Pediatrics

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.

Breastfeeding is best, but why do some countries struggle?

Melvin Sanicas, MD

Conditions and Diseases

August 18, 2019

Breastfeeding provides ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. Breastfeeding has numerous health benefits for both the mother and infant. Breast milk contains all the nutrients infants need in the first six months of life. Breastfeeding protects against diarrhea and common childhood illnesses such as pneumonia and may also …

Toy magnets need to be banned for good

Amy Garcia, MD and Sanjay Krishnaswami, MD

Conditions and Diseases

August 10, 2019

Over the course of little more than a month, we removed 54 tiny toy magnets from the digestive systems of four children. They were lucky: Despite invasive procedures and operations to repair holes in their intestines, their injuries were treated in time, and they will make full recoveries.

In the past, others across the nation have not been …

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Toy magnets need to be banned for good

Someone who is both a recalcitrant skeptic and an ardent proponent of childhood vaccines

John M. Glionna

Conditions and Diseases

August 8, 2019

Amid the contentious dispute over immunization requirements for children, Kelley Watson Snyder stands out: She has been both a recalcitrant skeptic and an ardent proponent of childhood vaccines.

Snyder, a Monterey, Calif., mother of two, was a so-called anti-vaxxer for many years, adding her voice to those that rejected mandatory vaccinations for school-age children.

She later realized she was wrong and in 2014 founded a pro-vaccination Facebook group called “Crunchy Front Range …

How a collarbone fracture made this physician remember her past

Dhanya Puram Limaye, MD

Physician

August 7, 2019

One of my most vivid early memories is from when I broke my collarbone. In a first-grade relay race, kids were running at top speeds in opposite directions, so it was no surprise that I collided into a classmate. I was knocked to the ground and cried in pain. The school nurse called my mother, who came and took me home, carrying me all the way.

Now that I have a …

When doctors are right

Sophia Zilber

Patient

August 7, 2019

As I was scrolling through my Facebook feed one morning, I noticed an article with a title starting with: “When Doctors are Wrong” with a picture of a newborn baby with a breathing tube in the NICU. I immediately opened the article and started reading it with interest because my baby also looked this way, so tiny, in the NICU, with lots of tubes all covering her little body.

As I …

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When doctors are right

Are pediatric hospitals ready to embrace value-based payment models?

Johanna Vidal Phelan, MD, MBA

Health Policy

July 30, 2019

Although pediatric (children’s) hospitals are not yet mandated (as are their general population counterparts) to participate in value-based contracts (VBCs), as competitive medical institutions they are very cognizant of the market changes toward value-based payment models while tirelessly seeking to increase value in pediatric health care delivery.

The push towards better alignment of payers and hospital systems continues to change the landscape of competitive health care. Children’s hospitals “are the backbone …

How to raise a resilient child

Angela Mattke, MD

Conditions and Diseases

July 21, 2019

An excerpt from the Mayo Clinic Guide to Raising a Healthy Child.

If you look it up in the dictionary, you might see the term resilience explained as having the ability to bounce or spring back into shape after being compressed, stretched or bent. Trees are resilient to wind and …

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How to raise a resilient child

The scourge of the pediatric urgent care fellowship

Ron Yalon, MD

Physician

July 19, 2019

I am one of those lucky souls who actually likes their job. Since I completed my pediatrics residency two years ago, I have been working in urgent care settings. What’s not to like? I get to see a wide variety of patients, I’m always learning something new, and I get to finish my encounters with a high-five from an overeager toddler. If you’re a general pediatrician like me, that’s the …

Why an asthma action plan is so important for children

Christopher Johnson, MD

Conditions and Diseases

July 16, 2019

Asthma is a common childhood condition. Estimates are that around 8 percent of all children have it. The incidence had been steadily increasing for many years, but some recent data suggest the burden of the disease in children may have leveled off over the past couple of years. That’s encouraging, but the number of children with asthma is still huge. The peak age group is 5 to 14. The …

Do after-hours call centers send too many children to the ER?

Christopher Johnson, MD

Physician

July 13, 2019

A large number of pediatric practices these days use after-hours call centers for parents who have questions about a sick child. I’ve been looking around to find some data about how common this is, but my sense is that the majority of pediatricians use them. There is no question these call centers make life easier for the doctor; having somebody screen the calls, answer easy questions, and only call you …

The basics of the MMR vaccine from a pediatrician

Roy Benaroch, MD

Medications

July 8, 2019

As the U.S. endures its largest measles outbreak in 25 years — one that’s almost certainly going to get worse before it gets better — we’re getting a lot of calls and questions at my office. What’s measles, what’s the best way to prevent it, when should the vaccine be given to adults and children?

The measles vaccine is given as “MMR,” which teaches the immune system to fight off measles, …

What to do with disparaging doctors

Christopher Johnson, MD

Physician

July 5, 2019

Doctors who disparage, or even ridicule, what parents tell them are, fortunately, rare. Nevertheless, sometimes parents may infer from what the doctor says or how he acts that he does not value what they are telling him, even though he did not mean to imply such a thing. All physicians have had the experience of overly touchy parents inappropriately assuming from our questions that we do not respect their ability …

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What to do with disparaging doctors

What to do with physicians who don’t explain

Christopher Johnson, MD

Physician

June 29, 2019

How doctors treat patients’ need for information has changed significantly over the past decades. Sixty years ago medical practice was much more paternalistic than it is now, although some would say it continues to be so in important ways. Still, not too long ago it was common for doctors to tell patients or their families next to nothing about what was going on. The presumption always was: the doctor knows …

If we don’t pay now to vaccinate our children, they will pay later

Peter Ubel, MD

Medications

June 27, 2019

The HPV vaccine saves lives. It does so by reducing a person’s chance of being infected by the human papilloma virus, a virus that causes a whole range of cancers including, most importantly, cervical cancer. Vaccinate your teenage daughter against HPV, and you will increase the chance she will live to old age. Simple as that.

Yet currently, the majority of American teenagers, boys and girls, are reaching adulthood without the full …

Are antibiotics needed for your child with an ear infection?

Christopher Johnson, MD

Conditions and Diseases

June 22, 2019

The common practice in this country (although not everywhere — Europe, for example) has long been to treat all acute middle ear infections (otitis media) with antibiotics. This is not necessarily needed. We now know that for many children another reasonable approach is to wait a day or so to see if the symptoms get better on their own without antibiotics. Parents have an important role in making this choice. …

The horrors of the diseases that vaccines prevent

Alice Ruscica, MD

Conditions and Diseases

June 17, 2019

In October of 2016, I returned to Bernard Mevs Hospital in Port Au Prince, Haiti. Hurricane Matthew, a category 4 hurricane, had touched down near Jeremie only four days prior. Hurricane Matthew caused significant devastation with over 2 million people directly affected, and over 500 reported deaths. As local health care facilities in southwest Haiti had limited capabilities to care for pediatric trauma patients, Bernard Mevs had arranged transport …

Death threats won’t stop this doctor from advocating for vaccines

Linda Girgis, MD

Physician

June 14, 2019

In the U.S., we now have an outbreak of measles where the cases number more than it has in decades. Most of the people being infected are unvaccinated, and we’ve all seen the media reports of the growing tide of anti-vaxxers. While the CDC, WHO, and pretty much every medical and scientific authority across the globe stand by the efficacy and safety of vaccines, those opposed rather rely on the …

Bottle-feeding grandmothers vs. breastfeeding daughters: advice from a pediatrician

Johanna Vidal Phelan, MD, MBA

Conditions and Diseases

June 10, 2019

Recently, a friend’s mother asked me how to best support her daughter’s decision to breastfeed her first grandchild. The new grandmother questioned her ability to encourage her daughter’s decision because she had not breastfed her own child, and this lack of experience made her feel unqualified to provide support. With mixed emotions and a lingering sense of guilt, this new grandmother wanted to learn, from a pediatrician friend, how best …

How anti-vaxxers are just like the rest of us

Jennifer Reich, PhD

Medications

June 5, 2019

Whenever I talk about my research on how parents come to decide to reject vaccines for their children, my explanations are met with a range of reactions, but I almost always hear the same questions.

What is wrong with those parents?
Are they anti-science?
Are they anti-expert?
Are they simply ignorant or selfish?
Are they crazy?

The year is not half over, and the number of measles cases has now exceeded highs not …

School vaccine exemptions must be for medical conditions only

Shetal Shah, MD

Health Policy

June 5, 2019

No, vaccines do not cause autism.

No, vaccines do not cause cancer.

No, vaccines are not toxic.

No, getting the disease is not safer than vaccination.

Yes, they are safe. Yes, they are effective. As a pediatrician, I spend countless hours each week talking about vaccines and counseling parents about the importance of immunization. While parents may not know anyone with rubella, polio or tetanus — almost every parent knows someone who knows someone …

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