algorithm or other PCP resource

Evaluation and management of a child with suspected seizure 

Epilepsy is the most common neurological disorder in children, but a child’s first contact with the medical system after a suspected seizure is almost always through the emergency room or their primary care provider, not directly with a pediatric neurologist. Therefore non-neurologists are the first line of evaluation, care and often long-term management in areas without immediate access to a neurologist. Thoughtful evaluation of a suspected seizure patient, whether they are presenting with a first suspected seizure or are a known epilepsy patient who is new to a primary care practice, allows these children to receive the correct level of care and helps worried families to know what to expect next.

• See our new Epilepsy/seizure algorithm.

History

Just as with any other medical condition, the history and physical examination are the first step.

Common suspected seizure types include “convulsions” and “staring spells.” The terms “grand mal” and “petit mal” are old-fashioned and only indicate whether the onlooker saw a convulsive or nonconvulsive event; they do not indicate whether the event was epileptic, or even what type of seizure was witnessed if it was in fact an epileptic seizure. Read full post »

Specialists in our Cancer and Blood Disorders Center have created a new evidence-based algorithm to help PCPs evaluate lymphadenopathy in children and teens, manage pediatric patients effectively, and know when to refer to pediatric oncology.

View the lymphadenopathy algorithm.

Lymphadenopathy is extremely common in pediatrics with the vast majority of cases being benign or related to an infectious etiology. This algorithm will help ensure patients who are at high risk for malignancy are referred to oncology and will help provide guidance for management of patients who are likely to have a benign etiology of lymphadenopathy.

Find other algorithms and other clinical care resources for PCPs on the Seattle Children’s website at seattlechildrens.org/algorithms.

More than 100 new patients are referred to Seattle Children’s GI program each month for functional abdominal pain, with an average wait time to be seen of typically 3 to 5 months. To help PCPs manage these patients longer in primary care so they can get care sooner and identify situations and red flags that indicate specialty care is needed, our GI doctors developed an algorithm for chronic abdominal pain that is now available on our website at seattlechildrens.org/algorithms.

We spoke with Dr. Nicole Pattamanuch, director of our General GI program, to learn more about caring for kids with functional abdominal pain.

Q: What are the most common causes of functional abdominal pain, by age group?

Functional abdominal pain is one of the most common complaints we see in GI. The exact cause isn’t known; usually it’s multifactorial. We know emotional distress plays a role, by exacerbating gut/brain axis disorders  and making it more difficult for a child or teen to cope with the pain signals their body is sending.

We tend to see functional abdominal pain in school-age children and adolescents. For younger, preschool-age children who are reporting belly pain, I’d be less suspicious of functional abdominal pain and instead consider a more serious pathology.

For a quick introduction to the gut-brain interaction, two articles I recommend are:

• Recognizing and treating disorders of gut-brain interaction, by Christopher Velez, MD (Harvard Health Publishing, 4-20-22)
• Disorders of gut-brain interaction in pediatrics: a few observations, by Sam Nurko (Rome Foundation)

Q: What are the red flags for functional abdominal pain?

Read full post »

Eating Disorders

The Adolescent Medicine team, in partnership with the Department of Psychiatry, at Seattle Children’s has created an eating disorders algorithm to help PCPs know when and how to refer patients with disordered eating to Adolescent Medicine, Psychiatry and Behavioral Medicine (Psychiatry) or, in some cases, both.

Dr. Yolanda Evans, Adolescent Medicine, Eating Disorders Recovery Program

“We have a very high number of kids coming to our program for care, and our referral processes have changed over the last year as we’ve made care more accessible,” says Dr. Yolanda Evans. “We hope this new algorithm will clarify the referral process and help kids get their care started as quickly as possible.”

Patients referred to Psychiatry will meet with a clinical psychologist initially. If medication evaluation is needed, a separate appointment will be made with a prescribing provider (either an ARNP or psychiatrist).

“If the referring provider knows at the outset that their patient will need medication evaluation, they can submit 2 separate referrals initially to Psychiatry to speed up the process – one for the behavioral health evaluation with the psychologist and a second referral for medication evaluation with our psychiatrist or ARNP,” says Dr. Evans.

For those referring providers who request management of physiologic complications from malnutrition, all patients referred to Adolescent Medicine will receive a one-time telehealth consultation with a medical provider after which families will be offered support and resources to continue the patient’s care, either at Seattle Children’s if appropriate and care is available, or in the community. The Eating Disorders team will share the after-visit information with the referring provider to help guide continuing care of their patient.

The eating disorders algorithm is available along with 65+ other condition-specific resources for PCPs at seattlechildrens.org/algorithms.

As a reminder, when referring a patient for eating disorders, please include their growth charts and exam notes. You do not need to send labs or an ECG; we removed this requirement last year to reduce work for PCPs and help patients be seen sooner.

For more details about referral requirements and additional resources for PCPs, please visit our Eating Disorders – Refer a Patient page. You may also like to read “Treatment for Eating Disorders: A Q&A and Case Study by Robyn Evans, ARNP” from our March 2022 issue of Provider News.

Head Shape

Seattle Children’s Craniofacial team has created a head shape algorithm to help PCPs evaluate and refer their patient to either Craniofacial or Physical Therapy depending on their presentation.

For infants under 4 months who have positional plagiocephaly or positional brachycephaly but don’t have limited range of motion or neck tilt, the algorithm recommends repositioning strategies with reassessment at 4 months. However, these babies are welcome to be referred directly to Craniofacial if the provider feels they need to be evaluated before 4 months. Repositioning resources are available on the Seattle Children’s website, with links provided in the algorithm.

Febrile seizure pathway

Seattle Children’s has updated its clinical standard work pathway for febrile seizure; find it here. Key changes include updated admit criteria and risk of intracranial infection guidance. Additional clinical standard work pathways for dozens of other conditions are available on our website.