Pediatricians have new guidelines for depression screening in teens.

Family, health tips, parenting, pediatrics, teens, Uncategorized

It has been over ten years since the initial publication of the American Academy of Pediatrics (AAP) endorsement of guidelines for Adolescent Depression in Primary care (GLAD-PC).  The newest endorsement was released weeks after the most recent horrific school shooting trauma in Parkland, FL.

In our current society teens are at risk for depression and other mood disturbances like anxiety when exposed to traumas such as school shootings, cyber bullying, teen dating violence and even social media influences.  Those are all in addition to just normal puberty hormonal changes that can also affect mood.  Depression can look different in teens and can often present in the doctor’s office as somatic complaints like, “He’s been really tired.” or “She can’t remember things I tell her. It’s hard for her to concentrate.” Very seldom will an adolescent report having a problem with their mood.  It is estimated that 1 in 5 adolescents will suffer from depression prior to their adult years.  Although depression is treatable more than 50% of cases of adolescent depression does not get identified.

Depression is more than an occasional sad mood or defiance to the family rules.

Here are a few ways depression may present in your teen:

  1.  Poor performances in schoolwork when previously doing well.
  2.  No longer showing an interest in former social activities or hobbies.
  3.  Decreased energy.
  4.  Sleeping more or sleeping less.
  5.  Substance use.
  6.  Low self-esteem. Poor body image. Feelings of unworthiness.
  7.  Isolating themselves. Withdrawing from friends and family.
  8.  Lack of motivation.
  9.  Irritability, aggressiveness, outbursts, agitation.
  10.  Changes in eating habits.
  11.  Poor concentration.
  12.  Suicidal thoughts.  Self-harming behaviors.

One of the major updates in the new guidelines includes universal yearly screenings for all children ages 12 years and older.  The AAP also endorses the use of a formal depression self-reporting tool.  The prior guidelines only supported systematically identifying risk factors without any universal screening.

These screenings should be implemented during:  1. well child exams,  2. for adolescents who present with chronic somatic complaints  or 3.  if there are risk factors for depression like a family history of depression, trauma, substance use or psychosocial stressors. There should also be a time during your teens visit that they will be interviewed alone by their pediatrician. This helps to establish a rapport and to allow your teen to freely discuss what is on their mind. However, it is also important to have the guardians insight and even more important to include the physician, teen and guardian(s) all together when establishing a safety plan.

The safety plan needs to restrict any means an adolescent might have to committing suicide, removing firearms from the home, designating a trusted adult they can speak to during a crisis.  According to the CDC, depression can lead to suicide. Suicide is the second leading cause of death in children ages 10-24. The National Suicide Prevention Line is  available 24/7.  They provide free and confidential support and crisis resources for people and their loved ones during times of distress.

The new depression screening guidelines were updated to help primary care physicians screen for depression in adolescents in the primary care settings.  It is imperative to start the screening early during this era of shortage of behavioral health resources.  If your teen meets the criteria for mild depression this can be managed by your pediatrician.  For moderate to severe depression, starting an anti-depressant may be required. This therapy should be managed by your pediatrician in adjunct with a mental health professional who can provide psychotherapy simultaneously.

In summary, our children deserve the best and it is important to identify signs of depression early on for the best possible outcomes.

 

 

 

 

 

 

 

P.S. Remember you can book an appointment with me for any pediatric non-emergent illnesses like ear aches, rashes, vomiting, pink-eye etc. or for any parenting questions about pediatric illnesses, behavior, mood or development.

All posts containing medical information are for informative purposes only and is not direct medical advice nor establishes a patient-physician relationship. 

Photo by G. Madeline on Unsplash.

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Burn Injuries in Kids: 5 Myths & Facts!

Family, health tips, parenting, telemedicine

 

I talked a little bit about an old wives tale about butters and burns on my instagram page last week during Burn Awareness week.  Every 60 seconds someone sustains a burn injury severe enough to require medical attention. Children are also 2.4 times more likely to suffer burn injures that require emergency medical treatment than the general population. 75% of burn injuries in children come from liquids or steams. Burn injuries includes thermal, chemical and electrical causes. 

Here is what you need to know if your child sustains a burn injury:

 

MYTH:  You should rub an ice cube over the burn area

FACT:   Do not put ice directly on thermal burns as this can make it worse and can make the healing time longer. Rubbing burns will slow down the healing process.  Instead run cool water over the area until there is pain relief.  If the burn is from a chemical injury remove the clothing and wash off the skin and contact your pediatrician or Poison Control at 1-800-222-1222.

 

MYTH:  Pre-testing the bath water with your hand is sufficient enough to gauge the temperature intensity for your child.  If it’s not hot for you its not for them!

FACT:  Younger children have thinner skin and their skin can burn more quickly, even at lower temperatures.  Water temperature should be at 120 F or the manufacture’s recommended setting.  Always test the temperature of bath water for younger kids with a bath toy thermometer.  If that’s not available use your elbow or wrist.

 

MYTH:  You should pop the burn blister.

FACT:  There are three levels of burn severity.  First degree burns are like sunburns. They turn red, somewhat painful but do NOT blister.  Second degree burns are superficial.  The first outer layer of skin is burned. This burn is painful and will have blisters.  Third degree burns involved the first two layers of skin.  The skin will appear white in color.  Popping a blister is not recommended as this can increase the risk of infection. Gently cleanse the burn with soap and water.  Cover the burn with a clean non-sticking bandage until new skin forms and there is no longer fluid coming from the burn.  Don’t forget to give pain medication like acetaminophen or ibuprofen.

 

MYTH:  Microwaves are safer than ovens.

FACT: Children, especially young toddlers, are at risk for burn injuries from microwaves as well. Most burns in children requiring medical treatment are related to the preparation or consumption of food.  This includes injuries like splashing of hot liquids, spills,  opening hot containers or consumption of  unevenly cooked foods.

 

MYTH:  Do like grandma says and put some butter on that burn. It helps!

FACT:  Applying butters, oils, creams, grease or powders will worsen the burn injury.  If the burn is more severe than a superficial (redness only) burn then they require immediate attention. You can cover non-oozing burns with a sterile gauze or a clean and dry towel.  If the burn covers  their face, hands,  feet, genitals, joints or has a surface area of more than 10% of  their body then immediate medical attention is required.  All electrical burns should be evaluated by a medical physician.

 

 

   

 

P.S. Remember you can book an appointment with me for any pediatric non-emergent illnesses like superficial burns, ear aches, rashes, vomiting, pink-eye etc or for any parenting questions about pediatric illnesses, behavior or development.

All posts containing medical information are for informative purposes only and is not direct medical advice nor establishes a patient-physician relationship. 

Photo by Caleb Jones on Unsplash

Fourteen extra sweet ways to love my baby on Valentine’s Day!!

Family, Holidays, Love, parenting

 

As I lie on the floor of the nursery (hey, this mamá is tired!) I look up and see a framed picture of Sweet Sage at one week old. I remember hanging that pesky ole thing before she was even born. Watching it swing back and forth on the nail head as I stepped back and forth.  Readjusting, catching my breath as my belly was beyond watermelon size, and then realigning with my eyeball measurements. Now, inside that frame is a picture of her at one week of life. I remember that day too-clearly. Propping her up against my pillow makeshift backdrop with the floral arrangements we got after her birth. She’s smiling in that picture. I lie here and I smile at that smile. Thinking, I will always remember that day.
Yesterday morning I was taking to my neighbor about the morning tantrums and she said “these days won’t last forever”, as she compared it to her now days with her 10 year old.  She told me that time flies by.  It always sounds cliche but it’s the honest truth, “they grow up so fast”.   I lie here thinking she was JUST one week young and now we are half way done with February in this third calendar year of her existence.
Time slow down please so I can give….
  1. Extra bedtime story to read.
  2. More rounds of singing her favorite nursery song.
  3. Additional “high-fives” when she solves a problem on her own.
  4. Longer hours in the day to sit and play without worrying about an undone chore.
  5. Extra minutes of chasing her around the playground.
  6. -ty seconds more to soak in those sweet besitos before leaving for work.
  7. Days of pure rest to disconnect from the world and focus solely on family time and to express my thankfulness.
  8. Fun attempts at Pinterest crafts, even if that means a messy house and questionable finished product.
  9. Silly dances, in the car, on the couch, at the library, at bath time, to the rhythm of our in synced heartbeats.
  10. Extra minutes to listen to her giggles as she explores with her own imagination.
  11. More cuddle sessions.
  12. Additional hours so I can savor every detail of those precious “first” moments.
  13. Daily practices of extra grace for the tough moments.
  14.  More “I Love You’s” and covered prayers for her health, protection, development, wisdom, joy, purity, peace,  humility, courage, resilience, gratefulness and self-love throughout each and every day.
There is only one Author of time and time slows down for no one. So while Sweet Sage is still small enough to cuddle in my lap and not shy away from my hugs and kisses I am going to do my best to intentionally shower extra love not just on this Valentine’s Day but on every day that follows. IMG_0678

Baby’s First Flight

Family, Toddler Life, travel, Uncategorized

Sweet Sage’s  first flight of 2018 is actually her 24th flight of her life.  Wait! Maybe it’s number 26, I have lost count.  Where is she going so often, you ask? I’m pretty sure she has more airline miles than I do and any day now American Airlines should be sending her an enrollment form for their “elite gold members club”.  But I digress, today’s flight had me sitting in the window seat (as usual) feeling cramped like a dried out sardine thinking, “Never again”. Traveling with a toddler, alone, is NO JOKE!

Do you want to know why?

From slamming window shields up and down repetitively, similar to how she performs her favorite song “Open shut them”, or as she calls it “sha shutt”! To walking down the plane aisle during boarding testing out every seat like she’s Goldilocks. She doesn’t understand yet that although they all feel hard as crap some are more pricier than others despite being in the back of the plane.

Oh, how could I forget about the middle of the airport meltdown as I’m packing up bags and breaking down strollers- that just about broke my shoulder. There we were, middle of the busy turnpike. Passengers and workers walking in all crazy directions and the 2.5 ft toddler running aimlessly in the OPPOSITE direction of our gate.  The gate agent is on the mic in the background announcing for group eight to board.  They only have nine board groups.  Our board group is number SIX!!!  I’m down on my knees, in the middle of the busy turnpike of people,  with a food bag in one hand, stroller clutched by my pinkie finger, backpack strapped on and trying to clutch the pinky of the toddler with my free finger on the opposite hand.

Oh no! Not the grab and hold move.  Every mom of a toddler knows that’s a fight waiting to happen. To the ground she melts like lava. SCREAMING!!! MELTING!!!! My “Mommy MacGyver” system is now falling apart. In the middle of the freaking turnpike while the agent is calling the LAST BOARDING group. We’re two gates away! Remember, I chased her in the opposite direction!!!!

We finally get BACK to our gate. I sit her down. Regroup. Search for my inhaler. Wait, I’m not an asthmatic but I felt like one in that moment. My cup spills all over the stroller spilling ice everywhere. Everywhere right where I am preparing to have my ticket scanned by the agent.

ICE!!!  Ahhh, her favorite non- nutritious thing to demand whenever it is in sigh. This toddler loves ice so much I have to hide my cups at restaurant’s under the table or on the seat.  Honest truth. Back to that fallen ice.  Welp, you can guess what happened next. Toddler win. Down the jetway we go. She runs. I waddle, holding on to wet items and open cups. On the plane we go. Second plane of the day. I let her lead and off she takes. Shout out to passenger in seat 29E who pointed his finger over his seat to let me know where she was “hiding”. Of course I knew where she was. No sense in chasing her with bags and open cups.

Speaking of bags and open cups, I sit the cup down in the middle seat. I retrieve the toddler who is NOW eight rows further back and return to our seat. Shimmy my way in to the window seat and, bam!  The open cup spills all over the middle seat and inside the bag of fresh food.  Food that was intended to be my breakfast, lunch, dinner and SANITY during this eight-plus hour travel day. Does toddler care? Nope she’s climbing seats. I’m hot. I’m sticky and I’m starving!!!

Anyone ever been so happy to have that middle seat open when traveling? I know right! Well having TWO empty seats open is like the lotto for this tired traveling mama. I think the guy in the aisle seat didn’t want to take any chances after that cup incident so he graciously moved to the row behind us.  Good looking out sir!

Welp, here I am now 34k feet in the air. Writing, eating cold soggy fries. They were at the bottom of the bag. The bag that the open cup spilled into, remember? Where’s the toddler you ask? Asleep. On those two empty chairs, resting peacefully as she once did when she was an itty bitty baby way back in the days of her former travels? Ha! No she’s lying right on top of me making my right arm go numb. So blame any and all of  my typos on that!

Happy Travels!

Sweet Sage’s Mom

A Germaphobes Guide for Pediatric Waiting Rooms!!

health tips, pediatrics

As a brand new mom one of the things I appreciate the most about our pediatric office, well maybe a few things, is that they have several waiting rooms. There are separate waiting rooms for sick visits, well-child visits and there is also a waiting room for newborns.  In addition to the designated waiting rooms, I also like that the earlier appointment slots are  for infants as this helps to limit the volume of people your infant would come in contact with. Simply having a designated space for my brand new baby (who hadn’t had her first set of vaccinations yet) put an ease to my mind that was already in overdrive PLUS survival mode of learning how to parent a newborn. Now she would be less likely to become ill days later after having a visit to the doctor’s office.

My baby can become ill after visiting a doctor’s office??  That sounds like irony, right? It is possible that it can happen and frankly at times it does happen. Your child can become infected from cross-contamination of toys, play tables or other commonly shared items in the waiting rooms as well as other fomites in the examination rooms.

The American Academy of Pediatrics updated their guidelines from 2007 to now include the encouragement of pediatric offices to have policies that address the methods and frequency of cleaning toys available to patients.

Other updates are in summary below:

1. Offices should not include “furry” or “plush” toys such as stuffed animals. They harbor germs and are hard to clean.
2. Parents should consider bringing their own toy from home to keep their child entertained while waiting to be placed in a room.
3. Parents should inquire about the influenza immunization policy for the office staff.
4. “Hand hygiene is the single most important act you can do to prevent the transmission of infection” – professor Mobeen Rathore
5. Endorsement of mandatory flu vaccination for healthcare providers.
6. Special isolation precautions for children with certain diagnoses and/or syndromes.
7. Health care providers should practice standard precautions and cough etiquette.
8. Timely public health notifications of specific reportable diseases.

To see a complete review of the new guidelines CLICK HERE

Telemedicine: The Virtual Doctor Visit. Saving you time and money!

health tips, pediatrics, telemedicine

In our modern society where we can live video chat with relatives across the world, or visit our local farmers market’s and swipe our credit cards on “square” devices, the concept of Telemedicine is not foreign at all!  In fact, the first use of telemedicine was during the 1950’s.  Two hospitals in Pennsylvania, several miles apart, transmitted radiograph images via telephone. Telemedicine originated from the advances in technology to help physicians provide care to patients in rural areas, as well as serving as a bridge for the gaps in healthcare seen particularly in areas with shortages in medicine sub-specialties.

Telemedicine now allows health care professionals to use modern technology and telecommunications to evaluate their patients in a virtual visit. The American Telemedicine Association (ATA) defines telemedicine as”… the remote delivery of health care services and clinical information using telecommunications technology.  This includes a wide array of clinical services using internet, wireless, satellite and telephone media. ”

Here is how telemedicine could work for you and your family:

  1. SAVES TIME:  Often times a trip to the Pediatrician’s office for an illness, like a cough, results in a diagnosis with a lot of reassurance and instructions for home care.  As parents we feel more comfortable sleeping (those of us who still have this luxury) at night knowing that we have the right instructions on how to manage their symptoms at home, even if that doesn’t include a prescribed medication.  This same reassurance and education can be given via a virtual evaluation for non-urgent acute illnesses such as ear pain, fever, sore throat, vomiting/diarrhea , rashes and cough/cold symptoms, to name a few.  It saves you the time you would have otherwise missed from work or your child missing school.
  2. CONVENIENCE :  Colder weather is here and it’s not going away anytime soon. BRRR!   Having to dress my toddler in layers and warm up the car for a quick errand makes me realize, sometimes, maybe I really don’t need those Oreos like I thought.  Being able to connect with a physician on my phone or tablet from the comfort of my home with a sick child is a true #MomWin for me!  Let’s face it, those of us with toddlers spend most of our days scheduling our adult life around THEIR nap time.  So when my child is sick during after hours when our community physician is not available and the only option is the local ER that is full of adult patients, using telemedicine services makes sense for me.
  3. ON DEMAND ACCESS: As a physician I can name hundreds of reasons why I may not make it into your exam room at the exact start time of your appointment.  From tasks like, helping a mom to clean up her son who just vomited, to returning a phone call from a worried mother, to double and triple checking prescription accuracy with the pharmacist, or writing out detailed home instructions for the first time mother who is fearful she isn’t “doing the right thing” for her newborn.  As a mother of a pediatric patient I get it when the doctor is running behind BUT,  I still think about the gazillion things I need to be doing as I am waiting and I do secretly wish it wasn’t “taking so long.” Telemedicine eliminates the wait-time, the time spent looking for parking, registering, updating insurance information, checking in at triage, sitting in the waiting room, waiting in the exam room and then waiting on your discharge instructions.  Having a telemedicine visit connects you directly and instantly to the physician and most visits do not take more than 20 minutes to complete from start to finish.
  4. STRENGTHENED RELATIONSHIPS:  Telemedicine helps keep the patient (parent) engaged with the provider by allowing more frequent contact.  It is useful in pediatric practices when children often need follow-up appointments after a treatment plan has been started. Telemedicine use in pediatric offices helps cut-down on the length of time it could take to “get in to see the doctor”, especially during cold flu season when offices are very busy.
  5.  SAVES MONEY:  Not only does a virtual visit save time but it keeps more money in your pocket.  Most telemedicine visits are equal to,  if not less than, the price of a co-pay for an urgent care visit and they are less than a co-pay for an emergency room visit.

Telemedicine is modern technology that allows the patient to connect with their provider for evaluation and treatment of non-emergent, nor life-threatening illnesses and injuries. It is not meant to replace the routine well child visits. If you would like to learn more about telemedicine please visit my website for more information or to schedule a demo visit.

– C. Tilford, MD

Gratefulness

Family, Holidays

Today is “Thanksgiving”.  Although I don’t enjoy the historical context of this “holiday” I do appreciate the time to pause and reflect in gratefulness. With long work hours,  countless tantrum melt downs that require redirection , missed hours of sleep,  endless errands and unanswered emails it becomes easy for me to get flustered in the “day to day” rituals and forget to pause at times to simply give thanks and to appreciate the moments, even the simple ones.

Being a new mommy reminds me to have those moments more often. Sometimes they come unexpectedly. Like now,  I was in the kitchen with my father trying to learn the secret to making his great gravy but the toddler meltdowns began and continued with no end in sight.  Having the death grip of those tiny hands into my thighs as I’m blending, in a tripod stance, is not quite how I envisioned creating this memory.  So now we’re watching lullaby’s and eating frijoles. Not quite the traditional picture of “Thanksgiving” but for this very moment I am very grateful!

What are you grateful for today?