The pandemic we’re currently experiencing has exposed all the weaknesses of modern medicine. Family physicians have organized themselves in many cases and have adapted the way they treat patients. If this adaptation has been possible with relative ease for adult patients, what’s happened with pediatric patients?
We discussed this with Dr. Maria Lucia Santoro, pediatrician at the ASL of Lecce, Referent of the Italian Federation of Pediatricians and President of the “Italian Association of Health Environment Society”.
Dr. Santoro, what are the most frequent questions that parents ask you?
They’ve changed a lot, especially in the last little while. In the past, the mother and grandmother used to come into the clinic, but now both parents come and it’s a good sign to see the active participation of fathers during health assessments.
The questions are more specific now; the parents are better informed and are more in-tune with the environment in which they live. They’re looking for the most natural environment possible and they ask questions about how they can make it less dangerous for their children. Particularly in this pandemic year, the most frequently asked questions have been about sterilizing the environment in which the child lives. My advice is always to make very limited use of bleach and other harsh cleaners, which in most cases are also endocrine disruptors that can interfere with a child’s neurodevelopmental milestones as well as their endocrine system.
For example, instead of sterilizing the pacifier with amuchina (Italian product) or other detergents, I recommend going back to the old remedy of boiling. In the same way, instead of using bleach to clean the floor, I recommend using an eco-friendly cleaner or simple heat. This is in order to prevent your child, by crawling and then putting their hands in their mouth, from ingesting chemical cleaners that can be harmful.
Are there also many questions about feeding?
Certainly, and they’re now quite frequent. We always try to discourage the use of snacks and fast food in favor of a healthier diet, consisting of raw or cooked organic food but not of industrial origin, in order to avoid the presence of preservatives, pesticides and dyes. I recommend a traditional Mediterranean diet, for example. To encourage the development of an olfactory memory, I urge parents to cook broths or other foods that spread the good smell of food around the kitchen that can be memorized by the child.
I can imagine that parents will also have many questions about vaccines and specifically the COVID-19 vaccines. We know that the Pfizer-BioNTech, Moderna and AstraZeneca vaccines are all in Clinical Phase 3, to evaluate their efficacy and safety in the pediatric age group. They’re expected to be available in the Fall. What will be the concerns and questions from parents?
I believe that most parents will have by then understood that vaccines are safe and they will be the first ones to want to vaccinate their children so that they can see them play and hang out with other kids again, as well as see them go to school, on an ongoing basis.
Those who will be more hesitant will be those parents who have doubts (even now) about the vaccine for adults. Unfortunately, variants have shown us that SARS-CoV-2, which initially marginally affected children, is now more aggressive in the pediatric population as well. In addition, the virus will still mutate, so we need to be quick to expand our vaccination targets.
An interesting bit of news that has spread recently, concerns two girls born in Padua (Italy) to two different mothers but both were vaccinated in the third month of pregnancy, the two girls showed antibodies to COVID-19. This is encouraging news because it means that newborns from vaccinated mothers will already have a natural degree of protection; it is also further evidence in favor of the effectiveness of immunization and its safety — even during pregnancy.
How do you see your role as a pediatrician evolving?
The pandemic has given us a very strong push towards digitization. Starting with the electronic prescription, which has also greatly simplified the relationship with pharmacies. In addition, I’ve had visits via video call or Skype, which have proven effective. The work is better organized, as we work exclusively by appointment, and therefore the queues and waits due to patients showing up unannounced have been eliminated: a win for patients who can better schedule their time and a win for we physicians who can become more efficient.
Another positive effect has been the reduction in otherwise avoidable visits to the pediatric emergency room that, especially during holidays, recorded up to 35 visits during a 6-hour shift; many of them due to excessive concern on the part of parents.
Will telemedicine also be able to develop for general practitioners?
Certainly it will be of great help, and in my opinion, it represents the future. For example, we could perform an electrocardiogram and have it read by a cardiologist, thus shortening time and saving an additional step for parents and the young patient. Above all, it’ll be essential to work as a team with other healthcare professionals, and to do this, digitalization and telemedicine will be fundamental in order to make practicing medicine more effective and efficient. For example, the presence of a pediatric nurse would be of great help, and we’re preparing to introduce this professional discipline in pediatric clinics.
Soon, we pediatricians will also be able to perform the mandatory vaccinations of the pediatric age in clinics, thus freeing-up resources of the various territorial services to perform work that is more widespread with our young patients. For this, it’ll be necessary to be equipped with refrigerators suitable for storing vaccines, have access to the database of vaccinations with everything needed to deal with emergencies.
When the COVID-19 vaccines for the pediatric age will also be authorized, we pediatricians could be ready to vaccinate.
Finally, out of curiosity, how did your passion for pediatrics begin?
I’ve always had a love for children, so the choice to specialize in pediatrics was very natural for me. In addition, the profession of family pediatrician has allowed me (and still allows me) to accompany my patients on their growth path. Another aspect that’s always motivated me is the role of the pediatrician in helping parents, especially young couples and those couples who don’t have the support of grandparents who, for various reasons, no longer have the role they had in the past.
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