Patient Articles

OB Articles:

• Fetal Kick Counts
• Testing for Fetal Problems
• Gene Disorders
• Nausea and Vomiting during pregnancy
  
  

GYN Articles:

• The Importance of Your Annual Well Woman Exam
  
  

Miscellaneous Articles:

• Cardiovascular Health
• Depression and Your Options
• Choosing a Pediatrician
• Baby Proofing - what does it mean and where should you start?
• Protecting Against Influenza - the flu shot

OB Articles:

Oct 31, 2012:Fetal Kick Counts 

Woohoo!  You are nearing the end of your second trimester and heading into the beginning of your third and last trimester.  You have probably been able to feel your baby move since about 18-22 weeks, and by now you will be feeling your baby move daily.  You may also have a good grasp on your baby's sleep-wake cycles, different types of movements such as rolls and jabs, and what triggers activity.  

The American College of Obstetrics and Gynecology supports starting Fetal Kick Counts between 24 and 26 weeks gestation by timing how long it takes to feel 10 movements.  This is used to help evaluate the health of the fetus.  These movements may consist of kicks, flutters, rolls, or swishes and ideally, you will feel 10 movements in one hour.  One of the best ways to do this is for you to choose two times during the day when you know your baby is most active.  Let's say between 9:00 and 10:00 in the morning and then again between 4:00 and 5:00 in the afternoon.  During these times you may go about your normal routine while making sure to pay special attention to your baby's movements.  If you feel 10 movements in 5 minutes, then you're done, but it may take a bit longer for other's to reach 10 movements.  

If you do not feel 10 movements in one hour, then eat a high-carbohydrate snack.  After this, lie down comfortably on your side and put your hands on your belly so that you are better able to feel movements.  If you still do not count 10 movements within one hour it is important to call your provider so that you can be evaluated for signs of fetal distress. 

For more information on Fetal Kick, Counts visit the American Pregnancy Association.

Oct 31, 2012. Updated Jan 29, 2013: Testing for Fetal Problems

There are 3 categories of problems that fetuses can be evaluated for:

• Structural Problems like cleft lip, heart defects, and limb deformities. Not all structural problems can be identified before birth but an ultrasound performed at 18-20 weeks looks at detailed fetal anatomy and evaluates the baby for these types of problems.
• Gene disorders are a category of genetic disorders that are inherited from family or in some cases caused by random mutations. Gene disorders include problems like Cystic Fibrosis, Sickle Cell Disease, and Spinal Muscular Atrophy. Testing for the most common gene abnormalities is available and will be discussed separately. You may be offered additional gene tests depending on your family history and ethnic background.
• Chromosomal disorders are those genetic abnormalities which increase with maternal age. This includes disorders like Down Syndrome where there is an extra chromosome and Turner's Syndrome where there is a missing chromosome. There are many different possible chromosomal errors but the most common in live born infants are Down Syndrome and Trisomy 18.
  
  

Advanced Maternal Age increases the risk for chromosomal abnormalities, however, all women have some risk and the American College of Obstetrics and Gynecology recommends that all pregnant women, regardless of age, be offered testing for Down Syndrome and certain other chromosomal birth defects. The tests discussed below are most of the available options to evaluate for chromosomal abnormalities.

Although the tests discussed here and elsewhere significantly reduce your risk of having a baby born with a disorder there is no combination of tests that can 100% eliminate the possibility of a birth defect or genetic problem. 

There are 2 categories of tests available for chromosomal abnormalities:

• Screening tests can help identify if a pregnancy has an increased risk of a disorder. However, a positive result does not diagnose a disorder and a negative result reduces but cannot eliminate the possibility of a problem. Screening tests are noninvasive and carry no risk of miscarriage. They include First Trimester Screening and Sequential Screening.
• Diagnostic tests, are more accurate and can definitively identify a disorder and make a diagnosis. Currently available diagnostic tests are invasive and carry a small risk of miscarriage. These tests include Chorionic villus sampling and Amniocentesis.
  
  

Many people opt to have a screening test done first and then have invasive/diagnostic tests done if the screening test indicates an increased risk. Some people, however, know they need a definitive result regardless of how reassuring a screening test might be and choose to skip directly to invasive testing.

Screening Tests:

Cell Free DNA Tests are non-invasive blood tests that evaluate fetal DNA found in the maternal blood stream. Because this is looking directly at fetal DNA it is extremely accurate, greater than 99%. Currently, the available tests evaluate for the most common chromosomal abnormalities. The cell free test (NIPT) we offer through AMDX laboratories currently evaluates for the following chromosomal abnormalities: Trisomy 21 (Down Syndrome), Trisomy 18, Trisomy 13, and Turner's Syndrome (45 X), as well as sex chromosome trisomies. Technology in this area is rapidly evolving, therefore this test may be able to detect additional chromosomal abnormalities in the future. This test is not accurate in all patients because it requires a comparison to maternal DNA. Because of this, it cannot be used in the setting of surrogacy or donor eggs. In addition, because it involves a determination of the amount of fetal DNA it is not yet able to be used in the setting of multiples. Although extremely accurate for the above chromosomal abnormalities, it does not test for every chromosomal abnormality and does not evaluate for open spine defects. Therefore, we recommend combining this test with nuchal translucency measurements at 12 weeks (an ultrasound measurement of the back of the baby's neck) and AFP1 Screening at 16 weeks (a blood test for a biochemical marker sometimes associated with fetal anomalies). 

The First Trimester Screen and Sequential Screen are noninvasive evaluations that combine a maternal blood test with an ultrasound evaluation of the fetus to identify a risk of Down Syndrome and Trisomy-18. In addition to screening for these abnormalities, a portion of the test (known as the nuchal translucency) can assist in identifying other significant fetal abnormalities. The nuchal translucency measurement has to be performed at or close to 12 weeks of pregnancy; it cannot be performed later. These tests identify greater than 86% of cases of Down Syndrome. These are the most accurate noninvasive tests available in the setting of surrogacy, donor eggs, and multiples. 

AFP-4, also known as Quad Screen, is a blood test similar to the First Trimester Screen, it but does not include nuchal translucency and is therefore not as accurate. It detects approximately 80% of cases of Down Syndrome. Because AFP-4 is performed at 16 weeks, it may be a good option for people who do not want invasive testing and are too late in their pregnancy to do the First Trimester Screening. Due to the lower cost, it is also sometimes a preferable option for those who do not have insurance coverage. It can also be performed for people who have missed the window for first-trimester screening.

Diagnostic Tests: 

In Chorionic villus sampling (CVS) a small sample of cells is taken from the placenta and tested. CVS detects the same chromosomal problems as amniocentesis does, but it is performed earlier in pregnancy than amniocentesis, often at 10-12 weeks of pregnancy. This early detection provides women with more options (especially for those who may consider termination of a pregnancy based upon the results), but the test is technically more difficult and slightly riskier than amniocentesis. Some women have cramping or spotting for a few hours after the procedure.

In Amniocentesis a small sample of amniotic fluid (the fluid that surrounds the fetus) is withdrawn from the mother's uterus for testing. This procedure can help detect certain birth defects in the fetus during pregnancy, such as Down Syndrome and spina bifida. Amniocentesis is usually performed at 15-20 weeks of pregnancy. Some women find that the test is painless. Others may feel cramping or pressure. It is advised to avoid intense activity and take it easy for the rest of the day. 

Making a decision about testing can be difficult. Some people need definitive answers because they would not continue an affected pregnancy. Some people want no testing because it would not change any decisions regarding the pregnancy and they would not peruse further testing. Many others opt to test even if they would continue the pregnancy so they can make advance plans if a problem is identified. For example, if a baby is found to have Down Syndrome then having a fetal ECHO can identify cardiac defects which Down's children are at higher risk for. If a cardiac defect is identified prior to delivery it allows parents to meet with a surgeon and make plans prior to delivery.

Please let us know if you need additional information or have any questions.

Oct 31, 2012: Inheritable Gene Disorders 

Discussing genetics can often be a confusing and frustrating process for patients, but understanding this subject and your testing options helps you prepare for the future. 

Inheritable Gene Disorders are disorders caused by an abnormal gene that you or your partner carry.  Most gene disorders are recessive and can be passed down through many generations silently.  This means that carriers of the gene show no signs or symptoms of illness or disease.  These disorders include Cystic Fibrosis (CF), Sickle Cell Disease (SCD), and Spinal Muscular Atrophy (SMA). 

The above disorders differ from chromosomal disorders, like Down Syndrome, which are a type of genetic disorder caused by either the addition or deletion of a chromosome.  This type of genetic disorder is almost never inherited, but instead is a chromosomal error that happens at the time of conception.

As mentioned above, inheritable gene disorders like CF, SCD, and SMA are caused by a change in a gene; this change is called a mutation.  Every person has two copies of each gene, one inherited from each parent.  A carrier is a person who has one normal copy of a gene and one abnormal copy.  Having one normal gene is enough to prevent the disease in autosomal recessive disorders.  However, if both parents are carriers of the same abnormal gene, there is a chance that each parent will pass his or her abnormal gene on to their baby.  If the baby inherits two copies of the abnormal gene, the baby will have the disease.  If both you and your partner are carriers there is a 25% chance the baby will be unaffected, 50% chance the baby will be a carrier and a 25% chance the baby will have the disorder.

Most people are unsure if they or their partner are carriers and the absence of having an affected family member does not eliminate the possibility of being a carrier.  We recommend carrier testing for certain genetic disorders (a simple blood test) to all of our pregnant patients. 

The most common inheritable gene disorders:

1. Cystic Fibrosis (CF) – the most common inherited disease of children and young adults. CF causes the increased thickness of mucus in the body and affects the lungs causing frequent infections, and digestive system causing decreased ability to absorb vitamins. With aggressive treatment, those affected can live a relatively normal life, though shortened, with the life expectancy currently being around 37 years old.
2. Spinal Muscular Atrophy (SMA) – a serious condition which causes muscle and respiratory weakness that may manifest itself during pregnancy, shortly after birth, or during childhood.
3. Fragile X syndrome (FX) – the most common inherited cause of intellectual disability which is characterized by autism spectrum behaviors and moderate to severe mental retardation.
   
   

Testing for the above disorders is offered to all patients.  Currently, we are using aMDx laboratories for the gene testing listed above.  aMDx is a lab that specializes in genetic testing.  They also have a patient assistance program, which helps make testing affordable for most patients.  For more information on this program, you may call their helpline at 855-293-2639 extension 4.

In addition, being a member of certain ethnic groups may increase your risk for specific types of inheritable gene disorders such as: 

1. Sickle Cell Disease: 1 in 65 African Americans and/or Southeast Asians are carriers of the gene for this disease.  Normal red blood cells are round, flexible, and able to move easily through the blood vessels to transport oxygen.  However, in sickle cell disease the red blood cells are abnormally shaped leading to early death of the red blood cells as well as blockage of blood flow in the limbs and organs.  These blockages have a tendency to lead to pain, life-threatening infections, and damage to multiple organs.
2. Tay-Sachs disease, Cystic Fibrosis, Canavan disease, and Familial Dysautonomia:   1 in 5 individuals of Eastern European Jewish Descent may be a carrier of one of the above autosomal recessive conditions, but testing is also offered to those of French Canadian descent.  Other disorders which have an increased frequency in the Jewish population include Bloom Syndrome, Fanconi anemia group C, Gaucher's disease, mucolipidosis IV, and Niemann Pick disease type A (generally recommended if you have an affected family member).  Testing for these disorders is also available. 
   
   

The Victor Center is a center dedicated to the prevention of Jewish genetic diseases.  It offers information about counseling and genetic testing and in some instances may be able to help with the cost of testing.  For more information, you may visit their website. 

If you receive a positive test result additional testing may be indicated.  Your partner may be tested to see if he is a carrier and if both parents are carriers, diagnostic prenatal testing (chorionic villus sampling or amniocentesis) is available to find out whether or not the baby has inherited the abnormal genes.

Please let us know if you need additional information or have any questions.

Oct 23, 2012: Nausea and Vomiting During Pregnancy 

You are not alone!  Approximately 50% of women experience nausea and vomiting during pregnancy.  However, only 1% of women develop symptoms severe enough to require hospitalization.

Symptoms most commonly occur between 4 and 18 weeks of pregnancy.  Theories on the cause of nausea and vomiting during pregnancy include stimulation of ovarian estrogen production by the pregnancy hormone hCG (which peaks at about 9 weeks) and vitamin B deficiency.  Ultimately though, the root cause of nausea and vomiting during pregnancy remains elusive.

The American College of Obstetrics and Gynecology recommends as first-line therapy the combination of vitamin B6 (10-25 mg every 8 hours) and the antihistamine doxylamine (available over-the-counter as Unisom).  Use 1/3 to 1/2 tablet of a 25 mg Unisom every 8 hours as needed along with the vitamin B6.  This combination is associated with a 70% reduction in nausea and vomiting during pregnancy in randomized trials.  If the Unisom causes too much sleepiness, use the B6 alone during the day and add the Unisom at night.

Dietary management includes eating frequent snacks and small meals that are bland, high in protein and carbohydrates and low in fat.  Plenty of fluid intake between meals is also encouraged.

Avoiding triggers can be helpful in reducing nausea.  Examples of triggers include: Heat and humidity, odors (perfume, chemicals, coffee, certain foods, smoke), loud noise, visual or physical motion (flickering lights, driving), and not getting enough sleep.

Other safe options include ginger products, acupressure wristbands like Sea Band, electrical median nerve wrist stimulator like PrimaBella, and sweet candies or syrups such as Preggie Pops or Emetrol.

Should first-line treatment fail there are other medications that may be made available by your healthcare provider.

For more information on nausea and vomiting during pregnancy visit Medline Plus or The American College of Obstetrics and Gynecology.

GYN Articles:

Nov 20, 2012: The Importance of Your Annual Well Woman Exam

In medicine, there are always new discoveries and changing guidelines.  One such recent change has to do with how often women should be receiving pap smears, a part of routine gynecological care.  This change has many women wondering why it is still important to have a yearly GYN visit.

A Papanicolaou test is a smear taken from the cervix to aid in the identification of precancerous cells that have the potential to develop into cervical cancer.  The guidelines for how often this test should be administered have been under consideration.  In March of 2012 the U.S. Preventative Services Task Force issued their recommendations, in agreement with the American Cancer Society and the American College of Obstetricians and Gynecologists, that women ages 21-65 should have a pap smear at least every three years.  Women ages 30-65 may choose to prolong this interval and have a pap smear and human papillomavirus (HPV) screening every five years.  Both of these recommendations are based on evidence showing that this time interval between screenings substantially reduces cervical cancer incidence and mortality, without regard to sexual history.

(These recommendations differ in women who are immunocompromised, have a history of cervical cancer or have had a previous diagnosis of a high-grade precancerous cervical lesion.  These guidelines also do not apply to women who have had a hysterectomy with removal of the cervix.)

Many women want to know why a yearly visit to your gynecologist is still important if they are not receiving a pap smear.  Annual exams fall into the realm of preventive care.  Preventive care is highly recommended by all medical organizations as it can help a provider identify potential health problems before they occur or identify a problem early.  If an issue is caught early, it may be easier to treat and much less likely to pose serious health risks.

Providers also use annual exams as a way to keep up to date on their patients, address problems or concerns, and provide counseling and education on many topics.  Some topics that may be covered in your yearly visit include:

Your provider will also perform the following assessments to make sure your body is healthy and no problems have arisen since your last exam:

Additional screening tests that you may need include:

These are general screening guidelines and the timing of your screens may differ based on your personal and family health history.

The Highlights

Your annual exam not only includes the thorough health assessments mentioned above, but it provides you with the perfect opportunity to ask questions and discuss concerns.  We are also available to make referrals for you to other specialty areas if a problem is detected.

Yearly breast exams aid in the detection of cysts and cancerous masses.  In addition, during your visit, if indicated you will receive your referral to Breast Care Specialists for your mammogram. 

Pelvic exams aid in the detection of ovarian cysts and masses, uterine fibroids or enlargement, and bladder abnormalities.

Your provider will also be able to renew your prescription for oral contraceptives or discuss alternative birth control options.  They may also use this opportunity to adjust other current medications that they have prescribed for you.



Miscellaneous Articles:

Nov 20, 2012: Cardiovascular Health 

Heart disease is the leading cause of death in women and includes several different diseases related to the buildup of plaque in the arteries.  This buildup, also known as atherosclerosis, leads to thickening, narrowing, and hardening of the arteries, which dramatically increases the risk of heart attack and stroke.  Other related conditions include arrhythmias (irregular heartbeats/rhythm) and heart failure. 

Do you know your risk of developing heart disease?  Take the following quiz to determine your risk and then read about a few ways to reduce that risk.

You can help reduce your risk of heart disease by following these guidelines:

Oct 31, 2012: Depression and Your Options

Depression is often a misunderstood or unrecognized problem.  It is not something to be ashamed of, nor is it a character flaw or sign of a weak personality.  It isn't worried about an important test or problems at work, and it’s not just a day or two of being moody or having the blues.  Depression involves a lack of neurotransmitters in the brain and affects millions of people every year.  It is a significant medical condition that needs treatment, just like diabetes, asthma, or heart disease.  Having untreated depression increases your risk of many other medical disorders.

It is important to distinguish depression from bipolar disorder, which is characterized by alternating manic and depressed moods.  Manic moods are times when a person feels invincible like nothing can go wrong in his/her life.  This feeling may cause a person to make unwise choices.  Please let us know if you have experienced symptoms of mania. 

Signs and Symptoms of depression consist of depressed or irritable mood most of the day—nearly every day; Loss of interest or pleasure in activities (such as hobbies, work, or socializing); a sudden change in weight or appetite; Inability to sleep or sleeping too much; Agitation or restlessness; Constant fatigue or loss of energy; Frequent feelings of worthlessness or guilt; Difficulty concentrating or making decisions; and/or frequent thoughts of death or suicide. 

Treatment:  A number of options are available for the treatment of depression.  Some of the treatments that have been shown to help are counseling, exercise, time outdoors, behavioral therapy exercises (see below) and medications.  We encourage all of our patients who are having problems with depression to make an effort to exercise, eat well, get an adequate amount of sleep, and spend time outdoors.  These are simple steps that can have a big effect on mood.  We also encourage counseling because it is a safe and effective form of treatment.  We understand that sometimes counseling is not an option secondary to cost or time constraints.  However, we encourage you to investigate this option.  Many health plans cover some counseling and many churches and other groups offer discounted rates.  If you would like a referral please let us know.

Conservative options for treating depression include exercise, time outdoors, journaling, positive affirmations and engaging in creative hobbies.

Exercise is a great way to achieve a positive boost in mood, improve self-esteem, lower rates of depression, and ward off anxiety.  The endorphins released during regular physical activity play a significant role in these mood changes.  Endorphins are chemicals that bind to receptors in your brain to trigger a positive feeling in the body as well as decrease your perception of pain.  For example, many people describe a positive and energizing outlook on life, or "runner's high," after a run or workout.

Journaling is a way of reflecting on how you reacted to and felt about the events of the day.  This process can be very useful in figuring out how you see yourself and the world around you. It can also provide a way for you to evaluate the progress you're making with your chosen treatment plan.  Another tool that may be helpful in treating depression is giving yourself positive affirmation.  This involves focusing on the positive aspects of your life and constantly reminding yourself of them.  While you’re journaling, take some time to reflect on the good things in your life and write them down as another reminder.

Cognitive-behavioral therapy (CBT) works under the theory that a person’s patterns of thought directly affect their mood, sense of self, behavior, and even physical state.  The main goal of CBT is to evaluate a person's patterns of thinking in order to help them recognize these patterns, decide if they are valid or invalid, and then replace them with a healthier way of thinking.  A number of studies have shown CBT to be at least as effective as antidepressants in treating mild and moderate depression.  Studies also show that a combination of antidepressants and CBT can be very effective in treating depression.   Although CBT is traditionally practiced through counseling, if seeing a counselor is not an option for you then we recommend the book “The Client’s Guide to Cognitive-Behavioral Therapy: How to Live a Healthy, Happy Life, No Matter What!”  by Dr. Aldo R. Pucci.

Medications: There are several different types of antidepressants available to help manage symptoms.  These medications work through increasing levels of the different neurotransmitters that influence mood.  For this reason, a medication that is good for one person may not work for another person and several trials of different medications may be necessary to find the right one for you.  Furthermore, when starting a new antidepressant sometimes symptoms worsen before they improve or it may just take some time before benefits are seen; mild side effects are also common and almost always resolve within a few weeks.  Antidepressants are not addictive and should be taken every day.  It is important to contact your healthcare provider before discontinuing the use of your antidepressant for any reason.

Important note: if you or someone you know has thoughts of suicide, or if you are having a crisis and need immediate help please call us or one of the hotlines listed below.

Fulton County hotline:  404-730-1600 | Dekalb County hotline:  404-892-4646

Peachford Hospital:  770-454-2302 (Peachford Hospital has an open door policy where anyone who needs emergency help for a mental health crisis can walk in and see a counselor 24 hours a day, including weekends and holidays.)

Arbor OB/GYN office:  770-399-5055 (after hours our number connects to a paging center who will call the on call provider. If your problem is urgent where you cannot wait for a call back please call Peachford or one of the hotlines above.)

Click here for additional suicide hotline information.

Oct 22, 2012: Choosing a Pediatrician

Pediatricians are medical doctors who specialize in the healthcare of infants, children, and young adults.  Choosing a pediatrician to look after the health of your child is a very important and sometimes stressful decision for any parent, whether you are a first-time parent, need a new pediatrician, or have recently moved to a new area.  It is crucial that you and your pediatrician share similar philosophies on pediatric healthcare because of topics like vaccinations and monitoring developmental milestones.  A pediatrician who is on the same page as you is better able to serve you and your child during these critical years.

Some things to look for in a pediatrician include proximity to your home for the convenience of those sometimes frequent visits, same day sick appointments, and easily accessible phone nurses for quick questions that pop up.  In addition, depending on the practice, pediatricians who have privileges at Northside Hospital are able to begin care for your infant within 24 hours of delivery.  If the pediatrician you choose does not have privileges at Northside there is no need to worry.  An on-call pediatrician will care for your infant and then turn over their care at discharge to your pediatrician of choice.

When calling around to different offices make sure to inquire about hours of operation, hospital affiliations, other on-call physicians, and insurance companies accepted by the physician.  It may be a good idea to meet with some pediatricians once you have narrowed down your list.  Many offices offer a meet and greet to parents giving them a chance to evaluate their comfort level with the staff, office facilities, and the pediatrician.

• Children's Wellness Center with Dr. Kristen Mekelburg, Dr. Julie Segal, Dr. Bethany Jackson, and Dr. Gary Loventhal
• Medilag Pediatrics Dr. Babatunde Onasanya Tel: (770) 935-0500
• Find a Pediatrician through the American Academy of Pediatrics. 
• Find a Pediatrician through Children's Healthcare of Atlanta.
  
  

BabyProofing - What does it mean and where should you start?

What is Baby Proofing?

Baby proofing does not, in fact, mean protecting your house from menacing babies lurking outside; it does instead mean protecting your newborn child from the many everyday menaces lurking within your house that could pose a threat to their safety.

One important consideration before you implement a lot of baby-protecting changes in your household is to think about the implications for everyone in the home. You've probably been in the home of a friend or family member who has children and discovered you can't open a drawer in the kitchen or pass through the safety gate without having to ask for help from the parent. The issue you need to consider is how to ensure your child's safety without total disruption to your smoothly running, stylish home. Some products scream "baby here" whereas others can be more subtle and stylish while still safeguarding your new family member.

Getting Started:

We don't advise you wait until your little peanut has learned to crawl and pull him or herself up onto the furniture before you engage yourself in your new project of baby proofing. It's a good idea to start looking at your house from a young one's point of view before they get moving. Begin by getting down on your hands and knees and start to look for potential safety threats in your home. You will be surprised how much trouble you can get into in just 10 minutes of crawling around your living room and kitchen.

To save your knees a little, here's our beginner's guide on childproofing your home:

First, take a look at all those low-level easy-to-open cabinets throughout the house. It won't be long before their contents are spread out, if not shattered all over the floor; moving parts, like cupboard doors, are immensely attractive to a little one. If your harmful products for babies cabinets don't have locks, look for products to secure the handles that don't slow you and the rest of your household down too much from their chores while also preventing your newly mobile family member from accessing them.

By securing your cabinets, you probably blocked access to most, if not all, of the hazardous products (cleaning sprays, toilet cleaners, air fresheners, etc.) around your home. But to be safe, check around all the accessible rooms for other places you store potentially harmful products for your infant.

You'll be surprised at how many unsecured heavy or breakable objects you have decorating and enhancing your home – think large screen television sets on low reachable console tables, as well as lamps, glass ornaments and pottery on shelving units, buffets or side tables. All of these can be an attractive place for your baby to lean on while trying to stay standing, or an attractive item to play with. Consider ways to secure these items, or move them out of reach, if needed.

For many young children, harm comes in the form of sharp corners on furniture (kitchen tables and counters, desks and chairs) as well as architectural features (columns, poles, fireplaces, and hearths). Glass furniture, also, can result in a banged head or cut cheek without the normal visual cue of a solid surface. For glass and other sharp corners, consider protecting edges with cushioning fireplace hearth baby protection products, as well as moving delicate or difficult-to-protect furniture into rooms protected by a safety gate or a lock. Jamboo Creations has designed an elegant solution to baby proofing the fireplace with the HearthSoft, which protects your baby from the sharp edges of a hearth's brick, tile or another hard surface while also complementing your home design.

If you're like us, your electrical wiring probably isn't the neatest job in the home. But beyond having a tangled bunch of wires behind your TV, those cables and outlets are also a potential threat to wandering children. You can purchase safety covers for all electrical outlets as well as wire protectors to conceal cables to protect your child from shocks. Rhoost provides a neat electrical outlet insert product at a reasonable price.

And there's nothing wrong with locking doors. If you don't want to draw your little one's attention to the junk room at the back of the house full of sharp edges, breakable items, and heirloom favorites, just keep that door locked. Safety gates are great for places you regularly need to access in your home, but if you have some areas that you don't need to enter frequently, don't waste the money on childproofing accessories and just keep that area secure. You can also use this space to put any items from the rest of the house that is not safe or too precious to risk while your child is exploring their new domain.

Sept 26, 2011: Getting a flu shot is the first and most important step in protecting against influenza

How does the Flu Vaccine Work?
Flu vaccines (the flu shot and the nasal-spray flu vaccine (LAIV)) cause antibodies to develop in the body. These antibodies provide protection against infection with the viruses that are in the vaccine.

Who can get the Flu Vaccine?

The “flu shot” is an inactivated vaccine that contains a dead virus and is approved for use in people older than 6 months (see your pediatrician to vaccinate your children), including healthy people and people with chronic medical conditions.  While everyone should get a flu vaccine each flu season, it's especially important that certain people