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Interviewer: How about the next time you need to see the doctor, you don't have to go into the office, but you can see your physician virtually? We're going to talk about virtual doctor visits next on The Scope.

Announcer: Medical news and research from University of Utah physicans and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Nathan Bexfield is with University of Utah Health Care at the South Jordan Health Center. A brand new thing, because of technology, is starting to happen called virtual visits and I want to find out more about how I can visit my doctor virtually and what conditions qualify. So thanks for taking time. Tell me more about virtual visits.

Dr. Bexfield: Virtual visits are a very cool thing that we have happening here. You can have a visit with your doctor on your computer, on your iPad, iPhone, on your smartphone and just talk to them about what's going on. And we can even diagnose some disorders and some rashes and illnesses via the technology that we have.

Interviewer: So are you using live video streaming. Is it like I call you on FaceTime?

Dr. Bexfield: Yeah, it's like a FaceTime or a Skype call. It goes through something called True Clinic and we are able to talk to you and interact with you like we would if we were in the office.

Interviewer: All right. So if I have a cold, is that a good thing for Virtual Visit?

Dr. Bexfield: Actually, that one's not.

Interviewer: Okay.

Dr. Bexfield: Because that's one where we actually need to lay hands on you and listen to the heart, listen to the lungs, make sure you don't have any ear infection or anything else going on. So we need you to be in the office for that type of visit.

Interviewer: Yeah. So what virtual visits, what are they good for? What conditions?

Dr. Bexfield: Things that we can see so things like rashes. Sometimes eye things that we can look at and just tell whether or not you have a very simple pink eye or something like that. Other things that it's good for are behavioral health issues like depression, anxiety, ADHD, things like that where we are mostly discussing on how things are going, how medication is working, and things like that.

Interviewer: So a follow-up visit.

Dr. Bexfield: Yes.

Interviewer: And why is that beneficial?

Dr. Bexfield: An initial visit where we diagnose those sort of things requires us to do a physical exam and have a little more interaction face-to-face as opposed to virtually.

Interviewer: Yeah. And then those follow-up visits, why is it advantageous not to have to come into the clinic?

Dr. Bexfield: Well, often those follow-up visits are every 3 to 6 months so while that's not super often, we want to make things as convenient as possible. If you don't have to come in for the visit, and you can just talk to me for 15 or 20 minutes through a call, then we can do that. You can do that on your lunch break at work if you want to.

Interviewer: How do you get on the road to a virtual visit?

Dr. Bexfield: You call and make the appointment through our call center.

Interviewer: Just like I would call to make any appointment.

Dr. Bexfield: Exactly.

Interviewer: Okay.

Dr. Bexfield: And they will send you an email, which will have a link that you just click on and it will take you right to the platform that we use for the actual visit.

Interviewer: Do I have to ask for the virtual visit, or is that something the receptionist will offer based on what I've told them?

Dr. Bexfield: They should offer it to you, depending on what the complaint is. But if they don't, and you're wondering whether or not you can do a virtual visit, then just ask.

Interviewer: Okay. And then after I've made that appointment, how quickly does that turn around?

Dr. Bexfield: Well, it's like any other appointment. If you could be seen in the same day, we could do the virtual visit in the same day.

Interviewer: Gotcha. And if it's a rash you'd just take a look at it and you'd go, "Well, that's an easily identifiable rash. I'll write you a prescription." And bing, bang, boom, done.

Dr. Bexfield: Exactly. If we can diagnose it through the virtual visit, then that's even better. Sometimes, there are going to be cases where we can't really tell for sure whether or not it's something that we can diagnose, or whether or not it's something that we need to see in the office. So if that's the case, we may ask you to come in.

Interviewer: And if you have a physician relationship already, and maybe a reoccurring condition, you just need a refill or something that required an office visit at one point, you might even be able to do that virtually, I suppose.

Dr. Bexfield: That is definitely conceivable.

Interviewer: How is this going to change health care?

Dr. Bexfield: I think it's going to make it easy on the patients. I think if you have trouble with transportation, getting in to the clinic, this is going to make things easy for you to do some stuff at home. We can basically do anything through the Internet these days now, so why not do medicine?

Interviewer: And completely secure and private?

Dr. Bexfield: Yes. And that's why we go through True Clinic, as opposed to a FaceTime or a Skype platform. True Clinic is secure; it keeps everything private.

Interviewer: Anything else that you feel compelled to say that I forgot to ask?

Dr. Bexfield: Virtual visits are going to make things way easier on parents, especially parents who have lots of kids. I think we're going to have parents who really appreciate the fact that they can get into and see their doctor whenever they like, provided we have an appointment available, from the comfort of their own home.

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Interviewer: How do you know if your teenager is just being a mopey teenager or might have depression issues? We're going to find out next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Nathan Bexfield is at the South Jordan Health Center part of University of Utah Healthcare, and today we're going to give you some tips as a parent how you can figure out if your child might be suffering from depression or maybe if they're just a mopey teenager, and it can be difficult to tell the two things apart sometimes. So give us some insight.

Dr. Bexfield: So yeah, I think every parent of a teenager wonders how motivated they are to actually get out and do things, but depression is kind of on a whole different level. So with depression, obviously they need to be depressed, and being depressed is like not having really much joy in life. A good example of a kid that may have depression is that maybe this kid enjoyed playing soccer at one point, and that was their passion and they loved it and they wanted to do it a lot, but then suddenly they're not even really wanting to play soccer anymore, and you're wondering, "Well, why don't you get out and play with your friends?"

Interviewer: Yeah, not finding joy in things you used to find joy in.

Dr. Bexfield: Right, exactly. Exactly. Another symptom that can be a little more concerning with kids who might have depression is changes in eating habits. They might eat more than they used to or not eat as much as they used to. Also, watching their sleeping habits. So some kids oversleep. A lot of teenagers will oversleep.

Interviewer: Guilty.

Dr. Bexfield: But these kids are sleeping like 18 hours a day, a crazy amount of sleep, or not being able to fall asleep or stay asleep. So those are the things that you want to look at as well. And teenagers, another thing I find that a lot of them do is they get more irritable. Now I know what you're saying. Irritable teenagers, you're probably like, "Well, every teenager is irritable."

I'm talking like out of proportion irritable like you can't really even have a conversation with them without them just blowing up or getting really frustrated and angry, or crying a lot, extreme sadness. So those are some things I often see in kids of this age. I think extreme cases, there are kids that want to hurt themselves or have thought about suicide, which is very sad, especially to think of a teenage boy or a teenage girl who wants to hurt themselves.

Interviewer: Yeah, I've heard if it gets to that point, that you should seek help immediately.

Dr. Bexfield: Definitely.

Interviewer: If there's any indication that suicide's on the table you should go seek help, because it does one of two things. It either gets the child help and the parent help, or it calls the bluff, if it is bluffing, because sometimes that's what it can be. But what are some other things parents can do? If they recognize what they think to be symptoms of depression, should they seek out help right away or is there something parents can do?

Dr. Bexfield: Definitely. If you are worried about depression in your child you should go see your physician, whether that be your pediatrician or your family practice doctor, but go see your doctor, because we can do some simple screening tests and just have a simple conversation with you and the child, and just kind of find out how things are going. And if your child meets the criteria for someone who has depression, then there are certainly lots of things we can do. The big things that we do that I find works the best is starting an appropriate medication and also getting them into some sort of therapy to allow them to talk things out and have coping mechanisms in place. Sometimes that therapy works even better when the whole family is involved.

Interviewer: Medications, do you find that some parents are little hesitant?

Dr. Bexfield: I do, because there's a little bit of stigma that comes with taking medications for depression or any mental health issue. But the actual truth is there are a lot of people that have gotten a lot of benefit from these medications. So I think this is something that actually helps these kids, and I've seen it in my experience.

Interviewer: How often is depression caused by actually a chemical imbalance in the brain versus just what's going on in their life?

Dr. Bexfield: Well, I think it's a combination of both of those things. Certainly genetics plays a factor in it. If there's a family history of depression, then certainly that child may be a little more prone to depression or anxiety or whatever mental health disorders run in the family. Also, the environment plays a factor. What's your home life? What's your life at school? How are people treating you? How are you being perceived as being treated or how are you perceiving others as treating you? That sort of thing. So I think it's more than just a chemical imbalance versus environment. I think all those factors sort of play in, and once it overwhelms them, then they feel like they're drowning and they can't get up.

Interviewer: You've told me that depression is something that you see more and more often, you feel, in your practice at times, and it seems like you're something very passionate about. So what I'm getting at right now is what would be that one message you'd have to a parent if they think that their child is depressed? Even if they're not sure, because that's a scary step to take, right, to say my child might be depressed?

Dr. Bexfield: That one message I would get out is if you're worried at all, come see your doctor. Let's talk about it. The best case scenario, we can tell you, "Hey, you know what, your child is not really depressed and maybe this is something you guys need to talk about, communicate better," sort of a thing like that." Worst-case scenario is if you don't address it something really bad could happen and your child could end up being harmed.

Interviewer: So even if you have an inkling, no action is worse than action?

Dr. Bexfield: That would be my suggestion, yeah.

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Interviewer: A lot of time parents are looking to save a little extra money and maybe a crib might come into your life because it's a hand me down or it's something you found at a garage sale. Should you buy it? We'll examine that next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to the scope.

Interviewer: Secondhand cribs, are they a good idea or not? We're with pediatrician Nathan Bexfield from University of Utah Hospital. Secondhand cribs, what do you have to say about that?

Dr. Bexfield: So first, and foremost it's probably not a good idea to use a second hand crib.

Interviewer: Under any circumstances?

Dr. Bexfield: Under most circumstances I would say.

Interviewer: That's a pretty strong statement, why is that?

Dr. Bexfield: Well, there are so many different cribs out there and actually we see a lot of recalls for cribs. It's kind of hard to find out which ones have been recalled and which ones haven't. Although there is an excellent website, you can go to www.recalls.gov and you can look and see if that particular crib has been recalled. But they get lost in the mix of things and people go to yard sales and they find a crib and they need a crib and they just buy it without checking into it. The reality is the rules for how cribs are made changed in July of 2011. Some of those changes we have seen are that drop side cribs are pretty much illegal.

Interviewer: Really?

Dr. Bexfield: Yes, you can't sell them in the store.

Interviewer: So don't pull that mattress tag off and don't get a drop side crib.

Dr. Bexfield: No, definitely do not get that drop side crib.

Interviewer: All right.

Dr. Bexfield: You actually see a lot of those in yard sales. We have a yard sale in our neighborhood every year and I think we see one every year just on the side of the road.

Interviewer: And what makes them so dangerous? Why should you avoid them?

Dr. Bexfield: Because it's very easy for the child to drop that side of the crib and fall out.

Interviewer: Okay, or be able to get into things that they shouldn't get into.

Dr. Bexfield: Yes and they can actually get trapped under that side of the crib, they can get pinched on that side of the crib, and like you said, it's pretty dangerous for them to be out roaming around when you think they're safe in their crib and asleep.

Interviewer: What other things should you watch out for when it comes to those used cribs?

Dr. Bexfield: Other things that I watch for with used cribs are things that go into the crib, namely crib bumpers. You want to make sure that the crib bumpers are actually mesh material that fit tight to the side of the crib. Crib bumpers are generally used to keep babies' arms and hands from getting trapped through the slats of the cribs. A lot of crib bumpers are made that do not have that mesh material that are breathable and can actually suffocate children if they're used inside cribs.

Interviewer: All right, so avoid the garage sale crib. Look out for those crib bumpers if they're the solid plastic kind it sounds like. When it comes to cribs what else should you look out for?

Dr. Bexfield: When it comes to cribs you should look out for the old cribs that were made before 2011. Sometimes the height adjustment on those can be somewhat unsafe for the child. If the child is able to get up and get over the side of the crib then they're going to fall and hurt themselves potentially.

Interviewer: That's another issue. But you would just avoid all these things entirely, it sounds like.

Dr. Bexfield: Completely. I would buy a brand a new crib.

Interviewer: All right. Any final thoughts?

Dr. Bexfield: I would say that you want to be smart and make sure you put your child in the safest position possible in their crib and make it so they don't have those sorts of hazards around them while they're sleeping or playing in their crib.

Announcer: We're your daily dose of science, conversation and medicine. This is The Scope. University of Utah Health Sciences Radio.

Interviewer: Why you should avoid that garage sale car seat. We'll examine that next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: It might seem like a really good deal. You go to a garage sale and you find a used car seat. You need a car seat. Should you buy it? We're going to find out right now. We're with Dr. Nathan Bexfield. He's a pediatrician with University Utah Hospital. Tell me, garage sale car seats, good idea or bad idea?

Dr. Bexfield: Well that depends.

Interviewer: Okay. It's not that easy, huh?

Dr. Bexfield: It's not that easy.

Interviewer: All right.

Dr. Bexfield: Now there are some concerns I have when I see car seats at yard sales. The first thing I'm concerned about is does it have the original instruction manual to go with it? The reason I worry about that is that I want to know how to install this car seat correctly. The next thing I get concerned about is are there any missing parts? That's vital to putting the car seat correctly into a vehicle. I want to know if there are any missing parts to this. Also, something we don't normally ask about car seats, especially at yard sales, are has this car seat ever been in an accident? The integrity of the car seat is compromised when a car seat is involved in a car accident. It's recommended if you are in a car accident, you just throw that car seat away.

Interviewer: Kind of like bike helmets.

Dr. Bexfield: Yes. Exactly.

Interviewer: Maybe that alone might be a reason why you might not ever want to buy a car seat whose history you do not know.

Dr. Bexfield: Definitely. Definitely.

Interviewer: All right.

Dr. Bexfield: You also want to ask how old the car seat is. Generally, you want a car seat that's been produced in the last five years. Every car seat has an expiration date. You can actually find that on the car seat. Look it up online through the manufacturer and find out what the expiration date of the car seat is...

Interviewer: Really?

Dr. Bexfield: ...if it's not on the car seat itself.

Interviewer: Why does it have an expiration date like my mayonnaise?

Dr. Bexfield: Well, you don't want the car seat to be too old. The plastic can get really hard and crack especially when it's in an accident.

Interviewer: I mean, I guess that makes sense because they sit in hot cars in sunshine. I guess, just like anything that you leave in there it's going to weaken fairly quickly.

Dr. Bexfield: That's true. That's true. It just puts your baby more at danger when you use an older car seat that's past its expiration date.

Interviewer: That may be a false sense of security, too.

Dr. Bexfield: Exactly.

Interviewer: What are some other things we should watch out for if we decide that we do want to get that garage sale car seat?

Dr. Bexfield: I think one of the biggest things you want to look out for is to see if that car seat has been recalled. We get these little cards with our car seats when we buy them to say register this car seat. The main reason you should do that...

Interviewer: We all do that.

Dr. Bexfield: Exactly. The main reason you should do that is to get a notification whether or not this product needs to be recalled or not due to safety issues.

Interviewer: If you're at a garage sale is there a way you can check that out?

Dr. Bexfield: You can definitely check that out online. There is a website, www.recalls.gov, where you can put in the product and the product number and the brand. It will be able to tell you if that product has been recalled.

Interviewer: Any other thoughts on car seats, that garage sale car seat, that great deal?

Dr. Bexfield: I think the most important thing is to make sure that you are putting your baby in the safest possible scenario. It may be worth the few extra dollars to go out and get something new to make sure your baby is protected.

Announcer: We're your daily dose of science, conversation medicine. This is the Scope, University of Utah Health Sciences Radio.

Interviewer: You might get it free from a relative or maybe you found it at a killer garage sale, but there are second hand items that you should avoid. Hand me downs that harm. We'll examine that next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialist that you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: What second hand kids items should you watch out for? We're calling it hand me downs that harm with Pediatrician Nathan Bexfield from University Utah Hospital. Let's talk about some of these things that maybe you might want to get free from a relative or you found a great deal at a yard sale, but they could cause more harm than their worth. How many would you say that there are?

Dr. Bexfield: I'd like to talk today about strollers, high chairs, used toys and baby furniture.

Interviewer: All right. Let's start out with strollers. What are the things that you should watch out for with strollers? Old hand me down strollers.

Dr. Bexfield: So, first of all you don't want to get any stroller made before 2007. The safety standards have changed with those strollers and they're probably not the safest ways to go when deciding to get a used stroller.

Interviewer: What are some of those safety standards that changed?

Dr. Bexfield: It's the parts that can pinch, cut, harm or fall off and hurt the child.

Interviewer: So, every stroller before 2007 you should avoid?

Dr. Bexfield: I would. If I . . .

Interviewer: Really.

Dr. Bexfield: Yeah

Interviewer: If it was you and you were the parent?

Dr. Bexfield: If it was me and I was the parent I would avoid most strollers before 2007.

Interviewer: All right. Hand me down that harm, number two.

Dr. Bexfield: Number two. I would say high chairs. A lot of people will get hand me down high chairs from grandparents or parents that they used when their kids were kids.

Interviewer: That kind of cool.

Dr. Bexfield: Yeah. It is kind of cool and it's very nostalgic and nice, but you want to watch out for those things because they might not meet the safety standards that newer ones meet.

Interviewer: Okay.

Dr. Bexfield: Such as a five point harness.

Interviewer: Okay.

Dr. Bexfield: So the child doesn't fall out. Also there is a crotch bar that keeps the child from falling out the bottom.

Interviewer: I've seen some of the antique high chairs. There are beautiful. There made out of wood but there legs are very narrow and the seats are very slippery and there is none of those things that keep the kids from just going . . .

Dr. Bexfield: Yeah. And if the kid rocks back and forth a little too much, they can just topple over . . .

Interviewer: All right.

Dr. Bexfield: . . . and have a nice little head injury on your hands.

Interviewer: So if you have one of those heirlooms just display item only or put a dolly in it.

Dr. Bexfield: Exactly.

Interviewer: Not a real kid.

Dr. Bexfield: Exactly. Exactly.

Interviewer: Hand me downs that harm. What's number three?

Dr. Bexfield: Number three. Used toys. So used toys are very, very common in yard sales, garage sales, and online sites. Main thing you want to look at is make sure there is no chips, break in the paint or old paint like lead paint used on those toys, because that can poison the child and also cut them or harm them.

Interviewer: All right. So old dolls might have heads that could easily be removed and become a choking hazard or something like that?

Dr. Bexfield: Exactly.

Interviewer: Gotcha. Hand me down that harm. What's next?

Dr. Bexfield: The last one I got is baby furniture.

Interviewer: All right.

Dr. Bexfield: Baby furniture. Very, very common at yard sales. Expecting parents are looking for these things all over the place. Again, you want to make sure these items have not been recalled and you can check that by looking on the manufacturer's website or calling the manufacturer.

Interviewer: That's probably a good rule for all of these things.

Dr. Bexfield: Definitely.

Interviewer: Some of them could be recalled so you can check for that.

Dr. Bexfield: Definitely. Another thing you want to look for on furniture is peeling paint, chips in the paint, and missing parts that could actually end up harming the child. Like getting fingers pinched. The actual piece of furniture falling apart or falling on the child is a concern as well.

Interviewer: Sure. Something that is old and might not be as stable or sturdy as . . .

Dr. Bexfield: Exactly.

Interviewer: . . . something newer. Any final thoughts on this.

Dr. Bexfield: Final though I would say anything that you buy used or online that's used you want to ask a few questions. Those questions what are what is the model number or product name. If you get an answer to that question, you can always go to a website called www.recalls.gov and that website will tell you if that product has ever been recalled.
Another one is does this product have the original instruction manual with it. Which would be helpful in knowing if you have any missing parts or if it has been recalled. The last thing is when was the item made, how long was it used, and if the seller bought it new or used.

Interviewer: Okay. And by asking those questions like that question there, what kind of answers are you looking for that might make you go ugh?

Dr. Bexfield: An answer would be like I got this used form my cousin that used this with her other three children. By the time it gets to you, it's been used five or six times.

Interviewer: So that's a red flag in your opinion.

Dr. Bexfield: That's a red flag in my opinion. Definitely.

Interviewer: So you as a pediatrician or you as a parent when in doubt . . .

Dr. Bexfield: Don't get it. If you're questioning yourself at all, just don't buy it.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.