Dr Balfanz to retire

Balfanz_retires-slideAfter 40 years of practice at Pediatric and Young Adult Medicine I have made the difficult decision that it is time to retire. My last day in practice will be June 30, 2015.

I have been blessed to be able to be a pediatrician and it has been very rewarding to be able to care for your children. I have been able to see them as newborns, counseled you in normal newborn care and well child care. I have been able to watch them as they grew up, shared in their successes and in their difficulties and taken care of them when they were ill. I have shared my experiences in raising my children in teaching you how to care for your children. You and your children have been an extended family to me.

The decision to retire is the most difficult one I have ever made. I cannot tell you how much I am going to miss seeing you and your children. I will miss seeing them grow up. I am honored that you trusted me with their care and it has been a privilege to serve you.

We have nine pediatricians and one nurse practitioner at Pediatric and Young Adult Medicine and in June will be adding a second nurse practitioner. They have been great partners and will provide outstanding medical care for your children.

Again, thank you for allowing me to care for your children over the past 40 years.

Sincerely,

John Balfanz, MD, FAAP (Dr. B)

The Truth about Tantrums

tantrum1Every parent sees it and every parent has to deal with it. It happens at home and it happens in public. That most feared behavioral issue, temper tantrums, happen. While similar to aggressive behavior (which starts to show up at about the same time) tantrums are slightly different. Aggressive behavior occurs when a youngster can’t or doesn’t know a better way to deal with a situation involving another child; tantrums on the other hand are nearly always a function of the child’s squaring off against parents or caregivers. In other words, when they don’t get what they want.

tantrum8Why do children have such a tough time learning that they can’t have or do everything they want? Look at it this way. From the very moment of birth onward every adult in a child’s life diligently gives him whatever he needs— food, attention, toys, etc. but during the second year of life, the game abruptly changes—baby can’t have whatever he wants, he can’t do whatever he wants—like running into the street. The adults in baby’s world suddenly start imposing rules and expectations. In addition to this children of this age are beginning to develop a sense of self, a person separate from his parents. He wants to develop and use new skills and explore the world around him. This creates conflict and a normal healthy child will respond by occasionally lashing out or by launching a full-blown tantrum.

While this behavior is normal, it can be very unsettling and disruptive but there are many things parents can do to stop or ameliorate the behavior.

Parents themselves have to take the blame for some tantrums, the ones that happen when they have dragged a kid to the mall and missed nap time, meal time and whatever else is part of the child’s normal routine. A tired, hungry kid can explode in this situation. This sort of ‘tantrum’ is best recognized for what it is, an event that could have been avoided by better planning. All other tantrums are plain andsimple, power struggles.

Power struggles by age

tantrum7Usually by 18 months children start testing the limits. They want to be free to explore the world and be independent— ‘me do it’. At this age, children can’t see another person’s point of view, only their own. When their actions or desires are checked, they react by crying, shouting, hitting or kicking.

It is pointless to try to reason with a child in this situation. At this point, parents have options but ‘talking them down from the ledge’ just doesn’t work and usually makes things worse. Strategies and tantrum-busters are discussed later.

By the age of three years, kids have better language skills and have learned to be less impulsive. Generally there are fewer and less dramatic tantrums at this age. At four years of age children can do many things by themselves; they have better language skills and have acquired some self-control. These abilities help kids keep it together. Still, when they are faced with challenging situations tantrums can flare up. In fact children of all ages can have an occasional tantrum, up to and including teenagers.

tantrum6Temper tantrums are a lot like forest fires: they are easier to prevent than to control after they have started. Here are some ideas that can help you squelch a temper tantrum at its onset or at least ride one out, because sometimes, that’s just what you have to do.

Strategy, not screaming

Parents can start controlling tantrums by knowing their child’s triggers, those things that in the past have set the child spiraling out of control—hunger, fatigue, stress, interruption of an activity. Plan ways to head these off ahead of time so that you are prepared.

  • Don’t expect a small child to go without eating or sleeping as long as you can. Restrict outings to times when your child is fed and rested and when he does tire, go home.
  • Establish a routine for your child and then stick to it as much as possible. Respect his schedule. Some people can ‘switch gears’ more easily than others. If your child has difficulty transitioning from one activity to another, help him out by giving him a couple of notices that this will be happening. “Owen, in ten minutes you will need to stop playing with legos because it will be lunchtime.” Then repeat the warning again at 5 minutes. This way Owen has time to process and come to terms with the change that is coming.
  • Give kids control over the little things in their life this helps them deal with times when they can’t be in control of a situation.
  • Try not to say ‘no’ automatically. Up your game, say yes, avoid fighting over little things.
  • Child-proof his environment so that he can explore and experiment without always hearing ‘no.’
  • Redirect, distract or somehow change things up when you see your child on the edge. That oftentimes works to prevent a blow-out.
  • Keep your expectations of your child’s social, academic and behavioral abilities at a realistic level, where he can meet them without becoming too frustrated. For example, you can’t expect the same things from a two year old that you can from a four year old.
  • When doing something new or unfamiliar, tell your child ahead of time what your expectations are for his behavior.
  • Keep your sense of humor, it will serve you well.

At all times, parents need to remain calm themselves. Losing their temper, shouting, or making threats is like pouring gasoline on a fire and is a sort of grown-up version of what their child is doing. Not the best message to send, is it? When a child is out of control reasoning and threats don’t work. Believe it or not, young children are often scared by their own behavior; someone has to be calm and that is the parents’ job.

tantrum5One excellent strategy is to remove the audience from his performance by simply walking away and telling him that you will talk to him about the problem when he calms down. Make sure he can’t harm himself or others, then leave the room. Kids realize sooner or later that their actions are not yielding the desired results and the tantrum fizzles out.

At home, you can simply walk away from a tantrum in progress and wait for the child to settle down. This isn’t a realistic strategy in a grocery store or mall. If your efforts to head off the tantrum fail, then the best course of action is to remove the child from the store and go outside or to your car and let him have at it without any observers (again, making sure that he is safe)until he is in a more reasonable state.

It is beyond annoying to have to abandon your grocery cart or leave unpaid purchases behind, but by doing this the child learns that you mean what you say and that he can’t use tantrums for leverage. You, the parent simply aren’t buying into his demands no matter what.

One of the worst things a parent in this predicament can do is to give in to the child for the sake of convenience or out of embarrassment. That tells junior that he has the power to get what he wants by using these unacceptable behaviors. Forget about what others might be thinking, your job is to help your child grow emotionally as well as physically, not impress other people or worry about their disapproval.

tantrum3Buy into a tantrum and the next ones will be harder to deal with; refuse to play along and the child learns that tantrums don’t work.

Sometimes, little and not so little kids can get so out of control they are in danger of hurting themselves or others. When this happens you have to step in and physically restrain the child, maybe with a ‘basket hold’ for safety sake, until calm is restored.

Time-outs can be useful by giving the child the time and space to get his control back. Don’t use it as a punishment but as an opportunity that he can use to help himself. Babies need to learn to self-soothe and children need to learn to regain and maintain self-control.

tantrum4As mentioned earlier, parents can do a lot to teach their kids that tantrums aren’t the way to get what they want. Teaching them to ask nicely, be patient, and understand that they can’t always have what they want. Consistency is key, at home, at daycare and at school. Talk to teachers and caregivers; explain to them what methods you find work best for your child.

It is also very important to show your child that you dislike his behavior but you always love him.

Lastly talk to your child when things get back to normal. Discuss what happened and why the child responded as he did. Was he angry, frustrated, or simply confused? Talk about his feelings and what he can do to deal with them at other difficult times. Keep the evil twins, shame and blame, out of the discussion, that is unproductive and doesn’t help a child learn from his mistakes.

tantrum2Physical growth doesn’t happen over night neither does emotional maturity or social skills. Step-by-step children work their way through the complexity of being human. You are their guide. They can’t make it without you. For their sake, learn how to deal with tantrums firmly and lovingly. Everyone’s life will be the better for it.

Watch the Bald Eagle Babies Be Born!

The Minnesota Department of Natural Resources has done it again! This time they have a live webcam focused on an enormous bald eagle’s nest with 3 eggs. Watch with your children as this mother lovingly turns the eggs and cares for them. Will you be lucky enough to see the eaglets hatch? This is a wonderful insider’s look at nature. Google www.webcams.dnr.state.mn.us/eagle today.

Healthy Hearts and Happy Heads for Girls Ages 9-11

The spring session of Healthy Hearts and Happy Heads is scheduled for March 24th , March 31st, and April 7th. This is a wonderful opportunitiy for girls ages 9-11 to get together with their mother or another adult female to learn, share, and have fun. During this session, Jenny Hanlon will be presenting a talk on the media and body image. Please see their Facebook page for more information.

Dr. Delahunty Says Goodbye In An Open Letter To Patients And Their Families

March 2014

To My Dear Patients and Families:

It is with a very heavy heart that I announce my resignation from PYAM effective April 16, 2014. I have spent 16 of the most meaningful years of my life here with you. Meeting your children and watching you grow as a family has deeply affected me. You have become my community of dear friends and neighbors. It is because of you, that I woke up every morning looking forward to the day ahead and the bright faces that I would be seeing.

Now it’s time for me to focus on my family. The new insurance requirements have added several hours of charting to my day which has significantly worsened my arthritis and my back pain. My husband and I plan to rest, picnic, walk, travel, chat, read and live simply for awhile. I also plan to do some additional training in some areas of pediatrics that most intrigue me.

I have great confidence in my partners and truly feel that Pediatric and Young Adult Medicine provides the best pediatric care and the most accessibility to your doctor in the metropolitan and surrounding areas. I trust them implicitly with the care of my own family and my extended family, you. I would be happy to discuss this with you and help direct you towards one of the remaining 10 doctors and the best nurse practitioner in town! I know that I leave the children and the families that I have come to love in expert hands.

Thanks to all of you for making my work so meaningful and so very much fun, Dr. D.

Marked Rise In Influenza Illnesses

Early January of 2014 has brought us a steep rise in the amount of Influenza activity throughout our community. We’ve seen several cases of Influenza A which is thought to be the H1N1 strain. This particular strain is the one responsible for the large outbreak of “swine flu” 2 years ago. It is not too late to get your children vaccinated. Please call 651-256-6714 to make an appointment. While the vaccine is not 100% effective, children who have had the vaccine but become ill, typically have less severe symptoms and a shorter duration of illness

ADHD PRESCRIPTION HOTLINE

651-256-6796

Pediatric and Young Adult Medicine refill voicemail line is now available. You may now call and request your refills when it is convenient for you 24-hours a day/7-days a week.

To use this service, we ask that you review the following procedures to ensure that we receive the proper notice and information to guarantee the prescription(s) for your child is ready when you need it.

  1. We will have your prescription ready within two business days for pick-up and 5 days for delivery to a pharmacy. If there is a problem with your child’s present dosage, please speak with your primary provider by calling 651-227-7806.
  2. Please provide all of the information that is required to process your request. We have provided you a template on the back of this sheet. We suggest that you write the information in the blanks that are provided so you will be able to read it over the phone.
  3. This service will be available to request your refill for ADD/ADHD RX only.
  4. You may request them 24 hours a day, seven days a week. Please remember we can only fill the prescriptions during regular business hours.
  5. At this time, no other prescriptions can be filled using this line. Other concerns or topics should be addressed with your provider by calling 651-227-7806.
  6. All voice mails will be listened to and processed daily during regular business hours.
  7. All ADHD/ADD patients who are on prescriptions are required to have a medication check-up every 6 months. lf you are a patient either starting a new prescription or are restarting a prescription you must be seen 2 weeks after you have started your new prescription. Failure to do this may cause your refilled to be denied.

Thank you, Pediatric and Young Adult Medicine, PA

adhd_checklist.pdf Use this checklist to collect the information you need before you call in and make your request.
To view this file you will need to have Adobe’s Acrobat Reader. Its a free download and is available for both the Mac and Windows.

 

PYAM ADHD HOTLINE

News Release: Online Parenting Resource for parents of 10-16 year olds

We’re excited to announce the release of a new University of Wisconsin, Cooperative Extension online Parenting resource. It’s called Parenthetical and it’s available to educators and parents throughout the state at http://www.myparenthetical.com. Parenthetical is a combination blog, website and social network for parents of 10-16 year old tweens and teens designed to provide parents and other caregivers with ongoing education, support and networking.

Happy New Year!!!

From all of the doctors and staff at Pediatric and Young Adult Medicine, we wish you a really happy and healthy 2014!

Bullying = A World of Hurt

Which phone call is more disturbing for a parent, one informing you that your child is being bullied or one telling you that your child is the bully? Surprisingly, most children will experience both roles at some point on the road to adulthood. Either way, as a parent, you have to respond quickly. The sooner you get involved the better it will be for your child, no matter which role he happens to be playing at the moment

Why kids bully
Many factors contribute to bullying. First, children are not born with social skills. They learn through trial and error. In addition each child needs to find out how he fits into his peer group. Throughout elementary school and high school children learn how to deal with others in a variety of situations and they don’t always get it right. Sometimes a child might feel threatened by another and resorts to bullying to feel ‘safe’, or to maintain his perceived position in the group. Another child bullies in order to get the attention he is not getting elsewhere. Lastly, a child could be modeling his behavior after a parent or older sibling—are there any bullies in your house? Even too much teasing constitutes bullying and should not be tolerated at home or anywhere else.

Who are bullies?
Since most kids are a bully sometime during childhood is it fair to say that there is a ‘type’ of child who bullies? While all kids might try out bullying once or twice there are kids who habitually use this behavior in their dealings with others. Generally speaking, habitual bullies fall into one of two categories. One group is made up of the popular girls, the athletic, good-looking boys—members of the in-crowd. Kids in the other group tend to be children who have been marginalized themselves, possibly through bullying, and are typically kids with poor grades who aren’t involved in sports or other school activities. However, just because a child fits into one of those categories doesn’t mean he is a bully.

Signs Your Child is Being Bullied

Complaints about headaches and stomach aches

Unexplainable injuries from self or others

Changes in attitude, behavior, and achievement at school

Lost or damaged property

Changes with friends and social circles

Changes in sleep or eating habits

Reluctance / avoidance / inability to talk about it

Expressing no interest in anything

Intense feelings of hopelessness, shame and depression

Who gets bullied?
Here again, most kids end up on the receiving end of bullying at some time. There are, however, certain traits that predispose a child to being a target. Kids are quick to pick up on any physical or cultural difference, which can be useful tools for bullies. Children with physical and learning disabilities can be at risk. A child who stutters, or is extremely shy or even kids who dress outside the norm can be bullied. Kids who stand out by excelling in sports or academics can be targeted. More subtle targets are the children who have trouble reading and responding to social cues, like children with Asperger’s.

Defining bullying
Bullying can take many forms. It can be teasing that goes too far, name-calling, stealing or breaking another’s belongings—even physical violence. Another form of bullying is spreading rumors about, or excluding a child from the group. In recent years, technology has put a dangerous edge on bullying through the use of smart phones and the Internet. Whatever form it takes, though, bullying makes children miserable and fearful for their own safety. If bullying is allowed to continue a child can suffer negative consequences for life with problems like depression and low self-esteem.

Where does bullying happen?
Bullying can happen anywhere at any time, but it most commonly occurs in the absence of adult supervision. Think about the times during your child’s day when he is with other kids and there are few or no adults around: playgrounds, cafeterias, the neighborhood, or public places like skating rinks, libraries and swimming pools. Does your child walk to and from school? That is a prime opportunity for bullying to occur.

Boys tend to be more physical bullies.
They often target smaller, weaker kids who are less likely to fight back. Stealing money, lunches or property is more common with boys. Threats of violence or actual physical harm, is more likely to happen with boys.

Girls on the other hand, tend to bully in less overt ways.
They frequently use tactics like telling others not to talk to or play with their victim, excluding them from social activities or spreading damaging rumors about another. In junior and senior high school, girls are more likely than boys to use electronic devices and the Internet to bully, although boys are catching on to this as well.

Why victims remain silent
Children who are being bullied frequently remain silent or are reluctant to talk to anyone about what it going on. First, they are afraid of retaliation. Secondly, some believe that they have done something to deserve the treatment, and will be further punished if they go to someone in authority. In fact, many parents and teachers hold the belief that if a child is being bullied, he has done something to warrant it. Little wonder that children keep quiet, desperately hoping it will just stop. Adults need to make clear that bullying is not acceptable at home, school or anywhere, including the Internet

Cyber-bullying: the ultimate torture
If you think bullying on the Internet is the same as a shove on the playground you’re wrong—cyber-bullying triples the risk of suicide in teens. Middle and high school age kids are well aware that images and text on the Internet or cell phones, is indeed, available to the entire world. There is no place for them to escape the notoriety that has been pinned on them. It is easy to understand a victim’s sense of helplessness and hopelessness.

Cyber-bullying allows bullies and their followers to cause unbearable pain to a classmate without being able to see their victim as they are acting. Without the consequence of seeing the victim’s pain, kids can go too far. This is obviously bad for the victim but it is also bad for the bullies. Children need to see the consequences of their actions, hopefully before it is too late.

What recourse do parents have?
If the phone call you receive tells you that your child is being bullied there is a great deal that you can do to help him. First though, take a deep breath and try to take in the information, calmly. Maintaining your composure will help your child as much as anything else you do. Actually that is good advice for the parents who receive the other phone call, the one telling them their child is the bully.

Help for the victim

Find out who is doing the bullying and where it is happening. If it is at school, you can arrange to meet with your child’s teacher and devise a plan to help keep him safe. Do not suggest a meeting at school with the bully and his family. Those meetings get heated and out of control; in the end little is accomplished. Still, it is your duty as a parent to approach the bully’s parents if the problem is in your neighborhood, but if it is at school have the administration do that.

You can advise your child to avoid the places where he might encounter problems and you can teach him ways to respond to bullying. Sometimes simply telling the other kid to ‘knock it off’ or by making a joke of the taunt, your child can defuse the entire situation. What about fighting back? That sometimes makes bullies back off, but unfortunately, your child needs to know that he then risks being punished as well. It needs to be stated for parents of both bully and victim that parents are legally responsible for their child’s behavior and assault is illegal at any age.
Lastly, bullies seldom target a child with a circle of friends. Even one good friend can be enough to discourage a would-be bully. If your child struggles socially, help him find that one friend through play groups or other activities.

Help for the bully
Bullies need help too. They attempt to control other kids through dominating, hurtful behavior. If left unchecked, they can assume that pattern for life. If your child is the perpetrator, you want him to understand that what he is doing is wrong and it won’t be tolerated. He will likely try to shift the blame and make excuses for his behavior, but he needs to acknowledge that he has hurt another person and that his behavior was not acceptable. If talking and reasoning don’t work, rescinding privileges, grounding, keeping him indoors when other kids are out playing are all strategies that help modify behaviors.

The important role of bystanders
In most episodes of bullying there are more kids present than the two main participants. The other children might be friends of the bully, the victim, or they might be bystanders not associated with either child. But the bystanders are the key to ending bullying. Bystanders have tremendous power. They can tell adults what is going on and they can let the bully know that they don’t approve of his actions. Fitting in with other kids is crucially important to school age children and they do not want to risk the opinion of others by backing a bully. Sometimes the disapproval of other children is enough to discourage the bully as well.

Discuss bullying with your kids. It is important that they know how to respond to bullies and that they can help other kids. It also lets them know that they can come to you for help if they need to.