#68: AAP Recap Part 2!

October 26, 2022 | By Sam Masur

Summary

Practice-changing pearls coming in hot in our second AAP 2022 recap episode recorded live in Anaheim, CA! Learn top tips for diagnosing and managing ADHD, precocious/delayed puberty, and neurologic complications of Covid19; find out what’s new in contraception; and hear how pediatric providers can be essential advocates for the safety and well-being of the kids we care for.

Credits

• Written, Produced, and Hosted by: Joan Park MD, Chris Chiu MD, Nick Lee MD & Sydney Engel FNP 
• Executive Producer: Nick Lee MD
• Showrunner: Sam Masur MD
• Cover Art: Chris Chiu MD
• Editor: Justin Berk MD; Clair Morgan of nodderly.com

AAP 2022 Highlights: Speakers, Resources, & References

How to Diagnose and Treat ADHD in a Busy Practice (David Childers MD)

• Template letter to request an initial evaluation for special education services: https://www.parentcenterhub.org/evaluation-2/
• Tool to convert doses of stimulant medications: http://www.adhdmedcalc.com/ 

Contraception and Menstrual Suppression (Rachel Goldstein MD & Jonathan Avila MD) 

• CDC Contraception App is helpful to assess eligibility criteria for contraception use
• LNG-IUDs are noninferior to Copper IUDS as emergency contraception if used within 5 days of unprotected sex (Turok et al., 2021)
• Medroxyprogesterone Acetate is now available in a subcutaneous form. Though self-administration is off label, it has been found to increase continuation rates with  similar effectiveness. (Curtis et al, 2021) 

Variations in Pubertal Development (Marissa Kilberg, MD)

• Framework (“The David Langdon Approach”)
  • Is it really a sex hormone effect?
  • Are other sex hormones involved? What else is associated
  • Is it pathologic? / How do I screen?
  • Does it warrant a referral?
• Essential oils as endocrine disruptors? The evidence is mixed: 
  • A small 2020 systematic review did not find evidence of endocrine disruption due to lavender or tea tree oils and advised further epidemiologic research (Hawkins et al., 2020)
  • Case reports have identified links between lavender-containing fragrances and  prepubertal gynecomastia/premature thelarche (Ramsey et al., 2019)
• Use immunochemiluminescent (ICMA) or similar ultrasensitive assays when assessing LH levels in children – this level of sensitivity is needed due to a significantly lower baseline LH secretion (Clark et al., 1997)

Published Studies that Could Change the Way You Practice (Lewis First MD & Alex Kemper MD)

• “Safe Sleep Behaviors and Factors Associated With Infant Second Sleep Practices”: Study demonstrated that less than 10% of infants met safe sleep criteria throughout the night, with a decreased likelihood of safe sleep practice use during the second sleep period (Bryan et al., 2022).
• “Age-Dependent Responsiveness to Smoke Alarm Signals Among Children”: Children were significantly more likely to awaken and escape the test room when alarms with a human voice and/or low frequency tone were used (84-88% awake; 83-88% escape) when compared with a high-frequency tone (53% awake; 51% escape) (Smith et al., 2022)
• “Watchful Waiting for Acute Otitis Media”: Of approximately 2.2 mil AOM encounters, 22% of clinicians appeared to use watchful waiting; whereas otolaryngologists appeared to use watchful waiting 72.2% of the time (Smolinski et al., 2022)

Pediatricians’ Role in Solving the National Addiction Crisis (Scott Hardland MD)

• 2 in 3 individuals in opioid treatment report first use before age 25, and 1 in 3 report first use before age 18 (SAMHSA, 2017).

Preparticipation Physical Evaluation (Patrick Lehman MD)

• AAP resources for Preparticipation history and physical exam: https://www.aap.org/en/patient-care/preparticipation-physical-evaluation/ 

Framing Immunizations: How To Move the Needle on Vaccine Acceptance (Julie Sweetland PHD)

• Report: Communicating About Vaccination in the United States: A FrameWorks Strategic Brief (O’Shea et al., 2021)

• Find additional resources at https://www.frameworksinstitute.org/ 
• AAP resources for communicating about vaccines with families: https://www.aap.org/en/patient-care/immunizations/communicating-with-families-and-promoting-vaccine-confidence/ 

Uvalde Pediatrician Gives Voice To School Shooting Victims (Roy Guerrero MD)

• “Pediatric Firearm Injury Mortality Epidemiology”: Data indicates that in 2019, firearm injury surpassed MVA to become the number one cause of death in children aged 0-19 years old (Andrews et al., 2022)
• AAP advocacy page on gun violence prevention: https://www.aap.org/en/advocacy/gun-violence-prevention/

Goal

Listeners will recall key pearls from topics presented at the AAP 2022 conference.

Learning Objectives

After listening to this episode listeners will be able to…  

1. Be familiar with the latest topics in pediatric hospital and outpatient medicine
2. Consider how these pearls and studies will change their current clinical practice

Disclosures

The Cribsiders report no relevant financial disclosures. 

Citation

Park J, Lee N, Engel S, Masur S, Chiu C, Berk J. #68: “AAP Recap: Part 2”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com/ October 26, 2022.