Hot Button Pediatric Health Issues

BY  |  Tuesday, Nov 02, 2010 11:00am

Child healthcare experts gathered last week to discuss a range hot button issues facing pediatrics today. From concussion awareness to eating disorders, the doctors from the Goryeb Children’s Center at Overlook Hospital shared their expertise with the community.

First Dr. David Cooper, director of the Pediatric Exercise and Extreme Environment Laboratory at the Respiratory Center for Children, took on student athletes’ concerns.

“We have some serious, dedicated athletes in this area,” Cooper said, noting he sees a lot of high performing athletes and even some elite athletes who get assessed for non-medical purposes.

The main issue plaguing the patients he sees is difficulty breathing during exercise. And the lab, one of only a handful in the country, is specifically designed to better assess and help treat these athletes. With its sophisticated equipment and capability to simulate the real-life situations athletes face, the doctors can more accurately evaluate them.

Aside from these athletes the lab also treats asthmatic children.

With asthma rates rising worldwide from 5% 30 or 40 years ago to 15% to 20% according to Cooper, the lab works with children in developing safe exercise and sports programs. “With proper treatment all people can participate in sports at the highest level.”

But for those that don’t the lab has a program for them. The Kid Fit Program addresses the obesity epidemic, which Cooper acknowledged is spreading to affect children at younger and younger ages.

“A big chunk of preschoolers are obese,” he said, mentioning the program considers obesity as well as life style factors.

“The awareness that we should be active throughout our lives is important,” Cooper stressed.

And it is, but with all that activity kids must be careful, which is what Dr. Harvey Bennett, director of Neurology and Developmental Medicine, was there to speak about.

“I think concussion was the obvious choice,” Harvey stated. “It’s all around us. In the past few years, I’ve seen more and more patients coming in with concussions.”

While Harvey acknowledges parents and coaches fear neurological damage and cumulative effects of multiple concussions, called Second Impact Syndrome, he asserts concussions themselves are benign. He points to the new definition of concussions, which states concussions cause no permanent structural damage.

He does concede, however, that concussions have the potential to be serious and recommend immediate assessment after sustaining a concussion. The signs to look for are headaches, slowness to respond, amnesia, and slurring of words. Post concussion Harvey said most kids are fine, but he treats the one with persistent symptoms.

At the Children’s Center Harvey uses the same tool the NFL uses to establish the child’s nuero-psychological profile. This establishes a cognitive baseline which the child must once again reach after sustaining a concussion in order to play a sport again. But Harvey says the real treatment for concussions is rest.

“Everyone recovers from concussions, but we want them to rest.”

And since the head usually leads to the stomach, Pediatric Gastroenterologist Alycia Leiby was on hand to discuss a topic that affects everyone during his or her lifetime  – bellyaches. Although viral infection or other types of infection may trigger this pain, these bellyaches, known as functional abdominal pain, occur when there is no infection or blockages. The pain arises because the nervous system is hyper-sensitive.

The red flags to look for are consistent vomiting, diarrhea, stunted growth, bloody stool, and belly pain so severe it wakes the child from sleep.

Although the diagnosis of inflammatory bowel diseases such as Crohn’s, Ulcerative Colitis, and Celiac in children is on the rise, Leiby suggests this could be due to increased recognition of the diseases. Treatment of these diseases at the Center integrates holistic approaches. In addition to medication, Leiby said the Center uses guided imagery, clinical hypnosis, deep breathing and yoga.

“More and more parents are using these treatments as alternative to medications that have side effects,” Leiby said.

The last topic, also related to the stomach, was eating disorders. Dr. Leslie Sanders, interim director of Adolescent/Young Adult Center for Health, discussed the more recent understanding of the disorders. While children with eating disorders were typically thought of as emaciated teenage girls who don’t want to be fat, now children who haven’t lost weight but who haven’t gained weight either are also considered to have the disorder.

“Fifty percent of adult weight is gained during adolescence,” Sanders said, emphasizing the importance of weight gain not just loss.

The modern understanding of the disease also includes boys. “This year I’ve seen four boys on the cross country team who look like skeletons on the run,” Sanders said.

And the problem has grown to include younger children. “I can testify in my practice the age at which kids are presenting is getting younger and younger.” Sanders said she is currently treating  a dozen 8 and 9-year-olds.

The fast facts are the disorders are complex medical/psychiatric illnesses that are ways of dealing with stress or emotional needs not being met and really have nothing to do with dieting, food or appearance; the disorders can result in serious and lifelong medical problems; and they have highest morbidity of any psychiatric disorder. Recovery is possible but early recognition and treatment is key.

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