Lately I have tried to keep current regarding the COVID 19 outbreak, which is virtually the only thing on our minds. A great concern for pediatricians has been a marked increase in “accidental” injuries, driven mainly by 2 factors: normal routines disrupted, allowing greater opportunity for errors affecting safe practices previously built into daily schedules; and increased at home time for children resulting in more potential for harmful incidents.

Everyone  now focuses on cleanliness: clean hands, all surfaces constantly scrubbed.  Be careful! These agents are all caustic and poisonous. We pediatricians have been warning about the risk of household cleansers left out inadvertently. This was a concern before Mr. Trump’s unfortunate public comments about their use (at least hypothetically) as some form of treatment.  Whatever one’s politics, that certainly was not helpful in this regard.  Hand sanitizing agents are all high in ethyl and isopropyl alcohol, which also can cause serious toxicity when swallowed  or in one’s eyes.  We all must be vigilant in handling these materials.  Keep them high up, out of reach of all young children(<10 at least);  BE SURE to assess if older children are intellectually and emotionally equipped to use properly. Wherever possible, direct parental supervision is best.

Keep ALL medicines in original, properly labelled bottles, replace  in medicine cabinets immediately after taking the prescribed dose–DO NOT leave them on the counter where they may be discovered by children when unsupervised, even momentarily.  Don’t leave batteries, lighters, coins, jewelry around for toddlers–everything in boxes,  drawers up out of reach.

A special word about FIREARMS if you keep them in your home: both the weapon AND the ammunition should be stored in locked containers, SEPARATELY, away from all minors.  Children should NOT have access to the keys. It is always more dangerous to keep loaded weapons at home.  That is even truer now–children are home more!

Regarding emergency rooms: most pediatric ER’s are closed due to low volume with all care now shunted to the main ER.  I have previously advised against overuse of ER’s for more trivial, non-emergent matters.  Now, it seems, the opposite may be occurring.  Local pediatric ER physicians and surgeons report that the incidence of appendicitis diagnosis has shifted.  The ratio of early to perforated (later, more serious) diagnosis –previously 70/30 in favor of early, safer identification is more recently exactly the opposite– 70% of appendicitis diagnosis currently have already perforated and the children are much sicker. Likely this is due to an understandable, but in this instance misplaced, fear of being exposed to COVID.

That is just one statistic that reminds us that we must balance our legitimate worries with what we see in front of us at the time with a potentially sick child. I remind all of my patients that I am in my office and available by phone almost every day(where am I going to go?–I’m locked down too!) Please do not avoid addressing your child’s health concern.  Call me–we can discuss it, I can see them in the office, the PARKING LOT, and we are set  up for televisits as well.  I can call ahead to the ER to streamline your visit if we both agree it’s necessary.

Thanks for following.

When Can We Be “Normal?”

I hope everyone is coping with our “new normal.” We must be patient for everyone’s protection.  Currently there are press reports about “opening up” and “getting back to work.”  Everyone wants that, and be free to make choices for ourselves.  However, we also know 2 things about covid: people are contagious well before they feel sick, and there is a substantial pool of infected persons who never feel clinically unwell.  Thus, our choices effect not just ourselves but all we contact when we are out. I think all reasonable people accept that we each owe our friends and neighbors to take reasonable steps to avoid infecting each other with a potentially life threatening disease. As the saying goes, we are in this together.

Currently testing reveals about 20% positive results.  This number is so high because the total number of tested subjects is still too low–still not enough tests available. Officials indicate that a safe “+” rate is < 10%; then we know that infected people do not “slip under the radar,” spreading the infection further, but rather can be isolated for the appropriate duration, allowing all others to more safely go about as before.  The medical establishment–government officials and private industry–are working diligently to produce the necessary testing structure for that.   2 other things are necessary to return “to normal”: marked decrease in new cases, and ability for widespread antibody test to assess immune response.  Admittedly, the latter is still only partial information: the presence of antibody doesn’t guarantee immunity. Knowing that association will take longer, but we’ll have to go with the best information available.  Everyone agrees that we cannot do this forever, but, again, let’s be patient and listen to the public health experts.

We in the American Academy of Pediatrics continue to monitor children’s health.  We are concerned that the present situation, with parents too understandably fearful to keep regular well care, may allow common medical conditions to fester.  Children with  asthma, diabetes, obesity, chronic skin problems, ADHD and mental health difficulties should try and keep regular well/follow up care so we can monitor them and prevent transient exacerbations from turning more serious. Additionally, there are already reports of marked decrease in the worldwide administrating of regular vaccines.  That means we are at risk to see the return of major illnesses like whooping cough, measles, meningitis. It is imperative for us to prevent that from happening on top of corona, so we pediatricians urge parents to bring those < 2 years old and all children in need of vaccines to come in and get immunized.

My office continues to be open to help you with your child’s health needs, including routine “anticipatory guidance” regarding diet and sleep habits, child development, phone/game use, personal safety, smoking/vaping and drug/alcohol prevention, school and discipline issues, adolescent sexual health/responsibility and all other aspects as your child grows up. We have televisit capacity, are manic ourselves about cleaning surfaces and glove/mask (frankly, for our own protection too!), can administer vaccines in the parking lot–whatever we should do to keep your child healthy as I’ve enjoyed the opportunity to do for 35 years as a pediatrician.

Call with questions or concerns, and thanks for following.

More on Your Kid and COVID-19

Of course we are all dealing with unprecedented stress during this difficult time.  People are concerned for their physical and financial well being while being cooped up and unable to enjoy typical stress relievers like family/friend interaction, going out to dinner, movies/plays/sporting events (to participate or watch), as well as deeper endeavors like attending religious worship.

There are already studies chronicling the toll this may be taking on family interactions.  19% of parents admit shouting or screaming at their children now, 15% report spanking or slapping them and 11% admit to multiple such incidents.  The AAP has concerns that the incidence of child abuse and/or neglect could rise.  In many instances, a teacher, clergy, or doctor is the first person to recognize a problem and notify the authorities.  With these contacts largely on hold, some of these mistreatments may go unnoticed and unreported.

We at the AAP advocate that it is essentially never appropriate to discipline a child with acts of physical force, or to take actions that berate, belittle, or humiliate them. I cannot overemphasize how strongly we pediatricians feel about this subject.  Here are some of the Academy’s guidelines on how to limit the stresses of “shelter in place.”

With children at home so much more, there is also a greater risk of accidental injuries there.  Some suggestions/reminders:

1. Use childproof locks and gates, including on staircases.
2. No walkers–jumper/saucer seats are safer. Better yet, just let your young toddler play freely on the floor with you to supervise.
3. Be careful in the use of elevated surfaces with toddlers(changing tables). The floor is safer.
4. Secure electric wires and use electric outlet covers.
5. Secure window treatment cords.
6. No small hard foods or toys within reach of toddlers (if the object fits in a toilet paper roll in 2 planes–length and width– then it can be swallowed or inhaled)
7. Store cleansers, toxins, poisons high up, out of reach of young children.
8. Do not use space heaters in your home.
9. Never leave infants or toddlers unattended by standing water like a bathtub.  Little children can even fall head first into a toilet and drown.  Keep the bathroom door closed so they do not wander in unnoticed.
10. Keep all medicines in their original containers and store in medicine cabinets at all times.
11. Rubber bumpers on all sharp edges (coffee tables, fireplace).
12. If you own firearms, keep them and ammunition stored separately in locked containers, out of reach of children, and keep keys in separate, secure location.

Keep distance, keep safe, and thanks for following.