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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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June 13, 2019

Legislators, like students cramming for a big test or project, often work best under the pressure of deadlines. That was the case this legislative session, too, as it took an old-fashioned “all-nighter” for legislators to complete the work of the 2019 legislative session. Legislators, called back to the Capitol for a special session by Governor Walz on May 24, worked for more than 20 hours straight to complete the work for the year.

The MNAAP had a very strong legislative session. Most notably, the chapter played a leading role in the successful effort to repeal the sunset of the provider tax. The tax, used to support funding for Medical Assistance and MinnesotaCare as well as other access and public health programming, had been slated to be repealed on Dec. 31, 2019, however the Legislature’s actions now extend the tax indefinitely. The MNAAP joined a group of more than 150 health care providers, hospitals, social justice advocates, labor unions, and others in the robust campaign to preserve funding for these important programs.

Investments in pediatric mental health, another chapter priority, was also an area that saw strong results. The Health and Human Service (HHS) budget saw a significant investment in school-linked mental health funding in 2020 and beyond, and funding was also appropriated for mental health services delivered in homeless shelters. Robust funding for suicide prevention was adopted, as was authorization for the Department of Human Services to add up to 80 additional residential mental health beds.  An important measure to strengthen the state’s laws that mandate parity for mental health services was also adopted into law.

The session saw a number of other notable wins. Advocacy by pediatricians saw the innovate, effective “Reach Out and Read” program receive funding in 2020 and 2021, as part of a new emphasis on disparities in prenatal care. Two important tobacco control proposals – state funding for a nicotine cessation services and an extension of clean indoor air requirements to include e-cigarettes – also became law.  And while the move to increase the age at which individuals may purchase tobacco and nicotine products from 18 to 21 did not become law, this session saw significant progress. A newly created task force on rare diseases will bring together health care leaders (including at least one pediatrician) to provide advice on research, diagnosis, treatment, and education related to rare diseases.     

Unfortunately, several other MNAAP priorities were less successful. A MNAAP-supported effort to reduce death and injury by firearms could not draw support in the Senate despite a forceful lobbying effort by advocates and the House of Representatives. The chapter was also unable to secure funding to improve the state’s immunization rates.

A House-led effort to fund education and outreach efforts in communities with lower rates of immunization was not included in the budget bill, and a related proposal in the Senate came up short, too. The good news is that no anti-vaccine proposals became law, despite lobbying by anti-vaccine legislators and advocates. Regrettably, a MNAAP-supported effort to bar the use of so-called “conversion therapy” for minors was also rejected by the Senate.

The increased profile of pediatricians and the MNAAP was another highlight of the 2019 session.  Pediatricians testified on almost a dozen different bills or issues, and a nearly equal number of letters of support were distributed to policy makers. Coupled with the action alerts to lend the chapter’s support to the provider tax fight, the 2019 session saw a very active and vibrant chapter. The pediatric community was well represented by the terrific pediatricians who participated in these efforts.

With the 2019 session having concluded, the chapter will begin building our game plan for the 2020 session very soon. The 2020 legislative session starts on Feb.11, 2020, and there are innumerable threats and opportunities awaiting pediatricians and the state’s most vulnerable patients.

About the Author

Eric Dick is MNAAP’s lobbyist. 

Lindsey Yock serves on the chapter’s Board of Directors, acting as co-chair of MNAAP’s policy committee. She has been an AAP member since 2011 and works at Children’s Minnesota. Dr. Yock answered these questions from Minnesota Pediatrician as part of our quarterly member spotlight.

You’re an attorney and a physician. How do these two roles intersect for you in your work?

I attended the Joint Degree program in Law, Health and the Life Sciences at the University of Minnesota, receiving my law degree in 2008 and my medical degree in 2011. After finishing residency at Mayo, I stayed in Rochester for a year as chief resident. Since 2015, I have been at Children’s Minnesota as both a pediatric hospitalist and an adjunct attorney.

My position consists of clinical work (80%) and assignments through the office of the General Counsel (20%). In my legal role, I am a member of the Institutional Review Board (IRB), where my familiarity with federal regulations can be helpful, and I consult on various initiatives and projects, such as our onsite healthcare-legal partnership and the legal implications of clinical practice guidelines that Children’s develops. This year, on behalf of the Children’s advocacy team, I testified at a hearing at the state capitol in support of a program to reduce childhood hunger.

More informally, these two roles intersect daily on the wards when I’m working with social workers and staff attorneys to address problems that affect vulnerable families, including guardianship and family law matters, immigration status, and landlord-tenant issues.

What does a typical day at Children’s Minnesota look like for you (or just a typical work day)?

When I’m on clinical service, I’m either seeing patients on my own or working with our teaching services, which I love because of the energy, curiosity, and competence of the residents and students who rotate at Children’s.

When I’m not on service, my days are more varied. In addition to preparing for and attending bi-weekly IRB meetings, my days typically involve collaborating with various members of the health system, working independently on projects that I’m responsible for, and occasionally testifying or otherwise speaking about child health issues.

What interests you about your work on the MNAAP policy committee?

University Dean Kathy Watson introduced me to a wonderful quote from physician Rudolf Virchow: “If medicine is to fulfill her great task, then she must enter the political and social life. . . . The physicians are the natural attorneys of the poor.”

The MNAAP policy committee provides a meaningful way to engage in political and social issues that relate to the health and wellbeing of our patients. Through the Chapter, the policy committee, and all the wonderful people who support its advocacy work, we are able to deal directly with legislators and others in state and local government to champion Minnesota’s children. As one example, at the invitation of Representative Frank Hornstein and Senator Scott Dibble, whom I met during MNAAP Peds Day at the Capitol, I provided information and perspective at a MN Congressional District 61 Town Hall in 2017, when Minnesota children were at risk because of possible cuts to Medicaid.

In short, working with the MNAAP policy committee, and as a member of the MNAAP board, I get to consider issues that involve both law and medicine, and I get to contribute to discussions that affect society beyond individual patients.

What is something people might be surprised to learn about you?

Although I’m a lawyer and enjoy debate, I am not temperamentally litigious!

What would a perfect day be like for you?

After the winter we’ve just had, it would start out with low humidity, uninterrupted sunshine and a temperature in the 70s. I would open the newspaper to headlines proclaiming that vaccination rates in the United States are at an all-time high; confidence in science and physician experts is robust; childhood homelessness, food insecurity and socioeconomic disparity have fallen to unmeasurable levels; and every child feels loved and supported and excited about their future. The day would include meaningful work with my excellent colleagues (my current reality). Then it would end with an episode of “Wait Wait . . . Don’t Tell Me!” and wonderful food with loved ones.

The MNAAP fosters an interest in pediatrics in upcoming medical students through grant funding for special projects within Pediatric Interest Groups at medical schools in Minnesota. Kylie Andersen, with the Mayo Clinic School of Medicine Pediatric Interest Group, offered this overview of the group’s most recent project using MNAAP grant funding, the Pediatrics Selective.

The Pediatrics Selective is a week-long introduction to the field of pediatrics for first-year students from Mayo Clinic School of Medicine (MCSOM). Now in its sixth consecutive year, the week is planned by the Pediatrics Interest Group with a goal of providing first-year students a broad overview of the specialty, simultaneously offering an early opportunity to explore more targeted interests within pediatrics.

Throughout the selective program, students had the opportunity to interact closely with residents, consultants, allied health professionals and patients. Early in the week, students received introductory lectures on the field of pediatrics, pediatric surgery, and research within pediatrics. They also learned about music therapy, services provided by Child Life, and ways to talk with patients about sexual health, as well as more difficult topics such as child
abuse and neglect. Later in the week, students had the opportunity to tour the pediatric departments of the hospital, spend time shadowing pediatric specialists, and sit in on interviews with inpatient child and adolescent psychiatry patients. They also spent an evening volunteering by preparing dinner for residents of the local Ronald McDonald House. The week concluded with a lecture on the “Path to a Peds Residency” from Mayo Clinic’s Pediatric Residency Director, Jay Homme, MD, FAAP.

Each year, students complete surveys before and after the selective in order to help the Pediatric Interest Group better understand the interest of incoming students, learn what sessions were useful, and to improve the week in the future. Over the course of this program’s history, it has continued to be well received by students and faculty at MCSOM and we look forward to watching continue to develop in the coming years.

Long summer days in the sun are just around the corner, which makes this an excellent time to take a few minutes to talk with your patients about sun protection.

The past five years have seen a surge of attention when it comes to sun protection. In 2014, the U.S. Surgeon General issued a “Call to Action” for skin cancer awareness and prevention, and specifically called out health care providers to educate our patients about sun safety.

Why is this a high-priority topic?

Sun exposure in childhood is an important risk factor for the development of skin cancer later in life. Even one sunburn is dangerous. A 2008 meta-analysis published in the Annals of Epidemiology concluded that more sunburns meant a higher risk of melanoma. One sunburn prior to age 13 meant a 1.9 times higher melanoma risk.

Tanned skin is sun-damaged skin. Cumulative suntans over time leads to cumulative sun damage and higher skin cancer risk.

In 2015, the Sunscreen Innovation Act was passed with the intent to bring currently unavailable sunscreen products onto the market. Earlier this year in 2019, the U.S. Food and Drug Administration (FDA) released a proposed rule asking for sunscreen manufacturers to provide safety and efficacy data on many chemicals currently used in sunscreen products. New data suggests that certain sunscreen chemicals may have negative effects on coral reefs, leading to bans on the sale and use of oxybenzone and oxtinoxate in select parts of the world.

As trusted sources of information, patients look to us to help them make the healthiest decisions for their children. Here are some key points to consider when having discussions with your patients about the sun:

Empower parents to make a plan for sun protection.

There are lots of ways to reduce sun exposure. Seeking shade or planning outdoor activities before 10 a.m. or after 2 p.m. are simple ways to reduce risk. Recommend sun protective clothing, such as a swim shirt. These garments are easy to find (most large retailers offer them in the swimwear section) and typically cost less than the equivalent amount of sunscreen used over time. Recommend routine use of a hat and sunglasses to protect the scalp, ears and eyes.

Reiterate that sunscreen is safe.

The buzz in the media about sunscreen has sent some parents into a panic. Although the FDA is requesting more safety and efficacy data on many sunscreen ingredients, they have clearly stated that this is not because they are suggesting these products are unsafe. There are no known reports of sunscreen causing harm to humans. More data about sunscreen ingredients will help us make choices based on science instead of fear, and might help drive more choices onto the market. For your youngest patients and patients with sensitive skin, recommend the “physical” sunscreens made with only zinc oxide and titanium dioxide, since these already endorsed by the FDA and tend to be the most hypoallergenic. The coral reef question is one that needs further investigation: some argue that changes in water temperature and other water pollutants are main factors behind declining reef health.

Permission slips for sunscreen are a thing of the past. 

Students will be able to possess and apply sunscreen during the school day under a new law signed into law by Gov. Walz. The bill makes clear that school districts must allow a student to possess and apply a topical sunscreen product during the school day, while on school property, or at a school-sponsored event without a prescription, physician’s note, or other documentation from a licensed health care professional.


About the Author

Ingrid Polcari, MD, FAAP, FAAD, is a pediatric dermatologist at University of Minnesota Masonic Children’s Hospital and an assistant professor in the department of dermatology at the University of Minnesota Medical School.


Firearm-related fatalities are the third leading cause of death among children in the U.S., taking about 1,300 young lives annually. Several thousand children are injured by firearms yearly, and as many as 4 percent of children have witnessed a shooting in the past year causing immeasurable psychological trauma.

But what can we, as pediatricians, do to protect children from gun violence?

We can give very specific guidance to parents on how to safely store guns (if owned) and how to talk to their children about firearms. We can advocate for policies that have a track record for decreasing gun violence. This is an issue “in our wheelhouse” that we are equipped, and obligated, to address.

As pediatricians, we are in a unique position to rise above the partisan debate and advocate for children in the office, in our communities, and in our capitol.

Guidelines for Safe Firearm Storage

A 2018 study from the Journal of Urban Health found that 4.6 million U.S. youth live in homes with at least one loaded, unlocked firearm. Safe gun storage prevents accidental injuries and suicides. States with laws that require handguns to be locked have 68 percent fewer firearm suicides per capita than states without such laws, even after controlling for confounding variables. Share with parents and caregivers:

  • Hiding a gun in a drawer or closet is not safe storage
  • Firearms should be stored in a locked cabinet, gun vault or safe and/or secured with a gun-locking device (e.g.cable lock).
  • Ammunition should be stored and locked separate from firearm

Messaging for Children

  • Ask children to problem-solve at well check appointments: What would you do if you were playing at a friend’s house and found a gun? What if it looked like a toy?
  • The message you can share with children is: Stop. Do NOT touch the gun. Don’t let anyone else touch it. Even if the gun looks like a toy, don’t touch it because some real guns may look like toys. Go tell an adult.

Legislative Advocacy

Reducing firearm violence is one of MNAAP’s legislative priorities. The chapter advocates for policies that can protect children, including:

  • Background checks universally applied to all gun sales
  • Laws requiring waiting periods that create an important window for gun purchasers to reconsider their intentions and prevent impulsive acts of violence, particularly suicide
  • Minimum age for purchasing a firearm should be 21 years old
  • Safe storage laws can mandate safety requirements such as a locked container or gun lock

Additionally, since the federal assault weapons ban expired in 2004, banning assault weapons and large capacity ammunition magazines is an important area of policy to prevent mass shootings.


About the Author

Nadia Maccabee-Ryaboy, MD, FAAP, is a pediatric hospitalist at Children’s Minnesota. She serves on MNAAP’s child safety workgroup.


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