A View from The Treehouse - Treehouse Pediatrics Newsletter

Thank you for all the positive comments regarding our walk-in and late night clinics! We know this has worked well for everyone, and we’ve decided to continue with extended hours throughout the spring/summer.

Walk-in clinic is available 8:00a.m. – 10:00a.m. Monday-Friday

Sick appointments can be scheduled thru 5:45 p.m. Monday-Thursday

Reminder, the Saturday Sick Clinic still requires an appointment if you need to be seen.

We are excited to announce our next step in the endeavor to go green! Our website is being enhanced with a patient portal that will allow secure messaging back and forth. This will:

Reduce paperwork - “user friendly” online data entry!

Pre-registration, insurance/demographic changes

Completion of health forms and patient questionnaires

Manage and print Personal Health Records

Communicate with a nurse

Secure patient messaging – lab/test results

Prescription refill requests

On-line bill pay and budget payment plans


On March 5, 2009 the Executive Commissioner on Health & Human Services approved several revision to the requirements for children in Texas Public and Private Schools.
Hepatitis A Vaccine: Beginning August 1, 2009, all students entering kindergarten, will be required to have 2 doses of Hepatitis A vaccine.
Measles, Mumps, Rubella (MMR) Vaccine: Beginning August 1, 2009 all students entering kindergarten will be required to have two doses of measles, mumps, and rubella (MMR) vaccine.
Varicella Vaccine: Beginning August 1, 2009 all students entering kindergarten and 7th grade will be required to have 2 doses of varicella vaccine. (A written statement attesting to a child’s positive history of chickenpox is acceptable in lieu of either dose of vaccine.)
Tetanus, Diphtheria and acellular pertussis-containing vaccine (Tdap): Beginning August 1, 2009, all students entering the seventh grade will be required to have one dose of Tdap vaccine. Students in the seventh grade will be required to have a booster dose of Tdap only if it has been five years since their last dose of a tetanus-containing vaccine. Students in grades 8-12 are required to have a booster dose of Tdap if it has been ten years since their previous dose of a tetanus-containing vaccine.
Meningococcal Vaccine: Beginning August 1, 2009, all students entering 7th grade will be required to have one dose of meningococcal vaccine.
Question - What does this mean to our Treehouse patients?
Answer - Effective August 1, 2009, Kindergarten and 7th grade entries will be required to be immunized. Then the upcoming years will begin to phase in. For example by the school year 2014-15 – Menactra /Tdap / will be required for all students in grades 7-12.
Parents - Treehouse has been offering the Hep A series to all older kids and now give it routinely at ages 12 months and 18 months. We have also been encouraging all older kids to get their 2nd Varicella vaccine and routinely give the Menactra and Tdap at the 11 year well checks. If in doubt, call and we’ll check to see that everyone’s up-to-date.

Who is the newest “bully” on the block?

The days of getting your lunch money stolen or your house “TP’d” are gone. In today’s techno-savvy world, children are being bullied in new and inventive ways – through the Internet.

According to the National Crime Prevention Council, cyberbullying is the use of the Internet, cell phones, or other communication devices to send or post text or images intended to hurt or embarrass another person. The prevalence of cyberbullying is difficult to determine; however, an estimated 9% to 34% of adolescents are victims of bullying, and 4% to 21% of adolescents are perpetrators.

A study of 177 seventh graders found that approximately 60% of cybervictims are females, while over 52% of cyberbullies are males. The use of technology has increased drastically in the past few years, yet many adults -- parents, teachers, and healthcare providers -- remain unaware that youths are being harassed by their peers through technological devices.

Cyberbullies typically hide behind the mask of anonymity afforded them by the Internet by using fictitious screen names. Because they lack face-to-face contact with their victims, they may not be aware of the trauma they cause, and they are thus unlikely to feel sympathy, regret, or compassion toward their victims. Cyberbullies are often difficult to trace, reducing their fear of getting caught and being punished, and helping them avoid the consequences of their actions.

Methods of Cyberbullying

According to the National Crime Prevention Council and Cyberbullying.org, bullying techniques are as inventive as they are cruel:

	Pretending they are other people online to trick victims;
	Sending cruel, vicious, and sometimes threatening messages via texting, instant messaging, or emails;
	Creating Web sites that have stories, cartoons, pictures, and jokes ridiculing others;
	Posting pictures of classmates online and asking students to rate them, with questions such as, "Who is the biggest ___ (add a derogatory term)?";
	Posting unflattering photos of peers on the Web;
	Taking a picture of a person in the locker room using a digital phone camera and sending that picture to others;
	Altering pornographic photos by adding a peer's face to the image and sending it to porn sites or posting it in a blog;
	Breaking into an e-mail account and sending vicious or embarrassing material to others;
	Engaging someone in instant messaging, then tricking that person into revealing sensitive personal information and forwarding that information to others; and
	Criticizing or defaming teachers and administrators on the Web.

Cyberbullies also use "bash boards." Bash boards are online bulletin boards or chat rooms where youths can anonymously write whatever they want, true or false, creating or adding mean-spirited postings for the world to see. The nature of today's technology makes it possible for cyberbullying to occur more secretly, to spread more rapidly, and to be preserved more easily.

There are several conditions that foster cyberbullying: (1) the Internet serves as a mechanism for self-disclosure, where teens post everything from sexual experiences to suicidal ideation, and the more outlandish a post is, the more attention it receives -- typically the goal of posting in the first place; (2) cyberbullies claim they are exerting their rights to freedom of speech; (3) the "disinhibition" that arises from anonymity and invisibility afforded by the Internet; and (4) social norms support cyberbullying with the belief that "everybody does it."

The Effects of Cyberbullying

Cyberbullying may be more harmful than traditional bullying because there seems to be no escape. The bullying can take place any time of day or night and anywhere the child has a communication device — even the child's bedroom, which should be a place of safety. Hurtful material may be posted globally and become irretrievable. Unlike victims of school-yard bullying, victims of cyberbullying may not know the identity of the bully, creating frustration, fear, and feelings of helplessness.

Victims of cyberbullying suffer the same effects as those who are victimized by traditional bullying. Victims may exhibit signs of depression (such as lack of interest in school or pleasurable activities, changes in sleep and eating patterns, depressed mood, and withdrawal), develop school phobias, complain about somatic symptoms such as headaches and abdominal pain, or demonstrate aggressive behaviors. Victims of cyberbullying may not tell their parents about the problem due to their fear of losing their technical devices; they may simply suffer in silence.

What, as parents, can you do to help protect your child?

	Develop awareness of the various types of communications tools used by your children. In addition to their (and your) cell phone, do they use their friends’ phones? Their computers?
	Empower your child to handle cyberbullies. Because bully motives vary, there isn't a single way to deal with all cyberbullies. However, you can encourage your child to delete unwanted or unidentifiable emails without reading them, not respond to instant messages or text messages from bullies, and report the problem to you and their teachers.
	Foster strong self-esteem and social skills to better enable your children to ward off the effects of cyberbullying.
	Stay informed: know what your children are doing and with whom they are communicating. Parents need to talk with their children and keep the lines of communication open so that your children will feel comfortable telling you if they are experiencing cyberbullying. Parents should also keep the child's computer in a visible location. It may also be helpful to keep cell phones out of bedrooms at night (something that may also improve sleep patterns by reducing midnight text-messaging, bully-related or not.)
	If your child is a victim of cyberbullying, keep a log of the malicious activity. If your child is intentionally harmed by a peer, a written log may help in tracking down the offender. Threats and stalking behaviors may also warrant criminal action. Should threats be made to the child or personal information be posted on the Internet, parents should take immediate action and contact law enforcement.
	Realize that cyberbullying often becomes a 2-way street. Discourage your children from retaliating by becoming bullies themselves.

For more information, please see:

www.cyberbulling.org

National Crime Prevention Council

This article was adapted from the following:
Muscari, M. (2008). How Can I Help Teens Who Are Victims of Cyberbulling? © 2008 Medscape.

The American Academy of Pediatrics invites children to enter its 2009 National Art Contest with a chance to win a trip to Washington, DC. The contest is open to boys and girls in three groups, grades 3-5, 6-8 and 9-12, and the theme is "Protecting Children from Tobacco Smoke.”

“There are still far too many young people who smoke and many pick up this deadly habit while they are at school,” warns AAP President David Tayloe, Jr, MD, FAAP. “This is an opportunity for children to exercise their creative side to alert other children – and parents - to the dangers of tobacco and second-hand smoke.” Rules, official entry forms and consent forms must accompany all entries and are available online at http://aap.org/artcontest/



Liz McAtee, Heather Gage, and Stephanie Copes are the “cheerful” front office greeters, both in-person and on the phone. How do they manage to remember everyone’s name?
	Sandi Roughton is the friendly face you see at checkout and the “voice” behind the appointment reminder calls.
Maryann Morrison ensures that insurance is verified and everything’s ready before the upcoming visits. Way to go!
	Summer Looney helps with charge entry; follows up with insurance and patient collections to keep us up-to-date. Brooke McConathy enters daily charges, patient and insurance payments. *What would we do without them?*
	Need a referral, ask Jessica Riley. She’s the one that contacts the insurance companies and works closely with parents and specialist. *It’s all about the kids, right?*
Cassie Barnett is currently working part-time and helps out whenever and wherever we need her. You’ll often find her at the front desk, answering phones, checking patients out or recently helping the billing staff. *Thanks for being there for us!*

It's Spring! by Linda Glaser

A child observes the arrival of spring and its effects on plants and animals. Includes suggestions for nature study projects

My Spring Robin by Anne Rockwell, Harlow Rockwell (Illustrator)

Before finding the robin she is searching for, a child discovers other interesting fauna and flora in her backyard. Before she finds "my spring robin," she encounters a variety of signs of the new season in her backyard: a toad and an earthworm; crocus, forsythia, magnolia, violets, and daffodils blooming; and fiddlehead ferns emerging.

An Egg is Quiet by Diana Aston, Sylvia Long (Illustrator)

At this time of year, when children think of eggs, they tend to think of Easter eggs. This is a fascinating look at different kinds of eggs found in nature. In addition to being a children's picture book, the book is also a children's science book. An Egg is Quiet provides an introduction to eggs of all kinds, from a variety of birds’ eggs to a fossilized dinosaur egg, from a hummingbird’s tiny egg to an eight-pound ostrich egg. This book will interest the whole family.

Don't forget to send an e-mail to info@treehousepedi.com and let us know how we're doing, what you'd like to find on our website, or even read about in future newsletters.