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​​​​​​The Section on Early Career Physicians offers members a monthly newsletter published with the SOECP "What's New" e-blast. If you are interested in writing an article for the SOECP "What's New" e-blast, please contact Barbara Miller​ or the editing staff​.


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Elizabeth A. Cilenti, MD, FAAP
Newsletter Editor
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SOECP What's New

What's New Articles

​November 2016

​New COCM Policy Statements and a New Toolkit Available for Parents
By Corinn Cross, MD FAAP
COCM Executive Board

The Council on Communications and Media (COCM) has updated two policy statements: "Media and Young Minds" and "Media Use in School-Aged Children and Adolescents," both published in the November issue of Pediatrics.  These policies, and the accompanying technical report, "Children and Adolescents and Digital Media," summarize the latest research regarding the risks and benefits of modern media and provide pediatricians and parents with guidance and resources to help families make meaningful media choices.

With the hope of re-framing the discussion in a way that addresses the ubiquitous nature of media in our children's world, the AAP and COCM has developed a new toolkit for parents, "The Family Media Plan" which will be available through the HealthyChildren.org website. When discussing media, obesity, or sleep issues with their patients, pediatricians can direct parents to this toolkit which will guide parents through the process of developing a personalized Media Use Plan for each child and family. Working through the toolkit will facilitate family discussions around media choices and how these choices fit into their family's values and goals.

October 2016

​Supporting Children with Down Syndrome
By: Teda Arunrut, MD, MS, FAAP

Lately I have been dancing with some really cool kids!  With Justin Timberlake's "Can't Stop the Feeling" blasting in the background, we form a circle and bob to the beat.  One at a time, each child moves to the center and solos his or her favorite dance move.  Each dance move is as unique as the child.  Here at the Down Syndrome Association of Los Angeles, the children meet monthly for social events.  As a volunteer, I go with the flow, letting each child learn at his or her own pace.  Our parents and staff are great at challenging the kids while also respecting their comfort zones.  

Children with Down syndrome face a unique set of health risks.  The AAP published the most recent guidelines for "Health Supervision for Children with Down Syndrome" in Pediatrics in 2011.  The National Down Syndrome Congress (www.ndsccenter.org) is another great resource with up-to-date information for providers and families.  As a pediatrician, I am always thinking about how best to talk to families about medical issues; I try to do it in a way that helps them feel understood and supported.  In a recent issue of The Mighty (a site for sharing personal experiences with disability, disease, and mental illness) newsletter, a mother of a child with Down syndrome shared three things she appreciated hearing when she was at the hospital with her newborn baby girl: 1. "I am glad she is here." 2. "Congratulations!  She is beautiful!"  3. "Enjoy her.  She is a keeper."

The family of a child with special health care needs is often longing for acceptance and inclusion.  Pediatricians are in the position to validate the child's potential for growth and accomplishment and to provide a greatly appreciated source of emotional-spiritual support.  When we dance to the same tune and enjoy each other's goofiness, we are affirming that our patients are kids first.    

Cyberbullying
By: Alexander M Hamling, MD, MBA, FAAP

With the start of each new school year comes transitions for students and concerns for parents.  As our connected society entrusts younger students with smart phones and tablets, ease of access of data puts all students at risk for cyberbullying.  October is National Bullying Prevention Month so let's discuss a few key points that make talking about cyberbullying easier. 

Cyberbullying is an attack conducted electronically.  This can originate from text messages, e-mails, or social media sites.  Cyberbullying is more common than traditional bullying, as 7 out of 10 children are victims of cyberbullying and 20% experience cyberbullying on a daily basis. (source: NoBullying.com).  Cyberbullies do not need to confront their subject face to face and cyberbullying can snow ball on social media.

The peak age group for cyberbullying is 11-14 years, but can persist well into high school.  It's important to set ground rules at this age for phone use and to ask about cyberbullying red flags in a nonthreatening manner.  A series of questions that pediatricians and parents can ask include: "Do you have any friends who have ever been picked on?;" "Have you ever been picked on by other kids?;" and "Have you ever picked on anyone?" 

For children who are being bullied, parents should be proactive for their child.  Parents should talk to their child and find out how they are feeling, teach self-respect and to never just ignore the bully or to retaliate.  In the office, support parents and children by making it clear that bullying should not be tolerated.  Encourage parents to seek an apology, and encourage friendships and building social skills.  Bullies tend to go after children who are alone.

If a parent feels that their child is the cyberbully it's important for parents to try to understand the reasons for the behavior.  It could be related to anger issues or trouble resolving conflicts.  Avoid aggressive behavior with or around the child.  Discuss and develop healthy ways for the child to display angry feelings without taking them out on others.

I hope these few suggestions help keep kids in your community safe. 

​September 2016

Newborn Screening Updates
By Krista Birnie, MD, FAAP

​Over 4 million newborns are screened annually in the United States as part of state newborn screening (NBS) programs. It's one of the nation's most successful public health programs.  Pediatricians should be aware of available resources for abnormal screens and recent considerations of ethics, quality improvement, and translational research.[1],[2],[3]

The American College of Medical Genetics (ACMG) has created ACTion sheets as a decision support tool for abnormal NBS results.[4]  For each NBS marker there is guidance on communication with families, essential short term actions, and algorithms for follow up steps.  PDF versions are available on the ACMG website and as a free mobile app for Android and iOS devices.[5]

A recent article on the ethics of NBS (June 2016) by Norman Fost, MD, MPH discusses legal informed consent in NBS, including disorders with high benefit-risk ratios.[6] Currently, informed consent is not required for the initial screening but consent is required for newborn blood spots to be used in federally-funded research.[7]

The Newborn Screening Quality Assurance Program (NSQAP), of the CDC's Environmental Health Laboratory, is committed to the quality assurance of NBS tests. The NSQAP adds disorders and analytes to expand the program and assists public health laboratories. The Newborn Screening Translation Research Initiative is a CDC Research group working to identify new screening tests. Be on the lookout for more diseases to be added in the coming years.[8]

[1]Newborn Screening Portal. (2016). Retrieved August 03, 2016, from https://www.cdc.gov/newbornscreening/
[2] Newborn Screening Laboratory Bulletin. CDC. (2014). Retrieved August 03, 2016, from http://www.cdc.gov/nbslabbulletin/bulletin.html
[3] Newborn Screening. AAP. Retrieved August 03, 2016, from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/PEHDIC/pages/newborn-screening.aspx?nfstatus=401
[4] NBS ACT Sheets and Algorithms Table. Retrieved August 03, 2016, from http://www.acmg.net/ACMG/Publications/ACT_Sheets_and_Confirmatory_Algorithms/NBS_ACT_Sheets_and_Algorithm_Table/ACMG/Publications/ACT_Sheets_and_Confirmatory_Algorithms/NBS_ACT_Sheets_and_Algorithms_Table.aspx?hkey=e2c16055-8cdc-4b22-a53b-b863622007c0
[5] ACMG ACT Sheets. Retrieved August 03, 2016, from http://www.nccrcg.org/NCCRCG/Resources/ACT_Sheets/NCCRCG/Resources/ACT_Sheets.aspx?hkey=57d33627-08d8-4590-bddc-3edb6eaaba83
[6] Fost, N., MD, MPH. Informed Consent Should Be a Required Element for Newborn Screening, Even for Disorders with High Benefit-Risk Ratios. The Journal of Law, Medicine & Ethics [1073-1105] Yr:2016 Vol:44 Iss:2 Pg:241 -255.
[7] Roybal-Allard, L., Rep. H.R.1281 - Newborn Screening Saves Lives Reauthorization Act of 2014. Retrieved August 03, 2016, from https://www.congress.gov/bill/113th-congress/house-bill/1281​
[8] Snyder, D. Newborn Screening Translation Research Initiative. Retrieved August 03, 2016, from http://www.cdcfoundation.org/newbornscreening​

August 2016

Breastfeeding Misinformation and Misconceptions:  What All Pediatricians Should Know
Eliza Agrest Varadi, MD IBCLC FAAP, doktoreliza@gmail.com

Breastfeeding, although one of the most natural things for humans as mammals, isn't always easy. There are many hurdles new mothers face: physiological, psychological, and sometimes even bad advice from the medical community.

Life doesn't stop when a mother/child is breastfeeding - mothers still get sick, often requiring medications, surgeries, and other procedures. Babies also get sick - often requiring the same. There is extensive research and well-accepted published guidelines regarding the breast milk safety profile of most medications, radiological compounds, and anesthetics. Although this information exists and is readily available, it does not prevent many medical professionals from giving misinformation.

What can we do? First, we need to remember - THERE'S ALMOST NO REASON TO PUMP AND DUMP. If a medical professional tells a mom to pump and dump, she should ask them to provide medical literature to support that recommendation. If they cannot provide it, they may not know the recommendations and mom can ask her pediatrician or an IBCLC.

As pediatricians, we need to know our resources for breast milk safety profiles: LACTMED, InfantRisk, and professional organizations such as the American College of Radiology and the American Society of Anesthesiologists. Anecdotally, the most common misconceptions regarding medications and breastfeeding I hear are related to antibiotics (most are completely safe), anesthesia (typically anesthetics have very short half lives and once awake, mom can breastfeed), pain medications (at standard dosing, they are safe with rare exceptions). Mothers have even being told to stop nursing for 48 hours after dental local anesthesia. There are safe medications for ADHD, depression, anxiety, migraines and seizures. The biggest misinformation is probably about radiological procedures. CT scans, HIDA scans, X-rays, Ultrasounds and PET scans do not require cessation of breastfeeding. For a thyroid scan, moms need only wait only 4 hours to breast feed if 99mTc-pertechnetate is used instead of Iodine. Thyroid ablation, unfortunately, does require stopping breastfeeding. Finally, if baby requires sedation or anesthesia for surgery, they need to stop taking breast milk 4 hours, not 8 hours, prior to the procedure.

​July 2016

AAP Early Career Physician Delegate to the American Medical Association A16 Report
Toluwalase (Lase) Ajayi, MD

It was another great meeting in Chicago for the 2016 Annual American Medical Association (AMA) House of Delegates (HOD).   I serve as the AAP SOECP delegate to the Young Physician Section (YPS) of the AMA and a delegate to the full HOD on behalf of the AAP.  Your AAP delegation diligently advocated for pediatric related resolutions with great outcomes, and some highlights follow.

Increasing Availability and Coverage for Immediate Postpartum Long Acting Reversible Contraceptive Placement:

Resolution that the HOD recognize that LARC as a safe practice, and that the AMA support coverage of LARC by Medicaid, Medicare and private insurers and encourage provision of training for patients regarding placement protocols and procedures. Your AAP spoke in strong support of this resolution and it was made into AMA policy.

Safe Drinking Water:
This resolution asks the EPA to update its Lead and Copper Rule, including removal of lead water service lines, routine testing of drinking water in certain settings, notification when water samples test above the action level for lead, and to improve compliance with deadline requirements in the Safe Drinking Water Act.

Support for Equal Health Care Access for Eating Disorders:
While the AMA has policy concerning Parity in coverage for Mental Illness, Alcoholism and Related disorders, patients with eating disorders were excluded.   As the AAP has policy related to this matter, we were able to speak to this and help pass this resolution.

Board of Trustee Report and Resolution 1011: Reducing Gun Violence
This report highlighted the importance of reducing gun violence and the effect it has on our patient population. With your AAP delegation and YPS leading the charge, we were able to pass AMA policy calling Gun Violence a public health crisis and asking Congress to lift its ban on research. 

View a complete listing of resolutions at http://www.ama-assn.org/sub/meeting/reportsresolutions.html. We as a section can submit resolutions to the house with AAP delegation support. If there are issues that are pertinent to you, as an early career pediatrician, please reach out to me.

​June 2016

Editor's Note:

Welcome to the newest version of the Section on Early Career Physicians What's New! We are excited to bring you an enhanced version of the ongoing "What's New" that you have been receiving! This new format now features monthly articles written by Section members and highlights important member benefits in addition to the ongoing "What's New" that you have been receiving!  

As the newest co-editor, I'm excited to be part of the team bringing you content relevant to practice as an Early Career Physician! As an introduction, I completed residency in combined Internal Medicine and Pediatrics in 2012 and have been practicing at a community health center in Washington, DC. I have been serving as our center's director of pediatrics for the last year. This summer I will be relocating to Boston with my husband and pursuing my master's degree in public health and working part time. I enjoy travelling, sailing, and running and am looking forward to exploring the rich history of Boston!

Looking forward to learning with you in the coming months!

​Elizabeth Cilenti, MD, FAAP
SOECP What's New Co-Editor


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