The Child Advocacy Center at Children’s Hospital: Protecting Our Most Vulnerable Children

By Rachel Berger, MD, MPH, chief, Child Advocacy Center

Berger_RachelP_MD_9246webApril is National Child Abuse Prevention Month. As a pediatrician who cares for children who have been victims of abuse and neglect, I look forward to April as a time when my colleagues and I are given the opportunity to raise awareness about child abuse in the community, in the media, and in blogs such as this one.

Child abuse is more prevalent than we want to admit — one out of 111 children in this country are substantiated victims of abuse every year. And this almost is certainly a significant underestimate. By comparison, one in 10,000 children in the United States are diagnosed with cancer every year. But, how many times have you participated in fundraising walks to raise money to fight childhood cancer? How many times have you been asked to donate to childhood cancer research when you make a purchase in a store?

More than 1,500 children die every year from abuse; 80 percent of these children are younger than 4 years of age. That’s more than four children every day. Child abuse is the leading cause of death due to brain injury in young children. What’s killing our children is no longer infection. What is killing our children is injury, and a large percentage of those fatal injuries are from child abuse.

What does this mean for us in western Pennsylvania? At the Child Advocacy Center at Children’s Hospital of Pittsburgh of UPMC, a team of forensic specialists interviews close to 600 children every year who have made disclosures of sexual abuse. A team of physicians, social workers, and therapists have evaluated more than 400 children in the past 12 months who were admitted to Children’s with injuries due to physical abuse or neglect, including broken bones, brain injuries, toxic ingestions, and abdominal injuries. Our physicians, nurse practitioners, and nurses evaluate over 1,500 children every year in the outpatient clinic called ARCH (Advocacy Resources for Children). These are children with less serious, but still significant injuries, such as bruises, failure to thrive due to neglect or a poor environment, and children in foster care who often have many unmet medical needs.

I’ve been working in the field of child abuse for almost 15 years and unfortunately, I can say that the problem of child abuse and neglect is not getting better. What compounds the problem is that children who have been victims of abuse have no voice. They cannot advocate for themselves. Rarely do they have parents who can advocate on their behalf. Their parents are not going to Congress and asking for help. Their parents are not going to appeal for more funding for research to prevent and treat child abuse. We must be the voices for children who cannot advocate for themselves.

There is some good news. The Pennsylvania Task Force on Child Protection, which was established in large part due the Jerry Sandusky case, completed its work and submitted its recommendations to the Pennsylvania Legislature in November 2012. As a result of the recommendations, more than 10 new bills have been signed into law by the governor with several more expected to pass. These new laws will, hopefully, protect Pennsylvania’s children better than our previous, outdated laws. More recently, the Obama Administration established the National Commission to Eliminate Child Abuse and Neglect Fatalities. The commission met for the first time in February 2014 and will be making recommendations to Congress in late 2015 or early 2016.

People often ask what they can to do to help. The answer is “almost anything.” You can donate time and volunteer for one of the many wonderful nonprofits in our county who serve these children and their families. You can call your local legislators to advocate for the passage of laws that protect children and for funding to support agencies throughout the Commonwealth that serve children who are victims of abuse and those at highest risk of abuse. You can donate money to support research to determine how to recognize abuse as early as possible and to support education of the public, physicians, lawyers, emergency medical technicians, teachers, and police officers. Though education, we can ensure that everyone who interacts with children knows how to recognize abuse and how to intervene early because that’s when the outcomes are the best.

To learn more about the Child Advocacy Center at Children’s Hospital of Pittsburgh of UPMC, please visit www.chp.edu/CHP/cac and consider attending the 9th Annual Child Maltreatment Conference, which will be held April 24-25, 2014.

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Applying the Science of Nutrition to Family Meals

By: Ann Condon-Meyers, RD, LDN, Children’s Hospital of Pittsburgh of UPMC

ann condon meyersMarch is National Nutrition Month, which is good news for licensed dietitian nutritionists (LDNs) because it gives us a chance to blog about our favorite subject … food! Now, to be fair, food is something we all love to talk about regardless of our age or expertise in the kitchen. Everyone has strong opinions about foods in my house and I’m sure in your house as well.

As the science of nutrition grows, our feelings about foods grow more complex as well.  Unfortunately, foods often get a bad rap in these scientific studies setting off either fear or worship of specific foods. What to feed our families often seems unclear in light of the newest scientific studies.

The U.S. Food and Drug Administration (FDA) announced last week a proposal for new labeling guidelines that will attempt to assist us to make better food choices by giving us more useful information about the foods we buy in our grocery stores. Some of the changes include more realistic portion sizes, stating whether sugar has been added to a product and if so how much, and an update of the percentage of daily values based on current nutrition science.

First Lady Michelle Obama gave this statement to the press in regards to the FDA label changes proposal: “You as a parent and a consumer should be able to walk into your local grocery store, pick up an item off the shelf and be able to tell whether it’s good for your family.”

I hope she is right. Most of us are looking for ways to improve the nutrition of our families112808754_5 and these new labels should help us make informed choices when we shop for our family meals. Unfortunately, the new label guidelines will not be finalized for another year and manufactures will have another two years to comply with the guidelines. What do we do in the meantime? Let’s apply what we currently know about nutrition to our family meals:

1. Research tells us that the simple act of eating together will have lasting positive effects on relationships in families and the nutrition we consume. Whether it’s “take-out” or Grandma’s recipes, the time together is priceless. Remember to turn off all electronic devices!

2. Variety is still the spice of life. Serving your family a variety of foods will go a long way in improving their nutrient intake. And if you have some picky eaters at your table, check out the book “Fearless Feeding” by Jill Castle and Maryann Jacobsen for lots of sound advice on how to allow your children to “expand” their food choices.

3. Cook more often. Even if you only prepare and share one meal at home together each week, you will be setting a great example for your children. Most children love to make things in the kitchen and research shows they will be more receptive to new foods they have prepared themselves. Not a natural-born cook? Keep it simple. An easy recipe can be just as nutritious as one that takes all day to prepare.

Here is one of my favorite family recipes that is easy to prepare and good for you. It is an Irish dish that I always make this time of year. You can use an electric mixer to mash the potatoes but your kids might enjoy the challenge of “smashing potatoes” themselves! A quick substitute for the kale is a ½ bag of shredded cabbage and carrots sautéed in 2 tablespoons of olive oil or butter.

This version of Colcannon is from EATRIGHT.org, the web site of the American Academy of Nutrition and Dietetics.

Colcannon (Mashed Potatoes with Greens) Recipe

Recipe by Roberta L. Duyff, MS, RD, FADA, CFCS

Tip: Either choice — kale or cabbage — is traditional, but kale makes this dish greener and more nutrient-rich.

Ingredients
2 pounds baking (russet) potatoes, peeled, cut in 3-inch chunks *
2 medium parsnips or carrots, peeled, cut in 2-inch chunks *
2 tablespoons unsalted butter or soft margarine, softened
1/4 cup low-fat milk
1/2 teaspoon mace
1/2 teaspoon salt
1/4 teaspoon pepper
2 cups chopped fresh kale
1/3 cup chopped green onion

Directions
1. Place potatoes and parsnips in a large pot, and cover with water. Bring to a boil.

2. Reduce heat, cover and cook for about 20 minutes until potatoes and parsnips are tender but not falling apart. Drain; add butter, milk, mace, salt and pepper.

3. Meanwhile blanch the kale in a medium saucepan by immersing it in boiling water for about 1 minute. Drain.

4. Mash the potatoes and parsnips with a potato masher or fork. Add kale and green onion; mix well.

5. To reheat if needed, cover mashed potatoes and place over very low heat for 5 minutes. Fluff with a potato masher or fork before serving.

Cooking Note
* Leave peels on potatoes and carrots, if desired, for more fiber. Since parsnips typically have a wax coating, they need to be peeled.

Nutrition Information
Serves: 6
Calories: 190, 
Calories from fat: 40; Total fat: 4.5g; Saturated fat: 2.5g; Trans fat: 0g
Cholesterol: 10mg; Sodium 220mg
Total carbohydrate: 35g; Dietary fiber: 4g; Sugars: 3g;
Protein: 5g

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Keeping Your Teeth Healthy!

By: The Dental Team at Children’s Hospital of Pittsburgh of UPMC

dentalFebruary is National Children’s Dental Health Month, which is sponsored by the American Dental Association to raise awareness about the importance of children’s oral health.

Did you know that every year, dental disease causes children to miss 51 million school hours? New reports show that 60 percent of children will have at least one cavity by the age of 5. Developing good habits at an early age and scheduling regular dental visits helps children get a good start on a lifetime of healthy teeth and gums.

Here at Children’s Hospital of Pittsburgh of UPMC, the Division of Pediatric Dentistry provides dental care to approximately 15,000 infants, children, teens and patients with special health care needs every year.  We take great pride in caring for the dental health of the children in the greater Pittsburgh area and strive to increase the awareness of children’s oral health in our community.

Dental Fun Facts:

- Babies should have their first dental exam by age 1 or six months after they get their first tooth.

-Some babies are born with teeth.

-Children should never take any liquids other than water to bed with them.

-Kids lose their first baby tooth at around age 6.

-Alligators get five different sets of teeth in their life.

-Humans have 20 baby teeth and 32 adult teeth.

-Some flavors of Gatorade have more sugar than Mountain Dew.

-Even “all natural” fruit juice has a lot of natural sugar and acid, which can cause cavities.

-Tooth decay is the most common chronic disease of childhood. It is five times more common than asthma and seven times more common than hay fever.

-You should change your toothbrush every season (spring, summer, fall, winter).

For more information on the Division of Pediatric Dentistry, visit www.chp.edu/CHP/dental.

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Adolescents and Young Adults (AYAs) with Cancer Need Specialized Care

By Peter Shaw, MD, Director, Adolescent and Young Adult (AYA) Oncology Program, Division of Pediatric Hematology/Oncology, Children’s Hospital of Pittsburgh of UPMC

shawThe ages of 15 to 25 are a difficult time in anyone’s life: you are physically and emotionally still maturing, in the midst of school or working, and most importantly, just trying to define who you are as an individual and where you fit in with your peers. If you throw a new diagnosis of cancer into the mix of what adolescents and young adults, or AYAs, have to deal with, one can only imagine the impact it can have at  such a point in a young person’s evolution into adulthood. Everything gets put on hold:  your school, extracurricular activities, your job, and even some of your important relationships. It is like someone hit the “pause” button on your life just when you were getting some momentum.

Every year, 70,000 new adolescents and young adults (AYAs) in the United States are diagnosed with cancer.  These patients aged 15 to 39 have had stagnant cure rates while older and younger cancer patients have seen overall improvement. In 2006, I was invited to a national meeting in Denver which was called to address this issue and brought pediatric and medical oncologists together with other experts to examine this problem. The AYA Progress Review Group (as the meeting was called) concluded that there were several reasons these patients are not seeing the same successes as older and younger cancer patients:

  • Less access to cutting-edge clinical trials
  • Less access to insurance
  • Lower suspicion of cancer by health care providers leading to delays
  • Referral patterns, meaning physicians without the proper expertise/best therapies are treating these patients:

For example it has been established internationally that for some diseases such as acute lymphoblastic leukemia, AYA patients have significantly improved survival at five years when treated on pediatric regimens at pediatric centers.

  • Poor compliance with care

If you are interested, the report is available free at the following link: http://planning.cancer.gov/library/AYAO_PRG_Report_2006_FINAL.pdf

We also know that AYA oncology patients are not children and not truly anchored inDSC_0268 adulthood, so they cannot be treated as either bigger children or younger versions of older cancer patients. That is why I started an AYA Oncology Program at Children’s Hospital of Pittsburgh of UPMC not long after the 2006 PRG was held — to address these issues and improve the care AYA cancer patients receive in western Pennsylvania. We realize that patients in this age range require a specialized team approach to treat their cancer, which is why we work with medical oncologists, surgeons, radiation oncologists, and radiologists to make sure we are offering our patients the most up-to-date therapy.  As a member of the Children’s Oncology Group (COG), we offer clinical trials from the largest pediatric cooperative group in the world, with many of them accepting patients as old as 30.

We also realize that we have to treat the whole person for his or her special needs, so we have social workers, an embedded psychologist, and fertility specialists at Magee-Womens Hospital of UPMC as part of our team.  We also have Child Life specialists who give these patients age-appropriate electronic media to pass the time in the hospital and clinic as well planning social outings specifically for our AYA patients, such as our annual Seven Spring ski weekend.

We are proud of what we have built, yet seek to make it better and better so we can close the survival gap for AYA cancer patients and care for them as the unique patients they are!

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My Two Year Concussion – Journey to a Headache-Free Day

By: Jennifer and Chris Carlin, parents to Alex Carlin, patient at Children’s Hospital

img059It was August 18, 2011.  After conditioning all summer with the high school football team, camp had finally arrived.  Alex was in amazing physical shape and being very sturdy and strong for his age, he was excited to join the team. Alex had spent four years playing football and devoted his entire summer to conditioning. At the age of 14, Alex was making many new friends with fellow ninth graders as well as upperclassman.

Football camp consisted of physical contact practice three times a day. Alex doesn’t remember a specific hit that was extra hard. Maybe it was too many consecutive hits. Whatever it was, at the end of the day…Alex had a headache.

Alex stopped practicing as soon as the headache occurred. The trainer was obviously concerned and told Alex to rest; maybe it was dehydration. With a continuous headache the next day, the trainer had Alex take ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) and the results were not favorable.

After a month of having a continuous headache, the concussion doctor referred Alex for a trial of medications to relieve the headache. None of the eight medications that were used over that year helped with his concussion symptoms. In fact, his symptoms progressively increased. They reached the point that Alex had a continuous pounding headache every day. There were days that his head hurt so badly that he could not even speak. The doctor was concerned, so she referred Alex to Catalina Cleves-Bayon, MD, headache specialist in the Brain Care Institute at Children’s Hospital of Pittsburgh of UPMC. Dr. Cleves-Bayon was incredibly sincere, professional, and knowledgeable. By the way she spoke to Alex, it was obvious that she knew exactly how Alex felt and was very aware of his symptoms. Past medications had horrendous side effects, so she administered one more medication. The reason for trying one more medication is that most medical trials before had been inadequate. When that medication failed, she declared that medications were toxic to Alex. She immediately took him off all medications and referred Alex to Angela Garcia, MD, in the Division of Pediatric Rehabilitation Medicine.

Dr. Garcia was amazing from the start.  If it weren’t for Dr. Garcia, Alex would still be suffering.

Upon exam, Dr. Garcia felt that Alex had issues with his neck and immediately referred2013 X-Mas Pics 149 him to physical therapy.  She took the time to research who would be the best therapist to help Alex. We were shocked that a physician would actually take the time to ensure such a specific therapist.

Dr. Garcia’s efforts were a godsend. The referred physical therapist was highly skilled and was able to greatly improve Alex’s neck issues. It was during physical therapy that the therapist discovered raising Alex’s head about 1/8 of an inch when he lay on his back almost instantly made his headache go away. So back to Dr. Garcia we went. Dr. Garcia diagnosed Alex with occipital neuralgia, a neurological condition in which the occipital nerves — the nerves that run from the top of the spinal cord at the base of the neck up through the scalp — are inflamed or injured. After discovering this, she immediately sent Alex to see Dr. Samantha Kanarek, a sports and spine fellow for UPMC Physical Medicine and Rehabilitation, for injections in the C1-C2 area of his upper neck.

Upon arrival to meet with Dr. Kanarek, we learned that Dr. Garcia had already spoken to Dr. Kanarek, obviously at length, because she already knew Alex’s entire story. The injections and their effects were exactly how Dr. Garcia explained them to us. This was the final piece that cured Alex and finally ended two extremely long, painful, and horrific years of suffering from severe concussion symptoms.

The doctors at Children’s Hospital are amazing.  We met many people over the course of Alex’s injury.  It took a team of doctors to help find the answers to heal Alex’s concussion.  Children’s doctors are in a league all of their own!  Dr. Garcia gave Alex hope that he’d get better and her positive and chipper attitude made the appointments very pleasant even though Alex wasn’t feeling well. All of the doctors we encountered at Children’s were very special and made Alex feel a very personal connection with them. He didn’t feel that he was just another patient, but rather a true human being who they (especially Dr. Garcia) actually cared about and were determined to help.  After two very long years of suffering, Alex is finally feeling well. It brought a tear to my eye when Alex gave Dr. Garcia a big hug as we left our last appointment.  It took a team and Dr. Garcia to give Alex his life back.  Alex can now be a healthy 17-year-old boy, and begin to make up all the fun that he missed.

It was a complete pleasure working with all of the physicians at Children’s.  Alex went through two very difficult years and Dr. Garcia is our hero and we are forever grateful for her help.

We’re glad to have Children’s EVERY DAY.  They were there for our son and are there for your children too!

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Staying Safe This Halloween!

By Chris Vitale, MSN, RN, Injury Prevention Manager, Children’s Hospital of Pittsburgh of UPMC

VITALE_C_RN_CAMEO_CHP_20100803Halloween is always an exciting time of the year for both children and adults, but parents especially need to be aware that it can be one of the most dangerous nights of the year for young children who are out trick-or-treating. Keep these tips in mind so an injury doesn’t spoil this fun family event:

• Look both ways when crossing the street and don’t cross between parked cars — use crosswalks.
• Be sure costumes fit well. Place reflective tape on them or make sure they are brightly colored, not a tripping hazard, and are fire-resistant.
• Never trick-or-treat alone! Walk in groups or with a trusted adult.
• Use a flashlight in the evening and walk — don’t run!
• Avoid masks, and choose make-up that is non-toxic and meets federal standards.
• Stay in familiar neighborhoods.
• Instruct children not to eat any treats until they get home and an adult has checked them. Make sure the candy is not homemade and also throw out unwrapped treats or anything that looks like it may have been opened or tampered with.

Parents: Please take a look at the additional safety tips for Halloween:

• Talk with preschoolers in advance about what is real and make-believe so they are notTrick or treat - childhood activities frightened.
• Keep your home well lit for trick-or-treaters.
• Clear walkways and pathways around your home.
• If you are on the road, be extremely cautious on Halloween. Expect kids to do the unexpected — slow down!
• Contact the police for any suspicious treats.

For more information and safety tips for the Halloween holiday, please visit http://www.chp.edu/CHP/Halloween+for+Parents.

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Bullying Prevention – What All Of Us Can Do!

By Elizabeth Miller, MD, PhD, Chief, Division of Adolescent Medicine, Children’s Hospital of Pittsburgh of UPMC

MILLER_ELIZABETHLast week, I had the privilege of joining an assembly with Penn Trafford Middle Schools as part of 100.7 Star’s “Shine a Light on Bullying” campaign, sponsored by UPMC.  Along with Bubba from the morning talk show, Bubba’s two daughters (both of whom have experienced bullying), stars from Lifetime’s hit show, “Dance Moms,” and the band, A Great Big World, I had a chance to talk to students about what they can do to stop bullying if they see it in their schools and communities. When we asked students who had ever been bullied or knew of someone being bullied, EVERYONE raised their hand.

October is National Bullying Prevention Month, so first, some national statistics. In 2010, an estimated 2.7 million children experienced bullying. In Kindergarten through grade 12, about 1 in 7 students report being either bullied or being the aggressor. More than half of the bullying incidents happen in school. The magnitude of the problem is staggering.

The latest research finds that bullying behavior is related to other forms of interpersonal violence such as adolescent relationship abuse and sexual violence. Homophobic teasing (calling someone “gay” to make fun of him or her) and holding more rigid ideas about how boys and girls should behave differently among school-age children are strongly associated with participation in sexual violence perpetration later in adolescence. Increasingly, bullying prevention programs recognize the need to address such prejudice among children that leads to discrimination and ultimately, profoundly hurtful behaviors.

For youth who are being bullied, it is critical for them to understand and hear from those around them that it is NOT their fault. Remember that the problem lies with bullies choosing to be cruel, not because the individual deserves in any way to be mistreated. Bullying experts recommend that children who experience bullying should be taught to document the bullying:

  • Write down specifics about verbal taunting.
  • Take pictures of any property damage or physical injury.
  • Take screenshots of cyberbullying.

Then, the child and his or her parent or adult caregiver are encouraged to bring that documentation to school to make a formal report, and work with the school to create a written plan on steps to be taken to protect the young person. This plan should be revisited in a couple of weeks to see if any revisions are needed.

What we are learning from research on bullying is that the most important aspect of prevention appears to be teaching children skills in empathy and teaching them not to tolerate their peers being abusive and harmful toward others.  Also called the positive bystander approach, these bullying prevention programs teach youth to be an ally, not to ignore or do nothing when bullying behaviors occur. In addition to teaching youth to speak up and say something to stop the behavior, they also need to be encouraged to use strategies like:

  • Distracting the aggressor
  • Engaging the child who is the target by inviting him or her  to lunch
  • Getting the target involved in another activity elsewhere
  • Sending a supportive text to the target

Children also should be encouraged to talk to a trusted adult (at school if this is occurring in school) to investigate and to help.

An area that is particularly challenging for parents is bullying that occurs through texting and other social media such as Facebook and Twitter, also called cyberbullying. Children should be reminded NEVER to share their password with a friend, use the strongest privacy settings available, never to impersonate someone else online, and never to talk about sex with strangers online.  If being targeted via texts or social media, the key is to disengage: Block and delete the aggressors. Parents can also help by having a rule that all cell phones and computers stay outside of the bedroom when it’s time to sleep. In one national study, more than a quarter of youth report receiving texts in the middle of the night.

In summary, bullying occurs far too often, but there is something that we all can do to stop such cruel behaviors. We can teach children how to practice daily acts of kindness; encourage them to reach out to other kids who are being bullied or isolated; and interrupt bullying behaviors.

Below are some local and national resources that may be helpful.  You can also always find me in the Division of Adolescent Medicine at Children’s Hospital of Pittsburgh of UPMC by calling 412-692-5325.  If you are in crisis and in need of immediate support in Allegheny County, call the re:solve Crisis Network hotline at 888-796-8226.

Persad Center
https://www.persadcenter.org/
888-873-7723

PFLAG Pittsburgh (Parents, Families, and Friends for Lesbians and Gays)
412-833-4556
info@PFLAGPgh.org

GLSEN (Gay Straight and Lesbian Education Network)
http://glsen.org/chapters/pittsburgh

StopBullying.gov
http://www.stopbullying.gov

Cyberbullying Research Center
http://www.cyberbullying.us

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