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Why Well Child Checks are Important

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From infancy through the teen years, well child visits are important to make sure your child is in overall good health. In the first year, the American Academy of Pediatrics recommends 7 well-child checks; these get less frequent as your child gets older, and for kids 3 years old and up, are just once a year. These visits offer many vital benefits:

  • Tracking your child’s growth (weight, height and for infants, head circumference)
  • Checking development in terms of language, motor skills, social development, and in older kids, pubertal changes. School progress is also covered. Identifying delays means earlier helpful intervention.
  • Talking about nutrition, sleep, stooling, and urination
  • Discussing mental and emotional health
  • Supporting you as you navigate raising your child. Your provider will provide ‘anticipatory guidance’ about upcoming stages and issues such as discipline, behavior, etc.
  • Reviewing and discussing in detail any vaccines needed to protect your child
  • Providing information on important safety issues relevant for your child’s age
  • Completing sports PE paperwork if needed for your child to participate
  • Following up on any chronic health issues
  • Giving your teen some confidential one-on-one time with the provider, helping them form a trusting relationship. This can empower your child to share concerns with the provider as they get older.

You know your child best and are a vital part of the ‘pediatric team’- you, your child, and your provider. Well child visits are your opportunity to share any concerns you might have. Referrals to specialists can be made if further investigation or therapy is indicated. If your child has special needs and sees specialists frequently, well child checks are still important to look at their health holistically.

Even if your child is young, you can help make the visits go smoothly. Talk to them about who they will see at the visit, including the medical assistant/nurse and provider. Explain that they will have their growth and blood pressure checked with a snug cuff on their arm. They may be asked to change into a medical gown and sit on the exam table. The provider will then do the physical exam, explaining what they are doing as they proceed. You can pretend ‘going to the doctor’ at home beforehand, especially made fun and easy if your child has a toy doctor kit.

As a parent, you can prepare for the well child visit by having a list of any health concerns or questions ready. Make sure any relevant paperwork (for example, school evaluations) have been sent to the office or bring them with you. The American Academy of Pediatrics website has a Well Visit planner to help make the most of these important check-ups (see below).

Resource:  www.wellvisitplanner.org

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Seasonal Affective Disorder in Kids

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The dark and grey days of winter can affect anyone’s mood. If the down feelings are frequent and last more than 2 weeks, this may be Seasonal Affective Disorder (SAD), a type of depression related to the shorter and darker days of fall and winter. While most common in teens and adults, SAD may also occur in children.

Decreased sunlight can cause the brain to make less of the chemical serotonin which helps to regulate mood. The increased darkness can result in excessive production by the brain of melatonin which helps to regulate sleep.  The result is feeling down, sluggish, and tired. Sleep problems may occur, including difficulty falling and staying asleep. This can then result in trouble waking up and oversleeping.

Mood changes such as irritability, negative thinking, and a lack of interest in what used to give pleasure are common with SAD. There may also be less interest in friends, socializing, and going out in general. Decreased appetite or changes in eating patterns are not unusual. If SAD is severe, there can be a deeper depression with thoughts of self-harm.

The ideal treatment for SAD is sunshine and more daylight, which is why it resolves in spring and summer. Until then, getting adequate exercise, especially outside (even in suboptimal weather) is helpful. If there are sunny days, encourage your kiddo to get out and enjoy it- better yet, go out together even if you have to bundle up due to cold temperatures.

 It is important to follow a regular schedule for sleep, which means no naps and no screen activities for the hour before bed. Even on the weekend, limit ‘sleeping in’ to no more than an extra hour or two because it can throw off the sleep schedule. If your child is struggling due to SAD, listen to how they are feeling, show support, and brainstorm together things that night help.

A UV light box (also called a sun lamp) is often recommended for SAD as it mimics natural sunlight and gives the brain better cues for healthy serotonin and melatonin production. Studies show that light boxes are effective if they provide 10,000 lux (‘light power’) and are used for at least 30 minutes each morning.  They are considered safe though it is important not to look directly at the light.  Check with your child’s provider to make sure light therapy is appropriate for your kiddo.

If symptoms are not improving despite the above suggestions, or last into spring and summer, your child’s provider should be consulted. If at any time your child has severe depression or thoughts of self-harm, seek care immediately.

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Why Volunteering is Important for Your Child

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Encouraging your child to volunteer is a great way to help them think of others. Depending on the activity, kids as young as 2 years old can be involved, and starting young helps instill a service attitude that your child will carry forward throughout their life. The benefits of volunteering are many, not only to those receiving help or support, but for your child and your family.

  • Volunteering teaches caring, empathy, and selflessness. It raises awareness of those who are in need and teaches that even small acts of compassion are valuable.
  • Helping others increases self-esteem, as your child realizes their ability to make a difference on a personal level.
  • School performance and attendance are improved in kids who volunteer according to multiple research studies.
  • Some volunteer opportunities may provide information about possible careers in medicine, politics, conservation, etc. and listing volunteer involvement is helpful on a resume or college application.
  • Physical and emotional well-being are increased by volunteering, as are social skills especially if the activity involves working as a team. Group activities provide the opportunity to meet people of different ages and backgrounds.
  • In the wake of a tragedy or natural disaster, having the opportunity to help, for example by having a food drive, makes kids feel less powerless and overwhelmed.
  • Volunteering as a family connects kids and parents with a common compassionate goal.

There are lots of ways children of all ages can volunteer. Your local chamber of commerce or downtown association typically has a calendar listing about volunteering opportunities. Food banks often need helpers as well as food donations. Schools and houses of worship are good sources for more options. Look online for organizations that send letters to veterans, deployed troops, first responders, etc.; they love to have cards and notes written by kids to distribute. Think (very) local and see if there is a neighbor who needs help with raking leaves or maybe would appreciate a visit from you and your child. As a reminder, younger children should always be accompanied by an adult for one-on-one situations.

Volunteering helps us feel capable and connected, and yet only 25% of Americans volunteer annually. Coming up is more incentive to get involved– Friday, December 5 is International Volunteer Day. Knowing the benefits, start early making volunteering part of your family’s ‘brand’. You may well inspire others to do the same and we will all be the better for it.

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Dr. Elise Herman

Blog Posts
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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Bee and Wasp Stings in Children

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Being outside in spring and summer is terrific, but it does come with the risk of bee and wasp stings. It is important to know how to treat stings, what to watch for, and even better, steps you can take to decrease your child’s risk of being stung.

Most bees and wasps can sting multiple times since they do not lose their stinger. Honeybees have a barbed stinger, which remains embedded in the skin so they can only sting once. The honeybee stinger looks like a small black dot in the area of the sting.

The immediate symptoms of a sting are pain and burning; itching may follow. The area becomes red and swollen and this may increase over the next 3 days. A sting on the face can cause severe swelling including around the eye.

If there is bee allergy, anaphylaxis may occur within 15-60 minutes. Anaphylaxis is a severe allergic reaction which may be life threatening and needs emergency treatment with epinephrine, available only by prescription. Signs and symptoms include wheezing, hives, respiratory distress, throat tightness, nausea and vomiting, and swelling of the lips and/or tongue. There may be paleness and fainting. An allergic reaction typically happens after one has had previous stings though can happen with the first sting. Bee allergy occurs in less than 1% of children.

Home care of bee/wasp stings:

  • If you see a stinger, try to remove it by scraping gently with a credit card or fingernail. Do not squeeze or pinch as this can release more venom. Wash with soap and water.
  • Apply a paste of meat tenderizer or baking soda for 20 minutes. Aluminum-based deodorant on the area is another option.
  •  Tylenol (acetaminophen) or Advil (ibuprofen) helps discomfort. Topical or oral Benadryl (do not use these together as it can cause oversedation) helps with itching. 1% hydrocortisone also decreases itching, is available without a prescription, and may be used 2-3 times a day.
  • Cool cloths or an ice pack can help relieve the pain.
  • Use an epinephrine product (injection or nasal spray) as directed if your child has a history of bee allergy

When to call your child’s provider:

  • If there is increasing redness and swelling after 3 days
  • If your child was stung in the mouth or eye
  • If the area of swelling is more than 4 inches across

When to go to the ER/ call 911:

  • If your child has known bee allergy and was stung, even if you treat with an epinephrine product (only available with a prescription)
  • If there are more than 5 stings per 10 pounds of body weight (or more than 50 stings in a teen)
  • If your child appears severely ill

How to help prevent bee/wasp stings:

  • Avoid scented lotions and perfumes
  • Avoid clothes with a floral print or floral colors
  • Have your child always wear shoes since some bees live in the ground
  • Keep food and drink covered; make sure there are no bees in open drink cans or on a straw

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

When is it OK for Kids to Have a Smartphone?

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Seemingly everyone has a smartphone, and kids are drawn to these at a very early age. Parents do their best to supervise and set appropriate boundaries for their kids around phones, but may wonder when it is OK for their child to have their own phone. Making this decision can seem daunting, especially as younger and younger kids seem to have a phone in their pocket. According to Common Sense Media/Research, 43% of kids age 8 to 12 and 88% to 95% of teens up to age 18 have their own smartphone. If you are the parent of a 10-year-old, the begging may have already started. The general recommendation has been “Wait Until 8th (the end of 8th grade)”, but many kids get phones earlier.

Parents often see the benefit of staying in touch as a reason to give their child a phone. Other positives include use in an emergency and socializing. As kids get older, phones can help them stay connected to their friends and communicate about school work, sports, and other activities.

There is no perfect age for a child to have a phone. It may depend on the child’s maturity and sense of responsibility as well as family values. Is the child impulsive? Do they generally respect rules and limits? Are they generally honest? Are they good about following the rules regarding other tech, such as a Chrome book use at school? ATT and the American Academy of Pediatrics have partnered on an online ‘quiz’ to assess a child’s readiness (see resources, below).

The potential negatives of cell phones include less time spent with family, less physical activity, and sleep disturbance. Phones offer access to social media which can increase the risk of depression and anxiety. There is the possibility of kids oversharing, experiencing cyberbullying, and being victimized. Phone addiction is a concern for users of all ages.

On-line pornography poses significant risk to kids and teens. The average child is exposed to pornography by age 12 years. Pornography often portrays physical and verbal aggression and sexual violence, usually directed towards women, including women being choked, slapped and spit upon during sexual activity. It is horrific to note that free porn sites carry videos of child rape and assault. Early exposure to pornography is related to anxiety, depression, and difficulty forming healthy intimate relationships later on.

So how to navigate this complicated situation? Communication is key. Have open discussions with your child regarding the pros and cons of a smartphone. Take the “phone readiness quiz” and review the results with your child. Parental controls restricting the amount of usage as well as access to social media and inappropriate sites are vital. Discuss where and when the phone can be used (not at meals, not during family social time, not after bedtime, etc.) Your child should understand your concerns and the importance of respecting these limits when using other devices, for example, the phone of a friend who may not have the same restrictions.

As the parent, you should have your child’s password, be able to track their usage, and maintain the right to take the phone away if rules are not being followed. Having your child contribute to the purchase of the phone or service plan financially or by doing extra chores teaches responsibility.
As a trial, many families opt for a flip phone (calls and texts only) for a year to assess their child’s readiness. If connection to your child is most important, a smart watch, iPad, or tablet is a good way to start without the complications and potential risks of a smartphone.

Resources

Wait unitl 8th: https://www.waituntil8th.org Parents can join together, pledging to avoid phones for kids in elementary and middle school.

Phone Ready Quiz: https://www.healthychildren.org/English/Pages/PhoneReadyQuiz.aspx

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Dog Safety for Children

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Most kids have a natural attraction to dogs, but we need to teach our children to be safe around them. Of the roughly 4.5 million dog bites annually in the US, the most common victims are kids, and their injuries tend to be more severe. In general, people are most likely to be bitten by a dog they know as opposed to a stray. Talk to your child about dog safety (starting when they are very young) and be a good role model when interacting with dogs. Basic dog safety includes:

  • Always be gentle. This applies to all animals and is a valuable lesson for our kids. Keep voices calm and reassuring as raised voices or screaming are understandably upsetting to dogs and may cause unpredictable actions. Praise your child when you see calm, kind behavior towards any animal. Practicing gentleness at home with a stuffed animal makes kids more confident when interacting with the real thing!
  • Never disturb a dog when sleeping, eating, or caring for puppies. No grabbing at dogs, touching eyes, pulling on ears or tail- even the most patient dog has limits. Stay away from the food bowl, treats, or special toys as any dog can become protective.
  • Never leave a young child (under age 5 years or so) alone with a dog.
  • When out and about, greet a dog’s owner first, and ask about the dog’s temperament and tolerance for children. You or your child can then ask for permission to pet the dog and after greeting the dog by name, can offer the top of a closed hand for a sniff. Stand to the side of the dog and pet gently on the back or side. Keep interactions brief. Commend your child for behaving kindly and gently.
  • If your child is fearful, do not force an interaction. From a comfortable distance, you and your child can chat about the dog, its size, cuteness, etc., to encourage positive feelings.
  • Any treats should be offered with a flat hand. Never tease a dog by offering a treat and then whisking it away.
  • Notice body language: A tucked tail, laid back ears, and a stiff stance may indicate fear. If a dog is trying to hide behind its owner, it is not ready to be social. A wagging tail often indicates friendliness but, in some dogs, may signal being on alert.  If you have concerns, you can say, “It looks like this doggy isn’t ready to meet new friends. Let’s give him some space.”
  • Stay away from strays. If approached by a stray, turn away, avoiding eye contact with arms crossed. Sometimes saying, “Go home!” emphatically will work. Do not scream or run away.

It is important to teach our kids to be kind to animals, and dog safety is particularly vital given the fact that about 65 million US households include at least one dog. So even if you are dogless, your child will undoubtedly have lots of opportunities to interact with them—and you can help those interactions to be positive and safe.

Resources:

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Measles in Children

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The rise in measles cases recently has many people, parents included, very concerned, and with good reason. Measles is a viral illness that can be very dangerous especially for infants, children under age 5 years, pregnant women, and those with immune system problems. As of 2/26/25, there have been 165 cases in 10 states, including Washington, and sadly one child has died. Although the number of infected people does not sound very high, measles is one of the most infectious viruses known, so numbers are likely to grow. Measles infects 90% of those exposed if they are not vaccinated.

Measles starts with a fever (as high as 104), runny nose, cough, and red watery eyes. These symptoms usually start 7-14 days after exposure though it can take as long as 21 days to show signs. Two- three days later, small white spots inside the cheeks (Koplik spots) may show up. The typical measles rash starts on the face at the hairline about 3-5 days after symptoms begin. This rash consists of red, usually flat, spots that spread head to toe and may join together. Fever may spike to 104 when the rash appears. Diarrhea can also occur.

Complications are common with measles, especially in infants, children under age 5 years, pregnant women, adults over age 20 and those who have immune system deficits. Ear infections occur in 1 out of 10 kids with measles and pneumonia happens in 5% of all people infected. Brain inflammation (encephalitis) afflicts 1 out of 1,000 infected children and can cause brain damage, deafness, seizures, and death.  Nearly 3 in 1,000 kids with measles die, most commonly due to pneumonia or encephalitis. Pregnant women are at increased risk of delivering early and having a low-birth-weight baby.

There is a very rare complication that can occur 7-10 years after measles infection called Subacute Sclerosing Panencephalitis (SSPE). It is a brain disorder related to the earlier measles for which there is no treatment and results in death within 3 years of diagnosis without exception.

The good news is that the measles vaccine (either as MMR [measles, mumps, and rubella vaccines] or MMRV (as above plus varicella [chickenpox] vaccine) is safe and effective. For kids it is a 2-dose series, given at ages 12-15 months and 4-6 years; adults who are unvaccinated may only need one dose. One dose of a measles vaccine is 93% effective at preventing infection, and 2 doses gives 97% protection. Common side effects include muscle soreness at the injection site, low grade fever, and a mild rash. Rarely there can be a brief harmless seizure due to fever, occurring in less than 8 kids per 10,000 vaccinated.

The Health and Human Services Secretary Robert F. Kennedy, Jr, issued a statement on March 3, 2025, with the subheading “MMR vaccine is crucial to avoiding potentially deadly disease” and then noted “Vaccines not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons.”

Earlier concerns about MMR vaccine and autism have been strongly disproved in multiple studies. The doctor who made those claims was found to have fabricated his ‘results’ and lost his medical license. Autism is often diagnosed at around the same age as when kids receive MMR vaccine, but the vaccine does not cause autism.

During a local measles outbreak, students who are unvaccinated are excluded from school for 21 days from the last measles rash identified in the community. If they are given the first dose of the MMR or MMRV series, they may return to school. If an unvaccinated child is exposed to measles, they should be immunized as soon as possible to decrease the risk of infection.

If you have questions about measles vaccination, contact your child’s health care provider. Measles is a very dangerous virus that is unfortunately also extremely contagious. Our best way of protecting our kids and our community is vaccination.

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Bad Breath in Children

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As a parent, you may occasionally wonder how your sweet child can have such bad breath, but bad breath in kids happens!

As opposed to just ‘morning breath’, chronic bad breath (“halitosis”) can have a variety of causes and occasionally can indicate a true medical problem. The most common reasons for halitosis in children include:

  • Poor dental habits: Without routine brushing and flossing, bacteria on the teeth increase, which can cause a filmy layer called plaque. Plaque can lead to cavities and gum inflammation, both of which can cause bad breath.
  • Dry mouth: This can result from not drinking enough water, sucking of thumbs or fingers, chronic nasal congestion, or chronic mouth breathing.  A dry mouth means saliva is not adequate to wash bacteria and food particles away.
  • Infection or disease: Viral or bacterial throat, tonsil, or sinus infections can cause bad breath. The bad breath should improve once the infection resolves. If your child has fruity breath, this is quite unusual and could indicate a serious problem like diabetes, though other signs like excessive thirst and urination would typically be present as well.
  • Allergies: Chronic nasal congestion or postnasal drip due to allergies can create bad breath.
  • Foreign body: If a bead, piece of tissue, or some other small foreign body is stuck up in the nose, a foul odor and nasal discharge from one side of the nose may develop.
  • Large, pitted (having an irregular surface) tonsils: Although shallow pits are normal, they can trap bacteria, nasal secretions, and bits of food, which can become calcified, resulting in a tonsil ‘stone’ or tonsillith. This looks like a small whitish lump and can have a bad odor. It is not, however, pus and does not indicate a throat infection.
  • Certain foods: Eating foods with strong odors like garlic, onions, etc. can cause bad breath, but it is usually temporary.

There are multiple things to try if your child is having bad breath. Brushing teeth well (begin when teeth are touching) at least twice a day, flossing, and brushing the tongue is important. Make sure your child is drinking plenty of water throughout the day. Older kids can chew sugar-free gum with Xylitol which increases saliva, decreases bacteria, and lowers plaque buildup which can keep the mouth healthier overall.

If you observe chronic nasal congestion or mouth breathing, talk with your child’s health care provider.  If tonsil stones are noted, recall that these are harmless and usually go away on their own. Older kids can try gargling with salt water which may loosen the stone. If your child’s breath has a fruity odor especially if there are signs of diabetes, call your child’s provider right away.

Remember that in most cases bad breath is not serious and can be easily remedied. If your child’s breath is not improved by the above measures, a visit with your child’s healthcare provider and/ or dentist may be in order.

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Maternal Health Awareness Day

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January 23, 2025, marks Maternal Health Awareness Day, an important occasion to reflect on the health and well-being of mothers both globally and locally. It highlights the challenges many women face during pregnancy and childbirth, while emphasizing the urgent need for better care, resources, and support in communities everywhere. Whether in remote areas or urban centers, raising awareness can help ensure that all mothers, regardless of their location, have access to the care they deserve, paving the way for a healthier future for mothers and their children.

KVH is dedicated to supporting local families and maternal health through 4th Trimester Resource Center and KVH Women’s Health clinic.