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Needle phobia. It's something that as a pediatrician I see every day, several times a day. At least two-thirds of children have a fear of needles. It's hard to tell who is worse with it though, little kids or teenagers.

Unfortunately, vaccines are still given as shots at this time, and kids get a lot of shots to help build their immune system. At the mere mention of being due for vaccines or blood work, some kids will just burst into tears.

So what can you as a parent do to help when your child is due for a vaccine or needs blood work done? I always will tell parents and kids at the well visit before they are due for vaccines that the next time they have a checkup, there are shots involved.

Mainly, I do this to avoid surprises. Often parents will say that they had no idea their child was due for shots. So when I tell the kids, they remember the next time and that actually seems to help them be better prepared. It's the surprise "you need a shot" announcement that catches kids off guard more and their anxiety goes through the roof.

Parents also feel better knowing that they can tell their child that, "We talked about this," and that they can prepare their child in advance, not spring it on them on the drive to the office or once they get here.

One thing we as pediatricians ask that you don't do is tell your kid that if they don't behave, they'll get a shot. I hear that all the time as a scare tactic and it really bothers me. I'm not going to give your child a shot if it's not needed.

If you tell your child in front of me that I will give your child a shot if they misbehave, I will tell your child that I don't give shots for behavior, but I do have time out spots in the clinic.

And for the teenagers, if they get out of hand, we do have security officers who can help with behavior outbursts. And yes, sometimes that has been needed when the teenagers become violent.

Kids often will ask me if the shots hurt. Well, they are shots. They're not fuzzy caterpillars. Same with the needles we use to draw blood. I tell kids that, "Yes, they hurt just a little, but it's over quickly," and, "We have to use the needles, but for a good reason," and it's to make sure that they are healthy.

I try to be upfront and honest with the kids. Even little kids understand when you tell them the truth in a calm manner and explain why we are doing what we are doing.

I had a vaccine one day and I saw a patient later who was afraid of getting a shot. I showed her my Band-Aid and she was so surprised. She was like, "But you're the doctor." And I said, "Yes, I am, and I sometimes have to get shots too." She then said if I was brave enough to get one, then so was she.

I also tell kids when they're old enough what vaccines they're getting and why they're getting them. I ask if they have any questions about the vaccines, and that seems to help them understand the importance of the vaccines.

Same with the blood work. I explain everything to them so that they know I'm not ordering labs just because I want to torture them. It's because I'm trying to figure out what is going on in their bodies and how to make them healthier.

I also have the advantage of telling kids and parents that my medical assistants are who I trust with my own family and who I trust to draw my blood and give me any immunizations. So they know that they're in good hands.

I let them know that I don't like getting needles poked in me either, so they know they're not alone and that I get it.

I talk directly to the kids so they know they're heard and we are doing what we can to make this as easy an experience as we can. And they know that they get a sticker when they're done for being so brave, no matter how old they are.

So while needle phobia is a real thing, there are ways as parents that you can help make immunizations and blood draws less scary, which goes a long way when the kids are here in the office.

It seems there has been a big increase in the number of children being diagnosed with sensory disorders. One reason may be that kids with sensory issues actually have other diagnoses, such as ADHD, anxiety, PTSD from abuse, and autism, just to name a few examples. Other times, some kids may just be sensitive to some things but not others and don't actually meet the full criteria. It has only recently been added to the psychiatry diagnosis textbook, the DSM-5.

Sensory processing disorders are basically where kids are sensitive to sounds, textures, or other stimuli to the point where it is beyond normal childhood behavior and causing a disruption in the child's life and also in the life of the family. Any of the five senses, taste, touch, smell, sight, and sound can be affected. Often children with sensory issues also have poor fine motor skills or have a hard time with social cues and interactions. They have a hard time regulating their emotions.

One study shows that sensory processing disorders affect 5% to 15% of school-aged children. Another study showed that there may be a biological cause with abnormalities in the white matter of a child's brain that could explain sensory issues.

Some children are hypersensitive to things and may think everything is too loud or too bright. They are the ones who are covering their ears often or have a low pain threshold or are super picky with eating certain textures. They have a hard time focusing and controlling their emotions, and they don't like to be touched. Other children are hyposensitive and they crave input, trying to get more sensory input. They're more likely to have a high pain threshold, put things in their mouths, hug too tightly, invade other people's personal space, or rock and sway.

One big issue is that there is still so much to be learned about sensory processing disorders. Your pediatrician can suspect your child has a sensory processing disorder but cannot actually make the diagnosis. Again, there are so many other brain issues that can present with similar symptoms so it takes a developmental or a behavioral specialist or even a neuropsychologist to get an official diagnosis. Your pediatrician will refer your child to someone who can help do a full and complete evaluation to get the correct diagnosis. The mainstay of treatment for sensory processing disorders is occupational therapy. Occupational therapists can help kids and parents learn ways to manage their sensory needs.

If you have concerns that your child may have a sensory issue, please talk to your child's pediatrician and ask them for a referral to a specialist who can get them the right diagnosis and treatment.

Interviewer: So what exactly are growing pains, and are they normal? I'm here with Dr. Julia Rawlings, a non-operative sports medicine physician at University of Utah Health. And I just want to start out by asking what exactly are growing pains? Is it the legs actually growing? Or what causes these pains in kids?

Dr. Rawlings: Yeah, so the name growing pains is a little bit misleading. Children are growing, but that is not causing pain. There's no evidence that growth itself causes pain. What we think is actually happening is that when a child is just very active during the day, the muscles get a little tired and achy. And we'll see that kids get this achy, throbbing muscle pain that usually happens later in the afternoon or evening, or it can even wake the child up at night.

Interviewer: Geez. So it doesn't have anything to do with bones getting longer, muscles getting stretched. It's just them being active kids?

Dr. Rawlings: That's what we believe, yes.

Interviewer: When do kids usually start experiencing growing pains, if they do?

Dr. Rawlings: So there are two peaks that we typically see growing pains. It's usually the preschool age group, and then the preteen, so kind of 11, 12, maybe early teen, 13.

Interviewer: And it's normal, right? There's nothing . . .

Dr. Rawlings: Completely normal. It doesn't affect growth.

Interviewer: It's just a little uncomfortable?

Dr. Rawlings: Or quite uncomfortable. It can be pretty painful, yeah.

Interviewer: And let's say a kid is experiencing some severe pain in their legs, it's maybe keeping them up at night, etc. What are some ways that maybe you could treat it at home to give them a little bit of relief?

Dr. Rawlings: Yeah, so I think starting with just some massage, rubbing their legs is helpful. You can try a heating pad, or if they prefer it, you can even try ice. Sometimes just a dose of ibuprofen or Tylenol can be very helpful. And if they have this pain that comes up pretty frequently, you might even see if they'll be willing to stretch a little bit during the day and see if that helps at night.

Interviewer: Just running stretches, yoga stuff?

Dr. Rawlings: Yeah, yoga for kids, that's perfect.

Interviewer: Oh, fantastic.

Dr. Rawlings: Yeah, just some hamstring stretches probably is a good place to start.

Interviewer: Sure. And say a parent is listening right now. When can we expect these growing pains to stop?

Dr. Rawlings: Yeah, hopefully they'll stop after they leave those peak periods, so after they've left the preschool years or they enter their teen years. They can continue throughout the teenage years, but usually not through adulthood, into adulthood.

Interviewer: And until then, you've got stretches, ibuprofen, anything to help.

There have been concerns by some parents that they don't want their kids wearing masks because they believe their child will be inhaling their own carbon dioxide with prolonged mask wearing and that will cause oxygen deprivation. Some say that children will inhale up to six times the safe limit of carbon dioxide.

Let me help clear the air on this one. It's not true. Here's the science behind the truth. Carbon dioxide poisoning or hypercapnia from re-breathing the air we normally breathe out doesn't happen because carbon dioxide molecules are extremely small, even smaller than the respiratory droplets, which is what we are protecting against when we wear the masks. They cannot be trapped by cloth or medical masks or any sort of breathable fabric. Those tiny molecules just pass right through the material.

Surgeons, nurses, respiratory therapists, all of us in the medical profession, in fact, wear our masks for hours and hours during the day. Studies done by having surgeons wear oxygen monitors during their entire time in the operating rooms show that masks have no effect on the amount of oxygen they have in their bodies.

If your child is wearing their mask properly, covering their mouth and their nose and fitting snugly over their face with the ear loops or ties, then your child will be protected from the respiratory droplets we don't want going through the breathable fabric, but still letting them breathe in oxygen and exhale carbon dioxide through their masks.

The bottom line is masks work. Last year during what is usually a very busy winter season, I hardly saw any sick kids. Now we are seeing RSV and rhinovirus and all sorts of other winter viruses because people have loosened up on mask wearing and viruses are taking advantage of that. Hospitals are full with kids who are having respiratory virus complications. I've had parents of children with asthma tell me that since their kids wore masks, the last school year, they didn't get sick and didn't have any asthma flare-ups. We can do this.

The kids I've spoken to have no problem wearing their masks. They like to coordinate their masks with their outfits and get cool ones with princesses and superheroes on them. I tell them they actually are little heroes. They tell me they have no problem wearing masks all day at school either. My own kids even say that they're so used to their masks, they don't even think about them anymore. And they're in junior high and high school. So mask up. And if you have any other concerns about COVID and COVID precautions, be sure to talk to your child's pediatrician.

A lot of parents of younger children are now asking themselves a big question. I'm vaccinated against COVID, but my kids are too young for the vaccine. Can I let them play with their friends again? Do they have to wear a mask?

Kids have usually seemed to fare better with COVID than adults. But we know this isn't always the case. There are those kids who get COVID and then are affected by MIS-C, the multi-inflammatory system complication that will land a child in the intensive care unit. That is seriously scary. And that's why so many of us pediatricians worry about kids around COVID.

Another big concern has been that younger children would bring the virus home to vulnerable adult family members, and those would be the ones who would become significantly ill. So now that many places are not requiring masks anymore and places are opening up, it puts many parents in a situation where they're not sure what to do with younger kids. These kids have missed a whole year or more of socialization with friends and are really wanting to get back to playing.

The current recommendations are that if a person is not vaccinated, they should continue to wear a mask. That said, if your child is playing outside with friends that you trust and who have also been following precautions, it may be okay to let the kids play outside without masks on. There is evidence that kids who play outdoors have a low risk of being infected. There are also a lot of summer camps now, where masks are still being required. But they offer a lot of fun activities for kids who are too young to be vaccinated.

Adolescents ages 12 and up can be vaccinated now. My kids are both fully vaccinated now, and it was their choice, especially knowing that next year there will be no masks in junior high or high school in our area. They asked a lot of good questions about the vaccine and understood the science behind the vaccine. They both said it was such a relief to know that they are now protected. Vaccine trials are now underway for kids older than six months old at the time I'm recording this. The current projections are that kids ages 5 to 11 may be able to be vaccinated as early as September. And kids ages six months to four years may be able to be vaccinated by next spring.

The more people around your child who are vaccinated, the safer they will be. The bottom line is this is a choice your family needs to make. Are others in your family at high risk? Do you know who your kids are playing with? Are they outside? Is anyone sick? Or has anyone been exposed to COVID within days of the playdate? There is hope in sight for the youngest population, and science is working as fast as possible to get everything back to normal as quickly as we can.

Donating your child's organs when the unthinkable happens is not normally something parents ever think of. If you've been following my recordings, you know that a dear friend lost her teenage daughter recently. We had been very close to her daughter since she was a baby. And it was amazing that even in this difficult time, my friend thought of others. Her daughter was an organ donor. She improved the lives of at least six other children by this selfless act.

Before I was a pediatrician, I worked in organ transplant as one of the original 12 organ placement specialists for UNOS, the United Network for Organ Sharing. My job was to take information on those who had been declared brain dead, enter it into the computer, and find matches. That means finding those people waiting on the transplant list, who were genetically similar enough to the persons whose organs were being offered and coordinate with the transplant teams on both sides to get lifesaving organs from one person to another.

People can declare if they want to be organ donors on their driver's licenses or in their wills. But what happens when a child passes? Parents have to make that decision under the most difficult of circumstances. The process starts when a child is admitted to the intensive care unit and the doctors there suspect that the child will not recover from their injuries. They will discuss if the parents are interested in donating their child's organs if their child is declared brain dead.

Brain death happens when the brain essentially stops being able to do what it normally does — think, feel, and tell the body what to do. It cannot be reversed. While the heart can continue to beat and machines can keep a patient breathing, the brain is no longer working. A child may appear to be sleeping, but they're not. They're kept alive by machines and medicines. When the machines are turned off, the rest of the body will die, just as the brain already has.

Specific exams are done by specialists to confirm brain death. Someone is never declared brain dead without all of those tests being done to confirm that the brain is no longer functioning. Once brain death has been declared, someone from the local transplant team, called the organ procurement organization, will come and meet with the family. They are usually medical personnel with special training in how to handle this most sensitive situation. They will be able to answer questions and help the family through the process.

Once parents give consent, the paperwork begins, and that is where what I did comes in. When donors and recipients are matched, organ placement specialists will help with transportation to get the organs to where they need to go. Once everything is coordinated, the donor is taken to the operating room where the organs that were placed are then removed from the body and the machines are turned off, and thus, the patient has now become cardiac dead. Their heart stopped beating and they are gone.

The donor patient can have a full open casket funeral if desired. The organ procurement team works closely with funeral homes to make sure this can happen. For privacy, the recipients of the patient's organs are not disclosed to the donor family. But the organ procurement team does let the family know how many organs were able to be transplanted into waiting recipients.

While nothing can make the pain of losing a child suddenly better, families often say that knowing that, during the tragedy of their loss, they were able to give the precious gift of life to another and that helps the healing process begin. Their child will live on through those they have helped.

Knowing their friend was an organ donor started the conversation with my boys. They both told me that they would like to be donors if anything happened to them. They know their father and I are both registered donors as well. If you would like to be an organ donor, you can sign up at UNOS, UNOS.org/register-to-be-an-organ-donor. I would like to dedicate this podcast to all who have made the choice to donate and save another life. Thank you.

Dr. Spivak: The vaccine looked 100% effective. There were 16 cases of COVID in those 2600 kids, all of them were in kids that got placebo, no infections in kids that got the vaccine. So it looks really safe and really effective, maybe even more effective than an adult.

Interviewer: How we know the COVID-19 vaccine is safe for kids and why your children should get it? Dr. Emily Spivak is an Associate Professor of Medicine in the Division of Infectious Diseases at University of Utah Health. So first of all, should kids get the COVID vaccine? I mean, I've heard that kids are a lot less likely to get sick from COVID-19. So is the vaccine necessary? And is that a true statement?

Dr. Spivak: That is a true statement. But I'd like to point out that they're not immune or completely protected from getting sick, right? There have been over 400 kids hospitalized in Utah since the pandemic hit from COVID-19, and I think around two or three have died. Nationally, over 300 children have died from COVID-19, and that's 50% higher than like our worst influenza year, deaths-wise in kids nationally. And then I'd also point out, we don't talk about whether you want to call it long COVID, long haulers, any sort of long-term side effects from other viruses, like influenza or other respiratory viruses. We don't see that like we do with COVID-19. And so, I think the long-term side effects that happens in children as well. And that should be a reason to get your kids vaccinated as well just protecting them from being hospitalized.

Interviewer: We hear that they don't transmit it as readily as adults, is that a true statement?

Dr. Spivak: I don't know that that is totally true. And a lot of that original data and understanding came in the setting of, you know, last spring, when we had shut schools down, kids were sheltered at home. And then, when we brought them back to school, in many places, it was with masks. And so, it's a little bit confounded understanding how well kids can transmit it.

I will say clearly, we are seeing an uptick in cases in younger populations so less than 18, people who are less likely to be vaccinated, relative to nationally cases going down overall and going down and over. . .going down in older populations that are vaccinated. So clearly, kids are susceptible. And I think if you ask most kids, they would tell you, "I would like to get vaccinated because then I can start seeing my friends. I can start doing sports. We can start riding in cars or doing things together without a mask. And I want to protect my friends, my grandparents, and the people around me." So, there's a lot of personal reasons for them to do it to not get sick. But also just to get back to the things that are fun for them and that they want to do.

Interviewer: So we've got the why. There's a couple good why reasons. What about the safety aspect? So I mean, there's some skepticism from some individuals if it's safe for adults. So is it safe for kids? Is it more risky for kids? What do we know about that?

Dr. Spivak: It looks safe. And I will say just talking about this vaccine in general, we have. . .so almost over 275 million doses have been given of COVID vaccines in the United States. Again, all. . .most of that is to adults. But I would just point out, we have, you know, the most intensive safety monitoring in U.S. history for this vaccine compared to any other vaccine that we have given. So there's been new safety monitoring systems in additions to the ones that existed that have been deployed, essentially, to monitor COVID-19 vaccine safety.

These vaccines look incredibly safe. And we have much longer-term data right with adults since we've been doing this since about December in adults. But the data that exists looks also like these are quite safe in children. Same side effects, right, 80% are going to have some arm soreness after the injection and about 20% to 30% will have this flu-like symptoms fever, myalgias, headaches, you know, muscle pain after the second dose. And that is. . .that's just your body showing you that the vaccine is working and your immune system is responding. But there do not seem to be any serious side effects.

Interviewer: And you have children yourself. When it comes to the question of getting your children vaccinated when it's time, because right now 12. . .as of the recording of this, children 12 and older can get vaccinated. It is not been approved for any younger. What are you going to do with your decision-making process?

Dr. Spivak: I'll be honest with you, I have three girls ages nine, almost seven, and three, but I will get my kids the vaccine as soon as it's available for them. I don't have any concerns.

Interviewer: So there have been some side effects with adults and some negative outcomes, the blood clotting, for example, is one. As a parent, does that worry you that that could happen to your child? I mean, that would be scary, right?

Dr. Spivak: It would be scary, but I'm not worried. So the blood clotting there's no signal to blood. . .to my knowledge for blood clotting with the mRNA vaccine, so with Pfizer or Moderna. And currently what we're talking about with adolescents is the Pfizer vaccine is approved. We expect the Moderna trial to be finished in 12 to 15, 16-year-olds and that one to be approved in the very near future. The blood clots are with the adenovirus vector vaccines specifically in the U.S., the Johnson and Johnson vaccine that has been licensed. So that vaccine is not really in the pool and available for adolescents. So, you know, again, the overall risk really is lower than getting COVID, depending on how much is in the community and also of these long-term side effects from COVID. So we're still talking minuscule risk.

Interviewer: Give me your two-sentence summary about for a parent that's hesitant to get the vaccine for their children, you know, maybe they would get it for themselves, but not their kids. What can we say to make parents feel better about the decision to get their children vaccinated?

Dr. Spivak: These concerns exists in parents who ran to get the vaccine for themselves, but they're still concerned about the safety, I think is the main thing for their kids balancing that with, we hear kids don't really get that sick. So if I'm unsure about safety, does my kid really need to get it?

Interviewer: Yeah, that risk-benefit kind of question that you as a physician face all the time.

Dr. Spivak: Yeah. There is a lot of data in adults showing that these vaccines are highly effective and safe. Again, probably more data than any other vaccine in U.S. history. The risks of getting COVID and severe consequences maybe not death, but this multi-system inflammatory syndrome MIS-C or sort of long haulers or long COVID is real in kids. And then, also just even the more proximal goal of getting your kids comfortably back socializing, playing, camp, sports with their friends. And I think if you asked your kids as sort of what they want to do, they would probably. . .many of them say, "I'd like to do this for myself, but do it for my friends and do it for my teachers and other people as well."

Interviewer: And if somebody wants more information beyond what we talked about, what's a good reliable source for them to go to?

Dr. Spivak: I'd say coronavirus.utah.gov. The state website also cdc.gov. If you Google cdc.gov... CDC COVID vaccine, there's a lot of frequently asked questions, fact sheets in there, that's a good resource as well.

Pandemic fatigue, we all have it. However, it is affecting children more than adults in many cases.

Pandemic fatigue by definition is the mental exhaustion caused by being in a state of heightened awareness and alertness in the face of COVID combined with the uncertainty of how the pandemic will develop. Parents are struggling to continue to juggle working from home and teaching their kids who are doing online school. Healthcare workers are getting burned out from the stress of working with COVID patients and seeing the numbers of infected patients continue to go up.

Kids are becoming more anxious and depressed, not just about isolation and not seeing their friends, but I'm having parents bringing their kids to me about anxiety over things they've never been anxious about before. This is especially true because just as COVID numbers started to increase locally, we also had a major earthquake. I have some patients who if they get a cold are asking me if they're going to die. I have others who are terrified of germs and think they will get COVID if someone touches their dog or they will change their clothes as soon as they get home from being out of the house, even if they just went to a store.

People are tired of wearing masks. People are tired of physically distancing, of not having normal life milestones being able to be celebrated in the way we have done for years. So since this is not showing any signs of slowing down anytime in the immediate future, how can you help your children do the best they can while dealing with COVID in the long haul?

First, continue to make mask wearing fun. I've said it before, and I'll repeat it again. If the mask is something fun, kids will want to wear them more. Have fun characters on their masks. Let the kids have enough variety in their masks that they can coordinate them with their outfits. That's exactly what my younger son does every day. His teachers comment all the time about his cool masks and how they match what he's wearing.

For hand sanitizers, have seasonal scents. If your child doesn't have eczema and they're not sensitive to different fragrances, let them choose what they want to smell on their hands all day long.

Empower kids. Let them know it's okay to tell family members and friends that if they just aren't masked or they're not social distancing, then your kid can't play with them. It's okay to remind others of the rules. Just make sure it doesn't turn into a daily battle and they don't turn into the germ police.

Let kids connect with friends online. I know we didn't use to be a video game family, but when the pandemic hit and schools went online, I caved. I bought an Xbox for my boys and I let them have a certain amount of time to play with friends every day. It helps them still feel connected to their friends, but in a safe way. It also lets them get a break from school and just play and be kids.

Finally, remember that it's okay for them to be bored and figure out new things to do. It's okay to let them cry, even if they can't tell you what they're sad about. It's okay to have breakdowns and just get angry and need you to hug them until they're screaming turns into crying and then I'm sorrys. As long as your child isn't disrespectful or violent, let them express their emotions. Then, if they want to talk about their feelings, if they don't want to, that's okay. Let them have their space. The bottom line is everyone is feeling pandemic fatigue in one way or another. If we all help each other, then we will get through this together.