Maggie McKay (Host): Welcome to Total Health Talks, your Cook County Health podcast, where we empower your journey to better health. I'm your host, Maggie McKay. And today, we're going to talk with Dr. Denise Cunill, Associate Medical Director of Ambulatory Pediatrics at Cook County Health and lead provider of the Belmont Cragin Health Center, about healthy minds and bodies for back to school. Thank you so much for joining us.

Denise Cunill, MD: Thank you, Maggie. I'm excited to be here with you.

Host: Yeah, I can't wait to hear more on this topic. The back-to-school rush is upon us and kids are picking out backpacks, new shoes, preparing to meet their teachers and, oh wait, parents are scheduling back-to-school physicals right now. What is the type of things parents should discuss with their child's doctors during these appointments?

Denise Cunill, MD: So, back-to-school physical time is actually a wonderful opportunity to do a well-child checkup, especially if a family hasn't had an opportunity to schedule a well-child checkup. A well-child checkup could be included with back-to-school physical visit. And actually, we prefer to do back to schools separately, but it's a wonderful opportunity to catch up on checkups.

So, one of the first things that I would recommend is scheduling the appointment. It's really hard to see a family for such a comprehensive visit on a walk-in basis, but it is possible as well. The reason why we want you to schedule the appointment is because if, for example, the patient or the child, the children have multiple medical issues, it's going to require a little bit more comprehensive interviewing. And we definitely want to make sure that we have the right timeframe set out for the appointment itself. So, scheduling appointment is number one.

Number two, have any forms that you need filled out or completed by the provider ready to roll. And it's so much more appreciative also if you can bring them to the clinic even before your visit. That way, the provider and the staff, your medical home has time to prep for the visit because providers and staff members may have questions for the parents regarding the forms. So, that's the second thing. So if you have any special forms that need to be completed, if you have any children with multiple medical issues, asthma, diabetes, or any special needs, and there are forms that are necessary on an annual basis, if you can take them to your medical home prior to the appointment, It would be so appreciative.

Thirdly, really important that if you've gone to any emergency rooms for any type of issues, bring those discharge summaries. We want to know what has happened because you are part of the medical home, and we want it to be a patient-centered experience, meaning that we want to be able to service all of your needs.

And then, lastly, if you have been started on any new medications from any specialty appointments that you've had while we haven't seen you. So, that's pretty much the bread and butter of our asks, Maggie. But if you just schedule an appointment, we'll figure it all out.

Host: Yeah. So, how should parents and caregivers prepare their children for the appointment?

Denise Cunill, MD: So, the first thing is please don't tell them that they're going to get shots. We're just setting the situation up to not end well. And the thing is that, depending on the age of the child, they may not get any immunizations. They may not be due for any vaccinations. So, just being as honest as you can. "Hey, we're going to see Dr. Cunill tomorrow. You're getting your checkup to go back to school."

Secondly, what we really want is to be able to continue to foster a relationship with the child and to build that confidence. And so, if the parent does know that the patient is due for immunizations, be honest with them. They want to know, are we going to get any shots? And the honest answer from the parent may be, "I don't know, but we'll figure it out together."

Host: So, let's talk about vaccines, because that's always a hot topic. What do you say to those who are maybe hesitant about getting their children vaccinated?

Denise Cunill, MD: So, vaccinations, immunizations have been a part in the framework of preventive care, period, the end. And we know that vaccinations are one of the first, if not utmost important factors in preventing illnesses and diseases that potentially in the past have led to death. And we know that our immunization schedule is such that it is based on science and fact that all of the immunizations that we provide children and adolescents, including adults, are necessary in order to prevent morbidity and mortality.

So when we have families that are hesitant in providing immunizations, the most important element in discussing vaccine hesitancy is understanding what the family's experiences have been that have led them to that opinion that vaccines may not be right for their child and their family. And so, having that open conversation will really allow a free-flowing conversation with the family to better understand where they're coming from. But also it's okay for me, as the provider, to first ask permission. Because if a vaccine-hesistant family may not be ready to discuss their experiences, I have the opportunity to provide another appointment with them to continue the discussion.

Host: Why are vaccines needed for diseases that we don't see much of anymore?

Denise Cunill, MD: The reason why we don't see diseases anymore is because vaccines work. And it's hard sometimes for vaccine-hesistant families and caregivers to understand that concept. But when we do review history as fact, we know that it is because of immunizations that we don't see these diseases anymore. And it is when we don't provide the immunizations and don't provide enough vaccinations that there are illnesses that creep up. For example, measles. For example, chicken pox. There's a reason why we have the immunization schedule the way that we have it, it is to prevent disease.

Host: Can parents delay or skip some vaccines?

Denise Cunill, MD: So, the recommendation is to follow the immunization schedule as closely as possible, because that's what science has been based upon. The schedule is such that it is necessary to receive those vaccines at the given age intervals, because that is what we have studied. And we know that what we have studied has prevented disease and have prevented associated deaths.

So to break the schedule up into a shot here and a shot there, it's not the most recommended way in providing the best preventive healthcare for the child or the adolescent.

Host: And aside from physicals and vaccines, what other things should parents think of when they're at the appointment?

Denise Cunill, MD: It's really age dependent. So during a typical well-child visit or back-to-school visit, in general, we want to understand the behavior and development of the child, depending on the age. But also, we want to know about their nutrition. We want to know about their physical activity. And especially these days, we want to know about screen time, whether that be on their individual phones or the parents' phone. We want to know about the tablet time, all of that counts; computer time, all of that counts. We want to know if you went to the dentist, okay? Because back to school is about getting our healthcare back in check. And that means visiting the dentist. That means getting our eyes checked. And sometimes, it means, "Hey, it's time to go get a haircut." It's all part of natural behavior and development.

Host: Dr. Cunill, was there a doctor when you were little that influenced the way you now deal with children at wellness visits?

Denise Cunill, MD: Actually, there was our family doctor, Dr. Latifa, who was Cuban, my dad's Cuban, my mother's Mexican. And every year, back to school time, we would go visit Dr. Latifa. And something called out to me to explore medicine. And I had always been intrigued by science and biology and seeing someone in that role influenced me that I wanted to also take part in that piece of my community and give back to my community by becoming a pediatrician and letting my patients know that anything is possible and everything is possible. And so, when I meet with my families, I meet with them with a perspective of culture and language, that they also share in common with me. And so, knowing that I too had issues with reading, I learned at a very subjectively older age, I didn't learn how to read until I was in first grade. I can really understand sometimes the challenges that my patients face with learning disabilities.

And so, back-to-school visits, that may be our only opportunity to understand what the patient has experienced as a student and to help lead that family in advocating for more services for their child. And me as an adult, as a pediatrician, as a Cuban-Mexican-American physician here, I want to be able to provide that service for our families.

Host: And what can parents do to help lessen their children's anxiety about returning back to school or even starting school?

Denise Cunill, MD: Firstly is routine, like let's get our sleep schedule back on check, okay? We're outside playing all day. Maybe, in the evening, watching lots of TV. And all of a sudden, before we know it, it's like 11:00 at night when normally I go to sleep at eight. So, getting back on track with regards to sleep hygiene, so trying to go to sleep little by little at the same time that you would during a normal school year and waking up as well, number one.

And number two, as part of that routine, start getting in those three meals. With our time clock changing and our sleep schedule changing, maybe we're not eating those three meals like we do usually during school.

And then, lastly, again, getting back to the habit. Let's take out our timetables. Let's take out some books. Hopefully, they would've been doing a little bit of homework or a little bit of fun reading, fun math, fun science during the summer break. But if they didn't, let's start using that other piece of our brain that we haven't tackled since June.

Host: Any advice for a parent or a caregiver of a neurodiverse and/or special needs child on how to practice advocacy for equity and inclusion?

Denise Cunill, MD: So again, during our back-to-school visits, we want to know what happened last year academically. And if we do have neurodiverse patients, if we do have children with different learning styles or learning disabilities, if they have not received the services that they've needed, if we find out that they went to summer school and there was no explanation, they were just mandated to go to summer school, that's our opportunity to talk to the parents a little bit more in detail what did you see? What did you experience working with them doing their homework?

And we, as pediatricians, pediatric providers, we can provide a letter in advocating for an evaluation to be attached to the school physical. And so, the families can then complete the packet and present that to the office on registration date or on first day of school and start the process of receiving an appropriate evaluation. That's why back-to-school visits and well-child visits in general are so very important because it's not just about examining a patient and finding out how they're growing and how tall they are and what shots they need, but it's about how are we doing socially, how are we doing academically because we want our children to succeed.

Host: Anything special that parents should prepare for when their children are entering high school or maybe transferring schools?

Denise Cunill, MD: So, the first thing is I want us as the adults to think about how do we feel when we're starting a new job? Because that's the same type of experience that children have in teenagers have when they're changing their environments, and there's pressure. And so, one of the first things that I would recommend in this type of scenario is keeping that line of communication open and watching for any type of behavioral changes.

It's a huge jump going from elementary school to high school. It's a whole new world, lots of new pressures. And one of the things that us, as parents and caregivers, can do is reassure them that you're going to have some really great days. You really are. And you may have not such good days, but it's on those such not good days that you're going to learn other things to get through, to help you understand where your place is in this new world, in this new school.

And so, most importantly is keeping that line of communication open. Getting to know their friends, getting to know other parents of their friends and especially when we're transitioning to a new school or a new high school, is understanding what type of programs, after-school programs, because the more comfortable the child has or the teen has in being in the environment, the more successful they're going to be throughout the entire process of transition.

Host: I love the comparison to adults with a new job. It's not easy. So, just to wrap things up, what can parents be doing now to ensure a healthy school year? And do you have any strategies for keeping our immune system strong while we're at it, for keeping from getting sick as much as possible as we go back to school?

Denise Cunill, MD: So, we all know that back-to-school means cold season. We're all going to get the sniffles, especially our little ones. If they've never been to daycare, it's normal to have a cold almost every month as a child getting into school or getting into daycare, pre-K. Most importantly is learning how to wash your hands appropriately. That's the first thing, okay? And whether that be with hand sanitizer or actually learning to wash your hands with water and soap, most importantly, hand hygiene.

Secondly is nutritionally having a well balanced diet, okay? We just ended summer, maybe we were drinking a lot of juice, a lot of soda. And we were in Chicago, it's been very hot and humid. Gatorade and Power Aid and all those other sport drinks have probably been the mainstream for a lot of families. But getting back to basics, water, milk, our fruits and veggies. So, very important to help our immune system and to stay strong.

And then, lastly, I would say you need to get your sleep. We need to get that sleep schedule on target. And we joke about teenagers being gentle giants because they sleep a lot. There's a reason why they sleep. Let them sleep with the appropriate timeframe of going to bed early and waking up early. So, depending on the age of the child's sleep is a hundred percent a vital piece of staying healthy.

So to recap, hand hygiene, nutrition, sleep, and very important, visiting your provider, visiting your medical home so that you can be up to date with your immunizations. Not just your typical and regular childhood immunizations and adolescent vaccinations and immunizations, but we're talking about seasonal flu, seasonal COVID-19 immunizations, so very important.

And we can't forget our patients with medical issues that could potentially impact their immune system, including patients with chronic illnesses such as diabetes, asthma, or immunodeficiencies. Immunodeficiencies is a long medical term for saying that your immune system might be a little weak. Those patients may actually need other types of vaccinations to help keep them healthy. So, it takes a lot. But it's something that's necessary and that's why you need to go visit your provider. Because it's not just about filling out a form, it's about prepping for success and to be healthy, as healthy as we can be throughout the year until next summer.

Host: Absolutely. Thank you so much for sharing your expertise. This has been very educational and helpful, especially right before back to school.

Denise Cunill, MD: Thank you, Maggie. It was my pleasure.

Host: Again, that's Dr. Denise Cunill. To find out more, please visit cookcounty health.org/podcast. As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast, share and connect with us on social media as well. Stay tuned for more engaging discussions. This is Maggie McKay signing off from Total Health Talks. Stay well.