(503) 667-8878
Gresham Office
(503) 261-1171
Happy Valley Office
(503) 295-2546
Northwest Office
(503) 531-3434
Westside Office

Metropolitan Pediatrics

Ask Dr. Doug: The All-Too-Common Cold

As seen in:


Q: My child started preschool this year, and it seems like he’s constantly sick. What do you think about over-the-counter remedies for kids with colds? Do any of them actually work? Or do we have no choice, but to wait it out?


A: There are few things in parenting cuter than a parade of preschoolers with little backpacks off to make new friends. But with that comes the parade of runny noses. I tell parents that within a week to 10 days after the first day of school or daycare, expect your tyke to have a drippy nose, cough, and sometimes fever.

Kids 6 and under have an average of six to eight colds per year, which usually happen between September and April. That’s about once a month. And symptoms from routine colds usually last 10 to 14 days, which means he’ll basically be congested off and on until about March! Usually kids handle the symptoms pretty well, and we have to trust their bodies to fight off these common viral infections.

The best way to feel better is to try and prevent colds in the first place. (Sounds easy, right?) Teach your little one to wash his hands after coughing or sneezing, before eating, after using the bathroom, and when you get home. Hand sanitizer doesn’t work quite as well for stomach viruses, but use it if that’s what you have. Teach your child early how to cough into his elbow. Sleep and good nutrition are musts to keep our bodies healthy, so get plenty of both. And don’t forget flu shots — they are the best protection we have against influenza, a specific virus that can make kids miserable and very sick.

Once your child gets sick with a common cold, you can help him feel more comfortable while his body fights off the virus. Start with trying to get the mucus out with nasal saline and suction (like a NoseFrida) — although if that’s turning into a wrestling match, don’t fight too hard. Steamy baths and a humidifier can help. Ibuprofen (for babies older than 6 months) and acetaminophen can treat fever and body aches. Make sure they are drinking, but don’t worry about their appetite — none of us want to eat much when we feel crummy.

Cough is usually the most bothersome symptom for everyone. Over-the-counter cough and cold preparations are not safe for kids under 6 and should not be used. Last year the FDA recommended against any cough medicine with codeine for kids as it can stop their breathing. A study a few years ago found honey was better than Robitussin at treating nighttime cough, and I regularly recommend it for children older than 1 year. Herbal tea or warm water with lemon and honey works well. Our grandmothers were right!

We may need to tweak these recommendations for specific viruses (like croup, which comes with a barky cough and noisy breathing called stridor), or if your child has other issues such as asthma. For fever lasting longer than three to four days, concerns about dehydration, any breathing difficulty, a cough lasting longer than four weeks, or if you’re just plain worried, call your pediatrician. And remember, antibiotics don’t kill viruses. But cuddles and soup boost our immune system, so I’ll prescribe those year-round.

Ask Dr. Doug: Eczema, the Itch That Rashes

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Q: My 9-month-old baby has pretty bad eczema. Is it painful? She seems to be scratching all the time, even at night when she’s trying to fall asleep. Is there anything I can do to make this better?


A: A dermatologist friend of mine likes to call eczema “the itch that rashes” and I agree. Babies and children with eczema can be pretty miserable, and it absolutely can impact sleep, mood, and even attention spans in older kids. This time of year, with the cold, dry air, it often gets worse. The good news is with consistent skin care, eczema can be a manageable condition.

Eczema, or atopic dermatitis, is very common, affecting around 15 percent of children. It can be as mild as a few itchy patches on the hands and elbows in the winter, or as serious as an inflamed, scaly, oozy rash on the face and body that flares up year-round. It usually shows up by 6 months of age and tends to get better as we get older. The exact cause isn’t known, but genetics plays a role. Eczema often goes along with other allergic issues like asthma, seasonal allergies, and food allergies.

Those who suffer from eczema have skin that doesn’t keep water in and bacteria and irritants out as well as it should, causing inflammation and itching. Scratching only makes the inflammation worse.

So how to make it better? I break it down into two parts: hydrating the skin and controlling the inflammation. Plain water baths and moisturizers are the first line of defense. The frequency of bathing probably doesn’t matter, as long as you use plain water and a non-soap cleanser on just the dirty bits at the end of the bath. Soap is not your friend. After the bath, pat dry and within a few minutes apply any prescribed ointments, followed by sealing them in with a thick layer of moisturizer. The thicker, the better – I like Vanicream, Cerave, Eucerin, Aquaphor, or Vaseline. Coconut oil will make your baby smell delicious, but is not thick enough to be a good moisturizer for most cases of eczema.

The best medications to control inflammation are steroid ointments like hydrocortisone. I tell parents to use these twice a day until the skin is smooth. When used as prescribed, these are safe and they work – it’s like putting out a fire. Once the skin is smooth, keep moisturizing, twice a day, every day. Antihistamines can also help with itching and sleep. In some cases, food can be a trigger for a flare up, but getting overzealous with elimination diets can cause more harm than good without a clear history. As always, make sure you talk to your pediatrician about recommendations unique to your little one. And enjoy some moisturizer massage time with your baby!

Ask Dr. Doug: Typical Toddler Behavior or ADHD?

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Q: We have a very rambunctious 3-year-old. I know that’s pretty normal for this age, but he doesn’t seem able to really focus on things, even bedtime stories. I’m wondering whether there are any early warning signs for ADHD that I should know about — should I have him tested at this age? What can we do to support him besides medication if he does have ADHD? Would behavior therapy help?


A: Three is exhausting, isn’t it? In addition to all that energy, 3-year-olds add a dose of independence and negativity. “No!” enters their vocabulary more and more. Attention spans are short and tantrums can get more intense. The behavior you’re describing sounds developmentally normal to me (which I know doesn’t make the tough days easier!), but I would encourage you to meet with your pediatrician to discuss your concerns and think of some helpful supports.

ADHD is a specific grouping of behavioral symptoms that includes impulsivity, hyperactivity, and inattention — often with big emotional responses and trouble shifting from one thing to the next. Think of ADHD as less “not able to pay attention” and more “trouble regulating attention and emotion.” Kids with ADHD can even get “hyperfocused” on engaging activities, but often have a hard time showing regulation in other situations.

At the same time, I often worry we’re too quick to label behavior a “disease.” Children demonstrate a remarkable level of neurodiversity. That means developmental differences exist along a spectrum and, in many cases with the right supports, can function as strengths in life. In my practice, I approach behavioral concerns by considering whether it is causing impairment or distress. What usually matters more than labels is supporting families to ensure a child’s highest level of functioning with a growth mindset. This means considering a child’s history, environment, nutrition, and sleep when thinking about treatment. Evidence-based therapies, such as parent-child interaction therapy, can be very helpful. Medication may play an important role, but should never be a knee-jerk response.

A few other thoughts: Kids are not robots, so normal behaviors vary considerably based on age and gender. I often see kindergarteners with summer birthdays get mislabeled as “problem kids” when really they just need a bit more time to develop. And keep in mind, the behaviors we see in children with ADHD overlap substantially with anxiety, learning disabilities, trauma, and mood disorders, requiring a thoughtful approach to diagnosis and treatment.

At Metropolitan Pediatrics, I’m lucky to practice with an integrated behavioral health team that includes a psychologist, social worker, and care manager, which allows us to support preschoolers with tantrums and toileting issues all the way up to teens with anxiety, depression, and ADHD. And if your 3-year-old is bouncing off the walls and melting down within minutes of waking up, remember you’re not alone (and maybe put that second pot of coffee on)!

Seeking Full-time Pediatric Provider


Metropolitan Pediatrics, a 5 Star Medical Home serving Portland and surrounding communities, is seeking a passionate and enthusiastic board-certified/board-eligible pediatrician or nurse practitioner for our growing practice family!


With multiple locations featuring 30+ providers and a staff of more than 160 support team members, we stand dedicated to providing patient and family-centered care in alignment with the Bright Futures delivery model. Our practice is open 7 days a week, providing after-hours assistance and extended access opportunities in a way that best serves active families who want the best possible care for kids! We want to hear from you, and have a preference for an experienced clinician with either a sports medicine background, behavioral or developmental specialty, and/or general pediatric experience to help expand our services.

With integrated behavioral health, on-site advice nurses, lactation consultation, and in-house administrative services, such as Human Resources, Information Technology, and Revenue Cycle, Metropolitan Pediatrics offers a strong practice partnership for any provider! Providers are a member of the Metropolitan Pediatrics medical staff and responsible for pediatric patient care, consulting with other specialists, and performing administrative duties related to the care of patients with excellent service delivery outcomes.

Our administrative office is located in Beaverton, OR, and shares space with the Westside clinic serving Beaverton, Hillsboro, Tigard, and surrounding communities. The Happy Valley clinic is located just off of I-205 in Clackamas County serving the southeastern communities of Portland, including Clackamas, Happy Valley, Oregon City, Milwaukie, Damascus, and more. Our Gresham clinic is located on the campus of Legacy Mount Hood Medical Center and provides robust pediatric services to the families of Gresham, Northeast Portland, Sandy, Troutdale, and surrounding communities. And our Northwest clinic is located on the campus of Legacy Good Samaritan Medical Center, providing active pediatric coverage for central Portland and surrounding communities.

For more information, or submit your CV to:

Attn: Cynthia Jacobs, Chief Operating Officer
Metropolitan Pediatrics
15455 NW Greenbrier Parkway, Suite 112
Beaverton, OR 97006

Email: cmosearch@metropediatrics.com

About the Pacific Northwest

Lush, green, and serene, the Pacific Northwest—from northern California to British Columbia—is known for undeniable natural beauty. Ocean waves lap the western shore and mountains line the east. Breathtaking forests, country, canyons, lakes, and waterfalls lie in between. It’s a picturesque place to call home and an outdoor recreationalist’s paradise.

Urban areas are also on point with one of the most unique, hip, eco-friendly cities in the country: Portland, OR. We boast an expansive foodie community, taking pride in locally grown eats sold at year-round farmers markets and posh restaurants. Residents are also fond of their spirits (Portland has more breweries than any other city in the world!). Bike culture is a thing with spacious bike lanes sharing most streets and some rather unusual cycling events. Recycling is a big deal here, as are most opportunities to celebrate the earth’s splendor!

Despite frequent showers (what we call “liquid sunshine”), there’s always a cool coffee or book shop nearby to duck inside and take cover. There are plenty of entertainment options and a booming arts scene to keep you dry, but outdoor fairs and festivals never let the rain dampen their fun.

This is the Pacific Northwest, home to Costco, Adidas, Columbia Sportswear, Nike, Microsoft, and Intel.

It’s beautiful.
It’s quirky.
It’s wet (summers are sunny – we swear!).
There’s no sales tax.

Why wouldn’t you move here?

Bring your sense of adventure! Just don’t bring an umbrella… true Oregonians soak up the liquid sunshine.

Metropolitan Pediatrics is FLU ready!

Flu season is on its way, and we want to help you get ready! Vaccination helps limit the chance of your child getting the flu and is known to greatly reduce the length and impact of flu symptoms if they do get sick. All Metropolitan Pediatrics locations are fully stocked with flu vaccine. Call today to schedule your immunization appointment!

Learn more about this year’s flu prevention recommendations >>


Gresham Flu Clinics

Immunization appointments can be made by calling (503) 667-8878.

Day Date Time
Tuesday 9/25/18 4-6pm
Saturday 9/29/18 10am-noon
Tuesday 10/2/18 4-6pm
Tuesday 10/9/18 4-6pm
Saturday 10/13/18 10am-noon
Tuesday 10/16/18 4-6pm
Tuesday 10/23/18 4-6pm
Saturday 10/27/18 10am-noon
Tuesday 10/30/18 4-6pm
Tuesday 11/6/18 4-6pm
Saturday 11/10/18 10am-noon
Tuesday 11/13/18 4-6pm

Strikethrough indicates all appointments for that day have been reserved.


Happy Valley Flu Clinics

Immunization appointments can be made by calling (503) 261-1171.

Day Date Time
Wednesday 9/26/18 4-6pm
Wednesday 10/3/18 4-6pm
Sunday 10/7/18 10am-noon
Wednesday 10/10/18 4-6pm
Wednesday 10/17/18 4-6pm
Sunday 10/21/18 10am-noon
Wednesday 10/24/18 4-6pm
Wednesday 10/31/18 4-6pm
Sunday 11/4/18 10am-noon
Wednesday 11/7/18 4-6pm
Wednesday 11/14/18 4-6pm
Sunday 11/18/18 10am-noon

Strikethrough indicates all appointments for that day have been reserved.


Northwest Flu Clinics

Immunization appointments can be made by calling (503) 295-2546.

Day Date Time
Wednesday 10/3/18 2-5:10pm
Saturday 10/6/18 9-11:30am
Tuesday 10/9/18 4-5:30pm
Saturday 10/13/18 10am-noon
Tuesday 10/16/18 4-5:30pm
Friday 10/19/18 9am-5pm
Saturday 10/20/18 10am-noon
Tuesday 10/23/18 2-5:30pm
Thursday 10/25/18 8-11:30am
Saturday 10/27/18 10am-noon
Tuesday 10/30/18 4-5:30pm
Saturday 11/3/18 10am-noon
Thursday 11/8/18 2-5:20pm
Saturday 11/10/18 9am-noon
Wednesday 11/14/18 2-5:20pm
Saturday 11/17/18 10am-noon
Tuesday 11/20/18 2-5:20pm
Wednesday 11/21/18 8:30-11:50am
Saturday 11/24/18 10am-noon
Tuesday 11/27/18 2-5:20pm
Saturday 12/1/18 10am-noon

Strikethrough indicates all appointments for that day have been reserved.


Westside Flu Clinics

Immunization appointments can be made by calling (503) 531-3434.

Day Date Time
Tuesday 10/2/18 9am-noon & 3-7pm
Thursday 10/4/18 3-7pm
Saturday 10/6/18 9am-12:30pm
Tuesday 10/9/18 3-7pm
Thursday 10/11/18 9am-noon & 3-7pm
Saturday 10/13/18 9am-12:30pm
Tuesday 10/16/18 9am-noon & 3-7pm
Thursday 10/18/18 3-7pm
Saturday 10/20/18 9am-12:30pm
Tuesday 10/23/18 9am-noon & 3-7pm
Thursday 10/25/18 3-7pm
Saturday 10/27/18 9am-12:30pm
Tuesday 10/30/18 9am-noon & 3-7pm
Thursday 11/1/18 3-7pm
Saturday 11/3/18 9am-12:30pm
Tuesday 11/6/18 9am-noon & 3-7pm
Thursday 11/8/18 3-7pm
Saturday 11/10/18 9am-12:30pm
Tuesday 11/13/18 9am-noon & 3-7pm
Thursday 11/15/18 3-7pm
Saturday 11/17/18 9am-12:30pm

Strikethrough indicates all appointments for that day have been reserved.

Ask Dr. Doug: Food Allergies & School

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Q: My child has a severe peanut allergy, and I’m nervous about leaving her with caregivers, like her teachers, when she starts kindergarten next year. Can you offer any suggestions for talking with people about how to deal with it if she goes into anaphylactic shock?


A: Your big 5-year-old grinning on her first day of school is such a bittersweet moment — how did she get so big? Unfortunately for parents of children with food allergies, this milestone often comes with added worry. Food allergies are common and have been on the rise over the past 20 years. Around 8 percent of children have one, so your daughter likely won’t be the only student with a food allergy. However, there are still plenty of misunderstandings around food allergies, which is why your communication with her school is so important.

I would recommend starting with teaching your daughter, calmly and matter-of-factly, that she needs to only eat the foods you give her, and to ask “Does this have nuts in it?” if any snacks are distributed in school. If you are reassuring and calm while discussing this, you can help ward off the natural anxieties she may have around school and food.

Next, call the school and ask to talk to the administrator regarding their food-allergy policies. Do they have allergen-free rooms or areas? How are staff trained to use epinephrine autoinjectors and is the training current? Educating caretakers how to handle an exposure or a reaction — even before the first day of school — is important so they can take the time to feel fully prepared before they are in charge of caring for your daughter.

In order to plan for an accidental exposure, I would highly recommend you fill out an allergy action plan with input from your pediatrician or allergist. This is a specific plan on how to recognize symptoms of a reaction and how to treat them. The best version is from FARE (Food Allergy Research and Education), found at foodallergy.org. Remember, when in doubt, give epinephrine. Antihistamines like diphenhydramine (Benadryl) only treat itching or hives and will not stop anaphylaxis. A quick poke to save a life is worth it.

View this transition as an opportunity for education and growth. Be prepared, but don’t forget to tell yourself (and your daughter!) that you can handle this. Hug her tight the first day of school — she will be graduating from high school before you know it!

Confirmed Case of Measles in Portland-area Traveler

8/21/18 Update

The Oregon Health Authority confirmed a second, related case in the Portland metro area.

If you crossed paths, you may have been exposed:

  • Aug. 17, Portland International Airport, 9:15-10:45 p.m.
  • Aug. 18, Marco’s Café and Espresso Bar, 7910 SW 35th Ave, Portland, 8-11 a.m.

If you’re concerned that your child may have been exposed, please contact our offices for guidance.


The best way to protect your kids from vaccine-preventable diseases (like measles) is to make sure they’re immunized on schedule. MMR is very safe and effective, and could absolutely save your child’s life.


There have been several confirmed cases of measles in the Portland metro area this summer, the most recent involving a traveler visiting from July 30th through August 6th. Public health officials are in the process of notifying individuals who may have been exposed at the following locations:

  • July 30, PDX Airport, 2:15-3:45 p.m.
  • July 31, Leno Medoyeff Bridal, 710 NW 23rd Ave., Portland, 3:30-5:30 p.m.
  • Aug. 1, Tom’s Pancake House, 12925 SW Canyon Rd., Beaverton, 7-9:30 a.m.
  • Aug. 2, Max Red Line, Beaverton Transit Center to Pioneer Square, 12:30-1 p.m.
  • Aug. 2, Max Red Line, Pioneer Place to Beaverton Transit Center, 5:30-6 p.m.
  • Aug. 5, Verde Cocina, 5515 SW Canyon Ct., Portland, 2-4:30 p.m.

If you have been fully vaccinated against measles (two doses), your risk of becoming sick is low. Risk is highest for people who are not vaccinated, pregnant women, infants younger than one, and individuals with weakened immune systems.

Symptoms

Symptoms typically appear within two weeks of exposure and include:

  • Fever
  • Cough
  • Runny nose
  • Red, watery eyes
  • Blotchy, red rash that starts on the face and spreads to the rest of the body

People with measles are contagious prior to showing any symptoms up until four days after the rash appears.

When to Call Us

Contact your pediatrician immediately if your child develops measles symptoms, even if your child has been immunized.

We’re also happy to answer your questions about measles infection. Another great resource is your county health department:

  • Clackamas County Public Health: 503-655-8411
  • Clark County Public Health: 360-397-8182
  • Multnomah County Public Health: 503-988-3406
  • Washington County Public Health: 503-846-3594
  • Yamhill County Public Health: 503-434-7525

Centers for Disease Control and Prevention: Measles (Rubeola)

Air Quality Advisory for Portland Metro Area & SW Washington


With wildfires blazing in nearly every direction, local air conditions have now reached unhealthy levels for everyone.


Yesterday the Oregon Department of Environmental Quality and the Southwest Clean Air Agency issued an air quality advisory for the Portland metro area and SW Washington in effect until noon today. Conditions are expected to improve by this afternoon; however, smoke and haze will remain through the week.

How bad is the air around you? Check the air quality in your area. You can also check air conditions from your smart phone using the OregonAir app.

With smoke levels this high, even healthy people could be affected. Stay inside if you can. Keep windows and doors closed. Avoid frying or boiling food, which can affect indoor air quality. If you have to venture out, run your car’s air conditioning on recirculate mode to avoid pulling in smoky air. Small children, pregnant women, and those with heart and lung conditions should take extra care to avoid time outdoors until air quality improves.

Children with asthma should have a current and filled prescription for a rescue inhaler (ideally in advance of wildfire season). Outdoor exercise is especially risky right now, so if you must, really listen to your body and be aware of any respiratory issues. Contact your primary care provider if you are experiencing any airway concerns or distress. Our advice team is also available for any questions and to help determine whether an office visit is needed.

Stay safe, folks!

Confirmed Case of Measles in Gresham

7/13/18 Update

A third case of measles was confirmed in Multnomah County today. There’s a possible related case in Clark County, but it’s still under investigation. If you’re concerned that your child may have been exposed, please contact our offices for guidance.

There has been a confirmed case of measles in Gresham.

To minimize the spread of illness, Multnomah County Health Department is excluding all children under the age of four who have not had their first MMR immunization AND anyone over the age of four who has not received two doses of MMR. The exclusion will remain in effect until July 14th.

Anyone who has been exposed and is not immunized or current on immunizations has been contacted by the Health Department. If you are concerned that your child may have been exposed or is showing any symptoms, please call us immediately!

What is Measles?

Measles is a highly contagious illness. Infected children tend to be contagious for a couple days prior to developing symptoms until several days following the appearance of measles’ characteristic rash.

If you suspect your child has measles, keep him or her away from others who may not be immunized (or fully immunized) against the disease.

Symptoms

Symptoms usually begin 8-12 days after exposure to the virus and may include:

  • Cough
  • Sore throat
  • Runny nose
  • Fever
  • Red, watery eyes
  • Light sensitivity
  • Muscle aches
  • White spots inside the mouth

The initial symptoms tend to worsen during the first few days of the illness. In some cases, younger children develop ear infections, croup, diarrhea, pneumonia, or encephalitis (inflammation of the brain).

  • Blotchy, itchy rash
    • Appears 2-3 days after initial symptoms begin
    • May last up to 8 days
    • Usually starts on the face and neck, then spreads to the entire body

When to Call Your Pediatrician

Contact your pediatrician immediately if your child develops measles symptoms, even if your child has been immunized.

For more information on measles and the MMR vaccine, click here.

Source

“Measles,” by American Academy of Pediatrics