Twitter Facebook RSS Feed Print
Your Teen

Concussions May Affect Kid’s Academic Performance

2:00

Can a concussion affect your child ‘s academic performance? According to a new study it might, depending on two factors - the severity of the concussion and the grade level of your child.

A concussion is a brain injury caused by a fall or blow, jolt or bump to the head that causes the brain and head to move back and forth rapidly. While most recover from mild concussions quickly, the young and the elderly can have symptoms that last for days or weeks.

Researchers from the Children's National Health System, George Washington University School of Medicine and Brody School of Medicine at East Carolina University studied 349 students ages 5 to 18 to find out what happened to their academic performance after concussions. They divided the students into those who were continuing to experience problems following head injuries and those who were fully recovered, and asked the students and their parents to fill out questionnaires about their academic performance.

The study found that the severity of the concussion symptoms was directly related to the degree of academic problems among all grade levels. Eighty-eight percent of the children who were not fully recovered still had problems with concentration, headaches and fatigue. Seventy-seven percent of those same children had problems taking notes and found themselves spending more time on homework and having problems studying for exams and quizzes.

High school students reported having the most learning problems, significantly more than middle or elementary school children.

The authors say that their findings suggest that school systems and medical professionals should be working together to support students who are still in the recovery phase.

"Our findings suggest that these supports are particularly necessary for older students, who face greater academic demands relative to their younger peers," the study's authors say.

The signs and symptoms of a concussion can be subtle and may not be immediately apparent. Symptoms can last for days, weeks or even longer.

The Mayo Clinic says that common symptoms after a concussive traumatic brain injury are headache, loss of memory (amnesia) and confusion. The amnesia, which may or may not follow a loss of consciousness, usually involves the loss of memory of the event that caused the concussion.

Signs and symptoms of a concussion may include:

•       Headache or a feeling of pressure in the head

•       Temporary loss of consciousness

•       Confusion or feeling as if in a fog

•       Amnesia surrounding the traumatic event

•       Dizziness or "seeing stars"

•       Ringing in the ears

•       Nausea

•       Vomiting

•       Slurred speech

•       Delayed response to questions

•       Appearing dazed

•       Fatigue

Some symptoms of concussions may be immediate or delayed in onset by hours or days after injury, such as:

•       Concentration and memory complaints

•       Irritability and other personality changes

•       Sensitivity to light and noise

•       Sleep disturbances

•       Psychological adjustment problems and depression

•       Disorders of taste and smell

Symptoms in infants and toddlers can be difficult to recognize because these little ones are unable to communicate how they feel. However, there are nonverbal clues of a possible concussion. These are:

•       Appearing dazed

•       Listlessness and tiring easily

•       Irritability and crankiness

•       Loss of balance and unsteady walking

•       Crying excessively

•       Change in eating or sleeping patterns

•       Lack of interest in favorite toys

Concussions should always be treated seriously even when a child doesn’t seem to be showing physical or mental symptoms. If you suspect your child may have a concussion seek a professional diagnosis to make sure.

Sources: Sandee LaMotte, http://www.cnn.com/2015/05/11/health/concussions-academic-problems/index.html

http://www.mayoclinic.org/diseases-conditions/concussion/basics/symptoms/con-20019272

Your Teen

Teens Getting Less and Less Sleep

2:00

Today’s American teens are getting a whole lot less sleep than they did in the 90s according to a new study. Too little sleep makes focusing difficult and depletes one’s energy. As a result, school performance often suffers and unhealthy and/or unwise decisions are much easier to make.

Just 63 percent of 15-year-olds reported getting seven or more hours of sleep a night in 2012. That number is down from 72 percent in 1991, according to the study.

Between the ages of 13 and 18, teens getting 7 hours or more of sleep a night plummets. At 13, roughly two-thirds of teens get at least seven hours of sleep a night; by 18 that percentage drops to about one-third.

"After age 16, the majority are not meeting the recommended guidelines," said study author Katherine Keyes, an assistant professor of epidemiology at Columbia University's Mailman School of Public Health in New York City.

Why is it so important that teens get enough sleep? A lack of sleep can impact just about every part of their life. Hormones are escalating, social interactions are fragile, school demands are heightened, self-image is developing and many begin testing boundaries with parents, teachers and each other. It can be a rugged time for teens and those around them.

For the study, researchers from Columbia University looked at sleep data from a national survey of more than 270,000 teens from 1991 to 2012. Each year, teens reported how often they got seven or more hours of sleep, as well as how often they got less sleep than they need.

The most recent recommendation from the National Sleep Foundation says teens aged 14 to 17 need eight to 10 hours a night and people aged 18 to 25 need seven to nine hours.

The largest declines in those getting enough sleep occurred between 1991 through 2000; then the problem plateaued, Keyes said.

Researchers also found that girls were less likely to get an adequate amount of sleep compared to boys.

So what’s causing the decline? There a several theories about what may be contributing to this downward slide in teen sleep.

Keyes did not have access to information about the teens' use of electronic media, a factor often blamed for lack of sleep as teens text, check social media, play video games and work on laptops late into the night. However, that might be a factor, she said.

"On an individual level, excessive use of technology may impair an adolescent's ability to sleep," Keyes said.

Caffeine may also be a culprit. It’s estimated that about 30 percent of adolescents report consuming energy drinks which are packed with caffeine. Many teens drink specialty coffees as well.

Another issue may be early school start times. Some sleep disorder experts believe that starting school – even an hour later- could help teens get more valuable sleep. Starting school, for instance at 8:30 a.m., is an approach favored by the American Academy of Pediatrics.

Other studies have noted that a lack of sleep is linked with many other teen health problems including obesity, car accidents, depression and a drop in school performance.

When kids are younger, parents are more likely to set limits on bedtime behavior as well as bedtimes. Once kids reach their teens, some of those limits may get a little lax, but this is the time when they are needed most.

Parents still have the authority to set a bedtime and require that computers, tablets and phones are off at least an hour before bedtime. Many kids (and adults) are addicted to their smartphones, so it’s a tough rule to set; it takes a strong commitment and a good example for it to work.

Lack of sleep is hard on everyone, but teens really need the extra help to stay healthy and function well in school. It has such a big impact not only on their present but for their future as well.

Source: Kathleen Doheny, http://www.webmd.com/children/news/20150216/us-teens-getting-less-sleep-than-ever

Your Baby

FDA Warning: No Homeopathic Teething Tablets or Gels

1:45

Some babies have little to no symptoms during teething, while others experience quite a bit of pain for months. When teething pain occurs, infants may cry and be irritable until they find relief.

Homeopathic tablets and gels aimed at helping soothe babies’ pain may be dangerous for infants and toddlers, the Food and Drug Administration (FDA) recently announced in a statement. 

The FDA is investigating reports of seizures in infants and small children who were given homeopathic teething products, which may contain "natural" compounds but are not regulated as drugs by the FDA.

In addition, the FDA said in the statement that "consumers should seek medical care immediately if their child experiences seizures, difficulty breathing, lethargy, excessive sleepiness, muscle weakness, skin flushing, constipation, difficulty urinating or agitation" after using homeopathic teething tablets and gels.

According to the National Center for Complimentary and Integrated Health, homeopathy relies on two theories: “like cures like”—the notion that a disease can be cured by a substance that produces similar symptoms in healthy people; and “law of minimum dose”—the notion that the lower the dose of the medication, the greater its effectiveness.

The FDA said in the statement that the agency is not aware of any proven health benefit of using homeopathic teething tablets and gels.

In 2010, the FDA issued a safety alert about a homeopathic teething tablet that contained belladonna. Belladonna — also called deadly nightshade — is a poisonous plant that contains a chemical called atropine. At high levels, atropine can be deadly. In homeopathy, it is used to treat redness and inflammation.

At the time, the FDA found that the teething tablets contained inconsistent amounts of belladonna. The company that made the tablets, Hyland, subsequently recalled the product.

Hyland issued a statement and video in response to the current FDA warning against the use of homeopathic teething remedies.

"As you may have seen, on September 30, 2016, the Food and Drug Administration issued a surprise statement recommending that consumers discontinue use of homeopathic teething tablets and gels because they may pose a risk," Hyland's stated. "We are fully cooperating with FDA’s inquiry and we’re providing them with all the data we have. We also hope to learn from FDA what facts, if any, the Agency has based its action on."

Hyland also noted “The safety and effectiveness of Hyland’s natural homeopathic medicines is our top priority. That’s why we work with regulators to ensure that our products meet the highest standards. If we ever had reason to be concerned of that safety, we would act immediately."

"Teething can be managed without prescription or over-the-counter remedies," Dr. Janet Woodcock, director of the FDA's Center for Drug Evaluation and Research, said in the FDA statement. 

The American Academy of Pediatrics (AAP) recommends teething rings or hard, unsweetened teething crackers. Do not use frozen teething toys because they can cause more discomfort by injuring a baby's mouth, the AAP advises.

Be sure and check with your pediatrician about teething pain relief if your little one is having a hard time getting through the teething process.

Story sources: Sara G. Miller, http://www.livescience.com/56352-fda-warning-homeopathic-teething-tablets.html

Michael Johnsen, http://www.drugstorenews.com/article/hylands-responds-fda-teething-tablet-warning

 

Your Child

Never Use Q-Tips to Clean Your Child’s Ears

1:45

Parents and caregivers seem compelled to clean their child’s ears with a cotton swab. Despite repeated warnings to not put anything smaller than one’s elbow inside a child’s ear, more than 263,000 U.S. children had to be treated in emergency rooms for ear injuries related to cotton-tip applicators between 1990 and 2010, according to a new study.

Almost three-quarters of the cases — 73 percent — involved ear cleaning. About two-thirds of the patients in the study were younger than 8.

"There's this misconception that people need to clean their ears in the home setting and that this is the product to do that with," Dr. Kris Jatana, senior author of the study and a pediatric ear, nose and throat specialist at Nationwide Children’s Hospital, told TODAY.

"The ears themselves are typically self-cleaning... It is risky to use cotton-tip applicators in the ear canal across all age groups, and certainly we are seeing way too many injuries as a result of this practice."

The most common incident in the ER was the presence of a foreign body, such as part of the cotton swab and a perforated eardrum, researchers said.

"It's difficult for people to gauge how deep they're putting [the swab]," Jatana said. "Sometimes, it just takes a small movement to puncture the ear drum."

Physicians specializing in ear and throat diseases say that Q-tips and similar products should never be used for cleaning the ears. Not only can they cause ear canal injuries, but can also push ear wax deeper into the canal causing it to become trapped.

Studies have found 90 percent of people believe ears should be cleaned and say they regularly clean their ears or their children’s ears, according to the American Academy of Otolaryngology—Head and Neck Surgery Foundation. Kids also apparently learn to stick Q-tips into their ears by watching their parents: about 77 percent of the injuries in the study happened when the child was handling the swab himself.

If you see earwax on the outer part of your child’s ear, you can clean it with a washcloth or wipe, Jatana suggests. In most cases, earwax is actually beneficial for the ear. It protects, lubricates and cleans the ear canal. Occasionally, children and adults have excessive wax build-up, but a doctor should be consulted about removal.

Hearing loss, a feeling of fullness in the ear or ear pain are symptoms that should be checked out. An ear, nose and throat doctor can remove more stubborn excess wax.

Story source, A. Pawlowski, http://www.today.com/health/cotton-swabs-are-causing-ear-injuries-thousands-kids-t111296

 

Parenting

Pregnancy May Actually Modify a Mom’s Brain

Baby, motherhood, health

Moms often feel like they have a “sixth sense” when it comes to their newborn’s needs and survival. What they may really be experiencing are the physical changes that pregnancy can have on the brain.

Researchers in Spain wanted to know if pregnancy could actually change the structure of a woman’s brain, impacting how she reacts to her newborn. What they found was that long-term changes to the brain do occur and that they may have evolved over time to improve a mother’s ability to protect and nurture her child.

The researchers used information gathered from MRI scans that compared the brain structures of 25 women before and after their first pregnancies.

After giving birth, the women had significant reductions of gray matter in areas of the brain associated with social interactions, the findings showed. Those brain regions overlapped with ones that activated when mothers watched images of their own babies.

“The changes concern brain areas associated with functions necessary to manage the challenges of motherhood," study co-lead author Erika Barba said in a news release from the Autonomous University of Barcelona.

Some women feel like they have trouble remembering things during and after their pregnancy, sometimes referred to as having “baby brain.” The good news is that researchers reported the participants had no changes in memory or other thinking functions during pregnancy. That means the loss of gray matter does not lead to problems in those areas. The brain changes, which lasted for at least two years after the women gave birth, probably help them adapt to motherhood, the study authors suggested.

According to study co-director Oscar Vilarroya: "The findings point to an adaptive process related to the benefits of better detecting the needs of the child, such as identifying the newborn's emotional state. Moreover, they provide primary clues regarding the neural basis of motherhood, perinatal mental health and brain plasticity in general."

Researchers also found that they were able to use the brain changes to predict a mother’s attachment to her baby. The changes were similar whether women got pregnant naturally or through fertility treatments.

This is the first research to show that pregnancy involves long-lasting changes -- at least for two years postpartum.

The term “mama bear” has often been used to describe the fierceness that some mothers’ exhibit when they feel their child is in danger or has been wronged. Now science may have found out why that is.

The study was published in the journal Nature Neuroscience.

Story source: Robert Preidt, http://www.webmd.com/baby/news/20161219/pregnancy-may-spur-mothering-changes-in-a-womans-brain

Daily Dose

Jaundice in Newborns

1:30 to read

It is not at all uncommon for a healthy newborn to develop jaundice in the first several days of life. Bilirubin is produced when red blood cells are broken down. It is a yellow pigment that we all metabolize in the liver and then it is excreted in urine and stools. In an newborn, the body produces almost 2-3 times the bilirubin that an adult does. Because newborns are also “immature” their liver cannot keep up with the bilirubin production and therefore bilirubin levels rise. In some cases the bilirubin is high enough to cause a yellowing of the skin (jaundice), and this is termed physiologic jaundice of the newborn. 

 

Your infant will have their bilirubin level checked while they are in the hospital and your pediatrician will follow any bilirubin levels that seem to be rising. In most hospitals the bilirubin is tested transcutaneously (through the skin), and you may never know that you baby has been tested. If bilirubin levels seem to be high, a blood test will be performed to more accurately assess the bilirubin level. If bilirubin levels continue to rise a baby may then be put under phototherapy (special blue lights that breaks down bilirubin in the skin and help it to be eliminated). Phototherapy prevents extremely high levels of bilirubin which may get into the brain and could be toxic to the baby and cause brain damage.

 

When a baby is put under phototherapy they may be in a basinette or wrapped in a “bili-blanket”  and they will wear sunglasses to prevent any damage to their eyes from light. They are usually naked or only in a diaper so that as much skin is exposed as possible. In most cases the bilirubin levels have peaked by day of life 3 or 4 and the baby will no longer need phototherapy. While the baby is under the “bili-lights” they will continue to have blood tests (from their heels) to follow the bilirubin levels.

 

As babies are now being discharged in 24-48 hours after delivery some babies will develop jaundice after they have already gone home…so you your doctor will plan on seeing you 1 to 2 days after your are discharged. But, should you notice that your baby seems to be getting more jaundiced you should call you doctor and be seen sooner.  

 

Just this week I saw a baby who continued to become more jaundiced after he went home. At times I see this when a mother is breast feeding and her milk has not yet “come in”.  If a baby is not getting a lot of milk then they cannot poop and pee out bilirubin…somethings just take time to get going with feeding, peeing, pooping and liver maturation. So…this baby boy was started o home phototherapy. Rather than re-admitting him to the hospital, a pediatric home health care company sent out a nurse with a bill blanket who instructed the parents on the use of it. The baby was then able to feed at home every 2-3 hours, and the bili-blanket was used throughout the day and night. The parents lived so close to the office that they would bring the baby in for bilirubin tests, while in other cases the nurse will go to the home to do the testing.  Home phototherapy in an otherwise healthy infant does not disrupt the new family and really helps the mother establish her breast feeding and lets “everyone” sleep in their own beds!

 

This baby only required phototherapy for 24 hours…in some babies it may be longer. Once the bilirubin was back in a “safe range” the lights were discontinued and he will continue to process the bilirubin on his own. His little yellow face and eyes will be the last evidence of his newborn jaundice and “one for the baby books” as it should never be a problem again.

 

Your Child

Concussions May Have Long Term Impact on Kids’ Mental Health

1:45

There’s been a tremendous amount of information about concussions in the news lately. One question many parents want answered is, if my child suffers a concussion could it have an impact on his or her mental, physical or intellectual health for the rest of their lives?

The answer is yes according to a recent study, and for kids who have had more than one concussion; the risks are even higher that they will suffer repercussions into adulthood.

A report released by the health insurer, Blue Cross Blue Shield, said diagnosed concussions among people under the age of 20 climbed 71 percent between 2010 and 2015. Part of that increase may be attributed to an improved awareness of the dangers of concussions, prompting coaches and parents to seek medical attention for athletes and kids.  However, the high numbers also suggest that more children are experiencing head injuries than in the past.

The data also showed that twice as many boys were diagnosed with concussion than girls, although the rates for girls increased by 119 percent during the dates examined.

While more general information about concussion is becoming abundant, the effects on the health of children into adulthood have largely remained unknown.

For the new study looking into the long-term effects, multiple data sources were reviewed including a valuable collection of records from Sweden.

A plethora of linked registries in that nation contain information about people’s medical and hospital visits, socioeconomic status, education, physical disabilities and other aspects of their lives, says Dr. Seena Fazel, a professor of forensic psychiatry at Oxford and the new study’s senior author. The registries also allow researchers to compile information about family members.

In this case, the scientists concentrated on all Swedes born between 1973 and 1985 and looked for those who had experienced a head injury of some kind before the age of 25. More than 104,000 people qualified. Researched reviewed data about these people for 40 years.

Along with each patient, researchers also compiled similar medical records for a sibling who had not been diagnosed with a head injury and compared the results between family members and the total population of the country.

The results of the study were unsettling. They found that young people who had experienced a single diagnosed concussion were more likely to be receiving medical disability payments as adults, to have at some point sought mental health care, were less likely to have graduated from high school or attended college and were twice as prone to die prematurely than their uninjured sibling.

If the patient had experienced more than one concussion while young or if the brain injury was more severe than a concussion, the possibility of physical and psychological problems during adulthood increased.

While the results of the study were disconcerting, there was also good news in the report. Not everyone who had a concussion or brain injury as a child or teenager experienced mental or intellectual problems -related to the brain injury - as an adult.

“The majority of individuals who had diagnoses of brain injury in our study did not experience adverse outcomes,” Dr. Fazel says.

Unfortunately, it is impossible at the moment to identify which children or teenagers who experience head trauma may be most at risk of struggling in later life and which will instead recover without apparent complications, he says.

The overall message from this study is that all steps should be taken to prevent childhood head injuries.

If a young person does suffer head trauma, he continues, more and longer-lasting monitoring is also probably a good idea. Such monitoring may be especially important if the child shows any signs of “a decline in psychosocial performance,” Dr. Fazel says, such as a drop in grades or a change, even subtle, in personality. A neurologist can provide useful assessments, and regular follow-up neurological assessments may need to be continued, even into adulthood.

The study was published online in the journal PLOS Medicine.

 Story source: Gretchen Reynolds, http://www.nytimes.com/2016/10/05/well/move/a-single-concussion-may-have-lasting-impact.html?WT.mc_id=SmartBriefs-Newsletter&WT.mc_ev=click&ad-keywords=smartbriefsnl

Your Child

Preschoolers Should be Examined for Possible Vision Problems

2:00

For very young children, blurry vision may seem normal to them. There’s also a good chance that their parents won’t know their little ones are having difficulty seeing clearly.

That’s why the U.S. Preventive Services Task Force (USPSTF) is recommending that 3 to 5 year olds receive vision screening at least once to detect abnormal visual development or risk factors for it.

A couple of visions problems that first show symptoms at this age are Strabismuc (crossed eyes) and Amblyopia (lazy eye).)

Crossed eyes do not look in the same direction at the same time. Six muscles attach to each eye to control how it moves. The muscles receive signals from the brain that direct their movements. Normally, the eyes work together so they both point at the same place. When problems develop with eye movement control, an eye may turn in, out, up or down.

Infants and young children often develop this condition by the age of three, but older children and adults can also get crossed eyes. People often believe that a child with strabismus will outgrow the condition. However, this is not true. In fact, strabismus may get worse without treatment. An optometrist should examine any child older than 4 months whose eyes do not appear to be straight all the time.

Lazy eye is the loss or lack of development of central vision in one eye that is unrelated to any eye health problem and is not correctable with lenses.

Lazy eye often occurs in people who have crossed eyes (misalignment) or a large difference in the degree of nearsightedness or farsightedness between the two eyes. It usually develops before age 6 and it does not affect side (peripheral) vision.

Treatment for lazy eye may include a combination of prescription lenses, prisms, vision therapy and eye patching. In vision therapy, patients learn how to use the two eyes together, which helps prevent lazy eye from reoccurring.

According to the American Public Health Association, about 10% of preschoolers have eye or vision problems. However, children this age generally will not voice complaints about their eyes.

Parents should watch for signs that may indicate a vision problem, including:

•       Sitting close to the TV or holding a book too close

•       Squinting

•       Tilting their head

•       Frequently rubbing their eyes

•       Short attention span for the child's age

•       Turning of an eye in or out 

•       Sensitivity to light

•       Difficulty with eye-hand-body coordination when playing ball or bike riding

•       Avoiding coloring activities, puzzles and other detailed activities

If you notice any of these signs in your preschooler, arrange for a visit to your doctor of optometry.

While the two may sound similar, there is a difference between a vision screening and an eye exam.

Vision screenings are a limited process and can't be used to diagnose an eye or vision problem, but rather may indicate a potential need for further evaluation. They may miss as many as 60% of children with vision problems. Even if a vision screening does not identify a possible vision problem, a child may still have one.

Sometimes, parents get a false sense that their child doesn’t have a vision problem if he or she passes a vision screening.

A doctor of optometry performs an eye exam. He or she will look for any developmental problems and evidence of disease. If needed, your doctor of optometry can prescribe treatment, including eyeglasses and/or vision therapy, to correct a vision development problem.

When considering an eye exam, parents should:

•       Make an appointment early in the day. Allow about one hour.

•       Talk about the examination in advance and encourage your child's questions.

•       Explain the examination in terms your child can understand, comparing the E chart to a puzzle and the instruments to tiny flashlights and a kaleidoscope.

The preschool years are a time for developing the visual abilities that a child will need in school and throughout his or her life. Steps taken during these years to help ensure vision is developing normally can provide a child with a good "head start" for school.

Story sources:

http://www.aoa.org/patients-and-public/good-vision-throughout-life/childrens-vision/preschool-vision-2-to-5-years-of-age?sso=y

Molly Walker, http://www.medpagetoday.com/ophthalmology/generalophthalmology/63476

 

Daily Dose

HPV Vaccine

1:30 to read

I don’t think I have posted the latest good news about vaccines. As you know I am a huge proponent of vaccinating children (and ourselves), and remind patients that there continue to be ongoing studies regarding vaccine safety, as well as efficacy.  The CDC and ACIP recently announced that the HPV vaccine may be protective and effective after just 2 doses of vaccine rather than the previous recommendation of a series of 3 vaccines.  That is good news for teens, especially those that are “needle phobic”!  

 

The ACIP (Advisory Committee on Immunization Practices  recommended  a 2 dose HPV vaccine series for young adolescents, those that begin the vaccine series between 11 and 14 years.  For adolescents who begin the HPV vaccine series at the age 15 or older, the 3 dose series is still recommended.

 

This recommendation was based upon data presented to the ACIP and CDC from clinical trials which showed that two doses of HPV vaccine in younger adolescents (11-14 years old) produced an immune response similar or higher than the response in older adolescents (15 yrs or older). 

 

The HPV vaccine, which prevents many different types of cancer caused by human papilloma virus, has been routinely recommended beginning at age 11 years  approved to use as young as 9 years), but unfortunately only about 42% of girls and 28% of teenage boys has completed the 3 dose series.  

 

By showing that a 2 dose series (when started at younger ages) is effective and protective the hope is that more and more young adolescents will complete the series.  The two doses now must be spaced at least 6 months apart and may even be given at the 11 year and then 12 year check up which would not require as many visit to the pediatrician.

 

According to the CDC more HPV - related cancers have been diagnosed in recent years, and reported more than 31,000 new cases of cancer each year (from 2008 - 2012) were attributable to HPV, and that routine vaccination could potentially prevent about 29,000 cases of those cancers from occurring.  But, in order to see these numbers shrink, more and more adolescents need to be immunized…before they are ever exposed to the virus. Remember, the HPV vaccine is protective against certain strains of HPV, but does not treat HPV disease.

 

So..once again a good example of using science based evidence to provide the best protection against a serious disease…with less shots too!! Win - Win!!

 

 

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

DR SUE'S DAILY DOSE

Are your kids too busy with school & activities?

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.