What is a Medical Home and how does it relate to my child’s care?

Medical Home - Emergency vs. Urgent Care vs. Pediatrician

By Abbie Engelhardt, R.N. for Lee’s Summit Physicians Group

Some of you are probably thinking, what in the world is a Medical Home? Well, let me explain.

A Medical Home is all about you and your child. It’s a team approach, combined with information technology, to create an accountable “continuity of high quality care”. In other words, to make sure that patients don’t fall through the cracks. At Lee’s Summit Physicians Group, our primary focus is to provide comprehensive, personalized care to our patients and families in a compassionate and welcoming environment.

A Medical Home means that your pediatric team –

  • Knows the health history of your child. (Family, life situation and health goals.)
  • Keeps your child’s complete medical history in one place.
  • Takes care of any short-term illness, long-term chronic illness, and your child’s all-around well-being.
  • Follows up with any other health care providers your child receives care from, when necessary.
  • Works in partnership with you to make sure that the medical and non-medical needs of your child and family are met.
  • Creates a trusting, collaborative relationship with you and your child.
  • Treats your child with compassion and an understanding of his/her strengths.
  • Develops a plan of care with you and your child when needed.
  • Notify you of test results in a timely manner.
  • Respects and honors your culture and traditions.
  • Help make the best decisions for your child’s care.

What is your job as a parent?

  • Know that you are a full partner with us in your children’s care.
  • Come to each visit with any updates on medications, supplements, or remedies you are using, and with any questions you may have.
  • Remember to tell your pediatric team about any care received between visits (emergency room, urgent care clinics, specialists).
  • Keeps scheduled appointments or call to reschedule or cancel as early as possible.
  • Understand your children’s health conditions and what you can do to stay as healthy as possible.
  • Work with us to develop and follow a plan that is best for your children’s health. Let us know of any obstacles to the plan.
  • Give medication as prescribed.
  • Learn about your health insurance coverage.
  • Don’t be afraid to ask questions!

Is it okay to go outside of your primary Medical Home?

Yes, however, you should always start at Home (for example, Lee’s Summit Physicians Group.) When your child is sick or hurt, it can be difficult to tell whether an urgent care or emergency department is the best choice. In making that decision, it’s important to stay calm and recognize the difference between a medical emergency and a medical situation where a different type of care is more appropriate.

Remember… for non-emergency situations, first call your child’s pediatrician. We have phone nurses available Monday through Friday 8am to 4:30pm. After hours calls are available with a small fee. Many insurance companies provide phone nurses as well. We have urgent care hours 7 days a week.

If you believe the injury or illness is life threatening or may have caused permanent harm, go to the emergency room or call an ambulance. If your child is seriously ill or injured, it is safer for your child to be transported by an ambulance.

Who are we? We are your pediatric Medical Home!

Our pediatric department is open 7 days a week. Lee’s Summit, Raintree and Blue Springs offices all have urgent care hours Monday through Thursday 8am-6pm and Fridays 8am-11pm.  On weekends, only the Lee’s Summit office is open and the hours are 8-11 on Saturday and Sunday.

Medical Home Frequently asked questions:

What does a Medical Home eliminate?
Unnecessary ER visits, missed immunizations/labs, doctor hopping, expensive co-pays, unnecessary costs, duplicate testing (labs, imaging).

My child may need an x-ray, can you do that in your office?
No, but we can evaluate the child and if an x-ray is necessary, we will send an order to Children’s Mercy or Diagnostic Imaging. You don’t need to go to an urgent care that has x-ray services.

Is it okay to go to Children’s Mercy urgent care?
Yes, especially if it is after hours here and can’t wait until the next day during our urgent care hours. If it can wait, you can wait to bring them to their Medical Home.

Does my child really need a Well child check every year even though they don’t need immunizations?
Yes, it is important to monitor their growth and development. Prevention is key to raising a healthy child.

Do you live in a Haunted House? That might not be candy…

By Dena Pepple, R.N. for Lee’s Summit Physicians Group.

We’re not far from Halloween… Are there monsters under your bed or ghosts in your closets? Do you hear creaks and noises in the night? Are you afraid to go to the basement alone? Maybe, you live in a haunted house!

Most of you are laughing or rolling your eyes right about now, but I’m here to tell you that your house may very well be haunted and those dangers are lurking before your very eyes. How do I know this? Unfortunately, it’s all in the numbers.

The National Safety Council says more than a third of child injuries and deaths happen at home. Every year, 3.4 million children are injured unintentionally in the home. About 2,000 of these children (age 14 and under) die as a result. According to the Consumer Product Safety Commission, every 17 minutes an injury from a home furnishing tip-over occurs. The National Safety Council also states that medications are the leading cause of child poisoning.

The causes of these unintentional injuries include burns, suffocation, drowning, firearms, falls and poisoning.

Poison and Candy Look AlikesEvery cause is equally important and must be addressed in every home where children live or visit. The following web sites are overflowing with great information, handouts, education, interactive games, videos, safety checklists, and more:

Poison Look-alikes

One of the causes of unintentional home injuries that I want to discuss in more detail during this Halloween season are poison look-alikes.

I recently received a pamphlet from the Missouri Poison Center (PDF) that had some eye-catching and disturbing pictures of these poison look-alikes. Rat poison pellets look like Nerds candy. Nicotine gum and Dentyne gum come in similar little white squares. Some cleaning solutions and Gatorade have the same purple color. Gummy bears can be candy, vitamins, or even CBD infused. Of course, we all know the old joke of x-lax and chocolates.

Can children tell the difference?

We adults can see or read what the look-alikes really are, but our children may not be able to tell the difference.

In 2017, the Poison Control Centers in the United States received 2.12 million phone calls for human poison exposure. They state peak poison frequency occurs between one and two years of age, and 45% of poison exposures occur in children under the age of 6 years.

So, what can you do?

OUT OF SIGHT, OUT OF REACH, AND LOCKED UP should be your mantra for all medications and other potentially hazardous materials in your home. Keep all medicines and products in their original containers.

Be clear with your children that candy is candy and medicine is medicine.  Do not tell your children medicine is candy so they will be more inclined to swallow. As you are thinking about trick-or-treating and candy bags, look and see what else could be on that look-alike list. Keep the Missouri Poison Center phone number in a prominent place at home and in your cell phone. Most importantly, if you even suspect a poisonous ingestion CALL, CALL, CALL the poison center number!

Missouri Poison Center Phone Number: 1-800-222-1222

Tip-over Injuries

There is another safety issue hidden in plain sight in our homes. Our home furnishings can cause tip-over injuries. 195 deaths were caused by furniture tip-over accidents between 2000 and 2016. Sadly, from 2015 to 2016 the number of tip-over accidents increased by 33%, raising the total number of deaths to 26 per year. ER visits from tip-over accidents are estimated at >30,000 between 2014 and 2016.

The fix here is the use of furniture straps on every potential tip-over furnishing.

Dressers, televisions, bookcases, and any other tip prone furniture should be securely attached to the wall. These straps can be found online at many stores (Home Depot, Target, Walmart, Lowes, and more).

Charlie’s House

Charlie's House LogoYou can also get these straps for free at Charlie’s House.

Charlie’s House is a non-profit organization started here in Kansas City, in memory of a beautiful little boy named Charlie. Charlie died in his home in a dresser tip-over accident. They educate on home safety and are in the process of building a real safety house to better educate parents about these safety issues, and ultimately save lives.    They also offer other home safety devices such as cord covers, drawer latches, outlet covers, and more.

Thirty-two years ago I child proofed my home for the first time.

We read about home safety advice, put up gates, attached drawer locks, had poison control numbers ready, and used a “real” car seat to bring our baby home. We were ready to keep our kiddo safe… or so we thought.

That baby (my daughter) is now having her own babies and childproofing her own home. She makes me look like a rookie. She has multiple gates, doorknob grips everywhere, soft furniture corner covers, a locked medicine box, furniture straps, cabinet locks, and more. I teased her that her house was almost grandma proof! But she did it right and knows that it’s an ongoing, evolving and everyday process. I am proud of her and her vigilance to protect her children.

As our family fun month of October continues, enjoy the cooler weather, school activities, pumpkin spice everything, and of course Halloween candy and parties. Have fun with your scary costumes and haunted houses. But don’t forget the scares in your own “Haunted House”.  Be prepared, stay alert, use the resources listed, and protect your little goblins.

Let’s keep the haunted houses in Halloween where they belong!

Taking Care of our Own: Sabrina’s Story

By Rhonda Pfaffly, Referral Coordinator for Lee’s Summit Physicians Group.

It seems like the news and social media are focused on sensational, negative things most of the time. It’s draining. Wouldn’t it be nice to hear some good news for a change? Well, I’ve got a story for you. Here at Lee’s Summit Physicians Group, we’re family… not a collection of employee numbers or bodies filling chairs. I’ve gotten to watch this story play out over the past few months.

Sabrina

SabrinaSabrina works at the front desk at our Rain Tree office. She’s been with LSPG for several years, working full time and going to school to be a radiologist technician.

Unfortunately, a couple of months ago, she was involved in a grease fire and sustained 1st, 2nd and 3rd degree burns to her face, arms, legs, chest, abdomen and back. She was in the Research Burn Unit for the past several months.

Since the day of her accident, she’s gone through several surgeries and skin grafts. And last week, she finally got to come home. She still has a long road ahead of her involving physical therapy and more surgeries. In spite of that, she has a great spirit and keeps us posted on her recovery through Facebook and emails.

Taking Care of our Own

The minute we heard about Sabrina’s accident, the front desk employees didn’t bat an eye. They started figuring out how they were going to cover her shifts. Rachel in our billing office made ribbons for us to wear to show we support her. They were a great reminder around the office. Purple is Sabrina’s favorite color, so we made purple bracelets inscribed with her favorite saying, “Don’t Worry, Be Happy”. We sold them for $2 each and raised $700 to help with Sabrina’s expenses.

We also held Sabrina Spirit Week by dressing up every day:

  • Monday – Purple Monday
  • Tuesday – Tie Dye Tuesday
  • Wednesday – Wacky Wednesday (Mismatched clothing day.)
  • Thursday – Twinning Thursday (Find a coworker and be their twin… or triplet… or quadruplet!)
  • Friday – Royals day

Supporting SabrinaWe donated $1 each day to be able to participate. All told, we raised $1,620 for Sabrina to help with her expenses.

She continues to amaze us with her “Don’t Worry Be Happy” attitude and we know she will pull through this. Her boyfriend, Toby, says, “She’s a warrior!!!”

We will continue to be here for Sabrina and her family while she is recovering. That’s why I couldn’t be more proud of our team. I get to spend my days with my second family here at LSPG. I’ve experienced this support personally when I lost my husband in January. My friends and coworkers took care of me and continue to show their support. I hope you never have to face this situation, but it really helps to know people are in your corner and you can count on them to understand if something terrible happens.

The moral of this story is… I hope you work in a place where you’re treated like family. Not just the easy stuff… but the times when it really matters and you need to show up!

August is National Breastfeeding Month. Thoughts about reducing mom shaming.

By Dena Pepple, R.N. for Lee’s Summit Physicians Group.

Breast FeedingAugust is National Breastfeeding Month. I was asked about a month ago to write a breastfeeding blog because I do a lot of prenatal and newborn education here at LSPG, RTP, and BSP. I thought sure, easy enough as I’ve had extra education on breastfeeding, educate our patients about it daily, and breast fed my own children.  Easy-peasy right? Not so fast… As I pondered what to write, I thought about what I’ve seen and heard from our pregnant moms, successful and unsuccessful breastfeeding moms and even my own experience and realized this might not be an easy task.

The world is very passionate about breast feeding and that’s great, right?

What other food product in the world is as perfect as breast milk? It’s often referred to as “liquid gold.” The AAP, CDC, WHO, and probably thousands of other sources tout its goodness. But if you Google breast feeding vs. formula, read many “mommy blogs” and Facebook sites, or just talk to moms as I do daily, you realize it’s much more complicated. To “decomplicate” it a little bit, I am going to cover three main points.

“BREAST IS BEST”

When I Googled “breast is best”, 177,000,000 items popped up. Wow.

According to the AAP, breastfeeding protects the baby from numerous diseases such as asthma, eczema, diabetes, obesity, some cancers and more. It benefits maternal health by decreasing postpartum bleeding, hypertension, type 2 diabetes, and risk of breast and ovarian cancers. It is of course great for the environment as it does not require outside manufacturing (formula) and equipment (bottles, nipples, cleaning supplies, etc.)  Breast feeding is estimated to save up to $4,000 per year due to the price of formula.

The Mayo Clinic Healthy Lifestyle site states “Breast milk is the right balance of nutrients for your baby, it is easier to digest than is commercial formula, and the antibodies in breast milk boost your baby’s immune system.” According to a Missouri Department of Health and Human Services brochure “Breastfeeding is the most important gift you can give to your baby.” Besides being great for our babies, several studies are showing breast milk’s potential benefit in killing cancer cells and use of in stem cell research. Indeed, “breast is best.”

“FED IS BEST”

141,000,000 sites popped up when I Googled “fed is best.” We know in a head to head battle, breast milk is best for baby. However, there are times our baby’s breastfeeding MUST be supplemented either with expressed breast milk, donor milk, or formula.

I teasingly say formula is not the “F” word. Formula, as well as expressed and donor milk make healthy babies too. These supplements are sometimes needed for baby’s weight loss, jaundice issues, and a plethora of other possible issues mom or baby may experience. We don’t have our parents supplement on a whim. It is ALWAYS for the baby’s health, growth and development if we do encourage supplementing. During this time, we will have mom continue breastfeeding on demand, and talk to their lactation consultants.

“HAPPY MOMMA/HEALTHY BABY IS BEST”

I don’t think one can really argue against either idea above. However, I am adding this third baby feeding mantra.

I talk to 5+ pregnant women a week, and 50+ new moms per week, and what I hear can be downright maddening. While buying formula, one mom was asked by a complete stranger, “Why are you buying that poison for your baby?” Another mom was afraid to call the lactation consultant for an issue because she had supplemented formula. Numerous moms say the mommy blogs are “hateful.”

Several pregnant moms have become tearful when I told them they were good moms whether they breast fed or not as I was one of the first people to validate them and not berate them. These examples are a drop in the bucket of “mom shaming” that I see when it comes to how you feed your baby. So, I say, “STOP THE MADNESS!”

Of course, we want our moms to breast feed their babies as much and as long as they can.

The AAP encourages a minimum of 6 months of exclusive breast feeding. But we don’t improve the breastfeeding rate by nagging and berating. This may even make it worse.

When I visit with our pregnant and new moms about breastfeeding, I try to do four things:

  1. Listen: What does mom want? What are her concerns? What has she heard/read?
  2. Educate: As I said above there are literally millions of educational resources for mom. Of course, I do remind moms to be careful where they get their information.  org, the AAP and CDC, and lactation consultants are wonderful resources.
  3. Support: We support our parent’s choice whether breast feeding, formula feeding, or a mixture somewhere in between, as long as it makes/keeps baby healthy. I try to empower our mom’s daily that they are doing a good job and we are here for them. It’s okay to ask for help!
  4. Consider breast feeding in the future: I do remind moms that every pregnancy, baby, and life experience is different, so I encourage them to consider breast feeding, if not this time, maybe next time.

The CDC is a huge proponent of breast feeding.

The tendency toward increased breast feeding in the USA is slowly trending upward.

Their latest statistics from 2015, show that 83% of new moms try breastfeeding. That is great! Unfortunately, the national average for exclusive breastfeeding through 6 months is 25%. Here in Missouri, we’re ahead of the group at 31%. There IS room for improvement.

I have four children (all adults now!) and they all got something different in the breastfeeding arena from nothing to a full twelve months of breast milk. If you were to look at them now, or even at their medical records you would have a hard time guessing who got what. Maybe this is why I am passionate about both breast feeding AND supporting our new moms.

As I look back, I do sometimes wish I had breast fed longer/more, but not at the hands of shaming/nagging/berating. Rather, let’s work on better education, support and empowerment of our new and breastfeeding moms. I believe we can improve our breastfeeding education and support which will lead to increased breastfeeding statistics and healthier babies. If we truly do this, we will be able to bring all three ideas together and say “BREAST/FED/HAPPY MOMMA/HEALTHY BABY” are all BEST!

How do you know if your child has a concussion?

By Cindy Aldrige, F.N.P., Provider for Lee’s Summit Physicians Group

Spring fling… for sports goers sometimes that’s more than just having fun. Spring brings more physical activity and sometimes falls and concussions. New standards and precautions are in place to keep brains healthier and ultimately happier.

Symptoms of Concussion

ConcussionSymptoms of head injury and concussion a few hours after an event is memory loss of what happened right before the injury. There can also be confusion, headache, dizziness or trouble with balance, nausea or vomiting, sleepiness, and being fussy/cranky.

Symptoms that can occur hours to days after the injury include trouble walking or talking.

Memory issues include problems paying attention, trouble sleeping, mood or behavior changes, vision changes or trouble with bright lights/sun or even noise.

If you notice these symptoms report them to the coach and seek treatment from medical professionals. Exams, testing and follow up is a must for a successful recovery.

Treating a Concussion

Treatment includes limiting activity until symptoms resolve which includes physical rest and mental/brain rest. In other words not going to school or work to avoid mental exercise/stress and not returning to exercise or activity that stresses the body. Also avoiding screen time until symptoms are resolved, then slowly introducing it back into daily life… YES. It means your PHONE and TEXTING or SOCIAL MEDIA TOO!

Oh, part of treatment is brain rest, so allowing the person to sleep is okay, just make sure that they’re checked on frequently, and when they do wake, that they are evaluated to make sure symptoms are not getting worse. Returning to school sports will also include notification to the athletic trainer or coach for retesting before returning to normal practice and game routine.

Be Careful Out There!

Be careful out there this spring/summer, but remember that activity is always important for healthy bones/muscles and brains/minds, so don’t use this article as an excuse to rest your brain and body for too long. Activity keeps us young and healthy.

Source: In part from the Up to Date patient handout: Concussion in children and adolescents.

Traveling with kids: Tips to reduce your stress levels.

By Ashley Campbell, DO with Lee’s Summit Physicians Group

Ashley Campbell, D.O.Traveling with young children may seem like a daunting task. There is so much that can go wrong when considering naps, tantrums, boredom, snack time, diaper changes, etc., but with a little bit of planning and ingenuity, travel with little ones can go from anxiety provoking to cherished time and memories with family.

While traveling with kids can cause anxiety for parents, it’s important to remember that new experiences and schedule changes can be overwhelming for little ones too.

Starting with toddlers, it can be helpful to talk about what to expect when traveling.

For example, saying, “This will be a long car ride. We will be in the car from breakfast until dinner time.”

Talk about the sights and sounds you will experience. Consider providing toys or reading books about travel, perhaps even focusing on your mode of transportation. Talk about expectations for behavior while traveling, as well as at your destination. Discussing the trip can assist your child in understanding what he/she can expect when you get to where you are going (what you will do, who you will see, where they will sleep…), thus helping to ease anxiety and concern.

Preparation is key for any family trip, no matter how you plan to get there.

That means Busy Bags, fully charged and updated electronics, LOTS of snacks, and for smaller kiddos/infants, an extra change of clothes that are easily accessible. For plane rides, or in the car, I love stocking up on toys and snacks that: #1) won’t be a giant mess and, #2) are easily packed.

For airplane travel, bring a simple, no-spill sippy cup. We learned the hard way that cups with spouts, valves, and straws may pressurize in flight and leave quite a surprise when opened. Don’t forget pacifiers, bottles, suckers, and/or gum to help with ear pressure changes during the flight.

Kids on the Plane with TabletsWhile I generally recommend limiting screen time, long car rides or airplanes rides are a definite exception.

Tablets can be a life saver in these instances.

I make sure to download parent approved movies, music, and shows ahead of time. In addition, make sure to bring headphones, particularly children’s headphones with sound limits to protect little ears. Try scheduling long drives and flights around your child’s schedule when possible. We’ve found that coordinating with nap/quiet time can lead to a more peaceful journey.

Finally, it may be a good idea to write your name and contact information on your child’s wrist/forearm, in case you happen to get separated in the chaos of any busy, crowded situation (ex. airport, amusement park).

If planning to fly, be aware that flying with children comes with its own set of challenges.

Children under the age of 2 can generally fly as “lap children”, meaning you will not need to buy the child an individual ticket; however check with your airline carrier for requirements regarding lap children. Many airlines will still require a boarding pass that you can obtain at check in, and you may have to provide a copy of his/her birth certificate.

Keep in mind, while this is more cost effective, it is safer to buy a seat and have your child buckled in a car seat in case of in-flight turbulence. Be sure to check with the airline that your car seat is compatible with the airplane seats.

When traveling with kids that require either a bit more attention or gear, I recommend checking your luggage. It’s hard enough to ensure everyone gets where they are going, while also potentially managing a stroller, car seat, diaper bag, and everyone’s carry on item, without the headache of finding storage in overhead bins and having enough hands to manage it all.  It might add a couple of minutes to your time in the airport, but it’s worth it.

Kids with their own bagFor preschool age children and older, utilize their desire for independence and put them in charge of their own activity bag/carry on (just make sure it isn’t too heavy for them to manage – I love small backpacks for this). Additionally, make sure to utilize pre-flight check in so you can drop off your bags and be ready to go.

Check the TSA website for information on what can and cannot go through security, and what is required of children when they go through TSA (ex. children under 12 can generally keep their shoes, light jacket, and hat on). If you fly frequently it may be worth looking into TSA Precheck, kids 12 and under can go through with parents (anything to avoid standing in long lines with little ones).

While preparation is important, this does not mean you need to pack everything.

You may already be managing strollers, diaper bags, snack bags, etc; the less you bring the better.

With that in mind, try to maximize resources at your destination. Most rental car companies offer car seat rental. Many hotels offer cribs or Pack ‘n Plays. If you’re staying at a rental (ex. Airbnb, VRBO), many places will offer cribs, Pack ‘n Plays, toys, high chairs, and even baby safety equipment (ex. gates). It’s always a good idea to check before you book.

If a rental doesn’t list these items as an amenity, just ask. We’ve had equipment shipped to a rental to be more accommodating. In addition, most major cities and vacation destinations have companies that will allow you to rent baby equipment by the day.

If available, utilize laundry facilities to cut down on what you need to pack. Also remember you can grab a lot of your day to day necessities at your destination. We plan a quick trip to the store once we arrive for diapers, wipes, sunscreen, snacks…  If you are an Amazon Prime member, you can ship some of your necessities for the day of your arrival to help cut down on what you have to bring!

Kids at the airportYou also want to make sure to address any health concerns prior to traveling.

Make sure you have any needed medications refilled and ready to go.

If your child has motion sickness, make sure to bring bags (just in case), and you may want to talk with your pediatrician about age appropriate medications that you can give to help.

For medically complicated children, it’s a good idea to have a summary of your child’s diagnoses, medications, allergies, and physician contact information in case you need to seek medical care while away. If traveling abroad, it’s always a good idea to check the CDC travel website, or with your local health department, about potential vaccines or precautions that may be recommended based on your destination.

Particularly in this current era of vaccine hesitancy/refusal, we’re seeing a re-emergence of previously nearly eradicated diseases (ex. measles); therefore, in the case of an outbreak at your planned destination, you may want to check with your pediatrician about recommendations regarding booster shots or other potential advice.

Finally, you want to keep in mind that things will go wrong. I’ve been there.

As a mom of three under the age of 6, we have had our share of traveling mishaps (meltdowns in the TSA line, lost devices, car sick children, flight delays…), but none of these mishaps have outweighed the experiences we have shared. Happy travels!

Additional Resources

Part II of Kids and Electronics (Ages 6-18)

By Daniel E. Gershon, D.O. and Laura Salitros, D.O. – Lee’s Summit Physicians Group

We recently posted a blog about social media and young children (ages 0-5).  Now we move on to a more challenging situation: media and how it applies to school aged children and adolescents.

When our children are young, they’re more easily entertained by the simple things. As they get older, their interests become much more specific and much more influenced by their peers. Kids start participating in sports, music, theater, cooking, reading, Girl Scouts, Boy Scouts, and many other activities. However, electronics remain a fierce competitor for their attention and time, whether they are participating in these activities or not.

Get Them Involved

Get Kids InvolvedThe more involved they are, the less idle time they have at home to engage in electronics. This is one of the reasons why pediatricians recommend getting your kids involved in activities outside the school and home.

We worry about kids who have few interests and prefer to stay home. Sadly, there are also many families that do not have the means to allow their kids to participate in organized activities. Because electronics are a very appealing activity that is part of almost every household, they can very quickly become the preferred activity for children.

As parents raising children in this digital age, part of our job is to help them navigate media so they can reap the benefits while also being protected from the risks.  In order to teach our children to use media safely and respectfully, we first need to educate ourselves about what is out there, what the potential risks and benefits are, and what the recommendations are.

What are they watching?

Teens and Smart PhonesIt is important to understand the types of media that kids are consuming. There is broadcast media (TV and movies) and interactive media (social media, video games). In recent years, we’re seeing a shift toward more interactive media. There are many devices that allow us to connect to digital media, perhaps the most important being the smartphone.

Smartphones give kids and teenagers the ability to stay connected constantly. In fact, according to a study published in 2015, about three-quarters of teens have access to a smartphone and one-quarter of teens describe themselves as being “almost constantly” online (Lenhart A. Teens, Social Media & Technology Overview 2015. Washington, DC: Pew Internet and American Life Project; 2015).

So what exactly are the risks?

Addiction

If you read our last blog, we discussed how electronics cause DOPAMINE to be released. This neurotransmitter creates a similar response to the one seen from a cocaine high on a functional MRI of the brain. When the reward pathways become overused, the brain craves more and more dopamine. As we are seeing more addictive behaviors related to screens, the medical community has needed to respond. The most recent version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has even added Internet Gaming Disorder as a diagnosis.

Sleep problems

The light that is emitted by screens mimics daylight and suppresses MELATONIN release. This leads to an upset of the circadian rhythm, which leads to sleep disorders. Beyond that, being woken throughout the night because of phone alerts can lead to poor sleep quality. Inadequate sleep has been linked to physical and mental health problems, as well as problems with executive function and learning.

Obesity

Screen time has a tendency to displace active time with sedentary time. It also encourages mindless snacking, which tends to lead to excess caloric intake.

BullyingBullying

Digital media gives kids a new platform to use for bullying. Cyberbullying is something that all parents should be aware of, and kidshealth.org has a good article for parents about this (https://kidshealth.org/en/parents/cyberbullying.html)

Depression

There is evidence that increased social media use is associated with increased depression rates in adolescents. There are many potential reasons for this association. Teens spend less time connecting to their peers in person, which may lead to feelings of isolation. They also have a tendency to compare themselves to their peers’ online identities, which may lead to feelings of inadequacy.

They are constantly aware of what their peers are doing, which may lead to feeling left out. Teens also have a tendency to associate the number of “likes” with their self-worth. This article from the Child Mind Institute has some good information about depression and media use (https://childmind.org/article/is-social-media-use-causing-depression)

Earlier exposure to adult content

Pornography, sexting, and online solicitation are all concerns here. Exposure to pornography can have long-term adverse effects, as discussed in this article: (https://preventchildabuse.org/resource/understanding-the-effects-of-pornography-on-children/).

Our youth are also becoming desensitized to sexting, as it is becoming more common.  This article (https://jamanetwork.com/journals/jamapediatrics/article-abstract/2673719) from 2018 discusses the prevalence of sending and receiving sexual content.

Are you seeing the problem?

We are treating more children and adolescents for ADHD, anxiety, depression, suicidal thoughts, suicide attempts, anger and aggression issues, sleep problems, and poor social skills. We’re also seeing interesting trends, such as teens beginning to drive at older ages and lower rates of sexual activity.

A recent study from the Pew Research Center showed lower levels of teenage reported sexual activity, drinking, and drug use, but higher levels of depression and loneliness.  Could these trends be due to the

Question MarkAre there any benefits?

Despite all the risks we tend to name regarding digital media, we still need to remember that there are some benefits.

Social media and video chatting help us keep in touch with friends and family members, especially those who live far away. Digital media exposes us to new knowledge, new ideas, and can help us keep up with current events. The Internet and social media allow us a large platform to access in emergencies or to promote charitable events or programs. There are apps and online communities that help support a healthy lifestyle.

There is evidence to suggest that the use of social media may provide valuable support to some of our kids and teens who may feel isolated, including LGBTQ individuals and their allies (Krueger EA, Young SD. Twitter: a novel tool for studying the health and social needs of transgender communities. JMIR Ment Health. 2015;2(2) ).

Social media likely also provides valuable support to those who are struggling with serious mental illnesses (Naslund JA,Aschbrenner KA, Marsch LA, Bartels SJ. The future of mental health care: peer-to-peer support and social media. Epidemiol Psychiatr Sci. 2016;25(2):113–122pmid:26744309)

So what recommendations do we have?

1) Develop a plan and stick with it.

This website (www.healthychildren.org/MediaUsePlan) can help you develop a plan that works for your family.

2) Limit, reduce, and restrict the amount of time spent in front of screens.

– A recent study showed actual brain changes in kids getting more than 7 hours of screen time per day, while another study showed kids who spend more than 2 hours per day scored lower when tested on language and thinking skills.

– Do not focus only on hours per day.  FOCUS ON TAKING MORE BREAKS.  Try to limit a single screen time session to less than 1-1.5 hours, then have them take a break for an equal amount of time.  In front of a screen for 1 hour?  Off all screens for an hour.  Simple.

Keep Bedrooms Screen Free3) Keep bedrooms screen free – No TVs in rooms and charge other devices in another place overnight.

Kids are less likely to access dangerous or otherwise unhealthy content if they are using screens in a high traffic area in the home while parents are nearby monitoring their screen use.  Also, I don’t know about you, but I don’t want to go to bed worrying about what my kid is watching and how late they may be staying up on a school night.

4) Never let screen time be a part of routine daily activities.

What we mean here is to avoid making screen time part of meals, car rides, grocery store trips, and other daily activities.  Kids need to lean to be patient, to tolerate boredom, and to interact with people around them.  Allowing them screens all the time will create a sense of entitlement to having the screen.  Screens should either be earned or reserved for special occasions like long car rides, vacation, illness, bad weather, etc.

5) Make kids EARN screen time.

This is ONE OF OUR ALL TIME FAVORITE RECOMMENDATIONS! It will help develop the habit of DOING THE WORK BEFORE HAVING THE FUN.  This is a habit of successful people.  I like to have kids and teenagers do 3 things before they get screen time:

HOMEWORK – Grab a glass of water and snack.  If they have no homework, have them find an activity that requires mental effort or creativity (studying, reading, drawing, LEGOs, etc).  If their homework is only available on a computer, that’s ok.

CHORES – ALL kids are capable of helping contribute to the household.  We all participate in the fun activities, so we should all help the house run.  In general, keep chores short, simple, and mix them up.  Give kids more responsibilities as they want more freedoms.

EXERCISE – Have your child spend 30-60 minutes engaged in an activity that they love, which also gets their heart pumping and their body sweating!  If they have a game or practice that night, that can be their exercise for the day.

Kids and Family6) Make sure your kids have time to socialize with family and friends.

These days, you can do just about anything without leaving your home.  Kids need to learn to talk politely, make eye contact, and interact with people if we want them to be successful adults.

7) Know what types of media your kids are using as well as what apps they are using. You can do this by having a family account through the app store, which allows you to see all of the app purchases and downloads for each individual. Once you know what they’re using, download the same apps so you can know what they are, how they work, and what advertisements your kids are being exposed to.  Make a habit of “following” or “friending” your kids on social media.  Also, don’t be afraid to periodically check their devices to monitor their use.

8) Help your kids protect themselves from misinformation. There are many websites out there that appear to be legitimate that are actually spreading misinformation. Common sense media has put together a list of websites to help with fact checking (https://www.commonsensemedia.org/lists/fact-checking-tools-for-teens-and-tweens)

9) Consider an alternative to a smartphone when you feel your child may need a phone. According to this article (http://influence-central.com/kids-tech-the-evolution-of-todays-digital-natives/), the average age kids are when they get their first phone is 10.3. Fortunately, smartphones aren’t the only option.  There are multiple options available for basic or “dumb” phones.  There are also several watches that allow texting or two way calling.  Wait until 8th (https://www.waituntil8th.org/) is a pledge that parents can make to wait until at least 8th grade to give their children smartphones.

10) Lastly, make sure you are modeling healthy digital media use.

Make sure you find time to put your phone away and talk with your kids.  Show them how you can wait in a line or on an elevator without having your eyes on a screen.

Additional resources used for this article:
https://pediatrics.aappublications.org/content/138/5/e20162592

Here are some great tips to get you prepared for seasonal allergies.

By Cindy Aldrige, F.N.P., Provider for Lee’s Summit Physicians Group

Seasonal AllergiesAllergy season is upon us. Do you know what the symptoms are? Of course sneezing, runny nose, watery eyes are the first symptoms we think of, but clearing the throat frequently, coughing and head pressure or headaches are other more subtle signs that some don’t think about.

There are different ways to treat allergies and specialist recommendations start with some of these basic non-medication steps.

  • Did you think about how much dust and particles are in carpets? Vacuuming doesn’t get rid of anything down deep or tiny particles. Also there are special filters on HVAC units that can greatly reduce symptoms of those in the building.
  • Changing your pillowcase regularly because your face rubbing in it overnight can make allergy symptoms start or worsen depending on what the individual is sensitive to.
  • How about avoiding smoke/pollutants as a treatment? Not many remember that step!
  • OK, here is one that I can attest to the most… KEEP THE WINDOWS CLOSED in your home. For those that suffer from pollen and mold allergies, this is one of the best things that you can do to keep symptoms controlled. I requested windows that don’t open in most of my house because that drives my allergies CRAZY!
  • Another one that is less popular these days is hanging clothes/linens out on the line… a bad mistake for allergy sufferers.
  • Using a sinus irrigation system that you can get at your local drug store is one of the best preventive and treatment measures. Using distilled water only, not bottled or tap, you can actually rinse out the tiny particles that cause your body to react with tons of mucus and tears!

Okay, what about over the counter allergy medications? How do I choose?

Over the counter products use to be prescription only. They can actually be used effectively and are main line treatment. Allergy specialists are now using nasal steroids like name brand Flonase/Nasacort/Rhinacort for baseline therapy once daily. Be sure to follow the package instructions on administration because often they are not administered correctly. And ideal results are not achieved. (So reading the package insert is really helpful.)

If that alone is not enough to control your allergies, then consider Claritin/Allegra/Zyrtec/Xyzal or a generic equivalent. They work well at stopping the mucus production to help control symptoms.

As we always recommend, please talk to your health care provider about these specific recommendations and what might be right for you and your health. Have a great and active spring /summer 2019!

The Epidemic of Kids and Technology – Part One: Ages 1-5

By Daniel E. Gershon, D.O. and Laura Salitros, D.O. – Lee’s Summit Physicians Group

This is the first in a series of blogs about children and technology.

Child with Cell PhoneWe’ve wanted to write about this subject for the past two years. It has become painfully clear to us that electronics/screen time (TVs, computers, tablets, and smart phones) has become a major concern as pediatricians. The effect it’s having on kids and adolescents is staggering. A typical day in our office will involve evaluations for ADHD, learning difficulties, anxiety, depression, sleeping problems, and extreme behaviors.

We’ll go ahead and call it an EPIDEMIC.

Most parents today grew up with electronics, including smart phones while they were in high school. It is a big part of who they are and their way of life. Consequently, they introduce screens to their children at young ages. Kids will often see their parents in front of screens. No one is to blame. Technology moves lightning fast. It moved so fast that science got a late start and is now telling us there are inherent dangers in what we are doing.

Let’s start with some science first:

When every finger swipe brings about a response of colors and shapes and sounds, a child’s brain responds gleefully with the neurotransmitter dopamine, the key component in our reward system that is associated with feelings of pleasure. Dopamine hits in the brain can feel almost addictive, and when a child gets too used to an immediate stimuli response, he/she will learn to always prefer smartphone-style interaction – that is, immediate gratification and response over real world connection. This is a mild version of the dangerous cycle psychologists and physicians see in patients with drug and alcohol addictions.

The Critical Period

Toddler and ComputerBetween birth and age three, our brains develop quickly and are particularly sensitive to the environment around us. This is called the critical period in some circles because the changes that happen become the permanent foundation upon which all later brain function is built.

A child needs specific stimuli from the outside environment for the brains neural network to develop normally. Spend too much time in front of a screen and development becomes stunted. Their social skills (frontal lobe) can be effected as well. Empathy, the near-instinctive way you and I read situations, get a feel for other people, can be dulled, possibly permanently. Heavy parent use of mobile devices is associated with fewer verbal and nonverbal interactions between parents and children.

AAP recommendations for children younger than 2 years were based on research on TV and videos, which showed that in-person interactions with parents are much more effective than video for learning of new verbal or nonverbal problem- solving skills.[1] Before 2 years of age, children are still developing cognitive, language, sensorimotor, and social-emotional skills, which require hands-on exploration and social interaction with trusted caregivers for successful maturation. Therefore, adult interaction remains crucial for toddlers to learn effectively from digital media.

For example, from 12 to 24 months of age, toddlers can begin to learn novel words from commercially available “word learning” videos, but only if their parents watch with them and reteach the words, essentially using the videos as a learning scaffold to build the language skills.[2]  In fact, recent reviews of hundreds of toddler/preschooler apps labeled as educational have demonstrated that most apps show low educational potential, target only rote academic skills (eg, ABCs, colors), are not based on established curricula, and include almost no input from developmental specialists or educators.

An additional concern is that the formal features (ie, bells and whistles) that are designed to engage the child in an interactive experience may actually decrease the child’s comprehension or distract from social interaction between caregivers and children during use.[3]

Here are some troubling numbers:

In 2011, 52% of children zero to eight years of age had access to a mobile device. By 2013, this access had increased to 75% of 0- to 8-year-olds.[4]

A large international study (2013) with almost 300,000 children and adolescents found that watching between 1 and 3 hours of TV a day led to a 10% to 27% increase in risk of obesity.[5]
(It should be noted that TV viewing in children has decreased dramatically in the past two years with content moving to smart phones and tablets)

Here are some frequently heard comments from our parents:

“Sometimes I just need to get things done.”

YES! Sometimes we parents need to get stuff done and cannot supervise our kids like we would like to. We like to think of these as worst case scenarios, not something we do regularly. Don’t forget that engaging even our youngest toddlers in household responsibilities early on results in benefits for the entire family in the long run. Yes, it requires a lot of work up front, but it will be worth it

“He focuses better on the TV or tablet than on anything else.”

Boy and TVDigital content can be very stimulating. However, evidence shows that digital media is likely harmful to attention and executive function.  See this article about a study that was published in Pediatrics in 2011. This may be one of the factors as to why ADHD numbers have significantly risen over the past decade.

As a child spends more time in front of a screen, their frontal lobe has a harder time turning on when acknowledging a spoken voice, looking at books, or picking up visual clues. It prefers the digital or electronic format.

“I don’t really have a strict limit because we only use educational media.”

Even the AAP distinguishes between quality digital media and media that should be avoided, such as violent or fast-paced media. This doesn’t mean that “educational” shows/apps don’t count. Kids need time to engage in unstructured play. They need to be read to, talked to, and engaged with. They also need regular physical activity and adequate sleep.

“My kids can’t settle down for the night without having the TV on.”  

Results from one study show a relationship between screen time and poor sleep, especially when screens are used in the evening hours.[6]  As mentioned above, we are seeing a lot of kids with sleep issues. Some are due to common, age appropriate reasons, but many are due to screen time.

“It helps my child calm down when she gets upset.”

Distraction can be helpful in distressing or painful situations. This is why many children’s hospitals have child life departments available to help during painful or otherwise anxiety provoking procedures.  We use virtual reality in our office for vaccines and blood work.  However – Using screens to alleviate the discomfort of everyday disappointments or frustrations interferes with our children learning healthy emotional regulation without reaching for an external device.

One reason that children may be less socially engaged during digital play is that gaming design involves behavioral reinforcement meant to achieve a maximum duration of engagement, which may explain why interrupting children’s digital play leads to tantrums.[7]

“The TV is on in the background all day, but they’re not actually watching it.”

However, having the TV on in the background distracts children from their play, interferes with good language exposure, and decreases parent-child interaction, all things that can have an effect on their development. It is amazing what kids pick up from background TV. Yes, my son, at 4 years old, asked me if my heart was healthy enough for sex!

Here are our recommendations for ages 1-5:

1) No screen time for anyone under 24 months of age
Exceptions are video chatting (Facetime) or worst case scenarios (DMV, illness/doctor’s visit, etc.)

2) No screens in bedroom
Having screens in the bedroom was an independent factor associated with obesity. As kids get older, the temptation and addiction will only get worse. This is a place for quiet time, music, drawing, reading, sleeping, etc.

Limit Screen Time3) For ages 2 through 5 years old: No more than 1 hour a day of quality content.
Use sources like Common Sense Media to help you determine what is quality and what is not. Most evidence now suggests that long amounts of time in front of a screens is more damaging than short exposure (30-45 minutes).

We recommend teaching your kid that screens are an earned privilege not an expectation. It should never be a part of your everyday routine. Kids can look out the window while in the car. They can eat their meal or they can be hangry by their next one.

4) Find apps and games that you can play with your child.
Studies show that retention is much better when educational apps/games are played with a parent vs. alone with a device.

5) Develop a Family Media Use Plan
www.healthychildren.org/MediaUsePlan

6) Watch the time YOU spend in front of screens
Try your best to wait until the kids are asleep. If it is work related, let them know.

Finally, we know parenting is the hardest job there is. There is no perfect parent. It is our goal to let you know electronics can be harmful and potentially damaging to a child’s developing brain through the age of 5. Hopefully we have given you some tips on how to safely raise your kids in an electronic/digital world.


References:

[1] Brown A; Council on Communications and Media. Media use by children younger than 2 years. Pediatrics. 2011;128(5):1040–1045

[2] . DeLoache JS, Chiong C, Sherman K, et al. “Facetime doesn’t count”: video

Do babies learn from baby media? chat as an exception to media Psychol Sci. 2010;21(11):1570–1574 restrictions for infants and toddlers.  Richert RA, Robb MB, Fender JG, Wartella E. Word learning from baby videos. Arch Pediatr Adolesc Med. 2010;164(5):432–437

[3] Vaala S, Ly A, Levine M. Getting a Read on the App Stores: A Market Scan and Analysis of Children’s Literacy Apps. New York: The Joan Ganz Cooney Center at Sesame Workshop; 2015. Available at www.joanganzcooneycen ter.org/wp-content/uploads/2015/12/.  Guernsey L, Levine MH. Tap Click toddlers learn language. Child Dev. Read: Growing Readers in a World of

2014;85(3):956–970 Screens. San Francisco, CA: Jossey-Bass; 2015

[4] Rideout V. Zero to Eight: Children’s Media Use in America. San Francisco, CA: Common Sense Media; 2013

[5] Braithwaite I, Stewart AW, Hancox RJ, Beasley R, Murphy R, Mitchell EA; ISAAC Phase Three Study Group. The worldwide association between television viewing and obesity in children and adolescents: cross sectional study. PLoS One. 2013;8(9):e74263

[6] Michelle M. Garrison, Kimberly Liekweg, Dimitri A. Christakis Pediatrics July 2011, VOLUME 128 / ISSUE 1

Article Media Use and Child Sleep: The Impact of Content, Timing, and Environment

[7] Hiniker A, Suh H, Cao S, Kientz JA. Screen time tantrums: how families manage screen media experiences for toddlers and preschoolers. In: CHI’16. Proceedings of the 2016 CHI Conference on Human Factors in Computing Systems; May 7–12, 2016; New York, NY. 648–660. Available at: http:// dl. acm. org/ citation. cfm? doid= 2858036.2858278. Accessed May 9, 2016

Reflecting on Star Wars and Lightsabers in examination rooms.

By Dr. Gershon and Dr. Yannette

Thoughts on Star Wars from Dr. Gershon

Daniel Gershon, D.O.Dr. Yannette likes to tell his parents that his Star Wars rooms are better than mine. It’s a fun competition between us, but ultimately something that entertains our patients, their parents, and both pediatricians. Some days I hear the sounds of lightsabers being turned on inside the rooms, and sometimes I get to hear my patients tell me the name of every character or spaceship on the walls. Star Wars is still (amazingly) a part of so many peoples lives.

For me, Star Wars was and remains my escape from reality.

When I was little, I would spend hours recreating scenes from the movies. I would carve out Styrofoam or cut and tape cardboard pieces to create new scenes for my action figures and ships. My Mom would take me to Dolgins, Children’s Palace, and Venture to see what new Star Wars toys were available. I used to send in my proof-of-purchases to get the “not available in stores” action figures and bring my toys over to other kids houses to “battle.”

Return of the Jedi came out in 1983.

I was in 3rd grade. There were new toys over the next few years, and eventually some ‘special edition’ releases to get excited about. But I was getting older and Star Wars became a poster on my wall and fond memories. Then word of the prequels came out. I was a kid all over again. I remember downloading (on a zip drive!) the teaser trailer for The Phantom Menace. I convinced a medical school professor to allow me to play it for the entire class before the lecture. The lights dimmed, I played the trailer, and the class went wild!

Dr. Gerhon - Star Wars BlogA Star Wars Marathon

The next few years were spent collecting lightsabers (now displayed in exam rooms), debating what was good and bad about the new movies, and even incorporating Star Wars into my wedding! I’ve spent hours in line for tickets to the premiers and even made if to a Star Wars convention before Revenge of the Sith. I even did a Star Wars marathon with my brother before The Force Awakens… We didn’t run 26 miles in costume, but rather watched Episodes I through VII in one theater with other crazy fans like myself.

Important Themes

Luke Skywalker always defeated Darth Vader. Han Solo always escaped. Princess Leia and Luke always fell in love (until I realized they were brother and sister!)  Good always triumphed over evil. One person can change the fate of a galaxy. Hope is all you need. These themes were and remain a large part of who I am and how I operate. They’re also a large part of pediatrics.

When I examine a newborn, I see potential. I see the look in parents eyes that their new child may live a life of meaning, do something to improve their community or even the world. Infants, toddlers, kids, teens all fight to get better. They make amazing recoveries from set backs, infections, cancers, chronic diseases and disabilities. It is the one consistently optimistic field of medicine and I’m proud to be a part of it.

Thoughts on Star Wars from Dr. Yannette

Jeffrey Yannette, M.D.May 26, 1977. That was the day after Star Wars Episode 4 – A New Hope debuted in the United States. I could tell it was a special day because my father was actually excited about going to see a movie with his three boys. Previous to this, it was mostly cartoon type movies from Disney that he was subjected to. In any event, it is one of my earliest memories involving my brothers and my father.

Back then, of course, there was no going online to reserve you desired date, time and seat.

I can remember going to the theater two hours before showtime, waiting in what seemed like an eternal line, and wondering if we were going to get tickets at all. My oldest brother even counted the number of people in front of us.  He assured me, this 5-year-old boy, that we were going to get tickets. I was still doubtful.

In the end, it worked out just fine. As we waited in our seats, I can remember that the popcorn never smelled or tasted so good and there was an electric vibe in the air. Then… the lights dimmed, and the ever iconic Star Wars theme played with the movie’s narrative being set by words scrolling from the bottom of the screen towards the top. It was a magical moment for me and my family which would prove to have a lifelong effect on us all. Over the next 40 years, we would continue to discuss the movies and debate the meaning of, well, everything Star Wars.

For those that do not know me well, I have passion for two things – North Carolina Basketball and Star Wars.

They are so meaningful to me that I had no choice but to decorate some of the Raintree Office rooms with these two themes. Room #1 is, of course, the North Carolina Room because – yep, you guessed it, UNC is #1 (sorry to all you KU and MU fans). Star Wars deserved two rooms – decorated with vintage memorabilia and replica lightsabers – so if you’re ever in the area, stop in and see Rooms #3 and #22 – I think you will enjoy them.

I know that most people have a “Star Wars Moment” that they remember. If you do, I would love to hear it! Comment away by responding to this post and as always – May The Force Be With You!