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YOUR HOME FOR QUALITY PEDIATRIC CARE • LATE WINTER 2020/2021

Welcome to The PediaMag.............. 2

MENTAL HEALTH Psychological Health and Sport-Related Activities................... 3

HOLIDAY TRADITIONS Favorite Christmas traditions........... 4

ASTHMA Asthma Season - Autumn 2020....... 6

HEALTHY LIVING The Fundamental Things Apply, as Rabbits Go By............................. 8

VEGETABLE RECIPE Sheet Pan Roasted Vegetables......... 12

HOLIDAY EATING Mindful Eating for the Holidays........ 13

FLU VACCINE Flu Vaccine in Kids — 2020/2021.... 14

Publication Provided by:


Welcome

Welcome to The PediaMag Welcome to another issue of The PediaMag. The Holiday Season is upon us, and this year will be a holiday like none we have ever known. Covid-19 and the precautions needed to protect ourselves and our families will complicate everything from flu season to family holiday celebrations. From the added importance of making sure your entire family has their flu shots this year to the adjustments that you may need to make for your family holiday traditions, the PediaMag has information and suggestions to help keep your families safe, healthy, and happy. Have an idea or suggestion for a topic you would like to see covered in a future issue of the PediaMag? We want to hear from you. Send your thoughts to us at Rebecca.Scalise@AHN.org.

About Us: Pediatric Alliance was formed in 1996 when eight individual practices joined together to provide quality health care throughout Southwestern Pennsylvania. Over the years, Pediatric Alliance grew to be the largest physician-owned group pediatric practice in the area. In 2019, Pediatric Alliance joined with Allegheny Health Network to allow expansion of resources in order to stay abreast of the latest technology and advances in health care. Our board-certified pediatricians offer primary care to children and adolescents in 16 different office locations including two specialty care offices for allergy, asthma, and immunology and pediatric endocrinology. We are proud to offer personalized, patient-centered care to patients from birth to 21 years of age. We strive to meet your family’s pediatric needs, provide convenient access to care, and build strong relationships with families to maximize your child’s health. To learn more about AHN PediatricsPediatric Alliance, visit our website at www.ahnpediatrics.org.

AHN Pediatrics-Pediatric Alliance 1100 Washington Ave., Suite 219 Carnegie, PA 15106 pediatricalliance.com

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The PediaMag is published quarterly, copyright 2020. All rights reserved. Publisher AHN PediatricsPediatric Alliance

Editor Rebecca Scalise

AHN Pediatrics-Pediatric Alliance • Winter 2020/2021 • www.ahnpediatrics.org

Art Director Brent Cashman


Mental health

Psychological Health and Sport-Related Activities Written by Rebecca Zill, Psy.D. – Psychiatry and Behavioral Health Institute

Research has illustrated a connection between individuals’ psychological health and their approach to, or performance in, sport-related activities. As sports are a societal microcosm for many, this process may be linked to cultural influences that can shape the mental and emotional well-being of today’s competitive athletes (National Collegiate Athletic Association, 2020). As a result, athletes are often tasked with navigating both intra- and interpersonal barriers regarding their participation in sports. This includes managing anticipatory pressure, executing responsibilities, and navigating the positive or negative consequences of performance. This necessarily highlights the importance of an open dialogue regarding the mental health of athletes. For many athletes, this may appear similar to the concept of “mental strength,” which Loehr (1995) defines as, “the ability to consistently perform toward the upper range of your talent and skill regardless of competitive circumstances.” Developing and maintaining this sense of mental strength can often be challenging and stressful, illustrating the broad importance of athlete mental health. Behavioral health professionals work with athletes to optimize health, improve performance, and manage symptoms while operating within an interdisciplinary team. As such, these professionals are well positioned to support athlete mental health. Athletes may seek mental health services across a variety of settings, though, many educational settings have begun to employ these professionals in an effort to support coordinated care. While some athletes may resist seeking mental health support due to stigma or misunderstanding of the service, mental health support is non-invasive and driven more so by an athlete’s willingness for engagement, honesty, and self-exploration. Athlete medical and substance-induced etiologies are typically ruled out as contributing factors. Then, individual psychological conceptualizations within a developmental, systemic, or environmental framework are developed. Common mental health concerns arising in athletes include, but are not limited to, anxiety, mood, abnormal eating or purging, body image, adjustment to recent stressors, or psychosomatic symptoms. Services should be individualized and

targeted to these specific symptom domains, with medication management and psychotherapy as the foremost treatment options. Mental health treatments are also culturally sensitive and flexible, so due diligence should be exercised to seek a quality fit between athlete and professional. Psychotherapy techniques used may include positive self-talk, imagery, goal setting, mindfulness, biofeedback, and modeling. Common treatment goals can include skills training, reduction of symptoms, behavioral activation, and generalization across settings.

As athletes, and society in general, are made increasingly aware of the benefits of mental health services, negative stigma may dissipate and make these valuable services feel more accessible to everyone. These services may one day become an essential feature of the holistic support of athletes.

References Loehr, J. E. (1995). The new toughness training for sports: Mental, emotional, physical conditioning from one of the world’s premier sports psychologists. Plume. National Collegiate Athletic Association. (2020). Mind, body and sport: The psychiatrist perspective. Retrieved from http://www.ncaa.org/sport-science-institute/mind-body-and-sport-psychiatrist-perspective

AHN Pediatrics-Pediatric Alliance • Winter 2020/2021 • www.ahnpediatrics.org

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Holiday Traditions

Holiday Traditions Stacey Endlich Office Manager Greentree My favorite Christmas tradition started as an adult actually. My sister is a nurse at AGH in the neuro ICU, she is on a holiday rotation so we don’t always get to see her on Thanksgiving or Christmas. Every year when we are all free we pick a day and a restaurant, usually downtown because of all the decorations and lights. We get dressed up and have a nice family dinner together. It’s my favorite tradition because it’s quality time with my immediate family. Coming from an Italian family, holidays can be a little crazy and very loud, the holidays in general for everyone can be hectic. It’s nice to take one night to relax and celebrate with the people you love most.

Jill Devinney - Clinical Access Coordinator Every year since 2010, my family and I visit the BAKERS FAMILY CHRISTMAS EXTRAVAGANZA in Cranberry Township. It has been named one of the neighborhoods with the best holiday lights in the

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Pittsburgh area. Donations are collected for PACE which is dedicated to educational and therapeutic treatment of kids with Autism and other special needs.

AHN Pediatrics-Pediatric Alliance • Winter 2020/2021 • www.ahnpediatrics.org

All of the lights are sequenced to Christmas music that plays on your car radio and it’s a really great fun for kids and families, and it gets bigger and better each year!


Rebecca Scalise Department Secretary Our holiday tradition for many years now has been the Nutcracker. Not going to the professional Nutcracker downtown, but participating in the Nutcracker performances at Carnegie Performing Arts Center in Carnegie. All three of my daughters have danced parts in the show, my son helped to manage the props and sets, and I helped the dancers backstage and in the dressing rooms with their costumes (when I wasn’t watching my daughters from the wings :). My kids have all moved on from participation, but those years will always be my most special holiday memories.

Ashley Loboda, MD St. Clair Office Every year we go out to a farm to cut down a Christmas tree. There is a hayride out to the field of trees, deliberating to find the best tree, the adventure of cutting it down together, and finally hot chocolate while the tree is tied to the car. We all enjoy this family adventure that starts off our Christmas season.

Renee Faletto - RN Clinical Coordinator Every year we do a breakfast with Santa at the bar we own. Proceeds benefit Fort Cherry Angel Tree. Also we do Gingerbread houses with all of the cousins at Thanksgiving.

AHN Pediatrics-Pediatric Alliance • Winter 2020/2021 • www.ahnpediatrics.org

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Asthma

Asthma Season - Autumn 2020 Written by Sergei Belenky, MD, PhD – Office of Allergy, Asthma, & Immunology

Highly unusual and grim circumstances are setting the stage for this year’s asthma fall season which is full throttle underway across the United States. COVID-19 has created an all year round viral season with staggering consequences for communities around the country and worldwide. Autumn is commonly associated with numerous respiratory viruses, like rhinovirus, metapneumovirus, adenovirus, and influenza virus. The latter and the former are the most important groups triggering seasonal exacerbations of asthma. Asthma exacerbations or flare-ups are events in the course of the disease when utilization of care is at its utmost level, when healthcare resources are maximally employed, and medical, social, economic impact of asthma are felt the most. The toolkit that can prevent asthma exacerbations includes optimal asthma control achieved with effective and safe asthma treatment. Asthma is a common inflammatory condition of the airways affecting 340 million people worldwide, and up to 10% of the population of the United States. Seven million children are diagnosed asthma sufferers, with millions more undiagnosed. Clinical characteristics of asthma include wheezing, shortness of breath, tightness in the chest and cough. Reversible or variable airway obstruction is its main physiologic feature, and airway inflammation is

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the hallmark of its pathobiology. The goal of any asthma therapeutic plan is achieving asthma control. Ideally that involves reduction or elimination of daytime symptoms, nocturnal awakening with any difficulty breathing, improvement of the quality of life by increasing functional capacity including recreational and sports activities. Maintaining lung function at normal or near normal level as well as reduction of the risk of exacerbation are the ultimate parameters of overall success in asthma management. For the past almost 50 years inhaled corticosteroids (ICS) have been the cornerstone of asthma treatment representing so-called asthma controller therapy, whereby short-acting beta-2 agonists (SABA) being a reliever therapy - indicated for relief of symptoms whose very prevention is one of the most important therapeutic goals. Frequent use of SABA is a reliable marker of poor control of asthma with increasing risk of exacerbation. Unbridled use of SABA in the 1980s is believed to be associated with a spike in asthma mortality. And conversely wide use of ICS as the mainstay of asthma control led to decreased asthma mortality. along with many other benefits like daytime and nighttime symptom control, improvement in lung function, and decreased frequency and severity of exacerbations.

AHN Pediatrics-Pediatric Alliance • Winter 2020/2021 • www.ahnpediatrics.org


Since the mid-90s ICS combination therapy with long-acting beta-2 agonists (LABA) has been used widely and found to be superior to high dose ICS. ICS/LABA combination therapy is currently recommended by all latest guidelines in adolescents and adults, as well as children 6 years and older in situations where ICS monotherapy is insufficiently effective. LABA agents however should NOT be used as single controllers as FDA 2010 public health warning emphatically stated. There’s certainly the role for other classes of asthma medications that are used in pediatric and adult asthma populations. They include leukotriene receptor antagonists (LTRA) and long-acting muscarinic receptor antagonists (LAMA). Montelukast is widely used in children (1 year and older) for the treatment of mild asthma and allergic rhinitis. FDA recently issued a ‘black box’ warning about possible neuro-psychiatric adverse effects of the drug with no removal from the US market. Spiriva Respimat is the only LAMA agent approved for asthma monotherapy for children 6 years and older and adults. ICS/ LABA/LAMA combination therapy long available for COPD patients has recently been approved for moderate to severe asthma ages 18 and older - TRELEGY ELLIPTA available in 2 different strengths. Despite significant progress in achieving measurable results in asthma control, 5 to 10% of all asthma patients belonging to so-called severe asthma remain to be poorly controlled comprising the group most vulnerable to crippling effects of the disease and death. Over 20% of all asthma patients are in the group of so-called difficult to control, requiring additional resources and increased attention to adherence to therapeutic regimen. In the last decade significant strides have been made in our understanding of pathobiology of asthma, its phenotypes and endotypes. Airway inflammation is presently categorized into type 2 (T2) and non-T2 inflammation. Important biomarkers of T2 inflammation have been determined and used for practical purposes of asthma treatment with a new and revolutionary class of BIOLOGICS which have drastically changed the landscape of asthma care in this country and beyond. Fractional exhaled nitric oxide (FeNO), blood eosinophils, and total as well as antigen-specific IgE are widely used biomarkers of T2 inflammation allowing to select most appropriate of FIVE available biologic agents approved as an add-on treatment for different endotypes of asthma. Two of them are FDA approved for children 6 years and older - OMALIZUMAB (XOLAIR), a monoclonal antibody against IgE and MEPOLIZUMAB (NUCALA), an anti-IL-5 monoclonal antibody. Xolair is designed to address allergic asthma phenotype, whereas Nucala is most appropriate for eosinophilic asthma. These biologics

are targeting difficult- to-treat and severe asthma patients whose prospects previously were dismal at best.

PEDIATRIC ASTHMA DURING COVID-19 PANDEMIC Risk associated with COVID-19 as it pertains to asthma in general is not quite clear, however in March of 2020 about 25% of young adults hospitalized with COVID-19 had a history of asthma. Risk of COVID-19 in asthmatic children is even less well known, but does not appear to be high. Nonetheless asthma control is extremely important during the pandemic. No step down strategy is to be applied to avoid breakdown of asthma level of control, where possible nebulized ICS and SABA should be switched to MDIs or dry powder inhalers. But never at the expense of losing asthma control, therefore if necessary nebulized form of asthma drug delivery should be continued. Spring time shortages of SABA appear to have been resolved. All basic approaches to asthma treatment are unchanged including use of ICS, ICS/LABA, and biologic agents. Systemic steroids whose role in COVID-19 remains to be controversial in children should be used unequivocally for asthma flare-up treatment.

Fractional exhaled nitric oxide (FeNO), blood eosinophils, and total as well as antigen-specific IgE are widely used biomarkers of T2 inflammation allowing to select most appropriate of FIVE available biologic agents approved as an add-on treatment for different endotypes of asthma. Considerable morbidity is anticipated from influenza driven asthma exacerbations in both children and adults. In order to avoid ‘twindemic’ influenza vaccination should be completed by the end of October ideally, clearly November flu vaccination is also appropriate and utterly important. Hopefully social distancing, mask wearing, home education and hybrid modes for school children will serve not only COVID-19 spread mitigation, but also other respiratory viruses dissemination. In summary, be prepared for a viral season in earnest, making sure your children are well equipped with inhaled therapeutics, follow the guidelines and action plans. AHN Pediatric Institute Allergy, Asthma. Immunology Clinic is there for you for both in person and telemedicine consultations - call at 412-348-6868. Stay healthy and stay safe.

AHN Pediatrics-Pediatric Alliance • Winter 2020/2021 • www.ahnpediatrics.org

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Healthy Living

The Fundamental Things Apply, as Rabbits Go By Written by Brian W. Donnelly, MD – AHN Pediatrics Wexford

In “The Rabbit Effect : Live Longer, Happier, and Healthier with the Groundbreaking Science of Happiness,” Dr. Kelli Harding takes us along on her path of discovering the keys to better health. Following her rabbit meant exploring the interactions between mental and physical health. In New Zealand, a group of white male rabbits was fed a high fat diet. It had been established that these rabbits developed heart disease much like humans if they were fed the lagomorphic equivalent of ‘junk’ food. After several months, all the rabbits had the expected elevations in cholesterol, blood pressure and heart rate. But, surprisingly, one subgroup did NOT have the pathologic changes in their blood vessels that the other bunnies had. The researchers scoured the testing model for a plausible explanation. What they discovered was that the rabbits whose blood vessels had not changed for the worse were taken care of during the study by someone who petted them, who talked to them, and who nurtured them. The investigators had not controlled for the ‘tender loving care’ factor.

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This unexpected finding intrigued the author and ultimately affected the direction of her career. In varied clinical settings during her training, she was compelled to wonder why some patients did much better than others in almost identical circumstances. She looked for other evidence of how that TLC could impact health. Her search led her to the work of Dr. Hans Selye. Dr. Selye was an endocrinologist who studied the effects of stress on rats. He described the General Adaptation Syndrome, which was experienced by all of the subjects in his stress experiments. The alarm stage is first, where the body identifies a stimulus as stressful. The body activates the adrenergic or “fight or flight” hormones and the brain’s vigilance is heightened. Ordinarily, the stress would be short-lived, and the body could relax afterward. But with prolonged stress, the Resistance stage follows, where the body stays activated at a higher than normal level. Unrelenting stress causes distress, which causes triggers internal harm. Because the body cannot maintain this state indefinitely, the final stage is Exhaustion. Distressed humans seem to follow the same pattern. For us, the observable results of this last stage include heart disease, diabetes mellitus, digestive ailments, asthma, depression, and Alzheimer’s disease. Another scientific finding that emerged to help explain the TLC effect involved telomeres. Telomeres are repetitive nucleotide sequences at the ends of our chromosomes. They can be thought of as protective caps at each end of our DNA strands. They are known to get shorter with age. In studies of twins, the one with the shorter telomeres was three times less likely to outlive the other. Briefly, the shorter the telomeres get, the shorter your life gets. Optimizing diet and exercise can reduce the rate of telomere shortening. The ingestion of anti-oxidants can also slow the process. Conversely, cigarette smoking and obesity have both been shown to increase the rate of telomere shortening. Exposure to certain pollutants and high levels of stress are also potent telomere shorteners.

AHN Pediatrics-Pediatric Alliance • Winter 2020/2021 • www.ahnpediatrics.org


Epigenetics is the another biological phenomenon that helps explain the cellular consequences of the mind-body interactions. It can be defined as the study of changes in organisms brought about by modification of gene expression, rather than by alteration of the genetic code in the form of DNA. A simple example involves the boy with the genetic capacity to be tall, but suffers malnourishment and chronic illness during his childhood, so ends up much shorter than expected. The best known mechanism of an epigenetic change is DNA methylation, where a methyl group binds to a base on a portion of DNA, which subsequently renders that region less active. Another common example is histone modification. Histones act as spools around which the DNA winds. If a histone is chemically modified, the DNA expression can change. Early life stress has been associated with epigenetic changes, which can impact the person’s daily functioning. Similarly, anxiety and depression have been linked with similar epigenetic alterations. The example given is the Great Canadian Ice Storm of 1998. This storm killed 35 people, stranded thousands of people and deprived millions of people of electricity for up to 6 weeks. Afterwards, some researchers approached women who happened to be pregnant during the time of this calamitous stressor. They measured biological markers of stress on the women, then followed their babies up until age 13. They found that the ice storm babies whose mothers suffered high levels of stress had more health, behavioral and language problems compared to their age-matched peers. This and other studies suggest that the effects of emotional trauma can be passed down through future generations. (This is important for all of us to realize while we battle through the societal lockdowns caused by our current COVID paranoia syndrome.) At the same time, Dr. Harding was learning more about how some patients did better than anticipated. She cites Dr. George Engel, who proposed that the biomedical model of insufficient to explain human illness. He proposed a biopsychosocial model, with layers of complexity. The model starts with the molecules that comprise the cells, then moves to tissues, then organ systems, then the whole person. Enveloping the person is the family, then the community, then the culture. Continuing outside, we find the nation/state, and then the biosphere. With this wider perspective, we can see that many other processes can affect our overall health. Traumatizing life events can act to poison our health over time. In the 1980’s, Dr. Vincent Felitti was working with obese patients. He was frustrated by the failure of many patients to keep weight off. Somewhat by accident, he discovered that most of the patients

had a history of significant childhood trauma. For these patients, the previous emotional damage was unrecognized as a factor in their current health struggles. This led to the development of the ACE (Adverse Childhood Experiences) Study. The ACE study identified a clear dose-related response, meaning that the greater the severity of childhood trauma, the greater the likelihood of chronic diseases in adulthood. Chronic stress can bring on chronic inflammation, which complicates and shortens our life.

Regular exercise is important. Minimizing the distress that life can bring is also very important for the mind- body connection. Find happiness. It is not always tied to more money. Finding a sense of purpose is the key. Armed with this knowledge, and inspired by the rabbits, Dr. Harding looked for ways to pre-empt these challenges. Part of the approach was seeing all patients as equally deserving of love, regardless of their circumstances. She decries the innate bias that might affect how doctors would diagnose and treat those with a different cultural background. She stresses that there may be hidden factors in the interaction of patients’ physical and mental health. Her approach re-examines the definition of health. The World Health Organization defines health as “the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Another, more functional, definition (as proposed by the National Institutes for Health) is that health is a state that allows the individual to adequately cope with all demands of daily life (implying the absence of disease and impairment). So, how do we get there? Good nutrition is important. Remember the rabbits. Eat more of the foods that they do. And consider eating less. Regular exercise is important. Minimizing the distress that life can bring is also very important for the mind- body connection. Find happiness. It is not always tied to more money. Finding a sense of purpose is the key. Develop and strengthen social ties. Connect with other people. Studies show that social support helps patients heal faster. And that workers who are supported in their workplace are significantly healthier. Get to green spaces more. Studies show that regular exposure to trees, grass, and bodies of water reduces levels of cortisol, lowers blood pressure, and boosts immune function. (It’s like my mother used to say : Go outside and play.) It turns out that nature nurtures us.

AHN Pediatrics-Pediatric Alliance • Winter 2020/2021 • www.ahnpediatrics.org

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Healthy Living

The executive summary here is that happiness increases health. Dr. Harding’s findings here resonate with those of Stephen Pinker. In his book “The Better Angels of Our Nature : Why Violence has Declined,” he chronicles the long rise and recent fall of violence in human society over recorded history. He identifies the major factors that have influenced the eventual lessening of violence throughout the world. In most places, nation-states have monopolized the use of force. So people who commit violence are more likely to be incarcerated, which lessens their threat to society but also diminishes the factor of violent revenge by their victims. (Think how many fewer Hatfields and McCoys there are now than there might have been.) Thomas Hobbes famously described man’s life in anarchy as “solitary, poor, nasty, brutish, and short.” His solution was the Leviathan, a powerful third party that had no stake in potential conflicts between citizens, other than fairness. The Leviathan would embody the will of the people and penalize the aggressors that had visited violence

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upon their victims. Of course, a corrupt Leviathan needs to be guarded against, but this model has served mankind reasonably well. Also important is the development of commerce, where other people are more valuable to you alive than they might have been before. Back in the day, life was cheap. Now, we live longer and in greater comfort, which makes it easier to have greater regard for others. Markers of our societal advances include lower occurrences of infanticide and of rape. Increased literacy and improved interpersonal communication are important factors that make it easier to eschew violence in resolving our conflicts. Effectively communicating our grievances helps us more easily appeal to what President Abraham Lincoln famously referred to as “the better angels of our nature” in seeking a peaceful resolution of our differences. Pinker’s historical perspective is valuable for public health purposes. He quotes Henry Maine’s idea that “war is as old as mankind; peace is a modern invention.” We just need to keep inventing it. Empathy is also an important aspect of the decreased violence over time. We live in an age of empathy. As Pinker puts it: “In every era, the way people raise their children is a window into their conception of human nature. When parents believed in children’s innate depravity, they beat them when they sneezed; when they believed in innate innocence, they banned the game of dodgeball.” Sophocles told us that kindness gives birth to kindness. It also begets better health. So, keep reading. Read to your young children. If they are older, encourage them to keep reading. As Mark Twain said, a person who won’t read has no advantage over one who can’t read. Maybe the appeal to their competitive urges will win the day. Dr. Harding emphasizes the “ripple effect.” Take care of yourself first. Maintain your cells, and be at peace. Next, take care of your family. Nurture and be nurtured by whatever circle (or circles) of friends you have. Then consider reaching out to support larger causes. As Mother Teresa instructed : “If you want to change the world, go home and love your family.” Demethylation happens, but love abides.

AHN Pediatrics-Pediatric Alliance • Winter 2020/2021 • www.ahnpediatrics.org


This year, it’s more important than ever to protect your entire family from the flu – especially your little ones. ~ It’s not too late to get your child’s flu shot! Call our office now to book your appointment. ~ Learn more about the flu at AHN.org/flu-shot.


Vegetable Recipe

Sheet Pan Roasted Vegetables Succulent roasted vegetables with a sweet and smoky, herby taste. Good for a main course with noodles or rice, or as a side dish.

Prep: 30 mins Cook: 1 hr 30 mins Total: 2 hrs Servings: 24 Yield: 24 servings

Ingredients 8 zucchini, peeled and chopped 1 eggplant, peeled and diced 8 carrots, diced

Directions

16 cherry tomatoes

Step 1 In a large bowl mix the zucchini, eggplant, carrots, tomatoes, onions and peppers with the oil, rosemary, thyme, bay leaves, oregano, garlic, lemon juice, lemon zest, salt and pepper. Cover and chill for at least 2 hours, and preferably overnight.

2 red onions, sliced 1 red bell pepper, sliced 1 yellow bell pepper, sliced

Step 2 Preheat oven to 400 degrees F (200 degrees C).

½ cup olive oil 1 teaspoon dried rosemary 1 teaspoon dried thyme 2 bay leaves, crushed 1 teaspoon dried oregano 2 cloves garlic, minced 2 tablespoons fresh lemon juice 1 teaspoon grated lemon zest salt and pepper to taste

Step 3 On a large roasting pan, roast the vegetables, uncovered, for 20 minutes, or until the tomatoes have split and the edges of some of the vegetables are starting to crisp. Remove from the oven and stir before returning to the oven for another 20 minutes. At this time reduce heat to 200 degrees F (95 degrees C) and continue cooking until vegetables are tender, turning every 20 minutes.

Nutrition Facts Per Serving: 72 calories; protein 1.5g 3% DV; carbohydrates 7.3g 2% DV; fat 4.7g 7% DV; cholesterolmg; sodium 11.1mg.

© COPYRIGHT 2020 ALLRECIPES.COM. ALL RIGHTS RESERVED. Printed from https://www.allrecipes.com 11/04/2020

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AHN Pediatrics-Pediatric Alliance • Winter 2020/2021 • www.ahnpediatrics.org


Holiday Eating

Mindful Eating for the Holidays Written by Jennifer Yoon RDN, LDN, IBCLC

The Holiday Eating Season is upon us, and with celebrations, food, and treats continually at hand, maintaining healthy eating habits can be very difficult. Mindful Eating techniques are based on listening to your body, eating when hungry, enjoying food, and stopping when satisfied. Mindful Eating can help you enjoy the holidays while maintaining healthy habits. • Enjoy the special treats you really want. Really enjoy them. Eat them slowly and without distraction. And when you are satisfied, stop. Pass on treats that you can have any time of year. • Avoid going to events and gatherings hungry. Don’t skip meals. Eat small, light meals prior such as fruit, yogurt, a small salad, veggies and hummus, or some soup. • Stand away from the food tables at parties and family gatherings. • Take a small portion of favorite dishes. Go back for another small portion if needed. • Holiday meals are often heavy on high calorie starchy foods. Roasted vegetables or a green salad loaded with veggies are healthy additions to the holiday table and are much lower in calories. • Eat slowly and drink water throughout the meal. • Avoid the misery of feeling overly full. Stop eating when you are satisfied. • Take a container with you to take some favorite foods home to enjoy later. • Adults should use alcohol in moderation. Alcohol calories add up fast, and can derail normal hunger and satiety signals resulting in over indulging. • Avoid having tempting treats easily accessible. Store away or freeze sweets received as gifts. Pull out small amounts as needed to take to gatherings or enjoy for months to come. • If treats and goodies are in abundance around the office, choose a small portion of a favorite to have for dessert. • Have a few easy meals on hand for busy nights. A frozen pan of pasta or containers of soup that can be reheated in a pinch can prevent

unhealthy fast food runs. If take out is necessary, avoid fried foods. Choose establishments that offer salad, whole grains, vegetables, and baked or grilled proteins. Physical activity is an important part of a healthy lifestyle and part of Mindful Eating practices. Use these tips to achieve or maintain beneficial mind and body movement through the holidays. • Prioritize your exercise routine during holiday busyness for a feeling of health and well-being. • Be active with family during holiday gatherings. Take a walk, play tag, throw a Frisbee, organize a family football game. • Take the emphasis off of the food. Plan a craft, look at family photo albums, play a card game or charades. • Build new habits. Manage the stress and busy-ness of the holidays without using food. Try meditation, breathing exercises, rest, or exercise to cope with stress. Restrictive diets and regimented eating will lead to stress, frustration, and feelings of failure- especially over the holidays. Learn to listen to your hunger, honor your food desires without over indulging, and stop when satisfied. Move your body regularly and get adequate rest. Be well this holiday season.

AHN Pediatrics-Pediatric Alliance • Winter 2020/2021 • www.ahnpediatrics.org

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Flu Vaccine

Flu Vaccine in Kids — 2020/2021 Written by Divna Djokic, MD – Bloomfield Office

This year more than ever, medical providers, American Academy of Pediatrics (AAP) and Centers for Disease Control and Prevention (CDC) are recommending for all people older than 6 months of age to get vaccinated against flu. Incidence of Covid-19 disease, caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), is on the rise all over the world. Doctors and public health experts expect that coinfection with influenza virus might result in more severe and complicated cases from either virus.

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The Influenza virus is a common virus in cold months, with the highest incidence from November through March each year in the Northern Hemisphere. Symptoms of the flu may vary from mild, self-limiting cold symptoms, to several days of high fever, cough, and severe body aches. Some people experience unfortunate complications like pneumonia (directly from the flu virus or secondary to bacterial superinfection), inflammation of the heart (myocarditis), brain (encephalitis) or muscle (myositis, rhabdomyolysis), multi-organ failure (respiratory or kidney failure) and death. Young children and patients with chronic medical conditions are especially at risk of having complications with flu disease. Below is a graph from the CDC with yearly pediatric deaths from flu complications from the past three seasons. The best way to reduce the risk of flu infection is to get the flu vaccine. The vaccine can lessen symptoms of flu even when a vaccinated person gets sick. Getting the vaccine and preventing influenza illness is important in healthy individuals since it could be the only way to protect loved ones who are at risk for severe infections but can’t get a vaccine, like infants younger than 6 months of age. Children with flu infections are highly contagious and can easily transmit the virus to other family members who could get sick and develop unpredictable complications. Typical flu symptoms are bad enough without complications: high fever, headaches and body aches, and cough forcing both patient and caregiver to stay at home, unable to go to school or work More than any other vaccine, adults often hesitate on getting flu vaccines for themselves or their children. The reasons for hesitance are multifactorial, even as every parent wants the best for their children. Some parents worry about side effects, of which injection site pain and low-grade fever are most common and of short duration.

AHN Pediatrics-Pediatric Alliance • Winter 2020/2021 • www.ahnpediatrics.org


Some parents worry about effectiveness which depends on predicting which flu type will be circulating. Even if there is a mismatch, illness with influenza is usually milder in a vaccinated person. There is a common misconception held by some parents that the flu vaccine can actually cause the flu. In fact, injectable flu vaccines contain viral particles, not the whole virus, that stimulate the immune system to produce antibodies that will protect us. Live attenuated flu vaccine contain virus that was inactivated, so it’s still able to stimulate an immune response without producing flu symptoms. In my practice, I’ve had parents report that the flu vaccine makes them sick with the flu. But multiple studies have shown that those symptoms are likely due to being infected with the flu virus prior to getting flu vaccine. Because it takes 1-2 weeks to produce protective antibodies after the flu vaccine, it is recommended to start

giving it prior to start of the flu season, before the virus begins to circulate in the community. Quadrivalent influenza vaccines are currently recommended for the coming 2020-2021 flu season. The composition of the vaccines for this year was updated to include new A and B strains of influenza: A(H1N1)pdm09, A(H3N2) and B/Victoria. The B/Yamagata strain is unchanged from last season. There are several inactivated quadrivalent influenza vaccines (IIV4) and one live attenuated influenza vaccine (LAIV4) that can be used for vaccination in children. The CDC and the AAP have no preference of one over another as long as there are no contraindications. Please schedule an appointment with your medical provider as soon as possible to discuss different flu vaccine options and the best flu vaccine for you and your family.

AHN Pediatrics-Pediatric Alliance • Winter 2020/2021 • www.ahnpediatrics.org

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MyChart

Now that Pediatric Alliance is part of Allegheny Health Network, we’re moving from Patient Portal to MyChart. MyChart is a secure online platform that gives you a quick and easy way to connect with our office: • Book appointments • View test results • Communicate with our care team • Request prescription refills • Review your child’s health history • Pay bills and view statements

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Follow these steps to register for MyChart now: 1. Visit mychart.ahn.org and click “Sign Up Now.” 2. O  n the next screen, under “No activation code?” click “Sign Up Online” and f ollow the onscreen prompts. 3. Once you’re logged in, click “Profile” in the top right and then “My Family Access.” 4. Based on your child’s age, follow the instructions to get proxy access.

AHN Pediatrics-Pediatric Alliance • Winter 2020/2021 • www.ahnpediatrics.org

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The PediaMag Winter20-21