Pediatrics fundraising event at Altru helps children with critical needs Grand Forks Herald
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Category Archives: Pediatrics
Public perceptions of families affected by pediatric cancer and educational work in pediatric oncology | Pediatric … – Nature.com
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The pediatrician, the resident, the strawberry monster, and the zebra – VUMC News – VUMC Reporter
There is a saying in the world of medicine: when working toward a diagnosis, think horses, not zebras.
In other words, if you see a symptom that could be something common or could be something rare, proceed first on the theory that the common is what youre seeing. If you hear hoofbeats, its probably a horse, not a zebra.
This does not mean that zebras do not exist.
Gerald Hickson, MD, the founding director of the Vanderbilt Health Center for Patient and Professional Advocacy, was a young resident physician in Pediatrics at Vanderbilt in the early 1980s, and one of the older pediatricians he thinks it was likely William Buck Donald, MD passed along some hard-earned advice about a common clinical finding: blood in the stool.
Donald, a 1947 graduate of the Vanderbilt School of Medicine, who had been on the faculty since 1960, was the director of the Pediatric Ambulatory Care Unit located, as all VUMC clinics were those days, in the building we now call Medical Center North. He spent his days seeing to the cornucopia of ailments the children of Nashville could bring to his door.
I remember being taught theneed to check stool for occult and not-so-occult blood, Hickson said. That is, blood that is hidden and blood that is visible.
Here comes the zebra how about blood that is not blood at all?
In the 1970s a new breakfast cereal came on the market called Franken Berry, which was sugary and had a lot of artificial strawberry-like flavors and artificial colors. It was marketed by General Mills along with another monster-themed cereal, represented by the cartoon vampire Count Chocula.
Franken Berry (the character) was depicted on the box as basically what would happen if Frankensteins monster was crossed with a giant strawberry.
Franken Berry (the cereal) was sold in grocery stores all over the country, including in one location a stones throw from VUMCs walk-in pediatrics clinic: the H.G. Hill supermarket that once stood where a small park and Vanderbilt Stallworth Rehabilitation Hospital are now.
Among the food dyes in use at that time were FD&C Red Nos. 2 and 3, and these were in the original formulation of Franken Berry. It was fairly quickly discovered that these colors are not absorbed by the body, and resulted in children who were especially fond of the cereal having pink stools and showing up at pediatrics clinics, often in the company of freaked out parents.
A 1972 report in the journal Pediatrics by a physician at the University of Maryland tells of a case of a 12-year-old whose terrified mother brought him to the hospital suspecting internal bleeding, and the resulting research that solved the mystery. The child had pink poop, but otherwise seemed fine, even after four days of hospitalization and many tests. The mystery was solved when, upon close questioning about his diet, his mom mentioned his fondness for this new cereal, Franken Berry. The children in this family were really fond of Franken Berry; it turned out his sister was pooping pink, too.
They were not alone, as evidenced by the fact that Donald felt the need to teach VUMC residents about the phenomenon several years later.
Franken Berry still haunts the cereal aisle, but not the colons of its young fans. Its current pink hue is achieved without the dyes that caused the problems in the 1970s.
Amazingly, this isnt even the only time unnaturally hued breakfast foods have led to similar outcomes. Another monster-themed cereal introduced in the 1970s, the faux-blueberry flavored Boo Berry, used a blue food dye that somehow turned stools green. And Smurfberry Crunch, introduced by Post in 1982, produced blue poop in some children who ate it.
Hickson recalled his own experience with a patient who showed up, not with blue stools but with blue hands a concerning symptom of a lack of oxygen saturation but who turned out to be fine.
The girl had been sent by her school because of a concern that the blue on her hands meant a problem with her heart.
When I walked into her exam room, she looked good, Hickson recalled. The diagnosis was made when I found that an alcohol pad removed what turned out to be blue dye from a new pair of blue jeans.
You just never know, he said. You see a lot of strange things in practice.
Research sources: Gerald Hickson; James Thweatt, VUMC Archives; Pediatrics; Smithsonian; Atlas Obscura.
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The pediatrician, the resident, the strawberry monster, and the zebra - VUMC News - VUMC Reporter
Receptor targeting to identify medications for pediatric mental health concerns – Contemporary Pediatrics
In this Contemporary Pediatrics video interview, Joanne M. Howard, MSN, MA, RN, CPNP-PC, PMHS & Anne Craig, MSN, RN, CPNP-PC, of C.S. Mott Children's Hospital, Ann Arbor, Michigan, highlight their session titled "Pediatric Psychopharmacology: Understanding Receptor Targets to Identify Medications That May Work Best for Children and Teens," presented at the 2024 NAPNAP National Conference.
Their session explored psychopharmacologic agents used in the pediatric population, with a focus on their interactions with receptor targets in the brain and body.
"[We wanted to] take a deeper dive into the medication management for pediatric mental health disorders and empower our [colleagues] out there in the community to maybe be more comfortable or knowledgable about managing things like depression, anxiety, aggressive behaviors, or ADHD," said Howard.
"We gave an overview of what neurotransmitters are, and then focused on the neurotransmitters monoamines that are implicated in psychopathology or development of many psychiatric disorders," added Craig. "We wanted to approach it from what [a particular] medication is targeting, what receptors, and how does that translate into a clinical effect."
Click here for more NAPNAP coverage.
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Hypoglossal nerve stimulation offers hope for pediatric Down syndrome patients with OSA – News-Medical.Net
While Obstructive Sleep Apnea (OSA) affects about five percent of the general pediatric population, 80 percent of children with Down syndrome experience OSA. Continual OSA results in poor health, including disruptions to cognitive development and functioning, leading physician-researchers from Mass General Brigham to investigate better methods to treat these patients as early as possible to maximize their health outcomes.
In a new case study published April 11 in Pediatrics, they report on a 4-year-old boy with Down syndrome and OSA who underwent a procedure to implant a hypoglossal nerve stimulation device, and experienced improvements thereafter.
Currently, adenoidectomies and tonsillectomies are among first-line treatments for pediatric OSA, however they are not always effective for children with Down syndrome because OSA can recur. Additionally, continuous positive airway pressure (CPAP) treatment, which streams compressed air into airways during sleep, is often not tolerated by children with Down syndrome due to sensory sensitivities.
The hypoglossal nerve stimulation device by Inspire has been an option increasingly used to treat OSA in adults since its 2014 FDA-approval. The device detects when the airway is blocked and sends an electrical pulse to the hypoglossal nerve that controls the tongue, causing it to move forward in the mouth, thereby opening the airway. Positive treatment data in adults first led lead study author Christopher Hartnick, MD, director of Pediatric Otolaryngology at Mass Eye and Ear, to wonder whether the treatment may help his patients with Down syndrome whose lives were impacted by OSA. With Mass General Brigham colleague Brian Skotko, MD, MPP, the Emma Campbell Endowed Chair on Down Syndrome at Massachusetts General Hospital, they organized a clinical trial looking at the safety and effectiveness of the procedure in children between the ages of 10 and 22 with Down syndrome. Results of a 42-patient trial showing the benefits and safety of the procedure were published in 2022, leading to FDA approval for the device for adolescents with Down syndrome over the age of 13 nearly a year later.
These results spurred the researchers to examine whether the procedure could benefit younger children who are impacted by the physical and neurocognitive effects of OSA during pivotal developmental years.
Hartnick and Skotko identified a patient candidate, 4-year-old Theodore "Theo" Scott of Knoxville, Tenn., who had been on CPAP therapy since he was 1 year old.
After Hartnick and his team had extensive discussions about potential risks with colleagues in other medical specialties and Theo's parents, Rachel and Andrew Scott, a surgery took place in May 2023. The surgery was successful without complications, and the procedure was modified to allow for Theo's continued growth.
After one month, Theo experienced an improvement in sleep, and his obstructive apnea-hypopnea index (a measure of apnea severity) decreased by 40 percent. Additional follow-up care will take place for Theo to monitor effects of the procedure on neurocognition and surveillance of the device as he grows.
"The most significant change we have seen is the amount of sleep Theo is now getting, routinely over 10 hours a night versus what we experienced with CPAP where he would pull his mask off up to fifteen times a night. Theo sleeping through the night has also benefitted us as parents since we would need to get up and assist him, and we could each feel the toll poor sleep was taking on our health," Rachel and Andrew Scott said in a statement. "We have also noticed Theo wakes up more easily in the morning and has a longer attention span than before the surgery, and his language development has accelerated from one-word statements to multiple word sentences. This procedure has absolutely been a game-changing intervention in Theo's life and in our family's."
Hartnick and Skotko are currently leading an NIH-sponsored 4-year trial examining the impact of upper airway stimulation on neurocognition and language in young patients with Down syndrome.
Children with Down syndrome are disproportionally affected by obstructive sleep apnea and often don't benefit from traditional interventions, and research shows this impacts their cognitive development and IQ scores. The potential long-term impact on neurocognition was a major driver of our team and the family's shared decision-making to pursue this treatment, and this case suggests it may be a possible option for some families."
Christopher Hartnick, MD,Director of Pediatric Otolaryngology at Mass Eye and Ear
"In our Down Syndrome Program, I see first-hand how frustrated families become when their child with Down syndrome runs out of options to treat significant sleep apnea," said Skotko. "Theo now opens up a new frontier for research and potential clinical care."
Source:
Journal reference:
Wasserman, I.,et al.(2024) Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea in a Young Child With Down Syndrome. Pediatrics. doi.org/10.1542/peds.2023-063330.
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Efforts to reduce wait times for developmental evaluations – Baylor College of Medicine | BCM
In the state of Texas, there are over 500,000 children and adults with IDD (intellectual or developmental disabilities inclusive of autism spectrum disorder (ASD), intellectual disability, and related conditions). Additionally, thousands more have learning and/or attention difficulties (ADHD, dyslexia, etc.).
Children referred to a developmental-behavioral pediatrician often wait well over a year for a developmental evaluation. This delay in assessment is even more problematic in light of evidence that has demonstrated the importance of early recognition and intervention in achieving optimal outcomes for children with developmental diagnoses such as autism or intellectual disability.
This problem is not unique to Texas. There are just over 700 board-certified developmental-behavioral pediatricians nationally (compared to nearly 3,000 pediatric cardiologists in 2021, for example) and wait times are similar for developmental pediatrics clinics nationwide. This problem does not end after childhood. In fact, even fewer physicians providing primary care for adults have received training in healthcare transition or adult care for individuals with intellectual and developmental disabilities (IDD) and autism.
The Maternal Child Health Bureau (MCHB), a branch of the Health and Resource Services Administration (HRSA), has responded to this workforce crisis by offering a select number of Developmental-Behavioral Pediatrics (DBP) Training Grants to academic medical institutions across the nation. For the first time, Baylor College of Medicine is the recipient of a DBP training grant as of July 2023.
Project directors Dr. Holly Harris, assistant professor of pediatrics in the section of developmental and behavioral pediatrics, and Dr. Jordan Kemere, assistant professor of internal medicine in the section of transition medicine, were awarded just over 1.3 million to be distributed over the 5-year grant cycle. The majority of the activities for the DBP Training Grant are housed at the Meyer Center for Developmental Pediatrics and Autism at Texas Childrens Hospital, in addition to the Transition Medicine Clinic at Baylor and Texas Childrens. DBP trainees and faculty also interface with the Harris Health System to provide developmental evaluations to children at the Pasadena Pediatric and Adolescent Health Center.
The grant objectives are to train the next generation of leaders in DBP, to provide continuing education and technical assistance to providers and agencies caring for individuals with IDD/autism, and ultimately increase access to care.
This funding will allow Baylor to expand its DBP Fellowship program by increasing the number of incoming trainees and by facilitating more robust recruitment activities. The funding also supports a novel one-year Transition Lifespan Fellowship, a nationally unique offering that trains a physician specifically in healthcare transition and lifespan care for individuals with IDD and autism, a priority within the Autism Cares Act of 2019 and HRSA/MCHBs Blueprint for change.
Along with training subspecialists, the grant funding also supports a unique training opportunity for primary care pediatricians (PCPs) interested in honing their skills in developmental assessment. This training enables a pediatrician to confidently diagnose and provide appropriate recommendations for straightforward cases of developmental conditions, such as autism or intellectual disability, in the medical home. Not only are children and families able to work with a provider with whom they have had continuity of care, but they also are able to immediately access appropriate interventions without waiting for a specialist assessment. Thus far, there has been overwhelming interest in this position from primary care pediatricians across the Houston area.
The grant faculty are also planning to conduct needs assessments of local community agencies to determine how to best support individuals in the community who are providing care for individuals with IDD and autism. Surveys with underserved populations, including Spanish-speaking families and transition-aged youth, are also underway. These will allow us to understand the needs of our population better so that we can construct our educational offerings accordingly. The DBP workforce crisis will clearly take time to address, but investigators at Baylor are excited to play a part in moving the needle through education and, ultimately, increased access to care for individuals and families of individuals with IDD.
By Dr. Holly Harris, assistant professor of pediatrics, program director, developmental-behavioral pediatrics fellowship at Texas Childrens Hospital/Baylor College of Medicine and Dr. Kathryn Jordan Kemere, assistant professor of medicine transition medicine at Baylor College of Medicine
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Efforts to reduce wait times for developmental evaluations - Baylor College of Medicine | BCM
Nasal oxidative stress mediating the effects of colder temperature exposure on pediatric asthma symptoms | Pediatric … – Nature.com
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Week in review: A new dermatology case study, and a new treatment for severe asthma – Contemporary Pediatrics
Thank you for visiting the Contemporary Pediatrics website. Take a look at some of our top stories from last week (Monday, April 8, to Friday, April 12, 2024), and click on each link to read and watch anything you may have missed.
1.) Young woman with tick bites presents with erythematous papules, headaches, and fatigue
A young woman with no significant past medical history returns from hiking with several white-spotted ticks and experiences erythematous papules, rashes, headaches, and fatigue. Whats the diagnosis?
Click here for the full case, differential diagnosis, and case diagnosis.
2.) FDA approves benralizumab for children aged 6 to 11 years with severe asthma
The FDA approval of benralizumab for patients ages 6 to 11 with asthma follows the conclusions of the phase 3 TATE study. Click here for full FDA approval details.
3.) FDA approves dolutegravir/lamivudine to treat HIV infection in adolescents
The indication is approved for those with no antiretroviral (ARV) treatment history or to replace current ARV regimen in those, "are virologically suppressed (HIV-1 RNA less than 50 copies/mL) on a stable ARV regimen with no history of treatment failure and no known substitutions associated with resistance to the individual components of [dolutegravir/lamivudine]," ViiV stated.
Click here for full approval details.
4.) Does vitamin C among pregnant smokers improve airway function trajectory in offspring?
"Our findings provide evidence for a direct association between maternal smoking during pregnancy and wheeze occurrence," wrote the authors.
Click here for the full article.
5.) Does acetaminophen intake during pregnancy influence childrens risk of neurodevelopmental disorders?
A recently published study in JAMA sought to determine if there is a link between acetaminophen use during pregnancy and childrens risk of developing autism, ADHD, or intellectual disabilities.
Click here for the full article.
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Chordae Tendinea Rupture and Pulmonary Valve Vegetation in Pediatric Endocarditis: A Rare Condition – Cureus
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Pruitt named director of academic pediatrics division Washington University School of Medicine in St. Louis – Washington University School of…
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Recognized for developing, leading growth of clinical programs
Cassandra M. Pruitt, MD, has been named director of the Division of Academic Pediatrics in the Department of Pediatrics at Washington University School of Medicine. A professor of pediatrics, Pruitt has served as interim director since July 2022.
Cassandra M. Pruitt, MD, a professor of pediatrics, has been named director of theDivision of Academic Pediatricsin theDepartment of Pediatrics at Washington University School of Medicine in St. Louis. She had served as interim director since July 2022.
The academic pediatrics division is home to the universitys Complex Care Clinic, which offers primary care to children with complex medical needs, and the General Academic Pediatrics Clinic, which provides a range of services, including well-child visits, immunizations and same-day visits for illness and other concerns. The division also offers physicians who specialize in developmental and behavioral pediatrics, which includes medical and psychosocial aspects; and physicians who specialize in pediatric physical medicine and rehabilitation, including musculoskeletal and neurologic conditions.
The division also houses the community pediatrics section, which provides a connection between community physicians to university specialists and St. Louis Childrens Hospital.
Beginning in 2019, Pruitt led the development and growth of the clinics and services in her role as medical director for the Complex Care Clinic and the General Academic Pediatrics Clinic. In her new role, Pruitt will continue to oversee development of the entire division in the Department of Pediatrics.
Dr. Pruitt brings a wealth of administrative, educational and clinical experience to this role, saidGary A. Silverman, MD, PhD, the Harriet B. Spoehrer Professor and head of the Department of Pediatrics. She is a dynamic leader who has already made significant contributions to the expansion and influence of the academic pediatrics division. With her extensive experience in leading the development of clinical programs, she is well-positioned to spearhead and propel the success of new initiatives.
A member of the School of Medicine faculty since 2010, Pruitt has worked as a pediatric hospitalist at St. Louis Childrens Hospital. As medical director for pediatrics at Progress West Hospital for eight years, she led the development of the pediatric hospitalist program and spearheaded improvements in clinical protocols and standardization of care for various medical conditions affecting newborns and patients being seen in the emergency room. She also has been a leader in quality-improvement projects with the American Academy of Pediatrics and the BJC HealthCare Center for Clinical Excellence.
In her role as vice chair of outpatient health in the Department of Pediatrics, she serves as medical director for Washington Universitys pediatric subspecialty clinical spaces. These include Memorial Hospital Shiloh in Shiloh, Ill.; Northwest HealthCare in Florissant, Mo.; and the Specialty Care Centers in west and south St. Louis County. She sees patients at St. Louis Childrens Hospital.
Pruitt earned her bachelors degree from Emory University in Atlanta and her medical degree from Texas Tech University Health Sciences Center School of Medicine in Lubbock, Texas. She completed her residency in pediatrics at the University of Texas Medical Branch Childrens Hospital in Galveston, Texas, where she also served as chief resident.
About Washington University School of Medicine
WashU Medicine is a global leader in academic medicine, including biomedical research, patient care and educational programs with 2,900 faculty. Its National Institutes of Health (NIH) research funding portfolio is the second largest among U.S. medical schools and has grown 56% in the last seven years. Together with institutional investment, WashU Medicine commits well over $1 billion annually to basic and clinical research innovation and training. Its faculty practice is consistently within the top five in the country, with more than 1,900 faculty physicians practicing at 130 locations and who are also the medical staffs of Barnes-Jewish and St. Louis Childrens hospitals of BJC HealthCare. WashU Medicine has a storied history in MD/PhD training, recently dedicated $100 million to scholarships and curriculum renewal for its medical students, and is home to top-notch training programs in every medical subspecialty as well as physical therapy, occupational therapy, and audiology and communications sciences.
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