This session will be the initial venue for release of the proceedings from the current NHLBI Working Group. The Working Group, appointed by the National High Blood Pressure Education Program, is presently conducting an update of the national guidelines for the evaluation and management of hypertension in children and adolescents. Presentations will include reports on the results of a re-examination of the national childhood blood pressure data and the rationale for definition of hypertension in childhood. Speakers will also address the impact of obesity on pediatric hypertension, methods to detect and evaluate target organ damage due to hypertension, blood pressure instrumentation issues and new data on treatment of hypertension in the young, including both pharmacologic and non-pharmacologic treatments.

Definition of Hypertension with a Re-examination of the National Data on Blood Pressure in Children and Adolescents
Bonita E. Falkner, Thomas Jefferson University, Philadelphia, PA

Relationship Between Cardiovascular Risk Factors and Sequelae in Hypertensive Children
Elaine Urbina, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Pharmacologic and Non-pharmacologic Management of Childhood Hypertension
Joseph T. Flynn, Children's Hospital of Montefiore, Bronx, NY

Measuring Blood Pressure: The Truth Revealed
Bruce Z. Morgenstern, Mayo Clinic, Rochester, MN

As defined by the American Academy of Pediatrics, a goal of the pediatrician is the promotion of children’s optimal growth and development. Efforts at the state and national levels to enhance the effectiveness of child health supervision services have focused on such strategies as the early detection of developmental and behavioral concerns through effective monitoring, the provision of anticipatory guidance to address parental concerns and the promotion of such skills as language and literacy development. Such strategies have been informed by a wealth of new findings in neurobiology. Furthermore, enhancing practice quality may be facilitated by the effective application of basic change principles drawn from the field of organizational development, planning and change. This mini course will examine the impact on children’s development of such components of child health supervision as anticipatory guidance, developmental monitoring and developmental promotion, as well as review techniques to incorporate and promote rapid change within the practice setting. Ample time will be allotted for discussion among speakers and the audience.

The Science of Developmental Promotion
William Greenough, University of Illinois College of Medicine, Chicago, IL

Optimizing Anticipatory Guidance To Enhance Children’s Development
Paula M. Duncan, University of Vermont, Burlington, VT

Strategies for Effective Developmental Monitoring and Early Detection
Michael Regalado, Cedars-Sinai Medical Center, Los Angeles, CA

Promising Strategies To Promote Development
Neal Halfon, University of California, Los Angeles, CA

Enhancing Service Delivery Through Rapid Practice Change
Peter A. Margolis, University of North Carolina School of Medicine, Chapel Hill, NC

This session will review the development and clinical usefulness of blood/blood products and derivatives used in the treatment of patients with hematologic and oncologic diseases and the bleeding patient. The role of these novel and often modified products in selected patient groups will be discussed.

Introduction
Naomi L. C. Luban, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC

Transfusion Support of the HSCT Patient
Terry Gernsheimer, Puget Sound Blood Center, Seattle, WA

Transfusion Support of the Chronically Transfused Patient with Sickle Cell Anemia
Naomi L. C. Luban, Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC

Novel Therapies for Acute Bleeding
Guy Young, Children's Hospital of Orange County, Orange County, CA

Pathogen Reduction—Risks, Benefits and Hidden Benefits for GVHD
Lawrence Corash, Cerus Corporation, Concord, CA

Traditional newborn screening has successfully identified and allowed treatment for newborn infants with several inborn errors of metabolism including phenylketonuria, galactosemia and biotinidase deficiency since its advent in the 1960s. Novel methodologies have been developed that allow detection of a large group (>30) of inherited metabolic disorders that have not been screened for by traditional methodologies. Expanded screening has now been introduced in several states and will likely continue to be developed throughout the United States.

This workshop will review traditional approaches to newborn screening and summarize novel methodologies including tandem mass spectroscopy. The experience in public health programs will be described, and the outcome of several years of expanded newborn screening (tandem mass spectroscopy) will be summarized. Prospects for future screening methodologies will be reviewed. This workshop will bring the pediatrician rapidly up to speed on expanded newborn screening and describe the clinical benefits for patients who are identified at an early age.

Expanded Newborn Screening: The North Carolina Experience
Joseph Muenzer, University of North Carolina, Chapel Hill, NC

Newborn Screening and Public Health: Past, Present and Future Perspectives
Ken Pass, Wadsworth Center, NYS Department of Health, Albany, NY

Development of Novel Methodologies for Newborn Screening
David S. Millington, Duke University Medical Center, Research Triangle Park, NC
 

There are approximately 200,000 school-aged children with diabetes in the United States. Pediatricians must be aware of the increasing complexities of the diabetes regimen and strategies that can be implemented in schools to improve management and prevention. This workshop will address how to set up a diabetes health care plan, empower families, improve the nutrition environment and promote physical activity. Numerous tools will be presented, including a guide for school personnel, materials to energize the student body to form nutrition clubs and support materials for families.
 

This mini course will set the stage for several discussions of particular issues of major importance and interest. What is "preparedness" and what are the real risks of continuing terrorism in the United States? What is the current status of preparedness in the U.S. hospital and public health systems? How do children differ from adults in terms of response to weapons of mass destruction (chemical, biological and radiological)? How do these differences matter in disaster planning? Are the needs of children being incorporated in local, state and federal disaster plans? Smallpox, anthrax and other biological threats: Where do we stand? What do we do? Nuclear power plants, nuclear weapons, dirty bombs and potassium iodide: What do we know? The mental health consequences of terrorism: What have we learned since 9/11, how do we prepare children for an increasingly vulnerable world, building resiliency and sustaining a positive vision. The new pediatric agenda: What do we have to teach students, residents and pediatricians about the pediatric aspects of terrorism planning. Children and exposure to weapons of mass destruction: science and the essential research agenda.

Introduction
Paul H. Saenger, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY

Welcome and Context
Irwin Redlener, National Center for Disaster Preparedness, Columbia University Mailman School of Public Health, New York, NY

Pediatric Preparedness for Terrorism and Disasters
David S. Markenson, Columbia University Mailman School of Public Health, New York, NY

Biological Weapons of Terror: What Pediatricians Need to Know
Theodore J. Cieslak, U.S. Army Research Institute of Infectious Diseases, Ft. Detrick, MD

Helping Children and Families Cope with Terrorism
David J. Schonfeld, Yale University School of Medicine, New Haven, CT

Radiologic Terrorism, Children and the Question of Potassium Iodide
Thomas P. Foley, University of Pittsburgh, Children's Hospital of Pittsburgh, Pittsburgh, PA

Potential conflicts of interest litter the halls of academic medical centers like unexploded ordnance. This symposium will discuss both non-financial and financial conflicts of interest and will demonstrate their power to erode trust. There is now overwhelming evidence for systematic bias due to conflicts of interest associated with financial links between researchers and their institutions to commercial entities. We will discuss managing and eliminating conflicts of interest and propose steps to regain public trust.

Overview
Ruth A. Etzel, George Washington University School of Public Health and Health Services, Washington, DC

Should Researchers Care About Trust? Climbers Do—Their Lives Depend on It
The Importance of Conflicts of Interest to Clinical Researchers
Drummond Rennie, University of California, San Francisco, CA

Discussion
 

Children who are victims of violent behavior or merely observers of violence may learn destructive or self-destructive patterns of behavior. Violence is a major public health problem. This symposium will focus on breaking the cycle of violence and will showcase speakers who are working on violence prevention in the pediatric emergency department, school and community. The speakers will demonstrate what can be done by physicians who see the importance of this issue and the ways in which we can make a difference.

Violence Prevention in Primary Care: Moving from Public Health to Private Practice
Robert D. Sege, Tufts-New England Medical Center, Boston, MA

Beyond Treat and Street: Violence Prevention in the Emergency Department
Joel Fein, The Children’s Hospital of Philadelphia, PA

Efforts in the Community
Sheryl A. Ryan, University of Rochester School of Medicine, Rochester, NY

The Nutrition Friendly (NF) school process has been developed to help address the rising rates of childhood overweight. It is an ecological model based on the coordinated school health model, which impacts the entire school environment including students, staff and families to prevent the development of overweight in children. School community stakeholders in collaboration with the UCLA School of Public Health Nutrition Friendly Schools and Communities Group developed the NF school certification process and self-evaluation tool.

The goal of the workshop is to report on the continued development and preliminary results of the NF School pilot study and introduce the NF School model to any new participants. Participants will also gain an understanding of the participatory action research method used to develop the NF School model.
 

The National Children’s Study is a national prospective, longitudinal study of environmental effects, including physical, chemical, biological and psychosocial effects, on child health and development. The goal of the study is to improve the health and well-being of children. The study will examine these environmental effects on the health and development of more than 100,000 children across the United States, following them from before birth until age 21. The study is led by a consortium of federal agency partners: the U.S. Department of Health and Human Services, including the National Institute of Child Health and Human Development (NICHD); the National Institute of Environmental Health Sciences (NIEHS); the Centers for Disease Control and Prevention (CDC); and the U.S. Environmental Protection Agency (EPA). For additional information, visit the website at http://www.nationalchildrensstudy.gov/.

The National Children’s Study—An Overview
Duane Alexander, NICHD, National Institutes of Health, Bethesda, MD

The National Children’s Study—Methods
Peter C. Scheidt, National Institutes of Health, Bethesda, MD

Children’s Health and Environmental Exposures: The Most Important Unanswered but Answerable Questions
Michael Weitzman, The AAP Center for Child Health Research at the University of Rochester, Rochester, NY

The application of imaging technologies to solving questions in biology and medicine is revolutionizing medicine by accelerating analyses in situ and in vivo and providing new perspectives on biological processes as diverse as development, neoplasia and injury repair. In this plenary session, three internationally recognized speakers will focus on developmental processes and discuss how these new imaging technologies are providing dynamic insights into the genetic and epigenetic mechanisms that underpin hematopoiesis and vascular development.

Introduction
Lisa M. Guay-Woodford, University of Alabama at Birmingham, Birmingham, AL

Dynamic Imaging of Fluid Forces in Developing Mouse Vasculature
Mary Dickinson, Beckman Institute–Caltech, Pasadena, CA

Microscopic Imaging of Angiogenesis
Donald M. McDonald, University of California, San Francisco, CA

Watching Hematopoietic Stem Cell Engraftment and Hematopoiesis in Living Animals
Christopher H. Contag, Stanford University School of Medicine, Stanford, CA

Questions from the audience
 

Vaccines have an important function in preventing birth defects. The most obvious one is rubella vaccine and its application for the purpose of preventing congenital rubella syndrome (CRS) will be discussed. In addition, prospects of the development of other relevant vaccines will be presented. These will include: cytomegalovirus, parvovirus, herpes simplex and malaria. The first three, because they affect the fetus directly; the last, because of its adverse effect on pregnancy that results in small-for-gestational-age newborns.

Elimination of Rubella from the Americas by the Year 2010
Mirta Roses Periago, Director of PAHO, Panamerican Health Organization (PAHO), Washington, DC

Prevention of CRS by Universal Application of the Rubella Vaccine
Susan E. Reef, Center for Disease Control, Atlanta, GA

Prospects for a Vaccine Against Cytomegalovirus
Stanley A. Plotkin, Aventis Pasteur and the University of Pennsylvania, Doylestown, PA

Prospects for a Vaccine Against Herpes Simplex
Richard J. Whitley, University of Alabama at Birmingham, Children's Hospital, Birmingham, AL

Prospects for a Vaccine Against Parvovirus B-19
Neal S. Young, National Institutes of Health, Bethesda, MD

Prospects for a Vaccine Against Malaria
N. Regina Rabinovich, Bill & Melinda Gates Foundation, Seattle, WA

Discussion

Patient safety is a growing national initiative, particularly for children. Several studies have shown that hospitalized children experience rates of medical errors equal to or more frequently than adults and tackling safety in ambulatory settings is a relatively new but growing priority area. Many institutions, organizations and practices have started tackling patient safety as Job One in the context of routine daily practice. Overarching this the AAP and ABP have joined forces to place safety and quality on the forefront for practicing pediatricians and for board certification. This workshop will have several brief presentations from two institutions adopting wide-scale safety initiatives encompassing inpatient and outpatient settings and two representatives from the AAP and ABP to discuss joint efforts to promote quality and safety. Workshop participants will gain knowledge, attitudes and skills to help them bring patient safety and quality to real-time implementation in their daily practice. The workshop will include one hour of presentations from the workshop leaders and then rotating 30-minute roundtables with individual leaders for workshop participants to share:

1. Pediatric patient safety concerns and strategize on wide-scale systems solutions, and
2. Ideas and inputs on joint efforts of AAP and ABP on quality and safety.
    

Since 1993, the Family Advocacy Program at Boston Medical Center has provided legal assistance to low-income patient-families whose children's health is compromised by lack of access to basic needs such as housing, public benefits, family stability/safety, education services and health insurance. FAP also trains clinical staff and residents. We have helped start up dozens of medical–legal collaborations nationally in the past several years. The goal of this workshop is to teach participants how to initiate and/or support a similar effort in their own clinical setting. Participants will learn basic legal advocacy through tools and curriculum developed by FAP and participate in facilitated small group discussion on concrete strategies for implementing a collaboration, including: identifying stakeholders, navigating confidentiality and ethics, demystifying legal services for the health care provider, linking individual advocacy to systemic change and incorporating training for providers and residents. The workshop will utilize case examples and advocacy action plans to bring to life the integration of advocacy in the clinical setting.
 

Worldwide, more than 1,500 children per day become infected with HIV through mother-to-child transmission. Currently there are 2.7 million children living with HIV infection across the globe, >90% of whom reside in developing countries. While there have been enormous successes in the prevention and treatment of pediatric AIDS in the United States and Europe, it remains an open question as to how effectively these public health gains can be replicated in the poor countries of the world, which bear the greatest burden of disease. Efforts to develop an HIV vaccine appropriate for preventing infection among the world's children and adolescents are finally under way on a global scale. We will discuss these issues and accompanying controversies as they apply to the children of the developing world.

AIDS in Children—A Global Public Health Crisis
David L. Pugatch, Hasbro Children's Hospital and Brown Medical School, Providence, RI

Preventing Mother-to-Child Transmission of HIV in Developing Countries—Successes, Failures and Challenges
Catherine M. Wilfert, Elizabeth Glaser Pediatric AIDS Foundation, Santa Monica, CA and Washington, DC

HIV Treatment for Children—Can the Successes of Rich Countries Be Duplicated in Resource-Poor Settings?
Mark W. Kline, Baylor College of Medicine, Houston, TX

Finding an AIDS Vaccine That Works for the World's Children
Richard A. Koup, Vaccine Research Center, National Institutes of Health, Bethesda, MD

The symposium will be held on May 4, 2004 at the Moscone West Convention Center (8:00am–3:30pm). The symposium will bring together a distinguished, international group of scientists and clinicians to discuss several major childhood health problems of global significance, including:

• Micronutrient deficiency in childhood
• Perinatal aspects of maternal malaria and tuberculosis
• Genetic susceptibility to malaria and tuberculosis

Researchers are invited to submit abstracts relating to the above topics. Abstracts concerning other global health issues suitable for presentation to a diverse audience of paediatric scientists and clinicians will also be considered. Selected abstracts will be chosen for symposium or poster presentations. 

The workshop will be held on May 5, 2004, at the Hilton San Francisco (8:00am – 5:00pm). It will provide an opportunity for individual scientists and clinicians interested in global childhood health issues, and representatives of participating societies, with the unique opportunity to help shape the direction of this new initiative. Plenary sessions and small group meetings will be used to plan for the future of the Programme for Global Paediatric Research. Topics will include:

• Establishing international communication between scientists
• The role of societies and paediatric research organizations in the study of global health problems
• Defining global health problems suitable for collaborative research
• Sites and topics for subsequent symposia

If you wish to attend the workshop and/or require further information please contact:

Obesity is currently one of the greatest health threats facing the health of our children and youth. Reasons for this epidemic are rooted in the changing lifestyle of Americans: one that embraces little physical activity and the consumption of large amounts of processed, high caloric foods. While problems in our societal fabric may take decades to address, pediatricians need effective ways to treat children who are already obese or are at imminent risk. Despite the significance and magnitude of this problem, most attempts at therapy have not been effective. We will discuss current dietary, pharmacologic and surgical approaches to therapy that are gaining in popularity in pediatric populations and will address what is known about the effectiveness of these approaches and the controversies associated with them. The rationale for different diets, including "popular" ones, their efficacy and safety will be discussed. Data concerning safety and efficacy of approved and experimental drug therapies in children will be presented. Finally, we will discuss when to consider bariatric surgery in children.

Novel Dietary Treatments for Obesity and Related Complications
David S. Ludwig, Children's Hospital, Boston, MA

Pharmacotherapy of Childhood Obesity
Robert H. Lustig, University of California, San Francisco, CA

Surgical Weight Loss in Pediatrics
Victor F. Garcia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Premature birth accounts for nearly 75% of the neonatal mortality and up to 50% of the long-term neurologic disability in children. In the United States, the incidence of premature birth has not decreased over the past 40 years and, in fact, despite considerable investigational, public health and clinical effort, has increased slightly in the past decades. The faculty of this session will discuss the epidemiology of premature birth and our current understanding of the etiology of premature labor. Current and future investigational, interventional and therapeutic strategies will be outlined.

Biological Influences on the Premature Labor
Robert L. Goldenberg, University of Alabama, Birmingham, AL

Insights from Clinical Trials in the Management of Premature Labor
Jay Donald Iams, Ohio State University, Columbus, OH

Every day, nearly 5,000 children in the United States smoke their first cigarette. Approximately 60% of smokers start by the age of 13 and fully 90% before the age of 20. Publicly the tobacco companies have always maintained that they do not target youth, but internal documents reveal that they set out to aggressively advertise to kids.

This session will describe litigation as a public health strategy for fighting Big Tobacco in the United States and provide examples of the techniques used to attract children to smoking. Global trends and counter-advertising measures will be discussed.

Overview
Ruth A. Etzel, George Washington University School of Public Health and Health Services, Washington, D.C.

Fighting Big Tobacco in the United States: Litigation as a Public Health Strategy
Madelyn J. Chaber, Law Offices of Wartnick, Chaber, Harowitz & Tigerman, San Francisco, CA

Goliath Fleeing from David: The Global March of the Marlboro Man
Ronald M. Davis, Henry Ford Health System, Detroit, MI

Discussion
 

Hot Topics in General Pediatrics is a potpourri of topics of interest to all pediatricians. The topics include lead poisoning, West Nile Virus infection, sleep disorders and esophagitis. Each of these conditions has varied symptoms, signs and manifestations. For each topic there have been new findings that are in the "need to know" category for all pediatric generalists and subspecialists.

Kawasaki Disease
Jane C. Burns, University of California, San Diego, CA

West Nile Fever
Janak A. Patel, Children's Hospital, University of Texas Medical Branch, Galveston, TX

Lead Poisoning
Kevin Osterhoudt, The Children's Hospital of Philadelphia, Philadelphia, PA