Here is some useful information for our patients and their parents. For specific medical advice please contact the office, of course.

Immunizations

Immunizations are designed to protect against serious illnesses ranging from polio and tetanus to measles, mumps, and the seasonal flu. Immunizations are vaccines made of either weakened or “killed” versions of the bacteria or virus that causes a particular disease. When these altered viruses and bacteria are injected or taken orally, the immune system mounts an attack that stimulates the body to produce antibodies. Once produced, the antibodies remain active in the body, ready to fight off the real disease. For example, if whooping cough broke out in your area, an immunized child would be much less likely to contract the disease than one who wasn’t immunized

DTaP, to protect against diphtheria, tetanus, and pertussis (whooping cough)

Hepatitis A, to protect against hepatitis A, which can cause the liver disease hepatitis

Hepatitis B, to protect against hepatitis B, which can cause the liver disease hepatitis

Hib, to protect against Haemophilus influenza type B, which can lead to meningitis, pneumonia, and epiglottitis

HPV, to protect against human papillomavirus, the most common sexually transmitted disease in the United States and a cause of genital warts and of cervical, anal, and throat cancers

Influenza (the flu shot or, for age 2 and up, nasal spray vaccine), to protect against seasonal flu and H1N1 (swine flu)

Meningococcal, to protect against meningococcal disease, the leading cause of bacterial meningitis in U.S. children in pre-vaccine days

MMR, to protect against measles, mumps, and rubella (German measles)

Pneumococcal (PCV), to protect against pneumococcal disease, which can lead to meningitis, pneumonia, and ear infections

Polio (IPV), to protect against polio

Rotavirus, (given orally, not as an injection) to protect against rotavirus, which can cause severe diarrhea, vomiting, fever, and dehydration

Varicella, to protect against chicken pox

Every year, the U.S. Centers for Disease Control’s Advisory Committee on Immunization Practices publishes a new schedule showing which vaccines are recommended and when to get them. If your child is behind on immunizations, ask your doctor about the “catch-up” schedule.

Well Child Check-Ups

Childhood is a time of rapid growth and change. Your child will have more pediatric well-child visits when they are younger and developing the fastest. Each visit includes a complete physical examination. At this exam, the health care provider will check the infant or child’s growth and development in order to find or prevent problems.

The health care provider will record your child’s height, weight, and other important information on a growth chart. Hearing, vision, and other screening tests will be part of some visits.

Even if your child is healthy, well-child visits are important because it is good time to focus on your child’s wellness. Preventive care is important to keep children healthy. Well-child visits are key times for communication. Make the most of these visits by writing down important questions and concerns to bring with you.

Office Procedures

To Schedule an Appointment: To help us provide you with enough time to see the physician, please have the following information ready when you call to make an appointment:

Who needs to be seen
2. Name of the insurance carrier
3. Reasons for visit (e.g. illness/problem/physical, etc)

Appointments for urgent problems are available daily. If you need to cancel or change your appointment, please do so within 24 hours prior to your appointment, otherwise there will be a cancelation fee.

Your Appointment: Please arrive 15 minutes before your scheduled appointment time so that we can update your patient information.

Office Policy Addressing Missed Appointments:

After the first missed appointment, the parent or guardian will be notified by letter/ or phone call of our office policy. The appointment may be rescheduled.
If a second scheduled appointment is missed, a $50 fee will be charged. Missed appointment letter #2/phone call is made, again reiterating our policy. The appointment may be rescheduled.

Bring Your Insurance Card: You are required to present your insurance card to the receptionist at the time of check-in for an appointment. Please notify the receptionist of any changes in your insurance coverage or other vital information such as your address and phone number.

Co-Pays: You are expected to pay your office co-pay at the time of check-in.

Late arrival: If you are late for your appointment, you will be asked to wait and be worked into the schedule.

We make every effort to stay on time with appointments, but emergencies do occur. If we are running behind, we will keep you informed as to how long your wait will be.

Phone Advice: Patients are encouraged to call with any medical questions they may have. The doctor and nurse are available during most times to answer your questions or return your calls.

Form Completion: From time to time, you may have forms that need to be completed by your physician (physical forms, immunization records, medical clearances, etc). When possible, we ask that you provide us with 72 hours to complete the forms. There is a service charge per form.

Insurance and Billing: All patients will be responsible for any fees or co-pays incurred at the time of service. You may be responsible for charges not covered or authorized by your insurance. Our office participates with many insurance plans. If you have questions as to whether we participate with a specific insurance, please ask our practice manager. Should you have any questions regarding filing claim forms, please contact our billing office.

Referral Requests: Many insurance plans require you to have a referral and authorization from your primary care provider to see a specialist outside of your office. We recommend that you become familiar with your health plan’s specific policy. We require 24 hours notice to process these requests and check eligibility with your insurance carrier.

Prescription Policy: If you have an illness that requires prescription medication, you may be asked to schedule an appointment to be examined before treatment is started.

Narcotic prescriptions will not be refilled over the phone. A paper prescription must be obtained for all narcotics.

Medical Records: In order for your medical records to be at our office before your first appointment, you will need to sign a medical release form. We will then request a transfer of your records from your doctor. In the event that you need your medical records sent to another physician, we ask that you give us at least one week notice. You will be asked to fill out a release of information form. If you request a personal copy of your medical records, a fee will be applicable.

Concerns: Our office strives to provide quality medical care in a courteous and professional manner. Should you have concerns regarding your care, please contact the Office Administrator.

Thank you for allowing us to provide your care.

Recommended Visit Schedule

Well Child

Full medical exam performed by doctor and registered nurse
Immunizations provided
Electronic hearing and vision screening
Blood draws and urine collected on site
School, camp, or after school/sports forms
New medical issues addressed

Well Visit Schedule

3-5 days old
1 week old
2 week old
1 month old
2 months old
4 months old
6 months old
9 months old
12 months old
15 months old
18 months old
24 months old
2 1/2 years old
3 years old and yearly thereafter

Adolescent care

Full medical exam performed by doctor and registered nurse
Immunizations provided
Electronic hearing and vision screening
School/college forms
Blood draws and urine collected on site
Adolescent gynecology exam available
STD screening available
Pregnancy testing available

Sick Visits

Same day appointments available
Rapid streptococcal (strep) testing
Rapid influenza testing
Rapid mononucleosis (mono) testing
e-prescribing – no need to run to pharmacy with prescription

Emergencies/After Hours

Doctor is available to examine patient in office based on medical necessity

Emergencies

If your emergency is life threatening, call 9-1-1 and proceed to the emergency room. (Be aware of your insurance protocol for emergency room authorization and notification of your primary care physician) Dr. Mulinda is affiliated with Lakeland Regional Medical Center, located a block from our office.

If your child is in a pediatric emergency room, be sure to contact Dr. Mulinda so that he can help monitor your child’s management with their staff physicians.

Admissions

Dr. Mulinda is an attending physician at Lakeland Regional Medical Center

In the event that your child needs to be admitted to the hospital, Dr. Mulinda will assist you in the process. Dr. Mulinda will also visit your child daily, while admitted to the hospital.

IMMUNIZATION SCHEDULES

Recommended Immunization Schedule for Persons Aged 0 Through 18 Years

United States, 2015

NEW ACIP Recommendation for Human Papillomavirus Vaccination

EFFECTIVE MAR 27, 2015

9vHPV, 4vHPV, or 2vHPV for routine vaccination of females 11 or 12 years* of age and females through 26 years of age who have not been vaccinated previously or who have not completed the 3-dose series.
9vHPV or 4vHPV for routine vaccination of males 11 or 12 years* of age and males through 21 years of age who have not been vaccinated previously or who have not completed the 3-dose series.
9vHPV or 4vHPV vaccination for men who have sex with men and immunocompromised men (including those with HIV infection) through age 26 years if not vaccinated previously.

*Can be given starting at 9 years of age.

See MMWR for complete vaccine recommendations.

Compliant version of the schedule

Print PDF document of this schedule

These recommendations must be read with the footnotes that follow. For those who fall behind or start late, provide catch-up vaccination at the earliest opportunity as indicated by the green bars in tables below. To determine minimum intervals between doses, see the catch-up schedule. School entry and adolescent vaccine age groups are 4-6 yrs and 11-12 yrs.

Fever Medications

ACETAMINOPHEN DOSAGE

Please note: One dose lasts 4 hours. Do not give >5 doses in 24 hours.

IBUPROFEN DOSAGE

Please Note: One dose lasts 6-8 hours. Not to be used under 6 months.

Milliliter is abbreviated as mL; 5mL equals one teaspoon (tsp).
Don’t use household teaspoons, which can vary in size.
Aspirin should not be used in children to treat fever or pain.

SERVICES

Prenatal

Prenatal Visits

Picking a physician for your baby is not easy. Expectant parents have numerous questions…often too numerous to remember once your baby arrives. That is why Dr. Mulinda recommends that expectant parents make a prenatal visit within three months of the due date. Often parents leave the prenatal visit to the end of the pregnancy and this is not a good option. Preterm labor, maternal illness, bed rest, and the sheer exhaustion from pregnancy can interfere with a prenatal visit after 36 weeks. Parents must feel comfortable with their pediatrician’s style, bedside manner, and medical expertise. It is amazing how one prenatal consult really helps to decide if this pediatrician is a good match for your family. Dr. Mulinda will obtain a short medical history from the parents and advise them about important medical decisions to be made at the time of delivery (i.e vaccination, circumcision, cord blood storage, etc.). Dr. Mulinda will come to see your baby in the nursery if you deliver at Lakeland Regional Medical Center. It is all right if you do not have a prenatal visit…all babies are welcome. But remember, your pediatrician will become an integral part of your life…from birth to age 21 years if you choose!

Weight Loss Program

Obesity can cause a range of problems in children including:

Anxiety/depression
Type II diabetes
Worsened asthma
Hypertension
Obstructive sleep apnea
Elevated cholesterol and triglycerides
Joint pain
Non alcoholic fatty liver disease
Nutritional deficiencies
Dr. Mulinda’s weight loss patients range in age from 2 to 21 years of age, and Dr. Mulinda designs an individual plan for each patient. The plans include education, lifestyle modification, behavior modification, and a fitness component. Dr. Mulinda does not believe in using meal plans for children, as they are often very expensive and usually yield only temporary results. The goal of Dr. Mulinda’s weight loss program is to provide both his patients and their families the tools for healthy living.

Coming up with a Realistic Plan:

Taking the initial steps to make an appointment can be challenging, however, these steps are the beginning to a healthier life for your child. Dr. Mulinda will discuss with the patient about being healthy on the inside, and provide tools to reach realistic goals. Each patient will receive a weight loss plan that is specific to their needs.

Obtaining the Best Results:

Dr. Mulinda will discuss the role of the family and caregivers as weight loss programs are usually more successful if there is a support system in place. Finally, Dr. Mulinda will discuss the correlation between physical activity, weight less, and overall well-being. It is important to note that in addition to being a physician, Dr. Mulinda also works to develop the best possible fitness plan for each child.

Expectant Mothers

Congratulations!!!

Having a baby is one of life’s most rewarding experience. While we feel the best care is given by informed parents; your child’s pediatrician remains an important person in providing an environment that both you and your child will thrive and develop.

At Buena Vista Pediatrics we share your joy and enthusiasm and look forward to many years of providing care for you and your child.

Prenatal Visits
We encourage new and expecting parents to schedule a prenatal visit with us. It provides an excellent opportunity for you to see who and where we are. The prenatal visit also gives you an opportunity to discuss any issues or concerns you may have prior to the baby’s arrival.

Arrival
Simply inform your obstetrician or hospital staff at our affiliated hospital (Lakeland Regional Medical Center) of your choice of pediatrician.

We will be contacted and begin caring for your baby.

If you delivered at a non-affiliated hospital, simply contact us upon discharge and arrangement will be made for the baby’s first visit – usually 3-4 days after discharge.

Remember, you can contact us at anytime should you have concerns.

Ticks & Lyme: Healthy Advice

First of all, the best treatment is prevention. When in an area more likely to have ticks, wearing long sleeve shirts and long pants can help reduce the likelihood of being bitten. Ticks are also easier to spot on lighter colored clothing. As the mother of two young boys, I’d like to say that this is not always practical, especially when it’s 80 degrees outside. Insect repellant can also be somewhat helpful. The Centers for Disease Control, or CDC, recommends using a repellent with at least 20% DEET on exposed skin, taking care to avoid the hands, eyes, and mouth. You can also use products that contain permethrin on clothing or gear.

While these methods definitely help, the best recommendation is to do a “tick check” once a day. Ticks need to be attached and feeding for at least 36 hours to transmit Lyme disease (more about this later), so by checking every evening you ensure that, if bitten, the tick would be attached for no longer than 24 hours. I usually check my kids from head to toe, but pay particular attention to their hair, in and around their ears, their armpits, belly button, behind their knees, around their waist and their groin area. If you’ve been out in higher-risk areas (areas where branches and bushes are brushing against you), I also recommend examining your pets or any gear you had with you (stroller, backpack, etc.) as ticks can catch a ride home this way and attach to a person later.

If you do find a tick, what should you do? Remove the tick as soon as you notice it. Clean the area with alcohol and use tweezers or forceps to firmly grasp the tick very close to the skin surface. With steady motion, pull the tick’s body away from the skin in a vertical direction. Do not jerk or twist. Then clean the skin with soap and water and apply antibiotic ointment if possible. Avoid crushing the tick’s body. Do not be alarmed if the tick’s mouthparts remain in the skin. Once the mouthparts are removed from the rest of the tick, it can no longer transmit the Lyme disease bacteria. If you crush the tick, clean your skin with soap and warm water or alcohol. DO NOT use petroleum jelly, a hot match, nail polish or other products to remove a tick.

Let’s say your child has been bitten and now you’re concerned about Lyme disease. What exactly is Lyme disease? Lyme disease is caused by spirochetal infection by Borrelia burgdorferi (in the U.S.) and is transmitted by the bite of an infected Ixodes, or deer, tick. The disease can involve the skin, joints, nervous system and heart. It is most commonly transmitted by ticks in the nymphal stage which are typically most active during late spring and early summer. Adult ticks transmit the disease less commonly as they are less likely to bite humans and are more easily detected. Adult ticks are most active on warm days in the fall. The Ixodes ticks are small, examples of the different stages can be seen below:

As mentioned earlier, Lyme disease is rarely transmitted within the first 48 hours after a bite. This is because the B. burgdorferi are restricted to the tick gut during the first 36 hours of feeding. They then enter the tick’s midgut during feeding and migrate to the salivary glands after approximately 48 hours. Thus, by checking for ticks once every 24 hours, you limit the potential of transmission of Lyme disease even if your child is bitten by a tick.

Lyme disease usually occurs 3 to 30 days after a bite by an infected tick. The majority of people infected will have a characteristic rash, called erythema migrans or a bulls-eye rash. The rash can occur with or without other symptoms. Other individuals infected with Lyme disease may have fever, headache, muscle and joint pain. In the days to weeks after the bite infected individuals can also develop multiple erythema migrans lesions, facial or Bell’s palsy (loss of muscle tone on one or both sides of the face), severe headaches and a stiff neck, pain and swelling in the large joints, or changes in the heartbeat. If your child develops any of these symptoms you should have your child seen in the office.

Can my child be treated after a tick bite? Children who meet ALL the recommendations for prophylaxis can be given a single dose of doxycycline to prevent the development of Lyme disease. These children are 8 years or older (doxycycline cannot be given to children under 8) where a deer tick (not a dog tick) was attached for at least 36 hours and prophylaxis is given within 72 hours of tick removal. For those children who do not meet the criteria for prophylaxis, the Infectious Disease Society of America (IDSA) does NOT recommend prophylaxis with an alternative antibiotic. Since the majority of those infected with Lyme disease will develop the characteristic rash, observation of the tick bite site for a rash is an acceptable alternative for those who meet the criteria for prophylaxis.

Should I have my child tested? When a child has the typical erythema migrans rash, no testing is necessary and they will be treated with a course of antibiotics. If these children had a blood test they would likely test negative as the rash often appears prior to the development of a diagnostic, adaptive immune response that can be measured with a blood test. If your child has any of the symptoms for early, early disseminated, or late disseminated Lyme disease as listed above, then you should make an appointment to see your health care provider. If your child does not have any symptoms then the recommendation is to observe your child but not to perform any testing. If at any point they do develop symptoms, then they should be seen in the office.

So, the best way to prevent Lyme disease is to prevent a tick bite by wearing long pants and long-sleeved shirts, using insect repellant, and, most importantly, doing a “tick check” daily. If your child is bitten, then remove the tick promptly. If the tick is attached for at least 36 hours and your child meets the other criteria for prophylaxis, then you can call the office for an appointment. If your child develops the erythema migrans, or bulls-eye rash, or any of the other symptoms described above you should also bring them in for an appointment. If they have no symptoms then the best course of action is observation. And please don’t hesitate to call the office with any questions and continue to enjoy the outdoors!

Useful Links and Resources

We know that there is an enormous amount of information available via the Internet regarding child-rearing, health, and medicine. It can be difficult to sift through this information and decide if it is trustworthy.

We have assembled some links to websites we believe will be of interest to many patients and families. On these sites, you can find information on common illnesses and diseases, along with information on preventative medicine. Additionally, some identified sites may be fun and educational for children.

This website is not responsible for any information found on these or any other associated or linked websites. A link to another website does not imply an endorsement of the site’s content or services.

Please use these sites for informational purposes only. If you have specific questions about illnesses please make an appointment to see us at our office.

Government Agencies

Centers for Disease Control and Prevention
CDC Vaccine Information
Consumer Product Safety Commission
The American Red Cross
National Library of Medicine
Vaccination

National Network for Immunization Information (NNii)

www.immunize.org & www.vaccineinformation.org – Immunization Action Coalition (IAC)

Children’s Vaccine Program

Institute for Vaccine Safety
Mercury and Vaccines

Professional Associations

American Academy of Pediatrics
American Academy of Child and Adolescent Psychiatry
La Leche League: national breastfeeding support group
Food, Allergy and Nutrition

Healthy Eating
Kids and Snacks
Dieting vs Proper Eating Habit
Anorexia and Bulimia
The Food Allergy and Anaphylaxis Network
Asthma and allergy Foundation of America
WebMD Allergy
First Aid

Red Cross
A Proper First Aid Kit
Common Household Child Injuries

Protecting Your Medicine Cabinet
Diseases and Conditions

Animal Bites
Lyme Tick Disease
Eastern Equine Encephalitis
Attention Deficit Disorder
The Food Allergy and Anaphylaxis Network
Lice Resources
Family Health & Safety

KidsInDanger.org

: updates on recalled products, advocacy news, and other important information.

cpsc.gov

: government website for Consumer Product Safety; excellent source for recall information and other safety news.

Check Yourself

: for teens with questions about drug and alcohol abuse

Zero to Three
Just for Parents
Just for Teens
Just for Kids

Mobilize

: online community for teens to volunteer, find a cause, or share a passion

WebMD.com
Family TLC
AAP Press Room/Seasonal Safety Tips
AAP Car Seat Safety
Kids Health Car Safety
Cheap Car Insurance Safety Tips
National Highway Traffic Safety Administration

SPOCK : From the Dr. Spock Company and based on the advice of Dr. Benjamin Spock, this site offers parenting advice, information about pediatric medical problems, message boards, newsletters and consumer alerts.
GREENE : Parenting information on most major pediatric topics in a question and answer format. Also organized by children’s stage of development

Lemon Tree Center – Literacy and Language Development Center

Healthy Children – Powered by Pediatricians. Trusted by parents.

Fun Stuff For Kids

How Stuff Works
stonesoup.com: for young writers & artists

SkippingStones.org

: international magazine written by and for kids

Kids National Geographic

makezine.com

: for school-age kids and parents, a how-to magazine with cool projects

familyfun.go.com

readymademag.com

: comprehensive magazine with projects, instructions, and ideas…even for the non-crafty parents!