From birth to adulthood. The role of the paediatrician in child development. Episode 7

Monika Rachtan
I invite you to listen to the podcast. First of all, the patient. I welcome you very warmly. I welcome you very warmly to the podcast. Patient First, in which we address issues that are important to patients. We ask questions that you would probably like to ask your doctor, but for some reason you don't have the opportunity to do so. Today I am going to talk to a paediatrician. My guest is Dr Dagmara Pokorna Kalwak. Welcome.

Dagmara Pokorna Kalwak
Good morning, ladies and gentlemen. Good morning, Madam Editor.

Monika Rachtan
Your doctor is a specialist in paediatrics and a GP, but she is primarily involved in paediatrics, the area she enjoys the most. Yes, of course. And she deals with children, so we are going to talk about children's health today. Doctor, let me start by reminding you that this is a patient-directed podcast, so I'm going to ask for that kind of language so that our audience can understand everything. I will also ask questions if something is not clear to me, but please remember that I am acting here in the interests of patients and we want everything to be clarified, all doubts. Another very important point, which I also warned you about, and you know this very well, is that I am collecting questions from the social media group and I am asking them to our experts. So I am already appealing to you that if you would like to ask our experts something, you can write these questions in the comments, while also such a session of questions just from the groups will appear, so there are no stupid questions. There are only questions that patients want answers to. So let me give you these questions.

Monika Rachtan
Right.

Dagmara Pokorna Kalwak
I hope to rise to these challenges.

Monika Rachtan
So, rest assured, ladies and gentlemen, I would also like to remind you that you can listen to the podcast, of course, but now also to the programme, in various places, and I invite you to subscribe there. The video material will also be available on our YouTube channel, where you are also very welcome. I also invite you to follow us on social media. We are on Instagram, on Facebook, on LinkedIn, on Twitter, everywhere. And we invite you to react , to contact us. If we can address your concerns in any way, Madam, we warmly invite you to do so. Doctor, today I am talking about children. I thought we were going to talk about children from infants to preschoolers to the elderly. Can we have this conversation today.

Dagmara Pokorna Kalwak
And we end up with a teenager?

Monika Rachtan
Oh yes! Oh yes, that's exactly right, doctor. So about the health of these little ones. I think to myself that when a woman is pregnant, well, she is concerned about her health, but above all she is also concerned about the health of the child who is about to be born. It's a nice moment, so I smile, and here she is every moment facing a very important choice. That is, she has to decide which paediatrician she will enrol the child with. And this time, when this baby is born, is already so a bit nerve-wracking. There's a lot going on, so maybe it would be a good idea to meet the doctor beforehand, that is to come to such an appointment, show up, say that we're going to, but get to know this paediatrician first of all in order to decide whether this is my paediatrician. And now I would ask, is this possible?

Dagmara Pokorna Kalwak
I think so, and it would be wonderful how we would be able to do a lot more before this baby comes into the world. And it would also build a cool relationship like that between this mum-to-be, who will be standing on the new path of her life. Because it's going to be a completely different life than it was when you didn't have a child. That goes for the father too. So as a mother, not just a mother yes? So it's the building of these relationships that is very important. In reality, however, it is probably most often the case that parents decide to choose a doctor for their child at the mother's clinic, because this is the clinic they attend themselves, and if they attend it, then hopefully they are satisfied with the medical services that this clinic offers them. And maybe somewhere in the corridor they have already met the paediatrician, and it also seems to me that the situation will be completely different with the next pregnancy, where the couple will already have experience of what it was like before, right? However, it can be said that in the current situation, this antenatal care is provided by the community midwife.

Monika Rachtan
Very important.

Dagmara Pokorna Kalwak
A very important person who has what is known as antenatal education and meets with these mothers-to-be, with pregnant women during certain weeks of pregnancy, this also happens, only here it is qualified by the National Health Fund as community midwifery care.

Monika Rachtan
This is something else I'll ask on behalf of patients, because I honestly didn't know that I could sign up to see a midwife during my pregnancy to talk to her. Of course, the birthing school is one thing, and this National Health Service visit is another matter I understand

Dagmara Pokorna Kalwak
It is not even the lady who signs up or when she chooses a particular facility as. The woman chooses the doctor, the midwife, the nurse. There is such a rubric exactly. However, you can also choose a midwife in another district. It is not the case that all comprehensive medical care has to be provided in one centre. Here, too, the woman has the right to choose. And then, once she has chosen a facility which has a contract with the National Health Fund, the midwife, once she has been informed that she is pregnant, will make an individual appointment with her for antenatal education.

Monika Rachtan
This is very important and we recommend using it in this case, because we have a lot of valuable information.

Dagmara Pokorna Kalwak
Of course, as much as possible. And indeed I, looking at my own so-called backyard, observe that very many young mothers-to-be are taking advantage of this.

Monika Rachtan
And I'm going to ask now about the relationship of the patient doctor, and in fact I think now the parent doctor, Well, because we're talking about children and it's very important that this relationship is based on trust. Yes, it's very much about that.

Dagmara Pokorna Kalwak
He says, of course, and by agreement. And then it can be said that through this we also achieve a better therapeutic effect, because the doctor, having also the appropriate trust in the parent, here I will say from the point of view of my work, it is also this therapeutic effect, one can say better achieved. It is known that the parent trusts the doctor, so he or she disciplines him or herself regarding diagnostic and therapeutic recommendations related to the child's health. However, if these relations are somehow disturbed, whether on the one hand or on the other, then, unfortunately, this affects both the health of the young patient and the proper relations.

Monika Rachtan
Is there a recipe for how to build this relationship? Something we could advise these young parents to listen to this doctor?

Dagmara Pokorna Kalwak
Well, I think that is the first thing. However, I have also observed, in my very long practice as a paediatrician, that when a more convinced mother comes to see a doctor, not necessarily on the basis of a well-known doctor, but at least using the website of a given clinic or some other information, or even on the basis of the so-called 'grapevine', this is probably the best advertising. Yes, if a friend or colleague or someone in the family recommends a particular doctor, then it can be said that this relationship is in fact much easier to build, much simpler, than if someone comes, as they say, from the proverbial street, because they came here, because, let's say, they live fairly close by, and this is the most convenient form of using medical services.

Monika Rachtan
And what are the most common problems young parents report to their paediatrician?

Dagmara Pokorna Kalwak
Young parents It is like this. We have to divide it into two such main problems, that is to say, here it will concern the problems of sick children, and here I have a whole bag of different paediatric ailments and morbidities in general, while, well, we make a distinction, here healthy children, healthy children, it is mainly these most frequent queries that will simply concern the parents' behaviour during a given period of the child's life. Other questions will be about the newborn infant period, others about older children or teenagers. But it is fair to say that the most common among these populations of children are the healthy ones. The youngest questions concern the management of the first days of life related, for example, to the care of the navel or to the vaccine that was given on the first day of life, because such a vaccination is given. This is the vaccination against tuberculosis. It has a characteristic evolution of its own and it's parents are very important. It is very important that they know not to panic, that this can happen after this vaccination. Such questions are often asked, and also about nursing issues and, above all, about what preventive tests are carried out on healthy children in the first few weeks of life.

Monika Rachtan
Because these preventive tests I'll ask in a moment, but now I'd like to ask, because especially I think with the first child, there's exactly a whole range of things that are worrying, because how do we know if something is normal and something is abnormal? Like a theory is everything we read in these guides, even created by doctors. That's what a theory is. And then when you are left with that.

Dagmara Pokorna Kalwak
A child, and life is life,

Monika Rachtan
What should you be concerned about? When we leave the hospital, everything is fine. The doctor assures us that nothing wrong should be happening. What should concern us and make us call, visit the paediatrician, or rather.

Dagmara Pokorna Kalwak
Generally speaking, during these first days in the home environment, the newborn baby is provided with care again. Comprehensive care in the form of a community midwife who checks not only the wellbeing of the baby and the wellbeing of the mother, but also, and above all, the conditions in which the baby is brought up. She answers the most common questions that arise. If, on the other hand, there is anything that she feels is wrong, then any such midwife has direct contact with the doctor. We find out about this very quickly and then there should be a medical visit as soon as possible, which will either solve the problem or simply result in us having to carry out a diagnosis, let us say here, of the child in question. What might worry us? It is a whole range of symptoms, but in general we can say that it is a change in the nature of the child's functioning that suddenly appears, i.e. a lack of appetite, some kind of sleep-related disorder, restlessness, increased body temperature, urinary or faecal disturbances, a change in the colour of the skin. So indeed these symptoms can be very numerous. Sometimes we talk about a so-called developmental leap and this can be completely physiological. But if some worrying symptoms appear among such youngest children.

Dagmara Pokorna Kalwak
It seems to me that in any case it is worth consulting a doctor.

Monika Rachtan
I think the midwife is a bit like our guide in those early days, that kind of thing.

Dagmara Pokorna Kalwak
Liaison with.

Monika Rachtan
Doctor. A very important person. It's very, very important, I think, to talk to her in that way too, and the advice she gives us, not to take it absolutely as criticism, but of course advice that is meant to help.

Dagmara Pokorna Kalwak
Yes, yes. And in addition to that, the infant attention with which he visits these patients is also equipped. It can also have bilirubin, which is the kind of instrument that measures bilirubin concentration. We can tell the severity of infantile jaundice in general. Whether she is still within physiological norms or whether it is necessary to react medically. So. And, above all, apart from these various additional equipment, she is very experienced, very skilled and, most often, she has also worked through these topics herself, because they are often already mothers who have, let's say, their children reared, so it is indeed worth using such services. But following on from what the editor asked me at the very beginning about this very educational contact, our midwives themselves talk about the fact that the more mums have another child, the fewer visits they make over a period of time, because they already have their own experiences and they probably just feel more at ease.

Monika Rachtan
I'm going to ask you one more thing about this jaundice, because I think our viewers might have doubts. So could it happen, Doctor, that the doctor discharges us home and this jaundice is not there, or at such a level that this discharge is possible, and then suddenly it can.

Dagmara Pokorna Kalwak
It can happen. Yes, all the more so as there may be other factors at work that cause this level of bilirubin not to be completely flushed out of the body of such a young child. Natural feeding, for example, is such a factor. Yes, of course, we highly recommend it. However, in the case of natural feeding, bilirubin levels can remain higher for longer than in the case of artificial feeding. Therefore, sometimes one of the various methods of treating elevated bilirubin levels in newborns is to stop feeding natural food for 24 to 48 hours, and this is one element of the treatment, and this can happen. Of course it is not.

Monika Rachtan
Of course.

Dagmara Pokorna Kalwak
A common situation. Yes, as much as possible it is the mums who want to breastfeed who always come back. It is not a problem for them at all and there lactation remains as high as possible all the time.

Monika Rachtan
For many mothers, when they are so set on this feeding.

Dagmara Pokorna Kalwak
And here, all of a sudden, the medical recommendation is to abort for 24 hours. Yes, but these are not frequent situations, but as a rule, if a newborn baby is discharged with what is known as borderline bilirubin, in other words, let us say jaundice, which is to be observed, then he or she is advised to have a quicker check-up at the paediatrician's surgery and possibly to have more rapid diagnostic tests carried out. This visit, as we often call it, the antenatal visit, which more or less takes place during the baby's third week of life, takes place much, much sooner.

Monika Rachtan
I will now ask about more difficult situations, although I would like this episode to have a very positive tone. I hope it will be that way. But there are also parents who find themselves in this more difficult situation. For example, during a hospital stay. And please tell me, when a child receives a diagnosis just after birth, is it worth sticking to the specialists they point out to us in this hospital, and for this log we will be referred to, let's say, a neurologist, a cardiologist? Is it nevertheless also worth referring ourselves in this difficult situation to this paediatrician, to talk to him about the situation? Can he be a helping hand?

Dagmara Pokorna Kalwak
I think we need to act, dear readers, at all levels, that is to say, the paediatrician as a guide and, as we said a moment ago, as a first line of communication, but, of course, specialist consultations in the case of all kinds of illnesses, especially illnesses with which the child is born, that is to say, all kinds of genetically conditioned disorders or chronic illnesses. They do, however, require that such a child has a paediatrician on a daily basis, perhaps not on a daily basis, but that it also has specialist consultations and examinations, which, for example, are not included in the basket of the POZ. Because, as we know, we as primary care physicians have specific diagnostic possibilities. On the other hand, if we are talking about broader diagnostics or specialist diagnostics, then we have to make such a referral to a specialist. Because a successful specialist doctor already has a wider range of diagnostic possibilities.

Monika Rachtan
I didn't plan to ask the doctor about this, but I think it is important information for parents. That also when there are such health problems in a young child, these parents may also have some special rights when it comes to, for example, access to specialist doctors. I am referring here to the pro-life law.

Dagmara Pokorna Kalwak
Yes, of course, by all means. Whether it is a specialist doctor or we, that is, primary care doctors, on the basis of the child's medical records, we can issue such a card, and this is what happens in practice.

Monika Rachtan
Thank you very much for this information. I think it is very important information for patients. Now back to healthy children. The doctor has already mentioned that prevention is also necessary in this first year of life. Even if there is nothing wrong, certain tests simply have to be done. You cannot argue with that and you have to go for them. What are these tests?

Dagmara Pokorna Kalwak
To be precise, just after birth, a so-called zero balance is performed. This is a so-called 'neonatal check-up', which, in general terms, determines the health of the baby. This takes into account the course of the pregnancy, the course of the birth and the adaptation period, which usually takes place after the neonatal unit, and then individual recommendations are made for the baby. However, we also have so-called permanent recommendations, i.e. for all babies who are born either prematurely or on time. All babies are recommended a hip ultrasound. Here we can accelerate this preventive examination. The acceleration applies to babies who are born in multiple pregnancies or premature babies, or babies who were not born physiologically, such as a breech birth. This is the group of these very little ones who will require a more rapid diagnostic procedure in terms of just hip staging. Such a referral is either issued in the neonatal unit or it is issued by the doctor at the first visit, and there is also the possibility of simply bypassing the so-called queues to issue a referral in risk groups as a cit referral, and then this registration of such a child takes place outside of the usual appointments.

Monika Rachtan
I will also ask you about this saying that I have heard, for example, from your registrars, that everyone is on a tight deadline and how to manage then more easily, because these are defined situations, yes, when.

Dagmara Pokorna Kalwak
Of course, here doctors should take into account that, as I have now mentioned, there are certain situations. And I also sometimes encounter that parents ask the doctor, but there you would have to mark just the referral as urgent. So I list these disease entities and ask the parent which disease entity we are going to group you, the child, under. And at that point, if the answer is none, I say. So we have no reason to issue the referral as an urgent referral. So here.

Monika Rachtan
A situation where you don't have to do.

Dagmara Pokorna Kalwak
So it seems to me that this is a very good situation and it needs to be explained to parents. On the other hand, these are preventive examinations, which means they affect, as I said, the entire infant population. Such other tests that are performed include hearing tests. These tests are performed in. Neonatal wards. But we also have to remember that if the mother indicates to us that she had risk factors during pregnancy that could cause hearing loss, and even the first test in the neonatal unit comes out ok, we still have to refer such a child for prophylaxis at three months and 12 months of age. So these are further tests that the child should have. Other examinations, typically preventive ones. In fact, you could say that these are health checks, those health checks that are carried out along with immunisation. And the problem is that if, for example, parents refuse to have their children vaccinated because, for example, they do not want to have their children vaccinated for various reasons and out of different convictions, then we have to carry out these preventive examinations. And even though we do not vaccinate, we invite parents to attend these balance checks at the clinic.

Monika Rachtan
Your doctor told you about these hearing tests and so I thought it was worth linking here, because our project partner is the Institute for Patients' Rights and Health Education, which is working with the Great Orchestra of Christmas Charity. It's a beautiful initiative, we all create it. And it is precisely in such a place, when we have these preventive examinations, that our kindness can be seen. Because first and foremost. Because the Great Orchestra of Christmas Charity has funded these screenings.

Dagmara Pokorna Kalwak
Exactly right, exactly like my son, who will celebrate his 18th birthday this year. I keep telling him in January to get together as a volunteer and work, because when he was lying in the incubator after his birth, he had lots of hearts taped up and that was it. See 18 years of how the orchestra works plays what I associate with the so-called own skin. And we have had the effects for a very, very long time, because I think the 31st was this year's final.

Monika Rachtan
Yes, we are an orchestra, evenly aged, so which final is it? And yes, it was the thirty 31st final this year. Also, congratulations to the people who, yes, who make it happen and thank you very much on behalf of the patients and you too.

Dagmara Pokorna Kalwak
And I say that I have come of age eighteen years ago with an orchestra on my own and on my so-called own children.

Monika Rachtan
Doctor, I'm going to go back to these patient questions, and this is going to be a bit of a statement from a colleague of mine, but I took the liberty because we're talking about children and she told me something like this You know, with my first child I was running around all these physiotherapists, speech therapists and other people that they weren't sending to. One, two, three. The doctor kept saying I had to go somewhere with this child. By the second one it's easy, and by the third one you don't go and he says You know, they're pushing us a bit in this first year of life, because we all want to take care of this child. Because what do you begrudge such a little baby? You don't go to the physiotherapist. And maybe I'm saying now, but that's what it really looks like. And does your doctor also find that we overdo it a bit as parents?

Dagmara Pokorna Kalwak
It seems to me that yes, there is such a fashion now. Well, it has become such a fashion that it would be good for the child to be assessed not only by the doctor who is in charge, but also by other specialists. This fashion is connected with the fact that, to use a colloquialism, we are throwing the baby out with the bathwater. Why? Perhaps I can give this by way of example. It concerns frequent procedures which are really very difficult in terms of pain, and then the so-called rehabilitation concerning the frenulum undercutting of the tongue, usually the lower one, and sometimes also the upper and lower one. And believe me, dear readers, I have not yet met an opinion of a neurologist who would advise against such a procedure. So it seems to me that reason plays a very important role here. The same applies to various types of rehabilitation and improvement exercises. Of course, there are many children who require it. God forbid, I am not denying this. Let's just do it with our heads, because we can really have a great impact on the psycho-motor development of these youngest children by, for example, enrolling them in a swimming pool, in various kinds of exercises, or even mothers who are at home with these children, who do not participate in nursery classes, have a club where these children can meet and create various kinds of reactions among themselves, so these are very useful things.

Dagmara Pokorna Kalwak
And such rehabilitation, typical rehabilitation, or just the various types of typical such medical treatments I mentioned, are not indifferent. Believe me, for the body.

Monika Rachtan
The child is also a major stressor and for the parents, a.

Dagmara Pokorna Kalwak
Exactly for the child too it seems to me. Gross such confidence in his doctor. Unless the doctor is somehow concerned about the child's condition, his psycho-motor development, I think there is simply no point in spending the money and it is better to spend it in other ways.

Monika Rachtan
For something enjoyable. Also to say how it is with this breastfeeding. Because I might also ask about the benefits. Oh that's right, I'll ask about the benefits for the baby.

Dagmara Pokorna Kalwak
The benefits for the mum. Well, you know, yes, there are mutual benefits. And to this day, no one clever has yet produced better milk than our breastfeeding mums do. Also, this lactation is good for mums, because there is a lot of research that children who are fed by their mums, mums are more relaxed, they get back to their pre-pregnancy condition quicker, they have better, you know, physical and mental wellbeing. So there are some very tangible benefits here, but also for the baby, and above all, well, the composition of the milk, but also the practical aspects of not having to get up at night, burn the bottles, mix the milk, select the right milk, because it is not always possible to select the right artificial milk for a particular baby straight away. So here. And above all the fact that the baby has the option of being switched to mum at any time. And the contact of closeness, which a bottle can never give.

Monika Rachtan
I also thought to myself, sorry to get into the word, that I was following the voice of the expert who was our guest. In the second episode, the doctor just talked about breastfeeding, a very important piece of information, that breastfeeding also protects us women from cancer. This is very important information.

Dagmara Pokorna Kalwak
Yes, as much as possible. As much as possible. Such research has also emerged, so we can also advertise it as an oncology strategy.

Monika Rachtan
Super, super, super. This is very important information. I would still like to ask Young mothers often use groups. We are from Breslau, breastfeeding mums, in Breslau Breslau. Mums. I am there on these groups because I am there privately, but I am also there professionally, because I read as I said and then I consult it with you. So I wanted to ask if these groups are good and what should we look for on them?

Dagmara Pokorna Kalwak
I think it's good, because on the one hand, mothers can exchange information, they can consult each other. I often see the phenomenon that parents compare their child to, for example, a child, a friend or someone in the family. You know, for example, that Kaziu, who is 8 months old, already has 4 teeth, and my 9 or 10 month old has none, right? So there are exchanges between mothers, but on the other hand, the mother may not be aware that something is wrong with her child. And it is precisely through this exchange of information, or by observing other children, or through consultation on these portals, that she can come to the conclusion that she should see her doctor or take a different interest in her child's health. That is one nice thing. Another thing is access to all sorts of information about where to go with your child, which kindergarten is good, which nursery you should choose. So here I am not going to talk about the clinic.

Monika Rachtan
About the doctor, if I want to talk about it, I found a recommendation just now that patients from Wrocław recommend her as a paediatrician. Yes, yes, because that's where the information is. As far as this evaluation of doctors is concerned, I think that yesterday I was looking for a doctor privately for myself and I went to such a portal that we all go to in order to find this doctor. It's now 5 stars, and yet on a group up to 5 stars it's only the top specialists that you can get information about the clinic. From the doctor you can also get. These are reliable, very verified.

Dagmara Pokorna Kalwak
Tested.

Monika Rachtan
Well, little by little we are leaving our cradle, we are going to kindergarten, because kindergarten it is. This is a difficult time in my opinion when it comes to infections. And actually it's like this is kind of the next level of contact with the paediatrician, because they start.

Dagmara Pokorna Kalwak
I would make the distinction once again. Your question about the nursery? I make a distinction between those children who have been at home for three years and go to nursery school and those who go from nursery school to nursery school, and I have even observed this with my own children. My children did not go to nursery schools. I had a situation there that I just happened to have childcare for them. When they came to the nursery school, they just behaved like such misguided, misguided, strangers. They were not adapted, not only let's say here, and the healthiness we are going to talk about, but they were not so socially adapted to be in such a group of collectives and to cope precisely as these first, first steps in the kindergarten. So that's one problem, and the other problem is that actually those children who were at home and didn't have that kind of contact with a different population of their peers are also probably more likely to get these infections, and these are mostly upper respiratory infections. And not only that, but there is also stress, which we know further encourages such infections.

Dagmara Pokorna Kalwak
In addition, it is the autumn/winter period, which is beginning in our climate. And in addition, it is a new collective of children, so everyone has their micro-symptom, let's call it the truth, that is, their deficiencies, their set of microorganisms. And we start mixing in the first weeks of September and sometimes we already feel it in the clinics. In the second week of September, because we definitely see an increase in the peak of admissions of children with upper respiratory tract infections.

Monika Rachtan
I also think to myself, as you explained to the doctor, why it happens that there are more of these illnesses. Very often I hear that parents are unhappy that the lady in the nursery is ventilating too much or it is one group. The other group you are neither ventilating nor ventilating and we do not know what it is like, do these factors, can we ourselves as parents, can the kindergarten do anything more so that these children do not get ill? Is it true that this child just has to get sick?

Dagmara Pokorna Kalwak
The truth is also that this is something that parents generally don't accept and don't want to hear from the doctor, that this can happen and that 8 to 10 infections of a preschooler a year in 12 months is the norm, right? Of course, there are children who some get sick more, others me. This is also individual. It depends not only on what happens in the kindergarten, because we also have to take into account that these children spend the second part of the day in the home environment. And here, too, there may be all sorts of factors which will not be healthy for such a little one. But I would like to draw attention to a little here in Covida. We have learnt to follow the rules of, let's call it healthy, healthy functioning in such a way that children who were cold or ill were not sent to kindergartens. I am already talking about how we had kindergartens, nurseries open and schools. These children were actually kept at home, they were isolated and this is probably the most important factor, no, this is where we do not have air conditioners, air ionisers and so on. Whether this kindergarten has one or not, it is precisely to not let a sick child go to kindergarten or to school.

Dagmara Pokorna Kalwak
This is the basis, because as we know, an infection is most often spread by the droplet route, and all it takes is for such a sick Jasiu to come in and cough two or three times in such a group, and out of this and out of that next week, maybe half the group will have similar symptoms to this Jasiu. But also, ladies and gentlemen, I have encountered a situation where parents sometimes don't have the opportunity to leave their child at home because they are working, because they can't take time off work, because they don't have other care. I know that these are individual situations, but then I hear from the parents, for example, that the situation is such that the mum or dad of such a child explains that the child has an allergy and that these are not symptoms of an infection, but are more symptoms associated with allergic hypersensitivity. I think that we would not do such things here and, if such a situation arises, take the good of the child above all. It's not just a matter of spreading infections, but everyone knows that when they are ill, they feel unwell, and a child in this kindergarten simply has the right to feel unwell.

Monika Rachtan
I will also ask about the hot topic of inflation. Parents often demand antibiotics from the doctor, from the lady doctor too, when the children just get sick a lot. Work doesn't know what to do anymore, because they keep getting discharged. Maybe the doctor would finally write me an antibiotic, because how much is a child supposed to be sick?

Dagmara Pokorna Kalwak
An antibiotic is a double-edged weapon. That is to say, on the one hand, it cures, but on the other hand, it causes very great disorders in such an organism, especially if it concerns the use of antibiotics among children. This is why we need to make parents aware of what an antibiotic is prescribed for. An antibiotic is a drug that has an antimicrobial effect, that is, it is indicated for the treatment of infections that are caused by bacteria. However, more than 90% of upper respiratory tract infections in autumn and winter among nursery, pre-school children In our climate, these are infections of viral aetiology. These viruses are very numerous. They can also mutate. I think they were educated a bit more during covidu, so we need to be able to explain to the parent that if it is a viral infection, an antibiotic will not help. I will say more an antibiotic at this point will harm.

Monika Rachtan
Let me ask you one more thing from the patients: can your doctor prove to me that it is a virus and not a bacterium?

Dagmara Pokorna Kalwak
I can.

Monika Rachtan
How?

Dagmara Pokorna Kalwak
First of all, on the basis of. The first thing. These are the symptoms we will be comparing here. Viral infections and bacterial infections. Second a history, third a very thorough physical examination in a child who should not. Some. We should remember that the otoscopic examination should not be omitted, because this is very important, that is, the examination of the ear drill.

Monika Rachtan
Eyes.

Dagmara Pokorna Kalwak
We are watching the ears. Put it this way, we watch. Whenever a paediatric patient comes to us, they should always have their ears looked at.

Monika Rachtan
And this is something that parents must also bear in mind, pay close attention to.

Dagmara Pokorna Kalwak
Sometimes it can happen through our forgetfulness or negligence, but it is an indispensable part of such a physical examination among children. So a thorough physical examination is the third factor that will be proof, but let us say that sometimes this may not fully convince parents, in which case we may recommend, for example, a protein test from this phase. What is this? It is such a quick test, which can be done in a GP practice by taking a small amount of blood from a finger, which is such a tiny saw. It is about two or three millimetres and within five minutes. On the basis of just such a quick test, you have a very accurate result. And here it is already such a proof not tangible. With bacterial infections this measurement will never be within the limits of the norm, i.e. negative. It can rise minimally in acute, viral infections, but already in infections of a bacterial course it is significantly increased.

Monika Rachtan
What does it mean to be significantly elevated?

Dagmara Pokorna Kalwak
We also need to correlate this with the child's examination and the age of the child. Well, but significantly elevated is a double-digit result, usually above 40 milligrams per cent with a normal of 5. So that. So we can say that this is an eight-fold increase in the normal.

Monika Rachtan
OK, I'm going to ask still inhalations, because I used to see inhalations just prescribed to children a lot, and now I feel like they're getting a little bit away from them or going.

Dagmara Pokorna Kalwak
It was a very common treatment with nebulisation. It was as number one covid, so I think we are unlikely to move away from inhalation therapy. There is a group of children who use this method of therapy very frequently. These are mainly children who have a recurrence of laryngitis, who are diagnosed with early childhood bronchial asthma. So here it is really the machine with the right medication that has to be at hand, because therapy such as inhalation therapy may not always be sufficient here in warnings of various kinds. Therefore, this is one group of children, but also everything depends on what kind of disease entity we are dealing with, as well as the age of the child. Because in the youngest children we do not always recommend nebulisation therapy and this may be due to the fact that, let me tell you, there is a lot of distance between the nose and the throat and the bronchi. This communication is preserved in these organs, greater. If we apply therapy and dilute the secretions that are in the nose or lodge in other parts of the respiratory tract and put the child exactly no, i.e. we do not perform kinesiotherapy, it may happen that we simply harm instead of cure.

Dagmara Pokorna Kalwak
So, depending on the type of disease, the age of the child and the parents' awareness, it is important that the inhalation is done well and that the parents behave appropriately after the inhalation. Because I have to tell you that if you inhale steroid medicines, it is very important that the child does not have to take them. It is very important that the child's face is washed after removing the mask and that the child drinks a sip of water, and if older, that the child knocks on its mouth as when brushing its teeth. And sometimes doctors don't say that, pharmacists don't say that. And so that there are no fungal overgrowths of various kinds in the mouth or on the skin. So here such a prophylactic procedure should take place.

Monika Rachtan
Now let me ask you about when we should think about our child's health more broadly. We've already talked a bit about this prevention, but, well, that's it. We're coming out of all these colds, tissues, syrups, inhaler. And we have a schoolchild in front of us. What prophylactic measures would be worth applying to this child so that it translates into health later on?

Dagmara Pokorna Kalwak
You know, as we also say on the one hand there is no escaping genetics, which means every child is different. Even if it is a child of the same parents, every child is different and we observe that. I myself have three and I would also say that each one is different. However, I have to tell you that there is no 'golden formula', no 'golden mean', but we can support the proper development of such a child, to help him or her learn properly, and to help him or her spend their so-called free time appropriately. We focus here on the so-called rational diet. This diet is designed for children of all ages. And here, I think, parents are becoming more and more aware that a great deal depends on proper nutrition, proper eating habits and not snacking. I even observe that in the other direction, we have lollipops as prizes for children, and not every child in the clinic can be given one. So here we always ask the parent, because, for example, the child doesn't eat sugar at all, so then there's a way out b The sticker always has to be at hand, so it seems to me that this awareness is growing, and to this rational nutrition we always add a second, second, very important thesis, which concerns the appropriate physical activity of the child, right?

Dagmara Pokorna Kalwak
Because we are observing, so to speak again, women. The children sat at home, they had no contact with each other. Online lessons, after lessons again, the computer. Well, because you have to play, right? So displacement when it comes to, let's say, organs such as the organ of sight. Hence, we are now seeing that there are more and more of these children who require so-called urgent ophthalmic consultations. However, we are also observing that these children lacking in exercise, and in most cases inadequate nutrition, because the parents were often at work and the children were eating at home, so we could say that this has also caused such a problem as excessive body weight among these older children, school-age teenagers.

Monika Rachtan
What percentage of teenagers in Poland are obese?

Dagmara Pokorna Kalwak
Here we divide it into girls and boys. And this is actually how we can say that we have to distinguish between overweight and obesity. We assess it on the basis of the BMI index, which means we measure the child in metres and we also measure the body weight in kilograms. We divide the body weight by the height, which we square. That's how we assess it. This is how we build up this BMI. And now we plot it on a centile grid. These percentile grids are different for boys, different for girls. And if we have a range, that is high above, we reach the end of the percentile grid, that is above this 95 cm centile, or as we say colloquially, the child escapes from the table, then we are dealing with obesity. If it is a little lower, between 8.5 and 9.5, the child is in this channel. If it is a little lower than 8.5 to 9.5, the child is in this channel. Dividing by girls and boys, we can say that boys are marginally, minimally in the lead here. When it comes to adolescents and this range concerning, let's say, overweight, it is about 18% versus girls some 13%, obesity 3%, and then it actually, one could say, statistically drops somewhere to about 2.5%.

Dagmara Pokorna Kalwak
Among such young adults 17 18 years.

Monika Rachtan
Apart from obesity, what other diseases affect teenagers?

Dagmara Pokorna Kalwak
We can say that, looking at what is happening outside the window and also at the conditions we are developing in our bodies, we are seeing more and more allergic diseases, for example, or some kind of allergic, conjunctivitis or allergic rhinitis, or various types of skin changes among smaller children, such as skin allergy or atopic dermatitis. And we can say that this is related not only to what we live with, but also to fetal development, because the older the mother, it is known that these ova that she has in her body have been exposed for a longer period of time. Terapogenic factors, right? So the kind of factors that can cause all sorts of diseases among the children born. The subsequent children that this mother gives birth to are at greater risk of the occurrence of various types of diseases, let's call them civilisational diseases, that is, diseases that are related to the environment in which we develop, to our lifestyle. And than one who gives birth at, let's say, the age of 20-something.

Monika Rachtan
And is the paediatrician's office a good place for sex education? Does your doctor happen to talk?

Dagmara Pokorna Kalwak
I think yes, I think it's a good place, but everything has to be balanced here so as not to stress such a teenager out too much. First of all I talk to the parents, first we also take a history. Are there any disorders that suggest various hormonal or sexual disorders? Any health problems, menstrual periods not appearing at a certain time, or very painful periods, or abdominal pain, or nervousness, or some skin lesions of the type of, for example, very aggravated, exacerbated juvenile acne can have a basis here in such a hormonal or sexual sphere. It seems to me that these first talks are also often held as education in schools. I myself also participated in promoting the Wrocław HPV vaccination programme, which we set up many years ago. I myself took part in such talks, and these children were able to talk very openly about sexuality, both among their teachers and their classmates.

Monika Rachtan
You mentioned the HPV vaccination to the doctor.

Dagmara Pokorna Kalwak
Yes, because now

Monika Rachtan
Ministries

Dagmara Pokorna Kalwak
Specifically for Children's Day.

Monika Rachtan
And I just wanted to ask about this vaccination. What do we vaccinate for? Can we vaccinate in the paediatrician's office? And right away I would like to dispel the myth that this vaccination induces children to be promiscuous, so your doctor I could ask.

Dagmara Pokorna Kalwak
So as much as possible, we invite those children who are born in 2010 and 2011, because this programme is aimed at them. We have the possibility to vaccinate with two types of vaccines that the Ministry has purchased. A parent has the right to know which vaccine his or her child will be vaccinated with when enrolling such a child for this procedure.

Monika Rachtan
And can I choose?

Dagmara Pokorna Kalwak
Absolutely. You can choose this two vaccine. It is a vaccine that has the two most common androgenic types of virus 16 18. Yes, as much as possible. The ones that are precisely responsible for pre-cancerous conditions, for cervical cancer. But it is not only cancer of the cervix, but also of the vulva, the vagina or the anus. As well as the second vaccine, which in addition to these typically oncogenic types also contains other subtypes, which are responsible, for example, as 6 11 for the development of so-called genital warts. These are genital warts, which are caused by HPV or other types 31, 33, 45, 52 and 56.

Monika Rachtan
The paediatrician will explain all this

Dagmara Pokorna Kalwak
Yes, these are the additional, oncogenic types, but the most common ones are the first two I mentioned, and here this range in this second vaccine is simply wider.

Monika Rachtan
OK, well, it's still this myth of promiscuity, because I'm really reading these opinions on the internet that some parents think that when they vaccinate their child, they're sort of already giving their child permission for this sexual activity. And I don't think that's what we're talking about, is it?

Dagmara Pokorna Kalwak
All the more so because sexual activity, ladies and gentlemen, is not just HPV, and here we are typically vaccinating just against, against this virus. It's a lot of different serious decisions, both health and emotional. So I think this is a very, very, very erroneous statement here.

Monika Rachtan
Doctor, we are moving on to my favourite part of my programme, the patient group questions. The hard ones are the most difficult and I ask for such short, minute answers so that I have that essence for our audience. And I read the first question I read on one of the groups. Often when I call the paediatrician, I hear that there are no more places for today. The lady registrar suggests that I go to the night medical care in the evening. How should I react in such a situation? I feel that night medical care does not offer us much.

Dagmara Pokorna Kalwak
It hurts the night care because, after all, there are doctors there. If we stay at home and we have a very urgent situation concerning a particular child, it seems to me that this will be the best option, because the child will be examined the same day. Let's remember that in paediatrics, every hour counts. And some illnesses can take a very fulminant course. Therefore, this consultation should take place, because in the end the child will be consulted by a doctor who will give an appropriate opinion as to whether it is possible to wait until the next day to consult the attending doctor, or whether the child will require, say, hospitalisation?

Monika Rachtan
It's OK to meet with a professional. We have the answer right here and right now. Let's not be afraid to stay up all night.

Dagmara Pokorna Kalwak
Exactly, exactly. Exactly as I say, in paediatrics every hour really does count.

Monika Rachtan
I read another question from a lady who was a participant in the Wrocław group and has a child with a rare disease, but feels that the paediatrician doesn't know what her child's disease is, how she has to cope and whether she has to go to the neurologist who is guiding them with every problem and says she finds it difficult already.

Dagmara Pokorna Kalwak
We do not know what rare disease it is. However, some of those diseases that are genetically determined, or are generally classified as so-called rare diseases, may require very intensive specialist consultation and care, because exacerbations of such a disease may cause various types of treatment-related issues. Not all drugs can be prescribed in these children. Not all drugs can be combined and not all drugs a given specialist would want to use here. It seems to me that a good solution for this mother would be so-called tele-counselling, which means that, on the one hand, she would make use of the services of her general practitioner, but, on the other hand, she would be in close contact with a specialist who would then take responsibility in a given situation. Does this specialist consultation have to be here and now, or is it appropriate for the attending doctor, the paediatrician?

Monika Rachtan
I too think that these professionals are very open, also often giving phone numbers.

Dagmara Pokorna Kalwak
Exactly, exactly. It seems to me that here the contact with such a specialist is hardly difficult and that most of these parents, who have children with what we would call generally chronic diseases, have a good contact with the attending physicians.

Monika Rachtan
Now here's a question that came from one of the people who co-hosts this show and she knew that I was going to have a paediatrician on the show, so she asked me to ask this question to the doctor. And so I'm thinking, let's just show that. The power of the paediatrician doctor, that they can do a lot. Because yes. A colleague of mine said that as a child he sits in front of a computer for many hours and just stares at this computer and stares and he noticed that he was looking from less and less distance, closer and closer he had to be to see well. So should he see a paediatrician or an ophthalmologist straight away? What should be done, what tests should be carried out?

Dagmara Pokorna Kalwak
The pathway is there. It seems to me that a paediatrician can be used as much as possible. We have opportunities to make referrals for eye consultations to the eye clinic for children. We also have the possibility of an orientation eye test. I have tables that are located in our offices and then we also assess. Well, you could say it's more of a screening test. Is there really something very worrying? What is happening to a child's eyesight? As I said before, we are now seeing an increased rate of visual impairment among children, but this is linked to what you just mentioned, isn't it? So, if not the computer, then the television or the telephone.

Monika Rachtan
That's right.

Dagmara Pokorna Kalwak
You can also use this second pathway, which I also observe quite often, that parents bypass the paediatrician here and go directly to a private practice for an ophthalmology consultation.

Monika Rachtan
But under the National Health Service you have to have a referral but it has changed. I remember a time when you wouldn't need one. I remember it not being necessary, but I wear my glasses frequently at the surgery

Dagmara Pokorna Kalwak
Yes for several years we have been making referrals you need to have a referral to an ophthalmologist.

Monika Rachtan
Doctor last question in this programme will I be writing your doctor? A brief summary, but. But one last question already to each of my guests, because as I mentioned the Institute for Patients' Rights and Health Education has taken over the sponsorship of this programme, for which we thank the Institute very much. We are delighted to be involved in this initiative and the Institute is talking a lot about the humanisation of medicine. What is medical humanisation from your perspective, from a paediatrician's perspective?

Dagmara Pokorna Kalwak
It seems to me that it is all about building such a good relationship, a good bond between doctor and patient, based on empathy, understanding, trust between one side and the other. I also work on a daily basis with students who visit us in the department of family medicine for family medicine classes, and they have had such a subject as doctor-patient communication in the sixth year for several years. Yes, for a short time, but it has already found its way into the sixth year clinical exercises.

Monika Rachtan
I know whose credit this is.

Dagmara Pokorna Kalwak
And so we see how important this topic becomes here, that the doctor knows how to talk to the patient, right? Because this is very key. It seems to me that in order to achieve therapeutic success, communication and good understanding are very important, not only so that we understand the patient, but above all so that the patient understands us.

Monika Rachtan
Finally, let me ask you what would you like parents to remember three important things from our conversation today?

Dagmara Pokorna Kalwak
A difficult question, probably the most difficult. The first thing is I think it's very important for parents to know and trust their doctor to whom they are enrolling their newborn and to simply know that the doctor always wants to do good. We are always guided by the principle of primum non nocere, above all, to do no harm. If this trust is appropriate, built up, then on the other hand, I would like it to come out here that this doctor should be listened to, that he should be given the opportunity to act.

Monika Rachtan
It does not cure.

Dagmara Pokorna Kalwak
A visit alone does not cure. Exactly. That is to say, if we say put to bed, put to bed, not give fever syrup let out to the nursery, just put to bed. That is, to, to. To just reckon with what the doctor says to us. And another thing, to make, let's say, every child happy, joyful, is, above all, to also create the right conditions for their development. Not only to have the doctor on our minds, that it is the doctor who is responsible for the health of our child, but in this health, that every parent actively participates through the right conditions of being, through proper nutrition, through proper diet and physical activity. And I think these are the kind of key conclusions that you, Madam Editor, draw from our meeting today.

Monika Rachtan
Me thinks to myself, from every conversation in the programme. It comes out that the patient and the doctor are a team. If they work together, all will be well and there will then be, first of all, the patient and the doctor will be able to treat that patient very, very well. If the patient puts some effort into building that relationship with the doctor, that's also very, very important.

Dagmara Pokorna Kalwak
This is exactly where we are talking about parents. But I would also like to add that along with this parent goes this child, it grows, it gets used to its doctor. And I remember that when I had a short break from work due to giving birth, when I came back to work I was told by my patients that the children did not want to cross the threshold and see another doctor, because they were so used to me being there all the time. And it's so very nice on the one hand, but on the other hand it shows that the little patient also gets very, very attached to their doctor.

Monika Rachtan
And sadly, doctor, when these patients fly out of the nest? They are 18 years old.

Dagmara Pokorna Kalwak
But they come to me with their children. Already they are going to the next generation that I lead, also in a different role.

Monika Rachtan
Doctor, thank you very much for this pleasant conversation.

Dagmara Pokorna Kalwak
Thank you very much.

Monika Rachtan
To you. Thank you for your attention. Once again, welcome to our social media. We invite you to follow our activities. Thank you once again to the doctor.

Dagmara Pokorna Kalwak
Thank you very much to you and the Editor. I look forward to your questions. Thank you. Thank you.