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A local pediatrician on pivoting, protecting patients and parenting during a pandemic

children, masks, coronavirus, Covid-19
For all children, the idea of wearing a mask may take a little explaining.

In the five weeks since schools closed and so many other businesses followed, we’ve all been rocked by fast-changing guidelines and orders related to stemming the coronavirus outbreak. We talked with pediatrician Jason Vargas, MD, of Cactus Children’s Clinic in Glendale, to find out how recent recommendations have impacted pediatrics practices and the families they serve.

Dr. Vargas is a board-certified pediatrician and a fellow of the American Academy of Pediatrics. He is also president-elect for the Arizona chapter (AzAAP), a position he will assume in July.

Pediatrician Jason Vargas, MD, of Cactus Children’s Clinic in Glendale.

So, first question: Is your practice open?

We are open. Our office made chances early to pivot, do the best we can [to address families’ concerns]. It’s super important that people know their pediatrician is still open for business. Maintaining a child’s regular schedule for visits is essential. Kids still get earaches, injuries, rashes. Healthy kids still need to get their checkups and vaccinations. And if everyone avoids those regularly scheduled visits now, it’s going to be extremely difficult when things start opening up again for us to manage [scheduling requests] if we’re behind. If anything, it’s a good time to do it now. Offices are less busy. We can do these routine procedures in a safe environment.

What is your office doing to protect the health and safety of your families?

We see healthy kids in the morning, from 8 a.m. to noon, and sick kids in the afternoon, between 1 and 5. In both cases, we ask parents to wait in the car until we call them on their cellular devices. We ask that only one child come inside with one parent or guardian, if possible.

The CDC recently issued guidelines asking everyone to wear masks while out in public, given the difficulty of maintaining six-foot social-distancing recommendations. How does this apply to children?

In pediatrics, we agree the best way to protect your kids is to stay at home and practice social distancing. But life is unpredictable. You may have to go to the store, the pediatrician’s office. For children over the age of 2, certainly, it would be important they wear a simple cloth mask if you can’t guarantee you can keep a six-foot distance. It has to fit, of course.

No child under the age of 2 should wear a mask. First of all, it’s not practical. More importantly, young children can fall asleep at unpredictable times. You don’t want their face covered — it could be a choking hazard.

For all children, the idea of wearing a mask may take a little explaining. Use simple terms: “We are doing this to keep us safe, protect us from germs.” Maybe practice on a stuffed animal, or draw pictures of people wearing masks. Praise children for wearing their masks and doing their part to protect themselves and others.

While masks are good for keeping us from touching noses, eyes, etc. you want to be sure family members are not touching their masks, either. You have to view a mask as a contaminated surface. When you do take it off, remove it from the back. Lay it on a flat surface away from other things. Wash your hands.

There is no need for a child to wear a mask in the home unless there is a known carrier of COVID-19 in the household. And N95 masks should only be used when the child has an underlying immune-compromising condition.

I’m seeing (and hearing about) families getting together, setting up play dates, etc. Your thoughts on that?

I live on a bike path, so I see people coming by. I can see how people are getting cabin fever, itching to get out, and we’ve had these beautiful days. [As pediatricians], we recognize the importance of getting outside, getting exercise, but we have to keep practicing social distancing. So many things can go wrong: a child grabs someone else’s handlebar, or a parent forgets and shakes a neighbor’s hand.

Even though official guidelines recommend avoiding groups of 10 or more people, that doesn’t mean a nine-person get-together is safe, even outside. Think about it like this: you have a group of six people going for their walk together. There is no way they are maintaining six-feet distancing or they’d be spread out over 36 feet! Say these six are from six different families who all have different risks of exposures. That’s an exponential increase in your contacts. It’s very easy to forget that.

Arizona is not experiencing as high a rate of infection as we initially thought it might, and we’re almost bending that curve, but we have to keep fighting the good fight. These social gatherings — outside, in the backyard, or seated in lawn chairs in front of the house — that’s not social distancing.

What do parents need to know about telemedicine? When is that a good option?

No pediatrician is going to want to put children or patients in a contagious situation unnecessarily. Always our preference is an in-person visit, and each pediatrics practice will figure out how to make that safe. In this unprecedented time, however, an unheard-of amount of physicians are also practicing telemedicine.

We don’t recommend it for well care, but what if your child is fussy, maybe has an ear infection or a rash, and you don’t want to go in? The advice you get on a telemedicine visit might help protect you if you end up having to go to urgent care in the middle of the night.

We jumped in quickly. It’s a learning curve. I’d tell parents to invest a little time at the beginning. Register in the platform you’re using. Make sure your camera and microphone are working properly, be in a well-lit area, make sure you have a good internet connection and make sure the patient is with you (during the call). It know it sounds obvious, but you’d be surprised.

If the condition is something you can photograph ahead of time, do that. Some platforms will allow you to upload photos ahead of time.

You and your wife have two children. How is your family coping?

My kids are 12 and 13. So they’ve transitioned to online school like everyone else. At first it was “different” and they were interested in what was going on, but that quickly faded.

It’s been interesting. We really pushed minimal screen time for our kids; now they’re spending all their time on screens. We’ve had to do some adapting. At their ages, social time is SO important. We are encouraging them to do social activities online. Our daughter gets together with friends online and they all bake the same recipe. My son has nightly Zoom time with friends.

We’ve found it’s super important to keep them on a schedule — they crave that schedule to get through the day. They wake up, do their exercises — which we feel are very important — then simulated class periods, recess time to get them outside for a bit, then back to work. At dinner we shut things down and focus on family time together.

We try to take advantage of the down time, have discussions with them, answer their questions. We thank them and remind them, “You are doing something important; you are preventing this thing from spreading. This is hard work.” Nurturing the positive helps build extraordinary resilience. And if there is anything we all get out of this, hopefully it’s that it makes us stronger and more resilient.

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