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Ensuring a healthier and more inclusive future for LGBTQIA+ children and teens is of utmost importance to health systems in our community, especially Renown. Supporting the physical and mental health of youth in this community is key to those efforts, especially as they face unique challenges in terms of identity acceptance and social integration.   Dr. Caroline Barangan, Adolescent Medicine Physician with Renown Children’s Pediatric Specialty Care, discusses what you as a parent, caregiver, friend or support system can do to be a safe space for children and teens who identify as LGBTQIA+. 1.  Create a Safe Space at Home The most important action you can take for your LGBTQIA+ teen or child is to accept and support them for who they are, regardless of how they identify. “Being a teenager is already difficult enough, especially within the LGBTQIA+ community, which puts them at risk of being stigmatized, rejected and targets for bullying,” said Dr. Barangan.  Your supportive words and actions can make a huge difference as a profound expression of love and understanding. Being patient and willing to learn are the foundations to a healthy and loving relationship with your LGBTQIA+ teen or child.  2.  Encourage Regular Check-Ups with a Primary Care Provider (PCP)  Establishing your child or teen with a PCP is not only important when an illness occurs but also for annual preventative visits and regular check-ups. “A primary care provider can screen for high-risk behaviors that would put a patient’s health in jeopardy, such as sexual experience, substance use, suicidality and self-harm,” said. Dr Barangan. “These screenings are an opportunity to provide the education and support these kids and teens need to stay healthy.”  One of the main concerns LGBTQIA+ youth often have is that they will experience judgment from their provider, or the PCP will disclose sensitive information, including their sexuality or gender identity to their parents, when they are not ready to do so. Dr. Barangan emphatically reminds us that this legally cannot happen. “If a patient asks me to keep something confidential, unless they disclose that they have plans to harm themselves or others, I am legally not allowed to share that information with anyone without their permission,” said Dr. Barangan.  3.  Locate Local Resources  Northern Nevada is home to a variety of resources for the LGBTQIA+ community at large, including youth members of this community. "Finding resources to help them develop in a positive way and provide them with the information they need, whether it be in school, the household, the community or through a medical or mental health provider, is incredibly important,” said Dr. Barangan.  Below is a list of local LGBTQIA+ community resources open to you and your children:  Our Center LGBTQIA+ Health Services at Northern Nevada HOPES Northern Nevada Pride Festival & Community Parade (happens every July in Reno) Sassabration (happens every September in Carson City) Lake Tahoe Pride (events and resources shared on Facebook)

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For Michael J. Elliott, MD, a pediatric orthopedic surgeon specializing in scoliosis, it’s just another day helping patients. But to local five-year-old Makenna Christensen, her substantial spine correction is life-changing. Though her journey to body confidence was months in the making, her smiles are a reminder that a thorough, thoughtful treatment plan can yield amazing results. A Surprising Start Words don’t adequately describe the feelings you have when you unexpectedly learn your child has a birth defect. For Nicole and Nick Christensen it was a shocking surprise. During Nicole’s sonogram appointment something unusual was seen. After an amniocentesis, their baby girl was diagnosed with Noonan syndrome, which can affect a child’s height and bones. To prepare, the couple read all they could on the subject. Fortunately their daughter Makenna, was born full term and healthy. Shortly after birth, Makenna had some feeding issues and returned to the hospital. Although they resolved and she had no major complications, both parents felt unsure about their newborn’s future. With the help of Nevada Early Intervention Services , Makenna’s development was monitored until she was three years old. “Her posture has been an issue her whole life,” says Nicole. Nick also noticed when Makenna started walking her range of motion was poor. It was especially noticeable when she got dressed and raised her arms to put on clothing. Nicole observed Makenna was falling a lot in preschool. She asked Makenna’s pediatrician about physical therapy to support her coordination and muscle tone. Although physical therapy was helping Makenna, her therapist suggested Nicole seek the opinion of Dr. Michael Elliott, a pediatric specialist in orthopedics at Renown Children’s Hospital. Scoliosis Casting - A Successful Treatment Approach Dr. Elliott diagnosed Makenna with scoliosis, an abnormal curvature of the spine. While this condition is most common during a teenage growth spurt, it can also happen in early childhood. Affecting about four million people in the United States, it is estimated 20 percent of all spinal deformities in the U.S. are people living with scoliosis. Makenna’s spinal curve was significant – over 30 degrees. Through years of experience Dr. Elliott opted to put Makenna in a spinal cast, instead of multiple surgeries. “My approach is to postpone surgery as long as possible - it is tough for the patient and families,” he says. “Often excellent results can be achieved through non-invasive treatments such as, casting and bracing.” Nicole appreciated Dr. Elliott’s reassurance through the treatment plan. “It was obvious through the X-rays that there was a significant issue,” she shares. “He guided us through the timing and process and how correcting it sooner would help keep her future growth on track.” For seven months Makenna wore a cast that looked like a tank top, bracing her spine while allowing movement. Now she wears a hard plastic brace, specially fitted to her body.  “Kids tolerate casting well,” explains Dr. Elliott.  “It is a 45-minute procedure. The patient sleeps while their spine is put into traction as the cast dries.” She will continue to wear larger braces as she grows, eventually only wearing them at night. A Straight Path into the Future Dr. Elliott admits, “Not every cast is a cure. Two thirds of a child’s spinal growth happens by the age of five. Getting past the five-year mark means fewer surgeries. It’s wonderful to see Makenna’s body image improved.” Nicole agrees, “The way Makenna holds herself is completely different. She’s more confident on her feet and more balanced.” She can now play with her sister Aria, 4, and brother Lexi, 8 months, without the fear of falling. Nick is in awe of the improvements she has made, “Seeing her thrive more has been wonderful.” The Christensen’s are hopeful about the future. “Makenna is doing really good. She’s wearing her hard brace full time and her growth is consistent,” expresses Nicole. “She’s even starting swim lessons this week.” With mask wearing at every doctor visit during the COVID-19 pandemic, Makenna and Dr. Elliott look forward to seeing each other’s smiles in the future. Makenna’s story highlights the over 18 different specialty options for children locally at Renown Children’s Hospital.

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Michael Elliott, MD, head of the Department of Pediatric Orthopedics and Scoliosis, answers some common questions about bone fractures. Is there a difference between broken bones and fractures? No, these are two different names for the same injury. Of course the common term is a broken bone. Using either name will describe your concerns. Medical personnel typically describe a broken bone as a fracture to a specific bone. For example, a broken wrist is also a fractured distal radius. To clarify, this describes the injured bone and the precise location. How do I know  if my child has broken their bone? Many times children will fall and complain of their arm or leg hurting. In most cases the pain goes away and the child will return to their activities. When there is a deformity to the limb (curve in arm) and the child is complaining of pain, it is probably a fracture. If the arm or leg looks straight, look to see if there is any swelling or bruising. Both are signs of a possible fracture. Finally, if the limb looks normal but the child continues to complain, gently push on the bone. Likewise if it causes the same pain, then they likely have a fracture and should have an x-ray. My child fractured their growth plate, what does this mean? Growth comes from this area of the bone. In detail, these are located all over the body but typically at the end of the bones. With this in mind, fractures to these areas can result in the bone growing abnormally. Because of potential shortening of the arm or leg, or bones growing crooked, it is important to follow fractures closely (up to 1-2 years or longer). It is better to identify a problem early. Small problems can be treated with small surgeries. What if the bones of the x-ray do not line up? Because children are growing, unlike adults, their bones will remodel and straighten with growth. The amount of remodeling occurring depends on a child’s age, the bone fractured and the location. In many cases an angled bone will grow straight over the course of a year. For this reason, someone with experience in caring for children needs to follow bone growth. How long does it take fractures to heal? Factors deciding when a cast can come off include: Child’s age. Bone fractured. Fracture location. Young children heal faster than teens, teens heal faster than young adults, who heal faster than older adults. In young children most fractures heal in 4-6 weeks. However, teens generally take 6 weeks to heal, and adults can take much longer. Although your child  is out of their cast, it may not be healed completely to return to all activities. Placing a splint is during this time is common. This typically gives them added protection for several weeks after their cast is removed -  in case they forget their limitations. What if my child is still limping? Whether a child is in a walking or non-weight bearing cast, removing it often leaves them stiff and sore. Therefore many children will walk as though they still have a cast in place. In most cases this resolves in about three weeks. Regardless, if your child is still limping or walking abnormally after three weeks, contact the treating doctor. They may benefit from physical therapy or a repeat evaluation.  (This article was original published in the July 2019 issue of South Reno Kids & Sports.)

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A clubfoot is where the foot is turned in on itself and points toward the ground. A clubfoot diagnosis during pregnancy is surprising and challenging during any circumstance. And in the case of parents anticipating surgery during a pandemic, options can be scarce. These parents took a deep breath, and with the help of Michael J. Elliott, MD, pediatric surgeon with Renown Children’s Hospital, their baby is on the road to recovery.

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