When a previously healthy-weight child comes in with a high body mass index (BMI) — especially above the 85 percentile — the ensuing discussion can be one of the most delicate conversations we have with our families. We need to open a dialog in a way that won’t alienate the parent or child so they will feel comfortable returning for this problem.
If this is the first conversation about a BMI problem, my main goal is to identify why the child’s weight has increased (Change in diet? Change in exercise?) and suggest changes in ways that encourage the patient to return in a month. I try to balance the conversation with information, understanding and hope, pointing out that making some changes over the next month may make a difference.
But how do you find an opening to get the conversation started? …Read More
Much of pediatric care focuses on prevention. Pediatricians generally understand how to prevent communicable diseases (by vaccinating) and injuries (periodic guidance around safety). But current pediatric practice also demands prevention of more chronic diseases. Some, like asthma, have good prevention guidelines. But one chronic disease that seems hard to prevent is obesity.
Childhood obesity is a multi-factorial disease that is poorly understood and has different etiologies in different children. Seen through another lens, however, obesity prevention is a matter of understanding how a person takes in energy (eats) and uses up energy (exercise and activity) and running a household that promotes healthy “energy” habits. Obviously, if that were easy to do, we would all do it. So, as pediatricians we must strive to help families create homes that promote healthy eating and exercise.
But, how can a pediatrician help a parent prevent childhood obesity? I have struggled with this question for many years and my solutions are a work in progress. However you go about it, it’s important to set all families up for success by promoting weight-healthy behaviors from the very beginning. Here are some of the approaches I have come upon as this health crisis has become more and more widespread. …Read More
As every general pediatrician, family practitioner and nurse practitioner knows, the pediatric well visit is a rich, full 15-20 minute encounter. It is during this time that we hope to address all aspects of a child’s health and well being, with the ultimate goal of being able to “launch” that child into adulthood as physically, cognitively and emotionally healthy as possible. A few years ago, I realized I wasn’t just taking care of the child in front of me; I was also trying to care for the 25-year-old adult that child will become. No small task!
Pediatric constipation results in 2.5 million health care provider visits every year. Nearly 625,000 of these visits are funneled to pediatric gastroenterology specialists, costing, by some estimates, nearly $3.9 billion per year in the United States.
According to members of Boston Children’s Hospital’s Division of Gastroenterology, Hepatology and Nutrition, constipation is one of the most common diagnoses for which children are referred to pediatric GI across the United States. This large volume of referrals presented an opportunity to improve care outcomes by supporting decision- making in the primary care setting.
In an effort to address these challenges, the division joined with the hospital’s Integrated Care Program and the Pediatric Physician’s Organization at Children’s (PPOC) to launch a shared care/quality improvement initiative. This initiative armed primary care providers (PCPs) with education, decision-support tools, pre-referral diagnosis and management advice about treating children with constipation. The primary goal of the study was to investigate whether a “shared care” model might reduce unnecessary referrals and improve adherence to established clinical guidelines.
Notes sat down with Richard Antonelli, MD—Boston Children’s medical director of integrated care and one of the initiative’s leaders—to discuss the initiative, its results (recently reported in Pediatrics) and what he and his colleagues learned about how PCPs and GI specialists can work together to improve the management of constipation. …Read More