Primary Care Perspectives

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. 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. ©2021 by Children's Hospital of Philadelphia, all rights reserved.

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. 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. ©2021 by Children's Hospital of Philadelphia, all rights reserved.

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.

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. 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. ©2021 by Children's Hospital of Philadelphia, all rights reserved.

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. 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. ©2021 by Children's Hospital of Philadelphia, all rights reserved.

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. 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. ©2021 by Children's Hospital of Philadelphia, all rights reserved.

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. 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. ©2021 by Children's Hospital of Philadelphia, all rights reserved.

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. 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. ©2021 by Children's Hospital of Philadelphia, all rights reserved.

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.

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. 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. ©2021 by Children's Hospital of Philadelphia, all rights reserved.