Scott Webb (Host): Welcome to the Iowa Specialty Hospitals and Clinics ISH Dish Podcast, practical Health Advice From Iowa Specialty Hospital experts. We want to connect the members of our communities with the latest healthcare information that's understandable, relatable, and useful to your daily life. I'm Scott Webb, and today, pediatrician Dr. Alice Meng is joining me for a wide ranging pediatric conversation, including routine checkups, the latest autism research, the importance of vaccines, and more.

Doctor, it's so nice to have you here today. We're going to do a wide ranging podcast on pediatrics, you know, and cover a bunch of different topics. So let's start with just sort of the pediatric routine checkup. What are some of the standard components? How often should they be scheduled you know, for the different age groups?

Alice Meng, MD, FAAP: We typically see newborns a few days after birth, and then sometimes one month, sometimes at two months, and then usually at four months and then six months, at nine months, 12 months. And then, sometimes 15 months, 18 months, 24 months, so about two years of age. And then maybe like a two and a half year. And then usually by that point it's every year, once a year after that.

Host: Right.

Alice Meng, MD, FAAP: So components of a checkup. We typically look at how the child is growing, look at their weight and their height, making sure they're meeting their developmental milestones, check general health, and then check social influences on health, such as any adverse childhood experiences, and especially for teenagers looking at a H exam.

So that's going to be looking at home life. How is education going? Any activities they're in such as sports, sometimes even jobs. Asking about substance abuse, sexual activity and, any mental health issues. Then we do a head to toe exam. This may also include a presports participation physical, for anybody who's in middle school or high school. And then any anticipatory guidance as well.

Host: For sure. Yeah, I have a couple of kids. They're older, 17 and 22, but I was checking all the boxes, everything you were saying. I was like, yeah, we were there a lot those first couple of years. And then we got into sports physicals later and all that good stuff.

And just wondering, get a sense from you, like what are some of the common childhood illnesses that you encounter during these routine checkups and how can we safely manage them at home?

Alice Meng, MD, FAAP: We see a lot of viral illnesses, during sick season, especially the runny nose, cough, congestion, fever, as well as vomiting and diarrhea. Typically, we do recommend, giving supportive care such as ibuprofen and Tylenol for any fever or discomfort, making sure they're drinking lots and lots of fluids, making sure they getting some rest.

Can try some cough medicines, especially if you're over the age of six. And we do, see a lot of rashes such as diaper rash, eczema, and can have different treatments for that too.

Host: Yeah, rashes are so common, of course. And as I mentioned and teased a little bit, we're going to do a wide ranging pediatrics podcast today. So want to talk to you about how general practitioners effectively differentiate between ADHD and typical childhood behaviors in preschool aged children.

Alice Meng, MD, FAAP: Yeah, this is very difficult because every toddler has some degree of inattentiveness and impulsivity and hyperactivity, so it's a little hard to distinguish as well, during this age range. You can use a Connor's Comprehensive Behavior Rating Scale, which is like a questionnaire for parents and teachers or even daycare providers.

And you would still require positive symptoms and functional impairment in at least two of these settings., Know that the first line treatment for kids under the age of six is behavioral therapy. So we don't typically start kids at this age on any medications unless it's very severe.

Host: sSo s So then what are the current diagnostic criteria for autism spectrum disorder and how have recent research findings influenced these criteria?

Alice Meng, MD, FAAP: Diagnostic criteria for autism spectrum disorder as from the DSM 5, which is kind of the psychiatric Bible. You have to meet diagnostic criteria in two of the broad groups. The first broad group is persistent deficits in social communication and social interaction across multiple contexts.

They do list some examples here and then the second category is having restrictive, repetitive patterns of behaviors or activities as manifested by at least two of the following, currently or by history such as stereotyped or repetitive motor movements, use of objects or speech. Number two, insistence on sameness. Inflexible adherence to routines or ritualized patterns of verbal or nonverbal behavior. Number three, highly restricted or fixated interests that are abnormal in intensity or focus. And number four, hyper or hyporeactivity to sensory input or unusual interest in sensory aspects.

Now it is a clinical diagnosis, meaning that there is no laboratory testing that is necessary at this time or that is conclusive at this time for autism spectrum disorder. And we do have some more research, newer research, implicating some genetic components to autism spectrum disorder. But unfortunately, we still don't know a whole lot, especially the causes. We think it might be multifactorial in this case. And, more research is really necessary in this.

Host: Yeah, there's no doubt, when it comes to autism especially, it's just the research is ongoing, of course. But, nice of you to be able to, you know, kind of catch us up to date where things are today anyway. And let's go back to infections a little bit. Want to talk through maybe some preventative strategies that you recommend to minimize the risk of those, you know, dreaded childhood infections, especially during the school year.

Alice Meng, MD, FAAP: It is very hard to keep kids healthy when they are around other kids. The most helpful thing is just to keep kids at home if they are sick. So if they have any fever, really bad cough, vomiting, diarrhea, just have them stay at home. And then having them wash their hands very well, especially before eating, especially after school or after going to the bathroom, things like that.

Cover your cough such as, using your elbow or even a mask to cover any coughing. And you can consider having a mask on during the sick season, especially if you have a child who is immunocompromised.

Host: I want to have you talk about vaccinations and maybe what role they play in the prevention of childhood illnesses and maybe what's the latest guidance on the pediatric vaccination schedule.

Alice Meng, MD, FAAP: Yes. They play a very huge role in helping your immune system recognize and fight any deadly diseases very quickly. It is very important to have them. A vaccine really is just to take a small part of the virus or bacteria or a weakened virus and it can't cause any illness within you and then inject it to, into your body just to kinda help prime it for in case it gets exposed to any of these childhood illnesses.

There is a schedule when it comes to the routine childhood immunizations, and you'll find that every doctor has a schedule and tries to follow that schedule.

Host: Just want to finish up today and have you talk about some of the common myths, if you will, about autism spectrum disorder and how healthcare professionals address these misconceptions with families.

Alice Meng, MD, FAAP: Yes, there's a lot of myths out there. I would say one of the most common ones is that autism spectrum disorder is caused by vaccines. Although we don't know the exact cause of autism, we do know that vaccines do not cause autism because, back in 2004, the CDC did a research study of more than 2000 children. And it showed no links between vaccinations and autism spectrum disorder. So, at least that can be tabled.

Now some people will think of autism spectrum just like somebody with autism spectrum disorder and either think of that quirky genius, or doctor or the severely intellectually disabled nonverbal person. And know that this is a spectrum. There's a huge variation in between. And although these may be the extremes of the spectrum, there's a lot of people who have varied symptoms in between the spectrum as well.

 I would say another big myth is that people with autism don't experience the full range of emotions. They do. Now, how they choose to express them, that is what's a little bit different. Another one is that autism can be cured and know that there is no cure right now. There's no medication that we can give you to make that autism go away. There is appropriate interventions so that people with autism can acquire the skills needed for a successful and meaningful life. Lastly, there might be a myth out there that people with autism can't have meaningful relationships, know that they can, and they do have fulfilling relationships. Now they can still have difficulties understanding social cues and navigating social interactions. But most people with autism do have an interest in forming relationship with others, and they do have very meaningful relationship with others as well.

Host: Yeah, and as you said earlier, Doctor, you know, there's still so much to learn as much as we've learned and know now about autism spectrum disorder. And as you say, it is a spectrum and so kind of a wide range, you know, depending on the person of course. But there's just so much more that we know now and research will continue and it's great to have your expertise today. So thank you so much.

Alice Meng, MD, FAAP: Thank you.

Host: And thank you for listening to Iowa Specialty Hospitals and Clinics ISH Dish Podcast. For more information on the topic we discussed today, visit us on the web@iowaspecialtyhospital.com. There you can read a transcript of today's episode or previously aired episodes, as well as get the latest news from Iowa Specialty Hospitals and Clinics, and explore all the services that we offer. For the ISH Dish Podcast, I'm Scott Webb. Thanks for tuning in.