To help parents and guardians who need to leave a child in the care of another adult, we have created a form consistent with the Arizona Revised Statute (A.R.S. 14-5104) which states: A parent or a guardian of a minor or incapacitated person, by a properly executed power of attorney, may delegate to another person, for a period not exceeding six months, any powers he may have regarding care, custody or property of the minor child or ward, except power to consent to marriage or adoption of the minor. This new form can be found on the Other Forms page (http://www.ponderosapediatrics.com/forms/other-forms/). For the Power of Attorney form, click here.

We’ve also added a simple Revocation of Power of Attorney in case the parent/legal guardian want to remove these rights (Click here for the form). Power of Attorney is the simplest way for a parent to authorize others parental rights and responsibilities. Per law, the maximum period this can be valid is six months, so if the expiration date is left blank, we assume the maximum legal period of six months. If the parent wants to extend this for a longer period, a new form must be completed for every six month period.

This does not relieve parents from their legal responsibilities, nor does it assign those responsibilities to the person designated. It is designed to allow parents to leave their children in the care of others for a period of up to six months. Other documents, typically associated with Superior Court proceedings, can authorize temporary or permanent guardianship or custody. Adoption is typically done through the court system as well.

We see this form helping in a variety of situations, but we are not experts in family law, so consult a lawyer if you have questions. Here are a few of the scenarios we see:

1.    Parents are taking a vacation for a few days or weeks and are leaving children in the care of a friend or family member. (Copays, payments for service and coinsurance still need to be paid at the time of service, so parents need to ensure methods of payment in the event services are needed.)

2.    Parents have personal medical, emotional or other reasons that they cannot fulfill responsibilities for a short period of time and ask for family or friends to help. Unfortunately, we see this when parents separate and their ill feelings toward each other impact their influence on children or they cannot functions. Other reasons are substance abuse programs or mental health in patient programs. As long as the person granted Power of Attorney is a competent adult and consents, this can be used for up to six months.

3.    Separation due to incarceration. If the parent in prison or jail for up to six months, this form can be used. Recently, we received a Yavapai County Jail form for a baby whose mother was in jail at the time of birth. If parents are incarcerated for extended periods, temporary or permanent guardianship or custody through the court system is advised.

As we learn more, we’ll attempt to provide processes and forms to help. For instance, as we understand Arizona law, step parents have no rights for their step children, and to permit step parents decision making ability, both birth parents need to consent. We know this can be problematic in cases where the step parent is not liked or trusted by the other parent
Our job is to take of and protect children to the best of our ability and consistent with the law. We only ask questions and look for authorization for that purpose, not to be troublesome! If you have ideas, forms, resources or other thoughts you’d like to share, please let us know through Facebook comments or blog article responses. Please do not disclose protected health information if you make any type of public post! Thanks.

When I was in college, I remember a professor making this statement about a problematic student, “I don’t believe in ADHD, but she has it!” That sums up what many think about this psychiatric condition; they don’t believe it’s real, yet they know when children have behaviors consistent with it. I hope to shed some light on this intriguing condition and review some of the ways we try to help children and their families.

The acronym ADHD stands for “attention deficit hyperactivity disorder.” The name is a pretty good description of the symptoms, that is, some people with this condition have problems paying attention, some have problems with being hyperactive/impulsive, and most actually have problems with both attention and hyperactivity. It is a common disorder as psychiatric conditions go with up to eight percent of school age children meeting the diagnostic criteria.

Typically, children with ADHD struggle with school, forget to do (or turn in) homework, take much longer to complete assignments, and in general seem disorganized. They often get in trouble at school and at home. They “bounce off walls” and seem to have excess energy that drives them to constant motion and activity that the Energizer Bunny would be hard pressed to match! There can be a high degree of stress in the home attributed to these symptoms. ADHD can co-exist with other conditions like bipolar disorder, depression, oppositional-defiant disorder, etc.

A proper evaluation for this condition is one that takes into account both parents’ and teachers’ impressions of the child.  Children should also be assessed for other problems, both mental and physical that can cause or mimic the symptoms.

Fortunately there is hope for children (or adults) with ADHD. Behavioral therapy, done by trained therapists, can be helpful. There are also well studied and very effective medicines that can be used. These include stimulant medications as well as non-stimulants. While medications are not for everyone, if they are used wisely and in the right setting, they can make a huge difference.

If you have questions about ADHD or are concerned that your child may suffer from this condition, talk to your doctor about it. It may be one of the best things you can do for your child.

Dr. Matt Hinton is a Prescott native and board certified pediatrician. He graduated from Prescott High School and went to Yavapai College before completing his undergraduate degree at Brigham Young University. He came “home” to care for the Quad-Cities children after completing his MD at the University of Arizona. More health information and links to reputable sources can be found at www.ponderosapediatrics.com.

It’s that time of year again – the holidays! It is also flu and RSV season. Both influenza (the flu) and RSV are viral infections and cannot be treated with antibiotics.

Influenza comes on suddenly with fever, chills, headache, muscle aches, tiredness and a dry cough. Progressively sore throat, runny and stuffy nose, and cough become more prominent. Occasionally croup or pneumonia can develop.

Influenza can be prevented by vaccine, either a live nasally administered version (flumist) or a killed injectable type (flu shot). Vaccination is recommended for everyone six months of age and older. It should happen every year, since immunity wears off and the vaccine is updated to cover new strains and other changes in the virus. Vaccinations are available at most pediatrician offices, Yavapai County Health Department and many pharmacies. Most insurances cover all costs of flu vaccines, and children without insurance are eligible for free vaccinations through Vaccines for Children (VFC).

RSV (respiratory syncytial virus) causes respiratory infection in all ages, but tends to cause lower respiratory tract infections (bronchiolitis, pneumonia) in infants and young children. It is especially worrisome in the first year of life and in infants who have heart or lung disease. Signs of illness include common cold symptoms, wheezing, working hard to breathe, poor feeding and sleeping, and occasionally lethargy and long pauses between breaths.

Those at high risk with predisposing conditions (prematurity, weak lungs or heart) can have expensive monthly antibody shots. The best preventative measures are still routine thorough hand washing and avoiding exposure to illness, especially between November and April. There is no vaccine like there is for influenza.

Once a child contracts RSV, there is no antiviral medicine available for treatment. For influenza, antiviral medications have some benefit if given within the first 48 hours of illness. Treatment for both includes measures to reduce aches, cough and other symptoms. If necessary, oxygen, IV fluids and hospital care are available. In other words, the old adage, “an ounce (or less) of prevention” still applies.

Have a healthy, happy Holiday Season!

Dr. Mick has been caring for local children since 1986 at Ponderosa Pediatrics, PLC. For more information on children’s health, go to www.ponderosapediatrics.com.

Technology and the internet impact healthcare in many ways. Ponderosa Pediatrics works hard to embrace new technologies and give patients opportunities to access information and research various health related issues.

Our website, www.ponderosapediatrics.com, contains links to various sources of reliable health related information. Sources like the American Academy of Pediatrics, Mayo Clinic, Centers for Disease Control and WebMD offer reliable and proven information widely accepted by pediatricians nationwide. However, this information cannot replace the training, expertise and experience offered by licensed clinicians and should never be used in lieu of medical care and doctor’s attention. These sources are interesting reads and provide good general information, but outside the context of doctors, could prove wrong and have serious consequence.

The website also offers information about providers, policy, hours and appointments, patient forms, our blog where we publish all articles (including this one), and the ability to contact us for general information. Our Facebook page is great for lighter discussions, blog posts, contests and general information. Per federal law, we cannot publish any private or protected medical information on any unsecure media, including our website, email, and Facebook.

To answer the need for secure communication, Ponderosa Pediatrics now has a secure patient login system accessible from ponderosapediatrics.com. Patients need to enable an account through our office, and they can log in to access and/or discuss protected patient information. Currently, patients (parents) can review and print medical records, immunization records, appointment history, statements, etc. Those with accounts established also receive appointment verification via email, and receive notices when we publish protected information to their accounts. They can send messages (not directly to providers yet, however), request appointments, and update demographic information. Shortly, they will be able complete medical history and screening information, new patient forms and pay bills online.

While we have not “formally” rolled these capabilities out as we are working the bugs out, the system is online and active. Several hundred parents have logged on and have provided feedback. Patients interested in learning more should call the office or send an email (without divulging protected health information).

Please feel free to post general questions on the Ponderosa Pediatrics Facebook page or comment on this article at www.ponderosapediatrics.com.

By Matthew J. Hinton, M.D.

In the course of a typical day at the office, one particular scenario frequently comes up. While examining a patient, I will detect a heart murmur. When I mention this to the parent, usually there is a look of alarm, ranging from simple anxiety to bordering on panic. Because this is such a common situation, it is appropriate to shed some light on what a murmur is, and what it typically means.

A murmur is best described as a sound the heart makes. That sound could be from any number of things, but basically is categorized as either pathologic or non-pathologic. In other words, is the sound (murmur) because there is a problem with the heart (pathologic), or is the heart normal (non-pathologic)?

The good news is that the great majority of murmurs are non-pathologic. That is, the heart is completely normal and is creating a slight vibration as it is doing its job of pumping blood to the body. Think of the appliances in your home that make noise while functioning – the refrigerator, the dishwasher or even a toaster. We get concerned that something might be wrong only if the noise gets unusually loud or changes out of the ordinary.

In a similar way, the heart makes a soft vibration when beating. In children, this vibration is easily heard because of their thin chest walls and relatively rapid heartbeats that “hum” right along. This is typical and we call it a vibratory or innocent murmur. It is almost always normal, of no concern whatsoever, usually gets softer with time and eventually disappears. I hear these murmurs almost every day. In fact, I believe that just about everyone has a murmur at some point in their life!

A small percentage of the time, the sound could be from a problematic source. Perhaps there is a heart valve not working properly, a hole in between the chambers of the heart, or some other abnormality. Most, but not all, of these will be identified early in the child’s infancy. Some are more worrisome than others. Your child’s healthcare provider will decide what further evaluation may need to be done in these instances.

If you have any concerns about what your doctor is hearing, please ask. Most heart murmurs, or sounds, are a just normal part of growing up!

Dr. Matt Hinton is a Prescott native and board certified pediatrician. He graduated from Prescott High School and went to Yavapai College before completing his undergraduate degree at Brigham Young University. He came “home” to care for the Quad-Cities children after completing his MD at the University of Arizona and has been with Ponderosa Pediatrics since 2004. Additional information and articles about child healthcare can be found on the Ponderosa Pediatrics website at www.ponderosapediatrics.com or on our Facebook page.

One of the realities of healthcare is that it takes time. I’ve had only one primary care physician who I could always count on to be on schedule. However, if I wanted an appointment where I could discuss issues in detail, I had to tell the scheduler in advance the specific details to include. If I did not, I had to schedule a second appointment. That was great for time conscious patients, but not so great for patients who wanted their providers to really know them and understand their health. This takes time.

Things like computer problems, power outages, sick doctors, medical emergencies, or just an overwhelming number of sick children are out of our control. There are things that patients can do to help providers stay on time.

1. Always try to arrive at least five minutes early for routine appointments and earlier for appointments where additional paperwork (new patients, well child checks) needs to be completed. If available, download paperwork from the web and complete it beforehand.
2. Plan extra time with the provider! Most appointments are scheduled for 15 minutes. This includes time to take vital signs, history or other information before the provider sees the patient. If you tell the person scheduling your appointment of everything you want to discuss, they can schedule adequate time.
3. Know what your insurance will cover and how much you should expect to pay for the visit. Then be ready to pay at the time of check in. If you have balances due, expect to be asked about them. Always bring current insurance cards with you. The less time required before the appointment, the faster you will be ready for the providers.

The most common reason providers get behind schedule, resulting in longer wait times, is that they want to provide each patient the best possible healthcare. If a parent wants to discuss things outside the reason for the appointment, it takes longer. Providers must balance how much they can reasonably accomplish with the number of patients scheduled. If we can plan adequate time based on patient needs, there will be fewer times we get behind schedule.

Please feel free to post general questions on the Ponderosa Pediatrics Facebook page or comment on this article at www.ponderosapediatrics.com.

This article originally was published in the August – September 2011 issue of Prescott Woman Magazine. Now that school has started, it’s a good time to review some of these issues!

Dr. Mick

It’s already time to start planning for the school year! There are many issues to consider. The ten I’ve listed are not necessarily in order of importance or the only ones to consider. From a pediatric medical stand point these are ten that are important and sometimes overlooked.

1. Sleep schedules. Children need eight to ten hours of restful sleep on average. It’s important to readjust the summer schedule (earlier to bed, earlier to rise) starting at one to two weeks before school starts.
2. Physical exams. The American Academy of Pediatrics recommends yearly check-ups and some schools require completed exam forms for entry. Also many students are required to have athletic participation medical clearances. Plan ahead by scheduling your child before these are needed AND bring the athletic participation form.
3. Immunizations. There are vaccines required and recommended for kindergarten and for 11 to 12 year olds (Tdap and meningococcal being two).
4. Good nutrition. Plan now for how your child is going to get good breakfasts and lunches that are healthy and support good student performance. Carbohydrates should be limited to improve focus and avoid the one o’clock drowsiness. Include some protein and healthy fats in meals.
5. Adequate fluids. Drinking adequate water improves learning ability and decreases headaches and fainting.
6. Limit screen time. Total media time, especially on school days, should be limited to one to two hours per day of quality viewing. Monitor what is being watched.
7. Make bedrooms TV free zones. Children with TV’s (or video games, computers, etc.) in their rooms spend more time using them than those who don’t have them. Moreover parents can’t monitor the content and children tend to sleep less when these are in bedrooms.
8. Social concerns/peer pressure. Bullying, substances of abuse, and peer pressure are topics to discuss with your children – even elementary aged.
9. Communication. Work at keeping the lines of communication with your child and his/her teacher(s) open. Too often problems have been worsening for months before parents become aware.
10. Encourage healthy activities. Hiking, athletics, hobbies, reading, creative play, singing, and conversation are valuable at all ages and should not be eliminated by TV, video games and the like. Balance is key.

For the past two months I have covered several common newborn issues that worry parents. In this final article of the series, I cover two more, though by no means will we answer all questions parents have.

My baby has gas. This is one of the most universal complaints of parents. Firstly, it should be understood that all babies “have gas.” With their first breaths, newborns swallow air into their stomachs, which then passes quickly into the intestines. Having air in the gastrointestinal tract is a normal aspect of being a human being – and most of the time is isn’t bothersome. However, many babies experience discomfort when they feel the pressure of gas or stool at the rectum. They manifest this by crying, grunting, or straining to pass stool or gas. This is a transient phenomenon that usually appears in the first couple of weeks and goes away after a few weeks or months. Many caregivers try gas drops or stomach massage. Sometimes these measures help, sometimes not. Ultimately this distressing problem goes away no matter what you do – even though they still have gas throughout their intestinal tract!

My baby cries “all the time.” While parents often associate crying with gas, it is probably unrelated. Most infants have an increasing need to cry, a phenomenon that increases until it peaks about six weeks of age. Colic represents the extreme of this crying behavior. Often this crying is in the afternoon, evening, or nighttime hours. The baby seems to be in terrible distress, but no obvious problem can be identified. It is a difficult time for parents, as nothing seems to help. Few things are more stressful than seeing your infant son or daughter in distress and not being able to figure out or help the problem. The good news is that colic, like gas, goes away within three months or so. The babies then generally become happy, well adjusted, delightful little people. So, if you are in the throes of a colicky baby’s first months of life, hang in there, and know that it will get better! However, on rare occasion, intense crying can be the sign of a serious problem. When in doubt, take your child to his or her doctor for evaluation.

This concludes our series on newborn health issues. If you have questions, want to read the entire series in one place, or for more health related information and links to reputable sites, go to www.ponderosapediatrics.com.

Dr. Matt Hinton is a Prescott native and board certified pediatrician. He graduated from Prescott High School and went to Yavapai College before completing his undergraduate degree at Brigham Young University. He came “home” to care for the Quad-Cities children after completing his MD at the University of Arizona.

In the first article on newborns, we began to discuss some common concerns about newborn babies.  In this article, I would like to continue that discussion with some more common, and generally harmless issues that affect newborns that often cause unneeded worry for their parents.   Each is framed as a question, the kind I hear every day in my office.

1. My baby sneezes all the time, do you think she has allergies?  Sneezing is one of the most common things that newborns do.  The reason for this is unclear, but it almost never is allergic.  It generally decreases in a few weeks to a few months.  Often bright light, especially sunlight, on the infant’s face can trigger a sneeze in a baby.  This is quite harmless.  True seasonal allergic problems usually take three or four seasons to develop sensitization, thus most children don’t develop allergies to pollen until they are four years old or older.
2. Why does my baby hiccup all the time?  This is another very common, almost universal, infant phenomenon.  Most mothers can recall their baby hiccupping in the womb, and this usually continues after birth.  Some parents think that the hiccups are due to not burping the baby, or feeding him or her too fast, but truthfully, I don’t think it’s related to any of those things.  It just happens, and like sneezing, it will fade in the coming weeks to months.
3. Why does my baby go cross-eyed?  Due to the immature neurologic system of most babies, they often have trouble keeping their eyes straight, and will sometimes have one or both eyes wander inward or outward.  This is not a typical cause for concern, it usually improves as the child matures in a matter of months, but if it persists beyond this it is definitely something that your child’s doctor needs to know about.  It is also worrisome if the eye is always crossed or not aligned properly.

Part three of this series will be in late July. For more health related information and links to reputable sites, go to www.ponderosapediatrics.com.

Dr. Matt Hinton is a Prescott native and board certified pediatrician. He graduated from Prescott High School and went to Yavapai College before completing his undergraduate degree at Brigham Young University. He came “home” to care for the Quad-Cities children after completing his MD at the University of Arizona.

Most adults have the life-changing experience of becoming a parent, either through childbirth or adoption. This experience brings some of the greatest joys and toughest challenges of life. It constantly amazes me that the smaller the human being, the more “stuff” is needed to take care of them. Virtually all of these items are larger than the newborn infant they support!

Parents of newborns have shared a number of common concerns and worries with me over the years. From these, I have compiled a “top 10 list” and I will address them briefly in this series of articles. Be aware that this advice is general only. There are exceptions to everything in medicine! If you have concerns please talk with your child’s healthcare provider. Nonetheless, this information generally holds true.

1. My baby has yellow eyes (and skin). This is jaundice, very common in babies. Most newborns will start to turn a bit yellow after about 24 hours thanks to an immature liver and rapid breakdown of red blood cells. Jaundice is noticed first in the face and moves toward the feet. It generally peaks in about 3-4 days. Because the white of the eyes are so, well, white, any discoloration is readily noticed. Breastfeeding babies are prone to jaundice more than formula fed ones, partially because of the amount of time it takes for the mother’s milk to come in. This is called breastfeeding jaundice.  Sometimes there are other conditions that cause the jaundice to be more severe. In these cases, it may need to be treated with phototherapy (blue lights), so make sure your baby is seen regularly by his or her doctor in the early days of life.
2. There is a red mark in my baby’s eye. This is a common side effect of birth and is caused by pressure during delivery, resulting in the rupture of small blood vessels in the white part of the eye. This “bruise” on the eyeball is very noticeable – and quite harmless. It will fade in a week or two.
3. My baby’s skin is very dry and lotion isn’t helping. Not to offend your cute little one, but babies are like snakes: they shed their skin after they are born. It doesn’t all fall off in one fell swoop like a rattlesnake, rather is peels off bit by bit like a sunburn. This is usually most noticeable on the hands and feet, but can involve the entire body. No amount of lotion, cream, or ointment will stop it. It just happens! In a week or two the process will be over and your baby’s skin will be beautiful and soft again.

Part 2 of this series will be published in a future blog. For more health related information and links to reputable sites, go to www.ponderosapediatrics.com.

Dr. Matt Hinton is a Prescott native and board certified pediatrician. He graduated from Prescott High School and went to Yavapai College before completing his undergraduate degree at Brigham Young University. He came “home” to care for the Quad-Cities children after completing his MD at the University of Arizona.