Pertussis at Trinity High School!
A case of Pertussis (whooping cough) was diagnosed at Trinity. All our patients who go there should come in to get the new Adacel vaccine and possibly antibiotics.

Great News!
Dr. Segeleon is back! And, most exciting of all is her precious new baby girl born in September. Her name is Calloway, and she joins big brothers Logan and Grayson.  "We are calling her Callie," Dr. Segeleon said with a smile.

Achoo!
It’s cold and flu season again. Most children will have at least two to four episodes of viral cold symptoms, lasting seven to ten days this winter. Fever is expected during the first few days. We urge you to read the labels of multi-symptom products very carefully. Try to avoid products with fever reducers, acetaminophen (Tylenol, Tempra) and ibuprofen(Advil, Motrin). Overuse of acetaminophen and ibuprofen can damage the kidneys and liver. Use products that target your child’s particular symptoms, and use fever reducers separately.

Brrr!
It’s cold outside again. Please help us do a complete and thorough exam. Many clues are obtained by examining patients with their clothes off. If your child feels cold, put his or her coat back on. Every attempt will be made to get your children dressed as soon as possible.

Holidays!
They’re here again. The office will be closed Saturday, December 24th and Monday, December 26th. For New Years, the office will be closed Saturday, December 31st and Monday, January 1st . As always help can be obtained by phone all day every day. Please use the answering service for urgent and emergency questions. Routine questions, chronic problems, behavioral issues and dosage questions should be saved for office hours whenever possible.

New Year!
When you come in for your first 2006 visit, we will need you to fill out a patient information form. We too hate filling out forms when we go to our doctors. Please be nice to the staff when you’re asked to fill out the form.

Flu Shots!
A special thanks to the office staff again. Tina Wilson, Jan, Lynn, Tara, Tina Young and Stephanie were awesome. We are out of vaccine, except for the few children who are on our list. Flu shots are still available from the Health Department and some pharmacies. Mark your calendar for the 2006 Flu Shot Saturdays, which will be on the first Saturday in October for high risk patients and the second Saturday in October for all others.

Free Clothes Swap!
A clothes swap for sizes newborn to 4T is held at Clifton Baptist Church on Frankfort Avenue on Wednesday nights. Please call the church for further information.

The American Heart Association Tips for Raising Heart-Healthy, Active Children:

• Help your children develop good physical activity habits at an early age by setting a good example yourself. Practice heart-healthy habits.

• Limit television, movies, videos and computer games to less than two hours a day. Substitute the rest of leisure time with physical activity.

• Plan family outings and vacations that involve vigorous activities such as hiking, bicycling, skiing, swimming, etc.

• Give your children some household chores that require physical exertion, keeping in mind their levels of strength, coordination and maturity. Mowing lawns, raking leaves, scrubbing floors and taking out the garbage not only teach responsibility but can be good exercise.

• Observe sports and activities your children like, then find out about lessons and clubs. Some children thrive on team sports; others prefer individual activities. Some activities, like tennis and swimming, can be enjoyed for a lifetime and are much easier to learn during childhood.

• If it's safe to walk or bike rather than drive, do so. Use stairs instead of elevators and escalators. Increase the distances you and your children walk.

• Stay involved in your child's physical education classes at school. At daycare, make sure the kids exercise at least 20 minutes a day. Ask about frequency of classes and activity, class size, curriculum (instruction in lifetime fitness activities as well as team sports should be emphasized), physical fitness assessments, qualifications of the teacher (should hold appropriate certification in physical education and be an appropriate role model for students). Physical fitness should be measured at the beginning and end of each year, and goals should be established for each child. Encourage your school board to emphasize skills students can use for the rest of their lives.

• Discourage homework immediately after school to let children find some diversion from the structure of the school day. Kids should be active after school and before dinner.

• Choose fitness-oriented gifts -- a jump rope, mini-trampoline, tennis racket, baseball bat, a youth membership at the local YMCA or YWCA. Select the gift with your child's skills and interests in mind.

• Take advantage of your city's recreation opportunities -- from soccer leagues to fun runs. Check out the various camps or organizations like the Sierra Club that sponsor outdoor activities such as camping, hiking trips and bird watching.

• Free your infant from mechanical restraints as much as possible. Strollers and playpens are high on convenience but low on activity potential. Try to unleash your diapered dynamo whenever and wherever he or she can safely move around.

• When your children are bored, suggest something that gets them moving, like playing catch or building a snowman in the yard.

Wishing you and all the Best Kids blessed and joyous holidays.
Sincerely,
 
Harold J. Livera, MD FAAP
Jennifer L. Segeleon, MD FAAP
The Best Kids
217 Breckenridge Lane,
Louisville, KY 40207-3858
502-895-9421
office@thebestkids.com

Flu Vaccine Update and CPR Classes
Many parents have asked if their child should receive the vaccine if they have no risk factors and are older than 23 months of age.

In 2003-2004, 152 children died from influenza. Many were healthy kids without risk factors. We feel all children over six months of age should get the Flu vaccine.

Children 6 to 23 months of age, children with risk factors, and those living with them will be immunized first. Any remaining vaccine will given to the other children and adults. We will reserve second doses for children under nine years of age who are receiving Flu vaccine for the first time.

CPR Classes - Knowing CPR can save a life. Be prepared to be a superhero.
Provides CPR certification: Red Cross  589-4450

These classes provide CPR instruction not certification:
Kosair Children's Hospital     629-1234
BHE     897-8131
Suburban Hospital 629-1234

School Physicals
Thanks so much to everyone for signing up for school physicals early. Your working with us really helped to make this busy season go smoothly in the office. We appreciate your efforts.

Dr. Segeleon due to deliver a baby girl soon!
You may have noticed already; but in only a few weeks, the Segeleons will have their first girl. We are excited for them. Dr. Segeleon will be on maternity leave for six to eight weeks. We look forward to Dr. Segeleon’s return in November.

Healthy Eating
This year we have been stressing the importance of establishing healthy eating habits early. Try to choose one of these strategies now and try another in a week.

Eliminate all soda from your home. I promise no one will faint, seize or die if you do this. Take the money you save and go to the Zoo. The Zoo is fun, educational and you burn calories as you walk.
Institute after dinner family walks. Play the I Spy or other games as you walk. This is a great family tradition to start. Do what parents do best -- combine fun and activity as a family. You’ll feel better and the kids will think they are having only fun!

The links below include good information and fun activities. The site is sponsored by the Produce for Better Health Foundation. The information provided is accurate.

http://www.5aday.com/html/kids/kids_home.php
http://www.5aday.com

Adacel -- The new Tetanus booster vaccine
There is a new type of Tetanus booster being used in our office. It has been recently released for use in patients who are at least 11 years old. In addition to the tetanus and diphtheria protection provided by the old vaccine, it provides a boost in immunity against Pertussis which causes whooping cough. Older children and adults are a natural reservoir of this bacteria . This will decrease the incidence of this disease in babies, who are not yet immune, older children and adults.

A New Vaccine for Meningitis -- Menactra
If you have a child who is at least 11 years old, she should get on our waiting list for the new meningitis vaccine. The new vaccine, Menactra, is made differently from the previous vaccine, Menomune, and induces a better immune response. It offers protection presumably for life, so booster doses are not required. If your child received the old meningococcus vaccine, she can also get the new one to improve protection. The old vaccine only provides protection for three to five years.
Infection with meningococcus may result in a bloodstream infection, called sepsis, or an infection of the brain and spinal cord, called meningitis. Symptoms of sepsis may include fever, chills, rash, low blood pressure and dark purple spots on the arms and legs. Symptoms of meningitis can include fever, headache, confusion and stiff neck.

Flu Vaccine Information
We will offer the flu vaccine October 1st and October 8th. Appointments for flu shots can now be scheduled for these two Saturday afternoons. Children who meet the criteria listed below will be scheduled first. Please make your appointment early, as appointment times fill up quickly. Flu vaccine is recommended for all children 6-23 months of age. Call us now if you want to get the vaccine.

For children under 9 years of age, who are receiving the vaccine for the first time, a second booster dose is needed. We will give those on November 12th if we have any doses remaining. Children under 9 years of age, who could only get one dose last year due to the shortage do not need to get two shots this year.

Your insurance company will be billed for the children's Flu vaccine. For parents who wish to get the vaccine, the cost is $25 for the injection.

Flu Recommendations:
People who should receive flu vaccine include those at risk of complications if they get influenza disease, and adults and children who live, work, or may come in contact with people at high risk.

Persons at high risk for influenza-related complications include:

• All children 6-23 months of age;
• Children (6 months – 18 years of age) who are receiving long-term aspirin therapy;
• Children living in a home with an infant less than 6 months old;
• Everyone 6 months and older with chronic diseases of the heart, lung or kidneys, diabetes, or immunosuppression including HIV infection;
• All pregnant women;
• Adults and children who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases, (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immunosuppression (including that caused by medications or by human immunodeficiency virus {HIV});
• Residents of nursing homes and other chronic-care facilities that house persons of any age who have chronic medical conditions;
• Persons age at least 50 years,
• Others who should consider getting influenza vaccine are persons traveling to the Southern hemisphere between April and September or to the tropics at any time of year; students and staff at schools and colleges; and anyone who wants to reduce their chance of becoming ill with influenza.

See Special Notice below!
An October seminar for parents of Picky Eaters

Sincerely,
 
Harold J. Livera, MD FAAP
Jennifer L. Segeleon, MD FAAP
The Best Kids
217 Breckenridge Lane,
Louisville, KY 40207-3858
502-895-9421
office@thebestkids.com

Date: October 20th, 2005

Location:    Partners in Speech Pathology, LLC
                    3103 Breckenridge Lane, Suite 7B

Speakers: Anne Eddins, Speech Pathologist
Diana Pantalos, Dietitian
Jocelyn Warren, Occupational Therapist

Cost: $35.00

To register call Partners In Speech Pathology at (502) 500-7079

The seminar will provide strategies in how to help PARENTS work with their picky eaters. The course is designed to apply to children of all ages. We will answer questions and give handouts so that families can implement strategies effectively at home. (Course is for parents, no childcare available for children.) If you need help before the conference date arrives, call 500-7079 to arrange an individual session.

# 25 / 26  June and July, 2005 
This is a combined newsletter for June and July

Meningitis Vaccine Alert
If you have Cigna or United Healthcare insurance, call your customer benefits phone number now. Ask about Menactra the new meningitis vaccine. We need to be reimbursed for at least our cost plus 10 % to provide the vaccine to our patients. Our children, 11 years of age and up, need this vaccine.

Insect Repellent
DEET-containing products are the most effective mosquito repellents. DEET is not recommended for use on children under 2 months of age. The higher the concentration, the longer DEET lasts.

10% DEET lasts for approximately two hours, and products with about 30 percent provide about six hours. Aerosol and pump applications can be used directly on skin, and are also good for spraying clothes but not under clothing.

Avoid putting DEET on the face and hands. The AAP warns about the use of DEET over cuts, wounds or irritated skin and suggests washing treated skin with soap and water after returning indoors.

Did you know about "Buckle That Kid?"
1-888-235-8KID
If you see an unrestrained child in a moving vehicle, call 1-888-235-8KID and give the Kentucky license plate number to this hotline. Your call is confidential and no records are kept. The Kentucky Transportation Cabinet will mail an education kit to the owner of the vehicle. The kit has safety tips and illustrations that show proper child restraint usage.

Infant CPR
You can make a difference! Kosair Children’s Hospital offers classes. To attend a class, call
629-7348. This skill can save the life of your child or someone you are near to. Ask if caregivers to your children are certified in CPR.

Water Safety
Swimming is a life skill. Every kid should know how to swim. Swim Lessons are offered close to the office through the YMCA, the Jewish Community Center and the Mary T. Meagher Swim Center, a.k.a. "The bubble."

Say Cheese! Who Has the Best Kid Picture?
We can't get enough of these. If you haven't done it before or you have an update, we'd like a picture of your child. It can be a funny or serious photo. Put yours on our office bulletin board with the other Best Kids.

Motion Sickness
Summer is here and families are on the go. Unfortunately, some kids have trouble with riding in cars, boats and planes.

Here are some favorite suggestions for motion sickness:

• Open the window for fresh air;
• Have your child sit in the middle of the vehicle facing forward;
• Have your child look out the front window into the distance;
• Don’t let your child read or play with hand-held video games in the car;
• Feed your child a small snack, not a big meal, before the trip;
• Avoid spicy or greasy foods;
• Avoid strong odors such as smelly foods and never smoke with a child in the car.

Ask us about motion sickness drugs and the appropriate dosage for children if all else fails.

Sincerely,
Harold J. Livera, MD FAAP
Jennifer L. Segeleon, MD FAAP
The Best Kids
217 Breckenridge Lane,
Louisville, KY 40207-3858
502-895-9421
office@thebestkids.com

# 24 May 1, 2005

Sunscreen
Summer is soon here. Remember that re-application of sunscreen is the critical step in preventing sunburn. Applying sunscreen 30 minutes prior to exposure increases effectiveness. Babies less than 6 months of age should not have direct exposure to sunlight. Use of hats and sunglasses is encouraged. Sunscreen is not recommended for use in children less than 6 months old.

Phenergan Warning
In a letter dated January 21, 2005, the FDA warned physicians that Phenergan should not be used in pediatric patients less than 2 years of age because of the potential for fatal respiratory depression. This occurred with a range of weight based doses.

MyPyramid.gov
The nutrition recommendation for this month is to visit www.foodpyramid.gov . This government sponsored site offers an interactive mode to personalize the pyramid based on age and sex. Advice on portion size and a food/exercise log are available.

Allergy Suggestions
Once again Louisville is at the top of the ratings for allergen levels! Yikes!!

Here are some strategies to minimize your symptoms.

• Keep windows and doors closed to avoid exposure to pollen.
• Limit outdoor activities when pollen counts are highest.
• Use special HEPA filters either in the central system or in individual rooms. Use only well rated filters.
• Dry clothes in the dryer, not by hanging them outside so they don’t get covered With pollen dust.
• Have your child take his bath at bedtime, which may help to wash off allergens and prevent nighttime allergy problems.

A New Vaccine for Meningitis -- Menactra
If you have a child who is 11or older, you should check with us about the new vaccine recommendation for meningitis.

Please call your insurance company to see if they will cover the vaccine. This is a new vaccine and your calls are important. Call the member service number and ask about Menactra.
Recently, the vaccine recommendation for meningococcus changed because a new, more effective vaccine became available. It is given as a shot.

The new vaccine Menactra is made differently and induces a better immune response. The new vaccine is also better because it decreases the likelihood that it will be passed from one person to another. There is also a benefit from the new vaccine - it offers protection presumably for life so booster doses are not required.

If your child received the old meningococcus vaccine, she can also get the new one to improve protection.

Infection with meningococcus may result in a bloodstream infection, called sepsis, or an infection of the brain and spinal cord, called meningitis. Symptoms of sepsis may include fever, chills, rash, low blood pressure and dark purple spots on the arms and legs. Symptoms of meningitis can include fever, headache, confusion and stiff neck.

Sincerely,
Harold J. Livera, MD FAAP
Jennifer L. Segeleon, MD FAAP
The Best Kids
217 Breckenridge Lane,
Louisville, KY 40207-3858
502-895-9421
office@thebestkids.com

#23 April 1, 2005

After Hours Calls
Please use our night call nurses for serious medical problems only. They provide a wonderful service but they are overrun with calls about medication dosages. Please save these calls for when we are open.

Pick up our Fever Advice Sheet when you are in next.

School Physicals for Fall    Who needs physicals?
Would you like to avoid headaches for both you and for us? Schedule your school physical today! School physicals done now are valid for the start of school in the Fall. First-time school enrollees are required to have a valid original immunization certificate and a physical exam.

Additionally, an eye exam must be done by an ophthalmologist or optometrist.

The school physical must be completed within one year prior to enrollment. In August, we run out of appointments, so please schedule yours now!

Well Checks - a reminder
Did you know that after the 18 month well check, we start yearly checks? Yearly well visits are at 2, 3, 4, and age 5. Then we change to every two year checkups at ages 7, 9, 11....

Sincerely, 
Harold J. Livera, MD FAAP
Jennifer L. Segeleon, MD FAAP
The Best Kids
217 Breckenridge Lane,
Louisville, KY 40207-3858
502-895-9421
office@thebestkids.com

#22 March 1, 2005

Scheduling Appointments
Did you know that the length of time scheduled for your appointment is based on what you tell us? Help us make your next office visit meet your expectations. Let the staff know all the problems you want addressed when you call in. We will then have time set aside for all your questions.

RSV
The season is beginning to ease up, but many of our youngest patients are struggling with the cough and runny nose caused by this virus. A large number of positive tests are still being reported by Kosair Children’s Hospital.

FLU
Yes, there have been confirmed cases of Influenza A in Louisville. Influenza B is now also being seen. The season has started late but we are feeling the full effect now. Some schools have reported 30% absentee rates. Tamiflu® is an effective antiviral treatment if started within the first two days from exposure or symptom onset of Influenza type A or B.

Office Survey -- Hooray for our staff!
The results:
99% are pleased with the overall quality of care.
99% are happy with the convenience of our location and our office hours.
97% are seen within 30 minutes!
We realize our scores were not perfect in every category. We are making every effort to improve and make appropriate changes, especially in our efforts to improve telephone contact and intake services.

We appreciate your continued feedback. There is always room for improvement. Our goal is to make your visit with The Best Kids enjoyable and hassle free. We take pride in answering our phones directly and will continue to provide this personal service to our patients, as we are opposed to voicemail and phone trees, which have become commonplace.We are proud of the work we do. We will act on your comments and suggestions to improve. Thanks for your help and support.

Well Checks
Did you know that after the 18 month well check, we start yearly checks? Yearly well visits are at 2, 3, 4, and age 5. Then we change to every two year checkups at ages 7, 9, 11....

Sincerely,
Harold J. Livera, MD FAAP
Jennifer L. Segeleon, MD FAAP
The Best Kids
217 Breckenridge Lane,
Louisville, KY 40207-3858
502-895-9421
office@thebestkids.com

#20 January 1, 2005
 
Resolutions
Happy New Year to all the Best Kids and their families. Well now, this is the traditional time to make resolutions and plans. In that spirit we would like to encourage our families to make small but significant changes to improve their health. See if you can pick one of these changes each month for next three months. After that or if these ideas do not fit your families needs, make up your own change that you can stick with. Remember the idea is to make small but doable changes.
 
1. Start a family tradition of walking together after a meal. Start off with short walks, then increase the distance slowly. Then include friends and neighbors.

2. Eliminate sodas or juices or sport drinks from your house. Getting them out of your food environment will help make this change successful. Use water and fruits as replacements.

3. Start a low fat meal day once a week. Expand to other days as you find more recipes the family likes.

4. Make a list of indoor exercises you can choose from on the days we can't get outside.

5. When you eat out, make an effort to avoid the worst foods such as fried foods, larger size portions, high fat foods or foods that are high calorie but low volume.

6. Vegetables, Vegetables, Vegetables! Grandma was right! They are good for you. Make a list of vegetables and pick two new ones to try. Prepare them two ways to see if the family likes them.
 
Free Resources
Here is a great free resource from the Agency for Health Care Policy and Research (AHCPR). This is a federal government agency. http://www.ahcpr.gov/child/dvdobesity.htm 

You can request this free DVD. Max's Magical Delivery: Fit for Kids is a fun, interactive DVD targeted to children ages 5-9 and their families. http://gold.ahrq.gov/eorders/order_page4907.cfm
The DVD offers suggestions to:

• Try to eat five fruits and vegetables a day
.
• Get away from the TV and computer screens and move around.

• Find fun ways to be physically active inside and outside.

There is a separate section for parents on small, achievable steps they can take to encourage these healthy habits in their children and themselves.

For our newer families
During the winter months we see only acutely ill patients on Saturdays. We are open to see patients that might need an emergency room or urgent care center. We do keep one well check at 9 AM. Allergy shots are given too. Routine follow-up and chronic problems need to be scheduled during the week.
 
Have a great healthy and happy new year.
Sincerely,
Harold J. Livera, MD FAAP
Jennifer L. Segeleon, MD FAAP
The Best Kids
217 Breckenridge Lane
Louisville, KY 40207-3858
502-895-9421
office@thebestkids.com