Owner's Manual:
Read before operating your baby!!

Allen Menkin, MD, MS, FAAP
Patrick A. Caruso, MD, FAAP
Adam M. Dick, MD, FAAP
Melissa Libert, DO, FAAP
Kristen Walsh, MD, FAAP
Jenna Stephens, RD

Welcome to Plaza Family Care.
Thank you for trusting us with your children.

Office hours seven days a week, evenings, holidays.

(908) 850-7800
www.pfcmd.com
Facebook.

 

Welcome to Plaza Family Care.
Thank you for trusting us with your children.

Our pediatricians are all graduates of American schools and have completed their post-graduate training at some of the most prestigious hospitals in the country. They are Board Certified and have held teaching positions at major medical schools in the tri-state area.

We have modern offices in Chester and Hackettstown. The Pediatricians are "in" 365 days a year (including evenings, weekends, and holidays) and are available by phone 24 hours a day.

We have an extensive adult medical division and are happy to take care of your entire family. Our Board Certified Internists and Gastroenterologist see patients from late adolescence through old age. Dr. Sandra Carlson, our newest Internist is fluent in Spanish and Portuguese.

Patients customarily transit from Pediatrics to Internal Medicine at age 18 but some teenagers want to see an "adult" doctor at an earlier age and some want to stay with their Pediatrician until they are older. We are flexible and try to accommodate individual choices. Patients with special needs or diagnoses often remain under Pediatric or "shared" care for a longer time.

Some Other Things You Should Know About Us That Might/Not Make Much Difference to You… Right at This Minute.

Plaza Family Care has been around for almost 40 years. Nearly a third of our current newborns are second or even third generation patients. We might well have been your mother's Pediatricians, but we are not "your mother's Pediatricians."

We are a "green practice". Our offices are as environmentally friendly as the buildings and economics allow. Our newsletter articles on raising a "green baby" are available at www.pfcmd.com and have been re-published by NJ Family magazine.

We know that doctors prescribe much more medication than our patients ever use. Those excess or out-dated drugs are a threat to our toddlers, our teenagers, and our environment. Unintentional poisoning is the nation's second leading cause of injury and death; prescription drugs cause four times as many deaths than in the United States as heroin and cocaine. Flushing drugs down a sink or toilet, or putting them in the trash doesn't destroy them, it just pollutes our soil and drinking water.

We have a take-back program for excess medications. Just bring them to us during regular office hours and we will destroy them. Our patented Smart Sink™ technology renders them unusable, unrecoverable, and non-polluting. This is a community service; there is no charge and you don't even need to be our patient to take advantage of it. As far as we know we are the first and only practice in the world offering this service.

We can take pills, liquids or patches. Please bring solid medicines in a plain paper or plastic bag; we do not want pill containers, labels, or packaging material. At this time we cannot accept injectibles, chemotherapy, narcotics, or samples from other medical offices or clinics.

We have an over-arching dedication to keeping you and your family well. We are skilled at treating illnesses, but we would much rather keep you healthy. Existentially, that means we want to keep you and your children from becoming victims of the national obesity epidemic. To support that objective we routinely monitor BMI (Body Mass Index) and have established a dynamic nutrition program. Our on-site nutritionist works closely with the Pediatricians and Internists to help you and your children stay healthy and fit.

We routinely test vision in infants and children using the Diopsys® computerized system. This lets us diagnose vision impairment long before it would be detected by traditional clinical examination.

We do not think children should be senselessly exposed to weapons, drugs, media violence, bullying, or discrimination. Our commitment to their health and well being would be a hollow promise if we didn't do everything we could to protect them while they are growing up. STAND UP FOR CHILDREN is the tax exempt foundation we established and fund to help accomplish that. You will see evidence of it throughout the practice. You can click on it at www.pfcmd.com for info.

Congratulations on the birth of your baby!

We hope you have had a successful pregnancy and a safe delivery of a healthy child.

If there have been any problems we, and a team of sub-specialists, are ready to do all we can to help.

We jokingly refer to this pamphlet as your, “Owner’s Manual.” We wish there was such a thing, but it doesn’t exist; there are just too manydifferent models.

Pick your baby up, hug him, tickle him, and get to know him. If this is your first child, welcome to parenthood. Don't expect to feel very confident right away, (you are really in your fourth trimester.) With patience and common sense you will be able to adapt to your new role.

BABY NEEDS

Your baby needs you, not everything featured at Babies R Us or The Bump. Besides your love and care she needs:

• A car seat. Believe it or not, infant safety seats are a fairly recent invention. We used to drive children around completely unrestrained. In 1973 Plaza started the first Buckle Up Your Baby campaign and the only hospital based car seat distribution program in New Jersey. Now infant seats are the law, there are plenty of approved systems, and most pre-school children are seat belt vigilantes. Keep your baby in an approved seat, in the rear of the car, facing backward until at least two years of age! And buckle up yourself….every time!!
• A crib that meets current safety specifications and a firm, well fitted mattress. Do not put loose blankets, pillows, bumpers, or stuffed animals in a newborn's crib. Sleep positioning devices are unsafe and should not be used!
• Babies go through an amazing number of diapers; most of them disposable. We support the use of environmentally sound, reusable diaper wraps with liners but they are not for everyone. Very early toilet training seems to work for families that believe in it but has never gained much of a following. Mild soap and water or diaper wipes are adequate for cleansing. Any good, protective diaper cream is helpful. Corn starch or talc powders are not recommended.
• There are all sorts of digital thermometers available. We suggest you get, and learn to use a rectal thermometer. It gives the most accurate and reproducible measurement of your baby’s temperature. We use ear models in the office, but not on small babies.
• In spite of recent news reports and product recalls most simple, over the counter pediatric fever medications are safe and effective. You should have infant acetaminophen (Tylenol) and/or ibuprofen (Advil, Motrin) in the house. Dosages for infants and children are weight dependent; the calculations for them are listed later in this booklet. Contact us if you have any questions.
• Unless you have a potentially contaminated well or some other unusual circumstance you don't need to sterilize anything. It's probably a good idea to boil bottles and nipples before first use but after that a dishwasher or hand washing with hot water is fine. Washing your hands before handling or feeding the baby is probably worth more than all the sterilization devices on the market.
• It is possible to remote monitor your baby’s pulse, respiration, and movement. You can listen in on every sound she makes or run continuous video monitoring; but you don’t have to. You do need functioning smoke and carbon monoxide monitors.

FREQUENTLY ASKED QUESTIONS

• What about nursing/formula feeding?
• What about formula?
• Does my baby need to be circumcised, how is it done, who does it, how do I take care of him if I do/don’t have it done?
• What do I do with the umbilical cord?
• What about bathing my baby?
• What temperature should I keep the house?
• When can I take the baby out?
• How can I tell why my baby is crying? (And how can I make her stop?)
• How many wet and dirty diapers should my baby have; what is a normal bowel movement?
• What is SIDS and what has sleeping on their backs got to do with it?

What about nursing/formula feeding?

• Nursing is the gold standard against which all other infant feeding is held. It is good for your baby and it is good for you. It helps prevent infant infections, it gets your uterus back to normal size, and it is protective against breast cancer; but you don’t get graded on it. Breast feeding does not and should not define you as a woman and a mother. Generations of babies have grown and thrived on a variety of infant formulas that were far less complete than the ones we have today.
• Nursing a baby for the first time can be a little unnerving. We instinctively worry that the baby will starve, we can’t measure the amount of colostrum or milk he is getting, and there are all sorts of well meaning relatives and experts offering conflicting advice. We need to remember that breast feeding is not under conscious control; learning all about it is not the same thing as doing it. Sometimes we need to turn off our thinking brain, relax, and trust our bodies.
• Suckling is the stimulus that causes your body to produce and release milk; so frequent nursing is the best way to “bring your milk in.” However some babies seem indifferent or outright disinterested, and prolonged nursing right after delivery can result in cracked, sore nipples (even if your baby latches on properly). Pain is not a great inducement to keep nursing a baby. It has become common for new moms to use a breast pump to collect breast milk which is then fed to the baby in a bottle. A pump doesn’t require your baby’s participation and is easier on your skin; but it does not induce milk production and sometimes you end up formula feeding your baby…not a crime but maybe not what you intended.
• Before nursing wash your hands with plain soap and water, wipe your nipples with plain water and pat them dry. Don’t scrub them!
• Most women hold the baby in one arm so a hand is free to support the nursing breast and make the nipple accessible, but you can position the baby any way that is comfortable for you.
• Guide the nipple into the baby’s mouth; at the same time keep the breast from interfering with her breathing. You may need to encourage her to nurse by gently stroking the cheek nearest the breast. Usually this will make her turn her head and hunt for the nipple (rooting). You may have to stroke her feet or wipe her forehead with a moist cloth to rouse a sleepy baby.
• Your milk may not come in for 3-4 days. This is normal. Your body is producing colostrum during that time which primes the baby’s gastro- intestinal system.
• Some newborns are feeding machines, but many babies don’t know how to nurse and it can take them a frustratingly long time to figure it out. Be patient. Keep him at or near the breast even if he isn’t feeding. Have your baby nurse equally from both breasts for the first day or two. After the first few days let him nurse 5minutes on one breast, 10-15minutes on the other and reverse it at the next feeding. If you go longer than 20-30 minutes on a breast you may not be accomplishing much more than making your nipples sore.
• After the first few weeks you can substitute a bottle feeding. It’s a good way to involve dad. You will appreciate the sleep if you can get him to take a night feeding.
• You can eat anything you normally eat, in moderation. Drink plenty of fluids, especially during the summer. Do not drink alcohol. If you are a smoker this is a good time to quit.
• You should continue taking your pre-natal vitamins. We will prescribe a fluoride/iron vitamin for your baby at the six month visit. Acetaminophen and Ibuprofen are safe for you and your baby. Please check with us before taking other medication.
• For you men: Nursing is hard physical and psychological work for a new mom. Your wife/partner may get a little cranky. You had better be a great cheerleader, all around support guy, and have a pretty good sense of humor.

Go back to FAQ »

What about formula?

• There are several very good cows’ milk formulas on the market. They are all vitamin and iron enriched and have DHA and probiotics added. Most major brands also have modified cow’s milk formulas that may help babies with feeding problems. There are also highly modified and synthetic formulas, but they are expensive and seldom necessary. We very rarely use soy based formulas.
• Some of our families exclusively use organic formulas. Beyond the general concept that production additives or contaminants could have unintended or adverse effects on your baby there is no data that these are safer or better in any measurable way. They are usually a little more expensive. Every manufacturer has an organic line.
• Formulas are available in ready to feed, concentrate, and powder forms. The latter two must be mixed (bottled water is not necessary.) ALWAYS FOLLOW THE MANUFACTURERS INSTRUCTIONS.
• Most newborns feed 1-3 ounces at 3-4 hour intervals, but there can be enormous variation. Once she has established an average amount you can keep about ½ ounce more in successive bottles and let her adjust upward.
• Your baby may be uncomfortable if she sucks in belly full or air while feeding. Bubble or burp her after each 1 ½-2 ounces.
• Bottled water with or without nutrients or fluoride is completely unnecessary.

Go back to FAQ »

Does my baby need to be circumcised, how is it done, who does it, how do I take care of him if I do/don’t have it done?

• Circumcision is the surgical removal of approximately 1/2-3/4 inch of foreskin from the end of the penis. Aside from ritual observance among Jews and Muslims newborn circumcision is elective. When done properly it is a safe, painless procedure.
• Circumcision is performed by different specialties in different parts of the country; in the NY metropolitan area it is frequently done by obstetricians. However, Dr. Menkin has privileges to perform circumcisions at Morristown Memorial and St. Clare's Hospital. He is also a certified Mohel.
• As with any elective procedure, you should choose the doctor who does it. Regardless of whom you choose, we suggest you encourage the use of anesthesia jointly recommended by the American College of Obstetrics and Gynecology and the American Academy of Pediatrics.
• The relative benefits and disadvantages of this procedure have been endlessly debated. (We are presently experiencing a wave of irrational anti-circumcision propaganda.) It is clear that circumcision significantly lowers the risk of infection with HIV and other STD's. Circumcised men have a lower incidence of urinary infections. Their sex partners have a lower incidence of cervical cancer. There is no clear data that circumcision either improves or detracts from sexual performance or pleasure. However, circumcision is a surgical procedure. It can cause bleeding, infection, or damage to the penis. If done badly it can require re-operation. It does not eliminate the need for good hygiene.
• Your circumcised baby will be checked for bleeding or other complications before he is released to you. Doctors have individual recommendations for post-op care. Some will keep him in hospital until he voids. Some apply sterile dressings; many just advise copious amounts of Vaseline at every diaper change for the first week. The doctor who performs the surgery should give you detailed instructions for initial care and we will give you follow up instructions at your first visits.
• Your uncircumcised baby needs no initial care of his penis. In the past we have advised gentle retraction and replacement of the foreskin at diaper changes with the eventual goal of it being fully mobile for purposes of hygiene by age 5. Current recommendations are to do absolutely nothing at all to it; almost 100% of them should be fully retractile by 5-6 years of age. You should never force the foreskin back.

Go back to FAQ »

What do I do with the umbilical cord?

• Keep it from getting infected and encourage it to come off. We just can’t get a consensus on how to accomplish that. The umbilical stump is a fairly good portal for bacteria to enter your baby’s blood stream. In the past we have had epidemics of this. That is why some nurseries apply blue antibacterial dye to the cord; fear mongers have attributed all sorts of risks and hazards to this. We have been using the dye for over 30 years, and as far as anyone can tell it carries no risk or hazard of any kind. Some hospitals no longer apply the dye because they no longer keep babies very long and don’t really have nurseries. We are sufficiently impressed with the incidence of resistant bacteria in all hospitals to support its continued use.
• Most pediatricians agree that you should leave the cord alone for the first several days. After that we can’t decide whether you should keep it dry or clean it with alcohol. Experientially, it seems to come off more easily if you clean it with alcohol. Don’t be afraid to take hold of the cord and manipulate it; nothing terrible will happen and it does not hurt your baby. If the cord doesn’t come off in two weeks, if it has a heavy drainage, or if it smells terrible let us know right away.

Go back to FAQ »

What about bathing my baby?

• All you need is mild soap, water and a light cotton bath towel. The room should be warm and free of drafts. Sponge your baby until the cord is off and the circumcision is healed, then you can tub bathe. Your baby’s hair only has to be washed about once a week. If your baby has dry skin apply a non-scented lotion or oil after bathing.
  Our experience as Pediatricians and as parents long ago made us subliminally aware of the almost ritual aspects of baby bathing. Along with feeding and bed times it can either be a chore or a discrete moment when you can bond as a family.

Go back to FAQ »

What temperature should I keep the house?

• 68-72 degrees Fahrenheit is fine. If you keep the house a little cooler in the winter it’s not usually a problem. Within reasonable limits babies do better with a cool environment that with a hot one. Encourage ventilation in hot weather and minimize drafts when it is cold. As a rule your baby doesn’t need to be dressed more heavily than you are. Air conditioning is fine.

Go back to FAQ »

When can I take the baby out?

• “Out” is a moving definition. There is nothing particularly healthy or harmful about being outside on a nice day. Insects can be a problem, sun exposure and overheating need to be avoided. If “out” means exposure to a lot of people (supermarket, parties, public transit) you should probably avoid it for the first 1-2 months .

Go back to FAQ »

How can I tell why my baby is crying? (And how can I make her stop?)

• Babies do a lot of things that seem strange. They sneeze, yawn, hiccough, twitch, pass gas, and strain at stools. (Actually, we all do most of the same things but no one is watching us.) They startle at noises and position changes, have tremors, and get blue in the hands and feet; and they cry… long and hard. Often they cry the most and hardest at night…just when you are exhausted. It's what they do! Try not to get too upset. If your baby is eating, voiding, having bowel movements, and not running a fever he is probably alright.
  After a while you can usually distinguish between crying from hunger, a dirty diaper, pain, and just fussing. You eventually develop a mental checklist of things to look for and tricks you can try to settle your baby down, but some babies can be challenging. Doctors (and parents) have known for decades (at least) that swaddling, blank noise, motion, and position change can settle a crying baby. Your mother may tell you how she put you in the car and literally drove you to sleep, or how you couldn't sleep without a vacuum cleaner running somewhere in the house; or how she rocked you non-stop until finally you fell asleep..but only wrapped like a mummy and laying head down on her legs. If your baby just never stops crying get someone to relieve you for a while; she will be alright and you need a break!
  If you have no one to relieve you, and you get so UPSET that you think of harming your baby STOP, PUT THE BABY DOWN IN THE CRIB, AND WALK AWAY FOR TEN MINUTES. You need time to regroup and crying a bit longer won’t hurt him. NEVER SHAKE THE BABY out of frustration. It can cause permanent brain damage. IF YOU EVER GET SO UPSET THAT YOU JUST DON’T KNOW WHAT TO DO CALL US!!

Go back to FAQ »

How many wet and dirty diapers should my baby have; what is a normal bowel movement?

• When insurance regulations mandated early discharge after delivery it became obvious that new parents would have to do some of the monitoring that was traditionally done in the nursery. So we have you counting and charting soiled and wet diapers, (and maybe raise your anxiety level in the process.) Dirty diapers are only proxies for your baby’s intake and state of hydration, not measurements of your success or failure as parents. If your baby has one or two dirty diapers and half a dozen wet diapers in 24 hours you are probably doing fine. We are going to see you two days after you go home to check her weight and nutrition. (We rarely look at the sometimes elegantly graphed data or hermetically sealed stools parents bring along.) Some babies poop after every feeding, some every day, some (even breast fed) only once in several days. Normal stool can be yellow, brown or green and vary from soft and mushy to more formed. Formula fed babies will have a firmer stool. Straining is normal.
  You may see a little blood in your baby’s diaper. In girls it is often vaginal, estrogen withdrawal bleeding. In boys or girls a little blood streaking in stool can be from a juvenile polyp and very rarely indicates anything serious.
  If your newborn baby develops diarrhea (frequent water stools that soak into the diaper) you can substitute an oral electrolyte solution for a feeding. If it persists call us.

Go back to FAQ »

What is SIDS and what has sleeping on their backs got to do with it?

• Sudden Infant Death Syndrome used to be the leading cause of death in infants under a year of age. Data indicated that keeping infants on their backs significantly lowered its incidence. Now all babies sleep on their backs and we see this tragedy far less frequently. Sleeping in the parental bed and many socio-economic factors increase the incidence of SIDS.

Go back to FAQ »

Breast/Formula and Beyond: Feeding Your Baby 101

The good news is that you will have plenty of time to think about this; we don’t start solids until at least the fourth month. The bad news is that almost all recommendations are subject to cultural influence and change.

We are pretty sure that just breast milk or formula is optimum until at least the fourth month. We used to tell moms that exclusively breast fed babies would get fat and have trouble transiting to solids. That is almost certainly incorrect.

Historically we have started solid feeding with rice cereal and introduced pureed fruit or vegetables as a side dish or dessert. However, we practice in an era of childhood obesity and celiac disease is the diagnosis of the decade. A prominent pediatrician long ago advocated fruits first, some gastroenterologists advise vegetables first; one has even suggested meats as the first solid.

The take home message is that most babies are pretty tolerant of what we feed them as long as we don’t rush things. For the time being we will stick with rice cereal with either fruit or vegetables for dessert at 4months. You can introduce a new product every 4-5 days just so you can identify a food that disagrees with your baby. We avoid meat until about 6-9 months, and honey and whole milk until 12 months. Nut products are withheld until 18-24 months. Continue nursing or formula for the full first year.

If you are nursing continue your pre-natal vitamins. All infant formulas are vitamin and iron supplemented. At six months we will give you a prescription for iron/fluoride baby vitamins. There is no fluoride in our local wells or water systems. There is no data supporting the efficacy of fluoride baby water. In fact, there is absolutely no reason to believe that bottled water is better or safer for any of us than tap water; it is just environmentally unsound and more expensive.

There is tremendous interest in the effects of plastic residues, pesticides, hormones, and antibiotics in our food chain. “Organic,” whatever that may mean, is appended to many baby foods including formula. At this time there is very little hard data available to support either the insidious effects of unwanted/intentional food additives or any benefit from avoiding them .

There is a growing body of evidence that probiotics (lactobacillus cultures) are protective in many ways. They are in virtually all infant formulas. Their additional role in infant nutrition and health has yet to be fully delineated.

Well Care Visits and Immunizations

 

At each visit your child will be measured and given a complete age appropriate exam. We record Body Mass Indices on all our patients. Her social/mental, language, and motor development will be assessed and you will receive anticipatory guidance about her current and future needs. Her immunizations will be updated; most vaccines can be safely given even if your child has a mild illness. Not least of all, you will have the opportunity to ask questions.

We screen all infants and toddlers for autism and lead exposure. We test hearing, and offer a state of the art computerized vision test.

We are aware that some parents prefer to split vaccines and give them over an extended period. This strategy is totally ineffective in decreasing any real or imaginary complications of vaccination. All it does is leave your baby defenseless against life threatening diseases of infancy. It is dangerous, and we strongly discourage it, but we are powerless to prevent it. If you insist we will follow a vaccine schedule of your choice, but we refuse to see a child who has not completed her primary immunizations by her second birthday. We recommend that Hepatitis B vaccine be started immediately upon birth, not at later visits.

Periodically, a vaccine may be unavailable. In that event we will catch your child up at the earliest time convenient for you.

Childhood Illness

Infants and toddlers seem to always be sick. In fact with/without day care they can have respiratory or gastrointestinal infections for much of their first two years. It’s normal.

We are available 24 hours a day, seven days a week.
Unless you have a bona fide emergency please contact us before going to an emergency room.

What you need to know

Earaches:
Ears are part of the respiratory system. When we catch colds our ears can become infected. We usually see children with ear pain in the office.

Ear aches always seem to happen at night and they make infants and children miserable, but they are seldom emergencies. Acetaminophen or Ibuprofen along with an antihistamine can usually get you through to the next day.

Sore throats:
Sore throats in infants are usually viral; they seldom have strep throats or are helped by antibiotics. An older child with a sore throat may need a strep test. If she tests positive she requires a full course of a prescription antibiotic.

Fever:
Temperature elevation is seen with many diseases but it is not specific for any particular diagnosis. You can usually control it with acetaminophen/ibuprofen/tepid water baths. It is perfectly alright to treat your child before calling us.

A rectal temperature over 100.4 in a child under 2 months of age requires our attention. A child with persistent temperatures over 104 or one who is visibly ill should also be seen.

There are many brand and generic fever preparations on the market. They all give you the milligrams (mgs) of the active component somewhere on the label (usually in the small print.)
To determine the dose in milligrams your child needs you can either follow the package instructions or use the following formula:

Acetaminophen (Tylenol). 1) Weight in pounds divided by 2.2=Weight in kilograms. 2) Weight in kilograms x 15=milligrams of Tylenol every 4 hours. Ibuprofen(Motrin). 1) Same 2) Weight in kilograms x10=milligrams of Motrin every 6 hours

For trauma:
Is there uncontrolled bleeding? Loss of limb? Is your child unconscious? If so CALL 911!

For poison ingestion:
Do not induce vomiting. Call Poison Control. 1-800-222-1222.

What we need to know

You are our eyes and ears. When you call we will need to know what the problem is. In most cases we would also like to know your child’s age, symptoms, duration and progression of illness, temperature, and what you have tried so far. Please tell us if there is any underlying medical problem.

For respiratory problems:
What is his respiratory rate? (breaths in a minute.)
Is he struggling to get air?
Is he making harsh sounds when he breathes in and out?
Is he asthmatic?
Is he being followed by an allergist or pulmonologist; have you contacted them?
What medications do you have on hand? What have you tried?

For gastro-intestinal problems:
Is there vomiting or diarrhea? Is there both? Since when, how frequent? Is she still urinating? Is her mouth moist? Does she have tears? What have you been feeding her?
Is there severe abdominal pain or swelling? Where is it most intense? When was the last bowel movement?

Non-life threatening trauma:
What was the accident…describe it. How long ago did it happen. Was the head involved? Was there a loss of consciousness? Is your child alert? Vomiting?
Is your child moving around normally?

Wellness and Nutrition

Plaza Family Care is dedicated to keeping you and your family well. We are skilled at treating your illnesses, but we would much rather keep you healthy. Good nutrition is an important part of this. Our Nutritionist works closely with our Pediatricians and Internists to help you and your children stay healthy and fit.

STAND UP FOR CHILDREN

Our commitment to your children's health means that we will do what we can to protect them from the violence that seems to accompany growing up. STAND UP FOR CHILDREN is the tax exempt foundation we established and fund to help accomplish that.

Business Procedures

We are open every single day and four evenings a week. We have our weekend/holiday hours in the Hackettstown office because it is the larger facility and gives us access to lab and radiology. Our schedules (and almost everything else about us) are posted on our web site, www.pfcmd.com . We send out periodic newsletters. You can follow us on Facebook.

Phones:
Our phones come off service at 8:30 in the morning. Please call after then if you think your child needs to be seen that day. We return phone calls throughout the day. Please give us a number (home, business, or cell) where we are likely to reach you.

If you call our office and it is clear that you are just not getting a response, our phones are dead, please contact our answering service directly at (877) 844-5225. That will put you in touch with a doctor on call for either Pediatrics or Internal Medicine. Please, only use this number during regular hours if it is obvious that you are just not connecting to our operators.

 

Office Visits:
We would appreciate it if you could arrive several minutes before your appointment. If you are new to the practice you can download our registration forms from the website and fill them out before coming to the office. We request your e-mail address. We do not share this with anyone, but it is the only rapid way we have of keeping you informed of medical or practice issues (H1N1 for example.)

 

During inclement weather please check our office opening status before coming for an appointment.

Hospitals:
We attend newborns and hospitalize patients at Morristown Memorial/Goryeb Children’s Hospital, and St. Clare’s Hospital. They are the only hospitals in our area that are fully equipped to take care of sick babies and children. Please contact us before going to a hospital or emergency room.

We constantly strive to maintain a medical home for your child. We do not refer, recommend, or accept clinical reports from store based walk-in clinics.

Referrals:
Some insurance plans require a referral before you go to a specialist. We cannot issue these retroactively. As a rule, we need to assess your child before issuing a referral.
Most insurance plans determine the specialists we may refer you to. We have no control over this, but apologize for any inconvenience it may cause you.
Almost all mental health referrals are at the complete discretion of your insurance plan.

Lab/Radiology:
Laboratory work is almost always contracted by your insurance plan. Please do not go to a laboratory without the appropriate form from us.
We use both hospital and non-hospital radiology departments. We prefer to make the decision on clinical grounds, but your insurance plan may dictate our choice.

Payment:
We are contractually required to collect your co-pay at the time of your visit. We accept cash, debit cards, VISA, and MasterCard.
We make every effort to obtain payment from your insurance company, however that is not always possible. Within the limits of your insurance contract, you are personally responsible for charges incurred.
If your account is seriously in arrears we may have to make budget or other arrangements in order to see your child.

Forms:
You probably are not thinking about it right at this moment, but we are inundated with paperwork from schools, camps, and athletic programs.
We will fill these forms out at no charge if you bring them with you to your child's well care exam or if they can be handled by our administrative staff.
If the doctors have to complete them outside of a regular visit there is a ten dollar fee payable at your next office visit.

If at any time you have questions about bills, insurance, comments about your care or suggestions how we can serve you better please contact our practice administrator at 908 850-7800