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In Bright Exam Rooms...
In bright exam rooms, laughter fills the air,
Pediatricians watch with utmost care.
Preparing vaccinations, their hearts alight,
In upcoming conferences, they'll guide with insight.
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President's Column
Nicole Webb, MD, FAAP
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Hello to all of our wonderful members. This month I want to take a moment to highlight some of the wonderful work being done by our amazing chapter. First up, our Immigrant Health Task Force, led by Dr. Shazeen Suleman, is now a chapter committee. This will enable us to continue to build on and expand the wonderful work done by the task force in the past, and recognizes that issues pertaining to immigrant and refugee health are an area of ongoing need for advocacy, not a more time-limited topic. I encourage you to read Dr. Suleman’s article this month on medical insurance resources for immigrants and refugees, Covered Parents, Healthier Kids: Help the Parents of Immigrant Children Enroll in Medicaid. Dr. Suleman and the committee are excited to continue this important work and always looking for additional members to join. If you are interested in joining this or any of our committees, please reach out to us at info@aapca.org.
I also want to highlight a new section of our newsletter, the Equity Corner, led by our wonderful AAP CA-1 Equity, Diversity and Inclusion champion, Dr. Amna Khan. As a chapter, we are committed to promoting equity, diversity, inclusion and justice for our patients and communities, as well as for our members and in health care overall. Dr. Khan will use this space to highlight resources and initiatives, discuss ongoing chapter EDI efforts, and share her thoughts. She would also like to highlight the important health equity work that many of you are engaging in, so stay tuned for a call out to highlight
member work.
We are also very fortunate this month to have a piece authored by one of our amazing trainees, Dr. Katrina Marks, with support from one of our board members, Dr. Lena van der List. Dr. Marks is a second-year resident at UC Davis and Dr. van der List is an AAP CA-1 board member and a pediatrician at UC Davis. Their piece about the importance of pediatricians voting in the upcoming primary and in general, is so timely and critical. As we all know, we are a voice for kids. Unfortunately, as Drs. Marks and van der List discuss, physicians have historically very low voter participation. Using our voice at the polls is one of the most critical advocacy tools we have at our disposal.
Lastly this month I want to draw your attention to a piece entitled “Why Pediatrics”, submitted by Dr. Graciela Wilcox, who is a pediatrician on the Central Coast and one of our AAP CA-1 board members. I was very moved reading Dr. Wilcox’s reflections on why she continues to choose pediatrics, despite the many challenges of the modern health care landscape and world we live in. I imagine you will be, too.
I am constantly humbled by the dedication, passion, creativity, and resilience of you, our members. Thank you to those I’ve highlighted here and to all of you out there in the trenches, doing the work. As always, this primary and in all elections, local, state or federal, VOTE KIDS!
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Equity Corner
Amna Khan, MD, FAAP
EDI Champion, Chapter 1 AAP
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This month’s health equity focus is on food insecurity, defined as the “lack of adequate and dependable food resources for families to maintain a healthy and active lifestyle”.
The COVID-19 pandemic increased US national rates of food insecurity in children from 1 in 7 households to 1 in 4 households. Food insecurity has long been associated with poor health status, developmental risk, mental health problems and poor educational outcomes in children. With the end of federal and statewide COVID subsidies, such as the child tax credit, complicated by the rising rates of inflation in our state, food insecurity continues to rise.
In Santa Clara County, where I practice outpatient pediatrics, we have increasing need for food resources as more children reside in households that earn 185-300% of the Federal Poverty Level (FPL). 21% of black children and 24% of Latinx children live in families between 185-300% of the FPL vs 7% of White and 8% of Asian children in our county, making food insecurity also a significant racial health inequity. Many of our families experiencing food insecurity are ineligible for federal food programs, ie CalFresh, due to immigration status. Simultaneously, national rates of enrollment in WIC (Women, Infants and Children), a federal supplemental nutrition program, have been decreasing despite increasing need for more robust food Resources.
The awareness of this background information has provided the impetus for my fellow colleagues and I who lead Pedi POWER, our physician-led, anti-racism department working group, to dive deeper into our community food resource needs and address this issue more comprehensively in our patient population.
Some takeaways from our current investigation include:
Before asking the question of our patients about their food needs, identify and maximize the proposed interventions for when a patient screens positive for food insecurity
Standardize screening for food insecurity with all patients during Well Child Checks
Utilize a Likert scale to capture the most patients with need versus a “yes/no” option
Create interventions that place the responsibility on the community partner resource to reach out to patients instead of patients being responsible to reach out to resource
Provide a wraparound system that informs the healthcare provider of whether resources were accessed and obtained by patient, alleviating burnout and moral injury experienced by healthcare provider
Consider how you can champion connecting families to vital food resources in your own scope of work. For additional information about anything described in this health equity corner, please reach out to me at thepeoplespediatrician@gmail.com. For additional child-focused, health equity resources and the link to subscribe to my monthly health equity newsletter, visit www.thepeoplespediatrician.com
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Developing Concerns: Waiting times for Autism Assessments
Renee Wachtel, MD, FAAP
Chair, Committee on Developmental and Behavior, School Health
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Pediatricians are rightly concerned about the wait times for Autism Spectrum Disorder (ASD) Diagnostic Assessment for young children. Since the AAP Bright Futures recommends ASD specific screening at 18 and 24 months, pediatricians are aware that 1 in 36 children in their practice will have ASD. Yet when they refer the child and family for an ASD Diagnostic Assessment, they are often confronted with long wait times, which can be many months or even a year at a critical time in child brain development. Parents are frustrated, as are pediatricians. What can they do?
One thing they can do is refer to the Regional Center in their area, which is required by law to do an evaluation for free within 45 calendar days to determine whether the child has developmental delays that would qualify them for early intervention services. BUT, often the Regional Center Program for children 0-3 years old will document the delays, but refer them back to their pediatrician for an ASD assessment through their health insurance. They may qualify to receive early intervention services during the interim, such as speech language therapy, but not ASD specific therapy without a diagnosis of ASD. And the wait time for the ASD assessment can be months, or longer. What can we do about this? What are others doing about this problem?
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Covered Parents, Healthier Kids:
Help the Parents of Immigrant Children Enroll in Medicaid
Shazeen Suleman, MD, FAAP
Immigrant Child Health Committee Chair
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As of January 1, 2024, California allows adults ages 26-49 to qualify for Medicaid if they meet income requirements, regardless of immigration status. Many immigrant adults in this age group are the parents of children, some US-born and others are immigrants themselves. Studies have shown that children receive more preventative care when their parents have health insurance. As pediatricians that care for immigrant children, we can help our eligible patients and their families the care they need and deserve by supporting their enrollment in Medicaid!
Things that you can do to help:
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Reassure families that Medicaid benefits are not included in the Public Charge rule and will not affect their immigration process.
- Explain how health insurance, referrals and prescriptions work in the United States, and in your county. In many parts of the world, health insurance is not a common concept and access to specialists or medications may be quite different than here.
- Connect to your county’s human services offices to help them with the enrollment process: you can share their address, phone number and hours of operation.
More information:
Interested in continuing to support immigrant child and family health? Join the Immigrant Child Health committee!
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Why Pediatrics?
Gracie Wilcox, MD, FAAP
Monterey Bay Area Director
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Why pediatrics?
Every time I open my email I feel bombarded by articles on physician burn-out.
I woke up on a recent Saturday knowing I had a busy morning of hospital rounds, followed by a busy Saturday clinic, after which I’d return to the hospital for more rounds; all of this would be accompanied by seemingly non-stop phone calls from parents, ED physicians and nurses. Hello winter. As I lay in bed anticipating the busy day and weekend ahead, there was a sense of dread, even exhaustion, with thoughts of the work (and documentation of that work) ahead.
Why pediatrics?
At the end of that busy weekend I stepped back and thought about the experiences I’d had in that short time frame. I saw life at its most beautiful, and its most painful.
Beautiful: After the morning clinic I arrived back at the hospital just in time to join a mom, dad and their newborn baby being wheeled into their room after a tough delivery that ended up going to c-section. Our hospital is fortunate to have volunteer musicians who come to play for our patients and their families. One of our phenomenal nurses had asked the harpist who was there that day to serenade this newborn with “Happy Birthday”. The privilege of being present for this meaningful and emotional moment for the family was not lost on me.
Painful: Later that evening I was called back to the hospital to attend to a child who had ingested drugs that belonged to the person who was supposed to be caring for her and looking out for her.
Why pediatrics?
Each of our workdays bring us encounters that might bring us joy or leave us raw. If I focus on “all that work that needs to be done” I feel dread. If I focus on the lives I am privileged to be a small part of, I feel energized. At our AAP-CA1 leadership retreat we had a presentation on narrative in medicine and the role it can play in preventing burn-out. Narrative allows us to reflect on and process the stories that our professional encounters bring. I have been trying to use narrative in my own practice to remind myself of the privilege it is to do the work I do.
Why pediatrics?
Beauty, pain, connection, exhaustion…all in a day’s (and night’s) work.
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Doctor's Orders - Vote
Katrina Marks, PGY2 & Lena C. Van Der List, DO, FAAP
PGY2 & Sacramento Valley Area Director
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As a busy clinic day wraps up, I start to tackle the mountain of paperwork sitting on my desk. Under a pile of school forms, prescription orders, and other various tasks vying for my attention, I spot my primary election sample ballot. Some coworkers comment about how many candidates are on the ballot and how long the polling lines were for the last election, and I overhear others wonder if their vote is even worth the effort.
Studies have shown that physicians and other healthcare workers are less likely to vote than the general population. This is due to a number of reasons – many of those who didn’t vote cited their busy lives or conflicting work schedules as their main barrier. However, this trend has been improving since the COVID-19 pandemic, which speaks to the growing influence of physicians as expert advisors in an ever-political health landscape.
As healthcare workers, we see the impact of health inequities in real-time, and voting gives us a voice to advocate for change. In addition to choosing representatives who will help us support patients, elections give us the opportunity to vote directly on issues facing our communities. This includes the state proposition on the upcoming California primary ballot calling for $6 billion to build mental health and substance use treatment facilities. If that’s not enough, the ballot in November will also include propositions to raise the minimum wage and set aside funds to establish a California Pandemic Early Detection and Prevention Institute.
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SUDC Foundation
Erin Bowen, MD
Vice President, The SUDC Foundation
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Dear Colleague,
March is Sudden Unexplained Death in Childhood (SUDC) Awareness Month.
Throughout the entire month of March, the SUDC Foundation will be leading a global movement to raise awareness of Sudden Unexplained Death in Childhood (SUDC). We invite you to help us shine a light on SUDC and join us in raising awareness in the medical community this March.
I am a pediatrician and the Vice President at the SUDC Foundation. I was unaware of SUDC until it affected our family directly when our happy and healthy 17-month-old son Conor died during a nap on October 25, 2016. His cause of death was undetermined. Our world was shattered with Conor’s death. I felt betrayed by my medical education that I did not know this could occur.
My colleagues were equally unaware of SUDC. Fortunately, our family was connected to the SUDC Foundation, where we were given the opportunity to connect with other families who had experienced similar losses. We received emotional support and an opportunity to participate in a research study. Through these connections, we learned that there were striking similarities in children affected by SUDC and that there was a gap in medical awareness relative to this category of death.
I hope that you will take the time to read about SUDC and the SUDC Foundation…
SUDC is the sudden and unexpected death of a child 12 months of age or older which remains unexplained after a thorough death investigation is conducted. According to CDC data, approximately 450 children between the ages of 1 and 18 are affected by SUDC annually. SUDC is the fifth leading category of death in children between the ages of 1 and 4 and yet it is not a part of medical education, and there is no targeted federal funding to support research. Sadly, due to this lack of awareness, many medical professionals do not feel equipped to manage the needs of these families.
While SUDC is currently both unpredictable and unpreventable, there have been research advances that are improving our understanding of this category of death. Studies have shown that 30% of children affected by SUDC have a history of febrile seizures and a recent study published in Neurology, January 2024, examining crib videos of 7 children, indicated convulsive movements prior to their death. There has also been a study showing de novo genetic mutations in cardiac and brain muscle cells in some children affected by SUDC. It is likely that there is not one unified diagnosis explaining SUDC, but rather multiple underlying diagnoses. These research findings are highlighting the need for future research to identify which children are at higher risk for these deaths with an ultimate goal of prevention.
Perhaps you will only see one family in your career affected by SUDC, but you will make a tremendous difference if you can support them through this unthinkable tragedy.
Here's how you can help shine a light on SUDC…
colleagues.
For inquiries or to order your FREE SUDC Awareness Monthly Kit, please contact The SUDC
Foundation at: info@sudc.org. We thank you in advance for your support and helping us work towards our vision of a world without SUDC.
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The SGA Side
Your Key to State Government Affairs
Nora Pfaff, MD, FAAP and Anna Kaplan, MD, FAAP
SGA Chapter Representatives
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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 https://aap-ca.org/advocacy/ 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.
For the most up-to-date information on AAP California bill positions, letters, and outcomes from the current California Legislative year, go to www.aap-ca.org/bill. 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 info@aapca1.org.
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Update on High Blood Lead Levels in Children Consuming Recalled Cinnamon Applesauce Pouches and Potential Chromium Exposure | |
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The Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), as well as state and local officials are investigating a link between blood lead levels
(BLLs) ≥ 3.5 µg/dL and children consuming certain apple purée and applesauce products containing cinnamon. FDA product testing has also identified high levels of chromium in cinnamon samples and recalled apple cinnamon puree pouches. This CDC document includes recommended actions for clinicians regarding possible lead and chromium exposure from these products.
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See All Available Pediatric Jobs on our Job Board! | |
Opportunities for Your Benefit | |
Seeking applications for a new Advocacy Committee Attending & Trainee Chair! | |
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Are you passionate about child health, health equity, and advocacy? Are you looking for an outlet to meet others with similar interests and to expand your advocacy and leadership skills? If so, we invite you to apply to serve as a Co-Chair for the Advocacy Committee!
About the roles
We are looking for one trainee (student, resident, or fellow) to serve a one-year term and one attending member to serve for at least two years, starting late Spring/early Summer. Ideal applicants will show strong leadership and collaboration skills, a demonstrated commitment to health equity, and advocacy interest/experience.
About the committee
The AAP-CA1 Advocacy Committee brings together pediatricians and trainees from throughout Northern and Central California to build relationships, enhance advocacy skills, and effect change towards healthier, more equitable ecosystems for young people. We host advocacy committee meetings on a quarterly basis and organize advocacy-related events and collaborations, such as Chapter Chats on advocacy skills and Advocating for Children Together (ACT) conferences. Our leadership structure consists of 2-3 attending co-chairs and 1 trainee co-chair, because we value a diverse range of perspectives and experiences.
How to apply | Deadline: April 1, 2024
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Complete the application form here:
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Email your CV to Co-Chairs Morgan Leighton (morganleighton89@gmail.com) and Stephanie Fong Gomez (fonggomezmd@gmail.com) and cc info@aapca1.org
If you have questions about the role or would like to learn more, please contact Co-Chairs Morgan Leighton or Stephanie Fong Gomez!
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Have you Adapted Your Antibiotic Prescribing Approach to Telemedicine? | |
 |  | Is your pediatric practice interested in optimizing antibiotic use in telemedicine? The Agency for Healthcare Research and Quality (AHRQ) is recruiting practices for a free 18-month program starting June 2024. This initiative aims to improve antibiotic use in telemedicine, enhance patient satisfaction, and provide coaching from experts in infectious diseases. Participants will receive personalized guidance to implement sustainable improvements in diagnosing and treating infectious syndromes over telemedicine, with a focus on pediatric conditions like otitis media. The program also covers topics such as determining the need for in-person visits, managing diagnostic uncertainties in telemedicine, and effective communication with parents. Participating providers can earn continuing education units (CEUs), continuing medical education (CME) credits, and American Board of Pediatrics maintenance of certification (MOC) points. For details and to register for a webinar, visit safetyprogram4telemedicine.org.
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ACEs Health Champions Gathering | |
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Professor Hamilton will discuss the Statutes of Limitations (SOL) movement. "Why should there be limitations on child sex abuse prosecution and civil lawsuits if there is no SOL on the suffering of the victims?" Who are the opponents of the victims and what are their strategies?
Date: March 22
Time: 12 pm - 1 pm
Location: Virtual via Zoom
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DMHC Wants to Hear from Physicians about Health Barriers | |
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The Department of Managed Health Care (DMHC) is in the process of conducting behavioral health plan investigations to assess barriers and challenges physicians and other provider types experience in providing or ensuring behavioral health services for their patients. DMHC is looking to identify systemic changes that could be made to improve timely and appropriate access to behavioral health care services. For 2024, DMHC is conducting investigations of the following five health plans:
- Chinese Community Health Plan
- Molina Healthcare of California
- UnitedHealthcare of California
- San Francisco Health Authority
- Aetna Health of California
This is an opportunity for physicians to share specific barriers both they and their patients encounter when trying to provide or secure timely and appropriate access to behavioral health services for their patients. Click here to see CMA’s article.
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Pre-teen Vaccine Week March 4-8 | |
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This year’s Preteen Vaccine Week is March 4-8. Use the strategies below to help make sure your preteen patients are up to date on vaccines and ready for 7th grade to prevent the back-to-school rush that many clinics and families face as the new school year approaches.
- Use the immunization registry and your EHR to identify children who missed well-child visits and/or recommended vaccinations. (See the CAIR Reminder/Recall User Guide.)
- Reach out to schedule in-person appointments using a Robocall Script, letter, or text.
- Plan back-to-school immunization clinics at convenient times for working parents, including weekends and evenings.
- Administer needed vaccines at ALL visits, not just well-child checks.
- Designate a certain number of “immunization-only” appointments each day leading up to school entry.
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Inflammatory Brain Disorders Conference 2024 - Saturday, June 22, 8:00am - 4:30 pm
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Join us for a two-day virtual CME conference! The Inflammatory Brain Disorders Conference features nationally and internationally renowned experts skilled in diagnostic and therapeutic approaches who will present a diverse range of emerging clinical and research challenges, insights, and advances in the field of inflammatory brain disorders.
While the conference is also being hosted live in Palo Alto and chaired by UCSF and Stanford hosts, the virtual conference is being offered free of charge to 500 physicians. The link to register and request the fee be waived can be found on our website.
Date: June 22 - June 23
Time: 8:00 am - 4:30 pm PT each day
Location: Virtual CME event
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Brightlife Kids is a website that provides support, education and free coaching for parents of children 0-4 years, 5-8 years and 9-12 years.
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Soluna is an app intended for use by teens and young adults, ages 13-25 years. It offers personal and interactive tools, monitored chats, and free coaching with therapists.
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March 7-8 UCSF Livestream Conference 23rd Annual Developmental Disabilities - REGISTER HERE
March 22 ACEs Health Champions Gathering REGISTER HERE
June 22-23 Inflammatory Brain Disorders Conference- REGISTER HERE
May 13-14 Legislative Day in Sacramento SAVE THE DATE
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Add our social media accounts to get the latest chapter updates!
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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.
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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.
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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 Area Director: Thiyagu Ganesan • Sacramento Valley Area Director: Lena van der List • Central Valley Area Director: Deborah Shassetz • South Valley Area Director: Sireesha Palkamsetti • San Francisco Area Director: Maya Raman • Santa Clara Area Director: Bindya Singh• San Mateo Area Director: Jackie Czaja • North Coastal Area Director: Jeffrey Ribordy • Monterey Bay Area Director: Graciela Wilcox • Alameda Area Director: Renee Wachtel • Contra Costa/Solano Area Director: Omoniyi Omotoso
Pediatric Insider News Editors:
• Mika Hiramatsu • Deborah Shassetz • Yolanda Ruiz
Staff:
Executive Director: Yolanda Ruiz • Project Coordinator: Sana Sayyid •
Marketing Assistant: Arathzy Portillo
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