Friday, April 18, 2014

Synthetic Marijuana: A Growing Problem Among Teens

Teens are always looking for different ways to occupy their time, and with snow days and winter breaks, time at home without adult supervision increases with their curiosity.

Sometimes that teenage curiosity can lead to drug use. Marijuana or cannabis has been one of the substances parents fear their teenagers will use. While marijuana may be legal for medical conditions in 21 states, the side effects of abuse can be harmful to anyone’s health, especially in the case of synthetic marijuana.

Children’s National Health System’s Joanna Cohen, MD, wrote the study on negative effects of synthetic marijuana for the journal Pediatrics.

“Synthetic marijuana is actually made in a lab, but has the chemical components of marijuana, but when people sell it, they mix it with other stuff to make it more desirable or effective for other people,” said  Dr. Cohen, an Emergency Medicine physician.

Synthetic marijuana, called K2, Spice, and Skunk used to be easily purchased at gas stations and online, but now these products are deemed controlled substances making them illegal to sell, buy, or possess. For high school seniors, synthetic marijuana is second only to marijuana in illicit drug use.

According to the American Association of Poison Control Centers, there have been more than 2,000 synthetic marijuana intoxication cases reported as of October 31.

Graphic courtesy of National Institutes of Health
National Institute of Drug Abuse

How does synthetic marijuana affect a person?

Just like marijuana, synthetic marijuana is usually smoked like a cigarette. Users report feelings of elevated mood, relaxation, altered perceptions, extreme anxiety, paranoia, and hallucinations, as some of the symptoms.

Dr. Cohen’s study revealed more of the negative effects, as three patients, all of whom showed up at the emergency department, had symptoms of rapid heartbeat, high blood pressure, excessive sweating, rigidity and even became unresponsive.

And more recently, stroke, has been added to list of hazardous side effects of synthetic marijuana. In a study recently published in the Journal Neurology, researchers found that two previously healthy young adult siblings suffered acute embolic-appearing ischemic strokes (loss of blood supply to the brain due to an obstruction), after independently smoking synthetic marijuana.

The study’s author said in an article  that synthetic marijuana may be more potent than real marijuana because the psychoactive ingredient strongly fastens to the brain’s cannabinoid receptors.

How can parents talk to their kids about these dangers?

“Parents need to be open, straightforward, honest, and clear with teens that they should not use any illicit substances. There should be no ambiguity. Send a clear message to not use any illicit substances,” Dr. Cohen said.

Have you heard of synthetic marijuana? How do you talk to your teens about drugs?

Wednesday, April 16, 2014

Recognizing Signs of Abuse

April is National Child Abuse Prevention Month, a time when the community can come together to prevent child abuse and neglect. It can be tough to recognize the signs of abuse, since it takes on many different forms. The U.S. Department of Health and Human Services Child Welfare Information Gateway provides a list of signs for parents, caregivers, teachers, and friends to look for in children:

Signs of Neglect:

  • The child shows signs of malnutrition or begs, steals, or hoards food
  • The child has poor hygiene: matted hair, dirty skin, or severe body odor
  • The child has unattended physical or medical problems
  • The child has excessive unexplained school absences

Signs of Physical Abuse:

  • The child has broken bones or unexplained bruises, burns, or welts in various stages of healing
  • The child is unable to explain an injury, or explanations given by the child or caretaker are inconsistent with the injury
  • The child is unusually frightened of a parent or caretaker, or is afraid to go home

Signs of Sexual Abuse:

  • The child displays age-inappropriate play with toys, self, or others
  • The child has inappropriate knowledge about sex
  • The child reports sexual abuse

Signs of Emotional Abuse:

  • The parent or caretaker constantly criticizes, threatens, belittles, insults, or rejects the child with no evidence of love, support, or guidance
  • The child exhibits extremes in behavior from overly aggressive to overly passive

How Children’s National Can Help

Children’s National Health System’s Child and Adolescent Protection Center’s Division Chief, Allison Jackson, MD, said another sign to physical abuse is wearing clothing that is inappropriate for the weather, like long sweaters in July when it is typically warm in an effort to conceal injuries.
The Center evaluates and treats children suspected of abuse. Anyone can report concerns for child abuse to a child protective service agency.

“If abuse is identified, we report suspicions of child abuse and neglect,” Dr. Jackson said. “We also treat any physical injuries and provide mental health services for child abuse victims.”

Dr. Jackson said they try to connect families with community resources so they can be a better parent. She said that sometimes parents of abused children were abused themselves and had never sought treatment. The team helps to make sure these families have all of the resources they need to be better families.

To make appointments with the Child and Adolescent Protection Center, call 202-476-4072.

To report child abuse, contact the child protective service agency in the jurisdiction in which the abuse occurred:

•    District of Columbia:  202-671-7233 (SAFE)
•    Prince George’s County:  301-909-2450
•    Montgomery County:  240-777-4417
•    State of Virginia: 800-552-7096
•    National Reporting Hotline:  1-800-4-A-CHILD

Monday, April 14, 2014

Children’s National's Kid-Friendly
Approach to Imaging

The staff at Children’s National Imaging in Rockville know getting an MRI can be scary, which is why they use state-of-the-art equipment to ease the process and provide quality care that makes it safer for even the smallest and youngest patients undergoing sedation for imaging.

Children respond differently to anesthesia than adults so Children’s National Imaging’s latest low-dose technology ensures optimal utilization of modern imaging techniques. The technology also allows for faster scans while still generating high quality, detailed images, so children do not need to sit still for as long.

At Children’s National Imaging, we also want to make the child’s experience an adventure with procedure rooms decorated using GE’s Adventure Series™. The rooms are designed to feel like an underwater adventure in a yellow submarine or a carefree day floating in a boat, helping to put children and families at ease and provide a sense of comfort and fun, along with opportunities for distraction, if needed.

“When the kids smile, it makes me smile,” said Children’s National Imaging manager Rosemarie Cloughley-Plessinger RN, BSN, CPN.

This unique environmental design leads to safer and more efficient procedures and less stress for the patient and families.

Since its opening in 2011, Children’s National Imaging has provided outpatient imaging services by staff that focuses solely on children’s medicine. The team includes board certified pediatric radiologists, pediatric anesthesiologists, registered pediatric radiologic technologists, certified pediatric nurses and a full-time Child Life Specialist who is trained in addressing the developmental and psychosocial needs of patients and families.

Children’s National Imaging is located in the same building as the Montgomery County Regional Outpatient Center and Ambulatory Surgery Center. The same specialists that provide expert care at our hospital location downtown see Montgomery County patients closer to their homes, and at Children’s National Imaging, patients get a unique experience designed with kids in mind, for an appointment, call 301-765-5700.

Monday, April 7, 2014

Advancing Pediatrics: Hands-on Care

Experts with the Hand Program at Children’s National Health System provide surgical and nonsurgical treatments for hand and upper extremity problems in infants and young adults.

“We help more than 3,000 pediatric patients each year with congenital hand deformities, post-traumatic reconstruction, and sports-related injuries that include acute or traumatic fractures of the wrist, hand, and elbow,” says Emily Hattwick, MD, MPH, pediatric hand and upper extremity surgeon from Pediatrics Specialists of Virginia who also practices at Children’s National. “Our expertise is in caring for the challenging, less common problems in the pediatric upper extremities, and we have developed a multidisciplinary program to maximize patient outcomes and success during treatment.”

The nationally ranked Hand Program team at Children’s National includes members of the Orthopaedic Surgery, Sports Medicine, and Plastic and Reconstructive Surgery departments. Dr. Hattwick and Robert Wilson, MD, pediatric orthopaedic hand surgeons, work alongside Gary Rogers, MD, a pediatric plastic surgeon with additional training in hand surgery.

The Hand Program also includes pediatric hand therapists, as well as specialists in Neurosurgery, Physical Medicine, Prosthetics, and Physical and Occupational Therapy.

A delicate touch

“Treating a child’s complex injuries or deformity often requires a creative, innovative approach,” Dr. Hattwick says. “When a growing child sustains a fracture, careful attention must be given to how the injury will heal and affect his or her growth plates and joints. A child’s future growth plays a huge part in our treatment approach.”

For children with congenital conditions and chronic upper extremity deformities, Dr. Hattwick typically operates around age 1 to best improve function. Children’s National offers hand and microsurgery options for an array of conditions, including:
  • Brachial plexus birth palsy
  • Central deficiency/cleft hand
  • Congenital dislocation of the radial head
  • Congenital radioulnar synostosis
  • Duplicate thumb/finger polydactyly
  • Finger hypoplasia
  • Neuromuscular upper extremity contractures
  • Radial club hand
  • Syndactyly
  • Trigger thumb
  • Ulnar deficiency

In addition to providing consultations, evaluations, and reconstructive treatment mfor complex injuries or physical deformities, Children’s National offers nonsurgical rehabilitation, including physical and occupational therapy.

“More often than not, I start by offering patients and their families the best nonsurgical options available,” Dr. Hattwick says. “Depending on the level of injury or deformity and the risk for a larger problem developing down the road, corrective surgery may turn out to be the best option.”

Working in conjunction with researchers at the National Institutes of Health’s Department of Genetics, the Hand Program at Children’s National Health System is committed to ongoing research measuring the outcomes of surgical treatment of patients with hand and wrist deformities caused by certain rare diagnoses. Physicians with the Hand Program also conduct educational programs about pediatric hand and upper extremity surgery for Georgetown University, George Washington University, Inova, Howard University, and the Walter Reed Orthopaedic Residency students.

Read more about hand surgery in the winter 2014 issue of Advancing Pediatrics. Download the app on iTunes to receive the latest issue to your iPad.

Friday, April 4, 2014

Treating and Preventing Otitis Media (Ear Infections) in Children

More than 80 percent of children have at least one episode of otitis media by the time they are 3 years of age. Otitis media, a common type of ear infection, occurs when there is inflammation located in the middle ear. It can be a result of a cold, sore throat, or respiratory infection.

Earlier this year, the American Academy of Pediatrics (AAP) updated its guidelines for treating acute otitis media (AOM), which is the type of ear infection that is one of the most common illnesses in children. The AAP’s guidelines included “recommendations for treatment with antibiotics and pain relievers, or observation alone, based on the child’s age and severity of symptoms.”

To help prevent otitis media, parents should avoid exposing children to any tobacco products or second hand smoke, and keep up-to-date with children’s recommended immunizations. Additionally, breastfeeding babies for 12 months or more can help them obtain antibodies to fight off and prevent ear infections.

In this video, Children’s National Health System’s pediatric otolaryngologist Brian Reilly, MD,  discusses the new guidelines, including the emphasis on using observation as an initial treatment option, as well as age groups that are more prone to otitis media. 


Related Stories:
The New Guidelines for Treating Ear Infections
New Guidelines for Ear Tubes

Wednesday, April 2, 2014

Celebrate Kids, Prevent Injuries, and Save Lives on Safe Kids Day

In honor of Safe Kids Day, Kate Carr, president and CEO of Safe Kids Worldwide, authored this guest post to spotlight the significance of protecting children from preventable injuries. Follow Kate Carr on Twitter at @safekidsceo.

Twenty-six years ago, Children’s National Health System started Safe Kids Worldwide to ensure no family had to endure the loss of a child due to an injury that we can predict and prevent.

Injury prevention is not about watching your children every minute of the day or securing them in bubble wrap. It’s about creating an environment where kids can explore and take chances while minimizing the risk of serious injuries and deaths.

And we know it works. Since our inception, Safe Kids has worked closely with partners to help reduce the U.S. childhood death rate from preventable injury by 55 percent.

Still, preventable injuries are the number one killer of kids in the United States and a serious problem around the globe. Every year, more than one million children around the world die of a preventable injury. Millions more are injured in ways that can affect them for a lifetime. These are more than statistics. They represent tragedies for families and communities.

What is Safe Kids Day?

There is nothing more empowering than being part of a sea of people committed to changing the world. It’s that feeling that inspired Safe Kids Worldwide to create Safe Kids Day, a day to celebrate kids, prevent injuries, and save lives.

Safe Kids Day brings together families, celebrities, donors, and communities to raise awareness and funds so more children have a chance to grow up and becomes whatever they can imagine.

Read Jennifer's story about her daughter, Regan, to see why Safe Kids Day matters to her family.

How to Get Involved

Here are three great ways for you and your family to get involved.
  1. Spread the word about Safe Kids Day with family and friends. 
  2. Make a donation to support the Safe Kids Day campaign.
  3. Become a fundraiser to encourage your friends and family to help protect children.
Please join us as we work together to make a difference in the lives of children and families around the world. It’s a feeling you’ll never forget. 

Tuesday, April 1, 2014

Advancing Pediatrics:
A Global Approach to Neurosurgery

India. Israel. Germany. Saudi Arabia. These are just a few places neurosurgeons from Children’s National Health System travel to collaborate with international colleagues on cutting-edge medical research.

This world-renowned research has profound effects for pediatric patients in the greater Washington, DC area and across the nation and globe. Children’s National neurosurgeons are pushing the envelope of advanced care in:
  • Intraoperative MRI (magnetic resonance imaging) for tumors and other intracranial lesions
  • Minimally invasive and stereotactical approaches to brain surgery
  • Surgical treatments for intractable epilepsy

“We are a department of five neurosurgeons dedicated to pediatric patients,” says John Myseros, MD, neurosurgeon with Children’s National. “We offer comprehensive pediatric neurosurgical solutions for conditions including hydrocephalus, spina bifida, brain tumors, movement disorders, vascular malformations, Chiari malformations, and epilepsy.”

Neurosurgeons at Children’s National also are promoting new, minimally invasive ways of treating familiar concerns—with smaller incisions, less radiation, shorter hospital stays, and equal or improved results.

Excellence attracts excellence

Last year, neurosurgeon Chima Oluigbo, MD, joined the Division of Neurosurgery, bringing expertise in epilepsy and functional neurosurgery.

“Dr. Oluigbo is one of the few physicians cross-trained in pediatrics and functional neurosurgery,” says Robert Keating, MD, Chief of Neurosurgery at Children’s National. “He brings the ability to use deep brain stimulation— typically used to treat adult conditions such as Parkinson’s— as an approach to pediatric movement disorders.”

Dr. Oluigbo also treats pediatric pain with deep brain stimulation and surgical approaches, which hold the promise to ameliorate intractable pain and pain disorders.

Multidisciplinary work groups create patient-centered care

Neurosurgeons at Children’s National collaborate with colleagues in other disciplines to promote cross-specialty understanding and seek the best treatment for each patient.

“We work with various departments depending on the condition we’re treating,” Dr. Keating says. “For instance, craniofacial surgery involves surgery, plastic surgery, genetics, and otolaryngology specialists. By taking a concentric approach to the patient, we can learn from each other, as well as provide immediate feedback to families.”

From a personal focus on each patient to a global scope in research and innovation, Children’s National bridges the gap between caring for each child and caring for the world’s children.

Read more about our Neurosurgery Department in the winter 2014 issue of Advancing Pediatrics. Download the app on iTunes to receive the latest issue to your iPad.