A new project: a podcast

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If I haven’t written as much here lately it is because I have been busy launching a new project: a podcast. A few months ago I took on a new leadership position and was tasked with educating a geographically and professionally diverse group of physicians. My boss gave me the freedom to creatively tackle this challenge and I decided a podcast would be the best approach. It allows physicians to update their knowledge on current events and hot topics in primary care without being tied to their desk or being told when they need to do it. These 15-20 minute podcasts are interviews between myself and content experts at Children’s Hospital of Philadelphia and they will be published on average every other week.

 There are a few ways you can listen:
·         www.chop.edu/pcppodcast

As this is a new venture, I look forward to hearing your feedback. If you have ideas for future episode topics, please leave a comment. I hope you enjoy listening to the Primary Care Perspectives podcast!

Halloween in Philadelphia

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The neighborhood I grew up in as a young child had only a few houses on each block separated by thick patches of pine trees. Trick-or-treating became tedious, so it was common for moms to drive kids around in the back of an open station wagon trunk, hopping in and out at each house (I do not recommend this! It was the 1980’s!). Over time, we would seek out other neighborhoods where the houses were closer together, making it more fun to walk around with friends. There were always streets that developed a reputation for high-quality decorations or king-sized candy bars too.

For the first eight years that I lived in Center City Philadelphia, I probably had a collective eight trick-or-treaters venture down our small side street. Since moving to a more residential area of the city though, we have had a steady stream of costumed children. We also have experienced more Halloween parties and public gatherings at parks. It has been great joining in the festivities as parents and neighbors.

This year, Zillow ranked Philadelphia #1 in their 20 Best Cities for Trick or Treating statistics. Although I love trick-or-treating in Philadelphia, my first thought was, really? Zillow created their top 20 listed by looking at home values, how close together homes are, the number of children under age 10, and crime rates. Knowing this made me even more excited that Zillow found Philadelphia to be #1! See if your neighborhood ranked in the top 5 and the rest of the cities on the list here.

No matter where you are trick-or-treating this year, it is important to think about how to make it safe for your children and others. Halloween brings with it many dangers, whether it be from the costumes themselves, taking candy from strangers, or walking the streets in the dark. See these tips from the CHOP Poison Control Center about how to make your Halloween safe!

So have fun this Halloween, Philadelphians, and be safe! And remember, I’ll eat any Whoppers that you don’t want.

 

[Some material provided by Zillow. I have no relationship with Zillow and was not compensated for this post. I am not responsible for the content of external links.]

Just Keep Swimming, Safely

swimming

Growing up at the Jersey shore it was unfortunately not uncommon to hear about children and adults drowning. It was often blamed on many things, such as a strong rip current, drinking alcohol, or swimming without a lifeguard. Sometimes the victim was even an experienced swimmer. Once it was my classmate. I was in eighth grade when one of my friends was swept out to sea while swimming out to save another classmate. The memory of this friend and the tragic early loss of his life is something I reflect on often, but always when I am thinking about water safety.

As a resident in the Emergency Department or Pediatric Intensive Care Unit (PICU) I knew that each summer there would undoubtedly be patients being treated for complications of their drowning. Some would die, some would have life-threatening complications, and most would be forever changed. The location of their drownings would vary: pool, bathtub, ocean, lake. The stories though almost always started with “I just looked away for a second.” A life changing second.

Now in my primary care practice, I talk about drowning risks with parents, whether it is with infant parents and bathtub safety, toddlers and safe-guarding pools, or school-aged children and swimming safety. It is a topic I hope parents realize how important it is, even when raising city kids. Here are a few of my tips:

  • never leave your children unattended around water. You should always be within arms reach of your infant while in the tub. You should always have your eyes on a child who can swim independently, even if you aren’t in the water with them.
  • children should wear life jackets when on boats, even if they can swim. (Not floaties!)
  • swim when there is a lifeguard on duty and stay between the flags
  • pools should be gated with a 4-foot fence and a latch that is out of reach of the child.
  • make sure pool drain covers are in place
  • never swim alone!
  • teach children over the age of 1 to swim
  • caregivers should be trained in CPR

I recommend swimming lessons for children over the age of 1 based on some small studies that suggest even children age 1-4 may benefit from formal swim instruction in terms of preventing drownings. However, it is important that parents are not over-confident about their child’s abilities after teaching them to swim and remain vigilant while their child is in the water. Also, not every child 1 and up is ready for swimming lessons, so parents should decide whether or not they need lessons based on their exposure to water, emotional development, physical abilities, and health conditions.

Where I grew up, everyone knew how to swim. The question was usually how well you knew how to swim. There were those on the swim team, those who could pass the lifeguard test, and those who were surfers. We swam in pools, the town lake, and the Atlantic Ocean. I had a boating license before my driver’s license. And I spent just about every Summer I can remember taking swim lessons before the pool opened and then swimming, diving, and likely annoying the lifeguards with incessant chatter about my technique until the pool closed. Even though I am now a city-dweller, I am appreciative of this lifelong skill and when I am lucky enough to be in the water again, I feel confident. This is why I am passionate about spreading the message about water safety to my patients and instilling it in my own children.

I started my oldest in group swimming lessons at the YMCA as a way to expose him to the water and get him used to blowing bubbles and kicking when he was an infant. More than anything though, it was a bonding activity for us. When my children were 2 and 5 though, we decided to enroll them in private swim lessons to advance their skills. I knew that they were ready to learn more and that if I wasn’t in the pool they would be more likely to learn from an instructor. My 2-year-old, who thinks she is a mermaid, made a few bold attempts to jump into pools unattended, so making sure that she developed some skills to orient herself in the water and get her head to the surface became a necessity. We took lessons this past Summer with Holly Waters of Fitness Alive, who is the perfect balance of enthusiastic cheerleader and disciplined coach. She had patience with both my reluctant, anxious 5-year-old swimmer and over-zealous, determined 2-year-old mermaid simultaneously. After a few weeks, both were moving themselves in the water in a fashion that some could call swimming. Most importantly though, they developed a respect for water safety while also growing in their love of a new hobby.

 

For more information about drowning prevention from the AAP, click here.

For more information about Fitness Alive swimming, click here.

[I have no affiliation with Fitness Alive and was not compensated for this unsolicited post. The above is for informational purposes only and should not be used as individual medical advice. Please contact your physician for individual guidance on whether or not your child is ready for swimming lessons. See full disclaimer here.]

The First Back-To-School

Monster school

In the past few weeks, we joined the ranks of parents with children in school. Our first-born headed off to kindergarten and no tears were shed on either side. The enormity of this milestone does not escape me, but we are a school-loving household so although it is a sign of my baby growing another step closer to being a man, it is a happy one.

Meanwhile in clinic, I have been catching up children on their immunizations so that they can also head to school. Some have told me about how excited they are to rejoin friends, return to sports, and prepare for college. Others have complained about things that plague many public Philadelphia schools, such as lack of a school nurse, limited sports teams, and sparse school supplies. Parents have worried about getting services for their children who need help with reading, speech, or writing. We have brainstormed solutions to many of these problems in our short time together, knowing that to truly tackle these issues we would need many more hours, people, and dollars. However, there is so much that we as parents and pediatricians can do to help children succeed in school.

One week in, here are my tips for the day-to-day success of getting your child ready for school:

  1. Talk positively about school! I am always telling my son how many years of school his father and I chose to attend because we loved it. When I know what his agenda includes that day, I act as excited about it as possible. “Oh you have sports today, that sounds so fun!”
  2. While maintaining a positive vibe, I acknowledge the struggles. Starting at a new school is hard! Making new friends, learning a new schedule, setting and meeting new expectations are all stressful challenges for me, nevertheless a five-year-old.
  3. Get enough sleep! Our new schedule starts almost an hour before our prior routine, which means that bedtime needed to move earlier as well. We are still adjusting our routines, but we all need to be well rested so have prioritized this.
  4. Do as much preparation the night before as possible. I try to pack up some of the lunches for the morning and pick out clothes. Although there should theoretically be time for these things in the morning, you never know what curve balls you will be facing and being prepared is important!
  5. Communicate with the teacher. We are lucky to have a kindergarten teacher who has solicited feedback from us and wants to know more about our son’s strengths, weaknesses, and goals. Even if she hadn’t initiated this conversation though, I knew it would be important to have these discussions before the mid-semester parent-teacher conferences.

Inevitably there will be students who are struggling though and we should all know how to offer help. Children who are struggling in school should receive comprehensive psycho-education testing to determine if a learning disability may be a factor and whether or not the child may benefit from supportive educational services. All services outside of the standard school curriculum are considered “special education services,” but there is a wide range of intensity in those services.

An Individualized Education Plan (IEP) is required under the Individuals with Disabilities Education Act (IDEA) for any child 3-22 receiving special education services. An IEP should address a child’s specific learning issues and include goals to support and meet their educational needs. This is a legally binding document and the public school must provide everything in the IEP for the student. If you think your student needs an IEP, you should request an evaluation, which includes a school psychologist or other professional giving your child various tests and performing classroom observations as part of a multidisciplinary team evaluation. Then, the school and parents should review the evaluation and determine what if any services or supports the student needs. The IEP goes into effect after a parent gives consent and any reduction in services later on requires prior written notice before changes are made. Private schools are not required to follow an IEP, but private school students can be evaluated for an IEP through their local public school. An IEP should be reassessed on a regular basis.

If your child doesn’t qualify for an IEP, but needs accommodations to meet their educational needs, they may need a 504 plan. A “504” for short is part of the federal civil rights law that prohibits discrimination against students with disabilities, under Section 504 of the Rehabilitation Act of 1973. Any public K-12 student with a disability may qualify for a 504 plan and the list of disabilities is broad, including things like ADHD or learning disabilities. A 504 is less standardized than an IEP and does not include educational goals.

So as we head back-to-school or start out on our children’s educational journeys together, let us prepare for a great academic year. I know there will be bumps along the way, but I feel optimistic and prepared. After all the smiling first day of school photos I saw in my news feed, I hope that those smiles continue throughout the school year!

 

CDC School Immunization Guide

[Portions of this post were previously published in the Sept 2016 QVNA Magazine.]

Exploring the Gardens Around Philadelphia

Schuylkill River

When we reach the time of year that my children point to every puddle of water on the sidewalk and announce, “mama, don’t step in the pee,” I know it is time to expose them to more nature. The steamy sidewalks radiating heat, and bearing too many bodily fluids, wear us down by the end of August, so we ventured beyond the city to two nearby escapes friendly to nature-reluctant urbanites.

Bartrams Garden

First, Bartram’s Garden, a 45-acre National Historic Landmark with gardens, arts events, an after school program, and river boating. We went on a Saturday, when there are free kayak and rowboat rentals from 11AM-3PM seasonally. My dear husband rowed the four of us in midday sun around the Tidal Schuylkill River. We loved seeing our city from the viewpoint of the river. The next time we go it will hopefully be less than 95 degrees so we can spend more time exploring the grounds. If you are looking for something to do this weekend, the Philadelphia Honey Festival will be there with a children’s bee parade.

Out on a Limb

Then, we went to Morris Arboretum, 92-acres of gardens and educational programs run by the University of Pennsylvania. The kids enjoyed running and jumping in the bridges and nets of the Out on a Limb exhibit, a canopy walk 50-feet up in trees. There is also an impressive toy railway, including a hot dog train car that caused my 5-year-old to scream with glee every time it circled near us. I enjoyed wandering the gardens and having my Fit Bit hit 10,000 steps before lunch!

fountain

Along the way, my kids enjoyed finding spiders, squirrels, and fish; tossing stones in the river or pennies in a fountain. They ran in open fields and frolicked among the bees. They wandered a little too far even. They did the exact same things that they do in the city, except when we found a puddle, we didn’t wonder if it was dog or human urine. So while we sweated out the end of Summer amid gardens, we appreciated living somewhere with such beautiful landscapes a short drive from our beloved concrete abode.

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