Clinical Updates

Expanding Access to Genomic Testing in Level IV Neonatal Intensive Care Units
Expanding Access to Genomic Testing in Level IV Neonatal Intensive Care Units 1024 575 Pam Georgiana
conceptual art of DNA

Recent study identifies variations in availability and highlights opportunities to improve access to genomic testing in the United States and Canada. In the Nationwide Children’s Hospital neonatal intensive care unit, patients needing rapid genome sequencing can get it on demand without administrative approval. However, that is not the case in all level IV neonatal intensive…

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Congenital Heart Disease and Extracardiac Phenotypes Associated With Novel Pathogenic Variant in GATA6
Congenital Heart Disease and Extracardiac Phenotypes Associated With Novel Pathogenic Variant in GATA6 1024 575 Jessica Nye, PhD

A study published in Pediatric Research describes a novel pathogenic variant in the gene GATA binding protein 6 (GATA6) associated with congenital heart disease (CHD), diabetes mellitus and necrotizing enterocolitis.   GATA is a family of transcription factors that encode zinc finger DNA binding proteins which are critical regulators during organogenesis. Pathogenic variants in three…

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Enhancing Intestinal Rehabilitation Workflow with Disease-Specific Documentation Tools
Enhancing Intestinal Rehabilitation Workflow with Disease-Specific Documentation Tools 150 150 Erin Gregory

Structured data entry not only reduces the amount of time physicians are spending in the electronic health record but also opens the door for new research. A recent study published in JAMA Pediatrics by Nationwide Children’s Hospital’s Ethan Mezoff, MD, Jennifer Lee, MD, and team has shed light on a promising solution to improve the…

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Treating Pediatric Melanoma: Ultrasound Surveillance vs. Completion Lymph Node Dissection for Sentinel Node Positive Patients
Treating Pediatric Melanoma: Ultrasound Surveillance vs. Completion Lymph Node Dissection for Sentinel Node Positive Patients 1024 683 Pam Georgiana

Treatments for pediatric melanoma are usually based on adult studies, but increasing recognition of the differences between pediatric and adult melanoma could change that. Pediatric melanoma is rare in the United States. The Skin Cancer Foundation reports that about 400 children under 20 years old are diagnosed with melanoma each year in the United States.…

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Novel Cause of Brain Mosaicism and Focal Epilepsy Identified
Novel Cause of Brain Mosaicism and Focal Epilepsy Identified 1024 575 Abbie Miller

In Nature Genetics, researchers report a novel mechanism for the origin of brain chromosomal mosaicism and link brain mosaic chromosome 1q gain to a distinct clinical phenotype.   In most people, every cell in their body contains the same genetic information. However, sometimes people can have two or more genetically different sets of cells. This…

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Increasing Same-Day Amoxicillin Graded Dose Challenges
Increasing Same-Day Amoxicillin Graded Dose Challenges 1024 683 JoAnna Pendergrass, DVM

A quality improvement initiative overcomes several barriers to de-labeling penicillin allergies. In a study published in The Journal of Allergy and Clinical Immunology: In Practice, a research team led by Margaret Redmond, MD, a pediatric allergist at Nationwide Children’s Hospital, reported on a quality improvement (QI) initiative that sustainably increased rates of same-day amoxicillin graded…

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Building Hope, Recovery, and Life Beyond Substance Use Disorder
Building Hope, Recovery, and Life Beyond Substance Use Disorder 1024 702 Abbie Miller

Five years ago, Pediatrics Nationwide dedicated its fall issue to a comprehensive look at the effects of the opioid crisis on children and families. At that time, Sarah Parker was working hard to stay sober, recovering from the very crisis holding the nation’s attention. Parker grew up in Chillicothe, Ohio, halfway between Portsmouth, Ohio, the…

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Whole Child, Whole Family Care
Whole Child, Whole Family Care 150 150 Abbie Miller and Jeb Phillips

Meeting the needs of children and caregivers with evidence-based programming and intentional support for access. Parenting a young child can be tough in the best circumstances. But when you overlay poverty, inequity, and concerns about employment and education on top of it, parenting a young child can feel overwhelming. Whitney Raglin Bignall, PhD, has dedicated…

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Tissue Engineered Trachea: State of the Research
Tissue Engineered Trachea: State of the Research 150 150 Lauren Dembeck

The promise of tissue-engineered trachea grafts is moving closer to the clinic, as recent preclinical studies have shown successful implantation and neovascularization. Breathing is an essential biological function that provides our bodies with the oxygen necessary for survival. However, most of us rarely think about the biological structures that make it possible. The trachea, commonly…

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Preventing Accidental Ingestion of Marijuana
Preventing Accidental Ingestion of Marijuana 1024 683 Abbie Miller

If you are a child, and you find a bag of fruit snacks — you don’t eat just one piece. The THC/marijuana products on the market today have an average of 10-20 mg in one serving. That’s one square of a chocolate bar, one gummy (which looks like a fruit snack) or one chip. “THC…

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User Experiences with Subcutaneous DMPA
User Experiences with Subcutaneous DMPA 1024 683 Mary Bates, PhD

Survey reveals high satisfaction among adolescents and young adults using subcutaneous DMPA. Depot medroxyprogesterone acetate (DMPA) is a progestin-only injectable contraceptive that is used as a birth control method and in the treatment of heavy or painful menstrual periods, endometriosis, and for menstrual suppression. DMPA can be injected intramuscularly or subcutaneously, with no difference in…

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Should You Offer Fentanyl Test Strips in Your Office?
Should You Offer Fentanyl Test Strips in Your Office? 150 150 Abbie Miller

Harm reduction approaches support the use of fentanyl test strips for individuals who are taking illicit substances but want to avoid fentanyl. Nichole Michaels, PhD, a principal investigator in the Center for Injury Research and Policy at Nationwide Children’s, is conducting two studies about the efficacy of offering and educating about fentanyl testing among adults.…

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Combined Pediatric-Adult Anticoagulation Program Exceeds Goals
Combined Pediatric-Adult Anticoagulation Program Exceeds Goals 1024 580 Mary Bates, PhD

The program achieved excellent quality of anticoagulation therapy in children and adults. The goal of most anticoagulation programs is to improve the care of adult patients on warfarin therapy, specifically by treating and preventing thromboembolic events while minimizing bleeding risk. In a new study, researchers from Nationwide Children’s Hospital report excellent outcomes for a combined…

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Recognizing the Benefits of Music and Massage Co-therapy in Pediatric Palliative Care
Recognizing the Benefits of Music and Massage Co-therapy in Pediatric Palliative Care 1024 680 JoAnna Pendergrass, DVM

For adolescent patients in home-based pediatric palliative care, co-treatment with music therapy and massage therapy benefits both the patients and their families. A case study recently published in Music & Medicine reported the benefits of co-treatment with music therapy and massage therapy for a patient in home-based pediatric palliative care. Complementary therapies, such as music…

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QI Initiative Reduces Emergency Room Visits for Functional Constipation
QI Initiative Reduces Emergency Room Visits for Functional Constipation 1024 683 Katie Brind'Amour, PhD, MS, CHES

Preliminary data from a large accountable care organization’s quality improvement efforts suggest advanced care visits dropped 27% in two years. Partners For Kids (PFK), the nation’s oldest and largest pediatric accountable care organization, launched a series of quality improvement (QI) projects targeting disease management strategies that could significantly impact healthcare utilization and outcomes for children…

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Ensuring Vulnerable Babies Receive the Benefits of Human Milk
Ensuring Vulnerable Babies Receive the Benefits of Human Milk 1024 575 Mary Bates, PhD
small baby with nose canula

A QI project increases human milk consumption among newborns hospitalized with congenital heart disease. The American Academy of Pediatrics and the World Health Organization recommend human milk for infants because of its important health benefits. However, most newborns with congenital heart disease (CHD) are separated from their mothers shortly after birth and admitted to a…

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Safe, Minimally Invasive Upper Urinary Tract Surgery for Infants
Safe, Minimally Invasive Upper Urinary Tract Surgery for Infants 1024 575 Patti Doud
small baby with nose canula

Evidence supports robotic surgery as a safe approach to upper urinary tract procedures in infants 6 months or younger. While robotic surgery has risen in popularity and feasibility for procedures in both older children and adults alike, there has been little data to determine whether it’s a safe possibility for young children and infants. But…

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Ask A Specialist: What Are the Recommendations for Sexually Transmitted Infections (STI) Screening in Primary Care?
Ask A Specialist: What Are the Recommendations for Sexually Transmitted Infections (STI) Screening in Primary Care? 1024 575 Cynthia Holland-Hall, MD
Teen girl with backpack

STI screening is recommended for all sexually active adolescents. According to the American Academy of Pediatrics, nearly 1 in 4 teens have an STI. Safe sexual practices and routine screening can prevent these infections – that’s where health care providers come in. By offering routine testing for all sexually active teens in addition to safe…

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Fertility Concerns in Boys and Men With Sickle Cell Disease
Fertility Concerns in Boys and Men With Sickle Cell Disease 1024 575 Mary Bates, PhD
Color photo of Black father holding infant on shoulder in front of nursery background with clouds on the wall

Sickle cell disease and its treatments may impact fertility, but more research is needed to help counsel this population. Sickle cell disease (SCD) affects approximately 100,000 Americans, most of whom belong to underserved, minority populations. Advances in disease-modifying therapies, such as hydroxyurea, have led to better clinical outcomes. However, as more individuals with SCD survive…

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Assessing Respiratory Stability in Infants Hospitalized with Bronchopulmonary Dysplasia
Assessing Respiratory Stability in Infants Hospitalized with Bronchopulmonary Dysplasia 1024 683 Mary Bates, PhD

The Behavioral Signs of Respiratory Instability Scale is a valid, reliable measure of respiratory status and developmental ability. In a new study, researchers at Nationwide Children’s evaluated the Behavioral Signs of Respiratory Instability (BSRI) Scale, which was developed as an objective measure of developmental capacity of infants with severe forms of bronchopulmonary dysplasia (BPD). The…

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Home Infusions of Infliximab for Inflammatory Bowel Disease
Home Infusions of Infliximab for Inflammatory Bowel Disease 1024 683 Mary Bates, PhD

With a standardized care approach, home infusions may be an effective alternative to hospital-based infusions. Pediatric inflammatory bowel disease (IBD) is often treated with infusions of infliximab in a hospital setting. However, these can be costly and present time and travel barriers to patients and their families. Due to these considerations and recent insurance mandates,…

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Expanding Use of Trikafta for Cystic Fibrosis to Patients as Young as 2 Years Old
Expanding Use of Trikafta for Cystic Fibrosis to Patients as Young as 2 Years Old 1024 683 Karen McCoy, MD
Smiling boy outside

When I first started my pulmonary training, the average life expectancy in the United States was about 70 years, and the average life expectancy for someone with cystic fibrosis (CF) was 14 years! Intense study and pursuit of consistent care across the country yielded improvements. By 2010, with standards of treatment very consistent and implementation…

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Implementation Science to Expand Contraception Access for Adolescents Hospitalized with Mental Health Issues
Implementation Science to Expand Contraception Access for Adolescents Hospitalized with Mental Health Issues 1024 575 Pam Georgiana
Black and white image of teen girl posing outside

Research has documented that adolescents with mental health concerns have a higher need for contraceptive counseling and care because they are at a higher risk for unintended pregnancy.[i] [ii] Unintended pregnancies can make mental health symptoms worse, especially depressive symptoms. [iii] Counseling and use of contraceptives are simple evidence-based strategies to reduce unplanned pregnancies. However,…

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Exploring Disordered Eating Beyond Binge Eating in Youth with Obesity
Exploring Disordered Eating Beyond Binge Eating in Youth with Obesity 150 150 JoAnna Pendergrass, DVM

Youth with obesity can suffer from various disordered eating behaviors beyond binge eating. A holistic approach to caring for these youth can help improve their long-term physical and psychological health outcomes. A literature review recently published in Nutrients shed light on eating disorders beyond binge eating in youth with obesity. In this review, Eileen Chaves,…

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Ask A Specialist: What Running Distances Are Safe for Children?
Ask A Specialist: What Running Distances Are Safe for Children? 1024 895 Gabriella Gonzales, MD and James MacDonald, MD, MPH

Sports Medicine experts offer advice for pediatricians about what age it is appropriate for children to run and train for races such as the 5K, 10K, half marathon and marathon. Running is a great activity! It requires very little equipment and can be done individually or with a team. Running can be beneficial for children…

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Is Growth Hormone Replacement Safe Following Central Nervous System Tumors?
Is Growth Hormone Replacement Safe Following Central Nervous System Tumors? 1024 683 Mary Bates, PhD

Research suggests the benefits of growth hormone therapy outweigh the risks for pediatric cancer survivors. In a new review paper, researchers from Nationwide Children’s Hospital evaluated the risks and benefits associated with administering growth hormone to pediatric patients after diagnosis of a central nervous system tumor. The authors conclude that the therapy has many important…

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Does Etiology Impact Outcomes After Hemispherectomy?
Does Etiology Impact Outcomes After Hemispherectomy? 1024 575 Jessica Nye, PhD

Patients with cerebral palsy (CP) who have comorbid medically intractable epilepsy (MIE) had similar quantitative functional and seizure outcomes following functional hemispherotomy (FH) or anatomic hemispherectomy (AH), regardless of vascular or dysplastic MIE etiologies.   Early onset seizures are a common comorbidity in CP, affecting between 30% and 50% of patients. Among the patients with…

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An Alternative Method for Diagnosing Central Adrenal Insufficiency in Newborns
An Alternative Method for Diagnosing Central Adrenal Insufficiency in Newborns 1024 683 Mary Bates, PhD
Baby in NICU

Researchers evaluate the utility of random cortisol levels to diagnose adrenal insufficiency. In infants with central adrenal insufficiency, adrenocorticotropic hormone (ACTH) fails to signal to the adrenal gland, leading to decreased cortisol levels. It is a potentially life-threatening condition requiring urgent diagnosis and treatment. Diagnosing central adrenal insufficiency typically involves a low-dose synthetic ACTH (cosyntropin)…

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Creatine Supplements and the Youth Athlete
Creatine Supplements and the Youth Athlete 945 825 Natalie Wilson

Researchers at Nationwide Children’s Hospital found there is insufficient evidence that creatine supplementation is effective for consistently improving athletic performance in adolescents. They also identified a gap in knowledge of the long-term effects of creatine supplementation in this population. Creatine is naturally found in skeletal muscle and acts as an energy source during muscle activation.…

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Understanding and Implementing the Latest Recommendations for Asthma Management
Understanding and Implementing the Latest Recommendations for Asthma Management 770 513 Emily Siebenmorgen

New guidelines for the care and treatment of asthma in children were released in 2020, but implementation has been slowed by the pandemic and need for education. An estimated 8% of children had asthma in 2020, and it continues to have a significant impact in the lives of many kids. It interferes with their sports…

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Kidney Support for Babies: Building a Comprehensive and Integrated Neonatal Kidney Support Therapy Program
Kidney Support for Babies: Building a Comprehensive and Integrated Neonatal Kidney Support Therapy Program 1024 575 Lauren Dembeck
Nurse caring for infant in Neonatal Intensive Care Unit (NICU)

Kidney support therapy (KST), commonly referred to as dialysis, is a life-saving procedure used to manage complications associated with acute kidney injury and kidney failure, such as fluid overload and electrolyte imbalances, or to remove toxins, such as those in patients with inborn errors of metabolism. Most KST or dialysis machines are designed for adults…

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Evaluating Chronic Constipation and Abnormal Colonic Motility in Children With Autism Spectrum Disorder
Evaluating Chronic Constipation and Abnormal Colonic Motility in Children With Autism Spectrum Disorder 1024 680 JoAnna Pendergrass, DVM
Close up color photo of little boy holding hands on his belly

In children with chronic constipation, rates of abnormal colonic motility are similar between children with and without autism spectrum disorder (ASD). For children with ASD, symptom duration and soiling due to fecal retention are risk factors for abnormal colonic motility.   Treating constipation in children with autism spectrum disorder (ASD) is challenging because of feeding…

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1 Year In, the Molecular Characterization Initiative Has Analyzed Samples From Over 1,000 Patients
1 Year In, the Molecular Characterization Initiative Has Analyzed Samples From Over 1,000 Patients 1024 614 Abbie Miller
abstract art of magnifying glass over DNA strand

Data from the analysis helps clinicians confirm diagnoses and identify targeted treatments. The data also support new pediatric cancer research through the National Cancer Institute’s Childhood Cancer Data Initiative.   The CCDI Molecular Characterization Initiative (MCI) is a project that aims to collect, analyze and report clinical and molecular data and is currently supporting Children’s…

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What Pediatricians Need to Know About Lymphedema in Pediatrics
What Pediatricians Need to Know About Lymphedema in Pediatrics 150 150 Abbie Miller

Lymphedema is chronic, progressive swelling caused by maldevelopment or disruption of the lymphatic system. Typically, patients present with an asymmetric swelling of an arm or leg that progressively worsens. Min-Jeong Cho, MD, a microsurgeon and assistant professor at The Ohio State University and Nationwide Children’s Hospital, says that lymphedema affects more children and teens than…

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Investigating Caregiver Disclosure of Pediatric Urologic Surgery
Investigating Caregiver Disclosure of Pediatric Urologic Surgery 1024 575 Mary Bates, PhD
Toddler playing with toys

A survey reveals most caregivers plan to disclose urologic surgery to their child but would like more guidance from providers. Some pediatric urologic surgeries are performed early in childhood and with short-term follow-up. When children have surgery before the age of memory formation, it is up to their caregiver to disclose this surgery to them.…

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Evolution of the Youth Crisis Stabilization Unit
Evolution of the Youth Crisis Stabilization Unit 1024 538 Mary Bates, PhD

An alternative to inpatient hospitalization for youth experiencing a mental health crisis and their families sees success at Nationwide Children’s.   The Youth Crisis Stabilization Unit (YCSU) is an inpatient psychiatric setting at Nationwide Children’s for children and adolescents experiencing a mental health crisis. Over the last 12 years, the YCSU has grown from a…

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Deep Brain Stimulation Ameliorates Symptoms of Genetic Movement Disorder
Deep Brain Stimulation Ameliorates Symptoms of Genetic Movement Disorder 150 150 Mary Bates, PhD

First report of DBS for management of tremor in a treatment-resistant AIFM1-related disorder.   In a new case series, researchers from Nationwide Children’s report using deep brain stimulation (DBS) to help manage tremor due to a genetic movement disorder in two brothers. The report, published in the journal Pediatric Neurology, suggests DBS may be useful…

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Social Needs Associated with Postpartum Depression
Social Needs Associated with Postpartum Depression 1024 683 Mary Bates, PhD

Screening for social needs at pediatric well-checks may help identify vulnerable mothers. In a new study, researchers from Nationwide Children’s found a significant relationship between self-reported social needs and postpartum depression symptoms of mothers screened in pediatric primary care clinics. The findings suggest that social needs could be targeted concurrently in future interventions addressing postpartum…

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Comprehensive Care Model and Integrated Sickle Cell Disease-Pulmonary Clinic Improves Access and Outcomes
Comprehensive Care Model and Integrated Sickle Cell Disease-Pulmonary Clinic Improves Access and Outcomes 1024 683 Jessica Nye, PhD

A comprehensive care model which incorporates pulmonology services in the sickle cell disease (SCD) clinic aims to reduce access barriers and improve outcomes.   “Our sickle cell clinic at Nationwide Children’s Hospital used to see patients just for their comprehensive [sickle cell] care. One of the biggest morbidities and causes for mortality in patients with…

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Advancing Genomics-Driven Precision Medicine in the NICU
Advancing Genomics-Driven Precision Medicine in the NICU 1024 683 Natalie Wilson

According to the Children’s Hospitals Neonatal Consortium, as many as half of newborns hospitalized in level IV neonatal intensive care units (NICUs) due to critical illness have an underlying genetic condition. Most don’t get their diagnosis for months or even years. However, clinical assays, new testing modalities and clinical trials are improving their care. Advanced…

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Intraoperative Evaluation of Penile Blood Flow During Bladder Exstrophy
Intraoperative Evaluation of Penile Blood Flow During Bladder Exstrophy 150 150 Mary Bates, PhD

Laser angiography technology allows for real-time measurements of penile perfusion during exstrophy repair operations. In a new pilot study, researchers from the Pediatric Urology Midwest Alliance (PUMA) demonstrated that intraoperative laser angiography is a safe and easy method to evaluate penile perfusion during bladder exstrophy closure. The optimal technique for repair of bladder exstrophy in…

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Ask a Specialist: When Should Primary Care Providers Refer Dental Injuries to the Emergency Department?
Ask a Specialist: When Should Primary Care Providers Refer Dental Injuries to the Emergency Department? 150 150 Ehsan N. Azadani, DDS, MS

An expert reveals the most common red flag dental injuries that should be referred to the ED and what precautions PCPs can take before sending the child.   The most time-sensitive dental injury is the avulsion of a permanent tooth; that is, when the permanent tooth is completely knocked out of its socket (and the…

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Improving Outcomes for Infants and Children With Congenital Hypothyroidism
Improving Outcomes for Infants and Children With Congenital Hypothyroidism 1024 575 Mary Bates, PhD
Toddler playing with toys

A quality improvement project identifies high-risk patients and ensures they receive necessary care.   Congenital hypothyroidism (CH) is one of the most common preventable causes of intellectual disability. In the United States and many other countries, newborns are tested a 24-72 hours after birth for CH as part of standard screening tests. This condition must…

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Reducing Opioid Prescriptions for Common Pediatric Urologic Procedures
Reducing Opioid Prescriptions for Common Pediatric Urologic Procedures 1024 682 JoAnna Pendergrass, DVM
smiling baby being held up by an adult

To address the national opioid epidemic, clinician-scientists developed a quality improvement initiative to achieve significant, long-term reductions in opioid prescriptions after common pediatric urologic procedures.   Opioids are commonly prescribed for pediatric urologic procedures. However, studies have reported a troubling practice of overprescribing opioids in pediatric health, contributing to the ongoing opioid epidemic. “There is…

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Multidisciplinary Treatment for Is Effective for Patients With Rumination Syndrome
Multidisciplinary Treatment for Is Effective for Patients With Rumination Syndrome 150 150 Jessica Nye, PhD

Tiered, multidisciplinary behavioral treatment is effective at improving symptoms of rumination syndrome (RS) among children and adolescents, even in the outpatient setting.   Children with RS present with repeated, effortless regurgitation of undigested food. Although limited data about treatment are available, previous studies have indicated that inpatient treatment can improve outcomes among pediatric patients with…

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Pediatric Obesity Can Be Treated Safely and Effectively
Pediatric Obesity Can Be Treated Safely and Effectively 1024 575 Abbie Miller

New guidelines from the American Academy of Pediatrics emphasize evidence for safe, effective treatment of pediatric obesity for long-term benefit of children and adolescents.   More than 14.4 million U.S. children and adolescents have obesity, making it one of the most common chronic conditions facing American youth and families. Obesity is a chronic disease associated…

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Addressing the Clinical Challenges of Caring for Children with Cystic Fibrosis and Autism Spectrum Disorder
Addressing the Clinical Challenges of Caring for Children with Cystic Fibrosis and Autism Spectrum Disorder 150 150 JoAnna Pendergrass, DVM

A recent study sheds light on the unique clinical challenges faced by children with cystic fibrosis and autism spectrum disorder and offers potential solutions to these challenges.   Cystic fibrosis (CF) and autism spectrum disorder (ASD) pose significant clinical and emotional burdens to patients and their families. A concurrent CF-ASD diagnosis presents even greater challenges, but…

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5 Things Neonatologists Should Know About Vitamin K Deficiency
5 Things Neonatologists Should Know About Vitamin K Deficiency 1024 683 Mary Bates, PhD

Vitamin K prophylaxis is safe and effective. Why are more parents refusing it, and what can be done? In a new perspective paper in the Journal of Perinatology, researchers from Nationwide Children’s say that vitamin K prophylaxis is an essential component of newborn care and yet, parental refusal of the intervention is on the rise.…

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The PROMISE Program Reduces Cardiac Arrests in High-Risk Patients
The PROMISE Program Reduces Cardiac Arrests in High-Risk Patients 600 400 Mary Bates, PhD

This proactive quality improvement initiative improved outcomes for high-risk pediatric cardiology patients undergoing cardiac intervention. Faculty within The Heart Center at Nationwide Children’s recently initiated proactive risk mitigation strategies to reduce post-procedural cardiac arrests in high-risk congenital heart patients. In a new paper, the team used quality improvement methodology to show that their efforts resulted…

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Using 3D Motion Capture Technology to Improve Outcomes
Using 3D Motion Capture Technology to Improve Outcomes 150 150 Mary Bates, PhD

  Kirsten Tulchin-Francis, PhD Kirsten Tulchin-Francis, PhD, joined Nationwide Children’s in March 2022 as director of orthopedic research and director of the Honda Center for Gait Analysis and Mobility Enhancement. In a Q&A, she discusses how she uses motion capture technology to improve outcomes for pediatric patients. What is your area of expertise? I have…

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