In this episode, Helen Cai and Dr. Faith Crittenden chat with Katherine and Dr. Porto about the challenges and opportunities of relying on infant formula, especially if it wasn’t a parent’s original plan.

=== Outline ===

Chapter 1: The realities of Infant Feeding

Chapter 2: The history and science behind formula

Chapter 3: Safe practices in handing infant formula

Chapter 4: Formula’s unintended benefits on family life

=== Learning Points ===

1. All infant formula are safe and complete due to regulations by the FDA and Infant Formula Act of 1980
2. The majority of infants thrive on standard intact cow’s milk protein formula
3. Prepared, refrigerated formula can be safely stored for up to 24 hours
4. Never dilute formula to stretch it, as this can lead to electrolyte abnormalities and failure to thrive

=== Our Expert(s) ===

Dr. Anthony Porto is a board-certified pediatric gastroenterologist and Professor of Pediatrics at Yale, where he serves as Associate Chief of Pediatric Gastroenterology and Medical Director of the Yale Pediatric Celiac Program. He is a recognized expert in infant nutrition and feeding, co-author of The Pediatrician’s Guide to Feeding Babies and Toddlers, and a spokesperson for the American Academy of Pediatrics

=== Further Reading ===

• CDC 2022 Breastfeeding Report Card: https://www.cdc.gov/breastfeeding-data/breastfeeding-report-card/index.html
• NASPGHAN list of formula equivalents: https://naspghan.org/recent-news/naspghan-tools-for-hcps-affected-by-formula-recall/
• Cernioglo K, Smilowitz JT. Infant feeding practices and parental perceptions during the 2022 United States infant formula shortage crisis. BMC Pediatr. 2023 Jun 24;23(1):320. doi: 10.1186/s12887-023-04132-9. PMID: 37355589; PMCID: PMC10290398.
• Calello DP, Jefri M, Yu M, Zarraga J, Bergamo D, Hamilton R. Notes from the Field: Vitamin D–Deficient Rickets and Severe Hypocalcemia in Infants Fed Homemade Alkaline Diet Formula — Three States, August 2020–February 2021. MMWR Morb Mortal Wkly Rep 2021;70:1124–1125. DOI: http://dx.doi.org/10.15585/mmwr.mm7033a4
• Anderson CE, Whaley SE, Goran MI. Lactose-reduced infant formula with corn syrup solids and obesity risk among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Am J Clin Nutr. 2022 Oct 6;116(4):1002-1009. doi: 10.1093/ajcn/nqac173. PMID: 35998087; PMCID: PMC10157812.

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories.

Hosts: Helen Cai

Producers: Helen Cai, Josh Onyango

Logo and Name: Eva Zimmerman

Theme music and Editing: Helen Cai, Josh Onyango

Other background music: Jeremy Black, Nat Keefe, Schwartzy, Corbyn Kites, Dan Bodan, The Mini Vandals, Moonrise, Density&Time, Quincas Moreira, Jesse Gallagher, John Patitucci, Steve Adams

Instagram: @pcpearls

Twitter: @PCarePearls

Listen on your favorite podcast platforms: linktr.ee/pcpearls

In this episode, Helen Cai chats with Dr. Chen and Dr. Nardella about the challenges and joys involved with feeding babies through breastfeeding.

=== Outline ===

Chapter 1: Motivation for Learning

Chapter 2: Counseling on benefits of Breastfeeding

Chapter 3: Collecting a history and troubleshooting

Chapter 4: Not all situations are the same

=== Learning Points ===

1. Breastfeeding Pain is Not Normal: While some tenderness may occur in the very early days, ongoing pain, is a sign of a problem.
2. Supply and Demand Basics: Breastfeeding largely operates on supply and demand. Parents need to be encouraged to drain the breast 8 to 12 times in 24 hours to establish an adequate milk supply.
3. Universal Provider Responsibility: All primary care physicians should have a foundational knowledge of common breastfeeding challenges and counseling techniques.
4. Focus on Parent Goals and Informed Decision: Counseling should avoid shaming and move past yes/no questions and use motivational interviewing.

=== Our Expert(s) ===

Deanna Nardella, MD, MHS is a general pediatrician at Yale who completed her pediatrics residency at The Children’s Hospital of Philadelphia and later joined Yale as a National Clinician Scholar, bringing a strong background in infant care and breastfeeding medicine to her work with families.

=== Further Reading ===

1. American Academy of Pediatrics. Policy Statement: Breastfeeding and the Use of Human Milk https://publications.aap.org/pediatrics/article/150/1/e2022057988/188347/Policy-Statement-Breastfeeding-and-the-Use-of?autologincheck=redirected
2. Academy of Breastfeeding Medicine: links to “Need to Know” videos
   https://www.bfmed.org/need-to-know-videos
3. Institute for the Advancement of Breastfeeding and Lactation Education (IABLE): Offers online CME and eCourses, including a “1 Day Primary Care Breastfeeding Medicine Course for Physicians and Other Providers”
   https://lacted.org/
4. Global Health Media Project: Offers free instructional videos on a wide range of breastfeeding topics
   https://globalhealthmedia.org/video/?_topic=breastfeeding&_language=english&~1
5. E-lactancia: Spanish and English information about compatibility between medications and breastfeeding. https://www.e-lactancia.org/
6. Drugs and Lactation Database (LactMed), maintained by the NIH: https://www.ncbi.nlm.nih.gov/books/NBK501922/

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories.

Hosts: Helen Cai

Producers: Helen Cai, Josh Onyango

Logo and Name: Eva Zimmerman

Theme music and Editing: Helen Cai, Josh Onyango

Other background music: Alge, futuremono, Joel Cummins, Schwartzy, Density & Time, The Tower of Light, Asher Fulero, Track Tribe, Penguinmusic, Esther Abrami, the Mini Vandals, Godmode, Quincas Moreira, Nathan Moore, Adam MacDougall,

Instagram: @pcpearls

Twitter: @PCarePearls

Listen on your favorite podcast platforms: linktr.ee/pcpearls

In this episode, Dr. Liang chats with Alexis and Dr. Quinn about the challenges involved with helping adolescents transition care into the adulthood.

=== Outline ===

Chapter 1: Building a team of specialists

Chapter 2: Transitions to adult care

Chapter 3: The role of parents

Chapter 4: Parting advice

Chapter 5: Conclusion

=== Learning Points ===

1. While it’s tempting to think of adolescents as simply younger versions of adult patients, we need to recognize that they have their own needs and considerations. They’re learning about how to navigate the health care system for the first time, and will likely need our help to understand it.
2. If you’re listening to this as a specialist or as an adult provider who sees young adults, just remember that they may need a little bit of extra grace and kindness when they show up to see you for the first time. Your attitude easily becomes their attitude.
3. Emphasize interdependence, rather than independence. Who do teens have on their team, and how can we build up their toolkit of strategies and problem solving to best set them up for success?

=== Our Expert(s) ===

Sheila M. Quinn, DO, is an attending physician in the Craig-Dalsimer Division of Adolescent Medicine and the Transition to Adult Care Program at Children's Hospital of Philadelphia. Her areas of expertise include adolescent and young adult health, reproductive health, and health care transitions.

=== Toolkits and Resources ===

• https://gottransition.org/

=== About Us ===

The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories.

Hosts: Addy Feibel

Producers: Helen Cai, Josh Onyango

Logo and Name: Eva Zimmerman

Theme music and Editing: Helen Cai, Josh Onyango

Other background music: Patrick Patrikios, Nat Keefe, The Mini Vandals, John Patitucci, DivKid, Joel Cummins, Godmode, Ammil

Instagram: @pcpearls

Twitter: @PCarePearls

Listen on your favorite podcast platforms: linktr.ee/pcpearls