Clinical Tools

A Clinical Guide to Delayed Puberty

The treatment of delayed puberty involves address the underlying primary concern and appropriate management, and may not even require any endocrine or hormone therapy.

Obesity - Choosing the Right Referral

Obesity has been increasing in the United States over the past 50 years. It disproportionately affects certain ethnic groups including Hispanic, black and Native American children.

Polycystic Ovary Syndrome (PCOS)

Three diagnostic guidelines exist for PCOS in adult women; each using a combination of the following diagnostic criteria: androgen excess, ovarian dysfunction and polycystic ovarian morphology (PCOM).

Precocious Puberty Disorders

Puberty is a normal component of a child's growth and development into adulthood, yet premature puberty is a frequent cause of anxiety and stress.

Thyroid Function and Screening

To determine when it is appropriate to perform testing for thyroid dysfunction in children, please refer to the following tools.

Vitamin D Deficiency

Vitamin D is crucial for bone health – it plays a role in calcium absorption, increased bone mineral density, and in preventing rickets, osteomalacia and fractures.

Down Syndrome: Birth to 1 Month

Here, we summarize guidelines designed by the American Academy of Pediatrics to assist the pediatrician with medical care for a child with Down syndrome from birth to 1 month of age.

Down Syndrome: 1 Month to 1 Year

Here, we summarize guidelines designed by the American Academy of Pediatrics to assist the pediatrician with medical care for a child with Down syndrome between one month and one year of age.

Down Syndrome: 1 to 5 Years of Age

Here, we summarize guidelines designed by the American Academy of Pediatrics to assist the pediatrician with medical care for a child with Down syndrome from one to five years of age.

Down Syndrome: 5 to 13 Years of Age

Here, we summarize guidelines designed by the American Academy of Pediatrics to assist the pediatrician with medical care for a child or young adolescent with Down syndrome between 5 and 13 years of age.

Down Syndrome: 13 to 21+ Years of Age

Here, we summarize guidelines designed by the American Academy of Pediatrics to assist the pediatrician/ primary care providers with medical care for an adolescent or young adult with Down syndrome between 13 and 21+ years of age.

Otitis Media

Approximately one in every three children will be treated for otitis media at least once before their third birthday.

Topical Otic Therapy Recommendations for Bacterial Acute Otitis Externa

View topical otic therapy recommendations for bacterial acute otitis externa.

Celiac Disease in the Pediatric Patient

A high index of suspicion for celiac disease and liberal use of screening tests is needed to avoid delays in diagnosis. This guide includes associated conditions, gastrointestinal and non-gastrointestinal manifestations, and an algorithm for diagnosis.

Elevated Liver Enzymes

Transaminases, or “liver enzymes” – alanine aminotransferase (ALT) and aspartate aminotransferase (AST) – are often checked during routine blood tests or may be tested in response to a patient’s specific signs or symptoms. Elevated transaminases may indicate inflammation of, or damage to the liver.

Eosinophilic Esophagitis in Children

Because symptoms of EoE may mimic medically refractory gastroesophageal reflux, this guide provides detailed symptoms, diagnosis, and referral tools to support your patient.

Evaluating and Treating Functional Abdominal Pain

This guide defines the functional origin of abdominal pain, possible diagnoses for pain, and what alarm features may warrant further testing.

Gastrointestinal Infection Array

Because diarrhea and other symptoms are common to many pathogens, their clinical presentation may not tell you all you need to know for GI concerns. The Gastrointestinal Infection Array aims to solve the problems of traditional GI pathogen detection methods.

IBD in the Pediatric Patient

Distinguishing Crohn's Disease and Ulcerative Colitis, clinical presentation of IBD, and what to expect during consultation with a gastroenterology expert.

Motility Disorders in Children

Motility problems may cause vomiting, diarrhea, constipation, abdominal distension, abdominal pain, and difficulty swallowing, and can result in significant physical and emotional distress. This guide highlights these disorders, from simple to complex.

Nonalcoholic Fatty Liver Disease in Children & Adolescents

In fact, nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children, and it is the most common cause underlying elevated transaminases in asymptomatic children and adolescents cared for by the liver specialists (hepatologists) at Nationwide Children’s Hospital.

Helping Your Teen Patients Choose the Right Contraception

Teens, however, are less likely than adult women to use the most effective contraceptives (intrauterine devices (IUD) and implant) and instead rely on birth control pills, condoms and withdrawal. Very few use both condoms and a prescription contraceptive.

Dysmenorrhea

Painful menstruation — dysmenorrhea — is the most common menstrual disorder, with up to 90 percent of adolescent women experiencing pain with menses.

Labial Adhesion

Labial adhesions occur most commonly between 3 months and 6 years of age. The peak incidence is between 13 and 23 months of age.

Adnexal Torsion

Torsion can happen at any age, but it is most commonly seen between the ages of 9 and 14 years.

Polycystic Ovary Syndrome (PCOS)

Three diagnostic guidelines exist for PCOS in adult women; each using a combination of the following diagnostic criteria: androgen excess, ovarian dysfunction and polycystic ovarian morphology (PCOM).

Motivational Interviewing for Weight-loss Counseling

Motivational interviewing is a style of counseling developed to identify and engage the patient’s intrinsic motivation for changing health-related behaviors. The technique takes practice, but it can be a very effective tool for identifying realistic goals, feasible approaches and opportunities for progress with all patients — especially those who are resistant to change or struggle to acknowledge their health problem.

Best Use for Echocardiograms

While echocardiograms are effective in detecting certain cardiac conditions or diseases, many times an echocardiogram is unnecessary to answer the questions a pediatric provider or family may have. In fact, the majority of questions can be answered with a thorough cardiac evaluation, without an echocardiogram.

Evaluating ECG Results

From preventative screening based on risk factors to acute diagnosis associated with specific symptoms, Electrocardiograms (ECGs) can help identify or rule out cardiac problems in patients.

Genetic Testing for Cardiomyopathies

Learn what to look for and when to refer a patient to a cardiology specialist when it comes to cardiomyopathy in first-degree relatives.

Heart Failure

Symptoms, causes, testing and treatment options available for patients who may be at risk for heart failure.

Identifying & Treating Chest Pain

Chest pain can be cause for alarm in both patients and parents and warrants careful examination and treatment. Learn when it could be of concern and warrant further evaluation from pediatric cardiologists.

Infective Endocarditis Prophylaxis

Also known as bacterial endocarditis or subacute bacterial endocarditis, infective endocarditis (IE) occurs when blood-borne bacteria infect the endocardium and/or heart valves. If not detected and treated, heart valves can be damaged or even destroyed.

Kawasaki Disease

Kawasaki disease (KD) is a rare condition in children that involves inflammation of the blood vessels. Learn how to recognize, evaluate, and care for this patient population.

Lipid Screening

With rising rates of obesity, type 2 diabetes, atherosclerosis and other known risk factors for Ischemic cardiovascular disease (CVD), it is increasingly important to identify at-risk populations to prevent the development of future CVD events with effective management.

Pediatric Cardiomyopathy

Get up to date about the types, genetic factors, and next steps for patients with cardiomyopathy.

Post-procedure Care for Cardiac Patients

Learn the best way to manage and treat your patients who have recently undergone cardiac-related surgery, and how to effectively communicate patient care with the cardiology staff.

Sudden Cardiac Arrest

Many states have passed legislation regarding the education of sudden cardiac arrest for schools, parents and students. Understand who is at risk for SCA and how to discuss concerns with your patients.

Syncope & Palpitation

Initial work-up for patients presenting with palpitations is often aimed at ruling out an arrhythmia. The diagnostic and therapeutic modalities that are most appropriate for the individual patient can be determined after completing a patient history, physical examination, family history and ECG.

Transitioning Patients from Pediatric to Adult Care (ACHD)

Help your teen and young adult patients with congenital heart disease and their families transition to care with adult cardiology providers.

Anemia and Milk Consumption

Over consumption of cow's milk is the leading cause of anemia in toddlers over one year of age.

Deep Vein Thrombosis and Pulmonary Embolism

Deep vein thrombosis (DVT) is the formation of blood clots inside the deep veins of the body. Occasionally, these clots may travel to the lungs causing a pulmonary embolism (PE).

Heavy Menstrual Bleeding and Bleeding Disorders

When is a "heavy period" a possible sign of a bleeding disorder?

Idiopathic Thrombocytopenic Purpura (ITP)

Immune Thrombocytopenia

National guidelines currently recommend non-intervention as the standard of care, as ITP is typically a benign illness in children with rare recurrence. Symptoms usually begin to improve within 3 to 10 days. However, ITP can present as a symptom of other disorders especially in adolescents and should always be brought to the attention of a Hematologist.

Recommendations for Vaccination of the Immunocompromised Child

Vaccination of the immunocompromised child is important given their increased risk of disease and higher rates of morbidity and mortality from vaccine-preventable infections (VPI).

Sickle Cell Disease & Bone Marrow Transplant

The Comprehensive Sickle Cell and Thalassemia Program at Nationwide Children’s Hospital currently cares for 370 patients with sickle cell disease, ranging from birth to age 21. Learn when you should refer a patient with Sickle Cell Disease for BMT.

Diagnosing Food Allergy in Children

Any medical professional who diagnoses a child with food allergy is obligated to offer evidence-based education and support to the family to help them understand risk from ingestion, avoidance strategies, recognition and treatment of allergic reactions, as well as prognosis.

Diagnosing Lupus in Pediatric Patients

Children and adolescents may present with a variety of symptoms of lupus, several of which may also be shared with other autoimmune diseases.

Gastrointestinal Infection Array

Because diarrhea and other symptoms are common to many pathogens, their clinical presentation may not tell you all you need to know for GI concerns. The Gastrointestinal Infection Array aims to solve the problems of traditional GI pathogen detection methods.

Screening Adolescents for Sexually Transmitted Infections

All sexually active adolescents are at risk for STIs. Both biological and behavioral factors place young people at elevated risk.

Diagnosis and Intervention for Cerebral Palsy

While cerebral palsy diagnoses have traditionally been made at 2 years of age or older, studies have shown that specialist providers can make the diagnosis as early as 6 months of age in some cases. This algorithm provides answers on what to look to and when to refer.

Neonatal Abstinence Syndrome

Neonatal Abstinence Syndrome (NAS) is a drug withdrawal syndrome that occurs in infants who were exposed to prescription or illicit drugs in utero. The long-term neurodevelopmental impact of NAS remains uncertain; therefore, it is essential that these children are properly support during and following care.

Pediatric Hypertension

The long-term health risks for children and adolescents with hypertension have become increasingly clear in the last two decades. Nationwide Children’s Hospital has created this algorithm to guide the evaluation and management of pediatric hypertension.

Differentiating Craniosynostosis from Positional Plagiocephaly

The number of infants with head shape deformities has risen over the past several years, likely due to increased awareness of the “Back to Sleep” program. Early diagnosis and treatment of craniosynostosis can improve outcomes and reduce possible adverse effects on brain development.

Febrile Seizures

For most children, fevers cause minor discomfort; but for a few children, fevers can cause seizures. While these seizures are considered benign and self-limiting, a febrile seizure is a terrifying event for most parents and is one of the most common reasons for a trip to the emergency department (ED).

Headaches in Children & Adolescents

Approximately 60% of children experience occasional headaches. Learning the “red flags” and increasing your level of suspicion can be crucial for catching any serious underlying cause.

Hip Dysplasia

Early diagnosis and management of Developmental dysplasia of the hip (DDH) is extremely important, in order to help prevent early onset arthritis and pain as the patient grows.

Scoliosis: Symptoms, Evaluation & Treatment

Scoliosis cannot be prevented, but the treatment options are varied for children with this musculoskeletal disorder. Learn the crucial warning signs of scoliosis and when to refer to Nationwide Children's Hospital Orthopedic Department.

Adolescent Criteria for Bariatric Surgery

Criteria including assessment, diagnosis, risks, signs, and symptoms for patients who may be candidates for bariatric surgery.

Diagnosis & Treatment of Chest Wall Deformities

Pectus deformities affect approximately one in 400 people and usually become more severe during adolescent growth years. Learn the types of chest wall deformities and proper diagnosis and treatment recommendations.

Pediatric Hernia

The two most common types of congenital hernias in children are umbilical and inguinal hernias. The information below offers information on symptoms, diagnosis and treatment of these medical conditions.

Breast Reduction for Macromastia

Macromastia, or breast hypertrophy, is characterized by breasts that are disproportionately large compared to the rest of the body. Learn the criteria for eight management, physical therapy and, in some cases, surgical reduction available for your patients.

Gynecomastia

Gynecomastia is defined as an abnormal growth of breast tissue in males. Learn how to diagnosis and treat gynecomastia and when a consultation with reconstructive surgery may be appropriate.

Identifying & Treating Brachial Plexus Injuries in Infants

Injury to the brachial plexus nerves may occur around the time of birth or later through trauma, inflammation or tumor compression. Diagnosis, symptoms, and referral tips for patients who may need surgical or non-surgical treatment.

Cystic Fibrosis

Children with an abnormal newborn screen should have a sweat chloride test done. This is the best test we have to figure out if a child has cystic fibrosis or not.

Prescribing Guidelines for Asthma

This tool was created by Partners For Kids to assist in following recommendations from the guidelines to treat asthma after proper diagnosis.

Knee Injuries in Pediatric Patients

Each year, an estimated 2.5 million sports-related injuries occur in adolescents. Knee injuries account for up to 60 percent of all sports-related surgeries on high school athletes.

Shoulder Injuries in Pediatric and Adolescent Patients

Shoulder injuries account for up to 10 percent of all sports-related surgeries on high school athletes. Sports and recreational activities are the primary causes of shoulder injuries in individuals under the age of 25.

Sports Concussions

Concussions result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury. Knowing the correct concussion protocol is extremely important in protecting your patient from further injuries.

Pediatric Undescended Testicle

Undescended testicles (UDTs), also called cryptorchidism, occur in 3% of term and up to 33% of preterm boys.

Urinary Tract Infection Diagnosis and Management

Urinary tract infections (UTIs) are common infections of childhood that may affect any part of the urinary tract, from the urethra to the kidneys. The following guidance will focus on uncomplicated UTIs in otherwise healthy children.

Alopecia

Some alopecic patches will spontaneously regrow hair without treatment. Most patients and families, however, are interested in trying treatment to accelerate hair regrowth. Selection of treatment depends on the age of the patient, extent and duration of hair loss and comorbidities.

Breakthrough Bleeding on the Etonogestrel Implant Nexplanon

Management and treatment options with Nexplanon implant bleeding.

Evaluating an Existing Penicillin Allergy

10% of patients will report a penicillin allergy when seeking medical care, but only 1% of patients have an IgE mediated penicillin allergy that puts them at risk for anaphylaxis.

Gastroesophageal Reflux Guidelines

Prescribing medications to treat Gastroesophageal Reflux (GER) or symptoms of heartburn has become increasingly common and there is an array of options available. To address the chronic use and varying costs of these medications, Partners For Kids, in collaboration with Nationwide Children’s Division of Pediatric Gastroenterology, have created this tool.

Managing Pediatric Molluscum Contagiosum

Most lesions of molluscum contagiosum can be treated by the primary care physician. However, some circumstances may warrant referral to a dermatologist.

Prescribing Guidelines for Acne

Goals of acne treatment include using the least aggressive, but most effective, regimen that targets the largest number of pathogenic factors and avoids the development of bacterial resistance.

Prescribing Guidelines for Acute Otitis Externa and Otitis Media with Tympanostomy Tube Otorrhea

Due to recent drug shortages and cost increases of the otic solution, Partners For Kids and Nationwide Children’s Hospital’s Otolaryngology Department recommend using Ofloxacin 0.3% ophthalmic solution as an ear drop for a safe and effective alternative.

Prescribing Guidelines for ADHD

This tool is designed to help primary care practitioners and behavioral health providers provide timely and effective treatment for children with attention deficit/hyperactivity disorder (ADHD).

Prescribing Guidelines for Anxiety Disorders and Depression

This tool is designed to help primary care practitioners provide timely and effective treatment for children with mental health disorders.

Prescribing Guidelines for Behavioral Health

This tool is designed to help primary care practitioners provide timely and effective treatment for children with mental health disorders.

Prescribing Guidelines for Head Lice

When live head lice are identified on a child, treatment should be quickly initiated. Many treatment options exist with the ideal treatment being safe, readily available, easy to use, effective and inexpensive.

Prescribing Guidelines for Outpatient Antimicrobials in Otherwise Healthy Children

When treating common illnesses such as ear infections and strep throat, it is important to know how best to use prescription antimicrobial drugs. The continued misuse and overuse of common antimicrobials is contributing to antimicrobial resistance and other health care challenges.

Prescribing Guidelines for Prescription Contraceptives

Many types of prescription contraceptives are available for patients.

Prescribing Guidelines for Urinary Tract Infections

Urinary tract infections (UTIs) are common infections of childhood that may affect any part of the urinary tract, from the urethra to the kidneys. The following guidance will focus on uncomplicated UTIs in otherwise healthy children.

Prescribing Opioids

According to the Center for Disease Control, 17.3% of those who abuse prescription painkillers are prescribed medication from a physician. This is why it is important to know all the facts about opioids and safety.

Preventing Peanut Allergy

Given the large potential beneficial impact on a population level, the guidelines recommend that age appropriate peanut-containing foods be introduced to all infants prior to 11 months of age, and ideally closer to 6 months of age.

Screening Infants for Hepatitis C

Hepatitis C is a viral infection that causes inflammation of the liver. Increased rates of intravenous drug use resulting in hepatitis C virus (HCV) infection among women of child-bearing age in Ohio and much of the United States have placed an increasing number of infants at risk for vertically acquired infection.

Tick and Mosquito Diseases

Lyme disease and other tick- and mosquito-borne illnesses continue to increase and cause significant morbidity in Ohio. This is particularly true for children, who spend a lot to time outdoors during the spring and summer.