Category Archives: Pediatrics

Pediatrics

American Association of Critical-Care Nurses Recognizes the Pediatric ICU at K. Hovnanian Children’s Hospital with … – Hackensack Meridian Health

The American Association of Critical-Care Nurses (AACN) recently conferred a gold-level Beacon Award for Excellence on the Pediatric ICU at Hackensack Meridian Childrens Health K. Hovnanian Childrens Hospital, part of Jersey Shore University Medical Center. This accolade adds to quality recognitions K. Hovnanian Childrens Hospital has received in 2023. In June, K. Hovnanian, and Joseph M. Sanzari Childrens Hospital at Hackensack University Medical Center - filed jointly under a single program - were ranked #1 in New Jersey for the third year in a row by U.S. News & World Report.

The Beacon Award for Excellence a significant milestone on the path to exceptional patient care and healthy work environments recognizes unit caregivers who successfully improve patient outcomes and align practices with AACNs six Healthy Work Environment Standards. Units that achieve this three-year, three-level award with gold, silver or bronze designations meet national criteria consistent with the ANCC Magnet Recognition Program, the Malcolm Baldrige National Quality Award and the National Quality Healthcare Award.

I commend the work of our pediatric ICU nurses and team members, said Ellen Angelo, DNP, MSN, R.N., CCRN, CENP, chief nursing officer, Jersey Shore University Medical Center. The gold-level Beacon Award is a welcomed confirmation of the compassionate, exceptional care they provide our youngest patients and community.

AACN President Terry Davis, PhD, R.N., NE-BC, CHTP, FAAN, applauds the exemplary efforts of the Pediatric ICU caregivers at K. Hovnanian Childrens Hospital for working together to meet and exceed the high standards set forth by the Beacon Award for Excellence. These dedicated healthcare professionals join other members of the exceptional community of nurses who set the standard for optimal patient care, Davis said. The Beacon Award for Excellence recognizes caregivers in stellar units whose consistent and systematic approach to evidence-based care optimizes patient outcomes. Units that receive this national recognition serve as role models to others on their journey to excellent patient and family care.

The senior leadership team and I are incredibly proud of our Pediatric ICU team and all of our nurses, said Vito Buccellato, MPA, LNHA, president and chief hospital executive, Jersey Shore University Medical Center. The Pediatric ICU team joins our Cardiac ICU in achieving gold-level Beacon awards this year. Recognitions that are so befitting of a six-time Magnet hospital, recognizing excellence in nursing.

The gold-level Beacon Award for Excellence signifies an effective and systematic approach to policies, procedures and processes that include engagement of staff and key stakeholders; fact-based evaluation strategies for continuous process improvement; and performance measures that meet or exceed relevant benchmarks.

Considering that our Pediatric ICU team cares for our most vulnerable patients, this is a wonderful acknowledgment for the team and highlights their dedication to providing the best care, Harpreet Pall, M.D., MBA, CPE, chair of Pediatrics, K. Hovnanian Childrens Hospital and Hackensack Meridian School of Medicine.

The Pediatric ICU team earned the gold award by meeting the following evidence-based Beacon Award for Excellence criteria:

K. Hovnanians Pediatric ICU is only the second in our state to receive gold-level, one of only 13 Pediatric ICUs in the U.S. to receive gold-level, and add to that, just 13 ICUs in our states 72 acute care hospitals have achieved gold-level Beacon Awards. In light of the rarity of this recognition, the dedication and expertise shown by the Pediatric ICU team is absolutely remarkable and deserves celebration, said Kenneth N. Sable, M.D., MBA, FACEP, regional president, Southern Market, Hackensack Meridian Health.

Four other Hackensack Meridian hospitals intensive care units have received silver awards, including Hackensack University Medical Center, Riverview Medical Center, Old Bridge Medical Center and Raritan Bay Medical Center. Recipients who earn a silver-level award demonstrate an effective approach to policies, procedures and processes that include engagement of staff and key stakeholders; evaluation and improvement strategies; and good performance measures when compared to relevant benchmarks.

For information about K. Hovnanian Childrens Hospital, visit http://www.hackensackmeridianhealth.org/en/locations/k-hovnanian-children-hospital. For a free physician referral, call 844-HMH-WELL.

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American Association of Critical-Care Nurses Recognizes the Pediatric ICU at K. Hovnanian Children's Hospital with ... - Hackensack Meridian Health

Pediatrics

Uptick in pediatric mental health ER visits persists through pandemic … – Cornell Chronicle

Mental health crises among children and adolescents requiring emergency department care skyrocketed during the pandemic and have stayed elevated despite a return to normalcy, according to a study by Weill Cornell Medicine and NewYork-Presbyterian investigators.

The study, published Oct. 20 in the journalPediatrics, compared rates of pediatric mental health visits in the emergency departments of five New York City medical centers from a pre-pandemic period through five pandemic waves. Each wave saw elevated rates of youth mental health-related visits compared to before the pandemic.

They found no relationship, however, between pediatric mental health visits and COVID-19 prevalence or how strict mitigation measures were.

The pattern we saw is different than other tragedies because even after the acute COVID-19 emergency was over, we saw that an elevated rate of mental health emergencies persisted, said senior author Dr. Cori Green, vice chair of behavioral health in pediatrics, associate professor of clinical pediatrics at Weill Cornell Medicine and a pediatrician at NewYork-Presbyterian Komansky Childrens Hospital.

Youth mental health was already in a crisis, but (t)he COVID-19 pandemic made the problems more pronounced, noted first author Dr. Deborah Levine, associate professor of clinical emergency medicine, associate professor of clinical pediatrics at Weill Cornell Medicine and a pediatric emergency medicine physician at NewYork-Presbyterian/Weill Cornell Medical Center.

The data analyzed for the study came from the New York-based INSIGHT Clinical Research Network, part of the National Patient-Centered Clinical Research Network (PCORnet).

One of the early epicenters of the COVID-19 pandemic in the United States, New York City faced enormous challenges. As pandemic restrictions shut down many health clinics, schools and other youth services, emergency departments became the only option for those experiencing mental health crises. Consequently, emergency visits for a range of mental health issues increased dramatically:

The researchers also observed that patients who were female, adolescents, Asian, or from communities with more resources were overrepresented compared to what would have been expected pre-pandemic. As this study focuses on New York City, Levine cautioned that the conclusions may not be universal. However, other studies within the United States and around the world have also demonstrated increased rates of mental health emergencies during the pandemic.

Levine and Green hope their analysis helps draw attention to the urgent need for greater pediatric mental health care resources. Post-pandemic families are still struggling to access pediatric mental health care. Many emergency departments must hold young people while they wait for beds to open on psychiatric units, and outpatient settings have limited openings. Community mental health services have a three-to-six-month waitlist, Green added.

The data may also help identify high-risk groups requiring greater attention. For example, Levine and Green found while children from communities with fewer resources did come for emergency mental health visits, there was not as drastic an increase in rates of their visits as expected considering the impact of the pandemic. Youth from more historically marginalized populations may have been less likely to come to the emergency department to access care and silently suffered, said Levine. While some of those patients are now being identified during routine primary care screening, their mental health conditions may have progressed to a more severe stage since they did not seek help earlier.

We are trying to bring this crisis to peoples attention, Levine said. The more we study the problem, the more we may be able to identify solutions, bring them to policymakers and try to get more funding for youth mental health care.

This crisis has reached a point where you cant ignore it, Green added. There has to be action and not everyone is acting as quickly as they need to.

This study was supported by a grant from the RTW Foundation.

Bridget Kuehn is a freelance writer for Weill Cornell Medicine.

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Pediatrics

Discussing software that helps track progress after an autism … – Contemporary Pediatrics

Contemporary Pediatrics:

Can you explain what types of software are helping families after their child has been diagnosed with autism?

Lauren Lanzon, MSW, MA, BCBA:

Software and technology have come a long way since I first started in the field about 10 years ago. Back then, paper and pen data collection and graphing through Microsoft Exel was more the standard for Applied Behavior Analysis (ABA). Now, platforms like CentralReach are able to do all of this and more through their system.

This allows us to streamline multiple processes, and now, with CR Care Coordinator, even parent education and training can take place through an online system. Whats so helpful about this is that parents can access specific ABA training and learn how to potentially manage behaviors, teach skills, and navigate daily routines and changes with their children who carry an autism spectrum disorder (ASD) diagnosis.

So, in this sense, technology is not only evolving and helping providers, but is now taking a step further to be a great resource for families as well.

Contemporary Pediatrics:

What questions can parents or caregivers ask their general pediatrician when it comes to this software?

Lanzon:

Receiving a diagnosis of ASD can be a daunting and challenging experience for some families. Then, even once a diagnosis is obtained, getting access to evidence-based and effective treatment like Applied Behavior Analysis can sometimes take a significant amount of time.

Families have to navigate insurance policies, waiting lists, and sometimes years of time between a diagnosis and treatment. In this interim, valuable skill development opportunities are often missed, and families are left on their own to manage sometimes significant challenging behaviors like aggression or self-injurious behaviors.

What parents need to ask, or even better yet, what a pediatrician should share with families, is that tools like CR Care Coordinator are out there and available to help them during this time.

Here at Carolina Behavioral Innovations (CBI), we believe parents are the best advocates for their children and asking questions about online resources and training materials to their pediatricians can help them gain access to this kind of technology to assist them in navigating their daily lives before, during and after ABA treatment.

Contemporary Pediatrics:

How important is it (or how helpful can it be) for families to have a tool like this when it comes to autism?

Lanzon:

Extremely helpful! Applied behavior analysis is a science; it can be technical, confusing, and not always intuitive to a parent or caregiver. However, it is evidence based and when implemented correctly, can be extremely effective in teaching skills and managing challenging behaviors.

At CBI, we really emphasize parent training because empowering and giving our parents skills to teach promotes consistency and generalization of skills. Tools like CR Coordinator help to train parents, at the core, to be able to implement ABA strategies independently. Its lessons can help parents understand the function a challenging behavior may be serving for their child so they can respond to it.

It can help them teach their child how to communicate effectively, through various modalities, to get their wants and needs met. It can help explain to them how to teach their child daily living skills like handwashing or getting ready for school or crossing the street safely.

It can even help them navigate other logistical challenges like understanding their rights as consumers, how to manage stress, or simply to understand the ASD diagnosis.

I would consider all of these to be critical and necessary skills for any family who has a child with an ASD diagnosis.

Contemporary Pediatrics:

Can you explain the market for software like this, or other similar tools? Should the use of these types of tools be discussed with the pediatrician, or what do you recommend to the parents looking into this?

Lanzon:

To be transparent, Im not super familiar with other options that are similar to CR Care Coordinator. I believe there may be perhaps 1 other system out there that may offer this kind of support, but as far as I know, the options for specific parent training and education software are somewhat limited.

While there are countless autism-focused books on parenting along with websites available on the topic, they are often not evidence based, meaning that there is not always research to back up what these resources are directing parents to do.

Trying to sift through all of these resources can often be overwhelming as well, and often parents are pulling from a hundred different sources and spending hours of their time to try and find an answer to their one question.

Parents need to ask pediatricians about evidence-based resources that are cohesive, understandable and individualized to them. Unlike having to read an entire book on ABA or autism which is not individualized to that family, in CR Care Coordinator, parents can jump right to lessons that apply directly to them and their individual challenges and questions.

And those that designed the platform at CentralReach, have already done the painstaking hours of analysis to present material that is grounded in research and proven to be effective, unique to each patient and their family.

Every parent should ask about this and they all deserve access to this kind of training and support.

Contemporary Pediatrics:

Can you talk about the training the software offers? How can the training avoid pauses or setbacks when it comes to care?

Lanzon:

The setup of CR Care Coordinator is fantastic! Its organized into lessons on various topics and each lesson presents the pertinent information for the parent by having them click through a narrated presentation.

After the lesson, it proves the parent with homework to actually apply the material and there is even a Rubric test so the parent can make sure they really understand the material.

Many of the topics are on specific ABA interventions; understanding and identifying functions of behavior, positive versus negative reinforcement, prompting procedures, and so on. CR Care Coordinator even offers topics related to vocational skills, community safety, understanding treatment options, and even data collection.

This can help to create seamless transitions from treatment to daily living for families, ensuring consistency with what occurs during session time and what occurs outside of it. Providers are not in the home 24/7 and parents now have a tool that is with them all the time to help them navigate challenges and questions at all times.

That accessibility also allows for continuity of care for when there may be a pause in care. For example, staffing shortages, insurance changes, sicknesses, and so on can all result in a potential pause in services, but with access to CR Care Coordinator, the resource doesnt just go away when the provider does - it is with them to be that support when a provider may not be able to.

Here at CBI, we really value the individual, not the diagnosis, and I feel that CR Care Coordinator really aligns with this mentality, in that they provide a really unique way for parents to individualize their experience, which is through the integration of values and relationship building with their child.

These lessons walk parents through establishing, integrating, and understanding their values and how those values impact their everyday lives. It can teach them how to connect with their child, how to be present, how to play, how to prioritize and this whole other set of processes that not only focuses on treatment, but the child and family as a whole.

For us here at CBI, we feel that CR Care Coordinator helps share the message to families that they are the biggest part of their childs treatment and that their thoughts, concerns and feelings about treatment decisions and care are valid and extremely valued.

Contemporary Pediatrics:

How can providers navigate patient expectations with a tool like this? Lanzon:

With CR Care Coordinator, as with ABA, or any other therapeutic treatment, there is no quick fix to challenges like maladaptive behaviors or learning communication. Utilizing a platform like this requires work, consistency, and dedication from a family to really see the impacts on their daily lives. Providers need to be transparent about this and let families know that challenges and questions will arise, but that families can focus on progress, not perfection. However, with access to a tool like CR Care Coordinator, families can have gaps filled in for them, where previously there were just voids of information. While waiting for services, during services and after discharge from services, CR Care Coordinator gives families an incredible opportunity to access quality, evidence-based skills and lessons that they can implement to help them, and their child feel empowered, unique and supported, which every family and child deserves to feel!

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Pediatrics

Lessons in asking patients’ gender identity and sexual orientation – Contemporary Pediatrics

Takeaways

Lessons in asking patients' gender identity and sexual orientation: Jeff Bergen/peopleimages.com - stock.adobe.com

A recent study presented at the 2023 American Academy of Pediatrics National Conference & Exhibition evaluated how clinicians can ask patients' sexual orientation and gender identity for EHR documentation.

The research conducted between November 2022 and February 2023 at an academic adolescent medicine clinic in the northeastern United States sheds light on the importance of collecting and documenting sexual orientation and gender identity (SOGI) data, particularly among adolescent and young adult (AYA) patients.

The study involved 260 participants aged 10 to 26 years, with a majority falling into the 18-20 year age group. These patients sought care in various programs offered by the clinic, including primary care, gender, eating disorders, and gynecology/menstrual health. Among the participants, 50% identified as gender diverse (GD), 52% as lesbian, gay, or bisexual (LGB), and 38% identified as both GD and LGB. This diversity in the sample is essential for understanding the varied perspectives on SOGI data collection.

One of the key findings of this research was that a significant proportion of AYA patients, regardless of their SOGI, acknowledged the importance of healthcare providers inquiring about their gender identity, chosen name, and pronouns. Sixty-four percent of the respondents believed that asking about gender identity, chosen name, and pronouns was important. GD youth, in particular, expressed a significantly higher agreement (83%) than cisgender youth (45%), emphasizing the relevance of understanding gender diversity within the healthcare context.

The study also highlighted differences in the perceived importance of inquiring about sexual orientation. While a majority of LGB youth (56%) found it important for providers to ask about their sexual orientation, this perspective was less pronounced among heterosexual youth (38%). This finding underscores the significance of considering the specific needs and sensitivities of LGB individuals during patient-provider interactions.

Data also showed that the majority of AYA patients (70%) felt comfortable when asked about their SOGI. This suggests that young people are open to discussing their sexual orientation and gender identity in a health care setting, which can lead to more patient-centered care. Importantly, no single method of SOGI data collection was favored over another, indicating flexibility in the approach.

One significant aspect of the study was that over 96% of GD youth expressed a desire to have their chosen names and pronouns displayed in their electronic health records (EHRs). According to the authors, this speaks to the importance of providing a supportive and respectful environment for GD individuals, where their preferred names and pronouns are not only recognized but also incorporated into their medical records.

The study authors concluded that this research emphasizes the significance of collecting and documenting SOGI data in healthcare, particularly in the context of AYA patients. It shows that most AYA individuals are comfortable discussing their sexual orientation and gender identity with health care providers. Moreover, GD and LGB youth expressed higher rates of comfort compared to their cisgender and heterosexual counterparts when it comes to SOGI questions. The lack of a preferred method for SOGI data collection underlines the importance of flexibility and adaptability in healthcare practices.

Reference:

Rusley JC, Purian JJ, Kapadia JH, Li MM. 3A0P4A225: Asking Adolescents and Young Adults About Their Sexual Orientation and Gender Identity: Lessons for Clinic Staff and EHR Documentation. Poster. Presented at: Presented at: 2023 American Academy of Pediatrics National Conference & Exhibition.

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Lessons in asking patients' gender identity and sexual orientation - Contemporary Pediatrics

Pediatrics

New Study In The Journal Of Pediatrics Says Maybe It’s Not Social … – Techdirt

from the correlation-and-causation dept

Weve been covering, at great length, the moral panic around the claims that social media is whats making kids depressed. The problem with this narrative is that theres basically no real evidence to support it. As the American Psychological Association found when it reviewed all the literature, despite many, many dozens of studies done on the impact of social media on kids, no one was able to establish a causal relationship.

As that report noted, the research seemed to show no inherent benefit or harm for most kids. For some, it showed a real benefit (often around kids being able to find like-minded people online to communicate with). For a very small percentage, it appeared to potentially exacerbate existing issues. And those are really the cases that we should be focused on.

But, instead, the narrative that continues to make the rounds is that social media is inherently bad for kids. That leads to various bills around age verification and age gating to keep kids off of social media.

Supporters of these bills will point to charts like this one, regarding teen suicide rates, noting the uptick correlates with the rise of social media.

Of course, they seem to cherry pick the start date of that chart, because if you go back further, you realize that while the uptick is a concern, its still way below what it had been in the 1990s (pre-social media).

In case that embed isnt working, heres an image of it:

Obviously, the increase in suicides is a concern. But, considering that every single study that tries to link it to social media ends up failing to do so, that suggests that there might be some other factor at play here.

A recent study in the Journal of Pediatrics suggests a compelling alternative. Its not social media, but the rise of helicopter parenting, in which kids no longer have spaces to just hang out with each other and be kids. Its titled: Decline in Independent Activity as a Cause of Decline in Childrens Mental Well-being: Summary of the Evidence. If you cant see the full version, theres a preprint version here.

The research summarizes the decline in independent mobility for kids over the last few decades:

Considerable research, mostly in Europe, has focused on childrens independent mobility (CIM), defined as childrens freedom to travel in their neighborhood or city without adult accompaniment. That research has revealed significant declines in CIM, especially between 1970 and 1990, but also some large national differences. For example, surveys regarding the licenses (permissions) parents grant to their elementary school children revealed that in England, license to walk home alone from school dropped from 86% in 1971 to 35% in 1990 and 25% in 2010; and license to use public buses alone dropped from 48% in 1971 to 15% in 1990 to 12% in 2010.11 In another study, comparing CIM in 16 different countries (US not included), conducted from 2010 to 2012, Finland stood out as allowing children the greatest freedom of movement. The authors wrote: At age 7, a majority of Finnish children can already travel to places within walking distance or cycle to places alone; by age 8 a majority can cross main roads, travel home from school and go out after dark alone, by age 9 a majority can cycle on main roads alone, and by age 10 a majority can travel on local buses alone. Although we have found no similar studies of parental permissions for US children, other data indicate that the US is more like the UK concerning childrens independent mobility than like Finland. For example, National Personal Transportation Surveys revealed that only 12.7% walked or biked to school in 2009 compared with 47.7% in 1969.

And then it notes the general decline in mental health as well, which they highlight started long before social media existed:

Perhaps the most compelling and disturbing evidence comes from studies of suicide and suicidal thoughts. Data compiled by the CDC indicate that the rate of suicide among children under age 15 rose 3.5-fold between 1950 and 2005 and by another 2.4-fold between 2005 and 2020. No other age group showed increases nearly this large. By 2019, suicide was the second leading cause of death for children from age 10 through 15, behind only unintentional injury. Moreover, the 2019 YRBS survey revealed that during the previous year 18.8% of US high school students seriously considered attempting suicide, 15.7% made a suicide plan, 8.9% attempted suicide one or more times, and 2.5% made a suicide attempt requiring medical treatment. We are clearly experiencing an epidemic of psychopathology among young people.

But, unlike those who assume correlation is causation with regards to social media, the researchers here admit there needs to be more. And they bring the goods, pointing to multiple studies that suggest a pretty clear causal relationship, rather than just correlation.

Several studies have examined relationships between the amount of time young children have for self-directed activities at home and psychological characteristics predictive of future wellbeing. These have revealed significant positive correlations between amount of self-structured time (largely involving free play) and (a) scores on two different measures of executive functioning; (b) indices of emotional control and social ability; and (c) scores, two years later, on a measure of self-regulation. There is also evidence that risky play, where children deliberately put themselves in moderately frightening situations (such as climbing high into a tree) helps protect against the development of phobias and reduces future anxiety by increasing the persons confidence that they can deal effectively with emergencies.

Studies with adults involving retrospections about their childhood experiences provide another avenue of support for the idea that early independent activity promotes later wellbeing. In one such study, those who reported much free and adventurous play in their elementary school years were assessed as having more social success, higher self-esteem, and better overall psychological and physical health in adulthood than those who reported less such play. In another very similar study, amount of reported free play in childhood correlated positively with measures of social success and goal flexibility (ability to adapt successfully to changes in life conditions) in adulthood. Also relevant here are studies in which adults (usually college students) rated the degree to which their parents were overprotective and overcontrolling (a style that would reduce opportunity for independent activity) and were also assessed for their current levels of anxiety and depression. A systematic review of such studies revealed, overall, positive correlations between the controlling, overprotective parenting style and the measures of anxiety and depression.

They also note that they are not claiming (of course) that this is the sole reason for the declines in mental health. Just that there is strong evidence that it is a key component. They explore a few other options that may contribute, including increased pressure at schools and societal changes. They also consider the impact of social media and digital technologies and note (as we have many times) that there just is no real evidence to support the claims:

Much recent discussion of young peoples mental health has focused on the role of increased use of digital technologies, especially involvement with social media. However, systematic reviews of research into this have provided little support for the contention that either total screen time or time involved with social media is a major cause of, or even correlate of, declining mental health. One systematic review concluded that research on links between digital technology use and teens mental health has generated a mix of often conflicting small positive, negative and null associations (Odgers & Jensen, 2020). Another, a review of reviews concluded that the association between digital technology use, or social media use in particular, and psychological well-being is, on average, negative but very small and noted some evidence, from longitudinal research, that negative correlations may result from declining mental health leading to more social media use rather than the reverse (Orben, 2020)

Indeed, if this theory is true, that the lack of spaces for kids to explore and play and experiment without adult supervision is a leading cause of mental health decline, you could easily see how those who are depressed are more likely to seek out those private spaces, and turn to social media, given the lack of any such spaces they can go to physically.

And, if thats the case, then all of these efforts to ban social media for kids, or to make social media more like Disneyland, could likely end up doing a lot more harm than good by cutting off one of the last remaining places where kids can communicate with their peers without adults watching over their every move. Indeed, the various proposals to give parents more access to what their kids are doing online could worsen the problem as well, taking away yet another independent space for kids.

Over the last few years, theres been a push to bring back more dangerous play for kids, as people have begun to realize that things may have gone too far in the other direction. Perhaps its time we realize that social media fits into that category as well.

Filed Under: age appropriate design, age verification, depression, independent spaces, mental health, social media, studies, suicide, teens

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New Study In The Journal Of Pediatrics Says Maybe It's Not Social ... - Techdirt

Pediatrics

UCLA Health clinic helps ensure survivors of pediatric and … – UCLA Health Connect

Each year, about 15,000 children and adolescents in the United States receive the terrifying diagnosis that they have cancer.

The vast majority about 85% will survive, thanks to dramatic improvements in treatment over the last several decades. But with that comes another challenge: meeting the need for longer-term follow-up, to address the wide range of issues survivors may face either as a result of their cancer or the specific treatment they received.

Thats where UCLAs Pediatric and Adolescent Survivorship Clinic comes in.

When Jacqueline Casillas, MD, a pediatric oncologist, founded the clinic 20 years ago, the number of survivors was much smaller, and having a clinic dedicated to meeting their long-term needs was a new concept.

Now, though, there are about 500,000 survivors of pediatric, adolescent and young-adult cancers, according to data from the National Cancer Institutes Childhood Cancer Registry. The focus has expanded beyond keeping patients from succumbing to their initial cancer to tracking and addressing related issues that may emerge even many years later, from secondary cancers to an increased risk for endocrine disorders or cardiovascular disease.

We focus on survivors of all sorts of pediatric cancers anything from neuroblastoma to hepatoblastoma, said Dr. Casillas, a member of the UCLA Health Jonsson Comprehensive Cancer Center. But we also focus on those that cross into the young adult age group, which includes leukemia, lymphoma, brain tumors, germ cell tumors and sarcomas.

Patients need to be at least one year past their cancer treatment to receive survivorship care at the clinic, although some are referred there even many years afterward, said Dr. Casillas, who serves as the clinics director and is also a professor of pediatrics at in the division of hematology and oncology at the David Geffen School of Medicine at UCLA.

The only other requirement is that their treatment needs to have occurred at some point between childhood and young adulthood. Thats because the issues they face may affect them developmentally and can have ripple effects throughout their lives.

At the clinic, survivors of childhood and adolescent cancers receive personalized treatment plans to address what are termed late effects: a broad category that can include secondary cancers as well as various psychosocial effects such as mental health issues or learning difficulties.

Chemotherapy and radiation can have an effect on the heart and lungs, Dr. Casillas noted, and there are heightened risks for various secondary cancers. Patients diagnosed with cancer during their youth also face increased risks for accelerated aging, such as decreased cardiovascular function or an increase in frailty, much sooner than is typical. Were actually seeing that the aging process is sped up, Dr. Casillas said.

Not only have these late effects become more apparent now that there are far more survivors of childhood cancers, the treatment protocols continue to evolve as well. One example: A new study showed that a blood pressure medication can help protect against heart damage caused by doxorubicin, a widely used chemotherapy drug.

Patients may also have challenges such as learning difficulties as a result of radiation therapy, or may need help navigating school issues such as returning to college or requesting accommodations such as additional time for test-taking.

We know specifically which late effects youre at risk for, because its very targeted based on your individual cancer treatment, said Dr. Casillas. Even if you had the same diagnosis as someone else, you may not have gotten the same treatment. Thats why this clinic is critical, because it provides a specific plan based on your treatment history.

While treatment for cancer can be considered a traumatic life event, she noted, it can be even more so for a young person who may be grappling with body image issues, such as coping with baldness, or worrying about potential future impact on their fertility.

Undergoing cancer treatment can be overwhelming, but once it ends, patients can feel unmoored.

Some people have described going through chemo as kind of like a safety net, Dr. Casillas said, given the all-encompassing nature of frequent treatments such as chemotherapy, blood transfusions and radiation. But afterward, patients may not even know what questions to ask about potential future issues, or may wonder if various symptoms theyre experiencing are related to their cancer treatment.

Survivorship care bridges that gap, Dr. Casillas explained. Even though patients will typically be followed by their oncologist for a period of time and will likely have a primary care provider as well, neither specializes in the wide range of survivorship issues, including the need for additional late effects screenings (or earlier cancer screenings) based on the patients cancer treatment history.

Although patients treated at freestanding childrens hospitals may be receiving survivorship care there, it typically ends once they turn 21 and reach the age cutoff.

At UCLA, though, which provides both pediatric and adult care, theres no such cutoff. Were able to provide care across the age continuum from childhood through adulthood, Dr. Casillas said. We have the ability to provide care without an end date, and thats very unique.

Patients may be referred from other treatment centers or from within UCLA Health, and some patients are even referred from adult oncologists treating survivors of childhood cancers. What matters is the age at which the cancer was diagnosed, not the age of the patient or even the specific prognosis, Dr. Casillas said.

We may have patients who have a brain tumor who are now being followed by the neuro-oncology team, but they have specific survivorship needs. We are not diagnostic specific in the sense that we are doing these survivorship care plans based on an individuals treatment, not necessarily on their diagnosis, she said.

In addition to Dr. Casillas, the clinic includes a nurse practitioner who helps patients navigate referrals, an education specialist who helps with learning and school-related issues, and a robust referral network of various specialists, including cardio oncologists.

We refer within UCLA Health to targeted multidisciplinary providers to help care for our patients when they have specific late effects, Dr. Casillas said.

Although patients dont start receiving care at the clinic until at least one year after their treatment ends, the goal is to educate them about the need for survivorship care much earlier than that, Dr. Casillas said, to empower them to be active consumers in their survivorship care.

Thats currently being done via text-messaging-based outreach to the clinics patients, but she hopes to expand the audience by working with pediatric oncology departments to identify patients and sign them up right when they finish treatment.

We want to bring survivorship care to where the survivor is, Dr. Casillas said. There can be a lot of missed opportunities for needed survivorship care screening as they move into adulthood, she explained. It might have been the parent driving the care, or they moved out of state and are no longer connected to their cancer center.

Patients are prompted via text to select their top three goals, then directed to additional recommended steps and resources. They also receive follow-up calls to help them navigate through issues such as insurance roadblocks or delays in getting a referral to a survivorship doctor.

Not only does the text-messaging outreach distill down what can be an overwhelming amount of information into an accessible format, she noted, it also increases the likelihood that patients will seek out survivorship care, which in turn helps improve their long-term outcomes.

"Right now we are focusing on the young adult patients and have not yet done it with parents," Dr. Casillas said, "but that is phase 2 of the research, to start reaching out to parents and younger teens.

Reaching out to survivors in a way thats effective also means doing so in a way thats culturally relevant, Dr. Casillas noted. We know that having more culturally targeted communications and understanding the unique needs of our diverse populations are critically important.

Because more than half of the clinics patients are Latino, she recently created a fotonovela (a photo-based booklet with text bubbles for dialogue) in both Spanish and English. The booklet was funded via a grant from the National Cancer Institute and developed with input from local community members, including an advisory group of survivors and their families.

We know that within our Latino community, the importance of family is so critical, Dr. Casillas said, so when we wrote the booklet, we took a family-centered approach.

The story is told through the lens of a young teenager whos a cancer survivor and wants to play soccer. It integrates the family, and it also integrates the discussion with the doctor, she explained. Many times, people dont want to challenge their doctor or ask them for things. Were trying to educate them that yes, its OK to ask your doctor for a survivorship care plan.

The fotonovela also addresses health insurance, which can be a big barrier, for teens and young adults, Dr. Casillas said. Health insurance literacy isnt easy for anybody, she pointed out.

Although fotonovelas have previously been used in other health contexts, such as diabetes educational outreach, they hadnt yet been used for reaching cancer survivors. But it was a format that made sense for this audience, she noted.

We knew the key survivorship messages to convey to help change health behaviors. The goal is to help ensure theyll get that needed care, Dr. Casillas explained, versus I dont want to deal with it, because Im too scared.

The booklet is available in print and in an electronic format.

Weve taken these national educational tools that are very dense and wordy and made them understandable for teens and young adults and their family members, Dr. Casillas said. Theyre still getting the same health messages, she noted, but in a more accessible and relevant format.

Above all, Dr. Casillas said, we want it to be a hopeful message."

Because the whole thing with survivorship care and late effects is that if we know that something could be a risk, we can screen for it, she said. And if you do develop it, we can pick it up early enough so that its not a big health risk.

Lisa L. Lewis is the author of this article.

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UCLA Health clinic helps ensure survivors of pediatric and ... - UCLA Health Connect

Pediatrics

Fauci to Pediatricians: You Have a ‘Reservoir of Trust’ With the Public – Medpage Today

WASHINGTON -- Anthony Fauci, MD, former director of the National Institute of Allergy and Infectious Diseases, reminded pediatricians gathered here for their annual meeting that they play a key role in public health.

While there's been concern about an erosion of trust in science, Fauci said, the "reservoir of trust that you as pediatricians have built every day increases our chance to realize the full potential of what we have to offer our children, our young adults, and in fact everyone throughout the world."

Mostly, that's "proven vaccines and medicines that we already have to keep our people healthy, as well as the anticipation of the promise of the development of new medical tools in the future," said Fauci, who spoke during the Monday plenary session at the American Academy of Pediatrics (AAP) annual meeting here.

Fauci was at the meeting to receive an Honorary Fellow designation, which, according to the AAP, "represents the highest distinction and expression of gratitude by the Academy."

Sandy Chung, MD, president of the AAP, presented Fauci with the honorary designation, noting that "pediatricians are no strangers to the vast misinformation and disinformation that became increasingly prevalent during the last few years. And we're so grateful for Dr. Fauci's steadfast leadership, guiding our nation's response in that especially trying time."

Fauci, who is also the former White House chief medical advisor to the Biden administration, said he was "truly humbled and honored" to accept the honorary fellowship.

"When I was first contacted about whether I'd be willing to come here to receive this, my thought was, 'are you kidding -- of course,' for a number of reasons," he continued.

"One, for the great deal of respect that I have for, not only your organization, but for the entire field of pediatrics, but also to take this opportunity -- which I don't get to do often in a venue such as this -- to really sincerely thank you for what you have done throughout your entire careers as pediatricians," Fauci said. "But particularly, you've been the shining light over the last 3 years -- 3 years, 9 months, and 42 days, but who's counting -- of the COVID outbreak."

Following Fauci's remarks, the plenary session featured presentations on issues currently affecting pediatric practice, including the pediatric mental health crisis and the legal landscape of abortion.

Joan Jeung, MD, MPH, of the University of California San Francisco, detailed how relationships can be leveraged to address a national emergency in child and adolescent mental health.

"Children exposed to four or more ACEs [adverse childhood experiences] have roughly double the odds of being diagnosed with asthma, five times the odds of being diagnosed with ADHD, about four times the odds of facing teen pregnancy or depression, and 32 times the odds of having any learning or behavior problem," Jeung said. "But we are in this because we know that adversity is not destiny."

"The scientific literature around what promotes resilience in children shows us that the children who go on to do well have had at least one stable and committed caring parent or other adult caregiver in their lives," she noted. "Relationships are so important that we can think of them as a vital sign. Just as we measure heart rate, blood pressure, height, and weight because they tell us important things about the state of that child's health and trajectory that they're on, we should also look at the state of caregiving relationships around the child."

This involves partnering with patients and their caregivers, and creating a plan together, she explained, as well as having empathy and using listening as an intervention.

In the last presentation, Katie Watson, JD, of Northwestern University Feinberg School of Medicine in Chicago, noted that 12% of abortion patients are 19 years old or younger, while 59% are mothers. "Many moms and kids in your office have needed, or will need, an abortion," she said.

So, what can pediatricians do?

"Well, first of all, maximize flourishing within the laws," Watson said. "And what that means, of course, is doubling down on health education or contraceptive access, and then when ... unwanted pregnancies occur, focus on counseling and referrals."

"And then also, I urge you to work towards changing the law to maximize family flourishing," she added. "We don't agree on abortion, that's okay. But in your role as healthcare providers focusing on the ethics of access."

Jennifer Henderson joined MedPage Today as an enterprise and investigative writer in Jan. 2021. She has covered the healthcare industry in NYC, life sciences and the business of law, among other areas.

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Fauci to Pediatricians: You Have a 'Reservoir of Trust' With the Public - Medpage Today

Pediatrics

Lee Health Reminds the Southwest Florida Community that … – South Florida Hospital News

October 24, 2023 As children and teenagers gear up for fall sports, Lee Health wants to remind the Southwest Florida community that pediatric electrocardiograms (EKG) are an easy and painless test to measure the electrical activity of childrens and teenagers hearts.

An EKG records the electrical signal from the heart to check for different heart conditions, listens to the rhythm of the heartbeat, the size of the chambers of the heart and the amount of blood going to the heart muscle itself.

All children and teenagers benefit from getting an EKG that helps identify any potential problem that warrants a follow-up with a cardiac specialist, said pediatric cardiologist, Dr. Eric Eason. Preventive medicine and peace of mind can help save lives and enable our children and loved ones to live full and happy lives.

According to the Centers for Disease Control and Prevention (CDC), in 2010, one in 250 to one in 59 children and teenagers were living with a congenital heart defect in certain areas of the United States.

A couple of years ago, the American Academy of Pediatrics called for all children to be screened for conditions that can lead to cardiac arrest or death, regardless of their athletic status and particularly as they enter middle school or junior high school.

Ongoing specialty care helps people with heart defects live as normal and fulfilling a life as possible, especially when detects are found and established early.

Golisano Childrens Hospital of Southwest Florida offers free EKG testing to middle and high school-aged athletes. The free EKGs are available without an appointment. More information can be found by visiting https://www.leehealth.org/our-services/pediatric-cardiology/youth-heart-screening.

Marcella McIntyre took advantage of the free EKG when she brought her 17-year-old daughter in for a test.

My daughter had headaches and I brought her in for the free pediatric EKG. She plays soccer and I wanted to rule everything out and make sure she doesnt have anything to be concerned about when it comes to her heart, McIntyre said. It was easy and you dont need to make an appointment. We only waited about 10 minutes and it gave us both peace of mind. I think every child and teenage athlete should do it. Its good to know where you stand.

Lee Health also works with national organizations like Who We Play For to provide free EKG screenings for children and teenagers at various community events throughout the year.

If your child is presenting any of the below symptoms of a heart problem, consult your childs primary care physician or pediatric cardiologist:

For more information, please visit http://www.leehealth.org.

About Lee Health

Since the opening of the first hospital in 1916, Lee Health has been a health care leader in Southwest Florida, constantly evolving to meet the needs of the community. A non-profit, integrated health care services organization, Lee Health is committed to the well-being of every individual served, focused on healthy living and maintaining good health. Staffed by caring people, inspiring health, services are conveniently located throughout the community in four acute care hospitals, two specialty hospitals, outpatient centers, walk-in medical centers, primary care and specialty physician practices and other services across the continuum of care. Learn more at http://www.LeeHealth.org.

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Pediatrics

Phoenix Childrens will train first responders for pediatric 911 calls – Arizona Big Media

In an effort to improve prehospital care of children facing medical emergencies, Phoenix Childrenswill host the EMS and Prehospital Care Conferenceon Oct. 30 at the Wild Horse Pass Resort, located at 5040 Wild Horse Pass Blvd. in Chandler.

Phoenix Childrens physician experts will headline the event, that will bring together nearly 1,000 first responders, doctors, nurses, allied health professionals and other medical providers from across Arizona.

Ranking Arizona: Top 10 hospitals for 2023

Every second counts in an emergency, especially when children are involved said Julie Augenstein, MD, emergency department physician and EMS Base Hospital medical director at Phoenix Childrens. We want to make sure first responders have access to the knowledge and tools they need to provide immediate life-saving care for Arizonas children, who come with different symptoms, ways of communicating and require different treatments than adults.

This is the fifth EMS conference Phoenix Childrens has produced. The health system prioritizes this training to ensure EMS partners can recognize pediatric-specific symptoms and know how to help stabilize Arizonas youngest patients. The goal is to ensure children arrive at the hospital in the best condition possible.

The day-long event will provide training in emergency care for infants and children experiencing trauma, heart issues, heat-related illnesses, sepsis, complications after a home birth and other serious and life-threatening emergencies. Emergency medical technicians, paramedics and nurses can earn up to six accredited pediatric continuing education hours.

The conference will also include an address by Shaughn Maxwell, a nationally acclaimed leader, speaker and writer about human factors, performance, leadership and community paramedicine. Maxwell has more than 30 years experience in fire service and currently oversees EMS and Community Paramedic Operations for more than 300 firefighters who respond to 30,000 calls annually in South Snohomish County in Washington.

Phoenix Childrens is a communications hub for pediatric emergencies, providing guidance to EMTs, paramedics and firefighters in the field regardless of whether the patients final destination is Phoenix Childrens or another hospital.

The Phoenix Childrens Hospital Thomas Campus Emergency Department is an Advanced Life Support (ALS) Base Hospital verified by the Arizona Department of Health Services specifically for pediatrics. Phoenix Childrens is the only childrens hospital inArizonato earn this accreditation.

The health system has pediatric emergency departments at Phoenix Childrens Hospital Thomas Campus and the new Phoenix Childrens Avondale Campus, which opened in July 2023. Phoenix Childrens will further expand its number of pediatric emergency departments in 2024 with the openings of Phoenix Childrens Hospital Arrowhead Campus and Phoenix Childrens Hospital East Valley Campus.

The EMS and Prehospital Care Conference will also feature an exhibitor hall with vendors who provide services to first responders. This years exhibitors include Maricopa Ambulance, Banner Air, Native Air, Guardian Air, Gila River EMS, Gila River Health Care, Grand Canyon University, Blueline AZ Homes brokered by My Home Group, Ruiz Team at Prime Lending, Academy of Emergency Arts and many others.

First responders are encouraged to register in advance for the conference at https://ems.phoenixchildrens.org/.

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Phoenix Childrens will train first responders for pediatric 911 calls - Arizona Big Media