The Hirsch Pediatrics FAQ's and Policies...

Health and Medical

• What if I have a medical question or are unsure if my child needs an appointment?
• What is your policy on antibiotics?
• What is your policy on vaccinations?
• What is the vaccination schedule?
• Do you have sick and well-child waiting rooms, and how can I reduce the chances of my child picking up a sickness at your office?
  
  

What if I have a medical question or are unsure if my child needs an appointment?

During regular office hours, please call the office, and we will respond as soon as possible. You may also send us an e-mail request which will be responded to before 9:00 AM the next business day. Those messages that are more urgent or may require an early morning appointment will be responded to first, typically by 8:30 AM.

NOTE: If you have an urgent medical question or concern that arises after regular office hours, and you feel that it would be unsafe to wait until the following day for medical treatment, please click here.

What is your policy on antibiotics?

Unfortunately, with the increased use of antibiotics we have seen an accelerated growth of antibiotic resistant bacteria. In order to combat this resistance, doctors have been called upon to restrict the use of antibiotics to those situations in which there is a very high likelihood that the infection being treated would benefit from antibiotics. Most illnesses (such as a cold, upset stomach, or flu like syndrome) are caused by viruses. These viruses are very different than bacteria. Antibiotics do not affect viruses. Antibiotics only work to kill bacteria. Unfortunately, the degree of sickness does not always indicate whether or not the infection is bacterial or viral.

It is impossible for a doctor to conclusively diagnose an infection over the phone without a physical exam and even more difficult to determine whether an infection is due to a bacteria or virus. Therefore, we do not call in antibiotic prescriptions without an office visit. With the increasing prevalence of antibiotic resistant bacteria as well as the risks of antibiotic side effects and allergic reactions, I always want to confirm, by physical exam, that there is most likely a bacterial infection.

While I understand that this policy may seem inconvenient at times, it has been developed to ensure the highest quality care for your child.

What is your policy on vaccinations?

One of the cornerstones of my medical philosophy is to keep our children safe and healthy through disease prevention. The routine use of vaccines is arguably one of the greatest medical interventions with its dramatic reduction of childhood disease and death—the statistics are quite impressive. The following table published by the CDC demonstrates the dramatic impact of vaccines on public health in the 20th century:

I wholeheartedly support the American Academy of Pediatrics recommendation that every child be fully vaccinated in a timely fashion. If you wish to modify the vaccination schedule, we will work together to create a timetable that both supports your beliefs and your child’s safety.

NOTE: Unfortunately, if this vaccination schedule includes withholding certain vaccines altogether, we will work with you to find another pediatrician that may have an alternative vaccine philosophy.

Understandably, many parents will ask the following question, “If these diseases are so rare, then why is it so important for my child to be vaccinated?” In fact, as long as a disease still exists in any part of the world, vaccinating your child will offer protection not only to your own child but to all of the children in your community. This is the principle of Herd Immunity:

The effectiveness of a vaccine depends, amongst other things, on the percentage of the population which has received it and is still within the period of protection offered by that vaccine. Vaccinated people act as a sort of "firebreak" in the spread of the disease, slowing or preventing the further transmission of the disease to others. Since the protection offered by vaccines is rarely 100%, the vaccine will be more effective if more people have been vaccinated. This is because the disease may be able to jump from one unvaccinated person to another person who has not been vaccinated, but is unlikely to be able to jump from one unvaccinated person to another who has been vaccinated. Virologists and epidemiologists who have studied these areas have found that when a certain percentage of a population is vaccinated, the spread of the disease is effectively stopped. This critical percentage depends on the disease and the vaccine, but 90% is not uncommon. This is herd immunity - the fact that others in the herd or population have been vaccinated provides protection to all others, whether or not vaccinated themselves.

Finally, in responding to questions of vaccine safety, I consider rigorous scientific research and continued post-marketing surveillance for guidance on what is the best choice for your child. When it comes to the health of our children, I want to be sure that these vaccines are as safe as possible, and like any medical intervention, that the benefits of vaccinating your child strongly outweigh the risks.

If you wish to learn more about the safety and effectiveness of vaccines, please refer to our resource center.

What is the vaccination schedule?

Hirsch Pediatrics utilizes the vaccination schedule recommended by the Centers for Disease Control and approved by the American Academy of Pediatrics. Because of the flexibility in the exact timing and choice of vaccines, we have been able to design a vaccine administration schedule that will provide complete protection to your child while minimizing the total number of injections.

In most cases, your child will receive vaccinations prior to leaving the hospital and at the 2 month, 4 month, 6 month, 12 month, 15 month, and 18 month visits. The remaining vaccines will be given at age 4, between ages 10 to 12 years, and then finally in high-school prior to college.

Prior to administering any vaccine to your child, we will always review the most up-to-date research to ensure the highest level of safety and effectiveness in the vaccine.

Do you have sick and well-child waiting rooms, and how can I reduce the chances of my child picking up a sickness at your office?

In theory, having two waiting rooms sounds like a wonderful way to decrease the incidence of children being unnecessarily exposed to contagious infections in a doctor’s office. However, as clearly stated in the American Academy of Pediatrics Policy Statement on Infection Control in Physicians’ Offices:

There are no studies documenting the need for, or benefit of, separate waiting areas for well and ill children. Efforts should be made to limit transmission of infectious agents by avoidance of crowding, shortening waiting times, and minimizing the sharing of toys.

Thus, in designing the office, I purposefully chose not to create two separate waiting rooms. Rather I chose to focus on those areas that have been proven to reduce disease transmission in any setting, whether it is a doctor’s office, shopping mall, grocery store, or your own home.

Most infections are spread by transmitting a germ from a contaminated surface to a mucous membrane. When I say, “contaminated surfaces,” I am referring to surfaces where a living germ has landed or been placed (usually by a contaminated hand), such as doorknobs, elevator buttons, chair rails, toys, and other people’s hands. Mucous membranes are parts of your body that can internalize a germ and thus lead to infection. These include your eyes, nose, and mouth. After several hours, many germs die and the contaminated surfaces usually become less infectious. Therefore, the vast majority of infections are transmitted when a child or their caregiver touches a contaminated surface and thereby contaminates their hands, and then touches their (or someone else’s) eyes, nose, or mouth.

To minimize the risk of infection, I have instituted the following proactive infection control policies for my office:

• Toys: No group toys will be provided. Especially because it would be impossible to clean every group toy after every child, I have created a system where each child has their own bucket of toys for the duration of their visit. These toys are given to the child upon their arrival in the waiting room and kept throughout the visit. After the bucket has been used and prior to the next use, the toys are either disinfected or allowed to sit out overnight to allow the germs that may have been placed on them to die.
• Waiting Room: Twice a day we will do a thorough disinfectant wipe down of the waiting room, including all chairs, countertops, and door handles. Also, we will strive to minimize your time in the waiting room.
• Examining Rooms: Although table paper prevents some contamination, the use of it is an ineffective substitute for true examining room infection control. If in fact the only surface that the doctor, patient, and parent touched throughout the entire visit was the table paper, simply changing it would suffice. However, changing the paper does not disinfect the rest of the potentially contaminated examine room surfaces. After every patient visit, either my staff or I will use a antimicrobial wipe to disinfect the entire examining room, including the part of the examining table not covered by the paper as well as the doorknobs, drawer handles, computer keyboards, and exam room chairs. The room is only ready for the next patient after all of these surfaces have been disinfected.
• Hand Disinfection: Throughout the office you will notice what looks like small upside down canisters of whipped cream attached to the walls. This is not for spontaneous ice cream socials; rather it is the most effective way of keeping my hands disinfected in between patient appointments. The canisters contain an alcohol based disinfectant foam that has been shown to be substantially more effective at disinfecting hands then the conventional soap and water system (Guideline for Hand Hygiene in Health-Care, MMWR. 2002; 51:1-44). Additionally, proper hand washing techniques are very time consuming and are rarely ever used in traditional doctor offices. While in my office, I encourage you to use the foam for yourself and your children as needed. Remember, just a small dab is plenty and it dispenses like a whipped cream container.