fall 2012/winter 2013
Pediatric
A Fun & Fact-Filled Newsletter from the University of Maryland Children’s Hospital
Pediatric epilepsy program
Helps patients and their families Pop quiz: What’s an epileptologist? Besides being a word that’s fun to say (try it!), it’s a neurologist who specializes in treating epilepsy. The University of Maryland Children’s Hospital is pleased to have two pediatric epileptologists: Kathleen Currey, MD, founder of the pediatric epilepsy program, and Alpa Vashist, MD.
HEY KIDS! find? How many can you See how many hidden logos you can find in s! each Pediatric Pres
“There’s more demand for pediatric epilepsy programs than there is availability, so the University of Maryland Children’s Hospital started a program in October 2010,” says Dr. Currey, an assistant professor of pediatrics at the University of Maryland School of Medicine. More than 300,000 American children under age 15 are affected by epilepsy.* “The number of children with epilepsy isn’t increasing, but the medical community is doing a better job of identifying and treating kids with epilepsy or seizure disorders than in days past,” she adds. Epilepsy is a brain disorder that causes people to have recurring seizures. The seizures happen when clusters of nerve cells in the brain send out the wrong electrical signals. Epilepsy affects people of all ages, from newborn to elderly, and has many possible causes, including illness, brain injury and abnormal brain development. In many cases, the cause is unknown. ... continued on page 6
www.umm.edu/pediatrics 1.800.492.5538
Dear families, of Maryland’s own Alessio Fasano, MD, is helping Celiac disease was once considered rare, but University rics at the University of Maryland School of Medicine, change that perception. Dr. Fasano, a professor of pediat icans, 1 out of every 133 people has celiac disease, has completed research that found among healthy Amer including 10-year-old Alexis Carlin. protein gluten, which is found in wheat, barley and other Celiac disease is a digestive disorder that is triggered by the for example, the gluten in that food would set off an autoim grains. If patients like Alexis were to take a bite of cupcake, of tion absorp proper the ts intestinal symptoms and preven mune reaction in the intestines that causes a variety of gastro serious that Alexis was actually transferred from a New So s. uence conseq food and nutrients, leading to serious health tal where she was an inpatient for two weeks. Jersey hospital to the University of Maryland Children’s Hospi e her serious pain and her comAlexis is an inspirational patient. She is a fighter and despit she wanted was to be well all that promised health, she told physicians, nurses and staff se of her accomplishments, Becau that! enough to dance on a stage. She eventually did just at the Children’s Hospital. staff Life she was awarded the Hero of the Month by the Child
Alexis Ca rlin
around her neck was great! Alexis’ mom said that the moment the medal was placed and she was just so proud of “Alexis was just smiling. She had been through so much r,” says Elissa Carlin. herself and so proud that she had been recognized as a fighte
en’s Hospital is all about. This story illustrates what the University of Maryland Childr hours from their home to get Alexis needed specialized care and her family traveled 3½ of the great care given. They the expertise their daughter needed. The family is in awe team, who helped make the are especially grateful for Dr. Fasano and the Child Life inpatient experience as normal as possible for Alexis. children and families of We are on a mission to deliver great sub-specialty care to the mission to make sure a on is staff Our . Maryland and the region – like New Jersey received here. they care te ssiona patients and families remember the compa Wishing you good health, Steven J. Czinn, MD
Steven J. Czinn, MD Chief of Pediatrics, University of Maryland Children’s Hospital; Professor and Chairman, Department of Pediatrics, University of Maryland School of Medicine
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fall / winter
Find out more about celiac disease from the UM Center for Celiac Research at celiaccenter.org.
Valuable information is just a click away at umm.edu/pediatrics! Or by phone at 1.800.492.5538.
0123456789 Escape the
dangers of fire
Teach your children how to act in the event of a fire – it could mean the difference between life and death. Download a fire activity sheet at umm.edu/firesafety.
Most families think a fire won’t ever happen in their home. But what if the unthinkable happened? Would you know what to do? Would your children know how to react? While many assume children would call for help or get out, the fact is many kids hide under beds or in closets, which contributes to why more than 400 children die in the United States each year in residential fires. Teach your children how to act in the event of a fire – it could mean the difference between life and death. Safe Kids Baltimore, housed at the University of Maryland Children’s Hospital, recommends the following:
Teach your– Have chilSmoke alarms a working smoketo act in dren how alarm on each level of the event the home, whichof cutsa fire in the risk ofmean dying the – half it could in a home fire. Test your difference alarms monthly and install between 10-year lithium batteries (or change batlife and death teries annually). Make sure your children know what the smoke alarm sounds like.
Escape plan – Many families have an escape plan but less than half actually practice this plan with their children. An escape plan needs two ways out of each room and out of the house. Practice home fire drills! Sound the smoke alarm and time how quickly it takes your family to get out of the house. A fire can double in size every minute. You want to get out as quickly as possible. The plan should also have a designated family meeting place. This needs to be away from your home. Everyone should go there and wait for all family members. Call 911 when outside – never make the call from inside the burning home.
Get outside – Children are often scared by smoke and the smell of fire. Teach them to leave immediately if you hear the smoke alarm, smell smoke or see flames. Stay low and crawl on the floor below the level of the smoke. Feel the doors of rooms with the back of the hand before opening. If they are hot, go out another way. If you are trapped in a room, hang a piece of clothing or bedding out the window – this alerts firefighters that there is someone in this room who needs help.
Get out and stay out – No one should ever enter a burning building for any reason. If someone has not reached the meeting place, alert firefighters. Firefighters are dressed and equipped to rescue any family members from a fire. You are not – so do not go back inside.
www.umm.edu/pediatrics 1.800.492.5538 3
Pediatric critical care medicine
A day in the life of the PICU A child’s illness or injury can be overwhelming and stressful for families – especially when it involves critical care. Yet the treatment plan and road to recovery needn’t be. The University of Maryland Children’s Hospital offers outstanding critical care for the youngest patients within a warm, caring environment. Nan A. Garber, MD, is assistant professor of pediatrics at University of Maryland School of Medicine and one of seven attending pediatric intensivists specializing in round-the-clock care of critically ill patients. Dr. Garber says the underlying mission of the pediatric intensive care unit (PICU) is to provide expert critical care to Maryland’s children. “Our goal is to be the place families in our state can come to and trust every step of the way.” providing multi-disciplinary care
“Other than starting each day with patient care rounds, there is no typical day in the PICU,” says Dr. Garber. “Just as each pediatric patient is unique, so is the multi-disciplinary care and treatment plan arrived at for each patient. We see everything from cardiac failure, respiratory failure, severe infections and neurological emergencies to managing patients after surgery.” Care is delivered by an expert team of attending physicians, highly trained nurses, respiratory specialists, physical and occupational therapy managers, nutritionists, case managers, social workers, pediatric nurse practitioners, pastoral care professionals and support staff. Specific medical subspecialists are called in as needed to complement the team. In addition, child life specialists are involved in all aspects of each patient’s care plan, including helping siblings adjust. State-of-the-art diagnostics and treatments within the PICU focus on: • The age and size of the patient. • Individualized care plans based on patient requirements. • Pain management.
The team in the PICU, inc luding Dr. Nan Garber, is always focused on the patients. • Continuous monitoring and evaluation throughout the day. • Including the family as an integral part of their child’s care team. “We value parents at the bedside and in provider/parent team meetings,” says Dr. Garber. “We listen to families’ concerns and answer questions as they arise. Parents are allowed to remain with their child around the clock, seven days a week, which often helps to calm anxieties and provide reassurance to little ones.” Translation services are also available to aid in communication needs. welcome to the pediatric unit
The 24-bed PICU is designed to be warm and inviting. It features: • A secured unit that keeps children safe. • Special art by pediatric patients that lines the rotunda and hallways. • A kid-friendly environment with fun activities, including reading, movies and video games. • Pet therapy for patients who are well enough. Dr. Garber is also medical director of Maryland ExpressCare for Kids. “This pediatric specialty transport team is available 24/7 to transport critically ill children by air or ground ambulance from area community hospitals to a higher level of care, such as our PICU,” says Dr. Garber. “It provides a valuable service to allow us to more effectively treat Maryland’s children.” To learn more about pediatric critical care services at the University of Maryland Children’s Hospital, visit umm.edu/pediatrics or call 1.800.492.5538.
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0123456789 Incorporate MyPlate to your
plate
Most of us grew up with the food pyramid as a point of reference for what to eat in a given day. Times have changed. Now we have another geometrical shape to teach us what to eat! The USDA unveiled MyPlate a year ago, giving children and adults a better visual of what to consume. Imagine an empty plate. Now follow these tips to make that plate full of good choices, to help keep your family healthy: • Fill half your plate with fruits and vegetables. Most are naturally low in fat and calories. • Make at least half your grains whole grains, such as whole wheat bread, oatmeal, brown rice and whole cornmeal. • Choose a variety of lean protein sources, including seafood and dried beans and peas. Unsalted nuts and seeds are also alternatives to meat and poultry. • Switch to fat-free or low-fat milk, yogurt and cheese. Send us a drawing of your healthy plate at coloringcontest@umm.edu and we’ll share some of our favorites online!
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Leave it to you
A big gust of wind blew these leaves off a tree! They may all look similar at first glance, but there are two that match exactly. Can you find the leaves that are twins? Which two leaves match? Your answer: _____________ Answer below.
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ANSWER: 2 & 9
www.umm.edu/pediatrics 1.800.492.5538 5
Pediatric epilepsy program ... continued from page 1
frightening for observers
“For parents, watching their child have a seizure can be one of the scariest events of their lives, especially if they don’t understand what’s going on,” Dr. Currey notes. “One emphasis in this program is providing information to parents. We educate them about seizures — what to do during and after, and what they do and don’t need to worry about. Information is power, and although seizures are still worrisome, knowing what to expect can allay a lot of anxiety.”
Susan and Shawn Burke’s 7-year-old daughter, Emma, was at school one day when she suddenly didn’t feel well and went to the school nurse’s office. Her mom arrived within a few minutes and found her daughter disoriented and unable to speak in complete sentences. She called 911 and they headed to the hospital, where a seizure was diagnosed. “I had never even seen a seizure before,” Burke comments. “It came completely out of the blue.”
Dr. Currey likes to point out to parents that U.S. Supreme Court Chief Justice John Roberts has a seizure disorder or epilepsy. “It hasn’t interfered with his ability to be successful!” she shares. “Epilepsy doesn’t have to limit anyone, but it does require a common-sense approach to many situations.”
Three months later, Emma had a second seizure, and went to the local hospital’s emergency department. “They administered a drug to stop the seizure,” Burke says. “But in our daughter’s case, it also caused acute respiratory distress; she stopped breathing.”
advanced diagnosis methods
Her daughter was rushed to the pediatric intensive care unit (PICU) at the University of Maryland Children’s Hospital and
The pediatric epilepsy program at the University of Maryland Children’s Hospital has the capacity to put patients under simultaneous video and EEG monitoring. (See “What Is an EEG?” below.) “This is especially helpful for neonates (infants younger than 4 weeks old),” Dr. Currey says. “We work collaboratively with neonatologists to monitor patients in the neonatal intensive care unit. It can be very difficult to determine when infants are having a seizure because they normally have a lot of herky-jerky movements. Their nervous system is immature and seizure activity may not be readily apparent. It’s often the case that when you think they’re having a seizure just by looking at them, they aren’t. And when you think they aren’t having a seizure, they are. That’s
What is an EEG? An electroencephalogram (EEG) is a test used to detect abnormalities related to electrical activity of the brain. It tracks and records brain wave patterns, and is safe and painless. Small metal discs with thin wires (electrodes) are placed on the scalp, and then send signals to a computer to record the results. The electrodes don’t transmit any sensations. Normal electrical activity in the brain makes a recognizable pattern. Through an EEG, doctors can look for abnormal patterns that indicate seizures and other problems.
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One family’s story
fall / winter
why it’s important to have both video and EEG monitoring, so you can correlate movements with what’s happening on the EEG. “The video-EEG monitoring also helps us diagnose children who have ‘spells.’ And for patients with hard-to-control epilepsy, it allows us to get a better sense of their seizures and what treatment options may be most appropriate,” she continues. An ambulatory EEG service provides long-term outpatient monitoring, and can include video.
0123456789 put on a ventilator. “We found out that there were some other complicated pulmonary issues with her that we had been unaware of. She had to stay on the ventilator for two months,” she continues. While she was in the PICU, Emma began taking a daily anti-seizure medication. A few weeks into that treatment, she developed a severe allergic reaction to it. “So we switched to anti-seizure medication No. 2,” Burke says. “That controlled her seizures and worked well for about a year. Then she started having episodes that looked like seizures. She was in and out of the hospital several times, and it turned out they weren’t epileptic seizures; they were a reaction to the anti-seizure medication and an unusual stress reaction.
pediatric epilepsy program at the University of Maryland Children’s Hospital. “What we most appreciate about Dr. Currey and the entire team at the pediatric epilepsy program is the personal connection. The staff is very accessible and willing to answer questions. Dr. Currey will return a phone call at 3 a.m.! She works tirelessly and is very compassionate to families who are under a great deal of stress when dealing with a new and scary diagnosis of seizure disorder. “The entire team communicates openly, honestly and respectfully, which builds a great deal of trust. And the care is exemplary!”
“Now she’s been on anti-seizure medication No. 3 for a few months, and it looks like it’s a good one for her. She hasn’t experienced the side effects she had with the previous medications.”
Grateful for active problem-solving
Burke is effusive in her praise for Kathleen Currey, MD, and the
“We have an amazing staff. They truly care about our patients, and are very accommodating to our patients and their families.” The program also features dedicated epilepsy clinics and first seizure clinics, where patients are fast-tracked to be seen soon after experiencing their first seizure. treatments tailored to the patient
The goal of epilepsy treatment is to control seizures. “Medication is a common approach, and some of the newer medications have fewer side effects,” Dr. Currey comments. “We work hard to find the right medication for each child, keep them on it long enough — two years seizure-free is a common measure — and then get them off the medication, if possible. Some children outgrow their seizures, but for others, it will be a lifelong concern.” Other treatments for epilepsy include: • Surgery, which may involve removing seizure-producing areas of the brain or another procedure to interrupt the spread of electrical energy in the brain. • Vagus nerve stimulation, during which short bursts of electrical energy are directed into the brain via the vagus nerve, a large nerve in the neck.
Drs. Alpa Vashist and Kathleen Currey by the bedside of a patient undergoing monitoring to determine if she has a seizure disorder. The University of Maryland Children’s Hospital pediatric epilepsy program takes a multidisciplinary approach to tackling what often turns out to be a complex problem. In addition to the two pediatric epileptologists, team members include specially trained nurses, EEG technologists, neuropsychologists, neuroradiologists and neurosurgeons. “We have an amazing staff,” Dr. Currey comments. “They truly care about our patients, and are very accommodating to our patients and their families.” To learn more about the pediatric epilepsy program or to make an appointment, call 410.706.6091. * Source: Epilepsy Foundation, www.epilepsyfoundation.org.
• A ketogenic diet, which is high in fats and low in carbohydrates.
www.umm.edu/pediatrics 1.800.492.5538 7
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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. Websites not belonging to this organization are provided for information only. No endorsement is implied. Images may be from one or more of these sources: ©Thinkstock, ©Fotolia, ©iStock. ©2012 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.
Steven J. Czinn, MD
Mary Taylor, MS, RN
Professor and Chairman, Department of Pediatrics
Director of Nursing, Women’s & Children’s Services
Alison G. Brown, MPH Senior Vice President, Planning, Marketing & Business Development
Alexandra Bessent
Editor, Pediatric Press
Mark your calendars for Baltimore’s second annual American Girl Fashion Show
®
to benefit University of Maryland Children’s Hospital and the Cool Kids Campaign! Model searches are set for January, and the Fashion Shows will take place on March 23 and 24, 2013. Visit www.americangirlfashionshow-baltimore.com to learn more.
PORTRAITS OF PRESIDENTS
Test Your Knowledge Our country honors its presidents by sometimes know our presidents and your money? Match the
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1) The capital of our country is named after this president. 2) This president was the first one born in the 20th century. 3) Our 32nd president is on this coin. 4) This president appears on both sides of some coins. 5) This president wrote the Declaration of Independence.
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ANSWERS: 1) quarter – George Washington, 2) half dollar – John F. Kennedy, 3) dime – Franklin D. Roosevelt, 4) penny – Abraham Lincoln, 5) nickel – Thomas Jefferson
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