Get a Sports Physical for Athletics and Other Activities

By Daniel Smoots, MD | Family Medicine

The beginning of the school year means new opportunities. Is your child is starting a sport for the first time, changing sports, or deciding to try a new physical activity outside of class? Then it is time for them to have a sports physical so a medical professional can make sure they can play their new sport or activity safely.

What is a sports physical?

  • Screening for safe and healthy participation in sports and activities.
  • Checking that your child’s body is ready for the physical demands of the activity.

Does my child need a sports physical?

  • Yes. In Arizona it is state law that a student gets a sports physical if they are playing a team or club sport at school.
  • And where it isn’t required, it is highly recommended because almost all kids are active in some way! This physical looks at the physical and mental demands of their sport or activity and can address any concerns related to their health.
  • To make life easier and to have less appointments, the American Academy of Pediatrics recommends scheduling a sports physical with your child’s next routine well-child visit.

What happens during the appointment?

  • Bring your child’s completed Pre-Participation Physical Evaluation form with you. Write down any important medical information like past surgeries, injuries, or illnesses, and any family history of heart disease should be reviewed. Write down any questions you may have to discuss with the doctor.
  • At the appointment, the doctor will check your child’s:
    • Vitals: height, weight, pulse, and blood pressure
    • Eyes: if your child may need corrective lenses, or a new prescription
    • Medical history
    • Fitness: check heart, lungs, abdomen, joints, flexibility, strength, and reflexes             
  • This is also a good time to talk with your child’s doctor about any concerns for your child’s new or ongoing activity or sport, such as:
    • Concussions
    • Special needs or disabilities       
  • We want your child to be safe in their activities, so sometimes they may need to have lab work done or another exam with a specialist. If needed, their doctor will help set up the next steps for this, and most children are able to play after this extra clearance.

Safe and healthy participation in sports and physical activities is the goal, so get your child’s physical scheduled with your NOAH provider and enjoy watching them play.

The Importance of Children’s Eye Health

By Mitchell Ducett, DO | Family Medicine PGY-1

August is Children’s Eye Health and Safety Month and the perfect time to share one of the most common conditions of pediatric eye health, strabismus. Strabismus is the fancy medical term for when eyes don’t naturally look at the same place. This is also known as lazy eye and can cause issues like double vision that can negatively affect your child.

Tips to help children with eye health

  • Make sure you attend all your child’s well-child appointments, and all follow-up appointments with your family doctor or pediatrician to catch this issue early on.
  • Always feel comfortable asking your child’s doctor questions and telling them concerns like if you see something “funny” with the movement of your child’s eye. You know your child best!
  • If either parent had a lazy eye or was crossed eye, your child has a higher risk. Tell your child’s doctor of a family history of eye or vision issues.
  • Does your child bump into things when they are walking or crawling? That could be a sign that they have vision issues that you should talk to their doctor about.
  • The sooner you have it diagnosed, the better! Knowing if there is a problem and addressing it will help your child’s vision and development.
  • Treating a child can prevent amblyopia – where the brain favors the “good eye” making the lazy eye even worse.  Half of children with a lazy eye will develop amblyopia, which is still treatable. But the sooner, the better!
  • Treatments usually include eyeglasses, visual exercises, and/or an eye patch over the “good eye” to increase the use of the other eye. Occasionally, surgery is needed on the muscles in the lazy eye that help it move.

The best way to help your child with their eye and vision health is to catch it early. Knowing these signs and learning a few more here, will help parents, family, and any babysitters or caregivers. Vision and eye health is so important to their overall development, so keep an eye on your child’s eyes!

5 Things to Know for Flu Season 2021-2022

Flu season is around the corner and NOAH is ready to keep you and your family protected. We know that with COVID there might be additional questions about the virus, symptoms, and the vaccines. NOAH has you covered with these top five things to know about flu season.

1. Flu Season Is Almost Here

Flu season officially starts in October and can last through May of the following year. But the peak of flu usually happens around December through March with February being the month that often has the most flu cases nationwide.

2. Try These Safety Measures Stop the Flu

Many of the things we are doing now to slow or stop the spread of COVID like extra hand washing, more antibacterial gels and wipes, staying home when sick, wearing masks (especially if sneezing or coughing), will help reduce the flu as well! During last year’s flu season, the flu was minimal because of these safety measures, along with a lot of social distancing, so it is possible to keep the spread of flu lower than previous years.

3. The Flu Vaccine Helps

Every year, flu shot manufacturers identify the strains of influenza A and B that pose the most risk for the coming season. Flu shots also include H1N1, and because of flu shots, H1N1 isn’t causing outbreaks anymore. Flu shots are adjusted every year with new influenza (flu) strains because it mutates like all viruses.  

4. Flu Shots Help Different Ages Appropriately

Children are a high-risk group with flu so anyone 6 months and older should get the flu shot. When children under eight are getting the flu vaccine for the first time ever, they will need to have two doses, given four weeks apart. The following flu seasons will be just one dose.

A high-dose flu vaccine made specifically to support the more fragile immune system of people 65+ is available during flu season.

5. Flu Shots and COVID Shots Can Go Together

The CDC says that it is safe to get the flu and COVID vaccines at the same time.  If you have any concerns about potential side effects or changes in effectiveness of the vaccines if given together we suggest talking to your NOAH provider to come up with a vaccine plan that is right for you.

Almost everyone can and should get the flu shot every year, including people with egg allergies.. The only people who shouldn’t are patients under 6 months old or someone with history of an anaphylactic reaction to the flu shot in the past or a flu shot component. 

The CDC has a lot of information about flu season including updated flu cases and vaccine activity on their website here. NOAH offers patients different options including regular appointments and drive-up flu shots. If you have questions about the flu vaccine or want to schedule your appointment, contact NOAH today!

Be in the Know: Childhood Vaccines

By Amit Jain, MD FAAP MBA | Pediatrician

We’ve all heard about immunizations; the good, the new, the questions, and even the confusion. Unfortunately, confusing and misleading information causes fear or uncertainty in parents who only want the best for their kids with childhood vaccines. The truth is that the significant benefits that have come from childhood vaccinations is can be forgotten and even taken for granted. Humans have benefitted immeasurably from immunizations for over 200 years!

Pediatricians follow the lead and research of the American Academy of Pediatrics which recommends vaccinating children on the Centers for Disease Control (CDC) Immunization Schedules for Infants, Children, and Adolescents.

Concern and distrust about vaccines is real when there is so much misinformation, lack of knowledge about what vaccines really are and how they work. Let’s clear that up!

What are vaccines?

When various viruses, or other germs enter our body, our immune system sees parts of the germs as foreign (called antigens) and that they don’t belong. Then, our immune system creates a defense against the germs – called antibodies – to attack the viruses. Most vaccines work in the same way, with weakened or dead pieces of the virus (so it is impossible to get the virus from the vaccine) prompting the body’s immune system to create the antibody defense without actually getting the virus – many of which can cause lifelong problems or even death. Vaccines help your body fight the real thing without risking your health to develop the antibodies.

Why give vaccines?

The reason is simple – vaccines save lives! According to the Journal of American Medical Association, there was a 99% decline in deaths from diseases prevented by vaccines given during childhood.

Childhood Vaccines protect against 16 known viruses and bacteria. Before vaccines, these germs caused severe illness, disability and whole-body paralysis, and death. I have personally seen some terrible cases of many of these, such as meningitis, as well as their complications with children being paralyzed, requiring lifelong hearing aids, or needing feeding tubes for infections caused by HiB (Haemophilus influenza Type B), which is now prevented by a vaccine.

Schools also require children to receive at least some immunizations before starting school, and throughout school years.

Are vaccines safe, what about side effects?

Vaccines are generally very safe. They are backed by the American Academy of Pediatrics, American Academy of Family Practice, and the U.S. Center for Disease Control (CDC). But here is an overview of how vaccines are tested for safety.

It is normal for kids (and adults) to have some mild and temporary symptoms like fever or soreness at the site of the immunization. Serious allergic reactions are extremely rare – like anaphylaxis. As a provider, in weighing the risks and benefits of giving vaccines, as I do for any treatment or prevention, the benefits far outweigh any risks.

When should I get my child immunized?

Childhood vaccines should start right after birth with the Hepatitis B vaccination! From there, there is a specific schedule of when certain immunizations should be given. Pediatricians and Family Practitioners follow the CDC Immunization Schedule for Children and Adolescents that you can find here.

Do you know if your child’s immunizations are up to date? Do you have more questions about vaccines? Call and make an appointment with your child’s NOAH Provider to discuss your child’s immunizations.

Ask the Expert: COVID-19 in 2021

Dr. Jennifer Vanyo-Novak, D.O. | Family Physician, Medical Director

The COVID-19 pandemic has given us ups and downs over the past year and a half. We hear about the “return to normal” but what does that mean and how do we get there?

NOAH’s Medical Director and Family Physician Dr. Vanyo-Novak breaks down the facts, explains the complex, and clears up rumors and misunderstandings about COVID, vaccines, and the new normal.

Dr. Vanyo-Novak

A lot of places are opening back up. Do we really need masks again since places stopped requiring them? Isn’t COVID almost over?  

Unfortunately, no, COVID is not almost over. Though the number of cases declined for a while thanks to mask mandates, social distancing, and vaccines against COVID-19, we are now seeing the cases rise.  As of 7.27.2021 the CDC has advised that even vaccinated individuals begin to mask again indoors in high risk COVID regions which includes us here in Maricopa County. This is in part due to lower than needed vaccine rates, not enough people following guidelines, and an increase in travel and social gatherings.  Like with most viruses that go uncontained, we are seeing the virus that causes COVID-19 evolve into new variants (strains of the virus) that are smarter, more easily transmitted, and harder to defeat than the original strains of the virus.

Right now we are hearing about variants, especially the Delta variant, but what is the difference? Should we be worried about another outbreak?

Viruses are living things and they continuously change so they can evolve and survive. There are several different strains right now, Delta being the most common one in the U.S. Several new strains are labeled as “Variants of Concern” by the CDC meaning they are more transmissible, cause more serious illness, don’t respond as well to treatments, and can be more resistant to vaccines.

With a rise in cases due to the Delta variant and other “Variants of Concern” we are seeing an increase in hospitalizations in younger patients without risk factors, even young children.  The virus is not just a risk for the elderly or people with underlying conditions. 

If someone got the vaccine, are they safe from new COVID strains? Will they need to take booster shots?

Honestly, we are still learning about the virus, its’ variants, and the vaccines. In the beginning health experts and scientists weren’t sure booster shots would be needed. Now, it looks likely that boosters will be needed but we don’t know when. Originally, they did not think boosters would be needed soon, but this can change as the case numbers rise. What the experts are working on understanding is if vaccinated people are getting COVID, is it because these new strains are outsmarting the vaccines, if the vaccine effectiveness is fading, or a combination of the two. 

Currently 97% of COVID-19 hospitalizations are unvaccinated individuals. That tells us that while we will not ever be 100% protected, most vaccinated people are protected and if they do get infected it is unlikely that they will get seriously ill. That was always a big goal with the vaccine.

If someone didn’t get vaccinated and doesn’t plan to, won’t they be safe since other people got the vaccine and infections are lower than earlier in the pandemic?

It is great that as of 7.28.21 338 million Americans have been vaccinated against COVID. However, that is only 49% of the U.S., putting us well below the 70-80% needed for herd immunity.

COVID cases aren’t looking as good as they were even a month ago. Less than 50% of Maricopa County is fully vaccinated and with school starting, travel increasing, and mask mandates mostly gone, the number of infected people will continue to increase.

Most of us interact with other people: school, work, stores, travel, transportation, exercising at gyms, and more. We can’t just think about ourselves, we must consider our community – the herd – and protect that. We have a responsibility to our friends, family, neighbors, and society to take care of each other.

The virus will continue to mutate into new variants and harm people, and the vaccines are our greatest defense.  We need to achieve herd immunity before we can truly begin to feel safe.

Kids don’t get COVID, so why do they need a vaccine?

In general most children have a much more robust immune system than adults. Children have gotten COVID throughout the pandemic, but they are getting it more now, and ending up in the hospital more. With new variants this trend may continue, and more children may become seriously ill or worse, die from this virus.

Children, like the rest of us, interact with family members, friends, classmates, teammates, and many other people. We want children to be protected from this virus, but also for them to protect their community as well.

How can we possibly know if the vaccines are safe if they aren’t fully approved?

They have all been given Emergency Use Authorization by the Food and Drug Administration (FDA) and here is a short video to explain it. All vaccines have trials that require at least 3,000 people. The COVID vaccine trials were done on 30,000 people before the first approvals in late 2020!

The main difference in the approval and process for the COVID vaccines is that while most vaccines go through a series of steps, finishing one step before moving the next one, with COVID vaccines, they moved to the next step once all the data showed things were looking good (as opposed to fully completed). But every step was still included, all the monitoring and review was still happening, but in a more fluid way.

At this time, every step has been fully completed and vaccine makers are beginning to apply for full FDA approval.

If the risk of getting really sick from COVID-19 is still low, why should someone take a new vaccine?

Possible side effects from the vaccine are still much less than the risk of COVID-19 and serious illness, including what we are now seeing as long-haul COVID. The vaccine side effects are mostly normal, expected, and mild. COVID is mutating and with each strain it can be more deadly, or more infectious than before.

We cannot just consider ourselves; we have to consider the effects of our choices on those around us. 

If the mRNA (vaccine technology used in some vaccines) isn’t new medical technology, why haven’t we used it in vaccines before.

t hasn’t been used in vaccines before COVID because we haven’t needed a new vaccine on this scale until now. The mRNA technology has been used successfully for decades, with a lot of research done on its benefits and any risks.

Anyone 12 and older can schedule their vaccine appointment one of NOAH’s locations. Click here to request an appointment. If you have additional questions or concerns about COVID-19 or the vaccine, make an appointment with one of our medical providers.

The Benefits and Support for Breastfeeding Month

By Dr. Roberta Matern, MD

I am a family physician who delights in caring for the couplet (newborn and new mother) because helping growing families is so rewarding, and I strongly encourage breastfeeding and support families however I can.

Trusted organizations like the American Academy of Family Physicians and the American Academy of Pediatrics recommend babies are breastfed until at least 6 months old. Studies show that exclusively breastfed babies are generally healthier, but any amount of breastmilk is wonderful and encouraged!

Benefits of Breastfeeding

In general – though individual babies may differ – babies fed only breastmilk for their first 6 months have many benefits; moms too!

  • Babies tend to be healthier with fewer colds and doctor visits.
  • Decreased likelihood of SIDS (sudden infant death syndrome).
  • Babies are less likely to have diabetes, obesity, leukemia, and high blood pressure later in life.
  • Helps moms lose weight.
  • Decrease mom’s chances for breast cancer, diabetes, heart disease, and high blood pressure.
  • Breastfeeding has the added bonuses of no waiting for formula to warm up, it is free, and it is easy on the environment.
  • And more!

It’s Not Always Easy

While natural and better for babies and moms, breastfeeding can have challenges, and helping the couplet through that is important.

Challenges include:

  • The time it takes to get it going, especially if it is your first baby
  • The time commitment, which can be stressful for some moms and families
  • Moms needing to watch what they eat and drink – too much caffeine and alcohol, dairy, spicy foods, etc.

The good news is, we have lactation consultants that love being able to help moms and families through these issues!

Plan for Breastfeeding

I start talking about breastfeeding during prenatal visits, exploring mom’s feelings and answering questions. If there are any issues with mom’s breasts or nipples, I try to coordinate with a lactation consultant before delivery.

Next is promoting skin-to-skin contact right after delivery. Putting the newborn directly on mom’s belly or chest right after birth improves chances of exclusive breastfeeding and increases the duration of breastfeeding! Skin-to-skin helps mom and baby bond by increasing their levels of oxytocin…the “love” hormone.

Helping families know what is normal and what to expect during the first few days is key. At first, mom’s breasts produce colostrum – a very important food for babies full of nutrients and antibodies that fight infection. There is only small amounts of colostrum produced and babies will eat frequently because their stomachs are only about the size of a cherry – so they fill up and empty quickly.

A few days after delivery, mom’s breast milk will come in and that’s about the time babies’ stomachs start to grow. Newborns eat a lot and it’s important (regardless of breastfeeding or not) to learn your baby’s ques to know when they are hungry. Moms should have babies close to them and continue skin-to-skin during those early days and weeks.

While breastfeeding is recommended through 6 months, it can continue for months (or even years) after that. The World Health Organization recommends breastfeeding until age 2, while most couplets in the US do not breastfeed for that long. But any amount of breastfeeding is super healthy for baby and mom!

If you have questions about breastfeeding, talk to your NOAH prenatal doctor or your baby’s pediatrician

Back to Bed for Back to School

By Annette Liao, DO | Family Medicine PGY-1

Can you believe it? The end of summer is quickly approaching. With fall around the corner, many families are thinking about the school year and how to prepare their kids for the classroom. This could prove to be a bigger challenge this year, as schools reopen their doors for in-person classes after a very different year. Now, after a summer of staying up late and sleeping in, it is time to help kids get back on a normal classroom schedule, and that starts with a good night’s sleep.

Back-to-School Kids Sleep Tips

  • As their brains develop, school-aged children need more sleep than adults to do their best in school and to stay alert during the day. Here is how much sleep kids should have:
    • Preschoolers (ages 3-5) require 10-13 hours of sleep
    • School-age children (ages 6-13) require 9-11 hours of sleep
    • Teenagers (ages 14-17) require 8-10 hours of sleep
  • Start slow – most kids will not be able to suddenly switch from being night owls to morning birds. A slow transition over a few weeks is best. Move bedtime by 15 minutes each day until they are getting the amount of sleep they need.
  • Keep a clock in each child’s bedroom so that they know what time they should go to sleep and what time they should wake up.
  • Avoid using electronics at least 1 hour before bed, and no electronics in bed! The light from the screens on TVs, tablets, and phones tricks our brains into thinking it is daytime and keeps us from a good night’s sleep. It’s good for everyone to turn off screens starting two hours before bedtime.
  • Instead of electronics, establish a relaxing bedtime routine. This could involve reading, stretching, or meditation. Routines will train the body that it is bedtime and can decrease anxiety around bedtime in kids and adults. Make the environment as relaxing as possible.
  • Keep the schedule, even on weekends. Parents and caregivers should all be on the same page with the sleep schedule. Children over the age of 5 should be informed on what that plan is as well.

Having quality sleep is essential for success in school. Not getting enough sleep affects a student’s ability to function, learn, and grow. These tips will not only help to get your kids back on track for school, but also set them up for a lifelong healthy habit! Learn more about other back-to-school tips for a healthy and happy start to the new school year.

Time to get Back to School!

The 2021-2022 school year is just around the corner and the back-to-school feeling is nice to have back. As kids everywhere get ready for in-person learning this year, here are ways to make sure the start of the school year is a healthy and safe one.

  1. Get Well-Child appointments. During the pandemic, many people got behind (or forgot about) medical appointments like well-child and other annual preventative check-ups. Make sure your child has their well-child appointment before school starts!
  2. Schedule a sports physical. If your child is playing any sport this fall or spring, it’s a good time to get them a physical before the season gets into full swing.
  3. Make sure immunizations are up to date. Schools require immunizations and they keep your child and their classmates protected from unnecessary, dangerous, and sometimes fatal diseases. If students are 12 or older, they should also get the COVID-19 vaccine. Here is the CDC list of childhood vaccines.
  4. Start a good sleep routine. Kids need enough sleep to develop and do well in school and everything else. Most children need between 9 and 12 hours of sleep each night, so start a routine now and keep it up!
  5. Be physically fit. Kids need at least one hour of exercise every day. Make sure they get enough activity whether it is walking, swimming, playing soccer or basketball, dancing, or something else.
  6. Get school supplies ready. Start the school year with a sturdy backpack. Make sure your student has whatever supplies, like notebooks, folders, pens, and pencils, etc. to start the year successfully.
  7. Talk about bullying. Make sure your child knows about the seriousness of bullying. It can hurt people emotionally and mentally and can harm their learning. If your child is being bullied or sees another student bullied, make sure they know to tell a bully to “Stop!” and to talk to a trusted adult (teacher, counselor, nurse) at school.

Ready to start this school year and get your student in for their back-to-school medical appointments? NOAH pediatricians, counselors, nutritionists, and community resource specialists can help your student and family head into the year with everything you need for success. Make an appointment today!

Summer Fun Part 2

Water safety tips

By Dr. Amit Jain, MD FAAP MBA | Pediatrician

The summer is here and it is time to have some fun in the sun, and in the water. NOAH’s Pediatric team wants you to have a fun summer in the sun and in the water so here are some water safety tips!

Water Safety

Swimming is a great way to beat the summer heat here in Arizona and is a fun, healthy way to enjoy summer. However, water safety and drowning prevention are CRITICAL! Drowning is a very common cause of accidental, injury related deaths. Kids between 1 and 4 are at the highest risk.

  • Never leave children alone – even for a moment – in or near pool areas or other bodies of water (lakes, beaches, and even bathtubs or buckets of water!)
  • Install a fence at least 4 feet tall around the pool, which should ideally surround the pool on all sides and completely separate the pool from your home and yard. It should not have any gaps that a small child could slip over, under, or through. The gate should be a self-closing and self-latching gate that cannot be opened / reached by a small child.
  • Newer technology offers alarms, both for the gate and the pool that alerts you to anyone around the pool.
  • If an unexperienced swimmer is near the pool, make sure there is a designated adult for supervision. This adult should not be under the influence of alcohol or anything else, should not have any distractions (cell phone turned off or handed off to another adult), and preferably knows how to swim and perform CPR.
  • Keep rescue equipment such as a shepherd’s hook and a life preserver to reach / throw for rescues.
  • Avoid inflatable swim aids such as floaties, as they are not a substitution for proper life-preserving equipment such as life jackets.
  • Start swimming lessons early! Consider swim lessons for your child around age 1, but definitely by age 4. It may reduce the risk of drowning. Some neighborhoods that have pools have frequent swim classes for all ages.
  • Infant swim lessons are not advised because there is no evidence that swim lessons reduce a child’s risk of drowning under age 1 year old.
  • Talk to your pool operator to make sure your pool / spa and its drains are compliant with the pool and spa safety act.
  • Be safe and have a fun-filled summer!

Looking for more water safety tips? Check out the Red Cross’ tips to help you and your family have a fun and safe summer.

Summer Fun Part 1

Sun and summer safety tips

By Dr. Amit Jain, MD FAAP MBA | Pediatrician

Summer is here and many of us will be out with our kids to enjoy the sun. NOAH’s Pediatric team has a few summer safety tips for safe fun in the sun!

The sun brings many great things, but it also brings harmful UV (ultraviolet) light. UV light can cause melanoma, a deadly form of skin cancer more common in people who have had bad sunburns when they were young. The sun can also cause other health risks and skin damage.

The first, best defense against the scorching summer sun is proper clothing and lots of shade.

  • Limit your time in the sun during 10 a.m. and 4 p.m. (the most intense time).
  • Take frequent shade breaks if staying in the sun for long periods of time.
  • Cotton clothing is best – it’s protective against the sun and keeps moisture low so you stay cool outside. Tightly woven fabrics are best.
  • Wear a hat: wide brimmed is best to protect your child’s entire face, including the nose, cheeks, chin, ears, and back of the neck.
  • Kids sunglasses should have UV protection. They aren’t expensive and are sold lots of places like dollar stores and Walmart. But make sure they’re labeled with UV protection.
  • Use SPF 15 (or higher) sunscreen on any skin not protected by clothing. Don’t forget the ears, back of the neck, arms, and legs. Carefully apply around the eyes, avoiding eyelids.
  • Choose a sunscreen that has the words “Broad Spectrum” on it – that will cover both UVA and UVB rays. Avoid sunscreens with oxybenzone because it has bad hormonal side effects in males and females.  
  • Before applying sunscreen for the first time, test a small amount on your child’s back for an allergic reaction.
  • Apply sunscreen at least 30 minutes before sun exposure, because it takes this long to start working.
  • Reapply sunscreen at least every 1 hour.
  • If playing in the water, reapply sunscreen every half an hour, and use a waterproof sunscreen.
  • Babies under 6 months need more sun protection.
    • Avoid direct sun exposure. Keep them in shade with a canopy or under a tree.
    • Use wide brimmed hats to cover their face, ears, and neck.
    • Dress babies in lightweight clothing that covers their arms and legs.
    • If a young baby will be in the sun, apply small amounts of sunscreen SPF 15 or more to your baby’s face, hands, and legs.
  • Don’t forget to use sun protection even on cloudy days, as the harmful UV rays come through clouds.

If your child experiences a serious reaction to sunscreen, gets a bad sunburn or rash, talk to your NOAH pediatrician.

Looking for more summer sun safety tips? Visit HealthyChildren.org for tips from the American Academy of Pediatrics.