Wednesday, October 1, 2014

How the Fetal Medicine Institute Creates a Road Map for Expecting Parents

Pregnancy can be a joyous time, but it can also be a scary time. One thing that can add fear to a pregnancy is when something unusual happens along the way. It could be an abnormality in a routine test or maybe your doctor wants to find out more information about something seen on an ultrasound.

That’s where Children’s National’s Fetal Medicine Institute team comes in. The Institute combines the expertise of Children’s National's pediatric specialists, three genetic counselors, and a nurse practitioner to help families during this stressful time.

“We help patients to learn and interpret as much information as possible about their pregnancy,” said Margaret Menzel, GCG, MS, one of the Institute's board-certified genetic counselors and care coordinators. “A patient may come to see us to talk about a concern they have about a family history of a particular genetic abnormality prior to conception, or we may see them on a more urgent basis when the possibility of a fetal abnormality arises during a pregnancy.”

For example, a family might be referred to Children’s National's at 20 weeks gestation because they are carrying a fetus with bilateral clubbed feet and need more testing. When they come to the Fetal Medicine Institute, they will have an ultrasound and meet with a genetic counselor and a pediatric orthopaedic surgeon and learn what having bilateral clubbed feet means and what type of evaluation and/or intervention to expect after delivery.

Additionally, many congenital heart defects can be diagnosed during pregnancy. The Institute has specialists in fetal cardiology who help families plan, prepare, and manage a serious fetal heart defect diagnoses.

An obstetrician/gynecologist, perinatologist, or radiologist may refer a family to the Institute for more tests, which may include:
“The number of people who are involved in this multidisciplinary team and the wide range of expertise here is what makes us so unique. We truly do have the top physicians here in every specialty,” Menzel added. “Our pediatric patients have access to top notch care and our fetal patients have access to both during and after pregnancy.”

The Fetal Medicine Institute team works with the patient’s referring physician immediately following the initial visit to discuss next steps and any delivery management and planning, like whether or not a baby will need to be immediately transferred to the Children’s National's Neonatal Intensive Care Unit (NICU). The Institute's specialists also provide care to the baby after birth to provide the family with continuity of care and ensure access to all required special services.

“What most families are looking for is a roadmap. Anytime there is uncertainty in a pregnancy, there is a lot of anxiety, so our goal is to give families the tools to be able to deal with this,” she said.

Birth defects can be isolated or present as part of an underlying genetic syndrome. The fetal geneticists on the team play an important role in working with the genetic counselors to discuss potential diagnoses with families during a pregnancy or as part of pregnancy planning.

The team also works with outside social workers, counselors, area support groups, and even past families that have gone through similar experiences to help support families.

“We want to empower families with information,” Menzel said. “We want to make them feel that they have gotten as much information as is possible during the pregnancy. In a time when many families feel they have lost control of what is happening, we hope to make them feel that they are at the right place, have tapped into all the right resources, and that we are here with them to hold their hand no matter what happens.”

Monday, September 29, 2014

How Children’s National Neurosurgeons Use Laser Treatment to Send Epilepsy Patients Home Sooner

Using novel laser technology, our neurosurgeons can now use minimally invasive procedures to eradicate deep-seated brain lesions that cause drug-resistant epilepsy.

Hypothalamic harmatomas are a type of noncancerous tumors that live deep in the brain, in the hypothalamus, and can cause gelastic seizures. These seizures resemble laughing fits and are difficult to treat with medications, and when left untreated, they can cause significant learning and behavioral difficulties.

However, with Visualase magnetic resonance imaging (MRI)--guided laser technology, neurosurgeons, like Children’s National’s Chima Oluigbo, MD, can eradicate these tumors using minimally invasive surgery, which means smaller incisions, smaller scars, and a faster recovery time for children.

According to Dr. Oluigbo, the neurosurgeons use an intraoperative MRI to see where to place the guide wire, and then software calculates the precise amount of energy necessary to destroy the tissue. The neurosurgeons can then check the affected area immediately, using MRI, to confirm the tumor was destroyed.

“Following Visualase treatment, children return home in no more than two days,” Dr. Oluigbo said. “With traditional surgical treatments, children would remain in the hospital for 10 days and experience more pain.”

William D. Gaillard, MD, Chief of the Division of Epilepsy, Neurophysiology, and Critical Care Neurology, adds that this type of procedure reduces the risk of morbidity and mortality associated with open surgeries.

“Children with uncontrolled seizures need to be cared for in a place with specialized experience in childhood epilepsy so treatments that have the potential to preserve the quality of life can be considered earlier,” Dr. Gaillard said.

Friday, September 26, 2014

Get Psyched Friday: 5 Ways to Prepare Your Child for Their First Sleepover

In her latest Get Psyched Friday, psychologist Eleanor Mackey, PhD, discusses how to decide when your child is ready for a sleepover.

I have been thinking a lot about when my child can go to sleepovers because I am now asked this frequently by my oldest daughter, who is now 5 years old. At first when she started to ask this question, I threw out random ages that seemed “old” in my head, like 7 or 8. I will admit that there have been more times than there should where a “how old” question gets a postponed decision by tossing out a number that I hope she forgets by the time it rolls around! I should know better than to be surprised that her memory is better than mine.

However, I think the reason I’ve found it hard to answer this question for my own daughter is that the real answer is “it depends.”

Every child gets to this point at a different time and there is no magic age at which a sleepover is appropriate. Generally speaking, the child has to be old enough to go to sleep on his/her own without a long, specific ritual from a parent. Children who have a lot of anxieties about sleep or the dark, who have significant separation anxiety, or who have nighttime enuresis, or bedwetting, which causes distress, may need to wait a little longer than children without these concerns.

Honestly, as a parent you just have to give it a try in order to find out whether your child is ready or not. I’ve seen a number of children appear ready and then panic when the time comes. I’ve seen others that I thought wouldn’t last 10 minutes stick it out and enjoy it. So, to help parents, here are my top five tips for a trial run to see if your child is ready for their first sleepover.

1.  Start with a known quantity
Pick a family member (cousin, for example), or close family friend whom your child already knows well.

2.  Practice
A good way to practice is to do it together. For example, when vacationing with extended family or with friends, allow your child to share a room with another to see if they can even sleep in the same room as someone with whom they’d rather play than sleep.

3.  Talk about it ahead of time
It is important to prepare your child for what to expect, potential difficulties, and how to handle them. Read a book about sleepovers (there are a lot out there) to show your child that it is okay to be nervous and how to ask for help. Talk about who they can go to at their friend’s house if they are scared. Discuss a plan for what happens if they wake up in the middle of the night afraid. Let the parent of the other child know the plan.

4.  Don’t set your expectations too high
Your child may do just fine, but don’t be surprised if you need to pick them up early or if they come home tired and cranky. Don’t plan a lot for the next day to allow them to recuperate.

5.  Praise success
Even if your child isn’t as successful as you may have expected or hoped, praise them for any success they had and reassure them that it takes practice and time, but that you will help them get there.

Monday, September 22, 2014

What Parents Need to Know about Teen Dating Violence

While dating violence may often be associated with adults, it also happens in relationships among adolescents. The Centers for Disease Control and Prevention’s (CDC) 2013 Youth Risk Behavior Survey found that nearly 12 percent of high school students in Washington, DC, and more than 10 percent of students in the United States reported being hit, slammed into something, or injured with an object or weapon on purpose by someone they were dating in the year prior to the survey.

This survey also found that more than 9 percent of high school students in the District of Columbia and more than 10 percent of high school students in the United States experienced sexual dating violence by someone they were dating  one or more times in the year prior to the survey.

We enlisted experts Allison Jackson, MD, PhD, Division Chief, and Siobhan Copeland, Crime Services Coordinator, of the Freddie Mac Foundation Child and Adolescent Protection Center at Children’s National Health System, to weigh in on teen dating violence and what parents need to know.

What is teen dating violence?

Teen dating violence is the physical, sexual, or psychological/emotional violence within a dating relationship, as well as stalking. It can occur in person or electronically and may occur between a current or former dating partner, according to the CDC.

Typically, the rates of teen dating violence are higher in females than males, both locally and regionally. Dr. Jackson explained that traditionally rates of certain forms of victimization such as sexual abuse and rape are higher in girls than boys.

“Culturally, however, males may be less likely to disclose dating violence than females,” she said.

At-risk teens

Dr. Jackson noted that teens are at an increased risk for suffering or committing dating violence if they’ve experienced prior traumatic experiences, such as child abuse or witnessing family violence or violence among peers. Depression and difficulty communicating within relationships also increases teens’ risk for dating violence.

The CDC states that “teens receive messages about how to behave in relationships from peers, adults in their lives, and the media. All too often these examples suggest violence in a relationship is okay. Violence is never acceptable.”

For a comprehensive list of risk factors, parents can visit the CDC’s webpage on teen dating violence.

Signs and symptoms of teen dating violence

According to Dr. Jackson and Copeland, parents should be aware of and watch for these signs and symptoms of dating violence in their teenagers:
  • Isolation from loved ones and friends
  • Spending excessive time with their partner
  • Unexplained injuries or bruising
  • Multiple physical complaints like headaches or abdominal pain
  • Mood swings or depressed moods
  • Sudden changes in friends, dress, or activities

Diagnosing dating violence in teens

Dating violence is diagnosed when the patient discloses the violent actions to their provider, noted Dr. Jackson and Copeland. 

“Though youth may present to the Emergency Department with injuries resulting from dating violence, knowledge of the event resulting in injury is needed to make the diagnosis of teen dating violence,” Jackson said.

Additionally, Dr. Jackson noted that similar to victims of child abuse or adult victims of domestic violence, teens may be too fearful or ashamed to disclose their experiences with dating violence.

Healthcare providers can also routinely screen adolescents using the FISTS (Fighting, Injuries, Sex, Threats, Self-Defense) or HEADSS (Home/Environment, Education and Employment, Activities, Drugs, Sexuality, Suicide/Depression) assessments.

Treating teens for dating violence

When dating violence is identified in adolescents, the team at Children’s National treats the patient’s physical injuries, provides information on how to protect themselves, and offers mental health services to mitigate the impact of the violence.

Long-term effects of dating violence

Dr. Jackson said teens who experience dating violence may develop depression, posttraumatic stress disorder, chronic pain, and gynecologic and gastrointestinal complaints. Additionally, these teens can experience re-victimization at the hand of other partners throughout their lifetime.

Learn more

To learn more about the services we offer and our multidisciplinary teamwork, visit Children’s National’s Child and Adolescent Protection Center page or call 202-476-4100.

Wednesday, September 17, 2014

How to Avoid Back Pain Resulting in Heavy Backpacks This School Year

Heavy backpacks go hand-in-hand with the return of the school year, and parents need to know how to help their children avoid the pain.

The U.S. Consumer Product Safety Commission estimates more than 7,300 injuries a year are backpack-related.

Children’s National Health System’s Division Chief of Orthopaedic Surgery and Sports Medicine, Matthew Oetgen, MD, said about 30 percent of his patients complain about back pain caused by heavy backpacks every year.

“It’s a weird endemic issue that kids face; they carry all their books with them all the time,” Dr. Oetgen said. “Similar to lifting weights or when you run after you haven’t for a long time, your muscles hurt the next day, and it’s the same for kids. They’re doing this long, moderately intense exercise for the whole day. Muscles have no time to rest, and so, they get back pain.”

Dr. Oetgen said while there are no studies showing that carrying a heavy backpack causes structural deformity to the back, kids with chronic back pain are predisposed to becoming adults with chronic back pain.

The National Safety Council, founded in 1913 by Congress to build awareness, training, and share best practices on safety issues, has developed the following warning signs that a backpack is too heavy:

  • Change in posture when wearing a backpack
  • Struggling when putting on or taking off the backpack
  • Tingling or numbness
  • Red marks

A child’s backpack should not weigh more than 10 to 20 percent of the child’s body weight, according to the American Academy of Pediatrics (AAP).  Dr. Oetgen added that younger children and girls seem more susceptible to backpack-related pain, so parents may want lean more towards 10 percent.

“Just ask the kids if the backpack feels too heavy. Sometimes even 15 percent of the child’s body weight is too heavy for a child, and you may need to decrease the weight even more,” he said.

Dr. Oetgen also suggests children use a locker, if that option is available. Parents can also talk to their child’s teacher and ask how they can help lighten the workload.

The AAP provides some more tips to prevent back pain and injury from backpacks:

  • Always use both shoulder straps. Slinging a backpack over one shoulder can strain muscles. Wearing a backpack on one shoulder may increase curvature of the spine. 
  • Tighten the straps so that the pack is close to the body. The straps should hold the pack two inches above the waist. 
  • Organize the backpack to use all of its compartments. Pack heavier items closest to the center of the back. 
  • Bend using both knees when you bend down. Do not bend over at the waist when wearing or lifting a heavy backpack.
Learn back-strengthening exercises to build up the muscles used to carry a backpack.

Back pain among children and adolescents is very common, but if lightening the load and back exercises are not working, it may be time to see an orthopaedic specialist.

Tuesday, September 16, 2014

Spanking and Corporal Punishment: Advice for Parents

Parents may have heard about alleged child negligent or injury in the news because Minnesota Vikings star running back Adrian Peterson was indicted recently on charges of reckless or negligent injury to a child.

For perspective on this situation, we spoke with Allison Jackson, MD, PhD, Chief of the Division of Child and Adolescent Protection Center at Children’s National.

Jackson advises parents to respond in a corrective, nurturing way when disciplining their children that supports a child’s self-esteem. Appropriate discipline should begin early on, she says.

Dr. Jackson said, as a pediatrician, “We don’t recommend physical discipline. Research continues to demonstrate the negative impact of physical discipline on the health and well-being of children.”

Spanking teaches a child it’s okay to hit

“The starting point for families is that the word discipline means to teach,” she said. “We admonish our children in an effort to teach them what is acceptable and unacceptable behavior, what is safe and not safe to do. When spanking, what are you teaching?”

“By hitting your child your kids learn that it’s okay to hit. Children imitate our behavior. That’s exactly how they‘re acting out their experiences, so if you set the precedent that hitting is okay, don’t be surprised that they hit others,” Dr. Jackson said.

The child-injury charge against Peterson has sparked discussions about discipline, parenting, boundaries, and tough love. And studies show hitting children can cause long-term damage “that increase the likelihood of depression, anxiety and antisocial behavior,” according to a Washington Post report on how spanking affects brain chemistry.

Consistency Is Key

“Children need consistency and repetition,” says Dr. Jackson. “The rules have to be the same regardless of whose household they are in. And you have to provide a consistent response. You have to respond appropriately to the misbehavior. If it’s wrong at grandma’s house, it’s wrong in our house. Kids don’t learn their ABCs in one try, and they won’t learn your rules in one try, they learn by repetition.”

Parents, Time-Outs Aren’t Just for Kids

Timeout is very effective and not just for children, according to Dr. Jackson.

“Kids can make us angry, they make us frustrated,” acknowledges Dr. Jackson, a parent herself. “But we have to understand their development and as they’re becoming mentally and physically more independent, they start to test their limits. It’s not that they’re being bad, but they‘re experimenting and we have to put the boundaries in place in a nurturing way.” Parents should take a time out themselves - take a deep breath, walk away for example.

The Child and Adolescent Protection Center treats more than 1,300 children annually from Washington, DC, and surrounding jurisdictions, and serves more than 1,800 children annually through its participation in the District of Columbia's Multidisciplinary Team on Child Abuse.

When differentiating between parenting and abuse, Dr. Jackson said she and her team look for physical and psychological damage.

Friday, September 12, 2014

Get Psyched Friday: What is the Correlation Between Weight and Mental Health?

In her latest Get Psyched Friday, psychologist Eleanor Mackey, PhD, explains how weight and mental health are related for children.

With childhood obesity affecting millions of youth across the United States, I feel it is important to discuss the relationship of weight and mental health. Often people think of “mind” and “body” as two distinct things. However, the brain is an organ in your body the same as your heart, lungs, or stomach.

Therefore, like other parts of the body, the brain can be affected negatively by excess weight. Moreover, the brain is a major contributor to how we eat and exercise, such as controlling our motivation to be healthy, our desire for food, and our impulse control. Because of all of these factors, it is important to think about the relationship between weight and mental health.

Mental Health Disorders Common in Youth with Obesity

Children with obesity are more likely than their peers to experience things like depression, anxiety, or attention difficulties. These conditions are sometimes caused by negative experiences due to being overweight. For example, many of the patients we see in our clinics at Children’s National Health System report that they have developed social anxiety as a result of feeling judged about their weight and appearance by their peers.

Others report the onset of depression due to feeling socially isolated or being teased about their weight. In turn, these experiences of depression or anxiety often make it more difficult to engage in behaviors that might improve health, such as eating well or exercising. Depression often makes motivation difficult, and kids who are concerned about others judging them may be reluctant to engage in activities like exercising in public.

Research at Children’s National Health System

Excess weight can also affect the way brains function in terms of learning, memory, and impulse control.

In our research at Children’s National, we are working to identify areas that are particularly challenging for youth with obesity and how weight loss affects mental health. This is important information needed to provide treatment to youth with obesity in order to help them be healthy and function at their best each day.

What Can Parents Do?

Given the relationship between weight and mental health, it is important for parents to consider their child’s mental health as another component of their physical well-being.

If you have concerns about potential depression, anxiety, learning problems, or other behavior or mood concerns, it is important to seek a consultation from a professional. There are many treatments available that work to help a child with mental health concerns. Parents should consider this treatment as important a component of health care as any other.

At Children’s National, the Obesity Institute IDEAL Clinic helps families prevent and manage obesity, ensuring the best chance for a healthier future. To speak with a member of the Obesity Institute, please call 202-476-7200.