What to Do if Your Child Has a Positive Covid Test (At Home or in the Office) - Updated 5/20/22

Symptoms of COVID-19
Symptoms of COVID-19, which is caused by the SARS-CoV-2 virus, range from mild to severe and generally begin 2-14 days after being exposed to the virus. Someone with these symptoms may have COVID-19:

·  Fever and chills (we have seen children range from low grade fevers for several days to children with 105F fever for a week)

·  A cough (with this strain we have been seeing several kids with a croup like cough)

·  Shortness of breath or difficulty breathing

·  Muscle or body aches

·  Headache

·  Fatigue

·  New loss of taste or smell

·  Sore throat

·  Congestion or runny nose

·  Nausea or vomiting

·  Diarrhea

·  Conjunctivitis (pink eye)

Testing
A home test can be used to confirm a positive result. Home rapid tests usually are most accurate a few days into the symptoms. A positive is a positive. A negative could mean a false negative. If you have a positive rapid test at home on your child, please be sure to contact the Department of Health Hotline at 516-227-9570 to ensure that they have a record of your case for the purpose of contact tracing and releasing your children from isolation. This reporting will also apply for future travel documentation. You should also notify the school. This website will provide you with a letter clearing the child back to school once the appropriate isolation has been completed:
https://coronavirus.health.ny.gov/isolation
https://health.suffolkcountyny.gov/covidreleaseletters/Release.aspx

YOU DO NOT NEED TO CONFIRM A HOME POSITIVE TEST WITH A PCR. A POSITIVE RESULT IS CONSIDERED A POSITIVE RESULT-just report it to the DOH hotline above, and the school if applicable.

Of course, we are providing PCR testing in our office and are happy to see your child, especially if they are acting sick.

When to Worry

·  If your child complains about chest pain, shortness of breath or fainting,

·  If the child seemed to be getting better and then suddenly takes a turn for the worse, fever starts again a day or two later, they become more miserable or cough worsens.

·  If your child has asthma or any history of wheezing, please make sure you start them on their maintenance medications and use albuterol as needed-this may require an office visit if the child’s asthma is being triggered by the infection.

·   If the child can’t stop coughing. Some children may get a croupy (very barky sounding) cough associated with it.  If your child does develop a barky cough, we recommend keeping them in the steamy bathroom, and/or bringing them out into the night air (it usually gets worse at night), and/or sticking their heads in the freezer (that cold, humid air usually helps the cough).  If all of that does not work, or you think your child is having any trouble breathing, please let us know right away.  If consistent coughing persists, please let us know immediately.

·  Any signs of respiratory distress-if you think your child is having trouble breathing, you need to let us know immediately. Retractions is a finding in pediatrics where kids use extra chest and abdominal muscles to help them breathe. This is what retractions look like: https://www.youtube.com/watch?v=qsFR8evfrK8

·  Dehydration-make sure your child is urinating something every 6 hours, even if less than usual. If this is not the case, then you need to let us know immediately.

Treatments
At this time there are no specific treatments approved for healthy kids. Monoclonal antibody therapy and a newly approved oral drug can be used in children with severe illness or special healthcare needs.  Thankfully, none of our patients have required these treatments as the current strains of Covid-19 circulating have overall caused mild symptoms in children.  The best care is supportive care. Antibiotics are not helpful in treating COVID. Home remedies you may hear about on social media, such as the lice and animal de-worming product ivermectin, are NOT proven effective against COVID-19. Worse, they can be toxic if used not as directed.

Please refer to our cold/cough handout that gives you all of the resources needed to treat a child with Covid:
https://static1.squarespace.com/static/5528765de4b037749ced9985/t/576d777b414fb53649609fd2/1466791804573/5.+Treating+COLDS.pdf

TREAT THE CHILD, NOT THE NUMBER ON THE THERMOMETER. The purpose of Tylenol and Motrin is to make the child more comfortable, not to lower the number. If a child is acting normally and has a fever, we recommend not giving anything. Other treatments for a fever are to keep the child lightly dressed and offer plenty of fluids. Sponge bathe your child’s face and arms with lukewarm water. Avoid ice or alcohol baths. We want the child to be comfortable and to be able to stay hydrated (urinating something every 6 hours even if less than usual). DON’T LET FEVER SCARE YOU! Nature created it for a reason, to help fight infection. Fever doesn’t scare us as pediatricians and there is no absolute number where you need to go to the hospital (see above for what does make us worry). Just make the child comfortable.

If you find your child is still uncomfortable after giving a dose of Tylenol, it’s ok to then give a dose of Motrin without waiting for the Tylenol to wear off or vice versa. However, make sure you are giving weight appropriate doses and no more often than Tylenol every 4 hours from the last dose of Tylenol, and Motrin every 6 hours from the last dose of Motrin. Alternating these medications should be done sparingly and neither of these should be given in an around the clock manner. Motrin is not recommended for children less than 6 months of age.

Motrin or Tylenol does not CURE a fever. All it does is make the child more comfortable while they have a fever. When the medicine wears off, the fever may come back, and that is ok. Fevers due to covid (or any virus) may last several days. If your child has a fever and you give Tylenol or Motrin, and the number on the thermometer does not go down, don’t worry. Again, the purpose of the medications is to make the child more comfortable, not to lower the number.

Here is the link to our medication dosing handout that will show you exactly how much medication to administer if needed:

https://static1.squarespace.com/static/5528765de4b037749ced9985/t/576d7774414fb53649609f5d/1466791797500/4.+Medication+Dosing+Charts.pdf

Vitamin D and C
We have been recommending additional Vit D for years for boosting immune systems and contributing to better overall wellness.

·  In children under 12 months of age- 400 IU/day as recommended

·  From the ages of 12 to 24 months- 1000 IU/day

·  2 years of age-12 years of age-2000 IU/day

·  12 years of age +-4000 IU/day

The multivitamin with fluoride that we prescribe (in all fluoride concentrations 0.25mg, 0.5 mg, and 1 mg) all contain 400 IU/day. If you refuse the fluoride vitamin or live in NYC and give an over-the-counter multivitamin, please check to see how much vitamin D it contains.
Over the age of 1 year of age, we are recommending these supplements in addition to the multi vitamin with fluoride we recommend.

If we have tested your child and found him or her to be deficient, we may have recommended doses higher than what is listed above. The doses above are based on maintenance, not correcting for deficiency.

Blood levels on our lab reports state that a level of 30 ng/mL in the blood is normal. But what the literature supports is that true cellular protection from Vitamin D is from levels of 40-80 ng/mL. It is recommended by experts in the field of Vitamin D research that healthy children receive approximately 1000 IU per 11 kg of body weight each day to achieve optimal Vitamin D levels year-round- and it’s this calculation that has caused us to make these recommendations.
If you are exposed or positive to Covid-19-everyone in the home should double up on their dose of vitamin D for 1-2 weeks. Very unlikely to cause toxicity (especially since they are doing Vitamin D IV infusions in hospitalized patients), and if only doubled for 1-2 weeks.
Extra Vitamin C is worth having in the house for treatment just in case (also low in sugar):
Birth-5 years of age-no additional supplementation needed-they get enough between diet and multivitamin.
5 years of age-12 years of age-250 mg/day (one chewable referenced below)
12 years of age +-500 mg/day (one tablet referenced below)
For kids:
https://www.amazon.com/gp/product/B01N2V4GHZ/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1
For adults: https://www.amazon.com/gp/product/B003BVICUU/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1

Preparing Your Child for a Covid Test
Unfortunately, most kids have already had several covid tests, but just in case, these are some good resources:
· How to best prepare children for the nasal swab to test for covid https://www.megfoundationforpain.org/blog/nasal-swabs-creating-comfort-and-preventing-pain
https://www.nytimes.com/2020/07/15/parenting/kids-covid-19-test.html?smid=em-share

Mental Health
Chronic stress has been proven to lower our immune systems. Try to relax and take it easy. Reassure the older kids that they are going to be ok. Say positive manifestations like “I am strong and healthy, and I will be ok”. I know it sounds a little hokey, but it has scientifically proven to work. We control our thoughts, and what we chose our thoughts to be will directly affect our anxiety and the strength of our immune systems. Here are some more resources:

https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Mood-Boosting-Tips-for-Families-COVID-19.aspx

As you know, things are constantly changing, and we will try to keep you as updated as possible. We are here to help!

11/1/21 - Pediatric Covid-19 Vaccines, Ages 5-11

As many already know, the FDA is recommending the Pediatric Covid vaccine for children 5-11.  The CDC is expected to approve the use this week.  As per direction from NYS, we have pre-ordered the vaccine and are waiting for delivery.  Please see the important notes below:

·         We completely understand that there is a lot of conflict on this right now.  At this point in time, there are no mandates, and this vaccine is optional.  We are personally going to administer to our own children; however, we understand that many people have strong feelings about this.

·         We are going to follow CDC and AAP guidelines for administration.  Right now, the direction is to administer based on age, not on weight.  That is the guidance that we are going to follow.  We do not intend to vaccinate anyone outside of the recommended ranges.

·         We do not have the delivery dates yet.  Once we do, we will be determining the best administration plan for those who want it.  We will communicate the details of scheduling as soon as we learn more from the state.

FOR THOSE WHO WANT THEIR CHILDREN TO RECEIVE THE COVID VACCINE, please bear with us as everything unfolds.  Unfortunately, like everything throughout the pandemic, we are at the mercy of the fed and state.  We have created several distribution plans, however, nothing can be finalized and published until we know more (quantities dates etc.).  Please sit tight and be assured we will communicate more specifics as they become available.

I was on call this weekend, and almost every call I got was either of a parent testing positive and wanting to know how to proceed, or about a possible exposure.  This virus is not going away any time soon.  And I definitely see it getting worse.  NOW IS NOT THE TIME TO LET YOUR GUARD DOWN.  If we all don’t do our part and follow the rules, the schools are not going to be able to stay open.  And inevitably our goal is to keep the schools open!

We did get a shipment in of rapid COVID tests.  I just want to be clear that we will do them for your sanity (which has a lot of worth to us), but WE WILL NOT CLEAR YOU CHILD TO GO BACK TO SCHOOL OR DAYCARE BASED SOLELY ON A RAPID TEST.  We have one of the best rapid Covid tests that are available, but there still is a much higher risk of a false negative than with the PCR test.  WE WILL ONLY CLEAR THE CHILD TO GO BACK TO SCHOOL OR DAYCARE BASED ON THE PCR RESULTS.  Most schools now will only accept the PCR results anyway.  If your school or daycare will take the rapid result (which we think is a mistake), we will give you a copy of the results to give to the school or daycare, BUT WE WILL NOT GIVE YOU A NOTE CLEARING THEM FOR RETURN.  We are doing this for several reasons.  First, it is good medicine, and that’s how we roll.  Secondly, we care about you!  We want to support our community and keep everyone safe and the schools open.  Thirdly, it’s about integrity.  God Forbid we clear a kid based on a rapid test, and they go back to school and 2 days later the PCR is positive.  By then tons of other people would have been exposed.  I can’t put my head on my pillow at night living with that possibility. 

These are very scary, hard times.  I want you to realize YOU ARE NOT ALONE.  WE WILL GET THROUGH THIS.  As I say to my girls when they are scared-WE GOT YOU!!!!!  I have no idea how this is going to play out.  I have no idea when all of this will end and we can go back to normal.  But I DO know that we are in this together and together we will persevere. 

**Tests are available now.  We do not know, nor have we received guarantees about supply going forward.  Please bear with us if we run out and are waiting for additional to arrive**

​​​​​​​Halloween has so many fun traditions for children, choosing and wearing costumes, decorating pumpkins, special treats and much more.  While balancing fun and safety has always been a concern for parents, this year COVID 19 obviously poses a completely new set of challenges.  While everyone has their own comfort levels, I wanted to share some perspective on how I am handling it, and resources for alternative fun for the family. COVID-19 is still very much in our community, so we need to be safe in how we approach this. Most importantly, continuing to maintain appropriate distance from others (6 feet), wearing cloth face coverings (think superhero!), good hand hygiene.

Trick-or-treating in​ our community...

If you are going to go trick-or-treating, avoid large groups or clustering at doorsteps or anywhere else. I recommend individually prepacked treat bags for families to take.  We are setting up the trunk of my car which will be parked in my driveway very close to the curb.  I bought Halloween themed disposable tablecloths and decorations.  I personally do not feel comfortable having people come to my doorstep and ring the doorbell.  I pre-packed small, sealed bags of candy while wearing gloves and a mask.  Everyone can just take their own.  Non-edible treats are a good option, especially for children who suffer from food allergies.

How much touching objects spreads the COVID-19 virus isn't clear. But if your child collects treats from a few, socially distanced neighbors, you may want to wipe the packages or let them sit for a couple days before giving them to your child. And, of course, good hand hygiene like washing hands or using hand sanitizer before and after trick-or-treating is always a good idea!

Travel with hand sanitizer and don’t let the kids eat any candy while trick-or-treating to minimize the risk. Don’t let your kids stick their hands in communal bowls.  Limit how long you participate and only go to houses that have individually wrapped treats that the kids can pick themselves in a socially distanced way.  Make sure everyone washes their hands and changes their clothes when you get home.

I have seen a lot on social media about using a PVC pipe to slide treats to kids.  The CDC defines this as a moderate risk activity since there is still direct handoff of treats from one person to another, even if still 6 feet apart.  I do not recommend this.

I plan on hiding a stash of candy in the house and letting them eat that candy the night of Halloween.  Everything they collect from Trick-or-Treating I plan to leave in the garage for at least 72 hours before they can start digging in (only 2 pieces/day to portion control).

Trust your instincts.  If things feel overwhelming and it is hard to socially distance due to the volume of kids out, then ABORT MISSION.  Make a contingency plan (Pinterest has 1000’s of ideas-putting candy in plastic Easter eggs and making an Egg hunt on your property, scavenger hunts, etc)

Remember: a costume mask is not a substitute for a cloth face covering unless it has multiple layers of breathable fabric and covers the mouth and nose snugly. ​

If children plan to use their cloth face coverings as part of their costumes, they should not paint them since some paints contain toxins​.

Try to get your flu shot before Halloween.

MOST IMPORTANTLY, IF YOUR CHILD IS SHOWING ANY SIGNS OF ILLNESS (EVEN JUST SOME SNIFFLES), LIVES WITH SOMEONE WHO IS SICK, OR THE CHILD OR ANY MEMBER OF THE IMMEDIATE FAMILY IS ON QUARANTINE DUE TO DIRECT EXPOSRE TO COVID-19, OR HAVE TRAVELED INTERNATIONALLY OR TO A STATE AFFECTED BY THE NYS TAVEL ADVISORY IN THE LAST 14 DAYS THEN PLEASE JUST STAY HOME AND DON’T LEAVE OUT TREATS FOR OTHERS TO TAKE.

Below You Will Find Several Alternative Fun Options!

​Virtual costume parties & parades

Use video chats for an online party with friends and family and show off costumes and play games. Have fun with it! In cold climates, this may be the first time your child can wear a costume that isn't buried under a parka! Outdoor costume parades are another option, if it is possible for everyone to stay at least 6 feet apart and wear cloth face coverings.

Spooky movie night

Celebrate with a movie night and dress as your favorite characters. Do this as a family at home or consider letting your child watch with their friends while video chatting, with everyone starting the movie at the same time. For tips on finding age-appropriate movies for your child, read more here.

Decorating pumpkins

This is one Halloween tradition that's as safe and fun as ever. As always, just be careful to avoid pumpkin carving injuries. Children can draw a face with markers. Then parents can do the cutting. When the carving is done, consider putting a battery-operated light rather than an open-flame candle inside. Roast the seeds​ from the pumpkin for a healthy snack!

​Halloween-themed treats​

Make some fun Halloween treats as a family. Decorate a pizza with toppings in the shape of a jack-o'-lantern, for example, or make tangerine pumpkins (peel the tangerine and stick a thin slice of celery on top to look like a stem). Make sure the treats are not choking hazards if you have children under age 3.

Outdoor community events

Look for community events focused on safe ways to have fun. These may include programs offered by a park district, arboretum, zoo or other outdoor venues in your area. Stay away from crowds and clustering, and follow safe distance rules even when outdoors.

Avoid indoor events such as haunted houses. A local haunted forest or corn maze may be a better option, as long as cloth face covering use, physical distancing and one-way walk through is enforced. If you think there may be screaming, leave extra distance to lower the risk of spreading respiratory virus. If you go to a pumpkin patch or apple orchard, also use hand sanitizer before and after touching what you pick.

If your children will be outside, mark their costumes with reflective tape. Remind them to be careful around cars, as drivers may not see them. Make sure shoes fit well and costumes are short enough to prevent tripping or contact with flames. Bring flashlights if needed.

​Remember

Halloween during the COVID-19 pandemic is a chance for you and your children to get creative, and maybe even invent some new traditions for your family! It's also a great opportunity to model flexibility and a positive spirit. If you're excited and make it fun, your kids will have fun, too.

More importantly, this is a good time to teach children the importance of protecting not just themselves but others, as well. The decisions we make on this one day can have a ripple effect beyond our own families. Reinforcing to our kids that we are taking these precautions to protect our community is a great lesson in good citizenship.

This is all about how we frame this for the kids.  Like everything else this year, this can be used as a lesson in resilience.  We need to adapt to our ever changing world. 

10/5/20 - Clearing Kids for School - New DOH Guadance

The NY State Dept of Health just released updated guidelines on when kids should not go to school and require a doctor visit to be tested for covid. 

"Does your child currently have (or has had in the last 10 days) one or more of these new or worsening symptoms:

·         A temperature equal to or greater than 100.0 F or 37.8 C

·         Feel feverish or have chills

·         Cough

·         Loss of taste or smell

·         Fatigue/feeling of tiredness

·         Sore throat

·         Shortness of breath or trouble breathing

·         Nausea, vomiting, diarrhea

·         Muscle pain or body aches 

·         Headache

·         Nasal Congestion/runny nose"

Please understand, we are just trying to follow the Department of Health and CDC guidelines.  This is also a matter of INTEGRITY by trying to do the right thing to keep the schools open and lessen the spread of this virus.  If you make an appointment for any of the symptoms listed above, please EXPECT that a covid test is GOING TO BE DONE as per the DOH and CDC recommendations.  We have no option to not test. Any of these symptoms, even if mild, could be Covid and we have to check in order to clear your child to go to school.  This past week we continued to diagnose a few more kids who had very mild symptoms.  

Many schools are no longer accepting the rapid tests, and the CDC recommends that be the case.  We agree since one child we saw this week had a negative rapid test and then a positive PCR.  Rapid tests are good (like the rapid strep tests), but PCR is more sensitive which is why we ARE NOT GOING TO PROVIDE ANY CLEARANCE LETTERS FOR BACK TO SCHOOL UNTIL THE PCR TEST IS RESULTED AS NEGATIVE.  If the school wants a printout showing the rapid test was negative, then we can provide that, but BACK TO SCHOOL CLEARANCE WILL NOT BE GIVEN UNTIL THE PCR IS NEGATIVE.  If a rapid test is done and was negative, and the PCR was sent to the lab, it is recommended that the child remain quarantined until the PCR is resulted as negative. 

In addition, we are currently out of rapid tests (as of Saturday).  They are on a tight allocation from the manufacturer.  We are doing everything in our power to get as many tests as we can.  

THIS ALL SUCKS!!!!  We can’t emphasize enough how much we wish this was a different world, but we are trying our best to provide excellent care for your children and protect our community.  We are checking PCR lab results multiple times/day and Dr. Rubin will continue to come in on Sundays to make sure we minimize children missing school as much as possible. Please know your school's fax numbers, and Dr Rubin can fax the notes to the schools on Sunday to minimize any interruption Monday morning.  We really are trying our best to evolve with this ever-changing situation to best meet your needs.  Our intentions are pure.  This is just incredibly stressful, tough times.  

We know the test is not comfortable for kids, though it is very quick. Here are some resources to help best prepare them for the testing.

PREPARING YOUR CHILDREN FOR A COVID TEST

·  How to best prepare children for the nasal swab to test for covid https://www.megfoundationforpain.org/blog/nasal-swabs-creating-comfort-and-preventing-pain 

https://www.nytimes.com/2020/07/15/parenting/kids-covid-19-test.html?smid=em-share

9/28/20 - Important -Testing and School Procedures

This has been SOME back to school season.  We feel like we are all being faced with our own personal family challenges in this journey. We are certainly feeling it here at Happy and Healthy.  We wanted to have an open communication with you about some of the challenges we have been facing over the past few weeks as schools have re-opened.  Keep in mind, that a large part of these challenges stems from EVERY SCHOOL district having their own requirements AND constantly changing recommendations from the schools and the department of health. 

There are a few IMPORTANT points to this E-Mail

1.    This is far from over.  We diagnosed, this past week, 3 cases of COVID in our office, and there have already been several school closings.  Prior to this past week, we have not seen a positive case since April.  We are not informing you of this to scare you-believe me, we are doing everything in our capability to protect our patients, staff, and physicians-for that, you have our word.  We want to just remind everyone to be very diligent with social distancing, avoiding large crowds of people, and wearing masks.  We want the schools to stay open.

2.    Most schools have been insistent that any ill child have a covid test before returning. Honestly, we can see where they are coming from - the three people we diagnosed had either mild fever or no fever, mild cold symptoms, and/or mild sore throat at the time of diagnosis.  Based on school requirements (and the fact that the kids we diagnosed positive had minimal symptoms) we cannot simply clear a child to return to school without Covid testing. We are not trying to give anyone a hard time. We are just trying to practice good medicine with integrity.. Based on some local cases and community reactions, you do not want to be the one who didn’t do your due diligence and infected others at a school.  NONE OF THIS IS IDEAL.  We don't like this anymore than you do, but we are just trying to do the right thing. 

3.    Important - Clarity on Testing.  There are two types of tests that we currently have.  One is a rapid test in which we can get results in about 15 minutes.  The other is a PCR (a test that we send to the lab) The rapid test has a 100% specificity and 93.75% sensitivity, which is very good.  We confirmed with several pediatric ID specialists that a positive on these rapids is considered a true positive and no additional testing is needed.  There is a chance for false negatives, therefore if the rapid is negative, we still have to send out a PCR test to the lab.  At that point, we are at the mercy of the lab and how busy they are and how quickly they can get us the results.  We have seen results come back in 24 hours, and other times 5 days. 

We are asking parents to leave the office after we collect all specimens, and we call you with the result (minimum of 15 minutes based on volume).  Since this is so new, we are not sure if the rapid tests are covered by all insurances yet. We are asking you to sign a waiver that if not covered by insurance, you may be billed $75 for the test. These tests are very expensive for us to purchase.  Some schools will take a rapid test as good enough to go back to school if the child is better, while some want only the PCR test (some even are asking us to fax over the lab results from the lab as proof the child is negative).  The CDC recommends that the child remained quarantined until the PCR comes back negative, even if the rapid test is negative, so therefore, that is what we are recommending.  But if your school is ok with the rapid test, then we will give you a note saying it is negative, even though we would prefer to follow the CDC recommendations (and we still have to send the PCR to the lab).

We want to be clear that we don't want anyone to feel like they are "wasting money" on the rapid tests.  We are offering it as an optional service, but the PCR we send to the lab is the gold standard.  The two advantages for the rapids are that if it is positive, we have our answer.  If it is negative, you have at least partial peace of mind until the PCR comes back in 1-5 days.   After speaking to our local school doctors a few weeks ago, I was told that rapid tests would be accepted by all schools and that has already changed for a lot of school districts.  So please look up what your school requirements are so you can make educated decisions if your child does get ill and needs to be seen.

4.    This is all EXTREMELY TIME consuming and logistically challenging for us! We also completely own and APOLOGIZE FOR the longer than usual wait times.  We have had a much larger than usual influx of sick visits (mostly due to clearance needed for back to school) and there are a lot more steps needed regarding testing that take considerably more time.  We are taking significant steps to improve this.

a.    We have made significant investments to create a sick office. Starting today, we are seeing sick patients on our designated side of the building as our construction is almost complete. We will have 6 dedicated rooms, rather than two tents. The tents were by no means ideal, but it got us through the construction period.  We will forever now have separate areas of the building for sick and well appointments to best protect our patients.

b.    We are adding staffing to better manage the new demands of testing procedures.  This staff will facilitate the flow of patients and information and help expedite visits and results.

5.    We want to help get kids back to school. An issue we encountered for the first time this past Monday, is the need for kids with negative PCR's, and whom were clinically better, to be able to go to school and need that note first thing in the morning for the schools to let them in.  We understand completely the need for parents to go to work and for the kids to go to school. Dr. Rubin is personally forfeiting her family time and going to go to the office on Sunday to look up all of the Covid lab results, call the family to give them the results and make sure the child is clinically better. If appropriate, and if you provide the school fax number, she will fax the notes directly to the school.  This should help lessen the Monday morning insanity we are all experiencing right now.

These are very hard, scary times.  And what makes it even harder, is everything keeps changing.   We truly have the intention of trying to help our community get through this.  We appreciate any feedback-both positive and negative, as we are all trying to navigate these uncharted territories together.  Please stay safe and let us know how Happy and Healthy can help you through this journey.  

7/27/20 - Important Office Procedure Updates

Balancing safety pandemic and patient experience during the COVID 19 is extremely challenging.  We are researching and evolving daily to ensure we are making the best decisions to keep you and your families safe, while still supporting families and practicing the highest level of medicine.  We recently sent out a COVID response survey and while we received a lot of terrific feedback, we have also discovered some areas of opportunity.  We would like to address one of the topics below.

One of the safety measures that we put in place at the peak of the outbreak was only allowing one parent to accompany the child/children per visit.  This was intended to reduce the overall number of people coming into the office and reducing any additional potential exposure to COVID 19.  While this has reduced the number of people in the building, it has caused difficulty for some.  We recognize that in many cases (such as newborns or those with complex issues children) both parents need to be involved in the face to face visit. Please see below for UPDATED visit protocols:

·         If you are able, WE STILL ASK that only one parent be present for your child/children’s visit, however both parents will be able to attend the visit (from start to finish) if you prefer.

·         We are going to be using a forehead scanner to check temperatures of EVERY family member entering the building as an additional safety measure to offset this change

·         For those with three children, we will continue to book “triple” visits to reduce the number of times that you need to come to the office.  In those cases, we are asking that 2 adults accompany the children to the visit, and we will ask one adult to wait in the car with 1 or 2 of the children to better manage the number of people in the room at one time.  With 3 kids at once, it can become chaotic in the exam room, affecting our ability to provide the best care.  If this applies to you, please discuss with the front staff and they will help you best manage. 

·         IMPORTANT – masks MUST be worn by anyone entering the building over the age of 2.  Masks MUST cover the mouth AND nose.  Many people are using masks with a valve or outlet (see examples below). These masks protect the user, but DO NOT protect others as that acts as an exhaust that allows particles to escape.  If you are using a mask with a valve, we are requiring an additional covering over that mask (surgical mask or cloth covering).  This is for patient and staff safety and to reduce potential COVID transmission. You may notice us wearing them as they are the only ones that we can get.  We always take the precautions of adding either a surgical mask or face shield.

We continue to thank you ALL for providing us the opportunity to care for you and your family during this challenging time.  We have learned a lot from our recent surveys and well as direct patient feedback. More announcements and positive changes to come.  Stay tuned!!!

6/4/20 - Vitamin D and Vitamin K

We see articles coming out saying that Vitamin D is not “the cure all” for covid.  We agree with that.  As usual, research is coming out saying it is helpful, and others saying it is not helpful.  As I have owned from the beginning, I don’t know - none of us really KNOWS for sure since all of this is new to us.  But after researching how much vitamin D effects so many areas of our bodies, I still think that supplementing is overall good preventative medicine.

We also have heard concerns about possible toxicity.  Levels of over 150 ng/mL in the blood are considered toxic.  In a healthy child with normal kidneys, it is very unlikely to reach toxic levels based on the amounts that we are recommending.  Plus, we are following the recommendation of 1000 IU of vitamin D per 11 kg of body weight.  In clinical practice, I would say approximately 2.3 children that we check are vitamin D deficient, so I think we are in a safe place.

Others felt that what the kids were getting from the sun would be enough.  Again, 2/3 of the kids we are testing are deficient, so I don’t necessarily think that is true.  It does NOT change based on the time of year.  All of the children’s well exams are scattered throughout the year.  We see just as much deficiency in the summer as we do in the winter. However, in the colder seasons, I think the supplementation is very important.

We have also been getting a lot of questions about Vitamin K supplementation. Other than the injection of vitamin K given to newborns when they are first born, it is not recommended to supplement children with additional Vitamin K.  Vitamin K is an essential nutrient, but it is available in several foods:

Foods high in vitamin K
100 g of the following foods contain high levels of Vitamin K

• cooked spinach – 540.7 mcg

• cooked kale – 418.5 mcg

• cooked mustard greens – 592.7 mcg

• cooked collard greens – 623.2mcg

• cooked beet greens – 484 mcg

• raw swiss chard – 830 mcg

• raw dandelion greens – 778.4 mcg

• cooked turnip greens – 518.9 mcg

• broccoli – 141.1 mcg

• cooked cabbage – 108.7 mcg

• raw arugula – 108.6 mcg

• dried basil –1714.5 mcg

• dried sage – 1714.5 mcg

• dried thyme – 1714.5 mcg

• dried marjoram – 621.7 mcg

• dried oregano – 621.7 mcg

• fresh parsley – 1640 mcg

• dried coriander leaf – 1359.5 mcg

• endives –231 mcg

• chives – 212.7 mcg

• raw cress – 541.9 mcg

• cooked brussel sprouts – 193.5 mcg

• red leaf lettuce – 140.3 mcg

• green leaf lettuce –126.3 mcg

• soybean oil – 183.9 mcg

• mayonnaise – 163 mcg

• margarine – 101.3 mcg

• goose liver – 369 mcg

• beef liver –106 mcg

• turkey sausage – 36.6 mcg

• chicken meat –35.7 mcg

• turkey frankfurter – 31.2 mcg

• salami – 28 mcg

• pepperoni – 41.7 mcg

• soft cheese – 506 mcg

• blue cheese – 440 mcg

• hard cheese – 282 mcg

• full-fat milk – 38.1 mcg

• bacon – 35 mcg

5/29/20 - Vitamin D Update

I have been doing tons of research on vitamin D and it is more than a vitamin. It is involved in cellular repair with receptors on the nucleus (access to DNA) in every cell in our body! Deficiency is associated with Covid-19, Kawasaki, Depression, anxiety, cancer risk, bone development and strength, overall immunity, chronic pain, migraines, etc.
 
Since my previous email about Vitamin D, tons of new research has come out supporting the importance of Vitamin D, especially right now.  Many studies have recently surfaced including “The role of Vitamin D in the Prevention of Coronavirus disease 2019 infection and mortality”-scientists concluded based on their data that Vitamin D supplementation could protect against SARS-CoV2 infection.  Research out of Northwestern University noted that Vitamin D appears to play a role in Covid-19 mortality rates.  Another article reports evidence that Vitamin D supplementation could reduce risk of Influenza and Covid-19 Infections and death.  Now all of this is new to us, so of course more research has to be done, but I feel good about at least having this as a starting point.
 
As part of my research, I extensively searched the AAP for any guidance.  There last update on Vitamin D supplementation was made in 2008 (recommending newborns and infants get 400 IU/day to prevent rickets, and they say older kids may need 600 IU/day).  And the AAP does not give us any guidance on when to test levels in children to check for deficiency.
 
So after much research and collaboration with all of the physicians at Happy and Healthy Pediatrics, here is what we came up with as a protocol:
 
In children under 12 months of age- 400 IU/day as recommended.

From the ages of 12 to 24 months- 1000 IU/day.

2 years of age-12 years of age-2000 IU/day.
 
12 years of age +-4000 IU/day.

The multivitamin with fluoride that we prescribe (in all fluoride concentrations-0.25mg, 0.5 mg, and 1 mg) all contain 400 IU/day.  If you refuse the fluoride vitamin or live in NYC and give an over the counter multivitamin, please check to see how much vitamin D it contains.  
 
Over the age of 1 year of age, we are recommending these supplements in addition to the multi vitamin with fluoride we recommend.  
 
If we have tested your child and found him or her to be deficient, we may have recommended doses higher than what is listed above.   The doses above are based on maintenance, not correcting for deficiency.
 
Blood levels on our lab reports state that a level of 30 ng/mL in the blood is normal.  But what the literature supports is that true cellular protection from Vitamin D is from levels of 40-80 ng/mL.  It is recommended by experts in the field of Vitamin D research that healthy children receive approximately 1000 IU per 11 kg of body weight each day to achieve optimal Vitamin D levels year round- and it’s this calculation that has caused us to make these recommendations.
 
As far as testing goes, we have decided to test at ages:
1 year of age (when AAP recommends anemia and lead levels be done anyway so not an additional stick)
2 years of age (when AAP recommends anemia and lead levels be done anyway so not an additional stick)
3 years of age (Only if the child was deficient at age 1 or 2 years of age)
5 years of age and then every 2 years after that along with checks for anemia and lipid levels when appropriate.
 
Weighing risks vs benefits it is hard for us to make any arguments why this is not just good overall preventive medicine, even beyond this pandemic.  It makes sense as to why we are all so deficient.  We are inside more as a society overall, especially season dependent.  And we destroyed the ozone layer with pollution, so we use sunblock to prevent the risk of sunburns and skin cancer.
 
One brand we recommend for Vitamin D supplementation is Carlson’s because the vitamin D is suspended in an oil, but any supplement is ok as long as not a gummy (contain a lot of sugar and are sticky).  Please read ingredients to make sure you child is not allergic to any components of the supplement. And if your child has kidney disease in any form, please make sure they follow-up with their specialist who manages the issue before giving the additional supplement.

5/28/20 - Antibody Testing - AAP Guidance

A few more words about antibody testing….  We have been receiving numerous calls regarding COVID antibody testing.  We are currently not offering antibody testing at this time. Here is an article from the AAP explaining all of the different types of testing available and how they should be used and interpreted Please bring your attention to the sentence towards the end of the article saying “At this time, antibody testing is not recommended for use in a pediatrician’s office”.  

https://www.aappublications.org/news/2020/05/22/covid19antibodies052220

Another report from the CDC -  “antibody tests used to determine if people have been infected in the past with [SARS-CoV-2] might be wrong up to half the time, the US Centers for Disease Control and Prevention said in new guidance posted on its website.”

If our direction changes for any reason down the road, we will certainly let you know!  Thanks and stay safe!

5/27/20 - Covid Safety and Risks

We are getting many calls from patients asking for advice on seeing family members and other means of breaking social distancing. Believe me, I understand.  My parents have not seen my kids for weeks and I was feeling pretty blue this past Memorial Day weekend-another holiday under quarantine. These decisions are very multifactorial and very hard. 

Here is what we do know:  What was about 100 children in NY with the multisystem inflammatory syndrome is now 100’s of children-and this number grew in only a few weeks.  There is now evidence of covid causing type 1 diabetes in children.  And new reports are coming out about dangerous blood clots being a complication of covid in children.  The way I see this, new information is coming out very quickly as we learn more about this virus and I am scared. As NY starts to open and many business resume, the recommendation for wearing a mask and social distancing and not changed.

As people are conflicted and unsure about what they can and cannot do, we have compiled some resources that discuss risk vs. benefit along with tips to maintain as much safety as possible as you venture out

Here is a great article that summarizes the risk vs benefit of some summertime activities…

https://www.npr.org/sections/health-shots/2020/05/23/861325631/from-camping-to-dining-out-heres-how-experts-rate-the-risks-of-14-summer-activit  The only thing I DISAGREE with in this article is the pool-for adults in a public pool. Yes, social distancing in the pool and the dilution effect of the water is likely ok.  But a herd of children in a kiddy pool is a different story - most of us have experienced the joys of Coxsakievirus after a trip to a town pool or water park.  For kids, I worry the transmission rate could be much higher, so I consider this HIGH risk.  A personal, family pool would be lower risk if the only people in the pool are the ones you have been social distancing with.

Safety Tips for Visiting Any Public Beaches or Parks

Aslam Jangda, MD, a board-certified pediatrician at Crystal Run Healthcare joined with his daughter Maha Jangda, MD, a recent Medical School graduate, to compile useful tips for families visiting the beach this summer during the COVID-19 pandemic.

·         Maintaining six feet of distance is key

·         Wear a face mask whenever you are unable to maintain that social distance

·         Bring hand sanitizer and disinfectant wipes to be able to clean your hands after touching surfaces (bathroom stalls, handrails, rental beach equipment)

·         Try not to use benches and picnic tables if any of these items are available for use

·         Bring a water bottle from home instead of using water fountains

·         There is no known information available to show if the virus can or cannot live in saltwater, so keep this in mind when making decisions to swim or not

·         There is no known information available about whether or not the virus can live on sand

·         Do not take mass transit unless absolutely necessary

Safety Guidelines for Visiting Beaches in Nassau and Suffolk Counties

When visiting beaches throughout Long Island, the Office of Parks, Recreation and Historic Preservation and the State Department of Environmental Conservation encourages New Yorkers to follow these guidelines:

·         Stay local and keep visits short

·         Visit in small groups limited to immediate household members

·         Maintain distance from others while in places where people tend to congregate, such as parking lots, trailheads, and scenic overlooks

·         Avoid games and activities that require close contact, such as basketball, football, or soccer

·         Avoid playground equipment like slides and swings and other frequently touched surfaces

·         Do not share equipment, such as bicycles, helmets, balls, or Frisbees

·         If you arrive at a park and crowds are forming, choose a different park, a different trail, or return another time/day to visit

·         If parking lots are full, please do not park along roadsides or other undesignated areas. To protect your safety and that of others, please choose a different area to visit, or return another time or day when parking is available.

The beach is my happy place, but I don’t think we will be there this summer. What I encourage all of you to do when making these decisions, is weigh the risks vs benefits.  They are all very personal decisions.   For example, if your 87 year old grandmother lives with you, you might make different decisions.  If you have a child with special needs, you might make different decisions.  Follow your heart and make educated decisions about what is safe for you and your family.  Trust your instincts. Whatever decision you make for you and your family, be kind to others who chose differently.  We are all just Mama and Papa Bears trying to protect our cubs.  .  And even if you had antibody testing, and it came back positive, that does not mean you are immune and/or could not be an asymptomatic carrier to someone else.

5/7/20 - Vitamin D Supplementation

As you can imagine, once we started to see this wave of pediatric multi-system inflammatory syndrome potentially associated with coronavirus disease (COVIV-19) in children, I was filled with an array of new emotions. First was anger at this virus. I was very comfortable living in the world where this virus was not really affecting children.  And then when the anger settled the fear set in.  Then the helplessness.  So we started doing some research.  NOW LET’S ALL KEEP THIS IN PERSPECTIVE-WE ARE TALKING ABOUT 100 CASES WORLDWIDE SO THIS IS STILL VERY RARE. 

We have no real data to go by since all of this is new to us.  We started doing literature searches about Kawasaki disease since it is presenting similar to it.  I found ONE article, from the National Institute of Health showing a relationship between “Severe vitamin D deficiency in patients with Kawasaki disease: a potential role in the risk to develop heart vascular abnormalities?” The article did show an association.  I of course acknowledge that one article does not prove or disprove anything.  And this is in relation to Kawasaki and not even this new inflammatory syndrome. 

More than half of the kids we test in the office are below the normal range for vitamin D, and now more than ever we are not outside as much as we used to be so thereby getting less vitamin D via sunlight.  So, while I know this is a stretch, we are not doing any harm in kicking up the vitamin D supplementation of our children.  Also see the Vitamin D handout on our patient resources page here - http://www.happyandhealthypediatrics.com/parent-resources

In children under 12 months of age, I would make sure they are getting the 400 IU/day as recommended.
From the ages of 12 to 24 months, I would make sure they are getting 1000 IU/day.

Over the age of 2 years of age, I would make sure they are getting 2000 IU/day.

In kids who are deficient in Vitamin D, we give 4000 IU/day or more, so bumping it up a little seems worthwhile and safe.  

Here is one product I like: https://www.amazon.com/Carlson-Immune-Health-Strength-Unflavored/dp/B06XSJ4DZP/ref=sr_1_5?dchild=1&keywords=carlsons+vitamin+d+2000+IU+drops&qid=1588856532&sr=8-5

It is from the brand name Carlson’s and it comes in all different concentrations.  It is all natural-just coconut and palm oil and vit D.  I put one drop of this product on top of my kid’s multivitamin, and they just chew the entire thing.  You can also easily hide this drop on a bite of food.  Any form of vitamin D you can get is fine, just try to avoid gummies since they are sticky, usually contain a lot of sugar and can increase the risk for cavities (which we need to avoid even more now since the dentists are not available except for emergencies).

I have no idea if this is really preventative or not, but what do we have to lose?  Either way it promotes good health and well-being.  And as a mother and pediatrician, it makes me feel better to do something for possible prevention.  
Stay safe.   

5/6/20 - Important – New Information About COVID 19 and Children        

COVID 19 is a new virus and we are learning more every day.  While we were initially not as concerned about the impact on children, that is now changing.  You may have seen on the news that there are some newly reported complications in children with, or who have had COVID 19.  15 children in NYC hospitals have been found to have a serious inflammatory syndrome (similar to Kawasaki Disease / Toxic Shock).  The symptoms include inflammation of the blood vessels, including coronary arteries.  All patients had subjective or measured fever and more than half reported rash, abdominal pain, vomiting, or diarrhea. Respiratory symptoms were reported in less than half of these patients.

If you observe these symptoms in your child, please call us.
This weekend, the weather was perfect! Maintaining physical and mental health is soooo important right now. However, it HAS to be done safely.  We observed SO MANY people not following social distancing and mask guidelines.  Yesterday and today, we also had more calls about sick children than we have had in weeks – not a coincidence!  THIS IS NOT THE TIME to take our foot off the gas when it comes to protecting ourselves and others from COVID 19.  While we are seeing lower hospitalizations and mortality, this is still very real, and it is DANGEROUS.  The reductions that we are seeing are a result of the social distancing and infection control that we have all been working so hard to do.  We must keep this up!

As a result of the above, along with changes in testing guidelines and ACCURATE TEST availability, we are going to begin testing for ACTIVE COVID 19 – NOT ANTIBODY TESTS AT THIS TIME (please see the post from 5/1 on our COVID 19 page as to why http://www.happyandhealthypediatrics.com/covid-19). 

Below are the guidelines for testing:

You must have a visit with a doctor to determine if testing is appropriate

• Ideally a telemedicine visit to minimize exposure.  If the doctor decides that testing is appropriate, they will instruct you to come to the office and pull into the parking garage.  A nurse will come to your vehicle in full protective gear and administer the test.  We will call you when the results are available.

• If you are in our sick office (TWO COMPLETELY SEPARATE OFFICES WITH SEPARATE ENTRANCES) and the physician determines a test is appropriate, it will be administered right there.

• We are ONLY testing symptomatic children

• We are not testing entire families (parents need to go to an adult facility if they would like to be tested)

If you have any questions, please call the office.

5/1/20 - COVID 19 Antibody Testing Update

We are getting a lot of questions about the Serology Testing for COVID-19 (The Antibody blood test).  The goal of this test is to see if you have already had COVID-19.  We are currently NOT offering this test (the current version) here at Happy and Healthy Pediatrics for a few reasons:

1. There is a high likely hood of a false positive.  These tests do not only detect COVID 19, but they can pick up other viruses (such as standard Coronavirus aka the common cold) and read as if they were COVID 19. The do not clearly differentiate yet.  False positives are DANGEROUS!  They give a false sense of security, and despite showing as being positive, you/your family could still be at risk.

2. If done too soon, it could lead to a false negative, still bad information

3. It is not clear that having these antibodies offers protection against contracting the virus

Many experts are advising NOT to do this test yet (based on the current testing and knowledge of antibody impact).  There is not enough evidence at this time to suggest that people who DO have the appropriate antibodies are protected against future COVID 19 infection.  We do not want people to think they are protected or safe when they may not be.  This test is licensed at this time for research and making policies about COVID 19 and not to see if any individual has had COVID 19.  The testing that is currently being conducted is not FDA approved.

This is taken DIRECTLY from Quest diagnostics website (in the fine print):

* This test has not been reviewed by the FDA. Negative results do not rule out SARS-CoV-2 infection, particularly in those who have been in contact with the virus. Follow-up testing with a molecular diagnostic should be considered to rule out infection in these individuals. Results from antibody testing should not be used as the sole basis to diagnose or exclude SARS-CoV-2 infection or to inform infection status. Positive results may be due to past or present infection with non-SARS-CoV-2 coronavirus strains, such as coronavirus HKU1, NL63, OC43, or 229E.

We at Happy and Healthy Pediatrics always strive to do good medicine based on AAP guidelines.  We know that several labs, adult doctors, pediatric specialists and urgent care centers are jumping on board with this and financially, I understand why.  We are researching constantly what antibody tests are emerging and what their sensitivities and specificities are.  When those tests become available, you have our WORD that we will make them available to our patients (as appropriate).  As health care providers, we of course would want to know if we are immune to COVID too.  Unfortunately, the tests we have available RIGHT NOW are not providing us with meaningful information.

4/23/20 - Why you should still come in for your child’s well exam

Skipping or postponing vaccines is scary. Our concern is children falling behind on their vaccines and normal preventative visits. The last thing we need is to create a vaccine preventable epidemic amongst all of this.  And we want to follow the American Academy of Pediatrics and the CDC recommendations as closely as we can.

“The Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American Academy of Family Physicians have each been urging doctors to maintain vaccination schedules as rigorously as reasonably possible, particularly for the youngest children. Vaccinate Your Family, a national nonprofit group, is pushing families to set reminders to reschedule canceled vaccine appointments.”  Link to full article: https://www.nytimes.com/2020/04/23/health/coronavirus-measles-vaccines.html.  “The legacy of COVID-19 must not include the global resurgence of other killers like measles and polio.”  Link to full article: https://vaxopedia.org/2020/04/06/the-second-covid-19-wave-might-not-be-covid-19/

From a parent on a recent well visit “Just wanted to say my daughter had her well visit today and my husband said he was impressed with the procedures you put into place.  He said he never saw another patient and as always the exam was thorough, all of our questions and concerns were answered, and she was able to get her 5 year old vaccines.  Thank you for your honesty and openness with your procedures, as I must admit I was nervous, but your daily updates and communications eased my concerns.”

We have been doing everything in our power to make this the safest place for you and your family. Please see the video we made for more details on all the precautions we are taking to protect you and your families. http://www.happyandhealthypediatrics.com/  In addition, For a more comprehensive list of our protocols, please visit our COVID 19 page here http://www.happyandhealthypediatrics.com/covid-19 and scroll down to the announcement on 4/6/20.

If you prefer, and really want to limit the amount of time spent in the office, then the nurse will measure your child and the MD will examine them and counsel on any vaccines being given, any vaccines or bloodwork can be performed and we can do a scheduled telemedicine visit afterward to discuss all concerns, discuss growth, do developmental screenings and ask all pertinent questions.   In and out in 10 minutes and then we can do the rest of the visit face to face via telemedicine. 

If you do refuse to come in for your well exam, I just want to be clear, that we are here to support you as your medical home as best as we can. Any questions or concerns can be made into a telemedicine visit at any time. We are here to support you during these unprecedented times in any way we can. The telemedicine visits at this point have to be billed as encounters, which means you might have an associated copay or deductible (which is completely based on your insurance plan).  As of now, well exams are not recognized as covered services via telemedicine. Should that change, we will let you know.

When the world does open again, we will not be able to fill out any school/camp forms, daycare forms or sports permission forms if the child is behind on well exams and vaccines.

4/20/20 - Great Resources

Some great resources:

We did post some of these before, but these really are excellent resources worth a second post

Sesame Street did an excellent job with these two resources

• Sesame Street video on talking with your kids about a health crisis

https://sesamestreetincommunities.org/topics/health-emergencies/?utm_source=SS.org%20Caring%20for%20Each%20Other%20Page%20links&utm_medium=Link&utm_campaign=Caring%20for%20Each%20Other

• Live Zoom with Elmo!

https://people.com/tv/sesame-street-elmo-to-host-virtual-play-date-to-bring-comfort-to-kids-amid-coronavirus-pandemic/?xid=socialflow_facebook_peoplemag&utm_medium=social&utm_source=facebook.com&utm_campaign=peoplemag&fbclid=IwAR0x5eu8C6UJFL4y8PFT-v0GGz2rbxp5-i8zm2F3DZeM_aJf4ajF2c_-aBQ
You’re invited to virtually attend “COVID-19 and your kids: What you need to know from your trusted health experts”  This virtual event is intended for all parents who are interested in hearing from highly respected child health experts from across the nation discuss the current pandemic.

This took place last week, but we thought was excellently done:

Speakers:
Dr. Kerry Fierstein, Pediatrician at Allied Physicians Group, NY
Dr. Susan Sirota, Pediatrician at PediaTrust in Chicago, IL
Dr. Raphael Strauss, Allergist at Allied Physicians Group, NY
Dr. Patrick Hynes, Pediatrician at One Pediatrics in Louisville, KY
Dr. Shauna Freedman, Child Psychologist at PediaTrust, Chicago, IL

Topics that were discussed:
Talking to Your Children about Quarantine and Social Distancing for COVID-19, Dr. Patrick Hynes
Allergies, Asthma and Immunologic Concerns During the COVID19 Pandemic, Dr. Raphael Strauss
Addressing the Mental Health Needs of Children and Adolescents During COVID-19, Dr. Shauna Freedman
Using Telemedicine for sick and well visits, Dr. Kerry Fierstein and Dr. Susan Sirota

Here is the full recording:

https://zoom.us/rec/play/vMZ7duit-zw3TtDAtQSDBaB8W421L6qs2ygY_vdbyE21W3NSYAagY-cUNLDDTax93I25dnvrceq22fN4?continueMode=true&_x_zm_rtaid=dmeGS_IqRbCV_mxpQ5JXbw.1587135936397.c5f946025e786d56325e4957655b8834&_x_zm_rhtaid=649

Part two is tonight if you want to register:

Date: Tuesday, April 21, 2020 

Time: 8:00pm EST

Title: COVID-19 and your kids: What you need to know from your trusted health experts 

Meeting Location: Zoom Webinar Register. 

Partial Speaker list: 

Dr. Kerry Fierstein, Pediatrician at Allied Physicians Group, NY 

Dr. Susan Sirota, Pediatrician at PediaTrust in Chicago, IL 

Dr. Raphael Strauss, Allergist at Allied Physicians Group, NY 

Dr. Patrick Hynes, Pediatrician at One Pediatrics in Louisville, Kentucky 

Dr. Shauna Freedman, Child Psychologist at Pediatric Partners, Chicago, IL 

And more… 

We ask that all parents click here and register. Please enter any questions you may have during registration that you would like the panel to answer 

Also, the Child Mind Institute has started telemedicine:

Our team of board-certified psychiatrists, psychologists, neuropsychologists, learning specialists and social workers are providing remote consultations and telehealth treatment or children, teens, young adults, and parents.

Please give us a call at 212.308.3118 or email appointments@childmind.org to discuss how we can support your patients during this time. You can also find additional resources for your patients at childmind.org/coronavirus

We have many other mental health telemedicine resources for you if you feel either you or yourself need additional support right now.  Please just give the office a call.

People magazine article on why we should continue to do well exams:

https://people.com/health/pediatricians-want-parents-to-keep-childrens-vaccination-appointments-amid-coronavirus/

4/20/20 - Important Updates and Resources

At Happy and Healthy Pediatrics our ultimate goal is DOING GOOD MEDICINE AND TAKING EXCELLENT CARE OF YOUR CHILDREN!!!!  We are very concerned about the misuse of the telemedicine and the over prescribing of unnecessary antibiotics and other medications. We plan to use the telemedicine platform for sick visits (colds, seasonal allergies, pink eye, etc.) to start with.  If the physician who sees your child via telemedicine feels that your child needs to be seen in person by one of our physicians for a more complete physical exam or additional testing, then they will recommend you make an appointment with one of us who is in the office.  If the physician who does the telemedicine visit does ask you to make an appointment in our office, YOU WILL NOT BE BILLED TWICE FOR THE VISIT.

Important tips to make the visit as productive as possible:

·         Weigh your child if possible

·         Check in 15 minutes before scheduled appointment

·         Please make sure you are in an area that has good lighting

·         Make sure your child be present for the visit (not napping or in the other room, etc)

·         Make sure not to have other applications running on WIFI at the same time (streaming movies, etc.). 

·         Take videos ahead of time (especially if concerned about certain behaviors or movements)

·         Attach additional photos- especially for rashes and injuries.

·         Check your child’s temperature

·         Check your child’s heart rate or pulse (there is an app called pulse oximeter that you can download for $4.99 onto your phone that easily takes a pulse ox  and heart rate)

·         Check your child’s respiratory rate (count the breaths per minute)

·         Write down all of the medicines your child has been taking-and have them with you if possible.

·         Write down all of your child’s symptoms, including how long they have had them and if they are getting better or worse

·         Write down how your child’s symptoms are affecting their eating, sleeping, and other activities, for example, are they drinking fluids, playful, consolable, or are they just crying all of the time?

·         Write down any questions you have, as you might forget them during the telemedicine visit!

·         Make sure you have a flashlight handy in case your provider wants to take a look at your child’s throat. Maybe even practice having them open wide before the visit

·         Choose the right place and the right time (try not to pick the child’s usual nap time or meal time if possible

·         Have some toys handy to distract and occupy your child

·         Have a second set of hands available especially with younger children

4/6/20 - Important Updates and Resources

Telemedicine:

Telemedicine is working very well.  We are able to see and treat so many issues and concerns virtually.  If you have a concern about your child or family, call our office.  We will route you to the appropriate resources, whether online or with one of our providers.  We are here and want to take care of your families!

Telemedicine is NOW AVAILABLE ON SATURDAYS FROM 9:00 – 11:30 am

It is EASY – just download the Anytimepediatrics App and use practice code 5910.  You can also visit our website happyandhealthypediatrics.com and click on the anytime pediatrics link.

Important – you MUST call the office to schedule your appointment.  If you just try to schedule yourself online, you will not be seen.  An appointment must be made by our receptionists. 

Resources:

We are committed to providing various resources to best support your families:

Sesame Street video on talking with your kids about a health crisis

https://sesamestreetincommunities.org/topics/health-emergencies/?utm_source=SS.org%20Caring%20for%20Each%20Other%20Page%20links&utm_medium=Link&utm_campaign=Caring%20for%20Each%20Other

Live Zoom with Elmo!

https://people.com/tv/sesame-street-elmo-to-host-virtual-play-date-to-bring-comfort-to-kids-amid-coronavirus-pandemic/?xid=socialflow_facebook_peoplemag&utm_medium=social&utm_source=facebook.com&utm_campaign=peoplemag&fbclid=IwAR0x5eu8C6UJFL4y8PFT-v0GGz2rbxp5-i8zm2F3DZeM_aJf4ajF2c_-aBQ

Allied Pediatrics and Straus Allergy Associates has put together a live meeting for parents on several topics.  While we are not hosting, this could provide some terrific information. Please see below.

You’re invited to virtually attend “COVID-19 and your kids: What you need to know from your trusted health experts”  This virtual event is intended for all parents who are interested in hearing from highly respected child health experts from across the nation discuss the current pandemic.

Date: Tuesday, April 14, 2020
Time: 8:00pm
 Title: COVID-19 and your kids: What you need to know from your trusted health experts
 Meeting Location: Zoom Webinar https://bit.ly/2y6oX7v

Speakers:
Dr. Kerry Fierstein, Pediatrician at Allied Physicians Group, NY
Dr. Susan Sirota, Pediatrician at PediaTrust in Chicago, IL
Dr. Raphael Strauss, Allergist at Allied Physicians Group, NY
Dr. Patrick Hynes, Pediatrician at One Pediatrics in Louisville, KY
Dr. Shauna Freedman, Child Psychologist at PediaTrust, Chicago, IL

Topics that will be discussed:
Talking to Your Children about Quarantine and Social Distancing for COVID-19, Dr. Patrick Hynes
Allergies, Asthma and Immunologic Concerns During the COVID19 Pandemic, Dr. Raphael Strauss
Addressing the Mental Health Needs of Children and Adolescents During COVID-19, Dr. Shauna Freedman
Using Telemedicine for sick and well visits, Dr. Kerry Fierstein and Dr. Susan Sirota

We ask that all parents click https://bit.ly/2y6oX7v and register. Please enter any questions you may have during registration.
If you do not have any questions prior to the discussion, no worries, the physicians will be taking questions at the end!

4/6/20 - Well Visit Safety Precautions

We are receiving some questions about how we are ensuring your safety during well exams. We have and are continuing to take extreme precautions to keep you, your families, and ourselves safe from the Coronavirus.

Our concern is that we don’t want children falling behind on their vaccines and normal preventative visits.The last thing we need is to create a vaccine preventable epidemic among all of this.We want to follow the American Academy of Pediatrics and the CDC as closely as we can.
 

• All patients are asked to wait in their car until the nurse is ready to bring you back into a clean room.

• All parents and children over 2 years old must wear face covering.

• Currently 2 rooms on one side of the building (near the feeding room-rooms 1 and 2) are only reserved for newborn and weigh t checks of babies less than 1 month of age.

• One full hallway of exam rooms is being dedicated to only well exams for children over the age of 1 month of age.  No sick children ever enter those rooms.

• One nurse per day will be dedicated to only rooming sick children.  One-two nurses per day will be assigned to only work up the well children.

• All sick visits with fever and/or cough are being seen only in our dedicated space (what ironically used to be our “wellness center”) which is completely blocked off from the rest of the office and even has a separate entrance. 

• Most sick visits we are going to try to push to telemedicine when appropriate to try to avoid all sick children from being in our office as much as possible.

• We are asking only one WELL adult accompany the child during their well exam, and all siblings be left at home when possible. 

• All staff wearing N-95 masks and eye shields and are washing their hands before and after every well visit.   For any sick visits seen in the “wellness center” we are also wearing gowns and gloves.  Each staff member has separate protective masks they use while seeing sick and well visits.

• All rooms and common space are being thoroughly and routinely sanitized with hospital grade disinfectant.  We have also significantly increased the frequency of cleaning crews for complete office cleaning and sanitizing.

• And ALL patients are screened (sick and well) PRIOR to entering the office for known contact with a confirmed case or travel exposure and do not enter if increased risk.

• If you prefer, and really want to limit the amount of time spent in the office, then the nurse will measure your child and the MD will examine them and counsel on any vaccines being given, any vaccines or blood work can be performed, we can do a scheduled telemedicine visit afterward to discuss all concerns, discuss growth, do developmental screenings and ask all pertinent questions.

4/2/20 - Natural Remedies to Boost the Immune System

Please read the enclosed PDF document from Dr. Rubin regarding natural remedies to boost the immune system

Natural Remedies to Boost the Immune System

3/31/20 - TELEMEDICINE - IMPORTANT INFORMATION

Important Updates to Telemedicine

Yesterday we launched Telemedicine in the office.  While this is very successful, there are a couple of items that we want to address to help this continue to work well:

1.       YOU MUST CALL THE OFFICE TO SCHEDULE YOUR APPOINTMENT.  You do have to register and create your appointment online, however, to get a time slot and arrange to be seen, you need to call the office to schedule

2.       Make sure you have the latest version of the anytime pediatrics APP.  They are updating frequently.  Please continue check to see if there are any updates and if so, install.  This can cause delays and glitches.

3.       REGISTER REGISTER REGISTER!  Even if you do not need an appointment now, we are encouraging everyone to register so it is easier once you need that appointment.

We are continuing to expand our virtual offerings to families.  Please visit our site http://www.happyandhealthypediatrics.com/virtual-family-classes  for a complete list of classes, days and times.  Some are simply for fun, some are typically paid sessions by experts in the field.  Take advantage of these offerings to provide variety and activity for your kids and some self-care for YOU!  So far we have:

3/30/20 - TELEMEDICINE - IMPORTANT INFORMATION!!!

Our telemedicine should be up and running by today.  We know the importance of telemedicine, especially during this pandemic.  But at Happy and Healthy Pediatrics our ultimate goal is DOING GOOD MEDICINE AND TAKING EXCELLENT CARE OF YOUR CHILDREN!!!!  We are very concerned about the misuse of the telemedicine and the over prescribing of unnecessary antibiotics and other medications. We plan to use the telemedicine platform for sick visits (colds, seasonal allergies, pink eye, etc.) to start with.  If the physician who sees your child via telemedicine feels that your child needs to be seen in person by one of our physicians for a more complete physical exam or additional testing, then they will recommend you make an appointment with one of us who is in the office.  If the physician who does the telemedicine visit does ask you to make an appointment in our office, YOU WILL NOT BE BILLED TWICE FOR THE VISIT.

 AS OF RIGHT NOW, all telemedicine visits will be available Monday-Thursday 9am-4:30 pm and Fridays 9am-3:30pm).  This may be subject to change, but we are all just trying our best to figure all of this out and meet the needs of our families.  TELEMEDICINE WILL NOT BE AVAILABLE CURRENTLY ON WEEKENDS OR AFTER HOURS (AFTER 5 pm).  After the office is closed, a physicians is available for Urgent matters as always by phone.  

If you do have a telemedicine visit with us, please expect that your child be present for the visit (not napping or in the other room, etc) and you can attach additional photos to the platform if needed.  Please make sure you are in an area that has good lighting and make sure not to have other applications running on WIFI at the same time (streaming movies, etc.). 

It can also help if, just before the visit, you:

·         Weigh your child

·         Check your child’s temperature

·         Check your child’s heart rate or pulse

·         Check your child’s respiratory rate (count the breaths per minute)

·         Write down all of the medicines your child has been taking

·         Write down all of your child’s symptoms, including how long they have had them and if they are getting better or worse

·         Write down how your child’s symptoms are affecting their eating, sleeping, and other activities, for example, are they drinking fluids, playful, consolable, or are they just crying all of the time?

·         Write down any questions you have, as you might forget them during the telemedicine visit!

·         Make sure you have a flashlight handy in case your provider wants to take a look at your child’s throat. Maybe even practice having them open wide before the visit.

EXTREMELY IMPORTANT DETAILS ON HOW TO USE

There are a few ways to access Telemedicine:

·         The first is through a desktop or laptop. If using one of these, you MUST use CHROME as your browser (it will not work with explorer, safari or any other browser) and MUST have a camera, microphone and speakers.

·         The second is through the “ANYTIME PEDIATRICS” App on your smart phone or tablet.  THIS IS THE RECOMMENDED WAY!!

EVERYONE NEEDS TO REGISTER THEIR CHILDREN ASAP.  IF YOU CALL THE OFFICE BEFORE REGISTERING, WE ARE GOING TO ASK YOU TO REGISTER AND CALL US BACK.  WE CANNOT SCHEDULE ANY TELEMEDICINE VISITS UNTIL YOU ARE REGISTERED.

YOU MUST PRE-REGISTER YOUR CHILDREN – 2 WAYS TO DO THIS

·         On your computer or laptop, click this link:  https://portal.anytimepediatrics.com/login/5910 and follow all steps

·         On your mobile device – RECOMMENDED, go to your APP STORE AND DOWNLOAD THE “ANYTIME PEDIATRICS” APP.  It will walk you through the registration.  **IMPORTANT** IT WILL ASK YOU FOR A PRACTICE CODE – THIS IS 5910. This links you to our practice.

HOW TO SCHEDULE YOUR APPOINTMENT

Once you have registered, if you would like to schedule an appointment, please call the office as usual.  The receptionist will schedule the appointment based on availability as usual and let you know your time.  Log into the Anytime Pediatrics App 10 minutes prior to your appointment.  You will be notified once your physician arrives

BILLING

Telemedicine visits are billed EXACTLY THE SAME as a regular visit.  It is up to your insurance carrier as to whether or not they will cover.  Based on the current landscape, we have been told that most insurance carriers are covering.  A couple of important notes, please read carefully:

·         If your insurance DOES COVER YOUR VISIT - All co-pays, co-insurances and deductibles apply just as they would for a standard visit.  If your visit has a patient responsibility portion, you will be responsible, JUST AS YOU WOULD FOR A TRADITIONAL VISIT.

·         If your insurance DOES NOT COVER YOUR VISIT -  if your insurance carrier does not cover your visit, the maximum that we charge for a telemedicine visit that is not covered is $100.00

**Please note, some deductibles can come back higher than $100.00 depending on the insurance plan.  As per our contracts with the insurance carriers, we are obligated to collect the amount that THEY determine for the visit.  If they determine that a visit goes to patient responsibility, we must collect that amount.**

COVID-19 Update 3/26/2020 - Important Updates – PLEASE READ

• No Shows – We are committed to continue to care for you and your families for ALL needs.  We are all working so hard to do so.  We are seeing a number of people NO SHOW to appointments without calling or cancelling first.  This takes valuable time away from those who desperately need the visits.  If you cannot make your scheduled appointment CALL and let us know.  We are going to have to take significant action if this continues.

• Telemedicine should be operational by the end of the week!  Stay tuned

• Our FREE online program for families is underway.  We are going to try to pilot a class today at 3:00.  Full calendar on its way. Stay tuned for more!

• 
  A note from Dr. Rubin regarding managing our stress through this pandemic.
  You guys have to remember, I’m right there with you.  I have generalized anxiety disorder and I have always been very open about that with my patients.  Yesterday one of my nurses who I have worked with for years said to me “thank God this happened now and not 7-8 years ago. We would have had to scrape you off of the floor.  You would never have been able to cope with all of this”.  And as much as I hate to think that is how my staff had perceived me in the past, I know she is right and I am so grateful for my mindfulness practice which helped me make change. 
  
  I have moments where the fear is overwhelming. I feel it seeping out of every pore of my skin.  My chest feels tight.  It feels hard to breath.  My mind races.  I think to myself “I should be stronger than this, I shouldn’t be feeling this afraid”.  And then I remembered something Cory Muscara had taught me in the past.  I was creating suffering for myself by resisting the fear.  I was gripping against it.  It was my resistance to my emotions that was hurting me.  So instead I decided to surrender to it.  For now, this is our new way of life.  It won’t be forever, but I don’t have enough energy left to resist.  Fear is going to be walking beside us for quite a while.  I rather hold its hand than to spend what little energy I have left pushing it away.
  
  We are all afraid-just surrender to it.  Don’t grip at it.  Don’t resist it.  Just let it be there.  We will all get through this together.  Check out Cory’s podcast number 75 “The moment before letting go” and this will make more sense to you. https://podcasts.apple.com/us/podcast/practicing-human/id1299444208

COVID-19 Update 3/25/2020 - Important Updates – PLEASE READ

·         No Shows – We are committed to continue to care for you and your families for ALL needs.  We are all working so hard to do so.  We are seeing a number of people NO SHOW to appointments without calling or cancelling first.  This takes valuable time away from those who desperately need the visits.  If you cannot make your scheduled appointment CALL and let us know.  We are going to have to take significant action if this continues.

·         Telemedicine should be operational by the end of the week!  Stay tuned

·         Our FREE online program for families is underway.  We are going to try to pilot a class today at 3:00.  Full calendar on its way. Stay tuned for more!

A note from Dr. Rubin regarding managing our stress through this pandemic.

You guys have to remember, I’m right there with you.  I have generalized anxiety disorder and I have always been very open about that with my patients.  Yesterday one of my nurses who I have worked with for years said to me “thank God this happened now and not 7-8 years ago. We would have had to scrape you off of the floor.  You would never have been able to cope with all of this”.  And as much as I hate to think that is how my staff had perceived me in the past, I know she is right and I am so grateful for my mindfulness practice which helped me make change. 

I have moments where the fear is overwhelming. I feel it seeping out of every pore of my skin.  My chest feels tight.  It feels hard to breath.  My mind races.  I think to myself “I should be stronger than this, I shouldn’t be feeling this afraid”.  And then I remembered something Cory Muscara had taught me in the past.  I was creating suffering for myself by resisting the fear.  I was gripping against it.  It was my resistance to my emotions that was hurting me.  So instead I decided to surrender to it.  For now, this is our new way of life.  It won’t be forever, but I don’t have enough energy left to resist.  Fear is going to be walking beside us for quite a while.  I rather hold its hand than to spend what little energy I have left pushing it away.

We are all afraid-just surrender to it.  Don’t grip at it.  Don’t resist it.  Just let it be there.  We will all get through this together.  Check out Cory’s podcast number 75 “The moment before letting go” and this will make more sense to you. https://podcasts.apple.com/us/podcast/practicing-human/id1299444208

COVID-19 Update 3/25/2020 - Important Updates – PLEASE READ

First of all, we want to thank our community so much for coming forward and donating supplies.  Due to family donations we got the N-95 masks we really needed to protect ourselves in addition to sanitizing wipes, gloves, etc.  Thank you all so much for helping to take care of us.  We so sincerely appreciate it!

We are working hard to get a full schedule of the mindfulness classes, yoga, and exercise classes up and running by next week.  We will keep you posted as it becomes finalized.  We want this to be a very fluid process.  Please tell us what works and what doesn’t work and we will adjust accordingly. 

Today I want to provide a kind of reality check.  I am seeing several parents getting to the point of panic.  Several of us are getting beyond concern and worry. I totally get it, but I want to try to get you to see another perspective.  Kids are the least affected by this virus.  Pediatric doctors in our local hospitals are being asked to help on the adult side since they are not seeing the pediatric population being hit by this virus.  Our recommendation for a child with a fever and /or cold like symptoms have stayed the same. 

·         Make them comfortable. 

·         Make sure they are not getting dehydrated (make sure they are urinating at least every 6 hours even if less than usual). 

·         Make sure they are not miserable. 

·         Monitor them for any signs of respiratory distress or trouble breathing (wheezing, having very noisy breathing, or breathing faster or harder than usual). 

If you are concerned for your child based on the symptoms above, of course we are here for you.  The point is simply, not to panic regarding a diagnosis, or potential diagnosis.  Even in patients with COVID-19, nothing is being done unless symptoms become severe.  Labeling the virus at this point is not significant, especially since we are already isolated and the testing is not readily available.

The flu is MUCH MORE LIKELY to cause these complications in kids than the Coronavirus.   And the flu definitely has a much higher mortality rate for children in this country than the Coronavirus.  Our children are going to be ok.  We will get through this.  We just need to come together and lean on (figuratively of course, practicing social distancing, lol) one another for support.

COVID-19 Update 3/24/2020 - Important Updates – PLEASE READ

Happy Tuesday everyone.  So a few updates.

Children with asthma: As of now Covid-19 has not been significantly affecting children and there does not seem to be any additional risk to kids even if they have a history of asthma.  The recommendation for all asthmatics is to continue on your typical maintenance medications of inhaled steroids and to have rescue medications (albuterol) available if needed.  If any of you need refills on any of these medications, please call our office and we are happy to help you.

Starting next week March 30, we are reducing our hours to 8:30am-5pm.  Consolidated hours will help us provide tight care and expand our cleaning and maintenance protocols.  For the remainder of this week we will continue our typical normal hours of 8:30-7pm Mon-Thursday, Friday 8:30am-4pm.  Saturday hours of 9-12 will remain the same.

We are trying very hard to get telemedicine up and running hopefully by next week.  This will be a terrific resource through this to ensure we can still safely care for you and your families.  More to come

We are in the process of creating free resources for you that you can watch at home via ZOOM.  If all goes as planned, we will have:

·         A mental health professional who specializes in mindfulness for adults who will be doing some workshops in the evenings when the kiddos are asleep. 

·         We have a mental health professional who specializes in mindfulness for kids who is going to do some workshops for the kids during the day. 

·         A yoga teacher who works with kids, adults and does family yoga who is going to do some virtual classes. 

·         Exercise classes for the kids to burn some energy at about that 3pm time when they are usually done with their schoolwork and have that energy that needs to be burned off.  Those are going to be taught by Kelly (my nanny) and my kids Ava and Sarah.  They have created exercise moves all based on Disney characters to make it more fun and relate able to the kids.  They are super excited to get started-we will keep you posted. 

Part of our evil master plan is not only to get you the resources we all need to get through this cray time, but also to give the parents a break while the kids are engaged for 30 minutes in an activity that could really benefit them. 

COVID-19 Update 3/23/2020 - Important Updates – PLEASE READ

Happy Monday! Please see below for important updates regarding COVID 19 and steps that we are taking:

Testing for the Coronavirus is again, in extremely short supply. Because of the extremely high volume of testing and urgent nature for certain high-risk patient populations, there have been tight restrictions placed on who can get a test. The current guidance that we have received is that unless it will cause a significant change in medical management of the patient, people should not be getting tested. This is to ensure that the ones who truly need it (those hospitalized and at extreme risk) have access.

Thank God in pediatrics we are the least affected by this virus. Kids are constantly getting colds and fevers and they recover beautifully in a few days with supportive care. THIS IS NO DIFFERENT NOW THAN EVER BEFORE! The only difference is this feels different to all of us. We feel scared and panicked. If your child shows signs of respiratory distress, is miserable, or is acting very sick, then please call us for an appt. If not, then just treat the symptoms at home to keep the child comfortable as you would with any other cold. The important part of all of this is to manage our own anxiety. The kids will recover no matter what virus it is. Naming the virus is not going to change that. And right now, very sick hospitalized adults need the testing more than we do. Please hang in there. We are here to support you. We are already isolating and there is not specific treatment. Keep your families safe, inside and isolated.

• Don’t go to Emergency Rooms or Urgent Care Canters – this goes for adults too (unless you have severe symptoms or any signs of respiratory distress).
• Treat symptoms with Tylenol as per dosing recommendations on our website http://www.happyandhealthypediatrics.com/parent-resources lots of fluids, honey (for kids > 1 years of age), and rest (please refer to our cold/cough handout linked to our website).
• Don’t forget, we are also about to hit the seasonal allergy season. If you child has cough/congestion and no fever, try some children’s Zyrtec first to see if it makes a difference. Dosing is for children 6 months-2 years=2.5 ml per day. Ages 2-6 years=5 ml per day. Ages 6 and above=10 ml per day. Children’s Zyrtec is over the counter.

We are continuing with check-ups as this is a very important component of care, ESPECIALLY for well visits that include vaccines as per AAP guidelines. We do not want our hesitation based on COVID-19 to potentially spark another epidemic. In order to reduce exposure, when coming to the office we are asking (unless it is not possible) ONLY ONE HEALTHY PARENT BRING THE CHILD.

Just like much of the community, we are on a very short supply of PPE (Personal Protective Equipment). If anyone has access to ANYTHING, N95 masks, regular facemasks, gowns, please let us know. We will gladly pay for them and be eternally grateful!

COVID-19 Update 3/19/2020 - Important Updates – PLEASE READ

One thing I have been thinking about a lot these past few days is just how freaking awesome kids are.  Especially as I watch my Abigail (who is 2 ½ years old) playing and jumping and singing without a care in the world.  Kids are the best version of us.  They are the epitome of mindfulness.   They are not caring about the previous moment.  They are not worrying about future moments.  They are just living.  So many of the resources we have been and will continue to provide to you help in the way we role model resilience to our children.   But don’t forget, they are also our role models.  Breathe in their joy, their light-heartedness, their freedom from worry.  In so many ways, they are role modeling to us resilience.  I can understand the many frustrations that come from being home with your kids all day-trying to balance working from home and their mandatory school work.  I get it, I do.  But also let some of their innocence be contagious.  Let their joy seep into your pores.  Breathe their positive energy into your lungs.  Hold them close.  Give yourself the permission to not feel fear or worry even just for a few moments.  We are all going to be okay. 

-Dr. Rubin

Now for our updates for 3/19/20.

·         Initial guidance for Coronavirus inquiries and issues has been to call the NYS Coronavirus Hotline.  They are inundated with calls and wait times and access can be challenging.  We received word that there is now a Nassau County Coronavirus Hotline with easier access (516) 227-9570.  We are recommending using this as a first line for improved access.

·         We are seeing a number of parents calling for appointments for children with developing fevers and symptoms of illness as soon as the symptoms begin.  WE TOTALLY UNDERSTAND WHY YOU ARE CALLING.  Under normal circumstances we would say to bring them in.  FOR THE TIME BEING, we are asking that you do not bring your kids in until there is fever or symptoms for at least 12-24 hours.

o    Rapid testing is less effective with new onset of fevers/illness.  Very often, the illness will not be able to be detected yet and can lead to incorrect diagnosis.  Typically, we send testing to the lab for confirmation (strep, respiratory panels etc.) and receive results in 1-2 days.  Because of the backlog in the labs, we are often not seeing results for up to 5 or 6 days.  If you wait until 24 hours (or closer to it) we can get more accurate testing.

o    Guidance is to stay home as much as possible to protect yourselves.  If in fact a simple virus, better to isolate.

·         This is just general guidance.  If you are concerned about your child’s health, regardless of how long they have been sick, call us and we will see you.  We are simply working to protect you as much as possible AND provide accurate treatment.

·         There is a lot of talk about the impact of Ibuprofen on COVID-19.  Some experts are telling us that it makes the condition worse, and some are saying that there is no negative impact.  There is not good consistent information at this point.  That said, we are staying with our guidance from yesterday.  We will continue to update you as more information develops and let you know of any changes.

·         We are in the process of getting Telemedicine up and running in the office.  This is going to be a last resort measure, however, we are implementing EVERYTHING at our disposal to ensure we can continue to care for you and your children, no matter the circumstances.  Telemedicine is not a substitute for traditional care, however, may become necessary.  More to come.

·         Supporting our children IS CRITICAL at this time.  We are constantly researching resources for family support.  Please take a look at the enclosed link from the child mind institute.  Our children are going to remember this, and how we respond.  The enclosed article has some terrific points on supporting your family and maintaining a healthy emotional environment. https://childmind.org/article/supporting-kids-during-the-covid-19-crisis/?utm_source=newsletter&utm_medium=email&utm_content=%20Parents%20Guide%20to%20Problem%20Behavior&utm_campaign=Weekly-03-16-20

·         As always, here is the link to Cory Muscara’s awesome podcast – helps us daily!  https://podcasts.apple.com/us/podcast/practicing-human/id1299444208

More to come…

COVID-19 Update 3/18/2020 - Important Updates – PLEASE READ

Good Morning All!  As this all continues to evolve, we are going to continue to provide regular updates as to how we are going to continue to care for your children and families and work to keep everyone safe!  There is a lot of important AND CLINICAL information in this e-mail, so please read.

Starting on a positive note, we are SO lucky to have found our newest physician Rachael Bilello.  She has a terrific blog and just wrote a wonderful article on managing your families through this.  Please take a moment and read the blog – it’s terrific!  https://doctormom.blog/2020/03/17/covid-19-how-to-keep-our-kids-calm-informed-and-worry-free/

·         All staff members from now on are going to be wearing gloves and face masks with eye protection during all patient encounters.  This includes our secretaries, nurses and physicians even during well exams and newborn visits.  This was a hard decision to make, and we acknowledge that it is very off-putting, but we need to protect ourselves.  Not because we are afraid of getting sick- as a health care provider that is part of our gig.  But god forbid we do get sick, then we cannot continue to support our community.  Our number one goal right now is to stay open and be here for the families in this practice.

·         We have made the difficult decision to no longer rounding to see newborns at NYU Winthrop Hospital at the current time.  I spoke to the head of the Department of Pediatrics at NYU Winthrop, and we mutually agree that at this time it is not appropriate for us to be entering the hospitals and putting ourselves at additional risks while they have hospitalists stationed only to the newborn nurseries who can see all of the babies.  We do expect to resume rounding on newborns once things settle down. If  any of you are planning to be delivering at Winthrop over the next couple of weeks please expect to be seen by the newborn hospitalist and call us as soon as you know when the baby is going to be discharged and we will see you in the office the following day. 

·         I have seen a lot of articles online about not giving kids ibuprofen or steroids to kids as it could make Covid-19 symptoms worse if they are infected.  Most of these articles have been coming out of France.  I have spoken to the Department of Health, a pediatric allergist/pulmonary specialist whom I really trust and an Infectious disease specialist in our community all who do not think this is substantiated.  As of now Covid-19 has not been effecting children and there does not seem to be any additional risk to kids even if they have a history of asthma.  The recommendation for all asthmatics is to continue on your typical maintenance medications even though they are inhaled steroids.  Those articles are talking about oral steroids, not inhaled anyway.

·         As far as the ibuprofen and acetaminophen goes, I do think overall we are grossly overusing these medications.  FEVER IS A GOOD THING-IT IS HOW WE FIGHT INFECTION. GOD CREATED IT FOR A REASON, BUT IT FILLS EVERYONE WITH SO MUCH FEAR AND PANIC.  WE NEVER RECOMMEND TREATING A NUMBER.  WE RECOMMEND TREATING THE CHILD.  IF A CHILD HAS 105F FEVER, BUT IS HAPPY AND PLAYFUL, YOU DON’T NEED TO DO ANYTHING.  THE PURPOSE OF THE IBUPROFEN OR TYLENOL IS TO MAKE THE CHILD COMFORTABLE WHILE THEY HAVE THE FEVER, NOT TO LOWER THE NUMBER.  If a child is miserable and not drinking enough because of them feeling so crappy then yes, please give ibuprofen or acetaminophen for comfort.  We don’t want our kids to be miserable and/or dehydrate.  But if they are ok, leave them alone.   Let nature be.  There is no absolute number in a child that is worrisome.  101F is the same as 105F.  Children do not get seizures from high fevers-if a child is predisposed to febrile seizures (which usually runs in families) then they can get a seizure from any rapid change in temperature-even from 99F-100F.  If a child is predisposed there is nothing to do to predict it or prevent it.  Giving Ibuprofen or acetaminophen is not going to change that possibility. 

I like to think that over the years I have provided you guys some good recommendations and insights.  Listening to Cory Muscara’s podcast is probably the best advice I have ever given to any of you.  Please listen, stay grounded, and know you are not alone.  We will all get through this together.

COVID-19 Update 3/17/2020 - Important Updates – PLEASE READ

We want to keep you guys as updated as possible since things are changing so quickly.   Please read the points below on how we are working to continue to provide care and keep you and your families safe through this.

·         We are still NOT testing for COVID-19.  There are more and more testing sites available.  We will let you know if this changes

·         Our split office worked perfectly.  There was fantastic isolation of sick and well children and families.  Please refer to our communication yesterday regarding our new protocols.

·         Due to staffing issues we are trying to see children with fevers and coughs between the hours of 10am-5pm.  We are not going to turn away sick children (when those times cannot be met by working parents), but if you could please try to respect these hours when making an appointment, that would really help us out.  Also, we do apologize in advance for longer wait times both for visits and phone calls being returned.  This is all a work in progress, and we are trying to work out the kinks.  We really appreciate your patience.

·         We do recognize that there are local urgent care groups that are doing telemedicine appointments.  We ourselves are looking into telemedicine platforms, but as a last resort.  It can have it’s place, however there are significant concerns. A main concern with using telemedicine is the gross over-prescribing of antibiotics.  We had two patients of ours who used the service from Urgent Care Centers over the past few days. 

o   One was “diagnosed” with strep and started on antibiotics. He did not get better after two doses of the antibiotics so mom bright him in for us to see.  He probably does not have strep and we cannot get an accurate test now for strep since the antibiotics were already started, but now this kid is committed to a full 10 day course of antibiotics potentially for no reason. 

o   Another of our patients was diagnosed with an ear infection via telemedicine and started on an antibiotic.  I saw them less than 12 hours later and his ears were normal-there is no way after one dose of antibiotic that his exam would have changed that quickly.  

·         WE ARE HERE!!!!!  Please let us do good medicine and see your child to make accurate diagnoses from the start.  I know we are all concerned about this viral illness, but we don’t want to create bacterial resistance either as a side effect!!!!   Don’t go to urgent cares and ER’s.  Call us first!!! We will guide you.  We are your medical home and your community.   Lean on us-PLEASE!!!!

·         I am very concerned about the well-being of our children.  Not because of them getting Covid-19. Thank God, they are the one group least affected by this virus.  But I am worried about the emotional repercussions of how they are experiencing these very unique circumstances. While they need to learn from this (good handwashing, transmitting germs etc.) children deserve life to be Rainbows and Unicorns.  We need to manage our own anxieties and feelings so we can be the best version of ourselves as parents.  Find your self-care-cry in your car or in the shower, meditate, listen to music (all of my personal favorites).  Listen to CORY MUSCARA’s podcasts.  THEY ARE AMAZING.  THEY HELPED ME FEEL SO MUCH MORE GROUNDED IN THIS PROCESS.  SHARE THEM WITH YOUR LOVED ONES.  WE WILL GET THROUGH THIS TOGETHER.   LET’S RISE UP SO OUR CHILDREN CAN THRIVE AND FLOURISH IN THESE HARD TIMES.  

Please continue to stay tuned for more important announcements

COVID-19 Update 3/16/2020 - Important Updates – PLEASE READ

Wow.  Who knew the world was going to turn this way, but here we are.  Everyone here at Happy and Healthy Pediatrics is doing our best to provide the best care for our families and our patients. 

Below are updates as to how we are working to keep you and your families safe, yet still provide medical care:

·         As of now, we ARE still open and taking ALL visits, well, sick, newborns and weight checks.  This is much needed care that needs to continue to the best of our ability.

·         We made a significant investment in disinfecting the office over the weekend and had a patented antimicrobial disinfection process over the weekend for the entire office which provides antimicrobial protection for up to 90 days.

·         We have split the office with separate entrances. We have transformed the wellness center into 4 exam rooms where we will only be seeing sick patients with fevers (they are not pretty, but they are functional).   The rest of the office will be dedicated to seeing well children and non-infectious issues such as rash, ear aches etc.   The nurses and physicians stationed in the wellness center will be wearing gowns, gloves, and protective masks to ensure our staff is kept safe and that we can continue to provide to you the best care possible.  Our ultimate goals is to limit potential exposure and prevent any patients from having to go to urgent cares or hospitals for routine sick visits.  We understand this may be a little off-putting to the children, but please prepare them in advance that we are just wearing “fancy new clothes” right now.  Again, this will only be during sick visits where the child has a fever and not for well exams.

·         We are currently not testing for COVID-19.  For any patient that meets the CDC/DOH criteria for testing of having symptoms consistent with COVID-19 and have had direct access to someone who has been infected, is under investigation or has travelled to one of the hot spots, we are referring to an appropriate facility that offers testing.  For anyone with symptoms similar to COVID-19 (fever and cough particularly), we are asking that you call when you arrive and wait in your car until you receive instructions.  We will escort you through the wellness center doors to a specific exam room to treat.  While this is not a CDC recommendation, we want to take additional measures to protect patients at all costs.

·         For now we are asking all visits, well too, to wait in your car until we call you into the office.  Please call us and let us know that you are here, and we will call you on your cell phone when the exam room is ready.  That way we have completely empty waiting rooms. 

·         If your child has a low-grade fever and cough, but is showing NO signs of respiratory distress, please try to ride this out AT HOME.  Treat the symptoms with Tylenol/Motrin as per dosing recommendations on our website http://www.happyandhealthypediatrics.com/parent-resources lots of fluids, honey (for kids > 1 years of age), and rest (please refer to our cold/cough handout linked to our website). We cannot test for Covid-19 and we have no treatment for it either.  We are happy to see all patients with worsening respiratory symptoms, ear pain or sore throat, and of course children that are miserable and acting very sick—but recommend everyone with mild symptoms to self -quarantine until resolved.

·         Don’t forget, we are also about to hit the seasonal allergy season.  If you child has cough/congestion and no fever, try some children’s Zyrtec first to see if it makes a difference.  Dosing is for children 6 months-2 years=2.5 ml per day.  Ages 2-6 years=5 ml per day.  Ages 6 and above=10 ml per day.  Children’s Zyrtec is over the counter.

·         And please remember, most young kids will remember how their family home felt during the coronavirus panic more than anything specific about the virus.  Our kids are watching us and learning about how to respond to stress and uncertainty. Let’s wire our kids for resilience, not panic.  We will get through this!!!

·         This is a dynamic and ever changing situation.  We will be sending regular updates to keep you informed

·         One final resource from our friend Cory Muscara on managing anxiety during this.  Check out the podcast https://podcasts.apple.com/us/podcast/practicing-human/id1299444208 episode 103!