The PediMag Fall 2021

YOUR HOME FOR QUALITY PEDIATRIC CARE • FALL 2021

Getting ready for fall

Welcome to The PediaMag.............. 2 LEARNING LOSS Addressing Summer Learning Loss................................. 4 Fun in the Sun: WATER SAFETY....... 5 ALLERGIES AND ASTHMA Am I Allergic to Penicillin?

Probably Not!.................................. 6 Asthma in the Fall........................... 7

BREASTFEEDING Breastfeeding: Answers and Support for Common Struggles....... 8 FIRE SAFETY The 3 P’s of Fire Safety................... 12 COLLEGE DAYS College Advisor: “They’re Fine”........ 14

Publication Provided by:

Welcome

Welcome to The PediaMag Welcome to the Fall 2021 issue of The PediaMag. Autumn is here.

Boots and sweater weather is just around the corner. Piles of leaves for jumping in, bonfires, high school football games, apple picking, and visiting the pumpkin patch. Kids of all ages are back to school, catching up and moving ahead. And Fall allergies are in full swing, bringing with them itchy eyes and stuffy, runny noses. In this issue of the PediaMag, Dr. Russell Traister talks to us about management of Fall allergies. Dr. Bethan Ziss gives advice for overcoming the educational backslide that can happen over the summer, and Dr. Ned Ketyer reminds parents of college-aged kids that everything is going to be ok. So grab a pumpkin-spice flavored drink, and settle in for another fun and informative issue of the PediaMag.

About Us: Pediatric Alliance was formed in 1996 when eight individual practices joined together to provide quality health care throughout Southwestern Pennsylvania. Over the years, Pediatric Alliance grew to be the largest physician-owned group pediatric practice in the area. In 2019, Pediatric Alliance joined with Allegheny Health Network to allow expansion of resources in order to stay abreast of the latest technology and advances in health care. Our board-certified pediatricians offer primary care to children and adolescents in 18 offices in the Pittsburgh and Erie areas including 14 primary care offices and 4 specialty offices - Allergy, Endocrinology, Developmental Pediatrics, and Dermatology.

We are proud to offer personalized, patient-centered care to patients from birth to 21 years of age. We strive to meet your family’s pediatric needs, provide convenient access to care, and build strong relationships with families to maximize your child’s health.

To learn more about AHN PediatricsPediatric Alliance, visit our website at www.ahnpediatrics.org.

AHN Pediatrics-Pediatric Alliance 1100 Washington Ave., Suite 219 Carnegie, PA 15106 www.ahnpediatrics.org

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The PediaMag is published quarterly, copyright 2020. All rights reserved.

Publisher AHN PediatricsPediatric Alliance

AHN Pediatrics • Fall 2021 • www.ahnpediatrics.org

Editor Rebecca Scalise

Art Director Brent Cashman

New & Expectant Parent Classes Increase your knowledge and confidence as you prepare for the birth of your baby. Receive helpful tips to calm a baby, ease fussiness, and much more!

Advanced registration is required for these complimentary classes. Make sure to register early to reserve your space. www.AHNPediatrics.org

All classes are free and conducted online via Zoom. Login information is provided up on confirmation of registration. Visit www.AHNPediatrics.org for class schedules and registration.

BABY BASICS

BREASTFEEDING 101

Expectant parents can meet with a physician and receive basic information about the care of their newborn and what to expect while they are in the hospital.

Expectant moms and their partners can meet with a BoardCertified Lactation Consultant and gain knowledge on how to successfully initiate breastfeeding from day one.

JOURNEY TO TABLE FOOD

BREASTFEEDING: REWARDS AND REALITIES

Starting solids can be scary! There is so much information about what to feed baby, when to feed baby, and how to feed baby, that it can be overwhelming. This fun and informative discussion will help you understand the role of complimentary foods in your baby’s first year of life and navigate the best feeding choices for your baby and family.

Learn all about the how-to’s and benefits of breastfeeding, both short-term and long-term, for Mom, Dad, and baby.

Be aware of some challenges you may experience breastfeeding to be prepared for your journey and make decisions about your baby’s feeding.

AHN Pediatrics • Fall 2021 • www.ahnpediatrics.org

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Learning Loss

Addressing Summer Learning Loss

By Dr. Bethany Ziss, AHN Pediatrics Bloomfield, Developmental Pediatrics.

The first day of school, the sixth graders get a math assessment to see how much they remember. Next week, the first graders will take the DIBELS to evaluate early reading skills. Perhaps you spent the summer trying to get your kindergartener to practice writing letters or your teen to read a book, any book. Perhaps you decided your child needed a summer of running around after a year of school on screen.

Every year, parents and educators worry about “summer learning loss.” This year, the fears are larger as many students struggled to make expected academic progress last year under the uncertainty and changes due to COVID. Summer learning loss has been studied extensively for several decades. On average, students tend to lose about a month of skills over the summer. Math skills drop more

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than reading skills. Students with more socioeconomic challenges tend to lose more.

Older students tend to lose more. Summer reading programs might help. Or not. One study found that sending text messages to parents over the summer reminding them about reading improved test scores of third and fourth graders but not younger children.

Students receiving special education services are known to be at increased risk of

AHN Pediatrics • Fall 2021 • www.ahnpediatrics.org

losing skills over the summer, and children with a history of skill loss or regression over school breaks can be eligible for Extended School Year services over the summer as part of their IEPs. Some newer studies show less of a loss than older ones, perhaps not much of a loss at all, depending on which tests were used. Often children would be given the same test in the fall and spring, and then a different, harder test the following fall.

Newer testing methods are different, often using a computer to adjust the questions during the test. Everything we all thought we knew about summer learning loss may not be quite as worrisome as we thought.

Enter COVID. What do we know about children’s learning progress during the era of COVID? We know that COVID affected us all, but not to the same extent. Some schools and districts struggled more than others when switching to remote learning, and some districts resumed in-person learning much sooner in the 2020-2021 academic year than others. Access to needed devices and reliable internet access also varied widely.

Some children struggled more than others when learning remotely compared to being in the classroom. (A few students thrived.)

Early data about COVID learning suggests students were an average of 1-2 months behind at the start of the 20202021 year, compared to usual test scores.

But if everyone, or nearly everyone is 2 months “behind,” then maybe we can all worry a little less, and just accept that students are in a slightly different place than usual. Children, already under the usual stresses of growth and the unusual stresses of the pandemic, are not likely

to make up any gaps more successfully if they sense the adults are all terribly worried about their test scores. In fact, we have long known that children learn best when they feel safe and supported at home and school. Social-emotional education in schools has been shown to raise test scores and overall academic achievement.

So has recess.

This summer is over, and the children are back in school, most in person, some, for various reasons, online. What to do next year?

1. Ask your child’s teacher if they have concerns and if they recommend any specific summer academic work.

2. Balance any recommendations for summer work at home, summer school, or

extended school year services with your child and family’s overall needs.

3. Read, read, read. a. Read to and with younger children.

Look for letters or words in the kitchen, on walks, out the window of the car on long trips. b. E ncourage older children and teens to read a little, most days. c. For reluctant readers of fiction, keep in mind that reading also includes: i. Graphic novels ii. How-to books iii. Recipes and instructions on food packages iv. Biographies about athletes, musicians, and other famous people

v. Internet articles about Minecraft (Parents should review first for content).

4. Math is everywhere a. There is always something to count for the youngest children. b. Cooking, crafts, and home improvement projects all involve math. c. What does your tween want to own?

How long will it take to save up the money?

Remember, If you have any concerns about your child’s progress, please discuss with your child’s teacher. He or she will be happy to address your concerns and work with you to create a plan to keep your child on the right educational track.

AHN Pediatrics • Fall 2021 • www.ahnpediatrics.org

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Allergies and Asthma

Am I Allergic to Penicillin?

Probably Not!

by Russell Traister, MD, Bloomfield Allergy

Are you one of almost 10 percent of people who believe they have an allergy to penicillin, a common antibiotic used to treat many common infections? You are likely not alone as it is the most commonly reported drug allergy. It turns out that up to 19 out of 20 patients who believe they have a penicillin allergy, in fact, do not.

This can seem inconsequential if you are someone who is not sick often or rarely requires antibiotics, but carrying this diagnosis long-term could lead to issues when you are older or require hospitalization.

Older patients often carry this diagnosis

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from childhood and have no recollection of why they were labeled penicillin allergic.

For many infections, a penicillin or related antibiotic is considered the first-line treatment. Treatment with alternative agents could lead to less efficient treatment of an infection and can also lead bacteria to develop resistance to treatment. In fact, patients labeled with a penicillin allergy have a 70 percent higher risk of developing methicillin-resistant Staphylococcus aureus (MRSA) infections. In addition, many alternative agents are costly and can have significant side effects.

AHN Pediatrics • Fall 2021 • www.ahnpediatrics.org

The reason for the high rate of misdiagnosis of penicillin allergy is multifactorial.

Allergists are primarily concerned about immediate, IgE-mediated, anaphylactic reactions, as these can be life threatening and require immediate treatment. This type of reaction could include diffuse hives, swelling, shortness of breath, wheezing, vomiting, diarrhea, and syncope. If this reaction occurs, strict avoidance of the offending drug is necessary. Despite this, patients with a true life threatening allergy to penicillin are likely to outgrow it over time, with up to 90 percent being able to tolerate penicillin after 10 years of avoidance. Adding to the confusion is that many viral infections can cause rashes that can be easily confused with reactions to medication, and this often leads to misdiagnosis of penicillin allergy.

However, viral rashes or even delayed-onset drug rashes (without other symptoms) can be bothersome. Luckily, they can often be treated with steroid medications or left to resolve on their own. These reactions do not require future avoidance of the offending agent, if a drug was implicated. Lastly, patients could also simply have intolerances to penicillin, such as diarrhea, which can be common with antibiotic treatment.

It is important to discuss any drug allergies, including penicillin, with your allergist. After discussion, they may decide to perform skin testing to penicillin. If negative, the last step is to challenge the patient to an oral dose of penicillin to ensure that it is tolerated. If so, your allergist will remove penicillin from your allergy list, and you will be free to receive such antibiotics in the future without concern for reaction.

Asthma in the Fall

by Russell Traister, MD, Bloomfield Allergy

Many people look forward to autumn, with the start of school, cooler weather, pumpkin spice, and of course, Steeler football. Though it is well known that asthma exacerbations can occur with the onset of the spring pollen season, many people forget that there is another peak for asthma exacerbations in the fall, typically sometime in September. Though the timing is different, symptoms of an asthma exacerbation are the same regardless of the time of year they occur and include shortness of breath, wheezing, and chest tightness.

Fall exacerbations can occur for several reasons. One main factor is the presence of ragweed pollen, a common allergy and asthma trigger that peaks in the fall and remains present until the first frost of the year. Ragweed pollen is difficult to avoid, but steps can be taken to minimize exposure.

Keeping home and car windows closed and drying clothes in a dryer instead of hanging them on a clothesline can help.

Cold and damp weather in the fall can also increase mold spores, another common asthma trigger. If ragweed or mold are a significant trigger for your asthma, your allergist may suggest allergy shots, which could help decrease your asthma exacerbations.

Another major cause of fall asthma exacerbations is viruses such as the cold and flu. Often when school starts in the fall, children are around many other kids in class and viruses can spread more easily.

If you have asthma, this is one of the major reasons your doctor recommends you receive the yearly flu shot.

Fall is also a time of quite dramatic weather changes, and change in temperatures from hot one day to cold the next can affect the airways of patients with asthma, leading to more symptoms. Regardless of the cause, it is important to be mindful of your symptoms and alert your doctor if any worsening of your asthma occurs.

Many patients and parents are unsure when they should contact their doctor or seek emergency care for their child when asthma symptoms flare. I typically advise families to administer albuterol, a rescue inhaler, providing 2-4 puffs. If symptoms are unresolved or not improving after 20 min, albuterol can be administered again. After that if symptoms are not improving/resolving, or if you cannot space the need for albuterol out to a minimum of 4 hours, emergency care should be sought. Additionally, it is important to recognize if your asthma is not under optimal control. If you or your child have asthma and are requiring albuterol more than twice a week (apart from exercise), are waking at night with asthma symptoms more than twice a month, or are requiring more than one course of oral steroids yearly, contact your doctor to discuss more optimal treatments for asthma control.

AHN Pediatrics • Fall 2021 • www.ahnpediatrics.org

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Breastfeeding

Breastfeeding: Answers and Support for Common Struggles Jennifer Yoon, RDN, LDN, IBCLC

Breastfeeding provides the best nutrition and protection for your baby. The benefits of breastfeeding for mother and baby include protection from infection and long-term health concerns including allergies, diabetes, and certain types of cancer.

Breastfeeding is low cost and environmentally friendly. Breastfeeding is natural! But breastfeeding does not always come naturally, and many moms experience challenges on their breastfeeding journey, especially in the early days. Here are some common breastfeeding challenges and how to handle them:

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AHN Pediatrics • Fall 2021 • www.ahnpediatrics.org

Sleepy feeder: Newborns are often sleepy and will choose sleep over feeding.

Your newborn may need to be woken every 2-3 hours to feed. Baby may also require rousing during the feed. Baby should be unclothed and uncovered for feeds – mom’s body provides adequate warmth. Baby may also require stimulation of cheek, chin, hands, feet, or ribs to stay awake for feeds.

Some parents will resort to applying a cool wash cloth. Getting baby away from mom’s warm body and possibly exposing the diaper area to air are also helpful for keeping baby awake and on task for a productive feeding.

Difficult or painful latch: The early days of feeding are a learning curve for mom and baby. Latching baby to the breast within the hour after delivery provides a great start for successful latching, but even babies who latch well initially can have trouble in the days that follow. To help baby latch successfully, watch for early hunger cues such as lip smacking, rooting, or chewing on fists. Begin feeds by placing baby on your chest skin to skin and return to this position intermittently if baby has difficulty latching. Baby should be

supported on a firm base, in close, belly to belly with mom. Baby should be positioned where his nose is lined up with mom’s nipple so the chin comes in first to achieve a deep comfortable latch. Enlist the help of your partner or other caregivers to help you achieve a good position- a bird’s eye view can be helpful. Finally, the breast should be supported to help newborns achieve and maintain a deep latch.

Is my baby getting enough?: Uncertainty about how much milk baby is drinking at the breast, whether baby is getting enough, or fear baby isn’t getting any milk at all is a common concern and often leads moms to reconsider breastfeeding.

For reassurance, watch for long sucks and listen for swallows. In a typical feed, baby will swallow once for every long suck for the first few minutes, and then slow down to swallow once every 2-3 sucks for the duration of the feed- typically around 20-30 minutes total but this can vary. Look for signs your baby is satisfied after the feedbaby will be relaxed and restful, hands will be relaxed. Look for an increasing number of wet and poopy diapers, and poop that is

changing from black and tarry to green or brown, then to yellow.

Cluster Feeding: Common in newborns, Cluster feeding is a block of time when baby is fussy and demanding to be fed very frequently, is consoled while feeding, and can not otherwise be calmed.

The reason babies cluster feed is not fully understood, but thought to be a combination of normal feeding and developmental needs. Cluster feeding is emotionally and physically exhausting and leaves many moms questioning whether their breast milk is enough for baby. For reassurance your baby is getting enough nutrition, listen for swallows during the feeding, monitor for adequate wet and poopy diapers, and consider whether baby is feeding at least 8 times a day in a 24 hour period. To manage during cluster feeding sessions, enlist the help of other caregivers to comfort baby – swaddling, shushing, rocking, swaying – and rest as you have opportunities. Change positions often and use a breastfeeding pillow to reduce fatigue. Keep food and water close by. Use calming music, diffuse essential oils, and dim lights to create a calm atmosphere.

Deep Latch Technique From The Pump Station & NurturyTM

Images used with permission of Fit Pregnanacy magazine 2001

AHN Pediatrics • Fall 2021 • www.ahnpediatrics.org

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Breastfeeding

My Milk Isn’t In Yet!: Colostrum is present in small amounts for baby’s first few days of life and provides the perfect nutrition for your baby. Colostrum provides important antibodies, coats baby’s stomach and intestines to help release meconium, and prepare for the milk that is to come. Mother’s milk generally starts to come in on baby’s third or forth day of life. Sometimes, the transition from colostrum to milk can happen more gradually over 10-14 days. The best way to hasten the milk supply is feed baby often and on demand. Time spent skin to skin with baby also helps increase of oxytocin which triggers the milk supply. Rest and self care is important to reduce stress hormones that can work against milk supply and let down. Hydrate well and eat nutritious foods that can contribute to a healthy milk supply such as oats, flax, nuts, and seeds, carrots, spinach, and fennel.

Engorgement The milk is in!: And suddenly the breasts are full, firm, and perhaps painful. Very full breasts can also make latching a challenge for the baby.

This fullness and discomfort is partially from the sudden supply of milk, but also from the collection of blood vessels and tissue springing to action. Warm compresses or warm shower prior to feed can help soften tissue and relieve pressure before a feed.

Reverse pressure softening is a massage

Education and support: We offer a variety of support services for breast-feeding moms, including: > Breast-feeding classes: Moms-to-be and new moms can participate in classes led by lactation consultants. Learn more about our pregnancy and childbirth classes. > Phone consultations: Lactation consultants from West Penn Hospital

are available to answer your questions. Please call (412) 578-7030.

If we miss you, please leave a message and we will return the call as soon as possible. > Support groups: West Penn Hospital lactation consultants host free

weekly support groups for breastfeeding moms. For more information or to register call (412) 578-7030.

technique that can reduce pressure and alleviate discomfort (see video here https://youtu.be/3ULnIUeHAIM). Supporting, or sandwiching, the breast in a U Hold can help baby latch to a full breast- like taking a bite of a big hamburger. Cool compresses after the feed can calm the tissue and relieve discomfort. Hand expression, the use of a haaka, or very brief use of a manual or electric pump can be helpful in alleviating pressure but should be used with caution as your body may respond by making more milk than your baby needs, resulting in prolonging engorgement and causing an over supply.

Nipple Pain: Frequent feedings in the first days of life, especially before the milk comes in, inevitably leads to sore nipples.

Normal nipple pain generally peaks in the first few days of breastfeeding, healing completely in the first couple of weeks, and is most prominent during the first minute of the feed until the milk starts to flow. Help for sore nipple includes applying warm compresses, breast milk, or nipple cream or oil after each feed. Allowing the breast

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AHN Pediatrics • Fall 2021 • www.ahnpediatrics.org

to be exposed to air a few times a day or using nipple shells in the bra to reduce friction can be helpful. Nipple soothing gel pads can also be worn to protect the nipple and promote healing. Ensure positioning and support of baby to achieve and maintain a deep latch. Use a finger to relieve the suction before unlatching baby. If nipple pain persists for longer than a week, lasts throughout or after feed, or is not bearable, it should be evaluated.

There are many more questions and concerns that can arise in the early days of breastfeeding and beyond. At AHN Pediatrics, your baby’s healthcare team is here to help. Board Certified Lactation Consultants place phone calls to families of babies born and AHN facilities and choosing AHN doctors within 48 hours of discharge, when many of these feeding questions and concerns arise. The Breastfeeding Support Line is available to all of our families throughout their breastfeeding journey. For families who may need more help, video or in person visit are available at many of our AHN Pediatric Sites.

AHN Pediatrics Breastfeeding Support Line (412) 325-5616

Board Certified Lactation Consultants are just a phone call away

Breastfeeding check-ins within 48 hours of going home with your baby

Phone consults for questions or concerns

Virtual or in person lactation support

Breastfeeding offers the best nutrition and protection for your baby, but there are many challenges that can arise in the early days of feeding your newborn and beyond.

At AHN Pediatrics, we are dedicated to supporting families throughout their feeding journey to navigate the challenges and find the feeding methods that fit the needs of the baby and family.

Offering extensive knowledge and training to support our mothers in their breastfeeding journey Our IBCLCs offer telephone support, virtual Telehealth visits, or in-person consultations for those patients who need additional support IBCLC providers are conveniently located throughout our Greater Pittsburgh Locations: Allegheny Jefferson

Chartiers Cranberry

McMurray McKnight

Upper St Clair Seven Fields

AHN Pediatrics • Fall 2021 • www.ahnpediatrics.org

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Fire Safety

The 3 P’s of Fire Safety

by Mike Talotta, PA-C, AHN Pediatrics Allegheny

As summer winds down and we move towards winter, don’t forget the importance of fire safety. While house fires can occur at any time throughout the year, they are more common during the cooler months. Fireplaces, furnaces, electric blankets, and candles are just a few of the reasons that the rate of house fires increase in the winter. As a parent, how can you protect your family? The 3 P’s of Fire Safety are a good start!

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AHN Pediatrics • Fall 2021 • www.ahnpediatrics.org

1. Prepare: No one ever plans for their house to catch on fire, but you should be prepared for the unexpected. Consider these ideas when preparing your family for an emergency: > Make sure that you have working smoke and carbon monoxide detectors and that you change the batteries regularly. > Test your smoke detectors monthly and make sure that everyone in the house knows what to do when they alarm. > Develop an emergency plan with a designated meeting spot in the event of an emergency (for example, a neighbor’s porch, a mailbox, or a street sign). Make sure that everyone knows how to get out of the house and where to meet in case you are separated. > Consider buying emergency escape ladders for rooms with high windows. > Discuss how to recognize an emergency with your children. > Make sure that your children know how to access and use a phone and how to call 911. > Educate babysitters and neighbors about your emergency plans and meeting spot.

2. Prevent: It is important to think ahead about how to avoid a fire in your house. To reduce the risk of a fire in your home: > Have your furnace and fireplaces inspected and maintenanced regularly. > Store matches and lighters out of reach of children. > Move anything flammable away from space heaters, fireplaces, or other heating equipment. > Turn off electric blankets and space heaters when leaving the room. > Never leave food unattended while cooking. > Never leave candles unattended, and use caution or avoid use around pets and small children.

3. Practice: Just like any skill, it is easy to forget! Practice your emergency plan twice per year! This will help remind everyone what the smoke alarm sounds like, how to evacuate the house, and remind everyone where the emergency meeting place is. Practice closing doors behind you as you leave the building as this can help contain the fire and slow its spread. Practice simulating smoky conditions and crouch or crawl out of the building. Do not underestimate how important this step is!

Preparation, prevention, and practice are important and may one day save a life. Engaging your children will help prevent fires, but will also ensure everyone is prepared in the event that it happens in your own home. Do you want more information about fire safety? Contact your local fire department for more information about how to keep your family safe.

AHN Pediatrics • Fall 2021 • www.ahnpediatrics.org

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College Days

College Advisor: “They’re Fine”

By: Ned Ketyer, MD

By Ned Ketyer, MD Originally posted at www.thePediaBlog.com on December 12, 2019

As a residential faculty advisor living in a freshman dorm at a major university, Leslie Zacks has As aseat residential faculty200 advisor don’t hang out with us a lot because They painted something.

If they joined ront row watching new freshmen flor around adorably2.every fall.”

The Zacks family is living in a freshman dorm at a major unithey are incredibly busy and focused something, they probably also painted reated well enough by the “semi-interested” first-year students.

Zacks 1.

versity, Leslie Zacks has “a front row seat people, and that’s how I know they something. Don’t panic. This (usually) watching 200 new freshmen flor around are totally fine. vandalism or rebellion. Most They are nice to our teenaged kids and chatty with us whenisn’t they’ve had enough sleep. The adorably every fall.” The Zacks family is universities have a rock or a wall or gratefully devour the freshly Zacks baked we that occasionally leave the common treated well enough by the “semi-interestrelayscookies 8 other indicators your some otherin semi-permanent structureroom lik they’ve ed” first-yearnever students. tasted sugar. college freshman is perfectly fine: that gets painted by spirited groups > They are nice to our teenaged kids 1. They joined something. Anything. It on campus […]

They go totally bonkers, drop down on all fours and speak in tongues every time they and chatty with us when they’ve had seriously doesn’t matter what it is. Usuenough sleep.

They dog. gratefullyBut devour ally it’s an a capella group.

Couldus be ana lot because 3. They quit something.

Maybe it’s meat. encounter our they don’t hang out with they are incredibly busy the freshly baked cookies we occainterpretive dance company, or a fringe Or an instrument. Or a hometown honey. focused people, and that’s howpolitical I know they are totally fine. sionally leave in the common room committee. Maybe it’s a sorority.

They showed up with something that like they’ve never tasted sugar.

Their choice might surprise you. Personwas seriously woven into the fabric of relays 8 other indicators that your college freshman is perfectly fine: ally, I might draw the line at improve, but their personalities for as long as they > They go totally bonkers, drop down on guess what – parents don’t get to weigh can remember and then they woke up They joined something. Anything.

It seriously doesn’t matter what it is. Usually it’s an all fours and speak in tongues every in. Whatever it is be happy. They found one day, got distracted, and, without capella group. betheyan interpretive dance oreven a fringe political committee.

M time they encounterCould our dog. But their people and they are notcompany, alone. deciding, dropped that thing like a

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AHN Pediatrics • Fall 2021 • www.ahnpediatrics.org

French fry on the floor of the dining hall and never looked back. Whatever it is might still be important to you, but it isn’t to them. At least not right now. As long as that thing isn’t critical to their health and well-being, who cares. Don’t worry about it.

6. T hey are studying something. Anything. It seriously doesn’t matter […]

As long as they are upholding their end of the tuition bargain and earning those credits like the little achievers you raised them to be, it’s fine. It’s all leading somewhere. I promise.

4. T hey changed something. Their name, wardrobe, gender identity, favorite band.

It’s all good. It’s all normal. It’s all fine.

They are experimenting and changing their minds. Be grateful that they have minds that are capable of change. […]

7. They planned something. And it doesn’t involve coming home. <sob> Probably spring break somewhere warm with friends. Or maybe a summer internship. They’re clearly on the trail of something amazing […]

5. They did NOT tattoo or pierce something. Strictly speaking, neither of these are real cause for concern either […]

8. T hey started doing something. Something adults do. They’re doing laundry, holding the elevator door for others and

emptying their trash cans regularly.

Maybe they’ve started responding to your texts promptly, making their own doctors appointments and perhaps even keeping them.They are calling their grandmothers unprompted and saying good morning to the actual adults in the hallways. The most evolved, true heros among them might see me struggling with bags of groceries on my way in and offer to help.

These are all things that fully formed, good people do. They are becoming members of a community and caring for each other and themselves.

Parents of college students may find themselves reassured after reading the rest of this terrific essay by Leslie Zacks here.

Find us in Erie!

Erie West Side Health + Wellness Pavilion

Erie East Side Health + Wellness Pavilion

4247 W Ridge Rd, Suite 105 Erie, PA 16506 Phone: (814) 833-3002 Fax: (814) 835-2587 Dr. Susan Moore Dr. Anne Zomcik

4950 Buffalo Rd Erie, PA 16510 AHN Pediatrics Erie Dermatology 3822 Colonial Ave Erie, PA 16506

Phone: (814) 897-2597 Fax: (814) 899-0334 Dr. Marjorie Cua Dr. Anuja Sabapathy

Phone: (814) 616-0322 Fax: (814) 528-5643 Dr. Wendy Ripple

AHN Pediatrics • Fall 2021 • www.ahnpediatrics.org

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MyChart

Now that Pediatric Alliance is part of Allegheny Health Network, we’re moving from Patient Portal to MyChart.

MyChart is a secure online platform that gives you a quick and easy way to connect with our office: • Book appointments • View test results • Communicate with our care team • Request prescription refills • Review your child’s health history • Pay bills and view statements

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Follow these steps to register for MyChart now: 1. Visit mychart.ahn.org and click “Sign Up Now.” 2. O n the next screen, under “No activation code?” click “Sign Up Online” and follow the onscreen prompts.

3. Once you’re logged in, click “Profile” in the top right and then “My Family Access.”

4. Based on your child’s age, follow the instructions to get proxy access.

AHN Pediatrics • Fall 2021 • www.ahnpediatrics.org