Author: Charish Barry, MD

Pod Care Program

The mission of Petite Pediatrics has always been to optimize medical care and provide services that parents desire and children deserve. With this in mind, I am excited to introduce the Pod Care Program at Petite Pediatrics. The Pod Care Program encompasses home visits, virtual care, and our Pod Care site, which is a secure outdoor care space with a Basecamp Airstream Trailer and adjacent pergola. As patients of Petite Pediatrics, your Peapod Membership provides direct access to the Pod Care Program.

Petite Pediatrics has long offered conveniences such as telehealth and virtual care through the Peapod Membership Program. These features have been our standard-of-care, distinguishing us from a general pediatric office. By establishing the Pod Care Program at Petite Pediatrics, we are able to further distinguish our care services for children and offer more choices for families who desire secure, safe and convenient delivery of medical care.

With safety as a top priority during the COVID-19 pandemic, launching our home visit service for children with a telehealth and virtual care platform has been an essential way for us to continue to care for our patients. Additionally, our enhanced office safety features, environment controls and outdoor care site provide more security for families and staff during the necessary in-person experiences at the office. I am pleased to be able to extend the Pod Care Program to patients at Petite Pediatrics as we adapt to the changing needs of our community.

The Pod Care Program will have complete physician oversight with direct care provided by Board Certified Pediatric Nurse Practitioners and requires a signed Home Visit Financial Policy/Agreement (provided below). A pediatrician house call visit may be arranged separately (terms and fees are confidential and available upon request). Please contact us for more information about the Pod Care Program or for scheduling future visits.

On behalf of the providers and staff at Petite Pediatrics, thank you for trusting your child’s care with us.

 

Sincerest Regards,

Charish L. Barry, MD, FAAP

Summer 2020 Update

Summer 2020


During these difficult times, I would like to personally update patients and families at Petite
Pediatrics and our greater community about our “Practice Commitment” and the modifications
we are making to ensure the safe delivery of care for children.
– Charish L. Barry, MD, FAAP


Practice Commitment

Petite Pediatrics remains committed to providing personalized care for children in an
environment that is inclusive, safe and nurturing.
Environment of Inclusivity
We treasure the uniqueness of each child and we support and celebrate all aspects of the
diversity of each child and family. As a medical home for children providing wellness and acute
care, fostering an environment of non-discrimination is paramount. As such, at Petite Pediatrics,
we believe patients and parents/guardians have the right to be treated considerately and
respectfully regardless of the patient and/or family’s race, religion, sex, sexual orientation,
gender identity/expression, cultural background, economic status, education or illness.
Environment of Health & Safety
We are dedicated to ensuring that our office meets the highest standards of safety to help
decrease the spread of the novel coronavirus, SARS-CoV-2. Our Pueblo Street location has
expanded on-site services to provide separate locations for well and sick visits by utilizing both
indoor and outdoor space. Additionally, we will continue to care for children via telemedicine
and provide home visits. Updates of our practice modifications are provided below.


Practice Updates

The in-office hours have been modified for the summer months.

SUMMER SCHEDULE:
Hours:
M/F: 9 am – Noon (Dr. Barry)
T/Th: 9 am – 2 pm (Dr. Barry) / 2 pm – 4 pm (Catherine Cordero, PNP – Telehealth)
W: 9 am – 4 pm (Erin Baird, PNP – Home Visits) / 9 am – 4 pm (Dr. Iris Office Location – Acute Visits)

CARE SITES:
Patient care will be provided either indoor, outdoor, virtually or by home visit.
A. Indoor:
The main office is reserved for all well-child visits, vaccines, behavioral or non-infectious
acute care with Covid19 guidelines:
(1) Pre-visit Covid19 symptom screen
(2) On-site temperature check for parent/guardian
(3) One parent/guardian with patient per visit
(4) Use protective facial coverings (face masks) unless under 3 years of age,
developmental or behavioral limitations, or any safety concerns.
(5) Practice social distancing (as able) by use of outdoor space
B. Outdoor:
During the COVID19 health crisis, our parking lot will serve as our Acute Care Site. This
secure and private outdoor space provides a safe perimeter for children and has
adequate social distancing capability for adults and providers. The handicap parking
space and will remain accessible, however, general patient parking will be unavailable.

  • Petite Pediatrics Acute Care Pod: An Airstream Basecamp trailer has been set-up as our Acute Care Unit for
    children.
  • Petite Pediatrics Car Visit: A select parking space has been designated for drive-up testing / car visits.

C. Virtual:
Telehealth to continue via Spruce and arranged as clinically indicated or requested.
(Services are covered by and billed to insurance.)
D. Home:
Currently available on Wednesday to minimize exposure risk for patients with health
issues or concerns that prohibit ability to come to the medical office site.
(Home visit services incur a separate fee that is not covered by insurance.)

PATIENT PORTAL:
Passport is our new patient portal for direct access to your child(ren)’s immunization records,
lab results, patient visit summaries and informational handouts. Passport does not replace
Spruce for secure messaging, but will increase access to your child(ren)’s health profile.
Stay posted for your invitation to Passport!

BILLING SERVICE:
As of June 1, 2020, Petite Pediatrics has partnered with Accuquik, a local medial billing
company for all of our patient insurance billing needs. Sheryl Hopkins is the liaison for Accuquik
and will be able to directly assist with any insurance billing needs. Katie Welch will continue to
assist with billing needs for services rendered prior to June 1, 2020.

STAYING CONNECTED:
• website: www.petitepediatrics.com
• social media links:
– Instagram: @petitepediatricssb
– Facebook: PetitePediatrics
– Twitter: drbarry@petitepeds

SUPPORTING THE IMMUNE SYSTEM AND BODY:
To help boost our immune response, we are offering Springboard pediatric supplements,
vitamins for kids.

  • Shoots & Vines Product Page

    Springboard Supplements & Vitamins (Shoots & Vines) online purchase/onsite pickup members-only.
    Excellent for overall immune support include: D-Hist and D-Hist Jr, Buffered Vitamin C,
    Reacted Zinc, Probiotics (Flora Bites and FloraBoost), Imu-Max, Natranix immune
    support for respiratory health, Kid-D liquid and Vitamin K/Vitamin D and Wholemune,
    an immunity supplement for older kids, teens and adults. These are available on our
    website or directly at the office via curbside pickup.

MEMBERSHIP OPTIONS:
Petite Pediatrics’ goal is to offset the burden on Emergency Departments by offering acute
care and telemedicine services for our patients. Additionally, visiting family or friends this
summer can access care through our Virtual Peapod memberships. Overview of plans:

  • Virtual Peapod Membership: Patients can have regular telemedicine services, which
    are billed to insurance and may include acute care visits, vaccine planning, behavioral,
    growth and developmental visits. Ideal for short-term residence in Santa Barbara area.
  • Virtual Visits: Telemedicine Virtual Visits for patients who may need a single visit or
    brief follow-up concern. If you have family or friends who are in need of assistance with
    their child’s care, please direct them to our website to learn how to join.
  • Annual Peapod Membership: This will continue for existing members as is. However,
    we are aware of the significant impact the COVID19 pandemic has had upon our
    economy. If there is a financial concern directly affecting a family’s ability to continue
    the PMP service, please reach out to our office directly to discuss possible options. Any
    inquiries are completely confidential and will be treated with the upmost respect and
    understanding.

    Charish L. Barry, MD, FAAP Petite Pediatrics

Cloth Face Coverings for Children

Cloth Face Coverings for Children During COVID-19

 

Why are people wearing cloth face coverings right now?

  • Since so many people who have COVID-19 don’t have symptoms, wearing cloth face coverings reduces the chance of transmitting the virus through the spray of spit or respiratory droplets. This is especially true for when someone with COVID-19 comes within 6 feet of you, which is the range of transmitting infection through acts like sneezing or coughing.​​

Should children wear cloth face coverings?

  • Children under the age of 2 years should not wear cloth face coverings.

When do children need to wear cloth face coverings?

  • There are places where children should wear cloth face coverings. This includes places where they may not be able to avoid staying 6 feet away from others. For example, if you have to take them to the doctor, pharmacy, or grocery store.
  • However, there are other places where children do NOT need to wear a cloth face covering:
    1. At home, assuming they have not been exposed to anyone with COVID-19.
    2. Outside, as long as they can stay at least 6 feet away from others and can avoid touching surfaces. For example, it’s fine to take a walk as long as your children stay 6 feet away from others and do not touch tables, water fountains, playground equipment or other things that infected people might have touched.​
  • Caution: you may need to reconsider the use of cloth face coverings if:
    1. The face coverings are a possible choking or strangulation hazards to your child.
    2. Wearing the cloth face covering causes your child to touch their face more frequently than not wearing it.

Staying home and physical distancing is still the best way to protect your family from COVID-19. Especially for younger children who may not understand why they can’t run up toward other people or touch things they shouldn’t, it’s best to keep them home. Children who are sick (fever, cough, congestion, runny nos​e, diarrhea, or vomiting) should not leave home.

What if my child is scared of wearing a face covering?

  • It’s understandable that children may be afraid of cloth face coverings at first. Here are a few ideas to help make them seem less scary:
    1. Look in the mirror with the face coverings on and talk about it.
      Put a cloth face covering on a favorite stuffed animal.
    2. Decorate them so they’re more personalized and fun.
    3. Show your child pictures of other children wearing them.
    4. Draw one on their favorite book character.
    5. Practice wearing the face covering at home to help your child get used to it.
  • For children under 3, it’s best to answer their questions simply in language they understand. If they ask about why people are wearing cloth face coverings, explain that sometimes people wear them when they are sick, and when they are all better, they stop wearing them.
  • For children over 3, try focusing on germs. Explain that germs are special to your own body. Some germs and good and some are bad. The bad ones can make you sick. Since we can’t always tell which are good or bad, the cloth face coverings help make sure you keep those germs away from your own body.

One of the biggest challenges with having children wear cloth face coverings relates to them “feeling different” or stereotyping them as being sick. As more people wear these cloth face coverings, children will get used to them and not feel singled out or strange about wearing them.

What about children with special health care needs?

  • Children who are considered high-risk or severely immuno-compromised are encouraged to wear an N95 mask for protection.
  • Families of children at higher risk are encouraged to use a standard surgical mask if they are sick to prevent the spread of illness to others.
  • Children with severe cognitive or respiratory impairments may have a hard time tolerating a cloth face covering. For these children, special precautions may be needed.
  • What is the “right way” to wear a cloth face covering?
    1. Place the cloth face covering securely over the nose and mouth and stretch it from ear to ear.
    2. Remember to wash your hands before and after you wear it and avoid touching it once it’s on your face.
    3. When back inside, avoid touching the front of the face covering by taking it off from behind.
    4. Cloth face coverings should not be worn when eating or drinking.
  • Wash cloth face coverings after each wearing.
  • What kind of cloth face covering is best?
    1. Homemade or purchased cloth face coverings are fine for most people to wear.
    2. For children, the right fit is important.
    3. Pleated face coverings with elastic are likely to work best for kids.
    4. Adult cloth face coverings are usually 6×12 inches, and even a child-sized 5×10 inch covering may be too large for small children.
    5. Try to find the right size for your child’s face and be sure to adjust it for a secure fit.

Due to very limited supply now, professional grade masks like N-95 masks should be reserved for medical professionals on the front lines who have increased risk of exposure to coronavirus.

More Information:

For a complete list of COVID-19 content for parents, go to the AAP HealthyChildren.org website and link to the HealthyChildren.org 2019 Novel Coronavirus (COVID-19). Most resources are also available in Spanish.

Practice Update COVID-19

Please review the following updates to our practice due to the COVID-19 pandemic.

OFFICE HOURS:

Shared daytime coverage with Dr. Iris Castaneda Van Wyk:

Mon & Wed – Dr. Iris

Tue, Thur & Fri – Dr. Barry

Nighttime: Dr. Barry on-call

Weekends: Dr. Barry & Dr. Iris alternate on-call coverage

TELEMEDICINE:

(All covered by and billed to insurance)

-Virtual Well-Visits:  Pre-visit surveys will be emailed in preparation for a virtual well-visit; vaccine plan of care to be determined with Dr. Barry at that time; will arrange for in-office or home-visit for vaccines, testing for vision/hearing or labs for screening iron, lead levels and urine tests as needed;
-Virtual Care-Visits: Non-emergent care visits set-up with Dr. Barry; May include Spruce-visits, direct  Spruce video visits, image or video transfers and/or text messages;
-Virtual Check-ins: Communication using voice call, text message, transfer of information via image or video; can be used for any concern about a child’s health;
-Virtual  E-Visits: Communication through our online patient portal. (We are launching our new patient portal called Passport. Stay tuned, as it will become available this month.)

SOCIAL MEDIA CONNECTION:

We want to stay connected with you!  Keep up-to-date via our website www.petitepediatrics.com, the hub for all practice updates and a great resource for parents. It’s also has our social media links including our newly launched instagram page. Follow us and share our links with your friends!

-Instagram:  @petitepediatricssb,
-Facebook:    PetitePediatrics,
-Twitter:         drbarry@petitepeds

COMMUNITY SUPPORT:

During this COVID19 crisis Petite Pediatrics will help offset the burden on the Emergency Departments by providing Telemedicine Virtual Visits for patients who aren’t established members of Petite Pediatrics. If you have family or friends who are in need of assistance with their child’s care, please direct them to our website to learn about our Virtual Peapod Membership Program that can provide as needed Telemedicine services.

HOME VISITS:

We are launching a Peapod Visiting NP Program as a separate home visit service that will allow us to provide vaccine visits or simple evaluations that require an in-person assessment. We believe this is  a safe way to deliver necessary care for children and protect families during the COVID19 health care crisis. Pediatric Nurse Practitioners will work directly with Dr. Barry to provide medical care for Petite Pediatric families.

SUPPORTING THE IMMUNE SYSTEM AND BODY:

We are strong supporters of staying healthy and active. Home exercises and finding ways to let kids get their wiggles out is always good for our response to stress both physically and emotionally.  Other ways to support our bodies is through a healthy diet. Supplements can benefit a balanced diet in unique ways as well. We offer supplements for our patients exclusively. The OrthoMolecular Products line called Springboard has products for overall immune health: D-Hist and D-Hist Jr., Buffered VitC, Reacted Zinc, Probiotics (Flora Bites and FloraBoost), Imu-Max, Natranix, Kid-D liquid and Vit K/Vit D and WholeImune immunity supplements for older kids, teens and adults.  Available on our website soon.

Novel Coronavirus Update

2019 Novel Coronavirus (COVID-19)

Human Coronaviruses (https://www.cdc.gov /coronavirus/about/index.html) are a family of viruses that usually cause illnesses like the common cold. Almost everyone gets one of these viruses at some point in their lives. Most of the time the illness only lasts for a short time.

COVID-19: a new coronavirus

It was discovered in December 2019 and has now spread throughout the world. As the virus spreads, we are seeing some people with mild illness, some who get very sick, and some who have died. The reason health officials are concerned is because the virus is new, which makes it hard to predict how it will continue to affect people. Researchers and doctors are learning more about it every day, including exactly how it spreads and who is most at risk.

Symptoms of COVID-19

Symptoms can range from mild to severe and can include:

  • Fever
  • Cough
  • Shortness of breath

Who is at risk?

According to the CDC (https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/high-risk-complications.html), children do not seem to be at higher risk for getting COVID-19. However, some people are, including older adults and people who have serious chronic medical conditions like:

  • Heart disease
  • Diabetes
  • Lung disease
  • Suppressed immune systems

How to protect your family:

There is currently no vaccine to prevent COVID-19, but there are a few things you can do to keep your family healthy:

  • Wash your hands (/English/health-issues/conditions/prevention/Pages/Hand-Washing-A-Powerful-Antidote-to- Illness.aspx) often with soap and water for at least 20 seconds.
  • If soap and water are not available, use hand sanitizer (/English/safety-prevention/at-home/Pages/Keep-Hand-Sanitizer-Out-of-Childrens-Reach.aspx). Look for one that is 60% or higher alcohol-based.
  • Keep your kids away from others who are sick or keep them home if they are ill.
  • Teach kids to cough and sneeze into a tissue (make sure to throw it away after each use!) or to cough and sneeze into their arm or elbow, not their hands.
  • Clean and disinfect (/English/health-issues/conditions/prevention/Pages/Cleaners-Sanitizers-Disinfectants.aspx) your home as usual using regular household cleaning sprays or wipes.
  • Avoid touching your face; teach your children to do the same.
  • Avoid travel to highly infected areas (https://www.cdc.gov/coronavirus/2019-ncov/locations-confirmed- cases.html#map).

A note about facemasks:

The CDC only recommends facemasks for people who have symptoms of COVID-19, not for people who are healthy. Healthcare workers and anyone taking care of someone with COVID-19 should wear facemasks.

Preparing for School and Daycare Closures:

The COVID-19 outbreak in our community and many others has resulted in the temporarily closure of schools and childcare centers in order to help slow the spread of the virus. Many schools use email to update families. Be sure your child’s school knows how to get in touch with you.

Working parents can be prepared by having alternative childcare plans or talking with their employers about work from home options during school closings. If your child attends a college or university, encourage them to communicate with their school’s plan for the COVID-19 outbreak.

While your children are at home try to keep their days as routine and scheduled as possible. Here are a few tips that can help:

  • Read books with your child. It’s not only fun, but reading together strengthens your bond with your child AND helps their development.
  • Make time for active play. Bring out the blocks, balls, jump ropes and buckets and let the creativity go. Play games that kids of all ages can play, like tag or duck duck goose. Let your kids make up new games. Encourage older kids to make up a workout or dance to keep them moving.
  • Keep an eye on media time. Whenever possible, play video games or go online with your child to keep that time structured and limited. If kids are missing their school friends or other family, try video chats to stay in touch.

Talking to children about COVID-19

There’s a lot of news coverage about the outbreak of COVID-19 and it can be overwhelming for parents and frightening to kids. The American Academy of Pediatrics encourages parents and others who work closely with children to filter information and talk about it in a way that their child can understand. These tips can help:

Simple reassurance. Remind children that researchers and doctors are learning as much as they can, as quickly as they can, about the virus and are taking steps to keep everyone safe.

Give them control. It’s also a great time to remind your children of what they can do to help – washing their hands often, coughing into a tissue or their sleeves, and getting enough sleep.

Watch for signs of anxiety. Children may not have the words to express their worry, but you may see signs of it. They may get cranky, be more clingy, have trouble sleeping, or seem distracted. Keep the reassurance going and try to stick to your normal routines.

Monitor their media. Keep young children away from frightening images they may see on TV, social media, computers, etc. For older children, talk together about what they are hearing on the news and correct any misinformation or rumors you may hear.

Be a good role model. COVID-19 doesn’t discriminate and neither should we. While COVID-19 started in Wuhan, China, it doesn’t mean that having Asian ancestry – or any other ancestry – makes someone more susceptible to the virus or more contagious. Stigma and discrimination hurt everyone by creating fear or anger towards others. When you show empathy and support to those who are ill, your children will too.

Stay informed

Families are encouraged to stay up to date about this situation as we learn more about how to prevent this virus from spreading in homes and in communities. Your local and state public health department will have up-to-date information regarding your community and the most current health and safety recommendations.

Spruce Telehealth: A Standard of Care

Petite Pediatrics has offered this technology as a standard of care for our patients since 2018.

The current COVID-19 global pandemic, requires families to remain home to minimize exposure to the novel corona virus.  We want to assure our families that this is the latest technology in the delivery of medical care and we are committed to ensuring confidentiality while maintaining the safety and well-being of our patients.

Spruce provides the following services:

● Direct text messaging with Petite Pediatrics
Virtual visits for pediatric rashes, allergies, cold/cough and flu symptoms, and newly added COVID-19 risk questionnaire to assist with care during the MERS Cov-2 global pandemic
● Secure Video Visit for complaints that need a live interaction
● Prescription refills and requests

How do I get started?

1. Navigate to Spruce.care/petitepediatrics on your iOS or Android phone.
2. Click on “Get the App & Connect” to download Spruce.
3. That’s it! You should be welcomed by Petite Pediatrics in the app.

Spruce won’t replace all in-office visits.  This service has been offered to enhance our member’s patient-care experience so that we can extend care on occasions when coming to the office is not available, can be efficiently handled remotely, or as a way to better decide that in-person care is needed. We will continue to work with families to deliver excellent pediatric care and will update families via Spruce regarding the latest developments related to COVID-19 and how we can continue to provide pediatric care to our community.

Flu Update for 2018

 A Message for Caregivers & Teachers

Get Vaccinated for Seasonal Flu Now!
Flu activity is quite elevated in the US. Getting vaccinated is still the single best way to protect against influenza and reduce the risk of becoming sick from it. Annual influenza vaccination is recommended for everyone 6 months of age and older, including all child care staff. It is recommended that everyone get vaccinated NOW if you have not already had the vaccine this season. Because young children pass on infections to others in the community, vaccination of every person in a child care setting is an incredibly valuable step in protecting the public’s health.

Prevent the Spread of Germs
With flu activity increasing during the winter months, as it does every year, the challenge is to keep these flu germs from spreading. Staff members and children should be taught to cover their mouths and noses with a tissue when they cough or sneeze (and then put the tissue in the trash right away) or cough/sneeze into their elbow or upper arm.
Everyone should be encouraged to wash their hands with soap and water or use an alcohol-based hand sanitizer. Consider displaying educational materials in Head Start or early education and child care programs to encourage proper hand hygiene and cough/sneeze etiquette. “The Flu: A Guide for Parents”, “Everyday Preventive Actions that can Help Fight Germs, Like Flu”, and “Teaching Children About the Flu” are examples of free materials available on the CDC Print Materials Web page.

If You Get the Flu, Antiviral Drugs May Be an Option
Antiviral drugs are prescription medicines that are used to treat the flu. They can shorten a person’s flu illness, make it milder, and can prevent serious complications. Antivirals can be given anytime during the illness, but they work best when started during the first 2 days. Antiviral drugs are recommended to treat flu, especially those who are at high risk of serious flu complications, are very sick, or are hospitalized. Antivirals can be given to children and pregnant women.
Ready Wrigley and Preparedness for Flu Season

The American Academy of Pediatrics (AAP) worked with the Centers for Disease Control and Prevention (CDC) to develop a Ready Wrigley Activity Booklet on influenza. This book includes tips, activities, and stories to help families prepare for influenza. The book is designed for children 2 to 8 years of age. The Ready Wrigley Activity Book series is produced by the CDC Children’s Preparedness Unit and CDC communication specialists. Child care professionals can print copies of the book for their center or share a link to the book with families.
Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide (4th Edition)
This AAP manual provides child care directors, teachers, and caregivers with important information about the prevention and management of influenza and other infectious diseases that circulate in group care settings. The guide contains helpful reference guides, including quick reference sheets on specific conditions or diseases. Detailed chapters address infection control measures, immunizations, and inclusion/exclusion criteria. Information within this manual can be used to implement new strategies within the center.

Archived Webinar
In January 2018, the AAP collaborated with CDC to conduct a webinar titled, “Preparing Head Start/Child Care and Communities for Seasonal and Pandemic Influenza.” By watching this archived webinar, the viewer can learn about the recommendations for this flu season and find out why everyone who works in Head Start and child care programs should get the vaccine each year. The webinar also shares strategies to prevent and control the spread of influenza in child care settings and explores ways to prepare for an unlikely but dangerous flu pandemic. The webinar is available online.

Coping with Disasters

How Families Can Cope with Relocation Stress After a Disaster

​Unplanned evacuations during a disaster can cause great stress on a community and on the individuals in that community.

First Steps of Recovery
Recovering from a disaster occurs in phases over days, weeks, and months. Soon after being uprooted by a disaster, families can start the recovery process. Right now, there are three general steps to take to improve the mental and emotional strength of the family.

The following steps will help everyone to begin to retake control over life:

Step 1: Rebuild physical strength and health. Once everyone is in a safe and secure place, whether a shelter, a new apartment, or a place with relatives or friends, make sure to tend to their immediate medical needs, if any. Be sure everyone has enough to eat and drink to regain their physical strength. Make sure everyone gets some restful sleep in as private a space as possible. Rebuilding physical strength is a good first step to calm shattered emotions.

Step 2: Restore daily activities. Restoring daily routines helps build a sense of being home mentally and emotionally, even in the absence of a physical home. Simple routines normally done together, such as family walks, watching television, and bedtime stories, help pull the pieces of daily life back together even in a new place. Restoring daily activities rebuilds the normal sense of morning, afternoon, evening, and night. Even though you are away from home and in a strange place, try to resume the daily routines as much as possible.

Step 3: Provide comfort. Family members are better able to deal with the stress of relocation when they are comfortable and informed. Comfort can be increased by

Providing family with information about other family members, friends, and news of home.

Expressing affection for family members, in the ways the family normally shows affection.

Discussing, when ready, the emotions associated with the disaster and relocation feelings of loss, missing home, and worry about family members, friends, and pets.

Rebuilding Family Life
After the initial emergency has passed and the shock and confusion from disaster relocation have subsided, the physical rebuilding and long-term emotional recovery phase begins.

This longer recovery phase has two steps:
Assess all physical and emotional losses your family has experienced. This inventory can help identify practical actions to take in rebuilding the physical losses the family has experienced.

Develop an emotional understanding of the disaster experience and relocation situation to help rebuild family life. Working through emotions takes time. There is no set timeframe or stages for it.

Resolving emotions is a natural healing process that relies on talking to friends about feelings, mental sorting of emotions, and receiving practical and emotional help from family, friends, your place of worship, or other organized support groups in the community.

About Disaster-Related Stress in Children
Disaster-related stress affects young people in several ways:

Damage, injuries, and deaths that result from an unexpected or uncontrollable event are difficult for most children to understand.

Following a disaster, a child’s view of the world as safe and predictable is temporarily lost. This is true of adults as well.

Children express their feelings and reactions in various ways, especially in different age groups.

Many are confused about what has happened and about their feelings. Not every child has immediate reactions; some can have delayed reactions that show up days, weeks, or even months later, and some may never have a reaction. Children’s reactions are strongly affected by the emotional reactions of their parents and the adults around them. In addition, children can easily become afraid that a similar event will happen again and that they or their family will be injured or killed.

How Children Show Disaster-Related Stress
It is normal for young people to show signs of stress after a disaster. Young people show signs of stress differently at different ages or school levels.

  • Signs of stress in preschoolers:

Waking confused and frightened from bad dreams

Being reluctant to going to bed or refusing to sleep alone

Acting and showing behaviors younger than their actual age, such as whining, thumb sucking, bedwetting, baby talk or fear of darkness

Clinging to adults more than normal

Complaining often about illnesses such as stomachaches

Not having fun doing things they normally enjoyed

Being irritable

  • Signs of stress in elementary or middle school age:

    Ongoing concern over their own safety and the safety of others in their school or family

Irrational fears

Becoming extremely upset for little or no reason

Having nightmares and sleep problems

Experiencing problems in school, such as skipping school or misbehavior (e.g., loss of interest, withdrawal, and excessive need for attention)

Complaining of headaches or stomachaches without cause

Not having fun doing things they normally enjoyed

Disruptive behaviors-outbursts of anger and fighting

Being numb to their emotions

Experiencing guilt or shame about what they did or did not do during the disaster

  • Signs of stress in high school age:

Feeling self-conscious about their feelings concerning the disaster

Feeling fearful, helpless, and concerned about being labeled “abnormal” or different from their friends or classmates (this may lead to social withdrawal)

Experiencing shame or guilt about the disaster

Expressing fantasies about retribution concerning people connected to disaster events

Not having fun doing things they normally enjoyed

Difficulty concentrating

Impulsive behaviors

Emotional numbing

Seeing the world as an unsafe place

When Children May Need Additional Help
Situations may develop when children need additional help dealing with emotional after-effects of the disaster. They may benefit from help from a healthcare professional if the emotional stress associated with the disaster does not get better in a few weeks or when they:

Display continual and aggressive emotional outbursts

Show serious problems at school (e.g., fighting, skipping school, arguments with teachers, or food fights)

Withdraw completely from family and friends

Cannot cope with routine problems or daily activities

Engage in vandalism or juvenile law-breaking activities

Express suicidal ideas

Reaching out for help is not a sign of weakness. People have limits and sometimes need help when stretched beyond their limits. Seeking help from others can offer solutions that may not be known to you.

Additional Information & Resources:
Responding to Children’s Emotional Needs During Times of Crisis

Talking to Children about Disasters

How Children of Different Ages Respond to Disasters

Taking Care of Yourself during Disasters: Info for Parents

Helping Children Adjust to a Move

National Mental Health Association

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Last Updated 9/27/2017

Thomas Fire: Stay UP-TO-DATE

Thomas Fire Resources

  • Families can stay updated on the local conditions by checking the Count of Santa Barbara Website. There is also helpful information regarding the use of masks for safe breathing. N95 masks provide protection from small particles in smoke and should be fitted for proper usage.  

http://countyofsb.org/thomasfire.sbc#update

If they cant reach you, they can’t alert you….Register for Santa Barbara County alerts!

http://awareandprepare.org/

Thomas Fire (wildfires) and the Health Risk to Children

The Thomas Fire has been devastating and poses a major health concern for the young and old, alike.  Here are some guidelines that can be helpful during the acute phase of this fire:

The Pediatric Environmental Health Specialty Units (PEHSU) Network encourage families, pediatricians, and communities to work together to ensure that children are protected from exposure to environmental hazards. Wildfires expose children to a number of environmental hazards, e.g., fire, smoke, psychological stress, and the byproducts of combustion of wood, plastics, and other chemicals released from burning structures and furnishings. During the acute phase of wildfire activity, the major hazards to children are fire and smoke. Acute stress from fire activity and response to the fires and the emotional responses of those around them can also impact children during this time.

Children, individuals with pre-existing lung or cardiovascular problems, pregnant women, elderly, and smokers are especially vulnerable to environmental hazards such as smoke. Children are in a critical period of development when toxic exposures can have profound negative effects, and their exploratory behavior often places them in direct contact with materials that adults would avoid.

The acute phase environmental hazards for children and their family are highlighted below.

SMOKE consists of very small organic particles, liquid droplets, and gases such as CO, CO2, and other volatile organic compounds, such as formaldehyde and acrolein. The actual content of smoke depends upon the fuel source.

HEALTH EFFECTS OF SMOKE: Symptoms from smoke inhalation can include chest tightness, shortness of breath, wheezing, coughing, respiratory tract and eye burning, chest pain, dizziness or lightheadedness, and other symptoms. Asthma symptoms may flare up. The risk of developing cancer from short-term exposures to smoke is vanishingly small.

RECOMMENDATIONS

Stay indoors with windows and doors closed and any gaps in the building envelope sealed. Avoid strenuous activity.
If available and if needed for comfort, run an air-conditioner on the “recirculate” setting. Be sure to change the filter at appropriate intervals. Other types of room or central air filtration systems may help remove airborne particles, but they need to be selected to adequately filter the area in which they serve. Some electronic air cleaners and ozone generating “filters” can generate dangerous amounts of ozone indoors (see the Wildfire Smoke – A Guide for Public Health Officials resource). These ozone filtration systems do not remove harmful contaminants from the air and are not recommended.

Never operate gasoline powered generators indoors – they produce dangerous carbon monoxide. Avoid smoking, using wood stoves, and other activities that add to indoor air contamination.
If there is a period of improved air quality, open up (air out) the house and clean to remove dust particles that have accumulated inside.

Humidifiers or breathing through a wet washcloth may be useful in dry climates to keep mucous membranes moist, although this does nothing to prevent inhalation of contaminants.

When riding in a car, keep the windows and vents closed. If comfort requires air circulation, turn the air-conditioning on “re-circulate” to reduce the amount of outside air drawn into the car.

Children with asthma, heart disease, and others considered at high risk from health effects from contaminant inhalation should be moved to an adequate “clean air” shelter, which may be in their home, in the home of a friend or relative, or in a publicly-provided “clean air” shelter.

Use of Masks

Paint, dust, and surgical masks are not effective obstacles to inhalation of the fine airborne particles generated by wildfires. For information on use of respiratory protection for adults see “Wildfire Smoke – A Guide for Public Health Officials.”  [See local Neighborhood Clinics for distribution of masks]

Although smaller sized masks may appear to fit a child’s face, none of the manufacturers of masks recommend their use in children. If a child is in air quality severe enough to warrant wearing a mask, they should be removed to an indoor environment with cleaner air.

Air Quality Index

The Air Quality Index indicates how dangerous the air is to breathe based upon the measurement of various pollutants such as ozone and small particles (PM2.5). The smoke from wildfires contains large amounts of these hazardous particles. In areas where the Air Quality Index is not determined, measuring PM2.5 is a good substitute for determining the air quality. 
Recommended actions for each level of air quality can be found in the Wildfire Smoke – A Guide for Public Health Officials and Air Quality Index – A Guide to Air Quality and Your Health resources cited below. The current air quality index can be found at http://www.airnow.gov.

CLOSING OF SCHOOLS AND BUSINESSES may become necessary because of smoke exposure risk when air quality is so poor that even traveling between indoor locations places people at risk. However, in some situations the school may be a relatively protected indoor environment with better air quality and where children’s activity can be monitored.

CONSIDERATION OF EVACUATION because of smoke should weigh the effects of smoke exposure during the evacuation versus what the exposure would be while resting quietly inside one’s home. A disorderly evacuation can unnecessarily increase the duration and extent of smoke exposure. Remember to pack at least 5 days of any medications taken by family members.
ASH: Recent fires may have deposited large amounts of ash on indoor and outdoor surfaces in areas near the fire. This ash may be irritating to the skin and may be irritating to the nose and throat and may cause coughing. The following steps are recommended:
Do not allow children or animals to play in ash.
Wear gloves, long sleeved shirts, and long pants when handling
ash, and avoid skin contact.
Wash any home-grown fruits or vegetables before eating.
Avoid spreading the ash in the air; wet down the ash before
attempting removal; do not use leaf blowers or shop vacuums.

PSYCHOLOGICAL EFFECTS ON CHILDREN: During the acute phase, parents and caregivers should also be alert to children’s emotional health and psychological wellbeing. It is important to keep in mind the youngest members of our society may easily become saturated with graphic pictorial images and incessant talk of smoke, flames and destruction. Resulting stress and anxiety may be manifested in a variety of ways, depending upon the developmental stage of an individual child:
Clinging, fears
Uncooperative behaviors, irritability
Nightmares
Physical complaints
Changes in eating or sleeping patterns
Regression
Indifference
Parents and caregivers can support children in a number of ways:
Maintain previously established routines and structures as much as possible.
Provide an open door and a listening ear for children; encourage the expression of feelings through a variety of pathways, e.g.,music, art, journaling, talking.
Answer questions openly and honestly, remaining mindful of the age of the child will determine how information is shared.
Reassure and hug when hugs are wanted; practice patience and adopt a peaceful demeanor, as children take their cues from the clues given by their parents and the environment.
To contact your local Pediatric Environmental Health Specialty Unit with any questions about this fact sheet please visit http://www.pehsu.net.

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