Bio

Clinical Focus

  • Developmental Behavioral Pediatrics
  • Autism
  • Developmental Disorders
  • ADHD
  • Spina Bifida

Academic Appointments

  • Clinical Associate Professor, Pediatrics

Professional Education

  • Fellowship: Stanford University Developmental-Behavioral Pediatrics Fellowship (2015) CA
  • Board Certification: American Board of Pediatrics, Developmental Behavioral Pediatrics (2017)
  • Residency: Children's Hospital Medical Center of Northern California (1994)
  • Internship: Children's Hospital Medical Center of Northern California (1992)
  • Medical Education: University of Michigan Medical School (1991) MI

Community and International Work

  • Watch Me Grow

    Topic

    Developmental Care of Children

    Partnering Organization(s)

    First 5 California

    Populations Served

    Children under 5

    Location

    Bay Area

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

  • Help Me Grow, San Mateo County

    Topic

    Developmental Screening

    Partnering Organization(s)

    First 5 California

    Populations Served

    Children under 5

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

Contact

  • LPCH Developmental and Behavioral Pediatrics 750 Welch Rd Ste 212 MC 5731 Palo Alto, CA 94304
    • Tel: (650) 725-8995
    Fax: (650) 724-6500

Research & Scholarship

Current Research and Scholarly Interests

Telemedicine to teach pediatrics residents Developmental Behavioral Pediatrics

Publications

All Publications

  • Colocated Developmental-Behavioral Pediatrics in Primary Care: Improved Outcome Across Settings. Journal of developmental and behavioral pediatrics : JDBP Martin-Herz, S. P., Buysse, C. A., DeBattista, A., Feldman, H. M. 2020

    Abstract

    We developed a colocation "Rapid Developmental Evaluation" (RDE) model for Developmental-Behavioral Pediatrics (DBP) to evaluate young children for developmental concerns raised during routine developmental surveillance and screening in a pediatric primary care Federally Qualified Health Center (FQHC). In this low-income patient population, we anticipated that colocation would improve patient access to DBP and decrease time from referral to first developmental evaluation and therapeutic services.Children were assessed at the FQHC by a DBP pediatrician, who made recommendations for therapeutic services and further diagnostic evaluations. A retrospective chart review over 27 months (N = 151) investigated dates of referral and visit, primary concern, diagnosis, and referral to tertiary DBP center and associated tertiary DBP center dates of service and diagnoses if appropriate. We surveyed primary care clinicians (PCCs) for satisfaction.The DBP pediatrician recommended that 51% of children be referred to the tertiary DBP center for further diagnostic evaluation or routine DBP follow-up. Average wait from referral to an RDE visit was 57 days compared with 137.3 days for the tertiary DBP center. Children referred from RDE to the tertiary DBP center completed visits at a higher rate (77%) than those referred from other sites (54%). RDE-recommended therapeutic services were initiated for 73% of children by the tertiary visit. Fidelity of diagnosis between RDE and the tertiary DBP center was high, as was PCC satisfaction.Colocation of a DBP pediatrician in an FQHC primary care pediatrics program decreased time to first developmental assessment and referral for early intervention services for an at-risk, low-income patient population.

    View details for DOI 10.1097/DBP.0000000000000789

    View details for PubMedID 32108124

  • Co-Location of Developmental-Behavioral Pediatrics in Primary Care: Improving Outcomes for Providers and Families Martin-Herz, S. P., Buysse, C. A., DeBattista, A. M., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2018: S11

    View details for Web of Science ID 000429375100036

  • Neurodevelopmental assessment in patients who underwent prenatal fetoscopic and open fetal neural tube defect repair Sanz-Cortes, M., Torres, P., Sharhan, D., Yepez, M., Espinoza, J., Shamshirsaz, A. A., Whitehead, W., Ostermaier, K., Buysse, C., Blumenfeld, Y., Castillo, H., Castillo, J., Belfort, M. A. MOSBY-ELSEVIER. 2018: S294?S295

    View details for Web of Science ID 000422946900491

  • Patient Protection and Affordable Care Act of 2010 and Children and Youth With Special Health Care Needs JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Feldman, H. M., Buysse, C. A., Hubner, L. M., Huffman, L. C., Loe, I. M. 2015; 36 (3): 207-217

    Abstract

    The Patient Protection and Affordable Care Act (ACA) was designed to (1) decrease the number of uninsured Americans, (2) make health insurance and health care affordable, and (3) improve health outcomes and performance of the health care system. During the design of ACA, children in general and children and youth with special health care needs and disabilities (CYSHCN) were not a priority because before ACA, a higher proportion of children than adults had insurance coverage through private family plans, Medicaid, or the State Children's Health Insurance Programs (CHIP). ACA benefits CYSHCN through provisions designed to make health insurance coverage universal and continuous, affordable, and adequate. Among the limitations of ACA for CYSHCN are the exemption of plans that had been in existence before ACA, lack of national standards for insurance benefits, possible elimination or reductions in funding for CHIP, and limited experience with new delivery models for improving care while reducing costs. Advocacy efforts on behalf of CYSHCN must track implementation of ACA at the federal and the state levels. Systems and payment reforms must emphasize access and quality improvements for CYSHCN over cost savings. Developmental-behavioral pediatrics must be represented at the policy level and in the design of new delivery models to assure high quality and cost-effective care for CYSHCN.

    View details for PubMedID 25793891

  • Myofascial Structural Integration Therapy on Gross Motor Function and Gait of Young Children with Spastic Cerebral Palsy: A Randomized Controlled Trial. Frontiers in pediatrics Loi, E. C., Buysse, C. A., Price, K. S., Jaramillo, T. M., Pico, E. L., Hansen, A. B., Feldman, H. M. 2015; 3: 74-?

    Abstract

    Though the cause of motor abnormalities in cerebral palsy is injury to the brain, structural changes in muscle and fascia may add to stiffness and reduced function. This study examined whether myofascial structural integration therapy, a complementary treatment that manipulates muscle and fascia, would improve gross motor function and gait in children <4?years with cerebral palsy. Participants (N?=?29) were enrolled in a randomized controlled trial (NCT01815814, https://goo.gl/TGxvwd) or Open Label Extension. The main outcome was the Gross Motor Function Measure-66 assessed at 3-month intervals. Gait (n?=?8) was assessed using the GAITRite(®) electronic walkway. Parents completed a survey at study conclusion. Comparing Treatment (n?=?15) and Waitlist-Control groups (n?=?9), we found a significant main effect of time but no effect of group or time?×?group interaction. The pooled sample (n?=?27) showed a main effect of time, but no significantly greater change after treatment than between other assessments. Foot length on the affected side increased significantly after treatment, likely indicating improvement in the children's ability to approach a heel strike. Parent surveys indicated satisfaction and improvements in the children's quality of movement. MSI did not increase the rate of motor skill development, but was associated with improvement in gait quality.

    View details for DOI 10.3389/fped.2015.00074

    View details for PubMedID 26442234

  • Myofascial structural integration therapy on gross motor function and gait of young children with spastic cerebral palsy: a randomized controlled trial FRONTIERS IN PEDIATRICS Loi, E. C., Buysse, C. A., Price, K. S., Jaramillo, T. M., Pico, E. L., Hansen, A. B., Feldman, H. M. 2015; 3

    Abstract

    Though the cause of motor abnormalities in cerebral palsy is injury to the brain, structural changes in muscle and fascia may add to stiffness and reduced function. This study examined whether myofascial structural integration therapy, a complementary treatment that manipulates muscle and fascia, would improve gross motor function and gait in children <4?years with cerebral palsy. Participants (N?=?29) were enrolled in a randomized controlled trial (NCT01815814, https://goo.gl/TGxvwd) or Open Label Extension. The main outcome was the Gross Motor Function Measure-66 assessed at 3-month intervals. Gait (n?=?8) was assessed using the GAITRite(®) electronic walkway. Parents completed a survey at study conclusion. Comparing Treatment (n?=?15) and Waitlist-Control groups (n?=?9), we found a significant main effect of time but no effect of group or time?×?group interaction. The pooled sample (n?=?27) showed a main effect of time, but no significantly greater change after treatment than between other assessments. Foot length on the affected side increased significantly after treatment, likely indicating improvement in the children's ability to approach a heel strike. Parent surveys indicated satisfaction and improvements in the children's quality of movement. MSI did not increase the rate of motor skill development, but was associated with improvement in gait quality.

    View details for DOI 10.3389/fped.2015.00074

    View details for Web of Science ID 000209897400072

    View details for PubMedCentralID PMC4564770

  • Gait changes following myofascial structural integration (Rolfing) observed in 2 children with cerebral palsy. Journal of evidence-based complementary & alternative medicine Hansen, A. B., Price, K. S., Loi, E. C., Buysse, C. A., Jaramillo, T. M., Pico, E. L., Feldman, H. M. 2014; 19 (4): 297-300

    Abstract

    Children with spastic cerebral palsy experience difficulty with ambulation. Structural changes in muscle and fascia may play a role in abnormal gait. Myofascial structural integration (Rolfing) is a manual therapy that manipulates muscle and soft tissues to loosen fascia layers, reposition muscles, and facilitate alignment. This study aimed to document (1) gait characteristics of 2 children with cerebral palsy and (2) effects of myofascial structural integration on their gait. Children received 3 months of weekly therapy sessions by an experienced practitioner. Gait parameters were recorded at baseline and after treatment using an electronic walkway. Children with cerebral palsy demonstrated abnormal velocity and cadence, decreased step length and single support times, and increased double support time. After treatment, both children demonstrated improvement for 3 months in cadence and double support time. The objective gait analyses demonstrated temporary improvements after myofascial structural integration in children with spastic cerebral palsy.

    View details for DOI 10.1177/2156587214540466

    View details for PubMedID 24989994

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