How Telehealth Can Help You and Your Child

/

By Troy Nelson, MD, pediatrician and medical director, DMG Children’s Rehabilitative Services

telehealth family

Contents:

A March 2021 survey found that 61 percent of respondents had used telehealth vs. less than 20 percent in March 2020.  The COVID-19 pandemic created a need for a safe way to visit with a medical provider to get non-emergent medical care, and telehealth was the answer.  At District Medical Group (DMG), including DMG Children’s Rehabilitative Services (DMG CRS), we offer telehealth appointments and have encouraged patients to use this technology to continue care for themselves and their families.

While many of our DMG CRS patients have complex conditions, telehealth can still be used to support ongoing treatment and ensure our young patients remain healthy and on course with prescribed treatment plans during the COVID-19 pandemic and beyond.

Here’s some ways telehealth is being used at DMG CRS to support the health of our pediatric patients and support their families:

Intake Appointments for New Patients

While we love to meet new patients and their families in-person, their health and safety is our number one priority.  Fortunately, through a telehealth meeting, we can gather all needed information about our new patient, understand the family’s health and wellness goals for their child, and begin development of a multi-specialty treatment plan. We can also get to know your child and you through these telephone visits.

Consultations with Specialty Providers

Like intake appointments, when a new pediatric specialist is being engaged to support your child’s health, a consultation between you and the DMG CRS medical specialist can usually be completed through a telehealth appointment.  As all clinics within DMG CRS use the same electronic medical records (EMR) system, the new DMG CRS medical specialist can easily view your child’s medical history and discuss next steps with you.

As well, if you have a regular follow-up scheduled with a DMG CRS specialty physician who has been treating your child, it may be able to be completed through a telehealth appointment. Through a telehealth appointment, your child’s DMG CRS physician and you can determine if an in-person visit is needed based on how your child is doing on his/her treatment plan.

Behavioral Health Visits

Because a physical examination is not needed, behavioral health visits are among the easiest to facilitate through telehealth.  COVID-19 has been stressful for people of all ages, including children. That’s why maintaining scheduled visits for your child with his/her DMG CRS behavioral health specialist is important.

Primary Care for Minor Illnesses or Injuries

If your child has a minor scrape or bruise that is concerning you or woke up with a cough, mild fever, or other non-emergent symptoms, contact the primary care clinic at DMG CRS to see if a telehealth visit is appropriate.  In some cases, minor symptoms can be easily diagnosed and treatment prescribed without an in-person examination.

Reengaging with Your Child’s Providers

If you missed regular medical appointments for your child during the COVID-19 pandemic, a telehealth appointment is a good way to reengage your child’s medical provider(s).  Through a telehealth visit, you can provide medical updates so the DMG CRS physician can determine your child’s present health status and make appropriate referrals.

The health, wellbeing and safety of your family is our number one priority.  At DMG CRS, we’re here for you providing options to ensure your child’s treatment plan stays on-track and support you in helping your child live a happy and healthy life.

This post was originally published on April 27th, 2021 at DMGAZ.org

 

Early Intervention for Infants and Toddlers with Developmental Disabilities

/

By Troy Nelson, MD, pediatrician and medical director, DMG Children’s Rehabilitative Services

child with development disabilities

Contents:

March is Developmental Disabilities Month.  According to the Centers for Disease Control and Prevention (CDC), the United States has experienced an increase in children with developmental disabilities.  Examples of development disability include:

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Autism spectrum disorder (ASD)
  • Cerebral palsy
  • Moderate-to-profound hearing loss
  • Learning disability
  • Intellectual disability (ID)
  • Recurrent seizures in the past 12 months
  • Stuttering or stammering in the past 12 months
  • Visual impairment
  • Any other developmental disability or delay

The same CDC study also revealed that some groups of children were more likely to have a developmental disability than others, such as:

  • Boys compared to girls
  • Non-Hispanic white and non-Hispanic black children compared to Hispanic children or non-Hispanic children of other races
  • Children living in rural areas compared to children living in urban areas
  • Children with public health insurance compared to uninsured children and children with private insurance

The CDC found that 17% of children 3–17 years old had a developmental disability, and this percentage increased over the two time periods compared (2009–2011 and 2015–2017).  Specifically, diagnoses increased for ADHD, ASD and ID.

One of the potential reasons for the documented increase is improved awareness, screening, diagnosis, and service accessibility. Healthcare providers and parents/guardians are having more conversations about symptoms (called “developmental delays”) of a potential developmental disability early, allowing for improved diagnosis and early intervention.

What is a “Developmental Delay?”

Parents or guardians are in the best position to detect a developmental delay in an infant or toddler.  Developmental delays fall into five categories:

  • Adaptive development: The ability level of a child related to age-appropriate life skills, such as self-care (feeding, dressing, etc.)
  • Cognitive development: How children think, explore and figure things out, including knowledge and understanding and problem solving
  • Communication development: The skills to understand and express thoughts, feelings, and information
  • Physical development: Motor skills defined as children’s abilities to use and control their bodies, including vision and hearing
  • Social or emotional development: how children start to understand who they are, what they are feeling and what to expect when interacting with others

If you sense a developmental delay in your child, share your concerns with your child’s primary care provider (PCP) immediately.  Your child’s PCP will assess your child through a developmental screening and engage the right specialists and support, as needed, to optimize early intervention for a diagnosed developmental disability.

Benefits of Early Intervention

“Early intervention” describes services and support that help a baby or toddler (from birth to three years of age, in most cases) with a developmental disability or delay. Early intervention may include speech therapy, physical therapy, behavioral health support and other types of medical services based on the needs of the child and family.

According to the CDC, intervention is likely to be more effective when it is provided earlier in life because:

  • Connections in a baby’s brain are most adaptable in the first three years of life.
  • Services can change a child’s developmental path and improve outcomes for children and their families.
  • Families are better able to meet their child’s needs at an early age and throughout their lives.

As the largest multi-specialty interdisciplinary clinic (MSIC) in Maricopa County, DMG CRS provides all needed medical and support services in one place, so your child’s treatment plan is managed through a single medical record with coordinated care among all pediatric specialists and services.  If you have questions about your child’s development at any age or need care of a child with a developmental disability, please contact us to schedule an appointment with a pediatrician or the appropriate pediatric specialist.

This post was originally published on December 9th, 2020 at DMGAZ.org with light contextual revisions August 10th, 2023.

 

COVID-19 and Kids’ Mental Health

/
By Melissa Meyer, DNP, PMHNP-BC, child psychiatry specialist at DMG Children’s Rehabilitative Services
family in the kitchen together2020 has been a year like no other, especially for children.  Kids have had to completely change their routines, including:

  • Attending school from home (“virtual learning”)
  • Limiting and/or eliminating in-person social activities
  • Limit extracurricular activities, such as team sports, clubs, etc.

All the above activities are critical to providing balance to a child’s life, and without these options, children, like many adults, may be feeling isolated.  And to top it off, we don’t know when things will change and return to “normal.”  As a result, children may feel increased stress, fear, anger, hopelessness, anxiety and may experience depression.

Depending on how old your child is, he or she may deal and/or reveal these emotions in different ways.  Adolescents and young adults may try to hide their struggles because of fear, shame, or a sense of responsibility to avoid burdening others. Younger children may not know how to talk about these feelings but may show changes in their behavior or development.

Here’s some tips for supporting your child through these uncertain times and helping them deal with these confusing emotions.

  1. Check in with your child often. Ask him or her how he or she is feeling and be (age appropriately) open in sharing how the changes brought on by the pandemic are impacting you.  The goal is for your child to know that his or her feelings are not “strange,” and people of all ages are having these emotions.  At the same time, you want to share empathy and confidence with your child.
  2. Watch and listen for signs that your child is struggling.
    1. Younger children: Bedwetting; fussiness, tantrums or hitting; difficulty sleeping; taking steps backward in development; stomach issues such as nausea or loose stool; and/or separation anxiety
    2. Adolescents: Challenges sleeping; changes in mood or increased moodiness; decreased appetite and/or weight loss; less interest in activities previously enjoyed, including texting and video chatting; issues remembering things; less interest and/or apathy for academics and schoolwork; use of alcohol or drugs or new risky behavior; talk or interest in suicide; and/or lack of personal hygiene
  3. Stay in touch with your child’s primary care provider (PCP) or pediatrician through telephone, patient portals, and/or in-person or telehealth visits. He/she can do basic depression evaluations and help you determine if additional support is needed, be it counseling/therapy, medication, or other tools or activities to help your child.

DMG Children’s Rehabilitative Services has behavioral health providers to support children of all ages.  As a parent, you’re not alone; healthcare providers are here to support the health of your child and your entire family.

Originally published by District Medical Group

Healthy Weight, Child Diabetes and Your Child

/

By Troy Nelson, MD, Medical Director at DMG Children’s Rehabilitative Services

children playing outdoors

Contents:

Did you know November was American Diabetes Month?  According to the American Diabetes Association, more than 34 million people in the United States have diabetes, and more than seven million of those people are undiagnosed. About 210,000 Americans under age 20 are estimated to have diagnosed diabetes.

Type 1 Diabetes: Diagnosed at Younger Ages

According to the Centers for Disease Control and Prevention (CDC), type 1 diabetes accounts for approximately 5-10% of diabetes cases in the United States.  Symptoms of type 1 diabetes often develop quickly. It’s usually diagnosed in children, teens, and young adults.

Type 2 Diabetes: Increasing Pediatric Cases

Type 2 diabetes is the most common type and is generally diagnosed in middle age or older.  However, the incidence is on the rise in children because more children are becoming obese.  Being overweight or obese increases the risk of developing type 2 diabetes, regardless of age.

Symptoms of Type 2 Diabetes in Children

Your child may develop type 2 diabetes so gradually that there are no noticeable symptoms. Sometimes, the disorder is diagnosed during a routine check-up, which is why regular well-child exams are important.

Symptoms of type 2 diabetes in your child may include:

• Blurry vision
• Darkened areas of skin, especially around the neck and armpits
• Fatigue
• Frequent urination
• Increased thirst

Type 2 Diabetes Risk Factors in Children

• Age and sex: Many children develop type 2 diabetes in their early teens. Adolescent girls are more likely to develop type 2 diabetes than are adolescent boys.
• Family history
• Inactivity
• Overweight, especially in the abdomen
• Pre-term birth (before 39-42 weeks)
• Race or ethnicity: Black, Hispanic, American Indian, and Asian American people are more likely to develop type 2 diabetes

Preventing and Managing Pediatric Type 2 Diabetes

You can help decrease the risk of your child getting type 2 diabetes as well as help manage it if your child has been diagnosed.

• Get an annual well-child exam with your child’s pediatrician or family medicine provider.
• Eat healthy foods as a family; encourage your child to participate in meal planning and preparation.
• Ensure your child gets plenty of physical activity; identify activities you can do as a family, like hiking or walking the dog.
• Help your child maintain a healthy weight.

DMG Children’s Rehabilitative Services includes pediatric and young adult providers,  endocrinologists and nutritionists to support your child and your family.  We are committed to educating you and your child and developing treatment plans to optimize your child’s health and long-term wellness.

 

This post was originally published on December 9th, 2020 at DMGAZ.org

 

Supporting Your Kids through Holiday Stress

/
By Melissa Meyer, DNP, PMHNP-BC, child psychiatry specialist at DMG Children’s Rehabilitative Services

 

Family at ChristmastimeThe holidays are a time of peace, love, joy, and family, but it’s also a time where schedules are irregular, routines are disrupted, meals are heavier, and sugar abounds.  For children of all ages, these changes can be difficult; if the child has depression, anxiety, an eating disorder, attention deficit disorder (ADHD) or other emotional or behavioral health challenges, the holidays can compound the issue.

Did you know?

  • Depression and anxiety: According to a 2019 study published in the Journal of Pediatrics, about 1.9 million children ages 3 to 17 years have been diagnosed with depression, and 4.4 million have been diagnosed with an anxiety disorder.
  • ADHD: Nearly 6.1 million kids ages 2 to 17 have been diagnosed with ADHD, according to a 2018 study in the Journal of Clinical Child & Adolescent Psychology.

If your child suffers with emotional or mental health issues, here’s some tips to help you child and your family decrease the stress and impact of the holidays:

  • Communicate plans: With each activity or outing, let the child know what will be happening ahead of time- who will be there, how long you will be staying, what food to expect, etc.  Knowing what will be happening will help decrease anxiety.
  • Share feelings: If you are feeling stressed, tired, or anxious, share your feelings with the child.  He or she will take comfort in knowing that even adults get nervous and stressed during the holidays.
  • Maintain a sleep schedule: Everyone in the family will benefit from a good night’s rest, especially children. According to the American Academy of Sleep Medicine, kids with mental health issues need adequate sleep; for teens, 8 to 10 hours per night is recommended.
  • Manage screen and device time: When adults are busy, it’s easy for children of all ages to occupy themselves with television, video games, and social media. However, too much “technology time” has proven to negatively impact sleep as well as contribute to depression.
  • Keep medication schedules: If a child takes medication, ensure he or she continues to take it at the same time each day.
  • Watch sugar intake: Help keep the child’s diet balanced with regular nutritious meals and limit sweets and sugar-filled drinks, especially before bedtime.

Most importantly, be aware of the child’s mood and listen to him or her.  The child or teen make need some downtime in between the hustle and bustle of the holidays.  Allow time in the family’s schedule for everyone to decompress, so each member of your family can enjoy the spirit of the holidays.

Article originally published by District Medical Group at DMGAG.org

Dental Health in Children: Get the Facts

/
By Lyn Hughes, dental hygienist, DMG Children’s Rehabilitative Services

parent and doctor showing child how to brush teeth

Originally published at District Medical Group on October 21, 2020

 

October is Dental Hygiene Month, which is somewhat ironic as Halloween, the day of the year where children probably get more candy than ever, is also in October.  So, why not take this month to talk to your children about the importance of taking care of their teeth?

Getting your children into healthy dental habits now can save them time and pain and give them advantages throughout their lives.  According to the Centers for Disease and Control and Prevention (CDC), children who have poor oral health often miss more school and receive lower grades than children who don’t.

Did you know cavities are one of the most common childhood diseases in the United States?

When untreated, tooth decay can cause pain and infections which can lead to problems with eating, speaking, playing, and learning.

The CDC also shares these facts about cavities in children:

  • 20 percent of children ages 5-11 and 13 percent of adolescents have at least one untreated cavity.
  • Children ages 5-19 from low income households are more than twice as likely to have untreated tooth decay.
  • About one-third of cavities in baby teeth can be prevented by a fluoride varnish.
  • Dental sealants applied to the surfaces of back teeth can prevent 80 percent of cavities.

Beginning dental care when your child is a baby is a great first step towards optimal dental health.  Schedule your child’s first pediatric dental care appointment at the age of one to spot signs of early problems.  We’ll help you identify good at-home dental habits to engage your child in taking care of his or her pearly whites for a lifetime.

What Is Pediatric Physical Therapy ?

/
By Linda Thunn, DPT, physical therapist at DMG Children’s Rehabilitative Services

young child receiving physical therapy

Originally published at District Medical Group on October 21, 2020

 

Did you know October is National Physical Therapy Month?  Each year during October, the physical therapy team at DMG Children’s Rehabilitative Services (DMG CRS) supports the Spina Bifida Association of Arizona through their annual Walk-N-Roll® fundraiser.  The team is passionate about serving patients in and outside of the clinic.

What do pediatric physical therapists do?

Pediatric physical therapists provide services for children with developmental disabilities from birth to 21 years-old; in addition, the team provides support and education to the patient’s family.  At DMG CRS, our goal is to develop, restore and/or improve mobility to enhance quality of life for the child and his/her family.

Pediatric physical therapy benefits children and their families and/or caregivers by promoting activity and participation in everyday routines, increasing functional independence, improving strength and endurance, facilitating motor development and mobility, and easing the challenges of daily caregiving.

The team has also begun serving adults with disabilities who may benefit from the services specifically available through DMG CRS.

DMG CRS physical therapists treat patients one-on-one in the physical therapy and rehabilitation clinic at DMG CRS as well as serve patients being treated at other DMG CRS clinics such as:

DMG CRS physical therapists also perform equipment evaluations, trialing each child in specialized equipment before ordering it to determine what works best. Types of equipment evaluations provided include:

  • Adaptive seating
  • Adaptive car seats
  • Forearm crutches
  • Gait trainers
  • Standers
  • Walkers
  • Wheelchairs

Additional Content

For more information on DMG CRS equipment evaluation services, watch this video.

For additional information on  the services offered by DMG CRS physical therapists, view this video.

 

Newborn Screenings: What You Need to Know

/

By Troy Nelson, MD, pediatrician and medical director, DMG Children’s Rehabilitative Services

 

Did you know September is Newborn Screening Awareness Month?  Newborn screenings allow identification and treatment of a disease before symptoms even emerge.  A newborn may appear healthy, but still have a serious condition that cannot be seen.  If left untreated, these conditions can lead to slow growth, blindness and/or intellectual disability, and may be life threatening. Early detection and treatment can help prevent these serious problems, which is why newborn screening is critical.

Based on published research by Dr. Robert Guthrie in 1963, newborn screenings have evolved with newborns now being screened for more than 25 conditions within days of birth; newborn screenings involve just a few drops of blood.  According to the National Institute of Health, newborn screenings detect a treatable condition in about 1 in 300 babies born each year, a total of about 12,500 cases each year. In Arizona, approximately 100 babies annually are found to have a serious condition identified through newborn screenings.

Providers in Arizona are required by law to order newborn screenings for all newborns.  Arizona requires newborns to be screened twice to help ensure accuracy, as some conditions are easier to detect on a subsequent screen.  In addition, approximately 98 percent of all infants born in Arizona are screened for hearing loss prior to hospital discharge.  The first newborn screening sample will be taken before the baby leaves the hospital and the second will be taken between 5-10 days after birth, or at the first well-baby visit, whichever comes first. For those newborns born at home, the healthcare provider present at the birth will collect the first screen.

At DMG Children’s Rehabilitative Services (DMG CRS), we provide specialized treatment for newborns for which a condition was detected during screening.  Our goal is to provide most medical specialties and services in one location by physicians and staff that work exclusively with children from birth through age 18.  With early detection, intervention, and treatment, we can partner with you and your family to enable your baby to thrive to the maximum of his or her abilities.

Dr. Nick Tanner’s Three Tips for Parents of Children with Health, Developmental, and Behavioral Differences

/

First:

Doctor Nick Tanner

Dr. Nick Tanner

Never stop advocating.

When parents have a kid with extra needs or differences, things may things get contentious between parents schools, healthcare providers, and government agencies.  Sometimes it can feel a little like it is “us vs. the world.”

As a psychologist, part of my job is encouraging my parents to engage with these complex systems of care, help them navigate the procedural challenges inherent to these systems, and facilitate collaboration with the goal of helping patients and families thrive.

Although it’s important to have realistic expectations, the old saying is true; squeaky wheels tend to get the grease. Families and parents who are persistent tend to be more successful in getting more individualized and intensive treatment.

Though conflict can be uncomfortable, it’s important to be your child’s biggest cheerleader – never stop advocating.

Second:

Think about the long-term big picture.

Parents often and understandably get caught up in what their children’s limitations are, right now and in the present. They may lose sight of what’s important to them.

Part of my job at CRS is helping parents and families identify and connect to their values.  Most parents want their children to live vital and meaningful lives, and sometimes an extra need or illness can make it hard to see what’s important in the long run.

Identifying values is one way to help figure out the big picture. Values can act as a compass, providing direction and assisting parents to move from a place of “My child can’t do this,” “What if they fail,” or “My child will never,” to a more productive place. A place where parents can begin to ask “What can my kid do now,” “What do I hope they’ll be able to do later,” and “How can we help them get to that place.”

Think about the big picture, dare to dream, and focus on what is important.

Third:

Take care of yourself.

For a good reason, many parents do not consider themselves, or their wellbeing, a critical contributor to their child’s outcomes or a priority.

On top of the already hectic demands of parenting, families of children with extra needs also have additional requirements on financial resources and their time.

Many of the families I work with have to manage busy schedules that include juggling therapy appointments, doctors visits, school, and work.  However, there is reason flight attendants tell parents to put on their air masks before attempting to help others in an emergency – it’s impossible to help other people if you do not take care of yourself.

Research shows that socially isolated parents struggle to build fulfilling relationships with their children and are more likely to develop mental illnesses. It’s not “selfish” to take care of yourself.  Finding some time for yourself is essential.

So go ahead, make that therapy appointment for yourself, get a pedicure, or meet up with some supportive friends. It might be one of the best things you can do for yourself and your child.

Ask a Doc: Do your kids need sunscreen if they’re in the shade?

/

kids and sunscreen

You should put sunscreen on your kids even if they’re playing outside in the shade. – Paul Bradbury, Getty Images

Mansi Sarihan, MD  |  Contributor
As originally published USAToday.com 9:20 p.m. June 18, 2018

Question: Do you need to wear sunscreen if you’re outside in the shade?

Answer: I receive this question often and every time I answer:

Definitely yes!

You may think you’ve got it made in the shade, but you can still be hit by harmful UV rays that bounce off the sand, sidewalk, pool or ocean. They can even bounce off grass!

Even under an umbrella or a shade structure, UV rays can slink through the fabric and cause skin damage.

Yes, shade is a blessing. But if you’re relying on it to protect your skin from sunburn, you may be very disappointed. That’s why you’ll want to apply sunscreen before you step outside, even if you’ll stay in the shade.

Here’s the best way to protect yourself and your loved ones from direct and indirect UV rays:

  1. Use sunscreen of at least SPF 50 or higher, with full UV spectrum. Find a brand that you like – you’ll be more likely to use it. Reapply sunscreen every two hours you’re outside.
  2. Wear wide-brimmed hats (at least 3 inches of brim all around the head) and UV protective clothing.
  3. Avoiding the sun during peak hours is essential. From around 10 a.m. to 2 p.m., try not to go outside. Or, stick to shaded areas such as swimming at times when the pool is out of the direct sun.
  4. Get in the habit of applying sunscreen. Daily application of sunscreen in the morning, regardless of your activities during the day (even just driving in the car), can yield healthier and happier skin.

Follow these rules and your skin will thank you.

Mansi Sarihan, MD, is chief of dermatology at Maricopa Integrated Health System and Clinical Assistant Professor, University of Arizona, College of Medicine-Phoenix.

As originally published USAToday.com 9:20 p.m. June 18, 2018