Medically Speaking #17

Welcome to today's episode of Medically Speaking. Today we're going to be talking about pediatrics, and I have a special guest with me today, Dr. Polanco. So welcome to the podcast. Certainly, I'm glad to have you here with me today. Let's just start with maybe let the audience get to know you a little bit. Tell me a little bit about your background and how you found yourself in Greenwood. So I'm originally from Dominican Republic. I did my medical training there, and then I completed my pediatric residency in New York. And then after residency back in 2015, I was looking for a job and find Greenwood. So I've been here now for 10 years. In the community, I recently joined SELF last year and have been happy to be here. Good. Good. Well, we're certainly glad to have you in the community and working at SELF Regional. Well, great. So I thought we'd just have a conversation about just pediatrics in general and maybe just to start off with. So when do you get involved? So you're not necessarily at the hospital when a baby is born, but how soon after birth does a pediatrician like to kind of get involved in a new baby's care? So usually we'll see them right after discharge from the hospital. We are not rounding directly in the hospital. The residents with Montgomery Center will round on our babies, and then they will make sure they have an appointment right before discharge to come and see us, usually in the first day or two after discharge. And then we get involved then till they go to college. Yeah, that's awesome. So what are some things that that very first visit when a baby comes out of the hospital and you're seeing them for the first time, like what are the types of things that you screen and look for? So usually that first visit, I think, is important for parents. Right after a baby is born, there is a lot of questions, lots of anxiety about a lot of little things. So we do our best to focus on answering any questions. We are also checking for weight. So we do see some weight loss in babies. So we want to make sure feedings are being established, that the baby's gaining good weight. And the other big thing during that first visit is going to be checking bilirubins, just because we do have jaundice issues in some babies. So we're usually screening for that and basically getting to know the family. Awesome. So is it a pretty seamless process if a baby comes in, or a mom comes in to South Regional and has a new baby, and they want to follow up with you? How does that happen? So usually when they come in the hospital, usually the nurses, when they are getting registered, they will ask who the pediatrician is, and they just have to, let them know that they want to come to us, and they will make sure the process gets started. Awesome. Awesome. Now, you speak more than just English, right? Yeah. So I do speak Spanish. So I get to see a lot of the Hispanic community here in Greenwood. Yeah. I think that's a big plus, right? And I think, you know, having that native language probably is super helpful to families that may not speak English quite as well. So that's, that's really great. So talk to us a little bit. So you see them initially, and then when do vaccines start? Like, do you, it's not the first visit, but at what point do we start thinking about that? So they will get the first hepatitis B in the hospital. So that one is recommended at birth, but there is, in the outpatient setting, vaccines don't start till two months. Two months is when they start the first set of immunizations, where they will get their tetanus vaccine, polio, they get their pneumococcal vaccine to prevent pneumonia, and Mofilo vaccines, which prevents meningitis in babies, and then rotavirus. So that will be the first set of vaccines they get at two months. And I understand that there's like, when a baby's first born, they're kind of that neonate period. Like if they start running a fever, it's like more of a big deal than if they're a little bit older. Can you talk to us about that a little bit? Yes. So of course, in a newborn, so the first 28 days of life, baby's fresh out of the womb. So immunity-wise, we do take fevers in that period a little more seriously, just because they can progress faster. So a fever in those first 28 days do require some workup, and may need some extra additional steps, and sometimes antibiotics and admission to the hospital. Mm-hmm. Yeah. I know you know I'm an ER physician, and that was one, I guess, a population we would need a lot that would come to us is that first 28 days of life, and if they start running a fever. And how do we define a fever as a pediatrician? So it's going to be a temperature of 100.4 and above. And usually for the little ones, we prefer rectal temperatures just because it's going to be the most accurate. Right. Yeah. And it is a pretty big workup. And we do usually put those little babies in the hospital just to watch them and make sure, because they're, like you mentioned, their little immune system's not quite up to full speed yet. So another thing that's commonly asked, is around breastfeeding, the neonatal period. And like, what are your thoughts on breastfeeding and the benefits or whatnot of that? Yeah. So the Academy of Pediatrics and us as pediatricians, we strongly encourage breastfeeding is the best for the baby, not only for that immune protective factor that mom passes the immunity to baby indirectly, but also that bonding experience for the mom. So we do recommend that first year of life, exclusively. Yes. Exclusively breastfeeding. Now, it's one of the most difficult jobs as well. So I think a lot of support is needed, especially for first time moms trying to establish that breastfeeding. And the nurses in the hospital do an amazing job making sure they get that support. And then we do have also a breastfeeding consultant, which is available even after they get discharged from the hospital to kind of, like, if there is any problems or struggles, they try to help. Yeah. And so I personally think it's very important, particularly in those first couple years of life, that the children, they see their pediatrician on a regular basis. Maybe you can talk about that a little bit. Like, what are some of the things you look for, like developmental delays and things like that? And how do you identify some of those potential issues early? Yeah. So it's very important that we do those wellness exams. So the first two years of life, we do have more encounters. So we are tracking not only development, but also growth. So we want to make sure babies are growing healthy and achieving the milestones they're supposed to. So in every encounter, we're going to be checking what they are doing. And we do have validated tools and questions. And questionnaires that we will use during those visits just to kind of, like, score and see, kind of gives us an idea when there is any red flags or where we may not. I feel like every baby is going to develop differently. But there is certain things that we look for at certain times. So we are also always scoring and kind of, like, touching base with parents because we want to, if there is any delay that is identified, we want to start intervening early because we know the earlier we start treating and managing those delays, the better success we're going to have down the road. Mm-hmm. Maybe give me an idea of some of the more common types of delays that you may come across in your practice. I think, especially in the last few years, we've had, I feel like, increase in speech delays. There is a huge amount of speech delays that we are seeing overall. And I think it has to be with a lot of the electronic use. Mm-hmm. We are, more and more, we are seeing babies, starting at a young age, watching the phone and the tablet and things like that. And that has a really negative effect on that speech because their brain is not really mature enough for all that stimulation. So when they are watching, even though they are maybe, you know, learning programs or, like, shows, their brain is not really mature enough for all that stimulation. So when they are watching, even though they are maybe, you know, learning programs or, like, shows, their brain is not really mature enough for all that stimulation. So when they are watching, even though they are maybe, you know, learning programs or, like, shows, their brain is not really mature enough for all that stimulation. So when they are watching, even though they are maybe, you know, learning programs or, like, shows, their brain is not really mature enough for all that stimulation. So when they are watching, even though they are maybe, you know, learning programs or, like, shows, their brain is not really mature enough for all that stimulation. So when they are watching, even though they are watching, even though they are watching, even though they are watching, they are not really mature enough for all that stimulation. So when they are watching, even though they are watching, they are not really mature enough for all that stimulation. So when they are watching, even though they are watching, they are not really mature enough for all that stimulation. So when they are watching, even though they are watching, they are not really mature enough for all that stimulation. So when they are watching, even though they are watching, they are not really mature enough for all that stimulation. So when they are watching, even though they are watching, they are not really mature enough for all that stimulation. 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So when they are watching, they are not really mature enough for all that stimulation. So when they are watching, they are not really mature enough for all that stimulation. So when they are watching, they are not really mature enough for all that stimulation. So when they are watching, they are not really mature enough for all that stimulation. So when they are watching, they are not really mature enough for all that stimulation. So when they are watching, they are not really mature enough for all that stimulation. So when they are watching, they are not really mature enough for all that stimulation. So when they are watching, is a great way to help them. is a great way to help them. is a great way to help them. Because even though it may be positive, Because even though it may be positive, Because even though it may be positive, there is a lot of drama that goes on, there is a lot of drama that goes on, there is a lot of drama that goes on, and then definitely plays a role in and then definitely plays a role in and then definitely plays a role in the mental health of a lot of our the mental health of a lot of our the mental health of a lot of our teenagers. And it does link with the teenagers. And it does link with the teenagers. And it does link with the amount of depression anxiety that we amount of depression anxiety that we amount of depression anxiety that we are seeing. are seeing. are seeing. Yeah. Yeah. I've seen that and read a Yeah. Yeah. I've seen that and read a Yeah. Yeah. I've seen that and read a lot about that as well. So yeah, lot about that as well. So yeah, lot about that as well. So yeah, it's hard though, particularly when it's hard though, particularly when it's hard though, particularly when your kid says, well, everybody else your kid says, well, everybody else your kid says, well, everybody else is doing it. It's like, why don't I is doing it. It's like, why don't I is doing it. It's like, why don't I get to be on whatever, fill in the get to be on whatever, fill in the get to be on whatever, fill in the blank social media site. But yeah, blank social media site. But yeah, blank social media site. But yeah, and you know, I've seen that in my and you know, I've seen that in my own kids too, where they kind of own kids too, where they kind of own kids too, where they kind of almost compare themselves to what almost compare themselves to what almost compare themselves to what they're seeing out there and may not they're seeing out there and may not they're seeing out there and may not feel like they're up to the whatever feel like they're up to the whatever feel like they're up to the whatever level that someone else is. And it level that someone else is. And it level that someone else is. And it does create some anxiety and depression does create some anxiety and depression does create some anxiety and depression and kind of that self-image. Maybe not and kind of that self-image. Maybe not and kind of that self-image. Maybe not healthy at times. healthy at times. healthy at times. And it's normal, right? It's a normal And it's normal, right? It's a normal And it's normal, right? It's a normal part of development to like look into part of development to like look into part of development to like look into your peers and want to kind of follow your peers and want to kind of follow your peers and want to kind of follow onto those steps and fit in. But also onto those steps and fit in. But also onto those steps and fit in. But also like, you know, it's sometimes as a like, you know, it's sometimes as a like, you know, it's sometimes as a parent, you need to kind of take that parent, you need to kind of take that parent, you need to kind of take that step back and say it's okay. It's okay step back and say it's okay. It's okay step back and say it's okay not to fit in, even if they they feel bad about it. not to fit in, even if they they feel bad about it. not to fit in, even if they they feel bad about it. Eventually, it will be beneficial for them, Eventually, it will be beneficial for them, Eventually, it will be beneficial for them, for them down the road, especially if we for them down the road, especially if we for them down the road, especially if we are, you know, seeing the struggles. are, you know, seeing the struggles. are, you know, seeing the struggles. Yeah, for sure. For sure. Okay, cool. Well, Yeah, for sure. For sure. Okay, cool. Well, Yeah, for sure. For sure. Okay, cool. Well, another thing that I think is real common, another thing that I think is real common, another thing that I think is real common, particularly in kids and certainly, you know, particularly in kids and certainly, you know, particularly in kids and certainly, you know, things that come into the emergency things that come into the emergency things that come into the emergency department, urgent care center, I'm sure department, urgent care center, I'm sure department, urgent care center, I'm sure you've seen in your office too, is like, you've seen in your office too, is like, you've seen in your office too, is like, my baby had a fever and they're four my baby had a fever and they're four my baby had a fever and they're four years old and they look puny. Like, how years old and they look puny. Like, how years old and they look puny. Like, how does a parent know, like, when can I give them some Tylenol or ibuprofen at home, or when do I need to take them to see a doctor? How does just the normal person who may not be in health care, kind of how do they make that decision or what would you recommend? So I think, you know, it varies. So if you're anxious, I think it's always a good idea to call your pediatrician, touch base with them and kind of let them guide you. Because if you have a question, it's better that you get some guidance. I think for the older child that is in school daycare facilities, they're going to spike fevers. They're going to get cold symptoms. So as long as you are able to get them to drink, get them to eat something, you give them medication, the fever goes down, they're okay. I think, you know, 24, 48 hours, you can wait it out and see how things go. Now, if fever is not going down with the medication, we are not wanting to eat, we are not really drinking anything, we are concerned about dehydration, then definitely get some help. Yeah. So, yeah, those were the red flags is going to be my next question. And you just. Just touched on some. Any other red flags that folks should watch out for in their kids? So with like a febrile illness. Yeah, yeah, fever illness, yeah. So I think those will be the bigger things, especially if they're not acting as active or they are not, you know, they're too sleepy, you cannot wake them up or anything like that, complaining of like a CBR headache or anything like that. We definitely want to see those little ones. Yeah. Gotcha. What are some other common things that you see as kids grow? Like, say, to start getting to that, you know, we talked about the little babies. What about that, like that grade school age? Are there common things that you see more common in grade school age kids versus like the little ones or even the teenagers? I think upper respiratory illness, we're going to see a lot of that, especially with the school age child. We do see a lot of ear infections secondary a lot of times to upper respiratory illnesses. Of course, we'll see your stomach bugs and just diarrhea in general, sometimes rashes, which is one big thing that worries parents. So there is a lot of little viral rashes, but also like eczema and things like that. So usually we do see a lot of those patients, but I think that will be probably the most common visits that we'll get. Gotcha. As kids get older and on to like those teen years, like say, I don't know, eighth grade to senior in high school. Yeah. Like what does that age tend to have more of? They tend to be pretty healthy. I mean, of course, during the seasonal changes, we do see a lot of allergies, the flu and the respiratory illness as well, probably prevalent. Still also strep is another thing. But I think sick illness, like acute illnesses is probably about the same, but they just get sick less frequent. Gotcha. What are your thoughts on? What are your thoughts on mental health in pediatrics? Have we, do you think you've seen more of that lately or kind of stable or just what are your thoughts on mental health? Definitely a large increase from when I did my training to today. I feel like also with COVID, we saw like a huge spike in anxiety, depression in kids. We're seeing a lot of more ADHD and things like that also in pediatrics. So definitely a huge increase in. And I think, you know, when you read about it and what that trend is, I think I'm almost convinced that it kind of like coincides with the use of smartphones and the huge mental burden that it has had in our teenagers, especially. Absolutely. What are some treatment options that we have locally to help these kids? So I think treatment options are a little more limited, especially for our younger kids. But there is, we do manage a lot of like the mild cases of like anxiety, depression, ADHD. We're able to manage that in the office. We do have great options for like counseling and mental health support in that aspect. And then with the Beckman Center sees a lot of our patients as well. But there's no child psychiatrist in the area, which does. Makes it a little more challenging, especially for what are more complicated patients. So they tend to either go to Greenville and some may actually end up going to Charleston. Certainly, I think that's an opportunity that we need to explore a little bit more here in Greenwood area. Tell me a little bit about ADHD and some of the treatments that you guys do for that. And I think you mentioned earlier, even telemedicine may be something that you guys use some to follow ADHD. Yeah. So. I think ADHD as a diagnosis, it does require. We need information from a school and then we have validated screening tools for that as well for management. We do get a lot of younger kids coming in the office concerned about ADHD. And I think it's important to recognize that, you know, early like four or five year olds may have a lot of hyperactivity, a lot of energy, but doesn't necessarily mean they have a diagnosis. Of ADHD, because a lot of that is probably developmentally appropriate for that age. Now, for the older kids, six years and older, that's when they we tend to typically diagnose ADHD. And I think for we try to combine. So I like to always say, like, pills don't teach skills. So a lot of the children that have a lot of difficulties with school and things like that, they may benefit from like a. Combined approach of not just medication, but also combining some mental health support or like parenting skill just to build those skills on like what to do in certain situations. So always combining some some extra support for the families along with medication is going to be the ideal set up. Gotcha. So so early, say, first, second grade is typically where like screening if needed and less. How long do people have to take those type medications? So I think so. With. Yes. So the younger school age children is when you're going to start getting the reports from school. And that's the main reason why parents come in our office is just, you know, they're struggling in school. They're lack lack cannot focus in school. They're not completing assignments and then it becomes a problem as they get older, because if they're disruptive, it disrupts the whole teaching. And then what happens with that is if you let it go, it it has a negative effect on that child. Overall perception of himself, because they get level labeled like the bad kid or the troublemaker, and that hurts their their self-seem because now, you know, I'm not good. So I usually like to to talk about to talk to parents about like, you know, we we are all able to be good. We are all good. We're making bad choices and then just reframing that. So we are able to get in that path of like, even when I'm not having my medication, I can still make good choices. And that's why the the the goal of combining with some skill building a lot of our patients will, you know, if you are truly hyperactive and having an ADHD, you'll probably need medication as you get older and like going into school just to be able to to to function, especially those kids are more severe. What we see. Sometimes is the kids are not so hyper, but more inattentive. They may outgrow it as they become more mature, may be able to focus, but it's sometimes it's just going to be a long lasting problem that's going to just follow you through life. Mm-Hmm, gotcha. Yeah, I know some adults take medications to help with that as well. So, well, good. Let's touch on vaccinations just a little bit. Can we just talk about just the the normal childhood vaccinations, general recommendations from like the. American College of Pediatrics and maybe touch on some of the, I guess, rumors or misperceptions or just basically wrong things that are information that's out there around, like autism and vaccines and things like that, if that's okay. Yeah, so I think so childhood immunizations, we started two months, so we will get vaccines at two, four and six months is your first big round of vaccines. Then MMR, varicella, chicken. And hepatitis eight at one. So there is a lot of concerns about the amount of vaccines that children get, and then, of course, there is all that information in social media misinformation about the link with autism, which has been proven to be false. And then the thing is, it does create a lot of questions for parents, and we are certainly able to answer any questions that come up because I think they're every parent. So the best for their child. So when we are talking vaccines, we are trying to protect your child from like severe illnesses and things that can lead eventually to like the death of a child. And we are trying to prevent those illnesses. And even though there is a lot of misinformation regarding autism, we in it, certainly recently there was a study or like some data that came up about the increased rate of autism, which the anti vaccine community. Has taken advantage of and say, and linking it directly to vaccines. But what we feel is that we are getting way better about screening for autism and diagnosing autism, which has in in in the long run increased that that number of patients that get diagnosed with autism, not because they're necessarily a link to anything, but just because we are better at picking up new vaccines. So that's one of the things that we need to be careful about. Picking it up and getting resources for those children. Yeah, I think that really cuts to the just because someone has it and it happened at the same time as something else doesn't always mean that that caused that link to happen. You could make probably a very similar argument that there's more dyes and foods now than there was, you know, 30 years ago. And maybe that's causing autism or maybe it's the screen times causing autism because there's an increase in screen at the same time as that. But in the reality is like, like you mentioned it, it may just be that we're screening. More for it and looking for it. So we're finding it more often. So the correlation does not always equal the causation, which I think sometimes is where a lot of that kind of misinformation type stuff can come from. Sometimes this is just me chatting, but I think that has a lot to do with definitely. And I think like that's that's when we start seeing. So when we're talking about autism, we're talking about like a problem with speech and also impairment in your social skills. Well, when you're two months, four months, you're not having. A lot of socialization or talking, right? So when that it starts emerging, it's at one. So that's when that link with that MMR vaccine and autism diagnosis started. But truly is like after we look at it is when we are picking it up. That's when we are noticing that the child is not responding to its name or is not looking at you or is not talking like the little older one year old that is in his class. So it's just that that coincidental. Age where things start emerging. It's interesting. We were talking just a second ago about the increased screen time and how kids talk like their speech doesn't develop as quick, which can also be a sign. Right. So it's just a lot of variables that I think it's hard to nail it to one thing. Certainly vaccines of all the things in history in the last 200 years that have increased lifespan vaccines are the number one thing that have done that. Definitely. So there's tons of evidence that shows that to be the truth. Tell me a little bit more about autism resources. If you do have concern that one of the children you're seeing in your office may have autism or be at risk based on your exam and history, like how do you how do you make that formal diagnosis and what resources are available in the community to help the kids and the families? OK, so once we have those red flags, we are concerned about something is going on. I think the most important thing is accessing resources. So that will be started. I think the most important thing is accessing resources. So that will be started. So usually we'll go ahead and screen, we'll refer them to ENT to check their hearing. That's going to be one of the first approaches that we'll do. We'll go ahead and refer for speech and other services that we may need. And usually if they're less than three, they're going to go through like BabyNet, which is that state early intervention program. And then if they're older than three, we'll find other outpatient resources for them regarding the diagnosis. One of the little things that are going to probably take long because we usually do a referral for developmental pediatrics, but there is a shortage of like developmental pediatricians. I guess right now, the waiting time for evaluation is probably going to be about 18 months. Wow. So that's why it's really important that we start services, because what we want to do is start a treatment, get things going and we'll get that diagnosis when we get that. But the most important thing is going to be starting that path of getting the services that the child is going to need to start moving forward. Yeah, absolutely. And I think about some of the community resources that are here and really in other parts of the state, too. But Project Hope is I think that's what a neat, a neat program there. And my understanding is they're building a brand new campus over near the Greenwood Genetics Center, which is going to be great for the community. Do you have patients of yours that go to Project Hope or that y'all plug your your practices plugged into the Project Hope network? I don't have any patients that go there at the time. I think they they because of the capabilities, they tend to serve the more limited, like the more severe children in the spectrum. And I personally don't have any patients that but it's a great resource for our community. We are lucky to have them. Yeah. What are some other any other topics? Are any other things that you might want to touch on with our podcast audience today? No, I don't know. Not really. Well, you know, we are MA, so I think what we are seeing a lot is sports physicals. So we want our patients to come to the office, come to us for those sports physicals. We'll get them done. I feel like a lot of times parents don't know that we can fit them in for their sports physical that day or day after, especially at the day. They wait till the last minute, but we can get them done. I was going to say that, too. I'm kind of mad about that. Wait until the last second to get that sports physical form taken care of. So if someone were to call the office, like how quick can you get someone in for like either sports medicine physical or just in general, like this acute illness? So usually we are we are able to get them in usually the same day or day after we are trying to we usually try to be very accommodating to our patients and be available when they need us. So usually we have some available. You may not necessarily be able to see your regular provider, but we can get you in in the office and get to see somebody within 24 hours. Yeah, absolutely. OK, cool. Well, gosh, Dr. Polanco, thank you so much for spending a few minutes with me today. And we're glad you're here and thank you for what you do for the patients in the community and great, great talking with you today. So thank you so much. Thank you for having me. Yeah. So thank you all for joining us for today's episode of Medically Speaking. And we'll see you next time. Thank you.