In the midst of a global pandemic, pediatricians are serving a unique role. While the coronavirus is generally showing milder effects on babies and children than on adults, there are still health concerns and considerations for infants in need of scheduled vaccinations, and kids who are home all day with parents who may be facing stressful situations.
In the second episode of our special COVID-19 series of The Brain Architects, host Sally Pfitzer speaks with Dr. Rahil Briggs, National Director of ZERO TO THREE’s HealthySteps program, to discuss how pediatricians are serving their patients during the pandemic, including using telehealth; why caregiver health is child health; and what she hopes the healthcare system can learn as a result of the pandemic.
Upcoming episodes will focus on racial disparities in the effects of the virus, and domestic violence. Subscribe below via your podcast platform of choice to receive all new episodes as soon as they’re released.
Sally: Welcome to The Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Since our last podcast series was released, things have changed drastically as a result of the Coronavirus pandemic. During this unprecedented time, we’d like to share resources and provide guidance that you may find helpful. So, we are creating a series of podcast episodes that address COVID-19 and child development. This episode is the second in our series, and our guest today is Dr. Rahil Briggs, the National Director of ZERO TO THREE’s HealthySteps Program. Good morning, Rahil.
Dr. Briggs: Good morning, Sally.
Sally: And just so our listeners know, we’re recording this podcast today on a video call, so the sound quality may be different from what you’re used to hearing when we typically record this podcast in the studio. Rahil, what are you starting to see out in the field with pediatric practices effected by this virus, particularly in the HealthySteps locations, and how are the pediatricians starting to respond to the Coronavirus situation?
Dr. Briggs: Sure, thanks Sally. It’s an excellent question and honestly, depending on when listeners are catching this it may have already changed by now. The American Academy of Pediatrics is really our guide star for figuring out what’s going on and what they’re recommending, but a couple of facts on the ground really remain the same. That pediatric primary care is the main system we have for reaching young children. In a normal time, whatever that was and may be in the future, pediatric primary care reaches nearly all young children in our country. Right now, the American Academy of Pediatrics in recognition of the importance of vaccinations, and in recognition of the importance of really high quality newborn pediatric care continues to recommend actually, that families bring newborns, and bring infants and toddlers who need vaccinations into the primary care practice. So, that is pretty extraordinary and speaks to the importance of those services even with the Coronavirus swirling around. As you know, there are about 12-13 well child visits in those first three years. 7 of them occur in the first year of life, and a big chunk occur in that newborn period where they are checking everything from the bilirubin levels to maybe redoing the newborn blood stick to the weight gain and all these really critical pieces. So to your question – what are we hearing now and what are we hearing from our HealthySteps specialists who work side by side alongside the pediatricians in these practices? We’re hearing that babies still need vaccinations, and parents are more stressed than ever. That really needs attention. All of this discussion about how children are saved by the worst impacts of the medical parts of the Coronavirus, they are at home often with parents who are incredibly stressed and really looking for new approaches and ways to just frankly get through the day. So that is where our HealthySteps specialists are really coming in handy. I’ll leave you with one particular point that has really stuck with me. We had one of our HealthySteps practices in Colorado say that they were going to move to drive through vaccination services, which sort of boggles the mind, but I suppose that’s the world we are living in right now. And as they grappled with that and went back and forth with whether or not that was the right thing to do, they decided they weren’t going to do drive through vaccination services. One of their driving pieces was knowing how important it would be for the family to still touch base with the HealthySteps specialist. They’re hearing that families are running out of diapers, families are struggling to get formula, families are struggling to get needed medications for children with special healthcare needs. The HealthySteps specialists are doing so much of that care coordination and that systems navigation because as we know this is disproportionately affecting those who are impacted by poverty.
Sally: Would you mind giving us a really quick summary of what HealthySteps is for the listeners who may not know about the program?
Dr. Briggs: Sure. HealthySteps is a team-based, evidence-based primary care program where we add a new team member to the primary care network, which is a HealthySteps specialist who is an expert in child development, focusing a lot on parent-child relationships, focused on infants and toddlers; babies, toddlers, birth to three. We are an evidence-based program and have a three-tiered system of intervention with a universal level of services that include needed screenings for family concerns and child concerns and follow up on those screenings. And then a tiered level of intervention based on need for families with young children.
Sally: That’s really interesting, and you’re actually teeing us up for our next question. How are pediatricians helping families manage stress with all that’s happening right now, and what advice would you be thinking about giving to those families that are dealing with the highest adversity and stress?
Dr. Briggs: It’s a great question, Sally. I think a couple of things remain true, even though we are living through pretty extraordinary times. We know that there are two main ingredients for happy families with healthy children, and those continue to be safe, stable and nurturing relationships and a sense of routine and predictability to some extent. So obviously right now people are very stressed, and families are worried about lost income or even about not having enough groceries on the table. We also know from some of the great work that’s been done that babies pick up on that stress. They’re like recording devices that are always on. We don’t get to choose whether they record just the good or some of the bad, it is always on. So, what do you do and what can pediatricians do to help families during this time? I’d say three important things. One, and again this remains true no matter what time we are in – take care of yourself so that you can take care of your children. It’s about going easy on ourselves. Recognizing that nobody can overnight, turn into a perfect stay at home employee, pre-school teacher, care coordinator, systems navigator and parent when you’re not sleeping because you’re worried about trying to get food on the table. It’s about asking for help and organizations are scrambling to try to figure out the best ways to help families – moving to telehealth and moving to much more nimble service delivery options. Two, some semblance of a daily schedule. I think again this is a moment to go easy on yourself. It doesn’t have to be color coded and beautiful and every 5 minutes mapped out, but some daily schedule where there is some play time, time without screens and hopefully safe outdoor time. We’re advising families to expect that behavior will change and you may see in young children sleep disruptions or feeding difficulties. One thing we know for sure is that they’re going to be sensing the worry in the house and the stress in the house and needing a few extra hugs. And three, connecting with children when parents are in a good place. When they feel that they can be that safe, stable and nurturing environment for the children, and if not then to take a break and to ask for help. Maybe one of the best parts of being a toddler is that favorite books are just that and can be read every single day and multiple times a day. There’s not that exhaustion. Being able to just spend that 5 minutes. Depending on the age of the kid and how good their receptive language and understanding is, we can also explain to them a little bit about what is happening here in a developmentally appropriate way, but they rely on parents to interpret the world around them. If parents are sort of saying ‘no, no it’s fine, it’s all good you have nothing to worry about’, that’s going to feel discordant to a young child. So I would say really helping parents develop the language to explain that there is a virus and it’s making some people sick, children are not getting very sick from it, we’re staying home to help keep other people from getting sick and what can we do to really make sure we stay well? We have to wash our hands and not give hugs to prevent the spread of the virus. And we have to focus on our youngest patients to ensure that there are healthy and resilient families in the future.
Sally: Yeah, I hear a lot of what you are talking about also kind of swirling around mental health needs. I was wondering if you could speak a little more to what families and friends and neighbors and communities could do to help support the entire family’s mental health needs in the current situation.
Dr. Briggs: I was reflecting back I think earlier this week when a friend of mine who is a social worker himself, and someone that I’ve always thought of as very mentally healthy. He hasn’t seen struggle with depression or anxiety, and he is one of those folks who can be the calm within the storm. We were chatting and he told me he had a panic attack. He’s 45 years old, never had a panic attack before in his life. These are pretty extraordinary times and so they are taking a toll on folks. I think with all of this worry that we are hearing it’s incredibly important for parents to be that home base, for parents to be able to provide some of that calmness routine. They don’t need the latest game, they don’t need the latest app, it’s not about the latest and greatest sort of interventions. It’s about just some level of safety and stability in this highly stressful situation. Self-care is not selfish. It’s the best way that we can take care of ourselves and our children. There are plenty of resources out there that used to be fee-based and now are free, like Headspace and Calm. Physical activity to the extent we can get it; walking, jogging, jogging in place if need be, dancing, whatever it is that feels good and can be done safely. Cooking, journaling, taking a bath, having a cup of tea, chatting with friends, getting on a video chat. If you’re not a member of a HealthySteps practice and don’t have access to that mental health support right there in pediatrics, there are also other support organizations that have moved completely to an online service delivery model and are free. The Erikson Institute’s Fussy Baby Network is one of them. They’re starting to, I think starting last week, providing online support, video home visits, parent web support groups, they’re launching Facebook live sessions for infant massage and baby yoga and play and connection ideas. So, all sorts of options. And again, just asking for help. One thing that I’ve learned through this last month already is that we’re all just doing the best we can and we’re all struggling in one way or another. We have a section on our website on healthysteps.org on caring for yourself during Coronavirus, and there is also a zerotothree.org for tips for families Coronavirus if that could be helpful.
Sally: What are the pros and cons of health services that are delivered by technology instead of in person?
Dr. Briggs: Telehealth is emerging as this wonderful solution to so many of our problems, and it is absolutely a vehicle that can really help us reach families right now. There are some challenges to telehealth, not the least of which is that the guidelines around telehealth vary state by state. So you have 50 sets of guidelines about how to use telehealth, who can be reimbursed, what qualifies as a telehealth visit and then when we think about infants and toddlers, if you’ve ever tried to get an 18 month old to just stand in front of the camera for a 20 minute telehealth visit – good luck, right? I think as much as it’s an extraordinary platform and we can really extend the reach of services through telehealth, we’re going to see limitations both because we don’t have a national infrastructure around this and because infants and toddlers are not great at sitting still for the camera. We’re losing some of that key interaction piece of the parent and the child together perhaps and creating even more stress for a family because Dad is worried making sure that the baby stays in front of the camera for this visit. So, we are thinking a lot about yes, the promise of telehealth and the unique challenges particularly related to infants and toddlers.
Sally: You’re definitely speaking to the fact that our healthcare providers are being seen as real heroes right now, and we are wondering what should our healthcare system learn from this experience in order to adapt and improve the system for the future?
Dr. Briggs: Maybe, we finally recognize that we absolutely need a healthcare infrastructure for everybody in our country, and maybe we finally recognize that that healthcare infrastructure includes mental health. That there is no health without mental health. That there is no child health without caregiver health, and that goes for mental health as well, and that developmental wellbeing is a key construct in there. I am thinking so much about our increased understanding of all of these drivers of health. We’ve known for a long time that you can’t solve all problems within those four walls of the medical practice. That if someone goes back to unstable housing, if someone goes back to community violence, that those things are going to undo the important health interventions efforts we’ve made. My first decade of work was at Montefiore Health System in the Bronx, a borough where people are dying from COVID at twice the rate of their neighbors and the rest of New York, due largely to pre-existing health conditions and other risk factors associated with poverty. There is a higher incidence of asthma in the Bronx, largely based on a higher incidence of air pollution in the Bronx. And so, my greatest hope for all of us is that we recognize what heroes healthcare workers are and we recognize that we need a massive rethinking of the healthcare system to focus on those drivers of health that have to do with safe housing and environmental justice and safe and stable and nurturing relationships that are going to really create the foundation for health for folks, whether they’re facing this virus or another one down the road. We’ve got an extraordinary moment to get this right coming out of it, and it’s about whether or not we’ll have the courage to do so, the will to do so, and the resources to do so.
Sally: Thank you so much, Rahil for taking the time to be with us today. You’ve articulated so clearly the importance in making sure healthcare, including mental healthcare, is available for all. And that as you said, caregiver health is child health. We’re really grateful that you took the time to speak with us today.
Dr. Briggs: Thanks, Sally.
Sally: I’m your host, Sally Pfitzer. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu. We’re also on Twitter @HarvardCenter, Facebook @CenterDevelopingChild, and Instagram @DevelopingChildHarvard. Brandi Thomas is our producer, and Charley Gibney is our producer and audio editor. Our music is Brain Power, by Mela from FreeMusicArchive.org. This podcast was recorded at my dining room table.