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Parenting, Patient Care, Pediatrics, Stanford News

Children’s hospital volunteers snuggle infants to soothe tiny patients and reassure their parents

Children's hospital volunteers snuggle infants to soothe tiny patients and reassure their parents

Calling all cuddlers! As previously written about here and in the most recent  Stanford Medicine Newsletter, volunteers Pat Rice and Claire Fitzgerald have been holding and soothing infants at Lucile Packard Children’s Hospital Stanford for 16 years, providing comfort both to the tiny patients and their parents. Rice and Fitzgerald, Ronald Cohen, MD, and sweet babies were featured on ABC’s World News with Diane Sawyer in the segment above.

Previously: Paying kindness forward through infant-cuddling“I opened the doors:” A look back at two special babies and Neonatologist celebrates 50 years of preemie care

Behavioral Science, Pediatrics, Research

Abstract gestures help children absorb math lessons, study finds

Abstract gestures help children absorb math lessons, study finds

mathAs a member of a minority group characterized by fluency in classical ballet pantomime, studies of gesture pique my interest. So I was delighted to come across research from the University of Chicago finding that children who used specific abstract hand movements during a math lesson were able to absorb the class lessons deeply and generalize the concepts they had learned.

Published in Psychological Science, the study (subscription required) compared three learning methods, each requiring a different level of physical interaction in solving a math problem, in 90 third-graders. As described in a university release:

In one group, children picked up magnetic number tiles and put them in the proper place in the formula. For example, for the problem 4 + 2 + 6 = ___ + 6, they picked up the 4 and 2 and placed them on a magnetic whiteboard. Another group mimed that action without actually touching the tiles, and a third group was taught to use abstract gestures with their hands to solve the equations. In the abstract gesture group, children were taught to produce a V-point gesture with their fingers under two of the numbers, metaphorically grouping them, followed by pointing a finger at the blank in the equation.

The children were tested before and after solving each problem in the lesson, including problems that required children to generalize beyond what they had learned in grouping the numbers. For example, they were given problems that were similar to the original one, but had different numbers on both sides of the equation.

Children in all three groups learned the problems they had been taught during the lesson. But only children who gestured during the lesson were successful on the generalization problems.

The study’s lead author, Miriam Novack, a PhD student in psychology, said, “We found that acting gave children a relatively shallow understanding of a novel math concept, whereas gesturing led to deeper and more flexible learning.”

Previously: Peering into the brain to predict kids’ responses to math tutoringNew research tracks “math anxiety” in the brain and We’ve got your number: Exact spot in brain where numeral recognition takes place revealed
Photo by woodleywonderworks

Mental Health, Pediatrics, Research, Stanford News

Excessive homework for high-performing high schoolers could be harmful, study finds

Excessive homework for high-performing high schoolers could be harmful, study finds

homeworkToo much homework. (How do you feel after just reading those words?) Researchers from the Stanford Graduate School of Education, Lewis and Clark College and Villanova University conducted a study in high schoolers living in high-income, high-achieving communities and found that spending too much time on homework could have negative effects on students’ health and well-being.

The researchers engaged with 4,317 participants in 10 California high schools through surveys and interviews. Students had an average of 3.1 hours of homework each night. As Stanford News reports, the study cites earlier work that found 90 minutes to two-and-a-half hours of nightly homework to be optimal for high schoolers.

From the Stanford News article:

Their study found that too much homework is associated with:

• Greater stress: 56 percent of the students considered homework a primary source of stress, according to the survey data. Forty-three percent viewed tests as a primary stressor, while 33 percent put the pressure to get good grades in that category. Less than 1 percent of the students said homework was not a stressor.

• Reductions in health: In their open-ended answers, many students said their homework load led to sleep deprivation and other health problems. The researchers asked students whether they experienced health issues such as headaches, exhaustion, sleep deprivation, weight loss and stomach problems.

• Less time for friends, family and extracurricular pursuits: Both the survey data and student responses indicate that spending too much time on homework meant that students were “not meeting their developmental needs or cultivating other critical life skills,” according to the researchers. Students were more likely to drop activities, not see friends or family, and not pursue hobbies they enjoy.

Co-author Denise Pope, PhD, wrote, “The findings address how current homework practices in privileged, high-performing schools sustain students’ advantage in competitive climates yet hinder learning, full engagement and well-being.”

The study was published in the Journal of Experimental Education.

Previously: Stanford researchers use yoga to help underserved youth manage stress and gain focusA prescription for reducing medical student stress and Can sleep help prevent sports injuries in teens?
Photo by openpad

Complementary Medicine, In the News, Mental Health, Pediatrics, Stanford News, Videos

Stanford researchers use yoga to help underserved youth manage stress and gain focus

Stanford researchers use yoga to help underserved youth manage stress and gain focus

A segment on PBS NewsHour yesterday explored how Stanford researchers have brought yoga and mindfulness practices to students who experience post-traumatic stress disorder owing to difficult life circumstances. At Cesar Chavez Academy in East Palo Alto, Calif. – a low-income, high-crime area – a group of seventh-graders worked with Stanford’s Victor Carrion, MD, professor of psychiatry and behavioral sciences, and his team during a 10-week program introducing breathing and movement practices to help students manage their emotions and improve their concentration in school.

The researchers used imaging techniques to understand how children respond to daily stress. “With functional imaging, we actually can see what the brain is doing,” Carrion told PBS. “There is a deficit in the area of the middle frontal cortex in kids that have PTSD,” which, he noted, may discourage learning.

In the piece, seventh-grader Brayan Solorio describes how rolling out his yoga mat at home helps him keep his cool.

Previously: Med students awarded Schweitzer Fellowships lead health-care programs for underserved youthThe remarkable impact of yoga breathing for trauma, The promise of yoga-based treatments to help veterans with PTSD and Stanford and other medical schools to increase training and research for PTSD, combat injuries

In the News, Parenting, Pediatrics, Sleep

Study: Baby sound machines may be too loud for little ears

Study: Baby sound machines may be too loud for little ears

DSC_0293Sound machines that help babies sleep more soundly are a staple on many new parents’  baby registries (I had a little sheep that mimicked the sounds of rainfall and ocean waves). Well, as you may have read about elsewhere today, a new study published in the journal Pediatrics finds those soothing sounds may actually do more harm than good. Researchers from the Hospital for Sick Children in Toronto have found that infant sleep machines can reach sound levels that are hazardous to infant hearing and development. Writer Michelle Healy outlines their findings in an article in USA Today:

When set to their maximum volume:

– All 14 sleep machines [studied] exceeded 50 decibels at 30 cm and 100 cm, the current recommended noise limit for infants in hospital nurseries.

– All but one machine exceeded that recommended noise limit even when placed across the room, 200 centimeters away.

–Three machines produced outputs greater than 85 decibels when placed 30 cm away. If played continuously, as recommended on several parenting websites, infants would be exposed to sound pressure levels that exceed the occupational noise limits for an 8-hour period endorsed by the National Institute for Occupational Safety and Health and the Canadian Centre for Occupational Health and Safety.

It’s important to note that the researchers only tested the maximum output levels produced by the sound machines, and not their direct effect on infants. But Nanci Yuan, MD, tells Healy that the study does raise some important concerns:

​Parents “can feel desperate and want to try anything” when a baby has difficulty sleeping, says Nanci Yuan, pulmonologist and sleep medicine specialist at Lucile Packard Children’s Hospital Stanford.

But this research highlights the potential for a previously “unknown harm that can occur,” Yuan says. “We’re getting more and more concerned about issues related to sound and noise and hearing-loss in children because it’s progressive.”

Photo by Margarita Gallardo

Clinical Trials, Immunology, Pediatrics, Research, Stanford News

Simultaneous treatment for several food allergies passes safety hurdle, Stanford team shows

Simultaneous treatment for several food allergies passes safety hurdle, Stanford team shows

milk and eggsLiving with one food allergy is a challenge; living with more than one can make ordinary activities such as eating at a restaurant feel downright impossible.

That’s because the standard medical advice for the 4 million Americans with food allergies is to avoid all of your allergy triggers, all the time – and, by the way, make sure you always carry injectable epinephrine in case you accidentally eat something contaminated with a food that triggers anaphylactic shock.

So it will be welcome news to these food-allergy sufferers to hear that a Stanford team is making progress on a new way to help them. In research published today in the journal Allergy, Asthma & Clinical Immunology, a team led by Kari Nadeau, MD, PhD, found that an experimental treatment already being widely tested for single food allergies, called oral immunotherapy, could be modified so that patients can be desensitized to multiple food allergens at the same time. The results now being reported are the products of a pair of phase-1 safety trials.

In our press release about the findings, Nadeau explained why she wanted to develop the new therapy:

“Parents came up to me and said things like, ‘It’s great that you’re desensitizing children to their peanut or milk allergies, but my daughter is allergic to wheat, cashews, eggs and almonds. What can you do about that?’” said Kari Nadeau, MD, PhD, associate professor of pediatrics at the medical school and an immunologist at Stanford Hospital & Clinics and Lucile Packard Children’s Hospital Stanford. Nadeau is the senior author of the new study.

… [O]ral immunotherapy is still experimental and quite slow: In prior studies, patients took as long as three years to become desensitized to one food. Being desensitized to several foods, one at a time, could prospectively take decades. Yet Stanford researchers succeeded in safely desensitizing patients to several food allergens at once and were able to speed up desensitization by supplementing oral immunotherapy with injections of omalizumab (brand name Xolair).

With omalizumab, patients were desensitized to up to five of their allergens in a median of 18 weeks; without the medication, the same process took a median of 85 weeks, the research team found. The published results add weight to the anecdotal findings from three of Nadeau’s patients who participated in the trial and shared their experience in a story in the New York Times magazine last spring.

The researchers stress that the treatment is still experimental and must be performed in a hospital setting, but they are excited by the next step in the process: a phase-2 trial to evaluate the therapy more rigorously in a larger number of patients. The phase-2 trial will be conducted at Stanford, where recruitment of new patients has already begun, and at four other centers across the country, which will begin recruiting patients in the coming months. Individuals who are interested in learning more about participating in the new studies can check the federal clinical trials website for opportunities in their region.

Previously: Researchers show how DNA-based test could keep peanut allergy at bay, A mom’s perspective on a food allergy trial and Searching for a cure for pediatric food allergies
Photo by Logan Brumm Photography and Design

Parenting, Patient Care, Pediatrics, Stanford News

One family’s story caring for their children with type 1 diabetes

One family's story caring for their children with type 1 diabetes

diabetesFamily members may share a set of values, a sense of humor, or various personality traits. And sometimes members of a family have a health condition in common. The recent Stanford Medicine Newsletter features a San Jose, Calif. family with five children – two of whom have type 1 diabetes and a third who has been identified as likely to develop it in the next two years. The Bergh family receives care for their children at Lucile Packard Children’s Hospital Stanford.

From the piece:

Roughly 5 percent of families who have one child with diabetes will have a second child with the disease, but it’s unusual to have three, according to Bruce Buckingham, MD, professor of pediatric endocrinology at Lucile Packard Children’s Hospital Stanford and the School of Medicine.

Buckingham, who treats the Bergh children, assessed everyone in the family for the disease by testing for antibodies that can generally predict when a child is going to develop diabetes. Four months after Maleki got his diagnosis, Marae tested positive for the antibodies. She did not get the disease for five more years, but by then Tierra Bergh [the mom] knew what to do. After noticing that Marae was drinking and urinating excessively one weekend, she used her son’s glucose meter to test Marae’s glucose levels and immediately called Buckingham.

“I was devastated,” she recalled, “but Dr. Buckingham was very calm. He said, ‘You already know how to take care of a child with diabetes.’”

Previously: A tale of two Shelbys: The true story of two diabetes patients at Lucile Packard Children’s Hospital and Tips for parents on recognizing and responding to type 1 diabetes
Photo courtesy of Bergh family

 

Mental Health, Parenting, Pediatrics, Public Health

Doctors advised to screen for depression and test cholesterol during well-child visits

Doctors advised to screen for depression and test cholesterol during well-child visits

Child_depressionHow old should children be before their doctors start annual depression screenings? According to revised guidelines from the American Academy of Pediatrics, the suggested age is 11. The national physician group also suggests pediatricians check middle school-age children’s cholesterol levels, test 16 to 18-year-olds for HIV, and not perform pap smears in girls younger than 21.

As reported in a Health Day story:

The changes attempt to address several pressing health issues affecting U.S. families today. The nation’s obesity epidemic means that children are developing high cholesterol levels — a risk factor for heart disease — at earlier ages. And depression is linked to higher risk for teen suicides and murder.

“One in five kids will, at some point in time, meet the criteria for depression,” said [Joseph Hagan, MD, co-editor of the guidelines and] a professor in pediatrics at the University of Vermont College of Medicine.

The article continues with explanations for specific changes. A full version of the updated guidelines was published yesterday in the journal Pediatrics.

Previously: Lucile Packard Children’s Hospital partners with high schools on student mental health programs and The link between teen depression and suicide
Photo by D. Sharon Pruitt

Pediatrics, Public Health, Stanford News

Stanford physician leading efforts to track emerging polio-like illness in California children

Stanford physician leading efforts to track emerging polio-like illness in California children

Sofia JarvisJessica Tomei remembers the exact moment her daughter’s arm stopped functioning.

It had been a rough week. Sofia Jarvis, Tomei’s then-two-year-old, had been sick with a respiratory illness. Tomei and Sofia were leaving the pediatrician’s office with a pneumonia diagnosis and a prescription for antibiotics when, on the way out, Sofia reached for a toy.

“Her left arm, in mid grasp, stopped working,” Tomei said.

The next day, when Sofia was still not using her arm, Tomei and husband Jeff Jarvis took her back to the doctor. An MRI showed a lesion in Sofia’s spinal cord. At first, she was diagnosed with transverse myelitis, a form of paralysis from which some patients recover. But when the family eventually found their way to pediatric neurologist Keith Van Haren, MD, at Lucile Packard Children’s Hospital Stanford, he had bad news.

“Dr. Van Haren immediately said, ‘She probably will not get back the function of her arm,’” Tomei recalled.

Sofia’s case fit into a pattern that Van Haren and other neurologists around California had begun to observe: Since late 2012, about 20 children in the state have developed sudden-onset, permanent paralysis that looks similar to polio. Van Haren is the primary author of an abstract that describes five of the cases, which will be presented at the annual meeting of the American Academy of Neurology, April 26 to May 3 in Philadelphia.

From an AAN press release about the abstract:

“Although poliovirus has been eradicated from most of the globe, other viruses can also injure the spine, leading to a polio-like syndrome,” said case report author Keith Van Haren, MD, with Stanford University in Palo Alto, Calif. and a member of the American Academy of Neurology. “In the past decade, newly identified strains of enterovirus have been linked to polio-like outbreaks among children in Asia and Australia. These five new cases highlight the possibility of an emerging infectious polio-like syndrome in California.”

All five of the children in the report, including Sofia, had been immunized against polio. Two others in addition to Sofia had respiratory symptoms before the paralysis began. In two of the children, the physicians found evidence of infection with enterovirus-68, which is from the same family as polio virus. Although the team suspects this form of paralysis is infectious, they have not completely excluded other causes such as autoimmune disease. They are asking other physicians to report similar cases to the California Department of Public Health so that the cause of the disease can be pinpointed.

One concern, Van Haren added, is that physicians who have not heard of the new disease may make the same misdiagnosis of transverse myelitis that Sofia received, giving affected children and their families unrealistic expectations about the likelihood of recovery.

“The MRI can look similar but the clinical exam is very distinct,” he said. “There’s a knee-jerk reaction to just call it transverse myelitis. This is something else, and it’s quite bad.”

The good news is that the disease is very rare and likely to remain so. “There have been similar reports in Southeast Asia for many years, and the disease has rarely reached epidemic proportions there,” Van Haren said. “We want to temper the concern about this. It is not a massive epidemic.”

Meanwhile, families like Sofia’s will be watching closely to see what is uncovered by the upcoming research.

“We really want to know what caused this,” Tomei said, adding that the disease and a string of attempted treatments have been difficult for Sofia to go through. Now four, Sofia is generally healthy, but her arm is still paralyzed and the muscles have begun to atrophy.

Still, the family is keeping a positive outlook. Said Tomei, “We’re lucky it was just her left arm.”

Photo courtesy of Jessica Tomei and Jeff Jarvis

Patient Care, Pediatrics, Stanford News

Paying kindness forward through infant-cuddling

Paying kindness forward through infant-cuddling

CUDDLEMy runner-up dream job is to snuggle infants at a hospital. (Second only to attending yoga teacher trainings full-time.) So I might have squealed a little when coming across a sweet story about a couple of volunteer cuddlers at Lucile Packard Children’s Hospital Stanford. For the last 16 years, husband-and-wife team Pat Rice and Claire Fitzgerald, both psychologists, have been assuring babies and relieving their parents by providing non-clinical, fully human support.

From Stanford Medicine Newsletter:

“The baby cuddler program has tremendous value,” said neonatologist David Stevenson, MD, director of the hospital’s Johnson Center for Pregnancy and Newborn Services. Parents with hospitalized infants must sometimes be away from the bedside, and physicians and nurses are focused on their patients’ essential medical needs, which sometimes limits their time to attend to more personal needs, said Stevenson, who also is the Harold K. Faber Professor of Pediatrics at the School of Medicine.

“The cuddlers are volunteers who address the personal needs of another small human being, holding and talking to them when their parents can’t be present,” he said. “The cuddlers become a part of the health-care team.”

Rice and Fitzgerald are returning the tender loving care once provided to them and their son, who was treated at what was then called Stanford Children’s Hospital. He has since grown up and fathered three children of his own.

Previously: “I opened the doors:” A look back at two special babies and Neonatologist celebrates 50 years of preemie care
Photo of Pat Rice and Claire Fitzgerald by Norbert von der Groben

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