fall 2011/winter 2012
Pediatric
A Fun & Fact-Filled Newsletter from the University of Maryland Children’s Hospital
Beyond Diabetes: Endocrine
Disorders in Children
When it comes to endocrine disorders – problems affecting the body’s hormones and glands – diabetes gets the lion’s share of attention. Yet a variety of other conditions can affect the body’s hormone production, and many of these affect children.
HEY KIDS! find? How many can you See how many hidden logos you can find in s! each Pediatric Pres
The Endocrine System
Hormones are the body’s chemical messengers, helping to regulate mood, metabolism, growth and development, as well as sexual and reproductive processes. The glands that produce hormones are major players in nearly all of the body’s functions. For example, the pituitary gland produces growth hormone, endorphins that help lessen feelings of pain, and a hormone that helps keep the body’s water balance in check. The pituitary gland in turn is controlled by the hypothalamus gland, which links the endocrine and nervous systems. Another endocrine gland, the thyroid, secretes hormones that determine the speed at which food is turned into fuel for the body. The adrenal glands influence metabolism, the immune system, sexual function and how the body responds to stress. When the endocrine system becomes unbalanced, producing too much or too little of a hormone, the results can be harmful. But pediatric endocrinologists at the University of Maryland Children’s Hospital, like Parissa Salemi, D.O., can help. “The endocrine system functions similarly in children and adults, yet each stage of life is unique,” explains Dr. Salemi. ... continued on page 7
www.umm.edu/pediatrics 1.800.492.5538
Dear
Families,
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Steven J. Czinn, M.D. Chief of Pediatrics, University of Maryland Children’s Hospital; Professor and Chairman, Department of Pediatrics, University of Maryland School of Medicine
Seven-year old Brasen VonMoose-Lemin has been a patient at the University of Maryland Children’s Hospital since 2008 when he was diagnosed with acute lymphoblastic leukemia. Brasen’s illness does not limit his passion, creativity or selflessness. He decided to show off his entrepreneurial skills and hold a lemonade stand to raise money for “his” hospital. What was supposed to have been a simple lemonade fundraiser turned into a much larger event – a small fair at a school with games and raffle prizes donated by local businesses. This one-day event raised more than $1,800 – a major feat for anyone, let alone a 7-year-old. Brasen’s long-term goal is to raise enough money to cure cancer. In the meantime, his fundraising will support toys and gifts for children, a very important component of UMCH’s pediatric cancer program. Thank you Brasen for raising funds for us! Also, thank you for helping inform the community about the great work our physicians, nurses and staff provide. Every day, we care for Maryland’s children and families. If you need us, we are here for you. In good health, Steven J. Czinn, M.D.
BRAIN FACT
Start
Did you know … that your brain is really made up of three main parts? The forebrain, midbrain and hindbrain. When fully grown, your brain will weigh about 3 lbs. (1.5 kg).
Your Amazing Brain! Your brain is one of your body’s most powerful tools! Not only does it help you learn things at school, but it also helps you to feel, think and move. In fact, think of it as your body’s control room. It tells the rest of your body what to do and when to do it. You can use your brain to find your way through this maze by starting at the top and coming out at the finish line!
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Children should be properly restrained on every ride – all the time.
Are You Riding in
the Safety Zone?
It is true that the death rate from motor vehicle crashes has decreased in the past decade, but it remains the leading cause of death for children over age 4. Are your small passengers riding safely? Here are the basics you need to know, according to Safe Kids Baltimore:
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Children should be properly restrained on every ride – all the time.
All infants and toddlers should ride in a rear-facing car safety seat until they are 2 years old or until they reach the highest rear-facing weight or height limits of the safety seat manufacturer. This is what the American Academy of Pediatrics recommends as well.
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All children who are 2 years or older, or those who have outgrown the height or weight limits of the rear-facing convertible seat, should then use a forward-facing child safety seat with a harness for as long as possible.
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All children whose height or weight is above the forward-facing (with harness) limits of the seat should use a belt positioning booster with the lap/ shoulder belt.
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Children should remain in the booster seat until the lap/shoulder belt alone fits properly – usually not until they have reached 4’9” and are between 8 and 12 years old. A lap/shoulder belt should then be used at all times for optimal protection.
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All children under 13 should ride in the back seat.
Safety Tips
Don’t be so quick to move from one stage to another. Riding rear-facing in a safety seat is the best level of protection. Many parents worry that their child will be uncomfortable or his or her legs will be hurt riding rear-facing beyond the first year – but there is no evidence to support this.
When purchasing your next level child safety seat, take the time to shop well. Take your child with you to the store to test seats – shop for one that will give your child adequate time to grow to the height and weight limits. Some stores will even let you test the seat in your vehicle to see if it can be safely installed, especially if you also have seats for other children in the vehicle. Always follow the manufacturer’s instructions for use and installation. Keep in mind too that seats have expiration dates. If you are unsure if your child is in the correct type of seat or if it is safely installed, attend a local safety seat check to have it checked by a certified Child Passenger Safety technician. If you would like more information, please contact Safe Kids Baltimore at 410.328.7532 or safekidsbaltimore@umm.edu.
www.umm.edu/pediatrics 1.800.492.5538 3
New Division Head of Pediatric Hematology/ Oncology to Build Program for Cancer Survivors Patricia Shearer, M.D., has a passion for helping survivors of childhood and adolescent cancers manage the lasting or late effects of treatment into adulthood. As the new Division Head of Pediatric Hematology/Oncology at the University of Maryland Children’s Hospital and a Professor of Pediatrics within the University of Maryland School of Medicine, she plans to establish a Cancer Survivor Program to serve patients in our hospital and community, as well as Maryland residents and patients who may travel from across the nation to participate in this specialized program. Modeled after the one at the University of Florida that Dr. Shearer started in 2008, the Cancer Survivor Program at the University of Maryland will be designed to: • Help survivors and their families understand the late effects of treatment, including surgery, radiation and chemotherapy. • Help survivors monitor and manage current health and/or developmental issues. • Take a proactive approach to anticipate problems that may occur in the future.
Following Patients into Adulthood
Survivors of pediatric cancers of any age may enter the Cancer Survivor Program when they are off therapy for two years and are tumor-free. Survivors are given an individualized Treatment Summary to help them anticipate long-term or late effects of therapy based on their own chemotherapy, radiation and/or surgeries. “Late effects are complications that occur or persist five years after the end of treatment, and extend for the life of the patient,” Dr. Shearer explains. “The cure rate for childhood cancers is now close to 80%, so we expect that most patients will become long-term survivors. However, the disease and/or its treatment may put as many as two-thirds of survivors at risk for other complications that they need to know about.” The Cancer Survivor Program addresses the whole person – not just the medical issues – and covers all aspects of cancer survivorship in the daily life of the patient. Some examples of late effects include problems with growth or development, problems with vital organ function such as heart or kidney damage, hormonal issues such as infertility or hypothyroidism, and secondary cancers. “We give specific information to each survivor about how often to have tests such as hearing evaluations, echocardiograms, pulmonary function tests and mammograms. We discuss options for fertility and provide referrals to other specialties,” Dr. Shearer says. Other issues that may be addressed include anxiety, pain, depression, fatigue, problems with mobility, problems with insurability and school problems. “Many survivors report academic challenges, including having difficulty with memory,
Introducing Dr. Patricia Shearer Patricia Shearer, M.D., M.S, Professor of Pediatrics and Division Head of Pediatric Hematology/Oncology, has been working in the field of childhood and adolescent cancers for more than 25 years. She joined the staff at University of Maryland in July. Most recently Dr. Shearer was on the faculty at the University of Florida, Gainesville, where she was founding director of a program for survivors of childhood and adolescent cancers in the Department of Pediatrics in the College of Medicine. This serves as the model for the program Dr. Shearer is establishing at the
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University of Maryland. She also served as a Vice-Chair on the Institutional Review Board.
Research to Improve Lives
Dr. Shearer earned a Master’s degree in Audiology from Tulane University in New Orleans and graduated from Louisiana State University School of Medicine in 1986. She did her pediatric residency at Johns Hopkins and a fellowship at St. Jude Children’s Research Hospital in Memphis. Dr. Shearer’s research focuses on young adult survivors, particularly quality of life issues and access to care. She
0123456789 concentration or processing. We can take that information and communicate with the teachers, school board or even colleges to facilitate an ideal educational experience for our cancer survivors,” Dr. Shearer says. “Even though I am a pediatric oncologist, in my survivor programs I’ve had patients who were in their 30s and 40s,” Dr. Shearer continues. She recommends that survivors of childhood and adolescent cancers be followed for life so they can benefit from new research and have access to the right care at the right time.
A Network of Caring
Another advantage of the program is that it empowers local providers in the community so they know what to look for and what to do when caring for these patients. “We make sure every survivor of any age has appropriate downstream care. This may be with a primary care provider or oncologist at the University of Maryland, with a pediatrician, internist, family practitioner or nurse practitioner in the Baltimore community, or similar care in the larger community,” Dr. Shearer says. “If providers know what to look for as a result of childhood cancer therapy, we can help patients stay well and help providers in the community take care of them.” There are similar programs around the country, but the Cancer Survivor Program Dr. Shearer is developing in Baltimore is unique in its focus on childhood cancer survivors of any age. “In addition, our medical center is ideally poised to offer this because we are an academic medical center that emphasizes clinical care, education and research,” Dr. Shearer states. For more information about pediatric oncology at the University of Maryland Children’s Hospital, visit umm.edu/pediatrics or call 410.328.2808.
has been published extensively on a variety of pediatric solid tumors and their late effects, notably Wilms tumor, as well as thyroid carcinoma, sarcomas and acute myeloid leukemia. Dr. Shearer was the first member of the National Wilms Tumor Study Group from St. Jude Children’s Research Hospital, and she was appointed as Co-Chair of the Auditory Hearing Late Effects Task Force in Children’s Oncology Group because of her background in audiology. She has recently been appointed to the Pediatric Sub-Committee of the Oncology Drug Advisory Committee of the Food and Drug Administration.
Vision for Teaching
Dr. Shearer has worked in various sites around the world to develop expertise in cancer therapy in countries with limited
A Team of Specialists The physicians in Pediatric Hematology/Oncology have a wide range of expertise to meet the needs of pediatric patients with blood disorders and cancer. Lucille Ferrante, M.D., specializes in pediatric bleeding disorders and coagulation disorders. Suzie Noronha, M.D., specializes in sickle cell disease. Patricia Shearer, M.D., M.S., specializes in pediatric solid tumors and cancer survivorship. Teresa York, M.D., specializes in childhood leukemia.
Offering Care in the Community University of Maryland Children’s Hospital hematology/ oncology services will be available soon in Harford County on the campus of Upper Chesapeake Medical Center. University Pediatric Specialists in sub-specialty areas such as asthma, allergy, cardiology, endocrinology, gastroenterology, neurology, ENT and surgery are already seeing patients in this new office. Appointments can be made at the Bel Air location by calling 410.879.7730.
resources. She has served as the Co-Director of the China Program of the International Outreach Program at St. Jude Children’s Research Hospital and coordinator of telemedicine conferences between St. Jude and the Intituto Maternal Infantil de Pernambuco in Recife, Brazil. In 2009, she was an invited lecturer at Hong Kong University on late effects of cancer therapy in young adult survivors. As the recipient of seven Teacher of the Year awards, Dr. Shearer enjoys the opportunity to share her experience with medical students and residents. Due to the emerging population of cancer survivors into the global health care delivery system, she believes that it is critical to train our physicians of the future to anticipate what happens with this inspiring group of patients.
www.umm.edu/pediatrics 1.800.492.5538 5
Who Loves to
COLOR? If you do, enter our coloring contest and a chance to win a $20 Target® gift card by coloring this Jack O’Lantern critter. You can submit a scan of your completed artwork to coloringcontest@umm.edu or mail your picture to:
Coloring Contest, C/O Marketing
University of Maryland Children’s Hospital 110 S. Paca Street, 8th Floor Baltimore, MD 21201 You can also find more blank copies of this coloring page at umm.edu/coloringcontest. Deadline for entry is Nov. 15, 2011. Winners will be awarded in two age groups: 1 to 8 years, and 9 to 16 years. The winners will be notified by mail.
Entry Form Please enter my picture in your fall coloring contest. Name ______________________________________ Address ____________________________________ City/State/ZIP _______________________________ Age category (check one): 1 to 8 years
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9 to 16 years
0123456789 Common Endocrine Disorders and Their Symptoms HYPERTHYROIDISM
When the body produces too much thyroid hormone.
Beyond Diabetes: Endocrine
Disorders in Children ... continued from page 1
“In newborns, there are several endocrine diseases that may vary greatly in severity. For instance, congenital adrenal hyperplasia can be life-threatening if not identified quickly. Others, such as congenital hypothyroidism, can compromise cognitive abilities if left untreated. The lack of proper diagnosis and therefore treatment can have profound effects on these babies. That’s why these diseases are included as part of the Maryland newborn screening test. Once a baby is identified with a positive screen result, the pediatric endocrinologists are immediately involved in addressing such problems.”
The Effect of Puberty
For teenagers, puberty brings a natural change in hormone levels, which can necessitate changes in the treatment of existing endocrine disorders. “The body’s needs change with the hormonal changes of the body,” adds Dr. Salemi, an assistant professor of pediatrics at the University of Maryland School of Medicine. “With this in mind, we need to look at each patient individually. For instance, we may adjust insulin doses in a diabetic patient or the amount of growth hormone supplementation a patient may be receiving. Puberty certainly has an effect on the endocrine systems of the body, so it’s important to follow patients closely in order to provide optimal care.” The onset of puberty can also signal new endocrine problems. “A delay in the onset of puberty can be concerning. For instance, this could be due to an undiagnosed genetic condition. Or frequently it may be simply because a patient is a ‘late bloomer.’ We work to differentiate between the two,” Dr. Salemi explains. “In terms of treating these youngsters, if needed, we can provide hormonal supplementation to jumpstart puberty. We can also offer the reassurance that everything is normal. Early puberty
Symptoms: • Enlargement of neck area (called a goiter) • Unexplained weight loss • Trouble sleeping • Heart palpitations • Heat intolerance • Diarrhea
HYPOTHYROIDISM
When the body produces insufficient thyroid hormone. Symptoms: • Excessive sleepiness • Weight gain • Cold intolerance • Constipation • Dry skin
GROWTH HORMONE PROBLEMS
When the body produces too much or insufficient growth hormone. Symptoms: • Very tall (gigantism) or very short for one’s age • Hypoglycemia (low blood sugar)
ADRENAL INSUFFICIENCY
When the adrenal gland does not produce adequate amounts of adrenal corticosteroid hormones. Symptoms: • Weakness • Fatigue • Abdominal pain • Nausea • Dehydration • Skin changes
... continued on page 8
www.umm.edu/pediatrics 1.800.492.5538 7
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22 South Greene St. Baltimore, MD 21201
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How many did you find?
We found 8
This publication does not constitute professional medical advice. Although it is intended to be accurate, neither the publisher nor any other party assumes liability for loss or damage due to reliance on this material. If you have a medical question, consult your medical professional. Images may be from one or more of these sources: ©Thinkstock, ©Fotolia, ©iStock. ©2011 University of Maryland Children’s Hospital. Our mailing list is generated through a national mail service; no patient files are used. If you do not wish to receive Pediatric Press, please pass it on or recycle it.
For more information about the newsletter, please e-mail abessent@umm.edu. To learn more about the Children’s Hospital, please log on to umm.edu/pediatrics or call 1.800.492.5538. Pediatric Press is an information service of the University of Maryland Children’s Hospital and published by the University of Maryland Medical Center.
Beyond Diabetes: Endocrine ... continued from page 7
also warrants evaluation. This rare condition may have a serious underlying cause, such as a hormone-producing tumor or early activation of the brain’s chemicals that signal puberty. But quite often the body’s biological clock may just be starting a little early. Early puberty can have a serious impact on height and other issues, so this concern needs to be carefully evaluated.”
What Can Be Done
Many endocrine disorders can be treated effectively using medications that regulate or replace specific hormones. Other conditions may respond to simple lifestyle changes. In nearly all cases, instilling healthy habits in children can help them manage an endocrine disorder well into adulthood.
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“We encourage lifestyle modification in many of our patients. This includes a healthy diet, increased physical activity and limiting screen time (exposure to TV, video games and computers). Focusing on these can help treat and even prevent certain endocrine disorders that may be caused by obesity, such
Steven J. Czinn, M.D.
Professor and Chairman, Department of Pediatrics
Alison G. Brown, MPH
Mary Taylor, MS, RN Director of Nursing, Women’s & Children’s Services
Senior Vice President, Planning, Marketing & Business Development
Disorders in Children as type 2 diabetes, hypercholesterolemia and polycystic ovary syndrome (an imbalance of a female’s sex hormones that can lead to irregular periods, excess body hair and acne),” Dr. Salemi says. “The habits we instill upon our pediatric patients now help form healthy habits in the future. For example, a youngster with poorly controlled diabetes may not fully understand the serious consequences of poor care until they are older. As adults, they may suffer from diabetic retinopathy that can lead to blindness, or neuropathy and vascular disease that may lead to amputation. We are here to provide as much support and follow-up care as is needed to prevent these tragic outcomes.” Many endocrine disorders are genetic or autoimmune diseases, and there is no known way to prevent them. But nearly all are treatable. See the box on page 7 for symptoms that signal some common endocrine problems, and be sure to contact your pediatrician if you have any concerns about your child’s health. To learn more about endocrinology services at the University of Maryland Children’s Hospital, visit umm.edu/pediatrics or call 1.800.492.5538.