Pediatrician, Tiffany Otto, M.D.

0:00 Hi, it's Doctor Robert Seikard with a brand new exciting episode of Doctor Podcast. And today we're going to be talking about the most important thing on the planet and that is our children. And in order to talk about our children today, I have a excellent guest today, Doctor Tiffany Otto, who's a board certified pediatrician and practices in New York City in Manhattan, in the Tribeca section of Manhattan. Doctor Otto is an attending physician at the New York Presbyterian and Cornell Weil Cornell Medical Center here in Manhattan and also at the NYU Langone Medical Center in Manhattan, both very prestigious institutions.

0:48 Thank you very much for coming today, Doctor Otto. I really appreciate it. Thank you for having me. Yeah, Thanks. Thanks for your time. I know you're very busy taking care of a lot of kids, so we really appreciate your coming today. I know that your kids referred to you as Doctor Tiffany on occasion. Can I call you that? Please do. That's how all of our patients know me. All right. Yeah, fantastic. Doctor, Tiffany, So you're a pediatrician. Tell us what age groups that covers Pediatrics. Sure. So we actually see patients from the time they're born newborns through early 20s.

1:26 Early 20s. Early 20s. So most of the time patients will transfer care to an adult physician when they go to college or when they graduate college. It's usually a natural transition time. But all pediatricians are trained to see newborn through early 20s. It's very special because you know, we really see children grow up, we see babies turn into young adults, we see families grow. So it's a it's a very special part of what we do. Right. And once those young children get used to you and see you year after year, they get very comfortable and they don't want to leave.

2:03 Probably some of them don't want to go to adult physicians. Do you have any like 30 or 40 year old kids if? We count the parents well, you know we'll we'll occasionally do a strep test or to look in a year on a parent and give them assurance and then tell them they need to call their physician. What are the most common things that you see children for? What types of conditions? So there's the medical conditions, and those are things like ear infections, skin rashes, sore throats, strep throats in babies, things like jaundice, weight gain issues, feeding problems.

2:47 And then there's sort of the more nebulous symptoms and issues that come up like difficulty sleeping, changes in appetite, difficulty adjusting to school transitions, things like that, which are sort of the, we'll call it, less medical in some ways, but very common things that we see children for. Right. So you're dealing not only with medical physical conditions, but often with psychological conditions in the children as well that can affect their medical and physical health, right? Absolutely, absolutely.

3:26 I mean I think we very everybody does this, but especially children what can really somaticize. So there may be a stress at home. There may be, you know, a grandparent that's I'll there may have been a move to a new home And children present with headaches, stomach aches, changes in sleep patterns, difficulty gaining weight. And sometimes those same symptoms can have a true medical root. And it's our job certainly to figure out if there is a medical cause, but it's also our job to figure out what's the root of the 'cause if it's not medical, and how can we help with that If there is a stress at home, if there is a sick grandparent, we ask a lot of what we we ask a lot of probing questions about what's going on in the family, what's going on in the home, because it can help us get to the root of those issues.

4:24 Right. So first you have to rule out a true medical problem. Once you've ruled that out and make sure that there are no problems there, you can then decide if there are other psychological components that are causing the problem. Absolutely. And there's a lot of overlap. I mean, often when there is a real medical problem, there is a psychological component layered on top of that. There's anxiety about the medical issue or anxiety about the symptoms. So there's it's all sort of interconnected. It's.

4:56 All tied in pediatricians I believe have have the most difficult job in medicine because not only do they have to take care of the kids and their medical issues, psychological problems, but also you're you're kind of a psychiatrist I think for the parents in in many situations because parents get very anxious when their children are ill or sick. Yes, absolutely. There's a big part of that to what we do. I'm a parent. I've got two boys. And so I'm very sympathetic to the anxiety that parents have around their children, whether it's, you know, around a sick child, around a child who's well, but maybe going through some developmental changes.

5:42 But a big part of what we do is helping to educate parents about the health and Wellness of their child, whether there's a acute medical issue or not. They just need to understand how to help support their child on a healthy sort of trajectory. And I'm a big believer that our job is to also help educate children as they get older about their bodies, about their own health, about their own Wellness. And you know, it's a big part of what we do. And there's definitely some psychology that plays in with parental anxiety, stress, New parents especially, you know, have a lot of anticipatory anxiety about how to care for a newborn.

6:31 I tell them all the time that parenting is an on the job, training for everyone. Even pediatricians, you know, they don't train us how to be parents in residency or medical school, but it's on the job training. And my job as a pediatrician is to help support them in that journey of learning how to care for their children. That's. Great. You mentioned some of the common things that you see kids come in with. You probably have seen some unusual things over the years that children come in with that are very atypical or fascinating or amazing at times.

7:13 Can you tell us maybe a few of those? Sure. So there's again, there's the medical category of things and in that I would say you know things like scorpion stings and jellyfish stings and there's. Scorpions in Tribeca. No scorpions in Tribeca, but the families that travel to Mexico for spring break? Something like that, right. You know, And then there's very rare and unusual infections, tuberculosis, malaria, rare bone infections, strange fungal infections in the esophagus. You know, there's a slew of unusual medical issues that have come up.

7:54 And then what I think is very special in a in a fun way with Pediatrics is the we'll call them less medical kind of unusual things that come up. And so give you some examples of real calls that I've gotten. My child picked up deer poop and licked it. Now what do I do?

8:20 My child pulled a cheerio out of a vacuum cleaner and ate it right. Now what do I do? A very common theme in Pediatrics are beads shoved up, noses put in ears, swallowing coins, swallowing Legos, swallowing band aids. You know the theme of eating non edible objects and putting small things in small body orifices. So those are, believe it or not, fairly common, but still unusual. Wow, you get those calls like Sunday at 2:00 AM? Usually, yeah. Usually those are when they come in well. Actually, I would say we we got a lot of those sort of unusual calls like around bedtime because you know, whether it's the swallowing something or you know, kid jumped off a bunk bed, you know, usually around bedtime is when nobody's judgment is in tip top shape.

9:18 Right. Kids don't want to go to sleep, so they do weird things to stay awake, and parents are tired from the whole day and so they have trouble dealing with that. That's very interesting. Makes the job very interesting. It's. Very interesting. You have to be a detective to figure out exactly what's going on and when. When it's important and when it's something not that important, like the deer poop, probably. Don't worry about it, right? Basically, yeah, deer, try not try, try to make sure it doesn't happen again, You know?

9:48 There's not much you can do about it at that point, so. Now occasionally some of your patients that kids get seriously ill and and need to be hospitalized, right? Right. And these days it's it's once they're in a hospital or emergency room, usually they have hospitalists or special pediatricians that take care of them. But how do you get involved with that? If it's a patient you've known for a while, or even if it's a new patient, how do you deal with that? Right. So there are some private practice pediatricians that will see their patients in the hospital, but the general trend in academic hospitals now is to have their hospitalists who are on site take care of the patients once they're admitted.

10:34 Especially in New York City. Especially in New York City and frankly the type of medicine that's required to care for a hospitalized patient is quite different from what we do in the outpatient setting. So it's actually quite appropriate to have those doctors care for our patients. But what what we do when we have a hospitalized patient, something that I sort of refer to as helicopter doctoring. So if our patients admitted, I generally call the team, the medical team taking care of that patient at least twice a day after the morning rounds and after the evening rounds find out in the morning, how did the night go, what's the plan for the day in the evening find out, you know, how did the day go, what's the plan for the night.

11:21 And I generally touch base with the parents at least both of those times, if not more frequently. Do you understand what's going on? Do you understand why this is the, the treatment plan? Is your child comfortable? Reassure them that I've been speaking with the doctors regularly. I always offer to make a courtesy visit to the hospital, you know, just to sort of have an in, in person. I'm here. I'm supporting you on this. That's awesome for parents because there's nothing more stressful and more anxiety creating than having your child hospitalized.

11:59 Oh, absolutely. And then meeting new doctors that you never met before and all kinds of procedures that you've never heard of. Exactly, that's. Terrific that. You. But I have two boys and one of them has been in the ER four times and admitted once for three nights. Really. So I'm a very sympathetic, I'm very sympathetic to that experience of being a worried parent. I was no less worried when my own child was in the ER in the hospital than any other parent that doesn't have medical training. Right.

12:33 All of a sudden you become not a doctor, but. Exactly, exactly. How did you decide to become a pediatrician? I think there's an interesting story behind that. Oh, thank you. Yes. Well, it was something that I wanted to be from a very young age. I'm the middle child and I always liked any opportunity to sort of be a big kid. I also had sort of an innate sense of empathy and had a mother who also had a lot of empathy and compassion. And the way that manifested in our home was we didn't kill bugs. We carried them outside.

13:12 We spread all the stray cats and dogs, and many of them eventually became family pets. We would leave food out for the raccoons and the squirrels. I obviously grew up in suburbia, not in New York City, and when I the right after I turned 5 that Christmas, my parents asked me, you know, what do you want for the holiday? And I said a stethoscope. And I think many parents would have gotten them a toy stethoscope. My parents bought me a real stethoscope, and I immediately started listening to the hearts of my siblings, all of the creatures in our home.

13:52 And thus my medical career was launched and you know it. I when I got into medical school, my mom found that stethoscope in our basement. Dug it up, mounted it like in a shadow box, and I have that in my office now as sort of a constant reminder of, you know, one, how long I've been on this path and also a reminder that determination and persistence will take you far and that childhood interest really shouldn't be dismissed. You know, if they're, you know, if it's, if it's not something absolutely, you know, fantastical and imaginary, you know, children should be supported in their interests because you never know where it's going to take them.

14:47 And just to sort of to to go on that stethoscope theme, it was such an important part for me. It was so symbolic as sort of the origin of my path to medical school that we have in our office, a big bin of the disposable stethoscopes that they use in hospitals, real stethoscopes, you know, in the bright primary colors. And any child that expresses an interest in my stethoscope or what did my heart sound like? I always, you know, clean off my stethoscope. I let them listen to their own heart. I teach them how to do it, and then we give them one to take home with them.

15:27 And it never gets old for me, watching a child's reaction when they hear their own heart for the first time, it's just it's so wonderful. So that's that's kind of the story. So Doctor Tiffany got started at age 5. I got started at age 5. You know, I meandered a little bit. I mean, I graduated college as an English and psychology major, so I I, you know, I had a very, I think, diverse educational experience. But I ended up taking the same path that I had anticipated. Right. So you have to go back and take organic chemistry and biochemistry and physics and math.

16:10 But you did it, and with hard work and persistence you achieved your goal, right? Exactly. Right. And you're a board certified pediatrician, which is very important. Can you tell the audience listening to what board certified means? What's the significance of being board certified? Sure. That's a great question that I think a lot of people probably don't actually understand the nuances there. So it is separate from getting your medical degree and your state licensing. So board certification is technically a voluntary process where you are demonstrating A commitment to your specialty and in ongoing process of learning.

16:56 You know, medical education is we call the lifelong learning and board certification requires you to demonstrate your, your proficiency and knowledge in your particular area. You do quality improvement, you have ongoing assessments and it's really just a message to your patients and to your colleagues that you are committed to that journey of lifelong learning. Right. So you have to constantly stay on top of the medical literature, be aware new things that are happening so that you're providing the best possible care for your patients with the available knowledge and technology at that time.

17:37 That's that's that's very important. If if you see a child with a very complex problem, let's say they have, you've diagnosed a complex heart or kidney or lung problem that that you feel is beyond the scope of your abilities or knowledge, what what do you do then all. Right. Well, that happens, absolutely. You know, we're very lucky we live in New York City and have access to all the best specialists, certainly you know in the country, not some in the world. And I'll refer to one of the sub specialists in Pediatrics generally the way I do that is you know I'll talk to the parent about and the patient if the age is appropriate, what the concerns are and why they need, should or need to move on to a specialist.

18:28 And then I reach out to that specialist directly whether it's e-mail or phone call, I let them know why I'm referring the patient to them. And then again this is my helicopter doctoring. I it but a little different because this is really I think an integral part of any primary care whether it's adults or Pediatrics. If you have a patient who's seeing multiple physicians to manage medical issue, everyone needs to be communicating with each other. All this physicians need to be communicating about what tests they're doing, what they're working, diagnosis is, what the treatment plan is.

19:09 The right hand needs to talk to the left hand. You know, it's a little bit I think in Pediatrics and any primary care specialty we need to function as sort of the quarterbacks or the captain of the ship and. Great analogy. Yeah. And really just make sure everybody is is supporting that patient as much as possible. You know, I really believe that medicine is a team sport and in a situation where a child has a complex medical issue, it really is important to function that way. Right. All the organ systems are connected, so if you've got a kidney problem, it can affect your heart and vice versa and lungs.

19:49 So it's important that all the specialists communicate with each other so. Absolutely. And you're the quarterback and you're the one that's in contact with the family, right, With the parents. Exactly. Making sure they understand what all the decisions are in the management. Exactly, yeah. Usually follow up with the parents after they have that her specialist appointment. How did it go from your perspective? Were you comfortable with the physician? Were you comfortable with the plan? Do you understand what the next steps are?

20:18 And that's usually after I've spoken with that specialist so that I know what the medical diagnosis and plan is moving forward. And it happens often. You know, I'm I'm sure in in your work as well, you know, parents are uncomfortable with a diagnosis or uncomfortable with the treatment plan. And you know, I'm always very encouraging of then let's get a second opinion or let's get a third opinion. And often I'll have some sense as to whether the second or third opinion are likely to be the same as the first opinion.

20:54 But sometimes parents just need to hear it more than once And sometimes the delivery can be different between different physicians. You know, it's the the bedside manner, the personality or the style. And so I think that that's a very appropriate step when parents are not comfortable with that first evaluation or decision. And they always have Doctor Tiffany to go back to, to make sure that they understand everything and reduce their stress and anxiety level. So that's great. Now you mentioned the various specialties.

21:33 You have a specialty as well, right? You did additional training beyond general Pediatrics. Can you tell us about that and how long that took? Yeah, absolutely. So after my pediatric residency, which is 3, the three years after medical school, I did additional training to be a pediatric infectious disease specialist. So I did that at Yale and at NYU and fellowship training generally in Pediatrics, you know it generally consists of both clinical work and for infectious diseases. Most of that work, not all of it, but most of it is hospital based.

22:12 So we act as consultants on complicated cases or sometimes if it's a patient that already has a diagnosis of a, you know, rare infectious disease will be the primary team taking care of that patient. And then it also includes doing scholarly research, independent scholarly research. And that's, like I said, a three-year process. It was extremely interesting. And, you know, I really loved that experience. After I finished the fellowship, I was a parent with two young kids and I made the decision to go back to general Pediatrics rather than to stay in infectious diseases because it became so much more important to me the role of a pediatrician as I became a parent.

23:03 I love that continuity of care. I love getting to know families and when you're a lot of the hospital based work is you know, care closely for a family while they're in the hospital, see them for some follow-ups and then you know hopefully especially in infectious diseases, they're better and you discharge them and you don't see them again. So you know I do have that training. So I think I'm a little bit more, my antenna are up a little bit more around infectious processes, but I do practice just general Pediatrics.

23:42 That's many years of education and learning for younger people in the audience. If you want to become a pediatrician and A and then a specialist, work at it and have a goal and and you'll achieve it. Exactly. We touched briefly before about the psychological issues with children. I've seen in the media and in the medical literature in recent years that there's an increased amount of anxiety and depression and in the pediatric age group. Have you seen that in your practice? Why do you think that is?

24:19 Is it related to COVID or not? And and what where is that heading and and what do you do about that? Those are very, very good questions and this is such an important topic. Yes, I have seen a lot of that. I do think there's been a change and an increase in the mental health of our tweens and teens and even younger children. It I think a long running parallel to the COVID pandemic was a mental health pandemic, if you will, which I think we're still as medical community struggling to keep up with in.

25:03 I I think some of it was certainly related to COVID, the isolation, the anxiety, the fear. I think that there are some social media influences in mental Wellness.

25:24 There are not enough mental health providers to keep up with with this. You know, we see in the tweens and teens generally mental health tends to present in very similar ways as it does in adults. You know, too much sleep, too little sleep, withdrawing from activities. Grades are dropping. Appetite has been suppressed in younger kids. Sometimes the symptoms are a little bit less clear. So for instance, they may not be sleeping well. You know, a baby that was sleeping, or you know, a toddler young child that was sleeping through the night, isn't sleeping through the night.

26:07 Some of the younger school age children you know may start having nightmares. They may not be eating well. Often we see behavior as a manifestation of anxiety or sadness. Like a child that was doing great in kindergarten is suddenly hitting other kids, biting other kids. You know, these are often signs of anxiety in some way. And there was also an adult mental health crisis during these last few years, especially with COVID. And children really absorb and reflect their parents anxiety. And you know, I'm a parent and I, I try very hard to not let my children see when I'm anxious or upset, when I think that's appropriate.

27:00 But they kids can read us. They see it in our eyes. They can tell in the tone of our voice, in our body language when we're anxious, when something is Askew in in our world. And they pick up on that. And I think that that was absolutely impacting children's mental Wellness during the pandemic. I don't know a single adult that wasn't anxious and stressed and fearful in the, you know, 2020 to 2022 period. Right. How how many children are you? What percentage? I should say, are you referring out to pediatric psychiatrists because their stress, anxiety, depression levels are so severe and and there's more cases of suicide here.

27:53 Now are you finding yourself referring more to psychiatrists? I am referring more and again it's there's not enough of them. Fortunately, I'm very lucky that I have established some very good relationships with the pediatric mental health specialists in New York. So if I call them and say I'm really concerned about this kid, can you please fit them in? They usually will.

28:22 And if not, if they can't or they won't or you know sometimes a parent may be hesitant to get that type of help. We just bring them into the office more often, spend a little bit more time with them screen for suicidal tendencies, almost idle tendencies. You know this is these are these are big issues now and you know we're sort of on as primary care physicians, we're kind of on the front lines of screening for that. So it it's a big problem. You mentioned social media as an issue. There's a lot of press and media attention about that now.

29:04 Also articles in the medical literature that social media, especially things like TikTok and the very quick YouTube videos and things like that are harmful to children. Do you do you think those are harmful to children? And if if you think they are, how should parents control that and deal with that? Right. Well, there's certainly are there. There's media out there that is harmful, absolutely. But there's also a lot of content that's educational, informative, and those those things are safe and sometimes useful.

29:45 I think it's very important for parents, especially of the younger children, to be extremely involved in what their children are watching, what they're using iPads or phones for. Generally children under 3, two, you know, really shouldn't be on computers or you know, iPads by themselves if they're on it. It's just certainly shouldn't be for more than an hour and a parent should be engaged with whatever the activity is. And ideally it's an educational activity. You know, it's they should never be used.

30:24 iPads, phones should never be used as a babysitting device like you know that's going. Often, however, I see that all the. Time it is, and they should not be used that way. You know what? What I really try to educate parents about, which is probably one of the most common things I see along these lines is parents want to go out for a nice dinner, maybe with another, you know, couple friend, and they give the child the iPad to sit at dinner and be quiet at the restaurant. And what I try to communicate to parents is meal time is social, right?

31:06 Like we make plans to go out for dinner with our friends because we want to chat and engage and catch up and we need to model that for our children. If we model that you sit at at sit at the table and you stare at an iPad like this, they're never going to learn that meal time is actually intended to be a social opportunity. And so a lot of parents say, well, I can't get my kid to sit at a table. So either don't make the dinner plans out, invite your friends in, or try non-technical technological interventions.

31:47 Bring crayons, you know, use the little sugar packets and have them stack them up and build a tower. You know there's. Good. Ideas. I I mean, I have. I have two kids 18 months apart and I used to take them out for breakfast at the diner and we would order our meal and ask for the check all in the same breath so that if I couldn't get them to behave appropriately, we'd just get up and leave. So. That fixes. Everything that fixes everything. Yes, you know, we want two omelets, an order of bacon and the check.

32:27 Sounds good. Do you think those short videos on TikTok and YouTube are addicting? They can be. Yeah, they can be. And they certainly, I think, have led to sort of this culture of impatience with teenagers and young adults, You know, immediate gratification, constantly needing stimulus. You know, the concept of being bored is like, almost nonexistent in kids that have devices. Right. Right. And, you know, I tell my own kids like it's OK to be bored, right? So, you know, I I'll, I always love telling stories about my own children, my patients.

33:11 It's like they almost know them. But my son, who's now 13, when he was 11, maybe was, you know, misbehaving in some way. And, you know, I took away the electronics, whatever it was, the TVI mean. He didn't have a phone at that point. He went in his room, you know, stomping and mad, and he came out three hours later and could solve a Rubik's Cube. It's like, well, there, there you go. It's like the next time you get mad at me, you're going to be able to, you know, cure cancer. So I mean there there are opportunities for children to grow in meaningful ways without the devices.

33:57 So I'm going to put you on the spot. At what age should a child get their own phone? This is, I hear different opinions on this. What do you think? Is the youngest that a kid should have their own? Phone. Well, I don't think there's a right answer. I think it depends on the particular circumstances of that family. If a child is, let's just say, let's say 12 and going to and from school by himself or you, your daughter is going to gymnastics on her own and it's only a few blocks away, that child should have a phone, right?

34:37 It's a safe, It's a safety issue, you know, I think that there should be limits on what they can put on their phone, who they can contact. Parents should be checking those phones. There should be rules in the home around where the phones can be used, where they can't be used, when they can be used, you know, generally. We like the problem is when they have a play date with Johnny down the block and you don't know what Johnny has access to. Absolutely right. Absolutely. Computers, whether the parents are watching or not.

35:15 Or Johnny may have a teenage brother or sister. Absolutely right. Right. So I do think it's important to talk to your child when you give them a little bit more independence with the device about what's appropriate, what's inappropriate. I just had a conversation today with an 11 year old, 12 year old who had a phone and is on social media and said, do you ever get anything, you know, sent to you or in your feed that just makes you feel icky, you know? And sometimes that's all it is. It's like if something makes them feel icky, they need to know they should go show a parent or a teacher, you know?

35:54 And they might not be able to identify why that made them feel icky, but it's an easy way to communicate that to a child and the parents should really be monitoring their social media. And I like to think of it as, you know, the parents should have sort of full access and control over that their child's experience and that child. As they demonstrate that they use good judgement, make good choices, know when to alert a parent. You know that child can gradually get more freedom with the device. Seems like a best bet is to just make sure your child is communicating with you so that if they come across something strange or weird, they'll tell you about it rather than keep it hidden.

36:45 So it's important to encourage kids to communicate. Another controversial topic, especially in the last three years, is vaccines. In the old days there were certain vaccines every kid got, nobody questioned it, no issues. Now there's an increasing anti vaccine sentiment. Some of it is based on some data, a lot of it is just based on incorrect information that's out there. What are the critical vaccines that children have to have? Right. So as an infectious disease trained physician, I am incredibly, I'm, I'm a incredible advocate for vaccinating your children.

37:36 We are lucky that we live in a country where we have access, easy access to vaccines that prevent diseases that cause death and cause death in many other countries where they don't have access as readily to these vaccines. You know, I think a lot of young parents now grew up in a time when a lot of these vaccines were already in place. So things like polio and tetanus seem like diseases that just people don't get. I don't need to worry about that. But if they ask the grandparents tell me about what it was like to be in New York City during polio, you know, they'll hear stories that will really reinforce why we give those vaccines.

38:33 That's an excellent point that I didn't think about. People just kind of assume these diseases don't exist because I don't hear about them. Nobody ever gets them. But the reason they don't hear about them, nobody gets them, is because the previous generation got vaccinated for. Them. Exactly right. Yeah. I mean, young parents now really grew up in a vaccinated error. So I think most of the vaccines that are sort of the routine childhood vaccinations are critical, right. They prevent death and long term sequelae, long term, you know, complications and the vaccines themselves don't cause death.

39:15 So there are some side effects, you know, common side effects, fever, fussiness, a sore arm from a tetanus shot or a flu shot. But generally death is not a side effect of vaccines, but it is a risk that you take with refusing the vaccine and possibly getting the disease. So you know the the I try to educate parents about what each vaccine is, why we give it, what the risk is of waiting for it or or declining it. You know, the first year of life there is one set of vaccines that's given three times.

39:53 And then the second year of life, there's the MMR and the chicken pox, which are new, not new vaccines. But after a child turns one year, that's the first time they would get those vaccines and then boosters for the vaccines that they got. The first year of life. There's a couple of vaccines that are on the routine schedule that New York City public schools don't require. They recommend generally. I encourage those. I believe it. Rotavirus and hepatitis A are not required for school. But hepatitis AI tell parents all every so often.

40:41 You know, every every year or two there's an outbreak in a restaurant in New York City. So I tell parents, if you're ever giving your child food that's prepared in a restaurant, you should, you should give them this vaccine, right? And it's shed through the stool. So if they have, you know, a preschooler and somebody else wasn't vaccinated, that kid could be shedding it in their stool. And a lot of those kids are diapered. And, you know, hand hygiene is not great at in the preschool age. So, you know, I really encourage those vaccines.

41:16 What about the MMR? There's been some information out there. Causes autism or is associated with it. What? What's your opinion on that? Right, so any. Evidence of that. No, There's so the initial report that that drew a, a, a, a conclusion that MMR resulted in autism. It was a very small sample size and it was very poor science. I see that article has since been retracted from the journal where it was published. The physician who published it lost his medical license and the experiment. The the study was repeated dozens and dozens of times to see if they used good science to figure out if that connection was there.

42:12 Would they find the that there was? And dozens of times over there was no connection between autism and MMR. Unfortunately, the timing of giving the MMR shot tends to overlap with the time that autism gets picked up. I see so, so. It's a coincidence, but people mistake it as an association. Exactly. Lots of things in medicine are like that. People assume, Oh well, if A happened and then B happened right afterwards, A must have caused B. But it's it's not always the case. There are many coincidences in in medicine, but they're not causal.

42:55 What about even more controversial, the COVID vaccine? In the pediatric age group, there are many people, prominent physicians, experts, who believe that kids don't need the COVID vaccine because the incidence of severe illness in an otherwise healthy child is is near 0. What's What's your opinion on that? Right. So the American Academy of Pediatrics and the CDC recommend six months and I'll get the COVID vaccine. And again, there are very few risks that we've identified associated with the COVID vaccine.

43:34 What about the heart? Problem, right. I knew we would talk about that. So I'm going to, I promise I'm going to get there. But the vaccine has been demonstrated. I mean it's been a short amount of time. You know, at this point it's three years, but the IT has been demonstrated over and over and over again to prevent serious illness, hospitalization and death. And the people, young and old, who are still dying of COVID tend to be the unimmunized, the very old, the very young, the very sick, like an underlying medical condition.

44:15 But if you can minimize the risk that your child is going to end up in the hospital or dead by giving them the vaccine, give them the vaccine. With regards to the heart issue. So there have been incidents of sort of this inflammation around the heart about a week or two after administration of the COVID vaccine, more common in boys than girls, more common in teens than the younger children or the older young adults. The cases that have come up have been very mild. They've been treated, which is generally the treatment for inflammation around the heart is generally rest and ibuprofen which is Advil or Motrin and nearly all of the cases the child recovered and didn't have any long term heart issues.

45:14 Now, I always like to point out that many viral infections, the infection itself, can cause inflammation around the heart. Right? So. It's tough to differentiate what caused it, so you're a proponent of vaccinating. Is. For for COVID. I am, yeah. Here's another controversial one. There's an entity called Munchausen Syndrome by proxy, which I find to be fascinating and and bizarre at the same time. Can you tell us what that is and have you seen any cases of that? Oh. Sure. It is bizarre and fascinating, actually.

45:56 So Munchausen by proxy is really a mental health illness. Typically it's in the adult caregiver, usually a mother. And that caregiver fabricates symptoms in their child or actually induces symptoms in their child in order to seek medical care. And that caregiver is seeking attention. You know, like they want the attention of their caring for their child. The child is so sick it it's a very strange mental health illness. As pediatricians, we tend to use a different term for it that focuses less on the perpetrator, which is Munchausen by proxy is referring to the perpetrator and focus more on the child.

46:50 And we call it medical child abuse because it it is abuse of a child exactly. And then it puts our focus on the child more so than the person caring caring for the child. It's often very difficult to detect because the symptoms in the child are often real and nobody, ever, ever their first thought is never to think that a parent or a caregiver would be doing anything to harm their child. I've had a couple of instances over my few decades of practicing where it was suspected or discussed as could this be going on?

47:40 Never confirmed. And what we did was just reach out to mental health experts to help sort of navigate the parent, to help support the child, tease things apart a little bit. It's a It is a complicated and strange diagnosis, yeah. It's very bizarre and fascinating. As we said now you have a a unique type of private practice I mentioned in in Tribeca and Manhattan and and this is your website, right, The WMP and T care.com in New York City. Can you tell us how your practice is different and how it benefits your patients and their parents?

48:26 Oh, sure. So we have a very small boutique style practice or concierge practice. A lot of people tend to know that term more than boutique. I like to think of it as sort of old school medicine. Country Dr. meets all the sweet conveniences of New York City in, you know, the twenty 20s. We have a limited number of families in the practice and that enables me to really get to know each family well, spend a lot of time with each family at each visit, whether it's a check up for a well child or a sick visit to help do a lot of the things we talked about, coordinate care with specialists, talk to the medical team or not.

49:13 Patients in the hospital. All of our patients have my personal cell phone number and e-mail. If they have a question or concern. After hours they call, they get me. There's no third party that answers those calls after hours

49:31 and even the. Very dedicated and loyal to your patients. They they appreciate that. Thank you. I, I, you know, I started the practice when my children were young and I was having a hard time finding a pediatric practice that met my needs as a parent. You know, again you're. Not your kids pediatrician. I am not my kids pediatrician. You know, it's like the the old any lawyer that represents himself as a fool for a client, right? I mean, as my children have have gotten older, you know, I'm a little looser on the, you know, I'll prescribe the cream for that rash.

50:13 I'll look in your ear, but for the most part, you know, I think if you're caring for your own child, you worry too much about some things, not enough about other things. So, you know, I really created this practice because I couldn't find a practice that met my needs as a parent. And you know, there's dozens of well trained, clinically skilled pediatricians in New York City. So those aren't hard to find. What is hard to find are sort of the extras in a practice and what I'll call, for lack of a better term, almost like the customer service pieces.

50:57 So you know, being available to take a phone call, you know, on a holiday weekend, being able to see a patient on a holiday weekend, not having to wait when you come to the doctor's office when you call, having your doctor know who you are, what your your child's medical issues are without having to start from scratch. You know, I generally know who has asthma, who has a peanut allergy. You know, I might not remember if the child was 30 lbs or 40 lbs at the last visit, but you know, I know who they are.

51:32 You know, we even designed our our space in a way that I like to believe is is innovative in the sort of form meets function concept. It feels more like you've walked into my home than into a doctor's office. And we did that because I'm a big believer that coming to the pediatrician should not invoke fear in everybody. It should not make the parents anxious. It should not make the child anxious. It's an opportunity for parents to learn about health and Wellness of their child, for the child to learn about their own health and Wellness.

52:12 And if everybody's anxious, nobody can pay attention, nobody can think, nobody remembers their questions. So you know, we have a very sort of engaging and colorful and home like office. We have art on the walls and beautiful, you know, light fixture. I looked at your website. I noticed you also have a lab in your office, which I think is unusual, right? Usually you have to bring the kid to a hospital or a clinic or a laboratory. How does that work? We do, yeah. We have a lab on site and we run on site all of the routine testing for Pediatrics like all the general well visit labs and we now do a lot of these sort of sick visit labs.

52:57 So we've, you know everybody's become an expert in you know, PCR testing and COVID and flu. And so we can do you know PCR testing for strep flu, RSV, COVID and from 1 swab in the nose get 17 different PCRS in an hour. We have the same machine that a lot of the Ers. Use. You can tree quickly instead of waiting the day. Exactly. So we can make clinical decisions in real time, and that often can help a child get better faster. And it certainly helps with parental impatient anxiety being able to say, here's the diagnosis, here's the treatment plan before they ever walk out the door.

53:44 You mentioned strep. That's very important. Can you explain why it's important to diagnose and treat strep very quickly? Strep is a bacteria that that gives an infection. Absolutely. What is? What are other things that strep can do? Got it. So strep is a very common bacteria. Usually kids will present with sore throat and a fever. Sometimes a rash and strep is an infection that a healthy immune system can actually heal. Right The the child can actually feel better from strep without medication in a few days.

54:21 The reason we treat it is because untreated strep can actually result in heart disease, Rheumatic heart disease, which before the onset of antibiotic use for strep was the most common cause of childhood heart disease. And so I always tell parents, you know, sometimes they'll they'll call me on a Monday morning and say we were away for the weekend. You know, my child had sore throat and a fever for three days, but now feels fine. Do we need to come in? Yes, you still need to come in because we have a narrow window of time that we can treat that strep and prevent the heart disease later.

55:04 Right, so the immune system, while it's fighting the bacteria, the strep inappropriately, also attacks the heart. Valves, right, exactly. So that's why it's critical to treat that rapidly. It can also cause other types of conditions, like kidney problems. There's a new entity where it can cause some mental health problems as well. Also, it's sort of an autoimmune thing. So it's very important to treat Strep infections rapidly and for the duration of the antibiotic. And I always tell parents something that I think sometimes gets overlooked in a busier practice.

55:44 But 24 hours after starting that antibiotic, Change the toothbrush, wash the water bottle, throw out or wash anything else that's going in the mouth of mouth, guard or retainer, because otherwise they're going to just keep reinfecting themselves with the bacteria. Right. You don't develop permanent immunity to strep. You can get it repeatedly. Exactly. Now in addition to all the work that you're doing and all the time that you take care of your patients, you still found some time. To. Become a best selling author and you wrote this book.

56:21 It's called My Doctor book, The Not So Scary Adventures of Brothers Anderson and Riley. Can you tell us about this book and why you wrote it? I would love to. So Anderson and Riley are my sons. And when Anderson was about four years old, he asked me, mommy, what a doctors do. And he's also a very cerebral kid. Even then he is, now that he's 13, still cerebral. And I said, oh, I'm so glad you asked. Let me bring you to work with me. You can hang out with me for a day at work. And he said, well, Mommy, could you just read me a book that tells me what doctors do?

57:03 And I said, sure, I could do that too, but don't you want to come to work with me? He said, Could you please just read me a book? I said, OK, fine. So I went to get him a book about what doctors do and I couldn't find an age appropriate book that explained what, you know, a pediatrician Dr. does in in educational and engaging way. So I went to their preschool teacher and I said you guys probably have a good recommendation for this. You know a lot more of these you know, books for four year olds.

57:38 Where can I get a book that tells my 4 year old what pediatricians do? And they said, oh, we have a great one about what vets do. And I said, well, that's not really going to help. So as a little sort of hobby at night, I would just start writing in a in a a Rimey sort of Doctor Seuss way, you know, a little a stanza or two every night and read it to my son. And he loved it, and he kept asking for more. So I kept writing more. And the next thing you knew, we had a book. So. So we got it illustrated and published, and here it is.

58:19 Where? Where can people get this book if they're? Amazon you can get it. It's on Amazon, so it's my doctor book by Doctor Tiffany Otto that that's fantastic. Thank you. How long ago did you write that? About it, Well, let's see, the conversation started when he was four. I think by the time we had it together and published, he was probably about six. So, you know, Illustrated published and he's 13 now. So, so. It's been out a few years, so you sold millions of copies of. This, yeah, you know, my a lot of my patients know my children.

58:56 They hear me tell stories. My kids do come to work with me sometimes. And you know, I think they're my patients really like reading the book and it's fun and informative and I think. I looked at it earlier. The illustrations in here are amazing. Also, they're very entertaining, even if you don't read it, just looking at the illustrations. It's our our illustrator Martha Napier is incredibly talented and yeah, she did a beautiful job for us. I noticed she's also done work on your on your website, right?

59:31 She did, yeah. She designed our logo and designed our website. She's very talented. Well, this has been extremely great interview. I really enjoyed it. I learned a lot. I I think the audience will learn a lot as well and I really appreciate you taking time to come here today to speak with us. Thanks very much. Thank you so much for having me. Thank you for listening.