Flu shots At Pyam

At PYAM we wholeheartedly endorse the CDC, American Academy of Pediatrics and the Advisory Committee on Immunization Practices recommendation that all children ages 6- months to 21 years receive a influenza vaccine each year.

Despite not being able to prevent all influenza disease, the flu shot does provide protection from severe disease. It is especially important for our high risk patients to remember to get immunized each year


In case you’re wondering, the Flumist will not be offered again this year. It was not approved for use.

To schedule your flu shot only appointment simply call our central appointment line at 651-256-6714.

Dr Coyne has Retired

October 14, 2016

Dear Patients,

Dr Terence CoyneIt is with deep regret that I announce I will be leaving Pediatric and Young Adult Medicine at the end of 2016. It has been my pleasure to service the community for the past 43 years as your family’s pediatrician, but I have decided it is time for me to spend more time with my family.

I’ve been very fortunate to care for so many wonderful children. I’ve helped provide care for many beautiful little babies during my career and have had the privilege to watch them go through infancy, childhood and grow into adults, and watch them raise their own families. I have been able to share your successes and tried to help you through the difficulties of growing up. I’ve watched my patients grow in maturity, confidence, and independence. You have given me a wonderful career. I will take these memories with me as a constant reminder to how privileged I am to have been a part of your family’s life.

I appreciate the loyalty you have shown to me throughout the years and hope you will extend that loyalty to the other providers at Pediatric and Young Adult Medicine. The clinic is fortunate to have seven pediatricians and three nurse practitioners. Each of them has been an excellent partner, and they will provide outstanding care for your children.

This has been a difficult decision to make, and I will miss seeing each of you. I can’t express enough how grateful I am to you for allowing me to care for your children. I wish each of you the fullest of lives and the best health.

All my best,
Terence Coyne, MD

Flu shots for 2016

flu-shots-2016bAfter a mild flu season it is easy to forget how very nasty the flu can be. One of the many reasons why the flu is so difficult to manage from a community health stand point is its unpredictability. No one can say that any given year will produce a virulent strain that sickens and hospitalizes hundreds, or whether it will be a mild flu season.

Our suggestion is to be proactive and get immunized this fall when clinics are available, or during well visits. When you and your children are vaccinated, it doesn’t matter what kind of season it turns out to be. Last year, doctors across the country reported that the vaccinated kids who did get the flu (no vaccine is 100%), had a much milder case. Either way, you win if you get vaccinated.  We have flu shots available now.  For flu shot clinic times and locations check our website or facebook page.

flu-shots-2016Unfortunately, On June 22, 2016, the Advisory Committee on Immunization Practices recommended that Flu Mist not be used in the 2016-17 influenza season due to poor effectiveness. The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) are supporting this recommendation.  PYAM will also be supporting this recommendation given by the ACIP, CDC, and AAP and will not have Flu Mist available this year.





Advisory Committee on Immunization Practices (ACIP)

On June 22, 2016, the Advisory Committee on Immunization Practices recommended that Flu Mist not be used in the 2016-17 influenza season due to poor effectiveness.  The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) are supporting this recommendation.

PYAM will also be supporting this recommendation given by the ACIP, CDC, and AAP, and has cancelled all orders for Flu Mist.  We are reaching out to our vendors and hope to be increasing our supply of the injectable thimerosal-free influenza vaccine so that all PYAM patients can be vaccinated during the 2016-2017 influenza season.  At this time, we will receive a limited supply of the influenza vaccine this fall, and have been put on a waiting list with several vendors for more vaccine as it becomes available.

We understand that the absence of the Flu Mist is likely to be disappointing for many of patients.  PYAM strongly believes that every child should be vaccinated with the Influenza Vaccine.  Please watch our web site at www.pyam.com and our face book page for updates on the Influenza Vaccine.

Thank you,

PYAM Providers and Staff

PYAM St. Paul Is Moving To A New Location


We are delighted to announce that PYAM St. Paul location is moving to a new building about 3 miles from our current loacation!  We are very excited and looking forward to the move.  

Watch for more information about the move to our new location here, on our website, and Facebook in the upcoming weeks.

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.


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.

New MN Immunization Requirements

FINAL – Vaccine release

Measles has reached nightmare levels in the USA!

Please make sure your child has been appropriately immunized against Measles. The Measles vaccine is safe and highly effective.  imagehttp://www.cdc.gov/features/Measles/index.html?  s_cid=cdc_homepage_whatsnew_001 

For our Wisconsin families

There has been an outbreak of Salmonella food poisoning tied to the use of a Chia powder. Please see this CDC site.  http://www.cdc.gov/salmonella/newport-05-14/index.html?s_cid=cdc_homepage_feature_002