Pediatricians and the clinicians who care for children writing on KevinMD about child health: childhood illness, development, vaccines and the parents who refuse them, breastfeeding and the pressure around it, childhood obesity, prevention, and the realities of caring for young patients and their families. Most contributors are pediatricians. For a maintained record of what pediatricians have said about children's health since 2004, from fever and sleep through obesity, abuse, teenagers, and Medicaid, see Children's health: what pediatricians say, in their own words. For what physicians have said about vaccines and vaccine hesitancy, from the autism claim through measles, exemptions, and federal policy, see Vaccines: what physicians say, in their own words. For what child psychiatrists and pediatricians have said about children's and teens' mental health, see Mental health: what psychiatrists and physicians say, in their own words. For what pediatricians have said about breastfeeding and postpartum care, see Women's health: what physicians say, in their own words.
Sometimes an image captures the heart of a nation by putting a face on a human crisis. The one of Óscar Alberto Martínez Ramírez and his 2-year-old daughter Valeria lying face down in the Rio Grande after drowning was powerful. Their family had been turned away from crossing the border and decided to take their chances and swim across the river. They were not successful.
Why did this picture seize our attention? Is it because …
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When we ignore a child’s preventable suffering, we lose a piece of our humanity
Victor Frankl is an Austrian neurologist, psychiatrist, and Holocaust survivor, who survived three years in the concentration camps of Dachau and Auschwitz.
He once told a story about a woman, his patient, who called him in the middle of the night saying that she wants to commit suicide. Viktor Frankl kept her on the phone, giving her many reasons to keep on living, until she promised not to take her life. …
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To anyone in medicine: This is why listening matters
It was flu season.
I was meeting the usual frustrations of trying to convince my patients to get the flu shot. The flu vaccine has such potential to save lives, yet its reputation is marred by misinformation, leading people to decline this simple, inexpensive, and effective way to limit disease and death. Day in and day out, I felt like I was beating my head against a wall.
This particular day, I …
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We need vaccine advocacy now more than ever
My wife is a teacher. Her passion is helping the Bart Simpsons of the education system. This past year the school district in the rural area where we live tasked her with the job of opening the community’s first alternative education school.
Imagine taking 60 of some of the hardest kids in the area and creating a school just for them, so they have an opportunity to feel success, thrive, and …
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Save health care by saving kids
During intern orientation a few months ago, they promised we would never be alone in the hospital. And they were right. Until they weren’t.
It’s hard to see colors in the dark — that’s why he looks blue. That’s strange; it almost seems like his chest is not moving. I must be overreacting. Everything is fine.
My right hand began flicking his foot.
Yell for help.
This baby is a healthy newborn.
Call a code.
Interns …
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Interns: You’re not alone, until you are
My first transgender patient was a teenager who said although he was born female, he’d protested his gender from the time he could talk. He told a story of being asked, “Well, if you are a boy, where is your penis?” and he pointed to his umbilicus (which was an “outie”). OK, no problem, we have a gender clinic I can refer you to.
When he came back and asked for …
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A physician is worried about gender transition in pediatrics
When children are diagnosed with attention deficit hyperactivity disorder, stimulant medications like Ritalin or Adderall are usually the first line of treatment.
The American Academy of Pediatrics issued new guidelines Monday upholding that central role of medications accompanied by behavioral therapy in ADHD treatment.
Some experts say, however, they are disappointed the new guidelines don’t recommend behavioral treatment first for more children, as that might lead to better outcomes, recent research suggests.
When …
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Should pediatricians treat ADHD with medications or behavioral treatment first?
In his article, “Medical education needs to stop burning out students — now,” Augustine Choi suggests the culture of medical education is responsible for increasing numbers of depression and burnout among medical students, and suggests that more programs are needed to address self-care and wellness in order to build resilience.
While I agree that mental health treatment should be readily available and easily accessible to those in …
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To extinguish burnout, bring back physician autonomy
I pass by one of our local parochial schools on the way to clinic two mornings a week. With the school year in full swing, each Friday I see the children lining up outside to go to weekly Mass. With the girls in their grey tartan skirts and blue vests and the boys in their blue shirts and pants, they form a colorful, large nameless entity to which I don’t …
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Wonder about each patient outside the exam room
“I don’t understand, and no one will explain why it happened.” Jake, my adolescent patient, lamented his experience to me during his well-child visit. “Those boys say that people like me are the devil. They don’t even know me. I’m a good person.” Hours before seeing me in clinic that day, a group of minority teens had confronted Jake while at a local youth community center because he was “the …
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Why pediatricians must talk to their patients about diversity
It’s an odd thing doing what I do sometimes. Dichotomies of highs and lows, life and death, joy and sorrow. In the past 15 years that I have been in health care — a nurse’s assistant, to registered nurse, to now pediatric nurse practitioner — I have had the strange experience of all this emotion. It wasn’t until recently, maybe because I have a family of my own now, that …
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My patients teach me, guide me, and remind me that I am here
Gravel crunched beneath our feet as my co-residents, and I walked alongside one another. Our laughter filled the air as the shadow of our large white camper van stretched behind us, looming farther and farther away. We had escaped the warmth of a vehicle that had been our home all week; it was cold, and we were underdressed, not uncommon in Iceland. Surrounded by sea, the wind blew furiously, unforgivingly, …
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Discovering resolve: a trainee’s thoughts on advocacy and the crisis at the border
Imagine your typical yearly physical. It’s probably booked for 20 to 40 minutes. Since you, like many of us, may see your physician only once a year, it is important for you to have your physician’s complete attention and to have all of your concerns addressed. Some of these concerns may be of a sensitive – even embarrassing – nature. Your physician may likewise ask you some probing questions about …
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A pediatrician speaks out against combining sibling appointments
As a pediatrician, who is also the busy mother of two school-aged children, the end of the summer brings a lot of mixed emotions. As parents and guardians, we can rejoice, while our kiddos may experience a wide range of feelings. The joy of reuniting with their school friends is often tainted by worries of the unknown challenges ahead. When preparing for and beginning a new academic year with new …
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A pediatrician’s top 10 back to school tips
An interesting article in the journal Pediatrics is both intriguing and sobering. It is intriguing because it lays bare something we don’t talk much about or teach our students about; it is sobering because it describes the potential harm that can come from it, harm I have personally witnessed. The issue is overdiagnosis, and it’s related to our relentless quest to explain everything.
Overdiagnosis is the term the authors use to describe …
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The problem of overdiagnosis: What can patients do?
All physicians naturally make judgments regarding the parents they are interviewing. For example, we assess how accurate and plausible their history is. We try to decide if they are telling us the whole story and, if not, if they are inadvertently or deliberately holding something back from us for whatever reason. All experienced physicians do this. What we rarely do, however, is judge the parents’ worth as people, as individuals …
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When physicians inappropriately judge
It was a simple chief complaint: sore throat and fever. As expected, the little girl’s rapid Strep was positive. Instructions given. Antibiotics sent. This was Peds 101. But for some reason, before mom walked out the door, she made mention of their stay at the shelter.
Although I had seen this child many times before, somehow, I never knew that she was homeless. Nothing in my detailed history and exam had …
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Improving health outcomes for children requires us to look at the big picture
A debate highlighting gender discrimination in medicine currently rages within the pediatric hospitalist medicine community.
The debate centers on the board certification process for “grandfathering” for the new pediatric hospitalist subspecialty which effectively excludes women on the basis of motherhood.
For those not familiar with “grandfathering in,” this is the process by which a new subspecialty may grant board certification to physicians who have been practicing in the specialty. The alternative option …
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Don’t make me choose between motherhood and my career
