Primary Care Perspectives

At what age should pediatricians worry if a patient hasn’t had their first period? How can they help patients manage chronic period pain?What is “period poverty” and how can doctors help? Shelby Davies, MD, a fellow in the Division of Adolescent Medicine, Children’s Hospital of Philadelphia, discusses a variety of period-related topics, including: a review of the normal sequence of puberty and menarche and a normal menstrual cycle; etiologies of amenorrhea and how to evaluate for different causes ; laboratory tests to consider in cases of primary and secondary amenorrhea; a review of causes and management suggestions for irregular cycles and heavy flow;  a review of management options for dysmenorrhea, including effectiveness of different OTC painkillers; an explanation of menstrual cups and reusable period underwear, alternatives to tampons and pads that are increasingly popular; a discussion of “period poverty” and the barriers some teenagers face in managing their periods, and how doctors can screen for this and help; and more. Published June 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.

In this discussion, Colleen Lukens, a psychologist specializing in children's feeding concerns, joins Sherri Cohen, a medical director at the Pediatric Feeding and Swallowing Center. They unpack various underlying causes of feeding disorders and the importance of a multidisciplinary approach. Topics include common referrals, key feeding milestones, and strategies for parents dealing with picky eaters. They also highlight when to consider additional GI referrals and provide practical tips to encourage healthier eating habits in children.

Approximately 15% of school-age children and adolescents in the U.S. are thought to have an emotional or behavioral disorder, and nearly two-thirds receive no formal mental health care. Pediatricians are increasingly being called on to screen for and treat mental health problems. Billie Samantha Schwartz, PhD, a Psychologist in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at Children's Hospital of Philadelphia, sits down to tackle common communication challenges faced by primary care providers, and how to find a common factors approach (as recommended by the AAP) to build into practice. Published May 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.

Parents often have questions about organic foods and environmental toxins such as BPA and phthalates. This conversation will help provide answers. Leonardo Trasande, MD, MPP, Jim G. Hendricks, M.D. Professor of Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, and author of “Sicker, Fatter, Poorer: The Urgent Threat of Hormone-disrupting Chemicals to Our Future...and What We Can Do” discusses a range of topics, including why environmental medicine is important in pediatrics; the importance of studying disease-related costs of chemicals; racial disparities in exposures to pesticides and other harmful chemicals; and information about topics parents often ask about, such as benefits of organic food, minimizing phthalate exposure, plastics versus glass, BPA and BPA-like chemicals in canned food and drinks, the safest water (probably from your tap!), safe baby food, and more. Published April 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.

In celebration of the 100th episode of the Primary Care Perspectives podcast, Dr. Katie Lockwood welcomes a special guest, author Jessica Lahey, to discuss her most recent book, “The Addiction Inoculation: Raising Healthy Kids in a Culture of Dependence.” Lahey, whose perspective is informed by her own recovery from alcohol addiction and her experiences as a writing teacher and parent, writes for The New York Times and The Washington Post and is the author of the bestseller “The Gift of Failure: How the Best Parents Learn How to Let Go So Their Kids Can Succeed,” from 2015. Here she shares insight on topics including: countering myths about drinking and drugs (such as “everyone does it”); the gateway hypothesis; how pediatricians can be an ally for parents and teenagers in decision-making around alcohol and drugs; the AAP guidelines for substance abuse in youth; tips for effective discussions with teenagers; and more. Published April 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.

A baby who can’t sit up by 7 months of age. A “clumsy” child who struggles with tasks such as riding a bike. A teenager experiencing dizziness 2-3 months after concussion. What do these patients have in common? They may benefit from assessment for a vestibular disorder. Robert O’Reilly, MD, attending physician, Division of Otolaryngology, and director, Balance and Vestibular Program, Children’s Hospital of Philadelphia, discusses vestibular issues in children and teenagers. Includes: a review of the vestibular apparatus; clinical symptoms and signs of chronic vestibular issues; review of common causes of vestibular issues; when to refer for post-concussion dizziness or post-concussion positional vertigo; and more.  Published March 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.

Ergonomics is the science of fitting a given environment to a person, to limit exposure to physical stressors that could lead to discomfort or injury. Ian Leahy, PT, DPT, a physical therapist with the Sports Medicine and Performance Center at Children’s Hospital of Philadelphia, discusses: the basics of a good home set-up; whether to recommend a standing desk; advice to help parents avoid unnecessary costs; tips for laptop users; importance of variability of position; tips to encourage movement; how static positions can cause adaptive shortening and trigger soft-tissue injury with return-to-sport; what to ask in the history to elicit information about home learning set-ups; relationship between forward head posture and new onset of headache; and more.  Published March 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.

Matthew Elias, attending cardiologist, Children’s Hospital of Philadelphia, discusses COVID-19’s impact on the heart and how it affects outpatient care for children who have recovered. Includes: a refresher on clinical symptoms of myocarditis, which vary by age and can be subtle; review of EKG findings with myocarditis (again, tricky); other cardiac effects of COVID; the potential for long-term cardiac effects; lack of knowledge about the extent to which other pediatric viruses affect the heart; significance of troponin levels in adults versus children; guidelines for return to sport following COVID infection, with age and severity of infection as factors; when to consider referral for EKG and outpatient cardiology evaluation; symptoms of multisystem inflammatory syndrome in children (MIS-C); differences between MIS-C and Kawasaki disease; whether patients with congenital heart disease are at higher risk; and more.  Published February 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.

Fifteen million children are exposed to intimate partner violence (IPV) in the U.S. every year, with 50% of those exposures severe. This podcast offers perspective from Kalena Brown, an advocate and mother whose primary care pediatrician helped her and her three children safely leave a domestic violence situation; Ashlee Lynn Murray, MD, MPH, attending physician, Emergency Department, Children’s Hospital of Philadelphia; and Melissa Dichter, MSW, PhD, associate professor, Temple University School of Social Work. They discuss the importance of routine screening for IPV in primary care; barriers to disclosure; co-occurrence of IPV and child abuse; how to screen under and over the age of 2; safety in screening and documentation; how to manage a positive screen; how to offer support when the family isn’t ready to be directed to resources; importance of longitudinal relationships between pediatricians and families; and more.  Published February 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.

Kerri Heckert, MS, RD, LDN, CEDRD-S, clinical dietitian, and Eleanor Benner, PsyD, psychologist, of the Eating Disorder Assessment and Treatment Program at Children’s Hospital of Philadelphia (CHOP), discuss the most recent (and more inclusive) diagnostic criteria for anorexia and bulimia; the relatively new diagnosis ARFID (Avoidant Restrictive Food Intake Disorder); the role of growth charts in diagnosis; red flags to look for in a primary care setting; strategies for promoting positive body image; indications for inpatient admission; CHOP’s inpatient protocol for eating disorders; resources for parents; family-based treatment; how to make a referral, and more.  Published January 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.