Knee pain: Helping families access care

An Athletic boy Holding her Painful Injured Knee

Many parents don’t hesitate to bring their child to the emergency department (ED) for orthopedic injuries, including knee conditions. In fact, many head straight for the ED without contacting their child’s pediatrician or primary care provider. However, many common knee conditions can be managed in the primary care office.

Read on for an at-a-glance guide to managing knee pain, and learn how partnering with a pediatric orthopedic specialist can help you help your patients. See how a particularly challenging case led to surgical innovation. …Read More

Food allergies and EpiPens: The latest news and research


Peanut and food allergies can be stressful for parents and patients. The skyrocketing EpiPen price tag has outraged parents and pediatricians, and many families may be unsure about their options. John Lee, MD, clinical director of the Food Allergy Program at Boston Children’s Hospital, shares his insights on the EpiPen price increase and and offers updates on peanut allergy research.

What you need to know about EpiPen now

  • Cost
    • EpiPen recently raised its commercial price to $600 for a standard twin pack. For families with no insurance or high-deductible plans, this can pose some serious challenges. However, the good news is there are a few strategies for lowering the cost.
      • Parents can go to, and download a free, reusable, discount card for up to $300 off a prescription.
      • Mylan, EpiPen’s parent company, has an EpiPen assistance program for families with incomes up to four times above the poverty line.
      • Adrenaclick is an alternatives to EpiPen. Although it has the same epinephrine doses as EpiPen, the mechanism is slightly different. Most school nurses and staff are not trained on Adrenaclick, so it is important to talk to a child’s school nurse before choosing this option.
      • EpiPen has announced it will release a generic model at half the current retail price sometime this fall.
  • New instructions
    I always remind parents to make sure there are unexpired EpiPens with their child’s name at school. Schools typically ask for two injectors that won’t expire during the school year (EpiPens last about one year).
    Parents should also review their child’s Anaphylaxis Action Plan, and be sure to understand the written plan they give to the school.
    • EpiPen recently updated its instructions, because there were numerous reports of kids suffering lacerations in their legs. It’s important for parents to note the changes.
      • Step 1: Stabilize the patient’s leg to minimize movement.
      • Step 2: Hold the EpiPen against the thigh for three seconds.
      • Step 3: Monitor for signs of infection at the injection site.

…Read More

Re-circumcisions on the rise: What pediatric providers need to know

Re-Circumcision notes

It is widely recognized by pediatric urologists that male circumcision reduces the risk of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV.

Although the majority of circumcisions in infants occur without complication, a percentage of children require urology intervention.

In a recent study, Boston Children’s Hospital searched the Pediatric Health Information Systems database and examined re-circumcision trends from 2004 to 2009.

The research shows 119 percent increase in re-circumcision rate and offers the following as potential causes for the uptick:

  • decreased quality of newborn circumcision
  • increases in the total number of circumcisions being performed
  • changing expectations regarding “normal” penile appearance after circumcision.

Notes sat down with Boston Children’s Hospital urologist Erin R. McNamara, MD, MPH, and discussed the complications associated with circumcision, why a revision is necessary and when to refer to a pediatric urologist. …Read More

Ventricular Assist Devices (VADs) in children: It takes a village

A closeup look at a ventricular assist device for children

Children with end-stage heart failure now have more options than ever before. When they have no other medical or surgical options to treat their heart failure,  they may be evaluated for a ventricular assist device, or VAD, that can help support their hearts until heart transplant.

As recently as 15 years ago, these devices were a rarity in pediatric hospitals — and they surely weren’t portable for use outside of the hospital setting! But thanks to new technologies that make living life at home and at school possible for children with VADs, an entire new field of care management is emerging.  The newer VADs are mechanical heart pumps implanted inside the body that are electrically powered, either by batteries or being plugged into the wall. …Read More