We will ask for basic information about your family, your insurance, and your child’s medical history before a first visit.

Your first visit will go more quickly should you print, read, and complete the Patient Packet, Privacy Notice, Acknowledgement of Privacy Notice, and Authorization to Release Information prior to coming in for your visit.

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When you arrive at your appointment, please bring the following:

• Your health insurance card or Medicaid information, or the information of the person who covers the child’s medical care

• Any changes in personal information such as address, insurance, or phone number

• Picture ID

• Completed forms (don’t worry if you forget these - we have plenty of blank ones in our offices)

If you do not have insurance or have other concerns regarding insurance bills, please call and inquire about our sliding fee program. We do offer discounts to our patients based on household size and income.

For more information please call: 386-758-0003

Sliding Fee Policy

*** North Florida Pediatrics does not discriminate any individual for provision of care based on ability/inability to pay or based upon an individual’s race, color, sex, national origin, disability, religion or sexual orientation.

COVID-19 is a new disease and we are still learning how it spreads, the severity of illness it causes, and to what extent it may spread in the United States.

How COVID-19 Spreads

• Person-to-person spread

The virus is thought to spread mainly from person-to-person.

• Between people who are in close contact with one another (within about 6 feet).

• Through respiratory droplets produced when an infected person coughs or sneezes.

• These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

Can someone spread the virus without being sick?

• People are thought to be most contagious when they are most symptomatic (the sickest).

• Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads.

Spread from contact with infected surfaces or objects

It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

How easily the virus spreads

How easily a virus spreads from person-to-person can vary.

Some viruses are highly contagious (spread easily), like measles, while other viruses do not spread as easily. Another factor is whether the spread is sustained, spreading continually without stopping.

The virus that causes COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in some affected geographic areas.

Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected.

We think you will like the welcoming staff, the comfortable offices, and the easy scheduling. You can see doctors who work with your schedule, know your children by name, and look for new ways to keep your family healthy. We know that your kids want to feel better here and now, so we have seven different locations to help treat them faster.

Older adults and people who have severe chronic medical conditions like heart, lung or kidney disease seem to be at higher risk for more serious COVID-19 illness. Early data suggest older people are twice as likely to have serious COVID-19 illness. This may be because:

As people age, their immune systems change, making it harder for their body to fight off diseases and infection.

Many older adults are also more likely to have underlying health conditions that make it harder to cope with and recover from illness.

If a COVID-19 outbreak happens in your community, it could last for a long time. Depending on the severity of the outbreak, public health officials may recommend community actions to reduce exposures to COVID-19. These actions can slow the spread and reduce the impact of disease.

If you are at increased risk for COVID-19 complications due to age or because you have a severe underlying medical condition, it is especially important for you to take actions to reduce your risk of exposure.

First Trimester: Week 1 (conception) – Week 12

Physical and Emotional Changes a Woman May Experience

• Hormonal changes will affect almost every organ in the body. Some signs of early pregnancy in many women include symptoms like:

• Extreme fatigue

• Tender, swollen breasts. Nipples may protrude.

• Nausea with or without throwing up (morning sickness)

• Cravings or aversion to certain foods

• Mood swings

• Constipation

• Frequent urination

• Headache

• Heartburn

• Weight gain or loss

Changes in a Woman's Daily Routine

Some of the changes you experience in your first trimester may cause you to revise your daily routine. You may need to go to bed earlier or eat more frequent or smaller meals. Some women experience a lot of discomfort, and others may not feel any at all. Pregnant women experience pregnancy differently and even if they've been pregnant before. Pregnant women may feel completely differently with each subsequent pregnancy.

First Trimester: The Baby at 4 Weeks

At 4 weeks, your baby is developing:

• The nervous system (brain and spinal cord) has begun to form.

• The heart begins to form.

• Arm and leg buds begin to develop.

• Your baby is now an embryo and 1/25 of an inch long.

First Trimester: The Baby at 8 Weeks

At 8 weeks, the embryo begins to develop into a fetus. Fetal development is apparent:

• All major organs have begun to form.

• The baby's heart begins to beat.

• The arms and legs grow longer.

• Fingers and toes have begun to form.

• Sex organs begin to form.

• The face begins to develop features.

• The umbilical cord is clearly visible.

• At the end of 8 weeks, your baby is a fetus, and is nearly 1 inch long, weighing less than ⅛ of an ounce.

First Trimester: The Baby at 12 Weeks

The end of the first trimester is at about week 12, at this point in your baby's development:

• The nerves and muscles begin to work together. Your baby can make a fist.

• The external sex organs show if your baby is a boy or girl.

• Eyelids close to protect the developing eyes. They will not open again until week 28.

• Head growth has slowed, and your baby is about 3 inches long, and weighs almost an ounce.

Acetaminophen (i.e., Tylenol®, Feverall®, Tempra®) is an over-the-counter medicine used to reduce fever and relieve pain. Improper dosing is one of the biggest problems in giving acetaminophen to children. This chart, based on your child's weight, can help determine the right dosage amount, but is no substitute for your pediatrician's advice.

For children older than 2 months of age only.

Dose is every 4-6 hours. Infant's and Children's Tylenol are the same dose; infant's comes with a syringe instead of a cup.

Caution: In 2011, the U.S. Food and Drug Administration (FDA) recommended liquid, chewable, and tablet forms of acetaminophen be made in just one strength. Since that time, manufacturers and retailers of pediatric acetaminophen have voluntarily worked to change the amount of acetaminophen in these medicines to one standard amount (160 milligrams [mg]). Some manufacturers have recently made chewable tablets into a single strength of 160 mg. Infant drops are no longer available. Liquid syrup acetaminophen is available as 160mg/5mL. Pediatric acetaminophen products on store shelves can continue to be used as labeled.

Age limit: Do not use acetaminophen under 12 weeks of age unless directed by your pediatrician because fever during the first 12 weeks of life should be documented in a medical setting. If a f​ever is present, your baby needs a complete evaluation. (Exception: Fever from an immunization in a child 8 weeks of age or older. If present, please consult with your pediatrician.)

Combination products: Avoid multi-ingredient products in children under 6 years of age.

Dosage: Determine by finding child's weight (in pounds) in each row of the dosage table below.

Measuring the dosage (in metric units): Dosing syringes are more accurate than household utensils. Use the syringe or device that comes with the medication. If one does not come with the medication, ask the pharmacist for a medicine syringe. Household spoons are not reliable.

Frequency: Repeat every 4-6 hours as needed. Don't give more than 5 times a day.

Oral disintegrating tablets: These are dissolvable tablets that come in 80 mg and 160 mg (junior strength)

Suppositories: Acetaminophen also comes in 80, 120, 325 and 650 mg suppositories. The rectal dose is the same as the dosage given by mouth.

Extended-Release: Avoid 650 mg oral extended-release products in children.

When a baby becomes part of your family, it is time to make sure that your home is a safe place. Look around your home for things that could be dangerous to your baby. As a parent, it is your job to ensure that you create a safe home for your baby. It also is important that you take the necessary steps to make sure that you are mentally and emotionally ready for your new baby.

Here are a few tips to keep your baby safe:

• Do not shake your baby―ever! Babies have very weak neck muscles that are not yet able to support their heads. If you shake your baby, you can damage his brain or even cause his death.

• Make sure you always put your baby to sleep on her back to prevent sudden infant death syndrome (commonly known as SIDS). Read more about new recommendations for safe sleep for infants here.

• Protect your baby and family from secondhand smoke. Do not allow anyone to smoke in your home.

• Place your baby in a rear-facing car seat in the back seat while he is riding in a car. This is recommended by the National Highway Traffic Safety Administration

• Prevent your baby from choking by cutting her food into small bites. Also, don’t let her play with small toys and other things that might be easy for her to swallow.

• Don’t allow your baby to play with anything that might cover her face.

• Never carry hot liquids or foods near your baby or while holding him.

• Vaccines (shots) are important to protect your child’s health and safety. Because children can get serious diseases, it is important that your child get the right shots at the right time. Talk with your child’s doctor to make sure that your child is up-to-date on her vaccinations.

• Breast milk meets all your baby’s needs for about the first 6 months of life. Between 6 and 12 months of age, your baby will learn about new tastes and textures with healthy solid food, but breast milk should still be an important source of nutrition.

• Feed your baby slowly and patiently, encourage your baby to try new tastes but without force, and watch closely to see if he’s still hungry.

• Breastfeeding is the natural way to feed your baby, but it can be challenging. If you need help, you can call the National Breastfeeding Helpline at 800-994-9662 or get help on-line at http://www.womenshealth.gov/breastfeeding. You can also call your local WIC Program to see if you qualify for breastfeeding support by health professionals as well as peer counselors. Or go to http://www.ilca.org/why-ibclc/falc to find an International Board-Certified Lactation Consul­tant in your community.

• Keep your baby active. She might not be able to run and play like the “big kids” just yet, but there’s lots she can do to keep her little arms and legs moving throughout the day. Getting down on the floor to move helps your baby become strong, learn, and explore.

• Try not to keep your baby in swings, strollers, bouncer seats, and exercise saucers for too long.

• Limit screen time. For children younger than 18 months of age, the American Academy of Pediatrics (AAP) recommends that it’s best if babies do not use any screen media other than video chatting.

• Make sure your child gets the recommended amount of sleep each night: For infants 4-12 months, 12–16 hours per 24 hours (including naps)

A novel coronavirus is a new coronavirus that has not been previously identified. The virus causing coronavirus disease 2019 (COVID-19), is not the same as the coronaviruses that commonly circulate among humans and cause mild illness, like the common cold.

A diagnosis with coronavirus 229E, NL63, OC43, or HKU1 is not the same as a COVID-19 diagnosis. Patients with COVID-19 will be evaluated and cared for differently than patients with common coronavirus diagnosis.

CDC provides recommendations on postponing or canceling travel. These are called travel notices and are based on assessment of the potential health risks involved with traveling to a certain area. A list of destinations with travel notices is available

at https://www.cdc.gov/coronavirus/2019-ncov/travelers/

Warning Level 3: CDC recommends travelers avoid all nonessential travel to destinations with level 3 travel notices because of the risk of getting COVID-19.

Alert Level 2: Because COVID-19 can be more serious in older adults and those with chronic medical conditions, people in these groups should talk to a healthcare provider and consider postponing travel to destinations with level 2 travel notices.

Watch Level 1: CDC does not recommend canceling or postponing travel to destinations with level 1 travel notices because the risk of COVID-19 is thought to be low. If you travel, take the following routine precautions:

• Avoid contact with sick people.

• Avoid touching your eyes, nose, or mouth with unwashed hands.

• Clean your hands often by washing them with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer that contains 60%–95% alcohol. Soap and water should be used if hands are visibly dirty.

It is especially important to clean hands after going to the bathroom; before eating; and after coughing, sneezing or blowing your nose.

What to Expect

In the hospital, the doctor and/or nurse will probably:

1. Check your baby's weight, length, and head circumference and plot the measurements on the growth charts.

2. Ask questions, address any concerns, and offer advice on taking care of your baby:

Feeding. Breast milk is the best form of nutrition for infants, but formula also can provide the nutrients they need. Newborns should be fed on demand (when they're hungry), which is about every 1 to 3 hours. Your doctor or nurse may watch as you breastfeed and offer help with any problems. Formula-fed newborns take about 1–1½ ounces (30–45 ml) at each feeding. Burp your baby midway through a feeding and at the end. As they grow, babies start to eat more at each feeding, so will need fewer feedings over time.

Peeing and pooping. A breastfed baby may have only one or two wet diapers a day until the mother's milk comes in. Expect about six wet diapers by 3–5 days of age for all babies. Newborns may have just one poopy diaper a day at first. Poop is dark and tarry the first few days, then becomes soft or loose and greenish-yellow by about 3–4 days. Newborns typically have several poopy diapers a day if breastfed and fewer if formula-fed.

Sleeping. A newborn may sleep up to 18 or 19 hours a day, waking up often (day and night) to breastfeed or take a bottle. Breastfed babies usually wake to eat every 1 to 3 hours, while formula-fed babies may sleep longer, waking every 2 to 4 hours to eat (formula takes longer to digest so babies feel fuller longer). Newborns should not sleep more than 4 hours between feedings until they have good weight gain, usually within the first few weeks. After that, it's OK if a baby sleeps for longer stretches.

Developing. Newborn babies should:

pay attention to faces or bright objects 8–12 inches (20–30 cm) away

respond to sound — they may turn to a parent's voice, quiet down, blink, startle, or cry

hold arms and legs in a flexed position

have strong newborn reflexes, such as:

rooting and sucking: turns toward, then sucks breast/bottle nipple

grasp: tightly grabs hold of a finger placed within the palm

fencer's pose: straightens arm when head is turned to that side and bends opposite arm

Moro reflex (startle response): throws out arms and legs, then curls them in when startled

3. Do a physical exam with your baby undressed while you are present. This will include an eye exam, listening to your baby's heart; feeling pulses; inspecting the umbilical cord; and checking the back, hips, and feet.

4. Do screening tests. Your baby's heel will be pricked for a small amount of blood to test for certain harmful diseases. Your baby should also get a hearing test and oxygen levels checked before leaving the hospital.

5. Give first immunizations. While in the hospital, your baby should have his or her first immunizations. Immunizations can protect infants from serious childhood illnesses, so it's important that your baby get them on time. Immunization schedules can vary, so talk to your doctor about what to expect.

Looking Ahead

Here are some things to keep in mind until your baby's next routine checkup in a few days:

Feeding

If you breastfeed:

• Help your baby latch on correctly: mouth opened wide, tongue down, with as much of the breast in the mouth as possible.

• Don't use a bottle or pacifier until nursing is established (around 1 month).

• Feed your baby when he or she is hungry. Pay attention to signs that your baby is full, such as turning away from the nipple and closing the mouth.

• Continue to take a prenatal vitamin or multivitamin daily.

If you formula-feed:

• Give your baby iron-fortified formula.

• Follow the formula package's instructions when making and storing bottles.

• Don't prop bottles or put your baby to bed with a bottle.

• Pay attention to signs that your baby is full, such as turning away from the bottle and closing the mouth.

Routine Care

• Wash your hands before handling the baby and avoid people who may be sick.

• Hold your baby and be attentive to his or her needs. You can't spoil a newborn.

• Keep the diaper below the umbilical cord so the stump can dry. The umbilical cord usually falls off in 10–14 days.

• For circumcised boys, put petroleum jelly on the penis or diaper's front.

• Girls may have vaginal discharge that may include a small amount of blood during the first week of life.

• Give sponge baths until the umbilical cord falls off and a boy's circumcision heals. Make sure the water isn't too hot — test it with your wrist first.

• Use fragrance-free soaps and lotions.

• Call your baby's doctor if your infant has a fever, is acting sick, isn't eating, isn't peeing or pooping, isn't latching on or sucking well when nursing, doesn't seem satisfied after breastfeeding, looks yellow, or has increasing redness or pus around the umbilical cord or circumcision. Do not give any medicine without talking to the doctor first.

• It's common for new moms to feel tired and overwhelmed at times. But if these feelings are intense, or you feel sad, moody, or anxious, call your doctor.

• Talk to your doctor if you're worried about your living situation. Do you have the things that you need to take care of your baby? Do you have enough food, a safe place to live, and health insurance? Your doctor can tell you about community resources or refer you to a social worker.

Safety

1. To reduce the risk of sudden infant death syndrome (SIDS):

• Breastfeed your baby.

• Let your baby sleep in your room in a bassinet or crib next to the bed until your baby's first birthday, or for at least 6 months, when the risk of SIDS is highest.

• Always place your baby to sleep on a firm mattress on his or her back in a crib or bassinet without any crib bumpers, blankets, quilts, pillows, or plush toys.

• Avoid overheating by keeping the room temperature comfortable.

• Don't overbundle your baby.

• Consider putting your baby to sleep sucking on a pacifier. If you're breastfeeding, wait until breastfeeding is established before introducing the pacifier.

1. Don't smoke or use e-cigarettes. Don't let anyone smoke or vape around your baby.

2. Always put your baby in a rear-facing car seat in the back seat. Never leave your baby alone in a car.

3. While your baby is awake, don't leave your little one unattended, especially on high surfaces or in the bath.

4. Never shake your baby — it can cause bleeding in the brain and even death.

5. Avoid sun exposure by keeping your baby covered and in the shade when possible. Sunscreens are not recommended for infants younger than 6 months. However, you may use a small amount of sunscreen on an infant younger than 6 months if shade and clothing don't offer enough protection.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.

What Is ADHD?

ADHD stands for attention deficit hyperactivity disorder. It is a medical condition. A person with ADHD has differences in brain development and brain activity that affect attention, the ability to sit still, and self-control. ADHD can affect a child at school, at home, and in friendships.

What Are the Signs of ADHD?

All kids struggle at times to pay attention, listen and follow directions, sit still, or wait their turn. But for kids with ADHD, the struggles are harder and happen more often.

Kids with ADHD may have signs from one, two, or all three of these categories:

• Inattentive. Kids who are inattentive (easily distracted) have trouble focusing their attention, concentrating, and staying on task. They may not listen well to directions, may miss important details, and may not finish what they start. They may daydream or dawdle too much. They may seem absent-minded or forgetful, and lose track of their things.

• Hyperactive. Kids who are hyperactive are fidgety, restless, and easily bored. They may have trouble sitting still, or staying quiet when needed. They may rush through things and make careless mistakes. They may climb, jump, or roughhouse when they shouldn't. Without meaning to, they may act in ways that disrupt others.

• Impulsive. Kids who are impulsive act too quickly before thinking. They often interrupt, might push or grab, and find it hard to wait. They may do things without asking for permission, take things that aren't theirs, or act in ways that are risky. They may have emotional reactions that seem too intense for the situation.

Sometimes parents and teachers notice signs of ADHD when a child is very young. But it's normal for little kids to be distractible, restless, impatient, or impulsive — these things don't always mean that a child has ADHD.

Attention, activity, and self-control develop little by little, as children grow. Kids learn these skills with help from parents and teachers. But some kids don't get much better at paying attention, settling down, listening, or waiting. When these things continue and begin to cause problems at school, home, and with friends, it may be ADHD.

How Is ADHD Diagnosed?

If you think your child has ADHD, make an appointment with one of our providers! He or she will give your child a check-up, including vision and hearing, to be sure something else isn't causing the symptoms. The doctor can refer you to a child psychologist or psychiatrist if needed.

To diagnose ADHD, doctors start by asking about a child's health, behavior, and activity. They talk with parents and kids about the things they have noticed. Your doctor might ask you to complete checklists about your child's behavior, and might ask you to give your child's teacher a checklist too.

After gathering this information, doctors diagnose ADHD if it's clear that:

• A child's distractibility, hyperactivity, or impulsivity go beyond what's usual for their age.

• The behaviors have been going on since the child was young.

• Distractibility, hyperactivity, and impulsivity affect the child at school and at home.

• A health check shows that another health or learning issue isn't causing the problems.

Many kids with ADHD also have learning problems, oppositional and defiant behaviors, or mood and anxiety problems. Doctors usually treat these along with the ADHD.

How Is ADHD Treated?

Treatment for ADHD usually includes:

• Medicine. This activates the brain's ability to pay attention, slow down, and use more self-control.

• Behavior therapy. Therapists can help kids develop the social, emotional, and planning skills that are lagging with ADHD.

• Parent coaching. Through coaching, parents learn the best ways to respond to behavior difficulties that are part of ADHD.

• School support. Teachers can help kids with ADHD do well and enjoy school more.

• The right treatment helps ADHD improve. Parents and teachers can teach younger kids to get better at managing their attention, behavior, and emotions. As they grow older, kids should learn to improve their own attention and self-control.

When ADHD is not treated, it can be hard for kids to succeed. This may lead to low self-esteem, depression, oppositional behavior, school failure, risk-taking behavior, or family conflict.

What Can Parents Do?

If your child is diagnosed with ADHD:

• Be involved. Learn all you can about ADHD. Follow the treatment your child's health care provider recommends. Keep all recommended appointments for therapy.

• Give medicines safely. If your child is taking ADHD medicine, always give it at the recommended time and dose. Keep medicines in a safe place.

• Work with your child's school. Ask teachers if your child should have an IEP. Meet often with teachers to find out how your child is doing. Work together to help your child do well

• Parent with purpose and warmth. Learn what parenting approaches are best for a child with ADHD — and which can make ADHD worse. Talk openly and supportively about ADHD with your child. Focus on your child's strengths and positive qualities.

• Connect with others for support and awareness. Join a support organization for ADHD to get updates on treatment and other information.

What Causes ADHD?

• It's not clear what causes the brain differences of ADHD. There's strong evidence that ADHD is mostly inherited. Many kids who have ADHD have a parent or relative with it.

• ADHD is not caused by too much screen time, poor parenting, or eating too much sugar.

• ADHD can improve when kids get treatment, eat healthy food, get enough sleep and exercise, and have supportive parents who know how to respond to ADHD.

Ibuprofen (i.e., Motrin®, Advil®) is an over-the-counter medicine used to reduce fever and relieve pain. This chart, based on your child's weight, can help determine the right dosage amount, but is no substitute for your pediatrician's advice.

For children older than 6 months of age only.

Dose is every 6-8 hours. Infant and Children's Motrin are different dosages, please check the label carefully.

Age limit: Don't use under 6 months of age unless directed by your child's pediatrician, because safety has not established and doesn't have FDA approval. Avoid multi-ingredient products in children under 6 years of age.

Dosage: Determine by finding child's weight in the bottom rows of the dosage table.

Measuring the dosage (should be in metric units): Dosing syringes are more accurate than household utensils. Use the syringe or device that comes with the medication. If not available with the medication, medicine syringes are available at pharmacies. Household spoons are not reliable. Note:1 level teaspoon equals 5 mL and that ½ teaspoon equals 2.5 mL.

Ibuprofen drops: Ibuprofen infant drops come with a measuring syringe

Adult dosage: 400 mg

Frequency: Repeat every 6-8 hours as needed.

Your Baby Should Be Doing This. . .

Physical Skills:

​Raises head & chest when on stomach

Stretches & kicks on back​

Opens and s​huts hands

Brings hand to mouth

Grasps and shakes toys

Social Skills:

Begins to develop social smile

Enjoys playing with people​​​​​

More communicative

More expressive with face & body

Imitates some movements & expressions

Sensory Milestones:

Follows moving objects

Recognizes familiar objects and people at a distance

Starts using hands and eyes in coordination

Prefers sweet smells

Prefers soft to coarse sensations

We do not have information from published scientific reports about susceptibility of pregnant women to COVID-19. Pregnant women experience immunologic and physiologic changes which might make them more susceptible to viral respiratory infections, including COVID-19. Pregnant women also might be at risk for severe illness, morbidity, or mortality compared to the general population as observed in cases of other related coronavirus infections [including severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)] and other viral respiratory infections, such as influenza, during pregnancy.

Pregnant women should engage in usual preventive actions to avoid infection like washing hands often and avoiding people who are sick.

Our motto is compassionate care close to home. We are so excited that now we can offer compassionate care at home!

Call Us to schedule your first virtual telehealth visit!

All insurances are currently covering virtual telehealth visits. These visits are subject to your normal co-pay and/or deductible amounts.

In order to be eligible, you must have a smartphone/tablet/laptop with camera and microphone. You will also need a thermometer and scale at home.

We are offering the following services via telehealth:

♥ Allergy medication refills

♥ Asthma maintenance & medication refills

♥ Behavioral health follow-ups

♥ COVID-19 Screening

♥ Help with Formula issues

♥ Diagnosis and treatment for:

♥ Constipation

♥ Diaper Rash

♥ Diarrhea

♥ Ear Pain

♥ Eczema

♥ Hand foot mouth disease

♥ Impetigo

♥ Insect Bites

♥ Pinworms

♥ Pink eye

♥ Rash

♥ Reflux

♥ Seasonal Allergies

♥ Sore throat with fever

♥ Sty

♥ Thrush

♥ Vomiting

If your child is sick, and you are interested in scheduling a telemedicine visit with one of our providers give us a call! Our doors are still open at all our locations with normal business hours!

Your Baby Should Be Doing This. . .

Physical Skills:

​Raises head & chest when on stomach

Stretches & kicks on back​

Opens and s​huts hands

Brings hand to mouth

Grasps and shakes toys

Social Skills:

Begins to develop social smile

Enjoys playing with people​​​​​

More communicative

More expressive with face & body

Imitates some movements & expressions

Sensory Milestones:

Follows moving objects

Recognizes familiar objects and people at a distance

Starts using hands and eyes in coordination

Prefers sweet smells

Prefers soft to coarse sensations

APPOINTMENTS:

We understand that children can get sick without warning, and we do our best to see them as soon as possible. The earlier you call to schedule an appointment, the more likely you are to get an appointment that day. Should you call later in the day, we will do our best to provide you with an appointment as soon as possible, but may have to schedule your appointment for the next day. Of course, walk-ins are always welcomed if that happens.

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If you would like to see a specific doctor for a regular checkup, plan on calling at least four weeks ahead of time to schedule an appointment with him or her. If you are unable to call that far in advance, we may be able to provide you with appointment but may need to schedule you with a different doctor or request for you to go to a different office.

​

We are here to schedule appointments starting at 8:00 a.m. on weekdays.

​

Please Note: To keep people from having to wait too long in our offices, we will reschedule your appointment if you are more than 15 minutes late to your doctor's visit.

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REFERRALS:

Sometimes your pediatrician may recommend that your child will see another doctor or a specialist after their appointment. We will work with you and your insurance provider to find the best specialist near you for your child. In the event that you might have any questions about this process, you may personally ask your doctor or you may call our Lake City office and ask to speak with our Referral Coordinator.

Any other questions? Please do not hesitate to contact our main office at (386) 758-0003 for any questions or concerns.

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Your Baby Should Be Doing These Things. . .

Physical Skills:

Rolls bot​h ways

Sits with and ​without support of hands

Supports whole weight on l​egs

Reaches with one hand

Transfers object from hand to hand

Uses raking grasp​

Social Skills:

Begins to develop social smile

Enjoys playing with people​​​​​

More communicative

More expressive with face & body

Imitates some movements & expressions

Sensory Milestones:

Follows moving objects

Recognizes familiar objects and people at a distance

Starts using hands and eyes in coordination

Prefers sweet smells

Prefers soft to coarse sensations

At North Florida Pediatrics we provide unique expertise in all aspects of newborn care, parental education and support. Our job is to help nurture and care for newborns while providing guidance and education for the parents.

Our board certified providers will be able to assists our parents with compassionate care such as:

• Bathing

• Diaper Rash Prevention

• Feeding

• Fever/illnesses

• Genitalia Care for all genders

• Health & Safety Tips

• Immunizations

• Juandice

• Sleeping

• Stools

• Umbilicial Cord Care

• Urine

• Vitals

• Vitamins

• Weight Management

• & Much More.

• Have supplies on hand

• Contact your healthcare provider to ask about obtaining extra necessary medications to have on hand in case there is an outbreak of COVID-19 in your community and you need to stay home for a prolonged period of time.

• If you cannot get extra medications, consider using mail-order for medications.

• Be sure you have over-the-counter medicines and medical supplies (tissues, etc.) to treat fever and other symptoms. Most people will be able to recover from COVID-19 at home.

• Have enough household items and groceries on hand so that you will be prepared to stay at home for a period of time.

Take everyday precautions

• Avoid close contact with people who are sick

• Take everyday preventive actions

• Clean your hands often

• Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing, or having been in a public place.

• If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.

• To the extent possible, avoid touching high-touch surfaces in public places – elevator buttons, door handles, handrails, handshaking with people, etc. Use a tissue or your sleeve to cover your hand or finger if you must touch something.

• Wash your hands after touching surfaces in public places.

• Avoid touching your face, nose, eyes, etc.

• Clean and disinfect your home to remove germs: practice routine cleaning of frequently touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks & cell phones)

• Avoid crowds, especially in poorly ventilated spaces. Your risk of exposure to respiratory viruses like COVID-19 may increase in crowded, closed-in settings with little air circulation if there are people in the crowd who are sick.

If COVID-19 is spreading in your community, take extra measures to put distance between yourself and other people

• Stay home as much as possible.

• Consider ways of getting food brought to your house through family, social, or commercial networks

• Have a plan for if you get sick:

• Consult with your health care provider for more information about monitoring your health for symptoms suggestive of COVID-19.

• Stay in touch with others by phone or email. You may need to ask for help from friends, family, neighbors, community health workers, etc. if you become sick.

• Determine who can provide you with care if your caregiver gets sick

Watch for symptoms and emergency warning signs

• Pay attention for potential COVID-19 symptoms including, fever, cough, and shortness of breath. If you feel like you are developing symptoms, call your doctor.

• If you develop emergency warning signs for COVID-19 get medical attention immediately. In adults, emergency warning signs*:

• Difficulty breathing or shortness of breath

• Persistent pain or pressure in the chest

• New confusion or inability to arouse

• Bluish lips or face

*This list is not all inclusive. Please consult your medical provider for any other symptom that is severe or concerning.

We do not have information on adverse pregnancy outcomes in pregnant women with COVID-19. Pregnancy loss, including miscarriage and stillbirth, has been observed in cases of infection with other related coronaviruses [SARS-CoV and MERS-CoV] during pregnancy. High fevers during the first trimester of pregnancy can increase the risk of certain birth defects.

Watch for symptoms

Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed coronavirus disease 2019 (COVID-19) cases.

The following symptoms may appear 2-14 days after exposure.*

• Fever

• Cough

• Shortness of breath

Call your doctor if you…

Develop symptoms, and have been in close contact with a person known to have COVID-19

OR

Have recently traveled from an area with widespread or ongoing community spread of COVID-19.

Your Baby Should Be Doing These Things. . .

Physical Skills:

Rolls bot​h ways

Sits with and ​without support of hands

Supports whole weight on l​egs

Reaches with one hand

Transfers object from hand to hand

Uses raking grasp​

Social Skills:

Begins to develop social smile

Enjoys playing with people​​​​​

More communicative

More expressive with face & body

Imitates some movements & expressions

Sensory Milestones:

Follows moving objects

Recognizes familiar objects and people at a distance

Starts using hands and eyes in coordination

Prefers sweet smells

Prefers soft to coarse sensations

Because your child is moving around more, he will come across more dangers as well. Dangerous situations can happen quickly, so keep a close eye on your child.

Here are a few tips to help keep your growing toddler safe:

• Do NOT leave your toddler near or around water (for example, bathtubs, pools, ponds, lakes, whirlpools, or the ocean) without someone watching her. Fence off backyard pools. Drowning is the leading cause of injury and death among this age group.

• Block off stairs with a small gate or fence. Lock doors to dangerous places such as the garage or basement.

• Ensure that your home is toddler proof by placing plug covers on all unused electrical outlets.

• Keep kitchen appliances, irons, and heaters out of reach of your toddler. Turn pot handles toward the back of the stove.

• Keep sharp objects such as scissors, knives, and pens in a safe place.

• Lock up medicines, household cleaners, and poisons.

• Do NOT leave your toddler alone in any vehicle (that means a car, truck, or van) even for a few moments.

• Store any guns in a safe place out of his reach.

• Keep your child’s car seat rear-facing as long as possible. According to the National Highway Traffic Safety Administration it’s the best way to keep her safe. Your child should remain in a rear-facing car seat until she reaches the top height or weight limit allowed by the car seat’s manufacturer. Once your child outgrows the rear-facing car seat, she is ready to travel in a forward-facing car seat with a harness.

*Please review our dosage notes for more useful information. Please remember even though this chart that should be based on your child's weight can help determine the right dosage amount, it should never substitute for your pediatrician's advice.

What to Expect During This Visit

The doctor and/or nurse will probably:

1. Check your baby's weight, length, and head circumference and plot the measurements on the growth charts.

2. Ask questions, address any concerns, and offer advice about how your baby is:

• Feeding. Newborns should be fed whenever they seem hungry. Breastfed infants eat about every 1–3 hours, and formula-fed infants eat about every 2–4 hours. Your doctor or nurse can watch as you breastfeed and offer help with any problems. Burp your baby midway through a feeding and again at the end.

• Peeing and pooping. Newborns should have about six wet diapers a day. The number of poopy diapers varies, but most newborns have 3 or 4 soft bowel movements a day. Tell your doctor if you have any concerns about your newborn's bowel movements.

• Sleeping. A newborn may sleep up to 18 or 19 hours a day, waking up often (day and night) to breastfeed or take a bottle. Breastfed babies usually wake to eat every 1–3 hours, while formula-fed babies may sleep longer, waking every 2–4 hours to eat (formula takes longer to digest so babies feel fuller longer). Newborns should not sleep more than 4 hours between feedings until they have good weight gain, usually within the first few weeks. After that, it's OK if a baby sleeps for longer stretches.

• Developing. In the first month, babies should:

• pay attention to faces or bright objects 8–12 inches (20–30 cm) away

• respond to sound — they may quiet down, blink, turn head, startle, or cry

• hold arms and legs in a flexed position

• move arms and legs equally

• lift head briefly when on stomach (babies should only be placed on the stomach while awake and under supervision)

• have strong newborn reflexes, such as:

• rooting and sucking: turns toward, then sucks breast/bottle nipple

• grasp: tightly grabs hold of a finger placed within the palm

• fencer's pose: straightens arm when head is turned to that side and bends opposite arm

• Moro reflex (startle response): throws out arms and legs, then curls them in when startled

3. Do a physical exam with your baby undressed with you present. This exam will include an eye exam, listening to your baby's heart and feeling pulses, inspecting the umbilical cord, and checking the hips.

4. Do screening tests. Your doctor will review the screening tests from the hospital and repeat tests, if needed. If a hearing test wasn't done then, your baby will have one now.

5. Update immunizations. Immunizations can protect infants from serious childhood illnesses, so it's important that your baby get them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

Looking Ahead

Here are some things to keep in mind until your next routine visit at 1 month:

Feeding

• Continue to feed your baby when he or she is hungry. Pay attention to signs that your baby is full, such as turning away from the nipple or bottle and closing the mouth.

• Don't give solid foods or juice.

• Don't put cereal in your baby's bottle unless directed to by your doctor.

If you breastfeed:

• Help your baby latch on correctly: mouth opened wide, tongue down, with as much breast in the mouth as possible.

• Continue to take a prenatal vitamin or multivitamin daily.

• Ask your doctor about vitamin D drops for your baby.

• Don't use a bottle or pacifier until nursing is well established (usually about 1 month).

If you formula-feed:

• Give your baby iron-fortified formula.

• Follow the formula package's instructions when making and storing bottles.

• Don't prop bottles or put your baby to bed with a bottle.

• Talk to your doctor before switching formulas.

Routine Care

• Wash your hands before handling the baby and avoid people who may be sick.

• Keep the diaper below the umbilical cord so the stump can dry. The umbilical cord usually falls off in 10–14 days.

• For circumcised boys, put petroleum jelly on the penis or diaper's front.

• Give sponge baths until the umbilical cord falls off and a boy's circumcision heals. Make sure the water isn't too hot — test it with your wrist first.

• Use fragrance-free soaps and lotions.

• Hold your baby and be attentive to his or her needs. You can't spoil a newborn.

• Sing, talk, and read to your baby. Babies learn best by interacting with people.

• It's normal for infants to have fussy periods, but for some, crying can be excessive, lasting several hours a day. If a baby develops colic, it usually starts in an otherwise well baby around 3 weeks of age.

• Call your baby's doctor if your infant has a fever or is acting sick, isn't eating, isn't peeing, or isn't pooping. Don't give medicine to an infant younger than 2 months old without talking to your doctor first.

• It's common for new moms to feel tired and overwhelmed at times. But if these feelings are intense, or you feel sad, moody, or anxious, call your doctor.

• Talk to your doctor if you're concerned about your living situation. Do you have the things that you need to take care of your baby? Do you have enough food, a safe place to live, and health insurance? Your doctor can tell you about community resources or refer you to a social worker.

Safety

1. To reduce the risk of sudden infant death syndrome (SIDS):

• Breastfeed your baby.

• Let your baby sleep in your room in a bassinet or crib next to the bed until your baby's first birthday or for at least 6 months, when the risk of SIDS is highest.

• Always place your baby to sleep on a firm mattress on his or her back in a crib or bassinet without any crib bumpers, blankets, quilts, pillows, or plush toys.

• Avoid overheating by keeping the room temperature comfortable.

• Don't overbundle your baby.

• Consider putting your baby to sleep sucking on a pacifier. If you're breastfeeding, wait until breastfeeding is established before introducing the pacifier.

1. Don't smoke or use e-cigarettes. Don't let anyone else smoke or vape around your baby.

2. Always put your baby in a rear-facing car seat in the back seat. Never leave your baby alone in a car.

3. While your baby is awake, don't leave your little one unattended, especially on high surfaces or in the bath.

4. Never shake your baby — it can cause bleeding in the brain and even death.

5. Avoid sun exposure by keeping your baby covered and in the shade when possible. Sunscreens are not recommended for infants younger than 6 months. However, you may use a small amount of sunscreen on an infant younger than 6 months if shade and clothing don't offer enough protection.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.

If you are interested in learning about our self-pay options please call: 386-758-0003 for information! We will be happy to answer all your questions and provide you with all the information needed to apply.

• Give your child water and plain milk instead of sugary drinks. After the first year, when your nursing toddler is eating more and different solid foods, breast milk is still an ideal addition to his diet.

• Your toddler might become a very picky and erratic eater. Toddlers need less food because they don’t grow as fast. It’s best not to battle with him over this. Offer a selection of healthy foods and let him choose what she wants. Keep trying new foods; it might take time for him to learn to like them.

• Limit screen time and develop a media use plan for your family. For children younger than 18 months of age, the AAP recommends that it’s best if toddlers not use any screen media other than video chatting.

• Your toddler will seem to be moving continually—running, kicking, climbing, or jumping. Let him be active—he’s developing his coordination and becoming strong.

• Make sure your child gets the recommended amount of sleep each night: For toddlers 1-2 years, 11–14 hours per 24 hours (including naps)

We treat kids from birth to age 21.

Yes. Layovers at airports in destinations with level 3 travel notices are included in CDC’s recommendation to avoid nonessential travel. If a layover is unavoidable, CDC recommends that travelers not leave the airport. Travelers with layovers may still be subject to screening and monitoring when entering the United States.

Anxiety disorders are the most common type of mental health disorder in childhood, affecting approximately 8% of all children and adolescents. There are many types of anxiety disorders that affect youth, the most common being Generalized Anxiety Disorder, Panic Disorder, Separation Anxiety Disorder, and Phobic Disorders.

Symptoms Symptoms of anxiety disorders can include:

• ​Recurring fears and worries abo​ut routine parts of every day life

• ​Physical complaints, like stomachache or headache

• ​Trouble concentrating

• ​Trouble sleeping

• ​Fear of social situations

• Fear of leaving home

• ​Fear of separation from a loved one

• Refusing to go to school

• Co-morbid disorders, in particular ADHD and depression, are not uncommon.

Treatment Anxiety disorders are treatable! Studies have shown that cognitive behavioral therapies (CBT) and medication treatments are both effective in treating anxiety disorders in youth. Parent involvement in treatment has also been shown to improve outcomes in some children. Early treatment can prevent future difficulties, such as academic or social difficulties and low self-esteem.

Understanding Childhood Fears and Anxieties

My child seems to be afraid of a lot of things. Should I be worried?

From time to time, every child experiences fear. As youngsters explore the world around them, having new experiences and confronting new challenges, anxieties are almost an unavoidable part of growing up.

Fears are Common:

According to one study, 43% of children between ages 6 and 12 had many fears and concerns. A fear of darkness, particularly being left alone in the dark, is one of the most common fears in this age group. So is a fear of animals, such as large barking dogs. Some children are afraid of fires, high places or thunderstorms. Others, conscious of news reports on TV and in the newspapers, are concerned about burglars, kidnappers or nuclear war. If there has been a recent serious illness or death in the family, they may become anxious about the health of those around them.

In middle childhood, fears wax and wane. Most are mild, but even when they intensify, they generally subside on their own after a while.

About Phobias:

Sometimes fears can become so extreme, persistent and focused that they develop into phobias. Phobias – which are strong and irrational fears – can become persistent and debilitating, significantly influencing and interfering with a child's usual daily activities. For instance, a 6-year-old's phobia about dogs might make him so panicky that he refuses to go outdoors at all because there could be a dog there. A 10-year-old child might become so terrified about news reports of a serial killer that he insists on sleeping with his parents at night.

Some children in this age group develop phobias about the people they meet in their everyday lives. This severe shyness can keep them from making friends at school and relating to most adults, especially strangers. They might consciously avoid social situations like birthday parties or Scout meetings, and they often find it difficult to converse comfortably with anyone except their immediate family.

Separation anxiety is also common in this age group. Sometimes this fear can intensify when the family moves to a new neighborhood or children are placed in a childcare setting where they feel uncomfortable. These youngsters might become afraid of going to summer camp or even attending school. Their phobias can cause physical symptoms like headaches or stomach pains and eventually lead the children to withdraw into their own world, becoming clinically depressed.

At about age 6 or 7, as children develop an understanding about death, another fear can arise. With the recognition that death will eventually affect everyone, and that it is permanent and irreversible, the normal worry about the possible death of family members – or even their own death – can intensify. In some cases, this preoccupation with death can become disabling.

Treating Fears & Phobias:

Fortunately, most phobias are quite treatable. In general, they are not a sign of serious mental illness requiring many months or years of therapy. However, if your child's anxieties persist and interfere with her enjoyment of day-to-day life, she might benefit from some professional help from a psychiatrist or psychologist who specializes in treating phobias.

As part of the treatment plan for phobias, many therapists suggest exposing your child to the source of her anxiety in small, nonthreatening doses. Under a therapist's guidance a child who is afraid of dogs might begin by talking about this fear and by looking at photographs or a videotape of dogs. Next, she might observe a live dog from behind the safety of a window. Then, with a parent or a therapist at her side, she might spend a few minutes in the same room with a friendly, gentle puppy. Eventually she will find himself able to pet the dog, then expose herself to situations with larger, unfamiliar dogs.

This gradual process is called desensitization, meaning that your child will become a little less sensitive to the source of her fear each time she confronts it. Ultimately, the child will no longer feel the need to avoid the situation that has been the basis of her phobia. While this process sounds like common sense and easy to carry out, it should be done only under the supervision of a professional.

Sometimes psychotherapy can also help children become more self-assured and less fearful. Breathing and relaxation exercises can assist youngsters in stressful circumstances too.

Occasionally, your doctor may recommend medications as a component of the treatment program, although never as the sole therapeutic tool. These drugs may include antidepressants, which are designed to ease the anxiety and panic that often underlie these problems.

What Parents Can Do:

Here are some suggestions that many parents find useful for their children with fears and phobias.

• Talk with your child about his anxieties, and be sympathetic. Explain to him that many children have fears, but with your support he can learn to put them behind him.

• Do not belittle or ridicule your child's fears, particularly in front of his peers.

• Do not try to coerce your youngster into being brave. It will take time for him to confront and gradually overcome his anxieties. You can, however, encourage (but not force) him to progressively come face-to-face with whatever he fears.

Since fears are a normal part of life and often are a response to a real or at least perceived threat in the child's environment, parents should be reassuring and supportive. Talking with their children, parents should acknowledge, though not increase or reinforce, their children's concerns. Point out what is already being done to protect the child, and involve the child in identifying additional steps that could be taken. Such simple, sensitive and straightforward parenting can resolve or at least manage most childhood fears. When realistic reassurances are not successful, the child's fear may be a phobia.

On February 11, 2020 the World Health Organization announced an official name for the disease that is causing the 2019 novel coronavirus outbreak, first identified in Wuhan China. The new name of this disease is coronavirus disease 2019, abbreviated as COVID-19. In COVID-19, ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease. Formerly, this disease was referred to as “2019 novel coronavirus” or “2019-nCoV”.

There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses. COVID-19 is a new disease, caused be a novel (or new) coronavirus that has not previously been seen in humans. The name of this disease was selected following the World Health Organization (WHO) best practice for naming of new human infectious diseases.

Second trimester: Week 13 – Week 28

Second Trimester: Changes a Woman May Experience

Once you enter the second trimester you may find it easier than the first. Your nausea (morning sickness) and fatigue may lessen or go away completely. However, you will also notice more changes to your body. That "baby bump" will start to show as your abdomen expands with the growing baby. By the end of the second trimester you will even be able to feel your baby move!

Second Trimester: Physical and Emotional Changes in a Woman

Some changes you may notice in your body in the second trimester include:

• Back, abdomen, groin, or thigh aches and pains

• Stretch marks on your abdomen, breasts, thighs, or buttocks

• Darkening of the skin around your nipples

• A line on the skin running from belly button to pubic hairline (linea nigra)

• Patches of darker skin, usually over the cheeks, forehead, nose, or upper lip. This is sometimes called the mask of pregnancy (melasma, or Chloasma facies).

• Numb or tingling hands (carpal tunnel syndrome)

• Itching on the abdomen, palms, and soles of the feet. (Call your doctor if you have nausea, loss of appetite, vomiting, yellowing of skin, or fatigue combined with itching. These can be signs of a liver problem.)

• Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you gain a lot of weight quickly, call your doctor immediately. This could be a sign of a serious condition called preeclampsia.)

Second Trimester: The Baby at 16 Weeks

As your body changes in the second trimester, your baby continues to develop:

• The musculoskeletal system continues to form.

• Skin begins to form and is nearly translucent.

• Meconium develops in your baby's intestinal tract. This will be your baby's first bowel movement.

• Your baby begins sucking motions with the mouth (sucking reflex).

• Your baby is about 4 to 5 inches long and weighs almost 3 ounces.

Second Trimester: The Baby at 20 Weeks

At about 20 weeks in the second trimester, your baby continues to develop:

• Your baby is more active. You might feel movement or kicking.

• Your baby is covered by fine, feathery hair called lanugo and a waxy protective coating called vernix.

• Eyebrows, eyelashes, fingernails, and toenails have formed. Your baby can even scratch itself.

• Your baby can hear and swallow.

• Now halfway through your pregnancy, your baby is about 6 inches long and weighs about 9 ounces.

Second Trimester: The Baby at 24 Weeks

By 24 weeks, even more changes occur for your growing baby:

• The baby's bone marrow begins to make blood cells.

• Taste buds form on your baby's tongue.

• Footprints and fingerprints have formed.

• Hair begins to grow on your baby's head.

• The lungs are formed, but do not yet work.

• Your baby has a regular sleep cycle.

• If your baby is a boy, his testicles begin to descend into the scrotum. If your baby is a girl, her uterus and ovaries are in place, and a lifetime supply of eggs has formed in the ovaries.

• Your baby stores fat and weighs about 1½ pounds, and is 12 inches long.

*Please review our dosage notes for more useful information. Please remember even though this chart that should be based on your child's weight can help determine the right dosage amount, it should never substitute for your pediatrician's advice.

We have different options to offer to our patients.

We offer sliding fees, or Selfpay.

Please view our Billing Page to see more information about sliding fees or Selfpay.

Your Baby Should Be Doing This. . .

Physical Skills

Gets to sitting​ position​ without help

Crawls forward on belly

​Assumes hands-and-knees ​positions

Gets from sitting to crawling position

Pulls self up to stand

Walks holding on to furniture

Social Skills

​Shy or anxious with strangers

Cries whe​n parents leave

Enjoys imitating peopl​e in play

Prefers certain people and toys

Tests parental response

Finger-feeds himself

Cognitive Thinking

​Explores objects in different ways

Finds hidden objects easily

​Looks at correct picture when the image​ is named

Imitates gestures

Begins to use objects correctly

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your baby's weight, length, and head circumference and plot the measurements on the growth charts.

2. Ask questions, address any concerns, and offer advice about how your baby is:

• Feeding. Infants should be fed when they seem hungry. At this age, breastfed babies will eat about eight to twelve times in a 24-hour period. Formula-fed infants consume about 24 ounces a day. Burp your baby midway through feedings and at the end.

• Peeing and pooping. Infants should have about six wet diapers a day. The number of poopy diapers varies, but most breastfed babies will have three or more. Around 6 weeks of age, breastfed babies may go several days without a bowel movement. Formula-fed babies have at least one bowel movement a day. Tell your doctor if you have any concerns about your infant's bowel movements.

• Sleeping. Infants this age sleep about 14 to 17 hours a day, including 4 or 5 daytime naps. Breastfed babies may still wake often to eat at night, while bottle-fed infants may sleep for longer stretches.

Developing. By 1 month of age, babies should:

• focus and follow objects (especially faces)

• respond to sound by quieting down, blinking, turning the head, startling, or crying

• still hold arms and legs in a flexed position, but start to extend legs more frequently

• move arms and legs equally

• lift the head briefly when on the stomach

• have strong newborn reflexes:

• rooting and sucking: turns toward, then sucks breast/bottle nipple

• grasp: tightly grabs hold of a finger placed within the palm

• fencer's pose: straightens arm when head is turned to that side and bends opposite arm

• Moro reflex (startle response): throws out arms and legs and then curls them in when startled

3. Do a physical exam with your baby undressed while you are present. This will include an eye exam, listening to your baby's heart and feeling pulses, examining the belly, and checking the hips.

4. Do screening tests. Your doctor will review the screening tests from the hospital and repeat tests, if needed. If a hearing test wasn't done then, your baby will have one now.

5. Update immunizations. Immunizations can protect infants from serious childhood illnesses, so it's important that your baby get them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

Looking Ahead

Here are some things to keep in mind until your baby's next routine checkup at 2 months:

Feeding

• Continue to feed your baby when he or she is hungry. Pay attention to signs that your baby is full, such as turning away from the breast or nipple and closing the mouth. Between 6 and 8 weeks, your baby may be hungrier due to a growth spurt.

• Don't give solid foods or or juice.

• Don't put cereal in your baby's bottle unless directed to by your doctor.

• Continue to burp your baby midway through and at the end of feedings.

If you breastfeed:

• If you haven't yet, you can now pump and store breast milk for future use.

• If breastfeeding is well established, it's OK to introduce a bottle or pacifier. You might need to have someone else offer the bottle if your little one rejects it when you try.

• Continue to take a prenatal vitamin or multivitamin daily.

• Ask your doctor about vitamin D drops for the baby.

If you formula-feed:

• Give your baby iron-fortified formula.

• Follow the formula package's instructions when making and storing bottles.

• Don't prop bottles or put your baby to bed with a bottle.

• Talk to your doctor before switching formulas.

Routine Care

• Wash your hands before handling the baby and avoid people who may be sick.

• Hold your baby and be attentive to his or her needs. You can't spoil a baby.

• Sing, talk, and read to your baby. Babies learn best by interacting with people.

• Give your baby supervised "tummy time" when awake. Always supervise your baby and be ready to help if he or she gets tired or frustrated in this position.

• It's normal for infants to have fussy periods, but for some, crying can be excessive, lasting several hours a day. If a baby develops colic, it usually starts in an otherwise well baby at around 3 weeks, peaks around 6 weeks, and improves by 3 months.

• Call your doctor if your baby has a fever or is acting sick. Don't give medicine to an infant younger than 2 months old without talking to your doctor first.

• It's common for new moms to feel tired and overwhelmed at times. But if these feelings are intense, or you feel sad, moody, or anxious, call your doctor.

• Talk to your doctor if you're concerned about your living situation. Do you have the things that you need to take care of your baby? Do you have enough food, a safe place to live, and health insurance? Your doctor can tell you about community resources or refer you to a social worker.

Safety

1. To reduce the risk of sudden infant death syndrome (SIDS):

• Let your baby sleep in your room in a bassinet or crib next to the bed until your baby's first birthday or for at least 6 months, when the risk of SIDS is highest.

• Always place your baby to sleep on a firm mattress on his or her back in a crib or bassinet without any crib bumpers, blankets, quilts, pillows, or plush toys.

• Avoid overheating by keeping the room temperature comfortable.

• Don't overbundle your baby.

• Consider putting your baby to sleep sucking on a pacifier.

1. Don't smoke or use e-cigarettes. Don't let anyone smoke or vape around your baby.

2. Always put your baby in a rear-facing car seat in the backseat. Never leave your baby alone in the car.

3. Keep all cords, wires, and toys with loops or strings away from your baby.

4. While your baby is awake, don't leave your little one unattended, especially on high surfaces or in the bath.

5. Never shake your baby — it can cause bleeding in the brain and even death.

6. Avoid sun exposure by keeping your baby covered and in the shade when possible. Sunscreens are not recommended for infants younger than 6 months. However, you may use a small amount of sunscreen on an infant younger than 6 months if shade and clothing don't offer enough protection.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.

On February 11, 2020, the International Committee on Taxonomy of Viruses, charged with naming new viruses, named the novel coronavirus, first identified in Wuhan, China, severe acute respiratory syndrome coronavirus 2, shortened to SARS-CoV-2.

As the name indicates, the virus is related to the SARS-associated coronavirus (SARS-CoV) that caused an outbreak of severe acute respiratory syndrome (SARS) in 2002-2003, however it is not the same virus.

PREVENTION:

There is currently no vaccine to prevent coronavirus disease 2019 (COVID-19). The best way to prevent illness is to avoid being exposed to this virus. However, as a reminder, CDC always recommends everyday preventive actions to help prevent the spread of respiratory diseases, including:

• Avoid close contact with people who are sick.

• Avoid touching your eyes, nose, and mouth.

• Stay home when you are sick.

• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

• Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

Follow CDC’s recommendations for using a facemask.

CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases, including COVID-19.

Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others. The use of facemasks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a health care facility).

Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.

If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.

For information about handwashing, see CDC’s Handwashing website.

For information specific to healthcare, see CDC’s Hand Hygiene in Healthcare Settings

These are everyday habits that can help prevent the spread of several viruses. CDC does have specific guidance for travelers.

TREATMENT:

There is no specific antiviral treatment recommended for COVID-19. People with COVID-19 should receive supportive care to help relieve symptoms. For severe cases, treatment should include care to support vital organ functions.

People who think they may have been exposed to COVID-19 should contact their healthcare provider immediately.

Community Support for Older Adults

• Community preparedness planning for COVID-19 should include older adults and people with disabilities, and the organizations that support them in their communities, to ensure their needs are taken into consideration.

• Many of these individuals live in the community, and many depend on services and supports provided in their homes or in the community to maintain their health and independence.

• Long-term care facilities should be vigilant to prevent the introduction and spread of COVID-19.

Family and Caregiver Support

• Know what medications your loved one is taking and see if you can help them have extra on hand.

• Monitor food and other medical supplies (oxygen, incontinence, dialysis, wound care) needed and create a back-up plan.

• Stock up on non-perishable food items to have on hand in your home to minimize trips to stores.

• If you care for a loved one living in a care facility, monitor the situation, ask about the health of the other residents frequently and know the protocol if there is an outbreak.

Your Baby Should Be Doing This. . .

Physical Skills

Gets to sitting​ position​ without help

Crawls forward on belly

​Assumes hands-and-knees ​positions

Gets from sitting to crawling position

Pulls self up to stand

Walks holding on to furniture

Social Skills

​Shy or anxious with strangers

Cries whe​n parents leave

Enjoys imitating peopl​e in play

Prefers certain people and toys

Tests parental response

Finger-feeds himself

Cognitive Thinking

​Explores objects in different ways

Finds hidden objects easily

​Looks at correct picture when the image​ is named

Imitates gestures

Begins to use objects correctly

*Please review our dosage notes for more useful information. Please remember even though this chart that should be based on your child's weight can help determine the right dosage amount, it should never substitute for your pediatrician's advice.

• Hard Copies shall be charged at $0.10 per page, up to a total of $6.50. (Must not exceed the total amount of $6.50)

• For reproducing specific types of reports, they will be charged at the actual cost of the reproduction, including supplies and labor associated with the request.

• If the patient prefers medical records to be on a USB or CD, North Florida Pediatrics will provide the flash drive or CD with a cost of $6.50.

• You may request that the records be e-mailed to you free of charge, with the understanding that you assume the risks associated with transmitting your information through the internet.

• You may receive a written summary or your personal health information. The cost will be $6.50.

• If records are for a lawyer - please be advised it will be a different cost.

As your child becomes more independent and spends more time in the outside world, it is important that you and your child are aware of ways to stay safe.

Here are a few tips to protect your child:

• Tell your child why it is important to stay out of traffic. Tell him not to play in the street or run after stray balls.

• Be cautious when letting your child ride her tricycle. Keep her on the sidewalk and away from the street and always have her wear a helmet.

• Check outdoor playground equipment. Make sure there are no loose parts or sharp edges.

• Watch your child at all times, especially when he is playing outside.

• Be safe in the water. Teach your child to swim, but watch her at all times when she is in or around any body of water (this includes kiddie pools).

• Teach your child how to be safe around strangers.

• Keep your child in a forward-facing car seat with a harness until he reaches the top height or weight limit allowed by the car seat’s manufacturer. Once your child outgrows the forward-facing car seat with a harness, it will be time for him to travel in a booster seat, but still in the back seat of the vehicle. The National Highway Traffic Safety Administration has information on how to keep your child safe while riding in a vehicle.

It is important for children to visit the pediatrician at regular intervals. During these visits we will evaluate your child's growth and development; administer vaccines; discuss behavior, safety and nutrition; administer hearing and vision tests; run routine lab tests; and answer any questions you may have.

Autism spectrum disorder (ASD) is a neurodevelopmental disability that affects a child's social skills, communication, and behavior.

Because most children with ASD will sit, crawl, and walk on time, you may not notice delays in social and communication skills in the first year of life.

Looking back, many parents can recall early differences in interaction and communication.

ASD symptoms may change as children get older and with intervention.

As many children with autism develop, they may likely have other developmental, learning, speech/language, behavioral issues, as well or other medical diagnoses. Other children, while not very common, may improve so much with intervention that they might no longer meet criteria for a a diagnosis of ASD.

How common is ASD?

• ASD affects about 1 in 59 children. Boys are diagnosed with ASD about 4 times more often than girls.

• The number of children reported to have autism has increased since the early 1990s; the increase could be caused by many factors.

• Many families are more aware of ASD.

• Pediatricians are doing more screening for ASD, as recommended by the AAP, and children are identified earlier—which is a good thing.

• Schools are more aware and children are receiving more appropriate special education services.

There have been many changes in how ASD is defined and diagnosed.

Changes in how autism is defined & diagnosed:

​Doctors use the a book called Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to assist in diagnosing autism. In the past, only children with the most severe autism symptoms were diagnosed. But in 2013, the diagnostic criteria for autism spectrum disorder (ASD) changed based on the research literature and clinical experience in the 19 years since the DSM-IV was published in 1994. Now children with milder symptoms are being identified and helped.

Several conditions used to be diagnosed separately under the term "pervasive developmental disorders" or "autism spectrum disorders" in the DSM.

Those conditions were:

• Autistic disorder

• Pervasive developmental disorder—not otherwise specified (PDD-NOS)

• Asperger syndrome

• Disintegrative Disorder

With publication of the fifth edition of the DSM in 2013, the terms listed above are no longer used and these conditions are now grouped in the broader category of autism spectrum disorder or ASD. Many people may self-identify as having Asperger Syndrome, but professionals should no longer use this terminology when making a diagnosis.

​The benefits of early identification:

Each child with autism has different needs. The sooner autism is identified, the sooner an early intervention program directed at the child's symptoms can begin.

The American Academy of Pediatrics (AAP) recommends that all children be screened for ASD at their 18- and 24-month well-child checkups. Research shows that starting an intervention program as soon as possible can improve outcomes for many children with autism.

Children with ASD may have other medical problems that may need further evaluation and treatment. These may include seizures, problems with sleep, gastrointestinal problems (feeding problems, abdominal pain, constipation, diarrhea, and behavioral health problems (such as anxiety, ADHD, irritability, and aggression).

Each company establishes its own refund policies, and CDC cannot intervene to get them to change their policies. Some companies may base their policies on CDC’s travel health notices.

The decision to post or change the level of a travel health notice is based on the best available science and takes into account numbers of cases, sustained spread, geographic spread of cases, risk to travelers, and other factors. https://www.cdc.gov/coronavirus/2019-ncov/travelers/

In some cases, trip cancellation insurance can protect your financial investment in a trip if you need to change your itinerary in the event of an international outbreak. https://wwwnc.cdc.gov/travel/page/insurance

Pregnant healthcare personnel (HCP) should follow risk assessment and infection control guidelines for HCP exposed to patients with suspected or confirmed COVID-19. Adherence to recommended infection prevention and control practices is an important part of protecting all HCP in healthcare settings. Information on COVID-19 in pregnancy is very limited; facilities may want to consider limiting exposure of pregnant HCP to patients with confirmed or suspected COVID-19, especially during higher risk procedures (e.g., aerosol-generating procedures) if feasible based on staffing availability.

Third Trimester: Week 29 – Week 40 (birth)

Third Trimester: Changes a Woman May Experience

The third trimester is the final stage of pregnancy. Discomforts that started in the second trimester will likely continue, along with some new ones. As the baby grows and puts more pressure on your internal organs, you may find you have difficulty breathing and have to urinate more frequently. This is normal and once you give birth these problems should go away.

Third Trimester: Emotional and Physical Changes a Woman May Experience

In the third and final trimester you will notice more physical changes, including:

• Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme swelling or if you gain a lot of weight really quickly, call your doctor right away. This could be a sign of a serious condition called preeclampsia.)

• Hemorrhoids

• Tender breasts, which may leak a watery pre-milk called colostrum

• Your belly button may protrude

• The baby "dropping," or moving lower in your abdomen

• Contractions, which can be a sign of real or false labor

• Other symptoms you may notice in the third trimester include shortness of breath, heartburn, and difficulty sleeping

Third Trimester: Changes as the Due Date Approaches

Other changes are happening in your body during the third trimester that you can't see. As your due date approaches, your cervix becomes thinner and softer in a process called effacement that helps the cervix open during childbirth. Your doctor will monitor the progress of your pregnancy with regular exams, especially as you near your due date.

Third Trimester: The Baby at 32 Weeks

At 32 weeks in the third trimester, your baby's development continues:

• Your baby's bones are soft but fully formed.

• Movements and kicking increase.

• The eyes can open and close.

• Lungs are not fully formed, but practice "breathing" movements occur.

• Your baby's body begins to store vital minerals, such as iron and calcium.

• Lanugo (fine hair) begins to fall off.

• Your baby is gaining about ½ pound a week, weighs about 4 to 4½ pounds, and is about 15 to 17 inches long.

Third Trimester: The Baby at 36 Weeks

At 36 weeks, as your due date approaches, your baby continues development:

• The protective waxy coating (vernix) thickens.

• Body fat increases.

• Your baby is getting bigger and has less space to move around. Movements are less forceful, but you will still feel them.

• Your baby is about 16 to 19 inches long and weighs about 6 to 6½ pounds.

Third Trimester: The baby at 37 to 40 Weeks

Finally, from 37 to 40 weeks the last stages of your baby's development occur:

• By the end of 37 weeks, your baby is considered full term.

• Your baby's organs are capable of functioning on their own.

• As you near your due date, your baby may turn into a head-down position for birth.

• Average birth weight is between 6 pounds 2 ounces to 9 pounds 2 ounces and average length is 19 to 21 inches long. Most full-term babies fall within these ranges, but healthy babies come in many different weights and sizes.

• Talk with staff at your child care provider to see if they serve healthier foods and drinks, and if they limit television and other screen time.

• Your toddler might change what food she likes from day to day. It’s normal behavior, and it’s best not to make an issue of it. Encourage her to try new foods by offering her small bites to taste.

• Keep television sets out of your child’s bedroom. Set limits for screen time for your child to no more than 1 hour per day of quality programming, at home, school, or afterschool care and develop a media use plan for your family.

• Encourage free play as much as possible. It helps your toddler stay active and strong and helps him develop motor skills.

• Make sure your child gets the recommended amount of sleep each night: For toddlers 1-2 years, 11–14 hours per 24 hours (including naps)

*Please review our dosage notes for more useful information. Please remember even though this chart that should be based on your child's weight can help determine the right dosage amount, it should never substitute for your pediatrician's advice.

As the weeks and months pass leading up to your delivery date, you’re probably eagerly planning for the new addition to your family, and adjusting to what is going on in your own body.

During the third trimester, you’ll notice many changes that may affect how you feel:

​

• You’ll gain weight, typically at a rate averaging about one pound a week during the last trimester.

• As your baby grows in size and places pressure on nearby organs, you may experience episodes of shortness of breath and back pain.

• You may urinate more frequently as pressure is placed on your bladder, and you might have episodes of incontinence.

• You may find it harder to get comfortable, and sleep may become more difficult. You may prefer to sleep on your side.

• You could experience more fatigue than usual.

• You may have heartburn, swelling in your feet and ankles, back pain, and hemorrhoids.

• You may have “false labor” contractions known as Braxton- Hicks contractions. These Braxton-Hicks contractions begin to soften and thin the cervix, preparing it for the delivery of the baby. But unlike true labor contractions, they are irregular, do not occur more often as time passes, and do not become stronger or more intense.

​

While you’re pregnant, you and your spouse/partner may be participating in childbirth education classes, which will give you information about labor and birth, provide the chance to meet other parents-to-be, and help you prepare for the birth. Several types of classes are available in many communities. The Lamaze method, for example, uses approaches such as focused breathing, massage, and labor support that can be used during the actual childbirth process.

​

The Bradley method emphasizes natural childbirth, and relies heavily on deep breathing techniques. Many childbirth education classes discuss a combination of these as well as other methods to teach expectant parents about the birth process and ways to make the delivery successful, comfortable, and enjoyable.

​

Whatever class you’re considering, ask in advance about the topics and methods of childbirth that will be emphasized, and whether the classes are primarily lectures or also involve your active participation. What is the instructor’s philosophy about pregnancy and birth? Is he or she certified? Will you learn proper methods for breathing and relaxation? What will the classes cost? Is there a limit on class size?

​

At the same time, consider signing up for other classes that can help prepare you for the parenting challenges ahead. Ask your doctor for referrals to breastfeeding classes, infant care programs, or instructional courses on cardiopulmonary resuscitation (CPR).

​

Some education classes encourage their participants to develop a “birth plan,” and may provide guidance in helping you do so. The birth plan is usually a written document for both you and your doctor in which you’ll record your own preferences for labor and delivery.

For example:

• Where will you be delivering your baby?

• Based on your doctor’s instructions, do you plan to go directly to the hospital when labor begins, or will you call the office first? What arrangements have you made for transportation to the hospital or birthing center? Do you have a doula or want to participate in a doula program? (A doula provides various forms of nonmedical support in the childbirth process.)

• Who would you like to deliver your baby (an obstetrician or a nurse midwife)?

• Who do you want to be present to support you during the childbirth experience?

• What position would you prefer to be in during delivery?

• What are your preferences for pain medication (if any is going to be used)?

• What options would you consider if unexpected circumstances develop (e.g., the need for an episiotomy or a Cesarean section)?

• If you deliver prematurely, does the facility have adequate resources to take care of your prematurely born infant?

​

Not only should you talk about and share this document with your doctor, but also let your family members and friends know of your decisions.

Your Toddler Should Be Doing This. . .

Physical Skills

Walks alone

Pulls toys behind when walking

Begins to run

Stands on tiptoe

Kicks a ball

Social Skills

Imitates behavior of others

Aware of herself as separate from others

Enthusiastic about company of other children

Cognitive Thinking

Finds objects even when hidden 2 or 3 levels deep

Sorts by shape and color

Plays make-believe

Cruises put large numbers of people, often from countries around the world, in frequent and close contact with each other. This can promote the spread of respiratory viruses, such as the virus that causes COVID-19. You may get sick from close contact with an infected person or by touching contaminated surfaces.

To reduce spread of respiratory viruses, including COVID-19, CDC recommends that crew members and passengers:

• Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.

• If soap and water are not readily available, use an alcohol-based hand sanitizer that contains 60%–95% alcohol.

• Avoid close contact with people who are sick.

• Avoid touching your eyes, nose, and mouth with unwashed hands.

• Stay in your cabin when you are sick and let the onboard medical center know immediately if you develop a fever (100.4°F/38°C or higher), begin to feel feverish, or have other symptoms (such as cough, runny nose, shortness of breath, or sore throat).

Yes, we accept Florida Medicaid. Unfortunately, we are not able to accept Medicaid from any other states. To view a complete list of insurances that North Florida Pediatrics accepts, please visit our insurance page!

*Please review our dosage notes for more useful information. Please remember even though this chart that should be based on your child's weight can help determine the right dosage amount, it should never substitute for your pediatrician's advice.

We provide a full exam and necessary papers to fulfill back-to-school, sports and camps requirements.

We will make sure you hit the ground running with your sports physical.

Call ahead to a healthcare professional if you develop a fever1 and symptoms of respiratory illness, such as cough or difficulty breathing, and have been in close contact2 with a person known to have COVID-19 or if you live in or have recently traveled to an area with ongoing spread. Tell your healthcare professional about your recent travel or contact. Your healthcare professional will work with your state’s public health department and CDC to determine if you need to be tested for COVID-19.

Steps to help prevent the spread of COVID-19 if you are sick

If you are sick with COVID-19 or suspect you are infected with the virus that causes COVID-19, follow the steps below to help prevent the disease from spreading to people in your home and community.

Stay home except to get medical care

People who are mildly ill with COVID-19 are able to isolate at home during their illness. You should restrict activities outside your home, except for getting medical care. Do not go to work, school, or public areas. Avoid using public transportation, ride-sharing, or taxis.

Separate yourself from other people and animals in your home

People: As much as possible, you should stay in a specific room and away from other people in your home. Also, you should use a separate bathroom, if available.

Animals: You should restrict contact with pets and other animals while you are sick with COVID-19, just like you would around other people. Although there have not been reports of pets or other animals becoming sick with COVID-19, it is still recommended that people sick with COVID-19 limit contact with animals until more information is known about the virus. When possible, have another member of your household care for your animals while you are sick. If you are sick with COVID-19, avoid contact with your pet, including petting, snuggling, being kissed or licked, and sharing food. If you must care for your pet or be around animals while you are sick, wash your hands before and after you interact with pets and wear a facemask. See COVID-19 and Animals for more information.

Call ahead before visiting your doctor

If you have a medical appointment, call the healthcare provider and tell them that you have or may have COVID-19. This will help the healthcare provider’s office take steps to keep other people from getting infected or exposed.

Wear a facemask

You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) or pets and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then people who live with you should not stay in the same room with you, or they should wear a facemask if they enter your room.

Cover your coughs and sneezes

Cover your mouth and nose with a tissue when you cough or sneeze. Throw used tissues in a lined trash can. Immediately wash your hands with soap and water for at least 20 seconds or, if soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol.

Clean your hands often

Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry.

Soap and water are the best option if hands are visibly dirty. Avoid touching your eyes, nose, and mouth with unwashed hands.

Avoid sharing personal household items

You should not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people or pets in your home. After using these items, they should be washed thoroughly with soap and water.

Clean all “high-touch” surfaces everyday

High touch surfaces include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. Also, clean any surfaces that may have blood, stool, or body fluids on them. Use a household cleaning spray or wipe, according to the label instructions. Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during use of the product.

Monitor your symptoms

Seek prompt medical attention if your illness is worsening (e.g., difficulty breathing). Before seeking care, call your healthcare provider and tell them that you have, or are being evaluated for, COVID-19. Put on a facemask before you enter the facility. These steps will help the healthcare provider’s office to keep other people in the office or waiting room from getting infected or exposed. Ask your healthcare provider to call the local or state health department. Persons who are placed under active monitoring or facilitated self-monitoring should follow instructions provided by their local health department or occupational health professionals, as appropriate.

If you have a medical emergency and need to call 911, notify the dispatch personnel that you have, or are being evaluated for COVID-19. If possible, put on a facemask before emergency medical services arrive.

Discontinuing home isolation

Patients with confirmed COVID-19 should remain under home isolation precautions until the risk of secondary transmission to others is thought to be low. The decision to discontinue home isolation precautions should be made on a case-by-case basis, in consultation with healthcare providers and state and local health departments.

Footnote

1Fever may be subjective or confirmed

2Close contact is defined as—

a) being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a health care waiting area or room with a COVID-19 case

– or –

b) having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on)

If such contact occurs while not wearing recommended personal protective equipment or PPE (e.g., gowns, gloves, NIOSH-certified disposable N95 respirator, eye protection), criteria for PUI consideration are met.

See CDC’s updated Interim Healthcare Infection Prevention and Control Recommendations for Persons Under Investigation for 2019 Novel Coronavirus.

Data to inform the definition of close contact are limited. Considerations when assessing close contact include the duration of exposure (e.g., longer exposure time likely increases exposure risk) and the clinical symptoms of the person with COVID-19 (e.g., coughing likely increases exposure risk as does exposure to a severely ill patient). Special consideration should be given to those exposed in health care settings.

No. Coronaviruses are a large family of viruses. Some coronaviruses cause cold-like illnesses in people. Others cause illness in certain types of animals, such as cattle, camels and bats. Rarely, animal coronaviruses can spread to people. This happened with SARS-CoV and MERS-CoV. The virus that causes COVID-19 likely also originated in an animal and spread to humans. The coronavirus most similar to the virus causing COVID-19 is SARS-CoV. There are ongoing investigations to learn more. The situation is changing, and information will be updated as it becomes available.

The virus that causes COVID-19 is thought to spread mainly by close contact with an infected person through respiratory droplets. Whether a pregnant woman with COVID-19 can transmit the virus that causes COVID-19 to her fetus or neonate by other routes of vertical transmission (before, during, or after delivery) is still unknown. However, in limited recent case series of infants born to mothers with COVID-19 published in the peer-reviewed literature, none of the infants have tested positive for the virus that causes COVID-19. Additionally, virus was not detected in samples of amniotic fluid or breastmilk.

Limited information is available about vertical transmission for other coronaviruses (MERS-CoV and SARS-CoV) but vertical transmission has not been reported for these infections.

More physical ability and more independence can put children at risk for injuries from falls and other accidents. Motor vehicle crashes are the most common cause of death from unintentional injury among children this age.

• Protect your child properly in the car. For detailed information, visit the American Academy of Pediatrics’ Car Seats: Information for Families.

• Teach your child to watch out for traffic and how to be safe when walking to school, riding a bike, and playing outside.

• Make sure your child understands water safety, and always supervise her when she’s swimming or playing near water.

• Supervise your child when he’s engaged in risky activities, such as climbing.

• Talk with your child about how to ask for help when she needs it.

• Keep potentially harmful household products, tools, equipment, and firearms out of your child’s reach.

What is adolescent depression?

Depression may be present when your teenager has:

• A sad or irritable mood for most of the day. Your teen may say they feel sad or angry or may look more tearful or cranky.

• Not enjoying things that used to make your child happy.

• A marked change in weight or eating, either up or down.

• Sleeping too little at night or too much during the day.

• No longer wanting to be with family or friends.

• A lack of energy or feeling unable to do simple tasks.

• Feelings of worthlessness or guilt. Low self-esteem.

• Trouble focusing or making choices. School grades may drop.

• Not caring about what happens in the future.

• Aches and pains when nothing is really wrong.

• Frequent thoughts of death or suicide.

Any of these signs can occur in children who are not depressed, but when seen together, nearly every day, they are red flags for depression.

What should I do if I think my teen is depressed?

• Talk to your child about his/her feelings and the things happening at home and at school that may be bothering him/her.

• Tell your teen's doctor. Some medical problems can cause depression. Your doctor may recommend psychotherapy (counseling to help with emotions and behavior) or medicine for depression.

• Your child's doctor may now screen your teen for depression every year from ages 12 through 21, with suicide now a leading cause of death among adolescents. Treat any thoughts of suicide as an emergency.

What can I do to help?

Promote health

• The basics for good mental health include a healthy diet, enough sleep, exercise, and positive connections with other people at home and at school.

• Limit screen time and encourage physical activity and fun activities with friends or family to help develop positive connections with others.

• One-on-one time with parents, praise for good behavior, encouragement for seeking care and pointing out strengths build the parent-child bond.

Provide safety and security

• Talk with your child about bullying. Being the victim of bullying is a major cause of mental health problems.

• Look for grief or loss issues. Seek help if problems with grief do not get better. If you as a parent are grieving a loss, get help and find additional support for your teen.

• Reduce stress as most teens have low stress tolerance. Accommodations in schoolwork is critical as well as lowered expectations at home regarding chores and school achievements.

• Guns, knives, long ropes/cables and medicines (including those you buy without a prescription), and alcohol should be locked up.

Educate others

• Your teen is not making the symptoms up.

• What looks like laziness or crankiness can be symptoms of depression.

• Talk about any family history of depression to increase understanding.

Help your teen learn thinking and coping skills

• Help your teen relax with physical and creative activities. Focus on the his/her strengths.

• Talk to and listen to your child with love and support. Encourage teens to share their feelings including thoughts of death or suicide. Reassure them that this is very common with depression.

• Help your teen look at problems in a different more positive way.

• Break down problems or tasks into smaller steps so your teen can be successful.

Make a safety plan

• Follow the treatment plan. Make sure your teen attends therapy and takes any medicine as directed.

• Treatment works, but it may take a few weeks. The depressed teen may not recognize changes in mood right away and may become discouraged with initial side effects of treatments (such as antidepressants).

• Develop a list of people to call when feelings get worse.

• Watch for risk factors for suicide. These include talking about suicide in person or on the internet, giving away belongings, increased thoughts about death, and substance abuse.

• Locate telephone numbers for your teen's doctor and therapist, and the local mental health crisis response team.

• The National Suicide Prevention Lifeline can be reached at 1-800-273-8255 or online at www.suicidepreventionlifeline.org.

• Eat meals with your child whenever possible. Let your child see you enjoying fruits, vegetables, and whole grains at meals and snacks. Your child should eat and drink only a limited amount of food and beverages that contain added sugars, solid fats, or salt.

• Keep television sets out of your child’s bedroom. Set limits for screen time for your child to no more than 1 hour per day of quality programming, at home, school, or afterschool care and develop a media use plan for your family.

• Provide your child with age-appropriate play equipment, like balls and plastic bats, but let your preschooler choose what to play. This makes moving and being active fun for your preschooler.

• Make sure your child gets the recommended amount of sleep each night: For preschoolers 3-5 years, 10–13 hours per 24 hours (including naps)

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your baby's weight, length, and head circumference and plot the measurements on the growth charts.

2. Ask questions, address concerns, and offer advice about how your baby is:

• Feeding. Your baby might be going longer between feedings now, but will still have times when he or she wants to eat more. Most babies this age breastfeed about eight times in a 24-hour period or drink about 26–28 ounces (780–840 ml) of formula a day.

• Peeing and pooping. Babies should have several wet diapers a day and tend to have fewer poopy diapers. Breastfed babies' stools should be soft and may be slightly runny. Formula-fed babies' stools tend to be a little firmer, but should not be hard.

• Sleeping. Your baby will probably begin to stay awake for longer periods and be more alert during the day, sleeping more at night. Breastfed babies may have a 4- to 5-hour stretch at night, and formula fed babies may go 5 to 6 hours between feedings. Waking up at night to be fed is normal.

• Developing. By 2 months, it's common for many babies to:

• 
  

• There's a wide range of normal, and children develop at different rates. Talk to your doctor if you're concerned about your child's development.

3. Do a physical exam with your baby undressed while you are present. This will include an eye exam, listening to your baby's heart and feeling pulses, checking hips, and paying attention to your baby's movements.

4. Do screening tests. Your doctor will review the screening tests from the hospital and repeat tests, if needed.

5. Update immunizations. Immunizations can protect infants from serious childhood illnesses, so it's important that your baby receive them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

Looking Ahead

Here are some things to keep in mind until your baby's next routine checkup at 4 months:

Feeding

If you breastfeed:

• If possible, breastfeed exclusively (no formula, other fluids, or solids) for 6 months. If desired, pumped breast milk may be given in a bottle.

• If you plan to go back to work soon, introduce the bottle now to get your baby used to bottle-feeding.

• Ask your doctor about vitamin D drops for your baby.

• Continue to take a daily prenatal vitamin or multivitamin.

• Do not introduce solids (including infant cereal) or juice. Breast milk or formula is still all your baby needs.

• Pay attention to signs that your baby is hungry or full.

If formula-feeding, give iron-fortified formula.

• If your baby takes a bottle of breast milk or formula:

• Do not prop your baby's bottle.

• Do not put your baby to bed with a bottle.

Routine Care

• Wash your hands before handling the baby and avoid people who may be sick.

• Hold your baby and be attentive to his or her needs. You can't spoil a baby.

• Sing, talk, and read to your baby. Babies learn best by interacting with people.

• Give your baby supervised "tummy time" when awake. Always supervise your baby and be ready to help if he or she gets tired or frustrated in this position.

• Limit the amount of time your baby spends in an infant seat, bouncer, or swing.

• It's normal for infants to have fussy periods, but for some, crying can be excessive, lasting several hours a day. If a baby develops colic, it usually starts in an otherwise well baby at around 3 weeks, peaks around 6 weeks, and improves by 3 months.

• It's common for new moms to feel tired and overwhelmed at times. But if these feelings are intense, or you feel sad, moody, or anxious, call your doctor.

• Talk to your doctor if you're concerned about your living situation. Do you have the things that you need to take care of your baby? Do you have enough food, a safe place to live, and health insurance? Your doctor can tell you about community resources or refer you to a social worker.

Safety

1. To reduce the risk of sudden infant death syndrome (SIDS):

• Let your baby sleep in your room in a bassinet or crib next to the bed until your baby's first birthday or for at least 6 months, when the risk of SIDS is highest.

• Always place your baby to sleep on a firm mattress on his or her back in a crib or bassinet without any crib bumpers, blankets, quilts, pillows, or plush toys.

• Avoid overheating by keeping the room temperature comfortable.

• Don't overbundle your baby.

• Consider putting your baby to sleep sucking on a pacifier.

1. Don't use an infant walker. They're dangerous and can cause serious injuries. Walkers also do not encourage walking and may actually hinder it.

2. Soon, your baby will be reaching, grasping, and moving things to his or her mouth, so keep small objects and harmful substances out of reach. Keep your baby away from cords, wires, and toys with loops or strings.

3. While your baby is awake, don't leave your little one unattended, especially on high surfaces or in the bath.

4. Never shake your baby — it can cause bleeding in the brain and even death.

5. Always put your baby in a rear-facing car seat in the back seat. Never leave your baby alone in the car.

6. Don't smoke or use e-cigarettes. Don't let anyone else smoke or vape around your baby.

7. Avoid sun exposure by keeping your baby covered and in the shade when possible. Sunscreens are not recommended for infants younger than 6 months. However, you may use a small amount of sunscreen on an infant younger than 6 months if shade and clothing don't offer enough protection.

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.

Coronaviruses are a large family of viruses. Some cause illness in people, and others, such as canine and feline coronaviruses, only infect animals. Rarely, animal coronaviruses that infect animals have emerged to infect people and can spread between people. This is suspected to have occurred for the virus that causes COVID-19. Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) are two other examples of coronaviruses that originated from animals and then spread to people. More information about the source and spread of COVID-19 is available on the Situation Summary: Source and Spread of the Virus.

Because of how air circulates and is filtered on airplanes, most viruses and other germs do not spread easily on airplanes. Although the risk of infection on an airplane is low, travelers should try to avoid contact with sick passengers and wash their hands often with soap and water for at least 20 seconds or use hand sanitizer that contain 60%–95% alcohol.

*Please review our dosage notes for more useful information. Please remember even though this chart that should be based on your child's weight can help determine the right dosage amount, it should never substitute for your pediatrician's advice.

• Parents can help make schools healthier. Work with your child’s school to limit access to foods and drinks with added sugar, solid fat, and salt that can be purchased outside the school lunch program.

• Practice healthy eating habits and physical activity early. Encourage active play, and be a role model by eating healthy at family mealtimes and having an active lifestyle.

• Make sure your child gets the recommended amount of sleep each night: For school-age children 6-12 years, 9–12 hours per 24 hours (including naps)

• Provide plenty of fruits and vegetables; limit foods high in solid fats, added sugars, or salt, and prepare healthier foods for family meals.

• Keep television sets out of your child’s bedroom. Set limits for screen time and develop a "media use" plan for your family.

• Encourage your child to participate in an hour a day of physical activities that are age appropriate and enjoyable and that offer variety! Just make sure your child is doing three types of activity: aerobic activity like running, muscle strengthening like climbing, and bone strengthening – like jumping rope – at least three days per week.

What to Expect During This Visit

Your doctor and/or nurse will probably:

1. Check your baby's weight, length, and head circumference and plot the measurements on the growth charts.

2. Ask questions, address concerns, and offer advice about how your baby is:

• Feeding. Breast milk or formula is still all your baby needs. Iron-fortified cereal or puréed meats can be introduced when your baby is ready for solid foods at about 6 months of age. Talk with your doctor before starting any solids.

• Peeing and pooping. Babies this age should have several wet diapers a day and regular bowel movements. Some may poop every day; others may poop every few days. This is normal as long as stools are soft. Let your doctor know if they become hard, dry, or difficult to pass.

• Sleeping. At this age, babies sleep about 12 to 16 hours a day, with two or three daytime naps. Most babies have a stretch of sleep for 5 or 6 hours at night. Some infants, particularly those who are breastfed, may wake more often.

• Developing. By 4 months, it's common for many babies to:

There's a wide range of normal and children develop at different rates. Talk to your doctor if you're concerned about your child's development.

3. Do a physical exam with your baby undressed while you are present. This will include an eye exam, listening to your baby's heart and feeling pulses, checking hips, and paying attention to your baby's movements.

4. Update immunizations. Immunizations can protect infants from serious childhood illnesses, so it's important that your baby get them on time. Immunization schedules can vary from office to office, so talk to your doctor about what to expect.

Looking Ahead

Here are some things to keep in mind until your baby's next routine checkup at 6 months:

• Feeding

• If your doctor recommends introducing solids:

• Share your family history of any food allergies.

• Start with a small amount of iron-fortified single-grain cereal mixed with breast milk or formula. You can also start with a puréed meat, another iron-rich food.

• Use an infant spoon — do not put cereal in your baby's bottle.

• If your baby is pushing a lot out with the tongue, he or she may not be ready for solids yet. Wait a week or so before trying again.

• Wait until your baby successfully eats cereal from the spoon before trying other solids. Introduce one new food at a time and wait several days to a week to watch for a possible allergic reaction before introducing another.

• Breast milk or formula is still all your baby needs.

• If breastfeeding, continue to give vitamin D supplements. Breastfed babies may need iron supplements until they get enough iron from the foods they eat.

• Pay attention to signs that your baby is hungry or full.

• Do not give juice until after 12 months.

• Do not prop bottles or put your baby to bed with a bottle.

Routine Care

• Many babies begin teething when they're around 4 months old. To help ease pain or discomfort, offer a clean wet washcloth or a teether. Talk to your doctor about giving acetaminophen for pain.

• Sing, talk, read, and play with your baby. Babies learn best by interacting with people.

• TV, videos, and other types of screen time aren't recommended for babies this young.

• Continue to give your baby plenty of supervised "tummy time" when awake. Create a safe play space for your child to explore.

• Limit the amount of time your baby spends in an infant seat, bouncer, or swing.

• It's common for new moms to feel tired and overwhelmed at times. But if these feelings are intense, or you feel sad, moody, or anxious, call your doctor.

• Talk to your doctor if you're concerned about your living situation. Do you have the things that you need to take care of your baby? Do you have enough food, a safe place to live, and health insurance? Your doctor can tell you about community resources or refer you to a social worker.

Safety

1. To reduce the risk of sudden infant death syndrome (SIDS):

• Let your baby sleep in your room in a bassinet or crib next to the bed until your baby's first birthday or for at least 6 months, when the risk of SIDS is highest.

• Always place your baby to sleep on a firm mattress on his or her back in a crib or bassinet without any crib bumpers, blankets, quilts, pillows, or plush toys.

• Avoid overheating by keeping the room temperature comfortable.

• Don't overbundle your baby.

• Consider putting your baby to sleep sucking on a pacifier.

1. Don't use an infant walker. They're dangerous and can cause serious injuries. Walkers also do not encourage walking and may actually hinder it.

2. While your baby is awake, don't leave your little one unattended, especially on high surfaces or in the bath.

3. Keep small objects and harmful substances out of reach.

4. Always put your baby in a rear-facing car seat in the back seat. Never leave your baby alone in the car.

5. Avoid sun exposure by keeping your baby covered and in the shade when possible. Sunscreens are not recommended for infants younger than 6 months. However, you may use a small amount of sunscreen on an infant younger than 6 months if shade and clothing don't offer enough protection.

6. Protect your baby from secondhand smoke, which increases the risk of heart and lung disease. Secondhand vapor from e-cigarettes is also harmful.

7. Be aware of any sources of lead in your home, including lead-based paint (in U.S. houses built before 1978).

These checkup sheets are consistent with the American Academy of Pediatrics (AAP)/Bright Futures guidelines.

We try to make sure you never have to worry about getting an appointment when you need one. We now have nine locations to serve you. Our Lake City location is open until 6:00 p.m. on weekdays and on Saturdays and Sundays from 9:00 a.m. to 1:30 p.m.! And our Chiefland office is open on Saturdays from 9:00 a.m. to 1:00 p.m. as well! You can call the Lake City office at (386) 758-0003 to schedule an appointment. Closer to a different office? Call them now.

Public health emergencies, such as the outbreak of coronavirus disease 2019 (COVID-19), are stressful times for people and communities. Fear and anxiety about a disease can lead to social stigma (1) toward people, places, or things. For example, stigma and discrimination can occur when people associate a disease, such as COVID-19, with a population or nationality, even though not everyone in that population or from that region is specifically at risk for the disease. Stigma can also occur after a person has been released from COVID-19 quarantine even though they are not considered a risk for spreading the virus to others.

It is important to remember that people – including those of Asian descent – who do not live in or have not recently been in an area of ongoing spread of the virus that causes COVID-19, or have not been in contact with a person who is a confirmed or suspected case of COVID-19 are not at greater risk of spreading COVID-19 than other Americans.

Some groups of people who may be experiencing stigma because of COVID-19 include:

• Persons of Asian descent

• People who have traveled

• Emergency responders or healthcare professionals

Stigma hurts everyone by creating fear or anger towards other people.

Stigmatized groups may be subjected to:

• Social avoidance or rejection

• Denials of healthcare, education, housing or employment

• Physical violence.

Stigma affects the emotional or mental health (2) of stigmatized groups and the communities they live in. Stopping stigma is important to making communities and community members resilient (3). See resources on mental health and coping during COVID-19.

Everyone can help stop stigma related to COVID-19 by knowing the facts and sharing them with others in your community.

Communicators and public health officials can help counter stigma during the COVID-19 response.

Maintain privacy and confidentiality of those seeking healthcare and those who may be part of any contact investigation.

Quickly communicate the risk or lack of risk from associations with products, people, and places.

• Raise awareness about COVID-19 without increasing fear.

• Share accurate information about how the virus spreads.

• Speak out against negative behaviors, including negative statements on social media about groups of people, or exclusion of people who pose no risk from regular activities.

• Be cautious about the images that are shared. Make sure they do not reinforce stereotypes.

• Engage with stigmatized groups in person and through media channels including news media and social media.

• Thank healthcare workers and responders. People who have traveled to areas where the COVID-19 outbreak is happening to help have performed a valuable service to everyone by helping make sure this disease does not spread further.

• Share the need for social support for people who have returned from China or are worried about friends or relatives in the affected region.

Key Terms

• Stigma occurs when people associate a risk with a specific people, place, or thing – like a minority population group – and there is no evidence that the risk is greater in that group than in the general population. Stigmatization is especially common in disease outbreaks. (https://emergency.cdc.gov/cerc/cerccorner/article_123016.asp)

• Resilience is the ability to withstand and recover from stress. (https://blogs.cdc.gov/publichealthmatters/2017/08/predicting-community-resilience-and-recovery-after-a-disaster/)

• Mental health is defined by the World Health Organization as a state of well being in which a person realizes his or her own abilities, can cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community (https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response).

More independence and less adult supervision can put children at risk for injuries from falls and other accidents. Here are a few tips to help protect your child:

• Protect your child in the car. The National Highway Traffic Safety administration recommends that you keep your child in a booster seat until he is big enough to fit in a seat belt properly. Remember: your child should still ride in the back seat until he or she is 12 years of age because it’s safer there. Motor vehicle crashes are the most common cause of death from unintentional injury among children of this age.

• Know where your child is and whether a responsible adult is present. Make plans with your child for when he will call you, where you can find him, and what time you expect him home.

• Make sure your child wears a helmet when riding a bike or a skateboard or using inline skates; riding on a motorcycle, snowmobile, or all-terrain vehicle; or playing contact sports.

• Many children get home from school before their parents get home from work. It is important to have clear rules and plans for your child when she is home alone.

Based on limited case reports, adverse infant outcomes (e.g., preterm birth) have been reported among infants born to mothers positive for COVID-19 during pregnancy. However, it is not clear that these outcomes were related to maternal infection, and at this time the risk of adverse infant outcomes is not known. Given the limited data available related to COVID-19 during pregnancy, knowledge of adverse outcomes from other respiratory viral infections may provide some information. For example, other respiratory viral infections during pregnancy, such as influenza, have been associated with adverse neonatal outcomes, including low birth weight and preterm birth. Additionally, having a cold or influenza with high fever early in pregnancy may increase the risk of certain birth defects. Infants have been born preterm and/or small for gestational age to mothers with other coronavirus infections, SARS-CoV and MERS-CoV, during pregnancy.

Your Preschooler Should be doing this. . .

Physical Skills

Climbs well

Walks up and down stairs, alternating feet

Kicks ball

Runs easily

Pedals tricycle

Bends over without falling

Social Skills

Imitates adults and playmates

Show affection for familiar playmates

Can take turns in games

Understands "mine" and "his / hers"

Cognitive Thinking

Makes mechanical toys work

Matches an object in hand to picture in book

Plays make believe

Sorts objects by shape and color

Completes 3 - 4 piece puzzles

Understands concept of "two"

(Coughs, Sneezes, Cold, Flu, Cuts, Minor Injuries, Etc.)

We make every effort to schedule appointments for ill children on the day that you call us. Please call our office early in the day so we can minimize the time that you will spend waiting.

Common Illnesses - View For More Info.

*Please review our dosage notes for more useful information. Please remember even though this chart that should be based on your child's weight can help determine the right dosage amount, it should never substitute for your pediatrician's advice.

Mood Disorders & ADHD

The mood disorders most likely to be experienced by children with ADHD include dysthymic disorder, major depressive disorder (MDD), and bipolar disorder. Dysthymic disorder can be characterized as a chronic low-grade depression, persistent irritability, and a state of demoralization, often with low self-esteem. Major depressive disorder is a more extreme form of depression that can occur in children with ADHD and even more frequently among adults with ADHD. Dysthymic disorder and MDD typically develop several years after a child is diagnosed with ADHD and, if left untreated, may worsen over time. Bipolar disorder is a severe mood disorder that has only recently been recognized as occurring in children. Unlike adults who experience distinct periods of elation and significant depression, children with bipolar disorder present a more complex disturbance of extreme emotional instability, behavioral difficulties, and social problems. There is significant overlap with symptoms of ADHD, and many children with bipolar disorder also qualify for a diagnosis of ADHD.

What to Look For

Every child feels discouraged or acts irritable once in a while. Children with ADHD, who so often must deal with extra challenges at school and with peers, may exhibit these behaviors more than most. If your child claims to be depressed, however, or seems irritable or sad a large portion of each day, more days than not, she may have a coexisting dysthymic disorder.

To be diagnosed with dysthymic disorder, a child must also have at least 2 of the following symptoms:

• Poor appetite or overeating

• Insomnia or excessive sleeping

• Low energy or fatigue

• Low self-esteem

• Poor concentration or difficulty making decisions

• Feelings of hopelessness

Before dysthymic disorder can be diagnosed, children must have had these symptoms for a year or longer, although symptoms may have subsided for up to 2 months at a time within that year. The symptoms also must not be caused by another mood disorder, such as MDD or bipolar disorder, a medical condition, substance abuse, or just related to ADHD itself (low self-esteem stemming from poor functioning in school, for example). Finally, the symptoms must be shown to significantly impair your child’s social, academic, or other areas of functioning in daily life.

Major depressive disorder is marked by a nearly constant depressed or irritable mood or a marked loss of interest or pleasure in all or nearly all daily activities. In addition to the symptoms listed previously for dysthymic disorder, a child with MDD may cry daily; withdraw from others; become extremely self-critical; talk about dying; or even think about, plan, or carry out a suicide attempt. Unlike the brief outbursts of temper exhibited by a child with ODD who does not get her way, a depressed child’s irritability may be nearly constant and not linked to any clear cause. Her inability to concentrate differs from ADHD-type inattention in that it is accompanied by other symptoms of depression, such as loss of appetite or loss of interest in favorite activities. Finally, the depression itself stems from no apparent cause—as opposed to being demoralized as a result of specific obstacles posed by ADHD or becoming depressed in response to parental divorce or any other stressful situation. (In fact, research has shown that the intactness of a child’s family and its socioeconomic status have little or no effect on whether a child develops MDD.) While children with ADHD/CD alone are not at higher than normal risk for attempting suicide, children with ADHD/CD who also have an MDD and are involved in substance abuse are more likely to make such an attempt and should be carefully watched.

Talk of suicide (even if you are not sure whether it is serious), a suicide attempt, self-injury, any violent behavior, or severe withdrawal should be considered an emergency that requires the immediate attention of your child’s pediatrician, psychologist, or local hospital.

A depressed child may admit to feeling guilty or sad, or she may deny having any problems. It is important to keep in mind the fact that many depressed children refuse to admit to their feelings, and parents often overlook the subtle behaviors that signal a mood disorder. By keeping in close contact with her teacher, bringing your child to each of her treatment reviews with her pediatrician, and including her in all discussions of her treatment as appropriate to her age, you can improve the chances that her pediatrician or mental health professional will detect any signs of developing depression, and that she will have someone to talk to about her feelings.

A child with bipolar disorder and ADHD is prone to explosive outbursts, extreme mood swings (high, low, or mixed mood), and severe behavioral problems. Such a child is often highly impulsive and aggressive, with prolonged outbursts typically “coming out of nowhere” or in response to trivial frustrations. She may have a history of anxiety. She may also have an extremely high energy level and may experience racing thoughts and inflated self-esteem or grandiosity, extreme talkativeness, physical and emotional agitation, overly sexual behavior, and/or a reduced need for sleep. These symptoms can alternate with periods of depression or irritability, during which her behavior resembles that of a child with MDD. A child with ADHD/ bipolar disorder typically has poor social skills. Family relationships are often strained because of the child’s extremely unpredictable, aggressive, or defiant behavior. Early on the symptoms may only occur at home, but often begin to occur in other settings as the child gets older. Bipolar disorder is a serious psychiatric disorder that can sometimes include psychotic symptoms (delusions/hallucinations) or self-injurious behavior such as cutting, suicidal thoughts/impulses, and substance abuse. Many children with bipolar disorder have a family history of bipolar disorder, mood disorder, ADHD, and/or substance abuse. Children with ADHD and bipolar disorder are at higher risk than those with ADHD alone for substance abuse and other serious problems during adolescence.

If your child has ADHD with coexisting bipolar disorder, her pediatrician will generally refer her to a child psychiatrist for further assessment, diagnosis, and recommendations for treatment.

Treatment

As with ADHD with anxiety disorders, treatment of ADHD with depression usually involves a broad approach. Treatment approaches may include a combination of cognitive-behavioral therapy, interpersonal therapy (focusing on areas of grief, interpersonal relationships, disputes, life transitions, and personal difficulties), traditional psychotherapy (to help with self-understanding, identification of feelings, improving self-esteem, changing patterns of behavior, interpersonal interactions, and coping with conflicts), as well as family therapy when needed.

Medication management approaches, as with ADHD and other coexisting conditions, include treating the most disabling condition first. If your child’s ADHD-related symptoms are causing most of her functioning problems, or the signs of depression are not completely clear, your child’s pediatrician is likely to start with stimulant medication to treat the ADHD. In cases when the depressive symptoms turn out to stem from poor functioning due to ADHD and not to a depressive disorder, they may diminish as the ADHD symptoms improve. If the ADHD and depressive symptoms improve, your child’s pediatrician will probably maintain stimulant treatment alone. If her ADHD symptoms improve but her depression remains the same, even after a reasonable trial of the type of broad psychotherapeutic approach described previously, her pediatrician may add another medication, most commonly an SSRI—a class of medications including Prozac, Zoloft, Paxil, Luvox, and Celexa. Selective serotonin reuptake inhibitors can make the symptoms of bipolar disorder worse, so a careful evaluation must be completed before starting medication. If this approach is unsuccessful, you may be referred to a developmental/behavioral pediatrician or a psychiatrist, who may try other classes of medications.

Diseases can make anyone sick regardless of their race or ethnicity.

People of Asian descent, including Chinese Americans, are not more likely to get COVID-19 than any other American. Help stop fear by letting people know that being of Asian descent does not increase the chance of getting or spreading COVID-19.

Some people are at increased risk of getting COVID-19.

People who have been in close contact with a person known to have COVID-19 or people who live in or have recently been in an area with ongoing spread are at an increased risk of exposure.

Someone who has completed quarantine or has been released from isolation does not pose a risk of infection to other people.

For up-to-date information, visit CDC’s coronavirus disease situation summary page.

You can help stop COVID-19 by knowing the signs and symptoms:

• Fever

• Cough

• Shortness of breath

Seek medical advice if you

• Develop symptoms

AND

• Have been in close contact with a person known to have COVID-19 or live in or have recently traveled from an area with ongoing spread of COVID-19. Call ahead before you go to a doctor’s office or emergency room. Tell them about your recent travel and your symptoms.

There are simple things you can do to help keep yourself and others healthy.

• Wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food.

• Avoid touching your eyes, nose, and mouth with unwashed hands.

• Stay home when you are sick.

• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

This virus was first detected in Wuhan City, Hubei Province, China. The first infections were linked to a live animal market, but the virus is now spreading from person-to-person. It’s important to note that person-to-person spread can happen on a continuum. Some viruses are highly contagious (like measles), while other viruses are less so.

The virus that causes COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in some affected geographic areas. Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected.

Learn what is known about the spread of newly emerged coronaviruses.

• Encourage your teen to be physically active. She might join a team sport or take up an individual sport. Helping with household tasks such as mowing the lawn, walking the dog, or washing the car also will keep your teen active.

• Meal time is very important for families. Eating together helps teens make better choices about the foods they eat, promotes healthy weight, and gives your family members time to talk with each other.

• Keep television sets out of your teen’s bedroom. Set limits for screen time, including cell phones, computers, video games, and other devices, and develop a family media plan.

• Make sure your child gets the recommended amount of sleep each night: For teenagers 13-18 years, 8–10 hours per 24 hours (including naps)

• Encourage your teen to get enough sleep and physical activity, and to eat healthy, balanced meals. Make sure your teen gets 1 hour or more of physical activity each day.

• Encourage your teen to have meals with the family. Eating together will help your teen make better choices about the foods she eats, promote healthy weight, and give family members time to talk with each other. In addition, a teen who eats meals with the family is more likely to get better grades and less likely to smoke, drink, or use drugs, and also less likely to get into fights, think about suicide, or engage in sexual activity.

• Make sure your child gets the recommended amount of sleep each night: For teenagers 13-18 years, 8–10 hours per 24 hours (including naps)

North Florida Pediatrics focuses on the medical and emotional issues most specific to teenagers and young adults, including puberty, sexuality, identity, mental health, social and emotional development.

What can my child do at these ages?

As your child grows, you’ll notice him or her developing new and exciting abilities.

A child age 6 to 7:

Enjoys many activities and stays busy

Likes to paint and draw

Practices skills in order to become better

Jumps rope

Rides a bike

A child age 8 to 9:

Is more graceful with movements and abilities

Jumps, skips, and chases

Dresses and grooms self completely

Can use tools, such as a hammer or screwdriver

A child age 10 to 12:

Likes to sew and paint

What does my child understand?

As children enter into school age, their skills and understanding of concepts continue to grow.

A child age 6 to 7:

Understands the concept of numbers

Knows daytime and nighttime

Knows right and left hands

Can copy complex shapes, such as a diamond

Can tell time

Understands commands that have 3 separate instructions

Can explain objects and their use

Can repeat 3 numbers backward

Can read age-appropriate books

A child age 8 to 9:

Can count backward

Knows the date

Reads more and enjoys reading

Understands fractions

Understands the concept of space

Draws and paints

Can name the months and days of the week, in order

Enjoys collecting objects

A child age 10 to 12:

Writes stories

Likes to write letters

Reads well

Enjoys using the telephone

How will my child interact with others?

An important part of growing up is learning to interact and socialize with others. During the school-age years, you’ll see a change in your child. He or she will move from playing alone to having multiple friends and social groups. Friendships become more important. But your child is still fond of you as parents, and likes being part of a family. Below are some of the common traits that your child may show at these ages.

A child age 6 to 7:

Cooperates and shares

Can be jealous of others and siblings

Likes to copy adults

Likes to play alone, but friends are becoming important

Plays with friends of the same gender

May sometimes have temper tantrums

Is modest about his or her body

Likes to play board games

A child age 8 to 9:

Likes competition and games

Starts to mix friends and play with children of the opposite gender

Is modest about his or her body

Enjoys clubs and groups, such as Boy Scouts or Girl Scouts

Is becoming interested in boy-girl relationships, but doesn’t admit it.

A child age 10 to 12:

Finds friends are very important and may have a best friend

Has increased interest in the opposite gender

Likes and respects parents

Enjoys talking to others

How can I encourage my child's social abilities?

You can help boost your school-aged child's social abilities by:

Setting limits, guidelines, and expectations and enforcing them with appropriate penalties

Modeling good behavior

Complimenting your child for being cooperative and for personal achievements

Helping your child choose activities that are suitable for his or her abilities

Encouraging your child to talk with you and be open with his or her feelings

Encouraging your child to read, and reading with your child

Encouraging your child to get involved with hobbies and other activities

Promoting physical activity

Encouraging self-discipline and expecting your child to follow rules that are set

Teaching your child to respect and listen to authority figures

Encouraging your child to talk about peer pressure and setting guidelines to deal with peer pressure

Spending uninterrupted time together and giving full attention to your child

Limiting screen time (TV, video, and computer)

*Please review our dosage notes for more useful information. Please remember even though this chart that should be based on your child's weight can help determine the right dosage amount, it should never substitute for your pediatrician's advice.

*Please review our dosage notes for more useful information. Please remember even though this chart that should be based on your child's weight can help determine the right dosage amount, it should never substitute for your pediatrician's advice.

Under current federal regulations, pilots must report to CDC all illnesses and deaths before arriving to the United States. If a sick traveler is considered to be a public health risk, CDC works with local and state health departments and international public health agencies to contact passengers and crew exposed to that sick traveler—according to CDC disease protocols.

Be sure to give the airline your current contact information when booking your ticket.

We try to keep your family healthy so no one has to go to the hospital, but if your child has an emergency such as a severe fall, cardiac issue, or asthma attack, seek medical help immediately by calling 911 or by going to the nearest emergency room.

You play an important role in keeping your child safe―no matter how old he or she is. Here are a few tips to help protect your child:

• Make sure your teen knows about the importance of wearing seatbelts. Motor vehicle crashes are the leading cause of death among 12- to 14-year-olds.

• Encourage your teen to wear a helmet when riding a bike or a skateboard or using inline skates; riding on a motorcycle, snowmobile, or all-terrain vehicle; or playing contact sports. Injuries from sports and other activities are common.

• Talk with your teen about the dangers of drugs, drinking, smoking, and risky sexual activity. Ask him what he knows and thinks about these issues, and share your thoughts and feelings with him. Listen to what she says and answer her questions honestly and directly.

• Talk with your teen about the importance of having friends who are interested in positive activities. Encourage her to avoid peers who pressure her to make unhealthy choices.

• Know where your teen is and whether an adult is present. Make plans with him for when he will call you, where you can find him, and what time you expect him home.

• Set clear rules for your teen when she is home alone. Talk about such issues as having friends at the house, how to handle situations that can be dangerous (emergencies, fire, drugs, sex, etc.), and completing homework or household tasks.