Pediatrics

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Clinical Care

Physician educators in the Division of Pediatric Endocrinology and Diabetology at IU School of Medicine provide comprehensive services for infants, children and adolescents with dysfunction of the endocrine glands. This specialist team also offers extensive, multi-disciplinary educational services for newly diagnosed patients and parents requiring specialized instruction, focusing on family education, empowerment and psychosocial support.

In addition to diabetes, clinicians treat children with both common and extraordinarily rare endocrine problems. These include, but are not limited to, abnormalities of growth and puberty; disorders of sex development; thyroid, adrenal, pituitary and bone conditions; and syndromes with endocrine manifestations.

All of the division’s clinical faculty are Board-certified in pediatrics. They are also Board-eligible or Board-certified in Pediatric Endocrinology and Diabetology.

Diabetes Program

The  diabetes team at Riley Hospital is led by childhood diabetes physician specialists and supported by endocrine fellows, pediatric residents, nurse practitioners, nutritionists and social workers who design individual management plans that optimize glycemic control and reduce the risk of long-term complications. These physician specialists provide multi-disciplinary services for children and adolescents with diabetes.

Physicians and nurse practitioners see patients every 3-4 months to evaluate their metabolic control. All patients followed in the outpatient clinics have access to 24-hour per day consultation with a nurse practitioner or physician. Clinics are located at Riley Hospital for Children and satellite clinics on the north and south sides of Indianapolis, Bloomington, South Bend, and Evansville, Indiana.

All patients referred to Riley Hospital with newly diagnosed Type 1 diabetes mellitus are hospitalized for approximately two days of medical evaluation and individual instruction in basic survival aspects of diabetes management. More than 150 patients enter the program annually by this route. Parents begin participating in their child’s care from the time of diagnosis.

Patients are discharged when they demonstrate adequate competence in the technical skills they have learned. They are then followed by phone at least twice per week by a nurse practitioner until the patient’s blood sugars stabilize.

Members of the diabetes team at Riley Hospital play an integral role at Camp John Warvel, the American Diabetes Association sponsored summer camp. This annual week long, sleep-away camp for children with diabetes provides fun and educational experiences for children from 7-18 years of age. The camp also provides diabetes training experiences for medical students, nursing students, parents, dietary interns, and other medical professionals and individuals with an interest in diabetes. Pediatric Endocrinology fellows attend this camp, as it provides a unique insight into the lives of  children with diabetes.

Endocrinology Program

The Outpatient Pediatric Endocrine Service treats all endocrine problems of infancy, childhood and adolescence. These include growth disorders, Turner syndrome, ambiguous genitalia, delayed and precocious sexual development, goiters, congenital and acquired disorders of thyroid function, hypoglycemia, disorders of calcium metabolism, metabolic bone disease, adrenal disorders including congenital adrenal hyperplasia and adrenal insufficiency, anterior pituitary dysfunction and diabetes insipidus. More than 30 outpatient clinics are held each week in downtown Indianapolis and at satellite clinics located on the north and south sides of the city as well as in Bloomington, South Bend and Evansville.

The inpatient pediatric endocrine service consists of a faculty attending, a pediatric endocrinology fellow, two pediatric residents, and one or two medical students. Rounding out the team is a group of dedicated diabetes educators that includes dietitians, nurse educators and social workers. In addition to caring for patients on the endocrine service, pediatric endocrinology faculty, fellows and residents also provide consultative support to other clinical services at Riley Hospital for Children.

Special Clinics and Programs

The Cancer Survivor Clinic is designed to care for children with endocrine diseases related to cancer treatment. This includes patients with pituitary dysfunction related to treatment of brain tumors, thyroid dysfunction in association with head andneck radiation and chemotherapy, and patients with pubertal disorders and gonadal insufficiency resulting from chemotherapy and radiation effects.

In collaboration with the Division of Adolescent Medicine, the Youth Diabetes Prevention Clinic delivers targeted interventions to at-risk adolescents with obesity and pre-diabetes. The Youth Diabetes Prevention Clinic evaluates and assesses the needs of adolescents (ages 10 – 21) who have evidence of prediabetes or obesity in combination with multiple risk factors for the development of diabetes, including a family history of diabetes in a first- or second-degree relative, minority race/ethnicity, history of gestational diabetes in the mother, acanthosis nigricans, irregular menstrual periods or polycystic ovary syndrome and hypertension. Patients are cared for by physicians, nurse practitioners, dietitians and health coaches.

This clinical treatment program uses the Diabetes Prevention Program modified for families and goal-setting strategies to implement therapeutic lifestyle changes in children and their families. See Riley Hospital Youth Diabetes Prevention Program for additional information.

The Riley Type 2 Diabetes Clinics treat youth with type 2 diabetes and complications related to diabetes. The Diabetes Team, consisting of physicians, nurse practitioners, dietitians and social workers, provides comprehensive diabetes education and ongoing medical care in a setting appropriate for youth and their families.

The Riley Pediatric Metabolic Bone Disease Clinic is run by Drs. Linda DiMeglio and Erik Imel, both of whom are members of the American Society for Bone and Mineral Research and are nationally recognized as experts in pediatric bone and mineral disorders. Patients seen in the Riley Pediatric Metabolic Bone Disease Clinic may have conditions such as  osteogenesis imperfecta or other disorders associated with low bone density, sclerotic bone disorders including osteopetrosis, or calcium and phosphate disorders, such as X-linked hypophosphatemic rickets.

The Gender Health Program provides comprehensive support to children, teens and young adults who have experienced gender dysphoria. This is the only gender health program in Indiana serving patients under age 21. Members of the gender health team include adolescent medicine doctors, pediatricians, pediatric urologists, pediatric endocrinologists, psychologists and social workers. Individualized care plans are designed to help patients feel safe, healthy and supported. The program assists patients as they make a decision about whether to transition into a different gender and offers care at each stage of transition.

Riley Hospital for Children has been designated by the CARES Foundation as a Comprehensive Care Center for the treatment of congenital adrenal hyperplasia. Working with our colleagues in Pediatric Urology, the CAH Clinic provides ongoing subspecialty care for infants, children and adolescents with this condition in addition to providing outpatient consultative services for patients being evaluated and treated by Pediatric Urology specialists.

The Hip Hop Obesity Clinic was created to help deal with the increasingly prevalent problem of obesity in children. The clinic utilizes a team approach including physicians, pediatric dietitians, exercise physiologists, psychologists, nurses, and social workers. The evaluation includes assessment of insulin sensitivity in obese children and the effect of early intervention with a comprehensive weight management program.

A comprehensive outpatient endocrine testing clinic provides for state-of-the-art evaluation of a broad range of endocrine conditions. Provocative serial tests done on an outpatient basis include growth hormone stimulation, leuprolide stimulation, standard and low-dose ACTH stimulation, glucose tolerance testing, insulin tolerance testing, water deprivation studies, and mixed meal stimulation testing. This facility is staffed by nurse specialists who provide pre-testing verbal and written education and psychosocial preparation for the procedure to the families of patients. Testing is performed in an area where there are appropriate diversion materials and a calm, quiet environment.

The Division of Pediatric Endocrinology and Diabetology is the site of the Indiana Congenital Hypothyroidism and Congenital Adrenal Hyperplasia Follow-up Programs. These programs represent a collaborative approach to newborn screening, with the goal of providing expedient and optimal care to every infant born in Indiana affected by these disorders. Pediatric Endocrinology fellows work closely with the program coordinator in the initial evaluation and treatment of infants with abnormal newborn screens. In addition, the programs provide ongoing consultative services for primary care physicians throughout the state. Educational activities for families and healthcare providers include parent brochures, written material, and formal lectures.