Explorez tous les épisodes du podcast Primary Care Perspectives

Heart murmurs are one of the most common reasons pediatricians consider referring a child to cardiology—but which murmurs can be safely followed in primary care, and which require urgent evaluation? In this episode, host Katie Lockwood, MD, MEd, speaks with Aaron T. Dorfman, MD, about a practical, bedside approach to distinguishing innocent from pathologic murmurs, recognizing red flags before sports participation, and counseling families about common concerns. Through real-world clinical scenarios you'll gain confidence in evaluating murmurs, deciding when additional testing is appropriate, and knowing when referral to pediatric cardiology is warranted.

This episode qualifies for AMA PRA Category 1 Credits™. Visit chop.cloud-cme.com and search for the episode title to claim credit.

Generative AI is being used at home, school, and in hospitals. So what do pediatricians need to know so they can guide patients and families on safe usage of AI? In this episode, Stephon N. Proctor, PhD, ABPP and Daria F. Ferro, MD, share insights from their research on the implications of generative AI For families and pediatricians and explore how pediatricians can mitigate negative effects of this technology.

This episode qualifies for AMA PRA Category 1 Credits™. Visit chop.cloud-cme.com and search for the episode title to claim credit.

Do all children need a pediatrician visit after bronchiolitis hospitalization? Not necessarily. Join host Katie Lockwood, MD, MEd and Christopher Bonafide, MD, MSCE, as they discuss the evidence behind as-needed follow-up, reducing unnecessary healthcare visits, empowering families, and the exciting work of the I-DECIDE study to bring evidence-based care into everyday practice.

This episode qualifies for AMA PRA Category 1 Credits™. Visit chop.cloud-cme.com and search for the episode title to claim credit.

We’re joined by Juhee Lee, MD, to discuss de-labeling drug allergies and why reassessing reported allergies can be an important part of improving patient care. Dr. Lee shares practical insights for primary care clinicians on evaluating drug allergy histories and identifying patients who may safely benefit from de-labeling. Why is de-labeling important? It can improve care, lower costs, and slow antimicrobial resistance. 

National Penicillin Allergy Day is September 28th, marking the anniversary of Sir Alexander Fleming's discovery of penicillin in 1928!

For more information, visit: Drug Reaction Evaluation and Management Program | Children's Hospital of Philadelphia

When you hear people talking about Section 504 or a 504 plan, this usually refers to a part of a U.S. law called the Rehabilitation Act of 1973. This civil rights law protects people with disabilities from discrimination, and that helps protect our patients while they are at school. Join a discussion about Section 504 with Margie Wakelin, Esq, from the Education Law Center, Layla Abdulla, MD, a pediatric resident, and Noreena Sondhi, JD, Director of the Community Pediatrics and Advocacy Program at CHOP.

In recognition of National Breastfeeding Month, join host Katie Lockwood, MD, MEd, for a practical conversation on the latest evidence in breastfeeding medicine. Dr. Meg Kawan, pediatrician, breastfeeding medicine specialist, and IBCLC, discusses how pediatricians can better support breastfeeding families—from creating a breastfeeding-friendly office to managing mastitis, navigating tongue-tie, and addressing common breastfeeding challenges. Tune in for evidence-based updates and practical pearls you can apply in your practice right away.

This episode qualifies for AMA PRA Category 1 Credits™. Visit chop.cloud-cme.com and search for the episode title to claim credit.

In this episode, we’re diving into hereditary hemorrhagic telangiectasia, or HHT—a genetic condition that often first shows up in ways pediatricians see every day, like recurrent nosebleeds or unexplained anemia. Nihal Bakeer, MD, a hematologist and Allison Britt, MS, LCGC, a genetic counselor, help us recognize the early signs, understand when to suspect HHT, and evaluate how to manage and refer these patients in the outpatient setting.

Learn more about CHOP's HHT program here. 

Eosinophilic esophagitis (EoE) is a chronic immune-mediated condition that affects feeding, growth, and quality of life, traditionally diagnosed and monitored through repeated endoscopies. Recent advancements include the esophageal string test, a minimally invasive method that captures disease activity through biomarkers rather than tissue biopsies, potentially transforming personalized care for EoE patients. This discussion features insights from Amanda Muir, MD, MTR, a pediatric gastroenterology and Melanie Ruffner, MD, PhD, an allergist/immunologist, and highlights how the esophageal string test is being integrated into clinical care programs, such as the Frontier Program at Children's Hospital of Philadelphia, with ongoing research addressing unanswered questions in EoE to enhance patient-centered care.

For more information, visit: Center for Pediatric Eosinophilic Disorders | Children's Hospital of Philadelphia

Drowning remains one of the leading causes of death for children. In this episode, Drs. Rotherham and Stafford explain the “layers of protection” concept, including swim lesson timing, effective home pool safety measures, and the risks of floatation devices versus life jackets. We also clarify terms like “dry drowning” and dispel myths around water safety. This episode includes key water safety messages that all pediatricians should share with patients and families.

This episode qualifies for AMA PRA Category 1 Credits™. Visit chop.cloud-cme.com and search for the episode title to claim credit.

The coauthors of a new study in the journal Pediatrics titled “Black Teenage Male and Caregiver Perspectives on Anticipatory Guidance for Police Encounters”, join Katie Lockwood, MD, MEd, in this episode to discuss how pediatricians can help prepare Black youth to safely navigate police interactions. We address the challenges and importance of conversations about racism, especially for racially non-concordant providers, the role of caregivers in facilitating these discussions, and the professional development needs of providers. Thank you to Jeffrey Eugene, MD, and Nikki Jaffe, MD, for sharing their research and lessons learned from their focus groups on how patients and caregivers want to have "the talk" with their pediatric provider.

In this episode, Haley Pearlstein, MD, a CHOP gastroenterologist, discusses cyclic vomiting syndrome (CVS), a pediatric condition marked by recurrent severe nausea and vomiting episodes separated by symptom-free intervals, with a prevalence of up to 3.2% in children. We cover typical presentation in primary care, NASPGHAN guidelines, differential diagnoses including CNS tumors, and diagnostic work-up strategies. In addition, we explore how acute treatments parallel migraine therapies, recommended lifestyle modifications, and preventive medications.

For more information on CVS or to refer to CHOP GI, visit: Division of Gastroenterology, Hepatology and Nutrition | Children's Hospital of Philadelphia

In Philadelphia, a 2007 Board of Health regulation allows capable adolescents ages 11–18 to self-consent to vaccines that prevent reportable diseases, recognizing that teen vaccine coverage remains suboptimal in part due to access barriers and inconsistent uptake when decisions rest solely with parents. This episode explores how that policy works in practice and what it means for autonomy, equity, and public health.

We’re joined by Dr. Marva Schödel, co-author of a recent paper on adolescent vaccine self-consent, to unpack the real-world impact of this approach. This research was done with the Pediatric Research Consortium (PeRC), a primary care practice-based research network at Children’s Hospital of Philadelphia. Dr. Schödel is, as of the time of publication, an employee of Merck, who manufactures the HPV vaccine, Gardasil 9. 

81% of food allergy parents report significant worry about their child. We know that food allergies and anxiety are both common childhood diagnoses, but in this episode we explore the correlation and how we as pediatricians can help recognize when is this anxiety helpful and when is this anxiety unhelpful? In this episode, learn from Tamara Hubbard, MA, LCPC, a licensed clinical professional counselor and family therapist, and Megan Lewis, MSN, RN, PCNP, a Pediatric Nurse Practitioner in the CHOP Division of Allergy and Immunology.  

We have discussed on this podcast before in Episode 143 how to help children who have both food allergies and anxiety, but in this episode, we focus on the parent-child dyad and how parental anxiety may impact a child.

Transition of care from pediatric to adult medicine is sometimes a stressful process, but adolescents with autism and intellectual disabilities have additional considerations and steps that should be taken to make this transition optimal. In this episode, Stacy Ellen, DO, Karin Roseman, LCSW, and Mary Stephens, MD, MPH, from St. Christopher's Hospital for Children tell us about their medical home model, practical tools for preparing for transition, and resources for pediatric primary care providers. 

Why does autism spectrum disorder attract so many myths? In this episode, Kate Wallis, MD, MPH, a developmental behavioral pediatrician, explains why there are so many questions about autism and gives us some expert answers and advice. We discuss acetaminophen, leucovorin, assisted communication, vaccines, and more!

#AutismAcceptanceMonth 

Contraception counseling is an important part of comprehensive primary care for adolescents. The past decades have drastically changed the landscape of available contraception options. However, with so many options, contraception counseling can seem overwhelming. In this episode, Gladyne Confident, M.D., an attending in the Division of Adolescent Medicine at Children’s Hospital of Philadelphia, addresses the basics of contraception counseling, how to approach misinformation about contraceptives, and more, using a nuanced and patient-centered approach.

Special thanks to our guest host, Julia Pickel, MD, a pediatric resident at CHOP completing an Advanced Skills in Podcasting.

Eczema, or atopic dermatitis, is common, but it is rare that a food allergy causes atopic dermatitis. In this episode, CHOP allergist Katie Kennedy, MD, explains that only about 25% of children with severe atopic dermatitis have flares driven by foods. She also discusses the pitfalls of allergy testing, approaches to identifying food triggers, and when to refer to an allergist. 

Dr. Kennedy talks about beef tallow and eczema, but for more information view Pediatric Health Chat. CHOP also has a Clinical Pathway for the Evaluation/Treatment of Children with Suspected Atopic Dermatitis. For more information on CHOP's Allergy Program, visit: Allergy Program | Children's Hospital of Philadelphia

#foodallergies #eczema

There is a lot of information online about vaccines-- some good, some bad. This means that patients are coming to their primary care providers with more vaccine questions. In this episode, Lori Handy, MD, MSCE, and Charlotte Moser, MS, from the CHOP Vaccine Education Center discuss communication skills that clinicians can use in discussing vaccines with patients and families to provide clarity, build trust, and open dialogue. 

Another resource with good information for patients and families on common vaccine myths is CHOP's Pediatric Health Chat. 

#vaccines

In this episode, pediatric residents, Drs. Frances Avila-Soto and Michelle Rose, discuss the challenges immigrant families face while seeking healthcare. They also discuss how access to healthcare has been impacted by recent policy changes, what to do when ICE presents to a clinical space, and how pediatricians are uniquely equipped to advocate for immigrant patients. They hope that this episode leaves clinicians feeling more confident in caring for immigrant families and in their ability to continue advocating for their patients.

For more information on the CHOP Pediatric Residency Program, visit: Pediatrics Residency Program | Children's Hospital of Philadelphia

Did you know that in the early 1900’s, a dentist figured out that people who had high levels of fluoride naturally occurring in their water supply had very low rates of tooth decay? This led to further research and ultimately community-wide fluoridation programs. Today, many places have fluoride in the water, toothpaste, and applied topically by the dentist or pediatrician. In this episode, we talk about topical fluoride dental varnish with Brian Jenssen, MD, MSHP, a CHOP researcher with Clinical Futures and the Possibilities Project, whose QI project on fluoride varnish was published in Pediatrics in October 2025. While fluoride continues to be a hot topic in the news, learn from Dr. Jenssen why we should embrace it in pediatric primary care. 

Many people do not know the difference between the terms deaf, Deaf, and Hard of Hearing, so in this episode we discuss the diverse landscape of hearing loss. Michael Hoffman, PhD and Matthew E. Fasano-McCarron, PsyD, discuss why some comorbidities may be more common in patients with hearing loss and some of the challenges in making diagnoses of comorbidities such as autism, ADHD, and intellectual disability. We also discuss the impact of language deprivation on the brain and how it impacts development, particularly psychosocial functioning. For more information on services for hearing loss and speech disorders offered at CHOP, visit the Center for Childhood Communication. 

Pediatric residents, Drs. Kelly McNult and Colleen Lynch, explain how they created an advocacy project related to bike helmets inspired by their personal experiences with patients and the loss of a colleague, Dr. Barbara Friedes. In this episode they not only explore how to execute an advocacy project as a resident but also teach us more about the effectiveness of bike helmets, how to ensure helmets fit, and other bike helmet anticipatory guidance. 

In the early 2000’s pediatricians recommended delaying the introduction of highly allergenic foods, like peanut, but we saw that the rates of peanut allergy continued to rise. However, the 2015 LEAP trial showed that early introduction was better. In fact, the LEAP trial found an 81% decrease in peanut allergies by age 5 in children who had an early introduction. In this episode, Stanislaw J. Gabryszewski, MD, PhD, discusses what we have learned in the decade since the LEAP trial and explains his recent study on how these guidelines have impacted the rates of peanut allergies in children. 

In this episode, Andrew Cohen, DMD, who is board certified in dental sleep medicine and a comprehensive restorative dentist, explains how anatomy, behavior, and overall health impacts sleep-related breathing. We discuss common issues like mouth-breathing, teeth grinding, thumb-sucking, and extended pacifier use and how these impact dental health and sleep. For more information, visit the CHOP Sleep Center.

Opinions expressed in this episode are those of Andrew Cohen, DMD, and not necessarily representative of Children's Hospital of Philadelphia.

We learned a lot about pediatric asthma during the COVID-19 pandemic, including how significant the impact of viruses is on causing asthma flares. In this episode, Shikha Saxena, MD, from our Children's Hospital of Philadelphia Division of Pulmonary Medicine, Pulmonary Asthma Program, and Pulmonology and Allergy Personalized Asthma (PAPA) Clinic, discusses ways to help keep asthma in good control through the viral season. We discuss when to use inhaled corticosteroids, school-based management approaches, and navigating insurance coverage challenges. Also, Dr. Saxena reinforces the importance of getting a flu shot!

Can you reduce the risk of concussion through specialized protective equipment? In this episode, two of our Minds Matter Concussion Program experts, Kristy Arbogast, PhD, and Christina Master, MD, FAAP, CAQSM, FACSM, FAMSSM, discuss whether the specialized equipment used by NFL players has evidence in pediatric athletes. We also learn other ways that parents, coaches, and trainers can mitigate concussion risk and how we can keep young athletes safe. This episode is a mix of physics and physical education classes, and you are certain to learn a lot about football protective equipment!

Imagine intentionally eating an allergen to re-teach your immune system to overcome this allergy? That's what our CHOP Allergists are doing in the Oral Immunotherapy Program and it is life changing science in practice! In this episode, Antonella Cianferoni, MD, PhD, explains oral immunotherapy including the immunologic process, the logistics for patients, and managing the risk of anaphylaxis. A great episode for providers and families!

Less well known that SIDS, SUDC is a category of death for a child 12 months of age or older that remains unexplained after a thorough investigation. In this episode, Richard Goldstein, MD, Director of the Roberts Program on Sudden Unexplained Death in Pediatrics and Associate Professor of Pediatrics at Harvard Medical School, teaches us more about SUDC including possible causes, how to navigate this diagnosis with families, and where the research is leading us. 

A special surprise guest joins us for the 200th episode anniversary! In this episode we explore why CHOP started a medical education podcast, how topics/guests are chosen, and what impact the podcast has had on listeners. Get behind-the-scenes with host and creator, Katie Lockwood, MD, MEd, and learn about the important role of podcasting in medical education. 

This year the Children's Hospital of Philadelphia (CHOP) Poison Control Center celebrates it's 40th anniversary! In this episode, Fred Henretig, MD, one of the founders of the Poison Control Center reviews the history of how the Center came to be and it's role in keeping children safe and healthy in 2025. Robert Bassett, DO, teaches us about how the Poison Control Center operates and what the most common poisoning threats are today and how to prevent them. Meanwhile, Katie Lockwood, MD, MEd, shares that her family has called, so make sure you have 1-800-222-1222 saved in your phone and listen to this fascinating episode for more tips on poison prevention!

Dengue fever is a mosquito-borne viral illness that can have serious complications. In this episode, Lori Handy, MD, MSCE, an attending in the Division of Infectious Diseases and Associate Director of the Vaccine Education Center at CHOP, explains the symptoms of dengue, why the vaccine is uncommonly used, and how to manage fever in a returning traveler. With half of the world's population living where dengue is common, this is an important infection for us to all know about and keep on the differential!

Marijuana use by teens has been stable over the past few decades with 1 in 5 high schoolers using marijuana regularly. However, THC levels in marijuana have increased and we are seeing more Cannabis Hyperemesis Syndrome (CHS). In this episode, Adam Kronish, MD, explains current trends in marijuana use, the physiology of CHS, and what we can do in primary care to identify and manage this condition. 

Delivering serious news is unfortunately a part of pediatrics. While some believe that we are inherently either good or bad at this skill, we know that is not true and that you can learn how to do this well. In this episode, Julie W. Stern, MD, the Director of Outreach Services with the Division of Oncology at Children's Hospital of Philadelphia, shares best practices and lessons learned from years of having difficult conversations. 

Tzield or Teplizumab, is a CD3-directed monoclonal antibody to delay the onset of Stage 3 Type 1 Diabetes in adults and pediatric patients aged 8 years and older. This is an important new treatment option because when diabetes is recognized in the early stages (Stage 2), there is an approved treatment that has been shown to delay the need for insulin by about 2-3 years. In this episode, Neha S. Patel, DO, who is an Associate Professor of Pediatrics and an attending physician in the Division of Pediatric Endocrinology and Diabetes at Children's Hospital of Philadelphia, teaches us what we need to know about Tzield and how patients can access it. 

Jessi Gold, MD, MS, shares some of the lessons from her book, How Do You Feel: One doctor's search for humanity in medicine, including managing emotions, addressing burnout, and exploring self-identity. This episode feels like self-care! Learn the difference between secondary trauma, burnout, PTSD, and why healthcare workers are particularly at risk for experiencing trauma. Dr. Gold not only explores the current state of healthcare worker mental health but gives actionable ideas to help the helpers!

Paul Tran, MD, a pediatric gastroenterologist and medical educator, empowers and encourages medical learners through his comedic online medical education, using the handle @alimentaryschool. Listen as we discuss how he got started, the anatomy of a post, and how to respond to online criticism. In addition, we hear about his viral posts and why he's always carrying a notebook. 

Two experts from the CHOP Bariatric Program, Joy Collins, MD, and Elizabeth Parks Prout, MD, MSCE, update us on the state of pediatric obesity, the current medication and surgical management options, and the outcomes of these interventions. The Adolescent Bariatric Program at CHOP is a unique collaboration between our Health and Well-being Clinic, surgeons at CHOP and HUP, clinical psychologists, a clinical dietician, a social worker, and a physical activity specialist. In this episode, Drs. Collins and Prout discuss the psychosocial impacts of bariatric surgery and their team-based, holistic approach to treating patients. 

An estimated 11.4% of US children are diagnosed with ADHD. In this episode, Thomas Power, PhD, ABPP, Director of the Center for Management of ADHD at CHOP, discusses a new Clinical Pathway for the Evaluation and Treatment of ADHD and how primary care providers can utilize and promote psychosocial interventions for ADHD. We discuss behavioral parent training, peer interventions, school supports, emotion regulation, and more, in this fascinating episode!

In light of the recent measles outbreaks, Scott Krugman, MD, MS, FAAP, created a series of social media posts about vaccine-preventable infections. In this episode, he shares pearls from those posts so that we can learn more about these illnesses, which many practicing pediatric providers have never seen outside textbooks thanks to the success of vaccines. He also talks about how his social media posts were received online and why they were so popular.

In this episode, we discuss the definition and work-up of short stature as well as treatment of growth hormone deficiency. Marissa Kilberg, MD, MSEd, an attending physician in the Division of Endocrinology and Diabetes teaches us about who might qualify for growth hormone deficiency treatment, possible side effects, the logistics of treatment, and when treatment is not indicated. Dr. Kilberg offers primary care providers strategies about the work-up that can be done in primary care as well as management pearls for patients on growth hormone therapy. 

In this episode, Juhee Lee, MD, an attending physician in the Division of Allergy and Immunology at CHOP, discusses some of the nuanced ways anaphylaxis can present and reviews the diagnostic criteria for anaphylaxis. We use a few cases to apply the diagnostic criteria to real-world challenges and discuss how to manage patients with anaphylaxis in the outpatient setting. Dr. Lee teaches us about what's new in anaphylaxis treatment, including intranasal epinephrine, and when patients need to carry epinephrine auto-injectors. Lastly, we review the CHOP Clinical Pathway for the Evaluation/Treatment of Children with Anaphylaxis, which is a great resource. 

Sine 2023, both the FDA and AAP have supported the use of goat milk-based infant formula, but awareness of this option still lags and many think of it as a niche product. Ari Brown, MD, a board-certified practicing pediatrician in Austin, Texas, the author of the best-selling Baby 411 book series, and Kabrita’s Chief Medical Advisor, teaches us more about why families would choose a goat milk-based formula and the safety data behind its use in the US. Dr. Brown also gives us a great review of all of components of formula and what we should be looking for in the ingredients. In this episode, we also discuss the risks of homemade infant formula, raw milk, and unregulated formula, and Dr. Brown shares her experience in working in both the formula industry and in her pediatric clinic. 

In honor of American Heart Month, Jonathan Edelson, MD, an attending cardiologist at Children’s Hospital of Philadelphia (CHOP) and the Medical Director of the CHOP Sports Cardiology Clinic, talks with Katie Lockwood, MD, MEd, about sports participation for athletes with cardiac disease. Dr. Edelson addresses the importance of physical activity for children with cardiac conditions and how exercise plans should be individualized based on a child’s cardiac condition so that they can meet their exercise goals safely. Learn about the unique CHOP Sports Cardiology Clinic and how they guide athletes and may coordinate care with cardiologists and primary care providers. #HeartMonth @HeartCare4Kids #Cardiology2025 #CHOPHeartWarrior #SportsCardiology

70-80% of patients do not use their asthma inhaler properly and use deteriorates over time. As Dr. Lockwood admits, many providers also don't know how to use some of the inhaler types out on the market and asthma medication shortages have led to prescribing challenges lately, so in this episode, Marcia Winston, MSN, RN, CPNP-PC, AE-C, a nurse practitioner with the Division of Pulmonary and Sleep Medicine at Children's Hospital of Philadelphia, walks us through various inhaler types and troubleshoots management issues. We also discuss the implementation of the 2020 GINA guidelines SMART therapy recommendations, use of and cleaning aero chambers, and a poster guide to identify mystery inhalers!

Although relatively rare with 300 cases per year in the United States, we look for retinoblastoma at every well visit. Amish Shah, MD, PhD, a neuro-oncologist at CHOP, educates us on the epidemiology, presentation, management, and prognosis of retinoblastoma, as well as how partnership between Children's Hospital of Philadelphia and Wills Eye Hospital has improved outcomes for children. 

Become better prepared to respond to an emergency situation on an airplane through the experience of an emergency medicine physician at Nemours Children's Health, Steven Selbst, MD. In this episode, Dr. Selbst and Dr. Lockwood discuss why healthcare providers should respond to emergencies, the most common types of emergencies, what supplies are on board, and the resources available to responders. 

Iron plays a crucial role in many vital functions and in this episode, Char Witmer, MD, Clinical Director of Hematology at Children's Hospital of Philadelphia, gets us excited about hepcidin, ferritin, reticulocyte counts, and more! We discuss why premature infants are particularly vulnerable to iron-deficiency anemia, how to provide supplementation, dietary sources of iron, laboratory measurements of iron, and more in this fascinating episode on anemia. 

Have you ever seen a baby eating a chicken drumstick? Or gnawing on a whole strawberry or broccoli floret? Many healthcare providers may not have learned about baby-led weaning and therefore, may not teach parents about this method of introducing solids and teaching babies about self-feeding. In this episode, Dr. Katie Lockwood and Kary Rappaport, OTR/L, MS, SCFES, IBCLC, a senior feeding and swallowing specialist on the team at Solid Starts, discuss the differences between choking and gagging, serving sizes at different ages, feeding challenges, handling allergens, and more, just in time for Thanksgiving! 

Healthcare professionals may use social media for a variety of purposes including developing a professional network, increasing personal awareness of news, listening to experts, and/or consulting colleagues. It can also be a tool to disseminate research, market practices, engage in health advocacy, and engage with professional organizations. Increasingly we are seeing health care professionals provide health information to the community and engage with patients on social media platforms. On this episode, Anjuli Gans, MD, a pediatrician at Karabots Pediatric Care Center in West Philadelphia, a CHOP Care Network primary care practice, who is known online for her site Resilient Rascals and its popular Instagram account of the same name with 141,000+ followers, discusses the rules of engagement, how to fight mis/dis-information, and why healthcare providers might want to create a social media account.

Of the roughly 500,000 US children with epilepsy, 30% will continue to have seizures despite medication management. This seizure burden can have significant impacts on a child’s development, school performance, social life, sports participation, driving ability, mental health, and more. In this episode, we talk about surgical approaches to drug-resistant epilepsy and explore some of the newest advances in neurosurgery with Benjamin Kennedy, MD, an attending neurosurgeon and the Director of Epilepsy and Functional Neurosurgery in the Division of Neurosurgery at Children’s Hospital of Philadelphia.