Have you ever received a bill from your doctor’s office and said to yourself, “Wait a minute, why do I have a bill? I always pay my co-pay in the office”.

Insurance coverage in the 21st century can be confusing . It is not always easy to discern what you owe your doctor or why it is owed. It is often confusing for you the consumer and even at times for the doctor’s office. Some families pay their monthly premiums directly to the insurance company while others pay through their employer.

The amount owed is dependent on your employment contract.

Many years ago employers paid the entire amount of a health insurance policy however, in today’s economy, more and more employers are shifting a portion of the health care costs to their employees.

While some look at the escalating cost of medical care and point the finger of blame at doctors, and hospitals and the cost of medication, one need only look at the ever increasing profits of the insurance company to find the true culprits.

According to the New York Times in February 2012, one large national insurance company posted a 73% increase in profits.

Many American families are feeling the pinch of the ever increasing cost of healthcare. Therefore when you have paid the co-pay at the time of the office visit and you receive a bill stating you still owe money, there is disbelief. Depending on your individual insurance policy you might have a deductible before the insurance company will pay any benefits. This is typically seen in the beginning of the calendar year. Another possibility is that your insurance policy might cover a percentage of the charges leaving the balance for you to pay.

It is also possible that your policy does not cover a specific office visit or procedure and you are responsible for the payment. An example of this might be a breathing test performed in the doctor’s office. Your policy might cover this if and when given at the hospital but not at the doctor’s office. It might be a rapid strep test which is not covered. Occasionally a policy might exclude well visits or only cover one every other year.

It is your employer who has chosen what benefits to cover, not your doctor.

It is important to know the details of your individual insurance policy so that you know its limitations. Your doctor does not have this information. Once you receive a non-covered service you then take on the financial obligation for that service. So make it your business to know the details ahead of time. It will avoid a lot of pain and misunderstanding if you do.

Then when you receive a bill from your doctor, you will know not to discard it and assume it is a mistake because you know you paid your co-pay. Call the doctor’s office and discuss it.

Dr. Lander has been practicing pediatrics for 32 years in New Jersey and is the immediate past chairman of the American Academy of Pediatrics Section on Administration and Practice Management.  He says if he had to do it all over again he wouldn’t hesitate to be a pediatrician.

Photo Credit: Andrea Sproxton

F calls it our, “Seattle Vitamin.” In the upper left hand corner of the US (read:Seattle) we’re a little lacking in sunshine. It’s a product of not only our rainy weather, but our latitude on the globe. New data finds that taking supplemental vitamin D may be more important for we mamas, we city dwellers, and we little ones (infants) than we thought. Especially up here where the sunshine comes around about every fifth day.

Vitamins are so well engineered these days (gummy what?) my boys think they are a marvelous daily treat. So do I.

A study in Pediatrics finds that urban Boston moms (think Northern climate) who spent at least ½ of their pregnancy living in the city, were at far greater risk for having vitamin D deficiency than we thought. So were their babies! In this group of urban moms, up to 58% of newborns and 36% of the moms at the time of delivery were vitamin D deficient. Holy deluge of D deficiency! Say it with me…

A second study published yesterday found that we are doing a poor job getting babies the vitamin D they need. Less than 1/10 of all breast fed babies and less than 1/3 of formula fed babies are getting the vitamin D pediatricians recommend.

Something has to change.

To read Dr. Wendy Sue Swanson’s post, click on the link.

Any parent with school aged children knows that homework can be a battle. Even good students can procrastinate, prefer to play, or have practice after school leaving little time for homework. Then there are the kids who struggle.

I think I threw my son’s middle school homeroom teacher for a loop on back to school night. She mentioned that I can always look on line to see the assignments, and I replied something to the effect of, “I don’t have homework, so I’ll never look. It is his responsibility to know what is due.” I am not an absent parent.

I do ask about his day, what he’s doing in class, and what his plans are with friends. He knows I care because I show interest in him, but I don’t micro-manage his day. I do not want to be the parent responsible for the college kid who fails because Mommy can’t manage his schedule.

Of course, I know my son and he’s self motivated and capable of keeping track of assignments. Another child might need more help, but at this age I would recommend covertly looking at the assignments and guiding with questions and looking for the student to offer solutions and plans to get the work done.

How can you help your kids with homework without letting it become your problem?

I am a firm believer that kids are the students, not the parents. Kids need to take ownership of their homework and all other aspects of school. Of course, for many kids this is easier said than done, but I hear all too often of college kids who have Mommy call the Professor to question a grade. That is totally unacceptable. Kids need to practice ownership from early on. Parents need to guide always, but manage less and less as the kids grow.

Not every solution comes from a cookie cutter mold. Kids have different personalities and abilities. You know your kids best. Think how they work and what makes them tick.

Many parents underestimate the problem with missing out on basics: sleep, nutrition, and exercise. If kids don’t get the amount of sleep they need, healthy foods, and regular exercise, they will not be as successful academically. I have blogged on this previously, and really feel that finding balance is important for everyone.

Kids have different problems with homework at different times, and they each deserve their own solutions. Not one of these “types” fits every child perfectly. Most kids have more than one of these qualities, but tend to fit into one type best.

Procrastination:

There is always something more fun to do than work. Kids will put off overwhelming tasks or big projects because, well, there’s a lot to do.

Ask not only what homework they have for tomorrow, but if there are any big projects due in the future. See if they can estimate how much time it will take to do the project and help them plan how much to do each night to get it done on time.

Breaking big assignments or long worksheets into small pieces with short breaks in between can help kids focus. Use a timer for breaks or do a fun quick activity, like silly dance to one song.

Allow kids to have some “down” time after school for a healthy snack (brain food) and to run off energy. Limit this time with a timer to 30 minutes or so. The timer helps kids know there is an end point to the fun, and then it’s time for work. Play can resume when work is done correctly.

Poor Self Confidence:

Kids who are afraid they won’t understand their homework might fear even starting. They blame the teacher for not teaching it correctly. They might complain that they are stupid or everyone else is smarter. They blame the class for being too loud, causing distraction and therefore more homework. They might complain of chronic headaches or belly aches.

Be sure to praise when kids do things right and when they give a good try. Be honest, but try to think of something positive to tell them each day. When they don’t meet expectations, first see if they can see the mistake and find a solution themselves. Guide without giving the solution. Then praise the effort!

Find their strengths and allow them to follow those. If they are poor in math but love art, keep art materials at home and display their projects with pride. Consider an art class. Remember to budget time. Over scheduling can result in anxiety, contributing to the problems.

Perfectionist:

While the desire to do everything right has it’s benefits, it can cause a lot of anxiety in kids. These kids think through things so much that they can’t complete the task. See also the “poor self confidence” section above, because these kids are at risk for feeling they are failures if they don’t get a 100% on everything. They can have melt downs if the directions don’t make sense or if they have a lot of work to do.

Help your child learn organizational techniques, such as write down assignments and estimate time to do each project. Plan how much time to spend each day on big projects and limit to that time. Help them review their progress in the middle of big projects to see if they are on track. If not, have them establish another calendar and learn to review why they are behind. (No self-blame. Is it because one step took longer than projected, they were invited to a movie and skipped a day, they got sick and were not able to work… This helps plan the next project and builds on planning skills.

Remember to give attention and praise for just being your kid. These kids feel pressure to succeed, but they need to remember that they are loved unconditionally.

If you notice they have an incorrect answer, state “that isn’t quite right. Is there another way to approach the problem?”

Not everything is about the grade. Praise the effort they put into all they do, not the end point. Make positive comments on other attributes: a funny thing they said, how they helped a younger child, how they showed concern for someone who was hurt.

Encourage them to try something new that is outside their talent. Not only are they exploring life, but they are developing new skills, and learning to be humble if they aren’t the best at this activity. Help them praise others. Model this behavior in your own life.

Co-dependence:

Helicopter parenting is a term often used to describe the parent hovering over the child in everything they do. This does not allow a child to learn from failing. It does not allow a child to grow into independence. It allows the parent to “own” the problem of homework. These kids call home when they leave the homework or lunch on the kitchen table for Mommy to bring it to school. These kids grow up blaming everyone when things don’t go their way and Mommy can’t fix it. They don’t learn to stand up for themselves. They seem constantly immature with life situations.

Young children need more guidance, but gradually decrease this as they get older. Teachers can help guide you on age appropriate needs. Most parents must sign a planner of younger kids, but as kids get older the kids become more responsible for knowing what the homework is. Many schools now have websites that parents can check homework assignments, but be sure the kids own the task of knowing what is due too.

Have a place that children can work on homework without distraction (tv, kids playing, etc).

Be available to answer questions, but don’t do the work for them. If they need help, find another way to ask the question that might help them see the solution. Get a piece of scrap paper that they can try to work through the problem. If they have problems with reading comprehension, have them read a few lines then summarize to you what they read. They can take notes on their summary, then read the notes after the entire chapter to get a full summary.

Busy, busy, busy:

Some kids are really busy with after school activities, others just rush through homework to get it done so they can play.

Set limits on how much screen time (tv, video games, computer time) kids can have each week day and week end. A maximum of 10 hours per week of screen time is recommended by experts. If they know they can’t watch more than 30 minutes of tv, they are less likely to rush through homework to get to the tv.

Ask kids to double check their work and then give to you to double check if you know they make careless mistakes. Don’t correct the mistakes, but kindly point them out and ask if they can find a better answer. Once they learn that they have to sit at the homework station until all the work is done correctly, they might not be so quick to rush.

If kids have after school activities the time allowed for home work and down time are affected. Avoid over scheduling, especially in elementary school. Be sure they have time for homework, sleep, healthy meals, and free time in addition to their activities. Are the activities really so important that they should interfere with the basic needs of the child? Is the child mature enough to handle the work load?

Kids who are in constant motion can’t seem to sit still long enough to do homework. Be sure they have the proper balance of sleep, nutrition, and exercise or all else will fail. Praise their efforts when they are successful. Set a timer after school to let them play hard for 30 minutes, but then make them sit. Help little ones organize what needs to be done and break homework into several smaller jobs. Set regular 5 minute breaks every 30 minutes so they can release energy. Set a timer to remind them to get back to work and compliment them when they get back on task.

Struggling despite help:

There are many reasons kids struggle academically. Reasons vary, such as behavior problems, anxiety, illness, learning disabilities, bullying, and more.

If they are struggling academically, talk with the teacher to see if there are any areas that can be worked on in class or with extra help at school. Can the teacher offer suggestions for what to work on at home?

If kids have chronic pains or school avoidance, ask what is going on. Depression and anxiety aren’t obvious and can have vague symptoms that are different than adult symptoms. Bullying can lead to many consequences, and many kids suffer in silence. If your child won’t talk to you, consider a trained counselor.

Talk with your pediatrician if your child is struggling academically despite resource help at school or if he suffers from chronic headaches or tummy aches. Treating the underlying illness and ruling out medical causes of pain is important. Depression, anxiety, ADHD, and other learning disorders can be difficult to identify, but with proper diagnosis and treatment, these kids can really succeed and improve their self confidence!

Dr. Stuppy is a practicing pediatrician in Kansas. I feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.  

“The secret to feeding a healthy family is to love good food, trust yourself, and share that love and trust with your child. When the joy goes out of eating, nutrition suffers.”

The quote comes from a blog post titled Constructing Snacks into Mini-Meals on Dr. Wendy Sue Swanson’s blog, seattlemamadoc.com.

I found the article very interesting. Particularly because in our house, snacking is a bit of an issue. In fact, for my kids, snacks seem to be more important than the actual meal.

I’ve come to the conclusion that the only reason my kids eat regular meals, is because otherwise, they won’t be able to have a snack or dessert. It is like they view it as a means to and end. This is what I assume goes through their heads:

“The only way I’m gonna get the snack, is if I eat my lunch. Might as well eat the lunch, so I can get to my snack.”

And apparently, my family is the not the only one with this issue. It is a growing trend in the US.

Over the past 20 years, the amount of calories consumed by children from snacks has increased by 30%. Kids eat a third more calories everyday from snacks! What kids snack on certainly can reflect how their diet is shaped and how they grow. Plain and simple: snacks make us fatter by packing in lots of calories in relatively small bits of food, the definition of “calorie dense” foods. They also discourage our eating of things like fruit and veggies because they fill us all up. One recent study found it was our over-consumption of snacks more than our under-consumption of fruits and veggies that is getting us into trouble.

Dr. Swanson says that there has a huge shift in the way children eat and get their nutrition in the US. She highlights some examples, such as:

• The introduction of processed foods in the 1970’s transformed what we eat from fresh to packaged food
• TV advertising of snacks directed at kids increases their desire for snack foods
• The challenge for busy families to find time to sit down and eat meals together
• Watching TV during meals in households
• Ubiquitous availability (they are everywhere!) and easy access to snack foods
• It is okay to be a little hungry. Dr Grow says, “Teaching kids it’s okay to get a little bit hungry (not ravenous) and work up an appetite for a regular meal” is a healthy way to learn to eat right.
• It’s our worst fear that our kids will starve. It’s almost an instinct to offer and offer and offer food all day. Our kids won’t starve, especially if we offer 3 meals and 2 healthy snacks daily.
• Red/Orange/Yellow packaging is dangerous. These colors are known to make you hungry and eat more. Advertisers know this! Think about leading fast-food chains, junk food, candy bars and soda containers. Red/Orange/Yellow is threat level alert for high-calorie foods that often have little nutritive value.

We’ve written about snacking before on Survivor Pediatrics. In the this post, Dr. Hackell ask: with the national alarm increasing about the rate of obesity in our children (and adults as well), what message are we giving our children about eating when we provide them with a continuous stream of things entering their mouth throughout the day?

Dr. Swanson does offer a possible solution. She mentions the idea of switching the snack for a mini-meal. So, anything that we would feel comfortable eating during a normal meal, but in smaller portions.

I like this idea. Except the part about preparing yet another meal, even if it is mini. Snacks in little packages are just so convenient. But I guess I’ll give it a try and see.

To read the rest of Dr. Swason’s post, click on the link.

Two articles recently caught my eye while I was spending some time on Twitter. First, an op-ed piece was published on Time.com discussing how patients and doctors perceive the use of the online health information. The article was closely followed by the results of a recent PEW research study which stated that 80% of Americans used the internet to “prepare for or recover from” their doctor visit.

The results of the PEW study were less than surprising to me. Everyday I have a concerned mom or anxious dad refer to something they have read online.

Everyday.

And, everyday I get to learn about new articles and websites that are claiming to have reputable health information. I learn from my families who bring in articles and links, and often share the good information with other families who may be struggling with the same concerns.

As a medical doctor who regularly navigates the web, however, I did not expect nor appreciate the author’s tone in the Time.com piece. I was made to feel that all doctors were like lazy cattle, being poked with an electric switch towards a glowing computer screen.

I find that troubling as a practicing pediatrician. Although doctors have traditionally been thought of as “late-adopters,” not all of us fit that archaic mold. There are many, many doctors who are embracing e-communication of all types within their daily medical practice. And all successful doctors practice “shared clinical decision-making” with their families, regardless if the internet is a piece of the information puzzle.

How can you discuss online health information with your physician, without being labeled a “cyberchondriac?”

Here are some things to consider before you approach your provider with some internet research of your own.

Critique what you find

Commercial advertisers and agenda-based groups can be very deceiving online. Does the information have sources to original, peer-reviewed medical articles?

Who is writing the article, and what are their credentials? Who is paying for the study to be completed? Are there a lot of banner ads, or references to a certain brand of product? Does the writer of the article have financial interest in the items they recommend? Dr. Meisel did state this well, saying,

Many patients are going to discover the best online health information way before their doctors do. They, too, have a responsibility: patients will need to signal to their doctor how they conducted their search in a way that was smart, directed and grounded in evidence. Only then will the Google stack be recognized and used in a helpful, not counterproductive, fashion.

My favorite public sites for health information include:

• Is your child sick? This feature is on our practice’s website to give families some information about common childhood symptoms. The site also give some guidance about what symptoms are concerning enough to contact the on-call physician.
• www.uptodate.com This is a very well-designed site providing general information on health conditions and their treatments.
• www.healthychildren.org A website full of childhood health information developed by the American Academy of Pediatrics.
• www.cdc.gov General information on illness, vaccines, and travel concerns.
• www.vaccine.chop.edu Complete, concise vaccine information.

If your provider allows, send links and articles to your doctor before the visit

Bring a list of keywords that you searched. This allows your doctor to look over the information more critically, and hopefully more thoughtfully. If your doctor does not allow you to provide information prior to your appointment, don’t expect organized discussion about your findings in a brief appointment slot. Thinking about online information critically is a time-consuming process. Give your provider ample time to look over the information after your appointment.

Be prepared for a “no”

It may be possible, that despite your best efforts, keywords or articles you have found may have been misleading. If your physician disagrees with some online information you have found, it is very appropriate to ask, “Why?” Your provider should explain why the information may not be relevant or appropriate for your specific situation, hopefully providing alternate online references to help continue your search.

We are partners

Bring information to your provider with an attitude of partnership and shared decision-making. No one likes a confrontation. Navigating health online information is a learning process for all of us. If we don’t listen to each other, we don’t learn.

If patients and doctors can have open dialog about information found online – good and bad – we can take care of patients better. And that is more than Dr. Google could ever do alone.

Dr. Burgert is a pediatrician. She works at Pediatrics Associates in Kansas City, MO .  She is a distance runner and enjoys road races around the city. She also has a passion for travel that will certainly lead to many memorable family vacations with her husband and two children. And, of course, she bleeds Husker red. Dr. Burgert regularly blogs at kckidsdoc.com

Driving through narrow, winding roads on a wet and cold afternoon, I wonder (silently) if we are going the right way. After our second near miss of a head on collision, I speak up. “This doesn’t seem right”, I finally say, more than a little perturbed.

“I know, but the GPS says we’re almost there.”

I want to shout out about how dumb the GPS must be and that we could clearly have been there already if we had just looked out our window, used our common sense, and followed the signs. I know I don’t need to speak the obvious. He already knows what I’m thinking. I’m certain he is thinking the same thing.

Then it hits me, right there on that narrow, winding road, how much parenting advice is like this GPS. As parents we want to do things “right” by our children. We seek out advice from books, from experts, from google, and from friends. And, while that advice can be helpful and much needed at times, we have to remember that parenting advice is meant to be a guide, not a how to manual.

I’ve definitely been led astray myself when I felt compelled to do things by the book. I was certain that if I just followed the steps laid out before me, my child would be sleeping through the night, using the potty, and eating a variety of healthy foods.

In my quest for finding the “right way”, I got lost. I forgot to look at my child, use my common sense, and follow my motherly instincts. I forgot to read the signs that my child was giving me. Now, I know a little better. I know that there are many paths to take in this parenting journey. Some roads might be narrow and winding and perhaps not the best way for my child. Others may be smooth and straight, with only a few bumps along the way.

My job as mom is to figure out the best road to take for my own child. To remember to look up from my book, magazine, or computer and see the signs right in front of me. The ones that will ultimately lead me in the right direction because they are the ones given to me by my child.

Dr. Arca is a pediatrician. She works part-time while raising her two young children, Big Brother (age 6) and Little Sister (age 3). She is passionate about writing and writing about motherhood, parenting, and children’s health is what she does best. Dr. Arca blogs regularly at Confessions of a Dr. Mom

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As cold and flu season approaches, I have been thinking about how our kids are managed when they become sick. Not only what we do to treat symptoms, but how, when, and where patients get medical advice and care.

We are a busy society. We want things done now. Quickly. Cheaply. Correctly. Resolution so we can get back to life.

Illness doesn’t work that way. Most childhood illnesses are viruses and they take a few weeks to resolve. There’s no magic medicine that will make it better.

Please don’t ask for an antibiotic to prevent the runny nose from developing into a cough or ear infection.

Don’t ask for an antibiotic because your child has had a fever for 3 days and you need to go back to work.

Don’t ask for an antibiotic because your teen has a big test or tournament coming up and has an awful cough.

Antibiotics simply don’t work for viruses. They also carry risks, which are not worth taking when the antibiotic isn’t needed in the first place.

Urgent Cares are not always the best choice

Many parents in this community have grown accustomed to using after hour urgent cares because they are convenient.

Convenient isn’t always the best choice. Many times kids go to an urgent care after hours for issues that could wait and be managed during normal business hours. I know some of this is due to parents trying to avoid missing work or kids missing school, but is this needed? Can it hurt?

Some kids will get unnecessary tests, xrays, and treatments at urgent cares that don’t have a reliable means of follow up. They attempt to decrease risk often by erring with over treating. Our office does have the ability to follow up with you in the near future, so we don’t have to over treat.

Urgent cares don’t have a child’s history available.

They might choose an inappropriate antibiotic due to allergy or recent use (making that antibiotic more likely less effective). They might not recognize if your child doesn’t have certain immunizations or if they do have a chronic condition, therefore leaving your child open to illnesses not expected at their age.

We know that parents can and should tell all providers these things, but our own new patient information sheets are often erroneous when compared to the transferred records from the previous physician… parents don’t think about the wheezing history or the surgery 5 years ago every visit. It is so important to have old records!

To treat or not to treat?

There is some evidence that treating things too soon does not allow our bodies to make immunity against the germ. A great example of this is Strep throat. Years ago we would go to a doctor when our sore throat didn’t get better after a few days. They would swab our throat and send the swab for culture, which took 2 days. We would treat only after that culture was positive. That delay in treatment allowed our bodies to recognize the Strep and begin making antibodies against it.

Now kids are brought in the day they have symptoms, and if the rapid test is positive, they immediately start antibiotics. The benefit? They are less likely to spread Strep to others and they can return to school 24 hrs after starting the antibiotic. The negative? They might be more susceptible to recurrent illness with Strep, so in the end are potentially sick more often and end up missing more school.

Receiving care at multiple locations

Receiving care at multiple locations makes it difficult for the medical home to keep track of how often your child is sick. Is it time for further evaluation of immune issues? Is it time to consider ear tubes or a tonsillectomy? If we don’t have proper documentation, these issues might have a delay of recognition.

Urgent cares and ERs are not always designed for kids.

I’m not talking about cute pictures or smaller exam tables. I’m talking about the experience of the provider. If they are trained mostly to treat adults, they might be less comfortable with kids. They often order more tests, xrays, and inappropriate treatments due to their inexperience.

This increases cost as well as risk to your child. We have been fortunate to have many urgent cares available after hours that are designed specifically for kids, which does help. But this is sometimes for convenience, not for the best medical care.

What About Cost?

As previously mentioned, cost is a factor. I hate to bring money into the equation when it comes to the health of your child, but it is important. Healthcare spending is spiraling out of control. Urgent cares and ERs charge more. This cost is increasingly being passed on to consumers.

Your co pay is probably higher outside the medical home. The percentage of the visit you must pay is often higher. If you pay out of pocket until your deductible is met, this can be a substantial difference in cost. (Not to mention they tend to order more tests and treatments, each with additional costs.)

So what kinds of issues are appropriate for various types of visits?

(note: I can’t list every medical problem, parental decisions must be made for individual situations)

After hours urgent care or ER:

• Difficulty breathing (not just noisy congestion or cough)
• Dehydration
• Injury
• Pain that is not controlled with over the counter medicines
• Severe abdominal pain
• Fever >100.4 rectally if under 3 months of age

Your Primary Care Pediatrician Visit:

• Fever
• Ear ache
• Fussiness
• Cough
• Sore throat
• Vomiting and/or diarrhea
• Any new illness

Issues better addressed with an Appointment in the Medical Home:

• Follow up of any issue (ear infection, asthma, constipation) unless suddenly worse, then see above
• Chronic (long term) concerns (growth, constipation, acne, headaches)
• Behavioral issues
• Well visits and sports physicals (insurance counts these as the same, and limits to once/year)
• Immunizations – ideally done at medical home so records remain complete

If your child gets a vaccine at any other location, please send us documentation (including the date, brand, lot number, and place administered) so we can keep the records complete.

Remember your pediatrician’s website might offer trusted answers to questions and many treatments to try at home for various illnesses and conditions! Be careful of surfing for answers though… the internet is full of bad advice! Go only to trusted sources (such as your doctor’s website or HealthyChildren.org).

Dr. Stuppy is a practicing pediatrician in Kansas. I feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.  

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1. Why Can’t Pediatricians Prescribe Medicine Over the Phone?
2. If a patient can charge for her time, why can’t the doctor charge for his?
3. She has a fever, her temperature is 99.2. Is It Normal?
4. Michele Bachmann Is Not a Doctor (she reveals), But Pediatricians Are
5. What I Wish Parents Knew About Medical Billing
6. Things Your Mother Told You That Were Wrong
7. In Defense of Cough
8. Six Reasons You May Want to Bring Your Child to the Pediatrician’s Office Instead of a Retail Based Clinic
9. Are High Fevers in Children Dangerous?
10. What is the most important thing I can do to make sure my child is as healthy as possible?

Well, there you have them. Do you have a favorite one? We’d love to hear your thoughts.

In the fall of 1957, the Asian influenza pandemic was spreading across the country. My younger sister had just been diagnosed with that flu, and my grandmother had arrived shortly thereafter to help at our home when my mother entered the hospital to give birth to another sister. In those days, one could count of a solid seven days in the maternity hospital, even for an uncomplicated delivery.

Knowing the extremely contagious nature of the flu (she had lived through the devastating influenza pandemic of 1918), my grandmother set out with every weapon known to modern grandmotherhood to prevent my father and me from getting sick, fearing the consequences for my mother and newborn sister. With isolation, chicken soup and constant scrubbing and disinfecting, my father and I were spared the disease, as were my mother and sister, and, as long as she lived, my grandmother delighted in telling the story of how she confounded the pediatrician who had predicted that we would all very soon be ill.

Flash forward fifty-four years to 2011. What are the risks to siblings today when one member of a family contracts a communicable disease, and how should we respond? I think that the answer depends on many factors, one of which concerns the nature of the particular illness that one person has contracted.

Viral Illnesses

Some viral illnesses are highly contagious, even without direct contact. Certainly chicken pox and measles used to spread through families like wildfires, but immunization has largely reduced the occurrence of these diseases, primarily by greatly reducing the amount of disease in circulation, and, further, by producing immunity in children who might somehow be exposed. The same goes for influenza, the bane of my grandmother; since universal influenza immunization was recommended a few years ago, the burden of disease has been reduced, although not as much as it could be if everyone actually did get their flu shots.

Contagious Illnesses

How about other types of infectious, contagious illnesses? The common cold is just that, common, and most people will suffer one or multiple episodes each year. Unfortunately, there is no effective preventive immunization, and it does tend to spread readily; fortunately, it tends, in most people, to be relatively  mild and of short duration.

Strep Throat

Strep throat is another common contagious illness, especially in children. There certainly are families where multiple members will get strep in close temporal relationship to each other, and these may be the result of spread within the family.

But it is also possible that multiple family members were exposed at school or work, and contracted the illness elsewhere.  But strep is harder to spread than some of the illnesses discussed previously, and there are many cases where one family member gets it, and no one else becomes sick. This is one illness where good handwashing, and avoidance of sharing of food, utensils and so on, can be a useful preventive measure.

Infectious Mononucleosis

The same can be said for infectious mononucleosis–”mono,” also known as the “kissing disease,” primarily for its reputation as a common occurrence during adolescence. Yet in most of the families where one child has mono, it is very uncommon for other siblings to also contract it. Thus simply sharing a room, or time at the dinner table, is generally not enough to transmit an illness like mono.

Pneumonia

Pneumonia in children is also common, and the vast majority of cases are viral in origin–and they are often caused by the same viruses which cause the common cold. I tend to think of most cases of pneumonia as “a common infection in an uncommon place,” and generally feel that, while another member of a family might catch the same virus, it is far less likely to be caught as pneumonia. Rather, it might cause a head cold, sore throat or ear infection in someone else.

So why does this matter?

Rare is the day which goes by that I am not asked a question like “his brother has strep (or pneumonia of the flu or…), so why can’t you just treat all my kids for it without having to see them?” In response, it is important to point out that every person who gets a fever after being in contact with someone who has strep is far from guaranteed to have strep as the cause of that fever; most illnesses are just not that contagious, and most fevers require individual evaluation regardless of the person’s exposure.

The same thinking goes into my response to the schools who send home notices every time someone in a class is diagnosed with strep, ostensibly warning parents to be on the lookout for strep in their children. About the only thing these notices accomplish is the wasting of paper.

I would far prefer that parents react to each of their children’s illnesses in a vacuum, paying no attention to what the child might have been exposed to (assuming, of course, that the child has been fully immunized, thus pretty effectively–but not 100% completely– ruling out those preventable illnesses as a cause of the fever.)

What to do when your child is ill

When your child is ill, pay more attention to how he or she is acting, how sick he or she appears, and how well the illness is being handled by the child, than to what diseases he or she might have been exposed to.  Discussing that information with your pediatrician will enable you to better decide what y our next course of action should be for evaluating the illness in that child.

Dr. Hackell is a founding member of Pomona Pediatrics PC, a division of Children’s and Women’s Physicians of Westchester. He practices in the lower Hudson River Valley just north of New York City.

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