Transcription:

Prakash Chandran: So you've invested in the collection of children's books that show just how fun it is to go to the doctor. You've rehearsed the meeting, played with the toys. But when something happens that makes that visit necessary, it's tears from your kids. And oftentimes, parents are confused about the right place to go. How can we make pediatric visits a less intimidating affair? How should parents prepare for their first pediatric visit? And when is the emergency room or urgent care an appropriate choice? We're going to talk about it today with Dr. Sonali Vashi, a pediatrician at McLaren.

This is McLaren's In Good Health, the podcast from McLaren. I'm Prakash Chandran. So Dr. Vashi, thank you so much for joining us here today. I really appreciate it. This is a topic that's near and dear to me. I have a two-and-a-half-year-old and a three-month-old. And this is something that typically my wife organizes, but I'd love to just get a basic understanding of when children should start visiting the doctor and how often they should go to the doctor in general.

Dr. Sonali Vashi: Yeah, absolutely. Thanks so much for having me. This is a great opportunity to get some general knowledge out to the public. The short answer is that children should be seen at least once a year after they're three years old. So you're going to have that annual well visit with your pediatrician. But less than the age of three, you're going to see the pediatrician much more frequently.

So I will typically see kids just a few days after they're born, maybe a two-week to one-month checkup and then 2, 4, 6, 9, 12 months in the first year. And then after that, it's going to be every three to six months. Once they hit three, it's annually after that.

Prakash Chandran: Okay. Understood. And just so parents can understand, why is it so frequent before the age of three?

Dr. Sonali Vashi: So when kids are younger, the biggest thing that we want to make sure is that they're growing and developing the way they should be. So, at those visits, a lot of times you're going to be talking about weight, making sure they're gaining weight appropriately, they're getting the right nutrition. Also, the key thing during those visits is the vaccination. So those will usually start around two months and there's a certain schedule that we follow to get kids caught up by the time they're two years old.

Prakash Chandran: Yeah, that makes a lot of sense. So, you know, as children start to get older, and this is certainly the case for my two-and-a-half-year-old, they might get a bit anxious during a physician visit. So how do you go about putting them at ease during the visit?

Dr. Sonali Vashi: Yeah, that's a really fun question and kind of the reason I'm a pediatrician, is because when kids come to the office, even though they're scared, they're still a kid. They love to play. They love to kind of learn and see what's going on. So I like to just kind of sometimes show them the instruments that I'm using. I'll say, you know, "Here's my stethoscope. Where do you think it goes?" And a lot of times the kids have their toy stethoscopes at home, they're like, "Oh, that goes right here on my heart." I'll have them touch the stethoscope to make sure they know it's not pointy, it's not going to hurt them. Same with like the otoscope, ophthalmoscope. Anything I'm using on the child, I'll have them kind of interact with first.

And then sometimes, I'll make it a game too. So we're doing a neuro exam and we're testing their refluxes or their strength, I'll say, you know, "Pull me as hard as you can," like "Let's push in this direction." And then the other thing sometimes I'll try to do is give them choices. 'Do you want me to listen to your heart first or do you want me to feel your belly?" So that kind of gives them more autonomy in the process.

Prakash Chandran: Yeah. I love that. And I can certainly say that with my daughter, giving her more autonomy during those visits has made all of the difference. So I wanted to move on and ask you, what are the most frequent childhood conditions or illnesses that you see in your practice?

Dr. Sonali Vashi: Yeah. So that's really varied actually. A lot of my practice is going to be the well visits. So making sure kids are growing and developing the way they should be, seeing them for those annual physicals, seeing them for sports exams, seeing them for vaccinations, the kind of things we've already talked about.

When kids are coming in for sick or acute visits, it generally tends to be a common cold, some sort of virus, upper respiratory infection. Sometimes it could be rashes, asthma, allergies. And recently with the COVID-19 pandemic, we've been seeing a lot more of behavioral and mental health. So those kids are coming to their pediatrician first and we're able to make the appropriate referrals to the specialist from here.

Prakash Chandran: You know, one thing that I have always wondered about as a parent is, you know, when our children get ill or sick, and it seems like they need immediate attention, how do we know when we need to come into the doctor's office versus going to an urgent care or emergency room?

Dr. Sonali Vashi: Yeah, that's a really good question. It's a question I get all the time. Sometimes it's going to be really obvious. Your kid falls, has an injury, has a broken bone, you're taking them straight to the ER. They probably are going to see a specialist, an orthopedic surgeon or something like that. But the way I practice is I always give my parents anticipatory guidance. So I say, you know, if your child has a fever, say they are less than a month old and their fever is over a 100.4, then that's when you need to take them to the ER.

Sometimes it's things that I don't talk to my parents about in their visit. And for those, there's always the opportunity for them to call us first. So we like them to call us and say, "Hey, this is what's going on. I'm not sure where to take my kid." If it's during the work day and I have an opening, I would be happy to see them the same day. If it's after hours, I'm still on-call for my patients. So they can call the answering service. They can still speak to a physician and then I can direct them to say, "Yes, the urgent care sounds like the right place," "No, I think you need to go to the ER" or maybe "You can wait until tomorrow and come see me in the office."

Prakash Chandran: Okay, that makes a lot of sense. So, you know, there are likely going to be some parents listening that are looking for a new pediatrician. And we touched upon some of the things that you did, for example, to make the child's feel at ease, to make the parents feel at ease during the visit, but what characteristics or experiences should our parent listeners be considering when they're selecting or evaluating a new pediatrician?

Dr. Sonali Vashi: Yeah, definitely. So a pediatrician should be someone that both the child and the parents are comfortable with. So if it's a young child, you know, someone that they're not scared to go see. If it's an older child, then someone who, you know, feel like they can share their thoughts and feelings with. After the age of 12, usually we start taking kids on their own. So if it's an older kid, it's important that they themselves are comfortable talking to the doctor.

And then from a parent perspective, the pediatrician should be someone who listens to your concerns and addresses all your questions, that's really open, available, friendly, easy to communicate with. I mean, things that you would expect any doctor to be but especially a pediatrician who's taking care of your child.

Prakash Chandran: So one of the things I wanted to touch on is seeing a new pediatrician for the first time. I know that for myself, it was a little overwhelming, especially with a sick child. So I imagine that in general, it's important that parents come prepared with questions to ask during that first visit and sometimes maybe even a written list is helpful. So what tips or questions do you suggest parents ask a new pediatrician on their first visit?

Dr. Sonali Vashi: Yeah. I think a list of questions is a great idea. I often tell my parents, like if you think of something, write it down, because if you're a new parent coming in with your baby for the first time, I mean that new parent brain is so foggy that if you don't write it down when you think of it, you won't remember it when you come to the office.

And same if your child is sick, right? You're so worried that you forget what to ask in the moment. So writing down questions is a great idea. And really, if it's a well visit, I'm going to say we're talking about diet, nutrition, elimination habits, sleep schedule, behavioral issue, anything like that would be kind of the topics we discuss.

And then if they're coming in for a sick visit, it's going to be more specific to what they're coming in for. So it's hard to say, like right off the bat, "You should ask these X, Y, and Z questions." But really if there's something going on with your child, write it down and you can ask your doctor about it.

At my office, usually, I try to give handouts at the end of the well visits especially. That gives parents some of the main anticipatory guidance topics that we talk about. So it's going to have your nutrition section. It's going to have what we talked about at this visit, what to expect at the next. And I always most importantly like to highlight the safety section on those forms. If they're coming in for a particular reason, I'll try to find handouts that are associated with their concerns and I'll give them resources that are more evidence-based like the AAP or the CDC. So I always try to give parents something written because just the same way they should come with a written list to me, I want to give them something to go home with.

Prakash Chandran: Yeah, I love that. Another thing I wanted to ask you is sometimes in between visits, a parent might have a burning question that they kind of need an immediate answer for, whether it be related to, I don't know, a rash they might see on their child or just the behavior that the child is exhibiting. What is the best way to get a hold of your pediatrician in between visits?

Dr. Sonali Vashi: So every pediatrician's a little bit different. The way we function in my office is that, during office hours, the phone lines are open and parents can call. They're usually answered by the front desk. And if they feel like it's a question for the physician, they'll transfer it back to me. And so I'm able to answer the question right away.

Say for example, I'm with a patient or I'm not available at the time, then they'll have a message for me to respond to. If it's after hours, the patient still calls the same office number. So that's one thing I really like about our practice. They call the same number. They don't have to look for anything else. They get transferred to an answering service after hours, and that answering service is able to directly transfer them to the physician. And so day or night, I'm available 24/7 to answer questions for my families.

Prakash Chandran: So the final question that I always like to close with is, you know, you have probably seen hundreds of children and parents. And in all of that experience, I'd love for you to share maybe one thing that you either know to be true or a piece of advice that you wish more parents knew before they came to see you.

Dr. Sonali Vashi: That's a great question. So definitely, parents, I think underestimate how much they're truly doing for their children. So I just want to reassure them that you are doing a great job and you know your child best. So if there's something that concerns, you bring it up to your pediatrician and, you know, hopefully you'll get an answer that way, but also, you know, trust the pediatrician's judgment.

We see like you said hundreds of kids. And so sometimes if it's say a developmental concern, there are ranges of ages that we can look at. So say a child should be sitting by the time they're six to seven months. So if you're at that six-month range and your child's not sitting, then your pediatrician will say, "Oh, it's okay. Let's just wait and watch it at the next visit." So sometimes there's got to be a balance between, you know, you as a parent knowing your child, but also the physician knowing kind of the medical side of things.

Prakash Chandran: Well, Dr. Vashi, thank you so much for that. What a great place to end, and I really appreciate your time today.

Dr. Sonali Vashi: Thank you.

Prakash Chandran: That's Dr. Sonali Vashi, a pediatrician at McLaren. Thanks for checking out this episode of McLaren's In Good Health. To learn more about Dr. Vashi or to make an appointment, you can visit mclaren.org/vashi. And that is spelled V-A-S-H-I . If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been another episode of McLaren's In Good Health. My name is Prakash Chandran. Thank you so much, and we'll talk next time.