04 and the results were electrifying. Feature: We got ... · dystonia, a disorder that makes...

FALL/WINTER 2014

Feature:

We got inside Francisco’s head and the results were electrifying. 04

02 UCSF BenioFF Children’S hoSpital

At first, the 2-month old infant attached to a network of intravenous tubes doesn’t seem to be listening to the strumming of her music therapist’s guitar. But as Oliver Jacobson continues singing Twinkle, Twinkle Little Star, she turns her head toward the music and raises her face to his. She can’t quite smile, but the joy is in her eyes.

Oliver’s song is more than a lullaby. It’s part of the girl’s ongoing music therapy sessions that can help regulate her heart rate, control her pain, maintain her spirits and soothe her soul—all invaluable elements in treating her condition.

The idea of using music to heal people was what changed Oliver’s musical path. He was a rock aficionado at Boston’s Berklee College of Music when a music therapy course captured his imagination and fostered his decision to enroll in the school’s four-year music therapy program. Practicing an evidence-based science that not only helps heal the body but also supports emotional and spiritual well-being was exactly what Oliver realized he wanted.

healing in the key of “J”.From calming lullabies to joyous sing-a-longs, Oliver Jacobson proves that music can be very potent medicine.

Today he’s a board-certified, full-time music therapist at UCSF Benioff Children’s Hospital. His passions for creating music, writing songs and performing are all integrated into the music therapy interventions he develops for each patient.

Rolling his cart full of instruments through the halls, a guitar slung over his shoulder, he’s a welcome sight for patients and caregivers alike. Whether he’s helping kids write lyrics, play solo on an iPad® or jam on a drum, the music helps alleviate their pain, manage stress, improve motor skills, facilitate treatment, and just as important, gives them joy.

As Oliver says, “I know it works when the kids forget they’re in a hospital and they just light up.”

For more information and to view a video on music therapy at UCSF Benioff Children’s Hospital San Francisco, visit www.ucsfbenioffchildrens.org/ musictherapy.

For a more in-depth version of this article, click here.

iPad® is a registered trademark of Apple Inc.

www.ucsfbenioffchi ldrens.org 03

Winning the food fight. Ongoing developments at the Allergy Diagnostic and Treatment Centermay soon help families better manage their children’s food allergies.

Treating your children’s food allergies may seem simple: avoid the offending substance and they’ll be fine. But that’s often difficult, especially for common allergens, and ingredients, like wheat, peanuts and eggs. For kids with the most severe food allergies, the consequences of accidental exposure, even to trace amounts, can be lethal. Fortunately, some promising new approaches to combat food allergies are on the way.

A new test, component resolved diagnostics (CRD), may help doctors more accurately predict the extent of a child’s allergy. “Unlike standard tests, CRD can potentially determine whether the patient is merely sensitized or has a clinically relevant allergy to certain foods,” says Dr. Morna Dorsey, who leads the Allergy Diagnostic and Treatment Center at UCSF Benioff Children’s Hospital San Francisco. Armed with that information, patients and families can manage their allergies better while avoiding unnecessary diet restrictions.

Oral immunotherapy, another strategy to control allergies, is also on the horizon. It aims to desensitize

the patient to serious allergens such as peanuts and eggs. Under careful medical supervision, patients ingest tiny but gradually increasing amounts of the foods that trigger their allergies. “The idea is to build sustained tolerance to the allergen so that it no longer causes a reaction,” says Dr. Dorsey. Clinical trials for the treatment will begin soon.

In the meantime, patients and families benefit from the center’s unique, multidisciplinary team approach to diagnosing and treating allergies. “Food allergies can be very complex,” says Dr. Dorsey. “That’s why we bring together a whole team of specialists to tailor treatment plans for each child’s needs, not just the medical aspects, but the psychosocial aspects as well. For patients and their families, dealing with food allergies can be a real struggle. Having a better understanding of their condition, and how to safely manage it, can be a huge relief.”

For more details visit www.ucsfbenioffchildrens.org/immunology.



It was a simple incident that marked the beginning of a complicated journey for 15-year-old Francisco Alvarez: While helping his father in the yard, he had trouble holding a rake. “His right hand just stopped working,” recalls his mother, Dora.

The family embarked on an odyssey of doctors’ visits as the symptoms multiplied. Francisco’s right foot twisted inward and his neck contorted in powerful spasms. Walking, speaking and swallowing soon became difficult.

But it wasn’t until he went to UCSF Benioff Children’s Hospital San Francisco that his problem was diagnosed. “Francisco had dystonia, a disorder that makes muscles contract and spasm involuntarily,” says Dr. Jill Ostrem, Francisco’s neurologist.

Medications and Botox® injections, which control dystonia symptoms in some patients, didn’t work for Francisco. But there was still a ray of hope: UCSF Benioff Children’s Hospital is one of only a few hospitals in the US offering deep brain stimulation (DBS) to curb the symptoms of dystonia.

The procedure involves placing thin wires capped with tiny electrodes in the areas of the brain shown by sophisticated testing to be the origin of the problem. The electrodes are powered

by a neurostimulator, which is implanted near the collarbone in a second operation, and connected under the skin to the electrodes in

the brain. The system overrides the abnormal brain signals that cause the muscle contractions.

“Precise placement of the electrodes is critical,” says Dr. Philip Starr, Francisco’s neurosurgeon. In

a futuristic twist, he performs the surgery while the patient is inside an MRI scanner. “MRI gives

us real-time images of the brain, allowing pinpoint accuracy for electrode placement and on-the-spot corrections,” he explains.

Programming the neurostimulator also takes extraordinary skill. “The frequency and amplitude need to be at just the right level—high enough to control symptoms but not cause side effects,” says Dr. Ostrem, who programmed Francisco’s device.

Today, Francisco is 18, virtually symptom-free and attending college. “He has his life

back,” says Dora.

For more information on deep brain stimulation and the Surgical Movement Disorders Center in

San Francisco, visit www.ucsfbenioffchildrens.org/movementdisorders.


Botox® is a registered trademark of Allergan, Inc.


Just because you’re 2,000 years old doesn’t mean you don’t belong in a pediatric hospital. That’s what Dr. Cynthia Kim thought as she began to consider acupuncture as an alternative to the Western pain treatments for her young patients at UCSF Benioff Children’s Hospital San Francisco. The ancient Eastern medical art she’d grown up with in Korea might help them manage pain, while avoiding the common side effects of conventional medication such as nausea, constipation and itchiness.

The children’s hospital agreed. Through its innovative Integrated Pediatric Pain and Palliative Care Clinic, acupuncture began to be offered in conjunction with traditional care and other complementary pain management strategies.

Today, Dr. Kim, a graduate of Harvard University and Cornell Medical College, is one of three physicians at the children’s hospital who’s also a licensed medical acupuncturist. She consults on about 200 inpatient

and outpatient cases involving acupuncture each year, and notes that more than 3 million people nationwide turn to the ancient treatment annually as part of their health care regimen.

Studies show that acupuncture can reduce post-operative nausea by up to 70 percent, and is effective in reducing chronic headache pain in children. The ancient treatment has also been shown to relieve lower back pain, neck pain, fatigue and anxiety.

And like any good idea that withstands the test of time, acupuncture is still evolving. Originally practiced with ultra-thin needles, the therapy can now be performed with a laser that delivers a subtle dose of thermal energy to a pressure point. This is good news for children who may become anxious at the prospect of needles. Kids also think the Dr. Kim’s laser is really cool. And really cool things can be highly effective in relieving pediatric stress.

For more on the Integrated Pediatric Pain and Palliative Care Clinic, call (415) 353 -1328 or visit www.ucsfbenioffchildrens.org/acupuncture.


Zapping the pain. Look out, pediatric pain! Dr. Cynthia Kim has a laser and she’s not afraid to use it.

Dr. Kim’s laser, which resembles a small flashlight, delivers patient-friendly acupuncture as effective as needles.

www.ucsfbenioffchi ldrens.org 07

ASK THE PEDIATRICIAN

The Pediatric Sleep Disorders Center at UCSF Benioff Children’s Hospital Oakland offers services at Oakland (510) 428-3305 and Walnut Creek (925) 979-3429.

First there was diet. Then exercise. “Now sleep is becoming the new frontier in achieving overall health for children,” says Dr. Gwynne Church. As director of the UCSF Pediatric Sleep Disorders Center, she’s acutely aware that a good night’s sleep is an important key to children’s health—and in many cases, family function.

Many children experience a sleep disorder at one point during their early years. Left untreated, this can have a major impact on learning, attention span, behavior, growth and development.

The first step in diagnosing a child’s sleep problem is to notice it. Among the most common are sleep apnea (snoring, start-stop breathing), insomnia (difficulty falling or staying asleep), restless leg syndrome (crawling sensations in the legs) and

To vaccinate or not to vaccinate? Health care experts urge parents to consider this question carefully. “The prevalence of polio, measles, rubella (German measles), diphtheria, chicken pox, H. influenza, and pertussis (whooping cough) has decreased dramatically since the

introduction of vaccines,” says Dr. Lee R. Atkinson-McEvoy, a pediatrician at UCSF Benioff Children’s Hospital. “However, we’re seeing more cases of some of these infections for a variety of reasons, including parents

delaying or declining their children’s vaccinations.”

In 2014, the Centers for Disease Control and Prevention reported a record number of measles cases. In California, there’s been a pertussis outbreak at high levels. “If your children aren’t vaccinated, they’re vulnerable,” says Dr. Atkinson-McEvoy. “For the health of your child and the community, have your child vaccinated.”

The American Academy of Pediatrics recommends that children receive nine vaccinations for 13 primary childhood diseases. For more information on these vaccines, go to www.ucsfbenioffchildrens.org/vaccinations.


Sweet dreams start here.

periodic limb-movement disorder (rhythmic leg kicking). The second step is to get a physician referral to a fully accredited pediatric sleep disorders center.

Hundreds of infants, children and adolescents are assessed at the UCSF Pediatric Sleep Disorders Center each year, sometimes including an overnight sleep study in one of the center’s comfortable, family-friendly sleep-lab bedrooms. “Treating a sleep disorder doesn’t just help the child,” says Dr. Church. “It benefits the entire family.”

For more information on children’s sleep disorders and the Sleep Disorders Center in San Francisco, go to www.ucsfbenioffchildrens.org/sleepcenter.


The doctors at the Pediatric Sleep Disorders Center will not stop until their little patients get a good night’s rest.

Vaccines virtually eliminated many infectious outbreaks of the last century. So why are these diseases making a comeback?

i thought whooping cough was wiped out.

A life restored: Deep brain stimulation is a revolutionary treatment for dystonia.12Pediatric relief 2,000 years in the making.14

The facts about vaccinations.16

Sleep disorders:Helping kids to get their zzzzzzzs.15

To explore a particular article in more detail, click on a title to the right.

extended articles

Breathing in all the possibilities.04 06 12

FALL / WINTER 2014

On the leading edge to clear more hurdles.

UCSF Benioff Children’s Hospital We got inside Francisco’s head and the results were electrifying.

10 Music therapy:It’s more than just songs.

11 On the horizon:New strategies for food allergies.

Once you’ve finished reading what we’re doing for children, why not discover what we’re doing for adults as well? Click here to read “Healing Abounds”.

The hospital’s mission is to take care of the entire child, body and spirit, and few clinical disciplines do this as well as music therapy.

It’s an evidenced-based science that can be described as a real multitasker. Music therapy interventions designed to address neurologic issues or help regulate heart rate also help patients with emotional processing and self-expression. It’s a compassionate science that opens a space for children to be children, and supports them on their path to recovery.

The idea of using music to help heal people is what drew the hospital’s music therapist, Oliver Jacobson, to the field. Music had always been his passion, so when he enrolled in Boston’s Berklee College of Music, he studied classical, jazz, violin and world music. But then an introductory course in music therapy showed him that music could do a lot more than fill stadiums. He entered the school’s four-year program and became a board-certified music therapist (MT-BC).

Today Oliver integrates his passion for music into every intervention he creates. There are no “typical” music therapy sessions because each one is individualized for a particular patient. A teenager with leukemia might be writing lyrics to a song to help her process the enormity of the disease,

while a neurological patient gets help through rhythmic exercises that improve his motor skills. An intervention can be vocal, too. Original rap songs are not unheard of on Oliver’s beat.

In fact, the beat goes on just about everywhere in the children’s hospital. Oliver can be found at a patient’s bedside as easily as he can be spotted making music with outpatients in the pediatric dialysis unit. His music therapy also supports patients with severe neurologic needs in the pediatric cardiac intensive care unit. And then there are the group music therapy sessions every Monday that turn the All-Star Room into an “open music studio.”

Encouraging family support is another way the hospital focuses on the whole child. It’s not unusual for moms, dads or siblings to be in a music therapy session, sharing the joy of seeing the patient “being themselves” again. You can even catch the nurses humming along. What they love about music therapy is that it distracts children from the discomfort of treatment. The nurses say it changes the vibe in a patient’s room and makes time pass in a pleasant way. And that makes everyone feel better.

Visit www.ucsfbenioffchildrens.org/musictherapy to see Oliver Jacobson making music for his young patients.

Music therapy: it’s more than just songs. Not many medical centers have a full-time music therapy program—but it makes perfect sense that UCSF Benioff Children’s Hospital San Francisco does.

For some children, exposure to even trace amounts of a certain food can have deadly consequences. The most serious is anaphylaxis––a life-threatening allergic reaction that requires immediate medical attention.

While non-food allergies can be treated with medication and immunotherapy (allergy shots), the only approved treatment for food allergies is avoidance. But that’s not always easy, especially when common allergenic ingredients such as wheat and peanuts can show up in unexpected places. And even less severe food allergies can cause uncomfortable symptoms like itchy skin rashes, stomach pain, wheezing and clogged sinuses.

Fortunately, there’s hope. At the Allergy Diagnostic and Treatment Center at UCSF Benioff Children’s Hospital, doctors are exploring exciting new strategies to better combat food allergies.

An accurate diagnosis is the critical first step. A potential new test, component resolved diagnosis (CRD), gives doctors and patients valuable information on the extent of a patient’s allergy.

“Current tests don’t really give us any information on how allergic a patient is to a certain food,” says Dr. Morna Dorsey, an allergist and immunologist, and head of the Allergy Diagnostic and Treatment

Center. “The patient may react to the substance, but we don’t know whether exposure will cause a life-threatening reaction or only mild symptoms. CRD can better predict the level of reaction, so patients can know whether or not a certain food has to be strictly avoided.”

CRD testing is currently considered an experimental treatment while it awaits FDA approval.

Another promising approach is oral immunotherapy. The strategy is similar to allergy shots: expose the patient to gradually increasing amounts of the allergenic substance to desensitize the immune system. In oral immunotherapy, the patient––under close medical supervision––swallows a tiny amount of the food that’s triggering the allergic reaction. Over a period of weeks or months, the amount is slowly increased, until the body gets accustomed to the food and exposure no longer triggers an allergic reaction––or triggers a less violent one.

“Even if oral immunotherapy doesn’t result in a cure, it may desensitize the patient’s immune system enough so that a small exposure doesn’t automatically trigger anaphylaxis but a milder reaction instead,” says Dr. Dorsey. She expects to be able to offer the treatment as part of a clinical trial soon.

The Allergy Diagnostic and Treatment Center treats patients with non-food allergies as well, focusing on a multidisciplinary team approach to address each patient’s individual needs. “Allergies can cause a whole range of symptoms––gastrointestinal, respiratory, neurological and skin problems,” Dr. Dorsey notes. “We recognize that to offer the best care, we need to work with a whole team of experts in other specialties to help us understand and manage each patient’s unique situation.”

For some children and their families, it’s been a long and difficult journey. “Many of our patients have gone through a diagnostic odyssey before they finally arrive in our clinic. When we’re able to diagnose the allergies that are causing their symptoms and come up with a comprehensive treatment plan, it can be a tremendous relief for them. Some parents just break down in tears.”

You’ll need a referral from your child’s pediatrician or specialist to make an appointment. Once you have the referral, call (415) 353-7337. For more information, visit www.ucsfbenioffchildrens.org/immunology.

on the horizon: new strategies for food allergies. For kids with severe food allergies––and their parents––the simple act of choosing what to eat can feel like navigating a minefield.

It was 2011, and the once active South San Francisco teen had seen his life turned upside down by a condition he and his parents had never heard of: dystonia. By the time Francisco and his parents turned to the Surgical Movement Disorders Center at UCSF Benioff Children’s Hospital San Francisco, he’d been experiencing a range of baffling and frightening symptoms for months. First, he lost control of his right hand; later, his right foot began twisting inward, and his neck muscles contorted in painful spasms, making it difficult to raise his head, speak or even swallow. As his symptoms worsened, he went from being a multisport, high school athlete and band member to barely being able to walk or lift a spoon to his mouth.

A neurological disorder that causes muscles to contract and spasm involuntarily, dystonia is the third most common movement disorder in the United States, after essential tremor and Parkinson’s disease. “Dystonia can affect anyone at any age,” says Dr. Jill Ostrem, medical director of the UCSF Surgical Movement Disorders Center and Francisco’s neurologist. “It occurs when the circuit in the brain that regulates movement doesn’t work in a normal way.”

Symptoms may affect a single part of the body––a hand or foot, for example––or spread to multiple body parts. In severe cases, dystonia can cause

disability and crippling pain as uncontrolled muscle spasms contort the body into awkward, uncomfortable postures.

Blood tests confirmed that Francisco’s condition was the result of a genetic mutation––a type often associated with more severe symptoms. But today, Francisco is pain-free, his symptoms are under control and his life back to normal––thanks to a remarkable surgical procedure called deep brain stimulation (DBS).

Most often used to treat patients with Parkinson’s disease, DBS has only recently been utilized to treat dystonia. “DBS is a great option for certain patients whose symptoms don’t respond to other treatments,” says Dr. Philip Starr, surgical director of the UCSF Surgical Movement Disorders Center. One of the leading experts in DBS surgery, Dr. Starr has performed the procedure on more than 100 dystonia patients and more than 1,000 Parkinson’s patients.

During the procedure, thin wires tipped with tiny electrodes are implanted in the brain. The electrodes are powered by a pacemakerlike neurostimulator, about the size of a quarter, which is implanted in the chest during a second, much shorter surgery. The neurostimulator sends carefully programmed electrical impulses to the electrodes to override the faulty brain signals causing the muscle spasms. Dr. Starr cautions that while DBS doesn’t cure dystonia, it often reduces symptoms significantly.

The surgery worked like a charm for Francisco. But perhaps the best part was that he slept through the whole procedure. Even more extraordinary is that he was in an MRI scanner at the time. “In the past, one of the challenges of DBS was that it required patients to stay awake throughout the entire procedure,” says Dr. Starr. “This allowed them to respond to stimulation during surgery, which helped guide electrode placement.”

But being awake during your own brain surgery can be challenging. “Even adults have a hard time with it,” says Dr. Starr. “For pediatric patients, it’s just not practical.” So instead, Dr. Starr, together with fellow UCSF neurosurgeon Dr. Paul Larson and imaging scientist Dr. Alastair Martin, invented a revolutionary technique that allows the entire procedure to be performed in an MRI scanner, while the patient is “asleep” under general anesthesia. Not only is this technique easier on the patient, but it helps with the precise placement of the electrodes in the brain. “The MRI provides real-time, high-resolution images of the patient’s brain during the surgery, allowing pinpoint accuracy for electrode placement and on-the-spot corrections as needed,” says Dr. Starr.

The newer technique takes half as long as the “awake” version of the surgery, and is less invasive, requiring fewer incisions. “This technique has proved to be a wonderful option for our pediatric

a life restored: deep brain stimulation is a revolutionary treatment for dystonia.For Francisco Alvarez, 15, the decision to undergo brain surgery wasn’t difficult.

patients,” notes Dr. Ostrem. “Many of our adult patients prefer it as well.”

DBS requires extraordinary skill, not only for the surgery itself, but also for programming the neurostimulator afterward. Settings can be adjusted with a remote control device. “By changing the frequency and amplitude of the stimulation, we affect the outcome,” says Dr. Ostrem. “The challenge is to achieve just the right level: high enough to control symptoms without causing side effects.” Francisco visits Dr. Ostrem about every six months to test and adjust his device.

For Francisco, now 18, it’s been a difficult journey, but he never lost hope. The decision to try surgery wasn’t easy, but after other treatments failed to help, DBS became the obvious next step. “The hardest part was going from being really active to not being able to do anything at all,” says Francisco. “I felt like I couldn’t live like that anymore. I decided I had to go for it.”

With the vast majority of his symptoms now gone, he’s happy with his decision. He’s attending community college, working part time in an afterschool program, and planning to get back into sports. “I’m able to do 90 percent of what I did before,” he says. Grateful for his own positive outcome, he’s also agreed to participate in clinical trials at UCSF to advance the treatment of dystonia.

“It’s a good feeling knowing I can help someone else,” he says.

To make an appointment for your child with a UCSF Benioff Children’s Hospital neurologist in San Francisco, call (415) 353-2311. For more information about dystonia surgery at our Oakland campus, call the Cerebral Palsy & Movement Disorders Center at (510) 428-3319.

So it’s surprising that Dr. Cynthia Kim would feel there was something missing from her medical education. But there was. Nothing had fully prepared her to handle the complexities of treating children in pain.

Conventional pain medications can cause nausea, constipation, itchiness and other side effects. Some treatments can affect the liver or kidneys. When Dr. Kim realized that 20 percent of her pediatric patients or their families were asking for other ways to manage pain, she turned to the East and the traditional Chinese medicine she’d grown up with in Korea—especially acupuncture. The 2,000-year-old practice uses thin needles (and now also laser and heat) to unblock channels of energy within the body, potentially enhancing the body’s natural healing abilities and biochemical balance.

“We have wonderful technology in the West, but we don’t have answers to everything,” says Dr. Kim, who subspecializes in pediatric pain management. Looking for options that were noninvasive and free of side effects, she decided to add the dimension of Eastern medicine to her practice. Luckily, she was at the right hospital.

The same way USCF Benioff Children’s Hospital San Francisco cares for the whole child physically and emotionally, it’s also open to treatments that include the entire spectrum of healing. Through its Integrated Pediatric Pain and Palliative Care Clinic, the hospital began offering acupuncture in conjunction with

traditional care and other complementary pain management strategies. Today, Dr. Kim is one of three physicians at the facility who is also a licensed pediatric medical acupuncturist.

Integrating acupuncture into her hospital practice offers Dr. Kim’s young patients the options she’d been looking for. “I can balance their medications with a complementary treatment,” she says. “I look at a child’s entire medical record and tailor his or her treatments to what’s happening. I do more and understand more.”

Acupuncture is also starting to be recognized by some insurance companies in certain cases. This is a significant benefit for the 3 million patients who seek out this ancient treatment each year to complement their traditional health care.

Now that the children’s hospital has incorporated acupuncture into its pain management program, Dr. Kim and her associates are conducting a controlled study to add to the body of knowledge about the treatment. Currently, they’re assessing how laser acupuncture can help children undergoing a renal biopsy—a procedure that can be painful and anxiety provoking for young patients. Preliminary findings show a 50 percent decrease in the use of pain medications and a significant reduction in procedure-related anxiety.

Numerous studies have also shown the benefits of acupuncture for chemotherapy-induced nausea in

children. In her own experience, Dr. Kim has seen patients get relief for fatigue and anxiety, in addition to back and neck pain.

When asked, “If the elevator doors were closing and you could tell parents only one thing about managing their child’s pain, what would you say?” she didn’t hesitate…

“Try acupuncture. It can help!”

For a referral to a UCSF Benioff Children’s Hospital San Francisco pediatrician, call (888) 689-UCSF (689-8273).

pediatric relief 2,000 years in the making.She completed her undergraduate studies at Harvard, received a master’s degree in health education from Stanford University, and graduated from Cornell Medical School.

If you’re not looking for something, chances are you won’t find it. This sums up the major challenge of treating sleep disorders in infants, children and adolescents. Parents, and some pediatricians, simply don’t know enough about sleep disorders to identify them. As a result, the symptoms of sleep deprivation in children are often overlooked or misdiagnosed.

But hopefully this will change because of physicians like Dr. Gwynne Church, director of the UCSF Pediatric Sleep Disorders Center. Leading the only sleep center in San Francisco accredited by the American Academy of Sleep Medicine and created for children, Dr. Church is raising awareness of healthy sleep as a fundamental building block of kids’ health. “Sleep is central to the way children and families function,” she says. “Whenever there’s a chronic disease that affects and impairs a child, it also affects the family.”

Sleep problems can wreak havoc on academic performance, cause behavioral and emotional issues, and contribute to the eventual development of serious physiological conditions like heart disease. Dr. Church encourages parents to be on the alert for symptoms that can be red flags for sleep disorders. This includes:

• Sleepwalking, ranging from going through repeated motions while sitting up in bed asleep to walking around the house with eyes open when still sleeping.

• Night terrors, in which children wake up screaming and flailing in fear, and remain in an agitated, semiconscious state for up to 20 minutes or more despite attempts to awaken them.

• Excessive daytime sleepiness, ranging from lapses in attention to irritability, hyperactivity and obvious sleep.

• Excessive leg kicking during sleep, signaled by leg jerking movements and constant changes in sleep positions.

• Trouble getting to sleep or staying asleep.

• Disordered breathing, including snoring, mouth breathing and sleep apnea (abnormally long pauses in breathing during sleep).

• A chronic sleep deficit that interferes with the functioning of the child or family.

An accurate diagnosis is essential because the effects of a sleep disorder can masquerade as symptoms of many other problems. For example, the diagnoses of attention defect disorder (ADHD) in children increased by 41 percent between 2003 and 2013. But many sleep experts believe that a considerable number of these children may have a sleep disorder instead. That’s because chronic sleep deprivation can make a child wired and moody, interfering with concentration and the ability to sit still or get along with classmates and teachers. Even

losing a mere 30 minutes a night of necessary sleep, either because of a sleep disorder or staying up late to play video games, may result in a child developing symptoms typical of ADHD.

Only a sleep study called polysomnographic (PSG) testing can provide a definitive answer about the presence of a sleep disorder. This overnight testing mode monitors sleep cycles, breathing patterns, heart rate, oxygen levels and other data. At the UCSF Pediatric Sleep Center Laboratory, overnight sleep studies in one of the labs’ comfortable, family-friendly rooms make it possible to gather the information necessary to diagnose problems and develop an individualized treatment plan.

One more important thing for parents to remember is to keep sleep on the agenda during well-child visits with their pediatricians, no matter what their child’s age. Sleep patterns are always a big topic for newborns, but the subject tends to fall off the radar as kids get older. And sleep is an especially big issue for teens. Which of course means, it’s a big issue for the whole family!

You’ll need a referral from your child’s pediatrician or specialist to make an appointment at the center. Once you have the referral, please call (415) 353-7337.

Sleep disorders: helping kids to get their zzzzzzzs.UCSF’s Pediatric Sleep Disorder Center is a good night’s sleep waiting to happen.

these diseases can be and how rapidly they spread.

In the past few years, reduced vaccination rates contributed to a resurgence of some diseases that were considered virtually eliminated. In 2014, the Centers for Disease Control and Prevention (CDC) documented a record number of measles cases, the majority of which were related to unvaccinated individuals.

Pertussis (whooping cough) has also made a comeback. It’s extremely contagious and particularly dangerous for infants too young to be vaccinated, who depend on adult and sibling immunization to protect them. In 2012 alone, the CDC documented 48,277 cases of pertussis nationwide.

California in particular experienced a surge of this disease, with 4,558 cases reported from January 1 to June 16, 2014, an increase of 2,000 more than the entire year of 2013.

“Serious diseases that had become rare are back, and endangering the most vulnerable members of our community: infants, older people and the chronically ill,” says Dr. Lee R. Atkinson-McEvoy, a pediatrician at UCSF Benioff Children’s Hospital San Francisco.

In addition to protecting children who are vaccinated, the benefits of immunization are shared by the entire community. The greater the number of people who are vaccinated, the more protection they create for those who aren’t able to receive the vaccine. This includes infants, the aged and those with

compromised immune systems. Community-wide vaccination also lowers the risk of a disease reaching the “tipping point” when it will become a full-fledged outbreak.

Dr. Atkinson-McEvoy’s advice to parents is simple: “It’s important to bring your children in to get vaccinated, or to have a discussion with your child’s physician,” she says. “A recent CDC report estimated that vaccines will prevent 322 million illnesses, 21 million hospitalizations and 732,000 premature deaths among children born in the last 20 years. Vaccinations have had a greater beneficial impact on child health than any other aspect of early medical care. If you have questions about vaccine safety, talk to your physician.”

To learn more about vaccinations and children, visit www.ucsfbenioffchildrens.org/vaccinations.

This added up to about 4 million cases of measles each year, some of which were fatal or seriously debilitating.

Polio also took its toll. In 1952, before the polio vaccine was developed, more than 21,000 people across the nation, many of them children, were paralyzed by the disease.

But with the introduction of vaccines, the prevalence of these and other dangerous diseases, including diphtheria, chicken pox, rubella (German measles,) H. influenza, pertussis (whooping cough) and tetanus was dramatically decreased.

Between 1989 and 1991, however, Americans found themselves in the throes of an extensive measles outbreak that spread to 49 states, putting more than 55,000 people out of commission for days. How could this happen in a country where the vast majority of children were vaccinated? There were large pockets of poor, uninsured children who hadn’t received the measles vaccine. The presence of these measles-vulnerable kids in the community was enough to set an epidemic into motion, claiming over 100 lives, most of them children.

Today, some parents are opting not to have their children vaccinated. Some are refusing all the recommended vaccines, while others are agreeing to only a few they want their children to have. From pediatricians to public health specialists, physicians are concerned about this trend, attributing it in part to a lack of knowledge about how devastating some of

the facts about vaccinations.In 1960, before the measles vaccine was introduced, 90 percent of Americans were infected by the virus by the time they were 15.

Unleash Your Inner Scientistoct. 23 – nov. 1, 2014 | www.bayareascience.org

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04 and the results were electrifying. Feature: We got ... · dystonia, a disorder that makes...

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Transcript of 04 and the results were electrifying. Feature: We got ... · dystonia, a disorder that makes...