Clinical Tools

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 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 Pediatric Insomnia

This document was developed by Nationwide Children’s Hospital in conjunction with Partners For Kids using evidence-informed clinical guidelines and expert opinion where evidence is lacking, and are generally reflective of FDA approved indications and recommendations.

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.

Thyroid Function and Screening

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

Turner Syndrome in Pediatrics

Turner Syndrome results from a chromosomal abnormality in children who are assigned female at birth. Children assigned female at birth with a completely missing X chromosome tend to present with the Turner Syndrome phenotype and may be more easily identifiable.

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.

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.

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.

Constipation Guidelines for Primary Care Providers

These guidelines explore how to manage functional constipation in a primary care setting and offer important information regarding medication coverage.

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.

Prescribing Guidelines for Prescription Contraceptives

This clinical pathway guides provider decision-making when assessing contraceptive readiness, selecting a contraceptive method and managing contraceptive use.

Breakthrough Bleeding on the Etonogestrel Implant Nexplanon

Management and treatment options with Nexplanon implant bleeding.

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.

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.

Lipid Screening in Children and Adolescents

This tool is designed to help primary care providers to identify and screen for lipids and diet recommendations for families.

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.

Anemia and Milk Consumption

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

Heavy Menstrual Bleeding and Bleeding Disorders

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

Idiopathic Thrombocytopenic Purpura (ITP)

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.

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.

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 Acute Respiratory Tract Infections

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.

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.

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.

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 Guidelines for Influenza

There are two common types of influenza viruses that cause seasonal infections: Influenza A and Influenza B. Flu symptoms can vary widely, but patients most commonly present with fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose and muscle aches.

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.

Hyperbilirubinemia

This practice tool overviews hyperbilirubinemia risk assessment, monitoring, and treatment.

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.

Scar Management in the Pediatric Patient

Scars form when the skin is damaged from a cutaneous insult, including but not limited to: infection, burn, trauma, surgery, and various skin conditions. This practice tool outlines scar management for pediatric patients.

Unified Preferred Drug List

Partners For Kids has condensed Ohio Department of Medicaid’s UPDL into commonly prescribed drug classes for pediatric primary care and behavioral health providers.

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.

Initial Outpatient Evaluation and Ongoing Management of Asthma

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

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.

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.

Prenatal and Postnatal Hydronephrosis Diagnosis and Management

Hydronephrosis, also known as urinary tract dilation, denotes dilation of the renal collecting system. Hydroureteronephrosis is the term used when the pathology extends to the level of the bladder, suggestive of ureteral dilation also. It can affect fetuses (prenatal) and babies (postnatal) and is the most common abnormality found on prenatal ultrasounds.

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.

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.

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 Nicotine Dependence

Nearly all tobacco use begins in childhood and adolescence. The majority of adults who have ever tried a cigarette reported trying their first by the age of 18. Vapes and E-cigarettes are the most commonly used tobacco products among adolescents.

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.