October 2, 2015

CAMC Women and Children's Hospital is the only freestanding women and children's hospital in the state, and offers a wide variety of pediatric specialties. Caring for children requires a different level of skill and expertise, from using smaller equipment to being extra sensitive to their developmental needs.

CAMC is home to three pediatricians who are the only ones in the state board-certified in their sub-specialties, offering valuable resources to pediatric patients in our region.

Child advocacy

The Children's Advocacy Center (CAC) at Women and Children's Hospital provides professional and compassionate care to children who are possible victims of child abuse. The center provides comprehensive services to pediatric patients and their families, conducting forensic interviews, performing complete medical evaluations and providing case management and advocacy services. In 2014, the center treated more than 500 patients.

Joan Phillips, MD, and Sharon Istfan, MD, are the only pediatricians in West Virginia board-certified in child abuse pediatrics, a sub-specialty that was recognized by the American Academy of Pediatrics beginning in 2009. Phillips' and Istfan's specialized training provides them with a solid foundation of the intricacies of caring for a pediatric patient who was potentially the victim of child abuse.

Both Phillips and Istfan started out in general pediatric practices, but as they got deeper into their careers, began to see the need for more specialists focusing on child abuse.

"I would see things that I felt were being missed, such as kids coming into the emergency room with broken bones, and the stories just didn't fit," Istfan said.

While medical students and residents are taught about the signs of child abuse, sometimes the training isn't comprehensive enough.

Istfan and Phillips attended conferences and completed continuing medical education that made the need for pediatricians specializing in child abuse more evident.

"I realized early on in my career that people were uncomfortable with the subject of child abuse, the medical exams and the legal process," Phillips said.

"Nobody wants to think about child sexual abuse," Istfan added.

The benefit of having Istfan and Phillips at the Children's Advocacy Center is that they can coordinate a multidisciplinary approach to caring for a child who is a suspected victim of abuse.

"It's a matter of making sure the child's needs are met so everyone involved in that child's care knows what's going on and what the plan of action is, whether it be Child Protective Services, other physicians or law enforcement," Phillips said.

Phillips and Istfan take turns taking call for the ER at Women and Children's Hospital, and they also see patients once they are admitted to the hospital if child abuse is suspected.

One of the main roles they play in the care of the child is testifying in court. Since Phillips and Istfan work with all members of the child's care team, they can serve as the clinical liaison to the court to provide an overview of the case.

"That's the great thing about working at the CAC," Istfan said. "I have the time to go to court to speak on behalf of these kids."

A general pediatrics practitioner or other specialist working in the hospital would find it much more difficult to make time for the advocacy component.

Medical residents at Women and Children's Hospital rotate through the Children's Advocacy Center, and Phillips and Istfan impress upon them the importance of critical thinking when dealing with a potential child abuse case.

"We get them comfortable with the exams and the process, helping them to learn when to be concerned and how to know when a story isn't adding up," Phillips said.

Phillips and Istfan also provide community education to other health care providers, particularly in rural areas, and to the community at large.

While dealing with difficult cases on a daily basis is saddening, it's rewarding as well.

"It's the sheer need of these children that keeps me coming to work every day," Phillips said. "They have a unique need, and if I can be one person who makes a difference, that's what matters. I want to be a part of their healing."

Developmental-behavioral pediatrics

Another specialist that is unique to the state is developmental-behavioral pediatrician Beth Emrick, MD. She works in the WVU Physicians of Charleston – Pediatrics office, located in the medical staff office building at Women and Children's Hospital.

Developmental-behavioral pediatricians treat children with learning, attention and behavioral disorders as well as other developmental disorders like autism spectrum disorders, feeding disorders and visual and hearing impairments.

"I see kids with any kind of developmental delays young kids with behavior problems, school-aged kids with ADHD, kids with feeding disorders, and more," Emrick said. She also sees children once they are released from the NICU if they are experiencing delays in developmental milestones.

Emrick, who grew up in Charleston, came back to the area because she saw the need for her specialty and wanted to give back to the community where she had lived.

"We didn't have anybody around here that specialized in developmental-behavioral pediatrics. When I was a resident, we sometimes identified developmental delays or suspected problems like autism, but we didn't have a specialist in the area to send them to. It was frustrating," she said. "I wanted to come back here to fulfill that need."

Emrick completed a three-year fellowship in developmental-behavioral pediatrics at Akron Children's Hospital and is now board-certified in the specialty.

Emrick coordinates medical care for children with developmental or behavioral disorders, which may include testing, prescribing medications, or making sure parents are in contact with all the additional resources needed.

"Sometimes I'm the first person to make a diagnosis like autism, so I review all the necessary services with the family to make sure they are getting all the therapies they need," Emrick said. "There are a lot of parents looking for answers as to why their child is having developmental delays or behavior problems, and if I can be that person who helps them figure it out, that keeps me motivated."

Having sub-specialists on one campus in addition to dozens of other pediatric specialties offered at CAMC is vital to ensuring the best, most comprehensive care for children served at Women and Children's Hospital.

The Children's Advocacy Center sees patients Monday through Friday. To schedule an appointment or for more information, call (304) 388-2391.

Emrick sees patients Monday through Friday at the WVU Physicians of Charleston – Pediatrics office located in Suite 103 of the medical staff office building at Women and Children's Hospital. Call  (304) 388-1552 for more information.

Learn more about other specialties offered at Women and Children's Hospital at camc.org/Kids.

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