WELLNESS CARE

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At Hanover Pediatrics, we follow the American Academy of Pediatrics Bright Futures Guidelines regarding wellness examinations for your child.  It may seem routine, and even superfluous if your child is in the office frequently for other concerns; but wellness examinations allow us to make sure that all of your information is up-to-date, as well as to make sure that there are no developmental or growth concerns.  Vaccines are typically given in accordance with the wellness schedule, and it offers an excellent opportunity to talk about what is most important to you and your child about the way they view the world. 

 

The following is a standard office schedule from the newborn period through adolescence:

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Newborn Visit (within 3-5 days)  ; 2 weeks ; 1 month ; 2 months ; 4 months ; 6 months ; 9 months ; 1 year ; 15 months ; 18 months ; 2 years ; 30 months ; 3 years ; yearly visits from 4 - 18

 

Children in foster care or kinship care are asked to come in in-between standard wellness visits to allow for our staff to assist you in assessing how well the child is adapting to their new surroundings.          

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VACCINE SCHEDULE

For more on our office’s approach to immunizations, click here. 

 

We do recommend adhering to the CDC guidelines on immunization practices.  The following is a standardized schedule for vaccination:

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Birth: hepatitis B (1/3)

1 month: hepatitis B (2/3) 

2 months: DTaP/IPV/HiB, prevnar, rotavirus

4 months: DTaP/IPV/HiB, Prevnar, rotavirus

6 months: DTaP/IPV/HiB, Prevnar, rotavirus

12 months: MMR, Varicella, Prevnar, Hepatitis A (1/2) 

15 months: HiB DTaP

18 months: hepatitis A (2/2)

4-6 years: MMR, Varicella, DTaP, IPV

11 years: Tdap, MCV, HPV

12 years: HPV

16 years: MCV

21 years: Tdap (if not done earlier than 10yrs)

(flu vaccine is recommended annually)

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Bold face denotes NC state required vaccines, even though it is recommended to adhere directedly to the listed CDC vaccine administration schedule.​

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BEHAVIOR & LEARNING PROBLEMS

 

Children face many challenges in today’s world.  School presents a number of difficulties as your child enters the ranks, whether they are enrolled in public, private, charter, on-line, or home-based education.  Difficulties in learning, paying attention, sitting still and behaving can often be temporary phenomena; but sometimes, continued struggles in multiple settings suggests something more significant. 

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If you are concerned about your child’s learning, behavior or attention, we are here to help you sort out how best to proceed.  While Attention-Deficit/Hyperactivity Disorder (ADHD) is what commonly comes to mind, this can actually be a symptom of another problem, and discerning whether or not this is the primary issue is often quite difficult. 

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At Hanover Pediatrics, we are dedicated to finding the right diagnosis and treatment for your child. Even if it seems obvious, we may request further evaluations with a child psychologist or neuropsychiatrist; or order additional testing such as a sleep study or looking for anemia.  Remember, even if we determine together that a particular disorder is present, that does not obligate your child to medication.  In fact, most studies have found that a multidisciplinary approach offers the best chance of improvement from both behavior and learning difficulties. 

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More information about ADHD and other behavioral/learning disorders here. 

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DISCIPLINE & BEHAVIOR

 

There are a large number of websites and books that describe in some detail how “time-out” (TO) works and how to implement it.  That said, a recent study showed that 0% of websites accurately reflected the methodology that has been critically examined and validated.  While the origins of TO are based on empirical observations (*), over time, psychologists, psychiatrists, therapists, and pediatricians have taken time to determine the elements that make TO effective.  No matter what form of discipline is used, the success depends on three critical factors:

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1.  It must be consistent, both in rationale and execution

2. It must be distinct from normal activity

3. It must be possible to explain in a broader context as your child ages

 

As TO is the recommended form of discipline, a short primer on how best to implement this is necessary.  The following is based on research-driven understanding of how TO works.

 

TO is principally based on the removal of reinforcers to an undesirable behavior

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Positive reinforcement of appropriate behavior is critical to the success of the remover of a reinforcer – this can take the form of a physical reward, attention in play, and verbal/physical praise.

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TO should be implemented as soon as possible after the undesired behavior occurs

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Limiting warnings and admonishments/explanations reduces the risk that TO will be ineffective

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Lack of reinforcing stimuli available to the child is critical to TO.  This takes two primary forms:

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Exclusionary: this utilizes a chair, corner, or hallway and eliminates participation in positive reinforcing tasks.  This is the form that is most often utilized in research

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Non-exclusionary: this is most appropriate in social settings like daycare/preschool and limits social interaction by direct observation and a new placement outside a social group.  This is often of a shorter duration and is often driven by the necessity of needing to have all children within visual range.

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Longer durations are often not effective, nor is allowing the child to end it on his/her own.  Typically, a good rule of thumb is 1 minute per year of life. 

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Contingent relief, which is the theory that a child should have self-calmed for a specific period of time (1-2 minutes, typically) is often suggested but has had conflicting results in studies.

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There is strong evidence (as if there needed to be!) that children will attempt to end TO before the allotted time has expired.  A “back-up” plan is therefore suggested.  However, there are limited data on the success of the following interventions:  repeated return to TO, removal of all positive reinforcement until successful completion of TO, shortening the interval based on compliance. 

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WHEN DO I COME IN?

 

At Hanover Pediatrics, we believe that wellness care starts prior to your child’s first official visit.  We welcome prenatal consultations to answer questions you may have about the practice, as well as to help guide you through the process of becoming a parent (even if it’s not your first time!).