December • 2023

In the Coolness of December...

In the coolness of December, pediatricians convene,

To our Puzzles 2023 Conference and continue their routine.

With stethoscopes poised and minds astir,

They eagerly anticipate the new year of 2024 to occur.

President's Column

Nicole Webb, MD, FAAP

Hello to all the amazing advocates in our chapter! I hope you are all surviving the onslaught of respiratory illnesses that this time of year brings. 

As many of you know, our chapter holds its annual CME event, Pediatric Puzzles, each December. This is the work of our amazing CME Committee, chaired by Dr. Mika Hiramatsu, and our Executive Director and Project Coordinator, Yolanda Ruiz and Sana Sayyid. This year’s event was held on December 2 at the California Academy of Sciences for the first time and it was wonderful. The combination of the inspiring venue and fantastic speakers made for a phenomenal day of learning and connection. We hope many of you are able to join us next year as we again gather at the Academy of Sciences for Pediatric Puzzles on December 7, 2024.

The day after Puzzles, we came together as an AAP CA-1 board for our annual retreat, to focus on our strategic planning for 2024 and beyond. We thank those of you who filled out our Annual Member Survey, as we prioritized your responses and feedback in our planning. Our key areas of focus remain Child, Member and Chapter health and among each of those we identified key priorities such as access to care, health equity, mental health, violence prevention, networking opportunities, CME, and many others based on your feedback and our existing champions in our many committees and among our members at large.

We will utilize this space in the coming months to share more information. We welcome your ongoing feedback and engagement. Our chapter is one of the largest and most active in the whole US, and it is entirely because of members like you. 

Stay safe and heal on,


AAP California Chapter 1 Completes Educational Engagement with California Health Data Exchange: Data Sharing

Seth Bokser, MD, MPH, FAAP

Project Lead, Data Exchange Framework

One year ago, the American Academy of Pediatrics California Chapter 1 (AAPCA1) was engaged by California Health & Human Services, as well as the Center for Data Insights and Innovation, to gather input and provide education related to the California Health Data Exchange. In summary, AAP Chapter 1 has provided the following:

California’s Health & Human Services Data Exchange Framework (DxF) aims to accelerate and expand the exchange of health information among health care entities, government agencies, and social service programs beginning in 2024. The DxF was mandated by state law AB 133, signed by Governor Gavin Newsom in 2021 with the stated aim of breaking down information silos that make it difficult for Californians to access effective, whole-person care.

The data exchange framework is not a technology, piece of software, or centralized data repository; instead, it’s an agreement and set of policies/procedures enabling providers to share health information safely. California health care providers can do so using their own technology that meets the state requirements and/or partner with one of nine designated Qualified Health Information Organizations.

Exhibit 1: State of California’s implementation plan for the DxF, including plan for health care providers in California to sign the Data Sharing Agreement (DSA) by Jan 31, 2023 and implementation of data sharing by Jan 31, 2024 or 2026–depending on practice size. DSA Signing Portal:

Read More Here!

Developing Concerns

Renee Wachtel, MD, FAAP

Chair, Committee on Developmental and Behavioral Pediatrics

Many parents ask pediatricians about preschool programs, and whether it is important for children to attend preschool. Since Governor Gavin Newsom is expanding preschool accessibility for California’s preschool children, a recent series of studies should inform our responses. 

Reynolds et al (JAMA November 20,2023) report in their study that compared predominantly low income children in Chicago who attended part time preschool (3 hours per day, n=513) to children who attended full day preschool ( 7 hours per day, n=361) school readiness and in third grade school performance. They had previously found that at the end of preschool the children who attended full time preschool had higher school readiness skills in 4 out of 6 domains. To see whether these effects were sustained, they assessed third grade scores in English and Math, and whether there were differences in grade retention or special education placement. They found that full day preschool attendees were better in Math and English proficiency on standardized testing, and were retained in grade less than 50% of the time compared to part time preschool attendees. Interestingly, there was no difference in Special Education placement (12.4% versus 10.1%). 

So we can tell parents that preschool is good, but full time preschool is better than part time preschool, at least for low income children.

ICYMI: 8th Annual Pediatric Puzzles CME Conference

Mika Hiramatsu, MD, FAAP

Chair, Continuing Medical Education (CME) Committee

An albino alligator, penguins and lots of pediatricians filled the California Academy of Sciences on Dec. 2 for the chapter’s 8th annual Pediatric Puzzles meeting. The sold-out conference, which addressed dermatology, mental health, and sports medicine, offered such pearls as “eating mangoes can cause perioral dermatitis” (Renee Howard, MD), “use root beer, blueberry and chocolate to mask vile medicine flavors” (Neal Rojas, MD), and “Go to for useful physical therapy handouts for families” (Tim Liu, DPT). Lisa Benton-Hardy, MD, and Emily Kraus, MD filled out the program with talks on medications for anxiety, depression and ADHD, and the female sports triad. One attendee told me, “I haven’t been to an in-person CME meeting since 2007, and this is great!” Another (David Marriott, MD) traveled from the most northern reaches of our chapter (Yreka) and came away with the raffle grand prize – half off of next year’s registration. One person remarked, “In 20 years of attending CME meetings I have never ever heard a physical therapist speak. Great idea!” Many conference-goers and their families chose to visit the museum exhibits during their time at the Academy, appreciating attractions such as the aquarium, planetarium and rainforest area. Many thanks to Yolanda Ruiz, Sana Sayyid, and CME committee members for their hard work in making this meeting possible. Save the date Dec. 7, 2024 for the 9th Puzzles!

The SGA Side
Your Key to State Government Affairs
Nora Pfaff, MD, FAAP and Anna Kaplan, MD, FAAP
SGA Chapter Representatives

2023 Legislative Year End

Wins, Losses for Children’s Health and Wellbeing in California

The following are just a few of the key bills to note of interest to AAP-CA. Visit the AAP-CA website’s Advocacy page at to see the entire list of AAP-CA tracked bills that made it to the Governor’s desk where you can read the outcome of each bill and an in-depth analysis.  



  • AB 816 (Haney D), AAP-CA’s only sponsored bill, will allow California physicians to safely expand youth access to effective OUD treatment with buprenorphine consistent with FDA recommendations and National AAP policy. In a letter to the Governor, AAP-CA stated, “As pediatricians, we consistently make every effort to engage families in the care of youth. However, obtaining parental consent is not always possible. For youth without an available or supportive caregiver (e.g., unhoused youth), or for youth who may be unwilling to disclose their substance use to caregivers, we strongly believe parental consent should not be a barrier to safe and effective care. The patients for whom parental consent is the most challenging are often the most vulnerable patients who need our care and advocacy the most.”


  • AB 935 (Connolly D) will explicitly authorize the CA Dept. of Health and the Attorney General to enforce the flavored tobacco ban pursuant to Business and Professions Code Section 22950.5, also known as the Stop Tobacco Access to Kids (STAKE) Act, consistent with other tobacco enforcement efforts. AB 935 will also replace the subdivision from the Health and Safety code which makes violation of SB 793 a misdemeanor and criminal penalty. Instead, pursuant to the STAKE Act, it will become a civil penalty to retailers, their agents, or their employees who are in violation.


  • SB 287 (Skinner D) is now a 2-year bill and still in play. This bill would hold social media companies financially responsible for certain harm they know they are causing our children through their failure to act with basic care in their operations. With an important focus on prevention, the bill will also motivate the platforms to audit their practices for child harm and promptly fix these harmful practices.

For the most up-to-date information on AAP California bill positions, letters, and outcomes from the current California Legislative year, go to For the latest organizational advocacy updates follow @AAPCADocs on Twitter. If you have questions and/or are interested in knowing more about certain legislation, reach out to our State Government Affairs Chapter Representative Nora Pfaff, MD, FAAP and Anna Kaplan MD, FAAP at

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Announcing The Pediatric Environmental Health: e-Toolkit for Prevention (PHET)

Do you get questions from parents about environmental health topics such as PFAS or heavy metals in baby foods or air pollution? The PEHT is here to help! The Pediatric Environmental Health:  e-Toolkit for Prevention is a FREE mobile-friendly set of online tools aimed at pediatric healthcare providers. You can search for topics by specific chemicals (like lead) or by the substance the kid is/could be exposed to (like baby foods). There is environmental health anticipatory guidance grouped by age, to complement bright futures, and key concepts to help you quickly build foundational knowledge in environmental health.

For every topic in the PEHT, we also have a companion Prescriptions for Prevention - an online handout you can provide parents on preventing exposures and health effects. There are even some videos! (English versions of the handouts and videos are available now, with Spanish following soon.

The Pediatric Environmental Health Specialty Units (PEHSUs) have created and maintained this resource, with the completely updated and revised 3rd edition. For more information on pediatric environmental health, reach out to your local PEHSU.

ACEs Health Champions Gathering - Monday, December 18, 12 pm

Topic - Where the Boys Are: Understanding and Responding to Trauma when the Victim is Male.

Utilizing a case study, this Gathering gives an overview of the research on the unique dynamics involved when a victim of abuse is a male. Given these dynamics, Mr. Vieth will provide concrete guidance for medical, mental health and spiritual care for male survivors.

TBD - The Balance Between Data Exchange and Privacy: Ask the Experts!

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Your membership makes a difference for children in California, thank you!

The AAPCA1's ability to advocate on behalf of children is only as strong as the support we receive from our members. Encourage your colleagues to join today by visiting the AAPCA1 website.

Our mission is to promote the optimal health and development of children and
adolescents of Northern California in partnership with their families and communities, and to support the pediatricians who care for them.

Executive Committee:

President: Nicole Webb • Vice President: Neel Patel

Secretary: Resham Kaur • Treasurer: Amita Saxena • Past President: Nelson Branco

Executive Director: Yolanda Ruiz

Board Members:

North Valley MAL: Thiyagu Ganesan • Sacramento Valley MAL: Lena van der List • Central Valley MAL: Deborah Shassetz • South Valley MAL: Sireesha Palkamsetti • San Francisco MAL: Maya Raman • Santa Clara MAL: Bindya Singh• San Mateo MAL: Jackie Czaja • North Coastal MAL: Jeffrey Ribordy • Monterey Bay MAL: Graciela Wilcox • Alameda MAL: Renee Wachtel • Contra Costa/Solano MAL: Omoniyi Omotoso

Pediatric Insider News Editors:

• Mika Hiramatsu • Deborah Shassetz • Alyssa Velasco


Project Coordinator: Sana Sayyid