Primary Care Perspectives

Approximately one-quarter of Americans have disabilities. How can primary care pediatricians better support the health and goals of patients with disabilities? Danielle Barber, MD, PhD, attending physician, Division of Neurology, Children’s Hospital of Philadelphia, discusses: the World Health Organization’s International Classification of Functioning, Disability and Health (ICF); making care decisions based on the child’s wishes and goals, such as swimming; fostering the growth of a disability identity; presumptions in diagnosing everyday ailments in patients with disability; how community integration and the ability to function affect quality of life and perceived good health; changes in the office setting to improve the patient experience; suggestions for resources and “first steps”; and more.

Updated clinical practice guidelines for management of hyperbilirubinemia – including revised phototherapy thresholds – were published in August, the first major change since 2004. Joanna Parga-Belinkie, MD, attending neonatologist, Division of Neonatology, Children’s Hospital of Philadelphia, provides a review for the nursery and primary care clinic, including a new name for “breastfeeding jaundice”; determining risk for isoimmune hemolytic disease; the importance of G6PD in bilirubin results; the limits of visual assessment of jaundice; using transcutaneous bilirubin meters in primary care; answers to parent questions such as, “Will sunlight help jaundiced babies?”; management of “rebound bili”; tools to help measure phototherapy thresholds by age as you adjust to the new guidelines; and more. Published December 2022.

This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2022 by Children's Hospital of Philadelphia, all rights reserved.

Updated clinical practice guidelines for management of hyperbilirubinemia – including revised phototherapy thresholds – were published in August, the first major change since 2004. Joanna Parga-Belinkie, MD, attending neonatologist, Division of Neonatology, Children’s Hospital of Philadelphia, provides a review for the nursery and primary care clinic, including a new name for “breastfeeding jaundice”; determining risk for isoimmune hemolytic disease; the importance of G6PD in bilirubin results; the limits of visual assessment of jaundice; using transcutaneous bilirubin meters in primary care; answers to parent questions such as, “Will sunlight help jaundiced babies?”; management of “rebound bili”; tools to help measure phototherapy thresholds by age as you adjust to the new guidelines; and more.

The Adolescent Protective Collaborative (APC) at Children’s Hospital of Philadelphia is dedicated to providing a specialized medical home for youth who have experienced or are at high risk for sex trafficking. Primary care physicians can be partners in identifying and helping children who are victims. Guests Kali Hackett, MSW, MPH, a public health social worker and clinical services coordinator for the APC, Polina Krass, MD, a fellow in Emergency Medicine and co-founder of the APC, and Anish Raj, MD, a fellow in Child Abuse Pediatrics and co-founder of the APC, provide an overview and practical information, including: defining sex trafficking and commercial exploitation of children (CSEC); red flags in history, complaints, and physical exam; the effects of exploitation beyond reproductive health; an explanation of the Adolescent Protection Collaborative, including what a clinic visit entails for the child and how the team works with other community organizations; and what a primary care physician can do to identify and help victims, including detailed suggestions for how to have the initial conversation, how to ask questions, and what to do if the child confirms they are abused.

Kali Hackett, MSW, MPH, a Public Health Social Worker and the Clinical Services Coordinator for the APC

Polina Krass, MD, a Fellow Physician in Emergency Medicine and Co-Founder of the APC

Anish Raj, MD, a Fellow Physician in Child Abuse Pediatrics and Co-Founder of the APC

This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2022 by Children's Hospital of Philadelphia, all rights reserved.

The Adolescent Protective Collaborative (APC) at Children’s Hospital of Philadelphia is dedicated to providing a specialized medical home for youth who have experienced or are at high risk for sex trafficking. Primary care physicians can be partners in identifying and helping children who are victims. Guests Kali Hackett, MSW, MPH, a public health social worker and clinical services coordinator for the APC, Polina Krass, MD, a fellow in Emergency Medicine and co-founder of the APC, and Anish Raj, MD, a fellow in Child Abuse Pediatrics and co-founder of the APC, provide an overview and practical information, including: defining sex trafficking and commercial exploitation of children (CSEC); red flags in history, complaints, and physical exam; the effects of exploitation beyond reproductive health; an explanation of the Adolescent Protection Collaborative, including what a clinic visit entails for the child and how the team works with other community organizations; and what a primary care physician can do to identify and help victims, including detailed suggestions for how to have the initial conversation, how to ask questions, and what to do if the child confirms they are abused.

Lyme disease can be challenging to distinguish from many common pediatric infections. Michael Russo, MD, attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia, reviews: disease history and incidence; disease stages, including early localized, early disseminated, and late; tips for distinguishing the Lyme-related symptoms bull’s-eye rash, facial palsy and arthritis from other ailments; indications for testing (and why tick-testing isn’t advised); amoxicillin, doxycycline, and ceftriaxone for different manifestations; duration of treatment; indications for post-exposure prophylaxis; and more.

This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2022 by Children's Hospital of Philadelphia, all rights reserved.

Lyme disease can be challenging to distinguish from many common pediatric infections. Michael Russo, MD, attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia, reviews: disease history and incidence; disease stages, including early localized, early disseminated, and late; tips for distinguishing the Lyme-related symptoms bull’s-eye rash, facial palsy and arthritis from other ailments; indications for testing (and why tick-testing isn’t advised); amoxicillin, doxycycline, and ceftriaxone for different manifestations; duration of treatment; indications for post-exposure prophylaxis; and more.

The new SMART guidelines for children whose asthma is not well controlled, including use of one inhaler for maintenance and rescue, was a significant change to which both caregivers and providers are still adjusting.  Tyra Bryant-Stephens, MD, Medical Director of the Community Asthma Prevention Program and Chief Health Equity Officer of the Center for Health Equity at Children's Hospital of Philadelphia, reviews: who is eligible for SMART; signs and symptoms of asthma that is not well controlled; case examples; tips for discussing the changes with parents; tips for SMART prescription-writing; benefits of the new guidelines; and more.

This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2022 by Children's Hospital of Philadelphia, all rights reserved.

The new SMART guidelines for children whose asthma is not well controlled, including use of one inhaler for maintenance and rescue, was a significant change to which both caregivers and providers are still adjusting.  Tyra Bryant-Stephens, MD, Medical Director of the Community Asthma Prevention Program and Chief Health Equity Officer of the Center for Health Equity at Children's Hospital of Philadelphia, reviews: who is eligible for SMART; signs and symptoms of asthma that is not well controlled; case examples; tips for discussing the changes with parents; tips for SMART prescription-writing; benefits of the new guidelines; and more.

More than half of infants experience gastroesophageal reflux (GER) and 10-20% have gastroesophageal reflux disease (GERD), and guidelines for this issue often change. Here to help clear up confusion is Jefferson Brownell, MD, pediatric gastroenterologist, Children’s Hospital of Philadelphia. He first provides a review of red flags for referral to GI or the emergency room, and then an overview of GERD in otherwise healthy babies, including: scheduled small-volume feedings; thickening options; amino acid formulas and other formula options; positioning during sleep; medication options; duration of meds and how to wean; counseling families hesitant to start meds; and more.

This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2022 by Children's Hospital of Philadelphia, all rights reserved.