In the fall of 2013, a group of community leaders came together to discuss the issues of children’s oral health in the city of San Francisco. Partners included SF Department of Public Health, UCSF, SFUSD, SF Dental Society, University of the Pacific, local health centers, and many other contributors for various disciplines, and organizations throughout the city. As a result of this year-long process, a city-wide three year Strategic Plan was developed to improve the oral health of children living in San Francisco.
The data collected as part of the environmental assessment and the development of the San Francisco Children’s Oral Health (SF COH) Strategic Plan show that while there has been a marked improvement in children’s oral health status over the past 10 years (i.e. decreased rates of untreated dental problems, as well as caries experience), the Healthy People 2020 goals have not yet been met for San Francisco’s children. Furthermore, oral health disparities persist among children in low-income schools and underserved neighborhoods.read more »
The mother of a patient was recently diagnosed with a rare eye condition, requiring her to take oral steroids and other immunosuppressive medications. If left untreated, her disease would likely progress and cause vision impairment and even blindness. She had to take her medications to save her vision. My patient, a cute little 2 month-old boy, was still breastfeeding. This mother was now in a dilemma – her vision-saving medicines could pass through her breast milk and potentially harm her child. After a long discussion, she decided that while she would stop breastfeeding and pump and dump until she was done taking her medications.
She asked me, “What is the best formula for my baby?” This is a not-so-uncommon question, one that many moms ask, when they are unable to breastfeed. This is a universal question after all – Isn’t it every mother’s instinct and to feed their child the best nutrition? She was overwhelmed by the incredible number of formulas, brands, and types, non-organic vs organic, whey vs casein, cow’s milk vs soy, infant or newborn, fussy or regular baby, the list goes on.
I was able to help this mother find the best way to feed her child, but what about all the other mothers who may have the same question? In our current system, an infant has 8 visits before their first birthday. Sounds like a lot of visits, but what about the other 357 days of the year? There must be another way to stimulate the discussion between patients, providers, nurses, social workers, and any advocate of child health.read more »
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.8read more »
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.read more »
Undocumented Parents and Children with Medical Conditions: How a Health Care Provider’s Letter can Help
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.read more »
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.read more »
Free and Appropriate Public Education in the Least Restrictive Environment: Some Special Education Basics
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.
read more »
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.read more »
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.read more »
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.read more »