Sam is a 10 year old boy who presents for his well child visit with behavioral issues. His mother describes him as impulsive, hyperactive, argumentative, and he has difficulties following the rules. His grades have dropped significantly. He gets into fights with other students and has been labeled a bully.
Rachel is a 7 year old girl who presents to the acute care clinic with recurrent abdominal pain and headaches. She is absent or tardy to school most days and is getting Ds and Fs. She appears withdrawn and sullen when you examine her in clinic.
Children exposed to Intimate Partner Violence (IPV) often present to medical care with behavioral concerns or somatic complaints that may be the result of witnessing violence in their home. They are at greater risk for being abused or neglected and are more likely to develop adverse health, behavioral, psychological and social disorders later in life.read more »
During medical school and residency, we are trained to assess symptoms, diagnose and manage a multitude of medical conditions, and hone our time-management skills. It should therefore come as no surprise that the bulk of medical training is devoted to the acquisition of medical knowledge and procedural skills rather than to screening and addressing social needs. This often translates to our experience as attendings, where we prioritize medical management over managing health-related social problems.read more »
In my work at the UCSF Pregnancy and Postpartum Mood Assessment Clinic, I see patients who are in all stages of their fertility, pregnancy and postpartum journey. As one of the facilitators of the postpartum support group “The Afterglow”, I hear many different versions of women struggling in the postpartum setting. It is probably the most vulnerable time in a woman’s life, and women have such diverse responses given their respective demographics and backgrounds. However, I have found that there are common themes from the beginning of a woman’s fertility journey to the postpartum period. This speaks to the universality of the transition to motherhood and also its challenges. We know that 1 in 5 women are diagnosed with mood disorders in the postpartum setting, and many struggle throughout their pregnancies as well. As obstetricians and pediatricians come into the most regular contact with postpartum women, here are 5 things to remember when screening or helping to treat women with Perinatal Mood and Anxiety Disorders:read more »
Hearing loss is the most common congenital sensory impairment, affecting 1 in every 500 babies born in the United States. When not addressed before 6 months of age, childhood hearing loss has lifelong educational, behavioral, and economic consequences; a child with untreated hearing loss has estimated direct educational costs of $400,000 and lifetime societal costs due to lost productivity of $1,000,000. For the 10,000 children born with congenital hearing loss every year in the United States, the estimated lifetime economic cost will be on the order of $10 billion, which is on a par with the most common childhood medical disorders, such as asthma. Intervention before 6 months in the form of early intervention social/educational services, hearing aids, and cochlear implantation is significantly associated with improved outcomes regardless of mode of communication, socioeconomic status, or presence of other comorbidities (1).read more »
At 6:20am on December 31st, 2013, the San Francisco division of the California Poison Control System received a frantic call from a family who found their 14 year-old son unresponsive in his bedroom. Emergency medical services were dispatched, the patient was rushed to the emergency room, and he spent the day on a naloxone drip while his care providers wondered how a 14 year-old managed to overdose on gabapentin, zolpidem (Ambien), and oxycodone.read more »
One of the commercials during the Super Bowl XLVIII this year was Coca-Cola’s “Going All The Way”. It featured a young football underdog taking his touchdown run all the way to Lambeau field. What was his reward? A cold soft drink. This advertisement knows the American public well. Research shows that 50% of Americans over the age of 2 reach for one or more sugar-sweetened beverages (SSBs), like a soda or energy drink, every day.1 What is so bad about soda? For starters, the average soft drink contains about 22 teaspoons of sugar. Sports drinks, iced teas, juice drinks, vitamin waters and energy drinks are all around us and despite trying to appear as drinks for athletes or health enthusiasts, usually have as much sugar as soda. These beverage choices tempt our patients daily and, despite promises in advertisements, they are liquid sugar that are a prescription for obesity, diabetes, and heart disease.read more »
How many times have we seen this scenario unfold: a 5yo boy is watching Spongebob Squarepants. We say hi to him and introduce ourselves, but his eyes are glued to the screen. We then proceed to talk to his parents about the plan for the day, assuming he is not listening. Let’s say we then discuss the need for labs. “I don’t want any pokes!” the child will shout. Was he listening the whole time?read more »
Eosinophilic Gastrointestinal Disorders (EGID) are a group of conditions characterized by aberrant infiltration of eosinophils into the lining of the GI tract, and can cause significant morbidity in children. Chief among EGIDs, eosinophilic esophagitis (EoE) has emerged as an increasingly commonly diagnosed disease of the esophagus, leading to difficult or painful swallowing, refusal to feed, vomiting, abdominal pain, and failure to thrive in otherwise healthy infants, children, and adults. Noel et al. identified a four-fold increase in disease prevalence in children with EoE in the Midwest of the United States occurring over a period from 2000 to 2003 (1). A rise in incidence has also been reported in Olmstead county, Minnesota over the course of three decades (2). Untreated, patients with EoE develop complications such as esophageal stricture, long segment narrow caliber esophagus, esophageal dysmotility, food impaction, and even esophageal rupture (Boerhaave’s syndrome) (3).read more »
Although the US rate of unwanted pregnancies in teens has dropped significantly, it remains significantly higher than all other industrialized (and some unindustrialized) nations. Pediatricians are often the first provider to see a teen who has started having sex, and often that teen is having sex without any form of contraception, including within the last five days! You can help prevent an unwanted pregnancy by dispensing or prescribing emergency contraception. The following presents a few tidbits to help guide your practice.read more »
San Francisco is facing a housing crisis. This is being proclaimed via social media and the newspapers, locally and nationally. While much attention has been focused on the middle-income individuals and families who are rapidly being priced out of the city via evictions. Less attention has been paid to the plight of the low-income when it comes to housing. Yet this is the housing issue that arises most often for me and the San Francisco General Hospital medical providers when we work with patients.read more »