#WellnessWeds: Ask an Expert: Questions about Kids' Health with Dr. Mark Ryan
Recently, MomsRising hosted a #kidshealth tweetchat with Dr. Mark Ryan (@richmonddoc), who answered your questions about everything from childhood asthma to breastfeeding to first dentist appointments, and more! Dr. Ryan is a family doctor in Richmond, VA and a member of the board of the National Physicians Alliance. He works mostly with medically under-served communities, and previously spent four years in a rural practice. Half of his current patient care is focused on pediatrics.
Here are a few commonly asked questions about kids' health, with expert answers and resources from Dr. Mark Ryan. Though he is an expert, his answers should not replace your doctor's advice.
Can children grow out of asthma?
A: It isn't so much that kids "grow out" of asthma--once present, the diagnosis is there for life. But there are often less side effects as kids grow. This might be because kids get more tolerant to irritants, allergens,etc. It also could be because their airways are larger, which leads to fewer side effects. Many of us outgrow the worst of the symptoms, but not the actual diagnosis. There's still a risk of triggering side effects as you get older. Here's more information about asthma: http://t.co/z61d5qiz
My kids complain that bodyparts hurt for no apparent reason. Are there growing pains?
A: Aches and pains can be growing pains, but can be a lot of other things: muscle/bone disease, stress fractures, etc. Even though we don't like to think about it, there is also a risk of bone cancer in kids; not all pains are innocent. Growing pains usually occur at night--they don't stop kids from running and playing during the daytime. I worry when kids stop playing, when they don't get better with easy measures (Tylenol, etc), and if there are other warning signs like fever, weight loss, limping, decreased activity, or any recent trauma that could have led to harm. Click here for more information on growing pains from the Mayo Clinic.
What can pediatricians do to support breastfeeding among new mothers?
Ask about how things are going. Be a resource to moms who are nursing. Use lactation consultants' help when able. Start asking about breastfeeding during pregnancy if possible and discuss the benefits in advance. You also need to acknowledge that it isn't always easy and help predict and prevent rough patches. Visit the Mayo Clinic website for more information on breastfeeding.
My 14 year old son seems exhausted a lot. How common is that for teens and how long will it last?
A: Not to be vague and/or scary, but fatigue as a symptom really merits a visit to evaluate in greater detail. A possible diagnosis could include mood issues, sleep issues, systemic illnesses (lupus, anemia, liver disease, kidney disease), etc. Often times fatigue is related to sleep issues (especially sleep apnea), but also it can be related to mood disorders, such as depression.
So fatigue could be more than just a teen thing?
Absolutely: fatigue is one of the more common complaints in primary care. Frankly, we rarely see physical source. I'm going to punt on this one: fatigue in any person is a hard thing to pin down; nearly impossible without a face-to-face evaluation.
When should kids start going to the dentist? Some say wait till age 3, others say as soon as they have teeth.
A: It depends who you ask. The American Academy of Pediatrics doesn't set a tight recommendation, but they do suggest that all kids see a dentist by age three, or sooner if they have any problems. I've started moving towards recommending dental visits at one year: so long as insurance covers it and parents can afford it, there's no harm in early care. In global health, we'll apply fluoride varnish to any kid w/ at least one tooth; if it works there, why not here? Here's some more information on pediatric dental visits: http://t.co/fhOlBf2z
I read that due to the obesity epidemic, it's no longer advised to give small children whole milk. True?
A: We still transition kids at one year over to whole milk. Probably after they turn two, it's okay to switch to low-fat or skim milk. A recent study showed that there's no harm using 2% milk instead of whole milk for toddlers if needed, but I still use whole if possible. There is a thought that the fat in whole milk helps w/ neurologic development of toddlers, but not clear if that is true. So, at one year I still recommend whole milk (as does our WIC program); if the child is in a high weight percentile or increasing, then I advise 2%.
Should kids transitioning from breastmilk or formula switch to lowfat milk and skip whole milk?
A: I think that is premature. I think whole milk is likely still the standard practice; lowfat if overweight.
Eye exams aren't covered by our insurance. How can our kids get checked?
Often, vision issues come to our attention because teachers notice kids struggling in the classroom. Sadly, if the professional eye folks are unable (or unwilling?) to do it--or insurance won't pay--someone must do it.
Usually, if people need eye checks and insurance won't pay, I'll often refer them to low cost eye clinics for an evaluation. Alternately, if a local group (like the Lions Club) is doing vision outreach mission, then you can refer kids there. Sometimes there are community organizations that help w/ eye screenings in school; often only for youngest kids. Unfortunately, like much of our system, we need to find a work around to address lapses in insurance coverage.
Are visions checks included in basic benefit package per the Affordable Care Act (ACA)?
A: Vision screening is a Category B recommendation by the U.S. Preventive Services Task Force (USPSTF). They should be covered should be covered by the ACA: http://t.co/veRxCt7V
From your clinical experience, what's the most important policy change that would improve?
A: One magic policy change? Take health seriously, and build all public policy with that in mind. We need to take nutrition seriously, make safe exercise available, and focus on education for all kids! It's too bad too many schools are cutting Physical Education and have choices of unhealthy foods on campus. We can do better.
Any recommended books or websites to turn to for prevention and wellness advice?
A: I don't have any single recommendations. I make great use of the American Academy of Pediatrics website and resources. I like the Mayo Clinic website and FamilyDoctor.org because they're bias-free, patient-friendly, and readily accessible.