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Seattle Children’s Outpatient Surgery Center Ousts Opioids From Surgeries

From Seattle Children’s On the Pulse blog

Eighteen months ago, Dr. Lynn Martin, an anesthesiologist and medical director of the ambulatory surgery center at Seattle Children’s, and his colleagues at the Seattle Children’s Bellevue Clinic and Surgery Center set out to reduce the use of opioids during outpatient pediatric surgeries while maintaining or improving pain management and outcomes for patients. Ultimately, they accomplished much more by successfully ousting opioid use during surgeries.

Dr. Lynn Martin

According to the Centers for Disease Control and Prevention (CDC), drug overdose deaths continue to increase in the United States. It is a problem Martin and his colleagues believe they can help address, which is what drove them to develop a novel initiative at Seattle Children’s to reduce opioids.

Martin and his colleagues completed their breakthrough quality improvement initiative to reduce opioid use, and their findings were published in Anesthesia and Analgesia. Read full post »

Preventing Child Abuse During COVID-19: A Q&A With Our Physicians

The strain on families from the COVID-19 pandemic raises serious concerns for child safety. “It’s a perfect storm,” says Christine Baker, program coordinator with Seattle Children’s Child Protection Advocacy/Outreach program. “The economic strain on families, health worries, the stress of being homebound with kids all day long, the housing insecurity for many, fear of becoming sick and losing loved ones. . . . Parents are stressed and isolated in many ways by this virus.” She notes that the depression of 2008 was followed by a three-fold increase in cases of abusive head trauma in Washington state (a diagnosis that applies only to children 2 years and younger).

The Zero Abuse Project noted last month, “Many child protection professionals believe child abuse is likely to increase during the COVID-19 pandemic because most abusers are parents or siblings who now have more complete access to the child victim. In turn, the victim may no longer have schoolteachers, faith leaders or other mandated reporters they can access for help or who may detect a sign of abuse. Children may also have reduced access to medical and mental health providers” (see Responding to Child Abuse During a Pandemic: 25 Tips for MDTs). Washington state’s child abuse hotline saw a 40% drop in calls in the week after Governor Inslee ordered all schools to close. Read full post »

Symptoms Mimicking Kawasaki Disease in Children With COVID-19

Although children don’t typically fall seriously ill from the new coronavirus, doctors in Europe are now expressing concern that children with COVID-19 have developed mysterious symptoms that mimic those appearing with Kawasaki disease.

On the Pulse asked Dr. Michael Portman, pediatric cardiologist and director of the Kawasaki Disease Clinic at Seattle Children’s, to help break this emerging issue down for parents and caregivers.

Read “Kawasaki Disease in Children With COVID-19” in On The Pulse.

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Ways Seattle Children’s Is Zeroing in on COVID-19

When health officials learned a Seattle Children’s patient tested positive for the novel coronavirus 2019 (COVID-19) in late February, it sent a ripple through health and scientific communities nationwide. It was the first example of community transmission in the state of Washington, indicating the virus causing COVID-19 had likely been spreading in Seattle and the surrounding region undetected.

It was a moment Seattle Children’s had prepared to face since establishing an incident command center more than one month prior. From this command center, teams from across the organization met to support advance planning and coordinate actions for a potential COVID-19 surge in the region.

“Before there were any confirmed cases in the U.S., Seattle Children’s anticipated the potential for an outbreak in our region,” says CEO Dr. Jeff Sperring. “Over the past several weeks, we have provided specialized training for our team, established strict protocols for health and hygiene, and consolidated essential supplies so we would be ready to protect our patients.” Read full post »

5 Important Things to Know About the Washington Mental Health Referral Service for Children and Teens

1. There IS a Washington Mental Health Referral Service for Children and Teens!

Washington’s Mental Health Referral Service for Children and Teens connects families to licensed providers in their local area with current availability who fit a child’s mental health needs and insurance coverage. Washington Healthcare Authority funds the referral service and Seattle Children’s operates it.

The service launched in Spring 2019, but many health care providers still don’t know about it. If you have been a subscriber to Provider News for the last year, you may have seen our April 2019 launch announcement and our update in August about the service growing.

2. It connects families to mental health providers who actually have availability and take the child’s insurance.

One of the unique features of the Washington Mental Health Referral Service is that families get connected with mental health providers who actually have availability to see their child. When a family receives a referral, it includes providers who take their child’s insurance.

There are more than 1700 pediatric mental health providers currently identified by the service. Read full post »

Fighting to Give Every Child With Cancer a Chance to Become a Parent

“You pay the price for having cancer over and over again.” Mai Nguyen’s words are loaded with sorrow as she speaks about her 17-year-old daughter, Taylor Tran, who is dealing with fertility concerns more than a decade after she survived late-stage cancer.

Taylor Tran (left) and her mother Mai Nguyen. Taylor underwent cancer treatment when she was 2 years old, causing her to go into early menopause when she was just 16.

It’s easy to understand the indignation Mai feels: Her daughter was diagnosed with stage 3 single-cell sarcoma of the kidney when she was 2 years old and was treated with intense chemotherapy and radiation. Now, the treatments that saved her life have put her into early menopause.

“It’s been traumatic,” Mai says. “We tried so hard to allow Taylor to have a normal childhood and this feels like one more thing cancer has taken from her.”

Stories like Taylor’s inspired Seattle Children’s urologist Dr. Margarett Shnorhavorian to tackle a challenging area of research that was largely uncharted when she started more than a decade ago. Since then, she’s helped change perspectives and protocols for fertility preservation in childhood cancer survivors. Read full post »

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.

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