Pediatric Associates of Richmond

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Archive: May 2020

  1. Three Chopt check-ups & other office changes

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    If you’ve held off scheduling your child’s check-up until appointments re-opened at Three Chopt, the wait is nearly over. Beginning June 1st, we will resume having check-ups at the Three Chopt location.

    Sick visits will continue to be only at the Three Chopt location, but will be in a completely different wing from the check-ups, and will use a separate entrance. Those coming for sick visits will enter the building as they normally would, but enter our west wing through a door immediately to the left. They WILL NOT go through our main glass doors with our logo on it. This will be the entry point for check-ups. Follow signs for more details.

    As has been the case for the last 10+ weeks, our phone screening protocols will remain in place to ensure patients with possible or likely COVID-19 are evaluated in the parking lot.

    On June 1st we will also be expanding our start time to 8:30 a.m. for the Mechanicsville and Short Pump locations. They will both remain well-child only for now. We appreciate it is less convenient for those who prefer these locations to come to the Three Chopt office for sick visits. But in order to optimize safety for you and our staff, this is the best option for now.

    The following have not changed:

    1. Parking Lot check-in for all 3 locations (no waiting rooms)
    2. Closing at 5:00 p.m. at all 3 locations
    3. Three Chopt location sick visit appointments start at 7:30 a.m. Monday-Friday
    4. Telemedicine appointments for select complaints/concerns during business hours Monday-Friday
    5. Saturday morning newborn and sick visit appointments

    We are excited to have more check-up appointments available, and at a 3rd convenient location. The above changes will also ensure we can safely continue to care for sick children.

  2. COVID-19 & Multi-System Inflammatory Syndrome in Children (MIS-C): What You Need to Know as a Parent in RVA

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    Let’s start with what we know about COVID-19.

    COVID-19 is a disease that is caused by a novel (i.e. new) coronavirus – SARS-CoV 2.  It was first recognized in December 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. The first confirmed pediatric case of COVID-19 was March 2, 2020.  As of May 17, 2020, CDC data for which age demographics are available show that children (0-17 years old) make up about 3% of confirmed cases in the U.S. COVID-19 remains an uncommon disease in pediatrics.

    What about MIS-C? Where did this come from? On April 26, 2020 health care providers in the United Kingdom began to report a severe inflammatory syndrome in previously healthy children. It was similar to toxic shock syndrome and Kawasaki disease.  These children had a persistent fever, elevated inflammatory markers (blood tests), low blood pressure and multiorgan (heart, skin, gut, kidneys, brain and blood) involvement.  These patients had either tested positive for COVID-19 or had a significant exposure. The original name given was Pediatric Inflammatory Multisystem Syndrome (PIMS). The CDC renamed it MIS-C on May 14, 2020 in order more specifically define criteria for diagnosis, treatment and data collection.

    In May, the New York City Health Department began to receive similar reports. Many, but not all, of the children in New York had tested positive for COVID-19. The CDC released an advisory to health care providers on May 14, 2020 to look out for this rare and unusual syndrome. 

    For those into numbers, consider that in NYC as of 5/17/20 only 3% (4,955) of their total cases (190,408) have been in children. Of those 4,955 confirmed cases in children, there have been 145 cases of MIS-C. In summary, about 3% of all COVID-19 cases in NYC have been in children, and only 3% of those 3% have experienced MIS-C. So while yes it is a serious syndrome, it is thankfully quite rare.

    Let’s briefly compare Virginia to NYC (we know this isn’t comparing apples to apples because of the population sizes, but it does give more perspective for us). As of May 17, NYC has had about 3,000 MORE pediatric cases of COVID-19 than all of Virginia, and more than half of Virginia’s pediatric cases (1,030 of 2,048) have been in Fairfax, Alexandria and Prince William (i.e. Northern Virginia). These data are not shared to diminish the impact this syndrome has on a patient or their family. But we think it’s helpful for parents at our practice to keep perspective on how rare this is, especially in Richmond, VA. And hopefully this helps you to worry less.

    Scientists and clinicians are hard at work studying MIS-C and developing effective treatment.  Having lots of experience treating toxic shock syndrome and Kawasaki disease has helped. Typically patients are monitored closely and treated in intensive care units.

    When should you worry as a parent?  Keep in mind that COVID-19 remains uncommon in children and MIS-C is a VERY rare condition (see above). Symptoms that would indicate that your child needs to be evaluated include:

                -a persistent fever

                -rash or changes in skin color

                -abdominal pain, vomiting or diarrhea

                -trouble breathing

                -confusion or difficulty arousing your child        

    We are here for you.  Call if you have any questions or concerns. As always, Healthychildren.org is an excellent resource offered by the American Academy of Pediatrics that is frequently updated. 

                                                                                                                                                

  3. Guiding Teens through Missed Milestones

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    This will be quite a tough May for many of our teenagers. May is prom season. It’s when spring athletes would be finishing up their seasons and possibly competing for championships. It’s when those in performing arts showcase all their hard work through instrumental talents, singing, dancing or acting. Perhaps most notable is that May signals preparation for graduation. This year’s senior class won’t get to experience these milestones the way they had expected or planned just a couple short (er, very long) months ago. For many, coping with that has been, or will be, trying.

    Similar to grieving the loss of a loved one, grieving the loss of these milestones is frustrating, maddening, confusing and sad. The phrase, “Life isn’t fair” has never been more true than it is right now. But that’s not what our teens need to hear. And it’s certainly not what they want to hear. Never more have our teens needed our empathy than in the face of missing these events, which likely are or would be the best, most memorable experiences of their young lives.

    As we parents fumble our way through helping our teens cope, there are many things we could say that may be hurtful rather than helpful – even if they’re well-intentioned. We may have the ideas of (1) telling our teen how much better the next phase of life is; (2) recounting horror stories from our own lives at the same stage; or (3) saying, “well at least you won’t have to deal with or worry about ______.” These types of statements attempt to help our teens look on the brighter side, but maybe they want, and quite frankly need, to wade in these waters of sadness and disappointment for a little while. Trying to help them look on the brighter side could invalidate or devalue the emotions they’re feeling, and lead to that dreaded phrase no parents want to hear: “you just don’t understand!”

    So, what can we do to help our teens navigate these milestones? (NOTE: these tips are in part from Dr. Neil Sonenklar, child and adolescent psychiatry, Children’s Hospital of Richmond – adapted from his Zoom lecture “Mental Health in Teens During Quarantine”)

    1. State the obvious: Life sucks! Or however you’d like to phrase it. This acknowledges their sense of loss, and helps them to see you “get it.”
    2. Let them vent. Not all day, everyday. Give them 10 minutes everyday to express their frustration, sadness, or other emotions of grief. But after that they need to drop it (until the next day).
    3. Ask: “Is there something we can do to honor this occasion?” Keep it open-ended. It could be something to do now. It could be something in a couple months when restrictions are loosened. It could be both. Don’t offer your suggestions, at least not at first. There’s going to be awkward silence. That’s ok. Again, if you’re grieving the loss of a loved one there are a lot of moments of awkward silence. Honoring something or someone fosters acknowledgement, celebration, remembrance of good, reflection on a long path successfully navigated, and assurance that though not physically experienced these milestones won’t be forgotten.

    Unless they ask for your input, it’s best for your teen to explore how honoring a missed milestone would be most meaningful to them. Your role as parent is to support, and help guide them through this. Not to do things for them in hopes of cheering them up. So start a dialogue, and let your teen know you’re there when they’re ready to talk.