From the category archives:

Pediatrics

WilliamsDavidDSC_0056PreviewlargeDavid A. Williams, MD, is chief of hematology/oncology at Boston Children’s Hospital and associate chairman of pediatric oncology at Dana-Farber Cancer Institute. This column was first published on Huffington Post.

The fact that childhood cancer is, thankfully, rare belies the fact that it is the leading cause of disease-related death in U.S. children age 1 to 19. The number of people with a direct stake in expanding research into pediatric cancer is quite large, well beyond the small number of children with cancer and their families. Not only are the life-long contributions of children cured of cancer enormous, but understanding cancers of young children could also hold the key to understanding a broad range of adult cancers. The time is ripe to allocate more resources, public and private, to research on pediatric cancer.

In an age of increased understanding of the genetic basis of diseases, one thing is striking about many childhood cancers. They are relatively “quiet” cancers, with very few mutations of the DNA. Young children haven’t lived long enough to acquire the large number of mutations that create the background “noise” associated with years of living. This makes it much easier to pinpoint the relevant genetic abnormalities in a young child’s cancer.

Add to this the growing realization that biology, including how various tumors use common “pathways,” is a major factor in how the cancer responds to treatment. Thus, a mechanism that’s relatively easier to observe in the cancers of young children could help scientists understand cancers in adults, in whom the same mechanism is hidden amid the clutter of mutations acquired over a longer life. Full story »

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pulse pressure

Subtract 68 from 100 to get a pulse pressure of 42 (Wikiphoto/Creative Commons)

Second in a two-part series on cardiovascular prevention in children. Read part 1.

Carrying too much weight is tough on the body. The dramatic rise of obesity in recent years means more and more people are confronting increased cardiovascular risk due to changes in their blood vessels, cholesterol levels, blood pressure, and blood sugar. And the problem isn’t limited to adults: Today, there are more than three times as many obese children in the U.S. than there were in the early 1970s.

However, not every person with excess weight has cardiac risk factors, and not everyone with cardiac risk factors carries excess weight. So what is the relationship between childhood obesity and cardiac risk factors later in life? What links excess weight to its consequences?

Justin Zachariah, MD, MPH, a cardiologist at Boston Children’s Hospital, was inspired to investigate these “risk factors of risk factors” when he observed a pattern in his pediatric preventive cardiology clinic. He noticed that many of his patients who were carrying excess weight did not have very high blood pressure, or hypertension. Full story »

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Blood pressure taken in child-shutterstock_181679828First of a two-part series on cardiovascular prevention in children. Read part two.

As childhood obesity has increased over the past 30 years, so has pediatric hypertension, which now affects one in 20 children. However, 48 percent of children with high blood pressure (BP) are of normal weight; other risk factors include low birth weight, which has also increased in the past 30 years (more recently dipping slightly to about 8 percent of births).

While children with hypertension rarely develop diseases that adults do, such as myocardial infarction, heart failure and stroke, they are at risk for adult hypertension and early symptoms of heart disease. “Attacking pediatric hypertension is the next frontier in cardiovascular disease prevention,” says Justin Zachariah, MD, MPH, of the Department of Cardiology at Boston Children’s Hospital.

The Affordable Care Act’s mandate to identify elevated BP in children is expected to increase referrals for screening. But diagnosing pediatric hypertension through BP screening in the clinic can be problematic. In a recent study, Zachariah found that ambulatory BP monitoring (ABPM) with a take-home device is both effective and cost-effective—especially when done from the get-go. Full story »

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Delivering a baby MEG

by Kipaya Kapiga on October 24, 2014

This array of sensors surrounding a baby's head will give researchers and eventually clinicians an clear and sharp image of neural activity.

This array of sensors surrounding a baby's head will give researchers and eventually clinicians a high-resolution image of neural activity.

Imagine you’re a clinician or researcher and you want to find the source of a newborn’s seizures. Imagine being able to record, in real time, the neural activity in his brain and to overlay that information directly onto an MRI scan of his brain. When an abnormal electrical discharge triggered a seizure, you’d be able to see exactly where in the brain it originated.

For years, that kind of thinking has been the domain of dreams. Little is known about infant brains, largely because sophisticated neuroimaging technology simply hasn’t been designed with infants in mind. Boston Children’s Hospital’s Ellen Grant, MD, and Yoshio Okada, PhD, are debuting a new magnetoencephalography (MEG) system designed to turn those dreams into reality. Full story »

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Hacking Pediatarics brainstorming wall

(Dana Hatic for MedTech Boston)

What are the pain points in pediatrics? There are at least 37: the number of clinicians, parents and others who lined up at the podium last weekend to pitch problems they hoped to solve at the second annual Hacking Pediatrics.

The hackathon, produced by Boston Children’s Hospital in collaboration with MIT Hacking Medicine, brought out many common themes: Helping kids with chronic illnesses track their symptoms, take their meds and avoid lots of clinic visits. Helping parents coordinate their children’s care and locate resources. Helping pediatric clinicians make better decisions with the right information at the right time.

Hackathons have a simple formula: Pitch. Mix. Hack. Get Feedback. Iterate. Repeat—as many times as possible. Full story »

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A fleet of toddlers get ready to race in their Go Baby Go cars, customized by therapists and parents to provide disabled children with mobility and help them strengthen weak muscles.

Start your engines: A fleet of GoBabyGo cars, customized by therapists and parents to give disabled children mobility and help strengthen weak muscles. (Courtesy Cole Galloway)

TEDMED2014 focused on a powerful theme: unlocking imagination in service of health and medicine. Speaker after speaker shared tales of imagination, inspiration and innovation. Here are a few of our favorites:

$100 plastic car stands in for $25,000 power wheelchair

In the first (and likely only) National Institutes of Health-funded shopping spree at Toys R’ Us, Cole Galloway, director of the Pediatric Mobility Lab at the University of Delaware, and crew stocked up on pint-sized riding toys.

Galloway’s quest was to facilitate independence and mobility among disabled children from the age of six months and older and offer a low-tech solution during the five-year wait in the United States for a $25,000 power pediatric wheelchair.

The hackers jerry-rigged the toys with pool noodles, PVC pipe and switches, reconfiguring them as mobile rehabilitation devices to promote functional skills among kids with special needs. Full story »

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My father had a favorite bit of advice as we embarked on our adult lives: “Go big or go home.” Going big is exactly what OPENPediatrics is doing, empowering physicians and nurses to care for children across the globe.

The Web-based digital learning platform was conceived 10 years ago by Jeffrey Burns, MD, MPH, chief of critical care at Boston Children’s Hospital, and Traci Wolbrink, MD, MPH, an associate in critical care. It concluded a year-long beta test in April 2014, and version 1 has now been launched.

Developed to impart critical care skills, OPENPediatrics uses lectures, simulators and protocols to deliver training. In the process, it has helped save lives. Full story »

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With initial help from her mother, Kailee West, 6, quickly masters the basics of Puddingstone Place, an interactive virtual environment that helps children with autism develop language skills.

With initial help from her mother, Kailee West, 6, quickly masters the basics of Puddingstone Place, an interactive virtual environment that helps children with autism develop language skills.

In the 1990s, Facilitated Communication (FC), in which assistants “facilitate” the typing of thoughts by minimally verbal children by supporting their hands, began raising hopes in the autism community. The unproven procedure caught fire, and Syracuse University established a nationally recognized Facilitated Communication Institute.

Upon closer examination, though, doubts emerged. The messages were surprisingly sophisticated and written by children who often were not even looking at the keyboard. Critics charged that the words were actually those of the facilitator rather than the patient. Studies and organizations began discrediting FC. Full story »

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PTSD risk in adolescents after Boston Marathon bombingsDaniel Busso, MSc, is a doctoral student at the Harvard Graduate School of Education and a researcher in the Sheridan Laboratory at Boston Children’s Hospital.

More than 60 percent of teenagers have experienced a traumatic event in their lifetime, but only a minority will develop post-traumatic stress disorder (PTSD). For both researchers and clinicians, this raises an important question: Why are some youth at greater risk for mental health problems after trauma? As our lab reports in two recent studies, conducted after the 2013 Boston Marathon bombings, the answer may lie in our neurobiology.

PTSD, which includes intrusive memories, increased anxiety and difficulty concentrating or sleeping, has been linked to a variety of psychosocial and biological risk factors, such as prior experiences of trauma or a history of mental health problems. Other studies suggest that disruptions to the body’s stress response system, or in patterns of brain activity when responding to threat, may predispose people to the disorder.

However, a common problem in this research is that biological and mental health data are collected only once, usually long after the traumatic event itself, Full story »

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Emmie was lucky enough to be diagnosed before age 3, but many families face a much longer journey.

Emmie Mendes was lucky enough to be diagnosed before age 3, but many families face a much longer journey.

At first, Corrie and Adam Mendes thought their daughter Emmie had an inner ear problem. She was late with several early milestones, including walking, and when she did walk, she often lost her balance. The family pediatrician sent them to a neurologist, who ordered a brain MRI and diagnosed her with pachygyria, a rare condition in which the brain is smoother than normal, lacking its usual number of folds.

Additionally, Emmie’s ventricles, the fluid-filled cushions around the brain, looked enlarged, so the neurologist recommended brain surgery to install a shunt to drain off fluid. He advised Corrie and Adam that Emmie’s life expectancy would be greatly reduced.

As Corrie recounts on her blog, Emmie’s Story, she went online and came across the research laboratory of Christopher Walsh, MD, PhD, at Boston Children’s Hospital. The lab does research on brain malformations and has an affiliated Brain Development and Genetics Clinic that can provide medical care.

After Walsh’s team reviewed Emmie’s MRI scan, genetic counselor Brenda Barry invited the family up from Florida. Full story »

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