Primary Care Perspectives

Each year in the U.S., more than 400,000 children are in foster care. Jennifer Keim, MD, MPH, primary care pediatrician at the Nicholas and Athena Karabots Pediatric Care Center of Children’s Hospital of Philadelphia, provides a review of important considerations in primary care for these vulnerable children, including: explanations of common terms, such as medical foster homes, resource parents, respite care, and more; the significance of placement instability and a trauma-informed approach to care; resources such as CHOP’s Fostering Care Program for outpatient assessment, and CASA volunteers; consent and confidentiality issues and how to sort through them; defining permanency, aging out and other outcomes and a review of national and local statistics; and more. Published May 2023. 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. ©2023 by Children's Hospital of Philadelphia, all rights reserved.

CHOP has a new primary care clinical pathway for the diagnostic evaluation of development delay and intellectual disability. Its co-authors, Elana Huang, MD, primary care pediatrician, CHOP Care Network, and Hana Alharbi, MBBS, MS, pediatric geneticist, University of Tabuk, Saudi Arabia (who did a fellowship at CHOP), review the pathway and how it might help a primary care practitioner, including information about: testing tiers; limits of newborn screening panels; non-genetic test recommendations; which subspecialties to refer to for certain symptoms; recommendations for next steps when encountering recognizable syndromes; 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. ©2023 by Children's Hospital of Philadelphia, all rights reserved.

It’s estimated that 20 percent of variation in health outcomes is due to medical and healthcare system factors. Environment makes up a significant portion of the other 80 percent. Stephanie Mayne, PhD, MHS, epidemiologist and research scientist at PolicyLab at Children’s Hospital of Philadelphia, provides information to help primary care clinicians understand neighborhood-level social determinants of health, including: the roots of disparities in resources by neighborhood and how this affects children; specific neighborhood attributes that impact sleep and mental health, such as noise, violence, pollution, tree canopy and green space; suggestions for how to advocate for interventions; 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. ©2023 by Children's Hospital of Philadelphia, all rights reserved.

Lunch at school. A birthday party. Dinner out. For kids with food allergies, everyday activities can be fraught. Megan Lewis, MSN, RN, CRNP, nurse practitioner and program manager, Food Allergy Center at Children’s Hospital of Philadelphia, and James (JP) Senter, MD, a third-year resident at CHOP, review: the extent to which food allergies affect quality of life for children and families; oral immunotherapy; Scale of Food Allergy Anxiety (SOFAA); tips for talking to patients with food allergies about anxiety; how history of anaphylaxis can lead to anxiety; 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. ©2023 by Children's Hospital of Philadelphia, all rights reserved.

Children born with congenital heart disease (CHD), the most common birth defect in the U.S., are at greater risk for emotional and behavioral health concerns. Lyla El-Messidi Hampton, PhD, ABPP-CN, pediatric neuropsychologist and co-director of the Cardiac Kids Developmental Follow-up Program at CHOP, and Nicholas Seivert, PhD, psychologist in the Cardiac Center at CHOP, review the many reasons for increased mental health risk among children with heart defects, especially single ventricle patients, and provide information about: importance of early identification and intervention; ADHD meds for CHD patients; the higher rate of autism spectrum disorders in this population; the parental distress loop; screening in primary care, and red flags; places to refer at CHOP; and more. Published February 2023. 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. ©2023 by Children's Hospital of Philadelphia, all rights reserved.

Are occipital headaches always cause for alarm? What if the headache is always on the right side or the left side? What is a thunderclap headache? Ishani Kumar, MD, pediatric headache fellow, Division of Neurology, Children’s Hospital of Philadelphia, provides a review to help primary care providers manage migraine headaches, including: tips for taking a headache history; red flags; distinguishing a migraine from a tension headache; explaining aura with headache; use of NSAIDs and triptans for pain; use of nutraceuticals for prevention; how to counsel patients about when improvements from treatment may begin (usually at least 8 weeks); when to refer for outpatient imaging and to neurology; when to send to the ER for urgent imaging or work-up; 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. ©2023 by Children's Hospital of Philadelphia, all rights reserved.

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. 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. ©2023 by Children's Hospital of Philadelphia, all rights reserved.

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. 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. ©2023 by Children's Hospital of Philadelphia, all rights reserved.

Joanna Parga-Belinkie, an attending neonatologist at Children’s Hospital of Philadelphia, shares insights on the updated clinical guidelines for hyperbilirubinemia management. She discusses the rebranding of 'breastfeeding jaundice' to 'suboptimal intake jaundice' to alleviate stigma. The importance of genetic factors like G6PD deficiency is highlighted, along with the significance of accurate bilirubin measurement over visual assessments. Joanna debunks myths about sunlight's effectiveness and lays out strategies for managing rebound bilirubin levels post-treatment.

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 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.