After careful consideration, we have made the difficult decision to transition MIAAP’s Annual Conference, from a Hybrid, to a fully virtual conference. As the delta variant continues to spread in Michigan, the safety and wellbeing of our members, staff, speakers and vendors, is the utmost priority.

Therefore all previously scheduled in-person elements of the conference will now be offered online. To ensure continuity, all of the conference’s originally planned topics, speakers and CME/MOC 2 offerings, will stay the same. Networking and “meet and greet” opportunities built into the virtual conference experience will remain in place.

We are excited about the great topics and speakers presenting this year and while we won’t be in-person, we anticipate an interactive and lively conference!

As a reminder, this conference offers a total of 11 CME credits and 20 MOC 2 credits (if you sign up for the MOC 2 activity). If you have not already, PLEASE visit the link below and register for MIAAP’s Annual Conference and join us from the convenience of your home or office!

MIAAP Annual Conference Registration: Annual Conference — MIAAP

By PAUL NATINSKY

It takes a special person to turn a personal tragedy into a protective message for other families. And that is exactly what Tammie Budrow did more than a decade ago, when she founded the Chill Out for Winter Safety Program. Chill Out educates children, their teachers and parents about how to stay safe when engaging in winter activities, some of which contain hidden dangers.

In the winter of 2007, Tammie lost her then 8-year-old daughter, Carly, to a sledding accident that involved a crash with a tree barely the width of a person’s calf. A fifth generation Fife Lake resident, Tammie made sure her adventurous Northern Michigan family left the house in the proper gear for their many outdoor activities.

Whether it was dirt biking, skiing or any other activity with an injury risk attached, everyone had their helmets, the proper clothing and protective gear.

But sledding on a local hill with only sparse, thin trees? Tammie and many other parents had no idea about the injury risks.

After Carly’s accident, Tammie set out to spread the word about winter sports risks to as many parents, children and teachers as she could. She and others in the community removed the dangers and installed a protective fence on the sledding site now known as Carly’s Hill.

She then combed through scores of Google hits and found hundreds of pieces of advice about winter sports safety. She hoped to find coloring books, posters or other educational aids that she could bring to schools to alert parents, teachers and kids about winter sports risks and proper precautions. Nothing.

Tammie took matters into her own hands and the American Academy of Pediatrics, orthopedic surgeons, all the children’s hospitals she could think of, the ski resorts, the company in Vermont that supplied the safety fence for Carly’s Hill.

“Every single place I checked—Alaska, Colorado, everywhere—everyone said, ‘We don’t (have materials like that), but that would be a good idea.’ Well, I thought, we’ll just have to make our own,” said Tammie.

That first winter she worked with local fire & rescue and police departments. They came together in a big group to put on a safety program for Carly’s school.

That first school presentation was a start, but Tammie wanted to expand the program, reach more people and potentially save lives. So she talked to her boss at Munson Healthcare who put her in touch with Jennifer Froelich, a safe kids injury prevention educator who showed immediate interest.

“Of course, she’ll tell you, when you have a grieving mom come to you with an idea, you don’t just shut them down,” said Tammie, with a chuckle.

Soon after, Tammie and her husband sat down at the kitchen table and thought of key points for every winter activity they thought they needed to cover.

Then Froelich brought another safety educator, Fred Doelker, onboard.

After that, “Fred, Jen and I got together and created Chill Out, the winter safety program,” said Tammie.

The program’s message is simple and straightforward. It’s commonsense advice, but raises awareness about dangers and precautions that might not occur to even cautious parents. The pillars of the program include:

Tammie says she will continue to present the multi-media program to schools and at winter sports festivals as long as possible. She figures the Chill Out for Winter Safety Program reaches about 5,000 children a year.

She says the program is growing as more people and organizations want to partner each year. In one case, a pilot who moved to Alaska has begun to spread the message there.

At a time when legal mandates are very out of fashion, Tammie says she has advocated for mandatory winter sports helmets for children younger than 12 years.

She has—and will continue to—raise the issue with legislators, but is realistic about the chances of advancing a mandatory helmet law in a state that just did away with one for motorcyclists.

Still, her hope is that enough people get the message that helmet wearing for high-speed sports becomes as common as seatbelt wearing in cars.

Question: I have a patient whose mood worsened when I started him on stimulants for ADHD symptoms. How do I know whether to treat the mood or the ADHD?

Answer: Treatment of ADHD with co-occurring mood disorder is a relatively common clinical problem. When both conditions exist, a rule of thumb is that providers treat the most problematic condition first, with the corresponding appropriate medication (stimulant for ADHD, SSRI or mood stabilizer for mood). Appropriate screening tools such as the PHQ-9 for depression or Vanderbilt/ACTERS for ADHD may help.

Children who have ADHD should also be receiving some sort of behavioral management treatment. Children with mood disorders should likewise be treated with cognitive behavioral therapy. For those children who have mood symptoms after initiation of a stimulant, the following should be considered:

●      Time of day/rebound symptoms: irritability and lability which occur as the medication blood levels are rapidly decreasing in the afternoon can be addressed by adding a small dose of PM stimulant before 4 PM.

●      Depressive symptoms which are problematic throughout the day may suggest an emerging mood disorder or may suggest that the stimulant is exacerbating a genetic predisposition toward major depressive disorder (MDD) or bipolar disorder.

●      For secondary symptoms of depression, often withdrawing the stimulant will allow the provider to determine whether the stimulant increased the effect of underlying depression. If stimulant is causing depressive symptoms, an alpha agonist and/or bupropion might be considered to address the ADHD. If the stimulant is clearly helping the attentional symptoms with co-occurring symptoms of MDD, then a cautious trial of SSRI might be introduced.

●      For symptoms of episodic lability, irritability, insomnia, and elevated or expansive mood suggesting bipolar disorder, the stimulant should be withdrawn and consideration given to a trial of mood stabilizer. Following stabilization of mood, cautious re-introduction of stimulant can be considered.

MIAAP is happy to present this monthly column with insights from the MC3 Program’s child and adolescent psychiatrists. MC3 offers no-cost psychiatry support to primary care providers in Michigan who are managing patients with behavioral health problems. To learn more or become an MC3 enrolled provider, visit mc3.depressioncenter.org

As summer turns to fall, MIAAP and the national AAP continue to work on your behalf, with full fall calendar of events, information and advocacy, including new guidance on sports and COVID, AAP Board work on COVID and children’s mental health, and a podcast addressing treatment and support for gender-diverse youth.

The AAP recommends pediatricians ask patients during sports exams if they have had the COVID-19 vaccine or SARS-CoV-2 infection. Updated pre-participation history and physical exam forms now have a section for COVID-19 information.

The changes give pediatricians a starting point to discuss vaccination and the opportunity to document the history in the patient’s medical record. The recommendations are included in the updated interim guidance on returning to sports and physical activity.

The Academy also has signed onto a statement with physician groups, sports medicine groups, high school and college associations, and the U.S. Olympic and Paralympic Committee that urges all medical providers to ask about COVID-19 vaccine at all sports preparticipation evaluations. The statement also encourages all youth sport and athletic associations to spread the message to their communities about vaccinating athletes to prevent “widespread disease, hospitalizations and deaths due to COVID-19” and to help “keep students in the classroom, athletes in the game, and athletic teams on the field, while protecting our communities.”

The groups are calling on all athletes who are eligible and do not have contraindications to be vaccinated against COVID-19 as soon as possible because it takes several weeks to reach full immunity.

For more information on how pediatricians should evaluate patients who want to return to sports or physical activities after COVID-19 infection, including the latest information on mask wearing, please follow the link below.

Interim Guidance: COVID-19 Interim Guidance: Return to Sports and Physical Activity

Pediatricians can play an integral role in addressing pandemic-related mental health concerns among children, which are at crisis levels, said Joshua A. Gordon, MD, PhD, director of the National Institute of Mental Health.

During a presentation at the AAP Board of Directors meeting this summer, Dr. Gordon discussed the pandemic’s impact on children’s mental health and how some have been affected more than others.

“Mental health was already crisis proportion for children prior to the pandemic, and the pandemic exacerbated that,” Dr. Gordon said. “(But) there’s a lot that primary care pediatricians can do.”

The proportion of mental health-related emergency department visits during April to October 2020 was higher than in the same months in 2019, according to a Centers for Disease Control and Prevention report. Visits increased 24% in 5- to 11-year-olds and 31% in 12- to 17-year-olds.

Nearly 40,000 children have lost at least one parent during the pandemic. Black children make up 14% of the childhood population but 20% of the population of children who lost a parent to COVID-19.

Several studies also have shed light on negative impacts of virtual and hybrid learning on children’s physical activity, time spent outdoors, and mental and emotional health.

Research prior to the pandemic identified disparities in mental health care.

“There is not uniformity across the different aspects of the U.S. population, with youths getting different access to treatment depending on their communities and different access to quality care within those communities,” Dr. Gordon said.

For more information on identifying mental health risks and treating children, please follow this link: https://www.aappublications.org/news/2021/06/09/mental-health-covid-pandemic-060921

On the latest episode of Pediatrics On Call, Ilana Sherer, MD, FAAP, executive committee member of the AAP's Section on LGBTQ Health and Wellness, offers best practices when it comes to treating and advocating for gender-diverse youth. Hosts David Hill, MD, FAAP, and Joanna Parga-Belinkie, MD, FAAP, also talk to Rebecca Scharf, MD, MPH, about her article in the journal Pediatrics focusing on developmental delays in children coming to the United States as refugees. Listen here. Pediatrics On Call is supported by Johnson & Johnson.

August 2021

Volume XXIX, Issue 8

MIAAP is urging Michigan Schools to adjust school guidance to reflect the AAP’s most recent guidance on safe, in-person learning.

This comes as Michigan experiences a surge in COVID-19 cases, as the virus’s highly contagious Delta variant makes its way across the country. Increases in infections, hospitalizations, and deaths have concerned medical and educational professionals, who wish to bring children back into classrooms while minimizing the risk of a COVID-19 outbreak.

“The recommendation for universal masking of all children older than 2 years is one of multiple measures to reduce transmission in the school setting. Currently, children under age 12 do not have the option to be vaccinated, vaccination rates remain low in 12-18 year-olds, some members of the school community cannot be vaccinated due to underlying medical and immune system conditions,” says MIAAP Past President and Pediatrician, Dr. Sharon Swindell.

To ensure children are able to return to school safely, the American Academy of Pediatrics recently updated its guidance around in-person learning, which includes—alongside vaccinations—a recommendation that everyone older than age 2 wear masks, regardless of vaccination status.

Other recommendations included in the AAP guidance are: