Recipient of the Julius B. Richmond Center of Excellence Visiting Professorship

Mary Cataletto, MD, MMM, FAAP

Mary Cataletto, MD, MMM, FAAP

(Dr. Mary Cataletto, MD, MMM, FAAP, FCCP is a pediatric pulmonologist and Associate Director of Pediatric Sleep Medicine at NYU Winthrop Hospital.  She is chair elect for Pediatric Chest Medicine NetWork of the American College of Chest Physicians and past chair of the Asthma Coalition of Long Island.  She is the Nassau Pediatric Society Representative to NYS AAP Chapter 2.)

This year’s award for the Julius B. Richmond Center of Excellence Visiting Professorship went to NYS AAP Chapter 2 serving the Pediatric Societies of Brooklyn, Queens, Nassau and Suffolk.  The award, funded through a grant from the Flight Attendant Medical Research Institute brings together tobacco control experts with pediatric organizations and training programs throughout the country. We were honored to host Dr. Karen Wilson as our visiting professor.  Dr. Wilson is the Debra and Leon Black Division Chief of General Pediatrics and Vice Chair for Clinical and Translational Research for the Department of Pediatrics at the Icahn School of Medicine at Mount Sinai.

In a series of three sessions over 200 community and academic pediatricians, fellows, residents and students had the opportunity to learn more about the impact of targeted marketing and deleterious health effects of e-cigarettes on adolescents, the impact of second and third hand smoke exposure and motivational interviewing to engage appropriate parents in smoking cessation discussions. There is clear evidence at all ages and developmental stages that exposure to tobacco is harmful.  Prenatal exposures have been associated with preterm birth, low birth weight and sudden infant death. During childhood increase rates of asthma, ear infections and pneumonia are well described.  There is no safe lower limit for tobacco smoke exposure.  Pediatricians are encouraged to advocate for smoke free environments for all children.

Tips for pediatricians to share with parents include:

  • Set a good example by not smoking
  • If you are a smoker, there are effective strategies to help you succeed in stopping
  • Keep your home and care smoke free
  • Work with your school and child care to keep play areas smoke free

While teen use of traditional cigarettes is declining, electronic cigarettes are on the rise. Targeted marketing, addition of flavors and the misconception that electronic cigarettes are a “safe alternative” contribute to changing trends.  Also known as e-cigs, e-hookahs, vapes, mods and ENDS (electronic nicotine delivery systems) these devices are not regulated and can contain nicotine, carcinogens and other toxic chemicals.  Nicotine is highly addictive and has harmful effects on adolescent brain development as well as to pregnant women and developing fetuses.  Multiple studies have shown that teens who use e-cigarettes are at higher risk for regular tobacco use in the future.

Key messages for pediatricians to share with parents and teens:

  • E-cigarettes are not a safe alternative to traditional tobacco products
  • There is no safe lower limit for exposure to nicotine in children
  • Teen users have a higher risk of nicotine addiction and higher rates of becoming long term tobacco smokers
  • Advocate for inclusion of e-cigarettes in tobacco free school legislation and prohibition of use in outdoor areas and locations where children may be present
  • Support ban on promotion and sale of e-cigarettes to children
  • Talk to your teen

Legislative Wins & Losses 2018; School Health Form

Elie Ward, MSW

Elie Ward, MSW

(Mrs. Elie Ward, MSW is the Director of Policy, Advocacy, and External Relations for NYS AAP Chapters 1, 2 &3.  She provides an update on the status of issues for which pediatricians across the state strongly advocated.) 

The New York State Legislature left Albany on June 20th.  Despite a chaotic and highly dysfunctional session, we were able to secure several high value victories for the children and families of New York.

NYS AAP Priority Legislation that Passed:

  • Standing Orders legislation, allows Nurses in the delivery room to admit a healthy newborn to the regular nursery without calling a pediatrician at home who has not seen the newborn. This was a high priority for our members.
  • Indoor Tanning Prohibition for all young people under the age of 18
  • Maternal Depression screening in pediatrics & primary care now covered by Commercial Insurance
  • Medically Necessary Donor Breast Milk for the tiniest, most medically fragile newborns now covered by Commercial Insurance
  • Sex Trafficking of a Child legislation was strengthened to include stronger penalties for perpetrators and stronger protections for child victims
  • CMV Testing Added to Universal Newborn Testing Under Specific Circumstances included CMV testing as part of universal newborn testing, if the newborn fails a hearing test, and requires a specific test for CMV as defined by the AAP

We and our partners were not able to move:

  • Statewide Lead Screening and Lead Action Level to 5 mg/l: The current statewide Action Level is 10mg/l which is above the CDC recommendation. But we have made progress with our coalition advocacy and as a result several key legislators who want to start working on moving the bill have reached out to start meeting as soon as early August. Memo of Support
  • Extreme Risk Protection Orders (ERPO) which allows a family member or other close friend to identify a person who is at risk and allows a judge to remove weapons from that person for a specified period of time.
  • Safe Storage of Fire Arms: Requires safe storage of all guns and stipulates exactly what safe storage means. Includes penalties. Memo of Support
  • Tobacco 21: Requires tobacco purchase age statewide to move to 21. Many counties have already moved in this direction, but a statewide approach would help protect all New York young people from being introduced to smoking too early.

IMMIGRATION ADVOCACY FOR SEPARATED CHILDREN

We are all too acutely aware of the inhumane treatment of families and children crossing our southern borders seeking safety.

The combination of Family Separation and Zero Tolerance policies have led to more than 3,000 children, including more than 150 infants and toddlers, being placed in various care situations away from their parents.  Some of the detention facilities for children are hellish and completely inappropriate, others, like some of the New York child welfare agencies that are caring for children, are more humane, but they are no substitute for family and parent caregivers.

Everything that we are doing at the NYS AAP is focused on reunification.  Only by reunifying children and parents and keeping families out of detention can we be assured that the children and families crossing our borders are being given the rights and supports they need as they work through their asylum processes.  The National AAP is doing work every day to help push the federal government to do the right thing for these children and their families. But we in New York can do even more.

Below are links to two letters your Chapter leaders wrote to both the Governor and the Mayor of NYC alerting them to our deep concern about the care of separated children in facilities in New York and demanding that all state and city efforts focus on reunification.

In addition, many of our members attended local rallies on June 30th Demanding Reunification for All Children Separated From Their Families.

But this problem is not solved. Children are still separated from their parents and there is the continuing specter of the federal government keeping these families in detention.

Here are some ACTIONS you can take to help these families:

  • Take any part of the letters we wrote (linked above) and edit them for publication in your local newspaper under your name.
  • Contact the Legal Services Offices in your area and offer your help and expertise to those attorneys who are trying to represent separated children in court. You can offer specific health, development and emotional impacts of separation.
  • Use this link to find Volunteer Opportunities in Your Area: Stand with Immigrants.
  • Call your Congress Person and your Senator and demand they focus on the reunification of separated families.
  • This is an election year. If you are attending any candidate forums, ask about the candidates’ positions on reunification and detention of families.
  • Attend more local rallies and events. Don’t stop speaking out until the children are back with their parents and the families are released into the community to await their asylum hearings.

NEW SCHOOL HEALTH FORM UPDATE

As many of you know, the State Department of Education (SED) announced a new School Health Form about 2 months ago.  No one from the NYS AAP was involved in the creation or design of the form.  We had been talking with the SED since last November asking to see a draft of the form and asking that it be electronically linked to EHR’s.  Our requests were ignored.  No one from the NYS AAP saw the form until the form was e-mailed, causing quite a stir among our members across the state.

We contacted the SED and asked for more conversations.  At this time there is a group of pediatricians who are involved in school health and experienced in practice administration who are attempting to work with the SED to make changes to the form and to get an extension on the implementation date.

At this time no one needs to use this form until the 2019-2020 School Year.  That would take implementation, unless we can get it delayed, to sometime in 2019 depending on when you see the child for the September 2019 school year.

Here is a link to the FAQ about the form:

https://www.schoolhealthny.com/cms/lib/NY01832015/Centricity/Domain/85/FAQsChangesHealthExam.pdf 

The important thing to remember is that no school district can demand the form now.

We will report back on the progress we make working with the SED to significantly change the form, the information it requests, and how it links with existing electronic health records.


June 2018

Dear NYS AAP – Chapter 2 Member,
May and June are busy months for our Chapter, with lots of important news to relate. Please check the Chapter 2 website frequently, as new events, initiatives, valuable practice management information, and links to articles are regularly posted.
Steven J. Goldstein, MD, FAAP
President, NYS AAP – Chapter 2
Firearm Injury and Gun Violence Prevention Committee
On May 17th our newly formed Chapter 2 and 3 Firearm Injury and Gun Violence Prevention Committee met at Cohen Children’s Medical Center. There were over 30 attendees from both Chapters, including students, parents, residents, and attending physicians. Jeff Ostreicherfrom Chapter 2 and Nina Agrawal of Chapter 3 will co-chair this joint endeavor. Four working groups are planned: Legislative Advocacy, Research and Education, Grassroots, and Media Outreach. If you would like to help, click Jeff and Nina’s names above to email them.
Stress Reduction for Pediatricians – June 7th
On June 7th the Chapter is sponsoring an informal Wellness Event: Stress Reduction for Pediatricians, at the Douglaston Club in Little Neck. There will be a gourmet vegetarian dinner, an introduction to yoga led by Dr. Ron Marino, and a talk on stress reduction by Dr. Peter Nieman of Calgary, Alberta. I had the opportunity to hear Peter speak last year at the AAP District I & II Annual Meeting in Vermont – his advice is worth hearing. The evening is free for Chapter 2 members and Chapter 3 members can attend for a reduced fee thanks to a generous grant from MLMIC. It promises to be a great evening.
Immigrant Health
Another joint initiative for Chapters 2 and 3 will focus on Immigrant Health. We oppose separation of children from their parents at the border. We oppose losing 1,500 of those children.
We are working to create safe spaces for immigrant children to obtain quality pediatric healthcare and oppose the dehumanizing of any group. Take a look at the AAP’s stance on this issue: http://www.aappublications.org/news/2018/05/08/immigration050818
Please contact Laurie Gordon at lsg9004@nyp.org if you would like to work with the Chapters on this issue.
Families Belong Together March – June 14th
On June 14 there will be a Families Belong Together march and candlelight vigil in Huntington, Long Island to protest the separation of children from their parents at the US border. Chapter 2 is a sponsor of this event and invites all our members to attend this vigil or others planned for the metropolitan region. The Huntington location is the Northwest corner of Park Avenue and Main Street in Huntington Village at 7 pm on June 14.
AAP President Dr. Colleen Kraft’s op-ed on this subject can be found here.
Tobacco 21 Victory
Congratulations to Chapter 2 Vice President, Dr. Shetal Shah, and all who worked on and attended the May 23rd vote of the Nassau County Legislature, where a bill that we worked on for the last 10 years passed unanimously. This important bill raises the age to purchase tobacco and related products, including e-cigarettes, to 21. Nassau County will finally join Suffolk County and all of NYC in complying with Tobacco 21. This is a big win for our Chapter and the children we care for!
Vaping and E-Cigarettes Lecture – June 18th
Drs. Mary Cataletto and Robert Lee received a grant from the AAP Julius B. Richmond Center of Excellence for Dr. Karen Wilson to speak with NYU Winthrop Hospital, Chapter 2, and Nassau Pediatric Society attendees about e-cigarettes, secondhand smoke, vaping and JUULing and how to address these issues in the office.
A free dinner lecture will be held on June 18th at NYU Winthrop Hospital.
Chapter Needs Assessment Survey
You should have received a Chapter Needs Assessment Survey that will assist us in creating a new Chapter 2 Strategic Plan.  Please take a few minutes to share your thoughts, help us serve your needs, and enter our Amazon gift card giveaway.
Addressing the Opioid Crisis
If you are interested in joining a NY State multi-Chapter Committee to craft strategies to deal with the opioid crisis, help develop and make available educational materials for pediatricians, learn how to use SBIRT (Screening, Brief Intervention and Referral to Treatment), and learn about other addiction related issues, please contact our Executive Director, Jessica Geslani, at jgeslani@aap.org.
Diversity and Inclusion
I am pleased to announce that Dr. Juan Kupferman, our Membership Chair, will head our new Diversity and Inclusion initiative. Juan is already working on this issue and if you would like to learn more or assist him, email him at kupferjc@gmail.com
Help with Billing & Practice Management Issues
Please periodically check the Pediatric Council section of our website to view new advisories from the National AAP. The most recent post deals with a billing problem at Anthem-Blue Cross.
In addition, the Chapter can help you in addressing your billing and practice management issues. Outline the problem in an email to us at jgeslani@aap.org.
The Officers of Chapter 2 welcome your feedback, thoughts, suggestions, and constructive criticism.  Please see our email addresses below to contact us.
Follow us on Twitter: @NYSAAPCh2
Follow Steve Goldstein on Twitter: @SteveGoldstei10
With our best wishes for a healthy and productive summer!
My best,
Steve Goldstein, Chapter President SJG34@Cornell.edu
and the Officers:
Shetal Shah, Vice President shetaldoc@hotmail.com
Robert Lee, Secretary rlee@aap.net
Sara Kopple, Treasurer sarakopple@gmail.com

May 2018

Dear NYS AAP – Chapter 2 Member,

Chapter leadership is a fulfilling role, with unlimited possibilities to aid the members and serve the children of New York State. It can be a full-time job for the officers. It is my pleasure to share some of what we are doing and plans for new initiatives.

Steven J. Goldstein, MD, FAAP
President, NYS AAP – Chapter 2
SJG34@Cornell.edu

NYS AAP Annual Advocacy Day

On March 6th, Chapter members attended our Annual Advocacy Day in Albany.  125 pediatricians from across the state were in attendance and heard from the Chairs of the Senate and Assembly Health Committees and Medicaid.  Members met with their State Senators and Assemblymen to promote the AAP Agenda for Children in New York State.View our 2018 NYS AAP advocacy materials below:·     Priority Pediatric Policy, Budget and Practice Issues·     Legislative Priorities

NY Chapters 1, 2 and 3, and New York State AAP

March Executive Meeting: Focus on Gun Violence Prevention

Our last quarterly Chapter Executive Committee Meeting was held on March 8th at Winthrop University Hospital.

In response to the tragic events at Parkland, the majority of the meeting was devoted to the issue of gun violence prevention (GVP). The speakers included Young Nelson of Everytown for Gun Safety, long time GVP advocate Dr. Nina Agrawal from Chapter 3, and Dr. Jeff Ostreicher from Chapter 2, a Peds ED physician with a research interest in gun violence. Jeff will Chair Chapter 2’s new GVP Committee and will work with Nina. Parents, educators, and activists attended the meeting as well. Contact our Executive Director, Jessica Geslani, at jgeslani@aap.org if you would like to work on this issue. The first joint GVP Committee meeting will be scheduled for sometime in May.

Annual Leadership Forum

From March 15 -18th, Chapter leadership from around the state attended the AAP Annual Leadership Forum. There were educational sessions and the leadership voted on resolutions submitted by the AAP membership. All passed resolutions are addressed, and the Top Ten are given priority by the AAP Board of Directors. The resolutions can be viewed here: http://bit.ly/2GNfYIV (AAP login required).

At the ALF, I had the opportunity to defend our nomination for the 2018 Outstanding Large Chapter Award. Although we did not win, it was an honor to be nominated, and we will instead receive a Chapter of Excellence Award. The winning Large Chapter, the Minnesota Chapter, helped stop a measles epidemic within their local Muslim community. I agree that this initiative deserved special recognition.

March for Our Lives – Long Island

On March 24th, I had the privilege of speaking at the March For Our Lives-LI in Huntington, along with family members of those killed in Parkland, clergy, former Congressman Steve Israel, students, and a representative from the local NAACP.

There were about 3,000 people in attendance, including a good number of Chapter 2 members.  Pictures and my speech can be found on the Chapter website here:

http://ny2aap.org/march-for-our-lives-2018/

I was asked by the AAP to write a blog for AAP Voices on my experience with the students, and our new joint Chapter initiative to address gun safety and GVP. It can be found here: https://www.aap.org/en-us/aap-voices/Pages/Pediatricians-Advocating-for-Gun-Safety-Should-Be-No-Surprise.aspx

AAP Legislative Conference & Leadership Fly-In

On April 9th and 10th, Chapter leaders from around the country met in Washington at the AAP Legislative Conference where we improved our advocacy skills and learned a great deal about issues of concern to our profession, including healthcare, the environment/climate change, immigrant health, gun violence prevention, and many others.

On April 10th, the 350 pediatricians in attendance met with their Senators and Congressional representatives to discuss the gun safety and GVP issue. The 20 or so pediatricians from New York State were very well received by the offices visited and much information was shared. You should all know that the AAP committed $500,000 to a Gun Research Initiative to aid in bringing science into the discussion of how to address this problem.

Congressman Tom Suozzi (center) with Drs. Steven Goldstein (left) and Shetal Shah (right)

Rome CATCH Visiting Professorship: Immigrant Health

On April 11th, NY Presbyterian-Queens hosted Visiting Professor Julie M. Linton for a symposium on immigrant health issues. The program was supported by a grant from the AAP obtained by Drs. Laurie Gordon and Sara Kopple. Dr. Alan Shapiro of Terra Firma spoke about his experiences in the Bronx, along with Dr. Linton. Their presentations were followed by a panel discussion. If you are interested in working with the AAP on immigrant health issues, please email our Executive Director, Jessica Geslani, at jgeslani@aap.org.

Social Event: Networking, Art & Pediatricians

On April 18th, about 60 pediatricians and medical students attended a joint Chapter 2 and 3 evening networking event at The Flowers Gallery in Chelsea. Attendees had the opportunity to socialize and hear from the Chapter leadership as they sipped wine and ate gourmet pizza. We plan to continue to hold events such as this one to keep our members informed and involve new pediatricians in our work. Attendees included practicing pediatricians, residents, fellows, Department Chairs, first year medical students, and retired members.

Coming Up: Watch Your Email & the Chapter Website

May 16:
Joint Chapter 2 & 3 Executive Committee Meeting
The National AAP President-Elect Candidates will join us via Skype.

Early June:
We plan to hold a Wellness Event for Pediatricians: Yoga, Stress Reduction, and Avoiding Burnout
More details to follow.

June 18 – 19:
Julius B. Richmond Visiting Lectureship Program with Dr. Karen Wilson
“How to Address the Problem of E-cigarettes and Vaping”

The Officers of Chapter 2 are happy to hear from you. Let us know about your concerns, your needs, and your suggestions. We regularly post webinars, educational opportunities, resources, handouts, and videos on our website: ny2aap.org

Follow us on Twitter: @NYSAAPCh2
Follow Steve Goldstein on Twitter: @SteveGoldstei10

My best,

Steve Goldstein, Chapter President SJG34@Cornell.edu

and the Officers:
Shetal Shah, Vice President shetaldoc@hotmail.com
Robert Lee, Secretary rlee@aap.net
Sara Kopple, Treasurer sarakopple@gmail.com


Gun Violence Prevention

Nina Agrawal, MD, FAAP

Nina Agrawal, MD, FAAP

Dr. Nina Agrawal, MD, FAAP is the Medical Director of the Child Advocacy Center at Lincoln Medical Center in the South Bronx, where she practices child abuse pediatrics and runs the Center’s Community Pediatrics residency rotation.  She is member of the NYS AAP Chapter 2 and 3 Gun Violence Prevention Committee.

NYS AAP Chapter 2 and Chapter 3 members:

For the first time since the shootings at Sandy Hook elementary school, I feel hopeful.  The next generation is standing up for kids everywhere – rural, suburban, and urban.  They are standing up for the countless children traumatized every day by gun violence – directly and indirectly.

We had over 100 medical students, pediatric residents, and practicing physicians from programs all over NYC participate in the nation wide March for Our Patient’s Lives on March 24th.  Kudos to Hofstra medical students for coming out in huge numbers! (https://www.youtube.com/watch?v=eFWIXT6_IiM&feature=youtu.be)

We must continue to stand up and speak out!  As pediatricians, we are a trusted voice and can save lives.  Here’s what you can do NOW:

  1. LEARN
    1. Gun violence is a public health crisis. This is not politics.  This is about policies that keep children safe.  Gun violence is now the 2nd leading cause of death in children and is on the increase.  Every day we do nothing, 7 more children die.
    2. Gun violence is preventable. We need research and data to support effective policies.  Because of the Dickey Amendment stating that “no funds could be used by the CDC and NIH to advocate or promote gun control, we are 22 years behind in identifying evidence based solutions.  We need Congress to repeal the Dickey Amendment and appropriate $50 million to the CDC to do their job.
    3. We are promoting gun safety not gun control. This is similar to past highly successful public health campaigns such as Safe to Sleep and Motor Vehicle Safety.  Because of “Back to Sleep” and car seats, we have dramatically reduced deaths from these preventable injuries.  We need to do the same for gun violence.
  2. CONNECT
    1. We can’t do this alone. There are lots of opportunities to get involved.  Whatever you can give – a day, a week, a month – It all makes a difference.
    2. Connect with gun violence prevention advocacy groups like Moms Demand Action or the new Gun Violence Prevention Committee of NYS AAP Chapters 2 and 3.  Other groups always welcome white coats!
    3. Create dialogue with other health professionals. Offer to speak at noon conferences, grand rounds, etc.  Connect with speakers and ask them to present at your institution.
  3. ACT
    1. Raise awareness about the need for research – on a state level and on a federal level.  Most physicians don’t know about the Dickey Amendment. Repealing the Dickey Amendment has bipartisan support.  There is proposed legislation to create a NY State firearm research center.
    2. Put a face on gun violence. Tell your story about a patient or an experience.  Legislators have the stats but don’t have the front line experiences we have.
    3. June is gun violence prevention month.  June 2nd is wear orange day. Orange is the color for hunters, warning people not to shoot.  Host an event. Can be large or small.  We are happy to help you!

Stay tuned for a gun violence prevention summit in NYC on June 23rd organized by NY Docs – A coalition of advocacy groups dedicated to improving health for all.  To learn more, feel free to contact me.  We will be educating health professionals on policy advocacy and giving you the tools to take action.

Please read the attached letter from a 9 year old advocating to keep kids safe from guns.

 

In unity,

Nina Agrawal, MD
ninaagrawalmd@gmail.com


 

Why Infants and Toddlers in Daycare Need to Get the Flu Vaccine

Heather Brumberg, MD, MPH, FAAP

Heather Brumberg, MD, MPH, FAAP

Shetal Shah, MD, FAAP

Shetal Shah, MD, FAAP

This blog post was originally published as an Opinion-Editorial piece in www.lowhud.com.

(Dr. Shetal Shah, MD, FAAP is a neonatologist at Maria Fareri Children’s Hospital.  He is NYS AAP Chapter 2 Vice President and Chair of the Legislative Committee.  Dr. Heather Brumberg, MD, MPH, FAAP is Director of Regional Neonatal Public Health Programs and Medical Director of the Lower Hudson Valley Perinatal Network.  She is NYS AAP Chapter 3 President.)

Influenza has a public relations problem.  Though often perceived as a mild inconvenience, this past influenza season, commonly known as “flu,” demonstrated how serious the virus can be, infecting an estimated 34 million people nationwide and killing almost 4,000 this year.

As pediatricians in the neonatal intensive care unit, we cared for several babies whose influenza was so severe they required mechanical ventilators to help them breathe and intravenous medication to help their hearts beat stronger.  Our patients survived, but about 150 other children weren’t so fortunate.

With the increased attention this year’s flu season has received, the New York State Legislature is considering a bill (A1230a/S6346) to increase flu vaccination rates in preschoolers – the pediatric population most likely to harbor, and get seriously ill from influenza.  The bill would require infants, toddlers and young children who attend certain daycares to obtain an annual flu shot.  The measure being considered in Albany, which is similar to existing legislation in New Jersey and Connecticut, is highly effective at protecting kids from flu’s most severe complications.  In Connecticut, the regulation reduced flu-associated hospitalization in young children, and in New Jersey, preschool rates of flu immunization increased to 88 percent in the law’s first year.

The numbers from this past flu season define a public health epidemic.  In New York State, there were about 120,000 cases of influenza this past season, which doesn’t include additional undiagnosed illness.  Almost 12,000 people have been hospitalized and roughly 8,300 children under 5 years old were infected.  Eight children in our state died.  Fortunately, immunization against flu is an effective and safe means of protecting children from influenza.  Even in years when the vaccine doesn’t confer as much protection as it could — this year’s vaccine was about 30 percent effective – it still minimizes the risk of the most severe complications from influenza, including hospitalization and death.

The Centers for Disease Control recommend an annual flu shot for all children and adults with rare exceptions.  Immunizing young children is paramount, because their immune systems are inexperienced, not having encountered many flu strains before.  These children are therefore more likely to get critically ill from influenza.  Children in the close confines of daycare also serve as reservoirs of disease – passing the virus to other young children, siblings, their parents and grandparents.

While preschoolers are roughly one quarter of the child population, they represented almost 40 percent of all pediatric deaths from influenza from 2004-2012.  Unfortunately, flu vaccination rates in children are shockingly low compared to other recommended vaccines.  In 2014-15, only two thirds of New York’s children received a flu shot, while greater than 90 percent were immunized against Hepatitis B.

Unfortunately, there are opponents who object to any new regulations, seeing scientific-based policies as an infringement of personal choice, combating scientific fact with passion and volume.  These arguments were made when sates introduced seat belt laws, which the National Highway Transportation Safety Administration estimates save 10,000 lives annually.  They were made when infant car seat rules were introduced, which save 250 babies per year.  Bike helmet laws, which reduce head injuries by 40 percent, prohibitions on smoking in airplanes and other vaccination rules have always been initially met with dissent, despite having roots in public health data.

Reinforcing our protection against influenza for children in daycare does not mandate flu vaccination.  Parents who choose not to immunize their child have a right to do so.  However, this right should not allow them to be in areas where disease can be easily transmitted.  This is especially true for a highly infectious disease like flu, which can infect children even before the initial child is sick.  It would also prevent passage of disease to children in same daycare who are too young to get vaccinated, like newborns.  Parents who disagree with school vaccination requirements have for years chosen to home school there children.  Similarly, parents who disagree with these medically-supported proposals can seek alternative child-care arrangements.

Immunization remains one of our country’s greatest public health success stories.  Failing to take practical steps to protect toddlers and young children from a highly infectious, potentially serious disease would represent a missed opportunity for New York State.


Cuts To Farm Bill Will Affect Hungry Children On LI

Eve Meltzer-Krief, MD, FAAP

This blog post was originally published as an Opinion-Editorial piece in the Huntington Patch.

(Dr. Eve Meltzer-Krief MD, FAAP is a pediatrician in Huntington and member of the NYS AAP Chapter 2 and Suffolk Pediatric Society.)

Cuts To Farm Bill Will Affect Hungry Children On LI, Doctor Says

Dear Editor,

As a pediatrician I feel compelled to speak out against the proposed cuts to SNAP in the Farm Bill, H.R.2, which is currently up for a vote in the House.

SNAP is the Supplemental Nutrition Assistance Program.  It is the most effective domestic U.S. hunger safety net program and nearly half of its recipients are children.  Over one million children in New York State receive benefits from SNAP.  Cuts to SNAP will adversely affect children in the nearly 22,000 households with children that participate in SNAP right here on Long Island.

SNAP delivers critical support to vulnerable families to ensure that they can put food on the table.  Children who live in households that are food insecure are likely to be sick more often, recover from illness more slowly and be hospitalized more frequently.  Lack of adequate healthy food can impair a child’s ability to perform well in school and can lead to higher levels of behavioral and emotional problems from preschool to adolescence.

SNAP is reauthorized under the Farm Bill, legislation that renews federal agriculture, trade and nutrition programs.  At present, SNAP benefits are not enough to provide funding with the resources to obtain an adequate healthy diet, and they should not be cut further.

No child should have to struggle with hunger and food insecurity in our country.  SNAP serves as a critical support for the health and well being of children and it’s funding should not be cut in the Farm bill.


 

March For Our Lives Long Island

Steven J. Goldstein, MD, FAAP

Steven J. Goldstein, MD, FAAP

(Dr. Steven Goldstein, MD, FAAP is a general pediatrician with offices in Brooklyn and Queens.  He is NYS AAP Chapter 2 President and Chair of the Pediatric Council.)

March For Our Lives Long Island
March 24, 2018
Huntington Town Hall

It is cold out here today, but I feel warm looking at all of you here to work on this problem!  Thank you for the honor of speaking to you today.  I applaud your courage and your commitment as young people to make this time different and help to end the epidemic of gun violence that includes 18 school shootings since January 1.

I represent the 1400 member Pediatricians of Chapter 2 of the New York State American Academy of Pediatrics.  As pediatricians, we care for you when you are ill and work to keep you well.  People generally bring children and teens to see the pediatrician when they’re already sick, but doctors are also charged with fostering safety, good health, and freedom from violence.  We don’t only care for you, we also care about you.  We care about your safety, your anxiety, your families, and your future.

The American Academy of Pediatrics has a long history of supporting measures to reduce gun violence and increase safety for young people.  As long as children continue to be injured and killed by guns in this country, pediatricians will not rest in our pursuit to keep them safe.

We believe that everyone deserves to feel and be safe where they live, learn, and play.  Our lives should not be shaped by fears of gun violence.  No one should be afraid to attend school, or to go to a movie, or to a concert.

We applaud your gathering here today to urge our elected officials to act on this issue and pass comprehensive gun safety laws that ban semiautomatic assault weapons, address firearms trafficking, require stronger background checks, and encourage safe firearm storage.  We strongly oppose arming teachers.  Where guns are present, there are more, not fewer, deaths.

Some of you here today may have heard of the Dickey Amendment, an addition to a bill passed in the1990’s that, as interpreted, prevented the Centers for Disease Control from using data from its studies on gun violence to advocate for gun reform laws.  This amendment had a chilling and widespread effect, reducing the role of science in informing the country about what can be done to protect against gun violence.  Just as we learned from scientific studies about highway deaths and smoking and saved thousands of lives, we can bring science back into this conversation about guns, and learn what works to reduce gun violence, suffering, and death.  I am pleased to tell you that on March 22 we heard that the new Omnibus budget bill clarifies in one sentence that research on factors that contribute to gun violence can be conducted by the Centers for Disease Control.  You are all to be congratulated because advocacy by young people like you and pressure from parents and organizations like the Academy of Pediatrics helped make this happen.  This is a first step.

We need multiple levels of government to fund gun-related public health research to help us learn not only how to prevent the next school shooting, but also the best ways to protect toddlers from accidentally firing a gun and the most effective methods to prevent firearm-related suicides.  I am pleased to tell you that the American Academy of Pediatrics is launching a bold new research initiative to protect children from firearm injuries.  Approaching these injuries as a public health epidemic, the AAP Gun Safety and Injury Prevention Research Initiative will bring together experts from around the country to study and implement evidence-based interventions.  While this will be privately funded by the Academy with an initial investment of $500,000 from the Friends of Children and Tomorrow’s Children Endowment Fund, more government support at all levels is sorely needed to address this problem.

It is time to hold our elected leaders accountable for their inaction on gun violence issues.  I urge you to stay connected with us and with other likeminded organizations, learn more about this issue, and most important, to register to VOTE.  Go to vote.org to learn about how to do so.  Find out which candidates support our shared agenda for preventing gun violence, and if they don’t, Vote Them Out.

Please remember that as long as children continue to be injured and killed by guns in this country, pediatricians like me will not rest in our pursuit to keep you safe.  Thank you all again for all you do and will do to make life better for everyone.  Perhaps your generation will accomplish what my generation could not.


Visiting Professorship Grant

Mary Cataletto, MD, MMM, FAAP

Mary Cataletto, MD, MMM, FAAP

NYS AAP CHAPTER 2 AWARDED VISITING PROFESSORSHIP GRANT FROM THE JULIUS B. RICHMOND CENTER OF EXCELLENCE

(Dr. Mary Cataletto, MD, MMM, FAAP, FCCP is a pediatric pulmonologist and Associate Director of Pediatric Sleep Medicine at NYU Winthrop Hospital.  She is chair elect for Pediatric Chest Medicine NetWork of the American College of Chest Physicians and past chair of the Asthma Coalition of Long Island.  She is the Nassau Pediatric Society Representative to NYS AAP Chapter 2.)

Chapter 2 of the New York State American Academy of Pediatrics is this year’s recipient of a Visiting Professorship grant which is awarded annually by The American Academy of Pediatrics Julius B. Richmond Center of Excellence with the generous support of the Flight Attendant Medical Research Institute.

AAP Chapter 2’s membership comes from the boroughs of Brooklyn and Queens and the counties of Nassau and Suffolk.  There are currently approximately 1400 members in the Chapter.  We share a common mission with the Julius B. Richmond Center to improve child health by eliminating children’s exposure to tobacco and secondhand smoke.  We recognize that pediatricians must advocate for a safe environment for all children.  While the use of tobacco cigarettes is decreasing in the United States, the use of electronic nicotine delivery systems has surpassed all previous use.  On Long Island our pediatricians have worked to increase the purchase age for tobacco to 21 years of age (Tobacco 21).  This has been adopted in some but not all of the communities in which we practice.  We still have work to do.

Chapter 2 leadership, in close collaboration with the Richmond Center will be working to provide our members with evidence-based programming to provide effective skills and resources for your practice.  Specifically, we are looking to provide you with a knowledge base and resources to educate children and families about emerging and alternative nicotine and tobacco products as well as electronic nicotine delivery systems.

Additional information will be sent out to the membership as soon as dates and times are finalized.  Programs will be scheduled for this spring.

Please watch for these special programs.


Seasonal Flu: What Every Parent Needs to Know

Mary Cataletto, MD, MMM, FAAP

Mary Cataletto, MD, MMM, FAAP

(Dr. Mary Cataletto, MD, MMM, FAAP, FCCP is a pediatric pulmonologist and Associate Director of Pediatric Sleep Medicine at NYU Winthrop Hospital.  She is chair elect for Pediatric Chest Medicine NetWork of the American College of Chest Physicians and past chair of the Asthma Coalition of Long Island.  She is the Nassau Pediatric Society Representative to NYS AAP Chapter 2.)

Fourth Child in NYC Dies of Seasonal Flu: What Every Parent Needs to Know

This week as the news of the fourth pediatric death in New York City hit the press, parents are asking what they can do to protect their children.  They turn to their pediatricians to put these findings into perspective, address concerns and to offer actionable strategies to modify risk factors.

This year’s flu season has been particularly severe and is likely to last several more weeks, possibly months.  The Centers for Disease Control have consistently recommended universal immunization against influenza for children ages 6 months and above through adulthood highlighting that children under age 5 years, particularly those under age 2 years as well as pregnant women, the elderly and those with chronic medical illnesses are at increased risk for flu related complications and hospitalizations.

Governor Cuomo declared a statewide influenza public health emergency on January 25, 2018.  As a result pharmacists are temporarily permitted to administer flu vaccines to children between 2 and 17 years of age.  Promotional campaigns can be seen throughout the state on print, social and other media sources.  Free flu shots are now available at multiple locations.

We know that the best defense against the seasonal flu is influenza immunization.  Immunization should begin as soon as the vaccine is available in the Fall.  This is especially important for those children between ages 6 months through 8 years who are receiving the vaccine for the first time because they will need to receive 2 doses given at an interval of about 28 days.  Protection for infants who are too young to receive the flu shot (<6 months) is best offered by immunizing parents, older siblings and caretakers as well as avoiding sick contacts.  Immunization against seasonal flu is now considered standard of care for all health care professionals.  They receive the flu vaccine not only for themselves but to protect the children they care for in offices, hospitals and community.

There are still a few stragglers, a few non believers, a few who were too busy to have their children immunized.  As long as influenza is prevalent in your community, it is not too late to get a flu shot.

The Centers for Disease Control supports this decision with the following findings:

  • The flu shot minimize the risk of contracting the flu by approximately 1/3
  • Flu season is likely to last several more months and could even stretch into May
  • The flu shot carries a low risk of significant side effects
  • There are no effective alternatives

What else can parents can parents do to protect their children and help to limit the spread of influenza?

  • Avoid contact with people who are sick
  • Keep your child home if they are sick
  • Practice healthy habits:
    • Cover your cough and sneezes
    • Wash your hands often
    • Avoid touching your eyed, nose and mouth
  • Be sure your child’s school and daycare centers have provisions to
    • Separate sick children from the rest of the group while they are waiting to be picked up
  • If you think your child may have the flu contact your pediatrician. Antivirals, such as Tamiflu, work best if given within 48 hours of symptom onset.

Additional information on flu surveillance and current recommendations for both parents and providers can be accessed at www.cdc.gov.