- [Announcer] Support for this series comes from Inland Empire Health Plan a health plan with a mission to heal and inspire the human spirit, serving over 1.5 million members in the Inland Empire.

- Excuse me, I have a call!

I think it's the hospital.

(musical phone ringing) It's the hospital.

I think I have a newborn baby.

(ringing stops) Hi, this is Dr.

Kwasman.

- [Caller] Hello, it's Ryan at Riverside Community.

I have a new baby.

- You have a new baby for me?

That sounds great.

- Behind every diagnosis is a person, a family, a story.

Hi, I'm Leticia Juarez and on this show we are listening to patients and the medical professionals who walk beside them, sharing their struggles, breakthroughs, and the lessons learned along the way.

Together, we're making healthcare clear, compassionate, and closer to home.

So, join me on this journey of Health Caring.

[soft piano music] ♪ - [Leticia] Today, we're talking about the tiniest patients with the biggest needs, kids.

We'll hear from pediatricians who know exactly what it takes to keep kids healthy and thriving.

And, meet one family whose wellness visit for their 2-year-old son turned into a life-changing diagnosis.

And as a mom, I've relied on my own pediatrician, Dr.

Alan Kwasman to guide my boys from day one, keeping them healthy, happy, and growing strong.

- Most accurate way to measure.

- I'm Alan Kwasman.

I'm a pediatrician.

I'm board certified in pediatrics.

I did my residency in Loma Linda, which is what brought me out to the Inland Empire.

- You've been in practice for how many years now?

- Ohh?

A little more than 30.

- 38 years, precise!

- 38 years.

I guess you did your research!

Okay.

- What is a child well visit?

- A child well visit has many aspects.

First, we want to know if the parents see a problem.

We wanna measure the baby and weigh the baby, see how the baby's growing.

We ask some development.

We do a physical exam.

And then, once again, we ask the parents if they have any other concerns.

We also give vaccines afterwards.

- You also talked about checking the mom out.

- That's correct.

At four days, every mother now is filling out a formal depression scale called the Edinburgh Depression Scale.

Postpartum depression is very serious and very important.

And if a mom is depressed, it has grave consequences, not just for the mother, but for the baby.

- [Leticia] Dr.

Alan Kwasman has been caring for children in Riverside for years, earning the trust of families like mine.

And in Upland and Fontana, families count on Dr.

Namita Mohideen to keep their little ones healthy and strong.

- So a lot of times, a family will come in and kind of meet me even before the baby's born, to kind of see if we're a good fit.

But then once the baby's actually born at the hospital, usually I'll see the baby within the first 24 hours of life and we'll continue to see the baby every day while the baby's in the hospital, until the time of discharge.

- And, it's that first exam where you can take a look at the child's health.

- Yes, exactly.

- Examination.

So Dr.

Kwasman, when should a parent start their child's first well visit?

- So, we see the baby at four days, two weeks, two, four and six months of age, nine months, and one year.

So, the very first well visit is usually at four days of age, because that's when jaundice is at its peak.

Most babies turn a little bit yellow in the first three or four days.

It's normal.

When it's normal it's called "physiologic jaundice."

But if it's very, very high, it could be dangerous and cause brain damage.

So, that visit's very important.

- So, that's something that you can determine and catch early in your practice here, and if you catch it, what are some of the things that parents can do?

- Well, I do ask every patient when they're discharged from the hospital, to put their baby by the window in indirect light with their shirt off for an hour a day.

That's a very good idea.

- [Namita] So, we typically will monitor and watch for the weight.

How's the baby gaining weight?

How's the baby feeding?

And, also that first well visit in the office is a really nice time to sort of really establish a relationship with the family and the doctor.

You know, it really kind of sets the tone for the next 18 years.

So, it's one of my most favorite visits to do and I absolutely love it.

- You don't really-- Do you see development at that stage, or probably not?

Those are gonna be in subsequent visits, correct?

- Right.

So, typically we will, throughout the baby's lifetime, look at different developmental milestones that we're looking for.

A lot of that will start around one month, two months of age, and we'll continue to follow.

As the development changes on the child, we'll keep monitoring for those milestones.

- That was something you were asking me during Hudson's visit.

You were asking me about whether he could hop on a foot, or his walking.

You were looking for his gait.

- [Alan] We're checking his gross motor abilities.

Also, I asked you about speech.

Remember that?

- [Leticia] Yes.

- [Alan] So, those kind of things.

But, you know, I was kind of interacting with him and although I know you think I'm playing with him, I'm really looking for how he speaks, how he interacts.

Does he make eye contact?

- And, the same for Emma.

- [Alan] Good job.

(soft voice) Good job.

(doctor cooing) What a great patient.

- [Leticia] Obviously that's a different type of development you're looking for at a 10-month-old child.

- [Alan] Well, it's-- We're looking for development.

And, you're correct; at each age the questions are different.

But, during her 10-month-old exam, or nine-month-old exam, I looked to see if she could pull to a stand.

That's a gross motor check.

- [Leticia] Oh, I did not know that.

- So, we're looking in their ears.

We're looking in their throat.

I'm listening for heart murmurs.

- There's other wellness visits that children do past the 15th month mark.

What are you looking for in, like, the 15-month to 30-month age range when it comes to a wellness and development visits.

- The wellness and development visits are consistent in monitoring growth, weight, height, and monitoring development and looking for problems.

We're also looking for diseases.

But, you know, at four, we're looking at language.

We're trying to get parents to talk to their kids.

We're pushing them to teach those letters and colors.

There's no substitute even to sing and dance around the baby, and interact with your child.

And, the most common problem I see is delayed speech.

But, I've gotta wonder.

You know, it seems to me, since I've got you here!

- Mm hm!

- that I'm seeing more and more speech delay and I'm blaming it on the tablet, the screen!

And, I guess I need to put a sign up that says, "Hang up your phone.

Talk to your kid."

- So, Dr.

Mohideen, if you see a delay in development in a child, what happens next?

- The next thing we will do is refer the child to a specialist.

- And, those early interventions are really important.

- Early intervention is the key to better outcomes.

- [Leticia] My next question pertains to when a baby should get their very first vaccine.

- [Alan] The first vaccine a baby should receive is hepatitis B. And, it should be given in the first day of life.

The Academy of Pediatrics recommends that because hepatitis B can stay on the surface of a counter for up to eight hours.

And, if you eat in the wrong restaurant, especially in California, you can get hepatitis B. You might still test negative and transmit it to your baby.

- [Namita] But once the baby is discharged, then the rest of the vaccines will be started in our offices and the pediatrician's offices starting at age two months.

- Two months, and what is that first one like?

- The vaccines will cover for most of all the childhood diseases, like polio and whooping cough and diphtheria.

- And, why is it so important to have those vaccines at that particular stage of life?

- The reason it's so important is because we know at about age two months, the baby's immune system is at an all-time low.

So, we want to give the immunizations at two months of age, so that we can boost up the baby's immunity, and so that the baby can fight off infection better.

- [Alan] So, at two, four, and six months, we give vaccines, and then at one year.

And, the vaccines have been amazing.

I wanna be really clear.

It's one of the easiest and best ways to promote child health.

And, I'm gonna tell you in here in Riverside, California the Kaiser Hospital, Parkview Hospital, Riverside Community Hospital, have all closed their pediatric units because the vaccines have been so successful.

There's no need for them.

- What about for parents who say, "Well, I breastfeed my child.

They're getting my antibodies?"

- [Namita] Yeah.

And, that is definitely protective, but it's not enough protection for these very deadly diseases.

- [Leticia] And, what if a parent says, "I'm just not gonna vaccinate my child?"

- Typically, I will tell the parents that in the end it is their decision to make.

But, I always tell 'em, if it was my child, I would definitely vaccinate.

I would not take a risk.

- And, that's a critical part, is to let them know that it is safe.

- It is very safe.

The vaccines are extremely safe.

- What do you tell people that come into your office?

They say, "You know what?

I've done my research "and I've decided that "I'm not getting my child vaccinated.

Sorry, Dr.

Kwasman."

What do you say to these parents?

- Well, they usually get a lecture from me telling them what selfish, self-centered people they are and how they're taking advantage of the fact that everybody else is getting vaccines and they are not.

My biggest fear is that the vaccination rate will go down so much that these diseases will come back.

- And I know, like, when I had my son, I made everyone in my family get the whooping cough shot, as well.

- Yes.

And I would recommend it not only for whooping cough, but I would also recommend it for influenza, as well.

So, if you have a baby that is less than six months and not eligible to get the flu vaccine, we recommend that all the people around the baby get the flu vaccine.

So, one of the reasons you really don't wanna overlook giving the flu shot, is because we know that if children get influenza, their risk of severe disease is much higher.

So, the younger you are, the worse the outcome can be if you get influenza.

- A baby that goes in to hospitals with a flu-related illness, what are you seeing when that happens?

- Well, they become hypoxic and they lose their oxygen.

And, whenever your oxygen goes below a certain point, you lose some IQ points.

The long-term consequences may be great.

So, we'd like to prevent that hospitalization.

It's trauma to the baby, trauma to the parents.

But also, there may be long-term consequences.

So, getting the flu vaccine would be very, very important.

- Typically around age four to five, there are a set of vaccines that children need.

Typically, we call it the "kindergarten vaccines."

So, these are vaccines that they'll need to be able to be enrolled in school.

Also, they can get another set of vaccines, usually around age 11 to 12, and we call those the "teenage vaccines."

And then, usually around age 16, there's another set of vaccines that protect against meningitis.

And so, these are usually vaccines we call that they're "getting ready to go to college."

- When does childhood- kind of the childhood part, wellness check end, and turn into the annual visits that goes into their teenage years?

- Yeah.

So, typically, the wellness visits we will do until about three years of age.

And then, after three years of age, they will have annual wellness visits.

It's just less frequent.

But, children are still supposed to get checked at least once a year by their doctor.

- Hello, Leticia.

Thank you for having me today.

My name is Jesse Tweed.

I'm a pediatrician.

I grew up in the Inland Empire.

I did my medical school at the Charles Drew program at UCLA, and I did my training at Loma Linda Children's Hospital.

So, I've been in the community now practicing for 10-plus years and I'm excited to answer your questions today.

- [Leticia] So, as a mother of a pre-teen?

I say a 10-year-old is pre-teen because starting to act like a teenager!

What are you in your experience seeing with pre-teens, teenagers, in your practice?

- Probably the biggest or most challenging issue we see in our teenage population is mental health conditions.

We do see a lot of anxiety and depression, but that's probably the most common.

We do see a lot of general health issues.

There are a lot of chronic conditions such as asthma, allergies or obesity related conditions.

- You know, you touched on a very important issue there.

I think mental health and that category of children.

Can you talk a little bit about mental health and what parents should know, what parents should do, and how do you talk to your patients about that subject?

- [Jesse] That's a tough subject to deal with, with anyone, but particularly with our teenagers.

I think parents really should try to stay engaged with their children as much as possible.

It's not a onetime talk or a onetime, sit down situation.

It should be an ongoing dialogue.

Parents know their kids best and if you see your kid just acting differently, the only way to really know that is to talk to them and stay engaged with them.

- What strategies can parents encourage in order to have open communication with their teenagers?

- I think one thing, listen.

Also be available and present.

Teenagers will push you away and you might have to have some tough skin as a parent.

You don't wanna be overbearing, but you wanna be available.

And also, don't assume they're doing well.

Don't assume anything really, 'cause they're changing rapidly.

And, I think that's when we kind of make mistakes or get in trouble.

- Yeah.

So, there's a lot of changes going on with, you know, children as they start approaching their teenage years.

And that, of course, is puberty.

What can parents know what's normal and what's not normal in terms of hitting puberty?

And, what stages should you be concerned if your child's not meeting that development in puberty?

- Puberty has a wide range of normal and girls tend to start a little earlier than boys.

Typically, we say onset of puberty is between the ages of 8 and 13 for girls and 9 and 14 for boys.

Trying not to compare yourself to others is a good start.

But, I think getting in regularly to your doctor, doing your annual checkups so they can monitor the growth, they can answer questions.

And so, regular contact with your pediatrician or provider is a good place to start.

- And, should parents be watching for changing moods and how to approach that?

- Well, that's comin' either way!

(laughs) I don't think you have to watch for it!

- There you go.

That's true!

- That's something to expect.

And, I think that's normal.

I think it's-- Anytime there's change, there's gonna be an adjustment, I think, for both parties involved.

I think anyone who has kids, I think those teenage attitudes start well before the teenage years sometimes.

So, you get some practice early on.

- So, as your teens are growing and they're growing into their new bodies, of course, they need that nutrition and fitness.

I know a lot of kids can be sedentary, especially with lifestyles that are more indoors now these days, around video games and television.

How do you make sure that your kids are getting that proper nutrition then they need to get that exercise?

What do you recommend for that age group?

- [Jesse] Yeah.

We see a lot of nutritional challenges, either too much or not enough.

We have kids underweight and overweight, and to get a kid in a healthy weight range seems to be really challenging for our community.

I always tell parents you can control what you shop and what you cook, and that's where you should start.

Typically, for adolescents, we recommend 60 minutes or more of daily moderate to strenuous physical activity.

I think most kids can do much more than that.

An important part of that is it's daily.

You wanna be consistent.

That helps with good habits but also reduces injuries and has a lot of mental health benefits.

- I wanted to talk to you about something that can be kind of controversial, and that, of course, is the HPV vaccination.

What is the HPV vaccination, and at what age do doctors recommend children get it?

- You know, the HPV vaccine is the vaccine against the human papillomavirus.

We recommend getting it between the ages of 9 and 13.

Ideally, you complete the series by the time you're 13.

It's the only vaccine we really have that can prevent multiple cancers.

- I know that some people are for it and other people have been against it.

What are some of the concerns that parents have talked to you about it?

I mean, I've seen stories where people say their kids have been harmed by this.

Are you really seeing that in children that have been vaccinated in your practice?

- Personally, I've never had a bad outcome or a horror story with the vaccine.

I wouldn't give it to kids if I did see that or if I thought there was harm.

Some parents are concerned about the vaccine maybe promoting sexual activity, 'cause the human papillomavirus is a sexually transmitted disease.

But, we don't see any increase in that behavior in kids that get the vaccine as opposed to kids that don't.

I really try to meet parents where they're at.

When I present it more as, this is a tool that we can benefit you for the rest of your life and it's most effective to give it now, most parents can understand that.

But, like I said, my job is to provide the information; what it does, what we know about it, and help them make a decision.

- As a young mom, you get your kids checked out at the pediatrician quite often, but as the kids get older, I feel like parents drop off on those wellness checks and those annuals.

But, would you tell a parent "Make sure you're up on them?"

- Yeah, absolutely.

I think there's a lot of growth in this age range.

Their needs change over time.

It's hard to help someone who you haven't seen in five years and discuss a sensitive topic if there's no trust, if there's no familiarity.

So, I think staying plugged in and staying connected with a provider that you can trust is a critical part of your child's growth and well-being.

[soft piano music] ♪ - [Justin] Yeah, you ready?

- [Leticia] So, let's talk about one of your patients.

- [Justin] Come on in.

- [Leticia] 30 month old Connor.

- [Justin] There we go!

- [Namita] I remember him because I actually saw him probably within the first 12, 15 hours of life at the hospital, actually.

- [Namita] Hello!

Hi!

- [Justin] Hey, Doc!

- Hey, Connor!

How are you?

- [Namita] So, that was my first time meeting Connor.

But, obviously, at the clinic now, I've gotten to know him over the last two, two and a half years.

And, he's just a very bubbly, bouncy, happy little boy that likes to get into everything.

- [Leticia] When did you discover that Connor had an anomaly in his health?

- [Namita] Yeah.

So, around 18 months of age, I noticed when I was listening to his heart, the heart just sounded a little funny.

Somehow the heart sounds were a little bit louder than normal, and I thought, "Huh, that's kind of funny."

And so, we referred Connor to a cardiologist.

And so, it was actually the cardiologist that discovered the cardiac condition in him.

But, if you don't catch it in a timely fashion, it can actually lead to heart aneurysms.

It can even lead to infections of the heart.

And, it can even lead to heart failure, if you don't catch this.

- So, very scary.

- Very scary stuff, yes.

- So, when you let Connor's parents know, I mean as a parent they're probably terrified, 'cause their baby who was perfectly healthy at birth, now has the condition and now they're gonna be navigating this with you now.

[soft piano music] ♪ - [Justin] Better watch out, buddy!

(kids speaking loudly) - Push me.

Weee!

(rumbling sounds) (muttering joyfully) - Oh!!

Stop!

- Oh... (thumping sounds) - Thank you, Justin, for welcoming us into your home to talk about your son Connor and the importance of wellness visits.

- Thanks for being here.

- Your son, Connor; he is how old now?

- He's two now.

Yeah, he's been one of Dr.

Mohideen's patients for a while now, and, you know, we love bringing him to her.

- Got it.

So, you saw Dr.

Mohideen-- - [Justin] Mm hm!

- because of your oldest.

- Yep!

- And then you thought, I'm gonna, we're gonna bring our second, which is how a lot of families end up doing it.

- Yeah, but I mean we've had such a good experience with her.

Like, even when we moved health insurances from my wife's work.

She had to shift from one health insurance to a different one, we made sure that we stayed in network with Dr.

Mohideen because we loved her that much.

- The pregnancy with Connor, was it a normal pregnancy?

- Yeah.

Connor was a pretty normal pregnancy.

We didn't have any issues.

My wife had some, you know, little things 'cause at the age that she was at, she was considered a-?

I forget what it's called, but- - Geriatric mother.

- A geriatric mother, which-- - Yeah!

- I don't get!

Thirty-five is not geriatric at all!

But, that's-- - No, it's not!

- That's the terminology.

So, they gave her extra attention.

They gave her extra care; minor things, but nothing out of the ordinary.

- [Leticia] So, Connor, a normal healthy child?

- Mm hm.

- You were going to your wellness visits, and I'm guessing those were pretty standard visits?

- Yeah, nothing out of the ordinary.

You know, you check everything.

Just head to toe, weight, height, and everything was totally fine.

Like, everything was telling us that he was a normal, healthy kid.

And, it wasn't until his 18 month appointment that we had any, you know, alarms or red flags of something potentially being wrong with him.

- What happened at that 18 month appointment?

Did you notice anything that you wanted to bring up to Dr.

Mohideen?

- Nothing at all.

Like, we just thought it was another routine appointment.

And, when we got there, Dr.

Mohideen did her exam and she came across something that was-- She thought could be a minor concern, but nothing too alarming.

Nothing that would require an immediate, like, medical visit.

But, it was something that she wanted to get us a referral for and to have us address with a specialist.

We went to that specialist, and we found out that it was a serious heart condition.

- She-- And, when I spoke to her, she said what she heard through her stethoscope was your son's heartbeat.

And, something about that did not seem quite right.

- [Justin] Correct.

- And, she sent you guys to a specialist.

And, in talking with your wife, she said the specialists were even surprised that Dr.

Mohideen was able to catch that.

- Yeah.

We went to two different specialists to check this out and both of 'em were just absolutely amazed at our pediatrician, Dr.

Mohideen, because they were so shocked that she was able to spot that during a routine exam.

And, it's something that we'll have to monitor throughout Connor's life.

But, this is something that now that we know about it, we can, you know, make sure he's safe.

We can have it regularly screened and checked up on by not only Dr.

Mohideen, but his specialist, and we can make sure that he lives a long and healthy and normal life.

- So, obviously, early detection is key here.

- Absolutely.

Early detection is just paramount.

- That's gotta be scary though, as a parent, to go to these wellness visits thinking everything's gonna be fine, and then to find out that this happened.

But, again, it speaks to the importance of these wellness checks that people need to have them for their children.

Not to think, oh, it's just a routine thing.

- [Justin] Yeah.

I mean, it gave us, me and my wife, some sleepless nights.

I mean, we were worried, like, what it could be.

And, even though we had those, like, concerns and those worries, getting it checked out, getting it screened and getting it seen by the right people, because of that wellness visit, was absolutely crucial to make sure that, you know, he's gonna live a long, happy and healthy life.

- And, I guess it speaks again to having a good pediatrician who you trust.

- We are so lucky to have Dr.

Mohideen.

Everything from her mindset, her-- the way that she talks through things, the way that she just has a rapport with the boys.

Like, everything is just so crucial and the care that she gives us is just second to none.

- So, if I could ask?

Connor is now-- he's being monitored, obviously, by a team.

- Yeah.

He's been monitored since his 18 month appointment.

He's being seen by specialists at Children's Hospital in Los Angeles.

They're not worried at all.

They think he can live a long, happy and healthy life because they know what they're looking for and they can have a constant monitoring of it.

There's nothing that says that he can't play sports or can't do, you know, anything outta the ordinary that a normal kid could do.

- And, I'm guessing as a 2-year-old, it's not slowing him down.

- Not at all!

(chuckles) If anything, like, this kid is fearless.

He's more fearless than his brother.

Like, they'll jump off of the couch.

They'll jump off the table!

They'll climb over, you know, everything.

They'll wrestle on the car-- on the carpet, and on the floor.

They do everything that a normal kid does.

And, just because he has this condition doesn't mean that he's not living a full, and fulfilling life.

[soft piano music] - [Leticia] From that very first checkup to every milestone along the way, families can count on their pediatrician for every stage of a child's growth and development.

They're not just there for when your child is sick.

They're partners in keeping them healthy, happy, and thriving.

So, whether it's scheduling that next appointment, asking questions, or following through on care, remember, a strong relationship with your pediatrician is one of the best investments you can make in your child's future.

[light uplifting music] ♪ ♪ ♪ - [Announcer] Support for this series comes from Inland Empire Health Plan, a health plan with a mission to heal and inspire the human spirit, serving over 1.5 million members in the Inland Empire.