• There are 20 primary teeth that erupt between the ages of 6 months and 3 years of age. The first tooth to appear is one of the bottom center teeth, typically around 6 months old. These primary teeth are not permanent, and children usually begin losing these teeth around the age of 4 or 5 years. If your child has not received their first primary tooth by the age of 18 months, consult with a Pediatrix pediatrician in Phoenix.

• There are 32 permanent teeth that erupt between the ages of 6 and 21 years old. The first of these teeth to grow in are the center teeth, on the top or bottom, between about 6 to 8 years of age. The last to erupt will be the secondary molars, more commonly known as wisdom teeth. Speak with your pediatrician in Phoenix to learn more about the effects that wisdom teeth may have on your child’s mouth.

• Set up a schedule to ensure that your children are brushing their teeth twice a day and flossing once a day. If your child is too young to brush their own teeth, use a clean, wet washcloth or soft child sized toothbrush with water only to clean the teeth. Children aged 2 to 6 should attempt to brush their own teeth using a pea sized amount of fluoride toothpaste. Make sure they understand that the toothpaste must be spit out and not swallowed. Most children are able to brush their own teeth with no assistance around the age of 6. Flossing may take additional time, and is more likely achieved around the age of 10 years old.

• Schedule an appointment to see your dentist at least twice a year for a dental exam and cleaning. Our Pediatrix pediatricians in Phoenix recommend scheduling your first dental visit after your child has reached 12 months of age.

• If your child has trauma in the mouth or has had a tooth knocked out, the tooth should be held in their inner cheek area with pressure from the tongue. If this is not possible, place the tooth in milk or a saline based solution. After any traumatic incidents, seek immediate medical evaluation from a dentist or pediatrician in Phoenix.

• If your child participates in sports, Phoenix pediatricians would encourage them to wear a mouth guard. This piece of gear significantly minimizes mouth related injuries during sporting events.

Teaching your child the basics of dental hygiene will give them the tools to achieve good dental health for the rest of their life. Establishing daily dental routines and visiting with a dentist and pediatrician in Phoenix will help your child to maintain a healthy, happy smile. Please feel free to discuss any questions or concerns with a physician at Pediatrix, your state-of-the-art pediatric clinic in Phoenix. Call Pediatrix at (602) 866-0550 or contact our Phoenix pediatricians online. Our pediatric clinic in Phoenix is dedicated to the health and happiness of your children, and is always more than willing to address any questions that you may have. We look forward to your visit!

Sincerely,

Michael Magalnick, DO, FAAP

For Parents:

•  Spend time with your children as a family, and ask them how they have been feeling.  If a concern arises about signs of depression, seek medical attention/advice.

• If your child is involved with a stressful situation give them ideas for how to deal with the situation.  Examples could be getting involved in a stress relieving activity like yoga, working out, playing games, reading a book, or focusing on an activity that your child really enjoys.

For Kids:

• Get involved in an activity where you help other people.  Being involved with an activity where you give your time toward helping others improves your well being, and puts some of the problems you are focusing on into perspective.

• Form good, solid relationships- not only with your parents and siblings, but with friends at school.  Being around a core group of people that share your values and act as positive role models for each other is important for your overall well being.

• Remember, everyone gets angry sometimes.  It is important to talk through your feelings and come up with appropriate resolutions to the conflict that has occurred.  Also, it is important to try to understand the other persons point of view.

Always remember that you can talk about things that are bothering you with your Pediatrician at Pediatrix.Sincerely,

Michael Magalnick, DO, FAAP

Mental and physical development depends directly on the amount and quality of sleep a child receives on a regular basis. When a child doesn’t receive enough sleep, our pediatricians at Pediatrix notice higher incidences of delayed physical development, higher risk of developing anxiety and depression, and an increase in behavioral problems such as ADHD.

The pediatricians at Pediatrix in Phoenix offer the following guide to help you determine how much sleep is essential for your child to properly grow and develop, according to your child’s age:

1 – 4 Weeks: 15 – 18 hours recommended. Newborns sleep a majority of the day, but in short periods usually lasting between two and four hours. At this stage, newborns have not yet developed an internal biological clock; therefore, they sleep without differentiating between night and day.

1 – 4 Months: 14 – 15 hours recommended. Babies at this age slowly begin to develop more regularity when it comes to their sleep patterns. They also sleep for longer periods at a time, usually between four and six hours.

4 – 12 Months: 14 – 15 hours recommended. At this age, 15 hours of sleep is the absolute ideal. Three naps are about average throughout the course of the day: the midmorning nap around 9 AM, the early afternoon nap between 12 and 2 PM and the late afternoon nap between 3 and 5 PM. At around 6 months of age, the number of naps can be reduced to two and babies gain the ability to sleep throughout the entire night.

1 – 3 Years: 12 – 14 hours recommended. Between one and three years of age, toddlers begin to nap only once a day, typically sometime in the early or late afternoon. They start to establish a more regular sleep routine, usually going to bed between 7 and 9 PM and waking between 6 and 8 AM.

3 – 6 Years: 10 -12 hours recommended. Children at this stage tend to keep the same sleep routine, but there is a slow reduction of napping. At three years old, the majority of children are still napping. By five years of age, very few children require a nap each day to function.

7 – 12 Years: 10 – 11 hours recommended. Children start to become very involved with school, homework, activities and friends, meaning there is less time available in the day for sleeping.  On average, children of this age only receive about nine hours of sleep per night, slightly below the recommended amount.

12 – 18 Years: 8 – 9 hours recommended. As teenagers, the combination of homework, activities and managing an active social life can become overwhelming.  Teenagers have difficulty finding the time for adequate sleep, which is essential to proper function of the body.

As a parent, it is important that you establish sound sleep patterns for your children. Children should be provided with an environment for quality sleep to ensure that they are getting the recommended amount of sleep for their age. By doing this, you will help your children to mentally and physically develop at a normal, healthy rate. Speak with family practice specialists in Phoenix for some helpful sleep tips.

If you are interested in learning more about child development, make an appointment with one of Pediatrix’s friendly, knowledgeable pediatricians in Phoenix. Our experienced pediatricians are well versed in child wellness, performing necessary examinations and checkups to sustain a child’s health. Visit our family practice specialists in Phoenix today. Call Pediatrix at (602) 866-0550 or contact us online with any comments, questions or concerns. Our Phoenix pediatric specialists would be more than happy to help.

Sincerely,

Subir K. Mitra, MD FAAP

Because you never know when an accident is going to occur, you should strap your child in every time you travel; no exceptions. This will not only keep them safe, but will also teach them the good habit of wearing a seatbelt anytime they ride in a vehicle.

Our children’s doctors in Phoenix would like to share the following guideline to choosing a seat that is best for your child’s age, height and weight:

Newborn – 12 Months: For babies in this age group, rear facing car seats should always be used. There are 3 types of rear facing seats: infant only, convertible and 3-in-1.

Ages 1 to 3: Keeping your child in the rear facing position is the best way to keep them safe. Convertible and 3-in-1 car seats have higher height and weight limits in the rear-facing position, so you can use the seat for a longer time. These types of car seats are perfect for toddlers in this age group. You should keep your child in a rear facing seat until they reach the height and weight limit listed by the manufacturer.

Ages 4 – 7: At this stage, your child can now begin using a forward facing car seat with a harness up until they reach the height and weight limit. After that, your child can be moved to a belt positioning booster seat.

Age 8 – 12: Children should remain in a booster seat until they are able to fit safely in a normal car seat belt. The lap belt should lie across the upper thighs while the shoulder belt should lie across the shoulder and chest. If the belt is positioned at your child’s stomach, neck or face, a booster seat is still the best seating option.

As a parent, you should know when to switch out one car seat for another to make sure that your child is safe when traveling by car. Also, read all of the car seat manufacturer’s installation instructions and your vehicle’s owner manual. This will help you to properly install the car seat. In addition to choosing and installing the proper seating, all children 12 years old and under should also sit in the back seat.

Pediatrix, your local children’s doctor in Phoenix, understands the pressures of parenting and knows that you may have concerns about child car safety. Our children’s doctors in Phoenix are always available to answer any questions you may have about the health and safety of your child. Please call (602) 866-0550 or contact us online to learn more about our expert children’s doctors in Phoenix.

Sincerely,

Subir K. Mitra, MD FAAP

Teething is a process that takes time and can be painful for your child. Before a tooth pokes through, the tissue around the tooth can become swollen and sore due to the pressure against the skin of the gum. The pain typically occurs for 3 to 5 days before the tooth cuts through, before disappearing altogether.

Infants who are teething can show the following behavior in reaction to the pain of a new tooth:

• Bite their fingers or toys
• Refuse food
• Become irritable
• Drool, causing rashes on the chin, face and chest areas
• Experience difficulty falling asleep

It’s hard for any parent to watch their child suffering each time a new tooth is about to grow in. To help ease the pain and fussiness, the following is a list of suggestions:

• Mild pain relievers, such as acetaminophen or ibuprofen (use ibuprofen only if the child is older than 6 months).
• Using your finger or wet gauze, massage your child’s gum for 1 to 2 minutes. This is soothing and can help break down tissues in the gums.
• Cold helps to decrease pain and inflammation. Giving your child a frozen wet washcloth to chew will help, as it decreases swelling.
• Distractions such as rocking, swinging, or playing will help to take your child’s mind off of the pain.
• Orajel is NOT recommended, as it can have unwanted side effects.

Following these tips will help to ease your child’s pain as they teeth. It’s also recommended that you take your child for their first dentist visit within the first six months of their first tooth. A baby develops quickly during their early months of life, so it’s also important that parents keep up with infant care in Glendale and the Valley area. At Pediatrix, we care for your children as if they’re our own. We provide high quality health care specialized for the different stages of your child’s development and are happy to provide parents with answers to any health related questions. Please call (602) 866-0550 or contact us online to learn more about quality and caring infant care in Glendale and the greater Phoenix area.

Sincerely,

Subir K. Mitra, MD, FAAP

Flu is spread among people in close quarters, typically within six feet of one another. This makes individuals such as children in classrooms more susceptible to the virus. Flu virus spreads through droplets deposited in the air when an infected person coughs, sneezes or talks.  It can also spread when a person touches his/her mouth or nose after coming into contact with an object, such as a door handle, infected with the virus.

Influenza is much more dangerous to children than the common cold. On average, 20,000 children under the age of 5 are hospitalized due to health complications from the flu. If your child exhibits any of the following flulike symptoms, visit with pediatricians at Pediatrix immediately.

• Fever up to 104°F
• Chills or Shaking
• Fatigue
• Aching
• Dry Cough
• Sore Throat
• Vomiting
• Stomach Pain

Taking children to your pediatrician at Pediatrix for a flu shot now will decrease their chances of catching dangerous flu viruses come winter. Remember, flu is very easily spread and your child can easily catch it while at school or daycare.

There are three types of influenza viruses: Type A, Type B and Type C. Types A and B cause yearly flu epidemics, while type C viruses cause more mild illnesses. While vaccines can protect your child from type A and B, there is no immunization available for a type C flu virus.

If your child catches a mild strain of flu, the following are some remedies to soothe symptoms:

• Ample rest, so the body can focus on repairing and healing
• Plenty of fluids to avoid dehydration caused by fever
• Children’s acetaminophen or ibuprofen to lower fever and ease aches and pains
• Saltwater nose drops to slow runny noses
• Humidifier or steamy shower for stuffy noses and coughs

Be prepared this flu season by vaccinating your child at Pediatrix. Also, learn about the symptoms to look for in regards to flu and any dangerous complications it may cause. At Pediatrix, our number one priority is making sure that your child is provided with the best health care and information possible. As always, if you have any questions regarding this upcoming cold and flu season, visit with our qualified, caring pediatricians in Phoenix. Please call (602) 866-0550 or contact us online to learn more about the services provided by our pediatricians in Phoenix.

Sincerely,

Subir K. Mitra, MD, FAAP

1. Plan a Route

When trick-or-treating, playing it by ear and maneuvering throughout a neighborhood can take you far away from home and even cause you to become lost.  Plan out a route in advance that you are familiar with and make sure it is a suitable walking distance for your child.

2. Wear Comfortable Shoes

Children should wear comfortable shoes that fit well, such as tennis shoes.  Make sure the laces are double knotted to avoid dealing with the hazard of untied shoelaces.

3. Be Visible

You are going to be wandering around in the dark, so make sure you carry a flashlight to light a pathway for you and your child. This will help you to avoid incidences, such as tripping over an unseen raised sidewalk, and will make you visible to other trick-or-treaters and drivers.

4. Wear Fitted Costumes

Make sure that costumes fit well to avoid frustration with clothing that is too tight or constantly slipping and falling down. Also make sure to hem any costumes that are dragging on the ground as these can cause tripping.

5. Avoid Accessories

Props with sharp points, such as wands or swords, should be avoided as they can injure your child or another child.

6. Candy Check

After you return to your house from trick-or-treating, dump out your child’s candy on a table or counter and throw out anything that is unwrapped or not in its original wrapper.

Following the above tips will ensure that you and your child stay safe while trick-or-treating this Halloween. At Pediatrix, an established pediatric office in Phoenix, we promote healthy habits for every child in our care. With a huge variety of candy freely available after trick-or-treating, your child’s eyes may be larger than their stomach. To avoid a sugar rush, our pediatric office in Phoenix recommends limiting your child to a couple pieces of candy per day. If you would like to put your child on the track to a healthy future, call a representative at our pediatric office in Phoenix at (602) 866-0550 or contact us online today to speak with a qualified representative. We wish you a safe and spooktacular Halloween!

Sincerely,

Subir K. Mitra, MD, FAAP

SIDS typically occurs while a baby is asleep, experiencing no suffering whatsoever. It is scary and worrisome for new parents as the condition comes on quickly and unexpectedly to babies who don’t appear to have any health concerns.  SIDS has been associated with possible abnormalities in the brain that control breathing and arousal of sleep. The syndrome has also been tied to certain sleep environments, which can increase an infant’s risk.

In order to reduce the risk of SIDS, consider the following:

• Babies should always rest on a firm mattress. Avoid pillows, waterbeds, couches, chairs and other soft surfaces.
• To prevent rebreathing, avoid placing blankets, comforters, stuffed animals or pillows that could restrict air flow.
• Keep the room at a comfortable temperature. If a baby gets too warm, they could enter a deeper sleep that may be more difficult to come out of.
• Breastfeeding helps to build a baby’s immune system and protect from infections.
• All recommended immunizations should be received as they can reduce the risk of SIDS by up to 50%.
• Infant care in Phoenix should be a priority. Make appointments with a pediatrician regularly for well child checkups.

While it is difficult to know the exact cause for SIDS, taking the above precautions may help to reduce the risk. Visiting with a physician for regular infant care in Phoenix will allow them to evaluate your baby’s growth and development, and detect any conditions or other health issues early on. At Pediatrix, providing expert infant care in Phoenix, we know your children are special to you – they’re special to us too – so we make sure that we are providing specialized medical attention to each and every child in our care to ensure that they lead healthy, fulfilling lives. For infant care in Phoenix, please call Pediatrix at (602) 866-0550 or visit us online today.

Sincerely,

Subir K. Mitra, MD, FAAP

In children, the following individuals will be most at risk for severe flu complications:

• Children under the age of five, and especially under the age of two. Those under two typically experience the most severe flu complications.
• Children with chronic health problems such as asthma or diabetes.
• Children under 6 months of age. Children should not be vaccinated until they are at least 6 months old, so the best way to protect your baby is to make sure everyone around them has been vaccinated.

Getting a flu shot is the first step in prevention of the flu, which could be potentially life threatening to a child. Last year, 52% of children under the age of 17 received the flu vaccination with a large percentage of children under two making up this statistic. Of the babies and toddlers, aged 6 to 23 months, 75% were vaccinated.

In addition to the vaccine, you and your family should also practice good hygiene to avoid spread of the flu. Don’t cough or sneeze into your hand, but rather into your arm or shirt. Make sure to wash your hands frequently throughout the day using an anti-viral soap. Also, taking antiviral medications can help treat and prevent influenza for those more susceptible to complications.

Flu seasons are unpredictable; they can turn out to be fairly mild to very extreme, so it’s important to prepare your children by getting a flu vaccine prior to the start of the season. The knowledgeable and friendly Phoenix family physicians at Pediatrix pride themselves on treating children with only the best care to ensure that they grow happily and healthily. In order to keep your children protected, our Phoenix family physicians would be more than happy to answer any questions or concerns you may have about this upcoming flu season. At Pediatrix, our Phoenix family physicians strive for excellence and provide the most specialized care for each child. Please give us a call at (602) 866-0550 or visit us online today.

Sincerely,

Subir K. Mitra, MD, FAAP

As a society, we are constantly trying to improve our health and the health of our children by making and encouraging healthier food choices and exercising to maintain or lose weight. Despite our best intentions, the rates of childhood and adult obesity have skyrocketed over the last 20 years.  To put this into perspective, Arizona’s obesity rates have gone from 10-14% in 1992 to well over 25% in 2012.  That is astounding.  We all hear about eating right and the importance of exercising; in fact, I have this conversation with my patients several times each day.   Unfortunately, no matter how much information I give, patients’ success rates for weight reduction are very low.  I have heard all the excuses:  “We try to eat healthy, but it’s too expensive”, “I exercise a lot without any results”, “We don’t have time to cook our own meals”, “We’ve tried a high protein diet or a low fat diet and to limit calories”. None of these excuses works to help patients permanently lose weight and the excuses only perpetuate the obesity problem.

While it may surprise you, I do not think portion size, lack of exercise, fast food and soda are the only culprits to blame in the obesity epidemic.  This summer I researched this topic further and have discovered that as our consumption of meat and dairy products has risen, so has our nation’s obesity level.  While some studies may be tedious for parents to read, there are a variety of easy to view documentaries on the subject.  My favorite is the documentary Forks Over Knives.  This is a game changer.  The researchers in this movie advocate a whole food, plant based diet—that is, a vegan diet.  I must admit, the very word “vegan” scared me.  With a vegan diet, individuals do not consume any animal products, which means no meat, fish, eggs or dairy.  What?  Give up meat, milk and my most beloved cheese?  How could I do that, much less ask my patients to do it?  After looking further into the issue and trying the vegan diet for myself, I have to say it makes a lot of sense.  All of the cholesterol and bad fats we consume are from animal products and processed foods.  Meat, including poultry, contains cholesterol.  When we eat meat, we also eat this cholesterol, which becomes a part of our bloodstream.  You may hope to avoid this by switching to fish, but this leads to other concerns, as many types of fish contain dangerously high levels of mercury.  Moreover, research is showing that meat and dairy products contain antibiotics and growth hormones, which are directly absorbed by those who consume these foods: us and our children.

But what about protein?  Don’t we, and our children, need protein?   We hear a lot about the need for protein from meat and dairy products.  While we do need this nutrient, the truth is that we don’t need nearly as much protein as we as a society presently consume.  Our consumption of meat per capita has increased dramatically in just the past 20-25 years.  Yet, our high protein meat based diets have not succeeded in improving obesity rates.  Substituting plant-based proteins for meat can still give us the nutrition our bodies need, with less health risk.  For instance, cultures with low consumption of meat and high consumption of plant-based foods typically have very low obesity rates.  Even if you do not want to become completely vegan, moving to a vegan diet 2 days, 3 days or even 6 days a week can help achieve weight loss and overall health.   Remember that this dietary change is a lifestyle change.   A plant-based diet can lower your cholesterol, blood pressure and risk for type II diabetes.  As a pediatrician, I am starting to see children with these issues.  The last thing I would ever want to do is put any of my patients on anti-hypertensive drugs and cholesterol reducing medications or have to treat them for type II diabetes.  Instead of prescribing medications for conditions related to unhealthy eating, I would rather prescribe healthy eating to prevent illness and obesity.

Part 2 of this series will discuss what to eat and the surprisingly low cost of eating healthy.

If you have a child with weight problems or would like to learn more about healthy eating, schedule an obesity or nutrition consultation with me at pediatrixmd.com or call for an appointment.

Sincerely,

Subir K. Mitra, MD, FAAP