Pediatrics
Medical specialties

Adolescent Medicine
Adolescent medicine offers primary and specialty care for a wide range of physical, emotional, and developmental needs of patients in this age group. Adolescent patients are seen for primary care and such problems as depression, substance abuse, attention deficit/hyperactivity disorder, school and family problems, reproductive issues, and adolescent gynecology.

The emotional stresses of adolescents must be considered when any physical disorders are addressed in this age group. A significant emphasis on preventative therapy and healthy lifestyles is encouraged with the adolescent patient. Every attempt is made to convince the patient of the need for on-time healthcare visits during adolescence and young adulthood. Programs for improved physical fitness, weight control, and smoking cessation are available at Janet Weis Children's Hospital, as are services for competitive sports medicine injuries.

Allergy & Immunology
Pediatric Allergy & Immunology  provides consultations to physicians and families, and continuing care to infants, children and adults with allergic and/or asthmatic conditions and immunologic disorders. In addition to physicians, the team includes an asthma coordinator. Its philosophy involves a multidisciplinary approach to care with intensive education and training at the time of diagnosis and re-evaluation.

Inpatient and outpatient consultation as well as continuing care are available for children with a wide range of allergic, immunologic, and respiratory disorders including: asthma; chronic cough; acute, chronic, or recurrent pneumonias; immunological lung disease;  recurrent sinusitis; allergic and non-allergic rhinitis; allergic conjunctivitis; atopic dermatitis; acute or chronic urticaria/angioedema; food allergy; latex allergy; drug allergy and insect allergy.

Two allergist/immunologists are available for consultation in Danville and Outreach clinics

Specialized services include:

• Skin testing
• Pulmonary function testing
• Exercise testing
• Immunotherapy
• Asthma program

Critical Care Medicine
Critical care medicine provides specialized care for pediatric patients admitted to the Pediatric Intensive Care Unit (PICU). The PICU at Janet Weis Children's Hospital in Danville is the only fully equipped and staffed pediatric ICU in the state outside of Pittsburgh and Philadelphia. It is staffed 24 hours a day by board-certified pediatric intensivists and emergency physicians and supported by their own team of certified pediatric intensive care nurses, respiratory therapists, nutritionists, pharmacists, and social workers. These pediatric intensive care specialists interact with all of the other clinical departments and subspecialties to provide the clinical care necessary for these very ill children.

The PICU is equipped with all the necessary technology for full life support and monitoring, including ventilation, hemodynamic monitoring and support, renal dialysis, pre- and postoperative support of trauma patients, invasive and noninvasive neurointensive monitoring for treatment of brain injury, pre- and postoperative support of infants and children with heart disease, organ transplantation, toxicological emergencies, high-frequency ventilation, and extracorporeal membrane oxygenation.

Both ground and air transportation with trained medical personnel is available for critically ill children. The PICU at Janet Weis Children's Hospital is also the home of the Pennsylvania Kiwanis Children's Heart Center.

Dental Medicine and Oral Surgery
In addition to pediatric dentistry and dental hygiene, this department delivers consultative services and direct patient care in the areas of cosmetic, restorative, prosthetic and oral and maxillofacial surgery for children. Patients are seen both on an inpatient and outpatient basis.

Pediatric dentistry provides comprehensive oral health care to meet the individual needs of each child. This includes prevention and management of dental caries (tooth decay), abscessed and infected teeth, management of injuries to teeth, recognition and management of oral abnormalities and diseases. Unique challenges posed by children with special health concerns are especially recognized. Management utilizing conscious sedation and other means are used and tailored to each of our pediatric patients.

Oral and Maxillofacial Surgery provides treatment for pediatric patients including:

• complex tooth removal
• removal of impacted wisdom teeth
• tooth exposure for the orthodontist
• diagnosis and removal of benign, non-cancerous growths in the mouth, lips or jaw bones
• diagnosis and treatment of oral conditions associated with systemic diseases
• orthodontic surgery of the upper and lower jaws, chin and skull
• TMJ treatments - both surgical and non-surgical
• safe general anesthesia or sedation

Dermatology
A full spectrum of pediatric skin disorders are treated including inherited, infectious and inflammatory dermatoses. Simple and complex surgery is performed in the clinic as is laser surgery of vascular and pigmented lesions.

Diabetes
The pediatric diabetes service provides consultation to physicians and families, and care to infants, children, and adolescents with diabetes mellitus. This service is provided by a team of physicians, nurse educators, and nutritionists, and there is easy access to psychologists and social workers. This team's philosophy is based upon a multidisciplinary approach to patient care and education so that several members of the service are actively involved with each patient. The service recognizes that an ongoing education program and regular clinical reassessment are vital to the optimum management of children with diabetes.

The service offers intensive education and training at the time of diagnosis and during re-evaluation, both on an inpatient and outpatient basis. It also offers nutritional and psychological counseling, as required. Care is coordinated with the referring physician to assure that appropriate monitoring and follow-up are available.

The service in consultative and seeks to assist primary care physicians in the management of the child's diabetes mellitus without intrusion into the patient's ongoing general health care. A member of the diabetes service is always available to answer patient questions or for telephone consultation with referring physicians.

The staff has a particular interest in devising individual education and management for childhood diabetes, especially during the challenges of infancy and adolescence. Pediatric diabetes is involved in the programs of the American Diabetes Association, including teen and parent support groups and camp, and is a collaborating center of the Diabetes Prevention Trail.

Endocrinology
Pediatric endocrinology provides care for the entire spectrum of endocrine and metabolic concerns, including diabetes and hypoglycemia; growth and failure to thrive; early and late puberty; adolescent menstrual and breast problems; metabolic and genetic bone disorders; problems of the thyroid, adrenals, pituitary, and genitalia; hypercholesterolemia and other lipid disorders; fluid and electrolyte abnormalities.

The other area of focus is normal and abnormal growth. Not all small children need extensive evaluation or treatment; prediction and reassurance can often be based upon a growth chart and bone age. Many of the children who require long-term treatment are enrolled in the National Cooperative Growth Study.

For the convenience of families in this area, pediatric endocrinology provides care for the rarer disorders of metabolism in conjunction with the metabolic geneticists of Philadelphia and Baltimore.

Primary physicians are welcome to call for advice in the above areas. Also available are printed guidelines for the primary care management of various endocrine and metabolic disorders.

Gastroenterology & Nutrition
The Department of Pediatric Gastroenterology and Nutrition offers comprehensive diagnostic and therapeutic services for pediatric patients from birth through adolescence with disorders of the gastrointestinal tract, liver and pancreas. Children with nutritional problems are also evaluated and treated by our department.

Our specialists are available for consultation for any pediatric patient with a gastrointestinal, liver, pancreatic or nutritional problem. A wide variety of diagnostic and therapeutic services are offered are offered including:

• 24 hour esophageal pH probe monitoring
• upper endoscopy
• colonoscopy
• rectal biopsies for Hirschsprung�s disease
• esophageal dilation
• liver biopsies
• breath hydrogen testing
• comprehensive radiologic services

Our providers have a special interest in patients with inflammatory bowel disease, gastro-esophageal reflux disease and its complications, chronic diarrhea, constipation, and obesity.

The department is also home to a highly respected, multidisciplinary obesity-weight management program that has been successfully treating patients for several years.
Members of Pediatric Gastroenterology and Nutrition include board-certified pediatric gastroenterologists, a physician board-certified in clinical nutrition, nurse practitioners, and three pediatric nurses and technicians with many years of pediatric gastroenterology experience.

Our service is consultative and seeks to assist the primary care physician in the management of a pediatric patient's gastrointestinal problem without intrusion into the patient's ongoing general healthcare. One of our providers is always available for telephone consultation with referring physicians. Gastroenterology & Nutrition also offers:

Pediatric Feeding Program
Feeding disorders can be a major problem in infants and children with neurological conditions and congenital anomalies. The pediatric feeding program is designed to assist such special children overcome oral-motor and nutritional deficits. Services are provided by in an outpatient setting by an interdisciplinary team consisting of an occupational therapist, clinical dietician, registered nurse, developmental pediatrician, behavioral specialist, and pediatric surgeon. The pediatric feeding program is the only such program of its kind in central and northeastern Pennsylvania.

Weight Management
This pediatric surgery program provides a comprehensive, multidisciplinary weight management program for young people ages 5-18. Weight management problems may include overweight and obesity, and inability to gain or maintain weight, and concerns about body shape and size. A registered dietician serves as the coordinator of the program, with pediatricians and pediatric psychologists on the team. Cardiologists, neurologists, surgeons, and endocrinologists are also available for consultation as needed. Services include history and physical, laboratory testing, nutritional analysis, exercise testing, behavior and eating habit evaluation, individual counseling as needed, referral to subspecialists, and long-term follow-up support. Group counseling sessions for patients or caregivers are offered throughout the year.

General Pediatrics
General pediatrics provides diagnostic and management consultation for general medical problems of infants, children, and adolescents through a scheduled primary care and acute care practice. Interests include growth and development, nutritional problems, lactation management, allergic disease, gastrointestinal disorders, Tourette syndrome, neurodevelopmental delay, phenylketonuria (PKU), acute and chronic diseases, and disabilities that do not pertain to a specific subspecialty area. Pediatricians throughout the health system participate in the Pennsylvania Early Periodic Screening Diagnosis Treatment (EPSDT) program.

Genetics
Geisinger Health System has established genetic services for families touched by genetic disorders. Genetic disorders and birth defects affect five to seven percent of all babies and account for up to 30 percent of all admissions to a pediatric hospital. Common genetic disorders include Down Syndrome, muscular dystrophy hemophilia and cystic fibrosis.

Genetic services include genetic evaluation and genetic counseling. Genetic evaluations include physical evaluation and appropriate testing to determine whether or not a particular condition or birth defect is inherited. Children with multiple or complex health problems, congenital birth defects or learning or developmental problems may be seen in genetic clinic by a pediatric geneticist. A genetic counselor is also available to provide information, education and support to the families of these children.

Since genetic disorders are found within every area of medicine, we work closely with all pediatric subspecialists to provide the best care for families and to help them understand the inherited nature of the condition in their children or family member.

Our genetic counselor is also available to answer questions about risks and/or testing for genetic disorders from physicians or the general public.

Hematology/Oncology
Comprehensive diagnosis and treatment for a full range of hematologic and oncologic problems in infants, children, and adolescents are available through a team of specialists, including pediatric hematologists/oncologists, pediatric surgery specialists, radiologists, pathologists, and radiation oncologists. Hematologic problems include anemias, white cell deficiencies, and platelet problems. Consultations for anemias, unusual infections, bleeding disorders and other problems are welcome. Diagnosis and treatment of children with leukemia and solid tumors are special concerns. Many patients are treated in cooperation with the Children' s Cancer Group.

Infectious Diseases
Pediatric infectious diseases provides consultation and evaluation for children with pediatric infectious diseases, including HIV and pediatric AIDS, immunodeficiency disorders, and recurrent infections, including otitis media, sinusitis, pneumonia, and strep throat. Physicians also consult on patients with recurrent or persistent fever, lymphadenopathy, bone and joint infections, skin infections, and viral infections, including hepatitis and infectious mononucleosis. Other areas of interest include physicals for newly adopted foreign children, chronic fatigue, and altered host defense problems. Research interests have included recurrent strep throat, otitis media, pediatric AIDS, vaccines, new antibiotics, and the febrile infant.

Neurodevelopmental pediatrics
The neurodevelopmental pediatrics service offers comprehensive diagnostic consultation and medical management of developmental disorders of brain function such as pervasive developmental disorders (autism spectrum disorders), attention-deficit/hyperactivity disorder, language disorders, learning disabilities, mental retardation, cerebral palsy, and neurogenetic disorders. Developmental and neurobehavioral assessment is offered from infancy through adolescence. In conjunction with the departments of neonatology and rehabilitation medicine, a developmental surveillance clinic is offered for high-risk graduates of the Neonatal Intensive Care Unit. The autism spectrum disorders are an area of clinical and research focus. Neuropharmacological/psychopharmacological consultation and management are available. Guidance is provided regarding educational, behavioral, and therapeutic interventions. Coordination of aspects of care related to neurodevelopmental disabilities is available and the service strives to work with the primary care provider in co-managing these aspects of the patient's care.

Neurology
Pediatric neurology provides in-depth diagnosis and comprehensive care to children with all varieties or neurological disorders. An extensive variety of ancillary services aid in the diagnosis and continued management of children with epilepsy, movement disorders, neuromuscular disease, neurodegenerative disorders, and developmental disabilities including cerebral palsy, mental retardation, and Attention Deficit Disorder. Consultative services are available for children with primary or secondary cancer. Neuro-diagnostic services available include routine and prolonged EEG monitoring (CCTV-EEG), ambulatory EEG, electromyography and nerve conduction studies, neuroradiology, speech and hearing, and psychiatric consultative services. Specialized therapies for epilepsy, including ketogenic diet, vagal nerve stimulation, and epilepsy surgery, are available. Botox therapy is available for management of spasticity and dystonia.

Neuropsychology
Geisinger's division of psychiatry provides pediatric neuropsychological services. Neuropsychological evaluations may be recommended when there is concern about memory, concentration, reasoning, organization, language, perception, and visual-motor coordination. Neuropsychological evaluations are available to help assess cognitive problems in the context of neurological disorders, including traumatic brain injury and concussion, as well as non-neurological medical diseases affecting cognitive functioning. A typical neuropsychological evaluation involves assessing general intellect, problem-solving skills, attention and concentration, visual-spatial skills, language, motor and sensory functioning, mood and personality.
To refer a child or adolescent to the neuropsychology section of the division of psychiatry, contact Bradley J. Wilson, PhD, ABPN, Program Director, Postdoctoral Fellowship in Clinical Neuropsychology. Dr. Wilson is board-certified by the American Board of Professional Neuropsychology with added subspecialty recognition in Rehabilitation Neuropsychology.

Ophthalmology
Pediatric ophthalmology provides comprehensive diagnostic evaluation, and medical and surgical treatment for all children under 16 years of age. Strabismus care is available to children as well as adults. The services available to treat problems include, but are not limited to, strabismus, amblyopia, cataract (congenital, infantile, or juvenile), congenital ptosis, nystagmus, nasal lacrimal duct obstruction, dacryocystitis in children and other juvenile tearing problems, tumors of the orbit in children, orbital and presceptal cellulitis, congenital malformations of the eye and orbit, and syndromes that affect the eye and orbit. A close working relationship exists with other subspecialty services to be certain that the appropriate subspecialty care is available to all patients. Diagnostic and therapeutic evaluations are available for adults with strabismus.

Surgical interventions for patients, where appropriate, include general anesthesia and the use of adjustable sutures with localized anesthesia. Pattern visual evoked potential (PVEP) is available to referring physicians.

Orthopaedics
This service treats the full spectrum of congenital and acquired pediatric musculo-skeletal disorders including neuromuscular disorders, spinal deformities in children and adolescents, complex limb deformities, limb length discrepancies, and congenital and acquired pediatric limb deficiencies.
The department also maintains a Sports Medicine/Sports Injury Clinic.

Otolaryngology/Audiology
Subspecialty trained pediatric otolaryngologists manage the care for disorders of the head and neck in children. These include management of a disease spectrum from a simple sore throat to the management of difficult airway problems or the most Laryngo-tracheal reconstruction for complicated congenital deformities. 

Psychiatry & Psychology
Comprehensive psychiatric and Ppychological services are available for children and adolescents experiencing a broad range of behavior and emotional problems. Staff includes child psychiatrists, pediatric psychologists, and social workers. Types of problems evaluated and treated include, but are not limited to:

• Anxiety disorders
• Eating disorders
• Adjustment disorders
• Depression
• Attention deficit hyperactivity disorder (ADHD)
• Social skill deficits
• Children with divorced parents
• Family conflict
• Suicide attempts
• School refusal
• Psychosomatic symptoms
• Disruptive behavior disorders
• Parent-child relationship problems
• Developmental delay
• Problems adjusting to acute and chronic illness

Outpatient Assessment and Psychotherapy - child/adolescent and their parents meet with a clinician to conduct a thorough assessment of the problem and develop a treatment plan. Treatment options include individual counseling, family therapy, group therapy, and medication.

Psychiatric Emergency Services - staff conducts psychiatric emergency evaluations of children and adolescents who present for urgent care in our emergency department or our outpatient clinic.

Consultation in the Janet Weis Children's Hospital - pediatric psychologist provides consultation regarding behavioral or emotional concerns for children who may have acute or chronic medical problems.

Psychiatric Medication Management by Child Psychiatrist - child psychiatrist provides assessment and medication management for children and adolescents in need of psychiatric medication.

Learning Disability Evaluations - pediatric psychologists conduct psychological assessments of children with learning disabilities.

Group and Family Therapy Program for Adolescents - several options for adolescents with behavior and emotional problems to participate in group psychotherapy and for their families to participate in family counseling.

Inpatient Psychiatric Treatment - Inpatient Psychiatric Unit, a short-term crisis/stabilization unit. The purpose of this treatment is primarily to evaluate adolescents who present in crisis situations, to consider psychiatric medication, to provide stabilization and recommend treatment options.

Evidence-based Treatment - our staff uses treatment approaches that have been established as effective in research studies of treatment outcome. We also conduct outcome research to help evaluate and demonstrate that our treatments work.

Disruptive Behavior Disorders Clinic - we conduct an assessment and treatment program for children with ADHD and related disruptive behavior disorders. We use treatments demonstrated as effective in research studies.

Anxiety Disorders Clinic - We conduct an assessment and treatment program for children and adolescents with anxiety disorders. It is employs treatments demonstrated as effective in research studies.

We accept referrals for all types of behavior and emotional problems. We do not provide treatment for primary drug and alcohol problems and we do not conduct child custody evaluations.

Radiology
The focus of pediatric radiology is the care of infants, children, and adolescents through diagnosis and management of the disorder by various imaging techniques. Pediatric radiology is staffed by fellowship-trained and experienced radiologists who perform and interpret pediatric imaging studies, including diagnostic radiology, fluoroscopy, ultrasound, CT, and MRI. Pediatric nuclear medicine imaging studies are directed and interpreted by a fellowship-trained pediatric nuclear medicine specialist.

The pediatric radiology section works closely with many pediatric subspecialties as well as general pediatricians and family and community medicine practitioners. A full array of specialized studies is offered. Examples include:

• Cranial sonography in infants;
• Sonographic, scintigraphic, and fluorscopic evaluation of the urinary tract for congenital and acquired abnormalities and urinary tract infection;
• Fluoroscopic evaluation of the airway and feeding disorders;
• Consultation and imaging evaluation for suspected child abuse; Magnetic resonance imaging of infant and children;
• Sonographic and diagnostic radiologic imaging of the premature and term infant; and
• Sedation to enhance the quality of diagnostic imaging.

Rheumatology
Pediatric rheumatology provides diagnostic services for both children with signs or symptoms suggestive of rheumatic diesease - arthritis, musculoskeletal pain, muscle weakness, unexplained fever, unexplained fever/rash syndromes, chronic fatigue, Raynaud's phenomenon, and unexplained multisystem disease. Pediatric rheumatology provides comprehensive treatment for children with juvenile rheumatoid arthritis, juvenile dermatomysitis, systemic lupus erythematosus, spondyloarthropathies, systemic vasculitic syndromes, reactive arthropathies, fibromyalgia, scleroderma, lyme disease, and scarcoidosis. Coordination of joint disease management, in conjunction with pediatric orthopaedic and rehabilitative services, allows the child to maximize pain relief and functional status while minimizing long-term degenerative changes.

Trauma Services
Pediatric trauma services are coordinated by the pediatric trauma specialists at Geisinger Medical Center. Children suffering multiple traumas are cared for by a multidisciplinary team in conjunction with the Pediatric Intensive Care Unit and all pediatric surgical subspecialties as necessary. ECMO support is available for unrelenting pulmonary or cardiac failure.

Support Groups
Precious Hearts Support Group - cardiology
POPS (pediatric oncology parent support) - hematology/oncology
Siblings Group - hematology/oncology
Middle School Kids Group - psychology
Parent/Child Group - psychology
Adolescent Group Therapy - psychology
PA Cystic Fibrosis, Inc. (Mifflinburg)