Prague pediatrician talks vaccines, screen burnout, and kids' mental health

Dr. Magdalena Kreimová is a certified Czech pediatrician with 20 years of experience in private clinics as well as the children’s ward at Prague’s Bulovka hospital. She recently joined the pediatric staff of My Clinic, a new medical center opening last year in Prague 6, with a pediatric department that specializes in comprehensive care from birth to age 18.

We spoke to Dr. Kreimová, Head of the Pediatrics Outpatient Clinic, about a number of trending topics from Covid vaccination to the biggest health threats facing kids today as well as how My Clinic is changing the narrative when it comes to children’s healthcare in the Czech Republic.

You have practiced pediatrics for 20 years both in state hospitals and private clinics. As a medical professional what appeals to you about My Clinic?

Being able to focus on the patient and building enough time into the appointment to talk about all of his or her concerns and, better yet, connecting that with care for the whole family. I get to spend more time reassuring parents who have a lot of questions about our smallest patients.

We also focus on preventative examinations which play a vital role in the healthy development of children and are performed annually.

I also enjoy working with foreigners as I find they are really open-minded! In general, I like to meet people from different cultures. I have patients from Israel and Pakistan and we can talk about what’s going on in the world.

You have had some interesting professional experiences that have allowed you to see the difference between medical approaches in the Czech Republic and elsewhere. For instance, with vaccination.

I've seen a lot of US citizens, including many of the employees of the US Embassy who were doing a different vaccination schedule. Here in the Czech Republic we now have a 6-in-1 “cocktail,” but in the US there are typically more injections administered into different parts of the body simultaneously or step by step.

Right now everyone is talking about Covid vaccination but I think that for most parents of small children, vaccination schedules are still on our minds.

In the Czech Republic vaccines are administered against nine childhood diseases: diphtheria, tetanus, whooping cough, Haemophilus influenza type b infections, poliomyelitis, hepatitis B, measles, mumps, rubella, and pneumococcal infections.

Compared with other countries, there are differences in age for when to give certain vaccines. There is a small age difference in when to give MMR, for instance.

Are there some vaccines that are mandatory here elsewhere but not here?

Some countries have obligatory vaccination with Prevenar. Pneumococcal vaccine is not mandatory here but parents can ask for it and be reimbursed by the insurance company. Most insurance companies will reimburse Prevenar. Children with full chronic conditions such as asplenia are fully covered.

I think these countries that make it obligatory are on the right path because they are seeing a decreasing number of kids with chest infections. I can say from my own observation at the hospital as well that vaccinated kids don’t have as many ear infections and there is a decreasing number of children with serious chest infections.

Also in the UK, for instance, they have meningococcal vaccination, starting before 6 months with three doses. They started to vaccinate the riskiest groups of babies there from 2 months of age.

What should you do if you started your vaccination in another country?

When you register with a GP here you bring your immunization records. The GP practice is responsible for looking at the immunization history and providing advice and/or vaccines to make sure that you and your child are vaccinated in line with the Czech program.

While you are living in the Czech Republic it is important to be protected against the infections that are a public health risk here. Some courses of vaccination that have been started overseas will also be completed by your GP here.

It makes sense here to talk about tick-borne illness in terms of public risk as the Czech Republic has a tick problem.

Many foreigners don’t realize we have so many ticks and they are very surprised when they find them on their children. I think above all it’s important to know how to get rid of ticks and also how to avoid getting them. We also need to learn to observe for signs that may develop after you’ve found one on the skin.

In terms of vaccinating, I’d encourage adults and parents to be vaccinated or the elderly who are at the highest risk for tick-borne illness. Encephalitis is of course very serious but statistically, is more likely to affect adults. But it’s really about your lifestyle; if you are outdoors a lot then you can get the vaccine from 12 months any time of year.

In Austria for instance, rates of encephalitis are much worse among families living in the mountains who drink unpasteurized milk. They have a high number of encephalitis cases so they have it on their vaccine schedule for children from 6 months.

Of course, now there is the Covid vaccine to consider. How are kids and their families responding to it?

It’s a tough question. I recently saw a patient, a twelve-year-old boy who didn't want to be vaccinated, but the family is traveling a lot and they were having to do a lot of testing.

So they came for a second opinion and to talk more about it. I showed him studies about adolescent boys and talked to him about the kids I’d seen with post-Covid in Prague’s Motol hospital who are very seriously ill. I think it’s important to make a decision about vaccination together with the doctor.

Aside from Covid what are some of the biggest health threats for kids these days?

Screen time is the biggest challenge not just for kids but parents. I see a lot of young parents who come in for their appointment and don’t put down the phone. There is a general lack of common time spent together, families don't talk - and all this screen time affects kids’ bodies negatively especially their weight.

This is one area where My Clinic can really help, correct?

Mental health specialists for children are a strong point of our facility. When I see kids who have problems that go beyond general care I can easily call my colleagues who are in the same place. We can also connect with ear, nose, or throat specialists, or endocrinologists.

We can also discuss diet and get the help of external specialists who can talk about this with kids and help them measure calories or write down a menu. We have a program for obese children with psychological support. We know that eat more because we are sad so there’s always more to it than just going on a diet.

So you provide mental health services as well?

Yes, and, unfortunately, good mental health specialists for children are hard to find in the Czech Republic. We are living in a strange time when kids are suffering mentally from the after-effects of Covid lockdown and for many reasons children increasingly need mental-health support.

Right now many hospital facilities in Prague are full and I have seen cases with young girls who are suffering from depression and self-harm and need care and there is no place for them. This is something that worries me, it's a symptom of the time.

Isn’t it true that there is a lack of pediatricians in the Czech Republic as well?

We don't have enough pediatricians practicing in our field. Our GP colleagues help and sometimes we need to refer kids from 15-19 to them. In general [in the Czech Republic]  we need to learn more about this age group.

Shifting to general care, can you talk a bit about the overall approach to pediatrics in the Czech Republic? I feel like Czech doctors are often very cautious.

It's good to see the child and observe the child and not to immediately prescribe medicine. I think in general we prefer to see the child more often. Many foreigners I see want to send their children to school right after an illness. I like to communicate. Check on the family. How does the child look? Is she eating and drinking? I try to find a middle ground.

How times have changed for pediatrics in general in the Czech Republic?

There is more participation from myself and my colleagues in international conferences. We can now hear experts from different clinics and universities talk about what works well in daily practice. We have the enrichment of facts and information. Not just in private practice but in state hospitals.

We also have better access to labs and technologies and know what is going on in the body within a couple of hours. Cooperation is deeper and synchronized between pediatrics and specialists and it is much easier to communicate.

Do you have any advice for families who move to Prague and are looking for a pediatrician?

I think parents should find a doctor that shows respect for them and their instincts and fears and are willing to provide detailed information about their children's care and conditions and their options for treatment. If you feel rushed or uncertain the first time you visit a pediatrician this is a red flag. We make sufficient time for communicating with the child and parents. Make an appointment with us for a talk. There is no obligation and the first visit is free.