Stories about: Patient Services

Copper: How much is enough for children fed through an IV?

Just like today's pennies, our bodies have only a little bit of copper in them. But what we have, we need. Danielle Arsenault wants to understand how much copper is enough for children fed via an IV. (stevendepolo/Flickr)

Check the nutrition label on just about any packaged food, and you’ll see how much carbohydrate or salt, or how many calories, are lurking inside waiting for you. But that label won’t give you the whole nutritional picture. How much magnesium does your bag of chips contain? Or iodine, or copper?

These elements are all on the list of human micronutrients: nutrients that help maintain many of the critical biochemical processes within our cells. And while we only need them in very small amounts, micronutrient deficiencies can be devastating, even fatal.

Most of us get the micronutrients we need from our diet (chips aside), but for children whose digestive tracts can’t process regular food – such as those with intestinal disorders like short bowel syndrome (SBS) – getting the right amount of micronutrients is a different story. These children often often have to get all their nutrition intravenously through a process called parenteral nutrition (PN).

Since dieticians can tailor the nutrients given to a child on PN, you’d think that it would be easy to get the right amount of micronutrients, like copper, into the mix. But that isn’t necessarily so.

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Fathoming teen attitudes about, knowledge of and experience with long-acting contraception

(michi003/Flickr)

Long-acting forms of contraception (think IUDs, or hormone implants that go under the skin) have long been available. But despite their effectiveness and ease of use, it’s been a tumultuous road to public acceptability. And while clinicians have a good sense of adult attitudes, teenagers’ attitudes toward such contraceptives – together called long-acting reversible contraceptives, or LARC – are less well understood.

“Rates of teenage pregnancy are going down nationally, but until very recently stayed steady in our clinic population,” says Pamela Burke, a nurse practitioner in Children’s Division of Adolescent Medicine. “Teenage girls who have access to LARC could have some advantage over their peers through the use of a more reliable birth control method, one that is not dependent upon human effort or memory.”

Burke, with colleagues at Children’s Martha Elliot Health Center (MEHC), the Dimock Center in Roxbury and the Division of Family Planning at Beth Israel Deaconess Medical Center (BIDMC), is currently running a study aimed at understanding teen’s knowledge about and attitudes toward LARC.

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Delivering psychiatric care in the ED: Keeping adolescents in crisis out of limbo

Suicidal teens who come to the emergency room for help are often kept there until an inpatient bed becomes available, which can take hours or days. Elizabeth Wharff is changing the standard of care by providing family-based psychiatric treatment right in the ED.

When teenagers come to an emergency department expressing suicidal thoughts or after a suicide attempt, the accepted model of care is to evaluate, then either send them home or keep them in the ED until an inpatient psychiatric bed becomes available.

The wait for an inpatient bed can take hours, even days. No psychiatric treatment is given. The child is simply “boarded” – kept waiting in the ED under supervision, a practice that can increase distress for the child and family, while taking ED beds out of circulation for other acutely ill patients.

“Generally speaking, there is no history of providing psychiatric treatment in the emergency room setting,” says Elizabeth Wharff, director of the Emergency Psychiatry Service at Children’s Hospital Boston. “Since the late 1990s, we have seen a significant increase in the number of cases where an adolescent comes to our emergency room with suicidality and needs inpatient care, but there are no available psychiatric beds anywhere in the area.”

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Does it get better? Surgical outcomes in children with cerebral palsy

Children with severe cerebral palsy sometimes need surgery to help their hips and spine. But do these operations actually improve quality-of-life? Rachel DiFazio would like to know. (PaulEisenberg/Flickr)

Children with cerebral palsy (CP), the most common form of physical disability in children, all experience at least some difficulties in communication and movement. Those with the most severe forms of CP sometimes undergo reconstructive surgery on their hips and spine to correct dislocations or scoliosis. But do these operations actually improve quality of life?

“I’ve taken care of children with cerebral palsy for 21 years, and I’ve always wondered what the outcomes were of the surgeries,” says Rachel DiFazio, a nurse practitioner with the CP Program at Children’s Hospital Boston. “We have a lot of X-ray data and range-of-motion data, but we don’t really know if it gets any easier to take care of these children, whether life gets a little bit easier after the surgery, and in what ways.”

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Putting technology to work to get kids exercising

Obesity among children is on the rise, but just telling them to out and get more exercise doesn’t work well. Tracy Curran hopes technology and counseling can help. (Photo: Wagner T. Cassimiro "Aranha"/Flickr)

[Ed. Note: This is the second in a series about Children’s Hospital Boston staff who received Patient Services Research Grants in 2011. This grant program engages the professional staff in the Department of Patient Services in high quality pediatric research with the ultimate goal of improving child health]

We all look at babies and fall in love with their chubby little legs and paunchy bellies. (When my younger son was a baby, a friend often jokingly threatened to “eat him like a marshmallow.”)

Cute as it is in babies, though, children can’t afford to have that cushioning as they get older. Obesity threatens the future health of a whole generation of children, putting them at risk for a host of long-term health problems like high blood pressure, type 2 diabetes (increasingly starting in childhood) and cardiovascular disease. This is on top of more immediate problems like sleep apnea, asthma, low self-esteem, depression, fatty liver disease (which can turn into cirrhosis) and joint pain.

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Helping heads get into shape

Photo: D. Sharon Pruitt/Flickr

[Ed. Note: This is the first in a series of six occasional posts about Children’s Hospital Boston staff who received Patient Services Research Grants in 2011. This grant program engages the professional staff in the Department of Patient Services in high quality pediatric research with the ultimate goal of improving child health.]

It has been nearly 20 years since the American Academy of Pediatrics released the recommendations that fueled the “Back to Sleep” campaign, which encourages parents to put babies to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS). And it’s worked: In less than 10 years, the rate of SIDS deaths dropped by more than half.

But with this drop came an upsurge of brachycephaly – a “positional head shape deformity” characterized by a gradual flattening of the back of an infant’s head from resting on a firm or semi-firm mattress.

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