TABLE OF CONTENTS

I.Welcome to Emerald Pediatrics

  1. Introduction
  2. Hours of Operation
  3. Calling the Office During Office Hours
  4. Calling the Office After Office Hours
  5. Policies
  6. Schedule of Appointments
  7. Screening Tests
  8. Vaccines

II.Welcome to Parenthood

  1. Introduction
  2. General Care of Your Newborn
  3. Infant Medicine Chest
  4. Development – The 2-4 Month Infant
  5. Development – The 4-6 Month Infant
  6. Development – The 6-9 Month Infant
  7. Development – The 9-12 Month Infant
  8. Development – The 12-15 Month Infant
  9. Development – The 15-18 Month Infant
  10. Development – The 18 Month-2 Year Child
  11. Development – The 2-3 Year Child
  12. Development – The 3-4 Year Child
  13. Development – The 4-5 Year Child

III.Common Illnesses

  1. Introduction
  2. Burns
  3. Chickenpox
  4. Colds
  5. Constipation
  6. Cough
  7. Diaper Rash
  8. Diarrhea
  9. Earache
  10. Fever
  11. Head Injury
  12. Nosebleeds
  13. Vomiting

IV.Acetaminophen/Ibuprofen Dosing Chart

WELCOME TO

EMERALD PEDIATRICS

INTRODUCTION

The Pediatricians and staff at Emerald Pediatrics feel it is our privilege to care for your child. We wish to provide superior pediatric care in a friendly, accessible environment. We respect the individuality of each family and are committed to assisting you in providing the best environment for your child’s medical, developmental and emotional well-being.

The Pediatricians have created the “Emerald Book” as a resource for families.Included in the book is information regarding your child’s medical care and development, as well as general office hours/policies and billing/insurance information.

HOURS OF OPERATION

Monday-Wednesday8:00am-6:00pm

Thursday-Friday8:00am-5:00pm

Sunday/HolidayNo routine hours

Walk-In Hours (ill only):

Monday-Saturday: 8:00am-9:00am

Walk-in hours are available all year for ACUTE illnesses only (illnesses arising suddenly) for established patients only. We will not see patients for chronic illnesses/problems during this time. Patients are seen on a first come, first serve basis. New patients (patients who haven’t yet been seen in our office) require a scheduled appointment with a physician for their first appointment.

Holidays observedNew Year’s Day, Memorial Day, July 4th, Labor Day,

Thanksgiving Day, Christmas Day

Limited morning hours Good Friday, the Wednesday before and the Friday after

Thanksgiving, Christmas Eve and New Year’s Eve

CALLING THE OFFICE DURING OFFICE HOURS

We strive to provide our parents with efficient service when calling our office. For this reason, when you call, there will be several options from which to choose to route your call appropriately. Calls are received from 8:00am until 4:30pm Monday-Friday. If you have a very urgent matter and need to speak to a doctor or nurse immediately, there is an emergency option. For routine matters, please consult this book or our website: prior to calling the office as these references provide useful information.

In order for the physician to have adequate time to address your concerns, it is crucial to inform the receptionist or nurse the exact nature of your visit.We gladly provide more time if we know ahead of time so that your doctor does not run behind and you do not feel rushed.

Well Visits/Physicals: Well visits can be made with any physician in the practice. The physicians share all of the patients. Therefore, you can choose which doctor your child sees for each well visit. In general, the further in advance you call, the more likely you are to get an appointment with the doctor and time of your choice. We have some evening appointments available for well exams during the weekdays.

Ill Appointments: If your child is ill and you are certain an appointment is needed, let the receptionist know and an appointment will be made. Please call as early as you can in the day so that we can see all ill children in a timely fashion. We want you to be reassured that all of our doctors practice similarly so that if your child’s doctor is unavailable that day, you can feel comfortable seeing one of the other doctors.

Medical Advice: If you are unsure if an appointment is warranted or would just like to

talk to the nurse about a medical issue, you have the option of leaving a message for the nurse. You will receive a call back from a qualified registered nurse (RN) in a timely fashion, generally within a few hours. Complicated medical, developmental or behavioral issues are best handled by the doctor and an appointment will be recommended.

Prescription Refills: Refills of prescription medications should typically not be needed as the doctor should give you enough refills to last until your follow up appointment. Please discuss the appropriate interval of appointments with your doctor as this varies. When you have no refills left, you should make another appointment. This appointment is called a “medical evaluation” or a “med eval” and can be made by the receptionist. If your child may need a change in a routine medication, you will need to speak to the nurse for advice.

If you do need a prescription called in to the pharmacy, you will be routed to our “prescription mailbox”. Follow the prompts and leave the appropriate information. Please allow 48 hours.

Referrals: A referral is processed by our nurses/office staff at your request because your insurance company requires it. It is then sent to your insurance company or specialist prior to the date of your appointment. This can be a lengthy process so one is not done if it is not needed. The only way to find out if one is needed is to call your insurance company and inquire. If a referral has been pre-authorized by your doctor, please leave a message for the nurse. Please allow at least 72 hours.

School/Sports/Immunization Forms: If any form is needed to verify shots or an exam, fill out your portion and bring in/fax/send the form for us to fill out the rest. If these forms are brought at the time of your child’s physical, we will do our best to complete our part right then. For middle/high school forms, the teen must fill out their portion of the form prior to the examination. Most schools or daycares accept these as “current” for one year. Please allow 72 hours.

Billing/Insurance/Managerial Questions are routed directly to our billing department and general practice comments/concerns are routed directly to our office manager.

Questions for the Doctor: If you have a specific question or concern you feel is only appropriate for the doctor, leave your information with the nurse and the doctor will contact you.

CALLING THE OFFICE AFTER HOURS/WEEKENDS

The philosophy of the Pediatricians at Emerald Pediatrics is to always be available to you 24 hours a day, 7 days a week, 365 days a year for urgent medical problems. We define an “urgent medical problem” as a medical problem that requires immediate advice or intervention. We expect you to contact us if you cannot find the answer to your question on our website or in this book. It is NEVER an imposition to answer calls of this nature.

Conversely, it is not appropriate to call after hours for routine, non-urgent medical questions, to make an appointment, or for over the counter medication dosing. Our doctors and staff have worked hard to provide accurate, accessible information on our website, in the Emerald Book and office handouts as well as provide phone service availability to families during the day. We expect that parents utilize the resources provided to answer routine concerns/questions or call the office during regular hours.

If your child has an urgent medical problem after hours, follow the prompts and leave a message for the doctor on call. If you do not receive a call back within an hour or two, please call again and remember to leave ONE unblocked phone # (a number that can accept blocked calls) where you can be reached, your child’s name and date of birth and a short description of your child’s symptoms. This option is NOT available from 9pm-8am, as the on call doctor is only available for emergencies during those hours (see “doctor’s line” option below).

If your child’s medical condition is so serious that you need to speak with a physician immediately, you may leave a message on the “doctor’s line”. This is a line that is typically reserved for hospitals or other doctors calling about our patients, but will be available to parents for serious medical circumstances, such as a child with breathing problems, seizures, severe accidents or other conditions of that magnitude. Follow the appropriate prompts and the doctor will call you back immediately.

**If for some reason, you do not receive a call back after two calls, assume that we are experiencing technical difficulties call 911or take your child to Nationwide Children’s Hospital Emergency Room (Downtown).

POLICIES

Unscheduled Appointments: We do not see children without an appointment unless it is an emergency. The doctors request that parents please refrain from asking the doctor questions about another child or asking the doctor to check another child that was not previously scheduled unless it is an emergency. This policy exists so the doctors do not get behind. If a 5-minute question was asked only 3 times, 15 minutes are added to other families’ wait time. Our staff is committed to respecting your busy schedule and running on time. It is appreciated if you please respect the time of our staff and our other families. Often we can work in an unscheduled child at a later time or with another doctor if needed. Ask the receptionist upon arrival to discuss your options.

Missed Appointments: Patients are charged $25.00 if an appointment is missed. We consider an appointment missed if you have not called the office to cancel the appointment before the appointment time.We waive the first occurrence.

Arriving Late for an Appointment: If you arrive more than 10 minutes late, without calling ahead, your appointment is missed. We will make every effort to reschedule you that day. If that is not possible, you will be asked to reschedule on another day.

Fees: Extra fees are charged on weekends, holidays and after published weekday hours.

Emergency Room/Urgent Care Use: Unless you have an extreme emergency, call the office or on call doctor before you take your child to Nationwide Children’s Hospital ER or Urgent Care. We would like to save you the long wait and exposure to illness if possible. Often we can advise you adequately over the phone until we can see your child in the office. In addition, your insurance company may not pay for the visit if you have not contacted us first. If an ER or Urgent Care visit is needed, we only recommend Nationwide Children’s Hospital.

Adult Children Age 18 & Older: At the age of 18 patients become their own responsibility. They will be required to complete their own financial responsibility and health history forms. We can only release information to parents with the written permission of the patient.

Resident and Medical Student Education: The Ohio State University College of Medicine and Nationwide Children’s Hospital Residency Program are located in Columbus and are among the nation’s top medical education programs. We feel very fortunate to have these facilities so close. The doctors at Emerald Pediatrics are committed to the betterment of these programs. One way we contribute is through volunteering to educate medical students and pediatric residents about outpatient pediatric care. Please welcome our young doctors and doctors-to-be. We advise them that listening to parents/patients is one of the most important parts of practicing medicine.

SCHEDULE OF APPOINTMENTS

The following is a general schedule of our recommended well-child appointments.The recommended vaccine/screening schedule changes frequently so you will be given an up-to-date vaccine/screening schedule at the office.

The schedule of well child appointments is as follows:

Newborn Exam (2-7 Days after hospital discharge)

1 Month

2 Months

4 Months

6 Months

9 Months

12 Months

15 Months

18 Months

2 Years

Annually thereafter

We see newborns up through age 21.

SCREENING TESTS

  • Hgb: Hemoglobin-a blood test by finger stick to check for anemia/low iron.
  • UA: Urinalysis-a test of the urine to check for diabetes, infection or signs of early kidney disease.
  • PPD: A screen for the disease tuberculosis. The patient must return to the office in 48-72 hours after receiving the PPD for the nurse or doctor to check the site.
  • Cholesterol Screen: Screens for hereditary high cholesterol which can be detected as young as 6 years of age.
  • Vision: Distance vision is checked by asking your child to identify letters or pictures through a vision screener.
  • Hearing: Hearing is checked using headphones and tone testing. Your child will be asked to push a button when the tone is heard.

VACCINES - We follow the AmericanAcademy of Pediatrics Vaccination Schedule.

Vaccinating your child is important. The pediatricians at Emerald Pediatrics keep up to date on all vaccine information and believe that the great benefits of vaccines far outweigh the small risks. Therefore, the doctors feel very strongly that your child should be vaccinated with all recommended vaccines. There is a lot of information (both good and bad) on the Internet and in the news about vaccines that can be confusing. Please talk with the doctor about any concerns or questions you may have about this very important topic.

The following is a brief description of the vaccines we currently recommend for all children. You will be given more detailed information in written form about each vaccine at one of your child’s first visits, as well on the day the vaccines are given.

  • DTaP: Diphtheria, Tetanus, Acellular Pertussis
  • Hepatitis A: Self-limited viral liver infection
  • Hepatitis B: Severe liver infection
  • Hib: Haemophilis Influenza type b (bacterial meningitis, blood infection, epiglottitis)
  • HPV: Human Papilloma Virus – given to both sexes at age 11 years
  • Influenza: Available in late summer/early fall
  • IPV: Inactivated Polio Vaccine (not live)
  • Meningococcal: Neisseria Meningitis bacteria; fast acting, life-threatening infection. This is most important for those children that do not have a functioning spleen and those living in crowded conditions (i.e., college dorms)
  • MMR: Measles, Mumps, Rubella
  • Prevnar: S. Pneumococcal Bacteria (meningitis, ear/sinus/blood infection, pneumonia)
  • Rotateq: Rotavirus
  • Tdap: Tetanus, Diptheria, Acellular Pertussis
  • Varivax: Chickenpox

WELCOME TO PARENTHOOD

INTRODUCTION

The following chapters of the Emerald Book have been prepared to assist you in caring for your newborn and young child. For each age, the pediatricians have summarized the most common nutritional, developmental and safety information questions asked by parents at well child visits. The newborn section, for babies from birth to 2 months, is the most detailed section because that is the age for which parents, understandably, tend to have the most questions. Newborns, and the children they become, seem overwhelming at first, but really just need your love and careful attention. Well-intended advice is often offered to new parents from family members, friends and the media. This information may be inaccurate, or may not be the best care for your baby. We hope you will use this booklet to guide your efforts to provide the best care for your child, and ask us for additional parenting information when the need arises. Our office has more detailed information in handouts, including sample menus for various ages. We also have a website which is regularly updated with medical news and articles you may find helpful. We wish our families the best experience possible with their new adventure in parenting.

GENERAL CARE OF YOUR NEWBORN

Hospital Stay: The earliest experience you will gain with your newborn is in the birth hospital. We encourage you to stay as long as you are allowed, especially with a first baby, to maximize rest and recuperation. Keeping your newborn close by (i.e. in your room for the most part) is helpful in gaining knowledge about your new baby’s care and needs from experienced hospital staff.

Once home, continue your rest and recuperation. Use pain medications offered by your obstetrician and continue your prenatal vitamins if breastfeeding. Your newborn will not need bathing, temperature measurements or any medical care prior to your first office visit with us, unless her condition changes. We would like to see your newborn in the office shortly after discharge. This is usually 2-7 days after discharge from the hospital. If you have any concerns or questions prior to this first appointment, do hot hesitate to call. Consider that many answers to your questions may be found in the following chapter of this book.

Call our office immediately if you notice any of the following:

  • Fever over 100.4 F rectal measurement in the first 6 weeks
  • Absence of stool or wet diapers for 24 hours
  • Increase jaundice (yellow skin)
  • Excessive (unrelenting) irritability, crying
  • Infant too sleepy to awaken for feedings at all

Infant Feeding: Hunger is the primary infant drive in the first weeks of life. We recommend on demand feeding (NOT on a schedule), until the first few months are behind her. Newborn infants need to eat often, up to every hour. Infants also require nighttime feeding until closer to 4 months. Feed your baby whenever she cries in the first few weeks, unless she was fed in the hour. Limit pacifier use, as suckling may indicate her hunger. Be aware many newborns suckle for enjoyment, and may continue this behavior after being fully fed. Limit a single feeding in time accordingly, usually 10-15 minutes per side if breastfeeding. Newborns lose up to 10% of their weight following birth, and will regain this in the following week. Feeding your newborn can be frustrating at first, but will quickly become a pleasurable time for you and your baby.