2012 Pediatrics in Review Disclosure

The American Academy of Pediatrics (AAP) Continuing Medical Education (CME) program aims to develop, maintain, and improve the competence, skills and professional performance of pediatricians and pediatric healthcare professionals by providing quality, relevant, accessible, and effective educational experiences that address gaps in professional practice. The AAP CME program strives to meet participants educational needs and support their life-long learning with a goal of improving care for children and families (AAP CME Program Mission Statement, October 2010). In keeping with this spirit, the information that follows is being communicated to all learners before beginning this CME activity.

Now in its 33rd year, Pediatrics in Review is a continuing medical education (CME) journal published monthly. Pediatrics in Review offers rigorously peerreviewed review articles mapped to the American Board of Pediatrics (ABP) content specifications in pediatric medicine, as well as special features and columns, including:

Back to Basics: Revisits basic science learned in medical school Consultation with the Specialist: Offers a specialist's perspective on a variety of pediatric topics What's New: Provides information on new developments in pediatric medicine Index of Suspicion: Tests diagnostic skills with cases that present in a suspicious manner In Brief: Summarizes the latest writing on key pediatrics topics Visual Diagnosis: Presents case-based, step-by-step diagnostic mysteries with clues from photos, images and video clips

Pediatrics in Review comprises a self-directed print and online journal CME activity that helps pediatricians, pediatric specialists and allied health clinicians keep current on new developments in the field while preparing for Maintenance of Certification MOC. In particular, the journal aims to: 1) 2) keep the general pediatric clinician current in all areas of pediatric medicine and assist those participating in MOC.

The journal is one of the key components of the Academys continuing medical education program, PREP (Pediatrics Review and Education Program). Pediatrics in Review and the PREP Self-Assessment constitute PREP the Curriculum. As the journal component of the AAP PREP The Curriculum program, Pediatrics in Review and its companion PREP Self-Assessment aim, over any five-year period, to cover the majority of the ABP content specifications in general pediatrics. The journal includes 3-4 review articles each month. These are followed by case-based quiz questions with multiple-choice answer options and, in the online version, a link to the spot in the text where the preferred response appears. Each article also clearly identifies the content specification(s) it addresses. While specific learning objectives vary from article to article, the journals overall learning goals are: To assist participants in acquiring and updating the knowledge and skills needed to facilitate good child health and manage acute and chronic illnesses in children from infancy through young adulthood; To help participants keep current on new developments and meet their need for continuing professional development using evidence-informed medical information; and

To aid general pediatricians in their efforts to prepare for MOC in general pediatrics.

Minimum System Requirements: Windows 98, 2000, XP, or Vista Recommended Browser: Internet Explorer 4.0 or above or Netscape 4.0 or above. The AAP does not support the Safari browser. Recommended Software: Adobe Acrobat Reader 6.0. Click here to download Adobe Acrobat Reader 6.0.

Completion of Pediatrics in Review Pediatrics in Review participants are required to read any one of the three continuing medical education (CME) articles in each issue; each article offers 1 AMA PRA Category 1 Credit. Each CME article is followed by up to 5 quiz questions. Each question represents an incomplete statement or asks a question requiring the selection of the SINGLE BEST ANSWER from five possible choices. A minimum passing score of 60% must be achieved in order to claim credit. The verified references in each article provide an avenue for further study and learning. The Pediatrics in Review Editorial Board, which comprises 33 pediatrics generalists and subspecialists, reviews articles as requested by the editor-in-chief, Dr. Lawrence Nazarian, MD, FAAP. If additional review is required, ancillary reviewers are consulted. Expert question writers create the questions associated with each review article. Readers occasionally respond in print and especially online with challenges to the best option choices, and the final resolution represents the editor-in-chiefs and authors best efforts to provide balanced, up-to-date, evidence-informed information. The point of the quiz questions is not so much to impart final authority as it is to stimulate critical thinking. The answers published herein have been checked carefully and represent authoritative opinions about the questions concerned. However, they do not represent the official opinion of the AAP, indicate an exclusive course of treatment, or serve as a standard of medical care.

Pediatrics in Review Faculty and Staff The following people are essential to the design, development and deployment of this print and online review journal: Faculty Lawrence F. Nazarian, MD, FAAP, Editor-in-Chief Clinical Professor Division of General Pediatrics Department of Pediatrics

University of Rochester School of Medicine & Dentistry Rochester, NY Tina L. Cheng, MD, MPH, FAAP, Associate Editor Professor of Pediatrics and Public Health Chief, General Pediatrics & Adolescent Medicine Johns Hopkins University School of Medicine and Bloomberg School of Public Health Baltimore, MD Joseph Zenel, MD, FAAP, Associate Editor Professor, Pediatrics Director, Pediatric Residency Division Chief, General Pediatrics Sanford Childrens Hospital The Sanford School of Medicine, University of South Dakota Sioux Falls, SD Robert J. Haggerty, MD, FAAP, Founding Editor and Editor Emeritus Professor and Chair, Emeritus, of Pediatrics University of Rochester School of Medicine & Dentistry Rochester, NY Henry M. Adam, MD, FAAP, Consulting Editor, In Brief Professor of Clinical Pediatrics Division of General Pediatrics Department of Pediatrics Albert Einstein College of MedicineChildrens Hospital at Montefiore Bronx, NY

Janet Serwint, MD, FAAP, Consulting Editor, In Brief Professor of Pediatrics and Public Health Division of General Pediatrics and Adolescent Medicine Department of Pediatrics Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health Baltimore, MD Deepak Kamat, MD, PhD, FAAP, Consulting Editor, Index of Suspicion Professor of Pediatrics The Carman and Ann Adams Department of Pediatrics Wayne State University Detroit, MI Laura Ibsen, MD, FAAP, Consulting Editor, Online and Multimedia Projects Associate Professor of Pediatrics and Anesthesiology Medical Director, Pediatric Intensive Care Unit Director of Medical Student Education in Pediatrics Doernbecher Childrens Hospital Oregon Health and Sciences University Portland, OR

EDITORIAL BOARD Hugh D. Allen, MD, FAAP Professor of Pediatrics and Medicine Vice Chair for Academic Affairs Department of Pediatrics The Ohio State University College of Medicine Staff Cardiologist, The Heart Center

Member, The Center for Gene Therapy Nationwide Childrens Hospital Columbus, OH Richard Antaya, MD, FAAP Associate Professor, Dermatology and Pediatrics Director, Pediatric Dermatology Yale University School of Medicine New Haven, CT Denise Bratcher, DO, FAAP Professor, Pediatrics Section of Pediatric Infectious Diseases Department of Pediatrics Childrens Mercy Hospitals and Clinics University of MissouriKansas City School of Medicine Kansas City, MO Brian S. Carter, MD, FAAP Professor of Pediatrics Division of Neonatology Director, NICU Follow-up Program Monroe Carell Jr. Childrens Hospital at Vanderbilt Nashville, TN Joseph Croffie, MD, MPH, FAAP Professor of Clinical Pediatrics Director of Motility Laboratory Section of Pediatric Gastroenterology, Hepatology and Nutrition

James W. Riley Hospital for Children Indiana University School of Medicine Indianapolis, IN B. Anne Eberhard, MB, BS, MSc, FAAP Associate Professor of Clinical Pediatrics Albert Einstein College of Medicine Department of Pediatrics Cohen Childrens Medical Center of New York New Hyde Park, NY Philip Fischer, MD, FAAP Professor of Pediatrics Mayo Clinic College of Medicine Division of General Pediatric and Adolescent Medicine Mayo Clinic Rochester, MN Rani Gereige, MD, MPH, FAAP Director of Medical Education Miami Childrens Hospital Clinical Professor of Pediatrics Florida International University Miami, FL Lindsey K. Grossman, MD, FAAP Chair, Baystate Childrens Hospital Springfield, MA

Patricia Hamilton, MD, CBE President, European Academy of Pediatrics Director of Medical Education (England) Department of Health Consultant and Senior Lecturer in Neonatal Paediatrics St. Georges Hospital Medical School London, United Kingdom Jacob Hen, MD, FAAP (beginning 1/1/11) Associate Clinical Professor of Pediatrics Yale University School of Medicine Chief, Pediatric Pulmonology Bridgeport Hospital/Yale New Haven Health System Bridgeport, CT Jeffrey D. Hord, MD Director, Showers Family Center for Childhood Cancer and Blood Disorders Professor of Pediatrics, NEOMED Akron Children's Hospital Akron, OH Donald W. Lewis, MD, FAAP Professor and Chairman Department of Pediatrics Childrens Hospital of The Kings Daughters Eastern Virginia Medical School Norfolk, VA

Gregory Liptak, MD, MPH, FAAP Upstate Foundation Professor of Development Director, Center for Development, Behavior and Genetics Upstate Medical University Syracuse, NY Michael Macknin, MD Professor, Department of Pediatrics/Secondary Appointment to Department of Clinical Investigation Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland, OH Susan F. Massengill, MD, FAAP Director, Pediatric Nephrology Department of Pediatrics Levine Childrens Hospital at Carolinas Medical Center Charlotte, NC Clinical Associate Professor, University of North Carolina Charlotte Campus Jennifer Miller, MD, FAAP Assistant Professor Department of Pediatrics Division of Endocrinology University of Florida School of Medicine Gainesville, FL Blaise Nemeth, MD, MS, FAAP Assistant Professor (CHS) Department of Orthopedics Department of Pediatrics

American Family Childrens Hospital and University of Wisconsin School of Medicine and Public Health Madison, WI Mobeen Rathore, MD, CPE, FIDSA, FAAP Professor and Associate Chairman Chief, Pediatric Infectious Diseases and Immunology Wolfsons Childrens Hospital and University of Florida College of Medicine Jacksonville, FL Renata Sanders, MD, MPH, FAAP Assistant Professor Division of General Pediatrics and Adolescent Medicine Johns Hopkins School of Medicine Baltimore, MD Thomas T. Sato, MD, FAAP Professor of Surgery Division of Pediatric Surgery Childrens Hospital of Wisconsin/Medical College of Wisconsin Milwaukee, WI Sara E. Shea, MD, FRCPC, FAAP Associate Professor Head, Division of Developmental Pediatrics Faculty of Medicine Dalhousie University Halifax, Nova Scotia, Canada

10

Andrew Sirotnak MD, FAAP Professor of Pediatrics Department of Pediatrics The Kempe Center for Prevention and Treatment of Child Abuse & Neglect University of Colorado School of Medicine The Children's Hospital Aurora, Colorado Nancy D. Spector, MD, FAAP Associate Professor, Department of Pediatrics Drexel University College of Medicine Associate Chair of Education and Faculty Development Associate Residency Program Director St. Christophers Hospital for Children Philadelphia, PA PREP COORDINATING COMMITTEE Mary E. Rimsza, MD, FAAP Professor of Pediatrics University of Arizona College of Medicine Tucson, AZ Daniel P. Krowchuk, MD, FAAP Professor of Pediatrics and Dermatology Chief, General Pediatrics and Adolescent Medicine Wake Forest University School of Medicine Winston-Salem, NC

11

Kurt Metzl, MD, FAAP Clinical Professor of Pediatrics University of Missouri-Kansas City School of Medicine Kansas City, Kansas PEDIATRICS IN REVIEW STAFF Erin Carlson, JJD, Editorial Assistant University of Rochester Rochester, NY

AAP STAFF Robert M. Perelman, MD, FAAP Associate Executive Director, American Academy of Pediatrics Director, AAP Department of Education Michael J. Held, Director, AAP Division of Scholarly Journals and Professional Periodicals Susan Piscoran, MT(ASCP), Senior Managing Editor Luann Zanzola, Managing Editor Kathleen Bernard, Editorial Assistant Consultants Christine Crane, HighWire Press, Stanford University Libraries Lorena Hitchens, HighWire Press, Stanford University Libraries

AAP Policy on Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities Background In order to support the professional needs of its members, the AAP CME program aims to develop, maintain, and improve the competence, skills, and professional performance of pediatricians and pediatric healthcare professionals by providing quality, relevant, accessible, and effective educational experiences that address gaps in professional practice. The AAP CME program strives to meet participants' educational needs and support their life-long learning with a goal of improving care for children and families. (AAP CME Program Mission Statement, September 2010)

12

The AAP recognizes that there are a variety of financial relationships between individuals and commercial interests that require review to identify possible conflicts of interest in a CME activity. This policy is designed to ensure quality, objective, balanced, and scientifically rigorous AAP sponsored or jointly sponsored Continuing Medical Education (CME) activities by identifying and resolving all potential conflicts of interest prior to the confirmation of service of those in a position to influence and/or control CME content. All AAP CME activities will strictly adhere to the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support: Standards to Ensure the Independence of CME Activities. In accordance with these Standards, the following decisions will be made free of the control of a commercial interest: identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, selection of educational methods, and evaluation of the CME activity (ACCME Standard 1.1). The purpose of this policy and its associated procedures is to ensure all potential conflicts of interest are identified and mechanisms to resolve them prior to the CME activity are implemented in ways that are consistent with the public good. Policy The ACCME requires accredited CME providers to identify and resolve all potential conflicts of interest with any individual in a position to influence and/or control the content of CME activities. A conflict of interest will be considered to exist if the individual has received financial benefits in any amount from a commercial interest within the past 12 months AND that individual is in a position to affect the content of CME regarding the products or services of the commercial interest. As a CME provider accredited by the ACCME, the AAP requires all individuals* in a position to influence and/or control the content of AAP directly and jointly sponsored CME activities to disclose to the AAP and subsequently to learners that the individual either has no relevant financial relationships or has any relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in CME activities. Individuals are required to disclose the following information per ACCME Standard 6.1: name of the individual** name of the commercial interest(s)*** nature of the financial relationship the individual has with each commercial interest**** discussion of off label use (per AAP policy)

13

Disclosure information provided by all those in a position to influence and/or control CME content must never include a trade name or a product-group message (ACCME Standard 6.4). Disclosure information must first be disclosed to AAP staff for determination of potential conflicts of interest. All disclosure information must be provided to AAP CME activity participants prior to the beginning of the CME activity (ACCME Standard 6.5). All potential conflicts of interest identified through the review of AAP Full Disclosure Statement forms must be resolved in order for individuals in a position to influence and/or control CME content to be confirmed for the educational assignment. The resolution process and outcomes must be documented in the CME activity file. Beyond disclosure of financial relationships, AAP CME faculty and authors are required to disclose to the AAP and to learners when they plan to discuss or demonstrate pharmaceuticals and/or medical devices that are not approved by the FDA and/or medical or surgical procedures that involve an unapproved or off-label use of an approved device or pharmaceutical. The AAP requires that the content of directly and jointly sponsored CME activities provide balance, independence, objectivity, and scientific rigor. Planning must be free of the influence or control of a commercial entity, and promote improvements or quality in healthcare. All recommendations in CME activities involving clinical medicine must be based on evidence accepted within the medical profession. The content or format of a CME activity and its related materials must promote improvements or quality in healthcare and not a specific proprietary commercial interest (ACCME Standard 5.1). All AAP CME activities must be compliant with the ACCME content validation statements (ACCME policy 2002-B-09): All the recommendations involving clinical medicine in a CME activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. All scientific research referred to, reported or used in CME in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection and analysis. Providers are not eligible for ACCME accreditation or reaccreditation if they present activities that promote recommendations, treatment or manners of practicing medicine that are not within the definition of CME, or known to have risks or dangers that outweigh the benefits or known to be ineffective in the treatment of patients.

14

Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the CME educational material or content includes trade names, trade names from several companies should be used and not just trade names from a single company (ACCME Standard 5.2). Educational materials that are part of a CME activity such as slides, abstracts, and handouts cannot contain any advertising, trade names without generic names (but listing of trade names from several companies is permissible), or product-group advertising (ACCME Standard 4.3).Any individual refusing to comply with the AAP Policy on Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities and/or not disclosing relevant financial relationships on a timely basis (defined by the Committee on CME as the initial invitation and two reminders) will not participate in, have control of, or responsibility for, the development, management, presentation, or evaluation of AAP CME activities. All AAP CME activities will be evaluated by learners and peer reviewers to determine if the content was free of commercial bias. All those identified as having influence and/or control of CME content perceived as either manifesting conflicts of interest or being biased may be disqualified from consideration as resources (planning group member, authors, faculty, etc) in subsequent CME activities for a time to be determined by the Committee on CME.

_________________________________________________________________________________ *faculty (live and online courses); authors of journal articles, self assessments, enduring materials (e.g. CD ROM, video, etc); CME planning groups/committees; CME editorial boards, AAP Committee on CME, AAP Section/Council program chairs; abstract reviewers; peer reviewers; abstract authors and presenters; staff serving as CME faculty or those directly impacting or managing CME content or activities; spouse/partner **ACCME considers relationships of the person involved in the CME activity to include financial relationships, in any dollar amount, of a spouse or partner. ***The ACCME defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. **** The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Financial relationships are those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest excluding diversified mutual funds) or other financial benefits. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, speaking and teaching (including Speakers Bureaus), membership on advisory committees or review panels, board membership, and other activities from which remuneration is received or expected. A personal financial relationship does NOT exist when a company contracts with an institution to perform research and the institution then independently employs individuals to work on the institutions project.

15

(September 2010)

Activity Title: Pediatrics in Review 2012 Activity Location: Print and Online Journal Activity Dates: Jan. 1, 2012 Dec. 31, 2014

DISCLOSURE OF FINANCIAL RELATIONSHIPS All individuals in a position to influence and/or control the content of AAP CME activities are required to disclose to the AAP and subsequently to learners that the individual either has no relevant financial relationships or any financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in CME activities. Commercial interest(s) is defined as any entity producing, marketing, selling or distributing health care goods or services consumed by, or used on, patients.

Name

Pediatrics in Review 2011-12 Editorial Board Disclosure of Off-Label Relevant Financial Relationship Name of Commercial Interest(s)* (Unapproved)/Investigational Uses of (Please indicate Yes, or No) (Please list name(s) of entity) Products AND AAP CME faculty are required to disclose to Nature of Relevant Financial Relationship(s) the AAP and to learners when they plan to (Please list: Research Grant, Speakers Bureau, discuss or demonstrate pharmaceuticals Stock/Bonds excluding mutual funds, Consultant, and/or medical devices that are not approved Other - identify) by the FDA and/or medical or surgical procedures that involve an unapproved or offlabel use of an approved device or pharmaceutical. (Do intend to discuss or Do not intend to discuss) Do intend to discuss but will identify off-label use. Do not intend to discuss.

Lawrence F. Nazarian, MD, FAAP, Editor Tina L. Cheng, MD, MPH, FAAP, Associate Editor

No No

None None

16

Joseph A. Zenel, MD, FAAP, Associate Editor Robert J. Haggerty, MD, FAAP, Editor Emeritus and Founding Editor Henry M. Adam, MD, FAAP, Editor, In Brief Deepak Kamat, MD, PhD, FAAP, Editor, Index of Suspicion Janet Serwint, MD, FAAP, Consulting Editor Laura Ibsen, MD, FAAP, Consulting Editor, Online and Multimedia Projects Hugh D. Allen, MD, FAAP Richard Antaya, MD, FAAP Denise Bratcher, DO, FAAP Brian Carter, MD, FAAP Joseph Croffie, MD, FAAP B. Anne Eberhard, MD BS, MSc, FAAP Philip R. Fischer, MD, FAAP Rani Gereige, MD, MPH, FAAP Lindsey Grossman, MD, FAAP Patricia Hamilton, MD, CBE Jacob Hen, MD, FAAP Jeffrey D. Hord, MD Donald Wray Lewis, MD,

No No

None None

Do not intend to discuss. Do not intend to discuss.

No No

None None

Do not intend to discuss. Do not intend to discuss.

No No

None None

Do not intend to discuss. Do not intend to discuss.

Yes Yes

No NO No No No No No No No No Yes

Muscular Dystrophy Association grant; AVI BioPharma consultant Astellas Pharma, US, Inc. speaker bureau, advisory boards, clinical trials; Novartis, Galderma speaker bureau None None None None None None None None None None Astra Zeneca, Merck Research grants,

Do not intend to discuss. Do not intend to discuss.

Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do intend to discuss. Do not intend to discuss. N/A

17

FAAP

Gregory S. Liptak, MD, No MPH, FAAP Michael Macknin, MD No Susan Massengill, MD, No FAAP Jennifer Miller, MD, No FAAP Blaise Nemeth, MD, MS, Yes FAAP Mobeen Rathore, MD, Yes CPE, FIDSA, FAAP Renata Sanders, MD, No MPH, FAAP Thomas T. Sato, MD, No FACS, FAAP Sarah E. Shea, MD, No FRCPC, FAAP Andrew Sirotnak, MD, No FAAP Nancy D. Spector, MD, No FAAP Mary Rimsza, MD, FAAP No Dan Krowchuk, MD, No FAAP Kurt Metzl, MD, FAAP No Robert M. Perelman, MD, No FAAP Michael Held No Susan Piscoran No Luann Zanzola No Kathleen Bernard No Erin Carlson, JJD No

consultant; Ortho McNeil, Lilly, Bristol-Myers Squibb, GlaxoSmithKline, Boehringer Ingelheim Pharmaceutical research grants None None None None Biomet unrestricted educational grant for fellowship Consultant and on the speaker bureaus for GSK, MedImmune, Merck, Novartis, and Pfizer None None None None None None None None None None None None None None

Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do intend to discuss. Do not intend to discuss. Do not intend to discuss. N/A Do intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do intend to discuss. Do not intend to discuss. Do not intend to discuss.

18

Melissa Schroen Sydney Sutherland Nahed Abdel-haq, MD, ancillary reviewer Helen Binns, MD, MPH, ancillary reviewer Charles Camosy, PhD, ancillary reviewer Maria Carrillo-Marquez, MD, ancillary reviewer Mark Cicero, MD, ancillary reviewer James Cirincione, MD, ancillary reviewer Stephen Cook, MD, MPH, ancillary reviewer Christy Cummings, MD, ancillary reviewer Carl DAngio, MD, ancillary reviewer Lynn Driver, MD, ancillary reviewer S. Jean Emans, MD, ancillary reviewer Marilyn Fisher, MD, MS, ancillary reviewer Arthur Hengerer, MD, ancillary reviewer William Hulbert, MD, ancillary reviewer Nina Klionsky, MD, ancillary reviewer Cheryl Kodjo, MD, MPH, ancillary reviewer Scott Langenburg, MD, ancillary reviewer

No No No No No No No No No No No No No No No No No No No

None None None None None None None None None None None None None None None None None None None

Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss.

19

No Robert Macauley, ancillary reviewer Jordan Metzl, MD, No ancillary reviewer John Pascoe, MD, No ancillary reviewer Cary Qualia, MD, No ancillary reviewer Chokechai Rongkavilit, No ancillary reviewer Thomas Rossi, MD, No ancillary reviewer Jeffrey Rubenstein, MD, No MBA, ancillary reviewer David Siegel, MD, MPH, No ancillary reviewer Laurence Sugarman, No MD, ancillary reviewer John S. Sullivan, ancillary No reviewer Rudolph Valentini, MD, Yes FAAP Sunita Vohra, MD, MSc, No FRCPC, FAAP, ancillary reviewer Joseph L. Wright, MD, No MPH, FAAP, ancillary reviewer Ferdinand Yates, MD, No ancillary reviewer Athos Bousvaros, MD, Yes MPH, question writer M. Robin English, MD, No question writer Paul G. Fisher, MD, No question writer Sydney A. Rice, MD, No question writer

None None None None None None None None None None Research grant relationship with Abbott Laboratories None

Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do intend to discuss.

None

Do not intend to discuss.

None

Do not intend to discuss.

Merck, UCB Research grants; Millennium Paid Do intend to discuss. consultant, speaker bureau None Do not intend to discuss. None None Do not intend to discuss. Do not intend to discuss.

20

No O.J. Sahler, MD, question writer Ashok Sarnaik, MD, No question writer Richard Sills, MD,, FAAP, Yes question writer Douglas Silverstein, MD, No FAAP, question writer Jim Wilde, MD, question No writer Hiram Stephen Williams, No MD, MPH, FAAP, question writer

None None Novartis Research grant None None None

Do not intend to discuss. Do intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss.

Name

Pediatrics in Review 2010-11 Editorial Board Disclosure of Off-Label Relevant Financial Relationship Name of Commercial Interest(s)* (Unapproved)/Investigational Uses of (Please indicate Yes, or No) (Please list name(s) of entity) Products AND AAP CME faculty are required to disclose to Nature of Relevant Financial Relationship(s) the AAP and to learners when they plan to (Please list: Research Grant, Speakers Bureau, discuss or demonstrate pharmaceuticals Stock/Bonds excluding mutual funds, Consultant, and/or medical devices that are not approved Other - identify) by the FDA and/or medical or surgical procedures that involve an unapproved or offlabel use of an approved device or pharmaceutical. (Do intend to discuss or Do not intend to discuss) Do intend to discuss but will identify off-label use. Do not intend to discuss.

Lawrence F. Nazarian, MD, FAAP, Editor Tina L. Cheng, MD, MPH, FAAP, Associate Editor Joseph A. Zenel, MD,

No No

None None

No

None

Do not intend to discuss.

21

FAAP, Associate Editor Robert J. Haggerty, MD, FAAP, Editor Emeritus and Founding Editor Henry M. Adam, MD, FAAP, Editor, In Brief Deepak Kamat, MD, PhD, FAAP, Editor, Index of Suspicion Janet Serwint, MD, FAAP, Consulting Editor Laura Ibsen, MD, FAAP, Consulting Editor, Online and Multimedia Projects Hugh D. Allen, MD, FAAP Margie Andreae, MD, FAAP Richard Antaya, MD, FAAP Denise Bratcher, DO, FAAP George R. Buchanan, MD, FAAP Brian Carter, MD, FAAP David N. Cornfield, MD, FAAP Joseph Croffie, MD, FAAP B. Anne Eberhard, MD BS, MSc, FAAP Philip R. Fischer, MD, FAAP Rani Gereige, MD, MPH, FAAP Lindsey Grossman, MD, FAAP

No

None

Do not intend to discuss.

No No

None None

Do not intend to discuss. Do not intend to discuss.

No No

None None

Do not intend to discuss. Do not intend to discuss.

No No Yes

None None Astellas Pharma, US, Inc. speaker bureau, advisory boards, clinical trials; Novartis speaker bureau None None MedImmune - Speaker Bureau National Institutes of Health grants. None None None None None

Do intend to discuss. Do not intend to discuss. Do intend to discuss.

No No Yes Yes No No No No No

Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do intend to discuss. Do not intend to discuss. Do not intend to discuss.

22

No Patricia Hamilton, MD, CBE Jacob Hen, MD, FAAP No Hal B. Jenson, MD, MBA, No FAAP Donald Wray Lewis, MD, Yes FAAP

None None None Astra Zeneca, Merck Research grants, consultant; Ortho McNeil, Lilly, Bristol-Myers Squibb, GlaxoSmithKline, Boehringer Ingelheim Pharmaceutical research grants None None None Biomet unrestricted educational grant for fellowship None None None None None None None None None None None None None

Do not intend to discuss. Do intend to discuss. Do not intend to discuss. N/A

Gregory S. Liptak, MD, No MPH, FAAP Susan Massengill, MD, No FAAP Jennifer Miller, MD, No FAAP Blaise Nemeth, MD, MS, Yes FAAP Renata Sanders, MD, No MPH, FAAP Thomas T. Sato, MD, No FACS, FAAP Sarah E. Shea, MD, No FRCPC, FAAP Andrew Sirotnak, MD, No FAAP Nancy D. Spector, MD, No FAAP Mary Rimsza, MD, FAAP No Dan Krowchuk, MD, No FAAP Kurt Metzl, MD, FAAP No Robert M. Perelman, MD, No FAAP Michael Held No Sydney Sutherland No Susan Piscoran No Luann Zanzola No

Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. N/A Do intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do intend to discuss.

23

Deborah K. Kuhlman

No

None None None None None None None None None None None None None None None None None None None

Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do intend to discuss.

Nahed Abdel-haq, MD, No ancillary reviewer Charles Camosy, PhD, No ancillary reviewer Mark Cicero, MD, No ancillary reviewer James Cirincione, MD, No ancillary reviewer Carl DAngio, MD, No ancillary reviewer Lynn Driver, MD, No ancillary reviewer S. Jean Emans, MD, No ancillary reviewer Marilyn Fisher, MD, MS, No ancillary reviewer Arthur Hengerer, MD, No ancillary reviewer William Hulbert, MD, No ancillary reviewer Scott Langenburg, MD, No ancillary reviewer Robert Macauley, No ancillary reviewer Cary Qualia, MD, No ancillary reviewer Chokechai Rongkavilit, No ancillary reviewer Thomas Rossi, MD, No ancillary reviewer David Siegel, MD, MPH, No ancillary reviewer John S. Sullivan, ancillary No reviewer Sunita Vohra, MD, MSc, No FRCPC, FAAP, ancillary

24

reviewer Joseph L. Wright, MD, No MPH, FAAP, ancillary reviewer Ferdinand Yates, MD, No ancillary reviewer Athos Bousvaros, MD, Yes MPH, question writer M. Robin English, MD, No question writer Paul G. Fisher, MD, No question writer Sydney A. Rice, MD, No question writer O.J. Sahler, MD, No question writer Ashok Sarnaik, MD, No question writer Richard Sills, MD,, FAAP, Yes question writer Douglas Silverstein, MD, No FAAP, question writer Hiram Stephen Williams, No MD, MPH, FAAP, question writer

None

Do not intend to discuss.

None

Do not intend to discuss.

Merck, UCB Research grants; Millennium Paid Do intend to discuss. consultant, speaker bureau None Do not intend to discuss. None None None None Novartis Research grant None None Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss.

Pediatrics in Review 2009-10 Editorial Board

Name Relevant Financial Relationship (Please indicate Yes, or No) Name of Commercial Interest(s)* (Please list name(s) of entity) AND Nature of Relevant Financial Relationship(s) (Please list: Research Grant, Speakers Bureau, Stock/Bonds excluding mutual funds, Consultant, Other - identify) Disclosure of Off-Label (Unapproved)/Investigational Uses of Products AAP CME faculty are required to disclose to the AAP and to learners when they plan to discuss or demonstrate pharmaceuticals and/or medical devices that are not approved by the FDA and/or medical or surgical procedures that involve an unapproved or off-label use of an approved device or pharmaceutical. (Do intend to discuss or Do not intend to discuss)

25

Lawrence F. Nazarian, MD, FAAP, Editor Tina L. Cheng, MD, MPH, FAAP, Associate Editor Joseph A. Zenel, MD, FAAP, Associate Editor Robert J. Haggerty, MD, FAAP, Editor Emeritus and Founding Editor Henry M. Adam, MD, FAAP, Editor, In Brief Deepak Kamat, MD, FAAP, Editor, Index of Suspicion Janet Serwint, MD, FAAP, Consulting Editor Laura Ibsen, MD, FAAP, Consulting Editor, Online and Multimedia Projects Hugh D. Allen, MD, FAAP Margie Andreae, MD, FAAP Richard Antaya, MD, FAAP

No No

None National Institutes of Health, US Centers for Disease Control, Office of Adolescent Pregnancy Program, various foundations Research grants None None

Do intend to discuss but will identify offlabel use. Do not intend to discuss.

No No

Do not intend to discuss. Do not intend to discuss.

No No

None None

Do not intend to discuss. Do not intend to discuss.

No

None

Do not intend to discuss.

No

None

Do not intend to discuss.

No No Yes

None None Astellas Pharma, US, Inc. speaker bureau, advisory boards, clinical trials; Novartis speaker bureau

Do intend to discuss. Do not intend to discuss. Do intend to discuss.

26

Denise Bratcher, DO, FAAP George R. Buchanan, MD, FAAP Brian Carter, MD, FAAP Latha Chandran, MD, FAAP David N. Cornfield, MD, FAAP Joseph Croffie, MD, FAAP

No No

None None

Do not intend to discuss. Do not intend to discuss.

No No Yes

None None Sucampo Pharmaceuticals (Lubiprostone), Braintree Lbs (Miralax, Halfytely), Medtronics (Bravo pH Capsule), Tap pharmaceuticals (Prevacid) research grant, speaker bureau None None; speaker and committee member of a Pediatric Board Review Course (sponsored by Abbott Nutrition) though AAP New York None None None None None

Do not intend to discuss. Do not intend to discuss. Do not intend to discuss.

B. Anne Eberhard, MD BS, MSc, FAAP Leonard Feld, MD, PhD, MMM, FAAP Rani Gereige, MD, MPH, FAAP Mark Goldstein, MD, FAAP Lindsey Grossman, MD, FAAP Patricia Hamilton, MD, CBE Hal B. Jenson, MD, MBA, FAAP

No No

Do not intend to discuss. Do intend to discuss.

No No No No Yes

Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do intend to discuss.

27

Donald Wray Lewis, MD, FAAP

Yes

Astra Zeneca, Merck Research grant, consultant; Ortho McNeil, Lilly, Bristol-Myers Squibb, GlaxoSmithKline, Boehringer Ingelheim Pharmaceutical research grant None None None None None None None None None None None None None None

N/A

Gregory S. Liptak, MD, MPH, FAAP Blaise Nemeth, MD, MS, FAAP John Pascoe, MD, MPH, FAAP Thomas T. Sato, MD, FACS, FAAP Sara E. Shea, MD, FRCPC, FAAP Nancy D. Spector, MD, FAAP Surendra K. Varma, MD, FAAP Mary Rimsza, MD, FAAP Dan Krowchuk, MD, FAAP Kurt Metzl, MD, FAAP Robert M. Perelman, MD, FAAP Michael Held Sydney Sutherland Susan Piscoran

No No No No No No No No No No No No No No

Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. N/A Do not intend to discuss. Do not intend to discuss. Do not intend to discuss Do not intend to discuss Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss. Do not intend to discuss.

28

Luann Zanzola Deborah K. Kuhlman

No No

None None

Do intend to discuss. Do not intend to discuss.

Continuing Medical Education Credit The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAP designates this journal-based CME activity for a maximum of 36 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity is acceptable for a maximum of 36 AAP Credit(s). These credits can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Members of the AAP. The American Academy of Physician Assistants accepts AMA PRA Category 1 Credit(s)TM from organizations accredited by the ACCME. This program is approved for 36 NAPNAP CE contact hours; pharmacology (Rx) contact hours to be determined per the National Association of Pediatric Nurse Practitioners Continuing Education Guidelines. It has been established that each months questions will take the learner a maximum of 3 hours to complete.

Claiming CME credit Activity Title: Pediatrics in Review 2012 Activity Location: Print & online journal Activity Dates: Jan. 1, 2012 Dec. 31, 2014

29

Pediatrics in Review subscribers may claim a maximum of 36 AMA PRA Category 1 Credit(s)TM upon completion of all the quiz questions over the course of their annual subscription. On a monthly basis members may claim a maximum of 3 AMA PRA Category 1 Credit(s).TM New Minimum Performance Level Per the 2010 revision of the American Medical Association (AMA) Physicians Recognition Award (PRA) and credit system, a minimum performance level must be established on enduring material and journal-based CME activities that are certified for AMA PRA Category 1 Credit. In order to successfully complete 2012 Pediatrics in Review for AMA PRA Category 1 Credit, learners must demonstrate a minimum performance level of 60% or higher on the quiz, which measures achievement of the educational purpose and/or objectives of the activity. Starting with the 2012 Pediatrics in Review, AMA PRA Category 1 Credit can be claimed only if 60% or more of the questions are answered correctly. If you score less than 60% on the assessment, you will be given additional opportunities to answer questions until an overall 60% or greater score is achieved. Once the minimum performance level has been achieved, members are provided with a link to their Transcript on pedialink.org to claim CME credit each time they answer all the questions for a subscription month. If you are not an AAP member or a PediaLink subscriber, please request a certificate of completion via e-mail to transcripts@aap.org. Include your first and last name, your AAP ID number, the title of the activity, and the date you completed the activity. Please allow 15 20 business days for your certificate to be processed. No product-specific advertising of any type, or links to product web sites, appear in this educational activity.

Acknowledgments The American Academy of Pediatrics (AAP) gratefully acknowledges the contributions to the development and production of the 2010 Pediatrics in Review of the following individuals: Robert Haggerty, MD, FAAP (founding editor and editor emeritus), Christine Crane (HighWire Press project manager), Lorena Hitchens (HighWire Press CME manager), and Erin Carlson (Editorial Assistant). Questions or Comments If you have a question, suggestion, or comment about Pediatrics in Review, please contact the AAP Customer Service Center at: Phone: Email: 866-843-2271 csc@aap.org

30

Address Changes Contact the AAP Customer Service Center at 1-866-843-2271, Monday through Friday, 7 AM - 5:30 PM Central Time, or e-mail csc@aap.org at anytime. AAP members can edit contact information by logging on to www.aap.org/moc and clicking on Update My Personal Profile. Be sure to provide your AAP ID number on any correspondence. Or mail your request to: American Academy of Pediatrics Customer Service Center 141 Northwest Point Blvd. Elk Grove Village, IL 60007-1098

Technical Support For technical support, please submit your request via the Pediatrics in Review feedback website http://pedsinreview.aappublications.org/feedback You should receive an emailed response within 1-2 business days. If you prefer, you may contact the AAP at 866-THE-AAP1 (843-2271) or csc@aap.org, To order products, visit the AAP on the web at http://www.aap.org.

AAP Privacy Statement The American Academy of Pediatrics (AAP) takes the issue of privacy very seriously. This policy is intended to help you understand how AAP collects, uses and safeguards the information collected on our Web site. This Privacy Policy does not apply to the use or disclosure of information that is collected or obtained through means other than this Web site. Collection of Information: Visitors may generally browse public portions of the AAP Web site anonymously without providing any personal information. However, AAP members are required to provide personal information in connection with registering for or accessing member portions of the site. In addition, personal information will be requested in connection with purchasing products or services, requesting additional information, signing up for newsletters or listservs, participating in forums or submitting questions through this site. In general, a visitor will know when personal information is being collected because he or she will have to fill out a form. AAP does not knowingly collect or use any personal information from users under 13 years of age. AAP will endeavor to correct, update or remove collected personal data if contacted (webmaster@aap.org).

31

AAP Use of Information: Any information collected on the Web site will be used by the AAP only for the purpose stated at the time of collection. Only those who ask to be added to AAP e-mail lists or who ask for information from AAP will receive e-mail communications from AAP. AAP members may be automatically added to AAP e-mail lists or certain other private lists if AAP has an e-mail address for the member. E-mail addresses may be removed from AAP e-mail lists at any time by following the applicable opt-out procedure specified in the list welcome message or by contacting the AAP Listmaster and specifying the name of the list. AAP may share statistical or aggregated, non-personal information about our visitors with affiliates, business partners and other third parties. This data is used for administrative purposes only. Sharing of Information: AAP may provide personal information to third party agents that have been hired to help provide a requested good or service. For example, in connection with a product order, AAP would need to provide the collected credit card number to a payment authorization service and the corresponding address to a shipping company to deliver the package. Unless directed otherwise at the time of collection, AAP may also share collected personal information with third parties who may have information or services that AAP believes could be helpful to members or visitors. AAP may also share personally identifiable information obtained from an AAP member for the purpose of facilitating the member's access to programs and activities consistent with AAP's goal of improving quality in the delivery of pediatric health care services. AAP members may change their preference for the sharing of information on the member page. Other visitors may also opt-out from the sharing of collected information by contacting the AAP Webmaster (webmaster@aap.org). Cookies and Tracking Information: AAP may use "cookie" technology to obtain non-personal information from its on-line visitors. AAP servers may also collect the IP addresses and domain names of visitors for site administration purposes. AAP does not extract personal information in these processes, nor does AAP provide this information to third parties. AAP does not contact on-line visitors based on information in the AAP cookie file. AAP has taken commercially reasonable steps to protect information received from online visitors against unauthorized access and use. All information is protected by AAP security measures, which are periodically reviewed. AAP reserves the right to disclose without notice to the user any information in its possession if required to do so by law, to protect or defend AAP's rights or property, or to respond to an emergency. This Web site contains links to third-party Web sites which are not under the control of the AAP. AAP is not responsible for the privacy practices of any linked site. AAP reserves the right to revise this privacy statement at any time by posting a revised statement on this Web site. Use of this Web site after such change signifies the user's acceptance of the changed terms.

32

Specific areas or pages of this Web site may include additional or different terms relating to the use of personal information collected from such areas or pages and, in the context presented, in the event of any conflict between those specific terms and this Privacy Statement, those specific terms shall control. This Privacy Statement is effective as of October 21, 2005. Questions about this privacy policy or requests concerning AAP privacy practices should be directed to the AAP Webmaster (webmaster@aap.org). 2012 by the American Academy of Pediatrics, Pediatrics in Review.

33