Cardiovascular disease is the most common cause of death in men and women and it begins in childhood with the development of atherosclerosis (clogged arteries). The development and progression of atherosclerosis relates to the number and intensity in childhood. By determining which children are at the greatest risk we can begin interventions such as lifestyle changes, more frequent monitoring and, occasionally, medication to lessen the chance of developing cardiovascular disease in adulthood.

Our office test is simple. The patient does not need to fast. Blood is taken from a fingerstick sample. Those with high results will be referred for a fasting lipid panel at an outpatient blood-drawing facility. Based on the fasting lipid results and other risk factors such as family history, blood pressure, smoking and weight, recommendations can be made to reduce the risk of developing cardiovascular disease.

The Children’s Medical Group of Greenwich

1. Strongly reinforce the supine sleeping position. Discourage both prone and side sleep positions for the first year of life. Preterm infants should be placed on their backs when medically stable or by 32 weeks of gestational age.

2. Infants should only sleep in safety approved bassinets and cribs with firm mattresses and bedding. No pillows, blankets or comforters should be in cribs, neither as coverings nor under heads. Wedges and bumper guards are discouraged. The room where infants sleep should be kept between 68°-70°F.

3. Discourage letting infants sleep in carseats or other sleeping devices.

4. Bed-sharing, or co-sleeping, is discouraged, especially with infants under 3 months and in beds with soft mattresses, pillows and blankets.

5. Offering pacifiers for naps and nighttime sleep may decrease SIDS. Experts suggest starting by at least one month of age. Breastfeeding success will not be affected.

6. To decrease the risk of developing posturally related flattening of the skull, referred to as positional or deformational plagiocephaly, additional recommendations are:

a. Daily turning of infant heads from left to right starting on the first day of life.

b. Supervised “tummy time” three times per day for 5-10 minutes starting on day one. This activity will strengthen neck muscles and decrease pressure on the back of the skull.

To read the complete recommendation:
http://aappolicy.aappublications.org

Who should get the vaccine?
The American Academy of Pediatrics (AAP) recommends flu shots for all children greater than 6 months old. We, at CMG, especially recommend flu vaccines for children with siblings under 6 months old in the household, infants older than 6 months to 4 years old, children with underlying medical issues including:
• Asthma or other chronic lung disease
• Significant heart disease
• Diabetes
• Immunosuppressive disorders or therapy
• Long-term aspirin therapy
• Chronic kidney disease
The vaccine is also required by day-cares and pre-schools in Connecticut.
2 doses are required for 1st time vaccinees between 6 months and 8 years, spread 4 weeks apart.

Who should NOT get the vaccine?
Children with egg allergy are NOT to get the flu vaccine because the vaccine is made using eggs. Children who are moderately or severely ill should wait to get their flu vaccine and those with a history of Guillain-Barre Syndrome should discuss whether or not to get the vaccine with your doctor.
Those children who have close contacts with people with compromised immune systems should NOT get the intranasal live vaccine.

What are the options?
Children who are under 2 years old or have underlying heart, kidney, lung, liver, anemia, or metabolic disease such as diabetes will receive the inactive flu vaccine.
There are two options this year for children over 2 years old with NO underlying medical condition and/or egg allergy.
• Option #1 is the traditional injection.
• Option #2 is the live intranasal flu mist.
Children should not have a significant degree of nasal congestion when the mist is administered. Both vaccines are thimerosal free and contain the seasonal and H1N1 flu strains.

What are the risks?
• Mild problems:
o Soreness/redness/swelling where shot was given
o Fever/aches/hoarseness/cough
o If symptoms occur, they will occur shortly after the shot and last 1-2 days.
• Severe problems:
o Allergic reaction – including difficulty breathing

How long does it take to work?
It takes about 2 weeks after the vaccine is administered to become protected. The flu vaccine does not protect against non-flu viruses.

How do you schedule an appointment?
Please call our office at 203-661-2440 for an appointment. Our first clinics have been scheduled for Sept 14th and Sept. 28th. More dates will be added.

The AAP now recommends rear-facing car seats for infants and children up to 2 years of age and booster seats for children until they reach 4′9″ tall and are between 8 and 12 years of age. In addition, forward-facing car seats for most children through age 4, belted booster seats for children through age 8, and lap and shoulder seat belts for children who have outgrown booster seats are recommended. All children younger than 13 should ride in the rear seats of the car.

Studies of U.S. crash data show that one-year-olds are five times less likely to be injured in a crash if they are in rear-facing car seats than forward-facing. Keeping toddlers in rear-facing seats better supports their spines, heads and necks if in a crash.

With the hope to reduce child injuries, we at Children’s Medical Group support the new AAP guidelines and urge your compliance.

Children’s Medical Group is searching for an outstanding pediatrician to replace Dr. Sanchez.

Dr. Sanchez will be seeing patients until May 27, 2011. Following that, Drs. Hedrick, Schiz, Cody and Mini will be happy to see Dr. Sanchez’s patients for preventative care and sick visits.

Pentacel has been shown to be as effective as when given in individual doses. Additionally, Pentacel does not contain any ingredients not found in the individual doses. We will now offer this combination vaccine to significantly decrease the number of shots administered at the 2, 4, 6, and 15 month infant/toddler well child visits.

MENACTRA
Currently, Menactra is recommended for 11/12 year olds to protect against severe bacterial meningitis and septic shock caused by the bacterium meningococcus and is 75 to 80% effective.

In 2011 the American Academy of Pediatrics, in conjunction with the CDC and Advisory Committee on Immunization Practices has recommended a second, booster, dose between 16 and 18 years of age to provide continual protection especially during the college years.

We now recommend this additional booster vaccine at the adolescent/young adult preventative visits in accordance with the above guidelines.

When: March 8th
Time: 7PM
Location: 42 Sherwood Place, Greenwich, CT

Presented by Allie Holzer, Registered Dietician
This lecture is open to the public.
Reservations requested: 203-661-2510 or cmgg@optonline.net

Steven Schiz, M.D.
Children’s Medical Group of Greenwich Pediatrician
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Tuesday, March 8, 7:00 PM
INFANT AND CHILD NUTRITION AND THE OBESITY EPIDEMIC
Learn how to feed your child from birth, when and how to properly introduce solids.
Childhood nutritional needs and obstacles and how to work through them will be covered.

Allie Holzer, RD, CSP, CDE, CDN
Registered Dietician and Certified Diabetes Educator
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Tuesday, April 12, 7:00 PM
(ALMOST) ANYTHING YOU WANTED TO KNOW ABOUT BREASTFEEDING BUT
WERE AFRAID TO ASK
An informal discussion with our lactation consultant

Denise Bulpitt, R.N.
Board Certified Lactation Consultant
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Children’s Medical Group of Greenwich
42 Sherwood Place
Greenwich CT
Reservations requested 203-661-2510 or cmgg@optonline.net
Open to the public as a community service; join us for 1, 2 or all 3 evenings.