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Live Well Cincy

Are the Kids Alright?

MENTAL HEALTH A TOP TOPIC IN PEDIATRICS, BUT COMPREHENSIVE CARE IS THE GOAL By Liz Engel

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r. Chris Bolling started to notice it about 10 years ago. An uptick in mental illness in his patients. All kids. And it’s still a major concern in pediatrics today. But, in this specialty, it’s never about just one thing. “Pediatrics is hard to pin down as one challenge,” Bolling, a physician at Pediatric Associates of Northern Kentucky, says. “There’s just a lot of issues that children face.” So it’s no surprise that many local offices are adding “extra” services as more kids battle issues like anxiety, depression and obesity. Pediatric Associates, for example, is at 90

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the tail end of a three-year grant from bi3, a Bethesda Inc. initiative, that’s outfitted its practice, and a few others in Greater Cincinnati, with a parenting expert—a person who can provide guidance and advice when it comes to navigating these challenges. There’s a dietician available now, and, most recently, Pediatric Associates has added a psychologist to its staff as well. A little farther north, at Suburban Pediatric Associates, which has offices in Liberty, Mason and Springdale, there’s definitely a strong focus on mental health, but also on complete, comprehensive care, says Dr. Ronna Schneider, a pediatrician at the practice. That’s why they offer lactation services in office. There’s a doctor trained specifically to treat adolescents. Another who deals with chronic illnesses. “I think everybody’s sort of moving toward that [adding more services],” Bolling

says. He co-founded Pediatric Associates along with Chris Cunha in 1992, and it has three locations: Crestview Hills, Florence and Cold Springs. “We want patients to see us a safe place.” If anything, the parent coaching may be unique, Bolling says. The program, called Parent Connext, is offered through Beech Acres Parenting Center, in partnership with TriHeath Pediatrics and Cincinnati Children’s Mayerson Center for Safe and Healthy Children. It’s free for patients. And access is easy; the parenting expert is on site. The goal is to provide support, whether in overcoming an adverse childhood experience, which is a huge health determinant, or more routine behavior issues, like toilet training and picky eating, that can cause stress for families. Bolling is on the board at Beech Acres and, when the program was proposed, he


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Dr. Ronna Schneider, Suburban Pediatric Associates jumped at the opportunity to help pilot. “Our families love it. Just having one more person they can sit down with [is huge],” Bolling says. “You can read about this stuff in a book, but it’s nice to troubleshoot with somebody who’s an expert. Someone with real-world experience. And it helps the pro-

viders. Rather than having a 15-20 minute well[ness] visit, you can do a deep dive into some of the bigger challenges of parenting. It’s become a vital part of what we do.” Childhood obesity is another area of focus. In the U.S., about 13.7 million children and adolescents, aged 2-19 years, are obese. And “what’s really distressing,” Bolling says, “is that severe obesity is on the uptick.” Children with obesity are more likely to have high blood pressure and high cholesterol, which are risk factors for cardiovascular disease, and breathing problems, such as asthma and sleep apnea. Childhood obesity is related to psychological problems like anxiety and depression, low self-esteem and lower self-reported quality of life. All providers at Pediatric Associates— there are 14 doctors, Bolling says, and four nurse practitioners—are versed in obesity prevention and treatment, but having a dietician adds another layer. That person can also aid with food allergies, sports nutrition, eating disorders and more. Pediatric Associates added that service in 2017. But it’s only in the last year that it’s

offered psychology services, too. Bolling says those offerings will only continue to expand. According to the Centers for Disease Control and Prevention, nearly 1 in 5 children have a diagnosable mental health illness. Most, about 80 percent, are not identified, and therefore, not treated. “It’s something we know is not going away,” Bolling says. “Kids live under different stressors. Social media and the screen stuff has a big impact. Before, I think kids could kind of leave school behind, and now they’re so tethered. There’s no escape. It can be a great source of connectedness in some ways, and we try to have families create a media use plan, but for kids, it’s about keeping them non-exposed as long as possible.” The American Academy of Pediatrics recommends only two hours a day for TV/ electronics, Schneider says. But an hour, at most, is plenty, she says. Mental health is at the forefront at Suburban these days, too, and pediatricians seem to bear more responsibility. “Pediatricians are at the forefront, because we see these patients at least

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Live Well Cincy once a year,” Schneider says. “There’s an overwhelming need for help with mental health. Counseling. Even recognition of symptoms. And mental health resources in Cincinnati—for pediatrics—are not abundant. So we’re very proactive.” Warning signs could include a change in behavior, erratic behavior or a drop in grades. Adolescents should be afforded some privacy, but Schneider says they “should be eating meals with their parents… or having some social interaction.” And early detection is huge. At age 12, patients at Suburban undergo a depression screen—which they complete in the office by themselves, without their parents. The practice is working with Cincinnati Children’s and Dayton Children’s on putting psychologists and social workers in private practices on a trial basis. And currently, Suburban is compiling a database of mental health resources in Cincinnati to further aid in access of care. Schneider hopes that information will be available on Suburban’s website by the end of summer. No matter the issue—whether it’s behav-

ioral health, breastfeeding assistance or even international adoption aid, which Suburban also offers—continuity is important. “If you start as a newborn in our practice, and you go to age 23—and we treat patients up to age 23. That’s amazing continuity of care,” she says. “Every issue you’ve ever had, we have on file, and we’ve gotten you through it. And it helps families. You’re not having to go to this specialist, or that specialist; that’s time consuming, and it’s disruptive for school and academics.” As for its part with Beech Acres, Bolling says he hopes the service can continue,

even after the grant expires. “We really want to figure out how to continue it,” he says. “It’s been a really, really great experience.” And another tool that could prove useful when it comes a child’s health. “I think a lot of parents think, ‘OK, I was raised by an alcoholic. Why would I tell my [kid’s] pediatrician?’ But by asking questions, sometimes we’re able to elicit that information from families and help them. We’re not pointing fingers. We’re just trying to identify things that might impact your health and your child’s health. And we can we address those.” n

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