Search for tag: "kids health"

Dizziness, especially in teenagers, seems to be a common concern I'm seeing lately. Is this something really concerning or a symptom of other more common issues?

Lately, I'm having one or two teenage patients a week coming to see me with the chief concern of dizziness. It's usually girls, usually around 15, but sometimes boys too. A conversation about their symptoms often points me down one or two paths -- vasovagal syncope or anxiety.

Kids who have vasovagal syncope feel lightheaded when they stand up too quickly. Their blood pressure drops and down they go. The most common reason is they aren't hydrated and their blood pressure can't compensate fast enough for how quickly they stand up. This type of reaction also happens with fear and strong emotions, such as seeing needles.

Often, if kids stay hydrated, which means drinking enough water so that when they pee their pee looks like water, their symptoms improve.

Parents often ask me, "Well, how many glasses of water is enough?" But there's no simple answer other than to monitor their urine. Everybody is different with their water needs.

With anxiety, the dizzy feeling is more a nervous system response. Along with the dizziness, they will say that they're hyperventilating or their heart rate goes up or they're sweaty or they're shaky. That's a panic attack.

Unfortunately, the treatment for that kind of dizziness is a bit more complicated than just drinking water. Drinking water won't help anxiety. The first step for anxiety is learning some coping skills to help stop the panic attack. Have your child learn some deep-breathing exercises such as square breathing.

You may ask, "What is square breathing?" We'll have your child use their finger to draw a square in the air in front of them. Every time they draw a side of the square, they either take a deep breath in or they let their breath out.

There are several free apps to help with meditation also. The schools will often use Calm. We've used Relax Melodies at our house.

If that doesn't help, the next step is finding a therapist who can help your child manage their anxiety.

Finally, if your child is still having panic attacks despite therapy, your pediatrician can help you find a mental health provider who can work more closely with your child on their anxiety.

Many teen girls that I am seeing for dizziness also admit to cutting or other self-harm behaviors as a coping mechanism. So a mental health provider can also help with this.

Many parents often ask me to do blood work for anemia for their teen's dizziness. In boys, because they don't have periods, this is rarely the case. In girls, if their periods are really heavy or frequent, that could be the cause. But I do not find that they are anemic for the most part.

Abnormal thyroid labs can also cause dizziness and anxiety, even depression. More so in older teen girls than boys, but this too is usually not the case.

Parents often want me to check vitamin levels because their kids don't eat as healthy as they should. That's not something that a pediatrician will usually do. Unless the teen has a specific underlying medical condition, vitamin deficiencies are not very common. And if a parent is very worried about vitamin deficiencies, they can just have their teen take a daily multivitamin designed for teens. There are several on the market, and they come in tablets and gummies.

The bottom line is if your teen says they are dizzy, try hydration first. And talk to them. See if they're anxious about anything. If the problem persists, then it's time to bring them in to see their pediatrician.

Boys in puberty. Most people think of teen boys eating them out of house and home, needing new clothes because they outgrow them every two weeks, and interesting smells. Well, there's more than that, and I'll help you navigate puberty in boys on today's Scope.

I've got a teenager at my house and one who is about to be a teenager. I can definitely say that all of those things that I just mentioned are absolutely true. But what exactly is going on in their bodies? There's going to be a lot of changes that they may come to you as parents to ask questions about. Puberty in boys can start as early as 9 but really hits between 11 and 14 and lasts for 3 to 4 years. Boys can continue to grow until they are 18 or even 20.

The first thing your boy will notice is that his private area will be changing. His testicles will get bigger, his penis will grow, and he will get pubic hair. Then comes hair under the arms and on his body, and that's usually when the body odor starts too. And you'll need to make sure to get your son some deodorant and you'll probably also need to stress the importance of hygiene.

Voice changes are next. Often boys get pretty embarrassed about how their voice cracks as it gets deeper. At our house, we pretty much just laugh about it because my boys know it's normal and it's happening to all their friends as well.

Their bodies will also start to bulk up, and their muscles will be getting bigger and stronger thanks to testosterone. Testosterone is also what triggers some mood changes in boys, especially the anger issues. So be prepared.

This is also when romances start to blossom so be sure you have the talk with your boys about your family's view on sex, birth control, and protection against sexually transmitted diseases.

Something else that testosterone causes is acne. Acne is not caused by not washing your face or by what you eat but by changing hormones. There is a lot of treatments for acne, including many that are over the counter.

Like I said, boys can continue to grow until they are 18 years old. They will usually have a growth spurt of about four to six inches towards the end of puberty. That's also when more body and facial hair shows up and boys need to learn about shaving beards and mustaches.

What about some of the more uncomfortable things that you may need to talk to your teen boy about? Well, boys start getting erections more, and sometimes they happen at embarrassing times like in the hall at school. They also start having nocturnal emissions, otherwise known as wet dreams. This is when they have erections and ejaculations during their sleep. It's normal. They have no control over it, and it can happen up to a few times per week.

Remember, puberty happens to all of us who make it to adulthood. While things change from each generation to generation, some things are constant, like the changes that happen to a boy's body as they go from being a little kid to being a man. It's a tricky time for kids, and if you or your child have any questions about what's going on in their bodies, be sure to ask your child's pediatrician for help.

here 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.

Learning disabilities are a common concern that parents bring to pediatricians. I'll be discussing those on today's Scope.

I have a lot of parents coming to me to see if their child has a learning disability. Usually it's dyslexia, which is a reading disability. But sometimes is dyscalculia, which is a math disability, or dyspraxia, which is a developmental disorder that affects motor skills like writing. Parents normally notice that their child is struggling in only one subject and does fine in others, or they notice that their child is writing letters, words, or numbers backwards. The teachers may be the first to recognize if there is a problem and tell the parents to have their child see their pediatrician for an evaluation.

Now, here's where it gets tricky. Yes, most of us can identify if there is a learning disability. However, we as general pediatricians are not the ones who can do a full evaluation and diagnosis. Even behavioral and developmental pediatricians are not usually qualified. Why? Because there is a lot that goes into determining if this is truly a learning disability or if there are other reasons for the difficulty in a particular area. We as pediatricians are the right place to start the process though. Schools also. School psychologists can actually do a lot of the testing to start the process, and that is what most of us recommend. While schools start doing the initial learning evaluations, pediatricians do full physical exams to rule out other medical reasons, such as ruling in or out movement disorders, ADHD, anxiety, depression, or speech issues.

The final evaluation and where the actual diagnosis is made is with a neuropsychologist. These are specialists who will do a huge evaluation with a lot of specialized tests, including IQ tests, standardized tests in reading, math, language skills, things like that, to get a good idea of how the brain itself is working, or not working, and be able to come up with the exact diagnosis specific for the child. This can be a long process, but it is necessary to get the correct diagnosis.

Once a child has been diagnosed with a learning disability, the next step is to notify the school and have them come up with an IEP or individualized education plan. This is a written contract stating what the child's disability is and what the school is able to do to help the child learn successfully. It's drafted with the parents, teachers, and school psychologists all involved and goes off of the results from the neuropsychology report. This IEP should follow the child all the way through graduation. It should be reevaluated every six months to make sure that the child's needs are being met and that there are not new issues coming up.

There are no medications to help with learning disabilities. As pediatricians, we can help direct you to resources that can help your child. Our relationship with your child will not change. And we too, like the schools can adapt if your child has problems with learning.

What your child needs most is encouragement and a lot of positive reinforcement when they get something right. Let them know that this is something that they can totally be successful with. Let them know some of the famous people that have had dyslexia, such as Keanu Reeves, Albert Einstein, Steven Spielberg, even Ozzy Osborne. They've all been successful. Henry Winkler had both dyslexia and math problems. Even Ben Franklin was thought to have a math learning disability.

Having a learning disability will make things harder, but not impossible. And often those who have a learning disability in one area often have exceptional abilities in other areas. Encourage your child to focus on what they are good at while they work hard things out that don't come easy. Remind them that they are not defined by their learning disability only by their abilities.

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.

Many kids, especially athletes, will complain that their feet hurt at some time. Heel pain is especially common and especially during growth spurts.

Heel pain in athletes who are growing actually has a name. It's called calcaneal apophysitis, otherwise known as Sever's disease. It is most common between the ages of 9 and 14 and is seen in athletes who do a lot of running and jumping. My teenage soccer player has this and actually so do several of his teammates, or the teammates of my younger son who will probably end up having this also. Basically, what it is, is inflammation of the growth plate of the heel bone. The bones, muscles, and tendons in that area all grow at different rates during puberty. And when they're out of sync, the muscles and tendons pull too hard on the growth plate and that causes the inflammation.

So what can your child do to help once the pain has started? Well, to be honest, the pain will improve most once your child is done with their growth spurt. Also, it's best to stop any activities that cause pain. But, of course, we know that's not going to happen, especially if your child is on a competitive or a school athletic team.

So other things that help include having an ice pack in a towel and icing the heel for 15 minutes every one to two hours during flare-ups. Have your child take an anti-inflammatory pain medicine, like ibuprofen or naproxen. But be sure to check with your child's pediatrician on dosing. Gel heel cups and shoes with good support are also helpful. They help put less pressure and less stress on the heel. Your child's pediatrician can also give you exercises that can help with stretching and which can help with the pain and help keep the condition from getting too bad.

If the pain continues, your child may be referred to a physical therapist. And if all else fails, then your child will be put into a walking boot and referred to an orthopedic specialist for management of severe cases. Eventually, Sever's disease gets better, but not really until your child has stopped growing and that growth plate closes. Until then, manage the pain and follow the advice your child's doctor gives them.

So your daughter just had her first period. What's normal, what's not, and what to expect now.

A girl's first period marks her entry into womanhood. It's called menarche. And many parents, especially moms, seem to have a lot of anxiety and questions about it. Many moms readily admit to me that they have forgotten what periods were like when they started. So if something doesn't seem right, they get incredibly nervous that something is wrong with their daughter. Some worry that their daughter has started too early or too late. Actually, any time between ages 9 and 15 is normal.

Some worry that their daughter doesn't have a period every month like clockwork and that they need their hormone levels checked or some sort of treatment to make their periods regular. Well, it is hormones to blame for this. However, it's because hormones are still settling themselves out. It can take two to three years before periods become regular. If there is a family history of irregular periods, they might never be regular. And that's okay too. Parents really worry if their daughter's periods are not regular. But unless their daughter is sexually active or they go months between periods after having them for about a year, there really isn't anything to worry about. Irregular periods by definition happen either less than three weeks apart or more than five weeks between periods. Otherwise, they're normal.

Moms also get concerned about cramps. Sorry, but cramps are part of periods. Your daughter should not miss school or stop being physically active because of cramps. Being physically active has been shown to decrease cramps. I have parents wanting me to write letters so that every month their daughter can miss school during her period. Periods normally last 3 to 10 days. So that's a lot of school missed. I try not to do these letters and instead discuss ways to help their cramps. Over-the-counter naproxen really helps and so does a heating pad.

Some girls will even have nausea or vomiting with their periods due to hormone fluctuations. Treating them supportively with anti-nausea medicines can help.

Moms also get concerned about their daughter's becoming anemic. This does not happen usually. Girls normally lose between 30 to 40 milliliters per period. This is six to eight teaspoons of blood. So while it looks like a lot of blood during a period, it's not as much as it seems. If your daughter has something called menorrhagia, that is excessive blood loss and that is 80 milliliters or more of blood loss per period. And these girls normally pass blood clots that are larger than a quarter. These girls will usually soak through a pad or tampon every hour for several hours during the heaviest portions of their periods. They may also need double maxi pads for protection. If this is the case, then you should talk to your daughter's pediatrician about ways to help.

I often get asked by moms if their daughters could have endometriosis or fibroids or other gynecological issues. As a pediatrician, I can do basic period management and gynecology. I can do oral or injectable birth control to help with periods. But often the best thing for me to do is to refer my patient to a gynecologist if it's more than I can address. They are much better at diagnosing and managing female concerns.

Finally, moms also ask me if their daughters need Pap smears now that they have started their periods. No. That used to be the case, and it's pretty traumatic for a young girl. The current guidelines are if a girl is 21 or has been sexually active for three years, then they get a Pap smear, and that would be done by a gynecologist, not a pediatrician.

Bottom line, most period concerns are actually part of normal development. Your pediatrician can let you know when something is not normal and refer you to a gynecologist who sees teenagers for additional help when needed.

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.

When you are expecting a baby, you have so many hopes for the future of your child. What if you learn that your child will have physical or developmental disabilities? I'll discuss your pediatrician's role in your child's care on today's Scope.

Often parents will ask me if I'm able to take care of a future sibling of one of my patients. The answer always is of course. Some parents will then get a little more quiet and say, "But my baby isn't normal." And I'm like, "Are any of us normal?" Seriously, if you've ever studied embryology and seen all the things that can go wrong during development, it's amazing any of us come out okay. When it comes to seeing new babies who may have some physical or developmental challenges, I honestly tell them I would be honored to be their new child's pediatrician.

When I was five, we moved to a house where the neighbors behind us had a son my age. His older sister had Down syndrome. In the five years that we lived at that house, his sister became one of my best friends. We would play school together, go to the pool together. She actually became a swimmer on the Special Olympics team. We did all sorts of things that friends do. Our families have kept in contact this whole time. And I've been so proud to see all she's accomplished.

I learned early on that just because someone has an extra chromosome and has some differences as a result, they're still an amazing person. They still have so much to offer. I mean, I was the asthmatic kid, allergic to everything. And I was in the school nurse's office all the time. So I also felt like I was a bit defective. We all are a little off in our own ways.

Parents are often overwhelmed when they have a new baby with special needs. And as their pediatrician, I serve as sort of a gatekeeper for all the specialists. My job is to take care of the well child visits, the usual colds and ear infections, and help manage some straightforward issues that most pediatricians are comfortable doing.

When a child needs a specialist, I know exactly who to refer them to. And the specialists and I coordinate together to make sure the child has all their healthcare needs addressed. It's called the medical home model. It's basically a community of doctors all working together, like a wheel with all the spokes of the wheel being the specialists, and the hubcap being the pediatrician. Depending on the needs of the child, the pediatrician also gets home health nursing involved or speech or physical therapists. Often we're the ones that fill out a lot of the paperwork for the insurance companies too and refill prescriptions for supplies if a child has a feeding tube or needs diapers long term.

Often one of the specialists is a pediatrician who has had additional training and certification in complex care management. That is someone I routinely refer my patients to, because they are an amazing resource and also help coordinate the specialists. They often try to make sure that a patient, if they are coming for a visit, have all of the specialists in the visit at once, so it's easier to make sure everyone is on the same page and can get extra help from dieticians, care manager nurses, and social workers if needed. Again, all part of the community of doctors caring for special needs kids.

Trust me, we as pediatricians love your kids as much as you do. And when they make certain milestones, we celebrate with you. I get so excited when I see my cerebral palsy kids walk into a clinic on their own. And I know that every child I see with Down syndrome means I'm guaranteed extra hugs that day. Special needs doesn't always mean limited, negative quality of life. Although their care will be certainly filled with challenges, it's our job as pediatricians to help you along your child's journey to reach their full potential.

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.

There are so many apps out there that it's hard to keep track of all of them. And with many kids having smartphone, it can be tricky to decipher what's what. There are some apps out there that look pretty harmless but they have dirty little secrets. They're not kid-friendly at all.

We're seeing some negative consequences of so much technology with kids, including cyberbullying and sharing or viewing inappropriate content online. Some apps are now even marketing to kids when they're more meant for adults. For example, there's an app called Bigo, B-I-G-O. It has an adorable baby dinosaur on it, but what it is really used is live video streaming with strangers. There's Wink and Yubo which are basically the same as Tinder.

Discord allows voice and text chat with no content filters. There's Wishbone which allows users to create polls vote on topics, and it seems to be marketed to girls. Signal is a messaging app but keeps messages private. AntiLand lets users anonymously chat and share photos with other users all over the world.

With teens trying to hide all their imperfections, there's Facetune which allows users to alter their images in photos. One app that is very concerning even though app image looks like owl eyes and a beak on a black background and looks pretty innocent, it's called Hooked, and it lets users read stories in a chat format, and features stories with sex, drugs, and violence.

There's one app which parents definitely need to be aware of. It's called The Calculator# app. It looks like a calculator, however, it's a secret storage app for photos, videos, and other files. If your child wants to hide things from you, they may use an app like this.

So with all this out there at your child's fingertips, what can you do as a parent to keep them away from these types of apps? Kids are craving social interaction more than ever right now, with in-person gatherings kept to a minimum with the pandemic. First, insist on transparency with your kids. Find out what apps they have on their phone. For my preteen and teenager, I have my fingerprint on their phones, so I can ask for it at any time and see what's on there. The apps they want won't even download on their phone unless they request it through my phone, and I put my password in the phone, and then it lets them know I've approved it. And guess what, they're totally okay with these safeguards because we've talked about it, and we've set boundaries with their phones.

Second, talk about what's okay and what's not okay on their phones, and why you want them to not see some of the stuff that's out there. Have open and honest conversations and let them know you're looking out for their best interests.

Finally, if they're not able to stay off apps that are inappropriate, you may need to take their phones away. Harsh, but necessary consequences. Most importantly, though, is, as a parent, you need to be aware of what apps they look at, and use, and educate yourself on what the apps are so you're in the know.

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.

Emotional support animals are a common request in doctor's offices lately. What are emotional support animals really? And what should you know before you request paperwork?

At least a few times a month we're getting asked to write letters for patients for their animal to be allowed in the home as an emotional support animal. While a pediatrician or a family doctor can legally write these letters, we can only do so if there is a clear mental health diagnosis that we are actively managing. Sometimes your pediatrician may refer you to a licensed mental health provider to get an accurate diagnosis and write your letter.

Not all primary care providers are comfortable writing emotional support letters, especially if we are not involved in managing the diagnosis. Please don't ask a doctor who has never met your child to write the letter for you. We can't. There are certain specific criteria for what constitutes a diagnosis that qualifies your child for an emotional support animal.

One thing parents need to understand when they are asking for a letter, they are now claiming that the animal is not a pet. The letter will have to be written to show that the purpose of owning the animal is that the animal will help with symptoms of mental illness that their child has. An emotional support animal is not covered under the Americans with Disabilities Act. That requires additional training and certification, and they would need to be qualified as a service animal in order to be covered under the Americans with Disabilities Act.

A letter from your doctor will not guarantee that your request will be accommodated as it will only state that your child has an emotional disability and that the pet helps calm their symptoms. An emotional support animal is not a service animal. You can't just take it wherever you want. Often parents are wanting the letter so the child can have their animal with them if they move, but they may also want a waiver of the pet fees in their new housing location.

While a landlord needs to allow the animal in the home with that letter, the landlord may or may not grant a waiver of the pet fees. Also, please don't ask a doctor to write a letter for you when you do not yet own the animal. Remember owning an animal is a huge responsibility. There's training, feeding, cleaning up poop, and vet bills for routine care, sick visits and all those vaccines that are required. You need to be able to properly care for an animal.

If you cannot give that animal the best care and love it deserves, then it would be best to find other ways to help your child treat their mental illness. I get it, I'm a hound mom myself, and I know how much snuggling a puppy can help after a stressful day. I know how much comfort my boys get from our dog when they are having a hard time.

However, it is very important to understand that emotional support animals are technically a form of therapy. The letters need to come from the provider who is addressing the child's mental health needs, usually a therapist or psychiatrist. If you have questions about emotional support animals, you can ask your child's pediatrician, but please understand if we think it best if your child's mental health provider write the letter.

Well-child visits are still happening during COVID. What can you expect during your child's visit?

When COVID first hit hard, the American Academy of Pediatrics had a big concern that came true for a lot of pediatric providers -- well-child visits would come to a screeching halt. We also became concerned that there would be outbreaks of diseases again due to kids, especially babies, not coming into the office to get their vaccines.

Well, the good news is, in most cases, your doctor's office is probably one of the safest places to be outside of your house. Every office is different, but most of us are trying to divide the waiting room into sick and healthy sides. At check-in, every person is asked screening questions to see what area they need to wait in and also to make sure if someone is sick, that our staff takes appropriate precautions.

Only one parent is allowed in a visit per child. Parents are informed of this when they schedule the appointments, and I know we welcome the parent who couldn't be in the clinic to be involved in the visits through FaceTime. I've actually done two visits today where the parent who couldn't be in the visit was involved via FaceTime, and we were able to have a great conversation. Everyone is wearing eye protection and surgical masks also, and if there are concerns about COVID, we have complete PPE gowns and respirators that we wear.

We disinfect chairs, table, and toys in between each patient, and I have several rooms, so we are able to let the room sit for about 15 minutes to let the disinfectant dry by rotating which rooms we have patients in. We have separate exits for the patients who do not need to go back to the front of the clinic, and there is abundant hand sanitizer. We also have strict precautions for when we think somebody has COVID in terms of letting the room settle with the droplets, cleaning everything including the floors, and using special filters to cycle the air through.

What about virtual well-child visits? Some providers are doing them that way if there are no vaccinations needed. Others are doing only in-person. It's best to check with your pediatrician's office to see what they're doing.

So the next question is, how do you know if your child is due for a well-visit? Well, at our office, we do what is called outreach, meaning that our computer people can generate a list of all the kids that are coming due for well-visits or shots. We call and send letters reaching out to those families to have them schedule appointments. Not all offices have this ability though. If you're not sure if your child is due, please call your pediatrician's office, and they can let you know if an appointment is due and help you schedule at the same time. Your child's health is very important to your pediatrician. Please be sure to keep up with all of their necessary visits during this crazy time.

We are several months into this pandemic, and schools are back in session. For some, they're online only. For others, they're in person. And for some, they are a mix of both.

Several schools are closed because of outbreaks. So how do we keep this up, and how do we keep our kids and teachers safe? First, I think there are a lot of kids doing a terrific job wearing their masks. I have been really impressed with how kids as young as 18 months have kept their masks on. We need to praise them when they're following the rules and let them know we appreciate how they're helping to keep themselves, their friends, and their teachers healthy.

Speaking of teachers, I've spoken to several since before school started. They're doing such a hard job of trying to keep our kids educated and everyone safe. In many cases, they're doing double duty by preparing in-person lessons and online lessons. I'm not sure if this is something that could still happen, but I think it would be great if teachers would be able to wear masks that are clear over their mouths so the kids can see them talking. My son has a mask like that that is for his American Sign Language class. Also, another option is to make sure they have face shields, especially the elementary school teachers. As we all know, kids that age don't necessarily cover their noses or mouths when they sneeze.

With a few exceptions, kids love their teachers. I think that became even more apparent when distance learning started. I know my kids really miss certain teachers. They are working long, long hours. If your child is a distance learner, please make sure they are logging in and doing their work. I know my kids are doing in-person, four days a week, and they are struggling with keeping up with all of the assignments given to them. It seems like some teachers are overloading them, but I think they're just trying to get as much in as possible in case the kids get sick. If kids are doing distance only, there's a tendency to get a little further behind because you don't have that in-person accountability. I've heard that phrase from a lot of parents whose kids are doing distance learning.

The only thing we know for sure is that this situation isn't going away anytime soon. We all need to adjust and figure out what works best for our kids and their teachers to keep them both safe, keep kids on the path of getting their education, and keep the teachers from burning out.

Halloween is a magical time for kids and adults. So how can you continue to enjoy Halloween during COVID? I've got some ideas for you on today's Scope.

Okay. So I admit it, I love Halloween. I was so looking forward to this year because Halloween is on a Saturday and there's a full moon, the perfect setup for the Halloween party we host every year at our house, and then COVID had to happen and mess everything up. Well, not everything. There are still a lot of fun things that you and your kids can do.

For example, we still plan on doing our outdoor decorations. We plan on welcoming trick-or-treaters but in a safe way. Our street is setting up tables that will go from our driveway to our neighbor's driveway across the street, not blocking the road, of course. And we will all be in costume, chairs for family set at least six feet apart, or people are bringing blankets to sit socially distanced on. The houses will all be decorated. We'll be wearing fun Halloween masks, COVID masks, and we'll be passing out individually wrapped treats, but we'll be using hotdog tongs to pick up the treats from the bowls and dropping them directly into the bags of the trick-or-treaters.

We also will have plenty of hand sanitizer available. We also have food and non-food treats. See, we are a teal pumpkin house, meaning we understand about kids with food allergies. I have many food allergies myself. And so we give away things like little tubs of Play-Doh. If kids want to walk past our place and just see all the scary decorations, that's great. If they want treats, we've got them. It's all what parents are comfortable with based on the risk factors that their family has.

So what are some other ideas that can make Halloween during COVID more fun? You can try an outdoor costume parade in the neighborhood or at a park with friends, keeping in mind that the kids still need to have their face masks on and stay six feet apart. And the masks that come with costumes, that's not what I'm talking about. We're talking the regular face masks that you wear every day.

You can also do virtual costume parties if you're good at setting up Zoom meetings. You can have all the kids dress up in their costumes and chat with each other. You can host an outdoor Halloween movie night with age-appropriate movies, or just have a Halloween movie marathon at home as a family. And don't forget decorating and carving pumpkins.

If you're planning on trick-or-treating, remember, again, the masks that come with the costumes are not a good substitute for the double layer COVID masks. Also, have the kids wait at the street if there are already kids at the door. Only go trick-or-treating with your immediate family members. And parents, if you're going with your kids, be sure to wear your masks also. Most importantly, remember this is a time for kids and parents to be creative about ways to celebrate Halloween in a safe way. Happy Halloween.