H N Update flu jitters

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					                                                                                                                                          Fall 2009




                      The Center For
                      Advanced
                      Pediatrics
Comprehensive Care for Infants, Children & Young Adults




H1N1 Update
by Kristen Baker, P.A.-C, M.M.Sc
Christine Aufderheide – Quinnipiac University PA
Program Class of 2010

Swine flu (H1N1 flu virus) is an influenza infection of respiratory        or take close care of infants under the age of six months, health
system. Swine flu dates all the way back to 1918, when pigs first          care providers or emergency medical personnel with direct patient
became sick with flu-like symptoms at the same time as humans.             contact; children that are school aged 6 months to 4 years of age;
Symptoms of H1N1 flu virus are very similar to the symptoms of the         and school aged children over age 4 through age 18 who have
seasonal flu virus and are usually more severe than the common             chronic medical conditions. If the vaccine supply is not limited by
cold. People often have a fever (100.3), cough, sore throat, runny or      the CDC; i.e., enough is manufactured then people age 24-65 will
stuffy nose, body aches, headache, chills and fatigue. There have          be the next group available to receive the vaccine followed by those
been reports of diarrhea and vomiting as well. Typically, if your child    over age 65. The vaccine is NOT a replacement for the regular flu
does not have a fever – they do not have H1N1 flu virus.                   vaccine.

When to Seek Medical Care: If a family member or your child                                       Great web sites for
becomes ill with influenza-like symptoms, the CDC recommends                          Keeping Up-to-Date with Information re. H1N1:
that you stay home and avoid other people for at least twenty-four
                                                                                             www.cdc.gov | www.ct.gov
hours after the fever is gone without using a medication that reduces
fevers. It is not recommended that people with H1N1 flu virus leave
their home unless they need to seek medical attention. Furthermore,        High Risk Children for Complications from the Swine Flu:
in children, it is advised that you seek emergency medical attention       Patients with lung disease, such as asthma, heart disease, weak
if your child has difficulty breathing, has blue or gray colored skin,     immune systems (cancer), diabetes, sickle cell disease, kidney
is not drinking enough fluids, is vomiting persistently, is not waking     disease, diseases requiring long term aspirin therapy, other chronic
up easily or interacting with others, or is very ill-tempered and          diseases, pregnant teens, or young children less than five years of
inconsolable.                                                              age are considered at higher risk for contracting H1N1, so vaccine
                                                                           is recommended.
Prevention: The H1N1 flu virus can be spread by sneezing,
coughing, and hand contact. People infected with H1N1 flu may be           Antiviral Medications for the H1N1 Flu: Antiviral medications
able to infect others from 1 day before getting sick to 5 to 7 days        such as Tamiflu are recommended by the CDC and by The
after. In order to help prevent the transmission of H1N1 flu virus it is   American Academy of Pediatrics for all high risk children who have
important to cover the nose and mouth with a tissue. It also is helpful    H1N1 symptoms to reduce duration of the flu by 1-2 days. They
to wash the hands frequently or use an alcohol-based hand cleaner.         must be started within 48 hours of the START of flu symptoms
Wash the hands with soap and warm water for 15-20 seconds.                 to have an effect. Most low risk children with H1N1 do not need
If using an alcohol-based hand cleaner, rub your hands until the           antiviral medications unless they develop more serious symptoms
cleaner is completely dry. It is also important to avoid touching your     such as pneumonia. Remember that the antiviral medications do
eyes, nose or mouth to prevent the transmission of germs. Generally        improve symptoms but do not eliminate them. Most of the time flu
in community and home settings, face masks and respirators are             symptoms without an antiviral will be as follows: fever 2 or 3 days;
not recommended. The CDC also recommends that ill                                       runny or stuffy nose 1-2 weeks, and cough up to three
children stay home when they are sick. Previously ill                                   weeks. The antivirals will reduce symptoms in general
children may return back to school or childcare once                                    by about two days.
the fever is gone for at least twenty-four hours.
                                                                                       Most importantly, there is no need to “panic” if your
H1N1 Vaccine:        The H1N1 vaccine should be                                        child has symptoms of the swine flu. Unless your child
available sometime this fall, according to the CDC.                                    is high risk or with a persistent fever (greater than
Children should be over six months old. If under age                                   3 days), treatment for the swine flu is like any other
9, the vaccine will most likely be administered in two                                 flu: rest, plenty of fluids, and Tylenol or Ibuprofen as
separate shots, 21 days apart. More information will                                   directed. Most cases of H1N1 are mild, and improve
be available once we know more from the CDC. If                                        quickly, with resolution of the fever within a few days.
a limited supply of the vaccine is available, then the                                 Remember to talk to your child’s school and be advised
vaccine will be recommended for specific groups of                                     of their policy regarding the swine flu. Most schools will
people: pregnant women, people who live with infants                                   allow the child to return once fever free for 24 hours.
                            - TEEN CORNER -
                                                             Teen Dating
                                                               Ellen Fahey APRN., FNP-C
                                                               It is an exciting time when your young teen starts to date. Most parents find it hard
                                                               to believe how fast the time has gone and worry that their child is not ready for such
                                                               a relationship. It is important for parents to talk to their teens about dating. Dating is
                                                               not something that comes natural, it is a learned process, like most things in life, and
                                                               the experience can be difficult for some teens. Most teens learn how a relationship
                                                               works from watching their parents, TV, and their peers. Discussing issues relating to
                                                               dating and personal boundaries is an important component to parenting. In order for
                                                               teens to develop healthy relationships we encourage you to have ongoing dialogues
                                                               with your teen about their relationships. If you feel uncomfortable or would like
                                                               further advice in talking to your teen we are always available to assist.
                                                               Signs of a Healthy Relationship
                                                               •	 You can express your thoughts and feelings without worrying about being
                                                                  ridiculed.
                                                               •	 You can spend time with family and friends without your boyfriend/girlfriend
                                                                  becoming jealous.
                                                               •	 You can have friends of the opposite sex
                                                               •	 You feel good about yourself when you are around your boyfriend/girlfriend
                                                               •	 You laugh a lot
                                                               •	 You both talk freely about your feelings
                                                               •	 Your mind and your body are respected by your boyfriend/girlfriend
Signs of an Unhealthy Relationship
•	   Your partner puts you down, criticizes you instead of supporting you
•	   Your partner gets extremely jealous or possessive                           Signs your teen maybe in an
•	   Your partner constantly checks up on you, gets annoyed if you don’t         unhealthy relationship
     text right back or answer your phone
•	   Your partner tells you how to dress                                         •	   Your teen spends all of his or her time with a dating partner
•	   Your partner tries to control what you do and who you see                        and little time with friends
•	   Your partner does not like you talking to other boys or girls               •	   Your teen loses interest in or
•	   Your partner make you feel nervous (like you are walking on eggshells)           gives up activities that once
•	   Your partner threatens to hurt you, raises a hand when angry, like he or         were important
     she is about to hit you                                                     •	   Your teen acts afraid of his
                                                                                      or her dating partner
Not all of these signs will be in every abusive relationship. If one
or more of these warning signs exist in your relationship, it doesn’t
                                                                                 •	   Your teen does not seem
                                                                                      happy, is depressed or
necessarily mean that your relationship is abusive, but your
                                                                                      anxious
relationship may not be as healthy as you deserve it to be.
                                                                                 •	   Your teen refuses to discuss
If you feel your child maybe in an unhealthy relationship, discuss                    his/her relationship
your concerns with your teen and provide guidance. The Center                    •	   Your teen has unexplained
for Advanced Pediatrics has Psychiatric Nurse Practitioners, Kym                      bruises or injuries
D’Agostino and Deirdre Trevett on staff for parents and teens to talk            •	   Your teen apologizes or
to. Please feel free to call the office for an appointment if needed.                 makes excuses for his/her
                                                                                      dating partner’s behavior,
Teen Dating                                                                           anger or jealousy
Ellen Fahey APRN., FNP-C
In the coming weeks the Center for Advanced Pediatrics will                  we feel there is a concern we will
launch Connecticut Talks. This public awareness initiative, which            provide information for both the
is a partnership with the Center for Youth Leadership at Brien               teen and the parent.
McMahon High School, educates teens and their parents about                  Connecticut’s Safe Haven law allows a parent to leave a newborn
two important issues: teen dating violence and Connecticut’s Safe            that is 30 days old or younger at a hospital emergency room, no
Haven law for newborns.                                                      questions asked. This is a safe and legal option for parents who
In Connecticut 13% of teens were in a physically abusive dating              are too overwhelmed to care for an infant.
relationship last year. This number is higher when we factor in              We are launching this initiative with Center for Youth Leadership
emotionally abusive relationships that tend to go undocumented.              in the hopes that we will educate other pediatricians in Fairfield
Connecticut ranks 9th in the nation for incidents of physical                County in the 2009-2010 school years about these teen issues.
dating violence. Connecticut Talks is a program that brings both             We applaud the students at Brien McMahon High School
teens and health care providers together to address this issue.              Center for Youth Leadership in taking such a proactive grass
Together with Center for Youth Leadership we have put together               roots leadership role promoting healthy relationship and teen
a questionnaire for teens to answer at their annual physicals. It            awareness.
is a screening tool for the provider to see if your child is at risk. If
School Refusal
by Kym D’Agostino, A.P.R.N.

Many children struggle following long holidays to get back into the           is important to continue to make them do school work, or read
routine of school again. It is perfectly normal to get the first day          until school would be out. In other words no video games or TV
jitters which are usually a mixture of nervousness and excitement.            time (which would serve to reward and reinforce the desire to stay
Some children may give parents some resistance to get out the                 home). Remember this isn’t a punishment, just a natural continua-
door, or on the bus, but once the child gets to school, he/she is             tion of the school day.
fine. But for some children it isn’t that easy. If your child seems to
                                                                             4) Contact a psychiatric mental health professional ASAP. A mix of
be more distressed than normal, which may include stomach pain,
                                                                             therapy and medication, and collaboration between school, parents
nausea or headaches, tearfulness, tantrums, clinging and a panic
                                                                             and treater may be necessary to return your child to school, or to
response to school, than it is important to follow these guidelines.
                                                                             ease a child’s anxiety.
1) If your child’s fears seem atypical, immediately contact school
                                                                             5) Try not to engage in arguments with your child about the issue
personnel such as the teacher, school social worker or guidance
                                                                             as it only heightens anxiety. Instead help them calm down with re-
counselor. Work with them to develop a plan to reintroduce your
                                                                             laxing breaths, and try to engage them with questions about other
child to full class days gradually. Identify a school personnel your
                                                                             times when they were able to cope with a frightening or anxiety pro-
child trusts and begin the day with that person.
                                                                             voking experience. Motivation and reward may also be necessary
2) The most important thing is to remember that once a child                 and helpful to give your child further incentive to return. The goal is
learns that staying home is an option, they will continually refuse          to help them get used to school again, and learn that they can get
to go and the problem will intensify. Don’t argue or negotiate with          through the day.
your child about missing days or staying home. It is important to be
                                                                             For further information on what the school can do to help with anxiety,
clear that staying home or switching schools are not options, but
                                                                             sample accommodations, and how parents can help anxious children,
also to recognize that your child’s fears are real and that you will
                                                                             the web site www.worrywisekids.org is very helpful. Please feel free
support him to feel better.
                                                                             to contact your physician
3) If your child has unusual distress during school and cries to             to request a referral to the
come home, attempt to work with school personnel to come up                  mental health professionals
with a plan to help your child to calm down and do work in a safe            within the practice.
place at school preferably. If they do succeed in going home, it


UNDERSTANDING CONNECTICUT’S
GRADUATED DRIVER’S LICENSE LAWS
By Jennifer Moore, MD

Connecticut is now one of the safest states in the country for a teenager to drive in thanks to new
Graduated Driver’s License Laws. As of August 2008, Teen Drivers have strict passenger restrictions,
driving curfew laws and extensive education requirements in order to drive. Studies have shown that
the more difficult and restricting teen driving laws are the safer it becomes. States that have young
driving ages and few restrictions are the same states where more teens have accidents and either die
in those accidents or kill others. Connecticut is one of the leaders in restrictive codes for teen driving
and one of the few that require parent/legal guardians to attend classes during the permitting process.
Here is a review of the current laws:

DRIVING PeRMITS:
Teenagers may obtain a learner’s permit on their 16th birthday.
While holding a learner’s permit, a teen may only drive with a driving instructor or parent/legal guardian with valid driver’s license.
NO OTHER PASSENGERS ARE ALLOWED IN THE CAR.

Permit holders must complete the following to apply for a driver’s license:
30 hours of classroom work,
40 hours of behind-the-wheel training and
Parents/legal guardians are required to complete a 2-hour class about teen driving laws before applying for a driver’s license.

Depending on who instructs the teen, they can apply for license after 120-180 days. (Commercial/secondary school training is 120 days)

VAlID DRIVeR’S lICeNSe:
FIRST 6 MONTHS after obtaining a driver license, a teen driver may drive with licensed instructor or parents/legal guardian ONLY.
SeCOND 6 MONTHS they may drive with the immediate family (brothers/sisters) in addition to above.
UNTIl 18TH BIRTHDAY, a teen may not drive between 11 pm and 5 am except for employment, school, religious activities, medical necessity.
eVeRY DRIVeR must ALWAYS use a seatbelt, may not use cell phones (even hands-free) while driving.
If any of the restrictions are violated there is an automatic suspension and fine that ranges from 30 days/$125 for 1st offense to 6 months
suspension/$125 and possible imprisonment.

For more information go to: www.ct.gov/teendriving
Is your child getting enough sleep?
by Miranda Vincent, MSN, APRN, PNP-BC, CDE

Do you worry about how much sleep your child is getting each                     relaxed neck muscles it will result in an obstruction in airflow. To
night? Many children don’t get enough sleep and many children                    restore airflow, the body will compensate by forcing a breath, which
don’t get quality sleep.                                                         causes a disruption in the sleep cycle. This can result in several
Every living creature needs sleep. Sleep is the primary activity of the          arousals or awakening through out the night, resulting in a child who
brain during early development. Children’s brains require sleep; good            does not get enough sleep.
sleep. Sleep is especially important as it directly impacts physical,            Sleep deprivation can have a significant impact on their behavior
mental, and cognitive development.                                               causing them to be cranky, irritable, impulsive and hyperactive.
Poor sleep affects children’s brains during the daytime. Without proper          Many children struggle at school, and some have been diagnosed as
sleep, children can have trouble concentrating, learning, cooperating            having ADHD (Attention Deficit Hyperactive Disorder).
and controlling their impulses. However, many parents are unaware that           Sleep deprivation can also affect metabolism. Sleep deprivation
their children are not getting quality sleep because                                             increase the body’s production of the hormone
some sleep issues aren’t so obvious. Some of the                                                  cortisol and lowers the satiety hormone leptin,
signs that your child may not be getting adequate                                                 causing children to be hungrier than usual resulting
sleep and may have a sleep disorder called                                                        in overeating. In order for a child’s metabolism to
Obstructive Sleep Apnea (OSA) are:                                                                work properly, the child needs to get his or her
➥	 Snoring, snorting or crying out in the night                                                   recommended hours of quality sleep. This coupled
➥	 Sleepiness during the day                                                                      with poor eating habits and lack of exercise, puts
➥	 Taking naps when it isn’t nap time (such as on                                                 the child at very high risk for obesity, hypertension
   car rides or in the classroom)                                                                 and type 2 diabetes.
➥	 Tossing and turning in bed                                                                     If you are concerned that your child may have
➥	 Waking several times per night                                                                 symptoms of Obstructive Sleep Apnea (OSA)
➥	 Sleeping with mouth open                                                                       contact our office for an appointment with your
When we go to sleep, our muscles also go                                                          child’s provider.
to sleep, including our neck muscles. If the
breathing tube is narrowed (most likely due to
increased tonsils and adenoids) combined with




Food For Thought
by Carolyn Gundell, M.S. Nutritionist

Parents, Are You a “Fitkid” Role Model?
When was the last time you ate breakfast? Took a walk? Ate fruit or vegetables as a
snack? Drank a glass of low-fat milk at the dinner table? We lead hectic lives, but one
thing is certain…. if parents are healthy role models-their kids eat better and exercise
more. Do you have a challenging eater at home, a child who is gaining weight slowly,
or a child who is gaining weight at a rapid pace? If so, make your day easier and have
more fun as a “fitkid” role model.

Parents’ attitudes toward food choices and fitness can have a significant impact on not
only their children’s awareness, but also their acceptance of healthy foods and exercise.
Children look to adults to learn behavior by watching and imitating them.

     Forget about “Kid Food” and
  “Adult Food” think “Healthy Food”
         for the whole family.
TeACH BY eXAMPle. It is so much easier, healthier and more fun!
MAKe FAMIlY CHOICeS-- What parents choose to eat and drink sets an example for what children will and will not eat. If Mom or Dad do not eat
fresh fruit and veggies then why should little Joey be expected to eat fruit and veggies? If parents do not eat breakfast, then why would children
think it is an important meal? If children are asked to not drink soda, then why should Mom and Dad choose it as a daily beverage.
CHOOSe FAIR-- Decrease the food fights at home. Choose healthy for the whole family. Just because one child is thin does not make it okay for
him to be eating the high sugar cereal or high fat chips. In fact, these items do not increase muscle or height.
TeACH FITNeSS, NOT lOW-CAlORIe-- Children want to see their parents taking good care of themselves. Children will learn how to be respon-
sible for their own bodies if they observe their parents making healthy lifestyle choices.
KeeP THe FAITH, PATIeNCe AND OFFeR OPPORTUNITY
•	 As adults—if we bring the unhealthy food home—we should not be upset when the kids eat it. Why did we bring it home in the first place?
•	 Try trusting that your child will eat something other than the “child friendly nugget”. After all it was an adult who invented it! If Susie hears that
   she is finicky, why should Susie be interested in anything else?
•	 Ask your child to keep an open mind and always assume that your child will enjoy new foods as he/she grows older.
Most children, if provided access to a variety of foods from each of the food groups, will consume the nutrients and energy they need. Providing the
healthy food choices frequently, with less healthy choices limited, is the parent/caregiver’s responsibility.
HELLO FROM PEDIATRIC ENDOCRINE
AND DIABETES SPECIALISTS   by Mina Kim, MD and Elizabeth Doyle, MSN, APRN, PNP-BC
Did you know that there is a Pediatric Endocrinology practice right here                  issues, including growth disorders , issues related to pubertal
in i.park for children with endocrine conditions including type 1                         development, thyroid disorders, Polycystic Ovary Syndrome (PCOS),
diabetes? Pediatric Endocrine and Diabetes Specialists (PEDS) opened                      Obesity/Metabolic syndrome, lipid disorders, and adrenal/ pituitary
in the Spring of 2008. We are the first comprehensive, state-of-the-art                   disorders. We also provide comprehensive, individualized care for
private practice in Fairfield County dedicated to caring for                                      over 85 children with type 1 diabetes, and many youth with
children and young adults with diabetes and endocrine                                             type 2 diabetes. These children are able to return for
disorders, both from Advanced Pediatrics and from other                                           follow-up visits at 1,2, or 3 month intervals (at the discretion
pediatric practices primarily in southern Fairfield County. This                                  of the parent and/or caregiver), and we have early (745a)
practice allows children with these disorders to get state-of-                                    morning, evening (latest 815p) and Saturday appointment
the-art specialty care close to home. Our staff includes a board                                  times available for follow-up visits to provide more flexibility
certified pediatric endocrinologist, Dr. Mina Kim, two pediatric                                  for families. We also have urgent visits available with one
nurse practitioners (Elizabeth Doyle and Miranda Vincent)                                         week for children with diabetes if a problem was to arise
whom have been certified in diabetes education and together                                       between appointments. PEDS also offers monthly support
have over 20 years experience in the care of children and                                         groups at the office on Monday evenings for parents and has
young adults with diabetes, and a pediatric nutritionist, Carolyn                                 also hosted many educational programs, and a diabetes
Gundell. We also utilize the services of psychiatric pediatric nurse                      health fair. Most recently, we have initiated our BeFit, Stay Fit
practitioners Kym D’Agostino and Deirdre Trevett and an exercise                          Program, a comprehensive program for children with weight
specialist Michelle Spaide to complete our team to provide                                challenges coordinated by Miranda Vincent, APRN.
comprehensive care to the children that we follow.                                        For more information about PEDS, check out our web page at
Dr. Kim now follows over 450 children with general endocrinology                          www.pedsct.com, or call (203) 229-2090.



 Car Seat Safety Guideline                                                                by Clare Cardo McKegney, DNP, APRN, CPNP
 Motor vehicle crashes are the leading cause of death among children ages 2 to 14, due in large part to the non use or improper use of child
 seats and seat belts. The Center for Advanced Pediatrics is committed to keeping our infants, children and adolescents safe in all aspects of
 their life. In order to do so we want you to know what the recommendations for car seat safety are according to the National Highway Traffic
 and Safety Administration. This table is a synopsis of the National Highway Traffic and Safety guidelines. It is important to contact your local
 fire and police department to have your child’s car seat fit properly into your car.
                                                                                                                            Remember:
                                                                                                                       •	   All children should be in a car seat as
                                                                                                                            recommended above.
                                                                                                                       •	   Keeping your child rear facing into the
        Infants                  Toddler                             Child                             Tween                second year of life is the safest.
Infants ages birth to one   It is best to ride     Booster seats are for older children           Once a child has     •	   Children should not ride in the front seat
year should ALWAYS          rear facing for as     who have out grown the five point              outgrown the              until 13 years of age.
ride rear facing until 1    long as possible.      harness. Recommendations are                   booster seat they    •	   No child should be left in a car alone.
year and 20 pounds. If      Once your child is     40-65 pounds. Once in a booster seat           should maintain      •	   Children’s whose parents use seat belts
your 1 year old has not     1 year and over 20     children should maintain with the back         in the back seat          are more likely to use a seat belt.
hit 20 pounds then keep     he or she can ride     support until the seat belts fits cor-         until age 13 years   •	   No child should use another child’s car seat
him or her rear – facing.   forward facing. Use    rectly. You may take the back support          of age.                   of reuse an old car seat.
It is better to be rear     a convertible – five   off if the seatbelt fits the child correctly                        •	   Any car seat involved in a motor vehicle
facing into the second      point harness.         across the chest and neck. Children                                      accident should be discarded.
year of life.                                      should use a booster seat until 4’9”.
                                                                                                                                        References:
                                                                                                                              www.nhtsa.gov | www.aap.org
    Halloween Safety                                                              by John Roney, MPA, PA-C
                                                                                                                                   www.fcsafekids.org

  Halloween is a favorite holiday for children and parents alike. With cool costumes and tasty treats, there are many opportunities for fun. It is
  important to remember that there are many obvious and hidden potential dangers that can accompany this exciting holiday. We wanted to
  take this opportunity to share some hopefully helpful tips so everyone can have a safe holiday.

  ➥	Many costumes are not flame retardant and many have loose straps. Never allow youngsters to sleep in
     costumes. Use extra caution around flames.
  ➥	Always put your child’s name and address in the child’s costume and “goodie bag”.
  ➥	Always make sure the child’s mask or costume does not interfere with their vision or cause suffocation.
     Loose straps and capes can cause strangulation or cause your child to trip and fall.
  ➥	Try to stay in well lit areas with sidewalks. Try to make your child’s costume more visible by adding
     reflective tape and using reflective bags. Carry flashlights with fresh batteries.
  ➥	Always travel in groups. Keep in communication with cell phones or walkie-talkies.                           Hope everyone enjoys a
  ➥	Teach children not to stray from the group and never go into strangers homes.                                  healthy and safe fall.
  ➥	Remind children to not eat treats until an adult has a chance to examine them for irregularities.
  ➥	Reinforce good eating habits by rationing treats over a period of time and do not allow them to consume them all at once.
  ➥	Open flames from jack-o’-lanterns pose a potential fire hazard and young children should be closely supervised near them.
     Be certain they are on a secure surface and keep them away from flammable objects (such as wooden furniture, draperies.)
  ➥	Halloween is an excellent time to change the batteries in smoke and carbon monoxide detectors. Review your fire safety and evacuation plan.
                                Special thanks to the American Academy of Pediatrics for help with the above tips.
                         Welcome Brenda M. Ritson, M.D.
                         My Mom tells me that even as a small child, I was always asking questions about how our bodies “work” -
                         I wanted to know where babies came from, what happened if I swallowed gum, and why my heart made a
                         lub-dub sound! So it only seemed natural that when I enrolled at Boston University for college that I declared
                         myself a “pre-med” and chose Human Physiology as a major.

   After finishing college, I decided to take a few years off before heading to medical school and accepted a position as a
   researcher at the Children’s Hospital of Philadelphia. There I studied transfusion techniques for children with blood disorders...
   but it wasn’t too long before I figured out that the lab bench wasn’t for me. I was much more interested in learning the stories of
   the patients behind all the samples and specimens! So my next move was gain some clinical experience by volunteering for a
   year of service through the Americorps National Service Program.... AND I packed my bags for San Francisco where I helped
   run a free clinic for women. At the end of my year of service, I couldn’t wait to get back into the classroom... and I was delighted
   to have been accepted to Yale School of Medicine.

   Medical school was truly an amazing time for me, as I explored basic science, learned my way around the hospital wards, and
   ventured into the world of health policy. In between my 3rd and 4th years of medical school, I won a congressional fellowship
   and worked in the office of Senator Hillary Rodham Clinton. There I gained invaluable experience learning the congressional
   process while covering the issues of medical malpractice, women’s and children’s health, and rural health for the senator. As I
   wrapped up both my time on the hill and medical school, I knew caring for children and serving as their advocate was definitely
   for me...so I packed my bags once again! This time to complete my pediatric residency at the Morgan Stanley/New York
   Presbyterian’s Children’s Hospital of NY (Columbia University Campus).

   Throughout residency, my days spent in clinic were the highlight of my week. I loved meeting new Moms and counseling them
   on newborn care, breast feeding, vaccines and following the bigger the kids as they progressed from day care to summer
   camps and school. And while my course to private practice has taken its twists and turns, I truly feel primary care is my calling
   and couldn’t be more happy to join the Center for Advanced Pediatrics. I look forward to not only making the community my
   home but getting to know all of the families at the practice.




                      The Center For
                      Advanced
                      Pediatrics
Comprehensive Care for Infants, Children & Young Adults
761 Main Avenue, Norwalk, CT 06851

Physicians:
Jeanne M. Marconi, M.D., F.A.A.P.
Arthur E. Dobos Jr., M.D., F.A.A.P.
Mark H. Vincent, M.D., F.A.A.P.
Jennifer Moore, M.D., F.A.A.P., I.B.C.L.C.
Brenda M. Ritson, M.D.
Pediatric Endocrinologist:
Mina Kim, M.D.
Certified Nurse Practitioners:
Clare Cardo McKegney, D.N.P., A.P.R.N., C.P.N.P.
Ellen Fahey, A.P.R.N.
Kym D’Agostino, A.P.R.N.
Deirdre Trevett, A.P.R.N.
Physician Assistant:
John J. Roney, MPA, PA-C
Kristen A. Baker, PA-C
Norwalk Office:
761 Main Avenue
Norwalk, CT 06851
Phone: 203-229-2000

Darien Office:
53 Old Kings Highway North
Darien, CT 06870
Phone: 203-656-1833
                                                     www.thecenterforadvancedpediatrics.com

				
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