Preventative Care is Essential During a Pandemic

Dr. Rema Merhi of Las Vegas, Nevada co-authors this post, sharing critical reminders for families of pediatric heart patients during the pandemic.

Dr. Rema Merhi and Rebeka Acosta, Education Director.

While most of us are worried about COVID-19, parents of pediatric CHD patients are definitely worried. In fact, they are so worried, they are refraining from receiving essential preventative medical care during the pandemic, including critical vaccinations.

Reports from the CDC this Spring showed a significant decline in orders of vaccines from pediatricians across the country. The decline was so drastic that American Academy of Pediatrics issued a full campaign to remind parents of the importance of preventative and well visits, especially during the pandemic.

#CallYourPediatrician uses “humor and real-world conversation to reach parents with timely reminders that going to the pediatrician, even during COVID-19, is important and safe.”

Conquering CHD advocates for all individuals living with CHD to stay in care and receive appropriate services. As patients and caregivers ourselves, we understand the worry about COVID-19. But we also know that by age 13, 50% of CHD patients are lost to care, and by age 18 that increases to nearly 61%. Those statistics are staggering on any given day, but when you add pandemic worries, pediatric patients across the country are at high risk of not returning to care.

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Dr. Rema Merhi, DO

Dr. Rema Merhi is a board certified pediatrician in Las Vegas, Nevada. She is a self-proclaimed Mario Kart champion and enjoys hiking with her husband and two children.

Before medical school, Dr. Merhi was a middle school science teacher. Those years in the classroom shaped her practice of patient-and-family-centered education and preventative medicine. We are thankful to have her co-author this post and share her thoughts on staying in care during the pandemic.

Tell us a little about your practice, Oasis Pediatrics.

Oasis Pediatrics was founded in 2018 on the premise of whole-person education and medical care. My partner, Dr. Lillie Hidaji, and I, are devoted physicians and our ultimate goal is to prevent and treat illness. As passionate child advocates, our mission is to listen, empathize and provide valuable guidance that will create trusting and enduring relationships.

What are some of the ways your practice is keeping patients and families safe during the pandemic?

Having patients in office during a pandemic can be challenging, however, we have implemented COVID-19 guidelines as per the American Academy of Pediatrics (AAP) recommendations to reduce exposure to patients and staff. Most importantly, we are notifying families of all procedural changes in advance so there are no surprises. Procedural changes can be accessed at any time via our website and are discussed via telephone when appointments are made. In addition to our regular cleaning and disinfecting, all doctors, staff, parents and patients (ages 2y and older) are required to wear a mask during all encounters. Medical personnel also wear appropriate PPE when necessary. Our office has always had a “sick” and “well” side however, we have further reduced interaction between sick and well children by scheduling newborn and wellness checks in mornings, and see sick visits at the end of the day or via telehealth when appropriate.

Why is preventative medicine so important during a pandemic?

Preventative medicine is important and necessary especially in pediatrics for so many reasons. As mentioned, there has been a decline of preventative medicine and vaccine administration since the start of the pandemic and this can lead to an unnecessary rise in vaccine preventable diseases. Lack of preventive care can also delay early diagnosis and treatment of developmental delays. There has been an increase in mental health and abuse related issues that have gone unchecked. As such, pediatricians must ensure newborns, infants, children, and adolescents receive well care, appropriate screenings, complete physical exams, and necessary laboratory evaluations.

Dr. Merhi visits with an 11-year-old CHD patient.

You mentioned development and we are wondering how young children are faring with all the restrictions the pandemic brings. Should families be focusing on anything specific to support their young children?

Timely wellness checks are important for parents to discuss developmental milestones, among other things. This allows the pediatrician and family to discuss current and future milestones and activities that foster development. In addition to wellness visits, consistency of routine, exercise, and limited screen time all play a role in the development of children. 

Consistency of routine and structure are very calming to children and can help decrease anxiety and anxious behaviors. For children of all ages, there should be consistency regarding eating, sleeping, and wake times. For younger children, parents can incorporate scheduled play and quite time.  For older children, this could include a visible school schedule, and alternating study, play and socialization.

Stay at home orders can make families feel “trapped” at home, however parents can incorporate new activities into their routines as well. For example, getting outside, taking a walk, a bike ride, or venturing to the park are all great movement activities. Also, eating lunch outside if the weather permits can allow for change of scenery, fresh air, and an opportunity to chat without distraction. 

Regarding screen time, the AAP and World Health Organization (WHO) recommend children 2 to 5 years old limit digital media use to 1 hour or less per day. Older children, however, will find this difficult to achieve as schooling is now predominantly online. For children ages 6 years and older, parents can address what type of media is used and allow them to place consistent limits on hours per day of media usage.

What should families of teens be focusing on during the pandemic?

In addition to the above mentioned measures, it is important to remember teenagers should also receive timely wellness checks. This allows the pediatrician to not only discuss development, but also screen teenagers for emotional distress. 

It can be perceived that teenagers are independent and require less supervision. However, this can lead to prolonged phone, computer, or game console use. As such, parents are encouraged to have “open, honest, age-appropriate conversations with their children and adolescents about what they see in the media.” Screen time should also be limited to education and socialization (video chat with family and friends) rather than passive viewing. The AAP states there should also be conversation about “excessive TV viewing and game playing, and the impact social media can have with regard to bullying and ostracism.”

Regulating screen time and allowing children of all ages to socialize within local, state, and national guidelines can nurture emotional and social wellbeing.

You see several children and teens with congenital heart disease in your practice. What are some of the most common questions you get from this group? What is your advice to them during the pandemic?

Families often ask what measures should be taken regarding travel, socializing, returning to school and the need to attend doctor’s visits. I advise following CDC, local, state, and national guidelines with regard to travel, social distancing and mask usage. The AAP recommends in-person school attendance when safe to do so. Parents and patients can be prepared in advance of doctors’ visits by calling ahead for office COVID-19 procedures and requirements.

Even though you are a pediatrician and your patients eventually graduate to adult providers, adults with congenital heart disease are also struggling during the pandemic. Is preventative care just as important for adults?

Absolutely! Routine care allows providers to monitor simple yet vital information such as blood pressure, heart rate, and oxygen level, all of which can be critical in ACHD patients. It also allows for the opportunity to discuss changes in mental health and wellbeing, especially when some may not have another opportunity to do so during the isolation of a pandemic.

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Our sincere thanks goes out to Dr. Merhi for sharing her time and expertise! For more help in navigating care during the pandemic, check out these resources:

Resources from Conquering CHD
Guided Questions Tool / Cuestionario de Preguntas Guiadas
Supporting Development for the CHD Child
School, CHD, and COVID-19
Guide to Your Child’s Future Care

Resources from Centers for Disease Control (CDC)
Well Child Visits are Essential During Pandemic
Milestone Tracker app (free)

Resources from American Academy of Pediatrics (AAP)
Calling the Pediatrician During COVID
Healthy Children Parenting Website

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