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MNAAP Newsletter

Minnesota Pediatrician is published quarterly (February, May, August and November) and is written by pediatricians for pediatricians. The newsletter is mailed and emailed to over 1,000 members.

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May 23, 2019

When I was 8 or 9 years old, I watched my younger sister, not yet 4 years old, jump off the diving board wearing her “bubble” (an inflated football shaped flotation device belted around her waist). The bubble floated to the surface; she did not. My young self swam to help her, and we both struggled. Fortunately, our father was watching. In a flash, he was in the deep end of the pool, helping us both to safety. We were lucky.

Several years ago, moments after fishing acorns out of my 9-month-old nephew’s mouth, I sprang into action, while still holding my nephew, to scoop my then 2-year-old niece out of the shallow end of the pool. Despite being told to stay on the steps, she ventured further and within moments was underwater. Another adult was supposed to be watching them both.

Swimming with my own kids at a local fitness center pool, with lifeguards and multiple other adults around, I saw yet another child slip underwater, the child’s caregiver facing another direction. I helped that child, too.

Drowning happens quickly and at unexpected times when supervision, for whatever reason, lapses. It only takes a moment. As parents, we must be vigilant, alert, responsible. As pediatricians, it is our duty to counsel parents about water safety, to practice what we preach and to lead by example. Active supervision in and around water is required to prevent drownings and is why I became a #WaterWatchdog. A #WaterWatchdog agrees to maintain constant visual contact with the children in your group, not to drink alcohol, talk on the phone, socialize or read while watching children, to keep a phone near the water for emergency purposes only, and to remain by the water until relieved by a new #WaterWatchdog.

I encourage everyone, my colleagues, friends, family members, and patients/parents to become a #WaterWatchdog. Pledge to actively supervise children in and around the water, and prevent drowning, here: Together we can make a difference, and keep kids safe. Take the pledge, share and promote safety, actively watch kids and prevent drowning. #PutKids1st, always.

Christina Dewey, MD, FAAP, is a pediatrician at All About Children Pediatrics, in Eden Prairie, MN, practicing in the Twin Cities Metro area since 1999. Learn more about Dr. Dewey at & follow her on Twitter @PedsMamaDoc. 

February 27, 2019

By Vijay Chawla, MD, FAAP; and Sylvia Sekhon, MD, FAAP

Immunization outreach group

Immunization presentation panel at Dar Al-Hijrah Mosque in Minneapolis (left to right) Wali Dirie, Imam Sheikh Abdirahman Sharif, Michelle Dittrich (MDH), Dr. Nasreen Quadri, Sabah Yusuf (interpreter), Dr. Beth Thielen, Roble Aden (foreign trained Somali physician)

The Minnesota Department of Health (MDH) identified that children of Somali descent who were 24 months of age had an MMR vaccination rate of nearly half that of their non-Somali peers: 46 percent compared to the rate among non-Somali children, which was 88 percent. During the 2017 Minnesota measles outbreak, 65 cases of measles were identified with the majority in unvaccinated persons.  U.S.- born Somali children over age 12 months accounted for 55 of the cases.

Since 2017, 37 pediatricians, med-peds physicians and pediatric residents have volunteered to provide immunization education at mosques in Minnesota and answer immunization questions of parents and elders. The outreach is part of the effort by the MNAAP Immunization Taskforce, which is committed to increasing infant, child, and teen immunization rates and decreasing barriers to vaccination.

Improving the Minnesota pediatric immunization rates is one of the four strategic priorities of the MNAAP Board for 2017-2020. New immunization outreach/education sessions at mosques started in January 2019 and are scheduled to continue through June. The hope is that by taking information to the Somali communities throughout Minnesota and by having a dialogue with parents, elders, and religious leaders in the place where they meet weekly, we might be able to change a few minds and protect all our Minnesota children.

Somali resources and tips that are used at these education sessions and are available to clinics include:

• Somali/English version of the childhood immunization schedule from MDH. Order online, at and searching “immunization order form”.

• Somali/English child development wheel from the Minnesota Department of Education is available free to anyone in the seven-county metro area (and MNAAP has copies to share for greater Minnesota in English, Somali, Hmong, Spanish and Karen). One side of the wheel explains what a parent can do to further child development and the other side lists what skills a child should have starting at age 3 months to age 5 years. Contact Kathy McKay at and complete an order form.

While most of our mosque outreach presentations have been in a formal format with speakers sitting behind a table in front of the room, a recent group of women requested that we return to attend a women’s group at the mosque to share food and conversation and all sit together. This is a positive sign that the information is reaching those who need it.

By Mat Edick, Ph.D.; Amy Gaviglio, MS, LCGC; Chuck Oberg, MD, MPH, FAAP; and Sue Berry, MD, FAAP

Newborn screening (NBS) is a baby’s first medical screen, but not all parents receive the screening results or understand their impact.  Primary care providers are often the only way parents receive their child’s newborn screening results; however, a recent survey of Minnesota families found that less than half of parent or guardians recall receiving NBS results from their primary care clinic.  No news is not good news, it is a missed opportunity to verify screening was completed and share important information with families.

With funding from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services, the Midwest Genetics Network and MNAAP offered a free Maintenance of Certification Part 4 (MOC4) and training to pediatricians in Midwest states.  The MOC4 was designed to improve communications between providers, clinics, and parents around newborn screening results and referrals.  Nearly 60 Minnesota pediatricians participated in this MOC4 project along with 30 additional pediatricians from Wisconsin, North Dakota, South Dakota, Iowa, Michigan, Illinois, and Kentucky. Using a “virtual learning collaborative,” participants received training on three topics:

  • Newborn Screening: An introduction (with Amy Gaviglio, MS, LCGC)
  • Newborn Screening: Normal Results (with Susan A. Berry, MD and Whitney Thompson, MPHIL)
  • A Guide: Positive and Borderline Newborn Screen Results (with Miriam J. Behar, MD)

With two-thirds of the participating clinics completing their three audits by mid-December, the baseline rates of communication with parents about newborn screening results were only 30 percent in the participating clinics. Pediatricians implemented a variety of quality improvement projects to improve NBS results communications with parents including using the patient portal to communicate results to parents, new EHR tools/template changes to document NBS results communication with families, training staff at clinic to address misconceptions on NBS tests and need for results, new patient education materials and training on this topic for all new physicians and clinic staff

After two quality improvement initiatives at participating clinics, communication rates rose to over 60 percent. This was an encouraging result, however, there is still room for improvement. Participants who completed this MOC 4 have been offered additional MOC4 credits to complete additional rounds of quality improvement, and Midwest Genetics Network will be enrolling a new cohort of pediatricians to participate in this free MOC4 early in 2019.    

Additional free MOC4 opportunities in 2019 will be shared through upcoming MNAAP all member emails.

By Christopher Vara, MD; Sarah Kelly, DPT, Shriners Healthcare For Children — Twin Cities

Adolescent idiopathic scoliosis (AIS) can be a frustrating diagnosis because the cause is unknown in more than 80 percent of cases. Shriners Healthcare for Children — Twin Cities offers a non-traditional 3D treatment approach for AIS. Therapists instruct patients using scoliosis specific exercises (SSE) according to the principles of Christina Lehnert-Schroth and the Barcelona Scoliosis Physical Therapy School (BSPTS). This program targets the AIS population, but can also be used to treat juvenile idiopathic scoliosis and several sagittal plane disorders, including Scheuermann’s kyphosis.   

At Shriners Healthcare for Children — Twin Cities more than 60 patients have seen improvements in postural control, pain reduction, strength and overall quality of life since inception of the SSE program two years ago. Here patients have the benefit of a low dose 3D EOS radiation imaging system, in-house orthotists for custom bracing, and expert care from pediatric orthopedic surgeons.

Various factors are considered to determine if a patient is ideal for our program, including but not limited to, Cobb angle, age, Risser score, menstruation, and other radiological findings. Research indicates that younger, skeletally immature patients with a higher Cobb angle at diagnosis correlate to a higher risk of progression and an increased need for possible bracing or surgery.

When postural asymmetries are noted and the Adam’s forward bend test is performed, the use of a scoliometer can be a very helpful tool to assess the angle of trunk rotation (ATR). The 2013 SRS recommendation for measuring ATR is 7 degrees to make a referral.

Comparison of postures in scoliosis patient

On the left: An SSE patient with AIS habitual standing posture
On the right: The same SSE patient with active stabilization in her corrected posture

The SSE program focuses on educating patients about body awareness while using sensory-motor and kinesthetic training, with a goal of creating stability around their corrected posture. The program empowers patients by providing them with an active role in their treatment.

Scoliosis Specific Exercises:

  • Improve aesthetics via postural correction
  • Address respiratory dysfunction
  • Reduce functional limitations
  • Minimize the progression of the spinal deformity

The SSE program is time intensive and requires multiple follow-up sessions over a span of time relative to the patient’s risk of progression. Patients are prescribed a daily home exercise program including education on adapting posture, and they are instructed to avoid activities that may negatively impact their spine. Successful outcomes are directly correlated to the patient’s compliance with their home exercise program.

Historically, high-quality evidence supporting physical therapy and scoliosis has been hard to find but now there is new and ongoing research regarding the impact of physical therapy on scoliosis. A recent study by Kwan et al. in 2017 in the journal Scoliosis and Spine Disorders revealed that Schroth exercise, in combination with bracing, was superior to bracing alone in improving Cobb angles, trunk rotation, and quality of life scores. Additionally, patients who were compliant with their exercise program had a higher rate of Cobb angle improvement.

Shriners Healthcare for Children — Twin Cities has two therapists certified in SSE: Sarah Kelly, DPT and Rebecca Rouse, DPT.  Both are BSPTS C1 and C2 certified to treat scoliosis and have extensive knowledge of the treatment of back pain and sacroiliac joint dysfunction. Currently, these physical therapists are two out of only four in the state of Minnesota with the advanced C2 certification, allowing for the treatment of a patient who have undergone spine surgery. Primary care providers who refer will receive progress updates and are welcome to reach out for more information. Referrals may be made by phone 612-596-6105 or fax 612-596-6102.

 The beginning weeks and months of a new year often give way to moments of reflection and preparation. I have taken a moment to look back on 2018.  With abundant optimism, I am recalibrating for upcoming opportunities and challenges ahead in 2019.  At our last meeting of 2018, the MNAAP board members reviewed the 2019 legislative priorities.  These priorities include reducing vaccine-preventable disease, promoting pediatric mental health services and expanding health care access.  The board had a more specific and robust discussion as we talked about Minnesota’s provider tax, which will expire on Jan. 1, 2020, per legislation enacted in 2011. The revenue from this tax is deposited into the Health Care Access Fund, which supports insurance for lower-income Minnesotans.  In a nutshell, if the provider tax expires, many of our patients and families who are just barely getting by will lose their health insurance.  After our discussion, the board members upheld that unless there is a viable alternative to replace this source of revenue, the chapter will advocate for repealing the sunset of the provider tax. Looking back, it is clear the chapter and foundation were busy in 2018. Recently, we submitted our annual report to AAP, which contains detailed descriptions of advocacy efforts, education, and grant projects.

Here are a few outcomes from 2018 that made me         particularly proud:

Trainings educated 235 people about addressing    poverty and disparities in the clinic through webinars and in-person meetings.

Our chapter was asked to provide testimony in support of gun safety legislation and over 40 pediatricians participated in gun violence rallies and meetings over the year.

A quality improvement project at two Minnesota clinics increased up-to-date HPV immunization status for about 400 patients, from 9 percent to 74 percent.

Dovetailing into an opportunity for advocacy, I invite you to attend the upcoming Pediatricians’ Day at the Capitol on Wednesday, March 6.  This is an energy-infused activity where community pediatricians, residents, and medical students have a unique opportunity to learn more about health issues that impact the children of Minnesota. You can speak up and address priority topics with your legislator.  Let’s join together and #PutKidsFirst.

Lori DeFrance, MD, FAAP
MNAAP President

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