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.

Monday, March 31, 2014

Managing Blood Sugar Levels in Sick Kids

When a diabetic child becomes ill, parents are not only tending to the child’s cold or flu symptoms, but also working to manage her blood sugar levels, which can fluctuate when a child’s body is fighting off an illness.

According to the American Diabetes Association, our bodies fight disease by releasing hormones. While these hormones can help a child fight an illness, they can also increase a child’s blood sugar levels and make it harder for their body to properly use insulin.

When a diabetic child is sick it is likely they may need extra insulin, blood sugar checks as often as every two to three hours, and blood or urine ketone checks as often as every four hours. Additionally, the American Diabetes Association recommends that parents make sure children drink a lot of clear liquids - no caffeine, and continue to take their regular medicine.

In this video, Erika Davies, MS, RD, LD, an endocrinology dietitian at Children’s National Health System, offers tips for parents on how to manage a child’s diabetes when they are sick and explains when to call a pediatrician. 

Helpful Links
Managing and Coping Childhood and Adolescent Diabetes

Friday, March 28, 2014

Tuberculosis: A local, global problem

A new study published in the journal Lancet found that drug-resistant tuberculosis (TB) infects as many as 32,000 children globally.

“Overall, as many as 1 million children become sick with TB each year, about twice the number previously thought, and of these, only a third of the cases are ever diagnosed, the study found,” Reuters reported.

The study was published World Tuberculosis Day, which aims to raise awareness of the issue and the status of prevention.

The World Health Organization estimates “that half a million people caught drug-resistant ‘superbug’ strains of TB in 2012, and that about 2 million people could contract it by 2015,” Time magazine reported. A study by  researchers from Brigham and Women’s Hospital’s Division of Global Health Equity stated,  “The researchers went through several databases to determine a more accurate number of children with TB, since the disease in kids is known to be underreported.”

Recent TB Scare In Local High School


Possible exposure to TB prompted health and school officials to make TB testing available earlier this week for more than 100 students and staff members at a Gaithersburg, Md., high school. The Washington Post reported that 126 people at Watkins Mill High School “were in classes or after-school activities with the infected person from October 2013 to January, officials said.”

Once a leading cause of death in the United States, TB is curable and preventable. Caused by bacteria called Mycobacterium tuberculosis, TB targets the lungs, but may spread to other organs such as the kidney, spine, and brain.

It is spread from person to person through the air, according to Children’s National Health System infectious disease specialist David Hyun, MD. It can be transmitted by droplets from infected people when they cough, sneeze, speak or sing, for example.

“For most children older than 4 years of age and adults, there can be a considerable lag time between time of infection of TB  and development of disease, which can be anywhere from months to years,” Dr. Hyun said. The period between exposure and the disease development is referred to as the latent period.

“In younger children, this interval can be a lot shorter, which is why it's all the more important to identify potentially exposed subjects early so that preventive measures can be put in place to prevent TB disease,” said Dr. Hyun.

Stages of TB


Exposure occurs when someone is exposed to or comes into contact with a person who may be infected.

Latent TB infection means they have the bacteria in their body, but it doesn’t make them sick; they may have a positive skin test, but a normal chest X-ray, and no illness.

Most people fight TB before it grows and becomes TB disease.  Having the disease means bacteria are active or multiplying in the body. Someone with the active infection will have a positive skin test, a positive chest X-ray detecting TB, and they might become sick.

“Latent infections are asymptomatic and usually treated with a single antibiotic to prevent development of symptomatic TB disease. If latent infections progress without treatment it can lead to most commonly pulmonary TB which exhibits as chronic coughing, fevers, night sweats, and weight loss,” Dr. Hyun said.

Symptoms of TB


The symptoms may resemble other lung conditions or medical problems and they differ depending on the child’s age, so consult your child's doctor for a diagnosis.

In children, common symptoms are:

  • Fever
  • Decrease in weight
  • Night sweats
  • Cough
  • Chills
  • Enlarged lymph nodes

In adolescents, common symptoms are:

  • Cough that lasts greater than three weeks
  • Cough
  • Chest pain
  • Blood in their sputum (phlegm)
  • Fatigue
  • Weight loss
  • Decrease in appetite
  • Fever
  • Night sweats

“For anyone who has been exposed to a documented case of TB disease, it is important to have either a PPD skin testing (all age groups) or an interferon-gamma release assays from the blood (for children older than 4 years),” Dr. Hyun said.

“The most important steps for families to take is if they have been notified of a exposure in the household or school, to make sure to follow the public health agency's (health department) instructions on obtaining the screening tests or contacting their pediatrician,” Dr. Hyun said.