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.
Monday
I walk into your room in the pediatric intensive care unit as two nurses are repositioning you. Your parents stand nearby — your dad in his frayed baseball cap and khaki cargo shorts. Your mom in baggy jeans wrinkled with the same worry as the lines near her eyes. Your little sister sits near the window with a blue hospital mask over her mouth and hugging her knees. Grandma sits …
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I’ll never understand why some patients end up as percentages
The complaint was constipation. In the exam room, a quiet girl stood in a too big johnny, her eyes staring down at the floor. The 13-year-old was here with her “aunt.” Like over 50,000 children before her, she’d made the fifteen hundred mile plus journey from El Salvador to escape the violence of government and gang fighting, perhaps not knowing Mara Salvatrucha and the other gangs hung out only a …
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To this physician, thankfulness is his lifeline
I was nearing the end of my pediatrics rotation as a third-year medical student when the senior resident asked me to admit a patient to the general pediatrics floor. The only information I had as I headed down to the intensive care unit was that she was a ten-year-old girl who had survived an extensive resuscitation at home.
By this point in my education, I was certain that I wanted to …
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The moment I became a passionate doctor
Most experienced pediatric intensivists, myself included, have encountered situations in which we, the doctors, believe continuing to support a child is unethical because it is not saving the life but prolonging the dying; whereas the child’s parents believe the opposite — that it is unethical to withdraw life support because all life is sacred, no matter the circumstances. Sometimes these situations arise because poor communication causes families to distrust the …
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Withdrawal of care in the PICU: What happens if there is disagreement?
On September 30th of this year, the Children’s Health Insurance Program (CHIP) ran out of federal funding. While CHIP has not received as much publicity as the Affordable Care Act (ACA), it has had a major impact on the American population: providing health insurance for 9 million children who would otherwise not be insured. Despite its success, there is currently a debate about the funding of CHIP.
CHIP, which was passed …
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There shouldn’t be a debate about funding CHIP
In an article published by the Atlantic earlier this year, Ryan Park writes that neither truck drivers nor bankers work the kind of gruelingly long hours that doctors — particularly young doctors in their residency programs — do. It is no secret that residency life is demanding and exhausting. Over the last decade, it has also become controversial. Almost a test in itself, as if gauging doctors’ …
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The hidden threat of the 80-hour resident workweek
Over the past several years there have been numerous reports on the rates of death and injury in children with firearms. In fact, a 2-year-old child recently accidentally took his own life in Philadelphia recently. Although the studies don’t entirely agree, two things are certain; 1 death is one too many and children don’t need to exercise their second amendment rights.
The United States has by far the highest rate of …
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Do children need to exercise their Second Amendment rights?
T was the last patient of a busier than usual morning. “New patient, establish care” was her reason for visit. As I would soon find out with the help of our remarkable Arabic interpreter, T and her family recently moved to our area after spending the better part of 3 years moving from refugee camp to refugee camp trying to escape the ravages of the civil war in their native …
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The patients that make you realize that we are part of a larger human family
I wonder what the best thank you any physician has ever received? I think this one is mine. This recent thank you was for our efforts to not save a child but for simply allowing this family to have a few more days with their infant who ultimately passed away. This amazing thank you has deeply and positively affected me so much …
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Thank you for performing CPR on my child
In theory, of course, it’s a great idea for people to give their opinions and rate their experiences with any goods or services they buy. The notion goes back long before the Internet with publications like Consumer Reports, which is now itself online. Sites such as Angie’s List are very popular and can give you testimonials about providers of everything from home renovations to car repair to daycare. So it’s not surprising several …
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Online physician reviews: A physician does a study on himself
It’s fall in the PICU, and we just saw our first severe case of respiratory syncytial virus (RSV) of the season. RSV is by far the most common cause of bronchiolitis in infants. To scientists, RSV is a fascinating virus with several unique properties. One of these is its behavior in the population. When it’s present, RSV is everywhere. Then it suddenly vanishes. There are exceptions to everything in medicine …
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Respiratory syncytial virus: Are we making any progress?
As policy experts cling to pay-for-performance (P4P) as an indicator of health care quality and shy away from fee-for-service, childhood immunization rates are being utilized as a benchmark. At first, glance, vaccinating children on time seems like a reasonable method to gauge how well a primary care physician does their job. Unfortunately, the parental vaccine hesitancy trend is gaining in popularity. Studies have shown when pediatricians are specifically trained to counsel parents on …
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Why immunization rates should not be used as a quality indicator
8:00 a.m.: Monday mornings are abhorred by almost everyone, but they are gloomier if you work as an intern. For me, this Monday was an anticipated work-free day — hence, it wasn’t too bad.
I had spent a long time at breakfast catching up with friends and later grabbed my books and went to the library to catch up on my studies. This happiness was short lived. And in the afternoon, …
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Always ask your patient this one thing
When I meet a new person, and they find out I am a pediatric ER doctor, the most common response is a variation of: “Oh, that must be hard,” accompanied by a sympathetic frown.
The statement is well-intentioned, but I wonder — is their view of medicine closer to “Grey’s Anatomy” or “Scrubs?” (Hint: “Scrubs” is a better show and a more accurately reflects life in medicine.)
I imagine they think my …
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A strategy for working in the ER: Serenity now, insanity later
Although my medical school created many opportunities for clinical exposure during the first two years, none of it compared to the immersive experiences that were to follow. Textbooks, PowerPoints, and lectures galore were supplanted by hundreds of patient interactions in my rotation months. Here are four patient communication tips that have served me well, and that I wish I knew from the outset of my rotations.
1. Build rapport with the …
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4 tips for better communication with patients
Twenty years ago, Congress made a commitment to its children when it created the Children’s Health Insurance Program, recognizing working parents who earned too much to qualify for Medicaid still couldn’t afford health insurance for their kids. For pediatricians who remember, the practice landscape was a great deal different then. So many children were uninsured that pediatric emergency rooms were filled with children who needed routine school physicals and regular …
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The next legislative battle for children’s health
