Provider Q&A

All Articles in the Category ‘Provider Q&A’

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 »

Climate Change Effects on Skin: A Q&A With Dr. Mark Boos

Dr. Mark Boos

Mark Boos

How are children affected by climate change?

Dr. Mark Boos, pediatric dermatologist, Seattle Children’s: We are all affected by the changes in our natural environment that have been precipitated by the climate emergency our world is experiencing secondary to elevated atmospheric carbon dioxide levels. But while natural disasters such as wildfires, hurricanes and other forms of extreme weather can cause lasting physical, mental and emotional harm to all people, specific populations are more adversely affected. This includes children, the elderly and individuals with disabilities. Currently, it is estimated that 88% of the existing global burden of disease secondary to climate change affects children less than 5 years old.

Children are uniquely vulnerable to changes in the environment, specifically to extreme changes such as heat waves and air pollution that are worsened by climate change. Children have an immature physiology and metabolism that prevent them from optimally regulating their temperature. Additionally, children have a greater challenge in clearing inhaled or ingested pollutants, while simultaneously having an increased exposure to these agents (per unit body weight) in air, food and water. Furthermore, their distinctive behavior patterns (i.e., spending more time outdoors) and dependence on adult caregivers place children at much higher risk of climate-related health burdens than adults. Specifically, children may suffer from impaired lung development, asthma exacerbations, worsening allergies and malnourishment as a result of climate change. Post-traumatic stress, physical injury, disruptions in education and loss of a stable home environment are additional ways that children can be negatively affected by natural disasters.

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The Latest in Pediatric Cranial Base Surgery: A Q&A With Dr. Randall Bly

headshot of Dr. Randall Bly

Randall Bly

What are cranial base diagnoses?

Dr. Randall Bly, principal investigator, Seattle Children’s: These are diagnoses of tumors or other lesions in the middle of the head. The cranial base is also sometimes called the skull base. Diagnoses can include nasal dermoids, orbital tumors, cholesterol granulomas, craniopharyngiomas, schwannomas, paranasal sinus tumors, pituitary adenomas, inverted papillomas, neurofibromas, angiofibromas, glomus tumors, esthesioneuroblastomas and cerebrospinal fluid (CSF) leaks.

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IBD Treatment: A Q&A With Dr. Namita Singh

Photo of Namita Singh

Namita Singh

What causes inflammatory bowel disease (IBD)? How has our understanding of it changed over time?

Dr.  Namita Singh, physician, Seattle Children’s: IBD is a multifactorial chronic disease. It is due to the overly active immune response to gastrointestinal (GI) enteric bacteria in genetically susceptible individuals, triggered by environmental factors. More than 200 genetic loci have been identified as playing a role in IBD, with some (i.e., NOD2) being associated with more progressive disease. Using our understanding of the inflammatory pathways affected in IBD, newer medications have been developed targeting these various pathways. The enteric bacteria, or GI microbiome, is known to be very different in IBD — with less diversity — than in healthy non-IBD patients. There has been an increase in IBD incidence worldwide over the past decade, suggesting a large impact in environmental factors rather than genomic shifts. For example, immigrants from countries with a lower prevalence of IBD assume a much higher risk when they immigrate to the United States, and their children even more so. The fastest-growing population is the pediatric Crohn’s disease population, and we are seeing IBD in very young patients as well.

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Caring for Transgender Youth

A Q&A With Dr. Juanita Hodax

Dr. Juanita Hodax

Juanita Hodax

Who needs to make the referral, and what happens once the referral is placed?

Dr. Juanita Hodax, physician, Seattle Children’s: A patient can be referred to the Gender Clinic by one of their providers, or they can self-refer. Once a referral is placed, they will receive a call to first schedule an intake call with a social worker who is the Gender Clinic care coordinator. During the intake call, we get a brief history and discuss goals of the appointment and provide resources (for mental health providers, local community resources, etc.) that may be helpful to the patient and family even before they have their appointment. After the intake call is done, an appointment with a medical provider is made.

What ages do you see?

Dr. Hodax: We see pediatric patients up to age 21 years old. As patients approach age 21, we work with them to find an adult provider who can take over the management of their transgender care. Many times, this is a primary care provider who has some experience in transgender care.

Does a patient need parent permission to get services from the Gender Clinic, and if not, at what point does the parent need to be involved?

Dr. Hodax: While some treatments require parental consent for patients under the age of 18 years, some treatments are available to patients without formal parental consent. Gender-affirming hormones (estradiol or testosterone) do require parental consent from all parents who have medical decision-making power, because these treatments have the potential for irreversible long-term effects. Puberty blockers (Lupron injections or histrelin implant) are a reversible treatment but do require parental consent, as patients are typically at a younger age when this treatment is being considered.

Complete parental consent is not required for medications used to suppress menstrual cycles in transgender boys or for some testosterone blockers in transgender girls. Parental permission is also not required to schedule an appointment in the Gender Clinic. However, our providers and our social work team try very hard to work with parents to help them understand why treatment is important and necessary for their child. Read full post »

Identifying Fatty Liver Disease

A Q&A With Dr. Niviann Blondet

Nonalcoholic fatty liver disease (NAFLD) – the accumulation of fat in the liver – is the most common liver disorder in the United States, affecting approximately 10% of children. Although incidence is increasing, this condition is uniquely difficult to diagnose.

To address this issue, Seattle Children’s has opened a new Fatty Liver Clinic to treat patients with a multidisciplinary approach.

“We estimate about 10 million children have fatty liver disease, but there’s a large population that goes undiagnosed,” said Dr. Niviann Blondet, a gastroenterologist at Children’s. “It’s not until they develop cirrhosis that they seek medical attention.”

Dr. Blondet offers the following information to providers in hopes that patients might be diagnosed sooner and treated more effectively.

What are the risk factors of NAFLD?

Obesity is the most significant risk factor. There is a direct correlation between NAFLD and body mass index (BMI). However, the disease can occur in children within a normal weight range.

The prevalence of NAFLD increases throughout childhood, possibly because BMI increases with age in children.

Studies have also shown an association with insulin resistance. NAFLD increases the risk of developing type 2 diabetes and may worsen glycemic control in children with diabetes and contribute to the development and progression of chronic diabetic complications.

Gender can also be a contributing factor. NAFLD is approximately 40% more common in boys than girls. Read full post »

Glue Embolization a Game-Changer in Treating Venous Malformations in Extremities

A Q&A With Drs. Giri Shivaram, Antoinette Lindberg and Eric Monroe

Image Giri Shivaram.

Giri Shivaram

In 2013, members of the Vascular Anomalies team at Seattle Children’s developed a method to use a medical version of super glue to treat venous malformations in the head and neck area. This glue embolization process has been highly successful in removing malformations altogether.

After seeing how well the process worked, interventional radiologists Drs. Giri Shivaram and Eric Monroe and orthopedic surgeon Dr. Antoinette Lindberg decided to try using it to treat malformations in extremities. Read full post »