Pediatricians can make an enormous difference in identifying family violence

October is Domestic Violence Awareness Month and Wednesday, Oct. 9, is Health Cares About Domestic Violence Day.

In the United States, more than 18 million children have been exposed to family violence. That’s one in four children who experience violence between their parents or caregivers.

Growing up in a violent home can be a terrifying and traumatic experience for child. It can impede their growth, early brain development and future health.

A study found that children of mothers who disclosed intimate partner violence are less likely to have five well-child visits within the first year of life and less likely to be fully immunized at age 2.

Other research has shown that the nonabusing parent is often the strongest protective factor in the lives of children exposed to domestic violence. When properly identified and addressed, the effects of violence on children can largely be mitigated, and can have a life-changing impact.

Well-baby and well-child visits provide an opportunity for clinicians and caregivers to partner to promote wellness and prevent illness and injury. It is this trusted relationship that places pediatric healthcare providers in a unique position to identify family violence in the primary care setting.

Simply by educating families about the impact family violence on their child’s health, and providing information and referrals, pediatricians can make an enormous difference for families.

Be the change.

Tamara M. Grigsby, M.D.
Clinical Associate Professor of Pediatrics Provisional
OHSU Doernbecher Children’s Hospital

‘Light the Night’ with OHSU Doernbecher’s Dr. Linda Stork

Team OHSU/Doernbecher

I’ll be walking “Light the Night” this year, as I do every year, alongside hundreds of folks propelled by memories, hope and courage.

Some of us walk as cancer survivors; others walk to honor loved ones. As a childhood cancer specialist, I walk to celebrate the lives of my patients — many alive, some dead  – who have taught me profound lessons of life.

Light the Night is a fundraising event of the Leukemia & Lymphoma Society, whose purpose is to support vital research and patient services to bring an end to cancer.

For those of us at OHSU and Doernbecher, Light the Night has special significance: it was with the help of the Leukemia & Lymphoma Society that Brian Druker, M.D., director of the OHSU Knight Cancer Institute, revolutionized the treatment of leukemia.

As an expression of deep gratitude, Joe Robertson, M.D., M.B.A., president of OHSU, is the corporate walk chair for this year’s Oct. 19 event.

With lighted balloons in hand, we will walk across the Willamette River as a collective spirit, energized by the hope that cancers like leukemia and lymphoma will someday disappear.

I invite you to join Team OHSU/Doernbecher for Light the Night.

Linda C. Stork, M.D.
Head, Division of Pediatric Hematology/Oncology
OHSU Doernbecher Children’s Hospital

Introducing Nike Doernbecher Freestyle designers for 2013 — Daniel Peña

2013 marks the 10th anniversary of Doernbecher Freestyle, and there’s plenty to celebrate. Since the program began, 58 shoes have been produced, each representing the life of a very special kid.

Nearly $8 million has been raised to support OHSH Doernbecher Children’s Hospital, and countless lives have been changed by the young designers who have so graciously shared their stories.

This year, we’ve got seven more stories to tell: DanielElijahKate, Kira, Ross, Bella and Jake have all used their very personal experiences to create a new collection of custom Nike footwear and, for the first time, apparel. In doing so, they add another chapter to the remarkable Doernbecher Freestyle legacy.

Daniel Pena, 12, of Bend, Ore. (photo by Dan Root)

Daniel Peña

For Daniel Peña, there are good days, and there are beyond-amazing days. The day he learned he was going to design a shoe for the legendary Air Jordan franchise was a beyond-amazing day.

“It was a total surprise when we got the phone call,” he said. “I kind of freaked out.” Daniel’s freak-out was justified — the 12-year-old Bend resident is a huge Michael Jordan fan, with an encyclopedic knowledge of every game, every comeback and every shoe released throughout Jordan’s illustrious career.

Like Jordan, Daniel has reinvented himself as an athlete again and again. Because his hemophilia causes problems in his ankles, he frequently changes up his sports so that he can continue to compete. “I raced BMX bikes for a while, and I love to play basketball. But I think I’m going to switch to swimming so it won’t be so hard on my joints,” he explained.

Daniel’s shoe, the Nike Air Jordan 10, is also a story of reinvention. It features a slew of first-ever features, like a modified logo that’s customized just for Daniel.

Daniel Pena’s Nike Air Jordan Retro 10 (photo by Paul Wegman)

It’s also the first time you’ll ever see a clear outsole on a Jordan 10 shoe. Daniel’s is embossed with a list of Jordan’s accomplishments.

The glossy upper sports a camouflage print that’s inspired by Daniel’s favorite video game. And in a nod to his days riding the BMX circuit, a tire tread races up the heel and straight into the sockliner. The shoe also bears a few more important distinctions:

“It’s the only Jordan 10 shoe that’s ever been designed by a kid!” smiled Daniel. And most importantly, it’s the first with power to help heal a child — by supporting the amazing hospital that changed Daniel’s life.

Daniels Pena’s initials on the side of his shoe (photo by Paul Wegman)

“Daniel is an active young man. However, his chronic pain limits his actions. Daniel’s quiet strength has not let hemophilia or pain change who he is or negatively affect the positive outlook he brings to all aspects of his life.” – Michael Recht, M.D., Ph.D., adjunct associate professor, Division of Pediatric Hematology/Oncology, OHSU Doernbecher Children’s Hospital.

The 2013 limited-edition Doernbecher Freestyle Collection includes apparel and footwear and will be sold at www.nike.com and at Nike retail locations across the country. All proceeds benefit OHSU Doernbecher Children’s Hospital.

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See more photos of Daniel’s shoe and apparel.

Ashley Schmidt
Associate Director of Development
OHSU Doernbecher Children’s Hospital Foundation

 

Early signs of autism are hard to detect; Latino children diagnosed less often, later

Autism Spectrum Disorders, or ASDs, are a type of developmental disability that begins in early childhood. ASDs are relatively common, affecting as many as one in 50 children.

As pediatricians, we know that identifying children with ASDs early in life is important. The treatment for autism is behavioral therapy, and the sooner that children with ASD starts therapy, the better their functioning will be later in life.

Early diagnosis is important, but the early signs of autism are difficult to detect, both for parents and for pediatricians. Your doctor might be concerned for ASD if your child:

  • Doesn’t take an interest in other people.
  • Doesn’t respond to his/her name or seems like he/she doesn’t hear.
  • Doesn’t point with his/her index finger, or look at things when you point at them.
  • Doesn’t bring you toys or other objects to show you.
  • Plays with objects or toys in an unusual way.
  • Has an unusually difficult time tolerating changes in his/her schedule or routine.

Because these signs can be subtle, the American Academy of Pediatrics (AAP) recommends that pediatricians screen for ASD at 18- and 24-month well-child checks using a standardized checklist. In addition, the AAP recommends that pediatricians screen for general developmental delays at the 9-, 18- and 24-month well-child checks. These tests help pediatricians better identify which children are in need of further ASD evaluation.

My research team is interested in finding out how many pediatricians are performing these important tests. We especially wanted to find out if they were offering tests to families who are at high-risk for delayed ASD diagnosis. Several studies show that Latino families are diagnosed with ASD much later than other families, and we wondered if one of the reasons might be that pediatricians were not offering ASD screening tests in Spanish.

We recently completed a survey of more than 250 primary care pediatricians in California, asking them about what kind of screening they were offering for children at risk for ASD. We found that:

  • Only 15 percent of primary care pediatricians were offering the recommended screening tests, and that only 10 percent were offering these tests in Spanish.
  • Even pediatricians who had more than 25 percent Latino patients in their practice were unlikely to offer screening tests in Spanish (only 13 percent had them).
  • Most pediatricians felt that ASD identification was much more difficult in Spanish-speaking families than in English-speaking families.

The study, which was recently published in the journal Pediatrics, suggests that pediatricians still have a lot of room for improvement in early ASD identification. They may especially need more support in identifying ASD among children whose families speak other languages.

Giving pediatricians better access to bilingual screening tools would probably help them identify Latino children earlier.   

If you as a parent have a concern about your child’s development, it is very important to discuss it with your pediatrician. Parents can help pediatricians do their jobs better by coming to them early with their concerns. A free online screening for ASD symptoms can found at: https://m-chat.org/.  Also, ask your doctor if your child was screened for ASD.

Doctors will be more likely to start screening for ASD if parents let them know it is important.

Katharine Zuckerman, M.D., M.P.H.
Assistant Professor of Pediatrics
OHSU Doernbecher Children’s Hospital

 

Nike, Doernbecher release special Freestyle shoe in honor of Isaac Arzate

Isaac Arzate, Salem, Ore.

A smart and outgoing kid at the center of a large and loving family, Isaac Arzate was a talented young athlete who pitched a no-hitter in baseball and savored an undefeated season in basketball.

With his dad, Henry, by his side as a coach, Isaac was a dedicated player with a passion for sports that nothing could dim – not even a heart defect.

In January 2012, Isaac suffered a cardiac arrest at basketball practice and was sent from Salem to OHSU Doernbecher Children’s Hospital, where doctors discovered he had a previously undetected abnormality that is one of the most common causes for cardiac arrest in young people.

Isaac Arzate’s Nike Air Jordan V Retros

After open-heart surgery, Isaac passed the time on bed rest playing his favorite video game.

Isaac was thrilled to be chosen for the 2012 Doernbecher Freestyle program and began to sketch designs for an Air Jordan V Retro that reflected his interests and his experience. Before long he was well enough to don his jersey and watch his basketball team from the bleachers, occasionally getting in a free throw during a break in the game.

Several parts of Isaac’s shoe glow in the dark.

As spring approached, he was preparing for baseball season by easing back into practice. But four months after his first cardiac arrest, Isaac suffered a second cardiac arrest and did not survive.

His parents are grateful to OHSU Doernbecher for helping to extend Isaac’s life for another precious four months.

“I never thought I would get him back the first time,” says his mom, Lindsay. When approached this year to help finish the shoe design that Isaac had started, they felt it was a fitting tribute to Isaac’s memory. “Finishing his shoe is a huge honor in his name to reflect all the things he loved about life,” says his mom. “What better way to say we love him.”

Nike still had Isaac’s original sketches, and his parents found some more. Using those as a guide, they created a design that incorporates Isaac’s jersey numbers and other favorite things. The shoe features a poem on the sock liner that Isaac wrote the day before his passing. It reads: “My team/my family/We are brothers forever/No matter what.”

“I believe we have captured Isaac’s essence in this shoe,” says Lindsay. “I hope it’ll touch those who wear it just as Isaac touched the lives of all those around him.”

Isaac’s Air Jordan will go on sale at select Nike retail locations and on www.nike.com Saturday, Sept. 14. Please visit insider.nike.com for more information.

Ashley Schmidt
Associate Director of Development
OHSU Doernbecher Children’s Hospital Foundation

Fifth Doernbecher Freestyle fan favorite to be rereleased Aug. 31

Lance Dillion with Nike designers

Pairing cancer-conquering teen Lance Dillon with legendary Nike designer Mark Smith back in 2007 resulted in one of Doernbecher Freestyle’s most memorable shoe designs.

The custom Nike Dunk Low is the fifth to be rereleased in celebration of the 10th anniversary of the Doernbecher Freestyle program.

Lance Dillon with his Nike Dunk Low (2007)

Lance’s shoes will be available for purchase on Saturday, Aug. 31, at select Nike retail locations and on nike.com. (Visit insider.nike.com, for more information about Shelby’s shoes.)

Lance Dillon was a quiet, shy 17-year-old when he joined the Doernbecher Freestyle program. But the creative collaboration brought out bold ideas, including lasered graffiti graphics that reveal something new every time you look you look at his shoes.

Elements include the date he was diagnosed with leukemia, the number of days he underwent chemotherapy at OHSU Doernbecher Children’s Hospital, and words like fight, warrior and power.

Today, Lance is a confident 24-year-old with a degree in anthropology from Oregon State University.

Reflecting on his Doernbecher and Freestyle experience, Lance says:

“Getting to work with the Nike staff and design my own shoe are things that I will always remember. But the greatest part of it was knowing that it was helping other kids who were going through the same things that I went through.”

Lance Dillion, 24 (2013)

Doernbecher Freestyle 10th anniversary special edition rereleases include:

  1. Mike Armstrong’s Air Max 95 (July 6)
  2. Cole Johanson’s Air Jordan 3 Retros (July 20)
  3. Colin Couch’s Air Force 1 (Aug. 3)
  4. Shelby Lee’s Nike Free Run 2 (Aug. 17)

Ashley Schmidt
Associate Director of Development
OHSU Doernbecher Children’s Hospital Foundation

 

Doernbecher Freestyle fan favorite No. 4 to be rereleased Aug. 17

Shelby Lee’s Nike Free Run 2

Shelby Lee’s Nike Free Run 2 is the fourth shoe to be rereleased in celebration of the 10th Anniversary of Doernbecher Freestyle’s 10th anniversary.

Look for Shelby’s shoes in select Nike retail locations and on nike.com beginning Saturday, Aug. 17. (Visit insider.nike.com, for more information about Shelby’s shoes.)

Mike and Tanya Lee adopted Shelby from China in 2007. She had been diagnosed with a congenital heart condition called single ventricle. Without treatment, Shelby’s life expectancy was severely limited.

The Lees turned to the Cardiology and Heart Surgery Program at OHSU Doernbecher Children’s Hospital, and after five heart surgeries and seven cardiac catheterizations, Shelby’s life was forever changed.

Today, Shelby’s doing well and gives her doctors and nurses all the credit: “Sometimes I feel like I’m flying, because I can actually run.”

Shelby, Ping and Jian Jun Lee

Shelby illustrated her medical journey on her Doernbecher Freestyle shoes, which include a hand-drawn map on the sock liner that traces her journey from the orphanage in China to her home here in the Pacific Northwest. On the tongue she included a graphic of a perfect heart with the letters “U.S.A.,” where her heart was fixed.

Now 14 and in the seventh grade, Shelby hopes to help people just like her by becoming a nurse when she grows up. She enjoys singing in the choir, riding horses, eating ice cream and playing with her recently adopted siblings, Ping and Jian Jun — both are from China and both are being treated for heart defects at OHSU Doernbecher.

As Shelby knows from experience, they’re in good hands. “When I came here, my heart was broken,” she explained. “But the doctors at Doernbecher made it whole again.”

Doernbecher 10th anniversary special edition shoes rereleased to date include:

  1. Mike Armstrong’s limited edition Air Max 95 (July 6)
  2. Cole Johanson’s 2010 Air Jordan 3 Retros (July 20)
  3. Colin Couch’s Air Force 1 Freestyle (Aug. 3)

Ashley Schmidt
Associate Director of Development
OHSU Doernbecher Children’s Hospital Foundation

 

Doernbecher Freestyle fan favorite No. 3 to be released Aug. 3

Colin Couch’s Air Force 1

Colin Couch’s Air Force 1 Freestyle design from 2008 is the third shoe to be rereleased by Nike in celebration of the 10th Anniversary of Doernbecher Freestyle.

Colin’s shoes will be available Saturday, Aug. 3, at nikestore.com and in select Nike retail locations across the country. Visit insider.nike.com for more information.

Colin Couch, 2008 Doerbecher Freestyle designer

With his signature bow tie and larger-than-life personality, Colin Couch is an unforgettable member of the 2008 Doernbecher Freestyle team.

Colin was treated for a congenital heart defect at OHSU Doernbecher Children’s Hospital and was more than happy to help give back to the hospital that took care of him.

“Doernbecher is a nice place to be – it makes me feel good to know that my shoe is helping other kids.”

Colin Couch, 23

Colin, now 23, is studying finance at Brigham Young University — Hawaii. He’s enjoying being back home in Oregon City for the summer and interning at a brick-oven pizzeria.

Colin also is preparing to get on the transplant list and has high hopes for a brand new heart in the near future.

Doernbecher  Freestyle 10th anniversary special edition shoes rereleased to date include:

  1. Mike Armstrong’s limited edition Air Max 95 (July 6)
  2. Cole Johanson’s 2010 Air Jordan 3 Retros (July 20)

Ashley Schmidt
Associate Director of Development
OHSU Doernbecher Children’s Hospital Foundation

 

Doernbecher sees increase in injuries from teen texting and driving

Teen texting is a popular way to communicate in 2013 – more than 75 percent of teens text in some manner. Unfortunately, texting can lead to a number of health issues, including sleep disturbances, bullying AND serious injury.

About 1 in 3 teens has been shown to text while driving – a staggering statistic. In the Pediatric Emergency Department at OHSU Doernbecher Children’s Hospital, we have seen an increase in injuries, both minor and serious, among teens who text while driving.

Following are some points for families to consider around texting:

Texting and driving

  • Texting and driving, for both adults and teens, is unsafe and against the law in most states.
  • Research shows that texting while driving increases the likelihood of a motor vehicle accident 20-fold.
  • Start talking to your teen about the consequences of texting while driving – including revoking his/her license.
  • Set clear rules about texting and driving.
  • Practice putting your phone away while driving. Role modeling good behavior is key to supporting good teen behavior.
Texting and homework
  • Establish reasonable hours for texting, including no texting until homework is complete.
“Sexting”
  • “Sexting” among teens is a form of bullying. This can lead to expulsion from school and isolation from friends. Talk to your teen about appropriate texting behavior.

David M. Spiro, M.D., M.P.H.
Medical Director, Pediatric Emergency Medicine
OHSU Doernbecher Pediatric Emergency Department

 

Of toddlers, tablets, apps and naps: thoughts on parenting the touch-screen generation

According to a recent Pew Research Center report, one-third of Americans own tablet computers and over half own smartphones. This means a lot of children have access to these devices — they rest in purses, diaper bags, on the dinner table and desk — often temptingly within reach.

These touch-screen devices are astoundingly practical: filled with direction-givers, dictionaries, cameras to record tender family times, and offer worlds of apps and videos — things that enthrall kids from toddlerhood to teens (and beyond).

With the spread of these touch screens outpacing our understanding of their impact on child development, we are armed with little data to answer parents’ tough questions:

  • When is it appropriate to introduce these devices?
  • How often should they be used and for how long?
  • Which apps may hinder development?
  • Might some apps might promote essential skills? Which ones?
  • How are we to parent what one writer in the Atlantic called “the Touchscreen Generation?”

In the absence of our own histories to draw on — my parents, for example, didn’t exactly have to wrestle the Speak & Spell out of my hand — or robust research data to guide us, I suggest to parents that they build a culture of touch-screen device use based on these principles:

Initiation

Research data has suggested that children younger than 2 who watch television have increased problems with sleep and may be slower to develop language skills than their non-television-watching peers. In light of this, the American Academy of Pediatrics has recommended that children not have passive screen time before age 2. This is probably a good cutoff for tablet devices as well, with infants and toddlers needing to develop the motor, sensory and other skills necessary to interact with and make meaning of the “real world” before encountering the digital representations of actions and objects.

Imitation

Remember, children watch closely what you do. When you are with them at the dinner table or the park, if you are checking out Facebook or playing Words With Friends, they will learn that this is what being together, eating together, playing at the park is all about.

If you find yourself having difficulty torn between your touch-screen world and parenting, you may wish to pick some times to be phone/touch screen-free, leaving devices outside the room or in bins or drawers — demonstrating to children how to initiate, engage, and then disengage from the world electronic.

Co-Participation

British pediatrician and psychoanalyst D.W. Winnicott provocatively wrote that “there is no such thing as a baby. . . . A baby cannot exist alone, but is essentially part of a relationship.” In the spirit of Winnicott, it is important to remember that there is no such thing as an iPad, but an iPad and the relationship children and their caregivers have with it. I recommend parents use the very apps and watch the same videos they download for their kids, many times pre-viewing/pre-experiencing these and then enjoying them alongside their children. Often a child can often learn more about an app and experience more pleasure in mastery of a particular skill with a parent alongside her.

Quantity

If you decide that touch screens are a good fit for your preschooler, then one of the next questions is: how much time is appropriate? Left to their own devices, pun intended, many children will put down their family’s tablet within minutes, preferring to play with toys or interacting with their parents. Others may find themselves transfixed by “Monkey Preschool Lunchbox,” unable to shift their attention. I suggest to many parents that tablet time be regulated so that children do not spend more than about 20 minutes on the device without “coming up for air.” This can be accomplished by sitting alongside your child and setting the timer on your device to ring your child’s preferred tablet/phone sound at 20 minutes, indicating to them, and to you, that it’s time to take an agreed upon break. This may wrap up a tablet session for the day or provide the necessary break for you and your child to discuss what they’ve discovered and what else they would like to do on the tablet.

Quality

It’s important to learn about the apps you download on your phone. Reviewing the parent comments on iTunes and on many parent blogs may provide you with the best sense of which apps match your child’s developmental needs and your family’s values in terms of how best to spend time.

Opportunities Gained and Lost

As important as reflecting on what your child is enjoying or learning (colors, shapes, letters, improving memory) on your tablet, how often she is enjoying it and for how long, it is equally important to examine what your child is missing as a result. For example, if you find yourself using the device in a crowded restaurant in order to distract your child, might she be missing an opportunity to learn patience or social engagement with you or others in order to distract herself from hunger? Don’t get me wrong, I am not opposed to touch screens in restaurants, but it is important to be aware about those opportunities (developing patience: say, to save the tablet for “dessert,” playing outside, learning social give-and-take, coloring, using her imagination, experiencing the world in a tactile as opposed to flat “touch-screen” manner) lost while a child is “on a tablet.”

Safety

It is important to learn about the parental control settings on your device and to use these to prevent children from stumbling upon apps, videos and Internet content that is not developmentally appropriate. There are a number of resources on the Web that guide parents through easily turning on/off parent controls on touch-screen devices.

Craigan Usher, M.D.
Assistant Professor of Pediatrics
Division of Child and Adolescent Psychiatry
OHSU Doernbecher Children’s Hospital

 

 

 

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