Primary Care Perspectives

Two pediatric physical therapists from Children's Hospital of Philadelphia discuss the importance of early detection and management of congenital muscular torticollis in infants. They cover how to distinguish between the three main types of torticollis, recommend early referrals to physical therapy, and emphasize the role of parents in at-home exercises for resolution.

Snuffles, Hutchinson teeth and saber shins — what do these things all have in common? They are symptoms of syphilis. Also known as the “great mimicker,” syphilis can present itself in many ways. Ericka Hayes, MD, attending physician in the Division of Infectious Diseases at Children's Hospital of Philadelphia, addresses the growing problem of congenital syphilis and the rising rates of transmission from mother to child; describes the common symptoms at birth or in early infancy as found in the newborn nursery and at early newborn checkups, including the classic syphilis rash and its variations; stresses the importance of universal STI screening for teens in prevention; 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.

Through no fault of their own, ADHD medications often bear the misconception of being ineffective — or worse, unsafe — yet they are the first line of treatment used by many physicians, including primary care pediatricians. Katrina A. Fletcher, MD, attending psychiatrist in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at Children's Hospital of Philadelphia, provides a broad overview of ADHD medications, including the highs and lows of varying treatments, from increased productivity to loss of appetite; the trial and error in determining the correct dosing; adjuncts such as behavioral 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.

Did you know that in the late 19th and early 20th centuries, there were “milk stations” that provided supervision of infant feeding and growth? The roots of pediatric care can be traced back to those early days, and there have been considerable changes since. With no signs of slowing down, pediatric care continues to evolve at a rapid pace. Katie K. Lockwood, MD, MEd, a pediatrician and holder of a Distinguished Endowed Chair in the Department of Pediatrics at Children's Hospital of Philadelphia, and Alex Fiks, MD, MSCE, a pediatrician, academic investigator, and the Director of both Clinical Futures (Research Center of Emphasis) and the Possibilities Project: Innovation at CHOP, review the present, past and future state of pediatric primary care, which includes the pros and cons of the electronic health record (EHR) and its evolution; the innovation of clinical decision support tools and its effect on patient outcomes; pediatric career outlooks, including expected labor shortages; and more while also offering supporting evidence and advice to trainees. 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.

Have you heard that babies can’t get sinusitis because they don’t have sinuses? Not true! Mark Rizzi, MD, attending physician in the Division of Otolaryngology (ENT) at Children’s Hospital of Philadelphia, provides a useful review for primary care, including: an overview of sinus formation by age; allergic rhinitis and other pre-disposing factors; how to decide if a routine URI has become sinusitis and antibiotics are warranted (you don’t necessarily need to wait 10 days); neti pots, nasal steroids and other adjuvant treatments; complications to look out for, including unremitting headache for intracranial spread; prevention tips; when to refer to ENT or the ER; 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.

Somatic symptoms are real; we all experience them. One Canadian study found that somatic complaints account for more than 25% of all primary care visits. Samuel Neher, MD, pediatric hospitalist at the Children’s Hospital of Philadelphia, introduces a new clinical pathway for Somatic Symptom and Related Disorder (SSRD) that suggests a standard of care for these symptoms. Goals are to build empathetic rapport with patients and families; encourage somatic symptom treatment alongside diagnostic testing; and promote strong communication and collaboration among the interdisciplinary care team. 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.

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.