Jon B. Tingelstad Conference: Practical Pediatrics 2025

Here's a brief bullet point list of behavior management tips, tricks, and techniques for pediatricians in the primary care office:

Establish Clear Expectations: Set rules and boundaries at the beginning of the visit.

Positive Reinforcement: Praise and reward desired behaviors (e.g., cooperation, sitting still).

Distraction Techniques: Utilize toys, books, screens, or conversation to redirect attention.

Redirection: Gently guide the child towards more appropriate behavior.

Ignore Minor Misbehavior: Avoid giving attention to attention-seeking behaviors that are not harmful.

Clear and Concise Language: Use simple terms the child can understand.

Offer Choices (When Possible): Give the child a sense of control (e.g., "Do you want to sit on the big chair or Mommy's lap?").

Time-Out (Judiciously Used): For persistent disruptive behavior, use a brief, consistent time-out in a designated area. Explain the reason beforehand.

Parent Involvement: Partner with parents to implement consistent strategies. Discuss home behavior and collaboratively develop plans.

Model Calm Behavior: Maintain a calm and reassuring demeanor.

Use Visual Aids: Picture schedules or social stories can help children understand expectations.

Prepare for Procedures: Explain what will happen in age-appropriate terms before starting.

Positive Framing: Phrase requests in a positive way ("Let's hold still so we can...") instead of negative ("Don't move!").

Be Patient and Consistent: Behavior change takes time and consistency from all adults involved.

Know When to Seek Help: Recognize situations requiring referral to a child psychologist or behavioral specialist.

Source: Google Gemini

Complete Guide to Managing Behavior Problems
https://childmind.org/guide/parents-guide-to-problem-behavior/

Correlates of Behavioral Care Management Strategies used by Primary Care Pediatric Providers
https://pmc.ncbi.nlm.nih.gov/articles/PMC1832082/

How to Discuss Behavioral Issues with Your Child’s Pediatrician
https://cimgpeds.com/discuss-behavioral-issues-with-your-pediatrician/

Positive Behavior Management
https://pmpediatriccare.com/blog/positive-behavior-management/

Practical Behavior Management in Pediatric Primary Care
https://thereachinstitute.org/training/practical-behavior-management/

Strategies for Improving Behavioral Health Care
https://www.childrenshospitals.org/news/childrens-hospitals-today/2021/10/strategies-for-improving-behavioral-health-care

Here's a brief bullet point list for "Stitching Success: Mastering Pediatric Laceration Repair":

• Thorough Assessment: Evaluate wound size, depth, location, contamination, and neurovascular status.
• Adequate Anesthesia: Prioritize pain control with local anesthesia (lidocaine with epinephrine often preferred, consider buffered solutions). Topical anesthetics can be helpful adjuncts.
• Gentle Wound Preparation: Irrigate copiously with sterile saline; consider gentle scrubbing for contaminated wounds. Avoid harsh chemicals.
• Appropriate Suture Selection: Choose based on location, skin thickness, and desired cosmetic outcome (e.g., absorbable vs. non-absorbable, suture size).
• Layered Closure (When Necessary): Deep dermal sutures to reduce tension, followed by epidermal closure.
• Precise Tissue Approximation: Evert wound edges slightly for optimal cosmetic result. Avoid excessive tension.
• Consider Tissue Adhesives: Useful for simple, low-tension lacerations, especially in younger children.
• Effective Hemostasis: Control bleeding with direct pressure, and occasionally epinephrine.
• Proper Wound Care Instructions: Clear guidance on cleaning, antibiotic ointment (if indicated), and signs of infection.
• Age-Appropriate Approach: Utilize distraction techniques, parental involvement, and a calm demeanor to minimize anxiety.
• Follow-Up and Suture Removal: Provide clear instructions on when to return for suture removal (if non-absorbable sutures are used).
• Documentation: Detailed record of the repair, including anesthesia, suture type/size, and patient/parent education.
• Managing Complications: Be prepared to address bleeding, infection, or wound dehiscence.
• Emphasis on Cosmesis: Aim for the best possible cosmetic outcome while ensuring proper wound closure.

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Here's a brief bullet point list of tracheostomies, airway clearance devices, and ventilator modes relevant to pediatric home care:

Tracheostomies:

• Artificial Airway: Surgically created opening in the trachea below the vocal cords.
• Bypass Upper Airway: Used for airway obstruction, prolonged ventilation, or secretion management.
• Various Sizes & Types: Cuffed vs. uncuffed, single vs. double lumen, fenestrated vs. non-fenestrated.
• Routine Care: Stoma cleaning, inner cannula changes, dressing changes.
• Humidification: Essential to prevent mucus plugging.
• Emergency Preparedness: Knowing how to manage accidental decannulation and tube obstruction.

Airway Clearance Devices:

• Chest Physiotherapy (CPT): Manual percussion and postural drainage to mobilize secretions.
• Chest Vest (High-Frequency Chest Wall Oscillation - HFCWO): Inflatable vest that vibrates the chest wall.
• Cough Assist Device (Mechanical Insufflation-Exsufflation - MI-E): Simulates a natural cough to clear secretions.
• Flutter Valve/Acapella: Positive expiratory pressure (PEP) devices to help mobilize secretions.
• Suctioning: Removal of secretions from the tracheostomy tube.
• Nebulized Medications: Delivery of bronchodilators or mucolytics to aid airway clearance.

Ventilator Modes:

• Pressure-Controlled Ventilation (PCV): Delivers breaths at a set pressure for a set inspiratory time.
• Volume-Controlled Ventilation (VCV): Delivers breaths at a set volume.
• Pressure Support Ventilation (PSV): Patient-triggered breaths are supported with a set pressure (often used for weaning).
• Synchronized Intermittent Mandatory Ventilation (SIMV): Delivers set mandatory breaths and allows for spontaneous patient breaths.
• Continuous Positive Airway Pressure (CPAP): Maintains a constant level of positive pressure to keep airways open (not a full vent mode).
• Bilevel Positive Airway Pressure (BiPAP): Delivers different levels of pressure during inspiration and expiration (also not a full vent mode, but can provide significant ventilatory support).
• Home Ventilator Specific Modes: Many home ventilators have simplified or combined modes.
• Ventilator Settings: Understanding and adjusting rate, tidal volume/pressure, inspiratory time, PEEP, FiO2 as prescribed.
• Alarms: Recognizing and responding appropriately to ventilator alarms.

Source: Google Gemini

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