Keānuenue Pediatrics Caring | Committed | Connected Wed, 31 Aug 2022 04:55:13 +0000 en-US hourly 1 Keānuenue Pediatrics 32 32 FAQs for COVID Vaccines for Children ages 6 months through 4 years. Mon, 20 Jun 2022 20:21:01 +0000 We’re excited to share we finally have two great options for COVID vaccine protection for children ages 6 months through 4 years. The FDA granted emergency use authorization for both the Pfizer and Moderna vaccines for this age group last week, and this weekend the CDC advisory committee recommended the vaccine, as expected.

COVID Vaccines for Littles: FAQs

Ok, you’ve had some really awesome questions, so we wanted to share some facts about the vaccines and make sure your questions are answered. If you have any more, send them our way and we’ll get you the answers.

First, the facts:

  • Two SAFE and EFFECTIVE vaccines were approved for children ages 6mo-4yo: Pfizer and Moderna
  • This news is different, because up until now, children have only had the option of Pfizer
  • Here’s a side by side comparison:
    Pfizer Moderna
    Type of Vaccine mRNA vaccine mRNA vaccine
    Dosage 3 mcg (1/10 of an adult dose) 25 mcg (¼ of an adult dose)
    Efficacy 80%, but only effective after 3rd dose 40-50% effective
    # of doses 3 2
    Schedule 2 weeks between first 2 doses, 2 months before the 3rd dose 4 weeks apart

NOTE: The dose is a standard dose for each vaccine and is the same across the approved age range 6mo through 4yrs. We don’t have to do any calculations based on your child’s weight. We just give the prescribed volume based on their age.

Now to your questions…

Do we have to have our infants/children vaccinated?

The quick answer is no, it’s totally your choice. Based on our review of the safety and efficacy of the vaccines that were studied, as well as the very low risk of any significant adverse reactions, we highly recommend having your child 6 months or older vaccinated against COVID.

If COVID doesn’t really affect kids that badly, why should I choose to vaccinate? 

Kids do bounce back quickly from COVID, thankfully. But there are more children that die annually from COVID than from the flu and from meningitis, which we routinely vaccinate children against. So, being unvaccinated is also a risk. Kids that have chronic medical conditions are more vulnerable, but there have been healthy children as well who had COVID and did not do well. It happens to some kids, and we can’t predict which ones are more likely to get very ill from COVID.

We know the vaccine significantly reduces the risk of serious illness, hospitalization, and death from COVID. Of all children who’ve been hospitalized with COVID, most were between 6 months and 4 years old. The vaccine also helps reduce transmission to more vulnerable grandparents or immunocompromised siblings or classmates. Having your child vaccinated might even help you feel confident getting them out more: into sports, other after-school activities, and just fun stuff like going out to the movies or dining at a restaurant indoors … imagine.

Also, remember that having COVID infection is not completely benign. There is MIS-C, the multi-systemic inflammatory syndrome that can occur after COVID infection. Children can have Long COVID, too. And, of course, being infected makes your child a likely source of infection to others, including you, your parents, and others in the community. Finally, has your kid been left out of daycare/preschool/school for being a close contact and you’ve had to scramble to find childcare? That scenario should be less frequent for you as more and more children get vaccinated.

Here, the benefits clearly outweigh the risks of getting the vaccine.


Why does the efficacy seem low?

Efficacy in adult recipients were very high when the vaccine was released. While the numbers are lower than for adults, both studies demonstrated something called immunobridging, which means that both vaccines elicited the same immune response seen in young adults.

The difference in efficacy between the vaccines is likely due to the differences is dosage and shcheduling. Both vaccines meet the high standard of approval set by the FDA and CDC for preventing serious disease and death.

Are the vaccines safe?

The safety data of the vaccines are both excellent. Moderna was tested in 2500 children (6mo-2yo) and 4200 children (2yo-6yo), Pfizer in 1678 chilldren. No adverse side effects were reported in either study. There was no evidence of myocarditis in study participants, and we know now that myocarditis from the vaccine is exceedingly rare and more likely in teenage boys, not this population.

If I got the COVID vaccine while I was pregnant, is it still ok for my baby to get the COVID vaccine now? 

Yes! Just like you get your Tdap shot in the third trimester so antibodies get to your baby across the placenta and protect them when they’re born until they can get their own shots, your COVID vaccine protected them too! But now, finally, they can get their own shot, and this type of active immunity is even more reliable than the passive immunity of maternal vaccines.

If my kiddo is almost 5, should we just wait and get the bigger dose? 

No, you should get whatever is available as soon as it’s available. Any protection is better than none. If your child turns 5 between doses, then they’ll qualify for the higher dosed booster. Remember, we give shots based on age, not weight. There’s now no reason to leave them unprotected.

How can I help my child prepare to get the vaccine?

We advocate for honest communication with your child if they’re verbal. Even from age 1 they understand more than you think. How about something like:
“We’re going to the doctor’s office to get your COVID vaccine. It’s a shot in your arm (or thigh) that will help protect you and make you stronger so you don’t get sick as often. We’ll get another shot later, and when you get all your COVID shots, we’ll get to go out and do [fill in miscellaneous fun things] more because you’ll be safer.”

Side effects? 

In both studies, side effect profiles were similar.

Most common:

  1. Irritability
  2. Drowsiness
  3. Fever
  4. Injection site pain

Since Moderna’s dose is higher, side effects were seen more often in this study group.

Tylenol and Motrin are ok to give for fevers, irritability, and injection site pain. But most kiddoes will just need to rest, typically after the 2nd (and possibly 3rd doses). Use our dosing calculator for the most accurate dose.

If we already had COVID, do we still need the vaccine?

Yes, we still recommend getting the vaccine. There’s a difference between natural immunity from being infected with COVID and vaccine-induced immunity from getting one of these vaccines. Both are a form of active immunity, meaning your body’s immune system produces antibodies to protect against future illness, but what we’re learning about COVID is that neither lasts forever.

There’s no minimum time frame after getting COVID, and your child can get their vaccine as soon as their isolation period is over. If you want to wait, then it’s ok to wait up to 3 months after natural infection to start the vaccine series, but it’s not necessary.

So, which one do I choose? 

Short answer: whichever is available. We know both the Pfizer and Modern vaccines are safe and effective.

Long answer, it depends what’s most important to you.

If both are available:

  • With Pfizer your child will likely have less side effects but won’t really have any immunity until after the third dose, which will be up to 3 months after the shot series begins.
  • With Moderna, your child will likely have more side effects with the larger dose but will have a good amount of protection in just 4 weeks. So if you’re traveling and in need of quicker protection and can’t wait nearly 3 months for the Pfizer vaccine to reach it’s 80% efficacy, then Moderna would be the choice.

Also of note, Moderna is working on a bivalent booster dose for adults that will likely be translated to a booster for kids. The benefit of a bivalent booster is that it accounts for omicron and newer variants that have arisen since the dawn of COVID vaccines, so it should offer more targeted immunity for the strains circulating now.

Short answer again: You can’t make a wrong choice.

Shout out to my friend and very well-informed nurse practitioner Laura Reichhardt for pointing me in the direction of this very informative article written by Katelyn Jetelina, epidemiologist, who breaks down the key differences between Modern and Pfizer quite nicely. Please read that for a deeper dive into the numbers and nice clear explanations about the vaccines and their efficacy.

Bottom Line

  • The vaccines are both safe and effective for children as young as 6 months.
  • We’ll have both shots available in our office
  • Text us if you’re interested in being on our call list for scheduling as soon as the shots arrive in our office, possibly as soon as next week
  • Any other questions? You know what to do 🙂
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All About Fevers: How and When to Cool Your Child Down Mon, 11 Apr 2022 03:02:14 +0000 Baby in jacket looking sad

Wrenny’s first fever

Wrenny had her first fever from a virus at 7 months. It was the worst! Her eyes were so droopy and it was the first time I actually saw her frown. What I wouldn’t give to take all that sick away and see her smiling again. Having a sick infant or child is heart-breaking and sometimes scary, because your laughing, energetic babe transforms into the opposite :(. This article will help you determine whether or not your child has a fever and decide what to do about it.

What is a fever? 

So we can get on the same page, let’s start with the basics. A fever is a rise in body temperature that’s temporary, usually a response mounted by your body to fight infection.

A fever is …

  • Body temperature >100.4
  • An emergency in infants < 1-month-old due to their naïve immune system
  • An increase in body temperature, often triggered by the immune system, as a mechanism to fight an infection
  • Possibly caused by other things besides infection

How do I measure my child’s temperature?

There are a variety of thermometers available, but the most reliable in-home measurement comes from an oral or rectal thermometer. Other thermometers may be more convenient, less invasive, and provide a good ballpark, but they’re not the most accurate measure. Touching the skin is also not an accurate or objective gauge of the intensity of a fever, but it can signal that you should get a real measurement.

Here’s a great article with more details on how to check your child’s temperature.

Should I give medicine?

There are medications available to treat fever, including acetaminophen, commonly known as the brand name Tylenol, and ibuprofen, commonly known as brand name Motrin. However, if you confirm your child has a fever, you don’t have to immediately treat the fever with medication. The fever is actually doing an important job by creating a hotter than normal environment in the body to help you fight off the infection. Viruses and bacteria are less likely to survive in a hot environment. Some studies show that allowing the fever (rather than bringing the body temperature down) can actually decrease the duration of an infection. 

But, we know that fevers can make your child feel really bad. They can have a rapid heartbeat, fast breathing, chills and sweats, or feel very tired or fussy. If they’re super uncomfortable, we definitely recommend treating the fever. In that moment, it’s more important for them to be comfortable and get rest than to tough out a fever.

If you decide to treat the fever, you can use acetaminophen at any age and ibuprofen after 6 months of age. Dosing is weight-based, not age-based.  Check out our Fever Medication Dosing Tables as well as our Symptom Checker for more guidance!

Dr Waipa & Wren sick at the office

Dr. Waipa and Wren at the doctor’s office to test for flu #firstfever

Should I go to the emergency room? 

We see fever as one piece of the puzzle. You shouldn’t go to the ER for fever alone. There’s no magic number that makes us automatically recommend going to the ER or coming into the office to see us. Instead, we want to look at all the other puzzle pieces:

  • Is your child breathing ok? 
  • Is your child drinking/feeding well enough and keeping hydrated?
  • Is your child in a lot of pain?
  • Does your child have enough energy to play or engage with you? 

If most of the answers above are YES, then you don’t need to seek immediate or emergent medical care, and you can probably continue supporting your child at home. Remember, as doctors, we never treat a number. We treat your whole child, and we need to keep the big picture in mind.

Remember, if you’re not sure what to do, you can phone the physician on call at our office number for advice. If you feel like your child needs urgent attention and our office is closed, we recommend Kapiolani Medical Center After Hours Clinic if they’re open, or their emergency room, due to their expertise in caring for children.

How long do fevers last? 

Most fevers will take about 3-5 days to resolve, though for viral infections, other symptoms can last longer than that and sometimes linger for weeks (pesky coughs and sniffles). Fever should not linger beyond 5 days. Also,fever should also have a pretty obvious cause … like if your child has a fever as well as a cold or a tummy bug then it makes sense that they’d have a fever. But if your child is having a fever with NO other symptoms for 5 days straight, then definitely give your pediatrician a call for further investigation.

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Kid Can’t Sleep? Understanding Stages of Sleep Can Help Fri, 25 Mar 2022 05:42:05 +0000 HOW SLEEP CHANGES THROUGHOUT CHILDHOOD

Sleeping infant on white bed sheets

We get so many questions about sleep in our office! How can I get my newborn to sleep in the daytime instead of the nighttime? How can I get my toddler to sleep without protest, even though I know she’s tired!? What is a normal bedtime? The first step to figuring it all out is understanding where your keiki is from a developmental standpoint. In this post, we lay the foundation and help set your expectations for what your kiddo will likely need at each stage of development. Once we crack this code, how sleep plays into their (and your) active, fun, crazy schedule gets a lot easier to manage!

We’re going to break it down by age with important sleep tidbits to help guide you through the coming years.


newborn in crib in hospitalUnfortunately, the days of sleeping for 8 hours straight and sleeping in on the weekends are over (for a while). But hang in there!

Your newborn does NOT know the difference between day and night. As far as they’re concerned, every day is just one looooong day, and this understanding probably won’t kick in until 2 to 4 weeks of age. They also probably won’t develop a true circadian rhythm (that lines up with yours) until about 2 months of age!

During the first 2 months of life, and especially during the first month, your baby can’t go throughout the night without waking up to eat. They’ll instinctively be more nocturnal, and since we want them to grow, they should feed frequently throughout the entire day, ideally every 2 to 4 hours … yes, day and night. The maternal hormone prolactin, which helps with milk production, actually peaks in the middle of the night (how cruel is that?)! This overnight surge in your milk-producing hormone is why you’ll realize the largest milk production is early in the morning or in the middle of the night. The more your baby stimulates you at night, the more milk they get, which is why you’ll see they’re more active (and demanding) in the night and early morning hours. Even if you’re not breastfeeding, your baby is still wired to be more active at night … it’s just biology!

Don’t forget to read our post on Safe Sleep for Children!

2 months to 6 months 

Baby sleeping on side in crib

Your baby will start to develop more day and night sleep patterns around this age since their circadian rhythm kicks around now, helping them sleep longer stretches at night. They’re still unlikely to sleep the whole night, but that’s expected! Since they’re still young, they’ll still need to feed in the middle of the night to help them grow, probably a few times.

You’ll hear and read everywhere about sleep training, but every baby is different. While the goal is for your baby to sleep 8 to 12 hours a night, some babies take a little longer to learn the skill of independent sleeping than others. We don’t expect infants to sleep through the night until about 6 months of age, although some babies can start at 4 months. Stay tuned for more specific information on sleep training, which is recommended around 4 to 6 months of age.  

As your baby sleeps longer at night, you’ll notice that their naps will shorten during the day and they’ll have more awake time to interact and learn. Babies have different phases of their sleep (active, light, deep). You may notice during active sleep, they might kick around, grunt. This is normal! In deep sleep, children are essentially motionless.

6 months to 1 year baby sleeping on her side

Around now, your baby is capable of sleeping through the night and not needing to eat for 12 hours! If 12 hours at night isn’t your reality, consider sleep training. There are multiple sleep training methods out there that are safe and effective, but one of the more efficient methods is the “cry it out method.” You might worry that letting your baby cry in the middle of the night is actually worse than quickly helping them to go back to sleep, especially if it risks waking up neighbors or siblings. But sleep training teaches your baby to fall back asleep independently, meaning it really pays off in the long run.

What’s more important than the method of sleep training you choose (all methods work), is consistency. Whatever you decide to do, stick with it. Routine and consistency help your baby learn better than trialing multiple different methods at a time or bailing half-way through the process. Instead of confusing your baby, trust the process! Most babies can be taught to sleep independently within a week.

Also keep in mind that during this time period, many changes can also impact your child’s sleep, such as teething, regression (although typically around 4 months of age), growth spurts, separation anxiety, and dreaming. If a night isn’t perfect, don’t worry! Just do your best and stay consistent.

1 year to 3 years

boy toddler in long sleeve shirt sleeping on pink bed

Your child will continue to sleep throughout the night. But OMG. Can we talk about separation anxiety?! Some kiddos this age may not want to let you out of their sight, throwing a wrench in falling asleep initially or falling back asleep when they wake at night.

Naps may decrease to just 1-2 naps during the day. Some children will have only 1 nap later in the day. Each nap may last up to 3 hours! Nice! Ideally, their afternoon nap would not be too close to their bedtime to make sure they will still sleep at night (try not to let your child nap past 4 pm).

How many hours of sleep does your child need? Check out this article from Healthy Children.

3 years to 5 yearschild sleeping in white bed

Goodbye naps. Lol. Well, not for everyone. But you may see that your child will no longer will need a nap during the day. Of course, unless they had an eventful day, full of lots of outdoor activities or other fun/stimulating activities.

Other sleep issues may start to arise such as refusing to go to bed, nightmares, and general sleep disturbances. During this stretch, sleep hygiene becomes important! Check out our IG for more details on sleep hygiene tips!

We commonly hear the concern that a child will not go to bed because they’d rather watch TV or stay up with their parents. This age group LOVES spending time with their family. If you notice these bedtime stall tactics, your child probably wants to stay up with someone who commonly also stays up. Have the whole family mimic bedtime at their bedtime. TVs off, lights down, place quiet. 

6 years to 11 years

Older school aged children are very likely sleeBoy child sleeping on bed on sideping throughout the night without issue. But it’s important to pay attention to any sleep disturbances in relation to their 1) Routine or 2 Everyday activities. More ipad use, phone use, TV watching occurs at this age, as well as sports participation and more socializing with friendship groups.

If your child has trouble sleeping or staying asleep, think about any stressors that might be going on in their lives. Any changes to the environment? How’s school going? Anything nerve-wracking coming up (i.e. tests, sports games, shots, being bullied)? Continue to check in with them to make sure they don’t need more support on any of the above concerns.

12 years and older

Oh the teen years. When scrolling on IG before bedtTeenage male asleep leaning on desk with book on headime is a given! And staying up late while sleeping in late is a big thing. Welcome teenagers! Same as the 6-10 year old age group, pay attention to possible stressors. Teens definitely need their sleep! There are other important demands in their lives during these times as well! Sleep hygiene is REALLY important for this age group but at the same time, one of the HARDEST to accomplish at this age. Having clear house rules around screen time, devices in the bedroom (hint: there should be none), and setting reasonable bedtime expectations can save you from struggling too much with a nocturnal teen or a super grumpy teen in the morning!


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Life-Changing Tips for Pumping When You Return to Work Sun, 31 Jan 2021 20:45:22 +0000

How to be a pumping/working mom

Figuring out mom-ming can be overwhelming, and one topic we get a lot of questions about is how to figure out the logistics of being a working, breastfeeding mom. While there’s no perfect way to maintain pumping/breastfeeding when you go back to work, that’s for sure, but I’ll share how I survived the journey as a first-time mom to my daughter Wren. See all my tips and tricks below!

I remember feeling like my maternity leave was crazy short, and I was nervous to return to work, super sad to be away from my baby, BUT I was also excited to figure out what my new normal would be as a pumping, working mom. I just wanted to figure out the logistics and how best to make it all work! It took some test runs, but I’m happy to share what I figured out … so let’s jump into pumping!

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The Basics

Why do I need to pump?

When you head back to work, you’ll presumably be away from your baby for 6+ hours per day, maybe even a full 12-hour shift. Because your milk production is based on supply and demand, when you’re away from your baby, your body notices a decrease in demand, which will compromise your supply. Your body just won’t think you have that hungry baby to feed anymore and will make less milk.

If you don’t empty your breasts regularly, pressure builds up in your milk ducts and signals back to your body to down regulate your milk production. It’s a pretty marvelous system, but it also obligates you to keep reminding your body that the demand for breastmilk is still there, even if your baby isn’t with you. Also, it can just be incredibly uncomfortable NOT to drain your breasts because of the fullness and pressure as well as the risk of developing clogged ducts.

The Gear

Disclaimer: I get no kickbacks for recommending these products. It’s just honestly what I used 🙂 

Here’s what you’ll need to be a working & breastfeeding mom.

1) A breast pump
2) A hands-free pumping bra
3) Storage containers
4) A cold place to store your milk
5) A wet-dry bag to store your pump parts

Optional gear:
1) Haakaa
2) Hand pump
3) Cooler bag/ice packs for transporting your milk from work to homeThere are lots of great breast pumps out there, but I’m a fan of the Spectra S1 rechargeable hospital-grade breast pump. It’s light, portable, rechargeable so you’re not tethered to a wall, and easy to carry back and forth to work. You can find lots of cute pump bags too. (The Spectra website shows a pretty new, fancy gold edition … I know nothing about it, but it looks really pretty).

What’s a breast pump? It’s a motorized pump that’s connected with tubing to flanges that are held to your breasts and essentially creates suction that simulates a baby suckling and extracts milk from your breasts. Flanges come in different sizes, but the standard size is 24mm. After you deliver, you can check with the lactation consultant in the hospital to make sure the standard size flange works for you or if you’ll need a different size that fits better.

A hands-free pumping bra holds the flanges in place while you’re pumping so that you don’t have to hold them yourself. It’s easy when you’re tired to slip off target, and it’s just no fun sitting there with your hands full, so being hands free while you’re pumping (and snuggling your baby or catching up on email with your free hands) is awesome. This hands-free pumping bra is my favorite (though it’s pricey, I’ve found it worth the convenience), but there are lots of great ones out there too.

For storage, you can decide which vessel is the best for you to store your milk in after pumping. You can use plastic containers or bottles, plastic bags, glass jars or bottles, or your baby’s bottles. I’ve tried them all, to be honest, but I settled on Kiinde plastic bags, which were great for storage and feeding (these are too), and sometimes I would pour my pumped milk into glass water bottles like these and transport the day’s work home in one big bottle. It’s ok to add multiple pump output from different sessions into the same bottle, even if the milk in the bottle is cold.

A wet-dry bag is convenient for storing your pump parts between pumps. You do NOT, I repeat, you do NOT need to wash your pump parts after every pump. I promise!! You can just wipe it down (I had a roll of paper towel in my office), and put all the parts in a wet dry bag like this one and store it in the fridge. Why is that ok? Because breastmilk is inherently antimicrobial and in a cold fridge, no significant amount of bacteria or other pathogen will grow in the few hours you leave it in there between pumps. You just have to wash your pump once every 24hrs in warm, soapy water. Seriously.

haakaa is a hands free silicone breast pump that extracts milk from your breast passively using gentle suction. It’s really great for passive pumping when your baby starts sleeping longer or collecting milk from one breast while your little one is nursing from the other.

Ok, so what are the logistics?

I work a standard 8-10 hour work day and, up to a few times a week, also a 15-hour night shift. On work days, I would nurse Wren right before I left for work and then pump again mid-morning, again at lunch, and again mid-afternoon. I would then be ready to nurse by the time I went home after work. I eventually got to the point where I could just pump at lunchtime. You’ll have to see what works best for you to maintain your milk supply as your storage capacity can vary!

The way I made my pumping most efficient at work was to wear my hands-free pumping bra underneath a nursing top. So I’d shut the door (you need a private non-bathroom place to pump … this is a legal responsibility of your employer), then I’d move my shirt out of the way, plug the flange into my pumping bra, and pump away while I was doing work. I usually pumped for 15min, while sending prescriptions and finishing notes (see why being hands-free is awesome?) but I was eventually able to get it down to 10min with about 2min of clean-up time. After I was done with that pumping sesh, I’d pour the milk into a storage container, stick it in the fridge, wipe down my pump and stick that in the fridge, put myself back together, and head back to work.

Then you just transport your milk home. If you put it in one big vessel while working, then when you get home, you can pour it into individual portions for your baby if they need it the following day or if you want to freeze it in smaller aliquots (2-4oz is usually ideal). You can pour it directly into tomorrow’s bottles for your baby too. If you freeze or store it, make sure to put the date on it (the time doesn’t matter, just the date).

Breastmilk is good on the counter unrefrigerated for 4 hours.
It’s good in the fridge for 4-5 days.
It’s good in a standard freezer for 6 months.
It’s good in a stand-alone/chest freezer for 12 months!!!

How much milk do I need to pump?

I recommend leaving 1-1.5oz/hour that you’ll be away from your baby for your child’s caregiver. For a standard workday, 8-12oz should be fine. If you need to provide more than that amount, you might want to talk to your caregiver about your child’s feeding patterns and make sure they’re not overfeeding (very common when the caregiver doesn’t know the baby’s cues or schedule as well as you do).

I hope that recommended amount shows that you do NOT need a huge freezer stash in preparation for returning to work. Remember that you’ll be pumping today for tomorrow, so you don’t need to supply days at a time, just the first day or two, since you’ll keep making fresh breastmilk for your baby while you’re at work.

By the way, it’s perfectly normal for one breast to produce more than the other. In fact, it’s so common that there are lots of funny memes about the “slacker boob” 🙂

Summary and more of my top pumping mama tips!

  • You don’t need to wash your pump parts more than once a day, just wipe it down and store it in the fridge between pumps.
  • I got an extra set of pump parts so that at the end of everyday I’d have a clean, dry set ready to pack for the next day. You can get authentic pump parts here. I tried to get some generic sets, and they didn’t work out very well for me, but Amazon has lots of those too.
  • I got a more portable pump (Spectra S9) for easier transport back and forth to work. If you feel like splurging, there are also wearable pumps such as the Willow or Elvie that have no tubing and just sit in your bra while measuring your outputs with an app! Insurance usually doesn’t cover these.
  • You can order your pump conveniently through They verify your insurance coverage and let you know which pumps are covered. You pick the pump you want, then email in a prescription from your OB. In a week or two, your new pump gets mailed to you directly! There’s no additional charge for using this service.
  • It will take some trial and error before you figure out how often you need to pump to maintain your supply away from baby, but err on the side of pumping on the same schedule as your baby would normally feed (as best you’re able).
  • Watching videos, facetiming, or looking at pictures of your baby while pumping can help your milk flow!
  • When you store your milk in the fridge, you’ll notice that it layers, which is normal. The fat, protein, and amazing antibodies usually float to the top when chilled, separating from the water (your breastmilk is 70% water!). You DO NOT need to reheat breastmilk to give to your baby. Yep, you can give your baby cold breastmilk. Most babies honestly don’t have a preference, because when you’re hungry, milk is milk, and one less step between your baby and milk is a no-brainer! Just be sure to swirl the bottle to mix up all the contents that have separated so that every chilled gulp is packed full of goodness!

Office News

  • Everyone at Keānuenue Pediatrics is officially vaccinated!! Every member of our team has received their final dose of the COVID-19 vaccine, and we feel so fortunate to be protected and to help protect you.
    • If you have the opportunity to get your vaccine, we recommend it! If you have any questions about the vaccine, please reach out to us!
    • The vaccine for children is still being studied, but we’ll keep you posted as there are new developments!
  • Our Reach Out and Read program is up and running! We have been giving out age appropriate books at every well visit this week (currently for ages 6mo through 5yo, but we’re ordering books to expand to 2 and 4mo visits too)! Thank you so much for the awesome feedback and support of our participation in this program. We love that you see the value in early childhood development and literacy just as much as we do!
Here’s a pic of one of our amazing patients Camden reading his book!!
  • We love hearing from you! If there are topics of interest to you, burning questions we can answer, or just fun stuff you’d like to learn, email us your requests, and we’ll include it in our newsletters!
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We Grow Life-Long “Reach Out and Read”-ers at Keanuenue Pediatrics! Fri, 22 Jan 2021 20:36:54 +0000 Logo

Reach Out and Read

We’re super excited to announce that Keānuenue Pediatrics has officially become a Reach Out and Read site!! I’ll tell you more about the amazing program in this newsletter, but we’re so stoked to be partnered with this national program committed to child literacy.

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What is Reach Out and Read?

Reach Out & Read is a nonprofit organization that gives young children a foundation for success by incorporating books into pediatric care and encouraging families to read aloud together starting in infancy.


They believe all families should have the tools and information they need to make reading aloud a daily routine. As a newly recognized Reach Out & Read site, Keānuenue Pediatrics has joined a network of other pediatric clinics who’ve committed to purchasing and providing books to give to families at their well-visits in order to promote reading early and often.

Why is reading out loud important?

There’s a LOT of evidence that growing up in a language-rich environment is critical during early childhood. Reading together helps your child learn language and builds powerful, lasting bonds that make them feel loved and secure.


We encourage reading out loud to your child starting in the newborn period. The sooner you get into the habit of reading, the easier it’ll be to establish a life-long love for reading and learning in your child.


Don’t take my word for it … data shows that children who are read to:

  • Have better receptive and expressive language scores
  • Have better recognition of sounds and letters
  • Know a wider range of vocabulary
  • Have increased listening skills
  • Have a better understanding of how stories work

Other benefits of reading out loud include helping to grow your child’s memory and curiosity, fostering their imagination and creativity, and with physical closeness to a loving caregiver, helps them develop a positive association with reading that can endure.


80% of your child’s brain is developed within the first 3 years of life, so reading early and often can provide the attention, nurturing, and stimulation for growing that brain!

What does this all mean?

We want to support your endeavor as a parent to give your child the best possible chance of healthy growth and development! We’re committed to giving your child (and every child) the advantage they need to reach their potential.


So, starting soon, you can expect to receive an age-appropriate book at every well visit in our office from age 6 months through 5 years that you can take home to read to your child, from our ‘ohana to yours. We’re hoping to expand to the newborn period as well!


We believe in you. We believe that small, simple habits like reading and talking aloud to your little one from day one, can make a huge impact on your child’s brain as well as your relationship.

Other News

Dr. Honda & I both received our second dose of the COVID 19 vaccine and are feeling healthy!! The remainder of our team will be receiving their second dose next week!


We updated our ABOUT US page on the website, with some more info about our awesome team. Check it out if you have time!!


Don’t forget:

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WHAT’S GOING ON?! Fri, 08 Jan 2021 06:22:11 +0000  

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1 week down!

1 full week already down in 2021! Can you believe it? How are you doing with your New Year’s resolutions? Good, I hope!


I originally wrote this newsletter with plans on discussing COVID updates in relation to pregnant and lactating mothers. It’s still in this newsletter! Just scroll toward the bottom for updates. There’s also a special announcement from Dr. Waipa. 🙂


However, a lot happened on Wednesday (1/6/2021) at the Federal Capitol. So we need to talk about it. As adults, we could talk about what happened for hours, days even. Our country remains divided. Violence is NEVER the answer. Let’s come together. Remember, we’ve expressed in another newsletter that we feel everyone has a right to their opinions and beliefs. But know that we will always put your keiki first, no matter what. If there’s something we can do to benefit them, we’ll always do it, especially through advocacy, much of which happens at the political level. So while we try to avoid politics, when we fight for what’s best for children, it’s necessary to share our point of view.


But the goal of this newsletter is not to get into the gritty details of what happened this week. The goal is to focus on your keiki, and since what happened was so distressing to us as adults, we know it could also be distressing to your kids.


I’m sure you’re thinking “How do I discuss this with my children?” “What should I do as a parent to help my children navigate what’s going on in the world, even when it’s not pretty?” Know you’re not alone if you’ve had these thoughts. I’ll try to break it down by age since, as you know, the way our keiki internalize information varies depending on their level of development.


School aged-children won’t be able to understand the same complexity as teens. And even teens can’t quite comprehend in a way that doesn’t cause them to react emotionally. Not to mention, technology and news information is so easily accessible, which makes it difficult to filter what your child is exposed to.


So let’s see what we can do.

Step 1: ASK

Ask your child about their thoughts. What’s going on? Get their point of view.That’ll help you set the stage and know how to address any worries or concerns they might have.

Step 2: TALK with them in the moment.

Once your child asks what’s going on and you ask about their perspective, talk about it right then and there.

Step 3: Avoid being too vague

Being vague makes it difficult for children, especially young children, to know how the event differs from other every day events. For example, saying “people are upset and did something bad” doesn’t distinguish from the school fights, burglaries, or other protests they may be exposed to. Their view of “something bad” could simply mean that someone ate a piece of chocolate when they weren’t supposed to because they were mad they didn’t get attention. Not quite the same thing…

How to talk based on your child’s age

  • Preschool kiddos: The chocolate example above relates more to this younger group of children.
    • Use short sentences. Multiple breaks when speaking to check for understanding helps with this age group.
    • You can say something like “A crowd of people went into an important building when they weren’t supposed to. That building is important to our country. It got scary and dangerous.”
    • Let them know it’s okay if they feel scared as these young kiddos pick up on adult emotions so easily. Support them.
  • School-aged (6-10yrs):
    • Because they’re in school, they might hear about the news from other children. The conversation from one child to another may not be the most accurate. We’ve all played telephone. We know how that goes…
    • So if you’re able to talk with them first, fantastic.
    • You can use longer sentences, but still start simple and basic. These kiddos ask a lot of “why” questions. Your conversation with them will be longer than with preschool children.
    • They will express their own emotions. Pay attention to how they’re feeling. More on symptoms to look out for below.
    • This is an example of a conversation that might happen with a child in this age group.
      • Parent: Do you know what’s going on in our country right now?
      • Child: I saw pictures of people breaking into a building. I HEARD SOMEONE GOT SHOT.
      • Parent: Yes, that did happen (Take the time to either acknowledge or correct their interpretation)
      • Child: WHY?
      • Parent: People are angry. They weren’t happy. They wanted to express themselves.
      • Child: What are they angry about?
      • Parent: They feel that the person who won the election for President wasn’t correct. (the older kids probably already know this was happening since the election).
      • Child: Why?
    • The why’s never stop. It’s part of their development. They’re curious and as they get older, they also start to have their own opinions. Some children will ask more questions. Some may ask less. Some may start showing their emotions already.
    • Be cautious of media exposure. The graphic, sensitive content of people getting shot can be accessed easily. Be prepared to help them know what’s appropriate and what’s not appropriate to look at. If you already saw it as a parent, chances are your older school aged child will see it as well. Do your best to filter what’s available but also be prepared to talk about it.
  • Teenagers
    • This age group has the most access to social media and graphic, sensitive content. Therefore, the emotional spiral can be greatest.
    • Have the conversation with them early.
    • They WILL talk about it more with their friends
    • They WILL express their opinions and their perspectives
    • They WILL have an easier time feeling emotional about the current events
    • Remember, listen and validate. Check in with your teen in a way that lets them know you’re there to speak with them but not for them.
    • Hmm, they don’t want to talk to you, you say? That’s expected. They’d rather talk to their friends, honestly, which is super normal for their developmental stage, remember? Still. Let them know you’re there for them. Knowing that fact goes a long way.


Step 4: Watch for signs and symptoms of coping difficulties

  • Emotional distress (depression, anxiety)
  • Difficulty sleeping
  • Feeling tired
  • Increased headaches
  • Stress eating (I’m guilty)

If you have a child with special healthcare needs:

It’s important to know their limitations. Where are they developmentally? How do they normally react to unexpected situations? You know them best.

The American Academy of Pediatric’s website has a few paragraphs on helping children with disabilities and Autism navigate these difficult times. It’s short but still helpful information!

They also have a video!

Here’s more about helping children build resilience during uncertain times!

Several weeks ago, we discussed the new COVID vaccine and how it relates to children. Here’s a quick recap:


  • Studied ages 16 and older
  • Ongoing studies for individuals as young as 12
  • 2 dose series 21 days apart
  • Efficacy of 95% after 2nd dose


  • Studies ages 18 and older
  • 2 dose series 28 days apart
  • Similar efficacy as Pfizer vaccine 94.1%

The vaccine will not be available for children younger than 16 for a while. We’re all over it though and will keep you posted once that information is available!

Dr. Waipa and I both got our first shot last month and will be getting our second shot in the upcoming weeks. Our wonderful office staff got their vaccine yesterday! Yay! We’re all partially protected and will be fully protected in a matter of weeks!

I have to be honest, though I’m extremely happy and fortunate to have received the vaccine, a part of me was sad. I felt privileged, and I don’t like feeling that way. The first people I thought about were my parents, knowing that they’ll still have to wait some time to get protected. I thought about the rest of my family, my husband, my friends … all those who have to continue to wait.

I am so appreciative of the science, the thousands of individuals who enrolled in the vaccine trials, the countless hours that other nurses, physicians, RTs, and frontline workers put in day in and day out. To protect myself, my family, my patients, and my friends, I was ready once the vaccine became available.


We’ve gotten texts, phone calls, and in-person questions about this topic quite a bit lately, and for good reason. It’s hard to decide what to do when there were zero pregnant women and zero lactating mothers enrolled in the vaccine trials for both Pfizer and Moderna.


HOWEVER, when we look at the risk benefit analysis, the risk of getting sick with COVID and potentially getting your baby or your family sick compared to the benefit of having a 95% reduction in the chances of getting severely sick from COVID (95% efficacy) is what we really need to discuss. After doing our research and after discussing with other physicians, including OBs, the benefit of getting the vaccine is much greater than the risk of getting sick with COVID and potentially getting your baby sick. Therefore, we recommend getting the vaccine if you are breastfeeding or if you are pregnant once it becomes available to you.


There is also a possibility that the antibodies you generate from the vaccine will be able to pass through to your baby via your breastmilk, so you can protect your baby too! While this isn’t proven, it’s a possibility since we know this shared protection happens when antibodies develop from other vaccines and viruses.


Hi guys! Dr. Waipa jumping in.

Wren wanted me to let you know that she’s been promoted to big sister. We’re expecting our second child in May! We’re over the moon excited about the big change to come in our family, and being able to share the journey with you. I’m sure the leap to a family of four will be a huge one!


If all goes well, I plan to be on maternity leave from mid-May through end of June and will be back in the office in July. My wonderful colleague Dr. Honda will be covering for me, as well as our very good friend and colleague Dr. Courtney Taum, who I’m equally excited to introduce you to in a future newsletter.


Finally, I want to explain how I came to my decision to get the COVID vaccine last week, while pregnant. Like you, I was initially apprehensive and basically said, “No way, I’m not doing it. I’ll just wait until I deliver,” … that was my original thought process.


But as a physician, I felt obligated to make an educated decision, not an emotional one. So I did a deep dive into the science, the research, and, of course, asked all of my friends and colleagues to weigh in. The science of mRNA vaccines is actually AMAZING, and if you ever want to geek out about it, hit me up. The vaccine trials conducted were well-done and clinically sound. Vaccine efficacy rates of 95% are incredible. I couldn’t find any flaws in the methodology, and there’s compelling evidence that both of the approved vaccines are safe and effective; the data bears that out.


While there is still no evidence that this conclusion is true for lactating or pregnant mothers, by applying what we do know of the science and mechanism of the vaccine, it’s logical to conclude that the benefits of protection from COVID-19 far outweigh the (so far theoretical) risks of side effects from the vaccine. Also, data clearly shows that pregnant women who get COVID-19 are at much higher risk for preterm delivery and more severe outcomes than non-pregnant women. Think of it this way: No matter what you choose, you’re taking a risk, so it really boils down to which risk you’re willing to take … a personal decision.


And I’ve heard this rumor, so I thought I’d make it clear, this vaccine should have no impact on future fertility. No vaccine ever has. There’s nothing about the mechanism of the vaccine that should have any impact on fertility or reproduction. If you’re thinking of starting or growing your family, that’s no reason to delay getting your COVID vaccine if and when it’s available to you.


After my own deliberation (aka soul searching), checking in with my family and my physicians, and getting the final seal of approval from a very best friend of mine who works for the CDC and whose smarts I trust implicitly, my decision became clear. I was surprised that I changed my own mind, but I feel confident in my decision and wanted to share my thought process with you. The shot was easy to take, and I look forward to getting my final dose in a few weeks. It will make me feel safer and hopefully my family and patients as well.


If you have any questions about the COVID vaccine and need help deliberating on what to do, we’d love to talk to you about it!

Dr. Waipa


This newsletter was a long one, but there was so much to talk about! Huge congrats to Dr. Waipa!

As always, let us know if you need anything from us or have further questions about what we discussed. We are here for you.

Dr. Honda


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New Year 2021 Sun, 03 Jan 2021 19:36:53 +0000 Logo
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Happy New Year!

After taking a hiatus from our newsletter last week, we’re super excited to be back, with a renewed energy for 2021. After the trials of 2020, we’re all due for a reset, and we have a lot of aspirations for the year ahead. We hope you had time this week to reflect on what 2020 brought and taught, and, of course, the best part … setting goals for next year!!

So … whether 2020 crushed you …

Or you came out on top ….

Whether you got rained on or not …

We hope you kept smiling 🙂

Let’s look ahead, and see how we can make this new year the best ever!!

It’s a tradition in my family and now in our Keānuenue ‘Ohana to set a goal (or more) and announce our intentions for the year ahead. Dr. Honda is especially keen on making sure our goals are S.M.A.R.T. (specific, measurable, achievable, relevant, and time-bound), just like health goals we set with our patients.

We want to share our intentions for 2021, but we’d also LOVE to hear your child’s and family’s resolutions, since we know sharing your goals can make your commitment to achieve them even stronger (and, of course, we want to support you!)… so just hit reply to this email. We read every email you send us!

Our 2021 Resolutions

While 2020 was probably a less than ideal time to start a new business, we managed to make it happen, and in just 3 months, we got Keānuenue Pediatrics up and running (even though we had to wait a little longer for some furniture to be delivered). We’re just starting to realize our vision of how we want a pediatric practice to be, but we have so much more in store.

  • Now that we have shifted to the hospital-based EMR system called Epic, we aim to get 100% of our patients registered to use MyChart, a portal for you to access child’s medical information, growth charts, and securely message the office
  • We’re working on curating more resources for you on our website. There are copies of our newsletters but other great information too!
  • We’re working on a few patient engagement projects that we think you’re going to enjoy
  • We’re certifying to be a Reach Out and Read site to help encourage early childhood development and literacy … more info coming soon!
  • We’re affiliated with Girlology, a national program to help girls and their parents openly navigate changes of adolescence … more resources coming soon!
  • We’re aiming to form more community partnerships to help promote the health and well-being of our keiki
  • Finally, we’re working hard to create video content and handouts to address your FAQs, like potty training, starting solid foods, and choosing a preschool, among many other topics you suggested!

But we have even more goals that we want to set for 2021 and we need your help. If you could take 2 minutes to give us your feedback and suggestions HERE, we’ll incorporate what you want too!

Check out our Office!

Since you might not have had occasion to visit our new office yet, we made this video to show you around. We’re really proud of the work we put into building our new space, and we’re excited for what the future holds for Keānuenue Pediatrics.

Thank you, as always, for your support. We wish you and your family your best year yet!!

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Autism Sat, 19 Dec 2020 19:42:19 +0000

Mele Kalikimaka!!

It’s the most wonderful time….of the year 🙂 I LOVE Christmas. I hope that you and your family enjoy this holiday season despite current circumstances. Your Keānuenue ‘Ohana wishes you all a Mele Kalikimaka and a Hau’oli Makahiki Hou!

Today’s topic doesn’t have anything to do with the holidays, BUT it’s still an important topic that I felt needed some discussion and one that we field lots of questions about.

Today I wanted to discuss AUTISM and touch base on what we do when there is any concern regarding your keiki’s development.

I feel like when people hear the word Autism, it has such a bad stigma. This is unfortunate because Autistic children are some of the most creative and intuitive ones out there. Because of this stigma, I wanted to shed some light on what Autism actually is and when and how we diagnose it.

So, if this is ever discussed with you during one of your visits with us, please know that it’s totally okay if your child ends up diagnosed with Autism. There are many resources out there which I will discuss soon. And most of our autistic kiddos end up doing really well.

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The definition can be complex but generally speaking, it’s a condition that includes difficulties with communication, social skills, and behaviors. Sounds too general, huh? That’s actually an important point to make. The reason why the overall definition is so general is because autism has a spectrum. This means that not every individual with autism will behave the same way. Some are higher functioning than others. Some have a difficult time with the social skills aspect while others may have a difficult time with the communication aspect of autism. Everyone is different.

Autism affects 1 in every 54 children and is usually diagnosed by the age of 3. The earlier the diagnosis, the earlier we can help children get access to necessary resources. Early diagnosis leads to improved outcomes, which is why we focus on developmental screening so much in Pediatrics!

Routinely, we screen for Autism during the 18-month and 24-month visits. We use a validated developmental tool called the M-CHAT. You may remember filling out that form for your keiki. While the validated screening tool helps us to see who MAY have Autism, we also use the history provided by each parent and our observations during your visit to help guide us on a possible diagnosis for Autism.


If we have a suspicion for autism, we usually refer to a Developmental Behavioral Pediatrician or clinical psychologist to help with the final diagnosis. Your general Pediatricians may also diagnose Autism. Here are some of the criteria used to diagnose someone with Autism:

  1. Persistent deficits in social communication and social interaction. Need 3 symptoms
    1. Difficulty with back-and-forth socialization
    2. Problems with nonverbal communication
    3. Difficulty maintaining relationships, making friends. No interest in others.
  2. Restricted, repetitive patterns. Need at least 2 of 4 symptoms
    1. Repetitive speech, motor movements or use of objects
    2. Resistance to change in routine, ritualized patterns
    3. Fixated interests in unusual objects
    4. Atypical sensory behaviors; i.e. looks at people from the corner of their eye, does not like certain textures or to be touched by certain objects
  3. Symptoms must by present in early childhood
  4. Symptoms impair their functioning

Do know that we do NOT wait until a diagnosis is made from a subspecialist or clinical psychologist before connecting the child with resources. It’s better to provide resources early whenever there is suspicion for delay rather than wait.

Remember that even with a diagnosis, Autism lies on a spectrum. There are different levels of severity with Autism depending on how much support the child will require.


  • Difficulty with transitioning from one activity to another.
    • Now, many toddlers do this. BUT it becomes more exaggerated. Even small changes in activities upset those with Autism.
  • Poor eye contact
  • Language delay
  • Little interest in other children or other adults
  • Upset with a change in routine


There are so many!!!!

  • Early Intervention –> offered to those less than 3 years old.
    • Helps with all aspects of developmental delay, not just with concerns for those with Autism.
  • Speech therapy –> helps with verbal and nonverbal communication
  • Occupational therapy –> helps with fine motor skills (writing, feeding, dressing)
  • ABA Therapy: Applied Behavioral Analysis therapy. Such a valuable resource! Helps those with autism develop the necessary skills needed to function optimally.
    • Helps with language, communication
    • Problem solving
    • Attention, focus
    • Other behaviors

No. That is not true. Why are people saying that? A study came out in 1998 by Andrew Wakefield that tried to link behavioral concerns like Autism to the MMR vaccine. It was a poor study that used an extremely small sample size of 12 children. There was a conflict of interest with his involvement in a lawsuit that targeted vaccine companies. He also tried to change the results of the study so that it showed what he wanted it to show.

There were many studies after this study came out that investigated whether MMR caused Autism. Over and over, these studies did not prove that MMR caused autism. It was retracted due to misinformation and it being a poor study. If you want a link or copy of that article at any time, I will be happy to send you the link. Know that Andrew Wakefield lost his license to practice medicine for disseminating this false information.

We still don’t know what exactly causes Autism, whether it’s genetic, environmental, or a complex combination of both, but there are many scientists and physicians that are working hard to answer this important question.

If you are concerned at any time that your child may have Autism, please give us a call. We will be more than happy to see your keiki in the clinic. Again, NEVER be ashamed of anything. As mentioned before, our goal is to get rid of the stigma and instead help your keiki be the best they can be. The earlier we give them resources, the better able they’ll be to reach their full potential. We will work together for the best possible outcome!

Please enjoy your holidays. Take care and stay safe.


Dr. Honda & Your Keānuenue ‘Ohana.

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Dental Health Sat, 12 Dec 2020 19:39:16 +0000

Can’t believe it’s mid-December!

Just a few more weeks left in this wild year, and we wanted to wish you all a very happy holiday season. At least during this time, even though it doesn’t look like a typical Christmas season, we have reason to hope for better in 2021 and reflect on the ups and downs of the past year.

One milestone we celebrated this week at Keānuenue Pediatrics is our office blessing, which was meant to honor and prepare our space and our team to serve Hawaiʻi’s keiki with aloha and a clear vision of service. It was amazing … see the highlights below!!

Before we get to that, I wanted to talk about a subject that’s important to me: oral health. I love teeth, and maybe in another life I’d be a dentist 🙂 But for now, I get to help empower you to take the best care of your child’s teeth.

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Why are teeth important?

While an infant’s gummy smile is adorbs, without teeth, older children can have challenges speaking, eating, and, of course, smiling with confidence. In fact, children, adolescents, and adults with poor dentition (rotting teeth, missing teeth, visible cavities) have lower self-confidence and a harder time interacting social and advancing in their careers. Not to mention, cavities and invasive dental work are pretty painful (and expensive!). The good news: it’s all preventable.

When do teeth come in?
Here are some helpful charts to give you an idea of when to expect teeth to the come in for most children. See the American Dental Association website for more information.

Most children need our help brushing and flossing until they’re about 6 or 7 years old. They don’t have the dexterity to the best job, especially in harder to reach places. So, we’re in it for the long haul and might as well do it right!

How can I take the best care of my child’s teeth?

For Babies

  • Wipe down gums twice a day with warm water and a soft cloth
  • When teeth come in, usually between 6-12 months, start brushing with a grain size amount of fluoride toothpaste and water on a soft bristle toothbrush twice a day.
  • Take your child to their first dental visit by 12 months old
  • Introduce a sippy cup as soon as your child can sit up on their own
  • Avoid juice and other sugary drinks

For Children

  • Brush 2x/day with fluoride toothpaste (size of a pea). Aim for 2 minutes in the day and night (yes, 2 minutes is forever … just try your best)
  • Watch your child brush until age 6 and make sure they spit out extra toothpaste.
  • You may need to help your child brush until they develop good brushing skills.
Photo credit:
Even starting with pregnancy, good dental health in mom can improve dental health in your baby, so floss daily and brush 2x/day.What about toddlers or fighters?

It can be challenging to get toddlers to buy in to the importance of toothbrushing, but the key (as with most things toddler-related) is consistency and routine. Do it twice a day, no matter what, even if your child resists.

I’ve had success sitting on the ground with my legs extended forward and laying my daughter on my legs upside down with her head on my lap and her feet by my feet. This gives me a great view of her mouth as I look down, and if she squirms away, the ground is just a few inches away so she won’t get hurt. Eventually, if you persist in making brushing a routine event, then your child will start to ease up on their fight.

If you have any questions about your child’s oral health, don’t hesitate to reach out to our office for help and advice. If you need finding a dental home for your child, we recommend a pediatric dentist that has lots of experience working with little ones. You can find a board-certified pediatric dentist in your area at If you live close to our office, the Pediatric Dental Group is located across the street and takes care of many of our patients’ lovely smiles.

Here are a few highlights from our blessing!

Our office blessing was performed by Kahu Kordell Kekoa, who Alyssa and I both met when we were 12 years old at Kamehameha Schools (of course, we were NOT 12 years old at the same time!), where he was our chaplain.

He shared so many words of wisdom and encouragement during his remarks, and with his powerful oli he cleared our new space of any past problems, prepared our office to receive all of our patients and families as well as their hopes and dreams, and granted us the energy and vision to best serve the keiki of Hawaiʻi. Here are some photos from our special day!

Mahalo to Dr. Honda for organizing the blessing, to our amazing team, and, as always, to our patients for your support!!

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Vaccines Sun, 06 Dec 2020 19:32:18 +0000

Aloha everyone!

Can you believe it’s already December?! Time sure does fly by. I love seeing all the lights while driving down the street. It really boosts my morale. So awesome.

Anyway, Dr. Honda here, and with all this talk about a COVID vaccine coming out soon, I wanted to take a moment to talk about vaccines in general and give an update on the COVID vaccine.

For those of you already registered with our clinic, you know that one of our requirements to be a part of our clinic is that we require our patients to be vaccinated. It’s one of those things that we as Pediatricians strongly believe in. We are always happy to discuss vaccines in more detail for those who may be hesitant prior to registering to become a patient at our clinic. Remember, we want you to choose a Pediatrician that’s the right fit for you and your family.

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Here we go!

Okay now, let’s educate or re-educate about vaccinations! First things first, I know it seems like there are a TON of vaccines for your child. I mean it seems like every time your keiki comes in to the doctor’s office after birth, they get a shot. I wish I could say it wasn’t so, but it’s kind of true…at least up to the 2 year old visit, then it spaces out more. Only the 9 month check-up (if otherwise caught up) is when they have a little bit of a break during the first year. Below is a copy of the vaccine schedule. We also included it at the end of our personalized baby book! Check it out if you already received one!

Here is a good visual from the CDC of the vaccine schedule…give or take. Some need to catch up on their vaccinations, so their schedules may look a little different. We also do our best to provide shots with combinations to prevent multiple pokes. For example, we could give DTaP, IPV, and HiB all in one. Therefore, it’s one shot instead of 3 shots.

What different diseases do vaccines protect against?

As you can see in the vaccine schedule above, there are many diseases that vaccines protect against! The newsletter would be WAYYY too long if we discussed each disease. BUT if you have a specific question about one of the vaccines or would like to know more about the disease, message us! We would be happy to discuss more. Here’s the list!

  • Diphtheria
  • Tetanus
  • Pertussis
  • Polio
  • Haemophilus Influenzae Type B
  • Hepatitis A
  • Hepatitis B
  • Measles
  • Mumps
  • Rubella
  • Varicella
  • Pneumococcal
  • HPV (Human Papilloma Virus)
  • Meningococcal
  • Rotavirus
  • Influenza

Why are there so many doses of the same vaccine?

If you looked at the the chart above, you’ll notice that the same vaccine is given multiple times. Why is that? Sometimes it takes more than one dose (for example 5 with DTaP) to allow the body to develop the right immune response. Ya but my grandma and great grandma didn’t have to receive this many vaccines. You’re right. That’s partially true. For example, here’s a list of the diseases that were covered by vaccines in the late 1940s

  • Smallpox
  • Diphtheria
  • Tetanus
  • Pertussis

Now, go back to the prior list. WOW. What a difference, huh? Luckily, medicine has advanced to protect your keiki against so many diseases.

Also notice that smallpox is no longer on the list. It’s considered eliminated since it’s eradicated WORLDWIDE. Like there have been ZERO cases since the 1980s. So amazing!

So, we have a vaccine … everyone’s protected, right?

No, not quite. I think many of you have heard of herd immunity. What this means is that you protect others that aren’t immunized once a certain percentage of the population is protected. See the images below!

To learn more about herd-immunity:

How are different vaccines classified?

To simplify it, there are inactivated vaccines, attenuated live vaccines, and other (subunit, polysaccharide, recombinant, conjugate and toxoid).

  • In the inactivated vaccinethe virus is killed.
    • Examples of inactivated vaccines are the hep A, polio and influenza
  • In live attenuate vaccines, the virus is weakened to the point that it will not cause the same infection as the wild virus, but it elicits enough of an immune response to develop immunity
    • Examples of live vaccines are the measles, mumps and rubella vaccine, varicella, and rotavirus.
  • Subunits, polysaccharide, recombinant, conjugate, and toxoid. (I know. A lot of big science words). But these are vaccines that only contain pieces of the bacteria or virus in order to provide an immune response.
    • Examples include HiB, Hepatitis B, HPV, pertussis, PCV (pneumococcal), meningococcal (meningitis), tetanus

COVID-19 Vaccine Update

Okay now that we have some background information on vaccines, I wanted to take some time to discuss where we are with the COVID-19 vaccine. Most of the news is focusing on Pfizer and BioNTech, so we will focus on that discussion. Moderna is the other company studying the vaccine.

Big takeaways

  • This was a randomized, placebo-controlled, double-blinded study. These are the key words you want to hear in a study. This helps to make sure that the study prevents as much bias as possible.
  • It’s a mRNA vaccine that targets one of the COVID-19 proteins
  • It’s a 2-dose series 21 days apart
  • The vaccine started to include children as young as 12 years old

The vaccine efficacy was noted to be 90% and then later noted to be 95%. The Moderna vaccine had an efficacy of 95%. What does that mean?

The efficacy is the risk reduction of getting COVID in those who are vaccinated compared to those who are not. So, by having a 95% efficacy, those who are vaccinated will have a 95% reduced risk of getting COVID compared to those who do not get the vaccine.

To put this into perspective, here are some numbers of vaccine efficacy for common vaccinations.

  • Measles: 93% after the first dose, 97% after the second dose.
  • Polio: 90% after 2 doses, >99% after 3 doses.
  • Yearly flu shot: 40-60%

But what about the keiki?!

Only recently (October-November) has Pfizer started enrolling children as young as 12 years old in their studies. Moderna is planning to do the same. The data for this age group may take a while before we understand the efficacy of the vaccine for children. Eventually, studies will include those even younger but that also takes time. Small doses, careful observation. This is a must. The right data needs to be produced before considering the vaccine safe in these age groups. As this can take time, the American Academy of Pediatrics is pushing for children to be included in the vaccine trials so that we may know sooner rather than later whether the vaccine is safe.

Going back to herd immunity, how much of the population needs to be vaccinated?

This is hard to predict, but in an article by Omer et al., they predicted that approximately 50-67% of the population would need to be vaccinated. Others are saying 70%. There’s still so much to learn about this virus!

Omer SB, Yildirim I, Forman HP. Herd Immunity and Implications for SARS-CoV-2 Control. JAMA. 2020;324(20):2095–2096. doi:10.1001/jama.2020.20892

How long will I be immune once I receive the vaccine?

We still don’t know that information. But with time, research will help guide us! We’re not sure if repeat immunization will be needed or if this first series of vaccination will be sufficient.

So, in a nut shell, vaccines are important to us because it protects us against dangerous diseases. There’s still a lot we didn’t discuss in this newsletter such as what to look out for after vaccination, when is vaccination not appropriate, which diseases need additional types of vaccinations, etc. COVID-19 vaccination has very promising data but unfortunately, not much with children…yet.

As always, call or message us if you have a question regarding vaccination and your keiki. We are here for you.


Your Keānuenue ‘Ohana

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