Focus on Children's Health

Host: Alka Goyal, MD Higher Postinduction Infliximab Serum Trough Levels Are Associated With Healing of Fistulizing Perianal Crohn’s Disease in Children. Wael El-Matary, MD, MSc Thomas D Walters, MD Hien Q Huynh, MDJennifer deBruyn, MD David R Mack, MD Kevan Jacobson, MD Mary E Sherlock, MDPeter Church, MD Eytan Wine, MD, PhD Matthew W Carroll, MD, Eric I Benchimol, MD, PhD Sally Lawrence, MD Anne M Griffiths, MD Background: There is some evidence in adults that higher serum infliximab (IFX) levels are needed to adequately treat fistulizing perianal Crohn's disease (CD). However, data in children are lacking. We aimed to determine postinduction serum trough IFX levels that are associated with healing of fistulizing perianal CD (PCD) at week 24. Methods: In a multicenter inception cohort study, consecutive children younger than age 17 years with fistulizing perianal CD treated with IFX between April 2014 and June 2017 who had serum trough IFX titers measured before the fourth infusion were included. Area under the receiver operating characteristic curve (AUROC) was calculated to determine the best cutoff to predict fistula ...

Host: Brian P. McDonough, MD, FAAFP Guest: Teresa Gil, PhD Since about 21 million mothers in America experienced sexual abuse in their childhood, there’s a good chance that some of these women are our patients. So as their physicians, how can we provide them with the best possible care as they continue to cope with the lifelong effects of sexual abuse? That’s what Dr. Brian McDonough explores with Dr. Teresa Gil, author of Women Who Were Sexually Abused as Children: Mothering, Resilience, and Protecting the Next Generation.

Guest: Masae Kawamura, MD Tuberculosis (TB) takes a life every 18 seconds…but you can play a part in putting a stop to the spread of this infectious disease by adopting screening best practices. Here to run down who and how you should screen for TB is Dr. Masae Kawamura, Qiagen’s Senior Director of Scientific and Medical Affairs.

Host: John J. Russell, MD Guest: Lee Reichman, MD, MPH To help us understand how primary care physicians can lead the way in proactively identifying and treating patients at high risk for TB, we caught up with Dr. Lee Reichman, Founding Executive Director of the Rutgers Global Tuberculosis Institute and Professor of Medicine and Epidemiology at Rutgers New Jersey Medical School.

Guest: Scott Lindquist, MD, MPH Primary care physicians play a critical role in eliminating TB, which is why they need to know who they should screen for TB and how. Join Dr. Scott Lindquist, state epidemiologist for communicable diseases and Deputy Health Officer for Washington State, as he explains the importance of risk-based TB screening and the testing methods that are appropriate for these patients.

Host: Paul Rokuskie Guest: David S. Mandell, ScD As prevalence rates for autism spectrum disorder (ASD) increase, so do economic costs. On average, medical expenditures for individuals with an ASD were 4 to 6 times greater than those without an ASD. Join Paul Rokuskie and his guest Dr. David Mandell, Associate Director of the Center for Autism Research at the Children’s Hospital of Philadelphia, as they dive into the economic impact of ASD.

Host: Paul Rokuskie Did you know that in just 10 years, the national prevalence rate for autism spectrum disorder (ASD) has nearly tripled, going from 1 in 166 to 1 in 59? Or that 2 percent of the US population under the age of 18 now carries a diagnosis of ASD? Join Paul Rokuskie as he speaks with Dr. Stuart Shapira, Associate Director for Science at CDC’s National Center on Birth Defects and Developmental Disabilities, about these and other findings from the 2018 study regarding prevalence rates for ASD.

Host: Paul Rokuskie As diagnostic information becomes more readily available, the importance of early diagnosis cannot be underestimated when it comes to helping those with autism spectrum disorder (ASD) and their families. Join Paul Rokuskie and his guest Dr. Stuart Shapira, Associate Director for Science at CDC’s National Center on Birth Defects and Developmental Disabilities, as they discuss the diagnosis criteria for ASD.

Host: Jennifer Caudle, DO Guest: Sarah E. Domoff, PhD To address the growing issue of prolonged screen time and media use among children, Dr. Jennifer Caudle speaks with Dr. Sarah Domoff, Director of the Family Health Lab at Central Michigan University, about the tools available to help physicians identify and curb screen addiction.

Host: Brian P. McDonough, MD, FAAFP Guest: Tanya Altmann, MD To investigate the concerning rise in both asthma and allergies in children, Dr. Brian McDonough is joined by Dr. Tanya Altmann, pediatrician and Editor in Chief of the American Academy of Pediatrics parenting books, to discuss why a missing component of the gut microbiome may be the potential cause and how nutrition and probiotics play a vital role in a child's growth and development.

Host: Jennifer Caudle, DO Guest: Jean Bennett, MD, PhD Guest: Albert Maguire, MD Power couple Drs. Jean Bennett and Albert Maguire discuss how their new therapy for the RPE65 gene, which causes retinal blindness, was recently approved by the FDA to become the first gene therapy treatment for a genetic disease in the United States and the first worldwide treatment for inherited blindness. Not only do they delve into the mechanics of the corrected gene injection, but they also explain what this milestone means for patient eligibility and how their marriage has played a role in the success of their research partnership. Dr. Jean Bennett is the F.M. Kirby Professor of Ophthalmology at the Perelman School of Medicine at the University of Pennsylvania, and Dr. Albert Maguire is a Professor of Ophthalmology at the Hospital of the University of Pennsylvania and Attending Physician in the Division of Pediatric Ophthalmology at Children’s Hospital of Philadelphia.

Host: Philip Stein, MD Guest: Neilanjan Nandi Guest: Susan Peck, MSN, CRNP From the ReachMD studios in Fort Washington, Pennsylvania, host Dr. Philip Stein talks with Dr. Neilanjan Nandi and nurse practitioner Susan Peck about their respective experiences with The Crohn’s & Colitis Foundation's Camp Oasis. This camp gives children with IBD the opportunity to meet other kids with the same chronic illness, teaching them how to cope with their disease, manage their own medical needs, try new sports and activities, build confidence and independence, and most importantly, spend quality time just being a kid.

Host: John J. Russell, MD Guest: Thomas Doyle, MD About 40,000 babies are born with Congenital Heart Disease each year, making it one of the most common birth defects and causes of infant death in the US. CHD is usually present at birth but shows very few outward signs and, in most cases has no known cause or origin. New and evolving surgical techniques, along with the dawn of pediatric heart transplant, are transforming the field of pediatric cardiology and offer new options for CHD patients. Host Dr. John Russell talks with Dr. Thomas Doyle about how continued research, improved surgical treatments and, emerging technology have altered the course of treatment for CHD, resulting in approximately 69% of children with CHD now living to age 18. Dr. Thomas Doyle is the Ann and Monroe Carell Jr. Family Associate Professor of Pediatrics at Vanderbilt University. Dr. Doyle was a 2016 Project Heart CHD research grant recipient.

Host: Paul Rokuskie Scientists have been doing research into many areas of autism spectrum disorder in the hopes of explaining the doubling of its prevalence rate over the past decade. Both environmental risk factors and genetic components are areas of intense scrutiny for researchers seeking to understand the root causes of autism. Host Paul Rokuskie talks with Craig Newschaffer, Professor, Associate Dean for Research, and Director of the A.J. Drexel Autism Institute, about the risk factors for autism spectrum disorder that scientists are working to better define.

Host: John J. Russell, MD Do pets help prevent allergies? Does the 5-second rule actually exist? And is dirt really good for a child’s immune system? Host Dr. John Russell talks with Jack Gilbert, Ph.D., Professor of Surgery at the University of Chicago and Director of the Microbiome Institute. Dr. Gilbert is author of the book Dirt is Good, answering questions about the potential benefits of exposure to germs and bacteria. He and Dr. Russell sift through common misconceptions about microbiomes to better understand their actual risks and benefits for the body's immune system, explaining its role in disease and health.

Host: Shira Johnson, MD Guest: Robert Vonderheide, MD For years, the foundations of cancer treatment, surgery, chemotherapy, and radiation therapy were utilized with the objective of weakening cancer. But over the past several years, immunotherapy – therapies that enlist and strengthen the power of a patient’s immune system to attack tumors - has emerged as a new tool for fighting cancer. In August 2017, one such treatment approach, called Chimeric Antigen Receptor or CAR T-cell Therapy, received FDA approval for the treatment of children and young adults with acute lymphoblastic leukemia (ALL). Additionally, research is continuing to look at CAR-T therapy’s effectiveness for treating solid tumors as well. Host Dr. Shira Johnson sits down with Dr. Robert Vonderheide, Director of the Abramson Cancer Center of the University of Pennsylvania and the John H. Glick, MD, Abramson Cancer Center Director’s Professor, to talk about the potential of CAR-T therapy alongside other emerging immunotherapies in fighting cancer.

Host: Paul Rokuskie Over the past two decades, the world has seen a dramatic rise of individuals being diagnosed with autism spectrum disorder. For decades scientists and medical professionals have been researching various aspects of this disease to uncover genetic and environmental factors explaining this rapid increase in prevalence; however, discovering definitive clues to causality has proven elusive. Host Paul Rokuskie talks with Dr. Craig Newschaffer, Professor, Associate Dean for Research, and Director of the A.J. Drexel Autism Institute about the latest research findings into environmental factors affecting autism risk.

Host: Maurice Pickard, MD Guest: Bonnie Rochman With the ever-expanding array of prenatal and postnatal tests, from carrier screening to genome sequencing, parents’ access to this previously unknown information is altering perceptions of disability, redefining the question of what sort of life is worth living, and who draws the line. Is this technology a triumph of modern medicine or a Pandora’s box of possibilities? Host Dr. Maurice Pickard chats with Bonnie Rochman, author of the book The Gene Machine: How Genetic Technologies are Changing the Way We Have Kids - and the Kids We Have, about the new frontier of gene technology and how it is transforming medicine, bioethics, health care, and the factors that shape a family.

Host: Paul Rokuskie Researchers have been challenged for years by the simultaneous results of numerous studies into brain network connections in individuals with Autism Spectrum Disorder. Some results show strong connections, while others suggest the opposite. New research has helped bring some clarity to this ongoing paradox. Host Paul Rokuskie is joined by Dr. Benjamin Yerys, a child psychologist in the Center for Autism Research (CAR) at the Children’s Hospital of Philadelphia. They talk about how it’s possible to see conflicting results and, paradoxically, for both to be true.

Host: Paul Rokuskie Autism Spectrum Disorder affects communication skills as well as emotional & social development. Researchers have been studying the brain for decades to better understand how these developmental differences manifest as autism. Recent studies that measure rapid eye movement (REM) have been showing great promise in elucidating the origins and mechanisms of disease. Host Paul Rokusie sits down with Dr. John Foxe to talk about his study on rapid eye movement, its implications on disease pathogenesis, and new insights it can bring to future autism research.

Anti-TNFα Treatment After Surgical Resection for Crohn's Disease Is Effective Despite Previous Pharmacodynamic Failure Assa A1, Bronsky J, Kolho KL, Zarubova K, de Meij T, Ledder O, Sladek M, van Biervliet S, Strisciuglio C, Shamir R. BACKGROUND: The outcome of patients with Crohn's disease who failed anti-tumor necrosis factor alpha (anti-TNFα) therapy despite adequate serum drug levels (pharmacodynamic failure) is unclear. We aimed to assess such pediatric patients who underwent intestinal resection and were re-treated with the same anti-TNFα agent postoperatively. METHODS: Pediatric patients with Crohn's disease who underwent intestinal resection and were treated with anti-TNFα agents postoperatively were assessed retrospectively. Patients were stratified to those with preoperative anti-TNFα pharmacodynamic failure and those with no preoperative anti-TNFα treatment. RESULTS: A total of 53 children were included, 18 with pharmacodynamic failure and 35 controls. Median age at intestinal resection was 14.8 years with 23 (43%) girls. The median time from intestinal resection to anti-TNFα initiation was 8 months (interquartile range 4-14 months). At the time of postoperative anti-TNFα initiation, there were no differences in clinical, laboratory, and anthropometric measures between groups. Similar proportions of patients from both groups were in clinical remission on anti-TNFα treatment after 12 months and at the ...

Host: Brian P. McDonough, MD, FAAFP Could constant cell phone use be damaging children's brains? Host Dr. Brian McDonough chats with Daniel Debaun, author of Radiation Nation: The Fallout of Modern Technology," about how electromagnetic frequency (EMF) radiation produced by modern technology such as cell phones, tablets, laptops, Wi-Fi, and smart meters may be emerging as a health threat with many unknown consequences.

Host: Adam Ehrlich, MD, MPH Guest: Philip Stein, MD The majority of adolescents with inflammatory bowel disease (IBD) will transition from a pediatric to an adult specialist. This process can be daunting, especially if patients are not ready to take control of their health care. However, with the right communication and preparation, the transition can be smooth for the patient, parent, and physician. Host Dr. Adam Ehrlich joins Dr. Philip Stein, a pediatric gastroenterologist at St. Christopher’s Hospital for Children, to discuss how physicians can best prepare patients to transition and overcome potential difficulties.

Host: Brian P. McDonough, MD, FAAFP Guest: Howard Spiva Wearing a helmet is an overlooked but critical safety precaution, particularly among children. Attorney Howard Spiva knows the lifelong struggle of individuals recovering from traumatic brain injuries, having devoting much of his career to providing helmet safety education for children. Joined by host Brian McDonough, Mr. Spiva discusses important details about helmet safety, the current status of helmet laws, and continuing efforts to reduce traumatic brain injuries nationwide.

Host: Maurice Pickard, MD Guest: Elijah Nealy, PhD These days, it is practically impossible not to hear about some aspect of transgender life, and kids are coming out as trans at younger and younger ages. But what resources are available to parents, teachers, and mental health professionals who need to support these children? Host Dr. Maurice Pickard chats with Elijah C. Nealy, therapist and former deputy executive director of New York City’s LGBT Community Center. Mr. Nealy is the author of Transgender Children and Youth: Cultivating Pride and Joy with Families in Transition, which provides insights about the physical, social, and emotional aspects of transition and the best practices to support trans kids.

Vedolizumab as Induction and Maintenance Therapy for Crohn's Disease in Patients Naïve to or Who Have Failed Tumor Necrosis Factor Antagonist Therapy. Sands BE1, Sandborn WJ, Van Assche G, Lukas M, Xu J, James A, Abhyankar B, Lasch K. BACKGROUND: Vedolizumab is a gut-selective α4β7 integrin antagonist for the treatment of moderately to severely active Crohn's disease (CD). Aims of this study were to characterize the efficacy and safety of vedolizumab induction and maintenance therapy in patients who were naïve to tumor necrosis factor-alpha (TNF-α) antagonist therapy (TNF-naïve) or who had discontinued TNF-α antagonist therapy because of inadequate response (i.e., primary nonresponse), loss of response, or intolerance (collectively classified as the TNF-failure population). METHODS: Post hoc analyses of the efficacy data for 516 TNF-naïve and 960 TNF-failure patients from the GEMINI 2 and GEMINI 3 trials were evaluated at weeks 6, 10, and 52 and included clinical remission (CD Activity Index [CDAI] score ≤150), enhanced clinical response (≥100-point decrease from baseline in CDAI score), durable clinical remission (remission at ≥80% of visits), and corticosteroid-free remission. Adverse events were summarized for the TNF-naïve and TNF-failure subgroups by treatment received. RESULTS: Among patients who responded to vedolizumab induction at week 6, 48.9% ...

Guest: KT Park, MD Recorded on location at the Crohn’s & Colitis Foundation's Annual Meeting in Orlando, host Dr. Sophie Balzora, Crohn's & Colitis Foundation Reach-IBD member and faculty advisor of the Greater New York Chapter Fellows' Education Committee, discusses general strategies for clinicians and families to optimize growth in pediatric IBD with Dr. K.T. Park, Assistant Professor of Pediatric Gastroenterology at Stanford University School of Medicine & Co-Director of Stanford Children’s Inflammatory Bowel Disease Center.

Host: Prathima Setty, MD A couple of extra minutes attached to the umbilical cord at birth may translate into a significant boost in neurodevelopment several years later, research suggests. Dr. Prathima Setty is joined by Dr. Kecia Gaither, a perinatal consultant at St. Lukes Hospital in Kansas City, MO as they talk about how delaying cutting the umbilical cord can be beneficial.

Host: Jennifer Caudle, DO Sleep apnea in children can lead to many behavioral, school and social problems. Recent research has even suggested that children who snore loudly were found to be twice as likely to have learning problems as children who don’t snore. What can be done to minimize sleep apnea in children? On this episode of Everyday Family Medicine, Dr. Jennifer Caudle speaks with Dr. Diana Batoon, dentist and founder of Bonita Dental in Scottsdale, Arizona. Dr. Batoon has devoted much of her dental practice and public education efforts around identifying and treating sleep apnea in children.

Host: David Weisman, MD Dr. David Weisman explores a study from Wake Forest School of Medicine that examined the effects of concussions for youth football participants.

Host: Paul Rokuskie As medical professionals gain better understandings of the etiologies, mechanisms, and progressions of autism spectrum disorder, they are looking for ways to standardize this diagnosis. This creates new needs to change the way autism is conceptualized clinically, from severity scales to behavioral impacts on quality of life. Host Paul Rokuskie welcomes Dr. Sven Bolte, Professor of Child and Adolescent Psychiatric Science and Director of the Center of Neurodevelopmental Disorders at Karolinska Institute in Stockholm, Sweden. The two discuss the complex process for building new diagnostic criteria for autism spectrum disorder.

Host: Brian P. McDonough, MD, FAAFP Holidays, life events, and even seasonal changes in general can cause an extraordinary amount of stress for young children. Host Dr. Brian McDonough chats with Christine Bronstein, entrepreneur and author of the children’s series Stewie Boom!, about different methods gleaned from pediatricians and other parents to help children cope with stress.

Host: Paul Rokuskie New research is vital toward better understanding the complexities of autism spectrum disorder. Joining host Paul Rokuskie to discuss the latest research projects striving to identify the underlying causes as well as effective treatments for autism is Dr. Robert Schultz, Director of the Center for Autism Research at Children’s Hospital of Philadelphia.

Host: Jennifer Caudle, DO Parents today are bombarded with confusing and sometimes harmful information in regard to which foods are best to give their kids. Nutritional guidelines are constantly changing and parents don’t know who to trust for medically sound and proven advice that works. Host Dr. Jennifer Caudle sits down with Dr. Tanya Altmann, pediatrician, founder of Calabasas Pediatrics, and author of the book, What to Feed Your Baby: A Pediatrician’s Guide to the 11 Essential Foods to Guarantee Veggie-Loving, No Fuss, Healthy Eating Kids. The two talk about the importance of introducing children to healthy eating habits from an early age to ensure a good eating adult lifestyle.

Host: Patrice L Basanta-Henry, MD, MHSc, FACOG Approximately just 0.5% of all births occur before the third trimester of pregnancy, yet these very early deliveries result in the majority of neonatal deaths and more than 40% of infant deaths. Care for infants born at the threshold of viability, less than 24 weeks of gestation and with body weights less than 1000 grams, poses many difficult clinical, social, and ethical questions among clinicians and families. Host Dr. Patrice Basanta-Henry speaks with guest Dr. Fyama Wenner, a maternal-fetal medicine specialist at Atlanta Maternal Fetal Medicine, about special care considerations for extremely preterm infants, as well as effective counseling strategies for families.

Host: Maurice Pickard, MD STDs are widespread in all walks of life, regardless of gender, race, social status, or education. Seduced into complacency by the notion that "it can't happen to me" many sexually active teens and young adults are stunned when they are diagnosed with an STD. In Seductive Delusions: How Everyday People Catch STDs, author and physician Dr. Jill Grimes reveals the truths about sexually transmitted diseases through narrated accounts of young men and women, their exam room conversations with doctors, and both the physical symptoms and the emotional reactions that can accompany infection.

[Read the Article] Since the legalization of marijuana in Colorado, there has been an increase in hospital visits and calls to regional poison centers due to unintentional marijuana exposure among young children. Researchers from the University of Colorado evaluated the number of children with exposures before and after recreational marijuana was legalized. Between 2009 and 2015 they found a rise in the annual number of unintentional pediatric exposures. On average, these children were about two years old. Most children ingested the drug in edible forms such as candies and baked goods. Almost half of the patients seen in the children's hospital in the 2 years after legalization had exposures from recreational marijuana, suggesting that legalization did affect the incidence of exposures. [Watch more videos of The JAMA Report]

[Read the Article] A new study suggests that teens undergoing bariatric surgery can experience benefits in terms of walking speed and joint pain. Researchers from the University of Minnesota School of Medicine are tracking long-term outcomes for 242 teens that underwent bariatric surgery at five centers around the United States. For the current study, researchers specifically focused on improvements in mobility and pain related to muscles and joints is a subset of 206 patients. All patients participated in a quarter mile walk test before and after surgery at six months, twelve months and twenty-four months. Improvements in time to complete the walk, resting heart rate and heart rate differences continued at one and two years after surgery. [Watch more videos of The JAMA Report]

Host: Alan S. Brown, MD, FNLA Like in the United States, Canadian citizens contend with a high pediatric prevelance of lipid disorders, particularly familial hypercholesterolemia. However, perspectives on clinical care and standards public health priorities to address dyslipidemia differ markedly between these two countries. Can American practitioners and health policy experts alike benefit from Canadian approaches to lipidology? Dr. Alan Brown welcomes Dr. Julie St. Pierre, Professor of Pediatrics at Sherbrooke University in Canada, to discuss pediatric lipid disorder management across North American borders.

Host: Brian P. McDonough, MD, FAAFP Joe Klest, Chicago attorney and author of The Whole Truth. Mr. Klest has represented victims in over 500 sexual abuse cases. He and Dr. McDonough discuss clinical recognition methods and action plans for child abuse, legal contexts for reporting, and the need for increased awareness by clinicians in primary care settings.

[Read the Article] Approximately one-third of children who experience a concussion will experience persistent post-concussion symptoms. Researchers have developed a new clinical scoring system that may help predict which patients are at a higher risk for prolonged symptoms.Canadian researchers evaluated more than 3,000 patients, ages 5 to 18, who presented within 48 hours of an acute head injury. About thirty percent ended up with persistent post-concussion symptoms at 28 days. Researchers identified nine clinical factors that were predictive of post-concussive symptoms. These factors were then used in a twelve point risk score that included items like age, sex, history of migraines or depression, prior history of concussion, and problems with balance.Although the clinical score was better than a physician's judgement alone, further research is needed before it is fully adopted into clinical practice. [Watch more videos of The JAMA Report]

Host: Brian P. McDonough, MD, FAAFP Kidney stones are on the rise, particularly among adolescents, females, and African-Americans in the U.S. This marks a striking change from the historic pattern in which middle-aged white men were at highest risk for the painful condition. While the overall increase in kidney stones in children and adolescents has been known, a recent study published in the Clinical Journal of the American Society of Nephrology provided greater clarity on the specific groups of patients at greatest risk by analyzing age, race and sex characteristics among children and adults in South Carolina over a 16-year period, from 1997 to 2012. Lead author Dr. Gregory Tasian, Assistant Professor of Urology at the University of Pennsylvania Perelman School of Medicine and an attending pediatric urologist at The Children's Hospital of Philadelphia, joins Dr. Brian McDonough to discuss this startling trend, the factors that may be driving it, and appropriate preventive and treatment strategies for kidney stones.