Charting Pediatrics

Scoliosis management will vary according to each patient's unique situation and presentation. Mark Erickson, MD, Rose Brown Chair of Pediatric Orthopedic Surgeryand Medical Director of the Children's Colorado Spine Center, joins us to discuss the diagnosis and treatment of scoliosis.

In this episode:

• The three primary types of scoliosis and their common presentations, symptoms, causes and treatments:
• • Congenital scoliosis
  • Neuromuscular scoliosis
  • Idiopathic scoliosis
• The key components of a physical examination for scoliosis
• Recommended imaging to order for aiding a scoliosis diagnosis
• Red flags that may indicate more serious problems and non-idiopathic scoliosis
• Scoliosis surgeryand treatment and its evolution
• Risk factors for disease progression
• The long-term prognosis for a child with scoliosis

Bart Schmitt, MD, pioneer and father of telephone triage pediatric protocols, discusses the role of telephone triage in the pediatrician's office. Dr. Schmittis the Medical Director of General Pediatric Consultations at Children's Colorado.

In this episode:

• Introduction to telephone triage and pediatric telephone protocols for nurses
• The benefits and importance of having protocols for a call center and medical practice caring for pediatric patients
• Why pediatricians offer telephone care and telehealth more often than other specialists
• Why electronic protocols are better than a book
• The importance of second-level physician triage for after-hours calls
• How pediatric telephone triage protocols and resources like the symptom checker support patient-centered care

Telephone triage resources:

• ChildrensMD, the pediatric symptom checker app for parents (iTunes,Google Play)
• "Pediatric Telephone Protocols"
• ParentSmart HealthlineTM, Children's Hospital Colorado's 24/7 telephone triage

Treating STDs in adolescent patients can be a challenge for today's busy pediatrician. Eliza Buyers, MD, of the Pediatric and Adolescent Gynecology team at Children's Colorado returns to our pediatric podcast to provide practical tools for preventing and treating sexually transmitted infections in teens.

In this episode:

• Why STD rates are higher in adolescents and young adults
• How PCPs can address teen reproductive health challenges
• Why we need to consider age as the primary risk factor for STDs
• Examining the issue of STD rates as a health disparity
• Importance of conducting universal screening in sexually active adolescents
• Expedited partner therapy (EPT) and its importance
• Recommended STD and HIV screening periods for different populations
• Screening guidelines for STD examinations in the absence of symptoms.
• Approaching one-to-one time with teen patients
• Importance of promoting condom use to prevent STDs in teens
• When to consider screening for less common STDs
• Why it's crucial to know confidential screening clinics you can send your patients

STD management resources:

• The CDC STD treatment guidelines mobile app
• CDC STD treatment guidelines for special populations

Feeding an infant brings about joys and challenges for every family. In this episode, we discuss the identification and treatment of feeding and swallowing problems in infants with Laura Pickler, MD, and Nancy Creskoff Maune.

Dr. Pickler is the Chair of Family Medicine and Medical Director of the Feeding and Swallowing Program at Children's Colorado. Nancy is an occupational therapist in the program with an extensive background in the evaluation and treatment of infants and children with feeding and swallowing problems.

In this episode:

• Recognizing the signs of pediatric feeding and swallowing problems
• The most common presentations of feeding difficulties that primary care pediatricians encounter
• Differentiating between feeding problems versus swallowing problems
• The visual and auditory signs of swallowing problems
• Referral criteria for a videofluoroscopic swallowing study (VFSS)
• Different approaches to feeding and swallowing issues for breast-fed versus bottle-fed babies
• Approaching feeding and swallowing problems in a breast-fed baby whose mom is returning to work
• Questions to ask and what to look for to avoid missing the big problems
• The importance of observing a feeding to evaluate meal-time behavior, stressors and physical findings
• A primary care physician's toolbox of questions surrounding feedings
• Recommended resources on feeding and swallowing for pediatricians

Caring for transgender, gender diverse and gender non-conforming patients is complicated, and it’s made even more complex by the dynamic nature of gender itself. In this episode, Natalie Nokoff, MD, from the Children’s Colorado TRUE Center for Gender Diversity, joins us to discuss healthcare for transgender and gender diverse patients.

In this episode:

• Common gender terminology physicians may encounter when talking with gender diverse patients
• How to communicate with pediatric patients about their gender identity
• Proactive strategies pediatricians can use surrounding early gender issues
• Understanding the relationship between puberty and gender or body distress (gender dysphoria)
• When to refer young patients experiencing gender dysphoria
• Why it’s important to ask all teens questions about gender identity
• Understanding the family dynamic and needs before referring gender diverse patients to a specialist
• Ensuring a safe environment at school and in the community before gender transition
• Hormone therapy and puberty blocking protocol and WPATH criteria for starting hormone therapy
• Most common methods and forms of hormone therapy and the side effects pediatric primary care providers should be aware of
• The unique mental health, social and emotional support needs of this patient population

Resources for transgender healthcare:

• The World Professional Association of Transgender Health Standards of Care
• Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline
• Resources from Gender Spectrum
• TRUE Center for Gender Diversity, our local Denver gender center

Caring for children with Down syndrome can be complicated. Francis Hickey, MD, Medical Director of the Sie Center for Down Syndrome, joins us to discuss primary care for kids and adolescents with Down syndrome (trisomy 21 syndrome).

In this episode:

• Recommendations for making an initial Down syndrome diagnosis
• The importance of congratulating parents on the birth of their child
• Helpful tips for siblings of children with Down syndrome
• What pediatricians should expect for growth and developmental milestones
• The importance of early visual stimulation for children with Down syndrome
• Why it's more important to focus on progress rather than on hitting specific goals
• Common Down syndrome-related GI, ENT, pulmonary and orthopedic problems to watch for
• The three most important screenings for Down syndrome patients: thyroid, vision and hearing
• Endocrine challenges and the autoimmune cluster
• How to recognize the onset of autism in children with Down syndrome
• Significant concerns to watch out for when adolescents with Down syndrome move into puberty
• Practical references available for primary care providers
• Special accommodations and educational advocacy for children with Down syndrome in the public school system

Browse our Down syndrome resources to share with patient families.

HLHS care poses a unique challenge for pediatric primary care providers. Pediatric cardiothoracic surgeon James (Jim) Jaggers, MD joins us today to discuss the primary care, treatment and future for patients with hypoplastic left heart syndrome (HLHS).

Dr. Jaggers is Co-Director of the Heart Institute and the Barton-Elliman Chair in Pediatric Cardiothoracic Surgery at Children's Colorado.

In this episode:

• Dr. Jaggers' approach to surgical intervention for HLHS
• How pediatricians and family doctors can support their patients and families confronting an HLHS diagnosis
• Ongoing and follow-up care for HLHS patients in the pediatricians' office
• The long-term prognosis for HLHS patients
• How the nation's leading pediatric hospitals are collaborating to provide solutions for patients with HLHS in a groundbreaking consortium
• Future innovation and care for HLHS patients

Dan Hyman, MD, and Heather Howman join us today to discuss the four parts of the American Board of Pediatrics' Maintenance of Certification (MOC) program. Dr. Hyman is the Patient Safety Officer at Children's Colorado and Heather Howman is the MOC Program Manager at CU Medicine.

Listen in as they share their expertise on the MOC and quality improvement projects for the pediatric primary care office.

In this episode:

• What is MOC?
• Four parts of the Maintenance of Certification (MOC) for board-certified pediatricians and pediatric subspecialists
• Achieving the credits that you need to maintain your certification
• Choosing a quality improvement project for your office
• Turning quality improvement into a team effort
• The length of time to complete quality improvement projects
• Barriers in a private office setting for these kinds of projects
• Leveraging your EMR in your practice
• Resources and tools to use in part four of ABP's MOC program
• Consensus building strategies to use within your pediatric practice

The American Board of Pediatrics

Welcome to season two of Charting Pediatrics. In this episode we address the timely and serious topic of firearm safety with Eric Sigel, MD. Dr. Sigel is the Fellowship Director of Adolescent Medicine at Children's Colorado and professor of pediatrics at CU Medicine.

In this episode:

• The AAP gun safety guidelines
• Principles that implicate firearms in suicide deaths
• The risks of having firearms in the home
• What age to start addressing firearm safety with your patients and families
• Approaches for addressing gun safety with parents and patients
• Informing people of the importance of safe storage for firearms
• Ways to become involved in the advocacy efforts around gun safety

American Academy of Pediatrics Gun Violence Policy Recommendations

American Academy of Pediatrics Gun Violence Prevention

AAP News & Journals: Firearm Related Injuries Affecting the Pediatric Population

Our guest for this episode is Jessica Malmberg, PhD, the Clinical Director of Outpatient Services at the Pediatric Mental Health Institute and assistant professor of child psychiatry at CU School of Medicine.

Dr. Malmberg talks us through a common behavioral issues of school-aged children – school refusal – and provides insights, advice and tools to help prevent, manage and understand this behavior.

In this episode:

• Outlining and identifying the underlying symptoms and signs associated with a child refusing to attend school
• How primary care providers (PCPs) can assist parents who are experiencing guilt
• Identifying the four most common reasons that children refuse to go to school
• Exploring the effects of social media on children's behavior when it comes to school refusal
• How a PCP should approach treatment of school refusal
• The recommended frequency of follow-up care for kids who are refusing to go to school
• The importance of connecting parents to community-based resources
• Preventative practices parents can set up in the home to prevent this behavioral issue
• What an excellent prognosis looks like for children experiencing school refusal
• When it's time to refer to a mental health professional
• PCPs in the Denver Metro Area can refer patients to the Children's Hospital Colorado Outpatient Psychiatry Clinic or to a local community mental health center

Resources for dealing with school refusal:

• School Refusal: Information for Educators (.pdf) from the National Association for School Psychologists
• School Refusal in Children and Adolescents from American Family Physician
• The Functional Assessment of School Refusal Behavior
• Effective Child Therapy
• Division 53 of the Society of Clinical Child & Adolescent Psychology website
• School Refusal from the American Academy of Child & Adolescent Psychiatry