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How would you support a child trying to live healthier?

by Tripp Underwood on February 3, 2012

Daivd Ludwig, MD, MPH

Every month the Journal of the American Medical Association (JAMA) publishes an article called Clinical Crossroads, where a patient case is presented and medical professionals are invited to share their thoughts on how they might treat that person. A few weeks later the case is presented again, this time with commentary from an expert who specializes in the medical condition profiled in the article.

The most recent Clinical Crossroads was written by David Ludwig, MD, PhD, director of the New Balance Foundation Obesity Prevention Center Boston Children’s Hospital. Ludwig’s case focuses around Ms K, a 14 year-old girl struggling to lose weight.

Unlike typical medical case studies that focus on diagnosis and treatment of acute illness, Clinical Crossroads often takes into account the ethical, emotional and economic issues related to the patient’s health and treatment. All three of these elements figure heavily in Ms K’s story, making it ideal for the Clinical Crossroads treatment.

But as Ludwig himself would tell you, overcoming childhood obesity isn’t just the job of pediatricians and their patients; parents play a vital role in helping children achieve and maintain a healthy weight and lifestyle too. With that in mind, we are presenting Dr. Ludwig’s Clinical Crossroads piece to you on Thriving and asking for your input as parents.

Given the following situation, what are some ways Ms K and her parents could work as a team to help her live healthier? If you were her mother or father, what would you do to support her efforts?

Ms K is an obese 14-year-old girl who is struggling with weight loss. She lives in the greater metropolitan Boston area. Ms K began to gain weight at age 8 years. Over the past 7 years, her weight has gone up by 20 to 30 lb annually … She reports trying various weight loss programs but either she did not follow through or they did not work. She has never lost more than 5 lb with any focused effort. Full story »

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Children’s becomes first hospital in New England to complete six organ transplant

by Childrens Hospital Boston staff on February 1, 2012

The cover of today’s Boston Globe features the beaming face of Alannah Shevenell, a 9 year-old who will be heading home to Maine this morning after a three-month stay at Children’s Hospital Boston.

For just under 100 days Alannah and her grandmother have been staying at Children’s while she received treatment for a rare and aggressive cancer that was compromising several of her internal organs. When all other treatments had failed, Heung Bae Kim, MD, director of Children’s Pediatric Transplant Center (PTC), suggested a multivisceral transplant that would remove Alannah’s tumor and replace the six organs that had been damaged by its presence.

Under Kim’s guidance surgeons from Children’s PTC performed the 14-hour procedure. Once Alannah’s tumor was successfully removed doctors took the donor organs, which came from one donor and were kept together as a single unit, and transplanted them into the young girl. Now, a few months later, Alannah is ready to head home, making Children’s PTC the first ever center in New England to successfully transplant six organs in a single procedure— a very impressive number in the field of multivisceral transplantation.

Watch this video from the Boston Globe on Alannah’s treatment:

A multivisceral transplant is one in which the small intestine and liver are replaced, along with one or more of the following organs: spleen, stomach, pancreas or colon. Multivisceral transplants are used to treat a variety of digestive conditions, with the most common being short bowel syndrome. However, the number of multivisceral transplants performed is significantly lower than procedures involving only one organ; and when you think about the organ transplantation process, it’s easy to understand why. Full story »

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Confession: this pediatrician is a sleep softie

by Claire McCarthy on January 31, 2012

Dr. Claire McCarthy is a primary care physician and the Medical Communications Editor at Children’s Hospital Boston. Take a look at her blog archive and follow her on Twitter @drClaire.

This may not be a great confession to make as a pediatrician, but when it comes to sleep and kids, I am a total softie.

Our kids slept in our bed. We slept in theirs (which was very cramped in the toddler bed, and didn’t do great things to the frame)—or lay next to them as they drifted off to sleep. We sat on the floor, telling stories and singing lullabies and slowly edging out of the bedroom as their breathing got deep and regular. We went in again and again to retrieve the stuffed animal from under the bed or to investigate the scary noise or possible spider. When they woke in the middle of the night, we held them until they went back to sleep—sometimes night after night. Full story »

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Experts recommend genetic counseling for young sarcoma patients

by Tripp Underwood on January 29, 2012

Genetic testing may help sarcoma patients and their famlies know their risk of other cancers later in life

If your child is diagnosed with a sarcoma—a tumor in connective tissue like muscles or bones—it’s natural to become totally focused on his immediate recovery. But what if beating sarcoma wasn’t the only time your child might face cancer?

Data shows that there is a link between sarcomas and Li-Fraumeni syndrome, a rare condition that raises a person’s risk of developing one or more cancers to as high as 85 percent. Cancers typically diagnosed in patients with Li-Fraumeni syndrome include breast cancer, sarcomas, brain tumors, acute leukemia and adrenal cortical carcinoma. Recently, the list has been expanded to include colon cancer and stomach cancer.

Li-Fraumeni syndrome may be rare, but the connection has led genetic specialists at Dana-Farber/Children’s Hospital Cancer Center (DF/CHCC) to recommend that all child sarcoma patients be offered genetic counseling for Li-Fraumeni syndrome.

“Identification of an inherited gene alteration can sometimes help guide current treatment decisions,” says Carly Grant, MS, CGC, a genetic counselor of the Pediatric Cancer Risk Program at DF/CHCC, one of the first programs in the country that provides multidisciplinary consultative care to patients and their families whose condition or family history suggests an increased risk of cancer. “It may also help with early detection and cancer prevention in the future.” Full story »

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Will sitting close to the TV hurt my kids’ eyes?

by Childrens Hospital Boston staff on January 26, 2012

Michael Rich, MD, MPH

Michael Rich, MD, MPH, is Children’s Hospital Boston’s media expert and director of Children’s Center on Media and Child Health. Take a look at his blog archive or follow him on Twitter @CMCH_Boston

Q: I have an son who’s 11 and a daughter who’s 9½, and for many years, they have sat close to the TV when watching. I have asked them to sit farther away, and they do move back maybe a foot…but they always go back to viewing the show close up, even if the screen is a 40” color flat screen. Any studies that show why? Any concerns? My wife and I sit 8 to 10 feet from the TV.
-Up Close and Personal, in Rochester Hills, MI

A: Dear Up Close,

Concern about sitting close to TV screens, like concern about reading in low light, is founded more on what our parents told us when we were little than on research. The worries about sitting close dates from the (not so long ago) time when TVs were actually “tubes”—cathode ray tubes, that is—and people were uncertain about how the cathode radiation emitted might affect a viewer’s eyes. Today’s TVs flatscreens only emit the light you see, which removes that concern. And there’s no evidence that sitting close to either kind of screen hurts your eyes.

That said, the fact that your children sit so close to the TV may be a sign that they are near-sighted and that this distance is where they best resolve the pixels of color, light, and darkness into a coherent image. Bring them in for an eye exam to see whether they need glasses.

If their eyes are fine, then they probably sit close because they like having the screen fill their peripheral vision. That shouldn’t cause any problems. Just make sure that they aren’t staring at screens all the time—that can cause eye strain and, of course, will take time away from all of the other activities they need to accomplish in a day to be happy and healthy.

Enjoy your media and use them wisely,
The Mediatrician®

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Shrinking in the shower: the wisdom of childhood magic

by Claire McCarthy on January 25, 2012

Dr. Claire McCarthy is a primary care physician and the Medical Communications Editor at Children’s Hospital Boston. Take a look at her blog archive and follow her on Twitter @drClaire.

Claire McCarthy MD

The other evening, as I was trying to get him into the shower, my 6-year-old son Liam explained to me the meaning of the phrase “hits the spot.”

“There is a spot,” he said, pointing to his chest. “It’s small when you are little,” he explained, putting his thumb and index finger close together, “but it gets bigger when you grow up. When you eat something, it passes by that spot and you feel good.” He wriggled out of his pants. “Sometimes it makes you feel dizzy—but in a good way, like how I feel when I drink hot cocoa.” He demonstrated by spinning around, narrowly avoiding the bathroom scale and towel rack. “It makes you just want to lie down.”

“So that’s what ‘hits the spot’ means,” he said, as he got his socks off and climbed into the shower. Full story »

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Children’s and Blue Cross Blue Shield usher in new age of quality-based benchmarks in pediatrics

by Sandra Fenwick, President and COO on January 24, 2012

Sandra Fenwick, president and COO

I’ve worked at Children’s Hospital Boston for more than a decade, and I’m still inspired every day by the hope and strength I see on the faces of our patients and their families. As Children’s navigates a challenging and evolving health care landscape, I draw on that inspiration and determination, especially when many in our industry seem to imply that cost is the only measure of a hospital’s worth.

At Children’s, our worth—our value—is so much more than just dollars and cents. It means being treated by pediatric experts—doctors, nurses and support staff—who understand that children are not small adults and their care needs to reflect that fact. It’s a commitment to care and innovation that produces programs like our Community Asthma Initiative, which helps children with asthma have fewer attacks so they miss less school and their parents miss fewer days of work.

And it’s about a commitment to constantly improving the quality of the care we deliver. To that end, I am pleased to announce that we have signed an innovative new contract with the state’s largest health insurance provider, Blue Cross Blue Shield of Massachusetts (BCBSMA).

This agreement, known as an Alternative Quality Contract (AQC), calls for us to reach quality targets based on national pediatric quality benchmarks—the first such contract in the country—and keeps the contract value well below medical inflation

The AQC has specific quality measures in the areas of primary care (prevention and treatment), effectiveness of treatment for patients with certain conditions or needs (cystic fibrosis, dialysis or general surgery needs) and safety (central line infections). In addition, we have agreed to accept a 0 percent rate increase in the first year and an average 1.5 percent annual increase over the three years of the contract.

Since 2009, Children’s has taken more than $125 million out of the health care system to benefit insurers, employers and consumers

This contract is aligned with our efforts over the last three years to improve quality while slowing the rising cost of care delivery. Since 2009, Children’s has taken more than $125 million out of the health care system to benefit insurers, employers and consumers. We have reduced insurers’ rates and prices, become more efficient and have innovated new ways to deliver care that improve quality while lowering costs. In addition, we have moved care to lower-cost settings within the hospital and to our less expensive suburban satellites and community hospital partners, and have improved care integration between primary care physicians and hospital subspecialists.

As far as I’m concerned, the greatest indication of Children’s value is the trust of the parents who place more than 170,000 children in our care each year. Whether they come to us from around the block, or the other side of the world, Children’s takes great pride in knowing that every patient who comes through our doors will receive the same level of world-class care that has made Children’s a leader in pediatrics for more than 140 years.

For more on the Blue Cross Blue Shield deal, read Sandra Fenwick’s interview with WBUR.

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Reflecting on Haiti

by Childrens Hospital Boston staff on January 22, 2012

By Dennis Rosen, MD

Photo: Dennis Rosen

This month marks the second anniversary of the January 2010 earthquake that devastated Port au Prince, killing more than a quarter million, injuring over 350,000, and leaving an estimated one million without shelter. Having gone there three times since then with groups from Children’s Hospital Boston to participate in the relief efforts, hardly a day goes by that I am not reminded of what I saw and lived during those weeks. Ranging from the truly horrible to inspiring and uplifting, many of the experiences were unlike any others I had had prior to setting foot in Haiti.

The first time I went was in May 2010 with a group that worked at the General Hospital along with Partners in Health. Conditions on the ground were utterly chaotic, and the disorganization made it difficult for foreign volunteers to work as we were accustomed to doing back home. This only added to our frustration at the discrepancy between the enormity of the challenges we faced and what we could (or could not do) to help. Many of those we cared for were suffering from the after-effects of injuries sustained in the earthquake, including chronic bone infections following amputations. A significant number of the children we saw were malnourished, their golden, frizzy hair and big bellies (often full of worms) helping us to make the diagnosis as soon as we saw them.

Others presented with routine medical and surgical problems which would have been straightforward in Boston but which were, in fact, very difficult to treat in Haiti because of the limited resources available and the lack of continuity of medical care. Perhaps the hardest of all was to repeatedly see children die from conditions and diseases which could have been prevented or treated back home, at little cost, and to be powerless to stop that from happening. On both the first and the second trips our teams cared for children who died from diphtheria. Previously widespread in the United States, it has not been reported here since 2003 thanks to widespread vaccination. However, diphtheria remains endemic in Haiti, and because most children do not have access to vaccinations, hundreds die from it there each year. Full story »

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