Chances are the next time you bring your child in for a wellness check, your pediatrician will talk to you about cholesterol.

While pediatricians have been checking cholesterol in children with a family history of heart problems for many years, the American Academy of Pediatrics recommends that all children be screened for high cholesterol between the ages of 9 and 11 and again between 17 and 21.

These recommendations refelect the understanding that too much cholesterol in the blood circulation contributes to the development of plaques that may lead to a blocked artery. A heart attack results when an artery delivering oxygen to the heart is blocked. A stroke results when an artery delivering oxygen to the brain is blocked.

We now understand that the process of an artery becoming blocked by cholesterol begins in childhood and gradually develops over a lifetime.

The diet of the average child contains too much sugar, fat and cholesterol. While some children manage to metabolize these foods without collecting an excess of cholesterol in their blood vessels, other children cannot. This leads to high levels of cholesterol in the circulation and a risk of a future heart attack or stroke.

A blood test is used to screen for cholesterol and is best performed after your child has not eaten for 12 hours. If cholesterol levels are elevated, your physician will first discuss changes in your child’s diet and exercise patterns. For many children, not only will this reduce the cholesterol levels, but it will also minimize other risk factors for early heart disease, such as diabetes, obesity, high blood pressure and inactivity. Healthier diet choses include the following:

If dietary changes are not enough to lower your child’s cholesterol, you may be referred to an expert in childhood cholesterol problems. This will give you an opportunity to discuss all of the available information as well as the potential risks of therapy (or no therapy).

I’ve heard physicians say that a 50-year-old person had “the arteries of an 80-year-old.” That same concept exists in childhood. There are things we can do to keep our children’s blood vessels clean, healthy and young!

While ignorance may be bliss, knowledge is power! and an opportunity to make healthier choices – for our children and ourselves.

Laurie Armsby, M.D.
Associate Professor of Pediatrics, Division of Pediatric Cardiovascular Medicine
OHSU Doernbecher Children’s Hospital

What’s the best way to keep my children’s skin safe while enjoying time outdoors this summer?
We recommend seeking shade, when practical, during outdoor activities. It’s best to plan trips to the beach or park in the early morning or late afternoon when possible. This avoids exposure to sun during peak UV (ultraviolet) radiation hours, between 10 a.m. and 4 p.m.

When out in the sun, physical covers such as hats, rash guards, umbrellas, sunglasses and long sleeves/pants are paramount. Most fabrics with tight weaves provide fairly good SPF (sun protection factor). There are also over-the-counter products that can be added to the wash and impart higher SPF coverage to clothing.

For skin that is left uncovered, look for a sunscreen that is labeled “broad-spectrum” to cover against both UVA (ultraviolet A) and UVB (ultraviolet B), and that has an SPF of at least 30. Higher SPFs correlate with a longer amount of time a person can stay out in the sun without getting sunburned.

For practical use, choose at least SPF 30 and plan to reapply every two hours, and always reapply immediately after swimming or sweating because no currently available sunscreen is completely “water-proof.” It is important to apply sunscreen liberally, because applying it too thinly will reduce its SPF effect.

What potentially harmful effects does the sun have on our skin?
Sunlight that reaches the Earth’s surface contains UVA and UVB radiation. Ultraviolet radiation damages the skin’s DNA, which is the first step to skin cancer development. Ultraviolet radiation also causes photoaging of the skin, such as brown spots, laxity and wrinkling.

Both UVA and UVB have been implicated in skin cancer development. UVA is the longest wavelength of UV radiation and penetrates the most deeply into human skin. UVA passes through window glass in homes and cars and is the form of radiation most often employed by tanning beds, which have now been definitively linked to increasing rates of skin cancer, including melanoma. UVB radiation is responsible, in large part, for sunburns.

UVB exposure over an individual’s lifetime is tightly linked to the risk of developing squamous cell and basal cell carcinomas, the most common forms of skin cancer. The amount of UVB radiation that reaches the Earth’s surface is proportional to the height of the sun in the sky. That’s why in the Oregon summer months, the risk of sunburn is greater.

I don’t have to worry about my kids getting skin cancer – that’s something that happens to older people.  Right?
Unfortunately, the deadliest form of skin cancer, melanoma, is the most common form of cancer from young adults ages 25 to 29. Melanoma is also the second most common form of cancer in adolescents and young adults 15 to 29. Further, rates of melanoma in both of these age groups are rising.

Is skin cancer among children and adolescents really a problem in Oregon?
Compared with other states, Oregon actually has a relatively high rate of melanoma. This may be related in part to the high proportion of Oregonians with fair skin, which is a known risk factor for melanoma. In addition, many Oregonians sustain episodic, intense UV exposure over Spring Break, via tanning bed use and during our fleeting, but intense, summer months (versus modest daily sun exposure in places where it is more sunny year-round).

Can skin cancer be prevented?
Research suggest that most skin cancers, including squamous cell carcinoma, basal cell carcinoma and melanoma, can be prevented if children, adolescents and adults are protected from UV radiation.

Do the sun’s rays have any health benefits?
UVB light helps the body create vitamin D. However, there is a threshold above which more UVB does not equate to more vitamin D formation. This amount of time is hugely variable depending on your skin’s natural pigmentation level (it takes less UV to make vitamin D if you have fair skin, and it is also takes less UV to sunburn), your age (older skin does not make vitamin D as efficiently), the latitude and time of year.

Any blanket recommendation about how much time people should spend in the sun is bound to be inaccurate for these reasons.

Won’t using sunscreen regularly lead to vitamin D deficiency?
Use of sunscreen has not been shown to significantly impact vitamin D levels. Studies in humans have shown that regular use of sunscreen does not put people at risk for vitamin D deficiency. Because there is no known “safe” amount of UVB to receive for any given individual and there are great sources of vitamin D that can be taken orally without increasing risk for skin cancer, we recommend photo-protection from ultraviolet radiation and obtaining vitamin D through foods, with vitamin supplementation if needed.

There are so many different types of sunscreen out there.  Which one should I buy?
There are two main categories of sunscreen, those that act as physical blockers (zinc oxide and titanium dioxide) and those made of chemicals that absorb UV. The advantages of sunscreens containing only physical blockers are that these agents tend to be less irritating for people with sensitive skin, and that they are active immediately after they are applied to the skin.

The disadvantages of physical sunscreens is that they tend be thicker and look a little white on the skin. We recommend physical sunscreens for infants older than 6 months (infants younger than 6 months should only spend time outdoors in the shade or covered up) and for our patients with eczema/atopic dermatitis.

Chemical sunscreens contain agents that absorb UV light. One of the advantages of chemical sunscreens is that they may be formulated into more sheer products (light lotions, gels and sprays), which older children may prefer to apply. A disadvantage of these sunscreens is that they must be applied 30 minutes prior to sun exposure, so some planning is needed.

Occasionally, people can become allergic to chemical sunscreens and their vehicles (bases) can be irritating for those with sensitive skin. Some have raised safety concerns regarding chemical sunscreens – particularly with oxybenzone and retinyl palmitate. Research to date suggests that these agents are safe for use as sunscreens (“Safety of oxybenzone: putting numbers into perspective.” Arch Dermatol 2011; Saftey of retinyl palmitate in sunscreens: a critical analysis. J Am Acad Dermatol 2012).

Do I need to avoid buying micronized physical sunscreens?
Some have raised concerns about the possibility that micronized physical blocker sunscreen agents may be absorbed into the bloodstream as “nanoparticles.” This concern has not been validated. Current evidence suggests that micronized zinc and titanium particles aggregate in the top layer of the skin (the epidermis) and are not absorbed into the systemic circulation (“Measurement of skinpermeation/penetration of nanoparticles for their safety evaluation. Biol Pharm Bull 2012; Stratum corneum is an effective barrier to TiO2 and ZnO nanoparticle percutaneous absorption. Skin Pharmacol Physiol. 2009; Huan safety review of “nano” titanium dioxide and zinc oxide. Photochem Photobiol Sci 2010).

What’s the bottom line?
Keep active and enjoy Oregon’s great outdoors this summer, but be sure to be sun smart with the above tips and techniques to keep your kids and yourself healthy!

Sabra Lofgren Leitenberger, M.D.
Assistant Professor of Pediatric Dermatology
OHSU Doernbecher Children’s Hospital

Alfons Krol, M.D.
Professor and Chair of Pediatric Dermatology
OHSU Doernbecher Children’s Hospital

Julianne Mann, M.D.
Assistant Professor of Pediatric Dermatology
OHSU Doernbecher Children’s Hospital

Gina Brown, M.D.
Fellow in Pediatric Dermatology
OHSU Doernbecher Children’s Hospital

Kaylan Weese, M.D.
Resident in Dermatology
OHSU Doernbecher Children’s Hospital

Ashley Treece, M.D., second-year resident in pediatrics

I have come to the conclusion that there are three types of people in the world: those who love children, those who are petrified of children, and those who are paralyzed by the idea of anything bad happening to children. Pediatricians are, of course, of the first group. (The latter two are the only excuses I hear for not working with children; and that is what they are — excuses.)

As pediatricians, we can be neither terrified by children’s energy nor by their frailty; in fact, we are most often inspired by their resilience. Bad things do happen, but we work to make them better. And for the children that we help, it is a privilege, a pleasure, of which we are daily reminded.

When I started as a pediatric resident, I believed that pediatricians, endowed with that love they have for children, somehow become immune to seeing sad things, or somehow those things are overwhelmed by good things – the successes, the lives saved, the smiles won. Or maybe just the fact that there are bubbles being blown everywhere and we get to walk around with toys on our stethoscopes.

However, it did not take long to realize that it only takes one devastating moment to completely annihilate the joy of an otherwise happy day. This, coupled with the fact that sadness in children is somehow cumulative, more so than in other demographics. In this thought, I am supported by Abraham Lincoln who once wrote, “In this sad world of ours, sorrow comes to all; and, to the young, it comes with bitterest agony, because it takes them unawares.”

In time, I began to understand those who claim affiliation with the third group of people. It became apparent that I needed a method to cope.  Looking around, I saw many different strategies: some people cry, some people lavish attention on their own children, some people eat … .

It took some time to find mine, but then I started to write.

I remember the feeling of elation of stringing words together, imbuing each sentence, each word, with my emotions. It was as though the page came alive, and myself with it. I had found my voice again, and a way of dealing with my experiences. Putting my observations, my thoughts, and my struggles into words helped me sort through the part that I played in patients’ lives. And it rewoke in me the simple joy of writing.

Over time, I started sharing some of my writings, at first with people I thought would understand; then, emboldened, with more and more people. To my constant surprise, many physicians and non-physicians shared and expressed empathy with the sentiments that I wrote. Not only did this encourage me that I was not alone, but it also inspired me that my words could help guide someone else on the path to discovery or help them say what they never could before. Delighted, I delved into a body of literature of medical writings by doctors and patients alike – along with my old favorites Tolstoy and Chekov – searching for written mentors. Over and over again I was impressed by how the words of others moved my own soul. Though I am far away or even in a different era, I am affected by the insight they had the courage to share. What a priceless gift they have left.

In finding myself writing again, I have learned that we all have something to share. From patients and their families to doctors and nurses to volunteers and social workers and everyone in between, we all have a unique way to express ourselves and reach out to others. For me, I write, partly because I am compelled to. As Perri Klass wrote in her book “Baby Doctor,” “Writing is a pleasure and an escape, an indulgence and a discipline, if you are someone who needs to write.” It is a way to help me stay afloat amidst a sea of sorrows, and if it can help others clamber onboard as well and peer through the spyglass toward the horizon, then I have accomplished something.

A family friend wrote a short book about her experience of a beloved sister with breast cancer. In it, she gives practical advice for how families can help with the daily life concerns of chemotherapy, hairstyles and food, but she also explores what it was like to have someone you care for face cancer. The love and struggle that are evident throughout her book make it beautiful, and I am sure the most poignant for readers sorting through their own heartache. Though often less recognized, such writings are powerful; they are moving because they are real, and speak to the multitudes of people who struggle with health problems; which if we think of it, in some ways, is all of us, for “No man is an island, entire of itself,” as John Donne so eloquently reminds us.

Therefore, I hope we all will find and remember some way to share with one another. And as for me, I think I will continue writing.

Ashley Treece, M.D.
Second-Year Resident in Pediatrics
OHSU Doernbecher Children’s Hospital

References:

• “My Sister Has Breast Cancer”
• “One Equall Light: An Anthology of the writings of John Donne”

Editor’s note: Dr. Treece recently won first place in the American Pediatric Association Special Interest Group Essay Contest. Congratulations!

It’s not often that we are pleasantly surprised, but the CARES Northwest staff and management were indeed surprised by the very generous donation that OHSU nurses made to the organization. As a pediatric nurse practitioner at OHSU Doernbecher Children’s Hospital as well as CARES Northwest, I was personally elated by this generous gift!

More importantly, I was inspired that this community of nurses — who give of themselves daily, nurturing and caring for others — saw the value of the services provided by CARES Northwest.

The gift will help pay for medical evaluations for children who may be victims of child abuse or neglect and will support our community’s coordinated response to child abuse. By helping to fund these evaluations, CARES Northwest can work to minimize the trauma child abuse victims experience by ensuring these children have access to caring experts with specialized training in assessing and responding to child abuse and neglect.

In addition, the OHSU nurses’ gift will help to support CARES Northwest’s community child abuse prevention efforts, which includes programs that aim to prevent the sexual and physical abuse of children.

The goal of all services offered by CARES Northwest is to give children an opportunity to grow up in a safe and healthy environment.

On behalf of the CARES Northwest directors, staff, and volunteers, I would like to express our sincere gratitude to each and every OHSU Nurse for their generous donation to CARES Northwest.  This gift will make a difference to some of our community’s most vulnerable citizens!

Following are some quick facts about CARES Northwest (CNW):

• CNW is the only child abuse medical program serving Multnomah and Washington counties.
• CNW sees an average of six children each day in our outpatient clinic, and triage almost twice that many referrals.
• More than two-thirds of the children we see are underinsured, or have no insurance.
• CNW believes all children should have access to an expert medical evaluation when someone is concern they have been abused, regardless of their family’s ability to pay.

Noelle Gibson, M.N., R.N., C.P.N.P.
Pediatric Nurse Practitioner
Suspected Child Abuse and Neglect Program, OHSU Doernbecher Children’s Hospital
CARES Northwest

More than 11,500 children were victims of abuse and neglect in Oregon in 2011. In addition to the immediate toll that abuse takes on the child’s physical and emotional health, studies have shown a strong association between child abuse and adult health problems, including heart disease, cancer and diabetes.

The trauma of child maltreatment lasts throughout a child’s life into adulthood. The good news is that child abuse is preventable.

As part of our ongoing efforts to improve the health and safety of Oregon’s children, OHSU was one of the sponsors of the “Preserving Childhood” report developed by the Children’s Trust Fund of Oregon in partnership with Prevent Child Abuse Oregon.

This report, presented by Cambia Health Foundation, focused on the most effective ways to prevent child maltreatment. The report highlighted the most successful prevention programs, including Period of PURPLE Crying, a prevention program already in place at OHSU.

Many families face daily challenges, including economic struggles, domestic violence, addiction and mental illness. These challenges are made more difficult when extended family or friends are not available to provide support. The Preserving Childhood report will help us identify the most effective ways to support and strengthen Oregon families and prevent child abuse.

Thomas Valvano, M.D.
Medical Director, Suspected Child Abuse and Neglect Program
OHSU Doernbecher Children’s Hospital

I often have families come to me looking for a magic formula that will cure their child’s cold and get rid of all the symptoms. Simply put: There is no magic formula for treating a cold, and there are no over-the-counter (OTC) products that are safe and effective for treating young kids.

You should never use OTCs in kids younger than 6, and I never recommend them in general.

Before we talk about the meds — let’s talk about colds.

As you probably know, colds are caused by viruses, tiny organisms that are transmitted easily when we cough, sneeze or otherwise come in contact with them. There are no antibiotics that treat these viruses — none, nada, zippo, zilch.

If there is going to be fever, it will be in the first one to three days of illness. Often, these fevers are 101 or lower, but we see higher fevers pretty frequently. A fever is not scary to pediatricians — it is the body’s natural response to the virus and actually can help the immune system function more efficiently.

The nose stuff generally follows pretty quickly. While at first runny and clear, the mucus quickly gets gunky, yellow and green. This is a sign that the body is fighting off the infection, and the color is not important. Symptoms can last up to two weeks.

The next thing we see is cough, which generally appears in the first few days. It starts off dry, and then gets harsher, deeper and junkier. The cough can take three weeks to go away – I know that is a really long time.

Let’s look at the OTC medications and how they might help (although, as I stated, they, for the most part, do not help.)

Fever: There are two types of medicine that can help decrease a fever in a child: acetaminophen (e.g., Tylenol) and ibuprofen (e.g., Advil). These actually work, and are useful if the fever is making the child feel cruddy. If the child is happy and playful, even with a fever, there is no need to treat! Ibuprofen may work a bit longer than acetaminophen (six to eight hours compared with four to six hours), but both will bring a fever down.

Runny nose: The most common medications used for a runny nose are antihistamines. You may see diphenhydramine, chlorpheniramine, brompheniramine (Benadryl, Dimetapp and many others) on the label. These have never been shown to make any difference in kids and have been associated with lots of bad side effects. They tend to dry up secretions, so in theory, less mucus. However, they also act on the central nervous system, causing sedation and a bunch of other potentially bad things. Not good for kids in general.

You can also find vasoactive agents, like pseudoephedrine. These meds act on blood vessels causing constriction, which in theory would decrease the swelling in the nasal tissues. Like antihistamines, they have been shown to be ineffective in kids, and have a ton of side effects as well, including sleep problems, heart beat irregularities and other unpleasant things. Stay away!

Cough: There are two types of agents for cough. The first are expectorants, like guaifenesin (used in Mucinex and others). These medicines are supposed to thin secretions and make it easier to cough up the mucus that forms in a child’s lungs in response to the virus. A number of studies have shown that this stuff doesn’t do anything for kids at all. Despite the cute ads, it is no better than a placebo (sugar-syrup).

The second cough medicine is dextromethorphan (the DM in all the cough syrups.) This is a cousin of codeine, which has been shown to help decrease cough in adults, but, interestingly, does not work in kids. DM has been been studied extensively, and is no better than sugar-syrup for cough in kids. It, too, has been associated with a host of bad side effects, including seizures, so it is something I would stay away from.

Among the most dangerous aspects of OTC cough/cold meds for kids is illustrated in a recent photo taken at a local pharmacy. There are multiple formulations of every OTC brand, and each can have one or more of these kinds of  meds. This leads to lots of confusion for parents. One person’s Dimetapp may be very different from another’s. This has led to overdosing and other bad things for kids.

The only thing that has ever really been shown to be better than a placebo (sugar syrup) for treating kids with colds is good old-fashioned honey. While honey should never be given to kids younger than 1, it has been shown to decrease cough in kids older than 1 with colds.

OK. So what are the take-home messages?

• If your child has a cold, know what to expect in terms of symptoms and duration. If things go longer than they should, if your child is not drinking or is acting very sick or has trouble breathing, he/she probably should be seen by a physician. It is always OK to give us a call with questions, and we can help you think through how to make your child more comfortable.
• Stay away form OTC meds. If your child is younger than 6 , you should never use them. If you have an older child, you should think carefully about whether using a medication that has never been show to help but has been show to have side effects is a good idea.
• If you are going to use an OTC med, be sure you know what is in it, and be sure that you are not using multiple different kids of the same medications. You do not want to overdose!
• Lots to drink and lots of love are always good ideas. Oh, and washing your hands often to decrease the risk of spreading the virus!

As pediatricians, we can do a lot to help ensure your child thrives. Sometimes the best thing we can do, however, is to help you protect them from unnecessary medications, and that can be magic.

Ben Hoffman, M.D.
Medical Director, OHSU Doernbecher Tom Sargent Children’s Safety Center
Assistant Professor of Pediatrics
OHSU Doernbecher Children’s Hospital

I was proud to see the publication of a landmark brain repair trial carried out at OHSU and Doernbecher Children’s Hospital. Our large team of researchers reported the results of this first-ever use of brain-specific stem cells in human patients.

The trial, begun in 2006, involved surgical transplantation of purified neural stem cells into six pediatric patients with the rare and uniformly fatal form of the brain degenerative disorder, Batten disease, plus extensive medical and imaging follow-up.

The cell transplants were also the largest undertaken in clinical trials, ranging from about 300 million to almost a billion cells per patient, and the first time cellular ‘brain transplants’ were utilized to help children.

The definitive publication of the OHSU trial demonstrates that the transplantation operations were all carried out safely at Doernbecher, and that trial patients tolerated the transplanted cells and related medications without serious complications.

OHSU and OHSU Doernbecher researchers and their collaborators at Stanford University and Stem Cells, Inc., the trial sponsor, also discovered that transplanted stem cells appear to survive in the brain for months to years after transplantation, offering hope that in future these types of transplants could help patients with various brain, spinal cord and retinal diseases that are currently untreatable.

Our stem cell transplantation trial was led by OHSU Doernbecher metabolic medicine specialist Robert Steiner, M.D., and myself. I was also privileged to serve as the treating surgeon for each of these six precious patients.

Batten disease is a devastating illness that has already claimed the lives of three of our six study patients, despite their stem cell-based therapy. During the trial, I have had the pleasure of knowing them and their marvelous, compassionate, and truly dedicated families, through their repeated visits to Doernbecher for more than five years.

The entire community of Batten disease families, caretakers, and researchers tremendously values their courage in volunteering to be a part of this groundbreaking attempt to works towards the development of a cure.

Nathan Selden, M.D., Ph.D.
Mario and Edie Campagna Chair of Pediatric Neurosurgery
Director, OHSU Neurological Surgery Residency Program
OHSU Doernbecher Children’s Hospital

Myron Child and his daughter, Bekkie Child

My story with Doernbecher began over 20 years ago when my daughter, Beckie Child, was 16 years old. At the time she was a popular, athletic and vibrant teenager at Parkrose High School.

One day at basketball practice, Beckie had a great deal of pain in her leg. My wife, Geri, and I took her to the doctor and were told we needed to get to Doernbecher Children’s Hospital as soon as possible.

Beckie’s doctor at Doernbecher, Dr. Boss, diagnosed her as having osteogenic sarcoma in her left femur bone — Beckie was not expected to survive. In early December 1989, Beckie underwent two surgeries — one to remove the infected bone and replace it with a prosthesis and the other to insert a port-a-cath into her chest so she could begin her chemotherapy treatment.

During one of these operations, Geri and I went back to Beckie’s hospital room to wait for her surgery to be completed as there was not enough room in the operation room waiting area. Beckie shared a room with three other patients and their families. The room was loud, cramped and we did not have the privacy we needed, so we moved our chairs out into the hallway for some peace and quiet.

At this time we witnessed another family going through a very difficult time, again without the privacy they needed. This family eventually lost their daughter to cystic fibrosis. It was clear to me something needed to be done about the old hospital facility so families could have the privacy and peace they needed during such difficult times. We needed a new hospital!

The experience we had at the old Doernbecher hospital inspired me to turn to the kids of Oregon and southwest Washington to begin fundraising for a new hospital. We started the Kids Making Miracles (KMM) program in 1992 and it played an imperative role in the construction of the new OHSU Doernbecher Children’s Hospital we know and love today.

Today, more than 20 years later, hundreds of area K-12 students continue to raise funds for the hospital through the Kids Making Miracles program. Since the program’s inception, students have helped raise more than $8 million. These funds have helped Doernbecher develop new clinical services, funded innovative research programs for serious childhood diseases, and it has allowed the hospital to address immediate children’s health care needs.

Even more importantly, students involved in KMM learn valuable lessons about the importance of philanthropy, helping their community and being leaders in their schools.

This past year, Beckie had her leg operated on again to remove the old prosthesis to replace it with new a new one. During this time, Beckie’s doctors found another cancerous tumor. It took two surgeries to remove the tumor, and she spent a lot of time in the hospital.

One day as Geri and I were visiting our daughter in the hospital, a nurse who was attending to Beckie explained that when she was a high school student at Tillamook High School, she had participated in the KMM program when she was a teen. She said she became a nurse because of her involvement in the KMM program.

I could hardly get over the reason she was a nurse today is because of what happened to Beckie when she was 16 years old and now this woman is taking care of Beckie as an adult. I am a true believer that things happen for a reason!

On Friday, May 10, the KMM Executive Student Council hosted the annual KMM Candlelight Ceremony at Doernbecher. This is a very special event where students from all over Oregon and southwest Washington come together to celebrate their efforts in fundraising for Doernbecher.

The ceremony took place at the OHSU Auditorium, followed by a procession down the hill and ending at the Miracle Garden in front of OHSU Doernbecher Children’s Hospital where students ceremonially rekindled the Eternal Flame — a symbol of hope for kids and families at Doernbecher.

Myron Child
Emeritus Board Member
OHSU Doernbecher Children’s Hospital Foundation

I have worked with pregnant women for 20 years as a dietitian and diabetes educator.

I love that pregnancy is a time of heightened awareness around the importance of good nutrition, which is why it is so fun to work with this patient population.

We now know that good nutrition is important — not only for the immediate health of the developing baby, but also for the baby’s future health as she grows into adulthood.

With this in mind, I set out to create a blueprint for healthy eating in pregnancy that reflected current science-based information that pregnant women could use to get the best possible nutrition during this important time.

The result of this effort is “My Pregnancy Plate,” which focuses on dietary patterns and is designed to guide people toward a nutrient-dense, well-balanced diet (“My Pregnancy Plate,” Spanish version”).

As a dietitian, I like to talk to people about their “eating style” because it’s a positive way to discuss nutrition and reinforces the goal of long-term healthy living. So, although it’s titled “My Pregnancy Plate, this blueprint, or tool, is a healthy way to eat before and after pregnancy, as well.

In pregnancy, mom’s additional need for energy is not very high, but her need for more micronutrients increases dramatically. Consequently, as the My Pregnancy Plate illustrates, a well-balanced pregnancy diet would include an abundant and varied amount of plant-based foods.

Moderate amounts of animal-based foods should be eaten, preferably non-fat/low-fat dairy, lean meats and oily fish. Small amounts of healthy fats in the diet should also be included.

There is a saying that sensibly emphasizes the concept of “thinking for two, but not eating for two.” Because foods or beverages containing a lot of sugar and/or saturated fat are high in calories and low in nutrients, these should be included on a very limited basis. Thanks to our graphic designer, the My Pregnancy Plate is a feast for the eyes, which brings me to my last point: healthy eating reflects balance, variety, moderation and enjoyment!

Christie Naze, R.D., C.D.E.
Clinical Dietitian
OHSU Center for Women’s Health

Editor’s note: Amy Wang with The Oregonian’s Omamas blog recently interviewed Christie about My Pregnancy Plate. You can read the article here.

As part of our training curriculum, pediatric residents at OHSU Doernbecher Children’s Hospital choose a special interest group (SIG) in which to participate. These groups allow us the opportunity to pursue other interests that may fall outside the everyday responsibilities of residency.

Last month our global health SIG held a health fair for the Neighborhood House Early Head Start program. Neighborhood House, a nonprofit social service organization, provides supportive services to more than 18,000 low-income families in the greater Portland area.

This event marks a great collaboration with Neighborhood House, OHSU and other area services and nonprofit organizations. Volunteers comprising general pediatricians, pediatric dentists, medical students, nurses and other volunteer organizations provided free health and dental screenings as well as lead screening to about 30 children.

With the help of the OHSU Doernbecher Tom Sargent Children’s Safety Center, we were able to arrange car seat installation appointments as well as offer valuable education regarding safety measures aimed at preventing childhood injuries.

OHSU Doernbecher residents provide free health screenings

In addition, we were able to provide each child with an age-appropriate book thanks to the Reach Out and Read program and local donations. Our medical student volunteers read to children waiting for their appointments and met with parents to discuss the importance of early literacy.

This is our second year partnering with Neighborhood House, and to date, we have provided health screenings and secure important follow-up for more than 80 children. While many of these children and families are assigned medical providers, obstacles to access, such as transportation limitations and language barriers, prevent many children from seeking regular health screenings.

Jeffrey Meyrowitz, M.D., third-year resident in pediatrics, OHSU Doernbecher Children’s Hospital

As we move forward, our SIG hopes to broaden our partnership with Neighborhood House, providing more preventive health education and help to reduce some of the barriers impeding the families from establishing a regular medical home.

Jeffrey Meyrowitz, M.D.
Third-Year Resident in Pediatrics
OHSU Doernbecher Children’s Hospital