Parental Leave for Residents and Pediatric Training Programs.

Residency and fellowship are unique occupational time periods for many early career physicians, generally consisting of long duty hours. Many early career physicians have or are in the process of building their families during this time period. The literature suggests many medical and psychosocial benefits of protected parental leave for both parents and children, which necessitates parental leaves of absence. The Institutional Requirements of the Accreditation Council for Graduate Medical Education require training programs to provide written policies regarding leaves of absence, including parental leave, and these policies must comply with current legislation such as the Family Medical Leave Act. The length of leave has considerable variability among residency programs. This policy statement aims to navigate and outline the challenges of parental leave policies in training programs and to put forth recommendations to protect trainees and their families. The definition of families should also be expanded to include all types of families.

Care of Adolescent Parents and Their Children.

Teen pregnancy and parenting remain important public health issues in the United States and around the world. A significant proportion of teen parents reside with their families of origin, which may positively or negatively affect the family structure. Teen parents, defined as those 15 to 19 years of age, are at high risk for repeat births. Pediatricians can play an important role in the care of adolescent parents and their children. This clinical report updates a previous report on the care of adolescent parents and their children and addresses clinical management specific to this population, including updates on breastfeeding, prenatal management, and adjustments to parenthood. Challenges unique to teen parents and their children are reviewed, along with suggestions for the pediatrician on models for intervention and care.

Four-month-old infant with intussusception presenting as altered mental status.

OBJECTIVE: To remind pediatric care providers that an altered mental status can be the only presenting symptom for intussusception, a life-threatening diagnosis. METHOD: A case report that presents a unique presentation of intussusception: a 4-month old boy with neurological findings after a reported head injury. CONCLUSION: Diagnosis of intussusception in the pediatric population is highly dependent on its classical presenting signs and symptoms: sudden severe colicky abdominal pain, vomiting, and an abdominal mass in children between 3 months and 6 years of age. Consider that an altered mental status can be the only presenting symptom.

Mentorship programs for faculty development in academic general pediatric divisions.

Introduction. Mentoring relationships have been shown to support academicians in areas of research, work/life balance, and promotion. Methods. General pediatric division chiefs accessed an electronic survey asking about mentorship relationships, their ability to create a mentorship program, and resources needed. Results. Dyadic mentorship programs were available at 53% of divisions. Peer mentorship programs were available at 27% of divisions. Overall, 84% of chiefs believed that dyadic mentorship would benefit their faculty. 91% of chiefs believed that peer mentorship would benefit their faculty. Chiefs were interested in starting peer (57%) or dyadic (55%) mentorship programs. Few divisions had a peer mentorship program available, whereas 24% already had a dyadic program. 43% of chiefs felt that they had the tools to start a program. Many tools are needed to create a program. Discussion. General pediatric division chiefs acknowledge the benefits of mentoring relationships, and some have programs in place. Many need tools to create them. Pediatric societies could facilitate this critical area of professional development.

Lower extremity paralysis in a male preadolescent.

A 12-year-old boy presented to the emergency department with bilateral lower leg sensory loss and inability to walk. The initial work-up revealed no significant abnormalities on physical examination other than bilateral paralysis and no laboratory abnormalities. The inpatient work-up included neurologic, psychiatric, and psycho-logic evaluations. The patient was diagnosed with a conversion disorder, and treatment included relaxation exercises and guided imagery as well as antidepressants. Upon discharge, the patient was walking without assistance. Follow-up therapy was initiated for stress and behavior management. No further episodes have occurred. Diagnosis, therapy options, and outcomes of conversion disorder are further discussed as they relate to treatment by general pediatricians.

Chromosome 3p25 deletion in mother and daughter with minimal phenotypic effect.

3p25 deletion syndrome is characterized by mental retardation, growth retardation, hypotonia, microcephaly, ptosis, and micrognathia. Of the 42 persons with this deletion syndrome cited in the literature, only 2 patients, a mother-daughter pair, have previously been reported without apparent clinical consequence. We present a second mother-daughter dyad with a terminal 3p25.3-3pter deletion, who present with only mild clinical effects. In addition to cytogenetic analysis, array CGH was performed to determine the breakpoints at the molecular level. Our data show that the 3p25 deletion syndrome may, therefore, reflect a much broader phenotypic spectrum than previously recognized.

Lessons learned from pediatric residents on a community pediatrics rotation.

Pediatric residents on block community rotations completed journals and exit interviews regarding their perceptions of the rotation. Three common themes present in residents' responses were identified via qualitative analysis: enlightenment and attitude change, impact of direct participation, and rotation challenges. Advantages and disadvantages to block rotations in community pediatrics, and their relationship to learning child advocacy skills, are discussed. Finally, the use of journals as a tool to document systems-based practice competency is explored.

Lessons learned from community site administrators involved in pediatric community rotations.

OBJECTIVE: Prominent pediatric organizations agree that young physicians need to be trained for the role of patient advocate in the community. However, information on the community site administrators' perspective on such training is limited. Therefore, the objective of this study was to explore community site administrators' perceptions of the advantages and disadvantages to pediatric resident training at their centers. Understanding these perspectives may lead to better partnerships and experiences for both the residents and the community sites. METHODS: Twenty-eight community site administrators participating in 2 residency community rotations located in Ohio and Florida were surveyed with a semistructured questionnaire. A qualitative data analysis methodology was used to explore the entire set of responses. Research team members reviewed the responses, coded them for emerging themes, and generated three themes: 1) awareness, 2) knowledge exchange, and 3) organizational issues. RESULTS: Fifty-seven percent of site administrators responded. These administrators consistently indicated that they valued the opportunity to increase residents' awareness of the services their sites provided to the community. The administrators and families served by the agencies appeared to benefit from the medical knowledge exchange, and this was a significant advantage from the community site administrators' perspective. Finally, community sites identified organizational issues of complex scheduling as an area for improvement. CONCLUSIONS: These findings demonstrate the value community sites place on active, early involvement of pediatric residents with community agencies. We have also identified key points to improve the experiences for both community sites and residents during a community pediatric rotation.