Search for tag: "children's health"

Suicide is one of those topics no one wants to talk about, but something that needs to be discussed. This is our topic today on The Scope.

Recently, a longtime family friend's daughter, who my kids have grown up with since they were really little, whom we have known since before our 12 year old was even born, acted on an impulse and took her own life. This podcast is dedicated to her. Her parents know I'm doing this podcast in her honor. During her services, her parents spoke about how important it is to bring awareness to the reality of suicide in teens, to talk about it, to talk to your kids about how they can come to you if they're having thoughts of self-harm, that there might not always be the warning signs that people tell you to look for.

With teens, their brains are not yet fully developed in terms of executive function skills. So they often can't see that while things may be bad right now, there is hope. And often, in time, things will improve. This is true so much this year with the pandemic. Our teens are not able to do normal teenager things like school functions, dances, hanging out with friends, having their first boyfriend or girlfriend. They have been cut off from interactions outside their families. Teens can only see what is happening here and now. And in their minds, it feels like things will never be the same again.

Unfortunately, they're probably right. Things will most likely never go back to the way that they had been. However, there is hope, hope that we are better able to understand COVID and hope that we will be able to bring an end to the pandemic. Hope that within the next year, people can start returning to what we consider normal life.

Knowing someone who has completed suicide will rock you to your core. Sometimes there are signs like sadness, wanting to sleep more, or stay away from others more than teens normally do, grades falling and your teen not really caring about school. Sometimes there is a history of mental illness or self-harm, and it gets the better of them. And sometimes, a teen will struggle in silence. They will appear happy and social on the outside, but be suffering within, until one day that wave of suffering overpowers them, and they act on their immediate feelings with fatal results.

The more I have spoken to teens and parents of teens, the more the subject of negative thoughts seems to come up. More and more teens are having these thoughts. More and more teens are doing self-harm, like cutting or attempting overdoses. I have about a patient a week lately, where I am having this conversation with them. It's real, it's serious. Teens need to know that we are there for them and that they can come to us, that they have options for help. No, we can't make everything go back to the way it was. No, we can't take their feelings away from them. But we can help them work through their feelings, give them options that are safe, and help them to understand that they aren't alone.

We see you, we hear you. You are beautiful and special, and you are loved.

Interviewer: Why should autism be diagnosed early in life? We'll talk about that next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs, the "Science and Research Show" is on The Scope.

Interviewer: I'm talking with Dr. Debbie Bilder. She's Principal Investigator of the Utah Registry Of Autism and Developmental Disabilities. We'll be talking about the need to diagnose children with autism spectrum disorder early in life.

So, Dr. Bilder, if I were sitting next to a three or four-year-old who has autism spectrum disorder, what might I notice about this child that may be a little different from a typically developing child?

Dr. Bilder: Well, that child may not be making eye contact or may be preoccupied with something that is really hard to separate them from, in particular something which is not a typical toy that a child that age might be interested in.

Maybe when you do talk with that child, that child would have a particular interest that that child would go on and on about regardless of whether you may share that interest or not. A child may also have self-stimulatory behaviors, like hand flapping or even looking at things through the corner of their eye.

Children with autism have a really difficult time connecting effectively with their peers. So that child may be sitting on the bench next to other friends or the other children are out playing on the playground.

Interviewer: And is it usually obvious? I mean, if I were a parent, would I just know that, you know, maybe there's something a little different about my child?

Dr. Bilder: For parents, particularly, you know, thinking about a parent in which that's the first child, so they don't have a child to compare their first child to, they might notice that there are significant delays. Some children with autism also have other delays as well. So there would be a delay in language that their pediatrician or family practice doctor would mention to them. They may have difficulty in interacting with other children or choose not to play with other children.

But the majority of children with autism who have normal [intellectual 00:02:06] ability, which is the majority of children with autism, it may not be apparent to a parent who does not have another child to compare that child to.

Interviewer: I think you would argue that it's important to make that diagnosis, to make that identification early on.

Dr. Bilder: Well, we know that children who are identified by two or three years of age and receive treatment right away, intensive treatment can really optimize their ability to function, optimize their ability to be in a school classroom with other neurotypical children.

And some children who receive this intensive intervention may even no longer meet criteria for autism when they get older, and even though that's a very small percentage, we want to give children whatever shot they can get to be able to develop these skills when their brain is most capable of learning them.

Interviewer: So it's more difficult to make this intervention effective later in life?

Dr. Bilder: Yes. There's a developmental window as we develop language, as we develop our interactive skills. Clearly, there's a time in which our brains are intended to develop these skills. And if we could take advantage of that in these children, even though they may not develop those skills inherently, they can be taught these skills and that is the time at which their brains are going to be most receptive to that education.

Interviewer: So you've been involved in some large-scale research recently, looking at the ages at which children are getting that diagnosis from autism spectrum disorder. What did you find?

Dr. Bilder: Well, as far as the diagnosis itself, as far as receiving a diagnosis, we did not see a reduction in the age at which that child first received a diagnosis. The median age, when we looked at this for children who were four years of age back in 2010, was about 35 months here in Utah, and similarly it was 35 months two years later.

And then this particular study actually extended over six years. We participated in two of those years that I just mentioned. But even looking across the six years, there was no significant difference in the median age at which these children across seven different sites were identified with autism spectrum disorder.

The focus of this study perhaps goes even a little bit before then. The real aim is to have these children recognized as having a developmental concern so that they then are able to access a comprehensive evaluation.

So for those children when they can access and they do access a comprehensive evaluation even before the diagnosis is made, the developmental delays will be identified and you can initiate treatment even before you have a clear diagnosis of autism.

Interviewer: And so you said that there was no change in these two years that you looked at the numbers of diagnoses. I mean, what does that mean to you? Why does that concern you?

Dr. Bilder: Well, there was no change in the age at which these children were identified with autism. And what concerns me is that we as medical providers, as medical professionals despite our best efforts and there is a lot of work going into early screening so we can subsequently have early identification of autism to give these children that opportunity.

Despite these efforts, that age at which they're first presenting for a comprehensive developmental evaluation is not going downward. So it makes me really wonder, well, what about the process we have in place, because we're working really hard to initiate this process, what about this is not ultimately leading to the goal in which it was established, which is to reduce the age at which these children can access treatment?

Interviewer: And do you have any insights into what barriers are in place there?

Dr. Bilder: Well, this particular study was an epidemiologic study. So its purpose was to look at this in a very systematic way across multiple sites so that we can say this is a problem, and with an epidemiologic study, it creates the validity that this really is a problem.

What's up to future research and we even have fabulous researchers here in our Department of Pediatrics, what's up for these researchers is not just to accept that there's a problem, but then to look to see, well, where is this process breaking down, and they're doing that. And I'm looking forward to seeing the results they come up with, because that's the type of research, even though not done at an epidemiologic level, but done on a more fine-tuned, kind of make more granular level to figure out what exactly needs to change so that we can be successful.

Interviewer: I'm wondering if you think part of the problem might be that there might be a reluctance of parents to admit that there's something different with their child.

Dr. Bilder: Part of this process is beyond the typical office setting in regards to the pediatrician or the family doctor. Part of this process in addition to identifying which children are screening positive and then making the referral for those children to obtain a comprehensive evaluation is the part about it which requires the parent to be able to do so.

And if that parent were having a difficult time accepting that there might be something wrong with their child, that can unintentionally affect their willingness and speed at which they access a comprehensive evaluation for their child.

So as we look at this bigger picture, recognizing and measuring the gaps between that positive screen and the time at which the child presented for a comprehensive evaluation could really help us get a sense for if there is a delay, what could be causing it?

Interviewer: Do you have a recommendation for parents in maybe looking at their child or thinking about their child or their future or being screened for autism spectrum disorder?

Dr. Bilder: Well, every child, regardless of whether there is a concern or not, should be screened by their pediatrician or family practice doctor at 18 months of age and again at 24 months of age.

My recommendation is that when that medical provider expresses concern and makes the recommendation of referral to allow themselves to ask that provider, you know what specifically are they concerned about to be able to have an opportunity to be convinced that this is important.

As far as red flags for parents, like things to look out for, you want to look for a baby at six months of age, they should be smiling, having a reciprocal smile. So the mother smiles or the dad smiles and they smile right back and expressing joy even their facial expression of joy by six months of age. You should be expecting back and forth sounds and other facial expressions certainly by nine months of age.

They should be babbling or at least pointing to objects by 12 months of age and indicating that desire to engage and initiate that interaction with the caregiver. Using single words by 16 months of age. And then if by 24 months of age they're not using two words together in a meaningful way, that also is a red flag that they need to be evaluated.

I think the big red flag that's important for parents to be aware of because primary care providers go through these developmental milestones routinely during their well-child visits, the particularly important red flag for parents to be aware of is that if their child loses any social skills or language skills, then they really need an immediate visit with their primary care doctor even before the next well-child check. That is not normal. That itself should initiate a visit to their primary care provider for further screening.

Interviewer: And what's next for your research?

Dr. Bilder: We are excited to have received a four-year grant from the Centers for Disease Control and Prevention through the Autism and Developmental Disabilities Monitoring Network. We are thrilled to be part of this. What this funding does it allows us, the University of Utah, along with the Utah Department of Health and the Utah State Board of Education, to really enhance our case finding for children who are affected by autism as well as allowing Utah to be part of these national prevalence numbers that are established for the U.S.

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Announcer: "Health Hacks" with Dr. Troy Madsen on The Scope.

Dr. Madsen: Well, today's health hack is a trick to try and get a raisin or any other sort of foreign body out of your child's nose. Now, this health hack is a little bit gross, but it works, and it could save you a trip to the ER.

So if your child sticks something up their nose, a raisin or anything else they find around the house, you can't see it to pull it out and you're thinking to yourself, "There's no way I'm going to get this out." One trick is to have your child lie down on a couch or on a bed. You place your mouth on your child's mouth. You blow into their mouth forcefully, quickly, only maybe a second or two of forceful air into their mouth. That air then gets forced up through the nose and that is going to ideally force this raisin or whatever else is in there out of their nose.

Now, it's a little bit gross because you've got to put your mouth on your child's mouth, you have to blow in there, and most likely that raisin or whatever else is in there is going to get blown out onto your face with some mucus. But the good news is you avoid the trip to the ER. If you were to come to the ER with the same problem, I would probably ask you in the ER, "Are you willing to try this here? Because it can avoid a whole a lot of trauma to your child, a whole lot of probing around in their nose." So, if this happens at home, give it a try. There's good evidence that this works well. It can save you a trip to the ER.

Announcer: For more health hacks, check out thescoperadio.com. Produced by University of Utah Health.

Dr. Gellner: Have you ever noticed that kids will cough until they throw up? It happens a lot, and it can really freak parents out. But should it? I'll tell you more about kids coughing till they puke on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering "The Healthy Kids Zone," with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Face it. Kids cough a lot, and it can get so bad that parents think the coughing will never stop. And then it happens, vomit. Kids have a very active gag reflex. You probably noticed that when you tried to get your child eat something they don't like. Sometimes coughing hard can trigger this gag reflex, and often that's a good sign.

While older kids sometimes know how to hack up and spit out their mucus, younger kids aren't really good at it. So vomiting is the body's way of getting that mucus that they coughed up to come out. No one likes it when kids vomit. It makes a mess. It can sometimes be so forceful that it comes out their nose, and it scares the kids. But is it really a big deal when kids vomit from coughing? Actually it can be.

If your child looks very sick and the cough sounds unusual, it could be pneumonia. Some kids with asthma can cough and cough until they vomit too if they're having a bad attack. So what should you, as a parent, do if your child does vomit with coughing?

First, stay calm. Kids really pick up on when a parent is nervous about anything, and that will make them even more worried. Make sure your child is breathing okay when they are not coughing. If they are working hard to breath or gasping, they should be taken to the emergency room right away, or even call 911 to evaluate for vomit in the lungs.

Rinse your child's nose and mouth out to clear the vomit. If your child is an asthmatic, give them their rescue inhaler. If they are over 12 months old, give them a spoonful of honey to calm the cough. If it's just a one-time vomit episode and your child is otherwise breathing fine, get your child to be calm and breathe normally. But if your child continues to vomit after coughing, it's a good idea to have them then seen by their pediatrician the next day.

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Interviewer: Common myths about ADHD that prevent parents from seeking treatment for their children. Dr. Trevor Wilde, what are those misconceptions?

Dr. Wilde: Parents commonly think that, "Well, it's not a real problem, and it'll just go away." They think that medications are dangerous and should not be used, or they feel that that child just needs more discipline.

Interviewer: And then not getting them help is actually pretty detrimental?

Dr. Wilde: It certainly can be. It can cause delays in their school and their learning. It can also cause problems with the law down the road if these problems are not recognized and taken care of appropriately.

Interviewer: If a parent does have a child with ADHD, what's your advice then?

Dr. Wilde: Come in, talk with a medical professional, go through a thorough evaluation, and then let's work together to come to find out what will be the best solution or the best direction to go for your child.

updated: March 9, 2021
originally published: March 7, 2018

Interviewer: It seems like your kids' stomach bug is lasting forever. Pediatrician Dr. Cindy Gellner, how long is normal?

Dr. Gellner: We're seeing a lot of this lately, the stomach virus going around that causes vomiting and diarrhea. While vomiting usually stops in about 6 to 24 hours, diarrhea can last up to 2 weeks. So don't be surprised if that lingers. The good news is the first few days are usually the worst. If your child has vomiting without diarrhea and it last for several days, it's time to get checked out. If you see blood in the vomit and your child hasn't had a nosebleed or a mouth injury, get them checked out quickly in the emergency room, as it could be serious. And if your child hasn't peed for over 12 hours, it's also time to go to the emergency room. You're going to want to keep them hydrated. Small sips of clear fluids and no solid foods for about four hours once they've started vomiting.

updated: August 25, 2021
originally published: January 9, 2018

Interviewer: New surgical procedures can potentially change the life of children that suffer from epilepsy. We'll talk about that next on The Scope.

Announcer: Health tips, medical news, research, and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: New advances in surgery for drug-resistant epilepsy have the potential to improve many children's lives in a lot of different ways, but yet many kids who would benefit don't get it. Those that don't get these treatments oftentimes get worse. In this episode, we're going to find out more about new evidence and benefits of pediatric epilepsy surgery. And to find out more, we're talking to Dr. Matthew Sweney, he's the Medical Director of the Epilepsy Program at Primary Children's Hospital, and the Surgical Director of the program, Dr. Robert Bollo. Thank you very much for joining us today.

This is exciting stuff. So the first statement that really kind of intrigues me is, when it comes to surgical options to help children with epilepsy, many kids that would benefit from it don't get it. Why is that?

Dr. Sweney: Well, there's an entity in pediatric epilepsy that we call the treatment gap, and that is the gap from getting kids the appropriate care that they need for the severity of their epilepsy. And the treatment gap is a global phenomenon and one that we deal with locally, and it's held to a very specific standard as to when you become drug-resistant in dealing with your epilepsy. And that's a global standard in which two to three typical seizure medications are failing and you continue to have seizures.

Interviewer: And what's happening? So people are going beyond that?

Dr. Sweney: Yeah.

Interviewer: They just keep trying other things as opposed to going to the next steps?

Dr. Sweney: Yeah, there's a sense of somewhat of despair in which medication after medication is tried. And statistically we know, as epilepsy care providers, that when you fail two, sometimes three medications, the likelihood of any of the additional medications, which currently is around 12 to 15, the likelihood of any of them doing any significant benefit in regards to seizure control is low single digit probability. So it's a global standard set by the International League Against Epilepsy, which is kind of the international governing body in epilepsy management that says, if you fail two to three medications, you should seek more advanced care through a dedicated epilepsy program.

Interviewer: And this isn't happening. People aren't seeking more advanced care. Why is that?

Dr. Sweney: Well, there's a disconnect. A lot of care is provided by folks that aren't necessarily familiar with the details of epilepsy care and the different tools available. And so those outside of the area of a large center, like our own, might find that their doctor is telling them to just continue to try seizure medications one after the other, so that five, six, seven are tried and failed, and they just assume that this is the best that it's going to get.

Interviewer: And then after some medications are tried, there's like a process that you go through to help treat children with epilepsy, right? It starts out least invasive and then builds up to surgery, which can be very beneficial and we'll talk about here with Dr. Bollo in a second.

Dr. Sweney: Yeah, absolutely. It's a fairly set approach to what you do under the circumstances of drug-resistant epilepsy. There's cornerstones to the evaluation that consist of a really long EEG, which is a brainwave test used to characterize where the seizures are coming from. There's imaging that's involved to identify any structural abnormalities to the brain. And from that point, we can then determine what are all the options available in dealing with that epilepsy.

Interviewer: And there's new evidence out there that actually says that surgery is a really effective option, like you've known that it has been for a while, but just within the past month of the recording of this. Tell me about that new evidence, Dr. Bollo.

Dr. Bollo: Yeah, so thank you. There was a new study published in "The New England Journal" about a month or so ago that is really the first class one evidence we have for pediatric epilepsy surgery. And it was a large center in India actually, where they typically have a long waiting list for surgery, and they randomized children with all different types of epilepsy. So a very real world type study, all different types that might come into a center for either surgical treatment or to continue medications for 12 months, which had been their standard of care. And they found a significant difference in not only seizure freedom but benefits to children across multiple domains, including quality of life, behavioral health, and cognitive function, who got surgery. And in general, patients who continued on medications either got worse or stayed the same. At the end of the study, they had about 77% of patients who met the criteria for seizure freedom at a year in the surgery group compared to 7% in the medical group.

Interviewer: Wow. And if you're a parent with a child with epilepsy, that's significant.

Dr. Bollo: Yes.

Interviewer: Or if you're the child with epilepsy, right?

Dr. Bollo: Absolutely. And children who had surgery, their quality of life improved, their behavior health, their conduct, all of these things tended to get better across that population. So I think that's a very important study that sort of reinforces what we've known for a long time but really shows a significant degree of clarity and resolution that not only is continuing to have seizures bad for the developing brain, and surgery is certainly scary, but it's actually quite effective.

Interviewer: So surgery could lead to a much better life for that child, but not getting surgery could actually be bad as well. I think we tend to think not doing something means status quo, but that's not the case with epilepsy.

Dr. Bollo: It's not, especially in the developing brain, so especially in a child. There's clearly loss of function across those same domains of behavioral health, quality of life, and cognitive function with persistent seizures. We often talk about epilepsy as a disease that's bimodal. It's the old and the young, and it is much more common in children than in adults. And in children, it's much more common in very young children compared to older children. So it's really a disease affecting the brain that's trying to develop.

Interviewer: So coming back in a real world situation, if you have a child that has epilepsy and you've gone beyond this treatment gap you talked about, if you've gone beyond the two or three medications, which research shows after you've tried two or three, is that correct, that odds are the other 18 or whatever else might be out there is not going to be effective, that that could be a detriment if you then decide, "Well, let's try some more medications."

Dr. Sweney: That's true. We know it's almost like a glass ceiling when it comes to epilepsy therapy that, two-thirds of the time, a combination of two to three medications can stop seizures. That leaves a third of the time that's not going to stop, despite any attempt at further anti-epileptic medications. So, I mean, the treatment gap, from our standpoint, for practitioners out there and families out there who are dealing with epilepsy early in the stages of the disease, to know what the resources available are and to know what the next steps should be and to not be complacent and to not just accept the status quo.

Dr. Bollo: And I would agree with that and I think we need to acknowledge that surgery is extremely scary. All of the time, families come to us and they say, "But I don't want memory loss, and I don't want the prospect of visual loss or a loss of an essential function like motor function." And that's very important, and I think a big part of the psychology that has led to this treatment gap and leads to long delays in getting access to surgery. And so I think we see it as our responsibility to come up with better and better ways to do surgery, less and less invasive ways, in order to do it in a way that is less risky, less morbid, gets kids home, back to school, and back to regular life as quickly as possible.

Interviewer: Yeah, because that could be scary, right, thinking about your child having their brain operated on, that's a terrifying thing. And some of this new technology, it's very high-tech, robots, lasers. I was reading a description of one of the procedures, image-guided endoscopic surgery, which is that surgery that needs just a small little hole that you can perform complex brain operations for the treatment of epilepsy. And that's what you do. Talk about some of these treatments, help us feel more comfortable with them and where they've come.

Dr. Bollo: Yeah, no, thank you. So I think if you think about 10 years ago how we did things was we would often do very large craniotomies, very large exposures of the brain. And there are three kind of main reasons to do that. Number one is, because oftentimes, an EEG, a regular EEG that you think about on the scalp doesn't have good spatial resolution. It's hard to target the structures and figure out exactly where that seizure is starting in the brain. So oftentimes, we have to put electrodes in the brain or on the surface of the brain to get better spatial resolution, better maps.

Another reason might be to map the functional cortex, where is motor function, how does my hand move, where is sensation, where is vision, where is language function within the brain in this child. And especially if the seizure's coming from areas that are close to that, we need those different maps to do things safely.

A third reason is obviously resecting the epilepsy focus or removing the cause of the seizures. So to take the first one, we've gone from doing large operations and putting large electrode arrays on the surface of the brain to robotically placing depth electrodes that are very carefully targeted to different areas of the brain and different functional circuits within the brain, all through tiny little stab incisions. So we can put up to 18 or 20 electrodes, each of which has about 10 contacts on it, through these methods, using computer technologies and robotic technology very safely and very quickly. And then when we take those out, the kids can go home the same day.

Interviewer: Isn't that kind of amazing?

Dr. Bollo: It is amazing to see.

Interviewer: I mean, really?

Dr. Bollo: Yeah. I think families are blown away when they go through it. And I'm like, "Okay, you can go home," and they're like, "Really? How long do I have to stay out of school?" I'm like, "You don't."

Dr. Sweney: Families are routinely kind of astounded with what we tell them is kind of the expected recovery with these. They're expecting weeks to months of being incapacitated, just because surgeries 30 years ago would have that. But, you know, this isn't 30 years ago.

Interviewer: And things are only getting better. I remember when I had my tonsils out a long time ago, I was in the hospital for a couple of days, right. And I don't know if that's still the same but that just is amazing, compare and contrast that.

Dr. Bollo: Yeah, so a large, big opening on the side of one's head to multiple, just little incisions closed with a single stitch that'll absorb over time and right back home and right back to school.

Interviewer: And with pinpoint accuracy, being able to know exactly where you need to target the surgery and where the trouble spots are to avoid them so you don't cause no harm, yeah.

Dr. Bollo: Absolutely.

Interviewer: What's the next step for somebody that wants to learn more? I think that hopefully this conversation has maybe helped people overcome a couple of things. One, the treatment gap, realizing there is a set continuum of treatment, steps that you take, "If this one doesn't work, we're going to move to the next one, we're going to move to the next one." If you don't move down that, it could actually negatively impact your child. If you move along it, it could make things much better. And then the other thing is just becoming more comfortable with the technology and surgery, that it's maybe not the scary thing.

Dr. Bollo: Yeah, I think that our responsibility as providers, and our team takes that very seriously, that we need to make surgery safer, less risky, and easier on kids, and this new technology that we have facilitates that. And so we try to bring it together in a synergistic way and offer as minimally invasive a surgical treatment as we could have for any given child in any given situation.

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