Speaker 1: 0:04

Welcome to the Healthy Matters podcast with Dr. David Hilden, primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, healthcare and what matters to you. And now here's our host, Dr. David Hilden.

Speaker 2: 0:20

Hey, everybody, it's Dr. David Hilton, your host of the Healthy Matters podcast. And welcome to the first episode of season two. Today we are gonna talk about pediatric healthcare with my colleague from Hennepin Healthcare, Dr. Krishna Subramanian. Kris, thanks for being here.

Speaker 3: 0:35

Thank you, Dr. Hilton. Thanks for having me. Um, congratulations on, on season two.

Speaker 2: 0:40

Thank you. Excited to be here. Thank you. We had a fun first year doing the podcast, and you are my first guest for season two. Well,

Speaker 3: 0:46

An honor and a joy, and I'm excited to talk about our youngest patients. So

Speaker 2: 0:50

You're a pediatrician. I am. You see kids. Tell me about your practice at Hennepin. What kind of work do you do?

Speaker 3: 0:55

Yeah, so I, I get the privilege of working with families and kids from the day they're born and sometimes even before the day they're born, uh, in preparation of a baby coming into someone's life. And, and we start there and we get to follow them. And it's one of the great joys of pediatrics is we get to follow families and kids and watch them grow up until 18 and beyond. Uh, you know, we have patients up, uh, sometimes beyond into their early twenties, uh, depending on the care they need. Um, and, and what I think about it is, you know, we are there to respond to acute health concerns. Of course, if you're sick, if you're ill, we're there to help with that. But one of the great joys of pediatrics is we get to help anticipate with you about life. Might look like we get to talk about how to keep yourself healthy, how to prevent illness, and, uh, give a little bit of education to families as we go through the, the really challenging job of supporting kids. Uh, you know, they say kids don't come with a guidebook, and they don't,

Speaker 2: 1:53

They sure don't<laugh>. They

Speaker 3: 1:54

Definitively do not. But, but one thing is, uh, we get the privilege of meeting a lot of families and crowdsourcing a lot of wisdom on, on what works, what helps kids. And I, I view one of my great roles as being able to share the wisdom that our community brings to the, to the art and science of raising children. I get to share that wisdom, uh, with other families.

Speaker 2: 2:15

It's often said that, uh, uh, doctors don't often listen to the parents, but nobody knows their child as well as the parent.

Speaker 3: 2:20

It is, it is so true. Uh, you know, e every kid needs an adult who's crazy about them, who loves them, who, who, uh, cherishes them. And and I get to see it every day, Dr. Hilden, you know, um, it, it is so joyful to see the way that parents devote themselves, families devote themselves to, to young people. But sometimes there's a lot of questions involved with that. How do we do this in the right way? Uh, I know we all second guess ourselves, a as, as parents and as family members. And so to be there a as something of a guide, as, as something of a, a colleague in the process of thinking, how do we do this next step of, of child reary? It is awesome. And, and then to see the way that families grow, the way that families develop it, it's a beautiful thing. And it's a honestly just such a great privilege that

Speaker 2: 3:08

We have. Uh, your perspective on childhood development inspires me. You, you weren't gonna be a teacher or you were a teacher before pediatrics, right?

Speaker 3: 3:16

Uh, I was, uh, before I decided to go down the pathway of medicine, I, I got to be a, a high school teacher. I was a high school special education teacher. And David, the kids were incredible. They were amazing. They inspired me. They, they moved me. They made me think, they challenged me. And, and I honestly loved my job as a special education teacher. Um, my hats and heart go off to, to all the special education teachers out there. They do incredible work. One of the things that, as I was thinking about my own career development was I thought about how could I help kids, uh, even earlier, like, how could I get to helping them even before high school? And I saw some of my colleagues down in elementary school teaching. They were teaching kids to read by the age of seven, eight. And, and if you can get a kid off to a great literacy start by the age of 6, 7, 8, boy, you have really changed their life trajectory. And so I thought, wow, that would be really cool. Maybe I should have gone into elementary school teaching. But then I saw, wow, there's stuff we can do even before kids get into the school system, even before the age of five. And I said, how could I get involved in that? And I was lucky enough to have had, you know, a lot of my science courses and had thought a little bit about med school, hadn't devoted myself to that, but I saw that there was a dirt, the providers in some communities in our country, I saw, uh, the opportunity to get involved before the age of five. And frankly, you can get involved even before kids are born. And so it was really that motivation to get to earlier that brought me to medicine and then brought me to pediatrics. To

Speaker 2: 4:50

Pediatrics. I wanna talk to you a little bit later in this podcast, if we could, about that early childhood discussion that you just brought up about the importance of reading, how we can foster, uh, reading development. Um, what is, uh, what is play look like for children? Look, we're gonna talk about that. Before we do that, let's talk about what's going on in the world right now. Um, we've got covid, o uh, we've got influenza. And in your population for your patients, you have something called R S V. What the heck is R rsv? And why are we hearing about it now?

Speaker 3: 5:22

Yeah. So R S V is respiratory, sensational virus.

Speaker 2: 5:28

Easy for you to say<laugh>.

Speaker 3: 5:30

It, it is a, it's a virus though, that really affects our smallest kids, our little babies. It's a virus that, for you and I, David, we probably have had it in the last couple years, and we probably had a cold from it. And we said, oh, this sniffle is annoying. This little sore throat is annoying. I'm gonna take some Tylenol, ibuprofen and I'm gonna be okay. Mm-hmm.<affirmative> mm-hmm.<affirmative> for our littlest kids, however, particularly those six months and younger, one year and younger.

Speaker 2: 5:54

Just babies. Just,

Speaker 3: 5:56

Just babies. Yeah. Um, it can be a scary disease. Uh, it causes a lot of mucus, a lot of snot, a lot of boogers. But if you can imagine those that snot and boogers in the airway of a very small baby, you can imagine how difficult it is to move air past that. Mm-hmm.<affirmative>. And so some of our smaller airways in these, in these little babies get clogged up with mucus and cause them a great difficulty breathing. Um, so what you see is you might see them come in with a cold, you might see them have a runny nose, a little congestion, but then you might see them be a little bit worse. They might start having fevers, and then some of them start to have a cough. And then unfortunately, some of them start to have difficulty of breathing. What

Speaker 2: 6:39

Does that look like in a one 12 month old infant? How do, how does a parent know my child is having trouble breathing now. It's worse than dimples. Do they look blue or do, how does a parent

Speaker 3: 6:50

Know it? It's a great question, because they can't tell you. Yeah. It's hard to breathe.

Speaker 2: 6:53

Exactly. Here,

Speaker 3: 6:55

Here's what I talk about. Um, once it starts to transition down into the lungs, once r sv or rank, frankly, any virus, it could be influenza, it could be covid, it could be R S V, it could be the common cold mm-hmm.<affirmative>. But once it starts to get down into your lungs, then we need to start thinking a little bit more seriously. And what does that look like? Number one, kids start to breathe faster. So kids breathe much faster than you and I, David, you and I might breathe 16 times a minute, 15 times a minute. They're, you know, a small kid may breathe at baseline 30 times a minute, 40 times a minute. But for our littlest babies, once we start to see those respiratory rates up around 55, 60 oh good.

Speaker 2: 7:34

65, that's like breath every second. It, it

Speaker 3: 7:36

Is. And, and when I, when I demonstrate this to parents, that's exactly what I show is it's a, it's a breath every second. And I go through a practice with the patients. I'm, I'm lucky enough to see of stopping for a minute, putting everything down, and we watch a clock together, parents and I, and we count, we count how many times is your child breathing? And if we start to see that number getting up there more than their average, and in particular for our youngest babies, you know, above 55, 60 times a minute, that means they're having to work a lot harder to get air in and

Speaker 2: 8:09

Out. They're almost panting there. It sounds like they're going fast.

Speaker 3: 8:11

Yeah, that's exactly right. It looks, it looks like panting. That's right. The other thing we might see is when we're watching for a minute, we might see their little ribs starting to suck in. We call that retraction. And what it means is that the, the child is having to exert a lot of muscular force to get air in and out. You can imagine that mucus is blocking the airway. They have to start pushing to get air in and out. And so when we see those two elements in particular, that is something that you can identify even at home. You can start to see those things and say, it's time to get care. We've gone from a situation of this is our cold to this is serious, and we need to get extra support.

Speaker 2: 8:52

Scary for parents. I know, but that's really good advice. If your little one is having those things breathing super fast, retracting in the muscles of their chest while you see their ribs, move those, that's really good advice. I was told by, um, Diana Cutts, the chair of pediatrics, luminary in pediatric care, if I could say, Dr. Cutts is one of our colleagues, and she was telling me about how busy things are, not just at our hospital, but at our city's hospitals, our state's, hospitals, our country's hospitals. Do you know why our R SV has been around for a long time? I remember, I I did listen, I did listen to that lecturer in pediatrics in the, in med school. It's been around for a long time. Why know what, what's going on that it, that it's suddenly like a headline story.

Speaker 3: 9:35

There's a couple factors that, that play into this. We have, you know, obviously the world has been through a lot the last couple years in terms of the pandemic, in terms of covid and, and in terms of the, the practices we took to keep people safe. And, and what we did is we masked up, we kept kids away from congregate settings, places like daycare cares in schools. And, um, I'm hopeful that that helped to protect a lot of older folks, particularly from the consequences of covid 19. But what that led to in some ways is a lot of kids who haven't seen viruses Mm. For the last three years, uh, they're what I would call immune naive. They, they haven't experienced a lot of flu. They haven't experienced a lot of the rhino bearson. They haven't experienced a lot of rsv, you know, prior to this wave, we would say that 90 plus percent of kids will have had RSV in their first two years of life. Right now, that population, it just isn't there not nearly that many of kids. It's

Speaker 2: 10:32

Sort of like the covid of kids.

Speaker 3: 10:33

It, it, you know, in an affects kids in, in much the same way I, in the sense that it causes that respiratory distress. Luckily, kids are resilient people. They, they are, uh, usually their organs, their lungs, their kidneys and liver are very healthy. And so we don't usually see that kind of death Yes. That we do in, in

Speaker 2: 10:53

That's a good point. Point. Yep.

Speaker 3: 10:54

Yep. Um, one of the things I love about pediatrics is that children are so resilient and strong, and that if we can keep their bodies supported through the bad times, they will get better. But that means we need to identify the bad time mm-hmm.<affirmative>, and we need to support them through that. So

Speaker 2: 11:10

That's what you would do for rsv. You're supporting them as their body heals. Yes. There's not medicines you use. Um, you, you might see him in the clinic, you might see some sick ones in the hospital, and you basically support them. Correct. Yeah.

Speaker 3: 11:22

So, so when I, you know, I think there's two situations. One is when I see you in clinic, David, with your child, you know, then we're gonna talk about what I would do at home mm-hmm.<affirmative> to help you get through what is a really challenging time. It's awful to have your kids sick at home. And so what I would talk about in that situation is a lot of suctioning. Um, I, I am not a paid endorser of the nose, Frida or other suctions, but whatever you can do to suck a lot of boogers out of the nose of a child will help. Two, keeping them hydrated. And that is, uh, fluids, fluids, fluids. I, I talk to, to kids frequently about your pee should be clear. If your pee is yellow, we're not getting enough. How about your,

Speaker 2: 12:02

How bet how many kids love to see you, especially ones who understand what that is. You probably tell'em your P's supposed to be clear, and you're talking about four-year old<laugh>. They probably think it's funny

Speaker 3: 12:09

That, you know, it, it's, it's always silly when you come to the pediatrician,<laugh>, I'll say, I'll say that. Um, so, you know, hydration, hydration, hydration, uh, we talk about depending on age, uh, Tylenol and ibuprofen and how that, that can help. Um, and then, uh, I talk about taking a couple warm bads a day, uh, a couple warm steamy bads so that you get that mucus flowing and

Speaker 2: 12:29

Loose helps loosen things up. Yeah, loosen

Speaker 3: 12:30

Things up. So those are kind of my at home sort of recommendations for the most part. And then parents are being vigilant and watching for those scary signs. Now, when it comes to kids who start, you start to see those ribs, you start to see them breathing faster, that's when our, uh, you know, incredible colleagues in the hospital, uh, and in our ICUs start to kick in. And they have, uh, they don't have great medicines, David. We don't have great medicines for R S V, but we do have technology, and we have things like high flow nasal cannula or positive pressure tools that help to push air in, push past those mucus plugs, keep the lungs of the babies open, and help them breathe. And so usually that's what we will we'll do is we will support phy the physiology and the children. But if they need it, luckily we have those technologies that can support them through the worst of times. You know, RSV has a pretty cyclical pattern. It gets worse for the first few days. Day five is what we sort of classically think of as the worst day. And so if we can support kids through day five, most of the time they'll start to get better.

Speaker 2: 13:37

We've been talking with Dr. Krishna Subramanian. He is a pediatrician at Hennepin Healthcare. After the break, I'm gonna ask Kris about early childhood development, the importance of reading the departments of play. How does a parent know? How does a community know how best to support children so that they develop at the earliest stages of life? It's a fascinating topic, so stay with us and we will be right back.

Speaker 1: 14:01

You're listening to the Healthy Matters podcast with Dr. David Hilden. Got a question or comment for the doc, email us at Healthy Matters hc m e d.org, or give us a call at six one two eight seventy three talk. That's 6 1 2 8 7 3 8 2 5 5. And now let's get back to more healthy conversation.

Speaker 2: 14:24

And we're back. We're talking about Children's Health with Dr. Christianna Subramanian. Kris, let me ask you this. We're, we're, we're recording from downtown Minneapolis where it gets cold. It's 10 15 degrees out today. Is there ever a, an age or a temperature when it's not safe for parents to bring your child out in the

Speaker 3: 14:40

Cold? David, we, we would say use caution once we're starting to go below zero, uh, Fahrenheit, you know, then, then we're starting to get into, to ranges. We're we need to use our smarts. Frankly, anytime that it's below freezing, we should be taking breaks. We can go outside for periods of time, 10 to 15 minutes, and then we should take a break and pop back into warmer weather. So we're all for activity. We want kids to get outside and be active and, and enjoy the aspects of winter that we get, but more than 10 to 15 minutes in subzero weather, that can get dangerous and our kids can experience frostbite. So, uh, we would just encourage families to one, bundle up your children with one more layer than what is comfortable for you. So if you're requiring a good heavy coat and a couple layers, put one more layer on your child, uh, cover all exposed skin. And then third, make sure you're building in breaks. No more than 15 minutes in a, in a sub-zero, uh,

Speaker 2: 15:34

Weather. For those of you not from Minnesota, usually about two weeks after a child learns to walk, parents are putting ice skates on'em and everything<laugh>. So, uh, we do embrace winter around you. Those are some really good tips. Kris. Let's talk about how we get our smallest friends off to the best start in life. Talk about early childhood development and importance of reading, the importance of play. How, how can we best support youngest

Speaker 3: 15:57

Kids? Yeah. David, when I, when I was talking about wanting to go back and, and help kids at the earliest stage possible, you know, I thought, oh, kindergarten, what, what a wonderful time. Uh, you can get kids off to a great start reading a plane. And then, you know, once I came into the pediatrics world, I learned actually 90 to 95% of brain development neuronal connections has actually happened by the age of five. Wow. Which was just shocking. And, and it leads us to think, wait a minute, what are we doing in those early years to help support that brain development to get kids off to the best start? So what this means is that even pre-birth in utero, brain development is starting and neuronal connections in those first few months and years of life are, uh, growing every day.

Speaker 2: 16:46

What's a neuronal connection?

Speaker 3: 16:48

Thank you. Um, the brain connections, the, the, the pieces of learning that helped to form the brain are happening every day. And, and the that can be daunting. It can be daunting to think, wow, this little baby in front of me is developing the brain that will set them up for the rest of their life. But it's also, I hope, really empowering for parents and families. And, and what way, what I mean by that is our ability to do what are in many ways very simple things, playing with children, talking to children, singing with children, actually help form a, a brain that is more able to learn, more able to grow and, and, and sets them up for success for the rest of their lives. There there's a type of interaction that with little children that we call serve and return learning. And, and it's the kind of things that you see folks do all the time. Hey, baby, how you doing? How's it going? And then waiting for that little response, that smile or that, uh, cue back from the baby. That kind of communication pattern, giving a little bit to the baby, waiting for the return and, and ensuring that we do that repeatedly, really does help form brain connections and can begin right from the very moment that they join our family

Speaker 2: 18:02

In your own home with the skillset and the tools you have as an adult. You don't need any special training to interact with your

Speaker 3: 18:09

Kid. That's right. Well, you know, I, I think we always think about what are, what are the apps we can use? What are the, uh, technology tools we can use at home? But the truth is, the greatest tool and gift we have for little babies and kids is an adult who loves them, is an adult who cares for them, is an adult who's investing their time and energy. If you can spend yourself, your time, your energy, that will make the biggest difference.

Speaker 2: 18:34

So I, I heard, and correct me if I'm wrong, um, that there was some study that parents who simply are adult caregivers who simply speak to their child in whatever language is your language, um, that, that that helps development. Is that a true thing? Just the verbal hearing words, I guess?

Speaker 3: 18:50

Absolutely. There, there was a study done a number of years ago that talked about a, a, a, a word gap. And, and it basically said this, kids who hear more words in their home from people that they love do better in kindergarten and beyond. And so what a wonderful power that we have a, as families to e engage in conversation wi with our littlest ones a and help promote their brain development.

Speaker 2: 19:18

What about art and music?

Speaker 3: 19:19

There, there's a lot of research out there about the value of music. Music not only has the word aspect to it oftentimes, but it also has these rhythmic patterns that help kids learn and help kids repeat back. And that kind of rhythmic sense to it is, is ingrained in us as well and ingrained in our little ones. And so, uh, I think combining both the language and the music I is, is a very powerful combination. What do

Speaker 2: 19:45

You say to a parent who's awful? They're busy, they're stressed, they're sleep deprived. They've either had this baby or they're the, um, the caregiver of this baby infant, this three year old, they're exhausted. They might be working two jobs. I don't have the time, the, the energy. I'm exhausted. I can't be bubbly and cute with my kid. I can't do what you've just said. I'm just too exhausted. How do you empower a parent to be interactive with your young child? Um, when they're feeling exhausted?

Speaker 3: 20:14

Yeah. Uh, and, and first, uh, if the pandemic has demonstrated anything, it's that parenting is exhausting. Hard a and, and challenging, you know, we've seen the families, um, caring for the kids at home for months with without any support, and that, that is, is really challenging. I, I think the first thing I say is, everything you expressed is so important and so true, and we need to make sure you are okay. And, and I, I think one thing that we as pediatricians get to do is check in on our, on our parents and our families too. And make, make sure you are okay if that means getting you physical healthcare, mental healthcare, any type of support that we can do that is part of our job as pediatricians, is to support the family to make sure parents are okay. Cuz if parents are not okay, it's hard for kids to be okay. Yeah. Yeah. Um, so I, I, I take that and all our, all my wonderful colleagues, uh, take that to heart that we wanna make sure you are okay. And if there's support we can provide, we will do it. Second, this doesn't have to be a, a, a production. What I'm talking about in terms of, of playing and loving and, and, you know, being with your child, you know, especially for those first few months, the visceral act of holding, of smelling, of hearing you talk to someone else, to, to be near you. Therein lies some important crucial connections. There. There are hormonal connections that are released both in parent and in child at that point, but also therein lies the beginnings of this development. So I think it starts very early and it's, and a lot of the simple things we do, what I'm saying is this doesn't have to add much more to your plate. This can be incorporated in all the things you're doing. If it's preparing dinner, it's talking about that out loud. If it's, uh, getting ready for bed, it's making sure that we're explaining and, and talking. And e even to the small baby who you think may not be hearing and listening to you, they are and they're absorbing it. So a lot of what we do, uh, in our daily lives already is shaping, uh, I think just cognizantly thinking about that and, and remembering that our children are watching and

Speaker 2: 22:19

Listening. Those are great tips. Uh, I, there's a father I know who used to like to read the newspaper, and when this father had an infant son used to hold the infant and simply read the newspaper out loud thinking that, I don't know, this kid doesn't catch him what I'm reading in the New York Times, but it's some words. I don't know if that was helpful, but that father was indeed me. I, I did that.<laugh><laugh>. Well, I said, what do I gotta hold the kid? And, you know, and I'm reading the paper here, I maybe I'll just read it out loud. I don't know if that helped, but my kid does like books. How do you promote the love of reading? Or if not the love of reading, at least the competence of reading. How do we, how do we promote that in children at a very early age?

Speaker 3: 22:56

Yeah. So, so first, uh, once again, thinking about how do we support parents, uh, you know, if if parents are, are, are not reading a lot, uh, that's okay. We can help support that, you know, and, and if you would like support in learning how to read or reading in a different language, those are things that we can find resources to help support you in. And I, I think, uh, sometimes it's our own, uh, fears of reading and participating in some of these activities that prevent us from doing it. But I promise there are resources out there, um, that your pediatrician would love to help connect you with, uh, that can help you get into some of these habits. But second, one of the great things about being a pediatrician is that we get to form relationships with, with families. And we get to see them numerous times over the first year. You know, we see them at, uh, two weeks of life. We see them at two months of life, four months, six months, nine months, 12 months. We see them a lot in one, in the first first couple years of life. And, um, Hennepin and, and our, many of our colleagues throughout the state get to participate in a program called Reach Out and Read and Reach out and read helps to provide us, uh, a book for all our kids who come in for their well-child checks. And we can give that book to the family. We can talk about, uh, strategies to use, including first, you know, a four month old or six month old. They may just be holding the book, flipping the pages, which is a great developmental skill, the ability to, to flip

Speaker 2: 24:13

Those pages. I never thought of that. Yeah.

Speaker 3: 24:15

So sometimes putting it in your mouth, feeling it, like, those are all great developmental skills. And then at each stage we can talk a little bit more about what developmentally appropriate reading strategies you can use. And we have some bookmarks and handouts that can help explain that. Additionally, there's a, there's a number of other programs. There's a program called Little Moments Count, uh, which has a ton of resources.

Speaker 2: 24:37

We could put the, we could put a link to that, um, on the show description for this podcast.

Speaker 3: 24:41

That would be wonderful. You know, they've have a ton of resources about ways to engage with your little ones, ways to promote brain development in these early years. They have resources in multiple languages and, and for folks across the country. So the wonderful thing about, uh, about the advent of the internet is we have resources everywhere. And, uh, you can ha you can find them. And if you can't find them, ask your pediatrician. This is something we love to talk about because it's just one of the joys of, of being a pediatrician is I get to see a baby. Uh, you know, yesterday I saw twins who are now six years old, and I saw them at their, their newborn visit. That

Speaker 2: 25:16

Must be so cool. You saw them when they're born and now they're six.

Speaker 3: 25:19

It's astonishing. It's humbling. I'm like, have I gotten that old<laugh>?

Speaker 2: 25:22

But, but, uh, and now they're, when they're graduating from high school, then you're getting that old fair, fair enough.<laugh>,

Speaker 3: 25:27

You know, it, it is, but it's, it's very humbling and it's a, it's a beautiful thing and it's, it's a great honor to be a part of, uh, children's lives from, you know, that nascent stage when, when we see parents who are both joyful and struggling to those hallmark and, uh, you know, highlights of love life, like, you know, starting kindergarten or graduating high school.

Speaker 2: 25:45

You mentioned about internet and resources. Now we have telephone visits, we have video visits. What can you do effectively by remote visits? In other words, when does, should a parent come to see you? Or are there some things that work on the modern method of healthcare, which is often by zoom or by phone? You

Speaker 3: 26:03

Know, at a pediatrics visit, particularly a well-child check, uh, some of the things that we really focus on is, is your child growing? Are they growing both from a height perspective and a weight perspective? Are they developing, are they doing things that are comparable to children, more or less their age? And then we like to talk about some safety elements of, of how to keep your child safe, including, you know, vaccines, but, but other safety strategies such as car seats and safe sleep. Right? So that's kind of the, the outline that we have at any given visit. Growth, development, and safety. I will say that for most well-child checks, we'd, we'd love to see you in person. And, and I say that because to, to measure growth, we need to see a child and to, to talk about development. We, we really like to, to observe a child doing some things. But I'll say that there's, there's some things that are really conducive to telemedicine through the pandemic. We've seen what I would call a parallel epidemic or pandemic of mental health concerns in young people

Speaker 2: 27:02

Of all ages,

Speaker 3: 27:04

Teenagers of all ages, teenagers in particular. Yeah. Again, and I, I have found that the opportunity to connect with our teenage patients over technological means zoom or

Speaker 2: 27:13

Or other, I've seen you do that. You've done some of that over Zoom and the like with preteens and teens, haven't you? I

Speaker 3: 27:19

Have. And, and honestly, to have that ability to connect in, in QuickTime from the convenience of their home, I think is really helpful for a lot of our teenagers. So I think that can be a really effective use is, is in our domain of mental health, medi medicine refills. Sometimes if things are pretty stable, kids are doing well, uh, with whatever condition they may have. Sometimes that can be really nice and convenient for families. And then I, I'll say sometimes, uh, depending on where the rash is and how it looks, seeing a rash and, and, uh, helping to identify it and give some, at least preliminary advice can be, uh, effective.

Speaker 2: 27:51

And kids get rashes,<laugh>,

Speaker 3: 27:53

Kids get rashes all the times. I'll say telemedicine for us, I think can be in many of these situations, a good beginning. Sometimes, you know, we will need to see the child ultimately, uh, in person. You know, o obviously in pediatrics we see a lot of, uh, ear infections, sore throats, that kind of thing. And, and sometimes we just need to see that part of the body to make a appropriate diagnosis.

Speaker 2: 28:13

We've been talking with Chris Subramanian. He is a pediatrician at Hennepin Healthcare. We've talked about R S V and the current surgeon in viral illnesses in young children. We've talked about early childhood development, reading language development, and we've talked about how to access your pediatrician. This has been a information packed episode. Thank you so much, Chris, for being here.

Speaker 3: 28:35

David, thanks so much for the opportunity. Thanks for what you do. And, uh, mostly thank you to all our, our patients and families who give us just the sacred honor of being a part of their

Speaker 2: 28:44

Lives. I can second that. It's been a great show and thank you listeners for tuning into the first episode of season two, and I hope you'll join us for the next episode as well. And in the meantime, be healthy and be well.

Speaker 1: 28:58

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden. To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. You got a question or a comment for the show? Email us at Healthy Matters hc m e d.org, or call 6 1 2 8 7 3 talk. There's also a link in the show notes. And finally, if you enjoy the show, please leave us a review and share the show with others. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive producers are Jonathan Comito and Christine Hill. Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.