Trick or Treat – Tips for a safe Halloween




Its that time of the year again… candy, costumes and lots of children in the streets! Here are some tips to stay safe this Halloween:



Make sure your child wears an appropriately fitting costume.

Consider using brightly colored costume and add reflective tape to the costume.

If your child is wearing a mask, make sure it does not obstruct his view.

If using makeup, avoid ones that your child may develop a sensitivity to.



Adults should always accompany younger children on the trick-or-treat trail.

Designated adult should avoid alcohol.

For older kids plan an acceptable route. Agree on a time they should come home.

Carry a cellphone for quick communication.

Remain on well lit streets.

Only approach homes that have a lit porch.

Stay in groups


Avoid the tummy ache:


Give your child a healthy supper before hitting the trail, this way they can avoid over indulging in their treats that night.

Wait until the children are home to sort out the candy. Although tampering is rare, do go through and remove any inappropriatly packaged candy or possibly spoiled ones as well.

If you have trick-or-treaters at your house, consider giving some non-candy treats such as stationary!




Have a safe and fun Halloween



You had a baby, now what?!!

Since you found out you were pregnant, you have been going to all your prenatal visits and all the classes. You and your OB have discussed the action plan and what to expect once its time to have the baby. You have read up on “What to Expect, When you are expecting” books and blogs.

Do you know what happens to your newborn however once he or she arrives?

It’s important to know what will happen to your child, and to understand why certain treatments are provided.

  1. Delivery room assessment: The obstetrician hands over the baby to the neonatal team, which usually consists of a registered nurse and respiratory technician. A pediatrician maybe called if any complications are anticipated. How soon the obstetrician hands over the newborn to the neonatal team depends on how well the baby is doing. The job of the team is to assess the newborn. This is done by assigning an Apgar score. This score helps describe how the baby was doing at 1 minute, 5 minutes and 10 minutes after delivery. This score however does not predict how well the baby will do in the long run.
  2. Vitamin K: After delivery your baby will have a few treatments. First is a Vitamin K injection. Infants are born with  premature livers, which is where vitamin K is utilized for blood clotting. By giving Vitamin K in the immediate newborn period, we are preventing a disease known as “ Hemorrhagic disease of the Newborn”. This is a disease in which a baby can start bleeding spontaneously due to vitamin K deficiency.
  3. Eye antibiotic ointment: This is pretty straight forward, babies born via vaginal delivery or who had a mom go into active labor, there is an increased risk of bacteria in the vaginal area entering  the birth canal. Some types of bacteria can cause eye infections and lead to blindness. By applying this antibiotic ointment, we can prevent this horrible complication.
  4. Blood work: You may notice that your child is returned to you with small slits on the heel. This is because every child born in the united States is tested for multiple inherited disorders. They are tested for illnesses that wouldn’t necessarily be picked up by a normal exam a doctor would do. We are talking about things like sickle cell disease and cystic fibrosis. In Florida, babies are tested for 150 different disorders. This is called the State Infant Screen. The state lab is usually pretty good about notifying all parties involved if there are any abnormalities detected.
  5. Jaundice: Almost all babies are born with some degree of jaundice. Jaundice is the yellowing of the skin. For the most part, the majority of infants have “ physiologic” jaundice – which is normal for newborns. A few babies develop higher degrees of jaundice that may require treatment. This usually occurs if the baby has risk factors, such as blood type incompatibility, prematurity or the baby is otherwise sick with an infection amongst others. Testing for jaundice utilizes a device that utilizes light to measure jaundice of the skin or a blood test.
  6. Weight checks: Most newborns can lose up to 10% of their body weight the first week of life. While in the hospital your baby will be weighed daily to monitor their weight.
  7. Ins and Outs: By the time the baby arrives majority of new moms have made a decision as to what they will feed the baby, i.e: breast milk or formula. There is a steep learning curve when it comes to breastfeeding. You can ask for help from a lactation consultant while in the hospital. What goes in must come out. While in the hospital you will be asked to keep a log of all your babies dirty diapers. If a baby does not pass urine in the first 24 hours, or have a bowel movement in the first 48 hours, this could indicate a problem.

Most of these treatments and assessments will occur while your baby is in the nursery. Remember its important to stay informed, and if you are not comfortable with any treatment or assessment, don’t be afraid to voice your concerns.

Were you aware of all these interventions? What has your experience been?


Babies cry. Its their thing. Sometimes as a parent, you can figure out why, other times, not so much. Lets say your baby is crying; she just fed, her diaper is clean, yet she is still upset. What do you do now?

Father and Baby Girl Crying Caucasian2

Here are five tips that may help. If your baby is still inconsolable, you may want to call your doctor to make sure she’s ok.

  1. Swaddling: This is especially effective for newborns under 1 month of age. They love to be snug, the thought is that swaddling mimics the confined intrauterine environment that they have been hanging out in for 40 weeks, give or take. However, once your child gets a little bit older, they tend to like their space more.
  2. Sucking: Babies love sucking – not in the “you suck” kind of way, but more of the “ here suck on this” type of thing. Sucking on a pacifier, or mom’s breast is very soothing for infants. Many new parents think that the baby is hungry when anything goes near their mouth and they elicit the sucking reflex. But that’s exactly what it is, a reflex. Babies have a very strong suck reflex. It is basic survival mechanism. Try it at home, touch the cheek of your baby  close to the corner of her mouth, and watch what happens. Most of the time, she will turn towards that side and pucker her lips ready to suck on something. If you’re child had a good meal, and she is still fussy, try to offer her a pacifier, see if it helps.
  3. Shushing( yes, I know its not a real word, but stay with me!): White noise! This is what newborns have been listening to during the entire pregnancy, its like their gestational soundtrack. You can recreate this by saying Shhhh loudly in baby’s ear – but please spare her the spit shower. Turning on a fan or vacuum cleaner would do the same. But lets not forget that in this day and age, there is an App. for that!
  4. Swinging: By gently rocking your baby, you are sure to help soothe her as well. You can be very gentle with this, you don’t need to go off the wall. Just gentle head bopping works well, like a rapper.
  5. Singing: Infants love the voices of their parents. So go ahead and sing your guts out, there are no judges here.

These recommendations are based on Dr. Karp’s Happiest Baby on the Block, and in my opinion, he provides good advice. Having said that, if your child is not responding to any of these soothing techniques, or you have a gut feeling that her cry is excessive and out of the norm, definitely talk to your pediatrician and get her checked out.

Have you had any luck with these techniques? What do you do to soothe your fussy baby?

Inadequate milk supply? Try fenugreek

One of the frequent problems I encounter in everyday practice is that new moms don’t always produce enough breast milk. This is usually problematic, especially in the first few days when breastfeeding needs to be established. The mother is exhausted and in pain, and baby won’t stop crying because she is hungry. Sounds like a recipe for disaster, doesn’t it!

Fortunately, there is a solution that has been around for centuries. It is a little natural herb that can be safely taken by breastfeeding mothers. Fenugreek is a known supplement in many parts of the world, and there is clinical evidence and science to back it up.(link : )

Fenugreek is what is known as a galactogague herb. That means it helps increase breast milk production. It mimics the estrogen precursor. In the United States, it is available as capsules or tea. You can also find the natural seed in some ethnic food stores.

Where I grew up, it is served to new moms as a pudding. I ate a ton of it during the first few days after I had my daughter. I recommend it to all the new moms in my practice, and they rave about it.

If you want to try it, scroll down for the recipe of Fenugreek Pudding (Madidat Hilba – مديده حلبه). This is by far the tastiest way to enjoy it in my opinion!

Be warned however, fenugreek has a musty / maple syrup odor to it, and it is excreted in sweat. Once you achieve adequate levels, you will smell a little musty! But have no fear, that goes away in a few days.

Fenugreek is known to lower blood sugar. Please make sure to talk to your doctor before you try any new supplements or medications.

Have you tried fenugreek? What is your experience with it?

Fenugreek Pudding Recipe:


2 cans evaporated milk .

4 tbsp sugar (you can vary this according to taste) – I have a sweet tooth!

1/4 cup Fenugreek seeds.

1 Tbsp corn starch

1 Tbsp flour

1/4 cup cold milk

In a medium sauce pan, pour the 2 cans of evaporated milk , fenugreek and sugar and bring to a boil. While that is going, in a bowl dissolve the the flour and cornstarch in cold milk. Once the ingredients in the saucepan are starting to simmer, turn down the heat to medium low, then add the cold milk/flour/starch mix to the pan and keep mixing constantly with a whisk. You want to mix it frequently so it doesn’t clump. It should develop the thick pudding consistency. You may need to add more milk/starch/flour to the mix if you are not getting it to be thick enough. This should take about 10-20 minutes. Once you are happy with the consistency, pour your yummy pudding in bowls and let it cool.


Back with a Whoop! What you need to know about Pertussis.

Pertussis, also known as whooping cough has been in in the news a lot lately. And for good reason too. There has been an increase in the number of reported cases throughout the country, including right here in Central Florida. So far this year there were 35 confirmed cases in Orange, Osceola and Lake counties according to the Orange county Health department, compared to 11 last year! ( Thats a 300% increase)!!

  • What is whooping cough / Pertussis?

Pertussis is a respiratory infection caused by bacteria called Bordetella pertussis. It is also called whooping cough because of the characteristic sound of the cough it causes.The illness has 3 phases. Each phase lasts about 2 weeks. The first phase usually starts with a runny nose, mild cough, and pink eyes.This phase is difficult to distinguish from a regular cold. The second phase is an increasingly severe cough that can last 2 to 4 weeks. The cough usually comes in spasms and ends with a high-pitched whoop. Often the coughing causes a child to vomit or his or her face to turn red or blue. Coughing spasms are usually worse at night. In infants, whooping cough is a very serious illness and the baby may need to be hospitalized. The third phase is recovery. This may last another 2 to 4 weeks as the cough slowly improves.

  • Treatment is difficult. In most cases by the time the illness is diagnosed it is far too late in the disease process for treatment to be effective.
  • How can whooping cough be prevented?

It is important to have your child immunized against all preventable illnesses, including whooping cough, at regularly scheduled health checkups. A type of tetanus-diphtheria-pertussis booster called a Tdap shot is now recommended for all teens and adults to protect themselves against pertussis. Getting vaccinated with Tdap is especially important for families with new infants. you can ask your pediatrician or Family doctor if they provide this vaccine.

Whooping cough is a very dangerous disease, especially for babies. The risk of suffering and death caused by whooping cough is far greater than the possible side effects of the shot. Complications of whooping cough can include pneumonia, seizures, and death. The risk of having neurologic problems or long term damage from the current vaccine is very low. Your healthcare provider will discuss any possible side effects with you.

There are 2 main ways to prevent the spread of whooping cough:

  • vaccinate exposed children
  • give antibiotics to anyone who has been exposed to the disease.

Recently and article was published in the NEJM suggesting that immunity from the current vaccine is short lived. In my opinion, the problem with this study is that it was conducted in California where there is already a high rate of unimmunized children or children on alternate schedules. This basically diminishes herd immunity and may lead to these findings.

It’s also a part of being human to lose immunity to infections, both from natural infection and from vaccines. Over time, our bodies forget how to protect against infections. This study points out that the new generation of children who have had only “acellular” pertussis vaccines may need additional boosters to keep them safe. Time will tell. New recommendations may come out later this year or next.The best practice is to make sure your child is up to date on their vaccines, and that teens and adults have received their booster as well. This will definitely help decrease the spread of infection. Ask your pediatrician or Family doctor if getting the vaccine is right for you and your family.

The Insurance Debacle!

Now that it has been 2 months into the practice, I am starting to finally see the insurance payments coming in. Awesome, right?!  Ehhh…

Let me explain this to you and you tell me your thoughts:

Patient X has Medicaid, this patient came in for a well visit, but he also happened to have some ear pain. so doing the reasonable thing, I did the appropriate assessment for the well visit part such as measurements, calculating BMI, checking the child’s vision, assessing him for any developmental problems or behavioral problems and discussing all the details of what is relevant to his age.

Now for the ear pain part of the visit, it’s a different assessment, and he needed a prescription, not only that but he had a lot of wax in his ears, which I went ahead and removed.

At this point all this patient’s issues are addressed.Now comes the billing part:  For insurance claims, one must submit an itemized list of things that were done and hope the insurance will pay for all the work.

In this particle instance, Medicaid decided to pay me only for the ear wax removal $37!!

Apparently I am not allowed to perform multiple “procedures” in one visit. Unfortunately this a game that one has to play to try to get the best reimbursement rates from the insurances. Is it ridiculous?! Abso-freakin-lutely!

What difference does it make if I do the procedures in one day verses have the patient come 3 separate times to get the same done from an insurance stand point?! The work is being done either way! How is having parents miss work and their children miss school repeatedly  reasonable according to the insurance company.

Unfortunately for me, a solo practitioner with my overhead and bills to pay, this type of reimbursement is not sustainable, and I unfortunately have to comply with the way the insurance company is going to pay me. I really hate that I have to do this…

What are your thoughts on the matter?