I’m a pediatrician and parent. Here’s how my family is coping with COVID-19.

By Dr. Marshneil Chavan, a CHOC Children’s pediatrician

After several months under stay at home orders caused by the COVID-19 pandemic, it has become clear that the normal way of life we knew a few months ago is not returning anytime soon.

As a pediatrician I am constantly having to deal with uncertainties at work and adapt to changes brought about by this pandemic. For example, our office has made changes to support physical distancing and implemented other measures to keep our patients, their parents and our staff safe.

As a parent of two young children, I realize that on most days the challenges I face at home far exceed those at work.

With very little time to prepare, we as parents have had to face challenges related to childcare, distance learning, explaining to kids why we cannot go to the park or see their friends, explaining COVID-19 to kids, and helping them make sense of the changing world around them. As we prepare for the coming months, I want to share how my family and I are dealing with this crisis, hoping this helps you to take care of yours.

Create structure where you can

Children thrive on structure and predictability. My family has tried to maintain a reasonable daily schedule for the kids that includes time for schoolwork, educational activities and free play; and we attempt to limit screen time. Ensuring children get a chance to go outside for exercise every day is also important for their physical and emotional well-being. These outdoor breaks could include walks, jogs, bike riding or walking the dog. Here’s more tips on creating structure and routine for kids during COVID-19.

Plan something to look forward to

Planning ahead for special activities with kids during your free time gives them something to look forward to, and they will enjoy the feeling of spending quality time with Mom or Dad. My family has had fun with backyard picnics, singing and dancing together, painting, baking, family movie nights and evening car rides.

art-project
One new piece of art that’s come from family art time in our home.

Our children have also enjoyed virtual playdates with friends, connecting with cousins over via phone calls and video chats, and celebrating virtual birthday parties. Since children are spending a lot more time at home than before, this is also a good time to engage them in additional age appropriate household chores. Here’s more activity ideas for kids during COVID-19.
family-movie-night-posterA homemade family movie night poster designed by my child.

How I’m protecting my family

All parents want to do their best to keep their family safe and healthy during this time. In addition to balanced nutritious meals (here’s some recipe ideas!) and exercise, sleep is a great immunity booster. Set reasonable hours for bedtime and waking up to make sure children get at least 9-10 hours of sleep every night. Minimizing outings in public places unless necessary, following face covering guidelines, good handwashing and sanitizing methods and maintaining social distancing in public are all key to ensure we play our part in continuing to limit the spread of COVID-19 in our communities.

 Maintaining well checks

Under the current stay at home orders, it can be tempting to skip your child’s well check if they’re feeling healthy. However, maintaining well child checks and staying up to date on vaccines is essential during this time. I have taken my children to their well check visits to make sure they are growing and developing well and are up to date on their vaccinations. When flu season comes around, I will also make sure our family gets our flu vaccines on time.

Be mindful of mental health

When speaking to children about COVID-19, ask them what they know since they have very likely already absorbed some information from news, elders or social media. It is important to provide reassurance and offer specific directions on what you are doing to keep them safe and what they can do themselves.

As a physician I cannot truly predict how this pandemic will evolve over the next several months. And, hence, there are no straight answers to my children’s questions of, “When can we go to Disneyland again? When can we fly to see Grandpa? When can I have a ”rea”’ birthday party?” If you’re getting the same questions from your kids, be honest and open to discuss possibilities as these can be great opportunities for kids to learn to live with uncertainty and build flexibility and resilience.

CHOC experts have created a variety of guides for parents on how to support their children during the pandemic A few are below, but you can find more resources here.

Practicing self-care

Meeting all these additional demands on our energies and attention for the foreseeable future is only possible if we maintain our physical, emotional and mental stability. Do not forget to take some time for self-care, which includes proper sleep, nutrition and exercise. Here’s more tips on self-care from a CHOC psychologist.

In my family, we avoid spending too much time watching or discussing COVID-related news, especially in front of the children. Amidst constant news of sickness, financial challenges and social upheaval I rely on my daily Heartfulness meditation practice to give me perspective and keep me going. Consciously practicing gratitude is also a great way to boost our self-esteem during these trying times. Personally, taking 5 minutes to list things I am grateful for every day as part of my bedtime routine has worked wonders to bring more optimism and joy to my day. Here’s more tips on practicing mindfulness and meditation.

Eventually, it is important to remember to accept the uncertainty, pat yourself on the back, pick your battles, stay connected and stay positive.

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I’m a pediatrician. Here’s what I want you to know about vaccines.

By Dr. Katherine Williamson, a CHOC Children’s pediatrician

dr-katherine-williamson
Dr. Katherine Williamson, a CHOC Children’s pediatrician

Proper vaccination is important for all people, but especially infants and babies. When children follow the recommended immunization schedule outlined by the American Academy of Pediatrics (AAP), they are better protected against potentially life-threatening diseases.

During the COVID-19 pandemic, your CHOC pediatrician’s office is a safe, socially distant environment to keep your child and family safe while still delivering high quality preventive care.

As a pediatrician, I get a lot of questions about baby vaccination and vaccines for children. Here are the most common questions I get about vaccines – and why maintaining your child’s immunization schedule is more important than ever.

Are vaccines safe?

Vaccines are one of the most important things we can do to help protect our children’s health. Vaccines and proper handwashing, more so than all other interventions, have proven to be the most safe and effective ways to prevent disease.

What is the proper vaccine schedule?

The current immunization schedule outlined by the AAP and Centers for Disease Control & Prevention has been researched and proven to be the most effective and safest way for children to be vaccinated against potentially fatal diseases. It’s important to know that no alternative schedule has been shown to be as safe and effective.

Is it better to do multiple vaccines at one time or space them out?

The safest way to keep your child safe from vaccine-preventable diseases is to get all their vaccines on time. There is no advantage to spacing them out, and instead the longer you wait, you increase the risk of them catching one of the preventable diseases before you protect them.

The amount of antigen (protein) in each vaccine is so tiny that your immune system can process multiple vaccines at one time and build an antibody “army” to protect your child for each of those potentially fatal diseases. In fact, the amount of antigen (protein) in each vaccine is 100,000 times less than if your child has a common cold, so there’s no concern about overwhelming their immune system when they get their vaccines.

Can I delay my child’s vaccines during COVID-19?

Getting vaccinated on time is important because even though we have the threat of COVID-19 to contend with, all the diseases that we can prevent easily with vaccines are still a threat. These diseases — such as whooping cough and measles — are ready to emerge at any time that we don’t have the majority of our kids vaccinated.

When global travel begins to pick back up again, the risk for the emergence of vaccine-preventable diseases is going to be very high if we don’t keep our kids protected against these fatal diseases. While we are waiting for a COVID19 vaccine to stop the pandemic, it is up to us to keep our kids safe and prevent any future epidemics by using the tools we already have to prevent disease.

Do I really need a flu shot every year?

Yes. Now more than ever, it is important that everyone 6 months of age and older receive an influenza vaccine this fall. As many experts are expecting an increase of COVID-19 cases in the fall, an important step to protect our families is to make sure they are vaccinated for influenza in addition to their routine vaccines. While the influenza vaccine does not protect against COVID-19, it may help children if they are exposed to the new virus and may be at higher risk of developing pneumonia or other complications if their bodies are also fighting influenza.

Influenza causes a higher number of death and illness over any other disease annually in the U.S., and your best chance of preventing influenza is the flu vaccine. Symptoms of influenza include high fevers, chills, muscle aches, and respiratory symptoms that can lead to pneumonia and respiratory failure. Children under 2 years and adults over 60 years of age are at the highest risk of becoming seriously ill if they are exposed to influenza.

The CDC recommends an annual influenza vaccine for everyone 6 months of age and older. You should be vaccinated as soon as the influenza vaccine becomes available. Although flu season peaks between December and February, it can start as early as October and last through May.

What can I do to make my child more comfortable while receiving a vaccination?

Studies have shown that preparing your child for vaccinations should ideally include three components: explaining what will happen, how it will feel, and strategies for coping with any related stress or discomfort. Here’s more tips on how to make shots less stressful.

This article was updated on May 18, 2020.

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Is it OK to skip your child’s checkup if they’re healthy?

The first few years of your child’s life are a major factor in their lifelong growth and development, which is why we recommend all well checkups for your child even if they’re healthy. During the COVID-19 pandemic, your CHOC pediatrician’s office is a safe, socially distant environment to keep your child and family safe while still delivering high quality preventive care.

These checkups, also known as well child checks, are an opportunity to track your child’s development, make sure they’re getting the care they need to stay healthy, and for parents to get answers to any parenting questions.

Under the current stay at home orders, it may be tempting to skip something called a “well child check” if your child is feeling healthy. Here are six reasons why it’s not OK to skip your child’s checkup, even if they’re feeling healthy.

dr-katherine-williamson
Dr. Katherine Williamson, a CHOC Children’s pediatrician

#1 Developmental screening

At every well checkup your pediatrician will be making sure that your child is meeting her or his developmental milestones, whether they are 4 months, 4 years, or 14 years old. For babies and toddlers, these milestones come rapidly as children’s brains are learning many new skills every day, from crawling to walking, and from first words to conversations. It is important to make sure your child is acquiring these necessary skills for brain development every step of the way. For older kids and teens, these milestones become less apparent, but are just as important, and are often reflected in a child’s ability to handle academics, relationship, and emotions. Your pediatrician is here to help at every stage of your child’s development.

#2 Relationship building

It’s important for your child to develop a rapport with their pediatrician. We are positive role models for young kids and help lessen their fear of going to the doctor. When your child is a teenager, parents are often asked to leave the exam room so the pediatrician can speak to the teen in private. Your child will feel more comfortable asking personal questions about their body and puberty later in life if their pediatrician has been a constant figure and steady resource since childhood.

#3 Mental health check up

Well checks also serve as a mental and behavioral health check-in. Your pediatrician can help evaluate your child’s mental health and wellbeing over time.

During well child checks amid the pandemic, mental health has been a bigger part of conversations during appointments than ever before. This is a chance for pediatricians to check on how the whole family is coping with stress related to COVID-19. They can share advice for how to talk to kids about COVID-19 and help them cope with COVID-19 anxiety as well as how to teach teens the importance of stay at home orders.

You can also talk to your pediatrician about how your child is coping with social distancing, or a lack of playdates and time with friends. They can offer advice on how to make this a positive time for your family.

#4 Enforcing healthy habits

Well child checks are a great opportunity to reinforce healthy habits. Often, kids will listen to their pediatrician more than their parents. We can remind children about the importance of eating healthy, doing their homework, brushing their teeth, wearing helmets—and listening to their parents!

Do you ever struggle with the question, “How much screen time is too much?” or find yourself battling your children over screen time limits? Your pediatrician can be a resource for you in helping reinforce screen time limits with your child. We can help explain to your children why their bodies need less screen time and more play, and how too much screen time affects their body and brain.

With children spending more time at home than ever, your pediatrician can be a resource on activity ideas for kids during COVID-19.

#5 Getting answers to questions you didn’t know you had

During many appointments in my office, my conversation with parents takes a turn from why they originally came in to see me. They might have an appointment to get a rash checked out, but then I’ll notice a mole on the child I hadn’t seen before, and they’ll realize they too were wondering about that, but just forgot to ask.

Pediatricians are resources for parents just as much as we are caretakers of your children. We’re here to help you get answers to your questions on acne, headaches, academic concerns and anything in between.

#6 A fresh perspective on parenting

Pediatricians specialize in taking care of infants, children and teens – but they can be there for you as a parent, as well.

Right now, parents have been asked to take on more than ever – working from home, overseeing their child’s distance learning curriculum, keeping kids entertained and engaged around-the clock, and more – and they are understandably overwhelmed.

Having a fresh set of eyes on a family’s situation may help troubleshoot what they are trying to figure out. Many of my patients’ parents are struggling with a seemingly never-ending to-do list. Their child’s pediatrician is someone they trust and respect, and I validate that they are doing their best.

Parents should congratulate and forgive themselves. At the end of the day they may be hard on themselves and wish they had done more, and that feeling compounds by the end of the week or month. What parents are juggling right now is Herculean. I applaud each and every one of you.

This article was updated on May 18, 2020.

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How parents can deal with COVID-19 stress

With schools and many businesses closed amid the COVID-19 pandemic, parents have been tasked with more than ever and many are dealing with COVID-19 stress. Their homes are now distance learning facilities, daycares, activity centers, remote offices and more.

The American Academy of Pediatrics (AAP) urges parents during this uncertain and difficult time to practice self-care, ask others for help, and use healthy discipline techniques when necessary.

How parents can practice self-care

“It’s more important than ever for parents to take care of themselves first,” says Dr. Katherine Williamson, a CHOC Children’s pediatrician and president of the Orange County chapter of AAP. “Unless parents are themselves well nourished, well-rested and maintaining healthy relationships, they won’t be able to provide the care or environment their kids need right now.”

There are several ways for parents to practice self-care while juggling their added responsibilities:

  • Eat a balanced diet
  • Exercise
  • Get enough sleep
  • Maintain social connections with friends and family via phone or video chat. These relationships are an important source of support during trying times. Discussion forums and online communities of other parents can be especially helpful.
  • Use your helpers. If you have a new baby at home, older siblings can help in developmentally appropriate ways.
  • Speak with your healthcare provider about your mental health. Many doctors and mental health providers are offering telehealth visits.

Healthy discipline techniques

Children have also had their lives disrupted by COVID-19. Schools are closed, and they can’t have play dates with friends. When children are bored or frustrated, they are more likely to act out.

“When children misbehave, effective discipline teaches them to regulate their emotions and helps them gain a better understanding of rules and expectations,” Williamson says.

The AAP recommends the following techniques when children feel stressed:

  • Engage kids in constructive activities. Here’s a roundup of activities for kids during COVID-19.
  • Help kids sort through their fears. Kids old enough to understand the news may be scared someone they love will die. Acknowledge their fear and share all the things your family is doing to stay safe, like washing your hands and staying home. Here’s a pediatric psychologist’s advice on helping kids cope with COVID-19 anxiety.
  • Call a time-out. Warn children they will get a time-out if their current behavior continues. Remind them what they did wrong in as few words with as little emotion as possible. Remove them from the environment for a pre-set amount of time. One minute per year of age is a good guide.
  • Know when not to respond. If your child isn’t doing something dangerous and gets plenty of attention for good behavior, an effective way to stop bad behavior can be just ignoring it.
  • Catch them being good. Point out good behavior, and praise children for their good tries and success. This is especially important in the disruption of children’s normal routines and friends.
  • Give them your attention. The most powerful tool for effective discipline is attention—to reinforce good behaviors and discourage others. Remember, all children want their parent’s attention. When parents are trying to work at home, this can be particularly challenging. Clear communication and setting expectations can help, particularly with older children.

“Corporal punishment – like spanking or hitting – can harm children and hinder brain development long-term. It is also not effective in teaching kids self-control,” Williamson says.

The AAP also cautions caregivers never to shake or throw a child. Tips for calming a fussy baby:

  • Check to see if your baby’s diaper needs changing.
  • Swaddle your baby in a large, thin blanket. Your child’s pediatrician can show you how to do it correctly to help her feel secure.
  • Feed your baby slowly, stopping to burp often.
  • Offer your baby a pacifier.
  • Hold your baby against bare skin, like on your chest, or cheek-to-cheek.
  • Rock your baby using slow, rhythmic movements.
  • Sing to your baby or play soft, soothing music.
  • Take your baby for a walk in a stroller.
  • Go for a ride with your baby in the car (remember to always use a car seat).

Most babies get tired after crying for a long period of time and then fall asleep. If your child continues to cry, call your pediatrician to discuss your concerns and stress. There may be an underlying medical reason for your child’s tears.

This article was last updated on April 14, 2020.

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Body mass index or BMI: What parents should know

By Dr. Angela Dangvu, a CHOC Children’s pediatrician

dr-angela-dangvu
Dr. Angela Dangvu, a CHOC Children’s pediatrician

 As a pediatrician, I spend much of my day doing well child visits for my patients. A big part of those appointments is looking at a child’s growth. Parents are usually interested in knowing their child’s weight and height percentiles, but they rarely ask directly about body mass index or BMI.

What is body mass index?

BMI is a measure of a person’s weight in relation to their height. It varies based on the age and gender of the person and is used to estimate the amount of body fat.

BMI is calculated starting at 2 years of age.  At this age it tends to be higher and will generally get lower until a child is 5 or 6 years old. Then, it will increase with age as they grow into early adulthood. Often, parents of children ages 3 to 4 ask me if their child is too skinny. They’ve begun to notice that their once chubby-looking toddler has thinned out. This is completely normal but can cause parents to overfeed their child because they think they are underweight.

Kids come in many different shapes, so they shouldn’t all have the same BMI. There is a wide range of BMIs that are considered normal. On the lower end, the normal range for BMI starts at the 5th percentile — meaning that 5% of children of the same age and gender will have a BMI lower than them. On the higher end of normal is a BMI in the 85th percentile, which means that 85% of kids of the same age and gender will have a lower BMI.

A BMI lower than the 5th percentile is considered underweight, while a BMI between the 85th and 95th percentile is in the overweight category. A BMI of more than the 95th percentile is considered obese.

When a child’s BMI indicates that they are underweight, it can be a sign of a medical condition that is preventing them from gaining weight. When a child’s BMI puts them in the overweight or obese range, we as pediatricians worry that they could be gaining too much weight, putting them at risk for diseases like diabetes or high blood pressure when they are older.

What body mass index is not

BMI is not a perfect measurement of a child’s body fat, but rather it is just one tool that we use in evaluating a patient’s overall growth and nutrition.

For example, a child being underweight doesn’t always mean they have a medical condition or are not getting enough calories. The child could be underweight because of genetic factors; perhaps both parents were thin as kids, and their child is taking after them.

How your pediatrician can help you improve your child’s BMI

As physicians we look at multiple sources of information to determine why a patient is underweight. We look at the growth chart, medical history and family history. We might order lab tests and refer our patients to a specialist depending on the findings. If the child appears to simply need to consume more calories, I usually encourage the family to incorporate some more calorie-dense foods into the child’s diet, rather than getting into a power struggle with their child about the amount of food they are eating.

If your child’s BMI is in the overweight or obese category, your physician should work with your family to determine possible causes, and solutions as well. Many parents already know that their child’s weight is a concern, but others may not notice that it has become an issue.  With my patients, I try to identify factors in their diet and activity levels to find potential areas for change. One thing to remember with children is that they will continue to grow into their teens, meaning that the goal doesn’t usually need to be weight loss. If they can slow their weight gain or even go for a period of time without gaining weight as they grow in height, their BMI will improve.

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