Developmental and Behavioral Pediatrics

• Elective and Site Director: Dr. Jennifer Heithaus, MD

  • jennifer.heithaus@health.slu.edu

  • 314-599-1681

• Faculty

  • Dr. DePorres Cormier

  • Dr. Jennifer Heithaus

  • Dr. Sulamit Portnoy

  • Dr. Cristiana Teodorescu

  • Dr. Luithohan (PsyD)

• Fellows

  • Katharyn Turner

• +/- Residents (pediatric, family medicine, internal medicine) and/or fourth year medical student on elective (2-4w)

• +/- Third year clerkship or career exploration student (1w)

• +/- Pediatric and family medicine residents

• +/- Introduction to Developmental Disability Preclinical Students (fall)

  • Second year student leads (21-22):

  • Up to 6 additional first or second year students

• Multidisciplinary healthcare team providers: nurses, medical assistant, therapists

• Contact Dr. Heithaus (at jennifer.heithaus@health.slu.edu or 314-599-1681) at least a week before starting to discuss your rotation goals, objectives, strategies, as well as any schedule requests. Developmental-behavioral pediatrics activities and schedule are personalized based on interest and can include clinics, observation of therapy sessions, participation in Program for the Education and Enrichment of Relational Skill (PEERS) as well as Ranken Jordan visit. Students are typically assigned to work primarily with one attending for the duration of the rotation. If you are interested in visiting Ranken Jordan during your elective, please let the student education office know as soon as possible.

• Individual Study

  • Developmental and behavioral pediatrics

  • Mental health

  • Genetics

• White coat: Bring your white coat on the first day and ask the attending if you should continue to wear it. Often, residents and students do not wear their white coats

1. Describe normal human growth and development

2. Discuss the epidemiology, pathophysiology, clinical manifestations, evaluation, diagnosis, prognosis, management, and prevention of common and/or important pediatric developmental and behavioral disease processes and syndromes

3. Recognize the early warning signs of major developmental disabilities both in primary care and in subspecialty care.

4. Discuss developmental screening and testing instruments

5. Identify various types of alternative therapies that patients often utilize

6. Develop empathy for the impact a developmental disability has on the family (parents, siblings, other relatives)

7. Understand the impact a developmental disability has on the affected individual and appreciate the patient's perspective.

8. Become knowledgeable about the role of patient advocacy and the presence of various community resources available for children and adults with disabilities.

9. Appreciate the role that different professionals play in the diagnosis and treatment of children with developmental disabilities, including physicians, psychologists, speech therapists, occupational therapists, behavioral therapists, and social workers

• ASD

• ADHD

• Anxiety

• Developmental delay

• Developmental Screening Tools

• Genetic conditions associated with developmental delay including: Charge Syndrome, DiGeorge Syndrome, NF-1, Trisomy 21, microdeletions/duplications

• Intellectual disability

• Language disorder

• Learning disability

• Mental Health Diagnoses: Anxiety, Depression, Oppositional Defiance Disorder

• Movement Disorders

• Pervasive developmental disorders

• Sleep Disorders

Knights of Columbus Developmental Center, 3800 Park Avenue, 2nd Floor, St. Louis, MO 63110

• Free parking along Spring and Park

• Clinic is located on the second floor.

• Your access card should work, but if it does not for some reason, hold the intercom and say, “Hello, this is the medical student requesting access to KOC”.

• The entrance to the patient rooms and faculty work rooms is to the right of the front desk, with a door code of 2+4 simultaneously, then 3.

• The expectation for all mini electives is a full work week in clinic potentially with a caveat that on half days a clinic is not held, you may be assigned to other tasks etc at the discretion of the site director or have Individual study. Attending two PEERS sessions counts as a clinical half day.

• Bring your laptop everyday for virtual visits, or if there is not enough computers.

• After a brief clinic overview you will actively observe patient encounters. As you become familiar with the way the clinics run, you will direct more of the evaluation, with supervision from your attending. You will be assigned to work with a consistent attending preceptor throughout your time in clinic.

  • • Dr. Cormier’s Student Priority: Confident Diagnosis and suggestions for plan

    • Dr. Heithaus Student Priority: PRE-CHART and prepared to lead any part of the visit- Ireton scoring, PMH, behavior history, etc.

• Reviewing charts prior to seeing patients will enhance your experience greatly. In addition to the EPIC medical record, we have shadow/hard charts that are located in the front of the clinic, which you are expected to review for all new patient evaluations.

  • • Often, outside records, intake packets, and individualized education plans (IEP’s) are located in that folder.

• Occasionally, trainees may help triage patients and obtain vitals. This is often good practice in learning the practical skills of working with patients with developmental disabilities.

• Physician visits usually start by obtaining history from the family, including the presenting problem, developmental/behavioral/school histories, and a medical history including ROS, family history, and social history. We then perform a physical examination and conduct testing as needed. At the end of the visit, you will actively participate in counseling with the family to discuss our findings and recommendations.

Pre-Charting Relevant Information

Patient Name/Age

Birth History: (Risk Factors and Preg/Labor Complications)

PMH/ PSH: Follow up dates and plans for all specialties

Family/ Social History: (mom/dad age, level of edu, siblings, grandparents: medical, psychiatric, learning disabilities)

Medication: current and past

Allergies/ Immunizations

Developmental History/Services: School, Grade, IEP, School/Private/Outpatient Services and how often/hours for each service

Home/School Behavioral History: e.g. Distractibility, Inattentive, Hyperactive, Tantrums, Busy, Concerns?

Sleep: Hours, initiation, maintenance, require melatonin?

Diet: Variable? Picky? Prefer Textures/Colors? Aversion? Require MVI?

ROS/ Labs/ Growth curve/PE

• The Keystones of Development Course (Mt Sinai Parenting Program)

• 4 min introduction video

• Modular individual study curriculum focused on promoting early childhood development and strengthening the parent-child relationships within the context of routine well-child visits. It focuses on six developmental keystones – Attachment, Autonomy, Self-Regulation, Perspective Taking, Problem Solving and Academic Knowledge – that are well-supported by research, largely dependent on caregiver behaviors and are strongly predictive of later social-emotional and cognitive well-being.

• The curriculum takes approximately 6hrs to complete, and provides a certificate of completion that you can place on your CV. Module completion of enrolled learners is tracked by the program and available to the course faculty and administrators.

• We need to specifically request access for individual students. Elective students will receive a separate email with log-in instructions.

• Journal Club Presentation

  • As a group, students and residents on the developmental pediatrics elective are expected to select a contemporary article related to developmental pediatrics (from a reputable medical journal) and give a powerpoint presentation about the article and its clinical implications via zoom, typically the last Thursday of your rotation. Link will be available via the clinical schedule document.

  • In preparation for the Journal Club activity, review

    • How to Prepare an Outstanding Journal Club Presentation, Sawhney

    • Pediatric Journal Club Literature Critique Form

• • EPIC Department: CG K of C

  • Check with your attending to see what documentation they would like you to provide.

Smartphrases:

• • KCRESFOLLOWUP

  • KCRESINTAKE

• • Our notes follow a standard format, with the addition of a few unique features. After the H&P part of the evaluation, behavioral observations are included. We then also summarize all of the testing and questionnaires. Including descriptions of testing is helpful for primary care physicians and schools, who may not be as familiar with the various tests and how they are scored. A true assessment should be provided on all patient notes - this should be more extensive than a listing of the diagnoses. Recommendations should be detailed, as we spend a good portion of our time in counseling and coordination of care with the families, and our notes are often distributed to schools, other physicians, and therapists.

PEERS is a social skills program for children with autism or other behavioral disorders which inhibit social functioning. It is a manualized, reproducible process which breaks social interaction down into more readily digestible steps. Examples of topics include appropriate use of humor, how to enter into a conversation, or how to set up an in-person meeting for relationship building (“hanging out”). Participants learn about various social skills through both lecture format as well as role-playing scenarios.

Sessions occur each Tuesdays 5-7:15PM and Thursdays 4:30-6:45 PM via telehealth-approved Zoom meetings.

Bootcamps take place in between Winter and Spring sessions to provide more opportunities for program participants to work on the skills they have learned so far.