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Parent Resources

Parent Resources

Sleep Habits

Dr. Katie D'Ardenne talks about best practices to ensure that you children are getting the good sleep that they need.


ADD & ADHD

Dr. Blake on identifying ADD or ADHD in your child.


Immunization Schedule

Bozeman Health Pediatrics Immunization Schedule

For a printable version of this immunization schedule please click on the image above.

Source content is from the CDC and the American Academy of Pediatrics.
https://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf - English
https://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs-sp.pdf - Spanish

Articles from our Pediatricians

Frostbite

Chris D'Ardenne MDWinter is upon us and it’s time to think about how to protect your family from cold temperatures while enjoying fun winter activities. There are many easy ways to prevent frostbite in your children by dressing them from head to toe in warm, dry winter gear. Prevention is always the best defense against frostbite.

A warm hat that covers the ears is essential to keep ears warm and trap body heat that would otherwise escape from the head. A gator is recommended for necks rather than a scarf because it won’t come unwound, and it can easily be pulled up over noses and cheeks to protect them from frostbite.

Mittens should be worn whenever possible, especially for small children and babies, as they keep hands warmer than gloves. Gloves may be necessary for work or play, but be sure the gloves fit properly. Too big, and they will easily fall off or allow snow in; too small, and they can affect blood circulation which is critical to keeping fingers warm. Winter boots should also fit properly for the same reasons.

Now that your child is geared up, it is important to keep them dry. Moisture from snow or sweat will become cold and eventually freeze. Even the very best clothing isn’t effective if it is wet. Have your child change out of wet clothing or have a play break while gear dries out. Layering goes a long way in helping against overheating, and therefore sweat.

If skin does get exposed or very cold, and looks white, waxy, or they have lost sensation-bring them inside and out of the cold. The next step would be to warm the area gently. Use warm water (body temperature) - not hot - and place the hands or feet in the warm water to thaw the skin gradually. A cloth with warm water can be used on cheeks, ears, and other body parts that can’t be soaked in water. If warm water is not available, use body heat - armpits work great! If it is the fingers-you can swing your arm like a windmill to move warm blood from your core to the hands. When the area is warming, your child might complain they are burning or tingling-this is normal and usually subsides in a few minutes.

“Frostnip” is difficult to tell apart from mild frostbite. If your child has full sensation of the area after rewarming, it is most likely frostnip. If it seems like they still don’t have sensation, this is likely frostbite. Regardless, this stage of frostbite does not generally require medical attention. If your child’s skin develops blisters or looks black, they should get medical attention. This is a more advanced symptom of frostbite and can lead to infection if not treated properly.

There are so many great winter activities to enjoy in our area! Bundle up - adults too - and make warm memories with family and friends this season.

Christopher D’Ardenne, M.D. is a pediatrician at Bozeman Health Pediatrics. For more information, call 406-414-4900.

Gun Safety

Gun Safety Tips for Families

Pepper Henyon MDThe most important thing parents can provide for their children is a stable, nurturing relationship in a safe and supportive environment. There are many things we do every day to keep our children safe. We use car seats and seat belts, baby proof our houses, and use helmets when riding bikes and downhill skiing. In Montana, a state with a strong heritage of firearm ownership, there are also ways to protect our children from an accidental shooting or death by suicide.

According to a 2017 report from the Montana Office of Public Instruction, nine percent of all high school students and nearly 12 percent of all middle school students in Montana have attempted suicide in the past year. Between 2005 and 2014, 80 Montana children ages 11 to 17 were victims of suicide. Fifty of the kids used a gun, which is the most lethal cause of death.

All prevention methods are critical in ensuring the safety of our children. The following are recommendations on how to store guns safely, and keep children and adolescents safe:

  • Store firearms unloaded and locked in a gun safe or lock box. The storage location should be inaccessible to children. Out of sight is out of mind.
  • Store and lock ammunition in a separate location from firearms.
  • Use a trigger or cable lock to render firearms inoperable.
  • Children are naturally curious about firearms and as a result may be tempted to handle firearms they find. Teach your children not to go looking for guns in the house.
  • Teach your children, if they find a gun in the house or anywhere else to STOP! Do not touch it, leave the area and immediately tell an adult.
  • Ask if firearms are stored safely in the homes of relatives and friends where your child visits.

Thanks to the Rural Institute for Veteran Education and Research, (RIVER), and their youth suicide prevention initiative, Bozeman Health Pediatrics received 1,000 gun cable locks to give to families with firearms in the home. These locks, pictured here, work to prevent the weapon from firing by blocking the barrel or making it so ammunition cannot be loaded into the gun. These devices are an excellent deterrent for small children to prevent an accidental discharge or for adolescents to deter a suicide attempt.

Cable locks are available at Bozeman Health Pediatrics in Bozeman and Belgrade. They are free and available to any family. Bozeman Health Pediatrics is also proud to share these free trigger locks with pediatric clinics across the state, so children across Montana are also protected.

Your family deserves to be healthy and safe no matter what, no matter where. Please take a moment to review firearm safety in your home. You can find out more by visiting www.bulletproofkidsutah.org and www.lokitup.org. Owning a gun is a right. Protecting children is a responsibility.

Pepper Henyon, M.D.
Pediatrician, Bozeman Health Pediatrics
Immediate Past President, Montana Chapter of the American Academy of Pediatrics

Leg Development

Normal Leg Alignment throughout Development

Is my baby bow-legged? Is my preschooler knock-kneed?

If you are one of the many parents who’ve asked yourself this question when your little bundle-of-joy started the transition from tiny infant to toddling human, the answer is: yes. It is very normal for a baby to be born with bowed legs which they will outgrow as a part of normal development. In fact, your child’s body will go through an incredible amount of change in the first five to seven years of life, and periods of bowed legs and knocked-knees can be normal expressions of those changes.

Babies are born bowlegged because of the time spent cramped in the womb. Infants enter the world in a curled position called “physiological flexion,” in which the spine, arms, and legs are flexed. Since the infant is unaccustomed to standing, bowing of the legs is very common and even expected.

In the exciting first year of development, your baby’s body will change a great deal as their body prepares for moving upright. Your child will begin moving freely and accomplishing new skills, including tummy play, rolling, sitting, crawling, and eventually standing. As your baby becomes more experienced with these new movements, muscles will get stronger and their posture will become more erect.

In the spectrum of normal development, bowing of the legs will typically diminish over the first 18 months as your child starts to pull themselves up to stand, cruise furniture, and walk. By 18 months of age, or six months after the onset of walking, this bowing will generally become less apparent, and the toddler’s legs will briefly straighten out completely. At this phase of development, the overall posture and alignment-not just of the legs-will become more similar to that of an adult.

Around three years of age you will see your child’s alignment change yet again, this time becoming more knock-kneed in appearance. Simply put: you will see that when your child’s knees are touching, the ankles are not. Your child’s feet may turn slightly outward. This alignment may continue through five years of age.

This stage is often a cause for concern or questioning by parents. However, like the early bowleggedness, the knock-kneed toes-out alignment should also resolve on its own with natural growth. By seven years of age, your child’s legs should straighten out again, the feet should face mostly forward. By this point, your child’s alignment and walking-pattern will, for the most part, look like that of an adult.

Nevertheless, while these are all normal stages of development, there are signs that can be monitored to determine when your child’s alignment or walking-pattern may benefit from talking with a health care provider. Prominent bowlegged alignment over two years of age, or prominent knock-kneed alignment, with toes pointing way in or way out over seven years of age, may be something you want to discuss with your child’s pediatrician.

If you have questions about your child’s leg alignment or walking pattern, a pediatric physical therapist can perform a full assessment to determine if your child’s alignment is normal or if treatment-which could including strengthening, or in some occasions, orthotic use-is needed to assure your little one remains on-track and thriving.

Sarah Riley DPT, C/NDT, is a pediatric physical therapist at Bozeman Health Pediatric Therapy.

Pacifiers

Saying “Bye-bye” to the Binky

Tips to help your little one give up the pacifier

Katie D'Ardenne MDAsk parents their opinion on pacifiers and you will hear a wide range of answers - from “lifesavers” to “my baby won’t take one.” Each family must decide for themselves how they want to handle the binky. Here is some helpful information about pacifiers, especially when the time comes to put them away.

Breastfeeding should be established before offering your baby a pacifier. There are many benefits of using a pacifier besides the obvious soothing mechanism which include a lower risk of SIDS when your baby uses one to fall asleep, and decreasing non-nutritive sucking (or sucking when they are not hungry). A pacifier should not be used to replace or delay meals. Remember safety always comes first. Choose a pacifier that is one piece, as the two-piece models can fall apart and pose a choking hazard, and never tie the pacifier to your baby or the crib!

Medical professionals vary in their opinion on the exact age to stop using a pacifier. We know that prolonged use can cause effects on tooth position and jaw alignment. Additionally, pacifier use can increase the risk of ear infections. As a pediatrician, I recommend putting away the pacifier by age two. By this time they are developmentally ready to stop on their own, and most children adjust easily to the change.

What do you do if your little one is not adjusting? The most important advice I can give is not to punish your child for using their pacifier. Instead, offer praise and reward your child when they are not using it. You may say something along the lines of “aren’t you a big girl (or boy) without your binky?” It is also helpful to give them something to keep their hands busy and offer distraction. This will deter them from sucking a thumb or finger, which is an even more difficult habit to break! If you find your child needs a slower transition, try to first eliminate the habit during the day and later take the pacifier away at night.

There are many inventive ways to ditch the pacifier and turn this stressful time into an event or celebration. For example, some parents have their child take the pacifier to the doctor and “turn it in” like a rite of passage. Others get creative and put the pacifiers out at night for the “Pacifier Fairy” to take away and leave a reward behind.

If you are like many parents I know who choose to use pacifiers, you will find they can be lifesavers in certain situations. Not every baby will take a pacifier, but if yours will, know that they are not harmful and your toddler will be able to break the habit when the time comes.

Katie D’Ardenne, M.D., is a pediatrician at Bozeman Health Pediatrics at Belgrade Clinic. For more information, call 406-414-4900.

Sports Physicals

Sports Physicals for a Health Start to the School Year

Angie Ostrowski MDAugust is here and it’s time to start thinking about heading back to school! Completing your sports physical is often part of the checklist to get ready for school and sports. The sports physical, also known as the pre-participation exam (PPE), is required in most states for middle school and high school athletes to participate in sports. It is an important assessment of a child/adolescent’s health and readiness for their sport.

As a pediatrician and primary care provider, it is the time to review the child’s medical history, important family history, and do a thorough and complete exam. The American Academy of Pediatrics also recommends the sports physical exam be part of the child’s complete health supervision check up with their primary care provider.

In reviewing your child’s medical history, the exam will focus on factors such as asthma, diabetes, migraines, heart disease, previous musculoskeletal injuries, hearing, and concussions. In addition, your provider will review growth, nutrition, sleep, screen time, puberty, and social aspects of health such as peer relationships, school performance, and high-risk behaviors. At Bozeman Health Pediatrics, we also screen all adolescents for depression, anxiety, and suicide risk at these visits. The visit is an opportunity to provide further guidance and resources for any of these concerns. In addition, it is a great time for your child to ask questions and have a discussion about their body and their health.

Family history is a significant part of the PPE. Main areas of concern are any family history of cardiac abnormalities that may raise your child’s risk of sudden cardiac death. It is important to know of any family history of arrhythmias, cardiac syndromes such as Long QT syndrome, or any family member who may have died from sudden cardiac death. Other family history of genetic concern is also important, such as Marfan’s Syndrome, which can also affect the heart.

The third piece to this assessment is a complete physical exam. I recommend a head-to-toe evaluation including a thorough cardiac evaluation, vision check, musculoskeletal exam, and puberty staging. The PPE is also a time to update immunizations and discuss adolescent vaccines such as HPV and meningococcus.

I encourage all families to get their back-to-school appointments on the books with their primary care provider and get ready for the school year! If you do not have a primary care provider for your child, this is a great time to meet and get established with a provider and get a complete health evaluation for your child.

Angie Ostrowski, M.D.
Bozeman Health Pediatrics

Winter Safety

Play It Safe this Winter

Melissa Shepherd FNPWinter is almost here so it’s an important time for parents to refresh on how to keep the kiddos warm, safe, and injury free. We are very lucky to live in an area that provides so many opportunities to be healthy and active outdoors.

All children, regardless of age or activity, should wear several snug, thin layers with insulated boots, mittens/gloves, hats, and a water-resistant outer layer. This gear is key to the prevention of frostbite or hypothermia. During outdoor activities, change wet clothing immediately, and provide breaks to come inside and warm up. Avoid being outdoors in extremely cold temperatures. Helmets are recommended for all the outdoor activities discussed in this article. Last, but not least, winter is cold, but it can still be sunny. Use sunscreen on exposed skin to protect it, just as you do in the summer.

Recommendations for safety vary by age and abilities, so let’s break those down.

Newborn-Preschool Group:

  • Bundle in one more layer than an adult would wear in the same temperature.
  • Car safety is important year-round, but in the winter, with multiple layers of bulky clothing, staying warm and staying safe is a bit confusing. In the car seat, wear snug thin layers and avoid all bulky coats and snowsuits between your child and the harness. In a crash, the bulky layers immediately flatten out from the force allowing too much space between the child and the harness. This could allow the child to slip through the harness and be thrown from the seat. You may put a blanket or the child’s coat on top of the harness as a blanket using caution not cover the child’s face. Do not put any layers between your child and the car seat.
  • Preschoolers are often just getting started in winter sports, however, is not recommended for them to skate, ski, snowboard, or sled until they are able to do it independently. They shouldn’t participate in these activities while being carried or sitting on your lap. A fall or crash could injure your little one.

Elementary School Age

Sports are fun and social! In addition to the sport specific tips below, make sure your child is always supervised by you or another adult you trust.

Ice Skating

  • Avoid thin ice! Your skating surface should be approved as safe by your local police department.
  • Stick with the crowd and skate in the same direction to avoid collisions.
  • Consider wearing elbow and knee pads and wrist protection.

Sledding

  • Sled feet first to decrease the risk of head injury.
  • Avoid sledding near motor vehicles or bodies of water.
  • Choose a spot with a slope of 30 degrees or less, and free of obstacles such as fences or trees.

Skiing/Snowboarding

  • Wear eye protection such as goggles and be sure all equipment fits properly.
  • Learn the sport with a qualified instructor or program designed for children.

Adolescents

The sport safety guidelines for skating, sledding, and skiing/snowboarding are the same as those listed for school-age children. However, older children may take an interest in snowmobiling. The American Academy of Pediatrics recommends that children under the age of 16 not operate snowmobiles, and children under the age of six never ride on snowmobiles. When operating or riding as a passenger on a snowmobile please remember:

  • Travel at safe speeds.
  • Wear helmets approved for motorized vehicles.
  • Wear goggles.
  • Do not pull sleds or skiers.
  • Never snowmobile alone or at night.
  • Stay on marked trails and avoid roads, water, and railroads.

These easy tips will help ensure you and your family play it safe and warm this winter!

Melissa Shepherd, FNP

Bozeman Health Pediatrics

Information based on guidelines from the American Academy of Pediatrics, healthychildren.org.