to use it." A 2016 study of nearly 300 families, published in the Journal of Pediatrics, found 91% of those parents made serious mistakes while installing their car seats or putting their newborns into those seats. Eighty-six percent of those errors were in positioning the newborn in the seat, and most of those mistakes were "critical" and increased the child's risk for injury in any accident. Over half of the families had older children, which should have given them practice for the task. For newborns, parents should make sure their infant's head doesn't flop forward, which could restrict breathing. That involves installing the seat at the correct angle to keep the baby's feet up, with the body reclined so baby can turn her head to the side and breathe normally. If the baby slouches down or to the side in the seat, the American Academy of Pediatrics suggests placing a tightly rolled receiving blanket on both sides of the baby, or using the newborn insert made for that car seat brand -- do not mix or match with other manufacturers. Don't place a blanket or roll across the top of the baby's head or put padding under your infant. 2. Back to sleep Stop using crib bumpers, doctors say The national "Back to Sleep" campaign of the 1990s brought a great deal of attention to SIDS, or sudden infant death syndrome, and other sleep-related deaths among infants. Guidelines from the American Academy of Pediatrics insist that every baby should sleep on their back, in their own crib, without any toys or soft bedding. During and after the campaign, sleep-related deaths sharply declined, but recent data shows the risk continues. Each year, some 3,500 babies continue to die from sleep-related causes. A 2015 study by the Centers for Disease Control and Prevention found one in five mothers report putting their baby to sleep on their side or stomach, and 39% of mothers said they use soft bedding in the crib with the baby. "Wow, that's alarming because you'd think everyone would know the recommended way to put their baby to sleep," said pediatrician Dr. Tanya Altmann, author of the new book "Baby and Toddler Basics." "But what a lot of parents still don't know is that you should not use bumpers anymore, and you don't want pillows, toys or extra stuff in the crib." 3. Not feeding on demand Some new parents make the mistake of letting baby sleep too long between feedings, likely due to exhaustion and their own need to get a bit of rest. But that's a mistake, say experts. "The first few weeks, the baby does need to be fed ... every two to three hours, even if they don't demand it," said Altmann. "But once they have regained their birth weight and you get your pediatrician's OK, it's fine to cross your fingers and hope that you get a stretch of three to five hours without the baby waking to be fed. But in the first few weeks, babies do need to be woken up." If you're doing everything right and your baby is growing and developing well, said Altmann, it's perfectly possible to get a baby to sleep through the night by 2 or 3 months of age. But be aware that some babies regress between three and four months and begin to wake up more frequently and feed more often. "If you jump in and turn on all the lights, start playing with them, and basically have a party in the middle of the night, they will continue to wake up," Altmann said. "I usually tell parents if every time you wake up there was chocolate cake on your nightstand, you would start eating it every night and you would wake up expecting it," she said. "Same with babies, right?" 4. Not burping baby properly One of the key mistakes many new parents can make is failing to take the time to properly burp their newborn. "I think many new parents are nervous about handling their newborn," said Gannon. "They will often put the baby down quickly after feeding because they are scared they aren't holding it properly." The result of failing to burp is that the baby may spit up and gag, losing some of that precious milk, or wake up in an hour or so screaming in pain. "I'm getting calls all the time where parents say that the baby is really peaceful after feeding, but then baby wakes up screaming and is up for the next 2 1/2 hours," added Gannon. "My favorite line is 'cheat the baby, cheat yourself.' If you cheat the baby out of a good burp and fail to get all of that air out, you and the baby are both going to suffer." There are several burping techniques you can try until you find the one that works best for your baby. In the most well-known, the-over-the-shoulder burp, you place your baby high on your chest with her chin resting on your shoulder and face turned to one side, tummy firmly against the chest. Pat or rub the baby's back gently until she burps. "It might take you an additional 10 minutes at the end of the feed," said Gannon, "but the baby will be happy." Another common technique is to place baby face down across your lap, and pat and rub. Other techniques include baby exercises. Lay them on a blanket on the floor and begin bicycling their legs, or moving their legs up and around in a circular motion in each direction. Gannon finds that a sitting posture works best for her clients. She places the baby sitting upright on her lap, facing the side. Using one hand to support the baby's head in the front (making sure to avoid holding the neck) she puts her other hand on the baby's back. "Keeping the baby's bottom firmly planted on my lap I move their whole body in a small, slow circular motion to the left for a while, then to the right for a bit," explained Gannon. "I sit the baby upright a few times, and usually get a good, hearty burp, even without a gentle pat on the back." 5. Failing to pre-burp Most of us think about burping after the baby eats. But experts say that you should also take the time to pre-burp your baby. "I try to pre-burp baby for at least two minutes before starting any feeding," Gannon recommended. "This helps eliminate the common spitting up and gassy problem that newborns often have for the first 30 days." "If you start out without gas in the stomach, and then do a really good feed and get the gas out at the end, they are going to be much more comfortable and more likely to be happy and content on their own," added Altmann. 6. Mistakes in mixing formula or breastfeeding Making a mistake measuring formula and water happens often enough in her practice, said Altmann, that she makes it a practice to quiz parents on how they prepare baby's meals. She asks the same of breastfeeding moms, too. "When I have new babies come into my practice," said Altmann, "whether they are breastfeeding or formula feeding, I take a step back and ask these questions: 'Exactly how are you feeding your baby -- what do they look like when they are latched on? How are you mixing the formula? How are you putting it in the bottle?'" On occasion she finds that one of the parents might be mixing formula wrong, by making it too concentrated or dilute. "Usually, it's too dilute," said Altmann. "Then the baby isn't getting enough nutrition and that's when they fail to thrive. You always want to be sure you're reading and following the directions on the formula properly." And some moms may not have the baby fully latched onto the breast, so while the baby looks like it's nursing, he or she isn't actually swallowing and feeding, said Altmann. "It's a good idea for breastfeeding moms to check in with a lactation consultant if they have any concerns or pain during feedings," said Altmann. "Then check in with your pediatrician regularly to make sure your baby is gaining weight appropriately." 7. Not enough tummy time Altmann says an unfortunate mistake many new parents make -- and continue to make as baby grows -- is keeping baby constrained in a car seat, bouncy seat or other sleepers. "I'll see parents out with their baby, at a restaurant, at the park, talking to friends, and they are carrying the baby in the car seat," said Altmann, who is also a spokeswoman for the American Academy of Pediatrics. "I'm always telling parents, 'Car seats are for cars, but don't carry them to and fro in the car seat.'" Not only can spending too much time reclining create a soft spot on the back of their head, says Altmann, but not interacting with the baby can cause language delays and other issues due to a lack of stimulation. "When your baby is not sleeping or not in the car traveling, they really should be on their tummy or held by a parent," Altmann said. "They shouldn't be strapped down, they need to move, stretch, roll and push their head up." 8. Under- or overreacting to a fever Fevers in newborns can be serious. If your baby is younger than three months and develops a fever of 100.4 or higher, call your pediatrician or medical professional immediately. But when it comes to a fever in babies and children older than that, the advice is more complex. "For the older babies, I'm usually telling parents not to freak out by what the number says on the thermometer," explained Altmann. "Instead, take a close look at your child to figure out what is happening with them, because not every fever needs to be treated." Look at your baby and observe. Are they drinking fluids? Are they happy and playing? Are they sleeping OK? Are they having any trouble breathing? Those are the questions to ask yourself, Altmann said. Experts say most fevers are harmless, and likely the result of a mild infection. "Don't just treat the number on the thermometer," Altmann added. "It doesn't matter if it's 101 or 103.5, it's more important how they are acting." 9. Proper temperature for baby in the home Another concern for parents: how warm or cool their baby should be. Shu said she is often asked by parents for the proper temperature setting for the home. The answer, she says, depends on the time of year and the insulation of the home, but in general "a thermostat setting around 68 to 72 is probably comfortable for baby." While Shu says she thinks many parents keep baby too warm, Gannon has found the opposite. At homes in her practice, she said, new parents may have their baby in a T-shirt and diaper, unswaddled. She said a baby's skin should always be warm, not hot or cold, to the touch. "If the baby is chilled, then his body will need to burn extra calories to raise his body temperature, instead of those calories going toward a healthy weight gain," said Gannon. "So even if the baby is feeding well, he or she may not be developing properly because they have to burn a lot of calories trying to get warm." Shu warns that newborns don't have good circulation at first, so "having cool hands and feet is normal." 10. Taking newborns into crowded places Some parents want to take their newborn to a large family gathering so everyone can ooh-and-awww over their tiny miracle. That could be a mistake, experts said. "It does scare me a bit when I see newborns out and about, especially during cold and flu season," said Altmann. "The first two months of your baby's life, you really need to protect them from exposure to germs and people that are potentially sick. Your baby's immune system is weak, and still growing and developing." That doesn't mean you can't leave the house, however. Experts encourage daily walks and say it's fine to sit in your backyard or on the front porch. "But don't take them to crowded spaces," Altmann said. "That's when you can expose them to people who potentially have the flu or another contagious illness that could spread, even if they are a few feet away."

U.S. CDC director urges flu vaccinations as pediatric deaths mount By Julie Steenhuysen CHICAGO (Reuters) - Of the 30 U.S. children who have died from the flu so far this season, some 85 percent likely will not have been vaccinated, said Centers for Disease Control and Prevention Director Dr. Brenda Fitzgerald, who urged Americans to get flu shots amid one of the most severe flu seasons in years. “My message is, if you haven’t gotten a vaccine, please get a vaccine. Also, please get your children vaccinated,” said Fitzgerald, who is urging citizens “to take every advantage that you can to protect yourself.” The dominant strain during this flu season is an especially nasty type called influenza A (H3N2) that in seasons past has been linked with severe disease and death, especially in the elderly and young. This year’s seasonal flu epidemic is especially severe. In past flu seasons, between 80 and 85 percent of children who have died from the flu had not gotten a flu vaccine that season, the agency said in an email. In its latest report, the CDC said the virus is present in every state, with 32 states reporting severe flu activity. Although the vaccine is only estimated to be about 30 percent effective against the H3N2 strain, it has been shown in studies to reduce severity and duration if people do become infected, said Dr. Dan Jernigan, director of the influenza division at the Centers for Disease Control and Prevention. Emergency room nurse Christine Bauer treats Joshua Lagade of Vista, California, for the flu as his girlfriend Mayra Mora looks on in the emergency room at Palomar Medical Center in Escondido, California, U.S., January 18, 2018. REUTERS/Mike Blake Fitzgerald conceded in a telephone interview that reports that the flu vaccine in Australia was only 10 percent effective may have caused people to think the vaccine would not be worth the trouble. Fitzgerald said the agency’s flu division has been on the job during the three-day federal government shutdown. Senators on Monday reached a deal to keep the government funded through Feb. 8. Studies have shown that even a vaccine that has lower overall effectiveness can decrease the number of days spent in hospital, duration of the flu and the degree of symptoms. “That helps support the point of getting a vaccine,” Jernigan said. Fitzgerald said the flu vaccine and antiviral drugs used to fight the flu are widely available across the country, noting that people can go to the CDC website and enter their zip code to find the nearest flu clinics with vaccines. (here) Fitzgerald also recommended that people frequently wash their hands or use hand sanitizer, avoid those who are sick or coughing and carry disinfectant wipes. The CDC does not have numbers for adult deaths from the flu because adult flu is not a reportable disease in all U.S. states. But she said North Carolina, which collects such data, has reported 42 adult flu deaths so far this season. Official estimates from the CDC are expected at the end of the current season, based on a calculation from hospitals and states reporting data to the agency. In the 2014/2015 flu season, in which the H3N2 strain was also the leading strain, there were an estimated 35.6 million cases, 710,000 hospitalizations and 56,000 deaths. At this point, it is not clear whether the current flu season will surpass those estimates, Jernigan said.

Children are dying - get the flu shot NOW! Not too late! U.S. CDC director urges flu vaccinations as pediatric deaths mount. By Julie Steenhuysen CHICAGO (Reuters) - Of the 30 U.S. children who have died from the flu so far this season, some 85 percent likely will not have been vaccinated, said Centers for Disease Control and Prevention Director Dr. Brenda Fitzgerald, who urged Americans to get flu shots amid one of the most severe flu seasons in years. “My message is, if you haven’t gotten a vaccine, please get a vaccine. Also, please get your children vaccinated,” said Fitzgerald, who is urging citizens “to take every advantage that you can to protect yourself.” The dominant strain during this flu season is an especially nasty type called influenza A (H3N2) that in seasons past has been linked with severe disease and death, especially in the elderly and young. This year’s seasonal flu epidemic is especially severe. In past flu seasons, between 80 and 85 percent of children who have died from the flu had not gotten a flu vaccine that season, the agency said in an email. In its latest report, the CDC said the virus is present in every state, with 32 states reporting severe flu activity. Although the vaccine is only estimated to be about 30 percent effective against the H3N2 strain, it has been shown in studies to reduce severity and duration if people do become infected, said Dr. Dan Jernigan, director of the influenza division at the Centers for Disease Control and Prevention. Emergency room nurse Christine Bauer treats Joshua Lagade of Vista, California, for the flu as his girlfriend Mayra Mora looks on in the emergency room at Palomar Medical Center in Escondido, California, U.S., January 18, 2018. REUTERS/Mike Blake Fitzgerald conceded in a telephone interview that reports that the flu vaccine in Australia was only 10 percent effective may have caused people to think the vaccine would not be worth the trouble. Fitzgerald said the agency’s flu division has been on the job during the three-day federal government shutdown. Senators on Monday reached a deal to keep the government funded through Feb. 8. Studies have shown that even a vaccine that has lower overall effectiveness can decrease the number of days spent in hospital, duration of the flu and the degree of symptoms. “That helps support the point of getting a vaccine,” Jernigan said. Fitzgerald said the flu vaccine and antiviral drugs used to fight the flu are widely available across the country, noting that people can go to the CDC website and enter their zip code to find the nearest flu clinics with vaccines. (here) Fitzgerald also recommended that people frequently wash their hands or use hand sanitizer, avoid those who are sick or coughing and carry disinfectant wipes. The CDC does not have numbers for adult deaths from the flu because adult flu is not a reportable disease in all U.S. states. But she said North Carolina, which collects such data, has reported 42 adult flu deaths so far this season. Official estimates from the CDC are expected at the end of the current season, based on a calculation from hospitals and states reporting data to the agency. In the 2014/2015 flu season, in which the H3N2 strain was also the leading strain, there were an estimated 35.6 million cases, 710,000 hospitalizations and 56,000 deaths. At this point, it is not clear whether the current flu season will surpass those estimates, Jernigan said. Reporting by Julie Steenhuysen; Editing by Cynthia Osterman Our Standards:The Thomson Reuters Trust Principles.

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