Adolescent Care

As your child moves from elementary school to middle school, their body and interests change, and our parenting changes along with them. As pediatricians, the way we care for your child changes as well. We assess for risky behavior, counsel on safety and discuss a large number of developmentally appropriate topics.

Adolescent Vaccines

As your child moves to middle school, there will be a number of vaccines that we will discuss and recommend:

• Tdap
  Now required by North Carolina before middle school entry, this protects children against tetanus as well as pertussis, or “whooping cough”
• Varicella
  A second dose of this chicken pox vaccine is recommended before adolescence
• HPV/Gardasil
  Protecting against a family of viruses that causes genital warts has also been shown to greatly reduce a young woman’s chance of getting cervical cancer. It is a two dose series if given before age 14. If a patient gets their first dose at 15 or older, they will get three doses.
• Menactra
  This meningitis vaccine is becoming a required vaccine for college entry. Patients get their first dose in 7th grade and a booster before their senior year in high school.
• Hepatitis A
  This viral infection leads to vomiting and diarrhea, along with the liver infection. It can be obtained from food contaminated from an infected person or from certain other high-risk behaviors. It is a two-dose series.

Adolescent Safety

It’s never too early to talk to your child about being an adolescent and becoming a young adult. The hardest part is starting the conversation. KidsHealth.org offers some great resources for you and your children to navigate their growth together.

Please take time to check out The Center for Young Women’s Health for valuable information on hundreds of teenage issues your young woman may be facing.

There has been recent concern about a new “game” adolescents play called the choking game. Like any risky behavior, parents need to educate themselves about the signs of such behavior.

Contraception

If you are interested in discussing contraception for your child, we have many providers that are available and willing to discuss the various means of contraception.  We can prescribe oral contraceptive pills and depo injections.  As of September 2015, we have a provider in each office that is qualified to insert the Nexplanon implant.  If you have questions about any of these methods of contraception, please call our office to schedule an appointment.

Transitioning to Adult Care

Perhaps one of the most important things we can teach our children is to prepare them to be an adult.  That includes treating them like an adult in the doctors office.  This means that we will often have conversations with the teenagers in the room by themselves to help them become accustomed to talking with a doctor.  As your children get closer to 21, then we will start preparing the transition to adult medicine, increasing the child’s responsibility in their own care.  The website Got transition, has lots of resources for parents and teens to prepare them for this transition.

Breastfeeding / Lactation Consult

Appointments are scheduled for one hour in our Cary office on Tuesday and Thursday mornings. Please speak with the front desk or call 919-467-3211 to set up your appointment.

• Please arrive 15 minutes prior to appointment time.
• Please bring a list of questions or concerns you have
• Please bring all items that you use regularly when nursing or pumping. This may include pillows, pumps, shields.
• If you have a support person available to attend, please invite them to join us if you feel comfortable.

Vaccinations

Our Vaccine Policy

We believe in the effectiveness of vaccines to prevent serious illness and to save lives.

We believe in the safety of our vaccines.

We believe that all children and young adults should receive all of the recommended vaccines according to the schedule published by the Centers for Disease Control and Prevention and the American Academy of Pediatrics.

We believe, based on all available literature, evidence, and current studies, that vaccines do not cause autism or other developmental disabilities.

We believe that thimerosal, a preservative that has been in vaccines for decades and remains in some vaccines, does not cause autism or other developmental disabilities.

We believe that vaccinating children and young adults may be the single most important health-promoting intervention we perform as health care providers, and that you perform as parents/caregivers.  The recommended vaccines and their schedule are the results of years and years of scientific study and research, with data gathered on millions of children by thousands of our brightest scientists and physicians.

These things being said, we recognize that there has always been and will likely always be controversy surrounding vaccination.

The vaccine campaign is a victim of its own success.  It’s precisely because vaccines are so effective at preventing illness that we even discuss whether or not they should be given.  Because of the safety and effectiveness of vaccines, many of you have never seen a child with polio, tetanus, whooping cough, bacterial meningitis, or even chickenpox.

Over the past several years, some people have chosen not to vaccinate their children with the MMR vaccine after publication in Europe of an unfounded suspicion that the vaccine caused autism.  This claim was later discredited and retracted.  Unfortunately, decreased vaccination rates have resulted in a rise in the number of measles cases across Europe.

Please understand that delaying or “breaking up” vaccines to give one or two at a time over several visits goes against expert recommendations and can put your child at risk for serious illness or even death.  Doing these things also goes against our medical advice.

As medical professionals entrusted with the lives of children we believe strongly that vaccinating children on schedule with currently available vaccines is the right thing to do.  With rising rates of pertussis being seen in this country we have made the decision here at Cary, Fuquay, and Apex Pediatrics to require our patients to meet certain vaccine standards to be part of the practice.  This is to protect the health of your child, our patients, and our community.

Finally, if you should refuse to vaccinate your child despite all our efforts and recommendations, we will ask you to find another health care provider who shares your views.

We write this statement not to scare you, nor to coerce you, but to make you aware of the facts, and to emphasize the importance of vaccinating your child.

Please feel free to discuss any questions or concerns you have about vaccines with any one of our providers.  Please also recognize that we will do everything we can to convince you that vaccinating your child according to the recommended schedule is the right thing to do.  It is our job to advocate for children and their health is our priority.

TYPICAL VACCINE ADMINISTRATION SCHEDULE:

2 month series (3 shots):  Pentacel (DtaP, IPV, HiB), Prevnar, Hep B, and oral Rotateq

4 month series (3 shots):  Pentacel (DtaP, IPV, HiB), Prevnar, Hep B, and oral Rotateq

6 month series (3 shots):  Pentacel (DtaP, IPV, HiB), Prevnar, Hep B, and oral Rotateq

1 year series (4 shots):  MMR, Varivax, Hep A, and Prevnar

15 month series (2 shots): DTaP, HiB

18 month or 2 year (1 shot): Hep A

4-6 years old (2-4 shots depending on combination used): MMR, Varivax, DTaP, IPV

11-12 years old:  TdaP, Menactra, HPV (2 doses needed)

16-17 years old:  Menactra, Meningitis B (2 doses needed)

To meet our practice standards, the following are required:

1 year standard:  Each infant should have 3 doses each of DTaP, IPV, HiB, and Prevnar by 1 year of age.

2 year standard:  Each toddler should have the 1 year standard + 1 dose each of MMR, Varivax + boosters of DTaP, HiB, and Prevnar (total of 4 each) by 2 years of age.

6 year standard:  Each child should have the 2 year standard + boosters of MMR, Varivax, DTaP and IPV. Note that Hep B is required for Kindergarten entry.

12 year standard:  Each child should have the 6 year standard, + TdaP booster and Menactra.

17 year standard: Each child should have the 12 year standard + Menactra #2

Vaccination Facts from the Centers for Disease Control

Bear in mind that diseases we vaccinate are not gone.  The number of cases of measles last year was more than any single year since the 1990’s; most of the cases in children who have not been vaccinated either because of age or by choice.

See the Downloads list below for fact sheets about each vaccine.

Contraception

At Cary, Fuquay and Apex Pediatrics, we are proud to be following the latest recommendations from the AAP for the most effective adolescent contraception. We offer traditional guidance for birth control, including but not limited to abstinence, condoms, oral contraceptives and Depo Provera.

Nexplanon

Our providers are trained in the insertion of Nexplanon, which is a small, soft, and flexible birth control implant that is just 4 centimeters in length.  It is inserted directly and discretely under the skin on the inside of the arm.  The procedure is quick with minor discomfort and Nexplanon provides up to 3 years of continuous pregnancy prevention.  No daily pills, sticky patches or injections.

Once it is inserted, Nexplanon is over 99% effective.  If you or your teen are interested in Nexplanon or any other form of contraception, ask to schedule a consult with one of our trained providers in ANY of our locations.  We can tell you all about it!

Circumcisions

We are now able to preform circumcisions on your newborn boy.  The procedure is currently only performed in our Cary office.  Currently, Dr. Villareal is the only one that preforms circumcisions in the office.  Here is what he has to say about the procedure.

“There are three different ways that a circumcision can be performed.  I was trained in the most common method using a Gomco clamp.  I feel comfortable performing circumcisions on newborns up to two weeks of age.

One of the most common concerns for a parent is how much pain their son will experience.  I take great care to numb the area and ensure that your son is numb prior to starting the circumcision.  I also have the baby suck on some sugar water throughout the procedure.  With these two soothing mechanisms, evidence and my experience shows that most babies are very comfortable, and I have a high percentage that will sleep through most of the procedure.

The worst part of the procedure is that they have to have their legs strapped down to the table so that they do not interfere with the sterile area, which can make kids a little cranky after the procedure.  The whole procedure takes about 25-30 minutes.  After the procedure, I have the parents wait in the office for about 15 minutes so that I can check the penis and ensure that everything looks appropriate.”

If you have any additional questions please do not hesitate to contact our Cary office with more questions.

Nutrition

Eating disorders, obesity, picky toddlers, and vegetarianism are just a few of the topics our registered dietitians can cover.  An appointment can be made at any time. Please discuss this service with your provider. We are excited to have Zeina as part of our practice.

Zeina works in our Cary office and she specializes in eating disorders.

Zeina bridges the gap between knowledge and application when it comes to nutrition, and works with clients of all ages to help them form a healthy relationship with food and their bodies. She specializes in binge eating disorder, emotional eating, restrictive eating disorders, and hormonal/endocrine imbalances. She works directly with clients to create an individualized meal plan that will empower them with confidence and knowledge so that they can reach their personal nutrition goals. Zeina has a special interest in adolescent athletes who struggle with disordered eating, and establishes customized fueling plans to enhance performance.  She educates her clients on how to fuel their bodies properly, provides guidance on nutrition supplements, exposes diet myths and strikes the balance between eating and health with an inclusive philosophy of conscious eating.

Zeina received her BS in Biological Sciences with a Nutrition Concentration at North Carolina State University, and completed her Dietetic Internship at Meredith College. She is an active member of the International Association of Eating Disorders North Carolina Chapter and a Certified Eating Disorder Specialist.  Zeina was a member of the Healthy Diets family while completing her undergraduate degree in 2008.  She then gained experience in both health and wellness clinics, hospitals, and settings that enabled her to provide nutritional guidance to members of special-forces units, mixed martial arts fighters, and triathletes.  She rejoined the Healthy Diets team in 2014, and has found her passion in providing nutrition education to those with eating disorders, women’s endocrine/hormonal health concerns and sports nutrition.

Apart from her passion for nutrition, Zeina is a fitness enthusiast with a love for Olympic lifting. When she’s not working, you can usually find her spending time outdoors with her family or experimenting with new recipes in the kitchen!

ADHD

Our office performs ADHD screening for our families and helps them navigate the confusing landscape of ‘attention’ in school and at home. Please call to set up a consult with one of our providers if you or the school has concerns.

Child Development

Developmental Screenings

We are using developmental screens in our office at many checkups to make sure we don’t miss any subtle problems.

Asthma

Asthma affects one in ten children and is one of the most common chronic diseases of childhood. As a practice, we are committed to helping you and your child control their asthma symptoms so that they can have a normal and active lifestyle.

Our patients with asthma are closely monitored.  We will see your child in the office every 6 months at a minimum – At their well child exam, and again six months later.  During your visit, your child may undergo pulmonary function testing and you may be asked to complete an Asthma Control Test. These tools help us understand how well your child’s asthma is controlled.

Your child will also have an examination and we will review his/her symptoms and medication use.

Questions on how to use a spacer properly?  Check out these videos!

https://youtu.be/o0M1lLpOu4U

https://youtu.be/C1ttDC2zicI