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June 16, 2020

The Child Friendly Cities Initiative (CFCI) was launched by UNICEF nearly 25 years ago to respond to the challenges of realizing the rights of children at a municipal level. The CFCI framework assists cities to become more child focused in all aspects of governance and services through the implementation of systematic procedures and the meaningful involvement from children. By 2018, more than 3,000 Child Friendly Cities existed around the globe. However, there were none in the United States.

MNAAP Member Charles Oberg, MD, MPH, FAAP, along with Dr. Jeff Goldhagen and Nicholas Spencer, from the International Society of Social Pediatrics and Child Health (ISSOP), met with UNICEF in Geneva in the fall of 2018 to change this situation. Following a workshop in Jacksonville, FL in the spring of 2019, a few selected cities, including Minneapolis, began the effort to make CFCI a reality in the United States.

In collaboration with and under the leadership of the Minneapolis Commissioner of Health, Gretchen Musicant, a strategic planning effort began. On Feb. 14, 2020, the Minneapolis City Council passed and Mayor Jacob Frey signed a Memorandum of Understanding (MOU) with UNICEF to launch the first Child Friendly City Initiative in the United States.

Pictured: Child Rights Advocate Rachel Peterson, UNICEF USA Representative Adriana Alejandro Osorio, Minneapolis Mayor Jacob Frey, Minneapolis Commissioner of Health Gretchen Musicant, and Dr. Charles Oberg at the MOU signing.

What drew you to pediatrics?

I knew early on that I was interested in primary care because I really enjoyed getting to know patients in the clinic as a medical student, but I was torn between wanting to work with children and the elderly. When I look back, I see that I kept choosing projects that focused on children, which I think subconsciously kept bringing me back to pediatrics. Then there was that gut feeling doing peds as my final third-year rotation that cemented my passion for working with and for children.

What is a typical day like for you?

I work exclusively in outpatient primary care pediatrics within a large academic institution, so most days I am doing some combination of seeing patients and teaching. Often that means having a medical student with me in the morning or supervising our resident pediatric clinic in the afternoon. I also serve as director of the resident continuity clinic which has given me the opportunity to create and implement a curriculum over the last several years. It has also taught me that the one constant I can count on in medical education is change!

You are involved with the AAP Council on Communications and Media (COCM) as the chairperson. Can you tell me about your work with the council?

I joined the council a little over a decade ago as the council itself had recently been formed as a combination of two committees, one that examined the effects of media on children and the other which served to prepare pediatricians to work with the media to accurately translate important science about children’s health to the public. I’ve been interested in children’s media exposure and its effects since residency. That interest hit me right in the face during my first year of practice when a four-year-old patient, after seeing a television commercial, told his dad that he was supposed to ask his doctor (me!) about Levitra.

Now, I feel that I have a foot in both worlds as we talk to parents about how to manage media when so many people are on lockdown due to the novel coronavirus, but I also use social media to inform, amplify, and advocate. As part of COCM’s Executive Board, I was the lead author and editor of Pedialink’s first-ever online CME media education module, which was also approved for MOC Part 2 credit. Before I became chair of COCM, I served as both Program and Education chairs, which involved creating programming for the AAP National Conference and Exhibition every year. I also chaired the 2016 Peds 21 pre-conference that focused on media. I’m also thrilled to be part of the 2020 Peds 21 program committee which will focus on racism, bias and health inequities for children of color.

What prompted you to go “back to school” to complete a Master’s in Public Administration through the Commonwealth Fund Fellowship in Minority Health Policy at Harvard University?

Becoming a grad student in my 40’s was not something I had planned on, but my long-standing professional and personal interest in working with immigrant communities coupled with the need to better understand the system outside the clinic prompted me to do a deep dive into policy. The last few years have been a crash course in how important it is to have informed leaders and elected officials who make laws that ultimately affect the kids I see in clinic. I can work hard to advocate on a one-to-one basis multiple times every day, but if the system is flawed, even this important work becomes Sisyphean. We need to do more work upstream to restructure broken systems that too often leave out some of our most vulnerable populations.

What is something your colleagues might be surprised to learn about you?

In sixth grade, I held the class record for upper body strength in the Presidential Physical Fitness Test and now I can barely do one pushup. I had my moment of triumph. It was awesome.

What’s the funniest thing a child has said to you recently?

We’ve been doing more telemedicine lately, which gave me a chance to pick a fun background and I’ve had a number of kids ask if that’s Baby Yoda behind me. It is!

By Heidi Hubbard, MD, FAAP

Many of us remember residency as the best, and most stressful, time on the path to becoming practicing physicians. It marks the period in training when a person is most likely to get derailed because very little margin exists to allow for balancing work and life. Trainees are especially vulnerable, considering their long hours, increasing responsibility, financial stress and limited time for personal health and wellness. A recent review of three years of national data about burnout in pediatric residency published in Pediatrics showed that a majority of residents met burnout criteria. But for anyone who has lived through residency, this information is not new.

In 2007, I established a fund at the University of Minnesota Medical School – where I completed my residency training – to provide an emotional and financial safety net for unforeseen life events as young doctors moved through residency. One of the most critical areas of need is financial stability. The Pediatric Resident Wellness Fund provides hardship grants for immediate support for residents who experience significant and unexpected financial burdens. Residents access the grants to relieve the stress associated with costs of travel for a family emergency or funeral, medical expenses, mental health resources, car repairs, child care and other critical needs. Ensuring residents can focus on their personal life demonstrates our commitment to their overall wellbeing.

Enhancements to the pediatric resident lounge at M Health Fairview University of Minnesota Masonic Children’s Hospital allowed for a dedicated space for residents to connect, socialize and relax with one another. The fund also created social and networking opportunities for residents, promoting community building, camaraderie and volunteerism. In 2017, the program sought to expand its mission by supporting an annual wellness retreat to connect residents with one another, reflect on their experiences and renew their purpose. Throughout the year, residents have opportunities to engage in wellness activities including meditation and yoga classes, participate in a wellness leadership series, enjoy healthy meals, and take part in other programs dedicated to promoting residents’ wellbeing during a demanding time.

Creating meaningful opportunities for residents to promote compassion and resilience has brought me great joy. I encourage you to consider ways you can support the next generation of pediatricians, whether through mentorship or programs like the Pediatric Resident Wellness Fund at the University of Minnesota. If you are interested in learning more, contact Jonna Schnettler, director of development with the University of Minnesota Foundation, at jschnett@umn.edu.

Abby Meyer, MD, MPH, FAAP

A study conducted through a collaboration between MNAAP Early Hearing Detection and Intervention (EHDI) Chapter Champion Abby Meyer, MD, MPH, and Minnesota Department of Health (MDH) EHDI personnel was published in the March 20, 2020 edition of the CDC publication Morbidity and Mortality Weekly Report. The study looked at disparities with regard to timing of identification of hearing loss among 729 infants born in Minnesota from 2012-2016 who were identified as deaf or hard of hearing (DHH). Based on the Joint Committee on Infant Hearing benchmark of identification of hearing loss by 3 months of age, 30.4 percent of DHH infants had delayed identification of hearing loss. Infants were more likely to have delayed identification of hearing loss if they had 1) low birthweight, 2) public insurance, 3) a residence outside the metropolitan area, 4) a mother with a lower level of education, 5) a mother aged <25 years, or 6) a mother who was Hmong.

Disparities in timely identification of hearing loss exist among infants who are DHH in Minnesota. Delayed identification might lead to delay in initiation of Early Intervention services, which has been shown to result in poorer language outcomes in children identified as DHH. More work is needed to understand the barriers to audiologic follow-up in these identified at-risk populations. Pediatricians are in an optimal position to enhance messaging about the need for follow-up after newborn hearing screening and are in a position to encourage or even facilitate scheduling of follow-up appointments for diagnostic hearing testing.

As part of a Community Access to Child Health (CATCH) grant project through the American Academy of Pediatrics (AAP), Jessica Hane, MD, a fourth-year Internal Medicine and Pediatrics resident at the University of Minnesota, began working with Simpson Housing Services about a year ago to form a partnership between the U of M residency program and Simpson to improve the health of children who have experienced housing insecurity or homelessness. Through the project Dr. Hane and Simpson Housing Services Early Childhood Program Manager Nedra Robinson held sessions every one to two months for young parents (ages 16-24, many who recently moved out of the shelter into stable housing at Simpson) to chat with pediatric and med-peds residents in a more convenient and relaxed environment. The sessions focused on childhood nutrition, fever in a child, when to take your child to the doctor, vaccines, and the importance of reading.

But when the COVID-19 pandemic started, Dr. Hane realized the project needed to adapt. After working with the AAP to change the project to better serve the families at Simpson. Simpson Housing staff hung up posters from the Minnesota Department of Health (MDH) encouraging hand hygiene and social distancing. Staff also passed out hand soap, paper towels, and cleaning products supplied through the grant to all the families. Robinson recognized that many families were worried about running out of formula and had questions about breastfeeding during the pandemic. She and her staff bought extra formula to pass out to families. Dr. Hane provided guidance from the AAP about breastfeeding, formula feeding, and COVID-19 specific questions. In order to maintain social distancing, Dr. Hane provided a presentation addressing the most common questions from Simpson Housing and Robinson shared this with her staff.

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