Minnesota Chapter of the American Academy of Pediatrics

Early Childhood

<h3 class="wp-block-heading">What is a work group?</h3>



The MNAAP work groups were formed as part of the chapter’s strategic priorities plan to address areas in which change or improvement would benefit the lives of Minnesota’s youth. During a work group meeting, members often identify opportunities for collaboration, potential projects to take on, or other ways to advocate for their cause. Email Bethany Venable (venable@mnaap.org) for more information.



Anti-Racism &amp; Disparities



The Anti-Racism &amp; Disparities work group is looking ahead to spring with plans to host a retreat to bring members together in an energizing session of planning and visioning. The group is also the chapter’s point of contact for a new contract initiated with the YWCA to help further embed diversity, equity, accessibility and inclusion in the MNAAP culture and operations. The Anti-Racism &amp; Disparities Work Group next meeting is set for Monday, Dec. 11, from 12:15 to 1 p.m. via Zoom.



Early Childhood



It has been a monumental year for investment in the littlest Minnesotans, thanks in part, to all the MNAAP members who spoke up for children who can’t speak for themselves. Yet, all this positive change yields more opportunity and more work to do! This year, our chapter will have monthly meetings or lectures about the ways we can advocate at the policy level for prenatal to five health and investment. We will also talk about how we can bring important programming into our daily practice. Our next meeting is Oct. 27, at 12:10 p.m. via Zoom.&nbsp; If you believe in the power of the first 1,000 days to change a life course, then please join us!



Behavioral/Mental Health



The Behavioral/Mental Health work group continues to work on the Minnesota Pediatric Mental Health Access Program MOC 4 focused on depression screening in LGBTQ+ and BIPOC communities. We are looking forward to learning more about how we can have open, affirming screening and supportive conversations around mental health from the youth in our community partnerships. 



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MNAAP Work Group News | Fall 2023

<div id="attachment_4261" style="width: 209px" class="wp-caption alignleft"><a href="http://www.mnaap.org/minnesota-begins-universal-congenital-cmv-screening-how-is-it-going-so-far/mn-aap/" rel="attachment wp-att-4261"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-4261" class="wp-image-4261 size-medium" src="http://www.mnaap.org/wp-lib/wp-content/uploads/2023/09/MN.AAP_-199x300.jpeg" alt="" width="199" height="300" srcset="http://wp.mnaap.org/wp-lib/wp-content/uploads/2023/09/MN.AAP_-199x300.jpeg 199w, http://wp.mnaap.org/wp-lib/wp-content/uploads/2023/09/MN.AAP_.jpeg 323w" sizes="(max-width: 199px) 100vw, 199px" /></a>Parent advocates Leah Henrikson and Steph Steidl are pictured here with their children, Vivian Henrikson Hank Steidl at the initiation ceremony for the new cCMV screening program. Both Vivian and Henry were born with cCMV. The “Vivian Act” is named after Vivian.</div>
On February 6, 2023, Minnesota became the first state to screen all newborns for congenital cytomegalovirus (cCMV), the most common infectious cause of pediatric disability in the United States. Most children born with cCMV are asymptomatic and have normal developmental outcomes, but up to 15 percent will have sensorineural hearing loss (SNHL). The need to monitor for SNHL is the driving force behind universal screening. This breakthrough in newborn screening was made possible by the passage of the “Vivian Act” in 2021, legislation driven by parental advocacy coupled with advances in biotechnology that made newborn dried blood spots sufficiently sensitive for newborn screening.
Since the advent of this newborn screening test, substantial numbers of infants with cCMV have already been identified. What is recommended if you, as a primary care pediatrician, receive a report from the Minnesota Department of Health (MDH) Newborn Screening Program that an infant’s cCMV screen is positive?
<ul>
<li class="p3">At this time, it is recommended that the infant have a PCR test of urine to confirm the cCMV diagnosis.</li>
<li class="p3">Evaluation should focus on the question of whether the infant has any signs or symptoms of cCMV. The history and physical exam are of great value. Was there a history of intrauterine growth retardation/SGA? Did the newborn demonstrate low birth weight, petechiae, microcephaly, hepatosplenomegaly, or other rashes? Did the baby “refer” on the newborn hearing screen? Does the baby have any neurological findings on the newborn physical exam that are abnormal?</li>
<li class="p3">Additional studies to help define whether the infant has CMV disease (versus asymptomatic infection) are recommended, including a complete blood count (including differential leukocyte count and platelet count), hepatic function tests, a cranial ultrasound examination, and ophthalmologic evaluation. If there is any uncertainty about cranial ultrasound findings, it can be very useful to have the imaging study reviewed by a pediatric radiologist. In some cases, MRI imaging might be warranted. A diagnostic algorithm for confirmed cCMV cases can be found on the MDH Newborn Screening Program’s website at:<a href="https://www.health.state.mn.us/people/newbornscreening/program/cmv/followup.html"> https://www.health.state.mn.us/people/newbornscreening/program/cmv/followup.html</a></li>
<li class="p3">A detailed audiologic assessment (preferably an auditory brainstem response, or ABR) is warranted in all cCMV cases: pediatricians should not just rely a routine newborn hearing screen at the time of newborn nursery discharge. This is important both to establish a baseline and establish a relationship with an audiologist for future follow-up. Ongoing care with an audiologist with specific pediatric training is preferred, when possible. As many as 75 percent of infants with eventual SNHL due to cCMV pass their newborn hearing screen and have normal hearing at birth.</li>
<li class="p3">Not all infants with cCMV need to be referred to a pediatric infectious diseases (ID) specialist. As ID clinicians, we note that most evaluations are being appropriately handled by primary care pediatricians and family practitioners. We are available, however, for consultation with primary care physicians if there is uncertainty on interpretation of laboratory, imaging, or clinical findings, or to review and discuss any cases identified by the newborn screen.</li>
<li class="p3">Consultation with a pediatric ID specialist can be particularly useful in making decisions about antiviral therapy. Antiviral therapy is of no proven benefit for infants with cCMV who are asymptomatic at birth. However, if an infant has signs or symptoms of cCMV disease, including abnormal ultrasonographic or laboratory studies, or an abnormal audiological evaluation, then discussion with an ID physician is recommended in considering the value of treatment.</li>
<li class="p3">All infants with cCMV should have regular follow-up audiologic assessments. Guidelines for audiological monitoring recommendations can be downloaded at the MDH web page at: <a href="https://www.health.state.mn.us/diseases/cytomegalovirus/professionals.html">https://www.health.state.mn.us/diseases/cytomegalovirus/professionals.html </a></li>
</ul>
Pediatric ID providers at the Mayo Clinic, the University of Minnesota Medical School, Hennepin Health, and Children’s Minnesota are available to assist Minnesota pediatricians with questions and, as needed, referrals for cCMV. ID providers available for consultation are listed at: https://www.health.state.mn.us/people/newbornscreening/providers/bloodspotresources.html. Excellent educational resources on cCMV for primary care physicians are available at <a href="https://www.health.state.mn.us/people/newbornscreening/program/cmv/resources.html">https://www.health.state.mn.us/people/newbornscreening/program/cmv/resources.html</a>. Physicians can also utilize resources for parents, families and caregivers that are available for download at the MDH website at <a href="https://www.health.state.mn.us/diseases/cytomegalovirus/parentpkt.pdf">https://www.health.state.mn.us/diseases/cytomegalovirus/parentpkt.pdf </a>

Minnesota Begins Universal Congenital CMV Screening: How Is It Going So Far?

What is Early Childhood Family Education (ECFE)?
<a href="http://www.mnaap.org/?attachment_id=4227">This handout</a> (shared from a parent and family educator at Robbinsdale Area Schools) details the who, what, where, why and how of ECFE.
Almost all new parents, whatever their education or income, have feelings of uncertainty. They are puzzled and daunted regarding how to care for and support the development and abilities of their new one. ECFE is present in virtually every Minnesota public school district to help meet this need. Guided by a parent educator, parents learn about child care and support one another. You can learn the names and numbers of ECFE leaders in your district through the <a href="https://r20.rs6.net/tn.jsp?f=001bF02fzZgLXuZ8Zv8dsJeMadETIS2ljmTdx4ES0PZ1rW284UQz18B4B8jG4_VAGjxkSN1oReQhz0gkZ5hSBvZFHSIzD13Hw_RSu900rdtv8wpZojVo8W6C4yPF8_I28WylzkdPSkIFcojuA7a9XoKWKGhMrXjjfQ0IXz_jUyhDBrSo03RVu4kaDJR6RvC2zUZwHZY90fzmDG7X9-YUo8xS6iee6YKypFy69kM2jEZwd-NWNq2rukmaw==&amp;c=vcGzcE7ES4U-72ZgQjM_1INhPsSyf8TN0lojEwfoXWEVWnI1bxtXsQ==&amp;ch=TkZG5GmWrdKTh5Jw5YoMkiYHC_jq6hlu-e-5PO8T8ptqzslB0GIiOg==" target="_blank" rel="noopener noreferrer" data-saferedirecturl="https://www.google.com/url?q=https://r20.rs6.net/tn.jsp?f%3D001bF02fzZgLXuZ8Zv8dsJeMadETIS2ljmTdx4ES0PZ1rW284UQz18B4B8jG4_VAGjxkSN1oReQhz0gkZ5hSBvZFHSIzD13Hw_RSu900rdtv8wpZojVo8W6C4yPF8_I28WylzkdPSkIFcojuA7a9XoKWKGhMrXjjfQ0IXz_jUyhDBrSo03RVu4kaDJR6RvC2zUZwHZY90fzmDG7X9-YUo8xS6iee6YKypFy69kM2jEZwd-NWNq2rukmaw%3D%3D%26c%3DvcGzcE7ES4U-72ZgQjM_1INhPsSyf8TN0lojEwfoXWEVWnI1bxtXsQ%3D%3D%26ch%3DTkZG5GmWrdKTh5Jw5YoMkiYHC_jq6hlu-e-5PO8T8ptqzslB0GIiOg%3D%3D&amp;source=gmail&amp;ust=1694626663294000&amp;usg=AOvVaw1AlZBxWooFkLSjppXvvw6z">Help Me Connect website</a>.

What is Early Childhood Family Education (ECFE)?

Authors: Ruegba Bekibele, MBBS; Lily Rubenstein, BSN, PHN; Sheyanga Beecher, CNP, MPH; Stacene Maroushek MD, PhD, MPH
INTRODUCTION
The Minnesota Department of Health Refugee Health Program (MDHRHP) aims to protect and promote the health of newcomer populations in Minnesota. The program assists in coordinating Refugee Health Assessments, supports new arrivals to Minnesota with complex medical needs, trains and supports providers in best practices and analyzes, summarizes, and shares data on newcomer health in Minnesota.
Newcomer populations often have unique clinical needs across the continuum of care. Knowing the steps of medical assessment and intervention before and after the resettlement process are key to being able to provide effective and efficient healthcare.
CASE EXAMPLE
A 10-year-old Afghani girl is brought in by her family for a routine well child check at the pediatric clinic. This visit was coordinated by the local public health agency and medical records have been made available prior to the visit. With the aid of a Pashto interpreter, the provider is able to determine that the family moved to the United States two months ago under the refugee resettlement program. The family shares their records of the overseas medical exam and immunization history paperwork.
A detailed review of systems is positive only for intermittent abdominal pain. After briefly reviewing the family’s diet, the mom shares the family has been eating more processed foods and packaged meals since arriving in Minnesota. The patient is straining with bowel movements which have been more infrequent than previously. The mother also mentions that the patient was found to have “low blood level” during the patient’s pre-departure screening at the refugee camp in Pakistan. The patient has no other past medical or surgical history. She has no known history of allergies.
Mom also says that the family has been stressed by the recent loss of patient’s paternal grandma who died of tuberculosis (TB) in Kabul last year. Family history is otherwise unremarkable. The patient lives with her parents and five siblings in temporary housing provided by the refugee resettlement program. The family has health insurance coverage under Medical Assistance. The patient and her siblings are enrolled in school. Transportation still remains a concern.
Vital signs: Temp 99.8, HR 107, RR 18, BP 96/54. The patient is tracking along the 15th percentile for weight and 20th percentile for height. Physical examination is remarkable for conjunctival and palmar pallor suggesting mild anemia and multiple carious teeth.
The provider orders a complete blood count with differential, lead test, and interferon gamma release assay (IGRA) TB blood test, Hepatitis A, Hepatitis B and HIV. Review of the patient’s immunization history paperwork and the CDC Childhood and Adolescent Immunization schedule indicates that the patient is due for Human Papilloma Virus (HPV) vaccine and Varicella vaccines for which the family consents. The provider review ways to increase fiber in the new diet and prescribes a course of polyethylene glycol laxative powder. The provider also counsels the family on dental hygiene. A dental referral is placed and the social worker is consulted to help co-ordinate transportation and provide the family with resources for housing. A two-week follow up visit is scheduled.
At the follow-up visit the doctor reviews the results of investigations with the patient’s caregiver. The CBC was remarkable for anemia with hemoglobin of 10g/dl, RDW 17%, MCV 65fL and RBC within normal range. Lead, IGRA TB blood test, Hepatitis A, Hepatitis B, and HIV were all negative. At this follow up visit, the patient initiates the Hepatitis A and B vaccine series and is started on a multi-vitamin with iron. Mother reports the patient is having softer stools and less abdominal pain. She also notes that they have an upcoming appointment with the dental clinic in 2-months’ time. The patient is discharged home with plans to follow up. The provider completes the Refugee Health Assessment Form (<a href="https://nam02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.health.state.mn.us%2Fcommunities%2Frih%2Fhcp%2Fassesfrm.pdf&amp;data=05%7C01%7CSheyanga.beecher%40hcmed.org%7C16928348c60e4f80e50e08db61db4d3c%7Cada0782c5f344003b5d63187f30aecdd%7C0%7C0%7C638211367177421560%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&amp;sdata=dHSoADiOqt986tKp0hSZ5lRHLWObc8MEsJBLGmj8qg8%3D&amp;reserved=0">https://www.health.state.mn.us/communities/rih/hcp/assesfrm.pdf</a>) and sends it directly to the local public health contact.
In three months, the patient is brought in by her mother for her follow up appointment. Mom has no new concerns. A review of the growth chart reveals that the patient is now tracking along the 25th percentile for weight and remains at the 15th percentile for height. A repeat CBC and IGRA TB blood test are normal. The patient no longer has abdominal pain. When asked about patient’s mental health and how the family is coping with paternal grandmother’s loss, Mom says the patient is seeing her school counselor. The family still lives in a temporary housing and relies on public transport. Dad is working on getting a job. Mom says they would like to establish care with this provider. The provider reaches out to the social worker to help with community resources for jobs and transportation needs. The social worker gets in touch with the family’s case worker at the local resettlement agency and discusses the families need and plan to address social determinant of health needs in more detail.
DISCUSSION
Immigration and visa status can have implications for one’s health as it determines benefits eligibility and the health care a newcomer may have received prior to and after arrival to the United States. MDHRHP works with arrivals who are eligible to receive Office of Refugee Resettlement benefits, including (but not limited to) refugees, Asylees, Special Immigrant Visa holders, Certified Victims of Human Trafficking, and certain humanitarian parolee groups. This article focuses on two of the largest populations currently served by the MDHRHP, refugees and those with humanitarian parole.
A refugee is someone who has experienced past persecution or has a well-founded fear of persecution on account of their race, religion, nationality, membership in a particular social group, or political opinion.
Humanitarian parole is a temporary status which gives individuals permission to be in the US legally for urgent humanitarian reasons. There are currently programs for those from Ukraine, Haiti, Cuba, Nicaragua, and Venezuela to seek humanitarian parole1,2.
Of note, asking one’s immigration status during a health care exam is not recommended as doing so may cause undue anxiety. However, one can ask about any overseas health screening as a surrogate because it is important to determine whether a patient has received any previous health exams.
Health Care Assessments Before and After Resettlement
Overseas Medical Exam
Those with refugee status receive an Overseas Medical Exam (OME) within six months of departure by a Panel Physician who is selected by the US Embassy and performs OME according to CDC recommendations3. The OME consists of several components including a medical history and physical examination and assessment for diseases of public health significance including Tuberculosis. However, Hepatitis B and HIV screening may not be included. Patients also receive some immunizations that are age-appropriate according to ACIP guidelines and protect against outbreak prone diseases or diseases that have been, or are in the process of being eliminated in the US4. Immunizations depend on availability in the country of departure which may vary. Consequently, refugee arrivals may not have received all ACIP-recommended immunizations at the time of arrival.
Within 1-2 weeks of departure, an abbreviated medical exam is performed (Pre-Departure Medical Exam). At this time, individuals may receive additional lab testing such as a COVID-19 and/or pregnancy test, additional immunizations, and presumptive treatment for parasitic infections5 and malaria6 if clinically appropriate.
The Refugee Health Assessment and Linkage to Primary Care
Thirty to ninety days after arrival in Minnesota, refugee arrivals receive an optional, but strongly recommended, comprehensive health assessment7 coordinated by MDHRHP and local public health agency in the county of residence. This visit is performed by physicians, PAs, and NPs who have been trained by the MDHRHP and consists of a history and physical, infectious disease, lead, and mental health screening, immunizations, and referral to ongoing primary care or specialty care as needed. Results are returned to the MDHRHP and monitored for trends. Aggregate results are shared to state and national partners.
Some Refugee Health Assessments are performed by primary care providers, and some are performed at more specialized clinics such as a city public health clinic. Newcomers may opt to stay with their assessment provider for ongoing primary care or move to a different provider or clinic. Those that receive their assessment at a public health clinic without ongoing primary care services will be referred to an alternate clinic.
Humanitarian parole health requirements
Those with humanitarian parole generally do not receive an OME. They may or may not be eligible to receive a Refugee Health Assessment depending on whether they have been granted Office of Refugee Resettlement benefits. For questions on which populations currently qualify, please reach out to MDHRHP. Several humanitarian parolee groups have health requirements set by the US Citizenship and Immigration Services office. These include, one measles, one polio, and one COVID-19 vaccine prior to departure, and completion of the COVID-19 series and an IGRA test within 90 days of arrival.
Medical records
Newcomers are provided with a copy of their Overseas Medical Exam records. The MDHRHP is also provided with a copy of these exams from the CDC and share them with the Refugee Health Assessment provider. These records hold lab results, immunizations, and history and physical results. A profile in the Minnesota Immunization Information Connection (MIIC) is established once these records are received, generally within 1-2 weeks after arrival. If a newcomer has not received an OME and not received care elsewhere, there may not be a MIIC profile.
Humanitarian parolees may have a copy of their immunization records and IGRA test results, or may be able to provide information on where domestic health care occurred. This information is not routinely collected by the MDHRHP.
For domestic records, determine where the Refugee Health Assessment occurred and request medical records per routine clinic processes. If the patient cannot remember where the RHA took place, please contact MDHRHP.
In addition to refugees, asylees, special immigrant visa holders, certified victims of human trafficking, and certain humanitarian parolee groups, there are other populations of foreign-born children, including unauthorized immigrants without any history of health screenings or immunization records. These patients also seek care in primary care clinics for routine well child checks and require thoughtful assessment and assistance navigating complicated healthcare needs. For additional information, please refer to Screening and Healthcare of Immigrant Children8 and the American Academy of Pediatrics toolkit on serving immigrant children <a href="https://downloads.aap.org/AAP/PDF/cocp_toolkit_full.pdf">https://downloads.aap.org/AAP/PDF/cocp_toolkit_full.pdf</a>
Works Cited
<ol>
<li>US Citizenship and Immigration Services. (2023, July 12). Process for Cubans, Haitians, Nicaraguans, and Venezuelans. <a href="https://www.uscis.gov/CHNV">https://www.uscis.gov/CHNV</a></li>
<li>US Citizenship and Immigration Services. (2023, July 12). Uniting for Ukraine. <a href="https://www.uscis.gov/ukraine">https://www.uscis.gov/ukraine</a></li>
<li>Centers for Disease Control and Prevention. (2019, October 16). Immigrant, refugee and migrant health, Panel physicians. <a href="https://www.cdc.gov/immigrantrefugeehealth/panel-physicians/introduction-background.html">https://www.cdc.gov/immigrantrefugeehealth/panel-physicians/introduction-background.html</a>.</li>
<li>Centers for Disease Control and Prevention. (2023, May 12). Immigrant, refugee and migrant health, Panel physicians on vaccines. <a href="https://www.cdc.gov/immigrantrefugeehealth/panel-physicians/vaccinations.html#:~:text=The%20panel%20physician%20must%20counsel,the%20vaccines%20they%20are%20using">https://www.cdc.gov/immigrantrefugeehealth/panel-physicians/vaccinations.html#:~:text=The%20panel%20physician%20must%20counsel,the%20vaccines%20they%20are%20using</a>.</li>
<li>Centers for Disease Control and Prevention. (2021, March 16). Presumptive treatment and screening for strongyloidiasis, infections caused by other soil-transmitted helminths, and schistosomiasis among newly arrived refugees. <a href="https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/intestinal-parasites-domestic.html">https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/intestinal-parasites-domestic.html</a>.</li>
<li>Centers for Disease Control and Prevention. (2019, September 13). Presumptive treatment of P. falciparum Malaria in refugees relocating from sub-Saharan Africa to the United States. <a href="https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/malaria-guidelines-domestic.html">https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/malaria-guidelines-domestic.html</a></li>
<li>Minnesota Department of Health. (2023, March 3). Minnesota Domestic Refugee Health Screening Guidance. <a href="https://www.health.state.mn.us/communities/rih/guide/index.html">https://www.health.state.mn.us/communities/rih/guide/index.html</a>.</li>
<li>Maroushek, SR. Screening and Healthcare of Immigrant Children, In: Nelson Textbook of Pediatrics, 20th Edition. Editors: Robert Kliegman, Richard Behrman, Hal Jenson, and Bonita Stanton. Elsevier Press, Philadelphia, PA, (2015).</li>
</ol>

Caring for a Newcomer Patient During the Initial Well Child Check in Pediatric Primary Care

Join the MNAAP Early Childhood Work Group for its next lunch and learn presentation on&nbsp;Wednesday, May 24 from 12:15 &#8211; 1 p.m.&nbsp;You&nbsp;do not&nbsp;need to be a member of the Early Childhood Work Group to attend. All MNAAP members are welcome!



Dianne Haulcy, president and CEO of The Family Partnership, will present information and data about how children develop racial bias from birth. Participants will learn strategies and language to analyze their own implict bias and work through how to respond to real world scenarios of young child and the issues of racial bias.



Haulcy has 30 years of experience in the non-profit sector with experience directing&nbsp;five early childhood programs and many other housing and human services programs all&nbsp;serving inner-city, low-income, ethnically diverse populations. She has worked on early&nbsp;childhood policy for the City of Minneapolis, and overseen financial&nbsp;support&nbsp;to parents at Think Small and The Family Partnership. She is also currently the host of a podcast focused&nbsp;on how to talk to very young children about race and racism called Early Risers sponsored by&nbsp;Little Moments Count and Minnesota Public Radio.



Use this link to join the lunch and learn on May 24: <a href="https://us06web.zoom.us/j/7703657035﻿" target="_blank" rel="noreferrer noopener" aria-label="https://us06web.zoom.us/j/7703657035 (opens in a new tab)">https://us06web.zoom.us/j/7703657035</a>

May 24 | Lunch and Learn Focuses on Early Childhood and Racial Bias

Early childhood education has been a popular term at the legislature this year! As pediatricians know (and most other people, young parents and legislators included, do not know), early childhood education is the same as early childhood life!&nbsp; No classrooms needed.&nbsp; An enormous amount of learning has to take place before any “schooling” or “kindergarten” or even “Pre-K” can succeed.&nbsp; The first thousand days of health, brain development and learning and life are the focus of the MNAAP Early Childhood Work Group. &nbsp;



Brain development occurs more consequentially and rapidly in the first 1,000 days than at any other time of postnatal life. Infants and preschoolers learn an enormous set of skills, but doing so is predicated on a strong foundation of relationships.&nbsp; &nbsp;



Babies must learn to direct their eyes, manipulate their arms and legs, grasp and maneuver objects in their world, and associate the look and feel and scent and taste of literally everything. As they get older, sitting up, rolling over, standing, walking, running, and turning somersaults all must be mastered. And that’s before learning the meaning of hundreds of words and how to say them.&nbsp; And all must be remembered for later use. What a wonderful organism that can accomplish all this in three to four years and in any language. (Sometimes more than one!)



But none of it can be accomplished alone. Early childhood “teachers” are parents and grandparents, and siblings and paid childcare providers—adults with an eye to the child’s developmental stage and needs and a consistent presence throughout. &nbsp; And perhaps more important, the brain cells and synapses that are not assigned a task and used repeatedly begin to be removed, “pruned”, toward the end of that same 1000 days—never to be available again!&nbsp;



Our Early Childhood Work Group wants to support you by collecting the practices, skills and knowledge to better empower families, educators and legislators to do the important work of early childhood support. To this end, we have started a lecture series on early childhood,&nbsp; bringing the newest science and best thinkers on topics such as autism identification, early brain development and trauma response.&nbsp; You can see those lectures on the MNAAP website (mnaap.org). Moreover, we have had a big presence at the legislature that belies the size of our patients, conveying the importance of the following topics:



We want to support the ability of families to be at baby’s side in the early critical period as well as consequential moments such as times of illness. This is why we have been supportive of Paid Family Medical Leave.



We have been ardent supporters of programs such as home visiting, Reach out and Read and Early Childhood Family education that promotes early learning and interaction.



Currently, our childcare “system” is lacking about 40 percent of the early childhood educators that it needs.&nbsp; Many families cannot find childcare at an affordable price if at all.&nbsp; And parents are forced to stay home and forgo some of the income they badly need. Advocating for childcare reform is imperative.&nbsp;



The Early Childhood Working Group would like to enlist you—as members of MNAAP, and as educators for the children and parents in your practices.&nbsp; Legislators need to hear your voice.&nbsp; Parents and families need your guidance and advice at every early childhood visit.&nbsp; Your local schools and childcare settings need your attention and support.&nbsp;



Please contact the chairs or members of the group to offer your advice and participation.&nbsp;



Early Childhood Work Group Co-Chairs:



Nate Chomilo, MD, FAAP (chom0014@umn.edu)



Krishnan Subrahmanian, MD, MPhil, DTM, FAAP (subrahm2003@gmail.com)



Roger Sheldon, MD, FAAP (rogeugshe@gmail.com)&nbsp;

MNAAP Work Group Update:  Early Childhood

If you were unable to participate in the most recent Early Childhood Work Group lunch and learn series installment, the replay is now available for you to watch on-demand.



Megan Gunnar, PhD, presented &#8220;Stress Reactivity and Regulation in Infancy: The Role of Relationships,&#8221; which covered the development of the stress system in the first years of life and the nature of the relationships that do and do not provide essential buffering of the system.



Dr. Gunnar is a Regents Professor at the University of Minnesota. She serves on the boards of Think Small, the Greater Minneapolis Crisis Nursery and is on the Advisory Council to Children’s Cabinet for the State of Minnesota.



Click this link to access the replay



<a href="https://us06web.zoom.us/rec/share/Z96VYhXJ2qpRfo1qZJJ6sotPZPCeK4wHvFphop4Kqh_8Ip8593sDM2zutCgcpLs5">https://us06web.zoom.us/rec/share/Z96VYhXJ2qpRfo1qZJJ6sotPZPCeK4wHvFphop4Kqh_8Ip8593sDM2zutCgcpLs5</a>



And use the passcode: &amp;rDRu6b=

Replay Available: Stress Reactivity and Regulation in Infancy: The Role of Relationships

The Minnesota Department of Health (MDH) is sponsoring a community-led initiative in the state called the <a href="https://www.health.state.mn.us/people/childrenyouth/earlychild" target="_blank" rel="noreferrer noopener" aria-label=" (opens in a new tab)">Minnesota Integrated Care for Early Childhood Initiative</a>. An initial goal of this initiative is to conduct a comprehensive systems assessment focusing on early childhood services for African American families and children – especially related to how early childhood services coordinate with health care. The Systems Assessment will provide insight on what is working well, what is beginning to work more effectively, what gaps remain, and where opportunities exist to address these gaps.



As part of its work, MDH is interviewing early childhood health professionals to gain better understanding of the early childhood healthcare system. MDH is interested in learning more about what your experiences have been with providing services to African American families and children, what challenges and barriers exist, and what could help to improve services for this population.



The interviews will be facilitated by Rainbow Research via Zoom and will take approximately an hour. If you are interested in participating in an interview, please schedule a time at: <a rel="noreferrer noopener" href="https://r20.rs6.net/tn.jsp?f=001UZimsa88UDw8Y4Xedq0hc_l09fj9CbVBqDT0RoFH7hL6oGK6wUS9pPneBQ7c6JtVgnFZdMGyGKqIxVxcxEQ9ggay-jgrahFasdynU6Wj7yF5GSkRZ0Jd84PNTugMa0JE-mYJqt6LCdrPNEIpasCBB8Bou718cBOONbHfyZPmW4fYZkOkZZqYfw==&amp;c=1LIn8AiLo0AJ2n3UoiaHUHEVTfeQnE2uYbg_JgQUA9ouwBbCQmfMMw==&amp;ch=BP6_zwMNHd9hXqZMLqjdceQsQqpMJs9h8P8CbgTFrz9zjB6unOCG3A==" target="_blank">https</a><a href="http:// https://calendly.com/tv_rr/mn-iceci-interviews" target="_blank" rel="noreferrer noopener" aria-label=": (opens in a new tab)">:</a><a rel="noreferrer noopener" href="https://r20.rs6.net/tn.jsp?f=001UZimsa88UDw8Y4Xedq0hc_l09fj9CbVBqDT0RoFH7hL6oGK6wUS9pPneBQ7c6JtVgnFZdMGyGKqIxVxcxEQ9ggay-jgrahFasdynU6Wj7yF5GSkRZ0Jd84PNTugMa0JE-mYJqt6LCdrPNEIpasCBB8Bou718cBOONbHfyZPmW4fYZkOkZZqYfw==&amp;c=1LIn8AiLo0AJ2n3UoiaHUHEVTfeQnE2uYbg_JgQUA9ouwBbCQmfMMw==&amp;ch=BP6_zwMNHd9hXqZMLqjdceQsQqpMJs9h8P8CbgTFrz9zjB6unOCG3A==" target="_blank">//calendly.com/tv_rr/mn-iceci-interviews</a>



A Rainbow Research team member will reach out to you to confirm the appointment time and send a Zoom link. If you have questions or would like more information, please reach out to Thao Vang at&nbsp;<a href="mailto:tvang@rainbowresearch.org" target="_blank" rel="noreferrer noopener">tvang@rainbowresearch.org</a>.

MDH To Examine Early Childhood Services and Health Care

Dr. Megan Gunnar, Regents Professor at the University of Minnesota Institute of Child Development, will be talking about the effects of toxic stress on early child development. Join the presentation using this Zoom link: <a href="https://us06web.zoom.us/j/770365703">https://us06web.zoom.us/j/770365703</a>Meeting ID: 770 365 7035

Monday, January 16; 12:15 – 1 p.m. | Early Childhood Speaker Series

So what is the duration of &#8220;Early Childhood?&#8221;  Of course, it varies.  This is biology after all.  But for policy purposes, it is often simplified to &#8220;the first 3 years&#8221; or &#8220;the first 1,000 days.&#8221; Notice the inaccuracy creeping in?  We probably need to say, &#8220;until the child goes to kindergarten,&#8221; but that age varies as well, often as late as 5 or 6. 



Perhaps a better definition would be until the child&#8217;s brain is fully formed, or when the great majority of possible neurons have populated that brain.  Perhaps when the neural connections are well underway or when the pruning away of unused cells and circuits has sculpted a more specialized &#8220;person.&#8221;



You get the picture: it&#8217;s just inexact.  Most of all this has mostly happened by the age of 3 or 4, so let&#8217;s not forget about the child who holds up three fingers and says &#8220;I&#8217;m three.&#8221;  



No matter the child&#8217;s age, we should never miss an opportunity to teach every preschool parent about the marvelous and crucial things going on inside that brain and how to help them along.

If “Early Childhood” and its amazing brain growth and development starts in utero, when does it end?

Grand Itasca Clinic & Hospital is seeking a board certified/board eligible outpatient Pediatric Physician to join our busy and growing primary care clinic practice. Grand Itasca is a fully integrated multi-specialty clinic and hospital located in Grand Rapids, Minnesota.

Pediatric Physician

Partners in Pediatrics, Ltd. is seeking a full time BC/BE Pediatrician. The standard work week for a full-time pediatrician is 4 days a week plus a rotation of nights and weekends. Night and weekend shifts are shared equally among all providers. The salary package is competitive. You will have paid time off (PTO) and be given a CME allowance as well as CME days to further your medical education. We offer health, dental, disability and life insurance. You will also be eligible for a lucrative profit sharing 401(k). For inquiries, please contact our recruiting leads, Dr. Lisa Irvin at lirvin@pipstop.com and Dr. Megan Camerino at mcarmerino@pipstop.com

BC/BE Pediatrician

We’re excited to announce an opening for a Communications Manager at the Minnesota Chapter of the American Academy of Pediatrics (MNAAP). This part-time, remote role is a unique opportunity for a communications professional with at least five years of experience, who is passionate about advancing child health through advocacy, education, and special projects.

Early Childhood Updates