Talking about Corona with your Kids

All of us are living through an unprecedented experience. We must keep aware of how this is affecting children; they are witnessing these events through the outlook of youth. What should you say to your child and how should you say it? A recent article in my journal Pediatric News interviewed child psychiatrist David Fassler, MD of University of Vermont. Please  allow me to summarize his recommendations, adding a few of my own.

First, be available.  Encourage your children to speak up about their concerns.  Ask them questions–what have they heard, what do they think, what are their friends saying? Don’t push them to discuss subjects if they seem reluctant to do so. Be sure to say only what you know–if you don’t have the answer, say so. You can then look up information together. While you are doing that, remember to share with them that not everything posted on the internet is true or accurate (of course, that applies generally–good opportunity to remind them of that FACT).  Take that opportunity to screen information for them; don’t shrink from gently steering your child away from a site or information that seems too technical, confusing, and in particular that which seems alarming or inaccurate. This is a great time to remind you all that one area to definitely avoid when seeking answers is social media sites which are generally riddled with misinformation.

Talk with your children about this in a calm, balanced, matter of fact way.  Your tone, facial expressions, and body language are all important. If in discussion with other adults, be aware that children may be listening from the side. Endeavor to keep more troubling exchanges out of their earshot. Do acknowledge their fears; its ok to  calmly share your own qualms as well to your child in terms at their intellectual/developmental level. It’s best, wherever possible, to deflect specific questions about family finances in the face of the myriad shutdowns in the community. Regarding that topic, gentle and general reassurance is best. Don’t promise too much, and, again, don’t make untrue statements. Examples: “We are fine right now”; “we are going to pull together and we will take care of each other as we always do.”

Make sure your children maintain their regular healthy lifestyle habits: regular bedtimes and awakenings(in particular with teens); 3 square meals (now that so many are home a lot more, avoid excess snacking); do homework assignments promptly and regularly; read for pleasure.

Finally, and old adage says that “every challenge is an opportunity.” Your children are unable to attend school and many parents are stuck at home idled from work as well.  A great chance for  family time! Read, watch movies together; play games (for the love of Gd, board or card games some instead of just video games!!); take family walks, bike rides, play sports–have a catch, shoot baskets, hit tennis balls together (maintaining appropriate “social distance”).  At least this is happening in springtime–enjoy it.

I quoted George Harrison in my last post–“All Things Must Pass.”  With my aches and pains, I have benefited from the gaining of a bit of wisdom from aging.  I certainly don’t know when, but, eventually, we will get through this.  We just need to remain calm, patient, and–most important– supportive of each other.  ESPECIALLY OUR CHILDREN!!

Thanks for following.

Coronavirus (what else?)

OK, to call these recent events “unprecedented” is just obvious.  I have been in practice for 35 years and have never seen  anything remotely like this. My job as a pediatrician has 2 basic roles:

  • Well care–providing immunizations and expectant evaluations like measuring growth for early identification to prevent problems; as well as discussion and “anticipatory guidance” to preview and prepare young families for what comes next in a child’s life.
  • Diagnose and treat illness and disease–everything from colds, injuries, rashes,  to mental health problems.

And here we are now facing  a worldwide health risk phenomenon. I will not address how or why we got to this point.  We are here now and have to deal with it. That requires some modification in office procedure and practice style. Most of the functions above will continue apace–well check ups and the large majority of acute complaints can be addressed as they always have been.  However, it is obvious that a large percentage of appointments are for cough/fever/ache type illnesses–the very symptoms of COV-19, the “corona” virus. So my office will have to make these adjustments:

  1. We suggest that most children with cough/fever simply stay home, rest, manage symptoms for comfort.  As we all know, most of these sicknesses are caused by viruses (corona included), are “self limited” and will pass on their own.  No specific treatment is necessary or, in fact, useful to shorten the course. Supportive care is all that we need or have.
  2. As always, I encourage my patients to call me for advise.  During this situation I will essentially be screening all sick appointments personally. I will help my staff and parents to decide the best approach for each child’s problem on a case by case basis. Absent fever some can be scheduled in the office. Likely we will ask you to notify us of your arrival, wait in your car and our staff will call your cell to bring you up so you can then be promptly ushered into an exam room.
  3. Along the above, we are going to limit appointment scheduling, seeing fewer patients per hour.  Our goal is to limit any waiting room time as much as possible.  You arrive and go right into a room.  If feasible check in may take place while you sit in the exam room.  Limit exposure for everyone as much as possible.
  4. I urge you not to rush to the ER or urgent care center.  Great way to expose your family to all kinds of nasty critters(we’re talking pathogens here, not other patients!) I will try and help you decide if you need to go, and will call ahead for you–again. minimize wait time and exposure where possible.
  5. In the coming days Coastal Healthcare will have telemedicine capability.  Let me state up front: I am old school.  Treating over the phone or video is, at best, suboptimal. However, under the present circumstances we simply have to make the best of it.  So, again on a case by case basis, and with parents’ agreement, I may opt to treat/prescribe for your child using those electronic encounters only.

Keep in mind: our goal is to help to stop the spread of this dangerous infection. But the good news is evidence from around the world indicates that the vast majority of children are spared serious complications from COV-19.  Unlike the flu, corona causes serious problems mostly for older people.

I appreciate everyone’s patience while we make these (presumably) temporary adjustments. Nothing is forever. George Harrison–typically–sang it so wisely and beautifully:

All Things Must Pass

Be safe, friends.

Common Limb Complaints

Two common and annoying orthopedic problems that we see regularly are growing pains and transient synovitis of the hip.  Both can cause considerable pain and distress but fortunately are otherwise self limited and apparently without any long term implications.

Transient Synovitis of the hip (TS) results from inflammation of the tissue covering the joint (synovium).  It actually can involve any large joint–in particular of the leg–but the large majority of cases involve the hip.  No one knows exactly what causes TS, but as it typically follows URI/viral infections by a few weeks the consensus is that it probably involves some mild, self limited auto-immune issue.  It occurs most typically in children aged 3-8 years with peak at 4-5 years. Children will develop pain and limp fairly abruptly over a day or 2.  The pain may be located in the hip, groin, or buttock and may extend to the knee.  It is very unusual for both sides to be involved.  There may be a mild fever but mostly the children are well appearing. Some children may complain of so much pain that they may at least temporarily be unable to walk.

Lab tests and x-rays are usually normal although on occasion there may be a  small amount of fluid in the joint (effusion) which will invariably resolve on its own.

The only treatment recommended is rest and analgesics like ibuprofen. Infrequently the pain may last for weeks; if so, physical therapy to reduce pain and preserve joint flexibility can be of benefit.

Growing pains are a well defined phenomenon of otherwise vague leg pains.  Nobody knows for sure what causes them either, although my personal guess is that it represents a response to overexertion, with muscle cramps/”Charlie horses.”  Children–or teens–will complain of leg aches and pains at night–NEVER during the day with growing pains.  The pain involves the thighs and calves–NEVER the joints themselves.  These children also are otherwise well appearing–no fevers, rashes , headaches or neck pains, swelling or discoloration of the involved limb.  Growing pains may be an ongoing complaint for some children throughout their early years. As with TS, rest and analgesics are all I recommend; massaging the painful limb often provides good relief as well.  Keep a close eye on activity levels to avoid overexertion. Growing pains ALWAYS resolve by the next morning.

Children with systemic symptoms like high fevers, weakness or fatigue, headaches or neck pains, rashes, multiple joint complaints or ongoing morning stiffness are less likely to have either TS or growing pains. Please call me in these situations so together we can figure out what may be wrong and relieve your child’s discomfort.

Please send along questions or comments, and thanks for following.