Just Add Water

-By: Anisha Patel, MD, MSPH, Karla Hampton, JD, and Ariana Oliva. Edited by Vivien Sun, MD- Nov 10, 2014

Increasing the cost of sugary drinks and reducing their access in schools and community settings is an important strategy for curbing intake of these beverages, which has been linked to negative health outcomes including obesity, diabetes, and dental caries.1-4 Perhaps equally important, however, is that children have access to safe drinking water throughout the day – at home and at school – where they spend much of their time. 

Across the U.S., there are emerging efforts to ensure easy access to safe and appealing drinking water. California Senate Bill 1413 and the 2010 Healthy Hunger-Free Kids Act require fresh, free drinking water to be available at school mealtimes both in California and nationally.5-6 In addition to legislation, some schools and their community partners are taking the lead in promoting drinking water access and consumption. In partnership with the San Francisco Public Utilities Commission, San Francisco Unified School District has installed appealing water stations that allow easy filling of reusable water bottles in schools as a part of the “Green the Next Gen” initiative.7 Just south of San Francisco, the Santa Clara County Water District in partnership with First 5 Santa Clara County is installing water stations in schools, parks, museums, and the San Jose airport through their “Water to Go” program.8

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Reflections of a Patient

- By: Morgan Gleason, Edited by Lilly Bellman, MD - Oct 13, 2014

Last fall, I went into the hospital to get my regular Solumedrol and IVIG treatment that I had been getting for about 3 years. After the treatment, I usually get a bad headache that sometimes lasts for a few days, but this time, it was different. I was discharged from the hospital on Friday, and on Saturday my headache was worse than normal, and I had new pain in my knee and back. I went to the Urgent Care because Advil and Tylenol were not working. They prescribed Vicodin, and other than me acting a little crazy and getting some short-term relief, the headache was still very bad.

That Monday, we called my doctor. He said to wait it out and maybe it was a virus. When we called back on Tuesday, he prescribed a higher dosage of steroids to take for a few days to see if that helped. Several times, we discussed going to the ER but I didn’t want to go because I knew it would mean a spinal tap.

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Undocumented Parents and Children with Medical Conditions: How a Health Care Provider’s Letter can Help

-By: Melissa Adamson, Edited by Vivien Sun, MD- Aug 25, 2014

Have you ever been asked to write a letter describing a child’s medical condition for immigration purposes?  Are these families holding out false hope or is there truth to the idea that children with special health care needs might qualify a member of the family for special immigration status?  The answer is complicated.  In this article, I will review three methods by which undocumented immigrants may seek legal permanent residence status in the United States. I will also explain how a letter from a physician detailing a child’s medical condition may support their application.   

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Health Services in Head Start and Early Head Start Programs

-By: Maryna Pecherska, MPH, Edited by Patrick Peebles, MD- Jul 23, 2014

Fifty years ago, in 1964, President Johnson declared The War on Poverty, and among the other programs like Social Security and Food Stamps, Project Head Start was launched to address the research findings that showed the impact of poverty and education on overall well being of families and children’s future success. In the last 50 years Head Start has grown into a highly esteemed child development program that addresses not only the school readiness skills of children, but also the social, health and educational needs of the whole family. The Head Start goal is to address the needs of the entire family in order to give them an opportunity to enter kindergarten ready to learn and empowered to succeed on par with their more privileged peers.

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Free and Appropriate Public Education in the Least Restrictive Environment: Some Special Education Basics

- By: Jia Min Cheng, Edited by: Sohil Sud, MD - Jul 7, 2014

FAPE in the LRE.  As with just about any other area of specialization, working within the world of special education comes with a whole new set of confusing acronyms to learn.

 As the attorney for the Medical Legal Partnership with the SFGH Children's Health Center, I had to start learning these acronyms very quickly once it became apparent that many families need help navigating the special education system. I started with the foundational phrase, concept, and legal requirement: FAPE in the LRE.  Free and Appropriate Public Education in the Least Restrictive Environment.  Having learned what the letters stand for, I next needed to learn what this meant practically and how to adapt it for each individual student. 


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Vein of Galen Malformations

- By: Maggie Chow, PhD, Edited by Lilly Bellman, MD - Jun 30, 2014

Vein of Galen malformations (VOGMs) are rare congenital malformations of blood vessels in the brain. In these VOGMs, the arterial blood coming from the heart flows directly into the veins without first passing through a capillary bed. This effect is known as an arteriovenous shunt. These shunts can have serious consequences on the development of the brain, heart and lungs. In this article, we will briefly review the epidemiology, symptoms, treatment and outcomes of children with VOGMs. 

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Toddler with a limp? Find out the diagnosis here!

- By Sabrina Santiago, MD - Jun 16, 2014

Last week I presented the case of an 18-month-old girl with limp for 5 days and refusal to walk for one day.  She was crying more with diaper changes, and had some tenderness over the lumbar spine.  Initial spinal films were negative, so she was sent home.  However, upon phone follow-up the next day, she had continued symptoms.  Readers were asked two questions:

1.      What’s in your differential?

2.      What’s your next step?


Thank you to everyone who sent their thoughts to our email address and those of you that shared your differential on our Facebook page.

This child had discitis!  Other diagnoses in the differential can be thought of in groups, including infectious (osteomyelitis, muscle abscess, septic hip, pyelonephritis, etc.), inflammatory (arthritis), musculoskeletal (trauma, including non-accidental trauma, disc degeneration or prolapse) and neoplastic.  These are just some of the diagnoses in the differential, but I thought I would take this opportunity to teach a little about discitis, which is rare in children, but a serious disease.  Thanks to Dr. Andrea Marmor for inspiring me to present this case.

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Toddler with a limp? Expand your Differential!

- By Sabrina Santiago, MD - Jun 9, 2014

You are the attending physician in Pediatric Urgent Care.  An 18 month old girl presents with a limp for the last 5 days, and then refusal to walk for the last day.  Her parents report that she has been more fussy and clingy.  She has no past medical history, and was born on time.  She doesn’t take any medicines or have any known allergies.  She hasn’t had any fevers, and has been eating well.  No URI symptoms or vomiting/diarrhea.  She is being potty-trained, but is still in diapers, and seems to cry more with diaper changes.  

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The Fetal Alcohol Spectrum Disorders

- By Tristan Sands, MD, PhD - Edited By Sabrina Santiago, MD Jun 2, 2014

Fetal Alcohol Syndrome (FAS), a condition characterized by a triad of 1) growth restriction, 2) characteristic facial dysmorphisms and 3) developmental impairment of the central nervous system. FAS represents only the most apparent amongst a set of diagnoses associated with fetal alcohol exposure, "only the tip of the iceberg." Collectively, they are called the Fetal Alcohol Spectrum Disorders (FASDs) and together they represent the leading preventable cause of neurodevelopmental disability. 

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Acupuncture Helps Pediatric Patients Manage Pain and Nausea

- By Leslie Lingaas - May 20, 2014

The pink plastic box that Cynthia Kim, MD, EdD, opens at the bedside of a young patient at UCSF Benioff Children’s Hospital San Francisco looks like it might contain art supplies. But inside is everything she needs to provide an ancient form of pain relief. Kim is one of three physicians within the UCSF Department of Pediatrics trained to perform acupuncture on hospitalized patients, making UCSF one of a very few academic medical centers to offer this complementary treatment to both inpatients and outpatients.

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