Primary Care Perspectives

In Philadelphia, sleep-related deaths (including SIDS, accidental suffocation, and unknown cause) are the second-highest cause of infant mortality, after prematurity. Two pediatricians, Roy Hoffman, MD, MPH, Medical Director, Fatality Review Program, Philadelphia Department of Public Health, who sees patients at a health department-run community health center (Health Center #6), and Stacey Kallem, MD, Director, Division of Maternal, Child, & Family Health at Philadelphia Department of Public Health, provide an overview, including: incidence and factors; racial-ethnic disparity; a review of barriers to safe sleep and ideas for effective counseling for prevention; ways to help parents get support, including for lactation and smoking cessation; genomic sequencing and other research into medical causes for sleep-related deaths; practical tips to share with parents; 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.

Parents worry when a child hits their head. This podcast will help inform the important decisions you need to make as a primary care provider, including whether to send them to the emergency room. Daniel Corwin, MD, MSCE, an emergency medicine physician and researcher at Children’s Hospital of Philadelphia, discusses acute (less than 24 hours) head trauma in otherwise healthy children, reviewing: the 6 criteria for each age group; why criteria for children younger than 2 are different (and the reassuring research behind the criteria); severe injury mechanisms; how to advise parents about keeping the child awake and what to watch for; the 9 features of the visio-vestibular exam; changes in concussion management and “return to normal” criteria; when to refer to a concussion specialist; 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.

One in 4 children will have an episode of chronic pain before they reach adulthood, and kids with chronic pain are 3 times as likely to suffer anxiety or depression. How can primary care pediatricians help de-stigmatize the role of psychology in treatment for chronic pain? Jessica Collins, PsyD, and Christina Holbein, PhD, psychologists who run Comfort Ability workshops at Children’s Hospital of Philadelphia for kids with chronic pain, discuss: common diagnoses that come with chronic pain and discomfort; evidence-based interventions for chronic pain, including the role of cognitive behavioral therapy; differences in reporting of pain and discomfort based on culture and race, and how language barriers affect reporting; how to recognize and address bias in pain management referrals and suggestions for how to help families overcome barriers to resources; a review of CHOP resources for chronic pain, including Comfort Ability; 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.

Chlamydia is the most commonly reported bacterial disease in the U.S., and half of the 1.8 million cases reported in 2019 were in youth. A recent publication by Kenisha Campbell, MD, MPH, and Sarah Wood, MD, MSHP, adolescent medicine physicians at Children’s Hospital of Philadelphia, showed providers are much more likely to screen Black adolescent females for chlamydia than white females. In a review of their study, the two doctors discuss how to address biases as individual providers and as practices or systems, and: a review of chlamydia screening guidelines, prevalence of asymptomatic cases, and effects of untreated infections; the recently modified CDC treatment guidelines, with doxycycline now preferred; when to still consider using azithromycin; when to refer to adolescent medicine; 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.

Less than a quarter of children with developmental disabilities receive early intervention services before age 3. The recent update to the “Learn the Signs: Act Early” guidelines is a step toward more children and families getting help sooner. Kate Wallis, MD, MPH, a developmental behavioral pediatrician at Children’s Hospital of Philadelphia, reviews: how and why the changes were made; how evaluating milestones when 75% of the age group is meeting them (rather than the previous rate of 50%) affects the wait-and-see approach; why it was important to add milestones for the 15- and 30-month visits; how the milestones may be helpful to parents; 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.

Friendships and social bonds are integral to children’s health. How can a pediatrician help those struggling with social skills? Emily DePaul, BS, MPH, MA, who is a clinical research coordinator for the PriCARE Parenting Program and runs group social skills training for children with autism spectrum disorders (ASD), provides an overview of the importance of social skills and possible diagnoses in children who have delays or deficits (consider ADHD and anxiety, in addition to ASD). She explains group social skills training, why these programs are valuable, and how a caregiver or pediatrician can find them; and provides tips and real-world advice pediatricians can use in practice (for example, how to help with issues like volume control and personal space, simple coping strategies, and how to encourage “perspective-taking”). If you’re searching for reasons to be positive and hopeful, hearing DePaul will help: A believer in social skills training at a very young age, she has received funding to start a social skills program (called First Friends) for toddlers and preschoolers. And her description of the resiliency of the ASD children in her groups during the pandemic – they had to do group social skills training on Zoom! – is inspiring.  Published March 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.

How should a primary care physician evaluate neutropenia, and decide when it’s time to worry? Kandace Gollomp, MD, pediatric hematologist, Children’s Hospital of Philadelphia, discusses: tips for evaluating a CBC with differential; absolute neutrophil count (ANC) parameters for mild/moderate/severe neutropenia; when to worry about increased risk of infection, both in previously well children and in those with risk factors; a review of risk factors; lymphopenia, granulocytopenia and agranulocytosis and how they are different; benign ethnic neutropenia; post-infectious neutropenia and when you should re-check the CBC; when an infectious history should raise a red flag; when to order a peripheral smear or refer a patient to hematology for bone marrow biopsy or other evaluation; 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.  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.

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.

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.