Drowning Prevention!
Laurie Wolf, CPNP    July 2019

 Summer fun often includes trips to the pool or other water oriented activities. As your family prepares for fun, be sure to consider the risks involved in water play and activities.

The greatest risk to children continues to be drowning. According to the American Academy of Pediatric’s 1,000 children died from drowning in 2017, and it is the No. 1 cause of injury-related death for children ages 1 to 4. It is the third leading cause of unintentional injury death in children 5 to 19.

The following drowning prevention recommendations were published by the AAP in March 2019:

• All children and adults should learn to swim. Most children will be developmentally ready for formal swim lessons between

ages 1 and 4.

Close, constant, attentive supervision around water is important. Assign an adult 'water watcher,' who should not be distracted by a cell phone, socializing, chores, or drinking alcohol. With young children or poor swimmers, the adult should be within an arm's length, providing constant 'touch supervision.'

• Empty wading pools immediately after use.

• Pools should be surrounded by a four-sided fence, with a self-closing and self-latching gate. Research shows pool fencing can reduce drowning risk by 50%.

• Adults and older children should learn CPR.

• Everyone, children and adults, should wear US Coast Guard-approved life jackets whenever they are in open water, or on watercraft. Small children and non-swimmers should wear life jackets when they are near water and when swimming. Inflatable "floaties" can't be relied upon to protect kids.

• Parents and teens should understand how using alcohol and drugs increases the risk of drowning while swimming or boating.  


Laurie Wolf, CPNP    March 2019

As spring approaches, so does the onset of allergy season. While allergy symptoms can occur at any time of the year, many find that the spring allergy season brings on the worst of their symptoms. Allergy symptoms can include headaches, runny noses, nasal congestion, sneezing, coughing, and red/watery eyes.

Common medications to treat allergy symptoms include:

* Antihistamines: Taken orally can help with watery eyes, runny nose and sneezing. Some types of antihistamines may cause drowsiness.
* Nasal Corticosteroids –Very effective for control allergy symptoms, especially when symptoms are chronic. They must be used daily for maximal effectiveness.

If your child suffers from allergy symptoms yearly in the spring, start medications before the onset of symptoms for the best control. An easy start date to remember is St. Patrick’s Day annually. Pollen driven allergies tend to begin within a few weeks after, and you may avoid the sudden onset of severe symptoms.
For severe allergy symptoms, finding out what your child is allergic to may help to find the ideal treatment for symptoms. Allergy testing may be indicated for your child at the advice of your pediatric provider. Nasal allergy symptoms can be caused by both indoor (dust mites, pets, insects/pests) and/or outdoor allergens (pollens). Molds may also trigger nasal allergy symptoms, and can be found both indoors and outdoors.
Avoiding allergens that cause symptoms in your child is a key part of treatment. If your child is allergic to a pet in your home, vacuum frequently and keep the animal out of your child’s room. If dust or exposures to insects/pests are a trigger, frequent dusting and vacuuming may help to decrease symptoms.
Dust mites are frequently an allergy trigger. Large amounts of them are found in bedding, upholstered furniture, and rugs. Bedding such as mattresses and pillows should be contained in allergen-proof coverings. Bed linens, including blankets and bed coverings, should be washed every 1 to 2 weeks in hot water. Dusting with dust trapping cloths and frequent vacuuming may also help with symptom control.

For outdoor allergens (pollens), limiting exposure is an important part of symptoms control. During warm weather use air conditioners and keep windows closed if possible. Shower or bathe every evening or after outside exposures. This including washing hair which can trap large amounts of allergens. If grass pollens trigger symptoms, try to stay indoors when grass is being mowed and avoid playing in clippings or areas of very tall grasses.
There are a large number of over the counter and prescription therapies to treat allergy symptoms. . Consult with your provider for further help in determining the best method of controlling your child’s allergies. Enjoy your spring! 

What Parents Need To Know About Influenza

Jennifer Bradford DO, FAAP      January 2019

Flu, or Influenza, is an illness caused by a respiratory virus.

When someone with the flu coughs or sneezes, the virus is spread into the air and the people nearby can inhale it; it can also be spread by touching contaminated surfaces and then touching your mouth or rubbing your eyes.

Symptoms of the flu can last a week or more and include:

  •     A sudden fever

  •     Chills

  •     Headache, body ache, and tiredness

  •     Sore throat

  •     Dry cough

  •     Stuffy, runny nose

  •     Some children may vomit and have diarrhea

People who have the flu are usually much sicker than those who have the common cold though sometimes the symptoms can look similar.

Common complications of the flu include ear infections and pneumonia.

Children with chronic health conditions (like asthma, cancer, Crohn’s disease, etc) have the greatest risk of complications from the flu; they are also more likely to be hospitalized.

Tylenol or Motrin can help decrease a child’s fever and help decrease body aches. Make sure your child is old enough to take these medicines first before giving them. Avoid aspirin use in children.

Rest and fluids are very important in treating children with the flu.

Tamiflu is an anti-viral medication that can help decrease the length of time you are sick with the flu by 1.5 days, but it needs to be started within 48 hours of fever onset.

The best way to prevent the flu is to receive the flu vaccine for those 6 months of age and older and to wash your hands frequently!

If children still get the flu even if they have had their flu vaccine, they usually have a much more milder course and recover more quickly!

Make sure you wash your hands!

Is your child coughing?

Rachna Patel, MD, FAAP  April 2019

Often, I see parents coming into the office asking what they can give their child to help stop them from
coughing. Coughing is one of the most common symptoms of childhood illnesses. However not all
coughs are the same and not all are bad.

Coughing is an important defense mechanism that our bodies use to help protect the airway in
the throat and chest. The cough reflex helps to prevent mucus or other foreign material from getting
into our lungs or obstructing the airway.

Sometimes, a cough does need special attention and warrants a visit to the doctors. The sound
of the cough can provide a lot of information about what is going on. Here are some common coughs
with distinct sounds that would require further attention by a doctor.

* Barky cough- this is caused by swelling of the upper airway and often occurs suddenly at night. It
can be associated with stridor which sounds like high pitch breathing. The barky cough is usually
described as sounding like a seal. Croup is the most common cause of this cough

* Whooping cough- also known as pertussis is caused by bacteria. This cough is known as “the
cough of a hundred days”. Children usually have coughing spells that can last up to a minute and
cough literally sounds like a whoop. Prior to developing the cough, there are other symptoms
such as low grade fever, sneezing, a runny nose.

* Wheezing- wheezing associated with cough is caused by inflammation of the airways in the lung.
It can be associated with a whistling sound and retractions of the chest muscles. This type of
cough is associated with asthma exacerbations and bronchiolitis most of the time. Sometimes, it
can be heard in children who have inhaled a small piece of food or foreign object.

Sometimes, it is difficult to determine where your child needs to be seen by a doctor for a
cough. If your child is having trouble breathing , has change color such as a blue, dusky color to the
face, they should be seen by a doctor. Other symptoms along with coughing that would warrant
further evaluation would be high fevers, coughing up blood, weakness, dizziness, and dehydration.


Katherine Abbott, MD      February 2019

There is an outbreak of measles across the country, centered in Washington State. The outbreak is in 10 states including California, Colorado, Georgia, Connecticut, Illinois, New Jersey, Oregon, New York, Texas, and Washington. However, the epicenter is in Washington State, in King County, in the city of Seattle. The most disturbing aspect of this is that the 49 cases diagnosed there to date are in unvaccinated children. This outbreak could have been prevented!

One of the unanticipated outcomes of the effectiveness of the MMR vaccine is that people have forgotten how serious measles can be. Before the MMR vaccine was available, measles caused 2 million deaths annually across the globe. Now it causes 110,000 deaths annually primarily in impoverished areas with limited access to health care.

Measles is highly contagious. It is spread through the air with a cough or a sneeze. This makes it contagious in school settings, the grocery store, and yes, in the waiting rooms of doctor’s offices. Due to this reason, we do not allow people who do not vaccinate against MMR to become patients in our practice. We feel this is our duty, to protect your children, our patients, against the vaccine preventable disease measles.

Measles presents clinically as a high fever, cough, runny nose, headache, light sensitivity and a classic red rash on the neck, face and trunk. The primary complication resulting in death, in 1 out of 500 patients is pneumonia. Please call our office if your child travels to one of these regions and is exhibiting this constellation of clinical symptoms.

Getting active! 

Dr. Jennifer Bradford, DO, FAAP    May 2019

Now that spring is here and the weather is getting warmer, it's time to get back outside and be active! Daily physical activity is recommended for all children. For all children over the age of 6, 60 minutes per day of moderately vigorous exercise is ideal. For younger children, active play is the current recommendation. So what can we do to be active or to build exercise into our day? 

You may need to first look at your family's daily schedule. Everyone's is different. When can you fit exercise in? You may find it easier to have the children play outside after school or enroll them in a sport encouraging them to practice it daily.

Count up how many hours per day your child is using a phone, iPad, computer, or playing video games. Ideally, technology for recreational use should be limited to less than 2 hours per day. You can easily find extra time in the day by decreasing the amount of time on technology and using that time for activities and exercise.

If your child is not currently active, start small. Encourage them to start walking for 15-20 minutes at a time and increase from there. Too much activity too soon increases the risk of injury.

Remember, exercise and daily activity should be fun! Try to find something your child is interested in and will want to participate in daily. They should look forward to it. We want exercise to become lifelong habits!


We at Crestwood Pediatric Associates are concerned about the increasing use by our patients of retail based clinics or urgent care centers. Here are some important things to consider before you go:

  • The medical provider at an urgent care center does not have your child’s record. All children are not the same.  Having your child’s record allows us to define a treatment program specific for your particular child’s needs taking into account all prior treatments and diagnoses.
  • The medical provider at the urgent care center is unlikely to be a board certified pediatrician. This means that they are not specialists in pediatric care. They do not have the same level of experience and training.  They are much more likely to miss a diagnosis or overprescribe antibiotics as compared to a trained pediatrician.
  • Bringing your child to an urgent care center breaks up the continuity of care. Recurring conditions such as recurrent ear infections and recurrent strep throat may need referral to a specialist for consideration for surgery.  The number of episodes will not be accurately recorded. This leads to a delay in treatment.
  • The urgent care center does not have the immunization record. Every time we see your child in our office is an opportunity for us to review their immunization record and update needed vaccines. Since the urgent care center does not have this record, your child’s vaccines are much more likely to be delayed.
  • Since the urgent care center does not have your child’s record, they do not know about any chronic conditions, outstanding tests, and results of referrals that your child has had. We take the opportunity on every visit to catch up on these or to arrange follow up visits to discuss these issues. Parents that have chosen to have their children go to the urgent care center then have to make a separate visit in our office to address these issues. This results in delays in treatment and increased cost.

Parents are often unsure when a problem arises when our office is closed if it can wait till the office opens in the morning. We have 24/7 on-call physicians that can help you make the decision to go to an urgent care center or ER, or if it can wait till the office opens in the morning.

We understand that children get sick at night and on the weekend. Our office is open until 9 PM most nights and on Saturday morning to give maximum flexibility in scheduling to our patients.

We remain your partner in your child’s care. We want what is best for your child as do you. Please consider the above carefully the next time you consider going to an Urgent Care Center. 

Healthy Eating during the Holidays

Rachna Patel, MD,  December 2018

  • With the holidays approaching, family and friends will be gathering together and mostly around food. It can be difficult to keep up with your family’s good eating habits during this time. Here are a few tips that can help keep you and your family on track:
  •  Offer plenty of vegetables and fruits during holiday meals
  • Choose more vegetable based dishes high in protein and fiber. Try to eat the fruits, vegetables, and protein first before going for the sweets.
  •  Keep normal eating patterns
  • Consistency is important to keep your children on track. Avoid eating light throughout the day and then binging on your favorite holiday meals. This will help you from overeating.
  •  Try healthy substitutes
  • Instead of butter, try using avocado or banana. Replace some sugar with applesauce or black beans for flour.
  •  Make sure the protein is lean
  • Turkey, roast beef, or fresh ham are good choices. Trim the visible fat before cooking. Instead of frying, try broiling, baking the protein, or cooking in an air fryer
  •  Organize a family activity
  • Enjoy a walk outside after dinner or visit to a park. Play games or organize a scavenger hunt!

Do you know how to tell if your child is being bullied?

Jennifer Bradford, DO, FAAP   September 2019

School buses are one of the top places where childhood bullying happens. Do you know how to tell if your child is being bullied?

Children being picked on aren't always comfortable telling others about it or asking for help. You may not suspect something is wrong until your child starts coming up with excuses to not take the bus or starts avoiding school entirely. Children may worry that if they report the bullying, it will lead to more bullying. Sometimes, younger children may not even recognize bullying behavior for what it is or know what to call it. Of course, some bullies will make outright threats about what may happen if a child tells someone.

So what can you do if you suspect something is wrong? First, know what your school's anti-bullying policy is. School buses are an extended part of the school environment, so they likely are covered in your school's bullying prevention policy. The bus driver, other adult staff, and the school have a legal and ethical responsibility to ensure children feel safe, valued, and welcomed on the bus. Next, follow the proper "chain of command"; usually, this means speaking with the bus driver directly. Although bus drivers can't always step in when bullying happens, many are very aware of the interactions between their young passengers and can provide some helpful context. Talking with your child's bus driver in the middle of a route can be difficult, but a call to the school can help in setting up time that isn't so awkward.

What if bullying happens at the bus stop? Bus stops are more difficult situations, because they aren't monitored by the school or bus company staff. Bullying can and does easily occur there. In younger grades, parents are often nearby to monitor situations. However, a parent presence at a bus stop in older grades may seem unusual and potential embarrassment-provoking. If a problem seems to be occurring at bus stops, rather than on the bus, a discussion with the school is still a good idea. They may be able to address it by raising awareness of bullying among children, a general message home to parents, or, if need be, directly monitoring the stop.

What if my child witnesses bullying, but the bullying is not directed towards them? Even if your child isn't the direct victim, you can still report the bullying behavior when your child witnesses it. Depending on their age and the situation, children who see the bullying happen may not feel comfortable getting involved but speaking up can have a big effect; bullies often back down if someone else calls out the behavior. Most importantly, have conversations with your child to make sure they know it is never OK to join in on bullying.

What if I feel that my child's school is not doing enough to prevent bullying? While not all bullying cases need extensive involvement by school administration, schools have a responsibility for providing a safe learning environment? The vast majority will take bullying on the bus seriously. Don't be afraid to keep going up the chain of command. If your child's school does not take the situation seriously or it is not adequately resolved, your pediatrician may be able to help advocate on your behalf with the school. In the meantime, investigate alternative options for getting to and from school such as carpooling or moving to a different bus route.

So when should I talk to my pediatrician? If you're unsure whether your child's symptoms are due to bullying or some form of physical illness, let your pediatrician know. It can only help. Bullied children have illnesses, just like anyone else, and deserve to have a proper evaluation.

Always call the pediatrician if you notice any significant physical or emotional symptoms lasting more than a few days or substantial decrease in grades. Once physical illness has been eliminated as a cause of your child's symptoms, work on understanding the pressures your child is experiencing on the bus and at school.

703-361-7131   Manassas

703-753-6184   Gainesville

Crestwood  Pediatric  Associates