Houston Area Pediatric Specialists

Independent pediatric specialists aim to serve our community. We want to share news and analysis regarding our specialties and our practices.

Saturday, September 25, 2010

Children with Autism Dont Yawn Contagiously

Children Under Four and Children With Autism Don't Yawn Contagiously

From Dr. Rotenberg - Fascinating news on a subconscious social behavior.

ScienceDaily (Sep. 16, 2010) — If someone near you yawns, do you yawn, too? About half of adults yawn after someone else does in a phenomenon called contagious yawning. Now a new study has found that most children aren't susceptible to contagious yawning until they're about 4 years old -- and that children with autism are less likely to yawn contagiously than others.


Wednesday, September 22, 2010

Neuropsychological and behavioural aspects in children and adolescents with idiopathic epilepsy

Neurology note - A comprehensive approach to epilepsy includes attention to neuropsychological function. Dr Rotenberg

Seizure. 2010 Aug 21. [Epub ahead of print]

Neuropsychological and behavioural aspects in children and adolescents with idiopathic epilepsy at diagnosis and after 12 months of treatment.

Piccinelli P, Beghi E, Borgatti R, Ferri M, Giordano L, Romeo A, Termine C, Viri M, Zucca C, Balottin U.

Child Neuropsychiatry Unit, University of Insubria, Macchi Foundation Hospital, Varese, Italy; Department of Child Neurorehabilitation, "Eugenio Medea" Scientific Institute, Bosisio Parini, Italy.


PURPOSE: To study neuropsychological functions in children with idiopathic epilepsy at onset of treatment and after 1 year of therapy and to identify factors associated with cognitive impairment.

METHODS: 43 Subjects aged 5.2-16.9 years with newly diagnosed idiopathic epilepsy were enrolled and started treatment with valproate or carbamazepine. At admission and after 12 months, all patients underwent clinical examinations, the Child Behavioural Checklist, EEG and a neuropsychological test battery. The results of each test were correlated to demographic, clinical, electrophysiological and therapeutic variables.

RESULTS: Except for attention, all neuropsychological functions were normal at admission and after 12 months. An improvement with time was noted for memory (p<0.05)>

DISCUSSION: Idiopathic epilepsy can affect attention, even before starting treatment. Emotional and behavioural difficulties and a low socio-economical status are associated with cognitive impairment.


PMID: 20732824 [PubMed - as supplied by publisher]

Rare condition sometimes mistaken for cerebral palsy

Rare condition sometimes mistaken for cerebral palsy

An Ontario mother refused to accept her infant had cerebral palsy and fought to get a second opinion. It turns out she was right: he had another, easily treatable disease called dopamine-responsive dystonia.
The condition is part of a group of illnesses that cause repetitive and painful muscle contractions. It can be mistaken for cerebral palsy, but unlike CP, this condition can be treated, if patients get the right diagnosis.
At three months of age, Corinne Fewster-Gagne's son Beckham started showing symptoms of clenched fists, painful stiffness, and uncontrollable crying.
"I was shocked," she told CTV News. "The only question I could think to ask at the time was, 'Is my son ever going to be able to walk?'"
She refused to accept the diagnosis and searched for a second opinion.....

Educational Note - Children can have movement disorders that mimic CP. JR


Another video...


Monday, September 20, 2010

Sudden Unexplained Death in Epilepsy - Unmasking Silent Killer in Epilepsy

Unmasking Silent Killer in Epilepsy

On July 9, 2009, Steve Wulchin went to wake his 19-year-old son, Eric, in their home in Boulder, Colo. Eric had been given a diagnosis of epilepsy three years earlier, but other than that, his father said, “there was nothing out of the ordinary.” His seizures had been well controlled; he had not had one in six months.

Yet that morning, Mr. Wulchin found Eric lying on the floor. CPR and paramedics were too late; Eric had died at about 2:30 a.m.

The cause of Eric’s death was ultimately listed as Sudep, for sudden unexplained death in epilepsy. The syndrome accounts for up to 18 percent of all deaths in people with epilepsy, by most estimates; those with poorly controlled seizures have an almost 1 in 10 chance of dying over the course of a decade.

Yet many patients and their families never hear about Sudep until someone dies. Mr. Wulchin said none of Eric’s four neurologists ever mentioned it to the family.

“The message we got back was, ‘There’s no reason why he can’t live a long and normal life,’ ” he said. “It never occurred to me that this was a possibility.”

Now, physicians, researchers, advocates and relatives like Mr. Wulchin, a technology executive, are trying to raise awareness about Sudep. One of their goals is to establish registries of deaths and autopsy results, building databases to support future research.

Sudep most often affects young adults, typically ages 20 to 40, with a history of the convulsive seizures once known as “grand mal.” Others at risk include those with difficult-to-control seizures, or seizures at night; people who take a large number of anti-epileptic medications or take them irregularly; African-Americans with epilepsy; and people with epilepsy whose I.Q. is under 70......more....


Saturday, September 18, 2010

Obesity and Disturbed Sleep - Eat less, Move more, SLEEP more

Obesity and Disturbed Sleep - Eat less, Move more, SLEEP More - Dr. Josh Rotenberg comments on new research on WABC News


Insufficient sleep increases the risk of obesity.

  • Both body and brain need quality sleep.

Sleep must be of adequate quantity and quality.
Watch for the the vicious circle
  • reduced sleep can increase body weight
  • increased weight can cause sleep apnea
  • sleep apnea fragments and reduces sleep
    Breaking the vicious cycle can help with weight loss. (tie in Denzel?)
If your child has a weight problem
  • Maintain a healthy and firm sleep schedule
  • Turn off video games, computer TV after dark
  • Make behavioral change a family project
  • Keep a sleep diary
  • Watch for a sleep problem
  • Call your physician for further testing

Monday, September 13, 2010

World Class Pediatric Specialists - Right Here in Your Own Back Yard

John M. Robertson, M.D. and Sarat C. Susarla, M.D.,
are pleased to announce the opening of their new pediatric specialty office in Katy for children with breathing and sleep disorders. They take care of children with asthma, sleep apnea, recurrent pneumonia, chronic cough, exercise induced breathing problems or symptoms, and shortness of breath, as well as respiratory problems related to prematurity like chronic lung disease and apnea. Experts in their field, these physicians bring experience and trusted care for your child right to your neighborhood. Houston Pediatric Pulmonary and Sleep Associates offer state of the art treatment options and equipment for your child’s health inside and outside of the hospital. They see patients at Christus St. Catherine, Kingwood Medical Center, The Women’s Hospital of Texas, Clearlake Regional Hospital, Texas Children’s Hospital, and Children’s Memorial Hermann in the Texas Medical Center. They currently have additional offices in the Medical Center, Clearlake, Kingwood and Sugar Land.

Dr. Robertson is board certified in pediatric and pediatric pulmonology. He received a B.S. in Microbiology from Texas A&M University in College Station TX and is a graduate of the University of Texas Southwestern Medical School in Dallas, Texas. He completed his pediatric residency at Children's Medical Center of Dallas and his fellowship in Pediatric Pulmonology at Texas Children's Hospital.

In his spare time, Dr. Robertson is a poet with 24 works published, as well as a mixed-media artist. His wife Julie, also an Aggie, works for the American Heart Association.

Dr. Susarla is a board certified pediatrician specializing in pediatric pulmonology. He grew up in the Houston area and received his B.S. in Molecular Biology from The University of Texas at Austin and his medical degree from The University of Texas Medical Branch in Galveston.

He completed his pediatric residency at Arnold Palmer Hospital for Children in Orlando, Florida and his Pediatric Pulmonary Fellowship at Texas Children's Hospital in Houston. His professional interests include pediatric asthma and sleep-disordered breathing.

In his spare time, Dr. Susarla enjoys tennis with his wife, and plays guitar and classical violin. He and his wife recently celebrated the birth of their first child, Gopal.
705 S. Fry Road / Katy, TX 77450
Phone: 713.794.0200 / Fax: 713.794.0203 / Website: http://www.hppsa.com/

Saturday, September 11, 2010

Adolescents With Chronic Fatigue May Suffer Long-Term Effects

Adolescents With Chronic Fatigue May Suffer Long-Term Effects
Keeping up with healthy peers results in increased fatigue, sleep need

WEDNESDAY, Sept. 8 (HealthDay News) -- Adolescents who do not recover from chronic fatigue syndrome (CFS) continue to experience extreme fatigue, to use medical services at a high rate, and to miss school and work; and, those who attempt to keep up with their healthy peers experience greater fatigue and need for sleep, according to two articles published in the September issue of the Archives of Pediatrics & Adolescent Medicine.

Stefan M. van Geelen, of the University Medical Center Utrecht in the Netherlands, and colleagues followed 54 adolescents with CFS for a mean of 2.2 years to describe the long-term outcomes, use of health care, and risk factors associated with non-recovery in this patient population. They found 28 (51.9 percent) had a near-complete improvement in symptoms, while 26 (48.1 percent) did not improve. Those in school had missed 33 percent of classes on average in the last month, while the other subjects had worked 38.7 percent of a full-time job on average. Of all the subjects, 66.7 percent were treated by a physical therapist, 38.9 percent received clinical treatment in rehabilitation, 48.1 percent had received psychological support, and 53.7 percent had used alternative treatment.


Friday, September 10, 2010

Baby Emergencies iphone App - When your mind goes blank

From Dr. Robertson

RN Tara Summers was inspired to make an iPhone app after a frightening episode where she saw her infant child choking. Because she was a nurse, she sprang into action and gave the Heimlich maneuver, but worried about parents (or babysitters) without the same training.

So, along with her emergency medicine physician husband, she created MedBasics -- a readily accessible information packet for the home about things to do in an emergency. Now, they're announcing an iPhone app called BabyMedBasics, for emergencies when you're not at home.


Playing Sports with Asthma

Playing Sports with Asthma

By John M. Robertson, M.D.

One of the most frequent questions asked by parents after their child is diagnosed with asthma is "Can he or she play sports?” Asthma is a chronic disease caused by inflammation of the airways that makes it hard to breathe. Typical asthma symptoms are one or more of the following: wheezing, coughing, chest tightness, or poor exercise tolerance. Some children only have asthma symptoms when they exercise, but most children with asthma develop asthma symptoms with exercise. So, if exercise can trigger asthma, shouldn't someone with asthma avoid sports? By no means! Long gone are the days when the asthmatic was forbidden from participating in sports. In fact, there are a number of professional and Olympic athletes with asthma such as Jerome “The Bus” Bettis, Amy Van Dyken, Kristi Yamaguchi, and Jackie Joyner-Kersee.

"Initially I thought that with asthma, I couldn't be involved in any sports or other activities. Thankfully, my mother encouraged me, instead of discouraged me, to play. She said, 'As long as you take your medicine, the doctor told me that you will be fine.‘” - Jerome “The Bus” Bettis, Super Bowl XL Champion Pittsburgh Steelers Running Back (1996-2005)

Modern medications combined with simple warm-up and breathing techniques make full athletic participation the norm for asthmatics. One common method to prevent exercise limiting asthma symptoms is to use a “rescue” medication, such as albuterol or levalbuterol, about 15 minutes before exercising. This helps to prevent or minimize the changes in the asthmatic lung that cause symptoms and limit exercise. This may be sufficient for the athlete who only has asthma symptoms during or after exercise. However, the athlete with asthma symptoms on and off the court may benefit from a daily “maintenance” (also called “controller”) medication on top of their “rescue” medication.

Today, asthma medicines are so effective that, if a child with asthma is unable to participate in sports because of breathing problems, then the top three most likely culprits are...

1. The child is not on the right medicine.

2. The child is on the right medicine, but not the right dose.

3. The child is on the right medicine, at the right dose but is not using it correctly.

The secret to controlling asthma is the right medication at the right dose and used the right way. In addition, there are simple warm-up and breathing techniques an athlete can use to further reduce asthma flare ups during or after exercise. Aerobic warm-up exercise of mild intensity, like jogging, for 20 minutes activates the body’s own anti-asthma defense mechanisms. This warm-up can be done before beginning strenuous exercise to prevent exercise induced asthma symptoms. Proper breathing during exercise can further minimize the triggering effect exercise has on asthma. Cold, dry air tends to promote asthma symptoms. The nose warms and humidifies air as it travels through toward the lungs. Therefore, athletes with asthma are taught to breathe in through their nose and out through their mouth to eliminate the exposure of their lungs to cold, dry air. Combined with proper medicine, these techniques can eliminate asthma as a barrier to athletic participation.

All of these interventions are not right for all child athletes with asthma. This is a situation in which a specialist such as a pediatric pulmonologist can help. Pediatric pulmonologists are trained to care for children (from birth to 18 years of age) whose asthma is still limiting their quality of life despite proper treatment by their primary care physician. A pediatric pulmonologist will evaluate the child’s current asthma symptoms, medications, and how those medications are being used. They will prescribe a plan tailored to the specific needs of the individual patient. This individualized plan will include teaching on the proper use of asthma medications and instruction on warm-up and breathing techniques to eliminate the impact of asthma on athletes.

Modern asthma management is extremely effective. In almost all cases, it is only when asthma is ignored or improperly treated that it limits a child’s ability to participate and enjoy athletics. A specialist like a pediatric pulmonologist can design a treatment plan to meet the individual needs of the child athlete, and can eliminate asthma as a barrier to athletic participation.

“It [asthma] interferes with almost everything I want to do from sleeping to laughing. But I've been able to work with my doctor on a good medication regimen so that it doesn't affect me as much.” - Amy Van Dyken, 6-time Olympic Gold Medalist in swimming (1996, 2000).

Monday, September 6, 2010

Does your child have a weight problem? Make sure they have sufficient sleep.

Does your child have a weight problem? Make sure they have sufficient sleep.
Children who sleep less than 8 hours, snack more and take in more fat and carbohydrates. JR


The Association of Sleep Duration with Adolescents’ Fat and Carbohydrate Consumption

Allison Weiss1; Fang Xu, MS1; Amy Storfer-Isser, MS1; Alicia Thomas, MS, RD, LD1; Carolyn E. Ievers-Landis, PhD2; Susan Redline, MD, MPH1

Study Objectives: To investigate the relation between sleep duration and energy consumption in an adolescent cohort.
Design: Cross-sectional.
Setting: Free-living environment.
Participants: Two hundred forty adolescents (mean age 17.7 ± 0.4 years).
Measurements and Results:Daily 24-hour food-recall questionnaires and wrist-actigraphymeasurements of sleep duration were employed to test the hypothesis that shorter weekday sleep duration (< p =" 0.004)" p =" 0.001).">Conclusion: Quantitative measures of macronutrient intake in adolescents were associated with objectively measured sleep duration. Short sleep duration may increase obesity risk by causing small changes in eating patterns that cumulatively alter energy balance.
Keywords: Sleep duration, diet, obesity, adolescents, 24-hour food recall

Citation: Weiss A; Xu F; Storfer-Isser A; Thomas A; Ievers-Landis CE; Redline S. The association of sleep duration with adolescents’ fat and carbohydrate consumption.
SLEEP 2010;33(9):1201-1209.

Saturday, September 4, 2010

Long waits and long distances for specialists at Childrens Hospital - Texas No Different

Some thoughts....

Wait times for children's hospitals can reach 13 weeks (developmental pediatrics) 9.5 weeks (neurology) and 8.1 weeks (pulmonology / pulmonary)

1) This article does not specify if these appointments are in a) resident clinics supervised by attending physicians OR b) with nurse practitioners as opposed to c) a full board-certified specialist.

2) Many parents are pleasantly surprised to find shorter waits (often only days) with private practice specialists of equivalent training & expertise.

Long waits and long distances for specialists at Childrens Hospital - Texas No Different

"...Conclusion: Children’s hospitals have experienced subspecialty shortages that affect timely appropriate care for children. While hospitals have adopted strategies to fill the gap, long wait times to see a subspecialist still remain. Policy changes are needed to attract and retain new pediatric subspecialists. "