Thursday, July 19, 2018

RE: Important PHA Policy Change and Summer Safety

PHA Policy Change regarding No Shows

Effective August 1, 2018 our no show policy will change.  Families will be allowed 4 NO SHOWS within 2 years before being dismissed from the practice.  A $35.00 no show fee will be charged for missing Check-Ups/Sports Physicals and $25.00 for all other appointments. 

This charge is per patient, not per family.  

You can avoid this charge by cancelling your appointment minimally 4 hours prior to your scheduled appointment time.

From the desk of Nishat Nasrullah, DO

Nishat Nasrullah, DO
Now that summer is in full swing, one of my family’s favorite pastimes is to go to the swimming pool!  It’s a great way to cool off on these hot summer days, but a fun day can turn tragic very quickly with drowning and nearing drowning events.  That is why it is essential as parents that we go through all of the preventative measures to keep ourselves and our kids safe in the water. Today, I will discuss some of the safety guidelines on the prevention of drowning as highlighted by the American Academy of Pediatrics. Furthermore, I will discuss what is dry and secondary drowning, what are the signs and symptoms to look for, and when to seek care.

According to the CDC (Centers for Disease Control) Injury Report drowning is the second leading cause of unintentional injury death, and the number one cause of death amongst 1 to 4-year old’s. Drowning rates vary with age, gender, and race, but research has shown that the groups at greatest risk are toddlers and male adolescents.

Drowning, dry drowning and secondary drowning.
You may have heard of the term ‘dry drowning,’ but in order to understand what this actually means it is important to know the definition of drowning. The World Congress on Drowning states that drowning is “the process of experiencing respiratory impairment from submersion/immersion in liquid.” In other words, drowning occurs when water goes into the lungs and causes impairment in breathing through suffocation. In contrast, in dry drowning your child may swallow and choke on only some water, but then his/her vocal cords will spasm and close up. This will prevent water from going into the lungs, and instead is swallowed. Therefore, in dry drowning liquid does not actually get into the lungs, so there is no damage to the lungs or impairment in breathing.

Another term that is sometimes used is secondary drowning.  This is when a child or adult swallows water, coughs and sputters and then appears fine, but hours later may start to develop difficulty breathing. This occurs because some water actually did enter the lungs leading to irritation and swelling, otherwise known as pulmonary edema. The signs and symptoms of secondary drowning may include fast breathing, labored breathing, wheezing, and increased fatigue. These symptoms will usually occur within 6-8 hours from the initial incident and can continue to worsen through the next 24 hours. If something like this occurs, then medical evaluation is necessary as soon as possible.

When is the best time to start swimming lessons?
The American Academy of Pediatrics’ (AAP) initial stance for swimming lessons was to start only after 4 years of age, because there was no data to suggest that there was any benefit in starting swimming lessons earlier.  The concern was that starting at an early age may give children and parents a false sense of security around water. This stance has become more relaxed after new studies showed that there is a less likelihood of drowning accidents to occur in those toddlers (less than 4 years of age) who had formal swimming instruction vs. those that did not. The updated guideline is “Children need to learn to swim. The AAP continues to support swimming lessons for most children 4 years old and older. Because children develop at different rates, not all children will be ready to learn to swim at exactly the same age. For example, children with motor or cognitive disabilities may not be ready for swimming lessons until a later age. The evidence no longer supports an advisory against early aquatic experience and swimming lessons for children of any specific age.” There has not been enough research to state that children between ages 1 to 4 must have formal swimming training, however this is an individualized decision of the parent based on the child’s maturity, physical limitations and health concerns. It is also important to remember that just because a child has had swimming lessons, it does not make him or her “drown proof.”  Essentially, parents cannot let their guards down around water with little ones.

House pools and inflatable pools safety:
If you own a pool the best way to prevent drowning accidents is to have a 4-sided fence installed that surrounds the entire pool, and separates it from the rest of the yard. Studies show that isolating the pool from the rest of the yard has been effective in preventing more than 50% of swimming-pool drownings.  Having pool covers and pool alarms alone is not enough of a preventative measure, but can be used as an adjunct to the fence. The fence should be at least 4 ft in height and climb resistant, which means no chain-linked fences that can easily be climbed by young children.  In addition, the fence should have a secure self-latching and self-closing gate.

Parents should also be aware of the risks that come with inflatable pools. These pools are sometimes left out with a small amount of water, which can be just enough for a young child to fall into and drown. Furthermore, the soft sides of these pools make it very easy for children to lean forward and fall in head first. Even though they may seem small and insignificant, inflatable pools can pose a great risk for young kids, and they need to be emptied out after each use.

Drowning is preventable in most cases, so let’s review some useful water safety guidelines:
     1.     Touch supervision: All young and inexperienced swimmers need to be at an arm’s length from an adult swimmer in any body of water including tub, pool, beach, etc.
     2.     Older children and those who can swim still need constant attention while in the water, which means parents put your devices away, stop socializing or tending to chores, and keep your eyes on your kids!
     3.     If children will be swimming in summer camps or out-of-home daycares, parents need to inquire about the ratio of adults to students, lifeguards on site and other safety measures for the water.
     4.     Parents, caregivers and pool owners should learn CPR.       
     5.     All children should wear life jackets whenever they are riding in a watercraft. The best way to get children to wear life jackets is if adults are setting a good example by wearing them as well.
     6.     Avoid using the inflatable arm flotation devices in place of proper life jackets. These can easily come off and/or deflate and are not a safe alternative. 
     7.     Beware that drowning can also occur in cold seasons. Do not walk, skate or ride on weak or thawing ice or any body of water.
     8.     Children of any age with seizure disorders should always have a parent present when swimming or taking a bath. Showers are preferable to baths in situations when a child cannot be observed.
     9.     Make sure that the swimming pools or spas being used have proper drain covers to prevent drain entrapment and hair entanglement.

Thank you for taking the time to read this installment of the PHA blog. I hope that it was beneficial to you, and I hope that you and your family have a fun-filled and safe summer! For more helpful information on drowning prevention please refer to the websites below.

     1.     Center for Disease Control;

     3.     Safe Kids USA:

     4.     Consumer Product Safety Commission (CPSC)  
Centers for Disease Control and Prevention National Center for Injury Prevention and Control. Web-based Injury statistic Query and Reporting System (WISQARS)

American Academy of Pediatrics Policy Statement---Prevention of Drowning. Committee on Injury, Violence, and Poison Prevention. Pediatrics Volume 126, Number 1, July 2010.

      Semple-Hess, J.  Behar, Sol. “Bonus Short—Dry Drowning.” Peds 
      RAP. July 2017


Pediatric Health Associates congratulates Nurse Practitioner Katie Parker on the birth of her first born son, Thomas!   Mom and baby are doing great!

Welcome to the World, Little One!

Tuesday, July 3, 2018

Are grandpa's medications stored safely?

Independence Day 2018
Have a safe 4th!

An important reminder from Shelly Flais, MD
Many grandparents take daily medications.  When the grandkids visit check to make sure those meds are out of their reach while visiting.  Read more at:

Shelly Flais, MD

Thursday, June 21, 2018

Re: Today is ASK day. Also, are you a new mom struggling with breastfeeding?

Today is ASK day.  ASK (Asking Saves Kids) is a campaign to promote a simple idea with the potential to help keep kids safe: We encourage parents to ask, "Is there an unlocked gun in your house?" before sending their child over to play at another home. 

Every day 78 children (28,470 annually!) are killed by guns in our country.  About one-third of homes with kids have guns, many left unlocked or loaded.  In 2017 at least 285 of those children inadvertently shots themselves or someone else because they found a gun that was unlocked and loaded according to

We tend to think that we live in a safe neighborhood and that this isn't something we need to worry about.  But even in safe neighborhoods people own guns.  Little ones who find guns are curious about them but do not understand the consequences should they shoot someone.  When they finally do understand, it's a burden they'll carry for the rest of their lives.  Yes, it may be difficult to ask whether a gun is in the home before your child visits but this simple question may prevent your child from being harmed.  Better to feel embarrassed than feeling remorse.

For more information:

Tara Doman, MD, IBCLC
Pediatric Health Associates (PHA) is now offering lactation services at our Naperville and Plainfield locations. Dr. Tara Doman and Nurse Practitioner Kim Gubbins saw a great need for more support for women who had a desire to give their babies breastmilk. They saw discouraged moms who were ready to give up by the  time they could get into a private or hospital based lactation specialist.  Jump a few years ahead, and now both are IBCLCs (International Board Certified Lactation Consultants)  and are very excited to serve, support and teach our PHA breastfeeding, bottle feeding and pumping moms!

Kim Gubbins, CPNP, IBCLC
Research tells us that breastmilk is loaded with ingredients to help nourish and keep our babies healthy. According to Steven Townsend, Assistant Professor of Chemistry at Vanderbilt University “breast milk provides all the energy requirements, vitamins and nutrients that an infant needs” (2018). Because of this it is recommended to exclusively offer breastmilk for the first 6 months of a baby’s life. Townsend also shares known research that “exclusively breastfed babies have lower infant mortality due to common childhood illnesses such as diarrhea, pneumonia, urinary tract infection, ear infection, necrotizing enterocolitis and sudden infant death syndrome (SIDS), compared to
formula-fed counterparts” (2018).

So what is in breastmilk that helps protect our babies from illness? Breastmilk contains
two types of proteins, simple and complex. We know that the complex proteins (IgA and lactoferrin) keep bacteria and viruses from growing. Additionally, breastmilk has a type of sugar called human milk oligosaccharides (HMOs) and there are over 200 types of these HMOs. We know these sugars are helpful to feed the “good” bacteria that lives in your baby’s belly. Because babies have this good bacteria in their gut, it helps them to stay healthier and get sick  less often. These HMOs are also being studied for not only supporting the good bacteria but fighting off the bad bacteria. These HMOs are found to some extent (much fewer) in formula although structured very differently and therefore do not offer the same protections as babies who are breastfed. This link provides a YouTube video that further explains how sugars in breastmilk, the HMOs, help to fight off bacteria:

So please let our office help you! If you are struggling with nursing your baby, latching, pumping or breastmilk supply make an appointment with our certified lactation consultants, Dr. Tara Doman or Nurse Practitioner Kimberly Gubbins.



Summer appointments are filling fast!  Schedule your school and sports physicals today!

We are happy to say that construction is underway at our North Aurora location and we anticipate an October or November opening.

Thursday, June 14, 2018

We, the pediatricians and pediatric nurse practitioners of Pediatric Health Associates, take seriously our mission to care for children’s health. We deeply value the relationships that we form over time with our patients and their families. We are honored to serve as primary care pediatricians for our communities by offering families guidance about normal growth and development of childhood and adolescence, emphasizing preventive care and health maintenance, and supporting and caring for children and their families through periods of acute or chronic illness, disability, or injury. We are dedicated to supporting, promoting, and protecting the health of all children, from birth through young adulthood, in every way that we can.

Caring for the health of children takes place at many levels, from studying the biochemical pathways underlying disease on a molecular and cellular level, to addressing social determinants of health and understanding children and their distinct health issues in the broader contexts of the family, the community, the society, and the world. It is from this perspective that we, along with pediatricians from around the country, and as members and Fellows of the American Academy of Pediatrics, are speaking out with deep concern against the practice of separating children from their families at the U.S. border, formalized as policy in May of this year by the Department of Homeland Security.

While exact numbers are unknown, at least 2400 children have been separated from their parents, including many from families fleeing violent and dangerous conditions who have formally sought asylum in the United States. By all accounts, this practice is ongoing and the number continues to increase; as many as 658 children were separated during a two-week period in May 2018. The policy has affected a significant number of children under four years old, including infants, who have then been placed in facilities around the country with no chance for the parent to explain or ease the separation, with no opportunity for contact or communication between parent and child, and with no time frame for reunification given. This policy contradicts everything that we know about child development, health, and well-being. Put simply, this policy hurts children.

Families come in many forms, in all shapes and sizes, from all backgrounds and from all walks of life. What is clear is that children benefit from and need the presence and support of their family. Children need close, in-person bonding, guidance, and nurturing from the people who care for and love them. Being unified with their families provides children with an opportunity to form secure attachments and with a sense of consistency and stability. Family is what allows a child to grow, to learn, to develop, and to thrive.

There is a growing body of research which addresses the consequences of adverse childhood events including their immediate and long-term impacts on children. Unpredictable, uncontrollable, and prolonged changes to children’s family structure and social situation can have a significant negative impact on their physical, mental, and emotional health. Children are particularly dependent on their family as a buffer or protective factor during times of extreme stress, fear, uncertainty, or anxiety. Adverse childhood events contribute over time to what is increasingly being recognized and termed as toxic stress, which is associated with physiologic and neurodevelopmental changes that can impact children’s health and well-being long after the initial trauma. Toxic stress of the type represented by the forcible separation of families leaves children susceptible to changes of brain development and neural architecture that contribute to long term problems such as developmental delays, post-traumatic stress disorder, learning deficits and attention disturbances, anxiety, depression, self-harm, and suicidality. The physiologic changes triggered and exacerbated by toxic stress contribute to concerns such as abdominal pain, headaches, poor growth, and chronic health problems that can manifest well into adulthood such as diabetes and other metabolic conditions, hypertension, and heart disease. Academic research and clinical experience are clear: this policy will devastate children’s health.

Pediatricians and parents know from experience that children have great strength and tremendous resilience. Children, however, are not just little adults. Children are an inherently vulnerable population with distinct physical, emotional, and developmental needs, and they depend on the support, protection and love of their families. They depend on our leaders and policymakers to craft policy that reflects their best interests, and they depend on adults in society to speak out, support them, protect them, and advocate for them when they are at risk. The American Academy of Pediatrics, an organization of 66,000 primary care pediatricians, pediatric medical sub-specialists, and pediatric surgical specialists has clearly, consistently, and strongly advocated against this policy, writing to the Secretary of the Department of Homeland Security on at least six occasions to oppose the forced separation of children from their parents at the border and to urge that the practice stop immediately. Last week, the AAP joined with 540 national, state, and local organizations to oppose the policy of forced separations, and individual pediatricians have spoken out and written opinion pieces in local newspapers around the country.

The American Academy of Pediatrics is non-partisan; it is pro-children and pro-family. The current policy of family separation is neither. The AAP and its members will continue to advocate for the health of all children, including speaking out against the separation of immigrant children from their parents. Today Thursday, June 14, 2018 will be a national day of action and an opportunity to express concerns about this practice and urge that it be ended. The voices of parents are essential to these efforts; if you are concerned about this policy and its effect on the health of children and families, please consider contacting your representatives in Congress, local representatives, and other elected officials to urge them to speak out to end the policy of family separation. Consider reaching out to community organizations with an interest in child health and other child and family issues to see if they are aware of this policy and encourage them to speak out about it as well. Strong, clear advocacy on the part of parents, pediatricians, and all other interested and concerned adults is crucial in changing policies detrimental to children. Together, we can offer a powerful voice in support of vulnerable children, and help to protect and promote the health of children, families, and communities.

Additional info and resources:

AAP Policy Statement on detention of immigrant children, March 2017:

AAP Statement opposing separation of children and families at the border, 5/8/2018:

Joint letter to DHS to halt separation of children from parents at the border, 6/7/2018:

Colleen Kraft, MD, AAP President, Los Angeles Times Op-Ed, 5/3/2018:

Contact information for elected officials representing our offices’ districts (note that borders of congressional districts for US Representatives are irregular; if your representative is not listed or if you are not sure who your representative is, you can look up your representative and their contact information at or call the US Capitol switchboard at (202) 224-3121):

Representative Bill Foster, IL-11 (includes Naperville and Bolingbrook offices): (202) 225-3515

Representative Randy Hultgren, IL-14 (includes Plainfield office): (202) 225-2976

Representative Peter Roskam, IL-6 (includes West Chicago office): (202) 225-4561

Senator Tammy Duckworth, IL: (202) 224-2854

Senator Dick Durbin, IL: (202) 224-2152