Nicole Keller, D.O.

About Nicole Keller, D.O.

Dr. Nicole Keller specializes in pediatrics. From the time she was a young child, Dr. Nicole Keller has wanted to be a doctor. She believes in guiding her young patients toward living a healthy lifestyle through incorporating a family approach to making optimal screening, immunization, nutritional and activity choices. Dr. Keller loves to see every age group from tiny babies to teenagers on their way to becoming young adults. She hopes to influence them in a positive way for years to come.

1 Jul 2019

4 Need to Know Sun Safety Tips

Nicole Keller, D.O.

Nicole Keller, D.O.

Now that spring has officially sprung (and summer is just around the corner) I thought it would be a good time to talk about sun safety and sunscreen. In social media lately sunscreen has gotten a bad rap. People are worried about the chemicals in the lotions we use and causing harm to their child by applying them. But, the truth of the matter is NOT using an effective sunscreen will cause much more damage!

Skin cancer is a real problem and in many cases is related to damage from the UV rays from the sun. This damage starts when we are young and compounds on itself as we age. Sun damage not only causes many skin cancers, but, also is related to wrinkles, skin discoloration and burns that can result in pain and scars.

To protect yourself and your kids from the sun, I’d recommend the following four need to know things:

  1. Sun avoidance: stay in the shade when you can! Use big brimmed hats, long lightweight clothing or the shade of a building to keep yourself out of direct sunlight. The hours of
    10 a.m. to  4 p.m.  are when the sun is strongest and tends to cause the most damage. Remember, though, clouds don’t count as sun avoidance – you can still get burned through the clouds.
  2.  Sunscreen clothing: there are clothes that are SPF rated that are long sleeves/pants that you can have your child wear. These items are lightweight to allow your child to not overheat but also cover a large surface area of skin requiring less sunscreen lotions to be applied. Hats can also be SPF rated and should also be used to protect the scalp, face, and neck.
  3. Sunscreen lotions: SPF of 30-50 is what is recommended no matter your age (even young babies who are going to be in direct sun should be protected!). Proper application is key. You need to put a generous layer on any exposed skin (don’t forget your ears!) and reapply every 2 hours – especially if swimming/sweating. You should apply sunscreen 15 minutes prior to going in the sun to allow it to dry. At first, many sunscreens are white on the skin – that’s OK! Get it all over your skin, let it dry for 10 minutes and then wipe in any remaining white spots.
  4. Type of sunscreens: there are two types – physical blockers (which contain titanium dioxide or zinc oxide) and chemical blockers (which have chemicals that block the harmful UV rays from the sun). Use of physical blockers (containing titanium dioxide or zinc oxide) may help to minimize irritation due to sunscreen use if your child has sensitive skin. Zinc oxide is the main ingredient in a lot of diaper rash creams (such as desitin) – you could even use this for a sunscreen if you didn’t have any other options!

I hope this helps you feel better about protecting your kids and your family from the sun’s harmful rays. We all want you to play outside, but in a safe way. Have a fun, sunny summer! As always, if you have any specific questions or concerns, feel free to call your pediatrician. Thanks for reading!

13 Sep 2018

Flu – The “Hulk” Version of a Cold

The seasons are changing – warm summer days at the pool will turn into cool fall days. As a pediatrician, I can tell the seasons have changed as my appointments go from nearly all school physicals to sick visits. This also means flu season is almost here.

The flu, or influenza, is “the Hulk” version of a cold – it is longer lasting and more intense than your typical illness. If you get the flu, you can expect to be sick with fevers, body aches, coughing, runny nose or congestion, a stomach ache and possible vomiting. These symptoms with typical colds last for 7-10 days. With the flu, you tend to have more intense symptoms for longer – 14 days is more typical.

Influenza does not discriminate – it infects the young, middle aged and old, male and female, those who eat healthy and those who don’t. It is spread by respiratory secretions: sneezing, boogers and coughing basically! It tends to cause the worst illness in the very young (newborns, infants, toddlers) and the elderly.

While for most, the flu will be a miserable few weeks of illness, those who are less lucky may have complications. These complications can require hospitalization and range from ear infections, pneumonia, meningitis, and most terribly, death. Last season, hundreds of thousands of people were hospitalized and deaths reached record numbers: nearly 200 children were among those who died after contracting the flu.

I’ve painted a pretty bleak picture, I know. So what can you do about this for you and your family? While I can’t offer much to prevent the common cold that will start to frequent our communities soon (other than hand washing and staying away from sick people), influenza is something I can offer some protection from: with the flu shot! Everyone with a working immune system (i.e. not fighting cancer for example) from ages 6 months and upward can and should get a flu shot yearly.

I know, I know…no one likes shots. And the flu shot gets a really bad reputation – I hear all sorts of reasons people don’t want to get the flu shot. People tell me it made them sick, it didn’t work, they are afraid of the side effects of the shot, or they haven’t gotten sick after skipping the shot in the past so don’t see the need for the shot of prevention. So let’s talk about the vaccine a little bit…

The flu shot is a killed vaccine – it cannot give you the illness. Most viruses, though, hide in our body for 3-5 days before producing any symptoms. So many people who get sick after getting the flu shot were already harboring their illness before they got their shot. In other words, it wasn’t the shot that got them sick.

Vaccines don’t work immediately either – to build full protection from the flu vaccine, you need to give your body 2 weeks to respond – this is why we recommend vaccination by November at the latest to protect yourself well before flu is heavily circulating. In kids 8 years old and younger, the first year getting the vaccine will require 2 shots separated by 1 month. Every year after that is only one booster.

Now I’m going to be honest with you: the flu shot isn’t perfect. There are multiple strains that circulate and the virus is smart and can morph mid-season. These facts make it hard to make a perfect vaccine. It also means the vaccine is only moderately good at fully preventing the flu.

Even so, if you come down with the flu after receiving your flu shot, your illness should be milder since your body has some awareness of the virus already.

Additionally, while full prevention may only be modest, prevention of severe illness and complications is excellent in those who receive the flu shot. In those who died of flu, more than 80% were NOT vaccinated. That’s a powerful statistic.

Beyond this, comparing risks versus benefits of getting the flu over getting the flu shot, the benefits of the vaccine WAY outweigh the risks. Risks of the flu shot may include allergic reaction (which is so rare that even people with allergies to components of the shot are recommended to still get the vaccine), redness, welt, soreness at the site. Other more scary reactions are so rare that they are hard to even quantify. On the other hand, risks of influenza are easily measured (remember all the complications I mentioned above), and occur to thousands of people across the globe annually.

Here’s the thing. You probably won’t get the flu every year – some estimates are that people contract the flu every 5-10 years. So sure, you could try to get lucky and not get your flu shot. But, you getting your flu shot not only gives you a chance at prevention, it also helps stop the spread of flu in the community. You getting your shot helps keep the newborn next door, your grandma, your friend with cancer and the rest of your family from getting the flu too. The more people that get protection, the less the flu will take hold of our community.

On a final note, I choose to have my family vaccinated every year from the flu. This is my choice. I would never recommend anything to my patients that I wouldn’t do for my family. We all got our family flu shots this year together! I’m pregnant as well which means my baby will have some protection via the womb after birth. Yes – pregnant women should also get the flu shot to protect themselves and their growing babies.

So here’s the message: get your flu shot and get it now. For yourself, your family, your pregnant friend, those with compromised immune systems (everybody knows someone with cancer, right?), the newborns and the elderly. Encourage others to get protected as well. Not only will the vaccine help you stay well, it will help keep others well too! As always, if you have questions, talk to your doctor about your specific health situation.

6 Feb 2017

The Beat on Bronchiolitis

Nicole Keller, D.O.

Nicole Keller, D.O.

Hello again! I just returned from maternity leave in the thick of cold and flu season. But in addition to the common cold and that nasty influenza bug, there is another illness that is roaring through the pediatric population at the moment – bronchiolitis! This is a big scary word and in my blog I’d like to help you understand what it means to us and to your kids.

Bronchiolitis is a fancy term for inflammation of the smallest parts of the lung tree (the teeny tiny little airways in the lungs). In addition to inflammation, the hallmark of this illness is large amounts of secretions – basically, your child becomes a boogery mess! It is a constant running of the nose, congestion, and mucus build up in the upper airway. This leads to stuffy noses, wet coughs, and sometimes difficulty breathing and eating.  You can also have fevers on and off with this illness. Some kids will have wheezing in their lungs but this is usually from mucus plugging – not airway muscle spasm (like in asthma).

Bronchiolitis tends to have the most effect on young children – you can contract the viruses that cause bronchiolitis at any age but the clinical presentation of bronchiolitis typically is seen in kids less than one year old.  Part of the reason we worry about bronchiolitis is because of this tendency for it to have the most power in our littlest patients. You see, they have the smallest of the smallest airways, so, when you clog up those airways with mucus, they have the hardest time clearing those airways to breathe. If you can’t breathe well, you can’t get oxygen where it needs to be and that’s bad. Additionally, if you can’t breathe, many times it makes it hard to eat. If you have a baby who can’t breathe well and has a hard time staying hydrated it can be a really tough road to get through this illness.

What causes this nasty bronchiolitis you might ask? One of the most common viruses associated with bronchiolitis is called RSV (respiratory syncytial virus). Other viruses (like coronavirus, metapneumovirus, parainfluenza, etc) cause bronchiolitis but RSV is the one we tend to worry about the most – although none of them are fun. The virus stays in the system for a few weeks but is the most contagious in the first days to weeks of the illness. The entire illness may actually take four to six weeks to resolve completely. That’s an eternity when you are dealing with a sick little one at home!

So what can you do for bronchiolitis – how do you get your kids through this common, yet miserable, disease? In short, supportive care. You see, bronchiolitis is caused by viruses, and viruses don’t respond to antibiotics. Viruses get better on their own with time. But, until that “time” has come when your child is finally recovering from this illness, there are some “supportive” things you can offer your child.

Supportive care options for bronchiolitis:

  • Push fluids, small amounts often to maintain hydration.
  • Acetaminophen (Tylenol) or ibuprofen (motrin) to help with discomfort or fevers. No motrin in kids less than six months.
  • Suction the nose with nasal saline – you can use drops or a mist to apply into the nasal passages and then suction out the mucus with a bulb syringe or other suction device (such as a “NoseFrida”).

Other treatment options can sometimes include breathing treatments and even less commonly steroids, but, the AAP doesn’t recommend these on a regular basis since they really don’t help much and may just result in side effects.

Your child should be seen if they are having symptoms like this. We’ll want to check their oxygen level, hydration, and breathing status to make sure they are handling the illness appropriately. Sometimes, kids that aren’t doing well with this illness need to be hospitalized for intense supportive care that may include oxygen administration, IV fluids for hydration, and frequent deep suctioning. Bronchiolitis can result in complications rarely so we are very cautious with these children.

If your child is having trouble drinking, having trouble breathing (such as sucking in between or under the ribs), having fevers for longer than five days in a row, or other worsening symptoms, they should be seen in your pediatrician’s office or in the ER if they are in distress. If you’re not sure, call us! We can help decide with you over the phone to make sure your child gets the care they need.

In the end, bronchiolitis is a common, miserable viral illness that affects nearly everyone at some point in their life. It is mostly harmless, but, can take a lot of effort and a long time to resolve and sometimes gets worse before it gets better. Remember to have your child seen if you are worried about this illness. Please call your pediatrician’s office if you have questions or concerns about this…oh, and wash your hands to help stop the spread of illnesses like this too. Thanks for reading!

4 Oct 2016

Helping Kids Digital Detox

Nicole Keller, D.O.

Nicole Keller, D.O.

A recent article published in The New York Post addressed screen time and kids. It compared screen time to a drug for children (“digital heroin” is the phrase they used). I suppose in many ways, screens can be as addicting and enticing as a drug – scary! Whether we like it or not, in recent years, screens have become a normal part of everyday life. Between TVs, phones, tablets and computers, many of us are participating in screen time for hours a day without even realizing it. But, like most things, this “addiction” affects kids in different ways than adults. Their growing minds are particularly impressionable which makes regulating screen time a new parenting challenge.

The American Academy of Pediatrics’ stance on screen time was initially very stringent. No screen time at all was recommended for kids less than two years old and for older children, two hours a day was the maximum recommended. In the past year, this recommendation was amended. It now doesn’t focus as much on the age and amount of time but the appropriate use of screen time in children. Overall, as pediatricians, we still don’t recommend using screen time in large amounts during the day, but, we also realize that screens are officially a part of our lives and it’s unrealistic to expect our kids to not be participating in their use. Instead, we ask that caregivers use screen time wisely. Like anything, when used in the correct way, screen time can have benefits/perks. On the other hand, when kids are allowed to dictate their use of screen time without supervision, the threat of it becoming an addictive drug becomes a reality.

There are some positives to screen time in general. Educational apps can help reinforce learning points in toddlers and school aged children. Communication has become easy among family and friends across the world. Classic games and puzzles can be easily transported and used in just about every environment, as well. These are some great things! We as caregivers and role models for our kids just have to keep these benefits in mind and assure that the scale doesn’t tip towards negative use of screen time.

Negative effects of too much screen time can be seen in your child’s behavior during the home time and at school. Kids become accustomed to immediate gratification that screen time tends to give them that is not present in real life. Patience wears thin very quickly in a child who is used to large amounts of screen time. In addition, attention is affected with large amounts of screen time. Multiple apps, music, and ads running at the same time make the brain fire rapidly at multiple targets but not focus for any amount of time on one task. This may make a single focus task (like reading a book) actually seem harder because their brain isn’t used to the lack of other background “noise.” Poor attention and lack of patience lead to tantrums and angry eruptions when kids try to complete other tasks they are asked to complete. Homework time, meal time, and other quiet moments in the day may become tense and rushed as kids are eager to return to their screens.

To help you avoid turning screen time into a potential dangerous “drug” in your child, try some of the following tips to keep screen time a safe and beneficial tool for your children:

  • Time limits: although many kids require computers to complete homework, make sure your kids aren’t spending excessive amounts of time on their screens beyond homework time (it’s hard to put a number on how much time is appropriate – I’d shoot for no more than one to two hours beyond homework time). In addition, while doing homework, make sure they are focused on their assignment and not being distracted by other open apps or programs.
  • Parental controls: most devices will allow you as a caregiver to have control over what apps are purchased, how long they can be used, or if they can be opened without a parental lock. Use these options to make sure your child isn’t getting into any inappropriate material or staying “plugged-in” for too long a period of time.
  • Keep screens out of the bedroom: make sure your kids are completely un-plugged at bed/nap time. Strict rules about not using any screens around sleep time is important to ensure kids are getting appropriate rest. This is really important!
  • Participate actively in screen time with you kids: if you are going to allow your child to use a screen for playing on, play with them! Let them show you what they’ve learned on their educational apps and teach them new ways to use apps for fun and for learning. This can be a great form of modern parent-child interaction.
  • Offer no-screen alternatives: while our kids may not like it, sometimes it is just best to take the screen away. Set rules/expectations for when screen time is allowed and when it isn’t every day of the week. During no-screen times, remember all the ways YOU used to stay entertained without a screen. Playing outside, going for family walks, exercising, board games, coloring, puzzles, reading books, or playing with toys (blocks, cars, dolls, etc.) all have their benefits in child development and entertainment. Don’t forget these seemingly simple and basic ways to entertain and enrich your child’s life.

Well, I’ve now had my full of screen time. I hope you’ve gotten some benefit from this blog on the appropriate use of screens in our kids. Thanks as always for reading!

12 Aug 2016

Safety First

Nicole Keller, D.O.

Nicole Keller, D.O.

Keeping our kids healthy, growing and developing well and safe are major goals for parents. We discuss their health a lot on this blog and at their doctor’s visits. Their growth and development are key points to most well visits. So, for this blog, I’d like to talk about basic safety that might get overlooked or skimmed over at otherwise busy check-up appointments.

Newborns and Toddlers

  • Preventing falls: be careful with kids on beds, couches, around windows or stairs and on diaper changing tables – tumbles happen quickly and without notice – always keep a close eye and when in doubt put the baby on the floor where they can’t fall. Never use walkers with wheels as it makes for increased risk of a baby wheeling their way down a staircase or tipping over and hurting themselves.
  • Childproofing: this means putting up gates, locking cabinets and removing small or easily breakable (and swallowable!) items from children’s reach. Get down on the floor at their level to see what hidden dangers you might be missing. Be especially careful with cabinets that have potential poisons that babies can get to (cleaning products, medications, soaps/detergents, pest control, etc). If you have older kids in the home, make sure they know to keep their small toys away from the younger babies and toddlers to avoid choking risks.
  • Water safety: never leave a young child alone around water. This includes during bath time, in/around swimming areas (pools, lakes, retention ponds, etc), near buckets of water or any other source of collected water. Burns from hot water and drownings happen quickly and without notice. Always designate a “water watcher” to make sure an eye is kept on your little one at all times when around water. Set your water heater in your house to a max of 120°F to help prevent the likelihood of severe burns if water temps change quickly during bath time.

School Age Children

  • Outdoor safety: make sure your child knows to never go anywhere without parental consent (or escort). They should know to look both ways when crossing a street and hold a responsible person’s hand when crossing. Also, remind kids of stranger safety – never get in a car or go anywhere with a stranger no matter how nice they look, if they have a cool car, or if they are offering candy – be specific with your little one and make sure they know these specific tricks that a stranger may try to engage them with.Glowing Neon Safety Sign
  • Recreation: helmets are a must for any sport with wheels – this includes skateboards, bikes, scooters, ATVs, etc. All it takes is one head injury to spell disaster. Please make sure your kids have appropriately sized helmets for these activities. A helmet should fit snuggly and not move when your child nods their head. Make them “cooler” by allowing your child to decorate them with puffy paint or stickers so they are more likely to want to wear them. Feel free to add in elbow and knee pads while you’re at it too!
  • Bullies: make sure your child knows what to do if they or someone they know is being treated inappropriately. Designate a few people that they know to go to if they need to alert someone about these bad behaviors to help empower them to seek help in a safe and comfortable manner without delay.
  • Water safety: see above! Hopefully your child has had some type of swim exposure at this point to make sure they know how to be safe around water and swim/wade in water as well as float when needed.

Tweens/Teens

  • Bullies: see above! Bullying can happen at any age – make sure your child is comfortable seeking help if needed.
  • Recreation: see above – helmets are still important!
  • Water safety: see above! Swim safety is a must at this age – floating and being comfortable in the water should be the minimum goal to shoot for.
  • Internet/phone safety: keep a close eye for these hidden dangers with parental monitoring apps and locks and discussing openly with your child internet/phone safety and expectations. Phones, tablets, computers and use of the internet is a privilege and should be treated that way. If your young adult knows these expectations from the start, safety can be more reasonably monitored. Lastly, no texting while driving! They should know this themselves and for their friends who are driving them around as well.
  • Alcohol, drugs, smoking: while this seems obvious, you have to start talking to your kids EARLY so they know from the beginning the dangers of these products. There is no safe amount of alcohol for a child, no safe cigarette, and no safe drug. Engaging in these behaviors at home with an adult monitoring them is no better. Be a good role model and make sure your young adult understands the danger that comes along with these risky behaviors. Make sure they know to never get in a car with someone who has had something to drink or has done drugs. Ensure they feel comfortable always talking to you as their parent to help them out of a situation like this in case they ever accidentally find themselves in harm’s way.
  • Communication: it is ever important to keep lines of communication open and honest between you and your tween/teen. If they feel comfortable talking to you as their parent, they are more likely to come to you if they get stuck in a risky situation. Make sure expectations are clearly discussed and rules are laid out and enforced. Be the person they can come talk to if they are in trouble and hopefully they’ll seek you out before things ever get bad.