Pediatric Care

Caring for a Newborn in a Pandemic

Posted on Aug 17, 2020 in Carousel, Palo Alto Medical Foundation, Pediatric Care, Quality, Safety, Scroll Images, Uncategorized, Women's Services

This article was written by Anita Mantha, M.D., pediatrician with the Palo Alto Medical Foundation for the August 2020 issue of Bay Area Parent magazine. 

Raising a newborn has never been easy. Nighttime feedings, coping with your own body’s recovery and the constant worry that comes with keeping your little bundle of joy safe are all part of being a new parent. In the midst of a pandemic, that job may be even more challenging. In the era of COVID-19, how do we keep our newborn baby safe, while enjoying the beautiful journey ahead?

If a mother is suspected or known to have COVID-19, how do doctors care for the newborn?

This is an evolving topic, as we learn more about this virus. Many hospitals are currently testing pregnant women around the time of their delivery for COVID-19. You can check with your obstetrician and the hospital team to find out if and when this test is being done if you have questions.

If you do test positive, do not panic. Hospitals have policies and procedures in place to help keep you and medical staff protected. While your care team may look a bit different than you imagined – gowns, face shields, masks and gloves – they will still work hard to support you during your delivery.

Once your baby is born, your care team will likely recommend that you wear a mask and practice good hand hygiene. Your baby may also be tested. Your care team will likely discuss additional precautions around topics such as physical distancing and feeding. Please remember not to put face coverings on children less than 2 years of age.

Can I still breastfeed my baby if I have COVID-19?

The benefits of breast-feeding have been long documented. One of the benefits is that breastmilk has antibodies that help protect the body against bacteria and viruses, potentially making it all the more important to breast feed your newborn now. In limited studies, COVID-19 has not been detected in breast milk. However, we do not know for sure whether mothers with COVID-19 can spread the virus via breast milk. 

What we do know is that it’s important to practice good hand and breast hygiene while pumping. Also, consider having a caregiver in good health offer bottles of your milk. If you have tested positive for COVID-19, you and your care team can discuss when and how to nurse your baby directly. 

What are the symptoms of COVID-19 in a newborn?

Newborns can have a wide range of symptoms including fever (defined as a temperature greater than 100.4F), poor feeding, being very tired, coughing, congestion, runny nose and/or breathing difficulties. The tricky part about newborns is that these symptoms can be caused by a variety of things, so it is important to discuss any concerns with your care team. The good news is that most children (including newborns born on time) with COVID-19 are asymptomatic or have mild symptoms. Prior to going home with your newborn, consider having a thermometer at home and being comfortable taking a rectal temperature, which is the most accurate temperature reading in newborns. Having your physician’s advice line number on hand is also important in case questions arise.

Can I let family members visit the baby? How do I keep my newborn safe from COVID-19?

Aside from COVID-19, we recommend caution, especially in the first month of life, to prevent your baby from catching an infection. Your newborn has an immature immune system and is at risk for serious bacterial infections. For these reasons, a fever is considered an emergency, and you should seek care for your child right away if it happens.

Now, more than ever, try to limit visitors in the first month of life. Anyone who visits should practice careful hand hygiene, practice physical distancing and wear a mask as much as possible. Please remember, even in the midst of a pandemic, normal newborn concerns still exist: jaundice, weight checks, etc. Please keep all regularly scheduled newborn care appointments and inform your care team if you or your baby are symptomatic prior to these visits so they can determine next steps.

I know moms can go through “baby blues.” Won’t physical distancing only make this feeling of isolation worse?

With all that is going on, it is natural for new mothers to feel as if they are on an emotional roller coaster. The important thing is, even though you may need to physically distance yourself to keep your newborn safe, you do not need to emotionally distance. Make sure to connect virtually with friends and family as much as possible. Connecting with other parent friends via video or phone calls can be helpful as well. La Leche League (llli.org) also provides great support to new parents.

What can I do to help my postpartum worries?

Make sure to take time for yourself and try to maintain a bit of a routine to help feel more balanced. Try to avoid frequently checking the news or social media, as this can lead to more stress. Consider some time for meditation, spending time outdoors or anything else you find enjoyable. Postpartum blues can turn into something more serious such as postpartum depression or anxiety, so please seek help if you are feeling that your mood is making it difficult to function. There are many resources to help, so do not wait to reach out. As things are constantly changing, please check with your healthcare team for updates on the care of newborns in this challenging time. The CDC also offers helpful information here.

3 Reasons Not to Skip Well-Child Visits

Posted on Jun 29, 2020 in Pediatric Care, Scroll Images, Wellness

SANTA ROSA, Calif. – A lot happens within a child’s mind and body as they grow. Their personalities emerge, their moods shift, and their bodies mature. With so much rapid change, its important they get on a path to being and staying as healthy as possible, and well-child visits can help ensure this happens. While these visits may have been postponed in recent months, now is the time to check back in.

“Well-child visits help track children’s health and development, address parents’ questions or concerns, and provide recommended immunizations to prevent illness,” says Tara Scott, M.D., program director of the Sutter Santa Rosa Regional Hospital Family Medicine Residency program.

Read on for reasons why scheduling your son or daughter’s well-child visit should be high on your list and the precautions Sutter care centers are taking amid COVID-19:

Physical Development

The physical part of a well-child exam may include checking your child’s blood pressure, vision, hearing, height and weight. Are they overweight? Underweight? A doctor will help address these concerns. The doctor may also listen to your child’s lungs, feel their abdomen and check their reflexes.

It’s during this part of the exam a doctor may also ask about sleep, exercise and their social circle.

“Over the course of a child’s life from birth to 18, they may have between 15 and 20 well-child visits, with more taking place in their early years and then annually or every other year as they get older,” says Scott. “Well-child visits are more than an annual physical, however.”

Mental Health & Development

Just as important as physical growth is mental growth.

“Many mental health problems occur early in life and may disrupt a child’s developmental processes,” says Scott.

During well-child visits, doctors may ask open-ended questions that assess a child’s mental and emotional state. Questions like “What do you want to be when you grow up,” “Tell me about what you’re looking forward to this fall,” “What are your favorite subjects in school,” or “What are you and your friends doing over summer break” may reveal a lot about what’s happening inside your child or teenager’s mind.

In times like a pandemic, where a lot of change is happening very quickly, a doctor may be able to uncover early signs of mental health problems that require specialized care. They may also be able to identify common signs of anxiety or depression and put in place interventions to help alleviate your child’s symptoms.

Vaccinations

Regular well-child visits are the time when important and recommended immunizations are given.

The measles vaccine, for example, is first administered between 12 and 15 months, with the second dose given between four and six years old. Measles are actually more contagious than COVID-19. Once a community measles immunization rate drops below 90 percent vaccinated, outbreaks can happen. In 2014, California dropped below this rate and experienced a measles outbreak, and another one in 2019.

According to Dr. Scott, “Keeping up with current recommended vaccinations keeps children safe from other illnesses that may be even riskier than COVID-19.”

Now is the time to schedule well-child visits. Even if your child is feeling OK, preventive care is very important.

Our Current COVID Precautions

Sutter care centers, including doctors’ offices, have implemented specific measures to help protect patients. These steps include:

Mandatory Masking – Staff, patients and visitors must wear masks at all times.
Isolation – Those with COVID-19 symptoms are treated in separate spaces.
Cleaning – Teams are performing cleaning and disinfecting.
Screening – Everyone is screened for signs and symptoms of COVID-19 before entering care sites.
Contact-Free Check-In – Skip the front desk and check in from your mobile device at some locations through Hello Patient, a new feature on My Health Online.

How to Stay Safe with Rising Heat and COVID-19 Cases

Posted on Jun 26, 2020 in Carousel, Pediatric Care, Quality, Safety, Scroll Images, Sutter Medical Center, Sacramento

Temperatures are rising in Northern California, and so are confirmed cases of COVID-19. How do you keep safe from both? Stay home, says an emergency medicine physician with Sutter Medical Center, Sacramento.

“Our recommendation for the heat is stay inside and exercise intelligently; that’s kind of what we would say about COVID-19. They overlap,” said Arthur Jey, M.D. “Because it’s so hot, we’re not going to want to go out anyway, so it’s a good excuse to stay home with your family.”

With communities opening up and more area residents wanting to take advantage of the great outdoors and other opportunities, Dr. Jey pleads for folks to keep their masks on … or at least handy. Popular activities in the region include walking and hiking, which are great ways to get some fresh air and exercise at the same time. Won’t wearing a mask make you even hotter?

“When you’re outside, walking and hiking, and there’s no one around, you don’t need to wear the mask,” he said. “But you don’t know when you’re going to come close to someone, so keep your mask close by. I am always wearing a mask around my neck or it’s in my pocket. As soon as someone approaches, I put it on. … When there are people around, my mask is on all the time.”

During an interview with the media, Dr. Jey gave some other tips on how to avoid heat-related illnesses, from heat rashes and sunburns to heat exhaustion and heat stroke. Those most susceptible to the heat illnesses include toddlers who can’t communicate that they’re suffering, the very old, and those who have to work in the sun, including farm and construction workers.

What and How Much to Drink

If you are out in the sun, Dr. Jey says the best thing to do is drink a lot of fluids. He recommends good, ol’ plain H2O. Not ice-cold water that can cause cramps, but cooled water. He also recommends sugar-free electrolyte drinks, which are good ways to replenish those essential minerals when working out. Avoid alcoholic beverages along with sodas and sports drinks that contain sugar.

“Make sure you’re smart about what you drink,’ he said. “Alcohol is going to dehydrate you. Really heavy sugared water, like Gatorade, is going to dehydrate you. Electrolyte waters with low or no sugar, fantastic. Water, fantastic.”

He also says it’s not important to count how much fluids to take in, but rather to sip consistently and continually, not a lot at one time. “Everyone asks me how much to drink. Many medical professionals say drink eight to 10 glasses a day. But really, just try to drink well.” He said to take sips at least every half an hour while out in the sun. His counsel: “Don’t wait until you’re thirsty to take a drink.”

He also recommends that those going outside wear light, loose clothing and a hat. “I tend to wear baseball caps a lot, but they aren’t the best choice. The ones that you really want are the wide-brimmed ones, like the fishing hats, that cover the back of your neck. We’ve all been sunburned there before.”

What to Do When You’re Feeling the Heat

“There’s a whole continuum of heat-related diseases,” Dr. Jey says, and they progressively worsen as you’re exposed longer to the hot weather.

1.       Heat rashes, which is a reddening of the skin.

2.       Sunburns, which can be very painful.

3.       Heat exhaustion, when you’re still sweating, but you’re feeling a little woozy or nauseous. Your urine at that point is a darker yellow.

4.       Heat stroke.

“This is when it gets scary,” Dr. Jey says. “You stop sweating and your thinking slows down, and you feel horrible. You look like you’re having a stroke; that’s why it’s called heat stroke. I’ve seen people come in completely confused, acting like they’re almost drunk, that’s when you really get scared. The way you prevent that is that you don’t wait until you’re thirsty to start drinking water.”

He says when heat stroke is happening, the first step is to get out of the heat and let someone know you’re not feeling good. That’s why toddlers who aren’t talking yet are very susceptible to heat illness, because they can’t verbalize how they’re feeling.

Next step: “Get some water in you. Don’t chug it, don’t drink a whole gallon of it. Just sit down in the shade or some air conditioning and sip some water. And, if you don’t get better, then come see us at Sutter.”

Dr. Jey said, even during this pandemic, don’t be afraid to go to the emergency room when you are in a medical emergency, whether it’s heat stroke, a real stroke, or any other kind.

“We get concerned that you push things off too far,” he said. “Our nurses and physicians here work really hard to make sure that we keep you safe. … So if you start feeling problems with temperature, problems with the heat, or for that matter, trouble breathing, come see us. Don’t be scared. We have a separate area for those who we think might have COVID-19. Especially now when we’re starting to have another uprising of it. We’re very cautious of it. But I don’t want that to stop people from coming in when they have other illnesses.”

The Sacramento Bee posted one of Dr. Jey’s interviews on heat illnesses. Click here to watch it, and notice his mask is around his neck for when someone comes close!

How to Support Children and Teens during COVID-19

Posted on Jun 23, 2020 in Pediatric Care, Scroll Images, Uncategorized, Wellness

SACRAMENTO, Calif. – Every young person’s response to a traumatic event like a pandemic is unique and varied, but one thing is certain—it’s stressful. For many children and teens, stress commonly takes shape in the form of resistance, grief or even loss. These are intense emotions for developing minds, so it’s critical they don’t go unchecked.

“As parents, we set the stage for how our kids learn to navigate experiences,” says Anna Morgado, a licensed marriage and family therapist at Sutter Health. “They model behaviors based on what they see, so it’s important we provide support and create channels for safe and open dialogue.”

Morgado continues, “One of the hallmarks of a crisis is that people may feel stuck and like it will go on forever. Talking about ‘when this is all over, we will do…’ provides comfort and a sense of control.”

Here are ways to talk with your kids about COVID-19:

Information provided by Sutter’s Children’s Bereavement Art Group.

• Talking to children about COVID-19 is similar to talking to children about grief. Parents and caregivers should use concrete, simple and developmentally appropriate language to explain concepts.
• Follow your child’s lead. Allow them to ask questions and see where the conversation goes. When talking to teens, you might say, “Are your friends talking about coronavirus? What are they saying?” For younger children, you might say, “Have you heard grownups talking about a new sickness that’s been going around? What have you heard?”
• Talk openly and honestly to children about what’s happening.
• Mention the symptoms of the virus are similar to a flu (cough, fever, shortness of breath). Most people who get the virus have mild symptoms.
• Explain that the virus isn’t very common in children.
• Let them know if someone feels very ill, they can go to the hospital.
• Empower your child by letting them know they can help by practicing good hand washing, not touching their face and sneezing into their elbow.
• Let them know this time of quarantine and social distancing will pass—it’s temporary.
• Explain social distancing as, “We need to stay at least six feet away from people in public and wear masks so that we protect ourselves and others.”
• Tell them that a pandemic can be explained as, “People all over the world are sick with this virus.”

Possible behavior changes from your child

It’s okay that things aren’t normal right now. However, we need to be vigilant when our kid’s behavior is off. Here are changes to look for:

• Excessive crying or irritation in younger children.
• Returning to behaviors they have outgrown (e.g., toileting accidents or bed wetting).
• Excessive worry or sadness.
• Unhealthy eating or sleeping habits.
• Irritability and “acting out” behaviors in teens.
• Poor academic performance or avoiding schoolwork during the school year.
• Difficulty with attention and concentration.
• Avoidance of activities enjoyed in the past.
• Unexplained headaches or body pain.
• Use of alcohol, tobacco or other drugs.

How to support your child

Supporting your child doesn’t have to be a huge lift. Here are activities that will go a long way in bringing normalcy and consistency to their day:

Provide structure and a daily routine. Work together to establish a daily plan that includes mealtimes, bedtime, work time, playtime, creative time and exercise. Set small goals every day. Do your best to attend to your child and your own body, brain and emotions.
Share your feelings while also providing reassurance. Let your child know caregivers are there to keep them safe. Helpful statements include: “There are lots of amazing grown-ups, such as doctors and nurses, working hard to keep us healthy” and “We’ll get through this together.”
Model good self-care. Take breaks, get plenty of sleep, exercise, eat well and stay connected to your friends and family members.
Encourage expression. Let your children express themselves through art, writing, talking things out and physical activity.
Use touch. Take advantage of extra time during the quarantine for cuddles, hugs and play. Physical closeness and care go a long way in helping children feel safe and loved.

Reaching out for help

“These are extraordinary times, so if your child’s in a temporary funk for a day or two that isn’t overly concerning. However, if this prolonged state doesn’t budge, then it may be time to enlist a third party,” says Morgado.

Whether by phone, video chat or in-person, talk to your primary care provider about options. “It’s important to meet children where they are. Our therapists are incredibly skilled at helping kids understand, build resiliency skills and move forward,” says Morgado.

The National Parent Helpline is at 1-855-4A-Parent (1-855-427-2736).

The Sacramento Regional Family Justice Center’s 24-hour Parent Support Line is 1-888-281-3000.

Coronavirus Science: Two Studies Raise New Concerns

Posted on May 5, 2020 in Carousel, Innovation, Mills-Peninsula Health Services, Palo Alto Medical Foundation, Pediatric Care, People, Research, Scroll Images, Uncategorized

Every day brings new scientific insights into COVID-19 and the coronavirus that causes it. Studies authored by Sutter Health experts examine the virus’s impact on children and diabetic adults.

COVID-19 and Kawasaki Disease

Recently, doctors began warning of a potential consequence of COVID-19 infection in children; some youngsters appear to develop an abnormal immune response that results in symptoms commonly associated with Kawasaki disease or toxic shock syndrome – two rare, but well-characterized inflammatory conditions. The first known U.S. case of Kawasaki disease possibly connected to COVID-19 was reported by Veena Jones, M.D., (lead author) and Dominique Suarez, M.D., both pediatric hospitalists with the Palo Alto Medical Foundation, part of the Sutter Medical Network.

Veena Jones, M.D.

Their six-month-old patient was diagnosed with classic Kawasaki disease, admitted to the hospital for treatment, and subsequently received a positive test result for COVID-19. The main reason for treatment in children with Kawasaki disease is to prevent further complications of the disease on the heart. The patient received appropriate treatment and has since fully recovered and has maintained normal heart function. But the case caused the doctors to question: could the COVID-19 infection have led the patient to develop Kawasaki disease?

“Our patient met the classic criteria for Kawasaki disease, so there was little doubt about the diagnosis or treatment plan,” said Dr. Jones. “But we do wonder if the COVID-19 infection could have caused the Kawasaki disease, especially because Kawasaki disease is widely thought to be triggered by an infection or an abnormal immune response to an infection.”

Dominique Suarez, M.D.

A careful review of the existing medical literature found that COVID-19 co-occurring with Kawasaki disease had not previously been reported, so the doctors decided to write up the case and submit it to the Journal of Hospital Pediatrics for publication. “Researchers still know very little about exactly why Kawasaki disease develops in some patients, so our hope was to accurately describe the novel case that we encountered and share that with the medical community to encourage further investigation and dialogue,” said Jones. In the race to understand the burden of COVID-19 on the human body this kind of early observation by doctors on the frontline can help inform future decisions around diagnosis and treatment.

COVID-19 and Diabetes

Since the start of the coronavirus pandemic many have warned that people with existing chronic illness who contracted the infection would become sicker than those without. Now, research authored by Sutter Health clinician David Klonoff, M.D. suggests that diabetes, one of the most serious chronic illnesses in the world, is strongly correlated with death among hospitalized patients diagnosed with COVID-19.

David Klonoff, M.D.

Accepted by the Journal of Diabetes Science and Technology, Dr. Klonoff’s paper represents the largest study yet reported on outcomes of patients with COVID-19 and diabetes or uncontrolled hyperglycemia. The observational study of 1122 inpatients with COVID-19 at US hospitals between March 1 and April 6, 2020, found that those with diabetes or hyperglycemia throughout their hospital stay had a four-fold greater inpatient mortality than those without diabetes or hyperglycemia. In a further subset analysis, death rates were seven-fold greater among those who did not have evidence of diabetes prior to admission, but developed hyperglycemia during their hospitalization.

The study also demonstrated that during a hospitalization for COVID-19, the presence of diabetes or hyperglycemia was associated with a longer hospital stay and slightly worse kidney function.

“I am now analyzing the same database to determine whether COVID-19 patients with diabetes and uncontrolled hyperglycemia, who were better controlled in the hospital, had better outcomes,” said Klonoff. If an association between greater survival and achieving target glycemia (following initial hyperglycemia) is demonstrated, and acted on, lives could be saved.

“These data may have wide implications for how we care for COVID-19 positive patients who experience hyperglycemia during their hospital stay or who have already been diagnosed with diabetes.”

The Surprising Place Where COVID-19 Can Appear

Posted on Apr 3, 2020 in Carousel, Pediatric Care, Quality, Safety, Scroll Images, Sutter Medical Center, Sacramento, Uncategorized

SACRAMENTO, Calif. – If your child is in diapers or is being potty-trained, don’t poo-poo this advice. During this coronavirus pandemic, it may just save your life or that of a loved one.

Paul Walsh, M.D., medical director of the Pediatric Emergency Department at Sutter Medical Center, Sacramento, says that babies and small children may not show any signs at all of being sick with COVID-19. But the “presents” they’re leaving behind may be especially harmful as they could contain traces of the virus.

Dr. Walsh said hand-washing during this time is important for everyone, but it’s critical for those who are changing diapers or potty-training toddlers.

“One of the cases that came out of China was a child who was orphaned at 6 months old because he was shedding lots of the coronavirus, but had no symptoms whatsoever,” he said. “So remember to wash your hands thoroughly after every diaper change or potty time.”

Dr. Walsh admits that everyone is at risk for catching the virus, but children usually handle such sicknesses much better than adults do.

“Children have vigorous immune systems,” Dr. Walsh says. “It’s not just with this virus, but with most colds and other sicknesses. Their bodies aggressively fight off the sickness.”

With the first death of an infant who tested positive for COVID-19, Dr. Walsh said parents shouldn’t be too anxious.

“There’s no need to freak out,” he said, “but be vigilant with hand-washing and social distancing. Observe your children in their activities. And, especially, keep them away from seniors. They’re still the most at risk.”

Dr. Paul Walsh treats a child in the dedicated Pediatric Emergency Department at Sutter Medical Center, Sacramento.