Joseph F. Hagan

Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening

Early identification of developmental disorders is critical to the well-being of children and their families. It is an integral function of the primary care medical home and an appropriate responsibility of all pediatric health care professionals. This statement provides an algorithm as a strategy to support health care professionals in developing a pattern and practice for addressing developmental concerns in children from birth through 3 years of age. The authors recommend that developmental surveillance be incorporated at every well-child preventive care visit. Any concerns raised during surveillance should be promptly addressed with standardized developmental screening tests. In addition, screening tests should be administered regularly at the 9-, 18-, and 30-month visits. (Because the 30-month visit is not yet a part of the preventive care system and is often not reimbursable by third-party payers at this time, developmental screening can be performed at 24 months of age. In addition, because the frequency of regular pediatric visits decreases after 24 months of age, a pediatrician who expects that his or her patients will have difficulty attending a 30-month visit should conduct screening during the 24-month visit.) The early identification of developmental problems should lead to further developmental and medical evaluation, diagnosis, and treatment, including early developmental intervention. Children diagnosed with developmental disorders should be identified as children with special health care needs, and chronic-condition management should be initiated. Identification of a developmental disorder and its underlying etiology may also drive a range of treatment planning, from medical treatment of the child to family planning for his or her parents.

The pediatrician and disaster preparedness

For decades, emergency planning for natural disasters, public health emergencies, workplace accidents, and other calamities has been the responsibility of government agencies on all levels and certain nongovernment organizations such as the American Red Cross. In the case of terrorism, however, entirely new approaches to emergency planning are under development for a variety of reasons. Terrorism preparedness is a highly specific component of general emergency preparedness. In addition to the unique pediatric issues involved in general emergency preparedness, terrorism preparedness must consider several additional issues, including the unique vulnerabilities of children to various agents as well as the limited availability of age- and weight-appropriate antidotes and treatments. Although children may respond more rapidly to therapeutic intervention, they are at the same time more susceptible to various agents and conditions and more likely to deteriorate if they are not monitored carefully. This article is designed to provide an overview of key issues for the pediatrician with respect to disaster, terrorism, and public health emergency preparedness. It is not intended to be a complete compendium of didactic content but rather offers an approach to what pediatricians need to know and how pediatricians must lend their expertise to enhance preparedness in every community. To become fully and optimally prepared, pediatricians need to become familiar with these key areas of emergency preparedness: unique aspects of children related to terrorism and other disasters; terrorism preparedness; mental health vulnerabilities and development of resiliency; managing family concerns about terrorism and disaster preparedness; office-based preparedness; hospital preparedness; community, government, and public health preparedness; and advocating for children and families in preparedness planning.

Psychosocial Implications of Disaster or Terrorism on Children: A Guide for the Pediatrician

During and after disasters, pediatricians can assist parents and community leaders not only by accommodating the unique needs of children but also by being cognizant of the psychological responses of children to reduce the possibility of long-term psychological morbidity. The effects of disaster on children are mediated by many factors including personal experience, parental reaction, developmental competency, gender, and the stage of disaster response. Pediatricians can be effective advocates for the child and family and at the community level and can affect national policy in support of families. In this report, specific childrens responses are delineated, risk factors for adverse reactions are discussed, and advice is given for pediatricians to ameliorate the effects of disaster on children.

Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure

Children and adolescents affected by prenatal exposure to alcohol who have brain damage that is manifested in functional impairments of neurocognition, self-regulation, and adaptive functioning may most appropriately be diagnosed with neurobehavioral disorder associated with prenatal exposure. This Special Article outlines clinical implications and guidelines for pediatric medical home clinicians to identify, diagnose, and refer children regarding neurobehavioral disorder associated with prenatal exposure. Emphasis is given to reported or observable behaviors that can be identified as part of care in pediatric medical homes, differential diagnosis, and potential comorbidities. In addition, brief guidance is provided on the management of affected children in the pediatric medical home. Finally, suggestions are given for obtaining prenatal history of in utero exposure to alcohol for the pediatric patient.

What Shall We Call Them

We are not surprised. We pretty much knew how the evidence would unfold. Authors of the article “The USA National Longitudinal Lesbian Family Study: Psychological Adjustment of the 17-Year-Old Adolescents” 1 report that late-adolescent girls and boys who are children of lesbians are doing just fine. When last discussed in Pediatrics in 2002, the American Academy of Pediatrics (AAP) Committee on Psychosocial Aspects of Child and Family Health statement “Coparent or Second-Parent Adoption by Same-Sex Parents”2 (reaffirmed February 2010) and the accompanying technical report written by Ellen Perrin, MD, FAAP,3 drew much attention and engendered controversy both within the AAP and outside of it. The AAP noted that there were large numbers of children being parented by gays and lesbians and that lesbian and gay couples were serving as coparents. It was important that pediatricians caring for these children understood these nontraditional relationships, and it still is. After a careful review of the literature … Address correspondence to Joseph F. Hagan Jr, MD, FAAP, Department of Pediatrics, University of Vermont College of Medicine, 410 Shelburne Rd, Burlington, VT 05401. E-mail: jhagan{at}aap.org

Reflecting on “Reflections on Well-Child Care Practice”

The word is out: we like our work with children and families. We really like it. Tanner, Stein, and their American Academy of Pediatrics (AAP) colleagues1 have let the cat out of the bag. Focus groups of primary care practitioners from around the country came together to discuss what we do, how we do it, and how we would like to do it better. They found practitioners who were committed to promoting health and preventing disease and were passionate about their anticipatory guidance and its impact on families. They noted how important we find our individual relationships with families and our passion for individualized care. This confirms our belief in preventive care. The history of our profession is in the care of the sick. The history of our specialty is in disease management … Address correspondence to Joseph F. Hagan Jr, MD, FAAP, Hagan and Rinehart Pediatricians, PLLC, 410 Shelburne Rd, Burlington, VT 05401. E-mail: jhagan{at}aap.org

A Health Policy Lesson Learned, or Not

Here’s an easy lesson for health reformers and policymakers: you get what you pay for. O’Leary and colleagues demonstrate how costs are the rate limiting step to enhancing US immunization rates, noting that “private practices are the backbone of the childhood immunization program.”1 Yet from their study we might glean how to change this step from rate limiting to rate accelerating. Immunization delivery policy in the United States has historically had 2 arms: (1) immunizations provided by the private sector to individuals who would accept or who requested this protection for themselves or their families; and (2) immunizations provided in public health clinics to the indigent or the general public in times of public health emergency. The public health sector, which includes the US Centers for Disease Control and Prevention and state health departments, researches and gives guidance on proper vaccine administration to all children, but the delivery of essential immunizations largely relies on the private health care sector. I believe I was fully immunized as a child certainly thanks to my caring and wise parents, but also owing to … Address correspondence to Joseph F. Hagan, Jr, MD, FAAP, Hagan, Rinehart and Connolly Pediatricians PLLC, 128 Lakeside Ave, Suite 115, Burlington, VT 05401. E-mail: jhagan{at}aap.org