1. Recent research allows for successful diagnosis and treatment of pediatric bipolar disorder
Pediatric bipolar disorder is a serious mental illness that affects at least 1 percent of children, resulting in significant developmental, social and emotional dysfunction, as well as academic failure. Indications are that early onset of bipolar disorder is significantly related to higher rates of anxiety, substance abuse, suicide and a chronic, more severe illness course. Recent research has allowed clinicians to accurately identify and successfully treat bipolar disorder in children and adolescents.
The diagnostic criteria for Bipolar I Disorder are the same for all ages and include a lifetime history of at least one manic episode. Children and early adolescents tend to present with rapidly cycling behaviors and a primarily irritable mood. Older adolescents and adults may present with more distinct periods of mood changes with a primarily euphoric mood. This rapid cycling or chronically ill presentation confuses the diagnostic picture of mania in children and adolescents. A manic episode consists of a period of time (at least one week) when the patient's mood has been abnormally and persistently elevated (euphoria) or irritable. If patients have been euphoric, they require three of the following symptoms; if they have been irritable, they require four:
- Grandiosity.
- Decreased need for sleep.
- Pressured or increased amount of talking.
- Flight of ideas or racing thoughts.
- Distractibility.
- Increased goal-directed activity or psychomotor agitation.
- Excessive pleasurable or high-risk activities.
These symptoms have to cause significant impairment in several areas of functioning and not be accounted for by any other mental or physical illness, including substance abuse.
The presentation of these manic symptoms in children is measurable, as long as developmental level is taken into consideration. In considering a bipolar disorder diagnosis and attempting to determine if mania is present, the following core symptoms from the above-mentioned diagnostic criteria should be considered:
Euphoria or elation can be difficult to distinguish in children. All children are giddy at times (such as during slumber parties). However, diagnostically a threshold of appropriateness should be considered. Families of children with mania do not think this giddiness, inappropriate laughter and elevated mood are funny or endearing. They find these moods disturbing and inappropriate, and often are annoyed and concerned.
Irritability in children experiencing mania can be relatively constant. Families describe these children as having the house "walking on eggshells." They have frequent, almost constant mood swings, as well as excessive and extended tantrums that can have unpredictable triggers. Aggression also may be associated with these mood swings and tantrums. Irritability is associated with many disorders of childhood and often is not the most helpful symptom in distinguishing mania.
Grandiosity can be confusing for clinicians evaluating children. All children may say things that are self-inflating, however, children who have a pathological level of grandiosity cross the threshold into believing they are better, stronger, smarter or more talented than others in a manner that is dysfunctional. They may act inappropriately on these beliefs, such as by telling adults what to do or engaging in risky, daredevil acts with no concern for their safety or the law.
Decreased need for sleep is easily assessed by a thorough 24-hour sleep history. A school-aged child should get 9 to 10 hours of sleep per day. The total amount of time slept in a 24-hour period should be determined. This includes naps and restorative sleep on the weekends. A true decreased need for sleep only is indicated in someone sleeping fewer hours cumulatively during the day with no resulting fatigue or recuperative sleep.
Pressured speech or the need to talk excessively is a relatively straightforward symptom. Children experiencing mania often speak rapidly, and frequently so quickly and excessively that others cannot understand or interrupt them. Some children may report their thoughts come so quickly they cannot get them out fast enough. Children may report their thoughts "need a stop sign," which can be indicative of racing thoughts.
Distractibility also is not particularly helpful in distinguishing mania in children since many children with bipolar disorder also meet the criteria for attention deficit hyperactivity disorder (ADHD). However, far fewer children with ADHD have bipolar disorder. The diagnoses can be distinguished by a trained clinician evaluating the above-mentioned criteria.
Increased goal-directed activity frequently is associated with the high energy level experienced by children with mania. They have more energy than most people, always are on the go and seem to engage in multiple projects or activities at once. At times these activities may be markedly creative or even unrealistic. Further, this increased energy, in combination with other hallmark symptoms, can result in high-risk behaviors.
Recognizing mania in children can lead to appropriate diagnosis and more effective treatment options. While it is a relatively rare diagnosis in the general population, for those children affected by bipolar disorder their level of impairment and resulting developmental problems can be significant. Early intervention and appropriate treatment appreciably can improve their quality of life, level of functioning and prognosis.
Source: Jennifer Niskala Apps, PhD, is a pediatric neuropsychologist in the Children's Hospital of Wisconsin Child and Adolescent Psychiatry and Behavioral Medicine Center. She also is an assistant professor of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin.
2. Tone Management Program assists children with spasticity
Many children with cerebral palsy, brain injury and spinal cord injury have something in common – spasticity. This increase in muscle tone can make moving, communicating, working and playing difficult, and leads to dependence on others. A new program, coordinated by Pediatric Rehabilitation and Fitness at Children's Hospital of Wisconsin, aims to address this problem.
The Tone Management Program focuses on improving children's level of function, comfort and ease of care, making them as independent as possible. Preventing problems related to spasticity, such as sleep disturbance, boney deformities, pressure sores and caregiver burden, also are goals.
The physiatrist, or physical medicine and rehabilitation physician, directs a team of specialists including orthopedists, neurologists, therapists and neurosurgeons in creating a long-term treatment plan tailored to meet each child's needs.
Spasticity commonly is treated using a multi-faceted approach including:
- Positioning devices and orthotics (braces).
- Physical, occupational and speech therapies.
- Oral medications, such as baclofen, Dantrium® and Valium®.
- Injectable medications, such as botulinum toxins and phenol.
- Surgical intervention, such as orthopedic, baclofen pump and rhizotomy.
These interventions may be used at different times or together depending on the severity and distribution of spasticity, age and diagnosis of child, impact on function, support systems available and orthopedic/neurologic status.
Typically, therapy is begun to stretch, strengthen and retrain spastic muscles, but aquatic or hippotherapy may provide wonderful alternatives for those "burned out" on traditional approaches. Foot, hip, trunk or hand braces – often made of soft materials that encourage, not limit, function – also can be helpful.
Medications
Oral medications, such as baclofen and Dantrium, can moderate tone, but because of their systemic distribution, they often cannot be titrated to the most effective dose without side effects. Baclofen commonly is given three times a day and can be taken long term. This medication should be crushed, as compounded elixirs are not stable and often have a variable effect. Dantrium is a capsule that can be used three times a day and is safely used in children, with only infrequent liver function monitoring needed.
Botox or phenol injections can focally treat a specific muscle that is out of sync with others or has become too tight due to rapid bone growth. Both medications work temporarily, so therapy to retrain muscles after the injections is important for long-term benefit. Botox easily is injected in the clinic setting with minimal discomfort. Its effect begins a few days after injection and lasts about three months. Phenol lasts much longer and is used in bigger muscles, such as those around the hip or knee. Its onset is immediate, and younger children may require sedation. Serial casting of the involved limb, which provides sustained stretch, is helpful when either drug is used.
Surgical interventions
Often, injections, pills and therapies are not enough to control the overwhelming effect spasticity has on function or orthopedic alignment.
Orthopedic surgery still is the mainstay of treatment for many children. While it does not alter spasticity itself, it can realign bones and muscles to give them a mechanical advantage that allows better function, less pain or easier brace fit. The timing of orthopedic surgery is important, and co-treatment with oral or injectable medications often is done at the same time. Gait lab studies can add important information about how spasticity is effecting movement, and the Children's Hospital Variety Club Orthopedic Clinic has one of only a few comprehensive clinical electromagnetic motion analysis laboratories in the country.
Selective dorsal rhizotomy is a neurosurgical procedure that cuts spinal rootlets, permanently altering tone to the legs. It allows a child with strong underlying muscles to walk more easily and with less energy consumption. It may allow some children to discard braces and walkers, and move independently. Daily therapy is needed post-operatively for best outcome, and younger children who can learn new gait patterns typically are best helped with this procedure.
Intrathecal baclofen pumps (ITB) are the newest tool to treat spasticity and dystonia in both arms and legs. This round disc is implanted under the skin and connects to a tube placed in the spinal canal. It can relax the limbs by "bathing" the spinal nerves in medication, doing so in a customized and reversible manner. While the pump needs occasional refilling in the clinic, its advantage is its ability to deliver medication tailored to the child's needs as they vary throughout the day, week or year. The improvement in arm and leg function, and the ability to "test" it before actual surgery is done makes it fairly unique.
Educating families, working with therapists and anticipating what interventions will best allow children to move, play and communicate – now and later in their lives – is our goal. Children may be referred through the Rehabilitation and Fitness Clinic or Cerebral Palsy Clinic for evaluation.
Source: Elizabeth Moberg-Wolff, MD, coordinates the Tone Management Program at Children's Hospital of Wisconsin and is an associate professor of Physical Medicine and Rehabilitation at the Medical College of Wisconsin.
3. Children's Hospital of Wisconsin rated third in the nation according to Child magazine's comprehensive study
Emergency Department number one in the nation; Herma Heart Center number five; Orthopedic services number six; Neonatal Intensive Care Unit number seven
In a comprehensive survey, Child magazine has rated Children's Hospital of Wisconsin as the third best children's hospital in the nation. In subspecialties, Children's Hospital's Emergency Department earned the elite ranking of number one in the nation in pediatric emergency medical care, the Herma Heart Center was rated fifth in pediatric cardiac care, the Variety Club Orthopedic Clinic was rated sixth in pediatric orthopedic care, and the Neonatal Intensive Care Unit was rated seventh in neonatal care. Survey results and articles about the top ten children's hospitals and five "super-specialties" are published in the February 2005 issue of Child magazine.
Children's Hospital's third overall ranking proved to be the greatest "upset" to this year's list, as the hospital has not been included on the list in previous survey years.
"This is only the third time that Child magazine has published this biennial report, and was by far the closest contest to date," said Karen Cicero, senior editor of Child magazine. "Children's Hospital of Wisconsin clearly emerged as a leader not only in the top ten, but as the prestigious third in the nation. The quality of pediatric care the hospital provides on so many levels is most impressive."
Children's Hospital's ranking is the result of Child magazine's comprehensive study of pediatric hospitals across the United States. In order to be selected, hospitals had to be full voting members of the National Association of Children's Hospitals and Related Institutions (NACHRI); 144 qualified. From that group, the field was narrowed to nearly 100 institutions based on evaluations by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The semifinalists received the 164-question survey developed by Child magazine's medical advisory board in spring 2004. The survey addressed critical areas of pediatric-specific care surrounding survival rates, heart surgeries, solid organ transplants, neonatology services, staff qualifications, nurse to patient ratios, research and clinical trials, family support and other services unique to pediatric health care. The Child magazine survey currently is the only comprehensive, data-driven ranking of children's hospitals in the nation.
"We are absolutely thrilled to have been ranked so high on this prestigious list," said Jon E. Vice, president and CEO of Children's Hospital and Health System. "We always have known that our hospital is a leader when it comes to caring for children. This ranking proves that we are highly competitive with the best in the nation, and now are part of this elite group."
Emergency Department ranked #1 in the nation
The Emergency Department (ED) at Children's Hospital was rated number one in the nation, and specifically highlighted in the Child magazine article. According to Cicero, only five hospitals were recognized for their emergency programs because of the unique and difficult set of criteria used to rank them.
"Despite the fact that Children's Hospital of Wisconsin's Emergency Department is one of the busiest in the nation, it was notably strong in all areas, including patient satisfaction scores, pediatric specific training of staff, staff to patient ratios, wait times, triage processes and prevention initiatives," Cicero said.
Also noted in the Child magazine article is the ED's commitment to keeping children out of the hospital. Prevention efforts like Project Ujima, which focuses on violence prevention and intervention; the Pediatric Emergency Care Applied Research Network, a federally funded network of leading pediatric emergency departments sharing research and information surrounding common childhood ED admissions; and clinical research on pain reduction measures were noted as pediatric emergency care unique to Children's Hospital.
More than 63,000 Emergency Department/Trauma Center and Children's Urgent Care visits are made each year. Children's Hospital was reverified as a Level I Trauma Center by the American College of Surgeons in 2004. The hospital currently is the only freestanding Level I Trauma Center dedicated solely to the care of children in Wisconsin.
Herma Heart Center rated #5 in the nation
Herma Heart Center was rated fifth in the nation for pediatric cardiac care. The center performed more than 700 pediatric heart surgeries, and nearly 12,000 total diagnostic, therapeutic and surgical procedures in 2003. In the highly competitive subspecialty of cardiac care, Children's Hospital has the best published survival rate for the Norwood procedure in the world. The center has achieved survival rates of greater than 98 percent for all cardiac operations for five consecutive years.
Child magazine noted that Herma Heart Center staff leads Project ADAM (Automated Defibrillators in Adam's Memory), a project that aims to eradicate sudden cardiac death in children through research, education and prevention initiatives. The center also coordinates with the Fetal Concerns Program, a joint initiative between Children's Hospital, Froedtert and Medical College that not only diagnoses babies with heart defects before they are born, but also offers services and care coordination to families faced with these diagnoses.
4. Regional outpatient clinics provide pediatric specialists closer to patients' homes
In addition to more than 70 pediatric specialty clinics located at Children's Hospital of Wisconsin near Milwaukee, Children's Hospital and Health System offers a number of outpatient clinics through its regional hospitals. Children's Specialty Group physicians staff the clinics and provide basic consultations, assessments and follow-up care.
These clinics provide area physicians with improved access to the pediatric experts needed by children in their communities. Patients and families benefit from the ability to see pediatric experts without having to travel to Milwaukee.
The clinic physicians are on staff at Children's Hospital of Wisconsin, Children's Hospital of Wisconsin-Fox Valley or Children's Hospital of Wisconsin-Kenosha. They also are faculty members at the Medical College of Wisconsin.
Children's Hospital of Wisconsin Clinics-Gurnee
This clinic opened in 1998 on the Greenleaf Professional Campus, Suite 201 at 310 S. Greenleaf Ave. in Gurnee, Ill. At this site, pediatric specialties offered include: asthma/allergy, cardiology, gastroenterology, neurology and urology. The asthma/allergy clinic treats children and adults. To schedule appointments, call (847) 662-4380.
Children's Hospital of Wisconsin Clinics-Kenosha
In 2002, this clinic opened on the Medical Professional Campus at 6308 Eighth Ave. in Kenosha, Wis. Pediatric specialties offered at this site include asthma/allergy, cardiology, gastroenterology, neurology and urology follow-up. The asthma/allergy clinic treats children and adults. To schedule appointments, call (262) 656-8895 for cardiology and (262) 653-2260 for all other specialties.
In addition, a pediatric cardiologist is available at the All Saints Medical Center Spring Street Medical Offices at 3807 Spring St. (2-North) in Racine, Wis. To schedule appointments, call (262) 687-8282.
Children's Hospital of Wisconsin Clinics-Fox Valley
Pediatric specialists have been seeing patients in the Fox Valley since 2000. The clinic is located in the Medical Office Building, Suite 480 at 200 Theda Clark Medical Plaza in Neenah, Wis. Pediatric specialty clinics offered here include: asthma/allergy, cardiology, endocrinology, gastroenterology/constipation, general surgery, pulmonology and urology. The asthma/allergy clinic treats children and adults. To schedule appointments with asthma/allergy or cardiology, call (920) 969-7970. For appointments with all other specialties, call (877) 607-5280.
Children's Specialty Group physicians also see patients at several other locations:
- Affinity Heart and Lung Center, 1611 S. Madison St., Appleton, Wis.–pediatric cardiology. To schedule appointments, call (920) 730-6700.
- Bellin Health Hospital Center, Medical Arts Building, 744 S. Webster Ave., Green Bay, Wis.–pediatric gastroenterology and pediatric surgery. To schedule appointments, call (920) 445-7272.
- Fox Cities Eye Clinic, 1301 E. Northland Ave., Appleton, Wis.–pediatric ophthalmology and adult strabismus services. To schedule appointments, call (920) 734-8714.
- St. Vincent Hospital, First Floor Clinics, 835 S. Van Buren St., Green Bay–pediatric endocrinology. To schedule appointments, call (920) 433-8345.
- Wisconsin Pediatric Cardiology Associates, Townsend Building, Suite 326, 10625 W. North Ave., Milwaukee, Wis.–pediatric cardiology. To schedule appointments, call (414) 258-4378.
5. Gastroenterology staff treats wide variety of digestive tract and liver disorders
The Gastroenterology Program at Children's Hospital of Wisconsin is a national referral source for the treatment of children with diverse digestive tract and liver disorders. Children's Specialty Group physicians provide comprehensive care for children within the region, as well as care plans and consultative services to primary care physicians outside the Midwest so children can be managed closer to home.
The program includes several pediatric gastroenterologists and specialty clinics to best address patients' and referring physicians' needs (see below). In addition, three scientists lead a number of research projects, including non-acid reflux and sleep disorders, developmental biology, gene types, obesity treatments and gastroesophageal reflux.
Physicians are on the faculty of the Medical College of Wisconsin and see patients at Children's Hospital. In addition, other Children's Hospital specialists provide care in these clinics including clinical nurse specialists, psychologists, speech-language pathologists, dietitians and social workers.
Colin Rudolph, MD, PhD, is the medical director of Gastroenterology at Children's Hospital. He also is a professor of Pediatrics (Gastroenterology and Nutrition) at the Medical College of Wisconsin and editor of Rudolph's Pediatrics 21st Edition textbook.
Programs/clinics and specialists
Celiac Disease Clinic – This clinic focuses on medical care, family education, psychological support and follow-up for this inherited immune mediated disorder affecting the small intestine. It is staffed by:
Constipation Clinic – This clinic is run by pediatric nurse practitioners to care for children with this common problem of childhood. It is staffed by:
- Marge Friedhoff, RN, MSN, CPNP.
- Margo Kinservik, RN, MSN, CPNP.
- Stephanie Mullin, RN, MSN, CPNP.
- Carol Roberson, RN, MSN, CPNP.
Gastrointestinal (GI) Motility Program – This program is staffed by:
General GI Clinic – This clinic offers diagnosis and treatment for a wide range of GI conditions such as g-tube placement/management, Crohn's disease, ulcerative colitis, abdominal pain, chronic vomiting, chronic diarrhea, failure to thrive or weight loss, pancreatic disorders and gastroesophageal reflux. It is staffed by:
- Praveen Goday, MD, nutrition.
- Kenneth Lee, MD, interventional endoscopy.
- Alfonso Martinez, MD, nutrition.
- Alan Mayer, MD, PhD.
- Adrian Miranda, MD, abdominal pain.
- Michael Stephens, MD, inflammatory bowel disease.
- Neelesh Tipnis, MD, motility.
- Steven Werlin, MD, motility and pancreatic disease.
Inflammatory Bowel Disease Clinic – This clinic provides family-centered care and consultation for children and adolescents with Crohn's disease and ulcerative colitis. It is staffed by:
Liver Disorders Program – This program provides care for children with liver disorders and those requiring liver transplants. It is staffed by:
NEW (Nutrition, Exercise and Weight Management) Kids TM Program – This program manages medical complications associated with children who are overweight. It is staffed by:
- Joey Skelton, MD.
- Denise Kilway, RN, MSN, CPNP.
Wal-Mart/Sam's Club Feeding, Swallowing and Nutrition Center – This program offers evaluation and management for children with swallowing problems. It is staffed by:
For more information
Specialists can be contacted directly through the Children's Transport and Physician Referral Center
(414) 266-2460 local
(800) 266-0366 toll free
To make an appointment
Central Scheduling
(414) 607-5280 local
(877) 607-5280 toll free
6. Pediatric Rehabilitation and Fitness program expands
Pediatric Rehabilitation and Fitness at Children's Hospital of Wisconsin helps practitioners and families care for children with impairments and disabilities. The team treats children in the hospital and in the community by helping to:
- Address the present and projected impact of disabling disorders.
- Identify, manage and monitor associated issues, impairments, disabilities and environmental factors.
- Establish objectives and coordinate and direct comprehensive plans.
- Determine, prescribe and acquire braces, wheelchairs and other needed durable medical equipment.
- Survey homes, schools and other environments for accessibility.
- Determine, prescribe and monitor therapies.
- Develop and direct families' education and instruction plans.
- Promote communication and interaction among health care providers, teachers and coaches.
- Prescribe medications and modalities, and perform procedures.
Elizabeth Moberg-Wolff, MD, and Melanie Cynthia Nicole Irwin, MD, recently joined Fred Klingbeil, MD, as part of the Pediatric Rehabilitation and Fitness team.
Klingbeil is the medical director of Pediatric Rehabilitation and Fitness at Children's Hospital and assistant professor of Physical Medicine and Rehabilitation at the Medical College of Wisconsin. He earned his medical degree from Wayne State University School of Medicine in Detroit before completing a combined residency in Pediatrics/Physical Medicine and Rehabilitation at the Detroit Medical Center. He is board certified in Physical Medicine and Rehabilitation.
Moberg-Wolff coordinates the Tone Management Program at Children's Hospital and is an associate professor of Physical Medicine and Rehabilitation at the Medical College. She earned her medical degree from the University of Wisconsin Medical School in Madison, Wis., prior to completing her residency at the Medical College of Wisconsin in Milwaukee and fellowship in Physical Medicine and Rehabilitation at the University of Colorado in Denver. Her clinical emphasis includes helping children and families successfully address the disabling consequences of burn injuries, cerebral palsy and spasticity. She is board certified in Physical Medicine and Rehabilitation.
Irwin is a pediatric physiatrist at Children's Hospital and assistant professor of Physical Medicine and Rehabilitation at the Medical College of Wisconsin. She earned her medical degree from Temple University in Philadelphia before completing a combined Pediatrics/Physical Medicine and Rehabilitation residency at the Medical College of Virginia in Richmond. She focuses on helping children and families address the impairments and disabilities associated with cerebral palsy, spasticity, spina bifida, neuromuscular diseases and feeding issues.
Two advanced practice nurses work with patients as part of the Pediatric Rehabilitation and Fitness program.
Pediatric Rehabilitation and Fitness staff see patients in the following clinics:
- Rehabilitation and Fitness Clinic.
- Cerebral Palsy Clinic.
- Gastroenterology Rehabilitation and Feeding Clinic.
- Spasticity Clinic.
- Neuromuscular Clinic.
- Seating and Equipment Clinic.
- Palliative Care/Fitness Clinic.
- Spina Bifida Clinic.
- Drooling Management Clinic.
7. Psychiatry Center establishes new intake procedure
The Child and Adolescent Psychiatry and Behavioral Medicine Center at Children's Hospital of Wisconsin has overhauled its clinic intake system to improve service to patients and provide a better referral process for community providers.
Nancy Reed, intake coordinator, is the single, centralized point of contact for parents and providers for psychiatric/mental health referrals. She works closely with patients and the interdisciplinary team to ensure a smooth and efficient experience for everyone.
Parents know at the time of their first call whether their child has been accepted for intake. Patients who have been accepted are assigned a physician or other clinician and a tentative appointment date, pending approval of their insurance. Patients who cannot be served by the clinic, for example, due to insurance constraints or a need for emergency psychiatric care, will be directed to appropriate care.
8. Cohen, dedicated pediatric surgeon, retires
After more than 32 years of service to pediatric patients, Roger D. Cohen, MD, retired from Children's Hospital of Wisconsin and the Medical College of Wisconsin on Dec. 31, 2004. He was a pediatric surgeon at Children's Hospital and an associate professor of Pediatric Surgery at the Medical College.
"Roger will be greatly missed. His surgical expertise, bedside manner and administrative leadership have been instrumental in moving surgical services at Children's Hospital to an exciting level," said Richard Berens, MD, pediatric anesthesiologist at Children's Hospital and associate professor of Pediatric Anesthesiology at the Medical College. "He has been innovative throughout his career, outlined by his lead role in establishing minimally invasive laparoscopic procedures in an attempt to decrease pain and duration of hospital stays."
Cohen's professional interests include congenital anomalies and newborn surgery, pediatric general and thoracic (non-cardiac) surgery, pediatric oncology, prenatal consults/fetal concerns and pediatric trauma and burns. He is board certified in Pediatric Surgery, General Surgery and Thoracic Surgery.
"Not only did Roger contribute significantly to the care of children in Milwaukee and to the training of countless numbers of residents–myself included–and students, but he also recognized the importance of professional citizenship by participating in medical staff affairs," said Robert Miller, MD, chief medical officer for Children's Hospital. "His active participation on many committees, including chairing the Tissue Review Committee for many years, as well as his service in leadership as the Surgery Department chief, exemplified his commitment to Children's Hospital and the community."
Cohen received his medical degree from Columbia University College of Physicians and Surgeons and completed his internship and a residency in the surgical division at Bellevue Hospital, both in New York. He served as a resident, surgical assistant and senior surgical resident at Presbyterian Hospital in New York. He also was a senior surgical resident and chief surgical resident at Children's Memorial Hospital in Chicago and a senior resident in thoracic surgery at St. Luke's Hospital and the Medical College of Wisconsin in Milwaukee.
"Following his training, Roger spent his entire professional life at Children's Hospital. For more than 30 years he served our patients as a productive and skillful general and thoracic pediatric surgeon," said Keith Oldham, MD, surgeon-in-chief at Children's Hospital and chief and professor of Pediatric Surgery at the Medical College. "In addition, his contributions as an educator helped create and nurture the Children's Hospital Pediatric Surgery Fellowship Program, now one of the most sought after training programs in the specialty in the United States. Lastly, his sense of humor and genuine good will have been a pleasure for all of us who worked with him."
9. Children's Specialty Group new hires
Critical Care
Jennifer McArthur, DO, a pediatric critical care specialist at Children's Hospital of Wisconsin, joined the department of Pediatrics (Critical Care) at the Medical College of Wisconsin as an assistant professor in August.
Medical school: Kirksville College of Osteopathic Medicine (Kirksville, Mo.).
Residency: University of Iowa (Iowa City, Iowa), Pediatrics.
Fellowship: St. Jude Children's Research Hospital (Memphis, Tenn.), Pediatric Hematology/Oncology; and LeBonheur Children's Medical Center (Memphis, Tenn.), Pediatric Critical Care.
Board certifications: Pediatrics and Pediatric Critical Care.
Dermatology
Sheila Galbraith, MD, a pediatric dermatologist at Children's Hospital of Wisconsin, joined the department of Dermatology at the Medical College of Wisconsin as an assistant professor in July.
Medical school: University of Iowa (Iowa City, Iowa).
Fellowship: Medical College of Wisconsin (Milwaukee), Dermatology.
Board certification: Dermatology.
Gastroenterology
Praveen Goday, MD, a pediatric gastroenterologist at Children's Hospital of Wisconsin, joined the department of Pediatrics (Gastroenter-ology) at the Medical College of Wisconsin as an assistant professor in November.
Medical school: Madras Medical College (Madras, India).
Residency: University of Connecticut (Hartford, Conn.), Pediatrics.
Fellowship: Children's Hospital Medical Center (Cincinnati), Pediatric Gastroenterology.
Board certifications: Pediatrics and Pediatric Gastroenterology.
Manu Sood, MD, a pediatric gastroenterologist at Children's Hospital of Wisconsin, joined the department of Pediatrics (Gastroenter-ology) at the Medical College of Wisconsin as an assistant professor in November.
Medical school: Indira Gandhi Medical College (Nagpur, India).
Residency: Birmingham Children's Hospital (Birmingham, United Kingdom), Princess Margaret Hospital (Swindon, United Kingdom) and Southampton University Hospital (Southampton, United Kingdom).
Fellowships: Birmingham Children's Hospital (Birmingham, United Kingdom), Gastroenterology and Nutrition; and Children's Hospital of Orange County (Orange County, Calif.), Pediatric Gastroenterology Motility.
Neelesh Tipnis, MD, a pediatric gastroenterologist at Children's Hospital of Wisconsin, joined the department of Pediatrics (Gastroenterology) at the Medical College of Wisconsin as an assistant professor in September.
Medical school: Medical College of Wisconsin (Milwaukee).
Residency: University of California, (San Diego), Pediatrics.
Fellowship: University of California, (San Diego), Pediatric Gastroenterology, Hepatology and Nutrition.
Board certification: Pediatrics.
Hematology/Oncology
William Grossman, MD, PhD, a pediatric hematologist/oncologist at Children's Hospital of Wisconsin, joined the department of Pediatrics (Hematology/Oncology) at the Medical College of Wisconsin as an assistant professor in August.
Medical school: University of Medicine and Dentistry (Camden, N.J.).
Residency: St. Louis Children's Hospital (St. Louis), Pediatrics.
Fellowship: St. Louis Children's Hospital (St. Louis), Hematology/Oncology.
Sachin Jogal, MD, a pediatric hematologist/oncologist at Children's Hospital of Wisconsin, joined the department of Pediatrics (Hematology/Oncology) at the Medical College of Wisconsin as an assistant professor in September.
Medical school: Washington University (St. Louis).
Residency: St. Louis Children's Hospital (St. Louis), Pediatrics.
Fellowship: St. Jude Children's Research Hospital (Memphis, Tenn.), Pediatric Hematology/Oncology.
Board certification: Pediatrics.
Neonatology
U. Olivia Kim, MD, a neonatologist at Children's Hospital of Wisconsin, joined the department of Pediatrics (Neonatology) at the Medical College of Wisconsin as an assistant professor in September.
Medical school: Indiana University (Indianapolis).
Residency: Children's Hospital of Michigan (Detroit), Pediatrics.
Fellowship: Children's Hospital of Michigan (Detroit), Neonatology.
Board certification: Pediatrics.
Rebecca Moran, MD, a pediatric neonatologist at Children's Hospital of Wisconsin, joined the department of Pediatrics (Neonatology) at the Medical College of Wisconsin as an assistant professor in August.
Medical school: University of Louisville (Louisville, Ky.).
Residency: University of New Mexico (Albuquerque, N.M.), Pediatrics.
Fellowship: University of New Mexico (Albuquerque, N.M.), Neonatology.
Board certification: Pediatrics.
Sajani Tipnis, MD, a neonatologist at Children's Hospital of Wisconsin, joined the department of Pediatrics (Neonatology) at the Medical College of Wisconsin as an assistant professor in September.
Medical school: Medical College of Wisconsin (Milwaukee).
Residency: University of California (San Diego).
Fellowship: University of California (San Diego), Neonatal/Perinatal Medicine.
Board certification: Pediatrics.
Neurosurgery
Sean Lew, MD, a pediatric neurosurgeon at Children's Hospital of Wisconsin, joined the department of Neurosurgery at the Medical College of Wisconsin as an assistant professor in September.
Medical school: Oregon Health Sciences University (Portland, Ore.).
Residency: University of Vermont (Burlington, Vt.), Neurosurgery.
Fellowship: Beth Israel Medical Center-Hyman-Newman Institute for Neurology and Neurosurgery (New York), Pediatric Neurosurgery.
Pediatrics
Jane Brotanek, MD, a pediatrician at Children's Hospital of Wisconsin, joined the department of Pediatrics (Community Pediatrics) at the Medical College of Wisconsin as an assistant professor in September.
Medical school: New York University (New York).
Residency: New York University (New York), Pediatrics.
Fellowship: University of Rochester (Rochester, N.Y.), Pediatrics.
Board certification: Pediatrics.
Pediatric Rehabilitation and Fitness
Melanie Cynthia Nicole Irwin, MD, a pediatric physical medicine and rehabilitation specialist at Children's Hospital of Wisconsin, joined the department of Physical Medicine and Rehabilitation at the Medical College of Wisconsin as an assistant professor in August.
Medical school: Temple University (Philadelphia).
Residency: Medical College of Virginia (Richmond, Va.), Pediatrics/Physical Medicine and Rehabilitation.
Elizabeth Moberg-Wolff, MD, a pediatric physiatrist at Children's Hospital of Wisconsin, joined the department of Physical Medicine and Rehabilitation at the Medical College of Wisconsin as an associate professor in September.
Medical school: University of Wisconsin (Madison, Wis.).
Residency: Medical College of Wisconsin (Milwaukee), Physical Medicine and Rehabilitation.
Fellowship: University of Colorado (Denver), Physical Medicine and Rehabilitation.
Board certification: Physical Medicine/Rehabilitation.
Pulmonary Medicine
Lynn D'Andrea, MD, a pediatric pulmonary medicine specialist at Children's Hospital of Wisconsin, joined the department of Pediatrics (Pulmonary) at the Medical College of Wisconsin as an associate professor in September.
Medical school: Medical College of Wisconsin (Milwaukee, Wis.).
Residency: Medical College of Wisconsin (Milwaukee), Pediatrics.
Fellowship: Yale University (New Haven, Conn.), Pediatric Pulmonary.
Board certifications: Pediatrics, Pediatric Pulmonary and the American Board of Sleep Medicine.
10. Condell Hospitalist Program completes successful first year
In January 2004, Children's Specialty Group and Condell Medical Center in Libertyville, Ill., started a 24-hour-a-day, seven-day-a-week pediatric hospitalist program. The program's goal is to support the primary care physician when a child is hospitalized.
Working hand-in-hand with the pediatrician, family practitioner or surgeon, quick responses to changes in a child's condition can be made around the clock. The hospitalists, who are onsite, can coordinate the inpatient management of complex care, which could involve several specialists. Hospitalist also easily can coordinate the continuum of care should a child's condition warrant the full services of Children's Hospital of Wisconsin for tertiary care.
Karim Shaltooni, MD, medical director of the program, and his team, Kathryn Martin, DO; Lola Odusanya, MD; and Aijaz Walji, MD; provide consultative care to infants and children in the emergency room and for those needing hospitalization when requested by the primary care physician.
"Condell Medical Center is an excellent medical center focused on enhancing the quality of service to families. Our physicians are pleased to represent Children's Specialty Group as the pediatric hospitalist team," Shaltooni said. "Our goal is to provide the best care to children and families close to home in conjunction with their primary care physicians. We have the ability to easily coordinate the continuum of care should a child's condition warrant the complex services of a pediatric tertiary hospital."
Condell's emergency room treats approximately 10,000 pediatric patients annually and expects to provide inpatient care to more than 1,000 infants, children and teens.
For more information about the Condell Pediatric Hospitalist Program or to request an inpatient consultation/admission, call (847) 990-2165, or contact Children's Specialty Group at (414) 266-3456.
11. Resident alumni focus: Rockford physician balances active practice and innovative teaching
Since completing his internship and residency at Children's Hospital of Wisconsin in 1984, Michael Potts, MD, has worked to blend his desire to provide excellent pediatric care and innovation in medical education.
Potts sees patients at an active clinical practice at the Women's and Children's Health Center, which is part of the University of Illinois College of Medicine campus in Rockford. He also is acting chairman for the Department of Pediatrics and an associate professor of Pediatrics at the college.
Potts earned his medical degree from the University of Illinois College of Medicine in Peoria, Ill. He then worked as a general pediatrician, first in DeKalb, Ill., and later in Escanaba, Mich., where he was the only pediatrician in a 50-mile radius.
"For many years I worked in a small rural area, and I had excellent preparation at Children's Hospital of Wisconsin for working independently with children at all levels of care," Potts said. "I felt very qualified to care for these patients as well as stabilize them and transfer them to Children's Hospital when needed."
Seeing patients at the Women's and Children's Health Center currently takes up about half of Potts' time. His patients at this ambulatory practice include infants through adolescents from the city of Rockford and three surrounding counties. The practice includes a second pediatrician and a nurse practitioner, and the three of them see 35 to 60 patients a day depending on the season. In addition, Potts provides inpatient pediatric, nursery and delivery room coverage at all three Rockford hospitals.
"Minor acute illnesses are the most frequent reason for visits to our center, but we also treat plenty of asthma, feeding problems, failure to thrive and more. In addition, we are seeing an increased number of chronic and technology-dependent children at our center," Potts said. "Many of our patients receive Illinois Public Aid, and we face the continual challenge of finding conveniently located, timely and skilled subspecialty care to meet their needs."
It was while he was in the Upper Peninsula of Michigan that Potts began his career in medical education. He first served as a preceptor and curriculum coordinator for students from Michigan State University and later became assistant director of Undergraduate Medical Education at the college's Upper Peninsula campus.
Potts continues to be actively involved in pediatric medical education. In addition to his faculty position and chairman responsibilities, he works with a family practice intern or third-year medical student at least two-thirds of the year. Over the years he has received several teaching awards and distinctions.
"I think teaching as well as practice adds so much to my career. I can't really envision not doing both at this point," Potts said.
Potts has helped promote the institution of some exciting innovations in pediatric medical education. His department is one of only a half dozen programs nationally to fully integrate the Computer Assisted Learning in Pediatrics Project, developed by the national Council on Medical Student Education in Pediatrics. This project offers 31 Internet-based pediatric cases that deliver information and allow students to practice differential diagnosis and problem solving.
Potts knows first hand that faculty clinicians feel the pressures of balancing clinical practice and teaching, and he is passionately committed to the notion that providing excellent medical education is necessary for quality medical care in the future.
"It's hard to learn good medical practice on your own. We need dedicated teachers to help students interpret the data they collect and help them develop skills in problem solving, patient advocacy and empathy for their patients," Potts said. "We can't expect students to learn this all from books and protocols if we want to provide tomorrow's children with the quality care they need."
12. Pediatric sleep disorders common, but often underdiagnosed
A good night's sleep is crucial for children's healthy growth and immune system development. Sleep also affects behavior–exhausted children are more likely to be cranky and irritable and do poorly in school. A recent survey sponsored by the National Sleep Foundation found that 30 percent of parents believe their children are not getting enough sleep. Seventy-six percent of parents would change something about their child's sleep behavior.
Children spend at least one-third of their time asleep, and they need to get as much as possible out of that time. However, sleep disorders are quite common in children. For a list of the most common pediatric sleep disorders, see Page 15.
The Children's Hospital of Wisconsin Sleep Center has the only board-certified sleep specialists in the state dedicated solely to children, from infancy through adolescence. A virtual tour of the center is located at www.chw.org/virtualtours.
Sleep Center overview
The Sleep Center at Children's Hospital was established in 1981 to diagnose and treat infants with apnea. It has grown into a state-of-the-art facility to diagnose and treat children of all ages who have respiratory and non-respiratory sleep disorders.
Children often are seen first in the Pediatric Sleep Disorders Clinic to evaluate their symptoms. Some children require only behavioral intervention, while others require detailed evaluation in the sleep laboratory.
The sleep laboratory is a four-bed facility designed to make each child and family feel at home. Physicians are board-certified intensivists and pulmonologists specializing in children with sleep disorders. A pediatric nurse practitioner also is an integral part of the program.
The Sleep Center is equipped to see children of varying medical complexity. This includes children who snore or who have noisy breathing and those who may be suffering from sleep apnea. Other areas of study include more complex children such as those who are overweight and may require CPAP or BiPAP for management of their obstructive sleep apnea. In addition, the center treats medically fragile children who may require ventilator support during sleep.
Sleep Center staff
Thomas Rice, MD, FAAP, FCCP, a pediatric pulmonologist, pediatric critical care specialist and medical director of Critical Care and Lung Transplants at Children's Hospital, oversees the Sleep Center. He also is professor and chief of Pediatrics (Critical Care) at the Medical College of Wisconsin. Rice received his medical degree from Creighton University, Omaha, Neb. He completed fellowships in Pediatric Critical Care and Pediatric Pulmonary Medicine at the Medical College of Wisconsin, Milwaukee, and Tulane University, New Orleans, respectively. He is board certified in Pediatrics and Pediatric Critical Care Medicine. He specializes in pediatric critical care and pulmonary medicine, with specific interests in children with sleep-related hypoventilation, complex upper airway problems and mechanical ventilation. He also has specialized in the care of children with sleep disorders since 1983.
Hari Bandla, MD, FAAP, leads pediatric sleep education and training for the Sleep Center. He received his medical training in India and the United Kingdom before serving his pediatric residency at Columbus Hospital, Chicago. Bandla is board certified in Sleep Medicine. His interest in sleep medicine began in 1996 during his fellowship in Pediatric Pulmonary Medicine at Tulane University, New Orleans. Earlier this year, Bandla received the first educational grant from the American Sleep Medicine Foundation to fund research to develop educational tools for the advancement of sleep medicine education for medical trainees.
Lynn D'Andrea, MD, who coordinates the Pediatric Sleep Disorders Clinic, received her medical degree and served her pediatric residency at the Medical College of Wisconsin, Milwaukee. A desire to study sleep medicine led her to a fellowship in Pediatric Pulmonary Medicine at Yale University, New Haven, Conn. Over the past 10 years, she has served on the faculty at the University of Virginia and the University of Michigan. A native of Oshkosh, Wis., D'Andrea returned to the Medical College of Wisconsin in 2004. She is board certified in Sleep Medicine.
D'Andrea has received funding from the National Institutes of Health to investigate the mechanisms of upper airway obstruction in children with sleep apnea. She recently was elected to the Medical School Education Committee of the American Academy of Sleep Medicine.
Thom Feroah, PhD, is an assistant professor Pediatrics (Critical Care) at the Medical College of Wisconsin. His doctorate of philosophy is from the Medical College of Wisconsin. He has received funding from the National Institutes of Health to investigate issues of control of breathing related to sleep-wake states.
Megan Grekowicz, RN, MSN, APRN, is the nurse practitioner for the Sleep Center. She completed her undergraduate and graduate nursing education at the University of Michigan, Ann Arbor, Mich. She is board certified as a Family Nurse Practitioner.
Most common pediatric sleep disorders
- Behavioral sleep disorders such as insomnia or sleep-onset association disorders.
- Circadian rhythm disorders such as delayed sleep phase syndrome.
- Parasomnias such as night terrors, sleepwalking or bedwetting.
- Obstructive sleep apnea.
- Narcolepsy.
When working with parents who believe their child may not be getting enough sleep, consider asking the following questions:
- Does your child have problems falling asleep or staying asleep?
- Is it difficult to wake your child in the morning?
- Is your child tired or falling asleep during the day?
- Does your child snore?
- Does your child have frequent nightmares, night terrors or episodes of sleepwalking?
- Does your child wet the bed?
If a parent answers yes to any of these questions, your patient may benefit from further evaluation at the Sleep Center. Be sure to ask how much sleep the parent believes the child is getting on average.
Children's Hospital of Wisconsin Sleep Center
Referrals can be made by calling the center at (414) 266-2790.
All referrals are reviewed by a physician. You may be contacted for additional information regarding evaluation in the Pediatric Sleep Disorders Clinic or an overnight sleep study.
Center staff
- Thomas Rice, MD, FAAP, FCCP
- Hari Bandla, MD, FAAP
- Lynn D'Andrea, MD
- Thom Feroah, PhD
- Megan Grekowicz, RN, MSN, APRN
Virtual Tour
www.chw.org/virtualtours
Mark your calendar for Best Practices in Pediatrics, Winter 2005
Children's Specialty Group will present a conference titled Best Practices in Pediatrics, Winter 2005 on Saturday, March 5, at the Kalahari Resort in Wisconsin Dells, Wis.
Topics covered at the conference will include: pediatric dermatology, gastroenterology, otolaryngology (ear, nose and throat), urology and pediatric and adult asthma/allergy.
Watch your mail for details or call the Children's Specialty Group office at (414) 266-6556 for more information.
13. Children's Transport and Referral Center provides one source to connect with Children's Hospital specialists
If you have an emergency, emergent or non-urgent patient issue, you have an easy way to access services at Children's Hospital of Wisconsin. With a single call to the Children's Transport and Physician Referral Center, you will connect with the resources you need, whether facilitating a patient transport, consulting with a physician specialist or setting up a clinic appointment with a pediatric specialist.
Transport nurse clinicians staff the line 24 hours a day, seven days a week. Nurses will expedite your transport, page the pediatric specialist on call or help you schedule an appointment for your patient with an appropriate specialist.
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