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Mental illness continues to rise within the United States. With the recent COVID-19 pandemic, adequate access to mental health services is becoming even more important. Despite this need, children facing mental health disorders are suffering from the lack of child and adolescent psychiatrists available. This shortage has been prevalent for decades with no permanent solution proposed. In hopes of providing care during this difficult time, pediatricians have been expected to take on responsibility for mental health disorder patients. However, research shows that pediatricians are unprepared and not confident in their abilities to take on this role. Therefore, they continue to provide inadequate care for these patients because of the ever-growing wait times on referrals and obligation to provide help to patients in need. This paper will explore the shortage of child and adolescent psychiatrists and the consequences of this shortage. In a case analysis, the patient, provider and systemic levels will be evaluated through different ethical frameworks including duty ethics, care ethics and justice. Changes will be proposed at the resident, attending physician and national level, in hopes of improving mental health care for children and creating a more accessible system.

Children 2-5 years of age can be vulnerable to being underweight due to characteristics like selective eating. As a result, children may not be consuming essential nutrients from balanced meals and may have a reduction in the variety of foods they eat. Medical nutritional supplements are often recommended by healthcare professionals including physicians and registered dietitian nutritionists (RDNs). Parents/caregivers may not research how the medical nutritional supplement benefits their child’s health and may not comprehend the meaning of the words “healthy growth”. This study investigated the attitudes and the perceptions of caregivers of children 2-5 years of age toward liquid nutritional supplements prescribed for weight gain by a healthcare professional for their child. Caregivers whose children were enrolled in the Special Supplemental Food Program for Women, Infants, and Children (WIC) program in the State of New Mexico and were prescribed Pediasure were recruited and a total of 17 surveys were collected. The majority of participants selected Hispanic or Latino as their race/ethnicity (n=9; 53%) and most participants learned about the medical nutritional supplement through their child’s pediatrician (n=9; 53%). Hispanics and Whites were more confident that their child’s health had improved because of the medical nutritional supplement than other race/ethnicities. (P=0.03). Further qualitative research should be done to investigate differences in perceptions towards liquid supplements by race/ethnicity.

The continued viability of the Physician's Office Laboratory (POL) has been questioned because of barriers imposed by managed care organizations, oversight by regulatory agencies and competition for professionally trained laboratory staff. Pediatricians view the POL as an important adjunct to quality healthcare services for children and do not consider the POL as a "profit center", whose priority is generation of revenues for the The practice. parents of pediatric patients consider an on-site laboratory a convenience and valuable service. Through an analysis of patients' satisfaction, physicians' perceptions of enhancement to quality care, managed care reimbursement data and costs associated with maintenance of a POL, this study justifies the continuance of in-office laboratory services by pediatricians. In addition, issues regarding POL regulation, .. waived" testing and professionally trained laboratory staffing, are addressed. The physician office laboratory (POL) has been an integral part of physicians' practices for decades. ln general, testing consisted of a few basic manual tests, which were run by the physicians or a physician-trained aide or nurse. The POL was considered an enhancement to the physician's practice, which was reimbursed by non-discounted fee­ for-service indemnity insurance plans. Clinical testing by physician in the POL was a profitable adjunct to a physician's practice. However, as the result of increasing regulations and oversight by the federal government, limitations posed by managed care and increasing difficulty accessing trained laboratory personnel, many have questioned continued viability of the POL.