Brenner Children’s Hospital faculty work to improve the lives of children

Ask any faculty member at Brenner Children’s Hospital “what’s new?” and watch as their eyes light up. It’s impossible to know where to start. In 2002, patients were moved into a new, state-of-the-art facility. With private rooms, expanded play areas, a roof top terrace and special video wall, patients don’t feel hospitalized as much as healed.
New faculty members have joined Brenner Children’s physicians, who have worked to improve children’s lives in this region for decades. Armed with research regarding violence prevention, alternative/complementary medicine and HIV prevention, these new faces are combating some of the social, emotional as well as physical challenges haunting our children. By blending their expertise with those who have spent their lives aggressively treating illnesses like cancer, infectious diseases and developmental disabilities, Brenner Children’s Hospital is defining the way children’s healthcare will be delivered in this region.
“You must treat the entire child when he or she comes to you with a medical problem,” said Dr. Jon S. Abramson, physician-in-chief of Brenner Children’s Hospital. “To ignore their social, emotional and spiritual needs does them an injustice. When recruiting faculty for Brenner Children’s Hospital, I have searched for expertise in areas that I felt would affect children directly over the next 20 years. In order to truly improve health care in this region, we must work to prevent violence in our schools and to provide nurturing, healing spaces within our hospital walls. To the best of our ability, we must heal the child – emotionally, physically and spiritually. ”
Below are the stories of some of the faculty who are working in unexpected ways – stepping outside the traditional role of a pediatrician. Combining their vision with skill, they hope to eliminate some of the problems that could derail our children’s futures.

Shari Barkin, M.D.: Looking for ways to curb violence
Shari Barkin, M.D., a pediatrician at Brenner Children’s Hospital, has conducted research that shows physicians and other health care providers can play valuable roles in violence prevention in their communities.
The study, published in a 1999 issue of Injury Prevention, states that physicians form unique bonds with patients and their families at critical times during development.
Barkin’s work has identified six potential ways clinicians can address violence prevention during a routine well-child examination: educate families about youth violence prevention, counsel the child directly, use the unique bond formed between doctor and patient to communicate regularly, advocate gun safety to either the parent or the patient, refer patients and families to community programs, and educate patients through brochures or posters.
“Violence prevention is not just about guns; that’s only part of it,” said Dr. Barkin. “During well-child examinations, pediatricians must provide education to parents regarding discipline and TV viewing. Corporal punishment is a very personal issue for most parents. Discipline needs to be respectful but firm. However, corporal punishment sends a negative message to your children. It is saying, ‘I have a conflict with you so I am going to strike you.’ It teaches children to resolve conflicts in aggressive ways.”
Viewing TV for extended amounts of time and watching violent programming can also negatively affect children.
Barkin also says that health care providers, while influential, don’t work in a vacuum.
“Physicians should reinforce positive messages that children get elsewhere,” Barkin said. “Physicians need to become familiar with community resources and refer families to programs that can enhance the pro-social capabilities of the child.”

Robert Schwartz, M.D.: Waging a war against obesity one French-fry at a time
Before making a quick run through the drive-thru tonight after work, consider this fact: Obesity affects one in five children in the United States. And for Robert P. Schwartz, M.D. a pediatric endocrinologist at Brenner Children’s Hospital, that is one child too many.
“We are experiencing an epidemic of obesity in children and adolescents,” said Schwartz. “And it is taking a significant toll on our children’s health.”
In the past 10 years, the prevalence of obesity has tripled for children and adolescents. High calorie snacks, sugar-sweetened drinks, and fast foods coupled with a sedentary lifestyle are contributing to this expanding problem.
“As a pediatrician, I see children and teenagers every week who are overweight,” he said. “As a result of their weight, these children also feel left out of social circles and may have a poor self-image.”
Yet reversing this trend is possible, according to Schwartz. Physicians must take the time to educate parents on the health risks associated with obesity, giving them nutritional guidance, and stressing the importance of daily physical activity, he said.
A recent survey showed that only 20 percent of children consumed the recommended five or more servings of fruit and vegetables each day and 25 percent of the vegetables were French fries. Snack foods now make up 25 percent of a child’s caloric intake.

Jane Foy, M.D. Taking health care inside school walls
When researchers began looking at ways to improve the health of the community’s children, they decided to work with other community groups to identify and address children’s greatest needs. Fifteen community organizations and agencies joined forces with Brenner Children’s faculty organizing a non-profit, called the School Health Alliance for Forsyth County. They receive support from area foundations and both local hospitals to provide school-based health centers, which serve students whose families have difficulty getting them to traditional sources of health care. Mental health professionals, nutritionists, nurses and physicians all work together on the school’s campuses to provide preventive and treatment services, helping students stay well and perform better in school.
“For many of the students, this is the only health care they receive,” said Dr. Jane Foy, a pediatrician at Brenner Children’s Hospital and President of the School Health Alliance. “We teach them about healthy choices and help them to identify and address medical and psychosocial issues that may prevent them from success in school and in their adult lives.”
At the two original sites, Independence High School and Mineral Springs Elementary/Mineral Springs Middle Schools, Foy and her team provide routine pediatric care, management of chronic illness, counseling for behavioral problems and skill-building in conflict resolution to students. Expansion to two additional schools, Ashley Elementary and Atkins Middle School, last fall has enabled the Alliance to pilot a new model, providing nursing and mental health services on-site at the schools and referrals to existing community resources for needed medical services. “Both models show great promise in preventing disruptive and violent behavior, as well as in improving attendance and academic performance,” Foy said.

Thomas Pranikoff, M.D.: Providing the latest in surgical modalities for children
For years now, adults have had the option of laparoscopic surgery, a type of minimally-invasive surgery, which can cut recovery periods in half, reduce pain and a lengthy hospital stay, and leave minimal scarring. Children have that option at Brenner Children’s Hospital.
“Laparoscopic surgery is much easier on a child than other standard surgical procedures,” said Thomas Pranikoff, M.D., a pediatric surgeon. “Children who undergo this procedure get up and around quicker, can return to a normal diet with fewer problems and have shorter stays in the hospital.”
While the surgery may be similar in children and adults, the equipment and techniques have to be modified for children.
“In children you obviously have less space to work with,” he said.
Cost may also be reduced because patients who undergo laparoscopic procedures may spend fewer days in the hospital, Pranikoff said.
“One of the benefits of performing this procedure in a children’s hospital is that we have all the components that are necessary to make the outcome both safe and successful,” he added. “We have anesthesiologists, nurses, and pharmacists all trained specifically to care for children. It makes for a much better outcome.”
With Pranikoff and his two partners Charles Turner, M.D. and Robert W. Letton, Jr., M.D., Brenner Children’s Hospital is the only hospital in the western half of the state to support three pediatric surgeons.

Jon S. Abramson, M.D. Preparing our country for the unthinkable: Germ Warfare

Since the events of September 11, many Americans struggle with fears that before seemed something out of a science fiction novel. Anthrax and smallpox have been ingrained into our lives birthing a new sense of uneasiness.
Scientists work to develop new guidelines regarding vaccinations for forgotten diseases, and prepare to shore up treatment modalities in preparation of virual attacks.
“If I were a terrorist and wanted to do massive damage killing thousands, I’d choose the virus that causes Smallpox,” said Jon S. Abramson, M.D. physician-in-chief of Brenner Children’s Hospital. “It is very easy to transmit, has a high mortality rate, and is a hearty virus.”
Smallpox was eradicated in 1980, and vaccinations have not been routinely performed in the United States since 1972. Therefore, a large segment of the population is at risk of contracting the disease, once exposed to the virus. Also, many adults who were vaccinated may have lost some, if not all, of their immunity.
“We have no idea how long the protection from an earlier inoculation lasts,” said Dr. Abramson. “In addition there is no treatment for smallpox.”
As chair of the Infectious Diseases Committee for the American Academy of Pediatrics, Abramson is developing new vaccination standards nationwide. “We have two choices: everyone is vaccinated for a potential outbreak or we treat those in a certain area if an outbreak is reported.”
Abramson says the United States, as well as other countries, will remain on alert to possible threats.

Sidebar
Brenner Children’s Hospital moves into new facility
In the late spring of 2002, Brenner Children’s Hospital moved into a new, state-of-the-art facility. Patients now have private rooms, expanded play areas, a special feature wall and a rooftop terrace to use while hospitalized. Below is a synopsis of some of the features of the new facility:

Facts at a glance:
• 160 beds
• Located on the main campus of Wake Forest University Baptist Medical Center
• More than 75 pediatric specialists
• Private rooms and bathrooms with day beds for families
• Ronald McDonald House family room
• Respite and resource centers for parents
• Six age-appropriate play areas
• Rooftop terrace with wheelchair accessible playground
• Six bed unit for dual diagnosis of developmental/behavioral problems
• Family-centered care
• An environment tailored to children’s needs
• Meditation Room