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AAFP National Conference

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July 28, 2022 – July 30, 2022

What is National Conference?
Simply put, the National Conference for Family Medicine Residents and Medical Students, from the American Academy of Family Physicians (AAFP), is the prime destination for family medicine residents and medical students who want to explore all the specialty has to offer.

The AAFP has hosted students and residents at National Conference for 47 years. We’re proud of National Conference because no other event exists that gives you the chance to interact with more than 3,000 peers, hundreds of residency programs, and leaders in the specialty—all in one convenient location. Learn more here

Kansas City Convention Center

Kansas City, Missouri United States + Google Map

Related Events

Dr. Elise Herman Retirement Party

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May 15, 2022 @ 3:00 pm – 5:00 pm

Facebook Event

After 31 years of pediatric practice in our valley, Dr. Elise Herman has retired from her position at KVH Pediatrics.

She continues to remain active in the community, volunteering for local children’s organizations and blogging about healthy families.

On May 15, we’re throwing an informal celebration party for Dr. Elise, and we’re hoping you and your family will attend. She’s chosen to have it at North Alder Street Park, which offers plenty of space for active children.

Please plan to drop by the park between 3-5 p.m. to enjoy light refreshments and give Dr. Elise your best wishes. She will be glad to see so many of her patient families again.

North Alder Street Park

2400 North Alder
Ellensburg, Washington 98926 United States + Google Map

Covid-19: Pediatric Insights

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medical providers that the family and the child trust can be an invaluable source of information and a big part of the decision making – Dr. Elise Herman

The AHA, American Academy of Pediatrics and Children’s Hospital Association host this panel discussion on how pediatricians and hospitals can work with parents to build trust in the safety and efficacy of the COVID-19 vaccine for children.

American Hospital Association

Insights from pediatric health care leaders on COVID-19 vaccines for children

Earlier this week Dr. Elise Herman, KVH Pediatrics, joined other pediatric health care leaders for a panel discussion hosted by the American Hospital Association (AHA), American Academy of Pediatrics and Children’s Hospital Association.

To learn more visit www.aha.org/vaccineconfidence

Resources mentioned by Dr. Elise Herman:
Speakers:
  • Yvonne (Bonnie) Maldonado, M.D., Chief, Division of Pediatric Infectious Diseases, Stanford University School of Medicine
  • Lee A. Savio Beers, M.D., FAAP, Professor of Pediatrics and the Medical Director for Community Health and Advocacy at Children’s National Hospital, President of the American Academy of Pediatrics
  • Elise J. Herman, M.D., Pediatrician, Kittitas Valley Healthcare-Ellensburg, Washington
  • Andrew Pavia, M.D., Chief, Division of Pediatric Infectious Diseases, Primary Children’s Hospital
  • Moderator: Roxie Cannon Wells, M.D., President, Cape Fear Valley Hoke Healthcare, and AHA Trustee

COVID-19 Vaccine for Children 5-11 Years Old

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Contributor: Dr. Elise Herman, KVH Pediatrics

Another milestone was reached November 3rd when the Pfizer COIVD-19 vaccine was approved for children 5- 11 years old, and many medical providers and families breathed a sigh of relief at the news. But parents also have important questions about vaccinating their children.

Why should kids be vaccinated if they usually don’t seem to get that sick?

Children do get sick with COVID; about 25% of all COVID cases currently are in kids. Over 8,300 children aged 5-11 years have been hospitalized due to the virus. There have been 172 deaths in this age group, and almost 800 in those 18 and under. We also know kids can get “Long Haul COVID” like adults, with problems such as foggy thinking, fatigue, and dizziness lasting for months after the illness. A dangerous inflammatory disorder called Multisystem Inflammatory Syndrome in Children (MIS-C) can affect the heart, kidneys and brain and typically occurs about a month after a mild case of COVID.

Though kids with common issues such as asthma or obesity are at increased risk of getting more severe illness, about 30% of kids hospitalized have no underlying health problems. Children can transmit the virus even if they don’t feel sick, infecting friends, family members, teachers, etc. Vaccinating as many people as possible also decreases the risk for other variants to emerge. We absolutely want to avoid another Delta-like surge.

 This vaccine dose is smaller than that for kids 12 years and above and adults. Why?

Dosing is a big part of the vaccine research. It was found that the 10-mcg dose (one third of the 30 mcg dose for those 12 and over) gave robust protection with fewer side effects. And don’t wait if your child is close to 12 years to get the bigger dose- getting vaccinated ASAP is very important, especially as we approach the holidays. 

 Was the research to approve this vaccine rushed?  How safe and effective is it?

The COVID vaccine research went through the same Phase 1,2, and 3 trials as every other vaccine and thousands of kids were studied.  No steps were left out to make sure the vaccine was safe and effective. It was the time in between these trials (usually months to years) that was shortened due to the urgency of the pandemic. The vaccine is 90.7% effective in preventing COVID disease in children.

 What are the possible side effects? Are there any long-term side issues?

The possible side effects in kids are the same as for anyone receiving the vaccine- soreness at the injection site, fever, muscle aches, and headache which usually resolve within 2 days. Long-term side effects for any vaccine are uncommon and typically happen within 6 weeks. The COVID vaccines have been studied for many months with no long-term problems found. 

Myocarditis (heart muscle inflammation) has occurred very rarely in teen and young adult males following the second dose of COIVD vaccine and may be related to puberty hormones. There were no cases of myocarditis in kids 5-11 years who were in the vaccine trials. COIVD itself causes myocarditis, and the risk of myocarditis is more common with the infection itself than the vaccine. 

There has been misinformation about the vaccine and fertility. It does not affect fertility; scientifically there is no way for it to do that and there has been no evidence to support this concern. 

Can COIVD vaccine be given with other immunizations? Yes, it can be combined with any other vaccine including influenza vaccine which is also very important right now.

 How can I prepare my child for the vaccine?

Firstly, don’t call it a ‘shot’ or ‘poke’ which obviously sounds frightening. Refer to it as a ‘vaccine’ and express confidence to your child that it will help to keep them safe. Kids are used to getting vaccines—don’t make this one seem any different.  And don’t tell them that it won’t hurt. Be honest, tell them it will briefly hurt but that they can handle it.

Point out other family members who are vaccinated. In some clinics, parents can get vaccinated along with their kids—a great way to be an example to your child! Ask your child what they have been missing due to the pandemic and explain that vaccination will help them get back to a more ‘normal life’, as well as keeping schools open and protecting others like grandparents. Getting to choose which arm to be vaccinated in gives kids some control. Of course, being in your lap or holding your hand helps, too.

 Will kids still have to wear masks once they are vaccinated?

For all of us, needing to wear masks even once vaccinated has to do with how active the virus is in our communities. So for now we all have to adhere to the mask mandate.  The more people of all ages are vaccinated, the less community transmission there will be and therefore the safer and more ‘normal’ life will be- for all of us.

Don’t wait to have your child vaccinated- even though the COVID numbers overall are slowly decreasing, most of the US is still struggling with a large amount of cases. Colder weather and the upcoming holidays are likely to make these numbers go up again. Your child will be considered fully vaccinated 2 weeks after the second injection, so if they get their first dose soon, the winter holiday season will look a lot brighter!

Elise Herman MD, Kittitas Valley Healthcare Pediatrics, November 2021

COVID-19 and Children

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Contributor: Dr. Elise Herman, KVH Pediatrics

Early in the COVID-19 pandemic, it was a relief to see that children were much less likely to get sick, be hospitalized, or die from the virus. Eighteen months later, many things have changed including the risk to kids, especially with the much more transmissible Delta variant. There have been over 5.7 million pediatric cases since the start of the pandemic, and recent reporting showed over 430,000 US child cases in just 2 weeks, from 9/9/21 to 9/23/21. More than a quarter of new cases are in children, and 55,000 kids total have been hospitalized since August 2020, most without prior health issues. Deaths continue to be rare in this age group but there have been 523 deaths in kids 17 years and younger including 168 in those under 4 years.

Kids can have similar symptoms to adults- fever, productive cough, sore throat, muscle aches, fatigue, and loss of taste or smell. Also common are intestinal symptoms like vomiting and diarrhea. Some children may just have mild cold symptoms or even no symptoms though they can still infect others.

One of the most concerning problems is MIS-C, “multi-system inflammatory syndrome in children” which causes inflammation throughout the body including the brain, heart, and kidneys. This severe illness typically occurs about a month after what seems to be a mild case of COVID-19. There have been over 4,000 cases so far of MIS-C according to the CDC (Center for Control for Disease Control and Prevention).

It is now known that “Long COVID” (prolonged symptoms after initial infection has improved) can happen in children as well as adults. Symptoms include cough and shortness of breath, heart inflammation, severe fatigue, and “brain fog” that last for weeks to months.

There are some clear steps we can take to protect our children. Everyone who is eligible for the COVID-19 vaccine should get it; currently that includes kids 12 years and up (and of course adults). As an example of the vaccine’s effectiveness, teens who are unvaccinated are ten times more likely to be hospitalized than those who have received the vaccine. The more people who are vaccinated, the less chance the virus has to mutate into a new and potentially worse strain. Pfizer has just submitted favorable data regarding vaccine trials in kids aged 5-11 years. A smaller dose than in adults was given in a two-vaccine series with strong antibody response and good safety outcomes. It is hoped that the COVID vaccine will be approved for this age range by the end of October.

Masks are essential in the fight against COVID-19, especially with the Delta variant. Masks have been shown to decrease the spread of the virus in schools this year. Outbreaks are much more likely in places where masking in schools is not required or was instituted after the start of the school year. The Washington state indoor mask requirement is for everyone’s protection, and we parents need to model consistent mask wearing to our children. Lower COVID numbers means fewer people needing medical care which also protects our health care workers, a scarce commodity these days.

In World War II, there was a sense of personal responsibility for everyone to pull together and do their part to help the war effort. This is a war, too, though of a different type. We all need to be part of the solution and be good examples to our children.

Helping Your Young Child Transition to School in the Pandemic

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Contributor: Dr. Elise Herman, KVH Pediatrics

The start of school this year may be a bigger transition than usual for young students due to the COVID-19 pandemic. For many young kids, education last year was largely done remotely, and for some this school year may be their first time doing in-person learning.

That ‘in-person learning’ will look different due to the pandemic. Desks will be spread out and masks will be worn. Given how important reading facial expressions is, kids may feel a bit uncertain about masked interactions with teachers and friends especially if they have not had to do this much before.

Parents may have worries about their child’s health and have other pandemic stressors related to jobs, financial issues, and the well-being of family members. Some families may have lost loved ones due to COVID-19, and for all of us these past 18 months have been difficult and isolating. Children may pick up on their parents’ worries and feel more stressed themselves.

Many kids have been home with their parents and few others during this time, so may experience separation anxiety when faced with going to school in September. This is in addition to the significant increase in childhood anxiety and depression already noted due to the pandemic.

Parents can help their child by doing the following:

  • Be calm and positive about going to school. Let them know you trust the teachers and school staff to take good care of them. Masking and distancing (as well as vaccinating when age-appropriate) are things we can all do to keep others healthy as well.
  • Get to know your child’s school a bit now. Go to the playground, check out the equipment, walk around the school grounds, and snap some photos. Look up the school on-line. Seeing a photo of your child’s teacher and the school will make things easier. According to Lincoln Elementary principal JoAnne Duncan, local students will receive a “welcome letter” in August with important school information. Parents are encouraged to call the school office if they have any further questions.
  • Summer learning, art classes, playdates, and camp programs help your child feel more comfortable interacting with others and being away from you. As we all know, social skills were lost by people of all ages during the pandemic, and we need a little practice to regain those skills.
  • Get back into the public library again, read daily with your child, show your enthusiasm for learning. Making it a habit to go once a week to the library speaks volumes to a child.
  • Start working now towards that early morning wake-up time. Kids should get 9-12 hours of sleep a night; less than that can impact learning and behavior.
  • Establish good routines for eating and exercise. Many children ate unhealthfully and gained extra weight during the pandemic. Getting back to good eating habits and family meals helps kids (and adults) feel better. Regular exercise (especially outside) helps fitness, mood, sleep, and learning—good for the whole family!

Knowing that there are things you can do to help your child with the transition to school especially in view of the pandemic should make this milestone feel less overwhelming and more positive.

COVID Vaccines & Children

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Contributor: Dr. Elise Herman, KVH Pediatrics

A year ago, deep into the COVID-19 pandemic, it seemed unimaginable that we would have a safe and extremely effective vaccine against the Coronavirus that causes COVID-19 infection any time soon. Yet here we are, with about half of all adults in the US fully vaccinated so far. The vaccine was approved by the FDA and recommended by the CDC (Center for Disease Control) for those 16 years and older in December of 2020 and for those 12-15 years old on May 10, 2021. Over half a million kids aged 12-15 years have already received COVID-19 vaccines, and the current research on vaccinating kids 6 months through age 11 years looks very promising as well. Fantastic news, but understandably some parents may be unsure if the vaccine is right for their child.

Why vaccinate children against COVID-19 if they are less likely to get very sick with the virus?

Although COVID-19 typically is mild in kids, thousands of children have been hospitalized in the US and over 300 have died. Some who seem to have mild COVID-19 later may develop a rare but potentially life-threatening complication called MIS-C (Multi-system Inflammatory Syndrome in Children). MIS-C causes severe inflammation in multiple organs including the kidneys, brain, and lungs. Like adults, children may also have long-term health problems after COVID-19 infection.

Children also transmit the virus, possibly infecting family members and other contacts even if they have no signs of it themselves. The COVID-19 vaccines effectively block this transmission. Any infection at any age is an opportunity for the virus to mutate into potentially a more dangerous variant, something we need to avoid. Once kids are vaccinated, parents can be more reassured that it is safer to return to a more ‘normal’ life including in-person school, sports, and other activities.

How do children respond to the vaccine?

Kids have very active immune systems and have been shown to respond very well to the vaccine, but this also means they may be more likely to develop a fever after being vaccinated. Other potential side effects are like those in adults– discomfort at the injection site, headache, muscle aches, chills, and fatigue. These symptoms usually last 1-2 days.

Is the COVID-19 vaccine safe for children?

Yes. It is important to remember that the technology the COVID-19 vaccines use has been researched for over three decades and has been well studied. These vaccines have gone through very rigorous trials with thousands of children and have been shown to be extremely effective and safe. These children will be followed for years to monitor for potential health concerns. This close observation of vaccinated children is how a concern was recently raised about mild myocarditis, or mild heart inflammation. This condition has been noticed very rarely following vaccination in older teens and young adults. It is not clear yet if the vaccines truly play a role. The risks of COVID infection are felt to outweigh the potential risk of this rare condition which typically resolves within 2 weeks.

Can my child get COVID-19 vaccine along with their other childhood vaccinations?

Yes, there is no problem with combining COVID-19 vaccine with any other routine vaccines your child may need.
The Kittitas County Medical Society strongly recommends all children eligible for the COVID-19 vaccine receive it. Speak with your child’s healthcare provider if you have questions or would like more guidance in making this decision. The Kittitas County Health Department Facebook page is also an excellent source for more information.

Tick bites in children

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Contributor: Dr. Elise Herman, MD, KVH Pediatrics

Ahhh, summer! As that much anticipated warmer weather comes, it brings with it the risk of tick bites and the diseases they can cause. Knowing how to prevent tick bites, what to watch for if your child is bitten and how to remove ticks can make us feel more ready for outdoor adventures with our kids.

Ticks have 8 legs, flat oval bodies, and vary in size from the tiny deer tick (size of a poppy seed) to the wood/dog tick (size of an apple seed). They can swell to two or three times their usual size when they have had a blood meal. After sucking blood for 3-6 days, ticks fall off on their own, often leaving a small red bump. As it feeds on the blood, some of the tick’s spit gets transmitted to the host’s body and can cause infection. Ticks must be attached for at least 36 hours to spread infection.

Washington has fewer tick-borne diseases compared to other parts of the country, but we do have cases of Lyme Disease, babesiosis, tick paralysis, and tularemia. Lyme Disease is the most common tick-borne disease in our state and the US. It is most prevalent in the Northeast, mid-Atlantic, upper Midwest, and to a lesser extent on the West Coast. It is spread by the very small deer tick. 80% of Lyme Disease starts as a circular or oval red bull’s eye rash called erythema migrans at the tick bite location within 3-30 days of a bite. It can expand to up to 12 inches and lasts 2-3 weeks. Other signs of early Lyme Disease are fever, body aches, headache, chills, and neck stiffness. If Lyme disease is diagnosed early and treated with antibiotics, progressing to later stages of the disease is very unlikely. The later stages can involve bull’s eye rashes elsewhere on the body, joint pain, temporary facial paralysis, and limb weakness.

There are steps you can take to help prevent tick bites. Avoid dense, grassy or wooded areas, and stay to the center of the trail. Ideally, everyone should wear hats, light colored clothing, long sleeves, and long pants tucked into socks. You can spray permethrin on clothing (not the skin) to decrease tick attachment. Insect repellent containing 20-30% DEET is safe for children but you should minimize its use on very young children and infants. Do not use products that combine DEET and sunscreen since sunscreen needs to be applied more frequently than DEET. Do not apply DEET to the hands of young kids or near their eyes or mouth.

Do a tick check of your child right after being outdoors where there might have been tick exposure. Look at the clothing first, then the skin and scalp. Don’t forget behind the ears, in the armpits and groin area. Showering may help prevent attachment. If you do find a tick, use tweezers to grasp it close to the skin; pull gently and slowly to remove. Try not to crush it when doing this and wash the area well afterwards.

It is important to remember that the chance of a tick bite causing any disease is extremely low. Only 2% of deer tick bites will cause Lyme Disease even in high-risk areas and here in Washington state we are at low risk of any tick disease. So, wherever your outdoor adventures take you and your kids this summer, a bit of planning to prevent tick bites and knowing how to handle them if they happen will help you to all enjoy those long summer days!

Sibling Rivalry

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Contributor: Elise Herman, MD, KVH Pediatrics

If we have more than one child, we hope they will get along and be good friends, and more than likely that will happen one day. But before that time and almost as soon as the second child arrives, sibling conflict and rivalry can start. Especially now with so much family together time given the COVID pandemic and its restrictions, it is helpful to understand sibling rivalry and to have strategies to help your kids live (somewhat) peaceably together.

Sibling rivalry occurs because kids are vying for their parents’ attention, and negative attention (attention for bad behavior) is better than none. Often times, parents give much more attention when behavior is troublesome than when it is ‘what is expected’.

Children also want to ‘become their own person’; to stand out and make a name for themselves within the family. Squawking the loudest and trying to be better than their siblings accomplishes this. Sibling rivalry is more common if family members don’t have functional ways to solve conflicts and resort to yelling and getting very angry. If life is stressful and parents are tired (thanks, COVID!), behavior may worsen. Likewise, hunger and fatigue may contribute as well.

So how can we our help kids get along?

  • Give lots of positive attention to functional behaviors and they will increase– being kind, helping a sibling, letting someone else go first, etc. Practice these skills as they take time to develop.
  • Teach kids to use “I” messages (“I feel upset when…”) instead of “you” messages (“You make me so mad!”) which make people feel defensive.
  • Help kids understand that things may not always be exactly equal, but they will be fair. For example, kids at different ages will have different chores and privileges.
  • Do not compare your children as this just fuels competitiveness.
  • Establish ground rules: no name-calling or physical aggression, etc. and clear consequences if these rules are broken.
  • Try to stay out of conflicts and let kids know that if you do step in, it will be the same ‘solution’ for all. Turning off the TV if they can’t agree what to watch solves the problem and teaches kids that they are better off resolving their own conflicts.
  • Have routine family time that is positive like family meals and getting outside regularly as this helps minimize the negative impact of occasional conflicts.
  • Try to have at least 10 minutes alone with each child daily and let your child choose the activity (within reason). Even a few minutes of your time one-on-one helps that child feel valued. No cell phones or distractions during this precious time.
  • Help kids learn to resolve conflict by discussing the issue when calm, troubleshooting what happened and having strategies to do better the next time
  • Teach your kids to say 3 nice things to each other every day; simple things like, “Good morning!” with a smile counts, as does “Thanks for helping me with…” and “You are nice to be with!”. Remember to do this for your kids as well, and everyone will have a more positive attitude.
  • Take heart that most siblings do become friends as they get older. Learning how to solve conflicts with siblings is very useful for future relationships be they with a coworker, spouse or boss. These important lessons from growing up certainly come in handy later in life.