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August 28, 2018
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Keeping your children safe is not only a parents, but also a pediatricians, number one priority. One of the most important areas to review safety and ensure you are doing everything you can to protect your child is in the car. 

Why is this so important?

According to the Kentucky Office of Highway Safety, combining all unintentional injury deaths among those between 0 and 19 years, motor vehicle traffic–related deaths were the leading cause. Each year thousands of young children are killed or injured in car crashes. In 2015, 31 children age 15 and under were killed in motor vehicles on Kentucky roadways. 55% of those were unrestrained.

- Research shows that REAR-facing child safety seats are over 70% more effective in reducing fatal injury. That means it is over 5 TIMES SAFER to be REAR-facing! Check your manufacture guidelines to see how long your car seat can be rear facing. Not only are rear facing car seats improving safety, but appropriate front facing car seats and booster seats lower risk of injury by up to 60% in comparison to a seat belt.

How do I choose a seat?

- You will find many different car seats to choose from and you can spend countless hours reading about each of them. No one seat is considered “the best" or "safest." The best seat is the one that fits YOUR child's size, is correctly installed, fits well in your vehicle, and is used properly every time you drive.  Educate yourself on what type of seat you are looking for and the manufacturer guidelines of height and weight. The following are different types of car seats you will see as your child grows and general guidelines of when to use each of them.

Image result for types of car seat

The following is quick, helpful information for common questions regarding car seat safety:

1. MIDDLE of the BACK seat is the safest place to ride for all children younger than 13 years. Sometimes it is difficult to install a car safety seat tightly in the middle. If the vehicle seat is narrow or if the vehicle does not have lower anchors for that seat, it is safest to put the car safety seat in a position where you can install it tightly with either the lower anchor system or seat belt; in some cases, this may be on either side of the back seat rather than the middle.

2. Place the harnesses in your rear-facing seat in slots that are at or below your child's shoulders. Ensure that the harness is snug! You should not be able to pinch any slack between your fingertips. Ensure the chest clip is in the center of chest, even with the child's armpits.

3. Bulky clothing, such as winter coats or multiple layers, can compress in a crash and leave the straps too loose to restrain your child, leading to increased risk of injury. Ideally, dress your child in thinner layers and wrap a coat or blanket over the buckled harness straps to keep them warm.

4. Even if you have a larger toddler, it is much safer to ride rear facing up to when your car seat's manufacture requirements for height/weight will allow. Do not change them to front facing because you fear they are uncomfortable. Children's joint spaces are not completely formed and they are actually very comfortable riding with their legs bent.

5. If you are unsure if your car seat is installed appropriately, go to your local fire department and they will ensure it is installed correctly. Read your manufacture installation guidelines to help you with a step by step process to ensure correct installation. You may want to call the fire department first as not every station offers this service.

6. Your child can safely use a seat belt when you can answer YES to all 5 questions below!                                                                                                                                     

    1. Can your child sit straight against the back of the vehicle seat?                                                                            

     2. Can your child’s legs bend at the knee on the edge of the vehicle seat?                                                                 

    3. Can your child sit comfortably in the vehicle seat without slouching for the whole                                                                trip?                                                                        

    4. Does the lap portion of the seat belt sit down on your child’s hips, touching the thighs?                             

    5. Does the shoulder belt stay at the center of your child’s shoulder, crossing the collarbone?  

- Check out the following websites recommended by the American Academy of Pediatrics for further information:

By: Dr. Ashley Meenach, F.A.A.P.

References:, www.,



May 07, 2018
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Let’s face it, we are in the age of technology and it is rapidly evolving. From tots to teens, kids are exposed to a multitude of electronic devices on a daily basis. While media can provide benefits including exposure to new ideas, a wide array of easily accessed knowledge for learning and increased opportunities for social contact and support, there are many negative side effects that can occur if used in excess or inappropriately.

As not only a pediatrician but also a mom, it is my job to keep up to date on technology, help educate parents on safety and how to develop healthy media habits early on. Most parents did not grow up with a cell phone and often feel “technologically challenged” when trying to work one or figure out what your child is doing on their devices. So, it is important to educate yourselves, so you can educate your child!

The American Academy of Pediatrics stands firm on their guidelines for media use in the home and can help guide a parent over when and how to introduce it.

-For children younger than 18 months, use of screen media other than video-chatting such as facetime should be discouraged.

-Parents of children 18 to 24 months who want to introduce digital media should choose high-quality programming/apps such as PBS, Sesame Street, ABC mouse, ect. for no more than 1 hour per day. Parents should use them together with children as opposed to independently, as this is how toddlers learn best.                                                                                  

 -For school aged children, media limits should be set and are dependent upon types of screen time being used. Co-view with children to promote learning and safety. Ensure 1 hour of exercise and 8-12 hours of sleep are achieved daily.

Why do we care? Brain development in the early years is enhanced by hands-on, unstructured, and social play to build language, cognitive, and social-emotional skills. Researchers have found that children with excess media exposure can have negative consequences long term. These consequences include behavior problems such as issues with attention, language and impulse control as well as delays in learning and social skills, sleep and even obesity. For example, a recent study in children aged 2 found that a child’s body mass index increased for every hour per week of media used. In adolescents, watching between 1-3 hours of media daily led up to a 27% increase in risk of obesity.

While we can better control what media children are exposed to early on, it becomes harder as they grow older. Not only TV but apps such as Twitter, Snapchat, Instagram and Facebook, etc. create different exposures and challenges for teens.  Presently, over three-quarters of teens report having their own cell phone and 76% of teens have at least 1 social media site. Four out of five households own a gaming device and 84% of them report playing a video game online via cell or gaming device.  Being exposed to social media sites and the internet in general may lead to exposure to alcohol, tobacco, sexual behaviors, violence, self-harm and disordered eating.  Exposure may lead to earlier initiation of these behaviors. For example, “Sexting” is sending/receiving inappropriate nude images or messages. It is estimated that approximately 12% of youth aged 10 to 19 years of age have sent a sexual photo to someone else.

Children today are growing up in an era of highly personalized media so parents must develop personalized media use plans for their children. Those plans must account for a child’s age, health, temperament, and developmental stage. Research shows that children and teenagers need adequate sleep, physical activity, and time away from media. Some of the following are examples to create a healthier media environment for your home:

  • Teach the value of face-to-face communication and be a good role model for your child. For example, have family dinners without electronics. You will be surprised how much more communication takes place without this distraction.
  • Sleep electronic free. Have a re-charge station that everyone puts their electronic devices into 1 hour prior to bedtime. This allows everyone, including your device, to re-charge overnight.
  • Families that play together, learn together! Keep electronic devices in an open room where family is present. Have your children show you what they are looking at on their device to help facilitate discussions and answer any questions they have.
  • Teach safety of electronic devices to your children. They underestimate the value of privacy and often lack the knowledge to understand the consequences of apps that detect locations or expose them to potential sexual predators online.
  • Use websites like to help identify appropriate and safe apps for your family. 



By: Ashley Meenach, DO, F.A.A.P

American Acedemy of Pediatrics, www.

April 12, 2018
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Image result for 30 month check up imAGE

We are now seeing patients at 2 ½ years of age for a routine well visit!  This is called the 30 month check-up.  The physician will do a complete exam and ask you questions regarding your child’s development.  The 30 month check-up is recommended by the American Academy of Pediatrics.   Please visit the following link for more information on the Pediatric Preventative Healthcare Schedule.

By Katrina Hood
October 02, 2015
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Over the last 15 years, I have seen an increase in the number of patients I care for with constipation.  I think this is easily attributed to two major changes in our society over time.  The first is the amount of processed food we eat on a daily basis.  The second is the decrease in physical activity due to time constraints.
Our colon, or the bowel movement maker, relies on what we eat and how we exercise to function at its peak performance.  The fresher and more fiber-filled our food, the better the colon works.  The job of the colon is to remove liquid from the stool to make it more formed.  If you didn’t have a colon, our stool or bowel movements (BMs) would be diarrhea.  So, if what enters the colon is sticky; like bread, potatoes, pasta, crackers, chips, and processed cereal, then the harder the BM will be.  If what enters the colon is more liquid, as in fruit and fiber-filled veggies, then the softer the BM will be.  Water also plays an important role in keeping the stool soft.

Food moves through our colon better if we exercise.  The more we sit and watch TV, the less the colon wants to move.  The longer BM’s stay in the colon, the harder they will become.  So, the message is to get up and move to wake up the colon and move things out.

So if your children are having constipation issues, they must cut back on the starchy carbohydrates like pasta, rice and bread and increase the color in their foods with broccoli, apples, sweet potatoes, and oranges (and many, many other options).  Also, turn off the TV and push them outside to play or dance or hike or bike.  Drink some water along the way!   Before long, the colon will be healthier and your child will be healthier too.

Dr. Katrina Hood

By Michelle Bennett
June 03, 2015
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Summer check-up season is upon us, which means we'll be seeing lots more teenagers in the office for camp, school, and sports physicals!  We MISS these teenagers, who don't tend to get sick or come into the office very often, so hooray for summer check-ups!  

One topic that many teenagers have concerns about (but often won't bring up) is acne.  Many families think acne is a normal, expected part of the teenage years, which can be true to some extent, but acne can have a significant impact on a teenager's life and really shouldn't be ignored if it's anything more than minor.  Teenagers who suffer from acne also suffer from more depression, lower self-esteem, and sometimes long-term facial scarring.  The good news is that we have lots of treatments available for acne now.  Here are some things you may want to consider for your teen:

General skincare recommendations:

-- Use a gentle cleanser twice daily (Cetaphil and Dove Sensitive Skin are good examples).  Avoid washcloths, and use only fingers for cleansing.  Make sure the water is warm, not hot. 

-- Choose facial products and make-ups that say "non-comedogenic."

-- Avoid abrasive products (exfoliators, scrub sponges, etc.).  

-- Avoid astringents and toners.

-- Apply a moisturizer with sunscreen of at least SPF 30 every morning.  (Keep in mind that many acne treatment products increase sun sensitivity, making this step all the more important.)

If acne is mild, over-the-counter products may be adequate:

-- Benzoyl peroxide washes and creams are effective.  A concentration of 2.5% has been shown to be as adequate as higher concentrations in some studies and less likely to cause dryness.  (Do remember that benzoyl peroxide bleaches towels, so be sure to pick up some white washcloths and towels at the store.)

-- Salicylic acid products can be beneficial.

-- The Proactiv skin care system is more expensive but can also be quite effective.

If acne is moderate, prescription products can help:

-- Topical retinoids, such as tretinoin (Retin-A) and adapalene (Differin), can work wonders.

-- Topical antibiotics can be effective for acne that is very pustular.

-- Oral antibiotics are sometimes used for a few months (not long-term) for more severe pustular acne.

-- Oral contraceptives can be helpful as an add-on therapy for acne in teenage girls.  (We don't prescribe OCPs through our office, but we can refer to dermatologists and gynecologists who do.)

If acne is severe, is starting to scar, or isn't responding to typical treatments, then evaluation by a dermatologist is recommended:

-- Dermatologists are skilled at combining multiple acne therapies to get the best results.

-- Dermatologists can also prescribe isotretinoin (Accutane) for severe acne.  Isotretinoin can be extremely effective and life-changing for teenagers who need it.

-- Above all, please don't wait until your teenager has scarring to seek out a dermatologist!  The sooner, the better if acne is becoming severe!

And I'll conclude with the age-old question:  does chocolate cause acne?  Nope.  There's no strong evidence that any particular foods are associated with acne, except perhaps for large amounts of milk -- and even that's uncertain.  

Looking forward to another wonderful summer here at PAA!  We can't wait to see you guys, so call to schedule that summer check-up now before it gets forgotten in the summer fun -- a new schoolyear will be upon us before we know it!

Michelle Bennett, M.D.

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