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‘Phubbing’ and Its Effects on Children

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Contributor Dr. Elise Herman

Smartphones are a mixed blessing. As amazing as they are, they take our attention away from what is right in front of us—and that can include our children. The term ‘phubbing’ describes snubbing someone we are with by paying attention to a smartphone, and ‘parental phubbing’ means interacting with a phone instead of one’s child. For kids over age 2, we do not have to be interacting with them constantly, but we do need to be emotionally available if they have a question or need us in some way, and being tethered to the phone impairs this.

When a parent chooses looking at their phone over paying attention to their child, the interaction between them suffers- the parent is less engaged with their child who may at first ask for more attention, but then soon give up. The child may become frustrated and sad and act out. Over time, this pattern of phubbing can lead to poor self-esteem and less confidence with other social interactions. Parental phubbing is also related to increased anxiety and depression in children and adolescents.

Research has shown the negative impact of parental phone use on babies, too, who may become more irritable and behave negatively when their parent ignores them to be on their phone. Studies of maternal phubbing revealed babies showing signs of stress (such as increased heart rate and emotional distress) and less effective learning. We know that simple eye contact between an infant and their parent builds brain development, so it is not surprising that taking this vital connection away can have a negative consequence for the child.

While most parents acknowledge that their cell phone usage gets in the way with interacting with their child, they may feel they ‘need it’ to be in touch with others, to keep track of their calendar, take photos, etc.  The more a parent uses their phone and especially ‘phubs’ their older child, the more that tween or teen will use their own phone similarly. Kids learn that it is OK to not be available and connected to those around them and miss out on how to relate to others emotionally.

So how to avoid parental phubbing? It takes real effort to break this habit, and both parents (and other adults in the child’s world) need to be invested in changing. Some suggestions include:

  • Have phone-free times for the whole family- at meals, at the park, while playing games, when out in nature, etc.
  • Have phone-free zones in the house such as the dining area, your child’s bedroom, and the playroom. If you have something urgent to take care of on your phone, explain this to your child and use it as quickly as possible
  • Disable notifications and put your phone on silent or ‘Do Not Disturb’ if you have it with you when you are with your child. If you forget to do this and hear a ‘ping’, ignore it (and then put it on silent mode)
  • Encourage mindfulness; pay attention and really notice what is in front of you. Even when not directly interacting with your child, make pulling out your phone intentional, ask yourself, “Do I really need to use my phone now?”
  • Work on dealing with boredom or ‘empty time’ (such as waiting in line) without reaching for your phone; you will be less likely to do this as a habit when you are with your child
  • Have a ‘code word’ for your child to let you know if they are feeling ignored by your being on your phone; this can be done in a playful manner and will encourage your child to speak up about phubbing

It is not easy to change our habits with technology, but our time with our kids is fleeting and vital to their social and emotional well-being. Being truly present with our children is one of the most important things we can do as parents. In addition, your child is watching, and you have an opportunity to be a good role model in how you handle your smartphone.

more about The contributor

Dr. Elise Herman

Blog Posts
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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Celebrating Public Hospital Districts during Hospital Week

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Written by: Michele Wurl, Chief Public Relations Officer at Kittitas Valley Healthcare

Your access to high quality healthcare should not depend on where you choose to live. In the last decade, more than 100 rural hospitals in the U.S. have closed.  Another 700, 30% of remaining rural hospitals, are at risk of closure.  Many, many more have been acquired by multistate hospital systems, private equity firms, or other for-profit companies.  Rural communities that lose their hospitals not only lose access to care, but they forfeit the economic vitality and many family-wage jobs. Rural communities that lose control of their local hospital find that governance, the ability to determine which services will be available, and how earnings will be reinvested are outsourced to national headquarters. 

Washington state is unique for the number of independent, community hospitals that continue to serve rural residents.  That’s because fifty-six communities in Washington State take advantage of a WWII-era statute that allows for the creation of Public Hospital Districts (PHDs).  These communities made a choice and investment to keep quality care local. Residents of Ellensburg made that choice in 1960 when they voted to form Kittitas County Public Hospital District 1, now operating at Kittitas Valley Healthcare (KVH). In 1969, Upper County voted to form Kittitas County Public Hospital District 2. For sixty years, KVH has been on the forefront of protecting Kittitas County’s community health.  As the only hospital in Kittitas County, KVH is responsible for the well-being of over 44,000 residents who call this valley home and for the millions of visitors who pass through.  Hospital District 2 operates the Medic One ambulance service, providing the only licensed advanced life support paramedics to all Upper Kittitas County, from Snoqualmie Pass to Elk Heights.

Back in 1960, the hospital was the hospital, and primary care was provided by small, private practices scattered around the hospital and throughout the community. Today most physicians choose to become employees of hospitals, health systems, or large groups, and Kittitas County is no different.  Like the rest of the country, we grapple with healthcare access.  This shortage is worse in rural areas and undermines the well-being of rural residents. Public hospital districts stand as unique champions for community-centric healthcare and prioritize accessibility and inclusivity. As nonprofit organizations, every dollar earned goes to answer the needs of the community. By pooling resources and leveraging community partnerships, these districts bridge healthcare gaps, ensuring that essential services are within reach for all residents. Moreover, they foster a sense of ownership and accountability, empowering communities to shape their healthcare futures.

The governing board of a public hospital district is elected by the district’s residents.  These elected board members are responsible for the oversight of the operations of PHDs.  The board is responsible for strategic direction, setting policies, approving budgets, and representing the interests of the community in healthcare matters.  Board members uphold the principles of accountability and stewardship.  Throughout this process, transparency, public participation, and adherence to legal requirements are crucial to ensuring the effectiveness of the publicly elected board.

Public hospital districts make a tangible contribution to the community’s health and economic vitality. PHDs tailor programs and services to address the unique healthcare needs of the residents, from preventive care to specialized treatments. By fostering partnerships with local providers and organizations, the district can create a robust healthcare ecosystem that fosters wellness and resilience.

The benefits of a public hospital district extend far beyond the realm of healthcare. By bolstering the local economy and attracting skilled healthcare professionals, it spurs economic growth and job creation, laying the groundwork for a thriving community.

From May 12 to 18, communities around the country are celebrating Hospital Week, when we honor and recognize the invaluable contributions of hospitals and healthcare workers to their communities.  This is an opportunity to express gratitude and appreciation for the dedication, compassion, and hard work of healthcare professionals. These individuals, including doctors, nurses, technicians, administrators, and support staff, play a vital role in delivering quality care and saving lives every day.

Hospital Week is also a time to thank our community for creating Kittitas County’s two hospital districts.  On behalf of the healthcare professionals and staff, I extend heartfelt gratitude for your unwavering support. We recognize and appreciate the trust you have placed in us as we work towards the shared goal of enhancing healthcare delivery and promoting wellness for all.  As we move forward, we remain dedicated to fostering transparency, accountability, and inclusivity. Together, we will continue to build a brighter future for the people of Kittitas County.

Helping Kids Deal with Climate Change

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Contributor Dr. Elise Herman

We are hearing and reading a lot about climate change and our kids are getting lots of exposure to this topic, too. The terms “eco-anxiety” and “climate change grief” refer to the psychological effects- feelings of worry, fear, despair, and hopelessness- that can develop with awareness of the realities of climate change including more extreme weather, increased heat, wildfires, and loss of biodiversity. There are steps we can take to help our kids be more resilient in the face of climate change and help ourselves cope at the same time.

Decreasing your own and your children’s exposure to media, especially media that is sensationalistic, is very important. There is a fine line between being informed and being overwhelmed—our kids feel it, too. Don’t have the news on (radio or TV) a lot, and don’t constantly refresh your online news source. There are media sites such as Earth Rangers which can give information that is more positive, such as what steps are being taken to combat climate change. The National Geographic Kids website explains this issue in a developmentally appropriate way while offering steps kids and parents can take together to help, even in small ways. The documentary show “An Optimist’s Guide to the Planet” on Apple Plus explores people, traditions, and ideas which foster optimism in the face of climate change. Look for books that explain climate change in age-appropriate ways and offer a hopeful outlook. Books that show kids as the ones coming up with some solutions and creating positive change are particularly empowering.

When discussing climate change, ask your child what they have heard and believe. Ask open-ended questions to encourage a conversation. What do their friends think? How are their teachers approaching climate change education? Don’t be afraid to discuss negative environmental stories (wildfires, etc.) and how they are feeling while reassuring them that they are safe. Validate your child’s emotions and response and share some of your own. You may be able to dispel some alarming misconceptions right up front. The bleak and scary possibilities may not come to pass; it is important to leave room for hope and to discuss what positive steps are being taken. Point out some ‘climate victories’ such as more electric vehicles and increasing use of solar and wind power. Knowing that scientists, governments, and environmental organizations are working together to combat climate change can be reassuring.

Encourage a positive mindset and take positive actions. When your child sees you driving less, being mindful with water use, and aiming to conserve energy, you are being a good role model. Find things you can do together—buy less, especially things encased in single-use plastic; consider a more plant-based diet; try to walk and bike instead of driving if possible, at times. Your child may be able to work with their school to help it be more eco-friendly perhaps by decreasing unused food waste, eliminating plastic straw use, or recycling, for example. You can become active with an environmental group or even help your child start one at school. Earth rangers.com has a free club portion geared towards kids with great ideas for your child to take action. Older kids may enjoy sites such as earth.org which highlight young adults making a difference through climate change activism.

Both parents and kids benefit from time in nature, which is known to improve mental and physical health. Getting outside regularly builds connection and a sense of responsibility to nature, as does showing gratitude, especially for the beauty here in Eastern Washington. Do things that help our local environment-plant trees, have a garden, scatter native wildflower seeds. These actions inspire hope and increase a sense of stewardship for the planet. Kids can feel powerless but listening to them and taking action together, even in seemingly small ways, can give them (and us!) a sense of optimism and control. Do consider talking with your child’s healthcare provider or counselor if you note persistent or severe feelings of anxiety or depression related to climate change.

Resources

http://www.earthrangers.com

http://www.natgeokids.com/uk/parents/eco-anxiety-guide-for-parents/

10 Young Climate Activists Leading the Way on Global Climate Action

    more about The contributor

    Dr. Elise Herman

    Blog Posts
    Profile

    Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

    The Daisy Award

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    The DAISY Foundation was established in 1999 by the family of J. Patrick Barnes, who died of complications of the auto-immune disease Idiopathic Thrombocytopenia Purpura (ITP) at the age of 33.

    During Pat’s eight-week hospitalization, his family was amazed by the care and compassion his nurses provided to Pat and everyone in his family. So one of the goals they set in creating a Foundation in Pat’s memory was to recognize extraordinary nurses everywhere who make an enormous difference in the lives of so many people through the super-human work they do every day.

    To learn more about the program and its growing list of partners, visit www.daisyfoundation.org.

    What is The DAISY Award?

    The DAISY Award is an international program that rewards and celebrates nurses’ extraordinary clinical skills and compassionate care every day. Kittitas Valley Healthcare is proud to be a DAISY Award Partner, recognizing one of our nurses with this special honor bi-annually. DAISY = Diseases Attacking the Immune SYstem

    DAISY Award

    Nominee

    Tamara Lewis, RN, Medical/Surgical Unit

    Reason for Nomination

    Developing a trusting relationship with a patient that aided in identifying a severe wound infection that required a higher level of care.

    Nominator

    Beth Isbell, RN, House Supervisor, House Supervisor Department

    Event

    Tamara was taking care of a patient on Med/Surg, preparing her for discharge after the patient had been admitted four days prior. Through a comprehensive assessment performed by Tamara, she became aware of a severe wound infection in this patient and alerted the provider. This wound infection had gone unnoticed by Nursing as the patient was extremely modest. Tamara’s ability to convey trust and compassion to this patient allowed this patient to feel comfortable enough to be examined and share with Tamara the wound she had kept hidden and confide in her the pain she was experiencing. Tamara is an excellent nurse and took time with this patient to get to the source of some significant findings. The decision was made to transfer this patient to a higher level of care. Tamara’s nursing care and promptness in alerting the provider to her clinical assessment indeed aided in an optimal healthcare experience and recovery.

    Measles Cases Rising 2024

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    Contributor Dr. Elise Herman

    Measles cases are on the rise, and although numbers in the US are small right now, there is cause for concern. Measles is one the most contagious human viruses, with a 90% chance of someone who is not immune getting infected if they are near someone with measles. People with measles can infect others for 4 days before they have any signs of being sick, and for 4 days after the rash appears. The virus stays in the air and is infectious for 2 hours after the infected person has left. There is no treatment for the measles virus, however there is life-long immunity (protection) after vaccination as well as infection.

    This recent rise in measles in the US is in part due to a mild drop in kids’ vaccination rates, often related to children missing routine health care visits during the pandemic. Although the current rate of kindergarteners fully vaccinated against measles is good at 92%, the previous rate of 95% was better particularly because that level gives ‘herd immunity’, meaning protection of those that were not or could not be vaccinated (due to young age, cancer treatment, or other immune system problems) by those who are vaccinated.

    The number of measles infections world-wide has increased dramatically, up almost 80% in the last year to 306,000 cases. As people travel more, they can bring the infection home if they are not immune, potentially exposing many people before they know they are sick.

    Measles spreads easily through airborne secretions from coughing or sneezing. Infection is also caused by direct contact with droplets from the mouth, nose, or throat. Symptoms develop 7-14 days later and start with profuse runny nose, cough, and red, swollen, watery eyes. Fever is often up to 104 degrees. The rash develops 3-5 days after cold symptoms begin and starts as flat red spots on the forehead, spreading downwards to the trunk and extremities. Some spots may become raised and join to from larger blotches. It is not usually itchy.

    Measles itself is miserable, but the biggest concern is regarding complications. Serious complications include pneumonia in 1 out of 20 of those infected, encephalitis (brain inflammation and swelling) in 1 out of 1000 infected, and rarely, temporary or permanent blindness (more common in developing countries). One out of 5 unvaccinated people in the US with measles will be hospitalized, and 1-3 out of 1000 will die. Children under 5 and adults over 20 are most at risk of serious complications. Also at increased risk are pregnant women and those with immune system problems.

    Measles vaccination is safe and effective and gives life-long immunity. Prior concern of a connection between the MMR (measles, mumps, and rubella) vaccine and possible autism was based on fake ‘research’ and has been disproven by multiple studies by the American Academy of Pediatrics, the World Health Organization, and the Institute of Medicine.

    There has been a 99% decrease in measles cases since the vaccine came out in 1963. Prior to the vaccine, there were 3-4 million cases annually in the US and about 48,000 people hospitalized, most of which were children. Add approximately 500 deaths and 1,000 cases of encephalitis each year, and it is easy to see how miraculous vaccination has been.

    The best way to protect ourselves, as well as the approximately 9 million people in the US who cannot get the vaccine due to an immune system problem, is to be vaccinated. Measles vaccine is recommended for kids aged 12 months and again between 4 and 6 years. It is also approved for adults who did not receive it as children. There are 2 types of measles vaccines- the MMR (as above) and the MMRV (also protects against varicella/chickenpox). Your child’s health care provider can provide additional information on measles vaccination.

    Recursos en español

    more about The contributor

    Dr. Elise Herman

    Blog Posts
    Profile

    Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

    The Importance of a Healthy Environment

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    Contributor Dr. Elise Herman

    One of the biggest factors in human health is the environment. Underlining this importance, the United Nations entities issued a joint statement in 2021 recognizing the “right to a safe, clean, healthy and sustainable environment” for all people. An unhealthy environment may include water pollution, air pollution, chemical exposures, loss of biodiversity, and the effects of climate change such as wildfires. There are more than 12 million deaths globally each year attributed to unhealthy environments according to the Office of Disease Prevention and Health Promotion. These deaths disproportionately affect lower income individuals, children, and impoverished populations. Children are more affected by environmental issues because they have greater exposure to air pollution, water pollution, toxins, etc. in proportion to their body weight than adults.

    Causes of air pollution include the burning of fossil fuels (such as coal, oil, and gasoline), industrial emissions, wildfires, and the open burning of garbage. Air pollution causes a variety of lung diseases as well as allergies. It is considered the most significant environmental risk factor and is blamed for about 7 million deaths worldwide each year. Three hundred million children worldwide routinely breathe air considered to be toxic.

    Water pollutants include industrial waste, agricultural runoff, microplastics, sewage, and waste that filters out of landfills. According to the World Health Organization, about 2 billion people have no choice but to use water polluted by human excrement, causing hepatitis A, cholera, and other diseases.

    As land development increases with loss of open spaces and wilderness, wildlife and people are forced closer to each other. This proximity results in increased risk of zoonotic diseases (diseases which can travel from animals to humans). Examples of zoonotic diseases include rabies, HIV/ AIDS, and COVID-19. Climate change also puts more stress on animal habitats, contributing to this problem.

    The benefits of a healthy environment are clear not just on physical health but also on mental and emotional well-being. Access to open green spaces and nature has been shown to help reduce stress, depression, anxiety, and mood disorders.  These ‘open spaces’ can include wilderness like a forest or mountain, but a green city park or a path by a river also count.

    Here in Kittitas County, we are fortunate to live in a beautiful location with clean water, (usually) clean air, and access to open space. The most significant problem locally has been intermittent air pollution from wildfires. We also have the excellent Kittitas County Public Health Department to surveil and manage environmental health issues. 

    Keeping in mind that human consumption is a huge contributor of harm to the environment, we can make a difference in our valley and beyond by taking simple steps:

    • Drive less, consider walking or biking, when possible, instead.
    • Turn your thermostat down in winter, and up in the summer if you use air-conditioning.
    • Buy in bulk when you can; avoid products that use a lot of packaging, especially plastic.
    • Avoid single use plastic bags; bring your own reusable bags for produce and other shopping.
    • Create a vegetable garden with your child or take part in a CSA (Consumer Supported Agriculture, where you can ‘subscribe’ to get produce from a local farm).
    • Learn to say “no” to unneeded, cheaply made toys and other goods (often plastic) which are giveaways or very inexpensive but will quickly be tossed in the garbage.
    • Purchase less clothing in general, and buy clothes from consignment shops/ secondhand stores, either brick and mortar or on-line (such as Poshmark and Thred Up)
    • Compost kitchen and yard waste.
    • Recycle properly; be familiar with what can and cannot be recycled locally.
    • Conserve electricity by using LED light bulbs, sealing air leaks around windows and doors, and turning off lights when not needed.
    • Be mindful of water use.
    • Buy local and avoid home delivery of goods when possible.
    • Eat produce in-season and from local growers- local farmers’ markets are terrific for this!
    • Use a reusable water bottle; avoid single use plastic water bottles and cups.

    Discuss these steps as a family and brainstorm other ways to help protect our environment.

    more about The contributor

    Dr. Elise Herman

    Blog Posts
    Profile

    Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

    Teen Acne

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    Contributor Dr. Elise Herman

    Teen acne is very common, affecting 85% of adolescents. It can occur on the face, neck, back, shoulders, and chest. Mild acne usually resolves without scarring, but more severe acne can cause darkened areas and permanent depressions in the skin. Teen acne does improve in most by age 20, but in the meantime, it can worsen a teen’s self-esteem, emotional health, and result in bullying.

    Acne occurs in teens due to increased pubertal hormones which cause sebaceous glands in the skin to make more sebum (oil which lubricates the skin). This sebum can plug the pores (hair follicles), resulting in swelling. Bacteria then can create inflammation, irritation, and redness in these swollen pores.

    There are factors which are known to increase acne, including stress. Hormones related to menstruation can also worsen acne the week or so before a girl’s period. Some skin products (moisturizers, sunscreen, and cosmetics) can make acne worse. Look for water-based products and avoid any that contain mineral oil, beeswax, sodium lauryl sulfate, cocoa butter, or coconut oil. Products labeled “non-comedogenic” (meaning not acne-causing) are ideal. Things that rub or cause excessive sweating can contribute to acne; think of phones, chinstraps, and backpacks. Research has not shown a connection between diet and acne, though a healthy diet with lots and fruits and vegetables and minimal processed food is recommended for all teens.

    There are four types of acne. Whiteheads are plugged pores that remain closed. Blackheads are plugged pores that are more superficial and open up, turning dark. Pimples are deeper plugged pores that become irritated and red due to bacteria (though this is not a true infection). Cysts or nodules are deeper, bigger, and may be painful. This severe type of acne can leave permanent scars.

    If acne is mild or moderate, start with over-the-counter products. Washing twice a day with a mild soap such as Cetaphil or an acne wash can help. Clean fingertips are ideal for washing the face; avoid scrubbing. After the skin has dried for about 20 minutes, apply a low strength (2.5%) benzoyl peroxide product sparingly to the face and other problem areas (not just on pimples) once a day, perhaps in the morning. Lower strength benzoyl peroxide products have been shown to work as well as higher strength for most people. Benzoyl peroxide can bleach towels and clothing, so apply carefully. After washing the face in the evening and allowing it to totally dry, apply a thin layer of adapalene (also called ‘Differin’) which is derived from Vitamin A. Both benzoyl peroxide and adapalene can cause irritation, dryness, and redness so always apply to dry skin and use a small amount. These products can initially be used every other day, slowly working up to daily, to help minimize this.

    It can take 2-3 months for acne to improve with an appropriate skin care routine, so patience is key. Squeezing acne lesions makes them more inflamed and take longer to heal as well as potentially causing scars, so should be avoided. If acne is more severe or not improving with over-the-counter care, seek help from your medical provider or a dermatologist. Treatment of more severe acne can help prevent permanent scarring.

    Remember that although acne does usually resolve after the teenage years, it can be a very big deal to your teen in the present, affecting them not just physically but emotionally. Let your teen know that you empathize, and together you will do what’s needed to treat their acne.

    more about The contributor

    Dr. Elise Herman

    Blog Posts
    Profile

    Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

    Helping Your Shy Child

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    Contributor Dr. Elise Herman

    By nature, some kids are more outgoing than others. Many children are shy and reserved when younger but become less so as they grow up. Being shy, however, just characterizes a child’s approach to the world (especially new situations) and does not have to be seen as a negative. There are felt to be some benefits of this personality trait as these children tend to be more observant and less impulsive. Shy kids may be slower to warm up and more cautious about jumping into a new social situation but given time and the opportunity to be involved when they feel ready, do fine socially.

    You can help your child if they fall into the ’shy’ category:

    • Don’t allow people to label your child as ‘shy’ which can make them feel negatively about themselves. You can say something like, “He just sometime needs a little time to observe and warm up”. You can suggest your child give a little wave or smile if they are not ready to talk to someone.
    • Accept your child’s shyness and acknowledge their feelings, but don’t be overprotective. Gently encourage them to try challenging situations such as answering a question in class, ordering an item at a restaurant, or saying ‘hi’ to a child they see on the playground.
    • Create opportunities to practice social skills especially in low-risk settings such as going on playdates, casually getting together at a park with another family, etc.
    • Roleplay certain situations such as meeting new adults and approaching kids at school. It is fine to be near your child if they ‘need’ you, for example when meeting other kids at a playground, but try to let them speak for themselves. If they seem comfortable, you can move away while reassuring your child that you will be nearby.
    • Participation in group activities can build social skills and confidence. Small groups or classes such as scouts, dance, sports, or music give your child a chance to get to know a group that they will see regularly and so become increasingly comfortable.

    It is important to separate common shyness from social anxiety disorder, which is more severe, long-term, and interferes with everyday life to a greater degree. Those with this issue worry excessively about social interactions and seek to avoid social situations when possible. This can negatively impact school, friendships, and overall emotional well-being. Talk to your child’s healthcare provider if you think your child may have social anxiety disorder as counseling and other treatments can be very helpful.

    But don’t fret if you have a shy child—things will get easier! Accepting your child for who they are and supporting them as they work on social skills will help them gain the confidence they need as they grow.

    more about The contributor

    Dr. Elise Herman

    Blog Posts
    Profile

    Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

    Preventing Respiratory Syncytial Virus Infections

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    Contributor Dr. Elise Herman

    As the winter weather approaches, so does the ‘sick season’, including illness due to RSV (Respiratory Syncytial Virus). RSV typically starts in fall, peaks in winter, and causes cold symptoms including runny nose, cough, and fever in children and adults. Most kids have had RSV by age 2. Although usually mild, RSV can cause more serious problems like wheezing, pneumonia, and trouble breathing. These problems are more likely in premature babies or in kids with heart disease, lung issues like asthma, and immune system problems. Between 58,000 and 80,000 kids under age 5 are hospitalized due to RSV each year. Adults aged 60 and above are also at higher risk of more severe RSV illness. Reinfections with RSV are common.

    Like other colds viruses, RSV spreads by the droplets released by coughing or sneezing. You can also get it by direct contact (for example kissing) or touching a contaminated surface like a counter or cup and then touching your eyes, nose, or mouth.

    There is no effective treatment for RSV and since it is a virus, antibiotics do not help. There are, however, two new good ways to prevent RSV—vaccines for adults and antibody treatment for young children. Vaccines stimulate the formation of antibodies to help fight infection (active immunity). Antibody treatments give antibodies directly to the body (passive immunity).

    RSV vaccines are available for those 32-36 weeks pregnant during RSV season and if given at least 2 weeks before delivery, will help protect the baby from severe RSV. RSV vaccine is also recommended for those 60 years and older.

    Antibody therapy (Nirsevimab) is approved for babies less than 8 months during RSV season (if mom did not get vaccine at least 2 weeks before delivery). Nirsevimab is also appropriate for some infants aged 8-19 months with severe health issues including extreme prematurity, immune system problems, cystic fibrosis, and heart disease. Nirsevimab is an injection and lasts 5 months, so helps protect for the entire RSV season. There is another antibody treatment called Palivizumab that has been used for years, but this is only approved for very high-risk children under age 2 and requires a monthly injection.

    Side effects of Nirsevimab are uncommon and include temporary discomfort, redness or mild swelling at the injection site, and a rash. Nirsevimab can be given with routine childhood vaccines and may be given if a child has mild cold symptoms. Children who have had RSV should still receive the antibody therapy due to the risk of getting infected again later in the sick season.

    There may be some difficulty having enough Nirsevimab for all kids who are eligible this year; contact your child’s provider about this. Supplies of RSV vaccine for those who are pregnant or 60 and over seem adequate; check with your provider or local pharmacy.

    Remember the routine ways we can all help prevent the spread of RSV and other viruses, such as frequent hand-washing, avoiding touching one’s face, staying home if sick, and wearing a mask when appropriate. Also, cover sneezes and coughs, do not share cups or utensils, and keep countertops and other frequently touched surfaces clean. Don’t forget your child’s other important vaccines including Influenza and COVID vaccines as these are also important to help keep your child healthy this winter season.

    more about The contributor

    Dr. Elise Herman

    Blog Posts
    Profile

    Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

    Vegetarian and Vegan Diets in Teens

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    Contributor Dr. Elise Herman

    Although still a minority, more people are exploring plant-based diets, including teens. If your teen has expressed interest in this, you may wonder if being a vegetarian or vegan is nutritionally sound and how to handle this change at home. In some families, a diet different than the rest of the household can be a source of conflict, but it need not be so.

    Understanding the reason behind a change in diet is important. Some choose vegetarianism or veganism for health reasons (in adults, these diets are associated with lower risk of some diseases including heart disease, high blood pressure, Type 2 diabetes, and some cancers). The American Academy of Nutrition and Dietetics along with the American Academy of Pediatrics have stated that vegan and vegetarian diets can be “nutritionally adequate during infancy, childhood and adolescence”, but emphasize the need to make sure kids are getting enough nutrition to maintain good health and grow properly. Other reasons for choosing to be vegetarian or vegan may have to do with the larger carbon footprint of animal-based foods and animal cruelty concerns. If your teen is doing this to lose weight, make sure there is not an underlying eating disorder, and touch base with your provider if this is a concern.

    There are different types of plant-based diets. Lacto-ovo vegetarians eat no meat but do eat dairy and eggs. Lacto-vegetarians eat no meat or eggs but do consume dairy products. Pescatarians don’t eat meat but do eat fish (and usually dairy and eggs). Vegans eat no food products that come from animals including dairy, eggs and for some, honey.

    Vegetarianism and veganism are not just about what is not eaten, but also about what is eaten to be fully healthy. It is important to be mindful of certain key nutrients that may be harder for vegetarians and vegans to get enough of:

    • Vitamin B12: important for brain and heart function; found in animal sources (meat, fish, dairy, eggs) and some plants (bananas, potatoes, etc.) but hard to get adequately from plants alone. Supplemental sources include fortified soy milk, cereals.
    • Calcium: creates strong bones and teeth; naturally found in dairy products. Vegans should eat lots of dark green veggies and look for foods fortified with calcium (juices, cereals, soy milk). Tofu is an excellent source of calcium.
    • Iron: essential for preventing anemia and keeping the immune system strong; found in meat and fish. Plant based sources include beans, peas, dark leafy veggies, and dried fruit. It is harder to absorb iron from plant-based foods, so one needs to eat more of these to avoid having low iron.
    • Protein: builds muscle and is found throughout the body. Protein is in meat, fish, eggs, and dairy. Vegans need to eat adequate plant-based protein sources like nuts, soy, whole grains, and legumes (lentils, peas, and peanuts).
    • Omega 3 fatty acids: very important for cognitive development and assuring adequate energy; most easily found in fish, but also canola oil, soy products and walnuts.

    In general, those following a vegetarian or vegan diet should take a multivitamin that has B vitamins, calcium, vitamin D, zinc, and other nutrients. Look for foods that are fortified with vitamin B-12, calcium, omega-3 fatty acids, iron, and vitamin D. Discussing healthy nutrition with your teen is important regardless of their preferences, but especially if they are interested in following a vegetarian or vegan diet. And since plant-based foods are important for all of us, this could be an opportunity for the whole family to learn more about healthy eating.

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    Dr. Elise Herman

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    Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.