The Back-to-School Special

As families prepare to head back to school, pediatric experts Dr. Jennifer Duchon and Dr. Meredith Grossman from the Mount Sinai Health System join The Vitals host Leslie Schlachter for a timely conversation on how to set kids up for a healthy, successful school year. From getting back into a learning mindset to essential immunizations, nutrition, and even backpack safety, this episode covers everything parents need to know for a confident return to the classroom.

Drs. Duchon and Grossman also discuss how to handle common school-year illnesses, offer tips for easing anxiety, and explain why preventive care is crucial to keeping children safe and thriving throughout the year.

👶 Make an appointment at Mount Sinai Kravis Children’s Hospital:
https://www.mountsinai.org/patient-care/service-areas/children

📺 Watch more episodes of The Vitals on Youtube: https://www.youtube.com/playlist?list=PLCT7BA-HcHliU8QIXyuk_74L_uH0gyKGt

Transcript

00:00:00:00 - 00:00:06:35

Leslie Schlachter

So we're looking at anywhere from, like 9 to 12 hours of sleep. Do naps count in that time frame or is that separate.

00:00:06:49 - 00:00:08:00

Dr. Grossman

Naps do count,

00:00:07:59 - 00:00:14:00

Dr. Grossman

birth through toddler years need those 10 to 12 hours plus a nap.

00:00:13:59 - 00:00:16:42

Dr. Duchon

And I take on my office floor for 30.

00:00:16:46 - 00:00:18:42

Leslie Schlachter

I also do that, but on my couch.

00:00:18:47 - 00:00:20:46

Dr. Duchon

Yes. I think that, you know.

00:00:20:51 - 00:00:22:50

Leslie Schlachter

I think it absolutely counts.

00:00:22:49 - 00:00:30:47

Leslie Schlachter

I think that there should be like a nap time at the end of a school day before extracurriculars and sports. There should be a 20 minute nap. I know I feel amazing after a 20 minute nap.

00:00:30:46 - 00:00:33:12

Leslie Schlachter

I wish nap time could come back for all ages.

00:00:33:17 - 00:00:35:08

Dr. Grossman

Amazing. I don't remember the last.

00:00:35:08 - 00:00:36:59

Dr. Duchon

Time I took it. Yeah.

00:00:41:32 - 00:01:03:01

Leslie Schlachter

Hello, and welcome back to the vitals Mount Sinai Health Systems groundbreaking new video podcast. I'm your host, Leslie Schachter, a neurosurgery physician assistant here at the Mount Sinai Hospital. Children are back in school, and families are juggling routines, schedules and many details that will help set up kids for success. Today, we're going to break down the essentials of a healthy and safe school year.

00:01:03:15 - 00:01:27:34

Leslie Schlachter

From mindset and hygiene to screenings, nutrition and backpack safety. To help guide us, we're joined by two of Mount Sinai leading pediatric experts. First, we welcome Doctor Jennifer Duchin, an assistant professor of pediatrics specializing in newborn medicine and pediatric infectious disease, here at the Mount Sinai Hospital. She works closely with families to ensure the health of children from birth through their school years.

00:01:27:39 - 00:01:37:35

Leslie Schlachter

And joining us here is also Doctor Meredith Grossman, a pediatrician at Mount Sinai Doctors Faculty Practice who cares for children of all ages with a focus of preventative health and well-being.

00:01:37:35 - 00:01:44:14

Leslie Schlachter

So I'm really happy to have both of you guys with us today. So back to school can be a stressful time, right?

00:01:44:18 - 00:01:45:05

Dr. Duchon

Yes, yes.

00:01:45:14 - 00:01:59:21

Leslie Schlachter

Stress number. Oh, I love that. I've never heard that before. What would you say are some of the most important? I want to, like, use the word health kind of broadly because health, a lot of people think is like going to the doctor or medicine's illness.

00:01:59:21 - 00:02:11:17

Leslie Schlachter

But health is also everything from like ergonomics of a backpack to how much cell phone time somebody is using. So what would you say are the most important health considerations when starting off the school year?

00:02:11:17 - 00:02:31:47

Dr. Grossman

I would say probably the most basic thing that should be done is seeing your pediatrician for an annual. Well visit. And at that visit, you're going to address so many different things. So of course, we're always looking at a child's growth and developmental milestones. We're making sure they're up to date on vaccinations or checking their hearing or checking their vision.

00:02:31:48 - 00:02:52:47

Dr. Grossman

We're also addressing any underlying health, you know, health problems that they have. We're giving anticipatory guidance, as to what to expect based on the age and the stage. We're also looking at things like mental health screen time. Right. So there are a lot of things that are addressed at the visit. So I would say the first thing to do is make sure you've seen your doctor within the last 12 months.

00:02:52:52 - 00:03:02:50

Leslie Schlachter

Is there like a checklist that goes through so on the annual visit, is it I mean, I'm sure the checklist has gotten even longer throughout the years. What does that checklist kind of look like? Everything that you just said.

00:03:02:55 - 00:03:23:57

Dr. Grossman

Everything that I just said, and then any problems or concerns that the parents have. So we always start out the visit asking for, questions, concerns and updates about the child's health, about the child's mental health, developmental health. Right. So all of that, it's really holistic. We're not just, you know, we're not just addressing medical issues.

00:03:23:57 - 00:03:25:33

Dr. Grossman

We're addressing the whole child.

00:03:25:38 - 00:03:26:18

Dr. Duchon

Okay.

00:03:26:23 - 00:03:38:39

Leslie Schlachter

And then so as far as strategies for helping kids get back to school, is that something that you guys typically go through at a, well, visit, or is that something that you guys like give handouts for or give YouTube links?

00:03:38:44 - 00:04:02:59

Dr. Grossman

So it runs the gamut, right? I think generally we sort of inquire about a child's readiness for school. Certainly if it's the first time they're going to school, it's a very different conversation. But we do talk about school readiness, based on each child's needs. So for, a five year old who's starting kindergarten, the conversation will be a little bit more about separation.

00:04:03:04 - 00:04:20:39

Dr. Grossman

Of course, we talk to everyone about sleep hygiene, but for a five year old, basic developmental milestones are extremely important. As children get older. A lot of things stay the same. But we do start talking a little bit more about, the academic rigor of school, and certainly about mental health.

00:04:20:44 - 00:04:40:18

Leslie Schlachter

What would you guys say? I want to kind of break up if we can, like the elementary age, the middle school and the high school and then I have I have a son who's a sophomore in college. So, I mean, for me, that's even more stressful now than it was back then. What would you say are some of, like three of the most important things for each age group?

00:04:40:18 - 00:04:46:44

Leslie Schlachter

And I don't even want to talk about like, vaccines or anything. Just like just like I know, I know we're.

00:04:46:48 - 00:04:51:31

Dr. Duchon

I know everybody's angry. I know I feel like we are.

00:04:51:31 - 00:05:03:24

Leslie Schlachter

So going to talk about vaccines, but let's talk about things that we don't inject our body with yet. Let's just talk about like the general hygiene of readiness for school and putting your best foot forward as a child. Sure.

00:05:03:38 - 00:05:16:20

Dr. Grossman

I think something that applies to every child, no matter what the age, is good sleep hygiene, right? The amount of sleep may change as the child gets older, but it's extraordinarily important for so many reasons. Good nutrition.

00:05:16:25 - 00:05:22:09

Leslie Schlachter

So hours. Let's talk hours because good to some parents. Might be seven hours where as good to me is like nine.

00:05:22:14 - 00:05:44:28

Dr. Grossman

Well, I would say a general rule of thumb is that every school age child needs somewhere between 9 and 12 hours of sleep, but the younger they are, the more they need. And every child has different sleep needs, right? So, in that kindergarten for a second grade stage, I would say 10 to 12 hours is aspirational. A lot of times it's tricky because, young, younger children take naps.

00:05:44:28 - 00:06:04:20

Dr. Grossman

And as they get into pre-K and kindergarten, they start to drop those now. Right. So they're going on a very long school day without a big rest period. So really 10 to 12 now some kids thrive on ten hours and some really need those 12 hours. As the years go on and the child gets older, there's some kids who still need that 12 hours.

00:06:04:20 - 00:06:25:54

Dr. Grossman

But, you know, as as they get older, it gets a little bit less, once you hit adolescence, we strive for eight hours. I would say most of my adolescent patients are not getting. Yeah, there's a lot of homework. A lot of kids are up late on their phones. For many of my adolescent patients, I'm hearing six hours of sleep, and then they're making up for it on the weekends.

00:06:25:59 - 00:06:30:51

Leslie Schlachter

That was not like that before. Phones and iPads. That cannot be how it's been.

00:06:30:56 - 00:06:35:14

Dr. Duchon

I feel like TV. Yeah, TV, or.

00:06:35:19 - 00:06:37:36

Dr. Duchon

God forbid, reading a book.

00:06:37:41 - 00:06:42:12

Leslie Schlachter

I feel like that's okay. Whereas, like being up late at night watching TV less okay.

00:06:42:17 - 00:06:44:02

Dr. Duchon

We always probably did something.

00:06:44:03 - 00:06:45:03

Dr. Duchon

Yeah.

00:06:45:08 - 00:06:49:15

Dr. Duchon

You know, to make ourselves as tired as possible for school the next day.

00:06:49:20 - 00:06:50:07

Leslie Schlachter

Yeah.

00:06:50:12 - 00:06:58:12

Dr. Grossman

And I think also their internal clocks shift a little bit. And so they naturally stay up later and then actually want to sleep later. Which is unfortunate because.

00:06:58:12 - 00:06:59:33

Dr. Duchon

Most school schedules don't.

00:06:59:35 - 00:07:01:03

Leslie Schlachter

Yeah, they don't allow for that.

00:07:01:08 - 00:07:06:00

Dr. Grossman

So so it's really tricky. But I would say sleep applies to all ages.

00:07:06:00 - 00:07:07:22

Leslie Schlachter

And then you said nutrition.

00:07:07:27 - 00:07:07:57

Dr. Grossman

Applies to.

00:07:07:57 - 00:07:09:28

Dr. Duchon

All ages. Okay.

00:07:09:33 - 00:07:23:51

Dr. Grossman

You know, I think we forget that food is fuel, right? Food is fun, but food is fuel, right? So you're fueling your brain in your body for the day and having a really balanced diet is extremely important for energy, for mood.

00:07:23:51 - 00:07:26:24

Dr. Grossman

and, and a lot of teenagers skip breakfast.

00:07:26:43 - 00:07:34:54

Leslie Schlachter

my son didn't eat breakfast for four years, and he still doesn't eat breakfast, and I can't I cannot wrap my head around that. I mean, I feel like you should eat breakfast even if you're not hungry.

00:07:34:59 - 00:07:50:14

Dr. Grossman

It's hard to for sleep, right? And so many of these teenagers wake up not hungry. A lot of school age kids because they're, you know, getting out of bed and, you know, still waking up. It's hard to get breakfast into them. Breakfast really is the most important meal of the day. So it's it's really important.

00:07:50:19 - 00:07:58:59

Leslie Schlachter

So if there's like one thing you could tell, like these middle school high schoolers grab just this one thing and eat that on your way to school. What would be that one nutritious thing?

00:07:59:12 - 00:08:08:46

Dr. Grossman

Could they grab a yogurt and some fruit? Okay. Something that's easy to bring along that, you know, protein and fiber. That would be ideal.

00:08:08:55 - 00:08:10:08

Leslie Schlachter

Yeah.

00:08:10:13 - 00:08:19:23

Dr. Grossman

A lot of kids don't have time to have a cooked breakfast in the morning a lot. I will warn against a lot of the, bars. And.

00:08:19:34 - 00:08:20:39

Leslie Schlachter

It's just like sugar, right?

00:08:20:48 - 00:08:27:58

Dr. Grossman

It's sugar. It's not processed. So not only will it, it might give them a hint of energy in the moment, but then they're going to have an energy crash.

00:08:28:05 - 00:08:30:39

Leslie Schlachter

Is that better than nothing, though?

00:08:30:44 - 00:08:44:03

Dr. Grossman

Probably better than nothing. Because what happens is then lunch is several hours later and they're starving mid-morning. So I would say if that's the only option, it's fine. But then maybe try to have a more balanced meal for lunch and dinner if possible.

00:08:44:08 - 00:08:52:38

Leslie Schlachter

Okay, so sleep and nutrition. What about what would you recommend for just putting them into the best emotional and mental state?

00:08:52:43 - 00:09:13:06

Dr. Grossman

I think open lines of communication is super important. I think, we're seeing a lot of anxious kids of all ages. I think there's a lot of anxiety. There's a lot of social anxiety, there's a lot of anxiety around school. There's a lot of anxiety around the start of school. And I think, shoving it under the rug isn't the answer.

00:09:13:07 - 00:09:26:53

Dr. Grossman

I think talking about it and labeling it, you know, starting school is, is nerve wracking. Starting school is really hard. Let's talk about it. And I think starting that conversation before, you know, instead of the day before school, maybe two weeks before school.

00:09:26:53 - 00:09:28:26

Dr. Duchon

Right.

00:09:28:30 - 00:09:31:54

Dr. Grossman

And and keeping those lines of communication open.

00:09:31:59 - 00:09:37:17

Leslie Schlachter

Is that like family dinners? That's probably where something like that really comes into into importance.

00:09:37:21 - 00:09:45:11

Dr. Grossman

Family dinners are aspirational. I think it's it's amazing if and almost shocking if an entire family has the same available.

00:09:45:22 - 00:09:46:41

Leslie Schlachter

It's really hard. It's really.

00:09:46:41 - 00:09:47:38

Dr. Duchon

Hard.

00:09:47:42 - 00:10:07:16

Dr. Grossman

I'll admit, in my family, we try to do that every Friday, but it's really hard the other days of the week. But put the phones away. Focus on the conversation. There are a lot of kids who don't talk freely, and it's a lot of one word answers. So I love games that, you know, not only model talking openly, but make it fun.

00:10:07:16 - 00:10:10:57

Dr. Grossman

So I don't know if you've ever heard of the Rose thorn, but no.

00:10:10:57 - 00:10:12:23

Leslie Schlachter

Tell us.

00:10:12:27 - 00:10:12:51

Dr. Duchon

Anything.

00:10:12:51 - 00:10:21:18

Dr. Grossman

About your the thorn is the thing about your day. That was the hardest. Okay. The rose is the thing about your day. That was the best. And the bud is the thing you're looking forward to tomorrow.

00:10:22:23 - 00:10:27:31

Dr. Grossman

And so you can, as the parents, start the conversation and then allow everyone else to join in.

00:10:27:42 - 00:10:32:14

Leslie Schlachter

That's what we do. Like, what was the best part of your day? Yeah. So I'll just add to that. That's a good idea.

00:10:32:19 - 00:10:33:41

Dr. Grossman

There are a lot of games you play like that.

00:10:33:41 - 00:10:45:11

Leslie Schlachter

that all sounds great, but there are times that, you know, parents need, like, a prescription for that. So we're looking at anywhere from, like 9 to 12 hours of sleep. Do naps count in that time frame or is that separate.

00:10:45:25 - 00:10:58:56

Dr. Grossman

Not to do count, but really young children. So, you know, birth through toddler years need those 10 to 12 hours plus a nap. Okay. And school age children really need 9 to 12 hours.

00:10:59:01 - 00:11:01:40

Dr. Duchon

And I take on my office floor for 30.

00:11:01:44 - 00:11:03:40

Leslie Schlachter

I also do that, but on my couch.

00:11:03:45 - 00:11:05:44

Dr. Duchon

Yes. I think that, you know.

00:11:05:49 - 00:11:18:51

Leslie Schlachter

I think it absolutely counts. I think that there should be like a nap time at the end of a school day before extracurriculars and sports. There should be a 20 minute nap. I know I feel amazing after a 20 minute nap. I wish, I wish nap time could come back for all ages.

00:11:18:56 - 00:11:20:47

Dr. Grossman

Amazing. I don't remember the last.

00:11:20:47 - 00:11:22:40

Dr. Duchon

Time I took it. Yeah.

00:11:22:44 - 00:11:31:39

Leslie Schlachter

And then food is there, like a certain amount of calories like that. You could tell a parent like, hey, your kid should really be getting in, like 2000 calories a day, or is that not really a thing?

00:11:31:52 - 00:11:59:21

Dr. Grossman

We don't really like to talk in calories, even for a child who you know where we're worried about their weight. Certainly if there is an extreme that child's extremely underweight. A child's extremely overweight. You know, we're likely talking to a nutritionist. Okay, all of this anyway. But for most kids, we like to just talk in, you know, meals, basically meals and snacks and to make it as balanced as possible.

00:11:59:26 - 00:12:24:02

Dr. Grossman

A lot of kids struggle with picky eating. It's very, very, very common. And so the best thing you could do is really one model healthy eating to make it fun. Three not force your child. You can't force feed. And four I would say to every parent with a picky eater, have faith that it will get better because the data show that really it does get better over time and you just have to make it as positive as possible.

00:12:24:11 - 00:12:26:53

Leslie Schlachter

Do we have nutrition services here at Mount Sinai for kids?

00:12:26:57 - 00:12:28:00

Dr. Duchon

We do.

00:12:28:05 - 00:12:50:10

Dr. Grossman

What's tricky is not every, most insurance companies or not every insurance company covers in nutrition does it. So sometimes it's a little bit tricky. If a child ends up being referred to our endocrinologist because they're severely overweight, part of that visit is with a nutritionist. And there are some nutritionists throughout New York City that take insurance.

00:12:50:10 - 00:12:53:24

Dr. Grossman

But not everyone does. And not everyone takes all of the insurance.

00:12:53:26 - 00:12:54:56

Dr. Duchon

Okay. Okay.

00:12:55:01 - 00:12:59:28

Leslie Schlachter

Let's talk vaccines. It's your favorite subject.

00:12:59:33 - 00:13:00:17

Dr. Duchon

Infectious.

00:13:00:22 - 00:13:01:13

Dr. Duchon

Yes.

00:13:01:17 - 00:13:06:34

Dr. Duchon

Now, everyone, your kids home sick. Like everyone's getting their fall respiratory virus.

00:13:06:36 - 00:13:07:27

Leslie Schlachter

Yes.

00:13:07:32 - 00:13:28:23

Dr. Duchon

Kind of like a little bit of a break. You know, you may get, like, you may get your strep at camp, but you may get a little diarrheal illness. But really, we sort of prepare in the hospital for the, for the fall surge of everyone's back together, everyone sneezing, sniffling. You know, we don't, you know, stay out of school just for a little bit of sniffles and then everyone.

00:13:28:28 - 00:13:30:04

Leslie Schlachter

Then there would be no kids in school.

00:13:30:07 - 00:13:31:22

Dr. Duchon

Exactly. Yeah.

00:13:31:26 - 00:13:34:23

Dr. Duchon

Teachers or us thing. So,

00:13:34:28 - 00:13:39:33

Leslie Schlachter

So we have guidelines for. I mean, kids can't go to most of these schools without specific vaccines, right?

00:13:39:38 - 00:14:15:31

Dr. Duchon

Yeah. So in New York City, we do have vaccine mandates. There are certain vaccines that you have to get to enter schools. In this city, we don't have, religious exemptions. Some places do. And we keep pretty good records of our vaccines here. So those are, bonuses. But of course, I'm wondering how many local policies and statewide policies are, going to hold up, but, you know, that's.

00:14:15:36 - 00:14:28:14

Leslie Schlachter

Wait, what do you mean, like, because you guys were talking before that there might be some policy changes with, like a specific age group getting. I think you guys are talking about RSV, right? Like, what do you mean by that? Is it possible that these kids aren't going to get what they're used to getting?

00:14:28:16 - 00:14:37:55

Dr. Duchon

Yeah. So, we know that the Covid vaccines were recently pulled back for healthy children, children without risk factors for severe Covid.

00:14:37:55 - 00:14:59:11

Dr. Duchon

the governmental body, the voting arm of the CDC that votes for vaccines and makes that recommendations for vaccines, has had a lot of changes recently. They're due to vote again on September 18th and 19th, and we know that on their ballot is going to be, hepatitis B vaccine for the youngest children.

00:14:59:16 - 00:15:13:55

Dr. Duchon

A product called their seven Mab which is a monoclonal antibody, immunization for the smallest kids against RSV which is a respiratory disease that just kind of wreaks havoc, right. Especially in the tiniest ones. But we see it surge.

00:15:13:56 - 00:15:16:50

Leslie Schlachter

With yeah, there was a problem last year with that. Pretty bad. Yeah.

00:15:16:57 - 00:15:44:21

Dr. Duchon

Yeah. There were it's part of it was part of the triple demic in 2000 and, in 20 to where we saw Covid, flu and RSV. Right. It's like around this time. And we're also worried about the MMR vaccine. Not the MMR per se, but, the MMR v, which is I believe you guys, preferentially give that vaccine as the four year booster for, for children and for school.

00:15:44:23 - 00:15:53:02

Leslie Schlachter

So we MMR so measles mumps rubella, varicella. So we want to drop the varicella. Part of it is what you're saying the vaccine.

00:15:53:07 - 00:16:17:26

Dr. Duchon

So there are, there are a couple of vaccines against measles mumps rubella. And there are. So so one is the MMR vaccine, right. That is given and then there's the varicella vaccine and there's a, there's a combination product, the movie. So there's been some heightened awareness of side side effect profile of the MMR vaccine.

00:16:17:27 - 00:16:40:48

Dr. Duchon

It's not contraindicated. Some pediatricians get it because it's one shot as opposed to two. Yeah. But many people will get the MMR and the varicella when kids are getting their first set of vaccines, against measles, mumps, rubella, 12 to 15 months of age. But then we have a school age booster, or I should say, to boost their school age second.

00:16:40:52 - 00:16:41:55

Leslie Schlachter

Like a second round, right?

00:16:41:58 - 00:17:02:42

Dr. Duchon

Yeah. And that's to capture the kids who didn't get it the first time or may not have mounted an immune response. And that school, those that prior to school that was around 4 to 6 years of age has really been credited with, helping tamp down a lot of pandemic measles.

00:17:02:46 - 00:17:08:24

Leslie Schlachter

So what's the problem? Is that, like what you said something about side effects? Is there like a side effect profile that people don't like?

00:17:08:28 - 00:17:23:12

Dr. Duchon

For the for the MMR vaccine, it seems to have more of the side effects, in children more prone to febrile seizures. So, in our particular society today, which has undergone a lot of changes

00:17:23:12 - 00:17:27:51

Dr. Duchon

Many of the negatives of vaccines are being played up as opposed to.

00:17:27:51 - 00:17:28:41

Dr. Duchon

A really global.

00:17:28:41 - 00:17:29:32

Dr. Duchon

Positive.

00:17:29:35 - 00:17:31:36

Leslie Schlachter

Right. Like here's your platform.

00:17:31:38 - 00:17:32:35

Dr. Duchon

Here's my. Yeah.

00:17:32:37 - 00:17:34:10

Leslie Schlachter

Tell us, tell them.

00:17:34:17 - 00:17:38:42

Leslie Schlachter

people think that vaccines cause autism. It does not like over and over again. It doesn't.

00:17:38:44 - 00:17:40:10

Dr. Duchon

So like the study shows.

00:17:40:10 - 00:17:40:33

Leslie Schlachter

Yeah.

00:17:40:33 - 00:18:07:34

Dr. Duchon

No, they've been studied in many randomized controlled trials. There are lots of really good data on the benefits of vaccines. And someone asked me in an interview, had I, you know, had I seen a death from a vaccine preventable disease? I'm like, no, of course not. Oh, no, of course not. Because vaccines are sort of a victim of their own success, right?

00:18:07:39 - 00:18:11:42

Dr. Duchon

We don't have vaccine preventable diseases because vaccines have prevented.

00:18:11:42 - 00:18:12:49

Dr. Duchon

That, right?

00:18:12:49 - 00:18:17:46

Leslie Schlachter

what's the issue? That they just don't want to pay for them anymore? Is that what is coming down to.

00:18:17:51 - 00:18:17:55

Dr. Duchon

The.

00:18:18:05 - 00:18:39:35

Dr. Duchon

Belief system? Okay. Shifted towards a belief system where, the sentiment is that vaccines are artificial, that they have all these side effects, the things that they're not well-studied, that they cause conditions that they just don't cause.

00:18:39:48 - 00:18:40:56

Leslie Schlachter

You're curling your upper lip.

00:18:40:56 - 00:18:43:32

Dr. Duchon

By the way. Right.

00:18:43:37 - 00:18:46:21

Leslie Schlachter

You're holding it in.

00:18:46:26 - 00:18:57:29

Dr. Duchon

And people respond to fear. Yeah. Natural course of things. Right? Like, if someone tells you something that sounds scary, you're probably going to Google it more than you will.

00:18:57:30 - 00:18:57:53

Dr. Duchon

Right.

00:18:57:59 - 00:18:59:04

Leslie Schlachter

Talk to your doctor about it.

00:18:59:09 - 00:19:07:44

Dr. Duchon

Right. Or. And when you Google unfortunately like if you Google vaccine side effects. Yeah. Things are going to come up.

00:19:07:55 - 00:19:11:53

Leslie Schlachter

So what do you tell your patients parents. What do you like. How does this conversation go?

00:19:11:58 - 00:19:12:35

Dr. Duchon

Please talk.

00:19:12:35 - 00:19:14:06

Dr. Duchon

To them. Yeah.

00:19:14:11 - 00:19:15:14

Leslie Schlachter

So what is talk to your Grossman.

00:19:15:14 - 00:19:16:44

Dr. Duchon

Say trust. Sure.

00:19:16:51 - 00:19:20:03

Dr. Duchon

We have a relationship with. Don't talk to me. Talk to like.

00:19:20:04 - 00:19:24:25

Dr. Duchon

You. Right. Talk to her to get all my. Yeah. I say.

00:19:24:30 - 00:19:50:04

Dr. Grossman

I think it really depends on where the family is. I will say, I think there was a lot of rising vaccine hesitancy leading up to what's going on in the federal government. And I think, I think that has propelled certain parents to a different stratosphere of worry. I always tell people if they ask, I vaccinated my children as early as possible with every single vaccine I possibly could.

00:19:50:09 - 00:19:53:40

Dr. Grossman

I also say that a lot of things have side effects, right?

00:19:53:45 - 00:19:54:08

Dr. Duchon

Right.

00:19:54:23 - 00:20:19:28

Dr. Grossman

Motrin has side effects. Tylenol can have side effects. Anything can have side effects. The side effects of the measles can be lethal, right? The side effects of, you know, any of these diseases we're trying to prevent can be extremely dangerous. Many vaccines have side effects. They always have. But usually it is a much milder version of getting that actual illness right.

00:20:19:29 - 00:20:26:28

Dr. Grossman

And I often say this. The fact that your child might have a fever after the flu shot is a sign that you're it's working.

00:20:26:32 - 00:20:27:46

Dr. Duchon

Pray.

00:20:27:46 - 00:20:50:26

Dr. Grossman

And the vaccine is actually working. Yeah. It's not a bad thing. But it's very hard. And of course, I try to not be judgmental. This is their child, right? They want to feel confident about what they're doing. I do say most of these vaccines have been studied for decades and decades. Right. Extremely compelling evidence about their safety and efficacy.

00:20:50:31 - 00:21:02:02

Dr. Grossman

And like anything, you know, nothing is a guarantee. But I feel, you know, I would never do something to your child that I think would put them at risk. I'm here for your child's best interest, and well-being.

00:21:02:05 - 00:21:13:28

Leslie Schlachter

What about when they want to break them up? Like we like? We know that their immune system can handle multiple immunizations together. What do you say to the parents that are like, that's too much for today. We'll come back another day.

00:21:13:33 - 00:21:18:43

Dr. Grossman

It's not my decision. It's theirs. So if they do want to space them out, I will do that.

00:21:18:48 - 00:21:21:50

Leslie Schlachter

But you educate them that that's not reality.

00:21:21:55 - 00:21:47:37

Dr. Grossman

It's not, beneficial. In fact, sometimes I think it's even more detrimental to the child to bring them back, on multiple occasions for pokes. But if that makes them feel more comfortable. And if that's the difference between not vaccinating and. Right. I'm happy to do that. My practice actually does have a vaccine policy that you have to initiate vaccines by certain age and complete certain vaccines by certain age, mostly because we share a waiting room with.

00:21:47:41 - 00:21:49:14

Leslie Schlachter

Like to stay in the practice. They have to.

00:21:49:15 - 00:22:05:41

Dr. Grossman

Yeah. Unfortunately. You know, at Mount Sinai, we have a lot of children who are medically fragile. So they might be sitting in the waiting room next to a child who's had a solid organ transplant. Right. And so if there's any risk that they could have the measles and give that child the measles, it's really not safe.

00:22:05:41 - 00:22:10:03

Dr. Grossman

So in our practice, we do have that policy. Not every practice does.

00:22:10:03 - 00:22:25:34

Leslie Schlachter

What do you say to the parents? This is like, this is probably why I don't work in pediatrics. Because I would not be able to bite my tongue to parents who are like, oh, but it's it's synthetic. There's preservatives. I want to be like, are you giving your child a completely organic diet or do you not use products on your skin?

00:22:25:39 - 00:22:27:55

Leslie Schlachter

Like, that's insane to me. But people say that.

00:22:27:55 - 00:22:34:49

Dr. Duchon

I mean, it's such a hard topic because. Yes, but there's also, you know, did you eat that bag.

00:22:34:49 - 00:22:37:51

Dr. Duchon

Of chips right. You know, what's the.

00:22:38:05 - 00:22:41:15

Leslie Schlachter

Did you have a Nutri-Grain bar every morning?

00:22:41:20 - 00:22:42:05

Dr. Duchon

Did you, did.

00:22:42:05 - 00:22:46:50

Dr. Duchon

You drop something on on pavement and pick up. So.

00:22:46:55 - 00:22:47:25

Dr. Duchon

I.

00:22:47:32 - 00:22:51:40

Leslie Schlachter

I guess is that not socially acceptable in a medical practice to say these things?

00:22:51:44 - 00:22:55:55

Dr. Duchon

It's it's not. So that's why I'm, like, looking at.

00:22:56:00 - 00:22:58:21

Dr. Duchon

Like. For what? But what are you saying?

00:22:58:21 - 00:23:20:48

Dr. Duchon

There there are a lot of good informational sites telling you, first of all, that many preservatives actually been pulled out of some of our vaccines. So, we don't generally use things like multi-use vials anymore, right? Bio Mersal, which was like the which was a big deal in the MMR vaccine. A lot of people were very concerned about that.

00:23:20:48 - 00:23:37:29

Dr. Duchon

Was actually pulled out of the vaccine products. And the preservatives that are there are extraordinarily common. They're used in a lot of different food products, medication products. They're not intrinsically harmful.

00:23:37:34 - 00:23:38:35

Leslie Schlachter

Yeah.

00:23:38:40 - 00:23:57:35

Dr. Duchon

I, I'm so lucky to to work with colleagues on the ground who, again, will be like, listen, I'm not doing something that's harmful for your child. That's what I did for my kid for, like, perhaps relationship with you. Trust me. Right. And that's really. I mean, it's hard for me to say. That's hard for me.

00:23:57:40 - 00:24:04:42

Leslie Schlachter

I think that's a love. I think it's a lovely thing for a practitioner. Say, is, please trust me. Like we would not do what is not best for your child.

00:24:04:46 - 00:24:10:06

Dr. Duchon

It's really hard for me to say no. Trust me, that amount of alignment on this trivial right?

00:24:10:10 - 00:24:13:51

Dr. Duchon

So yeah, it sounds fishy, even me saying it.

00:24:13:55 - 00:24:32:34

Leslie Schlachter

Right. But it is. But it is. Yeah. No, I mean, we're lucky here at Mount Sinai to be able to work with people and specialists in infectious disease, environmental medicine. And we know all of these things, and we're working from a public health perspective to to like, do better. Okay. So is there anything else we want to add about vaccines?

00:24:32:39 - 00:24:49:25

Dr. Grossman

Well, I'll just add on that in life there are no decisions that are perfectly easy. And there are a lot of, you know, weighing pros and cons. And so if there's this bit of hesitancy about what the vaccines are made of, I always say, but think about what could happen if your child gets that disease.

00:24:49:25 - 00:24:49:48

Dr. Duchon

Right.

00:24:49:48 - 00:25:06:52

Dr. Grossman

And I never like to scare parents, right. But if you've been around long enough to see some of these diseases, they're very, very scary. And I think to Jen's point earlier, we don't see a lot of these diseases because of vaccines. And so I think we have, you know, a little bit of memory loss about what polio was really like.

00:25:07:00 - 00:25:07:58

Leslie Schlachter

Oh, for sure.

00:25:08:03 - 00:25:24:25

Dr. Grossman

Is really like, and so just if you're in that sort of place of making this decision and want to make the perfect decision, there is no perfect decision. It's about making the best decision you can with the information at hand, and weighing the pros and cons. And the benefits of preventing these lethal.

00:25:24:25 - 00:25:25:31

Dr. Duchon

Diseases right.

00:25:25:36 - 00:25:27:15

Dr. Grossman

Away outweighs any of these other.

00:25:27:18 - 00:25:28:09

Dr. Duchon

Yeah.

00:25:28:14 - 00:25:41:33

Leslie Schlachter

I mean, we all remember what Covid was like, and people don't want to get boosters that are at risk. That's crazy to me. But so what is what's the party line right now about Covid boosters for children? Let's categorize them at risk and not at risk obviously.

00:25:41:39 - 00:25:55:09

Dr. Duchon

So the American Academy of Pediatrics, and in fact, New York State, has endorsed that, all children six months to 23 months of age receive an updated Covid vaccine.

00:25:55:14 - 00:25:56:32

Dr. Duchon

Okay.

00:25:56:37 - 00:26:12:54

Dr. Duchon

It's now Covid vaccines are like the flu. We target a different strain rate every year. So little tiny kids do get two vaccines or get a series of vaccines. But over the age of two, they're getting one vaccine.

00:26:12:58 - 00:26:13:54

Leslie Schlachter

Okay.

00:26:13:59 - 00:26:17:27

Dr. Duchon

We may have to fact check that,

00:26:17:31 - 00:26:22:20

Leslie Schlachter

Somehow we'll put a link below saying, look, click here for the updated.

00:26:22:25 - 00:26:24:22

Dr. Duchon

Yeah, I think it's.

00:26:24:27 - 00:26:25:41

Dr. Grossman

The primary series.

00:26:25:41 - 00:26:48:29

Dr. Duchon

Or not. Yeah. Okay. Absolutely. The vaccine. Luckily, we have really great resources of the American Academy of Pediatrics and New York State. Okay. Great website. On vaccines. So the American Academy of Pediatrics, and New York State are officially recommending a Covid vaccine for all infants 6 to 23 months of age.

00:26:48:34 - 00:26:49:27

Dr. Duchon

Okay.

00:26:49:32 - 00:27:02:40

Dr. Duchon

They're recommending vaccines, Covid vaccines be on that age for any child who's at high risk, for getting severe Covid or if they live with someone who has, risk of having severe Covid disease.

00:27:02:55 - 00:27:09:37

Leslie Schlachter

So we're talking like a 12 year old, maybe with asthma or a 16 year old who lives with a mom with COPD or something. Okay.

00:27:09:42 - 00:27:11:40

Dr. Duchon

Or if they live in a congregate setting.

00:27:11:40 - 00:27:12:00

Dr. Duchon

Okay.

00:27:12:15 - 00:27:31:07

Dr. Duchon

So colleges, boarding schools, and then any child whose parents want the vaccine, okay, for their child want that protection. The American Academy of Pediatrics and New York State endorse that. Parents have the right to choose that for their children to have that protection.

00:27:31:18 - 00:27:51:30

Dr. Grossman

Okay. I'll highlight that some of those underlying conditions that will qualify you for a vaccine include things like developmental delay and autism, obesity, physical inactivity. So a lot of kids actually will qualify. And so we're excited and happy to vaccinate anyone.

00:27:51:34 - 00:28:10:04

Leslie Schlachter

Yeah. You're like, everyone is welcome. Okay. Let's talk about things that sometimes are a little bit slower to pick up. So you talked about at the Wellness Check. You do things like, you know, hearing test how often should those like elementary, middle school and high school age children be getting their hearing and vision checked.

00:28:10:09 - 00:28:11:10

Dr. Grossman

Every year, actually.

00:28:11:19 - 00:28:24:59

Dr. Grossman

we start testing vision, actually at 12 months of age with, what's called an ocular screener and it's sort of a digital way to check, to check for eyes, reading from the chart, we call it the snail in that one.

00:28:24:59 - 00:28:27:46

Dr. Grossman

Yep. Can't do until you're able to read from a chart. So most.

00:28:27:46 - 00:28:28:02

Dr. Duchon

Kids.

00:28:28:08 - 00:28:29:56

Leslie Schlachter

Unless you do like smiley face.

00:28:29:56 - 00:28:30:52

Dr. Duchon

Sad face.

00:28:30:52 - 00:28:32:13

Leslie Schlachter

Flower. Right? Yeah.

00:28:33:12 - 00:28:48:50

Dr. Grossman

So most kids aren't able to do that until close to age four. Right. To use that ocular screener. Up until that point, we try we attempt the vision screen at age three, but usually it's not until age four. Yeah. Once you hit age four, it's yearly. Okay. We also start testing hearing, around the same time as well.

00:28:48:50 - 00:29:06:34

Dr. Grossman

We try at age three. A lot of kids aren't able to follow those instructions. And so we routinely start at age four. And we recommend doing that yearly. If there are any additional concerns about hearing and or vision, we'll ask a parent to bring it to our attention and to send them to a specialist, even if they pass.

00:29:06:34 - 00:29:10:44

Leslie Schlachter

But I'm sure the majority of the time the parents are like, something's definitely not right here.

00:29:10:49 - 00:29:15:02

Dr. Grossman

A lot of parents are very intuitive, and so if a parent is worried, I'm worried.

00:29:15:07 - 00:29:41:31

Leslie Schlachter

Okay, can we talk about weight? Also? I know from personal experience, that being heavy in a school setting is not only unhealthy for a child, obviously, but can also be really emotionally distressing. How do you guys handle, you know, even, like, mild obesity? How do you handle that in school age children?

00:29:41:36 - 00:30:08:38

Dr. Grossman

It's a very tricky conversation. Right. Because there is a lot of anxiety about body image. And I do think social media has contributed to that in a big way, for sure. So you want to have that conversation in a non-judgmental way. And in a way that, a child can understand. You also don't want a child developing a negative body image because of that conversation.

00:30:08:38 - 00:30:27:49

Dr. Grossman

So it's a very delicate conversation, in my opinion. I will say I do try to always spin it towards the positive. So let's talk about the ways you're keeping your body healthy. Tell me about all the foods you eat to feel your body. Tell me about the exercise you're doing. And I never, ever talk about how a child looks, but I do show them the growth curve.

00:30:27:50 - 00:30:46:50

Dr. Grossman

I show the parents the growth curve, and I show the child, and I just explain what a growth curve means and, what certain deviations might indicate. And then it's really, again, not about how you look, but about the health implications of a rising BMI. For example, BMI is a body mass index, which is essentially a measurement of your weight compared to your height.

00:30:46:55 - 00:30:55:06

Leslie Schlachter

What have you guys seen as far as like diabetes starting earlier in children? What does that look like over the years? Because I feel like we're just getting bigger and bigger.

00:30:55:11 - 00:30:56:20

Dr. Duchon

Yeah.

00:30:56:25 - 00:31:22:33

Dr. Grossman

Obesity is an epidemic in this country. And I think Covid really had a big impact on obesity. A lot of kids were home. Yeah, we're going to school for some kids. Their main physical activity is physically going to school, being in school, doing physical education at school and coming home from school. If you take that away and there's not other opportunities for physical activity, you see a weight increase.

00:31:22:33 - 00:31:28:11

Dr. Grossman

And so we saw a lot of children with significantly increased BMI as after the pandemic.

00:31:28:17 - 00:31:32:41

Leslie Schlachter

Do you do you tell children at their yearly visits, like how much physical activity they should be getting daily?

00:31:33:34 - 00:31:40:46

Dr. Grossman

I do recommend at least 3 to 4 times a week trying to do something that gets your heart rate up for about 30 minutes if.

00:31:40:46 - 00:31:42:26

Leslie Schlachter

Possible, like playing a game or something.

00:31:42:37 - 00:31:54:45

Dr. Grossman

It doesn't have to be proper exercise. It could be taking a walk. It could be, going to the park. I often say if there's an elevator or a stairwell and you have the opportunity to take the stairs, try to take the stairs.

00:31:54:54 - 00:31:57:18

Leslie Schlachter

You're so lucky their stairs take them.

00:31:57:23 - 00:31:58:23

Dr. Duchon

Right?

00:31:58:28 - 00:32:01:03

Leslie Schlachter

That's how I feel about stairs. I love taking the stairs.

00:32:01:08 - 00:32:03:00

Dr. Duchon

I do run up a lot of stairs to.

00:32:03:06 - 00:32:06:03

Dr. Duchon

Yeah, yeah I know, yeah.

00:32:06:07 - 00:32:30:33

Leslie Schlachter

Yeah yeah, I can imagine what a tough subject that is. I know as a parent, when my son was younger, he was pretty, he was heavier and he with us was very distraught about it. He would pretend like he wasn't in front of other people. But I know that was something that really bothered him until he kind of grew out of it, and it really affected him for several years in his friendships and his socialization.

00:32:30:37 - 00:32:40:46

Leslie Schlachter

You know, it really does go past just the health implications of it. There's mental health, too. So yeah, it's tough for parents to deal with that.

00:32:40:51 - 00:33:07:17

Dr. Grossman

And body image is something that a lot of kids struggle with. That's something we try to bring up at, well, visits with teenagers especially, but I, you know, I will just encourage everyone to sort of try to use as much positive language as possible. Actually, parents, when it comes to, you know, instead of saying, don't eat this, you know, it will make you fat, but what can we eat today that will, you know, right for you and make you feel good and make you feel energized?

00:33:07:28 - 00:33:25:59

Leslie Schlachter

Well, I think what you said is really important for our listeners to hear. For anyone who's a parent out there, if you are worried about your child being heavier than they should be, I mean, scheduling an appointment with your pediatrician to look at the growth chart and look at the curve and talk about the health implications of it, that's a reasonable visit to schedule.

00:33:26:04 - 00:33:45:16

Dr. Grossman

In fact, I once you hit age three, you only have a required visit with your pediatrician once a year. Yeah, but for many children, whether their weight is climbing, or they're actually falling off their growth curve, I'll, I'll actually schedule follow up growth checks more frequently. So I might say, you know what? Come back in 3 to 6 months.

00:33:45:16 - 00:33:53:34

Dr. Grossman

Let's take another look at the growth curve and see where things are. Because one point in time might not be enough information on waiting an entire year, it can also be super detrimental.

00:33:53:45 - 00:33:54:28

Leslie Schlachter

Okay,

00:33:54:28 - 00:33:55:58

Leslie Schlachter

You want to add something to that?

00:33:56:02 - 00:34:21:53

Dr. Duchon

I was going to say, I just think it's really interesting because here we're talking about these, vaccines that we're talking about, nutritional health and sleep hygiene all all together as positive interventions. And it seems like to me that, there that the vaccine component has just been pulled out of health.

00:34:21:58 - 00:34:22:36

Dr. Duchon

Right.

00:34:22:41 - 00:34:23:55

Dr. Duchon

And it doesn't it.

00:34:24:00 - 00:34:24:40

Leslie Schlachter

Doesn't make sense.

00:34:24:54 - 00:34:32:48

Dr. Duchon

Shouldn't be like we should just be doing what we're doing here, talking about all these things as sort of a bundled intervention to make your kids healthy.

00:34:32:53 - 00:34:33:58

Dr. Grossman

Absolutely.

00:34:34:03 - 00:34:52:41

Leslie Schlachter

I think it's actually completely crazy. I feel like we're in a society where everybody wants a quick fix. Everybody wants that special pill or the shot. People want to go on ozempic for weight loss instead of doing whatever it is that they're going to do. Here we have injections, vaccines that will make things so much easier, but we're still coming up with problems for that.

00:34:52:48 - 00:34:53:59

Leslie Schlachter

Yeah, it doesn't make any sense.

00:34:54:04 - 00:34:59:37

Dr. Duchon

Yeah. Is that right? Yeah. Yeah, I can give it to you. Yeah.

00:34:59:42 - 00:35:04:17

Leslie Schlachter,

Oh no I don't know. Yeah I know it doesn't. It really doesn't make any sense. Yeah I can't wrap my head around it.

00:35:04:17 - 00:35:07:37

Dr. Duchon

we're somewhat moving in a direction based on our,

00:35:07:37 - 00:35:25:10

Dr. Duchon

politicization of medicine, but some of those things are good. Like the focus on nutrition, focus on, you know, avoiding highly processed foods. Like, if only we could just keep the keep everything else going as well.

00:35:25:15 - 00:35:29:01

Dr. Grossman

That's all. In the interest of preventing disease.

00:35:29:05 - 00:35:47:55

Leslie Schlachter

Yeah. I want to talk a little bit about hygiene, which I can't believe we're talking about. But in school age children, they don't like to wash their hands or shower. Like, really. I mean, for years I remember having to be like, you need to get in the shower today. Now I have a 17 year old daughter who would shower all day long if I let her.

00:35:47:59 - 00:35:57:08

Leslie Schlachter

But let's talk about just like the basic stuff. Can we talk about hand-washing versus sanitizer? Like what? What is really good hygiene for school age kids?

00:35:57:08 - 00:35:57:27

Dr. Duchon

I think.

00:35:57:27 - 00:36:19:59

Dr. Grossman

If you have access to soap and water, that's always ideal, especially if you see visible dirt and particles. Fingers. But hand sanitizer is a great second option as long as you're using it properly and rubbing your hands until it's completely dried up. I usually say, you know, 20 to 30s ideally, yeah. Young kids I say sing a full round of ABCs and then you're done.

00:36:20:13 - 00:36:23:53

Leslie Schlachter

Yeah, that's a really long time. Kids do not have the patience for that.

00:36:23:58 - 00:36:24:51

Dr. Duchon

Yes. Yeah.

00:36:24:52 - 00:36:26:20

Dr. Duchon

I'm happy with just about anything.

00:36:26:27 - 00:36:35:35

Leslie Schlachter

Yeah. I feel like if, if in all bathrooms in schools there was like TikTok playing on the mirrors, they would all wash their hands for 20 to 30s. But I don't.

00:36:35:35 - 00:36:35:59

Dr. Duchon

Know.

00:36:36:04 - 00:36:46:20

Leslie Schlachter

I like if there was like something playing in the bathroom, kids would be in there washing their hands like that only plays if the soap gets dispensed and the water is running.

00:36:46:24 - 00:36:47:12

Dr. Duchon

Yeah, exactly.

00:36:47:13 - 00:36:49:30

Dr. Grossman

That's right. Or the TikTok could.

00:36:49:30 - 00:36:51:35

Dr. Duchon

Be about like that. Yeah.

00:36:51:39 - 00:37:03:27

Leslie Schlachter

I feel like I feel like I'm. Yeah, I don't know. We have to make maybe not put this out until I patent that. But okay. So if obviously visible are really grimy soap and water, but like, sanitizer, if we have to, that's fine.

00:37:03:32 - 00:37:05:46

Dr. Duchon

Okay, so

00:37:05:46 - 00:37:13:57

Dr. Duchon

think that not having phones in school, during school, during school, the school day is actually kind of a great thing also for hygiene.

00:37:14:09 - 00:37:16:01

Leslie Schlachter

Yes. Dirty, dirty hands all day.

00:37:16:01 - 00:37:28:21

Dr. Duchon

Yeah. I mean, sometimes in my department, infection prevention, when we have like little, you know, health fairs, this season that everyone wants to go to is where we swab your phone and tell you how filthy.

00:37:28:26 - 00:37:29:15

Dr. Duchon

Exactly.

00:37:29:20 - 00:37:41:19

Leslie Schlachter

You know, people don't wipe their phone. I wash my, I wipe my phone down with a hydrogen peroxide wipe three times a day like at work but not at, not like at home. People don't wipe their phones or chargers for I've learned.

00:37:41:24 - 00:37:43:37

Dr. Duchon

Like people need to wipe their phones and chargers.

00:37:43:42 - 00:37:58:01

Dr. Duchon

Like. So I'm wondering what what effect of any that's kind of going to independently have on like just general spread of germs. Although of course we had lots of germs before cell phones, but, yeah, like touching your cell phone and then,

00:37:58:06 - 00:38:08:06

Leslie Schlachter

Or like bringing your cell phone into the bathroom and using your cell phone while you're going to the bathroom, putting it down to wipe. And then, like, my kids bring their cell phones into the bathroom. Are we really doing this?

00:38:08:11 - 00:38:09:16

Dr. Duchon

But yeah, they do.

00:38:09:21 - 00:38:12:55

Leslie Schlachter

My poor kids are getting outed on this podcast pretty bad.

00:38:13:00 - 00:38:15:00

Dr. Duchon

With kids too. Yeah.

00:38:15:05 - 00:38:20:47

Leslie Schlachter

And like daily showers, people should be taking daily showers, but not necessarily having, like, wash their hair every day.

00:38:20:49 - 00:38:28:30

Dr. Duchon

Like what you just watched. Wash the park. It's going to touch other people. But I hope that generally school is in your hands.

00:38:28:35 - 00:38:30:09

Dr. Duchon

I hope so too. You know.

00:38:30:14 - 00:38:35:39

Dr. Duchon

At a minimum, please wash the other parts as you see fit. But yeah.

00:38:35:51 - 00:38:36:48

Dr. Grossman

And once a child starts.

00:38:36:48 - 00:38:38:28

Dr. Duchon

To go through puberty.

00:38:38:33 - 00:38:49:42

Dr. Grossman

They may need a more frequent shower. So that's something that we also talk about. But I agree with Jen. You don't have to wash your hair, but rinsing your body in your hands is very important.

00:38:49:42 - 00:39:03:22

Leslie Schlachter

So I do I want I know we were talking about dirty phones, but I want to talk actually about phones. So when I was growing up, it was television, right. And I had access to whatever was on when I was sitting at the TV or whatever it is that I might have taped, you know, the night before.

00:39:03:32 - 00:39:24:18

Leslie Schlachter

But now our children have access to their phones and iPads and all these social media outlets. They also have access to on demand everything through Apple and Netflix. What are healthy, appropriate tech choices now? I don't want to be like, you can't do this because that's how they talk to their friends. But there has to be some sort of guideline for us, for our children.

00:39:24:18 - 00:39:25:36

Leslie Schlachter

So can you speak about that?

00:39:25:41 - 00:39:44:45

Dr. Grossman

Sure. It's very, very tricky. And there's still so much emerging, you know, research that's being done. But obviously we say to limit screen time as much as possible. Ideally, if you can keep that under 1 to 2 hours a day, which sounds like a lot, but when you hear what a lot of kids are doing, it's it's hour.

00:39:44:46 - 00:39:47:26

Leslie Schlachter

The six hours. Yeah.

00:39:47:31 - 00:40:11:46

Dr. Grossman

Also making choices as a family as to what you think is appropriate and setting limits. So, you know, there are certain age limits, or cutoffs, for certain social media apps. Right. And, you know, I think as much as close, as close to sticking to them as possible, is ideal. Right. So a lot of social media apps say the minimum age is 13.

00:40:11:51 - 00:40:30:46

Dr. Grossman

Right. Because the younger you are and the more exposed you are, the more of a detriment it is to your physical well-being, your mental health. Right. And, you know, within each family, you know, you might have time that is screen appropriate. And times where you say the screen has to go off, whether it's meal time or before bed.

00:40:30:50 - 00:40:36:47

Dr. Grossman

A lot of kids go on their phones before they go to sleep. And that can actually prevent a child from.

00:40:36:52 - 00:40:37:36

Dr. Duchon

From going.

00:40:37:41 - 00:40:39:30

Leslie Schlachter

And prevents me from going to sleep.

00:40:39:35 - 00:40:42:29

Dr. Duchon

I have to yeah you do. Yeah.

00:40:42:34 - 00:40:47:40

Leslie Schlachter

I get stuck with the dog videos, like for an hour. I can watch dog videos that mean nothing to my life.

00:40:47:45 - 00:40:49:05

Dr. Duchon

And yeah, also.

00:40:49:10 - 00:41:06:49

Dr. Grossman

I did read an article recently where again, the research is still evolving and for some people, actually, depending on what they're looking at and for how long, it might not be a detriment to sleep. But for a lot of children, it really, really is. It's very stimulating. And so ideally we say to put the screens away an hour before bedtime, right.

00:41:06:54 - 00:41:15:53

Dr. Grossman

And that's aspirational. But I would say really having a conversation in your own family about what you feel is appropriate and trying to stick to the guidelines as much as possible.

00:41:15:58 - 00:41:25:43

Leslie Schlachter

Right? Yeah. And what age when, when parents ask, is there an age that you recommend is like typically for, how well did you say your kids are.

00:41:25:48 - 00:41:27:24

Dr. Grossman

12 and 15.

00:41:27:29 - 00:41:29:01

Leslie Schlachter

What is 1515? Freshman.

00:41:29:01 - 00:41:29:33

Dr. Grossman

So freshman.

00:41:29:33 - 00:41:46:49

Leslie Schlachter

Sophomore okay. So I know for us in like our school system, everyone got their kid a phone going into sixth grade because they were like far away. They were leaving home. They want to know where their kid was at. They want to track them on, find my friends or whatever. What age is a solid age that you think is reasonable to give someone a phone?

00:41:46:53 - 00:42:08:16

Dr. Grossman

Well, I think and again, it's family dependent in my family. We did start the phones in middle school when our children started going places by themselves. Right. And we used to get in touch with them in there where they were, getting a phone doesn't mean getting social media, right? Right. With the ability to call or text without having Snapchat, TikTok and Instagram.

00:42:08:20 - 00:42:16:47

Dr. Grossman

So I think it is, again, really family. Family specifically. Right? Our school tried to have a wait till eighth.

00:42:16:52 - 00:42:17:53

Leslie Schlachter

I'm sure that did not work.

00:42:17:58 - 00:42:20:04

Dr. Grossman

I would say majority did not stick to that.

00:42:20:04 - 00:42:23:39

Dr. Duchon

Yeah. Also, like I put.

00:42:23:44 - 00:42:39:01

Leslie Schlachter

Restrictions on my children's phone when they were younger, but they find ways around it. They find ways around the restrictions. There's like secret apps that cover the apps, and there's ways that like, if you can put time limits, I have a time limit. I'm, I'm on my daughter's phone and she just clicks right out of it like it's nothing.

00:42:39:05 - 00:42:40:55

Leslie Schlachter

Sometimes those don't even work, right.

00:42:40:55 - 00:42:52:34

Dr. Grossman

You can restrict the amount of time on the phone. You can restrict the amount of time on specific apps. You can restrict what they're looking at. So and if the child finds a way around it, change the password.

00:42:52:44 - 00:42:54:40

Dr. Duchon

Yeah.

00:42:54:45 - 00:43:10:37

Dr. Grossman

But I think also it goes back to open lines of communication. Why? You know, telling your child why you think this isn't good for them. Right. And every minute they're on the phone, it's not just extra time on a screen. It's time. They could have been outside or physically active or doing something else.

00:43:10:37 - 00:43:11:01

Leslie Schlachter

Yeah.

00:43:11:01 - 00:43:12:50

Dr. Grossman

So I think it's a double hit in my opinion.

00:43:13:03 - 00:43:32:15

Leslie Schlachter

Yeah. I just had this conversation in the car this morning with my husband. My daughter. You know, it's hard because I want her to have access to her friends on her phone. So if she's not done with her homework until ten, and I know she's not going to fall asleep until 11, I don't think it's unreasonable that she can be on her phone for a while, but then it's a little too long now.

00:43:32:15 - 00:43:46:18

Leslie Schlachter

I have no problem taking her phone away and be like, I'm sorry, I'm. You can roll your eyes at me. All you want. I feel nothing, whereas my husband is like, oh my God, if she's mad, I don't want to. Like, I don't like there we are not there to be our our children's friends. Like, take the phone away.

00:43:46:23 - 00:43:56:53

Leslie Schlachter

Take care. Also, they can see stuff on their computer you need to take that to. Yeah. Are they need their computer for their schoolwork? Not if their school work is done. We can take it all away.

00:43:56:58 - 00:44:01:33

Dr. Grossman

And I agree, you're their parent, not their best friend. You could be both. But parent.

00:44:01:34 - 00:44:03:10

Leslie Schlachter

Versus. Yeah.

00:44:03:14 - 00:44:21:06

Dr. Grossman

And I think there is a lot of data that shows kids really need and want the structure. And as much as it's uncomfortable to see them squirm and get upset and yell and be mad, they actually really do need that. They need you to say, I'm setting in here. It makes sense. Yeah, I secure.

00:44:21:11 - 00:44:45:28

Leslie Schlachter

Yeah. I have it's it's more of like, maybe your opinion of how you recommend parents doing it, but there are a lot of, children out there who have chronic illnesses or something where they need to be involved with a school nurse. I have friends whose children are celiac or type one diabetics, and they're attached to their Dexcom, and there's beeping and all this stuff going on, and there's constant fear of like, is my child getting exposed to gluten?

00:44:45:32 - 00:44:57:10

Leslie Schlachter

What is your recommendations on how parents can develop a relationship with a school nurse for all hosts of those chronic illnesses that they have to deal with? Because that's a really important relationship?

00:44:57:14 - 00:44:58:58

Dr. Grossman

Yeah, absolutely.

00:45:00:31 - 00:45:20:19

Dr. Grossman

You. Yeah. So first of all, in order to go to school, children need help forms filled out by their pediatricians. And the people that review those forms are the school doctors and nurses. And I've actually had a great history of interacting with school doctors and nurses. Sometimes they'll call and say, we couldn't read what you wrote.

00:45:20:24 - 00:45:23:46

Dr. Duchon

Yeah. This medication. But you want.

00:45:23:46 - 00:45:35:01

Dr. Grossman

To as pediatricians, we try to be as clear as possible on these health forms, because that is the go to for any school nurse or doctor. If a child enters their door, you know, having an asthma attack or having low blood sugar, what.

00:45:35:01 - 00:45:38:35

Leslie Schlachter

Are the most common illnesses that you would say the school nurses have to be in touch with you about?

00:45:38:35 - 00:45:42:58

Dr. Grossman

I would say asthma and food allergy are probably the most common.

00:45:43:23 - 00:45:55:44

Dr. Grossman

And those are probably the most common things we're filling out on school forms. Okay. We really want school nurses to know about if the child has an asthma attack. What can what can be given in school. If a child has a food allergy what can be given in school.

00:45:55:46 - 00:45:56:41

Dr. Duchon

Okay.

00:45:56:46 - 00:46:11:26

Dr. Grossman

And there are some kids who do have multiple medical issues or very complicated medical issues. In those instances, I sometimes get a phone call from the school nurse just reviewing the health plan. Sometimes there'll be a dialog between the parent, the nurse, and the pediatrician.

00:46:11:56 - 00:46:26:34

Dr. Grossman

So we try to be as communicative as possible. And they are really this, this at least in New York City, the school with the school based health program and providers are really excellent, very detail oriented.

00:46:26:38 - 00:46:33:32

Leslie Schlachter

Do you recommend that parents have like an ongoing meeting with school nurse or just like the beginning of the year to establish the plan is usually good enough?

00:46:33:36 - 00:46:50:55

Dr. Grossman

I think at least a one time check in at the beginning of the year, just to make sure everyone's on the same page. If things have all been changed, then I think it's appropriate to have a follow up meeting. So if the child's asthma becomes more severe and we bump up the medication, that requires a conversation with the nurse and the change in their school forms.

00:46:51:00 - 00:46:52:23

Dr. Duchon

Okay.

00:46:52:28 - 00:46:54:38

Leslie Schlachter

To an add anything to that?

00:46:54:43 - 00:46:56:14

Dr. Duchon

Okay. Definitely.

00:46:56:20 - 00:47:12:52

Dr. Duchon

Yeah. I mean, I'm really lucky that, you know, I, I kind of have a little bit of an ivory tower, right? I get to say, oh, you have to do this. You have to do that. You have to do this. Like, as an epidemiologist. But Meredith has to actually implement it all, keep it all right, all the recommendations and keep up to date.

00:47:12:52 - 00:47:13:48

Dr. Duchon

And like.

00:47:13:48 - 00:47:17:08

Dr. Duchon

We're really lucky to work on that. We went.

00:47:17:08 - 00:47:20:53

Dr. Grossman

So anytime there's a vaccine issue we call Gen and.

00:47:20:58 - 00:47:27:13

Leslie Schlachter

This seems like a lovely symbiotic relationship. You guys.

00:47:27:18 - 00:47:35:35

Leslie Schlachter

So when when like my my school age, you know, we carry these huge backpacks with heavy notebooks and heavy books, but that's kind of like gone away because a lot of stuff is and.

00:47:35:40 - 00:47:36:24

Dr. Duchon

Is really.

00:47:36:29 - 00:47:37:44

Leslie Schlachter

I know, but that's like, that's.

00:47:37:44 - 00:47:38:40

Dr. Duchon

Our yeah.

00:47:38:55 - 00:47:54:31

Leslie Schlachter

That's age appropriate for us. But our kids walk around with their like computer or iPads. They're using Google Classroom generally their books at home. Are there any like, you know, physical safety, ergonomic tips that you have for school age children? I don't even know what comes up anymore.

00:47:54:36 - 00:48:13:56

Dr. Grossman

Yeah, well, I would say, first of all, there are some kids who take all of their books back and forth to school every single day. And I think this is a good exercise in executive functioning. You know what books do you actually read? What else do you actually have tomorrow? What homework do you actually have? And actually practicing leaving some of it in your locker at school.

00:48:14:01 - 00:48:34:17

Dr. Grossman

But a lot of kids do have a lot of stuff, even if there is a lot of iPad usage. They do have a lot of notebooks and textbooks and things like that. You know, we do say if you're going to have a backpack, you know, make it a sensible backpack, make sure you're placing things in the backpack in an ergonomically appropriate way.

00:48:34:17 - 00:48:40:56

Dr. Grossman

Right. Ideally, you know, to a thick padded strap, put both straps over your shoulder instead of one strapping it.

00:48:41:02 - 00:48:41:58

Leslie Schlachter

That's not cool, mom.

00:48:41:58 - 00:48:44:16

Dr. Grossman

It's not. It went through a phase of being not cool.

00:48:44:24 - 00:48:48:06

Leslie Schlachter

I think it's back to being cool. I think it's cool again. I think it's cool again.

00:48:48:11 - 00:48:53:07

Dr. Grossman

Make sure the backpack is secure enough that it's not hanging very well on the lower back.

00:48:53:08 - 00:48:55:30

Leslie Schlachter

Yeah, they make it really loose. So it like flops on there.

00:48:55:30 - 00:48:56:25

Dr. Duchon

But yeah.

00:48:56:29 - 00:49:03:49

Dr. Grossman

In the straps when you're picking it up you should pick it up. You shouldn't bend your knees to pick it up instead of bending your back. Good like that. It's good life advice, right?

00:49:03:49 - 00:49:05:52

Leslie Schlachter

Yeah. We need that for our age group also.

00:49:06:45 - 00:49:10:05

Dr. Grossman

And and that's the best.

00:49:10:10 - 00:49:17:57

Leslie Schlachter

I see the kids. I live on the Upper East Side. They they wheel the wheelies like the suitcases. And I'm like, yes, I love the. Is it okay to love the wheelies?

00:49:18:02 - 00:49:18:40

Dr. Duchon

Yeah, I love it.

00:49:18:40 - 00:49:20:17

Dr. Grossman

A lot of kids love the wheelies. But I do.

00:49:20:17 - 00:49:23:44

Dr. Duchon

Think that upper side kids use the wheelies. Yeah.

00:49:23:49 - 00:49:26:04

Dr. Grossman

Some kids really do. But I see a lot of backpacks do.

00:49:26:17 - 00:49:31:25

Leslie Schlachter

Yeah. Yeah. Okay. So executive functioning only bring the books back and forth that you need that day.

00:49:31:30 - 00:49:34:46

Dr. Duchon

And plan that. Yes, it's hard sometimes.

00:49:35:01 - 00:49:47:53

Leslie Schlachter

So what would you guys both say are your top three tips. And it can be mom, dad or caregivers or the child. What are your top three tips for beginning of school year? I know what year already. Your top three. They're all the same.

00:49:48:01 - 00:49:52:19

Dr. Duchon

Exactly what next things so well.

00:49:52:19 - 00:50:08:30

Dr. Duchon

Check in with your pediatrician to make sure that you're up to date. So the recommendations change. And obviously they're different for different ages and new products to come out. Now we're immunizing teenagers against different kinds of

00:50:08:30 - 00:50:19:59

Dr. Duchon

Meningitis. So there are updates. So talk to your pediatrician, find out if you're actually up to date on everything that you need to do, because school doesn't require everything.

00:50:20:04 - 00:50:27:10

Dr. Duchon

But there are a lot of vaccines that are really important just for health. Okay? Like I cannot go to school unless I have them.

00:50:27:14 - 00:50:37:29

Leslie Schlachter

Yeah. So for teenagers, it could be something like the meningitis vaccine, making sure they get their flu, even like the Gardasil vaccine for certain age groups.

00:50:37:34 - 00:50:56:08

Dr. Duchon

Yeah, we're starting those in younger age groups now to to just like we do for hepatitis to get ahead of any kind of curve. So yeah those are, those are you know those recommendations are, are have changed. They change from year to year. So always good to check in.

00:50:56:13 - 00:50:59:12

Leslie Schlachter

So what link should we put below is at the CDC.

00:50:59:17 - 00:51:01:39

Dr. Duchon

American Academy of Pediatrics website.

00:51:01:41 - 00:51:03:04

Dr. Duchon

Okay. Okay.

00:51:03:09 - 00:51:18:52

Dr. Duchon

The American Academy of Pediatrics has put out, a, vaccine recommendation. I'm going to be honest, they don't always now align with the CDC recommendations.

00:51:18:52 - 00:51:19:49

Dr. Duchon

Okay.

00:51:19:53 - 00:51:33:20

Dr. Duchon

And again, there's a lot of discussion, about vaccine schedules. New York State has endorsed, for the Covid vaccine. The American Academy of Pediatrics recommendations.

00:51:33:31 - 00:51:34:27

Dr. Duchon

Okay.

00:51:34:32 - 00:51:38:53

Dr. Duchon

And I expect that they'll continue to do that, for the entire schedule.

00:51:38:58 - 00:51:42:34

Leslie Schlachter

Okay. So preferably look as soon as possible because it might change in the next couple of months.

00:51:42:43 - 00:51:45:01

Dr. Duchon

Yeah. Okay.

00:51:45:05 - 00:51:48:20

Leslie Schlachter

What about you? What are your top three cyber vaccines?

00:51:48:20 - 00:51:48:38

Dr. Grossman

Vaccines.

00:51:48:38 - 00:51:49:50

Dr. Duchon

Vaccines. Yes.

00:51:49:55 - 00:52:21:06

Dr. Grossman

I would say make sure to have an annual check in with your pediatrician so you can review everything. Do not underestimate the importance of, you know, sleep, nutrition, mental health, all the things we discussed. And I think what we spoke about, just open lines of communication between parent and child and the schools are important. And just kind of be on the lookout for any changes or concerns or having about your child.

00:52:21:11 - 00:52:43:14

Leslie Schlachter

Yeah, I think I want to join, too, because I learned three things today. Or maybe just like reprioritize them in my head, is that we're not our children's friends where they're parents. And if we feel that they're on their phone too much or not sleeping enough to, like, prioritize that and explain it to them. The second is you don't need to only see your doctor once a year.

00:52:43:14 - 00:52:56:56

Leslie Schlachter

You can make an appointment for something that's concerning to you and have the doctor speak about it in a way that's medically meaningful to your child. Yeah. So, I hope that helps other parents, too. Is there anything else that you guys want to add before we finish up?

00:52:56:56 - 00:53:32:37

Dr. Duchon

Times are. Times are kind of scary, There are a lot of, changing recommendations and it can sometimes seem like, it's difficult to know which organization, which body of evidence to trust. Which pediatrician has been there since the beginning with your child? They you guys generally have a relationship with them. So, I would just reaffirm that, you know, we you believe continue with our relationship and checking.

00:53:32:42 - 00:53:54:36

Leslie Schlachter

I think it's really important to say because a lot like, especially here at Mount Sinai, a lot of us have access to the Mychart. And the Mychart is an app that, the patients can use to look at their care and what's really great about it, and this is what I do for my, my children, is I go into their, their mychart and I click, you know, immunizations and it tells you what they're due like, thank you, thank you.

00:53:54:37 - 00:54:04:10

Leslie Schlachter

Oh I don't need that. Thank you. Like having making sure that we have access to our children's medical records and staying with an institution like Mount Sinai that will keep everyone up to date is really important.

00:54:04:15 - 00:54:23:02

Dr. Duchon

And obviously it's not just for for vaccines. A lot of recommendations about nutrition, are changing about sort of the way that, you know, we prioritize our time and life in school are changing. So, you know, again, your.

00:54:23:02 - 00:54:27:52

Leslie Schlachter

Pediatricians. Yeah. Do you have like a smart phrase for that? Or you can hand it out every time.

00:54:27:59 - 00:54:49:49

Dr. Grossman

I do think, just to piggyback off of what you're saying, there's just so much anxiety in parenting. And I think for good reason. There are a lot of things in the world to be worried about, but there are certain things that I'm really confident in, which is that certainly vaccines work, but also going to your doctor for preventative care actually.

00:54:49:49 - 00:54:51:02

Dr. Duchon

Really does help.

00:54:51:02 - 00:54:59:26

Dr. Grossman

And so to trust your providers and to trust what we've been doing for decades and decades, that the evidence supports. All right.

00:54:59:35 - 00:55:03:21

Leslie Schlachter

Well, thank you guys so much for being here today. I really appreciate your time.

00:55:03:26 - 00:55:05:03

Dr. Duchon

Yes. Yep.

00:55:05:03 - 00:55:16:12

Leslie Schlachter

That's it for this episode of The Vitals. I'm your host, Leslie Schlatter. Subscribe to the Vitals and Mount Sinai's other podcasts on YouTube, and find us on Apple Podcasts, Spotify, or wherever you get your podcasts.

00:55:16:12 - 00:55:28:22

Leslie Schlachter

For more information on how to get your child seen here by one of our expert pediatricians at Mount Sinai, or to have your child vaccinated here at Mount Sinai. You can scan the QR code below or click the link for more information.