Provider Q&A

All Articles in the Category ‘Provider Q&A’

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 »

Diagnosing and Treating Thyroid Cancer: A Q&A With Drs. Scott Manning and John Dahl, with Case Study

Headshot of Scott Manning

Scott Manning

Headshot of John Dahl

John Dahl

Is thyroid cancer on the rise?

Scott Manning, MD, program director, Otolarnygology Education, and John Dahl, MD, PhD, MBA, pediatric otolaryngologist, Seattle Children’s: Yes, the reported incidence of thyroid nodules across all age groups is increasing in the United States, with thyroid cancer now the fastest-growing cancer diagnosis for adult women. We believe environmental factors are contributing to this rise. For children, a thyroid nodule has an even higher chance of being malignant than for adults; in some centers, as many as 20% of pediatric thyroid nodules turn out to be cancer, versus 5 % in adults. That said, it’s important to keep in mind that the majority of thyroid nodules in children and adults turn out to be benign. About 350 pediatric thyroid cancers are reported each year in the United States.

What is the best way to diagnose a thyroid nodule?

Ultrasound is the best way to initially evaluate a nodule and will determine whether a particular nodule additionally needs a fine needle aspiration (FNA) biopsy in order to make the definitive diagnosis. Ultrasound does not require anesthesia/sedation or radiation and is cost-effective. It can also be used to evaluate for the presence of cervical metastases in children with thyroid cancer.

At Seattle Children’s, we are able to do FNA biopsies in clinic with our kids awake under local anesthetic, which makes the process that much safer and easier on the family and child. About 85% of our FNA biopsies are done this way, which is unique in the United States; most FNA biopsies elsewhere are done under general anesthesia.

It’s important to have a patient’s ultrasound read by a pediatric radiologist rather than an adult radiologist, because of their specialized knowledge and training in working with children and imaging.

For a variety of treatment-related reasons, we don’t recommend diagnosing a nodule by starting with a CT with contrast. Read full post »

All in A Day’s Work: A Q&A with Dr. Kathleen Kieran

Kathleen Kieran

Kathleen Kieran

Kathleen Kieran, MD is a pediatric urologist serving patients in both Seattle and Tri-Cities.

You’re from Boston originally. What brought you to Seattle Children’s?

Dr. Kathleen Kieran, pediatric urologist, Seattle Children’s: I’ve been slowly working my way across the country from the East Coast. I grew up in the suburbs of Boston, and went to college, graduate school, and medical school there. I attended the University of Michigan for my urology residency, and then the University of Tennessee for pediatric urology fellowship. I worked in Iowa for 5 years before I came to Seattle.

The greatest impetus for my move to the West Coast was that my husband (who grew up in Puyallup and is an adult urologist in Tri-Cities) loves living in the Pacific Northwest and will absolutely not entertain the idea of living anywhere else. So I called Dr. Paul Merguerian [Seattle Children’s division chief of urology], and luckily they were about to post a position. Read full post »

Kawasaki Disease: A Q&A With Dr. Michael Portman

Michael Portman

Michael Portman

How has our understanding of Kawasaki disease etiology changed?

Dr. Michael Portman, director, Pediatric Cardiovascular Research, Seattle Children’s: Kawasaki disease (KD) is considered a systemic autoinflammatory disease and vasculitis that shows specific predilection for the coronary arteries, resulting in dilation or aneurysm formation. Many KD experts believe that the autoinflammatory response is triggered by environmental factors in genetically susceptible children. Over the past decade numerous genetic loci and polymorphisms have been identified as influencing KD susceptibility and treatment response. For instance, studies performed at Seattle Children’s Research Institute have highlighted the importance of polymorphisms for genes encoding Fcγ receptors, which regulate immune cell responses. The specific environmental factors have not been clearly identified but may be related to a common antigen carried by certain bacteria or viruses. Read full post »

Spinal Muscular Atrophy: A Q&A with Dr. Fawn Leigh

Dr. Fawn Leigh

Fawn Leigh

Spinal muscular atrophy (SMA) is the leading genetic cause of death for infants. Seattle Children’s neurologist Fawn Leigh talks about the fast-changing landscape of research and treatment that is bringing new hope to patients and their families.

What do you want providers to know about SMA?

Dr. Fawn Leigh, neurologist, Seattle Children’s: Being aware of SMA and spotting it early is very important in getting babies into treatment. It can be seen as early as during the newborn checkup. The most common feature of infants with SMA is hypotonia (low muscle tone). We typically see babies with neck flexor weakness, where they can’t lift their head on their own, and significant head lag when pulling up. There’s an absence of reflexes too. But the main thing is hypotonia; that’s the red flag providers should watch out for. Read full post »