Outstanding Support Staff

We understand the importance of providing extended appointments without interruptions to address your concerns. Our outstanding support staff is highly qualified, experienced, caring and available during normal business hours to answer questions.

Efficient Appointments

We strive to make your appointment go smoothly and quickly. You will be asked to present your insurance card at each visit and also to verify your contact info. Please make sure your information is correct and be prepared to make your co-payment at each visit.

For more information you can also check WebMD.com
 
HOURS & APPOINTMENT
 
Mon-Fri 8:00 AM - 05:00 PM
Sat 9:00 AM - 12:00 PM
Sun Closed
Wilbraham Location Hours Monday- Friday 9am-6pm

BY APPOINTMENT ONLY
 
OPEN SATURDAY
FOR SICK PATIENTS
9A - 12P
 
 
 
 
 
FREQUENTLY ASKED QUESTIONS
 

Fevers

 
What is the best way to take my child's temperature?
  • The modern digital thermometers are faster than mercury thermometers, don't have to be shaken down, and are much safer if bit, dropped, or stepped on.
  • The most accurate temperature measurement in infants and young children is a rectal reading. In school-aged children, an oral measurement is ok to use.
  • Axillary (armpit) temperatures are ok to use to screen your child's temperature, but remember they are inaccurate 33% of the time. If an axillary temperature suggests your child has a fever, get a more accurate reading by using an oral or rectal temperature.
  • Some of the new ear thermometers work well if used correctly, but this takes a lot of practice. We don't recommend using the forehead strip and forehead "wand" thermometers. They are not really accurate at all.
  • Regardless of which method you use, please don't add or subtract degrees to the measurement. Recent evidence demonstrates that doing so, even though it is common practice, confuses the picture. Report to us the actual thermometer reading.
 

How to take an oral temperature

Have your child sit or lay down as long as thermometer is in his mouth. Gently insert the thermometer under your child's tongue as far as it will comfortably go. Hold it in place (or have your child hold it) until the reading is finished. Don't let your child talk or breathe through his mouth. Be sure the thermometer stays under the tongue by watching the angle of the thermometer. A correctly-placed thermometer should point up. A thermometer that has slipped out of place will be level or point down.
 

How to take an axillary (armpit) temperature

Have your child sit or lie down. Place the tip of the thermometer into the middle of the armpit, against the child's bare skin. (Don't do it through your child's t-shirt or nightgown.) Hold the thermometer in place with one hand. Keep your child's arm pressed firmly against his side with your other hand until the reading is taken.
 
 

How to take a rectal temperature

Hold the baby on his or her stomach across your lap. Let his or her legs hang down freely. Gently insert the thermometer about 1/2" into the baby's rectum. Hold the thermometer between two fingers as you lay the palm of your hand across the baby's buttocks. Don't leave the baby alone with the thermometer inserted. Leave the thermometer in for 3 minutes. Be sure to clean the thermometer well with soap and warm water after use.
 

How to take an ear (otic) temperature

Follow instructions that come with the thermometer. Remember that, to get an accurate reading, there must be a good seal around the tip of the thermometer, and the tip must be aimed straight toward the eardrum.
 

Vomiting & Diarrhea

 
What causes vomiting and diarrhea?
Vomiting (throwing up) and diarrhea (frequent, watery bowel movements) can be caused by viruses, bacteria, parasites, foods that are hard to digest (such as too many sweets) and other things.
 

Can vomiting and diarrhea be dangerous for children?

They can be. Vomiting and diarrhea can be harmful to children because they can cause dehydration. Dehydration occurs when too much fluid is lost from the body. Young babies can become dehydrated very quickly, but dehydration can occur in a child of any age. Signs of dehydration include:
  • Irritability
  • Not eating as well as usual
  • Weight loss
  • Not urinating (“peeing”) as often as usual
  • Urine that is darker than usual
  • Fast heartbeat
  • Dry mouth
  • Thirst (babies may show thirst by crying and being irritable and eager to drink when something is offered)
  • Sunken eyes
  • No tears when crying
  • Sunken soft spot in babies younger than 18 months
  • Skin that isn't as springy as usual
 

Should I feed my child during sickness?

Yes. Even though eating may cause the amount of diarrhea to increase, your child will be able to get some nutrients from the food. This may prevent your child from losing too much weight and help your child get better quicker.
  • Breast-fed babies
  • Formula-fed babies
  • Children on food
If your child has had diarrhea, dairy products are best avoided for three to seven days. Sometimes bland foods are recommended for the first 24 hours. Foods that are bland include bananas, rice, applesauce, toast and unsweetened cereals. If these foods don't bother your child, other foods can be added over the next 48 hours. Most children can return to normal eating habits in about three days after the vomiting and diarrhea stop.
 
 

Should I give my child medicine to stop diarrhea?

This usually isn't needed. Diarrhea doesn't usually last long. If it is caused by an infection, diarrhea is a way for the body to get rid of the infection. Giving medicines that stop diarrhea may interfere with the body's efforts to get rid of the infection. Antibiotics are usually not necessary either. Talk to your family doctor if you think your child needs medicine.
 

How can I prevent dehydration?

If your child has had several bouts of vomiting or diarrhea, he or she will need to drink fluids to replace those lost with vomiting and diarrhea. Encourage your child older than two years to drink water and other clear fluids. Ask your doctor about giving your baby or toddler oral rehydration solution (ORS), which contains the right mix of salt, sugar, potassium and other elements to help replace lost body fluids.
 
 

What can I give my older child to drink?

Children older than two years can have drinks such as apple juice, chicken broth, sports drinks (Gatorade), ginger ale or tea. Plain water can cause problems, such as lowering the amount of salt or sugar in the blood.
 

Should I give my child ORS?

If your child is younger than two years and you are worried that he or she is dehydrated, ask your doctor about using ORS. ORS comes as a powder that you mix with water, or a liquid that is already mixed and as frozen popsicles.

Brands of ORS include Pedialyte, Rice-Lyte, Rehydralyte and the World Health Organization's Oral Rehydration Solution (WHO-ORS). Ask your doctor about which one to use.
 
Call your doctor if your child is vomiting or has diarrhea and
 
  • Is younger than 6 months.
  • Is older than 6 months and has a fever higher than 101.4°F
  • Has Signs of dehydration.
  • Has been vomiting longer than eight hours or is vomiting with great force.
  • Has stools that are bloody or slimy.
  • Has blood or green slime in the vomit.
 
  • Hasn't passed urine in eight hours.
  • Could have swalloed something that could be poison.
  • Has a stiff neck.
  • Is listless or unusually sleepy.
  • Has had tummy pain for more than two hours.
 

Constipation

 
Definition of Constipation is Pain or crying during the passage of a bowel movement (BM) OR Unable to pass a BM after straining or pushing longer than 10 minutes OR No BM after more than 2 days. (EXCEPTION: If breastfed and over 1 month old.)
 

Imitators of Constipation

If breastfed and over 1 month old: Infrequent BMs every 4-7 days that are soft, large and pain-free can be normal. Before 1 month old, infrequent stools usually means an inadequate intake of breast milk. Grunting or straining while pushing out a BM is normal in young infants. (Reason: difficult to pass BM lying on back with no help from gravity). Infants commonly become red in the face during straining. Brief straining or pushing for less than 10 minutes can occur occasionally at any age. Large BMs - Size relates to amount of food consumed and BM frequency. Large eaters have larger stools. Hard or dry BMs are also normal if passed easily without straining. Often relates to poor fiber intake. Some children even have small, dry rabbit-like-pellet stools.
 

Causes of Constipation

  • High milk or cheese diet
  • Low fiber diet
  • Postponing bowel movements
  • Slow GI transit time (normal genetic differences)
 

When to Call Your Doctor for Constipation

 

Call Your Doctor Within 24 Hours If...

  • You think your child needs to be seen.
  • Age less than 2 months.
  • Bleeding from anal fissures (tears).
Parent Care at Home If Mild constipation and you don't think your child needs to be seen.
 

Call Your Doctor Now (night or day) If...

  • Your child looks or acts very sick.
  • Persistent abdominal pain longer than 1 hour (includes persistent crying).
  • Persistent rectal pain longer than 1 hour (includes persistent straining).
  • Vomiting more than 3 times in last 2 hours.
  • Age less than 1 month old and breastfed.
  • Age less than 12 months with recent onset of weak cry, weak suck or weak muscles.
 

Call Your Doctor During Weekday Office Hours

(M-Th 9am - 5pm, F 9am - Noon) If...

 
  • You have other questions or concerns. Child may be “blocked up”.
  • Leaking stool. Suppository or enema needed recently to relieve pain.
 
  • Days between BMs longer than 3 while eating a nonconstipating diet. (EXCEPTION: normal if breastfed infant older than 2 months AND BMs are not painful).
  • Toilet training is in progress. Constipation is a recurrent ongoing problem.
 

Home Care for Constipation

 

Normal BMs:

Once children are on a regular diet (1 yr), the normal range for BMs is 3 per day to 1 every 2-3 days. The every 4-5 day kids all have pain with passage and prolonged straining.

The every 3 day kids often drift into longer intervals and then develop symptoms.

Passing a BM should be fun, or at least free of discomfort. Any child with discomfort during BM passage or prolonged straining at least needs treatment with dietary changes.
 

Stop Toilet Training:

  • Temporarily put your child back in diapers or pull-ups.
  • Reassure him / her that the poops won't hurt when they come out.
  • Praise him / her for the release of BMs.
  • Avoid any punishment or power struggles about holding back poops, sitting on the potty or resistance to training.
 
 

Sitting on the Toilet (if toilet trained):

Establish a regular bowel pattern by sitting on the toilet for 10 minutes after meals, especially breakfast.
 

Warm Water for Rectal Pain:

Warmth helps many children relax the anal sphincter and release a BM.

For prolonged straining, have your child sit in warm water or apply a warm wet cotton ball to the anus.
 
 

Diet for Infants Under 1 Year:

For infants > 1 month on breast milk or formula alone: Add 1 oz./month-old of apple, pear, prune juice per day.

For infants > 4 months: add high-fiber baby foods twice/day (peas, beans, apricots, prunes, peaches, pears, plums).
 

Diet for Children Over 1 Year Old:

  • Increase 100% fruit juice (apple, pear, cherry, grape, apricot, prune) (citrus fruit juices are not helpful).
  • Add high-fiber fruits & vegetables (peas, beans, broccoli, bananas, apricots, peaches, pears, figs, prunes, dates).
  • Increase whole grain foods (bran flakes, bran muffins, graham crackers, oatmeal, brown rice, whole wheat bread.
  • Decrease milk products (milk, ice cream, cheese, yogurt) to 3 servings per day.
If diet alone fails: Add 1 tablespoon Dark Karo syrup or mineral oil once or twice daily.
 
Call your Doctor if constipation continues after making the recommended changes, your child becomes worse or develops any of the "Call Your Doctor" symptoms!

Protecting Your Child from the Sun

 
Babies under 6 months of age need extra protection from the sun. Babies have sensitive skin that is thinner than adult skin. This causes them to sunburn more easily than an adult. Even babies with naturally darker skin need protection. Since young children are more vulnerable to the sun, here are some specific rules for children younger than 1 year old:
  • Babies younger than 6 months should be kept out of the direct sunlight. Move your baby to the shade or under a tree, umbrella or the stroller canopy.
  • Dress your baby in clothing that covers the body, such as comfortable lightweight long pants, long-sleeved shirts, and hats with brims that shade the face and cover the ears.
  • If your baby gets a sunburn and is younger than 1 year of age, contact your pediatrician at once - a severe sunburn is an emergency.
  • If you cannot keep your child covered and in the shade, sunscreen can be applied. However, before covering your baby with sunscreen, be sure to apply a small amount to a limited area and watch for any reaction.
For children older than 1 year old and all family members, follow these simple rules to protect your family from sunburns now and from skin cancer later in life:
  • Choose sunscreen that is made for children, preferably waterproof. Before covering your child completely, test the sunscreen on your child's back for a reaction. Apply carefully around the eyes, avoiding the eyelids. If a rash develops, talk to your pediatrician.
  • Select clothes made of tightly woven fabrics. Clothes that have a tighter weave - the way a fabric is constructed - generally protect better than clothes with a broader weave. If you're not sure about how tight a fabric's weave is, hold the clothing up to a lamp or window and see how much light shines through. The less light, the better. Clothing made of cotton is both cool and protective.
  • If your child gets a sunburn that results in blistering, pain or fever, contact your pediatrician.
  • When using a cap with a bill, make sure the bill is facing forward to shield your child's face. Sunglasses with UV protection also are a good idea for protecting your child's eyes.
Here are some additional sun safety tips that apply to all members of your family:
  • The sun's rays are the strongest between 10 a.m. and 4 p.m. Try to keep out of the sun during these hours.
  • The sun's damaging UV rays can bounce back from sand, snow or concrete; so be particularly careful in these areas.
  • Most of the sun's rays can come through the clouds on an overcast day; so use sun protection even on cloudy days. When choosing a sunscreen, look for the words "broad-spectrum" on the label - it means that the sunscreen will screen out both ultraviolet B (UVB) and ultraviolet A (UVA) rays.
  • Choose a water-resistant or waterproof sunscreen. Sunscreens that are "waterproof" should be reapplied every two hours, especially if your child is playing in the water.
  • Zinc oxide, a very effective sunblock, can be used as extra protection on the nose, cheeks, tops of the ears and on the shoulders.
  • Use a sun protection factor (SPF) of at least 15.
  • Rub sunscreen in well, making sure to cover all exposed areas, especially your child's face, nose, ears, feet and hands, and even the backs of the knees.
  • Put on sunscreen 30 minutes before going outdoors - it needs time to work on the skin.
  • Keep your child completely out of the sun until the sunburn is totally healed.
Sunscreens should be used for sun protection and not as a reason to stay in the sun longer.

Dosages of Medication

 

Acetaminophen (Tylenol) or Ibuprofen (Advil) Dosing

Remember the following guidelines:
  1. Acetaminophen (Tylenol) or ibuprofen (Advil) can be given every six hours as needed for fever.
  2. If your child has a fever but is sleeping, don't wake him or her up to give medicine for fever! Let your child rest!
  3. Remember, fever is not harmful for children. We only treat with fever-reducing medications to make them more comfortable. Avoid the "tyranny of the thermometer" and go more by how your child is acting, rather than the height of the fever.
  4. Fever-reducing products, especially those containing acetaminophen, come in different strengths. (The chart below shows at least 3 or 4.) Be sure to check the label of the product you have, and be sure that you're giving the right amount for the strength of medicine you're giving.
  5. Many over-the-counter cough and cold preparations (Dimetapp, Robitussin, Triaminic, etc.) contain acetaminophen as well. Check the label. If you give your child one of these products, do not give extra Tylenol.
  6. Call us before giving any fever medication to children under age 3 months. Ibuprofen should never be used in children under age 6 months.

For Acetaminophen Products:

 
 
If your child weighs
 
Give this much
 
Infant drops
(80 mg/0.8 ml)
 
Children's syrups
(160 mg/5 ml)
 
Chewable tablets
(80 mg/tablet)
 
Adult capsule
(325 mg/caps)
 
 
6-11 pounds
 
40 mg
 
1/2 dropper (0.4 ml)
 
¼ tsp
 
------
 
------
 
 
12-17 pounds
 
80 mg
 
1 dropper (0.8 ml)
 
½ tsp
 
------
 
------
 
 
18-23 pounds
 
120 mg
 
1 ½ droppers (1.2 ml)
 
¾ tsp
 
------
 
------
 
 
24-35 pounds
 
160 mg
 
2 droppers (1.6 ml)
 
1 tsp
 
2 tablets
 
------
 
 
36-47 pounds
 
240 mg
 
------
 
1 ½ tsp
 
3 tablets
 
------
 
 
48-59 pounds
 
320 mg
 
------
 
2 tsp
 
4 tablets
 
1 capsule
 
 
60-71 pounds
 
400 mg
 
------
 
2 ½ tsp
 
5 tablets
 
1 capsule
 
 
72-95 pounds
 
480 mg
 
------
 
3 tsp
 
6 tablets
 
1 capsule
 
 
96 pounds and up
 
650 mg
 
------
 
------
 
------
 
2 capsules
 

For ibuprofen Products:

 
 
If your child weighs
 
Give this much
 
Infant drops 100 mg/2.5 ml
 
Children's syrup
(100 mg/5 ml)
 
Children's tablets
50 mg/tablet
 
Jr. strength chewables
100 mg/tab
 
 
13-17 pounds
 
50 mg
 
¼ tsp
 
½ tsp
 
------
 
------
 
 
18-23 pounds
 
75 mg
 
1/3 tsp
 
¾ tsp
 
------
 
------
 
 
24-35 pounds
 
100 mg
 
½ tsp
 
1 tsp
 
2 tablets
 
------
 
 
36-47 pounds
 
150 mg
 
¾ tsp
 
1 ½ tsp
 
3 tablets
 
------
 
 
48-59 pounds
 
200 mg
 
1 tsp
 
1 ¾ tsp
 
3 tablets
 
1 ½ tablets
 
 
60-71 pounds
 
250 mg
 
------
 
2 ½ tsp
 
5 tablets
 
2 ½ tablets
 
 
72-95 pounds
 
300 mg
 
------
 
3 tsp
 
6 tablets
 
3 tablets
 
 
96 pounds and up
 
400 mg
 
------
 
------
 
------
 
4 tablets
 
Due to the risk of Reye syndrome, we do not recommend giving aspirin or aspirin-containing products (such as Pepto-Bismol) to children with fevers
Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Developmental Screening: 3 Months

 

What are some of the developmental milestones my child should reach by three months of age?

By the time your baby is three months of age, she will have made a dramatic transformation from a totally dependent newborn to an active and responsive infant. She'll lose many of her newborn reflexes while acquiring more voluntary control of her body. You'll find her spending hours inspecting her hands and watching their movements.
Here are some other milestones to look for:
 

Movement Milestones

  • Raises head and chest when lying on stomach
  • Supports upper body with arms when lying on stomach
  • Stretches legs out and kicks when lying on stomach or back
  • Opens and shuts hands
  • Pushes down on legs when feet are placed on a firm surface
  • Brings hand to mouth
  • Takes swipes at dangling objects with hands
  • Grasps and shakes hand toys
 

Visual and Hearing Milestones

  • Watches faces intently
  • Follows moving objects
  • Recognizes familiar objects and people at a distance
  • Starts using hands and eyes in coordination
  • Smiles at the sound of your voice
  • Begins to babble
  • Begins to imitate some sounds
  • Turns head toward direction of sound
 

Social and Emotional Milestones

 
  • Begins to develop a social smile
  • Enjoys playing with other people and may cry when playing stops
 
  • Becomes more communicative and expressive with face and body
  • Imitates some movements and facial expressions
 

Developmental Health Watch

Although each baby develops in her own individual way and at her own rate, failure to reach certain milestones may signal medical or developmental problems requiring special attention. If you notice any of the following warning signs in your infant at this age, discuss them with your pediatrician.
 
  • Doesn't seem to respond to loud sounds.
  • Doesn't notice her hands by two months.
  • Doesn't smile at the sound of your voice by two months.
  • Doesn't follow moving objects with her eyes by two to three months.
  • Doesn't grasp and hold objects by three months.
  • Doesn't smile at people by three months.
  • Cannot support her head well at three months.
  • Doesn't reach for and grasp toys by three to four months.
 
  • Doesn't babble by three to four months.
  • Doesn't bring objects to her mouth by four months.
  • Begins babbling, but doesn't try to imitate any of your sounds by four months.
  • Doesn't push down with her legs when her feet are placed on a firm surface by four months.
  • Has trouble moving one or both eyes in all directions.
  • Crosses her eyes most of the time (Occasional crossing of the eyes is normal in these first months.)
  • Doesn't pay attention to new faces, or seems very frightened by new faces or surroundings.
  • Still has the tonic neck reflex at four to five months.