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.
Today I received a call from my son’s school informing me that he had been suspended for injuring his teacher and hurting another staff member. The week prior, I had received multiple calls requesting that I pick him up early due to escalating behaviors.
My story is not unique. Across the country, parents of children with autism navigate aggressive outbursts, elopement, self-harm, and school suspensions. We juggle IEP meetings, medication adjustments, …
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When the doctor is also the patient’s mom: Navigating severe autism
When my medically complex son Declan came home from the hospital, he needed round-the-clock care, 24 hours a day, 365 days a year. A full-time worker puts in about 1,960 hours a year, assuming 40 hours a week minus vacation and holidays. Each year has 8,760 hours. That means caring for Declan required an equivalent of 4.47 full-time employees every year.
In Minnesota, where we live, for even the highest-acuity cases, …
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Pediatric home health care oversight: Why accountability is failing
In 2016, Lauren Gambill wrote on KevinMD about being told, “She is not yours to grieve,” after a patient’s death. The message was clear: Grief was weakness, and physicians were expected to suppress it. Nearly a decade later, Arthur Lazarus argued that medical training does not change personality; it reveals scaffolding. He cited a “Blue Bloods” episode where Danny Reagan dismissed a racist watch leader and former cop with the …
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The danger of detachment: How medical training reveals character
Update from Oregon Health & Science University:
Oregon Health & Science University clarifies that no decisions have been made about the Oregon National Primate Center at OHSU.
In February, the OHSU Board of Directors authorized the university president to enter discussions with the National Institutes of Health about the possibility of transitioning the ONPRC to a primate sanctuary.
The board passed a resolution to begin a six-month timeframe for the parties to develop …
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Why the Oregon National Primate Research Center is shutting down
“Let’s Fly.” Captain Burnham’s words on the USS Discovery were more than a command. They were a declaration of trust, of forward motion, of refusing paralysis.
That is the question before us now: What happens when children with disabilities grow up?
For decades, pediatrics treated disability as a childhood condition. The grant language, the fellowship training, the systems of care, all built on the assumption that disability ends at eighteen. But children …
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Adult disability care transition: Why medicine must grow up
Cassandra saw the future. No one believed her. Medicine has its Cassandras too, clinicians who name the failures before anyone else. Their warnings are dismissed, their foresight ignored, until the damage is undeniable.
This essay is built on an AI comparison. It set my 1998 Nisonger grant beside my 2025 testimony. The themes are identical: health disparities, economic justice, ethics, listening to families. I named them then. I name them now. …
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Why medicine ignores its Cassandras: a case study in health disparities
Sometimes, the smallest failures expose the largest truths. At a remote Air Force base hospital, a silent pager revealed not my incompetence, but my supervisor’s lack of leadership, and set in motion a chain of events that reshaped the hospital’s command structure and ultimately influenced the future of Air Force pediatrics.
What began as a malfunction during an award ceremony became the catalyst for decisive leadership, a reorganization of medical services, …
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Leadership in action: How a broken pager fixed a hospital
As physicians, most of us do not need another Zoom webinar on burnout; we need open space.
Even at the earliest stages of training, we are made to feel that we cannot take a break. In a med school course I teach, I assigned a renewal activity with a short reflection. Some protested, but most expressed gratitude for an assigned pause.
Many admitted how afraid they felt to step away, to take …
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The pause medicine never taught us to take
When I arrived at a regional military hospital, it was not a dispensary or a community clinic. It was the referral hospital for the northern tier missile and bomber bases, positioned just below the major medical centers. We were second tier, but the stakes were global.
Into that setting, I brought the medical home and a mini-developmental clinic. Through a program for exceptional family members, families from around the world found …
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The honest broker in pediatrics: Building the medical home
In Accra, Ghana, the ward glowed ocean blue under phototherapy lamps. Chlorhexidine lingered in the air, cardboard rustled beneath a mother’s thin blanket, and the soft gasp of a preterm infant punctuated the hum of monitors. A baby’s drool pooled at the corner of her mouth; when my gloved fingers brushed her cheek, she flinched. Her body spoke a language beyond words, and her mother translated every twitch with love.
Behind …
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Pediatric care in Ghana: Addressing malnutrition and sickle cell disease
For most of my life, preventable infectious diseases existed at the margins of medicine. Influenza was seasonal but manageable. Hepatitis outbreaks were contained. Childhood hospitalizations from rotavirus or meningococcal disease were rare enough to be notable. COVID-19 may have shattered predictability, but even then, many of us believed the lessons we learned would be followed by renewed investment in prevention.
Instead, we now stand at a crossroads.
A crossroads in prevention
Recent guideline …
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The impact of CDC’s new childhood immunization guidance
I once left grand rounds with a donut and a fake pager buzz because I couldn’t understand the speaker, who often was a natural Mandarin or Arabic speaker. Humor aside, this was not just my problem; it was a systemic failure.
I have spent decades in developmental-behavioral pediatrics, and one truth has never changed: Communication is the currency of medicine. Without it, trust collapses.
International medical graduates (IMGs) are vital to our …
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When language becomes the barrier: IMGs and autism diagnoses
The inventor of the Post-it note deserves a medal. Not for convenience, but for clarity. In my practice, those little squares became tactical weapons, bright flags of truth in a sea of institutional delusion. My mother once told Kathy, before our wedding, never to touch the scraps of paper I left everywhere. She understood that my visual memory depended on those markers. Each Post-it was a breadcrumb, a map, a …
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Why scale of effort matters more than ego in health care
As a pediatrician, I spent many years in a busy, at times hectic, mostly enjoyable practice before retiring and segueing into teaching. Now as an adjunct professor in pediatrics, I aspire to help future health care workers pursue a career in pediatrics.
I have often asked myself: Have I missed anything about the day-to-day of practicing pediatrics?
My answer was what I truly missed were the interactions I had with the children: …
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From pediatrics to geriatrics: How treating children prepared me for dementia care
During my pediatrics rotation in my third year of medical school, the most important skill I learned was how to listen more carefully.
Children rarely have the language or power to fully articulate their needs. They are forced to rely on adults, systems, and institutions to advocate on their behalf. In pediatrics, that responsibility is not an abstract idea. It shows up in exam rooms where parents must choose to pay …
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Why AAP funding cuts threaten the future of pediatric health care
The false promise of efficiency
The latest punditry calls for three-year medical schools, stripped of ethics and other vital subjects, with less clinical training. The rationale? Efficiency. The result? A generation of physicians unprepared for the complexity of children’s lives.
General pediatricians themselves admit in published surveys that they “know squat” about developmental-behavioral pediatrics (DBP) after residency. Yet the proposed solution is to shorten training further. That is not reform; it is …
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A blueprint for pediatric residency training reform
I am no poster boy. I deal with significant physical challenges and mobility issues. The toll continues. I face major medical procedures in the coming year, the price of decades spent serving others while refusing to serve the system. I am actively planning my eventual funeral, which many in my field are likely looking forward to. I served the people, not the system. That choice was the death knell for …
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Why I chose disruption over conformity in medicine
They are not born into battle.
They arrive with open hands,
with laughter,
with faith that the world will keep them safe.
Yet, men who are not content with peace
clench their fists around power,
mistaking domination for strength
and control for legacy.
They draw borders with bullets
and call it victory.
In their pursuit to prove themselves,
they let the bombs fall.
Roads darken with blood.
Homes become rubble.
The sky learns the language of fire.
And in the wreckage stand the children.
They watch …
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The impact of war on the innocence of children
