Primary Care Perspectives

Neonatal abstinence syndrome (NAS) and neonatal opioid withdrawal syndrome (NOWS) have skyrocketed as a result of the ongoing opioid epidemic. Celina C.S. Migone, MD, attending neonatologist, CHOP at Einstein Montgomery, discusses inpatient management of NAS and NOWS, including a new scoring system (replacing the Finnegan) and a move away from pharmacologic management (morphine dosing), and how the changes have had downstream effects that may require a new approach to supporting babies and families in primary care. She reviews: withdrawal symptoms providers may see; which substances are safe for breastfeeding and which are contraindicated; plans of safe care, which are begun during pregnancy and should be in place for a year after the baby is born; developmental monitoring; the CHOP NAS/NOWS inpatient clinical pathway and why it’s helpful to outpatient providers; and more.  Published February 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.

Neonatal abstinence syndrome (NAS) and neonatal opioid withdrawal syndrome (NOWS) have skyrocketed as a result of the ongoing opioid epidemic. Celina C.S. Migone, MD, attending neonatologist, CHOP at Einstein Montgomery, discusses inpatient management of NAS and NOWS, including a new scoring system (replacing the Finnegan) and a move away from pharmacologic management (morphine dosing), and how the changes have had downstream effects that may require a new approach to supporting babies and families in primary care. She reviews: withdrawal symptoms providers may see; which substances are safe for breastfeeding and which are contraindicated; plans of safe care, which are begun during pregnancy and should be in place for a year after the baby is born; developmental monitoring; the CHOP NAS/NOWS inpatient clinical pathway and why it’s helpful to outpatient providers; and more.

The AAP recommends that infants get 400 IUs of vitamin D per day; fewer than 40% meet this guideline. Erica Schwab, RD, LDN, a clinical dietitian who supports the Division of Gastroenterology, Hepatology and Nutrition at Children’s Hospital of Philadelphia, discusses: why most babies, whether breast- or formula-fed, need vitamin D supplementation; how to know when to stop supplementation; good sources of vitamin D for babies transitioning to solid food; why Vitamin D is vital to the health and growth of babies; a review of rickets (breast-fed, non-supplemented infants are at highest risk); and risk groups that may require additional vitamin D supplementation, including preemies. She also provides a review of iron guidelines, including: when to start and stop iron supplementation for breast-fed infants; tips for getting babies to take iron; how to take a dietary history to ascertain whether supplementation is needed; differences between U.S. and European formulas; where to refer for complicated cases; and more. Published January 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.

The AAP recommends that infants get 400 IUs of vitamin D per day; fewer than 40% meet this guideline. Erica Schwab, RD, LDN, a clinical dietitian who supports the Division of Gastroenterology, Hepatology and Nutrition at Children’s Hospital of Philadelphia, discusses: why most babies, whether breast- or formula-fed, need vitamin D supplementation; how to know when to stop supplementation; good sources of vitamin D for babies transitioning to solid food; why Vitamin D is vital to the health and growth of babies; a review of rickets (breast-fed, non-supplemented infants are at highest risk); and risk groups that may require additional vitamin D supplementation, including preemies. She also provides a review of iron guidelines, including: when to start and stop iron supplementation for breast-fed infants; tips for getting babies to take iron; how to take a dietary history to ascertain whether supplementation is needed; differences between U.S. and European formulas; where to refer for complicated cases; and more.

Anxiety disorders collectively are the third most common psychiatric condition in children. Katrina Fletcher, MD, psychiatrist, and Jason Lewis, PhD, psychologist, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, review: tools to screen and assess anxiety disorders; other diagnoses to consider in your differential or as co-morbidities; medical causes and medications that can cause anxiety symptoms; importance of time course (such as abrupt onset) in your differential; types of anxiety disorders; how to determine severity; what is cognitive behavioral therapy (CBT); when to initiate an SSRI and tips for discussing antidepressants with patients and families; how to know if a treatment plan is working and when to taper or discontinue SSRIs; how to help families navigate anxiety disorders, such as encouraging healthy sleep, diet and exercise; CHOP’s new clinical pathway for anxiety disorders; and more. Published January 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.

Anxiety disorders collectively are the third most common psychiatric condition in children. Katrina Fletcher, MD, psychiatrist, and Jason Lewis, PhD, psychologist, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, review: tools to screen and assess anxiety disorders; other diagnoses to consider in your differential or as co-morbidities; medical causes and medications that can cause anxiety symptoms; importance of time course (such as abrupt onset) in your differential; types of anxiety disorders; how to determine severity; what is cognitive behavioral therapy (CBT); when to initiate an SSRI and tips for discussing antidepressants with patients and families; how to know if a treatment plan is working and when to taper or discontinue SSRIs; how to help families navigate anxiety disorders, such as encouraging healthy sleep, diet and exercise; CHOP’s new clinical pathway for anxiety disorders; and more.

Chalkin’ Your Walkin’ is a pandemic-era project to chalk inspirational messages on the South Street Bridge in Philadelphia, over which many healthcare workers walk and bike to work. The messages are created by Katie Woo Castelo, MSN, CRNP, a nurse practitioner in the Emergency Department at Children’s Hospital of Philadelphia, with help from her kids. In this 15-minute episode, Castelo explains why she started chalking your walking, and the response to the effort. She also provides useful ideas for how to encourage and connect with children and teenagers during the pandemic, and how to stay connected and support one another as healthcare workers. Published December 2021.

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. ©2021 by Children's Hospital of Philadelphia, all rights reserved.

Chalkin’ Your Walkin’ is a pandemic-era project to chalk inspirational messages on the South Street Bridge in Philadelphia, over which many healthcare workers walk and bike to work. The messages are created by Katie Woo Castelo, MSN, CRNP, a nurse practitioner in the Emergency Department at Children’s Hospital of Philadelphia, with help from her kids. In this 15-minute episode, Castelo explains why she started chalking your walking, and the response to the effort. She also provides useful ideas for how to encourage and connect with children and teenagers during the pandemic, and how to stay connected and support one another as healthcare workers.

Food protein-induced enterocolitis syndrome, or FPIES, is a rare and different food allergy with a complex etiology and management.  Amy Dean, MPH, RD, CSP, LDN, clinical dietitian, Gayle Diamond, MD, attending gastroenterologist, Terri Brown-Whitehorn, MD, attending allergist, who all work together in the FPIES Clinic at Children’s Hospital of Philadelphia, provide a review. Their discussion includes: symptoms and how FPIES may present in the primary care setting; tips for getting a useful history for diagnosis; how FPIES is different from other food allergies; which foods are the most common causes; what is acute FPIES; respecting parent fear of FPIES reactions, which can be upsetting; tips on diet modification; why a multidisciplinary approach, including allergy and GI, is important; an overview of how CHOP manages FPIES; biomarker research that may lead to a diagnostic test; and more. Published December 2021.

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. ©2021 by Children's Hospital of Philadelphia, all rights reserved.

Food protein-induced enterocolitis syndrome, or FPIES, is a rare and different food allergy – non IgE-mediated, perhaps driven by T cells. About 20% of babies with acute FPIES present in shock to the CHOP ER. There isn’t a diagnostic test for FPIES. Amy Dean, MPH, RD, CSP, LDN, clinical dietitian, Gayle Diamond, MD, attending gastroenterologist, Terri Brown-Whitehorn, MD, attending allergist, who all work together in the FPIES Clinic at Children’s Hospital of Philadelphia, provide a review. Their discussion includes: symptoms and how FPIES may present in the primary care setting; tips for getting a useful history for diagnosis; how FPIES is different from other food allergies; which foods are the most common causes; what is acute FPIES; respecting parent fear of FPIES reactions, which can be upsetting; tips on diet modification; why a multidisciplinary approach, including allergy and GI, is important; an overview of how CHOP manages FPIES; biomarker research that may lead to a diagnostic test; and more.