December 2020 Minnesota Pediatrician
Click to download the PDF: December 2020 Minnesota Pediatrician
Click to download the PDF: December 2020 Minnesota Pediatrician
Each year, the Minnesota Chapter of the American Academy of Pediatrics honors two members for their dedication to the health and wellbeing of Minnesota’s children and adolescents with the Child Advocacy Award and the Distinguished Service Award. During the chapter’s annual meeting held virtually as part of the Twin Cities Pediatrics Update in September, chapter President Sheldon Berkowitz, MD, FAAP, announced that Marjorie Hogan, MD, FAAP, received the Distinguished Service Award and Tom Scott, MD, FAAP, received the Child Advocacy Award. We applaud both of these members for their commitment to advocacy and advancement on behalf of Minnesota’s youngest residents.
The Distinguished Service Award is presented to a pediatrician recognized for dedicating his or her life to improving care for children in Minnesota. This year’s recipient is Dr. Marjorie Hogan, a pediatrician and adolescent medicine physician at Hennepin Healthcare. Dr. Hogan has dedicated her life to serving historically marginalized populations. Many know Dr. Hogan for her warmth and compassion with families, as well as her mentorship and generosity with her counsel and teaching. One of her colleagues recently said, “Margie is the embodiment of kindness. She has an unbelievably positive outlook on the world even though she worked for years as a child maltreatment specialist. She was a soft place to land for many children who needed to tell their story to someone. We all strive to be a ‘Dr. Hogan’ with our patients.”
The Child Advocacy Award is presented to a person or organization from the community who goes above and beyond his or her everyday routine to advocate for children. This year’s recipient is Dr. Tom Scott, former co-chair of the MNAAP Poverty & Disparities work group and former co-chair of the Early Childhood Caucus. Dr. Scott has been actively involved in a variety of issues over the years, from bullying and LGBTQ issues, to early brain development. One colleague stated, “Tom’s work as a child health advocate is really more of a calling. A calling he has consistently answered, while also teaching so many others how to answer their call.” Another colleague said, “He never lets any work feel small or unnecessary and celebrates the journey along the way.”
I have managed to find some paths to stay connected to advocacy for children by serving on the board for First Witness Child Advocacy Center in Duluth. I also partnered as a pediatric resource with MN Head Start as they re-started their programming across the state over the summer. MN Head Start leadership demonstrated admirable sensitivity and effectiveness in re-engaging with their vulnerable communities over the summer when the basic science around COVID-19 was evolving rapidly and best practices for re-opening required novel design and periodic review.
You serve on the board of First Witness Child Advocacy Center. How long have you been involved with the center and what drew you to this organization?
My initial involvement with First Witness was back in 1990’s when the organization formed and built their building across the street from the former Duluth Community Health Center (now Lake Superior Community Health Center) where I was a physician volunteer and board member. I became re-engaged a few years ago when First Witness approached the Duluth Family Medicine Residency (where I was on faculty) to form a partnership to assist in forensic clinical evaluations as part of their comprehensive programming for children and families suffering from abuse. The Duluth Family Medicine Residency carries on this partnership under the direction of Dr. Jennifer Jones. I am retired and have served on the First Witness board for 18 months.
What are your interests or hobbies?
My interests are local history of the Twin Ports (especially railroading and Great Lakes shipping), serving on the board of the Lake Superior Railroad Museum. Active outdoor pursuits are a special interest including kayaking Lake Superior, canoeing, bicycling, snow shoeing, and cross country skiing. My fly rod and other fishing tackle receives occasional use. Four growing grandchildren from 2-7 years of age receive increasing shares of my time, especially since my wife and I are doing the online schooling for our 7-year-old grandson during this pandemic interval.
What’s the funniest thing a patient has ever said to you?
The funniest thing a (young) patient ever said to me was: “My Daddy works as a (insert job here), what kind of work do you do?”
If you could share one lesson from your years in practice, what would it be?
One lesson to share from years of practice: learn and record in each patient’s chart the names of everyone in the family, where they live, and some vital themes around their family life. Review this info briefly before every encounter. Nothing emphasizes that you truly care for the family than being able to greet each child in the room by name and ask some pertinent question updating family life. It’s not just good patient relations; it turns a crowded schedule of ‘encounters’ into a rich series of ‘engagements.’ I found this to be the best means to avoid the dreaded ‘burnout’ that can come with the inevitable busyness of outpatient medicine. Going the extra mile for kids that feel like family does not seem to consume as much effort as it might if the day were just a list of tasks.
2020 has been an unpredictable year. If you could look into a crystal ball for the future, what would you hope to see?
My hope for the future after the pandemic year of 2020 is that all who work in healthcare through this crisis are drawn together into a bond of caring and service to each other and the people who seek care. As the pandemic deepens, the heroic service of all healthcare workers may be able to inspire the next generation to heed the call to choose a career in the health fields.
By Sarah Kinsella, MD, CAQ, FAAP, and William O. Roberts, MD, MS, FASCM, FAAFP
COVID-19 has upended almost every aspect of our lives, and youth sports are no different. In March 2020, many sports organizations were shut down due to the pandemic, and the Minnesota State High School League (MSHSL) canceled its winter state tournaments with two days remaining in the girls’ basketball tournament. Throughout the summer and fall, sports leagues at every level strategized how to navigate safer sports participation during this pandemic. As more people are exposed to and infected with SARS-CoV-2, physicians need to consider how athletes can safely return to sports once they have recovered.
As we learn more about the potential sequelae of COVID-19, particularly the risk of post-viral myocarditis, various national organizations are working together to come up with guidelines and cardiopulmonary considerations for returning athletes to sports during the pandemic based on the best evidence currently available. The National Federation of State High School Associations (NFHS) and the American Medical Society for Sports Medicine (AMSSM) formed a task force and published a guidance statement, and the American Academy of Pediatrics (AAP) updates recommendations on their COVID-19 specific website. The MSHSL recently established their own “Post COVID-19 Graduated Return to Sport Protocol” based on these guidelines which can be found on their website. When a student-athlete has been diagnosed with, or tests positive for COVID-19, a medical evaluation is recommended prior to returning to physical activity. General pediatricians will likely see this Minnesota-specific form during clinic visits this winter.
The MSHSL medical form prompts providers to ask specific questions about the patient’s diagnosis, treatment history, and current symptoms including a more detailed cardiopulmonary symptom history. COVID-19 induced myocarditis may predispose patients to arrhythmia and sudden cardiac arrest with activities. Given this concern post infection, certain criteria should be met before an athlete returns to sports. Athletes should be at least 14 days symptom free without medications and able to tolerate activities of daily living without cough, shortness of breath or fatigue. They should not have any cardiac symptoms including chest pain or tightness, unexplained syncope, dyspnea or fatigue with exertion, palpitations with activity, or a new heart murmur on exam. For athletes with a positive response to a cardiac screening question or a history of moderate to severe symptoms including hospitalization, additional cardiac evaluation is recommended which could include cardiology consultation, ECG, echocardiogram or other investigations. The AAP specifically recommends that those patients with severe illness, including organ failure, intubation or multisystem inflammatory syndrome (MIS-C), be treated like they have myocarditis and restricted from exercises for 3-6 months.
When an athlete is ready to return to sports, the protocol outlines a graduated return progression based on international recommendations. An activity progression is important to provide an athlete with a gradual increase in cardiac load. If cardiac symptoms develop during the progression, additional medical evaluation is needed. The protocol recommends a 7-day return to sport protocol starting with stage 1 of light activity, like walking, and progressing through more complex training at a minimum of 1 week. If symptoms develop with advances in activity, the athlete should return to the previous asymptomatic level for 24-48 hours before attempting the next level of activity.
At the high school level, athletic trainers can help guide athletes through this protocol. For younger or non-high school athletes, this protocol is a good template for pediatricians to educate parents on how to return their children to activities after COVID-19.
1) Drezner, et. Al. Cardiopulmonary Considerations for High School Student-Athletes During the COVID_19 Pendemic. Sports Health 2020; 12(5), 459-461.
2) American Academy of Pediatrics “COVID-19 Interim Guidance: Return to Sports” updated 9/18/2020: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-interim-guidance-return-to-sports/
3) Minnesota State High School League (MSHSL):
4) Elliott N, et al. Infographic. Graduate return to play guidance following COVID-19 infection. Br J Sports Med, 2020.
In fall 2019, I was appointed to the Minnesota Children’s Cabinet Advisory Council by Gov. Tim Walz after a very formal application and review process. As the only medical doctor on the 15-person council, I was excited to be given the opportunity to partner with leaders across the state and focus on children’s well-being across Minnesota. I soon learned that the council also included youth representation and that we would be working in tandem with the 15 community and government leaders who comprise the State Advisory Council on Education and Care. Who knew that in just four short months of the group convening, we would be faced with the worst public health crisis the world has encountered in the last century? As members of the MNAAP, it may be helpful to learn a little more about what this group does and how state government is using this council to engage feedback from representatives on the ground that work with children every day.
Let’s set some context. What is the Minnesota Children’s Cabinet and its purpose? The goal of the re-launch of the Children’s Cabinet by Gov. Walz has been summed up by state officials as “making Minnesota the best state for children to grow up” by focusing on: 1) a child-centered government, 2) a whole-family approach and 3) bringing equity into every governmental policy discussion. The cabinet itself has five areas of focus: Healthy Beginnings, Child Care and Education, Housing Stability, Educational Opportunity, and Mental Health & Well-being. When major policy decisions are made, the governor and lieutenant governor first meet with the commissioners of various departments in state government who comprise the actual Children’s Cabinet, and ask the question: “How will this affect children and families?” The Children’s Cabinet Advisory Council and the State Advisory Council on Early Childhood Education and Care make recommendations to support community engagement and the work of helping our politicians focus on children, families and equity.
Since March, the Advisory Council’s focus has been on addressing how the pandemic has affected children and families. Early on, much of our time was spent addressing the need for essential worker child care and how to help child care providers sustain themselves during these challenging times. We discussed school closures, distance learning and gave input on how educational disparities were worsening. We talked about lack of access to technology and the strain on families with children who may have special needs, as well as myriad other effects that we all are aware of as practicing clinicians – including homelessness and food insecurity.
In May, we all witnessed George Floyd’s murder just a few blocks from where I attended elementary school, and our hearts collectively broke. Our Advisory Council shifted some focus to share with our political leaders how children are affected by experiencing social injustice and racism. In August, we worked on school re-opening and I assisted in the creation of the Minnesota Department of Health’s School Exclusion Guidelines we are all now using in clinic.
As we move forward, our hope as a council is to balance our ongoing pandemic work with efforts related to the original areas of focus for the group as outlined above. It is simultaneously exhausting and energizing work. The needs of children and families must be front and center in government decision-making to have a truly healthy populous, of this there is no doubt and I feel privileged to be part of this work – sharing our stories with those who will listen. Please reach out with anything you would like me to share with the council on behalf of our state’s amazing pediatricians.