by Alyson Sulaski Wyckoff • Associate Editor
Three colleagues lingered
in the office with Fernando
Stein, M.D., FAAP, when the
mid-morning call came with
news that he won the election
as AAP president-elect. The
other physicians had inquired
so many times about the results, he invited them to wait
“I need all the help I can
get, win or lose,” he told them,
When the call finally arrived, “Fernando, congratulations” was the welcome
greeting on the line from
then-AAP President Sandra
G. Hassink, M.D., M.S.,
FAAP. Much excitement ensued, he recalled.
In the 2015 election, Dr. Stein, of Houston, ran
against Lynda M. Young, M.D., FAAP, of Worcester,
Mass. He follows Benard P. Dreyer, M.D., FAAP, of
New York, who assumed the office of AAP president
on Jan. 1. Dr. Stein takes over as
president on Jan. 1, 2017.
Two issues will receive priority
when he is president, Dr. Stein
The first focus will be to address the problems of toxic stress
for children “in every manifestation and including, at the top
of the agenda, the issues of gun
violence,” Dr. Stein said.
“You may remember that my
NCE speech (See resources on
page 4.) focused very much on
that because I consider it a public health problem,” he said. “I
think the Academy has the capacity to bring to the table different constituencies that can have a
constructive and positive influence on the trajectory
that the solution needs to have.”
www.aapnews.org Volume 37 • Number 1 • January 2016
See Election, page 4
In this issue
When to be concerned about ‘early’ puberty
While most cases in young children are normal variations,
some conditions require prompt referral to an endocrinologist. Page 12
How to examine eyes, visual system of patients
The updated guidance, now part of the 2016 Periodicity
Schedule, covers screening and eye exams throughout
childhood and adolescence. Page 16
Focus On Subspecialties
New techniques allow
MRI to be used
instead of CT
by Sarah Sarvis Milla, M.D., FAAP,
and Adina L. Alazraki, M.D., FAAP
The question often comes up: Should we do a
CT scan or MRI?
While both modalities now allow multiplanar
imaging of the body, each has advantages and
CT is a quick examination but exposes the patient to ionizing radiation. MRI has improved
soft tissue resolution, different sequences to accentuate different properties of pathology and is
free of ionizing radiation. However, certain metal
implants prohibit entrance into the MRI scanner.
In addition, MRI can take much longer than CT
because different sequences may be necessary for
full evaluation, and the need for sedation is not
without additional risk and service coordination.
Radiologists and physicists continue to collaborate to minimize the limitations of each technique.
Due to concerns about ionizing radiation and
exposure-related cancer risks, new CT scanners
now have software to help reduce dose according
to the size of the patient. Radiologists also create
specific protocols with optimized parameters to
keep radiation doses as low as reasonably achievable (the ALARA principle).
Similarly, techniques are being created to help
MRI overcome its limitations such as longer scan
times needed to achieve high-quality images. Improvements in techniques and novel sequences have
been created to reduce motion artifact from moving
patients. Fast MRI sequences, such as single shot fast
spin echo technique (See images on page 4.), can
acquire diagnostic images in as little as 20 seconds.
These techniques are tantamount when evaluating
nonsedated pediatric patients, including the fetus.
Furthermore, the need to sedate children prior
to an MRI scan is decreasing. Infants ages 0-3
months have a natural response to fall asleep after
a full feeding, so technologists can perform a “feed
See MRI, page 4
Houston-based critical care specialist
Fernando Stein, M.D., FAAP, the new AAP
president-elect, said toxic stress will be
one of his areas of focus.
After Robert E. Gross, M.D., FAAP (1905-’88),
made history in 1938 to become the first U.S. surgeon to successfully ligate a patent ductus arteriosus
(PDA), his boss was furious.
A surgical resident at the time, Dr. Gross operated
on 7-year-old Lorraine Sweeney at Boston Children’s
Hospital, affiliated with Harvard Medical School, after secretly practicing and planning in the hospital’s
postmortem room and animal laboratory. Though
he received a go-ahead from the acting chief, Dr.
Gross waited until his professor, William E. Ladd,
M.D., FAAP, chief of surgery at Children’s, took off
for summer vacation.
Collaborating with Dr. Gross was John Hubbard,
M.D., FAAP, a pediatrician who persuaded Dr. Gross
to undertake the risky procedure, which later was
written up in the Journal of the American Medical
Dr. Ladd, namesake of the AAP Ladd Medal from
the Section on Surgery, was outraged when he learned
of the surgery. Some reports say he promptly fired Dr.
Gross, while others maintain Dr. Gross went on strike
for a few months. Regardless, Dr. Gross eventually
returned to the staff.
Dr. Stein will be 2017 AAP president
Surgical pioneer Dr. Gross defied
authority to conduct landmark operation
Photo courtesy of Boston Children’s Hospital Archives
In 1963, on the 25th anniversary of the historic patent
ductus arteriosus operation, Robert E. Gross, M.D.,
FAAP, reunites with his patient in the surgical suite. See Surgeon, page 8