Should Your Kids Be Color Blind?

Ruchi Kaushik, MD, MPH, Medical Director, The Children’s Hospital of San Antonio Complex Care Clinic; Assistant Professor, Baylor College of Medicine

Are your children oblivious to what is happening in our world today? The peaceful protesting of the deadly interactions between law enforcement and persons of color is an historic moment in our country. Undoubtedly, whether you have talked about it at home or not, if they have access to an electronic device, your children know what’s happening. As a parent, it’s important for you to frame current events with the values you want to instill. You must remember that you will always be their favored and most trusted source.

Raising three little girls is no easy task, and I spend countless hours preparing them for issues that may arise in their worlds. I recently stopped at the grocery store and asked my two older daughters to run in quickly and grab a few things. My teen turned to my pre-teen and said, “We have to be on our best behavior and not call attention to ourselves. Don’t ever forget that we are brown.” We have talked about race in our home before, but apparently it was time to hold another family meeting.

How you approach the issue will differ according to your child’s age and to whether your family is white or made up of people of color.

1. Secure your own oxygen mask before securing your child’s: Are you OK? How are you coping? Take a moment to care for yourself. Your child will remember your reaction and emotions far more than your words. I, personally, found it very painful to watch the video of George Floyd’s death and reached out to pediatrician friends who reminded me of the good work we do to advocate for children and that hope is not lost.
2. Check-in with your children: It might be helpful to learn what your child already knows and how they feel about it. Be an active listener and validate their emotions. It is absolutely okay and correct to state out loud that racism is real and the pain that people feel from being mistreated because of their race is real. This conversation will likely be more detailed with older children.
3. Emphasize safety and security: Remind your children they will be OK. With the country’s reaction so visible, children will be most concerned with what will happen to their world. Feeling safe in their home is particularly important for younger children.
4. Take a news break: Young children will benefit from a break from current events.  Spending quality time together as a family will provide reassurance and security.  When you are watching, be sure to watch together and discuss what you see with your child. Be sure to avoid graphic images and sounds. Older children and teens will need help understanding what is true and what is not on the internet and in social media.
5. Listen, ask and answer questions, and teach empathy: When you ask open-ended questions and actively listen and validate their answers, you are role modeling this behavior for your children. Every child’s experiences will be different, but teaching them to be open to others’ perspectives encourages empathy. Explain to your child that just because she hasn’t experienced discrimination doesn’t mean that other children haven’t or that it is not real. A willingness to listen to others and attempt to feel their pain brings us closer as a community and allows us to heal together.
6. Know the Signs:  Children don’t often come out and tell you that they are having difficulty coping with a tragedy.  Rather, they often have difficulty with sleep, problems in behavior, vague physical symptoms such as headaches, changes in appetite, or emotional problems such as depression or anxiety.  Be sure to keep an eye out for these issues and bring them up to your pediatrician or a mental health professional if you have noticed them in your child.

For more information, age-appropriate recommendations, and resources, visit this HealthyChildren.org article written by national American Academy of Pediatrics experts Drs. Nia Heard-Garris and Jacqueline Douge. Dr. Heard-Garris recently participated in the CNN/Sesame Street Racism Town Hall.

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How to Prepare for Your Telemedicine Visit

Ruchi Kaushik, MD, MPH, FAAP, Assistant Professor of Pediatrics; Medical Director, Complex Needs Clinic

The widespread illness and loss of so many Americans is an absolute tragedy. But one great advancement that has come as a result, and that many of my colleagues and I hope will stay, is the growth in the use of telemedicine. It is a safe, effective, efficient, and convenient method to communicate with your child’s doctor for a variety of health issues. I’d like to share some of my own experiences, both as a leader in telemedicine in our institution and as a parent whose child was seen by one of our specialists over video.

Is it telemedicine or telehealth? Or are they the same?

In a telemedicine video visit, your doctor communicates with you in a two-way video and audio call. Telehealth visits can be for many types of health care delivery, such as physical therapy or medication education.

Telemedicine visits can be by phone or by video. We definitely prefer the video because it gives us the opportunity to see your child so we can get as close to an in-person visit as possible.

Examples of platforms used today for telemedicine visits include Microsoft Teams, Webex, Skype, FaceTime, or Doxy.me. The Children’s Hospital of San Antonio uses Zoom.

Before Your Visit

Before you engage in a telemedicine video visit, be sure to call your doctor to see if the type of visit you need can be done by video. A few other things you will need to participate in such a visit include:

• Electronic device (smart phone, tablet, computer)
• Reliable internet access
• Zoom (either the app or on your internet browser)
• Patient portal account with The Children’s Hospital of San Antonio

Once you schedule the appointment, our staff will send you a link to the Zoom meeting as a message on your patient portal account. Staff will also call you a few minutes before the appointment time to “check-in” your child. Then they will transfer the call to the nurse who will ask you essentially the same questions she asks you when you go to an in-person visit.

Keep your phone near you. My child’s specialist wasn’t too busy (surprisingly!) on the day of her appointment, so they called me a little early to see if we could start before our scheduled time. I definitely appreciated that!

During Your Visit

A few tips to having the best experience:

• “Arrive” on time. It gives us the opportunity to focus on your child for as long as possible!
• Make sure you are on mute and that your video is on.
• Place yourself in a room with few distractions (noise, pets, other children) if possible and safe.
• If you have questions, be sure to write them down ahead of time so you don’t forget during the visit.
• Bring your child! Yes! We definitely need (and want!) to see him.
• Don’t be surprised if we ask to look around your home a bit. There is so much we can learn about your child’s health from their environment.
• Know that you are safe. We take your privacy and safety very seriously and assure you our Zoom connections are secure.

As a parent, I remember sitting on the couch with my 11 year-old daughter wondering if the doctor was going to ask me to show him her belly. And I realized that I wasn’t too comfortable with doing that over a video. We will not ask you to show us parts of the exam that may not be appropriate for video and if there is anything you are uncomfortable doing over video, please let us know. Again, your child’s comfort and safety are our priority!

I have really enjoyed telemedicine video visits, both as a doctor and as a parent. And at this time, it may be ideal for a variety of types of appointments. Be sure to call your doctor to check and see if it is right for you and your child.

To schedule an appointment, check out of webpage https://www.christushealth.org/childrens/services-treatments/primary-care and give us a call!

In the Room or Via Zoom?

Ruchi Kaushik, MD, MPH, FAAP, Assistant Professor of Pediatrics, Medical Director, Complex Care Clinic

Today it seems as though the news is coming at us from so many directions and changing by the hour. It can be hard to know what is and isn’t recommended by health care professionals. And although your regular family trips to the grocery store or Fiesta Texas are not advisable, The Children’s Hospital of San Antonio assures you that if you need to make an appointment for your child to see the pediatrician, you can feel absolutely safe doing so.

We are currently seeing patients in person and via telemedicine video visits. Depending upon the type of appointment you schedule, we can help you decide which is best.

Well Child Care Check-Ups (Physicals)

You should continue to bring your child in for well-child care checkups. When we see your child for their checkups we assess several growth and development outcomes:

• Height, weight, and BMI, paying close attention to underweight and overweight
• Developmental milestones, with referrals to therapies as needed
• Immunizations
• A complete physical exam

We are conducting well-child checkups in person. We screen all patients for COVID-19 symptoms by phone and again with a temperature check when they enter our buildings. Any patients with a positive screen are not seen in our pediatric primary care offices.

Sick Visits

At this time, we are doing our best to see most of our patients with illness, and particularly those with COVID-19 symptoms, either by telemedicine video visits or “curbside” (depending upon the clinic location). We will likely offer you a telemedicine video visit, if your child has any of the following symptoms:

• Fever
• Cold symptoms (runny nose, cough, sore throat)
• Difficulty breathing
• Nausea or vomiting
• Diarrhea

Follow-up Visits

You may need a follow-up visit for your child for a chronic problem or for medication refills (e.g. ADHD, asthma). Some of these may require a reliable vital sign (weight, height, blood pressure) or laboratory testing. Call your pediatrician to ask whether an in-person visit is needed or if you may see them by telemedicine video visit.

The Children’s Hospital of San Antonio is devoted to keeping all of our children and families healthy and safe. We want to see your child and for you to feel safe when entering our clinics. For more information or to make an appointment, please visit https://www.christushealth.org/childrens/services-treatments/primary-care to find your pediatrician.