SOCIAL DISTANCING: The schools are closed, the malls and theaters are closed, and we all are practicing social distancing. What does this really mean. It means that even though you may feel well, we want you to limit contact with others, including other children. We want you to stay 6 feet away from others outside your intimate family members. When children play outside and go for walks and bike rides, they need to be six feet away from others.

WELL VISITS: We have changed our schedules to only allow well visits in the mornings, and only those that involve updates of vaccinations or follow up of urgent issues. Other routine well visits are being postponed to after this pandemic is over.

KEEPING OUR OFFICE OPEN: We need to keep our staff and doctors safe and healthy. PLEASE let us know before you come to our office if you have been exposed to someone with COVID-19 or someone who is under observation for it. We need everyone having any respiratory symptoms or any exposure to keep their nose and mouth covered. PHONE CALLS: We are experiencing a large number of phone calls. We want to help everyone but we ask to follow the recommendations below to lessen the calls for minor illnesses.

MINOR ILLNESSES AND FEVERS: Children will continue to get upper respiratory illnesses- mainly involving the body above the neck- and may run fevers. Most regular viral illnesses may cause a fever for the first few nights, and minor symptoms may last 7-10 days. We do not need to see you for these minor illnesses. We want you to keep anyone with a fever over 100.4 away from others, encourage rest, fluids, and fever reducers, and watch for any worsening symptoms.

SIGNIFICANT SYMPTOMS: Children will still get ear infections and strep throat. It is appropriate to call for an appointment if you suspect your infant is experiencing an ear infection or a significant sore throat. These respiratory illnesses will be seen in the afternoons and will need to be screened by our staff by phone before an appointment is given. Only one parent should bring just the sick child to the office and anyone with symptoms needs to cover their nose and mouth with a mask or scarf.

CHRONIC ILLNESSES AND ASTHMA: To prevent any worsening symptoms with COVID-19, we encourage asthmatics to be in good control now. We encourage the use of inhalers more than nebulizers. Others with significant illnesses like cystic fibrosis or cancer need to consider self-quarantining themselves during this pandemic.

COVID-19: This virus is expected to infect many of us, and children thankfully have been experiencing less significant symptoms than adults. COVID-19 particularly causes lower respiratory symptoms- in the chest. If your child has a fever and is developing a significant cough with trouble breathing or shortness of breath, that is when we need to hear from you. Please call and we will discuss whether we need to see your child, whether s/he will be referred to evaluate your symptoms for testing, or whether your child is fine to be cared for at home, quarantined away from others in your family. We expect most children with COVID-19 symptoms will be cared for at home, will not need definitive testing, and will recover easily within their 14 day quarantine time. We do not test for COVID-19 in our office.

There are many good websites to answer questions and get advice from. Healthychildren.org gives great advice from the American Academy of Pediatrics and has ideas on keeping children active, emotionally and physically, during this time.

Try to encourage healthy children to get outside and enjoy the beautiful spring weather, while keeping social distancing in mind. Encourage reading and board games. Enjoy this time together to talk with your family members. And remember laughter is great medicine too!

The Doctors of Main Street Pediatrics

We are continuing to see pre-screened, well visits for children who need vaccination in the mornings. We are using telehealth to manage more chronic issues (asthma follow ups, medication checks) and acute issues (cold and allergy symptoms, asthma flares and injuries). And for those who need to come in to be seen (throat cultures and concerns about ear infections), we are seeing them in the afternoons under very strict infection-control precautions.

HAVING SAID THAT, WE NEED YOUR HELP!!

Because we will need to move even more kids through the office for delayed well visits in the summertime to meet everyone’s needs, we are asking you to think ahead with us. Things that CAN be taken care of now, ought to be done separate from well visit time. For example, we know that for convenience, families often come to a well visit with a list of other health items that they have been wanting to discuss with us. Topics like allergies/asthma, mood issues, medication checks, medical complexities, behavioral/developmental questions (toilet training, temper tantrums, sibling issues, meeting milestones, school struggles) and other general concerns would be GREAT to take care of for you now. This way, when well visit time comes, we are able to meet the built up need that is rising as a result of this pandemic.

If you child has chronic issues for discussion or new concerns that you are “saving up”, please call us to schedule a Telehealth visit while we all have this available time.

We cannot create more hours in the day, but we can use our time now and then as wisely as possible. (And, we have LOVED it when the kids want to show us their rooms!)

Thank you for your consideration and be well.

The Doctors & Staff at MSP

The Good News Is….

Infants and children appear to experience coronavirus with very mild symptoms. Typically this includes the familiar symptoms of a cold: runny and stuffy nose, cough and fever. They tend to not have the severe illness course that we are hearing about in the elderly.

How do I know whether my child’s cold symptoms are from coronavirus?

The short answer is: you may not know. And, very importantly, if the symptoms are mild (s/he “perks up” when the fever is down, drinks enough to urinate at least once every 4 hours (infants) or 8 hours (toddlers and older children) and shows no signs of difficulty breathing) we do not really need to know for the sake of caring for that child. Having said that, a sick child needs to be kept isolated from other people to avoid spread. As we start to see more community spread of coronavirus in Baltimore, children will get COVID 19 illness and because it will be mild, there will not be any need to test them. The purpose of having a test is to help doctors determine what is causing a very sick patient to get sicker. In a stable child with cold symptoms, even in a pandemic situation, we will treat them as if they have a contagious viral illness. We will watch them carefully and teach you to watch them carefully for any signs of worsening illness.

But, I want to know if my child is infected!

We understand that sometimes it is reassuring given everything that is going on just to get checked out. We are working on being able to run tests from our office but we only anticipate using them when children are worrisomely sick, without another identified cause, which is not expected to be very often. Once again, if your child’s symptoms are not causing distressing respiratory symptoms, there is no need to test them since it will not lead to any specific medicinal treatment, as none exist at this time.

So what do I do if my child has cold symptoms?

More than ever, it is important to practice good infection control. Cover coughs with tissues and then discard them, wash hands (for 20 seconds!) when coming inside your home, before eating, after touching your face and after caring for a sick child. Keep your child away from others until s/he is fever free for AT LEAST 24 hours.

What if my child has had a cold and then gets worse?

THIS IS EXACTLY WHEN YOU NEED TO CALL US! As you know, sometimes a cold is the breeding ground for an ear infection or pneumonia. To avoid possible coronavirus spread in our office, we are prepared with the ability to increase physician phone triage and the use of Telehealth visits as alternatives to face-to-face visits, when appropriate. PLEASE, PLEASE, PLEASE CALL US BEFORE COMING TO THE OFFICE so that we can make the necessary preparations based on what we know about any local spread at that time.

A word about the psychological effects of social distancing and pandemics on our children (and ourselves!)

Social distancing and disruption of routines puts a strain on everyone’s mental health. We need to remind our kids about, and demonstrate our own, resiliency. Please limit media exposure for all family member. Too much exposure to what seems scary leads to unnecessarily heightened anxiety. Keep your kids in a routine: getting dressed, brushing teeth, regular meals, naptimes, homework even if doing remote learning, outdoor play and regular bedtimes. (Remember how they get at holiday time when there are too many days of no/low structure?!) Remind them what we do have control over to keep ourselves healthy: washing hands and covering coughs AND staying home after illness until we are truly well before returning to the wider community. If you suspect your child is not adapting well (very irritable, acting out, crying, withdrawn), we have resources in our office to help.

We continue to be here to help you navigate this health situation with factual information. When you do read news, be sure it is from a reliable scientific or public health source. Stay calm and focus on what you can do to prepare to keep your children safe both physically and emotionally. Children read our emotional state and you can help them immensely by avoiding unnecessary panic. Teach them by example that the way we deal with uncertainty and potential medical problem is by listening to public health officials and scientists who best advise us on how to keep ourselves healthy. For more information: https://www.cdc.gov/coronaviru... https://phpa.health.maryland.g...

What is Coronavirus?

Coronaviruses are a large family of viruses that can infect humans and animals. They are spread by respiratory droplet (sneezes and coughs). It is possible that there are other modes of transmission that are yet to be determined. Coronaviruses cause respiratory (cold-like) symptoms.

What is COVID-19 and why is it in the news?

Viruses do change themselves all the time. (For example, this is why the flu vaccine changes from year to year!) This novel strain of Coronavirus, named COVID-19 (“the Coronavirus that was identified in 2019”) is special because it is a strain of virus originally found in animals that is now infecting humans…and is being transmitted from human to human.

Who is at risk?

Currently, those at greatest risk are those who have had prolonged contact with a person who has confirmed COVID-19 infection and those with recent travel to China, especially the Hubei Province. Those who are elderly and those with compromised immune systems may have more difficulty recovering from this infection

What symptoms does COVID-19 cause?

COVID-19 has been reported to cause a mild to severe respiratory illness with fever, cough and sometimes difficulty breathing and pneumonia. Sometimes this has progressed to severe respiratory distress and septic shock.

What is the treatment for COVID-19?

The treatment is “supportive”, meaning staying hydrated and treating fever and cough with age appropriate over-the-counter medications. Currently, there is no medicine to cure this viral illness. There is no vaccine currently available and creating one for general distribution will take 12-18 months.

Are children at increased risk?

There is no evidence that children are more susceptible to this virus than adults. Studies thus far have shown that children with confirmed COVID-19 have generally presented with mild symptoms. However as with other respiratory illnesses, children with underlying health conditions (for example, severe asthma, cystic fibrosis, diabetes and sickle cell disease, to name a few) may be at increased risk of more significant infection.

What can I do to protect my children and family?

Practical, routine measures are the best. Since there are no confirmed cases in Maryland right now, we have the opportunity to reinforce these common practical measures

1. Teach your children infection control measures: wash your hands thoroughly (lather with soap for the time it takes to sing “Happy Birthday” TWICE) and frequently (when you come home from work or school, before eating, after being in public spaces, after caring for a sick child or sneezing or coughing into your own hand).

2. Keep kids home when they have symptoms of illness and model the same behavior yourself.

3. Cough or sneeze into your elbow, or a tissue that you throw away and then wash your hands. Teach your kids to do the same.

4. Keep your home well supplied with the regular medications that people need and use.

5. Be sure your children are up to date on the usual and recommended childhood vaccines. This can help prevent other infections that can come after having viral illnesses.

6. Make sure that you have signed up for Main Street Pediatrics health emails so that we can keep you informed.

7. For more information, visit the CDC’s website: https://www.cdc.gov/coronavirus/2019-ncov/index.html 

We are here to help you navigate this health situation with factual information. When you do read news, be sure it is from a reliable scientific or public health source. Focus on what you can do to prepare to keep your children safe both physically and emotionally. Children read our emotional state and you can help them immensely by avoiding unnecessary panic. Teach them by example that the way we deal with uncertainty and potential medical problems is by listening to public health officials and scientists who best advise us on how to keep ourselves healthy.

Situations that may be appropriate for a telehealth visit include:

- Discussion visits about medical, emotional or behavioral concerns when you or the patient are unable to make an office visit (for example, for a college student living away from home or if there are significant transportation issues to the office).

- A dermatology only visit (simple rash with no other concerning symptoms)

- Certain after hour situations which may be better assessed by telehealth than just a phone call.

The following insurers offer telehealth visit coverage through Main Street Pediatrics: All Blue Cross/Blue Shield policies (EXCEPT Federal employees) as well as all LifeBridge Health based insurances. These insurers will cover a telehealth visit as if it were an office visit (same copay or deductibles would apply). We are working with other insurers to expand coverage for these services. In addition, you must be located in Maryland or an adjacent state for insurance to cover a telehealth visit.

The current situation is NOT considered an outbreak in Baltimore. However, there are situations where your child should get an earlier than usually recommended measles vaccine:

• if your child has had direct exposure, eg, within a building, to a known case of measles
• if you are traveling to a specific location that has been designated as a significant outbreak area (within the community of outbreak)
• if you are hosting a guest in your home who is from a community of active measles outbreak

Our offices administer the Measles vaccine at the one year old and four year old checkups. If you think your child meets one of these criteria and needs an earlier vaccine, please contact our office to arrange for this to happen. If you believe that you have another reason that your child should receive an early MMR vaccine, we encourage you to discuss this with our staff. We also wanted to ask that if you think that your child may have measles, please call our office first for advice. Given the contagiousness of measles, we need to exercise caution in arranging for care.

So, please contact our office to schedule your child's and family's flu vaccine visit as soon as possible (you can get the most convenient times). We will have times available on most days our offices are open and have also set aside some dedicated days for flu vaccines on days when schools are closed as well as some weekends. Our offices can also offer flu vaccine to parents and grandparents for your convenience.

Click here if you want to view or fill out this paperwork.

With our Patient Portal, you can take advantage of the following features:

• Review your medical records online in a safe, secure environment
• Communicate privately with physicians via secure messaging
• View test and lab results
• Update your health information (allergies, medications, conditions, etc)
• Request prescription renewals
• Request or change appointments
• Create one proxy account that accesses the medical records for ALL your children or dependent adults

There are numerous benefits of the Patient Portal, including:

• SAVING TIME! No more waiting on hold to speak to staff or schedule appointments
• IT’S CONVENIENT! Anywhere anytime access lets you communicate on your time
• IT’S PRIVATE: Secure messaging ensures privacy between you and your physician
• MORE CHOICE: Gives patients a new way to communicate with their doctor
• SET & TRACK GOALS: Use the portal to track your health conditions/wellness goal and chart progress
• PATIENT-CONTROLLED: You own your portal and all of the data within it and control who sees what
• Create one proxy account that accesses the medical records for ALL your children or dependent adults

There are numerous benefits of the Patient Portal, including:

Just stop by our front desk and we’ll get you started. Or, click to register, and a staff member from our office will contact you by phone to complete the registration process.

Downloading the app is simple, just click here: app.everseat.com , or click the Everseat icon at the bottom of our home page. You can also visit the App Store or Google Play to download the Everseat app to your iPhone or Android. To sign up, you simply need to register your child (or if you have more than one child, then register each child), designate your regular pediatrician as your favorite, and let the app know when you are interested in making an appointment. A message is then sent to our receptionist who will confirm, or if necessary, arrange an alternate appointment. Appointments currently available through Everseat include acute illnesses, last minute available check-ups and some consultation visits. If we get a positive response from our patients about using Everseat, we hope to expand your scheduling capability through Everseat in the future.