Friday, January 30, 2015

Bullying of Children with Autism Spectrum Disorders

As children make friends, sometimes they bond over similarities – living in the same neighborhood, attending the same school, or having the same interests.

But children also can tease or ostracize each other if they think another child is different because of their appearance, intelligence, or mannerisms.

Schoolmates of an autistic teenager tricked the 15-year-old during the viral ALS Ice Bucket Challenge last summer. The incident drew national attention and put a spotlight on bullying among young people with autism spectrum disorders (ASD).

According to research posted on the Autism Speaks website, an autism science and advocacy organization, “children with ASD are bullied at a very high rate, and are also often purposefully ‘triggered’ into meltdowns or aggressive outbursts by ill-intentioned peers.”

“Kids with autism are less likely to pick up on social cues that they’re being ostracized,” said Adelaide Robb, MD, Division Chief, Psychology and Behavioral Health, Children’s National Health System. “They may not be aware that someone is picking on them.”

Depending on the child’s age and their level of autistic traits – for example if the child is nonverbal – a child “may not have the necessary social skills to navigate peer interactions including offers of friendship, teasing, and bullying.”

“One of the deficits of autism is difficulty in reading social cues and a deficit in social skills,” she said.

Dr. Robb said a subgroup of children with autism spectrum disorders “who have explosive, angry outbursts” may frighten their peers, which shields them from “being teased because they’re seen as someone you don’t want to antagonize.”

Where they fit on the spectrum also plays a role. Do they have physical characteristics that make them more likely to be bullied, such as being very tall or very short for their age?

“Sometimes kids with autism only like to wear a certain textured clothing and shoes,” Dr. Robb said, adding that if a child right now is wearing sandals and shorts in the winter, “they might be teased for appearing different.” Also, a child might be teased for their cognitive abilities or for repeating things.

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Monday, January 26, 2015

NICU Social Worker: 'An Honor to Support Families Through a Difficult Life Experience'

Home to the Washington, DC, metropolitan region’s only Neonatal Intensive Care Unit (NICU) ranked in the national top 10 by U.S. News and World Report, Children’s National Health System serves as a primary referral center for more than 40 hospitals in the region, and staffs four regional NICUs in Maryland and Virginia.

Providing the best care for our smallest patients requires a huge multidisciplinary team, or as NICU social worker Lauren Obidi calls it a “village to raise a child.”

A medical social worker at Children’s National since 2013, Obidi said the staff comes together to “support a patient and family through their NICU experience, and that team aspect is what makes it a great place to work.”

Obidi, a graduate of the University of Pennsylvania, said working in a NICU is both challenging and rewarding.

“The staff functions like a big family, supporting each other through all different situations,” she said. “We have the honor to work with families who are experiencing an extremely difficult time in their life and support them through the process of having a hospitalized child. My team of doctors, nurse practitioners, case managers, and nurses are outstanding and really supportive of each other.”

Visiting with NICU Graduates

Obidi said among the most memorable experiences she has include “families coming back to visit after long hospital stays.”

“I have one family who comes to visit me after every developmental appointment. He was one of my first patient’s at Children’s National and was really sick. He is doing amazingly well and now runs to give me a high five at every visit,” she said. “It honestly makes my day when he comes to visit.”

Helping Families Prepare to Leave the NICU

Some of Obidi’s other memorable experiences include celebrating when a patient meets a milestone or prepares to be discharged from the hospital.

“I also really enjoy when long-term patients are healthy enough to sit in a bouncy chair and interact with their surroundings,” she said.

“One memory that sticks out is of a patient who was here for five or six months, and whose family lived very far away. This patient would often be in a bouncy chair near the doorway and regularly you would see staff cooing, reading, and chatting with him. Watching this patient smile and engage with the staff when his parents were unable to sit bedside was pretty amazing.”

What amazes her most about her job is how on a daily basis she and her colleagues have the “honor to support families through a difficult life experience.

“We get to work with families whose newborns have an array of medical needs. Families allow us into their lives to provide support and help them navigate this experience,” she said. “I also learn so much from our families every day. They teach us about their culture and customs, make us laugh, and demonstrate their amazing strength and resilience.”

Learn more about the Division of Neonatology at Children’s National.

Friday, January 23, 2015

How Blood and Platelet Donations Impact Pediatric Patients

Each week, the Edward J. Miller, Sr. Blood Donor Center at Children’s National needs 100 whole blood donations and 35 platelet donations to provide our pediatric patients with life-saving surgeries and to nurse children back to health from cancer or sickle cell disease.

Below, explore the blood and platelet donation facts and figures to learn how you can give the gift of life to pediatric patients at Children’s National. Don’t forget to schedule an appointment to donate whole blood or platelets online or by calling 202-476-KIDS (5437).

View this infographic full size.

Blood Donor Center Infographic

Wednesday, January 21, 2015

Children’s National Uses T-Cell Therapy to Successfully Fight Tumors, and More

Children’s National Health System is initiating novel treatments that harness the body’s own cells to successfully attack leukemia, lymphoma, and non-malignant diseases such as immune deficiencies and sickle cell disease.

Much of this work involves T-cells.

What are T-cells?

T-cells are white blood cells that circulate around our bodies, scanning for abnormalities and infections. The T-cells themselves look like a blob of interwoven bits of curled up spaghetti.

At Children’s National labs, Catherine Bollard, MD, MBChB, a blood and marrow transplant specialist and head of the Program for Cell Enhancement and Technologies for Immunotherapy (CETI), and her research team are training these T-cells to fight tumors and target cells and viruses that occur in leukemia, sickle cell disease, and other ailments.

Patients Treated at Children’s National with T-cell Therapies

Since CETI’s opening in November 2013, Dr. Bollard’s team has treated 15 patients with T-cell therapies, often focusing on life-threatening infections that affect patients with a weakened immune system, specifically patients who have had a bone marrow transplant.

“There have been overwhelming success rates,” Dr. Bollard said.

Patients treated include those who have had received bone marrow stem cell transplants for cancers such as leukemia and lymphoma,  immune deficiencies, and sickle cell disease.

Making T-cells in the Lab

The team takes blood from patients, and in a state-of-the-art cell therapy good manufacturing practice (GMP) laboratory.

“We train T-cells to kill virus infected cells and cancer cells,” said Dr. Bollard. “Once the T-cells are ready, they are injected back into the patient, where they can travel throughout the body to seek out, find, and destroy the cancer or the virus.”

These T-cells are malleable, and so specific to each patient, Dr. Bollard calls it the “ultimate personalized therapy.” Some functions of T cells include:
  • Killer T-cells are able to see in our body and scan for trouble. These cells hunt down infection.
  • Helper T-cells orchestrate the immune response and play an important role in all immunity.
Each T-cell Tailored to the Patient

Each T-cell therapy is carried out differently, depending on the mechanism of immunotherapy. At Children’s National, Dr. Bollard’s team has pioneered a new approach in T-cell therapy using cord blood, the blood that remains in the blood vessels of the placenta and the portion of the umbilical cord that remains attached to the baby after birth. Cord blood is a life-saving donor source, and has a greater flexibility to be matched to a patient with fewer rejection symptoms, so patients without a familial match can undergo treatments.

However, virus infection is a major problem affecting patients after cord blood transplantation. Therefore, the CETI team has developed a novel treatment to prevent or treat life-threatening virus infection. They borrow a small fraction of cord blood T-cells and teach them to effectively target and kill virus infected cells and then inject these cord blood T-cells into the patients after their transplant.

“We are the first group to show that na├»ve cord blood derived immune system cells can be ‘trained’ in the laboratory to kill three viruses simultaneously,” said Dr. Bollard.

T-cell therapy targeting viruses has fewer toxic side effects, compared to many of the drug treatments these patients need. The other advantage of the T-cells is that they live forever and protect patients from infection or relapse for the rest of their lives, Dr. Bollard said.

Treating patients with virus killing T-cells after a bone marrow or cord blood transplant has resulted in a 93 percent success rate. Based on these highly successful results, the Children’s National CETI team is building their own bank of trained up T-cells to match and use whenever a vulnerable child is in need.

Learn more about the Cellular Therapy Program at Children’s National.

Friday, January 16, 2015

Children’s Researchers Find Potential Treatment for White Matter Injury

White matter injury (WMI), one of the most common consequences of premature birth, can produce long-term neurodevelopmental deficits. A study by researchers at Children’s National Health System provided direct evidence that targeting specific receptors in white matter cells after brain injury promotes cellular and functional recovery.

One of the Most Common Consequences of Premature Birth

In the United States, about 500,000 babies are born prematurely each year, with about 2 percent of them born at less than 32 weeks gestation. Up to 90 percent of these children survive, but they often suffer a number of abnormalities, including underdeveloped lungs. Underdeveloped lungs can lead to insufficient oxygen supply or hypoxia, which in turn contributes to WMI. No treatment currently exists to improve function in these infants once injury occurs.

During normal fetal and postnatal development, oligodendrocytes (myelin-producing cells in white matter) arise from oligodendrocyte progenitor cells (OPCs). In premature infants, hypoxia prevents OPCs from maturing properly, and the cells begin to die. Without sufficient myelin, the brain cannot process nerve impulses effectively, leading to significant delays in the development of sensorimotor skills and cognition.

Children's Researchers Study White Matter Injury Treatment Options

“We have only recently begun to understand how hypoxia (insufficient oxygen supply) and related brain injury affect white matter development and myelination in the developing brain,” Vittorio Gallo, PhD, Director of the Center for Neuroscience Research at Children’s National, who led the study, said. “We knew from previous research that the epidermal growth factor receptor (EGFR) plays a significant role in the maturation of oligodendrocyte progenitor cells (OPCs). In this study, we wanted to see if enhanced EGFR signaling could stimulate the OPCs to develop normally.”

The team was able to model premature brain injury and administered the EGFR treatment.

“After treatment, the selectively targeted OPCs were identical to normal, healthy oligodendrocytes,” Joseph Scafidi, DO, pediatric neurologist at Children’s National and the study’s lead author, said.

Due to limited duration of the OPC’s plasticity response, there is a very narrow window of intervention opportunity.

“Treatment must be administered within a week after injury,” Dr. Gallo said. “After that, there’s no effect.”

While the team’s finding, published in Nature, demonstrate that the treatment is clinically feasible and potentially applicable to children with WMI, Dr. Gallo cautions that more research is needed to develop safe and effective therapeutic approaches.

“This study highlights the importance of the brain’s plasticity response,” Dr. Gallo said. “Researchers need to take full advantage of that response for therapeutic purposes.”

Find this article and others in Advancing Pediatrics, quarterly publication.

Thursday, January 15, 2015

How to Conquer the Winter Blues

When the weather gets colder and winter flurries force your family indoors, it’s easy to understand why your children might not seem as spirited as usual. This change in mood could actually be a case of Seasonal Affective Disorder (SAD).

Each year, more than 1 million children and adolescents suffer from Seasonal Affective Disorder, also known as the winter blues, a subtype of depression that follows a seasonal pattern, according to the American Academy of Pediatrics (AAP). Sufferers of SAD usually experience symptoms in the winter and fall; however, symptoms can occur in the spring and summer too.

Symptoms of SAD:
  • Become sad because of the shortening days
  • Oversleeping
  • Weight gain
  •  Fatigue
  •  Withdrawal from social activity
  •  Experience feelings of low self-worth and hopelessness
  •  Struggle with school work
It is estimated that 10 to 20 percent of children and adolescents develop mild SAD symptoms as winter begins and the symptoms can worsen as winter progresses.

There is no known cause of SAD, however some researchers found it may be influenced by a disruption in a person’s circadian rhythm, or the body’s natural cycle of waking and sleeping. In the winter, there is less sunlight, which plays a role in the brain’s production of melatonin and serotonin. So, SAD could be caused by the body’s over production of melatonin, which encourages sleep, and under production of serotonin, which fights depression.

Diagnosing SAD involves medical exams to rule out other possible symptom causes, like hypothyroidism or hypoglycemia, but treating moderate SAD can be simple.

Treating SAD:
  • Spend time outside every day
  • Open window shades in the home
  • Exercise regularly and eat a healthy diet that is low in simple carbohydrates and high in vegetables, fruit, and whole grains
  • Use a “dawn simulator” to gradually turn light on in the bedroom to trick your body into thinking the sunrise is earlier
“For some people with SAD, behavioral modifications may not be enough and they need to be treated for major depression with therapy and or medications,” said Adelaide Robb, MD, Chief of the Division of Psychology and Behavioral Health.

For more information, search under Depression and Washington, DC.

Monday, January 12, 2015

Collaboration for Control:
How the WISH Clinic Helps Children with Wetting and Soiling Issues

The Wetting, Infections, and Stooling Help (WISH) Clinic at Children’s National Health System is dedicated to resolving recurrent urinary tract infections and wetting problems in children through a comprehensive and holistic interactive process.

“Between 60 and 70 percent of recurrent urinary tract infections, bedwetting, and daytime wetting can be related to habits,” says Naida Kalloo, MD, a pediatric urologist at Children’s National. “At the WISH Clinic, we educate parents and children about the behaviors that contribute to these conditions and provide tools they may use to take control.”

With a number of locations throughout Washington, DC, Maryland, and Virginia, the WISH Clinic is led by Dr. Kalloo, who works alongside three nurse practitioners, a clinical nurse specialist, and a pediatric urology nurse. Together, this group evaluates patients by performing in-depth, 30-minute assessments to address specific problems, such as bedwetting, daytime leakage, urinary infections, and associated constipation.

“The WISH Clinic provides a template that allows for extensive evaluation of and counseling for these conditions, which account for about 15 percent of all outpatient urology references,” says H. Gil Rushton, MD, Division Chief of Urology at Children’s National. “This comprehensive process offers a much better experience for patients and their families in comparison to being seen in a busy urology clinic. It is an invaluable part of the Division of Urology at Children’s National.”

Tests conducted by the WISH Clinic may include a comprehensive history and physical exam, a bladder scan, and urinalysis. Additionally, some cases require more in-depth tests, such as an abdominal X-ray, a renal bladder ultrasound, or urodynamic studies to measure bladder function.

Tailored Treatment for WISH Patients

Once WISH Clinic experts have determined the factors causing urinary and bowel complications, they work with parents to design treatment plans and provide educational materials for home reference.

“Many patients with recurrent urinary tract infections and wetting issues are constipated,” Dr. Kalloo says. “A comprehensive plan, including drinking, voiding, and bowel movement management, is often necessary for long-term resolution. The most important thing is for patients to be referred to us as soon as possible to we can give parents the power to help their children make positive changes.”

Find this article and others in Advancing Pediatrics, our quarterly physician publication.