Primary Care Perspectives

One in 5 children will experience the death of a loved one before age 18. Consuelo Cagande, MD, Division Chief, Community Care and Wellness Program, Children’s Hospital of Philadelphia, reviews the difference between grief and mourning; how children may grieve differently and the William Worden stages, which may be more applicable than the Kubler-Ross model; “masked” somatic and behavioral symptoms that may indicate grief; suggestions for how to help a child experiencing grief; how children of different ages may grieve; the importance of asking the family about their cultural norms for grieving; distinguishing between PTSD and grief; COVID and grief; resources to direct families to; and more. Published November 2021.

One in 5 children will experience the death of a loved one before age 18. Consuelo Cagande, MD, Division Chief, Community Care and Wellness Program, Children’s Hospital of Philadelphia, reviews the difference between grief and mourning; how children may grieve differently and the William Worden stages, which may be more applicable than the Kubler-Ross model; “masked” somatic and behavioral symptoms that may indicate grief; suggestions for how to help a child experiencing grief; how children of different ages may grieve; the importance of asking the family about their cultural norms for grieving; distinguishing between PTSD and grief; COVID and grief; resources to direct families to; and more.

Symptoms tend to be worse in the morning. Approximately a quarter of cases present without pain. And erythema is not generally a sign. Jay Mehta, MD, MS, attending physician, Division of Rheumatology, Children’s Hospital of Philadelphia, reviews juvenile idiopathic arthritis (JIA), one of the most common chronic diseases of childhood. He discusses: questions for a useful history; what to look for on physical exam; why labs aren’t super-helpful in diagnosis; symptoms that may indicate an oncologic cause; JIA classification criteria (a review of subtypes); potential genetic and environmental etiologies, including association with the microbiome; treatment paths, including steroid injections, low-dose methotrexate, TNF inhibitors, and tailored biologics, and why NSAIDs are no longer advised; complications of untreated arthritis, including uveitis and blindness; and more. Published October 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.

Symptoms tend to be worse in the morning. Approximately a quarter of cases present without pain. And erythema is not generally a sign. Jay Mehta, MD, MS, attending physician, Division of Rheumatology, Children’s Hospital of Philadelphia, reviews juvenile idiopathic arthritis (JIA), one of the most common chronic diseases of childhood. He discusses: questions for a useful history; what to look for on physical exam; why labs aren’t super-helpful in diagnosis; symptoms that may indicate an oncologic cause; JIA classification criteria (a review of subtypes); potential genetic and environmental etiologies, including association with the microbiome; treatment paths, including steroid injections, low-dose methotrexate, TNF inhibitors, and tailored biologics, and why NSAIDs are no longer advised; complications of untreated arthritis, including uveitis and blindness; and more.

Bridget Sullivan Garmisa, MSN, MS,CRNP, RD, a nurse practitioner and registered dietitian at a Children’s Hospital of Philadelphia primary care practice, discusses: tips for helping parents deal with picky eaters; importance of role-modeling by parents; how to help parents with common household challenges, such as having time to prepare a healthful dinner; suggestions for breakfasts teenagers might actually eat; healthful, easy-to-pack lunches; what to do when food options are limited, such as from vending machines and corner stores; ideas for on-the-go snacks; why sports drinks are a no-go; how to talk to kids and families about their food decisions; introducing cost savings as a motivator to modify food habits; and more. Published October 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.

Bridget Sullivan Garmisa, MSN, MS,CRNP, RD, a nurse practitioner and registered dietitian at a Children’s Hospital of Philadelphia primary care practice, discusses: tips for helping parents deal with picky eaters; importance of role-modeling by parents; how to help parents with common household challenges, such as having time to prepare a healthful dinner; suggestions for breakfasts teenagers might actually eat; healthful, easy-to-pack lunches; what to do when food options are limited, such as from vending machines and corner stores; ideas for on-the-go snacks; why sports drinks are a no-go; how to talk to kids and families about their food decisions; introducing cost savings as a motivator to modify food habits; and more.

More and more pediatric healthcare systems are incorporating acupuncture for pain management and other purposes. Dr. Winona Chua, attending physician, Division of General Pediatrics, and Douglas McDaniel, licensed acupuncturist, Cancer Center, Children’s Hospital of Philadelphia, discuss: a review of what acupuncture is, its history, and theories about why it is effective for some patients; why research in acupuncture in pediatrics has been limited; licensing for acupuncturists; how CHOP is using acupuncture; conditions for which acupuncture may be indicated and how a primary care physician can refer; how to explain acupuncture to children, who may fear needles; insurance coverage for acupuncture; and more. Published September 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.

More and more pediatric healthcare systems are incorporating acupuncture for pain management and other purposes. Dr. Winona Chua, attending physician, Division of General Pediatrics, and Douglas McDaniel, licensed acupuncturist, Cancer Center, Children’s Hospital of Philadelphia, discuss: a review of what acupuncture is, its history, and theories about why it is effective for some patients; why research in acupuncture in pediatrics has been limited; licensing for acupuncturists; how CHOP is using acupuncture; conditions for which acupuncture may be indicated and how a primary care physician can refer; how to explain acupuncture to children, who may fear needles; insurance coverage for acupuncture; and more.

Sleep-disordered breathing, including snoring and sleep apnea, affects up to 17 percent of youth, and the AAP recommends screening for it at every visit. Ariel Williamson, PhD, DBSM, psychologist, and Ignacio Tapia, MD, attending pulmonologist, of the Sleep Center at Children’s Hospital of Philadelphia, provide a review of high-risk populations for sleep-disordered breathing; how to screen for sleep-disordered breathing; what to ask parents to distinguish between primary snoring and obstructive sleep apnea; when to refer for a sleep or CPAP study; how to help prepare a patient for a sleep study; the information a sleep study yields and what will be reported to the provider; the importance of sleep hygiene/routine and sleep duration; when to recommend melatonin; daytime symptoms that may be caused by sleep disruption; the link between sleep and mental health; and more. Published September 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.

Sleep-disordered breathing, including snoring and sleep apnea, affects up to 17 percent of youth, and the AAP recommends screening for it at every visit. Ariel Williamson, PhD, DBSM, psychologist, and Ignacio Tapia, MD, attending pulmonologist, of the Sleep Center at Children’s Hospital of Philadelphia, provide a review of high-risk populations for sleep-disordered breathing; how to screen for sleep-disordered breathing; what to ask parents to distinguish between primary snoring and obstructive sleep apnea; when to refer for a sleep or CPAP study; how to help prepare a patient for a sleep study; the information a sleep study yields and what will be reported to the provider; the importance of sleep hygiene/routine and sleep duration; when to recommend melatonin; daytime symptoms that may be caused by sleep disruption; the link between sleep and mental health; and more.