To say this year has been crazy is an understatement. And along with all of the other changes, there have been many in pediatricians’ offices. Before this year, we had become accustomed to treating anyone who walks in. We now have a responsibility to ourselves, our staff and our other patients to ask about symptoms and possible exposures before anyone enters the office. Gone are the days in which sick patients filled our waiting room. Instead, we can have peace of mind that a child with cough, fever and runny nose won’t infect our entire office.
One major difference I have noticed in my practice during the past nine months is how much less illness there is in the community. Children, in particular young children, are little germ spreaders. With schools being closed, there are fewer chances for children to spread disease. Kids, for the most part, are staying home. The majority of their interactions come from their immediate family members. When kids do go outside, they are hopefully wearing masks and physically distancing themselves, which further cuts down on the transmission of disease. Before the pandemic, I would routinely get at least a dozen phone calls on the weekends I was on call. Now, I don’t even get half that many. The few calls I do receive are mainly injuries, not illnesses.
Here are my tips for protecting your kids health:
- Avoid large gatherings or places where people congregate including churches, restaurants and malls. Wear a mask or face covering when out in public.
- Wash your hands frequently and sanitize frequently touched services. Cough and sneeze into your elbow instead of your hands. Avoid touching your face unnecessarily.
- Stay home when sick. Most illnesses can be treated supportively at home. If you need to visit the doctor’s office, call ahead of time to discuss your child’s situation and determine the best way to access care. If emergency care is needed, bring two adults so your child can wait in the car while an adult checks in and is advised on the safest method of waiting.
- Stay active. Regular physical activity boosts the immune system and increases one’s self esteem. Individual sports such as walking, running, biking and swimming are all safe. Aim for at least one hour of physical activity five days a week.
- Keep up to date with your child’s well visits. These are excellent opportunities to review your child’s growth and development, stay current with their immunizations, and identify any potential problems.
There will always be a need, however, to treat sick children. In our practice, we screen all patients before they come in. We then may choose to bring a few ill patients in through our back door at the end of the day. We also use the outside of our office to examine patients al fresco, weather permitting.
Rarely thought of before the pandemic, telemedicine is now commonplace in most medical practices. Almost all insurance companies have loosened their restrictions as to what constitutes a telemedicine visit. It seems as long as there is some form of video or camera component, a visit can be billed as telemedicine. What’s more, there are now entire app-based programs available that allow for scheduling, documenting and coding of telemedicine visits. Physicians can now practice in the comfort of their own home while their patients wait in the virtual waiting room.
Of course, telemedicine does have its limitations. In pediatrics, telemedicine is great for looking at rashes. Throats can be examined if the camera is positioned correctly. The rest of the body is difficult, if not impossible, to examine. Luckily, we can rely on bringing well children into our office. Most children are relatively healthy with few chronic illnesses. Bringing these healthy children into the office pose few risks. They still need to be screened for symptoms and possible exposures, however. These exposures could include an ill family member or travel outside of the local area. It’s important to screen all family members since most children with COVID are either asymptomatic or only mildly symptomatic. If a child does screen positive, it might be prudent to postpone their visit for a few weeks.
The one thing I miss more than anything in my practice is giving handshakes. This ubiquitous salutation is a sign of trust. A sign that the patient is in good hands and will be cared for appropriately. I sometimes think that if I could go back to shaking hands with my patients and families, life would go back to where it was nine months ago. For now, I will have to be satisfied practicing my jazz hands.
Kenneth Follmar, MD is a pediatrician in San Pedro. During the pandemic, he has enjoyed spending more family time with his wife and three children.