Pediatric Prisms - Insights from VA-AAP - 09/30/2024
SEPTEMBER 2024, WEEK BEGINNING SEPTEMBER 30
Dear VA-AAP Members,
I want to take a moment to highli recent signing of the “Bell to Bell” the governor, which prohibits cel use in schools. A special thank y Perriello, for their diligent work phone exemption guidelines. You can find these guidelines in this week’s issue of PRISM.
I also want to express my gratitude to Dr. Lamb for his insightful article on concussion management. As fall sports are in full swing, this information is invaluable for ensuring the safety of our athletes.
I had the pleasure of attending committee meetings this past week, and it was exciting to hear about the passion and dedication everyone has for their projects. It’s inspiring to see that no one is taking a break!
As I write this, I’m on my way to Orlando for this year’s AAP-NCE. It’s always a wonderful opportunity to meet new people, network with colleagues, and reconnect with friends from residency and fellowship. If you’ll be at NCE, I invite you to join us for our Virginia meet and greet on Saturday evening.
Thank you all for your continued support of our children and families. Together, we are making a meaningful impact!
Safe journey to all those travelling this weekend. Be safe!
“Be the change you wish to see in this world.” -Mahatma Gandhi
Natasha K. Sriraman VA-AAP President
Meet Your Executive Committee
NATASHA
K. SRIRAMAN, M.D.
Events
NOV 8 - 9
Mohsen Ziai at INOVA
NOV 14
PERCITA
ELLIS, M.D.
TREASURER
SUZANNE BRIXEY, M.D.
MARCH 21-23, 2025
Birdsong McLemore at UVA
APRIL 24, 2025
Board Meeting (Virtual)
JANUARY 23 , 2025
VA-AAP Advocacy Day
Committees
ADVOCACY
CHILD SAFETY
EARLY CHILDHOOD
FOOD EQUITY
IMMIGRANT HEALTH
IMMUNIZATION
MENTAL HEALTH
PEDIATRIC COUNCIL
SCHOOL HEALTH
Board Meeting (Virtual)
JUNE 12, 2025
Pediatric Sports Medicine
We have a few committees & champions that are looking for Co-chairs. If you are interested in becoming a co-chair, or even a member of any of these committees, please click the Contact Us button below. Contact Us
KRISTINA
JULY 18, 2025
BOD Meeting & Dinner
JULY 18-20, 2025
Pediatrics at the Beach
Champions
ADOLESCENT MEDICINE
BREASTFEEDING
ENVIRONMENTAL
EQUITY, DIVERSITY, & INCLUSION
GUN VIOLENCE
HEALTHY LIFESTYLE
INFECTIOUS DISEASE
ORAL HEALTH
RURAL HEALTH
SPORTS MEDICINE
TELEHEALTH
POWELL, M.D.
Written by: Micah Lamb, DO Pediatric Sports Medicine Physician at CHKD
Fall is here and with it comes a return to school and a return to sports. This brings an increase in sports injury visits to pediatric outpatient offices. While many of these can be relatively quickly managed or triaged, one of the more time-consuming and potentially frustrating things to see is concussions. Often times these injuries come with an increased level of patient and parent anxiety requiring pediatricians to be up to date on management and have some readily available resources to help answer parent questions.
One area of concussion care that can often be overlooked by pediatricians or difficult to explain to parents is the eye-tracking and balance related issues that we often see. In my office, I typically like to highlight how coordinated eye movements have to be for effective binocular vision. These movements are directed by the brain and so fine-tuned that, if the brain can’t do them effectively, kids will get vision issues.
What I find interesting about concussion related vision issues is the opportunity that they present to change patient management. There is so much “visual load” on children and adolescents these days, that by picking up those with vision issues appropriate support can be provided. Even with a relatively basic understanding of the different ways the eyes track and focus, pediatricians can then provide tailored academic accommodations that truly support an individual’s particular symptoms.
This is also one of the few areas of concussion care where a provider can actively treat concussion symptoms as opposed to largely providing support. Through identifying potential concussion vision issues and prescribing vestibulo-ocular Physical Therapy, when appropriate, the vision issues can often improve more readily and many other concussion symptoms will follow suit.
I strongly recommend providers who typically manage concussions in the office use the resources on HealthyChildren.org. There you can find handouts for parents both on the basics of managing concussion (Healthy Children Concussions: What Parents Need to Know) and eye tracking issues in the setting of concussion (Healthy Children Concussion & Vision Problems).
This
LINK/LOCATION:
Each session will have a unique Zoom link sent upon registration. Registration is required to attend, and all sessions will be virtual only.
Please print this flyer out and share with patients.
in Providing Pediatric Mental Health Care
Bi-monthly virtual webinars on critical topics in pediatric mental health. Attend as many as desired and earn up to 1 CME credit per webinar.
Held on 1st & 3rd Wednesdays from Feb - Oct @ 7 PM on Zoom
Are you a Virginia PCP looking to gain professional education in pediatric mental health? Join us for a REACH PPP!
What to Expect with REACH PPP
A dynamic 3-day, 16-hour in-person interactive course focused on building skills and confidence in diagnosing and treating pediatric mental & behavioral health problems led by Virginia faculty.
Followed by a 6-month, case-based online program. Participants join 12 bi-monthly, 1-hour group conference calls with Virginia primary care and child psychiatry experts to learn how to manage pediatric mental health issues encountered in daily practices.. All participants will receive custom-designed toolkits with guides, assessment instruments, dosing and side effect charts, medication comparison tables, and handouts for patients and parents.
Course Goals
Participants will learn to:
Correctlyidentifyanddifferentiateamongpediatric behavioral health problems such as childhood depression,ADHD,bipolardisorder,anxietystates (includingPTSD),oppositionalandconductdisorders, andpsychosis.
Effectively manage psychopharmacology: selecting medications, initiating and tapering dosages, monitoring improvements, and identifying and minimizingmedicationsideeffects.
Createandimplementatreatmentplanbymobilizing existing resources like family members, school personnel,andotherprofessionalcaregivers.
Register for PEACE
Perinatal Education for Advanced Clinical Expertise (PEACE) is a 2-day comprehensive perinatal mental health education program for maternal health specialists, midwives, and PCPs developed by leading experts in the field. VMAP is presenting this training in partnership with Postpartum Support Virginia.
Scan the QR code on the left to register!
WHEN: WHERE:
Springhill Suites 301 Reserve Ave, SW, Roanoke, VA 24015
Perinatal Mental Health CME Training Identify Consider Manage Create Adopt
Course Objectives:
October 25th - 26th, 2024 8:30 - 4:30pm
COST:
$100
Lodging Provided
perinatal mental health disorders the impact of additional diagnoses psychopharmacology and implement a treatment plan trauma-informed practices
Consensus Statement: Cell Phone Exemptions for Children RESOURCES & REQUESTS
As Virginia schools work to implement a cell phone-free environment, families may have questions for their healthcare providers about medical conditions that make carrying a cell phone necessary for students during school hours.
The following guidance regarding medical exemptions for cell phones in schools does not replace conversations between families and healthcare providers about the risks and benefits of individual children carrying a cell phone.
Gastrointestinal
General Cell Phone Guidance
The medical conditions that may make requiring a cell phone for children in schools are very rare Healthcare providers should provide written recommendations for cell phone use, or other approved technology, to manage medical conditions during school hours
Ear, Nose, and Throat
Students with cochlear implants, bone conduction devices, and hearing aids use cell phone apps to adjust the devices, which qualify them for a medical exemption Specialists may also provide written exemptions for students with tinnitus, who may use cellphones for white noise generation
Endocrinology
Students with diabetes who utilize continuous glucose monitoring technology require access to their cell phones during the school day. Specialists should provide recommendations in the student’s Diabetes Medical Management Plan for cell phone use in schools.
Cardiology
Occasionally children utilize looping vent monitors, where a non-personal cell phone is used to send transmission. This requires a student to have this phone in their backpack near them This device cannot make calls or access the internet but would need to be recognized by the school as an allowed device.
Occasionally children may undergo testing that includes video capsule endoscopy or pH-impedance studies, and students will be given a recording device that is independent of a cell phone.
Genetics
Children with metabolic conditions do not routinely need to access their phones as medical needs are typically managed with written communications to a school nurse. Rarely, glucose monitoring may be required for students with rare genetic hypoglycemic disorders.
Palliative Care and Pain
Children should not require their phones during the day if they have access to a school nurse
Physical Medicine and Rehabilitation
Rarely, children may be monitored with smartwatches or wearable heart rate trackers (e g FitBit) if they have autonomic dysregulation Typically, the phone does not have to be in proximity and the data can be synced later in the day
Pulmonology
Rarely, children may be monitored for pulmonary function or oxygen saturations using a smart phone app, but most children will be able to go to the school nurse
Neurology
Children with epilepsy or seizures, migraines, or other neurological conditions do not require a cell phone in class. If a family is concerned about tracking events, this can be done on paper or through a school nurse
Nephrology
Children on dialysis may require access to their phones to access a ride (taxi services).
Urology
Older children who use catheters may require “timers” to keep to their catheterization or voiding schedule This is often done with a watch with a timer or smart watch; cell phones may not be required.
Anxiety, Depression, and Other Mental Health Conditions
Anxiety, depression, and other mental health conditions do not require a student to keep a cell phone in the classroom
Children and teens are better positioned to learn other coping skills when they do not have access to a cell phone at school and are receiving appropriate medical care Parents can support students with anxiety and other mental health conditions by connecting them with licensed therapists and medical providers In rare instances, a licensed psychologist or psychiatrist may provide written documentation and work with a school on a 504 plan (e.g. using an app to help with relaxation); however, efforts should be made so that cell phones are accessed only in a setting outside the classroom (e.g. nurses’ office) to avoid disruption to classroom learning.
Consensus Statement: Cell Phone Exemptions for Children
The following pediatric specialties have no associated conditions that make carrying a cell phone necessary at school:
• Allergy, Asthma, & Immunology
• Dermatology
• Gynecology
• Hematology & Oncology
• Orthopedics
• Rheumatology
• Sports Medicine
• Surgery
Based on these guidelines, medical reasons to allow cell phone use in schools should be very rare. This consensus statement does not recommend or support non-medical exemptions.
Obtaining a medical exemption for cell phone use. Specialists will continue to support schools and families with written documentation for individual students on a rare, as-needed basis, should the use of a cell phone be considered medically necessary. These determinations will be noted in each patient’s medical record and shared in writing with schools to support the school’s efforts on a student’s Individualized Healthcare Plan (IHP), Individualized Education Plan (IEP), or 504 Plan.
Sample Exemption Letter*
Date:
Name:
DOB:
To Whom It May Concern,
*Courtesy of Children’s Specialty Group, Pediatric Endocrinology, Norfolk VA
[Patient Name] is followed in my pediatric endocrinology practice due to their diagnosis of type 1 diabetes Diabetes affects the endocrine system, which is a “major bodily function” impacting major life activities In addition to endocrine function, caring for oneself, performing manual tasks, walking, seeing, speaking, learning, concentrating, thinking, and communicating are examples of the major activities affected by diabetes Based on these criteria, diabetes is a disability under the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1973
Diabetes treatment is individualized based on a multitude of factors. [Patient Name] manages their diabetes with a continuous glucose monitoring (CGM) device (i.e. Freestyle Libre or DexCom) that may or may not be paired with a hybrid closed-loop insulin pump and CGM receiver Use of CGM technology requires the student be allowed to have their cell phone and/or CGM receiver during school hours Close monitoring and treatment of high and low blood glucose and insulin doses are paramount to maintaining optimal glycemic control to reduce complications and enabling [Patient Name] to be well-positioned for optimal learning and academic success If prompt treatment of blood glucose does not occur, [Patient Name] could experience life-threatening complications such as seizures, unconsciousness, or severe lethargy for low blood glucose, or diabetic ketoacidosis for prolonged high blood glucose As such, below is a list of diabetes accommodations [Patient Name] requires in order to remain safe and healthy while in school:
[Patient Name] should be permitted to keep their cell phone and/or CGM receiver during school hours (on silent). The phone and/or CGM receiver must remain within twenty feet of them at all times to allow for continuous data transmission of blood glucose to their parent and/or their insulin pump It also allows for [Patient Name] and other school staff to see blood glucose levels in real time
[Patient Name] should be allowed access to their cell phone and/or CGM receiver to check blood glucose and to administer insulin as needed to maintain glycemic control
[Patient Name] should be allowed access to a glucometer and blood glucose monitoring supplies at all times to manually check blood glucose if the CGM is malfunctioning, or if they need to confirm a blood glucose
I appreciate your attention to this matter Please contact our office at [Phone Number] for additional questions or concerns
Sincerely, [Name]
RESOURCES & REQUESTS
FOLLOWING IS AN ABSTRACT OF HER CONTRIBUTION “PEDIATRICIANS’ PERSPECTIVE”
Theriseofmentalhealthdisordersinyoungpeoplehaspresentedatremendouschallenge,exacerbatedbythedeficitin trained mental health professionals. Pediatricians are positioned to help fill this gap by virtue of their long-standing relationships, understanding of a family’s social context and highly valued perspective. As pediatricians assume greater responsibilityformentalhealthcareinyoungpeople,thereisaneedtoincorporateclimatechangeasarisingrisk.
To address this need, pediatricians can serve in several roles. As clinicians, pediatricians meet the needs of patients sufferingfromclimate-relatedphysicalandmentalhealthharms.Aseducators,pediatriciansadvanceunderstandingof theintersectionsbetweenclimatechangeandhealth.Pediatriciansarealsouniquelypositionedtoadvocateforclimate changesolutions,promotinghopeintheprocess Thischapterdiscussesclimatechange-relatedmentalhealthconcerns inaprimarycaresettingandhowpediatriciansareworkingtoadvancesolutionsacrossthenation
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RESOURCES & REQUESTS
“DID YOU KNOW THE VA-AAP IS YOUR VOICE TO LAWMAKERS IN VIRGINIA?”
WE HAVE FOUGHT AGAINST BILLS THAT WOULD INCREASE YOUR:
Medical malpractice insurance rates
Loosen requirements for vaccines
Threaten the quality of medical care children receive in Virginia
WE HAVE ADVOCATED FOR BILLS THAT INCREASE ACCESS TO:
Mental health services for children
Protect children from the harmful effects of tobacco products
Increase Medicaid reimbursement for clinicians
WE USE YOUR CONTRIBUTIONS IN A NONPARTISAN FASHION TO GET TO THE TABLE WITH LAWMAKERS WHO HAVE CRUCIAL ROLES IN LEGISLATION THAT IMPACTS YOU & YOUR PATIENTS.
D TO OUR FELLOW PHYSICIAN GROUPS, PEDIATRICIANS CURRENTLY HAVE THE LEAST AMOUNT OF MONEY IN OUR KIDSPAC-WE CAN DO BETTER!! LET'S DO THIS!!
YOUR VOTE IS
TU VOTO TIENE PODER
Podermos influir directamente en estas politicas y ayudar a dar forma a la salud de nuestra comunidad para las generaciones venideras.
LATA DE VOTACION:
Los funcionarios que votamos para el cargo toman decisiones importantes como Cuánto cuestan los medicamentos recetados
Si tenemos acceso a frutas y verduras frescas...y más.
Voting is one of the most powerful ways to influence change at the local, state and national levels. There is a connection between voting and health equity.
Election Day is Tuesday, November 5
Candidates elected to positions up and down the ballot will shape policies that directly impact the health of young people, families and communities.
AAP is leading a nonpartisan Get Out the Vote campaign to provide pediatricians with the tools they need to cast their ballot and share the importance of voting.
To access these resources, please click here or scan the QR Code
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Thousands of health professionals across the country are using Vot-ER badges to give their patients an opportunity to access a nonpartisan voter registration platform in the hospital or clinic.
Get a free voter registration badge today and join the movement for a healthier democracy!
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Children are counting on us; vote like their future depends on it.
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Registration Deadlines
On-line registration or mail in registration is October 14, 2024. Or, register in person on election day at your designated polling place with proper ID.
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IN VIRGINIA Vote Early starting September 20, 2024
Apply for early absentee ballot online, by mail, or in person from September 20 - October 25
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