A medical home is a way of providing health care based on a trusting partnership between patients, their families, and a primary care team.  Medical homes offer increased access to health care (American Academy of Pediatrics, n.d., Medical Home). In pediatric care, it is especially important that care is not only patient-centered, but also family-centered, because pediatric patients are very reliant on their families. The primary care team, led by a physician or nurse practitioner (also called the primary care provider), oversees the patients’ continuous care over time and across multiple community settings.  Having a medical home facilitates comprehensive care across the numerous components of today’s complicated health care system.  Medical homes promote safe care that is based on research evidence.  Technological resources are used to enhance communication across care settings, allowing for more coordinated care. The care that medical homes provide is compassionate and culturally centered (American Academy of Pediatrics, n.d., Family-Centered Medical Home Overview).

Plateau Pediatrics strives to be an excellent medical home for your child.  We provide easy access to primary health care. We are conveniently located at 3234 Miller Avenue in Crossville. This places us at the heart of Cumberland County just a few minutes from I-40, US-127, and US-70. We offer same day appointments for sick patients and have a nurse phone line available for questions or concerns that do not require office visits. An on-call physician is available after hours by calling the Cumberland Medical Center main phone line and asking for the on-call pediatrician.  We are also available by email at office@plateaupediatrics.com.

We schedule our patients with their primary care providers whenever possible, and this consistency helps build trusting partnerships between patients, their families, and their primary care providers. We recognize that children are cared for in the context of their families, so we attempt to consider family circumstances and needs when planning their care.  As primary care providers, our physicians and nurse practitioners oversee their patients’ care over time, from birth until early adulthood. They also oversee their patients’ care across multiple settings, providing referrals to specialists, recommending counseling or behavioral services, arranging for developmental evaluations, arranging for inpatient treatment at Cumberland Medical Center, and arranging other services as they are needed.

Our primary care providers maintain communication with the other health care professionals who provide care for our patients to allow for comprehensive care that is well coordinated.  Communicating with other health providers also allows for avoidance of needlessly duplicating diagnostic tests. We are committed to providing care that is safe and effective. In order to do this, we practice evidence-based medicine.  This means that the treatment we provide and the care we recommend is based on medical research findings and also takes our patients’ individual values and preferences into account.  We utilize electronic medical records and e-prescribing to enhance clear communication between our practice and other facilities involved in our patients’ care.  Our patients and their families are precious to us, so we seek to treat each person we encounter in our office, on our phones, and through email with the utmost level of compassion.  We appreciate the cultural diversity of our population of patients and families. We strive to be sensitive to cultural differences and to provide treatment and education to our patients and their families in culturally appropriate ways. We seek to overcome language barriers, where they exist, by using a telephone based translation service and by producing many of our educational materials and patient forms and information in both English and Spanish.

References

American Academy of Pediatrics. (n.d.). What is a medical home? Family-Centered Medical Home

            Overview. Retrieved September 19, 2011 from http://www.medicalhomeinfo.org/about/medical_

home/

American Academy of Pediatrics (n.d.). What is a family-centered medical home? Medical Home.

Retrieved September 19, 2011 from http://aap.org/healthtopics/medicalhome.cfm

What is a “Section 504 plan?”

Section 504 is a civil rights law that prohibits discrimination against individuals with disabilities. Section 504 ensures that the child with a disability has equal access to an education. The child may receive accommodations and modifications depending on his/her needs, such as:

• Tailoring homework assignments
• Extra time for testing
• Preferential seating
• Supplementing verbal instructions with visual instructions
• Organizational assistance
• Using behavioral management techniques
• Modifying test delivery

What is an IEP?

An Individualized Education Plan (IEP)is an individualized plan for a public school child who receives special education and related services. It’s developed as a team effort between the teacher, principal, special education teacher, school psychologist, and the family. It is implemented when the parents sign it. Progress toward specific goals are measured and reported to parents. The IEP is reviewed every year, and is re-evaluated every three years (or sooner if needed.)

What’s the difference between a 504 plan and an IEP, and how do I know which one my child should get?

The 504 plan is considered a modification of regular education, while the IEP is part of receiving special education services. A 504 can be implemented faster and more simply, while an IEP is more comprehensive. An IEP permits broader, more comprehensive, and more expensive services not available in a 504. It is also monitored more formally and requires more parental participation. Some children can be best served by a 504 plan and others are best served by an IEP: it depends on the child and his disability.

The school said my child needs a diagnosis in order to continue getting services. Can you give me one now?

The Individuals with Disabilities Education Act (IDEA) does not require a child to be “diagnosed” before receiving special education. Disability classification (1 of 13 classes including speech-language, specific learning disability, autism, and emotional behavior disability) and medical diagnoses are not the same. The IEP team determines whether the child has an eligible disability, and a medical diagnosis is not necessary to obtain or continue getting IEP-driven services. The exception is “developmental delay,” which ages out when the child turns 9. At this time, a more specific diagnosis must be given for the child to continue to receive services.

My child has ADHD, and the teacher told me if he doesn’t get on medication, he can’t stay in class. Is the school allowed to do that?

No. The IDEA 2004 revision prohibits personnel from requiring a child to be medicated to attend school, be evaluated, or get services. The school is obligated to consider a behavior plan.

My child is going to be held back this year. What should I do?

The IEP team can make the determination for grade retention (“holding back a year.”) However, parents can challenge the retention decision, especially if they feel retention was the result of the student not receiving the services specified in the IEP.

My child has an innocent murmur. What do I need to do?
Actually, nothing. Think of an innocent murmur like freckles. Technically, it’s an “abnormality” in the skin, but practically, it means nothing. Freckles don’t require any special treatment or have any significance. So, children with innocent heart murmurs:

• do not need any special tests or X-rays
• can play sports or do any activity they want to do
• do not have an increased risk of heart problems later in life
• do need to take antibiotics before dental procedures or surgery
• should be treated like any other child

Why has no one heard this heart murmur until now?
Parents are sometimes upset when they are told their 4-year-old child has a heart murmur, wondering how the doctor could have “missed it” all this time. However, innocent heart murmurs are often “discovered” much later than the newborn period because:

• The murmur may not have been there before. Innocent murmurs tend to appear and disappear as children grow.
• The murmur may be quite soft. and difficult to hear if the child is crying, or if the child’s heart is beating very fast.
• Certain things (like fever or a change in body position) can make murmurs easier or harder to hear. If the doctor had never listened to the child’s heart during a certain circumstance before, the murmur might not have been audible.

What is causing this murmur?
See our page on what causes murmurs for more details and diagrams.

Will it go away?
Most innocent murmurs do go away as children get older — which is why adults don’t have them, even though so many children do. However, remember that, since it’s harmless, it really doesn’t matter whether an innocent murmur goes away or not.

How can you tell just from listening if the heart murmur is innocent or not?
The characteristics of the sound help classify it as good or bad. For instance, we listen for:

• How loud the sound is
• Where on the chest we hear the sound
• What it most sounds like (a hum, a click, a honk, a whoosh, etc.)
• When in the cardiac cycle the sound occurs (for example, right after the “lub,” or with the “dub”)
• Whether the sound comes and goes

Also, there are other things which suggest that a murmur is harmless:

• An otherwise normal circulation: a normal blood pressure, strong pulses, etc.
• An otherwise normal body: no other physical problems with the ears, kidneys, limbs, etc.
• Good growth and development.
• No symptoms. Children who can run, jump, and play without chest pain, shortness of breath, or heart palpitations are much less likely to have a serious murmur.

Once in a while (about 1% of children), the murmur may sound unusual, or a child may have other issues which make us more suspicious of a heart problem. In those circumstances, we will refer the child to a pediatric cardiologist for evaluation.

For more technical information on the mechanical causes of murmurs, see our page on what causes different kinds of murmurs.

Parents are often unsure if their child is getting enough sleep. In addressing this, we look at several things:

Where does the child compare to the normal range for his or her age?
A 2003 study (Pediatrics, 1111:2, Feb 2003, pp. 302-307) performed by Swiss researchers showed that 96% of children at a given age fell in the following ranges of total sleep hours (nighttime and daytime naps combined):

• 1 month old: 9 to 19 hours a day (average, 14.4 hours)
• 3 months old: 10.3 to 18.8 hours a day (average, 14.6 hours)
• 6 months old: 10.4 to 18.1 hours a day (average, 14.2 hours)
• 9 months old: 10.5 to 17.4 hours a day (average, 13.9 hours)
• 1 year old: 11.4 to 16.5 hours a day (average, 13.9 hours)
• 2 years old: 10.8 to 15.6 hours a day (average, 13.2 hours)
• 3 years old: 10.3 to 14.8 hours a day (average, 12.5 hours)
• 4 years old: 9.7 to 14 hours a day (average, 11.8 hours)
• 5 years old: 9.5 to 13.3 hours a day (average, 11.4 hours)
• 6 years old: 9.3 to 12.6 hours a day (average, 11 hours)
• 7 years old: 9.2 to 12.1 hours a day (average, 10.6 hours)
• 8 years old: 9 to 11.7 hours a day (average, 10.4 hours)
• 9 years old: 8.8 to 11.4 hours a day (average, 10.1 hours)
• 10 years old: 8.6 to 11.1 hours a day (average, 9.9 hours)
• 11 years old: 8.3 to 10.9 hours a day (average, 9.6 hours)
• 12 years old: 8 to 10.7 hours a day (average, 9.3 hours)
• 13 years old: 7.7 to 10.4 hours a day (average, 9 hours)
• 14 years old: 7.3 to 10.1 hours a day (average, 8.7 hours)
• 15 years old: 7 to 9.9 hours a day (average, 8.4 hours)
• 16 years old: 6.6 to 9.6 hours a day (average, 8.1 hours)

These guidelines may be helpful, but remember 2% of healthy, normal children sleep more than this and 2% of healthy, normal children sleep less than this. Children with different levels of physical activity, stress levels, illnesses, etc. will also show a lot of variability in how much sleep they require.

Does the child’s sleep seem like it refreshes him or her?
Sometimes, the answer is definitely no: a child who is ill, in a strange environment, etc. will have difficulty getting enough rest. But when the child is otherwise well and on a normal schedule, a child who is getting enough sleep should wake up refreshed and ready to go. Sometimes kids seem to “drag” in the morning on school days, but do better on weekends or holidays when that extra 30 minutes of sleep in the morning can make a difference. If you notice this is the case, try moving the child’s bedtime back by about 30 minutes.

Children who constantly wake up unrefreshed from sleep and fall asleep during the day should probably be evaluated for a sleep disorder.

When dealing with your child’s fever, remember:

• Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be given every six hours as needed for fever.
• If your child has a fever but is sleeping, don’t wake him or her up to give medicine for fever! Let your child rest.
• Fever is not harmful for children. We treat with fever-reducing medications only to make them more comfortable. Avoid the “tyranny of the thermometer” and go more by how your child is acting, rather than the height of the fever.
• Fever-reducing products, especially those containing acetaminophen, come in different strengths. Be sure to check the label of the product you have, and be sure that you’re giving the right amount for the strength of medicine you’re giving.
• In 2011, manufacturers are changing the amount (concentration) of acetaminophen (Tylenol) in medicines for infants. These new concentrations will have different dosing directions. During the transition, you may find both concentrations on store shelves and in your home. It is very important that parents look on the label to check the concentration of the product they are giving. If you are unsure, please call our office.
• Many over-the-counter cough and cold preparations (Dimetapp, Robitussin, Triaminic, etc.) contain acetaminophen as well. Check the label. If you give your child one of these products, do not give extra Tylenol.
• Call us before giving any fever medication to children under age 3 months. Ibuprofen should never be used in children under age 6 months.

For acetaminophen products

For ibuprofen products

Due to the risk of Reye syndrome, we do not recommend giving aspirin or aspirin-containing products (such as Pepto-Bismol) to children with fevers.