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.

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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 140: Primary Care Perspectives: Preventing Weight-based Harm in the Primary Care Setting

How can pediatricians move away from “diet culture” and encourage children and teenagers to have healthy relationships with food, exercise and their bodies? Two experts from the Eating Disorder Assessment and Treatment Program at Children’s Hospital, Eleanor Benner, PsyD, MA, psychologist, and Kerri Heckert, MS, RD, LDN, clinical dietician, discuss: suggestions for how pediatricians can talk about weight, nutrition and exercise without causing harm; socioeconomic factors that affect eating and activity; tips to offer parents, such as avoiding “fat talk”; encouraging kids to eat intuitively; limits to the usefulness of BMI; acknowledging weight bias in healthcare provider decision-making; explaining “body positivity” and “body neutrality”; red flags and what to do if there is suspicion for an eating disorder; and more.Published January 2023.

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Episode 139: Primary Care Perspectives: Disability Awareness: How to improve communication and care for patients with disabilities

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.Published January 2023.

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Episode 138: Primary Care Perspectives: Hyperbilirubinemia: A review of updated guidelines

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.

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Episode 137: Primary Care Perspectives: Sex-Trafficking and Sexual Exploitation of Youth: The CHOP Adolescent Protection Collaborative (APC) Clinic

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 Published December 2022.

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Episode 136: Primary Care Perspectives: Is That a Bull’s Eye? Is Tick-testing a Thing? And More!: Tips for Recognizing Lyme Disease

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.Published November 2022.

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Episode 135: Primary Care Perspectives: SMART Therapy for Asthma: A Review and Practical Tips

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. Published October 2022.

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Episode 134: Primary Care Perspectives: Reflux Redux: A Review of Primary Care Management of GERD

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.Published October 2022.

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Episode 133: Primary Care Perspectives: Giftedness with Thomas Flynn

Primary care physicians can play a key role in helping patients who are intellectually and cognitively gifted get the resources they need, including children who may otherwise be missed. Thomas Flynn, PhD, a pediatric neuropsychologist at Children’s Hospital of Philadelphia, discusses: characteristics a primary care physician can look for that may predict a high likelihood of being gifted; pros and cons of knowing a child’s IQ; variabilities in testing; racial and ethnic disparities in identifying intellectually gifted children; the pediatrician’s role in advocating for testing for children; “twice exceptional” children who are gifted and have ADHD or a learning disability; impact of giftedness on mental health; and more.Published September 2022.

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Episode 132: Primary Care Perspectives: Diagnosing Lupus: The Details of Symptoms, Clinical Evaluation and Labs

Lupus is one of the most common diseases in pediatric rheumatology, but it is complicated to diagnose because its symptoms can be broad and nonspecific, creating overlap with other diagnoses. Sarah Bayefsky, MD, a pediatric and adult rheumatology fellow at Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania, and Melissa Argraves, MD, MSEd, a pediatric rheumatologist at Nationwide Children’s Hospital, discuss what a primary care physician should look for if suspecting pediatric-onset lupus — a disease that is seen primarily in teenagers, and in particular females of color. They explain the nuances of possible symptoms; what can be observed during a clinical visit; what labs to order; and what a PCP should keep an eye on if a patient has been diagnosed with lupus. Published September 2022.

Episode 131: Understanding Vaccine Hesitancy in Black Families: A Discussion

In the U.S., Black women are 3 times more likely to experience infant mortality and previously healthy Black children are 3.4 times more likely to die within 30 days after a surgery. What do these statistics – and many others around healthcare, housing and other topics – have to do with vaccine hesitancy? Everything. Latasha Easter, MD, a pediatric resident at Children’s Hospital of Philadelphia, provides an overview of: disparities in immunization rates; the historical context for distrust of the medical establishment and government among Black patients, and the importance of acknowledging it; the CASE Approach, a framework for conversations with hesitant families; sample conversations and responses; an HPV vaccination success story; social media as an information source; and more. Published August 2022.

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Episode 130: Swimmer’s Ear or Something Worse?: A Review of Otorrhea for the Primary Care Physician

Did you know that lack of canal swelling should be a red flag in physical exam of otorrhea? Ryan Ruiz, MD, MS, attending physician, Division of Otolaryngology, Children’s Hospital of Philadelphia, provides a broad review, covering: key physical exam findings that indicate otitis externa; using antibiotic ear drops and/or oral antibiotics; when to culture; the role of cerumen; when to bring patients back to evaluate tympanic membrane closure; guidelines for water precautions, including for children with ear tubes; evaluating for acute mastoiditis; assessments after trauma; tools an ENT and audiologists have at their disposal that primary care doesn’t; and more. Published August 2022.

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Episode 129: Mental, Emotional, Social and Physical Health: Benefits of Youth Sports Participation

The Philadelphia Youth Sports Collaborative has more than 70 member organizations that help promote leadership, grit, and other important skills through sports. Beth DeVine, executive director, Philadelphia Youth Sports Collaborative, explains the term “sports-based youth development” and provides an overview of the organization’s goals and role, including trauma-informed coaching, outcome measurement, equitable access, sports as a promoter of social and emotional learning, differences between benefits to boys and girls, and more. She also provides advice on how pediatricians can encourage kids to participate in beneficial sports programs, including pointing them to rec centers and specific resources. Published July 2022.

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Episode 128: Climate Change and Children’s Health: A Few Steps Pediatricians Can Take to Help

Climate change has many health effects, yet doctors and patients don’t routinely discuss this topic. Harleen Marwah, MD, MS, a pediatric resident at Children’s Hospital of Philadelphia who is the founder of Medical Students for a Sustainable Future,provides an overview of the many ways climate changes affects children’s health, including prenatal health and mental health. Presented with overwhelming information about climate change, doctors may struggle to know how to put helpful steps into practice. Dr. Marwah discusses ideas for how pediatricians can incorporate anticipatory guidance and screening questions related to climate change into practice,with the goal of helping families navigate the changing environment; how doctors can participate in advocacy; and the one step every doctor, no matter how busy,can take today to help address climate change. Published July 2022.

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Episode 127: Of Fresh Fruit and Fuzzy Mouths: Managing Oral Allergy Syndrome in the Primary Care Setting

How can a primary care physician be sure their patient’s oral allergy syndrome (OAS) is not another type of allergy that may require more aggressive management? Katie Kennedy, MD, attending physician, Division of Allergy and Clinical Immunology, Children’s Hospital of Philadelphia, discusses: how to get a history to distinguish between OAS and IgE-mediated food allergies and seasonal/environmental allergies; the importance of pollen patterns in your region and a review of cross-reactive foods; why kids with OAS react differently to raw and cooked food (raw apples vs. apple pie); whether to recommend antihistamines; differentiating between contact rashes (such as from strawberries and tomatoes) and OAS; how to evaluate whether the child may be at risk for systemic reaction (and should carry epinephrine); can a child outgrow OAS; when to refer to a pediatric allergist, plus a review of the treatments the allergist might suggest; and more. Published June 2022.

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Episode 126: Sleep-related Death in Infants Is Common and Preventable

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. Published June 2022.

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Episode 125: Emergency Room or Not?

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. Published May 2022.

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Episode 124 - Psychology-based Interventions Help Kids with Chronic Pain

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. Published May 2022.

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Episode 123: Inequities in Chlamydia Screening

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. Published April 2022.

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Episode 122: Updated Developmental Milestones

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. Published April 2022.

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Episode 121: When Social Skills Are a Struggle: How the Primary Care Pediatrician Can Help

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.

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Episode 120: Evaluating Neutropenia in Primary Care: CBC Basics, Red Flags and More

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.

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Episode 119: Primary Care in the Opioid Epidemic: Supporting NAS and NOWS Babies and Their Moms

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.

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Episode 118: Infant Nutrition: Are Your Newborn and Infant Patients Getting Enough Vitamin D and Iron?

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.

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Episode 117: Managing Anxiety in the Primary Care Setting

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.

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Episode 116: Creative Approaches to Connection: About "Chalkin' Your Walkin'"

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.

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Episode 115: FPIES: A Complex Allergy with Serious Health Effects in Babies

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.

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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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