By Lisa Gilmer, MD, FAAP
Thank you for the opportunity to represent you as KAAP President for the next two years. If the time goes anything like the last few months, it's going to be quite a ride.
In May, the KAAP BOD met for a two day retreat. A weekend of hard work resulted in a strategic plan for the Chapter based on the pillars of communication, advocacy and education and focused on Gun Safety, Tobacco/Nicotine, Vaccination and Foster Care each in a phase of progress from planning to evaluation. Our goal is to engage the passion and expertise of our members to work together to make a difference for Kansan children.
In June, the "zero tolerance" policy separating children from their parents as a deterrent to migration was formalized. AAP President Dr. Colleen Kraft described the conditions at detention centers. Media outlets across to country carried her story of a crying child uncomforted by a loving adult exemplifying the effects of toxic stress. We called our legislators, we wrote letters to the editor, we rallied; even Oprah Winfrey asked what she could do to help. On June 20th, an executive order ended the practice and work began to reunite more than 2,300 children. We mobilized to make a difference for immigrant children.
In July, 18 days after a youth soccer team became trapped in a cave in northern Thailand following a summer storm, the world let out a sigh of relief as the last of the rescue divers emerged safely from the cave. From their discovery by British divers to the recovery by an international team, media outlets across the globe covered every emotional moment. Start to finish, the rescue operation focused on one goal, reunite these children with their parents. Whether on the ground in Thailand or praying from home, we worked together to make a difference for global children.
In August, the nation voted in primary elections. The red-blue divide was as deep as ever. Votes were cast for or against for singular issues or certain candidates. Races were close. Media reporting covered the candidates' stands on health care, gun control and immigration. Will we hear where they stand on issues related to children and children's health? We should but it will be up to us to ask candidates how their stance on issues will make a difference for American children.
Kansas children are at risk from gun violence. Hundreds of immigrant children are still separated from their parents. Global disasters continue to strike and the course of our nation will be decided in November. We have a lot of work to do. Advocating for children is hard but you don't have to go at it alone. The Kansas Chapter will continue to provide resources on local, national and global issues, bring together talented Kansas pediatricians to solve problems, and offer opportunities to expand the knowledge and skills you need to support the health and well-being of ALL children. Let's get started.
Kelly Kreisler, MD, FAAP
Recently, I was chatting with a community health worker (CHW) during our clinic team huddle. Our team included a CHW until July 1 when the CHWs in our community started to wrap up their work, because their grant ends in October. CHWs are members of underserved communities, not necessarily immigrant communities, who serve as a link between clinicians, their patients, and community resources. Their work is broad and includes assisting patients with the social determinants of health; they help with everything from accompanying patients to a pharmacy or subspecialty visit to helping them sign up for insurance to navigating the grocery store for culturally appropriate, healthy food choices.
I smiled as I briefly told the CHW about one of the families on my schedule that morning. I informed her the family is doing well, and I was certain she wouldn't need to see them. This mother is always smiling and laughing. The father works long days, so I have never met him. The family fled violence and poverty in Guatemala years ago, and they are working hard to make a better life for their children. Mom's laughter is so infectious the kids and I spend most of the visit laughing too, even though we're not always sure what is so funny. She soaks up the advice I give and is proud to share how she has applied it when she comes to the next visit. I have been following her two children, who are U.S. citizens, since they were born, and they are thriving. The six-year-old is obese, but her BMI plateaued when the family cut back on juice and portion sizes and starting spending more time at the park. The interactions with this family are exactly how I pictured spending my days when I first dreamed of being a pediatrician. I was excited for the anticipated break in my stressful day.
Even before I entered the room, I knew something was wrong. The older child's BMI curve was once again a vertical line going straight up. The nurse told me dad was "gone." I mentally prepared myself to talk about supporting children through parental separation and divorce and gave the CHW a heads up I might need her for this family after all. When I walked into the room, Mom was quiet and pale and ignoring the kids who were arguing. The mask of her grief and exhaustion was unmistakable. She apologized for the children's behavior and her appearance through a Spanish phone interpreter, and she tried to give me a small smile. "I am working nights now that their father has been deported. Juan cries for his father all day and Karla eats anything she can stuff in her mouth. I can't bring myself to tell her no. I only sleep for about an hour each day. On Sunday, my only day off, I sleep for 3 hours. I don't have the energy to take them to the park except on Sundays. The kids are fighting all of the time." As I quietly listened to her story and held her hand while noiseless tears fell, I suddenly realized the room was silent. I managed to croak, "I'm sorry", and we shifted our attention to the children who were now watching us intently. We spent the rest of the visit talking about the effects of trauma, how to support her children and herself, and resources for the family.
Executive Director Update
It is back to school time, as most of you are well aware because of your packed schedules full of well checks and filling out school forms. You probably see many of your adolescent patients this time of year for their sports physicals and take the time to screen for depression and other health risk factors for teens while they are in your office.
As a parent, I appreciate the time our pediatrician takes to ask questions and talk about more than just physical health with my teenagers. My older two are returning to their high school as a senior and sophomore this week, and my youngest is in his second year of middle school. My boys seem to be ready for a new school year at schools where they are comfortable, and that is a good feeling. Yet, even with the easy and relaxed mood our family seems to have this year about going back to school, there is part of me that is uneasy. It's scary having teenagers who will soon have the weight of school and social pressure on their shoulders knowing that suicide rates are rising. Suicide is the second leading cause of death for adolescents 15-24 years old. It's scary sending my three sons to school where I'm just not sure they are safe. Recently a ten-year-old child in our area discharged a loaded gun at a parks and recreation summer camp. Gun violence continues to happen in places where our children go to school and play, and it's something that I can't help worrying about as I send my kids off to school.
I'm thankful that I work for an organization that is doing something about these scary topics. The Kansas Chapter board members understand that gun safety is important enough to make it one of the four focus areas in our new five-year strategic plan. I am also excited that the American Academy of Pediatrics has invested resources into understanding and implementing evidence-based gun safety interventions. Our Chapter will be ready when AAP identifies the evidence-based child safety interventions.
Our fall CME meeting on October 4 and 5 in Wichita will feature expert speakers giving talks on gun safety for pediatricians and suicide prevention. I encourage Kansas Chapter members to join us at Progress in Pediatrics - Fall 2018 to not only spend time with colleagues from across the state, but to learn more about these important topics. KAAP members play an important role in the health of children and adolescents in our state and Chapter leadership is working hard to make sure that our members have the tools that they need to provide the best possible care.
By Dena K. Hubbard MD, FAAP
Children can't vote, but pediatricians and others who care for them can. Please consider joining KAAP's efforts to ensure Kansas children are heard this election!
The national midterm elections will be held on Tuesday, November 6, 2018. All 435 seats in the U.S. House of Representatives and 35 of the 100 seats in the U.S. Senate will be contested. In addition, 36 governors, including Kansas, and more than 6,000 state legislators, along with many other state and local officials across the country will be elected. Kansas gubernatorial candidates will be presented with questions on behalf of the Kansas AAP on firearm safety, Medicaid expansion/KanCare 2.0, and expanding mental health services to Kansas kids. Look for their answers on the KAAP website.
There were 383 gun related deaths in Kansas in 2016, and many of the victims were children and young adults under the age of 21. KAAP supports policies to save children's lives including promoting safe storage, requiring background checks, and banning assault weapons. Regarding Medicaid expansion, did you know 96% of Kansas kids have health insurance? Research shows that children who have health insurance grow up to lead healthier and more productive lives, and we need to ensure we maintain this trend and ensure affordable high-quality care for all Kansas kids. Keep in mind, parents who are enrolled in coverage are more likely to have children enrolled in coverage and results in increased use of preventive services. This high-quality care and coverage must also include mental health services for Kansas children. The lifelong costs of childhood toxic stress are enormous as manifested in adverse impacts on learning, behavior, and health. We know that early intervention provides critical opportunities to prevent these undesirable outcomes and generates large economic returns for all of society. Investing in the health of Kansas kids is truly an investment in the future of Kansas!
Pediatric Payment Corner
By Jennifer Mellick, MD, FAAP
Our Pediatric Council is undergoing some reorganization. I first want to thank Dr. Jon Janz for his leadership on the Pediatric Council over the last many years. I will work hard as the new chair of this council to follow in his footsteps.
We continue to look for member involvement, so if you find yourself looking for a way to get involved, please let us know at
. We are hoping to get a representative from each part of the state to tackle issues as they arise. We are also planning quarterly conference calls and emails as needed.
Since our last newsletter we have been investigating how pediatricians are paid for the Edinburg post partum depression screening. We have learned that it is not paid by all commercial insurers across the state and not paid at all by Medicaid providers. We have contacted KDHE who is discussing it with her program manager. We will follow up with more information as we get it.
Interestingly in our investigation we learned several interesting things. Not all pediatricians who perform the Edinburg even bother to bill for it anymore since it isn't paid. This is counterproductive and I would suggest that we all code for what we do. It is more difficult to make a case for the importance of something if we don't show that we are doing it by not billing for it. Also, there is some confusion amongst members as to the correct code (96161).
Please email if you have any information on this issue as it will help us as we continue this discussion with payors.
The 2017-2018 Kansas Pediatric Foundation annual report is now available to view at
2004, our mission has been to connect with individuals and organizations who share our commitment for a healthy and meaningful life for our children and adolescents in Kansas. These important collaborations have allowed KPF to put over 880,000 books into the hands of Kansas kids through Turn a Page. Touch a Mind. (TAP-TAM)®, continued to support Kansas KidLink, our children's mental health initiative, and has helped us grow our Kansas Kids Fund.
This year, the TAP-TAM program added 21 new sites and currently has 119 active sites, with over 575 participating providers. These providers will be handing out over 125,000 books to Kansas children at their well-child visits over the next year.
We hope to build on the success of our TAP-TAM program by growing the Kansas Kids Fund. Through the Kansas Kids Fund, we will support important child health initiatives in the areas of immunizations, early brain development, child safety, tobacco cessation, and more. Thank you to each individual and organization who contributed to the Kansas Pediatric Foundation this year!
Your Recommendation Matters!
by Immunize Kansas Coalition & Dr. Gretchen Homan (IKC Chair Elect)
August is National Immunization Awareness month! It is important for pediatricians to educate parents and patients about the risks posed by vaccine-preventable diseases and the importance of timely and thorough adolescent immunization. Kansas adolescent immunization rates have shown some progress but there is still a lot of work to be done to meet national standards. National Immunization Survey-Teen results for Kansas
. Key things you can do:
- Give a strong, unequivocal recommendation for indicated vaccines
- Capture opportunities to immunize at any and all types of adolescent patient visits
- Improve record keeping so that patients who are due for vaccinations are readily identified and their immunizations documented. Check vaccine names/types and dates
- Create a pro-immunization culture and mindset among everyone on staff
- Track your immunization rates and develop strategies to improve them
Opportunities for adolescent immunization are often missed, even during preventive-care visits. Be sure to assess immunization status and consider vaccination at every visit. A strong recommendation for vaccination can help reduce missed opportunities and improve coverage
The Value of School Meals
Robyn Stuewe, MA, RDN, LD, CHES
Across Kansas students are heading back to school and that means early mornings and rushing out the door. For some students that might mean skipping breakfast, which can have a negative impact on their health. Research has shown breakfast is important for children's health, academic achievement, cognitive development and mental health. When a student skips breakfast, whether because of time or not having food available, they aren't just missing out on needed nourishment but so much more.
The Food Research & Action Center (FRAC)
that efforts to increase breakfast participation pay off; school breakfast leads to reduced food insecurity, better test scores, improved student health, and fewer distractions in the classroom. In the 2016-17 school year, nearly 110,000 Kansas students ate school
each school day. Many schools across Kansas have taken breakfast out of the cafeteria and are using innovative service options to make breakfast more accessible to students. From serving breakfast in the classroom, to a grab and go option as students enter the building, to having a second chance option where students can eat after first period, these innovations meet students where they are and increase participation which is a win for the student and the school. Kansas is working to increase the number of schools and districts offering innovative breakfast service options and received a $50,000 grant from No Kid Hungry to help schools with equipment purchases to make changes this school year.
Around 95 percent of schools in the United States participate in the
National School Lunch Program
feeding more than 30 million children on an average day.
The National School Lunch Program
provides school children with one-third or more of their Recommended Dietary Allowance for key nutrients making it an important part of their day. Research indicates students participating in
consume more fruit, vegetables, and milk at breakfast and lunch. School meals help students meet their nutrition needs, keep them hunger-free and prepare them to learn.
to learn more about the value of school meals and the required nutrition guidelines.
Want to learn more and how to promote school meals in your community? Visit:
Caring for Children Survey
Dr. Timothy Smith, Dr. Emily Goodwin, Dr. Michael Kennedy and Todd Savolt are looking for primary care providers who provide primary care for children. They are recruiting research participants to help examine the perceived barriers and education gaps that limit primary care provider's self-efficacy when caring for children. The aim of this survey will be to identify the barriers and education gaps that limit primary care providers and residents' self-efficacy when caring for children with medical complexity in rural and urban settings. Participation involves completing a survey that will take about 5 minutes. The survey is anonymous. In addition to the survey questions, they request
medical practice setting and how long you have been practicing medicine. Consent to participation is assumed with completing the survey via the link below. When you have completed the survey, please submit it through RedCap.
There are no personal benefits or risks to participating in this study. Participation is voluntary, and you can stop taking the survey at any time. Participation in the survey or declining to participate in the survey will have no impact on your professional career.
If you have any questions, please contact Dr. Timothy Smith at
or Dr. Emily Goodwin at
. For questions about the rights of research participants, you may contact the KUMC Institutional Review Board (IRB) at (913) 588-1240 or
or Children's Mercy Institutional Review Board (IRB) at (816) 701-4358 or
2018 Breastfeeding Conference
November 1-2, 2018
The 2018 Breastfeeding Conference will feature multiple experts in lactation and coalition building. Attendees will have opportunities throughout the 2-day conference for networking and sharing resources.