Routine Childhood Immunizations - Bedrock of Primary Preventative Care

We’re all trying to endure as we wade through trying times. As a surfer on a rough wave, one keeps adjusting to maintain a balance on their board. Likewise, we have to seek that balance and use our tools, just like the surfboard – relying on self-care practices and our community of fellow pediatricians and pediatric providers. As we advocate individually in our local communities and nationally through AAP, take solace that our day-to-day tasks haven't changed. Our mission is to provide accessible, high-quality, evidence-based primary preventive care with routine childhood immunizations as a cornerstone. 

Niyi Omotoso, MD, FAAP

Chapter Immunization Representative, AAP-CA1

What is Cal-MAP and Why Should I Use It?

A worried mom brings her 10 year old daughter to see you for new severe anxiety since the birth of a new baby sister a month ago. The patient briefly stopped eating due to fear that she might vomit and make the baby sick. She has intense tantrums and has been resistant to going to school. She has started writing letters expressing guilt and feeling lost and asking for help. Her weight is stable, and she is without self harm or suicidality. She has started weekly therapy, but her anxiety seems to be getting worse. You are considering starting an SSRI but are wondering if it might be too soon.  

You have a few minutes in between patients, should you:  

1.  Avoid calling Cal-MAP because you have not had a chance to use an evidence-based rating scale for this patient’s anxiety
2. Avoid calling Cal-MAP because you don’t have enough time to consult with the Cal-MAP psychiatrist
3. Avoid calling Cal-MAP because you have not had a chance to register with Cal-MAP yet
4. CALL Cal-MAP for a consultation. 

I hope that with the Questions and Answers below, you will be convinced to use Cal-MAP for a free, prompt, provider to provider consultation for your patients with mental health concerns. Here is the Cal-MAP phone number so you can write it down and keep it handy: 800-253-2103. You can also sign up for the consultation service and educational resources at Cal-MAP.org.

Q & A

1.  As a primary care pediatrician, why is Cal-MAP useful? Cal-MAP provides expert guidance at our fingertips! There is a growing youth mental health crisis nationwide that will only be worsened by impending funding cuts to critical mental health services for youth. We are on the front lines of this crisis. Our patients and their families often come to us first with their mental and behavioral health concerns. As we know, kids wait months to see specialty mental health. Cal-MAP supports us to meet the mental health needs of our young patients immediately within our practices. With Cal-MAP, we are not alone.
2. Who does Cal-MAP serve? Primary care providers in California (MD/DO, NP, PA) working with patients age 0-25 yrs old (Pediatrician, Family Medicine, Internal Medicine, OB/Gyn)
3. Is there a cost for Cal-MAP services? All services are free and paid for by state and federal funding. No cost to clinics, insurance or families.
4. What services does Cal-MAP provide? Curbside consults by phone or E-Consults with a Child and Adolescent Psychiatrist (Mon-Fri, 8:30 to 5pm) for specific patient cases. 50+ hours of free CME training on diagnosing and treating mental health concerns: Webinars (live and recorded), Cal-MAP Statewide Curriculum Core Certification (6 hours covering ADHD, depression, anxiety, autism, suicidality and SSRI’s), Project ECHO (live virtual learning community). Curated resources for clinicians and families (downloadable and organized by diagnosis). Care Coordination services with referrals by geographic location and direct-to-family support in accessing services...continue reading...

Stay tuned for our August 28 Chapter Chat on Youth Mental Health from 6:30PM-8:00PM. This chapter chat will be about the current national political climate and the need for Cal-MAP and other resources that will support our patients (school based mental health services, Soluna, Brightlife).

CMA will be holding a Virtual Grand Rounds on Sept 9, 2025 from 12:00 P.M. to 1:00 P.M. Join this webinar to learn more about how Cal-MAP can provide clinicians with real-time consultation with behavioral health experts so they can help ensure their patients receive timely access to mental health care.

Lisa Leavitt, MD, FAAP

Chair, Committee on Mental Health, AAP-CA1

Redefining Primary Care's Role in Pediatric Obesity

Pediatric obesity is not merely a number on the growth chart—it is a defining public health challenge of our time. Today, 1 in 5 U.S. adolescents live with obesity, yet less than 0.5% ever receive medical treatment, as reported by Kompaniyets L, et al. Obesity Medication Prescriptions in Adolescents, as reported in the CDC MMWR 2025. The hopeful reality is that we now have clear, evidence-based guidelines. With proper care delivered at the right time, pediatricians can profoundly impact the health trajectory of an entire generation.

This is the moment for primary care to lead. Data from Münte E, et al. Prevalence of Extremely Severe Obesity. JAMA Netw Open. 2025 reveals a 253% surge in severe obesity (BMI ≥160% of the 95th percentile) since 2008, particularly among teens aged 16–18 and non-Hispanic Black youth. These children face an 8-fold higher risk of severe insulin resistance, a 5-fold increased risk of diabetes, and a 7-fold greater likelihood of developing fatty liver disease.

A recent Swedish study of over 6,700 adolescents treated for obesity found that successful intervention in childhood significantly reduced the risk of premature mortality, type 2 diabetes, and dyslipidemia (Putri RR, et al. Effect of Pediatric Obesity Treatment on Long-Term Health. JAMA Pediatrics. 2025). The findings underscore that obesity treatment during childhood and adolescence is not just about weight loss—it is critical for preventing chronic diseases and saving lives. This reinforces the vital role of pediatricians in addressing childhood obesity through early intervention and nutrition counseling.

Primary Care: The Frontline of Prevention

The 2023 AAP Clinical Practice Guidelines for the Evaluation and Treatment of Children and Adolescents with Obesity position pediatricians as leaders in this effort. At every well-child visit, we must systematically implement five evidence-based interventions...continue reading...

Sushma Chamarthi, MD, FAAP, DABOM

Chapter Member, AAP-CA1

Developing Concerns: Screen Time and Teens

Should pediatricians be concerned about teens and their screen use? 

Some new information informs us about how we should be asking teens about their screen time and advising them and their parents. Some questions used in studies of this issue are listed below. As noted by Nagata et al (JAMA Ped: 334 (3) 2025 ), adolescence is a vulnerable period for addictive behavior, and 48% of US teens lose track of time when using their phone, 17% have tried to reduce their use of social media but cannot, and 11% admit that screen use has negatively affected their schoolwork. 

What do we know about the effects of screen time and brain development?

A recent study by Lima Santos et al (JAMA Ped 334(3) June 2025) sought to identify the association between screen time during late childhood and depressive symptoms in early adolescence, and to investigate whether these associations are mediated by sleep duration and white matter organization.

The data for 976 children from 21 US cities who were seen at 9-10 years and then again in early adolescence (11-13 years) were used to identify the changes in clinical and neuroimaging characteristics as affected by self-reported screen time, sleep duration, depressive symptoms and brain development as measured on MRI scans evaluating brain white matter tracts implicated in depression. They found that each additional hour of daily screen time and shorter sleep duration was associated with a later increase in depressive scores, and worse brain cingulum bundle organization. They postulate that the longer screen time and shorter sleep duration may be the mediator of these negative clinical and developmental findings... continue reading...

Renee Wachtel, MD, FAAP

Chair, Committee on Developmental & Behavioral Pediatrics and School Health Committee, Area Director, Alameda County, AAP-CA1