Category Archives: Pediatrics

by Christina Echegaray

Monroe Carell Jr. Childrens Hospital at Vanderbilt has launched a new pediatric Oral Immunotherapy Clinic, which offers a special therapy to peanut-allergic children to reduce risk of a harmful immune response in the event of accidental exposure to peanuts.

Led by Rachel Glick Robison, MD, associate professor of Pediatrics within the Division of Pediatric Allergy, Immunology and Pulmonology, the clinic is located within the Allergy Clinic at Vanderbilt Health One Hundred Oaks.

Around for nearly two decades, oral immunotherapy (OIT) involves a patient eating small, but increasing, amounts of their specific allergen daily over a period until reaching a maintenance level dose. The process is known as desensitization. The maintenance dose is lifelong and must be consumed daily for continued protection.

The most important thing I tell families is that this is not a curative therapy at this point. This is a way to give you a level of protection against accidently ingesting the allergen in your daily life. We know that if you tolerate the therapy amount, then you would tolerate small amounts of the allergen if you were accidentally exposed. They also still have to carry epinephrine injectors, said Robison.

Food allergies affect about 1 in 13 children in the United States. Within that group, about 2.5% of all children have a peanut allergy. That number has steadily risen since 2010, with one study showing that by 2017, there was an estimated 21% increase in peanut allergies in the U.S.

A food allergy is a medical condition in which exposure to certain foods triggers a harmful immune response, which can range from mild (itchiness, hives) to severe or life-threatening (difficulty breathing, throat tightening). The top eight most common food allergies are: peanuts, tree nuts, milk, egg, wheat, soybeans, shellfish and fish.

Each year, about 200,000 people require emergency medical care for allergic reactions to food, according to the organization Food Allergy Research & Education.

OIT, Robison says, offers families the chance to broaden their life activities a bit, lessening some of the apprehension of daily exposure to peanuts for fear of ending up in the emergency room.

If someone has been apprehensive to travel or eat at restaurants, this can provide some benefits for them. Ive also seen people who, as their child gets older and is approaching school age or college, have concerns about accidental ingestion. For those people who really want some protection against accidental ingestion, we know OIT therapy can help provide that.

But OIT isnt for everyone. Robison says she sits down with families for an extensive conversation about all the benefits as well as the risks. She also needs to understand if a child has any other allergic disorders and a familys lifestyle/habits to ensure compliance to the daily dosing regimen. Some people would rather practice avoidance and not have the daily responsibility.

The clinic currently uses the only FDA-approved OIT for peanut allergy, PALFORZIA, which is approved for children ages 4 to 17.

The first couple doses are given in the OIT Clinic under observation. Each level of dosing lasts about two weeks over about six months until the maintenance dose is reached. Currently, the maintenance dose is lifelong.

Robison, who arrived at Vanderbilt in February 2022, previously helped build a food allergy clinical trials program at Lurie Childrens Hospital of Chicago, and she hopes to help develop something similar at Monroe Carell as understanding and therapies for food allergies continues to evolve.

I do believe OIT will likely be done earlier with more regularity and in younger kids at diagnosis, she said. But OIT is not necessarily a perfect fit for every individual, so there is still a lot of room for other options and therapies that are hopefully coming down the pipeline soon.

Episode 1: The Diagnosis of Pediatric Pneumonia – Medscape

May 5, 2023 medical

This transcript has been edited for clarity. For more episodes, download the Medscape app or subscribe to the podcast on Apple Podcasts, Spotify, or your preferred podcast provider.

Todd Florin, MD: Hello. I am Dr Todd Florin, and I am an associate professor at Northwestern University's Feinberg School of Medicine and the director of research for the Division of Emergency Medicine at Ann and Robert H. Lurie Children's Hospital of Chicago. Welcome to Medscape's InDiscussion series on Pediatric Pneumonia. Today, we'll discuss the diagnosis of pediatric pneumonia, a topic that seems simple but becomes challenging as we peel back the layers of the onion. This is largely because the clinical presentation of pneumonia in children overlaps with so many other common respiratory conditions, such as asthma, bronchiolitis, and viral upper respiratory infections. We'll discuss both clinical and radiographic approaches to the diagnosis of pneumonia in children. First, let me introduce my guest, Dr Mark Neuman. Dr Neuman is an associate professor of pediatrics and emergency medicine at Harvard Medical School and the director of research in the Division of Emergency Medicine at Boston Children's Hospital. He has been conducting research in pediatric pneumonia for the past 2 decades. Welcome to InDiscussion.

Mark Neuman, MD: Hi, Todd. How are you?

Florin: Great to see you. Mark, you and I have been working in this field for quite a while now. What do you think are some of the most exciting changes in care that you've seen over your time?

Neuman: One of the best things I've seen is the development of clinical decision rules to help optimize patient care. One of the areas in which there's been huge advancements is in the care of the febrile infant. I remember when I was a fellow training here in Boston, we used to do a full sepsis workup on all infants under 90 days of age, and those kids were admitted to the hospital often for up to 3 days. Now, as a result of clinical decision rules, we typically only perform a lumbar puncture (LP) or a spinal tap on kids older than 30 days. We're even moving that range down quite a bit.

Florin: I definitely have seen that changing in my career as well. I feel that it's a good link to the discussion that we're going to have today about how the approach to diagnosis and management to common pediatric infections has really changed as we've learned more about these infections. That leads us directly into our conversation today about the diagnosis of pediatric pneumonia. Pneumonia is really a broad term. We see it used in lots of different ways, some more specific (pus and consolidation in the lung) and others more general (any findings of lower respiratory tract infection in a kid with a fever). What do you think are the best clinical features to predict the presence of a radiographic pneumonia for something that you can see on a chest radiograph?

Neuman: I think the important thing with respect to clinical signs and symptoms of pneumonia is that there's no single sign or symptom that's highly accurate for the diagnosis of pneumonia. The typical scenario of a child who comes into the emergency department with a high fever, a productive cough on exam, maybe hypoxic, working to breathe, and having focal rales is a rare phenomenon. Most children present with a variety of signs and symptoms, but I think you can't really hang your hat on a single sign or symptom to predict pneumonia. Some studies that we and other groups have done found certain findings are more likely to be associated with pneumonia in children, such as the presence of fever, fever duration, decreased breath sounds, having rales or crackles (particularly if they're focal in nature), and hypoxia. I think the biggest takeaway is that no single sign or symptom is highly accurate. With that said, in a meta-analysis that we've done, we found that hypoxia and increased work of breathing were the two findings that were more likely to be associated with pneumonia and that altered your risk of diagnosing pneumonia more than any other sign or symptom. Wheezing was associated with not having radiographic pneumonia.

Florin: When that meta-analysis came out, which was published in the Journal of the American Medical Association (JAMA), I found that really fascinating because I think that traditionally tachypnea has been considered a diagnostic criteria for pneumonia, not only in the US but worldwide. Can you speak a little bit about what you found with regard to the role of tachypnea in diagnosing pneumonia?

Neuman: Tachypnea is interesting. Tachypnea, or rapid breathing, is often associated with pneumonia. However, many of the children who are being considered for having pneumonia also are tachypneic, which makes tachypnea a tough finding to say whether it's associated with pneumonia. Around the world, in resource-poor settings, tachypnea is the criteria that's used to define pneumonia in those settings. However, because tachypnea is associated with many other respiratory illnesses like asthma, bronchiolitis, even with upper respiratory infections, it is not commonly associated with pneumonia with respect to differentiating pneumonia from other types of infections or respiratory illnesses.

Florin: I think that's important for our listeners to know. I also want to flesh out the hypoxemia criteria. At what oxygen saturation do we see that risk of radiographic pneumonia go up?

Neuman: It's a challenging question to answer. In that meta-analysis, there were many studies that were done that used different thresholds of oxygen saturation. In that meta-analysis, the best cutoff in discriminating kids with and without pneumonia was less than or equal to 96%. At that threshold, the likelihood ratio of having pneumonia was 2.8, so that altered your pretest probability of having pneumonia more significantly than other thresholds.

Florin: That's interesting. I think a lot of us consider 96% to be a pretty high threshold. Did you see any changes when you lowered that threshold? Certainly, in the International Diseases Society of America (IDSA) guidelines, you see 90%, and you see 92% in some other guidelines around the world. Did you see any threshold effects at those lower oxygen saturations?

Neuman: Yes, we probably would have. The problem is that many of the studies that looked at pneumonia had very few children who were actually hypoxic at those levels. It limits your ability to really evaluate lower levels of hypoxia for the presence or absence of radiographic pneumonia.

Florin: Let's unpack a little bit of that second criteria that you mentioned: work of breathing. How is work of breathing defined in these studies and in your meta-analysis?

Neuman: It was defined quite differently in all the different studies that looked at work of breathing. For the meta-analysis, we included any element of work of breathing: grunting, flaring, retracting. Any element of work of breathing was included in that combined variable for the purposes of a meta-analysis. Unfortunately, meta-analyses have to rely on the data in the form that it's collected. Because there's not a uniform nature in which these are assessed in different studies, we had to rely on however it was described in those individual studies.

Florin: That last symptom that you mentioned wheezing is negatively associated with radiographic pneumonia. I know you and I have done work in this area. What does wheezing say about how we can predict radiographic pneumonia in a child who's wheezing, given that it is negatively associated with radiographic pneumonia?

Neuman: I think this is interesting. When I did my fellowship, we were traditionally taught that children with asthma and bronchiolitis have higher rates of pneumonia. I think it's challenging to look at wheezing as a potential predictor of pneumonia. The issue is that most children who are undergoing an evaluation for potential pneumonia have signs or symptoms of asthma, reactive airway disease, wheezing, and bronchiolitis. The rate of pneumonia is actually much lower in those children than other children who present with similar signs, like hypoxia. It's a tough finding to look at with respect to diagnosing pneumonia. Among kids who are wheezing, the same sort of signs or symptoms (such as high fever or profound hypoxia) may make them more likely to have pneumonia. But even in those kids, the rate of pneumonia is very low among wheezing children.

Florin: Great. We've talked up to this point about these individual signs and symptoms. No one individual sign or symptom is diagnostic of radiographic pneumonia. There's been work, largely led by you, over the last decade about developing clinical prediction rules or scores that can be used to increase the accuracy of predicting pneumonia diagnosis on x-ray. Can you talk about those clinical prediction rules?

Neuman: The biggest thing that folks need to know is that physicians tend to overestimate the likelihood of pneumonia, at least based on radiographic findings. In a study we did many years ago, we asked physicians, "How likely do you think it is that this child will have radiographic pneumonia?" Across the board, physicians overestimated the likelihood of the patient having radiographic pneumonia. There are two thresholds I like to talk about. Among those children where physicians thought there was more than a 50% likelihood of pneumonia, only about 35%-40% of those kids had any radiographic finding at all, and only about 20% of those kids had radiographic pneumonia. At the highest threshold greater than 75% only 50% of those kids had any radiographic findings at all, and only 30% had definite radiographic pneumonia. I think the two factors that call for decision rules in this area are: (1) Physicians overestimate the likelihood of pneumonia, and (2) No individual finding performed well enough to hang your hat on. With that said, multiple groups have tried to develop clinical decision rules to help physicians better determine the need for either x-ray or antibiotic use in this group. The findings in a lot of these clinical decision rules showed that the individual factors are actually quite similar things like older age, fever, fever duration, and focal lung findings like decreased breath sounds and rales. Those are findings that are typically incorporated in decision rules. Wheezing is also incorporated in many of the decision rules as a negative predictor of pneumonia. I think the interesting thing with these decision rules is that we found across the board, these rules perform much better than clinical judgment for the identification of radiographic pneumonia.

Florin: That's a great summary. This brings us to the next topic of discussion. I think there's still more work to be done to externally and widely validate these clinical prediction rules or scores. Let's say once validated, you apply some of these factors and have to make a decision. Do you treat this child empirically based on this clinical prediction rule, or this set of signs and symptoms? Or do you proceed with chest radiography in the diagnosis of pneumonia? How can we best use chest radiography in the diagnosis of pneumonia in children?

Neuman: I'll start by saying the IDSA recommends against the routine performance of chest x-ray in the outpatient setting when pneumonia is suspected. There are multiple reasons for that. The reasons cited in the guidelines include radiation exposure and the fact that chest x-ray can't reliably distinguish bacterial from viral infection. There's poor interrater reliability around specific radiographic findings. The most important one is that chest x-ray may not be accessible in all settings. The argument for chest x-ray, in my mind, relates to a couple of things. One is that clinical suspicion is not synonymous with radiographic pneumonia. Physicians tend to overestimate the likelihood of pneumonia to quite a big extent, and clinical findings are neither sensitive nor reliable for the prediction of radiographic pneumonia. One example of the argument for chest x-ray has to do with the fact that chest x-ray has a very high negative predictive value. In a study we conducted in our emergency department among 400 children in whom the clinician suspected radiographic pneumonia but had a normal or negative chest x-ray, only five children were subsequently diagnosed within the 2-week period following the emergency department visit. Thus, the negative predictive value of chest x-ray is 98.8%. Although a chest x-ray may not be particularly sensitive for the diagnosis of pneumonia, the negative predictive value is quite high.

Florin: Great. That's helpful to know. Another point that you made, which is one that I think is important to talk about, is this idea that any consolidation that you see on radiograph must be bacterial. The evidence suggests and the IDSA/Pediatric Infectious Diseases Society (PIDS) guidelines state that you cannot really differentiate viral from bacterial infection using a chest radiograph. Can you expand a bit on that point?

Neuman: I think there are certain radiographic features that make it more likely to be bacterial than viral, such as having pleural effusion or a large lobar consolidation. I think in those cases, most folks will suspect a bacterial etiology rather than a viral etiology. But most children with pneumonia actually have more subtle findings. Using radiographs to make the diagnosis of pneumonia has the challenge that most of the x-rays have findings that are not as likely for pneumonia.

Florin: Another challenge with the x-ray is that it can be notoriously difficult to interpret. We've all come across those x-rays where you see something, and you're not exactly certain if it's consolidation, atelectasis, or just peribronchial thickening that's masquerading as one of those findings. You mentioned the interrater reliability of a chest x-ray. We know that for a good reference standard, we really have to have a really reliable reference standard. Can you talk a bit about the limitations of x-ray in terms of its interrater reliability and specifically the reliability of different findings on x-ray?

Neuman: Sure. We studied radiologists and their interpretation of x-ray and looked at different findings on x-ray to see how often radiologists agree upon certain findings. We observed that, overall, the agreement for x-ray interpretation for things like infiltrate were quite low, with kappas in the range of 0.4-0.5. However, for the findings that are most suggestive of a bacterial etiology, like a pleural effusion or a lobar infiltrate, the agreement was a little bit higher. Overall, there is a lot of variation in the interpretation of x-ray, but the agreement was quite a bit higher for certain findings that are most suggestive of a bacterial etiology.

Florin: You alluded to obtaining a chest x-ray when the diagnosis might be uncertain maybe those kids in intermediate risk and avoiding x-ray when you're highly confident in the diagnosis or that the child does not have pneumonia. It's a little bit of a balance, particularly in the outpatient setting, where you may not have radiography immediately available to you. Do you obtain the chest radiograph and avoid potential antibiotics vs. empirically prescribing antibiotics without a chest radiograph and potentially overprescribing antibiotics? It's a bit of a tension, right? Can you discuss that tension between radiograph use and antibiotic use?

Neuman: In the outpatient primary care setting, where most children with suspected pneumonia are being treated and x-ray may not be as accessible, I think clinical decision rules can play a big role. Certainly, children who have a high level of suspicion of pneumonia probably don't need an x- ray as long as you're not concerned about a complicated type of pneumonia or pleural effusion. At the low end of the spectrum children in whom the suspicion is quite low I think those kids also don't need x-rays. The majority of children live in this zone of intermediate risk. For those kids, I think chest x-ray can be valuable in terms of reducing antibiotic use and potentially not treating children who likely do not have a radiographic finding.

Florin: An interesting part about all of this is the collateral damage of getting the x-ray. You alluded to the fact that most kids who have findings on an x-ray will have findings that are not going to be highly consistent with a consolidative pneumonia. There will be other findings. What's the collateral damage of getting that x-ray and seeing those other findings? The collateral damage is more antibiotic use, misdiagnosis, cost, and unnecessary radiation exposure. I completely agree with you that it really is a balance. The decision to get an x-ray is not always an insignificant one.

This was a great conversation. Today, I talked with Dr Mark Neuman about the diagnosis of pediatric pneumonia. A few takeaways I have from this conversation are that the diagnosis of pneumonia is challenging, and there is substantial overlap in the clinical symptoms of pediatric pneumonia with other common respiratory conditions, including bronchiolitis and asthma. We heard that no single sign or symptom is diagnostic of radiographic pneumonia, and we can use combinations of signs and symptoms in clinical prediction rules to help hone that accuracy to better predict which kids will have pneumonia on radiograph. The findings that are most important in combination are things like older age, longer fever duration, focal lung findings, and hypoxemia. Certainly, we think about wheezing as a negative predictive factor for having pneumonia on radiograph. The chest x-ray may be useful to exclude a clinically suspected pneumonia or to identify a complicated pneumonia, but routine chest x-ray is generally not recommended for well-appearing kids with suspected pneumonia who can be managed in the outpatient setting. The use of clinical scoring systems or clinical prediction models may help to reduce x-ray utilization and promote judicious use of antibiotics for children with respiratory illness. With that, I want to thank you for tuning in. If you haven't done so already, please take a moment to download the Medscape app to listen and subscribe to this podcast series on pediatric pneumonia. This is Dr Todd Florin for InDiscussion.

Pediatric Pneumonia

Boston Febrile Infant Algorithm 2.0: Improving Care of the Febrile Infant 1-2 Months of Age

Imaging in Pediatric Pneumonia

Does This Child Have Pneumonia?: The Rational Clinical Examination Systematic Review

The Management of Community-acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America

Physician Assessment of the Likelihood of Pneumonia in a Pediatric Emergency Department

Predicting Pneumonia From the Clinical Exam

Negative Chest Radiography and Risk of Pneumonia

Variability in the Interpretation of Chest Radiographs for the Diagnosis of Pneumonia in Children

Interrater Reliability: The Kappa Statistic

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Episode 1: The Diagnosis of Pediatric Pneumonia - Medscape

Pediatrics

Parents’ Awareness and Attitude Toward Pediatrics Eye Diseases in … – Cureus

May 5, 2023 medical

Specialty

Please chooseI'm not a medical professional.Allergy and ImmunologyAnatomyAnesthesiologyCardiac/Thoracic/Vascular SurgeryCardiologyCritical CareDentistryDermatologyDiabetes and EndocrinologyEmergency MedicineEpidemiology and Public HealthFamily MedicineForensic MedicineGastroenterologyGeneral PracticeGeneticsGeriatricsHealth PolicyHematologyHIV/AIDSHospital-based MedicineI'm not a medical professional.Infectious DiseaseIntegrative/Complementary MedicineInternal MedicineInternal Medicine-PediatricsMedical Education and SimulationMedical PhysicsMedical StudentNephrologyNeurological SurgeryNeurologyNuclear MedicineNutritionObstetrics and GynecologyOccupational HealthOncologyOphthalmologyOptometryOral MedicineOrthopaedicsOsteopathic MedicineOtolaryngologyPain ManagementPalliative CarePathologyPediatricsPediatric SurgeryPhysical Medicine and RehabilitationPlastic SurgeryPodiatryPreventive MedicinePsychiatryPsychologyPulmonologyRadiation OncologyRadiologyRheumatologySubstance Use and AddictionSurgeryTherapeuticsTraumaUrologyMiscellaneous

Parents' Awareness and Attitude Toward Pediatrics Eye Diseases in ... - Cureus

Pediatrics

Avanos Recalls Certain BALLARD ACCESS Closed Suction Systems – FDA.gov

May 5, 2023 medical

The FDA has identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries or death.

The manifold of the BALLARD ACCESS Closed Suction System for Neonates/Pediatrics is used to provide access to the artificial airway of a child, infant, or neonate, without breaking the ventilation circuit. It is a single patient use device that is used by trained medical professionals.

The BALLARD ACCESS Closed Suction manifold is indicated for use together with the BALLARD ACCESS Closed Suction catheter to remove secretions from the artificial airway of children, infants, and neonates

Avanos Medical Inc. is recalling the Avanos BALLARD ACCESS Closed Suction System for Neonates/Pediatrics with Y-Manifold or Elbow Manifold (labeled 72-hour-use) after receiving complaints from customers about cracked manifolds during use. A cracked manifold can cause leaks in the respiratory circuit, which may lead to the patient receiving inadequate ventilation.

Inadequate ventilation and oxygenation can lead to lead serious brain damage or death, especially in the vulnerable patient population (children, infants, and neonates) who receive care using this product. Additional risks from this issue include the possibility that a foreign body could be introduced through the cracked manifold, causing infection, damage to the airway, or a blocked endotracheal tube.

Use of this product could lead to serious injury or death.

Avanos Medical, Inc. reports four injuries associated with this issue.

On February 3, 2023, Avanos Medical Inc. sent an Urgent Medical Device Recall letter to customers. The letter included the following recommended actions:

Customers will be contacted by Avanos Customer Service to arrange for product return, credit, and replacement after the acknowledgement form is submitted.

Customers with questions about this recall should email Avanos at FieldActionCare@avanos.com.

Health care professionals and consumers may report adverse reactions or quality problems they experienced using these devices to MedWatch: The FDA Safety Information and Adverse Event Reporting Program using an online form, regular mail, or FAX.

05/02/2023

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Avanos Recalls Certain BALLARD ACCESS Closed Suction Systems - FDA.gov

Pediatrics

Rise in autism prevalence highlights continued need for early … – Contemporary Pediatrics

May 5, 2023 medical

Contemporary Pediatrics:

Hello and thank you for joining us. I'm Joshua Fitch, editor with Contemporary Pediatrics.

J. Thomas Megerian, MD, PhD, FAAP:

Hi, I'm Tom Megerian, Joshua. I am Clinical Director at the Thompson Center for Autism and Neurodevelopmental Disorders at Children's Health of Orange County (CHOC) and work as a lead of that organization for the the the center as well as a Division Chief for the Division of Neurodevelopmental Medicine at CHOC as well.

Contemporary Pediatrics:

Today we're discussing autism prevalence and children. recent findings from the CDC has Morbidity and Mortality Weekly Report suggests approximately 1 in 36 us children aged 8 years were identified with autism spectrum disorder in 2020, higher than the 2018 estimated average. First, what trends are you observing regarding prevalence of autism and children, and are there any associations with early detection disruptions potentially resulting from the COVID-19 pandemic or otherwise that may be contributing to an increase?

Megerian:

Yes, thanks, Joshua. It's a great question. You know, it's really hard to say if we're getting, say, a bolus of more kids that just weren't being diagnosed in the last two plus years, because of reluctance to come in to tertiary care centers like ours to receive the diagnosis, we know that there was a drop off in the number of kids that were being seen and referred. We've seen that in terms of vaccinations, that number dropped. We've seen it in terms of I think, well, health care visits, and so that's definitely a possibility. The counter argument to that, though, would be that this trend, increasing trend has been going on that we see every 2 to 4 years that we monitor that's been going on for a while. And if you look at the numbers, like over the last 5 years, it was one in 56, then one in 44. Now one in 36. And so those numbers, that trend of increasing, you know, by about 10, one in 10, every two to four years that's been going on. So it's a tough question to answer. Are we seeing this increase right now? That would have maybe flattened off from the 144, because we just didn't see a number of kids early? Or is this just a continuation of the trend we saw before? Hard to answer, and I think time will tell.

Contemporary Pediatrics:

Certainly. And on that point, my next question is what kind of research needs to be completed on a national scale to kind of get a better idea to maybe differentiate some of those timing factors you just mentioned?

Megerian:

I think continuing the research we're doing we do have, I think it's 11 or 12 monitoring sites in the monitoring network, the disabilities monitoring network. I know that there's opportunities, it sites can sign on to be a monitoring site network, we're considering doing that ourselves here. And I think having more of those, right now they are distributed across the country. So there's west coast, there's Midwest, there's east coast, I think adding more sites like, like the ones that are already in the developmental disabilities monitoring network, would be probably the best thing we can do, because those sites are already set up. And they do show really significant differences depending on the location, they have numbers that are much lower than one in 36 in certain areas of the country, and numbers that are much higher than one in 36 and other areas. So there's definitely a difference depending on the state. So having more surveillance locations within each state would be a great idea. Ideally, it would be phenomenal if every state would have one of those centers that that does surveillance monitoring for for the prevalence that would contribute to the national database.

Contemporary Pediatrics:

Obviously this upward trend in prevalence isn't something healthcare professionals want to see what is the reaction? What are next steps when findings such as these are presented? With this increased prevalence and austism. When these results are released? What is the reaction? What are some of the next steps healthcare professionals take?

Megerian:

I think it reminds them to be vigilant to continue monitoring. I know that here in in Orange County, Population Health Program at Children's Hospital of Orange County has been very good about encouraging the providers in network to really be vigilant about their monitoring and doing screenings, and so those numbers have gone up dramatically. The number of percentage of pediatricians doing screening has really gone from below 50% to well above I think at last I heard is upwards of 70% or more of practices are doing routine screening that is structured screening programs, not just kind of asking how are things going, but actually administering a structured screening tool. And that's really what we need to see, we need to get that number across the country up to 100%.

Contemporary Pediatrics:

You mentioned the screenings, what are some of the immediate benefits of earlier diagnosis and treatment for children at risk of behavioral health conditions,

Megerian:

Early intervention, that's really the number one, the number one intervention that we have that's effective has been proven time and time again to be early intervention. Be it speech for kids with speech delay, be it occupational therapy for kids with fine motor delay, physical therapy for kids with more gross motor delays, and then applied behavior analysis for the children who've got autism. Although even ABA, applied behavior analysis is now being used for other conditions besides autism, and has been shown to be effective as well. And getting those programs started as early as possible during the developmental window of neuroplasticity is so critical. The older a child is before they start receiving services, the more difficult it is for those services, or those therapies to be effective. They're still effective, so I don't want anyone to get the impression we shouldn't start therapies if the child is older. But we do know that because of the developmental windows, we can do better the earlier we start, and we we know that we've had that information for years. So starting as early as possible, is the number one improvement we can make in society to help kids maximize whatever potential they have.

Contemporary Pediatrics:

Certainly that early screening process sounds like it's top priority. What are some other ways then parents, healthcare professionals, even caregivers, can address autistic traits kind of before they begin to manifest further as a disorder.

Megerian:

You know, if you see a child, who has some traits of autism, not taking the watchful waiting approach is probably the best thing that we could do. There was there was always this tendency to say, well, let's see what happens. I see I see what you're talking about. Eye contact isn't great in your child. But let's just see if that's just, you know, a, an incidental finding that is really not going to be present in a year from now we'll just watch it. I think that's probably one of the lessons we've we've learned over the last several years is not to do that. And to really be more aggressive. Using some of the new tools that are out there, there are a number of new tools that are out for the primary care physician, especially in the AI field that can help with getting early diagnosis. There's also there are structured types of play up observations there's so I mentioned, artificial intelligence tools, there's a number of those that are out there that can help pediatricians really take a more proactive approach to saying, Does this child meet criteria for autism now? Or should I watch and see what happens?

Contemporary Pediatrics:

Certainly, and thank you very much. Is there anything else you'd like to add or comment regarding prevalence for this patient population, what you hope to see going forward or frankly, what you think needs to happen going forward?

Megerian:

I think putting diagnosis in the hands of primary care pediatricians and not having to have them refer to tertiary care centers for everybody is probably the number one thing we can do. And I think we need to address the insurance issues around that. Making sure that pediatricians are entitled and able to make a diagnosis and have payers cover both the diagnosis that pediatricians do and also approve referrals for therapies based on those diagnosis we do you see a lot of pushback, where payers will tell a pediatrician, no, you need to send this child for a further evaluation, or you need to do one of these very specified tests to make a diagnosis, you can't make the diagnosis using you know, one of the new tools that are out there. It's these three or four tools that we like you to use, and if you don't use them, we want to prove the referrals. I think that's a big mistake. I think pediatricians are trained to make these diagnosis, and there are tools out there, as I mentioned, that can help them make the diagnosis and help them feel more confident, and I don't think we need to have every child referred to a tertiary care center. We have waitlists that are I know if some centers three years to get an evaluation, you can't wait three years to refer a kid for therapy. It's like you said what can we do? What's the immediate approach that pediatricians can take when they have a suspicion for autism? If a child has to wait three years for them to get a, quote, "official diagnosis" is a tertiary center that's that's just that puts them outside that development the window where therapies can be most effective.

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Rise in autism prevalence highlights continued need for early ... - Contemporary Pediatrics

Pediatrics

How air pollution and climate change impact infants and birthing … – Contemporary Pediatrics

May 5, 2023 medical

How air pollution and climate change impact infants and birthing people | Image Credit: Soloviova Liudmyla - Soloviova Liudmyla - stock.adobe.com.

The impacts of climate change are being felt by both infants and their birth-givers, according to the session, Every breath you take: why ambient air pollution and climate change matter to birthing people and infants, presented at the 2023 Pediatric Academic Societies Meeting.

Presenter Heather L. Brumberg, MD, MPH, FAAP, immediate past president, Eastern Society for Pediatric Research, professor of pediatrics and clinical public health, New York Medical College, neonatology attending and associate director of the Regional Perinatal Center, Maria Fareri Childrens Hospital at Westchester Medical Center, Valhalla, New York, noted that air pollution and climate change are linked. Greenhouse gases come from the burning of fossil fuels, industry practices and clearing, and agriculture. Trapped heat from these gases can lead to climate change, increasing temperatures. Increased temperatures can lead to more forest fires and more secondary production of air pollutants.

According to Brumberg, there are several air pollutants that are a cause for concern. Criteria pollutants are carbon monoxide, lead, nitrogen dioxide (NO2), particulate matter (PM), including PM with a median diameter less than 10 m (PM10) and less than 2.5 m (PM2.5). Other criteria pollutants include sulfur dioxide (SO2) and Ozone (O3). Air pollutants that can be hazardous include polycyclic aromatic hydrocarbons (PAHs), metals, solvents, and formaldehyde. Carbon dioxide, methane, and perfluorocarbons are examples of greenhouse gases.

To contextualize air pollution, Brumberg demonstrated several pollutants that are common in tobacco products and tobacco smoke. Carbon monoxide, nitrogen dioxide, PAHs, PM, volatile organic chemicals (VOCs) (benzene, formaldehyde), and heavy metals such as lead, mercury, and chromium are components of tobacco products that are in common with air pollution.

These air pollutants can have impacts on health in adults, childhood outcomes, and birth outcomes according to the presentation. Potential adult health impacts are cardiovascular disease, chronic obstructive pulmonary disease, metabolic disease, obesity, diabetes, and cancer. Asthma, decreased lung function, atopy, respiratory infections, autism, cognitive effects, cancer, and obesity are potential childhood outcomes associated with air pollution. Worsened air pollution and extreme weather from climate change can have severe impacts on health during pregnancy including low birthweight, intrauterine growth restriction, prematurity, effects on brain development, and infant mortality.

Traffic-related air pollution, according to the presentation, is a risk for developing hypertensive disorders of pregnancy and has been associated with stillbirth, spontaneous abortions, and gestational diabetes, though more studies are needed, the presentation states.

Associations of air pollution and prematurity are also cause for concern. Nationally, 3.32% of all preterm births (PTBs) were attributable to PM2.5 (n = 15,808 PTB) in 2010. According to the presentation, risk of PTB may be exacerbated by heatwaves (climate) with air pollution synergistically more so than merely adding the risk of each, but more studies are needed.

The Air Quality Index (airnow.gov) provides information on air quality and actions you can take to protect your health. For example, plan outdoor activities away from major air pollution sources like the highway. Air pollution can be reduced at the individual level by taking public transportation, walking or biking when possible, and not allowing vehicles to idle.

Reference:

Brumberg HL. Every breath you take: why ambient air pollution and climate change matter to birthing people and infants. Presented at: Pediatric Academic Societies Meeting, April 27-May 1, Washington, DC.

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How air pollution and climate change impact infants and birthing ... - Contemporary Pediatrics

Pediatrics

Richmonds new home for pediatric inpatient, emergency and … – VCU Health

May 5, 2023 medical

RICHMOND, Va. (April 30, 2023) Childrens Hospital of Richmond at VCUs new Childrens Tower is now open. All patients in the pediatric acute and intensive care units were moved from the pediatric floor in VCU Medical Center to their new rooms in the completely kid-focused Childrens Tower over the course of the day. The childrens emergency department opened at 5 a.m.

For decades our community has been asking for a childrens hospital that matches the caliber of care provided by the pediatric experts at CHoR, and we committed to making it happen, CHoR president Elias Neujahr, MHA, MBA, said. Today, we have the immense pleasure of delivering on that promise. The Childrens Tower is a full-service, comprehensive home for our nationally ranked programs and exceptional teams who are passionate about meeting the unique health care needs of children.

When combined with the adjacent outpatient Childrens Pavilion, the Childrens Tower completes a city block and nearly 1 million square feet dedicated to caring for kids.

The first patient to move into the Childrens Tower was 12-year-old Cheyenne Snell, who is in the hospital awaiting surgery for a brain tumor.

Comprehensive, convenient care for kids

In addition to pediatric-specific operating rooms, imaging suites and trauma bays equipped with the latest advancements for optimal medical care, the Childrens Tower includes special touches to make the environment more comfortable for kids and families. The 72 all-private acute and intensive care rooms are among the most spacious in the country. Children helped the hospital team select the James River theme, along with colors and animal mascots to differentiate each floor and help with navigating the building.

Playrooms, a family gym and family lounges are among the many amenities available to patients starting today. Families will also have access to a RMHC In-Hospital-House, multifaith chapel and indoor childrens garden opening this summer. Even the cafeteria offers kid-friendly meals, with brick oven pizza and soft-serve ice cream among the dining options.

We spent countless hours training and testing the new environment to make sure the building and our remarkable teams were ready for this day for families like Cheyennes and the thousands of others who will turn to us for care in the coming months and years, Jeniece Roane, vice president of operations for CHoR, said. Though an entire city block may sound intimidating, accessing the highest level of pediatric care in our region has never been easier.

The Childrens Tower is located one turn off Interstate-95, with free on-site parking, including complimentary valet for families coming to the emergency department. The $420 million building houses the regions only Level 1 pediatric trauma center and emergency room with 24/7 access to any pediatric specialist a child may need.

Providers at CHoR care for both the most common and complex injuries and illnesses, from broken bones to cancers requiring bone marrow transplant. Last year, they served more than 70,000 families from Virginia, nearly all 50 states and outside the United States. The Childrens Tower is expanding inpatient bed capacity and emergency room access by 40 percent. Access is also increasing to imaging and Level 1 Childrens Surgery Center services.

We look at this building as a promise to children and families, in Richmond, throughout the commonwealth and beyond, said Shari Barkin, M.D., physician-in-chief of CHoR and chair of the Department of Pediatrics at VCU School of Medicine. It is our collective commitment to providing the highest quality of care for every child, every time.

Serving and supported by the community

After a long day, patients have a surprise ahead of them this evening. CHoR and VCU Police organized a special celebration goodnight lights to help the kids settle in for their first night in their new hospital rooms. Families will receive different colored flashlights with instructions to shine them out their hospital room windows at 8:45 p.m. First responders will wave and flash their vehicle lights on the streets below.

The goodnight lights celebration is an opportunity to show our children that theres a larger community rallying around them on opening night and every night, Roane said.

CHoR broke ground on the Childrens Tower in June 2019 as part of a comprehensive plan to address the needs of the community and state.

Donors and partners in the community have contributed more than $66 million toward Childrens Hospital Foundations $100 million capital campaign, which continues beyond opening day to support the building, as well as the teams and care within it.

Explore the Childrens Tower virtually at chrichmond.org/tower.

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Richmonds new home for pediatric inpatient, emergency and ... - VCU Health

Pediatrics

New pediatric guidelines aim to treat obesity without stigma. Critics … – Baltimore Sun

May 5, 2023 medical

From the time Alexandra Slick was little, she knew that when she went to the doctors office, at least one person was probably going to tell her that she needed to lose weight.

She remembers sitting in an examination room as a middle schooler, watching her mother cry as a nurse practitioner asked her if she wanted her daughter to die. At that point, while Slicks weight was considered obese by the body mass index, she already had been dieting for about four years and practiced karate every week.

It used to be that if I had a doctors appointment in the day, I wouldnt eat or drink anything until I had gone to the doctor whether or not that appointment was at 10 a.m. or if that appointment was at 3 p.m., she said. I just wanted to be as small as I could going into the doctors office.

When Slick, a 31-year-old Baltimore resident, heard about the American Academy of Pediatrics new guidelines for treating childhood and adolescent obesity, she shuddered.

The guidelines, released in January by the countrys leading pediatricians group, advise primary care doctors to offer families a variety of treatments early for childhood obesity. Watchful waiting to see if children with obesity developed into average weight adults the groups previous recommendation would no longer cut it.

The guidelines became an immediate subject of controversy, triggering backlash from nutritionists, eating disorder clinicians and people like Slick, who know what its like to live in a larger body.

They worry a focus on weight loss will trigger or worsen disordered eating in children with larger bodies, exacerbate weight stigma in doctors offices and lead physicians to overlook the diets and exercise routines of children whose weights are according to the body mass index average or low.

Especially controversial was a guideline that doctors consider prescribing weight loss drugs to children as young as 12 and referring 13-year-olds to be evaluated for weight loss surgery.

The guidelines use the body mass index, or BMI, a measure calculated from a patients weight and height. While controversial, BMI remains widely used by physicians to determine whether a patients weight is healthy.

Jane Zeltser, who works at the Eating Recovery Center, has struggled with eating disorders herself. (Karl Merton Ferron/Baltimore Sun)

Supporters of the guidelines say surgical treatment options wouldnt be offered in isolation. The recommendations also emphasize the need for ongoing lifestyle and behavioral treatments, such as proper nutrition and physical activity.

This is nothing that pediatricians can or should force on families, said Dr. Sarah Hampl, a lead author of the guidelines and a pediatrician in Kansas City, Missouri.

Research dating back decades has documented weight stigma among medical professionals. Primary care physicians may be less likely to show empathy, concern and understanding to patients whose bodies the doctors consider overweight or obese, while such patients have reported being mis-diagnosed and may even avoid going to a doctor.

The American Academy of Pediatrics guidelines explicitly recognize the role weight stigma historically has played in medical care.

At Kennedy Krieger Institutes Weight Management Program, patients work with their doctors to create unique treatment plans, said Dr. Anton Dietzen, a pediatric physiatrist with the institutes Fit and Healthy Clinic.

Every one of these cases is so different, Dietzen said. There are so many complex biopsychosocial issues going on a lot of multigenerational households, and parents working two jobs, and issues of food insecurity, and patients who are eating two of their three meals a day at school.

But no matter the circumstance, Dietzen said, its important to offer early and intensive treatment for childhood obesity.

The condition is a chronic disease, and its effects pile up over time, he said. The longer a childs weight is elevated, the more likely it is theyll develop serious diseases like cardiovascular health problems and Type 2 diabetes, he said.

Colleen Schreyer, an assistant professor at the Johns Hopkins School of Medicine who serves as the director of clinical research for the Johns Hopkins Eating Disorders program, has complicated feelings about the guidelines.

I see the need for treatment of obesity, Schreyer said. I also think we need to be thoughtful about how we implement those treatment interventions to prevent the onset of disordered eating.

Some researchers say people whose weights are considered obese by the BMI can still be healthy. But Schreyer said patients with a BMI above 30 are more likely to have conditions such as high blood pressure, elevated cholesterol levels, chronic pain and limited mobility.

Schreyer said bariatric surgery can alleviate some of those conditions. She said before adolescents undergo surgery at Johns Hopkins, they receive six months of a behavioral weight loss intervention and meet for six months with a psychologist to identify and treat mental health concerns such as eating disorders, depression and anxiety. Hopkins offers the surgery to adolescents as young as 16.

The guidelines recommend that doctors consider referring children to be evaluated for the surgery if their weight is 120% above the 95th percentile, according to the BMI. Schreyer said her typical adolescent patient weighs well above the 99th percentile for BMI some around 400 pounds and typically have other medical issues like high blood pressure and limited mobility.

Deborah Kauffmann is a nutrition counselor who practices a non-dieting approach to weight management and is the former director of nutrition services at The Center for Eating Disorders in Towson. She said the BMI is an inaccurate measure of health.

Many people are born with a high number of fat cells and that doesnt determine health, Kauffmann said. Even if the BMI did account for body composition, it would still be pretty meaningless and not be an indicator for your health in any way.

Dietzen said BMI is a useful tool when it comes to screening patients for potential weight management intervention, but doesnt capture the complete picture.

Just like anything in medicine, you have to look at the individual and not the numbers, he said.

Kauffmann strongly objected to the guidelines suggestion of considering weight loss surgery consultation for teenagers as young as 13. She said bariatric surgery comes with short and long-term complications, which shes seen in patients shes worked with after surgery who have digestive and nutritional issues.

Schreyer defended weight loss surgery as a long-term solution. One option involves removing up to 80% of a patients stomach, allowing them to feel full after eating significantly less food.

We know that 95% of people who start a behavioral weight loss intervention will regain the majority of their weight, Schreyer said. Around 60-65% of patients who undergo bariatric surgery keep their weight off five to 10 years later.

A bigger issue with the guidelines, Kauffman said, is that they treat obesity alone as an elevated health risk. Instead, Kauffman said, physicians need to pay attention to sudden, drastic weight loss or gain, which could be indicative of issues such as eating disorders or insulin resistance.

To assume that a child isnt healthy because of a higher weight is just wrong, Kauffmann said. Theres no way around it scientifically and morally, its wrong.

Jane Zeltser, who works at the Eating Recovery Center, formerly struggled with eating disorders. (Karl Merton Ferron/Baltimore Sun)

Jane Zeltser, the practice manager for the Eating Recovery Centers east region, said weight loss surgery is like butchering children just so they can fit a mold of looking a certain way.

Still, Zeltser, 38, said that when she was a teenager struggling with an eating disorder, she would have jumped at the suggestion.

I would have done anything and everything to make myself smaller, Zeltser said.

At 4 years old, Zeltser immigrated with her family from what is now Kyiv, Ukraine. She said that while she couldnt control her secondhand clothing or her accent, she could reject her hometown foods that set her apart from other students.

By the time she got to high school, that restriction morphed with a desire to occupy a smaller body, leading Zeltser to take weight loss pills. She experienced worrying symptoms: an elevated heart rate, insomnia, headaches and even hallucinations.

But because Zeltser never fell into the underweight category, help was hard to come by, especially from Zeltsers pediatrician.

He would say, Well, youre in the 75th percentile. So actually maybe you could stand to lose some weight, Zeltser said. I was hospitalized because of the effects of these diet pills on my body.

According to the National Association of Anorexia Nervosa and Associated Disorders, fewer than 6% of people with eating disorders are medically diagnosed as underweight.

Hampl said the American Academy of Pediatrics is working with eating disorder organizations to develop better tools to help doctors check their patients for the warnings signs of disordered eating, regardless of their weight.

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Research shows that kids who try to lose weight through fad diets are more likely to have an eating disorder, Hampl said. But kids who have a caring medical provider trying to help them achieve a healthier weight through a structured program are less likely to develop such disorders, she added.

Theres really no benefit in trying to pit the eating disorders community against the weight management community. Thats really counterproductive, Hampl said. Both of these issues are highly stigmatized. Theyre often interrelated.

Schreyer said that, in her experience, obesity specialists are not primarily interested in making their patients skinnier.

But Zeltser said her pediatrician constantly told her to eat less.

He fueled my eating disorder, Zeltser said.

Zeltser said she was sick to her stomach when she read the pediatricians new guidelines.

Children should be able to be children. And I feel like these guidelines are taking away from their childhood, Zeltser said. I didnt even have a childhood because of my eating disorder.

For the record

This article has been updated to clarify where Dr. Anton Dietzen works and his comments on body mass index. Dietzen works in Kennedy Krieger Institute's Fit and Healthy Clinic. And while he called BMI a useful screening tool, he said it doesn't capture the whole picture. "Just like in anything in medicine, you have to look at the individual and not the numbers," he said.

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New pediatric guidelines aim to treat obesity without stigma. Critics ... - Baltimore Sun

Pediatrics

Highlights from the Pediatric Academic Societies Meeting – Healio

May 5, 2023 medical

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This week, Healio provided live coverage of the Pediatric Academic Societies Meeting, an annual collaboration between the AAP, Academic Pediatrics Association, American Pediatric Society and the Society for Pediatric Research.

Program Chair Judith Shaw, EdD, MPH, RN, FAAP, a professor of general pediatrics at University of Vermont Larner College of Medicine, told Healio that the conference highlights a broad issue of interest across the full spectrum of pediatric research, science and education.

At this years meeting, researchers reported new data that showed adherence to the immunization schedule for children improved in the United States from 2011 to 2020, but rates differed by socioeconomic status.

Findings from another study found that most children who present to the ED with anaphylaxis can be discharged following a period ranging from 5 minutes to 2 hours, depending on their symptoms.

Read these and more highlights from the Pediatric Academic Societies Meeting below:

Pediatric vaccine adherence was improving before pandemic, but not for everyone

WASHINGTON Vaccine adherence was increasing among children in the United States in the years before the COVID-19 pandemic, but rates differed by socioeconomic status, researchers reported. Read more.

VIDEO: Observation time for anaphylaxis can safely be reduced

WASHINGTON Study findings suggest that most children who visit the ED with anaphylaxis can safely be discharged after 2 hours of observation or less. Read more.

Reframing HPV shot as cancer vaccine improved uptake among 9-year-olds

WASHINGTON Experts suggested reframing conversations about HPV to encourage parents to get children vaccinated starting at age 9 years. Read more.

VIDEO: Children living in states with lenient gun laws have higher death rate

WASHINGTON Children living in states with more lenient firearm policies have a significantly higher death rate compared with those in states with stricter legislation, a study found. Read more.

Clinician reminders in electronic health records improve pediatric asthma care

WASHINGTON Reminders included in electronic health records improved the use of preventive medication and reduced health care utilization for asthma, data show. Read more.

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Highlights from the Pediatric Academic Societies Meeting - Healio

Pediatrics

Career award to honor pediatric cardiologist Dr. Blanton Bessinger – Moultrie Observer

May 5, 2023 medical

MOULTRIE The Colquitt County Career Achievement Award will be presented Tuesday, May 9, to a respected physician who was born in South Carolina but grew up in Moultrie.

F. Blanton Bessinger, MD, MBA, will speak at that evenings ceremony at the Arts Center of Moultrie, as well as during an event at Colquitt County High School.

Dr. Blanton Bessinger.

The Colquitt County Career Achievement Award was designed to laud people who graduated from the Colquitt County School System and went on to earn recognition on the world stage.

Bessinger was born in Columbia, S.C., on Dec. 4, 1940. He moved with his parents, Forrest and Melba Bessinger, to Moultrie in 1947, and he entered the second grade at Central Elementary School. He attended Moultrie Junior High School and Moultrie Senior High School, graduating in 1958.

In high school, he was a member of the Beta Club (academic recognition) and the M Club (varsity letters in baseball and basketball). At graduation, he received the Edgar Holmes, MD, trophy for top all-around male student.

He went to Emory University for college, and was inducted into Phi Beta Kappa his junior year. After three years of college, he entered the Emory School of Medicine, receiving his M.D. degree in 1965. He was inducted into Alpha Omega Alpha in his junior year, and he graduated summa cum laude.

His next step was pediatrics internship and residency at the University of Minnesota Hospitals in Minneapolis/St. Paul. He then went on active duty in the USAF Medical Corps from 1967-69. He was stationed at Vandenberg Air Force Base and served as a pediatrician. Returning to the UM, he did a fellowship in pediatric cardiology, and, in 1971, began his academic career in the Pediatrics Department as an assistant professor. He was an active clinician, teacher, mentor to students and fellows, and a clinical researcher. He was the pediatric representative on several medical school committees, and was director of the cardiovascular curriculum for sophomore medical students.

In 1978, he moved from academia to private practice. In-hospital care was mainly at Minneapolis Childrens Medical Center. He was elected Chief of Staff at MCMC in 1982. He supported the pediatric residency training at the hospital with residents from the UM. With other professionals, he spearheaded quality efforts to improve care and improve the experience for families of hospitalized children.

In 1988 he reduced significantly his clinical practice, as he moved into medical management and became the Chief Medical Officer for St. Paul Childrens Hospital. While working full-time, he pursued and received his MBA degree from the Carlson School of Management at the UM in 1992.

Although both remained important, he became more involved in macro management of childrens health and development, different from the micro management of clinical care for a patient. He became deeply involved in child advocacy, joining various boards supporting children in the community. He was a founding member of Ready 4 K, and served as first chair for seven years. On the board were a former mayor and governor, business leaders, child care experts and others pushing a unified voice for the needs of this group in our society.

He was a ClearWay Minnesota director. This was an organization set up with funds from Minnesotas tobacco settlement. It was active in getting clean indoor air legislation, and it spent much effort to decrease and prevent use of tobacco products by teenagers.

Bessinger was an active member in the Minnesota Medical Association, serving as speaker of the House of Delegates in 1997 and

president in 1999. As a Minnesota delegate to the American Medical Association, he was elected to its Council on Constitution and Bylaws and served a total of eight years. He is a Fellow in the American Academy of Pediatrics and the American College of Cardiology.

He has been a member of House of Hope Presbyterian Church in St. Paul for more than 50 years and was part of its governing boards for 30 years.

He has been a member of Midland Hills Country Club in St. Paul for 40 years, serving as president in 1999-2000.

He was a member of the Emory School of Medicine Alumni board for a period of years attending quarterly meetings in Atlanta.

Bessinger stated he feels privileged and grateful to have received recognition with the MMA Distinguished Service Award in 2007, the MnAAP Distinguished Service Award in 2010, and the Department of Pediatrics Gold Headed Cane Award in 2021 (a lifetime achievement award for his efforts in child advocacy).

At his retirement in 2003, the Childrens MN professional staff recognized him with the Blanton Bessinger Advocacy Award presented to a staff member annually. He has had the privilege of presenting it at the annual meeting.