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Pediatricians and Public Health: The Perfect Partners to Optimize Children's Health

Gerri Mattson, MD, MSPH, FAAP
January 26, 2018

My first patient of the afternoon was a 9-day-old baby boy, here with his mother and father to follow up on his weight after he was seen once the week prior by one of my colleagues. His weight today was lower than last week, at about 8 percent below his birth weight.

I reviewed the hospital discharge record, the mother's prenatal labs, and notes. My colleague documented that the parents had refused hepatitis B vaccine in the hospital because they wanted to wait until he was older to get his first immunization. 

I introduced myself to the parents, thanked them for coming back so we could check on the baby, and asked how things were going. They shared that it was hard because they did not have their own place and were staying with friends.

As I was thinking about the family's housing situation, the nurse brought in the baby's newborn metabolic screening results. They showed an abnormal result for the thyroid screening. I was already concerned about the baby's ongoing weight loss, the parents' hepatitis B vaccine refusal, their housing situation and other possible stressors. How could I address all of these issues in a 10-minute follow-up visit?​

Pediatricians alone cannot adequately address the myriad factors impacting a child's health that extend beyond the examination room. To provide optimal care, we need to collaborate with public health professionals who share our profession's strong commitment to prevention and addressing the socioeconomic and environmental factors within families and communities that impact child health.  

In the mid-1980’s, the vaccine for HIB was released and thirty years later we no longer see this disease. Because of the effectiveness of this vaccine my younger partners only know of HIB meningitis through textbooks (and some of my anecdotes).

This is the recurring story of vaccine preventable diseases.

- See more at: https://www.aap.org/en-us/aap-voices/Pages/We-Can%27t-Let-Our-Guard-Down-Against-Vaccine-Preventable-Diseases.aspx#sthash.196pj2e8.dpuf

"To provide optimal care, we need to collaborate with public health professionals who share our profession's strong commitment to prevention and addressing the socioeconomic and environmental factors within families and communities that impact child health. 

​​Fortunately, my clinic has developed working relationships with state and local public health professionals. This allowed me to spend time exploring factors that might be affecting the child's lingering weight loss and explaining vaccine-preventable disease. While I focused on these issues with the parents, my nurse reached out to our state public health newborn screening follow-up coordinator to address protocol for the baby's abnormal metabolic results. We also have relationships with care coordinators from our county health department's home visiting program, who we contacted with concerns regarding this family's housing situation and potential other stressors.  


A newly released American Academy of Pediatrics (AAP) policy statement, authored by the AAP Council on Community Pediatrics and the Section on Epidemiology, Public Health and Evidence​, titled "
Pediatricians and Public Health: Optimizing the Health and Well-Being of the Nation's Children," highlights examples across the nation of pediatricians and public health working together to prevent or alleviate threats to children's health. These challenges range from emerging viruses such as Zika to environmental toxins such as lead.

I live in the state of North Carolina, where pediatricians have a long and successful history of working with public health experts. Together, we advocate and promote policies that make a difference in children's lives.  We collaborate on a range of issues, such as child safety and restraint laws, all-terrain vehicle use, increasing immunization rates, Medicaid coverage for important services such as medical lactation, and updating universal newborn screenings with conditions that benefit most from early treatment.

This sort of collaboration is needed more than ever as the health system evolves to address the challenge of improving the health of populations while reducing health care costs using new models of payment, systems integrations, and broader use of population health data. ​​​​

In the mid-1980’s, the vaccine for HIB was released and thirty years later we no longer see this disease. Because of the effectiveness of this vaccine my younger partners only know of HI

- See more at: https://www.aap.org/en-us/aap-voices/Pages/We-Can%27t-Let-Our-Guard-Down-Against-Vaccine-Preventable-Diseases.aspx#sthash.196pj2e8.dpuf

"We are all pieces of the population health puzzle," she said. "Collaboration is essential to solve the puzzle, create effective solutions to the challenges we collectively face, and optimize the health of our children and our communities."

My colleague and AAP Public Health Special Interest Group co-chair, Lillianne Lewis MD, MPH, FAAP, recounted to me her experience with one of the highlighted case examples, a coordinated response to Zika. She worked closely with pediatric providers and specialists, public health departments and public health labs, non-governmental organizations and federal agencies.

"Through collaboration and coordination, our common goal was to optimize the care of infants and families impacted by Zika," said Dr. Lewis, who also is an executive member of the academy's Section on Epidemiology, Public Health, and Evidence. At a 2-day joint meeting hosted by AAP and the Centers for Disease Control and Prevention, she helped lead three diverse, multidisciplinary workgroups to critically think through the evaluation and management of babies with possible congenital Zika virus infection. Sharing ideas, identifying needs and resources, engaging leaders across sectors and developing joint educational activities, participants created updated Zika guidance for healthcare providers.​

"The experience truly highlighted the importance of collaboration and the success that can be attained when partners work together," Dr. Lewis said.

"We are all pieces of the population health puzzle," she said. "Collaboration is essential to solve the puzzle, create effective solutions to the challenges we collectively face, and optimize the health of our children and our communities." 

My patient is thriving and doing well now.  Laboratory testing showed some signs of hypothyroidism and, with help from an endocrinologist, we started him on medication quickly.  After our discussion, his parents decided to proceed with his hepatitis B vaccine.  The public health care coordinator has been in touch with the family and is working on rental assistance through their church. As a team, we were able to help support this baby and his family on the best path toward a healthy life. ​

The views expressed in this article are those of the authors, and not necessarily those of the American Academy of Pediatrics. ​​​

​​​Ab​out the ​​Author


Gerri Mattson, MD, MSPH, FAAP, a public health pediatrician with the child health clinic at Wake County Health and Human Services in Raleigh, NC, co-chairs the American Academy of Pediatrics (AAP) Public Health Special Interest Group. ​


 



Contributing ​​Author​

Lillianne Lewis MD, MPH, FAAP, co-chairs the Public Health Special Interest Group with Dr. Mattson. She also serves as an executive member of the AAP Section on Epidemiology, Public Health, and Evidence, and is a Preventive Medicine Resident with the Centers for Disease Control and Prevention.