Recent Announcements

Stay up-to-date on the most current news at Brandywine Pediatrics. We will post office closings, vaccine availability, and more as news is available.

COVID-19 Vaccine Booster 5-11 years old

The FDA has approved a booster dose of COVID-19 vaccine (Pfizer) to be given at least 5 months after the primary series.

Brandywine Pediatrics will again offer Covid vaccine clinics, as demand indicates.  Nurse Rae is currently working with the state to ensure our supply.  If you are interested in receiving a booster with us, please e-mail raenepa@gmail.com to be placed on the waiting/call-back list.

 

Formula Shortages

See AAP guidance on how to manage if your formula supply is getting low.  Hopefully, this will be a very short-lived problem.

What if baby formula is out of stock everywhere?
The U.S. Food & Drug Administration announced it is taking steps to help improve supply of infant and specialty formula products. However, if you’re struggling to find baby formula during the shortage, here are some tips that can help.

Keep in mind, this advice is strictly for URGENT situations. If you have any concerns about your baby’s nutrition, please talk with your pediatrician.

Check smaller stores and drug stores, which may not be out of supply when the bigger stores are.

If you can afford it, buy formula online until store shortages ease. Purchase from well-recognized distributors and pharmacies rather than individually sold or auction sites.

For most babies, it is OK to switch to any available formula, including store brands, unless your baby is on a specific extensively hydrolyzed or amino acid-based formula such as Elecare (no store brand exists). Ask your pediatrician about recommended specialty formula alternatives available for your baby.

Check social media groups. There are groups dedicated to infant feeding and formula, and members may have ideas for where to find formula. Make sure to check any advice with your pediatrician.

Is it OK to put more water in baby formula?
No. While it may be tempting to water down formula to stretch it out, it is not safe to do that. Always follow label instructions or those given to you by your pediatrician. Watering down formula is dangerous. It can cause nutritional imbalances in your baby and lead to serious health problems. Always mix formula as directed by the manufacturer.

Can I make my own baby formula?
The AAP strongly advises against homemade formula. Although recipes for homemade formulas circulating on the internet may seem healthy or less expensive, they are not safe and do not meet your baby’s nutritional needs. Infant deaths have been reported from use of some homemade formulas.

What should I know about imported baby formula?
The FDA is considering accelerated approval of certain imported formulas. Many sold in Europe, for example, contain adequate nutrients but must be imported in a way that maintains temperature and other safety issues. That’s why FDA oversight is critical.

Can toddler formula substitute for regular formula?
Toddler formulas are not recommended for infants. However, if you absolutely have no other choice, toddler formula is safe for a few days for babies who are close to a year of age.

Can I give my full-term baby premature formula?
Formulas designed for babies who were born premature (and have “catch-up” growth to do) can safely be used for a few weeks to feed full-term babies if nothing else is available.

Is cow’s milk a safe alternative to baby formula?
If your child is older than 6 months of age and is usually on regular formula (not a specialty product for allergies or other special health needs), this may be an option. In a pinch, you could feed them whole cow’s milk for a brief period of time until the shortage is better. This is not ideal and should not become routine. However, it is a better option than diluting formula or making homemade formula. Although we don’t have a specific amount of cow milk that infants 6-12 months should drink in this situation, follow the limits of no more than 24 ounces a day for children over a year of age. See “Recommended Drinks for Children Age 5 and Younger.”

The most important concern with giving an infant over 6 months of age cow’s milk if you can’t find baby formula is making sure they get enough iron to prevent anemia. Be sure to include plenty of iron-containing solid foods in their diet while you are using whole cow’s milk. You may also talk with your pediatrician about giving your baby an iron supplement until you can find formula again.

What about feeding my baby goat’s milk?
Goat’s milk is not approved for babies in the United States. However, there are goat milk-based baby formulas registered in other countries that may be among those considered for accelerated import approval by the FDA.

Can I use plant-based milk instead of baby formula if needed?
Milk alternatives are not recommended for babies under a year of age or infants with certain medical conditions requiring specialized formulas. Soy milk may be an option to give babies who are close to a year of age for a few days in an emergency, but always buy the kind that is fortified with protein and calcium. Make sure to change back to formula as soon as some is available. Be especially careful to avoid almond milk or other plant milks as these are often low in protein and minerals.

What is the shelf life of baby formula?
Check the “use by” date on infant formula, which is required by FDA regulations to be on each container. Until that declared date, the formula will contain no less than the amount of each nutrient on the product label and will otherwise be of acceptable quality.

Remember:
Don’t hesitate to talk with your pediatrician if you have any concerns you have about your baby’s health and nutrition. If your child has special health needs, be sure to check with their doctor about medically appropriate and safe feeding alternatives.

Remember also that older babies (~6+ months) w/o allergies can have yogurt, etc, to help boost calcium intake and can drink water for fluids. A multi-vitamin w/ iron may help cover nutritional gaps, if typical formula intake is restricted for those babies.

 

 

 

Happy Nurses’ Week!

Brandywine Pediatrics has always appreciated our fabulous nurses, but our high regard for them has heightened after 2+ years of pandemic nursing! They have adjusted daily to changing protocols and have had to continually educate themselves to be able to inform our patients well. We didn’t close a single day throughout the pandemic and even in the early days, before vaccines, when fear was abundant, they donned their PPP and continued to provide excellent care. On a daily basis, they put enormous effort into making the experience for children as comfortable as possible, which is not an easy feat when it comes to administering vaccines and other scary things. We will be celebrating Nurses’ Week in our office this week so join us in thanking our incredible nurses!

New CDC Guidelines

The CDC has shortened Covid isolation * to 5 days, if you are improving and fever-free.  Additionally, if you are “currently vaccinated” ** you do not need to quarantine ***, but you should diligently wear a mask and social distance for 10 days following exposure.  If you are not “currently vaccinated”, you must quarantine for five days following exposure and then continue to mask and social distance for an additional five days. See below for further details.
[Healthcare worker guidelines remain stricter.]
* isolation = time you must stay home once diagnosed with COVID19
** currently vaccinated = within 6 months of your Moderna/Pfizer vaccine series or booster or within 2 months of your J&J vaccine
*** quarantine = time you must stay out of work/school monitoring for symptoms after an exposure
Masks should be triple layer surgical masks or N95s.  Cloth masks were never optimal and are much less effective against omicron variant.

What’s up with omicron?

The omicron strain of Covid is now widespread across much of the world, including the US.  It is many times more contagious than even the delta variant of Covid or than the flu.  It seems to be causing milder illness – whether due to the strain itself or to years of exposures and immunity to Covid or a combination.  Omicron protection from vaccines is not as strong as against previous strains but is still very helpful against severe illness and hospitalization, if vaccines and boosters are up to date (due 6 months after primary Pfizer/BioNTech  & Moderna vaccines and 2 months after J&J).  Good news, though, is that omicron disease seems to offer protection against more severe delta illness.

Cloth masks do very little to prevent omicron contagion, even worse than other strains.  Masks should be 3-layer surgical masks or N95s for best protection.

We do know that the more we do to stop the spread of Covid with vaccines, masking, and other hygiene methods, the less chance the current Covid has to change into something worse.

Some COVID-19 Vaccine Answers

Children rarely get ill from COVID-19.  Why should they be vaccinated?

  • To avoid getting Covid: Having Covid, isolations time, quarantine time all interfere with education and social time for children and work time for parents.
  • To avoid getting MIS-C (Multisystem Inflammatory Syndrome in Children):  While most children do not get sick enough with Covid to be hospitalized, MIS-C is a severe complication that occurs in about 1 in 1000 children who have had Covid, even mild illness.
  • To avoid “long haul” Covid: More research is being done into why and in whom “long haul” Covid appears.  “Long haulers” have continuing symptoms long after the original infection has cleared.
  • To avoid transmission:  Children who get mild illness could pass the infection along to peers or adults at higher risk.
  • To help protect everyone’s freedom to stay healthy and enjoy a “normal” life:  The vaccine is not perfect protection against infection.  But, the more people in any group (family, classroom, town, state, etc.) who are vaccinated, the better the group’s protection.

 

But what about Myocarditis?

  • It is still better to get the vaccine.
  • COVID-19 illness can cause severe myocarditisMyocarditis is inflammation of the heart muscle, makes the heart work harder to pump blood, and can cause permanent scarring & weakening of the heart.  It can happen from any virus to any person, but it is 37 times more likely in children with Covid and 7 times more likely in older teens and young adults with Covid.
  • Patients are still much less likely to get myocarditis from the vaccine than from Covid itself.  The rate of vaccine-associated myocarditis is about only 0.0004%.  The myocarditis cases after Covid vaccine, mostly in young men and male adolescents, has been very mild and treatable.  All patients studied have had a normal heart afterwards.

 

Which vaccine has been approved?

  • Pfizer-BioNTech’s COVID-19 mRNA vaccine has emergency use authorization for children ages 5 to 15 years old.  The vaccine has been named Comirnaty.  Children 5-11 years old will receive a dose 2/3 that of 12 and over.

(100% effective in preventing COVID-19 in children ages 12 through 15. The vaccine is 91% effective in preventing severe illness with COVID-19 in people age 16 and older. Early research also suggests that the vaccine is 96% effective at preventing severe disease with COVID-19 caused by the delta variant.)

  • Will it help against omicron variant?  So far, we just don’t know.  But as of now, omicron variant is only just being detected in this country.

COVIDVaccineAnswers.org  by Children’s Hospital of Philadelphia

The Science Behind COVID-19 Vaccines  by Healthy Children, American Academy of Pediatrics

 

 

Dr. Paul Offit of CHOP, infectious disease and vaccine expert, discusses COVID-19 illness and vaccination for teens and young adults.                          Video

 

COVID-19 and Myocarditis (excerpted from the American Academy of Pediatrics):

Across all ages, the risk of myocarditis was almost 16 times higher for people with COVID-19        compared to those who aren’t infected.
The myocarditis risk is 37 times higher for infected children under 16 years and seven times higher for infected people ages 16-39 compared to their uninfected peers. 
Males ages 12-29 years — the group with the highest rates of myocarditis after vaccination — 39 to  47 cases of myocarditis for every million second doses of vaccine. [Ed. ~0.004%] 
Benefits of vaccination outweigh the risks.

Read the full article: COVID-19 Vaccination & Myocarditis Risk in Children

 

 

 

 

 

 

COVID-19 Testing

COVID-19 testing is readily available at multiple Curative sites, through the Delaware Department of Health.

Testing sites in Delaware

 

We have COVID-19 antigen tests in the office, giving results w/in 15-30 minutes.  These tests require interpretation for each patient and at times may need to be verified by PCR.

We can still obtain samples for COVID-19 PCR testing in our office.  PCR testing gives the most accurate result.  Samples are picked up by LabCorp from our office that day and results sent to us within 1-3 days.

We use a soft swab in the front part of the nose only.  Lots of kids think it tickles.

 

 

HERE! Covid Vaccines for 5 years & up

COVID-19 Vaccines (Pfizer-BioNTech) for 5 & older are HERE!!

To request a vaccine appointment, please email raenepa@gmail.com.  She is responding as quickly as she can to provide appointments.

The Pfizer series consists of 2 vaccines given at least 21 days apart.  We are pairing appointments to make the 2nd appointment as organized as possible, so you will be provided with 2 dates when you make your appointment.

Please understand that due to the overwhelming demand coupled with staff shortages, these are very coveted slots.  As such, please realize that we will not be able to accommodate all after-school requests.  We feel strongly that receiving the COVID-19 vaccine is an excellent reason to miss an hour of school and will happily provide a letter of excuse for your child.  Please also keep in mind that your child will have to be monitored for 15 minutes following the vaccine.

  • Please note that “no show” appointments (those that do not provide 48hrs notice) will be charged a $20 fee and not be able to rescheduled.  (Missed appointments increase the risk of having to waste vaccine, as well as preventing other patients from using those times.)

Our highest priority is that eligible children receive their COVID-19 vaccines.  If a school clinic or pharmacy works best for you, we are happy for you to use that option.  If you bring a copy of the vaccine card to next appointment, we will ensure that it gets added to his/her vaccine record

Nurses needed

Would you like to work with us?  We are currently hiring R.N.s, LPNs, and M.A.s.  Send your resume to melissa.brandywinepeds@gmail.com or fax ATTN: Nurse Melissa (302) 478-2637.  Looking forward to hearing from you!

Face Mask Policy

The face mask policy for the office remains unchanged.  All adults (family and staff) and all patients who are old enough and capable must wear a face mask (covering mouth and nose) while in the Brandywine Pediatrics office, as per CDC guidelines for healthcare facilities. The majority of our patients are too young to be vaccinated or may still be at high risk even after vaccination.  We request your cooperation with face masking despite your Covid vaccination status.  Thank you.

Welcome to Dr. Kugan!

Dr. Ahila Kugan, the newest addition to our family, has started full-time.  Dr. Kugan comes to us with several years of experience in primary care pediatrics, having now permanently settled in this area.  She will be taking over Dr. Ray’s (previously Dr. Boudreaux’s) practice.  See more information on About Us page.

COVID-19 vaccine for all patients 12 years & older

We are now happy to vaccinate any patient 12 years of age and older.
If you would like to receive vaccine (we have been receiving Pfizer’s so far), please email us at the below address and you will be added to our list and contacted once a vaccine appointment is available:
RaeNepa@gmail.com    
Please include patient’s name, DOB, primary physician, and best contact number.
                       ** Please use this address only for COVID-19 vaccine appointments.**
Please note, it is important to answer when Nurse Rae calls or to call back promptly.  Unfortunately, she cannot hold spots waiting for call backs and continues to move down her list, if someone does not answer.  (This is due to logistical restrictions on administration of vaccine.  We must schedule people back-to-back, without gaps.)
Prior to your appointment, in order to improve overall efficiency, please print out the attached pre-vaccination questionnaire and bring it to your appointment.
You may also be vaccinated at multiple pharmacies throughout the area..

Physical Exams 2022

Get ahead of the summer rush!  Call Michelle @ 302-478-2604 to schedule your child’s physical.

Quarantine Rules Changed

The CDC has put out new guidance regarding quarantine.  The long quarantine period, based on the best understanding of contagion, has placed a huge burden on those who cannot afford to miss in-person work or school.

If you have been vaccinated against COVID-19, there is no need to quarantine after known exposure.  You should wear a face mask until able to obtain a negative test several days after exposure.

The CDC continues to recommend a 14 day quarantine after a known exposure* to COVID-19 for the lowest chance of spreading the virus (for unvaccinated individuals).  But new acceptable minimal quarantine limits are:

  • 10 day quarantine, if completely without symptoms     OR
  • 7 day quarantine, if completely without symptoms and with a negative COVID-19 test on day 5, 6, or 7.

Quarantine still begins on the last day of contact with infected person.  10 day isolation minimum is still necessary for COVID-19 infection.  Again, a 14 day quarantine is still superior for decreasing risk of being contagious to others.

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html

* The CDC defines exposure or close contact as:
    • You were within 6 feet of someone who has COVID-19 for a total of 15 minutes or more (15 minutes do not need to be a single block)
    • You provided care at home to someone who is sick with COVID-19
    • You had direct physical contact with the person (e.g., hugged or kissed them)
    • You shared eating or drinking utensils
    • You were with someone who sneezed, coughed, or somehow got respiratory droplets on you

 

Awaiting COVID-19 Results

Until the COVID-19 test is resulted, we advise that your child and all family members remain out of work/school/camp. If a negative test is confirmed, your child will be cleared to return to camp/school once fever free for 24 hours and with improving symptoms.
If your child if COVID-19 positive or should you decide to defer COVID-19 testing (ie, assume COVID-19), your child will need to remain out of school/camps/work until the child is fever free for 24 hours AND 10 days have passed since the onset of symptoms and all symptoms are improving.

All contacts in the household will need to quarantine for an additional 7-14 days from their last exposures to the sick contact (in most cases, the day that the child is cleared for return), which could be as long 24 days total.  Once a 10-14 day quarantine is completed, there is no need for a negative test as well.

Treat your child’s symptoms as you are used to with other viral illness. We encourage plenty of fluids, use of Tylenol (and Ibuprofen if you need it ) to improve symptoms of fever/achiness/headache and close monitoring.
Please call us immediately or seek care in the Emergency room if your child:
-spikes a temperature of 105.
-looks unwell
-experiences chest pain/trouble breathing or if you observe signs of difficulty breathing
-your child fails to void (urinate) every 6-8 hours
-is lethargic and not improving with Tylenol (acetaminophen) or Motrin/Advil (ibuprofen).

If you obtain a COVID-19 test for screening purposes only, you do not need to quarantine while waiting for results.

COVID-19 Testing in Office

We have COVID-19 antigen tests in the office, giving results w/in 15-30 minutes.  These tests require interpretation for each patient and at times may need to be verified by PCR.

We can still obtain samples for COVID-19 PCR testing in our office.  PCR testing gives the most accurate result.  Samples are picked up by LabCorp from our office that day and results sent to us within 1-3 days.  We are thrilled with how well this has been working so far.

We use a soft swab in the front part of the nose only.  Lots of kids think it tickles.

COVID-19 testing is readily available at multiple Curative sites, through the Delaware Department of Health.

Testing sites in Delaware.

 

Telemedicine Available

In response to the COVID-19 pandemic, Brandywine Pediatrics’ providers offer Telemedicine visits WHEN APPLICABLE, for our patients in Delaware, New Jersey, and Pennsylvania.  While some issues (for example, rashes & medication checks) are generally doable via telemedicine, some visits are unable to be conducted effectively by remote exam.  Our preference, of course, is always to see your child in person when able.  Please look under “Links and Forms” to download a consent form for telemedicine visits.

Note:  We will be unable to have telemedicine visits with patients who are physically out of state after the end of September, due to ending of pandemic emergency declarations.  As of now, we will be able to continue video visits in Delaware.

Office remains open

As Delaware and surrounding states begin slowly to lift restrictions, we want to remind you again that our office is open.  We are adhering to the guidance issued from the American Academy of Pediatrics.  Reduced vaccination rates during this pandemic could lead to a compounding outbreak of vaccine preventable disease.  The AAP is advising that all well visits be attended to in a timely fashion. Please call and make your child’s routine visit today.

Guidance on providing pediatric well care during COVID-19

In the midst of an already stressful time, the media is providing substantial coverage of MIS-C, a severe COVID-19-associated condition being observed in children.  Like the novel coronavirus, this condition is new and information about it is evolving.  We want families to be aware of symptoms to monitor but also want to remind you that it remains an extremely rare condition. Additionally, because aspects of the syndrome have been observed in similar conditions that we have been treating for many years, there are effective therapies and the vast majority of children are recovering.

Coronavirus (COVID-19) and Multisystem Inflammatory Syndrome in Children (MIS-C)