Parenting in a pandemic: Making the best decisions for your family [PODCAST]

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“You have made difficult choices about your family’s health and safety already. Pediatricians help parents make these kinds of decisions all the time. The shared- decision model for practicing medicine encourages doctors like me to help provide information and counseling to empower you to make decisions.

You’ve already made decisions essential to your family’s health, whether about vaccination, safe sleep, or car seats. Other more everyday decisions parents make also carry real risk — driving while tired or distracted or selecting other activities like skiing or soccer. You can make difficult decisions and, in the process of coping with the pandemic, maybe you’ll learn more about what’s important to your family.”

Kelly Fradin is a pediatrician and author of Parenting in a Pandemic: How to help your family through COVID-19.

She shares her story and discusses her KevinMD article, “Parenting in a pandemic: Making the best decisions for your family.”

This episode is sponsored by Elsevier Health. Looking to update your personal or professional medical library? Shop Elsevier Health’s Holiday Sale and save up to 35% on your purchase of medical books! Plus, you can take an extra 5% off your order with code KEVINMD at checkout. Take advantage of the biggest sale of the year from Elsevier, the world-leading provider of medical books and reference materials. Shop us.elsevierhealth.com now through December 31.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Kelly Fradin. She’s a pediatrician, and she’s the author of the book Parenting in a Pandemic: How to Help Your Family Through COVID-19. Kelly, welcome to the show.

Kelly Fradin: Thanks so much for having me. I’m happy to be here.

Kevin Pho: So you wrote the KevinMD article “Parenting in a pandemic: Making the best decisions for your family,” and we’re going to get into that article and your book in a little bit. But first off, can you share your story and your journey to where you are today?

Kelly Fradin: I am a pediatrician. I went right through from college to medical school at Columbia and finished my training at Montefiore Children’s Hospital in the Bronx. I stayed on there as an attending in academic complex care, taking care of children in and out of the hospital. And then I transitioned to working for New York City public schools in a public health capacity, which I was doing until the pandemic started, and now I’ve been home with my kids.

Kevin Pho: With your background in public health, especially in the New York City school system, talk about some of the challenges that both the school system and the families with kids, for that matter, are facing.

Kelly Fradin: Yes. You know, I started sharing parenting advice and general health education on social media about a year ago, and when the pandemic struck, I had a huge growth in my account. Parents were really searching for reliable information, from someone they could trust, and in a way they could understand it. So it felt really important for me to spend some time and energy putting those resources together.

You know, parents have really been struggling this year, and as a physician who cares about both the individual level, the high-risk families and children, and the population level, all the behavior that’s going on, I felt like it was a responsibility and an urgent priority.

Kevin Pho: Now, I’m a parent myself, and I go on my local town’s Facebook group, and sometimes it’s pretty polarized, like everything else in our country now. When you give advice as a pediatrician on the social media networks, do most people agree with you, or do you get some pushback?

Kelly Fradin: Absolutely. That was one thing that’s taken some getting used to: Things that I think of as relatively benign, like flu vaccines or sleep training or even discussions about ADHD and the utility of making that diagnosis, for some people can be viewed as polarizing. So I’ve had to thicken my skin a little bit and also understand that when people come from different perspectives, they can have strong reactions to even these everyday topics.

Kevin Pho: Now, for those other physicians who are also on social media, who want to do the same thing as you are and try to spread that information, what do you do when you get that pushback from a non-clinician online? When they tell you you don’t know what you’re talking about and they really doubt what you say, how do you respond, and what do you do in that situation?

Kelly Fradin: Well, you know, it does challenge me, especially now that my account is bigger, to really have the best sources and evidence I can, because I find when I can point back to a resource, it makes it much easier to feel confident about the advice I’m sharing. But for a lot of parenting advice, there isn’t good research in support of it. And sometimes when I get pushback, I just have to say, “Maybe we’re not the right fit. Maybe you need to find somebody more in line with your preferences.”

And when it comes to vaccinations, sometimes I have to protect myself, because the bullies can be quite vicious. I’ve had to turn off comments and just hide when they really come swarming.

Kevin Pho: All right, let’s transition into the KevinMD article that you wrote. It’s titled “Parenting in a pandemic: Making the best decisions for your family.” Now, for those who haven’t read your article, can you just walk my audience through it and maybe share the story of why you decided to write it?

Kelly Fradin: You know, as a pediatrician, I’m well aware of sort of the safety culture that we live in. I support it. I don’t want children getting hurt or people taking risks with their health unnecessarily. But I think the pandemic has forced us to have more nuanced conversations, which take a little bit more time. When making decisions about how you isolate your family or avoid seeing loved ones who may be higher risk, it’s important for us as physicians and as parents to understand that there are risks, but there are also important benefits to consider. And I think walking families through how to make these difficult decisions can help them to feel more confident in making decisions that are based in evidence but still right for their family.

Kevin Pho: Now, from your standpoint, what are some of the major issues that you see families facing during the pandemic?

Kelly Fradin: You know, I worry a lot. There’s a big CDC article about the mental health impacts of the pandemic, particularly on young adults, and I think on teenagers too. We’ve seen anxiety and depression, even suicidality. And I think we have a responsibility to try to protect our children from coronavirus and from the secondary impacts of the pandemic, the isolation, and to help our children cope with the grief from missing the opportunities that they thought they were going to have.

Kevin Pho: How can we walk that line? Because I’m a parent myself. I mentioned before our conversation that I have a teenage daughter who’s a sophomore in high school, and it’s very difficult sometimes to see her, because she is separated from her friends. You want to give that social aspect, but you want to keep her safe from the pandemic. Now, what kind of advice do you give the families who need to straddle both those worlds?

Kelly Fradin: You know, I think it’s very difficult, and that was part of the point of the article: There’s no one right plan. Every family has to consider their children’s and their parents’ needs. We have some parents that are very high risk, and they can’t really permit their children to have any contact. And how do they cope with that grief and guilt over having to make that decision, which is probably the right one for them?

But most people are in that middle ground of trying to balance the risks and benefits, and I think it can help to have sort of an algorithm approach, so that instead of making 100 decisions every week, you’re kind of making one decision: Is this a valid exception to our plan? We have a plan that we’re going to allow our family to do things outside and to do things within our pod, and there’s going to be Halloween, Thanksgiving, sporting events. There are always going to be challenges to your plan, and the question then is not restarting your plan from zero. It’s trying to determine whether or not it’s a valid reason to break your protocol.

Kevin Pho: Now, we’re speaking at the beginning of November, and a lot of schools in the country are either hybrid, and a lot of them are just simply remote only. And you talked about the mental health effects on kids and teenagers being remote only. What are some of the other challenges that you see stemming from this generation of remote learners?

Kelly Fradin: So I think the mental health impacts are probably the biggest one. But when children are removed from in-person school, and often removed from sports, we also see that they’re less physically active. I think on a population level, we’re going to see children gaining weight.

We know that children, and adults for that matter, have been delaying their routine care. So we saw at one point in the pandemic a spike in type 1 diabetes diagnoses, and everybody said, “Is it the coronavirus or not?” And likely there was a time period of three months or six months when people just weren’t going for their routine appointments, and we were missing opportunities to catch people early in the diagnosis of type 1 diabetes. So I think keeping kids and families active and keeping them on schedule for their routine health care, including vaccinations and dental care, is really important.

Kevin Pho: So you also wrote the book Parenting in a Pandemic: How to Help Your Family Through COVID-19. What was the reason you decided to write the book? For those who can’t see it, you’re showing it on the screen. Fantastic. What are some of the other issues that you talk about in the book?

Kelly Fradin: You know, I have found that a lot of pregnant women are very anxious. Women, or families, are considering whether they should delay their attempts to grow their family because of the risks. And so I try to break down what we know so far about pregnancy and coronavirus, because there’s a lot of nuance there. I think it was particularly challenging.

And then I also talked about the grandparent generation, in terms of how we think about the risk to those individuals and how we can work with them to make the best decisions for their health as well. Because I find a lot of parents want to parent up and sort of be in charge of the grandparent generation’s decisions, when in fact I think we have to kind of respect their autonomy and their choices too.

Kevin Pho: So talk about some specific scenarios. When you talk about parenting up and incorporating our relationship with our grandparents in the context of coronavirus, what are some specific scenarios that you’re seeing that you wrote about in the book, and how can we navigate through them?

Kelly Fradin: I give the example that a lot of children with medical complexity have severe dysphagia, and since mostly doctors are following, I’m sure they understand that’s trouble swallowing, which might lead them to have recurrent pneumonias or end up in the hospital. So as a pediatrician, when I’m dealing with those parents, it’s easy to say, “Just put in the gastrostomy tube, and then you’ll reduce your risk for these complications.” But what I learned in my years of doing that is that you have to understand the families: What’s important to them? What are their values and their preferences? Because so often the families will say that feeding the child brings them joy and connection, and it really matters to them. And sometimes, in specific circumstances, it’s what’s best for the family, even if it poses a direct risk of having pneumonia.

And I think using that example to extrapolate to grandparents: Especially if they are elderly, they may not have many Christmases left, and they may only have a few grandchildren. And if they want to take the risk of exposing themselves to coronavirus, and they understand that risk, and they understand what they can do to mitigate that risk, by masking and distancing, I think that we need to allow them to make those difficult choices for themselves, and respect.

Kevin Pho: We’re talking to Kelly Fradin. She’s a pediatrician. She wrote the book Parenting in a Pandemic: How to Help Your Family Through COVID-19, and she wrote the KevinMD article “Parenting in a pandemic: Making the best decisions for your family.” Kelly, we have a lot of other pediatricians and primary care doctors who listen to this podcast. From your perspective, can you share any tips and advice for these other clinicians when they’re seeing patients in the exam room?

Kelly Fradin: I would say that it’s important to be aware of how much families are struggling and how much they want your advice. When I give general advice on social media, I always have to say, “Your specific doctor knows best.” So I think it’s important, in the brief time you spend with your patients, to let them know if they are at average risk or high risk, and to be specific about what you recommend, because they really do listen and take your recommendations to heart.

I think in the parenting space in particular, there are a lot of influencers out on social media who share advice that isn’t from a medical perspective, but I think particularly this year, families are really looking for that advice. So I’m sure your loved ones, and your employees at your practice, and everybody in your community appreciate it when you share your insights, because people are confused and overwhelmed, often by the news that they’re processing.

Kevin Pho: And my final question, Kelly: What’s your take-home message that you want to leave with the KevinMD audience?

Kelly Fradin: You know, for all these health care providers who may be listening, I’d like to urge you to really take care of yourself. We know the moral distress that so many are facing when they see their hospitals filling up with an illness that we may have been able to prevent. And I just hope that everybody takes care of themselves and asks for help when they need it, to prevent them from burning out.

Kevin Pho: Kelly, thank you so much for your time and insight, and thanks again for being on the show.

Kelly Fradin: Thanks for having me. Have a good day.

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