Category Archives: Pediatrics

With drownings on the rise, prevention conversations with caregivers are crucial – Contemporary Pediatrics

With drownings on the rise, prevention conversations with caregivers are crucial | Image Credit: nata777_7 - nata777_7 - stock.adobe.com.

Drowning is something that happens quickly, it happens usually insidiously, and [it is] really difficult to unwind the damage from drowning as time goes by, said James Barry, MD, a pediatric emergency medicine fellow in Rochester, New York. It is why the National Drowning Prevention Alliance (NDPA) and the American Academy of Pediatrics (AAP) held a joint virtual panel to discuss drowning prevention strategies this summer.1

According to the Centers for Disease Control and Prevention (CDC), as of May 14, 2024, drowning deaths are on the rise in the United States, with over 4500 deaths reported each year from 2020 to 2022. These figures are 500 more per year compared to 2019. In children aged 1 to 4 years, drowning is the No. 1 cause of death in the United States.2

The best way to explain drowning to anybody is when you're submerged in water, you have this kind of panic response and you start flailing and at some point, you take a breath, said Barry. A breath leads to an aspiration or breathing in of the water, and that can disrupt the way that your body transitions oxygen and carbon dioxide across the lung and it actually disrupts the surface tension of the lungs, so you experience a lot of collapse of the lung. That leads to hypoxemia, or low blood oxygen, which can lead to loss of consciousness or apnea. That leads to bradycardia, which leads to arrest and then you have a lot of pulmonary edema, you can have neurovascular compromise.

Prevention strategies can save lives, which is why it is important that your patients caregivers and family members understand signs and symptoms and how to execute prevention initiatives that are lacking across the country. The CDC stated in a May 2024 report that nearly 40 million adults in the United States do not know how to swim, and over half of adults have never taken a swimming lesson.2

Something that I recommend to parents, even if it's a weekend course, even if it's a day with an EMS team, learning about rescue breathing, learning about basic life support is critical in preventing some of the long-term damage that happens after drowning, said Barry. The quicker that you're able to take care of the patient, the better their outcome will be.

Access to these lessons and courses has played a role in the recent rise in drownings across the country according to the CDC, which stated that self-reported swimming ability can be linked to access based on historical and social factors. Cost associated with swimming lessons or overall availability of lessons in some communities are factors that may have contributed to the 40 million adults who do not know how to swim.2

Disparities have also emerged in the research, as the CDC noted the highest drowning rates were among non-Hispanic American Indian or Alaska Native and non-Hispanic Black persons. The federal agency reported that 63% of Black adults and 72% of Hispanic adults reported never taking a swimming lesson.2

The CDC, NDPA, and AAP remind providers, and caregivers directly, how important basic prevention strategies are, such as fences that fully enclose and separate the pool from the house. They should be at least 4 feet high with self-closing and self-latching gates, according to the CDC.2

It's very important to have a fence around a pool, Barry reiterated. [Wearing a] life jacket at all times in any kind of watercraft [is also important]. A lot of pediatricians do a really good job of this, but it's always important to remind families with intellectually or cognitively delayed or impaired children, [that} they should have a lifejacket on regardless of what body of water they're in. Regardless of who's with them. It's extremely important for those patients.

Drowning rates are significantly higher for children and youth with special health care needs, especially neurodivergent kids and adolescents and those with seizure disorders, said Benjamin D. Hoffman, MD, FAAP, president of the AAP, in a Letter from the President published in May 2024. Building awareness and supporting programs to help address these kids needs can save lives.3

In toddlers, the AAP noted backyard pools present the greatest risk for drowning. Its important to recognize children are entertained by water, and if they can get to water, they will, said Hoffman in a May 2024 virtual panel. And if they get to water when there arent barriers in place to prevent access, tragedy can ensue.1

Treating drowning quickly and robustly is critical after a submersion incident, even if that incident doesnt seem serious.

It's really important for those children to get evaluated if they are having those pulmonary symptoms in the first 8 hours, even if you feel like it wasn't a real submersion, said Barry. I say this to every pediatrician as an emergency doctor, if you have a concern about the child after submersion incident, send them into the emergency department (ED). It's always important to just get that screened chest X ray to see if there's any kind of pulmonary injury to prevent a lot of that compromise later.

When it comes to drowning prevention, it starts with caregivers and parents, as theyre going to be the primary personnel dealing with a submersion incident or water difficulties in general that involve their child.

Its really important to counsel parents on water safety, Barry added. Counsel parents on making sure their children know how to swim, making sure their children know how to put on a life jacket and wear life jacket properly. Its critical to kind of press parents on these skills, these ways to recognize, and these supervision techniques that they should be practicing.

References:

1. NDPA And AAP share life-saving insights on childhood drowning prevention ahead of official start of summer and water recreation season. NDPA. Press release. May 24, 2024. Accessed June 6, 2024. https://ndpa.org/ndpa-and-aap-share-life-saving-insights-on-childhood-drowning-prevention-ahead-of-official-start-of-summer-and-water-recreation-season/

2. Drowning deaths rise in the United States. CDC. Press release. May 14, 2024. Accessed June 6, 2024. https://www.cdc.gov/media/releases/2024/s0514-vs-drowning.html

3. Hoffman B. Warmer weather leads to more drownings; what you can do to keep kids safe. AAP News. May 1, 2024. Accessed June 6, 2024. https://publications.aap.org/aapnews/news/28682/Warmer-weather-leads-to-more-drownings-what-you?searchresult=1?autologincheck=redirected

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With drownings on the rise, prevention conversations with caregivers are crucial - Contemporary Pediatrics

Chief Nursing Officer Honored with Miracle Maker Award – URMC

After more than 45 years serving as a nurse, a nurse practitioner, and a nursing leader at URMC, Sue Bezek, the chief nursing officer at Golisano Childrens Hospital, will be retiring.

Her career has been definedfrom the very beginningby a philosophy that emphasizes putting the needs of patients and families first.

Making a difference for people who were struggling with their health is what drew me in to the field, she said.

It didnt take long for Bezek to find a path in nursing that enabled her to fulfill this goal. While earning her BSN from Villa Maria College, Bezek became enamored with pediatrics during one of her training rotations as a student nurse. Her first nursing position was on the Infant and Toddler unit (4-1600) at Strong Memorial Hospital (SMH). After a year on that unit, she sought to augment her clinical skills in a pediatric intensive-care area and transferred to the NICU.

Soon after her transition to the NICU, she was elevated to the position of nurse leader. I think I was somebody who had an affinity for problem solving, but I still had to grow my skills to navigate the challenges of leadership, she said.

One of these challenges was earning the trust and respect of her peers after being promoted into leadership so early in her career. Bezek accomplished this by emphasizing collaborative problem solving with her team.

I would approach an issue and offer to the team: Heres how I think we could solve it, would you do it this way? How can we collaborate in finding solutions?

After two-and-a-half years in this position, Bezek took on a new role when the URMC Ambulatory Surgical Center opened in December of 1984. Bezek served as a Level II staff nurse, and was the only nurse on staff who had previous experience in pediatrics.

Bezeks three years in that position offered a great experience to learn about patients and clinicians across the URMC system, all while serving as a resource for her peers about pediatric care. I learned skills from my colleagues about caring for adult patients but also helped them learn about the care of children, she said.

While working at the ambulatory center, Bezek began her pursuit of an advanced educational degree in nursing and received a Pediatric Nurse Practitioner degree from the University of Rochester. She subsequently transitioned to serving as a Nurse Practitioner (NP) in various Pediatric Divisions in progressively more responsible roles.

Throughout these roles from serving as the first PNP in the new Pediatric HIV Program and then as a PNP in the Pediatric Primary Care Practice, to eventually ascending to senior leadership at GCH Bezek has been guided by words of Dr. Elizabeth McAnarney, former chair of the Department of Pediatrics.

She told me: If you keep your decisions focused on the right thing to do for the patient and family, all the other things will fall into place, said Bezek.

Bezek applied this approach at every level, first as a practicing NP serving patients directly, then in subsequent leadership roles as a senior nurse manager of the Outpatient clinic, followed by associate director of the Sovie Center for Advanced Practice, and subsequently, the director of pediatric nursing and then the inaugural Chief Nursing Officer for Golisano Childrens Hospital.

In leadership, you dont necessarily see your impact on a patient-to-patient basis, so you have to really listen to your team, who have these day-to-day experiences with patients and their families, and do collaborative problem solving while trusting their perspective, she said. This team-focused collaboration has also resulted in advocacy for initiatives that were aimed at improving both patient and staff safety in the past few years.

Through her tenure in leadership, Bezek focused on serving the needs of patients on a population-health level. As her responsibilities grew, so did GCH, from one floor on SMH to the major world-class facility that it is now. During this time, Bezek also witnessed the landscape of pediatric health care change.

The patient population that we care for is much more acute and complex than when I first started. The families have information at their fingertips through the internet. They have multiple, well-researched, and detailed questions that can make things tougher for clinicians to be at the ready for them and answer in a timely fashion. This requires more collaboration across specialties and more shared knowledge in order for us to serve families best, she said.

Sue Bezeks ability to solve problems creatively, build highly effective teams, and remain laser-focused on provision of high quality, family-centered care have made her an effective leader that has contributed greatly to the growth of GCH, according to Tim Stevens, MD, Chief Clinical Officer at GCH.

Nurses are the first point of care for many of our patients, so fostering a strong patient-first nursing culture is critical for building trust with our community, he said. Sue brings a thoughtful, inclusive, and family-focused approach to leadership that has shown great results toward helping children in the region and beyond.

In addition to her experience as a clinician and leader, Bezek has co-authored a few book chapters, has guest lectured at the University of Rochester School of Nursing, and has won several awards, including the 2010 Ruth Lawrence Academic Faculty Service Award in Community Service, and the 2012 Excellence in Nursing Leadership Award and the 2016 March of Dimes Nurse of the Year in Leadership.

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Chief Nursing Officer Honored with Miracle Maker Award - URMC

EEG and ECG are overused in children with breath-holding spells – Contemporary Pediatrics

EEG and ECG are overused in children with breath-holding spells | Image Credit: Contemporary Pediatrics

Electrocardiography (ECG) and electroencephalography (EEG) studies are conducted far more often than is necessary in children who experience breath-holding spells (BHSs). This was the main finding of a retrospective study in 519 Swedish patients younger than 10 years who were diagnosed with BHS during a 15-year period.

In most patients, BHS began and was diagnosed before the age of 2 years, and 26 patients (2.6%) were 3 months or younger at onset. Of the 61 children (11.8%) with comorbidities, asthma was the most frequent culprit. Anger was the most common trigger (in approximately half of patients), followed by pain and head trauma. Many patients were unresponsive during a spell; 43.4% experienced unconsciousness and 71.5% had seizures.

As for diagnostic procedures, although EEG was performed in 30.4% of patients, the study findings indicated pathology in only 6 children (3.6%), 4 of whom received a concomitant epilepsy diagnosis. An ECG was performed in 45.1% of patients, with pathology indicated in only 2 patients (0.9%). Blood samples were investigated at diagnosis in 37.2% of patients, and 10 patients (5.6%) had anemia, 2 of whom had iron deficiency. Another 13 patients had signs of iron deficiency.

Based on these results and those of earlier studies, investigators developed an algorithm indicating that only 7.7% of patients with BHS require an ECG at BHS diagnosis, a much lower proportion than the 45.1% of those who had undergone the test in the study sample. In addition, although almost one-third of children in the study group received an EEG, the algorithm would have called for the EEG in none of these children because they all had typical spells. Investigators also noted that they found pathological hemoglobin and iron levels in many patients who underwent blood analysis. As a result, their algorithm suggests an increase in blood sampling to recognize iron deficiency and anemia.

THOUGHTS FROM DR FARBER:

I was taught that a classic BHS, diagnosed by careful history, did not require any workup.Findings from this study support this with a useful algorithm, although it does suggest testing for iron deficiency (simple enough to do) in children with more than 1 episode.The authors do not routinely recommend an EEG, even though more than 70% of children (a huge number in my experience) had seizures with the BHS. Reference:

Schmidt SH, Smedenmark J, Jeremiasen I, Sigurdsson B, Eklund EA, Pronk CJ. Overuse of EEG and ECG in children with breath-holding spells and its implication for the management of the spells. Acta Paediatr. 2024;113(2):317-326. doi:10.1111/apa.17020

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EEG and ECG are overused in children with breath-holding spells - Contemporary Pediatrics

New Close To Home Center to Open in Grove City – Newswise

Newswise (COLUMBUS, Ohio) Nationwide Childrens Hospital announced plans today to expand its Close To Home network by opening a new center in Grove City. The new center will expand convenient access to urgent care and specialized pediatric services for families in Grove City and surrounding areas.

Planned services at the center, to be located at 1350-1370 Stringtown Road east of Interstate 71, include urgent care, lab services, imaging and EKG testing, and clinical therapies. The Grove City Close To Home Center is anticipated to open in 2026.

Central Ohio continues to grow, and Nationwide Children's wants to provide the best access to pediatric care for the entire region, said Tim Robinson, chief executive officer of Nationwide Childrens Hospital. Our new Close To Home Center in Grove City will help more children receive the care they need, when they need it.

Close To Home centers offer community-based diagnostic and therapeutic services for newborns, children and young adults, with services varying by location. Nationwide Childrens currently operates 23 Close To Home centers in central Ohio, with plans to open locations in Zanesville and Athens this year.

We and our children are truly blessed to welcome a Nationwide Childrens Hospital Close To Home center with urgent care to our community, said Grove City Mayor Richard L. Ike Stage. For 130 years, Childrens has provided the highest level of care for every child in need, now caring for children in 45 countries across the globe.

About Nationwide Childrens Hospital

Named to the Top 10 Honor Roll on U.S. News & World Reports 2023-24 list of Best Childrens Hospitals, Nationwide Childrens Hospital is one of Americas largest not-for-profit free-standing pediatric health care systems providing unique expertise in pediatric population health, behavioral health, genomics and health equity as the next frontiers in pediatric medicine, leading to best outcomes for the health of the whole child. Integrated clinical and research programs, as well as prioritizing quality and safety, are part of what allows Nationwide Childrens to advance its unique model of care. Nationwide Childrens has a staff of more than 14,000 that provides state-of-the-art wellness, preventive and rehabilitative care and diagnostic treatment during more than 1.7 million patient visits annually. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Childrens physicians train the next generation of pediatricians and pediatric specialists. The Abigail Wexner Research Institute at Nationwide Childrens Hospital is one of the Top 10 National Institutes of Health-funded free-standing pediatric research facilities. More information is available at NationwideChildrens.org.

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New Close To Home Center to Open in Grove City - Newswise

Dr. Robert Wilmott, pediatrics chair who gave parents advice as ‘Dr. Bob,’ dies at 75 – St. Louis Post-Dispatch

Dr. Robert Wilmott, long-time chair of pediatrics at Cardinal Glennon Childrens Hospital who wrote advice columns for area parents as Dr. Bob, died Sunday.

Dr. Robert W. Wilmott, who served as chair of the pediatrics department at SSM Health Cardinal Glennon Childrens Hospital for 17 years and provided advice to parents across the St. Louis region through his Dr. Bob columns for the hospital and St. Louis Post-Dispatch, died Sunday from bile duct cancer. He was 75.

Wilmott also served nearly three years as dean of the St. Louis University School of Medicine beginning in January 2019, a pivotal time as he strengthened the schools partnerships with SSM Health hospitals and SLUCare physician practices.

Despite his cancer diagnosis in 2020, Wilmotts leadership as dean was marked by the building of the new St. Louis University Hospital, the Center for Specialized Medicine, and the SLUCare Academic Pavilion, leaving a lasting impact on our growth and development, said Kevin Elledge, president of the SSM Health St. Louis Regional Medical Group.

Wilmott also shepherded the medical school through a difficult accreditation process and the first years of the COVID-19 pandemic.

As the chair of pediatrics at Cardinal Glennon, Wilmott was a thoughtful and engaging leader, said SSM Health St. Louis Regional President Jeremy Fotheringham. He was not only a gifted clinician, but a prolific researcher and mentor.

Wilmott was devoted to his patients, colleagues and work, Fotheringham said. His leadership was not just about maintaining the status quo, but about propelling us forward and reaching new heights.

Wilmott was born in London to Bill and Rose Wilmott on Sept. 12, 1948. He was the first member of his family to attend a university, earning his medical degree from University College London in 1973, according to family members. He received a research doctorate from the University of London, where he began specializing in treating children with cystic fibrosis.

During a fellowship at Londons Great Ormond Street Hospital in pediatric intensive care, he met his wife, Cathryn Clark, a nurse at the time. They married Dec. 12, 1981.

Wilmott first came to the United States in 1977 for a rotation at Childrens Hospital of Philadelphia, where he would return after his marriage in London. In 1986, he took an academic position at Wayne State University in Detroit; and from 1989 to 2001 he served as director of the pulmonary, allergy and immunology division at the Cincinnati Childrens Hospital Medical Center.

In 2001, Wilmott became the pediatrician-in-chief at Cardinal Glennon. He also served as an editor of the Journal of Pediatrics for 18 years and was a principal author of Disorders of the Respiratory Tract in Children, an authoritative textbook of pediatric pulmonology.

He was a frequent contributor to the former Healthy Kids advice column in the Post-Dispatch, writing dozens of columns between 2003 and 2015 on topics such as accidental poisonings, concussions, lice and screen time.

For years, parents could also submit questions about their childrens health under the Ask Dr. Bob section on Cardinal Glennons website.

Wilmott loved to ride horses, scuba dive, play the saxophone, ski and travel, his family said. He and his wife went on several medical mission trips together to Belize.

One of four daughters, Annabelle Wilmott, 31, of Sacramento Calif., said she observed her fathers kind and gentle approach with patients firsthand when she accompanied her parents to Belize. He would often maintain relationships with his patients long after caring for them as their doctor.

She also saw her dads compassion for the unhoused, getting to know many of their names and life stories.

Throughout my life, I witnessed the depth of my fathers care and empathy for others, she said.

Wilmott is survived by his wife of 42 years, Cathryn Wilmott; his sister, Rosemary Wilmott; his daughters, Jenny Wilmott, Francesca Wilmott, Gina Reed and Annabelle Wilmott; and five grandchildren.

A memorial service will be held at 1:30 p.m. Wednesday, May 29, at St. Francis Xavier College Church in St. Louis.

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Dr. Robert Wilmott, pediatrics chair who gave parents advice as 'Dr. Bob,' dies at 75 - St. Louis Post-Dispatch

American Academy of Pediatrics launches ‘Rx4DC’ initiative to address gun violence – DC News Now | Washington, DC

WASHINGTON (DC News Now) The D.C. Chapter of the American Academy of Pediatrics (DCAAP) unveiled a new initiative Tuesday to address gun violence in the District.

Our prescription for the district is really a call to action for all people who interact with children who live, work and play, explained Nia Bodrick, a pediatrician and the president of the DCAAP.

Prescription for the District, or Rx4DC, urges local leaders and stakeholders to adopt preventative approaches to reducing violence.

Among the actions prescribed include an increase in community spaces, funding for out-of-school time, more support for school attendance, improving mental health access and prioritizing economic investment.

Its sort of like taking your fruits and vegetables to live a healthier life, said Bodrick. Prevention is key. What are all the things, all the assets in our communities that we can build upon to prevent some of these dangerous outcomes like violence in communities?

Bodrick said violence is a public health issue.

So far this year, seven juveniles have been killed by gun violence, including 3-year-old Tyah Settles.

The number of homicides overall is nearing 70.

I think violence affects everyone, said Bodrick. It affects those who are the victims, the perpetrators, the communities. It can have a lasting effect on the growth and development of children.

The DCAAP is calling on all stakeholders to work collaboratively towards solutions.

The initiative was presented at the organizations annual spring symposium.

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American Academy of Pediatrics launches 'Rx4DC' initiative to address gun violence - DC News Now | Washington, DC

Utah Valley Pediatrics expands to Sanpete County by opening Ephraim location – Daily Herald

Utah Valley Pediatric nurse practitioner Viki Bailey will be working at the new clinic.

Children in Sanpete County now have access to pediatric care as Utah Valley Pediatrics recently opened its newest location in Ephraim. The new office, located off of North Main Street, will seek to maintain UVPs mission: Helping Children Be Healthy.

At Utah Valley Pediatrics, our providers receive extra training in the care of children, from infants to teenagers. That makes us more qualified to care for kids, said UVP administrator Kevin Moffitt. Our record of caring for children throughout Utah County is really unparalleled.

Were excited to expand, and we look forward to bringing the same quality of care children deserve to Ephraim and all of Sanpete County.

The new Utah Valley Pediatrics office is currently staffed by Viki Bailey, a family nurse practitioner with a Master of Science in Nursing degree from South University in Georgia. For as long as she can remember, Bailey wanted to be a nurse, but she says she found her true calling in 2018 once she began working in an urgent care that focused only on children.

Ive known I wanted to be a nurse since I was 4 years old, said Bailey, who speaks English, Spanish and Portuguese. As a mother of seven children, I completely empathize with parental concerns and worries as they relate to the health of their own children. My goal is to enthusiastically connect with the kids while addressing the concerns of parents as we face future health challenges together.

Bailey will be supported by the 31 full-time, board-certified pediatricians currently working in UVP offices throughout Utah County. These board-certified pediatricians specialize in childrens health and have an additional 30 months of training in child health beyond a family practice physician.

Utah Valley Pediatrics, Sanpete County Office is currently open 5-9 p.m., Mondays through Thursdays. To schedule an appointment, please call (435) 266-0500. Phone calls are answered 24/7.

Utah Valley Pediatrics, Sanpete County Office is located at 43 E. 450 North in Ephraim.

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Utah Valley Pediatrics expands to Sanpete County by opening Ephraim location - Daily Herald

Pruitt named director of academic pediatrics division – The Source – Washington University in St. Louis

Cassandra M. Pruitt, MD, a professor of pediatrics, has been named director of theDivision of Academic Pediatricsin theDepartment of Pediatricsat Washington University School of Medicine in St. Louis. She had served as interim director since July 2022.

The academic pediatrics division is home to the universitysComplex Care Clinic, which offers primary care to children with complex medical needs, and theGeneral Academic Pediatrics Clinic, which provides a range of services, including well-child visits, immunizations and same-day visits for illness and other concerns. The division also offers physicians who specialize in developmental and behavioral pediatrics, which includes medical and psychosocial aspects; and physicians who specialize in pediatric physical medicine and rehabilitation, including musculoskeletal and neurologic conditions.

Read more on the School of Medicine website.

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Pruitt named director of academic pediatrics division - The Source - Washington University in St. Louis

Integrating behavioral health within primary care settings – Contemporary Pediatrics

Behavioral health within the primary care setting: pressmaster - stock.adobe.com

Virginia Hatch-Pigotts, MD, FAAP, LMSW, article, "Child welfare: Now that we know better. Lets do better," is a powerful read for all pediatric health care providers to think about and collectively consider meaningful, impactful policy changes for children living within the foster care system.

Hatch-Pigott highlights the trauma children experience before and often while living within the foster care system. She states, The real problem is the lack of timely appropriate mental health services for these [foster care] children (p. 14).1

Her experiences caring for children within the foster care system, advising foster care parents, as well as her analysis of foster care statistics led her to recommend changes for funding at the macro and micro child welfare levels as well as the importance of changing the immediate evaluation of the children to focus on trauma-informed therapies. I highly recommend reading Hatch-Pigotts article.

Early in my career as a pediatric nurse practitioner (PNP), I had the pleasure of working with children within the foster care system, their foster care parents, and meeting the biological parents who were receiving therapies to improve their own behavioral issues and parenting skills.

My role was embedded within a foster care agency that provided comprehensive services from psychiatrists, psychologists, and social workers including case workers for each child and family, nursing care, with medical care provided by PNPs and pediatricians. The overarching goals were family healing and returning the children safely to their biological parents. We understood the importance of integrating mental health and behavioral health services within the primary care visits to enable the children to emerge as healthy individuals from the trauma they experienced prior to admission.

Today, the integration of mental health within the primary care system is supported in the literature but how often it is operationalized, and what is the effectiveness of these systems? A literature search shows several models have been developed and implemented to support behavioral health integration into primary care systems.

A report of an 18-month pilot study in which a Developmental and Behavior Access Clinic (DBAC) was designed for pediatricians to be trained and initially mentored by developmental-behavioral pediatricians to provide developmental care to children revealed that the average wait time for children to receive the needed developmental behavioral (DB) care decreased from 218 days to 41 days. This pilot study supports opportunities to include behavioral health into primary care settings.2

A comprehensive study for the integration of behavioral health (BH) services included an educational program, Behavioral Health Learning Community (BHLC), that delivered 10 sessions (16 hours) over a 2-year period was reported for 13 pediatric practices enrolled in a statewide program that included 105 primary care providers who cared for approximately 114,000 patients.3 Study outcomes revealed increased access to quality behavioral health (BH) services, provider self-efficacy and professional satisfaction, without increasing health care costs.3

I recently published an editorial in the Journal of Pediatric Health Care discussing the integration of behavioral and mental health care in pediatric primary care populations.4 I discussed the role of Pediatric Primary Care Mental Health Specialists (PMHS) developed and offered by the Pediatric Nursing Certification Board.5 Individuals who hold the PMHS credential often practice in dual roles serving both primary health care and behavioral/mental health care needs of the pediatric populations. From my personal experiences, parents appreciate having access to pediatric and/or pediatric-focused family nurse practitioner providers who provide these comprehensive services within one practice setting.

If infants and young children living within the foster care system and all infants and young children could speak for themselves, what would they say to policy makers? Help me please, I need to be safe, cared for, and loved.School-age children and adolescents can inform their healthcare providers of their concerns while living in the foster care system, but do we, the professionals, speak with policymakers on their behalf? The mental health of the pediatric population is in crisis. As mentioned, Dr. Hatch-Pigott supports funding at the macro and micro levels within the child welfare system to improve the outcomes for children within the foster care system. Funding for mental health services for all children also needs to be a legislative priority. PNPs need to continue their advocacy efforts through collaboration with all pediatric providers, remain actively engaged in helping children and families by supporting timely and appropriate health policy initiatives, and through continued support for legislative initiatives offered by the National Association of Pediatric Nurse Practitioners (NAPNAP).

References

1. Hatch-Pigott, V. Child welfare: Now that we know better, lets do better. Contemporary Pediatrics. 2014;40(04):13-19. https://www.contemporarypediatrics.com/journals/contemporary-peds-journal/may-2024

2. Jeung J, Talgo J, Sparks A, Martin-Herz SP. Expanding developmental and behavioral health capacity in pediatric primary care. Clin Pediatr (Phila). 2023;62(8):919-925. doi:10.1177/00099228221147753

3. Walter HJ, Vernacchio L, Trudell EK, et al. Five-year outcomes of behavioral health integration in pediatric primary care. Pediatrics. 2019;144(1):e20183243. doi:10.1542/peds.2018-3243

4. Hallas D. Integrating Behavioral and Mental Health Care in Primary Care for Pediatric Populations. J Pediatr Health Care. 2024;38(3):293-294. doi:10.1016/j.pedhc.2024.01.004

5. Pediatric Nursing Certification Board. The Pediatric Primary Care Mental Health Specialist (PMHS) role, settings, and ethics. Accessed May 20, 2024. https://www.pncb.org/pmhs-role

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Integrating behavioral health within primary care settings - Contemporary Pediatrics

Phones and kids: new pediatric guidelines, expert advice and info on new school rules – Kidsburgh

Photo above by Julia Coimbra via Unsplash.

The first iPhones and Androids hit the market when todays high schoolers were babies. Theyve never known life without smartphones. And today, the Surgeon Generals office estimates that 95 percent of kids ages 13-17 and nearly 40 percent of kids ages 8-12 use social media, connect to the internet and use a massive array of interactive apps through their phones.

Until recently, the advice was to limit kids screen time to two hours per day or less. That wasnt always easy and were now discovering that it wasnt enough to just focus on the number of minutes kids spent in the glow of their screens. It matters what theyre watching and reading, and how it affects a given child or teen.

Phones connect our kids with information and ideas, but they also appear to be causing increases in anxiety, depression, bullying and other distractions, especially in the classroom.

How do parents help their kids navigate our digitally connected world?

Last month the American Academy of Pediatrics (AAP) Center of Excellence on Social Media and Youth Mental Health unveiled its 5 Cs of Media Use a guideline for parents to better understand media influences and to strive for healthy screen time habits (we break down all the details on that below). And schools have begun testing new rules and grappling with the growing issue of phones in schools at all grade levels.

Weve got all that information, along with info on how starter phones can help:

SCHOOLS TAKE ACTION

To help control negative effects from cell phone overuse, schools are increasingly invoking strict rules to eliminate phones in classrooms. And earlier this month, PA state senator Ryan Aument (RLancaster) drafted a bill to lock up student phones due to the steep decline in mental health in children since the early 2010s, according to his website.

Data from Common Sense Media also found that 97 percent of students surveyed used a phone on average for 43 minutes during school hours, and 37 percent of that time was spent on social media.

Starting this year, Sto-Rox School District banned cell phones in classrooms in all grades.

Heres how it works: Over the course of about 10 minutes, nearly 600 students in grades 7 through 12 enter their school building, hand their phones to a staff member who places it in an envelope with the childs name on it, then its put in a bin to be locked in storage for the day. The students then pass through metal detectors and head to breakfast. Phones are returned by the students last period teachers during the days final five minutes.

The process was planned carefully and has been running smoothly. We are very good at it, says Sto-Rox superintendent Megan Marie Van Fossan. Were very strategic.

And the impact? At the start of the school year, the students werent happy about the new policy. But then positive changes began surfacing.

Van Fossan says kids have begun talking to each other again in the cafeteria. Back when phones were allowed, the cafeteria was a relatively quiet place where students were focused on their phones rather than one another.Mornings in the hallway are now the same: Rather than scrolling on their phones or texting, students are greeting each other as the day begins.

Rather than revolving around social media, these students days are full of in-person interaction and connection. No parents have complained about the policy, Van Fossan says, and the rule isnt difficult to enforce.

Other school districts in the region have been taking notice.

We get phone calls and emails (from other school districts), saying, We are looking at going to this policy. Tell us about your experience, Van Fossan says.

Why ban phones?

Phones were taken out of seventh and eighth grade classrooms last year and were never permitted in kindergarten. But the choice to start a district wide ban came because of increasing safety and security concerns.

Kids were texting one another to meet, fight someone in the bathroom, hurt someone after school, Van Fossan says. We dont need that going on during the school day.

Students were also paying less attention in class.

Beyond helping with focus, the new system also helps inspire kids to be on time: Late students must drop off and retrieve their phones at the schools office, potentially adding 20 minutes to the end of their school day.

In the Pittsburgh Public Schools 54 buildings, the electronic device policy generally prohibits students from using, displaying or turning on cell phones on school grounds. And in some PPS high school buildings, student phones are sealed in pouches at the start of the day.

But in many buildings, students have traditionally kept their phones with them.

A lot of our high schools are leaning (toward) collecting phones; not every high school does, says Carrie Woodard, director of school counseling for the district.

In recent years, PPS counselors have seen increases in cyber bullying in addition to anxiety and depression symptoms in students who arrive at school upset from social media postings made after school hours.

Its something I think weve been battling for over a decade now, Woodard says.

What can help besides banning?

To help win that battle, Woodard said its important for educators and school counselors to support the whole child, academically and personally by:

Some parents, Woodard says, are anxious about phones being taken away from students. They want to have instant communication with their child in the event of an emergency.

From the school level, we can always assure them, she says, that if there is an emergency there are systems in place where the educational team will get in touch with the parent.

What is a starter phone?

Starter phones are entry-level devices that allow kids to text, call and store photos. Some have limited access to the Internet or social media. They come in many shapes and sizes, and are usually budget-friendly. Here are some options parents may want to pursue:

The Bark Android phone has parental controls included. It sends alerts about your childs texts and searches and has location tracking. Approval to download apps is necessary. You can also install a Bark parental control app on any smartphone. Plans starting at $39/month at Bark.us

Also an Android phone, the Pinwheel has parental controls built in, and there is no web browser so it has no direct access to social media. There are several models. Note that you wont receive alerts about messages that will be a potential problem. The Plus 3 is $489 on Amazon.

The iPhone SE lets parents manage how much screen time a child spends in their browser. Through Apples Family Sharing, parents set screen time permission, approve what their child buys or downloads, and can disable apps and set limits from their own device. Like almost any iPhone, it can be set up with Apples parental controls. Costs starts at $429 from Apple.

The TCL Flip 2 flip phone allows calling and messaging, and it includes simple games and a limited web browser. $100 from Amazon.

The Nokia 2780 Flip phone is easy to use for texting and calling. $90 at Best Buy.

The Gabb Phone has no internet or social media and no app store. It does include a GPS tracker, and other basics like a camera, calculator, photo album. $75 at Gabb.com.

SCREEN TIME ADVICE FOR EVERYONE

Last month the American Academy of Pediatrics (AAP) Center of Excellence on Social Media and Youth Mental Health unveiled its 5 Cs of Media Use a guideline for parents to better understand media influences and to strive for healthy screen time habits.

The AAP is looking for a way to help parents and educators understand the issues cropping up with phones and other screens, and understand how they can help the children in their lives, says Pamela Schoemer, MD of UPMC Childrens Community Pediatrics. Schoemer tells Kidsburgh she has discussions about screen time effects in about half of her patient visits.

The 5 Cs stand for:

The calm element of the guideline, Dr. Schoemer notes, typically comes up when there are issues with falling asleep something that can spill over into the ability to focus or even stay awake throughout the next school day.

Kids need the ability to calm themselves and to deal with their emotions, she said. So often I see parents, especially with younger kidsputting something (a cell phone or tablet) in front of their child to calm them.

Instead of handing kids a digital device, she suggests:

Dr. Schoemer considers that final C, communication, to be the best resource for parents. Its helpful to have discussions about time limits with devices. But communication isnt just about how many minutes a child is looking at a screen. Its also important to know what your child is looking at it and explore its impact.

Its okay to ask what your child is looking at, she says, and it might even lead to a moment of shared laughter:A TikTok can be just as funny to us as it is to them.

Valuable screen time, like exploring interests, communication with extended family or for schoolwork, is great. Healthy screen habits at home can include educational videos that help deal with emotions or those that encourage an activity, like cooking or science experiments for younger children. Anything on PBS Kids (from Mister Rogerss Neighborhood and Daniel Tigers Neighborhood to the friendship-focused show City Island) is suitable for younger children over the age of 2 or 3.

All screen time isnt equal, and you have to assess it, Schoemer says. If that young person is following an influencer or playing video games with more violence or rudeness or language that you dont approve of or, unfortunately, is being bullied, those are bad screen times.

One last note: Kids are smart and may manage to work around parental controls. So parents should check devices, and also educate themselves by consulting friends, pediatricians and other resources like the AAP website or Common Sense Media.

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Phones and kids: new pediatric guidelines, expert advice and info on new school rules - Kidsburgh