Author: Erin Horan

From EKGs to echos: How broadly should kids be screened for heart problems?

Heart-screenings-athletes

Every three days, a young athlete somewhere in the United States collapses and dies due to an undetected heart problem. It’s a tragedy that Gian Corrado, MD, who works in Sports Medicine at Boston Children’s Hospital, has seen unfold firsthand. He was an undergraduate playing pick-up basketball when one of his teammates died suddenly on the court.

“It’s uncommon,” he says, “but it’s not so uncommon that it may not touch you. It happens, and we have no effective, efficient way to screen for it.”

There is a lot of interest in using heart screening in young athletes to reduce sudden death risk . The NCAA’s chief medical office recently suggested that it may be useful to routinely perform electrocardiograms (EKGs) and possibly other cardiac tests on some collegiate level athletes. A January 2016 opinion piece on this issue in the New York Times drew a lot of attention. Cardiac screening has also been proposed for other groups, such as children starting certain types of medications.

But there’s widespread debate in medical circles about such broad usage of EKGs. Why is this so controversial? If it’s such a valuable test, why doesn’t everyone get routine EKGs? …Read More

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Do hospital rankings matter?

Sree Bhagwat in the lobby of Boston Children's Hospital.
Bhagwat in the lobby of Boston Children’s Hospital

Everyone who works in health care is familiar with U.S. News and World Report’s annual Best Hospitals rankings. But the methods behind the numbers can seem complex and mysterious, even secretive. What do rankings really tell us about the quality of health care at various institutions? Are they even helpful? Do they impact care?

Sree Bhagwat, a senior marketing analyst at Boston Children’s Hospital who manages the hospital’s data collection and reporting to U.S. News, says “yes.”

“It’s not just about competition,” says Bhagwat. “It’s about improving the standards of health care everywhere. The rankings process reveals important metrics that can drive improvements in national health care. Data points are driven by expert clinicians who serve on the numerous U.S. News committees.”

…Read More

Dissecting the AAP’s new guidelines for child media use: Advice from The Mediatrician

baby-with-ipad

Children are exposed to screens earlier in life and for longer periods than ever before. Mobile technology has pervaded our society to the point where doctors and parents alike are asking: what effect is this having on young minds? On brain development? On socialization?

How much “screen time” is too much? How young is too young? And, of course, the follow-up question of our time: are all apps created equal?

Michael Rich, MD, director of the Center on Media and Child Health at Boston Children’s Hospital, has a crystal-clear message. “This is a critical part of parenting in the 21st century,” he says. “It is no longer a fringe issue. The first thing we have to do with pediatricians, he says, is get them to talk about it.

Rich, also known as “The Mediatrician,” conducted research that helped inform the American Academy of Pediatrics’ latest recommendations for children’s media use. …Read More

It’s complicated: Identifying and treating high blood pressure in children

high-blood-pressure-chidren-heart-center

High blood pressure is notoriously difficult to detect in children. And the consequences of undiagnosed hypertension can be severe.

Sustained high blood pressure can lead to target end-organ disease, meaning long term effects on:

  • the kidney, e.g. renal insufficiency and ultimately end stage kidney disease
  • the heart, e.g. left ventricular hypertrophy and ultimately congestive heart failure

In children, “the difference between normal and abnormal blood pressure can be small, depending on factors like age, height and weight,” says Sarah de Ferranti, MD, director of the Preventive Cardiology Program at Boston Children’s Hospital.

A reading of 120/75 would be:

  • Stage two hypertension in a two-year old
  • Stage one hypertension in a seven-year old
  • Pre-hypertension in an 11-year old
  • Either normal or pre-hypertension in a 17-year old
  • A normal reading for an adult

“Not all kids with high blood pressure are overweight, but all overweight kids are at risk for high blood pressure,” adds de Ferranti. …Read More