Primary Care Perspectives: Podcast for Pediatricians

Sleep-disordered breathing, including snoring and sleep apnea, affects up to 17 percent of youth, and the AAP recommends screening for it at every visit. Ariel Williamson, PhD, DBSM, psychologist, and Ignacio Tapia, MD, attending pulmonologist, of the Sleep Center at Children’s Hospital of Philadelphia, provide a review of high-risk populations for sleep-disordered breathing; how to screen for sleep-disordered breathing; what to ask parents to distinguish between primary snoring and obstructive sleep apnea; when to refer for a sleep or CPAP study; how to help prepare a patient for a sleep study; the information a sleep study yields and what will be reported to the provider; the importance of sleep hygiene/routine and sleep duration; when to recommend melatonin; daytime symptoms that may be caused by sleep disruption; the link between sleep and mental health; and more.

A team discusses a CHOP program called Picture This, in which colorful and interactive murals are used in primary care exam rooms to encourage parent-child interaction and facilitate care. Danielle Erkoboni, MD, primary care pediatrician, CHOP Care Network, Melanie Hoynoski, CCLS, STRS, child life specialist at CHOP, and Steve Wilmot, MSW, Associate Vice President of Primary Care, CHOP, talk about the goals of the mural project; how the visual environment in which a child receives care can change the patient-family experience; the importance of play and visual arts to children; how murals or other types of art can prompt conversations and be incorporated into care; and more.

Did you know that if a new mom is suffering from postpartum depression, the chances are high that the new dad or partner may be struggling as well? David Levine, MD, pediatrician and board member, Postpartum Support International, discusses perinatal mood and anxiety disorders (PMADs) in dads, partners, and adoptive parents. Among the topics: prevalence and risk factors for postpartum depression and other mood issues in dads and partners; cultural attitudes, including factors that keep dads from asking for help and the lack of public role models for struggling dads; how to include dads and partners in screening during obstetric or newborn care; use of the Edinburgh postnatal depression scale; how postpartum depression in dads may affect bonding with the infant; what to do if you suspect postpartum depression in a dad or partner; and more.

As children and teenagers return to summer activities and school sports, particularly after the pandemic down-time, injuries, including fractures, are on the rise. Brendan Williams, MD, attending pediatric orthopaedic surgeon, Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, discusses: physical exam findings that raise suspicion for fractures; the Ottowa Ankle Rules; clavicle fractures in older children (not newborns); how skeletal maturity changes fracture management decisions; pain management and immobilization guidance for sprains; when to send patients who are still in pain for follow-up evaluation or additional imaging; injury prevention advice to share with patients and families; when to send patients straight to the emergency room; and more.

Acne is one of the most common skin conditions, affecting about 80% of all teens. While some teens will only experience mild symptoms, others may develop scarring, hyperpigmentation and negative psychosocial effects. Amanda Shepard-Hayes, MD, an Attending Pediatrician specializing in dermatology at Children’s Hospital of Philadelphia, discusses the importance of recognizing and treating this condition; the combination of factors that cause acne including hormone level changes during puberty or when certain drugs (i.e., corticosteroids, oral birth control) are started or stopped; the different types of acne lesions, and when distribution patterns may indicate a more serious health issue; treatment goals and therapies including topical and systemic medications. In many cases, combination therapy is appropriate, which includes low-dose benzoyl peroxide to kill the bacteria and tretinoin to halt the development of new acne lesions. Recurrent acne that occurs in young children (aged 1 to 7), or in unusual places (like the groin area), should be sent for further evaluation.

Did you know that the pincers of head lice are perfectly suited to the caliber of children’s hair? And they need a blood-meal every 24 hours to survive? If you hate lice – and love puns – tune in for this discussion with Albert Yan, MD, pediatric dermatologist, Children’s Hospital of Philadelphia. He reviews: the epidemiology of lice, including why they may be more common in certain types of hair; distinguishing between nits and dandruff during exam; treatments for lice and resistance to permethrin and pyrethrum; and newer treatment options like spinosad and topical ivermectin. Scabies are also discussed: a review of transmission, findings and risk factors; where to look for lesions; correctly applying permethrin for scabies; differential diagnosis for scabies; secondary infections from scabies; when to consider referral to dermatology for lice or scabies; and more.

At what age should pediatricians worry if a patient hasn’t had their first period? How can they help patients manage chronic period pain? What is “period poverty” and how can doctors help? Shelby Davies, MD, a fellow in the Division of Adolescent Medicine, Children’s Hospital of Philadelphia, discusses a variety of period-related topics, including: a review of the normal sequence of puberty and menarche and a normal menstrual cycle; etiologies of amenorrhea and how to evaluate for different causes; laboratory tests to consider in cases of primary and secondary amenorrhea; a review of causes and management suggestions for irregular cycles and heavy flow; a review of management options for dysmenorrhea, including effectiveness of different OTC painkillers; an explanation of menstrual cups and reusable period underwear, alternatives to tampons and pads that are increasingly popular; a discussion of “period poverty” and the barriers some teenagers face in managing their periods, and how doctors can screen for this and help; and more.

Colleen Lukens, PhD, psychologist, and Sherri Cohen, MD, MPH, medical director, the Pediatric Feeding and Swallowing Center, Children’s Hospital of Philadelphia, discuss how their multidisciplinary clinic would manage this case, and review: some underlying causes for feeding disorders; common reasons for referral to the center; when an additional referral to GI might be appropriate; important feeding milestones; positive, simple strategies to recommend to parents of picky eaters, and more. 

Approximately 15% of school-age children and adolescents in the U.S. are thought to have an emotional or behavioral disorder, and nearly two-thirds receive no formal mental health care. Pediatricians are increasingly being called on to screen for and treat mental health problems. Billie Samantha Schwartz, PhD, a Psychologist in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at Children's Hospital of Philadelphia, sits down to tackle common communication challenges faced by primary care providers, and how to find a common factors approach (as recommended by the AAP) to build into practice. 

Parents often have questions about organic foods and environmental toxins such as BPA and phthalates. This conversation will help provide answers. Leonardo Trasande, MD, MPP, Jim G. Hendricks, MD, Professor of Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, and author of “Sicker, Fatter, Poorer: The Urgent Threat of Hormone-disrupting Chemicals to Our Future...and What We Can Do” discusses a range of topics, including why environmental medicine is important in pediatrics; the importance of studying disease-related costs of chemicals; racial disparities in exposures to pesticides and other harmful chemicals; and information about topics parents often ask about, such as benefits of organic food, minimizing phthalate exposure, plastics versus glass, BPA and BPA-like chemicals in canned food and drinks, the safest water (probably from your tap!), safe baby food, and more. 

In celebration of the 100th episode of the Primary Care Perspectives podcast, Dr. Katie Lockwood welcomes a special guest, author Jessica Lahey, to discuss her most recent book, “The Addiction Inoculation: Raising Healthy Kids in a Culture of Dependence.” Lahey, whose perspective is informed by her own recovery from alcohol addiction and her experiences as a writing teacher and parent, writes for The New York Times and The Washington Post and is the author of the bestseller “The Gift of Failure: How the Best Parents Learn How to Let Go So Their Kids Can Succeed,” from 2015. Here she shares insight on topics including: countering myths about drinking and drugs (such as “everyone does it”); the gateway hypothesis; how pediatricians can be an ally for parents and teenagers in decision-making around alcohol and drugs; the AAP guidelines for substance abuse in youth; tips for effective discussions with teenagers; and more. 

A baby who can’t sit up by 7 months of age. A "clumsy" child who struggles with tasks such as riding a bike. A teenager experiencing dizziness 2-3 months after concussion. What do these patients have in common? They may benefit from assessment for a vestibular disorder. Robert O’Reilly, MD, attending physician, Division of Otolaryngology, and director, Balance and Vestibular Program, Children’s Hospital of Philadelphia, discusses vestibular issues in children and teenagers. Includes: a review of the vestibular apparatus; clinical symptoms and signs of chronic vestibular issues; review of common causes of vestibular issues; when to refer for post-concussion dizziness or post-concussion positional vertigo; and more.

Ergonomics is the science of fitting a given environment to a person, to limit exposure to physical stressors that could lead to discomfort or injury. Ian Leahy, PT, DPT, a physical therapist with the Sports Medicine and Performance Center at Children’s Hospital of Philadelphia, discusses: the basics of a good home set-up; whether to recommend a standing desk; advice to help parents avoid unnecessary costs; tips for laptop users; importance of variability of position; tips to encourage movement; how static positions can cause adaptive shortening and trigger soft-tissue injury with return-to-sport; what to ask in the history to elicit information about home learning set-ups; relationship between forward head posture and new onset of headache; and more.

Matthew Elias, MD, attending cardiologist, Children’s Hospital of Philadelphia, discusses COVID-19’s impact on the heart and how it affects outpatient care for children who have recovered. Includes: a refresher on clinical symptoms of myocarditis, which vary by age and can be subtle; review of EKG findings with myocarditis (again, tricky); other cardiac effects of COVID; the potential for long-term cardiac effects; lack of knowledge about the extent to which other pediatric viruses affect the heart; significance of troponin levels in adults versus children; guidelines for return to sport following COVID infection, with age and severity of infection as factors; when to consider referral for EKG and outpatient cardiology evaluation; symptoms of multisystem inflammatory syndrome in children (MIS-C); differences between MIS-C and Kawasaki disease; whether patients with congenital heart disease are at higher risk; and more.

Fifteen million children are exposed to intimate partner violence (IPV) in the U.S. every year, with 50% of those exposures severe. This podcast offers perspective from Kalena Brown, an advocate and mother whose primary care pediatrician helped her and her three children safely leave a domestic violence situation; Ashlee Lynn Murray, MD, MPH, attending physician, Emergency Department, Children’s Hospital of Philadelphia; and Melissa Dichter, MSW, PhD, associate professor, Temple University School of Social Work. They discuss the importance of routine screening for IPV in primary care; barriers to disclosure; co-occurrence of IPV and child abuse; how to screen under and over the age of 2; safety in screening and documentation; how to manage a positive screen; how to offer support when the family isn’t ready to be directed to resources; importance of longitudinal relationships between pediatricians and families; and more.