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Primary Care

Perceptions About Type 2 Diabetes Differ Among Adolescent Patients, Parents and Physicians
 Perceptions About Type 2 Diabetes Differ Among Adolescent Patients, Parents and Physicians 1024 683 JoAnna Pendergrass, DVM
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Differing perceptions about type 2 diabetes among teens, parents and physicians can create barriers to diagnosing and managing the disease.   Type 2 diabetes (T2D) is becoming increasingly prevalent in adolescents, with a median age of diagnosis of 13.5 years in the pediatric population. Managing pediatric T2D is challenging, given that traditional medical and non-medical…

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The Success of an EMR-Based Health-Related Social Needs Screen in Pediatrics
 The Success of an EMR-Based Health-Related Social Needs Screen in Pediatrics 1024 683 Deborah L. Ungerleider, MD, FAAP
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Standardized universal HRSN screening with an EMR system and follow-up by social work consults can be successful and contribute to reducing health disparities.   Health-related social needs (HRSNs), sometimes referred to as social determinants of health (SODH), are the risk factors of food insecurity, lack of stable housing and poverty, all of which can play…

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Multiple Fractures in Children: When to Suspect Medical or Malevolent Causes
 Multiple Fractures in Children: When to Suspect Medical or Malevolent Causes 1024 770 Katie Brind'Amour, PhD, MS, CHES
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Girl with cast on her arm

Rapid growth and high-risk activities during childhood leave kids ripe for repeat fracture opportunities, but key factors can alert clinicians to possible underlying disease-related fragility or non-accidental injury. Fractures are common in childhood, with up to 40% of girls and as many as 50% of boys experiencing a fracture. There are many benign explanations for…

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Children Testing Positive for X-ALD on Updated Newborn Screening Panels Require Long-Term Monitoring
 Children Testing Positive for X-ALD on Updated Newborn Screening Panels Require Long-Term Monitoring 1024 575 Katie Brind'Amour, PhD, MS, CHES
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A condition soon to be added to the Ohio Newborn Screening Panel may not affect children for years or even decades after diagnosis, and follow-up involves more than just the infant. Hospitals across the country collect a card of small drops of blood from a baby’s heel shortly after birth. These “bloodspots” are used to…

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Right Care, Right Place, Right Time? Frequency and Duration of Boarding for Pediatric Mental Health Conditions at Acute Care Hospitals
 Right Care, Right Place, Right Time? Frequency and Duration of Boarding for Pediatric Mental Health Conditions at Acute Care Hospitals 150 150 Lauren Dembeck
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Mental health boarding durations significantly exceed standards by the Joint Commission, and youth receive minimal mental health services in these acute care settings. This study calls for increased awareness, dedicated resources and research to improve mental health care for youths in these settings. According to the results of a national survey conducted, in part by…

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Challenges and Experiences of LGBTQI+ Parents Regarding Infant Feeding
 Challenges and Experiences of LGBTQI+ Parents Regarding Infant Feeding 1024 681 Mary Bates, PhD
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sleeping infant

New study identifies challenges faced by LGBTQI+ parents, factors that can help healthcare providers improve their support. A new study is the first to explore the experiences of Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, or Intersex, Plus (LGBTQI+) parents and identify the factors that influence their decisions on infant nutrition. The authors of the report say…

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Teens on the Road: How Technology, Policy and Parents Influence Driving Safety
 Teens on the Road: How Technology, Policy and Parents Influence Driving Safety 1024 633 Abbie Roth
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Traffic crashes are a leading cause of death in the United States. For teens, the stakes are especially high.

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Reconsidering Screening in Primary Care
 Reconsidering Screening in Primary Care 1024 683 Jeb Phillips
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2021 Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (Periodicity Schedule) in color showing all of the screenings recommended across 34 patient visits through a patient's twenty-second birthday

Screenings are an important part of preventive care, but the growing list of recommendations is daunting. How do we prioritize the limited time we have with patients and families? There are 32 well-child primary care visits recommended by the American Academy of Pediatrics in its Bright Futures “Periodicity Schedule.” The first is prenatal, the last…

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Risk for Serious Complications From Vaccine-Preventable Infections After Hematopoietic Cell Transplant
 Risk for Serious Complications From Vaccine-Preventable Infections After Hematopoietic Cell Transplant 1024 683 Katie Brind'Amour, PhD, MS, CHES
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Clinician-scientists reveal the burden of vaccine-preventable infections among children post-transplant, when immunity is low and risk is high. When a hematopoietic cell transplant (HCT) recipient at Nationwide Children’s Hospital was diagnosed with a vaccine-preventable infection (VPI), treating clinicians decided to evaluate the burden of VPI in HCT patients at Nationwide Children’s and elsewhere. The team…

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Practical Tips for Clinicians to Support Transgender and Gender-Diverse Youth
 Practical Tips for Clinicians to Support Transgender and Gender-Diverse Youth 1024 683 Katie Brind'Amour, PhD, MS, CHES
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Experts share advice for family medicine and other practitioners hoping to learn more about supporting transgender and gender-diverse patients. Although gender identity-related health topics have made it into mainstream media in recent months, their lack of discussion in many clinician education programs has left some medical and mental health professionals unsure how to identify, interact…

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What Pediatricians Should Know about Long COVID
 What Pediatricians Should Know about Long COVID 1024 683 Octavio Ramilo, MD
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More than 4 million children have tested positive for SARS-CoV-2 in the United States. According to the American Academy of Pediatrics, long-term effects from COVID-19 can be significant, regardless of initial disease severity. Medical providers across the nation, including here at Nationwide Children’s Hospital, are seeing an increase in cases of what is being called…

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Ask A Specialist: When Should Patients With Molluscum Contagiosum Be Referred to Dermatology?
 Ask A Specialist: When Should Patients With Molluscum Contagiosum Be Referred to Dermatology? 1024 575 Patricia Witman, MD
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Toddler playing with toys

What are the current treatment recommendations for moderate to severe molluscum, and when would you suggest referring to a dermatologist? Molluscum contagiosum is an infection caused by a virus that typically results in benign, mild skin disease characterized by lesions (Mollusca) that are small, raised and usually white, pink or flesh colored with a dimple…

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The 5,000 Babies Project: Screening Newborns for Early Diagnosis of Developmental Delay
 The 5,000 Babies Project: Screening Newborns for Early Diagnosis of Developmental Delay 150 150 Lauren Dembeck
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Democratizing health care requires equal access to early identification of infant neurodevelopmental disorders.  Delayed diagnosis of disorders that involve developmental delays, such as cerebral palsy, can lead to lifelong disability. Yet not all families have access to health care facilities employing highly trained specialists who can test for these developmental delays. Infants from minority families…

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Providing Education and PrEP for Teens at Risk for HIV
 Providing Education and PrEP for Teens at Risk for HIV 1024 683 Abbie Roth
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In a recent PediaCast CME, Mike Patrick, MD, and Megan Brundrett, MD, share important information about offering PrEP and HIV-related education in your primary care practice. Listen to the Full Episode About 20% of new cases of HIV, the virus that causes Acquired Immunodeficiency Syndrome (AIDS), are occurring in youth aged 13 to 24. HIV/AIDS…

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9 Facts About the COVID-19 Vaccine
 9 Facts About the COVID-19 Vaccine 1024 683 Abbie Roth
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COVID-19 is a disease caused by the SARS-CoV-2 virus. In the United States, three vaccines are approved for emergency use, those produced by Pfizer, Moderna and Johnson & Johnson (J&J). These vaccines dramatically reduce your risk of getting severely ill or dying from COVID-19. The vaccines are also being shown to reduce the spread of…

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What is “Dry Drowning,” and How Do I Talk to Parents About It?
 What is “Dry Drowning,” and How Do I Talk to Parents About It? 1024 683 Daniel Scherzer, MD and Bema Bonsu, MD
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The concern about so called “dry drowning” (which is not an actual medical phrase; neither is “secondary drowning”) is based on the fear that a child can unexpectedly succumb to respiratory problems some unpredictable time after swimming. This fear has been exacerbated by media reports dramatizing events without fully explaining them. The concept that dry…

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Pediatricians Offer Valuable Oral Health Services for the Very Young, Before and Throughout Pandemic
 Pediatricians Offer Valuable Oral Health Services for the Very Young, Before and Throughout Pandemic 1024 680 Katie Brind'Amour, PhD, MS, CHES
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toddler brushing teeth

Medical professionals see very young children much more frequently during the first several years of life than dentists, and many states’ Medicaid programs have seized the opportunity to reimburse pediatricians for preventive oral care, such as fluoride application and oral hygiene education. Despite reimbursement options and national guidelines recommending dental care begin by age 1,…

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Even Severe Asthma Can Improve if Guidelines Are Followed
 Even Severe Asthma Can Improve if Guidelines Are Followed 1024 683 Mary Bates, PhD
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Patients treated with adequate medications and asthma family education can significantly improve irrespective of asthma severity. Severe asthma accounts for 5-8% of patients with asthma, but this group is more challenging to treat and is responsible for up to 40% of total asthma-care expenses. The majority of patients with severe asthma have difficult-to-treat asthma (in…

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How Important is Fasting for Pediatric Routine Cholesterol Screening?
 How Important is Fasting for Pediatric Routine Cholesterol Screening? 1024 575 Andrew Tran, MD
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A nonfasting lipid panel is a great first-line screening tool to use. While it is ideal to have a fasting lipid panel, this can be difficult to obtain in practice. For the purposes of screening, I think that it is much more important to go ahead and get the nonfasting lipid panel while the patient…

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How Has the COVID-19 Pandemic Affected Measles Vaccination Rates?
 How Has the COVID-19 Pandemic Affected Measles Vaccination Rates? 1024 575 Mary Bates, PhD
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Toddler playing with toys

Researchers are concerned about declining vaccination rates in the Nationwide Children’s Hospital pediatric primary care network. One consequence of the COVID-19 pandemic is that more families are putting off their children’s preventive care visits, causing pediatric providers to worry about missed vaccines. In a recent study published in Pediatrics, researchers at Nationwide Children’s evaluated changes in…

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More to Telehealth Than Meets the Screen
 More to Telehealth Than Meets the Screen 1024 535 Abbie Roth
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Collage of health technology tools

Telehealth has become essential to American health care during the COVID-19 pandemic, but is it really the solution to our biggest access-to-care problems? When COVID-19 ignited stay-at-home orders, public and private insurers quickly relaxed the rules for covering telehealth visits. Health care systems responded in kind by rapidly expanding their telehealth capacity and training. Expanding…

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When Should Breastfed Babies Be Supplemented?
 When Should Breastfed Babies Be Supplemented? 1024 575 Vanessa Shanks
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This question has received increasing attention in the last several years, especially when considering supplementation for late preterm and early term babies. As more hospitals focus on promoting and supporting breastfeeding, supplementation rates have decreased for infants in the newborn nursery. However, there has been increasing awareness from primary care providers who may see these…

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Distal Radius Physeal Bar and Ulnar Overgrowth: Indications for Treatment
 Distal Radius Physeal Bar and Ulnar Overgrowth: Indications for Treatment 1024 575 Julie Samora, MD, PhD
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Distal radius fractures are among the most common fractures in pediatrics. Although most heal without complication, some result in partial or complete physeal arrest. Risk factors for distal radius growth arrest include physeal fractures, ischemia, infection, radiation, tumor, blood dyscrasias, burns, frostbite and repetitive stress.  The distal radius physis is responsible for 75% of the…

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How Practical COVID-19 Education for Community Providers Sprang From a Pediatric Behavioral Health Project ECHO
 How Practical COVID-19 Education for Community Providers Sprang From a Pediatric Behavioral Health Project ECHO 1024 575 Katie Brind'Amour, PhD, MS, CHES
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When Partners For Kids® (PFK) and Nationwide Children’s Hospital launched Project ECHO in 2018, they did it to help community providers cope with common behavioral health conditions in their patient populations. Unexpectedly, it became a tool to supply Ohio physicians with some of the most proactive education in the nation about adapting their business practices to accommodate COVID-19-related…

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Preventing and Addressing Child Abuse During COVID-19
 Preventing and Addressing Child Abuse During COVID-19 1024 575 Kristin Crichton, DO, MPH
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With schools and daycares closed, stay-at-home orders in effect, and most non-emergency health care visits being conducted via telehealth, reporting and addressing child abuse is more difficult. Dr. Crichton from The Center for Family Safety and Healing shares advice for providers to identify child abuse during telehealth visits. As concerns about the coronavirus pandemic swept…

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The Path to a Long Career in Medicine
 The Path to a Long Career in Medicine 150 150 William Long, MD
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I want to be a pediatrician forever. But the laws of nature won’t let me. In addition, many of us of all ages, are feeling increased pressure and demands that come with our profession.  From insurance issues, and just about everything with the EMR, to the rise in patient behavioral health complaints — it is…

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Exercise as Medicine: What Does This Really Mean?
 Exercise as Medicine: What Does This Really Mean? 1024 575 Alyssa Schafer
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A child’s lack of exercise can contribute to numerous health issues. “Currently, physical inactivity is ranked as the number four cause of death. 5.5% of deaths are due to physical inactivity which is totally preventable and treatable,” says James MacDonald, MD, MPH, a physician for Nationwide Children’s Sports Medicine. The question at large is how much do…

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Medical Marijuana 101: What Does Increasing Legalization of Medical Marijuana Mean for Pediatrics?
 Medical Marijuana 101: What Does Increasing Legalization of Medical Marijuana Mean for Pediatrics? 479 272 Chet Kaczor
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The legalization of medical marijuana has been front and center in community conversation over the last several years. As more states turn to legalization under specific conditions, the federal law has not changed. Experts in pediatric health care are carefully considering what legalization of medical marijuana could mean for children and adolescents with chronic or…

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Addressing Childhood Obsessive-Compulsive Disorder in Primary Care
 Addressing Childhood Obsessive-Compulsive Disorder in Primary Care 150 150 Jeb Phillips
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Primary care providers play an important role in recognizing the disorder and in providing a bridge to mental health care providers.

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Should “Non-High Risk Patients” With Uncomplicated Influenza be Given Antivirals?
 Should “Non-High Risk Patients” With Uncomplicated Influenza be Given Antivirals? 150 150 Michael T. Brady, MD
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This question references a recommendation from the Centers for Disease Control and Prevention that is open to interpretation. For years, the CDC has recommended that all “hospitalized, severely ill and high-risk patients with suspected or confirmed influenza should be treated with antivirals.” Those at high risk include children younger than 2 years of age and…

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The Joys and Challenges of Rural Pediatrics
 The Joys and Challenges of Rural Pediatrics 1024 575 Jill Neff, DO
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I often tell my medical students to choose not just a specialty but, first, a place where they want to live. Being happy with one’s life is more important than just being happy with one’s job. If a person prefers to live in a rural setting, then they probably should not become a neuro- or…

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Primary Care for Refugee Children: What Providers Need to Know
 Primary Care for Refugee Children: What Providers Need to Know 1024 575 Aimee Swartz, MPH
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Toddler playing with toys

The growing number of refugee children across the United States means that more pediatricians need to be aware of the unique health needs of this population. The world’s estimated refugee population has surged to 24.5 million individuals – more than half of whom are children – at United Nations High Commissioner for Refugees (UNHCR) last count. Many…

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Primary Care Provider Guide to Neonatal Abstinence Syndrome Follow Up
 Primary Care Provider Guide to Neonatal Abstinence Syndrome Follow Up 150 150 Nationwide Children's
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Pediatricians have a unique challenge when it comes to caring for the broad spectrum of needs associated with opioid-exposed infants. Some babies who were treated with pharmacological methods in a hospital will be discharged home still on neuro-active medications. Other babies did not receive a neonatal abstinence syndrome (NAS) diagnosis or specific treatment after birth…

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How Primary Care Providers Can Address Suicidal Youth and Self-Harming Behaviors
 How Primary Care Providers Can Address Suicidal Youth and Self-Harming Behaviors 150 150 John Hofmeister
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Pediatricians are in an optimal position to see early warning signs and recommend treatment. Pediatricians are often in an optimal position to see early warning signs of suicidal and self-harming behavior in their patients, to diagnose and recommend treatment, and to provide referrals depending on individual presentation and symptom severity. To help providers who may…

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Considerations for Integrating Behavioral Health and Primary Care
 Considerations for Integrating Behavioral Health and Primary Care 150 150 Cody Hostutler, PhD
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As increasing numbers of pediatric patients require behavioral health care, primary care providers look to integrate behavioral health providers in their practice. You know the story. It’s the middle of a busy Friday afternoon, you just finished up an adolescent well-visit, your hand is on the door and you hear, “Doc, one more question?” The…

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8 Ways You Can Support Families in Need of Behavioral Health Services
 8 Ways You Can Support Families in Need of Behavioral Health Services 150 150 Nancy Cunningham, PsyD
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Long wait times and difficulties accessing behavioral health services cause stress for many patients and families. As awareness grows about the prevalence of behavioral health challenges for children and adolescents, more patients and families are seeking specialized care. However, due to a shortage of behavioral health specialists, wait times can seem daunting. As the pediatrician,…

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Managing Depression, Anxiety and Other Behavioral Health Issues in Primary Care
 Managing Depression, Anxiety and Other Behavioral Health Issues in Primary Care 1024 575 Rachael Hardison
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Teen girl with backpack

An estimated 20 percent of children struggle with mental health illness. As awareness grows, the call for primary care physicians to play a leading role in care grows louder. One in five children will struggle with a mental health illness by the age of 12, but a recent survey by the American Academy of Pediatrics…

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Childhood Kidney Stones: Their Surprising Connection to Future Disease
 Childhood Kidney Stones: Their Surprising Connection to Future Disease 150 150 Jeb Phillips
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Once thought to be an adult condition, urinary stone disease is increasingly found in children – and may be related to the development of cardiovascular disease, chronic kidney disease and low bone density. By one well-regarded estimate, the risk of developing urinary stone disease in childhood doubled between 1997 and 2012. That’s worrying enough on…

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Helping the Child by Helping the Mom
 Helping the Child by Helping the Mom 150 150 Dave Ghose
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Pediatricians can help babies by doing a better job screening new mothers for postpartum depression. Up to 20 percent of new mothers experience postpartum depression, but studies show that nearly half go undiagnosed. If pediatricians were to play a greater role in identifying mothers experiencing symptoms, they could play an important role in helping these…

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Digital Education for Patients and Families
 Digital Education for Patients and Families 150 150 Mike Patrick, MD
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When patients and parents want health information, they often turn to the Internet. Let’s make sure they’re finding the right sources. In the digital age, young patients and their parents have an encyclopedic world of health information at their fingertips. Answers are available on demand, and most people find them. In fact, according to recent…

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1 in 8 Children Exposed to Violence 5 or More Times in a Year
 1 in 8 Children Exposed to Violence 5 or More Times in a Year 150 150 Tiasha Letostak, PhD
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The average pediatric subspecialist sees two to four child polyvictims each day. What can physicians do to help these children and their families? According to the National Survey of Children’s Exposure to Violence (NatSCEV), 60 percent of children have directly experienced or indirectly witnessed at least one act of violence in the previous year. Nearly…

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