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MNAAP Newsletter

Sterilization of Minors — Ethical Issues and How to Proceed

By Sheldon Berkowitz, MD, FAAP

Sterilization of minors is an uncommon procedure in pediatric practices, but an important one to understand if a family requests information about it. This article will help to understand what the ethical issues are and how to proceed if it is requested for your patient. Typically, this issue is only brought up for our patients with complex health care needs for whom it is felt that pregnancy (or fatherhood) would present significant problems for your patient or the potential offspring.

The background of this subject and the main reason why there has been so much oversight provided is that in the past, eugenics and other movements to limit reproduction of certain elements of our society led to mistreatment of our most vulnerable patients. The desire to prevent patients with diagnoses such as Trisomy 21 or mental retardation from procreating and potentially bringing more children with these problems into the population resulted in young adults being sterilized, often without any oversight as to whether this was the right thing to do or not.

As a result of these abuses of the medical system, both the American Academy of Pediatrics (AAP) and the American College of OBGYN (ACOG) have published policy statements on when and how minors can undergo sterilization. The goal of these policy statements is to protect the rights of minor patients who may not be able to speak for themselves and to limit possible harm to them if the procedure is not indicated. Because minor patients cannot legally consent to invasive procedures, their parents are given the right as surrogate decision makers to make decisions for them – as long as they are acting in the best interests of their child.

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Food Insecurity Screening and Referrals

NeilBratneyNeil Bratney, MD, FAAP

Nearly 1 in 10 Minnesotans are food insecure; that’s a half-a-million Minnesotans who don’t always know where their next meal is coming from. While poverty is a common contributing factor, transportation and geographic factors may also affect families without cars or without a grocery store nearby. Many families are just above the threshold for qualifying for assistance programs and still cannot afford the nutritious food important for their families.
Screening

Screening for food insecurity can be easy, but may require small changes to your office workflow. Screening should be completed at every well child exam, and whenever concerns exist. Screening can be accomplished using a standard, validated, two-question screening tool, known as the Hunger Vital Sign.

  • Within the past 12 months, we worried whether our food would run out before we got money to buy more.
  • Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more.

A patient or caregiver can respond “Often true,” “Sometimes true,” “Never true,” or “Don’t know / Refused.” An “Often true” or “Sometimes true” response is considered a positive screen and should prompt advice and referral.

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Disasters Don’t Plan Ahead. You Can!

By Paula Kocken, MD

This was September’s theme for Disaster Preparedness Month and there certainly were enough disasters to test the theme. Hurricanes, earthquakes, and fires ravaged North America. I am certain that all of us were thinking, “What can I do to help?” I am also certain that many of us gave money to charitable organizations, donated food to groups going to aid the victims, and called our relatives and friends in the areas affected to offer help.

One thing you may not have thought was, “How can I best prepare for a disaster if it happens here?”

The best way to be prepared is to “Make a Plan” by thinking ahead in an organized fashion and creating a strategy for what you would do during the most likely disasters to strike your community. It is the idea of preparing yourself first so you are free to help others. The government has some excellent guidelines and tools listed on their websites that are very helpful and informative. Every time I go to those sites, I learn something new or get a great idea on what I need to do to prepare. Below are some of the ideas I think are the most helpful.

Have a family meeting and discuss which disasters would impact your family. In Minnesota, the top culprits include winter storms, tornados, and floods. If you have children, it is important to talk about what could happen and how they would respond to it. It is a good time for demystifying what the children see in the media while validating their concerns. The AAP Family Readiness kit has many suggestions on what to do and how to talk about disasters with children.

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Gender Nonconformity: Understanding Steps and Care

By Rhamy Magid, MD, FAAP, HCMC

Increasingly, primary care pediatricians, as well as pediatric subspecialists, are caring for youth who identify as transgender or gender nonconforming (GNC). Rather than an increase in prevalence, this phenomenon is more likely a testament to a gradually improving cultural environment, both nationally and in the state of Minnesota.

In the 2016 Minnesota Student Survey, 3 percent of 9th graders and 2 percent of 11th graders considered themselves transgender, genderqueer, genderfluid, or were unsure about their gender identity. We have a responsibility and an opportunity to lift the health and the spirits of one of our most vulnerable patient subpopulations.

In the AAP’s July 2017 Statement in Support of Transgender Children, Adolescents and Young Adults, Drs. Stein and Remley affirm that the Academy “stands in support of transgender children and adults, and condemns attempts to stigmatize or marginalize them…As pediatricians, we know that transgender children fare much better when they feel supported by their family, school and larger community…The AAP supports policies that are gender-affirming for children.”

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Member Profile: Emily Chapman, MD, FAAP

When did you know you wanted to become a pediatrician?
When I went to medical school, it was only to be a pediatrician. I had long known children were amazing, and I wanted to spend my life surrounded by them. And I adored partnering with the parents who loved them to help bring comfort. The worst part of medical school was suffering through all those adult rotations. Ugh. I don’t know how those guys do it!

You were recently named Children’s new CMO. What are you most excited to work on in this role?
The privilege that I have in this role is the chance to impact our culture – who we are, what we bring to work, and what we offer those we touch. These are terribly challenging times in medicine, but if we remember why we’re here, and who we’re here with, the calling will grab us all over again. If we see our potential, we will realize it. I’d like to help people see it.

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