The importance of well-checks during COVID-19

An upcoming well-check appointment for her teenage son had slipped Courtney Berney’s mind until her CHOC pediatrician called her one day with a reminder.

“I didn’t even remember that we had a well-check,” she says. “I did ask if we should still go, even with COVID-19 happening.”

Dr. Eric Ball gave Courtney an overview of the steps CHOC’s Primary Care Network had taken to keep patients, families and staff safe during the pandemic.

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Dr. Eric Ball, a CHOC pediatrician

Reassured, Courtney and her son, Jackson, headed to the appointment. Upon arrival, they both wore masks, had their temperatures checked and were asked about symptoms and possible COVID-19 exposure. The waiting room was kept largely empty and all staff wore masks.

“It felt very safe,” Courtney said. “I was impressed.”

A routine visit takes an unexpected turn

Including tracking growth, checking in on mental health and ensuring current immunizations, the well-check continued like every other routine visit 15-year-old Jackson had experienced before.

But then, Dr. Ball detected an inguinal hernia during his physical exam.

These can occur when the inguinal canal, which extends down the groin, doesn’t close on its own shortly after birth. If this opening is large enough in these cases, the intestine can come into the canal and create a bulge in the groin region.

This can grow dangerous if the part of the body that protrudes from the hernia becomes stuck, which can compromise blood flow to the trapped body part.

“Apparently, Jackson was born with it and always had it and he didn’t know,” Courtney says. “He’s had this exam every year since, but this year it felt different. I wouldn’t have known that, and he wouldn’t know it without having this visit.”

Because inguinal hernias should be repaired by surgery, Dr. Ball referred Jackson to CHOC’s pediatric general and thoracic surgeons for a follow-up appointment, and Jackson recently underwent a successful outpatient procedure to repair the hernia.

“Inguinal hernias are common but should be taken care of promptly,” says Dr. Ball. “They’re also something that often only a doctor can detect during a physical examination, which underscores the importance of regular well-checks for kids – even when they’re healthy.”

Taking a personal approach

Knowing that parents may be wary of healthcare settings during a pandemic but also how critical seeking both sick and well care remains, Dr. Ball and his colleagues earlier into the COVID-19 emergency made personal phone calls to families. Today, Dr. Ball still regularly has conversations with families about the measures in place to keep families safe.

“I’m happy to connect with them and personally reassure our families about the safety of our office,”  Dr. Ball says. “We want to ensure our patients and families know that we are here for them – during a pandemic and otherwise – and how critical it is to seek both routine and regular care.”

Here’s a look at other ways CHOC is ensuring its primary care practices are safe during COVID-19:

  • separated offices, waiting rooms, exam rooms and times/days for sick visits and well visits;
  • masking for staff, patients ages 2 and older and families;
  • enhanced cleaning practices;
  • screening of all patients for COVID-19 risks, by phone when families make appointments, and upon arrival for well and sick visits;
  • in-vehicle evaluation of children symptomatic or exposed to COVID-19; and
  • limiting the number of people who can accompany a patient to an appointment to one family member.

These extra steps helped reassure Courtney that it was safe to seek routine care for her children, even during a pandemic – and she’ll be coming back.

“My son is really healthy too, but I wouldn’t pass up a well-check,” Courtney says. “I know it might be scary and new, but I trust the doctors. I have to book my appointment for my other son in a couple weeks too.”

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Hernia Repair: Quick and Common

When hernias in children don’t close by themselves, surgeons can repair the protrusion caused by an organ or tissue pushing through an opening or a weak spot in the abdominal wall, a CHOC Children’s pediatric general surgeon says. NEWok20130425_1072

A common procedure, hernia repair is typically an outpatient surgery, meaning the child can go home the same day as the surgery after a few hours of recovery, Dr. Troy Reyna says.

An infant younger than 3 months, however, would be hospitalized overnight as a precaution, he says.

“During surgery to fix a hernia, we’re closing that little hole that causes the bulge,” Dr. Reyna says. “We can often do laparoscopic surgery, which means there is a tiny incision using a camera to direct the sutures and needles to the abdominal wall. With baby boys, we usually will make an incision, but it’s small.”

The operation is relatively short, usually taking 30 to 40 minutes, he says.

Parents are most often worried about their child undergoing general anesthesia for the surgery, but Dr. Reyna assures parents that the anesthesiologist treating their child at CHOC specializes in working with babies and children.

“This is what they do,” he says. “They know that children are not little adults and have a totally different anatomy.”

If they haven’t closed already, umbilical hernias can be fixed when the child is 2 or older, Dr. Reyna says. A child with an inguinal hernia should have surgery within one to three weeks of diagnosis to prevent possible complications to other organs, he adds.

Parents who suspect their child has a hernia should seek a medical evaluation from their pediatrician, Dr. Reyna recommends.

“I tell parents we don’t expect them to be medical experts but whenever their child has a lump or bump in an unusual place, feel free to ask about it,” he says. “The only silly question is the one that doesn’t get asked.”

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Hernias in Children: What Parents Should Know

CHOC_HerniasSpotting a lump or bump on a child’s body would be scary for any parent, but mom and dad can rest assured: Hernias are common and their repair is among the most common procedures performed on kids, a CHOC pediatric general surgeon says.

Just in time for national Hernia Awareness Month, Dr. Mustafa Kabeer offers detailed information on this common ailment.

Hernias occur when part of an organ or tissue pushes through an opening or a weak spot in the abdominal wall and creates a protrusion which is visually present. Children with hernias are often born with them, and when a hernia is first noticed depends on when enough pressure is generated to allow other tissues to protrude through the weakened area, Dr. Kabeer says.

“Families or kids might see big or little bumps, and, in most cases, near the belly button or groin,” he says. “Sometimes in premature babies, we see hernias right when they’re born, and sometimes we don’t see them until the child is older.”

Though there are many varieties of hernias, Dr. Kabeer recommends that parents of young children make themselves aware of three types.

Epigastric hernias

First, epigastric hernias occur when a tiny portion of fat protrudes through the abdominal wall in the midline between the belly button and chest, creating a tiny bump a few millimeters wide.

“They can cause some discomfort and they don’t go away on their own,” Dr. Kabeer says. “When we find them, we fix them.”

Inguinal hernias

Secondly,inguinal hernias occur when part of a child’s intestine protrudes between the abdominal muscles and is seen as a bulge in the groin. Girls born with this type of hernia are more likely to have a protrusion on both sides.

This type of hernia is very common, especially in premature babies. This type of hernia should be repaired in a timely manner because, if left unfixed, they can cause discomfort and, on rare occasions, lead to the intestine being stuck in the hernia. This could cause obstruction and require a more urgent operation, says Dr. Kabeer.

“We want to fix these soon,” he says.

CHOC_Hernias2Umbilical hernias

Finally,umbilical hernias appear in babies born with a weakness in the belly button. This type of hernia is very common, and not something that should concern parents, Dr. Kabeer says.
Present when a baby cries, strains or coughs, these hernias cause no discomfort and rarely prompt larger problems, he says.

Dr. Kabeer estimates that 85 percent of umbilical hernias go away with time. That said, if a child still has a protrusion by age 3 or 4, CHOC surgeons will repair the hernia, Dr. Kabeer adds.

Physician can advise treatment

Parents who notice a hernia on their child’s body – particularly those near the groin or between the belly button and chest – should make an appointment with their pediatrician to help determine the type and course of treatment.

Though often harmless, some hernias prompt concern because the protruding organ or tissue can get stuck in the opening, which can compromise blood flow, Dr. Kabeer says. This can damage the protruding part, such as the intestines or even an ovary in girls.

Aside from the obvious bulge, symptoms of hernias can include pain and swelling. Babies who have an obstruction often exhibit abdominal distention, vomiting, redness and pain. If this occurs, parents should seek emergency treatment immediately, Dr. Kabeer cautions.

Short surgery, recovery

Should surgery be required to repair a hernia, the short procedure is performed under general anesthesia and requires no hospital stay, he says.

Recovery is also relatively fast following hernia repair surgery, Dr. Kabeer says. School-aged children are back to normal after about a week, and younger children recover even faster.

Learn more about surgery at CHOC.

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