Provider Q&A

All Articles in the Category ‘Provider Q&A’

Kids’ Sports and Physical Activity During COVID-19: A Q&A With Drs. Monique Burton and Celeste Quitiquit

Dr. Monique Burton and Dr. Celeste Quitiquit are both sports medicine pediatricians. Dr. Burton is medical director of sports medicine and Dr. Quitiquit is co-medical director of the athletic training program at Seattle Children’s.

What does the sports landscape look like for kids this fall?

headshot of Dr. Monique Burton

Monique Burton

headshot of Dr. Celeste Quitiquit

Celeste Quitiquit

Drs. Burton and Quitiquit: Youth sports definitely looks different this fall. Some sporting teams are in full effect, with fingers crossed. Other teams already cancelled their seasons in advance. Many sporting teams tread carefully, building safety and contingency plans, creating hybrid practice agendas and trying to stay current with COVID-related news. To say there are some modifications is definitely an understatement. For example, the Washington Interscholastic Activities Association (WIAA) has divided the upcoming school year into four sports seasons rather than the usual three, limiting play in fall and moving more play to spring. Almost all of November and December will be a no-play period during which WIAA will reassess plans for 2021 based on what’s happening with COVID-19. It’s very much a fluid, “stay tuned” type of situation. Read full post »

Cardiac Safety and Screening in Teen Sports: A Q&A With Dr. Cory Noel

Dr. Cory Noel is a pediatric cardiologist in Anchorage at Seattle Children’s Pediatric Cardiology of Alaska.

How common is cardiac death in teen sports?

Dr. Noel: Sudden cardiac death is a rare occurrence, making it a challenge to get accurate numbers. Studies show different rates depending on what they’re looking at, what ages they cover and whether or not the children survived. A general estimate is 1 occurrence in every 80,000 to 100,000 children per year. However, when accounting for sudden cardiac arrest, that number is lower, at approximately 1 in 20,000.

The most common cause of sudden death in young competitive athletes is the inheritable condition hypertrophic cardiomyopathy (HCM), but other causes include a variety of congenital coronary artery anomalies, myocarditis, dilated cardiomyopathy and aortic dissection, as well as rhythm disturbances such as long QT syndrome (LQTS), arrhythmogenic right ventricular cardiomyopathy (ARVC) and catecholaminergic polymorphic ventricular tachycardia (CPVT). Read full post »

Diagnosing Autism Via Telehealth: A Q&A With Dr. Jennifer Gerdts

Dr. Jennifer Gerdts is an attending psychologist at Seattle Children’s Autism Center and principal investigator at the Center for Child Health, Behavior, and Development at Seattle Children’s Research Institute.

Why is Seattle Children’s offering autism spectrum disorder evaluations by telehealth?

Dr. Gerdts: The move to telehealth was spurred by the new restrictions on in-person visits due to COVID-19. Families already were facing an extensive waitlist for an autism diagnostic evaluation, so honestly, it crushed our soul to think about having to wait for in-person services to resume. We decided to get creative and looked around to see what evidence-based practices were out there for telehealth autism diagnostic evaluations. We really liked Vanderbilt University Medical Center’s method (TeleASDPeds instrument), which has shown to be effective in assessing younger children. We chose their method and have been very happy with it. Read full post »

Antenatal Hydronephrosis and Undescended Testes: A Q&A With Dr. Paul Merguerian

Dr. Paul Merguerian is division chief of Urology at Seattle Children’s and the Dr. Michael Mitchell Endowed Chair in Pediatric Urology.

Antenatal Hydronephrosis

How much of a problem is antenatal hydronephrosis?

Dr. Merguerian: Hydronephrosis is the most common condition found on antenatal ultrasound. It’s estimated to affect 1 fetus in 100. That said, about 75% of cases are not clinically significant and can simply be observed — which is important for physicians to be aware of and also potentially reassuring to parents who’ve been told their child has this condition. More than half of cases are physiologic and resolve on their own by birth or soon after. Most mild and moderate hydronephrosis never harms the kidneys.

What’s essential for both primary care providers (PCPs) and urologists is to identify infants who do need to be monitored or referred to a specialist and who might require intervention. 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 »

Functional Constipation: A Q&A with Kyle Lewis, PA-C

Constipation is incredibly common in the pediatric population. It affects up to 30% of children, accounts for 3-5% of general pediatric outpatient visits and up to a quarter of all pediatric gastroenterology visits. This represents significant cost to our healthcare system.

Peak prevalence of constipation occurs during preschool years. Painful stooling during this time can lead to withholding of stool. This can lead to harder, less frequent stools, which further reinforces the withholding cycle. Starting daycare or grade school often restricts access to the bathroom and it is common for our patients to avoid stooling in these environments. Other factors that can lead to constipation include diets without enough fruits, vegetables and fiber, inadequate water intake and a lack of physical exercise.

Constipation is a frustrating experience for both children and parents. It often takes a dedicated, long-term, multifactorial approach consisting of behavioral, lifestyle and medication management.

At Seattle Children’s, we use the Rome IV criteria to define constipation in children. There are separate definitions for children older and younger than 4 years old. Our detailed practical clinical protocol for constipation evaluation and treatment, which includes an algorithm, is found here. Read full post »

Headache Management in Primary Care: A Q&A With Dr. Heidi Blume

Heidi Blume

Heidi Blume

What are some important things to know about pediatric headaches?

Heidi Blume, MD, MPH, principal investigator, Seattle Children’s: Unfortunately, headaches are very common in pediatrics. One study found that over 10% of school-aged kids and more than 20% of teens had “frequent or severe” headaches in the past year, and about 5% of younger children and 20% of teen girls have migraines.

Headache is a frequent complaint in both primary care and the ED, and many families are afraid that something dangerous, like a tumor or aneurism, is causing headaches. Fortunately, this is very rare.

Many things can contribute to headaches, including genes (family history of migraine), poor sleep, poor hydration or nutrition, stress/anxiety/depression, other medical problems (e.g., anemia, thyroid abnormalities, rheumatological disorders), dental problems, concussion, pregnancy, drug abuse, musculoskeletal pain (e.g., from slouching over a laptop or other screen for hours) or medications (e.g., stimulants or tetracyclines). Thus, it is reasonable to consider workup for other underlying disorders when appropriate in the evaluation of a youth with headaches. Read full post »

Scoliosis and Back Pain: A Q&A With Dr. Jennifer Bauer

 

Jennifer Bauer Headshot

Jennifer Bauer

Jennifer Bauer, MD, MS is the only orthopaedic surgeon at Seattle Children’s whose elective practice is singularly dedicated to the treatment of pediatric spine problems.

She has been selected this year for both the Scoliosis Research Society’s Edgar Dawson North American Traveling Fellowship and the Pediatric Orthopaedic Society of North America’s International Traveling Fellowship, both of which will bring her to other leading centers to exchange ideas, give lectures and discuss research collaboration.

What is the basic treatment algorithm for idiopathic scoliosis?

Dr. Bauer: In general, children with curves of 20 to 25 degrees on an upright spine radiograph who still have at least a moderate amount of growth remaining (Risser 0-2) will be recommended a thoracolumbosacral orthosis (TLSO) brace to keep the curve from progressing, as well as offered scoliosis-specific Schroth physical therapy as an adjunct to the brace. This is continued until growth stops. If a child is younger than 5, they may be casted instead of braced. Children with curves over 45 to 50 degrees who still have a large amount of growth left will be offered surgery with growth-friendly implants that allow continued height. These will be converted to a final fusion once appropriate growth has completed. In patients with curves of this size without as much growth left (at least after their tri-radiate cartilages have closed), a final fusion may be recommended. The goal for surgery is to stop a curve from progressing, as curves that reach 70 to 80 degrees affect pulmonary function, and secondarily to correct deformity. The majority of curves over 50 degrees, even after a child stops growing, will continue to slowly progress, and thus these are offered surgery. Read full post »

Reducing Children’s Exposure to Radiation: A Q&A With Dr. Tom Lendvay

The U.S. population faces seven times more exposure to ionizing radiation from medical procedures than it did in the early 1980s, largely due to the growth in computed tomography (CT) and nuclear medicine, according to the National Council on Radiation Protection and Measurements. Children’s hospitals are increasingly looking for ways to use lower radiation doses for diagnosis and treatment. Success has come from using new technologies and equipment specially designed for children and constantly being on the lookout for opportunities to share information and collaborate better across teams.

Tom Lendvay

Tom Lendvay

Why is radiation bad for children?  

Tom Lendvay, MD, urologist, Seattle Children’s: If you start receiving radiation exposure as a child, you run the risk of having a larger lifetime dose of radiation. Children exposed to radiation, especially those undergoing X-rays and CT scans to evaluate primary cancers, are also at increased risk of developing what is called a secondary malignancy, or cancer due to the DNA-damaging effects of radiation exposure as a child. These include hematologic (blood cell) cancers.

For all these reasons, we look for ways we can reduce the amount of radiation our patients are exposed to during diagnosis and treatment.

What are some of the ways kids are exposed to radiation in the hospital?

Dr. Lendvay: Children may be exposed to ionizing radiation through X-rays, CT scans, fluoroscopy (live X-rays), nuclear medicine tests and intraoperative imaging. Fortunately, children’s bodies are generally smaller and contain less fat than adults, which makes ultrasound technology a good choice much of the time. However, there are a number of conditions that require radiation imaging tests. Over the last two decades, CT scans have provided rapid, rich data and anatomic detail that surpass many other imaging modalities and has proven invaluable to the diagnosis of severe medical conditions. Thus, the use of CT scans has increased in adults and children over the last two decades. Read full post »

Epilepsy Program Expanding to Federal Way

Seattle Children’s welcomes epilepsy specialists Dr. Priya Monrad and Dr. Ahmad Marashly to the Epilepsy Program, where they will serve as Epilepsy Monitoring Unit medical director and surgical program director, respectively. They come from Children’s Hospital of Wisconsin and bring a combined 15 years of experience seeing the most complex patients, including those needing surgery. They joined Seattle Children’s this fall.

What are your plans for the epilepsy program at Seattle Children’s?

Dr. Monrad: We have the largest epilepsy program in the Pacific Northwest, but we want to make it more accessible to families, especially to those families living in Washington state south of Seattle. Starting in December, we’ll be seeing patients at our regional clinic in Federal Way for the first time. Previously, we offered epilepsy services only at the main hospital and the Bellevue and Everett regional clinics.

Dr. Marashly: We’re also going to be putting a stronger emphasis on making sure providers in the community have easier access to us and can get their epilepsy-related questions answered. We know PCPs can handle so much of their patients’ epilepsy care if they have a good connection with a specialist when needed. We want to be a resource to them. Read full post »