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Posts for: May, 2018

By Pediatric Associates of Davidson County
May 25, 2018
Category: Pediatric Health
Tags: Sports Physical  

Sports PhysicalYour child or teenager is likely the picture of health, with an excess of energy, a healthy appetite, and a decent amount of rest, so having a sports physical every year may seem unnecessary. However, the doctors at Pediatric Associates of Davidson County encourage parents to look at yearly physicals for athletics as a way to keep children's medical records updated and to detect any potential problems early. Learn more about how our team of providers in Nashville, Tennessee is looking out for your child's health, both on and off the playing field.

Why are sports physicals necessary?

Sometimes known as pre-participation examinations, sports physicals from your child's Nashville pediatrician are very beneficial. Your child's health, in particular their heart and lungs, needs to be evaluated by a professional prior to stepping onto the sports field. This can prevent unforeseen problems and detect issues that need further treatment or evaluation. Yearly physicals also mean that your child's medical records are staying up-to-date.

What happens during a sports physical?

If your child has had a sports physical in the past, you probably know what to expect. However, if you're signing them up for the first time, you may have some questions. A typical sports physical includes the following:

  • Taking records of height, weight, heart rate and blood pressure
  • Checking vision, hearing, and breathing
  • Evaluating posture for potential scoliosis
  • Testing joint flexibility and strength

Of course, there is always time for your Nashville pediatrician to address any questions or concerns you may have. That's what makes sports physicals in a medical office the preferred method; they are much more thorough and personalized than school-sponsored screening events.

If your child showing interest in playing a sport during the next school year, contact the Pediatric Associates of Davidson County in Nashville, TN to schedule a physical with one of our pediatricians today!

By Rick Pescatore, Seth C. Hawkins
May 16, 2018
Category: Uncategorized
Tags: Untagged

Rick Pescatore, Seth C. Hawkins, For the Inquirer
Updated: Thursday, May 3, 2018, 12:20 PM

For years, always beginning in the spring, reports of “dry drowning” have appeared. Last year, when the death of a young child in Texas was attributed to “dry drowning,” the resulting accounts spread significant fear among parents.

Social media, in particular, spread tales of healthy children who suddenly developed respiratory emergencies or even died without warning, sending legions of “worried well” to emergency departments and pediatricians’ offices. Well-meaning activists posted warning signs at local pools and organized awareness campaigns and legislation.

Yet, there is no such thing as “dry drowning.”

In lay terms, to say a person drowned implies death. But in medical terms, the word refers to a range of issues.

Drowning always follows some kind of submersion in a liquid, but it is not always fatal. The outcome can range from mild respiratory symptoms to death.


People who think “dry drowning” exists describe it as a rare condition.

But real drowning — the wet kind — sadly is not rare. It is a leading cause of pediatric injuries and deaths.

The definition of drowning, established at the 2002 World Congress on Drowning, is “the process of experiencing respiratory impairment from submersion or immersion in liquid.” In other words, no drowning can occur without exposure to liquid and some respiratory problem.

Drowning has only three subtypes: drowning without injury, drowning with injury, and fatal drowning.

Further, there has never been a case reported in medical literature of an otherwise asymptomatic and healthy child who suddenly developed serious respiratory distress or died days after being in water.

But it is important to know that symptoms can get worse in the hours immediately after a drowning event. So even mild symptoms after a drowning episode warrant medical attention.

What do we mean by “mild symptoms”? Anything that feels worse than the sensation that, while drinking a glass of water, some of it went down “the wrong way.”

Every “dry drowning” tragedy has later been found to have its roots in another medical condition. But this part of the story seems never to make its way to social media.

Frankie Delgado, the 4-year-old boy whose 2017 death renewed the Facebook fervor over dry drowning, was later found to have died of viral myocarditis, a rare but dangerous heart condition with no relation to drowning, swimming, or any other water exposure. Other “dry drowning” cases have later been traced to rib fractures, pneumonia, collapsed lungs, and numerous other well-known medical conditions.

It has happened that people have died of drowning hours after leaving the water. But they died of untreated complications from “wet” drowning, not any sort of esoteric condition that could not have been prevented by timely medical attention.

Drowning is never “dry.”

Nearly every major medical organization has spoken out against misleading terms such as “dry,” “near,” or “secondary” drowning applied to cases in which a patient got worse within hours of water exposure.

Developing symptoms days later almost certainly has nothing to do with water exposure, unless there was a separate complication such as infection from bacteria in the water.

Think of it this way: If someone develops pneumonia related to food entering the lungs during a choking episode days earlier, he has not experienced “foodless choking.” That term makes no more sense than “dry drowning.”

Children with continued respiratory problems or other symptoms after swimming should always be brought to an emergency department for evaluation. A child who maybe had a brief coughing episode but no further symptoms almost certainly requires no further medical care.

Words matter when it comes to caring for our children. The widely spread tales of critically ill “dry drowning” victims succumbing days after swimming to a “rare” medical condition created fear among parents. Many likely grew to distrust physicians who tried to assure them their children did not need to be evaluated for a mythical condition.


Worse of all, the “dry drowning” uproar drew attention from the real crisis we face every summer: protecting children from all-too-real drownings in swimming pools, natural bodies of water, even 5-gallon buckets for the youngest kids.

The dangers of drowning are real, and not esoteric or rare, and we owe it to our children to approach this hazard armed with knowledge and understanding, not fear and fervor. We must remember that our most important tool is prevention: swimming lessons, appropriate pool fencing, and continuous supervision while kids are in the water. If, despite all these efforts, there is still a drowning incident, anyone with symptoms should receive medical attention.

Online networking platforms are an ideal medium to spread important information about public health and patient care. But we owe it to ourselves and to our children to approach information — especially anything that sounds hard to believe, or doesn’t come from sources we know and trust — with skepticism and diligence. And if it sounds especially unlikely — “dry drowning” surely fits that description — always be extra cautious.

Rick Pescatore, DO, is director of clinical research of the department of emergency medicine at Crozer-Keystone Health System. Seth C. Hawkins, M.D. is an assistant professor of emergency medicine at Wake Forest University. Hawkins is also director of Lifeguards Without Borders and medical director of Starfish Aquatics Institute.

Read full story: Drowning is never dry: Two ER doctors explain the real swimming danger kids faceDrowning is never dry: Two ER doctors explain the real swimming danger kids face

More Coverage: Don't Panic Over 'Dry Drowning' Reports, ER Docs Say

By Pediatric Associates of Davidson County
May 15, 2018
Category: Pediatric Health
Tags: Diabetes  

You disinfect their toys. You make sure they wash their hands. You keep them from putting odd things they find in their mouths. You do everything you can to keep your child healthy and happy, but some illnesses aren’t completely under your control. Type 1 diabetes, most commonly diagnosed in children and young adults, is an autoimmune disease where the body stops producing insulin. It has no known cause, there is no way to prevent it, it is not tied to lifestyle or diet, and there is no cure. But there are recognizable symptoms, which can help you catch it early and get your child the help they need.

Common Signs of Type 1 Diabetes

The most common early signs of diabetes are increased urination and thirst. This is because your child doesn’t have enough insulin to process glucose, leading to high blood-sugar and a reaction where their body pulls fluid from tissues. This makes your child constantly thirsty and in need of bathroom breaks. Other warning signs include:

∙         Fatigue: Your child always seeing tired or drowsy could signal their body is having trouble processing sugar into energy. Extreme instances of this include stupor and unconsciousness.

∙         Changes in vision: Having high blood-sugar often causes blurred vision and other eyesight problems.

∙         Fruity smelling breath: Having breath that smells fruity, even when it’s been a while since your child ate, often means there’s excess sugar in their blood.

∙         Increased hunger or unexplained weight loss: Extreme hunger can mean your child’s muscles and organs aren’t getting enough energy. Any sudden weight loss in your child should not be ignored, but especially when they’ve been eating more.

∙         Changes in behavior: Your child suddenly seeming moodier or more restless than normal while showing any of the symptoms.

Get Help from Your Pediatrician

Your child having heavy or labored breathing or experiencing nausea and vomiting are also signs of diabetes, but all of these symptoms, regardless of whether or not they are from diabetes, are cause for you to take your child to their pediatrician. Untreated, type 1 diabetes can be life-threatening. But with the help of a pediatrician and the same diligence you use to keep your child safe from viruses and bacteria, your child can grow up healthy and happy. If you have any questions or concerns, call our office today.

Tennessee Department of Health - Health Alert Network


The Tennessee Department of Health (TDH) has received reports of 9 cases of acute hepatitis A since January 1st: 8 of 9 are in middle Tennessee. Although a small number, this is higher than usual, and some cases have risk factors seen in large outbreaks currently going on in Kentucky (400 cases in 30 counties) and other states, including men who have sex with men and recreational drug users. The other common risk factor seen in other states is homelessness. TDH anticipates additional cases in coming weeks and months, given the long (1 month) average period between exposure and illness.

Based upon the experience of Kentucky and other states, Tennessee is at risk of a significant hepatitis A outbreak in the coming months. Clinicians can take the following important steps now to protect high risk patients and mitigate the spread of illness:

1. Hepatitis A vaccine is already recommended for adults at high risk of exposure or severe illness, but most adults who need vaccine have not received it. A single dose of the 2-dose series can provide protection for more than a decade. Offer vaccine or refer your patients who need hepatitis A vaccine now:

  • Persons who use recreational drugs (injection or non-injection)
  • Men who have sex with men
  • Homeless persons
  • Persons with chronic liver disease, including chronic hepatitis B or C

TDH is able to make some vaccine available through local public health departments to adults with these risk factors: local supplies vary. International travelers going to countries where hepatitis A is endemic are also recommended to receive vaccine from their healthcare provider or travel clinic.

2. Consider hepatitis A vaccine for any child through 18 years who has not had it. Tennessee began requiring this vaccine for kindergarten in 2011. It is routinely given at age 1, but the CDC advises it may be given to any older child through age 18 years who has not had it. Federal Vaccines for Children (VFC) Program vaccine may be used for any eligible child, including children without health insurance coverage and those on TennCare.

3. Recognize and report cases to public health. Persons with the acute onset of symptoms of hepatitis (yellowing of eyes or skin, fever, nausea/vomiting, dark urine, pale stool, abdominal pain, fatigue and loss of appetite) should have a serologic test for acute hepatitis A IgM. Do not test persons without signs of acute hepatitis: false positive IgM results can occur in persons without clinical illness, especially in the elderly. Acute hepatitis A is reportable to your local health department to initiate a time-sensitive contact investigation and provide post-exposure prophylaxis to at-risk contacts within 2 weeks of exposure.

This message was sent to EMS, Hospital, Public Health, ICP, and ED roles in TNHAN.


Thank you,
Tennessee Department of Health