The formative years is the time when a child becomes the person they will grow to be. But it’s also when many health concerns arise.
Q&A: Yegappan Lakshmanan
After a skillful operation, Dr. Yegappan Lakshmanan helped save the life of a 22-hour-old infant with a rare birth defect. Lakshmanan, who is the specialist in chief at DMC Urology Children’s Hospital of Michigan in Detroit, is a 2019 Excellence in Care Award winner. Read more about the honor, here.
Hour Detroit: Why did you choose to specialize in pediatric urology?
Yegappan Lakshmanan: I stumbled upon urology during my training in the U.K. Then, when I moved to the U.S., I had the opportunity to work with some giants in the field of pediatric urology, and I was smitten. It’s important work. What I do for a child now will affect the rest of their life.
Why do you continue with this work?
YL: Taking care of a child with a major defect from the time of birth and getting them to a point where they can function as normal young adults is very rewarding.
What is your favorite thing about what you do?
YL: Interacting with children and like-minded people all day is a joy!
What are the biggest urological issues you see in the children you treat?
YL: One of the common problems we encounter in the era of social media and handheld devices is the frequent neglect of basic elimination habits and hydration (in other words, not peeing and pooping enough or drinking enough) — this leads to common problems such as urinary and fecal incontinence, UTIs, scrotal pain, and in some advanced situations, kidney problems.
What are some things parents can do to keep those problems at bay?
YL: Make sure their children pee seven times a day at regular intervals, poop daily without straining, and stay hydrated.
What does receiving the Excellence in Care Award mean to you?
YL: It inspires me to do better. I know what I do is important, and I know others think so, too.
Many Children and Teens Struggle With Invisible Illnesses in the Formative Years
While Dr. Karen Alton sees plenty of healthy kids, as a physician who specializes in asthma, developmental pediatrics, and children with special needs, she shares that she also sees “higher rates of behavioral problems.”
“Common issues are kids who are on the spectrum; who have global developmental delays, primarily due to underlying autism; or who have difficulty with mood regulation,” says Alton, who practices pediatrics at Ascension St. John Hospital in Detroit. She’s also the director of adolescent health at the hospital.
And because kids with special needs may be more likely to also experience chronic issues such as asthma and obesity, they get bullied, which sometimes leads to depression and anxiety, even in children as young as age 6.
Alton says that she often refers families to the Wayne Children’s Healthcare Access Program Fit Kids 360 program. “They do really great work with parents and kids on food and nutritional issues and promoting physical activity. It’s a really comprehensive program focused on positive youth development and helping kids find their strengths.”
She also advocates for services with school providers and social workers, and finds counselors who can assist with parenting strategies.
Teens are having behavioral issues, too. And anxiety, depression, and non-suicidal self-injury (such as cutting) are quite common. The source? Often: self-imposed stress.
“They have very, very high expectations of themselves. If they get a B, they are devastated. There’s this expectation that I should be an excellent student, volunteer, play three sports, work, and play a musical instrument so I can get into college.”
“Really poor sleep” due to packed schedules is a contributing factor. So too is social media. “While some social media is positive, some is really negative.” Instances of kids being humiliated by private images shared by others throughout their school are examples of the problematic sides of social media.
A possible prescription to these issues — aside from more sleep: “We do need time together, face-to-face, off the electronics,” she says. “Kids and teens really do want to spend time together as a family. We’re pretty disconnected and that can be stressful.”
Beaumont’s Center for Human Development Diagnoses and Treats Children Who Struggle With Developmental Disorders
When children ages 6 to 18 visit Beaumont’s Center for Human Development, it’s often due to academic issues that tend to surface while learning to read or do math, says the center’s medical director, Dr. Stefani J. Hines, a developmental-behavioral pediatrician.
“If it is the child’s first time coming in, parents are usually concerned about the impact on the child’s education,” Hines says. Some behavioral issues including “sitting still, paying attention or being impulsive” may also be at play.
While these can be early signs of disabilities, “a big diagnosis in this age group is ADHD, learning disabilities, and autism,” of which there are three types, she notes — inattentive, hyperactive, impulsive, and combined. Since ADHD doesn’t always present stereotypically, especially the inattentive type, “parents can be confused if the kids aren’t hyperactive.”
Another potential diagnosis is autism — but “more mild and high-functioning. Children who have broadly normal intelligence but difficulty navigating the social environment at school, missing out on social cues, and that’s when they start having difficulties.”
That includes reading comprehension issues not necessarily evident until the third or fourth grade. “They have a hard time drawing inferences or not taking things so literally,” Hines says.
As part of the center’s comprehensive evaluation, they often invite teachers or social workers from the child’s school to brainstorm solutions alongside Hines and other staff members such as a child psychologist or speech pathologist.
“I really like our approach,” she says. “There aren’t many places that take our interdisciplinary approach. ”
Taking time to “put all of the pieces of the puzzle together” is crucial. So are the one-on-one interactions Hines has with both the children and the parents. “I really enjoy having the time to work with the kids and talk to parents.”
Parents are generally relieved after they meet and remark “feeling heard,” Hines says. “Parents are usually glad — even if we [can’t quickly identify what’s going on], we have a sense of what path we need to head down for treatment.”