The ABCDismantling of children’s health by MAHA

By Karla Lester, M.D.  

Airway

Breathing

Circulation 

 

 

It was the last hour of my shift covering the ER in residency as a senior resident in pediatrics. I was called down to see a 6 year-old with difficulty breathing and fever with a history of asthma. The adult doctors seeing her thought they were doing a good job by giving her a nebulizer treatment until I got there.

 

When I pulled back the curtain to see Josie, a sweet 6 year-old in what was clearly respiratory distress, I saw that they neglected to tell me she was covered in petechiae (tiny red spots) and purpura (bruise-like rash) from head to toe that looked to be spreading. She appeared cyanotic and was working hard to breathe. She was clearly in respiratory distress. Her “rash” appeared to be a classic rash of meningococcemia.  A glance up to the monitors tracing her vital signs showed all the ominous signs of distress and that she would likely code any minute. 

 

The nebulizer was doing nothing. This clearly wasn’t an asthma exacerbation, but rather looked like a case of meningococcemia, a fast-moving infectious disease caused by the bacteria, Neisseria meningitidis, that is oftentimes fatal or if the patient survives, leaves them with debilitating amputations. My heart sank as my heartbeat spiked. I paged the PICU attending, who happened to be The Attending, I called her. She was the most no-nonsense brilliant doctor. She only cared about the patients. Not your feelings. 

 

The Attending rushed down to the ER and pulled the curtain back, looked at me and said, “ABC,” and called for the crash cart and proceeded to start a rapid sequence intubation on a patient who was clearly in shock and getting ready to code. Josie was sedated, paralyzed and intubated. The Attending ordered high dose Rocephin (antibiotic) and drips of pressors to keep Josie’s blood pressure up as she was clearly in septic shock. She was moved to the PICU, where it was very tenuous and then, when she stabilized, it was clear that Josie would be left with marked disabilities. The Attending stayed by Josie’s bedside that night and the coming tenuous days. 

 

ABC which stands for Airway, Breathing, Circulation are the steps in the sequence for assessing and treating a patient with life-threatening conditions. Children can get sick and die. Children have disabilities from diseases that aren’t always preventable. Trump, RFK Jr. and Republicans under their marketing gimmick, MAHA are pulling back the curtain and watching children who are critically ill like Josie and instead of Airway Breathing Circulation, they are, 

 

Attack pediatricians

Berate science

Cut Medicaid

 

They have created preventable real emergencies in children’s health. Vaccine misinformation spread by RKF Jr. is causing severe illness and preventable deaths in babies and children who aren’t getting their pertussis and measles vaccines. There seems to be no end to the lies and misinformation about children’s health by the Trump administration, specifically RFK Jr. under the banner, MAHA. Republican leaders sit by and watch it happen. 

 

Attacks on pediatricians in this country are nothing new. Pediatricians are being accused of making it big from vaccines and big pharma, which is a complete joke. I’m a social media doc and believe me, their followers believe this lie. I never dreamed it would come to this. Pediatricians have more and more parents refusing Vitamin K, erythromycin ointment and Hepatitis B vaccine at birth. 

 

And we haven’t seen anything yet. The One Big Ugly Child Health Harming Bill is cutting Medicaid $880 Billion dollars, putting work requirements on Medicaid, and putting caps on federal graduate loans, meaning less primary care doctors to care for children. 

 

I never dreamed the Republicans would sit by and let this harm happen to children across the U.S. But it’s nothing new. When it comes to gun deaths in children, they sit by and watch it happen and collect money from the gun lobby. Even though there is bipartisan support for universal background checks, they cannot step up. It is a very complex issue, but to sit by and do nothing while collecting gun lobby money is morally unconscious. 

 

The problem for MAHA is that pediatricians are the only group of physicians who advocate for our patients ahead of ourselves. It has always been this way and always will be. Children are first and with that vision, mission and expertise and collective voice, as MAHA fades, we will not. But photo op advocacy is not the way forward. 

 

I’ve played the game. No more. 

 

I saw a video of Senator Fischer visiting a nursing school and watching a simulated training. As she walked out, she told the reporter, “It’s not the role of the federal government to fund these programs.” Nebraska has a nursing shortage and the dismantling of the Department of Education under Trump drops nursing as a professional degree and puts caps on federal loans. Senator Fischer does not care.

 

I asked to meet with Congressman Flood, who does not care, before he voted on the confirmation of RFK Jr., before he voted yes on Trump’s OBBB and spouted talking points at his Town Halls. I offered to fly to D.C. to meet with him and to hold a town hall of pediatricians at my home so he could learn about the harms of RFK Jr. and Trump's Bill. He only reached out to meet with me after he voted yes. No, you do not get a photo op with me, while you, 

 

Avoid the needs of children

Belittle experts

Confuse parents

 

Self-declared expertise is dangerous in medicine, especially when it comes to the life and death of children. Controlling the children’s health narrative is the name of their game. 

 

Cutting the CDC, putting out misinformation about the causes of autism. Putting shame on mothers who take safe medication during pregnancy as the cause of autism and blaming vaccines while cutting autism research. Their claims have been refuted, as their ABC is,

 

Autism misinformation

Big, horrible bill 

Control the narrative

 

But, what I’m here to tell you is they do not care about children’s health. They never have. Leaning into child health advocacy, I’ve spent time at the U.S. Capitol with the American Academy of Pediatrics advocating for gun violence prevention and I got to meet Katie Beckett’s Mom, Julie, a hero of mine. It was 2018 when I did the photo op tour in D.C. 

 

Julie had worked with her Iowa Congressman and President Reagan to put in place the Katie Beckett Medicaid Waiver so her daughter who had developed meningitis as a toddler and had ongoing medical needs could be cared for at home. Julie Beckett taught us how to talk with legislators when we went to Capitol Hill the next day to advocate for gun violence prevention and funding for CDC research. 

 

Our group of Nebraska pediatricians met with Deb Fischer, very briefly with Ben Sasse as he was rushing to another meeting and didn’t want to be bothered, and Don Bacon’s aides. We left our one pager with data, next steps, request to support funding for gun research and then got our photo ops in. That was when I thought the little morsels of photo ops and little wins were how we did things and the best we child health advocates could hope for. 

 

During the beginning of the first Trump Presidency, CHIP, the Children’s Health Insurance Program, was up for reauthorization. CHIP had always been a bipartisan program and had support from both parties and the reauthorization was approved after a lot of advocacy. Senator John McCain gave his famous thumbs down to the dismantling of the ACA, but now Republicans want to officially end it, and they don’t care about the millions of Americans who will lose their health insurance. 

 

The gloves are off during the second Trump term. Old school advocacy isn’t going to work in MAHA’s Merica. It’s a different world with social media and the ability to follow their harms at an exhausting pace. They are planning on child health advocates getting exhausted. 

 

I never would have imagined that things would be this bad. That their ABC, would be,

 

Abolish agencies

Block data

Create health misinformation

 

There isn’t a parent on the planet who wouldn’t choose The Attending to be the one to take care of their child at that ABC moment. Trump, RFK Jr., Fischer, Ricketts, Flood, won’t have a clue what to do. All they can do is peddle their MAHA cult of supplements, raw milk, beef tallow, TrumpRx prescriptions and lies. 

 

Real time advocacy calls for a continuous quality improvement lens. We can use social media and all outlets possible to share the stories of the harms of the OBBB. There will be self-inflicted fallout for Republicans at the voting booth. They own this. Children like Josie with complex medical needs and disabilities are going to lose out under Trump and the Republicans’ bill. 

 

If they don’t start listening. If they don’t start caring, our only response must be show up for children at the ballot box, and VTO,

Vote 

Them 

Out!