About

Nicole Cifra, MD, MPH, MHPed, is an Assistant Professor of Clinical Pediatrics specializing in Adolescent Medicine at the Children's Hospital of Philadelphia. She is an attending physician in the Division of Adolescent Medicine and serves as a Quality Improvement Leader for the Eating Disorders Program within the same division. Her clinical expertise includes eating disorders, disordered eating, malnutrition, adolescent gynecology, contraception, menorrhagia, and abnormal uterine uterine bleeding. Her research focuses on eating disorders, qualitative research, and public health, with notable contributions to programs aimed at reducing medical hospitalization in malnourished youth through quality improvement initiatives. Dr. Cifra's educational background includes a B.S. in Molecular Biology with minors in Chemistry and Psychology from Grove City College, an MD from SUNY Upstate Medical University, an MPH in Public Health Practice and Policy from SUNY Upstate Medical University and Syracuse University, and a MHPEd in Health Professions Education from the University of Rochester. Her work integrates clinical practice, research, and health communication, emphasizing adolescent health and nutrition.

Research topics

• Medicine
• Psychology
• Pediatrics
• Psychiatry
• Family medicine

Selected publications

• Rapid Intervention to Support Eating Issues ( <scp>RISE</scp> ) Program: Using Quality Improvement to Reduce Medical Hospitalization in Malnourished Youth

  International Journal of Eating Disorders · 2025-11-18

  articleOpen access

  ABSTRACT Objective Program‐led and focused models may overcome structural barriers to accessing ED care, such as limited availability, for youth with EDs by prioritizing strategic, evidence‐based care delivered through a structured approach. The Rapid Intervention to Support Eating Issues (RISE) pilot aimed to promote weight restoration and prevent hospitalization among malnourished adolescents at risk for hospitalization. We used a “home hospital” approach, integrating medical oversight, family‐based treatment principles, and nutritional support via structured outpatient care. Methods Participants completed 4–5 visits with adolescent medicine and nutrition over 8 weeks. They received psychoeducation and support in implementing home hospital. Vital signs, anthropometrics, dietary intake, ED behaviors, and cognitions were assessed. Results A total of 27 patients participated. Patients experienced low hospitalization rates ( n = 1 throughout; 3.7%) and significant weight gain (M end of treatment = +2.7 kg from baseline, 95% CI: 2.6–4.7). There were statistically significant increases in calorie intake (M baseline = 43.3% of recommendation; M end of treatment = 76.0% of recommendation; dz = 0.98, 95% CI: 0.45–1.50) and decreases in the report of disordered weight control behaviors ( n reporting at baseline = 10 [37%], n reporting at end of treatment = 3 [11.1%]; paired RD = −1.00, 95% CI: −1.00–−0.33). Discussion This program‐led and focused intervention produced meaningful outcomes and circumvented hospitalization for youth at high risk in a short time frame. This approach offers promise for scalable, early ED care that leverages programmatic expertise, consistent with evolving models of mental health service delivery.

  PublisherOA PDFDOI

• Reply

  The Journal of Pediatrics · 2025-03-21

  letterOpen access1st authorCorresponding
  PublisherOA PDFDOI

• The American Academy of Pediatrics Guideline for Obesity: An Adolescent Health Perspective

  Journal of Adolescent Health · 2024-08-07 · 9 citations

  articleOpen access
  PublisherOA PDFDOI

• Analysis of fellowship program director opinions of entrustable professional activities in adolescent medicine fellowship

  International Journal of Adolescent Medicine and Health · 2024-03-24 · 1 citations

  article1st authorCorresponding

  OBJECTIVES: This study aimed to explore the minimum entrustable professional activity (EPA) supervision levels at which pediatric fellowship program directors (FPDs) would be willing to graduate fellows and the levels deemed necessary for safe and effective practice for each of the common pediatric subspecialty and the four adolescent medicine-specific EPAs. METHODS: This cross-sectional study utilized survey data from pediatric FPDs in 2017. FPDs indicated the minimum level of supervision (LOS) for fellows at graduation and for safe and effective practice. RESULTS: 82 percent (23/28) of adolescent medicine FPDs completed the survey. For each EPA, there were differences (p<0.05) between LOS expected for graduation and for safe and effective practice. There was also variability in the level at which FPDs would graduate fellows. CONCLUSIONS: This study summarizes pediatric FPD opinions regarding the minimum levels of supervision required for fellows at the time of graduation as well as the levels deemed necessary for safe and effective practice. The difference between the minimum LOS at which FPDs would graduate a fellow and that deemed appropriate for safe and effective practice, along with variability in minimum LOS for graduation, highlight the need for clearer standards for fellowship graduation as well as more structured early career support for ongoing learning. These data highlight variability in FPD opinion regarding such expectations and both the need to better define desired training outcomes and potential need for post-graduation supervision in clinical practice.

  PublisherDOI

• Drawing as a Physician

  Journal of Adolescent Health · 2023-02-17 · 1 citations

  articleOpen access1st authorCorresponding
  PublisherOA PDFDOI

• Muscle Mania: An Adolescent Male Athlete

  2022-11-15

  book-chapter1st author
  PublisherDOI

• 158. Case Series: Eosinophilic Esophagitis Presenting as an Eating or Feeding Disorder

  Journal of Adolescent Health · 2022-03-11

  articleOpen access1st authorCorresponding
  PublisherOA PDFDOI

• Differentiating Eosinophilic Esophagitis and Eating/Feeding Disorders

  PEDIATRICS · 2022-03-04 · 12 citations

  articleOpen access1st authorCorresponding

  Eosinophilic esophagitis (EoE) is an inflammatory condition of the esophagus that causes symptoms of esophageal dysmotility. Patients with feeding or eating disorders (ED) can have similar symptoms, and there is a paucity of literature exploring these similarities. Furthermore, EoE can occur in addition to an ED, requiring clinicians to obtain a thorough history, make accurate diagnoses, and adequately treat all underlying conditions. We present 4 pediatric cases highlighting the similarities between EoE and ED symptomatology. Patients 1 to 3 were presumed to have an ED and were subsequently diagnosed with EoE. Patient 4 had a history of previously diagnosed and inadequately treated EoE, but was later found to also have a longstanding ED. The patients presented to the University of Rochester Pediatric Ambulatory Clinics in 2020. This series demonstrates that symptoms of EoE can overlap with those of an ED, such as anorexia nervosa or avoidant restrictive food intake disorder. Therefore, assessment for either EoE or an ED should include questions related to both diagnoses. Symptoms that may raise suspicion of EoE are indigestion, acute (versus chronic) weight loss, and dysphagia, including the inability to swallow pills, particularly in the presence of personal or family history of atopy. Patients with known EoE should be periodically evaluated for the presence of an ED. This case series illustrates that EoE can either present as an ED or complicate the diagnosis and/or treatment of an ED, making prompt diagnosis and treatment essential for successful management of all conditions.

  PublisherOA PDFDOI

• 35. Improving HIV Screening in the Outpatient Adolescent Medicine Setting

  Journal of Adolescent Health · 2021-02-01

  article1st authorCorresponding
  PublisherDOI

• Artist’s Statement: Think Zebras

  Academic Medicine · 2019-02-28

  article1st authorCorresponding

  Most of the general population is familiar with the “horses” of medicine. These are the common diagnoses, such as a virus, pneumonia, anxiety, or a urinary tract infection. In the medical field, however, we as doctors are stretched to learn about the “zebras.” What if the 10th patient with a cough you see today doesn’t have a virus but, rather, has an inhaled foreign body? What if the patient who appears anxious really has a pheochromocytoma (a tumor in the adrenal glands)? How do we tell the difference? Medical education teaches us how to do this. During my pediatrics clerkship, I helped take care of a patient who was admitted to the hospital for mild dehydration after experiencing several months of heartburn, nausea, and vomiting. At first glance, my patient’s symptoms seemed most consistent with gastroesophageal reflux, perhaps with a component of anxiety. However, when a physician on my team carefully took our patient’s history, characterizing the duration and nature of our patient’s symptoms, we pursued a barium swallow test, which revealed an impressive—and rare—swallowing disorder called achalasia. A case which seemed so simple and straightforward suddenly ended up being incredibly interesting. This experience showed me that common things aren’t always the correct answer. Attention to detail and consideration of all options are of paramount importance when gathering information about what a patient is experiencing. Like my patient with achalasia, my drawing Think Zebras, on the cover of this issue, reminds me that there is always something more curious out there and something more to learn. I’ve always thought zebras were aesthetically beautiful creatures, and their significance as a concept in medicine made them even more interesting. When preparing to draw this zebra, I decided to make the image especially eye-catching by using Prismacolor pencils to incorporate splashes of color. I found that translating the zebra’s monochrome stripes into colored stripes was technically tricky. To accomplish this, I created one colored stripe at a time, drawing the lightest and darkest portions of each stripe first and then filling in the intermediate shades of color. This was a fair bit more abstract than my typical, figurative style. However, I’m glad I took the risk, as my drawing had the unique effect I was hoping to achieve. I hope my piece reminds us all to think, or at least consider, the “zebras” in medicine.Think Zebras

  PublisherDOI

Frequent coauthors

• Philip T. Cox

  8 shared

• Honglei Chen

  Michigan State University

  6 shared

• Nur-Taz Rahman

  6 shared

• Heather Patterson

  Wartburg College

  6 shared

• K. Kaye

  6 shared

• Johanna H. Foster

  Indiana University School of Medicine

  6 shared

• Zachary Barnes

  Miami VA Healthcare System

  6 shared

• Tony Flatness

  Wartburg College

  6 shared

Education

• MHPEd, Warner School of Education

  University of Rochester

• Doctor of Medicine/Master of Public Health, College of Medicine

  State University of New York Upstate Medical University

• B.S. , Biology

  Grove City College

  2011