News & Announcements

This flu season we are seeing lots of kids with respiratory infections and many of them are requiring treatment in Emergency Departments and admission to the hospital. Many of these admissions are due to the Flu. Please be aware that the best protection against severe disease from the Flu is vaccination. If your child has not yet received their flu vaccine please schedule it ASAP!

If your child has fever or flu like symptoms, Children’s Medical Center has provided these helpful resources to help you know when your child needs to go to the Emergency Department.

• When to take your child to an urgent care vs the emergency room
• What to do when your child has a fever
• Sick with the flu: When to go to the ER [Infographic]

Summer is the time of year when our office gets inundated with summer camp forms and school forms as we prepare for the next school year. To help us get the form back to you as quickly as possible, please do the following:

• Complete all medical history/parent portions prior to sending, this includes any medications that will be taken at school/camp, and any allergies.
• Send the entire form for the doctor to review prior to signing, not just the portion we need to complete. This is especially important for Sports Participation forms.
• Forms must be sent as a PDF document.
• Be aware that due to the high volume of forms we receive it may take several business days to complete. We will get the form back to you as soon as possible.
• If you need a form returned the same day, please call the office to pay the $25 “same day fee” prior to sending the form.
• Forms will only be completed for patients who are up to date on their Well Visits (seen in the last 12 months), sick visits do not count
• Forms will only be received and returned via the Patient Portal, we do not accept or return forms via email.

Don’t use homemade formula. Don’t dilute formula.  Don’t give toddler formula to infants.  

Don’t give cow’s milk or plant-based milks (almond, soy, pea, oat, etc.) under 12 months of age. 

Babies younger than age 12 months should be fed infant formulas specifically designed to meet their nutritional needs. Adding extra water or other liquids to infant formula can be dangerous.

Store brand / generic formulas (storebrandformula.com):

– Walmart, Target, Amazon, Kroger, Costco and others sell formulas under their own labels.

– All store brand infant formulas currently sold in the US are made by the same manufacturer (Perrigo).

– Store brand formulas meet the same FDA nutritional and quality standards as brand name formulas.

FORMULA CATEGORIES:

Standard Cow Milk-Based: intended for infants who have a normal GI tract.  Standard formulas contain full-sized cow milk protein.

– Enfamil NeuroPro Infant

– Store Brand Infant (compares to Enfamil NeuroPro) – perrigopediatrics.com/infant

– Enfamil Enspire (includes lactoferrin protein which is also found in breast milk)

– Similac Pro-Advance

– Store Brand Advantage (compares to Similac Pro Advance) – perrigopediatrics.com/advantage

– Similac 360 Total Care (includes human milk oligosaccharides also found in breast milk)  

Partially Hydrolyzed Cow Milk-Based: intended for infants who are experiencing discomfort when they digest the full-sized cow’s milk proteins or who have a history of digestive issues.  

– Similac Pro Total Comfort

– Store Brand Complete Comfort (compares to Similac Total Comfort) – perrigopediatrics.com/complete-comfort

– Enfamil NeuroPro Gentlease

– Store Brand Gentle (compares to Enfamil Gentlease) – perrigopediatrics.com/gentle

– Enfamil Enspire Gentlease

– Gerber Good Start GentlePro (100% whey protein)

– Gerber Good Start Gentle Supreme (A2 milk beta casein protein)

– Gerber Good Start Soothe (100% whey protein/probiotics/30% reduced lactose)

– Store Brand Tender (compares to Gerber Good Start Soothe) – perrigopediatrics.com/tender

Cow Milk-Based Extensively Hydrolyzed / Hypoallergenic: intended for infants who are allergic to and/or cannot tolerate full-sized cow’s milk proteins. 

– Enfamil Nutramigen

– Store Brand Hypoallergenic (compares to Enfamil Nutramigen) – perrigopediatrics.com/hypoallergenic

– Similac Alimentum (ready to feed liquid is corn-free)

– Gerber Good Start Extensive HA (100% whey protein)

– Enfamil Pregestimil (with MCT oil for infants who have trouble absorbing fat)

Cow Milk-Based Amino Acid / Elemental: intended for infants who are allergic to and/or cannot tolerate intact cow’s milk protein and are not able to tolerate extensively hydrolyzed formulas. These formulas may be covered by insurance in Texas and typically require a prescription.

– Neocate (neocate.com/reimbursement)

– Similac EleCare (elecare.com/insurance-coverage)

– Enfamil PurAmino (​​enfamil.com/reimbursement-support)

– Alfamino (alfamino.com/reimbursement-support)

Plant-Based: intended for infants who have galactosemia, are on a vegan diet or are unable to digest lactose (usually temporary).  Soy formulas are not the first choice for cow’s milk protein intolerance since up to 50% of the infants who have milk allergy are also sensitive to soy protein.

– Enfamil ProSobee Simply Plant-Based

– Similac Soy Isomil

– Store Brand Soy (compares to Similac Soy Isomil) – perrigopediatrics.com/soy

– Gerber Good Start Gentle Soy (Kosher and Halal)

Cow Milk-Based, reduced lactose: intended for infants who are not able to tolerate lactose.  Lactose intolerance is not common in infants.  All plant-based formulas are lactose-free.

– Similac Pro Sensitive

– Store Brand Sensitivity (compares to Similac Pro Sensitive) – perrigopediatrics.com/sensitivity

– Enfamil NeuroPro Sensitive

Added rice starch: intended for infants with gastroesophageal reflux.  These formulas often cause constipation so it is best to discuss with your baby’s doctor before starting.

– Enfamil AR 

– Store Brand Added Rice (compares to Enfamil AR) – perrigopediatrics.com/added-rice-starch

– Similac for Spit-up

Organic: intended for families who prefer organic foods.

– Similac Advance Organic

– Enfamil Simply Organic

– Earth’s Best Dairy (standard), Sensitivity (reduced lactose), or Gentle (partially hydrolyzed whey) 

– Bobbie (hibobbie.com): European-style, Kosher, no corn syrup or palm oil, CLP Purity Award.

– ByHeart Whole Nutrition (byheart.com): Kosher, no corn syrup or palm oil, CLP Purity Award.

– Nature’s Own Baby’s Only (marketed for toddlers, but meets all nutritional requirements for infants)

Premature infant, 22 calorie Cow Milk-Based: intended for preterm infants (less than 37 weeks gestation); nutrient-enriched to promote catch-up growth and healthy development.

– Enfamil NeuroPro EnfaCare

– Similac NeoSure

Online resources for parents:

www.healthychildren.org/English/ages-stages/baby/formula-feeding/Pages/Choosing-an-Infant-Formula.aspx

www.hhs.gov/formula/index.html

www.cdc.gov/nutrition/InfantandToddlerNutrition/formula-feeding/choosing-an-infant-formula.html

www.nytimes.com/wirecutter/blog/baby-formula-shortage-what-to-do/

www.nytimes.com/article/combination-breast-bottle-feeding.html 

Due to the COVID-19 pandemic we have instituted the following procedures to keep our patients, staff, and doctors safe:

• Masks are required in public areas of the office for all persons 2 years and older. Once in the exam room, masks are optional.  If you or your child have a cold, cough, fever, or concern for COVID we require that a mask be worn at all times.
• When interacting with a patient, all doctors and staff wear appropriate personal protective equipment.
• Please only bring the patient who is scheduled to be seen to the appointment. Siblings who are not scheduled to be seen should stay home.
• We are limiting the number of people in the office by:
  • Requiring that insurance be verified and development questionnaires be completed prior to the appointment.
  • Scheduling the next well visit at check-in to decrease congestion at check-out.
• Enhanced cleaning procedures between every patient encounter

If you are scheduled to have a Virtual Visit, we ask that you do the following:

• Please make sure you have a strong internet connection and that the video and audio functions are turned on and working properly on your device. 
• Find a quiet, well-lit space for your child’s visit. 
• Please make sure that your child is present for the appointment.
• Please take your child’s temperature prior to the visit.
• Whenever possible, weigh your child prior to the appointment. This will help with the doctor’s assessment and will also allow the doctor to properly dose medications. 
• Keep a flashlight nearby to help the doctor examine your child. 
• Have any medications your child is currently taking with you during the appointment.

We are committed to the care and safety of our patients and families and encourage all of you to continue to wear face coverings and socially distance. If you have any questions or concerns regarding our infection control policies and procedures please do not hesitate to ask. 

The Omicron variant of COVID-19 is highly transmissible and causing record numbers of cases. As we work to try and meet the demand of the increased number of sick visits, there may be longer than usual waits on the phone or abrupt cancelation of non-urgent appointments. We apologize for these inconveniences and appreciate your patience as we do our best to make sure that we are available to care for our sick patients. Please be aware of the following changes to our office protocols:

• Only 1 parent per patient over 2 months old will be allowed in the office
• Siblings of patients should stay home and not come to the office if at all possible
• Virtual Visits are recommended for symptomatic patients with known COVID exposures

As of 1/13/22 we have rapid COVID and COVID PCR tests available in all offices.

Congratulations to Drs. Clarke, Liu, McGonnell, Mannering, and Straughn for being selected by D Magazine as “Best Pediatricians in Dallas”! We know they are amazing doctors and we are thrilled that D Magazine thinks so too. Please be sure to congratulate them the next time you see them.

Below are the updated Quarantine Guidelines per the CDC as of August 11, 2022 which can be found here. For more information about Isolation guidelines go here. 

What are the symptoms of COVID-19?

• Just like adults, children can have asymptomatic COVID infection or severe symptoms.
• According to the CDC, the following are symptoms of COVID infection in children.
  • Fever
  • Fatigue
  • Headache
  • Myalgia
  • Cough
  • Nasal congestion or rhinorrhea
  • New loss of taste or smell
  • Sore throat
  • Shortness of breath or difficulty breathing
  • Abdominal pain
  • Diarrhea
  • Nausea or vomiting
  • Poor appetite or poor feeding
• Unfortunately all of the symptoms listed above can also apply to other common pediatric illnesses. If there is a high rate of COVID-19 in a community then testing is the only way to determine if your child has COVID-19.
• Fatigue, Headache, and loss of smell were the most common symptoms reported in a study of 258,790 children published in the Lancet Journal.

How do I get my child tested for COVID-19?

• Visit a COVID-19 Testing Site
  • Tests are free for people exposed to COVID or having COVID symptoms
  • Test results typically take 2-4 days
  • There are are lots of testing site options, some options include:
    • MCI Diagnostic
    • Gogettested.com
    • MyCOVIDappointment.com
    • Dallas County testing sites
    • Dallas County Health and Human Services list of testing sites
• Schedule a Visit with your doctor
  • During the visit the doctor will identify when the child should be tested and what test the child should receive. 
  • A PCR test results will be available in 1-4 days (Result time depends on the lab used and what day of the week the test is ordered. Check with your doctor for a more accurate estimate at the time of the test) and is the most accurate test available.
  • A Rapid Antigen test result will be available no later than the end of the day of the test. The Rapid Antigen test is appropriate to use in the first 5 days of symptoms, or days 5-7 after exposure to COVID in an asymptomatic person. 

What do I do if my child tests positive for COVID?

• First, don’t panic. While COVID-19 is a scary disease, the vast majority of children who get COVID are asymptomatic or minimally symptomatic. 
• Your child needs to Isolate at home per the directions above
• When in isolation, the CDC recommends you do the following:
  • Monitor your symptoms. If you have an emergency warning sign (including trouble breathing), seek emergency medical care immediately.
  • Stay in a separate room from other household members, if possible.
  • Use a separate bathroom, if possible.
  • Avoid contact with other members of the household and pets.
  • Don’t share personal household items, like cups, towels, and utensils.
  • Wear a mask when around other people if able.
• Notify your child’s school and any person who was in close contact with your child for 2 days prior to the start of symptoms that they may have been exposed to COVID-19 and need to quarantine. 

WHY WE RECOMMEND COVID-19 VACCINATION

COVID vaccination is a critical tool to protect against COVID-19.

• The CDC COVID vaccination schedule includes 3 vaccines that are currently authorized for children.
  • Pfizer and Moderna (mRNA vaccines) are authorized for 6 mo and older; Novavax for 12 yo+.
    • AAP Pediatric COVID-19 Vaccine Dosing Quick Reference Guide
• Updated bivalent mRNA vaccines protect against the original virus and two Omicron variants.
  • The FDA discontinued authorization of monovalent mRNA vaccines on 4/18/23.
  • The top 5 Omicron variants account for 95% of the current cases in the US. 
  • Optimal 4-6 month (minimum 2 month) interval after last COVID infection or vaccine.
  • The dates when updated bivalent vaccines became available vary by age group.
• Staying up to date with your vaccine is the safer & more dependable way to build immunity.
• COVID vaccines don’t cause infertility, pregnancy, lactation or significant menstrual problems.
• FDA authorized COVID vaccines are effective against severe disease, hospitalization, and death.
  • MIS-C: 1 vaccine dose reduces the risk from 200 per million to 1 per million COVID cases.
  • Hospitalization: Unvaccinated 5-11 yo 2x, 12-17 yo 1.6x, & 18-49 yo 4x higher risk.
  • Death: Unvaccinated 5 yo+ 10x higher risk & 12 yo+ 20x higher risk. 

COVID-19 infection risks

• > 1.1 million U.S. COVID-19 deaths and > 234,000 U.S. children have lost a primary caregiver.
• 1,596 pediatric COVID deaths through 4/26/23: 46% 0-4 yo; 30% 5-14 yo; 24% 15-17 yo.
  • From 8/1/21 through 7/31/22, COVID was first the leading cause of pediatric infectious mortality.
  • In the < 5 yo age group: more deaths/year from COVID-19 than from pre-COVID pandemic flu; 24% of hospitalized admitted to ICU; 63% of hospitalized had no underlying medical condition. 
• 5.5 million reported pediatric COVID cases; most are mild, some develop significant health problems:
  • MIS-C (9,445 cases) is serious complication starting 2 to 6 weeks after COVID infection.
  • Long COVID in children ( > 56 days) is more common (~2%) than MIS-C (0.03%).
  • COVID infection may increase the risk of newly diagnosed diabetes in children and adults.

COVID-19 vaccination risks

• COVID vaccines are monitored by the most intense safety monitoring efforts in U.S. history.  
• Severe adverse events such as anaphylaxis are rare; anaphylaxis to amoxicillin is at least 40x more likely.
• Common side effects are typically mild, temporary and similar to those associated with other vaccines:
  • 6 mo to 3 yo: injection site pain, sleepiness, poor appetite, fussiness, lymph node swelling.
  • 4 to 17 yo: injection site pain/swelling/redness, fatigue, headache, chills, lymph node swelling.
• COVID vaccine-associated myocarditis is typically mild and self-limited.
  • Vaccine-associated myocarditis risk factors: 2nd dose; male > female; 12-29 yo; Moderna > Pfizer.
  • 12-17 yo boys are up to 6x more likely to develop myocarditis from COVID infection.  
  • CDC suggests that an 8 week interval between dose #1 and dose #2 in the primary series may increase protection and further minimize the rare risk of endocarditis.

Last updated on May 7, 2023

With the announcement that starting May 10, 2021, all persons 12 and older will be eligible to receive the COVID vaccine, we have been getting a lot of questions regarding the vaccine and children. The following are our responses to the most common questions we are getting.

Q: Do the doctors of Forest Lane Pediatrics recommend children receive the COVID vaccine?

A: Yes, we recommend that all persons who are eligible for the vaccine receive it. If there is a concern a person might have a medical contraindication to getting the vaccine then that person should discuss their concern with their doctor.

• COVID vaccines will help keep your child, your family and your community safe.
• Fully vaccinated asymptomatic people (bit.ly/3edFZmX) can resume activities such as…
  • Gathering indoors with other fully vaccinated people without masking or distancing.
  • Gathering outdoors without masking, except in large settings.
  • Not quarantining after a close contact COVID exposure or domestic travel.
  • Not requiring a COVID test before or after domestic travel.

Q: Is the Vaccine safe?

A: Yes, all of the COVID vaccines available in Texas have completed clinical trials showing that they are safe. As of March, 24, 2021, 114 million people have been fully vaccinated against COVID-19 and there has not been a single death attributed to the vaccine (contrary to what many peoples social media feeds will tell them). Not only have there been no deaths due to the vaccine, but the odds of dying from COVID after getting vaccinated are virtually non-existent. In fact you are 3 times more likely to get struck by lightning than you are of dying from COVID after getting vaccinated.

Q: Why should children be vaccinated?

A: It is true that children tolerate COVID-19 infection much better than adults and are at a much lower risk of severe disease or death compared to adults. However, we are seeing an increase in the number of children who are getting COVID and the risk of a more contagious or dangerous variant will continue to exist until we reach herd immunity. Fortunately we have an abundance of data showing that the vaccines are safe and the risk of bad outcome from COVID far exceeds any negative effects from the vaccine. Children should be vaccinated because it protects them from COVID and potential bad outcomes associated with COVID as well as increase the overall vaccination rates in our community. The more healthy people get vaccinated the sooner this pandemic ends and the greater protection we provide for people who can’t get vaccinated or are immune suppressed and don’t have strong protection from the vaccine.

• Children accounted for 22% of new weekly COVID cases during the week ending 4/29/21.
• The pediatric COVID case rate has risen steadily since the pandemic began:

Q: Are there any long term side effects from the Vaccine?

A: The short answer is No. The long answer is that this is a difficult question to answer because the vaccine has been around for less than a year, but we can say that there is no mechanism by which it would be expected that the vaccine would cause long term side effects and there has been no evidence of people having long term or delayed side effects from the vaccine. What is clear is that some people who get infected with COVID-19 have symptoms that persist for many months resulting in a condition currently described as Long COVID. Interestingly, people suffering from Long COVID have started to report that their symptoms have resolved after getting the COVID vaccine. Long COVID is still a poorly understood disease and there are no studies confirming that the the vaccine is a cure for Long COVID, but the excellent safety data of the vaccine combined with recent reports of improvement in long term symptoms of people with COVID strongly suggest that the probability of long term symptoms from the vaccine are incredibly low. For more information about why scientist are confident there will be no long term side effects from the COVID vaccines and why there is so much misinformation saying there are long term side effects, check out this excellent article from the Children’s Hospital of Philadelphia.

• As of 5/1/21, over 235 million mRNA COVID vaccine doses have been given in the US. 
• There have been no deaths attributed to mRNA COVID vaccinations.  
• Typical side effects are mild (chills, headache, fatigue, pain, redness and/or swelling at the injection site) and caused by the immune system appropriately reacting to the vaccine.
• Anaphylaxis (a severe allergic reaction) to an mRNA COVID vaccine dose is rare (2 to 5 people per million vaccine doses). For comparison, anaphylaxis to amoxicillin is about 100 times more likely. 
• Scientists are confident that there will not be long-term side effects from the COVID vaccines.

Q: When can my child get the vaccine?

A: On May, 2021 all persons 12 years and older are eligible for the Pfizer vaccine and all persons 18 and older are eligible for the Moderna or Johnson & Johnson vaccine. Dr. Fauci has expressed optimism that children as young as first grade may be eligible for the vaccine as early as September. Ultimately it will depend on how quickly the vaccine studies in children can be completed. Forest Lane Pediatrics is proud to be participating in a COVID-19 Vaccine study for children ages 6 months – 12 years old. If you are interested in enrolling your child please email infoDallas@JavaraResearch.com.

Q: How do I get a vaccine for my child who is 16 or older?

A: Forest Lane Pediatrics has been approved to be a COVID Vaccination Site! As a result we will be able to vaccinate all patients who are eligible for the vaccine. We expect to get the vaccine the week of May 17. Once we have the vaccine we will begin scheduling patients.

Q: Does my child need the vaccine if he has already had COVID?

A: Yes. While natural infection with COVID-19 does provide some immunity to future infection, it is clear that the immunity gained from the vaccine is superior. This is still an area of great interest, but so far the data suggests that the vaccine produces longer term immunity against COVID-19 and greater protection against COVID Variants than natural infection without the risk of developing Long COVID.

Q: Does the vaccine affect future fertility?

A: No. There is is zero evidence supporting the claim that the vaccine will cause infertility and any person or source claiming otherwise should not be trusted. We now have data from the vaccine trials where the incidence of miscarriages in the vaccine group and the placebo group were compared and there was no difference. The American College of Obstetrics and Gynecology (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) released a joint statement: “No loss of fertility has been reported among trial participants or among the millions who have received the vaccines since their authorization, and no signs of infertility appeared in animal studies.” For additional information about why the vaccine does not cause infertility check out this helpful post.

Despite the governor’s recent decision to end the mask mandate in Texas, Forest Lane Pediatrics will continue to require that all persons age 2 and older wear a mask while in the office. Until our community has herd immunity against COVID-19, masks are a critical tool to reduce the spread of the disease and protect the most vulnerable in our population. For information about how masks work click here. For an article explaining why we know masks are effective click here.

The Dallas office will be open from 10 am – 12 pm today. If your child needs to be seen please call us to schedule an appointment.

Forest Lane Pediatrics is pleased to announce that we now have the ability assess children for ADHD using a computerized testing system called Qb Test. This test will not replace the use of Vanderbilt Questionnaires and evaluation by our physicians, but it will provide valuable information in the assessment of hyperactivity, impulsivity, and inattention. For more information about this test, visit the Qb Test website. For more information about getting your child evaluated for ADHD, please visit our ADHD Assessment page.

Congratulations to Drs. Blair, Kravitz, Liu, Mannering, McGonnell, Mitchell, and Straughn for being voted D Magazine Best Doctors for 2020! We are thrilled that so many of our doctors were acknowledged by their peers as leaders in the field of pediatrics.

Influenza season is fast approaching. We have received shipments of both injectable and nasal influenza vaccines for this winter. It is recommended that all adults and all children six months and older receive the vaccine every year. As always, we will be giving quadrivalent (four strains) preservative-free vaccines. To read more about the influenza vaccines for this year, visit the CDC website.

We will be offering several weekday and Saturday morning vaccine clinics in the Medical City Dallas office.

For Frisco, we will be offering drive through options on some Saturday morning clinics as well as our standard in office clinics on weekdays. We are offering later appointments from 4-6pm on select Mondays.

The Mesquite office will also be offering some curbside and in-office options (weekdays only).

You can schedule an appointment for our flu clinics through the Patient Portal, or by contacting our offices during regular office hours.

Dallas 972-284-7770
Frisco 972-526-0700
Mesquite 972-629-2250

COVID Testing:

All three offices are able to assess children for illnesses, including COVID-19. We offer in-house antigen testing as well as send out PCR (molecular test) for COVID-19. In order to keep all parties safe, we need you to call our office in order to schedule these appointments.

Virtual visits in the evening:

We are currently testing on demand visits options for 6pm-8pm on weeknights, Monday through Thursday. These will be virtual visits only and the assigned on-call Forest Lane physician will be available to help your situation. Please go to our website for more details.

Thanks you for entrusting our children’s health with us,

Forest Lane Pediatrics

We do our best to begin virtual visits as close to your child’s scheduled appointment time as possible. However, the virtual visit appointment time is an estimation of when we will begin the process of checking in your child for the visit. The doctor will not be available to see your child immediately at the time of your scheduled appointment. When preparing to connect to the Virtual Visit, please be aware of the following:

• You will receive an email prior to the appointment to complete the required check-in process. After check in, if your visit is starting soon you will be able to go directly into a virtual waiting room. Otherwise, you will receive another email with the link to join your virtual visit. 
• Click “Start My Virtual Visit” ten minutes before you are scheduled to meet with your provider. You will see a virtual waiting room. 
• You do not need to wait and keep your child in front of the computer. A medical assistant will call you when the doctor is almost ready to see your child. 
• Once your provider is available, you will hear an alert noise and the “Join Visit” button will become active for you to click on and connect with your provider. Within moments, your provider will be visible to you on the screen and you may begin your virtual visit!

To ensure a successful Virtual Visit we ask that you do the following:

• Please make sure you have a strong internet connection and that the video and audio functions are turned on and working properly on your device. 
• Find a quiet, well-lit space for your child’s visit. 
• Please make sure that your child is available to be present for the appointment.
• Please take your child’s temperature prior to the visit.
• Whenever possible, weigh your child prior to the appointment. This will help with the doctor’s assessment and will also allow the doctor to properly dose medications. 
• Keep a flashlight nearby to help the doctor examine your child. 
• Have any medications your child is currently taking with you during the appointment.

For more information about what types of appointments are appropriate for Virtual Visits and FAQ’s go here.

Flu vaccines are now available for scheduling on our website through the Get Care Now link on our homepage. We will be constantly adding spots into our flu clinic as we are able. Please be patient with us as we strive to get as many of our families vaccinated for the flu while maintaining social distancing and keeping everyone as safe as possible! Any parents who would like to get a flu vaccine must be scheduled and paid for in advance. Please ask our staff for details.

See the guide below to determine if Flu Shot or FluMist is best for your child.

Saturday flu clinics:

Weekday flu clinics:

*Updated September 15, 2020

On August 20, DISD announced that the first 4 weeks of school will be virtual only and in person school will be available starting October 6.

On July 31, Children’s Medical Center published their Back to School Guidance with recommendations for Low, Moderate, and High risk conditions.

On July 23,  the Center for Disease Control published Safe Return Guidelines for schools K-12 as well as a Decision Making Tool for parents to help them decide if it is safe to return to in-person school. 

On July 16, the Dallas County Health Department announced that all public and private schools are prohibited from offering face-to-face instruction until September 8. 

As we reach the middle of summer and we see a steady increase in the number of COVID-19 cases in our community, many parents are appropriately questioning whether or not they should send their child back to school in the fall for traditional school or pursue Virtual Learning. If you read my answer to the question of “Should my child go to camp or daycare?”, you know that simple “yes” or “no” answers are hard to come by in a pandemic. The truth of the matter is that a global outbreak of a deadly virus is not a simple matter and there are no simple solutions, but I will do my best to provide helpful guidance.

To begin with, when we think about the question of whether or not your child should return to in-person school, we need to determine if we are talking about your individual child or all children in general. I would describe this distinction as being between the issues of Public Health or Personal Health. This is an important distinction because the answer to the question may be different when discussing the individual health of one child or one family compared to the collective health of all children. 

In addition to clarifying whether or not we are considering a personal health or public health question, we must also define the potential benefits and the potential risks of our choice. While the question of whether or not you should send your child to school is a binary choice, the factors that must be considered to make that decision are anything but binary and must be assessed along a risk vs benefit continuum. With that in mind, let’s look at some specific questions related to school.

*Advisory: Please be aware that the following is not intended to be, nor should be received as, medical advice specific to your situation. This is intended to be information only, and any decisions regarding the care of your child should be discussed with your pediatrician.

Q: Should schools open for in-person learning?

A: Yes, schools should open. The truth is that if you have the option of choosing an educational model other than in-person school for your child then you have a privilege many other families envy. For single parent families, or families where both parents work, the adult supervision of children that in-person school provides is a necessity, not a benefit. Other benefits of in-person school besides childcare include: increased educational opportunities, opportunity for social interactions, special education, support for learning differences, identification of children who are being abused, and access to meals for those who are food insecure. The American Academy put out a statement saying that “the AAP strongly advocates all policy considerations for the coming school year should start with a goal of having students physically present in school… Policies to mitigate the spread of COVID-19 within schools must be balanced with the known harms to children, adolescents, families, and the community by keeping children at home.” While it is clear that there are substantial benefits to opening schools to in-person education, the AAP acknowledges that doing so is not without risk of increasing the spread of COVID-19. However, there is mounting evidence that children and adolescents are less likely to be symptomatic and less likely to have severe disease from this virus than adults. According to the Center for Disease Control, 

The largest study of pediatric patients (>2,000) with COVID-19 from China reported that illness severity ranged from asymptomatic to critical:

• Asymptomatic (no clinical signs or symptoms with normal chest imaging): 4%
• Mild (mild symptoms, including fever, fatigue, myalgia, cough): 51%

• Moderate (pneumonia with symptoms or subclinical disease with abnormal chest imaging): 39%
• Severe (dyspnea, central cyanosis, hypoxia): 5%
• Critical (acute respiratory distress syndrome [ARDS], respiratory failure, shock, or multi-organ dysfunction): 0.6%

When compared to the flu, the data suggests that COVID-19 is not as dangerous for children as the seasonal flu. Per an excerpt from the American Academy of Pediatrics publication AAP News,

The risk of hospitalization in children and adolescents younger than 18 years from COVID-19 is less than one-fifth the risk of hospitalization from influenza during the 2019-’20 season for the same age groups (see table). Although these data may be skewed by school closings and social distancing, SARS-CoV-2 infection generally is considered to be less severe than seasonal influenza infection among children and adolescents.

While it is clear that there are significant benefits of in person school being available for all children and the rate of severe disease is low in children, it is also clear that COVID-19 is a dangerous disease for certain groups of people and there are many states and counties experiencing very high rates of cases. While there are infection control measures schools can implement to minimize the risk of student and teacher exposure, if rates of disease in the community are high then the risk of exposure in the school environment will also be high. The best measure of the rate of disease in a community is the number of cases per 100K persons in the community. This is typically calculated by county and the rates can be found at COVIDActNow.com. The rate of disease in a community is considered low when the number of cases per 100K people is < 4, although a rate of < 10 is considered low enough that schools should be able to reopen without substantial risk of an outbreak occuring (Sep 15: Dallas County 9, Collin County 7.2). Another key metric is the infection rate which is the number of people that a COVID infected person spreads the infection to. The goal for the infection rate is < 1 as that means that the rate of disease in a community is declining (Sep 15: Dallas County 0.88, Collin County 1.01).

Q: Should I send my child back to school if she, or someone she lives with, is high risk for a negative outcome?

A: No. While it is clear that children are at low risk for negative outcomes from COVID-19 and are less likely to spread it compared to adults, it is also clear that children can still spread this disease and those with certain medical conditions are more likely to have severe illness. When considering the increased risk for a bad outcome that is present in this scenario, it is reasonable to conclude that the risks outweigh the benefits described above. With this understanding, we must then qualify what is considered high risk. Due to the low numbers of children who have been infected relative to adults this is still a hard question to answer; however, UpToDate has reviewed numerous studies and complied this list of conditions that are at greatest risk for severe disease in children:

• Medically Complex (defined as dependence on technological support in association with developmental delay and/or genetic anomalies)
• Congenital Heart Disease
• Neurologic, Genetic, or Metabolic Conditions
• Age <1 year also has been associated with increased risk for severe disease, but this finding has been inconsistent.

Other conditions that increase the risk for severe disease in people of all ages include:

• Chronic kidney disease
• Immune compromise from solid organ transplant
• Obesity (body mass index >95th percentile for age and sex)
• Sickle cell disease
• Type 2 diabetes mellitus

Conditions that may increase the risk for severe disease in people of all ages include:

• Cerebrovascular disease
• Chronic pulmonary disease (eg, cystic fibrosis, moderate to severe asthma, pulmonary fibrosis)
• Hypertension
• Immune compromise from hematopoietic cell transplant, primary immune deficiency, HIV, medications (eg, glucocorticoids)
• Liver disease
• Pregnancy
• Smoking
• Thalassemia
• Type 1 diabetes mellitus

Children’s Medical Center has created a helpful guide that clearly identifies whether a child’s condition is Low, Moderate or High risk with COVID with corresponding back to school recommendations.

If your child, or someone in your child’s home, has one of these conditions, then please discuss whether or not your child should attend in-person school with the health care professional who is managing that condition. It is important to recognize that while all of the categories above represent a higher risk for severe COVID-19 disease than the baseline population, there are different degrees of elevated risk for the above categories. Only in consultation with your doctor will you be able to correctly quantify the specific risks to your child or to the high risk people in your home. 

Q: If I have the ability to provide a safe environment where my child can attend a Virtual Classroom and no one in my home is high risk, should I send my child to in-person school anyway?

A: Maybe. This is a much more difficult question and different families may end up with different answers. As discussed above, the risk of getting severe disease is incredibly low in healthy, school aged children. In fact, this is the age group least likely to have a negative outcome from infection with COVID-19. It is also clear that children are not as efficient spreaders of COVID-19 as adults; however, it is also clear that they can spread the disease and that the traditional school environment is one that can easily facilitate spread of a highly contagious illness such as this one. Consequently, if schools are going to be open for in-person education, then they must enact measures to reduce the risk of spread among students. Unfortunately, there is no single action or set of actions that will completely eliminate the risk, but implementation of the following interventions can significantly reduce the risk:

• Proper Hand Hygiene – washing hands for 20 seconds with soap and water or allowing a hand sanitizer with at least 70% alcohol to sit on the hands for at least 20 seconds both before meals and also after any encounter with an object another person has touched.
• Physical Distancing – keeping students physically as far apart as possible. Ideally students would be 6 ft apart but this is unlikely to be possible in the typical classroom environment. This virus is spread primarily through aerosolized droplets that are exhaled into the air when we cough, laugh, or breath. One of the reasons that this virus is so contagious is that people who are infected, but are not yet showing symptoms, can spread the virus into the air just by breathing. This is a concept referred to as asymptomatic spread. Studies have shown that asymptomatic carriers of COVID-19 do not spread these aerosolized viral particles further than 6 ft.
• Decreased exposure to other people – the less number of people your child is exposed to, the less risk there is of exposure to COVID-19. This is typically accomplished by eliminating visitors to the school. 
• Eliminate exposure of symptomatic persons – if your child has symptoms of COVID-19 defined by the CDC as the following, then he must stay home: 
  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
• Face Masks – have 2 benefits. The primary benefit is that they prevent people who are infected from expelling the virus into the air. This is why face masks with a valve are not recommended; they protect the wearer but do not restrict the wearer’s exhaled breath from exiting the mask. The other benefit of a face mask is that it will decrease the amount of virus that you inhale from air. This is considered a secondary benefit because not all face masks are created equal. Most homemade face coverings do not have sufficient filtration to reduce the amount of inhaled virus. Surgical face masks filter about 75% of small particles and N-95 respirators filter 95%. Ultimately, the act of wearing a face mask is more about protecting your neighbor than it is about protecting yourself.
• Face Shields – these are clear plastic barriers that can be secured to a child’s head so that the eyes, nose, and mouth are covered. The benefit of the face shield compared to the face mask is that it allows for the whole face to be seen by another person and is easier to wear for long periods of time. While some studies suggest that face shields can decrease how much virus is exhaled into the environment by asymptomatic carriers the CDC reports that there is insufficient evidence to recommend their use and “does not recommend use of face shields for normal everyday activities or as a substitute for cloth face coverings.”
• Flu Vaccine – while the flu vaccine will not prevent disease from COVID-19, vaccination against the flu provides two significant benefits. The first is that it decreases the number of febrile respiratory illnesses we will see in the Fall and Winter. The Flu and COVID-19 look very similar, the only way to discern between the 2 is a test. The less Flu in the community this year the less missed school and the less confusion regarding what illness a child has. The other benefit is that there is evidence that if a person has both Flu and COVID-19, their illness is significantly worse than if they had just one of the infections.

For additional information on measures that schools should be taking to reduce the risk of spread of COVID-19, see this Guideline published by the AAP. This Risk-Based Approach to Reopening Schools published by the Children’s Hospital of Colorado is also very helpful.

Ultimately, the decision regarding whether or not to send your child to in-person school in the Fall is up to each individual family,  and the needs of the individual child must be considered. Additional considerations for families should include:

• What is the best learning environment for your child? During forced home schooling in the Spring, some families learned that their child loved learning from home. If this is true for your child and you have the ability to provide a safe environment in which your child can learn virtually, then go for it. With time to prepare, there is good reason to believe the virtual learning that will be offered in the Fall will be vastly superior to what was offered in the Spring. For a description of what Virtual Learning will look like in the Dallas Independent School District click here. Conversely, many parents learned that for their child, learning from home was a complete disaster. If that was the case for your family, then sending your child back to in-person learning in the Fall is likely a good decision.
• Would your school benefit from having fewer children in the classroom? While it is clear there is a public health benefit of keeping schools open, it is also clear that the fewer children who attend school in-person, the easier it will be to physically distance and limit the spread of disease when someone in the school gets sick. This is not a situation in which any family should feel the need to be a martyr and keep their child out of school when that is the best learning environment for that child. However, if you have the ability to effectively provide Virtual Learning from home, there is a public health argument for that action. Having said that, it is important to recognize that while the health and safety of your child is your primary responsibility, all of us should approach this pandemic with the health and safety of every child in mind. Therefore we should advocate for policies that allow for all children to be equally educated in a safe environment. If our response to the pandemic is to create two different classes of students based on their available resources, then we risk increasing the educational inequalities that already exist in our communities. 
• What is the current spread of COVID-19 in your community? The risk of exposure to COVID-19 in the school is directly related to the prevalence of the disease in the community and this should be part of the equation when considering whether or not you should send your child to school. Based on current trends of this virus, as well as historical patterns of pandemics and the typical pattern of viral respiratory infections, it is expected that rates of disease will increase in the Fall and Winter. When this happens, it is possible that schools will be forced to shut down again or public health officials will recommend that anyone who is able to remove their child from school should do so. Ultimately, this is more of a public health consideration, but the expectation is that the State will do its best to keep schools open for as long as possible, so it is appropriate to take this information into consideration when making decisions for your family. This means that even if it is appropriate to send your child to school at the beginning of the school year, you may find the need to revisit that choice in November or December. 

I hope that you found all of this information helpful and not overwhelming. Unfortunately none of us have a magic crystal ball or the ability to see into the future. All we can do is make the best choice for our families with the information we have available. Whatever choice you make, please know that we will be here to support you in the care of your child no matter what may come. Whether or not your child attends in-person school in the fall, the risk of exposure to COVID-19 is still present and it is important to be aware of the protocols for a high risk exposure or confirmed or suspected infection. 

• High Risk Exposure: The CDC defines this as prolonged (15 cumulative minutes or more) close (less than 6 f to someone confirmed to have COVID-19. If this criteria is met, then the exposed person must quarantine at home for 14 days from the last exposure to the infected person. 
• Confirmed or suspected COVID-19 infection: If someone tests positive for COVID-19, then they must quarantine at home for at least 10 days from the start of symptoms AND be fever free for a minimum of 72 hrs AND have improving respiratory symptoms (cough) for a minimum of 72 hrs. 

With this information in mind, be aware that it is appropriate to make plans for the need to quarantine at home should you or your child have a high risk exposure or suspected infection. It is expected that every school will have at least 1 positive case in the coming year. While we hope for the best, it is appropriate to plan for the possibility that you may need to keep your child home for at least 2 weeks during the coming school year. 

Dr. Mitchell

Due to COVID-19 we have limited the number of patients that we can bring in to the office so that we can promote physical distancing and prevent large crowds in the office. As a result we have less well visit appointment times available than we normally would. To address this deficit we will be making Well Visits available during our Saturday morning clinics in both Dallas and Frisco through the summer. These visits will be first come, first serve so call the office to schedule if you are interested. The first clinic will be this Saturday, June 20, 2020, and will be staffed by Dr. Mitchell in Dallas and Dr. Menon in Frisco.

As the school year comes to an end and summer draws near many parents are wondering if it is safe to send their child to camp or resume other activities. Unfortunately, there is not an easy “yes” or “no” answer to that question. We have no way of knowing whether or not your child will be exposed to COVID-19 while at camp. All we can do is inform you of the measures you and the camp can take to minimize the risk of spread. All decisions in life require an assessment of the benefit as compared to the risk. Our goal with COVID-19 is to try and significantly reduce the risk to such a level that we are willing to accept it. While this approach can feel rather helpless, the truth of the matter is that we do this in lots of areas of our lives. Whenever we get in a car there is no guarantee that we will not get in a wreck, but we take that risk because we believe that we have sufficiently mitigated that risk by wearing a seatbelt and driving safely. Ultimately each parent will have to decide whether or not the safety measures put in place by the camp or daycare are sufficient to reduce the risk of exposure to COVID-19. To help you in that decision, let’s first review how COVID-19 is spread.

According to the CDC, a person can get COVID-19 by:

• coming into close contact (about 6 feet or two arm lengths) with a person who has COVID-19. 
• exposure to infected droplets when an infected person coughs, sneezes, or talks.
• touching a surface or object that has the virus on it, and then touching your mouth, nose, or eyes. 

One of the reasons COVID-19 has caused a global pandemic is that people can spread the virus before they know that they are sick; as a result it is necessary to take infection control precautions even when around healthy people. Just avoiding people who have fever is not sufficient to avoid exposure to COVID-19. The following are steps a camp or daycare can take to lower the risk of your child being exposed to COVID-19:

• Have activities outside 
  • When an infected person breathes, they can spread a small amount of virus into the air. If an infected person is in an enclosed room with minimal circulation for a long enough amount of time, they can expel enough virus into the air that someone else can breathe it into their body and get sick. When outside or in a well ventilated room, it is not possible for enough of the virus to build up in the air to infect someone else by simply breathing.
  • If a camp is held outside, then the risk of spread will be much lower than a camp held inside. 
• Screen for symptoms of COVID-19 
  • While simply avoiding people with fever is not sufficient to avoid COVID-19, avoiding people with any possible symptoms of COVID-19 does lower the risk of exposure. According to the CDC symptoms of COVID-19 include: cough, shortness of breath or difficulty breathing, fever, chills, muscle aches, sore throat, and new loss of taste or smell. Gastrointestinal symptoms like nausea, vomiting, and diarrhea have also been associated with COVID-19. 
  • When considering a camp or daycare, investigate whether they are screening children for all of the COVID-19 symptoms.
• Proper Hand Hygiene
  • Washing hands with soap and water for 20 seconds or applying an alcohol-based hand sanitizer to the hands and allowing it to dry for 20 seconds is one of the most effective tools available for stopping the spread of COVID-19. 
  • When investigating whether or not to send your child to camp or daycare, ask about their hand hygiene protocols. We recommend that children be required to sanitize their hands upon entry into the camp or daycare, prior to meals or snacks, prior to activities where they will touch other children or share items, after activities where they will touch other children or share items, after blowing their nose, and after touching their eyes, nose, or mouth.
• Wear a mask when indoors or within 6 feet of another person
  • Wearing a mask is crucial to limiting the spread of COVID-19 when indoors or in close contact with another person as it decreases the amount of virus a person can expel into the air when breathing.
  • Ask what your child’s camp or daycare policy is regarding masks. Be aware that the CDC recommends masks only for children ages 2 and older and in some situations masks may not be recommended as they may create an additional risk of injury when participating in certain sports or activities. 
• No unnecessary individuals should be present 
  • The less number of people your child is exposed to the less risk of exposure to COVID-19. 
  • All camps and daycare facilities should limit the number of people your child is exposed to. This means that parents should not enter camp or daycare facilities and should remain in their car at pick up and drop off if at all possible. 

An additional resource to aid in your decision is the Dallas County COVID-19 Risk Level. On a daily basis, the county updates the COVID-19 risk level for Dallas and provides recommendations for various activities based on the risk level. While this tool will not tell you exactly what you should do in every situation, it provides a good starting place to make decisions. The state of Texas has also published a set of minimum guidelines for Day Camps, Overnight Camps, Youth Sports, and Child Care which can also be used to help guide these decisions. Please pay special attention to the State’s recommendation that children who attend camp be restricted from being around people age 65 and older for 14 days after the camp has ended. 

While these minimum guidelines should be achieved by all camps and daycares we understand that not every camp or daycare will be able to implement all of the infection control measures that we have recommended; and even if they did implement all of them, it does not guarantee your child will not get exposed to COVID-19. We would love to be able to give you a simple “yes” or “no” answer to the question “should my child go to camp”, but unfortunately life right now is not simple. Ultimately each parent will need to assess the risks and benefits of their family’s situation and make a decision. We hope you find all of this information helpful as you try to make a decision. No matter what your decision, we will be here to help you care for your child. In our offices we have implemented all of the recommendations listed above, including the recommendation to do activities outside as we have available curbside visits for sick children in our Frisco and Mesquite offices. We are also available via Virtual Visit for sick visits that do not require an in-person exam as well as to help manage common childhood concerns. If you have additional questions about the safety of attending camp or daycare, or questions about any other concern regarding your child, don’t hesitate to contact us and schedule a virtual visit.

Dr. Mitchell explains our enhanced safety procedures for COVID-19.

Watch the video below to learn more about how Forest Lane Pediatrics is taking precautions and enhancing safety for patients coming to the office.

Why Forest Lane Pediatrics is Still Open & 

How We are Keeping our Staff and Patients Safe

In the midst of a worldwide pandemic and local orders to “Shelter in Place,” it is appropriate to question why any business remains open and whether or not it is safe to go there. 

Why is FLP still open? 

• Medical clinics are considered essential businesses. Ensuring the delivery of newborn and well-child care, including immunizations, remains a priority according to the Centers for Disease Control and the American Academy of Pediatrics.  Aside from the threat of Coronavirus, there are other serious health issues and vaccine-preventable illnesses that will continue to affect children. As per the CDC’s guidance, we are continuing to see children aged 2 years and under for those Well Visits where vaccines are due. While we need to socially distance to protect from Coronavirus, we also must maintain optimal health for our young children. Well Visits for older children will be rescheduled as soon as it is safe to do so.  
• Kids will still get sick from other infections and illnesses. Unfortunately, all of the usual childhood illnesses and infections didn’t get the message that they are supposed to take a break right now. We will continue to remain open so that we can continue to care for our patients in their time of need. 

How is FLP keeping their staff and patients safe?

COVID-19 infection is still relatively new, but we now have months of information about the virus and how it spreads. This particular strain of Coronavirus is so dangerous because it can cause severe illness, lives on surfaces for several days, takes 4-9 days for infected persons to show symptoms, and can be spread by asymptomatic people. This perfect storm of factors has led to the pandemic that we are in. 

The good news is that because we have learned more about how the virus is spread, we are now better able to avoid it. We have lots of information from the CDC, Infectious Disease experts, and Critical Care doctors who have witnessed this virus first-hand. From these experts, we have learned that it is not common to get Coronavirus by being in the same room for a brief time with someone who is sick. While the virus can linger as an aerosol in the air, it is not an airborne virus, and transmission by air is not a common way people get the infection. People are primarily infected by touching larger droplets containing the virus and then touching their mouth, nose, or eyes. If infection occurs from eating, it is because of viral droplets on the hands touching the mouth, not because of food contamination. Multiple reports suggest that a person can be in the same room with someone who has Coronavirus for 10-15 minutes with minimal risk of exposure. Hand hygiene and avoiding touching your mouth, nose, and face are the single most important elements for preventing infection. The risk is lessened even more if people are a minimum of 6 feet apart or at least one of the people is wearing a mask.  Standard surgical masks are enough to help decrease risk in this setting. Based on this information we have instituted the following protocols and procedures to create a safe environment at Forest Lane Pediatrics:

• We are limiting the number of doctors and staff working in the office each day as well as the number of patients seen each day. This will allow us to practice social distancing while in the office and avoid large groups of people gathering together in the waiting room or at check out. 
• We are screening all doctors and staff for signs of fever and cough every day. Any doctors or staff with symptoms suspicious for Coronavirus are not allowed to come to the office. 
• We are screening all parents for fever and cough. No parent with fever or cough will be allowed into the office. 
• We are limiting the patients we see in the office who have fever and/or cough. When possible, we are evaluating these patients via Virtual Visit. If an exam is needed, then we are taking extra precautions to isolate those children from other patients.
• We are temporarily allowing only one parent per patient in the office for each visit, with the exception of newborn follow-ups and 2-week well visits, where two parents are welcome.  If you have childcare available for siblings who are not being seen for an appointment, please leave them at home.
• To minimize time spent in the office we are requiring CHADIS be completed prior to all Well Visit appointments and insurance be verified prior to all appointments.
• We are separating Well children from Sick children by having Well visits in the morning and Sick Visits in the afternoon.
• All staff and doctors are wearing masks and gloves for every patient encounter. This serves as a precaution for you and for us, not because we suspect staff members are sick.
• We have instituted enhanced cleaning protocols for the waiting rooms, exam rooms, common areas, and equipment. 

We value the trust you have placed in us as healthcare providers for your children. We strive daily to protect the health of your family, as well as the health of our physicians and staff.  We look forward to healthier times and seeing you soon.  

Sincerely, 

The Physicians of Forest Lane Pediatrics

*Updated April 7, 2020*

Do I need to worry about my kids getting COVID-19

It would be great if no child got this illness, but the one good thing about this virus is that it appears to be less severe in children compared to adults. The journal Pediatrics recently published an examination of all of the pediatric cases reported by the Chinese Center for Disease Control. Their data showed that over 90% of all pediatric cases were asymptomatic, mild, or moderate cases.  Only 6% of pediatric patients became seriously ill compared to 18.5% of adults. Of those children who were seriously ill, more than 60% were age 5 and under and 32% were under 12 months old. Of the 2143 children confirmed or suspected to have COVID-19 in the study, there was only 1 death. All of this confirms that children are more likely than adults to have mild symptoms and in general tolerate this illness better than adults. However, it also showed that very young children, and children with chronic medical conditions are still at risk for serious illness.

If children don’t get sick, why are schools closed and government officials recommending Social Distancing for everyone?

While the risk of death or serious injury is low for those that are young and healthy, this is a very dangerous illness with significant risk of mortality for those who are immunocompromised, have chronic medical conditions, or are over the age of 60. The mortality rate of COVID-19 for people age 50 years and under who have no pre-existing conditions is around 0.2%, which is similar to the Flu. For people age 80 and older that number jumps to 15-25%. The current recommendations for social distancing and cancelling of large gatherings is intended to “Flatten the Curve” of the illness. The less we all have interactions with each other, the less opportunity there is for the virus to spread, and the less likely that more people get sick than we have the ability to care for. These efforts can be thought of as being similar to the herd immunity that the community receives from vaccines. When we vaccinate all who are able to be vaccinated, we protect those who are not able to be vaccinated. In the same way, when we all minimize our exposure to large groups of people and avoid unnecessary social gatherings we are doing our part to protect those who are most vulnerable to COVID-19 in our community.

How do I protect myself and my children?

The virus is spread from person to person when one person coughs or sneezes and another person inhales the infectious droplets or touches a surface that the infectious droplets are on and then touches their mouth, eyes, or nose. The good news is that we can only spread these infectious droplets about 6 feet when we cough or sneeze, and a much shorter distance when we cough into our elbow. The bad news is that one study showed that the virus can live in the air for up to 3 hours and on some surfaces for up to 3 days, although it is unclear how these studies translate to real world spread of the illness. Based on this information, it is clear that the best way to prevent getting COVID-19 is to wash your hands and stay 6 feet away from anyone who has a cough.

To clean your hands of any infectious particles, wash them with soap and water for 20 seconds. If soap and water are not available, then use an alcohol based hand sanitizer that contains at least 60% alcohol and allow it to sit on the hands for 20 seconds. Do not apply hand sanitizer and then immediately wipe it off, it needs time to kill any germs on your hands. It is especially important to clean your hands prior to meals or any activity when you will be putting your hands near your face. Check out this video to learn proper hand washing technique.

Avoiding large crowds or public places is the best way to ensure that you have a 6 foot buffer between you and strangers. If it is necessary to go to a public place, then be mindful of your surroundings and make sure that your gatherings are limited to no more than 10 people. There are special types of masks that can filter out small viral particles called N-95’s, however these should be reserved for use by healthcare professionals as there is currently a global shortage. There is evidence that regular masks, often referred to as surgical masks, can provide some protection when in public places. A recent article from the New York Times reported, “When researchers conducted systematic review of a variety of interventions used during the SARS outbreak in 2003, they found that washing hands more than 10 times daily was 55 percent effective in stopping virus transmission, while wearing a mask was actually more effective — at about 68 percent. Wearing gloves offered about the same amount of protection as frequent hand-washing, and combining all measures — hand-washing, masks, gloves and a protective gown — increased the intervention effectiveness to 91 percent.” If you have a cough and must be around other people, then it is necessary to wear a mask. During this outbreak, the only reason a person with cough should leave the house is to seek medical care. For instructions on how to properly use a mask click here.

For instructions on how to clean your home for Coronavirus, go here.

How do I know if my child has COVID-19

Unfortunately it is very difficult to tell from the symptoms alone if someone has COVID-19 as this virus is in the Coronavirus family which is a family of virus that cause the common cold. As a result COVID-19 starts as a common cold, but in some people it progresses to also cause viral pneumonia. The symptoms of viral pneumonia are similar to bacterial pneumonia which are fever and shortness of breath. The fever with COVID-19 often shows up several days into the illness which is different from the flu which typically has fever in the first 1-2 days of symptoms. Another distinguishing characteristic is that the shortness of breath typically does not show up until the second week of illness.

Below are the symptoms typically associated with COVID-19 as well as other conditions that may look like it. Due to the rapid spread of this illness, we advise that anyone with cough self quarantine.

• Allergies
  • Itchy eyes
  • Stuffy nose
  • Sneezing
• Cold
  • Runny nose
  • Cough
• Flu
  • Fever
  • Fatigue
  • Body Aches
  • Cough
  • Worsening Symptoms
• COVID-19
  • Fever
  • Cough
  • Shortness of Breath
  • Worsening symptoms
  • Exposure history

How do I know if my child has been exposed to COVID-19?

Close contact per the Dallas Health Department is defined as:

• Being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case
• Having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on). If such contact occurs while not wearing recommended personal protective equipment (PPE), criteria for PUI consideration are met.
• Affected areas are defined as geographic regions where sustained community transmission has been identified. For a list of countries with sustained community spread, visit this CDC website. For information regarding cities in the United States with high rates of spread, go here. 

Can I still bring my kids to the office?

Yes, if they don’t have fever or cough. In an effort to limit the spread of the virus we are not allowing any children or parents who have symptoms consistent with COVID-19 to enter the office. Instead we will evaluate these children by Virtual Visit. If we determine that a child needs an exam or a test, we will schedule a way to do that safely while minimizing exposure to anyone else in the office. These measures will allow us to continue seeing well visits in the office without fear that they may encounter someone who is sick.

Can my child be tested for COVID-19?

*UPDATE* Per the CDC guidelines we are not routinely testing for COVID-19. The current guidelines are that if a person has cough or fever, they need to stay home and self quarantine for 14 days. If the person is having labored breathing, dehydration, or significant worsening of symptoms, then they should present to a local Emergency Department or facility that is providing testing.  The following facilities are offering testing:

Medical City ER Stonebridge
8995 W University Dr., McKinney, TX 75071

Medical City ER Red Oak
317 East Ovilla Road, Red Oak, TX 75154

Medical City ER Flower Mound
4351 Long Prairie Rd, Flower Mound, TX 75028

Medical City ER Park Cities
5974 W Northwest Hwy, Dallas, TX 75225

If you are concerned that you or your child may have COVID-19, please schedule a Virtual Visit so that we can evaluate your child and help you come up with a plan. If you are referred to a facility for testing, please call before going so they can prepare for your arrival.

Yes, we now have the ability to test for COVID-19, but we do not have the proper protective equipment to protect our staff when doing the testing and we do not anticipate to have that equipment anytime soon. To get around this problem we are making drive by testing available in the parking lot of our Mesquite office, however the child must first be evaluated by virtual visit. Once the doctor has determined that testing is appropriate and the child is not sick enough to require immediate evaluation in the Emergency Department, an order for the test will be created. A member of our staff will then call the parent and schedule a time to arrive at the Mesquite clinic for testing. We will not accept walk in appointments or attempts to get swabbed for COVID-19 without first having a virtual visit. This test is covered by insurance and takes 48-72 hours to get the results. If you do not have insurance the cost of the test is $150.

If you would like testing for yourself or you are unable to bring your child to our Mesquite clinic for testing, Magnolia Diagnostics will deliver a kit to your home, collect the kit, and then contact you with the results. To request a testing kit email: coronavirus@magnoliadiagnostics.com with your name, address, phone number and the amount of household swabs you would like to be performed. Please be aware that the cost of this service is $300.

*Updated March 29, 2020*

The information regarding Coronavirus (COVID-19) is rapidly changing, but we will do our best to keep our families informed with the most up to date information. Initially there were hopes that the virus could be contained, but the rapid spread across multiple countries indicates that opportunity has been lost. The goal now is to “flatten the curve” of the illness. This means taking measures to limit the spread of the illness so that the healthcare system in the United States is not overwhelmed with critically sick people all at once. If the number of people who get sick can be spread out overtime then the healthcare system is capable of caring for those who get critically ill. The current mortality rate is believed to be 2-4%, but the risk of death or serious illness varies by age. The highest mortality rates are in those age 80 and older (~20%) while those age 50 and under with no pre-existing conditions have a mortality rate around 0.2%, which is similar to the Flu. Children age 10 and under seem to do even better as they have mild symptoms or don’t get it at all. While this disease appears to be much less severe for children than adults it is still a deadly virus and has been declared a national emergency.

Dallas County is currently under a Shelter In Place order and we are advising that all of our patients comply with this directive. This means that everyone is advised to stay home except for essential activities or work to provide essential business and government services or perform essential public infrastructure construction, including housing.

“Should we travel, visit with friends, or leave our house?“ are common questions that we are being asked by parents. The truth of the matter is there is no simple answer to these questions and the answer is changing by the day as more people get infected. When assessing how we need to modify our lives in light of this pandemic, it is necessary to recognize that there are two different issues we need to consider. The first is personal safety, the second is public safety.

If we were trying to determine what to do based solely on you and your family’s personal safety, the answer would be to live your life. Unless you have a chronic medical condition, smoke, or are elderly, there is a very low risk of a bad outcome from COVID-19. Even young infants have tolerated the illness very well and there have been no deaths reported in children ages 9 and under.

If we are making decisions based solely out of a concern for the public safety then closing schools, bars, and restaurants starts to make sense. While the risk of death or serious injury is low for those that are young and healthy, this is a very dangerous illness with significant risk of mortality for those who are immunocompromised, have chronic medical conditions, or are over the age of 60. The less we all have interactions with each other, the less opportunity there is for the virus to spread, and the less likely that more people get sick than we have the ability to care for. The current recommendations for social distancing and cancelling of large gatherings can be thought of as being similar to the herd immunity that the community receives from vaccines. When we vaccinate all who are able to be vaccinated, we protect those who are not able to be vaccinated. In the same way, when we all minimize our exposure to large groups of people and avoid unnecessary social gatherings we are doing our part to protect those who are most vulnerable to COVID-19 in our community.

We recommend you follow the CDC’s guidelines for prevention of infection which now include the recommendation to avoid gatherings of 50 people or more. COVID-19 is a collective problem that requires a collective solution and sacrifices from all of us. If you are concerned about possible exposure to COVID-19 and have questions about testing please call us or schedule a Virtual Visit. If you believe you may have been exposed do not come to the office as this puts other people at risk. If it is after hours or you have questions about yourself, visit MedicalCityVirtualCare.com and select the COVID-19 option to begin a free screen courtesy of Medical City Hospital.

What if you or your child has been exposed? The good news is that 80% of people who contract the virus have a mild course and will make a full recovery with minimal intervention.

• If your child has been exposed to COVID-19 and is well
  • Do not come to the office
  • Supportive care and self quarantine from other people is all that is required
  • If you would like your child tested, call our office for guidance.
  • We have Virtual Visits available to evaluate your child from the comfort of your own home and determine whether or not there is evidence of serious illness.
• If your child is ill and has been exposed to COVID-19
  • Do not come to the office
  • If your child requires immediate medical attention call 911
  • If you are not sure if your child is ill we are happy to assess your child via a Virtual Visit to help you determine if a visit to the Emergency Department is necessary.
  • If you believe your child needs to be seen at an Emergency Department, call prior to going so they can make arrangements to protect themselves and other patients from possible exposure.
• Do not come to the office without calling and notifying us first if you have done the following in the past 14 days:
  • Travel by Cruise Ship
  • Travel to a country with a Level 3 Health Notice or higher 
  • Travel to a city or region in the United States that has a high level of community spread 

What steps can you take to minimize your child’s risk of exposure:

• Wash your hands and your children’s hands often with soap and water for at least 20 seconds. Use an alcohol based hand sanitizer that contains at least 60% alcohol if soap and water are not available. This is especially important prior to meals or any activity when you will be putting your hands near your face. Check out this video to learn proper hand washing technique.
• There is evidence that regular masks, often referred to as surgical masks, can provide some protection when in public places. A recent article from the New York Times reported, “When researchers conducted systematic review of a variety of interventions used during the SARS outbreak in 2003, they found that washing hands more than 10 times daily was 55 percent effective in stopping virus transmission, while wearing a mask was actually more effective — at about 68 percent. Wearing gloves offered about the same amount of protection as frequent hand-washing, and combining all measures — hand-washing, masks, gloves and a protective gown — increased the intervention effectiveness to 91 percent.”
• If you or your child are sick with fever or cold symptoms, stay home and do not go to public places. If you must leave the house, then wear a mask to prevent the spread of infection.
• If your child is immunocompromised or has a chronic medical condition we advise avoidance of all public areas and interaction only with people known to be free of illness. 
• If you need to come to the office for a visit, bring the minimum number of people necessary for the visit.

For updates on the current outbreak visit the Center For Disease Control’s COVID-19 Summary Page. For updates about the virus in Texas, go here. To learn more about COVID-19 and how to protect your children, check out this website from the American Academy of Pediatrics. For answers to Frequently Asked Questions about COVID-19, check out this helpful FAQ provided by the CDC. 

For tips on how to talk to your children about Coronavirus, check out this pediatrician approved comic and video. As with all media about difficult topics, we recommend you watch these videos before you show them to your kids so you can confirm it is appropriate and be ready to answer any questions they may have. If you would prefer an article that walks you through how to talk to your child about Coronavirus as well as provide tips on how to listen to your child’s fears, check out this article.

For information about travel, check out this helpful Q&A from the Wall Street Journal as well as this guide from the CDC.

We will provide updates as they become available. If you have questions or concerns, please do not hesitate to call or message us on the portal. Please be aware that at this time our ability to test for COVID-19 is limited. We are however, still able to test for the flu as well as examine your child to determine if the source of a fever is a viral or bacterial infection. If your child has a fever don’t hesitate to schedule a visit, just be sure to let us know if your child has travelled internationally in the past 2 weeks or has had exposure to someone with, or suspected to have, COVID-19. We are working on making Virtual Visits available for those families for whom the child is believed to be highly contagious or for children who have conditions for which the diagnosis would not require an in-person physical exam. If you believe your child might benefit from a Virtual Visit instead of an in-person visit, then call and request to speak with a nurse.

Tuesday, December 24:

• Mesquite office Closed
• Dallas and Frisco offices open from 8 – 10 AM

Wednesday, December 25:

• all offices Closed

Saturday, December 28

• only Dallas clinic open from 8 -10 AM

Tuesday, December 31:

• Mesquite office Closed
• Dallas and Frisco offices open from 8 – 10 AM

Wednesday, January 1:

• all offices closed

The FDA has announced a voluntary recall of certain lots of ranitidine syrup.  The medication affected is a generic form of Zantac produced by Lannett Company, Inc.   By our records, your child may be currently on this product.  Out of an abundance of caution, we recommend that you stop giving your infant or child this medication until you can verify that your prescription is not part of this recall.  We recommend that you contact the pharmacy where you received the medication.  They can verify whether your prescription was affected by the recall and may be able to provide the same medication from a different manufacturer.  Please contact our office if you need to switch to an alternative medication.  More details about the recall are available at the FDA website.

Congratulations to Drs. Kravitz, Mannering, Mitchell, and Straughn for being selected by D Magazine as Best Doctors in Dallas for 2019.

Forest Lane Pediatrics is pleased to announce that we will be opening a new office at 1600 Republic Parkway in Mesquite, Texas April 8, 2019! The office will be open Monday – Friday and the doctors staffing the clinic are as follows:

Monday: Dr. Blair
Tuesday: Dr. Straughn
Wednesday: Dr. Blair
Thursday: Dr. Mitchell
Friday: Dr. Blair (am) / Drs. Clarke, Copeland, Strong, or Tang (pm)

Congratulations to Drs. Clarke, Straughn, and Strong from our Dallas office and Drs. McGonnell and Mannering from our Plano office for being voted Mom Approved Doctors by DFW Child Magazine! We think they are great and we are pleased that local moms agree!

The Perfect Workout is hosting a fitness seminar for children ages 6 and up in our B-308 office at Medical City Dallas on January 31 at 4:30 pm. Come join us for:

• 30 minutes of fun, strength building games and exercises
• Learn ways to help kids stay active and enjoy being healthy
• Learn about low glycemic snacks that are sweet and savory
• Receive easy-to-follow recipes for lunch boxes and after school snacks
• Q&A with certified personal trainers and nutritional coaches
• Free workout session vouchers for teenagers and adults

October is National Breast Cancer Awareness month and Forest Lane Pediatrics would like to invite you to join our fundraising efforts in support of the Susan G. Komen Breast Cancer Foundation. Click here to purchase a T-Shirt, and all proceeds go directly to Susan G. Komen Foundation!

Flu vaccine for children ages 6 months and older are now available. This year’s vaccine has been updated to cover the new Influenza A strain that appeared last year. It is recommended that all adults and all children six months and older receive the vaccine every year. As always, we will be giving quadrivalent (four strains) preservative-free vaccines. In addition, we will be offering the Flumist nasal vaccine to children over two years old. To read more about the influenza vaccines for this year, visit the CDC website.

We will be offering several Saturday morning vaccine clinics in both offices this winter. Our first clinic will be at our Medical City Dallas office on 9/15/18 and in Texas Health Plano office on 9/22/18. We will also be able to schedule weekday vaccine appointments on select days at both offices.  You can schedule an appointment for a Saturday vaccine clinic through the Patient Portal, or by contacting either office during regular office hours. The Dallas phone number is 972-284-7770 and Plano is 972-526-0700.

Congratulations to Drs. McGonnell, Mitchell, and Straughn on being chosen Mom Approved Doctors by DFW Child Magazine!

Congratulations to Drs. Kravitz, Mitchell, and Straughn for being selected by D Magazine as the best Pediatricians in Dallas!

Flu Season is here and we have flu vaccine available in both offices. To schedule your child’s flu shot, please click Make an Appointment or log in to your Patient Portal and choose “Injection/Vaccination” as the Appointment Reason. When asked to choose a provider, select “Flu Clinic Dallas” or “Flu Clinic Plano” then choose your appointment time.

Both the Dallas and Plano offices will be closed Monday, September 4, 2017 for Labor Day. Both offices will open and resume regular hours on Tuesday, September 5.

Due to Forest Lane Pediatrics joining Privia Medical Group you may receive a notification from your insurance provider that we will no longer be in-network with that provider come October. Please be assured that we are still in-network with all insurance providers we accepted previously except Blue Advantage. Our old contracts were terminated when we joined Privia which triggered the sending of the letter by our old contract provider. What the letter fails to mention is that we now have new contracts through Privia so there is no gap in our in-network status and ability to care for patients on the plans we accept.

As expected with insurance providers, there may be some technical hiccups during this transition. For example, if your insurance requires you to identify a Primary Care Physician (PCP) for your child, you will likely need to call them and reassign your doctor as the termination of our old contract likely disassociated your doctor’s name from your child’s insurance plan. Another problem some families may run into is that some of the insurance providers are slowly re-adding the names of our providers to their directory. This may mean that when you call to confirm that your doctor is in-network, they may say that she is not. We recognize this is frustrating and we are doing our best to resolve this issue. Please be assured, that even if the insurance provider does not have your doctor listed as being in-network, if your insurance is listed on our approved list, then we are in-network for your provider. If you have any questions about your insurance coverage, please message us through the portal or email our billing coordinator Maria@ForestLanePediatrics.com.

Congratulations to:

Michelle B. Kravitz, MD
Chris Straughn, MD

Congratulations to:

R. Adrian Clarke, MD
Diana V. Dickschat, MD
Michelle B. Kravitz, MD
Ann J. Liu, MD
Isha Mannering, MD
Chris M. McGonnell, MD
Damien H. Mitchell, MD
Chris J. Straughn, MD
Lily H. Strong, MD