Breastfeeding – Lactation Consulting

Breastfeeding – Lactation Consulting

Our pediatricians at Forest Lane Pediatrics of Dallas, Plano and Mesquite work closely with our Board Certified Lactation Consultants to support breastfeeding mothers in order to help all newborns, infants, and children. Even if you have decided not to breastfeed, or you are medically unable to do so, our lactation consultants want to help you with questions regarding preparation of formula, baby care and most importantly, support for your family! We strive to provide outstanding pediatric care for the families throughout the Dallas/Fort Worth metroplex who entrust their child’s well-being to our experienced team of board-certified pediatricians and lactation consultants. Below, please find some frequently asked questions & answers from our new Moms and Dads. To speak with one of our lactation consultants, email Janis Wilbert, BA, CLC, IBCLC – at janis@forestlanepediatrics.com.

Lactation Consultant
Janis Wilbert, BA, CLC, IBCLC

Breastfeeding and Pumping: 7 Tips For Success

Breastfeeding Library

Breastfeeding FAQs

Newborn/Infant Frequently Asked Questions

How often should I breastfeed?

Early and often! Breastfeed as soon as possible after birth, then breastfeed at least 8 to 12 times every 24 hours to make plenty of milk for your baby. This means that in the first few days after birth, your baby will likely need to breastfeed about every hour or two in the daytime and a couple of times at night. Healthy babies develop their own feeding schedules. Follow your baby’s cues for when her she is ready to eat.

How long should feedings be?

Feedings may take 10 to 20 minutes or longer per breast, but there is no set time. Your baby will let you know when he or she is finished. If you are worried that your baby is not eating enough, talk to your baby’s doctor.

What are signs of a good latch?

  • The latch feels comfortable to you, without hurting or pinching. How it feels is more important than how it looks.
  • Your baby’s chest is against your body and he or she does not have to turn his or her head while drinking.
  • You see little or no areola, depending on the size of your areola and the size of your baby’s mouth. If areola is showing, you will see more above your baby’s lip and less below.
  • When your baby is positioned well, his or her mouth will be filled with breast.
  • The tongue is cupped under the breast, although you might not see it.
  • You hear or see your baby swallow. Some babies swallow so quietly, a pause in their breathing may be the only sign of swallowing.
  • You see the baby’s ears “wiggle” slightly.
  • Your baby’s lips turn out like fish lips, not in. You may not even be able to see the bottom lip.
  • Your baby’s chin touches your breast.

How do I position my baby during feeding?

Hold your baby close, next to your skin, tummy to tummy. Press his chin into your breast with your nipple just opposite his nose. Tickle the baby’s upper lip with your nipple to make his mouth open wide, like a yawn. Hold your hand behind the baby’s neck and shoulders. This will allow the baby to tip his head back so he can open his mouth wider. Use your other hand to support the breast and compress it slightly in the same direction as his lips. This will help him to get more of a mouthful. When your baby’s mouth is wide open, bring him to your breast quickly to help baby get more breast into his mouth. Baby should latch onto the areola, not just the nipple. This will enable baby to get more milk. If you feel discomfort with nursing, the baby may not have enough breast tissue in his mouth. Insert your finger between his jaws and the breast tissue to break suction, and then re-latch.

Breastfeeding positions:

  • Cross-cradle: Hold baby tummy to tummy. Hold your forearm along baby’s back, with your hand supporting baby’s neck and shoulders. Your other hand supports the breast like a U.
  • Football: Baby’s body is under your arm and your hand supports his neck and shoulders. Baby’s head is under the breast, looking up at you. Your other hand supports the breast like a C.
  • Side lying: You can rest while your baby feeds! Lay on your side, baby tummy to tummy with you. Use your upper arm to support your breast in a C hold.

When baby’s mouth opens wide, press baby onto breast with your lower hand between baby’s shoulder blades. Another way is to hold your body up on one elbow. Place baby on her back, under your breast and use your upper hand to support the breast in C hold. Tickle the baby’s lip to get a wide gap then lower your breast into baby’s mouth. Once the baby is latched and sucking, pull out your lower arm and lay on your side.

How do I prepare powdered formula?

Per the Center for Disease Control guidelines, powdered formula must be mixed with water hot enough to kill germs, and safely storing formula can prevent growth of Cronobacter bacteria and other germs. These are keys to keeping your baby safe and healthy.

  • Clean up before preparation
    • Wash your hands with soap and water.
    • Clean bottles in a dishwasher with hot water and a heated drying cycle, or scrub bottles in hot, soapy water and then sterilize them.
    • Clean work surfaces, such as countertops and sinks.
  • Prepare safely
    • Keep powdered formula lids and scoops clean (be careful about what they touch).
    • Close containers of infant formula or bottled water as soon as possible.
    • Use hot water (158° F/70° C and above) to make formula.
    • Carefully shake, rather than stir, formula in the bottle.
    • Cool formula to ensure it is not too hot before feeding your baby by running the prepared, capped bottle under cool water or placing it into an ice bath, taking care to keep the cooling water from getting into the bottle or on the nipple.
    • Before feeding the baby, test the temperature by shaking a few drops on your wrist.
  • Use quickly or store safely
    • Use formula within 2 hours of preparation. If the baby does not finish the entire bottle of formula, discard the unused formula.
    • If you do not plan to use the prepared formula right away, refrigerate it immediately and use it within 24 hours. Refrigeration slows bacterial growth and increases safety.
    • When in doubt, throw it out. If you can’t remember how long you have kept formula in the refrigerator, it is safer to throw it out than to feed it to your baby.

How do I store prepared powdered formula?

Once opened, powder formula containers should be closed and stored in a cool, dry place — not in the refrigerator. Avoid extreme temperatures. Use contents within one month. Once mixed, feed immediately or refrigerate in a sealed container, and use within 24 hours. See the label for specific instructions. Do not leave prepared formula at room temperature and do not freeze it, because doing so can cause the protein and fat to separate. If your baby does not finish a bottle of formula within one hour, throw it away. Do not save it for later. During a feeding, your baby’s saliva can contaminate the formula in the bottle. Once this occurs, reheating or refrigerating will not kill the bacteria. If you warm the formula and your baby decides not to take it, do not refrigerate it and reheat it again later. Throw it out instead.

How do I store my breast milk?
How often should I make my baby’s bottles?

Some parents opt to make a bottle just before each feeding, but many others choose to pre-make and refrigerate enough to use for the day. If you know your baby eats every 3-4 hours, for instance, you can make six to eight bottles to last you all day. Mix your baby’s formula in 2 or 3-ounce (60- or 90-milliliter) servings for the first few weeks and gradually increase the amount as you become familiar with your baby’s eating patterns and appetite. Remember to refrigerate it immediately after mixing. If your baby is staying with a caregiver for a long period of time, you may want to prepare just one or two bottles and leave instructions and supplies (bottles, nipples, formula, and water, if necessary) so the caregiver can prepare bottles as needed and not waste any formula. After all, you’ll need to throw away any mixed formula after 24 hours.

Is my baby eating enough?

Babies grow at different rates, and at times you may wonder whether your baby is getting enough nutrients to develop properly. Here’s a general look at how much your baby may be eating at different stages:

  • On average, a newborn consumes about 1.5-3 ounces (45-90 milliliters) every 2-3 hours. This amount increases as your baby grows and is able to take more at each feeding.
  • At about 2 months, your baby may be taking 4-5 ounces (120-150 milliliters) at each feeding and the feedings may be every 3-4 hours.
  • At 4 months, your baby may be taking 4-6 ounces (120-180 milliliters), depending on the frequency of feedings and his or her size.
  • By 6 months, your baby’s formula intake can be between 24-32 ounces (720-950 milliliters). This also depends on whether you’ve introduced any baby food.

What should I expect for the first 6 weeks?

What are hunger cues? How do I know when my baby is hungry?

Babies show several cues in readiness for breastfeeding. Tuning into your baby’s cues will make your feeding more successful and satisfying for both your baby and for you. Your baby does not have to cry to let you know he is hungry. Crying is the last hunger cue! Here are a few of the most common hunger cues.

  • Awakening Soft sounds
  • Mouthing (licking lips, sticking tongue out, licking lips)
  • Rooting towards the breast (turning the head and opening the mouth)
  • Hand to mouth activity
  • Crying beginning softly and gradually growing in intensity

What is skin-to-skin contact? Why is it important?

Skin-to-skin contact is the close contact includes the baby unwrapped down to their diaper and tucked under mother’s clothing so that both mother and baby can begin or continue the attachment/bonding process. There are numerous reasons why keeping your baby right on your chest, skin-to-skin, is essential. Babies cry less and latch properly to the breast sooner. They are also able to maintain their skin temperature more efficiently, and they have a better tolerance for pain when receiving regular skin-to-skin contact.

How do I hand express breast milk?

  • Position the thumb (above the nipple) and first two fingers (below the nipple) about 1” to 1–1/ 2” from the nipple, though not necessarily at the outer edges of the areola. Use this measurement as a guide, since breasts and areolas vary in size from one woman to another. Be sure the hand forms the letter “C” and the finger pads are at 6 and 12 o’clock in line with the nipple. Note the fingers are positioned so that the milk reservoirs lie beneath them.
  • Avoid cupping the breast
  • Push straight into the chest wall; Avoid spreading the fingers apart; for large breasts, first lift and then push into the chest wall
  • Roll thumb and fingers forward at the same time. This rolling motion compresses and empties milk reservoirs without injuring sensitive breast tissue.
  • Repeat rhythmically to completely drain reservoirs; Position, push, roll..; Position, push, roll…
  • Rotate the thumb and fingers to milk other reservoirs, using both hands on each breast.

Avoid These Motions:

  1. Do not squeeze the breast, as this can cause bruising.
  2. Sliding hands over the breast may cause painful skin burns.
  3. Avoid pulling the nipple, which may result in tissue damage.

Does my baby need cereal or water?

No, your baby only needs breast milk or formula for the first 4-6 months of life. The American Academy of Pediatrics recommends exclusive breastfeeding for 6 months. Breast milk or formula alone will provide all the nutrition your baby needs. Giving the baby cereal may cause your baby to not want as much breast milk, gain too much weight, and have hard constipated stools. Even in hot climates, breastfed infants do not need water or juice.

Is my baby getting enough Vitamin D?

Vitamin D is needed to build strong bones. All infants and children should get at least 400 International Units (IU) of vitamin D each day. To meet this need, all breastfed infants consuming less than 32 ounces of formula per day should be given a vitamin D supplement of 400 IU each day. Sunlight is a major source of vitamin D, but it is hard to measure how much sunlight your baby gets, and too much sun can be harmful. Once your baby is weaned from breast milk, talk to your baby’s doctor about whether your baby still needs vitamin D supplements. Some children do not get enough vitamin D through diet alone.

Can I drink alcohol and nurse my baby?

Current research says that occasional use of alcohol (1-2 drinks) does not appear to be harmful to the nursing baby. If you are worried about the amount of alcohol in your breast milk, there are products available to test the amount of alcohol in your breast milk: www.upspringbaby.com

  • The American Academy of Pediatrics Committee on Drugs classifies alcohol (ethanol) as a “Maternal Medication Usually Compatible with Breastfeeding.” The American Academy of Pediatrics Section on Breastfeeding notes: “Breastfeeding mothers should avoid the use of alcoholic beverages because alcohol is concentrated in breast milk and its use can inhibit milk production. An occasional celebratory single, small alcoholic drink is acceptable, but breastfeeding should be avoided for 2 hours after the drink.”
  • Many experts recommend against drinking more than 1-2 drinks per week.
  • Per Hale (2008), “mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal.”
  • There is no need to pump & dump milk after drinking alcohol, other than for mom’s comfort — pumping & dumping does not speed the elimination of alcohol from the milk.
  • Alcohol has been shown to inhibit let-down and decrease milk production
  • If you’re away from your baby, try to pump as often as baby usually nurses (this is to maintain milk supply, not because of the alcohol). At the very least, pump or hand-express whenever you feel uncomfortably full–this will help you to avoid plugged ducts and mastitis.

How do I contact the Lactation Counselor at Forest Lane Pediatrics?

Call Janis Wilbert, CLC at 972.284.7770

Email janis@forestlanepediatrics.com

Prenatal Visits and Newborn Classes

Complimentary Newborn Classes

The physicians at Forest Lane Pediatrics are now offering complimentary classes for expecting parents via a virtual platform. These classes will consist of small group sessions led by one of our board-certified pediatricians. Our goal is to help parents feel more prepared during this exciting, but sometimes intimidating, journey. Discussion topics will include what to expect in the hospital after delivery, as well as helpful tips for the first few weeks at home with your newborn. There will also be plenty of time for parents to ask questions during the session.

To look at class times and register online, please click here

Please choose the “Newborn Class” option to schedule your class. You can also send us a message

Complimentary Prenatal Visit

A complimentary prenatal visit with one of our board-certified pediatricians is the first step in starting a partnership with a doctor. It is a time for expecting parents to become acquainted with our staff and have questions answered about parenthood. These visits are not required to become patient in our practice.

Prenatal Visit Topics

  • Office Hours (including Saturday morning clinic)
  • Communication – ways the nurses and physicians can be contacted by phone or patient portal
  • Availability of same-day sick visits
  • Availability of on-call doctor for after hours phone calls
  • Office protocols regarding vaccines and well visit care (Note: we adhere to vaccination recommendations of the American Academy of Pediatrics)

Additional Benefits of a Prenatal Visit

  • Learn about the doctor’s philosophy of medicine
  • Learn how to get to the office
  • Take a tour of the office
  • Ask questions
  • Learn about new technologies available to our patients like vision screening for children as young as 6 months as well as allergy testing and treatment.
  • Learn about Lactation services and Medela pump rental station. We will work with you to ensure that your child is properly nourished by assisting you with breastfeeding and other forms of feeding.

Affiliations

The physicians of Forest Lane Pediatrics have privileges to see newborns in the nurseries at the following hospitals:

  • Dallas    Medical City Dallas Hospital
  • Dallas    Texas Health Presbyterian Hospital Dallas
  • Plano    Texas Health Presbyterian Hospital Plano
  • Frisco    Baylor Medical Center at Frisco

Once you have chosen a pediatrician from Forest Lane Pediatrics, please notify your obstetrician and add your pediatrician’s name to your hospital’s pre-admission paperwork. The hospital will notify your pediatrician of your baby’s birth and he or she will come see your baby in the hospital. Every day you are in the hospital one of our pediatricians will examine your baby and answer any questions. On the day of discharge, the doctor will instruct you to call and schedule a follow-up appointment. Our physicians only see babies at our affiliated hospitals. If your baby is born at a different hospital, on the day of discharge please call our office to schedule a follow-up visit for 2 days after discharge.

Please call our practice to schedule a Complimentary Prenatal Visit or send us a message.

Dallas Office: 972.284.7770

Plano Office: 972.526.0700

We also offer complimentary interviews with families wishing to transfer to Forest Lane.

In-House Laboratory Testing

In-House Laboratory Testing

Forest Lane Pediatrics has an in-house laboratory that allows us to perform many tests in the office. Most often the results are obtained while the patient is still in the office. As a result, our doctors will be able to appropriately diagnose your child and prescribe the best form of treatment more quickly.

Rapid Diagnostic Tests:

  • Strep Test – Streptococcal Pharyngitis (Strep Throat) Test
  • RSV Test – Respiratory Syncytial Virus Test
  • Flu Test – Influenza Type A and Type B Test
  • Blood Glucose
  • Cholesterol Screening
  • Hemoglobin (test for anemia)
  • Lead Levels
  • Urine Cultures
  • Urinalysis (UA)

Outside Laboratory Testing & Services

For lab tests not available in our office, we will direct you to a lab (on the same campus of our office) where the specimen can be collected. We usually obtain efficient turnaround times for final results. An additional bill may be sent from the outside laboratories entities.

Please contact us for more information on in-house or outside lab tests.

Fluoride Varnish Dental Treatments

Fluoride Varnish Dental Treatments

Fluoride varnish dental treatments are safe and effective cavity prevention for children

As part of our comprehensive health care coverage, Forest Lane Pediatrics is happy to offer Fluoride Varnish Dental Treatments every 6 months for children ages 1 – 3 years old. Fluoride Varnish is a topical fluoride treatment that is applied directly to the teeth and has been shown to significantly reduce the risk of cavities in children. This type of treatment is often done in a dentist’s office; however, we realize that the cost of a dental visit plus the need to take additional time off of work can create barriers to adequate dental care. The American Academy of Pediatrics (AAP) recommends that children see a dentist starting at 1 year of age or within 6 months of the eruption of the first tooth. We are happy to provide all of our patients with a list of excellent pediatric dentists close to our offices; however, if you are not able to regularly take your child to the dentist, we are happy to provide Fluoride Varnish Dental Treatments at all well visits between 1 and 3 years of age. By 3 years of age, all children should have bi-annual visits with a dentist.

What causes cavities in children?

Fluoride is an essential tool to fight Early Childhood Carries (ECC), an infectious, chronic disease that destroys tooth structure leading to loss of chewing function, pain, and infection in children up to 5 years old. Carries (cavities) are caused by acid that is created when bacteria in the mouth digest sugars in the foods and drinks that we consume. This acid demineralizes the protective coating of our teeth called enamel. This demineralization eventually weakens and erodes the enamel creating a cavity. Fluoride prevents cavities by inhibiting tooth demineralization, enhancing remineralization, and inhibiting bacterial metabolism. The primary sources of fluoride are fluorinated drinking water, fluoride toothpastes (not recommended for children < 2 years old), and fluoride varnish. For many children, fluoridated water and fluoride toothpastes provide sufficient protection against cavities. However, for others, the addition of fluoride varnish is necessary. The benefit of fluoride varnish is that it is applied directly to the teeth in a concentrated manner. Because it adheres to the teeth quickly, there is no risk of ingesting the fluoride. Should a child ingest too much fluoride by swallowing fluoride toothpaste or taking an excessive amount of fluoride supplements, discoloration of the teeth called Fluorosis can occur.

Other benefits of fluoride varnish include:

  • It’s safe and effective
  • It can be quickly and easily applied
  • Children can eat and drink shortly after application
  • It strengthens enamel
  • Studies show a 30-35% reduction in cavities
  • It can reverse early cavity formation

Children who will benefit the most from Fluoride Varnish are:

  • Children with siblings who had cavities before age 6
  • Children born prematurely
  • Children with special health care needs
  • Children who use a bottle after 15 months or have sweet or starchy snacks more than 3 times per day
  • Children who don’t have regular dental visits

Currently, Fluoride Varnish Dental Treatments are only offered in the Dallas office.

For more information from the American Academy of Pediatrics (AAP) about caring for your child’s teeth, click here.

Medical Ear Piercing

Medical Ear Piercing

Medical Ear Piercing is now available at Forest Lane Pediatrics!

The doctors at Forest Lane Pediatrics are excited to offer this service to our patients. We have selected the Blomdahl® Medical Ear Piercing System which is only available to physicians.

Why should I choose medical ear piercing at Forest Lane Pediatrics?

In our office your child will receive professional care from a pediatrician who has been trained in sterile technique and wound management.

The Blomdahl® Medical Ear Piercing System uses single-use cassettes which minimize the chance of infection at the piercing site and medical-grade plastic piercing studs which eliminates the risk of nickel allergy. Using this system also eliminates the possibility of patient-to-patient cross-contamination because only the single-use part of the equipment ever comes in contact with the skin at the piercing site.

We also offer pre-procedure numbing cream for the ear lobe(s) (which needs to be left on for 30 minutes to be effective) in order to minimize pain during the procedure.

What are the age restrictions for ear piercing at Forest Lane Pediatrics?

We recommend ear piercing occur between 3 and 7 months for infants and when school-aged children are 7 years old or older. Waiting until children are 3 months old ensures that they have had their first set of vaccines and allows the ear to grow big enough to allow for accurate placing of the earring. We do not recommend ear piercing for children between 7 months and 7 years of age because the child must either be small enough to allow us to completely control her movements during the procedure or cooperative enough to sit still during the procedure and be capable of actively participating in aftercare. All eligible patients must be completely up to date on all vaccines.

Can I get ear piercing done at my child’s well or sick visit?

Ear piercings are only done during visits solely dedicated to the medical ear piercing procedure. We do ear piercing by appointment only and not as an “add-on” to another sick or well visit. This allows enough time to perform the procedure, explain and answer questions about the aftercare, and allow the numbing cream to take effect.

Where do we pierce?

We only pierce ear lobes and only do one piercing per lobe per visit. We will perform a second, but not a third piercing, in a single earlobe. We do not pierce ear cartilage (the upper part of the ear), noses, or belly buttons.

How much does it cost?

  • We charge $100 to pierce up to 2 ears. This price includes the piercing studs which are removed after 6-8 weeks and a permanent pair of hypoallergenic earrings. The parent can choose 1 pair of the following earrings:
    • 4 mm White Pearl
    • 3 mm Silver Titanium Crystal
    • Plastic Daisy Rose/Crystal
  • Full payment is due when you check in for your ear piercing appointment.
  • Payment covers the cost of numbing the ear prior to the procedure, piercing the ear(s), and the ear piercing studs (which you leave in for 6 weeks).
  • Six weeks after the procedure the piercing studs should be removed and replaced with earrings of your choosing.

Since this is a cosmetic procedure, it will not be filed to your insurance.

Is swimming ok immediately after ear piercing?

We recommend avoiding swimming for 2-3 weeks after ear piercing. Chlorine from pools and bacteria in unchlorinated waters may irritate or contaminate the wound and delay healing.

What are the risks of ear piercing?

Before we start the procedure, we will ask you to sign an informed consent form that reviews the risks listed below.

  • Infection: There is a risk of infection anytime the skin is broken. We reduce this risk significantly by using sterile technique, using sterile, single-use piercing cassettes, and providing specific aftercare instructions.
  • Pain: Even without numbing cream the pain is brief and similar to vaccine injection using the Blomdahl® system. Patients who are old enough to communicate verbally sometimes say that their earlobes briefly feel warm and flushed after the procedure. In order to minimize any discomfort, our price includes the use of numbing cream.
  • Nickel allergy: Allergic contact dermatitis (ACD) is an itchy rash that occurs when your skin comes in contact with a typically harmless substance. Nickel is one of the most common causes of ACD and once you develop nickel allergy you will always be sensitive to it. Unfortunately, nickel is commonly used as a metal hardener and most metals used for ear piercing contain (or “leak”) enough nickel to trigger a potential allergic reaction. Fresh piercings allow direct and constant contact between a minor open wound and the metal, which contains nickel.
  • We chose to use an ear piercing system that uses medical-grade plastic in order to avoid nickel exposure during the ear piercing healing process.
  • Keloids: Keloids are shiny, smooth and rounded skin elevations, which can form at the piercing site in some patients after ear lobe piercing because of altered wound healing. Keloids tend to be familial, are more likely to occur in patients with darker skin pigmentation, and generally occur in persons 10 to 30 years of age. In one survey of 32 patients with keloids related to ear piercing, keloids were more than three times as likely to occur when the earlobes were pierced at or after 11 years of age (80%) than before 11 years of age (24%) (Pediatrics. 2005; 115(5): 1312).

How long do we keep the ear piercing studs in place?

We recommend NOT replacing the original ear piercing studs for 6 weeks. The ear piercings studs we use are thicker (1.3 mm) than the standard earring post (1.0 mm). The larger piercing hole makes it easier to switch to normal earrings after the healing period and reduces the risk of repeatedly re-injuring the ear-piercing site when replacing earrings, which should, therefore, reduce the risk of piercing site infection.

How do I take care of the pierced ears afterward?

  1. Clean the piercing site thoroughly twice a day, using liquid soap and clean running water at least once a day (preferably after showering or washing the hair).
  2. Dry area well with clean gauze or a cotton tipper applicator and leave open to air.
  3. For supplementary cleansing, or when running water is unavailable, ear care solution is available at Claire’s or you may purchase Blomdahl® Ear Care cleansing swabs at our office.
  4. Leave the ear piercing studs in the ear lobe for 6 weeks before replacing with earrings.
  5. Unlike conventional ear piercings, there is no need to rotate the Blomdahl medical-grade plastic studs to prevent them from adhering to the skin.

Read more about medical ear piercing aftercare on Blomdahl’s website.

Sports Physicals

Sports Physical Form – Forest Lane Pediatrics of Plano and Dallas

If your child requires a sports physical in order to participate in athletics, please download the Sports Physical Form, complete the Medical History section, and bring both pages to your appointment.

UIL – Preparticipation Physical Evaluation

TAPPS – Preparticipation Physical Evaluation

This Medical History Form must be completed annually by a parent (or guardian) and student in order for the student to participate in athletic activities. These questions are designed to determine if the student has developed any condition which would make it hazardous to participate in an athletic event.

ADHD Assessment

ADHD Testing at Forest Lane Pediatrics of Plano and Dallas

Thank you for allowing us to participate in assessing your child’s educational needs. We know that your child’s emotional and educational well-being is important to you as a family. In order to make your visit with the doctor productive, please provide us with the items below and complete the questionnaire fully. A staff member will contact you once all appropriate documents are received. The providers also will need to examine your child prior to prescribing any medication. If you wish to meet with the doctor privately, please discuss with the scheduler when making this appointment.

Please download and fill out the hyperlinked forms below. In order to schedule an initial ADHD Assessment, all of the requested documents below will need to be submitted and reviewed by the physician:

  1. Initial Evaluation Questionnaire for ADHD Assessment
  2. ADHD Controlled Substance Policy (PDF) Download
  3. Vanderbilt ADHD Assessment – Teacher (PDF) Download
  4. Vanderbilt ADHD Assessment – Parent (Prefer that each parent complete the form) (PDF) Download
  5. Recent report card
  6. Any previous evaluations of your child’s learning (school IEP, psycho-educational testing, IQ testing, standardized test)

Please submit paperwork listed above. A staff member will contact you to schedule an appointment once the doctor has a chance to review the documents.

Prior to your appointment, please contact your insurance provider and confirm whether or not the following medications are covered by your prescription plan:

  • Adderall XR
  • Aptensio XR
  • Atomoxetine
  • Cotempla XR
  • Dexmethylphenidate ER
  • Dyanavel XR
  • Guanfacine ER
  • Methylphenidate ER
  • Methylphenidate CD
  • Methylphenidate LA
  • Vyvanse
  • Quillivant XR

Please bring a list of covered medications with you to your appointment to share with the doctor, should medication be recommended. Failure to provide the doctor with this information may result in a delay in your prescription or a prescription recommendation that is not covered by your insurance.

ADHD Resources and Frequently Asked Questions

Follow-up Evaluation Questionnaire for ADHD Assessment

To help us assess how your child is responding to treatment for ADHD, please download at least one Parent and one Teacher Vanderbilt Assessment Follow-up form and send the completed forms to us via the portal or bring them to your child’s ADHD follow-up appointment.

Allergy Testing

Allergy Testing for Children and Adults

Forest Lane Pediatrics of Dallas, Plano and Mesquite offers in-office allergy skin testing and treatment for children 4 years and older as well as for parents who meet certain screening criteria. This allows us to effectively treat one of our patient’s largest complaint, north Dallas allergy season.

Over-the-counter (OTC) and prescription allergy medications are very effective at treating allergy symptoms, however, these medications are merely treating symptoms and are in no way a cure. The only way to eliminate the need for life-long allergy medications is to eliminate the allergies using immunotherapy. Forest Lane Pediatrics of Dallas, Plano and Mesquite offers precision allergy testing through United Allergy Services and customized immunotherapy that could help you put an end to your allergies forever.

Allergic diseases (allergic rhinitis [hay fever], asthma, and atopic dermatitis (eczema) often warrant identification of specific allergic triggers for treatment. We’ll test you for the primary geographically specific mold and airborne allergens in our area, as well as common perennial allergens like those from dogs, cats, and dust mites. We do not test for food allergies as this type of testing can only be done in an allergist office, but we will be happy to refer you to a specialist if needed.

Test up to 50 different allergens including:

  • Dust mites, Pet hair and dander
  • Trees, grass and weed pollens
  • Molds and more like…
  • Cockroach droppings, Yuk!

Skin Allergy Testing at Forest Lane Pediatrics

Skin testing is the oldest and most reliable form of allergy testing. The testing process is not painful and involves scratch testing both arms to 50 different allergens. The results are read 15 minutes after the test is applied. A positive test will appear as a raised, red itchy bump on the skin that looks very much like a mosquito bite. This will tell us exactly what you are and are not allergic to enabling customized treatment. In order to achieve the most accurate test results, you should discontinue any antihistamines, over-the-counter or prescription, for at least 1 week prior to allergy testing.

Allergen Immunotherapy Treatment

Allergen immunotherapy is a form of treatment aimed at decreasing your sensitivity to substances called allergens. Immunotherapy involves introducing increasing amounts of an allergen to a patient over several months.

Forest Lane Pediatrics offers a home-based allergen immunotherapy program, which we hope will lead to a very significant abatement or resolution of symptoms and decreased need for medicine. Relief from allergies varies by individual, but the vast majority of patients see results as soon as 6 months after therapy begins. Our allergy technician initially gives the injections. Our technician will then teach the parent or patient how to administer the injections. Eventually, they are administered at home with occasional visits to the allergy clinic for monitoring. This allows the patient to not have to come to the clinic nearly as often as they would if all injections were administered in the office. The program has been very well studied and found to be safe with no serious adverse events.

Most insurance plans cover allergy testing and immunotherapy. We will verify insurance benefits prior to testing.

Take your first step towards allergy relief by calling us today. We are happy to answer any questions you may have.

Contact us about precision allergy testing and the customized medications that could help you say goodbye to your allergies forever. Our Allergy Library contains a comprehensive list of PDF download handouts for parents.

The Pollen Newsletter For Allergy Sufferers

Allergen Immunotherapy for Children: Immunotherapy has been studied and proven to be effective in children.

Allergic Rhinitis: Also known as hay fever, allergic rhinitis is an allergic inflammation of the nasal passages.

Allergy Testing Types: For allergy testing, there are four primary tests that can be done to determine if a patient is sensitive to a certain allergen or no; Skin (Prick) Test, Intradermal Skin Test, Specific IgE and Nasal Provocation.

Asthma: Asthma has often been shown to be preventable with allergen immunotherapy (IT), and the symptoms of allergic asthma may be improved with allergen IT.

SneezyDays: Learn about what makes us sneeze.

Skin Prick Testing: Skin testing is the oldest and most reliable form of allergy testing. It is the quick and virtually painless skin prick test.

Cold and Flu vs Allergy: Comparison between the symptoms of allergy, flu, and colds.

Molds: The typical symptoms of a mold allergy such as wheezing, cough, stuffy or a runny nose, itchy, watery eyes, rash or hives are also common with many other allergy symptoms.

Why the wait: Why are patients required to wait in the office after immunotherapy injections? Like all medications, allergen immunotherapy can induce an adverse reaction.

Ambrosia sp: Ragweed belongs to the Asteraceae family, Ambrosia genera and is considered one of the most allergenic offenders.

Animal Extracts: Have you ever wondered where the extracts that we test and treat for come from?

The Truth about Pollen Counts: Don’t let your local pollen scores influence your expectation of how you should feel today. Instead, use the scores as a guide

The Amaranthaceae: Learn about the Amaranthaceae (Am-a:-ranth-ā-cee) family of weeds.

Systemic Reactions: A systemic reaction is defined as any reaction that affects an area of the body not directly related with the injection.

Food Allergy: It is well known that patients can be allergic to both foods and/or pollen, but did you know that some patients can react to foods that they never reacted to before?

Local Reactions: A localized adverse reaction is defined as any reaction that is limited to between adjacent joints, i.e. the shoulder and elbow, and does not show signs of spreading to other bodily systems.

Grasses: There are more than 10,000 different types of grasses worldwide, yet 95% of the major allergic grasses fall into just three different subfamilies

The Economics of Immunotherapy: A review of 19 different economic studies found that patients can reduce health care costs by up to 80% after completing a 3-year course of IT.

Compliance with Immunotherapy: Quitting IT before this change has occurred can lead to increased severity or amount of symptoms.

Thommen’s Postulates: For a pollen to be considered allergenic, it has to follow the following set of requirements originally described by August Thommen of the NYU Allergy Clinic in 1931.

Well-Child Care

Well-Child Care

Well visits will be very frequent in the beginning and get less frequent as your baby gets older. Visits with the pediatrician are recommended at the following ages:

  • Prenatal visit to meet your new pediatrician before the baby is born (for new parents)
  • During the hospital stay our newborn care begins (our pediatricians will visit your baby and you daily in the hospital if you have delivered at Medical City Dallas, Presbyterian Hospital of Dallas, Presbyterian Hospital of Plano, or Baylor Frisco)
  • An early follow-up is recommended within 2-3 days after you leave the hospital with your baby to check the baby’s weight and check for jaundice.

The next well visits are at 2 weeks, 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 24 months, 30 months.  From 3 years of age, well visits should be scheduled annually until age 18 years.

Well visits are very important to your child’s well-being. They give you the opportunity of getting to know your child’s pediatrician and for the doctor to get to know you and your child and assess her growth, development, and general health. Your child’s development will be assessed at each well visit in the first 5 years of life.

When children are ill, it is much harder to assess their developmental and social skills. They usually do not want to show off their new walking skills nor do they relate as well to the doctor as they do when they are feeling well. That is why a sick appointment for an ear infection is not a replacement for a well visit.

Immunization Schedule

Pleases read about our immunization policy.

Well Visit History

At each well visit, you will be asked about:

  • Any illness since the last visit
  • Daily routine eating, sleeping, elimination habits
  • Developmental milestones
  • Child care arrangements/school
  • Any concerns you may have

Until your child is able to answer questions on his own, all questions about him will be directed to you. As your child is able to answer questions, we will start talking to him directly so that he learns we are his doctor and want to hear from him as well as from his parents. We will ask both the patient and the parents for their input from school age until adolescence. Starting in adolescence, we will ask parents for any concerns but we will also request time to speak to your teenager privately.

Well Visit Exams

Usually, for the first 6 months of life, the baby has no stranger anxiety and can easily be examined on the examination table. From the 9-month to the 18-month visit, we will often examine the baby on the parent’s lap to minimize stranger anxiety and resistance to the exam. Often, by age 2 or 3 years, the child feels more comfortable and is less scared of the exam. Usually, by age 4, the child will feel comfortable sitting on the exam table by herself.

At every well visit, the child will be weighed and measured. For the first two years of life, the head circumference will also be measured.

Height
For the first two years of life, the child will be measured lying down. After age 2, your child will usually be measured standing up. There are some small variations between a lying length and a standing height that can occasionally cause a decrease in the number from the last length to the first standing height. Don’t worry, this does not mean your child has shrunk.

Weight
In the newborn period, your child’s weight usually changes day to day and small measurements such as a few ounces are very important. There may be differences between the office scale and a scale you may have at home. The weight trend over time is much more important than any weight measurement on a particular day.

Head Circumference
Your baby’s head grows faster in the first 2 years of life than any time thereafter. Her head size and rate of head growth are important to monitor to ensure normal growth and development of the brain and skull.

Growth
At each well visit, your child’s weight, height and head circumference (first 2 years only for head size) are measured and compared to normal values for children of the same age and gender by plotting the measurements on standardized growth charts, such as those of the Centers for Disease Control.

Monitoring your child’s growth is one of the most important parts of the well visit. Each child grows differently, but steady growth is important. A short child who is steadily growing and following a curve of a lower percentile is not worrisome, but a child who suddenly stops growing or moves to a much lower percentile suddenly can be cause for concern. By following the trends of your child’s growth over a number of months, the normal slow periods of growth tend to even out with the spurts.

General Appearance
The pediatrician will begin the exam by making a general assessment of your child’s appearance and health. The order of the physical exam differs with age. With babies, your doctor will usually start with listening to the heart and lungs while the child is quiet and will try to save the ear and mouth exam for last since they are usually the least cooperative with these parts. As the child is older and more cooperative, the doctor may proceed in a head to toe fashion.

Blood Pressure
We begin taking blood pressure measurements in the office at age 3. Normal values for blood pressure vary with age and height. Normal blood pressures for children are lower than for adults. Anxiety, crying, coughing, and struggling can all cause the blood pressure to be elevated. Often the automatic blood pressure cuffs read the blood pressure as high. If the automatic blood pressure reads high, we will generally repeat the measurement with a manual cuff. High blood pressure or hypertension is less common in children than adults, but it can happen. While it can happen for a variety of reasons, the most common in childhood is kidney disease. If the blood pressure is high even with a manual reading, we will probably request that follow-up blood pressures be done over a few weeks. For school age children, we usually request this be done in the school nurse’s office to minimize “white coat hypertension,” which is when the patient has hypertension due to the anxiety of being at the doctor’s office but is normal when taken in other places.

Head
Upon examination of a child under 2, the doctor will check the “soft spots” of the skull, which are called fontanels. These are areas where the skull bones have not grown together yet to form a full protective cover for the brain. There are two fontanels that may be open at birth, the posterior and anterior. The posterior (located on the back of the head) is triangular, may be closed at birth, and usually closes within the first 2 months of life. The anterior fontanel on the top of the head is diamond-shaped and usually closes by 18 months of age. The fontanels are important to allow for the rapid brain and skull growth that normally occur in the first 2 years of life.

The doctor will also check the shape of your child’s head. Since the AAP recommendation to place babies on their backs of over 20 years ago, we frequently see babies with flattening of the back part of the skull. We encourage tummy time frequently during the day to counteract this effect on the back on the baby’s skull. It is best to avoid putting the baby in the car seat or swing too often, as the pressure of the seat on the back of the head usually has the same effect.

Ears
Your pediatrician will check your child’s ears for infection or fluid behind the eardrum. Ear infections are very common in young children, particularly from 6 months through 3 years. While most ear infections cause pain, fever, or prolonged cold symptoms such as a cough or a runny nose, sometimes babies develop ear infections without apparent symptoms. Undiagnosed persistent ear infections can cause problems for hearing and speech development in infants and young children. Your doctor will check to make sure a silent ear infection does not go undetected. If you have any concerns about your child’s hearing, be sure to let your doctor know about them. Even when your baby had a normal hearing test at birth, hearing loss can sometimes be detected later and can be due to ear infections or loud noise exposure. Parents are often the first to notice hearing problems. Please let us know if you are worried about your child’s hearing. Please do not worry about earwax, which is a normal lubricant of the ear canal. Earwax can sometimes be a problem for the physician because it obscures the eardrum. The physician will sometimes need to carefully remove the earwax in order to see the eardrum. We do not recommend parents try to clean inside the ear because the canal can be injured and it usually only causes the wax to be pushed further into the canal.

Eyes
Your physician will use a lighted instrument called an ophthalmoscope to examine your child’s eyes. We look for problems inside the eye such as cataracts or tumors. We also check for any misalignment of the eyes or excessive tearing. We offer cutting edge technology vision tests in our office called the Spot Vision test and the Visual Evoked Potential. Please see the Recommendations for Vision Screening on our website, which goes over these tests in detail. If any of these tests are abnormal, we do refer to a pediatric ophthalmologist for evaluation.

Nose, Throat, and Mouth
Your pediatrician will examine your child’s nose for signs of allergy or infection. We will also check the back of your child’s throat for enlarged tonsils or signs of infection. We examine the teeth and gums as well, but this is no substitute for the dental visit. We recommend that dental examination starts after the first birthday with a pediatric dentist. We have a list of pediatric dentists in the area we recommend.

Neck
Your pediatrician will check your child’s range of neck motion as well as feeling for any lumps, which can be enlarged lymph nodes or an enlarged thyroid gland. Swollen lymph nodes in the back of the neck often occur with a scalp infection. Swollen lymph nodes in the front of the neck are frequently seen with tonsillitis.

Chest and Lungs
Your pediatrician will look, listen, and feel during the chest and lung exam, observing the rate and quality of breathing, then using the stethoscope to listen for breath sounds.

Heart
The stethoscope is used to listen for normal or abnormal heart sounds. Many children have heart murmurs, but most of these are called innocent murmurs, meaning there is no problem in the heart causing this extra sound. We often will just observe these murmurs, but if they are persistent, we may refer to cardiology for an evaluation to ensure there is nothing wrong. If the murmur is unusual or very loud, we may refer to the cardiologist right away.

Abdomen
Your pediatrician will check for any masses or enlargement of the liver or spleen by percussing on the abdomen or tapping to detect differences in sound. We then will press down gently on the abdomen to make sure we do not palpate any masses or enlargement of organs. The abdominal exam may be difficult for ticklish preschoolers or school age children to lie still without giggling.

Genitals
Your pediatrician will routinely check the genital area for rashes and to look for any signs of sexual maturation. For boys, the testes are palpated to ensure they have fully descended and that there are no masses.

Nervous system
When the doctor checks your child’s reflexes, he is looking for any problems with the nervous system. Tests of coordination and muscle strength are combined with the developmental assessment to look for any diseases of the nervous system.

Skeletal System
Your pediatrician will check for different skeletal issues at different ages. At early well-child visits, we check to make sure your child does not have any problem with dislocated or dislocatable hip joints.

Sports injuries are the most frequent cause of bone and joint problems of older children. The next most common skeletal problem your pediatrician checks for is scoliosis, with is a linear curvature of the spine. Schools frequently screen for scoliosis and may send home a note to parents to have the physician check. Scoliosis is more common in girls and can be progressive. If it is diagnosed and even if it is mild with no treatment needed, the orthopedist will usually follow the patient periodically to ensure it is not worsening.

Skin
At each visit, the pediatrician will check your child’s skin for rashes, birthmarks, bruising, infection, or changes in moles. The skin can provide the first clue of an illness such as leukemia or some neurologic disorders.

In the teen years, acne may be a serious concern of your adolescent. We can manage mild to moderate acne in our office, but if it is severe, we may refer your child to dermatology.

Development
Your doctor will be monitoring your child’s development at each well visit and will assess this mostly by your report on surveys that you are able to fill out up to a week before the visit. Developmental areas that are assessed include gross motor (sitting, crawling, standing, walking), fine motor (pincer grasp, coloring), language, which includes expressive (speech) and receptive (understanding). If a problem is noted, we may refer your child to ECI or Early Childhood Intervention for evaluation.

Talking with the doctor
The well visits are an opportunity to talk with the pediatrician about your concerns or to ask advice about parenting or developmental questions.

We look forward to seeing you in the office with your child at her next well visit.

Developmental Screening

Developmental Screening in Early Childhood – Forest Lane Pediatrics

The doctors at Forest Lane Pediatrics screen children aged 2 months to 36 months for healthy development. Many children seem to be developing normally, but delays in healthy development can be undetected by parents. Our pediatricians will evaluate your children so that they can reach their full potential!

Ages & Stages – Developmental Screening Tool

From the moment our children are born, it is the desire of parents to provide the best for them, and make sure that they have an opportunity to pursue their wildest dreams. As pediatricians, we have the privilege of participating with families in the pursuit of that goal. The physicians of Forest Lane Pediatrics are committed to ensuring the health and development of our patients.

As part of this commitment, we administer the Ages and Stages developmental screen at all well visits for children ages 2 months through 3 years. Through the use of the Ages & Stages Questionnaire® (ASQ), we are able to monitor a child’s development in Communication, Gross Motor, Fine Motor, Problem Solving, and Personal Social skills. Through close monitoring of these skills, we can reassure parents that their children are developing appropriately, and give them the head start they deserve.

CHADIS

We utilize a company called CHADIS (Child Health and Development Interactive System) to administer the Ages & Stages Questionnaire electronically. You can use CHADIS on a computer, tablet (such as an iPad) or smart phone (Android, Windows, iPhone, etc.) to:

  • Tell us about any problems or concerns you want to discuss
  • Complete your developmental milestones checklist at home
  • Give us your child’s medical history and background

You should complete the CHADIS questionnaires before EVERY Well Visit.

All answers are completely confidential and cannot be viewed by anyone except your doctor.

Prior to your child’s 1 month Well Visit, CHADIS will send an email to the email address used to register for the Patient Portal. That email will contain instructions regarding how to register for CHADIS.

Two weeks prior to each Well Visit CHADIS will send you an age appropriate questionnaire to complete prior to the visit. 

Vision Screening

Vision Testing in Children

Approximately 80 percent of learning is acquired visually

Recommendations for Vision Screening in Children

The goal of vision testing is to identify and treat vision problems as early as possible. Up until now, we have relied on the doctor’s exam and the parents’ observations to diagnose an issue. Pediatricians and parents are sometimes able to recognize a vision problem, but often we don’t discover it until the preschool/kindergarten well visit when children are capable of being tested by the traditional eye chart.

Over the past decade, we have experienced a huge advance in vision testing for young children. We are now able to identify and treat significant issues in children as young as 12 months of age that would otherwise not be detected until at least age 4. The newer technologies used to diagnose vision problems in young children are expensive and may not be covered by your insurance. So that these tests are available to everyone, we offer them for a reasonable cash price regardless of insurance coverage.

Forest Lane Pediatrics has recommended a systematic schedule to have these screenings done. Like any screening exam, these tests are intended to be sensitive enough to detect any problem, but will sometimes result in a “false positive”. In other words, if your child’s test is abnormal, that does not mean he or she is blind or needs glasses or other treatment. We will refer you to an ophthalmologist (an eye doctor) who will examine your child and provide a more complete diagnosis. Whether or not you choose to utilize these optional vision tests, your doctor will always conduct a thorough examination of your child’s eyes at each well visit.

Vision Tests Available for Children age 12 Months to Teenagers

Visual Evoked Potential (VEP) – 12 months to 2 years old

The Pediatric VEP Vision Testing System is a child-friendly, non-invasive medical device used to test for visual deficits and visual nerve pathway developmental delays in children six months of age and older.

This machine is similar to the hearing test your baby had in the hospital. It measures brainwaves in the vision center of the brain as the child views images on a computer screen. The test will take about 10 minutes and requires us to apply sticky pad connected to small cables on the back of your baby’s head. If we cannot obtain an adequate test, we will not charge for the test. Though it cannot diagnose the specifics of a problem, it is a very sensitive test and will pick up on any brain or eye problem that affects your baby’s vision.

Spot Vision® – 12 months to 4 years old

Fast, child-friendly, camera-like vision screening test for kids!

Spot Vision® is a high-end optics and infrared light scanning device combined with sophisticated software, algorithms, and infrared imaging technology.

This machine is designed to assess for refractive errors that cause blurred vision. The test is quick and only requires the child to focus at the machine for a few seconds. Designed to work as easily with toddlers as with teenagers, the test presents immediate screening results. The sophisticated technology provides reliable analysis that enables informed decision making about the need for follow-up diagnosis if the following are detected:

  • Pupil size deviations (anisocoria)
  • Eye misalignment (strabismus)
  • Near-sightedness (myopia)
  • Far-sightedness (hyperopia)
  • Unequal refractive power (anisometropia)
  • Blurred vision, eye structure problem (astigmatism)

Snellen Eye Chart – 4 years and older

This is the traditional method to assess visual acuity. We use either letters or shapes to find out how well your child can see. This is an “old-fashioned test”, but it is still effective at diagnosing vision problems in older children. We start performing this test around 4-5 years old. If a child has trouble communicating the images of the eye chart, then Spot Vision testing is recommended.

Recommended Vision Screening Schedule

If your insurance covers vision screening for young children, we will screen as per their recommendations. If your insurance does not cover vision screening for young children, we recommend the following schedule:

  • 12 months to 2 years old: Visual Evoked Potential (VEP)
  • 12 months to 4 years: Spot Vision (annually)
  • 4 years and older: Snellen eye chart and Spot Vision if necessary

Please talk with your pediatrician if you have more questions about these tests.

Newborn Circumcision

Newborn Circumcision – Forest Lane Pediatrics of Plano and Dallas

Male circumcision is a common procedure, generally performed during the newborn period. To summarize, the American Academy of Pediatrics’ Circumcision Policy Statement (Copyright © 2012 AAP) reports that the preventive health benefits of elective circumcision of male newborns outweigh the risks.

Those benefits include prevention of:

  • Urinary tract infections
  • Penile cancer, and
  • Transmission of some sexually transmitted infections, including HIV
  • Complications are infrequent; most are minor, and severe complications are rare
  • Newborn circumcision has considerably lower complication rates than when performed later in life

Parents ultimately should decide whether circumcision is in the best interests of their male child. They will need to weigh medical information in the context of their own religious, ethical, cultural beliefs and practices. The American College of Obstetricians and Gynecologists has endorsed this statement.

Circumcision Procedure

Pediatricians from Forest Lane Pediatrics of Plano and Dallas perform neonatal circumcisions in the hospital and in their office. The doctors use the Mogen® and Gomco® clamps as part of their neonatal circumcision technique. Following a sterile cleanse of the area, a dorsal penile nerve block (DPNB) is done. DPNB is effective in reducing neonatal circumcision pain.

Your obstetrician may use other techniques including a Plastibell®. Plastibell® circumcision is a simple technique for neonatal circumcision. A clear plastic bell-shaped ring with a handle fits over the head of the penis. The ring is then covered over by the foreskin. A suture is tied firmly around the foreskin, compressing the skin against the groove in the Plastibell®. The excess skin extending beyond the ring is trimmed. Then the handle is removed. In 3 to 7 days the Plastibell ring will fall off. The circumferential wound will heal in about a week.

Circumcision Wound Care

Gomco/Mogen Circumcision:

Typical appearance: Expect redness of head of the penis, white or yellow granulation tissue, and/or swelling for the first 7 days after circumcision. Notify your pediatrician if there is significant redness, secretions, crusting, or swelling beyond 7 days. Call immediately if there is foul-smelling discharge.

Lubrication: Regardless of the type of circumcision done, we recommend protecting the head of the penis with Vaseline (petroleum jelly) after the procedure. For Plastibell circumcisions apply the Vaseline directly to the head of the penis every diaper change. For Gomco circumcisions apply the Vaseline to clean gauze and cover the head of the penis with the Vaseline gauze every diaper change for 3 days. After 3 days it is no longer necessary to use the gauze and the Vaseline can be applied directly to the head of the penis. See below for guidance on long-term lubrication.

Short-term prevention of adhesions: (reattachment of the foreskin to the head of the penis): Monitor the foreskin and the head of the penis. Starting as early as 24 hours after the circumcision, the foreskin may start to cover any part of the head of the penis. If this occurs, use gentle pressure to separate the foreskin from the head of the penis. Apply lubricant to the area that was attached and now has been separated for at least 2 weeks.

Plastibell Circumcision:

If the Plastibell technique was used to circumcise your son, there will be a plastic ring attached to the head of the penis by a string. The string will fall off with the bell within 5-10 days typically. The Plastibell should be mobile on the penis and the penis should not come through the top of the Plastibell. If the penis is protruding through the top hole of the Plastibell and is stuck, your son should be seen immediately.

Long-term prevention/treatment of adhesions:

Due to the large pre-pubic fat pad (the puffy area between the penis and the belly) that exists on most infants, it is common for the skin on the shaft of the penis to become adhered to the head of the penis. Check at least once a day to make sure that the groove around the base of the head of the penis is visible and clean. Boys with more fat are more prone to have adhesions develop.

Many parents make it part of their diaper changing and/or bathing routine to check for adhesions. Use gentle pressure to separate the foreskin from the head of the penis whenever necessary. Apply lubricant to the groove at the base of the head of the penis, or wherever there have been adhesions, for as long as necessary to keep the foreskin free from the head of the penis.

Other benefits to lubrication:

A 2008 study (Urol J. 2008;5:233-6) showed that applying lubricant with every diaper change for the first 6 months following circumcision promotes good healing and lowers both the risk for infection and the risk for meatal stenosis (narrowing of the hole where urine comes out because that area is rubbing directly on the diaper).

Please contact our office if you have any further questions about circumcision care.

Ear Deformity Correction

Ear Deformity Correction in Newborn Babies

Ear deformities can occur in 1 in 4 newborn babies. Our pediatricians offer a non-surgical ear deformity correction system for newborns, the EarWell® Correction System, thus avoiding possible cosmetic surgical correction when your child is older.

“10 fingers, 10 toes, heart sounds great, and he is breathing normally.” This statement pretty much sums up the words that a parent wants to hear when their pediatrician walks into the room shortly after the birth of their child. No matter how normal the pregnancy and delivery, all parents wait with bated breath before the pediatrician informs them of their child’s health. Fortunately, the vast majority of children are born healthy without any abnormality, but sometimes abnormalities are present, and thanks to modern technology, we can often correct them.

Mild Ear Deformities in Children

One such abnormality for which we have not previously had an easy solution is the abnormal shape of a child’s ears. According to a study published by Baylor University Medical Center, 15–29% of children are born with an ear deformity. Previously, the only option available to correct these cosmetic deformities was surgical correction at 5 or 6 years of age. Fortunately, we now have a non-invasive option for the correction of ear abnormalities, the EarWell Correction System produced by Becon Medical.

EarWell® Correction System

The EarWell® System consists of plastic molds that are applied to a child’s ear to gently reshape the ear into a normal, aesthetically pleasing appearance. Dr. Steve Byrd, a Dallas-based plastic surgeon with extensive experience in surgical ear reconstruction, designed the molds and perfected the device in his Dallas office. The EarWell System was so successful, in January 2010 Becon Medical began making the molds available to pediatricians across the country.

Our pediatricians were the first in the nation to use EarWell® and were
trained by the inventor Dr. Steve Byrd.

Forest Lane Pediatrics is proud to be one of the first pediatric practices in the nation to offer this procedure and honored to have been trained by Dr. Steve Byrd, the inventor of the EarWell Correction System.

Molds Applied at Birth

For those children with ear deformities amenable to correction with the EarWell Correction System, results are best when the molds are applied to the ear as soon as possible after birth, ideally within the first week and up to 2 weeks old. Each mold stays in place with an adhesive that lasts roughly 2 weeks, and most children will require 3 molds totaling 6 weeks of treatment so that by the time the child is 2 months old, the ear deformities should be corrected with no further molds needed.

Psychological Benefits for Your Child

Thanks to the EarWell System, we now have the ability to correct cosmetic ear deformities without surgery and without children having to endure years of teasing before a surgical correction can be achieved. Even better still is that almost all insurance companies cover the procedure, thereby allowing families to correct their child’s ear abnormality with minimal financial burden.

EarWell® Treatment at Forest Lane Pediatrics

If you are interested in learning more, please visit Becon Medical’s EarWell Correction System website. If you would like to speak with one of our doctors about the procedure, feel free to call our office and schedule a consultation with Dr. Mitchell or Dr. Clarke.

EarWell® Correction System:

  • Non-surgical correction of cosmetic ear abnormalities
  • Must be done in the first 2 weeks of life (ideally in the first week of life)
  • Covered by most insurances
  • Ear deformity corrected by 2 months of life

Services

Special Services

At Forest Lane Pediatrics our board certified pediatricians are committed to providing excellent care in all areas of pediatric medicine to our families. We offer newborn care, routine well-child care, and comprehensive diagnosis and treatment of illnesses supported by the latest medical research and technology. In addition to the comprehensive routine care, we are pleased to offer the following unique special services:

For New Mothers

For Infants

For Children

Medical Ear Piercing

The doctors at Forest Lane Pediatrics are excited to offer Blomdahl® Medical Ear Piercing System which is only available to physicians for piercing ears.

Fluoride Varnish Dental Treatments

Safe and effective cavity prevention in children.
As part of our comprehensive health care coverage, Forest Lane Pediatrics is happy to offer Fluoride Varnish Dental Treatments every 6 months for children ages 1 – 3 years old.

In-house Laboratory Services

Forest Lane Pediatrics has an in-house laboratory capable of performing most lab work in children.

Special Office Hours

Plano Office Evening Hours: Evening appointments are scheduled at the doctor’s availability.

Dallas Office Saturday Morning Hours (8 am – 10 am): Saturday morning sick appointments are available in our Dallas office.