Primary Care Perspectives

Primary Care Perspectives: Episode 120 - Evaluating Neutropenia in Primary Care

How should a primary care physician evaluate neutropenia, and decide when it’s time to worry? Kandace Gollomp, MD, pediatric hematologist, Children’s Hospital of Philadelphia, discusses: tips for evaluating a CBC with differential; absolute neutrophil count (ANC) parameters for mild/moderate/severe neutropenia; when to worry about increased risk of infection, both in previously well children and in those with risk factors; a review of risk factors; lymphopenia, granulocytopenia and agranulocytosis and how they are different; benign ethnic neutropenia; post-infectious neutropenia and when you should re-check the CBC; when an infectious history should raise a red flag; when to order a peripheral smear or refer a patient to hematology for bone marrow biopsy or other evaluation; and more.  Published February 2022. This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2022 by Children's Hospital of Philadelphia, all rights reserved.

Primary Care Perspectives: Episode 119 - Primary Care in the Opioid Epidemic

Neonatal abstinence syndrome (NAS) and neonatal opioid withdrawal syndrome (NOWS) have skyrocketed as a result of the ongoing opioid epidemic. Celina C.S. Migone, MD, attending neonatologist, CHOP at Einstein Montgomery, discusses inpatient management of NAS and NOWS, including a new scoring system (replacing the Finnegan) and a move away from pharmacologic management (morphine dosing), and how the changes have had downstream effects that may require a new approach to supporting babies and families in primary care. She reviews: withdrawal symptoms providers may see; which substances are safe for breastfeeding and which are contraindicated; plans of safe care, which are begun during pregnancy and should be in place for a year after the baby is born; developmental monitoring; the CHOP NAS/NOWS inpatient clinical pathway and why it’s helpful to outpatient providers; and more.  Published February 2022. This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2022 by Children's Hospital of Philadelphia, all rights reserved.

Primary Care Perspectives: Episode 118 - Infant Nutrition

The AAP recommends that infants get 400 IUs of vitamin D per day; fewer than 40% meet this guideline. Erica Schwab, RD, LDN, a clinical dietitian who supports the Division of Gastroenterology, Hepatology and Nutrition at Children’s Hospital of Philadelphia, discusses: why most babies, whether breast- or formula-fed, need vitamin D supplementation; how to know when to stop supplementation; good sources of vitamin D for babies transitioning to solid food; why Vitamin D is vital to the health and growth of babies; a review of rickets (breast-fed, non-supplemented infants are at highest risk); and risk groups that may require additional vitamin D supplementation, including preemies. She also provides a review of iron guidelines, including: when to start and stop iron supplementation for breast-fed infants; tips for getting babies to take iron; how to take a dietary history to ascertain whether supplementation is needed; differences between U.S. and European formulas; where to refer for complicated cases; and more. Published January 2022. This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2022 by Children's Hospital of Philadelphia, all rights reserved.

Primary Care Perspectives: Episode 117 - Managing Anxiety in the Primary Care Setting

Anxiety disorders collectively are the third most common psychiatric condition in children. Katrina Fletcher, MD, psychiatrist, and Jason Lewis, PhD, psychologist, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, review: tools to screen and assess anxiety disorders; other diagnoses to consider in your differential or as co-morbidities; medical causes and medications that can cause anxiety symptoms; importance of time course (such as abrupt onset) in your differential; types of anxiety disorders; how to determine severity; what is cognitive behavioral therapy (CBT); when to initiate an SSRI and tips for discussing antidepressants with patients and families; how to know if a treatment plan is working and when to taper or discontinue SSRIs; how to help families navigate anxiety disorders, such as encouraging healthy sleep, diet and exercise; CHOP’s new clinical pathway for anxiety disorders; and more. Published January 2022. This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2022 by Children's Hospital of Philadelphia, all rights reserved.

Primary Care Perspectives: Episode 116 - Creative Approaches to Connection

Chalkin’ Your Walkin’ is a pandemic-era project to chalk inspirational messages on the South Street Bridge in Philadelphia, over which many healthcare workers walk and bike to work. The messages are created by Katie Woo Castelo, MSN, CRNP, a nurse practitioner in the Emergency Department at Children’s Hospital of Philadelphia, with help from her kids. In this 15-minute episode, Castelo explains why she started chalking your walking, and the response to the effort. She also provides useful ideas for how to encourage and connect with children and teenagers during the pandemic, and how to stay connected and support one another as healthcare workers. Published December 2021. This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2021 by Children's Hospital of Philadelphia, all rights reserved.

Primary Care Perspectives: Episode 115 - FPIES: A Complex Allergy

Food protein-induced enterocolitis syndrome, or FPIES, is a rare and different food allergy with a complex etiology and management.  Amy Dean, MPH, RD, CSP, LDN, clinical dietitian, Gayle Diamond, MD, attending gastroenterologist, Terri Brown-Whitehorn, MD, attending allergist, who all work together in the FPIES Clinic at Children’s Hospital of Philadelphia, provide a review. Their discussion includes: symptoms and how FPIES may present in the primary care setting; tips for getting a useful history for diagnosis; how FPIES is different from other food allergies; which foods are the most common causes; what is acute FPIES; respecting parent fear of FPIES reactions, which can be upsetting; tips on diet modification; why a multidisciplinary approach, including allergy and GI, is important; an overview of how CHOP manages FPIES; biomarker research that may lead to a diagnostic test; and more. Published December 2021. This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2021 by Children's Hospital of Philadelphia, all rights reserved.

Primary Care Perspectives: Episode 114 - Grief in Children

One in 5 children will experience the death of a loved one before age 18. Consuelo Cagande, MD, Division Chief, Community Care and Wellness Program, Children’s Hospital of Philadelphia, reviews the difference between grief and mourning; how children may grieve differently and the William Worden stages, which may be more applicable than the Kubler-Ross model; “masked” somatic and behavioral symptoms that may indicate grief; suggestions for how to help a child experiencing grief; how children of different ages may grieve; the importance of asking the family about their cultural norms for grieving; distinguishing between PTSD and grief; COVID and grief; resources to direct families to; and more. Published November 2021.

Primary Care Perspectives: Episode 113 - A Review of Juvenile Idiopathic Arthritis

Symptoms tend to be worse in the morning. Approximately a quarter of cases present without pain. And erythema is not generally a sign. Jay Mehta, MD, MS, attending physician, Division of Rheumatology, Children’s Hospital of Philadelphia, reviews juvenile idiopathic arthritis (JIA), one of the most common chronic diseases of childhood. He discusses: questions for a useful history; what to look for on physical exam; why labs aren’t super-helpful in diagnosis; symptoms that may indicate an oncologic cause; JIA classification criteria (a review of subtypes); potential genetic and environmental etiologies, including association with the microbiome; treatment paths, including steroid injections, low-dose methotrexate, TNF inhibitors, and tailored biologics, and why NSAIDs are no longer advised; complications of untreated arthritis, including uveitis and blindness; and more. Published October 2021. This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2021 by Children's Hospital of Philadelphia, all rights reserved.

Primary Care Perspectives: Episode 112 – Real-world Nutrition Tips for the Primary Care Setting

Bridget Sullivan Garmisa, MSN, MS,CRNP, RD, a nurse practitioner and registered dietitian at a Children’s Hospital of Philadelphia primary care practice, discusses: tips for helping parents deal with picky eaters; importance of role-modeling by parents; how to help parents with common household challenges, such as having time to prepare a healthful dinner; suggestions for breakfasts teenagers might actually eat; healthful, easy-to-pack lunches; what to do when food options are limited, such as from vending machines and corner stores; ideas for on-the-go snacks; why sports drinks are a no-go; how to talk to kids and families about their food decisions; introducing cost savings as a motivator to modify food habits; and more. Published October 2021. This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2021 by Children's Hospital of Philadelphia, all rights reserved.

Primary Care Perspectives: Episode 111 - Acupuncture in Pediatrics: A Review

More and more pediatric healthcare systems are incorporating acupuncture for pain management and other purposes. Dr. Winona Chua, attending physician, Division of General Pediatrics, and Douglas McDaniel, licensed acupuncturist, Cancer Center, Children’s Hospital of Philadelphia, discuss: a review of what acupuncture is, its history, and theories about why it is effective for some patients; why research in acupuncture in pediatrics has been limited; licensing for acupuncturists; how CHOP is using acupuncture; conditions for which acupuncture may be indicated and how a primary care physician can refer; how to explain acupuncture to children, who may fear needles; insurance coverage for acupuncture; and more. Published September 2021. This podcast is for general informational and educational purposes only and is not to be considered as medical advice for any particular patient. Clinicians must rely on their own informed clinical judgment in making recommendations to their patients. ©2021 by Children's Hospital of Philadelphia, all rights reserved.