You’ve Been Diagnosed with Gestational Diabetes: Now What?

One you are diagnosed with gestational diabetes, how can you maintain a healthy pregnancy and reduce your risk of complications?

Q&A with Dr. Shad Deering, maternal fetal medicine specialist

Every year, 2 to 10 percent of pregnancies in the United States are affected by gestational diabetes. What exactly is it, and how can it be managed effectively? We recently sat down with Dr. Shad Deering to talk about gestational diabetes and what women need to know.

Q: Can you explain what gestational diabetes is and how and when it’s diagnosed?

A: Gestational diabetes is a type of diabetes that occurs during pregnancy. It’s usually diagnosed when a woman is between 24 to 28 weeks pregnant with a one-hour glucose tolerance test. 

Q: What are some common risk factors associated with gestational diabetes?

A: There are certain risk factors the predispose a woman to develop gestational diabetes. First, if you had it before with another pregnancy and specifically if your baby weighed more than nine pounds, the likelihood of you developing gestational diabetes is greater. Also, if you have polycystic ovarian syndrome (PCOS), you are also at risk. Other risk factors include being Hispanic or Black, having a family member with diabetes, having hypertension, or having a body mass index (BMI) of over 25.

Dr. Shad Deering recommends a balanced diet, exercise routine and blood sugar monitoring to reduce the risks associated with gestational diabetes.

Q: If you have the above risk factors, what are some things you can do to manage gestational diabetes better?

A: You can take some steps to lower your risk profile, including being mindful of what you eat and being active. Getting 30 minutes of exercise – at least three to five times a week – will help. Making changes to your diet and cutting out simple carbohydrates like white bread, for example, also will help. You should aim for 40% complex carbs (multigrain bread and cereals, beans, and vegetables), 20% protein, and 40% fats. In short, a balanced diet and exercise routine coming into pregnancy will significantly decrease your risk.

Q: If a pregnant woman is diagnosed with gestational diabetes, what should she eat? What should she not eat? How should she manage her pregnancy cravings?

A: When women receive a diagnosis of gestational diabetes, they immediately think, “what can I eat” instead of “what should I stop eating,” which is the more important question. Reducing soda intake as well as processed baked goods like crackers and chips can be effective in lowering blood sugar levels. Making dietary changes can be difficult, especially when a woman is experiencing cravings. However, just like lifestyle changes are a big deal in managing diabetes outside of pregnancy, they also play a role in managing gestational diabetes as well.

Q: When a woman is first diagnosed with gestational diabetes, what happens next? What is done to help them so they have a healthy outcome?

A: When it’s determined that a woman has gestational diabetes, they are often only given a handout providing some limited information on what they should or should not eat. But, if we are asking women to make significant changes in their eating habits for the health of their pregnancy, we think they deserve more.  When one of our patients receives this type of diagnosis, we take it a couple of steps further and immediately get them set up with one of our diabetic educators. The diabetic educator sits down with the patient, explains how to eat properly and what smart choices look like, and thoroughly answers a patient’s questions.

Q: Why is it important that a woman diagnosed with gestational diabetes take it seriously and follow the prescribed plan as set by either her physician or diabetic educator?

A: A diagnosis of gestational diabetes can cause multiple issues during pregnancy. One of them is having a large baby, which increases the likelihood of needing a C-section. Women with gestational diabetes are also prone to developing preeclampsia, a dangerous pregnancy complication which manifests with high blood pressure and can progress to eclampsia, or seizures. The risk of stillbirth also goes up substantially, especially if you’re not controlling your sugars. But, there is some good news. If you can control your blood sugars and get them within a specific range, then the risks of all of these things are much lower. It’s critical to keep in mind that what you’re dealing with is short-term and, in most cases, resolves after pregnancy.

Q: Besides diet and exercise, what are some other ways women can manage their gestational diabetes?

A: When it comes down to it, diet and exercise are key to managing gestational diabetes. Often, blood sugar levels will improve dramatically, and we won’t have to take any additional measures, like medication. However, if your blood sugars remain high, we’ll have to take further steps regardless of diet and exercise changes. 

What is the typical medication for a pregnant woman with gestational diabetes? Is it different from what somebody would take if they have Type 2 diabetes and were pregnant?

A: The medication of choice for women with gestational diabetes is insulin. The recommendations have changed over the years. At first, it was insulin, and then we thought oral medications might be better, but we have come full circle and have settled on insulin as the optimal treatment, which is now recommended by The American College of Obstetricians and Gynecologists (ACOG). If, however, a woman is on Metformin already at the beginning of pregnancy, they might be asked to continue taking it. However, Metformin is used to treat pre-diabetes and not gestational diabetes, so it’s slightly different. 

Q: How often does a woman with gestational diabetes need an insulin shot, and when?

A: It all depends on what time of day women are experiencing high blood sugars. Often women struggle first thing in the morning. In this case, they will take one dose of long-acting insulin before bed and hopefully, when they wake up, their levels will be in an acceptable range. On the other hand, if a woman experiences high blood sugar at dinner, one dose of short-acting insulin may be adequate. It is not only dependent on when a woman eats but what she eats as well. And all of this can change throughout pregnancy. You might start off not needing any insulin because the adjustments in your diet and exercise plan are working; however, you might need to start on a low dose the next trimester and even increase it later in pregnancy.

Q: Does a patient with gestational diabetes need to see her doctors more frequently?

A: If your diet is well controlled and you aren’t on medication, you will most likely be seeing your physician at almost the same intervals you would otherwise. Regardless, if you are on medication or not, you will need to track your blood sugar numbers and send them to your physician. This is especially important if you’re on medication because we’ll want to check those numbers weekly. After about 32 weeks, patients should plan on coming into the office so we can do fetal monitoring of the baby, which usually consists of an ultrasound where we are looking at fluid and movement and the size of the baby, or it can mean putting the patient on a monitor to watch the baby’s heart rate.

Q: So, throughout a woman’s pregnancy, can her gestational diabetes get worse? Why?

A: Yes, because the placenta makes hormones that predispose pregnant women to become diabetic. The human placental or lactogen HPL reduces the effectiveness of the insulin in your body when you are pregnant. As your pregnancy progresses, it’s not uncommon for women to require more insulin. 

Q: What happens when a woman with gestational diabetes delivers? Does diabetes go away? 

A: When you deliver, many things that would cause diabetes do go away. In other words, if you’re on insulin before having your baby, in many cases you won’t need it after you deliver. Your body will go back to a non-pregnant state. When this happens, you may not have gestational diabetes anymore, but you can still have diabetes. So, we highly recommend a two-hour 75-gram glucose test 4-12 weeks after you deliver to determine if you still have diabetes. If you have gestational diabetes, you have a 50 to 70 percent lifetime risk of developing Type 2 diabetes, which is why it’s so crucial for women to get checked and receive treatment if they need it.

Q: Is there a timeframe when a woman could develop Type 2 diabetes after having gestational diabetes? Is the risk higher right after she gives birth or later in life?

A: It depends a lot on the person because gestational diabetes has a lot to do with genetics and lifestyle. It’s a little hard to define an exact timeframe. The bottom line is if you have gestational diabetes, you should be checked for Type 2 diabetes regularly.

Q: Let’s say a woman leads a healthy lifestyle, exercises all the time, eats right, etc., and still develops gestational diabetes. What could be the reason?

A: It’s always a shock when women who don’t fit the profile are diagnosed with gestational diabetes. When someone comes in and their BMI is high, you’re going to expect some insulin resistance, but if they are the perfect picture of health, it’s a difficult pill to swallow. These women likely just have a genetic predisposition to developing gestational diabetes. 

Q: Do you have any advice for women planning to get pregnant and how to avoid a diagnosis of gestational diabetes?

A: If you’re planning to get pregnant, there are some things you can start doing right away, like taking prenatal vitamins, folic acid, looking at your diet, and getting into an exercise routine. By the time you have that first appointment with your obstetrician, it’s too late. Your baby has already started forming, and you’re well into your pregnancy journey. So, making lifestyle adjustments before getting pregnant is my No. 1 piece of advice.

If you have received a diagnosis of gestational diabetes and would like to make an appointment with a maternal fetal medicine specialist at The Children’s Hospital of San Antonio, please contact us at one of our three Centers for Maternal and Fetal Care:

Professional Pavilion (Downtown): 210.704.2718

Westover Hills: 210.703.8200

New Braunfels: 830.643.6140

Learn more by visiting us online.

Setting the record straight on COVID-19 vaccines and infertility

Research shows COVID vaccines do not affect one’s ability to have children.

With so much misinformation about COVID-19 vaccines, parents, especially of teenagers, find themselves confronted with some challenging questions that they may not know how to answer.

Among teenagers’ top concerns about the vaccines is whether or not they cause infertility later in life.

“It’s unfortunate this rumor is swirling around because there’s zero evidence of this occurring. It’s a theoretical risk that’s never been shown in any animal model to exist,” said Dr. Shad Deering, a maternal fetal medicine specialist at The Children’s Hospital of San Antonio.

This idea that the vaccines cause issues with fertility originated from a doctor who recognized something on the COVID-19 spike protein – on the virus itself, that was similar to a protein found in human placentas. The doctor thought that the vaccine might make antibodies against that protein and could affect placentas and pregnancies.  But COVID-19 vaccines don’t even cause that protein to be produced, and there have been studies of placentas of women who received the vaccine and there are no differences between them and women who didn’t get the vaccine.  According to Dr. Deering, unfortunate conclusions were quickly made, and soon after the information went viral and exploded on social media.

“There are inherent risks with anything we put in our bodies, from vitamin supplements to coffee and even chicken nuggets and we don’t know how those substances will affect us 10-20 years from now. In the case of the vaccine, the benefits of getting it greatly outweigh the risks,” said Deering.

Dr. Shad Deering, a maternal fetal medicine specialist at The Children’s Hospital of San Antonio, points to research showing there is no link between COVID-19 vaccines and one’s ability to have children afterward.

Teenagers may question the safety of the vaccines because of how quickly they were rolled out. 

Deering said the mRNA technology isn’t new – it’s been around for years.  In fact, Dr. Katalin Karikó, the scientist who was instrumental in developing ways to use it in medical treatments, has been working with mRNA since the 1990s. Additionally, the COVID vaccines now available were thoroughly tested before they were administered to the public and since they were introduced there has been ongoing research showing the vaccines are safe and effective.    

“The process was sped up because we needed an answer to help curb the pandemic. I think most of us are used to hearing vaccines take four to eight years to develop, but if you think about it, does it really have to take that long? With this vaccine, all of the red tape that researchers usually face was taken away which sped this vaccine up significantly while still keeping all of the safety protocols in place,” said Deering.

While the connection between COVID-19 vaccines and infertility is unfounded, the risks associated with being pregnant and contracting the virus are, in fact, real, which is why the medical community is strongly encouraging pregnant women to get vaccinated. 

“There are few things more difficult than seeing a pregnant woman, and sometimes her baby if it happens when too early in pregnancy, die from a disease that could have been prevented with a vaccine,”  said Deering.

There is also a chance that seemingly healthy young people are at risk of developing severe issues after they contract COVID. For example, The Children’s Hospital of San Antonio has seen cases of adolescents and teenagers developing myocarditis (inflammation of the heart) after a COVID infection.

“What it comes down to is getting COVID-19 and the possibility of becoming severely ill and dealing with the long-term effects of the virus versus getting the vaccine which carries minimal short-term. While we know the vaccine doesn’t cause infertility, what hasn’t been studied are the long-term effects of actually getting COVID-19,” said Deering. “Parents, especially teens, need to take the time to arm themselves with trustworthy information sources so they can help debunk some of the myths.”

The Children’s Hospital of San Antonio offers the Pfizer vaccine free of charge to members of our community who are 12 and older. Sign up for an appointment at this link. Once arriving at this link, select specialty: COVID-19 Vaccination. Under COVID-19 Visit Type, select Onsite Pfizer Vaccination Dose 1. Then click on the blue bar with SEARCH in the middle to find available appointments. We provided COVID vaccines in the Goldsbury Center for Children & Families located at 333 North Santa Rosa St., first floor, San Antonio, Texas 78207.  

Walk-ins are welcome on Tuesdays and Thursdays from 9:00 to 11:00 a.m. and 1:00 to 4:00 p.m. Experienced personnel provide the vaccines plus emergency attention is nearby in case of any immediate allergic reaction. If you have questions or concerns, please talk to your pediatrician about the vaccine.

Let’s hear it from our kids

San Antonio teens told us why they got the COVID-19 vaccine.

Across the country, parents and students are gearing up for a new school year. Along with conversations about school supplies and schedules, families are talking about the COVID-19 vaccine in preparation for returning to in-person school full time. The 2021-2022 school year is the third school year affected by COVID-19.

Compared to adults, fewer children have been infected with COVID-19 since the beginning of the pandemic. However, across the U.S., we have seen a rise in the number of children diagnosed with COVID and hospitalized as a result. The Centers for Disease Control and Prevention recommends everyone age 12 and older get a COVID-19 vaccination. Currently, only the Pfizer vaccine is approved for children aged 12 to 17. It’s given in two doses, 21 days apart.

To encourage more vaccinations among local kids, we asked some friends to share why they decided to get the COVID jab. 

“I decided to get the vaccine because I felt like it was my best protection against this dangerous virus. I wanted to have a life with friends, sleepovers, and school, so I knew I needed to do my part to stay healthy, and getting the vaccine is a step towards that. I also know too many people that have suffered from COVID or lost loved ones and I felt like the vaccine was created so that we can have fewer people suffering and dying from COVID.” – Izabella, 14

“I wanted a life with friends, sleepovers, and school.” – Izabella, 14

“I decided to get vaccinated because I know people that got sick with COVID and I wanted nothing to do with that. It could cause long-term health problems and keep me from playing soccer, climbing, doing theater and spending time with friends and family. I wanted to know that I could do all of those things more safely. I also wanted to see my grandparents and my cousin who is immunocompromised without fear that giving them COVID could cause them to be hospitalized or worse. I don’t know what I would do if I gave it to someone else. My little sister can’t get vaccinated so we’re still being very careful, but I’m loving being back in the climbing gym even if I have to wear a mask!” – Rowan, 12

“I wanted to practice sports, I wrestle which is a really close contact sport and I wanted to not be worried about it. I was the last person in my family to get vaccinated and I was so happy when they finally approved the 12-15 year olds. I wanted to do my part to help stop the spread of COVID so life could go back to normal.” -Connor, 15

“I wanted to practice sports.” – Connor, 15

“I just moved to a new state and getting vaccinated allowed me to go to summer camps.” Andrew, 13

“Getting vaccinated allowed me to go to summer camp.” – Andrew, 13

“I want to travel internationally. I was asked to present my vaccine information to travel to Mexico and the Bahamas.” Victor, 17

“I wanted to make sure I was keeping myself and others safe by not contributing to the spread. It is important for me because when I go to dance competitions and practices, I don’t always have my mask on. I just really wanted to be safe with everything I am doing.” – Maya, 12

“I wanted to make sure I was keeping myself and others safe.” – Maya, 12

The COVID-19 pandemic has taken a toll on everyone’s physical, emotional and mental health, especially for children. As we embark on the back-to-school season, amid another surge of COVID-19, let’s hear it from our kids and take the important steps to stop the spread of COVID-19.

The Children’s Hospital of San Antonio offers the Pfizer vaccine free of charge to members of our community who are 12 and older. Sign up for an appointment at this link. Once arriving at this link, select specialty: COVID-19 Vaccination. Under COVID-19 Visit Type, select Onsite Pfizer Vaccination Dose 1. Then click on the blue bar with SEARCH in the middle to find available appointments. We provide COVID vaccines in the Goldsbury Center for Children & Families located at 333 North Santa Rosa St., first floor, San Antonio, Texas 78207.  

Walk-ins are welcome on Tuesdays and Thursdays from 9:00 to 11:00 a.m. and 1:00 to 4:00 p.m. Experienced personnel provide the vaccines and emergency attention is nearby in case of any immediate allergic reaction. If you have questions or concerns, please talk to your pediatrician or family practice physician about the vaccine.

Should pregnant or breastfeeding moms get the COVID-19 vaccine?

Andrea Shields, MD, MS, Maternal Fetal Medicine; Shad Deering, MD, CHSE, COL(ret) USA, Maternal Fetal Medicine; Maria Pierce, MD, Neonatal Intensive Care

This week, after months of research and clinical trials, the first Pfizer-BioNTech COVID-19 vaccines will be administered to a select group of individuals including healthcare workers. This is the first step in the fight against the COVID-19 pandemic, but many questions remain unanswered. When will the general population receive the vaccine?  What does this mean for those who are planning to get pregnant, or are currently pregnant or breastfeeding?

To put it simply, the guidance for pregnant and lactating women or those wanting to become pregnant is not clear. While pregnant women were not included in the initial clinical trials, it does not mean they cannot get the vaccine. According to Pfizer, about two dozen people who got the vaccine became pregnant while participating in the studies and none of those women reported complications.

Since the onset of the COVID-19 pandemic, doctors have learned that if a pregnant woman contracts COVID-19 they are at a higher risk of serious complications from the virus. A pregnant woman with COVID-19 may develop severe symptoms such as pneumonia and the need for supplemental oxygen. They have a higher chance of needing to be intubated and admission to the intensive care unit.

Because of these potentially serious risks, the American College of Obstetricians and Gynecologists (ACOG) advises that those who are pregnant should be allowed to receive the vaccine after consulting with their physician. According to the CDC, the following considerations should be discussed when talking to your physician.

  • Level of COVID-19 community transmission (if there is a high rate of COVID in the community where you live, the risk of getting infected goes up and the vaccine may be more important for protection.)
  • Your personal risk of contracting COVID-19 (which may differ based on your job or other activities)
  • The risks of COVID-19 to you (which are increased during pregnancy) and potential risks to your fetus
  • The effectiveness of the vaccine (currently it is believed that the initial vaccines will be at least 90% effective in preventing COVID and it looks like even if someone gets COVID after vaccination, they are unlikely to develop severe disease.)
  • The known side effects of the vaccine
  • The lack of data about the vaccine during pregnancy

According to the CDC, the mRNA vaccines, such as the ones developed by Pfizer and Moderna do not contain live virus vaccines and do not alter human DNA in those who receive the vaccine.

What this means for our patients is that because the COVID-19 vaccine was proven safe and effective in both the phase II and phase III Pfizer clinical trials for non-pregnant patients, we believe the results would be similar in our pregnant patients. However, since these trials were not done specifically with pregnant or lactating patients, we do not fully know the potential risks to the pregnant mom or the fetus which is why each patient should discuss the pros and cons of getting the vaccine with their physician. We do, however, still believe the benefits of the vaccine for the mom and the fetus outweighs the risks.

In general, vaccines are one of the greatest health achievements of the 20th century saving millions of lives and protecting our population from many diseases that have been eradicated today such as polio, mumps and measles. Vaccines can reduce the risk of contracting conditions such as pertussis and influenza which can cause significant health issues and even death.  These vaccines have been given to pregnant and lactating moms for decades and have proven to be safe.

According to ACOG, the CDC will soon be providing additional guidance for pregnant and lactating moms. The CDC is encouraging pregnant or lactating individuals who are part of a high-risk group (i.e., healthcare personnel, or someone with an underlying health condition) and want to receive a vaccine may choose to be vaccinated. A discussion with their physician can help them make an informed decision. The general population will likely not start receiving the vaccine until the Spring and we hope by that time more research will be released regarding COVID-19 vaccination of pregnant and lactating women.

The Pfizer-BioNTech COVID-19 vaccine requires two doses 21 days apart for full protection. If a woman takes the first dose and becomes pregnant before the second dose, ACOG is recommending that she proceeds to take the second dose to gain the maximum benefits of the vaccine.

ACOG also states that while there has been a worldwide attempt to develop COVID-19 vaccines rapidly, this does not mean that any safety standards have been relaxed. In fact, there are additional safety monitoring systems to track and monitor these vaccines, including real-time assessment. ACOG will continue to monitor new developments and has urged the FDA to consider additional clinical trials focused on pregnant and lactating moms. However, ACOG feels strongly that the vaccine should not be withheld from these individuals, especially those in high-risk groups, which includes those who are pregnant.

We know our patients will have lots of questions and encourage them to come talk to us. We can help our patients make the right decision for their situation by providing information about the COVID-19 vaccines.

Ultimately, whether or not a pregnant patient gets the vaccine will be a personal choice. Even if a pregnant mom decides to get the vaccine, it will still be important that they remain vigilant about taking preventative measures against the virus such as washing their hands, social distancing and wearing a mask in public until the COVID-19 pandemic is over.

About the Authors

Andrea Shields, MD, MS, Women’s Services division at The Children’s Hospital of San Antonio Dr. Shields is the Chair of the Department of Obstetrics & Gynecology and Chief of Clinical Research and Education at The Children’s Hospital of San Antonio. She is an Associate Professor from Baylor College of Medicine.

Shad Deering, MD, CHSE, COL(ret) USA , Women’s Services division at The Children’s Hospital of San Antonio   Dr. Deering has served as the COVID-19 Medical Incident Commander for The Children’s Hospital of San Antonio during this pandemic.  He is a Maternal Fetal Medicine specialist and Professor with Baylor College of Medicine and has worked with local and national organizations to create simulation training resources for COVID care of pregnant patients.

Dr. Maria Pierce, Women’s Services division at The Children’s Hospital of San Antonio Dr. Pierce is a graduate of the University of Michigan Medical School and completed her internship, residency and fellowship at the University of Miami. After completing her fellowship in Perinatal-Neonatal Medicine, she joined the medical staff at Tulane Medical Center. She has been a practicing neonatologist at The Children’s Hospital of San Antonio since 1997. She is the mother of three adult children.

Gather Safely When Celebrating the Holidays

Katelyn Swizer, MD, PGY-2, Resident, Baylor College of Medicine, The Children’s Hospital of San Antonio

The COVID-19 pandemic influences every part of our daily lives, and over the past year we have seen changes in everything from graduation and prom to job interviews and family vacation.  Because of this continued pandemic, families are facing difficult decisions about the approaching holiday season. Many of us are separated across households around the country and as cases continue to rise the safety and health of family and friends is important to consider.

The CDC has recommended against in-person gatherings with multiple households, especially if you work or live with individuals at higher risk of hospitalization or complications from COVID-19. If you do choose to have any in-person gatherings this year, here are a few ideas and important pieces of information to consider as you prepare.

Before Gathering

Family and friends should consider the number of COVID–19 cases in their community and any area they may visit. Information on the number of cases in an area can often be found on your local health department website. 

Public transportation including airports, bus and train stations, and highly populated rest stops can increase the risk of exposure to the virus in the air and on surfaces.  When possible, individual travel by car can decrease this risk.

If higher risk travel is unavoidable, we recommend consistent mask use, maintaining six feet of distance between non-household members, and carrying sanitation supplies to disinfect commonly used surfaces during travel.

Long, indoor gatherings (especially small spaces with no outside air) are higher risk than outdoor gatherings. Being within six feet of someone with COVID–19 for a total of 15 minutes or more greatly increases the risk of catching the virus. 

The size of your gatherings should be based on the ability of family and friends to stay six feet apart, wear masks, wash hands, and follow your local health and safety guidelines and regulations.

It is important to realize that during the gathering, alcohol and drug use may alter judgment and make it more difficult to practice these COVID-19 safety measures. 

It is not recommended that you host or attend a gathering with anyone who has had COVID-19 or has been exposed to someone with COVID-19 in the last 14 days.

If you are an older adult or person with medical conditions putting you at an increased risk of severe illness, or you work with someone at an increased risk, you should avoid in-person gatherings with people who do not live in your household.

To keep your family safe, consider celebrating the holidays with only the people in your household. If people from multiple households are gathering, guests should wear masks and stay six feet apart.

During the Gathering

Increase air movement by opening windows and doors when it is safe and possible based on the weather, or place central air and heating on continuous circulation.

If you plan to use an outdoor tent, ensure guests are seated with social distancing in mind. 

Any gathering that includes people in different households should encourage every guest to wear a mask that covers both the nose and mouth unless eating or drinking. You should also encourage people to stay six feet apart unless they are from the same household. Space your furniture and seating positions so guests know where to sit to be safe.

Encourage guests to avoid singing or shouting, as this can increase the spread of the disease.  Keep music low so people do not have to shout or speak loudly to be heard.

Make it easy for guests to wash hands often with soap and water for at least 20 seconds. You can also use hand sanitizer that contains at least 60 percent alcohol.  Stock your bathroom with single use towels to prevent the spread of disease.

Clean and disinfect commonly touched surfaces and any shared items between uses, if possible.  Use touchless garbage cans if you have them.  Use gloves and/or wash your hands after removing garbage bags and handling or exposing trash.

Ask guests to avoid contact with other people outside of their household for 14 days prior to gathering.  Treat pets as you would other family members–do not let pets interact with people outside of the household.

Have one person wearing a mask serve all the food, so that multiple people are not handling the serving utensils.  Use single use options for salad dressing, food containers, plates, utensils, and condiments. Have a space for guests to wash hands after handling or eating food. Avoid crowded buffet and drink stations.

Select one person wearing a mask to serve food to all guests. This will avoid having multiple people handling serving utensils and platters. All guests should wash their hands thoroughly before and after eating. Provide paper towels for drying hands instead of sharing a cloth towel.

Wash dishes in the dishwasher or with hot soapy water immediately following the gathering.

Overnight Visitors

Visitors should launder their clothing and masks and stow luggage away from common areas upon arrival.

Wear masks while inside the house. Masks may be removed for eating, drinking, and sleeping, but individuals from different households should stay at least six feet away from each other at all times.

Spend time together outdoors. Take a walk or sit outdoors at least six feet apart for interpersonal interactions.

Hosts and guests should have a plan for what to do if someone becomes sick.

Learn More

For more information about gathering safely during the holidays, visit COVID-19: Holiday Celebrations | CDC

Doctor’s African Experience Shapes San Antonio Practice

Mary J. Stokes, MD, CHRISTUS Women’s Health, The Children’s Hospital of San Antonio, Baylor College of Medicine

Before moving to San Antonio and joining CHRISTUS Women’s Health, I worked as an OB-GYN for two years in Africa with Baylor College of Medicine. Many of the women I cared for arrived at our hospital too late: too late to perform a cesarean delivery to prevent a fetal death and maternal injury after prolonged labor, too late to start antibiotics and prevent a life-threatening postpartum infection.

Dr. Mary Stokes (left) was part of the Baylor Global Women’s Health Fellowship program at Kamuzu Central Hospital in Malawi, located in East Africa.

In these cases we provided the medical care that we could, but felt defeated when we could not save the life of a baby who had already died, or prevent permanent uterine, bladder and vaginal injury that had already occurred. These outcomes could have been avoided with prompt recognition and action, but the women did not have access to specialized obstetric care when they needed it.  They did not have sufficient prenatal care to identify potential risks for themselves or their babies. They labored at home or in small rural clinics without a physician or surgeon nearby.

During her time in African, Dr. Stokes participated in intensive clinical activities, teaching of students, interns, residents and others, as well as research projects to improve childbirth outcomes for women and their babies.

As I anticipated my move back to Texas, I knew I wanted to work in a setting where my patients would have access to every available resource to ensure the safety of both their baby and their own life and well-being.  I appreciated more than ever the importance of quality obstetric care. A majority of women will have smooth pregnancies and deliveries, but when an emergency arises, prompt recognition and immediate treatment is needed to prevent tragedy. 

We at CHRISTUS Women’s Health are committed to ensuring the highest level of care for our patients.  We are affiliated with Baylor College of Medicine, and our team includes OB hospitalists, maternal fetal medicine specialists, geneticists and neonatologists, all committed to the same goal of ensuring the best possible outcomes for our obstetric patients and newborns delivered at The Children’s Hospital of San Antonio.

In a perfect world, the same level of care would be available to women everywhere, but I am thankful to be part of a practice in San Antonio that can offer expectant mothers all the resources they need for a healthy pregnancy and delivery.

If you need an OB-GYN, we are accepting new patients at CHRISTUS Women’s Health located at 315 N. San Saba. Please call us at 210.704.4172 for an appointment.

5 Ways to Prep for School During a Pandemic

Mahwish Khan, DO, PGY2, Resident, Baylor College of Medicine at The Children’s Hospital of San Antonio

It’s that time of the year again, the time when stores’ aisles are filled with back-to-school supplies and composition books are 50 cents apiece. Back-to-school time used to be one of my favorite times of the year, and I really looked forward to getting to pick out all of my things for the new school year. But this year will be a little different with COVID in play. Whether your child will be in school in-person or partaking in distance learning, parents need to prepare children for a very different school year. Here are some tips to prepare you and your child for back to school:

1. Buy your school supplies online

While it may be tempting to go to your local department store for that specific blue three-pronged folder your child has on their school supply list, try and see if you can order school supplies online. Most department stores right now have options to order online and either deliver or pick up items curbside. We want to limit our exposure to others as much as possible, and back to school aisles can be some of the busiest aisles this time of the year.

2. Have your child practice wearing a mask at home

When schools open up for in-person learning, many schools will require their students in 1st grade onward to wear face masks all day. It’s hard for most adults to wear a mask all day, and this is going to be a big change for our kids. You can try to ease into this by having your child and family members wear their masks at home for extended periods of time. Start with just 30 minutes at a time and gradually work your way up to a full day. Make sure to demonstrate the proper way to wear a mask (covering both the mouth and nose).

3. Have your child practice proper hand hygiene

Make sure you go over proper hand washing techniques and have your child practice it at home. Remember, your child should wash their hands anytime they touch their face or mask, eat or drink, touch any contaminated surface or object, blow their nose, cough, or sneeze. Your child should follow the following five steps in hand washing. (These steps are from

  • Wet your hands with clean running water, turn off tap, and apply soap.
  • Lather your hands together by rubbing them together with soap. Lather the backs of your hands, between your fingers, and under your nails.
  • Scrub your hands for at least 20 second. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  • Rinse your hands well under clean running water.
  • Dry your hands using a clean towel or air dry them.

4. Demonstrate social distancing to your child

We should be staying at least six feet apart from each other when possible, but do you really know how far six feet is? Take out a tape measure at home and show your child just how much distance they should keep between themselves and others. You can also practice this among family members at home and try to maintain at least a six-foot distance for a whole day. If you are at the grocery store or any other public place with your child, make sure to put this into practice, by standing at least six feet apart from others and keeping your mask on at all times.

5. Be flexible with your children and yourself

This school year is going to be very different from other years. With many of our children in distance learning classrooms and having to learn outside of the traditional education model, we may need to adjust our expectations for our students and for ourselves. Many of our kids may need extra help getting their assignments done on time and communicating with their teachers. And with parents having to both work and help their children with schoolwork at home, it can be easy to get overwhelmed. Don’t be afraid to ask for extra help, be it from teachers, other parents, counselors, or anyone else.

We hope this list has given you some ideas on ways to prepare for back to school. If you or your child are having a difficult time coping with the pandemic or any of the changes that it has brought to our everyday lives, please talk to your pediatrician. If you need help finding a pediatrician, check out The Children’s Hospital of San Antonio Primary Care Clinics for a location near you.

Fresh Ideas for Summertime Fun

Likhitha Reddy, MD, PGY2, Resident, Baylor College of Medicine – The Children’s Hospital of San Antonio

How many times have your school-age children told you they are bored today and that there was nothing to do? Have they given up asking, “What are we doing today?” because they know the answer? It’s tough being a kid – even tougher being a parent the past few months.  

We’ve compiled a list of things parents and caregivers can do to keep kids of all ages occupied and maybe even stimulate their curiosity and knowledge – helping you all get through the crazy summer of 2020.  

1. Schedule activities ahead of time While it may not be possible for children to physically attend camps, extracurricular activities or play dates in person, there are an abundance of activities available for your children to enjoy. Scheduling activities beforehand will help children maintain a routine and have something to look forward to every day.

2. Active play is a child’s best friend It is important to incorporate as much active play into children’s schedules as possible. Playing outside, riding bikes in the park, hiking, playing soccer, basketball, volleyball, or just going for a walk around the neighborhood are great ways to get exercise while also spending valuable time with your children.

3. Read, read, read As much as exercise and active play are necessary, it is just as important to make sure kids have time to keep their brains engaged and continue to learn through the summer. Schedule time for reading or listening to audio books or podcasts this summer. The San Antonio Public Library is a wonderful resource to achieve this goal.

4. Limit screen time as much as possible Electronic devices may seem like the easiest option to keep kids busy for most of the day. You can still find ways to make sure screen time includes interactive and educational components. As a parent, it’s important to make sure screen time doesn’t interfere with activities that engage the brain and keep children physically active. Also, make sure devices do not interfere with sleep and family relationships.

Let’s keep our brains active!

Google Arts & Culture has partnered with thousands of museums around the world to offer virtual tours from the comfort of your home. Click here for the complete list.

If you prefer a virtual zoo experience, the San Diego Zoo has set up virtual cams for children to watch the animals. San Diego Virtual Zoo

The San Diego Zoo offers a virtual experience. What are the elephants up to today?

From drawings to science experiments, NASA is providing lists of activities for kids to enjoy with their parents at home! Check out Outta This World!

For a low price of $5, Scholastic provides educational activities for children all summer long. Learn at Home

Chrome Music Lab is a hands on website that helps kids tap into their musical side

Texas Home Learning provides at-home resources for parents to help access educational activities for children. Let’s Learn!

Summer camp…Virtually!? Use Varsity Tutors to help kids (K-12) make the most of their break with interactive camps taught by expert instructors online.

Get your art on with Ms. Sue! Let you and your kids’ creative side flow with free online art classes on Youtube! Ms. Sue’s Art Studio is always open!

Story time is fun time!

Audible is one of the world’s largest collections of audio books and they are currently offering free stories in all different languages for kids! Start Listening Here!  

Podcasts especially for younger children between 2  and 6 years old! List of Podcasts

Storyline Online is a children’s literacy website that streams videos of celebrities reading children’s books along with illustrations.

Imagine a world of possibilities thru the San Antonio Public Library! Subscribe to the Youtube Channel to get more information. IMAGINE!  

Summer sunshine

  • Go on family bike rides or hikes, try to see how many different animals they can identify.
  • Go to the San Antonio Zoo.
  • There are a number of parks still open in San Antonio and families can spend time there while safely social distancing:
    • Friedrich Wilderness Park – By far the most popular park in San Antonio!
    • Brackenridge Park – Great place for biking!
    • Government Canyon park
    • Woodlawn Lake Park – Great place for hikes and fishing!
    • Japanese tea garden
    • Botanical Gardens
    • Jenschke Orchards in Fredericksburg has peach picking tours available for the family. Pick Peaches here!
  • Plan a picnic in the park on a nice sunny day.

Stay in and bond!

Garden in your own backyard.

Cook with your brand new planted garden crop! Explore new recipes with the help of local San Antonio CHEF program. Children as young as 3 can help you cook in the kitchen and it can be a fun adventure to get them to try new cuisines as well!

Camp out in your backyard and cook up some s’mores.

Shoot for the stars! Go stargazing outside on a nice clear night. How many different constellations can you identify?

Pick up some chalk at any local store and decorate the sidewalks. Maybe even play a game of hopscotch!

How about a good old fashioned game of hopscotch on the sidewalk? Hopping can be great exercise. Use sunscreen and stay hydrated when playing outside.

It may have been a while since the kids saw their elderly loved ones. Have them write and decorate homemade letters to the grandparents! Plan time to visit with them through windows or glass doors. If it’s hard to hear each other, use your mobile phone to chat at the same time. They will love seeing how big you’ve grown … and they miss you more than you know!

We hope this list has given you some new ideas and resources to make it through the summer, get some exercise, and keep the boredom blues away!

If your child is having a tough time coping during the pandemic, talk to your pediatrician. If you need a pediatrician, check out The Children’s Hospital of San Antonio Primary Care Pediatricians

The Sky is Not Falling! Talking to your kids about COVID-19

By Sky Izaddoost, MD, The Children’s Hospital of San Antonio Primary Care – Stone Oak

It’s been about a month, y’all! The kids have been home for a month. Seriously. I said a month.  While our lives have changed, so have the lives of our kids. My 5-year-old thought she didn’t get dessert last night because of “the COVID” (really it was because she didn’t eat enough of her veggies). Yes, COVID-19 has made an impact on our kids regardless of age. The kids miss their friends. Mine haven’t left our neighborhood in weeks. But worst of all, they hear us talk. They hear us say that people are sick. They hear us say people are dying. They hear our anxieties of how to pay the bills when paychecks are getting cut. They know more than you think, but they react differently than we do.

Some kids can tell you how they feel when given the opportunity to talk. Some kids have nightmares. Some kids shut down all together and refuse to talk. It’s up to us as parents to start this conversation and help our kiddos with stress during this pandemic.

So let’s get started. First, find out what they know about COVID-19. If you ever played telephone as a kid, you know that facts get twisted when they are passed from person to person. Talk to your kids about what they know and help reduce their stress by dispelling some rumors that may not be true. A child with anxiety about getting sick will benefit from reminders that they are staying home to avoid getting sick and to stop the virus. Really, y’all are superheroes at home. You are welcome to wear a cape.

Second, a routine y’all! Your kids are used to doing the same thing every day at school or daycare. Set up something similar at home. While it may seem odd to have to wake up, get dressed and not go anywhere, it returns them to a sense of normal.

Wake up by 8 a.m. Get dressed, brush teeth, fix hair, wash face, and eat breakfast. Just like a normal day. Then get schoolwork done. Make sure you set an afternoon goal or surprise to make getting schoolwork done easier. You could make a fairy lantern, create a scavenger hunt for parents, volcano science experiment, tickle war, or bake something. Also, set aside time for exercise – at least 30 minutes a day or work in an hour if you can. Have your kids help make lunch and eat lunch together as a family. 

Add some self-care elements to your routine. Beyond just exercise, pull out that old yoga mat and try some moves with the kids. My kids love to relax in a bath with a fancy bath bomb. Extra points because they made the bath bomb themselves. (Amazon for the win!) Think about ways you relieve stress for the kids during the regular school year and modify them to current conditions. Eating out relieves stress. So, have a picnic.  The weather has been awesome lately. Just make sure to put on the sunscreen and insect repellent based on age.

Practice social distancing. Honestly, I prefer the term “physical distancing.” Let your kids talk to their friends via Skype, Zoom, or FaceTime to keep them involved in each other’s lives. Give bonus time to talk about schoolwork! Kids can play games on Skype like Scattergories, Heads Up, charades, and have dance parties. Another thing you can do is set up a scavenger hunt where each parent provides a list of items and kids have to run around their respective houses with their devices finding two matching socks, or something shiny, or a superhero in a book.

Finally, this is stressful for adults – just as much as it is for our children. Every day there is something new for us to worry about. Take time to have conversations with your kids about everything that is going on. Reassure them of all the things you are doing to keep them safe. And remember to stay positive. San Antonio is an amazing city and our citizens and heroes are rising to the occasion.

So thank you to all of our health care workers, grocery store workers, delivery truck drivers, and all essential personnel for keeping us together and keeping us safe.  And thank you to the stressed-out parents at home who are keeping the kids and our community safe by staying at home with grace. Wear your cape proudly San Antonio. And send us some pics!

Dr. Sky practices at The Children’s Hospital of San Antonio Primary Care – Stone Oak. We are accepting new patients and taking extra precautions at all of our clinics to keep children and their parents safe and healthy. We carefully screen all patients by phone and during each visit, separating our days into morning well visits and afternoon sick visits, minimizing waiting room time and practicing safe social distancing and masking. We also have the ability to do video visits, allowing families to talk with a doctor without leaving home whenever possible. To learn more about our services and locations, find us at

COVID-19 Testing in children

By Nancy Kellogg, MD, Child Abuse Specialist, and the team at the Center for Miracles

Parents and child advocates are questioning how and when children should be tested for COVID-19. There is also particular concern for children living in foster care and community shelters. At this time, there are insufficient numbers of tests available so public health authorities have prioritized testing protocols. 

The population who is at greatest risk for the infection and for serious illness are older than age 65, immunocompromised individuals, and those who have recently traveled from areas where there is widespread community transmission of the disease.  The protocols may change as more test kits become available and the regional epidemiology changes.  Please remember this is a virus that scientists knew nothing about until it appeared four months ago in China, so we continue to learn more about it each day.

We are just beginning to learn what effect COVID-19 has on children.  A recent research article from China indicates that out of 2,143 confirmed or infected children, more than 90% were asymptomatic, mild, or moderate cases. 

Although we may not be able to test and confirm whether an infant or child has COVID-19, please consider the following precautions:

1. If a child has fever please keep them at home or in the shelter; anyone with trouble breathing should seek immediate medical care.

2. Try to minimize contact with other caregivers or children when possible; caregivers should practice social distancing, good handwashing and if a child becomes symptomatic, wear masks, if available.

3. The virus is transmitted through close contact but can also survive on surfaces such as door handles and counter tops.  Whenever a caregiver has a sick child in the home, they should wash their hands each time they contact the child or surfaces.  Keep hands away from the face.

4.  Foster parents and shelter personnel may be caring for children infected with COVID-19, now or in the future.  Even though testing may not be available to confirm the presence of the virus in sick children, caregivers should employ universal precautions as if the child is infected and can transmit the disease to others in the home or facility.  While the infection is not likely to be serious and may not require medical attention, transmission to an adult is still possible and adults may have more serious symptoms.

5. If a child in protective custody has fever and symptoms of COVID-19 (cough, runny nose, sore throat, and/or gastrointestinal issues such as vomiting, diarrhea, nausea, stomach pain), foster parents and shelter officials are advised to call the San Antonio Metro Health hotline: 210-207-5779 and notify your manager or supervisor with Child Protective Services.

The Children’s Hospital of San Antonio and CHRISTUS Health have set up a hotline to answer any questions you may have about COVID-19. The number is 1-800-458-4559. We have also launched a the CHRISTUS COVID Chatbox on our website at The Chatbox allows you to confidentially evaluate your own or your child’s symptoms regarding COVID-19. The best way to avoid the virus is to stay home and practice social distancing.