Sansum Clinic
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Pediatric Consultation Guidelines

Scheduling An Appointment

Our Pediatrics reception staff schedules all office visits. We make every attempt to accommodate your requests when possible. When scheduling an appointment, please:

  1. Call early in the day. Our receptionists are available to assist you.
  2. Be brief and concise in explaining the problem(s).
  3. Understand the momentary dilemma of the receptionist who is attempting to accommodate multiple calls at the same time. If you have a true emergency, state so immediately. Otherwise, please be patient if you are placed on temporary hold. You may be asked to speak with our triage nurse prior to making your appointment, especially when requesting a same day appointment. He/she can assist in evaluating the illness, and provide advice about treatment.
  4. Leave your name, phone number and how long you will be available at the phone number provided if your call requires a callback response. Keep in mind that our immediate priorities are those patients in the office at the time. You can anticipate a return call within a reasonable time period. An emergency will receive an immediate return call.

Rescheduling or Canceling an Appointment

If you are unable to keep an appointment, for whatever reason, please call well ahead of time to reschedule or cancel your appointment to allow another person the opportunity of being seen at that time. "No show" visits for physical exams and consultations are not likely to be rescheduled in the near future because of the lost time involved. We thank you in advance for your thoughtful consideration.

"Well" vs. "Sick"

We use time to attempt to separate the well infants, children and young adults, from those acutely ill or sick.

Please understand our receptionists do not need to schedule an ill visit during these times. Contagious illnesses and problems, such as chicken pox, scarlet fever, lice, scabies, impetigo, etc. will be directed to an alternate entrance designated for infection evaluation.

Saturday Mornings

Our staff is available to see ill or sick children or arrange urgent care on Saturday mornings in our Santa Barbara office from 9 a.m. to 12 noon. Staffing is reduced on Saturday mornings, therefore we are unable to schedule physicals and well baby exams on Saturdays. Please call early Saturday morning to allow us to prepare for your arrival, and to segregate possible infectious or contagious problems.

Appointment Day

Please arrive at the office on time or a few minutes early. Late arrivals may need to be rescheduled. We will sincerely attempt to honor your appointment time as we value your time and understand the frustration of lengthy waiting periods. Unforeseen problems or emergencies will arise on occasion, and delay or alter our schedule. We request your patience and understanding when such incidents occur.

First Visit

For your first visit, please arrive 30 minutes before your appointment. You will be requested to complete a medical history questionnaire prior to your office visit to allow your physician to spend more time with your present problem rather than those of the past.

Walking In

"Walking in" without calling beforehand is disruptive and not respectful of those patients scheduled to be seen. In general, we will not see you ahead of the scheduled visits unless you have a true emergency.

Visitors & Tag-A-Longs

We wish to discourage visitors to the office including siblings and friends. Invariably, they risk being exposed to someone else's illness. Also, please do not schedule one appointment for one child and then surprise us with three children. We need a medical chart and the appropriate allocated time for every patient being evaluated.

Young Adult Evaluations

Our young adult patients will be directed to their own waiting area and examination rooms where we prefer to meet with them privately. We request parents, relatives and friends wait in the area outside the room.

Forms & Past Records

Please remember to bring all appropriate forms. It is very helpful to call your child's prior medical office before your first appointment with us and have copies of your immunization record. If you do not have a summary of immunizations, we will be happy to mail a record release to your child's previous health care provider.

Behavior

Please supervise your child's activity during your visit. We are happy to provide reading material upon request. Please do not permit "exploration" of drawers, trash cans or medical instruments. Thank you.

Antibiotics

Using antibiotics appropriately is important for your child's health. Remember to always complete the requested treatment regimen as prescribed. Do not start "left-over" antibiotics or "share" the antibiotic with other children or friends without discussing this with your pediatrician. We strongly feel that an illness requiring an antibiotic warrants an examination. Telephone requests for an antibiotic will not be honored.

Emergencies

True Emergencies

Usually a major burn, major bleeding, choking, a convulsion or a coma will not be overlooked or underestimated. However, there are some emergency symptoms that may be difficult to recognize or even be considered serious. Following is a list of "true emergencies."

  • Accidental or deliberate ingestion of medication or toxic material
  • Asthmatic wheezing with peak-flow meter in the "red"
  • Bleeding uncontrollably
  • Bluish lips or cyanosis
  • Bulging soft spot
  • Choking or labored breathing
  • Convulsions or seizure-like movements
  • Dehydration due to persistent vomiting or diarrhea
  • Fever over 105° Fahrenheit or 40.6° Celsius
  • Inability to arouse or awaken
  • Loss of ability to stand or walk
  • Purple or blood-red spots on the skin
  • Severe lethargy or pain
  • Sick newborn less than one month old
  • Stiff neck
  • Sudden onset of drooling or spitting
  • Tender abdomen or groin
  • Traumatic accidents such as head or neck injuries or burns

With any of the above, or any situation of great concern to you, please promptly call and let us know there is an emergency. On rare occasions, as in a motor vehicle accident (MVA) or a bicycle accident, you may have to call the paramedics (dial 911) to respond promptly to the scene with treatment and subsequent transport to the hospital emergency room.

Emergency Facilities During "After Office Hours"

A vital component of the health care system includes the Emergency Room at every hospital to render care for emergencies of every magnitude. To provide 24-hour service, state-of-the-art equipment capabilities, and a highly skilled critical care staff is a costly service. If laboratory studies and x-rays are needed, the charges increase rapidly. The inappropriate use of the emergency room or similar facilities has resulted in an unnecessary financial burden upon many families, especially when care could be readily sought during regular or extended office hours.

Should "after hours" examinations be necessary, we generally refer to a local hospital. We strongly recommend you call us before going to an Urgent Care, Emergency Room or similar facility so that we can discuss the problem and need for going there. If needed and appropriate, we will then refer you to the physician in charge or "on-call." We will call ahead to prepare the on-call physician and staff for your arrival and avail ourselves as consultants if the on-call physician desires. If hospitalization is necessary, we will promptly respond.

If you would like to have all Emergency Room visit records and laboratory results included in your child's medical chart, please make this request upon registration and provide the receptionist staff your child's physician's name and office address.

Fever

Fever, or temperature elevation, constitutes the majority of calls we receive both during and after office hours. Normal body temperature is generally about 97.6-99.6° Fahrenheit (36.4-37.6° Celsius, if taken in the rectum). If body temperature is taken in the armpit, it may be a degree or so lower. Fever may be a sign that the body is fighting an infection, and it is commonly accompanied by thirst, loss of appetite and general discomfort. Fever may follow the administration of an immunization for 24 to 48 hours.

While fever should be a cause for concern, it is rarely a cause for alarm. The degree of temperature elevation is not in itself a reliable indication of the severity of an illness. On the other hand, a serious illness may be developing in the absence of fever. The most important point is the child's general appearance and disposition. If he/she is doing reasonably well, you can be reassured things are going well. Otherwise, please consult us. We will be happy to supply you with our "Fever Information Sheet" for your easy reference.

Some helpful suggestions to assist your care of the child with fever:

  • Keep your child quietly occupied. Excitement, emotional stress or undue physical activity can further raise the body temperature.
  • Maintain normal room temperature (about 68 degrees Fahrenheit or 20 degrees Celsius), just as if your child were not ill.
  • Use light clothing and covers to allow the escape of body heat. If your child complains of being chilly, he/she may have another blanket or two, but remove the extra covers when the chills have passed. Fevers are higher in the late afternoon and early evening hours, and lowest in the morning hours.
  • If your child's temperature rises to a high level, a sponge bath with tepid or cool water will help reduce the temperature to a more comfortable level. Avoid the use of alcohol baths.
  • If your child has fever seizures, do not give him/her any oral medications or a bath.
  • Offer your child liquids (fruit juices, soft drinks, cool water, popsicles and cracked ice) as often as he/she will take them.
  • Do not force your child to eat. You will know soon enough when appetite returns.
  • For infants under three months of age with a temperature of 100° Fahrenheit or greater, please consult us immediately.

Poisons, Toxic Materials and Poisonous Plants

We remind parents on a daily basis to lock up medications at home and utilize "child proofing," whenever possible. Every home should have a bottle of Syrup of Ipecac in the medicine cabinet for use to induce vomiting. We provide complimentary samples for your home. Be sure to call before giving ipecac. With certain substances, vomiting should not be induced. Please call as soon as possible when ingestion is suspected. We consult with L.A. Poison Control (1-800-876-4766).

Cardiopulmonary Resuscitation (CPR)

We recommend that everyone from age 12 and above be knowledgeable in administering CPR. Certifying courses are taught in Santa Barbara as part of the curriculum in some local schools. CPR classes are provided by our Health Education Department, as well as American Red Cross, Santa Barbara County Fire Department, and various hospitals. You may save the life of a loved one or friend if such an emergency arises. Choking is the greatest concern with children. Do you know the Heimlich Maneuver? It is your responsibility to be prepared. If you own or live near a swimming pool, hot tub or jacuzzi, it is vital that you know CPR.

Telephone Calls

After Office Hours

After office hours, all calls to Sansum Clinic are taken by our answering service.

Please be patient with the operator as he/she handles a number of calls. Be sure to give the operator your phone number, especially if it is unlisted. If you have a "true emergency", please say so, and the operator will attempt to locate the on-call physician immediately. Otherwise, understand that your call will be returned at the time we have informed the operator.

This will especially apply to weekend hours. Usually, the call will be returned within a reasonable period of time (1 to 11/2 hours) unless we are delayed at the hospital or elsewhere, with another problem, in which case the operator will provide you with proper instructions of available options. If your call is not returned within 11/2 hours, please call again to make sure there have been no errors in recording your number, notifying the physician(s), phone operation ("out-of-order"), etc. Pediatricians have a lifestyle similar to yours, with family, friends and community activities. Please be sure "after hour" calls are for significant inquiries and advice that cannot wait until our regular office hours.

How to Get the Most from a Telephone Consultation

Prior to calling, have a pencil and paper by the telephone and the telephone number of your pharmacy, if possible. Assume that all local pharmacies will be closed after 9:00 p.m. (most by 6:00 p.m.) and do not open until 10:00 a.m. We appreciate you not holding your crying infant in your arms next to the telephone while we are communicating with you.

The quality of advice we give over the telephone depends on the information you give us. Prior to calling, please organize your thoughts as follow:

  1. What is the primary reason of your call? (For example: injury, earache, cough, etc.)
  2. When did the illness or injury begin? How many hours or days?
  3. In your opinion, how sick is your child?
  4. What treatment, if any, have you given?
  5. Does your child have a chronic illness or special need?

Schedules of Visits

Periodic health care begins at the time of birth and continues throughout life. The following schedule of visits is recommended (aside from acute illness or crisis visits):

Age What To Expect
Newborn Visit at the Hospital Daily newborn examination and arent conference
First office Visit (within a few days after leaving the hospital) Check for jaundice. Please remember to bring along your list of questions.
2 Weeks Physical Exam
6-8 Weeks Physical Exam and Immunizations
16-18 Weeks Physical Exam and Immunizations
22-26 Weeks Physical Exam and Immunizations
9-10 Months Physical Exam, Anemia Check and TB Skin Test (PPD), if indicated
12 Months Physical Exam and Immunizations
15 Months Physical Exam and Immunizations
18 Months Physical Exam and Immunizations
2 Years Physical Exam
3 Years Physical Exam, Check Blood Pressure, Vision and Hearing
4-5 Years Physical Exam, Check Vision and hearing, Immunizations and TB Skin Test (PPD), if a risk factor
6+ Years Yearly exams to age 6, and periodic evaluations thereafter with immunizations at age 10 years.

Prevention

The thrust of our efforts is in the prevention of problems, such as major diseases, accidents, and the so-called "life-style" disorders (stress, smoking, obesity, chemical/drug intake and promiscuity). This approach will include diet and exercise guidance, safety and other counseling when appropriate.

Immunizations

Immunizations against childhood diseases are one of the most valuable preventive medicine practices in the world. We follow the recommendations of the American Academy of Pediatrics. Immunizations are administered at appropriate intervals commencing after birth to protect your child against major childhood diseases.

  • DTaP: Diphtheria, Tetanus, Pertussis
  • Td: Tetanus-diphtheria booster every ten years
  • Polio: Inactivated (IPV)
  • MMR: Measles, Mumps, Rubella
  • Hib: H. influenzae type b
  • Hep-B: Hepatitis
  • Pneumococcal Vaccine
  • VZV: Varicella Zoster (chicken pox)
  • PPD: Tuberculosis skin test is applied to the arm when various risk factors are present to determine exposure to this highly contagious, but readily treatable, disease which is prevalent in Southern California

Information explaining each immunization and possible reaction that may occur, along with subsequent care if a reaction develops will be given to you prior to administering the vaccine to your child. Your questions are encouraged and a signed consent form for administration of the vaccine will be requested.

Your patience is greatly appreciated when waiting for the nurse to give your child's immunizations. The preparation time is needed to calculate the correct dosage, check for accuracy and document the immunization. You can help expedite the immunization process by bringing a complete vaccine record.

Summary

  • Attempt to seek care during our regular and extended office hours when possible. We encourage you to call to discuss symptoms and a treatment plan with our triage nursing staff.
  • The prevention of problems is still foremost important. Be knowledgeable regarding self-care and wellness by having adequate resource materials available for home consultation. Increasing your knowledge and experience, may prevent many office and emergency room visits.
  • Most illnesses in children are short lived and caused by viruses for which there is no specific treatment (i.e., medication remedy). Bed rest and encouraging liquids are the primary treatment recommendations. Be patient and allow 2 to 4 days to recover from most mild "evil spirits."
  • Reassurance from a parent or friend is a great mental boost. Children quickly sense your anxiety and apprehension, especially if you are focused on a specific disease entity. Not every cough is pneumonia, not every stomachache is appendicitis, not every headache is a migraine, and not every skin rash is leprosy.
  • Have a copy of our Fever Information Sheet available at home to manage temperature elevation.
  • Always attempt to remain calm. Medical facilities are close by and readily available 24 hours a day.
  • Illnesses always appear worse at night and "much improved" in the morning.
  • Lastly and most importantly, YOU are your child's best caregiver. We are here to help when you need us. Continue to give the same great loving care to your child.
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