Research

Those three attention-grabbing words can often make parents a bit uneasy when they think about how they relate to their kids. The words are also the title of a new book from Megan Moreno, MD, who heads up the Social Media & Adolescent Health Research Team at Seattle Children’s Research Institute.

Moreno is an adolescent medicine specialist at Seattle Children’s and she sees patients on a regular basis. Her aim, based on her research, is that healthy Internet use will one day be discussed in the same way we tell young people to get enough sleep, to drink in moderation and to eat healthy foods. She even sees it as a topic that will be brought up in the doctor’s office one day. Have you had your vaccinations, talked about safe sex and discussed your Facebook and Twitter habits?

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Vaccine hesitancy is on the rise. Nationally, it’s an issue, and the non-medical exemption rate continues to increase annually. According to the Centers for Disease Control and Prevention, 4.6 percent of children entering kindergarten in Washington state in 2012 had an exemption, and the figure was 6.1 percent in Illinois and Vermont.

Our Seattle-based team of researchers has been investigating if there’s a valid way of identifying parents who are hesitant enough early on in their child’s life that they will accept fewer immunizations than is recommended. Knowing early whether a parent is hesitant and will under-immunize their child might be helpful to clinicians as they try to understand and lessen a parent’s vaccine concerns.

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It’s 9 a.m. on a recent rainy morning in Seattle. Julie Park, MD, has her shoes drying out by the heater in her office at Seattle Children’s Hospital. She’s on a conference call with doctors and statisticians from Germany, Canada, the U.S. and Europe, and they’re discussing neuroblastoma, the most common solid tumor in children younger than 1 year of age.

Park leads the Neuroblastoma Committee for the Children’s Oncology Group (COG), the world’s largest organization devoted to childhood and adolescent cancer research. COG is supported by the National Cancer Institute (NCI) and unites more than 8,000 experts at more than 200 leading children’s hospitals, universities and cancer centers across North America, Australia, New Zealand and Europe.

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In honor of Childhood Cancer Awareness Month, we will be sharing a series of stories about some of our incredible patients who have overcome cancer or are currently fighting the disease.

In the beginning of June 2012, Jake Steiner was on top of the world. At age 18, he had just graduated high school and was looking forward to working as a camp counselor at the Museum of Flight in Seattle over the summer. He would then be heading off to college at Santa Clara University in the fall. Life was good.

That is, until one week after graduation.

Jake had noticed a pain in his leg and he had a bump on the backside of hip bone that was about the size of his hand. He thought he had just pulled a muscle and a little TLC would take care of it, but his dad took him to a doctor because the bump was so large.

It was then that he got an MRI and received some of the worst news of his life: He was told that the bump was a malignant tumor, and after three weeks, he learned it was Ewing sarcoma. Ewing sarcoma is a bone cancer that mainly affects children and adolescents between the ages of 10 and 20 years old. It’s the second most common bone cancer in children, but only accounts for about 1 percent of all childhood cancers. There are about 200 new diagnoses of the disease in people younger than 20 years old in the U.S. each year.

“I didn’t know what my future was going to hold, but I knew I was not going to be able to go to college in the fall, which really bummed me out,” said Jake. “I was also very scared because I thought I caught it too late and I didn’t know if the cancer had spread. I thought I would die young, and that terrified me.”

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When “Glee” star Cory Monteith died last month from an overdose of heroin and alcohol, his fans were baffled. Monteith, 31, seemed to have everything—a great job, fame and a loving girlfriend and co-star. He had just completed a stint in rehab in April, too. But the pull of addiction is strong and even the smartest people don’t make the best decisions when faced with temptation.

Now, a team led by Susan Ferguson, PhD, from Seattle Children’s Research Institute, and John Neumaier, MD, PhD, from the University of Washington, has used a new technique to identify and learn more about a key reward-based, decision-making part of the brain, the striatum.

The team’s findings have implications for addiction, attention deficit/hyperactivity disorder and obsessive compulsive disorder. Perhaps one day, with the help of medications targeting this part of the brain, addicts like Monteith can better control their urges and avoid tragic endings.

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An 8-year-old girl comes to the emergency room with what her parents think is stomach flu, then is rushed into surgery after X-rays show she swallowed three tiny magnets. A toddler eats magnets that look like candy, then has part of her bowels removed after the magnets click together inside her.

They’re stories that make parents squirm – and they’re becoming all too familiar to Julie Brown, MD, co-director of pediatric emergency medicine research at Seattle Children’s. Brown treats children in Seattle Children’s Emergency Department and is seeing more and more cases where kids accidentally swallow magnets or insert them into their nose, ears or other orifices, with potentially life-threatening consequences.

In a study published Aug. 6 in Annals of Emergency Medicine, she and her colleagues found that this is a national trend: From 2002 to 2011, there was a significant increase in kids receiving emergency care after accidentally taking magnets into their bodies, indicating that magnet-related injuries are an increasing public health problem for children.

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Recent research presented at the American Psychological Association’s meeting in Honolulu finds that about one in three American teens report being victims of dating violence. Almost one in three teens also acknowledge they’ve committed violence toward a date.

Researchers analyzed information collected in 2011 and 2012 from 1,058 youths, ages 14 to 20, in the Growing Up with Media study, a national online survey funded by the Centers for Disease Control and Prevention. The study defines teen dating violence as physical, sexual or psychological/emotional violence within a dating relationship.

“When we think about violence, we often think about someone being punched or beaten. Physical abuse is a devastating type of dating violence, but psychological and sexual violence also hurt keenly and can cause lasting damage,” said Jen Brown, a nurse with Seattle Children’s adolescent medicine team.

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The new technique was recently published in the journal of Plastic and Reconstructive Surgery, “Normalizing Facial Ratios in Apert Syndrome Patients with Lefort II Midface Distraction and Simultaneous Zygomatic Repositioning.”

Apert syndrome is a rare condition that occurs in one of 45,000 to 160,000 live births. For the children it affects, it’s very complex and is not only challenging to live with, but it’s also very difficult to treat.

That is, until now.

Thanks to Richard Hopper, MD, surgical director of the Craniofacial Center at Seattle Children’s Hospital, there is now a new treatment method that offers kids with Apert syndrome the opportunity to have a much better quality of life.

The new surgical approach not only treats symptoms more effectively, but also treats the “look” of the syndrome, offering children the chance to have a more normal face and head shape.

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Diabetic ketoacidosis (DKA), a complication of type 1 diabetes, is one of the most serious and potentially preventable conditions affecting children with diabetes today. A new national study led by Seattle Children’s found a wide variation in cost, length of stay and readmission rates for children with DKA.

“Delivery of care for diabetic ketoacidosis in the U.S. is not ideal,” said Joel Tieder, MD, MPH, of Seattle Children’s Research Institute. “One out of five diabetic ketoacidosis admissions are potentially preventable. Hospitals and doctors and nurses who care for children with diabetes should take a look at our data to see if there’s room for improving healthcare delivery on their home turf.”

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This week medical experts from across the country will gather in Seattle to discuss “Cases That Keep Us Awake at Night,” the theme of the 2013 Pediatric Bioethics conference. It’s not uncommon for things to keep us awake at night—a disagreement with a friend or neighbor or anxiety over a big work assignment—but the issues that clinicians and bioethicists will tackle at this confab are quite different.

Most of us, for instance don’t often think about the following questions:
• Should an organ transplant be performed over a family’s objections?
• Should Child Protective Services intervene when a family fails to address the eating habits of a morbidly obese child?
• Should healthcare professionals withdraw medical interventions against the wishes of a family?

Doctors, nurses and others will also discuss the intersection of the personal and the professional, and how it affects their work. At last year’s conference, Douglas Opel, MD, MPH, of Seattle Children’s, spoke about being diagnosed with Crohn’s disease and how it altered his role as a physician. Excerpts from that talk, which was published in its entirety in The Hastings Center Report late last year, are included below.

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