- Pediatric Care: The First Line of Defense coming up next on "Call the Doctor."

(upbeat music) - [Narrator] The region's premier medical information program, "Call the Doctor."

- [Narrator] In 2019, over 3.8 million babies were born in the United States.

The American Academy of Pediatrics recommends infants, children, and adolescents be under pediatric care up to the age of 21.

The goals of pediatrics are to reduce the rate of deaths of infants and children, control the spread of infectious disease, promote healthy lifestyles and help ease the problems of chronic medical conditions in infants and children.

Pediatrics is concerned not only about immediate management but also long-term effects on quality of life.

Treating a child is not like treating an adult.

The smaller body of an infant or a child is much different physiologically.

Pediatricians take this under consideration when evaluating symptoms, prescribing medication, and diagnosing an illness.

Some of the many tasks of a pediatrician is to prescribe or administer treatments, therapies, medication and vaccinations, to treat or prevent illness such as chicken pox, measles, mumps, and whooping cough.

Pediatricians serve as an integral part in the prevention, early detection and management of problems including behavioral problems, functional disabilities, mental disorders, as well as advising parents on diet and the overall health of their children.

Learn more about Pediatric Care: the First Line of Defense now on "Call the Doctor."

- Pediatric Care: the First Line of Defense.

Welcome to "Call the Doctor" here on WVIA.

I'm Paola Giangiacomo.

Tonight our topic is pediatric care and joining us on the panel, Dr. Alexies Samonte.

She's a board certified pediatrician and primary care physician at the Wright Center for Community Health.

Dr. Geralyn Cross is a board certified pediatrician practicing primary pediatrics at PAK Pediatrics, and Lynn Dunay-Matysczak, she is a pediatric occupational therapist at Allied Services' Wilkes-Barre Pediatric Rehab Center.

And I would like to remind our viewers that you can participate in the conversation at wvia.org/ctd.

You can also submit your questions for future shows by emailing ctd@wvia.org or using the hashtag WVIA CTD.

And be sure to check our website for a listing of future programs and watch "Call the Doctor" episodes any time on the WVIA app.

Now we'll begin our discussion.

Thank you all for joining us for this episode of "Call the Doctor."

I want to start you Dr. Cross.

What is the difference between a pediatrician and a general practitioner?

- So, a pediatrician is specifically trained in the care of children and infants all the way up until young adulthood and they do have different medical problems and different things that have to be watched for in contrast to an adult.

That's very different, so I know a lot of people like to say children are just little adults but they really aren't.

There's a lot more care that goes into them.

- And up until what age does a child need to see the pediatrician?

- It does vary based on your pediatrician and their specific preference.

A lot of times they'll go up to college age, about 22.

Sometimes we have patients that have chronic medical problems that would benefit from transitioning to adult care a little sooner, but overall, most of our patients will stay with us until about 22.

- Now Lynn, you're an occupational therapist.

So, when would a child need your services?

And what kinds of services would you provide?

- We take children from birth all the way up to usually 21.

It depends on their diagnosis and what they would need the therapies for.

We provide OT, PT, and speech services here.

So, our physical therapists get a lot of the babies who may have torticollis or if someone has a developmental disability or a physical disability to start with, we usually see them early but our services range all the way through depending on their diagnosis.

- So, if a pediatrician notices some cognitive issues or sensory issues, they would, that pediatrician would recommend you?

- Correct.

A pediatrician will, you know, follow the child if they notice anything is delayed or off a little bit, they will definitely recommend an OT, PT, or a speech eval.

And we will see them here and evaluate them.

Like I said, anywhere from birth to 21 depending on what the doctor recommends.

- Okay.

Now, since the onset of the coronavirus pandemic, Dr. Samonte have you noticed anything different in your practice?

- Yes.

So, after the initial COVID in March, there was a decrease in the number of patients coming in for well visits because they are afraid to go to the pediatrician.

So, actually the Academy of Pediatrics had that call your pediatrician campaign where they say that it's safe to go back to your pediatrician, call your pediatrician, and allow the pediatrician to see your child for vaccination and for well visit.

- Yeah, Dr. Cross, why are well visits so important?

Or why is it important to not skip a well visit?

- So, even if your child's not getting a vaccination at that scheduled well visit, there's a lot of things that go into what we do at each of these well-child visits.

We address any concerns a parent has, we look at their growth and development, talk about nutrition and sleep.

And it really is a way for us to catch problems or things that may not be very apparent to the family yet but maybe evident in other places, like if they're having issues falling off the growth chart, they're having issues sleeping, it kind of give us an idea if something really is going on that we're not aware of.

- And since the start of the pandemic, how is the coronavirus affecting children?

Or is it affecting children differently than it's affecting adults, Dr. Cross?

- Yes, fortunately from what we've been seeing, children seem to not be as severely affected.

They still are contracting COVID but they are not getting nearly as sick as our adult patients, meaning they're not needing the ICU level care that a lot of our adult patients are needing.

So we're very fortunate in that aspect but they still can contract it.

They may have more mild symptoms but they can also spread it.

So, we still have to be aware that children shouldn't be, you know, not thought during this pandemic.

- So, are the symptoms, Dr. Samonte, of COVID the same in children as they are in adults?

When should a parent contact the pediatrician if the parent notices symptoms in the child?

- So, the symptoms for COVID is just the same as what for the adults would be for in children.

There are cases where it's actually just as if you just have a cold or the flu so it can mimic any other illnesses.

So, there's a condition it's called M-I-S-C where it's a multi inflammatory syndrome in children where they actually had COVID earlier on and then in three weeks or so they will have that manifestation.

Like you would think back, "Oh this child probably had COVID earlier on."

So, if your child has had fever for three days, you probably should bring your child to the doctor.

- And they, that, the children can get tested, obviously for COVID.

So, you're saying that there are long-term health effects in kids if they can track COVID?

Or in some kids?

- In some kids, yes.

They can present, like sometimes there could also be like heart problems.

I don't want to scare people.

Right?

- Right.

- But that has been- - It's scary.

- Yes.

- Well, initially were there reports, Dr. Cross, that kids weren't getting it, you know, as much as adults, but now has that kind of reversed where kids are just as likely as adults to contract COVID?

Right, Dr. Cross?

- I think part of the issue with that is that we know children are exhibiting more mild symptoms.

So, they may not have come to the presentation in front of the doctor.

They may not have gotten tested early on.

So, the numbers may be an underestimate of how many children truly have contracted it.

- And Lynn, are you seeing any changes in your office since the onset of the pandemic with people avoiding coming to the office?

- We've been pretty, we've set up some protocols and stuff.

So, our children are masked.

We are masked all the time.

Everything is thoroughly cleaned in between each one.

So, there were certain issues at first, but everybody has seemed to kind of be pretty confident about it.

And parents have been truly, you know, if there's any sign of illness, they don't come in.

So, there's been some change in some status of it.

But overall, I think we're all compensating pretty well.

- Can you do tele-health?

- We have.

We've added tele-health to our services.

So if we feel and the doctor feels it's appropriate, we will handle it that way if at all possible.

- Okay.

So, there is the COVID vaccine.

But it's not yet available for kids.

Is that right?

Dr. Samonte?

- Yes.

So, the Pfizer vaccine can be given 16 years and older and then the Moderna is 18 years and older.

So, like older kids.

- Older kids, like not, no kid younger than 16.

- 16, yes.

- So Dr. Cross, do we know if a vaccine will be available for children in the near future?

- I think part of this is having children included in the clinical trials which there's not a large amount as far as I'm aware of children in the trials as of yet but the American Academy of Pediatrics certainly does recommend children being included in these trials.

And I think once we have more data for a younger population, we may see those recommendations on ages change.

- Okay, and Dr. Samonte, are kids with underlying conditions like respiratory issues or asthma, are they more at risk for contracting COVID?

- Not higher risk, but if they get it, they probably will get it like much worse because of their underlying respiratory condition.

- Okay.

Okay.

So again, if parents notice symptoms, they should definitely call the office right away?

- Mm-hmm.

- Okay.

And the vaccine, the COVID vaccine for children not yet available for 16 and under but there are many other vaccines that children have to follow according to CDC guidelines.

- Yes.

- Do you know why there are so many more vaccines today for kids than in the 1980s?

- Because we know more, right?

Like they're able to get more vaccines on board so that we don't have to worry about those illnesses.

Actually, for the first two years of life, there are only probably two visits where your child will not have any vaccines.

So, the first two years, just expect that your child will have multiple vaccinations.

- Well, there's many more diseases nowadays, - [Alexies] Included, yes.

- Do you think kids will need a COVID vaccine to go to school?

If and when one is developed for elementary aged kids?

- In the U.S, I don't think they would mandate because remember, like even the regular vaccines are not mandated.

So, we don't know.

I don't know.

- Yeah.

And how do you deal with parents who are anti-vaxxers or who want to space out vaccines?

Are you, do you support that?

- I used to think that, "Okay, I'm not going to see you "because you're not giving vaccines to your child" but that's a disservice to the child.

We need to be advocates for the children.

And what I've found out in my experience is that if you talk to the parents, it's an ongoing, you know, thinking and like you, they tell you why they feel not so good about giving the vaccines.

And if you have an open conversation and you get, engage the parents, actually, they actually change their mind.

- You can change their mind?

- Yeah.

(Paola and Alexies laugh) Not, probably not on that visit, but on the follow-up visit.

And studies have shown that about 60% of parents who say no to the vaccines but if the pediatrician or the caregiver like recommend it strongly, they will agree to the vaccine.

- Okay, and Dr. Cross, if children, and parents, or if children specifically are feeling anxiety, anxious, or depressed because of the pandemic and what they can't do and not being able to go to school or see their friends, how do you help those families cope during this time?

- We certainly are seeing an increase in the need for mental health services for our patients, both our patients that have had a history of mental health problems and patients who have not.

So, it really is a discussion with your provider and your child's pediatrician to see, is this just a direct result of COVID, is there something underlying that needs be managed?

Because we certainly can have our patients involved with mental health specialist that they may need that at this point in time.

- And Lynn, are you seeing any patients who are having an effect from the pandemic on them?

Like maybe some autistic patients or the ones with sensory issues?

Have you noticed anything?

- Yes, definitely.

Our autistic population has really, it's been, it's been tough adjusting.

Some of them easier than others.

However, again, I think from the lack of structure and the lack of just the services that they get provided in the school and the lack of them sometimes is really effecting some of their behaviors and that sort.

So, we've been really focusing a lot on that.

- The HPV vaccine, Dr. Cross, is that something, it's a fairly new vaccine, wouldn't you say?

And is it one that you recommend or is it a vaccine that has side effects that aren't totally understood yet?

- So, as far as vaccines go, I guess you can call it a relatively new one.

You know, it's definitely been out for more than a decade.

As far as recommendation, I absolutely recommend it to all my patients both male and female, because we know that HPV related cancers are not just in women, they also affect men as you get older.

And it's about having a conversation with your provider about your concerns with that.

As far as side effects, they're very similar to side effects we see with any other vaccine, injection site pain, fatigue, maybe headache, all things that are very manageable but if there is concern, then absolutely speak with your pediatrician about the HPV vaccine.

- And when it comes to diet, whether they're young kids or adolescents or teenagers, we know a lot of kids are picky eaters.

What do you think is an important diet for kids and how do you help parents deal with picky eaters, Dr. Samonte?

- So picky eater, actually, there's a diagnosed picky eater, right (laughs)?

- It's a diagnosis?

- A diagnosis, picky eater.

- I'm not surprised.

- So, there is like at age one to two, they are really picky.

So, you have to choose your battles, right?

Whatever, if you say, "You have to eat this," that's not, that's not going to happen.

So, you just have to make sure that you offer like fruits and vegetables.

If he does, if the child doesn't eat it at that, fine, then maybe the next meal, you would do that.

- Okay.

- And don't be too strict or else, you know, it will be a problem.

- Right, but how important is diet and proper foods for children, Dr. Cross, in terms of, you know, growing up healthy and to prevent other ailments in the future?

- Oh, it's huge.

We talk about it at every single well-child visit from infant to young adult and you have to be able to get them certain vitamins, nutrients, minerals, in your diet to help promote healthy growth, healthy growth of brains, brain, bones, muscle, the entire body really.

So, when you have patients that have, you know, difficulty eating, then we really take that seriously and address it with them.

- And Lynn, as an occupational therapist, are there patients with, who have issues with food, whether it's texture, taste, sight?

- Yes, we actually have a picky eater program here in which we see many kids who have sensory issues and autism, but others as well who just are picky eaters.

And we have a program here that we run through.

Obviously now with the COVID, it's been a little harder to access all these patients just because it's hard to watch them eat when everybody's masked.

So, we've been a little bit more strained on that but we do address those issues and it's a fairly common problem.

- Do you also address sleep issues with children or toddlers who have a hard time staying in their bed at night?

- If it's a sensory deficit or a sensory issue, yes, we will.

Occupational therapists usually create what we call a sensory diet and it obviously has nothing to do with food.

It has to do with sensory programming and sensory activities.

So, a lot of times kids who have trouble staying in their bed will have a sensory issue.

And it can be a simple recommendation of changing the sheet to a neoprene sheet that provides pressure or a weighted blanket, which they're very popular now, to just exercises to do before or after bath time to try to calm them and try to work on the sleep patterns.

So, we do address some of that with sensory issues.

Yes.

- I wouldn't think that an occupational therapist would address that kind of an issue.

And it's surprising to, to actually hear that that you do.

So, what other tips do you have for struggling parents out there who have children who can't sleep or who don't want to go to the bathroom?

When, you know, when they're potty training, I mean, it seems like you actually deal with a lot of those issues.

- We do.

You'd be surprised.

A lot of kids with sensory issues have all of those issues.

So, we have discussed many pottying issues and done routines and try, it depends on the child too.

There are certain things where you wouldn't think but a sensory child may be afraid of the sound of a toilet flushing which is what promotes them not to use the bathroom.

Or I had a child once who was scared when the toilet flushed and watched what went down the toilet and he was afraid he was to go with it.

So, it's a matter of breaking down little things and finding about what part of the task is difficult for them and how we change it.

Or can we add something to calm it down?

Such as, you know, a lavender bath or, you know, we work closely with the doctor.

Sometimes doctors recommend melatonin, you know, different things like that, but those are the issues.

Again, we surprisingly address those too.

- So, how long do you have to work with a child to overcome these issues or do they extend into adolescent years and even adulthood?

- It's very child-based.

Everything is individual based.

So, depending, we have kids that come in with mild sensory deficits and we can overcome them quickly.

And there's other kids, especially kids on the spectrum who have way more deficits that we need to, you know, constantly work out, iron out, and change that diet as needed for the kids.

- Dr. Samonte, are there any chronic conditions that are prevalent among children?

- What we see usually like asthma, allergies, constipation (laughs).

Constipation is a big thing because I think their diet is a mess, yeah.

- Their diet.

They need more fiber.

- Yeah.

- And then you would refer them to a specialist?

- If the pediatrician cannot handle it, like initial things that we can recommend then we would refer them to a GI doctor.

- With asthma, isn't it difficult to detect whether the child actually has asthma because of the testing?

- For the, yeah, for the younger kids you cannot really do the testing because they don't know how to blow on the tube forcefully.

So, you will do it clinically.

So like, based upon your evaluation, you probably have asthma and then you would try the medication and if they improve, you probably have that diagnosis.

- Oh, okay.

So it's like through question and answer.

- [Alexies] And then trial of medication.

- Okay.

Okay.

And what about vitamins for children, Dr. Cross?

Do you recommend those and what kind?

- So, in our practice here, we often give children a multivitamin fluoride because not all the water in our area's fluorinated so, to promote healthy teeth, we do offer that and children who are particularly picky with what they're eating.

If they're not getting the recommended vitamins and minerals, then we do often recommend just a standard multivitamin, nothing fancy.

Sometimes it can be prescribed but over the counter are okay as well.

It is different for infants.

All infants up to a certain age will need vitamin D which your doctor will talk to you about.

But generally yes, we do recommend vitamins in certain children.

- And in addition to vitamins, you also recommend to your patients to make sure they see a dentist and an eye doctor?

- Yes, absolutely.

We love our local dentists and eye doctors.

We could not practice without them.

We check, depending on the age of the child, we will recommend dental visit at certain ages.

And then eye visits as well, we do our own screening at certain ages in the office, but if things, if concerns come up or there's an abnormality with our screening, then we will very quickly refer to an eye doctor for additional help.

- And are there any injuries or ailments that you see that are more common nowadays, now in the winter time, as opposed to other times of the year?

- I think COVID because they're so, they're just at home.

Kids do a lot of things that, you know, makes them more prone to have injuries.

And sometimes they're afraid to go to the ER.

So they would have to call the pediatrician and they can manage probably by tele or like confirm that they can come to the clinic safely.

- Okay.

Okay.

Well, thank you.

This was all very good information.

Once again, I would like to thank our panelists for participating in our discussion on pediatric care.

For more information and resources on this topic, visit wvia.org/ctd.

I'm Paola Giangiacomo for "Call the Doctor."

Thank you for watching.

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