PediMag Spring 20

YOUR HOME FOR QUALITY PEDIATRIC CARE • SPRING 2020

Welcome to The PediaMag.............. 2 BEST DOCTORS IN TOWN Best doctors.................................... 3 MENTAL HEALTH Don’t Worry Alone............................ 4 COVID-19 STRESS COVID-19 Stress: Class of 2020...... 6 Allergy, Asthma and COVID-19......... 7 FOOD FUN Kids in the Kitchen.......................... 8 OUTDOOR FUN Make Time For the Outdoors............ 10 TELEHEALTH The Telehealth Revolution................ 12

We Are Here For You! CMAs Carol H., McKenzie S., and Lori B. – Fox Chapel Office

PREVENTION You Can Make A Difference............. 14 PATIENT PORTAL Helpful Tips for Patient Portal Users......................... 16

Publication Provided by:

Welcome

Welcome to The PediaMag These are unprecedented times for everyone, and no one can accurately predict what the future will look like post-COVID-19. This health crisis has reaffirmed the importance of keeping our minds and bodies healthy so we can be prepared for continuing changes as we move forward.

Throughout the global COVID-19 pandemic and the national state of emergency, we have continued, and will continue, to be here for our patients and their families. We have implemented a number of measures including universal masking, social distancing, and online forms to limit physical contact and keep our patients and families safe when they come to our offices. Whether you need advice about your newborn or teen, have a sick child or need to schedule your baby or toddler for vaccines, we are always just a phone call away. Our providers are now able to schedule telehealth phone visits with you and your child to provide care for many different needs. Please don’t hesitate to call your regular AHN Pediatrics office with any questions or to schedule a visit.

About Us: Pediatric Alliance was formed in 1996 when eight individual practices joined together to provide quality health care throughout Southwestern Pennsylvania. Over the years, Pediatric Alliance grew to be the largest physician-owned group pediatric practice in the area. In 2019, Pediatric Alliance joined with Allegheny Health Network to allow expansion of resources in order to stay abreast of the latest technology and advances in health care. Our board-certified pediatricians offer primary care to children and adolescents in 16 different office locations including two specialty care offices for allergy, asthma, and immunology and pediatric endocrinology.

We are proud to offer personalized, patient-centered care to patients from birth to 21 years of age. We strive to meet your family’s pediatric needs, provide convenient access to care, and build strong relationships with families to maximize your child’s health.

To learn more about AHN PediatricsPediatric Alliance, visit our website at www.ahnpediatrics.org.

Tabatha, MA, Northland

AHN Pediatrics-Pediatric Alliance 1100 Washington Ave., Suite 219 Carnegie, PA 15106 www.ahnpediatrics.org

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The PediaMag is published semiannually, copyright 2018. All rights reserved.

Publisher AHN PediatricsPediatric Alliance

Editor Rebecca Scalise

AHN Pediatrics-Pediatric Alliance • Spring 2020 • www.ahnpediatrics.org

Art Director Brent Cashman

Best Doctors in town

Best doctors Congratulations to Dr. Joseph Aracri (Greentree), Dr. Brian Davies (Chartiers McMurray), Dr. Brian Kilpela (Northland) and Dr. Jennifer Romero (Fox Chapel) for being recognized among the Best Doctors in town in the latest issue of Pittsburgh Magazine.

We are proud to have you on our AHN Pediatrics-Pediatric Alliance team.

Joseph Aracri, DO

Brian Davies, MD

Brian Kilpela, MD

Jennifer Romero, MD

AHN Pediatrics-Pediatric Alliance • Spring 2020 • www.ahnpediatrics.org

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Mental Health

Don’t Worry Alone

By Bethany Ziss, M.D.

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AHN Pediatrics — Pediatric Alliance Bloomfield

In the future, I suspect many of us will recall the spring of 2020 with the words “coronavirus” and “Zoom meeting” at equal intensity. The world has changed very quickly in ways most of us could not have predicted even a few months ago. We are building the airplane as we are flying it, and our children are with us on board for the test flight.

As a developmental-behavioral pediatrician, I spend my days with children who have delays or differences in development. About half my patients are diagnosed on the autism spectrum, while others have ADHD, anxiety, or genetic conditions. Many struggle with changes to their daily routine, and most receive community therapies or special education services. About 20% of all children have special educational needs or receive accommodations at school, and a similar number have a mental health diagnosis.

This spring, as COVID-19 reached our area, I watched my colleagues step up to meet the medical needs of our families. How do we provide testing? How do we protect well children from infection in our offices? What visits can be safely provided by video?

Meanwhile, I’ve been working to address the social-emotional needs of our patients. Providing video visits from my living room, I have talked with many families and keep encountering two related questions: > What about mental health? > And, what about school?

Underlying both of these is the related problem – the loss of our daily routines.

Mental health: Young children pick up more on the emotions and anxiety of those around them than the specific concerns. They may be extra clingy, whiny, or tearful. Expect them to ask “why” many times. There may be regression in toilet training or bedtime routines.

Preschool children may find masks scary to wear or to see on those around them. Mister Rogers used to invite actors onto the show to demonstrate that the person is the same under the mask or costume. You may need to practice or demonstrate this.

Older children will likely have a lot of questions and you may not have all the answers. They may worry about themselves or loved ones becoming sick. They may worry about family members who are out of work. Share with them the facts we know, and be truthful about the uncertainty.

Talking points: > Most people do not get very sick. Many children who get sick feel like they have a cold. > If someone does get very sick, people at the hospital work to help them get better. > Schools are closed and people are staying at home to make it harder for the disease to spread. > We are wearing masks if we are around other people outside the house. > We don’t know how long these changes are going to last.

Consider limiting news consumption (for you and for kids). Set aside a plan to check the news at certain times, and to try to step away at other times. Videos can be very distressing for some people.

Everything else may be closed but the outside is still open. Go outside if possible.

Try to give siblings physical space apart from each other.

If your child has anxiety or other mental health needs, reach out. Many outpa-

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AHN Pediatrics-Pediatric Alliance • Spring 2020 • www.ahnpediatrics.org

tient therapists and some school counselors are providing video sessions right now.

School: Over the last month, I’ve talked to students and parents who have experienced “remote school” in every model, from paper work packets to live online classes that take attendance. Some are thriving. One family solidified their decision to enroll in cyberschool for the fall. Working from home can make it easier for a student to move around and take breaks as needed and plan their work for the week.

But many children are struggling. High school students tell me, “the pre-recorded videos aren’t really teaching.” Children may have more difficulty focusing on live video classes than they do in the classroom. And it can be tougher to get clarification on directions.

In addition, some families are trying to assist their children while working full-time from home. One parent tells me they were sent a copy of the child’s daily school schedule, with a suggestion they try to follow it. Other families have essential workers who are still working full-time outside the home. In some homes, an adult is not able to help a child with academics until later in the day. Over and over, I am finding that families feel alone. If nothing else, I can hopefully provide assurance they are far from alone.

Some more advice I can share: > I don’t recommend we try to replicate our usual spring academic goals. > We should be helping students keep thinking and learning, to try to prevent an increase in the “summer loss” of skills that many students experience, but this may not be the best time to start new content (such as a new unit on long division taught

by YouTube video) > Second graders can pick up in the fall a month or so behind where second graders usually start the year. It will be OK. > What is realistic for your child and your family is enough > Keep in touch with the school. Let them know if your child is having difficulty understanding or completing assignments.

Also let them know if the expectations are not realistic for your child or family. They may be able to provide more support or adjust priorities.

I was a special education teacher before I was a doctor and of course believe education is important, but academic expectations

should not be pushed at the expense of your relationship with your child or your child’s mental health.

What about the changes to routine?

The autistic community, full of people who struggle with uncertainty and change, have a recommended strategy: the visual schedule. A schedule should be flexible and as detailed as it needs to be. “Visual” can be any combination of words, drawings or photographs that are meaningful. Include your child or children in the development as much as possible. Younger children may want to draw pictures for activities.

If the plans for the day are uncertain, use Post-its or a whiteboard and start with what you know. If three meals are it, write down breakfast, lunch and dinner. Put an empty box, a question mark, or a blank post-it on the schedule as a placeholder. You can go back later and fill in the hole, even at the last minute when the sun comes out and you decide to go for a walk. Add phone calls or Facetime with relatives and friends who you are missing right now.

You can use a schedule to build in choices. You will probably end up relaxing some of the usual limits on electronic usage, particularly if you are trying to work from home. A visual schedule can show when electronics are “on the menu” and when a child needs to pick other activities.

And finally, some advice I give families all the time, even under more routine circumstances: Don’t worry alone! If things are not going well, reach out. If you don’t know where to start, we may be able to help. Contact information for your nearest AHN Pediatrics-Pediatric Alliance office can be found on our website at www.AHNPediatrics.org.

AHN Pediatrics-Pediatric Alliance • Spring 2020 • www.ahnpediatrics.org

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COVID-19 Stress

COVID-19 Stress: Class of 2020

By Mike Scarff, LPC As the class of 2020 transitions into their final days of school, for many students the realization of what they are missing has settled in. The traditional hallmarks of senior year such as sporting events, prom, and even graduation have all disappeared. These high school seniors now not only face the anxiety of their future but are also grieving the loss of their last days of high school. This sudden change in routine and changing emotions has brought about a lot of uncertainty for the high school seniors I work with. Along with this uncertainty is stress. Research shows that people react differently to stress and that those with a lower tolerance for stress and uncertainty are more prone to negative thinking, low mood, and anxiety.

No one can avoid the unexpected but there are a few strategies that can help teenagers better face the stress that accompanies anxiety, grief and uncertainty.

Focus on what you can control and finding the positives As the days go on and our emotions change, it can be helpful to focus on areas of life that are controllable. For example, a senior who is planning to participate on his university’s swimming team is anxious because the Coronavirus has taken away his workouts. We changed up his routine. He now does many of his core exercises at home. Graduation may be postponed or canceled, but that does not mean it cannot be celebrated. Seniors can plan special events for after the pandemic has ended, like a trip with best friends or a post-graduation party.

Focusing on the positive events that can occur at the end of this crisis can give students something exciting to look forward to.

Journaling Often during periods of grief or anxiety our views on life are clouded.

This can be especially challenging for teens. Writing thoughts in a journal can help gain a better perspective on your thinking by forcing your mind to slow down. As you are able to slow down your thought process you can begin to identify negative thought patterns or cognitive distortions. Cognitive distortions contribute to the way people twist perception and create errors in their thinking. A helpful way to combat these negative thoughts is by using a technique called cognitive

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reframing. One student I work with was upset that the remainder of the school year was cancelled. I asked him to journal his negative feelings and then add a positive side to each one. By reframing his negative thoughts he realized he will be leaving to go to college soon and will now have more time to spend with his 90 year old grandmother.

Reframing his negative thoughts through journaling helped this young man realize the positives and, in turn, lessened his anxiety.

Self- Care It is essential to take care of yourself both mentally and physically during this time. One of the most important ways to practice selfcare is proper sleep hygiene. Due to the sudden change in routine teenagers may be struggling with keeping a consistent sleep schedule. The internet, including social media sites and video games, along with a lack of responsibilities may often lead to sleepless nights.

Turning off the television and cell phones at a specific time each night can do wonders.

Exercise is another vital source of stress relief. We are all quarantined in our homes with limited resources. Get creative by doing yard work, cleaning the house or taking the dog for a walk. Try a new sport or exercise.

Many studies suggest that regular exercise and sleep can increase dopamine levels.

Maintaining Normalcy Lastly, maintaining a routine and a sense of normalcy can reduce stress. A tip that I like to reinforce to my adolescent clients during this time is staying connected to their support systems through text messaging, social media and video chatting. Limitations in socialization have increased and the normal developmental avenues for autonomy and independence that teenagers crave are closed. Even though we are restricted, technology can allow us to be creative and maintain our positive support systems.

These are unprecedented times for everyone and no one can accurately predict what the future will look like post-COVID-19. This health crisis has reaffirmed the importance of keeping our minds and bodies healthy to be prepared for any adversity that may come our way. Acknowledging that our vision of the future might be a little different now than it was before will help your teenager reimagine and plan for their future in a positive and constructive light.

AHN Pediatrics-Pediatric Alliance • Spring 2020 • www.ahnpediatrics.org

Allergy, Asthma and COVID-19

By Sergei Belenky, M.D., Ph.D.

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AHN Pediatrics — Pediatric Alliance

As you may have noticed, this spring pollen season has been gaining speed at a very fast clip. In 2-3 weeks we should anticipate the peak of tree pollen season followed in close sequence by the grass pollen season, with overlap around mid-May. Allergy attacks are very common manifestations of seasonal allergy, with ocular and nasal symptoms being most prominent. “Eyes swelled shut”, deafening rounds of sneezing, unstoppable rhinorrhea, and sore throat — and, yes, decreased sense of smell or complete anosmia (an early sign of COVID-19 infection as well) — are all frequent complaints of seasonal allergies. Dysgeusia (loss of taste), a common early symptom of COVID-19, is not a feature of seasonal allergy.

Clearly, differential diagnosis is always an issue between upper respiratory viral infections and allergic rhinitis, but it is even more ominously important now. History of seasonal allergy or other allergic conditions like asthma, eczema, and food allergy is indicative of seasonal allergic rhinitis, along with lack of fever, profuse sweating, and profound weakness associated with COVID-19 virus. Shortness of breath (dyspnea) is another feature of this scourge, usually as a sign of viral pneumonia or pneumonitis. Of course, dyspnea is part and parcel of allergic asthma, whose seasonal exacerbations are quite commonly seen in spring along with allergic rhinitis flares.

However, such typical asthma features as wheezing and chest tightness are not described in COVID-19. Cough is very common in this viral disease and is frequently violent. It should be attributed to it when other signs and symptoms are present. Diarrhea is observed in almost 1/3 of all COVID-19 patients as a precursor of respiratory illness, and

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Specialty Health Services

never is a characteristic symptom of allergic rhinitis or asthma. Persistent cough — one of the presentations of asthma and post-nasal drip caused by upper airway allergic inflammation — should be differentiated from cough in COVID-19. An aggressive therapeutic approach to asthma and allergy usually leads to cough resolution in appropriate settings and thus informs diagnostic conclusions.

One of the challenges of this spring pollen season is educational emphasis on the use of inhaled steroids — both oral and intra-nasal — for the management of asthma and allergic rhinitis, respectively.

Inherent steroid-phobia in parents of many of our patients is made worse by the presumed risk of steroid use as a predisposing factor to COVID-19. Again, we are using the same strategy of explaining to our patients the cardinal differences between inhaled and systemic steroids while continuing to use short, 5-10 day courses of prednisone for the treatment of both asthma and allergy attacks when necessary.

As we all know, COVID-19 is not a pediatric infection, at least in its severe variants, and that serves as great reassurance for us and parents alike.

Allergy and seasonal asthma, as well as possible outbreaks of “strange itchy rashes” are on the march, and their early recognition and treatment are paramount to the mitigation of suffering in our patients.

Many of us, including myself, are now doing telemedicine, which I am finding very conducive to achieving good results in the management of allergic conditions. I am wide open, using hockey lingo, for telehealth (video or phone) consultations, so please let us relieve ourselves of the burden of overwhelming allergy season by grappling with it early on.

Stay healthy and stay safe. *You don’t have to wait for the pandemic to end before having your allergy symptoms and asthma evaluated and treated. Call (412) 348-6868 to make an appointment with Dr. Belenky. **Please visit our website at www.AHNPediatrics.org to check the daily Air Quality and Pollen Count reports. Links are available from our home page.

AHN Pediatrics-Pediatric Alliance • Spring 2020 • www.ahnpediatrics.org

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Food fun

Kids in the Kitchen

By Jennifer Yoon RDN, LDN, IBCLC

An alternative title for this article might be “Getting Your Kids to Help in the Kitchen without Making Extra Work for Yourself”. Guided by practicality, I dismiss many “kid friendly recipes” as too elaborate and time consuming to put into practice.

But kids really can be helpful in the kitchen when given age and developmentally appropriate tasks. Bonus: kids are more likely to eat when they are involved in food selection Grace M., Age 10 and preparation.

This table provides guidance for developmentally appropriate food preparation tasks for kids. Skills and comfort levels can vary widely, so it’s always safest to use the skill-building approach – I show you, we do it together, you show me. Also in the interest of safety, teach children to cut on a secure cutting board, cutting away from their hand, holding the food with their fingers curled under. Cutting the vegetable in half lengthwise and placing cut side down is safer since the vegetable or fruit isn’t rolling about.

A great way to get kids involved in the kitchen AND encourage snacking on fruits and vegetables is to enlist the help of your

Gia F., Age 6

kids to make selections at the grocery store or farmer’s market.

Prepping and storing a variety of fruits and vegetables to store in containers makes them readily available for snacking or quickprep meals. Examples of vegetables that store well are peppers, cucumbers, carrots, zucchini, squash, broccoli, cauliflower, and salad greens (a salad spinner for storage is ideal). Fruits to prep ahead include oranges, pineapple, and melons. Youngest children can wash the fruits and vegetables. Younger elementary children can peel and cut softer fruits and vegetables. Older elementary and

Crunchy Breakfast Tacos https://www.foodnetwork.com/recipes/food-network-kitchen/kids-can-make-crunchy-breakfast-tacos-3364407 Taco Cheeseburger https://www.foodnetwork.com/recipes/food-network-kitchen/kids-can-make-taco-cheeseburger-3362802 Roasted Turkey and Basil Cream Cheese Pinwheels https://www.foodnetwork.com/recipes/food-network-kitchen/kids-can-make-roasted-turkey-and-basilcream-cheese-pinwheel-sandwiches-3362682 Grace Y., Age 17

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AHN Pediatrics-Pediatric Alliance • Spring 2020 • www.ahnpediatrics.org

Build Your Own Quesadilla Ingredients > 8-10 Whole Wheat 10” tortillas > 4-6 cups Mexican Cheese > Cooking Spray > Choice of add-ins: > Black Beans > Corn

> Sauteed onions, mushroom, peppers, or spinach > Cooked, shredded chicken or pork > Cooked shrimp > Cooked, ground beef > Choice of toppings:

> Salsa > Sour Cream > Guacamole > Shredded lettuce > Diced tomato

Instructions Warm a large skillet over medium heat. Spray the underside of the tortilla with cooking spray and place in pan. Add selected toppings. Add ½ cup shredded cheese. Top with another tortilla and spray with cooking spray. Flip with large spatula when bottom tortilla is brown. Remove when opposite side is brown and cheese is melted. Place on cutting board, cut, and serve with desired toppings or dips.

Age-Appropriate Kitchen Tasks Ages 2-3 > Gather Ingredients > Give veggies and fruits a bath > Tear Lettuce > Wipe down countertops > Roll Dough > Use Cookie Cutters

Ages 4-5 > Measure Ingredients > Stir, Mix, and Pour > Mashing Potatoes > Cut soft ingredients > Shell Peas and Beans > Form ingredients like meatball and hamburger patties

Ages 6-8 > Crack Eggs > Grate Cheese > Peel fruits and vegetables (with a peeler) > Cut soft fruits and vegetables > Frost Cupcakes and Cookies > Use Stovetop with Supervision

Age 13+ Ages 9-12 > Make Rice/Pasta > Cut firm fruits and > Ability to make full meals vegetables and clean up > Make Salads > Steam Vegetables and Rice > Make & Cook Pancakes > Make Scrambled Eggs > Operate Small Appliances > Brown Hamburger > Use the Oven > Load/Unload Dishwasher

Build your own quesadillas, pizza, pasta, salad, stir fry, or even dinner omelettes give kids a chance to get involved, and everyone can have their favorite. pre-teens can cut the firm fruits and vegetables. Teens can cut pineapple and melon.

“Some Assembly Required” dinners are my favorite way to navigate everyone’s food preferences while getting the kids involved in the kitchen. Build your own quesadillas, pizza, pasta, salad, stir fry, or even dinner omelettes give kids a chance to get involved, and everyone can have their favorite. For example, using the Quesadillas recipe below, kids can be given age-appropriate prep tasks – young children can drain

and rinse canned beans and corn and wash vegetables. Elementary age children can slice or chop vegetables and grate cheese if needed. Older kids can sauté vegetables and cook meats. Everyone can help get out other ingredients and cheese, then let the quesadilla construction begin!

Here are some links to a few other delicious and healthy recipes from FoodNetwork that the whole family can enjoy. Keep it fun and positive, and don’t forget to have the kids help with the clean up.

Chan Y., Age 14

AHN Pediatrics-Pediatric Alliance • Spring 2020 • www.ahnpediatrics.org

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Outdoor fun

Make Time For the Outdoors

Since the kids are home and getting their class lessons done remotely, the American Academy of Pediatrics offers some wonderful ideas to keep them learning and having fun outdoors while maintaining the rules of social distancing: Exploring nature while social distancing Nature all around us. Nature exploration with proper social distancing can happen in your yard, a table-top garden, or even virtually (though not with all of the benefits).

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Bringing out baby. Even infants and toddlers can play and learn in nature. If you will be in public spaces, it may be safest to keep them in a carrier or a stroller. If they are in your own private space, it’s fine to have them explore even more. > Nature sculptures can be built with twigs, leaves, cones, rocks and more by sticking the collected items into a play dough base. Help your child put objects in the play dough and notice what kind of patterns are created by different items.

AHN Pediatrics-Pediatric Alliance • Spring 2020 • www.ahnpediatrics.org

(Google Images)

By Ned Ketyer, MD

> Biking with the family in your neighborhood can be a good option if you can keep your distance from others during your ride. If you have a child bicycle trailer, get some exercise while enjoying the outdoors with your baby in tow. > ​Playing in mud is very fun for young children and helps them develop their senses and motor skills. You can give your child old pots, pans, utensils, and other household tools to move, pour, and squish the mud for imaginary play.

Challenge older children. Keep older children and teens engaged outdoors. > Create a nature journal so they can describe what they see from a comfortable spot outside. Encourage them to write how that makes them feel or draw what they see. > Hold a nature scavenger hunt for the family. Include categories like plants, trees, animals, birds. Who can create the longest list of the signs of spring that they find? How many different flowers can you photograph? > Have a ball. Kicking a soccer ball or playing catch together can be fine if you are apart from each other and don’t share any sports equipment with others outside your household.

The AAP reminds us of some other health benefits of being outdoors:

and critical thinking. Studies have found that children who spent more time in nature exploration had improved learning outcomes.

Children who play and learn in nature can show positive behavior. Research has found that when children spent time in natural settings they had less anger and aggression. Impulse control also improves. This might be especially important when normal routines have changed for children.

Children who play and learn in nature are mentally healthier. Stress and depression are reduced for all people who spend time in nature. Children show increased focus and reduced symptoms of for Attention Deficit Hyperactivity Disorder.

Research has found that when children spent time in natural settings they had less anger and aggression.

We can all stay safe when we go outdoors AND take extra time to care for the world around us. Nature has a way of taking good care of you, too: Take advantage of the healing power of nature—in your own backyard or on a walk.

Just remember to follow local public health guidance and keep at least 6 feet from others outside your family. Wash your hands with soap and water or hand sanitizer once you return from your adventure. Getting outdoors, being in nature, and moving our bodies is good for everyone!

Getting outside provides more than a fun break for children. It is also good for their physical and mental health and development.

For example: Children who play and learn in nature can be healthier. Children play harder outdoors than indoors. Especially without the structure of preschool, school or afterschool activities, children especially need opportunities to move. Children who spend more time outdoors have improved motor development. More outdoor time is linked with lower obesity rates.

Children who play and learn in nature can be more engaged in learning. Playing outside promotes more curiosity, creativity,

AHN Pediatrics-Pediatric Alliance • Spring 2020 • www.ahnpediatrics.org

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Telehealth

The Telehealth Revolution

By Ned Ketyer, MD.

It only took a global pandemic to jump-start an idea — resisted for so long by medical providers, health insurers, and patients — and make it a reality. But with great speed and little fanfare, telehealth — the electronic, virtual health visit — has arrived, and it is here to stay.

What is telehealth?

Telehealth involves the use of technology to provide clinical services to our patients without an in-person visit. This will allow your child to be evaluated by one of our pediatric providers by extending your medical home beyond our office walls, to meet you where you are and provide the care you need.

Why is AHN Pediatrics – Pediatric Alliance adding telehealth services?

The ongoing COVID-19 pandemic has caused our providers to incorporate new ways to ensure our patients, their caregivers, and our office staff are Dr. Joe Aracri, AHN Pediatrics – Pediatric Alliance Greentree protected from picking up and conducts a telehealth visit on spreading the virus. Telehealth March 31, 2020. allows patients and parents to freely interact with their chosen provider to receive the best pediatric care that they have come to expect.

How will telehealth work at my pediatrician’s office?

Parents and caregivers are encouraged to call the office if they have important questions or concerns about their child. Most of these questions and concerns will be handled by our well-trained phone triage staff during regular office hours, and all of these calls will be reviewed by a provider, just as they always have been. This is not a telehealth visit.

In case questions are complex, or are of the type that usually result in scheduling an in-person office visit with one of our providers, a virtual telehealth visit will be offered instead in order to comply with appropriate “social distancing” strategies to prevent the transmission of COVID-19 infections by keeping you and your child safely at home.

After the parent or caregiver consents to a virtual visit, a telehealth visit will be scheduled with a provider during regular office hours.

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Can every problem be evaluated in a telehealth visit?

While a large number of pediatric conditions can be evaluated and resolved by a telehealth visit with a provider, there are others that must be seen in person in Dr. Susie Saunders (Arcadia) takes order to adequately provide a call in your medical home. the best care to your child.

When you call the office, you can speak with our triage staff and discuss which type of visit is most appropriate.

Examples of what qualifies for a telehealth visit include: > Feeding concerns and reflux > Asthma followup > Gastrointestinal issues — > ADHD vomiting, diarrhea, > Anxiety/depression and constipation > Behavioral/developmental > Headache concerns > Injuries (some) > Cold symptoms/sinusitis > Rashes (most) and eczema > Concussion > Worried well — > Conjunctivitis (pink eye) for reassurance. > Croup Our policy for prescribing antibiotics over the phone are the same in a virtual visit: We cannot prescribe antibiotics without evaluating a child in the office for conditions such as: > Ear pain > Throat complaints, which may need a strep culture > Pneumonia or wheezing or respiratory distress > Urinary complaints which may need a urine culture We also cannot conduct telehealth visits for the following: > Well-Child Check-ups > Newborn weight checks > Jaundice *NOTE: These lists are not all inclusive. Our staff and providers will assess each patient individually and determine the best course of action.

AHN Pediatrics-Pediatric Alliance • Spring 2020 • www.ahnpediatrics.org

How do I schedule a telehealth visit? > Call your AHN Pediatrics office as you normally would. Our triage staff will screen your concerns to determine the type of service needed: phone advice, telehealth, or in-person visit Dr. Aleksandra Grudziak (Greentree) >

If the concern is eligible can see you now — virtually! for a telehealth visit, you will schedule an appointment and will be provided with instructions. > Please remember that not all issues can be addressed with telehealth technology. Some issues will require an exam or testing in the office, and we will not prescribe antibiotics over the phone. > You will need a telephone line, smart phone and/or video capability for this visit. (**Note: we are currently expanding our technology capabilities so some of these instructions may vary as we move forward. Our scheduling staff will walk you through the process.) > The provider will call the number you provide at the scheduled appointment time. > Please make sure that you and your child are in a private, quiet, comfortable, well-lit space at that time. If using video, please utilize your WiFi if at all possible for a better connection. > Please weigh your child and take their temperature prior to the visit and have this information ready for the provider. > Rest assured that we are here for your family. Please see our website for updated information and other important resources with reliable information regarding the COVID-19 pandemic and telehealth services.

Reminder for parents with newborn babies: Please be sure to call your AHN Pediatrics-Pediatric Alliance office to schedule your newborn appointment with your pediatrician as soon as you and your baby are Dr. Susie Saunders (Arcadia) takes discharged from the hospital. a call in your medical home.

During this COVID-19 outbreak, our morning appointments are limited to well baby visits for patients 18 months old and under so we can do our best to allow our most vulnerable little ones to be in the office without any risk of exposure to sick patients.

How are telehealth visits paid for? > These visits will be billed to your insurance, just as your in-person office visit would be. Typically, the cost you are responsible for depends largely on your insurance coverage. However, most insurance carriers have indicated their intent to temporarily waive patient cost-share in light of the COVID-19 pandemic.

Therefore, we are not collecting any amount for your telehealth care at the time of service. Specific questions about your benefits or coverage should be directed to your insurance carrier.

During this period of uncertainty and concern regarding the COVID-19 pandemic, our most important priority is to keep our patients and families healthy and safe by keeping them home whenever possible.

By providing these new telehealth options to our menu of services, we wish to work with you and continue to provide the very best care to your children in your medical home, AHN Pediatrics — Pediatric Alliance!

Patients and Families: As part of our COVID-19 response we are making some temporary changes to our after-hours care protocols, with the goal of reducing the need for our patients to visit urgent care centers during evenings and weekends. Effective Monday, April 20, 2020, AHN Pediatrics began offering a limited number of telehealth visits with our Pediatric Nurse Practitioners and Physician Assistants for patients calling after hours with urgent, acute symptoms that don’t require an emergency room visit, but that cannot wait until the next day. When a patient calls their AHN Pediatrics office after hours, one of our pediatric triage nurses will review their symptoms and determine the appropriate course of action. Some concerns can be addressed by the nurse over the phone. Other non-urgent concerns may be sent to the patient’s regular AHN Pediatrics office for follow-up the next business day.

After hours telehealth appointments are being scheduled as follows: Monday through Friday from 5:00 PM to 9:00 PM; Saturday from 12:00 PM to 4:00 PM and Sunday from 8:00 AM to 12:00 PM. Our staffing is limited during these hours, so we ask that you call your regular AHN Pediatrics office during normal business hours regarding any non-urgent issues or symptoms or that arise earlier in the day. These hours are subject to change. As always, we will keep you updated should any changes arise.

AHN Pediatrics-Pediatric Alliance • Spring 2020 • www.ahnpediatrics.org

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Prevention

You Can Make A Difference

By Ned Ketyer, MD.

JAMA Patient Page featured an important reminder on how each of us can do our part to reduce the chances of transmitting COVID-19 to other people. It reminds us that the most common symptoms include fever, dry cough, body aches, and fatigue, and that shortness of breath is a “red flag” warning that requires immediate medical attention.

How novel coronavirus spreads is no mystery: Current evidence suggests that the virus can be spread through respiratory droplets after an infected person coughs or sneezes, between people who are within about 6 feet of each other, and possibly through touching surfaces that have the virus on them, such as handrails, telephones, or doorknobs.

Kayla, MA, Arcadia

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AHN Pediatrics-Pediatric Alliance • Spring 2020 • www.ahnpediatrics.org

Reducing transmission of the virus will reduce the amount of disease in our communities. We all should know the drill by now: > Wash your hands for at least 20 seconds with soap and water or hand sanitizer that contains at least 60% alcohol often (especially after touching common surface areas, using the bathroom, shaking hands, and other social interactions). > Avoid large crowds, crowded public places, and maintain at least 6 feet of distance between yourself and others, especially if they are coughing or sneezing. This is known as social distancing. > If you are older or have underlying medical problems, take extra care to avoid [large crowds or crowded public places], including nonessential air travel or cruises. > Avoid touching your eyes, nose, and mouth with unwashed hands, because contaminated hands can transfer virus to these areas and make you sick. > If you are sneezing or coughing, cover your mouth and dispose of tissues after used once. > Avoid shaking hands when greeting others. > Disinfect surfaces that are used regularly, using household sprays or wipes. > Unless you have respiratory symptoms, are a health care worker, or are in close contact with or caring for someone with COVID-19, wearing a medical mask is not indicated. > Wearing gloves in public is not effective protection from COVID-19, because gloves can be contaminated. > Frequently washing your hands is the best way to protect yourself and your loved ones.

* Addendum 4/27/20: In addition to health care providers and people having symptoms consistent with COVID-19, it is now recommended that everyone entering public spaces wears a mask.

AHN Pediatrics-Pediatric Alliance • Spring 2020 • www.ahnpediatrics.org

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Patient Portal

Helpful Tips for Patient Portal Users Patient Portal gives patients a secure way to connect with our office and access their medical information at home and on the road.

— Please ensure your email address is current in our system.

Patient Portal Tips under the Patient Tools section of our website. www.pediatricalliance.com/patient-portal/

• How to Renew Medications • How to Request an Appointment • How to Send Messages via Patient Portal • What to do if you forget your Username/Password In addition to these helpful tip sheets, you can also email or call our portal line if you need assistance. portal@pediatricalliance.com or (412) 278-5102

Your Home for Quality Pediatric Care 16

AHN Pediatrics-Pediatric Alliance • Spring 2020 • www.ahnpediatrics.org