Growth Attenuation Therapy in Children with Severe Physical and Cognitive Disabilities

by Julia R. Donner, MD (’23)

The goal of therapy for Ashley’s family and of those like hers is to prolong care time at home within the family and make this care more feasible to prevent transition to facilities. Lifting and transferring of children becomes more challenging the larger they grow and formation of bed sores and other side effects of being sedentary become a larger issue with increasing size. Growth attenuation could potentially prevent these effects and allow for better quality of life for these children as they age and are able to remain at home. 

HORMONES AND THE HEART

Julia Donner, MD (’23)

Prolongation of QT interval carries increased risk for sudden life threatening arrythmias, specifically torsades de pointes (TdP) and sudden cardiac death (SCD). Female gender is a risk factor for arrythmias, specifically drug related TdP, and both endogenous and exogenous sex hormones affect the QT interval. The impact of gender and gonadal steroids on cardiac rhythm and arrhythmias is recognized and is more prominent in females than in males. There is a higher propensity towards arrhythmia in females than males and rate corrected QT intervals are longer in females than males. While QTc intervals are longer in women than in men, this difference only becomes apparent after puberty suggesting that sex hormones may be responsible. In addition, progesterone, not estrogen has dominant effect on ventricular repolarization in women. Androgens are known to be protective and higher serum progesterone concentrations may be protective against drug-induced QT interval lengthening. 

Childhood Obesity in COVID-19: Ways to Counsel

by Leslia Gonzalez (’22)
reviewed by Celeste Corcoran

Childhood obesity has been a growing problem for many years. The COVID pandemic has unfortunately exacerbated this. A study published in JAMA that utilized the Kaiser Permanente Southern California population found an increase in childhood obesity across all ages, with the largest being within the age group of 5-11 yo. There was an increase of approximately 9%. We have seen this trend amongst our patient population as well.

OUCH MY BACK! Spondylolysis in the Pediatric Population

by Maya Spencer (’22)

Spondylolysis is a stress fracture that occurs within the vertebrae, typically at the pars interarticularis. When the fracture occurs bilaterally and completes all the way through the bone this can progress to spondylolisthesis, where the vertebrae slides anteriorly over the bone below it. As children are becoming more active in sports at an earlier age with a higher intensity of practice this is becoming an increasingly common condition in the pediatric population.

IT TAKES A VILLAGE: Community Approach to Preventing Child Abuse

by Greg Lopez (’24)

If we can identify community risk factors that contribute to higher rates of child maltreatment, we do our kids a disservice if we do not actively confront those issues. Thinking upstream widens the scope of possible solutions, as any approach that seeks to reduce poverty or make communities safer becomes viable. Advocating for causes like universal healthcare, increased wages, and more affordable housing would all directly impact risk factors of child maltreatment by providing socioeconomic benefits to families and communities. These broader efforts, in conjunction with existing targeted interventions, provide a truly comprehensive approach to addressing child maltreatment and ensure that we are doing everything we can to keep kids safe.

HEART ON FIRE: Post-COVID Vaccine Myocarditis

by Torie Quinn, DO (’23)

n between the Pfizer and Moderna mRNA SARS-CoV-2 vaccines and myocarditis. Recently, Marshall et al. Pediatrics. 2021 illustrated a case series of seven healthy males aged 14-19 who, just like the patient above, presented with chest pain within four days of their second dose of the Pfizer vaccine and were found to have ST elevations, significant troponin leak, cardiac dysfunction and positive cardiac MRI findings. 

While this is fascinating and ever-evolving science, it also highlights what I believe to be one of the most crucial skills in pediatrics – the ability to sift through the literature, look parents in the eyes, and counsel them on how to keep their children safe. It requires shared decision making, anticipatory guidance, and benefit-risk discussions. Because while we as medical professionals view a 12-in-one-million chance of developing myocarditis after receipt of a vaccine that can help curtail a pandemic as a significant benefit, parents will understandably focus on the risk of their child being one of those 12.

BITE ME!…NOT: Management of Animal Bites

by Bruna Olson, MD (’22)
Reviewed by Alison Heinly, MD

Animal bites are a common complaint seen in the Emergency Department throughout the year. Questions regarding whether to manage the wounds through suturing or antibiotics are common and this article aims to clarify the indications for these different management options when appropriate. 

MAKING PAIN MANAGEMENT LESS PAINFUL: Opioid Use in Pediatrics

by Sarah Harney, MD (’21)
reviewed by Angie Anderson, MD

As pediatric residents spending a lot of time in the inpatient setting, we encounter opioid use fairly frequently. There is a great deal of concern about opioid use in society at large, given the current opioid crisis our country faces. However, opioids are an important tool in our pain management toolbox, and can be an excellent choice when used safely in the appropriate clinical context. Therefore, it is critical for pediatric trainees to feel comfortable with opioid prescribing. Opioids may be indicated in pediatric patients with moderate to severe acute pain, acute exacerbations of chronic pain, and cancer-related pain. Even for these patients, your pain management approach should always be multifactorial including non-pharmacologic pain control techniques and non-opioid analgesics.

LET’S PARDS OUT THE DETAILS: Pediatric Acute Respiratory Distress Syndrome

by Carly Schmidt, MD (’21)
reviewed by Sarah Welsh, MD

Pediatric Acute Respiratory Distress Syndrome is a disease process of severe hypoxemia with oxygenation and (often) ventilation failure, with lung inflammation and poor lung compliance (see Pathophysiology below). It is similar to the adult counterpart (ARDS) but carries slightly different definitions. PARDS is an important cause of morbidity and mortality in the pediatric ICU, and awareness of degree of hypoxia is key, especially in patients who have not yet developed ventilatory failure.