Ask the Expert: Dr. John Cole

The Kalispell pediatrician answers questions about trends in pediatric care and how Montana's rural landscape impacts healthcare access for kids

By Beacon Staff

What trends are there so far this season with pediatric RSV and flu cases? How do you get treatment?

Pediatric influenza and respiratory syncytial virus (RSV) are viruses that spread year-round, but activity typically peaks in the fall and winter months. In Montana, the months of December through March are typically the peak for influenza and RSV infections due to the colder weather and being indoors in close proximity to others. The first case of influenza and RSV in Montana was during the month of October 2023, which is why it is important to get the annual influenza vaccine as soon as it comes out each year to prevent serious disease and hospitalization. It is a myth that waiting to get the influenza vaccine until later in the season will provide stronger immunity; in reality, an annual influenza vaccine given at the start of the season will provide the best protection to any infant, child or adult. Through Jan. 13, 2024, in the Flathead Valley, there have been five pediatric hospitalizations for influenza-related illness and we are nearing the peak of RSV visits in the clinic, ED, and hospital with hundreds of visits for infants and children in the Flathead Valley.

Pediatrician John Cole, MD, MS of Logan Health. Courtesy image

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How does Montana’s rural landscape impact healthcare access for kids? Has access in northwest Montana improved in recent years?

Montana is a very large state with pockets of pediatric care in the larger cities that leave large swaths of the state with little to no pediatric-specific access for kids, especially on nights and weekends after local clinics are closed. The 2020 census showed there were 235,070 children under the age of 18 living in Montana, with approximately 10% of those kids living in Native American reservations across the state. To address high risk populations and rural limitations for pediatric care due to lack of access for children, Montana pediatricians across the state have come together to create Montana Pediatrics, which is a novel telemedicine platform. This is a computer- or smartphone-based video-chat website that works by connecting families directly to a Montana pediatrician to provide evidence-based, high quality medical care by Montana pediatricians for Montana children. Montana Pediatrics has partnered with several local doctor offices, daycares, and shelters to provide 24/7 coverage including nights, weekends, and holidays for any pediatric advice, which alleviates the need for a child to miss school or a family member to drive hours to the emergency department or miss work to access pediatric care for their child.

Another focus of Montana Pediatrics is its partnership with the Fort Peck Tribe and Rocky Boy’s Reservation to improve health in their community by offering telemedicine pediatric care to their children during school days. A Montana pediatrician connects through a smart computer cart in the nurses office with an attached Bluetooth stethoscope (transmits heart and lung sounds) and otoscope (transmits video of the ears, nose, mouth and skin) that can be used to diagnose and treat many ailments affecting children in the school. This partnership increases timely access to a pediatrician when needed by meeting kids where they are in school and avoiding long drives to seek specialized pediatric care with less time for children missing school and parents missing work.

To learn more about Montana Pediatrics, please visit montanapediatrics.org.

As childhood obesity rates rise nationwide, what trends do you notice in northwest Montana? What treatments do you recommend?

Childhood obesity is a major problem for the United States, including the Flathead Valley, and we need to come together as a community with an all-hands-on-deck approach to support families and children with this epidemic. According to the 2021 Flathead County Community Health Needs assessment, based on height and weights reported by surveyed parents, 16.8% of Flathead County children age 5-17 are obese, which is slightly higher than the HP2030 target of 15.5%. Treatment for obesity should be realistic and supportive while modeling lifestyle changes for children that they can continue for the rest of their lives. Putting a child on a diet does not work in children, as diets are short-term fixes that often fail once the diet is over. Rather, working on lifestyle changes such as eating five servings of fruits and vegetables per day, exercising for 60 minutes per day, cooking and eating meals together as a family, not using food as a reward, and avoiding buying unhealthy food for the home (leave highly processed snacks and junk food on the shelfs at the grocery store) can be helpful. Most importantly, make sure your child has a primary care doctor and has an annual well-child exam to review their height, weight and BMI each year. Research shows that about one in eight children don’t get their annual well-child exams, especially in the teenage years, which is a missed opportunity to review height, weight and BMI along with discussing healthy lifestyle choices and preventing disease before it becomes a chronic debilitating disease such as diabetes, hypertension, stroke, or myocardial infarction. 

How are children in northwest Montana coping with depression? What treatments do you recommend?

Since the COVID-19 pandemic, the rates of childhood depression have skyrocketed across the entire country and Montana is no different. Montana has consistently ranked in the top five states in the nation for suicide per capita over the past 30 years and suicide is the second leading cause of death for those aged 10-24 years old. Data from the Youth Risk Behavior Survey (YRBS) in 2021 showed that 42% of high school students and 38% of middle school students in the Flathead Valley were depressed; 21% of high school students and 20% of middle school students in the Flathead Valley reported seriously considering suicide in the past year. These numbers are alarming and another reason why it is so important for a child to go to their annual well-child exams for depression screening and treatment options. The best treatment for depression in children is a combination of counseling (cognitive behavioral therapy) +/- medication such as an SSRI (selective serotonin reuptake inhibitor). Close follow-up and support with a licensed medical professional is critical to save lives and a suicide safety plan is recommended as well.

What vaccine outreach programs are available in the Flathead Valley?

The Flathead City-County Health Department (FCCHD) offers several vaccine programs throughout the year. Every October there is a flu clinic set up at the county fair buildings as well as Influenza + COVID-19 booster clinics at local businesses such as Bias Brewing, the Warming Center, and other pop-up vaccination clinics in Bigfork, Kalispell, Columbia Falls and Hungry Horse, usually listed on the Health Department website. The Health Department continues to offer the following vaccines and immunizations: Influenza, COVID-19, adult RSV, pediatric RSV, as well as all routine vaccinations. It also provides infectious disease counseling and immunization for international travel. Please contact (406) 751-8110 for more information about immunization clinics at the Flathead Health Department. 

Dr. John Cole, MD, has been a pediatrician in Kalispell since 2015 and has been the medical director for Flathead City-County Health Department since 2020.