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The Journal Gazette

  • Dave Gong | The Journal Gazette Dr. J. Dennis Fortenberry gives a presentation on gender dysphoria at the 2019 Indiana Chapter of the Academy of Pediatrics conference Saturday at Grand Wayne Center. 

Sunday, August 25, 2019 1:00 am

Opioids, gender discussed by pediatricians

Doctors from across state get informed at Grand Wayne event

DAVE GONG | The Journal Gazette

Pediatricians throughout Indiana gathered at Fort Wayne's Grand Wayne Center this weekend to discuss some of the most important topics in children's health. 

Topics discussed over the two-day conference included evidence in pediatric allergies, how to coordinate care between children with developmental delays and school systems, opioid use, gender dysphoria and more. More than 100 pediatricians attended the conference. 

“One of the best things that we're able to do at a meeting like this is not only lay out the problem but provide practical solutions so that the pediatricians can tackle some of the biggest pediatric topics that we face,” said Dr. Tony GiaQuinta, president of the Indiana Chapter of the American Academy of Pediatrics.

Dr. Carolyn Warner-Greer, a staff physician at the Otis R. Bowen Center for Human Services and medical director of the Bowen Recovery Center, focused her discussion Saturday on opioid prescribing, proper use of opioids, mental health care for the family and the way in which opioids can affect newborns. 

“There's a lot of access for treatment in the Allen County and surrounding area. There's still a great deal of stigma associated with any mental health or substance disorder,” she said. 

It's important for pediatricians to be informed about opioids, Warner-Greer said, because pediatricians treat the family, not just children.

“A family's struggle becomes a child's struggle,” she said. “The other thing is, I admit people all day, every day who have a moderate to severe opioid use disorder and it's very rare that they say this started when they were 25 years old. It almost always is an exposure, whether it be appropriate and medical or illicit from controlled substances.”

The No. 1 place children get controlled substances is from family and friends, Warner-Greer said. It is pediatricians' responsibility, she said to make sure they're arming families with knowledge on how to address concerns with substance use or mental health. Pediatricians must also be advocates for the medical care for everyone in the family, she said, adding that pediatricians are sometimes able to help parents examine their own substance use issues.

“Sometimes a pediatrician can tell an adult, 'Hey let's look at your substance use, even your legitimate prescriptions for opioids and how that's impacting your family, that sort of thing,” Warner-Greer said. 

Warner-Greer said she hopes her discussion will help point pediatricians toward evidence-based practices in dealing with substance use disorders.

“People listen to their kid's doctor much more than they listen to their own doctor,” she said. “Overall it's all about reducing stigma and advocating for health of the patients.”

Gender dysphoria is one area that often does not get the attention it deserves in medical schools, GiaQuinta said. 

“A program like this allows us to get caught up to speed in the latest diagnostic and therapeutic approaches like gender dysphoria and identity difficulties,” he said. “The big goal in this conference is to get pediatricians caught up to speed in some of the biggest issues facing Indiana's children.”

Saturday's discussion about gender dysphoria, a conflict between a person's physical gender and the gender with which he or she identifies, was led by Dr. J. Dennis Fortenberry, a professor of pediatrics at Indiana University School of Medicine and founder of the Child and Adolescent Gender Health Program at Riley Hospital for Children. 

“Pediatricians are often the first place people go for guidance, sometimes because they're concerned about other things,” Fortenberry said. “These young people and their families are part of each community and within those communities, a commitment to the health and well-being of all children includes children with gender dysphoria.”

Fortenberry said having a level of competence and literacy by pediatricians increases the quality of the help that they can provide. He added that over the years, there has been an emerging international consensus that a gender-affirming approach that incorporates hormones is an important part of reducing some of the consequences of gender dysphoria.

“The big change is, I think, people have begun to recognize that this isn't a phase, it's not something that's part of adolescence being changeable in terms of all sorts of things about identity,” Fortenberry said. “It's a recognition that it's a real experience of children and young people that has lifelong consequences.”

Fortenberry said he hopes pediatricians who attended his presentation Saturday will bring those topics to other people in their practice and do more to make sure their practice is a safe space. 

“These are young people that are probably in their practice right now that they may not recognize,” Fortenberry said. 

dgong@jg.net