Medical News – Fall 2020

Connecticut Children's Urgent Care Now Open in Farmington

When a child needs after-hours care, Connecticut Children’s is here for them – and you. Located at 599 Farmington Ave, Suite 202 in Farmington, patients can be seen Monday-Friday from 5-11pm and Saturday-Sunday from 10am-10pm. All services are provided by board-certified pediatric specialists, meaning each child will receive hospital-grade pediatric care, minus the hospital.

If a patient needs follow-up care, our urgent care clinic is connected to our vast network  of 30-plus pediatric specialties. We guarantee next-day appointments for most specialties, including via video visit when appropriate. No other pediatric urgent care in the state can offer that.

Connecticut Children’s Urgent Care provides full-service urgent care for infants,
children and young adults up to age 26. This includes:

  • – Diagnostic services, including X-rays and laboratory tests
  • – Minor cuts, sprains and burns
  • – Earaches and infections
  • – Pink eye
  • – Animal and insect bites
  • – Headaches
  • – Skin rash
  • – Mild asthma
  • – Allergies
  • – Fever (children over 2 months)
  • – Cold or flu symptoms
  • – Cough, congestion and sore throat
  • – Nausea and vomiting
  • – Digestive issues like diarrhea and constipation

If It Might Be an Emergency, Don't Wait

If a child might be having an emergency, please seek emergency care right away – it could save their life. Connecticut Children’s Emergency Department is open and safe.

Examples of When to Bring a Child to the Emergency Department

  • – Unconscious or altered mental status
  • – Severe allergic reaction
  • – Possible poisoning
  • – Trouble breathing
  • – Seizure
  • – Head injury
  • – Neck or spine injury
  • – Significant wound or bleeding
  • – Severe pain

Safe and Sound at Connecticut Children’s

Here’s how our Emergency Department is keeping kids safe and sound – and giving parents peace of mind.

  • – Dedicated entrances and areas for non-COVID patients
  • – Rapid triaging to avoid the waiting room
  • – Daily screenings and all the right protective gear for employees
  • – Extra cleaning, disinfecting and sanitizing precautions
  • – Masks for everyone who enters

Learn more at connecticutchildrens.org/safeandsound.

Now Performing Minimally Invasive Cardiac Surgery

Our Division of Cardiothoracic Surgery has begun utilizing a minimally invasive surgery approach, Video-Assisted Thoracoscopic Surgery (VATS), to better diagnose and treat issues in the chest.

This technique allows us to avoid open surgery by making small incisions and inserting a small camera, called a thoracoscope, to repair conditions such as a vascular ring. Benefits include decreased pain at surgical site and faster recovery time.

Connecticut Children's Virtual Gala 2020 - November 14th

The Virtual Gala on November 14th will deliver an unforgettable evening that will engage and inspire audiences near and far. Put on your glad rags, pop a bottle of bubbly and join us from the comfort of your own home, as we toast a century of pediatric advancements and cheer on our healthcare heroes.

We’ll begin the evening with a dazzling interactive reception at 7 p.m., then kick off our Main Event at 8 p.m. Prepare to be charmed by emcee Dandy Wellington, laugh away your cares with celebrity headliner comedian Jim Gaffigan and hear the uplifting stories of Connecticut Children’s healthcare heroes.

You can be part of this memorable experience by joining as a member of Connecticut Children’s
Virtual Gala 2020 Honorary Committee with your personal contribution of $4,250.

In appreciation of your philanthropic leadership, you will receive acknowledgment on Connecticut Children’s Foundation’s website and in the Virtual Gala’s printed program; customized wine and gift basket and twenty prize drawing tickets for ten guests; unlimited virtual event tickets to share with your personal and professional networks; and invitations to exclusive events when COVID-19 social distancing regulations have concluded.

This year’s Bid for Kids campaign—the special project highlighted during the Gala 2020—is extremely important and holds deep, personal meaning for us. Bid for Kids will address the pediatric behavioral health crisis in Connecticut. Toxic stress, abuse in all its forms and mental disorders have a devastating effect on children and families, yet, the stigma associated with seeking behavioral healthcare leaves many children suffering in the shadows. Connecticut Children’s is building programs to make it as normal to care for a child’s behavioral health as to care for their physical health. It’s long overdue, and we are proud to lead this effort.

To confirm your Honorary Committee membership or to make your Virtual Gala 2020
contribution, please visit www.connecticutchildrens.org/gala.

On behalf of our Honorary Committee Co-Chairs, Nicole and Skip Kodak, the Gala Planning Committee and the countless children and families Connecticut Children’s helps each year,  thank you for your consideration.

Sincerely,

Barbara Rugo Focht, MD & Glenn Focht, MD

Virtual Gala 2020 Honorary Committee Co-Chairs

Is It Safe to Send Your Child Back to School During COVID-19?

Connecticut Children’s Physician-in-Chief, Juan Salazar, MD, MPH, FAAP shares advice for parents.

Right now, we know there’s one question at the top of many parents’ minds: Is it safe to send my child back to school this fall?

Should I send my child back to school?

I wish I could give a simple yes or no. The truth is, this is complicated. There is no perfect choice, so each family will need to weigh the benefits and risks and make their own decision. It comes down to each child’s needs, each family’s circumstances and what’s happening with the virus locally.

What are the benefits for going back to school?

When it comes to education, studies show that nothing comes close to the experience of in-person learning. Classrooms provide stimulating, developmentally-appropriate settings that are difficult for most families to replicate at home. If your child struggles to stay on task or with time management, the structure of a physical classroom can be especially important to their academic development, and they’ll often have access to services at school that they can’t get from home. This may be especially true for kids with disabilities or special needs.

Children and teens need social interaction in order to develop language, communication, social and interpersonal skills. Being in a classroom teaches kids how to be part of a community – resolving conflicts, problem-solving and cooperating with others. It’s also key for their emotional wellbeing; kids often receive emotional and psychological support from peers and teachers in person that they don’t receive remotely.

And of course, school is a safe environment that provides child care and critical services like meal programs.

What are the risks for going back to school?

There is no way to open schools without opening up some risk of COVID-19 spread.

The good news is that, with the rare exception of MIS-C, kids appear far less likely than adults to become seriously ill from COVID-19. And some research shows that kids who are under the age of 12 are less likely to spread the virus to other people than older kids and adults.

The bad news is that teenagers seem to be very strong COVID-19 spreaders, so if your teen becomes infected at school, there’s a good chance they’ll bring it home. And even for younger kids, although the chance is smaller, there’s no guarantee they won’t become seriously sick or infect someone in your household. There’s still a lot we don’t know about this disease.

How will schools control possible outbreaks?

It’s absolutely critical that schools have protocols for masks,  social distancing, washing hands frequently and sanitizing everywhere.

Schools will try to ensure that all staff and students who can safely wear masks do so. They’re working with the physical setup of school buildings to maximize space for social distancing – so instead of sitting at clusters of desks, each student will likely be spaced at least several feet from others. They’re keeping class sizes small, and staggering when students eat lunch, use playgrounds and have passing time between classes. They’re also strengthening cleaning and sanitizing procedures, and taking steps for better air ventilation, whether that means opening windows or installing air filtration systems.

Many schools are creating hybrid models: some days in classrooms and other days online, depending on the comfort of families and community spread of the virus. They’re also developing virtual, at-home lesson plans for children whose families prefer to keep them home.

In Connecticut, the governor’s Adapt, Advance, Achieve plan includes guidance for schools to divide students into “cohorts,” or small groups that stay the same from day to day. Students stay with these groups across classes, lunch periods, recess, etc. This limits the number of other students and staff they’re exposed to, and makes it easier to trace any outbreaks. When an outbreak occurs, the school can close a classroom and have just that group of students and staff quarantine at home, rather than closing an entire district.

How will schools catch outbreaks early enough to prevent wide spread?

Each town has to very closely watch coronavirus cases at schools and be ready to close when an outbreak occurs. School districts should create a health monitoring plan to keep track of symptoms that could be related to the virus, and identify trends in attendance that could indicate an unreported spread. They need access to testing and clear protocols for notification and response if cases are identified.

Studies show that teens may be able to transmit the virus more easily than younger children, so high schools in particular should be prepared for spikes in infection. When that happens, each classroom, school or town has to be ready to close.

Ideally, schools would have a system for testing and daily temperature screenings – but the reality is that this may be impossible due to lack of funding and staff. Ultimately, the responsibility to monitor students’ symptoms and COVID-19 exposure will fall to parents. Check your child’s temperature every day and look for other possible COVID-19 symptoms and exposure. Don’t allow your child to go into school if they might be infected or exposed.

What about contact sports?

It’s going to be up to the school districts to figure this out. I think it’s going to be difficult to safely hold contact sports like tackle football. The players are in very close proximity, breathing hard and often shouting. These are all ways that the virus spreads. If an older child is shedding virus and playing a contact sport, there’s a good chance they’ll infect other players.

What about a vaccine?

The vaccine trials we’re hearing about are being tested on individuals age 18 and over. After they’ve been proven safe for that population, they’ll test children under 18. In other words, it will still be many months before a vaccine is available for schools.

Should my child wear a mask or face covering to school?

Yes. Here’s one way to think about it: We’re all eager for a coronavirus vaccine. But in a sense, we do have an active vaccine right now, and it’s called a mask. If you use a mask, you’re changing the dynamic of this virus by significantly decreasing its spread in the community. If we all use masks while we wait for a vaccine, that’s quite effective.

Is sending my child back to school worth the risk?

It depends on the health of your child, the health of the family members you have at home, the health of the community and your child’s individual needs when it comes to learning and social-emotional development.

This is a complicated issue. Ultimately, it comes down to understanding the benefits and the risks, and weighing what you’re comfortable with for your family.

Back to School Sleep Tips

As children across the state prepare to adapt to their new school schedule, whether in-person or remote, the shift back to a regular sleep schedule will come sooner rather than later. Lynelle Schneeberg, MD, Sleep Psychologist at Connecticut Children’s, provides some helpful tips and methods to ensuring that this transition goes smoothly.

How can parents help their children reset their sleep schedule?

Focus on three things in the morning to reset that schedule and reset the brain’s “clock”:

  • Sunlight exposure (30 minutes outdoors is best). The sun is a free and powerful stimulant and “clock setter”).
  • Physical activity (stretching, yoga, dance party?)
  • Food – try to get the child to eat something, no matter how small, because a meal signals the “stomach clock”
    that it’s time to wake up

How can you get children to comply with this schedule, despite the past 7 months of leniency?

Focus on having something fun happen at the desired rise time each morning. This could be an outing, a special breakfast, a dance party, or a quick yoga session.

What are some relaxing bedtime routines you would suggest?

Some relaxing and achievable routines to set in place before bedtime could be: dinner, quiet time with family, a healthy but delicious bedtime snack, washing up, teeth brushing, reading with mom and dad and then doing something quiet and non-electronic in bed, independently, until sleepy.

If a child is distance learning, should they comply with the same sleep schedule? Or is allowing them to sleep in a little later than usual okay?

It is absolutely okay to match sleep schedule to the rise time that is actually required. Some teens won’t have to log in until 9-10am and there is no problem with letting them go to bed later and get up later.

Calm During Uncertainty: Delilah's Story

Diana and Jarrod Perry remember sitting in the NICU at Connecticut Children’s, hearing that their newborn daughter needed open-heart surgery – and that her condition was so unique, specialists from the Divisions of Cardiac Surgery, Cardiology, Neonatology, General Surgery, Orthopedics and Plastic Surgery were working together to create a whole new playbook.

“As parents, we were terrified,” says Diana. “We didn’t know what to say or do.”

But pediatric cardiac surgeon Raina Sinha, MD, MPH did.

“Dr. Sinha said to us, ‘I’m telling you, we’ll figure out the game plan, and it’s going to be fine,’” Diana remembers. “Her confidence was so calming at such an uncertain time.”

“We really felt held as a family”

Delilah Perry was born in June. Right in the middle of her chest, in a spot about the size of a quarter, you could see her heart beating right through her skin. She’d been born without a sternum, the chest bone that usually sits right above the heart. She was rushed to Connecticut Children’s Neonatal Intensive Care Unit (NICU), where tests showed that in every other way she was healthy. But to protect her heart and her lungs, she needed surgery. Her diagnosis was quite uncommon, with few case reports in the medical literature– so her doctors would have to figure out the best treatment strategy for Delilah.

“Delilah’s condition is so rare, occurring in something like <0.1% of newborns,” says Dr. Sinha. “But our cardiac surgery experience in neonates and infants is helpful for planning this surgery. We routinely perform delayed sternal closure – that is bringing together edges of the chest bone together when we have left them open intentionally after heart surgery, once the tissue swelling has decreased. So, we would apply the same surgical principles to Delilah’s case. The philosophy is try to repair the defect as early as possible, to get the baby as close to normal, and home with the family as soon as possible.”

A multidisciplinary team approach was used to plan the management of Delilah’s case. They took their time and reached out to peers all over the country, making sure to include Jarrod and Diana in their process.

“We didn’t even have to ask any questions – they gave us all the information they had, as soon as they had it,” says Diana. “It made us feel safer that they were so honest and transparent. We really felt held as a family.”

“The time and people to make the right decision”

A few days later, Dr. Sinha led an all-female surgery team – joined by pediatric surgeon J. Leslie Knod, MD, and pediatric surgery fellow, Katerina Dukleska, MD – to close the gap where Delilah’s sternum should be. As Jarrod and Diana followed along on the EASE app, the team opened Delilah’s chest, brought the edges of her ribs together and connected them with absorbable sutures. After a short stay in the pediatric ICU for three days after surgery, she was able to go home.

The timing of the procedure was key: Because Delilah was just 5 days old, her tissues were naturally elastic, which helped prevent extra pressure on her heart, avoided the need for any prosthetic material to close the gap, and her body’s natural healing process will essentially grow a new sternum where her ribs meet. Because of that decision, her road to recovery is straightforward. Delilah’s pediatrician will keep a close eye on her sternum as she grows, but in all likelihood, she will not need any special follow-up or care long term.

To Diana and Jarrod’s astonishment, it’s almost as if the whirlwind of Delilah’s first week never happened. At home in Cromwell, she is happy and healthy, and getting acquainted with her 4-year-old brother, Jack – who, after some initial skepticism, now loves holding her.

“It’s wild. When she was born, it was obviously very serious. You’re thinking, ‘Is this going to end well?’” says Diana. “But because Connecticut Children’s took the time and all the people to make the right decision, the remarkable thing is that Delilah might just get to be a typical kiddo. She couldn’t have been in a better place.”

Not Appendicitis

By: John Brancato, MD, Division of Emergency Medicine

A 6-year-old female was brought to the Connecticut Children’s Emergency Department for evaluation of lower abdominal pain. She had had pain for approximately 1 month but had developed fever and worsening pain over the 3 days prior, especially with urination, which she described as burning within her abdomen. She reported foul-smelling urine though had not noticed a change in its appearance. She had also been experiencing some intermittent nausea and vomiting in addition to her chronic diarrhea.

The patient was seen by her PCP 2 days prior to ED presentation. At that time, a urine dipstick was reportedly positive only for trace blood. However, given the clinical concern for UTI, she was started on empiric cephalexin pending culture results.

In the ED, she was alert and nontoxic with a pain score of 2. Her vital signs were T 38.6C, P 116, R 22, BP 108/51. Her physical exam was notable for a diffuse area of erythema, induration and exquisite tenderness to light palpation in the suprapubic regions with bilateral inguinal tenderness, as well. There was no distension, rebound or guarding. Her external genitourinary exam was normal. Point of care ultrasound by ED faculty demonstrated an area of heterogeneous fluid anterior to the bladder. The subsequent formal ultrasound confirmed a complex avascular cystic mass/fluid collection superior to the bladder, measuring 5.7 cm in maximum dimension, consistent with an infected urachal cyst.

The patient was admitted to the General Surgery service and approximately 40 ml of purulent fluid was drained from the cyst on the following day. Subsequent culture grew Proteus mirabilis, sensitive to the amoxicillin/clavulanic acid on which the patient was discharged. Definitive excision of the cyst will be performed approximately 6 weeks after the infection was cleared.

The urachus, a remnant of the embryonic allantois, connects the fetal bladder to the yolk sac, removing nitrogenous waste. During normal development, it involutes becoming a fibrous cord, the median umbilical ligament. Failure of that closure can result in a variety of abnormalities, depending on the location of the patency. If the entire urachus remains patent, an urachal fistula connects the bladder to the umbilicus. An urachal polyp opens toward the umbilicus with no connection to the bladder, while a bladder diverticulum opens toward the bladder with no connection to the umbilicus. An urachal cyst results from patency in the mid duct. See Figure 1.

The incidence of urachal cysts, the most common remnant, is unclear as many are asymptomatic. However, it is thought to be present in 1 in 5000 births with a male to female ratio of 3:1. They often come to attention when infected and present with fever, painful voiding, and lower abdominal pain and fullness. When untreated, fistulas may develop between the infected cyst and adjacent bladder, bowel or skin. Rupture or hemorrhage may lead to peritoneal symptoms. The overlap of these symptoms with other pathologies results in a high rate of preoperative misdiagnoses, as high as 35%, with appendicitis, incarcerated umbilical, inflammatory bowel disease and Meckel’s diverticulum, among the possibilities. In this instance, point of care ultrasound was useful in rapidly narrowing the differential diagnosis. Infecting organisms include S. aureus, the most common, as well as E. coli, Citrobacter, P. mirabilis, Bacteroides and K. pneumoniae. The treatment of choice for urachal cysts is surgical excision.

Allen JW, Song J, Velcek FT. Acute presentation of Infected Urachal Cysts. Case Report and Review of Diagnosis and Therapeutic Interventions. Ped Emerg Care 2004;20:108-111.

McQuaid JW, Gorman EF, Johnson EK, Cilento BG. Granulomatous Inflammation Masquerading as an Infected Urachal Cyst. Urology 2014; 84:1496-1498.

Welcome Aboard!

Join us in welcoming two new additions to our medical staff!

Laura McKay, MD

Center for Cancer & Blood Disorders

  • MD, University of Connecticut
  • Pediatric Resident, University of Connecticut
  • Pediatric Chief Resident, University of Connecticut
  • Pediatric Hematology/Oncology Fellowship, University of Michigan

Lila Worden, MD

Neurology

  • MD, Johns Hopkins University School of Medicine
  • Pediatric Neurology Residency, Massachusetts General Hospital
  • Pediatric Epilepsy Fellowship, Children’s Hospital of Philadelphia

Continuing Medical Education (CME) Updates

For all CME events, stay up to date by visiting our calendar at cccme.eeds.com

2020-2021 Virtual Interactive Workshop Series

ZOOM URL to be provided upon registration

Date: October 20, 2020 • 6:30pm – 8:00pm
Title: Navigating Autism in the 2020: A Toolkit for Pediatric Primary Care

Date: January 14, 2021 • 6:30pm – 8:00pm
Title: Adolescent Gynecology: Contraception and STDs

Date: March 25, 2021 • 6:30pm – 8:00pm
Title: Ophthalmology Basics for the Pediatrician

Date: April 20, 2021 • 6:30pm – 8:00pm
Title: Helping Children with Learning Attentional and other Developmental Disorders/Understanding
Educational/Neuropsychological Evaluations and How Students Qualify for Intervention Services
at School

Postponed: 3rd Annual Joint Pediatric Symposium
The Joint Pediatric Symposium originally scheduled for June 5, 2020 in Danbury is postponed until June 2021

PEDIATRIC GRAND ROUNDS 

Virtual via ZOOM. Podcast also available.

When: Tuesdays between 9.1.20 – 6.30.21, 8am-9am

Visit our Eeds Portal- Live Calendar

ASK the EXPERTS 

Virtual via ZOOM. Podcast also available.

When: Tuesdays as needed, 8am-9am

Visit our Eeds Portal- Live Calendar

Pediatricians in PJs: CME from the Comfort of Your Couch

Virtual via ZOOM, on-demand recordings at your leisure

Visit our Eeds Portal

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