Playing with kids is the best part of Dr. Trevor Kwok's job

By Louise Kinross

Dr. Trevor Kwok loves children, so when the Vancouver native matched to do a pediatrics residency in Toronto he was ecstatic. "It meant I could work with children as a career for the rest of my life," he says. "I was beyond happy." The residency opened Dr. Kwok's eyes to childhood disability, and he decided to do a fellowship in developmental pediatrics at Holland Bloorview. Last summer he graduated and was hired on as a developmental pediatrician, primarily assessing children for autism. We spoke about how he's settling into his new role during a pandemic.

BLOOM: What do you love about kids?

Trevor Kwok: It's their energy and they always surprise you, with the things they say or do. They give me a different perspective. As a teenager, I babysat for some extended relatives, and I also volunteered with children at different festivals. I would do the kids' craft stations. We also had the equivalent of the Ontario Science Centre in Vancouver, and I did hands-on presentations there with children. I knew I wanted to work with kids from a way back. 

BLOOM: What do you enjoy about working with kids with autism?

Trevor Kwok: One of the main joys from working with children with autism, or with any of the children I see in developmental pediatrics, is that I feel like we can have an effect on a child's and family's day-to-day function. I know how difficult a diagnosis of autism spectrum disorder can be for children and families, and my hope is that we're able to break down the stigma of this diagnosis and show children and families how they can be supported.

At a follow-up appointment, the parents of a child that I had diagnosed with autism talked about a family tradition they started during the pandemic of sharing three things that they're grateful for every day, as a way of highlighting the positives. During one of these discussions, their child said 'having autism' was one of the things they were grateful for. It brought a huge smile to my face.

Stories from families like this, where the family has accepted and is thriving with their diagnosis, make my work feel very meaningful.

BLOOM: What is a typical day like now?

Trevor Kwok: The majority of my clinical time is doing autism assessments. I also do a half-day a week in our neuromotor clinic, and a half day a month in our psychopharmacology clinic.

A typical day is juggling between in-person and Zoom appointments. We do three appointments as part of the autism assessment. The first is information gathering, the second is a play-based assessment, and the third is sharing what we saw and think, then providing our recommendations.

BLOOM: What are some of the challenges of evaluating a child virtually?

Trevor Kwok: Lots of things come with virtual assessments, both good and bad. The good thing is we're able to access a lot of families. I hear from other staff members that we may have less no-shows because it's easier for a family to participate from home rather than come in. 

With a virtual assessment, we need to coach the parent to do what we normally do. For example, we may ask the parent to take a container with a snack the child is interested in, but can't open, and ask the parent to give it to the child and see how the child requests for the container to be opened. Some parents feel a sense of empowerment in helping us do the assessment, and they feel their child is more comfortable at home and can be seen at their best. Because they see and interact with their child during the assessment, they may have better buy-in in terms of our recommendations. 

Of course, we have certain challenges too like if the camera angle isn't right, we can't see the child properly. But I feel we've all adapted to this new normal. If a family wants to come in, we can accommodate that. 

BLOOM: What's the greatest challenge of the job?

Trevor Kwok: Making sure the families feel that they're supported and heard. I come with an agenda to every clinical situation and it's making sure we hear what the family needs and wants and is hoping for. We need to allign our goals. What I learned from my training here was you always start with that as a base question: 'What do you hope to get out of this assessment?' Then at the end, I try to tie it back in by asking if I've addressed all of their concerns. 'Is what I shared in line with what you were hoping for?'

BLOOM: What's the greatest joy?

Trevor Kwok: Definitely the children. Our autism assessment is mainly a play-based assessment. I'm so lucky that playing with a child is part of my job. Sometimes I get on the floor with them. I get to make up stories and scenarios, and I get them to make up stories and scenarios. Being able to play and work with children is so much fun. 

BLOOM: What emotions come with the job?

Trevor Kwok: Mainly joy, and gratitude. I feel quite privileged to play this role in a family's and a child's life. A lot of times I feel like I learn from families. I learn from one encounter with a family, depending on what happens, in a way that I can apply in the future. Some days can be harder because they're longer or frustrating in some way. But just being able to see and interact with a child can completely change my mood. I think a lot of clinicians here feel the same way. 

BLOOM: Do you do anything special to manage stress?

Trevor Kwok: Having family and friends I can talk to and hang out with is nice. Of course that's harder with the pandemic. 

I have friends who are in health care, so it's nice to be able to talk shop a little with them.

I really like to eat, but I don't like to cook. Finding things to eat in Toronto has been interesting now that places have pivoted to offering take-out. I've been able to try a lot of four-star restaurants that are on Canada's Top 100 that I couldn't have afforded pre-pandemic. I love dessert. There's one bakery that I enjoy in Corktown that's French. They do cakes and cookies. I like trying new and different things. 

BLOOM: How do you like living in Toronto?

Trevor Kwok: It's been nice to identify places to go for hikes or walks or runs. I'm a fairweather runner. When the weather is not too cold or too hot, I'll go for a run. I live downtown and I like running by the waterfront. There are also lots of nice parks and ravines in Toronto. 

SickKids is obviously renowned, and Holland Bloorview is renowned as a rehab facility in Canada and North America. We have preeminent physicians here like Dr. Fehlings and Dr. Milo-Manson. So being able to train here and learn from everyone here in this collaborative environment has been great. 

BLOOM: We've been talking a lot about racism recently in health care and during the pandemic. Have you ever experienced it as a trainee or doctor, or do you hear from families about their experiences?

Trevor Kwok: I can't think of any direct thing I've experienced personally because of my race as a health-care provider. I do have families who have talked to me about how they feel that they get pegged a certain way because of their race, whether at their child's school or in interacting with other health professionals. 

BLOOM: If you could change one thing about children's rehab, what would it be?

Trevor Kwok: Thinking of ways to make it more accessible to everyone. Even though COVID has been really difficult, offering virtual care has made it more accessible. I think the other part would be to think about how we can be more equitable in how we deliver care and services to different populations. I'm very early in my career, but I know this is something we're addressing here right now. How can we better serve all types of families?

BLOOM: Has anything surprised you since coming on as staff?

Trevor Kwok: I think sometimes for our immigrant families, not knowing what they can access or how to advocate for themselves. Some services rely on self-referrals, so that can be a huge barrier when English isn't a person's first language. We have a lot of people here, like our social workers, who can support families, so it's identifying that there's a barrier and helping families to advocate.

BLOOM: What are your hopes for your work in the future?

Trevor Kwok: My hope is to continue to work across the breadth of developmental pediatrics, being able to continue with clinical work, like I do now, with children with neuromotor and neurodevelopmental differences.

I'm still just starting my career and am exploring specific areas of research interest. I was fortunate to work with Dr. Smile during my fellowship on a research project using virtual methods to deliver therapy for children with food selectivity and autism spectrum disorder. This, and the current state of the world, has me thinking more about virtual means to deliver health care—both with direct care to families and through knowledge translation to areas where developmental pediatric services are more scarce.

BLOOM: What advice would you offer clinicians just starting out?

Trevor Kwok: Trust yourself. You probably know more than you think you do. But also, know there are people with a wealth and breadth of expertise around you, and they're more than happy to help you out. Don't be afraid to reach out and use your mentors and supports if you have a difficult challenge or a question.