Pediatric Care with Dr. Alexandra Iacob, MD - Growing Healthy One Visit at a Time

Dr. Alexandra Iacob, MD, a dedicated pediatrician, provides outpatient and inpatient care in San Bernardino, Loma Linda, Riverside, and Downtown LA. Born in Romania, she pursued her medical education at renowned institutions. Her practice focuses on establishing a medical home and administering vaccines at various milestones during the first months of a child's life. Attendees can actively participate in sessions using smartphones for an engaging experience.

• Pediatric care
• Dr. Alexandra Iacob
• Medical home
• Vaccines
• Child health

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1. Growing Healthy One Growing Healthy One Visit At A Time Visit At A Time ALEXANDRA IACOB, MD ALEXANDRA IACOB, MD

2. About Me About Me Born in Romania Med School: Univ of Texas Health Science Center Houston Pediatric Residency: Loma Linda University Current practice Outpatient in San Bernardino Inpatient in Loma Linda, Riverside, and Downtown LA San Bernardino County Medical Society California Medical Association American Medical Association

3. Thank YOU! Thank YOU!

4. PollEverywhere PollEverywhere Smartphones Actively participate during this session Anonymous Audience representation

6. Agenda Agenda 9:00-9:50 First Month: Establishing a Medical Home 10:00-10:50 Two, Four, and Six Month Visits: Vaccines and Milestones 11:00-11:50 Nine Eighteen Month Visits: Vaccines, Milestones and Screening

7. First Month Timeline First Month Timeline Birth 2 month 1 month

9. First Month Timeline First Month Timeline Birth at Hospital Hepatitis B vaccine Newborn Screen Hearing Screen Cardiac Screen Red Reflex Screen Lactation Consult 24 Hour Bilirubin Level Birth 2 month 1 month

10. First Month Timeline First Month Timeline 3-5 Days Visit Postpartum Depression Screen Birth 2 month 1 month

12. First Month Timeline First Month Timeline 3-5 Days Visit Postpartum Depression Screen Bilirubin Check Milk Production Weight Loss Vit D Supplementation Hip Dysplasia Screen Fever Danger Sleep Safety Birth 2 month 1 month

13. First Month Timeline First Month Timeline 2 Weeks Visit Post Partum Depression Home Dynamics Birth 2 month 1 month

15. First Month Timeline First Month Timeline 2 Weeks Visit Post Partum Depression Home Dynamics Weight Regained Cord Stump Hip Dysplasia Fever Danger Sleep Safety Birth 2 month 1 month

16. First Month Timeline First Month Timeline 1 Month Visit (optional) Depression Adjustment/Coping Skills Family Support Community Support Birth 2 month 1 month

17. First Month Timeline First Month Timeline 2 Month Visit Next section! Birth 2 month 1 month

18. Questions? Questions?

19. BREAK BREAK

20. Two, Four, Six Month Visits Two, Four, Six Month Visits Vaccines Milestones

22. Vaccines Vaccines Schedules Schedules

23. Vaccines Vaccines Hep Birth, 1-2 months, 6 months Hep B B Prevents hepatitis, liver cancer, liver failure, death Common side effects: Soreness Mild fever Serious side effects: Allergic reaction Contraindication: Allergic reaction to previous dose https://www.cdc.gov/vaccines/vpd/hepb/public/photos.html

24. Vaccines Vaccines Rotavirus 2 months, 4 months, (6 months) Rotavirus Prevents severe watery diarrhea, vomiting, fever, dehydration, death Common side effect: Mild diarrhea and vomiting Serious side effect: Intussusception Allergic reaction Contraindication: Immunological deficit Allergic reaction to previous dose Intussusception http://www.immunize.org/images/rotavirus/thumbs/rotavirus-1-lg.jpg

25. Vaccines Vaccines DTaP 2 months, 4 months, 6 months, 15-18 months, 4 years DTaP Diphteria (Throat infection), Tetanus (Lockjaw), Pertussis (Whooping Cough) Minor side effects: Fever, fussy, tired Redness, soreness Serious side effects: Seizure High fever Allergic reaction Contraindication Allergic reaction to previous dose Brain or nervous system disease after previous dose https://blogs.cdc.gov/publichealthmatters/files/2012/06/Coughing-child_Banner.jpg

26. Vaccines Vaccines Hib Hib 2 months, 4 months, 6 months, 12-15 months Prevents meningitis, pneumonia, epiglottitis, death Minor side effects: Fever Warmth, Redness, Swelling Severe side effects: Allergic reaction Contraindication: Allergic reaction to previous dose

27. Vaccines Vaccines IPV IPV 2 months, 4 months, 6 months, 4 years Prevents Polio disease Minor side effect: soreness Serious side effect: Allergic reaction Contraindication: Allergic reaction to previous dose https://www.cdc.gov/features/poliofacts/

28. Vaccines Vaccines PCV13 PCV13 2 months, 4 months, 6 months, 12-15 months Prevents pneumonia, bacteremia, meningitis Minor side effects Drowsy Mild fever, redness, swelling Serious side effect: Allergic reaction Contraindication Allergic reaction to previous dose https://carrington.edu/wp-content/uploads/2015/02/Pneumococcal-Disease-770x392.png

29. Vaccines Vaccines Free Resources Free Resources

30. Milestones Milestones Social Verbal Motor

32. Milestones Milestones 2 Months Social Begins to smile at people Verbal Coos Motor Can lift head off table Can push off in tummy time

33. Milestones Milestones 2 Months 4 Months Social Begins to smile at people Smiles spontaneously Mimics expressions Verbal Coos Cries in different ways Begins to babble Motor Can lift head off table Can push off in tummy time Rolls from tummy to back

34. Milestones Milestones 2 Months 4 Months 6 Months Begins to smile at people Smiles spontaneously Mimics expressions Observes self in mirror Likes to play with others Social Coos Cries in different ways Begins to babble Babbles with different consonants and vowels Verbal Can lift head off table Can push off in tummy time Rolls from tummy to back Rolls over in both directions Able to sit without support Motor

35. Questions? Questions?

36. BREAK BREAK

37. 9 9 18 Months 18 Months Vaccines Screening Milestones

39. Vaccines Vaccines - - MMR 1 year, 4 year MMR Prevents Measles (encephalitis, pneumonia, death), Mumps (meningitis, encephalitis, testes inflammation, deafness) and Rubella (rash, arthritis) Minor side effects Soreness, redness, fever Febrile seizure (~3 per 10,000) Major side effects Allergic reaction Contraindications Allergic reaction to prev dose Weak immune system

40. Vaccines Vaccines - - Varicella Varicella 1 year, 4 year Prevents Chickenpox (rash, shingles, pneumonia, encephalitis) Minor side effects Soreness, redness Fever Major side effects Allergic reaction Contraindications Allergic reaction to prev dose Weak immune system

41. Vaccines Vaccines MMR/Varicella MMR/Varicella Option to do MMR and Varicella vs MMR/V at 1 year and 4 years Klein NP, Fireman B, Yih WK, Lewis E, Kulldorff M. Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures. Pediatrics. 2010 Jul;126(1):e1-8. Klein NP, Lewis E, Baxter R, et al. Measles-containing vaccines and febrile seizures in children age 4 to 6 years. Pediatrics. 2012 May;129(5):809 -814. Rowhani-Rahbar A, Fireman B, Lewis E, Nordin J, Naleway A, et al. Effect of age on the risk of Fever and seizures following immunization with measles-containing vaccines in children. JAMA Pediatr. 2013 Dec;167(12):1111-7.

43. Vaccines Vaccines MMR/Varicella MMR/Varicella Option to do MMR and Varicella vs MMR/V at 1 year and 4 years If separate, ~4 per 10,000 have febrile seizure If combined, ~8 per 10,000 have febrile seizures Klein NP, Fireman B, Yih WK, Lewis E, Kulldorff M. Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures. Pediatrics. 2010 Jul;126(1):e1-8. Klein NP, Lewis E, Baxter R, et al. Measles-containing vaccines and febrile seizures in children age 4 to 6 years. Pediatrics. 2012 May;129(5):809 -814. Rowhani-Rahbar A, Fireman B, Lewis E, Nordin J, Naleway A, et al. Effect of age on the risk of Fever and seizures following immunization with measles-containing vaccines in children. JAMA Pediatr. 2013 Dec;167(12):1111-7.

45. Elephant in the Room Elephant in the Room - - Autism Autism 1988 article published 2002 article gains momentum 2004-2009 investigation 2010 paper retracted 1. UNDISCLOSED CONFLICT OF INTEREST 2. MANIPULATION OF DATA 3. INVASIVE AND UNNECESSARY TESTS WITHOUT PROPER CONSENTS AND APPROVAL

46. So is there a link? So is there a link?

47. Vaccines Vaccines Hepatitis A Hepatitis A 12 months, 18 months Prevents serious liver disease Minor side effects Low grade fever Soreness, redness Major side effects Allergic reaction Contraindications Allergic reaction to prev dose

49. Vaccines Vaccines Influenza Influenza >6 months, yearly Prevents Flu (upper respiratory infection, pneumonia, meningitis) Minor side effects Soreness, redness Fever, aches, cough Major side effects Guillan Barre Syndrome (1 in a million) Contraindications Allergic reaction to prev dose GBS https://gis.cdc.gov/GRASP/Fluview/PedFluDeath.html

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