Focus on Pediatrics Winter 2019

Sickle Cell Disease Program Mental Health First Aid CME: ADHD and digital media

Vol. 31.1 Winter 2019

on Pediatrics

A comprehensive approach to pediatric pain

Focus on Pediatrics is published by Children’s Hospital of Greenville Health System.

Medical Editor Joseph L. Maurer, MD Managing Editor Lark Reynolds GHS Photographer AV Services Art Director GHS Creative Services Editorial Board Nichole Bryant, MD Donna Carver, CFRE Carl Cromer, MSN, FNP-BC Jeanine Halva-Neubauer Carley Howard Draddy, MD Jennifer Hudson, MD Emily Hughes Desmond Kelly, MD Terri Negron, MN, RN Janine Sally, MS, CCC-SLP Robert Saul, MD Kerry Sease, MD, MPH If you would like your name added to or removed from our mailing list or have any comments, questions or suggestions, please send the appropriate information to: Marketing Services Greenville Health System 300 E. McBee Ave. Suite 200 Greenville, SC 29601 864-797-7544 The information contained in the Focus is for educational purposes only–it should not take the place of medical advice or diagnoses made by healthcare professionals.

FROM THE MEDICAL DIRECTOR

Continuing the mission As we start into 2019, we will look forward to exciting things ahead, but it will also be a time to reflect on the iconic career of a man who has been the smiling face of Children’s Hospital for the past 28 years.

William F. Schmidt III, MD, PhD, retired in January. His remarkable career laid the foundation and helped build a nationally recognized children’s hospital right here in the Upstate. So many physicians, staff, and pediatric patients and families have had their lives changed for the better because of him and his work – myself included.

This year, we also will see the name Greenville Health System retired and replaced with Prisma Health℠ as GHS and Palmetto Health continue on the path to create the largest and most comprehensive health care system in South Carolina.

Children’s Hospital will be branded with a distinctive logo, and Buddy the Bear, the longtime mascot of Children’s Hospital in the Upstate, will be adopted as the mascot for the Children’s Hospital at Prisma Health’s Midlands affiliate, too.

The two children’s hospitals will align more closely to build on the strengths both bring to the partnership. Using technology, we will be able to share outstanding grand rounds speakers, resident and medical student curriculum, and rotations.

The state’s only comprehensive dedicated pediatric rehabilitation hospital will open in the Midlands, so that our patients will have access to services without having to go out of state. Our partnership will allow NICU and other specialized pediatric areas to realize larger scale savings and efficiencies that were not possible before.

I am excited that children’s services and our dedicated providers will continue to be an integral part of the important mission of improving the health of the children of South Carolina.

Robin N. LaCroix, MD, Chair, Department of Pediatrics

All facilities and grounds of Greenville Health System are tobacco free.

“Greenville Health System” and GHS symbol design are trademarks of Greenville Health System.

© 2019 Greenville Health System 19-0140

The two children’s hospitals will align more closely to build on the strengths both bring to the partnership.

CONTENTS

Team approach is a game-changer for children with chronic pain 2 Pediatric Pain Medicine practice is providing children suffering from chronic pain with a way forward.

Lifelong care for a lifelong condition

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Comprehensive Sickle Cell Disease Program provides a stable medical home for patients of all ages with the condition.

First aid for a different kind of health issue 18 GHS is partnering with community organizations, schools and public safety agencies to equip more people to intervene in the lives of those with mental health issues.

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Departments What’s New? 6 Nasometry, pediatric procedure room in Radiology, Camp Cary’s Kids for younger children

Medical Staff Spotlight 7 Meet our new physicians

Academic News 9

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Collaborating to address nursing shortage

CME 10

ADHD and digital media

Quality Counts 15

Small Baby Unit highlighted by South Carolina Neonatal Medical Consortium

Celebrations 20

Awards and philanthropic news

Bulletin from the Bradshaw Institute 23

Family-centered pediatric weight management intervention

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Clinical Research 24

Auditory integration therapy research

Ask the Faculty 26

New AAP child safety seat recommendations

How can we improve Focus on Pediatrics?

Fill out a brief survey to let us know your thoughts about the usefulness of this publication and how we can make it more helpful for our audience.

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surveymonkey.com/r/DWS8FPC

On the cover: Blake Windsor, MD, a pediatric pain medicine physician, evaluates 16-year-old Rachael Brown during her initial assessment.

To access this publication online, go to www.ghs.org/publications.

LEAD STORY

Victoria Helmus, PT, measures range of motion on 16-year-old Rachael Brown during her initial assessment.

A comprehensive approach to pediatric pain Victoria Helmus, PT, was fresh out of physical therapy school when she began working with Kidnetics®, the pediatric therapies arm at Children’s Hospital of Greenville Health System. Helmus said lots of the patients she saw were considered “easier cases” – knee pain, back pain, basic orthopaedic issues.

“Many kids would keep coming back in and reporting 8 out of 10 pain, even while from an orthopaedic, physical standpoint, things looked pretty good,” Helmus recalled. “I felt like I was missing something. Why were they still, after more than six months, having pain?”

She started to do some research and found mountains of new information on pain and the most appropriate way to effectively treat it in children.

Now, Helmus is a member of GHS Children’s Hospital’s newest specialty, Pediatric Pain Medicine. She works alongside Blake 2

Windsor, MD, a fellowship-trained pediatric pain medicine physician, and Ben Jones, PsyD, a pediatric psychologist with formal training in pain psychology.

Dr. Windsor echoed Helmus’ sense that there was a better way to help patients with ongoing, unexplained pain. It was something he first noticed during his residency training at Boston Children’s Hospital.

“What I gathered from working on the floor with these patients was that they were being highly stigmatized by the care providers themselves because of their pain and suffering,” Dr. Windsor recounted. “While the teams taking care of them were very good at managing their chronic conditions, they didn’t really know how to help them feel better. That lack of ability to help turned to frustration from the medical teams and, ultimately, that frustration turned into blaming and stigma.”

Children’s Hospital’s Pediatric Pain Medicine practice is unique in its approach to pain, treating it in a multifaceted way that includes pharmacologic methods in addition to psychological counseling, physical therapy and complementary therapies such as acupuncture.

“When we talk about pediatric pain, what we really mean is pain that is limiting patients from doing something they want to do,” said Dr. Windsor.

That could include playing sports, attending school, doing things around the house or going out with friends. Research shows that the best way to treat such pain is using the biopsychosocial model.

“That means understanding the biological contributions of disease and injury to pain; the thoughts, feelings and opinions that patients have about their pain; and how they interact with their environment at school and at home,” Dr. Windsor noted.

After its start in August 2018, the practice is seeing about 12 patients a week. Referrals come from across the spectrum of pediatric specialties, from neurology and rheumatology to orthopaedics and gastroenterology.

“Sometimes a patient may have a more traditional disease such as inflammatory bowel disease, cancer or sickle cell disease, but that doesn’t mean he or she can’t also have complicated pain above and beyond what is going on in the tissues,” Dr. Windsor pointed out.

During an initial evaluation, Dr. Windsor seeks to understand what pain generators exist.

“We use the term ‘pain generator’ as opposed to injury or disease because that generator might be small,” he explained.

“It might not reach the threshold of being a disease state. It could be something like their biomechanics being off, their posture being off, a small limb length discrepancy or tight muscles that might be contributing to joint pain.”

His team also will assess how the tissues are activating the nerves and how the nerves are functioning. Then they will develop a treatment plan. A plan might include medications

such as muscle relaxers, anti-inflammatories or neuropathic medicines, as well as physical therapy and psychological counseling.

“We work to understand how people are thinking about their pain,” stated Dr. Windsor. “We have psychologists who work with our program to help us understand the contributing factors that can be very subtle.”

Once patients begin treatment, it often is Helmus who sees them most – usually once a week for physical therapy. The team holds a pain clinic at Greenville’s Center for Developmental Services on Wednesday and Friday mornings.

“I have to be able to know a little bit of everything, so I can pull it together for them during our sessions,” Helmus said.

For instance, she might remind a patient of an analogy Dr. Windsor shared to help him understand his pain, or help a patient work through some of the pain psychology tips he’s been given.

Education as treatment

Helmus said a key part of treatment for these patients is education.

“The main focus is on function and getting them moving again, and pairing that with a lot of pain education,” Helmus emphasized. “Over the last 15 or 20 years, there has been a lot more research on pain and how it works, and we’ve come up with a bunch of different handouts that are kid-friendly to explain patients’ pain to them. We’ve found that the more we teach patients about pain, the more it makes the idea of pain less scary and rather, something they can conquer.”

Helmus is the only physical therapist with advanced training in pain, but she’s working on recruiting colleagues so that more patients will have access to the therapy. In the meantime, she said, all clinicians who play a role in patients’ care can help them better understand and manage their pain.

“It’s amazing how powerful what we say is,” Hemus remarked.

“Especially for these kids – what you say can really get ingrained in their minds.”

Pediatric Pain Medicine is supported by GHS’ Office of Philanthropy. In 2018, funds came from the BMW Charity Pro-Am golf tournament (see Page 20), and efforts to continue this support in the 2019 tournament are ongoing.

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A primary care pediatrician who understands current research on pediatric pain can offer messaging as valuable as what Helmus shares with them during her physical therapy sessions.

Helmus suggests ExplainPain.com as a good resource.

Tackling pain as a team

“On their website, there are things that talk about how to explain pain on a patient’s level, and they have different toolkits for kids,” she stated.

“What these families want is relief,” Dr. Windsor emphasized.

“They want relief for their child; they want relief for their family.

We’ve had a few patients cry good tears of feeling heard and validated, of feeling like finally they had a plan, and a team they can go to that will help them get their life back.”

Avoiding opioids

Any practice that carries the name “pain” in it runs the risk of becoming caught up in debates about the opioid crisis in the U.S., but Dr. Windsor said the reality is that multidisciplinary programs like this one are actually a way of moving patients and families away from opioid use for pain relief.

“In our field, most people just want to feel better,” he observed.

“And the fewer tools you have, the more you rely on opioids.

We know how to treat pain without using opioids. The problem is the resources and time to do it, and GHS is affording us the opportunity to do those sorts of things.”

Families will occasionally ask him to prescribe opioids for a child struggling with pain. In those situations, he has a frank conversation about the known side effects of opioid use.

The addictive potential obviously tops the list, but there are numerous other potential downsides to using opioids, including compromising the immune system; changing the testosterone levels of adolescent boys; and causing sleep problems, depression and weight gain.

“It can affect every aspect of your body,” Dr. Winsdor said.

“And we know that the longer people take opioids, the more tolerant they get to them, so the higher doses they need, and then they get more side effects. I think when you have that type of conversation with families, they often understand why you’re not wanting to recommend it.”

When families learn more about the alternatives Dr. Windsor and his team recommend and provide access to, many times there is a wave of relief.

Dr. Windsor is quick to point out that the individual components of treating pain his team members are doing are not new, but the ability to offer patients a multidisciplinary team with all members on the same page of working to manage and reduce pain is something new.

“People here have been getting good care for their pain,” he noted. “What we are able to offer is more of a package and a direction and a plan for these patients to recover, and recover in what is a much more long-term way.”

Helmus agreed that the team approach is one of the biggest benefits of the Pediatric Pain Medicine program.

“We all work together,” she said. “In the past when I would try to treat these patients, they might be seeing a counselor at school, and I would have no idea what the counselor was telling them. I wouldn’t know what their other doctors were telling them. Now that we’re all on the same page, I think we’re going to be able to make even more progress for these kids that have been having pain for so long.”

Promoting self-sufficiency

When patients first walk in the door at Pediatric Pain Medicine, many are out of school because of their pain, seeing multiple specialists and unable to do much of anything that children their age do for fun.

“In our field, most people just want to feel better, and the fewer tools you have, the more you rely on opioids. We know how to treat pain without using opioids. The problem is the resources and time to do it, and GHS is affording us the opportunity to do those sorts of things.”

– Blake Windsor, MD

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Blake Windsor, MD, spends time during an initial evaluation working to understand the pain generators that are contributing to a patient’s pain.

“Essentially, they’re just not living a life that is compatible with where children and adolescents need to be going to become self-sustaining, productive members of society,” he stated.

While some patients may be able to eliminate most of their pain, often the goal is one where patients can manage their pain by themselves.

“Our goal is for people to be able to live their lives – they might have to do things a little bit differently, but we want to give them the tools as adolescents that they can continue using for the rest of their lives,” Dr. Windsor remarked.

For example, Dr. Windsor would consider it a success for a patient to get down to a single medication for migraine headaches, which he or she could see a primary care doctor or neurologist for; visit an acupuncturist to treat winter headache flare-ups; and do yoga once a week for social benefits and physical conditioning.

“You can do that for the rest of your life – that’s not problematic,” Dr. Windsor said. “You can work a job and manage all of those things. That would be considered normal behavior.”

The Pediatric Pain Medicine practice at Children’s Hospital is one of a few such comprehensive pediatric programs in the nation.

The American Pain Society maintains a list of all pediatric pain programs in the U.S., and the closest similar programs are located in Atlanta and Washington, D.C. Dr. Windsor believes the reason there aren’t more programs boils down to hospital leaders not recognizing the need and being willing to commit the necessary resources.

“That was one of the major reasons why I came to Greenville,” he shared. “GHS saw the need for it. I just think that’s very exciting, very forward thinking, and so far, the leadership has been incredibly supportive.”

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WHAT’S NEW? Children’s Hospital of Greenville Health System kicks off a new camp experience and adds a new therapy tool and imaging space.

Kidnetics® adds nasometry Kidnetics, GHS Children’s Hospital’s pediatric therapies arm, has begun offering nasometry as a tool for identifying and treating nasality problems often associated with cleft palate and other velopharyngeal disorders.

Many patients with these conditions also have a co-existing feeding disorder. Use of a nasometer, which measures the modulation of the velopharyngeal opening during speech and can detect nasal emission, helps identify patients at risk for feeding and swallowing difficulty resulting from nasality issues.

Funding for the nasometer was provided by a grant from the Margaret Linder Southern Endowment Grant, established with Community Foundation of Greenville.

Radiology procedure room Camp Cary’s Kids to be offered launches A room exclusively configured for pediatric radiology procedures for younger patients has been developed at Greenville Memorial Hospital, giving Camp Cary’s Kids, a weekend family camp for medically complex patients and those receiving supportive care services from GHS Children’s Hospital, will hold its first session for patients under 11 years old May 10-12, 2019. Camp Cary’s Kids takes place at Pleasant Ridge Camp and Retreat Center in Marietta, S.C. The camp is open to patients, their parents/caregivers, and siblings age 5 and older. It is designed to be a family vacationlike experience for these families who may not often be able to take vacations. Activities include pampering sessions for parents, swimming, canoeing, hiking, singing around the campfire and making a family craft. Health care professionals will be on-site to assist with medically complex care.

The first camp session, which was offered for patients 11 and older, took place August 2018.

GHS’ Office of Philanthropy is working to create an endowment for camps so that the variety of camps available to Children’s Hospital patients can continue to be supported for many years.

Any Children’s Hospital physician interested in developing a camp experience for a specific population should contact Denise Wiklacz at dwiklacz@ghs.org or Donna Carver, CFRE, at dcarver@ghs.org.

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these young patients a more private space designed with children in mind. The procedure room also offers a private waiting room, which creates an oasis from the bustling activity of the traditional radiology area.

MEDICAL STAFF SPOTLIGHT Children’s Hospital of Greenville Health System (GHS) welcomes several new physicians to the GHS Medical Staff.

Meet our new physicians General Pediatrics

Inpatient Pediatrics

Julie M. Linton, MD, FAAP, earned her medical degree from Perelman School of Medicine at the University of Pennsylvania in Philadelphia. She completed a residency in Pediatrics at The Children’s Hospital of Philadelphia.

She spent two years in a community internship with the Wake Forest School of Medicine Clinical and Translational Science Institute Program in Community Engagement, where she focused on immigrant child health, and currently is participating in Culture of Health Leaders, a program of the Robert Wood Johnson Foundation co-led by the National Collaborative for Health Equity and CommonHealth ACTION.

Annie T. Moroski, MD, earned her medical degree from Medical University of South Carolina in Charleston. She completed her residency training in General Pediatrics at University of California Irvine/Children’s Hospital of Orange County in Orange, Calif.

Dr. Moroski completed a fellowship in Pediatric Critical Care at Harbor UCLA/Children’s Hospital of Orange County in Torrance. She is working as a pediatrician at Kids’ Care, an urgent care facility at AnMed Women’s and Children’s Hospital. She can be reached at 864-512-6544.

Dr. Linton is co-chair of the American Academy of Pediatrics’ Immigrant Health Special Interest Group. She is working as a pediatrician at Center for Pediatric Medicine. Dr. Linton also is serving as medical director of the PASOs program at GHS. Dr. Linton can be reached at 864-220-7270.

Ashtin Nix, MD, completed her medical degree at University of Kentucky College of Medicine in Lexington. She completed her residency training in Pediatrics at GHS Children’s Hospital. Dr. Nix is working as a pediatrician at Center for Pediatric Medicine. She can be reached at 864-220-7270.

Andreea I. Stoichita, MD, earned her medical degree from University of South Carolina School of Medicine in Columbia.

She completed her Pediatric residency training at GHS Children’s Hospital. Dr. Stoichita is working as a pediatrician at Center for Pediatric Medicine. She can be reached at 864-220-7270.

Melanie H. Wills, MD, completed her medical degree at Medical College of Georgia in Augusta. She completed her residency training in Pediatrics at University of Mississippi Medical Center Batson Children’s Hospital in Jackson.

Dr. Wills is working as a pediatrician at Kids’ Care, an urgent care facility at AnMed Women’s and Children’s Hospital. She can be reached at 864-512-6544.

Pediatric Anesthesia Sara L. Walls, MD, attended medical school at Mercer University School of Medicine in Macon, Ga. She completed an Anesthesiology residency at Vanderbilt University Medical Center in Nashville, Tenn., and a fellowship in Pediatric Anesthesiology at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Dr. Walls can be reached at 864-522-3700.

Pediatric Gastroenterology Lindsay Moye, MD, earned her medical degree from Medical University of South Carolina in Charleston. She completed a Pediatric residency at University of Nevada School of Medicine, Las Vegas and a Pediatric Gastroenterology fellowship at University of Texas Health Science Center in Houston. Dr. Moye can be reached at 864-454-5125.

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Pediatric Hematology/Oncology Stephen C. Martin, MD, JD, earned his medical degree from Medical University of South Carolina in Charleston. He also earned a Juris Doctor from the University of South Carolina School of Law in Columbia. Dr. Martin completed his Pediatric residency at GHS Children’s Hospital and a fellowship in Pediatric Hematology/Oncology at Riley Hospital for Children/Indiana University School of Medicine in Indianapolis. He can be reached at 864-455-8898.

Pediatric Pain Medicine R. Blake Windsor, MD, attended medical school at Mercer University School of Medicine in Macon, Ga. He completed his residency training in Pediatrics at Boston University School of Medicine and a fellowship in Pediatric Pain Medicine at Boston Children’s Hospital. Dr. Windsor is the medical director of Children’s Hospital’s new Pediatric Pain Medicine practice (see Page 2).

He can be reached at 864-522-4888.

Pediatric Radiology Michael F. Brinkley, MD, completed his medical education at Johns Hopkins University School of Medicine in Baltimore.

He completed a Diagnostic Radiology residency and a Pediatric Radiology fellowship at Duke University Medical Center in Durham, N.C. Dr. Brinkley can be reached at 864-455-7107.

Ahmad

Neal

Crosby

Jones

McGee

Miller

Praytor

Wills

New community pediatricians Rubina Ahmad, MD, and Annemarie Neal, MD, have joined Pediatric Associates–Spartanburg. They can be reached at 864-582-8135.

Clay Crosby, MD, has joined Heritage Pediatrics & Internal Medicine–Wren. He can be reached at 864-859-0740.

J. Brannan Jones Jr., DO, has joined GHS Pediatrics & Internal Medicine–Wade Hampton. He can be reached at 864-522-5000.

Matthew McGee, MD, has joined Christie Pediatric Group.

He can be reached at 864-242-4840.

Melody A. Miller, MD, has joined Pediatric Associates–Greer.

She can be reached at 864-879-3883.

J. Gram Praytor, MD, has joined The Children’s Clinic.

He can be reached at 864-271-1450.

M. Andrew A. Wills, MD, has joined Clemson-Seneca Pediatrics. He can be reached at 864-888-4222.

Dr. Sease elected president of SCAAP

New medical directors announced

Kerry Sease, MD, MPH, was elected president of the South Carolina chapter of the American Academy of Pediatrics at the organization’s annual meeting in July. She will serve a two-year term.

New medical directors have been announced for GHS Children’s Hospital’s Pediatric Intensive Care Unit, Pediatric Cardiology, Pediatric Nephrology/Hypertension and Pediatric Urology.

Speakers at Governor’s Opioid Summit Jennifer Hudson, MD, medical director of Newborn Services for Children’s Hospital, and Michelle Greco, BA, BSN, RNC-MNN, manager of Child Abuse Prevention for Bradshaw Institute for Community Child Health & Advocacy, were featured speakers at the 2018 S.C. Governor’s Opioid Summit, held Sept. 6 in Columbia.

The summit represented an effort to bring together state agencies, private partners, law enforcement, health care providers, first responders and community members to combat the growing epidemic of opioid abuse, addiction and death.

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Eric Berning, MD, now is medical director for the PICU. Jon Lucas, MD, is medical director for Pediatric Cardiology.

Sudha Garimella, MD, is medical director for Pediatric Nephrology/Hypertension.

Regina Monroe, MD, is medical director for Pediatric Urology.

Pediatric & Adolescent Gynecology changes location Pediatric & Adolescent Gynecology has a new Greenville location: 1350 Cleveland St., Suite A, 29607. The phone number remains the same: 864-455-1600. The fax number has changed to 864-522-4455.

ACADEMIC NEWS The Clemson University Nursing building on Greenville Memorial Medical Campus provides a high-tech, modern setting for training more nurses for the workforce.

GHS, Clemson collaborate to ease nursing shortage Our nation faces a growing shortage of nurses. This demand will continue to rise because of an aging population, patients with chronic health conditions and an increase in patients in long-term care facilities.

According to the U.S. Bureau of Labor Statistics, 438,100 additional registered nurses will be needed between 2016 and 2026 to meet a projected growth of 16 percent in the nursing workforce. This need is evident in South Carolina, with a projected deficit of more than 10,000 nurses by 2030, according to the U.S. Health Resources and Services Administration. Greenville Health System and Clemson University have joined forces to help meet this critical health care need.

The building houses a portion of Clemson’s expanded baccalaureate nursing program. The program has expanded from a freshman class of 64 in 2015 to 173 in fall 2018.

This collaboration will combat the rising nursing shortage, address the challenge of retaining nursing faculty and increase access to the clinical learning environment. It also will provide opportunities for more nursing students to have clinical learning experiences on GHS campuses, improve opportunities for future employment, produce positive impacts on patient outcomes and expand nursing education.

Article author Carl Cromer, MS, FNP-C, is director of Nursing for GHS Children’s Hospital.

On August 21, 2018, the Clemson University Nursing building opened on GHS’ Greenville Memorial Medical Campus. The facility is a four-story, approximately 78,000-square-foot clinical learning and research building. It offers a hospital-like environment and contains high-fidelity patient simulators.

Dr. Ratliff-Schaub named director

Residents earn top spot at SCAAP meeting

Karen Ratliff-Schaub, MD, was named director of Children’s Hospital’s DeLoache Fellowship in Developmental-Behavioral Pediatrics. Dr. Ratliff-Schaub earned her medical degree at Northeastern Ohio Universities College of Medicine in Rootstown, Ohio. She completed her residency training in Pediatrics at Medical College of Ohio in Toledo and served as a postdoctoral fellow at the University of Maryland in Baltimore.

Dr. Ratliff-Schaub served as chief for the Division of Developmental and Behavioral Pediatrics at Mercy Children’s Hospital in Toledo from 1997-2005; during that time, she also served as medical director for the Pediatric Feeding Team and Myelomeningocele Team. She joined Children’s Hospital in June 2018.

Madi Merritt, MD (left), and Kindal Dankovich, MD, earned first place at the 2018 annual meeting of the S.C. Chapter of the American Academy of Pediatrics.

Their poster was titled “Y You Feeling So Low, Sugar: Standardizing Inpatient DKA Management.”

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CONTINUING MEDICAL EDUCATION

ADHD and Digital Media CME Credit Information To receive possible continuing medical education (CME) credit for this article, please complete the online Q&A that can be accessed on page 14. Both physicians and nurses are eligible to test for the credit.

It is the policy of the GHS Continuing Medical Education Committee to ensure balance, independence, objectivity and scientific rigor in all its individually sponsored or jointly sponsored education activities. Article author Karen RatliffSchaub, MD, has disclosed that she has no significant financial interest or relationship with any company that may be considered an actual or potential conflict of interest with this educational activity. The planning committee have listed no duality of interest with regard to potential relevant financial relationships for the FOCUS enduring activity. The CME committee have listed no duality of interest with regard to potential relevant financial relationships for the FOCUS enduring activity with the exception of Sandra Weber, MD (Committee Chair), Grant/Research Support–Eli-Lilly, NIH, and Pfizer.

The University of South Carolina School of Medicine Greenville-Greenville Health System (USCSOMG-GHS) designates this enduring activity for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The University of South Carolina School of Medicine Greenville-Greenville Health System is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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Your last patient of the day is a 10-year-old male with attention deficit/hyperactivity disorder (ADHD), doing well on his current medication regimen. His mother, although acknowledging that things are good overall, complains that it is a constant battle to limit his use of electronics. There is no family history of ADHD, and his grandmother apparently is wondering if all these video games are the cause of his condition.

Your instinct is to reassure her that he’s typical for his peers, but you find yourself wondering if that is really true. What is the connection between ADHD and digital media?

ADHD is a common neurologic condition affecting approximately 5.5 percent of children in the United States.1 Symptoms include deficits in sustaining attention and completing tasks, easy distractibility, impulsivity and hyperactivity. Prevalence estimates of ADHD appear to have increased over the past two decades, for reasons that are not entirely clear.

There have long been concerns about effects of media on children, whether media may be to blame for increasing rates of ADHD, and possible differential effects of media on children with ADHD. Issues surrounding media and ADHD can be thought of in three ways: 1. General media effects on children and teens.

2. Possible contribution of media to ADHD symptoms or prevalence.

3. Specific effects of media on children and teens with ADHD.

General effects of media

Electronic media have evolved over time, starting with television, then video games, and now games that can be played on portable devices as well as social media sites. In addition, newer versions of TV and movie viewing options such as YouTube and Netflix have been added to the mix.

Digital media usage in a variety of formats is common; 75 percent of teens report having a cellphone,2 and a similar percentage report using at least one social media site. TV use has decreased overall3 while other forms of media use have grown, particularly among teens.

A 2016 report from the American Academy of Pediatrics concluded that there are benefits as well as risks to media use.4 Knowledge acquisition, opportunities for social engagement, exposure to new ideas and health promotion information are some potential positive effects. Negative ones include effects on sleep and weight, compromised privacy, safety concerns, and exposure to inaccurate and misleading content.

For example, access to screens in bedrooms has been shown to be associated with less total sleep time. In general, children who spend more time on screens sleep less. Time displacement, psychological stimulation from content and the effect of light emitted from devices are potential underlying mechanisms of these associations.5 Excessive TV viewing has been associated with obesity— mediated by increased calorie intake, exposure to advertising for high-calorie foods and decreased levels of physical activity. Interestingly, decreased sleep associated with screen viewing also may be a contributing factor for obesity.

Moving beyond observational research, experimental trials of reduced screen time have shown positive effects on weight and BMI.6 Additionally, media exposure to alcohol, tobacco or sexual behavior has been shown to be associated with earlier experiences of these behaviors, with the potential for negative health outcomes.

Research looking at mental health and media use has shown both benefits and negative effects. Social media may offer youth with particular conditions or characteristics a source of belonging and inclusion. A U-shaped effect of media use on depression has been suggested by some studies, with more depression seen in both low and high users.7 The DSM-5 now includes problematic internet use and internet gaming disorder as mental health conditions, and it recommends further study of both.8 The prevalence of problematic internet use is between 4 and 8 percent of children, and up to 8.5 percent of youth in the United States meet criteria for internet gaming disorder.9

Media effects as the cause of ADHD symptoms

Numerous studies have examined the effects of media on attention. Some have been framed as looking at ADHD symptoms, but should not be interpreted as concluding that media is the cause of clinically diagnosed cases of ADHD. Two recent meta-analyses found statistically significant, although small, correlations between screen media use and ADHD behaviors. Ferguson10 focused on video games while Nikkelen11 looked at both TV and video games. The role of other digital media, including social media, has not been widely examined.

Prevalence estimates of ADHD appear to have increased over the past two decades, for reasons that are not entirely clear.

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Monitor digital media use Some specific strategies for parents and families14,19 Where: Keep digital media out of bedrooms; use in rooms with 2 or more people – child + adult(s) – instead.

How long: • Limit screen access for children <2 years of age to personal communication (i.e., video chatting).

• For children 2-5 years old, stick with high-quality programming, preferably viewing with an adult; for older children, limit to 1-2 hours total daily access.

• Structure digital media use into two or more shorter sessions to decrease resistance to transitioning to other activities.

When: Limit screens 1-2 hours before bedtime to minimize impact on sleep.

With whom: Encourage co-viewing (TV, YouTube); monitor social networks, encourage video game playing in real time with friends instead of anonymously or online.

What: Monitor content of social media, video games and other entertainment. The Entertainment Software Rating Board assigns ratings to video games, TV shows, movies, etc., and can provide parents with guidelines about appropriateness of the content for various ages and developmental levels.

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A 2018 study by Ra et al12 was one of the first to look at social media use. High school students without ADHD at baseline were prospectively surveyed about social media use. Over the course of the 24-month study, researchers found a moderate statistically significant association between high-frequency digital media use and newly reported symptoms of ADHD. Selfreported depression or delinquent behaviors increased this risk even further.

Various theories attempt to explain the apparent correlations between media and ADHD symptoms. One theory is that fastpaced media may force children to frequently shift attention, which can be very arousing. Over time and exposure, children may become habituated to this fast pace and actually become less aroused. Such exposure leads to decreased basal arousal levels, resulting in ADHD symptoms. An alternative view, the scan-and-shift hypothesis,13 states that fast pacing of media prevents children from developing attention-focusing skills.

Thus, children frequently shift attention, resulting in a scanning and shifting attention style.

may be related to deficits in executive functioning and increased mood reactivity, part of the underlying neurobiology of ADHD.

Advice to parents

So whatâ&#x20AC;&#x2122;s a parent (or provider) to do? Given how widespread digital media now is, it may be tempting to assume it is a hopeless effort. The impact of digital media is not, however, entirely beyond our control. Frequency, duration, location and media content all are factors that matter â&#x20AC;&#x201C; and ones that can be affected by parental practices.

As clinicians, we can inform parents about problems associated with excessive digital media use and encourage intervention.

Health care visits can include screening questions and offer anticipatory guidance about media use that is developmentally appropriate. It also is important to address or refer youth with underlying conditions such as ADHD, mood disorders or autism spectrum disorders, as these conditions may place children at risk for problematic digital media use.

Effects of media on ADHD

If media can lead to ADHD symptoms, what effect could media have on children who already have a diagnosis of ADHD? Anecdotally, many parents report that children with ADHD seem to attend better to TV and other forms of digital media than to non-screen-based activities. This observation may be related to hypoactivity in the dorsolateral prefrontal cortex and deficits in executive function and emotional regulation,14 which may explain why adult caregivers could come to over-rely on media to engage children with ADHD as well as the increased mood reactivity of the children and teens when those caregivers attempt to limit media use.

There is some research looking at the different effects of media on specific conditions. Youth with ADHD have been found to be at higher risk for excessive media use as well as more likely to experience negative effects on sleep, academic performance and attention.14,15,16 Mazurek and Engelhardt17 found that boys with ADHD were more likely to engage in problematic video game use, which was associated with symptoms of inattention.

Tahiroglu et al found evidence of a dose-dependent response to media use in general and that boys with ADHD, inattentive type, were most susceptible and more likely to play video games longer than their peers.18 Bioujac found that hyperactivity/ impulsivity symptom severity was linked to severe reactions when parents attempted to limit media use.15 These findings

As clinicians, we can inform parents about problems associated with excessive digital media use and encourage intervention.

13

Action steps for parents 1. Develop a family media use plan (see healthychildren.org for template).

2. Designate potential substitute behaviors. Just setting limits on digital media is not enough and is prone to resistance, rebellion and failure. Parents and other caregivers need to encourage children (and the entire family) to develop alternative habits. Family outings, board games, reading, crafts and other hobbies are some things to consider, but may require upfront effort and cultivation. Additionally, families should expect some resistance and be able to commit to trying a plan or alternative activities for a reasonable period of time – at least a few weeks – before abandoning or changing those plans.

3. Parents need to model the media usage habits they’re seeking to cultivate in their children. It will be difficult to get children to put their phones away at bedtime if mom and dad are on their own phones.

4. A variety of free or low-cost parental control options – apps or parental filters, for instance – are available to make the task easier. Parents sometimes feel that “will power” is the only way their child can learn better habits, but this often fails or, at best, requires so much parental oversight that it is either oppressive or not sustainable. Encourage families to use technology to their advantage for more youth buy in and less of a battle of wills.

Although often not easy and certainly not a quick fix, health care providers can support families in appropriate oversight of digital media. Doing so helps ensure that children and teens benefit from technology, with fewer adverse effects.

Article author Karen Ratliff-Schaub, MD, is a developmentalbehavioral pediatrician at Children’s Hospital and is director of Children’s Hospital’s DeLoache Fellowship in Developmental-Behavioral Pediatrics.

CME questions available online Access the CME questions online. http://ghscme.ethosce.com/peds-focus/series/focus

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References

1. Song M, Dieckmann NF, Nigg JT. Addressing discrepancies between ADHD prevalence and case identification estimates among U.S. children utilizing NSCH 2007-2012. Journal of Attention Disorders Sept 2018. https://doi.org/10.1177/1087054718799930.

2 Lenhart A. Teens, Social Media & Technology Overview 2015. Washington, D.C. Pew Internet and American Life Project: 2015.

3 Loprinzi PD, Davis RE. Secular trends in parent-reported television viewing among children in the United States, 2001-2012. Child Care Health Dev. 2016;42(2):288-291.

4 Chassiakos YLR, Radesky J, Christakis D, Moreno MA, Cross C, Council on Communications and Media. Children and adolescents and digital media.

Pediatrics 2016;138(5). DOI:10.1542/p3ew.2016-2593.

5 LeBourgeois MK, Hale L, Chang AM, Akacem LD, Montgomery-Downs HE, Buxton OM. Digital media and sleep in childhood and adolescence.

Pediatrics Nov 2017;140:S92-S96. DOI:10.1542/peds.2016-1758J. 6 Robinson TN, Banda JA, Hale L, Lu AS, Fleming-Milici F, Calvert SL, Wartella E. Screen media exposure and obesity in children and adolescents. Pediatrics 2017:140; S97-S101. DOI:10.1542/peds.20161758K. 7 Belanger RE, Akre C, Berchtold A, Michaud PA. A U-shaped association between intensity of Internet use and adolescent health. Pediatrics 2011;127(2):e330-e335.

8 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, D.C: American Psychiatric Association, 2013.

9 Gentile D. Pathological video-game use among youth ages 8-18: a national study. Psychol Sci. 2009:20(5):594-602.

10 Ferguson CJ. Do angry birds make for angry children? A meta-analysis of video game influences on children’s and adolescents’ aggression, mental health, prosocial behavior, and academic performance. Perspect Psychol Sci Sept 2015:10;646-666.

11 Nikkelen SWC, Volkenburg PM, Hulzinga M, Bushman BJ. Media use and ADHD-related behaviors in children and adolescents: A meta-analysis.

Dev Psychol 2014;50(9):2228-41.

12 Ra CK, Cho J, Stone MD, De La Cerda J, Goldenson NI, Moroney E, Tung I, Lee SS, Leventhal AM. Association of digital media use with subsequent symptoms of Attention-Deficit/Hyperactivity Disorder among adolescents. JAMA 2018;320(3):255-63.

13 Beyens I, Valkenburg PM, Piotrowski JT. Screen media use and ADHDrelated behaviors: Four decades of research. PNAS 2018;115(40):9875-81.

14 Ceranoglu TA. Inattention to Problematic Media Use Habits. Child Adolesc Psychiatric Clin N Am 2018;27(2):183-91.

15 Bioulac S, Arfi L, Bouvard MP. Attention deficit/hyperactivity disorder and video games: a comparative study of hyperactive and control children. Eur Psychiatry 2008;23(2):134-41.

16 Yoo HJ, Cho SC, Ha J, Yune SK, Kim SJ, Hwang J, Chung A, Sung YH, Lyoo IK. Attention deficit hyperactivity symptoms and Internet addiction.

Psychiatry Clin Neurosciences 2004;58(5):487-94.

17 Mazurek MO, Engelhardt CR. Video game use in boys with Autism Spectrum Disorder, ADHD, or typical development. Pediatrics 2013;132(2):260-266. DOI:10.1542/peds.2012-3956.

18 Tahiroglu AY, Celik GG, Avci A, Seydaoglu G, Uzel M, Altunbas H. Short-term effects of playing computer games on attention. J Att Dis 2010;13(6):668-76.

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QUALITY COUNTS

Small Baby Unit inspires NICUs statewide The South Carolina Neonatal Medical Consortium, a collaboration with our state’s four regional perinatal centers, shares ideas on the best ways to care for our smallest patients.

When ideas surface having wide applicability and great potential to improve quality, they often are developed into statewide Quality Improvement initiatives to standardize care and improve outcomes.

This year, Greenville Health System physicians were asked to share their experience developing the Small Baby Unit, the first of its kind in South Carolina, with the thought that the unit’s successes in Greenville may carry broad applicability across the state.

Units with a narrow focus–such as a pediatric, cardiac or neuro ICU–improve care and outcomes by providing consistency in practice and expertise. Our Small Baby Unit is an example of such a unit. Extremely low birth weight infants require specialized care, and this care is consistently provided in the Small Baby Unit.

GHS tracks neonatal outcomes through the Vermont Oxford Network, a database that holds critical information on over 2.2 million very low birth weight babies and infants meeting other eligibility requirements. Recently, network data revealed that our bronchopulmonary dysplasia rates in inborn infants having very low birth weight were high when compared to our peers. We also knew that our ventilator days were higher than average.

In 2016, efforts to combat these trends were put into place, including using Bubble CPAP (a single-use unit) and Drager ventilators for volume-based ventilation. Shortly thereafter, in January 2017, the Small Baby Unit officially launched, under the leadership of Michael Stewart, MD. Currently led by Catrinel Marinescu, MD, and nursing coordinators Ashley Childress and Amanda Coates, the unit is located in an isolated area of the Bryan NICU that allows it to be kept darker and quieter than the rest of the unit. A major goal is minimal stimulation of the infants, with designated “hands-on times” to coordinate care and maximize rest.

undergo extra training to primarily focus in this area. Their main goals involve protocols around respiratory care, interventricular hemorrhage prevention and best skin care practices.

For example, the first protocol emphasizes the “golden hour” and first three days of life. Goals of the golden hour include placing babies in their own bed, on their ventilator with lines placed and labs drawn, within that first hour of life to then allow time for rest and recovery.

In tracking early outcomes of this program, length of stay has decreased by an average of five days. Another outcome is a significant reduction in severe bronchopulmonary dysplasia with less tracheostomy requirement and home ventilator use at discharge. There has been a decrease in postnatal steroid use, around which there is concern for potentially worsening neurodevelopmental outcomes. Also positive, rates of surgical retinopathy of prematurity have dropped, likely secondary to less ventilator/oxygen exposure.

Our experience to date with the Small Baby Unit was presented to the consortium in May 2018, to share ideas and protocols as other institutions develop their own units. Moving forward, we can continue to share outcomes, expertise and experience across our state to maintain forward momentum and provide the best evidence-based care for our smallest patients.

Special thanks to Matthew Halliday, MD, a Pediatrix Medical Group neonatologist at GHS, for the data and information provided for this article.

Author Carley Howard Draddy, MD, is vice chair of Quality and Medical Staff Affairs and medical director of Pediatric Telehealth and Special Projects for Children’s Hospital.

Designated RNs (approximately 40-50 of our 150 NICU nurses) and a handful of RRT team members have volunteered to 15

SPECIAL PROGRAM

Ensuring patients have a lifetime home The comprehensive program launched in summer 2018.

According to the National Institutes of Health, SCD is an inherited blood disorder that alters the shape and longevity of red blood cells, leading to symptoms ranging from swelling of the hands and feet, fatigue, pain and infection to stroke, organ damage and red blood cell shortage, which often leads to transfusions. The illness disproportionately affects the AfricanAmerican community, Dr. Anderson noted, but can also affect those of Hispanic descent.

Over the last 20 years, Dr. Anderson recounted that pediatric SCD patients have seen a “drastic improvement in survival,” thanks to advances in monitoring hemoglobin, fighting infection and maintaining everyday health. “We now see that over 96 percent of children with SCD live at least to the age of 18.”

Alan Anderson, MD (left), with ToyAnita Jones, a patient of the Comprehensive Sickle Cell Disease Program.

ToyAnita Jones was diagnosed with sickle cell disease (SCD) at age 6, more than 25 years ago. As she transitioned from a child to a teenager and then an adult, she was forced to wrestle not only with her complex medical condition, but also with a transition from familiar doctors who knew her story to a new set of doctors who were starting fresh.

“I felt different and misunderstood enough as a child who couldn’t run or play the same way her friends did,” Jones said.

“Leaving the doctors who knew me as soon as I became a young adult made it even harder. Not to have to transition would have meant everything to me.”

Jones was overjoyed when she learned of plans at Greenville Health System to develop a Comprehensive Sickle Cell Disease Program that followed a patient over a lifetime – the first of its kind in the Upstate.

“The worst feeling for patients with a chronic illness is the thought of leaving a health care provider who knows them well,” said Alan Anderson, MD, a pediatric hematologist/oncologist with GHS Children’s Hospital. “Our vision was to serve Upstate patients with sickle cell disease and ensure they’d never need to go elsewhere. We wanted to create a lifespan clinic, and that’s just what we’ve done.”

16

For patients transitioning from pediatric to adult care, however, the statistics are less encouraging.

“Admission rates to the ER and hospital rise, mortality rates increase and overall compliance with health maintenance, including visits to subspecialists, go down markedly,” Dr. Anderson stated. Patients often lack a true medical home, he added, because few care options focus on sickle cell; the effects are costly both physically and economically. The Centers for Disease Control and Prevention estimates that costs for hospital stays related to SCD were roughly $488 million in 2004 alone.

“In patients with SCD, changes in temperature, decline in oxygen levels and other causes of stress to the body can lead to a change in the shape of the red blood cells and ultimately block blood flow to critical areas,” Dr. Anderson stated. “The biggest outward manifestation is pain, and sickle cell patients often need narcotic pain meds to treat it. We see many who use the ER to receive the help they need in medical crises.”

That isn’t the ideal model of care, he pointed out, but few hospital systems have offered other solutions. “We needed to fill that gap.”

Change fueled by community support

Fresh off two years in Botswana serving and studying patients with blood disorders and cancers, Dr. Anderson returned to Greenville in 2017 with a renewed determination to deliver care to an underserved population. He served as medical director of GHS Pediatric Hematology/Oncology before moving abroad and

had quite a challenge awaiting him upon his return: Open the system’s first lifespan sickle cell disease program.

take me and my symptoms seriously, and they take me at my word. It’s a huge relief.”

First, Dr. Anderson had to earn support by showcasing the need for seamless SCD care and proving its worth for area patients.

After assembling a community advisory board of political and religious leaders, along with concerned members of the health care sector and African-American community, Dr. Anderson led discussions about the lack of robust care for sickle cell patients transitioning into adulthood.

Filling a void and information gap

“They saw the value of having a dedicated team of providers follow patients throughout the continuum of their chronic illness,” Dr. Anderson remarked. “It’s a travesty in the American health care system to have life expectancies going down for a chronic illness. It shouldn’t be happening, and we intend to change things.”

A huge relief: the value of seamless care

At 21, Jones became pregnant. The difficulty of managing her disease was compounded by the challenge of having to walk through her history over and over with doctors who didn’t focus on sickle cell.

“At my old practice, they knew and trusted me,” she recalled. “I didn’t have to go to the ER as often. They helped me manage my pain or get transfusions when I needed them. I lost all that when I left.”

This experience drives Jones to support young sickle cell patients and their families, walking them through the highs and lows that can come with a chronic disease. She attends clinic support groups and mentors patients who experience the symptoms, both medical and social, she did at that time.

“My family support system was strong,” she acknowledged, “but I still could have used a peer or the advice of someone who had been in my shoes.”

“With sickle cell, you have symptoms inherent to your condition, and as a young adult, you also have things inherent to that age range, like a feeling of invincibility, lack of compliance, confusion about how to access health care for yourself and other social pressures,” Dr. Anderson explained. “You have very few medical homes that focus on all those facets. Outside of medicine there is a stigma associated with sickle cell and its symptoms. It’s a great deal to manage at any age.”

Jones agreed, remembering hospital visits when she was questioned or viewed “as someone just showing up to ask for pain meds. If you don’t know my diagnosis or my background, you see me as someone I’m not.”

Conversely, she said, “Dr. Anderson’s staff just gets it. I can walk right in and explain my level of pain, how many bags of fluids I think I need, what medicines have worked for me before. They

In addition to providing sickle cell patients a lifelong medical home and a place where they feel understood, Dr. Anderson aims to educate them. “We want our patients to understand newer modification agents available, preventive health recommendations and the value of knowing where to get IV fluids or pain meds when they travel. We discuss things that will keep them out of the ED or hospitals where there is less likely to be knowledge about their disease and how to manage it.”

“At 32,” Jones admitted, “I’ve learned the importance of slowing down, taking fluids and meds, and decreasing my symptom crises before they come. When I was younger, I didn’t see it that way. But I believe what the clinic is doing now can help the next generation avoid that mindset.”

Dr. Anderson’s team hopes to close the information gap for the community at large as well.

“The social stigma of a disease driven by pain is real,” Dr. Anderson said. “We train our patients to know what works for them. But when they request the medicine they need, they are labeled as drug-seeking, coming in and immediately requesting something from providers. The only way to combat that stigma is to educate those outside of the sickle cell community about what they face.”

Here for a lifetime In the months and years ahead, the clinic intends to add a new provider, expand care options, and continue to partner with community leaders for advocacy and awareness.

Members of the team that make up the program (left to right) are: Social worker Charlotte Hatton, LMSW; Marcellina West, CMA; psychologist Cortney Rieck, PsyD; Alan Anderson, MD; and clinical nurse specialist Katie Muschick, APRN, PCNS.

“Dr. Anderson’s team does more than care for us physically; spiritually and mentally, this kind of support is something I’ve always wanted,” Jones emphasized. “You see these kinds of coordinated efforts for cancer and other diseases, but the sickle cell community has never experienced that. Lifelong care is going to benefit everyone – those behind me and those older than me. It’s so much more than a doctor’s office for us.”

Jones is heartened by the knowledge that, whatever comes in the years ahead, she has a home at Dr. Anderson’s clinic.

Dr. Anderson concluded, “I tell my patients that as long as you’re here and you need us, we’ll be with you.”

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COLLABORATING FOR BETTER CARE Program aims to equip community members to help those struggling with addiction and mental illness.

Equipping the community for early mental health intervention

Two programs at Greenville Health System provide training to key community members that help them intervene early and effectively when they detect a potential mental health issue.

Robyn Ellison, MEd, is the instructor for both the Youth Mental Health First Aid and Adult Mental Health First Aid courses for GHS. The courses are a product of the National Council for Behavioral Health. Participants have had overwhelmingly positive feedback, such as this comment from a member of the Greenville Free Medical Clinic team: “I really enjoyed the class. It taught me a lot about dealing with issues that might arise with our patients and in life.”

In October 2018, Ellison and Lance Feldman, MD, a child and adolescent psychiatrist with GHS Children’s Hospital, received a grant from the federal Substance Abuse and Mental Health Services Administration to provide Mental Health First Aid training across the Upstate. This marked the first grant from 18

SAMHSA to GHS and the first time GHS Behavioral Health had received a grant of any kind.

Thanks to this grant, Ellison will be able to teach the course for free to community organizations, law enforcement and other key personnel for three years, training a minimum of 1,000 people annually. Without the grant, the course would cost approximately $100 a person.

These groups have already received training: • Pediatric nurses at Children’s Hospital • Chaplains and Chaplaincy residents at GHS • Greenville Free Medical Clinic team • Select Greenville County principals (primarily from underserved schools) • Members of the Children’s Residential Program at Marshall I. Pickens Hospital

One grant requirement is that GHS have commitment partners who work with the system to facilitate courses that impact specific populations. These partners are Pickens County Schools, Upstate Warrior Solution and Triune Mercy Center.

Pickens County Schools requires that all principals, assistant principals, guidance counselors, office staff and school nurses be trained over the three-year period; teachers are urged to take the course as well. Upstate Warrior Solution committed to have its team trained – and to offer quarterly training for veterans and their families over three years. Triune Mercy Center committed to train its team, too.

From these starting points, Ellison is working to diversify the training as much as possible to achieve the maximum impact – reaching out to community, education and public safety audiences, along with others. The program offers several modules that can be used with specific groups, making the training more relevant to their needs. Modules include those for veterans, higher education professionals, the elderly, first responders and public safety personnel.

Groups that have signed on to be trained through GHS include the following:

More participant feedback:

“I loved how interactive the training was! Very applicable information and very relevant.”

“Teaches legitimate strategies to use with students.”

– Assistant principal “The 5-step Action Plan provides a simple method to respond to mental health needs.” – Principal “It was educational and built knowledge around mental illness while offering practical tools to utilize while caring for a young person.”

“Excellent course. I feel strongly all educators should have this training.”

“More people need this and more often.” – Chaplain “I found this course extremely informative. I feel like I have tools to better deal with mental health.” – Pediatric nurse

• Human Services students at Southern Wesleyan University • Occupational therapy professionals at BEACON • Team members at Anderson School District 4 • New Chaplaincy residents at GHS • Members of Family Connections • Clemson Life personnel and resident assistants Ellison said more groups are added to the list each week.

In addition, leaders from other entities have participated in overview sessions to gauge whether the training would be appropriate for them. These organizations include the following: • Greenville Police Department • Greenville County Sheriff’s Office • Greenville Juvenile Detention Center • Milliken • Clemson Sports Psychology • USC School of Medicine Student Services • GHS Veterans Services Ellison said she’s thrilled to see the program taking off in the community. “We had no idea this would happen,” she said.

“We just strongly believed in this program and in the power of knowledge and conversation to change the stigma associated with mental illness.”

Participants in a Mental Health First Aid course do an activity to simulate experiencing an auditory hallucination to better understand how difficult interaction can be for a person experiencing this symptom.

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CELEBRATIONS

Children’s Hospital of Greenville Health System (GHS) has many reasons to celebrate!

Walmart campaign gifts $344,000 for Children’s Hospital Walmart’s 2018 Children’s Miracle Network campaign raised $344,000 for GHS Children’s Hospital. Our local Walmart and Sam’s Club partners have provided continued support and contributions to Children’s Hospital to the tune of more than $11 million. To recognize these area businesses for their partnership, Children’s Hospital now features a sea-themed mural near the first floor elevators spotlighting what these gifts have made possible.

Milliken & Company funds Buddy Boxes Spartanburg-based Milliken & Company funded 475 Buddy Boxes – boxes filled with age-specific toys, activities and comfort items – for patients at Spartanburg Pediatric Health Center. The Meeting Street Academy Girl Scout Troop helped assemble 175 of the boxes. Boxes were put together specifically for newborn babies, and they contained emollient cream, nasal suction, stacking cups, rattles, spoons, toothbrush kits and a parenting journal.

BMW Pro-Am raises over $44,000 for Pediatric Pain Medicine Children’s Hospital’s Pediatric Pain Medicine practice received $44,577.71 in funds raised during the 2018 BMW Charity ProAm golf event. The program was one of four recipients of funds raised through this annual event.

One of only a few such programs in the Southeast, Pediatric Pain Medicine provides comprehensive, multidisciplinary care for children with chronic pain. Patients are diagnosed and treated by a team of subspecialty-trained pediatric pain physicians, pediatric psychologists, pediatric physical therapists and nurse navigators. (For more information, see Page 2.)

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Radiothon tops $3 million in donations over 12 years GHS Children’s Hospital’s annual Radiothon raised $238,529 over two days Aug. 8-9. In partnership with Entercom Upstate, Radiothon takes place in the lobby of Greenville Memorial Hospital with live broadcasts on each of the seven Entercom stations in the Upstate. In addition, on-air personalities share stories and interviews from patients and families served by the Bryan Neonatal Intensive Care Unit, BI-LO Charities Children’s Cancer Center, and other programs and services.

Funds from Radiothon allow Children’s Hospital to have the resources necessary to provide a comfortable environment for patients and their families. These tools, programs and services often go beyond a normal operating budget and are not paid for by insurance.

CELEBRATIONS

Pediatricians recognized as Family-Centered Caregivers

Facility dogs get sponsors

Three pediatric physicians with GHS Children’s Hospital received Family-Centered Caregiver Awards in the fall of 2018.

These awards, sponsored by the Children’s Hospital Family Advisory Council, honor care providers who demonstrate exceptional family-centered care.

Two members of GHS Children’s Hospital’s Canine F.E.T.C.H. (Friends Encouraging Therapeutic Coping and Healing) Unit now have sponsors from the Upstate. Bijou Dental Spa is sponsoring Kalle (top), while The Noble Dog Hotel is sponsoring Kenzie (bottom).

The financial support of these sponsors makes possible the smiles, laughs and hugs these dogs bring to patients at Children’s Hospital.

Jordan Sammons, BSN, RN, Pediatric Intermediate Care Unit, was recognized for making a young patient feel at ease during a stressful time through her conversations with the patient and compassionate care.

William Wylie Jr., MD, was recognized by a parent whose children have been his patients since 2006. The parent said, “My girls love him – he makes them laugh and he makes us comfortable.”

Edward Penn, MD, was recognized by a parent whose daughter was referred because of a hole in the eardrum. The parent praised Dr. Penn’s kindness, his ability to connect with young children and his thoroughness in explaining what to expect before, during and after an upcoming surgical procedure.

Pediatric sleep center re-accredited GHS’ Center for Pediatric Sleep Disorders has been reaccredited by the American Academy of Sleep Medicine, indicating continued maintenance of the highest standards of sleep medicine practice.

Shropshire joins U.S. Play Coalition steering committee Megan Shrophire, manager of School Health, a performance team of the Bradshaw Institute for Community Child Health & Advocacy led by GHS Children’s Hospital, has joined the steering committee of the U.S. Play Coalition. The coalition is a partnership to promote the value of play throughout life.

Children’s Hospital leaders recognized At its annual meeting in July, the South Carolina chapter of the American Academy of Pediatrics honored two Children’s Hospital leaders with awards.

Tom Moran, MSW, received the Child Advocate Award, which is given to a South Carolinian who has made significant contributions to the health and well-being of the state’s children.

Moran joined Children’s Hospital in the 1980s. Some of the many positions he has held include program director of the Neonatal Developmental Follow-up Clinic, administrative director of the Center for Developmental Services, director of Physician Practices, director of Outpatient Services and director of Medical Center Clinics. Moran retired in early 2018.

William F. Schmidt III, MD, PhD, was given the Career Achievement Award. Dr. Schmidt moved to Greenville in 1995 and became administrator of the fledgling Children’s Hospital, along with chair of the Department of Pediatrics – a position he held until 2017 when he stepped down to assume other job responsibilities at GHS. Dr. Schmidt retired in January 2019.

The coalition’s steering committee is made up of 21 members, each of whom are leaders in industry, education or health fields, and lend their expertise and insight to the coalition’s work.

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CELEBRATIONS

Day of Joy for pediatric patients Joy in Childhood Foundation, the charitable foundation supported by Dunkin’ Donuts, brought joy to pediatric patients at Children’s Hospital by delivering superhero-themed Starlight Gowns provided by Starlight Children’s Foundation. Children donned their costumes, had their faces painted, and then strutted their stuff during “Superheroes Rule the Runway,” a fashion show celebrating the power and heroic bravery of children battling an illness.

Community Advisory Council awards At its annual celebration in September, the Children’s Hospital Community Advisory Council honored several team members, community volunteers and supporters of Children’s Hospital.

Caregivers of the Year (left to right): Alison Gosnell, RN; Sheila Walters, RN; Stephanie Tindle, PT; Yorleny Salazar; Kim Cummings, RN

Five Caregivers of the Year were announced: • Sheila Walters, RN, Bryan NICU • Alison Gosnell, RN, Inpatient Nursing • Stephanie Tindle, PT, Outpatient Services • Kim Cummings, RN, Outpatient Practices • Yorleny Salazar, Non-clinical Professional The Legislative Advocacy award went to Rep. Bruce W. Bannister, member of the Judiciary Committee and chair of the Criminal Laws Subcommittee, who has advocated to improve mandated reporting laws for child abuse and neglect. He also helped define laws relating to terms in the S.C. Children’s Code.

Leslie Latimer won the Buddy’s Spirit award for embodying the spirit of giving back to Children’s Hospital. This honor goes to a council member.

The evening’s capstone award – All for the Love of Children – went to William F. Schmidt III, MD, PhD, longtime medical director of Children’s Hospital and chair of the Department of Pediatrics. Dr. Schmidt was instrumental in expanding the hospital from a handful of general pediatricians and specialists to more than 185 employed physicians in 40 pediatric subspecialties. Dr. Schmidt recently retired.

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BULLETIN FROM THE BRADSHAW INSTITUTE This section highlights an area of focus for Bradshaw Institute for Community Child Health & Advocacy, part of GHS Children’s Hospital.

Combating obesity Grant supports measures to combat obesity at pediatric practices Over the next three years, GHS Children’s Hospital’s Bradshaw Institute for Community Child Health & Advocacy will coordinate disseminating and implementing Connect for Health, a family-centered pediatric weight management intervention that aims to improve care and outcomes for low-income children with obesity. Funded by a grant from the PatientCentered Outcomes Research Institute, Greenville Health System will join Denver Community Health and Massachusetts General Hospital as implementation sites for the study.

GHS’ involvement in the project originated through its relationship with the Aspen Institute Health Innovators Fellowship. This fellowship, funded by GHS, aims to connect Health Innovator Fellows with GHS physicians and programs with a larger goal of inspiring these leaders to create new approaches that enhance health and well-being.

Elsie Taveras, MD, MPH, principal investigator of the Connect for Health study and executive director of the Kraft Center for Community Health at Massachusetts General Hospital, is now in the second class of the Health Innovators Fellowship.

Through her fellowship, Dr. Taveras has connected with Kerry Sease, MD, MPH, GHS pediatrician and Liberty Fellow at the Aspen Global Leadership Network, to recruit GHS as a study site.

Dr. Sease, medical director for the Bradshaw Institute, is the principal investigator at GHS Children’s Hospital and responsible for the project in Greenville. Dr. Sease will identify and recruit Children’s Hospital pediatric primary care practices that deliver care to low-income children, who have a disproportionately high prevalence of obesity.

“Our goal is to improve the quality of care for these high-risk children,” Dr. Sease said. “We want to empower clinicians and engage and support parents to improve the short- and longterm health outcomes for these children.”

A practice coach will be responsible for the academic detailing of GHS providers and practices, and will provide resources to these practices as they adopt the intervention tools. (Academic detailing is “university or non-commercial-based educational outreach” that involves face-to-face education of prescribers by trained health care professionals.)

“We want to empower clinicians and engage and support parents to improve the short- and long-term health outcomes for these children.”

— Kerry Sease, MD, MPH Before implementing the strategies of Connect for Health, both qualitative and quantitative research will be conducted to assess parent and clinician needs, perspectives and preferences. This information will help the selected GHS practices adapt the intervention tools and strategies locally, while still maintaining fidelity to the model.

“We want to identify potential barriers to the intervention tools and customize our strategies to meet the needs of our practices and our local community,” Dr. Sease noted.

The proposed multi-prong intervention includes academic detailing, electronic medical record (EMR) alerts, patient education, behavioral support for families via text messaging and increased access to community resources. During wellchild visits, patients ages 2-12 years old with a BMI > 85th percentile will be flagged in Epic, the system’s EMR software.

The alert will prompt clinicians to document BMI percentile, a diagnosis of overweight or obesity, and counseling on nutrition, physical activity, screen time and sleep. The EMR template also will provide single-click opportunities to print educational materials, enroll the family to receive text messages that support behavioral change, and make an e-referral to weight management resources both within and outside the clinic.

If proven successful in Denver, Greenville and Boston, this highly scalable intervention package could be disseminated across the country and has the potential to reach the approximately 60 percent of the population with an EMR in Epic.

“We are excited to be a part of something that could really move the needle and improve the growth trajectories and lives of thousands of children,” Dr. Sease summarized.

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CLINICAL RESEARCH UPDATE Research studies at Children’s Hospital of Greenville Health System (GHS) are approved by the system’s Institutional Review Board.

Autism and neurodevelopment disorders research Manuel Casanova, MD, is the SmartState Endowed Chair in Childhood Neurotherapeutics. Dr. Casanova is a University of South Carolina research professor, with appointments in the Department of Biomedical Sciences at USC School of Medicine Greenville and in Children’s Hospital’s Department of Pediatrics. He is carrying out research on autism and related neurodevelopmental disorders.

Currently, his research is focused on the areas outlined below.

Auditory integration therapy

Many treatments and interventions in autism have focused on methods to reduce maladaptive behaviors and symptoms of related comorbidities such as seizures. There has been less research regarding some of the sensory problems observed in this condition. In spite of limited rigorous research, a variety of interventions directed at reducing sound sensitivity and related auditory problems are being used by practitioners and parents, with positive results reported in some cases.

Auditory integration training (AIT) was developed by French otolaryngologist Guy Berard, MD, and was based on the work of his predecessor, Alfred Tomatis, MD. Dr. Berard originally developed AIT to rehabilitate disorders of the auditory system, such as hearing loss or hearing distortion.

AIT uses filtered and modulated frequencies embedded in pleasant music to help retrain the auditory system and normalize the way the brain processes information. It seems very likely that if a child with autism could hear and process sounds more accurately, he or she could understand and speak more accurately and clearly, thus improving related areas such as social skills, emotional competence and relatedness, and social communication ability. The Berard AIT program is based on the theory that the use of electronically modulated and selectively filtered music retrains the ear and auditory system to work properly.

The standard Berard AIT protocol consists of two 30-minute sessions of listening each day for 10 days. Listening sessions are separated by a mandatory three-hour interval to allow a break from auditory stimulation. Music is represented by a variety of light rock, reggae and jazz, selected specifically to assure that it contains a wide range of frequencies from 20 hertz (Hz) to 20 kilohertz (kHz).

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A filtering device called the Eareductor modulates the music.

The processed music does not exceed an average output of 85 decibels (safety limit imposed by the FCC). The Earducator/6F intermittently emphasizes low- and high-sound frequencies in the music (called gating or modulation). Children listen to the music through closed, high-fidelity headphones without engagement in cognitive activities.

AIT has been reported to be beneficial with several conditions, including autism, dyslexia, attention deficit hyperactivity disorder (ADHD) and hypersensitive hearing at certain frequencies. Of 28 research studies that evaluated physiologic, behavioral and cognitive changes in AIT recipients, 23 (82%) studies concluded that their data supported the efficacy of AIT, three (11%) claimed to have found no evidence of efficacy, and two (7%) report ambiguous, contradictory results. Among those were 13 studies on autism. Eleven of those 13 reported positive results; two had mixed results (Edelson & Rimland, 2008). Review of theoretical models aimed at explaining the effects of AIT in children with autistic spectrum disorder (ASD) and other neurodevelopmental disorders can be found in Berard and Brockett (2011). Unfortunately, most studies have been open clinical trials with no control groups for comparison.

More research on AIT is needed as it has the potential to advance knowledge about neurodevelopmental abnormalities underlying atypicality of auditory processing in ASD, and it could provide the basis for theory-guided educational training capable of substantially improving hearing, sound processing acuity, selective attention and other important functions thought to be compromised in children with autism.

Neurofeedback

The ability of the brain to process information, similar to modern communication devices, is conveyed by voltage frequencies.

These frequencies are characterized by the total number of up and down swings, or cycles, in a given time. Traditionally, the number of cycles is measured per second; its unit is called a hertz. One cycle per second would be equal to one hertz.

Cellphones convey their information in gigahertz (10 to the 9th power or 1,000,000,000) frequencies, while TV and radio convey their information in the kilohertz (10 to the 3rd power or 1000) and megahertz (10 to the 6th power or 1,000,000) range. By way of comparison, frequencies generated by the brain are extremely slower (0-100 Hz) and of very low amplitude.

The brainwave frequencies can be decomposed into different bandwidths according to behavioral states to which they seem to be associated. Very deep sleep is associated with so-called delta frequencies. These frequencies range from 0.5 to 4 Hz. The next higher bandwidth is called Theta (4 to 8Hz); it is associated with daydreaming, sleep and raw emotions.

Individuals with ADHD get “stuck” in this Theta bandwidth and

have excessive Theta waves during wakefulness. Researchers have attempted to treat ADHD by having patients shift their brainwaves to higher frequencies (so-called alpha, beta or gamma frequencies). These higher frequencies are more conducive to establishing an attentive state.

Shifting of one’s brainwave activity has usually been done by using a real-time display of brain voltage activity and having the individual self-regulate brain function. As an example, a patient may sit in front of a laptop while wearing an electrode cap from which the researcher records brainwave activity. The laptop may play a movie and, if the brainwave frequencies are not in the target range, the overall viewing window may be quite small. If, on the other hand, the recorded brainwave frequency is on target, the window for the movie enlarges and can easily be watched. The job for the patient is to figure out how to keep the movie window open as wide as possible for the longest time.

This technique, called neurofeedback, has been recognized as a suitable tool for detecting and modulating neural plasticity because of its ability to noninvasively alter the excitability of neural circuits and induce a short-term reorganization of associated cortical and sub-cortical neural networks in the human cortex.

Many patients with autism have attention problems. In about one-third of cases, the deficit is so severe as to be called a “disorder.” Therefore, it seems reasonable to ask whether the same neurofeedback techniques being used in ADHD could offer some benefit in ASD. Several articles have reviewed the application of neurofeedback for ASD treatment; many provide evidence that some core symptoms of autism can be improved with this technique (Coben, 2013; Coben & Padolsky, 2007; Coben & Myers, 2010; Coben et al., 2010; Jarusiewicz, 2002; Kouijzer et al., 2009ab; Sokhadze et al., 2014; Wang et al., 2016).

Publications

Congratulations to Jonathan E. Markowitz, MD, MSCE, who coauthored an article published in Journal of Pediatric Gastroenterology and Nutrition. Their paper’s title is “Safety and efficacy of reslizumab for children and adolescents with eosinophilic esophagitis treated for nine years.”

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A S K T H E FAC U LT Y

Car seat recommendations

Q: How should I explain the AAP’s new car seat recommendations to parents?

A: “Rear facing or not rear facing, that is the question” is an obvious referral to Hamlet. However, the referral goes beyond merely words. In this scene, Hamlet is contemplating suicide and bemoaning the unfairness of life, much like a 20-month-old might (and if you have ever had one, you know how true this statement is) about sitting backward in a car seat.

But even morose Hamlet realizes that the alternative is worse, with “the undiscovered country, from whose bourn no traveler returns, puzzles the will, and makes us rather bear those ills.” Obviously, William Shakespeare did not realize how applicable his words would be to the most recent AAP recommendations on car seat use.

In 2018, the AAP released an updated statement and accompanying technical report on child passenger safety.

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Here are the new recommendations: • Infants and toddlers should ride in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by the seat. Most convertible seats have limits that will allow children to ride rear facing until age 2 or older.

• Once facing forward, children should use a forward-facing car safety seat with a harness for as long as possible, until they reach the height and weight limits for the seats. Many seats can accommodate children up to 65 pounds or more.

• When children exceed these limits, they should use a beltpositioning booster seat until the vehicle’s lap and shoulder seat belt fits properly. This often is when they have reached at least 4 feet 9 inches and are 8 to 12 years old. (South Carolina state law requires children to remain in a booster seat until a minimum of age 8.)

• When children are old enough and large enough to use the vehicle seat belt alone, they should always use a lap and shoulder seat belt for optimal protection.

• All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.

Pediatric Specialty Services

As a pediatric emergency medicine physician, I have both the fortunate and unfortunate opportunity to care for children involved in horrific accidents. The accidents we see in our Children’s Emergency Center could not highlight the need for these recommendations more strenuously.

Robin N. LaCroix, MD__________________________________________ 864-455-8401 Medical Director; Chair, Department of Pediatrics Matthew P. Grisham, MD___________________________________________ 455-7895 Pediatric Residency Program Director Russ C. Kolarik, MD________________________________________________ 455-7844 Medicine-Pediatrics Residency Program Director Karen L. Ratliff-Schaub, MD_________________________________________ 454-5115 Developmental-Behavioral Fellowship Program Director

Over the past year, we have had several motor vehicle collisions involving significant morbidity and mortality for patients. The most injured children were unrestrained and ejected/displaced passengers. In nearly every one of these traumatic events, the children properly restrained in a car seat/booster were discharged home with abrasions and bruises only.

Abuse & Neglect___________________________________________________ 335-5288 Adolescent Pediatrics_______________________________________________ 220-7270 Allergy and Immunology____________________________________________ 675-5000 Ambulatory Pediatrics ______________________________________________ 220-7270 Behavioral Health__________________________________________________ 455-5612 Cardiology ________________________________________________________ 454-5120 Critical Care_______________________________________________________ 455-7146 Developmental Pediatrics___________________________________________ 454-5115 Emergency Pediatrics_______________________________________________ 455-6016 Endocrinology_____________________________________________________ 454-5100 Gastroenterology___________________________________________________ 454-5125 Genetics__________________________________________________________ 250-7944 Hematology/Oncology_____________________________________________ 455-8898 Infectious Disease__________________________________________________ 454-5130 Minor Care (Spartanburg Night Clinic)________________________________ 804-6998 Children’s Hospital After-Hours Care_______________________________ 271-3681 Neonatology______________________________________________________ 455-7939 Nephrology & Hypertension_________________________________________ 454-5105 Neurology_________________________________________________________ 454-5110 Neurosurgery______________________________________________________ 797-7440 Newborn Services__________________________________________________ 455-8401 Ophthalmology____________________________________________________ 454-5540 Orthopaedic Oncology______________________________________________ 797-7060 Orthopaedic Surgery________________________________________________ 797-7060 Pain Medicine_____________________________________________________ 675-3488 Plastic Surgery_____________________________________________________ 454-4570 Pulmonology______________________________________________________ 454-5530 Radiology_________________________________________________________ 455-7107 Rheumatology_____________________________________________________ 454-5004 Sleep Medicine____________________________________________________ 454-5660 Supportive Care Team______________________________________________ 455-5129 Surgery___________________________________________________________ 797-7400 Urgent Care (Anderson)____________________________________________ 512-6544 Urology___________________________________________________________ 454-5135

Proper use of a car safety seat or booster decreases the risk of death or serious injury by over 70 percent; this finding is absolutely supported by our experience.

These recommendations are not made lightly and are conservative for a reason. The initial studies that recommended a forward-facing seat at age 2 did not have a large enough sample size to have statistical significance. As a result, there is not enough evidence to advocate for a hard age for when this transition should occur. Current S.C. law, however, has not had time to adjust for these new findings and the AAP’s recommendation. Therefore, the hard age of 2 years remains in effect for the transition to a forward-facing seat, unless a younger child has outgrown the rear-facing seat. However, it is clear that a rear-facing seat provides a shell that protects the most vulnerable parts of a child’s body.

A forward-facing seat restrains the child’s body, but allows greater mobility of the head, which is disproportionately large and heavy. Delaying the transition to a forward-facing seat will protect the child.

Children are our future. I hope you will read these recommendations in their entirety and continue to advocate for each child in your practice. Even Hamlet recognized that bearing those ills was too great a price to pay.

Article author Jeremiah Smith, MD, is a physician in GHS Children’s Hospital’s Children’s Emergency Center.

Children’s Hospital Programs BI-LO Charities Children’s Cancer Center______________________________ 455-8898 Bradshaw Institute for Community Child Health & Advocacy_____________ 454-1100 Bryan Neonatal Intensive Care Unit___________________________________ 455-7939 Child Life_________________________________________________________ 455-7846 Comprehensive Sickle Cell Desease Program___________________________ 455-5680 Cystic Fibrosis Clinic________________________________________________ 454-5530 Family Connection_________________________________________________ 331-1340 Ferlauto Center for Complex Pediatric Care____________________________ 220-8907 Gardner Center for Developing Minds_________________________________ 454-5115 Girls on the Run___________________________________________________ 455-4001 Infant Apnea Program______________________________________________ 455-3913 International Adoptee Clinic_________________________________________ 454-5130 Kidnetics® (pediatric therapies)______________________________________ 331-1350 Neonatal Developmental Follow-up Services___________________________ 331-1333 New Impact (weight management)_____________________________ 675-FITT (3488) Office of Philanthropy/CMN_________________________________________ 797-7735 Pediatric HIV Clinic_________________________________________________ 454-5130 Safe Kids™ Upstate________________________________________________ 454-1100 Spiritual Care______________________________________________________ 455-7942 Wonder Center____________________________________________________ 331-1380 Day treatment for medically fragile children

For admission to Children’s Hospital: (864) 455-0000

Did you know Safe Kids Upstate, the Injury Prevention team at the Bradshaw Institute for Community Child Health & Advocacy, offers free car seat inspections at over 20 locations in the community – including Greenville Memorial Hospital. These stations are staffed by nationally certified child passenger safety technicians.

This number connects you to GHS’ Patient Referral and Transfer Center, which can handle all arrangements for admission. You also may call 455-7000 and ask the operator to page the admitting resident.

Neonatal Transport: 864-455-7165 To reach a Children’s Hospital doctor or program, call 1-800-4RBUDDY. Pediatric Outpatient Service Locations Call the appropriate Greenville number above for an appointment.

Anderson

Cardiology Endocrinology Hematology/Oncology Nephrology & Hypertension Urology

Greenwood

Abuse & Neglect Cardiology Surgery

Spartanburg

864-573-8732 Abuse & Neglect Cardiology Endocrinology Gastroenterology General Surgery Hematology/Oncology

Kidnetics® Nephrology & Hypertension Neurology Neurosurgery Pulmonology Sleep Medicine Urology

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Non-Profit Org. U.S. Postage PAID Greenville SC Permit No. 842 701 Grove Road Greenville, SC 29605-5601 Change Service Requested

GHS Vision Transform health care for the benefit of the people and communities we serve.

GHS Mission Heal compassionately. Teach Innovatively.

Improve constantly.

GHS Values Together we serve with integrity, respect, trust and openness.

For information about Children’s Hospital giving opportunities, call GHS’ Office of Philanthropy at 864-797-7732 or visit ghsgiving.org.

Pediatrician of the Year Congratulations to Christopher Troup, MD, medical director for Pediatric Neurosurgery at Children’s Hospital of Greenville Health System, who received the 2018 Pediatrician of the Year award at the 27th Annual DeLoache Seminar in November.

Dr. Troup was recognized by his colleagues for being “a selfless, outstanding caregiver who always places the patient first” and for being “dedicated and incredibly hard working.” In addition, he was lauded for his bedside manner, handling difficult medical situations and questions adeptly and knowledgeably – and always with a smile.

One colleague who often refers patients to Dr. Troup noted the following: “These families constantly tell me how caring he is, how down to earth he is, how kind he is and how much time he spends with them. He is always willing to take time to talk to anxious and worried families. He is also amazingly adept at talking to children on whatever level or in whatever way is necessary.”

Robin LaCroix, MD (left), medical director of Children’s Hospital, presents Dr. Troup with his award.

Approximately 75 health professionals attended the seminar, which is named for the late William R. DeLoache, MD, the system’s first neonatal medicine specialist.

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