Updates

By Caren Kirschner, M.D.

Over the last several years, we have been screening all of our adolescent patients for depression with a validated depression screen call the PHQ-9. It is not surprising that a large proportion of our patients screen positive. The rates of pediatric and adolescent depression have been increasing over the last decade. Unfortunately, the pandemic has only intensified this trend.

Our kids are dealing with so many overwhelming stressors, including the deaths of family members or friends, parental job loss/financial strain/poverty, social isolation, and school and extracurricular disruptions. These stressors may trigger depression under certain circumstances.

Depression is a mental health illness that can be no less painful or difficult as many physical illnesses. It affects all aspects of a child’s social, behavioral, educational, and physical well-being and development. And most devastatingly it can be associated with suicide.

The good news is that depression is very treatable.

There are numerous evidence-based studies that show that most kids who are treated effectively can achieve remission. The two evidence-based therapies include psychotherapy and medication. For example, The Treatment of Adolescent and Depression Study (TADS) looked at 439 adolescent aged 12-17 over 12 weeks diagnosed with depression. Those treated with medication and cognitive behavior therapy (CBT) had a 71% recovery rate. The patients treated with medication alone had a 60.6 recovery rate vs CBT alone of 43.2%. The placebo group only had a 34% recovery.

In general, there is a lot of misinformation spread about mental health and its treatments. We understand that parents are concerned about having their children taking certain medications. The truth is that there are excellent studies that have shown that many medications we use to treat depression are safe and extremely effective when prescribed appropriately and in conjunction with psychotherapy.

Both Dr. Flynn and myself have both undergone training at The Reach Institute. This is an organization that serves to give pediatric primary care providers intensive specialized training in the diagnosis and management of mental health care. Please schedule an appointment with us if you have concerns about your child’s mental health so we can work together to get them the care they need.

By Timothy J. Flynn, M.D.

Coronavirus affects people of all ages. Most children who are infected have mild symptoms and recover completely. However, some children can get seriously ill or may have symptoms that persist for a prolonged period of time. For example, loss of taste and smell can persist for months in some cases. Although uncommon, some children will have a feeling of shortness of breath that persists for weeks even after the infection is otherwise gone. 

One area of ongoing investigation is the possibility that COVID-19 may affect the heart, possibly by causing myocarditis, an inflammation of the heart muscle tissue. Certain viruses can cause myocarditis in children. It is possible that COVID-19 affects some children’s heart muscle either by causing myocarditis or some other problem. 

Research into the effects of COVID-19 infection in athletes is still in the early stages; however, based on what is known so far, preliminary guidelines have been created to help medical professionals decide when athletes infected with COVID-19 can return to play. Everyone with a positive COVID-19 test should refrain from exercise for 10 days. Further evaluation is generally not needed for children who had no symptoms or fewer than 4 days of fever. Children who had more serious or prolonged symptoms (including 4 or more days of fever) should see a doctor to discuss if more testing is needed and to create a return-to-play plan.

By Yuliya Bilan Yu, MSN, CRNP

You might be wondering if your child is ready to start potty training or if there’s a “right age.” No two children are alike, and rather than going by chronological age, it is best to look at different signs of readiness, such as being able to:

• follow simple instructions
• understand and use words about using the potty
• make the connection between the urge to pee or poop, and using the potty
• keep a diaper dry for 2 hours or more
• get to the potty, sit on it for enough time, and then get off the potty
• pull down diapers, disposable training pants, or underpants
• show an interest in using the potty or wearing underpants

Most children begin to show these signs between 18 and 24 months of age, but some might not be ready to start until after their second birthday or later. Complete toilet training, that includes both daytime and nighttime dryness, as well as bowel control, might not be achieved until 4 years of age. Meanwhile, the process itself can take anywhere from a few months to over a year, so it is important to be patient and try to maintain a positive attitude.

There are different approaches to potty training, with some parents preferring to keep children in diapers or pull ups in between attempts to use the potty. You can start this method by having your child get his or her diaper changed while sitting on the potty and talking about the experience. While your child sits on the potty, praise him or her or engage in a fun activity, such as singing or reading books together. Your goal is to create a positive association for the potty. So if your toddler is resisting this part or the experience is turning out to be stressful, he or she might not be emotionally ready yet, so it is best to take a break for a few weeks before trying again.

Other parents prefer to discontinue diapers altogether and use cloth training pants or have the child wear real underwear, with the idea that having a sensation of wetness can help increase awareness of urination. In reality, at some point you’ll likely be somewhere in between the two methods. Your choice of an approach largely depends on your family’s preferences and your child’s personality. Regardless of the method of potty training, it is important to never shame your child for having accidents or mishaps, and you should be on the lookout for any possible discomforts that could arise with this change in their routine, such as constipation. A diet with plenty of fluids and fiber, such as fresh fruits and vegetables, will help keep your child regular and make potty training a more positive experience. Another point to keep in mind, is that your child’s feet should be well supported, with knees higher than the potty or toilet, to allow for a comfortable bowel movement.

While potty training might seem like a challenging journey, keep in mind that, as with other skills, your child will one day master it. Should you have any questions or concerns in the time being, we are here to help guide you through the process.

By Caren Kirschner, M.D.

It has been over six months since the COVID-19 pandemic has cruelly hit our community and completely changed all of our lives in both big and small ways. We have all experienced repercussions of this virus in countless ways. The effects have been scary and sometimes devastating.

• Some of our patients have contracted the virus, but thankfully recovered.
• We have had heart-breaking discussions with some of our patients who have lost friends or loved ones way too soon.
• We have had telahealth visits where we have seen sick relatives suffering in the background.
• Some of our parents have lost their jobs or had to resign due to loss of childcare.
• Our patients’ entire educational system has been drastically changed with little planning.
• Our kids have had to forgo so many special events including birthday celebrations, graduations, proms, entire high school sports seasons, plays, dances, musicals, and concerts.

The list goes on and on. And sadly, all of this and the need for our kids to socially distance from not only their friends but also their family members has led to a significant increase in incidences of anxiety and depression.

I believe it is important to acknowledge all of this and outwardly recognize how difficult this pandemic has made life over the last year.

But through all the heartache, we have also been incredibly impressed and humbled by the amazing resilience and fortitude of our patients and their families. We have so many parents who have been the frontline workers keeping us healthy, safe, fed, and functional at their own risk. Just this week, I had a long talk with a parent who heroically took care of multiple COVID patients in a hard-hit nursing home, at great cost to her physical and mental health.

So many of our adolescent patients have continued their part-time jobs at supermarkets, pharmacies, nursing homes, restaurants, and camp/childcare positions without ever taking time off. They worked but then came home to quarantine, missing the normal social gatherings of teenage life. This is not easy, and they have no idea how amazing they are.

And when I ask most of my younger school-age patients how school is going, the majority respond that it is going well. They love their teachers even if they only get to see them on computer screens. They are making the best of it, and that in itself is inspiring. And even our youngest patients have made us so proud. I can not express how much love we feel when we witness one of our three-year-olds walking into the exam room proudly (and correctly) wearing their favorite face mask. They too are heroes for this by keeping us safe.

We want to truly thank all of you for continuing to trust us in caring for your kids during these unprecedented times. We promise to continue to strive to provide the safest possible environment in our office in order to provide the best possible care.

Unfortunately, the pandemic is not over. In order to ensure the safety of our patients and our staff, we will continue to require that everyone in our office over the age of two wear a face mask properly — covering your mouth and nose.

And when not in our office, we strongly recommend that everyone wears a mask when they are with any non-household members and can not maintain a six-foot distance. It is important to follow the CDC recommendations of social distancing and avoid crowds. We all need to continue to practice good hand hygiene and avoid touching our face as much as possible. None of the recommendations are easy, but they are critically important in order to protect ourselves, our families, our friends, and our community at large.

Lastly, it is also still important for our kids to stay home if they are ill. We will continue to see our patients when they are sick at designated times or via telahealth. We are now able to perform rapid COVID testing under certain circumstances. We can also send the more sensitive PCR swab to an outside lab. Depending on certain factors, we may decide it is best to send patients to an outside hospital for drive-through testing. It is important to know that a negative test can not definitively rule out an infection with COVID-19. That means that if your child is ill, we may still recommend your child quarantine for 10 days even with a negative test, especially if we can not find an alternate diagnosis and/or there is a known exposure. Please know that we do not make these decisions lightly, but we are obligated to follow the public health guidelines.

We wish you, your families, and friends continued good health.

By Colleen McCabe, MSN, CRNP

Happy fall! Along with adding pumpkin to your coffee and cheering on the Eagles, it is also time for your child’s annual flu shot.  There are many reasons why it is important to have your child vaccinated against the flu, especially during the coronavirus pandemic.

• The annual flu vaccine helps prevent your child from getting sick from the flu. In fact, each year the flu vaccine prevents over four million people from getting sick.  Having your child vaccinated will help keep themselves and others around them healthy.

• If your child does become sick with the flu, the vaccine can reduce the need of your child being seen by a doctor, going to the emergency room, or worse, being admitted to the ICU. 

• Since we are in the midst of the COVID-19 pandemic, protecting your child from the flu with the vaccine will help keep them and those around them healthy. Strong immune systems are important during this time. 

• If your child has a chronic illness, such as asthma or an immunodeficiency, it is especially important you vaccinate them as soon as possible.  Children with chronic illnesses are more likely to end up in the emergency room due to complications from the flu.

Call our office today to schedule your child’s flu shot.  We are offering flu shots during the week as well as Saturdays and selective Sundays.

By Timothy J. Flynn, M.D.

What does acne look like?

Acne can look different on different people, on different areas of the body, or at different times. Whiteheads, blackheads, red bumps, and pus-filled bumps are all acne.

When does acne happen?

Acne usually appears as children and teens enter puberty. Most children have at least some acne at some point in their development. Luckily, for most people, acne does not last forever.

Where does acne happen?

Acne is most frequently found on the face, chest, and back.

Are there any special considerations for females?

For girls, acne is sometimes related to menstrual cycles or can be a sign of a hormonal disorder.

Ok, what about males?

For boys, if there is acne on the face it can make shaving more difficult.

Does sports or sweating cause acne?

Sports and sweating don’t cause acne by themselves, but certain athletic equipment may trigger or worsen acne. Anything that traps heat and sweat against the skin can be problematic. For example, headgear, helmets, and chinstraps can trigger acne on the face.

What sunscreen/makeup/skin care products should a child or young adult with acne use?

Use a gentle soap to wash trouble areas. Skin care products and cosmetics labelled as “non comedogenic” will be less likely to cause acne.

What should we avoid?

Please avoid the temptation to pop pimples or scrub too vigorously! It can lead to permanent scarring!

When should I bring my child to see a doctor about acne?

Your child has a skin problem but you are not sure if it is acne or not.

Your child is very young and seems to have acne.

Acne is interfering with your child’s happiness or quality of life.

Acne is not getting better with anything that you have tried.

You are concerned that the acne is leading to permanent scarring.

You are concerned that acne is a sign of another medical problem.

By Colleen McCabe, MSN, CRNP

Ask, Listen, and Reassure

• Ask your child how they are feeling in regards to the current situation.  Children handle stress in many different ways. Allowing your child to express their feelings may give better insight on how to reassure and calm them down. Younger children will be affected in different ways compared to an older child, which makes it even more important to talk to your children individually. 
• Children look to their parents for reassurance.  They will react similar to how you react.  Keeping adult conversations positive around the children is important to reduce panic.  If you panic, your child is likely to panic. 

News and Media

• Limit the amount of COVID-19 news your child is watching as best you can during this time.  If a child is hearing news throughout the day related to the pandemic, they are more likely to become anxious.
• Remind your older children to look for credible sources of information in regards to coronavirus updates. The CDC website has the most up to date and credible information.

Schedule and routines

• Children of all ages like predictability and routine; it helps to reduce the stress of the unknown.  Making a schedule for your child to follow during the week is important.  Allow time for schoolwork, exercise, meals, creative time and play time.  Older children can make a schedule for themselves that best fits their day. 
• Set aside time for your child to FaceTime their friends, write letters to their family members, or make art projects to drop off at grandparents’ houses.  Socialization is a major part of a child’s development. Continue to encourage your child to keep in touch with friends and family.

Activity suggestions

• Include your children when it comes to meal preparation. Allow them to help in the kitchen and brainstorm meal ideas.
• Create dinner themes such as meatless Monday or taco Tuesday in order to keep a predictable routine for your children. This may help your meal prep as well.
• Your family may have fun dressing up for a “Formal Friday” dinner. 
• Play a re-run of an old baseball game and cook hot dogs on the grill as a family.
• Music is great therapy for children of all ages. Many music studios are offering free music on their websites or on Facebook. Check them out!
• Make time on weekend nights for older kids to have a family game night where you can do board games, card games, or puzzles. Use prizes or incentives for the winner to encourage participation.

Concerns

• Encourage stress reduction by doing yoga, meditation, and journaling with your child. Check out Calm or Headspace apps for guided meditation.
• Remember, things will not look perfect at home all of the time during this pandemic.  You are doing the best you can with the resources you have at home. Take each day one at a time.
• If you have serious concerns about your child’s mental health at any time during this pandemic, please reach out to our office at 215-728-7711 so we can discuss and direct you further.