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Respiratory syncytial virus, also known as RSV, is a common respiratory virus that impacts the lungs and breathing pathways. The virus can be dangerous for infants and young children and is also concerning for older adults. While most older kids and adults only experience cold-like systems and recover in a week or two, an estimated 58,000-80,000 children younger than 5 years old are hospitalized due to RSV each year, and in 2022 healthcare organizations across the country are experiencing higher infection rates than in years past.  "We are experiencing a strong RSV season and do not expect it to go away anytime soon," said Dr. Kris Wilson, Division Chief of Renown Children's Primary Care. "Infants who are infected with RSV almost always show symptoms of runny noses and cough. Call your healthcare provider immediately if your child is having difficulty breathing, is not drinking enough fluids, or is experiencing any worsening of these symptoms.” Symptoms of RSV: Runny nose  Decrease in appetite/inability to drink Dry diapers, an indication of dehydration  Cough, which may progress to wheezing or difficulty breathing Irritability (most common in very young infants) Decreased activity (most common in very young infants) Decreased appetite (most common in very young infants) Apnea, pauses in breathing for more than 10 seconds (most common in very young infants) What to do if you think your child has RSV: Call your pediatrician! If you suspect your child might have RSV, consulting their healthcare provider is the best first line of defense. From here they will help you build an appropriate treatment plan for child. Keep in mind that many pediatrician offices offer 24/7 call lines.  If your child is experiencing retracted breathing (when the area between the ribs and in the neck sinks in when a person attempts to inhale), dehydration (not drinking and decrease in wet diapers) or apnea (pauses in breathing for more than 10 seconds) please call 911 or go to the closest emergency room.

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Austin was five years old when he was diagnosed with leukemia. A fever and pale looking skin prompted his mom, Brenda, to bring him into his primary care physician in Carson City. After doing some blood work, the fight to beat Austin's cancer began. The initial shock of learning your child has cancer is traumatic and can feel like a whirlwind. Then the questions begin – will my child survive, what happens next, how will we tell his siblings, will we have to travel out of state for quality care? The list of questions feel endless. While grappling with the news, Brenda brought Austin to Renown Children’s Hospital for an additional check-up. This weeklong hospitalization started with a series of tests to confirm Austin’s diagnosis and ultimately it led to treatment for the leukemia. Dr. Jacob Zucker, a pediatric oncologist at Renown Children's Hospital, was with Austin every step of the way, even meeting him in the parking garage on his first day of treatment. Brenda is eternally grateful that Dr. Zucker was on staff at Renown Children's Hospital, which allowed them to keep Austin's care in Reno. The alternative was to travel out of state for care. "Dr. Zucker was the best thing to ever happen to our family. I consider him a part of our family now," said Brenda. "His kindness and knowledge gave us faith in him." Treatment for Childhood Leukemia Austin’s treatment was broken into a number of stages with the first eight months of therapy being the hardest. He would receive almost weekly therapy at Renown Children’s Infusion Center as well as frequent spinal taps with chemotherapy. After eight months, and for the next three years, Austin would receive a maintenance phase therapy. This meant oral chemotherapy every day, IV chemotherapy once a month, spinal chemotherapy every three months and steroids for the first five days of every month. After more than four years of fighting cancer, Austin, now 10, is free of any disease. Currently, he has blood work every two months to ensure he is on the right track. Seeking Advice from Children’s Oncology Groups Throughout Austin's treatment, Brenda regularly sought advice from Children's Oncology Group (COG) members. COG is the world’s largest organization devoted exclusively to childhood cancer. Renown Children's was not a member of COG at the time of Austin's treatment -- with the closest facilities located in the Bay Area and Salt Lake City – but it is /now. “When faced with pediatric cancer, the last thing parents should worry about is traveling great lengths to receive the best in cancer care," said Larry Duncan, Vice President of Pediatrics and Surgery and Administrator at Renown Children's Hospital. "We are proud to now offer the most advanced childhood cancer treatment options here at Renown, close to home and convenient for area patients and their families.” This membership allows Renown to enroll our youngest patients – just like Austin – in the latest clinical trials, including groundbreaking treatments, studies to understand these diseases better and in addition, this program will focus on supportive care and survivorship. "The COG allows Renown providers to access treatment plans that were not available to non-COG hospitals when Austin was receiving treatment," said Brenda. "It comforts me to know that not only can children receive cancer treatment right at home, but their parents can now elect for them to participate in trials and plans that are at the forefront of cancer treatment today." How You Can Help Make a Difference Renown Health is focused on being the destination for all your family’s health and healthcare needs. As a not-for-profit health system, Renown relies heavily on community funding. If you are interested in supporting Renown Health, and kids like Austin, please consider giving to Renown Health Foundation. Donations are accepted through the following ways: Make a gift at www.renown.org/give Call Renown Health Foundation at 775-982-5545 Mail a check to Renown Health Foundation, 1155 Mill St., 02, Reno, NV 89502

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Roughly 59% of eligible Nevadans are fully vaccinated against COVID-19 as of mid-September. That number is up 9% from only a month ago, but our work is far from done!  One of the most powerful ways to convince someone to get vaccinated is for a person they trust and respect to take the time and have that complicated conversation with them.  We know these conversations can be daunting, so we consulted Marie McCormack, MD, Primary Care Division Chief at Renown, about the six best ways to approach and frame these conversations to be productive and effective.  1. Be firm, but not aggressive. 2. Listen to what they have to say, and don’t assume you know why they haven't gotten the vaccine yet. 3. Cater your responses to their concerns. The CDC even has a helpful reference table identifying main reasons people are not getting vaccinated.   If they are scared, offer to go with them.  If they are not worried about getting sick, explain that they are more at risk of infecting those around them who are more likely to have a severe reaction to   the virus.  If they don’t know how to make an appointment, help them find the most convenient time and place for their schedule.  If they are worried about how fast the vaccine was developed, remind them that the mRNA technology used in these vaccines has been studied for years.  If they are worried the vaccine will affect fertility, tell them that in August the CDC officially recommended that pregnant people can get vaccinated.  4. When in doubt, hit them with the stats!  1 in 500 Americans has died from COVID-19.  Vaccinated people are nearly five times less likely to get infected, according to the CDC.  Vaccinated people are 10 times less likely to get so sick they ended up in the hospital, according to the CDC. 5. Remind them of all the things they might not be able to do if they aren't vaccinated.  Attend concerts or sporting events  Travel  Potentially even keep their job 6. When all else fails, use the tough love approach. Tell these people you don’t feel comfortable meeting with them in person until they are vaccinated.

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Posture is important, but for those children diagnosed with scoliosis (spinal curvature) it can be a difficult issue. The Washoe County School District Student Health Services Department screens 7th grade students for scoliosis as growth spurts often reveal the condition and, if diagnosed early, scoliosis can stop progressing. We asked Michael Elliott, MD, head of the Department of Pediatric Orthopedics and Scoliosis to answer some frequently asked questions about scoliosis. What is scoliosis? There are many types of scoliosis: early onset (occurs before age 10), congenital scoliosis is when the bones of the spine do not form correctly, neuromuscular scoliosis which is due to children’s neurologic and muscle disease, and the most common is Adolescent Idiopathic Scoliosis. The term “idiopathic “ means the exact cause is unknown, although we do know it runs in families. This type of scoliosis occurs in 2-3 percent of adolescents and is mainly seen during their growth spurt. This is why middle school screenings are recommended. Both genders get scoliosis but girls are 8 times more likely to have their curves progress and become larger. What are the signs that my child may have scoliosis? A few signs for parents to watch for are: One shoulder might be higher than the other. One leg may seem longer. A hip may be higher or look more prominent. The waist may not look the same from side to side (asymmetry). The trunk or rib cage may be more prominent on one side or shifted. When they bend forward they may have a bump on their back. How is scoliosis diagnosed? It can be noticed by a pediatrician at a physical, school screening nurse, PE teacher or parents. Once the curve is suspected the child is usually referred to a pediatric orthopedic surgeon scoliosis expertise. At the initial visit the doctor will perform a thorough physical including a complete neurologic exam to assess the amount of curvature. Once the exam is completed the physician will determine if a spinal x-ray is needed. The curve on the x-ray is measured utilizing the cobb angle (a measurement in degrees) which helps guide the treatment. What are common treatments for scoliosis? The treatment depends on the size of the spinal curve and the amount of growth the child has remaining. An x-ray of the child’s hand is used to determine the amount of growth remaining. This allows the determination of the child’s bone age, and based on the hands growth plates it can determined if the child is in their rapid phase of growth. Treatments include: Observation - For curves less than 20-25 degrees. This entails visits every 6-9 months with a repeat scoliosis x-ray. Since scoliosis curves increase only 1-2 degrees per month, and variations in measurements can be 3-5 degrees, an x-ray is not recommended before 6 months. If the curve remains less than 25 degrees the child is followed until their growth is completed (usually age 16-18). Progressing Curve - If growth is finished and the curve is less than 40 degrees, the risk of more curvature into adulthood is small. If growth is completed and the curve is over 45 degrees, the child is followed for several years as these curves can progress into adulthood. If the patient is still growing and the curve has progressed greater than 25 degrees but still in the non-operative range (less than 45-50 degrees) bracing is used to stop the progression of the curve. Bracing - Indicated for curves over 25 degrees but less than 45 degrees. If a brace is required you will be referred to an orthotist (bracing specialist). The orthotist assesses your child, reviews the x-ray and then fits the brace. (Having a brace made usually takes 2-3 weeks.) Once the brace is fit, your child will visit the scoliosis specialist for an x-ray in the brace to ensure it fits correctly. The primary goal of bracing is to halt progression of the curve and prevent the need for surgery. The brace must be worn for about 16 hours per day to be effective. In a recent bracing study 72% of the patients who wore their braces as prescribed prevented the need for surgery compared to the group who did not wear their brace. Surgery: When a curve reaches 45-50 degrees, and a child is still growing, surgery is usually recommended because the curve is likely to continue progress. If a curve is over 50 degrees and the child is done growing surgery also may be recommended. This is because when curves are over 50 degrees they tend to increase 1-2 degrees per year for the rest of your life. As curves get larger the amount of lung function tends to decrease which could cause breathing problems later in life. The goals of surgery are to stop the progression of the curve and safely correct any misalignment. This is accomplished by attaching implants (rods, screws, hooks and bands) to the spine. Bone graft is then placed around the implants to encourage the spine to fuse (grow together). This then forms a solid column of bone with metal rods in place, preventing the curve from changing. Most patients are back to their regular sports and activities six months post surgery.

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