9www.ohioaap.org Ohio Pediatrics • Fall 2010

Prevalence: While 15-62% of female college athletes have disor-

dered eating, only 2-3% meet DSM criteria for anorexia or bulemia.

Likewise, 15-65% of female college athletes have some degree of

amenorrhea. A high school study has shown that 78% of athletes and

65% of sedentary controls have at least one component of the triad;

while the athletes tended to have more menstrual abnormalities, the

sedentary controls had a lower bone mineral density.

DiSORDERED EATiNG

While clinical suspicion is often heightened based on history or

parental concern, physical exam findings can include: Weight < 85%

of that expected for height, hypothermia, tachy/bradycardia, postural

hypotension or resting hypotension, thin body habitus, dry skin and

hair, hair loss, cold or discolored hands/feet, lanugo, yellow tinge to

skin, tooth enamel erosions on back teeth, parotid gland enlargement,

bloodshot eyes, knuckle scars.

Lab studies may reveal electrolyte disturbances, hormone level dis-

turbances, abnormal LFTs, elevated ESR or CRP, decreased leptin,

increased ghrelin (hormone signal for hunger), EKG findings

(increased QTc), + stool guaiac (laxative abuse).

Hospital Admission Criteria are similar to that for anorexia and/or

bulimia.

· Bradycardia: heart rate 20 bpm differential · Postural hypotension: >10 mmHg differential· Hypothermia: 430 ms or arrhythmia· Hematemesis / esophageal tears· Syncope· Weight loss or failure to gain weight which renders the patient at

10 Ohio Pediatrics • Fall 2010 www.ohioaap.org

WHAT iS THE FEMALE ATHLETE TRiAD?

A combination of three interrelated conditions associated

with athletic training in girls, all thought to be influenced by

an athlete’s desire to maintain a low body weight:

· Disordered eating· Menstrual cycle irregularities· Loss of bone density

DiSORDERED EATiNG

Any pattern of eating that does not supply an adequate

amount of calories to support a girl's activity level.

· Anorexia – girls who refuse to maintain a weight above85% of that expected for their height, are scared of gaining

weight, see their body image as fat when others see them as

too thin, and have missed at least three periods in a row.

· Bulemia – girls who will have eating binges (eating morefood at one sitting than is thought reasonable) and then

purges to rid body of food or calories.

· Disordered Eating (NOS – Not Otherwise Specified) –the diagnosis for girls who do not get enough calories in their

diets, but do not meet full criteria for the above two diag-

noses – includes girls who accidentally don't eat enough dur-

ing the day, those who will stop eating for a short time

(dieters), and those who are trying to eat too healthfully.

CONSEqUENCES OF DiSORDERED EATiNG

Irritability/depression; decreased concentration; loss of mus-

cle and bone mass and increased risk of injury; prolonged

recovery from injury; irregular periods; gastrointestinal disor-

ders; fluid and electrolyte disorders; cardiac disorders; death

Girls who tend to be more likely to have eating disorders

may have some of the following characteristics:

· Compulsive, rigid, perfectionist, very hard working · Anxious, depressed, socially withdrawn· Girls who exercise when injured or outside of practice· Participation in sports with revealing attire (gymnastics,swimming), that are subjectively scored (figure skating), that

have weight limits (rowing, martial arts), or where a low

body weight can mean improved performance (cross-country

running or skiing)

Treatment varies depending on the degree of disordered eat-

ing. While anorexia and bulemia can be very difficult and in-

tensive to treat, most girls have disordered eating NOS and

respond very well to meeting with a dietitian who specializes

Sports ShortsGuidelines for Parents, Coaches, Athletes

This information is available on the Ohio Chapter, American Academy of Pediatrics’ website at www.ohioaap.org

The Female Athlete Triadin sports nutrition. Girls can learn how many calories they

need. They can learn how to eat at different times of the day

to boost their performance and improve their energy levels.

MENSTRUAL CyCLE iRREGULARiTiES

· Primary amenorrhea (lack of a period) girls who have not had a period by the age of 15

· Secondary amenorrhea – girls who used to have periods, but have now lost them

· Oligomenorrhea – girls who have irregular periods or skip periods

When associated with athletic training and disordered eating,

a girl will lose her periods, or they will become irregular,

when her body has not taken in enough calories to supply her

daily activities and her sport over time. This is a starvation

response by the body to keep a girl from getting pregnant

when there's not enough food available. Tests may be ordered

to ensure that a girl has not lost her periods for a hormonal

reason, a thyroid condition, a structural reason, or even be-

cause she's pregnant, before diagnosing her with amenorrhea

due to the Female Athlete Triad.

Treatment involves increasing the number of calories in a

girl's diet, while perhaps cutting back on her activities. A girl's

periods will typically not come back until she gains 4-5 lbs.,

and even then it can take up to a year to return.

LOSS OF BONE DENSiTy

A girl's bone density continues to increase until about the age

of 20, at which time it stabilizes until about age 30. After 30,

bone density starts to decrease, regardless of calcium intake or

activity level. Loss of enough bone density can make the

bones fragile and more prone to fractures. When a girl does

not get enough calories, calcium, or vitamin D in her diet, she

may not increase her bone density enough during adolescence

and may even lose bone density. This can make her more

prone to stress fractures and injury fractures.

Treatment may include calcium and vitamin D supplementa-

tion, and an increase in the amount of calories in a girl's diet.

While birth control pills will start a girl's periods up again,

they will not solve the problem and will not help a girl gain

her bone mass back again unless her diet is addressed.

Author: Anastasia Fischer, MD.

Sports Shorts is provided by the Home and School Health Committee of the Ohio Chapter, American

Academy of Pediatrics.

www.ohioaap.org Ohio Pediatrics • Fall 2010 13

Ohio Pediatrics

Clark Kellogg and “Goodnight Moon”make Breakfast for Books a success

Fourth Annual Reach Out and Read Ohio fundraiser brings in nearly $12,000 for statewide program

Reach Out and Read Ohio would liketo extend a Thank You to Breakfastfor Books 2010 Sponsors and Sup-porters.

Where the Wild Things Are

Sponsor:

Drs. John C. Duby and Sara F.Guerrero-Duby

if you Give a Mouse a Cookie

Sponsors:

Akron Children’s Hospital Nationwide Children’s Hospital University of Toledo Medical Center,Department of Pediatrics

Very Hungry Caterpiller

Sponsors:

Center for Cognitive and BehavioralTherapy of Greater ColumbusMcDonalds, USA, LLC

Table Sponsors:

Edwin & Carol HallThad & Barbara Matta

Raffle items were donated by:

Richard & Sally JamesonJohn R. Green CompanyLori LeGendreThad MattaThe Step 2 Company, LLC

Special Thank you to:

Jeff Hogan Clark KelloggOhio AAP FoundationOhio UnionReach Out and Read Ohio AdvisoryCommittee

Jeff Hogan, WBNS 10-TV news anchor,was the emcee for this year’s event,which saw the largest crowd in theevent’s history at nearly 130. The eventwas held in the new Ohio Union on theOSU campus.

Through raffle ticket and centerpiecesales, attendees and sponsorships,Breakfast for Books raised nearly$12,000 for Reach Out and ReadOhio on Sept. 10.

Drs. Martha Kleinberg, and thelate Warren Kleinberg, werehonored for their dedication andcommitment to the ROR pro-gram. Lori LeGendre, ProgramDirector for ROR NorthwestOhio, accepted the award.

A Champion of the year award was givento American Elite Allstars, inc., for dona-tions of $72,000 and more than 41,000 newand gently used books to the Akron area,over the past five years.

Students and teachers from the G. TyreeLearning Center in Columbus were guest atten-dees, thanks to the generosity of sponsors Drs.John Duby and Sara Guerrero-Duby, andAkron Children’s Hospital.

Ohio AAP President Gerald Tiberio,MD, opens the fourth annual Break-fast for Books event by telling howReach Out and Read has been benefi-cial in his own pediatric practice.

14

Ohio Pediatrics

Ohio Pediatrics • Fall 2010

Legislation...from page 2

Ohio Attorney General

Former Republican United StatesSenator and former Lieutenant Gov-ernor Mike DeWine will challengecurrent Democrat Attorney GeneralRichard Cordray to serve as Ohio’slead attorney.

Ohio Auditor

With incumbent Mary Taylor joininggubernatorial candidate John Kasichon the ticket as the candidate forlieutenant governor, a couple of rela-tive “unknowns” will be on the ballotfor state auditor. Republican Dela-ware County Prosecutor Dave Yostand Democrat David Pepper will viefor the seat in the fall election.

Ohio Secretary of State

Sen. Jon Husted (R-Kettering) facesDemocrat Maryellen O'Shaughnessyfor Ohio’s secretary of state.

Ohio Treasurer

Incumbent Democrat Kevin Boycewill face a strong challenge by StateRep. Josh Mandel (R-Lyndhurst).Many around Capitol Square predictthat this race is “in the bag” for Rep.Mandel, an attorney, Iraq war veteranand prolific fundraiser.

Ohio Senate

Sixteen of the 33 Senate seats are upfor election this year (7 Republicanand 9 Democrat). As Republicanshold a 21-12 majority in this cham-ber, a change in leadership is not ex-pected. Dramatic upsets are alsounlikely.

Ohio House

With all eyes on the majority, bothparties in the Ohio House will be tar-geting swing districts. For those whohave followed Ohio politics in the

past, many of the key races for 2010have been the key races in years past.Races to watch include:

HD 17 – With current Rep. JoshMandel running for Ohio Treasurer,Republican Marlene Aneilski, mayorof Walton Hills, will be facing offagainst Democrat Kelli Perk, an as-sistant prosecuting attorney fromBroadview Heights.

HD 19 – Republican Ann Gonzales,mayor of Westerville, a Columbussuburb, is waging an active campaignagainst Rep. Marian Harris (D-Columbus).

HD 20 – Incumbent Democrat Rep.Nancy Garland faces a challenge byRepublican Matt Carle, an attorneyand campaign staff veteran.

HD 50 – Rep. Todd Snitchler (R-Uniontown) worked hard to win thisseat two years ago. He will have towork just as hard with a challengefrom Democrat Todd Bosley, a StarkCounty Commissioner.

HD 42 – Republican challengerKristina Roeger, an engineer with anMBA serving on Hudson City Coun-cil, will face off against Rep. MikeMoran (D-Hudson).

HD 46 – This is the race to watch inNorthwest Ohio as Rep. BarbaraSears (R-Maumee) faces a challengefrom Harry Barlos, an administratorfor the Village of Holland and formerLucas County Commissioner.

HD 63 –Rep. Mark Scheider (D-Mentor) will face former state repre-sentative Ron Young from LeroyTownship in the November election.

HD 85 – In a district that almost al-ways has a heated race, Rep. RayPryor (D-Chillicothe) faces Repub-lican Bob Peterson, a family farmerfrom Fayette County.

HD 89 – As Rep. Todd Book leavesthis seat due to term limits, DemocratRon Hadsell, a Portsmouth construc-tion executive, will be runningagainst Dr. Terry Johnson, a Repub-lican physician and colonel in theOhio National Guard.

HD 91 – Republican Bill Hayes, anattorney from Caldwell, will chal-lenge Rep. Dan Dodd (D-Hebron).

– Capitol Consulting GroupOhio AAP Lobbying Team

ImmunizationAdvocacy Networkof Ohio to meet

Join us before the 2010 OhioAAP Annual Meeting on Friday,Nov. 5 from 8 to 9 a.m. at theMarriott Northwest in Dublinprior to the Annual Meeting foran Immunization Advocacy Net-work of Ohio meeting.

This new network will bringtogether a broad range of organi-zations and individuals who be-lieve in the critical importance ofimmunization.

If you are interested, or wouldlike more information, contactMelissa Wervey Arnold, OhioAAP Executive Director, at (614)846-6258 or e-mail chapter@ohioaap.org.

15www.ohioaap.org Ohio Pediatrics • Fall 2010

Ohio Pediatrics

Reach Out and Read Ohio educatesproviders on early literacy skills

Teaching children to read can be aseasy as reading to children on a dailybasis. Reading aloud to children isthe single most effective thing par-ents can do to help prepare their chil-dren to succeed in school. That iswhy Reach Out and Read makes lit-eracy promotion a standard part ofevery well child visit from 6 monthsthrough 5 years old.

This message was reinforced at the2010 Reach Out and Read OhioAnnual Meeting on Sept. 29 at theState Library of Ohio in Columbus.

The meeting started with a keynotepresentation by Kathleen Hayes, edi-tor of Highlights High Five maga-zine. Her presentation, “For the Loveof Literacy: How reading aloud canhelp young children develop six keyearly literacy skills” outlined howvocabulary, print motivation, letterknowledge, print awareness, phono-logical awareness and narrative skillshelp prepare children to read.

In addition to explaining each ofthese six skills in detail, Hayes pro-ceeded to show attendees how theseskills are the foundation of the High-lights High Five magazine. At theend of the meeting, attendees re-ceived several hundred back issues ofthe magazine to take back to theirpractices and share with families.

After the keynote presentation, thesix skills were again discussed at twointeractive sessions lead by children’sauthor, Michael J. Rosen, and thePublic Library of Cincinnati and

Statewide Annual Meeting for providers, coordinators and volunteers reinforces messages in fun and informative manner

Kathleen Hayes, editor of Highlights High Five magazine, was the keynote speak-er at the Reach Out and Read Ohio Annual Meeting where she discussed the sixkey early literacy skills children need to learn.

Using dialogic reading and storytime,children’s librarian Natalie Fields, dis-cussed the role of public libraries inbuilding literacy rich environments forchildren.

Robert Needlman, MD, allows chil-dren’s author, Michael J. Rosen, tountie his shoes during an exerciseshowing how parents can use shoelacesto create letters of the alphabet. See ROR...on page 17

16 Ohio Pediatrics • Fall 2010 www.ohioaap.org

Ohio Pediatrics

Funding from CareSource will securecontinuation of Asthma Pilot Project

With the Chapter Quality Network(CQN) Asthma Pilot Project wind-ing down, the Ohio AAP was re-cently awarded a $75,000 SignatureGrant from the CareSource Foun-dation to support a second wave ofquality improvement work forOhio’s pediatric asthma patients.

The CareSource Foundation ispart of CareSource, a non-profit,public-sector managed-care com-pany, which has become one of thelargest and fastest growing Medi-caid managed-care plans in the na-tion.

“CareSource is committed to giv-

ing back and supporting health ini-tiatives that impact our members,”said Pamela Morris, President andCEO, CareSource. “As a health planthat serves the underserved, we un-derstand the emotional and financialburden that is placed on familiescaring for children with asthma, andwe’re glad to be able to support thispilot that improves the quality ofcare.”

In the first wave of the CQNAsthma Pilot Project, 13 practiceswith nearly 80 physicians worked toimprove patient care. An additional

P. Cooper White, MD, right, physician

leader for the CqN Asthma Pilot Pro-

ject, receives a check from Gail Croall,

MD, senior medical director for Care-

Source, to support a second wave of

the Asthma Pilot Project.See Asthma...on page 19

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www.ohioaap.org 17Ohio Pediatrics • Fall 2010

Ohio Pediatrics

Among themany challengesand opportunitiesfacing pediatri-cians in the fall of2010, none isgreater than that offacilitating imple-mentation of thebenefits ofhealth-care re-form for children inherent in health-care reform (ACA) passed by Con-gress last March. Health care for allchildren is within reach but the job isnot done. Access to excellent care isa major issue for children and if wecan take advantage of the potentialbenefits in ACA, access will be im-proved and pediatricians will be paidmore appropriately for their services.Your Chapter leadership is activelyinvolved with state government,

District V Report

Marilyn Bull, MD

Take advantage of benefits in ACAchildren’s coalitions, and membersof the legislature to advance thecause of children and pediatriciansin this effort. The national AmericanAcademy of Pediatrics is contribu-ting expertise as well and frequentcommunication occurs between yournational and state leaders.The De-partment of State and GovernmentAffairs has developed new resourceswhich are continually updated andcan be accessed on the AAP.org website on the “Members Only Center”under the heading of that departmentand titled State Health - State Imple-mentation of the Patient Protectionand Affordable Care Act (ACA)(http://www.aap.org/securemoc/stgovaffairs/acastatehealth.doc)

What can you do? Communicateyour concerns and specific problemsto the Chapter. Attend your statemeeting Nov. 5 and 6 and learn the

details of current initiatives. An ex-cellent program is planned for themeeting and it is a wonderful oppor-tunity to communicate your specificissues. You can also attend an OpenForum to discuss your ideas withhealth care and other professionals.Your voice will be heard!

Your district is continuing to focuson collaborative efforts to enhancethe role of subspecialists and youngphysicians. Your input and partici-pation in these endeavors will pro-vide depth to the potential benefitsand ensure that your needs are met. Iurge you to again share with yourpresident Dr. Gerald Tiberio andmyself any suggestions or ideas youhave in this regard.

Best wishes for a wonderful fall.

– Marilyn Bull MD, FAAPDistrict Chairperson

Hamilton County children’s librarianNatalie Fields.

Fields’ session reviewed how Ohiopublic libraries support early litera-cy, especially through the Ready toRead program. She also discusseddialogic reading, and how askingchildren to explain pictures in bookscan help them comprehend wordsand phrases as they grow older.

Letter knowledge was the primaryfocus of Rosen’s session, which fol-lowed his book You, Me and theABCs: 100 Ready-for-Reading Acti-vities for You and Your FavoriteGrown-up. Using everyday house-hold items, and some imagination,Rosen taught many ways for chil-dren to recognize, say, and write the

letters of the alphabet. During lunch, Katie Sabol, refer-

ence librarian at the State Library ofOhio, introduced attendees to theresources and services available atthe library.

In addition to the educational ses-sions, attendees were able to minglewith several book companies includ-ing AKJ Books; Books By TheBushel, LLC; Guardian Book Com-pany; John R. Green & ContinentalPress; Star Bright Books; ThirdWeek Books; and Usborne Booksand More.

For more information on ReachOut and Read Ohio, visit www.ohioaap.org/program-initiatives/reach-out-and-read.

ROR...from page 15

Looking for the

perfect fit?

The next time you need

to fill a position with a

qualified medical

professional...use the

Ohio AAP Career

Center

www.ohioaap.org

18 Ohio Pediatrics • Fall 2010 www.ohioaap.org

Ohio Pediatrics

Golfers support Foundation to a “tee” The fourth annual Ohio AAP Foun-

daton Golf Outing on Aug. 31 washeld at Rattlesnake Ridge Golf Clubin Sunbury, Ohio. The golf outingraised close to $7,000 to support theOhio AAP Foundation and the Foun-dation’s My Story Foster Care Pro-gram.

The Ohio AAP Foundation appre-ciates the support of the followinggroups and individuals in making the2010 Golf Outing a success

Birdie Sponsor:

Nationwide Children’s Hospital

Foursome Sponsor:

Buckeye Community Health PlanChildren’s Practicing PediatriciansCommerce National BankIndustrial Technology SolutionsOhio Children’s Hospital Association

Raffle Prize & Contest Donors:

John Duby, MDJohn HowenstineJohnny Buccelli’sPaneraP.F. Chang’sRed Lobster Rusty BucketThad & Barbara Matta

Ohio AAP Executive Director MelissaWervey Arnold showed off her newgolf game.

Finishing one stroke off the lead was Nationwide Children’s Hospitalgolfers, Bruce Meyer, MD, (putting), John Barnard, MD, (left),Grant Morrow, MD, (right), and Greg Bates, MD, (not shown).

John Duby, MD, President of the OhioAAP Foundation, watches his putt as itnears the yellow flag. Dr. Duby part-nered with Jessica Gliha and JustinBaker of Commerce National Bank.

Watching as Jo Ann Rohyans, MD, sinks a putt,Traci intihar of Capitol Consulting was the win-ner of two raffle prizes.

The Buckeye CommunityHealth Plan foursome ofTodd McCullough, SteveWhite, John Wiley andTom york, finished theday with a 60, to win theOhio AAP FoundationGolf Outing for the second year in a row.

Ohio Pediatrics

19www.ohioaap.org Ohio Pediatrics • Fall 2010

When a study is set up by the net-work, you will get a notice about it.You will have an opportunity toreview the study design and decide ifyou are interested. Next, you canlook further to see if it fits your prac-tice. If you have more questions, youcan contact PROS and get more in-formation. As one of the Chapter Co-ordinators, I can assure you eachstudy is vetted so you can participatewith minimal impact on your patientsor practice.

What will my patients think if I amdoing research?

My experience had been totallypositive. In fact, I would say it is anasset. I commonly supplement a dis-cussion with a parent or colleague byadding that I am a member of a na-tional pediatric research networkcalled PROS that has done a study onthis topic. If I personally participatedin the study, I add that information aswell. To use a political term, it adds“gravitas” to my comments.

Hopefully my enthusiasm forPROS has added to your interest. Iwould be happy to discuss this fur-ther with you on a personal basis.Let me also suggest that you learnmore about PROS by reading a re-cently published article in the JunePediatric Annals titled “PROS: AResearch Network to Enhance Prac-tice and Improve Child Health.” Ifthe journal isn’t handy, you can go towww.PediatricSuperSite.com and justtype PROS in the Google search win-dow.

– James B. Davis, MD, FAA Pdrjbdav@aol.com

PROS...from page 8 CATCH...from page 12

Asthma...from page 16

ranged from breastfeeding “Family

Feud” to “Pumping Basics.” One

session was peer-led, consisting of a

panel of Polly Fox students who

shared their breastfeeding experi-

ences with their classmates. The ses-

sions attempted to emphasize open

communication, extinguish breast-

feeding fears and increase the

breastfeeding “cool” factor. The

lunch time sessions were well re-

ceived and 72 attended.

While collaborators found mea-

surement of impact challenging,

nearly all who attended the final ses-

sion admitted they were more will-

ing to try breastfeeding after attend-

ing the session(s). Additionally,

three adolescents delivered their in-

fants in the last month of school and

each initiated breastfeeding. All

three had attended one of our breast-

feeding sessions.

We would like to sincerely thank

all those involved who supported

our project, especially the AAP

CATCH program for their financial

support. Although the Resident

CATCH grant “Friends for Teen

Breastfeeding” has concluded, the

Polly Fox Academy and WIC con-

tinue to provide regular breastfeed-

ing support to the attendees of the

Polly Fox Academy.

The CATCH Resident Funds Pro-

gram is a great way to support advo-

cacy among pediatric residents. Ap-

plications for the next cycle will be

available Nov. 1, 2010 thru Jan. 31,

2011. Applicants will be notified of

funding decisions by June 30, 2011.

– Norah Ledyard, DO

Danielle Paulozzi, MS4

15-20 practices will be recruited toparticipate in the second wave of theproject, which is expected to start inearly 2011.

Participating practices have stead-ily improved patient care over thepast 11 months of data collection.During baseline data collection inOctober 2009, a meager 37% of pa-tients were receiving “optimalasthma care” at their visits. Optimalcare is defined as that which in-cludes: use of a validated instrumentto assess a patient’s asthma control;a stepwise approach is used to iden-tify treatment options, or adjust cur-rent therapy; a flu shot, or flu shotrecommendation, for all patients 6months of age or older; and a writ-ten asthma action plan.

For the past five months, the opti-

mal care measure has held steady atabout 80%. Two additional measuresCareSource has studied are the per-centage of patients with one or moreasthma-related Emergency Depart-ment or Urgent Care visits withinthe past 12 months, and the percen-tage of patients with one or moreasthma-related hospitalizations with-in the past 12 months. Both meas-ures have seen steady decreases,especially in the past six months.CareSource reports a decrease ofapproximately 30% in both meas-ures from their membership at theparticipating practices.

For more information on thesecond wave of the CQN AsthmaPilot Project, contact Heather Hall at(614) 846-6258 or hhall@ohioaap.org.

The Ohio AAP announces the following meetings and events.

Nov. 4 – quality improvement Learning Session for Obesity Prevention CollaborativeMarriott Northwest, Dublin, OH

Nov. 5-6 – 2010 Ohio AAP Annual MeetingMarriott Northwest, Dublin, OH

Dec. 1 – Ounce Regional TrainingCincinnati Children’s Hospital, Liberty Township

Jan. 28, 2011 – Open Forum Meeting Baker Center, Ohio University, Athens, OH

– Ounce Regional TrainingBaker Center, Ohio University, Athens, OH

– Executive Committee MeetingBaker Center, Ohio University, Athens, OH

May 13, 2011 – Open Forum MeetingUniversity of Toledo

Calendar of Events

Dues remitted to the OhioChapter are not deductible asa charitable contribution, butmay be deducted as an ordi-nary and necessary businessexpense. However, $40 ofthe dues is not deductible asa business expense becauseof the chapter’s lobbyingactivity. Please consult yourtax adviser for specific infor-mation.

This statement is in refer-ence to fellows, associatefellows and subspecialty fel-lows.

No portion of the candidatefellows nor post residencyfellows dues is used for lob-bying activity.

Ohio ChapterAmerican Academy of Pediatrics450 W. Wilson Bridge Rd. Suite 215Worthington, OH 43085

PRESORTEDSTANDARD

Permit No. 156

U.S. PostagePAID

DUBLIN, OH

Dues disclosure

statement