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.


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