By Dr. Ashley McDonell, Providence Anesthesiology Associates

Whether your child’s upcoming procedure is elective or mandatory, we know that for many, the thought of surgery is scary.

For pediatric elective surgery, in children who are old enough to understand, we often explain that the administration process of general anesthetic is similar to flying an airplane:

1. Takeoff — induction or “going to sleep”.
2. Flying to a destination — the time during the actual surgical procedure.
3. Landing — emerging from anesthesia in the recovery room.

Each of these three phases have specific safety concerns that are constantly monitored by your physician anesthesiologist and the anesthesia care team. Since most children do not have significant health conditions, their overall risk of a rare or unforeseen event from anesthesia is extremely low.

We often receive the following questions from parents:

What is a pediatric anesthesiologist?

A pediatric anesthesiologist is a physician trained to direct the presurgical and peri-operative care of infants and children. They are involved with the pre-operative evaluation, administration of anesthesia and post-operative care of pediatric patients. While the pediatric anesthesiologist may not meet you or your child face-to-face until surgery day, rest assured that he or she knows your child’s medical history and surgical plan. We carefully and methodically create an anesthetic plan to carry your child safely through their procedure.

Will my child receive an IV?

Most children are given an oral sedative about 15-20 minutes before the start of the procedure to calm them and facilitate separation from the parents. Once your child is relaxed, your anesthesia team will transport him or her to the operating room where they “go to sleep” breathing an anesthetic gas through a mask. When your child is completely asleep, an IV is started for the administration of fluids and pain medications. During surgery, most children continue to breath the anesthetic gas to keep them asleep.

Why is it important for my child not to eat or drink anything prior to anesthesia?

It is safest to give anesthesia on an empty stomach to decrease the risk of vomiting during surgery. If vomit goes into a child’s lungs, it can cause life threatening complications.

What if my child is sick the day of surgery?

It is important to call the surgeon’s office or pre-operative clinic to determine whether the child is well enough to undergo surgery. Depending on the severity of the illness and the nature of the procedure, we may delay anesthesia for when the child is well again. The pediatric anesthesiologist may want to evaluate the child the day of surgery to determine whether it is safe to undergo anesthesia.

When can I see my child after surgery?

We want to reunite you with your child as soon, as is safely, possible. Once your child is awakening and becoming aware, we will bring you to the bedside.

What can I expect after my child’s surgery?

Most children continue to be sleepy or confused after surgery, often caused by the side effects of most pain medications – not the anesthesia.

Is anesthesia safe for my child?

Overall, anesthesia is very safe. More common issues include nausea, sore throat and confusion after anesthesia. Typically, these effects resolve after a short period of time. In very rare cases, anesthesia can cause complications in children, such as abnormal heart rhythms, breathing problems, or an allergic reaction to certain medications.

Physicians and scientists have been studying the effects of anesthesia on the developing brain for two decades and continue to do research on the subject. Recently published research indicates that short, brief exposure to anesthesia in patients, age three years and under, is unlikely to cause long-term cognitive effects on behavior and learning. There are concerns about young children undergoing repeated or prolonged use of general anesthesia or longer surgeries (greater than three hours); however, many conditions require multiple anesthetics so the benefit may outweigh the risk.

Please be sure to talk to your child’s doctor, surgeon and/or anesthesiologist about any concerns. To learn more please visit: smarttots.org, pedsanesthesia.org and provanesthesiology.com.

Dr. Ashley McDonell works for Providence Anesthesiology Associates and is dedicated to providing the safest, most ethical care to meet the needs of every patient. Dr. McDonell graduated from UNC School of Medicine. She completed her residency at Maine Medical Center and a Pediatric Anesthesiology Fellowship at Seattle Children’s Hospital.

This blog was produced in partnership with Charlotte Parent. Click here for the original post and other parenting resources.

By Lili Poon, MD, Novant Health

Night terrors, confusional arousals, sleepwalking and sleep talking: Most of us have heard of these or experienced them for ourselves. If you’re a parent, it’s likely that you’ve seen your child through one of these episodes. But what are they?

Parasomnias are unwanted or abnormal behaviors that occur during non-REM sleep. Though parasomnias can be concerning for a parent to witness and experience, they are not usually associated with negative health consequences. Often these conditions can be remedied or alleviated by helping your child get more sleep.

What are the most common parasomnias and what should you do, or not do, when your child is experiencing one? Let’s find out:

Sleepwalking

During a sleepwalking episode, the child may appear to be awake, wandering the home either in silence, mumbling, talking or yelling. As confusing as it can be to witness, the child is asleep and unaware they are sleepwalking. Sleepwalking can be dangerous if the right precautions are not taken to ensure a child’s safety, such as securing exterior doors, putting sharp objects out of reach and removing unstable furniture that they could bump into.

Confusional Arousals/Sleep Talking

Confusional arousals are variants of sleepwalking, where the child does not leave their bed.  During a confusional arousal, the child may look awake and cry, talk, point or even arrange their stuffed animals on the bed. Sleep talking can range from mumbling, to clear conversations, to yelling out.

Night Terrors

Night terrors, also known as sleep terrors, can be the most disturbing to parents of all of the parasomnias. Unlike nightmares that occur during REM sleep, night terrors happen during non-REM sleep. During a night terror, the child may continue to be laying down or sit up, appearing frightened and scream or cry. Their eyes may be open, but they do not appear to improve with calming interactions of the parent.

Parasomnias can be relatively common. According to the National Sleep Foundation, parasomnias affect approximately 16% of children. They occur in people of all ages but are more common in children and most likely to happen during non-REM sleep, within the first few hours. Interacting with your child in this state may prolong the episode or worse, prompt an irritable, aggressive or even violent response from the child. If they are sleep talking, having a confusional arousal or night terror and have not left their bed, check on them and if they are safe, leave them alone. The more we interact, the longer and more violent the behaviors can get. If they are sleepwalking, try to gently redirect your child back to bed.

Parasomnias can occur when a child is not getting enough sleep for their age. Children require much more sleep than we do as adults, but don’t always get it. Though children ages five and under require 12 hours of sleep per night (in addition to daytime naps), most families set bedtimes permitting only eight to 10 hours of sleep. Many children who suffer from parasomnias see an improvement simply by improving their sleep duration, for their age.

It is a common misconception that children outgrow parasomnias as they get older. The parasomnias improve as their sleep requirement decreases with age to meet the sleep schedule implemented in the home. Parasomnias may recur in adulthood when unforeseen circumstances cause us to be sleep deprived. So remember, enough sleep is crucial to maintaining a good, quality sleep for children and those who care for them!

Dr. Lili Poon is a fellowship trained pediatric sleep physician and the pediatric sleep medical director at Novant Health in Charlotte, NC. Dr. Poon completed her fellowship at Case Medical Center in Cleveland, OH, and did her pediatric sleep training at Rainbow Babies Hospital in Cleveland.

This blog was produced in partnership with Charlotte Parent. Click here for the original post and other parenting resources.

By Roy Lewis, MD, Charlotte Eye, Ear, Nose & Throat Associates

If you know someone with an allergy, chances are they’ve talked about needing an EpiPen. But what is an EpiPen and what does it do?

What is an EpiPen?

EpiPen is actually the brand name for a device that automatically injects epinephrine into someone having a severe allergic reaction, known as anaphylaxis. Epinephrine narrows the blood vessels and opens airways in the lungs, reversing severely low blood pressure, wheezing, hives and other symptoms. EpiPens are available in both adult and children’s doses.

Epinephrine is the first and most important treatment for anaphylaxis. While most commonly used for food or bee sting allergies, they can be used for any allergic reaction.

Auvi-Q is another brand name of auto-injectable epinephrine. Auvi-Q and EpiPens are not a substitute for medical treatment. If you have to use an EpiPen or Auvi-Q, seek medical attention afterward. Some patients with anaphylaxis will require more than one dose of epinephrine to resolve their reaction.

Auvi-Q and EpiPen Side Effects

Some side effects associated with epinephrine use include breathing troubles or severely high blood pressure. You may also experience an accelerated heartbeat, nausea, dizziness, tremors, or a headache. Some other medicines will affect an EpiPen, too. Discuss your other medications with your doctor before using an Auvi-Q or EpiPen.

Auvi-Q, EpiPens and Immunotherapy

Some patients with severe allergies receive immunotherapy. This is a regular series of treatments where patients are given gradually-increasing doses to increase their tolerance to allergens. In these cases, it is important for patients to have an Auvi-Q or EpiPen available.

Severe allergic reactions can be scary, and epinephrine injectors can be a good first treatment before receiving medical attention. But it’s important to remember that they’re not a replacement for proper medical care. Make sure you regularly discuss your allergy issues with your doctor and seek medical treatment when you need it.

This blog is for informational purposes only. For specific medical questions, please consult your physician. Dr. Lewis sees patients in CEENTA’s Mooresville office. To make an appointment with him or any of CEENTA’s ENT doctors, call 704-295-3000.

This blog was produced in partnership with Charlotte Parent. Click here for the original post and other parenting resources.

By S. Chad Hayes, MD, FAAP

Hand, foot, and mouth disease (HFMD) is a common illness in young children and a frequent reason for a visit to the pediatrician. Like the other cause of preschool panic (conjunctivitis, or “pink eye”), HFMD is typically a mild illness that causes a lot more worry than it should.

This illness can affect people at any age, but it is seen most frequently in preschool-age children, most often in the late summer or early fall. It can be caused by several different viruses—usually strains of Enterovirus or Coxsackievirus. So while most children will develop long-lasting immunity after an infection, they can still get HFMD again if they are infected by one of the other strains.

This viral infection can cause painful blisters in the mouth and a rash that often shows up on the arms, legs, and buttocks, in addition to the places you already guessed based on the name. The rash can look like red spots, blisters, or bumps, and it’s usually not itchy or painful. Many kids will have a fever as well.

For the vast majority of children, HFMD will go away by itself in about a week without causing any major issues. The most common complication is dehydration, which can happen if a child refuses to drink due to the painful mouth blisters. Dehydration can usually be prevented by treating pain with ibuprofen or acetaminophen and encouraging fluid intake (popsicles count!). Rarely, children who are unable to stay hydrated will need to be admitted to the hospital for IV fluids until the illness gets better. Other than that, there’s usually nothing else to do, because we don’t have any magic to make HFMD go away faster.

One little-known complication of HFMD is the loss of fingernails and toenails within a few weeks of the infection. Fortunately, this condition called onychomadesis is relatively rare. Even more fortunately, nails tend to grow back normally.

The viruses that cause HFMD can be spread by saliva, but more often, they infect new people via the “fecal-oral route.” This is a method of disease transmission that involves swallowing poop particles—an event that occurs far more commonly than most of us care to imagine. If you have trouble understanding how this could possibly happen, try volunteering at a daycare for a couple hours. Or keeping a handwashing log in the bathroom at your favorite taco shop. Or just trust me.

The best way to prevent the spread of HFMD is by good handwashing and hygiene practices, especially in places like daycares or preschools that deal with a lot of dirty diapers. This is far more important and effective than excluding kids with HFMD from daycare or school, because these viruses can be shed in the stool for several weeks after the rash resolves. Additionally, some people can be infected with these viruses without developing any symptoms, while stealthily spreading it to anyone who comes into contact with them…or, well, their poop.

Many parents are surprised to learn that HFMD shouldn’t keep kids out of school or childcare facilities. If a teacher or administrator tells you differently, try referring them to the guidance published by the North Carolina Department of Health and Human Services, which specifically says that exclusion is not required.

While HFMD is usually a mild disease that resolves without treatment, there are a few rare complications, as well as several other illnesses that can have similar symptoms. So as always, if you have concerns about your child’s health, contact your pediatrician’s office. Sorting those things out is what we do best.

Dr. Hayes is a pediatrician at South Lake Pediatrics, Huntersville, an Atrium Health Levine Children’s practice. His writing can be found on his blog at chadhayesmd.com and in several other publications, including the Washington Post and Newsweek.

This blog was produced in partnership with Charlotte Parent. Click here for the original post and other parenting resources.

By Michelle Capizzi, MD, and Sara Steelman, MD

As career emergency medical physicians, we know an unexpected trip to the emergency department can be overwhelming and anxiety-inducing for you and your child. There are several things you can do to either avoid a visit to the emergency department or make your experience less stressful.

Don’t Panic!

While you may feel scared and out of control, your child needs you to be brave. You are your child’s greatest comfort and biggest advocate. It’s amazing to see how a parent with a calm and assuring presence can help a child during emergency evaluation and treatment.

Be Prepared

One of the best ways to minimize your fears is to be prepared before disaster strikes. Have a first-aid kit in the home, take a CPR class and learn the Heimlich maneuver. Keep the number to your pediatrician, local urgent care and poison control center nearby. The mental calmness that comes from knowing you’ve done the prep work if your child ever experiences a medical emergency is invaluable.

Monitor Fever

Any infant under 2 months with a fever of 100.4 degrees or greater (measured rectally), needs a laboratory evaluation and is best served in a dedicated pediatric emergency department. Most pediatric offices have a nurse triage line designed to help you determine where your child would best be served by talking through their symptoms. If the nurse triage line is not available to you, your local healthcare system’s advice line offers this same evaluation.

Call Poison Control

If you suspect your child may have ingested something but is acting normal and seems okay, we advise calling poison control first. The poison control center is very knowledgeable and may save you a time consuming and expensive visit to the emergency department. Some household ingestions can be managed at home, but if you do take a trip to the emergency department, bring what you suspect was ingested (medicines, cleaning supplies, etc.) with you, along with any medications your child takes on a regular basis. That will help us determine what we need to do for your child.

Be Patient

If you do need to go to the emergency department, explain the process to your child beforehand to help minimize fear. Care is prioritized based on how sick your child is and is not determined on a first-come, first-served basis. This can be hard for some children to understand. The waiting can be long and feel frustrating. If possible, leave siblings at home. Grandparents, aunts, uncles and cousins are great, but will not benefit in the evaluation and treatment of the child. One or both parents is really all that is needed.

Take Notes

Bring a pen and paper so you can take notes and write down the names of those caring for your child. If you are having trouble understanding a condition or diagnosis, ask your providers to draw or diagram. And yes, you can ask a million questions. We don’t mind.

Know that as pediatric emergency physicians, we have dedicated our professional careers to caring for sick and injured children. We love what we do. We love the resilient and open nature of children. Seeing a child get better and have a positive experience in our emergency department is why we come to work every day.

Michelle Capizzi, MD, is a board-certified pediatric emergency medicine physician with Novant Health Hemby Children’s Hospital Emergency Department. She has 20+ years of experience in pediatric emergency medicine and is a mom of five.

Sara Steelman, MD, is a board-certified pediatric emergency medicine physician and medical director of Hemby Children’s Emergency Department. She has 25+ years of experience in pediatric emergency medicine and is a mom of three.

This blog was produced in partnership with Charlotte Parent. Click here for the original post and other parenting resources.

By Maria Baimas-George, MD, and Daniel Bambini, MD

You walk into a doctor’s office with your child. Your child is really sick and you’re scared. After all the tests are complete, the doctor walks in and proceeds to use words like appendicitis, leukocytosis, ultrasound, periappendiceal fat stranding, vestigial, laparoscopic, dermabond, etc. You try to keep up, but the more he speaks, the less you understand. Unfortunately, this can be common.

Medical doctors go to medical school for many years to learn this language. Throat pain becomes dysphagia; an ingrown toenail becomes onychocryptosis; and bed-wetting is elevated to nocturnal enuresis. Doctors get accustomed to using fancy words when describing even the simplest of things and sometimes forget that this is not a language known to everyone. Even if a doctor does a great job of explaining a serious illness or painful prognosis, a parent’s understandable fear — maybe even shock — means he or she needs time to process and be ready to comprehend what is being explained.

When these things happen and parents do not speak up or ask questions, inevitably they turn to Dr. Google, and that’s where miscommunication gets even worse. The internet is a wonderful resource, but it can contain incorrect or contradicting information, which can be detrimental in effectively advocating for your sick child.

Pediatric surgeons spend a lot of time explaining complex medical issues to parents and children, and find that regardless of the topic or complexity, it is best to start from the beginning and try to tell a story. Let’s use appendicitis as an example.

What is normal?

We first explain what is normal and what the appendix does in the body. “Once upon a time, there was a healthy appendix that did nothing but nap like a cat…”

Where is it?

We explain the anatomy, what the appendix looks like and where is located. We also incorporate drawings for visual learners. (Unless you’ve dissected a human cadaver in an anatomy lab, it’s difficult to envision the location of the appendix.) For those who are not artistically talented, there are computer and tablet apps that work well.

What went wrong?

Next we explain why the appendix is hurting your child. (Appendicitis occurs when this small finger-shaped organ becomes infected.) We assure your child that there’s nothing he or she did to make the appendix become infected; it just happens. In rare cases the appendix ruptures (or pops) like a balloon!

How are we going to fix it?

It’s our hope that these stories have a happy ending, so that’s how we explain it. The standard treatment for typical appendicitis is a short, simple operation to remove the appendix. With very small, specialized tools and scopes, we can remove an infected appendix with a few small incisions.

If you are working with a medical professional who is speaking “Greek” to you, remember:

• It is OK to interrupt and say, “Hold your horses, that word makes no sense.”
• Don’t be afraid to interrupt and ask questions. Ask for more detail or a visual until you understand.
• Repeat it back. Tell the doctor what you think he or she has said.
• Take notes! We even have parents in the health care field do this when it’s their child who is the patient. When your child is hurting and you’re scared, nervous or overwhelmed, even your own medical training can take a back seat.

Maria Baimas-George, MD, MPH, is a surgical resident who works with and is mentored by Pediatric Surgical Associates at Carolinas Medical Center.

Daniel Bambini, MD, is a board-certified pediatric surgeon with Pediatric Surgical Associates in Charlotte.

This blog was produced in partnership with Charlotte Parent. Click here for the original post and other parenting resources.

By William T. Chirico Jr., OrthoCarolina

The warm breezes of the summer months beckon children to play outdoors, burn off energy and get some fresh air. And in our modern era of video games, tablets and mobile devices, any alluring outdoor plaything that grabs kids’ attention will typically get parent votes, too.

But then your children see the neighbors’ kids jumping on their new trampoline, and come running to ask you if they can jump too. Sometimes the group on the trampoline is more than just one or two in number, and suddenly you envision a horde of ten kids screaming with delight, bouncing in close proximity. The what ifs race through your mind as your anxiety levels start to spike. As a parent, how do you respond?

As a physical therapist I never want to discourage children from getting exercise or that feeling of freedom and fun that comes from the joy of jumping on a trampoline. So here’s the low down about the injuries that typically happen and how to best avoid them.

It’s probably not a surprise to hear that most trampoline injuries happen as the result of children colliding with one another, tripping on the trampoline springs or frames, falling off the trampoline or attempting stunts that go awry. Most injuries happen to the leg or foot, followed by the arm or hand, and then the head/face/neck/shoulder/trunk area.

The Consumer Product Safety Commission (CPSC) is a governmental organization tasked with protecting consumers and families from dangerous products and working to ensure the safety of consumer products. They are considered the gold standard when it comes to checking product safety, especially by brand. The CPSC also sets consumer use guidelines for products like trampolines.

Here are some suggested safety guidelines for children using trampolines, and you can find the CPSC’s full set of trampoline recommendations on their website.

1. Use a trampoline net enclosure to prevent falls.
2. Ensure that trampoline padding covers all frames, hooks and springs.
3. Strictly prohibit children younger than six from jumping on trampolines over 20” tall.
4. Do not buy or use a ladder for your trampoline in order to prevent children under six from accessing ladders.
5. Closely supervise children at all times.

Obviously, part of the fun of jumping on a trampoline for kids is playing with their friends. And while in an ideal world the safest way to jump is one [child] on, one off at a time, we as parents know that’s not realistic. When children jump together try to make sure the children on the trampoline are similar ages in age and size. To accomplish this, consider having the children take turns or jump in shifts with another fun activity planned for those waiting for their turn on the trampoline.

An alternative to consider to backyard trampoline jumping is indoor trampoline parks, which can be found in many cities and offer a somewhat safer option to expel energy while still having fun. Indoor trampoline parks can put kids at risk just like outdoor trampolines would, but actually tend to have relatively low injury rates overall. According to Forbes.com these facilities actually have less frequent injuries than more common forms of kid recreation like baseball, soccer and football.

Most outdoor activities involve human bodies in motion, so any outdoor activity can be dangerous under certain conditions. Trampolines can provide fun and exercise for our children as long as we follow proper safety guidelines. Take the time as a parent to be knowledgeable on trampoline precautions, making sure you are familiar with the specific brand or product in use. Educate your kids on how to properly and safely participate in the activity. Have fun jumping!

William T. Chirico Jr., DPT, Cert MDT, Cert DN is a physical therapist with OrthoCarolina Monroe. 

This blog was produced in partnership with Charlotte Parent. Click here for the original post and other parenting resources.

Appendicitis is the most common reason for emergency surgery in children. About 8 percent of Americans suffer appendicitis during their lifetime. While appendicitis can occur in adults, the majority of cases occur in children between the ages of 6 and 16 (about 80,000 kids per year in the United States).

What is the appendix?

It’s a small finger-shaped organ that is attached to the end of the large intestine. It’s not clear why we have this appendage. There is evidence to suggest that early humans needed it to aid in digestion, but today the appendix has no known function. Appendicitis occurs when this organ becomes infected.

Kids have belly pain all the time for a wide variety of reasons: gas, too much ice cream, stress or viruses (“G.I. bugs”). Unlike other causes of abdominal pain in children, pain from appendicitis is unrelenting. It doesn’t come and go. Appendicitis is progressive, evolving from mild, achy pain to more severe over a period of 24-48 hours. Pain is typically the first sign, preceding other possible symptoms, such as nausea, vomiting, loss of appetite and low-grade fever.

Appendicitis pain starts in the middle of the belly and migrates to the right lower abdomen where the appendix resides. Movement worsens the pain. Children with appendicitis tend to hold still. They don’t want to walk, sit up, twist or turn. Classically, they complain about bumps in the road on the car ride to the hospital. When a child with appendicitis is lying down and relaxed, a gentle push on the lower right side of the abdomen always causes pain — called “right lower quadrant tenderness” by the doctors.

OK, now I’m worried about appendicitis. What should I do?

The first step is call your pediatrician’s office. Their team listens to the symptoms you share and can make a decision. Sometimes a quick visit to the pediatrician’s office can rule out appendicitis. If it’s outside of normal business hours or the suspicion for appendicitis is high, you may be directed to an urgent care or emergency department.

Here in Charlotte, we are fortunate to have two excellent pediatric emergency rooms, one at Levine Children’s Hospital (at Atrium Health Carolinas Medical Center) and one at Hemby Children’s Hospital (at Novant Health Presbyterian Medical Center). Each of these facilities is staffed by pediatric emergency physicians and nurses who exclusively care for children. Our recommendation is to have your child evaluated at one of those facilities, rather than an outlying urgent care or suburban emergency department where pediatric expertise may or may not be present. Though it might be a 15-minute further drive, your child will receive the best, most specialized care. And if it turns out your child does, in fact, have appendicitis, a time-consuming and expensive transfer to a children’s hospital is not required.

How is appendicitis diagnosed?

The diagnosis of appendicitis takes into account the story of the child’s illness, the characteristics of the child on physical examination, laboratory values obtained with a blood draw, and the results of radiologic studies, like ultrasound or CT scan. Most children with appendicitis do not require a CT scan for diagnosis.

How is appendicitis treated?

The standard treatment for typical appendicitis is a short, simple operation to remove the appendix before the appendix ruptures, which rarely happens until symptoms have lasted over 72 hours. Although the thought of an operation is scary, it needn’t be thanks to laparoscopy, or minimally invasive surgery. With very small, specialized tools and scopes, pediatric surgeons can remove an infected appendix with a few small incisions. The average procedure time is less than 30 minutes, and most children go home within six to 12 hours of surgery. Yes, often the same day!

After an appendectomy, kids have some achy discomfort from the operation that diminishes over three to five days, and athletic activities are limited for one to two weeks. The risk of any major complication following appendectomy for typical appendicitis is very low (less than 1 percent). Studies have been performed to determine if some children with appendicitis can be safely treated with antibiotics alone and not surgery. Complication rates in children treated without surgery are unacceptably high compared to children treated with surgery, so laparoscopic appendectomy remains the standard treatment for children with typical appendicitis.

In about 20 percent of cases, the appendix is perforated at the time of diagnosis, which means there is a small hole in the wall of the appendix. This is also known as a ruptured or burst appendix. When it occurs, the infection from inside the appendix leaks out into the abdomen. Children experiencing this condition usually have a longer recovery and are best treated with an extended course of antibiotics.

Many children with perforated appendicitis receive surgery at time of diagnosis, but sometimes, if the appendix has been perforated for an extended period of time, the best treatment is initially just antibiotics, followed by interval appendectomy after the infection resolves. Interval appendectomy is usually out-patient surgery performed eight to 12 weeks after the initial diagnosis.

For many parents, appendicitis is their first exposure to pediatric surgery. They may not know what to ask when a surgeon is referred to them. Remember that it is your right to choose the surgeon who operates on your child, and you should feel very confident in your pediatric surgeon’s abilities. To ensure the best outcome, look for a board-certified pediatric surgeon. Then ask as many questions as you need to feel comfortable.

The surgeons of Pediatric Surgical Associates have made important contributions to the improvement of appendicitis management in recent years, publishing data in the surgical literature on multiple subjects, including the minimization of CT scan radiation, more efficient diagnosis, better antibiotic stewardship, and streamlining the recovery and discharge process for children with appendicitis.

This blog was produced in partnership with Charlotte Parent. Click here for the original post and other parenting resources.

By Anna Schmelzer, MD, and Thomas Schmelzer, MD

One of the reasons we love pediatrics as a focus is the joy of seeing our patients grow before our eyes. Their waiting room experience is very telling. First, there are the babies that can sit in the car seat while parents read a magazine. Then come the toddler years when drawing them away from the fish or toys to go see the doctor literally is a feat of strength. The school-aged children are sometimes working on homework or reading a book. (Although let’s be real, they are usually utilizing some electronic device to bide their time.) But there is an age when most patients look around the waiting room and think: What am I doing in this room filled with babies?

Pediatric care encompasses physical, developmental health, as well as mental and psychosocial health, and can extend from the time of conception through early adulthood. The decision to transition to an adult provider can be complicated, especially in the presence of a chronic medical condition. The American Academy of Pediatrics has published guidelines outlining the age of 21 as the time to transition, but recognizes exceptions to consider on a case-by-case basis. Following are considerations for deciding when to transition away from a pediatrician to an adult physician.

What to Expect From Your Child’s Pediatrician

Pediatric providers help prepare your child a transition to an adult physician. Pediatricians should begin talking to patients in private sometime in the early teen years. Just like learning to pay bills or pump gas, an adolescent needs to learn to tell their own story and start to practice advocating for himself or herself. The provider can also help guide you, as the parent, if there are any considerations as described below.

The pre-college exam is a nice time to start the discussion of other resources if it has not already been addressed. Whether it is the student health options on campus, or mental health support provided by their school, college students need to know that they have other avenues open to them. We recommend starting the dialogue with your child and pediatrician in late high school to see what fits your specific child’s needs.

Most pediatric primary care and specialty groups have general, but not absolute, age cut-offs. For instance, Charlotte Pediatric Clinic sees its patients through college or until the age of 22. All the surgeons at Pediatric Surgical Associates are double boarded in both pediatric and adult general surgery. PSA sees patients through college or age 22, but this depends on the specific need. On the other end, internal medicine groups may not see patients younger than 18.

Chronic Medical Conditions

When chronic conditions are present from birth or at a very early age, they are managed by pediatricians and pediatric specialists. Examples would be congenital heart disease or cystic fibrosis. Once a child is older, finding an adult specialist can be difficult. For this reason, the pediatric specialist may continue to manage care beyond 18 or 21 years of age. They often, however, can help find a physician to transition your care to when they time is appropriate.

For some other diagnoses, the opposite is true. Chronic conditions that arise during early adulthood may be better managed by an adult specialist and possibly an adult primary care physician sooner than 18 to 21. If this is the case, it may be beneficial to transition care for this newly diagnosed disease to an adult specialist rather than starting care with a pediatric specialist and needing to change doctors in a year or two.

Changing Needs of the Patient and Sexual Health

Situations such as the need for gynecologic resources is a good example of transitioning earlier to streamline care. Individual pediatric groups have different approaches when it comes to contraception or management of sexual health. If patients need care in these areas, especially if they are close to the age the practice generally transitions, that could be a turning point. It may be more useful to transition to an adult primary care physician who can pick up the role of health maintenance, but also address the specific issues that are more likely to arise in the older patients.

Consent for Treatment

Age of consent is another issue to consider. Once 18, a child can legally sign consent for treatment and surgical procedures. For instance, after turning 18, the patient is asked to sign the forms for vaccines or procedures despite still being with a pediatric practice.

Mental Health

As children grow up, they have more adult feelings and needs from a mental health standpoint. Despite a pediatrician being perfectly capable and qualified to address these concerns, your child may not feel comfortable discussing these certain topics with the provider who has seen him or her throughout childhood. If a referral needs to be made to a psychologist or psychiatrist, there may be more availability with the providers who see primarily adults if the patient meets the minimum age requirements.

Insurance Considerations

There are some instances when insurance does not cover visits to a pediatrician or pediatric subspecialist when the patient is over age 21. This is policy-specific and worth a look as your child gets older.

The timing of transitioning from pediatric to adult care varies slightly depending on the needs of the individual patient, as well as the general age set out by the pediatrician. From day one, a pediatrician’s goal is the same as yours: to help set babies up to be the healthiest adults possible, even when they have “outgrown” pediatric care.

Anna Schmelzer, MD, is a board-certified pediatrician at the SouthPark office of Atrium Health Levine Children’s Charlotte Pediatric Clinic, and Thomas Schmelzer, MD, is a board-certified pediatric surgeon at Pediatric Surgical Associates. They are married and have two children.

This blog was produced in partnership with Charlotte Parent. Click here for the original post and other parenting resources.

Dr. Walid Eltaraboulsi, Tryon Medical Partners

Though the use of electronic cigarettes (e-cigarettes) among teenagers was essentially non-existent five years ago, it has risen to epidemic proportions. How did we get here? How bad is it for your adolescent or teen? How do you talk to him or her about it? Let’s start with the basics.

What is an e-cigarette?

An e-cigarette is a cigarette-shaped device that heats liquid into an aerosol that the user inhales. In addition to flavoring, the liquid usually contains nicotine, which is highly addictive. E-cigarettes are considered tobacco products because most of them contain nicotine, and nicotine comes from tobacco. Using an e-cigarette is called “vaping.”

In the last few decades, we have seen tremendous progress in our nation’s addiction to tobacco cigarettes. In fact, the percentage of tobacco smokers was at an all-time low last year and that is great news! Unfortunately, e-cigarettes usage rates among middle and high school students in the United States have increased tremendously in the last five years. Commissioner of the FDA, Scott Gottlieb, has called the surge in electronic cigarette usage in the teenage population an epidemic. In 2018, one in five high school students reported using e-cigarettes in the last month.

What are the health risks?

Brain risks: The brain is known to grow and develop until the age of 25. Nicotine can affect the way certain connections form within the brain, which can harm parts of the brain that control attention and learning. Among other concerns of exposing developing brains to nicotine are nicotine addiction, mood disorders and lowering impulse control.

Respiratory health risks: A recent study from Duke University shows asthma-like symptoms from smokers of e-cigarettes. Another concern is a disease related to the diacetyl compound from flavoring in e-cigarettes, known as popcorn lung or bronchiolitis obliterans. Scientists are still studying the health effects of the various other compounds found in e-cigarettes.

Use of other tobacco products: E-cigarettes among youth and young adults are linked to the use of other tobacco products such as cigarettes, cigars and hookahs. Some people have suggested that the use of e-cigarettes among teens may protect them from smoking tobacco cigarettes. There is no evidence for this claim. Nearly three out of five high school smokers also use e-cigarettes.

What can you do to protect your child?

The surgeon general has a great website dedicated to opening up the conversation between adults and their children about e-cigarettes. These are the tips I find most helpful for parents:

• Find the right moment. A more natural discussion will increase the likelihood that your teen will listen, rather than saying “we need to talk.”
• Be patient and ready to listen. Avoid criticism and encourage an open dialogue. Don’t lecture.
• Set a positive example by being tobacco-free. If you use tobacco, it’s never too late to quit. If you have trouble quitting, talk to your doctor and ask for help.

Despite the increasing usage of e-cigarettes among young adults and accompanying health risks, there are some encouraging signs that we, as a society, will not let e-cigarette use cause the same kind of damage as tobacco cigarettes. The FDA and surgeon general have recognized the problem early and released position statements. We have non-profit organizations developing anti-vaping commercials targeted to young adults.

And you are not alone! As a parent, you have access to many resources to start a conversation with your child and keep it open and on-going, helping your family be smoke-free.

Dr. Walid Eltaraboulsi is a board-certified pulmonologist at the Ballantyne location of Tryon Medical Partners, and is an expert in e-cigarette use among adolescents and teens. He holds a board certification in Critical Care Medicine. He has a Masters of Public Health and is getting his Masters of Business Administration.

This blog was produced in partnership with Charlotte Parent. Click here for the original post and other parenting resources.