Michael Anderson (Host): Hello everyone, and welcome to this episode of The FortCast, the official vodcast of Fort Healthcare. I am the host, Dr. Michael Anderson, President and CEO of Fort Healthcare. And with me today is a woman who doesn't need an introduction, but I'm going to give her one anyway, and that's Heidi Jennrich, our wonderful nurse practitioner in our pediatric clinic. Heidi, welcome to this episode of The FortCast.

Heidi Jennrich, APNP: Thank you for having me.

Host: And I see you're kind of swimming in the sea there. I love that background. It looks great. Tell us a little bit about how long you've been with Fort Healthcare, Heidi.

Heidi Jennrich, APNP: I joined for HealthCare in 2008, so over 18 years ago. And since November, we are now in our new pediatric clinic that is attached to the hospital. So, I had to show off our beautiful mural that we have in the background. So, I love our new space. It's been a change for everybody trying to find us, but I love it here.

Host: Well, that's wonderful to hear, and I can't thank you enough, Heidi, for just being so wonderful with our patients and our community. And your creativity around Halloween is always looked forward to. I mean, you really bring just a such a positive energy to that pediatric clinic and beyond. So, thank you.

Heidi Jennrich, APNP: Absolutely. And we have great things in the works for the first time up in our new pediatric space for Halloween.

Host: I love that. I love that. Well, today, we're going to be talking about the pediatric wellness visit. So, Heidi, why don't we just kick this off and just tell us what that visit means? What should parents or other loved ones know about that particular pediatric visit?

Heidi Jennrich, APNP: So, these are particular appointments that are scheduled starting when the babies are born, right after discharge. And then, they see us frequently, because there are so many milestones, developmental things that change, health, growth, development, in that first especially two years of life. So, everybody's used to it. The babies come to see us a lot.

And it will feel like a lot, but there's so many changes that go so very quickly. So, your first appointment is at two weeks, and these well visits are health visits. They are making sure that we are looking at everything on these babies, all the way through teenagers. So, you see us a lot. It's at two weeks, and two months, and four months, and six months, and nine months, and 12 months, and 15, and 18, and 2. And then, it's every year after that.

And so, there's a lot of times that they all of a sudden they're like, "I swear I have seen you. We were just here." I'm like, "I haven't seen you for two years. Where you been?" Those health visits are so important for lots of different reasons, and we absolutely love seeing you every year.

Host: That sounds like a pretty robust schedule, and I'm sure it's for very, very good reason. So, you kind of gave us a cadence on that, and I can see where parents will feel like, "Boy, I'm in this office all the time." But it's really remarkable how fast time goes. And then, when they get to those later ages, I bet you some time passes and parents are like, "Oh yeah, I need to get my child in for the well visit, the health visit."

So Heidi, can you tell us a little bit about what is entailed in kind of the younger age? So when a child is born and you're seeing them for those initial health visits, those wellness visits, what do you focus on in those visits?

Heidi Jennrich, APNP: So at each age, there are milestones that we are looking to make sure that each baby is reaching. So, milestones of when does your baby need to start to roll over? When do they start to use their hands to be able to grab things? When are they smiling and talking, babbling? When are they supposed to be rolling over, sitting up, pulling up to stand? All of those things are big motor skills that we watch.

The other part is the nutritional part. Are we making sure those babies are growing on their curve? Everybody loves, like, what percent your baby was. You know, it's 98th percentile. That doesn't mean you're going to be six foot eight in the end. It just means your baby picks a curve and follows.

I tell everybody, "I don't care if you're 1% or 98% right now. I just care that your baby grows." So on our end, we are watching to make sure we don't start to see they're slowing down on their growth. They are slowing down on their milestones. They're not reaching their milestones like they need to. Those are our big ones that we're seeing new on those little babies right in the very beginning.

And our job is to find things that we can intervene with or say, "You know what? Instead of two months coming back to see me, let's see you in a month just to make sure we catch up where we need to be." Our jobs are to find those things to make sure your baby's development is happening in the way that it should.

Host: Yeah. Because if something does surface, you want to catch it sooner rather than later to get those earlier interventions.

Heidi Jennrich, APNP: Absolutely.

Host: As a child gets a little bit older, as they get to beyond those milestones, those motor skill milestones, what do you look for at that point?

Heidi Jennrich, APNP: So, toddlers are, you know, their milestones of gross motor skills, we're still watching some of those, right? I love the development. I think my favorite development that I watch is the ability to scribble. Everybody does it exactly the same. And babies at two, they just go back and forth. And then, all of a sudden, you'll start to see curly-cue scribbles. And then, they can make a circle, and they can make straight lines. Now, teachers love that part too, but I just find it's a really cool development of like, did your baby start to scribble? Did they start to do these things?

So, the next part is speech. Speech is one of those really big things, especially on our one to two-year-old, to make sure, and it's by three. Early intervention, if we're not developing speech in the way, it's such a great thing to intervene early, because they're going to have a way better outcome later on if we pick that one up early. So, everybody understands their kids talking to them. You'll meet other people and you're like, "Wow, did you hear that? I don't even know what they said." And parent's like, "Oh yeah, they said they wanted this." I was like, "Okay." So on toddlers, it's finding out of, at three, yes, half of the speech should be understandable to me. A parent will understand way more because they listen to it all the time. By the time we get to four, it should be 90% of the speech is understandable.

And then, the other milestones of we're getting you ready for school. So, I want to intervene, especially on the speech early on. Gross motor skills, most kids at that point are pretty much on target for the gross motor skills. If we've picked something up early, we're already intervening.

The next part is we all talk about terrible twos and temper tantrum. Threes, threenagers, the hardest. And this is why I tell everybody, "This is why you start with a really cute baby. You don't start with a three-year-old, or you might not have another one."

Host: Well said. Well said.

Heidi Jennrich, APNP: Right. Threenagers are like legit. They are hungry little hangry monsters that they think the world revolves around them. And when it doesn't, they melt. So as a provider, I want to acknowledge that parenting is hard. It absolutely is the hardest job that we do. We're sleep-deprived and you're dealing with this three-year-old that is ridiculous. You could give every choice in the world. And it's just because you gave them the blue cup and they wanted the purple cup, and now it's 30 minutes of crying.

And so, that part is helping, how do you help raise those kids? How do we put in boundaries and barrier, you know, that the world's not fair and you got to learn it? I tell everybody, "If you don't learn this at three, good luck. Don't ask me at 13 when they're not following your rules because we didn't put all those parenting discipline, all those things in place prior to teenage years." So as they get to elementary school, then it is not as much necessarily gross motor skills. It is the development, how are they doing? How are they emotionally doing in school? Are they keeping up with their peers? Are they falling behind? I used to be a school nurse for five years. So, I have a different part hat that I always wear because I also know where can we help intervene early on in school? Are they struggling in school? Are there other things?

And sleep 100%. I would say every visit we talk about sleep because not everybody gets enough sleep, and that affects so much during the day, especially by the time we get to school. Sleep is the most important thing for kids to get good quality sleep at night.

Host: So Heidi, it sounds like the wellness visits, they have a remarkable scope as the child ages. First, you're looking at motor skills, neurodevelopment, you're looking at speech. And then, as kids get to a little bit older, toddlers, you're looking for different health aspects. As they become adolescent, the emotional aspect of entering school. And so, as that child gets into elementary school age, the wellness visit, you still want to see them annually, correct?

Heidi Jennrich, APNP: Correct. Every year.

Host: And when the kids get a little bit older, what's kind of the main talking points that you have, well, either with the child as they get older, and you communicate directly to the child, but then also the parents?

Heidi Jennrich, APNP: So elementary school, now one part of wellness is always a physical exam. I think I didn't mention, yes, we have to do a physical exam, and there are things that we do pick up on a year that, you know, we may have listened to that heart for the last eight years. And now, we hear something. So, there is the part of the physical exam as well as our talking. And that's why it's important every single year, because sometimes as kids are growing, something we haven't heard, we now are starting to hear as they've gotten bigger. So, the physical exam is part of it.

The next part in school, besides just the physical health, is the emotional health, the wellness overall. The mental health is huge, significant. I would say there's lots of reasons why things have changed over the years of parenting. I would say in the olden days, right? Nobody called your house after eight o'clock. You had to call on a real phone, and then your parents had a lot—you were able to parent in a different way prior to all of the cell phones and smartphones and everything. Nobody's disconnected all the time. And so, I see kindergartners that have cell phones, and we talk about the responsibility with it. What can they get into? What can they access? And if you had a, you know, everybody watched the same show on one TV, parents knew what you were looking at. And now on all of electronics devices, there's a huge range of kids getting into things that they probably didn't know. I've had to Google things on—I have teenagers now. I've had to Google to, like, put in screen time and put in all of these things. The kids are great at, you know, working around. And a lot of times parents don't even know, like, "Hey, do you have parental controls? Do you know how to edit these things?" I will show them on a phone. Like, can you check screen time? When is the off time? When are these kids going to bed? And are electronics in the room and are they off? So, sleep is the next part of making sure they're sleeping. What's their nutrition like? How much caffeine? I watch kids drinking bubblers. That's over a cup of coffee, natural caffeine that is in a bubbler, and you have four-year-olds and five-year-olds drinking bubblers. That it looks healthy because it's natural.

That's my job. I have to be aware of all of it. So, we're making sure nutrition, we're making sure just overall health is following kind of the curve that we want, so that you have the most well-adjusted, healthy kid growing up. And it changes as you get to middle school. There's a lot of change in puberty and what to expect. The seven and eighth graders I call hibernation phase. All of a sudden, they used to be around you all the time. And now, they want to be in their room, and they just start hibernating away from you, which is a natural development, but it's a really hard thing, because then, you know, parents are like, "They never talk to me about anything." I'm like, "I know, because they're hibernating. Mine did it all too."

And so, that's the part of, like, then we get to high school. There are very different conversations that start to happen, and that's really important that I think is when kids get to see me every single year, there's that built trust and relationship. And they're more likely to ask me more questions than, as my son says, "Oh, I just Google AI." Well, you're going to have very interesting information if you Google AI it. So, that's the part is that they have that trust to ask us the questions that they might not be able to ask parents.

Host: I tell you, just listening to you and highlighting some of the conversations that potentially you may have with patients and/or the parents, it is incredible how parenting has evolved over the last 20, 30 years. And I'd be willing to bet that, as kids age and parents seek out those wellness visits, that the parents are getting just as much out of it as the child.

Just listening to kind of those milestones on what to expect behaviorally or emotionally out of your child, that, that can be very, very difficult for parents to go through that parenting transition over the years. I have three kids of my own. I've gone through those transitions, and it can be really tough.

So, the milestones, incredibly important. But also, just listening as a parent, Heidi, the parents get something out of it too.

Heidi Jennrich, APNP: I always ask all the kids the questions. You'd be surprised, even at three, they can tell me almost all the questions. And it's great. They need to be the advocates of their own body, their own health. And then, I ask parents when, you know, "Okay, well, is that, you know, give me your other two cents."

But I want the kids to be able to know when they come to the doctor's visit, they're talking to us. I want to know about them, because I always tell kids, they're like, "Well, you tell her. You tell her." And I say, "But well, they're not living in your body. They have no idea how your tummy feels or how your head feels."

And trying to get kids to advocate for their health too, so that, as they age too, you're the one that needs to tell me all the most important information so that I know what to do with it.

Host: Yeah. Advocating at a young age is so important, because those are values that they're going to gain throughout their whole entire life, and that is just super important.

Heidi Jennrich, APNP: Oh, absolutely.

Host: Well, I got to tell you, Heidi, thank you very much for joining me on this episode of The FortCast to talk about wellness visits, health visits for our pediatric population. They are so important, and I know you take care of so many people in our community. Thank you again, and just thank you for joining me.

Heidi Jennrich, APNP: Absolutely. Thanks for having me.

Host: All right. Well, I hope you all enjoyed this episode of The FortCast. Please share us on your social media channels. And again, this is Dr. Michael Anderson signing off. Thanks again, and have a great day.