The Florida Pediatrician, Fall 2021

The Florida Pediatrician is a peer reviewed journal published quarterly by the Editorial Board of the Florida Chapter of the American Academy of Pediatrics. The journal includes scientific articles, case reports, legislative updates, and other information relevant to pediatricians, pediatric specialists, and pediatric allied health practitioners in Florida.

The Fall 2021 edition of The Florida Pediatrician is now available. Access the full edition here.

 

 

 

This edition includes:

Foreword to the Mental Health Supplement for the Florida Pediatrician
Neurocysticercosis: Discussion Over Two Presumed Cases of Brain Lesion
An Interdisciplinary Approach to Adolescent Weight Management
Evaluating Knowledge and Implementation of Early Peanut Introduction Guidelines: A Cross-sectional Survey
The Firearm Epidemic: How Can Pediatric Trainees Improve Firearm Safety?
Human Trafficking of Children and Adolescents: A Literature Review and Call to Action for Florida Pediatricians
Effect of Newly Proposed Definitions on Incidence and Classification of Severity of Bronchopulmonary Dysplasia
Complex Chromosomal Rearrangement Involving 15q11-q13 Interstitial Triplication and Duplication: A New Case Report of Dysmorphic and Neuropsychiatric Features
Effect of Underlying Connective Tissue Disorders on Pediatric and Adolescent Chiari I Malformation Neurosurgical Patients: A National Inpatient Sample Analysis
Missed Opportunities in HPV Vaccine Administration in a Pediatric Outpatient Clinic
Diagnostic Delay of Untreated Chronic Diabetes Insipidus and Rapidly Progressive Puberty in a 10-Year-Old

Please enjoy the Fall 2021 edition of The Florida Pediatrician! Use the full screen presentation/reader mode for optimal viewing.

Download a printer-friendly version here.

View past editions of The Florida Pediatrician here.

 

Governor DeSantis Recognizes October as Safe Sleep Awareness Month in Florida

Media Contact: HQW.Press.Office@MyFLFamilies.com

Governor DeSantis Recognizes October as Safe Sleep Awareness Month in Florida

TALLAHASSEE, Fla. – On October 22, 2021, Department of Children and Families (DCF) Secretary Shevaun Harris highlighted that Governor Ron DeSantis has recognized October as Safe Sleep Awareness Month in Florida, an effort that is spearheaded by DCF and The Ounce of Prevention Fund of Florida to reduce sleep-related infant deaths in the Sunshine State.

“Experiencing the loss of a child is tragic, but even more so when simple steps could have been taken to prevent that heartache,” said DCF Secretary Shevaun Harris. “By informing parents and caretakers on the best practices for safe sleep, we can work together to reduce the number of these fatalities that occur within our communities each year.”

Click to watch.

Annually, the leading cause of injury-related deaths for Florida infants under the age of one is attributed to suffocation or strangulation in an adult bed. In 2020 alone, preliminary data shows that 74 infants across the state died due to unsafe sleeping conditions. Safe Sleep Awareness Month aims to raise awareness on these tragedies and to educate families and caregivers on how to create safer sleeping environments to lower the risk of these preventable deaths.

“Babies sleep safest when they are alone, on their backs, in a crib or bassinette, and on a firm, flat mattress with no blankets, toys, or other objects,” said Chris Lolley, Executive Director of Prevent Child Abuse Florida, part of The Ounce of Prevention Fund of Florida. “When a baby is sleeping in a safe environment, the parent or caregiver can rest a little easier, too, knowing they are taking every step to prevent harm to their little one.”

Taking care of a newborn isn’t easy, but prioritizing a safe sleeping environment is a task that can be made as simple as A-B-C:

Alone – Do not put pillows, blankets, crib bumpers, toys, soft objects, or loose bedding in a baby’s sleeping area.
Back – Placing infants on their backs to sleep has drastically reduced infant fatalities from Sudden Infant Death Syndrome (SIDS). “Back to sleep” should always be followed unless under direction from the child’s pediatrician.
Crib – The safest place for a baby to sleep is in a safety-approved crib or bassinette. Cribs should have a firm, flat mattress covered only by a fitted sheet. Sleeping on soft surfaces can increase the risk of SIDS.
Whether an infant is in the care of a parent, grandparent, or childcare provider, all caregivers should promote and follow the ABCs of Safe Sleep guidelines until children are at least one year of age to reduce the risk of sleep-related fatalities. For more information on safe sleep, visit https://www.myflfamilies.com/service-programs/child-welfare/safesleep/ or https://www.ounce.org/safe_sleep.html.

Pediatricians, Child and Adolescent Psychiatrists and Children’s Hospitals Declare National Emergency in Children’s Mental Health

Pediatricians, Child and Adolescent Psychiatrists and Children’s Hospitals Declare National Emergency in Children’s Mental Health

AAP, AACAP and CHA call on policymakers at all levels of government to act swiftly to address mental health crisis

WASHINGTON, DC (October 19, 2021) – Today, the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP) and the Children’s Hospital Association (CHA) together representing more than 77,000 physician members and more than 200 children’s hospitals, declared a national state of emergency in child and adolescent mental health and are calling on policymakers to join them.

The COVID-19 pandemic has taken a serious toll on children’s mental health as young people continue to face physical isolation, ongoing uncertainty, fear and grief. Even before the pandemic, mental health challenges facing children were of great concern, and COVID-19 has only exacerbated them.

“Children’s mental health is suffering. Young people have endured so much throughout this pandemic and while much of the attention is often placed on its physical health consequences, we cannot overlook the escalating mental health crisis facing our patients,” said AAP President Lee Savio Beers, MD, FAAP. “Today’s declaration is an urgent call to policymakers at all levels of government – we must treat this mental health crisis like the emergency it is.”

The numbers paint an alarming picture. Between March and October 2020, the percentage of emergency department visits for children with mental health emergencies rose by 24 percent for children ages 5-11 and 31 percent for children ages 12-17. There was also a more than 50 percent increase in suspected suicide attempt emergency department visits among girls ages 12-17 in early 2021 as compared to the same period in 2019.

Additionally, many young people have been impacted by loss of a loved one. Recent data show that more than 140,000 U.S. children have experienced the death of a primary or secondary caregiver during the COVID-19 pandemic, with children of color disproportionately impacted.

“We were concerned about children’s emotional and behavioral health even before the pandemic. The ongoing public health emergency has made a bad situation worse. We are caring for young people with soaring rates of depression, anxiety, trauma, loneliness, and suicidality that will have lasting impacts on them, their families, their communities, and all of our futures. We cannot sit idly by. This is a national emergency, and the time for swift and deliberate action is now,” said AACAP President, Gabrielle A. Carlson, MD.

Amy Wimpey Knight, president of CHA added, “We are facing a significant national mental health crisis in our children and teens which requires urgent action. In the first six months of this year, children’s hospitals across the country reported a shocking 45 percent increase in the number of self-injury and suicide cases in 5- to 17-year-olds compared to the same period in 2019. Together with the AAP and the AACAP we are sounding the alarm on this mental health emergency.”

In the declaration, the groups emphasize the disproportionate toll on young people in communities of color and how the ongoing struggle for racial justice is inextricably tied to the worsening mental health crisis.

“Children and families across our country have experienced enormous adversity and disruption. The inequities that result from structural racism have contributed to disproportionate impacts on children from communities of color,” the groups stated in the declaration.

The organizations are urging policymakers to take several actions, such as increasing federal funding to ensure all families can access mental health services; improving access to telemedicine; supporting effective models of school-based mental health care; accelerating integration of mental health care in primary care pediatrics; strengthening efforts to reduce the risk of suicide in children and adolescents; and addressing workforce challenges and shortages so that children can access mental health services no matter where they live.

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American Academy of Pediatrics

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

American Academy of Child and Adolescent Psychiatry

The American Academy of Child and Adolescent Psychiatry (AACAP) promotes the healthy development of children, adolescents, and families through advocacy, education, and research. Child and adolescent psychiatrists are the leading physician authority on children’s mental health. For more information, please visit www.aacap.org.

Children’s Hospital Association

The Children’s Hospital Association is the national voice of more than 200 children’s hospitals, advancing child health through innovation in the quality, cost and delivery of care. For more information visit www.childrenshospitals.org.

 

Call for Focus Group Participants!

Registration is now open for 2 focus groups!

FCAAP is seeking Florida pediatric health care providers to participate in a 60-minute focus group session. Two dates are available, and participants will be provided a monetary incentive for their participation.

 

Each session will begin with time for questions and answers with the project leaders about the two educational videos previously created and released through the project (the videos and the corresponding CME information are available below). The last part of the session will include a live discussion with participants about their communications with patients regarding vaccine safety and their vaccination practices with immunocompromised children.

 

Register to Participate!

Space is limited to a total of 20 participants. Register to participate in one of the two focus groups here. Registrations will be reviewed as they are received, and registration will be closed once the available spaces for each date are filled. Anyone may attend the live Q&A portion by indicating that interest on the registration form.  The focus groups will be held at 6:00pm ET (5:00pm CT) on Thursday, October 21 and Thursday, October 28.

 

Register to participate in a focus group here.

 

Both educational presentations (General Vaccine Safety and COVID-19 Vaccine Safety and Vaccinating Immunocompromised GI Patients and Cancer Survivors) are available with CME. See the full accreditation details, watch the educational webinars, and claim 1.5 CME credits here.

 

October Atopic Dermatitis Pediatric State Society Series Meeting

Join FCAAP and Integrity CE for the October Atopic Dermatitis Pediatric State Society Series Meeting

Topic: The Critical Role of Pediatric Clinicians in Achieving Best Practices in Atopic Dermatitis Assessment, Management, and Referral

Date: Thursday, October 28, 2021

Time: 12:30-2:00 PM Eastern Time (US and Canada)

Speaker: Stanley M. Fineman, MD, Pediatric Allergist at Atlanta Allergy & Asthma Clinic

Program Overview

Atopic dermatitis (AD) is a chronic relapsing and remitting inflammatory skin disease that affects 7.2% of adults and 12% of children. Disability and a poor quality of life (QOL) are associated with AD, particularly among patients who are suboptimally managed. Pediatricians and primary care providers (PCPs) are often the first point-of-contact for patients with AD. Data from 1996-1999 compared to 2012-2015 found that PCP visits for children and adults with AD increased 300%, yet dermatologist visits for AD decreased 17%. In children, pediatricians were the most frequently sought provider for AD.

Although PCPs and pediatricians are seeing an increase in AD cases, recent evidence shows these clinicians are lacking in their ability to accurately diagnose and assess disease severity. In a recent survey, only 29% of PCPs were able to recognize essential features and characteristic distribution of AD to support diagnosis. Another survey found a discrepancy between how physicians and patients rate AD severity, with patients focusing more on skin-related QOL outcomes and physicians focusing more on sleep disturbance. In pooled data from prior Integrity CE programs on AD targeting PCPs and pediatricians, only 46% of participants selected to assess itch, sleep, and daily life vs objective measures to determine AD severity at baseline. Early-onset AD, which develops within the first 2 years of life, occurs in 60% of children with AD. While as many as 2 out of 3 of these children will experience remission before age 11, recurrences in adolescence and early adulthood are common. Many moderate-to-severe cases of AD in adulthood often begin as early-onset disease that was suboptimally treated or miscategorized. Education to ensure clinicians are prepared to effectively diagnose and assess disease severity is therefore necessary. This series will address these educational gaps among PCPs and pediatricians, and application of the knowledge gained will improve outcomes for patients with AD.

Target Audience

This educational initiative has been designed for primary care physicians, pediatricians, nurse practitioners, physician assistants, nurses, pharmacists, and other healthcare professionals.

Learning Objectives

  • Integrate evidence-based diagnostic criteria and assessment strategies into the routine identification and evaluation of children and adults with known or suspected AD
  • Apply current guideline recommendations to the effective management of children and adults with AD
  • Review safety and efficacy data on new and emerging therapies for children and adults with AD
  • Demonstrate prompt referral of patients with AD to specialist care in accordance with guideline
    recommendations and best practices

Integrity Continuing Education, Inc. designates this activity for a maximum of 1.5 AMA PRA Category 1
Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation
in the activity. Review full accreditation details.

Click here to RSVP for the event.

FCAAP and Simply Healthcare Launch SimplyHealthyMinds.com

FOR IMMEDIATE RELEASE
CONTACT: AMANDA BEVIS
(202) 680-9262
SEPTEMBER 20, 2021

Simply Healthcare and Florida Chapter of the American Academy of Pediatrics Launch SimplyHealthyMinds.com, Where Floridians Can Find Resources to Support Children’s Mental Health

One in Five Florida Kids Suffer Mental Health Conditions; Three in Five Experienced Stress During Previous Year

Miami, FL – Simply Healthcare, in partnership with the Florida Chapter of the American Academy of Pediatrics (FCAAP), launched today SimplyHealthyMinds.com, a toolkit of resources to help children, families, healthcare providers and others navigate mental health challenges facing children.

“At Simply Healthcare, we work to support the whole-health of Florida’s kids– physical, mental and emotional health,” said Holly Prince, President of Simply Healthcare Medicaid Plan. “It can be challenging to start a conversation about mental health or find programs that are available to support children in a particular part of the state. SimplyHealthyMinds.com brings all the trusted resources together in one place.”

“There are real consequences when children who need support don’t have access to it,” said Dr. Lisa Gwynn, President, Florida Chapter of American Academy of Pediatrics. “That’s why we wanted to make it easy to find the resources available and help Floridians navigate the challenges of mental health struggles among children.”

The Simply Healthy Minds toolkit is available at a pivotal time, when children are returning to school, but still face the risk of COVID-19. In addition, September is Suicide Prevention Awareness Month, an opportunity for families to consider the devastating consequences that could result from mental health struggles left unaddressed. The Simply Healthy Minds toolkit provides resources to help kids, families, healthcare providers and others navigate mental health challenges facing kids.

  • The goals of SimplyHealthyMinds.com are to support children by breaking down barriers, increasing understanding of mental health and reducing the stigma associated with mental illness and improving access to resources and care.

At SimplyHealthyMinds.com, users can find a variety of resources to support mental health in children, including:

  • Guidelines for parents to talk to teens;
  • Conversation starters for parents to talk with children;
  • Journal entry prompts to help children express their feelings in writing;
  • Access to local community assistance programs by searching zip codes; and
  • Suicide prevention hotline.

The resources are curated by Simply Healthcare in partnership with the FCAAP, a trusted organization for the health and well-being of children in Florida. The online toolkit is the result of a partnership between the two organizations to pursue initiatives toward their common mission of caring for children in Florida.

Both organizations recognize the growing need to support children struggling with mental health issues.

According to Jed Foundation Report: Fluent Family Wellbeing Study, 60% of parents report that children have experienced distress during the last year. Since COVID began, Florida experienced a 30% increase in Baker Acts – the action of committing an individual to a mental health treatment center – among kids ages 12 to 17.

In addition, the findings of the inaugural State of the Nation’s Mental Health, a report issued in May by Simply Healthcare’s parent company, showed that while more people, including children, reported increased pandemic-related stress and anxiety last year, there was not a corresponding increase in diagnoses and treatment.

Mental health problems can affect many areas of children’s lives, including their happiness, physical health and academic performance.

Visit SimplyHealthyMinds.com to find the guidelines, best practices and local programs.

About Simply Healthcare

Simply Healthcare is a Managed Care Plan that offers plans in Florida for residents eligible for Medicaid, Medicare and Florida Healthy Kids benefits. To learn more, visit www.simplyhealthcareplans.com.

About FCAAP
Through its more than 2,500 members, the Florida Chapter of the American Academy of Pediatrics promotes the health & welfare of Florida’s children and supports pediatricians & pediatric specialists as the best qualified providers of their healthcare. Learn more by visiting www.fcaap.org.

 

FCAAP Supporting Pediatric Healthcare Providers to Increase Vaccination Uptake

The American Academy of Pediatrics (AAP), with support from the Centers for Disease Control and Prevention (CDC), has funded FCAAP to participate in the Supporting Pediatric Healthcare Providers to Increase Vaccination Uptake project. FCAAP is hosting a focus group aimed to identify (1) the needs of pediatric healthcare clinicians related to increasing routine vaccination in children and adolescents to inform the development of strategies, action plans, and/or resources to meet these needs, (2) anticipated COVID-19 vaccination support needs and (3) identify potential barriers that practices face to fully vaccinate or re-vaccinate children, including those with chronic conditions and those within high-risk populations.  Focus Group participants will receive an incentive for participation.

Who should participate:

Practices providing primary care who:

  • Want to improve the quality of care for patients by developing strategies, action plans, and/or access to vaccination resources.
  • Anticipate COVID-19 vaccination support needs.
  • Provide primary care to patients with chronic medical conditions and high-risk immunocompromised pediatric populations.
  • Are interested in learning more about vaccinating or re-vaccinating children with chronic conditions and those within high-risk populations.

Focus Group Registration Available Here.

Contact Tracy Sumpter, FCAAP Grant Coordinator, at tsumpter@fcaap.org for any questions.

Join the Fall 2021 #FCAAPwellness Series

#FCAAPwellness

a pediatric provider wellness series
exclusively for FCAAP members

Purpose:             To provide activities and resources to support the all-around wellness of FCAAP members, including physical fitness, nutrition, mental wellness, mindfulness, and self-care.

Details:               The #FCAAPwellness series is free to all FCAAP members and will include at least one live activity or discussion each week, at least one email with resources and tips each week, and weekly raffle drawings for participants. For extra entries into the drawings, get connected with the series on social media by following FCAAP on Twitter (@FloridaAAP), Facebook (@FloridaChapterofAAP), Instagram (@floridaaap), and LinkedIn (@floridaaap) and use the series hashtag #FCAAPwellness. *A social media account is not required to participate in the series!

Schedule:

  • Week One – Physical Fitness
    Join your colleagues virtually or in-person for a one-mile Fun Run Challenge in the FCAAP Club in Strava during The Future of Pediatric Practice 2021! For full details and to participate in the Challenge, join Strava for free, join the FCAAP Club at: strava.com/clubs/FCAAP, then join the challenge. All fitness levels and types are welcome!

    • September 3-5, 2021
  • Week Two – Mental Wellness
    Join your colleagues from across the state for a discussion on mental wellness, led by Dr. John Morrison.

    • Wednesday, September 15, 2021 at 6:30pm ET.
  • Week Three – Mindfulness Activity
    Join your colleagues from across the state for a live 30-minute herb container garden demonstration, led by Wendy Wilber from University of Florida IFAS Extension.

    • Wednesday, September 22, 2021 at 6:30pm ET.
  • Week Four – Nutrition
    Join your colleagues from across the state for a plant-based meal cooking demonstration and nutrition discussion, led by Dr. Debora Duro.

    • Wednesday, September 29, 2021 at 6:30pm ET.

Login to the FCAAP Member Only website to access the Zoom link for each session and to request a calendar invitation for the series. The #FCAAPwellness series is provided exclusively to FCAAP members. Ensure your membership is current and your email is up to date by contacting Anayra Barreras Pena at abarreras@fcaap.org.

“Self-care is not a waste of time.
Self-care makes your use of time more sustainable.”
– Jackie Viramontez

Guidance for Monoclonal Antibody Use in Children with SARS-CoV-2 Infection or Exposure

Guidance for Monoclonal Antibody Use in Children with SARS-CoV-2 Infection or Exposure
Provided by the Florida Chapter of the American Academy of Pediatrics’ Emerging Infections Task Force

Tallahassee, FL (August 24, 2021) – The Florida Chapter of the American Academy of Pediatrics Emerging Infections Task Force, issued the following guidance on monoclonal antibody (mAb) use in children with SARS-CoV-2 infection or exposure.

The U.S. Food and Drug Administration (FDA) has issued an Emergency Use Authorization (EUA) for several monoclonal antibodies (mAbs) for the treatment of mild to moderate coronavirus disease 2019 (COVID-19) in individuals 12 years of age and older weighing at least 40 kg who are positive for the SARS-CoV-2 virus using viral testing methods, and who are at high risk for progression to severe COVID-19, including hospitalization and death. Initial data shows that mAbs reduce risk of hospitalization and death if given prior to 10 days after onset of symptoms. Patients to be considered for the infusion should not be already hospitalized or receiving increased oxygen support. The following mAb treatments are available:

  • Combination of Casirivimab and imdevimab at high risk for progression to severe COVID-19, including hospitalization and death.
  • Combination of bamlanivimab and etesevimab at high risk for progressing to severe COVID-19 and/or hospitalization.
  • Sotrovimab at high risk for progression to severe COVID-19, including hospitalization or death.

In addition, the FDA has issued an EUA for use of casirivimab and imdevimab combination in individuals 12 years of age and older weighing at least 40 kg for post-exposure prophylaxis of COVID-19 in those who are at high risk for progression to severe COVID-19, including hospitalization or death, such as those:

  • Not fully vaccinated.
  • Not expected to mount an adequate immune response to complete vaccination.
  • Exposed to an individual with COVID-19 consistent with close contact criteria per the Centers for Disease Control and Prevention (CDC).
  • At high risk of exposure to an individual infected with COVID-19 because of occurrence of COVID-19 infection in other individuals in the same institutional setting.

The most serious risk associated with administration of these medications is anaphylaxis. Most frequently identified side effects include fatigue and headache. All families and patients receiving these medications should be counseled prior to administration and with close follow up for 1-2 weeks after administration. These treatments have not been well studied in children because of the limited number of children that were included in the studies. It is expected that children should have similar side effects as adults.  Families should discuss with their physician the individual risks vs, benefits for their child.

The majority of children infected with SARS-CoV-2 are not at high risk for hospitalization and death; however, children who meet certain criteria or those with underlying medical conditions are considered high risk for complications, hospitalization, and death.  Immunocompromised and obese children are at high risk and should be considered to receive a mAb treatment. Children with other underlying conditions, such as diabetes, congenital heart disease, asthma, sickle cell disease, chronic kidney disease, chronic pulmonary disease, and other medically complex conditions should also be considered after discussion of risks and benefits of treatment with the family and patient.

About the Florida Chapter of the American Academy of Pediatrics
Through its more than 2,500 members, the Florida Chapter of the American Academy of Pediatrics promotes the health & welfare of Florida’s children and supports pediatricians & pediatric specialists as the best qualified providers of their healthcare. Learn more by visiting www.fcaap.org.

For more information:
Jamie Fortune, PR Counsel
Florida Chapter of the American Academy of Pediatrics
jamief@themooreagency.com or 850-284-5972

Participate in the Fall 2021 #FCAAPwellness Fun Run During FPP2021!

The Florida Chapter of the American Academy of Pediatrics will be kicking off the Fall 2021 edition of its popular #FCAAPwellness series this September with a one-mile Fun Run Challenge in the FCAAP Club in Strava during The Future of Pediatric Practice 2021 September 3-5! Whether you’re attending the conference virtually or in-person, the steps are simple: run, walk, or bike one mile either around Crescent Lake at Disney’s Yacht & Beach Club Resort or on the route of your choosing at home, take a selfie when you complete your mile, and post your activity containing your selfie photo to the group challenge. The best finishing picture wins a FREE pair of shoes from our member benefit partner Clove!

For full details and to access the Challenge, join Strava for free and then join the FCAAP club at: strava.com/clubs/FCAAP. All fitness levels and types are welcome!

Need to register for FPP2021? Virtual tickets are still available!

Watch for details on additional sessions in the Fall 2021 #FCAAPwellness series in the upcoming September issue of the FCAAP News!