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March 7, 2019

A bill to promote the benefits of immunization will be heard in the House Health and Human Services Policy Committee on Friday, March 8.

Please take 1 minute to contact your House member and urge them to support this effort to increase immunization rates. Our voice needs to be louder than those contacting legislators with anti-vaccine rhetoric.

In short, HF 1182 would provide funding to the Minnesota Department of Health and community-based organizations to promote the benefits of immunization for those communities most at risk. The education efforts would be focused upon geographic areas or populations experiencing or at risk of experiencing an outbreak of a vaccine-preventable disease.

Talking points:
  • Vaccines prevent serious illness and save lives. Yet misinformation about vaccines is all too common, leading many parents to opt out of vaccines and put children and others at risk.
  • States with more permissive vaccination laws, such as Minnesota, are at increased risk for outbreaks of vaccine-preventable disease.
  • Data from the Minnesota Department of Health shows that several communities and schools have high rates of non-medical exemptions. In Wadena County, for example, 13 percent of Kindergartners are entering school without required vaccinations.
  • Targeted education is needed to counter myths and falsehoods about vaccination, especially in communities with high rates of non-medical exemptions.

Please take 1 minute to contact your House member and urge him or her to support HF 1182. 

1. Enter your home address to find your MN House member:

2. Send him or her a brief email using the language above. Feel free to personalize or modify. Copy so we can track outreach.

Another option is a quick call saying, “I’m a constituent in your district and pediatrician calling to convey my support for HF 1182, a bill to help provide education to communities with low vaccination rates.”



April 9, 2021

The American Academy of Pediatrics (AAP) recently released a new public service announcement portraying parents who get their children caught up on their vaccines as animated superheroes in the latest installment in the AAP’s Call Your Pediatrician campaign urging childhood immunizations. The PSA is available in English and Spanish.

The Centers for Disease Control and Prevention’s public sector vaccine ordering data show a 14 percent drop in 2020-2021 compared to 2019, and measles vaccine is down by more than 20 percent. In Minnesota, childhood immunization rates continue to lag behind pre-pandemic numbers. According to MMR administration data for Minnesota children under 2, rates are down 7 percent in 2021 compared to the same time period in 2019.

Consider sharing the PSA videos to your social media accounts with the hashtag #CallYourPediatrician to join in the conversation about keeping children on track with immunizations during the COVID-19 pandemic. Once the COVID vaccine becomes available to children, it cannot be given at the same time as other vaccines, so children and teens who are not caught up on their immunizations will fall even further behind.

March 23, 2021

As part of a special meeting held Thursday, March 18, the MNAAP anti-racism task force co-chairs shared the group’s recommendations to the board of directors and asked that by June 1, the board report back which recommendations they can implement through one or more action steps within a given timeframe of six months, one year and 18 months.

The group’s report to the board included recommendations for:

  • Chapter Diversity and Inclusion
  • Chapter Member Education
  • Improved Clinical Practice
  • Child and Community Health
  • Child Health Institutions and Organizations
  • Academic and Training Programs

See the anti-racism agenda infographic here.

The Board of Directors voted and approved work that will begin in six areas, to be conducted over the next six months:

  • The chapter will conduct an internal review of chapter policies to ensure they promote anti-racism.
  • If the internal review identifies examples of past racist policies, the chapter will publicly recognize these and plan for reconciliation.
  • The chapter will identify a Diversity Chapter Champion, who will work closely with the AAP Diversity District Champion.
  • The chapter will update a resource webpage for the anti-racism work that is easily navigated and available to all child healthcare workers.
  • The chapter will advocate that the local Reach Out and Read program offers books that promote anti-racism and diversity.
  • The chapter will actively seek ways to promote anti-racism legislation.

As this work progresses, updates will be shared through future All Member Emails.

March 16, 2021

Amelia Burgess, MD, FAAP

 Adolescents who use e-cigarettes are three times more likely to become daily cigarette smokers than those who have never vaped.  The most recent survey of Minnesota’s students showed that more than one in 10 eight graders had vaped in the previous 30 days, and nearly one in 10 eleventh graders were vaping daily.   Nicotine dependence progresses rapidly from experimentation to dependence.  Substance use disorders, including nicotine addiction, are characterized by compulsive drug craving, drug seeking, and use that persists in the face of negative consequences, such as impaired sports performance, or trouble at school or at home.  

What can a pediatrician do?

A straightforward place to start is the “5As” recommended by the Agency for Healthcare Research and Quality:  

1. Ask.  Use a tool to assess vaping use in adolescents.  The Hooked on Nicotine Checklist and the E-Cigarette Dependence Scale are both validated for this purpose. These can identify vapers and help you assess the severity of their use. Other tools include the Modified Version of the Fagerstrom Tolerance Questionnaire and the DSM-5 criteria for tobacco use disorder. 

2. Advise. Make a clear, personal recommendation to quit.

3. Assess. Is your patient willing to try to quit at this time?

4. Assist. With your patient, develop a plan to quit. Behavioral interventions are needed in all cases.  There are a number of good online/app-based programs focused on adolescents. This Is Quitting,  My Life My Quit, and Smokefree Teen are good places to start. has a “Build My Vaping Quit Plan” function that adolescents can do on their own, or with you. Working through “Build My Plan” with your patients provides an excellent way to build your own skills in addressing smoking cessation.

Pharmacotherapy should be considered for people who are moderately to severely dependent on nicotine.  Pediatricians should review full clinical drug information before prescribing. No medications for tobacco use disorder are FDA-approved for individuals under the age of 18, and there are not adequate data to demonstrate effectiveness.  There is no evidence of serious safety concerns. When faced with adolescents who are vaping or using other tobacco products, remember that they are already using nicotine. Nicotine Replacement Therapy (NRT) provides a safer nicotine product, without the toxins found in tobacco products, including vape liquid.  It is also designed for a slower increase in blood nicotine level and maintenance of a steady-state, avoiding the rush and crash characterized by inhaled nicotine.  The rush/crash cycle leads to increased use and dependence, whereas a steady blood level facilitates weaning. NRT can be prescribed off-label to youth under 18.  Detailed prescribing information can be found on the AAP website:    Nicotine Replacement Therapy and Adolescent Patients: Information for Pediatricians.

Bupropion and varenicline are used in adults for tobacco cessation, but are off-label and not well-studied in adolescents. Bupropion has a history of safe use in adolescents for other conditions; varenicline does not. 

For patients not ready to quit, use motivational interviewing.

5. Arrange. Check in every 1-2 weeks to provide support.  This process is well-suited to telemedicine!


Clubfoot is a developmental deformity that typically occurs in the second trimester of pregnancy.  A newborn’s foot or feet appear rotated internally at the ankle, the foot points down and inward and the soles of the feet face each other.  Alongside bone malformations, there are vascular abnormalities, muscle lesions, abnormal muscle insertions and fibrosis within the foot.  Clubfoot can occur in otherwise healthy children or it can be associated with various syndromes such as arthrogryposis.  

The diagnosis is made intrauterine via ultrasound or through clinical exam after the baby is born.  X-rays are not necessary for the diagnosis or management of clubfoot.  Clubfoot is associated with a small calf and slightly shortened tibia which can present as a very minimal leg length discrepancy.  Classification of a clubfoot is made with respect to the degree of deformity, rigidity, depth of skin creases, and muscle tightness and contractility.  

Treatment for clubfoot is started around 2 to 4 weeks of age, or once the child has reached birth weight, with a series of weekly casts that follow the method pioneered by Ignacio Ponsetti, MD.  A majority of children will require an Achilles tenotomy at the end of treatment and remain in a cast for an additional three weeks.  After three weeks, children are immediately placed into a bar and shoe that they wear 23 hours a day for three months, and then at naps and nighttime until 4 years of age.  

Even if parents adhere to this schedule, a small number of children may require surgery, as they get older. 

Phase 1: Casting

The cast extends from the groin to the toes and is changed every one to two weeks to gently stretch and reposition the foot. The number of casts ranges from four to six.

Phase 2: Tenotomy

The Achilles tendon is clipped to lengthen the heel. This procedure is done in the clinic unless otherwise recommended by your physician. A cast is applied and worn for three weeks.

Phase 3: Bracing

When the final cast is removed, the child is placed in a foot abduction brace designed to prevent the clubfoot deformity from recurring.

At Shriners Children’s Twin Cities, our providers are trained in the Ponsetti method; treatment can start at time of the child’s initial evaluation.  On site, we have a dedicated casting room, a child life specialist to help keep children comfortable, and orthotists to ensure proper fit of the foot abduction brace’s bar and shoes at all visits.  

About the Author

Michael J. Priola, D.O., is a board-certified pediatric orthopaedic and sports medicine surgeon at Shriners Children’s Twin Cities. His areas of special interest include cerebral palsy, limb deficiencies, foot deformities, spina bifida, sports-related injuries and conditions of the knee. He is proud to be a part of the Shriners Children’s Twin Cities team, which is solely dedicated to the care of children with pediatric orthopaedic conditions.


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