The force is strong with this one: Justin’s Doernbecher story

Earlier this year, OHSU Doernbecher Children’s Hospital patients, family and employees were treated to a special visit from Star Wars characters from the Cloud City Garrison thanks to the hard work of 14-year-old Doernbecher patient Justin. Below, Justin’s mom, Joanna, shares her son’s story and why this project meant so much to their family.

***

When he was only 3 years old, Justin was diagnosed with Type 1 diabetes. We had been noticing that he was urinating frequently and was thirsty all the time. Coincidently, I had heard about the symptoms of Type 1 diabetes from a co-worker of mine, two weeks prior to Justin’s diagnosis. When Justin began exhibiting those same symptoms (extreme thirst, frequent urination, loss of weight, etc.), I knew we had to get Justin in to see his pediatrician.

They initially did a urine test, and the nurse came back in the room and stated that Justin had sugar in his urine. They then did blood work to confirm the diagnosis of Type 1 diabetes. Because he wasn’t sick, Justin wasn’t really aware of what was going on – but my husband and I cried when we heard the diagnosis. As parents, we were scared. At the time, we lived south of Eugene and Justin’s pediatrician immediately sent us up to OHSU Doernbecher Children’s Hospital.

Doernbecher welcomed Justin and our family with open arms when we arrived. We met with many people at the time of his diagnosis, including his new pediatric endocrinologist, Dr. Bruce Boston. Justin’s child diabetes educator, Joannie Kono, also met with us to go over all of Justin’s insulin needs and talk through what life would look like with Type 1 diabetes.

We were in the hospital and all of the nurses, volunteers and doctors were extremely supportive. Justin remembers having his blood pressure checked because the cuff had dinosaurs on it – every time his blood pressure was taken, Justin said it felt like the dinosaurs were giving his arm a big hug. The nurses thought that was cute!

There were many wonderful volunteers that came in to play with Justin so that my husband and I could take time to learn everything there was to learn about Type 1 diabetes and our new life with this disease.

Everyone involved in Justin’s care was compassionate, and it made our time there much more enjoyable, given the circumstances. He’s been going to OHSU for his diabetes care since his diagnosis and he continues to see Dr. Boston and Joannie Kono.

Doernbecher Children’s Hospital is a wonderful place to be, with a lot of amazing, caring people. I would tell other parents that they’re in the best hands at Doernbecher. The doctors, nurses and volunteers are extremely compassionate, giving individuals and the staff made our time at Doernbecher memorable.

When Justin was planning a community service project, he didn’t even have to think twice about what he was going to do. Doernbecher has been a place he’s remembered since his diagnosis, and he wanted to find a way to give back to the hospital that gave to him and to our family in his time of need.

Justin wanted to bring joy to the patients and families at Doernbecher – and he LOVES Star Wars – so he emailed the Cloud City Garrison (a chapter of the 501st Legion of Stormtroopers) to see if they’d be willing to volunteer their time to help out. Justin explained his service project and requested support from Target and Lowe’s, which both donated toys to hand out to Doernbecher patients and families. It was a great success!

On the big day, Justin got great satisfaction in seeing the looks on people’s faces – children, families and employees – when they saw that the Star Wars characters were coming in to bring joy to patients and families. He says “it was a joy to my heart” and wants to do this community service project every year.

Learn more about Justin’s community service project here.

Let’s talk about gender

This article was written by Katie Vaughan and illustrated by Sol Linero. It originally appeared in the Portland Monthly 2016 Kids’ Health Annual magazine. 

When kids are bombarded with messages about how girls and boys should act, families can help cut through the noise with a conversation.

With gender in the headlines – toy aisles ditching their pink and blue labels, the shocking pay gap for our Women’s World Cup champions, the evolution of Caitlyn Jenner – the complicated topic can feel like a news trend of the day. Of course, ideas about gender and its role in our lives, and in children’s development, are not trends at all. We’ve been carrying them around since we were born.

“The perception of gender impacts everyone throughout their lives, because of what gets imposed on us about gender roles, gender norms and societal expectations,” says Amy Penkin, program coordinator of the OHSU Transgender Health Program.

What’s new – and healthy – about today is the dialogue.

The definition of gender is still fluctuating in the medical community, but here’s the general idea: Sex is anatomical and chromosomal. Gender is how you identify psychologically or emotionally.

“Gender identity is about the inner sense of self. It’s about how we perceive ourselves,” says Dr. Kara Connelly, a pediatric endocrinologist at OHSU Doernbecher Children’s Hospital. Gender can be reflected in the way we think, feel, behave and present ourselves.

Children absorb ideas about gender from all directions. As a parent, it’s easy to be intimidated by the lingo or overwhelmed that everything children see and hear about gender could impact their development. So we asked child and family health care professionals how parents can tackle gender issues and raise healthy kids – who aren’t burdened by unhealthy stereotypes.

 

Finding their way

Children start to identify gender at a very early age. In most cases, a child will start to develop their own gender identity as young as 3. As they grow, children want to understand how they fit into the world, and their gender identity is an important part of that development.

Sometimes, what a child determines to be their inner identity conflicts with how society expects them to behave, which can be damaging to their sense of self.

“It creates a lot of internal conflict if a child’s beliefs about who are they are differ from the outside world’s acknowledgment of that identity,” says Dr. Naomi Fishman, a child and adolescent psychiatry fellow at OHSU.

It can be as simple as a girl feeling bad because the toys she wants to play with are considered “boy” toys or as complex as a child being ashamed and confused because their inner gender identity doesn’t match their outer appearance.

Kids can take in a lot of ideas just by observing what their parents say and do, but constantly worrying about whether you might be passing on judgments or reinforcing stereotypes will drive parents crazy. Fortunately, the solution is simple.

Dr. Fishman says it starts with taking time to listen: “If you want to support your kids in exploring their gender, be genuinely curious and spend time with them.”

If you’re worried about using the most PC terms and asking all the right questions, don’t be.

“You don’t need to interrogate them,” says Dr. Fishman. “Just be open, available and supportive. Allow kids to be honest about exploring their gender identity.”

 

Pink footballs, blue dolls

A lot of the messages children receive about gender come in the form of societal stereotypes, and it starts before we’re even born. Picture a standard baby shower, with everything from decorations to gifts to the cake in either pink or blue.

Kids start to notice these stereotypes right away. If your child repeats some conventional idea they’ve picked up somewhere (“girls play with dolls and boys play with trucks,” “pink is a girl color,” “boys are better at science”), Dr. Fishman advises taking it as an opportunity to talk openly: Ask your child if they believe it’s true. Encourage kids to talk about how they feel about a certain color or toy, instead of focusing on what someone else told them. You don’t need to be laser-focused on the minutiae of gender stereotypes and how you (or your friends or teachers or coaches or movies or…) might be passing them on. If you have an open mind and keep the conversation flowing, you’re on the right path.

Internalizing gender stereotypes can affect more than just the toys children play with; they can be especially damaging when it comes to body image.

“Kids today are inundated with images of what is supposed to be beauty and strength and power and desirability,” says Dr. Craigan Usher, program director of Child and Adolescent Psychiatry at OHSU Doernbecher. “We’re seeing the impact of that in a lot of ways, like the increased rate of disordered eating in the last 20 years or so.”

The best thing parents can do to help children deal with body issues and other negative effects of stereotypes is to make space for the multitude of ways in which someone can be a man or a woman.

“Expose kids to the different ways that people can dress and think, feel and look,” says Dr. Usher, adding that Doernbecher also offers a variety of psychiatric and therapeutic resources for adolescents who are struggling with gender identity or body image.

So while the repercussions of stereotypes and how they play into gender identity can seem limitless, the overall advice from health professionals is this: Don’t worry too much! Stay open-minded. Listen. Encourage kids to express themselves honestly and show interest in what truly makes them happy. And, hey, maybe start a family petition to address the pay gap for those Women’s World Cup athletes.

 

On gender’s spectrum, let kids settle where they’re comfortable

If children start to determine their gender identity as young as 3 years of age, that means that some children might realize early on that their gender identity doesn’t match their external appearance. Children easily pick up on gender stereotypes, and our society is constantly reinforcing ideas about how a certain gender should look, think and behave. That can lead to a lot of confusion and shame for children who feel pressured to look or act in a way that doesn’t line up with how they feel.

Every person is unique, and every person’s gender expression is unique. That also means each path to a comfortable gender identity is different. In their quest, some people may choose to change their name, style their hair a certain way, or be called by a different pronoun. Others might choose to undergo full surgical transitions. No matter the path, the earlier a person can start this process, the easier it will be in the long run.

“If kids are supported in their quest to explore their gender identity and expression from an early age, they can often be saved from years of emotional and psychological distress,” says Dr. Connelly.

As with most other issues families face, the path to raising a healthy and happy transgender child starts with an open mind.

“When you accept your child’s expression early on and allow them to live that role, your child can live a much more anxiety-free life,” Dr. Connelly says.

Still, parents don’t need to jump to conclusions: “A boy who wants to wear dresses for a while is very different from a boy who says with certainty, ‘I am a girl,'” she notes. “All children should be allowed to express their identity in a way that makes them feel comfortable.”

Gender transition may be in the public eye more these days, but it’s certainly not new. “We’ve been helping patients transition for decades,” Dr. Connelly says. “The hormones and surgical processes are not new.”

But with more public awareness comes, hopefully, more acceptance and more connections. Transgender youth have higher rates of anxiety and depression and a higher risk of suicide than cisgender children (those whose internal gender matches their sex at birth). They are also more likely to face bullying and abuse.

“Transgender kids really benefit from support and meeting other gender-diverse kids and families who are going through the same thing,” says Dr. Usher. “It helps to know that there are other people out there confronting the same issues and that there is a path for them.”

In 2014, OHSU created a work group devoted to improving transgender health services. The group hopes to better support children and families who may be struggling with gender identity considerations. Their aim is to improve access and links to a variety of resources, including mental health consultations, ongoing individual or family therapy support, hormone treatment, physical transitions and more.

Dr. Usher believes the increasing health resources for transgender youth and their families mean we’re moving in the right direction, but the psychology of gender transition is still a changing field, with still more steps to take in our growing understanding. Much of the study done on the topic in previous decades was heavily influenced by societal constructs.

“Even the term ‘gender dysphoria,’ which is now included in the latest psychiatric diagnosis manual, is problematic,” says Dr. Usher. “It implies that a child or teen needs to be sad because their internal gender doesn’t match their external sex; it doesn’t leave room for someone to be happy or proud.”

Additional resources

  • OHSU Transgender Health Program: People have come from around the world to access OHSU’s staff and facilities.For more on its Transgender Health Program, email transhealth@ohsu.edu or call 503-494-7970.
  • TransActive Gender Center: Community-centered local network that supports transgender and gender diverse young people and their families.
  • Outside In: A Portland non-profit dedicated to homeless youth, Outside In also offers LGBTQ-focused services.

Under pressure: For kids with hypertension, the time to make changes is now

This article was written by Megan Haverman and originally appeared in the Portland Monthly 2016 Kids’ Health Annual magazine.

While in the past high blood pressure in children has usually been considered a secondary symptom of something else, like kidney or heart disease, today children, like adults, are increasingly experiencing issues associated with being overweight.

According to Jennifer Huang, M.D., a pediatric cardiologist at OHSU Doernbecher Children’s Hospital, “It’s becoming more and more common for kids to have hypertension or high blood pressure even without the primary causes.” And every year this number goes up.

Hyperlipidemia, a condition defined as a high presence of fats circulating in the blood, frequently accompanies high blood pressure and is associated with obesity. “Some children have the disease because it’s familial,” explains Dr. Huang, “but most of the kids coming in are significantly obese.”

The good news is that children with hypertension aren’t condemned to a life of high blood pressure. When lifestyle is modified before adulthood, blood pressure can be “cured” in kids – as long as those changes are maintained.

“Change is easier with kids than adults,” Dr. Huang says, “but if you look at the kids with hypertension and hyperlipidemia, their parents have hypertension and hyperlipidemia because they already have that lifestyle.”

Dr. Huang says she and her colleagues – such as Laurie Armsby, M.D., also a pediatric cardiologist – can work to assist parents trying to alter their children’s lifestyle through a more holistic program, including children’s gym activity and consultation with a dietician.

Medication can also be helpful for controlling blood pressure, though the diuretics used as a primary line for adults aren’t the go-to for children. Pediatricians often prefer ACE inhibitors, which target the kidneys as they adjust blood pressure through many different hormones and markers.

“It’s a feedback loop. When you have high blood pressure a long time, your kidneys become intolerant to that, and they react the same way as someone with normal blood pressure,” Dr. Huang clarifies. ACE inhibitors work by blocking one of these kidney hormones to help lower blood pressure, stabilizing the feedback loop. Younger children have lower blood pressure targets than older children, and the scale varies based on age and height percentile.

But just like high blood pressure in adults, hypertension in children often displays no symptoms and is found during routine screenings. “In a cardiology clinic we check blood pressure with every visit,” Dr. Huang says, noting the contrast with a standard wellness checkup: “Especially with younger children, they’re not getting their blood pressure checked on their primary care visit.”

Parents who suspect hypertension – or simply want reassurance that their child doesn’t have a problem that needs addressing now – should ask their pediatrician to break out the blood pressure cuff.

If you’re concerned about your child’s blood pressure, talk to your pediatrician or call (503) 346-0640 to reach the pediatric cardiology program at OHSU Doernbecher.

Is rice cereal safe for your child?

A study conducted by researchers at Dartmouth published in JAMA Pediatrics found that infants who consume increased amounts of rice cereals and foods containing rice have higher levels of urinary arsenic. Arsenic exposure is associated with an increased risk of neurocognitive problems in children.

In light of these recent findings, what are parents to think?

The FDA has just proposed new guidelines on the allowable amounts of arsenic in rice cereal that is parallel to the level set by the European Commission (EC) for rice intended for the production of food for infants and young children. (The EC standard concerns the rice itself; the FDA’s proposed guidance sets a draft level for inorganic arsenic in infant rice cereal.) FDA testing found that the majority of infant rice cereal currently on the market either meets, or is close to, the proposed action level.

Why is rice higher in arsenic than other grains?

Arsenic is present naturally in soil and water, and fertilizers and pesticides contribute additional amounts. As rice plants grow, they take up arsenic more readily than other crops. A rice labeled as organic does not guarantee a low level of arsenic due to these natural sources.

What should parents feed their infants and children?

The American Academy of Pediatrics recommends that infants be exclusively breastfed for about six months, followed by continued breastfeeding as complementary foods are introduced. When a child is around six months, infant cereals can be gradually introduced. Rice cereal fortified with iron is a good source of nutrients, but it shouldn’t be the only source, and does not need to be the first source. Oat, barley and multigrain cereals are other options.

The FDA is also advising pregnant women to consume a variety of grains, in order to limit potential arsenic exposure to the developing fetus. Washing the rice prior to cooking also helps decrease the levels of arsenic, although this may also decrease the amounts of nutrients.

 

Natasha Polensek, M.D.
Director, Doernbecher Healthy Lifestyles Clinic
Clinical Associate Professor of Pediatrics
OHSU Doernbecher Children’s Hospital

 

Swimming in the NICU

The moment your child is admitted to the NICU, your life changes. Below, Megan explains how she stayed afloat in the NICU and shares some tips for other families who aren’t sure who or how to ask for help.

***

The birth of our youngest son on June 20, 2014, marked the beginning of a 3-month stay at OHSU Doernbecher Children’s Hospital. Although a prenatal diagnosis meant we were expecting a stay in the NICU, our family felt like we were thrown into the deep end of the proverbial pool.

As the mom, I felt like I was drowning in new medical terminologies, environments, demands, rhythms and uncertainties. It was sink or swim for the sake of our son. One fact I knew for certain: I needed help.

I slowly learned to ask for help, though it took longer in some areas than it did in others. At first, my voice was weak and sputtering, but with time, it became more clear and confident. No pamphlet or book could have prepared us for life in the NICU, but I hope my experiences will be helpful for other families learning to “swim” in the NICU.

Getting clarity from your care team

After experiencing my first set of “rounds” in the pod, I felt like I had more questions than answers – the medical staff seemed to be speaking a foreign language in an alternate universe and there were multiple unfamiliar monitors and equipment attached to my son.

On day 3, I realized my son’s nurse had been his nurse the day before. She was my first lifeline. I was discharged and able to spend some more time at his bedside. Nurse Mary slowly explained the equipment I was curious about, she talked through the different types of care she was providing and offered the postpartum practical tips for where to find pumping supplies and how to order lunch.

The next day when the doctors discussed my son’s case and post-surgery treatments, my mind was full of even more questions. Nurse Mary answered a lot of them and encouraged me to talk to the doctors for further clarification. I remember being surprised by the fact that we could actively participate in these conversations instead of letting them talk among themselves. My husband requested to talk to a doctor at the convenience of their schedule.

These initial conversations with the doctors laid a foundation for a mutual trust and respect with the end goal of improving our son’s health. The attending doctors were very knowledgeable with regard to diagnoses and treatments and the residents continually made time to answer our questions, even if it meant doing additional research or consulting their colleagues. They were eager to provide the help that we, as parents, needed.

Building your hospital team

While the doctors and nurses coordinated the care of my son, I soon realized that there were other hospital staff members who were available to care for patients’ family members. There is a social worker dedicated to the NICU patients and their families. The social worker can help with lodging, with postpartum care and with many other individualized need-based services.

In addition, a newly-formed hospital committee, which includes hospital staff and “graduate” parents, is dedicated to supporting NICU families at OHSU Doernbecher. The committee hosts activities near the unit and is also available to meet upon request. The committee is a great resource for those seeking conversation with and support from parents who have found themselves in similar circumstances. They understand what you’re going through, because they’ve been there.

Reaching out to volunteers

Weeks passed before I even considered leaving my son’s bedside vacant for an extended period of time during the day. I was “that mom” – the one who would have slept there if she could. Volunteers are often available to help on the unit – they provide an extra set of arms to hold your child if you need an afternoon away. Others serve families by taking pictures of the babies on unit and delivering printed copies back to the bedside. These volunteers delight in caring for the smallest lives at OHSU. Never hesitate to approach a volunteer and ask for help – that’s why they’re there!

Asking family and friends for help    

This last category of caregivers seemed to be the easiest to ask, but in the early days it’s hard to know what to ask! The moment your child is admitted to the NICU, your life seems to shift into crisis mode. Many friends and family generously offered to help – I’ll do anything I can, just name it! – but I wasn’t sure what I needed initially.

I found that offers to do very practical, simple tasks (bringing food, providing childcare for our older children, visiting to hold the baby at his bedside) were most helpful for us. Friends and family who were able to visit us on the unit were given a unique perspective on what life was really like with an infant in the hospital. Our visitors seemed to have an immediate compassion for our situation and they carried that into interactions after our child was discharged.

Simply being present by visiting was so helpful for us. We asked family to take our older children into their home for extended stays so we could focus our care on the hospitalized child. We asked those that were providing extended childcare for us to bring our kids to the hospital for a fun visit. We would take the kids to the playground at Doernbecher, go for a walk or ride the tram down for a treat at a nearby cafe. We asked other friends to come sit with our son so we could take a break away from the NICU and care for our older children for a day.

I quickly developed friendships with other NICU mamas who spent extended time on the unit. Sometimes, we would order meal trays at the same time so we could “have lunch” together or we’d escape the hospital for an hour or so to grab coffee or appetizers.

Our time spent together off of the unit were unforgettable. We could relate. We didn’t have to ask each other what it was like to have an infant in the NICU, because we already knew what it felt like. These “on unit” friendships provided a big help, because much like the pods in which we lived our lives, we didn’t feel isolated. We knew we weren’t alone. Often times, I found that family and friends helped buoy me up when I found myself sinking.

Every year, more than 5,000 babies in Oregon and Southwest Washington are born too soon. OHSU Doernbecher has joined thousands of teams across the country that support the March of Dimes‘ March for Babies. Interested in participating? Join Team OHSU/Doernbecher Tiny Feet!

Related reading
It’s a roller coast ride: One mom’s NICU experience
Once upon a time: Mae Lin’s Doernbecher story
A note of thanks from 8-year-old former NICU patient Elle

 

 

 

 

Preventing window falls: Tips to keep kids safe

Pediatricians often think of springtime as the beginning of “falling season.” Every year, 3,300 children younger than 6 fall from windows, according to the United States Consumer Product Safety Commission. Approximately eight of these falls will result in death.

In support of National Window Safety Week — April 3 to 9 — the Tom Sargent Safety Center at OHSU Doernbecher Children’s Hospital is sharing tips to prevent window falls:

  • Install it. Screens are not strong enough to prevent a child from falling. Installing window guards or stops is the best way to prevent window falls. Experts recommend leaving the guards and stops in place until children are 11 years old.
  • Move it. Prevent children from getting to windows by moving items they can climb on – including beds, dressers and shelves – away from windows.
  • Lock it. Keep windows locked. Only open the windows that children can’t reach. If you have double-hung windows, only open them from the top.
  • Teach it. Create a no-play zone by moving all toys and decorations away from windows. Teach children not to play in this area.

If a fall does occur: Don’t try to move your child; call 911 immediately.

“Sadly, we often think of spring as ‘falling season’ because the weather gets warmer, and people begin to open their windows. Children are curious by nature and can easily and quickly fall through an open window,” said Ben Hoffman, M.D., director of our Tom Sargent Safety Center. “Unfortunately, falls are the leading cause of injury hospitalization for children in the U.S. Parents and care providers should consider this and take necessary precautions to prevent potential falls. Using window stops and guards are an easy, cheap and very effective way to decrease the risk of serious injury.”

Ask about window safety toolkits at our Tom Sargent Safety Center (located just inside the OHSU Doernbecher lobby). For additional information about National Window Safety Week events and resources, visit ohsu.edu/childsafety or stopat4.com.

A day in the life of a Doernbecher doc

In her spare time, Dr. Guzman loves long-distance running. Here she is at the 2015 Paris International Marathon!

In her spare time, Dr. Guzman loves long-distance running. Here she is at the 2014 Paris International Marathon!

For the last 12 years, Dr. Judy Guzman has cared for OHSU Doernbecher patients with infectious diseases. She loves working with kids because of their optimism, and it’s safe to say our patients and families feel the same way about her. Affectionately known as “The Guz” among some patient families, Dr. Guzman is also involved in several projects aimed at decreasing hospitalized children’s risk of developing infections.

This Doctors Day, we sat down with Dr. Guzman to learn what an average Wednesday looks like for her.

***

6:00 a.m.: Wake up for a morning run around my neighborhood (although the recent Daylight Saving change has admittedly made me skip a few runs…)

7:00 to 8:00 a.m.: Get my kids ready for school. They’re old enough to make their own breakfasts at this point, so I’m just a supervisor now!

8:00 a.m.: Wave kids off to school. We’re lucky to live only three blocks from our school, so they can walk – rain or shine! Once they’re on their way, I drive up to Doernbecher.

Dr. Guzman and her amazing clinic team meeting with a sweet Doernbecher patient

Dr. Guzman and her amazing clinic team meeting with a sweet Doernbecher patient

9:00 a.m. to 12:30 p.m.: Wednesday morning clinic. I have the best clinic team ever!

12:30 p.m.: Lunch. Every Wednesday I have the kale Caesar salad from the Natural Food Store next to the OHSU gift shop. It’s my favorite!

1:00 p.m. to 5:30 p.m.: Various tasks, including patient care, research meetings and conference calls. Of course, there’s always some paperwork to do!

5:30 p.m.: Head home! I spend the rest of the evening making dinner, helping my kids with their homework – general household frenzy stuff!

 

Dr. Guzman with her family

Dr. Guzman with her family

 

Judy Guzman, D.O.
Associate Professor of Pediatrics, Division of Infectious Diseases
OHSU Doernbecher Children’s Hospital

 

 

Know a Doernbecher doctor you’d like to thank? Leave a comment below or email socialmedia@ohsu.edu, and we’ll be sure to pass along your note! 

Hemangiomas: What parents need to know

As their infant grows and matures, many parents will experience and express concern about birthmarks. Up to 20 percent of Caucasian babies will have vascular birthmarks. The most common type is the infantile hemangioma, also known as “strawberry hemangioma.”

Hemangiomas are benign vascular proliferations that tend to appear in the infant’s first week of life as a faint red stain or patch. Over the next several weeks to months, the hemangioma undergoes a rapid proliferation or growth phase. When the child is approximately 6-9 months, the hemangioma’s growth halts and is followed by a very slow involution or “shrinking” phase.

Approximately 10 percent of hemangiomas involute, or “disappear” by 1 year, 50 percent by 5 years and 90 percent by 9 years. Many will never completely disappear and can leave behind some residual changes in the skin and tissues. These are most troubling when located on one’s face or neck.

While we don’t know what causes hemangiomas, we do know that there are some risk factors for getting hemangiomas, including :

  • Caucasian race
  • Female gender
  • Prematurity
  • Low birth weight
  • Multiple gestation
  • Prenatal hypoxia (pre-eclampsia, placental abnormalities)
  • Advanced maternal age


What to know if your infant has a hemangioma
The rapid growth in hemangiomas occurs during the first 3-4 months of life in most babies; close observation is often suggested during this time to determine which lesions require treatment (e.g., those causing functional impairment or those with impending complications like ulceration, obstruction of the eye or breathing passages). Early treatment (as young as 4 weeks of age) is most effective in halting the growth of these birthmarks.

Learn more about birthmarks and get in touch with our Hemangioma and Vascular Birthmarks Clinic here.

Carol J. MacArthur, M.D.
Professor, Pediatric Otolaryngology – ENT
OHSU Doernbecher Children’s Hospital

 

 

 

The Talk: Let your kid’s questions be the guide

This article was written by Megan Haverman and originally appeared in the Portland Monthly 2016 Kids’ Health Annual magazine.

It’s inevitable. Maybe a curious 4-year-old inquires after the state of an obviously pregnant woman in the grocery aisle. Maybe a kid happens upon a racy scene on TV, or hears something from friends that requires explanation. This is the moment at which many parents balk: the beginning of the discussion of the bird and the bees.

Barbara Long, M.D., M.P.H., who’s worked as an adolescent doctor for more than 20 years, says these questions are often more benign than parents believe. “Sex is not a freak-out thing, but it tends to be perceived that way,” she says. “We worry about it! But if we’re matter-of-fact and use the right kind of language, it doesn’t have to be.”

The trick, according to Dr. Long, is to answer only what’s being asked; add more detail later, or upon further interrogation. “A baby comes from the mom” can easily expand into, “Mom pushes out the baby at the hospital.” Often, that might be enough. By giving the simplest answer, parents can maintain a developmentally appropriate conversation over time.

By 9 or 10 answers become more nuanced: “Mom has an egg and dad has sperm, and they get together and make a baby.” If a child asks how, then it’s time to break things down into penises and vaginas. While Dr. Long recommends using the correct words for each body part, she says it’s more important for parents to feel comfortable.

Parents can initiate conversation outside of the kitchen table to keep the discussion light: Dr. Long suggests using television, which often implies sexual activity, as a jumping-off point to talk about dating relationships, birth control or safe sex in the context of other people.

“I want to break down the myth that kids don’t want to talk to their parents about sex,” she says. “They want to talk, they don’t want to be talked at – there’s a big difference.” Parents can make it a two-way street by asking what their child thinks is happening, or how they feel about it.

A holistic approach to the conversation also helps kids to be in a better position when they’re teenagers. “We really just want our kids to make good decisions,” Dr. Long explains. “At 13 to 15, you’ve already done your work. They’re making decisions that are a reflection of their upbringing. That’s why the ongoing discussion is important.”

 

You’re not alone!

  • An online search for “talking to kids about sex” should lead to both helpful and personal tales.
  • Planned Parenthood offers tips for talking to children at any age about sexuality, plus a parents’ guide to Puberty 101.
  • A part of the National Campaign to Prevent Teen and Unplanned Pregnancy and aimed at older adolescents and young adults, Bedsider.org features a Guy’s Guide to birth control and a section on sexual myth-busting.

All tied up with latching

Nothing compares to the excitement of being a new parent. The bond between a mother and her baby starts to form soon after birth, and it happens in many ways. Mothers have to assist their newborns in basic functions, including sleeping and eating. So when breastfeeding does not go as smoothly as had been expected, it can cause significant frustration in new parents.

When discussing this issue, something that frequently comes up is whether or not a child could have a shortened tongue frenulum, also known as a “tongue tie.”

What is tongue tie?
We all have a frenulum underneath our tongue. As we develop in the uterus, our tongue starts out fused to the floor of our mouth. As we grow, the tongue is freed, except in the midline, where a small band of tissue remains – we call this the frenulum. The size of this band and the degree to which it restricts tongue movement can vary widely.  Studies show that up to 10 percent of the population can have this condition; however, it doesn’t always cause symptoms.

What problems can it cause?
Tongue tie has been associated with breastfeeding problems, including sore nipples, poor latch and poor weight gain. A quick procedure called a frenulotomy can be performed, and at least in some cases, can be helpful to improve breastfeeding. The procedure is not without risks, although they are fairly rare; these can include bleeding, infection, injury to surrounding saliva glands and recurrence of the tie due to scarring. It also doesn’t always work to fix all issues with breastfeeding.

Because this issue has not been researched as thoroughly as we would like, the degree to which your baby may improve with the procedure can be hard to determine.  Your Otolaryngologist will work with you to weigh the risks and benefits for your particular situation in deciding whether or not to proceed.

When does tongue tie need to be treated?
The procedure is reasonable to consider when there is significant pain with nursing that doesn’t improve with time, experience and improved latching technique. Additionally, poor weight gain in a child with a tight frenulum may prompt consideration of the procedure. A consultation with a lactation consultant can be invaluable in sorting out these issues.

Tongue tie can also be associated with speech problems.  These do not usually surface until later in childhood, often between 4-6 years of age, and affect only a minority of patients that are born with a tongue tie. For this reason, clipping the tongue in a baby solely to prevent future speech problems is not generally recommended.

Lourdes Quintanilla-Dieck, M.D.
Assistant Professor, Pediatric Otolaryngology – ENT
OHSU Doernbecher Children’s Hospital

 

 

Ericka King, M.D.
Assistant Professor, Pediatric Otolaryngology – ENT
OHSU Doernbecher Children’s Hospital

 

 

 

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