Welcome to the Developmental Behavioral Pediatrics rotation at the Center for Children with Special Needs Floating Hospital for Children @Tufts Medical Center! We are very pleased to have you with us.
The Center for Children with Special Needs prides itself on delivering interdisciplinary services that are child- and family-centered. The assessments that we conduct are comprehensive and evaluate the “whole child” with an appreciation of the child’s strengths and weaknesses and an understanding of the child’s role and functioning within his/her family, peer group, school and community. The CCSN offers clinical care and advocacy for children who have developmental, behavioral, and emotional issues that interfere with their growth, learning, and family or social functioning.
One in five children has a "special healthcare need", and behavior and development are relevant to ALL children. Despite this relevance, many pediatricians feel under-trained to identify and manage the developmental and behavioral challenges of their patients. YOU as the pediatrician and medical home provider will be among the most pivotal and continuous individuals responsible to the infant/child/adolescent and caregivers for following their developmental and behavioral needs; identifying special needs; shepherding families toward more specialized services; serving as an advocate for families; and other roles. Although developmental pediatricians can assist you in your primary role as the general pediatrician, the ball will still primarily be in your court to take the lead for the vast majority of your patients with special needs, and for all your patients in general.
Because your role as primary care provider is so singularly influential, the Pediatrics Residency Review Committee (RRC) requires a minimum of one month of DBP during pediatric residency training. Currently, at Tufts, this is accomplished by a 4 week rotation in your intern year. While Family Medicine Residency programs do not yet require a DBP rotation, Tufts Family Medicine recognized the need for DBP training in their own practices and arranged this rotation to fill that need. The focus of this rotation will be general developmental/behavior as well as children with special needs. The resources provided in this rotation can be used throughout your residency training as you manage the needs of children in your outpatient continuity clinic, subspecialty rotations, in the emergency department, and on inpatient services. The intended outcome is to leave you with the tools and strategies you will need to identify, manage and support your patients and their families with greater confidence.
This will be accomplished through participation in patient evaluations and discussion with clinicians about specific cases; Required readings, videos, and self-learning modules; quizzes, including a pre-test and post-test, field-trips to Early Intervention, a child care center, schools; and other written and/or creative assignments that allow you to demonstrate your understanding and thinking. There is time set aside for you during some weekdays and of course during your evenings and free weekends, to complete assigned work.
We welcome all feedback and suggestions from you. We realize that there is a great deal to accomplish over the month, but in the end we feel that your knowledge of Developmental-Behavioral Pediatrics will serve you well throughout your training and in whatever you choose to pursue for your career.
We hope you will learn a lot and enjoy your time here. The clinicians here are committed to educating residents so that you can provide the best care for children in the future.
DBP Experience: Overview and Structure:
A. PLI Core Rotation in Developmental Disabilities:
Your rotation will consist of many activities that are designed to provide you with a broad-based, well-rounded exposure to the subspecialty of Developmental-Behavioral Pediatrics (DBP) and to explore normal child development. Most of your scheduled activities will take place in the 2nd floor of the Floating. In addition to clinics and evaluations within the CCSN, there are several activities that take place outside of the Floating Hospital.
0-6 year Clinic
Parent Feedback Visit
Field Trip to TCC Day Care
LEAP Clinic (School Age Clinic)
Brookline School District with Dr. von Hahn
Observations and/or Field Trips, Self-Directed Learning (including report writing)
Grand Rounds and Didactic lecture blocks
Observations & Field Trips, Self-Directed Learning (including report writing)
Goals and Objectives
There are three components to a resident’s experience in Developmental-Behavioral Pediatrics. The first is the 4 week PLI Core Rotation in Developmental Disabilities. The second is the Maternal Infant Unit teaching experience in New born Attachment. The third is the three year longitudinal experience comprised of 9 lectures and mentorship groups during the Wednesday afternoon didactic lecture series.
1. PLI Core Rotation in Developmental Disabilities
Autism Spectrum Disorders (ASD). Understand the primary care provider’s role in screening, diagnosing, managing, and/or referring children with ASD.
Developmental Delay. Understand the primary care provider’s role in screening, diagnosing, managing, and/or referring children with developmental delays
School Performance. Understand the primary care provider’s role in the promotion of school performance and the evaluation and management of school problems in children and adolescents.
Attention Deficit/Hyperactivity Disorder. Understand the primary care provider’s role in screening, diagnosing, managing, and/or referring children with ADHD and co-morbid disorders.
Developmental consequences of prematurity.
Review available information from parents, early intervention programs, schools, community agencies, and prior medical consultations to inform diagnosis and management
Recognize the role of specialists, referral processes, and case management across multiple disciplines to care for children with developmental disorders. This may include the following professionals:
3. Goals and Objectives for the 3 year Longitudinal Experience in Normal Child Development and Behavior:
Identify age appropriate developmental and behavioral milestones for infants, children, adolescents:
Recognize the role of a primary care provider role in discussing difficult childhood and adolescent behaviors including:
DBP Experience: Overview and Structure:
The two week rotation has several components: observations, evaluations, field trips and self-directed learning. The resident has the opportunity to observe a broad range of professionals- from DBP to speech pathology. The resident contributes to the data gathering on a patient as a member of the Learning Effectiveness Attention Program Clinic (LEAP). The DBP rotation includes Field Trips! The resident observes typically developing children in a large child care center and has the opportunity to observe delivery of therapy to infants and toddlers in an Early Intervention Class.
Schedule for the 2 week elective:
7:30 am-12:30 pm
Early Childhood Clinic
Fellows Follow Up Clinic
Pediatric GR and resident didactic
Goals and Objectives for the Family Medicine Rotation in Developmental Disabilities
1. Social Worker/Family Counseling
2. Early intervention services
3. Educational intervention (preschool and school age)
4. Clinical Psychology and/or Neuropsychology
5. Child psychiatry
6. Community Resource Specialist
7. Developmental-Behavioral/Neurodevelopmental Pediatrician
8. Occupational therapy
9. Physical therapy
10. Speech/language therapy
11. Physical medicine and rehabilitation