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Pediatrics

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.”

Jen Baxter is a freelance writer and photographer. After spending eight years working for Kaiser Permanente Health plan she took a self-imposed sabbatical to travel around South East Asia and become a blogger. She enjoys writing about nutrition, meditation, and mental health, and finding personal stories that inspire people to take responsibility for their own well-being. Her website and blog can be found at www.jenbaxter.com.

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.

Jen Baxter is a freelance writer and photographer. After spending eight years working for Kaiser Permanente Health plan she took a self-imposed sabbatical to travel around South East Asia and become a blogger. She enjoys writing about nutrition, meditation, and mental health, and finding personal stories that inspire people to take responsibility for their own well-being. Her website and blog can be found at www.jenbaxter.com.

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

Patient Care, Pediatrics, Pregnancy, Stanford News, Women's Health

A prenatal partnership that benefits patients, medical students

A prenatal partnership that benefits patients, medical students

prenatal partnership

Over on the Lucile Packard Children’s Hospital Stanford blog, writer Julie Greicius highlights an elective program at Stanford’s medical school that fosters personal connections between prenatal patients and Stanford medical students. The course is designed to offer doctors-in-training the opportunity, early on, to be on the other side of patient care. Emily Ballenger, who’s expecting twins later this month, and medical student Sunny Kummar have partnered up through the program, with Sunny offering extra support by attending prenatal appointments, the babies’ birth, and the first few pediatric appointments.

Relationship building is fundamental to patient-centered care, and with this program the doctor-to-be has the opportunity to identify with the patient experience in his or her supportive role. Without the pressures of being in the medical provider role, the student has the opportunity to practice listening, empathy and compassion.

The value of programs such as this is that they shift the paradigm of the traditional-doctor patient relationship. The scale is tipped from being purely clinical to one focused more on listening and learning from each other. The patient, the doctor-in-training, and their future patients all stand to benefit.

Ballenger’s obstetrician is Susan Crowe, MD, who has long supported the program. “I encourage my patients to participate because it’s a win for future care of obstetric and pediatric patients,” she says in the piece. “I really believe that the patient-centered care we strive for can be better achieved if we train our physicians to really learn from and listen to our patients themselves. One of the biggest strengths of the program is that the patient perspective comes first. It sets the groundwork for that way of thinking in terms of training our medical students.”

Medical schools around the country offer similar programs, recognizing that it’s the human connection that initially draws young doctors to medicine, and Stanford has offered this program since at least 1991. The course directors are Yasser El Sayed, MD, obstetrician-in-chief at Stanford Children’s Health, and Janelle Aby, MD, clinical associate professor of pediatrics.

Jen Baxter is a freelance writer and photographer. After spending eight years working for Kaiser Permanente Health plan she took a self-imposed sabbatical to travel around South East Asia and become a blogger. She enjoys writing about nutrition, meditation, and mental health, and finding personal stories that inspire people to take responsibility for their own well-being. Her website and blog can be found at www.jenbaxter.com.

Previously: Countdown to clinics: The 5 best things about jumping into third year
Photo courtesy of Lucile Packard Children’s Hospital

Autism, Pediatrics, Research, Stanford News

Stanford research clarifies biology of oxytocin in autism

Stanford research clarifies biology of oxytocin in autism

For years, scientists have been trying to sort out the role oxytocin plays in autism. The developmental disorder affects one in 68 U.S. children, causing social and communication deficits, repetitive behaviors and sensory problems. Oxytocin, which functions in the blood as a hormone and in the brain as a neurotransmitter, has long been known to have roles in enhancing social ability. Based on research in animal models, some people have speculated that oxytocin deficiency might contribute to autism. But prior human studies of the purported connection have produced a confusing picture.

The previous hypotheses saying that low oxytocin was linked to autism were maybe a little bit simplistic. It’s much more complex…

Now, a new Stanford paper publishing online this week in Proceedings of the National Academy of Sciences adds interesting details to our understanding. The study is the largest ever to examine blood oxytocin levels in children with autism and two comparison groups without autism: kids who have autistic siblings and children who do not have siblings with autism.

The researchers found the same range of blood oxytocin levels across all three groups, with similar numbers of children with low, medium and high oxytocin levels in each category. Although, as expected, the kids with autism had social deficits, blood oxytocin level was clearly linked to social ability within each group. Children with autism who had low blood oxytocin had poorer social ability than autistic children with high blood oxytocin, for example, and typically developing kids with low blood oxytocin also had poor social ability compared to other typically developing children.

From our press release on the research:

“It didn’t matter if you were a typically developing child, a sibling or an individual with autism: Your social ability was related to a certain extent to your oxytocin levels, which is very different from what people have speculated,” said Antonio Hardan, MD, professor of psychiatry and behavioral sciences and the study’s senior author. Hardan is a child and adolescent psychiatrist who treats children with autism at [Lucile Packard Children's Hospital Stanford].

“The previous hypotheses saying that low oxytocin was linked to autism were maybe a little bit simplistic,” he said. “It’s much more complex: Oxytocin is a vulnerability factor that has to be accounted for, but it’s not the only thing leading to the development of autism.”

The findings suggest that, although oxytocin deficiency may not explain all cases of autism, some kids with autism may still benefit from oxytocin-like medications. The researchers caution that their study needs to be repeated with measures of oxytocin in cerebrospinal fluid, since this liquid that bathes the brain may give better information about the nuances of oxytocin biology.

A Duke University scientist commented for a story on NPR’s health blog, Shots, about what the findings imply for the potential value of oxytocin therapy:

“It could be that if a kid has low oxytocin levels then they might benefit,” says Simon Gregory, a genomics researcher at Duke University who was not involved in the study. He is part of another group investigating the use of oxytocin to treat people with autism.

Gregory says it’s not surprising that children with autism have widely varying levels of oxytocin. “Autism isn’t a disease, it’s a spectrum” that can’t be linked to any one cause, he told Shots.

Stanford’s research team is also doing more work to clarify further details of the biology of oxytocin in autism.

Previously: Volunteers sought for autism drug study, Using Google Glass to help individuals with autism better understand social cues and “No, I’m not ready yet”: A sister’s translation for her brother with autis

Stanford Medicine Resources: