Hour Change For Dr. Betancourt

We wanted to inform you that Dr. Betancourt's hours have changed. She will only be seeing patients from 9:00am to 1:00pm.

She will have a limited amount of appointment slots at 8:15 am for those parents that wish to be seen before work or school. 
The 8:15am appointment slot is outside of the normal schedule. If you are interested in this time slot, you'll need to call several days prior to your appointment and schedule it in advance. 
Dr. Graba and our Nurse Practitioner Marciann will continue to work our standard office hours. Saturday appointments will also remain the way they've alway been ( 9-to 1pm). Providers alternate Saturday appointments. 
And as always, thank you all so much for entrusting the healthcare of your child. We consider it an honor to partner with you to help your child reach his/her full potential.

How to Measure Medicine For Your Child Correctly

From the website:

Medicines can be helpful for a child’s health. But if they’re given in the wrong dose or at the wrong time, they can actually be harmful. Here’s how to give medicine to your child with confidence!


14 Ways to Show Love for Your Child This Valentine's Day

I found this list today. At first I thought, do parents really need to be reminded to show their love towards their children. I mean, I love them every single moment of every single day. But then I thought, how often do I show them? And is it enough?

Some of these may be silly, others not practical to your situation. Others are obvious. But that is OK. The important thing here is to remember  to show love to our children every single moment we can whether these tips are useful or not to you.

Use plenty of positive words with your child. Try to avoid using sarcasm with your child. They often don’t understand it, and if they do, it creates a negative interaction.


Respond promptly and lovingly to your child's physical and emotional needs and banish put-downs from your parenting vocabulary.

  • Make an extra effort to set a good example at home and in public. Use words like "I'm sorry," "please," and "thank you."
  • When your child is angry, argumentative or in a bad mood, give him a hug, cuddle, pat, secret sign or other gesture of affection he favors and then talk with him about it when he’s feeling better.

  • Use non-violent forms of discipline. Parents should institute both rewards and restrictions many years before adolescence to help prevent trouble during the teenage years. Allowing children of any age to constantly break important rules without being disciplined only encourages more rule violations.
  • Make plans to spend time alone with your young child or teen doing something she enjoys. Mark family game nights on your calendar so the entire family can be together. Put a different family member's name under each date, and have that person choose which game will be played that evening.

    Owning a pet can make children, especially those with chronic illnesses and disabilities, feel better by stimulating physical activity, enhancing their overall attitude, and offering constant companionship. One of the best ways to familiarize your child with good food choices is to encourage him to cook with you. Let him get involved in the entire process, from planning the menus to shopping for ingredients to the actual food preparation and its serving. It is wonderful when families eat together as much as possible. Good food, good conversations. As your child grows up, she'll spend most of her time developing and refining a variety of skills and abilities in all areas of her life. You should help her as much as possible by encouraging her and providing the equipment and instruction she needs.

  • Your child's health depends significantly on the care and guidance you offer during his early years. By taking your child to the doctor regularly for consultations, keeping him safe from accidents, providing a nutritious diet, and encouraging exercise throughout childhood, you help protect and strengthen his body.
  • Help your child foster positive relationships with friends, siblings and members of the community.
  • One of your most important gifts as a parent is to help your child develop self-esteem. Your child needs your steady support and encouragement to discover his strengths. He needs you to believe in him as he learns to believe in himself. Loving him, spending time with him, listening to him and praising his accomplishments are all part of this process.
  • Don't forget to say, "I love you" to children of all ages!
  • Wednesday

    The Pediatrician, Urgent Care or ER, Which One is the Best Choice if My Child Has a Cold?


    Today, we have Dr Kristen Stuppy as our guest blogger. Dr. Stuppy is a practicing pediatrician in Kansas. She feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.  

    In this post, she answers a common question among parents - My child has a cold, should I take her to the ER, urgent care or the pediatrician. 

    As cold and flu season approaches, I have been thinking about how our kids are managed when they become sick. Not only what we do to treat symptoms, but how, when, and where patients get medical advice and care.

    We are a busy society. We want things done now. Quickly. Cheaply. Correctly. Resolution so we can get back to life.

    Illness doesn’t work that way. Most childhood illnesses are viruses and they take a few weeks to resolve. There’s no magic medicine that will make it better.

    Please don’t ask for an antibiotic to prevent the runny nose from developing into a cough or ear infection.

    Don’t ask for an antibiotic because your child has had a fever for 3 days and you need to go back to work.

    Don’t ask for an antibiotic because your teen has a big test or tournament coming up and has an awful cough.

    Antibiotics simply don’t work for viruses. They also carry risks, which are not worth taking when the antibiotic isn’t needed in the first place.

    Urgent Cares are not always the best choice

    Many parents in this community have grown accustomed to using after hour urgent cares because they are convenient.

    Convenient isn’t always the best choice. Many times kids go to an urgent care after hours for issues that could wait and be managed during normal business hours. I know some of this is due to parents trying to avoid missing work or kids missing school, but is this needed? Can it hurt?

    Some kids will get unnecessary tests, xrays, and treatments at urgent cares that don’t have a reliable means of follow up. They attempt to decrease risk often by erring with over treating. Our office does have the ability to follow up with you in the near future, so we don’t have to over treat.

    Urgent cares don’t have a child’s history available.

    They might choose an inappropriate antibiotic due to allergy or recent use (making that antibiotic more likely less effective). They might not recognize if your child doesn’t have certain immunizations or if they do have a chronic condition, therefore leaving your child open to illnesses not expected at their age.

    We know that parents can and should tell all providers these things, but our own new patient information sheets are often erroneous when compared to the transferred records from the previous physician… parents don’t think about the wheezing history or the surgery 5 years ago every visit. It is so important to have old records!

    To treat or not to treat?

    There is some evidence that treating things too soon does not allow our bodies to make immunity against the germ. A great example of this is Strep throat. Years ago we would go to a doctor when our sore throat didn’t get better after a few days.

    They would swab our throat and send the swab for culture, which took 2 days. We would treat only after that culture was positive. That delay in treatment allowed our bodies to recognize the Strep and begin making antibodies against it.

    Now kids are brought in the day they have symptoms, and if the rapid test is positive, they immediately start antibiotics. The benefit? They are less likely to spread Strep to others and they can return to school 24 hrs after starting the antibiotic.

    The negative? They might be more susceptible to recurrent illness with Strep, so in the end are potentially sick more often and end up missing more school.

    Receiving care at multiple locations

    Receiving care at multiple locations makes it difficult for the medical home to keep track of how often your child is sick. Is it time for further evaluation of immune issues? Is it time to consider ear tubes or a tonsillectomy? If we don’t have proper documentation, these issues might have a delay of recognition.

    Urgent cares and ERs are not always designed for kids

    I’m not talking about cute pictures or smaller exam tables. I’m talking about the experience of the provider. If they are trained mostly to treat adults, they might be less comfortable with kids. They often order more tests, xrays, and inappropriate treatments due to their inexperience.

    This increases cost as well as risk to your child. We have been fortunate to have many urgent cares available after hours that are designed specifically for kids, which does help. But this is sometimes for convenience, not for the best medical care.

    What About Cost?

    As previously mentioned, cost is a factor. I hate to bring money into the equation when it comes to the health of your child, but it is important. Healthcare spending is spiraling out of control. Urgent cares and ERs charge more. This cost is increasingly being passed on to consumers.

    Your co pay is probably higher outside the medical home. The percentage of the visit you must pay is often higher. If you pay out of pocket until your deductible is met, this can be a substantial difference in cost. (Not to mention they tend to order more tests and treatments, each with additional costs.)

    So what kinds of issues are appropriate for various types of visits?

    (note: I can’t list every medical problem, parental decisions must be made for individual situations)

    After hours urgent care or ER:
    • Difficulty breathing (not just noisy congestion or cough)
    • Dehydration
    • Injury
    • Pain that is not controlled with over the counter medicines
    • Severe abdominal pain
    • Fever >100.4 rectally if under 3 months of age
    Your Primary Care Pediatrician Visit:
    • Fever
    • Ear ache
    • Fussiness
    • Cough
    • Sore throat
    • Vomiting and/or diarrhea
    • Any new illness
    Issues better addressed with an Appointment in the Medical Home:
    • Follow up of any issue (ear infection, asthma, constipation) unless suddenly worse, then see above
    • Chronic (long term) concerns (growth, constipation, acne, headaches)
    • Behavioral issues
    • Well visits and sports physicals (insurance counts these as the same, and limits to once/year)
    • Immunizations – ideally done at medical home so records remain complete

    If your child gets a vaccine at any other location, please send us documentation (including the date, brand, lot number, and place administered) so we can keep the records complete.

    Remember your pediatrician’s website might offer trusted answers to questions and many treatments to try at home for various illnesses and conditions! Be careful of surfing for answers though… the internet is full of bad advice! Go only to trusted sources (such as your doctor’s website or




    Waiting and Waiting to see the Doctor, Why?

    Written by: Herschel Lessin MD
    Recently I had a frank conversation with a mom who told me “I have been dying to ask a doctor this question for years and I think you might be able to give me a reasonable answer, so here it goes:  Why do I have to wait so long to see the doctor? Is there any good reason? A patient’s time is valuable too! 


    During my 30 years of practice, Our office has been trying our best to remedy this chronic problem with some degree of success, but some degree of failure as well.  

    As I thought about the question, I realized that it has a multitude of answers and explanations, as anyone who has ever worked in a medical office realizes.  When I run behind schedule, it makes me absolutely crazy.  The patients are angry, the staff is harried and I hate feeling rushed.. Here are just a few of the factors, which add up to a most difficult problem:

    1.  Unpredictability - When I walk into a room to see a child, I have no idea whether that child will have a minor illness or a major problem.  Most kids are healthy, but when they are sick, they are often VERY sick.  

    All it takes is one of these complex patients to completely disrupt a patient schedule.  It is not like you can tell a family that you don’t have enough time to admit their child to the hospital today.

    2.  Seasonality - If you come in the middle of winter, there are going to be lots and lots of sick kids.  We rarely, if ever, refuse to see a sick child on a same day basis. While we leave open many slots for same day calls, and are open until 9 pm every night, if it is winter, it will be busier and you may have to wait longer.  

    If you come in the summer months, it seems every child in the universe needs a physical for camp or school.  Certain laws and misguided insurance company policies make this problem even worse.   If you can do your check up any other time, please do so.

    In summer it will be busy, and you do not want to be told that you cannot have your form filled out because we are completely booked up.  We try to hire more doctors when we seem busier, but when the crunch time comes, we just have to get the job done.  You don’t want your child to be ineligible for sports or miss the first day of school.

    3.  Human nature – This issue applies both to patients and doctors.  Some doctors seem to think that it’s OK if they are late, but not if the patients are late.  Your doctor should show up on time and start on time.  

    But patients are subject to human nature as well.  No one wants to take their child out of school or miss too much work, so I am often sitting around doing nothing from 1-3 pm while it is totally swamped from 3-5 pm. It is kind of like rush hour.  

    If you don’t want rush hour traffic, try to drive some other time.  It is always busier on Mondays and after school than any other times of the week.  If you have an infant, don’t schedule your check up in the late afternoon for the reasons above.  Our office does time and motion studies to try to figure out where the problem lies.  

    We have discovered that a good part of the problem (assuming the doctor is arrives and starts on time) is patients coming 10 minutes early or 10 minutes late.  That doesn’t seem like much, but it has enormous impact on the ability to see patients in a timely fashion.

    This will blow the schedule out of the water and disruption builds as the day goes on. Believe it or not, if everyone actually showed up on time both doctors and patients, things would be a great deal better for everyone.

    So, I ask all of you to try to understand.  Running an office on time is better for patients and their doctors.  Scheduling enough time to discuss the problem is critical.  You cannot expect to have your child’s chronic stomachaches for the past 6 months be properly addressed in a same day sick visit.  

    There is not enough time scheduled.  A good doctor will make you come back and schedule enough time to evaluate your child properly.  Most doctors hate running late as much as their patients do.  If we all could try to understand the above issues and work together a bit better, we would all be much happier.

    Dr. Lessin has been practicing Pediatrician in the Hudson Valley since 1982. He is a founding partner and serves as both Medical Director and Director of Clinical Research at the Children's Medical Group