Focus on Pediatrics, Summer 2019 by Prisma Health

FOCUS Vol. 31.2 Summer 2019

Improving access to child psychiatry INSIDE

Delivery Buddy success story Children’s Hospital– Upstate bereavement programs CME: Scoliosis screening and management

on Pediatrics

Focus on Pediatrics is published by Prisma Health Children’s Hospital–Upstate. Medical Editor Joseph L. Maurer, MD Managing Editor Lark Reynolds Photographer AV Services Art Director Creative Services Editorial Board Nichole Bryant, MD Donna Carver, CFRE Carl Cromer, MSN, FNP-BC Jeanine Halva-Neubauer Carley Howard Draddy, MD Jennifer Hudson, MD Emily Hughes Jonathan Markowitz, MD, MSCE Terri Negron, MN, RN Janine Sally, MS, CCC-SLP Robert Saul, MD Kerry Sease, MD, MPH If you would like your name added to or removed from our mailing list or have any comments, questions or suggestions, please send the appropriate information to: Marketing Services Prisma Health–Upstate 300 E. McBee Ave. Suite 200 Greenville, SC 29601 864-797-7544 The information contained in the Focus is for educational purposes only – it should not take the place of medical advice or diagnoses made by healthcare professionals. All facilities and grounds of Prisma Health are tobacco free. “Prisma Health” and Prisma Health symbol design are trademarks of Prisma Health.

FROM THE MEDICAL DIRECTOR

Prisma Health Children’s Hospital update Spring brought the further incorporation of the Upstate and Midlands affiliates of Prisma Health, as the logo for Children’s Hospital was announced. The ability to keep a distinct identity as a children’s hospital in the larger organizational structure is key to raising awareness of the specialized programs we offer.

Because we now offer children’s services for two-thirds of the state, the alliance of the Midlands and the Upstate allows for a stronger voice to advocate for services and care systems that are dedicated and specialized for children. This advocacy not only will be legislative, but also will apply to insurers, both public and private.

The two children’s hospitals under the umbrella of Prisma Health provide a group of services that, when combined, allow children to receive care closer to home. Children’s Hospital–Midlands is developing an inpatient rehabilitation hospital with a dedicated pediatric physiatrist. This offering will allow children to avoid transfer to Charlotte or Atlanta for this type of care. This is the only dedicated pediatric inpatient rehabilitation unit in the state.

Teams from both hospitals are meeting monthly to develop needs assessments and strategic priorities that will help position the systems providing care for children to adapt and maximize pediatric services for the Upstate and Midlands of South Carolina. What an exciting time for pediatric care in the Palmetto State!

Additional synergies that continue to develop as the two hospitals more closely align involve quality initiatives in NICU, pediatric child abuse, rheumatology, telemedicine and hematology. The decision that Buddy the Bear will be the mascot for both children’s hospitals was a great day for the legacy of a wellknown Upstate symbol of children’s services. We look forward to the rollout of Buddy the Bear to the Midlands in the near future.

Robin N. LaCroix, MD, Chair, Department of Pediatrics, Prisma Health Children’s Hospital–Upstate

CONTENTS

Making help easier to find 2 New initiatives aim to increase access to child and adolescent psychiatry.

Walking with families through grief

When patients die, care for family members continues through bereavement programs.

Delivery Buddy delivers positive outcome

Isaiah McGuffin was born at Prisma Health Oconee Memorial Hospital at just 27 weeks, but today he’s a thriving 1-year-old.

Departments Academic News 5 Congratulations, graduates! Welcome, new residents and fellows! Medical Staff Spotlight

Meet our new physicians

What’s New?

MAiN Program expansion, Teen Driving Program, Healing Garden renovation

CME

Scoliosis screening and management

Clinical Research

Forehead temperature-regulation device for insomnia

Quality Counts

Safe sleep video delivery

Special Program

Kidnetics offers a broad array of therapies for children at locations in Greenville and Spartanburg

Collaborating for Better Care

Clement’s Kindness

Celebrations

Awards and philanthropic news

Bulletin from the Bradshaw Institute

A look back at Linda Brees’ career in children’s advocacy

Ask the Faculty

Vaping On the cover: A new fellowship in Child and Adolescent Psychiatry, led by Megan White Zappitelli, MD, aims to ease the strain on child and adolescent psychiatry resources in the Upstate and make it easier for young people to access the help they need.

To access this publication online, go to www.ghs.org/publications.

LEAD STORY

Improving access to child and adolescent psychiatry Dr. Zappitelli, program director for the new Child and Adolescent Psychiatry fellowship, often engages side-by-side activity when consulting with children and adolescents to reduce the sense of confrontation.

According to the U.S. Department of Health and Human Services, approximately one in five children and adolescents – over 14 million in the nation – has a mental health condition. A common frustration among pediatricians is limited access to child and adolescent psychiatrists who can help these patients. Referrals often present challenges, including long wait times, insurance coverage limitations and availability of the appropriate treatment. Prisma Health Children’s Hospital–Upstate hopes to ease the process of helping pediatric patients access the psychiatric care they need through a handful of new initiatives. 2

A Child and Adolescent Psychiatry fellowship – the first in the Upstate – began this year and aims to draw aspiring child and adolescent psychiatrists to the area. Patient access to psychiatrists who specialize in young people is a nationwide challenge. The Dartmouth Institute for Health Policy and Clinical Practice estimates there is one psychiatrist per 1,807 children who need services in this country. “Our goal is that we’ll train young physicians, and they’ll decide to stay here when they complete the fellowship,” said Megan White Zappitelli, MD, program director for the Child and Adolescent Psychiatry Fellowship. “We hope

that will increase access to child psychiatrists for all of our children in the community.” In addition, Dr. Zappitelli noted, young physicians in the Upstate interested in child and adolescent psychiatry have in the past had to leave the area for their fellowship training, making it less likely they would return and practice here. Offering a training program in Greenville will make it possible for these physicians to stay in the community they know and love while they are trained. The program will accept two fellows each year. The first two fellows began their training in March. Because of this new program, an expansion of existing Child and Adolescent Psychiatry faculty was needed. Between April 2018 and August 2019, five new child and adolescent psychiatrists will have been added to the medical staff at Prisma Health–Upstate, of which Zappitelli is one. In addition to teaching, these faculty members also will expand the availability of child and adolescent psychiatric services for the Upstate community. “It’s all about increasing child and adolescent psychiatry availability in the Upstate,” Zappitelli said. “So we’re increasing the opportunity for education. Because we have to hire more people to teach them, that’s going to increase access in the short term. Over time, we hope to have a more robust physician pool that has been trained here and want to live and work here.” In the meantime, the fellows themselves will help alleviate the strain on child and adolescent psychiatric resources in the Upstate. These physicians will provide additional coverage for inpatient psychiatric needs at Prisma Health– Upstate and Prisma Health Children’s Hospital–Upstate and will spend time in the outpatient clinics, too.

Emergency Psychiatry debuts Another service offered at Prisma Health to help address emergent psychiatric situations for children and adolescents is the relatively recent formation of the Division of Emergency Psychiatry. This team of general and child and adolescent psychiatrists is located in the Emergency Trauma Center of Prisma Health Greenville Memorial Hospital, with team members on call 24 hours a day, seven days a week. The key benefit for families around the Upstate is that this team also offers psychiatric consultations for patients – adults and children – in outlying Prisma Health emergency departments via telehealth technology. These telehealth consultations are available 12 hours a day, seven days a week. (The hours vary based on the schedules of psychiatric social workers who are embedded in each outlying emergency department.)

Dr. Zappitelli reviews case notes with the inaugural Child and Adolescent Psychiatry fellows, Jessica Grimes, DO, and Krishna Vijayasarathi, DO.

Upstate mental health resources • TEEN CRISIS Line: 864-467-8336 • National Suicide Prevention Lifeline: 1-800-273-TALK (8255) (press 2 for Spanish) • National Runaway Safe Line: 1-800-621-4000 • Mental Health America: 864-467-3344 • Trevor Project Crisis Line (LGBTQ youth): 1-866-4-U-TREVOR (488-7386) Greenville • CRISIS Line (Greenville): 864-271-8888 • Greenville County Mental Health Center: 864-241-1040 • Bethany Christian Services: 864-235-2273 Spartanburg • CRISIS Line (Spartanburg): 864-582-1100 • Children’s Advocacy Center (Spartanburg & Cherokee counties): 864-515-9922 Greenwood • Beckman Center for Mental Health Services: 864-223-8331 Anderson/Oconee/Pickens counties • Anderson-Oconee-Pickens Mental Health Center: 864-260-2220

Dr. Lommel speaks with a psychiatric social worker via telehealth technology.

“This way, if a pediatrician is in Laurens, and truly has a behavioral health crisis on his or her hands, the physician can send the child to Laurens County Hospital, and we’ll have a psychiatrist see the patient by telepsych,” said Karen Lommel, DO, MHA, MS, Prisma Health–Upstate’s Behavioral Health CMO and chair of the Department of Psychiatry & Behavioral Medicine. In addition, Dr. Lommel noted, the psychiatric social workers embedded in the community hospitals may be able to work through a disposition without activating the consultation. When consultations have been used, Lommel noted, results have been positive. Hold times are lower and discharge rates higher than similar telepsych services offered by outside organizations and entities. “The psychiatrists work with the psychiatric social workers to strategize for an appropriate and safe discharge utilizing local resources,” said Lommel. “We’re able to evaluate patients and direct them to appropriate treatment and resources, all while keeping them in their

own communities. It’s been a big satisfier for patients, physicians and team members.” As the pieces come together to provide more comprehensive psychiatric services for children and adolescents in the Upstate over the long term, another new initiative aims to equip community members to play a role in intervening with and supporting these young people. Mental Health First Aid provides training to key community members to help them intervene early and effectively when they detect a mental health issue. There are courses for adults and for youth. Thanks to a grant from the federal Substance Abuse and Mental Health Services Administration, Robyn Ellison, the instructor for both courses, can teach these courses for free to community organizations, law enforcement and other key personnel. Groups who have already received the training include all pediatric nurses at Children’s Hospital, chaplains and Chaplaincy residents at Prisma Health–Upstate, and select Greenville County principals.

ACADEMIC NEWS Prisma Health Children’s Hospital–Upstate congratulates all our residents and fellows who graduated in May 2019 and welcomes 11 new Pediatric residents, five Medicine-Pediatrics residents, two Child and Adolescent Psychiatry fellows and a Developmental-Behavioral Pediatrics fellow.

Congratulations, graduates! Pediatrics Hunter Altman, MD, will join Prisma Health Children’s Hospital–Upstate as co-chief pediatric resident and junior faculty member. Paolo Arce, MD, will begin working with Medical Group of the Carolinas–Pediatrics–Spartanburg (Westside) in Spartanburg, S.C.

Altman

Arce

Barnes

Dankovitch

Davis

Ford

Graves

Merritt

Nassif

Sayles

Vajta

Vandiver

Tyler Barnes, MD, will join Floyd Primary Care Pediatrics in Rome, Ga. Kindal Dankovitch, MD, will join Prisma Health Children’s Hospital–Upstate as co-chief pediatric resident and junior faculty member. Jennifer Davis, MD, will begin working with Atrium Health Levine Children’s Suburban Pediatrics in Charlotte, N.C. Rachel Ford, MD, will begin working with AnMed Pediatric Associates in Anderson, S.C. Christopher Graves, MD, will begin a Pediatric Emergency Medicine fellowship at UNC/WakeMed Health and Hospitals in Raleigh, N.C. Madison Merritt, MD, has joined The Children’s Clinic– Travelers Rest, a practice of Prisma Health Children’s Hospital–Upstate. Nicole Nassif, MD, will join Parkside Pediatrics in Greenville, S.C. Michelle Sayles, MD, will join Medical Group of the Carolinas–Pediatrics–Boiling Springs in Boiling Springs, S.C. Natalie Vajta, MD, will join Medical Group of the Carolinas–Pediatrics–Boiling Springs in Boiling Springs, S.C. Gretchen Vandiver, MD, will join Pediatric Clinic LLC in Opelika, Ala.

Medicine-Pediatrics Ryan Dean, MD, will join the medical staff at Orlando Health’s Arnold Palmer Children’s Hospital in Orlando, Fla. Tori Grenade, MD, will begin working as a hospitalist and urgent care physician at Houston Healthcare in Houston, Ga.

Dean

Grenade

Tate

Webb

Kidd

Charles Kidd, MD, will begin working in private practice at Fayetteville Medical Associates in Fayetteville, Tenn. Megan Tate, MD, will begin a fellowship in Pediatric Intensive Care at University of Arkansas–Little Rock. Lece Webb, MD, will begin a fellowship in Pediatric Intensive Care at University of Alabama–Birmingham.

Welcome, new residents! Pediatrics Lauren Clayton, MD: University of South Carolina School of Medicine Greenville, Greenville, S.C. Sarah Evins, MD: University of South Carolina School of Medicine Greenville, Greenville, S.C. Paige Gainey, MD: University of South Carolina School of Medicine Greenville, Greenville, S.C.

Clayton

Evins

Gainey

Griffis

Hendricks

Jones

Martin

McCartor

Rahim

Williams

Winstead

Megan Griffis, MD: University of Tennessee Health Science Center, Memphis, Tenn. Caroline Hendricks, MD: Medical University of South Carolina, Charleston, S.C. Heather Jones, DO: Edward Via College of Osteopathic Medicine–Carolinas Campus, Spartanburg, S.C. Ariel Martin, DO: Edward Via College of Osteopathic Medicine–Carolinas Campus, Spartanburg, S.C. Saylor McCartor, DO: Campbell University Jerry M. Wallace School of Osteopathic Medicine, Lillington, N.C. Sahar Rahim, DO: Philadelphia College of Osteopathic Medicine, Philadelphia, Pa. Brittany Williams, MD: University of South Carolina School of Medicine Columbia, Columbia, S.C. Megan Winstead, MD: University of Louisville School of Medicine, Louisville, Ky. 6

Medicine-Pediatrics Jonathan Bates, MD: University of Kansas School of Medicine, Kansas City, Kan. Saul Bautista, MD: Rutgers New Jersey Medical School, Newark, N.J. Sarah Bugg, MD: University of Kentucky College of Medicine, Lexington, Ky.

Bates

Bautista

Hussein

Ofodu

Bugg

Laila Hussein, MD: University of South Carolina School of Medicine Greenville, Greenville, S.C. Amaka Ofodu, MD: University of Missouri–Kansas City School of Medicine, Kansas City, Mo.

Fellowship news Developmental-Behavioral Pediatrics fellow joins faculty Fellowship graduate Darla McCain, MD, has joined Prisma Health Children’s Hospital–Upstate as a faculty member in Developmental Pediatrics.

New Developmental-Behavioral Pediatrics fellow Sara Lilly, MD, will join Prisma Health Children’s Hospital–Upstate as a fellow in Developmental-Behavioral Pediatrics. She earned her medical degree from Marshall University Joan C. Edwards School of Medicine and completed her pediatric residency training at Penn State Children’s Hospital in Hershey, Pa.

McCain

New Child and Adolescent Psychiatry fellows Jessica Grimes, DO, and Krishna Vijayasarathi, DO, have joined Prisma Health as Child and Adolescent Psychiatry fellows. Dr. Grimes completed medical school at West Virginia School of Osteopathic Medicine and a Psychiatry residency at Millcreek Community Hospital/Lake Erie College of Medicine. Dr. Vijayasarathi completed medical school at the College of Osteopathic Medicine of the Pacific at Western University of Health Sciences. He completed his Psychiatry residency at UCLA-Kern in Bakersfield, Calif.

Grimes

Vijayasarathi

M E D I C A L S TA F F S P O T L I G H T Prisma Health Children’s Hospital–Upstate welcomes several new physicians to the Prisma Health medical staff.

Meet our new physicians Adolescent Medicine

General Pediatrics

Michael Guyton-Nunley, MD, completed his medical degree at University of South Carolina School of Medicine in Columbia. Dr. GuytonNunley completed a residency in Internal Medicine-Pediatrics at Greenville Health System (now Prisma Health–Upstate) and a fellowship in Adolescent Medicine at Mount Sinai Adolescent Health Center in New York, N.Y. He can be reached at 864-2207270.

Hunter Altman, MD, completed her medical degree at University of Texas Medical School–San Antonio. She completed her Pediatrics residency at Children’s Hospital–Upstate in Greenville. Dr. Altman will be working as a pediatrician with the Center for Pediatric Medicine. She can be reached at 864-220-7270.

Child Psychiatry & Psychotherapy Megan White Zappitelli, MD, completed medical school at the Medical University of South Carolina in Charleston. She then completed a combined fellowship residency through the Triple Board program at the University of Kentucky in Lexington and is board-certified in Pediatrics, Adult Psychiatry and Child Psychiatry. Dr. Zappitelli is program director for the Child and Adolescent Psychiatry Fellowship (see p. 2) and medical director for the Children’s Residential Program at Children’s Hospital– Upstate. She can be reached at 864-454-5612.

Developmental Pediatrics Darla McCain, MD, completed her medical training at the McGovern Medical School at the University of Texas in Houston. She completed her Pediatrics residency at the University of North Carolina Hospitals in Chapel Hill and a fellowship in Developmental-Behavioral Pediatrics at Prisma Health Children’s Hospital–Upstate. Dr. McCain can be reached at 864-454-5115.

Kindal Dankovitch, MD, completed her medical degree at University of South Carolina School of Medicine Greenville and her Pediatrics residency at Children’s Hospital–Upstate. Dr. Dankovitch will be working as a pediatrician with the Center for Pediatric Medicine. She can be reached at 864-220-7270.

Supportive Care Team Cheryl Taylor, MD, MPH, earned her medical degree and completed a residency in Anesthesiology and Critical Care Medicine at The Johns Hopkins University School of Medicine in Baltimore, Md. Dr. Taylor also earned a Master of Public Health degree from Johns Hopkins and completed a Hospice and Palliative Medicine fellowship at Spartanburg Regional Health System. She can be reached at 864-455-5129.

Pediatric Cardiology opens second Greenwood office Hensley

Merritt

Sieckman

New community pediatricians

Pediatric Cardiology services now are offered in a second Greenwood site. The new office is located at 501 Epting Ave. The phone number is 864-227-8932. Office hours for the two Greenwood locations are:

Ryan Hensley, MD, has joined Pediatric Associates–Easley. Dr. Hensley can be reached at 864-855-0001.

• 155 Academy Ave.: Wednesdays, 8 a.m.–noon • 501 Epting Ave.: Wednesdays, 1–4:30 p.m.

Madison Merritt, MD, has joined The Children’s Clinic– Travelers Rest. Dr. Merritt can be reached at 864-5222600.

Pediatric Associates–Greer moves

Bradley Sieckman, MD, has joined Pediatric Associates– Greer. Dr. Sieckman can be reached at at the practice’s new location on 106 Physicians Dr. in Greer by calling 864-797-9100.

New roles Desmond Kelly, MD, a physician with Developmental Pediatrics, has been named chief medical research officer for the organization’s Health Sciences Center. Jonathan Markowitz, MD, a physician with Pediatric Gastroenterology, has moved into the role of vice chair of Research & Academics for Children’s Hospital–Upstate. Allison Ranck, MD, now is division chief of Pediatrics for Oconee Medical Campus. Dr. Ranck also is serving as the pediatric curriculum director for the new Family Medicine residency in Clemson and Seneca, which begins in 2020. As part of her role, she will help with the expansion of inpatient pediatric and newborn care at Oconee Memorial Hospital. She will continue as senior medical director for Pediatric Primary Care in the Western/Southern Regions. Katy Smathers now serves as director of Medical Center Clinics for Children’s Hospital–Upstate. Her responsibilities include the two offices of the Center for Pediatric Medicine (CPM), North Greenville Outpatient Center–Pediatrics, Ferlauto Center for Complex Pediatric Care, Pediatric Infusion Center, and CPM’s Social Work and Care Coordination services.

Pediatric Associates–Greer has moved to Greer Medical Campus. The new address is 106 Physicians Dr., Greer, SC 29650. Hours are weekdays, 8 a.m.–5 p.m., and Saturdays, 8–11:30 a.m. The phone number has changed to 864797-9100.

Infusion hours expand Beginning in June, the Center for Pediatric Medicine will offer extended hours two days a week for infusions. New hours of operation: Monday: 8 a.m.–7 p.m. Tuesday: 8 a.m.–5 p.m. Wednesday: CLOSED Thursday: 8 a.m.–7 p.m. Friday: 8 a.m.–5 p.m. For an appointment, call 864-220-2009.

Adolescent Medicine relocation Adolescent Medicine has moved to 1350 Cleveland St. in Greenville. The new phone number is 864-522-4888.

Child Abuse Pediatrics now in Anderson Child Abuse Pediatrics now has an office in Anderson at 216 E. Calhoun St. The phone number is 864-231-7273.

New Impact healthy lifestyle move New Impact, a weight management/healthy lifestyle program, has moved to 905 Verdae Blvd., Suite 202, in Greenville. This program is located within the Prisma Health Weight Management Institute. The new phone number is 864-522-2100.

W H AT ’ S N E W ? Prisma Health Children’s Hospital–Upstate expands its facility dog program and launches a program to help teen drivers stay safe.

Facility dog program expands pawprint Children’s Hospital–Upstate’s facility dog program, the Canine F.E.T.C.H. (Friends Encouraging Therapeutic Coping and Healing) Unit, will add a fifth dog to work with patients in Developmental-Behavioral Pediatrics at Patewood Medical Campus. The facility dog will help calm and distract patients, allowing care to be delivered in a less stressful environment for both patient and parent. Students at Stone Academy, a public magnet school with students in kindergarten through fifth grade, chose the Canine F.E.T.C.H. Unit as their 2019 philanthropic partner to provide support for peers who may be sick or in need of special care. Their efforts will help cover the $25,000 cost of the dog.

Safe Kids™ Upstate debuts Teen Driving Program Safe Kids Upstate, the injury prevention arm of Children’s Hospital–Upstate’s Bradshaw Institute for Community Child Health & Advocacy, now offers a Teen Driving Program to high schools in Greenville, Oconee and Pickens counties in hopes of lowering the number of teens involved in motor vehicle crashes. Thanks to funding from Kohl’s, Safe Kids offers the program for free. A school club must lead the initiative, which focuses on the five primary causes of teen crashes: • Driving at night • Speeding • Distracting objects • Not using seat belts • Using alcohol and drugs The program helps teens learn about safe driving practices and gives them an opportunity to simulate the experience of driving while impaired.

To give to the facility dog program, visit ghsgiving.org/ fetch, or text GOFETCH to 41444. To support Stone Academy’s efforts, text STONEROCKS. Taylor Stathes, a certified child life specialist with Children’s Hospital, has expanded her role as a handler to become Facility Canine Coordinator. She will now be responsible for program development, dog handling and community engagements.

MAiN program expands at Prisma Health hospitals Managing Abstinence in Newborns (MAiN), a treatment model developed and piloted at Prisma Health Greenville Memorial Hospital, now includes Baptist Easley Hospital and Richland Memorial Hospital in Columbia. MAiN targets symptoms related to neonatal abstinence syndrome, which newborns experience when exposed to addictive drugs while in utero. The program features three components: treatment for withdrawal in newborns is started right away to reduce pain and complications; mothers room-in with the baby for a week to help provide care and gain parenting skills; and the baby continues to be weaned off opioids at home, avoiding a lengthy hospital stay. The model has proven to be safe, effective and yields better outcomes than traditional care.

Keltin Cinema premieres at Prisma Health– Upstate

Healing Garden gets TLC renovation The Healing Garden at Prisma Health Greenville Memorial Hospital received a makeover thanks to funds from Clemson Miracle’s 2018 Dance Marathon and expertise from students at the university’s Horticulture Department. The renovation added items such as glider benches, a hardscape labyrinth and concrete animal sculptures to make the space more child friendly. Faculty of the Horticulture Department assigned the renovation update as a class project to students in the 2017 Sustainable Landscape Garden Design Laboratory Class. Students visited the garden to view the space and incorporate Children’s Hospital team members’ vision of what the Healing Garden could be. Key renovation components were accessibility, appeal, sustainability and a woodland theme where animals could be tucked away for children to search for. Clemson Miracle provided the funds needed to incorporate the final plans into the current garden.

Keltin Bennett died of cancer in December 2017 at 21 months old, but his family has left a legacy in his honor that will benefit families of patients being treated for cancer at BILO Charities Children’s Cancer Center for years to come. Keltin Cinema is a mobile movie theater that families can reserve while staying with their child at the Cancer Center to have a movie night. The set-up includes a cart, 90-inch projection screen, projector, Blu Ray player and binder with a list of available movies, movie snacks and beverages. Families can order the movie they want to watch, along with their snack and drink selections, and the cart and equipment will be delivered to their room. Special Toy Story pillowcases sewn by Keltin’s mom, Tiesha, also are delivered.

SC updates immunization requirements In February 2019, the state Department of Health & Environmental Control (DHEC) announced changes to immunization requirements that will take effect for the 2019-20 school year. The changes include: • Fifth graders now must have two doses of varicella with both doses received on or after the first birthday and separated by at least four weeks. A child with a positive history of the disease is considered immune and is exempt from this requirement. • Seventh graders now must have three doses of oral and/or inactivated polio vaccine, with at least one dose received on or after the fourth birthday.

• The requirement for measles, mumps and rubella vaccination has been updated to refer to MMR vaccine: Requirements are one dose of MMR vaccine on or after the first birthday for child care and two doses of MMR vaccine on or after the first birthday for school. • A new hepatitis A vaccine requirement will begin July 1, 2020, for child care and in the 2020-21 school year for students entering 5K. (The vaccine can be given starting at 12 months, followed by another shot six months later.) Note: Exemptions are unchanged – medical and religious exemptions remain the only ones allowed in South Carolina.

For more information, visit scdhec.gov and then search “child vaccinations.”

C O N T I N U I N G M E D I C A L E D U C AT I O N

Scoliosis screening and management

CME credit information To receive possible continuing medical education (CME) credit for this article, please complete the online Q&A that can be accessed on page 15. Both physicians and nurses are eligible to test for the credit. It is the policy of the Prisma Health–Upstate Continuing Medical Education Committee to ensure balance, independence, objectivity and scientific rigor in all its individually sponsored or jointly sponsored education activities. Article author David Lazarus, MD, has disclosed that he has no significant financial interest or relationship with any company that may be considered an actual or potential conflict of interest with this educational activity. The planning committee have listed no duality of interest with regard to potential relevant financial relationships for the FOCUS enduring activity. The CME committee have listed no duality of interest with regard to potential relevant financial relationships for the FOCUS enduring activity with the exception of Sandra Weber, MD (Committee Chair), Grant/Research Support–Eli-Lilly, NIH, and Pfizer. The University of South Carolina School of Medicine GreenvilleGreenville Health System (USCSOMG-GHS) designates this enduring activity for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The University of South Carolina School of Medicine GreenvilleGreenville Health System is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Scoliosis is a complex deformity of the spine with curvature in the coronal plane secondary to rotation of the vertebrae. There are multiple types of scoliosis, with adolescent idiopathic scoliosis (AIS), or curves over 10 degrees in children ages 10-17, being the most common. While AIS has an incidence of 3%, less than 1 in 1,000 patients with scoliosis will require surgical management.1 Other types of scoliosis seen in children include congenital, neuromuscular, syndromic and, rarely, pathologic. Congenital scoliosis is secondary to a true vertebral anomaly that occurs in utero at the same time as cardiac and renal development. Neuromuscular scoliosis is seen in patients with conditions such as cerebral palsy, spinal muscular atrophy, Duchenne muscular dystrophy, hypotonia, neurofibromatosis, Marfans and myelodysplasia. There are also many other syndromes where patients often will have an associated scoliosis; however, scoliosis management depends on many variables unique to each patient. Pathologic scoliosis is relatively uncommon, but may be secondary to a tumor such as an osteoid osteoma. Treatment of the tumor may allow the scoliosis to resolve if treated appropriately.

AIS has no known pathophysiologic cause. While there often is a positive family history in children with scoliosis, we have been unable to identify a specific gene association.2

Diagnosis In South Carolina, required school screening for scoliosis has not been conducted since 2004. However, many schools around the region still screen for scoliosis, often during required annual sports physicals. The majority of our referrals for scoliosis come from our primary care colleagues who identify spinal asymmetry at the yearly check-up. Contrary to the current recommendation from several orthopedic and spine societies, the United States Preventive Services Task Force (USPSTF) formally recommended against the use of routine screening for scoliosis. This was secondary to the concern for the low incidence of scoliosis with progression, the possibility of unneeded treatment and the low predictive value of screening. The American Academy of Orthopaedic Surgeons (AAOS), Scoliosis Research Society (SRS), Pediatric Orthopaedic Society of North America (POSNA) and American Academy of Pediatrics released a position statement in 2007 supporting routine use of scoliosis screening.3 In 2018, USPSTF released an updated statement again saying current evidence does not support routine screening for scoliosis.4 Multiple screening techniques are available to physicians who perform scoliosis screening in the office. The standard of care for screening is the Adam’s forward bending test looking for asymmetry. Using the scoliometer to measure the asymmetric hump, 5–7 degrees is a positive test, with 7 degrees typically correlating with a 20-degree curve. The classic scoliometer can be used if readily available, but studies have validated the use of smartphone apps (such as the one pictured) to perform the same test, many of which are free.5 Appropriate visualization and patient stance are important when performing this test. A rotation less than 7 degrees on the scoliometer has a 95% chance of being a curve less than 30 degrees. The chest, shoulders and waist should be evaluated as well for asymmetry.

Other important factors to consider during the exam are skin manifestations, foot abnormalities, leg length discrepancy and joint laxity.6 The SRS recommends that screening be performed at least twice in females around two years before puberty, or ages 10 and 12. Males should be screened at least once around age 13 or 14. On average, females stop growing at age 14 and males at 16.7 Once a positive test has been confirmed, an X-ray is warranted to further evaluate the spine. A standing posteroanterior (PA) X-ray of the spine from C7 to the pelvis is the ideal X-ray to fully evaluate the deformity. Back pain may warrant a lateral view to rule out spondylolysis, spondylolisthesis or other pathologies. MRI is not routinely performed, but indications for advanced imaging include onset before 10 years of age, abnormal neurological exam, asymmetrical abdominal reflex, left thoracic curve, increased kyphosis, structural abnormalities and rapid progression. The orthopedic surgeon will decide on advanced imaging after a full history, physical exam and X-ray evaluation. Radiographically, scoliosis is measured on the PA X-ray from the most tilted vertebra to the next most tilted vertebra. It must be over 10 degrees to be called scoliosis. Once scoliosis is diagnosed, it is crucial to determine the risk of progression, which depends on the patient’s sex, magnitude of the curve and future growth potential. Puberty takes about two years, and it is during this time that peak height velocity occurs, starting around age 11

Primary care partners are the first line of defense for detecting scoliosis and making the proper referral if needed.

in females and 13 in males. Growth velocity and skeletal maturity can be measured multiple ways. Peak growth velocity in females typically occurs around the year before she starts menarche. X-rays are further used to evaluate skeletal maturity.8 Curve magnitude, combined with skeletal growth potential, helps determine the next step in treatment. Curves with a magnitude under 20 degrees do not need any intervention other than observation and routine physical exams. These should be performed more often if the patient is skeletally immature. The risk of progression in curves less than 20 degrees is low; once the patient is skeletally mature, he or she no longer needs to be followed. Curves between 25–40 degrees have a higher risk of progression during puberty, but have a very low risk of progression once skeletally mature. Conservative treatment in a skeletally immature patient is usually indicated once the curve hits 25 degrees. Different surgeons vary as to when they may begin conservative treatment. Conservative treatment involves the use of bracing to stop scoliosis progression.1

Bracing basics The most recent high-quality evidence available supporting the use of conservative treatment was the BRAIST study in the New England Journal of Medicine in 2013.9 The study looked at risk of progression to 50 degrees in patients with or without a brace. Some were in a blinded randomized group while others were placed in a preference cohort. This study included the at-risk patient population: age 10–15; Risser 0–2; and Cobb angle of 20–40 degrees. The brace used in this study was a rigid thoracolumbar orthosis, similar to the commonly known Boston brace. The study was stopped early due to efficacy of the brace, which had a success rate of 72% compared to 48% in the control group with no brace. Time spent in the brace was also shown to be important, with at least 12.9 hours per day in the brace associated with a success rate of 90-93%. This was the first randomized controlled trial that supported the use of bracing.9 A more recent study

showed that for every three patients treated with bracing (who comply with the treatment plan), one surgery is prevented.10 Multiple types of braces are used around the United States. The most common, used in the BRAIST study, is the Boston brace. Others include the Milwaukee brace, Wilmington brace, SpineCor brace, Rigo-Cheneau brace and Lyon brace, all of which are full-time braces. The Charleston and Providence braces are nighttime-only devices. Each brace has a different design, mechanism of action and ideal curve type to treat. Brace complications are uncommon: Most involve the skin and, on occasion, the psychological impact on the patient. Unless circumstances prevent the use of a brace, patients in the rapid period of growth with a curve of 20–40 degrees should be considered for brace treatment. However, it is important to properly counsel the patient and family that the larger the curve and younger the patient, the more he or she still is at risk of progression even in a brace.1

When surgery is appropriate Brace failure is when a curve continues to progress or the curve reaches 45–50 degrees. At this point, the curve continues to have a risk of progression, anywhere from 0.5–1 degree per year, with thoracic curves being more at risk than lumbar curves. The goal of surgery is to stop progression, restore appropriate biomechanical spine balance and safely straighten the curve. A posterior spinal fusion is the most common surgical procedure performed for scoliosis. This involves placing screws and rods in the spine. While surgical complications do occur, some associated with older surgical methods are much less common with today’s techniques. Additionally, a significant amount of recent literature supports the ability of patients to be discharged home earlier than the historical lengthy hospital stays – typically a few days, without any increase in complications. The natural history of untreated scoliosis and long-term outcomes are well documented. Weinstein presented 50-year outcomes data on untreated significant scoliosis

Contrary to the USPSTF recommendation, it is highly recommended to perform a benign rapid screening in the office in hopes of helping patients who do have scoliosis to be treated in a timely manner. 14

showing no difference in survival. The main difference between scoliosis and control groups was an increased risk of back pain, although this is not functionally limiting. Cardiac and pulmonary symptoms usually do not occur until curves are over 80–90 degrees.

References

Quality of life and function have not been shown to be different between untreated scoliosis and controls. Nevertheless, studies show patients are self-conscious and depressed about the cosmetic appearance of their spine. This information is important to discuss with patients and families, as patients with scoliosis – even untreated – can live very fulfilling lives.11,12

3. Hresko MT, Talwalkar V, Schwend R. Early detection of idiopathic scoliosis in adolescents. Journal of Bone and Joint Surgery American Volume. 2016:98:e67(16).

Adolescent idiopathic scoliosis is relatively common, yet the need for treatment beyond a brace is uncommon. The body of knowledge and evidence surrounding modern-day treatments is growing to support the use of conservative modalities. For those who do progress to the point of surgery, research and technology have significantly improved the ability to perform these surgeries successfully. Newer techniques to avoid fusion surgery in adolescents are being researched in some centers around the country. Primary care partners are the first line of defense for detecting scoliosis and making the proper referral if needed. Contrary to the USPSTF recommendation, it is highly recommended to perform a benign rapid screening in the office in hopes of helping patients who do have scoliosis to be treated in a timely manner.

1. Gomez JA, Hresko MT, Glotzbecker MP. Nonsurgical management of adolescent idiopathic scoliosis. Journal of the American Academy of Orthopaedic Surgeons. 2016;24(8):555–64. 2. Janicki JA, Alman B. Scoliosis: Review of diagnosis and treatment. Paediatrics & Child Health. 2007;12(9):771–76.

4. Grossman DC, Curry SJ, Owens DK, Barry MJ, Davidson KW, Doubeni CA, Tseng C. Screening for adolescent idiopathic scoliosis: US preventive services task force recommendation statement. Journal of the American Medical Association. 2018;319(2):165–72. 5. Franko OI, Bray C, Newton PO. Validation of a scoliometer smartphone app to assess scoliosis. Journal of Pediatric Orthopaedics. 2012; 32(8):e72-5. 6. Hresko MT. Idiopathic scoliosis in adolescents. New England Journal of Medicine. 2013;368(9):834–41. 7. Labelle J, Richards SB, De Kleuver M, Grivas TB, Luk KDK, Wong HK, Fong DYT. Screening for adolescent idiopathic scoliosis: An information statement by the scoliosis research society international task force. Scoliosis. 2013;8:17. 8. Dimeglio A, Canavese F. Progression or not progression? How to deal with adolescent idiopathic scoliosis during puberty. Journal of Clinical Orthopaedics 2013;7(1):43–49. 9. Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. New England Journal of Medicine. 2013;369(16):1512–21. 10. Sanders JO, Newton PO, Browne RH, Katz DE, Birch JG, Herring JA. Bracing for idiopathic scoliosis: How many patients require treatment to prevent one surgery? Journal of Bone & Joint Surgery. 2014;96(8):649–53. 11. Danielsson AJ. Natural history of adolescent idiopathic scoliosis: A tool for guidance in decision of surgery of curves above 50°. Journal of Children’s Orthopaedics. 2013;7(1):37–41.

Article author David Lazarus, MD, is a pediatric orthopedic surgeon with Prisma Health Children’s Hospital–Upstate.

12. Agabegi SS, Kazemi N, Sturm PF, Mehlman CT. Natural history of adolescent idiopathic scoliosis in skeletally mature patients: A critical review. Journal of the American Academy Orthopaedic Surgeons. 2015;23(12):714–23.

CME questions available online http://ghscme.ethosce.com/peds-focus19/content/summer-2019

C L I N I C A L R E S E A R C H U P D AT E Research studies at Prisma Health Children’s Hospital–Upstate are approved by the organization’s Institutional Review Board.

devices have been studied and received FDA approval for use in adults with insomnia, but no studies have looked at whether children could tolerate the device. This study will enroll 20 pediatric patients. A baseline will be established by having the parent (or child, if old enough) complete a survey on the quality of the patient’s sleep, having the parent and teacher complete a Vanderbilt Assessment Scale, and having the child wear an Actigraph device for one week that records objective measurements related to sleep quality and quantity.

Pilot aims to measure effectiveness of temperatureregulation device Jonathan Hintze, MD, a physician with Pediatric Sleep Medicine, won a Transformative Seed Grant from the organization’s Health Sciences Center for a preliminary research project. Dr. Hintze and Goutam Koley, PhD, a faculty scholar with Clemson University’s School of Health Research, won a seed grant for their project, Forehead temperatureregulating device for insomnia in children with ADHD: A pilot study. Insomnia is common in children with ADHD. While insomnia often is related to an ADHD diagnosis, many ADHD medications also can cause or worsen insomnia. And although insomnia can be treated with medication, non-pharmacologic methods are preferable. The pilot will study the effectiveness among children of a temperature-regulating device worn on the forehead during sleep. The device consists of a small box containing rubbing alcohol and water, which is pumped through tubing to a pad wrapped around the forehead. The device maintains a temperature in the upper 50s to low 60s F.

During the second week, the child will wear the temperature-regulation device at night. At the end of this time, the survey and Vanderbilt Assessment Scale will be repeated. If it appears wearing the device may be correlated to reduced insomnia, funding for a broader trial will be sought.

Recent publications Saul RA, Wilson WG. COMMENTARY—The Saul–Wilson syndrome from its early days until now. Am J Med Genet Part A. 2018;1–2.https://doi.org/10.1002/ajmg.a.8 Moye LM, Liu Y, Coarfa C, Putluri N, Rhoads JM. Plasma Urea Cycle Metabolites May Be Useful Biomarkers in Children With Eosinophilic Esophagitis. Front. Pediatr., 10 January 2019 | https://doi.org/10.3389/fped.2018.00423 Khosla S, Deak MC, Gault D, Goldstein CA, Hwang D, Kwon Y, O’Hearn D, Schutte-Rodin S, Yurcheshen M, Kirsch DB. Consumer sleep technologies: how to balance the promises of new technology with evidence-based medicine and clinical guidelines. J Clin Sleep Med. 2019;15(1):163–165. https://aasm.org/read-10-viewedsleep-research-papers-published-jcsm-2018/ (Editors note: No. 5 most read this year from the most prominent sleep journal for clinicians)

People with insomnia show an increased level of metabolic activity in the prefrontal cortex; therefore, if that metabolic activity can be reduced, the associated insomnia might also decrease.

Gottlieb SJ, Markowitz JE, Dellon ES. New IgE immediate hypersensitivity reactions upon reintroduction of food restricted for treatment of eosinophilic esophagitis. Ann All Asthma Immunol. 23 Jan, 2019. https://www. annallergy.org/article/S1081-1206(19)30047-X/pdf

In other areas of research, such as after acute brain injury, temperature regulation has been shown to reduce metabolic activity. Forehead temperature-regulation

Banerjee R, Patel M. Adults with congenital heart disease: The critical transition from pediatric to adult care. J Clin Outcomes Management. 2018;25(10):467-478.

Children’s Hospital–Upstate Physician Directory For admission to Children’s Hospital: 864-455-0000 Phone Fax Phone Fax 454-5612 454-5121 Robin N. LaCroix, MD 455-8401 455-3884 Magan White Zappitelli, MD Critical Care Medical Director; Chairman, Department of Pediatrics Michael G. Avant, MD 455-7146 455-5380 Adolescent Medicine Eric L. Berning, MD 455-7146 455-5380 Michael Guyton-Nunley, MD 522-4888 522-4885 Christina M. Goben, MD 455-7146 455-5380 Sarah B.G. Hinton, MD 522-4888 522-4885 Darryl R. Gwyn, MD 455-7146 455-5380 Allergy, Immunology and Asthma Robert S. Seigler, MD 455-7146 455-5380 Erin M. Mullaney, MD 675-5000 675-5005 John M. Pulcini, MD 675-5000 675-5005 Developmental Pediatrics/Gardner Center for Developing Minds Ryan A. Baker, MD 454-5115 241-9205 Ambulatory Pediatrics/Center for Pediatric Medicine (Medicaid) James H. Beard Jr., MD 454-5115 241-9205 Hunter Altman, MD 220-7270 241-9211 Tara A. Cancellaro, MD 454-5115 241-9205 J. Blakely Amati, MD 220-7270 241-9211 Meghan Doyle, MD 454-5115 241-9205 Jessica P. Boyd, MD 220-7270 241-9211 Charles R. Hatcher III, MD 454-5115 241-9205 Ryan D. Bromm, DO 220-7270 241-9211 Desmond P. Kelly, MD 454-5115 241-9205 Elizabeth W. Burton, MD 220-7270 241-9211 Sara Lilly, MD 454-5115 241-9205 Kindal Dankovich, MD 220-7270 241-9211 Steven H. Ma, MD 454-5115 241-9205 Anthony E. Delgado, MD 220-7270 241-9211 Darla H. McCain, MD 454-5115 241-9205 Meredith A. Eicken, MD, MPH 220-7270 241-9211 Nancy R. Powers, MD 454-5115 241-9205 Sarah R. Emerson, MD 220-7270 241-9211 454-5115 241-9205 Janelle E. Godlewski, MD 220-7270 241-9211 Karen L. Ratliff-Schaub, MD, MBOE Emergency Medicine Gary M. Goudelock, MD 220-7270 241-9211 Zachary T. Burroughs, MD 455-6016 455-6199 Lochrane Grant, MD 220-7270 241-9211 455-6016 455-6199 Matthew P. Grisham, MD 220-7270 241-9211 Jacqueline J. Granger, MD Alison M. Jones, MD 455-6016 455-6199 Michael Guyton-Nunley, MD 220-7270 241-9211 Matthew B. Neal, MD 455-6016 455-6199 Sarah B.G. Hinton, MD 220-7270 241-9211 Kevin A. Polley, MD 455-6016 455-6199 Mark B. Krom, DO 220-7270 241-9211 Jimme J. Sierakowski, DO, MPH 455-6016 455-6199 Julie L. Linton, MD 220-7270 241-9211 Jeremiah D. Smith, MD 455-6016 455-6199 Cristina M. Lopez, MD 220-7270 241-9211 John D. Wilson Jr., MD 455-6016 455-6199 Dolores P. Mendelow, MD 220-7270 241-9211 Endocrinology Easter L. Pennington, MD 220-7270 241-9211 James A. Amrhein, MD 454-5100 241-9238 Mary A.S. Putnam, MD 220-7270 241-9211 Elaine A. Apperson, MD 454-5100 241-9238 Kerry K. Sease, MD, MPH 220-7270 241-9211 Melissa D. Garganta, MD 454-5100 241-9238 Anesthesiology Mary Gwyn Roper, MD 454-5100 241-9238 Carlos L. Bracale, MD 522-3700 522-3705 Ferlauto Center for Complex Pediatric Care Michael G. Danekas, MD 522-3700 522-3705 W. Kent Jones, MD 220-8907 220-2007 Lauren H. Doar, MD 522-3700 522-3705 Robert A. Saul, MD 220-8907 220-2007 Jessica Gonzalez, DO 522-3700 522-3705 Cady F. Williams, MD 220-8907 220-2007 John P. Kim, MD 522-3700 522-3705 Richard F. Knox, MD 522-3700 522-3705 Gastroenterology 454-5125 241-9201 Laura H. Leduc, MD 522-3700 522-3705 Liz D. Dancel, MD 454-5125 241-9201 Matthew R. Vana, MD 522-3700 522-3705 Michael J. Dougherty, DO Jonathan E. Markowitz, MD, MSCE 454-5125 241-9201 Sara L. Walls, MD 522-3700 522-3705 Colston F. McEvoy, MD 454-5125 241-9201 Randall D. Wilhoit III, MD 522-3700 522-3705 Lindsey M. Moye, MD 454-5125 241-9201 Bradshaw Institute for Community Child Health & Advocacy Genetics Kerry K. Sease, MD, MPH 454-1100 454-1114 250-7944 250-9582 Cardiology David B. Everman, MD R. Curtis Rogers, MD 250-7944 250-9582 Susan E. Haynes, MD 454-5120 241-9202 Elliot S. Stolerman, MD 250-7944 250-9582 Benjamin S. Horne III, MD 454-5120 241-9202 Jon F. Lucas, MD 454-5120 241-9202 Gynecology Dianna T. Gurich, MD 455-1600 522-4455 David G. Malpass, MD 454-5120 241-9202 Benjie B. Mills, MD 455-1600 522-4455 Manisha S. Patel, MD 454-5120 241-9202 Hematology/Oncology (BI-LO Charities Children’s Cancer Center) R. Austin Raunikar, MD 454-5120 241-9202 Alan R. Anderson, MD 455-8898 241-9237 Angela M. Sharkey, MD 455-7992 455-8404 Nichole L. Bryant, MD 455-8898 241-9237 Child Abuse Pediatrics Rebecca P. Cook, MD 455-8898 241-9237 Mary-Fran R. Crosswell, MD 335-5288 241-9277 Leslie E. Gilbert, MD, MSCI 455-8898 241-9237 Nancy A. Henderson, MD 335-5288 241-9277 Steve C. Martin, MD, JD 455-8898 241-9237 Lyle L. Pritchard, MD 335-5288 241-9277 Aniket Saha, MD, MSCI, MS 455-8898 241-9237 Child Psychiatry & Psychotherapy Infectious Disease Debbie Davis, MD (Psych) 454-5612 454-5121 Joshua W. Brownlee, MD 454-5130 241-9202 Jessica Grimes, DO 454-5612 454-5121 Sue J. Jue, MD 454-5130 241-9202 E. Jo Mason, MD 454-5612 454-5121 Krishna Vijayasarathi, DO 454-5612 454-5121 Robin N. LaCroix, MD 454-5130 241-9202 Continued on back

Phone Fax Phone Fax Inpatient Pediatrics Greenville Orthopedic Oncology April O. Buchanan, MD 455-3643 455-4241 Scott E. Porter, MD, MBA 797-7060 797-7065 Gretchen A. Coady, MD 455-4411 455-4241 Orthopedic Surgery Karen Eastburn, DO, MS 455-3643 455-4241 Michael L. Beckish, MD 797-7060 797-7065 Jeffrey A. Gerac, MD 455-4411 455-4241 Christopher C. Bray, MD 797-7060 797-7065 Matthew P. Grisham, MD 455-3643 455-4241 David E. Lazarus, MD 797-7060 797-7065 Amanda G. Hartke, MD, PhD 455-3643 455-4241 Otolaryngology Russ C. Kolarik, MD 455-7844 455-4241 Nathan S. Alexander, MD 454-4368 241-9232 Elizabeth S. Tyson, MD 455-3643 455-4241 Michael S. Cooter, MD 454-4368 241-9232 Teresa A.W. Williams, MD 455-4411 455-4241 Robert L. Eller, MD 455-5300 455-5353 Inpatient Pediatrics Anderson William D. Frazier, MD 454-4368 241-9232 Sara M. Clark, MD 454-5612 454-5121 Ross M. Germani, MD 454-4368 241-9232 Liz G. Dewald, MD 454-5612 454-5121 Patrick W. McLear, MD 454-4368 241-9232 Patricia C. Onuegbu, MD 454-5612 454-5121 Eddie B. Penn Jr., MD 454-4368 241-9232 Ann Marie Patterson Ravindran, MD 454-5612 454-5121 John G. Phillips, MD 454-4368 241-9232 Elizabeth A. Shirley, MD 454-5612 454-5121 Andrew M. Rampey, MD 454-4368 241-9232 Teresa A.W. Williams, MD 454-5612 454-5121 Charles E. Smith, MD, DMD 454-4368 241-9232 Miranda L. Worster, MD 454-5612 454-5121 Pain Medicine Inpatient Pediatrics Greer R. Blake Windsor, MD 675-3488 627-9131 Matthew N. Hindman, MD 455-4411 455-4480 Plastic Surgery & Aesthetics Inpatient Pediatrics Oconee J. Cart de Brux Jr., MD 454-4570 454-4575 Allison B. Ranck, MD 454-5612 454-5121 Psychology Inpatient Pediatrics Patewood Kristina M. Kania, PhD 454-5115 241-9205 Holly Dawson, MD 797-1404 797-1405 Anne M. Kinsman, PhD 454-5115 241-9205 George C. Haddad, MD 797-1404 797-1405 Frederick P. List, PhD 454-5115 241-9205 Carley M. Howard Draddy, MD 797-1404 797-1405 Julie M. Maldonado, PhD 454-5115 241-9205 Patricia C. Onuegbu, MD 797-1404 797-1405 Jane A. Ford, PsyD 454-5115 241-9205 Ann Marie Patterson Ravindran, MD 797-1404 797-1405 Benjamin A. Jones, PsyD 454-5125 241-9201 Rebecca P. Wright, MD 797-1404 797-1405 Ermindo J. Natale, PsyD 454-5115 241-9205 Minor Care Pulmonology Children’s Hospital After-hours Care (Greenville) Michael J. Fields, MD, PhD 454-5530 241-9246 Staffed by Prisma Health pediatricians 271-3681 271-3914 Sterling W. Simpson, MD 454-5530 241-9246 Children’s Hospital Spartanburg Night Clinic Steven M. Snodgrass, MD 454-5530 241-9246 Staffed by Prisma Health pediatricians 804-6998 596-5164 Radiology Neonatology/Bryan Neonatal Intensive Care Unit Michael F. Brinkley, MD 455-7107 455-6614 India C. Chandler, MD 455-7939 455-3685 Michael B. Evert, MD 455-7107 455-6614 Benton E. Cofer, MD 455-7939 455-3685 Erin M. Horsley, DO 455-7107 455-6614 Nicole A. Cothran, MD 455-7939 455-3685 Rheumatology Amber E. Fort, DO 455-7939 455-3685 Lara M. Huber, MD, MSCR 454-5004 241-9202 Matthew F. Halliday, MD 455-7939 455-3685 Sarah B. Payne-Poff, MD 454-5004 241-9202 R. Catrinel Marinescu, MD 455-7939 455-3685 Sleep Medicine/Center for Pediatric Sleep Disorders Bryan L. Ohning, MD, PhD 455-7939 455-3685 Dominic B. Gault, MD 454-5660 241-9233 Jeffrey M. Ruggieri, MD 455-7939 455-3685 Jonathan P. Hintze, MD 454-5660 241-9233 Michael S. Stewart, MD 455-7939 455-3685 Roni Socher, MD 454-5660 241-9233 M. Whitson Walker, MD, MS 455-7939 455-3685 Supportive Care Team Nephrology & Hypertension Arun L. Singh, MD 455-5129 455-5075 T. Matthew Eison, MD 454-5105 241-9200 Cary E. Stroud, MD 455-5129 455-5075 Sudha Garimella, MD 454-5105 241-9200 Cheryl M. Taylor, MD, MPH 455-5129 455-5075 Scott W. Walters, MD 454-5105 241-9200 Surgery Neurology John C. Chandler, MD 797-7400 797-7405 Michael A. Babcock, MD 454-5110 241-9206 Robert L. Gates, MD 797-7400 797-7405 Emily T. Foster, MD 454-5110 241-9206 James F. Green Jr., MD 797-7400 797-7405 Addie S. Hunnicutt, MD 454-5110 241-9206 Keith M. Webb, MD 797-7400 797-7405 Augusto Morales, MD 454-5110 241-9206 Urgent Care (Anderson) Sunjay R. Nunley, MD 454-5110 241-9206 Callie C. Barnwell, MD 512-6544 512-6995 William C. Taft, MD, PhD 454-5110 241-9206 Artur A. Charowski, MD 512-6544 512-6995 Neurosurgery Melissa R. Eldridge, MD 512-6544 512-6995 E. Christopher Troup, MD 797-7440 797-7469 Anna C. Neal, MD 512-6544 512-6995 New Impact: A healthy lifestyle program Jonelle M. Oronzio, MD 512-6544 512-6995 Laure A. Utecht, MD 522-2100 522-2105 Melanie H. Wills, MD 512-6544 512-6995 Newborn Services Urology Jessica P. Boyd, MD 455-8401 455-3884 Regina D. Monroe, MD 454-5135 241-9200 Jennifer A. Hudson, MD 455-8401 455-3884 J. Lynn Teague, MD, MHA 454-5135 241-9200 Ophthalmology Keith L. McCormick, MD 454-5540 241-9276 Janette E. White, MD 454-5540 241-9276 ghschildrens.org 19-0837

Revised 7/19

QUALITY COUNTS

New approach makes safe sleep education more convenient DSS adoption services, physician practices, and other requesters, and come in multiple formats. Kerry Sease, MD, MPH, medical director of the Bradshaw Institute and president of the SC Chapter of the American Academy of Pediatrics, and Nancy Henderson, MD, director of Child Abuse Pediatrics at Children’s Hospital, are the content experts featured in the videos.

Each month in South Carolina, an average of six infants die from sleep-related causes such as an unsafe sleep environment. In fact, sleep-related causes are the thirdleading cause of infant death in our state. In response to this critical issue, the South Carolina Birth Outcomes Initiative (SCBOI) – a statewide collaborative of public and private stakeholders focused on improving the health of moms and babies in the Palmetto State – formed the Safe Sleep Initiative in April 2017. The initiative aims to eliminate sleep-related infant deaths by providing prevention education to parents, caregivers and the community, and support to health care providers. Timothy Harkins, MD, an OB/GYN physician with Prisma Health–Upstate, and Michelle Greco, RNC, manager of Child Abuse Prevention for Prisma Health Children’s Hospital–Upstate’s Bradshaw Institute for Community Child Health & Advocacy, co-chair the Safe Sleep Initiative. On May 15, 2018, legislation was signed by Gov. Henry McMaster mandating the addition of a video presentation on safe sleep practices and the causes of sudden unexpected infant death (SUID) to the existing available video on the dangers of shaking infants and young children. The state Department of Health and Environmental Control (DHEC) produced two new videos, “Safe Sleep” and “Preventing Abusive Head Trauma,” in accordance with the legislation. The videos currently are available in English and soon will be available in Spanish. They are free to hospitals, birthing centers, child care centers,

At Prisma Health–Upstate, a multidisciplinary team led by Patrick Springhart, MD, and Kayce Sams has been working for over a year to provide a streamlined, efficient process of education addressing these critical topics. The team, which includes members from all Prisma Health–Upstate campuses and across various departments, developed a streamlined nursing workflow process for the video viewing and required documentation, all of which is done after the birth of the infant and before discharge. Once the process is finalized, it will be followed at all Prisma Health–Upstate campuses with birthing centers. Previously, when patients were being offered the opportunity to watch the abusive head trauma video, there was close to a 100% opt-out rate from this important education. As a result of the team’s work, patients now are able to view both the videos on iPads at our birthing hospitals. Additionally, our Epic team provides an area to meet the requirements for documentation, rather than paper verification forms, making the entire process easier, quicker and more convenient for parents and families. Participation rates climbed steadily in the months after implementation, and have leveled out around 80%. Previously, the participation rate was generally around 20%. In April 2019, 469 mothers watched the video (78%). Special thanks to Michelle Greco, RNC, manager of Child Abuse Prevention at the Bradshaw Institute and co-chair for the SC Birth Outcomes Safe Sleep Initiative, for the content of this article.

Article author Carley Howard Draddy, MD, is vice chair of Quality and Medical Staff Affairs and medical director of Pediatric Telehealth and Special Projects for Prisma Health Children’s Hospital–Upstate.

SPECIAL PROGRAM

When caring for families means helping them grieve While the physicians, nurses and other team members at Prisma Health hospitals, including Children’s Hospital– Upstate, work tirelessly to provide the patients they serve with positive outcomes, the reality is that such outcomes are not always possible. When a patient dies, family members are left behind to cope with their grief and changed family dynamic.

“She helped us communicate with my daughter and son, when we were trying to figure out a way to break the news that Dad was sick and was going to pass away,” Rosanna recalled. “When Mark did pass, she took the time to sit down with my whole family and explain what had happened in a way that was thorough and compassionate. She did it with ease, and the kids completely understood.”

The work of Children’s Hospital team members doesn’t end with a patient’s death, though. A trio of bereavement support programs at Children’s Hospital–Upstate helps families – from parents to siblings – navigate the challenging road in front of them following a family member’s death.

Rosanna added, “I don’t think I could have done that myself.”

Rosanna Ostrander and her children, 9-year-old Kennadi and 23-year-old Dalton, are part of Mending Hearts, a grief support group for families that focuses on situations where a parent or other significant loved one has died. Mark Ostrander died in April 2018 from liver and renal failure. Rosanna remembered the compassionate support that Child Life specialist Dana Bird, CCLS, provided her family while her spouse was ill.

Mending Hearts A few months after Mark’s death, Rosanna received a letter from Bird about a new support group that might prove valuable. Rosanna and the children began attending the monthly groups; as the numbers slowly grew, the three found fellowship and support that made the grieving process a bit easier. “It’s been nice knowing that there are other people out there like me – that we’re not the only family going through this,” she said. “There were people who actually understood what I was dealing with in the process of grieving. My friends would try to understand, but you can’t really unless you’ve been through it.” The group features separate meetings for adults and children, held at the same time. Both groups include a trained facilitator who walks participants through discussions and activities that are age appropriate and address significant themes in participants’ grief stories. Rosanna said Kennadi has made a connection with another young girl who recently lost her father, and that seems to be helping her process her emotions. “She has a hard time talking about Daddy passing,” said her mother. “She stays closed up when it comes to talking about her dad.” In the meantime, Rosanna and Dalton, who has autism, take part in the adult group. It’s been easier for her to see how the group is helping Dalton move through his grief.

Rosanna Ostrander (right) and her daughter Kennadi and step-son Dalton have benefited greatly from the connections they’ve made through the Mending Hearts bereavement group after Rosanna’s husband, Mark, passed away in 2018. 18

“He’s opened up tremendously in the past couple of months about his dad,” she noted. “His dad raised him since he was a baby and was really the only biological parent he had a relationship with.”

Rosanna said the family acted on some of the information they learned in the group meetings before the end of last year, talking together about ways to incorporate Mark in to the holidays. They placed a ribboned ornament of a red cardinal – often used to represent a lost loved one – on their tree. Plus, Rosanna bought a gift that her husband had especially wanted to give to Dalton, and she put Mark’s name, along with her own, on the tag. Chaplain Patrick Jinks, coordinator of Spiritual Care & Education at the hospital, said offering support groups such as Mending Hearts only makes sense in the contemporary health landscape that sees health care professionals stepping outside of clinical environments to help community members achieve better overall health. “We strongly feel like offering grief services to the community is part of our commitment to community health and taking health outside the walls of the hospital,” Jinks said.

and behavioral health issues – before they become problematic, Jinks said the bereavement groups are a valuable resource for those who come in contact with children regularly. “Many children are touched by loss at some point, and these groups are resources that pediatricians can make use of when they become aware of these situations during primary care visits,” he said. “Our core mission is helping children cope with their grief so that we can help them lead healthier lives, emotionally and physically, in the long term.” Grief support groups are free to the public, regardless of whether a patient was treated at a Prisma Health facility. Learn more or refer a family by contacting Jinks at ChildrensGrief@PrismaHealth.org.

STAR program Someone to Always Remember (STAR) is another bereavement program – the first one Children’s Hospital began offering, in 2010 – for families of pediatric oncology patients who have died or children who have died from a blood disorder. The program consists of a monthly dinner and semiannual weekend camps at Pleasant Ridge Camp and Retreat Center; it is made possible by funding from Clement’s Kindness Fund for the Children. At the monthly dinner, fellowship and conversation around the table are the focus. A separate monthly small-group gathering for adults only gives parents the opportunity to dive more deeply into conversations about parental grief. The camps create meaningful time and space for families to remember their child (or sibling), connect with other families in similar situations, and find support through therapeutic activities, conversations and play.

Family Support Group The Children’s Hospital Family Support Group meets once a month in Greenville and supports families who have lost a child to any condition or circumstance. The format is similar to Mending Hearts, with separate meetings for adults and child siblings. “We’re helping the children in their grief, but we’re also trying to help them by enabling parents to be able to process their own grief and help their children cope with the loss,” Jinks said. As the focus in health care shifts to population health and addressing health issues – including emotional

Top: Campers pause after a run on the zipline at the STAR semiannual weekend camp. Bottom: Activities at camp include making crafts to help participants remember and honor their lost loved ones.

SPECIAL PROGRAM

Kidnetics specialty programs expand treatment options ®

Kidnetics, Prisma Health Children’s Hospital– Upstate’s pediatric therapies arm, offers a variety of specialty programs that can be incorporated into a patient’s treatment plan. These therapies are offered in two locations (Greenville and Spartanburg) and include the following: Aquatic therapy (Greenville outpatient location only) Individual therapy is provided in a pool with water at a therapeutic temperature. Water facilitates greater freedom of movement while providing resistance that allows for strengthening.

Feeding, eating and swallowing disorders • • • • • •

VitalStim therapy MBSS (modified barium swallow study) FEES (fiberoptic endoscopic evaluation of swallowing) NMES (neuromuscular electrical stimulation) Intensive programs Sensory/behavioral, oral motor, oral praxis, oral awareness, pharyngeal

This approach offers a comprehensive look at the oral-motor and sensory components affecting the child’s feeding skills. Referrals to Gastroenterology, Developmental Pediatrics, Psychology and Nutrition can further help the child through collaboration. VitalStim therapy and NMES are safe and effective treatments for swallowing disorders, used in combination with traditional oral motor and pharyngeal exercises.

Special-needs car seat evaluations (Greenville outpatient location only) Children perform a motor action in time with a computerized metronome beat. Research shows that as rhythm and timing improve in children, so do attention, coordination, processing speed and academic skills.

In collaboration with Safe Kids™ Upstate, this service benefits children with challenges that make a typical car seat inappropriate for them. Evaluations are completed by a Kidnetics physical therapist along with a Safe Kids team member, both trained special-needs child safety technicians. Loaner seats are available for children in spica casts.

Augmentative and alternative communication

Insight

Interactive metronome

Kidnetics provides assessment, support and training by a speech-language pathologist and an occupational therapist for nonverbal children who are candidates for augmentative communication devices or environmental access devices.

This program helps integrate the visual and motor systems, which helps children develop adequate spatial awareness, body awareness, and coordination, thus improving their overall function. Fifty-minute classes are split between activities in the gym and work on fine motor coordination, visual perceptual/motor skills and self-awareness.

Social pragmatic group This group helps school-age children learn social pragmatic skills while engaging in functional activities in the community. 20

Preschool groups

Torticollis and Plagiocephaly Program

Preschool groups help children with articulation, language or social pragmatic difficulties carry over skills learned in individual therapy to a functional preschool setting.

In this program, children with neck tightness and/or abnormal head shape work directly with a Kidnetics physical therapist as part of their treatment.

ABC University

Pediatric Pain Program

This intensive program, aimed at children at high risk for reading difficulties or who are experiencing difficulties learning to read and/or write, trains parents in an alternative method for teaching these basic fundamentals.

This unique program offers a comprehensive approach to children with chronic pain. The team includes a fellowship-trained pediatric pain medicine physician, a physical therapist with special training in chronic pain, and a pediatric psychologist with training in pain psychology.

Birth-to-3 Clinic This weekly clinic, a collaboration between Kidnetics and Developmental Pediatrics, monitors and supports the development of neonates and infants treated in the Bryan Neonatal Intensive Care Unit or who have been identified with developmental disabilities.

Vestibular Rehabilitation Program

Muscular Dystrophy Clinic

Cochlear Implant Program

This collaboration between Kidnetics physical therapy, Pediatric Neurology, Genetics and the Muscular Dystrophy Association allows families of children with neuromuscular diseases to meet with multiple specialists on one day and in one place.

With this auditory verbal therapy, a speech and language evaluation is completed to establish a baseline assessment of language skills and develop an aural rehabilitative therapy plan.

Community and Service Integration Program (CSI) This internship program at Kidnetics fosters independence and teaches vital employment skills in collaboration with occupational and speech-language therapies.

Pectus Excavatum & Carniatum Program This collaboration with Pediatric Surgery provides a multidisciplinary approach for patients with chest wall deformities.

Neonatal Abstinence Syndrome Clinic This clinic serves babies exposed to substances in utero by evaluating for gross and fine motor performance abnormalities, maladaptive regulation or sensory disturbances, along with feeding difficulties.

Laryngoscopic Clinic (VPI and feeding) In this clinic, speech pathologists along with a pediatric otolaryngologist evaluate the velopharyngeal mechanism to determine if therapy, surgical intervention or further testing is required.

This program diagnoses and treats children with various forms of vestibular dysfunction, including canal dysfunction, dizziness/nausea with movement, trauma and vestibular hypo-function.

Pelvic Floor Program This program treats patients with pelvic floor dysfunction, including daytime wetting, nighttime wetting, increased or decreased frequency of voiding, pain with urination and constipation. Interventions are provided by a physical therapist specially trained in pediatric pelvic floor dysfunction.

Craniofacial Clinic This collaboration between Childrenâ&#x20AC;&#x2122;s Hospitalâ&#x20AC;&#x201C;Upstate, Kidnetics and Childrenâ&#x20AC;&#x2122;s Rehabilitative Services (CRS) provides a team approach for children with facial differences and their families. Individual specialists evaluate the patient at regular intervals. The team meets collectively after each clinic visit to plan and provide the best care possible.

For more information, visit ghschildrens.org/ specialists/kidnetics or call 864-331-1350 (Greenville) or 864-598-0420 (Spartanburg).

C O L L A B O R AT I N G F O R B E T T E R C A R E

Clement’s Kindness supports the family It’s a life-changing moment for parents when they learn their child has cancer. Hopes, dreams and expectations – for both the child and the whole family – change in an instant. Family nights and afterschool activities get replaced with doctor appointments and hospital stays. One parent often must quit his or her job or take an extended leave of absence to be there for that child.

Haynsworth Jr. and wife Priscilla, parents who find themselves in that situation have a helping hand when it comes to navigating financial challenges.

But thanks to Clement’s Kindness, a community organization founded by Greenville attorney Knox

“Parents naturally want to be there with their child who is undergoing treatment and ultimately miss a lot of

Clement’s Kindness helps families of children with cancer or serious blood disorders address financial needs such as mortgage payments, utility bills, travel and living expenses, and even general out-of-pocket costs.

Participants in Children’s Hospital’s Adolescent & Young Adult Oncology Program express their thanks to Clement’s Kindness at the annual teen holiday dinner, which is funded by Clement’s Kindness. 22

work, which takes a toll on the family financially,” said Sandra Miller, Clement’s Kindness administrator. “We support families with just about any need they might have, whether it’s emergency funding for housing or utilities or helping pay for extracurricular activities they couldn’t otherwise afford, so the family can maintain some sense of normalcy.” Clement’s Kindness also supports Camp Courage. This camp is part of the Prisma Health Children’s Hospital– Upstate summer experience for children with cancer and blood disorders. In partnership with Prisma Health’s Office of Philanthropy, Clement’s Kindness provides funds for many programs, educational and training opportunities, and facility updates at BI-LO Charities Children’s Cancer Center, also part of Children’s Hospital–Upstate.

Projects aplenty Projects the center has been able to offer thanks to Clement’ Kindness include: • Cary E. Stroud, MD, Camper Care Center at Camp Courage. • Teen events for patients in the Adolescent & Young Adult Oncology Program. • Family support dinners and camp experiences for patients with sickle cell disease. • The Knox & Priscilla Haynsworth Day Hospital and infusion center. • Someone to Always Remember bereavement support group for families who have lost a child to cancer or a blood disorder (see p. 18). • School Intervention Program for children with cancer and blood disorders to provide continuity in their education. “One way or another, every patient who comes through our doors is serviced somehow by Clement’s Kindness,” said Pam Broughton, a social worker with the center. Clement’s Kindness got its start after the Haynsworths’ 24-year-old son, Clement, died suddenly while a student at Coastal Carolina University. Knox and Priscilla Haynsworth asked that donations be sent to a foundation a workmate had recently started in Columbia after losing her 6-year-old daughter to cancer. So many donations poured in from friends and community members that a separate fund was established at the Community Foundation of Greenville.

Clement’s Kindness founders Knox Haynsworth Jr. (far left) and Priscilla Haynsworth (second from left) stand next to Cary Stroud, MD, longtime medical director of the BI-LO Charities Children’s Cancer Center, at the ribbon cutting of the Dr. Cary E. Stroud Camper Care Center at Pleasant Ridge Camp & Retreat Center.

That fund continues to hold parents’ hands as they navigate the frightening road of a child’s cancer diagnosis and treatment. “That’s our primary purpose – to walk with these families through their child’s journey,” Miller said. “All the hospital programs simply round that out and represent more ways we can reach families with support and assistance.”

Clement’s Kindness is unique in its focus on helping families with nonmedical expenses and on providing support for the whole family. “Especially during the healing process, the whole family unit is critical,” Miller said. “That’s why Clement’s Kindness feels it’s so important to provide support to the entire family as opposed to just the patient and his or her medical needs.”

M E E T T H E PAT I E N T

Delivery Buddy yields positive outcomes for preterm babies Hannah Holbrooks was 27 weeks pregnant when, one evening while talking on the phone at her Westminster home, she began having severe abdominal pain. “I got to the point where I was hunched over and couldn’t walk, the pain was so intense,” Holbrooks said. Somehow – miraculously, Holbrooks said – she drove herself to Prisma Health Oconee Memorial Hospital nine miles away. The pain was so bad that she called 911 from her car. Once inside the hospital, her OB sent Holbrooks to the operating room for an emergency cesarean section. During the surgery, the doctor discovered that a ruptured peritoneal vessel was the cause behind Holbrooks’ pain. The baby boy – Isaiah McGuffin – was born weighing a mere 2 pounds, 6 ounces. Members of the care team at Oconee Memorial Hospital initiated a Delivery Buddy consultation. Delivery Buddy is Prisma Health Children’s Hospital’s telehealth technology in the Upstate that connects care teams at outlying hospitals with specialists in the Bryan Neonatal Intensive Care Unit (NICU) at Prisma Health Greenville Memorial Hospital.

Hannah Holbrooks holds Isaiah McGuffin shortly after his first birthday at their home in Westminster.

“They saved both of our lives that day, so I’ll forever be grateful.” – Hannah Holbrooks

One of the first orders of business for the NNP who took the consult was to call for a NICU transport team, as it was clear Isaiah would need the specialized care of the Bryan NICU. A major benefit of having Delivery Buddy is that it can shave as much as 30 minutes from the time it takes to get a NICU transport team on the road. “Rather than it being 20 minutes before the doctor arrives in the delivery room and another 15 minutes to assess the patient and then make the call to the neonatologist, maybe now it’s five or 10 minutes before they’re starting to send the transport team,” said Carley Howard Draddy, MD, medical director of Pediatric Telehealth and Special Projects.

In the meantime, Michael Stewart, MD, medical director of Neonatology at Children’s Hospital, and Melissa Dunham, NNP, coached the care team at Oconee through intubating Isaiah, administering positive-pressure ventilation and CPAP, and placing an umbilical catheter when nurses were not able to place an IV. “The biggest challenge that arose was establishing an airway for the baby,” Dunham said. “Isaiah required intubation, or the placement of a tube into the airway. That’s a difficult skill to coach, if you’re not there at the bedside and able to do that yourself.”

“Having Delivery Buddy available is leading to better outcomes for the Upstate’s tiniest babies born in outlying community hospitals.” – Michael Stewart, MD, medical director of Neonatology at Children’s Hospital

While all nursing staff at Prisma Health community hospitals are trained in neonatal resuscitation, these skills are not among those they have to rely on regularly. “These are things they can do – they’re just not used to it,” Dr. Stewart said. “They did a fantastic job. Frankly, we were just on the phone, and they were the ones actually intubating and putting in the IV catheter. It’s a teamwork approach, and that’s where we’re happy to help out if it can make a difference.” Isaiah McGuffin was transferred to the Bryan NICU within hours of his birth and stayed there 76 days. At the time of his discharge, he weighed 6 pounds, 11 ounces. “His course in the NICU was pretty routine for being born as prematurely as he was,” Stewart said. “He was able to get home before his original due date, which we always consider a success.”

Melissa Dunham, NNP, performs a demo using the Delivery Buddy telehealth technology that helped yield a positive outcome for baby Isaiah McGuffin.

Isaiah turned 1 in April 2019. His mother said he continues to battle chronic lung disease, but a concern about premature blood vessels in his eyes is no longer an issue, as the vessels have matured fully. “Other than that, he’s a healthy baby boy,” Holbrooks said. “He’s actually already 20 pounds, and my 3-year-old is only 27 pounds. So he’s catching up with her!” Stewart said having Delivery Buddy available is leading to better outcomes for the Upstate’s tiniest babies born in outlying community hospitals. “Seconds to minutes do make a difference in these little babies,” he said. “If we can try to at least share our expertise via telehealth technology until our transport teams can get there and we can transfer them to specialized NICUs, it definitely improves outcomes.” Isaiah’s mom has no doubt the expertise of all the doctors and nurses on her care team saved both her and her baby: “They saved both of our lives that day, so I’ll forever be grateful.”

A photo of Isaiah McGuffin during his time in the Bryan NICU.

C E L E B R AT I O N S

Prisma Health Children’s Hospital–Upstate has many reasons to celebrate! Waiting room honors local credit unions In February 2019, a naming ceremony was held at BI-LO Charities Children’s Cancer Center to honor the Carolinas Credit Union Foundation and the Upstate Credit Union Charitable Giving Committee for a $150,000 gift to renovate the outpatient waiting room so that it could be a warm, inviting place to visit before being treated at Prisma Health. Credit unions that participated in raising the funds included Carolina Foothills Federal Credit Union, Greenville Federal Credit Union, Greenville Health System Federal Credit Union, Greenville Heritage Federal Credit Union, MTC Federal Credit Union and Self-Help Federal Credit Union.

Cystic Fibrosis Center lauded The Cystic Fibrosis Center of Children’s Hospital was one of 12 programs nationwide to be honored by the Cystic Fibrosis Foundation with an Outstanding Partnership Award for its service to patients and their families. The center helps about 80 patients manage cystic fibrosis, providing them with help for nutrition issues, respiratory problems and more.

CPM receives diversity award The Center for Pediatric Medicine of Children’s Hospital was the winner in the Business category of the Upstate Diversity Leadership Award. Selection criteria recognized “a business that internally models diversity management and serves as a community diversity champion.” The award was presented by the Riley Institute at Furman University and the Greenville Chamber.

Gault earns Innovators Award Dominic Gault, MD, a physician with Pediatric Sleep Medicine at Prisma Health Children’s Hospital–Upstate, was one of two recipients of the inaugural Innovators Award at Prisma Health. The annual award recognizes those with out-of-the-box ideas that enhance clinical practice. Priority areas of focus include: • Reducing the amount of time providers spend documenting care and using computers. • Making registration, scheduling and check-in paperwork more efficient for providers and patients. • Improving the process for making referrals, requesting consults and communicating with other providers. Dr. Gault’s idea pertained to patients pre-populating their Epic questionnaires, saving staff from asking the same questions multiple times.

Dickerson named a FamilyCentered Caregiver Beth Dickerson, NP, of Clemson-Seneca Pediatrics, received a Family-Centered Caregiver Award in April 2019. These awards, sponsored by the Children’s Hospital Family Advisory Council, honor Prisma Health–Upstate providers who demonstrate exceptional family-centered care. Dickerson was recognized for easing the nerves of a young patient and helping her feel comfortable every time she came for a visit.

Safelite funds Buddy Boxes Upstate locations of Safelite, a windshield repair and replacement business, funded 85 Buddy Boxes – filled with age-specific toys, activities and comfort items – for patients at Children’s Hospital. Boxes contained items such as board books and blankets for babies, stacking toys and balls for toddlers, bubbles and coloring books for young children, and journals and crossword puzzles for teens.

Students at Lander University reveal the amount of funds raised during their Dance Marathon, held in March 2019.

Dance Marathons support Children’s Hospital Four area universities – Clemson, Furman, Lander and Western Carolina – pledged monies from their Dance Marathon fundraisers to Children’s Hospital–Upstate. Funds from the marathons totaled $325,766. Monies will be used for camp endowments, the Canine F.E.T.C.H. (Friends Encouraging Therapeutic Coping and Healing) Unit and facility renovations.

State Farm agents raise funds for Canine F.E.T.C.H. Unit Local State Farm agents awarded the funds from the Marla Rogers Sate Farm Golf Tournament, held in April, to Prisma Health Children’s Hospital–Upstate’s Canine F.E.T.C.H. (Friends Encouraging Therapeutic Coping and Healing) Unit. Agents presented a check in the amount of $7,185.48 that will help cover costs associated with annual immunizations, baths, treats and more for the unit’s four facility dogs.

C E L E B R AT I O N S

Safe Kids™ Upstate shares key outcomes In 2018, Safe Kids Upstate, a program of Children’s Hospital–Upstate’s Bradshaw Institute for Community Child Health & Advocacy, offered aid to the Upstate in a variety of ways. Here are three important outcomes: • Provided 318 safe sleep educational consults to Upstate families, with cribs given to families who did not have a safe place for their baby to sleep. • Distributed and fitted 1,625 bicycle helmets to young cyclists. • Worked with over 6,000 students and families to promote injury prevention in Greenville, Pickens and Oconee counties.

Bryan wins school health award Holly Bryan, PNP-BC, was selected as the 2019 recipient of the Dr. Janice Key School Health Visionary Award. The award honors an advocate of school-based health and is given annually to the individual who best embodies the School-Based Health Alliance’s core competencies: Access to health care and support services, studentfocused care, school integration, accountability, school wellness, systems coordination and sustainability. Bryan provides care to students at five area middle schools where Prisma Health Children’s Hospital–Upstate offers School-based Health Centers.

Resident and faculty awards The following doctors and caregivers were recognized at Pediatric Residency Program graduation ceremonies: Christopher Graves, MD: Pediatric Resident Teaching Award Kindal Dankovich, MD: Pediatric Resident Teaching Award, Miracle Maker Award (given by Pediatric faculty for extraordinary care, community service and furtherance of health education) Matthew Grisham, MD, and Catrinel Marinescu, MD: John P. Matthews Jr., MD, Outstanding Faculty Teaching Award (given by residents to a general pediatrician and to a subspecialist for superb teaching and enthusiasm for resident education) Matthew Grisham, MD: Paul V. Catalana, MD, Exemplary Character Award (given by the graduating class to a caregiver who exhibits the qualities of honesty, fairness, compassion, altruism and leadership by example) Pediatric Intensive Care Unit: 2019 Division of the Year Award (chosen by Pediatric residents) Michelle Sayles, MD: Margaret L. Wyatt, MD, Outstanding Grand Rounds Award Grace Williams, MD, and Alex Yu, MD: Pediatric Resident Journal Club Award Ryan Dean, MD: Medicine-Pediatrics Resident Achievement Award (chosen by Pediatric faculty for teaching and research skills and commitment to education) Jackie Razzaghy, MD: Inpatient Care Award (voted on by inpatient Pediatric faculty) and Jill D. Golden, MD, Primary Care Award (for outstanding care in the outpatient setting as voted on by ambulatory Pediatric faculty)

BULLETIN FROM THE BRADSHAW INSTITUTE This section highlights an area of focus for Bradshaw Institute for Community Child Health & Advocacy, part of Children’s Hospital–Upstate.

A look at the career of Linda Brees After 25 years of leading child advocacy efforts at Prisma Health, Linda Brees will retire August 2019. Throughout her years with the organization, Brees has worked tirelessly to improve the lives of Upstate children and create a community where families can thrive. Child advocacy work at what is now Prisma Health Children’s Hospital–Upstate began in 1994. Brees was the sole employee working in what was called the Department of Children’s Advocacy. She established initiatives to decrease unintentional injury, the leading cause of death among those under age 15 in Greenville County. She distributed bike helmets and smoke detectors, and she worked with local car dealerships to hold regular infant safety seat inspections. Over two decades, Brees grew child advocacy efforts from a department of one to a team of over 30 people, all working to create optimal health for children and families. Her injury prevention efforts led to the creation of Safe Kids™ Upstate, an affiliate of Safe Kids Worldwide, in 1994. The coalition expanded to encompass not just Greenville but also Oconee and Pickens counties. In 2002, Safe Kids Upstate was named the National Safe Kids Coalition of the Year by Safe Kids Worldwide. Brees went on to form a School Health division within Children’s Advocacy in 2012. A third service line, Healthy Child Development, also began operating out of Children’s Advocacy that year. This division is home to Help Me Grow South Carolina, which connects families to developmental and behavioral services. In 2014, Brees was instrumental in establishing a Child Abuse Prevention

team, followed by the Community Pediatrics team in 2015. Community Pediatrics is the home of quality improvement projects within pediatric practices and the School-based Health Centers – a partnership with the United Way of Greenville County’s OnTrack Initiative. Her leadership and vision, along with the addition of Kerry Sease, MD, MPH, as medical director and the Bradshaw family’s generous gift, led to the creation of the Bradshaw Institute for Community Child Health & Advocacy in 2016. The institute now offers internships for college and medical students, conducts research and evaluation projects, and provides educational opportunities and workforce development strategies. As director of this institute, Brees has been responsible for community outreach, partnership development, government relations and program oversight. She has received many honors for her work on behalf of children and the community. A few of her statewide awards are the Order of the Jessamine for Community Leadership, Chamber of Commerce Vanguard Award for Children’s Advocacy, Order of the Palmetto, Child Advocate of the Year Award from the SC Chapter of the American Academy of Pediatrics and Lifetime Achievement Award for Children’s Advocacy from Children’s Trust of South Carolina. An active volunteer, she has served on numerous boards such as Safe Kids Worldwide, National Coalition for Campus Children’s Centers, Greenville First Steps and Institute for Child Success, where she was the inaugural chair. Brees continues to partner with the Institute for Child Success, working at both the state and national levels to fight for policy changes that have the potential to improve the lives of children and families. The future of the Bradshaw Institute is bright, having been supported for so many years by her hard work and leadership. Brees’ legacy is one of a caring leader who dedicated her life to the betterment of her community.

A S K T H E F A C U LT Y

Vaping Q: What advice should I offer to teens and their parents about vaping? A: There has been a rapid rise in the number of middle and high school students who “vape.” In 2018, 1 in 4 high school seniors and 1 in 10 eighth graders reported vaping nicotine or flavoring in the past month. After all our progress in decreasing use of traditional cigarettes, electronic cigarettes, or “e-cigs,” are putting a new generation at risk for nicotine dependence. What are e-cigs, e-hookahs, mod/pod systems, vape pens and JUULs? These devices contain a heating element, cartridge and “e-juice.” Many devices look similar to a sleek USB flash drive, highlighter, asthma inhaler or pen. This makes them easy to conceal and share with friends. Youth can take a puff in the bathroom, on the bus or even in the classroom.

The major constituents of e-juice are humectants, nicotine and youth-appealing flavors such as candy or fruit. Carcinogens, particulate matter and even tiny bits of metal also have been found in the aerosol. Youth can tinker with their device, adding CBD oil, marijuana, and other novel flavors and ingredients. JUUL is an immensely popular brand that comes in flavors such as mango and mint. One JUUL pod contains the same amount of nicotine as a pack of cigarettes, making it highly addictive. JUUL contains nicotine salts, which allow higher concentrations of nicotine and are less irritating to inhale. Youth have many misperceptions about vaping. Many think they are only inhaling harmless, fun flavors and water vapor, when in fact they are inhaling nicotine and other active chemicals. Nicotine is nearly ubiquitous in vaping products, including some that claim to not contain it. Nicotine is a highly addictive chemical, particularly so for the developing adolescent brain. It can cause behavior changes, sleep pattern changes and irritability in teens. Teens who vape are four times more likely to later smoke regular cigarettes. Vaping also is not recommended as a method for teens to quit traditional cigarettes. The flavorings – aromatic aldehydes – have not been tested for safety for inhalation. They have been found in the lab to negatively affect immune cell function and mucociliary function. Long-term health effects on users and bystanders remain unknown. Children and teens are exposed to e-cigarette advertising online, in social media, in magazines and on billboards. Many buy into the “cool” factor as they try to fit in with social groups. Products can also be ordered online.

Be proactive Pediatricians are encouraged to screen adolescents for vaping as well as for traditional cigarette and chewing tobacco use. Privacy and confidentiality are paramount. For teens who are using, listen for and support their “change talk” about quitting or cutting back, and use your motivational interviewing skills.

Pediatric specialty services

In the absence of evidence-based studies on how to help teens successfully quit e-cigs, we still need to offer thoughtful therapeutic suggestions and resources. Adolescents who are heavy users or having difficulty quitting may need addiction treatment. For both parents and pediatricians, seek to first understand what the adolescent knows or thinks about vaping. Be nonjudgmental and curious. Avoid saying, “you should”; instead, try saying, “I’m a concerned adult and would like to explore what may happen if you continue JUULing.”

Facts are powerful, and teens need access to truthful information. Do not twist the facts, though. Appeal to and support the adolescent’s own sense of self-worth as he or she makes health decisions. Advice to share with parents includes talking preventively to children about vaping and its dangers. Parents should not assume that their child would not try vaping or that they would know if their child were doing it. Finding unfamiliar USB drives or battery chargers may be a clue to use, as is a sweet or fruity aerosol smell. If parents smoke or vape, they should consider quitting and not use these products indoors or around their child.

Resources for teens and youth: • TruthInitiative.org • TheTruth.com (videos and text helpline) • TruthOrange (Instagram)

Resources for parents: • HealthyChildren.org • ParentsAgainstVaping.org • JustSaySomethingSC.org

Resources for pediatricians: • AAP Richmond Center Vaping Toolkit

Robin N. LaCroix, MD_________________________________ 864-455-8401 Medical Director; Chair, Department of Pediatrics Matthew P. Grisham, MD__________________________________ 455-7895 Pediatric Residency Program Director Russ C. Kolarik, MD______________________________________ 455-7844 Medicine-Pediatrics Residency Program Director Karen L. Ratliff-Schaub, MD________________________________ 454-5115 Developmental-Behavioral Fellowship Program Director Adolescent Medicine_____________________________________ 220-7270 Allergy and Immunology__________________________________ 675-5000 Ambulatory Pediatrics ____________________________________ 220-7270 Cardiology _____________________________________________ 454-5120 Child Abuse Pediatrics____________________________________ 335-5288 Child Psychiatry & Psychotherapy___________________________ 455-5612 Critical Care____________________________________________ 455-7146 Developmental Pediatrics__________________________________ 454-5115 Emergency Pediatrics_____________________________________ 455-6016 Endocrinology__________________________________________ 454-5100 Gastroenterology________________________________________ 454-5125 Genetics_______________________________________________ 250-7944 Hematology/Oncology___________________________________ 455-8898 Infectious Disease_______________________________________ 454-5130 Minor Care (Spartanburg Night Clinic)________________________ 804-6998 Children’s Hospital After-Hours Care_______________________ 271-3681 Neonatology___________________________________________ 455-7939 Nephrology & Hypertension________________________________ 454-5105 Neurology_____________________________________________ 454-5110 Neurosurgery___________________________________________ 797-7440 Newborn Services_______________________________________ 455-8401 Ophthalmology_________________________________________ 454-5540 Orthopedic Oncology____________________________________ 797-7060 Orthopedic Surgery______________________________________ 797-7060 Pain Medicine___________________________________________ 675-3488 Plastic Surgery__________________________________________ 454-4570 Pulmonology___________________________________________ 454-5530 Radiology______________________________________________ 455-7107 Rheumatology__________________________________________ 454-5004 Sleep Medicine__________________________________________ 454-5660 Supportive Care Team____________________________________ 455-5129 Surgery________________________________________________ 797-7400 Urgent Care (Anderson)___________________________________ 512-6544 Urology_______________________________________________ 454-5135

Children’s Hospital programs BI-LO Charities Children’s Cancer Center______________________ 455-8898 Bradshaw Institute for Community Child Health & Advocacy_______ 454-1100 Bryan Neonatal Intensive Care Unit__________________________ 455-7939 Child Life______________________________________________ 455-7846 Comprehensive Sickle Cell Desease Program___________________ 455-5680 Cystic Fibrosis Clinic______________________________________ 454-5530 Family Connection_______________________________________ 331-1340 Ferlauto Center for Complex Pediatric Care____________________ 220-8907 Gardner Center for Developing Minds________________________ 454-5115 Infant Apnea Program____________________________________ 455-3913 International Adoptee Clinic________________________________ 454-5130 Kidnetics® (pediatric therapies)______________________________ 331-1350 Neonatal Developmental Follow-up Services___________________ 331-1333 New Impact (weight management)__________________________ 522-2100 Office of Philanthropy/CMN________________________________ 797-7735 Pediatric HIV Clinic_______________________________________ 454-5130 Safe Kids™ Upstate_______________________________________ 454-1100 Spiritual Care & Education_________________________________ 455-7942 Wonder Center__________________________________________ 331-1380 Day treatment for medically fragile children

For admission to Children’s Hospital: (864) 455-0000 This number connects you to Prisma Health–Upstate’s Patient Referral and Transfer Center, which can handle all arrangements for admission. You also may call 455-7000 and ask the operator to page the admitting resident. Neonatal Transport: 864-455-7165

Article author Lochrane Grant, MD, is a pediatrician with Prisma Health Children’s Hospital–Upstate’s Center for Pediatric Medicine.

To reach a Children’s Hospital doctor or program, call 1-800-4RBUDDY.

Pediatric Outpatient Service Locations Call the appropriate Greenville number above for an appointment. Anderson Cardiology Child Abuse Pediatrics Endocrinology Hematology/Oncology Nephrology & Hypertension Orthopedic Surgery Urology Greenwood Cardiology Child Abuse Pediatrics Orthopedic Surgery Surgery

Spartanburg Neurosurgery 864-573-8732 Pulmonology Child Abuse Pediatrics Sleep Medicine Cardiology Surgery Endocrinology Urology Gastroenterology Hematology/Oncology Kidnetics® Nephrology & Hypertension Neurology

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For information about Children’s Hospital giving opportunities, call Prisma Health–Upstate’s Office of Philanthropy at 864-797-7732 or visit ghsgiving.org.

Dr. Schmidt retires William F. Schmidt III, MD, PhD, retired in January 2019. Dr. Schmidt was recruited to Greenville in 1990 as medical director of what is now Prisma Health Children’s Hospital–Upstate. The pediatric cancer specialist grew the program from a few general pediatric practices to a pediatric academic center of excellence that provides primary and specialty care for nearly 500,000 children each year. Before his retirement, he also served as VP of Development for the organization’s Health Sciences Center and as physician leader for the Office of Philanthropy. Schmidt was honored at a retirement celebration in January. Those wishing to help ensure his legacy at Children’s Hospital–Upstate are encouraged to donate to the Children’s Hospital Seed Fund for Advanced Pediatrics, which he and his wife created with a $1 million donation in 2014. The goal of the fund is to seed “big-leap-forward” innovations in pediatrics. To make a gift to the Seed Fund, text SCHMIDT to 41444 or visit PrismaHealth.org/SeedFund.

Schmidt speaks to friends and colleagues at the celebration honoring his nearly 30 years of service with Children’s Hospital.

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