Primary Care Perspectives: Podcast for Pediatricians

Listen in as Katie Lockwood, MD, a primary care pediatrician at Children’s Hospital of Philadelphia (CHOP), discusses hot topics in primary care with experts from across the Hospital and other kids health specialists. In this podcast series for pediatricians, subject-matter-experts weigh in on issues affecting the daily practice of pediatricians. You can also download these podcasts and subscribe to the series in the iTunes Store.

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. ©2018 by Children's Hospital of Philadelphia, all rights reserved. Use of this site is subject to the Terms of Use.

Recent Episode Details

The content contained in the following podcasts is current as of the date of publication.

Continuing Medical Education Statement

Physicians who view the podcast from the beginning to the end may self-report/self-claim .25 AMA PRA Category 2 Credit™ on their Category 2 CME Log for each podcast in which they participate.

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Episode 114: Grief in Children: How to Recognize Its Effects and Help Patients in the Primary Care Setting

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.

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Episode 113: A Review of Juvenile Idiopathic Arthritis

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.

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Episode 112: Pizza Is OK for Breakfast – Sometimes!: Real-world Nutrition Tips for the Primary Care Setting

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.

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Episode 111: Acupuncture in Pediatrics: A Review

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.

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Episode 110: Sleep Disordered Breathing

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.

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Episode 109: Picture This: Incorporating Visual Art into Practice

A team discusses a CHOP program called Picture This, in which colorful and interactive murals are used in primary care exam rooms to encourage parent-child interaction and facilitate care. Danielle Erkoboni, MD, primary care pediatrician, CHOP Care Network, Melanie Hoynoski, CCLS, STRS, child life specialist at CHOP, and Steve Wilmot, MSW, Associate Vice President of Primary Care, CHOP, talk about the goals of the mural project; how the visual environment in which a child receives care can change the patient-family experience; the importance of play and visual arts to children; how murals or other types of art can prompt conversations and be incorporated into care; and more. Published August 2021.

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Episode 108: Remembering the Other Parent: Postpartum Depression in Dads and Partners

Did you know that if a new mom is suffering from postpartum depression, the chances are high that the new dad or partner may be struggling as well? David Levine, MD, pediatrician and board member, Postpartum Support International, discusses perinatal mood and anxiety disorders (PMADs) in dads, partners, and adoptive parents. Among the topics: prevalence and risk factors for postpartum depression and other mood issues in dads and partners; cultural attitudes, including factors that keep dads from asking for help and the lack of public role models for struggling dads; how to include dads and partners in screening during obstetric or newborn care; use of the Edinburgh postnatal depression scale; how postpartum depression in dads may affect bonding with the infant; what to do if you suspect postpartum depression in a dad or partner; and more. Published August 2021.

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Episode 107: Is It Broken?: Managing Suspected Extremity Fractures in the Primary Care Setting

As children and teenagers return to summer activities and school sports, particularly after the pandemic down-time, injuries, including fractures, are on the rise. Brendan Williams, MD, attending pediatric orthopaedic surgeon, Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, discusses: physical exam findings that raise suspicion for fractures; the Ottowa Ankle Rules; clavicle fractures in older children (not newborns); how skeletal maturity changes fracture management decisions; pain management and immobilization guidance for sprains; when to send patients who are still in pain for follow-up evaluation or additional imaging; injury prevention advice to share with patients and families; when to send patients straight to the emergency room; and more. Published July 2021.

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Episode 106: Acne

Acne is one of the most common skin conditions, affecting about 80% of all teens. While some teens will only experience mild symptoms, others may develop scarring, hyperpigmentation and negative psychosocial effects. Amanda Shepard-Hayes, MD, an Attending Pediatrician specializing in dermatology at Children’s Hospital of Philadelphia, discusses the importance of recognizing and treating this condition; the combination of factors that cause acne including hormone level changes during puberty or when certain drugs (i.e., corticosteroids, oral birth control) are started or stopped; the different types of acne lesions, and when distribution patterns may indicate a more serious health issue; treatment goals and therapies including topical and systemic medications. In many cases, combination therapy is appropriate, which includes low-dose benzoyl peroxide to kill the bacteria and tretinoin to halt the development of new acne lesions. Recurrent acne that occurs in young children (aged 1 to 7), or in unusual places (like the groin area), should be sent for further evaluation. Published July 2021.

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Episode 105: Getting Itchy With It: What to Know About Lice and Scabies in the Primary Care Setting

Did you know that the pincers of head lice are perfectly suited to the caliber of children’s hair? And they need a blood-meal every 24 hours to survive? If you hate lice – and love puns – tune in for this discussion with Albert Yan, MD, pediatric dermatologist, Children’s Hospital of Philadelphia. He reviews: the epidemiology of lice, including why they may be more common in certain types of hair; distinguishing between nits and dandruff during exam; treatments for lice and resistance to permethrin and pyrethrum; and newer treatment options like spinosad and topical ivermectin. Scabies are also discussed: a review of transmission, findings and risk factors; where to look for lesions; correctly applying permethrin for scabies; differential diagnosis for scabies; secondary infections from scabies; when to consider referral to dermatology for lice or scabies; and more. Published June 2021.

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Episode 104: Menstruation and Period Poverty

At what age should pediatricians worry if a patient hasn’t had their first period? How can they help patients manage chronic period pain? What is “period poverty” and how can doctors help? Shelby Davies, MD, a fellow in the Division of Adolescent Medicine, Children’s Hospital of Philadelphia, discusses a variety of period-related topics, including: a review of the normal sequence of puberty and menarche and a normal menstrual cycle; etiologies of amenorrhea and how to evaluate for different causes; laboratory tests to consider in cases of primary and secondary amenorrhea; a review of causes and management suggestions for irregular cycles and heavy flow; a review of management options for dysmenorrhea, including effectiveness of different OTC painkillers; an explanation of menstrual cups and reusable period underwear, alternatives to tampons and pads that are increasingly popular; a discussion of “period poverty” and the barriers some teenagers face in managing their periods, and how doctors can screen for this and help; and more. Published June 2021.

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Episode 103: Feeding Concerns in Children: How to Address Them in Primary Care and When to Refer to Specialists

Colleen Lukens, PhD, psychologist, and Sherri Cohen, MD, MPH, medical director, the Pediatric Feeding and Swallowing Center, Children’s Hospital of Philadelphia, discuss how their multidisciplinary clinic would manage this case, and review: some underlying causes for feeding disorders; common reasons for referral to the center; when an additional referral to GI might be appropriate; important feeding milestones; positive, simple strategies to recommend to parents of picky eaters; and more. Published May 2021.

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  • The Pediatric Feeding and Swallowing Center at CHOP - The center sees patients at the CHOP locations in Philadelphia, King of Prussia and Virtua, New Jersey. To start the intake process, the family can call 267-425-3333, CHOP providers can enter a consult ORDER in EPIC, or non-CHOP providers can call 1-800-TRY-CHOP.

Episode 102: Effective Communication with Patients with Emotional or Behavioral Disorders

Approximately 15% of school-age children and adolescents in the U.S. are thought to have an emotional or behavioral disorder, and nearly two-thirds receive no formal mental health care. Pediatricians are increasingly being called on to screen for and treat mental health problems. Billie Samantha Schwartz, PhD, a Psychologist in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at Children's Hospital of Philadelphia, sits down to tackle common communication challenges faced by primary care providers, and how to find a common factors approach (as recommended by the AAP) to build into practice. Published May 2021.

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Episode 101: Environmental Pediatrics: A Conversation with Leo Trasande

Parents often have questions about organic foods and environmental toxins such as BPA and phthalates. This conversation will help provide answers. Leonardo Trasande, MD, MPP, Jim G. Hendricks, MD, Professor of Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, and author of “Sicker, Fatter, Poorer: The Urgent Threat of Hormone-disrupting Chemicals to Our Future...and What We Can Do” discusses a range of topics, including why environmental medicine is important in pediatrics; the importance of studying disease-related costs of chemicals; racial disparities in exposures to pesticides and other harmful chemicals; and information about topics parents often ask about, such as benefits of organic food, minimizing phthalate exposure, plastics versus glass, BPA and BPA-like chemicals in canned food and drinks, the safest water (probably from your tap!), safe baby food, and more. Published April 2021.

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Episode 100: The Addiction Inoculation: A Discussion with Author Jessica Lahey About Preventing Drug and Alcohol Problems in Kids

In celebration of the 100th episode of the Primary Care Perspectives podcast, Dr. Katie Lockwood welcomes a special guest, author Jessica Lahey, to discuss her most recent book, “The Addiction Inoculation: Raising Healthy Kids in a Culture of Dependence.” Lahey, whose perspective is informed by her own recovery from alcohol addiction and her experiences as a writing teacher and parent, writes for The New York Times and The Washington Post and is the author of the bestseller “The Gift of Failure: How the Best Parents Learn How to Let Go So Their Kids Can Succeed,” from 2015. Here she shares insight on topics including: countering myths about drinking and drugs (such as “everyone does it”); the gateway hypothesis; how pediatricians can be an ally for parents and teenagers in decision-making around alcohol and drugs; the AAP guidelines for substance abuse in youth; tips for effective discussions with teenagers; and more. Published April 2021.

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Episode 99: Balancing Act: Assessing Vestibular Disorders in Pediatric Primary Care

A baby who can’t sit up by 7 months of age. A “clumsy” child who struggles with tasks such as riding a bike. A teenager experiencing dizziness 2-3 months after concussion. What do these patients have in common? They may benefit from assessment for a vestibular disorder. Robert O’Reilly, MD, attending physician, Division of Otolaryngology, and director, Balance and Vestibular Program, Children’s Hospital of Philadelphia, discusses vestibular issues in children and teenagers. Includes: a review of the vestibular apparatus; clinical symptoms and signs of chronic vestibular issues; review of common causes of vestibular issues; when to refer for post-concussion dizziness or post-concussion positional vertigo; and more. Published March 2021.

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Episode 98: Virtual Learning Ergonomics: Encouraging Better Learning Environments and Evaluating for Injury

Ergonomics is the science of fitting a given environment to a person, to limit exposure to physical stressors that could lead to discomfort or injury. Ian Leahy, PT, DPT, a physical therapist with the Sports Medicine and Performance Center at Children’s Hospital of Philadelphia, discusses: the basics of a good home set-up; whether to recommend a standing desk; advice to help parents avoid unnecessary costs; tips for laptop users; importance of variability of position; tips to encourage movement; how static positions can cause adaptive shortening and trigger soft-tissue injury with return-to-sport; what to ask in the history to elicit information about home learning set-ups; relationship between forward head posture and new onset of headache; and more. Published March 2021.

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Episode 97: Cardiac Complications of COVID-19 in Children: How They Affect Outpatient Care Post-infection

Matthew Elias, MD, attending cardiologist, Children’s Hospital of Philadelphia, discusses COVID-19’s impact on the heart and how it affects outpatient care for children who have recovered. Includes: a refresher on clinical symptoms of myocarditis, which vary by age and can be subtle; review of EKG findings with myocarditis (again, tricky); other cardiac effects of COVID; the potential for long-term cardiac effects; lack of knowledge about the extent to which other pediatric viruses affect the heart; significance of troponin levels in adults versus children; guidelines for return to sport following COVID infection, with age and severity of infection as factors; when to consider referral for EKG and outpatient cardiology evaluation; symptoms of multisystem inflammatory syndrome in children (MIS-C); differences between MIS-C and Kawasaki disease; whether patients with congenital heart disease are at higher risk; and more.  Published February 2021.

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Episode 96: Intimate Partner Violence: A Mom and Survivor Shares Her Story

Fifteen million children are exposed to intimate partner violence (IPV) in the U.S. every year, with 50% of those exposures severe. This podcast offers perspective from Kalena Brown, an advocate and mother whose primary care pediatrician helped her and her three children safely leave a domestic violence situation; Ashlee Lynn Murray, MD, MPH, attending physician, Emergency Department, Children’s Hospital of Philadelphia; and Melissa Dichter, MSW, PhD, associate professor, Temple University School of Social Work. They discuss the importance of routine screening for IPV in primary care; barriers to disclosure; co-occurrence of IPV and child abuse; how to screen under and over the age of 2; safety in screening and documentation; how to manage a positive screen; how to offer support when the family isn’t ready to be directed to resources; importance of longitudinal relationships between pediatricians and families; and more. Published February 2021.

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Episode 95: Eating Disorders: An Update for Primary Care Pediatricians

Kerri Heckert, MS, RD, LDN, CEDRD-S, clinical dietitian, and Eleanor Benner, PsyD, psychologist, of the Eating Disorder Assessment and Treatment Program at Children’s Hospital of Philadelphia (CHOP), discuss the most recent (and more inclusive) diagnostic criteria for anorexia and bulimia; the relatively new diagnosis ARFID (Avoidant Restrictive Food Intake Disorder); the role of growth charts in diagnosis; red flags to look for in a primary care setting; strategies for promoting positive body image; indications for inpatient admission; CHOP’s inpatient protocol for eating disorders; resources for parents; family-based treatment; how to make a referral, and more. Published January 2021.

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Episode 94: Celiac Disease: What Pediatricians Need to Know

Arunjot Singh, MD, MPH, attending physician and Co-Director of the Center for Celiac Disease at Children’s Hospital of Philadelphia (CHOP), talks about when and how to start celiac screenings, genetic links to other autoimmune diseases, common presentations of celiac disease in a primary care setting, understanding IgG levels, role of different diagnostic tests and biopsy, how pediatricians can monitor celiac patients on an ongoing basis, vaccine considerations, and more. Published January 2021.

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Episode 93: Medical Ethics and COVID-19 Vaccines

In this episode, we explore the ethical considerations around the development and distribution of SARS-CoV-2 vaccines with Chris Feudtner, MD, PhD, MPH, Director of Research for the Justin Michael Ingerman Center for Palliative Care and Endowed Chair in Medical Ethics at CHOP. He discusses how are advisory groups are deciding who will receive priority immunization given limited supply, logistical distribution challenges, the question of equitable access, ethical considerations of including kids in vaccine trials, the mandate question, counseling parents and more. Published December 2020.

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Episode 92: Challenging Patient Behaviors

In this episode, Katie Lockwood, MD, sits down with a panel of experts to talk about CHOP’s clinical pathway for the management of challenging behaviors in children. Vicky Scheid, MD, Pediatrician, Melanie Hoynoski, Child Life Specialist, and Julie Ginsburg, MSN, CPNP-PC, AE-C, Ambulatory Nursing Practice Specialist, share strategies to support and promote proactive management of behavior safety needs of patients with the goal of improving care experiences for patients, families and staff. Topics include support resources, planning and preparation, de-escalation techniques, biopsychosocial pain management strategies and more. Published December 2020.

Episode 91: Integrative Approaches to Treating Autism

Autism effects as many as 1 in 54 children. In this episode, we focus on alternative treatments. Amanda Bennett, MD, MPH, developmental pediatrician and clinical chair of the Autism Integrated Care Program at Children’s Hospital of Philadelphia, talks about why families look to integrative medicine for treatment of autism, and dives into the safety and efficacy of some common integrative approaches, such as gluten-free diets, equine therapy, vitamin supplements, music therapy, social skills training, melatonin, CBD and more. Published November 2020.

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