My oldest son is about to turn seven, and I am of course proud of him in so many ways.  First grade is going well, and he has grown more independent and self-sufficient.  This is a particularly wonderful practical development, seeing as how his three younger brothers are decidedly high-maintenance and not self-sufficient at all right now.  An article in the New York Times a few months back still resonates in my mind, as it describes the hormone surge that occurs in the early elementary school years:  

"Middle childhood is when the parts of the brain most closely associated with being human finally come online: our ability to control our impulses, to reason, to focus, to plan for the future."

Simply put, one of my little monsters has grown more civilized.  The article, entitled "Now We Are Six," is a fascinating look at an underappreciated age of child development.  Believe me, I appreciate it very much.  

Another turning point has to do with sports -- for the first time, we are transitioning to Little League baseball instead of YMCA tee-ball.  After our first practice, I can tell you that there is still plenty of running to the wrong base and picking daisies in left field, but the thought that this eventually could lead to the Little League World Series on ESPN is a mental milestone for me.  This leads to the potential pitfall of becoming "one of those" sports parents -- the yelling, screaming at the ref, overly-critical parent that drives the joy out of it for everyone.  This essay from Kids in the Game summarizes nicely how we ought to behave.  After the next pee-wee soccer game, try saying, "I love watching you play" instead of "Why didn't you..." or "How many goals did you score?"  

Lastly, I wanted to mention this article from the New York Times entitled "Young Arms and Curveballs."  Even when I was playing Little League, the cautionary tale held that throwing curveballs at a young age would ruin your elbow.  This has become conventional wisdom, leading some leagues to ban young pitchers from throwing the curve.  Recent scientific studies seem to question this however, reporting that throwing a curveball does not put any greater stress on the arm compared to straight fastballs.  Instead, it is simply overuse that injures young arms.  Throwing too many pitches of any type, at too young of an age, is what causes the trouble.  It is often the most talented kids who are at highest risk; what parent or coach doesn't want their star player on the field as much as possible?  Which brings me back to my earlier point -- we need to remember the fun in sports and not push our kids too fast.  "I love watching you play" is a healthier attitude for our young athletes' bodies and minds.  

For years, our phone nurses have used Dr. Barton Schmitt's book of pediatric protocols to help advise families about a host of ailments.  Now, Dr. Schmitt has published a similar book geared towards parents entitled, "My Child is Sick!"  The book was selected by Library Journal as one of the 10 Best Parenting titles of 2011.  Dr. Schmitt's advice is very clear and practical.  This book makes for a great addition to your bookshelf, and it would also make a nice gift for a family expecting their first child.  To buy it, click here.  If an actual book made of paper is too old-school for you, check out HealthyChildren.org's KidsDoc Symptom Checker.

On October 25, the CDC’s Advisory Committee on Immunization Practices officially recommended that boys should receive Gardasil, a vaccine for Human Papillomavirus, at age 11 - 12.  (See New York Times article here.)  HPV causes cervical cancer in women and various other cancers in both genders.  The new recommendation is an important step in the effort to improve utilization of this cancer-preventing vaccine.  The HPV Vaccine has been recommended for girls since 2007, but many families have been slow or reluctant in vaccinating their girls.  Some families have a hard time thinking about this at age 11 or 12.   It is therefore worth mentioning a few plain facts about human papillomavirus, the HPV vaccine, and sexual activity:

• HPV is extremely common:  1 out of 4 adults have it
• HPV causes a variety of diseases; in addition to cervical cancer, it causes throat cancer, anal cancer, and genital warts
• The HPV vaccine works best when it is given before the age of sexual activity
• The vaccine gives the best immune response when given at age 11 – 12 (100-times better immune response compared to age 26)
• 43% of teenagers have been sexually active
• Only 78-85% of teenagers used contraception during their first sexual activity

So as you can see, this is an extremely common infection, and the vaccine works best when given at a younger age, well before the initiation of sexual activity.  To put it another way, would you advise your teenage driver to start wearing their seatbelt only after their first accident or two?  For any of the standard vaccines that we give, the goal is to protect our kids before they are exposed to the illness – the HPV vaccine is no different.    

Discussing the HPV vaccine is also an opportunity for you to begin an ongoing discussion about sexuality with your child.  Who do you want your child to learn about sex from?  If you are waiting to discuss it until puberty, or when you perceive that your child may be sexually active, you are waiting too late.  One resource in this discussion is Mary Flo Ridley, a local speaker and author who has become a nationally-recognized expert in advising parents on how to talk to their kids about sex.    

"Well, she has a runny nose,  and she has been fussy for 3-4 days, and we thought it was teething.  Now she has fever to 102.8, and she is more unconsolable and she can't sleep.  What do you think, doc?"

Teething can be an uncomfortable part of growing up that may affect babies off and on throughout the first two years of life.  Teething is unlikely, however, to be the explanation for more severe or serious symptoms.  A new study published in Pediatrics demonstrates this nicely -- the researchers followed a group of children and monitored them for symptoms in the days before, during, and after tooth eruption.  It turns out that fussiness, drooling, decreased appetite, loose stools, and sleep disturbance are common with teething, just like Grandma says.  Fever or more severe symptoms should not be attributed to teething, though -- such symptoms should prompt a search for some other cause.  The bottom line:  for fever of 100.0F or higher, some other illness should be suspected.  

Just in time for back-to-school checkups, we have received FluMist, the nasal spray form of the influenza vaccine.  The flu vaccine is recommended for everybody 6 months of age and older.  FluMist is only approved for those 2 years of age and older, but we anticipate receiving the injectable form of the vaccine approved for all ages soon.  Health Day reports here that children benefit from either form of the vaccine, but the nasal spray in particular gives a better immune response in kids.  The flu vaccine can be given at any well visit, at a nurse visit any time during the week, or during one of our special Saturday morning flu clinics to be scheduled throughout the fall.  We will be announcing dates soon for the Saturday vaccine clinics.  

A new feature debuts today on your friendly new-and-improved forestlanepediatrics.com -- the American Academy of Pediatrics' Patient Education Online database is now accessible through a purple search box on the right side of the home page.  Patient Education Online contains reliable, up-to-date health and safety information from the AAP.  You can type in any search term, say, "fever" or "temper tantrums" or "sunscreen", and helpful informational articles will pop up.  This can be a useful place to start if you are "Googling" about your child!  

The Environmental Working Group, my favorite resource for sunscreen reviews and safety, has released their Sunscreen Guide for 2011.  They even have an iPhone app you can use in the store.  Take-home-messages for this year:  

• zinc oxide and titanium dioxide remain the safest and most effective ingredients
• avoid oxybenzone, a possible hormone-disrupting chemical sunscreen ingredient
• avoid retinyl palmitate, a vitamin A derivative that can heighten skin-cancer risk
• make sure your sunscreen has good protection for both UVA and UVB rays  

 It appears that there are more sunscreens on the market than ever before, but it can still be hard to find sunscreens that meet the above criteria.  At a certain local supermarket the other day (rhymes with Groger), I could only find one acceptable sunscreen out of the dozens on the shelf.  Over the past year, I have had the best luck with Blue Lizard (CVS, Walgreen's), California Baby (Target, Central Market, Whole Foods), and Badger (Whole Earth Provisions).  Sun-protective clothing and hats are always a good idea, too.  It is definitely the time for fun in the sun, so keep you and your little ones safe this year!  

First of all, welcome to the shiny new web design for Forest Lane Pediatrics!  In addition to just looking mighty sharp, we hope the functionality is better, too.  Soon we will be launching a new-and-improved Patient Portal, where you will be able to review and print your child's vaccine records, see when your next appointment is scheduled, and share other information with us.  More info coming soon about that, but first and foremost, I need to mention the CDC's new advice for how we should all prepare for a Zombie Apocalypse.  Who knew the Centers for Disease Control had such a sense of humor?  Beyond the initial shock value/comedic value of this post, there is actually some useful information about how to prepare you and your family for any type of emergency, zombie-related or not.  Natural disasters can strike at any time, so a little bit of preparation can be a good thing.  Especially if World War Z breaks out.