Monday, June 23rd, 2014
A meeting of a sub-group of the American Academy of Pediatrics (AAP) that studies childhood resilience and the effects of toxic stress heard from a number of experts who all urged doctors to practice versions of the same advice–make understanding of the parent-child relationship a priority, and do that by modeling and teaching parents good listening skills. Too many doctors, the group heard, work with stressed out kids (on a rushed timetable, at that) without offering holistic support for the families, which includes understanding the mechanisms of how stress affects parents as well.
Toxic stress is chronic, unrelenting stress that can have serious and ongoing health effects on kids (and parents). More on the AAP’s prescribed “two generation approach” to helping families cope from The Boston Globe:
People need to feel safe to be able talk about what is important. This includes both the clinician and the parent. When the pediatrician feels stressed by a waiting room full of patients that the current system of care demands he must see, he is not able to be present with a parent in the way that careful listening requires.
It is like a set of Russian dolls. The society values the clinician’s time, offering the opportunity to listen to the parent, who listens to the child. And as many at the symposium recognized, it is not just pediatricians, but also child care workers, teachers, home visitors and others who have the opportunity to support stressed parents. All policy needs to be focused on protecting space and time to listen. Listening is not high tech. But it is this space and time, where parents feel safe and valued, that we have the opportunity to grow healthy brains and minds….
….when parents, who may be stressed and overwhelmed, feel heard, recognized and understood, they are better able to do the same for their child. When parents listen to their child, are fully present with their child, they offer the opportunity build resilience and the capacity to manage adversity. It is not about giving information, or even about teaching skills. It is about supporting parents’ efforts to connect with their most competent self.
Image: Stressed-out mother, via Shutterstock
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Friday, February 14th, 2014
A new study has linked routine well-child visits–which are advised and recommended at least on an annual basis–with an increased risk that children will be exposed to flu or flu-like germs in the waiting or examination rooms. The study, published in the journal Infection Control and Hospital Epidemiology, emphasized that the findings, which translate to more than 700,000 potentially avoidable illnesses and a $492 million pricetag each year, underscore the importance that doctor’s offices follow existing infection control guidelines.
“Well child visits are critically important. However, our results demonstrate that healthcare professionals should devote more attention to reducing the risk of spreading infections in waiting rooms and clinics. Infection control guidelines currently exist. To increase patient safety in outpatient settings, more attention should be paid to these guidelines by healthcare professionals, patients, and their families,” said Phil Polgreen, MD, MPH, lead author of the study, in a statement.
Researchers from the University of Iowa used data from the Agency for Healthcare Research and Quality’s (AHRQ) Medical Expenditure Panel Survey to examine the healthcare trends of 84,595 families collected from 1996-2008. Included in the analysis were demographic, office-based, emergency room, and outpatient cases records. After controlling for factors, such as the presence of other children, insurance, and demographics, the authors found that well-child visits for children younger than six years old increased the probability of a flu-like illness in these children or their families during the subsequent two weeks by 3.2 percentage points.
This incremental risk could amount to more than 700,000 avoidable cases of flu-like illness each year and $492 million in direct and indirect costs, based on established estimates for outpatient influenza.
In a commentary accompanying the study, Lisa Saiman, MD, notes, “The true cost of flu-like illnesses are much higher since only a fraction result in ambulatory visits and many more cases are likely to result in missed work or school days. Furthermore, these flu-like illness visits are associated with inappropriate antimicrobial use.”
The authors stress the importance of infection prevention and control in ambulatory settings, suggesting pediatric clinics follow recommended guidelines that include improving environmental cleaning, cough etiquette, and hand hygiene compliance.
“Even with interventions, such as the restricted use of communal toys or separate sick and well-child waiting areas, if hand-hygiene compliance is poor, and potentially infectious patients are not wearing masks, preventable infections will continue to occur,” said Polgreen.
Is your kid too sick to go to school? Take our quiz to find out.
Image: Pediatrician’s office, via Shutterstock
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Thursday, July 25th, 2013
A growing number of retail stores are offering pediatric care services, examining kids with minor health issues and saving parents a trip to the doctor’s office. A new study published in the journal JAMA Pediatrics is taking a closer look at whether these retail clinics are as effective as they are convenient. More from Time.com:
Researchers from Washington University School of Medicine, St. Louis report that even families with well-established relationships with a pediatrician take advantage of pediatric retail clinics to take care of their children’s minor health issues, even if they are staffed with non-pediatric health care personnel.
Why? The researchers surveyed 1,484 parents from 19 Midwestern pediatric practices who said that they took their kids to the clinics out of convenience; 74% of the parents said they first considered going to their pediatrician, but 37% decided on the retail clinic because it had hours that conformed better with their schedules.
In a corresponding editorial, Dr. Edward Schor of the Lucille Packard Foundation for Children’s Health in Palo Alto, California wrote that such decisions may become more commonplace: “Retail-based clinics reflect systemic changes occurring within the health care industry to which pediatric practices must adapt.” Retail clinics, which are typically run by nurse practitioners and physician assistants, are not only convenient, but cost patients about 30% to 40% less than office practices. Most of these clinics are located in retail pharmacy stores, while others are operated by hospitals or doctors’ groups.
The lower cost and increased convenience of the clinics are putting pediatricians on the defensive, and the American Academy of Pediatrics (AAP) formally opposes them as an appropriate venue for care of infants and children. AAP officials question the quality of care patients receive, stemming from the fact that children may see different practitioners at each visit.
Image: Mother and child at pharmacy, via Shutterstock
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Wednesday, January 16th, 2013
Parents who offer their children complementary and alternative medical therapies including acupuncture, herbal supplements, and chiropractic care, are not necessarily forthcoming about those practices with their pediatricians, a new study published in the journal Pediatrics has found. Sharing more information with pediatricians would, however, benefit children, parents, and doctors alike, as CNN reports:
The most commonly used CAM therapies included massage, faith healing, chiropractic and aromatherapy, while the most popular products to treat conditions ranging from cancer to asthma and inflammatory bowel disease were vitamins and minerals, herbal remedies and homeopathic medicines.
“Whether we’re looking at the general population or at children’s hospitals, it seems that complementary medicine use is extremely common,” says Dr. Sunita Vohra, lead author of the study and a pediatrician who is chair of the section on integrated medicine for the American Academy of Pediatrics.
In the United States, a recent survey found that one in nine children had used alternative therapies to treat a health condition.
Vohra says parents’ own beliefs about and reliance on CAM therapies is a major factor behind its use in children, as is parents’ desire to provide their children with every possible health option.
“For most parents, their number one priority is the health of their children so they’re interested in exploring all options to promote their children’s health,” says Vohra. “Many parents consider all products that are available and seek out not only conventional health care but also complementary health care.”
With CAM being used by so many children, however, she and her colleagues say it’s time for pediatricians to do a better job of discussing the safety and efficacy of the therapies with parents.
“Given the rates of use, we would like to encourage all health care providers to ask about complementary therapies and we encourage all parents to tell,” says Vohra. “In many cases, it’s not discussed because parents think doctors won’t support them, but it’s far better to have an open discussion.”
Such discussions can avoid potentially harmful interactions between conventional medicines and herbal remedies, for example, or other incompatibilities that can worsen, rather than improve, symptoms. In the study, parents reported 80 adverse effects, most of which were described as minor.
Most parents, says Vohra, will deny that their children are taking alternative therapies, even if they are — and not because they want to intentionally deceive their doctors.
“They don’t think of herbs as medicine,” says Vohra. “So doctors should ask parents, ‘What are all the therapies, including complementary medicines, that your child is taking?’”
Image: Acupuncture, via Shutterstock
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Wednesday, October 10th, 2012
A growing trend in pediatric care may be in the technology devices teenagers carry with them everywhere they go: doctors are using text messaging and other communication strategies to communicate better with their patients. From The New York Times:
But using social media also raises questions about doctor-patient boundaries, privacy laws and confidentiality. Should doctors “friend” young patients on Facebook? What rules should doctors establish about texting with teenagers: content, hours and expectations of speedy replies? How should doctors take into account the reality that teenagers’ cellphones are often missing in action, only to be found — and pored over — by friends and parents?
For these reasons, many doctors stop short of texting. Because texting is not encrypted and does not comply with privacy laws, “my clinic rules forbid me,” said Dr. Wendy Sue Swanson, a pediatrician who treats teenagers at the Everett Clinic, which is outside Seattle, and at Seattle Children’s Hospital.
But teenagers follow her on Twitter and her Seattle Mama Doc blog, on which she writes commentary and posts health news and videos.
During visits, she will ask a teenager the safest way to pass along private information. For those on birth control, she’ll say, “Take out your cellphone and put in a daily alarm about when to take your pill. Call it…‘strawberry.’ ”
Dr. Swanson won’t answer individual questions on her blog. “But if they ask a question in my office that I think a lot of teens would like to know about,” she added, “I can put the content on the blog without identifying the patient.”
In New York, Mount Sinai Hospital’s Adolescent Health Center uses a program called Text in the City to send patients tips and reminders about medications and appointments. Patients can also text questions, understanding that answers may not arrive for 24 hours. Dr. Katie Malbon, who writes most of the responses, said she cautions: delete an answer after reading it….
….But many doctors cannot imagine adding social media responsibilities to an already exhausting practice. Dr. [Natasha] Burgert, 36, is a juggernaut: With two children, she has a busy practice, keeps a blog on her group’s Web site, posts Twitter messages, texts her teenage patients and still sticks to an 8-to-5 workday.
She carries a paper notebook to jot reminders, and spends 15 minutes a day sending texts and e-mails. It saves her hours of phone tag with patients.
The teenagers don’t overload her with exchanges, she said. “They understand it is a privilege, that not all physicians will do this. Actually, I have more problems with first-time parents.”
Image: Doctor texting, via Shutterstock
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