Sleep Disorders in Children – Why Some Will Never Get Treated

If your child suffers from a sleep disorder, she may never get the treatment she needs. Noted sleep disorder authority, Dr. Dennis Rosen recently alerted the American medical community to an alarming trend: there is a growing shortage of qualified sleep disorder specialists who want to treat children. When it comes to adults, however, the trend is just the opposite. Most every doctor fresh out of medical school wants to treat adults. Why, you ask? Very simple: money.

Sleep disorder specialists who treat adults enjoy very lucrative salaries. Those who specialize in sleep issues for children, however, make only a fraction of those doctors who treat adults. To make matters worse, budding pediatricians must attend even more classes after their adult counterparts have already graduated from medical school and begun practicing. That means they’ll have even more debt to pay back once they finally get out and start working. These two major market factors have made pediatric specialties extremely unattractive from a financial standpoint. But laying the money issue aside, the implication of fewer pediatric sleep doctors is even greater. It means children with sleep problems won’t have access to the care they need.

This issue means one of two things, and neither of them are good. For starters, children who need these services will have to travel long distances to be diagnosed and cared for. Sadly, that’s the best case scenario. The not-so-good option is that children who happen to live near a qualified pediatric sleep specialist will most likely have wait a long time (perhaps months) before they get treatment.

The sleep disorder statistics in the U.S. tell the sad story. According to the American Board of Pediatrics, only 751 qualified pediatric practitioners are operating in the U.S. That’s only 1 for every 100,000 suffering children. If that’s not alarming enough check this out: In sparsely populated states (i.e., Montana, Wyoming, Idaho, and Alaska), there simply aren’t any. Not even one!

These market conditions could come at a worse time in American history. The government is under tremendous pressure to reduce spending, even under President Obama’s health care reform. Yet without some kind of relief from Congress, little is likely to change. But the lack of qualified medical professionals specializing in children’s needs are too few and far between. The extra training is definitely needed (children aren’t just “little adults”). However, doing nothing isn’t an option for these children. While the requirement for additional medical training can’t be relieved, the financial burden on these aspiring doctors can. Otherwise American children will go without the sleep disorder solution they need because it’s not in a young doctor’s financial best interest to give them one.

Research Offers Hope for Better Treatments of Pediatric Brain Tumors and Brain Cancer

Pediatric brain tumors and brain cancer, while rare, are considered to be the deadliest of all childhood cancers. While the incidence rate may be relatively low, with approximately 3,400 new cases diagnosed annually in the United States, the mortality rate of children with these types of cancers is significantly higher than other childhood cancers and diseases. Roughly one-third of these kids will not survive beyond five years.

However, it is encouraging to note that, as a result of advancements in research and treatment methods, there have been noticeable decreases in overall cancer death rates since the early 1990s, with an estimated 25,000 survivors currently living in the U.S. Although “survivorship” for these kids comes with its own lingering effects, such as cognitive damage, physical challenges and social isolation, the research that is taking place today will hopefully, someday help to minimize these effects, and allow these survivors to live longer, healthier lives.

Hope for the children and families who face this dreadful disease comes from the tireless efforts of many non-profit organizations, research foundations, hospitals and other pediatric medical institutions who are dedicated to finding the cause, and ultimately, the cure for this deadly invader of children. A few of the more notable milestones of late include:

• The creation of a tissue bank consortium, a collaborative initiative involving the Children’s Brain Tumor Foundation and a group of researchers at several leading pediatric oncology hospitals nationwide. The bank will enable researchers to obtain samples of brain tumor tissue that can be characterized, analyzed and used to evaluate treatments. The results can then be documented in a database that can be shared with pediatric cancer facilities across the country.

• The publishing of a landmark study of medulloblastoma*, a type of brain tumor typically found in children. The study team found that the number of mutations in pediatric medulloblastoma tumors is five to ten times fewer than in adult medulloblastoma tumors, which suggests that, compared to adult tumors, pediatric tumors may respond better to drugs that target the genes and pathways altered by mutations that drive cancer progression.

Pediatric brain and spinal cord tumors are difficult to diagnose because their signs and symptoms may mimic those of other disorders, and vary according to the exact location of the tumor. Once a diagnosis is made, successful treatment is also difficult because there are so many different kinds of brain tumors and cancers, and their precise causes are unknown.

Research holds the key to quicker, more accurate diagnoses and subsequently, better treatments. While progress is being made on a number of research platforms, it continues to be challenging for several reasons:

• There are many different kinds of children’s brain and spinal cord tumors, which has stymied research as investigators face the challenges of collecting and analyzing tissue, as well as the ethical issues posed in treating children.

• Because the disease is rare and tissue samples of tumors are small, it takes time to test and validate new treatment options, and there is currently not an adequate database for recording and sharing this information.

• Doctors and researchers are dealing with a growing child’s brain and body, so they must first ensure they avoid harming the child.

• Funds for research and treatment options are limited, due to the relatively low rate of incidence, compared to other childhood cancers and diseases.

As any research investigator would attest, much work has been done, much progress has been made, but it is not enough. It is never enough. The efforts will continue, and the unshakable commitment of so many will stand strong until the statistics dwindle from 3,400 to 0.

10 Hot Tips for Passing the AHA PALS Exam the First Time

Here is a guide to help you improve your chances of passing the AHA – American Heart Association certification exam for PALS – Pediatric Advanced Life Support. If you take the advice given here seriously, you will do very well on the exam. But you must allow yourself plenty of time to learn all of this material – especially if you are new to this.

1. Study and memorize the Zombie Notes study guides

The Zombie notes focus on information from the literature, test questions and the real life everyday situations – information you need to provide safe care during a pediatric emergency. As you read the study guide, try to memorize the medications and their doses. You must memorize and understand the algorithms; the arrhythmias and in which situations the medications and treatments may be required. Memorizing the algorithms and drug doses is the most difficult part. Repeating the information over and over, and even saying it out loud really helps with the memorization. Once the hard part is memorized, you can start using critical thinking in adjusting treatments based on patient symptoms. The Zombie notes helps you study the ‘need to knows’ and it is easy to take with you to study in your spare time.

2. Read and study the AHA-PALS Certification Manual

The American Heart Association (AHA) PALS Certification Manual may be distributed by the instructor. The AHA provider manual comes with a DVD and cards to assist the learner learn and apply their knowledge and skills. The textbook is filled with information of topics around assessing and treatment of critical situations, shock states, airway management, treatments and pharmacological modalities.

3. Understand basic EKGs

Any critically ill patient of any age may have their heart rate and rhythm affected. Trauma, medications, dehydration, and heredity all play a part in a patient’s arrhythmia. It is the practitioner’s role to recognize potential cardiac changes and treat appropriately. Knowing the difference in synchronized and unsynchronized cardioversion (shock) is important. YOU MUST be able to recognize the lethal arrhythmias in the pediatric patient: bradycardia – 4 heart-blocks; ventricular fibrillation; ventricular tachycardia; pulseless electrical activity (PEA); asystole. Other important rhythms to know are: sinus tachycardia; supraventricular tachycardia (SVT).

4. Watch YouTube videos on EKG and other PALS/ACLS topics

The YouTube videos can teach you and remind you of the topics you are studying and clarify any questions you may have had. You can always contact Michele if you have any questions.

5. Take practice tests over and over until you get them all correct

Practice tests can reinforce what you know and help you find the areas you need to focus your studies.

6. Take a BCLS course and be sure you can perform high-quality-CPR at the class

The prerequisite to any American Heart Association Certification Course is the ability to perform BCLS skills. The instructor may ask you for your valid AHA certification card. During the PALS course you will have to perform in practice and testing sessions. Some of the BCLS skills will include: Chest compressions for neonates, infants, small children and large children (including the two-thumb technique); ventilations using a bag-mask-valve (Ambu bag); the AED and appropriate age-group pads.

7. Review all the PALS medications and their doses (oxygen, epinephrine, amiodarone, adenosine, atropine, and procainamide, etc.)

These medications are used throughout the PALS program. Oxygen, fluids, epinephrine and amiodarone are used the most. Infusions that one needs to be familiar with are dopamine, levophed, magnesium, and dobutamine.

8. Read about different diagnosis (dehydration, epiglottitis, croup, septic and cardiogenic shock, trauma, etc.)

Knowing the common diagnosis and the common treatments will ready you for the practice scenarios and testing mega codes.

9. Be prepared to work in a team setting and be able to participate verbally with hands on participation

You may be assigned to a different role in the mega code. You may be practicing skills that your scope of practice does not allow in the work place. The skills allowed in the classroom, allows you to see how we can help each other in an emergency situation. Feel free to speak up when the instructor allows teamwork. Also be prepared to run a mega code as the team leader as well.

10. Participate in class, and ask and answer lots of questions

Speaking up and asking many questions helps you understand and will facilitate your classrooms ask more detailed questions as well.

What Happens During A Routine Physical For Children?

Taking your child for regular routine physicals is crucial, especially during those first few years. These routine physicals, also known as well-child visits, allow your child’s pediatrician to ensure that your child’s growth and development are happening as expected and that there is no cause for concern.

So many times parents worry that their kids do not start walking or talking at around the same time as most other children. Sometimes, this is really no cause for concern as every child starts walking and talking at different times. Sometimes, however, this developmental delay could be due to other factors. If you are worried, you can voice your fears at your child’s next visit to the clinic and the pediatrician may conduct a few additional tests to eliminate any possible problems.

Another reason why routine physicals are so important is that symptoms of some health conditions are not immediately noticeable and may go undiagnosed and untreated for too long. Because a younger child’s organs are not yet fully developed they are particularly vulnerable. At a well-child visit, the pediatrician will be able to identify the early symptoms and start treatment immediately so that the disease does not progress any further.

Here’s what the doctor will do at your child’s next pediatric routine physical.

Measure Vital Signs

The first thing that the pediatrician will do is to check that all vital organs are functioning normally and that there are no aberrations. They will check the pulse rate and blood pressure to detect whether there are no abnormalities related to the heart and the circulatory system.

They will also check the height and weight to determine whether your child is developing normally. Accordingly they may make some recommendations for making a few nutritional changes.

In addition, other checks will be done to ascertain the condition of the lungs.

Palpation

This involves physical touching different body parts to establish the location of the lymph nodes and determine whether they are larger or smaller than they should be. If anything unusual is noticed, they may make a note so they can continue to monitor this aspect during the next visit.

Check Your Child’s Eyes, Nose And Ears

Eye, nose and ear exams are conducted at every visit as they reveal a lot to the doctor. The condition of the eyes can indicate an infection or it may indicate some other type of visual problem. In checking the nose, the pediatrician will look for sign of upper respiratory distress and also for the development of sinuses. An ear exam is done to test the hearing abilities and also to check if there is any discharge from the ear.

Lastly, the doctor will do a complete physical check to ascertain if there are any general health issues.