On the Pulse

Preventing Throwing Injuries in Young Athletes

Young pitchers can avoid throwing injuries by following some simple guidelines.

According to The American Journal of Sports Medicine, more than 15 million people will be playing baseball and softball this spring and summer, nearly 5.7 million of which are children in eighth grade or lower. Dr. Michael Saper, an orthopedic surgeon and sports medicine specialist at Seattle Children’s, has some useful information about how young players can avoid arm injuries.

Before joining Seattle Children’s, Saper trained under Dr. James Andrews, a renowned orthopedic surgeon who has treated many professional athletes, including hall of fame pitchers Nolan Ryan and John Smoltz. It was in working with Andrews that Saper developed his passion and expertise for the treatment and prevention of throwing elbow and shoulder issues.

Saper noticed injuries that were common in high-level athletes occurring in younger athletes and realized that education about how to stay healthy is just as important as treating the patient after a serious arm injury occurs.

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Study: PAL Program Drastically Reduced State’s Antipsychotic Prescriptions for Children

The Partnership Access Line (PAL) has helped reduce antipsychotic prescriptions for Washington children enrolled in Medicaid by 49% since 2006.

Antipsychotic prescriptions for children enrolled in Washington state’s Medicaid program decreased by nearly half following the implementation of an innovative psychiatric consultation program affiliated with Seattle Children’s, according to a study published in the March 2017 issue of Health Services Research.

The 49% reduction in prescriptions from July 2006 to 2013 is a reversal from the steady statewide growth in the use of antipsychotics to treat children prior to the introduction of the Partnership Access Line (PAL). The number of children on Medicaid treated with antipsychotics in Washington decreased by 940 despite an increase of 186,855 enrollees in the joint Federal/state program during the study. According to the study, this counters a national trend of increased antipsychotic use with children from 2002 to 2015.

Other key findings in the study include:

  • High-dose antipsychotic use fell by 57.8% in children 6 to 12 years old; and by 52.1% in teens
  • 1,458 providers received a direct patient consult through PAL
  • 759 providers attended at least one of PAL’s 31 general psychopharmacology education conferences

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Study Links Exposure to Common Chemicals During Early Pregnancy to Altered Hormone Levels in Fetus

Food is the most likely source of exposure to the most harmful phthalates, which can also be found in household and personal care products.

Exposure during early pregnancy to some phthalates—man-made chemicals commonly found in household plastics, food and personal care products—can have adverse impacts on developing fetuses, according to a new study led by Dr. Sheela Sathyanarayana, a pediatric environmental health specialist at Seattle Children’s Research Institute and associate professor at the University of Washington.

The study, published in The Journal of Clinical Endocrinology & Metabolism, found that increases in exposure to certain phthalates during the first trimester of pregnancy was associated with higher estrogen concentrations and lower testosterone concentrations in the fetus, thus increasing the chance of a genital abnormality in male babies at birth.

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The Comfort of a Diagnosis and Knowing You Are Not Alone

Emmy Anderson and her daughter Wren sharing a happy moment

When your child is sick with a rare condition that can’t be named, the search for an answer can seem frustrating and hopeless. For Kirk and Emmy Anderson, navigating the lengthy diagnostic process for their daughter, Wren, was something they endured with the hope that an answer would eventually come.

By about 6 months of age, Kirk and Emmy noticed that Wren was not meeting her developmental milestones. After a febrile seizure led to a stay in in Seattle Children’s Neonatal Intensive Care Unit (NICU), they received the news that a brain MRI showed Wren had a decrease in the amount of white matter in the brain, as well as a fluid filled sack growing between her brain and spinal cord. Despite the findings, doctors didn’t yet know what was causing these issues to arise.

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Girl Born With Liver Outside Body Thrives as a Champion Gymnast

Kendall Stark was born with giant omphalocele, a condition where her liver protruded from her body. Now at 14 years old, she is a champion gymnast.

At 14 years old, Kendall Stark’s athleticism shines through her gymnastics medals and trophies that sit proudly on her shelf.

Glancing at this display, it might be hard to believe that the same young girl, who can bend, flip and dismount off the uneven bars eight feet from the ground, was born with a condition where her liver protruded from her body.

Kendall’s mother, Kyra Stark, was just 24 weeks pregnant when she was told by a doctor in her hometown of Billings, Montana, that her baby would be born with a condition called giant omphalocele.

Omphalocele is a type of abdominal wall defect where the intestines or other organs grow outside of the baby’s body and is covered by the layers of the umbilical cord, which forms a sac around them. It can vary in size and babies born with giant omphalocele face the risk of lung disease caused by organs squeezing against the lungs.

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Diagnosing Celiac Disease: Is It a Stomach Ache or Something More?

Today, Kyla Greenstein is an active 13-year-old girl who loves to skiing, among other sports.

From the time Kyla Greenstein was born, something wasn’t quite right with her digestion system. Kyla suffered from chronic diarrhea and bloating, and although she seemed to be an otherwise healthy child, it was concerning for her parents. It wasn’t until a well child check at the age of 5 when the family learned about an unexpected theory for their daughter’s tummy woes.

“On a day-to-day basis she was a happy child,” said Cindy Greenstein, Kyla’s mother. “But occasionally she would bloat and her stomach would be painful to the touch. We knew something was going on, just not what exactly.”

Her doctor recommended she be checked for celiac disease, and so the family was referred to Seattle Children’s where the diagnosis was confirmed.

Celiac disease is an autoimmune disorder. When someone with celiac disease eats gluten, a protein found in wheat and rye, it causes an immune system reaction and stimulates the body to attack the small intestine.

“Celiac is really common, occurring in about 1 in 100 people,” said Dr. Dale Lee, a gastroenterologist at Seattle Children’s and director of Seattle Children’s Celiac Disease Program. “It’s tricky because the presentation of celiac can be different for everyone. The symptoms of celiac can be quite variable, and so many people go undiagnosed.” Read full post »

Small Innovation Helps Train the Next Generation of African Cleft Surgeons

Cleft lip and cleft palate occur when part of the lip or roof of the mouth (palate) does not form properly.

When Dr. Richard Hopper, surgical director of Seattle Children’s Craniofacial Center, and his team of experts identify a problem, they won’t stop thinking about ways to solve it. Such was the case when they invented a device to help teach doctors in Africa how to perform cleft lip and palate surgery.

Cleft lip and cleft palate are birth defects that occur when part of a child’s lip or roof of the mouth don’t form properly, leaving a gap, or cleft. Cleft lip and palate are some of the most common birth defects in the U.S., occurring in about one in 4,000 babies. In Africa, the statistics are similar; however, the lack of medical care and shortage of surgeons to repair the birth defects can cause a cascade of problems for newborns, including malnutrition, social isolation and premature death.

Solving a problem through innovation

“When I visited Ghana for the first time, we found one of the greatest needs was in engaging and training more African doctors to perform the cleft lip and palate surgery,” said Hopper. “It’s a very technical surgery and you need a lot of education before you can do it safely.” Read full post »

Raising the Bar

Rini Olson, now 5, was dying in a Chinese hospital when she was adopted by Andrea and Eric Olson and brought home to the United States with hopes for a heart transplant. Dr. Erin Albers (left) and transplant nurse coordinator Pam Hopkins are part of the team that guides Rini and her parents through the follow-up care that keeps her new heart healthy.

When Andrea and Eric Olson adopted their daughter, Rini, from China, she was 22 months old and needed a heart transplant. But pediatric heart centers across the United States told the Olsons, who live in Salem, Ore., that Rini was too malnourished to endure the operation.

“We got ready to say goodbye,” Andrea Olson remembers. “Then Seattle Children’s called and said they would consider Rini for a transplant. I couldn’t stop crying — I could tell from Rini’s eyes that she didn’t want to give up.”

Families travel from around the world to Seattle Children’s Heart Center because, like the Olsons, they’ve been told their child is too medically complicated or too fragile to survive a transplant. Seattle Children’s is using innovative approaches to expand the boundaries of heart transplants and give these families hope. The center’s survival rates are among the nation’s best — more than 92% of patients live for more than three years after heart transplants.

“Sometimes you have to try something new or a child is going to die,” says Dr. Michael McMullan, who directs the transplant surgery program. “Those kids deserve a chance to live, and we believe we have the expertise and experience to be successful even when we’re doing something that hasn’t been done before.” Read full post »

Patient Families SHIFT to Peer Advisors as Weight Management Treatment Study Progresses

Heather Armstrong and her daughter, Lauren, saw positive results from their time in the SHIFT study last year. Armstrong is now a SHIFT peer interventionist helping other families.

Heather Armstrong made a commitment to a healthier lifestyle when she volunteered herself and her 8-year-old daughter, Lauren, for a weight management treatment study at Seattle Children’s Research Institute.

For five months, Armstrong and Lauren attended weekly sessions in the Success in Health: Impacting Families Together (SHIFT) study that provided guidance and education to help them reach and sustain better eating and activity behaviors and ultimately better weight management. The sessions focused on healthy eating, supporting children throughout behavior changes, improving the home environment for physical activity and healthy eating, building confidence and incorporating more physical activity into family life. Read full post »

Sneaky Sodium is Hard on the Heart

Nearly 90% of kids in the U.S. consume too much sodium, putting them at risk for high blood pressure in childhood, and heart disease and stroke later in life. While everyone needs a small amount of sodium to help control the fluid balance in the body and allow nerves and muscles work, too much sodium is harmful and is dubbed the ‘silent killer.’

In honor of American Heart Month, On the Pulse asked Kirsten Thompson, a dietitian in Seattle Children’s Pediatric Hypertension program, to provide insight into how kids are consuming so much sodium.

“When I ask patients and families about sodium intake, they often say that they don’t eat too much sodium because they don’t add salt from the salt shaker to the foods they eat,” said Thompson. “They’re often surprised to learn that sodium is actually hidden in a lot of foods that we wouldn’t normally think of as salty.” Read full post »