FOSTERING FAMILIES

5640 W. Atlantic Blvd

Margate, FL 33063

(T): 954-972-3430

(F): 954-972-3450

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Office Policies

Fever


Policies

  1. Sick patients take top priority. Emergencies are never predictable; consequently, occasionally your office wait may be longer than anticipated as we address urgent issues that can arise. You will always be given an explanation and every effort will be made to accommodate you and your child. The main point is that we ask your continued understanding when these uncommon situations crop up. No one likes to wait, particularly in this fast pace world of ours, but I am sure you will appreciate the same level of focused dedication should your child be seriously ill.
  2. We are here to help. If you haven’t heard from us in a timely manner-call again. Technical hiccups do occur and at times we are faced with tsunamis of requests and questions- this delays our response time so bear with us, but do call again if your concerns need closer attention.
  3. Try to be on time. Believe it or not, we make a concerted effort to run on time. Some days are better than others, but if you are late this creates a domino effect.

    Unless your child is sick, appointments will be rescheduled if more than thirty minutes late (if late, due to special circumstances let us know we will definitely work with you)- PLEASE UNDERSTAND OUR CANCELLATION POLICY.
  4. With the exception of infants, there is to be NO EATING in the office. Food debris leaves an unsanitary reflection on our office. YOUR COOPERATION IS GREATLY APPRECIATED!
  5. If your child has vomiting, diarrhea, unusual rashes, lice or anything that you feel is contagious- let us know. We will accommodate accordingly. We will do whatever it takes to prevent any exposure to our other families- let us know.
  6. No playing on the furniture. We love seeing the unbridled energy and joy children possess, but we respectfully ask that children not climb on any furniture, open doctor’s drawers, or play with the medical equipment. And be careful with doors- too many little fingers get caught.
  7. No one is allowed in the office area as this may breach patient confidentiality, a matter that we take very, very seriously.
  8. School forms, lab forms requested that do not correspond to a recent checkup will be subject to a processing fee- the staff will inform you about this when you request the forms.
  9. Referrals for non urgent procedures or specialist’s visit take ONE WEEK.

    Emergency referrals are offered immediately, for example a broken arm and so on. Generally, if you need a referral let us know as soon as possible so that we can process this request- remember to give us a minimum of ONE WEEK.
  10. I do not phone in antibiotics. In the Pediatric population this practice is unsafe and not in keeping with the level of care children deserve. This also places us in a position of great liability as things are not always as they appear.
  11. Feed back, we thrive on this. We receive compliments all the time-keep them coming it inspires us, but we are also open to critical review as we want to correct anything that needs to be improved. Your ideas or observations are always welcomed.
  12. Understand your insurance policy and have information ready to process your claim via Vital Billing. Payment is requested at the time of service.
  13. We offer ancillary lab services to expedite care and evaluations. Your nurse will review the consent form prior to any lab testing. Understand that you may always opt to go to the facility used by your insurance.
  14. Ask questions, if you are unclear about something on any level please ask. We are here to help you- we are all on the SAME team. Understanding and insight will enable us al to accomplish our set goal- the best care possible.
  15. The human factor. If you are having a rough day or time, please let us know. We truly want to help, just as you help us with you kind words, patience, and understanding; we too want to reciprocate and help when and where we can.

  16. Thanks for your understanding on these topics, I am sure that these guidelines will help us all . Dr R

It is my hope to dismiss some of the hype on fevers. No longer should we see a fever as some vile process that is harmful and un-natural. Fever is an immune response. When you subdue a fever you are arresting the body’s natural defenses. Fever is part of the healing process.


When the body temperature rises it becomes a hostile arena for viruses and bacteria. By allowing for a fever to run its course your are effectively “burning off” the infection and permitting the immune system to send out signals to aggressively mount its defenses.

So, if the little one has a temperature less than
102
It's O.K.


Now, if their temperature is over 102- I prefer motrin or advil over Tylenol in kids over 6 months of age. A warm sponge bath (for at least 20 to 30 minutes) will help. As a warm bath will help to dissipate or draw out the fever and be can be done as often as necessary. Never, never an alcohol bath.

IMPORANT EXCEPTION!
The above advice does not apply to infants less than two months. Infants with a rectal temperature of 100.4 degrees or more (rectal temperature take with a digital thermometer) requires an urgent call to us anytime- they will most likely need to be seen at the hospital. A rare event, but something that needs to be taken very seriously.

Generally you can refer to you baby book or office notes to check on the dosing for your child.

The Growth Curve - What Does This Mean?

When you come to Royal Palm Kid’s Care you will notice a lot of gadgets that are geared for the accurate measurement of children of all ages. Scales are electronic, a stadiometer is used to measure heights and a special board is utilized to measure infants. Accuracy is crucial and we take it seriously. We take the measurements and plot them out on the growth curve. These curves give a general idea where your child lies in relation to peers of the same age. The information is offered as a “percentile.”


Let me clarify what this implies. The average height and weight is the 50%. The NBA stars of tomorrow are at the 95%. Tomorrow’s jockeys are at the 5%. Anything in between is a comparison of where your child’s physical growth lies. Another way to think of it is to consider the following example: Your child is at the 25% for height and 50% for weight. Well, in a room of one hundred kids of the same age: 24 kids are shorter and 74 kids will be taller. Half the kids will weigh less and the other half will weigh more. (Time to eat less ice cream and play more). If this is not clear let me know.

These curves are not predictive of your child’s ultimate height or weight. They are merely a tool to help us monitor growth. Remember please that certain diseases or genetic conditions have their own growth curves and not that of the general population. Realize too that certain ethnic groups are not accurately represented on the conventional curves used. Understand as well that much of this growth pattern is genetics. Genetics, genetics, genetics-

Checkups

Insurances Accepted

Aetna

Avmed

Best Choice 

Blue Cross and Blue Shield

Cigna

FHA-TPA

Florida Blue Options  Florida Health Options   
Great West Humana  Neighborhood Health Plan
Tri Care
United Health Care



*We accept other insurance plans not listed. Please contact us. ​​​

General Tips

Viruses vs. Bacteria


Allow me a moment to get on my soap box. Intelligent, sophisticated parents need to have a good understand of the differences between the two. They are about as similar as an apple and a shoe. Yet, the symptoms they create are oftentimes similar.


First of all, bacterial infections tend to be more severe, but amenable to antibiotics- viral infections do not improve with antibiotics. Viral infections need to run their course. Antibiotics are not helpful for viral infections. I make a big deal about this because the lack of distinction leads to overuse of antibiotics, I hope you agree.

Secondly, there are characteristics of each type of infection that enable me to distinguish what we are up against. The blood test is also an extremely helpful tool that reveals the profile of the infection by identifying the immune cells that are present.

As we work together you will learn about the generalities of each infection and how to cope with the illness.

The aim here is to avoid the over use of antibiotics and medicines and to allow your child to build up their immunity. Sorry, there will be many times where watchful waiting will be the best therapy.
Copyright 2016 © Royal Palm Kids Care

Dealing with a Sick Child

No one, no one knows your child better than you do. No one. Trust your instincts - I do.

Having established this reality it is important that you understand that if you are worried about your child we are ready to help. Naturally, our preference is to see the child to gain the most accurate clinical evaluation. In the care of children we do not ask parents to wait and, in fact, more often than not see the child the very same day.


Hospitals and Pediatric urgent care centers are most helpful for worrisome situations outside of office hours that can not wait, but my preference is to see my own patient even if it means we “squeeze” you in. (Generally, parents do not mind waiting if I am attending to a sick child; you never know when it is their child that needs the immediate attention). Allow me to help by giving me a call so we can gauge the best and safest intervention So help is always on hand.

It is always better to be proactive than reactive.
There are common features that will help dealing with ill child.

HYDRATION:
Fluids, fluids, fluids (NOT WATER, NOT JUICE, NO DAIRY). Whether its Pedialyte, Gatorade, All Sport or Powerade kids need to keep hydrated. Many times this means small frequent sips. Big gulps or volumes may at times provoke vomiting. Don’t worry if your child does not eat. When was the last time you felt like eating when you were sick? Kids are no different. There will be plenty of time for eating, besides an increased appetite will be one of the earliest signs that your child is on the mend. Fluids, fluids, fluids!

FEVER
See the fever section above.

THE 24 HOUR RULE:
Unless your worry threshold tells you otherwise, it is sometimes a good idea to observe you child for a day to allow the infection to “mature“. This enables me to gain greater clinical accuracy and the blood tests become more predictive. As you know this does not apply to babies and to kids that just look sick. It does apply if there is an infection “going around” and you think your child has it.

TLC:
I'm not kidding. Plain love and comfort goes a long way into reassuring your child. I am certain this does not even need to be expanded on…

Sick Child

Growth Curve


How Often?

The general recommendation for children over two years of age is a checkup on a yearly basis. An easy way to remember that a checkup is due is to try to get into the routine of having these annual visits during the child’s birthday month. If you’re not sure or don’t remember - give us a call.


What to Wear?
Children are encouraged to dress in comfortable loose fitting clothing that can be easily removed for thorough evaluations. Try to avoid coming to a checkup straight from the playground- I think you know where I am going with this…

Be Prepared
Make lists. Take notes bring diaries, notes, anything that is of concern will be addressed. So, be ready with a list of your concerns or observations.

Focused Visits
Be clear on what the purpose of the exam is about. It is a careful evaluation of your child’s growth and general well being. Unfortunately it is not the forum to bring up other more involved issues that are beyond the scope of the visit. For example, the check up is completed and “by the way, the school says that my child is disruptive in the classroom and may have ADHD.” Although I would love nothing more than to resolve the problem right there and then, the reality is that this is a very complex topic and in all fairness to you, your child, the other scheduled patients and myself this and all complex issues require another appointment designed to focus specifically on the problem at hand.

Involve Your Child
Encourage you child’s questions. Help them understand that their concerns are important. They are not bystanders, but rather the very essence of the visit.

Labs
For convenience reasons and quick results most parents allow that blood tests, cholesterol testing and urine analysis be done at the time of the checkup. We will be happy to continue to accommodate these requests. If you opt to have the tests done at the lab we will furnish the lab slips for you as you leave the checkup.

School Forms
School forms (blue and yellow forms) are provided shortly after the checkup is complete- generally about a week. There is a small processing fee for lost forms or forms filled out beyond a reasonable time of the checkup (generally about a month or more).

EKG
I strongly encourage children, particularly athletic children, over the age of 11 get an EKG. Tragically, too many parents forgo this test and I think it is a very important test that can be done at the office. Yes, there is an expense but the results are immediate and accurate. You should know that there are countries, for example-Italy, where EKG are compulsory for preteens. Certainly, EKGs can be done at the hospital, but this is a more involved process- but I will be more than happy facilitate this for you. Just please, get a baseline EKG.
954-972-3430