A day in the life of a pediatrician

By Dr. Rei Tosu, a CHOC pediatrician

I’m a board-certified pediatrician at Los Alamitos Pediatrics, part of the CHOC Primary Care Network. I’ve been a pediatrician for 18 years and chose pediatrics because I love working with children. I feel that I can have the most positive impact on the health and development of my patients when I start taking care of them from day one.

Here is a typical workday for me.

6 a.m. — My alarm goes off. Most days, I’m able to forgo the snooze button and wake up the first time, mostly because I don’t want to be woken up by my alarm twice! I take a shower and make a hearty breakfast. I grew up with the idea ingrained in my head that breakfast was the most important meal of the day and I have continued to enjoy a hearty breakfast through my adult life. My husband usually leaves earlier than I do, but I wait for the kids to come down one by one and we eat breakfast together, going over the day’s schedule and making sure everyone is set for the day.

8:05 a.m. — I get into the office before my first patient is scheduled in order to give myself time to get ready for the day. I look through my email inbox, check my voicemail for messages that need to be returned and handle prescription refill requests that may need to be sent. This morning, I have a voicemail from the parents of a 13-month-old about his diet and transitioning from formula to milk. I notice in his chart that he has not had his 12-month well-check yet. I call the parents back and after addressing their questions, I ask them why they hadn’t brought him in for the 12-month checkup. They share with me their concerns about bringing their baby into the office during the pandemic, and I reassure them that it is safe to bring the baby in, that we have taken extensive safety precautions, and that it is in the baby’s best interest to keep up with their visits and their vaccines. The parents then ask that I transfer them to the front office staff so they can schedule their appointment, and I happily oblige.

8:25 a.m. — One of our nurses lets me know my first patient is ready to be seen. It’s a six-month well check. In the mornings, I tend to see a lot of well-checks, especially the younger ones who are not yet in school. Mom tells me that he has started eating solids and I can see during his exam that he is now sitting well on his own. He seems to be growing and developing well! I talk to the mom about child-proofing the home, since the chances are good that this little boy will be mobile before his next visit. During this visit, he receives his 6-month vaccines plus the flu vaccine. Flu season is upon us and it’s important for everyone to be vaccinated against influenza., Since babies and children who are receiving their first flu vaccine need two doses, they will come in another time for the second dose. I’m looking forward to seeing this baby again during his next well-check. He will have grown so much!

10 a.m. — After seeing a few other patients for their well-checks, I notice a telehealth appointment has been added to my schedule. Our office, just like many other offices around the country, started doing more of these virtual appointments this year in light of the COVID-19 pandemic. Not all medical appointments can be conducted virtually, but for the ones that can, it is a helpful way to promote physical distancing. This particular appointment is a follow-up for a 6-year-old patient with eczema. My patient finds it intriguing to see me on her parent’s laptop screen, and she proceeds to show me her room and tell me about her stuffed animals. After a tour of her room, we eventually talk about her eczema. Her mom points the camera at all the girl’s lesions so I can take a better look and we ultimately decide on a regimen for her eczema.

12:30 p.m. — Time for lunch. Before the pandemic, sometimes I would go out to lunch with co-workers or we would have lunch brought in for meetings or trainings. Most of the time, however, I bring my own lunch and eat in the office. Although current physical distancing guidelines prohibit us from all gathering in the same room and eating lunch together the way we used to, I am eager to get back to those shared meals with my colleagues. It’s a nice time to catch up with everyone and relax a little bit in the middle of hectic workdays. Many of the doctors and staff members have been working in the office for a long time and have become a tight-knit work family.

1 p.m. — I have a little bit of time before my afternoon appointments begin, so I take the opportunity to prep the charts for the following day. I go through the list of patients scheduled for tomorrow and notice I have a 3-year-old new patient. I go into her chart and notice she has had multiple specialist visits. I spend some time reading to find out she was diagnosed with kidney cancer and has been under treatment but is now in remission. One of the advantages of being part of CHOC’s Primary Care Network is that the electronic medical record platform is the same for all CHOC providers and I am able to access notes from her CHOC specialists and studies that have been done. Even though I will be meeting this patient for the first time tomorrow, I already feel well-versed with her medical history and feel comfortable taking care of her.

1:30 p.m. — I get ready for another telehealth appointment on Zoom, this time with a pregnant mom for her prenatal consult. She is expecting a baby boy next month, and I answer some questions she has about newborn care and circumcision. It’s nice for both sides to put faces to names before we meet for the first time when the baby is delivered.

2 p.m. — My first in-person patient of the afternoon is a 15-year-old healthy girl here for a sports physical. I know many teens come just because they need their forms filled out, but these appointments are nice opportunities to make sure not only that they are healthy enough to participate in sports, but also to find out how they’re doing in school, how they’re coping emotionally during the well-known turbulent adolescent years, and to make sure they’re up-to-date on their vaccines. This particular teen I have seen since day one of her life in the hospital when she weighed just under 5 pounds. Today, she towers over me and is a competitive rower. This is one of the most enjoyable and rewarding parts of what I do, getting to know the patients and their families, watching them grow from an infant to a young adult, and being able to take part in their journey.

4 p.m. — My last patient of the day is a 13-year-old boy with anxiety. Unfortunately, we’re seeing increasing numbers of patients, at younger and younger ages, with mental health issues. While we may refer some of these patients to our mental health colleagues, our job as the pediatricians is to be the first landing spot and a gateway for the specialists. We share a few tears, but I am glad that he has taken the first step to come see me and to talk about his issues.

5:30 p.m. — I finish updating my patients’ charts from today and head home.

6 p.m. — As I walk into my house, I can hear the familiar sound of a bouncing basketball. My 12-year-old daughter must be out in the backyard practicing again. I start cooking, my husband gets home, and we all sit to eat together. I believe it is important to eat together as a family and am grateful that we get to do that almost every night. After dinner, we are treated to a viewing of the latest production by my 14-year-old son who is a budding video editor.

7:30 p.m. — As my kids have gotten older, I have more of my own time in the evenings and have gotten better about self-care. Tonight will be a yoga night for me.

9:00 p.m. — Before bed, I get some reading in. More often than not these days, I’m reading books recommended to me by my 17-year-old son who is an avid reader.

A pediatrician’s tips for promoting a safe return to sports during COVID-19

With some kids and teens returning to team sports after an extended break amid the COVID-19 pandemic, parents and pediatricians alike have safety top of mind.

Taking care of your physical and mental well-being will lead to more achievement and fun on the field, says Dr. Matthew Kornswiet, a sports medicine pediatrician in CHOC Primary Care Network.

How can you keep your kids safe on the field after so much time off?

Coaches and parents should continue to follow safe return to sports guidelines from the Centers for Disease Control & Prevention and locally, the California Interscholastic Federation.

Remembering the acronym SPORTS can also help support a safe and healthy return to play and participation in athletic activities during the COVID-19 pandemic.

With support from Dr. Chris Koutures, a CHOC pediatrician and sports medicine specialist, Dr. Kornswiet offers these tips for parents, guardians and coaches:

S – Start slowly

It’s been a while since your child has played sports, so do not expect them to start where they left off. It may take several weeks to get back into shape. Start with a review of basic skills and techniques and build up to more advanced skills. Plan shorter workouts to give them time to build up endurance. And limit repetitive movements such as throwing, swinging and jumping.

P – Pay attention to your body

Quickly returning to athletic activities after time off increases the risk of overuse injuries. Follow your instincts – if you are hesitant to return to your activity, then wait or slow down. Also, maintain adequate sleep of eight hours or more per night, and stay hydrated to help your body perform at its best. Early in conditioning, especially during hot days, watch for signs of overheating. If you feel more tired than everyone else, or experience dizziness or confusion, seek medical care immediately.

O – Open mind

Reset expectations and short-term goals. You may not be able to practice like you usually do. Be mindful of your mental health and well-being during this extraordinary time. Think of ways to cross train or do alternative workouts.

R – Red flags

See your pediatrician, sports medicine physician, athletic trainer or physical therapist if you experience pain in a small, confined area; if you are limping or not able to move normally; if you feel pain/soreness greater than four on a scale of one to 10; if you experience pain or soreness when you are not playing sports; or if you feel pain or soreness that lasts two to three days after activity.

T – Take steps to limit the spread of COVID-19

Never practice or play when you are feeling sick. When possible, train outside to limit the risk of transmitting/catching infections. Wear a mask or face covering when possible (i.e. in team meetings and when on the sideline). Bring hand sanitizer and use on your hands often. Try not to share equipment. If that’s not possible, then limit the number of people using that equipment and plan how to clean between uses. Bring your own water and snacks. And avoid high-fives, fist/chest bumps, and hugs – create your own hands-free celebration. 

S – Stay positive

Sports are fun, social and make us stronger physically and mentally. Playing sports can help us through challenging times.

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.

dr-eric-ball-choc-childrens-pediatrician
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.”

Summer safety tips from your pediatrician

Kids are still kids, even during a pandemic – they play, they get sick and sometimes they get hurt. We spoke to Dr. Angela Dangvu, a CHOC  pediatrician, about what parents can do to keep kids safe this summer.

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

COVID-19 precautions

With no vaccine currently available, the best way to prevent illness is to avoid being exposed. In addition to practicing proper handwashing, people should watch for symptoms and avoid going out if they feel ill. When outside the home, people should physically distance from others whenever possible, and wear a face covering. The Centers for Disease Control and Prevention recommends the use of cloth face coverings in public for those over age 2. The governor of California has mandated that face coverings be worn by the general public when outside the home. Read the full order, including exemptions, here.

Be safe around water

A child can drown in as little as 2 inches of water – so keep an eye on all bodies of water like bathtubs and ice chests, in addition to pools. Assign a “water watcher” who knows how to swim and can provide constant, uninterrupted supervision. Learn more about water safety.

Wear your sunscreen

Everyone over 6 months should wear sunscreen when they’re outdoors. Infants younger than 6 months should be kept out of the sun.

Apply a sunscreen with SPF 30 at least 15-30 minutes before you go outside. Reapply every two hours or after swimming or sweating. Wide-brimmed hats and sunglasses offer extra protection. Limit time spent outside between 10 a.m. and 4 p.m. to minimize down on sun exposure. Also be aware that surfaces like sand and water reflect sunlight, so it’s possible to get burnt even when you’re in the shade. This is especially true for infants.

Review family emergency preparedness plans

Emergencies are not on pause just because there is a pandemic. Create and practice a fire escape plan with your family. Double-check smoke alarms and carbon monoxide detectors.

Practice poison precautions

Avoid household poisoning hazards and save the Poison Control Center’s phone number in your cell phone: 1-800-222-1222 for serious emergencies or simple questions. Store medicine and vitamins up high and out of sight. Remind children that medicine is not candy.

Helmet safety

Most serious head injuries can be avoided by wearing a properly fitting helmet. By law in California, everyone under 18 years of age must wear a Consumer Product Safety Commission-approved helmet while bicycling, riding a scooter, skateboard, or using roller-skates or in-line skates. Parents should enforce this rule even when kids are riding in areas where they don’t expect to encounter vehicles.

Learn more about the most common summer injuries that send kids to the emergency department – and how to avoid them.

If your child is ill or injured during the COVID-19 pandemic, rest assured that it is safe to seek the care they need. Here’s a guide on deciding where to go for care during COVID-19.

This article was updated July 22, 2020.

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

By Dr. Marshneil Chavan, a CHOC 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.