Archives: Courses
Intersex Traits, Genital Surgery: Who Gets to Decide & Why? Considerations in Health Care
(Note: a course evaluation is required to receive credit for this course.)

David E. Sandberg, PhD
Department of Pediatrics, Division of Pediatric Psychology
Susan B. Meister Child Health Evaluation and Research Center
University of Michigan

Lih-Mei Liao, PhD, FBPS
Clinical and Health Psychologist
Dr. David Sandberg uses research evidence to define the role of parents, patients, and providers in the decision making process regarding the care of patients with intersex traits (differences in sex development). Dr. Lih-Mei Liao describes the social and cultural influences on the treatment and care of patients with intersex traits. The presentation was recorded at Intersex Traits (Differences in Sex Development); Clinical and ethical considerations in care across the lifespan, on Oct. 25-26, 2021.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Identify the cultural and transactional influences on childhood genital surgery and the disadvantages of surgery.
- Recognize emotional constraints on informed consent.
- Analyze the roles that parents and clinicians have in the treatment decision making process of intersex patients.

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician
Boston Children’s Hospital designates this live activity for a maximum of 0.5 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Risk Management
This activity meets the requirements for 0.5 Risk Management Credits as proscribed by the Massachusetts Board of Registration in Medicine and defined in 243 CMR 2.06(5)(d) I. Please check your individual state licensing board requirements before claiming these credits.
Nurse
Boston Children’s Hospital designates this activity for 0.5 contact hours for nurses. Nurses should only claim credit commensurate with the extent of their participation in the activity.
Physician Assistant
Boston Children’s Hospital has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credits for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.5 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation.
Disclosure Policy
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CE activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
Disclosure Statement
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
David E. Sandberg, PhD
Lih-Mei Liao, PhD, FBPS
None
None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue urgent, call the CE office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CE Department to request a refund.How do I Navigate this Course?
How do I claim credit for this course?
How do I download a certificate?
How do I request a refund?
What is Problematic Interactive Media Use (PIMU)? Is It a “New Normal”?

Michael Rich, MD, MPH
Director, Center on Media and Child Health (CMCH); Director, Video Intervention/Prevention Assessment (VIA), Co-Director, Clinic for Interactive Media and Internet Disorders (CIMAID), Attending Physician, Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital; Associate Professor of Pediatrics, Part-time, Harvard Medical School
Dr. Michael Rich gives a brief overview of Problematic Interactive Media Use, its impact on children and adolescents, and some of the ways in which clinicians can identify, diagnosis, and treat PIMU in their patients. The presentation was recorded at Problematic Interactive Media Use (PIMU): Gaming, Social Media, and More, on 10/15/21.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Explain Problematic Interactive Media Use and its effects on physical, psychological, social, and academic health.
- Recognize adolescents’ motivations for using digital technology and identify different PIMU presentations and co-morbidities in patients.
- Discuss PIMU treatment strategies that promote the use of media and technology in a healthy way.

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians
Boston Children’s Hospital designates this live activity for a maximum of 0.75 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Risk Management
This activity meets the requirements for 0.75 Risk Management Credits as proscribed by the Massachusetts Board of Registration in Medicine and defined in 243 CMR 2.06(5)(d) I. Please check your individual state licensing board requirements before claiming these credits.
Nurse
Boston Children’s Hospital designates this activity for 0.75 contact hours for nurses. Nurses should only claim credit commensurate with the extent of their participation in the activity.
Physician Assistant
Boston Children’s Hospital has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credits for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.75 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation.
Psychologist
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibly for the content of the programs. This course has been approved for 0.75 continuing education credits.
Social Worker
As a Jointly Accredited Organization, Boston Children’s Hospital is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. Boston Children’s Hospital maintains responsibility for this course. Social workers completing this course receive 0.75 ACE CE continuing education credits.
Disclosure Policy
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CE activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
Disclosure Statement
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
Michael Rich, MD, MPH
None
The Digital Wellness Lab is supported by:
Age of Learning, The Alberta Teacher’s Association, AlphaEdison, Amazon Kids, Facebook, Facebook Reality Labs, Instagram, Joan Ganz Conney Center/Sesame Workshop, noggin, Optum Behavioral Health, Pinwheel, Point32Health/Harvard Pilgrim Health Care/Tufts Health Plan, Roblox, Ruderman Family Foundation, TikTok, Trend Micro Cares, and Walt Disney Entertainment.
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue urgent, call the CE office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CE Department to request a refund.How do I Navigate this Course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
Media Use Therapy for Problematic Interactive Media Use

Tarek Aly, MD, MPH
Psychiatrist, Mosaic Psychiatry; Associate, Digital Wellness Lab at Boston Children’s Hospital
In this course, Dr. Tarek Aly defines media use therapy through the modules listed in the MUT Manual and explains how it is used to treat Problematic Interactive Media Use (PIMU) cases. The presentation was recorded at Problematic Interactive Media Use (PIMU): Gaming, Social Media, and More, on 10/15/21.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Understand media use therapy through the modules in the MUT Manual: Assessment, Education, Intervention, Maintenance, and Closure.
- Expand upon general mental health evaluation and treatment by tailoring assessments, education, intervention, and maintenance to be related to PIMU.
- Discuss how culture, environment, medical comorbidities, and psychological and developmental issues may influence Problematic Interactive Media Use and media use therapy.

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician
Boston Children’s Hospital designates this live activity for a maximum of 0.5 AMA PRA Category 1 Credits ™ . Physicians should claim only credit commensurate with the extent of their participation in this activity.
Risk Management
This activity meets the requirements for 0.5 Risk Management Credits as proscribed by the Massachusetts Board of Registration in Medicine and defined in 243 CMR 2.06(5)(d) I. Please check your individual state licensing board requirements before claiming these credits.
Disclosure Policy
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CE activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
Disclosure Statement
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
Tarek Aly, MD, MPH
None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue urgent, call the CE office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CE Department to request a refund.How do I Navigate this Course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
Neurologic, Psychologic, and Cognitive Consequences of COVID-19 Infections in Children
(Note: a course evaluation is required to receive credit for this course.)

David Urion, MD, FAAN
Associate, Department of Neurology; Charles F. Barlow Chair in Neurology; Director, Education; Associate Director, Child Neurology and Neurodevelopmental Disabilities Residency Training Programs; Director, Behavioral Neurology Clinics and Programs; Co-Cha
Associate Professor of Neurology, Harvard Medical School
Dr. David Urion discusses the neurologic, cognitive, and psychologic consequences of COVID-19 in children. Dr. Urion also discusses the sources of excess mortality and morbidity of COVID-19 infections in the US. The presentation was recorded at the Holy Family Summit 2022 on June 1, 2022.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Identify sources of excess mortality and morbidity in COVID-19 infections in the US
- Recognize common and less common neurologic consequences of COVID-19 infections in children
- Recognize common and less common cognitive and psychologic consequences of COVID-19 infections in children

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians
Boston Children’s Hospital designates this live activity for a maximum of 0.75 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Disclosures
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CME activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
David Urion, MD, FAAN
None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue is urgent, call the CME office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CME Department to request a refund.How do navigate this course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
Strabismus
(Note: a course evaluation is required to receive credit for this course.)

Linda Dagi, MD
Ophthalmologist, Department of Ophthalmology; Director, Adult Strabismus Service; Director, Pediatric Strabismus Service; Director, Ophthalmology Quality Assurance; Associate Professor, Harvard Medical School

David Hunter, MD, PhD
Ophthalmologist-in-Chief; Richard Robb Chair in Ophthalmology
Professor and Vice Chair, Harvard Medical School

Jason Mantagos, MD, PhD
Ophthalmologist, Department of Ophthalmology
Assistant Professor, Harvard Medical School

Mary Whitman, MD, PhD
Ophthalmologist, Department of Ophthalmology
Assistant Professor, Harvard Medical School

Carolyn Wu, MD
Ophthalmologist, Department of Ophthalmology
Assistant Professor, Harvard Medical School
The practice of pediatric ophthalmology is constantly changing. Clinicians are faced with the challenge of keeping up-to-date with new information and strategically incorporating those advances into their daily practice. “What’s New in Children’s Eye Health: Strabismus” is designed to address gaps in knowledge and competence regarding the impact of strabismus on visual function in children. In an innovative teaching format, members from the department of Ophthalmology at Boston Children’s Hospital present the information using a TED talk-style lecture format to promote a novel and engaging approach to transfer of medical knowledge.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Understand the impact eye misalignment or strabismus on visual function
- Develop tools towards identification and characterization of types of eye misalignment
- Discover advances in treatment of eye misalignment in children

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians
Boston Children’s Hospital designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
MOC II
Successful completion of this CME activity, which includes participation in the activity, with individual assessments of the participant and feedback to the participant, enables the participant to earn:
1.0 MOC II points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program
1.0 MOC II points in the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) program
1.0 MOC II points in the American Board of Ophthalmology (ABO) Maintenance of Certification (MOC) program
Disclosure Policy
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CE activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
Disclosure Statement
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
David Hunter, MD, PhD
Rebion, Inc. (Founder, equity, patents) Pediatric Vision Screening; Luminopia, Inc. (Advisor, equity) Amblyopia Therapy.
Linda Dagi, MD
Boston Neurosciences
Jason Mantagos, MD, PhD
Luminopia, Inc. (previous research support)
Mary Whitman, MD
None
Carolyn Wu, MD
None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue is urgent, call the CE office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CE Department to request a refund.How do navigate this course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
RITA-T Online Training Program
(Note: a course evaluation is required to receive credit for this course.)

Roula Choueiri, MD
Neurodevelopmental Disabilities; Director, Early Childhood Community Outreach Program; Department of Neurology, Autism Spectrum Center
Faculty of Medicine, Harvard Medical School
Welcome to the RITA-T web-based training! We are happy you chose to utilize this resource to become trained to administer the RITA-T in order to help better identify children at high risk for an ASD diagnosis. This web-based training program has been designed for users to work through in linear fashion with access to activities and content set to become available as you work through each piece of content.
*The RITA-T Team will be updating the administration of item I: Mirror: Self-Recognition. Please check back on the course site or our website for updates as we continue to develop this. Updates to the training course and RITA-T material will be made accordingly.*
Thank you!
The RITA-T Team
Learn more about the RITA-T on the Boston Children’s Hospital website
This course would not have been possible without the help, support, advice, and patience, of a whole team that includes: Acknowledgements
Before beginning, please print 6 RITA-T scoring sheets and the RITA-T Administration Manual from the “Downloads” tab above.
Estimated completion time: 3.5 hrs.
You can do each part at a time, i.e. save and get back to it. When you have completed all 8 sections, and achieved the appropriate scores on the practice videos, you will be awarded your certificate. If you ordered a kit, it was shipped to you when you registered.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Train reliably on administering a level 2 interactive ASD screener, the RITA-T that differentiates between ASD and non-ASD
- List the early signs of ASD
- Integrate a level 2 ASD screener in practice to improve access to diagnosis
- Analyze community and clinical models that can facilitate evaluations for ASD in toddlers, and strengthen community partnerships
This program consists of 8 sections:
- Pre-test
The pre-test will allow you to test your knowledge on important elements such as the early signs of autism, and screening tests, and compare your progress on the post-test at at the end of the course. There is no passing score required for the pre-test. - Educational Background
- Early Signs of ASD
- An Early Intervention Model
- Overview of the RITA-T
- RITA-T overview, development, current models
- Video of RITA-T administration and scoring.
- Step by Step Training
- In this section, you first need 3 scoring sheets labeled: CLIP 1, CLIP 2, and CLIP 3. You will watch 3 different presentations of each of the RITA-T 9 items being administered. You can watch this as many times as needed.
- When ready, you will score that item on the corresponding sheet. After you hand score each clip, you will then enter your scores on the corresponding questions under the video.
- After selecting your answers, select “Finish Activity” and you will be given points based on how many items you got correct for that press and an explanation on how the scoring was determined. You can re-score as many times as needed.
- Once you have completed the “post-clip quiz” for all 27 clips you will be ready to move on to the Independent Practice.
- Independent Practice Videos
- For this final section, you will watch 3 complete administrations of the RITA-T, one video at a time. You will use the 3 remaining scoring sheets to score each administration.
- At the end of each of the 3 test administrations you will select the correct score range for the administration.
- You must get the correct final score on the 3 videos within 3 points range to pass the evaluation and receive your certificate. You can re-score the videos as many times as needed.
- Post-test
You will need to complete a post-test at the completion of this training. You must earn a 70% or higher to continue. You can repeat this test as many times as you need to achieve this score. - Course Evaluation
Following the post-test, we ask that you complete a very short survey about the course. We will receive notification that you have completed your training. - Now you have trained on the RITA-T! Then what?
Now you need to practice using the RITA-T! Allow yourself a few times to administer it “live” even with the manual until you feel totally confident. Administer the RITA-T on young children in your family. Become familiar with each of the items and how to use them correctly. Administer the test on young children in your program who you do not have concerns for. Score in pairs to become familiar with the scoring and to establish interrater reliability. Identify a system within your program to integrate the RITA-T.
Please review the RITA-T Syllabus below, or download it with the link in the sidebar to the right. Once you have done that, please take the pre-test. The pre-test is designed to asses your general knowledge of the early signs of autism as well as characteristics of certain screening tools. The post-test is designed to assess your knowledge gain after having taken the course. See the Help tab for information about navigation this course and other frequently asked questions.
Syllabus
You will need to download and print one (1) copy of the RITA-T Manual, which you should keep with you as you practice and administer the screening test. You will also need to print a minimum of six (6) scoring sheets for this training. However, you can print as many scoring sheets as you need for extra practice and/or future use.
RITA-T Telehealth Material
The Telehealth RITA-T can be implemented in your practice or program once you have trained and are comfortable with the use and administration of the in-person RITA-T. You do not have to print any copies of the Telehealth material for this training. Please reach out to us at RITA-T@childrens.harvard.edu if you have any questions.

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians, Physician Assistants, and Nurse Practitioners
Boston Children’s Hospital designates this live activity for a maximum of 3.5 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Nurse
Boston Children’s Hospital designates this activity for 4.00 contact hours for nurses. Nurses should only claim credit commensurate with the extent of their participation in the activity.
Psychologist
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibly for the content of the programs.
Social Worker
As a Jointly Accredited Organization, Boston Children’s Hospital is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. Boston Children’s Hospital maintains responsibility for this course. Social workers completing this course receive 4.00 ACE CE continuing education credits.
Disclosures
The RITA-T is an empirically derived, level-2 interactive measure that has been developed to screen for autism spectrum disorders in toddlers 18 to 36 months of age. Early Childhood and Health care providers can become trained to administer the RITA-T, which can be integrated into diverse settings to better screen and identify toddlers who are high risk and need further diagnostic evaluation. The screening test consist of 9 items and takes about 10 minutes to administer and score. Each of the 9 activities designed to evaluate five developmental constructs known to represent early signs of ASD in toddlers 18-36 months.
This online training program has been designed to mirror the in-person training protocol as best as possible. The content provided, requirements for certification, and time required for completion are all equal to what is offered in the live training. Efforts have been made to provide trainees with enough content to answer questions without additional support, however we understand there may be times when there are specific questions and we will answer this questions in a reasonable amount of time. It is important to note that this is an interactive screening test, and you should seek further diagnostic testing and consult your pediatrician if you have concerns for ASD.
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CME activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
Speaker Name, Degree
Entity name, or None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue is urgent, call the CME office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CME Department to request a refund.How do navigate this course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
Pediatric Asthma Updates

Kenan Haver, MD
Director, Asthma Program
Associate Professor of Pediatrics, Harvard Medical School
Dr. Kenan Haver gives a brief overview of updates in pediatric asthma care. The presentation was recorded at Pediatric Asthma and Allergy Updates for Primary Care Providers 2022, on 3/18/22.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Review asthma epidemiology
- Consider objective testing when diagnosing asthma
- Recognize factors that may influence the response to asthma therapy

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician
Boston Children’s Hospital designates this live activity for a maximum of 0.5 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Nurse
Boston Children’s Hospital designates this activity for 0.5 contact hours for nurses. Nurses should only claim credit commensurate with the extent of their participation in the activity.
Disclosure Policy
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CE activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
Disclosure Statement
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
Kenan Haver, MD
Spouse – Alexion
Author – UptoDate
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue urgent, call the CE office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CE Department to request a refund.How do I Navigate this Course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
What COVID Taught Us About Asthma

Andrew MacGinnitie, MD, PhD
Clinical Chief, Division of Immunology
Associate Professor of Pediatrics, Harvard Medical School
Dr. Andrew MacGinnitie speaks about the effects of the COVID-19 pandemic on pediatric asthma patients, and the impact of asthma on COVID infection. The presentation was recorded at Pediatric Asthma and Allergy Updates for Primary Care Providers 2022, on 3/18/22.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Understand impact of COVID-19 pandemic on pediatric asthma
- Understand how existing asthma influences COVID-19 infection
- Understand how asthma therapies affect COVID-19 infection

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians
Boston Children’s Hospital designates this live activity for a maximum of 0.75 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Nurses
Boston Children’s Hospital designates this activity for 0.75 contact hours for nurses. Nurses should only claim credit commensurate with the extent of their participation in the activity.
Disclosure Policy
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CE activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
Disclosure Statement
The following planners, speakers, and content reviewers, on behalf of themselves and their spouse or partner, have reported no relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients.
Andrew MacGinnitie, MD, PhD
None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue urgent, call the CE office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CE Department to request a refund.How do I Navigate this Course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
The 2020 Focused Updates to the Asthma Management Guidelines: Pediatric Recommendations
(Note: a course evaluation is required to receive credit for this course.)

Michelle Cloutier, MD
Professor Emerita Pediatrics and Medicine, University of Connecticut School of Medicine
Dr. Michelle Cloutier discusses the NAEPP 2020 Focused Asthma Updates to the Asthma Management Guidelines and how to use them in pediatric primary care. The presentation was recorded at Pediatric Asthma and Allergy Updates for Primary Care Providers 2022, on 3/18/22.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Discuss briefly the 19 new recommendations from the NAEPP 2020 Focus Asthma Updates with a focus on the new pharmacologic recommendations.
- Use the new pharmacologic recommendations in pediatric primary care.

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician
Boston Children’s Hospital designates this live activity for a maximum of 0.75 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Nurse
Boston Children’s Hospital designates this activity for 0.75 contact hours for nurses. Nurses should only claim credit commensurate with the extent of their participation in the activity.
Disclosures
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CME activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
Michelle Cloutier, MD
None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue is urgent, call the CME office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CME Department to request a refund.How do navigate this course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
Anti-Racism for the Asthma Specialist

Margee Louisias, MD, MPH
Director of Diversity and Inclusion, Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital
Instructor, Harvard Medical School
Dr. Margee Louisias talks about the impact of structural racism on disparities in asthma care and research. The presentation was recorded at Pediatric Asthma and Allergy Updates for Primary Care Providers 2022, on 3/18/22.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Describe common terminology
- Understand the root cause of asthma racial disparities – structural racism
- Review examples from the literature to provide evidence for the role of structural racism and interpersonal racism in asthma outcomes
- Challenge norms in spirometry

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians
Boston Children’s Hospital designates this live activity for a maximum of 0.75 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Nurses
Boston Children’s Hospital designates this activity for 0.75 contact hours for nurses. Nurses should only claim credit commensurate with the extent of their participation in the activity.
Disclosure Policy
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CE activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
Disclosure Statement
The following planners, speakers, and content reviewers, on behalf of themselves and their spouse or partner, have reported no relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients.
Margee Louisias, MD, MPH
None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue urgent, call the CE office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CE Department to request a refund.How do I Navigate this Course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
Vaping and Asthma
(Note: a course evaluation is required to receive credit for this course.)

Jillian King, MSN, RN, CPNP-C
Pediatric Nurse Practitioner, Division of Pulmonary Medicine, Boston Children’s Hospital
Jillian King discusses youth vaping and how it affects pediatric patients with asthma. The presentation was recorded at Pediatric Asthma and Allergy Updates for Primary Care Providers 2022, on 3/18/22.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Highlight the background and prevalence of youth vaping.
- Present and discuss asthma case complicated by vaping.
- Discuss asthma and vaping.

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician
Boston Children’s Hospital designates this live activity for a maximum of 0.5 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Nurse
Boston Children’s Hospital designates this activity for 0.5 contact hours for nurses. Nurses should only claim credit commensurate with the extent of their participation in the activity.
Disclosures
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CME activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
Jillian King, MSN, RN, CPNP-C
None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue is urgent, call the CME office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CME Department to request a refund.How do navigate this course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
Food Allergy and Anaphylaxis Management
(Note: a course evaluation is required to receive credit for this course.)

Elizabeth Burke-Roberts, RN, MSN, CPNP
Nurse Leader, Allergy and Immunology, Dermatology, and Rheumatology
Pediatric Nurse Practitioner, Division of Immunology
Elizabeth Burke-Roberts discusses food allergy basics including signs/symptoms of an allergic reaction, testing options and limitations, appropriate interventions, and current devices available in the U.S. The presentation was recorded at Pediatric Asthma and Allergy Updates for Primary Care Providers 2022, on 3/18/22.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Review food allergy basics
- Review testing options and limitations
- Discuss signs/symptoms of an allergic reaction
- Define anaphylaxis
- Review appropriate interventions based on clinical presentation
- Show current devices available in the U.S.
- Review their specific technique

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians
Boston Children’s Hospital designates this live activity for a maximum of 0.75 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Nurses
Boston Children’s Hospital designates this activity for 0.75 contact hours for nurses. Nurses should only claim credit commensurate with the extent of their participation in the activity.
Disclosures
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CE activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
Elizabeth Burke-Roberts, RN, MSN, CPNP
None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue is urgent, call the CE office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CME Department to request a refund.How do navigate this course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
Episode 1: History of Celiac Disease: Does Gluten Really Cause So Many Problems?
(Note: a course evaluation is required to receive credit for this course.)

Vanessa Weisbrod
Director, Celiac Disease Program

Janis Arnold, MSW, LICSW
Clinical Social Worker, Division of Gastroenterology, Hepatology and Nutrition

Dascha Weir, MD
Associate Director, The Celiac Disease Program; Attending Physician, Division of Gastroenterology, Hepatology and Nutrition
Instructor of Pediatrics, Harvard Medical School
In this episode, Dr. Dascha Weir describes celiac disease and the proper diagnosis techniques. Furthermore, Dr. Weir identifies the common and uncommon symptoms of celiac disease and explains common errors in celiac disease diagnosis.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Describe celiac disease and the proper diagnosis techniques
- Identify common and uncommon symptoms of celiac disease
- Explain common errors in celiac disease diagnosis

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician
Boston Children’s Hospital designates this live activity for a maximum of 0.5 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Nurse
Boston Children’s Hospital designates this activity for 0.5 contact hours for nurses. Nurses should only claim credit commensurate with the extent of their participation in the activity.
Social Work
As a Jointly Accredited Organization, Boston Children’s Hospital is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. Boston Children’s Hospital maintains responsibility for this course. Social
workers completing this course receive 0.5 ACE CE continuing education credits.
Dietician
Boston Children’s Hospital designates this activity for 0.5 contact hours for dieticians. Dieticians should only claim credit commensurate with the extent of their participation in the activity.
Disclosures
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CME activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
Vanessa Weisbrod
None
Dascha Weir, MD, MPH
None
Janis Arnold, MSW, LICSW
None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue is urgent, call the CME office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CME Department to request a refund.How do navigate this course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
Click Here to View Transcript
[00:00:00] Host: Welcome to Raising Celiac, a podcast dedicated to raising the standard of education, awareness, and research on celiac disease and related autoimmune conditions. I’m Vanessa Weisbrod, the Education Director of the Celiac Program at Boston [00:00:15] Children’s Hospital, and each month on the podcast, we will invite leading experts to dive into a condition related to Celiac. And look at how it impacts a patient family. The latest research and offers suggestions for health providers to manage these [00:00:30] complex cases. Every episode of the Raising Celiac podcast is accredited by the Boston Children’s Hospital Continuing Education Department for 0.5 AMA PRA category one credits for physicians. 0.5 contact hours for nurses. 0.5 ACE CCE Continuing education credits for social workers and 0.5 CEUs for registered dieticians claim your credits for listening to today’s episode, please visit [00:01:00] dme.hospital.org/raising celiac. Let’s get started with this month’s Raising Celiac story.
[00:01:09] Guest: Peter was a pretty normal toddler. He giggled all the time, played joyfully with his family and [00:01:15] friends, and loved every food his mom put in front of him, especially avocados, broccoli, and snicker doodle cookies. His mom lovingly referred to him as her chubby little munch. Until just before his third birthday when he seemed to thin out all around but not get [00:01:30] any taller. His preschool class photo came in and he was a full head shorter than the other kids in the class. Despite being one of the oldest, something had to be up right.
[00:01:41] Host: Celiac disease is a chronic genetic autoimmune condition that can [00:01:45] affect any system of the body. The only treatment is a lifelong gluten-free diet. In people with celiac disease, gluten damages the lining of the intestines. This can prevent them from absorbing important nutrients from food and cause a variety of symptoms like [00:02:00] abdominal pain, nausea, diarrhea, vomiting, fatigue, weight loss, mouth ulcers, and growth issues to name a few.
[00:02:08] Guest: Peter’s parents took him to the pediatrician. One of the first tests they ran was for celiac disease. It was [00:02:15] positive. Peter’s parents were both surprised and not surprised at the same. They were aware of this condition because Peter’s grandmother also had celiac disease. Though her main symptoms were diarrhea and vomiting. She never had issues growing. How could [00:02:30] Peter have the same disease but not obviously react when eating the foods that made Grandma so physically ill?
[00:02:35] Host: Celiac disease can affect patients in very different. Some might have very obvious physical symptoms, while others may be more subtle or even none at all, [00:02:45] regardless of the symptoms, the reaction in the body is the same. When food enters the stomach, it’s broken down into tiny digestible particles, which then travel through the small intestine. The small intestine is lined with vii, tiny finger-like projections that [00:03:00] absorb nutrients from the food passing. in celiac disease, gluten damages the intestines and causes the villa to break down, leaving a smooth lining that can no longer absorb nutrient. It’s.
[00:03:11] Guest: As Peter’s parents dove into researching everything about [00:03:15] celiac disease, they quickly learned that the rest of the family needed to be tested and that symptoms could impact any system of the body. Peter’s dad had spent his entire life with crippling neuropathy in his hands and feet. He also tested positive for celiac [00:03:30] disease. Then a few months later, his aunt tested positive after seeing a dermatologist for a blistery rash on her elbows. Oddly enough, Peter’s cousin also tested positive for celiac disease but had no distinguishable symptoms and was only tested [00:03:45] because he also had type one diabetes. Were all of these differing symptoms really related to eating gluten and as Celiac really so common that several family members all have it.
[00:03:55] Host: Not to give it all away, but the answer is yes. All of these different [00:04:00] symptoms and many more can be related to gluten. As Peter’s family quickly learned, celiac disease is far from uncommon. An estimated 1% of people in North America are affected by this autoimmune disease. Typically more girls than boys [00:04:15] and many are undiagnosed, and Celiac is also closely related to many other chronic diseases including type one diabetes and thyroid disease. So this season on Raising Celiac, we’re going to explore why we’ll talk to [00:04:30] experts across the United States and around the world to discuss why celiac disease is so complicated and how better understanding it may be the key to learning more about other autoimmune conditions. So let’s start raising Celiac.
[00:04:43] Today we talk about the history [00:04:45] of celiac disease with Dr. Dosha Weir, the clinical director of the Celiac disease Program at Boston Children’s Hospital. Dr. Weir first became interested in celiac disease during her medical training and is now a board-certified pediatric gastroenterologist with [00:05:00] expertise in celiac disease in children. Dr. Weir’s recent research has focused on non-responsive celiac disease in children, and she is a champion for supporting food insecure families with celiac disease. Dr. Weir sits on the executive committee of the Harvard Medical School [00:05:15] Celiac Research Program and the Board of the Celiac Kids Connection.
[00:05:18] Welcome Dr. Weir to Raising Celiac.
[00:05:21] Thank you so much for having me. It’s really a pleasure to be here.
[00:05:25] So before we talk more about Peter’s family story, I wanna talk about the history of [00:05:30] celiac disease. When and how was it discovered?
[00:05:33] Celiac disease is not a new thing, even though many of us have only just started to hear about it more regularly. It actually was first described by a physician back in the Roman [00:05:45] Times, around a hundred to 200 a d and he described, um, You know, he described patients who had problems with digestion and absorption, and actually called it celiac affection at that point in time.
[00:05:58] Celiac is [00:06:00] actually from the Greek word belly, which makes reference to one of the classical symptoms that we sometimes see with celiac disease of, of a vi, a big, distended belly. So, it really does go way back. Um, and then it was mentioned in the medical [00:06:15] literature as far back as the 16 hundreds and through the 18 hundreds and the 19 early 19 hundreds European, British, and American physicians identified and discussed celiac disease.
[00:06:27] And trialed various dietary treatments without [00:06:30] the understanding that gluten was triggering celiac disease, which is really interesting to look back at how that piece was fit into the, to understand celiac disease. Um, in 1920s there was an American physician named Dr. [00:06:45] Haas, and he noticed, um, in, in Puerto Rico that in the city where people ate bread, there was more suffering of celiac. While the farmers who lived in the country and [00:07:00] mostly ate bananas, rarely suffered from celiac disease. And he made that observation and decided that the key to treating celiac disease was bananas. He did not pick up that the gluten, perhaps it was the absence of gluten. That was really, was really the key [00:07:15] there. Um, and he, he really developed a banana-based diet that did have some success in treating kids. Celiac disease back in the early 19 hundreds. Um, so it’s just kind of interesting because he really was prescribing the diet without realizing [00:07:30] exactly what he was doing.
[00:07:31] That’s so interesting.
[00:07:33] Yeah, I thought it was really interesting. And they call people who had celiac disease in that era and survived, uh, banana babies actually, It wasn’t until after World War II when the connection was made between [00:07:45] celiac disease and the trigger of gluten, of ingested gluten, and there was a Dutch pediatrician whose name was William Carl Dickey, who observed that during the war when there was no bread available, that Dutch children with celiac [00:08:00] disease got better and that they were not dying. And he really noticed that there was this big improvement in kids with celiac disease and then when the bread returned, they started getting sick again. And that really, that really helped him make that connection which was obviously a huge breakthrough in the [00:08:15] treatment of celiac disease
[00:08:16] and that advancement was in the 1950s when we started being able to do small bowel biopsies and that really paved the way. For us to be able to confirm celiac disease by the characteristic inflammation [00:08:30] and damage that we see when someone with celiac disease is consuming gluten. And then the last piece was, um, the advent of serologic tests. So ttg IGA is a blood test that we have that we really rely on a lot to [00:08:45] help us figure out who has celiac disease. And that was really only recognized as a marker of celiac disease, um, in 1997. So that was another really big step that helped us understand celiac disease and recognize celiac disease [00:09:00] much better than we had done previous.
[00:09:02] it’s been amazing to see over the last, you know, 20 years how much we’ve learned and how far our community has come.
[00:09:09] It really is amazing, isn’t it?
[00:09:11] Absolutely. So as we heard from Peter’s family, [00:09:15] celiac disease affects people in many ways if there are so many symptoms. How can doctors know when the right time is to screen for celiac? Should they always just be testing no matter what the ailment?
[00:09:25] It’s a really good question because you’re right. The range of how people show up with celiac [00:09:30] disease is so broad. There are so many different ways people can show us that they have celiac disease. Um, and, and what’s really tricky about it is some of those symptoms are really common symptoms of, of being human, you know, and they’re not always linked to [00:09:45] celiac disease. And so, um, It can be really tricky to figure out who to screen. There’s really two groups that we think about who need screening. One are people who have a variety of symptoms, you know, including gastrointestinal symptoms, growth issues, and, and many, [00:10:00] many other symptoms as we’ve sort of outlined in Peter’s case. I think we should have a really low threshold to sending blood work to look for celiac disease. So There’s another group though, that we also need to think about, and that’s kids. Kids that are if you have a first degree family member with celiac disease, [00:10:15] for example, or you have another disorder like an autoimmune disease such as thyroid disease or type one diabetes, your risk of having celiac disease is higher than the average population. And so we should be thinking as a medical community about [00:10:30] actively screening those patients as well.
[00:10:32] Can you tell our listeners what some of the more common symptoms of celiac disease are?
[00:10:38] some of the common symptoms that we see in celiac disease are gastrointestinal symptoms like abdominal [00:10:45] pain, nausea. Some people will have changes in stool and it doesn’t just have to be diarrhea. It can also be constipation. Um, another big way that we see children presenting with celiac disease is not growing well, and that might be that their linear growth, their [00:11:00] height is stunted, and that they have something that we call short. Or it might be that they are not gaining weight well or are actually losing weight. Those symptoms in kids are red flags, that there is something going on in the body. And it turns out that celiac [00:11:15] disease is, is a very major cause of those symptoms in kids. Um, but there’s other non GI symptoms that are relatively common. Iron deficiency anemia is another big one that can be a sign of celiac disease. Um, and uh, fatigue [00:11:30] is another one that I actually see quite a.
[00:11:33] So is it really possible to have no symptoms at all, but still test positive for Celia?
[00:11:39] It is. So we keep track of the diagnosis of celiac disease in our program [00:11:45] and we’ve gone, we’ve been doing that since, you know, 2001. And when we look at the numbers of kids that we’ve diagnosed, we see that a a little bit under 10% of patients, uh, don’t have identifiable symptoms before the diagnosis. Um, which is [00:12:00] really surprising to families when they find themselves, you know, thinking about this diagnosis and a kid that they really were not worried about prior to, prior to the blood test that was sent.
[00:12:09] But one of the things that I think is really interesting is that I, I. Over the [00:12:15] years have become a little more reluctant to calling that asymptomatic celiac disease because I’ve had so many experiences where kids, we’ve identified that they have celiac disease, they go on a gluten-free diet, they come back for follow up, and there is something that’s better that they hadn’t [00:12:30] identified beforehand is off. Often it’s, Oh, my kid has so much more energy. Or sometimes kids will verbal. , I, I did have abdominal pain and now it’s gone. I think kids are so resilient that I think sometimes they don’t realize that they have a symptom until it’s [00:12:45] not there. Or they don’t realize that a symptom might not be normal that everybody else feels until it’s not there. So I, I, I hesitate a little bit to use asymptomatic, um, the asymptomatic label on patients. I can tell you that there are absolutely [00:13:00] people who do not have symptoms and do not feel better on a gluten-free diet. And it, and it can be a hard thing for families and patients to wrap their heads around.
[00:13:07] So let’s say you have a patient who is seemingly asymptomatic or you know, doesn’t have any obvious noticeable symptoms to themselves, [00:13:15] um, and they go in the gluten-free diet and they’re not feeling better, why should they stick to that gluten-free diet?
[00:13:20] There are a lot of good reasons to treat celiac disease. Even if you don’t have symptoms. Obviously, if you have symptoms, that’s a really big motivating factor to everybody. Um, but if [00:13:30] you don’t have symptoms, you still have the inflammation and damage in your intestine and, and long term inflammation in your intestinal tract is not a healthy thing.
[00:13:38] It can predispose you to nutritional deficiencies, which can have health. Including bone density [00:13:45] problems and osteopenia or osteoporosis, which is like a, um, um, a lack of bone density in weak bones. Um, he can also lead to things like infertility and there are descriptions in adults with untreated celiac disease who have certain [00:14:00] malignancies of the small intestine, um, which, uh, are associated with untreated celiac disease.
[00:14:05] so the stakes are really high. The other piece that is particularly relevant to the, like children and the pediatric population is growth. You [00:14:15] know, kids may not grow to their full potential and when they hit their growth spurt, they may not grow, as tall as they should be, and they won’t realize it until it’s too late.
[00:14:24] So that’s another big reason.
[00:14:26] All very good reasons
[00:14:28] We think so[00:14:30]
[00:14:31] Ad Break: The Global Autoimmune Institute works to empower solutions in the diagnosis and treatment of autoimmune diseases. Through research, education, and awareness, while supporting multidisciplinary approaches to health,[00:14:45] we are thrilled to support the production of this educational.
[00:14:50] welcome back. So, Dr. Weir, we hear all the time that it can take years for a patient to be correctly diagnosed with celiac disease. Why does it take so long in some.[00:15:00]
[00:15:01] I think a lot of this. Is because of the variety of how patients show up with celiac disease. And sometimes the symptoms can be very subtle or the symptoms can be atypical. I think, um, a [00:15:15] lot of people in the medical field and outside of the medical field, Note about the classic presentation of celiac disease.
[00:15:22] The young child who has failure to thrive, a big swollen belly might be throwing up or having diarrhea. tend to get [00:15:30] diagnosed, uh, very quickly. Okay. But what is actually more common is to be, to be less dramatic and to be older. So in our, in our program, the average age of diagnosis is about 10.
[00:15:42] And these patients may have some [00:15:45] abdominal pain, they may have some fatigue. And, and like I referenced before, a lot of these symptoms are very frequent symptoms of, of childhood and of adolescence, and can be explained away for other reasons, either by the family and not coming to present. Care, you know, [00:16:00] not asking for help and sorting out the, the, the symptoms, but also the physicians may, may not think to send, um, the celiac testing, the celiac serology testing.
[00:16:11] So I think, I think that the reason why it takes so long, or historically [00:16:15] why the reason why it has taken so long is because it, it, it, it can be, it can be complicated and tricky and I don’t think it’s always been on everybody. Um, radar to think about it in those more subtle, in those most more subtle cases.
[00:16:28] I, I like to think that [00:16:30] we’ve gotten better through the years, um, and identifying it. Um, but I think there are still people who have symptoms for longer than they should before we figure it out.
[00:16:38] so just so we’re setting the record straight, can you tell our listeners what are the correct tests for celiac disease [00:16:45] and what would you see on those tests come back where the pediatrician should refer to a gastroenterologist?
[00:16:51] Absolutely. Our best blood test is something called tissue transaminase. Which is a mouthful iga, we call it ttg IGA for [00:17:00] short, sort of a short way to say it. Um, so that test is a really helpful test, um, when you’re worried about someone having celiac disease, and we recommend sending it with a total iga.
[00:17:11] So immunoglobulin A is one of the components of our immune [00:17:15] system, and it’s a building block of the antibodies. And so you need to have enough IGA in your body in order to make the TTG IGA antibody that we see with celiac disease. And what’s interesting is that patients with celiac [00:17:30] disease have a. Risk of having something called an IGA deficiency where your body doesn’t make enough of that immunoglobulin.
[00:17:37] And so you need to know if your patient, if that person has enough IGA to have a positive test. So it’s really [00:17:45] important to send the ttg iga and the total iga now. If someone doesn’t have enough iga, um, there are other tests that we can send. Um, and the best test is something called the de contaminated GL and peptide, I g G, [00:18:00] and that’s the, that’s a really good test to send in someone who doesn’t have enough iga, to mount a positive response.
[00:18:07] So if they have a negative TTG level, but uh, only a positive iga, would they still be referred to gastroenter? [00:18:15] Um,
[00:18:16] They probably would be. Yes. Um, there are, like you’re referencing, there are other tasks that can be sent, um, looking for celiac disease and some of them are better than others. You know, I, I think the bottom line is that, um, some of the [00:18:30] tasks that are out. Are not as good. Um, but if they’re positive, they’re really hard to ignore.
[00:18:35] And we know that celiac disease doesn’t always follow the rules. And sometimes we have people with celiac disease who don’t have the typical blood test positive. You know? So if there’s [00:18:45] something that doesn’t seem right, whether that’s a lab, whether that’s an IgG based lab or something about your patient, even if the blood work comes back for celiac disease and it’s normal, if you’re worried about that.
[00:18:56] You know, most gastroenterologists will be happy to see them [00:19:00] and to help sort it out because we know that sometimes celiac disease can, can be difficult to diagnose.
[00:19:06] So the biopsy is something that happens once they get to the gastroenterologist, but it’s not something that all parents are comfortable with. Especially now that there’s more [00:19:15] knowledge about the European guidelines that aren’t always requiring the biopsy for diagnosis. Can you talk about how gastroenterologists evaluate if a biopsy is the right choice for a patient?
[00:19:24] Of course, this is another conversation. We have a lot with our, with our families and our patients. [00:19:30] Um, we’re lucky that we have the European guidelines that outline a subset of patients with celiac disease who might not need the biopsies because that has given us a lot of flexibility and how we make the D.[00:19:45]
[00:19:45] But the gold standard or what we have always thought of as sort of the gold standard or the best way to diagnose celiac diseases with biopsies. Um, and, and there’s a good reason for that. It is, it is a very clear way of knowing if somebody has celiac disease, because [00:20:00] we know the blood work isn’t right a hundred percent.
[00:20:01] So I think there’s a lot of value to getting small bowel biopsies to really know where you’re starting. I, there is data that shows kids who have biopsy confirmed disease do better long term on the [00:20:15] diet. Um, I think that that is true in some cases. I have other patients who have not been biopsy confirmed to do beautifully on the diet.
[00:20:22] Um, so that piece isn’t, isn’t a, a big convincing factor to me, but it is something that I mention to families. Um, [00:20:30] the other piece is that by having biopsy confirmed disease, I think it opens doors for you in the future in terms of being.
[00:20:37] Oh.
[00:20:38] Facilitating involvement in future clinical trial trials or having access to new medications that we [00:20:45] hope, or treatments that will, will come out to treat celiac disease.
[00:20:47] So, you know, I, I think that, we sort of go through the reasons why biopsies are helpful, but we also discuss the serologic guidelines if somebody does fit into that. And there are some kids who a [00:21:00] biopsy is not the right choice, you know, some. Have already put their child on a gluten-free diet, and, and if you do the biopsies on a gluten-free diet, you don’t get a good answer.
[00:21:09] Um, so if someone’s already on a gluten-free diet and feeling a lot better, it can, The idea of going back on [00:21:15] gluten for biopsies can be very difficult. Um, so that might be a, a patient that you would, you would not do the biopsies, and there’s some patients who have medical concerns that make the sedation and the procedure itself more dangerous.
[00:21:28: we break it down and, and, and in the end it comes down to shared decision making between the patient, their family, and us, you know, and deciding what the next best step is.
[00:21:39] So we can’t leave celiac testing without at least touching on genetics. Does a positive genetic test mean that they [00:21:45] have celiac disease or will get celiac disease?
[00:21:48] No, it’s a great question. So there are genetic tests for other diseases where if you have this gene, you will in your lifetime develop this disease. That is not what we have currently for celiac.
[00:21:58] So when you [00:22:00] look across the population, um, about 40% of people will have one of the HLA markers that we see with celiac disease, either D Q two or D Q eight. That’s a lot of people we know there’s a [00:22:15] lot of celiac disease out there, but it is certainly not 40% of the population.
[00:22:18] Our estimate is it’s about 1% of the population has celiac disease. Interestingly, if you take that group of people who have one of those HLA markers, only about 4% of them develop celiac [00:22:30] disease in their lifetime. So certainly having one of those markers makes your risk higher of developing celiac disease, but it is not a slam dunk diagnosis.
[00:22:39] And if you get a little more complicated, there are certain patterns of HLA typing that can, that can happen, [00:22:45] that give you even higher risk. So it, it, it is a helpful piece of information, but it does not seal the deal of the celiac diagnosis.
[00:22:54] So we know that a gluten-free diet eliminating all forms of wheat, Ry barley is the only treatment for celiac [00:23:00] disease. What is the best way for a patient family to learn how to adapt to this lifelong diet?
[00:23:07] It can be a complicated diet and we highly recommend that patients see a [00:23:15] specialized dietician who understands the gluten-free diet to really learn the nitty gritty details about where you need to be careful and where you don’t need to be careful. I think that is one of the most important steps that patients can, can do for themselves when they get the [00:23:30] diagnosis of celiac disease.
[00:23:31] so I think, I think you need, you need some education from a specialized dietician, and then you need to just plow forward and practice and, and Perfect, perfect. Your label reading.
[00:23:43] So let’s switch gears and talk about related [00:23:45] conditions. You touched on this a little bit in the beginning, but I wanna talk about it in more depth. We know there are a lot of other autoimmune diseases that are related to celiac. What are the most common.
[00:23:54] there’s so many different autoimmune diseases and I, you know, we see patients with celiac disease with many other [00:24:00] things like psoriasis or uh, inflammatory bowel disease, but I think the most common are diabetes and thyroiditis.
[00:24:06] So should someone who’s newly diagnosed with celiac disease be tested at the point of diagnosis for these coexisting conditions, or when is the right time to test,
[00:24:14] That’s a [00:24:15] great question. So certainly. When we make the diagnosis of celiac disease, if someone is having other symptoms that point towards another disorder, like an autoimmune thyroid condition or an autoimmune skin condition or diabetes, [00:24:30] certainly we would do testing and evaluation at that point in time.
[00:24:33] Um, and. It’s interesting. There are some of these autoimmune diseases that we can screen for with a blood test. Like it’s very easy to test someone’s thyroid function, uh, by a blood test. But some of the other, [00:24:45] um, some of the other autoimmune diseases is they’re not as easy to screen for and it’s really more of a clinical diagnosis.
[00:24:51] But we do absolutely recommend screening patients either with blood work or with close careful clinical monitoring by [00:25:00] asking questions and, and seeing how they’re. Um, Absolutely. And we do that from the moment they’re diagnosed. And importantly, we recommend continuing to do that through the years on a gluten-free diet.
[00:25:12] Is this something that you would test for at every annual follow up [00:25:15] visit?
[00:25:17] Yes, depending on the family history. Otherwise, you would do it certainly within the first year of diagnosis, and then maybe every other year, depending on your level of concern.
[00:25:29] Is there a [00:25:30] way to prevent developing a related condition or predicting if someone will get one?
[00:25:34] Not yet, but we’re really hopeful that we’ll have the science to be able to better predict that. And certainly if we’re able to prevent it, that would be amazing and I look forward to that [00:25:45] day. But right now, no. The best thing that we can do is to address the Celiac disease. Treat the celiac disease. Heal the intestine and try to promote health in every way possible to prevent other diseases.
[00:25:57] But it, but we don’t have a specific way [00:26:00] of, preventing autoimmune disease at this time.
[00:26:03] Well, thank you Dr. Weir so much for all of the wisdom you have shared today. This is really going to tee up the rest of the season of our podcast so nicely as we talk more about celiac disease and all of these different [00:26:15] conditions that are related to it. So now let’s find out where Peter and his family are today.
[00:26:21] Guest: It’s been almost seven years since Peter was diagnosed with celiac disease. Today he is a thriving fourth [00:26:30] grader, one of the tallest in his class. He’s an active member of the Celiac Kids Connection at Boston Children’s Hospital and loves attending gluten-free cooking classes. Gluten-free spaghetti with bona and tacos are his favorite foods. His [00:26:45] family has rallied together and adapted to gluten-free. vacations look a little different. They do lots of research in advance, but always find great food in the destinations they visit. In Peter’s words, I don’t mind being gluten free. It makes me [00:27:00] healthy and special.
[00:27:01] Host: Thanks for listening to this episode of Raising Celiac. A special thanks to the generous contribution from the Global Autoimmune Institute to make this podcast possible, A reminder to all physicians, nurses, social workers, and dieticians to [00:27:15] claim your continuing education credits. For listening to today’s episode, please visit DME dot children’s hospital.org/raising celiac and complete the short survey attached to this.
[00:27:26] If you like what you heard, be sure to write a review, like and [00:27:30] subscribe wherever you get your podcasts. For more information, check us out on social at at Boston Children’s Celiac, on TikTok, at Children’s Celiac, on Twitter, or at Celiac Kids’ Connection on Instagram. Join us next month when we discuss the relationship between celiac disease [00:27:45] and inflammatory bowel Disease with Dr.
[00:27:47] Ines Pinto Sanchez from McMaster University in Hamilton Health Sciences. Have a great month.
Diagnosis and Management of Pediatric Headache Disorders
(Note: a course evaluation is required to receive credit for this course.)

Hannah Shapiro, MD
Headache Neurology Fellow
Dr. Hannah Shapiro discusses how to formulate a headache treatment plan including lifestyle modifications, acute treatment, preventive medications, and non-pharmacological interventions. Furthermore, Dr. Shapiro introduces new headache treatments and discusses how to increase diagnostic accuracy of pediatric headache disorders. The presentation was recorded at the Network Summit 2022 on February 2, 2022.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Increase diagnostic accuracy of pediatric headache disorders
- Discuss how to formulate a headache treatment plan
- Introduce exciting new headache treatments

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians
Boston Children’s Hospital designates this live activity for a maximum of 0.75 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Disclosures
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CME activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
Hannah Shapiro, MD
None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue is urgent, call the CME office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CME Department to request a refund.How do navigate this course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
Running Sports Injuries in the Young Athlete – From Diagnosis to Return to Play
(Note: a course evaluation is required to receive credit for this course.)

Kristin Whitney, MD, MA
Sports Medicine Physician/Musculoskeletal and Sports Ultrasound, Sports Medicine Division, Department of Orthopedics
Instructor of Orthopedics, Harvard Medical School
In this presentation, Dr. Kristin Whitney discusses key features of presenting history and physical exam to guide diagnostic decision making for pediatric sport injuries. Furthermore, Dr. Whitney discusses guiding principles of clinical evaluation and management for common musculoskeletal injuries in the pediatric athlete as well as how to build a framework for Return-to-Play considerations in the young athlete. The presentation was recorded at the Boston Children’s Hospital Community Network Summit on February 2, 2022.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Identify key features of presenting history and physical exam to guide diagnostic decision making for pediatric sport injuries.
- Understand guiding principles of clinical evaluation and management for common musculoskeletal injuries in the pediatric athlete.
- Build a framework for Return-to-Play considerations in the young athlete that are both patient-centered and evidence-based.

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians
Boston Children’s Hospital designates this live activity for a maximum of 0.75 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Disclosures
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CME activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
Kristin Whitney, MD, MS
None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue is urgent, call the CME office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CME Department to request a refund.How do navigate this course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
Type 1 Diabetes: Sick Day Management
(Note: a course evaluation is required to receive credit for this course. Questions for presenters may be submitted under the Questions tab below.)

Elise Schlissel Temblay, MD
Attending Physician, Division of Endocrinology
Instructor of Pediatrics, Harvard Medical School
In this presentation, Dr. Elise Schlissel Tremblay discusses the general basics for type diabetes management for normal care, reviews what comprises a “sick day” for a child who has type 1 diabetes, and reviews sick day management guidelines from the perspective of the patient, family, general pediatrician, and endocrinologist.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Discuss the general basics of type 1 diabetes management for normal care
- Review what comprises a “sick day” for a child with type 1 diabetes
- Review sick day management guidelines from the perspective of the patient, family, general pediatrician, and endocrinologist.

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians
Boston Children’s Hospital designates this live activity for a maximum of 0.75 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Nurses
Boston Children’s Hospital designates this activity for 0.75 contact hours for nurses. Nurses should only claim credit commensurate with the extent of their participation in this activity.
Disclosures
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CME activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
Elise Schlissel Tremblay, MD
None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue is urgent, call the CME office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CME Department to request a refund.How do navigate this course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
Thyrotoxicosis
Note: a course evaluation is required to receive credit for this course. Questions for presenters may be submitted under the Questions tab below.

Jessica Smith, MD
Associate Medical Director, Thyroid Center; Attending Physician, Division of Endocrinology
Assistant Professor of Pediatrics, Harvard Medical School
In this presentation, Dr. Jessica Smith distinguishes thyrotoxicosis from hyperthyroidism, formulates a differential diagnosis for thyrotoxicosis, and reviews the investigations required to make the diagnosis. Furthermore, Dr. Smith discusses treatment options, risks, and benefits of each therapy for Graves’ disease (and neonatal Graves’ disease).
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Distinguish thyrotoxicosis from hyperthyroidism.
- Formulate a differential diagnosis for thyrotoxicosis.
- Understand the investigations required to make the diagnosis.
- Discuss treatment options, risks, and benefits of each therapy for Graves’ disease (and neonatal Graves’ disease).

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians
Boston Children’s Hospital designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Nurses
Boston Children’s Hospital designates this activity for 1.00 contact hours for nurses. Nurses should only claim credit commensurate with the extent of their participation in this activity.
Disclosures
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CME activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
Jessica Smith, MD
None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue is urgent, call the CME office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CME Department to request a refund.How do navigate this course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
Normal and Delayed Puberty
Note: a course evaluation is required to receive credit for this course. Questions for presenters may be submitted under the Questions tab below.

Kate Millington, MD
Attending Physician, Division of Endocrinology
Instructor of Pediatrics, Harvard Medical School
In this presentation, Dr. Kate Millington discusses the physiology of a normal or typical puberty, how to identify delayed puberty, how to consider the etiology of delayed puberty. Furthermore, Dr. Millington reviews the management of delayed puberty and gives guidance for when to refer to endocrinology.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Discuss the physiology of a normal or typical puberty.
- Identify delayed puberty.
- Consider the etiology of delayed puberty.
- Review the management of delayed puberty.
- Give guidance for when to refer to endocrinology.

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians
Boston Children’s Hospital designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Nurses
Boston Children’s Hospital designates this activity for 1.00 contact hours for nurses. Nurses should only claim credit commensurate with the extent of their participation in this activity.
Disclosures
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CME activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
Kate Millington, MD
None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue is urgent, call the CME office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CME Department to request a refund.How do navigate this course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
Transgender and Non-Binary Youth: A Guide for Primary Care
(Note: a course evaluation is required to receive credit for this course. Questions for presenters may be submitted under the Questions tab below.)

Jeremi Carswell, MD
Director, Gender Multispecialty Service (GeMS); Attending Physician, Division of Endocrinology
Assistant Professor of Pediatrics, Harvard Medical School
In this presentation, Dr. Jeremi Carswell discusses ways to create a safe space for LGBTQIA+ youth in primary care offices and explains the reasons behind this. Dr. Carswell also discusses both non-medical and medical initial support for youth, and the effects of estrogen and testosterone.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Know ways to create a safe space for LGBTQIA+ youth in your office, and understand the reasons behind this.
- Be knowledgeable about initial support for youth – both non-medical and medical.
- Have a basic understanding of the effects of estrogen and testosterone.

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians
Boston Children’s Hospital designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Nurses
Boston Children’s Hospital designates this activity for 1.00 contact hours for nurses. Nurses should only claim credit commensurate with the extent of their participation in this activity.
Disclosures
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CME activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
Jeremi Carswell, MD
None
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue is urgent, call the CME office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CME Department to request a refund.How do navigate this course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?
Sleep: Circadian Rhythm Disorders
(Note: a course evaluation is required to receive credit for this course.)

Joshua August, MD
Attending, Department of Neurology and Sleep Center
Instructor of Pediatrics, Harvard Medical School
Dr. Joshua August reviews the functioning and physiology of the circadian system to lay the groundwork for the treatment of circadian rhythm disorders. Furthermore, Dr. August discusses some of the diagnostic methods and how providers should go about a suspected circadian rhythm disorder. Dr. August also discusses delayed sleep phase syndrome while also touching on other circadian rhythm disorders that providers may see in clinical practice. The presentation was recorded for the Michael J. Bresnan Neurology Course on Sept. 12-16, 2022.
Learning Objectives:
At the conclusion of this educational program, learners will be able to:
- Review the functioning of the circadian system
- Discuss diagnostic methods
- Discuss delayed sleep phase syndrome
- Discuss other circadian rhythm disorders

In support of improving patient care, Boston Children’s Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physicians
Boston Children’s Hospital designates this live activity for a maximum of 0.75 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
Nurse
Boston Children’s Hospital designates this activity for 0.75 contact hours for nurses. Nurses should only claim credit commensurate with the extent of their participation in the activity.
Disclosures
Boston Children’s Hospital adheres to all ACCME Essential Areas, Standards, and Policies. It is Boston Children’s policy that those who have influenced the content of a CME activity (e.g. planners, faculty, authors, reviewers and others) disclose all relevant financial relationships with commercial entities so that Boston Children’s may identify and resolve any conflicts of interest prior to the activity. These disclosures will be provided in the activity materials along with disclosure of any commercial support received for the activity. Additionally, faculty members have been instructed to disclose any limitations of data and unlabeled or investigational uses of products during their presentations.
The following planners, speakers, and content reviewers, on behalf of themselves, have reported the following relevant financial relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on patients:
Joshua August, MD
Harmony Biosciences; Researcher
Please see the FAQs below for common questions about how to work through a course. If you have a question or issue that is not addressed in the FAQ, please use this form to submit a help request, or if your issue is urgent, call the CME office at: 617-919-9908.
How do I navigate this course? There are two ways to access and navigate course content with the interactive table of contents: at the bottom of the main course page or in the sidebar on the right side of the page. Select the links in the table of contents to access the corresponding content. Depending on the course, access to content may be linear, in which case each content module or section can only be accessed if the prior ones are completed, or non-linear, in which case modules and sections can be accessed in any order. Use the breadcrumbs at the top of any course page to orient yourself within a course, or return to a previous course section or the main course page. How do I claim credit? If the course has been accredited, available credits will be displayed on the course home page. Select only those credits that apply to your profession, and click/tap “Apply Selection.” You may make your selection at any point while you are taking the course, or after you have completed it. How do I download a certificate? There are two ways to view/download your certificate: from within the course or from the course listing under your profile (select the document icon). In either case, you must have selected at least one available course credit type to generate a certificate. How do I view/print my transcript? You must be logged in to view your transcript. Select My Profile at the top of the page. If you do not see the transcript selector, be sure the Courses tab is selected. Select the type of credit and dates to include in your credit report. To include all credits from all time, leave the options blank. Select Download Transcript to view/download your transcript. Note each credit type in your transcripts starts a new page. How do I request a refund? Please email the CME Department to request a refund.How do navigate this course?
How do I claim credit for this course?
How do I download a certificate?
How do I view/print my transcript?
How do I request a refund?