Let’s Free Teens From Social Media Addiction

Shetal Shah, MD, FAAP

Shetal Shah, MD, FAAP

Shetal Shah, MD, FAAP is a neonatologist at Maria Fareri Children’s Hospital and the Immediate Past President of the NYS AAP-Chapter 2.  He is the Chair of the Pediatric Policy Council and Executive Committee Member of the AAP Section on Neonatal Perinatal Medicine. This op-ed was published in Tampa Bay Times on June 3, 2023.

At restaurants, grocery stores, even at stoplights – everywhere, children and teens are online, exploring social media, interactive video games and apps that do everything from track school buses to inform you what Taylor Swift had for breakfast.  According to a report released last week by the surgeon general, 95% of teens use social media, a third of them “almost constantly.”

The nation’s top physician is confirming what pediatricians have known for years: Social media, as currently used, can be addicting.  These virtually unregulated digital spaces, run by for-profit companies, can pose legitimate threats to the mental health of our teens and young children.

As a pediatrician, I often discuss a child’s digital diet during clinical visits, instructing parents to refrain from using a screen as an electronic babysitter -a steep uphill battle when children as young as 2 use mobile devices daily.  For teens, I ask what social media platforms they have, whom they follow and how they use their account.

For many adolescents, these apps allow them to forge real friendships. LGBTQ+ kids can connect with like-minded and supportive allies.  Sexually active teens can access medically vetted information on topics they would feel uncomfortable disclosing to parents.  These platforms allow isolated children to find communities.  There are groups for children with cancer and those with parents with cancer.  This is social media at its best.

Teens spend an average of 3½ hours on social media daily, and as the surgeon general’s report describes, exorbitant time on these apps negatively affects their health.  Adolescents who spend more than 3 hours on social media are twice as likely to display anxiety or depressive symptoms, fueled by an unrelenting menu of 30-second videos strategically designed to hypnotize them.

And that is social media at its worst.

In the attention economy, time on a platform equals money, so technology companies create precise algorithms to keep you screen-bound.  And they are very good at it.  Unsurprisingly, one-third of 11- to 15-year-old girls feel addicted to social media.  These features are the reason videos you didn’t select automatically play in seconds, or why you’re served videos, clickbait and intentionally provocative messages, which prolong your time on the app.  It’s why I’m served up messages saying the moon landing was faked, vaccines contain microchips and children don’t “deserve” health care, baiting me to pass hours responding to misinformation and crackpots.

Since every scroll, click, tap and comment is tracked, algorithms provide you content you didn’t even know you wanted.  As a child of the ‘80s, I have a feed replete with nostalgic TV clips of Saturday-morning cartoons intent on holding me hostage.  Once the platforms discern the user is a body-conscious teenager, unrealistic posts featuring unhealthy exercise regimens, crash diets and extreme fasting are offered, amplifying potentially harmful content.  Forty-six percent of 13- to 17-year-olds say social media negatively impacts their body image.  Pairing these manipulative design practices with an impressionable and still-developing adolescent brain – neurologically primed for social approval but without understanding of long-term consequences – renders teens vulnerable to digital influence.  These issues are already coming at a time when our children’s mental health is so poor the American Academy of Pediatrics declared it a national state of emergency, and Montana banned TikTok.

Even worse, no protections exist to prevent kids from being targeted with inappropriate advertising for things like vapes and alcohol.  Children deserve a safe digital landscape that provides them the supportive environments they need without the exploitation for profit.

This spring, the Senate introduced the Kids Online Safety Act, a bipartisan bill to prevent promotion of social media content harmful to child well-being.  Companies would have to de-prioritize content related to self-harm, suicide and eating disorders.  Apps would also have to stop the suggested content feeds, and minimize the automatic video play and eternal scrolling elements that keep teens chained to devices.

Another bill, the Children and Teens Online Privacy Protection Act, would update privacy laws and prevent wholesale cultivation of information like search habits, which factor strongly into personalized advertising. It’s time for an update.  The last law addressing online protections for children passed in 1998 – an eternity in the pace of technological innovation.

The bill also closes a crater-sized loophole in the quarter-century-old law, which allowed companies to exempt themselves from regulations by burying a disclaimer deep in their user agreements.  In 2019, TikTok reached a $5.7 million settlement with the U.S. Federal Trade Commission over allegations it violated children’s privacy laws – pocket change for a company with a market cap of almost $200 billion.

No pediatrician, parent, school board or state can undo the ever-present influence of social media. We need strong federal laws that create safe digital spaces. Social media at its best.

Now back to resisting the urge to click on “Best Soundtrack from ‘80s Movies.”

Suicide Prevention Ambassador Program

Gary Krigsman, MD, FAAP

Gary Krigsman, MD, FAAP

Gary Krigsman, MD, FAAP, is a school health/public health pediatrician, now retired after a career of 30+ years with the NYC Office of School Health. He is the NYS AAP Chapter 2 Suicide Prevention Ambassador.

In mid-February, you may have read an introduction regarding the Suicide Prevention Ambassador Program, in the “Chapter 2 Upcoming Events” newsletter emailed out to Chapter 2 members.

The 20 AAP chapters, that have been selected to participate in Cohort 1 of the Suicide Prevention Ambassador Program, are now in the process of initiating implementation of their individual “action plans,” in collaboration with their partners from the American Foundation for Suicide Prevention (AFSP).  Each chapter was asked to submit “an action plan” that included at least one goal in each of 5 different sections.  The five sections are: 1) Health Equity, 2) Policy and Advocacy, 3) Community, 4) Communication and Media, 5) Sustainability.

The NYS Chapter 2 goals for each respective section are as follows:

  • Health Equity: Implementing the AFSP’s “Talk Saves Lives” program which involves presentations for high-risk communities. We will attempt to reach out to healthcare facilities with special services for the LGBTQIA+ community and bring this special program to them. We may consider presentations in other languages such as Spanish, Chinese, Korean, etc. We will be working closely with our AFSP partners to carry out this goal.  If you work with an LGBTQIA+ adolescent population and would be interested in bringing this presentation to your community (providers, staff and patients) please reach out and contact me at garykrigsman@gmail.com.
  • Policy and Advocacy: Creating a standing suicide prevention column/article in each periodic chapter newsletter.
  • Community: Collaborating with schools and school districts to gather information re: mental health services available on-site in specific schools or linked with specific schools and disseminating that information to pediatric providers in an effort to increase awareness re: mental health services available in their patients’ schools.
  • Communication and Media: Creating a suicide prevention specific page on the chapter website.
  • Sustainability: Including resource information regarding suicide prevention in Chapter new member materials; in addition to continuing to carry out goals 1, 2 and 3.

We and our AFSP counterparts are looking forward to collaborating on implementation of these goals throughout 2023. During that time we will participate in monthly ECHO meetings, coordinated by Kristen Kaseeska, Suicide Prevention Manager at AAP.  These meetings will consist of a didactic presentation, in addition to a presentation by a selected chapter regarding their experience achieving their stated goals.  The session allows for feedback and open discussion from other chapters.

I look forward to writing future articles for the Chapter Newsletter focusing on topics of special interest related to suicide prevention, as well as sharing useful resource information.

Remember the Pandemic’s Lesson

Shetal Shah, MD, FAAP

Shetal Shah, MD, FAAP

Shetal Shah MD, FAAP is neonatologist at Maria Fareri Children’s Hospital and Immediate Past President of the NYS AAP-Chapter 2.  He is the Chair of the Pediatric Policy Council and Executive Committee Member for AAP Section on Neonatal-Perinatal Medicine.  This op-ed was published in Tampa Bay Times on March 7, 2023.

Remember the pandemic’s lesson, and don’t let millions of kids lose Medicaid on April 1

The cruelest of April Fool’s Day jokes is coming.  According to a recent report, up to 6.7 million children may lose health insurance through Medicaid on April 1, which brings the end of pandemic protections that kept them insured.

Kicking so many kids off Medicaid will be disastrous.  It will mean children with asthma don’t get medications and wind up in emergency rooms.  It will translate to fewer children vaccinated and result in lower numbers of children with mental health conditions able to get care.  As a neonatal intensive care specialist, I know that these losses will render the premature babies I care for unable to see specialists for their ongoing lung, heart, neurologic and nutrition challenges.

Medicaid is the foundation of our children’s health insurance system, now providing coverage to 57% of the nation’s kids.  In Florida, 66% of children are covered by the program.  National COVID-19 legislation required states to keep children in the program as a condition of federal financial support — preventing states from removing health coverage for the duration of the COVID emergency.

This pause on canceling children’s coverage has been remarkable.  Since 2020, 20 million children gained Medicaid coverage.  The number of uninsured children dropped by 1.5 million to the lowest rate ever recorded.  As doctors, we saw more children coming to clinics for checkups, immunizations and hearing and vision screening.  During the recent “tripledemic” of influenza, COVID and respiratory syncytial virus, fewer ill children came to the hospital uninsured.  My newborn patients require uniquely made, concentrated, liquid medications that can only be obtained from specialized pharmacies, and it was refreshing to see new parents able to afford these complex prescriptions.

These protections will disappear at the end of the month, threatening to undo the gains over the past three years.  And it’s not just that some kids will no longer qualify.  Because of bureaucratic hurdles, more than 70% of these children may lose coverage even though they remain eligible.  States now face the herculean task of verifying if over 40 million kids remain Medicaid eligible, and several are eager to save budget dollars by canceling children’s coverage as families fail to grapple with the red tape and bureaucracy required to prove they still qualify.  In Florida, 1.1 million children could lose health insurance.

Even children not covered by Medicaid are at risk.  Congress is also considering repealing financial assistance to families who purchase insurance on the exchanges created as part of the 2010 Affordable Care Act.  At that time, the government provided tax credits so middle-income families would not pay more than 4% of their total salaries in premiums.

COVID relief measures fully covered the cost of modest insurance plans for these families, and increased the levels of support to those who earn higher incomes, ultimately lowering the cost of health insurance for 29 million people.  Removing these benefits means the cost of health insurance could swell, which will yield more uninsured families.

There’s a simple way out of this mess.

Cover all Medicaid-eligible children through early childhood, removing the governmental hurdles families must navigate to keep kids insured.  In December, Congress mandated all children in Medicaid be covered for their first year of life.  Extending that to kindergarten age eliminates the red tape and state cost of figuring out if children qualify for the program.  Most importantly, it prevents doctors from having to prescribe treatments based on whether they’re insured and takes advantage of the progress we’ve made throughout the pandemic.

Oregon now covers all children in Medicaid through age 6, and New York is considering the same measure.  Streamlining health insurance through early childhood provides coverage through the ages we administer most childhood immunizations, autism screening and nutrition screening — making kids as healthy as possible entering grade school.  As states wrestle with the burden of contacting tens of millions families, they should openly ask if Oregon hasn’t figured out a better and easier way.

Children suffered many setbacks during the pandemic.  Thankfully, losing health insurance wasn’t one of them.  As we emerge from the pandemic, state governments shouldn’t give children and families a new problem to deal with.

Addressing Food Insecurity

Sara Siddiqui, MD, FAAP

Sara Siddiqui, MD, FAAP

Eve Meltzer-Krief MD, FAAP

Eve Meltzer-Krief MD, FAAP

2 LI pediatricians aim to help with growing problem

Sara Siddiqui MD, FAAP is a pediatrician in Huntington. She is Co-Chair of the Legislative Advocacy Committee and Chapter Champion for Vaping Awareness and Cessation for NYS AAP-Chapter 2.

Eve Meltzer-Krief MD, FAAP is a pediatrician in Huntington.  She is Co-Chair of the Legislative Advocacy Committee and NYS AAP-Chapter 2 Treasurer.

This article was published in Newsday on February 5, 2023.

Two Long Island pediatricians have won a national grant to help detect food insecurity among young patients and connect their families with food pantries and other resources to help them get the nutrition they need.  Dr. Sarah Siddiqui of the NYU Langone Huntington Medical Group and Dr. Eve Meltzer-Krief of Huntington Village Pediatrics said they applied for the grant because food insecurity is a growing problem on Long Island.  “We tend to think that everyone is kind of well off,” said Siddiqui.  “But there are situations where people are losing their jobs or lack of shelter and these things lead to kids not having the right resources or food.”

The grant from the No Kid Hungry campaign of the Washington, D.C.-based nonprofit group Share Our Strength will fund a pilot project at Allied Physicians Group pediatric offices in in the Riverhead and Peconic areas with Long Island Cares as a partner.  Long Island Cares, which operates food pantries and other nutrition programs in Nassau and Suffolk counties, will assist families in providing food either on-site at the offices or through nearby facilities.

According to the nonprofit, one in four adults on Long Island and about 68,000 children face food insecurity.The U.S. Department of Agriculture defines food insecurity as “the limited or uncertain availability of nutritionally adequate and safe foods, or the limited or uncertain ability to acquire acceptable foods in socially acceptable ways.”

Screening survey

Meltzer-Krief, who works for Huntington Village Pediatrics, said all families will be asked through a questionnaire whether they have been concerned about or experienced running out of food before they could afford to purchase more.  “There will be a designated person in each office to follow up with the family,” Melzer-Krief said.  “We want this to be on the radar of all pediatricians so all families are screened for food insecurity on a regular basis and then connected with resources.”

The $20,000 grant was one of 14 awarded to state chapters of the American Academy of Pediatrics across the United States. Siddiqui and Meltzer-Krief applied as part of the American Academy of Pediatrics in New York Chapter 2.  “Sometimes pediatrician’s offices don’t know what’s available locally,” Siddiqui said.  “There may be a food pantry right down the road from us that we can partner with.  This grant allows us to build partnerships.”

Dr. Suanne Kowal-Connelly, Director of Pediatric Clinical Quality at Harmony Healthcare LI, which focuses on underserved communities in Nassau County, said teaching and advising families is a major part of the work pediatricians do.  “To achieve good health, children need to be able to eat well, sleep well, drink properly, and get enough physical activity,” she said.  “Children thrive when these elements are satisfied properly and everything really starts with a good sustenance which is eating healthy.”  Kowal-Connelly said kids who are not eating properly can face health issues and struggle in school.  “We know that without proper nutrition, children aren’t able to be at their best academically,” she said.

Rachel Sabella, Director of No Kid Hungry New York, pointed out that the average child visits their pediatricians on average about 20 times during their first five years.  “I grew up on Long Island, I know how hunger hides in plain sight there,” she said.  “Hunger isn’t a thing that’s easy to see or for people to talk about.  When people want to address this in their lives, they talk about it with someone they trust and pediatricians have that trust.”

Economy Impacts Families

Sabella noted that families are facing skyrocketing costs of living expenses ranging from utilities to groceries.  And they may not know about the different programs available to them, such as SNAP, WIC, or the free summer meal programs that provide breakfast and lunch at various locations including parks and playgrounds.  Some families may not realize they are eligible for free or reduced price school lunches and never fill out the paperwork.  “Families that hadn’t faced this issue before are dealing with it now,” she said.  “There really is a struggle and a lot of people don’t want to admit this.  We want them to know there is help. … Continuing to make them aware of these services and especially what is in there in their community is going to be a game changer.”

What Pediatricians are Hoping for in the New Year

Shetal Shah, MD, FAAP

Shetal Shah, MD, FAAP

Shetal Shah, MD, FAAP is neonatologist at Maria Fareri Children’s Hospital and Immediate Past President of the NYS AAP-Chapter 2.  He is the Chair of the Pediatric Policy Council.  This op-ed was published in Tampa Bay Times on December 29, 2022.

We want higher rates of flu and COVID vaccinations, more children’s hospital beds and relief from chronic shortages of children’s medications.

This past year hasn’t been a good one for your child’s doctor.  We are three years into a once-in-a-lifetime pandemic that reached a milestone 100 million US COVID cases last week and have witnessed 1.1 million people die.  We continue to tackle an exploding pediatric mental health emergency.  Now a surge of three major viral illnesses: influenza, COVID-19 and Respiratory Syncytial Virus — a “triple-demic” — is again straining our capacity to treat your child.

As we enter 2023, child health physicians are asking for: higher rates of influenza and COVID vaccinations, increased pediatric space in hospitals within a system that equitably values children and relief from chronic shortages of children’s medications.

Rates of pediatric viral illness are at biblical proportions.  The Centers for Disease Control and Prevention estimate 15 million cases of influenza already, with 150,000 hospitalizations and almost 9,300 deaths.  Hospitalizations are at levels normally not seen until February, and outpatient rates of disease are greater than in 2019-20, the last pre-pandemic season — with especially high rates in children under 4 years of age.  Nine children are dead from flu this year.

Meanwhile, child COVID cases continue to rise.  The American Academy of Pediatrics reports that in the first weeks of December, 47,581 children contracted COVID, more than double the number of cases in the first weeks of October, and not including unreported at-home testing.  Nationwide, pediatric COVID hospitalizations have risen steadily since fall, with children under 4 years disproportionately hospitalized.  Unsurprisingly, only 11% of kids in that age group have received even one COVID immunization, leaving too many children susceptible to hospitalization at a time when a bed might not be available under the current burden of disease.

Families of young children received an early Christmas gift in December with the Food and Drug Administration Emergency Use Authorization of the bivalent COVID vaccine for kids older than 6 months, but not enough children are getting immunized, even though these vaccines have been available for 2 years, 13 billion doses have been given worldwide and the bivalent vaccines creates a strong immune response similar to those of older children.

Too many parents succumb to “COVID-fatigue.”  They tell me “COVID is over,” so there’s no point vaccinating a young child, forgetting COVID vaccine is the best way to protect children.  Add cases of RSV and it’s no surprise hospital beds are unavailable.  Colleagues report that 25 to 30 children await beds in pediatric emergency rooms.  That’s the size of a whole pediatric ward.  Babies may need to be transported to another children’s hospital, which could be hundreds of miles away or out-of-state.  Nationally, 78% of children’s beds are full, an unprecedented number for this time in the winter virus season. Last month, six states were above 90%, meaning hospitals may soon be forced to turn patients away.

It’s easy to dismiss this current crisis as unintended fallout of the pandemic, but the current “No vacancy” signs are the end result of a health care system that prioritizes adults over your children.  From 2010-2020, pediatric hospital beds declined 20% nationwide, mostly at community hospitals.  The facilities buffer large academic children’s centers by caring for common, less acute illnesses.  As federal and state governments continue to pay only 40 to 60 cents on the dollar for pediatric care compared to adults, financially strained community hospitals closed pediatric wards, preferring more profitable adult bed space.

A simple fix — aligning Medicaid and Medicare payments — would seismically re-balance this uneven system.  Without increased support for Medicaid — the nation’s largest insurer of children — things will only get worse.  Last week’s $1.7 trillion dollar federal spending bill included a two-year extension for the Children’s Health Insurance Program, another major plan covering children.  This is a promising step, but without an increase in the payment, front line doctors and nurses know pleas for space for your sick child will be ignored.

More sick kids mean greater demand for medications.  For 2 months, common child health remedies and certain antibiotics have been in short supply.  Parents of my patients’ report going to seven or eight pharmacies to find pediatric medicine.  Walgreens now limits the sale of bottles of fever reducing drugs and at CVS, the quota for all children’s pain relievers is two.

Unlike the baby formula shortage several months ago, which originated from reduced supply when a factory went offline, the problem here is surging “triple-demic” demand.  The FDA could take similar action to that shortage and allow overseas import of medications until spot shortages improve, as some congressional leaders have urged.  Once these viruses naturally subside in spring, a thorough review is warranted to prevent parents from going on a retail and internet treasure hunt to control their baby’s fever.

Our national health care system has always been fragile when it comes to children’s care, but the “triple-demic” reveals it is damaged.  These changes to our system will make 2023 better for children, families and the doctors and nurses who care for them.

NYSAAP Advocacy & Policy Update

Elie Ward

Elie Ward

Elie Ward, MSW is the Director of Policy, Advocacy, and External Relations for NYS AAP Chapters 1, 2 &3.

With the election over, we are focusing once again on getting our bills, those that have passed both houses of the legislature, signed by the Governor.  Priorities for the Governor’s signature include Runaway and Homeless Youth Act, Cumulative Impact Act and the legislation to establish a primary care reform commission.

Whenever you get an Alert from me, please make your phone calls and send your emails.  Now that the Governor is secure for another four years, it’s time we raise our voices to encourage her to do the right thing for kids and for pediatricians.

Looking toward the future which includes the upcoming state budget and the 2023 Legislative Session, we are working with partners to push for significant investments to address child poverty, including an expansion of the Child Tax Credit, presumptive eligibility for all Medicaid and CHIP eligible children from birth through age 6, Universal Free School Lunch statewide, improving children’s access to vital mental health services, oversight of the spending and investment plan for the recently passed Environmental Bond Act, protection for children and families in the unwinding of the Federal Public Health Emergency, and working to assure that children and families’ needs are included in the State’s new application for the 1115Waiver.  We will also be working with partners on moving an Omnibus Adolescent Consent bill forward.  These are just some of the things we are engaged in on behalf of the children and families we serve.  There are many more, like the Birds and Bees Protection Act to protect children and all New Yorkers and our birds and bees from a toxic and unneeded neonicotinoid pesticide.

Even more issues will arise as we see the state budget develop and get a clearer picture how many of our priority investments are included.  And we will begin working with legislators again to help them understand and encourage them to support our issues.

One big issue that may be coming up this year is legislation requiring Influenza and COVID-19 (once fully approved by the FDA) immunization for school attendance.  A bill is already on file, and the sponsors have indicated that they want to try to move it in the 2023 session.  As you know, NYSAAP has a public policy statement clearly supporting this requirement.  If the sponsors do move the bill, and we engage in support, which we will, get ready for a rocky ride.

As always you are the voice for children, families, and pediatricians.  The legislative and policy work we do can only move forward if you join in the chorus.  Call the Governor when we ask.  Meet with your legislators when we have legislation or policy Alerts or Updates.  Make your voices heard.  There’s a lot of competition out there in the world of politics and policy, but we have credibility, and we take care of peoples’ children!  Ours is an important and highly valued voice.  Let’s use it and use it well.

Put Children First at the Polls

Shetal Shah, MD, FAAP

Shetal Shah, MD, FAAP

Shetal Shah, MD, FAAP is neonatologist at Maria Fareri Children’s Hospital and Immediate Past President of the NYS AAP-Chapter 2.  He is the Chair of the Pediatric Policy Council.  This op-ed was published in Tampa Bay Times on November 1, 2022.

Let’s put children first at the polls

 When I head to the polls, I’ll be voting with the needs of children and my patients in mind.

You haven’t heard much about one of the biggest issues facing voters this election.  While candidates focus on gas prices and inflation, problems directly affecting children are going unnoticed.  As a pediatrician, I am urging voters to head to the polls with the interests of children in mind and select representatives who prioritize programs the children I care for rely on to remain healthy.

Gun violence.  It is now the No. 1 killer of children. Kids in the United States die from firearms at a rate 7 times higher than in Canada and 19 times higher than other wealthy nations. In 2020, more than 4,300 children died from firearms, almost 40% from suicide.  Elected officials must be unafraid to address this violence, supporting research into ways to prevent childhood gun injury.  They must then have the courage to enact evidenced-based policies.  We already know requiring guns to be safely stored in a locked area separately from ammunition saves pediatric lives, but candidates are not running on platforms of making safe storage of firearms a requirement for gun ownership.

Insurance.  More than half of all children have health insurance from Medicaid and the Children’s Health Insurance Program (CHIP).  These programs acted as a strong safety net during the pandemic, as children of parents who lost jobs became eligible.  Federal provisions preventing states from removing children from Medicaid during the COVID health emergency further supported children.  Nationally, more than 4.1 million children who would have lost health insurance during the pandemic remained covered.  The result of these policies is historic.  The number of uninsured children is the lowest in U.S. history.

But candidates are not highlighting this remarkable achievement and pledging to thwart efforts to dis-enroll children from insurance coverage.  Candidates who protect Medicaid, and other programs that target low-income children and families will get my vote because they are helping me care for my patients.

Hunger.  Child hunger is both a national epidemic and a national disgrace.  One in five children, 14.6 million, participate in the Supplemental Nutrition Assistance Program, which provides assistance to purchase food for hungry families.  Hunger among children is so common that the American Academy of Pediatrics recommends screening all kids for food insecurity.  In addition to the nutrition assistance program, the Women, Infants and Children’s (WIC) program provides nutritional support to parents, babies and infants.  Babies under my care often require expensive special formulas priced at $50 per can — costs which add up for families on almost any income.  Our patients rely on this program, even if they are financially well-off.  Just last week I discharged an infant after 3 months in the neonatal intensive care unit.  His parents were both police officers, but because of their newborn’s unique medical condition, the baby’s special formula would cost up to $10,000 per year without this assistance.

These programs ensure new parents can feed their child.  But when politicians talk about caring for children, there is no talk about increasing funding for food programs despite the high inflation that has made even greater numbers of kids reliant on them.  A few months ago in the emergency room, we cared for a baby with salt levels that were so imbalanced — it’s a miracle he didn’t have a seizure.  Since prices had gone up and the program support they received limited, the families were diluting newborn formula to make it last longer, unaware of the potentially deadly consequences.

Candidates love to mention inflation, but fail to note it has driven more children into poverty and necessitates a strengthening of our safety net, so no newborns fall through the cracks.

Kids first.  When politicians put kids first, compromise and progress happen.  After the tragedy in Uvalde, Texas — legislators finally realized every child should feel safe at school.  The resulting Bipartisan Safer Communities Act was the first major federal gun violence reduction legislation in decades and a promising first step to more negotiated public safety measures for firearms.

Pundits and candidates alike classify votes into categories.  There is the “economy voter,” “crime voter” and “undecided, suburban voter.”  Legislators need to know there is a constituency of doctors, parents, nurses, grandparents and teachers whose vote depends on how highly those running for office prioritize children’s needs.  These voters give a voice to the 20% of the population with no vote.  When I head to the polls, I’ll be voting with the needs of children and my patients in mind.

If you love a child, so should you.

Tired of COVID? Lessons Learned

Shetal Shah, MD, FAAP

Shetal Shah, MD, FAAP

Shetal Shah, MD, FAAP is neonatologist at Maria Fareri Children’s Hospital and Immediate Past President of the NYS AAP-Chapter 2. He is the Chair of the Pediatric Policy Council.  This op-ed was published in Tampa Bay Times on August 1, 2022.

Tired of COVID? Okay, but here are lessons we should learn for the next infectious threat

After two years of surveys, public service videos, parent conversations, local information sessions, and clinics, here’s what we’ve learned about attitudes toward COVID vaccines, and what needs to change.

President Joe Biden has recovered from COVID-19, using his mild symptoms as an opportunity to reinforce the importance of immunization.  Fully vaccinated and “double boosted,” the president ended isolation last week.  I cautiously hoped the president’s short illness would spur COVID immunization rates, providing a high-profile case study of the mild disease experienced by those vaccinated to an under-immunized U.S. population.

Pediatricians provide the majority of vaccines nationwide, and low immunization rates can be devastating.  Look no further than the return of polio, contracted by an unvaccinated adult in New York, or the rapid spread of monkeypox — there are now more than 3,500 U.S. cases, the highest level in the world.

To increase COVID immunization rates, reduce vaccine hesitancy and promote the importance of childhood COVID vaccination, pediatricians nationwide have led local efforts to address concerns about immunization.  This is doubly important as the school year is about to begin across Tampa Bay.

After two years of surveys, public service videos, parent conversations, local information sessions, and clinics, here’s what we’ve learned about attitudes toward COVID vaccines, and what needs to change.

COVID Positivity Rates No Longer Influence Public Opinion

As the pandemic’s onset, the percentage of positive cases led the news.  Hospitalizations soared, elective surgical cases were cancelled and hospital leaders openly speculated facilities wouldn’t have sufficient space for heart attack and stroke patients.  Two years later, better COVID treatments and modest immunization rates have lowered adult hospitalizations, and the public has ceased to care about rates of circulating disease.  Consequently, vaccination rates are stagnant.

According to the Centers for Disease Control and Prevention, the number of children 5-11 and 12-17 years old receiving their first COVID shot has been low and flat since March, meaning only 30% and 59% of kids in these age groups are fully vaccinated, a concerning level considering unmasked kids will resume normal school schedules this month.  Only 4% of younger children, 6 months to 4 years, have received even one dose since the COVID vaccine was authorized for their age group last month.  Yet, positivity rates, the former headline grabbers, have reached Mount Everest levels, led by the BA.5 variant, which infected the president.  Nationally, 7-day positivity rates are about 17.8%, with 11 states higher than 25%.  Contrast that with January 2021, when rates of 14% drove millions to mass vaccination clinics, clamoring for the newly available vaccine.  Simply put, the public’s attention has turned elsewhere, and we are all at risk because of it.  Remember, that more than 77,000 Floridians have died of COVID — and more than 1 million across the United States.  Even now, more than 400 Americans are still dying each day from COVID.  Imagine how we would react if a full jetliner crashed every day and killed all of its passengers.  That’s what COVID is still doing.

Ignoring Long COVID

The BA.5 strain is less deadly than the original, omicron and delta variants, leading parents and families to perceive vaccination as less critical.  This perception ignores the risks of long-COVID, which impacts about 1 in 4 adults up to a year after infection.  Unimmunized patients are more vulnerable to disease and this complication, which can include difficulty breathing, problems with joints and muscles, heart conditions and “brain fog” up to a year after COVID.  Sadly, and despite the efforts of thousands of my colleagues, the unvaccinated do not see this as cause for concern.

Underestimating the Impact of COVID on Children

COVID in children is underappreciated.  14 million children have been infected, representing almost one-fifth of all COVID cases, with hospitalization rates steadily increasing since April.   Over 1300 children have now died, roughly one-third of them under 4 years old.  Immunizing younger children is an uphill battle.  Parents do not identify COVID as a serious health threat to their children.  Parents are more likely to permit flu shots, though flu last year killed 24 children and, in an average, non-pandemic year, claims 600 children.  Moreover, a recent study showed almost 6% of kids develop long-haul symptoms and a smaller percentage will develop the potentially fatal multisystem inflammatory syndrome in children.

Politicians Hijacked Medicine

The opportunism of politicians to use common-sense, well-researched and time-tested preventive health measures like vaccination as tools for demonizing public health officials will now be a long-standing impediment to protecting adults and children from vaccine-preventable diseases.  Instead of reinforcing efforts to mitigate the spread of disease, leaders attacked science, immunization experts, the CDC and by extension, the pediatricians and other physicians who carry out their recommendations.  Elected officials wore their refusal to be “jabbed,” as a merit badge — tying vaccination decisions to political party affiliation.

In a bitterly partisan country, this made convincing parents to get vaccinated like encouraging them to root for a different sports team.  Immunizing your child became an emotional decision, reinforced by widespread social media misinformation about magnetic arms and infertility — not a medical one.  The conscious decision to manipulate vaccination into a political issue will hinder not only our ongoing fight against COVID but attempts at combating future infections.

Monkey pox cases will increase.  New COVID variants will emerge.  Vaccine-preventable diseases like polio may return and we will face the first traditional flu season in 3 years this October.  How we deal with these emerging threats will largely be determined by how quickly we unlearn these biases.

E-Cigarette Chapter Champion

Sara Siddiqui, MD, FAAP

Sara Siddiqui, MD, FAAP

E-Cig Chapter Champion

Sara Siddiqui MD, FAAP is pediatrician in Huntington.  She is Co-chair of the Legislative Advocacy Committee and Chapter Champion for Vaping Awareness and Cessation for NYS AAP Chapter 2.

If you have or take care of children above the age of ten, I can rightly say that they have been exposed to one of the many Electronic Nicotine Delivery Systems (ENDS).  As we know, nicotine in ENDS products can be extremely addicting to those that are initially exposed under the age of 26.  Nicotine salts found in ENDS products have an increased bioavailability in the adolescent brain.  It can lead to addiction, anxiety, depression along with rapid heart rate, rise in blood pressure, headaches and irritability (1).

As a pediatrician and a mom, I have seen the professional and personal impacts of exposure to ENDS products.  I first learned of the concept of electronic cigarettes from my son, a freshman in high school in 2014.  Since then, I have been involved in schools, educational forums for parents, and legislation to remove availability of ENDS products, from the hands of those under twenty-one.  I was honored to be the Chapter Champion for Vaping Awareness and Cessation for New York AAP Chapter 2.  We have meetings and educational seminars with other pediatricians then share with our respective chapters.  I have exchanged ideas and met some great people within our group.  Two main objectives I had for my own chapter were to increase resources for helping adolescents to quit nicotine, and helping to promote alternatives to suspension for those adolescents found to be vaping in schools.  As pediatricians, we are the first line when our patients disclose a history of vaping.   A teen or young adult may need Nicotine Replacement Therapy (NRT) to successfully quit.  All pediatricians should be comfortable in prescribing NRT.  The New York State Quitline is one resource I have found to be of great assistance by using programs which include a quit coach, online resources and a Text to Quit® program.  As a member of the NYS Quitline Healthcare Task Force, I was invited to participate in a recent webinar entitled “Addressing Nicotine and Tobacco use in Youth and Young Adults”, which also included resources for pediatricians and parents to aid in prevention and quitting.

The Clear the Vapor 2022 conference, a fabulous online event put together by Parents Against Vaping E-cigarettes (PAVe), included a session I was asked to moderate.  Four delightful adolescents and young adults shared their heartbreaking stories about nicotine addiction and ultimately a successful path to quitting.  It was an eye-opener as to how easy it is for our youth to not only obtain vaping products but to become unknowingly addicted.

When children are addicted, they need to be led towards ways to help them quit with multiple areas of support.  Children who get caught vaping in school are likely exhibiting signs of addiction.  Tobacco Prevention Toolkit at Stanford Medicine has developed evidence-based interventions for teachers and administrators starting at the elementary school level to start pathways to encourage rehabilitation and resources for quitting, along with learning modules to prevent starting.  I am proud to be the New York AAP Chapter 2 Champion for Vaping Awareness and Cessation.  I am hopeful to continue helping to increase awareness of the dangers of ENDS products in children and help our young people avoid starting usage of ENDS products — a journey I will continue for as long as I can!


  1. “Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young Adults,” https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html

Gun Violence

Shetal Shah, MD, FAAP

Shetal Shah, MD, FAAP

Lois Lee, MD, MPH, FAAP

Lois Lee, MD, MPH, FAAP

Shetal Shah MD, FAAP is neonatologist at Maria Fareri Children’s Hospital and Immediate Past President of the NYS AAP-Chapter 2.  He is the Chair of the Pediatric Policy Council. 

Lois Lee, MD, MPH, FAAP, is a pediatric emergency medicine physician, member of the Pediatric Policy Council and co-editor of the book, “Pediatric Firearm Injuries and Fatalities: The Clinician’s Guide to Policies and Approaches to Firearm Harm Prevention.”  This op-ed was published in Tampa Bay Times on June 2, 2022.

After Uvalde, we should agree on these 3 things to stem gun violence against kids.  This is a public health issue, and we must treat it — and fund it — as such.

We grieve with the mothers, fathers, loved ones and the community of the 19 children and two adults gunned down in the school shooting in Uvalde, Texas.  As pediatricians who’ve dedicated almost three decades of education — and our entire professional career — to keeping children safe, we are outraged to live in a country that has allowed the massacre of elementary school age children to happen again.

In 2012, we vividly remember locking eyes with other parents as we picked up our elementary-school age children after the massacre at Sandy Hook Elementary School.  We recall the school board meetings announcing that forever after, our schools would be locked down for safety — and parents would need security guard escorts directly to the office if picking up a child early.  Coming less than two weeks after the shooting in Buffalo, this latest act of violence has again re-ignited discussion about how best to address America’s epidemic of gun violence.  As physicians and researchers, we urge consensus on three aspects of this issue.

Increase funding for gun violence research

In 2020, gun violence became the leading cause of death for children between 1 and 19 years old — surpassing motor vehicle accidents, cancer and drug overdoses.  According to the Centers for Disease Control and Prevention, 4,368 children and youth died by firearms in 2020.  This represents a 33% increase from 2019.  There were 1,293 (32%) firearm suicides and 2,811 (68%) firearm homicides.  Gun injuries also present a serious health disparity issue.  Black non-Hispanic youth have homicide rates (14.5 per 100,000 youth from birth to 19 years old) 14 times higher than white non-Hispanic youth (0.97 per 100,000 youth from birth to 19 years old).

Regardless of politics, we must invest in more research to better understand how to reduce child firearm injuries and deaths from assaults, homicides, suicides and unintentional shootings.  We must fund pediatric researchers who can identify children most at-risk of firearm injury and death, as well as protective factors.  In the past 3 years, Congress has appropriated only $25 million per year to address the public health issue of gun violence.  In contrast, the National Heart, Lung and Blood Institute, which partially funds research on heart disease, the No. 1 killer of adults, hosts a of budget of $3.8 billion.  This year, President Joe Biden has requested $60 million for funding gun violence prevention research.  This is a small national price to save the lives of children.

State-based solutions are limited

In the aftermath of the Sandy Hook murders, several states passed stricter gun control regulations.  However, those who live in states with tighter gun restrictions can’t be lulled to complacency.  The Buffalo shooter purchased his assault rifle in New York, a state with more restrictive gun laws.  In states with tighter restrictions on the sales, possession and use of firearms, upwards of 75% of guns used in crimes come from other states.  The public must realize limitations on firearm use are only as good as the interstate highway system.  No region of the country can enact meaningful reform alone.  The only true path toward creating policy to reduce the public health impact of gun violence on children runs through Washington, D.C., and must occur nationally.  For this to occur, there must be a reversal of the current polarizing state of politics that deprioritizes our children and public safety.

Public health must be part of this conversation

Whether in an emergency room, operating room or trauma center, every victim of firearm injury becomes a patient.  Physician researchers provide a unique perspective on gun violence, both as the medical responders with firsthand experience treating these patients and their families and by conducting studies to reduce its impact.

Yet in 2018, upon release of a paper reviewing public health strategies to reducing firearm injuries by the American College of Physicians, the National Rifle Association mocked the report.  The NRA warned doctors to “stay in their lane,” and demeaned physicians by calling them “anti-gun,” and “self-important.”  A social media backlash ensued, appropriately called “This is our lane.”  Nonetheless, the message sent by the most prominent pro-firearm advocate group in the nation stigmatized doctors and researchers by labeling their work as politically motivated.  Gun violence is a public health issue, and physicians, public health professionals and researchers must be part of a diverse group of voices that are heard.

Since the Columbine shooting in 1999, more than 550 children and school staff have been killed by guns.  The ripple effects of gun violence have affected an estimated 311,000 additional kids.  But the true emotional and mental health toll on the individuals and communities are unmeasurable.  The pace of these events is accelerating, demanding renewed commitment to protect children and families.  Our children are already forever marked by these events and the resultant active shooter drills they participate in at school.  We can’t just accept that firearm injuries and deaths to our children are inevitable.  We must begin creating solutions by agreeing on these simple, but small, pieces of a larger uniquely American argument.