Let’s talk about…

Teenage girl and physicianA recent study conducted in New Jersey and Pennsylvania looked at electronic documentation and notes from pediatric visits and showed pediatricians had only documented a sexual history for one out of five teenagers.  The authors of the study also found very low rates of recommended testing for sexually transmitted infections in teenage patients, a finding concerning given that half of all chlamydia and gonorrhea cases occur in people between the ages of 15 and 24.

So why aren’t some pediatricians talking about sex?

There several reasons to consider.   Time constraints on visits make in-depth history taking difficult and put pressure on providers to limit the questions that they are able to ask.  Some also believe that some pediatricians just are not that comfortable asking or assume that they’ll know what kids are at risk, though studies show that 47 percent of U.S. high school students have ever had sexual intercourse.  Lastly, because there are laws and ethics that protect the conversation between adolescents and their providers (except when there are reports of abuse or concern for imminent self-harm to the patient’s self or to others), some providers may chose not to document fully the conversations that they have with adolescents, even if they are asking the questions.

Many might wonder how important it is for a pediatrician to ask an adolescent about their relationships and sexual activity, but this is a critical part of providing the appropriate counseling, testing, and education to support health.  Here’s the deal:

Let’s talk about… much more than sex.  Though it’s often labeled a “sexual history,” the conversations between a provider and an adolescent encompass much more than that, ranging from safety and relationships at home and at school or work to diet, body image, drug and alcohol use, and mood.  The “sexual history” is just part of the interaction, and even that conversation covers a number of different topics.  Often, providers will start by talking about attraction, puberty, and healthy relationships at younger ages.  As teens get older, discussions are guided by the patient’s experiences and include anticipatory guidance and education to help teens be as safe and healthy in their relationships as possible, including delaying sex if they’re not ready.  We also screen for violence or abuse in relationships and open up a safe space for victims of sexual assault.

Families play an enormous role in education around all of these topics, and an open relationship that encourages straightforward discussion with lots of room for questions can be a teen’s best resource.   A pediatrician that asks these important questions can add to that by being another trusted adult with access to the latest up-to-date information and tools for screening and prevention of sexually transmitted infections and pregnancy.

Let’s talk about…
About Brittany Allen, MD
Dr. Allen is a pediatrician at UW Health University Station. Her special interests include preventive pediatric care, adolescent health and care of LGBT and transgender youth.

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Posted in Teens | Tagged , , ,

Educational and Social Opportunities for All Children

Katie and Benny

Katie and Benny

When I was in preschool my best friend was a boy in my class named Benny. He had spina bifida and used a wheelchair, which I was very jealous of and thought was super cool.  When I turned four I invited him to my birthday party. Benny arrived, and as soon as his parents left our house,  he screamed and cried. His parents had shared with my parents that this was the first time he had been invited to someone’s house and the first time he had been to a birthday party. His parents waited for a while on the porch to make sure he would settle in and have a good time, which he definitely did.  Benny and I were very fortunate to attend a preschool which was able to accommodate special healthcare needs children.  I was able to have a wonderful friendship with Benny, and Benny was able to engage in normal childhood activities.

As a pediatric resident in the children’s hospital I frequently see children with special healthcare needs (any child with medical needs above that of an average, healthy child). 15.5% of children in WI have special healthcare needs, and I wonder if they have the same early education opportunities as my friend Benny did.  Are children with special needs welcome at day cares, preschools, and other childcare venues? Are environments created where they have the same opportunities to interact with their peers and make friends?

While there are some local resources, the need is much greater than can be met by the available services. Families of children with special healthcare needs have a very difficult time finding childcare, and for those who do, sometimes their children are asked to leave because their needs are too great. Childcare centers do not always have the resources and support required to provide the necessary care for children with special needs. In addition, early education programs that do have the ability to do so aren’t able to enroll all of the eligible children.  It is important that families and healthcare providers be aware of what is available, but more importantly we need to know what is still lacking and work to fill those voids.  Benny’s life was positively impacted by being able to get the services that he needed.  We should work hard to ensure that every child with special healthcare needs has that same opportunity.

A few of the local resources are:

  • Head Start  provides need based early education and childcare
  • The southern regional center for children and youth with special healthcare needs at the Waisman Center helps connect families to resources
  • United Cerebral Palsy of Greater Dane County provides services and connects families with outside resources
  • 4-C  provides resources and referrals to childcare and facilitates free play groups for children and parents
  •  Gio’s Garden provides respite care for children with developmental or physical delays
  • Center for Families provides respite and crisis child care
Educational and Social Opportunities for All Children
About Katie Rebedew, MD
Dr. Rebedew is a pediatric resident at the University of Wisconsin Pediatric Residency Program.

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Contraception: What’s Best for Teens?

ss_160528112_teen_girlsTeen pregnancy is a public health concern, and it’s totally preventable. True, not having sex is the best way to prevent pregnancy. However according to the most recent CDC Youth Risk Behavior Survey (YRBS), over 64% of teens have had sex by the time they graduate high school, so we need to suck it up and talk about the next best way to prevent pregnancy: contraception. Last week, the American Academy of Pediatrics released an updated statement asserting that the best contraception for teens is Nexplanon (implant in the arm that lasts 3 years) and the intrauterine device (device placed in the uterus during a pelvic exam and lasts 3 years-10 years, depending on the type). Together, these contraceptives are called Long Acting Reversible Contraceptives (LARCs).  These are the most effective pregnancy prevention for a number of reasons.

For one, LARCs take the responsibility of adherence off the teen’s shoulders.  All forms of contraception work best when taken appropriately. For example, birth control pills should be taken at the same time every day (I’m going to repeat that. At the same time every day.  NOT “in the mornings during school days and at nights during the weekend, and oops, I forgot to take Friday’s pill so I’m going to take 2 on Saturday.”)  There are similar scenarios for the patch, ring, and injection; trust me, I hear them at least once a day from my patients.  This is why most sources list 2 effectiveness statistics for each method: one is for PERFECT use (as in, taking the medications exactly how they are prescribed down to the T) and another for typical use (how most well-meaning people take meds).  For the implant and IUD, once they’re in, they’re in.  There is no difference between perfect use and typical use. Even when looking at perfect use for those other contraceptives, LARCs still have a higher effectiveness rate.

The duration of LARCs (3 years for the implant, 3-10 years for the IUD) is perfect for females going through transitions like starting college or graduating from college and starting a job.  Sometimes there are issues that can make obtaining the other contraceptives more difficult (access to pharmacy to pick up the prescription, access to clinic to get the shot, finding a provider in the area that takes her insurance, transportation, etc).  Although having a LARC does not mean that the female should stop getting annual check-ups, at least she can rest easy that she is at low risk of getting pregnant during these transition periods.

Also, LARCS are also great for period control.  There are many reasons that periods need medical treatment, including being too heavy or long, too painful, or not often enough.  Hormone fluctuations during the menstrual cycle can be responsible for seizures, severe mood changes, skin changes, etc.  There are many medical conditions in which hormonal medication is a mainstay of treatment, including Polycystic Ovarian Syndrome and Endometriosis. In my clinic, I do the procedures for implants and IUDs as much for menstrual management as I do for contraception.

Don’t get me wrong – I am a big fan of whatever the teen chooses to prevent pregnancy, be it the birth control pill, patch, ring, shot or LARC. (Besides the “withdrawal method.”  I’m not a fan of that. I have lots of patients with babies due to that method of “birth control.”)  I just want each teen to know ALL her options and make sure she is choosing the right one for herself (and LARCs are a great option for everyone).   I also want each teen to know that nothing is 100% effective at preventing pregnancy besides abstinence; and no hormonal contraceptive method prevents sexually transmitted infections so condoms are always encouraged for dual protection.

Stay tuned for future blog posts describing each of these contraceptives in more detail.  In the meantime, let me know your thoughts in the comment section below.

Contraception: What’s Best for Teens?
About Paula Cody, MD, MPH
Dr. Paula Cody is fellowship trained in adolescent medicine and is a pediatrician at the UW Health John Stephenson Teenage and Young Adult Clinic.

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Vote to help AFCH win a $10,000 grant

Siena-8333A vote on Facebook can help American Family Children’s Hospital win a $10,000 grant from Jewelers for Children.

Goodman’s Jewelers  has nominated American Family Children’s Hospital for the Jewelers for Children (JFC) Local Grant Program. JFC, a non-profit organization founded by the jewelry industry in 1999, is dedicated to helping children in need. The Local Grant Program has set aside $100,000 to fund 10 $10,000 grants for local children’s charities around the country. Jewelers were asked to nominate their favorite non-profit.

To vote:

  • Visit http://woobox.com/7gkxcz/akss5q
  • Like the Jewelers for Children Facebook page
  • Click on the “Local Grant Program” link
  • Scroll down to the American Family Children’s Hospital logo and click the vote button below
  • Scroll to the bottom of the page, enter your email address and click the submit choice button

After you vote, use the buttons at the top of the page to ask your friends to vote for American Family Children’s Hospital, too.  You can vote everyday between October 6-19. One vote per day  per email address.. The top 10 vote-getters will receive the grants.

We won the grant last year, with the help of our Facebook followers and children’s hospital community, and we’d love to win again! Thank you so much for your support.

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“Mommy, I hit my head!”

ss_203413669_girl_crying_headYour toddler falls and hits their head but appears to be fine. Your grade-schooler hits their head after falling off of their bike and complains of a headache. Your football player collides with another player and is knocked unconscious. Head injuries are common in children and adolescents, but which head injuries require medical evaluation? Here are some tips:

A concussion is a traumatic brain injury that temporarily changes the way the brain functions. Concussions can occur after a direct blow to the head. They can also occur after violent shaking of the head or upper body.

Contrary to popular belief, most people do not have a loss of consciousness with concussions. Thus, it can be hard to determine if your child has a concussion. The most common symptoms after a concussion are headache, memory loss, and confusion. However, the following list of signs and symptoms may be associated with concussions.

Signs and Symptoms:

  • Headache
  • Blurred vision
  • Dizziness
  • Nausea or vomiting
  • Sensitivity to noise or light
  • Balance Problems
  • Feeling tired
  • Irritability
  • Change in mood (sad, nervous, anxious)
  • Difficulty concentrating
  • Memory loss
  • Change in sleep (sleeping more, sleeping less, trouble falling asleep)

If you believe your child has a concussion you should call your doctor for further advice.

Seek emergency medical care if your child has the following symptoms.

  • Loss of consciousness lasting more than 30 sec
  • Repeated vomiting
  • Worsening headache
  • Slurred speech
  • Confusion or trouble recognizing people/places
  • Seizure
  • Large (dilated) pupils or pupils of unequal size

Athletes with a concussion should never return to the game until they have been evaluated by a health care professional who is experienced in evaluating for concussions.

What can you do to help prevent your child from suffering from a head injury?

  • In the car, make sure to buckle up your child and to use the appropriate child safety seat or car seat.
  • Make sure your child wears a helmet when riding their bike, playing a contact sport, batting or running bases in baseball/softball, horseback riding, or when skiing/snowboarding.
  • If you have young children, install safety gates at the top or bottom of stairs and make sure that they do not play near open windows.
“Mommy, I hit my head!”
About Amanda Becker, MD
Dr. Amanda Becker is a pediatric resident at the University of Wisconsin Pediatric Residency Program.

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