Well Child Visits


We value well child checks as we feel that preventive medicine is the best medicine.  Well-child visits are times when you can express any concerns that you may have as well as learn about your child’s development, health, sleep, and growth.  After three years of age, we recommend that children be seen yearly, even if they are healthy.  Please see our recommended well child check schedule.

Make the most of these visits by writing down important questions and concerns to bring with you.

After your baby is born, Dr. Garriga will want to see you in the office within 2-3 days of discharge.  This visit is to see how you are doing and to make sure your baby is growing appropriately.  After the first visit, Dr. Garriga will tell you if another visit is needed before the one month check up.  After that, visits should occur at the following ages:

1 month            Hepatits B
2 months          {Dtap, HiB, Polio}, Prevnar, Rotateq
4 months          {Dtap, HiB, Polio}, Prevnar Rotateq
6 months          {Dtap, HiB, Polio}, Prevnar, Rotateq, Hepatits B
9 months          no vaccines
12 months        MMR, Varicella, Prevnar, Hepatitis A
15 months        {Dtap, HiB, Polio}
18 months        Hepatitis A
2 years
2 ½ years
3 years
4 years              {Dtap, Polio}, MMR, Varicella
Yearly after that
11 years            Tdap, Menactra, HPV
{   } indicates combined vaccines and one injection

Developmental Consultations

Dr. Garriga has a specialty in developmental and behavioral pediatrics.  She sees children who are struggling in any of a variety of areas including academically, socially, or behaviorally.  When you call the office for a consultation, you will be sent questionnaires for you and your child’s teachers to fill out.  You will also be asked for any pertinent information to be forwarded to the office before an appointment can be made.  Dr. Garriga will read over all of your information and her staff members will call you to make an appointment.  The appointments are generally 1 ½ to 2 hours long and during that time Dr. Garriga will speak with you and your child.  She may recommend further testing at that point, or she may have a diagnosis to offer you.  Either way, she will work with you to decide a reasonable course of action to ensure the success of your child.

Sick Child Visits

The following information is a set of guidelines to help you with decision-making regarding your ill child. Please do not hesitate to contact us or to seek medical attention if after reading the information below, you are still uncertain of  what to do, or if your gut instinct is telling you that your child is not OK.

Fever: Fever is an elevation of the body temperature caused by our immune system to help our bodies fight infections. Fever can help us get better faster. The height of the fever tells us very little about the seriousness of the illness. Many viruses can cause fevers over 104. When children have a fever, they breathe rapidly and may be fussy and tired. In general, how sick your child looks is much more important than the actual temperature.

What you can do: Children under two months of age: In infants under two months old, any fever is concerning, and you should go to the emergency room. Normal temperature in babies is up to 100.3 rectally, and a fever is any rectal temperature of 100.4 or more. All infants should have their temperature taken rectally only. Other methods are not accurate. Make sure that your baby is not overdressed, as this will sometimes raise their temperature. Do not give fever-reducers (i.e. Tylenol) to children under 2 months of age. Other concerning signs of infection in infants under 2 months of age include lethargy/sleepiness (i.e. you are unable to wake the baby for 2 feedings in a row) and irritability (i.e. you are unable to console your baby despite a variety of attempts).

Children two months of age or older: If your child has a fever but does not have any of the symptoms listed below, then it is probably better to leave the fever alone. You may give Tylenol (or Motrin if your child is over 6 months of age) if he or she is in pain or is miserable from the fever. These medications may not reduce the fever completely but will provide some relief from the discomfort.

NOTE: NEVER USE ASPIRIN IN CHILDREN UNDER 18 YEARS!!!

Croup

Croup is an infection that results in noisy breathing in and a cough that sounds just like the bark of a seal. Croup occurs mostly during the night in children under six years of age. Most children are normal during the day and at bedtime except for a mild cold and possibly a hoarse voice. They awaken suddenly during the night with very noisy breathing and a painful cough. After the croup resolves, your child may have cold symptoms for several days to a week.

What you can do

Keep your child calm
Go out into the cool night air for 5 to 10 minutes to help breathing.If this is not possible, steam up the bathroom or the shower. If he or she is having a very difficult time, take a drive in the car with the windows down towards the nearest emergency room (dress appropriately). IF THERE IS NO IMPROVEMENT, GO INTO THE EMERGENCY ROOM. After you have settled your child down, keep the room cool and humid (a humidifier will help) and avoid cold medicines.

Call if:
Your child has trouble breathing even after being outside.

Go to the Emergency Room If:
The croup is severe and you cannot control the symptoms.
Your child is sitting up while leaning forward, drooling, has his or her chin jutting out, and looks quiet.  This may be a very rare condition called epiglottitis, which is an extreme emergency.

About Antibiotics:
We get many questions about prescribing oral antibiotics over the phone. It is against the office policy to do so. Dr. Garriga feels that prescribing antibiotics over the phone without examining your child is poor medical practice. Many illnesses are caused by viruses, and antibiotics have no effect on such illnesses. There is also the possibility of allergy and side effects with any antibiotic use.  Furthermore, your child may have an illness that is more serious than you suspect and giving an oral antibiotic may not be adequate treatment. Giving an antibiotic from a previous illness or from someone else’s prescription may mask serious symptoms and signs and can affect test results.

 

 

Newborn Care

After the birth of your child, the hospital will inform Dr. Garriga there is a new baby that needs to be seen. Below are some things to know/remember about newborns.

 

1.
Feeding

Babies feed very irregularly in the first few days. They may not easily waken for feedings for the first two days.  You need to wake your baby to offer to feed her at least five hours by unwrapping her blanket, sponge-bathing her, or changing her diaper. If your baby refuses feeding or falls asleep while feeding, try undressing her and stimulating her to wake. If she still refuses, this is OK. Try again in another hour or two. As long as your baby is otherwise healthy and is urinating at least once in the first 24 hours and twice in the second 24 hours, do not worry.  Also, try to feed more often in the day, so that your baby gets used to awakening more during the day.

After the first three days, she should be feeding vigorously at least every three to four hours and urinating four to five times per day.  If this is not occurring, call the office. Feed your baby on demand, which may mean that she eats as frequently as every hour. 

2.
Nursing

Breastfed babies will tend to feed more frequently. Alternate the breast with which you start nursing and burp the baby between breasts. Initially nurse for five to twenty minutes per breast. Gradually increase feeding time to ten to fifteen minutes per breast. Be sure that the baby’s gums are behind the nipple on the areola (the dark skin around the nipple).

Unless there is a medical reason, there is no need to supplement with formula.  Babies who receive frequent bottles in the first two weeks often start refusing the breast. If you are having any nursing problems, Dr. Garriga can help you with lactation assistance. 

3.
Stools

Babies usually stool at least once in the first 24 hours. Initially, the stools will be thick, sticky, and almost black; this is called meconium. Over the next few days, the stools will change color to light green, yellow, or orange.  They may be soft, mushy, liquid, or seedy.  This is all normal.  Bottle-fed babies may initially have two to seven stools per day. Breastfed babies may have a stool after each feeding (up to twelve or more per day). Between one and two months of age, many breastfed babies start stooling much less frequently, sometimes as infrequently as every seven days.  If she is not bloated or uncomfortable and the stools are not formed, this is normal.
For any further questions regarding your newborn, please call the office during normal office hours.

For any further questions regarding your newborn, please call the office during normal office hours.