BUSINESS

1. Do you take any credit or debit cards?
Yes; we have recently added the option of paying with Visa or MasterCard.

2. What is your payment policy?
As in all medical offices, payment is expected at the time of service. However, many 
of our patients are fortunate to have medical insurance. Youth Care will file 
your insurance for each visit provided we are given accurate insurance information
along with a copy of your insurance card. We allow your insurance 45 days to pay 
your claim. If the claim is not paid by that time, the responsible party is expected to 
pay at that time. Our billing department will keep you appraised of the status of 
insurance payments at all times.

3. How do you handle co-payments and deductibles? 
As in most medical offices, co-payments and deductibles are due at the time of service. 
Most co-payments amount to $10 or $15 and the cost of billing this amount is 
prohibitive. Consequently, billing for co-payments is not an option.

4. Do you accept Medicaid?
Yes and no. We are contracted with "straight" Medicaid which includes most foster 
kids and handicapped or high risk kids. We are not contracted with "managed" 
Medicaid.
Current Medicaid cards must be brought to every clinic visit in order for us to provide 
service.

5. What is the difference between PPO plans and HMO plans?
There are several differences. One difference pertains to the cost of coverage and the
amount of the co-payment. A PPO plan has a list of providers called network 
providers and the patient can see any provider in the network without a referral from 
a primary physician. An HMO plan requires one to choose a primary care physician 
and one must have a referral from that physician in order to see any other physician 
and for some medical testing.


MEDICAL

1. WHAT IS THE BEST WAY TO MEASURE TEMPERATURE?
The true body temperature is represented by the rectal temperature. This method is
most reliable for infants and very young children. Axillary temperatures give an 
approximation of the body temperature but are more convenient and certainly
quite fine for screening. Please don't add a degree to the number obtained; just
report the temp obtained and the method used. Most children are able to provide
enough cooperation for an oral temperature by 4 or 5 years. Don't use any of the
older mercury thermometers. The ear or "tympanic" thermometers are certainly 
convenient. However, they should never be used in infants under one year. Their 
failure to provide consistently accurate readings makes their usefulness limited. We
have stopped using them in our office for this reason.

Normal rectal temperatures are under 100.4. Oral temperatures are fine if they are
less that 99 while axillary temps are usually under 98.

2. HOW MUCH TYLENOL OR IBUPROFEN (Advil or Motrin) DOES MY CHILD NEED?
They may not need any; don't treat minor fevers. The body uses fever to fight 
infection.
Acetaminophen: Tylenol: dose is 80 mg for every 11 lb of weight. To dose 
properly you must know the concentration of the product you are using. This 
information is available on the front of the label. Do not use the dropper from the
infant preparation in the larger bottle.
Ibuprofen: Advil or Motrin: dose is 50 mg for every 11 pounds 
Check your product to determine the concentration

3. WHAT DO I DO FOR MY VOMITING CHILD?
Vomiting is forceful emptying of the stomach. 90% of the time, this symptom is caused by a benign, limited viral infection. However, it can be the first symptom of far more serious problem such as appendicitis or infection, urinary or more serious. It is seen with poison ingestion and sometimes with concussion. Younger infants are more prone to dehydration at an earlier stage; but, in general, the average child over one year will not dehydrate seriously during the first 12 hours of vomiting alone. The association with fever and diarrhea, however, is more significant from this standpoint. Any child vomiting over 24 hours needs evaluation before further treatment can be recommended. Under 24 hours, clear liquids (non-carbonated, not too sweet) can be given in frequent, small amounts ( 1-2 oz). The most common mistake made is giving too much too soon. It is better to let the stomach rest for at least one hour after an episode of vomiting. Please see the section on vomiting in PEDIATRIC ADVISOR on this web site for more detailed instructions.

4. WHAT DO I DO FOR MY CHILD WITH DIARRHEA?
Diarrhea is the sudden increase in the frequency of bowel movements associated with an increase in the water content of the stools. It is more serious if the stools are bloody and/or frequent (over 10 per 24 hours) and associated with fever over 102. When occurring with vomiting, dehydration may occur at an earlier stage. Infants under 1 year are more prone to dehydration at an earlier stage. Over 90% of acute diarrhea is caused
by an intestinal virus. For mild diarrhea (fewer that 5 stools per 24 hours) make no change in diet but avoid soda and juices. For more frequent diarrhea, start Pedialyte type solution in infants and give for no more that 6 hours. Resume formula within 6 hours. For breast fed infants, continue breast milk but supplement with Pedialyte. For older children, Gatorade type fluids may be used for more severe diarrhea but continue to give solids, especially starches. Please see the section on diarrhea in PEDIATRIC ADVISOR for more detailed dietary suggestions. It is a good idea to come by the office for a weight check if diarrhea exceeds 10 stools per day or lasts more that 48+ hours.

5. WHAT DO I DO FOR MY CHILD WITH A COLD?
A cold is a runny or stuffy nose caused by a virus. Average healthy children average 6 colds per year though it is not unusual to for them to get 2 colds per month during the “sick” months of winter. Nasal drainage may be clear, cloudy, yellow or green. The color of the drainage has no significance in diagnosing a bacterial infection, sinusitis or a need for antibiotics. There is no cure. Treatments are directed at increasing comfort until the viral infection runs it course. Most important is to humidify the secretions with salt water drops (available OTC) or a vaporizer or humidifier. Most cold medicines are not very helpful. Antihistamines help only with allergic nasal discharge. The US food and Drug Administration has recently advised against using these medicines in children under 24 months because of reports of side effects, some with very bad outcomes. After 24 months, over-the-counter cold medicine may be tried. However, dosing has not been clearly defined. One-half  TEASPOON every six hours should be a safe starting dose for the average two year old. Always use a measuring dropper purchased at the pharmacy for this purpose. These cold medicines may not help at all and may make your child agitated and disagreeable. Persistent symptoms, especially with a fever over 101, should be evaluated within 48 hours.

6. WHAT DO I DO FOR MY CHILD’S COUGH?
A cough is the sound made when the lungs suddenly expel air and secretions from the airways. A cough can have many causes but it is usually caused by a viral infection of the upper airways. A cough is a symptom of an infection and a necessary evil. A cough can be your friend serving to rid the windpipe of nasty phlegm. When it keeps the child and family awake at night, it becomes the enemy. The main treatment of a cough is good oral hydration to help loosen the secretions. Also, humidification of the airways with a vaporizer or humidifier helps. Night time cough suppression can be offered to children over 24 months of age with dextromethorphan, the ingredient in most over-the-counter cough preps. The dose of dextromethorphan for coughing which keeps someone awake is
0.15 mg/lb/dose given every 6 hours (maximum of 20 mg per dose). Check your cough medicine to determine the amount of dextromethorphan per teaspoon. If you have further questions about dosing, call the office during regular hours. For more information, consult PEDIATRIC ADVISOR on this website.

7. WHAT SHOULD I DO ABOUT MY CHILD’S RASH?
A rash is a change in the skin characterized by color change and spots, either raised or flat. Most rashes are caused by skin contact with an irritant (usually very difficult to pinpoint) or an infection: viral, fungal, or bacterial. It is near impossible to determine the cause of the rash over the phone. I suggest that you consult PEDIATRIC ADVISOR.
There is an excellent discussion of home care for rashes by characteristic (localized vs.
widespread, with or without itching). Most rashes lasting longer that 1 or 2 days will need to be evaluated in the office to determine the risk of contagiousness.

8. WHAT SHOULD I DO ABOUT MY CHILD’S PINK EYE?
“Pink eye” or conjunctivitis is an inflammation of the covering of the eyeball and lining of the eye socket. There is usually associated eye drainage which may be clear to greenish-yellow and present in varying amounts during the course of the illness. Causes range from a benign viral infection which requires no treatment to a more serious bacterial infection which is very contagious requiring proper antibiotics. Other important causes include trauma (corneal abrasion), foreign body (sometimes stuck under the upper lid), irritant exposure, or a potentially serious herpetic infection. Initial treatment consists of cleaning the eye of drainage. This is best accomplished by use of a sterile eye irritant in a squirt bottle (such as Dacriose). We do not call in prescription eye drops because of the risk that misdiagnosis over the phone can delay definitive treatment with potentially harmful outcomes where vision is concerned.

9. MY CHILD HAS A SORE THROAT. CAN YOU CALL IN AN ANTIBIOTIC?
95% of sore throats are caused by an infection. Of these infectious sore throats, about 20% are caused by the strep bacteria and merit antibiotic treatment. This percentage varies greatly by season and swings from 5% to 40%, depending on the time of the year. I cannot tell by looking whether a sore throat is bacterial or viral, though the presence of some associated signs (rash, spots on the roof of the mouth) may increase the chance of strep being present. That is why I don’t treat sore throats over the phone by “guessing” as to the cause. This practice results in the overuse of antibiotics in as many as 80% of patients. We perform the most accurate test, a throat culture, to determine whether a sore throat is strep caused. I will treat family members by phone if I have confirmed by culture that a strep is present in the household. The pain of throat infection can best be handled with ibuprofen in the proper weight-based dosage (see FAQ #2).

10. MY CHILD HAS AN EAR ACHE. SHOULD I GO TO THE ER OR URGENT CARE? Ear pain is a common symptom in childhood. When it occurs with a high fever
(over 103), most parents are more comfortable with earlier assessment. However, many ear aches are not caused by a bacterial infection and therefore do not respond to antibiotic treatment. Even the bacterial ear infections may not require treatment, especially in children over 2 years of age. The action I recommend is home treatment with pain medicine (ibuprofen dosed on weight - seeFAQ #2) at night and follow-up the next morning in the office.

11. MY CHILD HAS ABDOMINAL PAIN. WHAT SHOULD I DO?
Abdominal pain has many different causes at different ages. Most causes are not serious.
The pain may start suddenly in a crampy fashion causing the child to double over. This leads many parents to seek emergency room care. This kind of pain is usually caused by a cramping of the muscle encircling the intestine and subsides within 30 minutes. Pain that is severe and persistent over one hour does merit more immediate evaluation. Other less severe pain that persists over 12 hours should be seen in the office (or ER on weekends). Avoid non-prescription medicines unless the child has been evaluated very recently.

12. MY CHILD BUMPED HIS HEAD (HEAD TRAUMA). WHAT SHOULD I LOOK FOR? All kids will experience minor head trauma and usually more than once in their lives. Minor household falls rarely have serious consequences. Falls from trees and bicycle accidents without helmets are potentially more of a problem. A concussion is an altered level of consciousness following a head injury. A loss of conscious is an obvious concussion. But, so is a loss of memory, even though minor, and any apparent confusion.
A significant loss of consciousness (minutes) merits a 911 evaluation. Minor confusion or memory disturbance can be observed at home. Progressive headache (getting worse by the hour), worsening confusion, or recurrent vomiting (more than two times) requires an ER (not urgent care) evaluation with a CT. It is OK to allow the child to sleep for 1 to 2 hours but they should be awakened regularly to determine level of alertness and memory.