Mahaska Health Pediatrician Explains Why Consistent Care Matters as Children Grow

Dr. Holly Van de Voort, MD, FAAP

OSKALOOSA, Iowa — Pediatric care involves much more than treating sick children.

In an interview with the Oskaloosa News, Holly Van de Voort, MD, FAAP, a pediatrician at Mahaska Health, talked about the importance of having regular well-child visits, developmental screenings, early intervention, and consistent care from infancy until the teenage years.

Van de Voort was born in Pella and, when she was in grade school, moved to Georgia with her family. She did her undergraduate studies at Mercer University in Macon, Georgia, and went to medical school at the Medical College of Georgia in Augusta. She also finished a three-year pediatric residency in Augusta.

Following her residency, Van de Voort held a number of instructor positions, such as that of clinic attending physician and hospitalist attending physician. She then carried out her work in private practice in Tennessee and Georgia before going back to Iowa, and in the end took up a pediatric post with Mahaska Health in Oskaloosa.

Working With Children and Parents as a Team

She said that it is important for parents to realize that child care is a partnership which involves the child, the family and the medical provider.

Van de Voort said that he likes to make certain that we’re all on the same team.

She stated that when giving her medical opinion, she also takes the parents’ ideas and concerns into account. When dealing with younger children, she makes an effort to get down to their level and speaks directly to them so that they know she is there to help.

Van de Voort stated that pediatricians give various kinds of care as children grow, such as routine well-child appointments, treatment for illnesses, and continued care for long-term conditions like asthma, ADHD, anxiety, and depression.

Why Well-Child Visits Matter

Van de Voort stated that children have a number of well-child visits during their first year of life, and these appointments allow the healthcare providers to monitor their growth and development even if the child seems to be in good health.

In early childhood, providers keep an eye on developmental milestones and might suggest early intervention or therapy if there are any concerns. When children are nearing school age, the providers also look at school readiness and possible learning difficulties. In the middle school and teenage years, providers can talk about social pressures, anxiety, depression, and other mental health issues.

Well-child visits can involve developmental screenings, screenings for autism at particular ages, checks for depression in older children, talks regarding vaccinations that are needed, and a look at the child’s growth chart. According to Van de Voort, the visit consists of a comprehensive examination of the child’s general health.

She added that if the same medical practitioner is seen over a period of time, the practitioner will be able to know what is normal for a particular child.

As Van de Voort pointed out, it is important to have the same provider because they witness the child through each stage.

Familiarity is particularly useful in the case of a child who is ill or has a complicated medical history since the child’s regular doctor is more likely to know their health record, normal behavior, and any signs which might indicate the need for further treatment.

Watching Developmental Milestones

Van de Voort stated that providers keep an eye on things to ensure that babies and young children continue to make progress towards various developmental milestones, such as rolling over, sitting, crawling, and walking.

She stated that all children do not attain those milestones at the same age; for instance, the average child starts to walk at about 12 months, whereas some may not walk until approximately 16 months.

The greater worry arises if a child’s development comes to a halt or if they lose a skill that they had earlier.

“But we get concerned when they stop progressing, or even worse, regressing,” Van de Voort said.

Knowing When a Sick Child Should Be Seen

Van de Voort stated that parents frequently have to make the decision of whether a sick child should receive medical care or whether they can instead be kept under home observation.

She stated that parents should get in touch with a medical provider if the fever continues for more than five days, does not reduce with normal medication, or keeps increasing. She also said that a fever appearing without symptoms such as a cough or a runny nose may require evaluation since another condition, for example a urinary tract infection, could be the cause.

Another reason to see a doctor is ear pain, particularly if it wakes a child during the night; children who have been exposed to strep throat and who now have a fever and a sore throat may also require testing.

Managing Long-Term Conditions

As Van de Voort pointed out, effective care for children who have ADHD and other chronic conditions will need the cooperation of the medical provider, the parents and the teachers.

ADHD care might involve the use of medication, but it is not confined to that alone. It is also important to consider the classroom environment, communication, and finding out which methods work best for each individual child.

Parents and teachers should inform the medical provider of what they are observing, since this information could indicate whether the medication is having the desired effect or instead causing side effects like increased irritability, anxiety, or behavioral issues.

Building Healthy Habits Through Small Changes

Van de Voort stated that when talking about nutrition, exercise, and growth, the emphasis should be on promoting healthy habits rather than making children feel embarrassed or judged.

She talks about aims like eating five portions of fruit and vegetables each day, having sufficient dairy and water, getting enough sleep, spending less time in front of screens, and carrying out about an hour of physical activity each day.

The first step is to assess whether the child and the family are ready to make changes; rather than setting a goal which might seem impossible, she advises families to start with something smaller and more realistic.

“What small change do you think we could be successful at changing?” Van de Voort said.

For instance, she suggested that a child who drinks several cans of pop each day should begin by slowly decreasing the amount rather than attempting to give up altogether. Achieving early success can then encourage either the child or the family to make another move.

Trust Becomes More Important During the Teen Years

Van de Voort pointed out that having a long-term relationship with the same provider becomes particularly important when children enter adolescence and have to deal with more emotional and behavioral issues.

A child who knows and has trust in a caregiver will probably be more inclined to talk about feelings of anxiety, difficulties at school, and other personal issues.

“Whenever they know you and trust you, the child will be more open and honest,” Van de Voort said. “If you do not obtain honest answers, then you can’t really deal with the problem.”

Therapy and Early Intervention Services

Van de Voort stated that Mahaska Health provides speech therapy for children who have speech delays or difficulty speaking clearly and that occupational therapy can also be of help to children with sensory issues, ADHD, fine-motor skills, and some gross-motor needs.

She emphasized the need to start therapy as early as possible when a possible developmental problem is detected.

Sports Physicals and Annual Exams

Van de Voort stated that a sports physical can be carried out as part of the adolescent’s annual well-child examination.

The visit involves a physical examination as well as a review of the child’s medical and family history, and the healthcare providers also look for any possible heart problems, past concussions, and other warning signs that might influence whether or not the student can safely take part in sports.

By combining the sports physical with the annual well-child visit, the provider is able to carry out the sports review as well as look at the student’s general physical, developmental, and emotional health.

Van de Voort stated that by providing regular care, pediatric providers are able to get to know children when they are healthy, notice any changes when the children become ill, and offer support to families at each stage of a child’s development.