Monday, April 14, 2014

Child Abuse Prevention

Blog contributed by Andrea Burks, DO, Heritage Pediatrics, PinnacleHealth Medical Group



April is child abuse prevention month.  In the United States of America there are approximately 3 million reports of child abuse and neglect each year involving 6 million children. 686,000 children were determined to be victims of abuse and neglect in 2012 and of those 1,640 resulted in death. That is greater than 4 child abuse related deaths per day. There are likely many more cases that are not reported. Child abuse and neglect happens at every socioeconomic level, across ethnic and cultural lines, within all regions and levels of education. Boys and girls are maltreated in equal numbers.  Children less than 4 years old are at greatest risk for severe injury and death from abuse. The most common abusers are parents, other family members, or an unmarried partner of a parent. Children who suffer maltreatment are at higher risk for cognitive delays, emotional difficulties, harm to development of nervous and immune systems, and health problems as adults. It is important to recognize, help prevent and report suspected child abuse and neglect because its lasting effects can impact us all. Small acts from everyone in a community can help save a child from harm.

The first step is to recognize child abuse. Child abuse can be physical, emotional, sexual, or involve neglect of a child by someone who has responsibility for the child. It is common for more than one type of abuse to occur at a time. It is important to note a single sign does not mean maltreatment has occurred but if signs appear repeatedly or in combination a closer look at the situation may be warranted.


  • Physical abuse involves non accidental physical injury including but not limited to hitting, kicking, biting, burning, choking, shaking, and throwing. It often leaves bruising at different levels of healing, marks on body consistent with objects or hand prints, or unexplained bruises, black eyes, or broken bones. The physically abused child may wear clothing inappropriate for weather (e.g. long sleeves in hot weather to hide bruising). They may also be reluctant to go home or fearful of parents.
  • Emotional abuse involves with holding love, support or guidance from a child. Emotional abuse is as strong a predictor of subsequent impairment in child development as physical abuse. Emotional abuse may include ignoring, rejecting, isolating, verbal assault, threatening, blame, belittling, or shaming the child in a persistent chronic pattern. The caregiver may appear unconcerned about the child. The child may show overly compliant or demanding behavior, be extremely passive or aggressive. They may speak of attempting suicide or they may report lack of attachment to parent.
  • Sexual Abuse can involve engaging a child in sexual acts, exposing a child to sexual activities, indecent exposure, or exploitation of a child through pornographic material. Effects of sexual abuse extend beyond childhood. These children often have loss of trust and feelings of guilt. The child may show signs of regression such as bedwetting, rocking, head banging, stranger anxiety, withdrawal from family and friends, suddenly refuse to change clothes in gym, or refusal to participate in physical activities. The adults may appear extremely protective and limit contact of the child with other children.
  • Neglect is failing to provide the basic needs for a child including food, clothing, shelter, proper hygiene, education, and medical attention. Neglect can also involve abandoning a child or putting a child in unsupervised or dangerous situations. The child may miss a lot of school, beg or steal from classmates or friends, or lack medical/dental care. They may have dirty clothes or clothing inappropriate for weather.


Prevention of child abuse and neglect is a community effort. Individuals in the community can play a role in helping families find the strength to raise safe, healthy, and productive children.  A majority of parents don't want to harm their children. Abusers are more likely to have been abused themselves and don't know other ways to parent. They may suffer from mental or chronic health problems, struggle with substance abuse, and commonly have high stress and lack of support. Parenting is one of the toughest and most important jobs. We all have a stake in ensuring parents have access to the support they need to be successful parents. You can start by getting to know your neighbors. Help a family under stress by offering to give them a break and babysit for a few hours, help run errands, help a parent with a small child get through checkout line at the grocery store, or reach out to children in the community. If a child discloses they are victims of abuse, first believe them, listen, and don't be critical or negative of child or parent. Assure the child they are not to blame and report the incident.

It is the right and responsibility of everyone in the community to report suspected child abuse or neglect. You can make a report by contacting your local child protective service agency or police department. You do not need to have evidence or actual knowledge of abuse to make a report. You should have reasonable cause, heightened concerns, or belief based on observation. Reporters can be anonymous but giving your name may help the investigation. Good Faith Laws protect the reporters from legal liability. Trust your instincts. Reporting your suspicions may protect the child and get help for a family who needs it.

If you are a parent under stress find ways to regain control. Try counting to 10, take deep breaths, call a friend, put your child in a safe place and take a few minutes to calm down and relax. Never be afraid to apologize to your child if you lose your temper and say something in anger that wasn't meant to be said. Reach out to community centers, church, schools, and physicians for guidance on positive parenting skills. It is often helpful to learn good communication skills, appropriate discipline, and how to respond to children's physical, developmental and emotional needs. Understanding appropriate developmental milestones may help you set reasonable expectations for a child. Creating social connections with family, friends and the community gives encouragement and can help improve parent child relationships. There is also concrete community support that assists with food, clothing, housing and access to healthcare.  You can contact you physician for information about these services.

In Pennsylvania report concerns for child abuse and neglect to ChildLine 1-800-932-0313

Wednesday, April 9, 2014

March is National Nutrition Month

Blog contributed by Tina Metropoulos, DO, Primary Care Physician

In primary care, we often counsel patients about healthy dietary habits. 
I’m frequently asked about what foods are healthy.  Another common question is whether a fad diet is safe, effective, or advisable – “How about Atkins?”, “Is South Beach okay?”, and should I go “Paleo?". Sometimes the goal is weight loss, and sometimes it is to improve lifestyle. Specifically, patients are often concerned about their heart health and providers often discuss diet as a means to reduce risk for heart disease.

Recently, the American Heart Association updated their healthy nutrition guidelines.  I read through them, after their release in 12/2013.  The overall focus is on a balanced, moderate, diet with limited processed food intake.  An important recommendation is to have a diet rich in fruits and vegetable – with an average of 9-10 servings a day for an adult.  There are other guidelines and diets which focus on fresh fruits and vegetables, such as the DASH diet and the Mediterranean diet.  This may seem as hard as climbing Mt. Everest, especially if you count an occasional side salad as your token veggie for the week.  However, I try to help patients realize how easy it can be to include healthful, and flavorful, fruits and vegetables in their daily meals.

First, it’s important to understand how much “a serving” is.  A serving of fresh fruit is equal to 1 medium fruit, ½ cup cooked, chopped, or canned fruit, ¼ cup dried, or ½ cup juice (easy to get when you add some dried cranberries to some mixed nuts!).  A serving of fresh or cooked vegetables is roughly ½ cup; vegetable juice is ½ cup, while 1 cup constitutes a serving of raw leafy greens.

So, if you chop up some tomatoes, peppers, cucumbers in your lunchtime green salad (or if you are feeling adventurous, some artichokes or asparagus), you’d have at least 3 servings to put toward your daily quota.  Add some sliced berries to your AM bowl of Wheaties and you have another serving.  Snack on hummus and carrot or celery sticks (much better for your afternoon slump than a double mocha) and you’ve added another serving or two – more than half-way there!  And, we haven’t even counted dinner yet.

Now that spring is in full swing we will soon have an abundance of fresh fruits and vegetables available!  By visiting your local farmer’s market or grocery store you can stock up on colorful, visually appealing, and delicious produce.  Eat up!

What is a serving size?

Recipe Ideas:



Monday, February 24, 2014

Does My Child Have an Eating Disorder?


Blog contributed by Kathleen Zimmerman, MD,  Pediatrician

If you are asking this question, then your child needs to be seen by his or her provider.  Over the past decade the United States and other parts of the world have seen steady increases in the incidence of anorexia (nervosa) and bulimia for both females and males.  There is also an increasing trend for younger children to develop eating disorders as well as teens.  Eating disorders present with many different signs and symptoms.  Sometimes these are difficult to detect if your child is hiding them.   Here are a few that should raise a flag and prompt you to bring your child to the office:

  1. Constantly worried about their size or weight
  2. Not eating as much food as they used to but insisting they ate when you weren't around
  3. Binge eating large amounts of foods 
  4. Menstrual period is becoming irregular or skipping months
  5. Intense exercise more than 1-2  hours per day and they are very stressed if they miss a workout
  6. Symptoms: cold intolerance, dizziness,  abdominal pain, constipation, diarrhea, muscle cramps, looks pale and weak
  7. Either parent has a history of eating disorder

Your provider will measure height, weight, BMI and get a thorough diet and exercise history.  They may need to talk with your child alone.  Follow up appointments will be important to track the weight.

Early detection of eating disorders is important to prevent serious consequences.  So, even if your child denies there is a problem, it is important to have your provider evaluate any concerning eating behaviors or weight changes.

Tuesday, February 18, 2014

Strep throat vs. Viral pharyngitis


Blog contributed by Julie A. Lundblad, MSN, CRNP

How do I know if child has strep throat? Medical care providers cannot always tell by looking in the throat. Most offices can run a rapid strep test and the results are just minutes away. 80% of all sore throat office visits are viral, only 20% are from Strep.

Common symptoms of step throat:
  • Sudden onset of sore throat
  • Pain with swallowing
  • Fever >101
  • Red, swollen tonsils (sometimes white patches)
  • Swollen lymph nodes

Strep can also cause headaches, nausea, vomiting, rash, body aches, or tiny spots on the back of the throat (petechiae)

What is viral pharyngitis? Basically inflammation of the tonsils and back of the throat, with or without a fever. These are caused by viruses and upper respiratory infections.

Common symptoms of viral sore throat:
  • Sore throat, dry and scratchy
  • Runny nose, sneezing
  • Headache
  • Cough
  • Fatigue
  • Low grade fever

Strep throat is contagious, so if there is a known exposure, testing is necessary.  I recommend calling your Primary Care Physician for an appointment to rule out Strep. It is usually easily treated with an antibiotic for 5-10 days. If the sore throat is viral, the treatment is supportive and symptomatic.

Monday, February 3, 2014

My Child’s Ear Hurts – Is it an ear infection?



Blog contributed by Kathleen Zimmerman, MD,  Pediatrician

All parents have experienced the middle of the night cry from their child, “my ear hurts!”  Ear pain is one of the most common reasons a parent calls their child’s doctor or provider.  But how do you know if it is an ear infection? When do you need to bring your child to the office?

There are many causes of ear pain.  Sometimes the pain has nothing to do with the ear itself.  Children can have “referred” ear pain that is actually coming from the tonsils or the teeth.  You may see ear pain or ear pulling in a baby that is teething, especially when the molars are coming in.  Children with swollen tonsils or strep throat will often come into the office complaining of ear pain.  This referred pain occurs because the tonsils and throat are actually quite close to the inner ear.  Another example of referred ear  pain is seen in an older child or teenager that has temporal mandibular joint pain (or TMJ syndrome) – the hinge of the jaw is right in front of the ear, so a child with teeth grinding or TMJ pain can also feel ear pain.

Of course many children with ear pain do have a problem with their ear.  This could be swelling of the ear canal as in “swimmer’s ear”, which is common in the summer.  But in most cases ear problems are behind the ear drum, which is sometimes referred to as the “inner ear”. The inner ear has a tube connecting it to the nose. This is called the Eustachian tube. If your child has a stuffy nose from a cold or from allergies, fluid can push back through this tube and cause ear pain. This kind of fluid and pressure will go away with time and also improves as the nose is decongested. Ask your provider if an over the counter medicine, such as a decongestant or an antihistamine, would be appropriate for your child.

In some cases, the fluid behind the ear drum develops bacteria in it.  The bacteria create pus and more fluid and pressure behind the ear drum.  This is an inner ear infection, or “otitis media”. A child with and ear infection and ear pain will usually need antibiotics.

When you call your medical provider about your child’s ear pain, they will ask questions to try to figure out the cause of the pain. In most cases, they will recommend your child be seen if the pain persists or is severe. Sometimes they may recommend over the counter medicines if it is safe and appropriate for your child. But the only way to know if it is an ear infection is for your provider to look in the ear. Antibiotics will not help your child if it is not an ear infection and antibiotics should only be used when needed.  This is why your doctor will usually not want to prescribe an antibiotic over the phone.

Sunday, January 19, 2014

Blood Donations

 Blog contributed by Dr. Joseph Cincotta, primary care physician

January is often a time when there is a greater need for blood donations.  So, once again this year we are coming to you to make a gift only YOU can provide – the gift of a blood donation.  You can be the one to save someone’s life.  You can be the one to make a critical contribution to the care of someone in need.  You can make a difference.

Donating blood does take some of your time, and it does require a needle stick.  I will not kid you on these facts. Yet, those who do this work are skilled professionals who work to make the experience efficient and friendly.  The discomfort is minimal and is short-lived.  The benefits are enormous and last a lifetime. 

PinnacleHealth's Blood Bank is located at: 

Alex Grass Medical Sciences Building100 South Second Street
Harrisburg, PA 17101
Telephone: (717) 231-8900
Blood Donation Hours: Monday through Friday, 7 a.m. – 5:30 p.m

Here are some facts about blood donations from the American Red Cross:

Facts about blood needs

  • Every two seconds someone in the U.S. needs blood.
  • More than 41,000 blood donations are needed every day.
  • A total of 30 million blood components are transfused each year in the U.S.
  • The average red blood cell transfusion is approximately 3 pints.
  • The blood type most often requested by hospitals is Type O.
  • The blood used in an emergency is already on the shelves before the event occurs.
  • Sickle cell disease affects more than 70,000 people in the U.S. About 1,000 babies are born with the disease each year. Sickle cell patients can require frequent blood transfusions throughout their lives.
  • More than 1.6 million people were diagnosed with cancer last year. Many of them will need blood, sometimes daily, during their chemotherapy treatment.
  • A single car accident victim can require as many as 100 pints of blood

Facts about the blood supply

  • The number of blood donations collected in the U.S. in a year: 15.7 million
  • The number of blood donors in the U.S. in a year: 9.2 million
  • Although an estimated 38% of the U.S. population is eligible to donate, less than 10% actually do each year.
  • Blood cannot be manufactured – it can only come from generous donors.

Facts about the blood donation process

  • Type O-negative blood (red cells) can be transfused to patients of all blood types. It is always in great demand and often in short supply.
  • Type AB-positive plasma can be transfused to patients of all other blood types. AB plasma is also usually in short supply.
  • Donating blood is a safe process. A sterile needle is used only once for each donor and then discarded.
  • Blood donation is a simple four-step process: registration, medical history and mini-physical, donation and refreshments.
  • Every blood donor is given a mini-physical, checking the donor's temperature, blood pressure, pulse and hemoglobin to ensure it is safe for the donor to give blood.
  • The actual blood donation typically takes less than 10-12 minutes. The entire process, from the time you arrive to the time you leave, takes about an hour and 15 min.
  • The average adult has about 10 pints of blood in his body. Roughly 1 pint is given during a donation.
  • A healthy donor may donate red blood cells every 56 days, or double red cells every 112 days.
  • A healthy donor may donate platelets as few as 7 days apart, but a maximum of 24 times a year.
  • All donated blood is tested for HIV, hepatitis B and C, syphilis and other infectious diseases before it can be released to hospitals.
  • Information you give to the American Red Cross during the donation process is confidential. It may not be released without your permission except as directed by law

Remember, this is a gift only you can give.  So, please consider donating blood this month - this year.  Your help is vital to save the lives of those in need.  Thanks.


Sunday, January 12, 2014

New Year’s Resolutions

 Blog contributed by Dr. Joseph Cincotta, primary care physician

Each year many of us start the New Year with a list of things we are going to do better or differently from last year.  Many of the items on the list are health-related.  And, a number of us, me included, will fall short of our declared intentions.  So, how can things be different this year?  When December 2014 rolls around (and the years seem to pass more quickly for me each year, the older I get), how can we look back with a sense of accomplishment for those things we set as goals for 2014?  I hope these ideas are helpful to you.

  1. Do not set too many goals.  Sometimes our list of things we are going to do differently takes up an entire page – it can be 20 or 30 items long.  Keep the list small – no more than 2-5 items that is plenty for one year.
  2. Understand that change is work and that improvement does not follow a straight line upward.  Shifting habits and ingrained ways of doing things takes time, attention, effort, and practice.  Expect that you will have some setbacks, and that you can recover from those and move forward.  Accept your capacity for failure – and commit to learn from those setbacks.
  3. Make incremental changes and build on small successes.  Sometimes we set our goals too high, and they need to be broken down into smaller pieces.  The ultimate goal remains the same, but having some intermediate goals along the way helps to identify and celebrate progress.
  4. Enlist the help of others.  By our very nature we are social creatures.  Teaming up with those who care about us or who may share the same goals can help along the way.  This past year I had a goal of doing a longer bike ride but I knew I had failed in my efforts the year before.  So, I teamed up with a friend in my office to help keep me focused and to share the same goal.  Together we made the ride in August – and I was proud of the accomplishment.

I wish you the best in your efforts, particularly as they relate to better health.  Being healthy and staying healthy requires each of us to be active participants.  Many of the health issues we face today can be addressed through better choices and some changes to current habits.  It is not easy work – yet it is important work – for each of us, and for those we love and who love us.