Healthy Mother & Baby: Gestational Diabetes

Wednesday, March 25, 2015 2:40 PM comments (0)

gestational diabetesGestational diabetes develops during pregnancy, typically between the 24th and 28th weeks. Most women will experience some change in glucose levels during pregnancy due to fluctuating hormone levels. Gestational diabetes develops when glucose levels rise but a woman’s pancreas is unable to produce enough insulin to regulate blood sugar levels. Developing gestational diabetes does not mean a woman was diabetic prior to her pregnancy, however approximately 20% of women with gestational diabetes will go on to develop type 2 diabetes later in life.  Women with gestational diabetes must make lifestyle changes to ensure their health as well as their baby’s. 

Rebecca Jacobson, MD, Obstetrics/Gynecology, discusses when women should be screened and what changes an expectant mother should make after diagnosis:

Women are screened for gestational diabetes approximately 24-28 weeks into pregnancy. However, women who are at a higher risk for developing gestational diabetes—risk factors such as obesity, previous instance of gestational diabetes, family history of diabetes—will likely require earlier screening. 

It’s important to keep gestational diabetes in check to prevent complications that could affect your baby, such as excessive birth weight, increased risk of cesarean section, increased risk of birth trauma, premature birth, low infant blood sugar at birth, and an increased risk for type 2 diabetes and obesity later in life. Left untreated, gestational diabetes can also result in a baby’s death. 

Treatment options:

  • Monitor blood sugar. Expectant mothers diagnosed with gestational diabetes will likely have to monitor blood sugar upwards of four to five times a day—in the morning and after meals— to keep levels within a healthy range. 
  • Maintain a healthy diet. The right foods and portion sizes, as well as steering clear of sugary snacks and drinks, will help keep sugar levels in check and prevent excess weight gain during pregnancy. Women newly diagnosed with gestational diabetes should work with their doctors and a nutritionist to create a balanced diet plan with weight gain goals because weight loss is not recommended during pregnancy. 
  • Exercise regularly. Exercise is important during pregnancy both for mother and growing baby. Exercise lowers blood sugar levels because the body transports glucose into cells, which produces the energy for physical activity. Moderate-to-vigorous exercise, with a doctor’s permission, is recommended nearly every day of the week.
  • Supplement with medication. Changing one’s diet and regular exercise might not be enough to combat gestational diabetes. Some women will require additional treatment with medication, which can be administered orally or as an injection. 

Have questions about gestational diabetes or advice to offer other women newly diagnosed with gestational diabetes? Join our new online community The Parent 'Hood to start a conversation today. Click here to find out more. 

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Q&A: Your Body After Baby

Monday, March 09, 2015 4:13 PM comments (0)

babyMany women know what to expect during pregnancy but do you know what changes could be in store for your body after your bundle of joy has arrived? Whether you’re wondering how long to wait before engaging in exercise or sex again, or if pelvic prolapse surgery might be right for you, find the answers here.

Roger Goldberg, MD, Director of the Division of Urogynecology at NorthShore and author of “Ever Since I Had My Baby,” answers “Body After Baby” questions.  

Is moderate pain, like a pulling sensation, normal in a c-section incision site after the incision itself has healed? 
Certainly any abdominal incision—including cesarean—can cause certain symptoms that are slow to fully resolve. This can include pulling or even sharp pain on occasion. The likelihood of any serious issue with the symptoms you describe are small, and symptoms like these typically linger for awhile and then fade on their own. Certainly if this or any symptom continues or gets worse, happens frequently, or disrupts your quality of life, have your surgeon re-check the area. 

Are there things a woman can do prior to or during labor to minimize tearing and nerve damage, and improve and/or speed recovery?

There are. Here are some strategies:

  1. Tone your pelvic floor with Kegel exercises before labor
  2. Perineal massage might help in some cases
  3. Discuss a labor and delivery strategy with your doctor including considering "passive" labor, where you delay pushing until the baby descends
  4. Try to minimize the use of forceps and vacuum extractor delivery, but remember that these are needed in some cases
  5. If you have a very large baby, a very small pelvis or other risk factors, an elective cesarean is worth discussing. I realize that this can be a “hot button issue” so have an open dialogue with your physician well in advance

After childbirth, there is the option of pelvic floor physical therapy. We work closely with our physical therapists here at NorthShore, and they're a great resource for rehabilitating muscles and tissues that have undergone change due to pregnancy and childbirth

How long after pregnancy and labor should you wait to exercise? 
There's not a great deal of science to "prove" the right answer to this question. Assuming you are feeling well, walking and general aerobic activity can usually be resumed around four weeks for your overall health and well being. However, I would be concerned about heavy weightlifting, excessive squatting and high-impact activities at a time when pelvic tissues are still recuperating. The pelvic tissues in terms of strength and tone look very different at one month postpartum compared to three months postpartum. As a doctor and surgeon who deals regularly with women that have prolapse symptoms, I would recommend to err on the side of caution by waiting three months postpartum for high-impact activities. Always check with your obstetrician to be sure. 

Is pain during sex normal after childbirth? How long could pain last? What remedies are there? 
The perineum (tissues between the vagina and rectum) can be very tender after childbirth. Some patients require more time, some require less, for pain to resolve. Studies have shown that roughly 25% of women will still have some sexual complaint at six months after “normal” vaginal birth. The good news is that many of these resolve spontaneously with time and patience.

If the area is extremely tender, check with your physician because in rare cases, a quick surgical revision may be required; however, for most, pain subsides with time, patience, lubrication and perhaps some estrogen cream.

When should you be concerned about pain after childbirth?
I want to emphasize that pain is not normal if it doesn't slowly but surely resolve on its own. If you're getting better and the pain is disappearing, there isn’t a problem; however, if you're experiencing worsening or persistent pain in the pelvic area, consider seeing a urogynecologist for a basic evaluation. 

Is it normal to leak urine when coughing or sneezing? 
This is called stress incontinence, and it's reported to some degree by up to 50% of post-childbearing women by age 40.  While it is common, it’s not normal and not something you must simply accept. Fortunately, stress incontinence is amazingly treatable. 

Treatment options:

  1. Kegel exercises, sometimes with the help of a nurse or physical therapist to ensure you are performing them correctly.
  2. A pessary is a device similar to a diaphragm that is designed to reduce symptoms when inserted.
  3. The “sling” procedure is a huge breakthrough. It's a 15-minute, outpatient procedure that eliminates stress incontinence in over 90% of cases. 

When would you recommend surgery for pelvic prolapse? How long is the recovery after surgery?

This is a personal decision for every woman. It’s important to note that there is rarely a medical reason to rush the decision. Minimally invasive surgical options are available, so some women opt for surgery rather than trying non-surgical methods. 

I perform 95% of surgeries without any abdominal incision, the majority of cases take less than an hour and many involve no hysterectomy. This has translated into a quick recovery for most, but, we always need to acknowledge that recovery can be slower than expected for some. In my current practice, nearly all patients go home the next day, use pain medication for only a short of number of days. 

My overall advice is that if you're considering surgery, the most important factor is that your surgeon has a lot of experience with the technique being performed. Part of the reason we believe our patient outcomes are so strong here at NorthShore is that we're committed to being the experts in these areas. 

Have questions about recovery following childbirth or advice to offer other new moms? Join our new online community The Parent 'Hood to start a conversation. 

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Matters of the Heart: Setting a Heart-Healthy Example for Your Children

Thursday, February 26, 2015 9:21 AM comments (0)

child on bikeParents, it starts with you. You are the first and most important influence on the current and future health of your children. The example you set could put your children on a course for a lifetime of healthy living, especially when it comes to heart health. The health risks posed by a sedentary lifestyle, poor diet and obesity are immediate because heart health matters at any age, even in young children. 

David Najman, MD, Cardiology at NorthShore, shares some easy ways that parents can set a heart-healthy example for their children while also improving their own health:

Healthy diet. If you want your children to eat fruits and vegetables, you need to set the example by eating fruits and vegetables yourself.  Include your children in the decision making and help guide them by discussing the benefits of the delicious fruits, vegetables and whole grains that you will eat together as a family every night.  If children grow up eating healthy foods together with their parents, eating those same foods as young adults and adults won’t feel strange or difficult at all; those same foods will be what they ate growing up. 

Exercise. Show your children that exercise is important by maintaining a regular workout routine. And, as often as you can, get every member of the family involved in a fun, physical activity. Jog together as a family; ride bikes together as a family; go on a brisk evening walk together as a family. Children experience the same health benefits of exercise as adults—strong bones and muscles, maintenance of a healthy weight, lower blood pressure and cholesterol, and a regular exercise routine reduces one’s risk for heart disease, diabetes, some cancers and more. Get your kids moving now and they will likely maintain that active lifestyle later in life. Lead by example!

Smoke-Free. If you quit smoking, your kids are less likely to start. Smoking is more common in teenagers whose parents smoke. If you are still smoking, quit. Secondhand smoke is linked to lung cancer but it also increases the risk of multiple types of cancers, heart disease, diabetes and many other medical issues as well. 

Maintain a healthy weight. Today in the U.S., one child out of three is considered obese or overweight. Type 2 diabetes and high blood pressure, once common health issues encountered only in adulthood, have developed in children as young as seven.  Obese children are also more likely to become obese adults, increasing their risk of developing heart disease later in life. Don’t focus on weight with children; instead, shift to leading a healthy lifestyle as a family. Lifestyle changes like eating right as a family and exercising can make all the difference. 

What do you do to set a heart-healthy example for your children?

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Highly Contagious: Measles

Friday, January 23, 2015 2:02 PM comments (0)

measlesMeasles is extremely contagious, infecting nearly 90 percent of unvaccinated people who come into contact with it. Why is it so contagious? It’s spread through the air (via coughing/sneezing).  People standing in the airspace around the infected person can become infected by breathing in these respiratory droplets; they do not need to be sneezed or coughed on directly.  Those infected with measles are at their most contagious the four days prior to the appearance of the rash, meaning they are extremely contagious before they themselves are aware of the virus. 

Measles symptoms develop approximately 8-12 days after exposure but the measles rash will not develop until 3 -5 days after symptoms first appear. The first symptoms are similar to a severe cold:

  • High fever
  • Runny nose
  • Cough
  • Red eyes (conjunctivitis)
  • And white-to-bluish spots may appear in the mouth immediately following the above symptoms

The measles rash begins on the face but quickly spreads downward, covering the body. Fever may be at its highest—topping 104 degrees Fahrenheit—at the appearance of the rash.  

Before the measles vaccine, more than three to four million people in the U.S. would contract the virus each year. Infected individuals can develop mild-to-severe complications including pneumonia, blindness, deafness, brain swelling, permanent neurological damage and even death. 

Julie Holland, MD, Head of General Pediatrics at NorthShore, discusses who should receive the MMR (measles, mumps and rubella) vaccine and when: 

Everyone should be vaccinated. Vaccines like MMR are a safe and effective way to prevent the spread of the virus. While there have been small outbreaks in the U.S., measles is very common in other parts of the world and can spread easily to the unvaccinated and under-vaccinated in the U.S. 

  • Children. The CDC recommends two doses of the MMR vaccine in childhood: the first dose between 12 and 15 months and the second at four to six years.
  • Teens and young adults. For unvaccinated individuals, two doses of the MMR vaccine are recommended for individuals in this age group: The first dose is given and then followed with a second dose a minimum of 28 days after the first.
  • Adults. For those born after 1957, the CDC recommends two doses of the MMR vaccine. 

Make an appointment or call your doctor or your child’s pediatrician to ensure you and your children are adequately vaccinated.

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Join the Conversation! NorthShore’s New Online Community—The Parent ‘Hood

Monday, January 05, 2015 12:24 PM comments (0)

pedsLife can be hectic, especially the life of a parent, which is why we hope to provide our community members with a place to find the answers they need. NorthShore’s new community is an online destination for parents to share their experiences and support each other, as well as connect with our team of medical experts, from obstetricians to pediatricians. Carl Buccellato, MD, OB/GYN at NorthShore, and an active expert member of the community, says, “I hope my experience both as a physician and a parent will be a resource for expecting parents” of the Parent ‘Hood.

The community will cover a variety of topics, from pregnancy issues like gestational diabetes and nutrition to parenting topics like how best to address your toddler’s tantrums and childhood vaccinations. You can join the conversation now!

On-going conversations:
Toddler Tantrums 
Itchy and Pregnant
Post-Partum Hair Loss

Sign up and start your own conversation:
Click "New Post"

Read articles on health topics relevant to parents in our community:
Blogs and Online Medical Chats

Watch videos from NorthShore physicians and NorthShore patients stories:
Featured Videos

What topics would you like to see in The Parent 'Hood?

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Managing the Meltdown: How to Handle Tantrums in Children

Monday, December 29, 2014 12:02 PM comments (0)

tantrumsEvery parent has been there at one point or another—at the mercy of his or her child’s tantrum in the checkout line at the grocery store, in a crowded restaurant or at home.  In a matter of minutes, your child goes from quiet and well-behaved to completely inconsolable. 

The good news is that temper tantrums are entirely normal, especially in toddlers. For toddlers, tantrums are often brought on by a young child’s inability to understand and cope with his/her emotions, emotions related to hunger, tiredness or feeling overwhelmed and over-stimulated. 

While it’s not possible to prevent every single emotional meltdown, there are ways to manage them. Leslie Deitch Noble, MD, Pediatrician at NorthShore, discusses some of the best techniques for approaching tantrums:

Don’t overschedule. Try not to overexert your child by packing too much into the daily schedule. This is not to say that every day needs to be the same, but when possible try not to push your child to the limits with errand running. A hungry or tired child is much more likely to act out. If you know you have a long day ahead, let your child know in advance so he or she will be better prepared for the change of pace.

Be consistent with your approach. Try your best to manage your child’s behavior during every tantrum. Encourage communication during a tantrum. Say, “Use your words” or ask clear questions to better understand what might be causing your child’s frustration. Lastly, do not give in. Letting your child have his or her way during a tantrum won’t help break the cycle, even if it ends the immediate tantrum. Ideally, you don’t want to give your child any attention—positive or negative—while he or she is having a tantrum. So, as long as you are not in public and your child is not going to hurt him or herself, the best approach is to completely ignore your child until the tantrum stops.

Distract. Distract. Distract. If you can, try to divert your child’s attention away from what may have prompted the tantrum in the first place. Be sure that you recognize that he or she maybe be upset by a situation, but then offer different options or new activities. For example, if your child has a tantrum over wanting a new toy or treat at the store, you can suggest that you find the “new” toy she got most recently when you go home. A similar approach can be tried with treats. If necessary, try to avoid going down aisles at stores that might prompt meltdowns.

Celebrate (and embrace) the good times. Let your children know when they are behaving well and encourage this type of behavior. Tell them how happy it makes you when they listen and follow the rules. Along with acknowledging good behavior (and even rewarding it), be sure your children know how much you love and care for them. Much of what triggers tantrums is children wanting to express their emotions and wanting attention.

Have questions about tantrums? Get answers from other parents and our team of experts in our new online community The Parent 'Hood. Find out more here: The Parent 'Hood

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From Crib to Bed: Ensuring a Smooth Transition

Friday, December 12, 2014 3:04 PM comments (0)

cribThere is no magic age for when it’s best to transition your toddler from a crib to the “big-kid” bed. Much of the timing depends on your child’s readiness as well the need to free up the crib for a new little brother or sister. In most cases, toddlers transition to a bed between the ages of 18 months to 3 years.

Whether you are mid-transition or only in the planning stages, Susan Roth, MD, Pediatrician at NorthShore, offers helpful tips to make the change a smoother one:

  • Maintain consistency with a bedtime routine. A big-kid bed shouldn’t mean a new bedtime hour or a different routine. Keep the bed the only significant change. Also, try to put your child’s new bed in the same place as the crib.
  • Make it fun! Get your child involved with this “big girl”/“big boy” step. For instance, let him or her choose new sheets for the bed. If you will be purchasing a new bed, let your child help out with this decision as well.
  • Start with naps. Make the new bed the naptime bed to start. If your child can’t manage to stay in his or her bed for the duration of an afternoon nap, it might be too early to make the transition. 
  • Keep safety in mind. Depending on the type of bed that you select, be sure that you are providing a safe sleeping environment for your toddler. If you transition straight to a twin bed, it may be best to place the mattress on the floor for a while. If this isn’t an option, consider installing guard rails so your child does not roll out of bed. Padding the floor with blankets and/or pillows can also help reduce the chance of injury.

    This is also a good time to rethink and revisit your overall household childproofing. Now that your child may get out of bed and walk around at night consider removing or safety-proofing other household hazards. If needed, consider installing a gate in your child’s doorway so he or she cannot exit the bedroom. This may be especially important in homes with an accessible staircase.
  • Be supportive, yet firm. Your toddler may not adjust to this new bed immediately. The newfound freedom may lead to him or her getting up more frequently or even trying to get out of bed. Try to stay calm and reinforce that it’s time for sleeping. 
  • Reward positive behavior. Don’t expect this transition to be without its hiccups. Be sure to positively reinforce a job well done throughout this transition period.

Have questions about transitioning your toddler from a crib to a bed? Join NorthShore's new online community, The Parent 'Hood, to ask and answer questions as well as connect with our team of medical experts. Check it out here

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Safe and Sound: Reducing SIDS in Infants

Monday, December 01, 2014 4:56 PM comments (0)

For exhausted new parents, it can be a relief when your infant finally settles down to sleep for the night (or even just a couple of hours) but there can be fear as well. Sudden Infant Death Syndrome (SIDS) can happen even when all the right safety measures are practiced. The exact cause of SIDS is unknown. SIDS is most common in infants less than six months of age but can occur between one month and one year. 

While nothing can prevent every case, there are ways to significantly reduce the risk of SIDS. William MacKendrick, MD, Neonatologist at NorthShore, shares safe sleeping recommendations every parent should practice:

  • Place your baby on his or her back in the crib. Incidences of SIDS are higher in babies placed on their stomachs to sleep.
  • Use a firm mattress and don't place anything other than your infant in the crib. It’s important to keep all toys, sheets, blankets, pillows and other materials out of the crib as they can be unsafe and hazardous. Crib bumpers are also not recommended.
  • Keep your baby away from smoke. If you smoke, only smoke outdoors away from your child. Fumes from smoking can increase a baby's risk for breathing difficulties.
  • Avoid co-sleeping (sleeping in the same bed) with your infant; however, cribs can be kept in your bedroom but your baby should sleep in his or her crib.
  • Keep the temperature in your baby’s room comfortable but not too warm. Warmer temperatures can put your baby too deeply to sleep, making it difficult to wake.

Have your own questions about safe sleeping or another parenting topic? Join the conversation in our new online community: The Parent 'Hood. 

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Sick Days: What Are Hand, Foot and Mouth Disease and Herpangina?

Tuesday, November 11, 2014 12:56 PM comments (0)

hand foot and mouthHand, foot and mouth disease (HFMD) is a typically mild but highly contagious viral infection most common in children under seven years of age. The illness is characterized by mouth or throat pain (due to sores), fever and a rash (typically involving the hands, feet, buttocks, arms and legs). The infection is caused by enteroviruses—most often coxsackie virus A16—which are transmitted from person-to-person by oral contact with stool, saliva, fluid from skin lesions or respiratory fluids via coughs or sneezes. Herpangina, also caused by enteroviruses, is a cluster of symptoms characterized by fever and mouth lesions (but no rash).  These illnesses are particularly common in child-care settings because of the frequency of contact and germ sharing between children and inadequate handwashing—especially after diaper changes or toilet use. The viruses can also be transmitted by contact with contaminated surfaces or objects, like toys.

Outbreaks occur most often in summer and fall but can happen anytime, especially if your child is in daycare. Kenneth Fox, MD, Pediatrician at NorthShore, shares symptoms parents should watch for and outlines ways you can make your child more comfortable while the virus runs its course: 

Symptoms of Hand, Foot and Mouth Disease:

  • Small, painful sores in the throat or mouth, including cheeks, tongue and gums 
  • These lesions cause pain and difficulty swallowing
  • Small blisters or red spots classically located on hands, soles of the feet and between fingers and toes 
  • Fever
  • Decreased energy and appetite
  • Diarrhea and vomiting
  • Respiratory symptoms like congestion, cough and “pink eye” (conjunctivitis)

Symptoms of Herpangina:

  • Fever
  • Painful red sores in mouth/throat (as above)
  • Vomiting
  • Abdominal pain
  • Headache

Fever and mouth/throat pain usually last three to five days. Other symptoms, like mouth sores and rash (with HFMD) can last up to seven to ten days. The virus is shed orally for one to three weeks and in stool for two to three months after infection. While there are no cures for HFMD or herpangina, there are things you can do to make your child more comfortable during those first few days, as well as reduce the risk for dehydration which can occur because of pain and difficulty swallowing. 

What can parents do?

Keep little ones hydrated. Try Pedialyte or Gatorade to keep their electrolytes up. Also popsicles, ice chips and other frozen treats can replenish fluids while also helping with pain. 

Reduce pain or fever. Use Acetaminophen or Ibuprofen but check age-appropriate dosages before administering. 

Make swallowing easier. Eliminate salty, spicy or acidic foods to avoid further irritating mouth sores. Consider providing a variety of soft foods, like yogurt, pudding and rice. And always rinse mouth after meals. 

While it is not always possible to prevent your child from contracting hand, foot and mouth disease, you can reduce his or her risk, and your own. Here are some ways to keep your kids healthy and prevent the spread of HFMD in your home:

  • Wash hands with soap and water for 15-30 seconds and dry with disposable towel after using the toilet, changing diapers; after touching another child, the floor or contaminated surfaces; before eating meals or snacks; after coming in from outdoor play; after sneezing, coughing or wiping nose or eyes 
  • Clean and disinfect contaminated surfaces and toys more than once a day
  • Avoid or prevent close contact like kissing, hugging, sharing utensils or cups 

If your child does get hand, foot and mouth disease, watch for these signs of complications:

  • Dehydration (dry mouth, pale skin and nails, no tears or urine, lethargy)
  • Breathing difficulty
  • Chest pain
  • Stiff neck
  • Mental status changes (inconsolable crying, confusion, poor balance, difficulty walking)

Have questions about hand, foot and mouth disease or any other pediatric illness? NorthShore's new online community, The Parent 'Hood, has answers. Join today to connect with other parents in the community as well as our expert physicans.  Click here to start now

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Pediatric Orthopaedics: Dr. David Roberts on the Rewards of His Unique Specialty

Friday, October 17, 2014 7:00 AM comments (0)

dr. robertsFor David Roberts, MD, Pediatric Orthopaedics at NorthShore, helping people was always the goal on the horizon, which is what ultimately brought him to medicine. Once there, it was the challenge and the enjoyment of treating children that brought him to pediatric orthopaedics.

Here, he explains the ins and outs of his unique specialty and how his experience as a father has informed the way he treats his patients and their parents:

What first attracted to you medicine? Was there something that inspired you to go into the field?
I chose a career in medicine because I wanted to help people. There wasn’t one specific moment of realization; it was always what I wanted to do with my life.  

Why did you decide to pursue pediatric orthopaedics as a specialty?

I decided to become a pediatric orthopaedist during the middle of my orthopaedic surgery residency.  During my training, I enjoyed all different areas of orthopaedics so it was hard to pick just one area! Pediatric orthopaedics is unique in that you take care of a variety of conditions affecting all areas of the body, from fractures and congenital anomalies, to scoliosis and spine conditions. It also covers a wide age range, from newborns to young adults.  The diverse nature of pediatric orthopaedics is challenging but that’s also what I enjoy most about it.  And, of course, kids are fun.

What do you like most about your job?
Seeing my patients get better.  Often my patients are in pain or recovering from an injury when we first meet. Seeing them recover and get back to normal, being a part of that, is what I like best about my practice. 

What do you find most challenging?
Encountering overuse injuries in young athletes is difficult.  Young kids are increasingly involved in sports at "elite" levels, playing harder and longer than ever before. Overuse inevitably can lead to chronic and recurrent injuries of various types.  Generally, the cure is simple—rest—but these are some of the hardest conditions to treat given the pressure from coaches, teammates, parents and even the children themselves.  Fortunately with time, rest and realistic expectations, these conditions typically resolve and permit the child to fully return to activities.

What do you think is an essential skill of a pediatric orthopaedic surgeon?
You have to really enjoy working with children.  Treating children is very different from treating adults. Children of different ages require different approaches at interview and examination, which represents the "art" of medicine.  To be truly good at it this, you really have to like working with kids, and this is what I like most about my job.

How is treating orthopaedic cases in children different from adults?
Kids are not just little adults.  From an orthopaedic perspective, treatment of children's conditions can be drastically different than in adults, and not just because we have more cast colors to choose from.

Unlike adults, children's bones are still growing, which means they require special respect and consideration during treatment for orthopaedic conditions.  For example, fractures that typically require surgery for an adult may be treated without surgery in a child because of the ability to correct bone alignment over time with growth.  Other injuries can potentially affect growth and require close monitoring over time for years after injury.  Very young children also may require different treatment for the same type of injury in an adult because a child may be too young to follow treatment instructions.

Within pediatric orthopaedics, you specialize in scoliosis. What inspired this interest?
I specialized in scoliosis because of the positive impact surgery for this condition has on a patient's life.  For many patients with severe scoliosis, the condition is more than just a curvature of the spine.  Severe curves negatively affects self-esteem and body image, which are already vulnerable during the teenage years even for those without scoliosis.  After surgery for scoliosis, these patients literally and figuratively stand taller and straighter. It can make a difference to the rest of their lives.

What are some of the biggest influences on the way you treat your patients?
My own experience as a parent has really informed my practice.  Having a child gives you practical experience working with children but also the perspective of a parent.  I believe it is my duty to care for your child as I would my own.

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