A “magic” approach to scoliosis

This article was written by Allison Jones and originally appeared in the Portland Monthly 2017 Kids’ Health Annual magazine.

Early detection and new treatment methods help doctors treat the spinal condition using magnets – and fewer surgeries. 

Some curves in life are great – the curve on a mountain road that leads to a great view, or curveballs from a star baseball pitcher – while other curves, like a spine that bends from side to side, can mean trouble for a growing body. And while some cases of scoliosis are congenital (meaning children are born with vertebral curves) or neuromuscular (stemming from cerebral palsy, spina bifida or other conditions), about 80 percent of scoliosis cases are idiopathic – doctor speak for “we don’t really know why it occurs” – and tend to develop during puberty.

According to Dr. Christina Sayama, pediatric neurosurgeon at OHSU Doernbecher Children’s Hospital, both parents and primary care physicians should be on the lookout for markers of this condition, which impacts up to 9 million Americans.

“Early detection is key to avoiding surgery or complications with the heart and lungs,” says Dr. Sayama.

Scoliosis tends to run in families, so be sure to speak to your pediatrician about any family history of spinal conditions, and watch for the development of uneven shoulders or hips, an unusual gait or a spine that curves to one side when a child bends over.

“Once scoliosis is suspected, the gold standard of diagnosis is an upright spinal X-ray – and anything greater than 10 degrees of curvature is considered scoliosis,” explains Dr. Sayama. “Up to 20 degrees is considered mild; between 20 and 40 degrees, many neurosurgeons and orthopaedic doctors will recommend using a brace; and I will recommend surgery for a curve greater than 45 degrees.”

For growing bodies with mild scoliosis, Dr. Sayama often recommends physical therapy and core strengthening in addition to the proven strategy of wearing a brace.

“The longer a child wears the brace every day, the more likely they are to succeed in keeping the curve from progressing and needing surgery,” she explains.

And what about when surgery is necessary? In the past, a severe scoliosis diagnosis meant multiple surgeries – every 6-9 months – to lengthen growing rods that guided the spine into a healthier position. Thankfully, a new treatment is drastically reducing the number of surgeries necessary for little ones. Called the Magec Growing Rod System, the technique requires an initial surgery to implant temporary growth rods that can be lengthened by magnets from outside the body until a child reaches skeletal maturity. That means less time in the hospital, and more time practicing those curveballs.

 

If you’re concerned your child may have scoliosis, talk with your pediatrician or call OHSU Doernbecher Children’s Hospital at 503 346-0640

 

 

How to beat bedwetting

This article was written by Scott Henjum and originally appeared in the Portland Monthly 2017 Kids’ Health Annual magazine.

First, the good news: Most kids grow out of it. 

If your child can’t seem to stop wetting the bed, it may reassure you to know that bedwetting is not typically a medical problem, and usually resolves with time. Even more reassuringly, there are a number of effective therapies to help your child transition to dry nights.

“We know that bedwetting is a frustrating and exhausting challenge for parents,” says Dr. Casey Seideman, pediatric urologist at OHSU Doernbecher Children’s Hospital. “For a child, it’s embarrassing and emotionally taxing. The key things to do as a parent are to be patient, set short-term goals and to commit the whole family to work with a bedwetting family member.”

Dr. Seideman says that up until age 5, wetting the bed is simply a part of potty training. For older children, Dr. Seideman advises parents to provide active encouragement, such as a sticker or other small reward for every dry night, and a larger reward for multiple dry nights. This behavioral therapy is most effective if a child is highly motivated, a light sleeper and has no family history of bedwetting.

If rewards don’t do the trick, it’s time to try a bedwetting alarm, a bedside device that establishes a mind-body connection to let the child know that they are about to wet the bed. The device has a sensor that goes off when a child starts to urinate, triggering an alarm that will wake the child to use the bathroom. These alarms are highly effective, but if your child is still wetting the bed after six months of use, it’s time to pursue other options.

“The last line of therapy for bedwetting is medical therapy,” says Dr. Seideman. The drug Desmopressin decreases urine production. The medication is effective for about one-third of patients, and can also be good for short-term goals, such as keeping dry on a sleepover or camp. Another option is treating a child with antidepressants, which relax the bladder muscle.

Children who do not respond to the therapies may need specialized care and further evaluation for conditions like sleep apnea, constipation and diabetes. But chances are good that they’ll grow out of it in time – especially with plenty of parental support.

If your child has difficulty with bedwetting, talk with your pediatrician or call OHSU Doernbecher Children’s Hospital at 503-346-0640. 

Lice do’s and don’ts

This article was written by Allison Jones and originally appeared in the Portland Monthly 2017 Kids’ Health Annual magazine.

Six tips for treating the itchiest of childhood problems from OHSU Doernbecher Children’s Hospital pediatrician Dr. Ellen Stevenson.

DON’T share combs, brushes, hats, ribbons or barrettes.
Beware the dress-up corner! Avoid sharing capes, hats, dresses and coats if there are lice in the classroom.

DON’T keep information to yourself.
The evidence is clear – getting head lice is not related to cleanliness and doesn’t reflect badly on parents. The sooner you tell teachers and parents when you notice nits or lice, the easier it is to stop the itchy cycle.

DO let there be light.
Make sure you can see what you’re doing by picking in good light – many parents find sunlight particularly helpful for finding nits.

DON’T give up the hunt too soon.
Lice lay up to 10 eggs a day! Check back every one to three days during an active infection, and again in two to three weeks.

DO think beyond the scalp.
To help limit the spread, wash bedding and clothing in hot water, vacuum couches and car seats, and seal stuffed animals and pillows that can’t be washed in plastic bags for a few weeks.

DO get help when necessary.
For ongoing concerns, discuss treatment options with your health care provider. Also, an entire industry has popped up around lice removal – if you’re not able to eradicate the bugs on your own, you can still consider professional nit-picking.
Parents and caregivers – do you have any additional tips to share? Leave a comment below! 

The vaccine low-down: Protecting your children against chickenpox, meningitis and more

This article was written by Katelyn Best and originally appeared in the Portland Monthly 2017 Kids’ Health Annual magazine.

From DTap to measles, mumps and rubella, the list of vaccinations children are advised to get can seem overwhelming. And with fears about side effects, allergic reactions and even autism on the wind, it might seem better to cut down on those shots or skip them altogether.

But is that hesitation justified? In short, no.

Dawn Nolt, M.D., M.P.H., pediatric infectious disease specialist at OHSU Doernbecher Children’s Hospital, recommends talking through any concerns with a trusted medical provider; however, she also emphasizes that “vaccines are very safe and very effective, and that serious diseases can occur if your child or family are not immunized.”

These serious diseases range from scary stuff like polio to seemingly more prosaic infections like chickenpox. But even if an illness doesn’t seem severe, that doesn’t mean it’s safe to skip immunizations. Even the common flu can lead to serious complications, such as a secondary infection or superinfection.

“When you combat viruses, your immune system gets distracted, and some bacteria that normally are held in check can surge up,” Dr. Nolt explains. Vaccines eliminate that risk.

If your own child’s health weren’t reason enough to vaccinate, there’s a bigger issue at play: herd immunity (otherwise known as community immunity). As Dr. Nolt explains, “An infection in one person can’t be spread to the population if there’s no one else vulnerable to that infection.”

That community-level protection is important, because not everyone can make the choice to get immunized, including infants and folks with certain medical conditions.

Once you’ve decided to vaccinate, how do you know what the right schedule is? 

“We encourage all families to have a discussion with their medical provider about the best care their child should have,” Dr. Nolt says. The list of shots required by Oregon schools is a start, but it doesn’t cover everything. The human papillomavirus (or HPV) vaccine, for instance, isn’t on that list, but doctors recommend both boys and girls get it by age 11 or 12 years. HPV is a sexually transmitted virus that can cause cancer years or even decades after exposure.

Another important series of shots not required by Oregon schools are the meningococcal vaccines, which protect against some strains of bacteria that can cause meningitis. There are three different bugs to cover here: Kids should be immunized against the first two by 15 months of age. The vaccine against the third one, Neisseria meningitidis – which Dr. Nolt says is the rarest but “most devastating” – is given to teens and young adults.

What if all those shots seem like a little much? Can you skip some, or delay them until later?

Nope, says Dr. Nolt. “The CDC meets every year to assess the effect vaccinations have had on our pediatric patients,” she explains. “The types of vaccines, and have they’re given, have been meticulously studied.”

Learn more about the HPV vaccine here.

Baby in a box? What you need to know about safe infant sleep

Every day, 10 babies in the United States die from unsafe sleep. That’s more than the number of children who die from cancer. It is a staggering number, and one that is much higher than I ever though it would be. While it is unlikely that we’ll ever be able to get this number to zero, we do know a tremendous amount about how to protect babies from sleep-related death.

As a pediatrician and a parent to three kids, I know firsthand how hard sleep can be for parents of infants. Some babies sleep wonderfully from the beginning, but most wake more often, or take much more effort to get to sleep, than most parents ever imagined. Infant sleep is a huge deal, and everyone searches for the magic answer. We know that the safest thing to do is to have infants sleep:

  • On their back, not their side or their tummy
  • Alone, with no blankets, bumpers, bears or anything else
  • In their own space (for example, in a bassinet or crib)

The U.S. National Institute of Child Health and Human Development’s “Back to Sleep” (now “Safe to Sleep”) message has resulted in a significant decrease in deaths from Sudden Infant Death Syndrome (SIDS), resulting in half as many tragedies. What has not changed as significantly are sleep-related deaths from strangulation and suffocation related to objects in sleep spaces, or from sleeping in unsafe places and positions.

A safe place for a baby to sleep is a flat surface, on an approved, firm mattress, in an approved sleep product. In the U.S., these products are all approved by the Consumer Product Safety Commission (CPSC), based on careful testing and monitoring. A crib, bassinet or play yard (for example a Pack ’N Play) with the original, approved mattress is the only safe place for a baby to sleep through his or her first year of life.

Unfortunately, a quick Google search about infant sleep will yield a number of products that have not been evaluated or approved by the CPSC as safe. These include baby boxes, angled sleep spaces and “breathable” mattresses. All of these products have several things in common:

  • They all market a solution to sleep problems that families face
  • They all claim to have been tested for safety
  • Almost none of them have actually undergone assessment by the CPSC, and therefore are not to be trusted!

At first blush, these products may seem like a good idea, but they are really preying on the anxiety and exhaustion of parents and caregivers. Let’s look at the baby boxes as an example.

In Finland, the Finnish government has distributed sleeping boxes to all families with newborns. This was done as a public health measure to ensure all babies had a safe place to sleep.

In the past few years, American companies have begun manufacturing and aggressively marketing similar boxes. I remember thinking that it felt like a disruptive idea, and a potentially easy, low-cost approach to dealing with our epidemic. I had many questions about how they would work, what they were made of, and how we knew they would be safe for babies in this country.

I now think differently. We are not Finland. They are a country of 5.5 million people, a country with universal health care, including prenatal care, early-infancy home visiting support programs and a much more homogenous populace, both in terms of economic and racial/ethnic characteristics. It’s not safe to assume that what works in Finland will work in the U.S.

Simply put, I am scared of baby boxes. I’m scared because I have no idea how safe they are, specifically how they compare to other established sleep spaces. To date, there are no standards that apply to the boxes; they are being marketed with no peer reviewed information about their safety, and no assurances that they are not harmful. If I cannot be certain, I am not willing to take risks with something so potentially devastating.

Right now, there are thousands of boxes being given to families of newborns across the United States, free of charge. This is because the for-profit companies that make them are giving them to hospitals to establish a market. We do not allow formula companies or drug manufacturers to do that, so why are we OK with the box makers? Companies are giving away a product that has no established safety standards, when we have plenty of alternatives that are safe and proven.

The boxes are made of cardboard, and come with a mattress. In using them, the infant simply sleeps in the box as they would a crib or bassinet (both of which must meet strict CPSC standards). Where does one put a box with a baby in it? On the floor? On a bed, table, couch? I am not sure any of those places are ideal. What happens if the box gets wet? Babies spit up and leak out of diapers, after all. What happens when a baby can roll to their side or tummy? This occurs between 3-6 months, which is also the highest risk period for SIDS.

A bassinet that meets CPSC standards can be purchased for a price similar to the cost of the boxes. They also can be used until the baby can roll, and they have a proven safety record when used correctly. Portable play yards are only slightly more expensive than the commercial boxes, meet stringent CPSC standards, and can be used for babies for well beyond a year or two of life.

As a pediatrician, my job is to do what’s best for kids. I do that through application of the best available science, and partnership with parents and caregivers. The science tells me that unsafe sleep is among the leading causes of death for babies, and we know the safest ways for infants to sleep are alone, on their back, in a safe place. Until I have science that shows that the boxes are a safe place, I would urge parents and caregivers to use what we know to be safe. It is simply not worth the risk.

The OHSU Doernbecher Tom Sargent Safety Center partners with the Cribs for Kids program, an evidence-based non-profit that helps distribute CPSC-certified play-yards for sleep at cost. We ensure that every sleep space that we distribute comes with face-to-face education about proper use and safe sleep. We hope to be able to reach a broader cross section of the Portland community, and will be working with community-based groups with moms in need to get the safe sleep message out there, and cribs into the homes of families that have no safe place for their babies to sleep. If you need help, let us know. If you have questions or concerns, please feel free to contact us.

Ten babies a day. How can we do anything other than what we know to be the safest?

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

Raising a reader in digital days: Comics galore!

Following up on his blog post about summer reading, Dr. Craigan Usher extols the benefits of reading comic books and makes some recommendations for families looking to dive into the world of comics.

Connecting with (and through) comics

For reluctant readers, comics (also called sequential art) can be read in bite-size pieces, rather than whole chapter meals. Because they’re less text dense, comics can be read in one sitting or over the course of a few days. Further, comics can be shared among kids while on trips – with younger children perhaps enjoying “reading” the images, while more mature readers engage with the text.

Since large comics (often referred to as graphic novels) can be ready very quickly, the price can add up. This inspires young readers and families to share with one another or to borrow from the library. This is a great excuse to connect with people in your neighborhood or make your way to the local library.

Comics invite readers to be transported into the story in a way that animated features may not. Simply put, most comics invite readers to imagine what occurs in the space between panels – requiring less intense effort than pure text formats, but certainly more than TV and movies.

Encouraging empathy

Comics encourage empathy by spelling out the ways we experience the world, with cognition as thought bubbles, verbal communication as speech bubbles, reactions creatively marked by stomach butterflies or sweat beads flying off one’s face, and so on. Further, graphic literature has blossomed to include many titles that help school-age kids imagine how to successfully negotiate bullying or deal with “drama,” and they encourage children to consider the thoughts, feelings and experiences of others who may be different than themselves. These include titles like Raina Telgemeier’s tale Smile, which depicts her struggles with dental trauma. Jennifer Holm and Matthew Holm’s Sunnyside Up about a young girl sent to live with her grandfather in Florida is also particularly moving. Finally, even space and otherworldly adventures like Ben Hatke’s Zita the Spacegirl, Jeff Smith’s Bone series or Kazu Kibuishi’s Amulet adventures help readers consider the often conflicted emotions and motivations behind character’s actions.

Storytelling through comics

Reading comics often inspires us to draw our own, working through exciting moments by distilling these BIG experiences into brief, but short stories. For example, a child might take a fun experience they had over the summer and want to remember it to tell friends or a teacher about it later. However, some of the usual ways we commemorate trips or experiences may fall short. For example, your child may not want to journal capturing all of the details of a particular experience and maybe you didn’t want to buy the commemorative tchotchke. What better way to preserve the experience than to distill a fun trip to the river than to draw a three-panel comic? One fun activity I encourage parents to do is to sit and write these with their children. For example, you might set a timer for 10 minutes and, sitting alongside your child, both write your own 3-4 panel comics with various prompts:

  • “The best thing about this summer was…”
  • “One thing I wish I could have changed about this summer…”
  • “The summer of 2017 will always make me think about…”

After you complete your comic, share them with another and put them up on the fridge or wall for a sequential art show.

We’d love to hear your thoughts! Was this helpful? What comics are you and your children reading? Leave a comment below to let us know!

 

Craigan Usher, M.D.
Clinical Associate Professor of Psychiatry
Program DirectorChild & Adolescent Psychiatry Training

 

Five ways to bring books back into your family’s summer

The benefits of early exposure to reading, of parents reading to their children, and kids being surrounded by books have been well-studied. Researchers emphasize that early reading stimulates important language centers and emotion recognition areas of the brain, specifically in the left temporal lobe. They also note that reading enhances academic performance, increases children’s confidence and inspires the life-long skill of curiosity. Hence, if your child is puzzled by a phrase you read together and wonders aloud, “What does that mean?” then you’re on the right track! You are co-creating space for discovery.

However, summers can be hard on kids and families. Routines are disrupted and some expectations for reading might be suspended. Further, like Superman avoiding kryptonite, perhaps your child has tiptoed around the bookshelf for the last month in favor of outdoor fun or screen time. Now, four weeks before school begins, you may find yourself concerned about summer brain drain, wondering, “Does my child still remember how to read?” or “are there skills I can work on to best prepare for the upcoming school year?” Here are five tips for bringing books back into your child’s summer experience:

1. Create (or restore) a nightly routine that includes reading.

While summer camping trips and other fun activities may interfere, insofar as possible try to establish the same nightly routine your family will have during the school year. In general, this should involve turning off screens in two hours before bed, perhaps a warm bath or shower, then snuggling into bed. For young children this is a great time for them to read to you and then to be read to by parents. I encourage parents to continue reading to their children even after children have learned. This a great time for bonding and for helping you polish your voice acting chops – experimenting with villain voices can be especially hilarious. This also allows your child’s vocabulary to flourish and for children to enjoy increasingly sophisticated stories they may grow frustrated reading alone.

2. Chart progress and incentivize reading.

Libraries in Clackamas, Multnomah, and Washington counties have reading incentive programs with prizes. It’s not too late to participate. In addition, some local bookstores are offering coupons for reading books over the summer with no book purchases necessary. So, your child could potentially read library books and use the coupon for that little Pusheen cat doll they’ve been coveting!

3. Taking a road trip: audiobooks!

While tablets or movies in the car may be enjoyable for kids, one way that parents and children can enjoy stories together ­– and have a shared experience to reflect upon when you arrive at your destination – is to listen to audiobooks.

4. Comic books are books. Summer blockbusters = great reading!

This summer offers myriad films inspired by comics: “Wonder Woman,” “Valerian and the City of a Thousand Planets,” “Guardians of the Galaxy Vol. 2” and “Spiderman Homecoming.” If your family chooses to enjoy one of these summer blockbusters, you might read the comic books that inspired them. For younger kids who want to watch the movie with older siblings but may find some of the images frightening, it can be helpful to get ahold of the graphic novel adaptation and read this with them before they watch the movie. After the movie, you can look at different writers and artists who take on the same characters. One fun aspect of reading comics with your kids is that it demonstrates that movies are not canonical; they do not represent the only way of viewing a character or myth. For example, the Caucasian Peter Parker is not the only version of Spiderman and some children may find themselves relating more easily to Miles Morales, a Spiderman with African-American and Hispanic roots.

5. Not only are comic books really books, but they are also passionate, empathyenhancing works that are not just about superheroes!

As with healthy foods, I fervently believe that comic books are an “anytime snack,” but they are particularly good for summer reading. To learn more about the benefits of comics (along with some recommended reading according to age/interest), click here!

 

Click here to watch Dr. Craigan talk comics and summer reading on KGW! 

 

We’d love to hear your thoughts! Was this helpful? How do you raise summer readers in these digital days? What are you and your children reading? Leave a comment below to let us know!

Craigan Usher, M.D.
Clinical Associate Professor of Psychiatry
Program Director, Child & Adolescent Psychiatry Training

Four water safety tips everyone should know

Drowning occurs with shocking frequency. According to the CDC, drowning is the leading cause of preventable death in children ages 1-4 in the U.S., and it’s second only to motor vehicle crashes in preventable deaths for kids over 4 years. Sadly, the problem is getting worse over time, as drowning deaths in pools in children ages 5-9 have increased 18 percent in the last 10 years. In Portland, we are blessed with proximity to water, in both natural and man-made settings: waterfalls, the Oregon Coast, lakes and pools. Water is ubiquitous in the Pacific Northwest, and with the joy and beauty comes the potential for tragedy. So what can we do to prevent drowning and keep our children safe?

  • Heads up – constant supervision is key
    First and foremost, supervision is the most important aspect of water safety. Data shows that the age of a child is associated with where they are most likely to suffer a drowning or near-drowning. Young children and babies are more likely to drown in bathtubs. Preschool and school-aged children drown most often in pools. Older children are most at risk in natural bodies of water such as lakes and rivers. The common thread that connects these events is a lack of adequate adult supervision, or sometime just a brief lapse in supervision. Drowning happens quickly, and can happen as a result of even a few seconds of inattention, so the supervision must be constant.
  • Lock it up (or empty it out)
    Preventing pool and spa drownings requires more than just supervision. Proper four-sided fencing with gates that latch, alarms on doors that access pools, and rigid covers should be used around all home pools and spas. Anything that collects water, whether it is a temporary plastic pool, a bucket, tub or other basin, should be emptied of water and stored upside down when it is done being used. Children can drown even in very shallow water – as little as an inch deep.
  • Buckle up
    To keep children safe around natural bodies of water and while canoeing, kayaking or boating, life jackets must be worn. Water wings or floaties are not a suitable life-saving flotation devices, and children need a life jackets that fit properly to reduce the risk of drowning in both open water and pool settings. Many public lakes, such as Henry Hagg Lake, now have free life jackets available to borrow. These can be the difference between life and death.
  • Sign up
    Finally, children need to learn to swim. While swim lessons and water safety training have not been shown to prevent drowning for babies and very young children, swim lessons absolutely can help protect school-aged children and equip them with skills that will last a lifetime. The American Academy of Pediatrics recommends swim lessons for children older than 4 years. The American Red Cross offers online water safety resources that parents and teachers can utilize to teach children about ways to stay safe in and around water. Unfortunately, not everyone has the opportunity to learn to swim. Classroom-based or pool-based survival swimming skills are not mandatory in public school curriculums, and this is something that can hopefully be implemented in the future. However, even with swim lessons, it should be reiterated that no child is drown-proof, and even a strong swimmer needs supervision and basic safety measures as discussed above to reduce the risk of drowning.

We must acknowledge the real risk of drowning among children, ensure heightened attention to the need for supervision for babies and children in and the water, and work to incorporate basic water safety practices in the home and our communities. With these efforts, many devastating childhood deaths can and should be prevented.

 

Laura Waagmeester, M.D.
Resident in Pediatrics
OHSU Doernbecher Children’s Hospital

 

 

 

About Dr. Laura Waagmeester: As a native of the Pacific Northwest and a former competitive swimmer, I have spent my life in and around the water – swimming, instructing and lifeguarding. After swimming at the University of Washington and obtaining dual bachelor’s degrees in architecture and psychology, I attended Oregon Health & Science University for medical school. Following this I stayed for residency in Pediatrics at OHSU Doernbecher Children’s Hospital, where I am now entering my third and final year. I am applying to Pediatrics Emergency Medicine fellowship, where I hope to continue working toward the health and safety of our children. In my spare time I am still active in swimming, as well as triathlons and long-distance running. I have competed in an Ironman Triathlon in Bolton, England, and have so far completed the Portland Bridge Swim – an 11-mile open-water race – twice!

Your scoliosis questions, answered

OHSU Doernbecher Children’s Hospital provides team-based care and the latest techniques for children and teens. Our multidisciplinary spine team includes Dr. Scott Yang, Dr. Christina Sayama and Dr. Matthew Halsey. We sat down with Dr. Yang to ask him some frequently asked questions about scoliosis.


What is scoliosis?
Scoliosis is a curvature of the spine that occurs from a variety of potential causes. This can lead to a deformity of the trunk, and – only in very severe cases or very young patients – lead to problems in pulmonary function. The time that the curvature of the spine gets worse corresponds to when the child is growing rapidly.

ScoliosisThe most common type of scoliosis occurs during the early teenage years when the child is growing rapidly; this is called adolescent idiopathic scoliosis. Other children can have scoliosis due to abnormal development of the spine in-utero (congenital scoliosis), or due to a neurologic condition such as cerebral palsy or spina bifida (neuromuscular scoliosis).

How is scoliosis diagnosed?
Scoliosis is often initially diagnosed with a clinical examination of the back. The doctor will often have the patient bend forward and look for a curvature or abnormal hump along the back. X-rays of the spine are obtained to confirm the diagnosis.

Why are girls more likely to get scoliosis?
It’s unclear exactly why girls are more likely to get adolescent scoliosis. Some believe it has to do with the timing of the adolescent growth spurt, though there is no proven answer. Other causes of scoliosis (including congenital and neuromuscular scoliosis) affect girls and boys equally.

What kind of treatments or procedures are available for patients with scoliosis?
If a child is very young, casting of the spine has been very effective in controlling and, in some cases, resolving the scoliosis. Bracing can be a very effective tool to help prevent progression of the scoliosis to a large curve. In young children, to allow for the spine to continue to grow, there are “growth friendly” spine surgery options including magnetic rods that lengthen as the child grows. In older children and adolescents, surgery to correct the curvature and fuse the spine can be indicated in larger curves.

What advice or information would you give someone who will have surgery for scoliosis?
In older children and adolescents, surgery to correct the curvature and fuse the spine may be recommended if the curve is large. We understand how difficult this decision is for families and we respect that process. The surgery is done very carefully with real-time live monitoring of the spinal cord to prevent injury. Patients and families can typically expect a surgery to last four to seven hours depending on how severe the curvature is. Patients with adolescent idiopathic scoliosis typically stay in the hospital three to four days after the procedure.

 

Scott YangScott Yang, M.D.
Assistant Professor of Orthopaedics and Rehabilitation
OHSU Doernbecher Children’s Hospital

 

 

To schedule an appointment with a member of our multidisciplinary spine team, please call 503 346-0640 and ask to be seen at our Portland location or our Salem location. 

 

 

“13 Reasons Why” poses risks to Oregon youth

Although a fictional story, the television series “13 Reasons Why” focuses on very real issues that affect youth and young adults. The show’s graphic depiction of the traumatic life events that led to the suicide of a young woman may have already adversely affected Oregon’s youth.

Since its Netflix release in March 2017, multiple young people in Portland area hospitals have reported they watched the series prior to their own suicide attempt. While the series seeks to capture the agonizing challenges of sexual trauma, bullying and suicide, its content poses a significant risk to vulnerable youth, particularly in the absence of supportive peers and adults.

There are many aspects of the series that represent incorrect notions about the psychology and behavior of most young people who die by suicide. The central character is portrayed as seeking revenge, and the adults in her life appear oblivious to her struggles and incapable of offering support. The overarching message glamorizes suicide as a heroic action while failing to offer any sense of hope or alternatives to self-destruction. In reality, most youth who die by suicide struggle with treatable mental health or substance-use disorders. Suicide is never heroic; rather, it is tragic and preventable.

While Netflix’s decision to increase viewer warnings about graphic content may have some value from a legal perspective, it does not do enough to offer specific avenues to seek help. The failure to include suicide prevention resources during each episode is particularly disturbing given the targeted population for the series appears to be teenagers and young adults. This demographic has an elevated risk for completing suicide. Perhaps the greatest concern is well-established evidence that sensational media coverage of suicide clearly leads to increased risk of contagion and clusters of suicide by other youth.

Bullying and shaming through social media, sexual trauma and suicide are very real challenges facing young people and deserve conversation and action. As mental health experts, however, we recommend against the use of “13 Reasons Why” as a tool to encourage conversation about suicide prevention, at any age. Young people who wish to view the program should do so with a supportive adult who can encourage conversation and recommend confidential local and national resources, if necessary.

“13 Reasons Why I Found Help” is the series that we really need to prevent one of the leading causes of death in the population this series seeks to engage.

This post originally ran as a guest opinion piece in The Oregonian and was written by Ajit Jetmalani, M.D., Joseph Professor of psychiatry and head of Child and Adolescent Psychiatry at Doernbecher Children’s Hospital. Other contributors include Kyle P. Johnson, M.D., associate professor of psychiatry and pediatrics at Doernbecher; Keith Cheng, M.D., interim medical director of Unity Center for Behavioral Health Child and Adolescent Psychiatry Unit.

Suicide prevention resources:
Lines for Life, a 24/7 suicide prevention service, offers advice to parents, teachers, youth and the media dealing with suicide, both in general and as related to this television series specifically. Those personally experiencing suicidal thinking or behavior, or who may be concerned about a friend or loved one, should call the National Suicide Prevention Lifeline at 1-800-273-8255 immediately.

Youth Line (Youth to Youth support): +1 (877) 968-8491 (4-10pm daily).  Text Teen2Teen 839863

The Trevor Project (LGBTQ Youth) 1-866-488-7386

Veterans Crisis Line 1-800-273-8255

Doernbecher Best in the Country U.S. News & World Report

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