Nicolas Fernandez
Dr. Nicolas Fernandez is a pediatric urologist. He joined Seattle Children’s in 2020. An artist also, he illustrated the images for this article.
Q: When does buried penis in an obese child require surgery?
Dr. Fernandez: This is a very interesting topic. Genital, and more specifically penile, appearance is very subjective and varies from culture to culture. There are three different types of buried penis, also known as hidden penis.
- Secondary to obesity
- Secondary to poor penile pubic and penoscrotal fixation of the skin
- Secondary to prior penile surgery that creates a trapped penis
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Dr. Danielle Zerr is medical director of infection prevention at Seattle Children’s.
Is vaccination underway at Seattle Children’s?
Dr. Zerr: Yes. We are pleased to say that Seattle Children’s began vaccinating its workforce for COVID-19 on Dec. 16, 2020. To date, we have received four shipments of the Pfizer vaccine (975 doses each) . We expect the vaccine supply allocated to us by the Washington State Department of Health to arrive in weekly shipments. Like other healthcare systems in Washington, Seattle Children’s has limited information at this time about the types and quantities of vaccines we will receive in the near future. As we learn more, we will share.
We rely on information from the CDC’s Advisory Committee on Immunization Practices (ACIP) and state and local public health authorities to guide our decisions on safe and equitable distribution of our vaccine supply. Read full post »
Susan Shenoi, MBBS, MS, RhMSUS, is interim division chief of Rheumatology at Seattle Children’s.
What’s new in Rheumatology at Seattle Children’s?
Dr. Shenoi: We are very excited that we have established a Myositis Center of Excellence, which is one of only four in the country and the only one on the West Coast. This began last year, in May 2019, and has been made possible with a grant from the Cure Juvenile Myositis foundation. It has been very well received by families and colleagues.
We see kids with inflammatory myositis, most of which is juvenile dermatomyositis (JM) and some of which is polymyositis and overlap syndrome. It’s a multidisciplinary clinic. Patients see a rheumatologist, a physical therapist, a research coordinator and a nurse. We have volunteer support from a Cure JM board member, Suzanne Edison, who provides additional support to families, and we are fortunate to have pilot funding for a psychologist in this program as well.
We are using validated disease activity measurement to track children’s disease status and activity over time. Because of all the research underway and high demand for our clinic, we’ve doubled our capacity over the last year to serve more kids. We now see patients once a month at the hospital and once a month at the Bellevue clinic, both in person and via telemedicine. Read full post »
Erika Miller is the clinical practice manager of Psychiatry Consult Services and Emergency Department Mental Health, Seattle Children’s. Kashi Arora is the mental and behavioral health project manager with Community Health, Seattle Children’s. Sophie King is the supervisor of program operations for triage and the Crisis Care Clinic, Seattle Children’s.
Q: What mental health services does Seattle Children’s offer?
A: We offer short-term, outpatient mental health services through our Psychiatry and Behavioral Medicine (PBM) team. We start with a diagnostic evaluation to determine the patient’s needs and the evidence-based interventions recommended for these needs. We also discuss with families where it would be most helpful to receive care (either at Seattle Children’s or in the community).
In order to provide equitable and efficient care, many of our treatment programs operate using a stepped care model. They begin with a group or class for patients/caregivers, followed by short-term individual therapy as needed. Capacity for individual therapy is very limited. For youth pursuing medication, we offer a brief consultation model. We do not provide long-term therapy or medication management. Read full post »
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?
Monique Burton
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 »
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 »
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 »
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 »
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 »
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 »
