October • 2022
In October, the Leaves May Fall

In October, the leaves may fall but we keep finding new opportunities!
Show no fright at the fight to eliminate race-based medicine and build unity.
Beware and learn the effects of domestic violence and child abuse,
And treat yourself to conferences to gain knowledge for daily use.

President's Column
Nelson Branco, MD, FAAP
We may not have the same fall foliage that I enjoyed growing up in New England, but there is no mistaking a change in the weather and a new season. For pediatricians the change in season is less about switching from sunscreen to pumpkin spice, and more about transitions from physicals and scrapes to fevers, coughs and wheezes. No matter how you mark change in season, I hope that the prediction of a winter ‘twindemic’ does not come to pass, and that the kids stay safe and healthy.
This month I have the pleasure of sharing some exciting news with you all. As you know, we have been searching for a new Executive Director since Isra left to begin medical school. Within a few days of advertising the position we received over 70 applications. After a careful and deliberate process of screening, interviewing and debating, the board members who had volunteered for this project met and came to a decision. I am happy to announce that Yolanda Ruiz, BSPH will be our new AAP CA1 Executive Director. Many of us have had a chance to meet and work with Yolanda over the past several months in her role as Project Assistant and then Interim ED. The chapter leaders who have worked closely with her have been impressed with her calm, capable and enthusiastic support for the work that we do. I am thrilled that Yolanda has accepted our offer and I look forward to working with her to continue the efforts of our chapter to support you and the children in our communities.

Along with congratulations to Yolanda, I’d like to acknowledge those who took the time to work through this process and help us find and recruit our next ED. Thank you to Dr. Raelene Walker, Dr. Nikki Webb, Dr. Niki Saxena, Dr. Resham Theti, Dr. Mika Hiramatsu, Dr. Renee Wachtel, Dr. Lena Rothstein and Dr. Niyi Omotoso for their time, effort and their careful consideration of all of the candidates for the ED position.
A few weeks ago, on the 20th of September, we held our Annual Chapter Member Meeting. We were fortunate to have our colleague and AAP CA1 chapter member Dr. Richard Pan speak to us about his experience as a California state legislator over the past 12 years. Dr. Pan also shared his perspective on how we, as pediatricians, can help ensure that we elect representatives who will help us advocate for children and those who care for them. The bottom line - encourage the parents in your practice to vote! If you missed the meeting, the recording is posted on our Past Events page.

The Annual Chapter Member Meeting is also an opportunity for us to present the details of our chapter operations. Not only do we introduce chapter leaders, but we also review chapter financials, membership, legal updates, grants and past and future events. This is a great time for our chapter, with lots going on. I’m happy to say that we are on strong financial footing and we have maintained our membership. I encourage you to watch the recording and review the slides for details, and please feel free to contact me if you have any questions about the information presented. 

I’m looking forward to meeting with our Chapter Board this coming weekend at our annual board retreat. I can’t wait to see all of my colleagues, in person or virtual, for what will be a great day of updates, brainstorming and planning on how we will continue to advocate for you and for kids. Please let us know if you have any ideas for us and if you’d like to fill one of our open leadership positions - South Valley MAL and Early Career Physician Representative - please email me or Yolanda!
Vice President's Column
Nicole Webb, MD, FAAP
Happy fall everyone! While this time of year brings traditions near and dear to many of our hearts it also brings overflowing offices and inpatient units, at a time when we are all already stretched very thin. We hope you are finding moments of calm and joy in the chaos. For me it was the mother of a former patient hugging me the other day when I ran into her unexpectedly, and telling me how her daughter is thriving at home. As a hospitalist I don’t always get these opportunities to hear about my patients’ lives at home, and I cherish them every time.

Thinking about how little we know of our patients and their lives, and how much we assume, however unintentionally, based on what we can see, I want to return to a topic I mentioned in my last column, which is race-based medicine, and the critical need to identify, name, and eliminate it. 

In its 2019 policy statement, The Impact of Racism on Child and Adolescent Health, the AAP names racism as a social determinant of health. It describes race-based medicine as “flawed science…used to solidify the permanence of race, reinforce the notions of racial superiority, and justify differential treatment on the basis of phenotypic differences as people from different parts of the world came in contact with each other.”

Another commonly cited definition comes from Cerdeña et al in their work From Race-Based to Race-Conscious Medicine: How Anti-Racist Uprisings Call Us to Act. They describe race-based medicine as “the system by which research characterizing race as an essential, biological variable, translates into clinical practice, leading to inequitable care.”

As I mentioned last month, one of the purposes of the AAP Annual Leadership Conference (ALC) is to provide time for district work. Much of our time was spent discussing the implementation and policy implications of the AAP Policy Statement “Eliminating Race-Based Medicine”. We had significant discussion regarding how we, as a district, will support chapters and their individual members in understanding and beginning to move forward with that. 

Understanding that race is a social and not a biological construct, it is critically important to systematically interrogate the ways in which race is used not just in medicine broadly, but in pediatrics specifically and in our own practice. One obvious example that many of you may be familiar with is the retirement last year of the AAP’s Clinical Practice Guideline for urinary tract infection, published in 2011 and reaffirmed in 2016, because of its use of race as a disease risk stratifier, with Black race being considered lower risk. This directly led to a different standard of care for Black children when compared to other races. 

Sadly, the use of race as a disease risk modifier with negative health implications for racially minoritized groups is not unique to the UTI guideline. In 2021 Dr. Courtney Gilliam and colleagues conducted a rigorous systematic review of the use of race or ethnicity in US-based pediatric clinical practice guidelines. Their work, published in JAMA Pediatrics, found that the use of race had a potentially negative impact on health outcomes for minoritized youth 50% of the time.
Strangulation: A dangerous, but often inconspicuous act toward women, children and teens  
Casey L. Brown, MD, MPH, FAAP and Melissa K. Egge, MD, FAAP
Child Abuse Prevention, Education and Treatment (CAPET) Committee Co-Chairs
October is Domestic Violence (DV) Awareness Month. Strangulation is common in intimate partner violence but is underrecognized and underreported. This article will review some epidemiology, signs and symptoms as well as steps for clinicians who practice in California to take.  

  • From the Centers for Disease Control: About 1 in 4 women and nearly 1 in 10 men have experienced contact sexual violence, physical violence, and/or stalking by an intimate partner during their lifetime and reported some form of intimate partner violence (IPV) related impact.
  • Due to the power and strength differential, strangulation is more commonly inflicted against women and children.
Teen dating violence is common. There are 4 types of teen dating violence: physical violence, sexual violence, psychological aggression and stalking. The CDC reported that U.S. high school students endorsed in the prior year:
  • About 1 in 12 experienced physical or sexual dating violence.

Strangulation is a silent and lethal form of violence used to dominate and control a partner or child, occurring in approximately 25% of incidents of DV and often with sexual assaults. Strangulation causes asphyxiation by compressing blood vessels and/or the airway reducing blood flow and oxygen to the brain. If one does not ask about this form of violence, it may not be known because often there are no external signs of trauma to the neck and many times there are no stigmata of increased venous pressure in the face. The signs of strangulation that may be visible to the medical provider when there is compression of the neck veins but incomplete compression of the carotid arteries are subconjunctival hemorrhages and facial petechiae. Close exam may also reveal petechiae in the mouth and on the scalp.  

Less than 10 seconds of occlusion of the carotid arteries leads to loss of consciousness. If the pressure is not released, the victim will die in 1 -3 minutes. . .
Additional Child Abuse and Pediatric Strangulation Resources
CEID: Hearing Services, Resources and Education 
Cindy Dickeson, MSW
I want to share a valuable community resource for pediatric audiology services and early education for young children (birth to 5) who are Deaf or Hard of Hearing.
Children who are Deaf and Hard-of-Hearing (D/HH) and their families encounter daunting challenges as they work to maximize their communication potential. The Berkeley-based Center for Early Intervention on Deafness (CEID) has helped thousands of children achieve that goal by providing the vital services and resources that children and families need to thrive in the classroom and community.

Established in 1980, CEID is a non-profit, community-based organization whose portfolio of services includes early care and education, specialized family support and resources, speech and language therapy, and occupational therapy. Grounded in recognized best practices, and prioritizing family collaboration, CEID’s core early education programs range from specialists making home visits to families for babies identified with D/HH to center-based toddler and preschool classrooms, including a preschool for typically developing children to promote inclusion.  
CEID also provides essential audiological services for children and adults at two clinics: one at its Berkeley center; the other at the Rising Harte Wellness Center in Oakland. Hearing evaluations and hearing devices are available at both clinics for patients of all ages, birth through senior, with MediCal, CCS and commercial insurances accepted.
CEID offers family support and education that include free sign language classes, loans of assistive technology, access to a parent library, deaf coaching mentor services, peer to peer support, and community based family activities. CEID is the author and publisher of the “Pediatric Resource Guide to Infant and Childhood Hearing Loss” and it provides monthly trainings of pediatric residents from major Bay Area hospitals. 
To refer or find out more about how CEID can partner with children and families, please visit www.ceid.org or contact:

Education Programs 510-848-4800 ext 306 info@ceid.org
Audiology Clinics 510-848-4800 ext 317  audiology@ceid.org
Registration is NOW OPEN for Our 7th Annual Puzzles CME Conference on December 10!
Join AAPCA1 for our 7th Annual Puzzles CME Conference with interactive lectures by experts in pediatric neurology, dentistry, infectious disease, and much more. We heard you! 

This year's Puzzles will include a lunchtime meet & greet / networking session, and the day will end by 3:45 p.m. so you can plan a Saturday evening out! 
The SGA Side
Your Key to State Government Affairs
Nora Pfaff, MD, FAAP and Anna Kaplan, MD, FAAP
SGA Chapter Representatives
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.
Opportunities for Your Benefit
Register Now! AAP National Conference & Exhibition in Anaheim, CA - October 7-11
Join us in Anaheim for the 2022 National Conference & Exhibition happening October 7-11, 2022. We can’t wait to welcome you back to connect in person and network with colleagues, participate in world-class education sessions, attend exciting special events, visit the exhibit hall, and much more! A limited virtual attendee experience will also be available.

Register Now! Ending Violence to Children in the United States: Changing Social Norms About the Hitting of Children - Friday, October 14, 9AM-1PM ET (Virtual)
General Admission: Free

CE Credits: 3.5 NY CE credits for psychology, social work, or mental health counseling are available for no charge. CE credits will only be awarded to social workers, psychologists, and mental health counselors who are licensed in New York State. 

Email FontanaCenter@nyfoundling.org with your name, license number, and the type of credit you are requesting. 


Register Now! 2022 Stanford Child Abuse Conference - November 4, 8:30AM-4PM PT (Virtual)
The virtual 2022 Stanford Child Abuse Conference aims to increase the fund of knowledge available to professionals working with children and families exposed to trauma and abuse. The Conference will feature multi-disciplinary experts in the field of child abuse offering education on trauma-informed and evidence-based approaches to the screening and care of children exposed to child abuse and neglect. Interactive presentations and case studies will help foster connections with peers in the field and offer practical strategies for implementing skills in clinical practice.

Registration Rate:
Physicians: $75
Nurses, Allied Health Professionals, law enforcement, legal, non-profit, and other professionals: $50

Register Now! 43rd Annual Las Vegas Seminars: Pediatric Update - November 17-20
Join us in Anaheim for the 2022 National Conference & Exhibition happening October 7-11, 2022. We can’t wait to welcome you back to connect in person and network with colleagues, participate in world-class education sessions, attend exciting special events, visit the exhibit hall, and much more! A limited virtual attendee experience will also be available.

October 7-11 - Experience: AAP National Conference and Exhibition - REGISTER HERE
October 19 - AAPCA1 Mental Health Committee and UCSF CAPP: Mental Health Referrals and Resources - SAVE THE DATE!
November 9 - Mental Health Chapter Chat: Suicide Screening and Assessment - SAVE THE DATE!
November 17-20 - 43rd Annual las Vegas Seminars: Pediatric Update - REGISTER HERE
December 10 - 7th Annual Puzzles CME Conference - REGISTER HERE
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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: Nelson Branco • Vice President: Nicole Webb
Secretary: Resham Kaur • Treasurer: Amita Saxena • Past President: Raelene Walker
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: Vacant • San Francisco MAL: Maya Raman • Santa Clara MAL: Vacant • San Mateo MAL: Neel Patel • 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 Assistant: Position Available