Stories about: Dr. Susan Laster

Ask the Expert: How can I make the most of a well-child appointment?

well-child visitIt happens to many parents. You leave work early and rush your child to her well-child visit so you can hurry off to the next activity. After the appointment is over, you feel like the visit was too fast. In fact, you realize you forgot to ask her doctor about some concerns.

Thriving checked in with Dr. Susan Laster, a pediatrician in private practice in Brookline, Massachusetts, affiliated with Boston Children’s Hospital, to learn how parents can make the most of a well-child appointment.

The reality is many pediatric checkups are rushed, and parents may forget to mention some of their questions or concerns. But it doesn’t have to be this way.

Doctors, parents and patients can spend a little time preparing and make the well-child visit as useful as possible.

Doctors are learning to “pause and prep” in advance of well-child visits — they do simple things like look back at notes from prior visits, review any specialist notes and prepare to address important issues in the 15- to 20-minute time slot. Pediatricians are starting to understand not everything can be addressed in one visit, and a follow-up visit for a very important issue is a good use of time.

Parents also can learn to pause and prep before the annual checkup or well-child visit. This is a good time for parents to mentally review their child’s year physically, developmentally, psychologically — all aspects of a child’s health that your pediatrician is trained to care for.

Take the bird’s eye view with your assessment. Think about these five groups of questions:

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How was your child’s health this year?

well-child visit
If you have ongoing observations or concerns about recurring health issues, it’s always good to share those with your pediatrician. Was it necessary to use their asthma inhaler all the time? Are your child’s ADHD medications still helpful? Were there monthly strep throats, and do you want to ask your pediatrician about this? Were there multiple sports-related bone fractures? Did your child seem to get ear infection after ear infection? And don’t forget to ask about skin issues at the visit, since it’s hard to talk over the phone about rashes.

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How is your family doing in the healthy lifestyle department?
healthy nutrition

Pediatricians see parents as the main stewards of a household’s lifestyle, mostly by planning for good nutrition, keeping a schedule and setting a good example. Do you have a goal or plan for your child’s digital life? Is your household committed to allowing everyone to get enough sleep? Do you have an ongoing commitment to managing your family’s nutrition? Or do you feel overwhelmed by this aspect of parenting and need some helpful tips?

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Does your partner have questions?

parents Perhaps your spouse or partner has concerns but can’t be at the visit. Do you know what those are, so you can get those questions answered?

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How is your child’s development progressing?
preschool

How is your child’s development progressing, according to you and to any other caregivers and teachers? Does your child usually speak like other children her age? Is your child riding a tricycle like other preschoolers? Is your child just about ready to read? Are any of your child’s teachers sharing any academic or developmental concerns? Pediatricians are trained to monitor child development and can help determine if these concerns require more evaluation.

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Do you have other concerns?

concerned parent Do you have significant developmental or emotional concerns about your child? Do you think the discussion of these would warrant a separate visit? Now might be a good time to schedule both the checkup and the extra visit. Be assured that most pediatricians will meet with parents alone, without the child, to allow for a free discussion of any emotional or developmental concerns.

If your pediatrician has paused and prepped and you have paused and prepped, you may be surprised at how rich the annual visit can be.

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Ask the expert: Can kids still get chicken pox?

Chickenpox1Q: A friend of mine is concerned because her child was exposed to chicken pox. Can babies and children still get chicken pox? A concerned parent

Thriving checked in with Dr. Susan Laster, a pediatrician in private practice in Brookline, MA, affiliated with Boston Children’s Hospital, to learn more about children and chicken pox.

Can children still get chicken pox?

Contrary to popular belief, kids can still get chicken pox. While it is usually not a serious illness, there can be some serious consequences, which is why the American Academy of Pediatrics recommends all children be vaccinated against chicken pox at 12 months of age and again at least 3 months later.

Rarely, a vaccinated child will get chicken pox, although when that happens the disease is usually less serious.

My child wasn’t vaccinated and has been exposed to chicken pox. What should I do?

If your child has been exposed to someone with chicken pox, the best thing to do is to check with your pediatrician. In some situations, there are ways to prevent the likelihood of getting the illness after being exposed.

Some data suggest unvaccinated children 12 months of age or older who are exposed to chicken pox may be helped by getting the chicken pox vaccine within 3-5 days of the exposure in two possible ways:

  • It might lessen the likelihood of developing chicken pox.
  • If the child ends up getting chicken pox it will be a less severe case.

In other situations, anti-viral medication can prevent chicken pox after exposure to the virus.

If your baby has never been vaccinated and is exposed to chickenpox call your pediatrician to discuss prevention options. However, the chicken pox (varicella) vaccine and anti-viral medications are not indicated in infants younger than 12 months.chickenpox3

Can my child get chicken pox if she is vaccinated against the disease?

Vaccination is very important to stop the spread of this potentially serious illness.

If your child has been vaccinated with both doses it is much less likely for her to contract chicken pox. If she does get chicken pox it will likely be a mild case with a few pox.

Some people have worried that the chicken pox vaccine will wear off when children reach adulthood. This possibility has been monitored for many years; so far that is not the case. Childhood vaccination is very successful.

Is chicken pox contagious?

Chicken pox is highly contagious. The actual pox are contagious to touch.

In addition, chicken pox is spread through the air by small droplets from the patient’s nose and mouth. These droplets are contagious up to two days before the pox appear, so someone with chicken pox can spread it before she is aware she had it!

If your child has been around someone with chicken pox either two days before the rash appeared or any day during the rash, she could get chicken pox. But the illness won’t show up for 10 to 21 days, so parents have to look out for symptoms for quite a while.

Children with chicken pox are so contagious that they really need to stay home and away from other people until they are fully better, which is when all of their pox have crusted over.

What do pox look like?

Chicken pox usually starts with “pox” (small blister on a red base, or classically described as a dewdrop on a rose petal) in the “middle” of the body — neck or trunk.  The pox are itchy and increase day by day going from the center of the body out to the limbs.

The pox can end up everywhere on a child’s body. In some serious cases, pox may appear in the eyes and mouth, but typically they are only on the skin. Each day often brings a new crop of pox, and the earlier ones start to heal with a little scab. The whole process lasts five to seven days.

How can I comfort my child if she has chicken pox?

The pox are generally very itchy and can be managed with some basic medicines like calamine lotion or colloidal oatmeal baths. In some cases, giving the child oral diphenhydramine (like Benadryl) may relieve itchiness. Check with your doctor about dosing for this.chickenpox4

When should I call my child’s doctor?

In rare cases, the pox can become infected and lead to serious skin infections. If the red base is spreading, the pox are tender or there is a lot of swelling, call your child’s doctor. In very rare cases, people can get chicken pox pneumonia or spinal fluid infections, so call your child’s doctor if your child’s breathing becomes labored or if you have any concerns about your child’s mental status.

 

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Don’t pull your hair out over head lice

So-called “super-lice” are big news now, just in time for children to go back to school. While that news may be somewhat overblown, as any parent who has been through one will tell you, a lice infestation can be a time-consuming and worrisome health issue. One of the bigger concerns for parents is that if their child is diagnosed with lice, they will have to stay home from school or daycare, something that recent guidelines have stated is NOT the case.

Here are six important facts about lice to keep in mind:

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Anyone can get lice.

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Lice are not related to cleanliness. Anyone can get lice if they are in prolonged, close contact with someone else with lice. Lice only infect people—not pets—and cannot hop or fly. They spread by crawling from one scalp to another scalp. It is very uncommon to get lice from hats or brushes or combs since they cannot survive off the scalp for more than 24 hours.

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