Pediatric Care

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.

After Saving Teen’s Life, School Nurse Pleads for Training

Posted on Feb 7, 2020 in Cardiac, Pediatric Care, Scroll Images, Sutter Medical Center, Sacramento, Uncategorized

SACRAMENTO, Calif. – Kathy Papa, a school nurse with the Live Oak Unified School District, spreads her duties among five schools. It was luck – some may say fate or providence – that she was at Live Oak High School just after lunch on Jan. 13 when she got a call to go to English teacher Dani Fernandez’s classroom.

Use of AED
Pediatric electrophysiologist Dr. Oleg Kovalenko of Sutter Children’s Center demostrates how to use an AED.

When she arrived, she found 14-year-old Annalese Contreras slumped in her desk in full cardiac arrest, not breathing and without a pulse. Having been a hospital registered nurse, Kathy knew immediately what was wrong and what needed to be done, but never did she think she’d come upon this situation outside the hospital without a skilled team to assist her.

Kathy immediately sprung into action, starting rescue breaths, directing the 911 call, having two classmates get Annalese out of the desk and onto the floor so compressions could be started, and sending Fernandez to get the school’s portable defibrillator, called an AED. The school had it for years, but it had never been used. After a few successions of CPR, the AED arrived and Kathy applied the pads. The second shock did the trick and Annalese’s heart was back beating. She was then stabilized by EMTs and airlifted to the Sutter Medical Center Children’s Center. 

Annalese suffered cardiac arrest due to ventricular fibrillation, an event that is often fatal. Thanks to Kathy’s heroics and the care she received at the Sutter Children’s Center, Annalese is alive and now recuperating at home. Sutter Children’s Center pediatric electrophysiologist Oleg Kovalenko, M.D., pinpointed her ventricular arrhythmia and Annalese had a defibrillator called an ICD implanted by Sutter electrophysiologist Jonathan Man, M.D., to shock her heart into the correct rhythm when it detects irregular heartbeats.

“Cardiac arrest is an electrical abnormality in the heart. It leads to sudden death in many, many cases and leads to 2,000 deaths a year in children,” said Dr. Kovalenko, Sutter Medical Center’s medical director of pediatric electrophysiology. “In cardiac arrest, there’s no blood flow to your brain and your organs, and the longer a patient stays in this condition, the less chance of survival,” he said, noting that usually that’s just three to five minutes. “The only way to fix it is to shock.”

Annalese Contreras, center, was saved by school nurse Kathy Papa, left, who received the Heartsaver Hero Award from Liam Connelly of the American Heart Association.

Thankfully, Annalese received those shocks within a few minutes. For her efforts, Papa received a Heartsaver Hero Award from the American Heart Association. The AHA and Sutter Medical Center physicians urged all schools to have an AED on-site and train staff on CPR and how to use the defibrillator. Papa started working at the school district in 2019 and already had classes set up to train staff on both, and this event has made it even more important in the staff’s eyes.

As Dan Falco, co-medical director of the Sutter Medical Center Children’s Center said, “That school nurse is the real hero here.” However, Papa was quick to point out that the quick action on the part of Fernandez and the two classmates got Annalese out of the desk are heroes, too.

Annalese’s parents are so grateful to the school and Sutter Children’s Center staff for saving their daughter’s life that they traveled from Live Oak to the hospital to thank them personally and shared their thanks publicly through the media.

“I’d just like to give thanks to everybody – the school, the nurse, the emergency room, the ambulance, the helicopter, the EMS and the hospital – because if it wasn’t for all of them, my daughter wouldn’t be here today,” said Annalese’s father, Felipe Contreras. “I consider all you guys heroes.”

As for Papa, she had a plea: “I want the public to be aware that anyone can save a life, and it just takes a day of training or even just a few hours so that you know what to do in case of an emergency. And,” she said, holding up a portable AED, “this awesome device saves lives. And we all can see that that has happened.”

Here is a video of this story from Fox 40 in Sacramento.