Update on the June 22, 25, 26 Emergency Department Measles Exposure

What Do I Need to Know?

A patient who arrived at our Emergency Department (ED) on June 22, June 25 and June 26 has tested positive for measles. During each visit, ED staff members followed the appropriate screening processes but the patient’s symptoms did not suggest measles until their third visit on June 26. Immediately, we implemented infection control procedures, which include isolating the patient and their family. As part of our standard process, we reported the event to King County Public Health.

If your patient or family has a concern regarding measles please direct them to visit the King County Public Health website at kingcounty.gov/measles. This is also an excellent resource for you and your staff if you have questions.

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Updated Clinical Standard Work Pathway for Febrile Seizure

Seattle Children’s has released an updated clinical standard work (CSW) pathway for febrile seizure. The pathway is intended to improve the safety and quality of care for children with a simple or complex febrile seizure. It identifies interventions that are not necessary for a child who is well-appearing and describes the small subset of children who need further evaluation. For questions or concerns, contact the Seattle Children’s Seizure Pathway team.

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Update on Hernia Surgery at Seattle Children’s

Seattle Children’s Hernia Program has adopted 16 years old as the age at which our pediatric patients with hernias will be referred to an adult surgery provider, if they need surgery. Adult surgery providers use treatments that are different from those used in young children and are more appropriate for youth 16 and older. Children 15 and younger will still have hernia surgery at Seattle Children’s. Our providers will continue to see patients for hernia diagnosis and evaluation all the way up to age 18.

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Case Study on Transgender Youth: Juanita Hodax, MD, and Catherine Sumerwell, DNP, ARNP

Summary: 10-year-old transgender male with gender dysphoria desiring pubertal suppression and to start testosterone in the future.

Patient History: The patient is a 10-year, 10-month-old child assigned female at birth who identifies as male. He started showing interest in wearing boys clothing around first grade, and in the last two to three years has been saying that he “wants to be a boy.” He now goes by his chosen name and uses he/him pronouns at school and at home, although his mom is still struggling with using these pronouns and name. He is out to his teachers and most of the kids at school, and most are supportive. The patient becomes very upset, aggressive and angry when people use the wrong name or pronoun. He has had some fights at school in these situations. Mom reports concern that the patient has been talking about hormones and surgery after doing some research on the Internet, and she worries about the permanency of these treatments. The patient started to have some pubertal changes, including breast development and pubic hair, three months ago, which has been distressing. He has not had any vaginal bleeding or discharge. The patient reports wanting a male body in the future and does not want to have breasts. He is very worried about menarche and wants to know what can be done to prevent his periods from starting.

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Bowel Management Treatment Program: Webinar for Providers

If you have patients who can’t control their bowels even after standard interventions, join Seattle Children’s webinar for providers on Aug. 14 to learn about our nationally known Bowel Management Treatment Program. The 1-week program serves patients ages 3-21 who:

  • Never succeeded at potty training and are still having accidents regularly
  • Experience repeated UTIs and tummy aches due to ongoing constipation
  • Have had pelvic reconstruction surgery and still experience incontinence
  • Have Hirschsprung disease or anorectal malformations and still
    experience incontinence
  • Have no known condition but have failed to improve with standard well-child
    constipation management strategies

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Climate Change Effects on Skin: A Q&A With Dr. Mark Boos

Dr. Mark Boos

Mark Boos

How are children affected by climate change?

Dr. Mark Boos, pediatric dermatologist, Seattle Children’s: We are all affected by the changes in our natural environment that have been precipitated by the climate emergency our world is experiencing secondary to elevated atmospheric carbon dioxide levels. But while natural disasters such as wildfires, hurricanes and other forms of extreme weather can cause lasting physical, mental and emotional harm to all people, specific populations are more adversely affected. This includes children, the elderly and individuals with disabilities. Currently, it is estimated that 88% of the existing global burden of disease secondary to climate change affects children less than 5 years old.

Children are uniquely vulnerable to changes in the environment, specifically to extreme changes such as heat waves and air pollution that are worsened by climate change. Children have an immature physiology and metabolism that prevent them from optimally regulating their temperature. Additionally, children have a greater challenge in clearing inhaled or ingested pollutants, while simultaneously having an increased exposure to these agents (per unit body weight) in air, food and water. Furthermore, their distinctive behavior patterns (i.e., spending more time outdoors) and dependence on adult caregivers place children at much higher risk of climate-related health burdens than adults. Specifically, children may suffer from impaired lung development, asthma exacerbations, worsening allergies and malnourishment as a result of climate change. Post-traumatic stress, physical injury, disruptions in education and loss of a stable home environment are additional ways that children can be negatively affected by natural disasters.

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Seattle Children’s Ranks Among Top 10 Nationwide (U.S. News & World Report)

In June, U.S. News & World Report named Seattle Children’s to its Honor Roll of the nation’s 10 best children’s hospitals, out of nearly 200 pediatric hospitals evaluated. Seattle Children’s is the top-ranked pediatric facility in the Northwest and ranks in the top 20 for all 10 of the individual specialty areas that U.S. News & World Report evaluates. It is the only pediatric medical center in Washington to be ranked.

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CMEs and Other Resources From Seattle Children’s

View Seattle Children’s full calendar of Category 1 CME events through May 2020.

July 19 to 20: Pediatrics Bioethics Conference, “Defining Moments in Pediatric Bioethics: Future Insights From Past Controversies,” at Bell Harbor International Conference Center.

View other resources for healthcare professionals, including Grand Rounds videos, neonatal nursing education briefs, upcoming courses and conferences, and more on our website.

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Spotlight on Cutting to Cope: What Is Nonsuicidal Self-Injury?

Yolanda Evans, MD, Seattle Children’s

Dr. Yolanda Evans

Today, nearly one in five children has a mental, emotional or behavioral disorder. While some seek relief from their distress using positive coping methods, others may choose methods that are harmful and potentially life-threatening.

Adolescent Medicine Specialist Dr. Yolanda Evans has seen a recent increase in teens coming to Seattle Children’s with self-injuries, such as cutting, burning, pinching and scratching, among others.

“It’s possible the increase may be partly due to the impact social media and technology has on the current generation,” Evans says. “Kids might see their peers online engaging in self-harming behavior as a way to cope with their emotions, influencing them to replicate that type of behavior.”

In the age of viral Internet challenges, such behaviors have become gamified — reaching an even broader group of young people. One, called the “blue whale challenge,” encouraged teens to complete 50 acts of self-harm over 50 days, ending in suicide by the final day.

However, Evans says people who injure themselves are not always suicidal. Read on to learn more about nonsuicidal self-injury, how you can identify it and how to address it.

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Grand Rounds Topics: Azithromycin, FASD, Genome Editing, and the Common Cold

Join us Thursday mornings from 8 to 9 a.m. for presentations by pediatric healthcare experts. All are welcome at this weekly free Category 1 CME event. Location: Wright Auditorium, Seattle Children’s. Or watch the live Webcast.

July 4, 2019 – Holiday (no session)

July 11, 2019Azithromycin: From Middle Earth and Beyond. Rasa Izadnegahdar, MD, MPH;
Deputy Director and Co-Leader of the Maternal, Newborn and Child Health Discovery and Tools Portfolio, Global Health Division, Bill and Melinda Gates Foundation; Hospital Medicine, Seattle Children’s.

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