The American Academy of Pediatrics National Conference and Exhibition
The annual meeting of the American Academy of Pediatrics was held from Oct. 25 to 29 in New Orleans and attracted approximately 12,000 participants from around the world, including primary care pediatricians, pediatric medical subspecialists, pediatric surgical specialists, and other health care professionals. The conference featured scientific sessions that focused on the latest advances in the care of infants, children, adolescents, and young adults, as well as scientific papers, posters, and exhibits.
During one session, Verena W. Brown, M.D., of the Stephanie V. Blank Center for Safe and Healthy Children at Children’s Healthcare of Atlanta, discussed how practicing clinicians should handle an adolescent or teen disclosing abuse.
“Children often do not disclose abuse until much later, sometimes in adulthood and sometimes never,” Brown said. “When they do try to disclose, it’s a process. When talking to children about their experiences, be reassuring and ask open-ended questions.”
Brown suggests that practicing clinicians try to avoid leading questions and stay calm, while maintaining neutral facial expressions. In addition, Brown recommends that clinicians should reassure children that they are being heard and believed.
During another session, Alyssa H. Silver, M.D., of Children’s Hospital at Montefiore in Bronx, New York, discussed what pediatricians can do to address firearm safety among adolescents and teens.
“As pediatricians, part of our job is to partner with parents to protect children and keep them healthy and safe. We can do this through advocacy, our clinical practice and clinical care of patients, education of ourselves and the next generation of pediatricians, and research,” Silver said. “We know that most often firearm-related injuries in young children are unintentional and in older children are more likely intentional in the context of suicide or homicide. Both of these point towards the importance of safe storage and preventing access to guns in older children, particularly in teens who may be impulsive.”
According to Silver, safe storage means keeping guns locked, with the safest option being keeping guns unloaded and with the ammunition locked up separately.
“Pediatricians can use our voices to advocate for effective legislation, which includes universal background checks, child access protection, and extreme risk protection order laws. We need more research to better study firearm-related legislation. Local and community level advocacy is also important,” Silver said. “Pediatricians should counsel patients and families on safe firearm storage and screen for access to guns for high-risk populations (kids who are victims of bullying, mental health concerns, violence risk factors, gang participation, etc.). Similarly, we should encourage parents to ask about any unsecured guns in the homes of others when their children go there to play or spend time.”
Silver said there are plenty of opportunities for educating trainees about talking about gun safety and gun violence prevention and emphasized how to have the conversation: education without investigation, being nonjudgmental, and establishing a partnership between pediatrician and parent.
“As pediatricians we have a responsibility to advocate, inform, and counsel parents on gun safety, educate the next generation of pediatricians, and research gun safety and gun violence prevention,” Silver concluded. “It is a public health crisis in need of health care providers to step up and act.”
Debra J. Hendrickson, M.D., of the University of Nevada Medical School in Reno, discussed how climate change is a health crisis for pediatric patients.
“The climate crisis is an urgent health crisis for children. They are especially vulnerable to environmental threats, and are already being impacted, in every region of the country,” Hendrickson said. “Pediatricians are caring for the population with the most at stake. For that reason, they have a special obligation to educate themselves and parents of their patients about the health impacts of climate change, and what everyone can do to reduce their own greenhouse gas emissions.”
In one study, Morgan Congdon, M.D., M.P.H., of the Children’s Hospital of Philadelphia, and colleagues demonstrated that racial/ethnic differences are pervasive in the health care setting, even among children who are considered our most innocent and potentially vulnerable populations. Specifically, the investigators identified differences in the treatment of children in the emergency department based on race/ethnicity.
“We found that nonwhite children with dehydration from gastroenteritis who presented to the emergency department had a shorter length of stay overall. When controlling for age and how sick a child was at presentation using triage acuity, white patients were more likely to get treated with intravenous fluids and were more likely to be admitted to the hospital,” Congdon said. “There were no differences in return visits to the emergency department within 72 hours of the initial visit and no difference based on insurance status.”
According to Congdon, these findings suggest possible overtreatment among white patients and undertreatment among nonwhite patients.
“It is important for physicians to recognize and minimize implicit bias that may contribute to racial/ethnic differences in care so that we can better serve our nation’s most vulnerable children,” Congdon said.
Jennifer A. Hoffmann, M.D., of the Ann & Robert H. Lurie Children’s Hospital of Chicago and the Northwestern University Feinberg School of Medicine, and colleagues identified a relationship between county poverty concentration and suicide among children. The investigators found that children living in counties with the highest poverty concentration, with more than 20 percent of individuals living below the federal poverty level, were at a 37 percent increased risk for dying by suicide as compared with those children living within the lowest poverty-level concentration.
“We also found a relationship between poverty-level concentration and suicide by a firearm. In particular, we found that children living in counties with a high poverty concentration were nearly twice as likely to commit suicide by firearm as compared to those living in a low poverty concentration,” Hoffman said. “Consistent with other work, we found that suicide rates among children have been on the rise over the last decade, and are more common in rural as compared to urban areas.”
As for clinicians, Hoffman recommends they screen for depression and suicide in clinical practice, and in those children for whom risk is identified, they should ensure that these children do not have access to a firearm.
“From prior work, we know that most adolescents who die by firearm suicide acquired the firearm from a family member. In addition, previous research efforts have demonstrated that firearms are the most lethal means of suicide,” Hoffman said. “To prevent teen suicide, parents should keep firearms locked and unloaded and keep ammunition locked separately. Clinicians should also ensure that adolescents do not have access to medications in the home that they could use to harm themselves by overdose. In addition, screening and counseling for suicide risk prevention should be a heightened priority for clinicians practicing in settings with a high poverty concentration, due to the higher suicide risk we found in those areas.”
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