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Advances in Pediatric Cancer Care: Fine-Tuning CAR T-Cell Immunotherapy to Benefit More Kids

Seattle Children’s On the Pulse reports the hospital’s research teams are advancing the ways hospitals treat pediatric cancer patients with CAR T-cell immunotherapies. For the youngest patients — between 1 and 3 years old — Seattle Children’s physician Colleen Annesley, MD, reports that CAR T-cell therapy is safe and effective in a paper presented in December at the 2019 American Society of Hematology annual meeting. For older patients experiencing the systemic inflammatory response cytokine release syndrome (CRS) as a side effect of CAR T-cell therapy, doctors at Seattle Children’s have found that treating mild CRS promptly instead of waiting does not reduce the persistence of CAR T-cells in the body, but does reduce by half the rate of severe CRS. The finding is likely to change the practices of other pediatric cancer centers using CAR T-cell immunotherapies. Read full post »

Families Raise Awareness of Rare, Underdiagnosed Lung Disease

Isabelle Zoerb, 13, and Elliot Fox, 5, both have primary ciliary dyskinesia (PCD), a rare genetic condition that prevents bacteria from clearing the lungs, sinuses, nose and ears. They are patients at Seattle Children’s, which is the only Pacific Northwest PCD referral center. Dr. Margaret Rosenfeld, an attending physician and researcher at Seattle Children’s, says parents often go through a “diagnostic odyssey” before their child is diagnosed. Most people with PCD have unexplained neonatal respiratory distress, requiring oxygen or breathing support. They generally develop chronic nasal drainage and chronic wet cough within the first six months of life. And it’s a progressive disorder, worsening with time.

“We hope to increase awareness of PCD, which is highly underdiagnosed, so doctors across different fields can identify children with PCD and help them,” said Dr. BreAnna Kinghorn, a researcher at Seattle Children’s.

Rosenfeld researches PCD as the Seattle Children’s site investigator for the Genetic Disorders of Mucociliary Clearance Consortium, which recently received a $7.5 million grant from the National Heart, Lung and Blood Institute. “We are hoping to make diagnosing PCD more streamlined so that we can hold clinical trials to develop new therapies for people with the condition,” Rosenfeld said. “We are hopeful that more effective therapies for PCD will exist in the future.”

Read the article: Families Raise Awareness of Rare, Underdiagnosed Lung Disease – On the Pulse

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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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.

Read full post »

Know the Signs of Human Trafficking

More than 87% of sex trafficking victims say they had some contact with healthcare workers while they were being trafficked. That and other alarming statistics were shared by a new trafficking work group recently formed at Seattle Children’s to raise awareness among staff about this issue and share tips for helping people being trafficked.

Human trafficking doesn’t always look like what you expect. It can be a new immigrant with limited language skills, as many people know; but it can also be a young American mom who needs food, a safe place to stay and diapers for her children. Trafficking survivor Kyra Doubek told Children’s employees during a recent presentation that she was a trafficking victim years ago at age 18 when she brought in her infant son for hernia surgery, with her trafficker. No one at the hospital recognized her situation. “The trafficked person could be anybody who comes into your hospital,” Kyra says. “You’d be surprised at who might need help.”

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Escape the Vape: E-cigarettes and Teens

A Q&A With Liz Wilhelm and Dr. Cora Breuner

Across the United States, e-cigarette use among youth has skyrocketed to epidemic proportions. Currently, one in five high school students reports using e-cigarettes. Also known as e-cigs, vapes, vape pens, mods or tanks, these electronic devices are highly addictive and unsafe for children, teens and young adults.

We spoke with Liz Wilhelm, Seattle Children’s drug-free communities Prevention Works in Seattle (WINS) coalition coordinator, and Dr. Cora Breuner, professor of pediatrics and adolescent medicine at University of Washington and attending physician at Seattle Children’s, about the dangers of e-cigarette use among youth and how healthcare providers can best relay the risks to patients and their families.

Read full post »

Recognizing and Treating Anxiety

A Q&A With Dr. Kendra Read

Anxiety affects 30% of children and adolescents at some point in their lives. Of those, 8.3% are severely impaired by it.

Anxiety in children can be a part of normal development, but unhealthy levels of anxiety can lead to significant distress and impairment in school, social and home functioning.

Unfortunately, patients with anxiety disorders do not always receive the help they need. When they do receive treatment, it is often insufficient or not evidence based.

We spoke with Dr. Kendra Read, an attending psychologist within Seattle Children’s Psychiatry and Behavioral Medicine department, to find out how providers can identify childhood anxiety, which treatment options are most effective and what information they should provide to parents. Read on to learn more. Read full post »

Treating First-Time Traumatic Shoulder Dislocation

A Q&A With Dr. Michael Saper

Dr. Michael Saper

While some pediatric and adolescent patients with shoulder instability will improve with physical therapy, research has shown that patients with a traumatic first-time dislocation may benefit from early surgery.

We asked pediatric orthopedic surgeon and sports medicine specialist Dr. Michael Saper to describe how patients with a shoulder dislocation benefit from being treated at Seattle Children’s.

Should patients with a first-time traumatic shoulder dislocation have surgery?

Research has shown that in adolescent patients, having stabilizing surgery after a traumatic first-time dislocation is more cost-effective and leads to lower recurrence, higher function and less shoulder arthritis. Furthermore, repeated dislocations can make surgical stabilization more difficult, more invasive and less successful.

After a shoulder dislocation, patients and their families will benefit from a consultation with the Children’s surgical sports medicine team to discuss this option. However, surgical decision making is individualized to each patient, and not every patient is an appropriate candidate for arthroscopic surgery. Read full post »

Advice on Diagnosing Plagiocephaly

A Q&A With Dr. Michael Cunningham

Positional plagiocephaly, also known as deformational plagiocephaly or nonsynostotic plagiocephaly, is a condition in which an infant develops a flat spot on the back or side of their head.

While this condition is common and arguably harmless, it can be challenging to differentiate it from the more detrimental condition craniosynostosis.

Additionally, recent research has led to some misunderstanding regarding the correlation between plagiocephaly and developmental issues.

Provider News spoke with Dr. Michael Cunningham, medical director of Seattle Children’s Craniofacial Center to gather information for providers diagnosing plagiocephaly and counseling families on this condition.  Read full post »

How to Talk About Firearm Safety

A Q&A With Drs. Mark Del Beccaro and Fred Rivara

A child or teen is killed by a firearm every nine days in Washington, and firearms are the third leading cause of injury-related death in our state behind poisoning and falls – and ahead of motor vehicle crashes. In 2016, 3,155 children and teens in the United States died of firearm-related causes.

Most of these shootings occur in or around the home. One out of every three homes with children in the United States has a firearm. Many of these firearms are kept unlocked or loaded.

Children and teens are at the greatest risk of unintentional death, injury and suicide by firearm. Young children are naturally curious. They explore in drawers, cabinets and closets. Some older children and teens view firearms as signs of power. Others struggle with depression and thoughts of self-harm and live in households where firearms may be accessible.

Physicians may not always feel comfortable screening for the presence of firearms in the homes of caregivers or places where the child visits due to lack of training and perceived parent discomfort when discussing the subject.

A 2016 study found that fewer than 15% of physicians regularly ask caregivers screening questions about firearm safety. Yet, with national attention on recent school shootings, ongoing political dialogue and the opportunity to protect families with safe storage, pediatrician interest in discuss the subject with families may be changing. Read full post »