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Parenting, Pediatrics, Public Health

Study shows cavities have become the most common childhood disease

Study shows cavities have become the most common childhood disease

Kids mouthA Washington Post blog entry published earlier this week reports that cavities are the most common childhood chronic disease in the United States. Fifty-nine percent of kids between the ages of twelve and nineteen have at least one cavity, according to a recent Pediatrics paper, and the American Academy of Pediatrics in turn issued new recommendations advising parents to start brushing children’s teeth with fluoride as soon as the teeth appear. The study refers to cavities in young children as a “silent epidemic” that disproportionately affects poor, young and minority populations.

From the article:

“We’re still seeing a lot of cavities in very young children,” said Rebecca Slayton, a pediatric dentist and member of the executive committee of the academy’s section on oral health.  “Various national surveys show that we are making progress in some age groups, but in the younger age groups we are not.”

Some of the problem stems from poor and immigrant children lacking dental care, but even among parents with the resources to get their children to dentists, there is a lack of awareness that baby teeth need the same care as permanent ones. And infants, of course, can’t complain about tooth pain.

Whether it’s a lack awareness or lack of resources that is preventing parents from addressing tooth health, the article makes clear that regular dental hygiene for children is an important part of their overall health.

Previously: Side effects of childhood vaccines are extremely rare, new study finds, “Mountain Dew mouth” rots teeth, costs taxpayers 
Photo By: Emran Kassin

Applied Biotechnology, Parenting, Pediatrics, Research, Sleep, Stanford News, Technology

Biodesign fellows take on night terrors in children

Biodesign fellows take on night terrors in children

baby on bed

Standing in the Clark Center’s grand courtyard, gazing upward at scientists ascending an outdoor staircase and traversing the exterior corridors on the top two floors, one senses that big ideas take shape here. But how?

Prototyping, say Andy Rink, MD, and Varun Boriah, MS, who spent the last year as Biodesign fellows. Part of Stanford’s Bio-X community, the Biodesign Program trains researchers, clinicians and engineers to be medical-technology innovators during its year-long fellowship. Fellows learn the Biodesign Process, which could be likened to design thinking for health care. On teams of two or four, the fellows identify a substantial health-care need and generate ideas to solve it using medical-device innovation.

Though most Biodesign projects take root after fellows complete a “clinical immersion” shadowing health-care workers in a hospital to observe problems, Rink found his inspiration when visiting family and waking up to a 3-year-old relative’s screams from recurring night terrors. The problem was not so much that it affected the child – pediatricians may advise that children will likely outgrow the condition – but that it affected the parents, Rink saw.  The parent’s lost sleep and anxiety over their child’s well being had huge effects on their quality of life. (In some cases, these are so severe that Xanax and Valium may be prescribed to the children as a last-ditch effort.) What if a treatment could be found that involved no medication and no parental intervention, offering everyone a solid night’s sleep?

The physician and engineer are working with School of Medicine sleep researchers Christian Guilleminault, MD, professor of psychiatry and behavioral sciences, and Shannon Sullivan, MD, clinical assistant professor of psychiatry and behavioral sciences, on a clinical method to treat night terrors in children. In a first-floor room of the Clark Center, they’re protoyping an under-mattress device that senses how deeply a child is sleeping and is able to prevent the nightly episodes from occurring, creating a healthier sleep cycle for the children.  This relieves the parent’s anxiety, and helps the entire family sleep better.

Faculty and students from more than 40 departments across Stanford’s campus, including the schools of medicine, business, law, engineering and humanities and sciences, play a role in Biodesign, as do experts from outside the university. Fellows work closely with the Institute of Design at Stanford, attending – and then teaching – the school’s d.bootcamp. They also have access to the d.school’s facilities and consult regularly with their faculty. Some of the d.school’s methods – focusing on big problems, encouraging radical collaboration, prototyping early and user-testing before focusing on functionality – guide the trajectory of Biodesign projects.

Physicians who are Biodesign fellows often work outside their specialty, and engineers bring a mix of academic and industry experience to the design table. While faculty mentors may simply provide advice to fellows, Guilleminault and Sullivan have become invested in the course of the research as lead investigators on the study. For their involvement, they were both honored with the Biodesign Specialty Team Mentorship Award.

Fellow Boriah noted that medical-device innovation is moving from products like catheters to systems such as health IT, mobile health and software. A former CEO and co-founder of a wearable patient blood-diagnostics device, he said the Biodesign program has provided valuable “access to clinical reality.” Rink, a surgical resident at Northwestern University, said that as a fellow, he’s been “exposed to a side you don’t see in a hospital.”

The researchers are currently recruiting participants ages 2-12 for their study. Rink and Boriah are also working with the Stanford-supported StartX to see their project into the next stage of development.

Previously: Sleep, baby, sleep: Infants’ sleep difficulties could signal future problemsStudying pediatric sleep disorders an “integral part” of the future of sleep medicine and At Med School 101, teens learn that it’s “so cool to be a doctor” 
Photo by MissMayoi

Medicine and Literature, Orthopedics, Patient Care, Pediatrics, Stanford News

From post-WWII Russia To 7-year-old Giana Brown, a limb-lengthening method evolves

From post-WWII Russia To 7-year-old Giana Brown, a limb-lengthening method evolves

young patientGiana Brown is one tough little girl. When she was 7 years old, an orthopedic surgeon, Jeffrey Young, MD, from Lucile Packard Children’s Hospital Stanford, placed a brace called a Taylor Spatial Frame on her lower left leg that would help lengthen it about three inches to match her right leg. To accomplish this, the brace would require adjustments of about one millimeter a day for more than six months.

Her parents could have made those adjustments, but Giana insisted on doing it herself. She used a little wrench to turn the knobs that would lengthen the struts on the brace according to a computer-generated, color-coded prescription sheet.

Sculpting Bones,” the story of Giana’s rare bone disorder, her surgery and her recovery, is featured in this summer’s edition of Stanford Medicine magazine. An animated graphic illustrates in detail how the brace and bone biology work together to lengthen limbs. The story focuses not only the remarkable method of cutting a bone and slowly lengthening the gap to allow it to grow — called “distraction osteogensis” — but also on the unusual history of the “external fixator” device that makes this growth possible.

The device originated in a remote region of Siberia, Russia, nearly 70 years ago, where a young doctor, Gavriil Ilizarov, MD, cared for a patient population that included soldiers returning from the front lines of World War II with a vast array of bone injuries. Ilizarov discovered his method of distraction osteogenesis by accident, and a revolutionary method of bone lengthening was born.

Several decades later, orthopedic surgeon Charles Taylor, MD, and his brother, engineer Harold Taylor, modernized the device, changing the angle of the struts for more flexibility, and creating a computer program that generated prescriptions, “accurate to within a millionth of an inch and a ten-thousandth of a degree,” for adjusting the struts daily.

Although Giana’s dad, Greg, accurately describes the device as “draconian-looking,” her surgeon, Young, hails it as an ideal tool for healing his pediatric patients. “I really like how the technology allows me to basically sculpt the bone,” he says. “It’s the perfect blend of engineering and art.”

For Giana Brown, the accuracy, simplicity, and artistry of the device has paid off: She’s back to running and playing with her friends the way a healthy, happy kid should. Read her story – and her tips for making life a little easier in the frame -  here.

Previously: Stanford Medicine magazine opens up the world of surgery
Photo of Giana Brown by Max Aguilera-Hellweg

Cancer, Parenting, Pediatrics, Public Health, Research

Study shows number of American teens using sunscreen is declining

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Despite an increase in cases of melanoma, the most dangerous type of skin cancer, growing percentage of high school students get a failing grade when it comes to using sunscreen. HealthDay reports:

The number of U.S. teens using sunscreen dropped nearly 12 percent in the last decade, a new report shows.

During that same time period, the number of teens using indoor tanning beds barely decreased. Both indoor tanning and failure to use sunscreen increase the risk of skin cancers, including deadly melanomas, the researchers noted.

“Unfortunately, we found a decrease in the overall percentage of teens who reported wearing sunscreen, from 67.7 percent in 2001 to 56.1 percent in 2011,” said lead researcher Corey Basch, an associate professor in the department of public health at William Paterson University in Wayne, N.J.

“Using sun-protective behaviors like applying sunscreen and avoiding intentional exposure to tanning devices will be key [to lowering cancer risk],” she added.

Use of indoor tanning devices by white girls decreased only slightly, from 37 percent in 2009 to 29 percent in 2011, she said.

Study authors say more research is need to understand why teens aren’t following national guidelines regarding sun protection.

Previously: Melanoma rates exceed rates of lung cancer in some areas, Beat the heat – and protect your skin from the sun, Working to protect athletes from sun dangers and Stanford study: Young men more likely to succumb to melanoma
Photo by Alex Liivet

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Obesity, Parenting, Pediatrics, Research, Sleep

Study shows poor sleep habits as a teenager can “stack the deck against you for obesity later in life”

Study shows poor sleep habits as a teenager can "stack the deck against you for obesity later in life"

11386276_c148dfd9bd_zNew research examining the effect of sleeplessness on weight gain in teenagers over time offers strong evidence that inadequate sleep may increase the risk of obesity.

In the study, researchers at Columbia University and the University of North Carolina pored over health information from the the National Longitudinal Study of Adolescent Health on more than 10,000 Americans ages 16 and 21. In addition, details about individuals’ height, weight and sleep habits were collected during home visits in 1995 and 2001.  According to a release, results showed:

Nearly one-fifth of the 16-year-olds reported getting less than six hours of sleep. This group was 20 percent more likely to be obese by age 21, compared to their peers who got more than eight hours of sleep. While lack of physical activity and time spent watching television contributed to obesity, they did not account for the relationship between sleeplessness and obesity.

“Lack of sleep in your teenage years can stack the deck against you for obesity later in life,” says [Columbia researcher Shakira Suglia, ScD]. “Once you’re an obese adult, it is much harder to lose weight and keep it off. And the longer you are obese, the greater your risk for health problems like heart disease, diabetes, and cancer.”

“The message for parents is to make sure their teenagers get more than eight hours a night,” adds Suglia. “A good night’s sleep does more than help them stay alert in school. It helps them grow into healthy adults.”

Previously: Want teens to eat healthy? Make sure they get a good night’s sleepProlonged fatigue and mood disorders among teensMore evidence linking sleep deprivation and obesityStudy shows link between lack of sleep and obesity in teen boys and Study shows lack of sleep during adolescence may have “lasting consequences” on the brain
Photo by Adrian Sampson

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Neuroscience, Pediatrics, Research, Stanford News

Kids’ brains reorganize as they learn new things, study shows

Kids' brains reorganize as they learn new things, study shows

arithmeticWhy do some children pick up on arithmetic much more easily than others? New Stanford findings from the first longitudinal brain-scanning study of kids solving math problems are shedding light on this question. The work gives interesting insight into how a child’s brain builds itself while also absorbing, storing and using new information. It turns out that the hippocampus, already known as a memory center, plays a key role in this construction project.

Published this week in Nature Neuroscience, the research focuses on what’s happening in the brain as children shift from counting on their fingers to the more efficient strategy of pulling math facts directly from memory. To conduct the study, the research team collected two sets of magnetic resonance imaging scans, about a year apart, on a group of grade-schoolers. From our press release:

“We wanted to understand how children acquire new knowledge, and determine why some children learn to retrieve facts from memory better than others,” said Vinod Menon, PhD, the Rachel L. and Walter F. Nichols, MD, professor of psychiatry and behavioral sciences at Stanford and the senior author of the study. “This work provides insight into the dynamic changes that occur over the course of cognitive development in each child.”

The study also adds to prior research into the differences between how children’s and adults’ brains solve math problems. Children use certain brain regions, including the hippocampus and the prefrontal cortex, very differently from adults when the two groups are solving the same types of math problems, the study showed.

“It was surprising to us that the hippocampal and prefrontal contributions to memory-based problem-solving during childhood don’t look anything like what we would have expected for the adult brain,” said postdoctoral scholar Shaozheng Qin, PhD, who is the paper’s lead author.

The study found that as children aged from an average of 8.2 to 9.4 years, they counted less and pulled facts from memory more when solving math problems. Over the same period, the hippocampus became more active and forged new connections with other parts of the brain, particularly several regions of the neocortex. But comparison groups of adolescents and adults were found on brain scans not to be making much use of the hippocampus when solving math problems. In other words, Menon told me, “The hippocampus is providing a scaffold for learning and consolidating facts into long-term memory in children.” And the stronger the scaffold of connections in an individual child, the more readily he or she pulled math facts from memory.

Now that the scientists have a baseline understanding of how this brain-building process normally works, they hope to run similar brain-scanning tests on children with math learning disabilities, with the aim of understanding what goes awry in the brains of children who really struggle with math.

Previously: Unusual brain organization found in autistic kids who best peers at math, Peering into the brain to predict kids’ responses to math tutoring and New research tracks “math anxiety” in the brain
Photo by Yannis

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Neuroscience, Parenting, Pediatrics

Can musical training help close the achievement gap between high and low-income children?

Can musical training help close the achievement gap between high and low-income children?

scope Music and kids

Drawing data from hundreds of students from low-income urban communities, a recent study offers new insights into understanding the academic gap between children from varying socioeconomic backgrounds and demonstrates the impact of musical training in helping low-income youth improve their language and reading comprehension skills.

The research (.pdf) was presented at the American Psychological Association’s annual convention and involved elementary and high school-aged students who participated in two separate projects measuring neural responses along with language and cognitive evaluations over a two-year period. Younger participants were part of Los Angeles-based nonprofit Harmony Project and older subjects attended three public high schools in Chicago. As explained in a press release:

[Researchers] studied children beginning when they were in first and second grade. Half participated in musical training and the other half were randomly selected from the program’s lengthy waiting list and received no musical training during the first year of the study. Children who had no musical training had diminished reading scores while Harmony Project participants’ reading scores remained unchanged over the same time span.

Over two years, half of the [Chicago] students participated in either band or choir during each school day while the other half were enrolled in Junior Reserve Officer’s Training Corps classes, which teaches character education, achievement, wellness, leadership and diversity. All participants had comparable reading ability and IQs at the start of the study. The researchers recorded the children’s brain waves as they listened to a repeated syllable against soft background sound, which made it harder for the brain to process. The researchers repeated measures after one year and again at the two-year mark. They found music students’ neural responses had strengthened while the JROTC students’ responses had remained the same. Interestingly, the differences in the music students’ brain waves in response to sounds as described above occurred after two years but not at one year, which showed that these programs cannot be used as quick fixes, [Northwestern neurobiologist Nina Kraus, PhD] said. This is the strongest evidence to date that public school music education in lower-income students can lead to better sound processing in the brain when compared to other types of enrichment education, she added.

“Research has shown that there are differences in the brains of children raised in impoverished environments that affect their ability to learn,” Kraus further explained in the release. “While more affluent students do better in school than children from lower income backgrounds, we are finding that musical training can alter the nervous system to create a better learner and help offset this academic gap.”

Previously: Pump up the bass, not the volume, to feel more powerful, Denver rappers’ music motivates kids (of all ages) to eat better and Brains of different people listening to the same piece of music actually respond in the same way.
Photo By: CherryPoint

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Behavioral Science, Health and Fitness, In the News, Pediatrics, Research

Regular exercise may help young girls struggling with depression

Regular exercise may help young girls struggling with depression

Girls running Scope Blog

Staying physically fit may help keep depression at bay for young girls, a study recently presented at the annual meeting of the American Psychological Association in Washington D.C. showed. On Thursday, the findings were reported in an article in U.S. News & World Report that pointed to a trend between fitness levels and depression in sixth grade girls.

“We don’t know exactly why there is a link [between fitness levels and depression], but it’s probably a number of things,” Camilio Ruggero, PhD, lead researcher and assistant professor at the University of North Texas, said in the article. “It might be better self-esteem, healthier weight or getting more positive reinforcements that go along with being active, and/or it could be more biological. We know certain proteins and hormones associated with less depression respond to increased exercise.”

The article goes on to say that the trend between fitness levels and depression in boys was not as statistically significant. Although the findings could not show a direct link between the two, they do suggest that for middle school children, staying active and being physically fit is an important piece of the puzzle for emotional well-being.

Previously: Using fMRI to understand and potentially prevent depression in girls, Yoga classes may boost high school students’ mental well- being and Lucile Packard Children’s Hospital partners with high schools on student mental health programs
Photo by Sangudo

Patient Care, Pediatrics, Stanford News, Videos

Pediatric patients create vibrant mural with help from Hewlett-Packard and DreamWorks Animation

Pediatric patients create vibrant mural with help from Hewlett-Packard and DreamWorks Animation

Here’s a feel-good story that will lift your spirits. Over at Lucile Packard Children’s Hospital Stanford, patients are working with volunteers from Hewlett-Packard and DreamWorks Animation to construct a unique piece of artwork designed digitally or drawn by hand. As described in the above video, the DreamWorks team worked with children in the hospital’s onsite school to create imaginary creatures, and next built a background and composited the patients’ art into a large mural. Then, Hewlett-Packard printed the custom designs onto PVC-free wallpaper. The final mural now hangs in Hewlett-Packard’s Palo Alto headquarters.

Previously: Ensuring young dialysis patients make the grade

Pediatrics, SMS Unplugged

Behind the glass window: Experiences in an infant follow-up clinic

Behind the glass window: Experiences in an infant follow-up clinic

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

behind window - smallAs I mentioned in my last entry, I’m in Boston this summer. I’m one of several interns who are part of the Newborn Summer Student Research Program, coordinated by the Harvard Program in Neonatology, in partnership with a number of Boston hospitals. Aside from connecting us with excellent research mentors, this program ensures that participants get some clinical exposure as well. Over the past 5 weeks, I’ve had a chance to shadow physicians in the Boston Children’s Hospital neonatal intensive care unit (NICU), the Brigham and Women’s Hospital delivery room, the BWH nursery, and most recently, the BCH Infant Follow-Up Program (IFUP).

It’s this last shadowing experience – in the infant follow-up clinic – that I want to touch on in this entry. When I first heard about this clinic, I thought it was for babies who were being seen soon after birth, just to make sure everything was okay. As soon as I walked into the clinic, I realized that IFUP was not for newborn babies but rather for kids of all ages, who were being followed up on for various developmental issues that had arisen during their previous time spent in the NICU.

During my brief time in the clinic, I met patients ranging from 22 months to 10 or more years of age. I use the word “met” loosely here, for in fact, I did not meet a single patient in person during my time at the clinic. I stood with some fellow interns and some physicians behind a one-way mirror, quietly observing as various tests were run on these children. At first, I found myself fascinated by the physician administering the various tests (ex. the Stanford Binet, the Beery VMI), for I had never seen them given in a clinical setting.

Soon, however, my attention slipped from the physicians to the children being tested. I felt such a complex mixture of emotions: sadness, for many of these kids had never experienced a week devoid of doctor’s appointments; amazement, at how far these children had progressed developmentally given where they started; and humility, for it was pure luck that prevented me from sharing the same developmental struggles that these little patients did.

As these thoughts swam around in my mind, my attention slipped once more, from the children in the room to their parents. I felt drawn into the emotions that flitted across these parents’ faces – pride when their kids correctly answered the physician’s questions, a pang of pain when a question was answered incorrectly, a sense of helplessness when the physician mentioned that the child would need yet more therapy. In response to the latter, one mother said, “I’ll do whatever it takes.” Such a simple statement, something I’ve heard several times before in movies and TV shows, but hearing it here, in a clinical setting, while standing unseen behind a glass wall, my heart broke. I wanted to reach past the divider and give these parents and these little kids huge hugs, to tell them it would be okay.

I can’t quite say why this clinical experience touched me so much. Perhaps it’s because the glass wall between me and the patients, physicians, and family members was less like a barrier and more like a window, offering me a view into the lives of not only patients but also the family members who love them so much and the physicians that strive to do everything in their power to help them heal.

Hamsika Chandrasekar just finished her first year at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo by A

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