What you need to know about Zika virus

Medical and public interest has focused on Zika virus and its effects on the unborn babies of pregnant women. Zika virus is spread by mosquitoes; this virus has been detected in countries in Central America, South America, the Caribbean and Mexico.

Zika virus usually causes mild disease (fever, rash, pink eye, joint pains) and goes away without the person needing much medical attention.

However, there may be a relationship between pregnant women having Zika virus infection, and their babies having a birth defect known as microcephaly (a head size that is much smaller than expected), which may cause significant brain damage and may be life-threatening. The Centers for Disease Control and Prevention (CDC) has strongly advised that pregnant women do not travel or live in areas with Zika virus. If a woman has traveled or resided in a country with Zika virus during her current pregnancy, she is advised to discuss with her doctor how this may affect her baby.

Zika virus has been seen in the continental United States in travelers returning to the U.S. from regions with Zika virus. In addition, the mosquito that can spread the virus does exist here in the U.S. There is the possibility that Zika virus may be spread to non-travelers if they are bitten by mosquitoes who previously bit a Zika-infected person in the U.S.

To prevent Zika virus infection in all persons (including pregnant women), people should focus on preventing and avoiding mosquito bites – this involves wearing long-sleeved shirts and pants, using plenty of approved insect repellent and avoiding being outdoors, particularly at dusk and dawn.

For more information on Zika virus, including possible effects on unborn children, please view the dedicated CDC webpage, the CDC’s Questions & Answers: Zika virus infection (Zika) and pregnancy and the CDC’s Travel Health Notices.

Dawn Nolt, M.D., M.P.H.
Clinical Associate Professor
Division of Pediatric Infectious Diseases
OHSU Doernbecher Children’s Hospital


OHSU in the news:
Our experts weigh in on the Zika virus
Traveling to Mexico? OHSU shares warning over birth-defect-linked Zika virus (January 25 via Portland Business Journal)
Birth defect-causing Zika virus likely headed to U.S. (January 25 via KOIN 6)
Travel advisory for pregnant women and Zika virus expands (January 23 via Bend Bulletin)

 

2015 in review: It’s all about the patients

Social media is great for connecting families, patients, employees, donors and community members with one another and with the hospital as a whole. We love sharing Doernbecher stories and news to help foster a sense of community and provide a space where folks can support one another, get advice from experts and learn how they can give back.

Below you’ll find this year’s most-read blog posts. Happy reading!

 

1. Meet Hope, Doernbecher’s hospital facility dog 
Our chief canine officer, Hope, was a hit from the moment she stepped her paws inside Doernbecher. This post explains more about her training, her personality and how she’s bringing hope to our halls.

2. Eleven things your ‘well child’ wants you to know
Pediatric resident Dr. Antwon Chavis shares how his brother’s autism defined him as a “well child” and shares 11 tips for parents and families with special needs children.

3. Isaiah’s Doernbecher story
Isaiah’s mom, Melissa, shares what it was like discovering her son had a brain tumor and offers tips for parents (stay away from Google!) who are going through similar challenges.

4. Once upon a time: Mae Lin’s Doernbecher story
You’ve probably heard Mae Lin on the radio! She was born when her mom, Dr. Dawn Nolt, was only 28 weeks pregnant. Dr. Nolt walks us through what it was like being both a mother and a doctor in the hospital where her daughter was treated and shares her pint-sized hero’s NICU story. Click here to listen to Mae Lin’s radio spot!

5. Five things you might not know about cancer survivorship
Dr. Susanne Duvall
and Dr. Caroline Grantz shared five helpful tips for patients and families who have completed active treatment for cancer. A great resource for family members and friends who want to know how to support survivors and caregivers, too!

6. Six strategies to improve your baby’s sleep skills
Part of an ongoing series, sleep expert Dr. Elizabeth Super shares six common-sense approaches for breezier ZZZs.

7. Behind the scenes: Doernbecher Freestyle XII
For the first time, we went behind the scenes of the Doernbecher Freestyle program, where our patients are teamed up with Nike designers and developers to create custom shoes and apparel. The Nike team weighed in on why the program is so important and impactful for them – and why it’s the highlight of their year.

8. Our lemonade experience: the Charles family’s story
Doernbecher Freestyle patient-designer John Charles was diagnosed with Crohn’s Disease last year. His parents, Tony and Mary Charles, explain how his diagnosis impacted their family and why they’re so committed to building awareness for others dealing with Crohn’s. Fun fact: John Charles can swallow seven pills at once!

9. A ‘purrfect’ pair: Meet Doernbecher volunteers Huck and Carol
Big cat, big smiles. You’ve likely seen Huck Finn and his human, Carol, wheeling around the halls of Doernbecher. Huck, a Maine Coon cat with a “checkered past,” has an enormous impact on our patients and families.

10. The vaccine every teenager needs
Dr. Jennifer Edman explains why the HPV vaccine is important for all teenagers (yep, girls and boys!) and when they should get vaccinated to prevent infection from the most common strains of HPV.

Give knowledge

At OHSU, we have the flame of knowledge as our symbol. For graduate school, I attended Yale University, whose motto is lux et veritas (light and truth). I like to think that each day in my lab we are working to bring light and truth to bear on the challenges facing human health: specifically, understanding childhood developmental disorders, such as autism, epilepsy and intellectual disabilities.

Most people assume that the government, through the National Institutes of Health (NIH), funds most health science research. While this is definitely true, what many people don’t realize is that often the biggest breakthroughs come from ideas that seemed, at first blush, too risky or that challenged the status quo. As of today, at the 11th hour we look to have a U.S. budget deal that will keep the government running. Even though the NIH’s budget for this fiscal year will have a raise, health science research funding for research labs is still suffering (read more here).

O’Roak lab members on a Marquam Hill hike

It is not uncommon for grants scoring in the top 10-20th percentile to go unfunded. For example, we have a grant in review to look at the risk factors for neuronal tube defects (spina bifida). The grant scored in the 8th percentile and the feedback from NIH was “cautiously optimistic,” but it still might not be funded. A natural result of these pressures is that many researchers are hesitant to propose research that might be deemed too “high risk.”

A counter to this risk adverse climate that has benefited my own work has been the generous support of individuals, families and private foundations. My first scientific publication as a graduate student (Abelson et al., Science, 2005) benefited greatly from funds given to my mentor from a family and foundation to take calculated risks and explore new approaches for understanding childhood psychiatric disorders. This led directly to our discovery of one of the first risk genes for Tourette’s syndrome, a discovery that Science magazine called one of the top breakthroughs of 2005. We went on to leverage similar approaches for autism. Our recent significant advances illuminating the genetics of autism risk would not have been possible without the foresight and significant investment of resources provided by the Simons Foundation and the efforts of many families.

Dr. O’Roak working in his genetics lab

With your support, we can strengthen the light of our flame together as we move onward on our quest for new knowledge that will lead to treatments for these major challenges affecting our kids!

Dr. Brian O’Roak
Assistant Professor of Molecular and Medical Genetics
Oregon Health & Science University

Learn more about the O’Roak Lab here. Families interested in participating in research studies can find out more here or email torch@ohsu.edu.

A Doernbecher patient gives back

Four years ago, 15-year-old Lydia Tam was undergoing inpatient chemotherapy at OHSU Doernbecher Children’s Hospital – and she forgot to pack socks. Our hospital provided her with a pair to keep her feet warm.

Although a sock snafu was the least of her concerns while she was being treated for a brain tumor, it sparked an idea.

“On our drive back to Eugene after treatment, my mom and I were talking about how supportive everyone was – volunteering their time and resources to our hospital,” Lydia said. “I just wanted to give back, so we were brainstorming ways that a high schooler could make a difference in someone’s life.”

She started collecting and delivering socks and slippers to patients at OHSU Doernbecher through her Socks of Care and Kindness (S.O.C.K.) Project, which she launched in 2012.

“I started small by donating socks on 10S, and we kept getting more socks and more support from other people,” she said.

Her deliveries grew as support swelled, and when she visits, she typically brings around 500 pairs of socks for patients in various units.

“I include a little card that explains who I am and how this got started,” she said. “It’s something so little but it makes a difference in someone’s stay at Doernbecher.”

Lydia says her main objective is simple: to bring a smile to someone’s face.

“Having stayed in a hospital for chemo treatments, I know how boring and gloomy it can be,” she said. “Having a pair of socks can bring some joy when you need it most.”

The S.O.C.K. Project collects slippers and socks that are age appropriate and can add a small dose of excitement to a child or teenager’s day with fun colors and characters.

Lydia, now a 19-year-old student at Stanford University, is studying biology and hopes to go into the medical field someday to give back in an even bigger way. For now, though, she’s grateful for her own care team (including Dr. Kelly Nazemi and Dr. Lisa Madison), whom she sees when she’s back from school.

“I was really touched by how Doernbecher cared for me more than just getting cancer out of my body,” Lydia said. “Volunteers and staff cared for me emotionally, and they cared for my whole family.”

Visit The S.O.C.K. Project’s Facebook page to learn more and get involved here. Donations will help warm a child’s toes and heart!

From Doernbecher to Tanzania

Pediatric hematologist/oncologist Dr. Sue Lindemulder knows that families are families, no matter where they are in the world.

For the last three years, Dr. Lindemulder has organized and led a group of Doernbecher fellows on annual trips to Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, Tanzania, where they care for kids at children’s hospital Jengo La Watoto and work with hospital staff to develop curriculum and improve their pediatric oncology unit.

We sat down with her to learn more about the training and instruction they provide – and how it ends up making a difference in the way we care for kids right here in Portland.

***

How did the relationship between Doernbecher and MUHAS develop?

Jengo La Watoto children's hospital at MUHAS

Jengo La Watoto children’s hospital at MUHAS

I was sent to Tanzania for three months when I was still in fellowship, and I ended up learning a lot and meeting a lot of people there. Over time I’ve become involved in a Masters program at MUHAS that educates and trains Tanzanian pediatricians to become hematologist/oncologists.

What kind of work do you do there?

I go back as a professor in the Masters program in Pediatric Hematology/Oncology and as a clinician to help with their unit and help manage their patients. I’ve brought senior fellows with me for three years, and Dr. Suman Malempati has also worked and taught there. With multiple providers we are able to spread out to work with students in the Masters program as well as with pediatricians, pediatric residents and others practicing on the pediatric oncology ward. We do formal education with them, we do clinical care, we do on-the-job training, give lectures – basically, whatever needs to happen.

How does their Pediatric Hematology/Oncology program differ from ours at Doernbecher and in what ways is it the same?

Their patient volume is higher – somewhere between 400 and 500 patients show up at their doors every year, and that continues to grow. They have a designated ward for children with cancer, and the facility itself is a large academic medical center like OHSU, although they don’t have the extent of support and ancillary services that we have here (for example, fewer resources in the radiology department or a lab spread over many more patients). If we do a blood count on a child at MUHAS, we might get a result the next day, or we might find out that the blood was lost and we’ll have to try again. As a result, you learn to make a lot more clinical decisions and depend a bit less on lab data. The pharmacy support is also very different – there, the nurses mix the chemo themselves!

One of the biggest differences in Hem/Onc is that there is no PICU, and there’s a single pediatric ventilator for the hospital – and it maybe works. When children get very ill, there really isn’t an alternative for support. If a kid at Doernbecher becomes extremely ill, we send them to the PICU, but the same patient in Tanzania might not make it.Ujasiri house

Another difference is that their nursing staff, though extremely dedicated, is not specifically trained in pediatric oncology as ours are in the United States. That’s something we’re working on; as we bring up the education of their physicians, we need to bring up the education of their nurses. I will say that nurses there can get an IV almost anywhere – it’s a sweaty environment, and tape doesn’t always stay on!

There are a lot of similarities between our hospitals. Tanzania is very much like Oregon, only larger. They have something called the Ujasiri House, which serves families in many of the same ways as Ronald McDonald House does here. They have a great school program at the Ujasiri House and on the unit, just like we do at Doernbecher – and these kids love school. They also have people who are Child Life equivalents – they come and color, play music or do projects with the kids.

What are some of the challenges associated with these trips?

Language is a big one. Most of the clinicians and nurses speak enough English to communicate, but if a patient comes from a village with a dialect that even local Swahili-speaking Tanzanians can’t understand, that can get tricky! I speak a bit of Swahili, so I can get the gist of a lot of things medically. Kids and families think it’s hilarious when I speak Swahili to them – they just laugh and laugh!

The kids come with much more extensive disease than we are used to seeing here due to the time and money required to get to Dar es Salaam. Patients may have first seen a medicine man, then a village provider, then gone to their district hospital, then a regional hospital and then, finally, to MUHAS. Between each visit, they return home to save up money from everyone they know for their next bus fare. Families literally strap their children to their back to get them where they need to go.

By the time they do get medical care, they are very, very ill. Once they get to Dar es Salaam, the care on the unit is mostly provided free of charge. This is huge, but a lot of families can never get there.

How do you foresee this exchange further developing?

We’ll be going back in April, and this year I hope to bring a couple of nurses with us to assist with the formal nursing staff curriculum we’re helping to develop.Hospital art MUHAS

The whole point of the Masters program is to train them in their own country, with their own resources. The flip side, though, is that in order to move their program forward, they need to visit other sites. We’re looking at bringing one of the students who just finished the program over here to do some training with me for a few months. I’d like that to be an ongoing thing.

We’re looking for grant funding, and it would be great to have some additional philanthropic support. The Kiwanis have helped, but a lot of this has been funded out of our own pockets.

How does the Tanzania experience impact Doernbecher doctors?

One of the fellows, Melinda Wu, poses with a patient in 2014

One of the fellows, Melinda Wu, poses with a patient in 2014

The trip exposes us to a degree of pathology we don’t frequently we see, which helps expand our knowledge base. It also teaches you a lot about the management of resources here and ways we can eliminate waste.

The fellows come back more comfortable, with more confidence in their ability to practice. It really reinforces what you know and it stretches what you think you know. My time in Tanzania makes me a better doctor here in Portland.

***

Learn more and follow along with next spring’s Tanzanian adventure with the DCH2Tanzania blog.

The real scoop on teething and sleep

KC FB Profile logoThe Dr. Super Sleep Series is written in collaboration with KinderCare. KinderCare believes that early childhood education creates brighter futures. They are the largest provider of early childhood education in the nation and they are passionate about creating a world of learning, joy and adventure for more than 169,000 children every day. For more parenting resources, crafts, learning activities and family fun, visit their blog.

What’s the deal with teething and sleep difficulties? That’s the kind of thing you find yourself wondering about at 2 a.m. when your very cranky little one just can’t seem to settle down. Like with many baby conundrums, from mysterious low-grade fevers and runny noses, to weird poops or general grumpiness, it’s easy to decree teething as the culprit for bursts of bad sleep. But is it really fair to blame their budding chompers for your snoozing woes? We asked Dr. Elizabeth Super, pediatrician and children’s sleep specialist with the Pediatric Sleep Medicine program here at OHSU Doernbecher Children’s Hospital, for the straight scoop.

“Teething is a very long process that lasts through the first two or three years of life,” Dr. Super says. It can cause a bit of discomfort and even pain, but how much – and how it impacts sleep – depends on your individual baby: Some children have a lot of physical teething-related symptoms and some don’t; some teeth may cause a lot of symptoms (we’re looking at you, first-year molars) and others may not.

TeethingYeah, we know that’s sort of vague. So, what’s the sleepy parent of a sleepy – and possibly teething – baby to do?

First, decide if it’s her teeth. Teething can’t explain all sleep difficulties, so consider whether she’s been showing other symptoms during the day. Indeed, some children are more irritable or run a low fever. You might be able to see, or feel with a clean finger, a new tooth budding just under the gums. She may also have found teething toys or cool things – like wet washcloths from the fridge – comforting. If she isn’t displaying any teething symptoms (and she isn’t sick) then sticking to your usual sleep routine will help her learn to sleep better in the long run. Read more about the building blocks of a great sleep routine here.

Next, adjust your expectations. If yes to the above, then the imminent arrival of a new tooth just might be keeping him up – some babies might fuss over a dull ache, while others might cry or express pain. You can expect two to three days of sleep disruption as the tooth erupts, after which his sleep habits should return to normal.

Know that it’s fine to treat the pain. If it appears teething is painful enough to interfere with your child’s sleep, try giving her Infant Tylenol or, if she’s over six months old, Infant Ibuprofen (Motrin, Advil) at bedtime. “It helps parents to feel better that the pain has been addressed,” Dr. Super says, and it will hopefully help your child get comfortable enough to settle down. The American Academy of Pediatrics doesn’t recommend medicated teething gels that are rubbed on gums, notes Dr. Super, as they have been proven to be ineffective (baby’s drool is enough to wash them away) and can have side effects like numbing your baby’s throat and making it difficult for her to swallow.

Finally, stick (more or less) to the bedtime routine. Your response to sleep disturbances during teething can actually start to create new sleep patterns and routines – e.g., mama comes when I call and rocks me to sleep – that aren’t ideal for building your baby’s longer-term sleep skills. If teething is keeping you both up at night, trust your instincts and find a balance in your response. If a bit of extra soothing works for the few days it takes a tooth to erupt, go for it. But be mindful that the troublesome tooth should arrive in two to three days and when it does, gently steer your baby back to his usual routine. You’ll all sleep better in the long run.

Other posts in the Dr. Super sleep series:
What is your baby’s ‘sleep temperament?’
Six strategies to improve your baby’s sleep skills
Monsters under the bed: Banishing bedtime fears

Battle bad dreams, night terrors and things that go bump in the dark

 

Dr. Elizabeth SuperElizabeth Super, M.D.
Assistant Professor of Pediatrics
Doernbecher Pediatric Sleep Medicine Program
OHSU Doernbecher Children’s Hospital

 

Merry Heart: a camp with its own beat

Tim LaBarge serves on the board of Merry Heart Children’s Camp. He’s also a photographer in Portland. Below, he shares some special moments and memories from Merry Heart Children’s Camp.

***

Twenty-five children sat on log benches high above the Bull Run River and Mount Hood, towering in the distance, turned a shade of orange and then pink as the sun began to set. But hardly anyone noticed. All eyes were on cardiac surgeon Dr. Ashok Muralidaran as he answered these young campers’ questions about their hearts.

This is Merry Heart Children’s Camp.


After a full career in the pediatric cardiology department at OHSU Doernbecher Children’s Hospital, Dr. Mary Jo Rice knew what she wanted to do when she retired. She knew that no Oregon camp existed to welcome the kids she’d been treating for 30 years – it was up to her to start one. And so, with the help of her husband, Rob McDonald (a recently retired pediatric cardiac sonographer at OHSU Doernbecher), a newly-formed board of directors and many volunteers, Merry Heart Children’s Camp came to be.

On day three of camp, the campers, sitting on log benches, asked the surgeon hard questions about their bodies – the “whys,” “what ifs” and “what’s next” kind of questions. Dr. Muralidaran helped them understand his answers with a mixture of humor and transparency. 

After spending four days and three nights together, the campers formed friendships based not only on the similarity of their conditions and scars, but on their interests in books and sports and art.

“This is the first time I felt normal and not out of place,” said 13-year-old Ash of her time at Merry Heart. 

Laurie Robinson, a world-class archer from Portland, steadied Jacob’s elbow as he drew the arrow back and prepared to release. Her peaceful voice calmed the young archer. The bow rattled slightly and the arrow sped through the air, piercing the target.

“Archery was the best,” said 13-year-old Jacob, who was born with hypoplastic left heart and has had a Fontan procedure. “I’ve been wanting to learn archery for a long time.”

Each evening, the children gathered for movie night or singing or game night. As at any other camp, things got silly on more than one occasion. At least one of the campers was wrapped in blankets and in a deep sleep before the end of the movie – the result of a full day of activities. 

“Game night and movie night were my favorites because I had never played BINGO with a spinner and movie night was fun because I enjoyed the movie that was shown,” said 9-year-old Lizzie.

Fourteen-year-old Gabe lives with a repair of an atrioventricular septal defect and a pacemaker. He helped lead the campers in pick-up volleyball games during free time and reeled in several fish at the pond.

“Being able to attend a heart camp in my state and meeting kids closer to my home with conditions like mine was a big plus for me,” he said. 

Prior to camp, many of the kids had never met another heart patient. Dr. Rice knew that these kids often lived isolated from each other and wanted to  help change that. Campers came from OHSU Doernbecher and Randall children’s hospitals. They traveled from Eugene, Pendleton, Salem, Vancouver, Scappoose and Portland to share their experiences – and make new memories together. 

“The camp was the best time of my life,” wrote 9-year-old Adrian in a thank-you letter decorated with a hand drawn hearts and a photograph. “I can’t wait for next year.”

Next year’s Merry Heart Children’s Camp takes place August 22-26 at a camp overlooking the Bull Run Watershed near Corbett, Ore. To help support the camp or to volunteer, please visit www.merryheartchildrenscamp.org.

Battle bad dreams, night terrors and things that go bump in the dark

KC FB Profile logoThe Dr. Super Sleep Series is written in collaboration with KinderCare. KinderCare believes that early childhood education creates brighter futures. They are the largest provider of early childhood education in the nation and they are passionate about creating a world of learning, joy and adventure for more than 169,000 children every day. For more parenting resources, crafts, learning activities and family fun, visit their blog.

It’s the wee hours of the morning and your child is standing at your bedside, tugging at your arm, wide awake and scared: She’s had a nightmare. While witnessing it can tug at your heartstrings, know that it’s also quite typical for children.Nightmare

“Dreams, even disturbing ones, are a part of normal development,” says Dr. Elizabeth Super, a pediatrician and children’s sleep specialist with the Pediatric Sleep Medicine program here at OHSU Doernbecher Children’s Hospital. “Nighttime fears are very common between ages 3 and 6 and often appear as children develop the ability to imagine.”

Nightmares

It’s not unusual for little ones to have one or two nightmares per week. The reason may be that children spend more time in REM sleep than adults (25 percent of a total night’s sleep versus 10-15 percent), the stage of sleep when nightmares (and all other dreams) occur. REM is an active sleep state during which our brainwaves are somewhat similar to a waking state. These REM periods get longer as the night progresses, which might explain why 2 a.m. seems to be the witching hour.

Have a freaked-out 5-year-old on your hands every few nights? Check out Dr. Super’s sensitive approach:

OfferNightmare 2 brief comfort. With most children who are developing typically, simple reassurance will likely be enough. If your child wakes up in the middle of the night, help her settle back down with a hug, a glass of water and kind words, and then lead her back to bed.

Give the fear a name. Younger children can have a difficult time describing what scared them, so asking your preschooler to explain the nightmare probably won’t help get him settled. Instead, provide reassuring words that describe and help him understand the scary experience: You’re safe; It was a bad dream. It wasn’t real; It was pretend. With time he will be able to use these words to calm himself.

Talk about it in the morning. Some children are able to describe bad dreams in the morning. The light of day is a great time to talk, especially if you suspect that the cause for her nightmare might be something in her waking life: scary movies, TV or books; a big transition, like starting a new school year; or a trauma, such as losing a pet. Ask her about what is bothering her – a simple discussion may help alleviate bad dreams.

Dream and discard. If your child is still rattled by his dream in the morning, invite him to draw it. Did the monster eat his dog? Help your child imagine another ending to the dream (the barking dog scares the monster away!) and draw it together. Discard the drawing and with it, hopefully, the nightmare.

Night terrors

Unlike a nightmare, which wakes a child and leaves her feeling fearful, night terrors happen while children continue to sleep. Children may even scream, cry out or become agitated without waking, and may not remember the incident in the morning.

Night terrors are a type of parasomnia, like sleep walking or talking. Unlike dreams, night terrors occur in deep sleep, during a stage called N3 – it’s the type of sleep where you can transfer your child from car seat to crib and she never stirs. Kids spend more time in N3 sleep than adults do, which may make them more likely to have night terrors. Longer stretches of N3 sleep typically happen in the first half of the night, which makes night terrors more likely at 11:30 p.m.

“If it offers a little comfort, know that night terrors are often scarier for the parents than they are for the child,” says Dr. Super. Here’s how to handle them:

Make sure your child is safe. A sharp cry in the middle of the night will send any parent racing into their child’s room. First things first, check that your sweetie is safely tucked in bed.

Decide if it’s a night terror. He may be breathing quickly, tossing and turning, or have a racing heartbeat. If he only briefly rouses and then quickly goes back to sleep, or never seems to wake up at all, then he could be having a night terror.

Minimal interaction. Because your child is still asleep, the simple reassurance that helps for nightmares can actually do more to agitate her. That said, you may want to wait out the episode by her side to reassure yourself that all is fine.

Review her sleep routine. Night terrors are more common if kids aren’t getting enough sleep, or if they’ve had a shift in their sleep schedule. If you suspect the latter, work on getting your child back to his normal routine, with an emphasis on plenty of quality sleep.

Speak to your doctor. If nighttime fears are starting to affect your child’s ability to fall asleep in the first place (he’s too scared of bad dreams to get into bed), if the terrors are persistent, or if you as a parent don’t feel that you are dealing adequately with the problem, speak to your child’s pediatrician.

Remember that this too will pass! This is a developmental stage that most children will grow through with your support and simple reassurance.

Other posts in the Dr. Super sleep series:
What is your baby’s ‘sleep temperament?’
Six strategies to improve your baby’s sleep skills
Monsters under the bed: Banishing bedtime fears
The real scoop on teething and sleep

 

Dr. Elizabeth SuperElizabeth Super, M.D.
Assistant Professor of Pediatrics
Doernbecher Pediatric Sleep Medicine Program
OHSU Doernbecher Children’s Hospital

 

 

 

 

“Inside Out:” A mindful movie for family film night

Pixar’s “Inside Out” provides an amazing look inside the mind of an 11-year-old girl. Child & Adolescent Psychiatry Training Program Director, Dr. Craigan Usher and Gabe Edwards, a fourth-year OHSU medical student planning to go into psychiatry, sat down to talk about the film.

They enjoyed “Inside Out” so much, they decided to document their conversation. We hope it sparks some thoughts for you and your family at your next movie night!


Animator Walt Disney once said that “movies can and do have tremendous influence in shaping young lives in the realm of entertainment towards the ideals and objectives of normal adulthood.” The word “entertainment” comes from the Latin word inter (between) and tenere (to hold). Many times, entertainment can be seen as simply keeping the viewer occupied – a temporary respite from life’s stresses. Yet, Disney’s quote challenges movie-makers, parents and kids to hope for something more – that instead, films could build bridges that take young people’s minds to a place that is unanticipated, rich and transformative. Pixar’s “inside Out” steps up to the challenge.

In fact, it seems to us that “Inside Out” uses bridging as a central theme, telling the story of a young girl named Riley who transitions geographically, moving from Minnesota to California, chronologically, shifting from childhood to preadolescence, and relationship-wise, with Riley’s interaction with her parents and mind growing more honest, mature and open to mixed-emotions.

“Inside Out” is a story that mainly takes place inside Riley’s mind, and it features fictionalized parts of the brain. There are various memory systems, a great imaginary friend (from when Riley was three years old) and five main emotions: Joy, Anger, Sadness, Fear, and Disgust. These “characters” interact and develop together in a way that deepens our insight about the human psyche. Their struggles demonstrate how emotion regulation is a process of continual refinement, with the mind constantly restructuring itself. The film’s ability to do so under the guise of “just being an animated movie” is part of its genius.

One of the main themes emphasized by “Inside Out” is mentalizing. Mentalizing, also called “mind-mindedness,” is the ability to reflect upon the thoughts, feelings, and motivations of one’s self and others. When people are mentalizing, they are concerned not just with external behaviors, but with the internal world—ideas and emotions that compel others to act the way they do.

We see a great example of poor mentalizing in one scene where Riley finds herself sad after a tough first day at her new school. At the dinner table, Riley’s parents ask a few questions. What they get in return is little detail and great sarcasm. Riley’s father registers this as Riley being snarky – in fact, his own Fear character announces: “Sir, reporting high levels of sass!” So he responds to what he sees as primarily oppositional behavior by “putting his foot down.” In doing so, he fails to take to mentalize, to consider Riley’s internal struggles – her despair at having left her life in Minnesota behind. So, she stomps away from the table. It’s an opportunity lost.

Another example of mentalizing gone awry appears when the animators turn their lens to the mind of a pre-teen boy, who is clearly attracted to Riley. The boy is simply dumbfounded, his brain repeating: “girl, girl, girl.”

The wonderful thing about this film is that it invites viewers to mentalize. It asks and answers: What might be inside the mind of someone whose life is uprooted? What happens to the machinery of the mind, to the very ability not just to experience joy, but also to draw upon memories, make new memories, and think clearly when a child becomes depressed?

An additional psychologically rich aspect of the film is how it demonstrates that each stage of development – thoughts, feelings and experiences – helps build toward the next. For example, in one scene Riley’s imaginary friend, Bing Bong, gives Riley’s emotions a boost. Sadly, this character ultimately had to be forgotten. This demonstrates how something like an imaginary friend helps provide support and a bridge. An imaginary friend allows a young child not to feel so alone or be afraid to be alone – and is then usually sacrificed once the child gains a new sense of confidence. They simply don’t need him or her or it anymore.

“Inside Out” also demonstrates to children and adults ambivalence: that more than one emotion can exist at a time. There is a scene where Riley is able to tell her parents just how much she misses her old home and friends and how sad she is. As her parents hug her tightly, we see Joy and Sadness both reach for Riley’s mental control panel – and begin working together. Rather than stalling at an antagonistic standstill, Riley’s mind seems to recognize the situation she is in as an opportunity for heartache and happiness to work together to help her move forward.

The British pediatrician and psychoanalyst Donald Winnicott once said that “a sign of health in the mind is the ability of one individual to enter imaginatively and accurately into the thoughts and feelings and hopes and fears of another person; also to allow the other person to do the same to us…”. We are so glad that filmmakers took it upon themselves to imaginatively consider the mind of Riley. We hope this film inspires children, adolescents and adults to mentalize, to consider their own minds and those of others and to support the process of growth – especially during tough times.

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

Gabriel Edwards
Fourth-Year Student
OHSU School of Medicine

Getting home safely

After finishing up clinic on a Monday evening at about 5:30, I headed over to the pharmacy to pick up a prescription. As I passed through the drop-off circle on the way to the Physician’s Pavilion, I noted a new family wrestling with their car safety seat – the father pulling straps while the mother sat in the back with their newborn. I could see the frustration on both of their faces, exhausted from the ordeal of birth and the hectic post-partum period. I thought about stopping to help, but I needed to get home to cook dinner for my family, so I walked on.

Twenty minutes later, I left the pharmacy to walk back to my car. As I approached the circle, I saw the new family was still there, still wrestling with their car safety seat, and clearly at the end of their rope. I stopped.

I introduced myself as a pediatrician and certified child passenger safety technician and offered to help. I spent the next 25 minutes teaching them to correctly use their car safety seat. We removed an insert in the seat that pushed the baby’s head too far forward, and lowered the harness straps to properly fit the baby in the seat. We tightened the harness straps to ensure a correctly snug fit. We adjusted the angle of the seat’s recline so the baby’s head would not flop forward, occluding his airway. We pushed the car seat into the cushion of the vehicle seat and tightened the lower anchor to ensure an appropriately tight installation. We rolled up receiving blankets to correctly position the infant’s head in the seat.

When we were finished, everything was perfect – and the parents could replicate everything we had done together. They shook my hand and graciously thanked me. My family ended up eating dinner pretty late that night, but that family left our hospital with their son protected as safely as possible.

During the 40-plus hours of that infant’s stay at OHSU, he had his vital signs (including his temperature) taken at least every eight hours. As a general pediatrician for more than 20 years, I cannot remember a single case where the temperature of a well newborn, with no risk factors for infection or other previously identified concerns, was abnormal. I know it happens, but I have never experienced it. Some of the reasoning behind taking an infant’s temperature at least once every nursing shift has to do with hospital policies and protocols, but nurses and medical assistants have told me it’s to ensure that the babies are “safe.”

Every single infant who is traveling home in a private vehicle is required by law to ride in an approved car safety seat. The newborn care team routinely asks families if they have a car safety seat. If families don’t have one, they’re instructed to get one, as a requirement for discharge. The pediatric team hands each family a sheet of paper with some basics of newborn care and safety, including the guidance to use their car safety seat facing the rear of the vehicle until the child is at least 2 years old. This is the generally the extent of the guidance and assistance that families get regarding safe travel.

According to data from the U.S. Centers for Disease Control and Prevention, 134 infants younger than 1 year of age died in motor vehicle crashes in the U.S. in 2013. Approximately 500 more infants were hospitalized and more than 8,000 were treated in emergency departments for serious injuries sustained in crashes. Twenty-three percent of the babies who died were unrestrained at the time of their death; 77 percent were in a car safety seat. Between ages 1 and 15, motor vehicle crashes remain by far the leading cause of death for children.

Anyone who’s ever installed a car safety seat will tell you it’s generally neither fun nor easy. Data from the National Highway Traffic Safety Administration has shown that approximately 3 out of 4 car safety seats are used incorrectly, with misuse errors that are likely to significantly increase the risk of injury to the child passengers.

My own experience as a CPS (child passenger safety) technician who has worked with more than 8,000 families since 1997 tells me that those misuse statistics are likely an underestimation of the problem. In 2014, with help from colleagues at the OHSU Doernbecher Tom Sargent Safety Center, we studied how families with well newborns at OHSU used their car safety seats. What we found was truly disturbing: Out of 292 families with well newborns, 93 percent made serious errors in how the infants were harnessed in their seat, and in how the seat was installed in their vehicle. The average family committed more than five serious mistakes.

How many families suffer the experience I encountered on that Monday evening? What might have occurred had I not stopped? At best, the child would have gone home at an increased risk for injury in the event of a crash. At worst, the exasperated parents may have given up and carried the infant in their arms. While this may seem difficult to believe, a full 10 percent of the infants injured or killed in crashes in 2013 were completely unrestrained – it happens.

The Tom Sargent Safety Center at OHSU Doernbecher currently employs a dedicated staff of certified CPS technicians. We can provide inpatient consultation for children who have suffered injuries, who have special transportation needs or who are in need of a car safety seat, collaborating as part of the care team to ensure a safe transition home.

We staff a community car seat fitting station at OHSU Doernbecher, generously funded by Kohl’s Cares, by appointment only, and work with more than 2,000 families in the Portland area each year. The demand for this service is so great that we routinely have a 3-week wait list. The Safety Center provides guidance and education to thousands of families each year and sells discounted home safety equipment (including bike helmets, stair gates, window guards, smoke detectors and cabinet locks) to many thousands more.

Here’s the thing: As hard as we work at the Safety Center and as much as we do, we simply do not have staff or resources to provide assistance to families with newborns. We know that each and every day, approximately 6-7 newborn babies will leave OHSU, and that almost all of them will be unsafe. We know that families will struggle, and that infants are being endangered, and we cannot unknow that. We also know that we need to change this.

A world-class health system should ask first and foremost “What is best for patients?”, and endeavor to do just that. So while you are reading this, you can be certain that every single infant born at OHSU today will have their temperatures carefully measured each nursing shift for the remote possibility of detecting an unsuspected fever. Perhaps an abnormal reading will lead to an intervention that will protect the baby.

You can also be certain that virtually every infant born today will travel home in a car safety seat that has been critically misused. You can be certain that families will try to do the best thing for their baby, as did the lovely family on that Monday evening. You can be certain that we will have very little to offer them.

I have a problem with that, and it’s time for us to change it. I have no problem with eating dinner late; I will be late forever if it means doing what’s best for kids. Is it best for kids to ignore their needs, to pretend we do not know what we know about how to best protect them? We owe it to our patients – to our community – to provide the best possible care. That is, indeed, what a world-class health system should do. Should that not include ensuring that each and every infant can get home safely?

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

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

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