Erin Johanek, PharmD

This month’s spotlight is Pediatric Oncology as 

 sits down exclusively with pediatric oncologist Lisa Diller, MD, vice chair, Clinical Affairs, and medical director, Clinical Cancer and Blood Disorders Service Line, Dana-Farber Cancer Institute, Boston, Massachusetts, to discuss the one key condition for which she believes community pediatricians should be especially aware-retinoblastoma.

Q.­ Dr. Diller, can you tell us why you think that retinoblastoma is something of particular concern for pediatricians?

 ­Retinoblastoma is important for pediatricians because early detection can make a huge difference in terms of the outcome for the child. Knowing who might be at risk for retinoblastoma or what signs and symptoms are important to pick up for retinoblastoma is very important because the pediatrician is usually the first person to see the patient who might have retinoblastoma.

Q.­ What are the underlying reasons for maybe the increased severity of retinoblastoma in children?

­ It’s not really increased severity that I’m thinking about. I’m thinking about the possibility of picking up a retinoblastoma early that makes a huge difference. So, the severity of retinoblastoma in terms of the aggressiveness of the treatment is often related to delays in diagnosis, and if we can find retinoblastomas early and get the children into treatment, we can often avoid therapies that can have long-term effects for the rest of a child’s life, such as radiation therapy or losing an eye. That’s what I think it’s important for pediatricians to know.

Q. ­What advice can you offer as far as those diagnostic clues that the pediatrician should be on the lookout for to properly identify retinoblastoma?

­ First of all, retinoblastoma can run in families, so it’s very important to have a good family history. Often adult parents who had retinoblastoma may not be aware of the word retinoblastoma because they were treated at a very young age. They may have had an eye removed as a young child for reasons that they don’t know. They’ve had a glass eye their whole lives or a false eye their whole lives and they may not know this. So, unless the pediatrician is aware of the parent’s history he or she might be missing a clue. I had a recent patient, for example, whose mother lost an eye as a baby, was never told why, and then her child was diagnosed with retinoblastoma but she was completely unaware of the relationship between her likely retinoblastoma and what happened to her child.

Another sign or symptom that a pediatrician should be aware of-and that we’re seeing at increased frequency because people take so many photographs-is the lack of red reflex that you normally see in a photograph. In a photograph, when you shine a light, use the flash, you often see the reflection of the retina in both eyes. If a parent comes in with photographs where one eye is white and one eye is red, and it’s in more than one photograph, it’s something to be aware of. Because people take so many photographs these days using their cell phones, we can therefore know that we need to pay attention to that a little bit more than we used to when we were looking back at old photographs.

Another sign is redness of the eye itself or glaucoma, changes in vision, lazy eye, which is an indication of a change in vision, and then just leukocoria on exam or the physician seeing the lack of the red reflex. Those are all signs that pediatricians should be looking for.

Q. What are the best treatment options for retinoblastoma in children?

 Children diagnosed with retinoblastoma with very small tumors often can be treated with what we call local therapies, mostly commonly cryotherapy or laser therapy, without needing a removal of the eye, also known as enucleation, or needing chemotherapy or radiation therapy. That’s one of the reasons we are very vigilant about doing exams on children who have a family history, for example, before they develop clinical signs of the disease, to pick up tiny little bits of retinoblastoma early to save them from those therapies.

The other treatments that are increasingly being used are chemotherapy delivered directly to the eye often through the ophthalmic artery where the child undergoes a cannulation of the ophthalmic artery and then chemotherapy is directed, is infused, directly to the retina. This allows us to avoid systemic chemotherapy, can be preserving of vision, can help us avoid removal of the eye, and avoids needing to use external beam radiation therapy.

Another therapy used when external beam radiation therapy is necessary is proton beam radiation, which is increasingly available and used in retinoblastoma patients because it can limit the dose in these very young children, limit the spread of the dosing of radiation outside of the eye. It really can target where the tumor is and avoid dosing areas such as the bones around the eye, because when we do that in very young children, the dose, to the bones around the eye or the soft tissues around the eye, is known to be associated with the development many years later of tumors of that area because of the tumorigenic effect of the radiation. So, if we can limit where we deliver radiation, we can hopefully reduce the risk that those secondary tumors will develop.

Q. Most importantly, at what point should a community pediatrician refer a patient to a specialist?

 Any child who has a family history suspicious for retinoblastoma-that would be an unknown history of visual losses in multiple family members, a parent who has a glass eye, a parent who says there was something wrong with his/her eye as a baby but didn’t know what it was-those children all should be referred just based on the family history, and that should be done very early in infancy. Pediatricians are very good at looking for red reflex and, obviously, if they see an abnormality on physical exam, that should be referred. If a parent comes in with photographs that are of concern, I think that’s a reason to refer to a specialist as well, and that specialist would be a pediatric ophthalmologist. It’s not necessary to go directly to a pediatric oncologist at that point. I think the diagnosis is mostly made by observation by a pediatric ophthalmologist who has expertise in this field.

Q. Dr. Diller, is here anything else that you would like to add as a final thought for our community of pediatricians?

 The other thing to remember is that increasingly genetic counselors who have expertise in cancer predisposition syndrome are able to take a family history and assess whether or not a child should be genetically tested for a risk of retinoblastoma. That is something that a pediatrician might consider if there’s a family history that is somehow concerning, and that might be the first level of referral before a pediatric ophthalmologist in certain situations.

Articles

This month’s spotlight is Pediatric Oncology as Contemporary Pediatrics sits down exclusively with pediatric oncologist Lisa Diller, MD, vice chair, Clinical Affairs, and medical director, Clinical Cancer and Blood Disorders Service Line, Dana-Farber Cancer Institute, Boston, Massachusetts, to discuss the one key condition for which she believes community pediatricians should be especially aware-retinoblastoma.

Recognize & Refer: Focus on retinoblastoma

This month’s spotlight is Pediatric Cardiology as 

 sits down exclusively with pediatric cardiologist Cheyenne Beach, MD, assistant professor of Pediatrics, Pediatric and Adult Congenital Electrophysiology, Section of Pediatric Cardiology, Yale New Haven Children’s Hospital, New Haven, Connecticut, to discuss the one key condition for which she believes community pediatricians should be especially aware-syncope.

Q. Dr. Beach, can you tell us what syncope is and why you think it is something of particular concern for pediatricians?

 Syncope is essentially passing out. Technically, the definition of syncope is an abrupt, transient, complete loss of consciousness with loss of postural tone. And this is something that is important for us as pediatricians to think about and talk about, first because it’s really common-about 15% of pediatric patients have at least 1 episode of syncope during their pediatric lifetime-and also because syncope can be really anxiety provoking, both for family members and friends who witness events and also for providers who know that syncope can be a symptom of a life-threatening condition.

Q. What do you think are the underlying reasons for the increase in the frequency and severity of syncope specifically in children?

 I don’t think that there’s necessarily been an increase in episodes of syncope in children, but more and more we’re hearing publicized cases of malignant or dangerous types of syncope, so I think it’s something that has been more anxiety provoking, both for people throughout the community and again also for providers taking care of these patients.

Q. What advice could you offer as far as diagnostic clues that pediatricians should be on the lookout for to properly diagnose syncope in their patients?

 This is a topic we can cover in a few minutes here but I feel like I could talk about this for a long time. It’s something I see pretty often in our arrhythmia clinic and I’ve become pretty accustomed to trying to use these diagnostic tools. So first, when we see patients with syncope we have to determine if thisis an episode of benign or usually vasovagal syncope or if it’s syncope from another more concerning cause. I’ll note that syncope can have a neurologic cause, something like a seizure, but I won’t focus on that today, instead really differentiating benign or vasovagal syncope versus a cardiac cause of syncope.

Cardiac causes of syncope can fall into 3 large categories and there’s a fair amount of overlap among these categories. The first is a primary arrhythmogenic cause of syncope-things like an inherited channelopathy, long QT syndrome, or something called catecholaminergic polymorphic ventricular tachycardia (CPVT). We also think of patients with Wolff-Parkinson-White (WPW) syndrome. Patients with ventricular tachycardia fall into this category. Second, there’s a structural category for patients who have a structural abnormality in their heart-things like aortic stenosis, an abnormal coronary artery, or hypertrophic cardiomyopathy. And third are patients who have a low cardiac output state, and these tend to be patients whose heart muscles aren’t functioning well due to things like cardiomyopathy from other causes such as a dilated cardiomyopathy or myocarditis. So, in thinking about these cardiac causes that are relatively rare but that we always have to have in the back of our minds, it’s important to ask a thorough detailed history about this event.

I think that there are 6 really important questions to ask related to any of these events.

 is the circumstances of the event. Was there anything different about that day? Where was the patient when this happened? What was the patient doing when this happened?

, were there any triggers leading up to the event? Was it particularly hot that day? Had the patient been standing for a prolonged period of time? We have all heard of the syncope that occurs during blood draws or during videos in school that make somebody feel queasy, but it’s important to think of triggers like exercise or even emotional exertion.

 is to ask about the presence of a prodrome. This is a very important question. My favorite question to ask these patients is, did you know you were going to pass out when this happened? People describe a prodrome as vision changes. It can be vision turning black, tunnel vision, seeing spots. They can also describe lightheadedness or nausea as part of this prodromal feeling.

, what other associated symptoms did you have? Did you have chest pain before this happened? Did you have palpitations? Did you have any trouble breathing?

 is asking about the post-event period. What did you feel like when you came to? Were you confused? And ask the person who was there, of course. Did the patient look confused? Ask about other kinds of symptoms when waking up. Were there palpitations when the patient woke up? And how did the patient then feel for the rest of the day or the following few days around that event?

So, again, the questions around the event are: What were the circumstances of the event? What were the triggers leading up to the event? Was there a prodrome? What were other associated symptoms? How long did the event last? What was the post-event period like?

After asking these questions about the event itself, it’s important to think about other factors that could have played a role-things like, has this ever happened before, or what medications is the patient taking? Specifically, is this patient taking any QT-prolonging medications? Is there family history of sudden death or accidents? Is there a history of any cardiac problems? Does anyone in the family have a pacemaker or a defibrillator? And finally, is there a history of syncope seizures or hearing loss in the family as well? These are all important questions for us to ask surrounding these events.

Q. What are the best treatment options for syncope in children?

 This is very important to think about, of course, and it’s all based on what the level of suspicion is whether this is a cardiac versus a noncardiac event. If a provider thinks that an event could be cardiac-and I’ll emphasize the red flags that can point us toward the cardiac cause here-the red flags are, did this episode of syncope occur during exercise or emotional exertion? I say emotional exertion on purpose because when somebody’s really worked up, emotional exertion can have the same effect or even more of an effect on a patient than physical exertion can have.

A second red flag is, was there an absence of a prodrome? Third, is there a family history of sudden death, malignant syncope, or other concerning findings? Next is, was the patient taking QT-prolonging meds? Was there an abnormal physical exam finding? For example, if the patient has a murmur that seems to be an outflow murmur, that could be a red flag. Also, if the patient injured himself or herself during the event, that’s a red flag. And then preceding symptoms are palpitations, chest pain, difficulty breathing. Those things could all point us in the direction of a cardiac cause of syncope.

What’s really important is to have these patients evaluated by a cardiologist if this is a concern. It can be helpful to get an electrocardiogram, an EKG, as this can be really helpful to then further delineate a cardiac cause. These visits for potential cardiac causes of syncope are often expedited because we also find them to be very important to figure out. As cardiologists, we are always happy to have conversations with providers to help determine the best plan of action to help make decisions around what to do. Also, these patients with suspicion for a cardiac cause of syncope should be exercise restricted, and I’ve even recently expanded that to be restricted from highly emotional activities such as these video games that seem to be very emotion provoking.

So, it’s these 3 things, really: to get an EKG, if possible; to expedite care to a pediatric cardiologist (and we’re all happy to help make that happen); and third, exercise restriction in that setting. There are some really helpful management strategies and treatments for vasovagal or benign syncope, but that would probably take another session for us to cover completely.

Q. Dr. Beach, is there anything else you’d like to add as a final thought for our community pediatricians?

 I really would stress that we as pediatric cardiologists, no matter where you are, are always happy to help you figure this out. We recognize that these decisions are not black and white. It’s not always easy, even when you take a thorough history and you do a thorough physical exam, to make the decision about what this is. So, I am happy to take phone calls, happy to see patients, and happy to help with anything else you need.

This month’s spotlight is Pediatric Cardiology as Contemporary Pediatrics sits down exclusively with pediatric cardiologist Cheyenne Beach, MD, to discuss the one key condition for which she believes community pediatricians should be especially aware-syncope.

Recognize & Refer: Syncope

This month’s spotlight is Pediatric Allergies as 

 sits down exclusively with Todd A. Mahr, MD, FAAP, FAAAI, FACAAI, president of the American College of Allergy, Asthma, and Immunology (ACAAI), director, Pediatric Allergy, Asthma, and Immunology at Gundersen Health System in La Crosse, Wisconsin, and adjunct clinical professor of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, to discuss the one key condition for which he believes community pediatricians should be especially aware-anaphylaxis.

Q. Dr. Mahr, why do you think anaphylaxis is of particular concern for pediatricians?

 As a pediatric allergist, I see this in the community quite a bit. Anaphylaxis is a serious allergic or hypersensitivity reaction that’s rapid in onset and can lead to death. So, I can’t imagine a key condition that isn’t more practical for a pediatrician to know about. The issue with anaphylaxis is that the diagnosis is really based on clinical symptoms and signs for which pediatricians need to be aware. Also, there’s obviously the history-what activities lead up to it, and so on.

Q. What do you think are the underlying reasons for the increased severity or frequency of anaphylaxis in children?

A. Well, we know that for children anaphylaxis is becoming more prominent because we’re seeing more food allergies. Food allergies have increased by 18% from 2007 to 2012,

 and another study found a 50% increase in episodes of food-induced anaphylaxis that presented to the emergency department (ED).

 What we’re seeing is also more common in 0- to 5-year-olds, and that’s something that maybe a lot of pediatricians aren’t as familiar with. They’re thinking bee sting anaphylaxis or food allergy in an older child and not really thinking about anaphylaxis in that 0- to 5-year-old child and what we need to know about what to do for that child.

Q. What advice can you offer as far as those diagnostic clues that the pediatrician should be on the lookout for to properly diagnose anaphylaxis?

 That’s a great question because basically it’s a little bit different. I mean, we all know what we think about. We think about anaphylaxis, we think about trouble breathing, hives, tightness in the throat, hoarse voice, feeling impending doom. In infants, that might be a bit different because the symptoms of anaphylaxis-vomiting, throat itching, and throat tightness-in an infant or toddler may be regurgitation or irritability and fussiness, drooling, inconsolable crying. and obviously they might have a rash, but they also might be lethargic and sleepy. So pediatricians need to be aware of that.

Anaphylaxis may not present in a used to seeing it in an older child. So, hives and vomiting are the most commonly described thing that people will see with anaphylaxis in infants and toddlers. We do know that, so that’s something they need to be aware of. Anaphylaxis is not always going to present with hives, but when there are hives and there’s vomiting or any kind of gastrointestinal (GI) complaint, that fits the criteria for anaphylaxis because it’s usually 2 symptoms within basically a system-2 different symptoms from that standpoint.

Q. What are the best treatment options for anaphylaxis in children?

 What has also changed a little bit is that treatment is still epinephrine. We need it to be epinephrine-epinephrine is the first choice and the one that we should always be using. Epinephrine is now available in an infant dose for children, one that’s available at 0.1 mg and that actually is available. Pediatricians should have epinephrine stocked in their office, too, to make sure that they have it available.

Q. If pediatricians identify a patient that has anaphylaxis or with these diagnostic clues that you’ve given, at what point should they refer to a specialist?

 That’s another great question. So, you’ve treated that anaphylaxis in your office. You then send the child to the ED, which would be the proper thing to do. The ED may give Benadryl or some other things after you’ve given the epinephrine. Then it’s really finding out what caused this anaphylaxis, what’s the trigger of the anaphylaxis. That basically means sending the patient to an allergist to help figure that all out; do the proper training for the self-injectable epinephrine at home; go over with parents what they need to be looking for and how they can avoid that trigger in the future. If it’s a food, what to look for, for cross-contamination and so on. So almost any child who has had anaphylaxis really should be sent to a pediatric allergist or an allergist.

Q. Is there anything else that you would like to add as a final thought for our community of pediatricians?

A. Well, I think it’s not to be afraid of using epinephrine. If that child is presenting to you, there are some people who feel you can’t use epinephrine until that child is shocky. You can’t give it until they’ve dropped their blood pressure or they’re really having trouble breathing, and you’re going to give them nebulizer first or you’re going to give Benadryl first. Epinephrine is the one drug that will actually treat the anaphylaxis and most of the symptoms to the greatest degree, so don’t be afraid of it and to feel really comfortable with its use in your office.

Dr. Mahr reports receiving honoraria from KalÃ©o, ALK-AbellÃ³, GlaxoSmithKline, AstraZeneca, Sanofi/Regeneron, and Optinose, and consulting fees from KalÃ©o and ALK-AbellÃ³.

1. Branum AM, Lukacs SL. Food allergy among children in the United States. 

 2. Parlaman JP, Oron AP, Uspal NG, DeJong KN, Tieder JS. Emergency and hospital care for food-related anaphylaxis in children. 

Contemporary Pediatrics sits down exclusively with Todd A. Mahr, MD, FAAP, FAAAI, FACAAI, to discuss the one key condition for which he believes community pediatricians should be especially aware-anaphylaxis.

Recognize & Refer: Focus on anaphylaxis

 recently spoke with Mary Koslap-Petraco, DNP, PNP-BC, CPNP, FAANP, a nationally known expert in immunization practice, about why measles infection rates have skyrocketed in her home state of New York, what’s in store for the rest of the United States during the current measles outbreak, and how physicians can engage with parents to boost immunization rates.

Dr Koslap-Petraco, pediatric nurse practitioner and community health specialist, is a nurse consultant on the staff of the Immunization Action Coalition (IAC) and CEO and primary care provider in her own private practice. She serves on the board and executive board of Vaccinate Your Family (VYF): The Next Generation of Every Child by Two, a national nonprofit organization founded in 1991 that is committed to reducing the burden of vaccine-preventable diseases in families and individuals. She is a nationally known expert in immunization practice and has been an advisor for the Centers for Disease Control and Prevention (CDC), serving on the CDC’s Advisory Board of the IAC and National Vaccine Advisory Committee. She is an adjunct clinical assistant professor at Stony Brook University School of Nursing, Stony Brook, New York, where she teaches in the Pediatric Nurse Practitioner Program. She has more than 25 years’ experience in public health and has advised local and state health departments on immunization public policies using her expertise as a public health nurse to influence system-level changes. Dr. Koslap-Petraco is a Fellow of the American Association of Nurse Practitioners.

 All right Mary Beth, can you briefly explain the situation going on in New York State right now with this measles outbreak. 

 Well right now here in New York we have a very big and very dangerous measles outbreak. It basically concentrated in two communities, two Orthodox Jewish communities, one in Upstate New York and one right here in lower New York, in Brooklyn. There have been a couple of cases outside those communities. So it’s not as insular as we think it is. The big problem is measles is a horrendous illness. The big thing is trying to contain and stop this. We’re also in danger of losing our designation as measles-free here in the United States which was a very hard fought battle for us in public health over the last many, many years. As we approach a thousand cases, we’ll be pretty surprised if they allow the United States to keep that measles-free designation.

 So you mentioned Upstate New York and Brooklyn, so is that where the outbreak originated or is there kind of like a ground zero for this measles outbreak?

 The ground zero are those two communities. What happened was a lot of their families, with their children, traveled to countries in Europe. This particular outbreak, there’s in Ukraine, there’s a huge Orthodox Jewish community there with a temple. It’s almost like a religious pilgrimage and several community members with their children traveled there and that was the original bringing measles back to the United States. It also is coming from Israel, it’s coming from England, it’s coming from Ireland, it’s coming from France, it’s coming from Spain, it’s coming from Italy. Whoever thought a travel medicine to Western Europe? Now the first thing that we health care providers say to people who say they’re going to Western Europe is, what’s your measles immunization status? Have you had two doses if you didn’t have real measles as a child? I’m one of the dinosaurs and I’m old enough to have had measles. So the outbreak we have here in the U.S. is from unvaccinated children and adults coming back into the United States but it’s also a result of parents who don’t want to vaccinate so everybody is at risk because we have these pockets, large pockets in these communities of children and adults who are not immune to measles.

 Were there any risk factors present before the outbreak started? And were these anticipated or mitigated well by the public health community? Or what could they have done differently? 

 I spent 30 years working for a county health department and we have always pushed for a very high immunization rate. Unfortunately, there were providers who gave in to parent’s demands to slow up vaccinating children or to not give measles, mumps and rubella vaccine at all based on these unfounded fears that the vaccine causes autism. Honestly, I think this was an accident waiting to happen and as far as anticipating it, we in public health probably knew that something like this was going to happen because the numbers of children who are not vaccinated is growing rather than receding in these insular communities. And I can’t say that it’s just isolated to religious communities because there are other pockets of children who are not vaccinated on the East Coast, the West Coast, the South, they’re all over. Most of the time it’s middle to upper middle class white families who are not vaccinating their children based on the unfounded fears of what they’re seeing on the Internet. Could we have stopped it? Quite honestly, I don’t think so because when I look now and what the data are telling us about what it is that convinces parents to vaccinate, first hand stories of others who have suffered from measles and other vaccine preventable diseases are the key that seems to be turning parents around to then vaccinate their own children. Because nobody was afraid of measles, they kind of were like ah it’s not a really bad disease, we haven’t seen it in so long, I’m not going to worry about it and now it’s rearing its ugly head again and as parents hear from other parents whose children have suffered from this disease, that’s one of the biggest things that’s convincing parents to turnaround and change their minds and begin to vaccinate again.  So can we anticipate it? Yes. Could we have prevented it? Honestly, with all the junk that’s on the Internet, I don’t think so.

 Do you see an end to this? When it this going to be over?

 Oh brother, honestly, at this point, I really don’t see an end to it. We just have to get a lot more children vaccinated and then a lot of young adults vaccinated as well. Wakefield came out with that horrible paper in the early 90s.  That means there’s a lot of young adults who are having children who were never vaccinated as well because their parents bought into those unfounded fears. So we have to get all those people vaccinated. We have to have between 90 and 95% and the closer you are to 95% vaccinated in the community to keep measles out of the community. And to protect those who cannot be vaccinated because of true medical contraindications. So we’ve got a long road to hoe here. It’s not going to happen overnight. This outbreak is going on for two years already. In fact, we’re into the third year and look what happened with the Somali community in Minnesota because the anti-vaxxers got into that community and convinced the families that measles vaccine was going to make their children autistic. And quite frankly, I don’t think the public realizes how much money this organized anti-vax community makes off parents who don’t know what to do and are looking for good information. They’re making a fortune.  Wakefield alone has become a multi-millionaire.                 

 He lives here in the United States under the cover of being a proponent of protecting children down in some big mansion in Texas while children are suffering. And we’re approaching a thousand children now, if we didn’t hit it already. So before the week is out, I can almost guarantee you we’re going to be hitting a thousand. Once we hit a thousand, that’s when the risk for children dying starts to begin.  Unfortunately, I am really worried we are going to lose a child and not in the too distant future.

 In your opinion, what are the key takeaways, what lessons can be learned so our readers can use those to take action in their own communities?

 Well what we need to do is, even though it takes a lot of time, we have to build that trust with our patients and their families. So they trust us as healthcare providers more than they trust Google or the University of Google. Honestly, the biggest thing that we need to do is build the trust. We also need to share the stories of parents whose children have been sickened by this horrible disease. The problem is, measles is another one of those gifts that keeps on giving because even after you recover from measles and the younger you are the more chance you have of getting this. There’s a condition called subacute sclerosing panencephalitis and it’s a complication of measles that can occur at any time after an infection with measles. It’s most likely to occur if children get measles before two years of age. And what it does is it literally liquefies the brain.  There’s no cure and the children or whoever else develops it, dies within three months to a year. And they lose their coordination, they lose their ability to speak and slowly but surely they lose all their facilities and capabilities until they die. If you vaccinate, there’s no risk for that. If you don’t vaccinate, there is a risk because the kill virus doesn’t work like that. 

 So we need to build the trust and kind of scare people in to what could really happen if they’re not vaccinating their children.

 Well I don’t really like to scare for it.  What I feel that we need to do is educate them to what can happen to their children if they develop measles that this is not a benign disease. My own sister had measles when we were children. I can see her face right now. I was 4 and she was probably a little over 2 when she had measles. I mean she looked like a lint rag doll in my mother’s arm. We lived in a cold water flat in a tenement building and here’s my mother sitting on the bed and rocking my sister who looked like this limp rag doll. Her vision was damaged from measles. That’s probably the least thing that could have happened to her. I don’t think she had measles encephalitis because I don’t know whether she would have survived that in the early 50s. She sure as heck was very, very sick. I remember very high fevers. I remember her face being very flushed and I remember my mother almost tearing up as she was trying to bring the fevers down and just sitting on the bed rocking my sister. And I’m sure she was doing a lot of praying that might sister would survive.

 Absolutely. So any final thoughts for our listeners?

 Well I think my final thoughts are, we pro-vaccine folks can’t be afraid to engage with parents and we need to take the time to speak with them. Always respectfully, always listening to them first, usually the way that I start out the conversation is tell me what you’ve heard and let’s discuss this point by point. Addressing every one of their concerns. There’s plenty of website where we could direct parents that has good information. We need to put the personal faith on it. I think we do too much Googling, texting and all of that other stuff. And I think if we pediatric and adult providers as well because this is an issue for adults, I think we need to put that personal faith on it, establish the trust, ask parents what their concerns are, don’t talk down to them, answer their questions honestly and be there for those parents.

 Thank you so much for speaking with me today.

 Well thank you very much for inviting me, I’m really grateful to have this opportunity because honestly, I don’t want to see any other families go through what my family has gone through.

Podcasts

Contemporary Pediatrics recently spoke with Mary Koslap-Petraco, DNP, PNP-BC, CPNP, FAANP, a nationally known expert in immunization practice, about why measles infection rates have skyrocketed in her home state of New York, what’s in store for the rest of the United States during the current measles outbreak, and how physicians can engage with parents to boost immunization rates.

Author | Erin Johanek, PharmD

Articles

Recognize & Refer: Focus on retinoblastoma

Recognize & Refer: Syncope

Recognize & Refer: Focus on anaphylaxis

Report from Ground Zero: Public health crisis in New York