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Posts for category: Children's Health

By contactus@amherstpeds.com
March 11, 2020
Category: Children's Health
Tags: coronavirus   COVID-19   pandemic  

How Amherst Pediatrics is responding

Amherst Pediatrics is taking the new coronavirus threat seriously. We are working closely with local health officials and hospitals to put in place mechanisms to keep our community as safe as possible.

Because the most effective approach to containing the spread of this virus is through aggressive personal hygiene and isolation, we ask that you not to come to our office without first calling. We are screening calls for risk factors and will make recommendations based on those responses.

As much as we can, we would also like to put the issue into appropriate perspective for our Amherst Pediatrics community.

What is COVID-19
Coronaviruses are not new, but COVID-19 is. It is a virus that likely began in China as an animal virus, and then became suddenly capable of infecting humans. Because of how readily viruses can spread from person to person, and because no one has ever been exposed to this virus and thus has any immunity to it, we are all susceptible. However, as we learn more about this virus and how it spreads and infects people, we are finding that there are some reassuring aspects to this global pandemic.

COVID-19 in children
COVID-19 impacts older individuals (particularly those over 70 years of age) and those with underlying heath conditions (such as chronic lung dissease like as COPD, heart disease, and immunodeficiency) much more than it does younger, healthier populations. It is relatively uncommon in children, and infected children appear to have much less severe infection overall, with significantly less risk of complications. Nevertheless, any infected person can spread the disease to several others, potentially infecting people who are at higher risk of severe illness and complications.

How contagious is COVID-19?
This virus appears to be slightly more contagious than influenza, and is likely spread via both airborne droplet as well as hand-to-mouth behavior. For this reason, and because we can all unknowingly spread infection to others, it is extremely important to follow good hand-washing practices (see below).

How serious is COVID-19?
This is a serious pandemic, and infection with this virus can produce severe illness in some people. As mentioned above, however, most people are at low risk for serious illness. As we learn more about the prevalence of the disease and how many mild and asymptomatic cases there are, the case fatality rate will likely become lower than it now appears to be.

What to do if you or your child is ill
Please call us right away if you or your child has fever and a cough or difficulty breathing, or if you have known exposure to someone with COVID-19 infection.

We cannot stress enough the importance of frequent hand-washing, and staying away from others as much as possible when you are sick yourself - and please remember to get an annual flu vaccine. Your child is hearing about this virus from many sources, some of which may not be reliable.

This is a confusing and alarming time for everone, and children in particualar are likely to have concerns that need to be addressed. The following are good resourcees for talking to your children about the new coronavirus:

Here are some useful places to get additional information about COVID-19, and how you can keep your family and community as safe as possible:

By contactus@amherstpeds.com
January 25, 2020
Category: Children's Health
Tags: Cold   URI Common cold  

(This post was written by John Snyder, MD and is reprinted from the blog sciencebasedmedicine.org)


Every drug store has row upon row of medicines designed to treat or prevent an acute upper respiratory tract infection, otherwise known as the common cold. Despite this, very few are able to live up to their promise. In most cases, particularly where children are concerned, the side effects of these medicines can be worse than the symptoms they are intended to treat. Because I am a pediatrician, and because the evidence for cough and cold medicines (I will refer to them here as CCMs) for children is particularly absent and because adverse events due to CCMs are most frequently seen in children, I will focus mainly on this population. 

The common cold – a (brief) overview

The term “cold” refers to a complex of signs and symptoms sharing similar characteristics but which may be caused by a variety of different viruses. Usually referred to by clinicians as viral upper respiratory tract infections (URIs), the very familiar features of the common cold include runny nose, nasal congestion, sneezing, cough, and sometimes sore throat and watery eyes. Colds may also be associated with systemic signs and symptoms, such as fever, chills, malaise, and body aches, though these are more typically seen in influenza, or “flu-like syndromes” caused by other viruses. At least 50% of colds are caused by rhinoviruses, of which there are approximately 100 serotypes. Other viruses that can cause colds include adenoviruses, enteroviruses, the respiratory syncytial virus (RSV), coronavirus, influenza and parainfluenza viruses, and human metapneumovirus (hMPV). Rhinoviruses survive best at the cooler temperatures found in the nose as opposed to the warm depths of the body, which is why the primary signs and symptoms of infection occur there. Other viruses can cause disease more systemically, and therefore are capable of producing more severe illness. The typical cold worsens for the first 3-4 days, plateaus for 1-2 days, and then improves over another 3-4 days. Most colds have resolved or significantly improved by day 7-10 of the illness.

An illness begging for a cure

Despite the relatively brief, self-limited, and generally benign nature of colds, they can be extremely uncomfortable nuisances, resulting in a staggering number of missed days from work and school. It is not surprising that many people are willing to try and pay for almost anything to relieve the annoying symptoms of the common cold, resulting in an estimated expenditure of close to $3 billion for over-the-counter CCMs in the US annually. Almost everyone has a favorite over-the-counter (OTC) or home remedy for the common cold. My mother always started me on 1,000mg daily of vitamin C at the onset of any cold symptoms (usually in the form of acerola with rose hips). Unfortunately, notwithstanding all of the marketing, hype and near universal belief in at least some form of cold remedy, there is little to no evidence supporting the efficacy of most CCMs.

The lack of efficacy of CCMs is not surprising when one considers the pathophysiology of common cold symptoms. Those familiar and annoying signs and symptoms are primarily a result of our body’s own inflammatory response to the viral destruction of infected cells in our upper airway. By the time this inflammation has begun, the progression of the illness and the resulting symptoms is inevitable. Our immune system (with the exception of those with congenital or acquired immunodeficiencies) is usually quite capable of rapidly countering the upper airway invasion by these viruses with this robust (though uncomfortable) inflammatory response. Most of the anecdotally reported benefits of CCMs are likely attributable to the self-limited nature of colds – a result our body’s own ability to clear the virus and repair the damage.

Not only is scientific evidence for the efficacy of CCMs lacking, their use in children is responsible for significant morbidity and even mortality. Every year in the US, over 7,000 children under the age of 12 are brought to emergency rooms as a result of an adverse event from a CCM. This is largely a result of incorrect dosing or frequency of administration. One study demonstrated that only 30% of parents were able to both accurately measure and correctly dose OTC CCMs for their child. Also contributing to the occurrence of adverse events is the fact that many children’s CCMs are “multi-symptom” products, containing several different drugs. When parents give more than one medication to their child simultaneously, they may be inadvertently overdosing at least one of these components. For example, many “multi-symptom” CCMs contain acetaminophen as a fever reducer. Unaware of this, parents often simultaneously give their children acetaminophen as a separate medication, resulting in potentially dangerous overdosing.

Common treatments for a common illness

By far, the most common diagnosis I make each day in my practice as a pediatrician is “viral URI”, otherwise known as the common cold. And every day, many times per day, I am asked by parents what they can give their suffering child to make them better faster. And every day, many times per day, my advice is far from modern or high-tech. That is because I am trying, as best as I can, to limit my advice to that which can be supported by the best science-based evidence. Too often, that leaves parents dissatisfied and sometimes even frustrated or angry. Some parents are thankful, however, for my honesty and for staying true to my oath to “first do no harm”. But the number of children who are prescribed or who are given OTC CCMs in the US is truly staggering. Every week approximately 10% of children (that’s over 82 million according to the 2012 US census) take these medicines without evidence of efficacy, and at significant risk.

In October of 2007, concerned about the lack of evidence supporting the efficacy of CCMs in children, and out of a growing concern about the safety of these products, the FDA’s Nonprescription Drugs Committee and Pediatric Advisory Committee unanimously recommended against the use of CCMs in children under 2 years of age. In response, US manufacturers voluntarily withdrew those products marketed for infants under age 2. In 2008, manufacturers revised their labeling to warn against use by children under age 4. Though a majority of the original FDA Advisory Committee members voted against the use of CCMs in children under age 6 years, the FDA has not yet officially ruled on that recommendation. The American Academy of Pediatrics, however, has officially recommended against their use in children under 6 years of age.

Even though the majority of randomized controlled trials show no difference in endpoints when CCMs are compared to placebo, and despite the potential for serious adverse events, these products remain ubiquitous on pharmacy shelves, and parents and many pediatric practitioners still turn to them for treating colds in children. Though the labeling changes noted above have resulted in a significant decline in reported adverse events from CCMs in children under 4, their use remains high.

The A-to-Z of OTC CCMs

Analgesics/antipyretics

In my practice, I find that parents frequently give acetaminophen or ibuprofen to their children with colds as if it were some sort of cure-all elixir. Although they may help with fever or muscle aches, they do not affect the upper respiratory signs and symptoms of a cold. Acetaminophen may actually suppress virus-neutralizing antibodies, potentially prolonging viral shedding and cold symptoms.

Antibiotics and antivirals

Being caused by viruses, it should be of no surprise that antibiotics do nothing for treatment of the common cold. There are upper respiratory tract infections for which antibiotics may be indicated, for example some ear and sinus infections, which are potential complications of colds. However, what we all know as the common cold is not treatable with antibiotics. Unfortunately, treatment of colds with antibiotics is not uncommon, and has contributed (along with the addition of antibiotics to livestock feed) to the very dangerous reality of antibiotic resistance. But that is a topic for another post.

There are major obstacles to the development of an effective antiviral agent for colds. These include the enormous number of viruses and virus serotypes that are known to cause colds, and the ease with which these viruses mutate and thus potentially evade any drug with which they may interact. For similar reasons, the development of a vaccine against the common cold remains elusive. One antiviral agent, pleconaril, has shown some promise in preliminary studies (mostly in adults), but was rejected by the FDA in 2002 due to its poor side effect profile.

Antihistamines

Some studies have demonstrated a modest decrease in sneezing and runny nose with the use of antihistamines in adults. While these drugs are helpful for the treatment of allergies, the signs and symptoms of which can resemble a cold, they have not been found to be effective when used to treat colds in children. Many OTC products marketed for use in children as “multi-symptom” cough and cold medicines contain first-generation antihistamines, which can have significant anticholinergic side effects. These can include gastrointestinal upset, dry mouth, increased heart rate, and even cardiac arrhythmias, central nervous system depression (or excitation), hallucinations, and respiratory depression.

Antitussives (cough medicines)

When I was training, I was taught never to treat a cough because coughing is a protective mechanism which clears the airway of mucus and pathogens. At that time, however, we weren’t aware that it probably didn’t matter, since no cough medicines have been shown to actually work better than placebo. But because they do contain drugs, however, they can have potentially serious side effects.

Dextromethorphan (think Robitussin-DM) is one of the most common “cough suppressants” on the market. It is a narcotic derivative which, when dosed correctly, has a low potential for side effects. At higher doses, however, it can have serious effects on the central nervous system, including hallucinations and dissociative states. Because of this, dextromethorphan has become a drug of abuse. Unfortunately, it doesn’t actually work. In a 2004 study, neither dextromethorphan nor the antihistamine diphenhydramine was found to outperform placebo at improving nighttime cough or sleep difficulty in children with colds. Other studies have shown that increasing the dose of dextromethorphan does not improve its efficacy, and can result in an increased risk of side effects. There is some evidence that dextromethorphan may even be responsible for some infant deaths.

Codeine has been used for a long time to treat cough in children despite no evidence that it is actually superior to placebo for this purpose. Codeine is an opioid compound that is converted in the liver to morphine, its active metabolite. Central nervous system effects of codeine are well described, as are serious, sometimes deadly events in infants and children. Individuals who are genetically predisposed to rapidly metabolize codeine into morphine are at particularly high risk of serious adverse events from the use of codeine-containing products. The American Academy of Pediatrics recently reaffirmed its prior policy statement that there are no well-controlled scientific studies to support the efficacy and safety of codeine for the treatment of cough in children, and that the use of codeine-containing products should therefore be avoided.

Aromatic vapor therapies

Vapor therapies containing some combination of menthol, camphor, and eucalyptus oil (such as Vicks VapoRub) are commonly used to treat cold symptoms in infants and children (though they are not recommended for use in children under the age of 2 years). These products are typically placed on the chest, neck, or under the nostrils (I have also encountered parents who swear by placing it on the soles of their infant’s feet). One study looking at inhalation of menthol vapor in school-age children showed no improvement over control in terms of cough or nasal airway flow or volume, though interestingly there was an improvement in the perception of nasal patency. Another study of colds in school-age children compared Vicks VapoRub, petrolatum, and no treatment. Parents gave Vicks the highest score in improving their child’s night time cough, congestion, and sleep difficulty. For obvious reasons this was not a blinded study, and the survey results should be interpreted in that light. After treating an 18 month old child with severe respiratory distress believed to be triggered by the application of Vicks VapoRub under her nostrils, a group from Wake Forest University School of Medicine studied the effect of this product on an experimental animal airway model. They found that Vicks increased mucin secretion and tracheal mucociliary transport velocity, and decreased ciliary beat frequency. Based on their findings, the authors hypothesized that Vicks may actually lead to mucus obstruction of small airways and increased nasal resistance to air flow.

CAM

There are so many so-called complementary and alternative therapies that are claimed to prevent and treat colds that I cannot possibly do justice to a discussion of them all here. I do discuss Echinacea below because this is the most commonly used and most studied CAM modality for treating colds. I will not even discuss homeopathy as there is no scientific plausibility for its efficacy.

Decongestants

These drugs (pseudoephedrine and phenylephrine) act on the sympathetic nervous system to cause constriction of capillaries, thereby decreasing swelling of the nasal and sinus mucosa. In adults, pseudoephedrine has been shown to decrease mucus production and runny nose. Similar evidence has not been demonstrated for phenylephrine, even though this drug has been steadily replacing pseudoephedrine in many products. This is because products containing pseudoephedrine can now only be sold at the pharmacy counter in an effort to prevent their use in the production of methamphetamine. There are no studies demonstrating the efficacy of decongestants in children, and dosing has been extrapolated from adult trials. One study by Hutten et al. and another by Clemens et al. found no difference between an oral antihistamine-decongestant combination containing phenylephrine and placebo. There are no studies on the use of pseudoephedrine in children. Unfortunately, the action of these drugs on the nervous system can produce serious side effects, including elevation of blood pressure, sleeplessness, headache, nausea, vomiting, and even cardiac arrhythmias and seizures. One drug once commonly used in OTC cough and cold medications, phenylpropanolamine, was taken off the market in 2000 because it could cause potentially fatal intracranial hemorrhages.

Echinacea

Echinacea is frequently touted as an effective, natural cold remedy. There are many published studies on the use of Echinacea for both treating and preventing colds. Most of these studies have significant methodological flaws. They also utilize different parts of the plant and at different doses, have produced conflicting results, and are difficult to interpret as a whole. The highest quality study to date, however, demonstrated no benefit over placebo in treating or preventing symptoms of the common cold in young adults.

Expectorants

Guaifenesin is the most common drug marketed as an expectorant. These agents purportedly work by drawing water into mucus, thinning it out and thus aiding clearance from the airway. It is found in products such as Mucinex, Robitussin DAC, Benalyin, and DayQuil mucus control. In one study, adults with colds reported subjective improvement in the thickness and quantity of sputum, but no decrease in cough. There are no studies demonstrating the efficacy of guaifenesin in children.

Honey

Perhaps the most promising treatment for cold related cough in children is turning out to be the golden sweet elixir, honey. In a well-designed, randomized, partially double-blind study, children receiving buckwheat honey showed significant improvement in cough symptom score compared to those receiving dextromethorphan or placebo. Another study demonstrates that honey given at bedtime was more effective than placebo in reducing the frequency and severity of nighttime cough. This was true whether the honey administered was eucalyptus, labiatae, or citrus honey. A criticism of other studies looking at the efficacy of honey has been the lack of a similarly sweet and viscous control group. In this study, the placebo compound was made from dates, and had similar sweetness, appearance, and texture.

>> Note: it is important to remember that honey should never be given to infants under 12 months of age due to the risk of botulism.

Probiotics

Probiotics have been in the news quite a bit lately for a variety of applications, including for the prevention of colds in children. A study of young children at a day care center in China found that those who received daily Lactobacillus acidophilus NCFM for 6 months had lower fever and less runny nose and cough during colds, as well as shorter colds and a reduced chance of being prescribed an antibiotic compared to those receiving placebo. Study children also missed fewer school days during colds.  A recent Cochrane meta-analysis of randomized controlled trials exploring the use of probiotics in children found that they may significantly reduce the likelihood of developing a cold or requiring an antibiotic. One criticism of this analysis was the heterogeneity amongst the studies reviewed for the primary outcome of number of colds in children. It was also unclear which probiotic might be conferring the protection from colds. It was suggested that the heterogeneity of the study outcome findings might be due to the fact that the immune-modulating effects of probiotics are likely to be species- and strain-specific. The current consensus is that more data for specific probiotic species and strains is required before generalized recommendations can be made.

Saline nasal sprays and washes

Perhaps the most commonly used treatment for colds in infants is the application of saline drops and sprays to the nasal passages, often followed by bulb suction. Though this is not likely to result in anything more than transient improvement in nasal obstruction, one study looked at symptomatic relief during a cold as well as prevention of colds in children receiving instillation of nasal saline wash. Their result showed significant improvement in sore throat, cough, nasal obstruction, and secretions when given as treatment for a cold, as well as fewer illness days, school absences, and complications in children receiving the saline as a preventative.

Zinc

While zinc has the ability to inhibit rhinovirus replication in the test tube, clinical trials for the treatment of colds have been disappointing. While there was a very modest improvement in symptom score in one study of adults, the benefit was seen only when zinc was taken in large doses 5-6 times per day. At these doses, GI side effects were significant and patients complained of a bad taste in their mouth. Needless to say, 5-6 times per day dosing with these side effects would preclude this as a viable option in children. Additionally, a well-designed, randomized, double-masked, placebo-controlled study demonstrated no effectiveness of zinc on cold symptoms in children and adolescents.

Prevention is the best medicine

The common cold is caused by a large number of different viruses and virus serotypes, and these viruses mutate rapidly in the human host. This makes finding effective treatments and vaccines elusive. Since finding a cure for the common cold is unlikely, the best approach is to prevent infection. Spread of inflection occurs primarily via aerosol droplet (from sneezing and coughing) or by touching a contaminated object or person and then auto-inoculating oneself (by then touching the nose or eyes for example). There is scant evidence to support any dietary or medicinal prophylaxis for the common cold. If one existed, it would need to be taken chronically to be effective, and the risk-benefit ratio would have to be very low. The best way to prevent the common cold is to limit transmission. That means frequent hand washing, staying away from others as much as possible when sick, and avoidance of those with colds. The now-ubiquitous use of alcohol-based hand sanitizers does not prevent secondary transmission of colds due to rhinovirus (the most common cause of colds in children), and “antibacterial” soaps (usually containing triclosan or triclocarban) have no evidence of efficacy for preventing colds, and are now under close scrutiny by the FDA.

Modern medicine is sometimes quite limited in its capabilities. We need to be honest and humble when faced with these limitations. This, ultimately, is what distinguishes science-based medicine from pseudoscience and belief.

 
By Amherst Pediatrics, LLP
June 18, 2019
Category: Children's Health
Tags: Diabetes  

If your child has just been diagnosed with diabetes, it’s important that you have a pediatrician you can turn to in order to create a customized and effective treatment plan. While diabetes cannot be cured, diagnosing, and treating your child’s diabetes as soon as possible is key to helping them maintain a long, healthy and happy life.

There are two different kinds of diabetes: type 1 and type 2. Type 1, also known as insulin-dependent diabetes, usually happens during childhood. This autoimmune disorder occurs when the body attacks the pancreas so that it doesn’t produce insulin. Type 2 is the most common form of diabetes in adults; however, children can also develop type 2 diabetes.

Unfortunately, with the increase in childhood obesity our doctors are seeing a rise in type 2 diabetes in children, as well. The pancreas of children and teens with type 2 diabetes does produce insulin but the body just doesn’t properly respond to it.

Symptoms of Diabetes

Both types of diabetes often present with the same symptoms including:

  • Fatigue
  • Increased hunger and thirst
  • Frequent urination
  • Blurry vision
  • Sores and cuts that don’t heal properly

Other symptoms may include:

  • Mood swings
  • Irritability
  • Unexpected weight loss
  • Numbness or tingling

Treating Type 1 Diabetes

There is no cure for type 1 diabetes. Since your child’s body doesn’t produce insulin this means that they will need to receive daily insulin injections. Along with taking these injections, you will need to monitor your child’s blood sugar every day to make sure their levels aren’t too high or don’t drop too quickly.

Treating Type 2 Diabetes

Even though children and teens with Type 2 diabetes produce insulin, the body doesn’t respond properly to it. Because of this, your child will need to take daily medication to maintain healthy glucose levels. As with type 1 diabetes, daily blood sugar monitoring is necessary to make sure that the medication your pediatrician prescribed is effective.

Along with taking medication, there are certain lifestyle modifications that can also go a long way to controlling your child’s type 2 diabetes. In fact, sometimes type 2 can be reversed with a healthy diet and regular exercise alone, depending on the severity. Lifestyle modifications include:

  • Eating a healthy balanced diet
  • Limiting sugar and carbs, which can spike blood sugar
  • Getting at least 30 minutes of exercise a day most days of the week
  • Losing excess weight and maintaining a healthy weight

If your child is experiencing symptoms of diabetes or if you have questions about the best way to treat your little one’s diabetes don’t hesitate to contact your pediatrician for an appointment.

By contactus@amherstpeds.com
May 19, 2019
Category: Children's Health
Tags: ticks   Lyme   tick  

It's Springtime in the Pioneer Valley, which means it's high tick season! If you find a tick attached to your skin, there's no need to panic!

How to remove a tick
There are several tick removal devices on the market, but a plain set of fine-tipped tweezers will remove a tick quite effectively.

  1. Use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible.

  2. Pull upward with steady, even pressure. Don't twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove everything easily with clean tweezers, leave it alone and let the skin heal.

  3. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water.

  4. Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers.

Clipart image showing how to remove an embedded tick with a pair of tweezers.

 

 

 

Now what?
The likelihood of developing an illness from a tick bite is low, particualrly if the tick has not been attached for more than 36 hours and is not engorged. While you do not need to see us for every tick bite, some situations do warrant evaluation and possiby treament. Please visit our website for more information. And please call if you develop a rash or fever within several weeks of removing a tick. If you do call us about a recent tick bite, make sure to tell us when the bite occurred, what kind of tick it was, how long it was attached, and where you most likely acquired the tick.

By Amherst Pediatrics
December 07, 2018
Category: Children's Health
Tags: Sick Child   Urgent Care  

When To Take Your Child To Urgent Care

 

As a parent, you want to always do everything you can when your child is sick, but sometimes it’s hard to tell exactly how sick your child is, especially when they’re very young and can’t communicate what is bothering them. Urgent care or a trip to the hospital isn’t always needed for simple problems such as a cold, mild diarrhea, or mild fevers. So, when is it necessary to take your child to urgent care?

 

Urgent Care

 

Not all illnesses need an immediate visit with your pediatrician and it’s important for you to know what symptoms to look out for. Some symptoms that may require urgent care are:

 

  • Vomiting and diarrhea that lasts more than a few hours

  • Rash, especially with a fever

  • High fever

  • A cough or cold that lasts several days

  • Large cuts or gashes

  • Limping or the inability to move an arm or leg

  • Ear pain with fever

  • Ear drainage

  • A severe sore throat or swallowing problems

  • Sharp and persistent stomach or abdomen pain

  • Blood in urine

  • Blood in stool

  • Not being able to drink for more than 12 hours

  • Rectal temperature of 100.4 F or higher in a baby younger than 2 months old

  • Fever and vomiting

  • Any pain that gets worse and doesn’t go away after several hours

 

While many illnesses may go away with love and nurturing after a few days, there are times when it is necessary to see your pediatrician as soon as possible. If your child has any of the symptoms listed above, be sure to call your pediatrician right away to find out if it is necessary for your child to go in for an appointment so that your child can get well as soon as possible.



Office Hours
Monday:8:00 AM - 6:45 PM
Tuesday:8:00 AM - 6:45 PM
Wednesday:8:00 AM - 6:45 PM
Thursday:8:00 AM - 6:45 PM
Friday:8:00 AM - 4:45 PM
Saturday:12:30 PM - 3:45 PM
Sunday:12:30 PM - 3:45 PM

Contact Us

Our Address
31 Hall Dr.
Amherst, MA 01002
Tel: (413) 253-3773
Fax: (413) 256-0215
Email: mail@amherstpeds.com

 

Please note temporary office hours
during the COVID-19 pandemic

New Office Hours: Monday-Friday 8:00 AM - 4:45 PM.
We are temporarily suspending our extended office hours (5:00 - 7:00 PM).

We are temporarily suspending our weekend office hours.
After hours, we will continue to be available as usual by phone for urgent matters and can schedule you for a virtual visit if indicated by the circumstances (see below). 


Due to the elevated level of illness in our communities, please remain at home if you or your child is ill. If you have concerns about how your child is feeling, please contact us by sending a message through this patient portal. The clinicians will be able to respond to you during our regular hours. Calling the office may present a further delay in response times.

The COVID-19 situation is ever unfolding. We are dedicated to the safety of our patients and staff. Please refer to our website for updates on this changing situation.



* Please note: It is our policy that we do not approve referral requests for visits to outside urgent care centers during times that our office is open.

Holidays
We are open for urgent visits only on most Holidays. Our office is closed on Easter Sunday, Thanksgiving Day, and Christmas Day.