Meeting Julia: Representing autism in the media

Beloved children’s television program “Sesame Street” recently welcomed a new Muppet on the air. The character’s name is Julia, and she has autism. We sat down with Lark Huang-Storms, Ph.D., to get her take on Julia’s addition to the cast and what this means for families in the autism community.

As a mother and as a provider who cares for patients who have autism spectrum disorder, how important is it to you that “Sesame Street” has added Julia to their cast?

I think it’s wonderful. It means everything to parents to see their own children’s experiences represented positively and kindly. I’m delighted that “Sesame Street” has been progressive enough to do this. For decades, they’ve been incorporating characters in situations that may be difficult for kids (and grown-ups!) to understand. They’re great at doing it in a way preschoolers can relate to,which means they are sending a clear message of acceptance and neighborliness that everyone can understand.

I think Julia can help demystify autism for a lot of families, kids, teachers and even professionals. Seeing how Julia responds in her own ways may help viewers empathize and understand how to reach out to all kinds of kids, whether they experience ASD, or other developmental disabilities, or really any behaviors that seem different or confusing at first. Children are really responsive to adjusting their thinking and play when they are given some guidance.

How would you recommend parents and caregivers use this as a starting point for conversations about differences and inclusion?

Watching an episode together and discussing kids’ observations is a good place to start. Maybe Julia reminds them of someone in their class. The show can even be a good jumping-off point for parents and caregivers who want to talk to their kids’ teachers, babysitters or their extended families about things they may be experiencing in their own family. It’s important to note, of course, that all children are very different. There’s no way Julia could represent all kids experiencing ASD, but it sounds like she shares some similar traits that many autistic children do (like loving to jump or not responding to a greeting right away).

With Julia, “Sesame Street” seems to be presenting a very open approach to understanding a new friend. As always, they manage to do this in a way that’s child friendly and provides families with a natural starting point in talking to their kids about accepting differences and inviting all kinds of kids to play.

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Lark Huang-Storms, Ph.D.
Director, Autism Program
OHSU Doernbecher Children’s Hospital




This blog post is based on an interview conducted and aired by KXL. You can learn more about Julia and watch full episodes of “Sesame Street” here.

We want to speed up research and advance our understanding of autism to help improve lives. If you or your child has a professional diagnosis of autism spectrum disorder and you live in the United States, we invite you to join SPARK for Autism, a landmark autism research project. 

Doctors Day Q&A with Dr. Casey Seideman

In celebration of National Doctors Day (March 30, 2017), we sat down with Casey Seideman, M.D. A pediatric urologist, Dr. Seideman takes care of kids and young adults with diseases and disorders of urination, reproductive organs and/or testes. Below, Dr. Seideman tells us more about her career path and why she loves caring for kids and families at OHSU Doernbecher Children’s Hospital.

What does an average day look like for you?

Every day is different, which is part of the reason I love this job. During the week, I spend time seeing patients in clinic – I get to meet families for the first time, and I also get to see how my patients are doing. Some of our patients need longer-term care, and it’s nice to develop relationships with families over time.

Casey Seideman, M.D., a pediatric urologist at OHSU Doernbecher Children's Hospital, says “Every day is different, which is part of the reason I love this job.” Like many of the doctors at Oregon's academic medical center, Seideman spends her days seeing patients and providing surgical treatment, all while teaching residents in the urology program. (OHSU/Kristyna Wentz-Graff)

When I’m not in clinic, I’m operating. Many of our patients need surgical therapy, and I love that I’m able to provide them both clinical and surgical care.

My third responsibility during the day is teaching. OHSU has an excellent Urology Residency program. and I spend a large part of my day helping train Urology residents both in and out of clinical situations.

What’s something people might be surprised to learn about your career path?

In college, I wanted to be an archaeologist – I’ve actually spent two seasons digging off the coast of Cyprus! I discovered my passion for medicine later in college, and once I was in medical school, I knew pretty quickly that I wanted to be a surgeon.

I met with a urologist to discuss my interest in the field and my future career goals. To my surprise, he told me that as a woman I should reconsider and choose a field that was more “female friendly.” This was the first of a few encounters during my training where I realized that being a woman and being a surgeon did not seem compatible to some people. Luckily, their doubts and misgivings only motivated me more.

Pediatric urology is a rewarding field – I enjoy caring for children every day, and helping improve their quality of life. I love being in the operating room and working with cutting-edge technology. And I enjoy the physician-patient relationships that develop with long-term care.

What are the most rewarding and most difficult parts of your job?

The most rewarding part of my job is helping families have a better quality of life. That might mean getting their child out of the hospital faster, reducing pain or fixing a surgical problem. The more quality time the family can spend together outside of the hospital, the better!

Sometimes the most challenging part of my job can be dealing with sick kids who require a lot of coordination of care. However, the biggest challenges can sometimes be the most rewarding.

What changes do you see in your field that you’re excited about?  

Urology and pediatric urology are at the forefront of technological advancements. Oftentimes, we are leaders in the technology that drives surgery. Here at OHSU, we offer a wide range of minimally invasive urologic surgeries. Minimally invasive surgery is an alternative to large incisions, and often reduces hospital stays and pain after surgery.

We also are pushing to consolidate care into multidisciplinary clinics. So instead of scheduling separate doctors appointments and imaging, we are pushing to create clinics where patients can be seen by multiple specialties at the same time.

What advice would you give to an aspiring physician or surgeon? 

To quote Winston Churchill: “Never, ever ever ever ever give up.” Medical and surgical training can be very long, and oftentimes grueling. The long hours and training can seem never ending, but it’s worth it – I promise!”

What do you like to do in your free time?

In my free time I enjoy exploring the Portland area and the outdoors. I believe work/life balance does exist, but it requires commitment. Working out, trying new local restaurants and spending quality time with my loved ones helps me maintain that balance.

Do you have any advice or words of encouragement for OHSU Doernbecher patients and families?

Patients and families are in great hands at Doernbecher. We go the extra mile to ensure that all patients get high quality, coordinated care. We strive to minimize multiple appointments and consolidate testing. And, most importantly, we want the best experience possible to improve your quality of life.


Casey Seideman, M.D.
Assistant Professor of Urology
OHSU School of Medicine




If you’d like to join us in thanking the physicians who care for our patients and families, we invite you to share your story or make a donation in your Doernbecher doc’s name.

Meet ‘Candlelighters for Children with Cancer’

This year, Candlelighters for Children with Cancer marks its 40th anniversary. Below, Candlelighters Executive Director Jackie Groah shares how the organization got started and who it serves.

Candlelighters’ beginning

 In 1977, five families who spent months living in OHSU Doernbecher Children’s Hospital while caring for their children with cancer realized that there were few services that supported the whole family – their shared experiences helped shape our organization, which supports patients’ entire families.

Candlelighters founder Joan Hill says their goal was to help families who felt they had nowhere to turn when their child was diagnosed.

Joan Hill, Candlelighters founder

Joan Hill, Candlelighters founder

“When my daughter was in the hospital, it was other families in similar situations who gave me good advice and strength to handle the ups and downs,” she said. “When my daughter got better, it was my turn to help other families who were in crisis.”

Over the years, the organization has grown from a one-person, home-based office into a statewide organization with offices in Portland and volunteer-led chapters in Central Oregon, the mid-Willamette Valley and Southern Oregon.

“It was always my hope that a cure would put this organization out of business, but until that happens, I am so proud that a little nonprofit that was founded to help a few families in the 1970s continues to provide a community of hope for families battling pediatric cancer today,” Joan said.

Candlelighters has partnered with OHSU Doernbecher Children’s Hospital for 40 years. Through our long collaboration, we have served thousands of family members affected by childhood cancer.

By the numbers

Candlelighters is a local nonprofit organization that provides hope, healing and light to families affected by the emotional and financial hardships caused by childhood cancer in Oregon and Southwest Washington. Families receive comfort in local hospitals through catered family meals, a 24/7 food pantry and a weekly snack cart. Some families depend on Candlelighters for monthly family experiences, emergency financial funding or bereavement support.

In 2016:

Celebrating 40 years

In the last four decades, Candlelighters for Children with Cancer has served 80,000 family members. This year, Candlelighters is hosting the Cancer Warrior Breakfast, a no-cost event where community leaders can learn more about Candlelighters’ mission to serve the whole family when a child is diagnosed with cancer. Join us on Thursday, April 6, from 6:30 to 8:30 a.m. at the Oregon Zoo.

Click here to register, become a table host or become a sponsor.

Using your head

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

Your child doesn’t need to be a high school football star to be at risk of a concussion. Also called mild traumatic brain injuries, concussions can be caused by any serious impact to the head, most commonly during a high-contact sport, a fall or a bike or car accident.

Jim Chesnutt, M.D., a sports medicine physician at OHSU and a concussion management expert, advises that athletes be immediately removed from sports and taken to a medical provider if they show signs of concussion, which include the following:

  • Physical: headache; nausea or vomiting; balance problems; dizziness; fuzzy or blurry vision; sensitivity to light
  • Cognitive: difficulty thinking clearly; difficulty concentrating; difficulty remembering new information
  • Emotional: irritability; sadness; anxiety
  • Sleep: sleeping more or less than usual; having trouble falling asleep

“Concussions can last from minutes to hours, weeks, months or longer,” says Dr. Chesnutt. “Fortunately, in about 80 percent of cases, people recover from concussions within three or four weeks.”

Rest is critical to treat a concussion: It helps the brain heal. Toddlers should avoid stimulation like loud music and television; school-age children should also avoid video games and texting. Students may need to take a few days off from school and limit homework, especially assignments requiring prolonged computer use.

“Researchers have determined that [step-by-step] transitions are critical to treat a concussion,” says Dr. Chesnutt. “It is important to modify school attendance and academic programs for a few days to allow a gradual return to cognitive and psychological stresses.”

OHSU and OHSU Doernbecher concussion specialists usually recommend approximately a two-day period of rest before transitioning back to schoolwork, and at least a weeklong break from athletics. Student athletes can return to contact sports only after obtaining medical clearance and following a “Return to Play” protocol.

Too much rest, however, can be detrimental and slow the recovery process.

“In one study, researchers compared students who returned to school after two days of rest after suffering a concussion with kids who returned five days after,” said Dr. Chesnutt. “They found that the ones who returned after two days did better than those who rested for five.”

So encourage your kiddo to hit the pillow for a couple of days – and then it’s time to hit the books!

If you are concerned your child has suffered a concussion, talk with your pediatrician or call the OHSU Sports Medicine Clinic at 503-494-4000. 

The healing power of art: CHAP at OHSU Doernbecher

Children’s Healing Art Project (CHAP) has been spreading joy at OHSU Doernbecher Children’s Hospital for 10 years. We asked CHAP Lead Hospital Art Teacher Sharon Jaye Perrins to tell us more about CHAP’s mission and impact at OHSU Doernbecher.

20161104_162835 copy“I just love this. This is how I heal.”

That’s how one mother of an oncology patient recently explained the solace she found through the healing power of art.

CHAP was started by Frank Etxaniz in 2006. Frank believed that it was possible to harness people’s nervous energy and transform it into creative energy. Making art can be such a release.

So many beautiful connections happen at the art table. We see young patients becoming fast friends. We witness mothers supporting each other, spot on. Fathers sit down and surprise their children with what they can do when they pick up a paintbrush. This feeling of community is at the heart of CHAP.

Where can OHSU Doernbecher patients connect with CHAP?

Each week at OHSU, CHAP’s teaching artists lead 36.5 hours of art-making all around campus. On OHSU Doernbecher’s 8th floor, CHAP connects with individuals awaiting surgeries. The waiting area is transformed into a beading workshop with patients and families pulling up chairs or kneeling on the floor alongside coffee tables topped with green felt tablecloths. Busy hands help change a room’s energy, and entire families are welcome – the more, the merrier!

CHAP also offers art in two inpatient locations at OHSU Doernbecher: the 9th floor (General Pediatrics) and 10 South (Pediatric Hematology/Oncology). Our style is to leave things very open-ended so children have freedom to decide what they want to create. It’s truly a pleasure to watch art-making unfold, whether it’s with clay, paint, beads, sequins or feathers.

Our longstanding philosophy at CHAP is that the children will be recognized for their creativity and ingenuity, not by their disease or diagnosis.

CHAP is proud to contribute to the patient’s experience in the hospital. Our dedicated team of volunteers and art teachers has crafted this in-hospital art program to bring patients into a communal space where they can work side by side with other patients and their families. When a patient is in isolation, CHAP can lovingly assemble art supplies to be delivered to the patient’s room to help keep them active, engaged and on the road to wellness.

A great way to connect with CHAP is by contacting one of OHSU Doernbecher’s amazing Child Life Specialists. Or just keep an eye out for our colorful art carts rolling down the hallways of OHSU Doernbecher. We’d love to bring a little ray of light your way!

How can families stay engaged with CHAP outside of the hospital?

When families are discharged from the hospital, we encourage them to keep in touch by visiting our CHAP studio in Southeast Portland. All children and teens affected by pediatric illness or special needs are invited to participate in inclusive Art Club events at the studio, free of charge. Learn more here.

Interested in learning more about CHAP? Visit their website to find out more!

Spring forward, fall back: time change tips

Adjusting to a new sleep schedule can be tricky, but a little help and a few days of preparation can make all the difference. Elizabeth Super, M.D., pediatrician and children’s sleep specialist with the Pediatric Sleep Medicine Program at OHSU Doernbecher Children’s Hospital, provides some tips to make sleep transitions easier on the whole family.  

Establish a routine
Bedtime and wake-time routines help anchor a child’s day and reduce anxiety.

  • In the evening: Keep things quiet, cool and dark. Dim lights 30 minutes before bedtime and restrict use of electronics or any other media in the bedroom environment as they emit a lot of light. Consider blackout shades if natural or artificial light is making its way into the child’s room and affecting sleep.
  • In the morning: Ease into the day by bringing in bright light, either by turning on lights indoors or opening curtains or window shades. If it’s bright enough outside, step outside. Increasing light in the morning can help shift kids’ body clock or Circadian rhythm, but this can be difficult, especially in Portland!
  • In between: Try to get as much light and as much exercise as possible. This goes for grown-ups, too!

Daylight Saving Time
>>Spring forward: The great thing about Daylight Saving Time is that spring is here! This is a nice time of year (especially for those living in the Pacific Northwest) to come out of the darkness and enjoy more time outside.

Consider shifting the schedule slowly. Although the time difference is only one hour, think about adjusting the sleep schedule three to four days before “springing forward.” Daylight Saving Time begins Sunday at 2 a.m., so start on Thursday and make incremental 15-minute shifts every day.

Move bedtime up by 15 minutes. The next morning, wake kids up 15 minutes earlier – it will likely be dark out, so introducing light in the morning will be extra important.

“Losing” an hour on Sunday can return kids to their “regular” schedule. For example, an 8 p.m. bedtime will inch closer to 7 p.m. in the days leading up to Sunday. Then on Sunday evening, “return” to an 8 p.m. bedtime and a “normal” wake time with less disruption.

>>Fall back: When Daylight Saving Time ends, bedtime will be an hour earlier. Kids may need a little more time to adjust, but a slow shift to their sleep schedule will lessen the shock. Parents can begin pushing bedtime back in small increments a few days in advance and can also try to wake kids 15 minutes later. Maintain the same morning routine and enjoy earlier morning light while it lasts!

What’s normal? What’s not?
Mornings may be a little more challenging, as kids may be a bit more tired or groggy than usual. Know that for the next week, it may be more difficult to wake them in the morning but that eventually should resolve as they acclimate to the new time.

If kids are having difficulty adjusting, parents and caregivers should consider speaking with their pediatricians. There could be something else going on, like a sleep disorder, anxiety or worry, and they want to help.

What about jet lag?
Adults typically need one to two days per time zone to fully adjust. Kids, however, can be more sensitive. For parents expecting a big swing with jet lag, begin shifting the child’s sleep schedule in small increments (the same strategy recommended for Daylight Saving shifts) in advance of any travel. Be patient and understanding with family needs.

How much sleep do kids need?

  • First year of life: 13-16 hours
  • Toddlerhood (ages 2-5): 11-13 hours
  • School-age kids: 11-12 hours
  • Middle-schoolers: 10-11 hours
  • High-schoolers: 9 ¼ hours

Adults should also make sleep a priority. It can be easy to put off because, as parents, there’s simply so much to do. Try to remember that eight hours of sleep a night really helps parents be at their best.

Other posts by Dr. Super:
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
Battle bad dreams, night terrors and things that go bump in the dark


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




2016 in review: Doernbecher’s top stories

Safety first! Tips and tricks to keep kids safe and healthy reigned supreme on our blog this year – from Pokémon GO to laundry detergent packets. At OHSU Doernbecher Children’s Hospital, we are committed to giving parents and caregivers the resources they need to make informed decisions about their children’s well-being.

Here are this year’s most-read blog posts. Enjoy!

1. Laundry detergent packets: convenient or catastrophic?
Ever since laundry packets were introduced to the U.S. marketplace in 2012, packet exposures have occurred at astonishing rates. Pediatric resident Katelyn Saarela explains the dangers of packets and encourages readers to #PassOnPackets to help implement change and keep kids safe.

2. ‘Grass Strong:’ Andy’s Doernbecher story
The Grass family’s world was changed in an instant when a sneaker wave hit 10-year-old Andy at the Oregon Coast. His dad, Paul, shares how Andy’s hospitalization and prolonged recovery affected their family – and how it continues to teach all of them strength, resilience and healing.

3. Tricks for dealing with Halloween treats
Dietitian Tracy Severson provides tips and tricks to minimize (or avoid) sweet Halloween temptations while still enjoying the holiday.

4. With Pokémon, not everything’s a go
Parents have a lot of questions about Pokémon GO – and OHSU Doernbecher Tom Sargent Safety Center Director Dr. Ben Hoffman has answers! He provides tips for staying safe (and having fun) while chasing Charmanders.

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

6. Braylin’s Doernbecher story
“She thinks of Doernbecher as a safe and happy place, and that has everything to do with the wonderful people who work every day to give children hope and health.” Doernbecher mom Delinah shares her daughter’s journey from a Autoimmune Hepatitis diagnosis to an emergency liver transplant.

7. Marijuana safety
After seeing a significant in crease in he number of reported marijuana exposures in the past three years, the Oregon Poison Center at OHSU developed safety recommendations around marijuana products. An important read!

8. From patient to med student: Shira’s Doernbecher story
When she was a freshman in high school, Shira Einstein was diagnosed with Hodkin’s Lymphoma. Now a third-year medical student at the OHSU School of Medicine, she believes being a cancer survivor comes with a responsibility to love her life and to invest in the health of others. In this post, she explains how the care she received and the bonds she developed at OHSU Doernbecher impacted her career path.

9. A day in the life of a Doernbecher doc
In celebration of Doctors Day, we sat down with Dr. Judy Guzman, a provider who’s cared for OHSU Doernbecher patients with infectious diseases for the last 12 years. She walks us through an average day – from her morning run to conference calls and helping her kids with homework.

10. Is rice cereal safe for your child?
Dr. Natasha Polensek 
addresses a study that found infants who consume increased amounts of rice cereals and foods containing rice have higher levels of urinary arsenic. She explains what parents (and pregnant women) should be aware of.


If you have a story you’d like to share in 2017 – or if there are specific stories you’d like to see more of – please contact our social media team at You can also submit your Doernbecher story  here.

Bedtime basics

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

While anything from caffeine to a chronic illness to the excitement of household visitors can make it tough for kids to sleep, one of the most common sleep disruptors for children – and adults – is simply stress.

“It’s when we’re stressed and hyperaroused, physiologically, that it’s hard to initiate sleep,” says Kyle P. Johnson, M.D., a child psychiatrist and sleep physician at OHSU Doernbecher Children’s Hospital. “Families can suffer stress that can resonate, given the sensitivity of kids. The resonating stress and worry may get in the way of sleep, either falling asleep at night or returning to sleep after natural awakenings in the middle of the night.”

Just like for adults, the lack of sleep can set off a vicious cycle for kids, Dr. Johnson says: “Then they begin to worry about not being able to sleep and this worry causes more stress, which perpetuates the problem.” Trying to catch up on lost sleep, as teenagers sometimes try to do by sleeping in on the weekends, “can impact your circadian system, which can exacerbate the problem.”

Between school and work schedules it’s easy for families to feel harried, and it’s impossible to eliminate stressors altogether. But there are steps parents can take to help their children be ready for sleep, and help themselves relax before bed, too. “All of us need wind-down time. When we’re stressed about certain things, we may be tempted to try to deal with that thing all the way up until the time we turn out our lights, and that can cause problems with sleep onset.”

When under stress, it is important to maintain wind-down time, including disconnecting from electronic items, decreasing light exposure and, says Dr. Johnson, “continuing with established bedtime rituals and routines.”

Dr. Johnson says it’s also smart to talk with children (at an age-appropriate level) about the anxiety they’re feeling or stressors that the family is under. “They’ll catastrophize,” Dr. Johnson notes: A child might overhear a parent talking about financial woes and start worrying they’ll lose their home. “If you have a discussion, you can often allay some of those worries and concerns.”

Have these talks well before bedtime, so kids have time to process. If a child brings up a worry at night, a parent can offer brief reassurance but suggest talking more at another time.

If your child has a persistent sleep problem that’s causing distress at home or difficulties at school, talk to your pediatrician. To schedule an appointment with OHSU Sleep Medicine, call (503) 346-0640.

Tips for supporting one another

Those of us working in the Division of Child and Adolescent Psychiatry at OHSU believe that the path to meeting the challenges of a complex world begins with the experience of being loved and loving others, in our homes and in our communities. Our education and experience with children and families help us to recognize that while science evolves rapidly, the basic nature of the human experience remains the same.

We are daily awed and inspired by the courage, strength and resilience of the youth and families we work with. We will continue to join with you to stand firm in advocacy for respect, diversity, compassion and equity. We will stand up against bullying, intimidation and exclusion.

We are deeply troubled that expression of hatred and threats toward various members of our society are commonly being expressed in our children’s schools and neighborhoods. Parents, teachers and mentors are struggling to find ways to reassure children that their country is not falling apart, that they will be safe and that their friends will be protected. Many find this task of providing reassurance difficult when there are so many unknowns.

Children need to know that adults around them will not accept cruelty toward others, that conflict and intolerance expressed by others should not to be emulated and perpetuated. We can help children recognize this by active discussion of cultural and moral norms and respectful listening. We must remember that youth who bully need our help as well, through limits, supervision and exploration of the source of their actions. They need sustained support to successfully participate in collaborative and mutually respectful peer culture.

Additional tips you may find useful during this time include:

  • Take care of yourself. Children are very aware of their loved ones’ emotions, even when they do not seem to be paying attention. Take the breaks you need to express your emotions with trusted supports and collect your thoughts. Be authentic and compassionate with your expression while helping your children learn how you are effectively processing your emotions.
  • Make time to spend together; when things are hard, being together and enjoying each other’s company is a really important way to feel better.
  • Let children and youth know that you want to hear about their thoughts and feelings, how they are experiencing the world, and that you will protect them.
  • Remind children to talk to a trusted adult if they hear or see something they don’t understand or that bothers them about how people are treating one another.
  • Monitor children’s access to media and have conversations with them about what they see or read. Limit exposure to visual media as it is harder to understand than conversation or written material.
  • Look for signs of struggle: behavior changes, irritability, difficulty sleeping, physical complaints that signal stress.
  • Young children typically express and work through their stress in their play. Encourage their imagination and creativity. They are exercising their minds: developing characters, stories and scenarios that help them manage their hopes and fears. Try not to jump in and offer interpretations (“this lion reminds me of a bully”) or interrupt with questions (“is this making you think of what you heard on the news?”). Instead, simply describe what you observe (“this lion is roaring.”)
  • Grade school age and slightly older children are applying their ideas in their world. Help them gain understanding and perspective by reading about history and how people can disagree, find common ground and work for good. Help them generate ideas about what they would like to do influence their world and implement what is feasible.
  • Teens and young adults have greater independence to engage in action. Supporting creative and safe participation in championing causes and addressing concerns can counteract despondency, fear and urges for withdrawal.

If you are worried that your child is struggling or if your child has talked about self-harm, seek care from a mental health professional or contact a crisis line: Suicide Lifeline (Lines for Life): 800-273-8255 or text 273TALK to 839863.

Love and connection are healing and powerful forces that promote courage, cohesion and resilience, setting the stage for healthy child development and a healthy society.

Learn more about the Division of Child and Adolescent Psychiatry at OHSU here.

Triple threat: The lasting effects of the female athlete triad

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


The 1972 passage of Title IX, a federal law that prevents discrimination on the basis of sex in any federally funded education program or activity, dramatically increased the number of female athletes.

It also brought a new focus on issues specific to them. One was the female athlete triad, three disorders that tended to coincide in young women:

  • low energy with or without disordered eating,
  • irregular menstrual periods
  • decreased bone density

An unexplained rate of stress fractures occurring in girls participating in lean-body-focused sports, such as dance, gymnastics, figure skating and distance running, brought attention to this phenomenon. Today, health professionals have a better understanding of how these conditions are related and what can be done to treat the triad.

Historically, there was a stigma and misconception that psychiatric issues and more serious eating disorders such as anorexia or bulimia predisposed those girls to sustain fractures: In essence, they were starving themselves. However, eating disorders like these are very rare: Two to four percent of girls with female athlete triad. Health professionals now understand that much of this is unintentional and many of these young athletes are simply “underfueled.”

If a girl is training more than 90 minutes per day, she needs a bare minimum of 30 calories per kilogram of body weight per day in order for her brain to release leutinizing hormone. The hormone stimulates estrogen production and ovulation, helping to maintain bone density. For example, a 130-pound girl would need a minimum of 2,700 calories daily, with the recommended intake being 45 calories per kilogram – around 4,000 calories a day.

Adolescence is also a critical time for developing bone mass. Athletes may be getting plenty of exercise, which helps in the bone department, but they also need to eat plenty of calcium-rich foods paired with foods high in vitamin D.

“If you spend your adolescent years losing bone density instead of building it, there’ll be less bone in the bank when you’re older,” says Andrea Herzka, M.D., an orthopedic surgeon at OHSU. “It’s like spending from your savings account: Even if you restart deposits, the total is less than if there hadn’t been a hiatus.”

Education from parents and coaches is crucial. Adolescent athletes need to understand their body needs fuel just like a car. Running on empty can cause long-term health complications such as osteoporosis (brittle bones), cardiac problems, infertility or immune system problems.

Also, keeping track of a girl’s period, especially during training season, is important. If periods are irregular during training, check with your pediatrician, Dr. Herzka suggests; he or she is likely skilled in treating this disorder or, if not, can refer to adolescent health or sports medicine specialists to provide further education to both families and patients.

“Kids have a hard time thinking long-term,” Dr. Herzka says. “Explaining there could be premature osteoporosis may not motivate a teen, but explaining the immediate risks of possibly breaking your tibia, hip or foot can see more realistic.”

For more information about the female athlete triad, talk to your pediatrician or call OHSU Sports Medicine at (503) 494-4000. 


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