Transformational Pediatrics: Recent Episodes

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Transformational Pediatrics features interviews with physicians and researchers at Children’s Mercy Kansas City who are transforming pediatric care through genomic medicine, personalized therapeutics, health services and outcomes research, and innovations in health care delivery.

In this episode, Dr. Ekta Patel and Dr. Devon O'Brien from Children's Mercy discuss the intricacies of congenital diaphragmatic hernia (CDH) and why it can be overwhelming for families. They delve into prenatal imaging, potential outcomes, and the multidisciplinary approach to care. Tune in to learn how to navigate this challenging diagnosis and access vital resources for support.

Explore why treating pediatric STEMI is not like treating adults. This podcast discusses clinical presentations, diagnostic challenges, and the critical role of congenital heart disease. Delve into the findings from a decade-long study that reshaped the management strategies for children presenting with STEMI symptoms. #PediatricCardiology #STEMI #CongenitalHeartDisease #ChildrensMercy #CardiacCare #PediatricHealth

Children’s Mercy set out to solve a persistent problem in hospital care: nurses spending too much time on non‑clinical tasks. In this episode, CEO Alejandro Quiroga, MD, MBA, shares how the Helen concierge ecosystem is returning meaningful time to nurses, reducing interruptions, and improving patient and family experience. He breaks down the outcomes, the safety and standard‑work design behind the model, and why applying complexity principles—rapid iteration, hypothesis testing, and responsive workflows—was essential. Ale also explores what health systems can learn from tech industries that excel at adaptability and speed.

In this episode, Dr. Sarah Guevara hosts Dr. Sanket Shah and Dr. Erin Opfer from Children's Mercy to discuss how the groundbreaking flash scanner technology is transforming pediatric imaging. Discover the advantages of reduced sedation and lower radiation exposure, and why this innovative approach is essential for diagnosing complex congenital heart diseases. Tune in to learn how the collaborative efforts of medical professionals enhance patient care. Don't forget to subscribe for more insights!

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Children’s Mercy is transforming pediatric genetic diagnosis with a single, advanced sequencing test. Learn how this breakthrough is delivering faster answers, fewer tests, and new hope for families facing rare diseases.

Join Dr. Anmol Goyal as he explains the educational power of 3D modeling in explaining complex heart conditions. This episode highlights how visual tools help families understand diagnoses and surgical procedures, making complex medical terms accessible to everyone.

Learn more about Anmol Goyal, MD, MBBS

J. Allyson Hays, MD, discusses the rare disease histiocytosis, how it presents in pediatric cases, how Children's Mercy treats it and more.

Learn more about Allyson Hays, MD

Mark Ryan, MD, MSPH, FACS, discusses the use of virtual reality and 3D imaging in pediatric surgery, and the impact it has on planning, outcomes and the future of pediatric procedures.

Discover the unique challenges faced by adolescent kidney transplant recipients and their families in this deep dive into patient-centered assessments. Host Dr. Mike and pediatric nephrologist Dr. Judith Van Sickle discuss barriers to medical adherence and the importance of a supportive network in optimizing health outcomes for young patients.

Tomoo Iwakuma, MD, PhD, discusses recent research findings around his studies of the p53 gene.

Children’s Mercy Kansas City is the first pediatric hospital in the U.S. to clinically launch Optical Genome Mapping (OGM), an advanced digitized technology that enhances the detection of genetic abnormalities. Dr. John Herriges discusses what this means for pediatric care and what's to come.

Ana Cohen, PhD, discusses Children's Mercy's cutting edge genetic testing, and how they're improving access by expanding research to rural communities.

Stephanie Burrus, DO, discusses physician burnout, and how Children's Mercy Kansas City's Center for Wellbeing is addressing it at their institution.

The Piccolo device is an innovative and minimally invasive way to close the Patent ductus arteriosus (PDA) in pediatrics. Dr. Rockefeller talks about how the Piccolo came to fruition, the benefits, and what else is on the horizon for the PDA closure world.

Bactrim is a commonly prescribed antibiotic used to treat a variety of conditions, including urinary tract infections, acne and skin and soft tissue infections. The American Academy of Dermatology recently revised its guidelines discouraging the use of Bactrim to treat acne based on research conducted by my next guests – Dr. Jenna Miller, pediatric intensivist, and Dr. Jennifer Goldman, Infectious Diseases, of Children’s Mercy Kansas City.

To accelerate precision medicine for pediatric oncology, Children’s Mercy Kansas City, together with its Research Institute (CMRI), pioneered a new whole-exome-sequencing-based genetic test for all children diagnosed with cancer. While many pediatric research institutions in the country conduct genetic sequencing of tumors, CMRI is one of the few institutions performing both research and clinical sequencing in-house on both tumor and normal DNA samples.

Children’s Mercy Kansas City, one of the nation’s leading independent pediatric health organizations, announced it is the first health care system to use 5-base HiFi sequencing, the world’s most-advanced genomic sequencing technology from PacBio, in the clinical setting to accelerate diagnoses for even more patients and families.

Incredible advances in the care of patients born with single-ventricle heart disease have led to significantly better quality of life and survival. Complex surgical palliation culminating in the Fontan procedure is effective and can allow patients to grow and develop similar to their peers. Unfortunately, changes related to Fontan anatomy lead to stress and increased pressure on the liver, known as Fontan-associated liver disease. These stresses can cause scar tissue to form and—rarely—liver cancer to form. Dedicated liver care is vital to providing Fontan patients with the healthiest life possible.

In this episode, Dr. Mark Clements leads a discussion focusing on population health management and pediatric type 1 diabetes.

Data science -- often discussed with terms like artificial intelligence, machine learning, big data, data goverernance -- has the potential to transform every aspect of health care, from the patient experience to how, when and where care is provided, and improving outcomes. In this Transformational Pediatrics episode, Mark Hoffman, PhD, Chief Research Information Officer at Children's Mercy Kansas City, discusses the challenges and opportunities for data science within pediatric health care and gives examples where it is already making a difference for children today.

The health care sector has begun to embrace coaching to promote resilience and innovation during a time of massive disruption while also cultivating healthier workplace cultures. In this podcast, Alyssa Stephany, MD, Director of the Physician Leadership Center at Children's Mercy Kansas City shares how professional and peer coaching can help reduce burnout, increase job satisfaction, and improve the overall provider experience of health care, while also having a positive effect on patient care.

Nearly 1 in 5 children in the United States live in rural areas. Rural children experience health and health care disparities compared to their urban peers and represent a unique and vulnerable pediatric patient population. Important disparities exist in all-cause mortality, suicide, firearm-related unintentional injury, and obesity. In this episode, Dr. Jessica Bettenhausen discusses research into these disparities, their causes and potential actions to address them.

Children's Mercy Kansas City has been at the forefront of implementing genomic sequencing in clinical pediatrics and neonatology. In this podcast, John Lantos, MD, Director of Pediatric Bioethics at Children's Mercy Kansas City, discusses the promise of genomic medicine and three suppressing lessons we have learned about the role of genomic medicine for diagnosing, the response of parents, and how testing is impacting care.

What is informatics and why is it important in health care? Listen as Jill Westcott, MD, MS, FACOG, Physician Informaticist for the Fetal Health Center at Children's Mercy, shares her expertise on the topic and how informatics is improving patient outcomes in fetal health.

The Children’s Mercy Research Institute® is undertaking a research initiative to build a first-of-its-kind pediatric data repository to facilitate the search for answers and novel treatments for pediatric genetic conditions. Our goal is to collect genomic data and health information for 30,000 children and their families over the next seven years, creating a database of nearly 100,000 genomes.

How do we create a healthier future for children? The Children's Mercy Research Institute with a core focus on genomics, personalized therapeutics, population health, health care innovation and bioethics is positioned to fundamentally transform pediatric research and create a world of well-being for all children. Listen as Thomas Curran, PhD, FRS, Chief Scientific Officer, discusses the institute and the future of pediatric research.

Children’s Mercy Kansas City is recognized as one of the top 10 nephrology programs in the nation by U.S. News & World Report, and the kidney transplant program has incorporated a number of innovative practices into their management plan that are designed to enhance patient outcomes. Join us as Dr. Bradley Warady discusses how the program’s personalized approach to meeting each patient’s unique needs — including repeated surveillance biopsies, epitope matching and pharmacokinetic assessment of immunosuppressive medication — has contributed to a 100% three-year patient and graft survival rate for the past six years.

To reduce the risk of complications related to hemodialysis, the Children’s Mercy Kansas City Division of Nephrology has implemented several strategies. Listen as Dr. Bradley Warady shares how the institution of standardized infection prevention practices has resulted in more than 1,200 consecutive days without an outpatient central line-associated blood stream infection (CLABSI) in a hemodialysis (HD) patient. In addition, Dr. Warady discusses how vascular preservation protocols also are improving the long-term venous access options for these and future patients.

Devika Maulik MD shares her translational research as it relates to folic acid and different responses to dosing among women of various races and ethnicities. She is using the information gathered to create recommended guidelines for folic acid dosing. She discusses current literature on this topic, as well as her studies in this area.

Dr. Christina Low Kapalu discusses cases and literature surrounding pediatric recurrent intentional foreign body ingestion.

Dr. Sarah Tsai discusses his recent findings from his study surround serum morning cortisol levels.

Dr. Emanuel "Mike" Vlastos discusses the algorithm for diagnosing and trading twin to twin transfusion syndrome.

Dr. James Daniel discusses improved outcomes for liver transplantation with Biliary Atresia.

Dr. Nathan Fleishman discusses the clinical characteristics of fractures in pediatric patients exposed to PPIs.

The COVID-19 pandemic has created an unprecedented work environment for pediatricians and pediatric subspecialists. How we practice medicine has been dramatically changed. When discussing physical precautions such as PPE and social distancing, provider mental well-being also should be a part of the conversation.

In this podcast, Jennifer Bickel, MD, pediatric neurologist and Medical Director of the Children’s Mercy Center for Professional Well-Being, discusses how pediatricians have responded to the pandemic on a personal and professional level, the impact on physical and mental health, adjusting to the decrease in patient and peer contact, warning signs of burnout and mental health issues, steps Children’s Mercy is taking to address physician well-being, and more.

Dr. Kelsee Halpin discusses Endocrinology and Diabetes.

Childhood Obesity continues to be on the rise and causes serious health consequences. In this podcast, Dr. Jason Fraser discusses the Bariatric Surgery program at Children's Mercy. We learn who is a candidate for bariatric surgery, the requirements for surgery, why Children's Mercy decided to offer bariatric surgery, the type of bariatric surgery offered at Children's Mercy and results.

Dr. Tania Burgert discusses Polycystic Ovary Syndrome (PCOS) and the current ideas surrounding a complex condition.

CHAMP (Cardiac High Acuity Monitoring Program) is a multi-disciplinary based team that has been designed to meet the needs of the most complex cardiac population with single ventricle heart disease. The program closely monitors patients with single ventricle heart disease between the critical first and second stages (before stage II Glenn surgery). The team at the Ward Family Heart Center at Children's Mercy has also developed a tool that makes it easier for families to report their single ventricle child's vital signs from home and provides the hospital team with frequent updates needed to keep these patients well between visits. Dr. Hancock discusses everything you need to know about CHAMP.

The CKiD study was recently approved for an additional five years and $4.7 million of funding, making 20 consecutive years of funding. Historically, when participants developed end-stage disease, they left the study. The next phase of study will focus on the entire spectrum of the disease, starting with early CKiD in infants and following those who progress to kidney failure, requiring dialysis and transplant. Currently, CKiD is enrolling an additional 190 children in the new cohort. The study will attempt to detect abnormalities earlier in the process for more timely interventions.

Patients that have residual leukemia stem cells after chemotherapy and other treatments have substantially higher risk for relapse. Survival rates for relapsed leukemia are very poor. Even when patients survive long-term, the very toxic anti-cancer treatments are escalated in treating relapsed leukemia. This particularly risks long-term health and substantially increases the risk of early death due to side-effects of the treatment itself.

John Perry, PhD, faculty member of the Children's Research Institute at Children's Mercy Kansas City is studying how leukemia stem cells resist current anti-cancer treatments.

Join us for this podcast as Dr. Perry discusses the promise of low-dose doxorubicin as a targeted therapy against leukemia stem cells rather than a broadly toxic chemotherapy drug.

Osteosarcoma is highly metastatic and drug-resistant cancer. The survival rate for metastatic osteosarcoma remains less than 20 percent for the last 40 years. Tomoo Iwakuma, MD, PhD, is leading research focused on the elucidation of mechanisms underlying osteosarcoma progression and the discovery of novel drugs against this osteosarcoma. His laboratory has identified a lead compound that specifically killed canine and human osteosarcoma cells lacking the activity of the tumor suppressor p53, with minimal impact on non-tumor cells. Join us as we visit with Dr. Iwakuma about this promising research.

Peutz-jeghers syndrome (PJS) is an inherited syndrome, characterized by the development of gastrointestinal polyps and characteristic mucocutaneous freckling. Individuals that present with PJS tend to have polyps often in their small intestine as well as their stomach and large intestine. Recently the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) group published the first set of guidelines in treating PJS in pediatric patients.

Hear from Thomas Attard MD, a core contributing author to the ESPGHAN guidelines and Caitlin Lawson, MS, CGC, on how Children’s Mercy manages pediatric patients in view of the new recommendations and how novel techniques available at Children’s Mercy impact patient management and outcomes.

Type 2 diabetes was commonly associated with the adult population. This diagnosis was even referenced as adult-onset diabetes but in recent years type 2 diabetes in children is on the rise.

Although researchers aren’t clear as to why some children develop type 2 diabetes there are some causes that can increase the risk. When children present with these risks the Children Mercy Diabetes Center can evaluate these patients and create a care plan to possibly alter the path to such a diagnosis.

Hear from Dr. Yan as she explains the types of children that can be seen in clinic and how to proactively get in front of a life altering diagnosis of type 2 diabetes.

Can an effective treatment for medically refractive Crohn’s disease be found in the gastrointestinal tract itself?

Dr. Alka Goyal with Children’s Mercy Kansas City is exploring the role of fecal transplant as a rescue therapy for patients whose inflammatory bowel disease has not responded to traditional treatment. Early research showed that a single transplant is relatively safe and can result in a short-term response in young patients with active IBD but doesn’t provide long-term relief. Now Dr. Goyal is launching a new study to help determine whether there is an advantage to a stronger induction phase for transplant, and any benefit to performing maintenance therapy for patients with Crohn’s.

Dr. Goyal highlights her research findings recently published in the IBD Journal, reviews her next study and the potential it holds for patients whose disease requires longer-term effective therapy.

As an expert in the treatment of Tourette Syndrome (TS), recently, Dr. Coffman was asked to author an article on the pharmacological treatment of Tourette Syndrome.

In collaboration with Dr. Quezada, the paper was published in CNS Drugs Journal, focusing on current approaches and new developments regarding treatment of Tourette Syndrome. The team developed a visual algorithm to help guide the treatment of TS using medication based on the level-of-evidence and side-effects. It has been designed for others to use both inside the U.S. and globally. In this podcast, Drs. Coffman and Quezada will discuss the findings of the review publication.

Neonatal pharmacotherapy is a field ripe with opportunity. Efficacy and toxicity is unpredictable and varies greatly for many drug classes commonly used. Weight-based dosing continues to be the standard of care as individualized drug markers are lacking. To better understand variability in drug response, the focus must shift from drug dosing to drug exposure.

Tamorah Lewis, MD, neonatologist and clinical pharmacologist, joins us to discuss how pharmacotherapy and individualized medicine can transform care for critically ill newborns.

Approximately 10 to 15 percent of childhood cancer cases are due to a genetic predisposition. Children’s Mercy Kansas City is searching within the genetic code to not only identify genes that may lead to cancer, but to find answers in how to better treat or cure pediatric cancer.

Erin Guest, MD, Director of Cancer Genomics at Children’s Mercy, discusses the growing role of cancer genomics and how big data, new tests, and personalized treatments could change the future of pediatric cancer treatment.

Thanks to the research being done in CKid, we know that children diagnosed with chronic kidney disease progress over time to dialysis and transplantation. That makes it very important to address therapies which can mitigate the progression of chronic kidney disease.

Joining the show today is Tarak Srivastava, MD, he has been awarded R01 funding from the National Institutes of Health to work on targeting EP2, one of the four PGE2 receptors to mitigate hyperfiltration–mediated kidney injury as a way to delay the progression of chronic kidney disease in children born with congenital anomalies of kidney and urinary tract (CAKUT).

In pediatrics care most often supports life-sustaining treatment to promote the best interests of the child. But in some circumstances (after weighing the balance of benefits and burdens of a range of treatment choices) continuing life-sustaining treatment is decided to no longer be in the child’s best interests. Collaboration and clear communication are essential in these difficult discussions.

Join Bioethicist and Neonatologist Brian Carter, MD at Children’s Mercy Kansas City, as he provides insights on his recommendations and contributions to the American Academy of Pediatrics’ newly updated policy statement on how to promote the best possible end-of-life care for children.

It’s well-accepted that there are a variety of complex pathways that contribute to abdominal pain in children; but what are these pathways, and how can they be measured? By combining the data from mobile body sensors and self-reporting from participants, researchers at Children’s Mercy Kansas City were able apply “big data” to identify pain triggers for each individual patient. The results were very encouraging.

Join Dr. Jennifer Schurman with the Division of Gastroenterology at Children’s Mercy Kansas City as she introduces us to the importance of monitoring and collecting data on triggers for abdominal pain and the value that data holds for individualizing pain treatment in the clinic setting, real-time.

Did you know over 17,000 children are treated for lawnmower injuries each year in the US, resulting in 4,000 trips to the ER. About 75 children die annually from these injuries.

Our Guest Dale Jarka, MD is leading a first of its kind research study at Children’s Mercy to better define the causes, patterns and effects of Lawn Mower injuries, identify predictors of severe injuries in order to elevate public education and prevent injuries.

Manometry has long been the standard to measure colorectal activity, but it’s a lengthy and invasive test.

Doctors at Children’s Mercy Kansas City wanted to know if there was a better, non-invasive way to monitor colonic activity. The search for an answer led to a promising innovation. Along with a scientific partner, John Rosen, MD, developed a device that monitors colorectal activity using electrical bio-impedance with electrodes on the skin.

Join Dr. John Rosen with the Division of Gastroenterology at Children’s Mercy Kansas City, as he introduces us to colonic monitoring, his pre-clinical findings presented at a major gastroenterology conference in 2017, and the potential the new device holds to make colorectal activity detection more accessible to patients.

What are the risk factors for CKID progression? Should children with CKID be screened for cardiovascular risks? Can we predict relative time to a composite event?

These are a few of the questions being answered by the CKID study. To date, the translational research study has resulted in more than 90 publications.

Listen as Dr. Warady highlights some of the key findings that are shaping care and providing answers that matter now to pediatric patients with CKID.

Children’s Mercy was one of the first pediatric cardiac surgery programs in the nation to voluntarily share surgical outcomes with the public via the Society of Thoracic Surgeons’ (STS) website.

That level of transparency is critical to quality improvement for patients, families and staff, as well as for pediatric heart surgery programs nationwide.

Today of the approximately 120 pediatric heart surgery programs belonging to the database, about half voluntarily share data publicly.

Children’s Mercy has been an early adopter of transparency.

In this podcast James E. O'Brien Jr, MD, explains that evaluating this objective information, Children’s Mercy has improved the care we provide patients and their families, helping us rank among the top programs in the country.

Since opening as one of the first fetal centers based in a children’s hospital, the Elizabeth J. Ferrell Fetal Health Center at Children’s Mercy has delivered nearly 1,000 high-risk babies, with more than one third having complex heart disease. The addition of Emmanuel “Mike” Vlastos, MD further expands the center’s fetoscopy experience, which includes open myelomeningocele repair and other advanced in-utero procedures. While fetal surgery has been around for decades, the hope has not always lived up the hype.

In this podcast, Dr. Vlastos discusses the current status of open and minimally invasive fetal procedures, where we’ve seen success, and where the field is heading.

How can technology improve adherence and control for children and their families dealing with type 1 diabetes?

Mark Clements, MD, PhD, Endocrinologist and Associate Professor of Pediatrics, University of Missouri-Kansas City School of Medicine, and Susana Patton, PhD, Psychologist and Professor of Pediatrics, University of Kansas Medical School, are working in partnership on three unique collaborative projects funded by the National Institutes of Health which are utilizing technology to investigate innovative approaches to adherence and control of type 1 diabetes in young children.

Join us to learn more about this collaborative research and preliminary results.

The recent trend in infants born exposed to neurotropic substances during pregnancy is increasing at an alarming rate across the United States, posing a public health threat in the form of neonatal abstinence syndrome (NAS). Jodi Jackson, MD, Children’s Mercy Neonatologist and Medical Director of the Shawnee Mission Medical Center (SMMC) level III NICU, has implemented family-centered care initiatives that have improved outcomes for these infants.

This family-centered protocol for NAS has been implemented at the other community hospitals where Children’s Mercy neonatologists serve as medical directors, and now Dr. Jackson is chair of the Kansas perinatal quality collaborative (KPQC) and working on a state wide initiative for NAS.

Hear from Dr. Jackson as she discusses the program and impact it is having on the neonatal population.

As a consortium partner of the NCI-designated University of Kansas Cancer Center and Stowers Institute for Medical Research, Children’s Mercy Kansas City is part of an elite group of pediatric cancer research centers. The strength in pharmacogenomics and genomics at Children’s Mercy, opens up new avenues for diagnosis and treatment of various forms of childhood cancer. Combining these strengths with the full range of expertise at The University of Kansas Cancer Center offers hope for current and future patients fighting cancer.

Join us as Alan Gamis, MD, discusses the importance of NCI designation and what it means to pediatric research and patient care.

Bradley Warady, MD, Division Chief of Pediatric Nephrology at Children’s Mercy Kansas City is an international leader in pediatric dialysis. In addition to being one of the principal investigators for CKiD, the largest study of pediatric chronic kidney disease ever conducted in North America, Dr. Warady is the lead editor of two authoritative textbooks: Pediatric Dialysis Case Studies and Pediatric Dialysis. He is also on the international committee developing new pediatric dialysis guidelines.

In this podcast, Dr. Warady discusses the state of pediatric dialysis today, where improvements can and are being made, and next steps for improving care.

Acute lymphoblastic lymphoma is the most common childhood cancer, with about 3,100 patients younger than 20 diagnosed every year, according to the National Cancer Institute. Children’s Mercy contributed to the trial of the first U.S. approved cancer gene therapy, Kymriah, for children and young adults with acute lymphoblastic leukemia that is resistant to treatment or has relapsed.

Doug Myers, MD, Children’s Mercy oncologist, was an early investigator of immunotherapy using chimeric antigen receptor t-cells to treat pediatric cancer and led the hospital’s participation in the Kymriah trials.

Join us as Dr. Myers discusses immunotherapy, the science behind chimeric antigen receptor technology, and it significance for patients now and in the future.

Special cases require specialty care. The new Children’s Mercy Adolescent Medicine Specialty Clinic is a clinic designed specifically to treat the extensive and complex needs of teenagers. This team of specialists utilizes a whole care approach, evaluating physical, social, environmental and psychological needs of each teen, recognizing the unique difficulties faced during this stage of life development, including mental health, gynecological and reproductive health, POTS, chronic fatigue, medication adherence and transition to adult care.

Michaela Voss, MD is here today to explain how they are working to expand their reach in the community and develop further clinics based on need, with the aim of supporting the primary care provider through collaboration and consulting.

Voiding dysfunctions comes in all shapes, sizes and symptoms. With so many presentations, sometimes the common feels uncommon, but you are not alone!

Mary Langston, RN, MSN, CPN, PPCNP-BC discusses voiding dysfunctions and what strategies primary care providers and families can use to help a child before referral to a specialist.

Medications are critical to treat diseases. Unfortunately medications do not come without risks and their use can result in adverse drug reactions.

Listen in as Jennifer Goldman MD, MS discusses the importance that providers understand how to classify adverse drug reactions, how these reactions influence future prescribing of medications, and the importance of informing patients about adverse drug reactions.

In patients with sickle cell concurrent pulmonary issues such as asthma, allergies, sleep apnea and acute chest syndrome are common. Alvin Singh, MD, is helping save these sickle cell patients an extra trip to the hospital through the multidisciplinary sickle cell pulmonary clinic. Dr. Singh ensures that patients are well oxygenated, ventilated and that pulmonary issues don’t affect their sickle cell disease.

Listen in as Alvin Singh, MD explains that although acute chest syndrome is the second most common complication of sickle cell disease, it can be difficult to determine the source of the problem, especially in young patients with a predilection for asthma.

Opportunities to optimize use of antibiotics in pediatric practice have focused on targeted interventions in acute respiratory infections.

Practice based strategies to improve unnecessary or inappropriate antibiotic prescribing in pediatric urinary tract infection (UTI) are also necessary. Practitioners should develop a process in their practice to appropriately identify those with clinical features of UTI, to optimize specimen collection, to appropriately interpret urinalysis results and to target the initial antibiotic therapy.

Listen in as Mary Anne Jackson, MD explains that pitfalls that may result in injudicious testing and antibiotic use in the child with suspected UTI will be discussed and specific practice based interventions to improve outcomes will be reviewed.

The field of Next Generation Sequencing is rapidly changing, both in instrumentation and applications, making it difficult even for experts to remain current. Recognizing the advantages and limitations of genomic sequencing is important, especially in clinical testing and research applications.

Listen to Emily Farrow, PhD, provide an overview of current sequencing technology including its strengths and weaknesses. Complimentary technologies commonly used in both the research and clinical setting, and strategies for their utilization will also be discussed.

Looking forward, the Center for Pediatric Genomic Medicine is actively developing new technologies and protocols to expand the use of NGS. Hear about ongoing projects under development that are addressing complex regions and structural variations.

Eating disorders present differently in every teen. Teens who look and seem healthy may be secretly suffering from this biologically influenced illness. The Eating Disorder Clinic at Children’s Mercy is fighting Anorexia, Bulimia and related disorders in children and teens using a multidisciplinary perspective by pediatric providers with expertise in treating eating disorders.

Listen in as Clinic Director Katheryn Pieper, PhD, expels some common misconceptions about the disease and discuss how to diagnose and treat it early. Learn how the Children’s Mercy Eating Disorder clinic can help your patients with specialized pediatric providers for the medical, psychological, nutritional, psychiatric and family therapy care for this population.

Childhood obesity is a growing problem across the US, particularly in rural areas. Rural children are disproportionately affected by obesity due at least in part to limited resources. Ann Davis, MPH, PhD, ABPP, and her team of co-investigators are trying to change that through a remotely delivered, family-based obesity intervention. iAmHealthy is composed of a 25-hour behavioral intervention focused on nutrition, physical activity and behavioral change. Families receive eight weekly group sessions followed by monthly group sessions, in addition to individual family-based health behavior coaching.

Listen as Ann Davis, MPH, PhD, ABPP discusses the iAmHealthy program at Children's Mercy.

In addition to the expert clinical care provided by our Heart Center team, Children’s Mercy also works to provide additional support to our patient and families through our THRIVE program. The THRIVE program focuses on the psycho-social needs of patients, their family members and even the staff members that treat these young patients.

The THRIVE team is made up of social workers, psychologists, child life specialists, chaplains, music therapists, financial counselors, and our palliative care team who are committed to helping everyone involved with their emotional health. This can include helping to create a smooth transition back home by easing fears about returning to school after hospitalization, supporting the emotional well-being of siblings, and providing resources both inside and outside the hospital.

Listen in as Jami Gross Toalson, PhD explains how THRIVE also helps patients and families look towards the future, whether that's going off to college, transitioning to adult care or finding independent living.

Thanks to years of experience, the Children’s Mercy Center for Pectus is getting children feeling better faster. The center is the oldest in the nation and sees more patients yearly than almost every other hospital. The center offers the “Nuss technique” of minimally invasive surgery with a 99 percent success rate for children with pectus excavatum. For pectus carinatum, the center corrects nearly every patient case without surgery through the dynamic compression device (DCD) bracing system.

Listen in as George ‘Whit’ Holcomb III, MD explains the “Nuss technique” and that Children’s Mercy is the region’s only authorized bracing system provider.

The medications used to treat gastroesophageal reflux (GERD) in children ignore one BIG factor – obesity. Obesity is a known risk factor for GERD in children, but the proton pump inhibitor (PPI) pantoprazole commonly used to treat GERD has no dosing guidelines for overweight and obese children.

Dr. Shakhnovich is here to explain that through her research, she has found that giving overweight children larger doses, a recently suggested practice with adults, could actually cause more harm than good and predispose children to unwanted side-effects from unintentional systemic overexposure to PPIs.

The award-winning Children’s Mercy Transport team has partnered with the Elizabeth J. Ferrell Fetal Health Center to provide safe and specialized transport for pregnant women needing immediate access to a higher level of care. This new service provides an invaluable resource for our region to ensure immediate transportation is offered, to the best place of care, for both mom and unborn baby.

Hear from Sherry McCool, RRT-NPS, MHA, CMTE and Melanie Foltz, MSN, RN, on the benefits it will offer our region.

Why does one child respond well to cancer treatment and another not? The Children’s Mercy Oncology Biorepository hopes to answer that question and more. This research facility includes biobanking technology and the staff to manage patient samples and assist with research. The 200 new pediatric cancer patients at Children’s Mercy each year can contribute to research efforts regardless of diagnosis or age simply by donating their blood, leftover tumor samples, DNA and clinical data.

In this segment, Erin Guest, MD explains that the biorepository is open to research scientists to study cancer and related diseases and hopes to collaborate with other oncology programs on novel research projects.

New innovations in digital media allow for more access to more health information than ever before. Parents and teens are now taking their health information into their own hands, but what does this mean for providers?

Rupal C. Gupta, MD, explains how this new digital health innovations affect the provider-patient dynamic and what providers can do to make sure their patients are receiving accurate and helpful information.

Whether regular or irregular, the causes of constipation in children can be broad and difficult to diagnose. The BRICK (Bowel Retraining in Constipated Kids) clinic is a special clinic within the Division of Gastroenterology at Children’s Mercy Hospital dedicated to the care of children with constipation and encopresis.

BRICK clinic director Kacie Kaufman will discuss the care children receive at the BRICK clinic and how doctors can implement best practices into their own clinics.

A newly FDA approved procedure has the power to save children from a painful cornea transplant. Keratoconus presents in about 1:2000, with a high prevalence in the Down Syndrome population. The disease causes the cornea to become thin and bulge. Corneal crosslinking improves the connections among the membranes of the cornea by a factor of four, preventing the need for a cornea transplant.

Erin Stahl, MD is here to explain that Children’s Mercy Kansas City provided one of the first FDA-approved pediatric treatments in February 2017, providing new hope for Keratoconus.

For kids with cancer, the treatment that cures them can also kill them.

Through the Genomic and Ontogeny Linked Dose Individualization and Clinical Optimization for Kids (GOLDILOKs) program, doctors can find a treatment not too big, not too small, but just right.

Listen as Dr. Jaz Tolbert explains that by finding the perfect dose, doctors can improve treatment outcomes and decrease treatment-related mortality.

Could jaw surgery help you sleep better?

This interdisciplinary clinic at Children's Mercy brings in orthodontics, sleep medicine and plastic surgery and focuses on a surgical orthodontic treatment of obstructive sleep apnea and other jaw deformities.

Hear Dr. Michael Lypka detail jaw surgeries from airway obstruction in the neonate to definitive jaw surgery in the adolescent.

In Ewing Sarcoma patients, exosomes in the blood may be an early detector of relapse. Partnering with the University of Kansas, Glenson Samuel, MD created a chip that could detect and analyze these exosomes and their proteins with minimum blood. Now, he is using that knowledge to find, and reverse, chemo-therapy-related resistance in tumor cells, making patients more responsive to therapy.

Join Glenson Samuel, MD as he discusses his studies and his work with the genome center.

Gerald Woods, MD, Division Director of Hematology/Oncology/BMT, has more than 30 years experience in sickle cell treatment. Dr. Woods is currently a PI for a study of GBT-440, a new drug to treat sickle cell.

Children’s Mercy is one of only two U.S. hospitals initially invited to participate in this research. Dr. Woods is leading the hospital’s participation in a Health Resources and Services Administration grant for the Sickle Cell Disease Treatment Demonstration Program Regional Collaborative.

Join us as Dr. Woods discusses the latest advancements in sickle cell disease and efforts to increase treatment options.

Researchers at Children’s Mercy have developed Astrolabe, software for predicting a patient’s response to medications using whole genome sequencing. When used with a newly developed, low cost sequencing method, the software can identify the pharmacogenetics profile of each patient, enabling physicians to tailor medication selection to the patient’s DNA.

Join Neil Miller, Director of Informatics and Software Development in the Children’s Mercy Genome Center, as he introduces us to the Astrolabe software and the benefits it will offer to physicians and our pediatric patients.

Minimally invasive interventional radiology services, including angiography, vascular malformations, and tumor ablations, boast lower costs, fewer complications and faster recovery times compared to open surgery.

However, 65 percent of patients are entirely familiar with interventional radiology (IR) with 54 percent of medical students “unclear” of IR duties.

Join Brenton D. Reading, MD, with the Division of Radiology at Children’s Mercy Kansas City, as he introduces us to IR, IR services and outcomes from his dedicated interventional radiologist team at one of the largest pediatric radiology divisions in the nation.

Research shows that the most common cancer treatments can result in damage to the heart or vascular system. Children’s Mercy is now one of only a few pediatric hospitals in the world offering a Cardio-Oncology Program to address cancer treatment-related cardiotoxicity. In one appointment, patients will receive evaluation and expert advice from an oncologist and a cardiologist.

The program provides early detection of patients at risk for cardiotoxicity, early application of cardioprotective agents and ongoing monitoring to minimize damage secondary to cancer treatment.

Aliessa Barnes, MD, Medical Director of Pediatric Cardiac Transplant and Joy Fulbright, Director of Survive and Thrive, discuss how they are helping make sure today’s cancer survivors are not tomorrow’s heart failure patients.

Children’s Mercy is one of only a handful of programs across the nation using a unique bridging technique called Rapid Exchange of Continuous Renal Replacement Therapy (RECRRT) for children diagnosed with acute kidney injury. By consistently using RECRRT, Children’s Mercy has become proficient in the bridging technique, resulting in significantly less blood exposure and therapy downtime for these critically ill children.

The technique’s primary goal is to reduce exposure to blood products for these patients.

Vimal Chadha, MD, Pediatric Nephrologist explains how this technique helps lower the risk for iron overload, transfusion reactions, exposure to infectious agents and sensitization to different antigens that could jeopardize a future kidney transplant.

The Children's Mercy Diabetes Center is making a change to the way it cares for the 250 to 300 type 1 and 2 diabetes patients newly diagnosed each year, transitioning them from inpatient to outpatient treatment.

Patients over 5 years old and their families will receive the education and training needed to maintain healthy blood glucose levels in three outpatient visits over the course of 1 month. Children under 5 or those who present with diabetic ketoacidosis will continue to be admitted to the hospital. This change is being made to enhance the patient experience in receiving and retaining education related to their new diabetes diagnosis.

Hear from Ryan McDonough, DO, as he discuss this new clinic model and the benefits it will offer to patients newly diagnosed with diabetes.

Children and adolescents diagnosed with cancer face months to years of chemotherapy, sometimes including radiation and surgery. These life-altering disruptions place demands on children, teens and their parents.

The diagnosis is usually stunning and unwelcome, followed rapidly by tests, treatments and lots of information. Yet helping children, teens and families cope with this unexpected and unwelcome intruder is vital to physical and psychosocial health.

Listen in as Kristin Stegenga, PhD explores typical patterns of coping among children and adolescents while touching on the role of parent and family coping in these patterns. Ideas for supporting children and teens will also be discussed.

The adolescent sports population is especially prone to knee ligament injuries with the increased specialized sport participation, overuse and suspected sedentary elementary years preceding highly active adolescent sports participation. The Center for Sports Medicine at Children’s Mercy is one of the nation’s leading sports medicine programs offering a comprehensive model of care from sideline trainers, to operative and non-operative treatment and return-to-play protocols.

Join Kevin H. Latz, MD, Chief, Section of Sports Medicine within the Division of Orthopaedic Surgery at Children’s Mercy Kansas City as he gives an introduction to knee ligament injuries, including prevention, epidemiology and choosing operative or non-operative treatment.

Eating disorders can be physically, emotionally and socially devastating for patients and are difficult for families of those affected. This disorder is the third most chronic condition in adolescents, after obesity and asthma.

Recently the AAP published a clinical report addressing the interaction between obesity prevention and eating disorders. Adolescents can misinterpret what ‘healthy eating’ looks like and thus can lead to an eating disorder.

Hear from Sara Gould, PhD, on how to best manage conversations with teens and providing the right tools on how to live a healthier lifestyles and how the Children’s Mercy Kansas City Eating Disorder Center focuses on the complex medical, psychological, and nutritional issues that contribute to an eating disorder

Chiari malformations, cerebellar tissue through the foramen magnum into the cervical canal, may clinically present in categories of pain-occipital/cervical (worsened with valsalva, cough, sneeze, or exertion), complications of syringomyelia (scoliosis, myelopathy), direct brainstem compression (e.g. nystagmus, strabismus, emesis, imbalance, auditory, swallowing/aspiration, and central apnea), as well as incidental.

Join Dr. Grabb and Transformational Pediatrics, as we discuss the relevant anatomy, discuss the pathophysiology of syrinx development, examine the different types of Chiari malformations and describe the classic clinical presentations for symptomatic Chiari 1 and 2 malformations.

Each year 13,000 to 15,000 extremely premature infants develop severe bronchopulmonary dysplasia (BPD). Despite major advances in neonatal intensive care and improved survival of infants born very prematurely BPD rates have not decreased over the last decade. While there are several reasons for this, a lack of understanding of the various paths to this disease, and the absence of personalized therapies have contributed to this problem.

Researchers at the Donald Thibeault Lung and Immunology laboratories are focusing their efforts on understanding how bacterial blood stream infections injures the developing lung and cause BPD in premature infants. Recently, Venkatesh Sampath, MBBS, MRCPCh, a physician-scientist with Neonatology at Children’s Mercy hospital was awarded a five-year grant by the National Heart Lung Blood Institute (NHLBI) to study the role of inflammatory angiogenesis in the developing lung. The major goal of this project is to understand how pulmonary endothelial immune activation during sepsis promotes lung inflammation and alters the formation of lung blood vessels predisposing to BPD. In collaboration with other researchers in the laboratory, center for infant pulmonary disorders, and clinicians in the NICU we hope to develop strategies and new therapies to decrease the burden of BPD.

Hear from Venkatesh Sampath, MBBS, MRCPCh on what their ongoing research tells us about how babies develop BPD and the other studies that are underway to investigate and treat BPD at CMH and Neonatology.

It is important to understand the difference between cardiac and non-cardiac causes of syncope. The cause of syncope can be identified in about 50 percent of patients by history and physical alone. Both past medical history and the history of the event are vital.

Cardiogenic Syncope can be life threatening. It generally requires specialized evaluation (echocardiogram, exercise stress test) and treatment and often requires activity restriction.

Listen in as Brian Birnbaum, MD explains that Vasovagal/Orthostatic Syncope is usually not life threatening and can often be diagnosed with history and a physical exam.

As one of the larger inflammatory bowel disease (IBD) programs in the nation, the Children’s Mercy Kansas City Division of Pediatric Gastroenterology cares for 550 to 600 patients and their families on an ongoing basis. A unique component to the program is the parent engagement.

The IBD program has been recognized as a leader in parent engagement through ImproveCareNow and other national organizations, including the Institute for Healthcare Improvement.

Hear from Julie Bass, DO, on the impacts and benefits of creating a strong partnership with parents in the care for patients with IBD.

A marrow or cord blood transplant could be the best treatment option, and for some patients, offer the only potential cure, when facing life-threatening diseases.

A FACT accredited (Foundation of the Accreditation of Cellular Therapy) program and a National Marrow Donor Program (NMDP) unrelated and cord blood donor center, Children’s Mercy Kansas City is a leader in research and the treatment of rare and complex diseases using bone marrow, peripheral blood stem cells and cord blood transplants. The program offers autologous, related allogeneic, unrelated allogeneic, and haplo-identical transplants.

Listen as Rakesh Goyal, MD, shares how the Children’s Mercy BMT program is expanding the use of transplants to successfully treat immunodeficiency, metabolic, sickle cell disease and other rare diseases.

When a child is sent home from the hospital after a serious injury or illness, the ongoing medical care for that child can be overwhelming for parents. Home Care services provide a smooth transition to home and assists parents in accessing the required ongoing care ordered by a physician.

Andrea Toomay, Children’s Mercy Home Care, joins us to discuss the pediatric home care services and the value they provide to families.

Children with heart conditions are at increased risk for life-threatening blood clots according to a statement from the American Heart Association. Pediatric hematologists and cardiologists at Children’s Mercy are leading a multidisciplinary effort to reduce risk of clots in this fragile population of patients.

Michael Silvey, DO is here to explain that the goal of treatment is to reduce clotting risk, without thinning blood too much and promoting bleeding.

SuPAR (soluble urokinase-type plasminogen activator receptor) has been shown to be a promising biomarker in its ability to predict the development of chronic kidney disease in adults years earlier than traditional risk factors.

Darcy Weidemann, MD, pediatric nephrologist at Children’s Mercy is leading the largest North American study ever conducted to look at whether suPAR may be helpful to predict kidney function decline in children.

Listen in to Darcy Weidemann, MD as she explains the potential role that monitoring suPAR levels may play in improving the care of children with chronic kidney disease.

Managing chronic pain in the pediatric patient can be a challenge, not only for the patient, but for their caregivers. The introduction to biobehavioral and congestive behavioral pain management strategies can help patients cope with the everyday pain.

Dustin Wallace, PhD, started the Comfort Ability workshop, led by staff psychologists from Children’s Mercy. This one day interactive workshop has been designed to teach new strategies to manage pain and improve day-to-day function.

Listen in to Dustin Wallace, PhD as he explains how the program emphasizes mind-body strategies for managing pain and pain-related stress, as well as individualized coping plans for improved pain management. Caregivers also gain an understanding of how to better support their child through their pain.

Only about 100 infants are diagnosed with acute lymphoblastic leukemia (ALL) in the U.S. each year. Most of these babies respond to chemotherapy treatment at first, but go on to relapse and die of the disease.

Dr. Erin Guest and colleagues at Children’s Mercy are performing genomics research to uncover the reasons why leukemia in infants becomes resistant to treatment. Dr. Guest is also leading a national clinical trial for infants with ALL, through the Children’s Oncology Group.

Listen in as Erin Guest, MD discusses how she is working with researchers from around the globe to design new treatment strategies that will cure more infants with leukemia.

Although a commonly recognized condition in adults, herniated nucleus pulposus (HNP) is often an unrecognized cause of back and leg pain in the pediatric/adolescent population. This often leads to a delay in diagnosis and/or inappropriate treatment. HNP is distinct from a "bulged disc", an MRI finding often cited as a cause of pediatric /adolescent back pain. With HNP, patients generally have some element of back pain, but it is the leg pain (radiculopathy) or sciatica that often leads to their presentation to a health care provider.

It is not uncommon for children to present with "sciatic scoliosis", a spinal deformity that is a response to the patient's nerve root irritation. This condition can have a sudden presentation from a traumatic event of occur spontaneously with no known cause.

Join Dr. Anderson and Transformational Pediatrics as we discuss HNP, associated conditions, presentation, and treatment.

It's been almost five years since pulse oximetry screening was recommended to be added to the uniform screening panel for newborns. While Missouri and Kansas each took different approaches, pulse oximetry screening for CCHD in the newborn nursery is now almost universal in the United States.

Prior to oximetry screening, about 20% of newborns with CCHD left the hospital with undiagnosed heart defects. Now that number is much, much smaller.

Listen in as Dr. Stephen Kaine, Children’s Mercy cardiologist, discusses the implementation process for the screening, reporting, and outcomes.

Amblyopia is by far the most common cause of unilateral vision loss in children, affecting 2 to 4 percent of the population. Screening for amblyopia is an important component of well-child pediatric care.

Join Children’s Mercy pediatric ophthalmologist Dr. Atkinson and Transformational Pediatrics, as we discuss the three generally-recognized types of amblyopia, available screening techniques, and treatments of the disease.

Each year in the United States more than 3 million referrals are made to child protective services (CPS) involving more than 6 million children. Of those referrals which are investigated, between 15 to 20 percent involve allegations of physical abuse. Deaths from abuse and neglect occur most commonly in children less than 4 years of age, which highlights the importance of recognition of abuse by pediatricians in this age group.

Join us as Emily Killough, MD, discusses the diagnosis and evaluation of child abuse and a new mobile app to aid medical providers in the recognition of abuse.

A recent study found that student-athletes experience mental health issues at about the same rate as the general student body—30 percent. However, while 30 percent of those struggling students will get help, only 10 percent of their athlete counterparts will. Several organizations are taking steps to eliminate the stigma including the NCAA, NATA and universities through programs like Athletes Connected.

Listen to Dr. Sullivant (Children’s Mercy) discuss the study and the steps the Sports Medicine Department and other departments are taking at Children’s Mercy to combat the issue.

Approximately 411,000 children live in a four county Kansas City metro area, accounting for 25.6 % of the population. A community health assessment by Children’s Mercy with assistance from Professional Research Consultants, examined current health status of children in the metro area, identified unmet needs and current health priorities, explored community strengths and gaps in resources, and provided insights to health advocates and providers.

The report identified numerous issues including poverty, employment, violence, parent support, access to care, mental/behavioral health, housing, obesity, food insecurity, early education and infant mortality.

Listen in as Margo Quiriconi, Director of Community Health Initiatives at Children’s Mercy, explains the key findings of the study and plans to address them.

For more than 20 years, Children’s Mercy Kansas City has served children, families and referring specialists for burn care. As the regions ONLY pediatric exclusive burn unit, electrical, chemical and frost bite burns are cared for, with access to every pediatric subspecialty all within a pediatric hospital.

Join Dr. Aguayo has he helps guide first responders, emergency practitioners and primary care providers on when to seek out the care of a burn care specialist.

Appendicitis has an incidence of 80,000 pediatric cases per year in the United States, and the gold standard for the past 100 years has been to treat children with appendectomy. However, recent research in adults has suggested antibiotics without surgery may be an effective treatment, challenging conventional practice.

Join Dr. St. Peter and Transformational Pediatrics, as we look to learn more about the Children’s Mercy randomized study looking to answer if broad-spectrum antibiotics may be used to successfully to treat acute uncomplicated appendicitis in children, helping these patients avoid surgery all together.

Two remarkable sisters, Alice Berry Graham and Katherine Berry Richardson, one a dentist and one a surgeon, founded Children’s Mercy Hospital in Kansas City in 1897. They brought to the task an indefatigable dedication to the plight of poor sick children that transformed the community forever. Along the way they founded a nursing school, worked around segregation to train African-American physicians and nurses in pediatrics, faced constant financial ruin and yet, managed to become the social conscience of the city. Their work created a legacy of caring that endures today.

Listen in as Jane Knapp, MD discusses these two women and how they started Children’s Mercy.

Brazil conducted a public vaccination campaign April – May 2016 that immunized 49 million people. However, Brazil’s Ministry of Health has reported 1,233 deaths through July 1, 2016 calling Brazil’s H1N1 p2009 season worse than at any time since the pandemic. With the “flu season” in Brazil usually from April through July, add severe H1N1 p2009 influenza as a hot topic about Brazil and Olympic travel, in addition to Zika virus and superbugs.

Listen in as Christopher J. Harrison, MD, discusses the possible implications for the U.S.?

Telemedicine has been around in various forms for decades. But is the promise of telemedicine more hype than actual health improvement? Can remote technology truly facilitate quality care? Are patients and families ready to adopt what can be perceived as less personal care?

Dr. Jay Portnoy answers these questions and discusses the growing role of telemedicine at Children’s Mercy Kansas City.

Human Papillomavirus (HPV) is a very common virus. Nearly 80 million people—about one in four—are currently infected in the United States. Although HPV is one of the most common sexually transmitted infections and is a linked cause of cervical cancer, the infection is often silent. Patients may never know they have the infection but often have serious consequences. Educating the population about the importance of the HPV vaccination is necessary to bring down the number of infections.

Hear from Dr. Pahud on the benefits of the HPV vaccination for eligible patients and impact it will have on the community.

It’s summer — so what do you need to know about Rocky Mountain Spotted Fever (RMSF), and ehrlichiosis, the two most common local tickborne infections associated with fever? During this season, when evaluating a febrile child, establishing if the child has had a tick bite or is tick exposed (lives or has visited an area where ticks have been seen) is helpful.

Listen in as Mary Anne Jackson, MD, a pediatric infectious diseases specialist with Children's Mercy, discusses the latest guidelines related to Tick-Borne infections.

As early as kindergarten, Autumn Nelson experienced problems controlling her left hand. By the time she was just eight years old, muscle spasms caused her to sometimes fling her pencil across the room, making it difficult for the left-handed student to complete her assignments.

Tiffannie, Autumn’s mother, scheduled an appointment for Autumn with Brian Aalbers, DO, one of just a handful of fellowship-trained movement disorders specialists in the United States, and a Children’s Mercy pediatric neurologist. Dr. Aalbers characterized Autumn’s first appointment with him as nothing short of “serendipitous,” leading to a diagnosis and treatment plan within a few days.

Learn more about the DYT1 case in this edition of Transformational Pediatrics.

Long-term use of total parenteral nutrition (TPN) can cause life-threatening complications. Patients that rely on TPN benefit from programs such as Intestinal Rehabilitation, with the end goal of weaning them off TPN and thus improving their quality of life. Creating a multidisciplinary team of dedicated surgeons, psychologists, nurses, dietitians and social workers can help enhance the outcomes for patients battling intestinal failure.

During this session hear from Joel Lim, MD on the importance and success gained from having a multidisciplinary approach in caring for pediatric patients with intestinal failure.

Often misunderstood or misdiagnosed, Tourette syndrome and tic disorders have high rates of co-occurrence with diagnosis of ADHD, anxiety, sensory integration disorders, and obsessive compulsive behavior with more than 80 percent of patients being diagnosed before the age of 10.

Listen in as Dr. Coffman discusses how he guides practitioners in recognizing Tic Disorders and Tourette Syndrome, presenting services and features available at The Tourette Association of America Children’s Mercy Center of Excellence – the nation’s ONLY Tourette Association Center of Excellence devoted exclusively to pediatrics.

Children with 22q11.2 Deletion/Duplication Syndrome are faced with many doctors’ visits across the health care system. With the burdens this puts not only on the family but also their doctors, Children’s Mercy created the Super Q Express 22Q Clinic multidisciplinary clinic. The clinic provides family access to a team of expert clinicians and provides comprehensive individualized diagnostic and management services in Cardiology, Immunology, ENT/cleft palate, GI, behavior/development, and Endocrinology. A social worker and medical coordinator are also present during the visits to provide additional support.

Listen in to hear from Max Feldt, DO on the impact the Super Q Express 22Q Clinic has had on patients with 22q11.2 Deletion Syndrome.

Amplified pain syndrome (APS) is a condition in which the child’s perception of pain is increased due to the abnormal firing of nerves which sense pain and control vascular tone. Amplified Pain Syndrome (APS) can include: Juvenile Primary Fibromyalgia Syndrome, Complex Regional Pain Syndrome (CRPS) (formerly Reflex Sympathetic Dystrophy (RSD)), and other types of nerve-related pain.

Treatment is as unique as the condition itself: intensive exercise, physical and occupational therapy; relaxation techniques; stress-management training; and music and therapeutic art.

Cara Hoffart, DO is here to explain how the RAPS program (Rehabilitation for Amplified Pain Syndrome) at Children’s Mercy is one of only a few treatment programs in the country and has attracted patients from as far away as Lima, Peru.

In a rare event, the four leading orthopedic societies have aligned on a combined statement on early detection for scoliosis.

The American Academy of Orthopedic Surgeons (AAOS), Scoliosis Research Society (SRS), Pediatric Orthopedic Society of North America (POSNA), and American Academy of Pediatrics (AAP) believe that there are documented benefits for children of earlier detection and non-surgical management of adolescent idiopathic scoliosis (AIS), earlier identification of severe deformities that are surgically treated, and of incorporating screening of children for AIS by knowledgeable health care providers as a part of their care.

Richard Schwend, MD is here to explain all the latest developments of early detection and management of adolescent idiopathic scoliosis?

Neurodevelopmental disorders, such as intellectual disability, Tourette syndrome, autism and neuromuscular diseases affect more than 10 percent of children.

Recent advances in genomic medicine are unraveling the etiology of these disorders and providing answers to more patients and families.

These discoveries, along with advances in pharmacogenomics are the foundation of precision medicine.

This topic is important to many and is an area of focus regarding active studies being conducted within the Genome Center.

Hear from Sarah Soden, MD, on GSEND (Genomic Sequencing for the Etiology of Neurodevelopmental Disorders) a prospective study designed to determine whether genomic sequencing early in a child’s diagnostic evaluation improves diagnoses and transforms outcomes.

The Headache Action Plan was developed as a simple tool to guide primary care providers in migraine management, including prevention and abortive therapy as well as recommendations for school and lifestyle.

Jennifer L. Bickel, MD is here to discuss how the Headache Action Plan web application takes medical providers through four sections to help guide the management of migraines and to provide handouts for the family and school.

In 2015, Children’s Mercy created the Children’s Research Institute to coordinate the work of its scientists and physicians and to expand its research portfolio.

This institute was designed to bridge science and medicine to benefit the pediatric community.

In February of 2016, Children’s Mercy welcomed Tom Curran, PhD to lead the new institute.

Hear from Dr. Curran as he shares the role the Children’s Research Institute will have within Children’s Mercy and vision to be the leader in pediatric research.

In 2012, Adolescent Idiopathic Scoliosis (AIS) patients were automatically slotted for PICU beds on the first night post-op.

Due to PICU access, 22 AIS surgeries had to be rescheduled.

In alignment with hospital-wide lean six-sigma management strategies, an AIS project team was tasked with development of AIS to floor guidelines, resulting in a 15% improvement in length of stay, a 100% increase in patients served and a renewed joy for staff nurses empowered to transform the lives of AIS patients.

Join Bobbie Carter, RN, to learn more about the background, implementation, and outcomes for AIS patients at Children’s Mercy Kansas City.

Medication adherence is critical to the long-term health of liver transplant patients.

Yet, adjusting to the demands of a complex regimen and coping with the psychosocial issues commonly associated with transplantation can negatively impact disease management, with average rates of nonadherence among pediatric liver transplant recipients exceeding 50% and accounting for nearly half of acute rejection episodes.

Children’s Mercy Kansas City has created the Liver Transplant Psychosocial and Adherence Promotion Service to aid in facilitating long-term disease management, enhanced patient well-being, and optimal health outcomes.

Jamie L. Ryan, PhD, is joining us to discuss this integrated service and share how Children’s Mercy is treating the whole patient by providing comprehensive psychosocial services as a part of standard liver care.

Genome sequencing within pediatric medicine delivers a new window into diagnosis and treatment of our pediatric population.

Along with the advancements and benefits offered in being able to diagnosis rare conditions and identify potential new treatments options, it is also the most challenging new technologies in pediatrics.

The technology for genome sequencing can create problems of interpretation for both next-generation genome sequencing as well as whole-genome sequencing.

Join John D. Lantos, MD, to learn more about the technology in genome sequencing and the clinician’s role in understanding how to interpret the data for their pediatric patients.

Accurate weight estimates are important because they are used to determine appropriate medication dosage, fluid volumes for resuscitation, breathing tube sizes, and more.

But what do you do in situations when you are unable to weigh the child?

The Mercy TAPE was developed by Children’s Mercy researchers led by Susan Abdel-Rahman, Pharm.D, Clinical Pharmacology and Medical Toxicology, (TAPE stands for TAking the guesswork out of Pediatric weight Estimation) to address that question.

The unique and pragramatic Mercy Tape has been demonstrated to be more accurate than any other method currently available for children ages two months to 16 years, accurately predicting weight within 10 percent of actual weight in about 80 percent of children, and within 20 percent of actual weight in 98 percent of children; in essence, getting within 20 percent of actual weight in nearly 100 percent of children (including children that are malnourished or obese)…all at a cost of about 1/3 of a penny per device.

Dr. Susan Abel-Rahman is here to explain how The Mercy TAPE allows clinicians to get an accurate idea of a child’s weight by making two measurements of the upper arm.

At Children’s Mercy Kansas City, Shao Jiang, MD coordinates an international adoption program with China for cleft lip/palate surgeries.

The experienced cleft palate/lip and craniofacial team provides comprehensive medical services, with pre-adoption counseling and social workers available for ongoing parental support.

Dr. Jiang is uniquely positioned to not only provide palate/lip and craniofacial care, but also to read Chinese medical records and translate.

Join Dr. Jiang to talk about the Cleft Palate/Craniofacial Clinic and its work with Chinese international adoptions.

About 60% to 80% of newborn Infants in the United States are jaundiced, that is they look yellow.

Kernicterus is a form of brain damage caused by excessive jaundice.

The substance which causes jaundice, bilirubin, is so high that it can move out of the blood into brain tissue.

Join Dr. Shapiro as he speaks with Transformational Pediatrics about the diagnosis, treatment and research supporting the pediatric population with kernicterus and other bilirubin-induced neurological disorders.

Early onset scoliosis (EOS) is a complex and heterogeneous group of disorders in children under 5 years of age.

It involves a spectrum of conditions from infantile resolving scoliosis to more severe deformity that is less likely to resolve without aggressive treatment.

EOS imaging technology captures whole-body images of a standing patient in a single scan.

Frontal and lateral digital images can be obtained simultaneously and converted to a personalized 3D bone modeling of the patient in a weight-bearing position with automatic calculation of clinical parameters.

The result is a customized model of each patient to ensure tailored treatment throughout the care continuum.

Nigel J. Price, MD is here to explain what EOS is, what are the benefits, and how has it changed your pediatric orthopedic management.

For more than a decade, the Preventive Cardiology Clinic at Children’s Mercy has been providing comprehensive evaluation, risk factor counseling and management for children with familial dyslipidemia, lifestyle-induced dyslipidemia and chronic diseases that associated with development of atherosclerosis.

Each year, the clinic sees approximately 300 patients.

The Preventive Cardiology Clinic began tracking patient outcomes in 2008 and has built a database that includes demographic, anthropometric, blood pressure, clinical and laboratory information on more than 610 children with dyslipidemia and other atherosclerosis-promoting factors.

Geetha Raghuveer, MD is here to explain how the database has been used as a resource for patient screening and research studies.

Children’s Mercy is preparing to become one of the few institutions in the country to perform a procedure known as “Double Balloon Enteroscopy” (DBE) for children with small bowel disorders.

Listen in as Thomas Attard, MD, FAAP, FACG, Medical Director of Endoscopy Services-Division of Gastroenterology, has shared that DBE provides a more complete evaluation of the small intestine because the instrument used allows access to areas beyond the reach of conventional endoscopes.

The DBE scope provides sharp, clear, high-definition images; it can be used to biopsy tumors, remove small lesions and mark an area with dye for future surgical localization, helping a surgeon know exactly where to go.

Gastrointestinal bleeding, abdominal pain, chronic diarrhea, polyps and tumors are among the conditions that can be evaluated and treated with DBE technology.

Drug-resistant temporal epilepsy can now be treated with minimally invasive Stereotactic Laser Amygdalohippocampectomy (SLAH).

This same technology also is being used to treat certain brain tumors, further expanding treatment options for children.

The state-of-the art technology allows patients to remain neurologically intact and be discharged home within one day of the surgery.

The technology dramatically can reduce risks, morbidities and length of hospital stay.

Learn more from Dr. Christian Kaufman on this edition of Transformational Pediatrics.

Typically, less than 10 percent of the patients transported by traditional “adult” transport teams are under the age of 14.

Research has shown that outcomes are better when children are transported by dedicated neonatal and pediatric transport teams.

Highly specialized neonatal and pediatric programs, such as the Critical Care Transport Program at Children’s Mercy Kansas City, can be the difference between life and death.

What do these programs offer that others don’t?

Angie Cunningham, RN, CCRN, C-NPT is here to explain how the Transport Program at Children’s Mercy is one of the largest in the nation and was the first neonatal/pediatric specialty program in the nation accredited by the Commission on Accreditation of Medical Transport Services (CAMTS) in all three forms of transport: ground, rotor wing and fixed wing.

While 80 percent of pharyngitis is viral in etiology, Group A streptococcus (GAS) remains an important cause of pharyngotonsillitis in the pediatric population.

Inappropriate testing for GAS pharyngitis inevitably leads to overuse of antibiotics, which can result in a pitfall of treatment with an inappropriate antimicrobial agent.

Join Dr. Myers, MD, MPH to learn more about an algorithm your office can use to optimize testing and treatment of GAS pharyngitis, avoiding the five most common pitfalls in diagnosis and treatment of GAS Infection.

Based on guidelines from the American Academy of Pediatrics (AAP), approximately 0.8 percent of adolescents 12 to 17 years old with dyslipidemia may qualify for pharmacological treatment.

That translates into approximately 200,000 adolescents who could be eligible for statin therapy.

With the increasing prevalence of overweight children, the incidence of clinically diagnosed coronary artery disease in young to middle-aged adults is expected to increase by 5 to 16 percent over the next two decades.

Jon Wagner, DO, is here to discuss how he is leading a research study looking at the liver specific protein transporter, OATP1B1, which is the major transporter of statins from the blood to the liver to better understand how children’s bodies distribute statins in the body.

Food allergies have increased dramatically over the past 15 years with more and more children affected.

In addition to traditional food allergies such as peanuts, dairy products and shellfish, there has been a increase in children with reactions to foods not previously considered part of the top eight allergens.

Specialists are now seeing allergies to sesame, fruits, and other foods as we are importing more foods and consuming more foods from other cultures.

The increase has been seen in both percentage of people with reactions and in the severity of reactions, and is particularly a problem in developed countries and among the children of immigrants.

How big is the problem? What is the reason for the increase? How do you prevent or treat these allergies?

Chitra Dinakar, MD is here to discuss the future with food allergy treatment and prevention?

Neurological movement disorders can cause symptoms that negatively impact a child’s quality of life.

Dystonia is of special concern in children, because research shows early intervention is imperative.

Deep brain stimulation is available as a treatment option for dystonia and other movement disorders to children as young as seven years old.

It works by altering abnormal signals in the brain that interfere with meaningful movement.

Brian Aalbers, DO talks more about deep brain stimulation as a treatment option and the success that’s been seen in the nine patients who have received treatment at Children’s Mercy Kansas City.

Children’s Mercy Kansas City is one of only 20 children’s hospitals in the nation selected to participate in the early user group for the MAGEC® (MAGnetic Expansion Control) System.

In early 2015, a seven-year-old became the first patient in Kansas and Missouri to receive a new, ground-breaking treatment for scoliosis, aptly named MAGEC.

To brace the spine and minimize the progression of spinal curvature, the MAGEC system’s magnetic rods are implanted along each side of the spine during a one-time, surgical procedure.

Nigel Price, MD shares more about how MAGEC is transforming pediatric medicine during this segment of Transformational Pediatrics.

In the NICU, the decision to initiate inotropic therapy, provide volume support, or initiate antihyperintensive therapy is often guided by blood pressure measurements.

However, research led by Doug Blowey at Children’s Mercy and reported in the Journal of the American Society of Hypertension, found that standard oscillometric measurement overestimates the blood pressure in very ill neonates.

Dr. Blowey is here to explain elevated blood pressure in children and is now part of an international committee that is writing guidelines to address the measurement, evaluation and treatment of hypertension in hospitalized children.

Children’s Mercy Kansas City’s Infant Tracheostomy and Home Ventilator Program provides infants and children who require long-term ventilation, individualized care in the home setting.

Children’s Mercy’s program is one of the largest in the U.S., with more than 25 new patients treated each year.

While at home, patients and their families are given the opportunity to have a sense of normalcy and thrive in an environment outside the hospital critical care units while still receiving complex medical care with access to on-call physician 24/7 and multidisciplinary care team and the support of local private duty nurse in the home.

The program has seen excellent results both in survival rate and short-term neurodevelopmental outcome since its creation in 2005.

Most infants are successfully weaned off the ventilator by the time they are 2 ½ to 3 years of age and the tracheostomy tube removed after several months.

Winston Manimtim, MD is here to discuss Children’s Mercy Kansas City’s Infant Tracheostomy and Home Ventilator Program.

Home to a Level IV designated Comprehensive Epilepsy Center, Children's Mercy offers one of the largest ketogenic diet programs in the U.S.

The diet is an effective non-medication treatment for intractable epilepsy.

While it is unclear exactly how the diet works, it has been shown to control seizures and minimize the need for antiepileptic drugs, which can have unpleasant side effects.

Children’s Mercy patients have fared better than national averages, with ketogenic diet patients seeing a 72 percent improvement after one year, and 90 % after two years.

Dr. Ahmed Abdelmoity, the Chief of the Section of Epilepsy and Neurophysiology at Children’s Mercy Kansas City, is here to discuss ketogenic diet programs.

Children’s Mercy Kansas City understands that children are not simply small adults.

From physical to cognitive process, pediatric medicine requires a holistic understanding of the child – including how they react to radiation.

With the guidance of staff physicist, Nima Kasraie, PhD, Children’s Mercy Kansas City radiology treatments provide the least amount of radiation possible to its patient – thought to be the least amount of radiation a child would receive from any hospital in the country.

Join Dr. Kasraie as we learn more about Image Gently and why it matters for our children.

The Children’s Mercy Beacon Program provides a patient-centered primary care medical home for children with the most complex special needs, as well as for their siblings.

The Beacon team communicates with health care providers in clinics, hospitals, schools and at home to coordinate care and assist with transition throughout the health care system.

The program streamlines the health care process for families with at least one child with medical complexity, from birth to 21 years, and their siblings.

Amber Hoffman,MD is here to discuss how care is coordinated across multiple specialties to simplify appointment scheduling and to reduce patent visits and inpatient admissions.

Bronchiolitis is a common lung infection in children and the leading cause of hospitalization in children under 2.

The Children’s Mercy Respiratory Outpatient Clinic provides 24/7 outpatient treatment for young infants who have been referred by their primary care provider following assessment and diagnosis of bronchiolitis.

Pediatric registered respiratory therapists provide respiratory assessments and airway clearance as well as educational resources with the goal of reducing hospital admissions and readmissions.

Therapists follow the hospital’s Bronchiolitis Care Process Model to assess and provide treatment.

Patrice Johnson, MBA, the Director of Respiratory Care at Children’s Mercy Kansas City, is here to explain The Children’s Mercy Respiratory Outpatient Clinic.

CHAMP (Cardiac High Acuity Monitoring Program) is a multi-disciplinary based team that has been designed to meet the needs of the most complex cardiac population with single ventricle heart disease.

The program closely monitors patients with single ventricle heart disease between the critical first and second stages (before stage II Glenn surgery).

The team at the Ward Family Heart Center at Children’s Mercy has also developed a tool that makes it easier for families to report their single ventricle child’s vital signs from home and provides the hospital team with frequent updates needed to keep these patients well between visits.

Amy Lay, MD, the Director of Inpatient Cardiology at Children’s Mercy Kansas City, is here to help you better understand CHAMP.

Clinicians involved in palliative care are inclined to be sensitive to the humanistic aspects clinical practice – foremost among them being good communication.

For both children and their families choosing the time, manner, environment and context into which communication about care that is oriented towards optimizing the quality of their days throughout a disease trajectory is extremely important.

Dr. Carter is here to discuss the verbal and non-verbal communication that clinicians should be aware, as well as strategies around active listening, reflection and an effort to engage in relational communication with an allowance for timely silence, acknowledgment of suffering and emotional validation.

Finally, the importance of key words – those that may be easily taken out of context, or heard differently than intended – will be addressed.

As many as 5 million women in the U.S. may be affected by polycystic ovary syndrome, a hormonal imbalance in which the ovaries make more androgen than normal.

PCOS can occur in girls as young as 11 years old and may lead to acne, excessive hair growth, weight gain, high blood pressure, pelvic pain, and problems with menstrual cycles and fertility.

The cause of PCOS is not known, but some have linked the condition to overproduction of insulin.

Tania Burgert, MD is here to discuss the Polycystic Ovary Syndrome Clinic at Children’s Mercy and how they're focused exclusively on identifying and treating PCOS in adolescent girls.

Though survival rates are increasing, critically ill premature and term babies are often at risk for long-term developmental issues due to neurological damage from hypoxia, hemorrhages, brain malformations, genetic disorders, seizures and other injuries and disorders.

New treatment approaches, as well as technology, are helping providers prevent, diagnose and treat neurodevelopmental disorders in newborns and improve long term outcomes.

Steven Olsen, MD is here to discuss how the Neuro NICU program at Children’s Mercy brings neurology and neonatologists together in the Level IV NICU to offer the highest level of care to these newborns and improve neurological development.

Feeding problems are quite common, affecting approximately 25 % of children.

With all these children, the number one treatment goal is to identify the underlying causes of the problem to better enable adequate growth.

Children’s Mercy Kansas City utilizes a multidisciplinary feeding clinic to bring all the specialists needed together to address the often complex needs of these patients.

Team members include physicians, psychologists, occupational therapists, speech pathologists and nutritionists.

The clinic focuses on assessing the need for tube feedings, weaning children off tube feedings, assessing for underlying causes, and providing education for parents all with an end goal focused on promoting oral intake while maintaining growth.

Listen today as Sarah Edwards, DO discusses Children’s Mercy's Multidisciplinary Feeding Clinic.

Venous thromboembolism in children is becoming a more common problem, particularly in the hospitalized population.

A retrospective study of patients between 2001 and 2007 found VTE increase 70% during the period of study, from 34 to 58 cases per 100,000 admissions.

The complications of VTE are serious, with 16-20% resulting in pulmonary embolus and 1-4% leading to death.

Prevention where possible is always best, but current strategies are frequently inadequate or unevenly applied.

Children’s Mercy has implemented measures to identify patients at risk and institute measures to prevent hospital-acquired VTE.

Shannon Carpenter, MD is here to discuss Venous thromboembolism.

Simulation-based training facilitates the use of higher order thinking skills.

The simulations Children’s Mercy Kansas City have developed in the NICU, Fetal Health Center and with ECMO challenge medical teams to develop cognitive, technical and behavioral skills through the use of mannequins, working medical equipment and colleagues.

During scenarios, trainees must make use of their knowledge base, analyze and synthesize factors contributing to the crises and evaluate the effects of their actions.

Danielle Reed, MD is here to discuss neonatal simulation and how practice makes perfect.

Historically, infants with end-stage renal disease who received dialysis in the first year of life have been less likely to survive or receive a kidney transplant compared with those who started dialysis later in childhood.

In a study published in the September 2015 issue of Pediatrics, Dr. Bradley Warady and colleagues looked at recent NAPRTCs data and found that survival and transplant rates have improved in recent years.

While the provision of chronic peritoneal dialysis to neonates and infants is by no means free of potential complications, improvements in medical and surgical care have resulted in greater patient survival on dialysis and greater access to successful kidney transplantation, according to Dr. Warady.

Dr. Warady is here to discuss dialysis in infants and how survival rates are on the rise.

The highly complex nature of hematology disorders and cancer care in children requires a well-coordinated, multidisciplinary team approach.

Children’s Mercy takes a holistic approach looking at the whole child to ensure that each child is meeting with every professional resource needed to manage the disease.

Every patient is assigned a case manager, usually an advanced practice nurse or physician’s assistant, teamed with a social worker and hematology/oncology specialist who oversees each child’s case from diagnosis through follow-up care.

The child has the same team throughout their entire treatment.

Gerald M. Woods, MD is here to discuss hematology disorders and cancer care in children.

Though mortality is the traditionally recognized measure of quality in children undergoing surgery for complex congenital heart disease, the Cardiac Neurodevelopmental Program at Children’s Mercy is seeking to redefine outcomes measures for this pediatric population.

The program coordinated by the Ward Family Heart Center, is one of just a handful of innovative programs across the nation designed to help these children and their families deal with the sequelae of complex congenital heart disease.

Elizabeth Willen, PhD is here to discuss the Cardiac Neurodevelopmental Program at Children’s Mercy.

Researchers at Children’s Mercy Kansas City are using a multi-pronged research approach to investigate the underlying causes of inherited conditions and possible new treatment options.

Dr. Seth Septer and partners are looking into the genotype and phenotype correlations within inherited gastrointestinal syndromes, such as familial adenomatous polyposis, to determine if patients may be at risk for certain type of cancer or a more aggressive form of cancer, depending on their gene mutations.

The team has already found success testing orphan drugs against patients tumor cells grown in a dish.

Dr. Seth Septer is here to discuss how he and his partners are making advances in hereditary polyposis and other inherited gastrointestinal conditions.

The Division of Pediatric Endocrinology and Diabetes is committed to providing patients the best medical care possible.

This commitment goes hand in hand with their dedication to discovering and pioneering the latest treatment methods through ongoing clinical research.

Their research areas include a vast range of topics associated with endocrinology, including diabetes, growth and growth hormone.

At Children’s Mercy Kansas City, approximately 200 children, adolescents and young adults are diagnosed with type I diabetes each year.

Patient volume, combined with a diverse patient population, the broad geographic area covered, and a full-service program, means Children’s Mercy is well positioned to conduct research on diabetes prevention, and serve as an Affiliate of the National Institutes of Health’s TrialNet.

The work TrialNet and Children’s Mercy do today may help prevent type I diabetes tomorrow or at least make it easier to control by preserving beta cell mass.

Mark Clements, MD is here to discuss how the goal is to identify individuals who have the genetic predisposition, but who haven’t develop the autoimmunity and have not experienced destruction of beta cells in order to preserve their beta cell mass and prevent the development of type I diabetes in these individuals.

Learning how to cope with adversity is an important part of growing up.

However, when adversities in childhood can exceed the child’s ability to manage them there can be negative consequences.

Stresses caused by exposure to poverty, neglect, abuse or community violence can alter the developing brain in ways which negatively impact physical and mental health well into adulthood.

Such experiences, when not buffered by caring, involved adult caregivers result in a type of neuro-developmental toxicity, changing neural pathways through epigenetic mechanisms.

Studies have shown that an alarming number of American children are exposed to or victims of violence involving a weapon.

According to one recent study published in the journal Pediatrics, nearly one-third of children in the United States are exposed to violence before the age of 18.

The study noted that about 1 in every 33 kids are assaulted with guns and knives during these incidents.

Denise Dowd, MD is here to discuss how the psychological and physical effects of these incidents are manifested in many ways and have long term implications on the child’s health.

Chronic abdominal pain is a common problem that affects up to 20 percent of all school-aged children and teens.

Despite how many youth struggle with abdominal pain, there is no clear agreement among medical professionals about how best to manage it.

What professionals do agree on is that abdominal pain is complex and can be difficult to treat effectively.

Craig Friesen, MD, is here to explain how the Gastroenterology Division at Children’s Mercy uses a biopsychosocial approach to chronic pain and has delivered resolution or near resolution of symptoms in 70-80 percent of patients within six weeks.

The incidence of acute lymphoblastic leukemia is approximately 15 percent higher in Hispanics than Caucasians and the overall survival rate is lower in this population.

But little is known about why.

Are genetic variations the cause of the differences in survival rates?

Are there variations even within the populations classified as Hispanic?

Dr. Terrie Flatt is here today to discuss leading research in conjunction with a partner hospital in Mexico to better understand the role of ethnicity in acute lymphoblastic leukemia (ALL) and how patients with certain cytogenetic arrangements in their cancer cells may respond to treatment.

Concussion is a growing and publicized concern in Sports Medicine.

We know that children are much more vulnerable to concussion because their neurological system is still developing and their neck muscles are unable to absorb the blow.

These important and unique services offered at a Children’s hospital used to treat concussions :
• trained to care for adolescents
• ability to identify risks for long-term return to play
• baseline testing, ImPACT Test, VSR Sport test
• vestibular therapy
• physical therapy

Unique approach to concussion treatment: a Comprehensive clinic. Our comprehensive clinic has experts in neurology, rehabilitation and sports med working together to treat concussions.

Greg Canty, MD is here to discuss how Children's Mercy works to treat concussions.

Few studies have prospectively evaluated the progression of chronic kidney disease (CKD) in children and adolescents, as well as factors associated with progression.

A multicenter observational study conducted as part of the NIH-funded Chronic Kidney Disease in Children study found characterization and modeling of risk factors for CKD progression can be used to predict the extent to which factors such as proteinuria, hypoabluminemia, blood pressure, dyslipidemia and anemia -- either alone or in combination -- would shorten the time to renal replacement therapy or 50% decline in GFR in children with chronic kidney disease.

Bradley Warady, MD is here to discuss chronic kidney disease in children and adolescents.

As pediatric cancer survival rates continue to improve, we are now faced with a new challenge --transitioning care to adult providers and managing the long-term effects of cancer and cancer treatment, which often includes endocrine and cardiac related problems.

There are currently very few adult-based follow-up or survivor clinics.

Children’s Mercy, in partnership with the Midwest Cancer Alliance and the University of Kansas Cancer Center, has developed a Transition Clinic to evaluate the needs of this patient population, track patients and adherence to follow-up guidelines, and improve long-term outcomes.

Joy Fulbright, MD is here to discuss the need for this type of program, and discuss the types of issues pediatric cancer survivors face as they transition to adult care and to talk about the work Children’s Mercy is doing in the areas of cardiotoxicity research; endocrine disorders in cancer survivors, study participation and interventional studies.

Designed with the patient in mind, the Great HeighTS Turner Syndrome Clinic at Children’s Mercy Kansas City is a one-day clinic where patients can see multiple specialists in one, convenient location.

Not only does this minimize the number of medical visits for families, but it also gives the girls with this rare disease, and their parents, an opportunity to meet and interact with others who are going through the same situations they are.

Joe Cernich, MD, a Pediatric Endocrinologist at Children’s Mercy Kansas City, is here to discuss Turner Syndrome.

With the opening of the Elizabeth J. Ferrell Fetal Health Center, Children’s Mercy Kansas City became one of only a few children’s hospitals in the country to offer comprehensive care, including on-site delivery, for babies with fetal anomalies.

This allows mothers, families and newborns to remain in the same hospital regardless of the complexity of the newborn’s medical condition with access to the region’s only Level IV neonatal intensive care unit.

Tim Bennett, MD, a Professor and Vice Chairman of the Department of Obstetrics and Gynecology of the University of Missouri – Kansas City School of Medicine, is here to discuss comprehensive care, including on-site delivery, for babies with fetal anomalies.

Both in our region and nationally, the occurrence of Neonatal Abstinence Syndrome (NAS) has grown steadily over the past few years.

Combining the expertise of neonatologists, pediatric clinical pharmacologists and a multidisciplinary team of caregivers into a single NAS program has put Children’s Mercy Kansas City in a unique position to explore new methods for treating this growing problem.

Children's Mercy has developed a family-integrated process for infants at risk for Neonatal Abstinence Syndrome.

The goal moving forward is to work with area community hospitals to prenatally identify infants at risk for NAS and provide education to the family before birth.

Dr. Tamorah R. Lewis, a Neonatologist at Children’s Mercy Kansas City, is here to help families better understand NAS.

Gender dysphoria, if left untreated, has a 40 to 50 percent attempted suicide rate.

Medical, social and psychological problems all need to be addressed and often dealt with simultaneously.

Children’s Mercy has developed the new Gender Pathway Services (GPS) Clinic to help manage these issues.

Based in the Division of Endocrinology, the team provides interdisciplinary family-centered services for transgender, gender-variant, and gender-questioning patients. This is the only center of its kind in the Midwest and one of only a handful in the country.

Specialists that are part of the clinic include: endocrinology, psychology, adolescent medicine and social work.

New patients receive a psychological evaluating to help ensure the mental health needs of the family and patient are continuously supported.

Jill Jacobson, MD is here to discuss Gender dysphoria.

Children’s Mercy Kansas City is one of four sites participating in Newborn Sequencing In Genomic Medicine and Public HealTh (NSIGHT), which is sponsored by the NIH along with the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Human Genome Research Institute (NHGRI).

NSIGHT is designed to explore the implications, challenges and opportunities associated with the possible use of genomic sequence information in the newborn period.

The emphasis of the Children’s Mercy NSIGHT project is gaining rapid access to genetic diagnostic information so that clinical care can be managed effectively for acutely ill neonates.

Early evidence of the feasibility of this approach was recently published by Children’s Mercy investigators in The Lancet Respiratory Medicine.

Conclusions from this study suggest that STAT-Seq, a rapid whole-genome sequencing test developed at Children’s Mercy, has the potential to alter clinical management or genetic counseling and provides a novel framework for implementing precision medicine in a level 4 NICU or PICU.

Josh Petrikin, MD is here to discuss Genomics of Newborns.

Why does one child respond to a medication, but another doesn’t?

What are the factors that influence how a child responds to a medication and how do those differ from adults?

Despite all the talk about “big pharma” and research, very little has been done about testing the safety and efficacy of medications for children.

Even with new FDA regulations in place, pediatric labeling is decreasing, not increasing.

The Clinical Pharmacology, Toxicology and Personalized Therapeutics program at Children’s Mercy is the largest and most comprehensive pediatric pharmacology program in North America and has been at the forefront of advocating and advancing research.

The GOLDILOKS initiative acknowledges that individual children are not small average adults; dosing of medications must include factors that make each child unique in order to deliver the dose of medication that is “just right” for each individual child.

Children’s Mercy faculty (trained in a pediatric subspecialty and clinical pharmacology) are looking at how this applies in several subspecialty areas including cardiology, infectious disease, asthma/allergy, rheumatology, gastroenterology, neonatology and hematology/oncology.

Steve Leeder, PharmD, PhD is here to discuss the best ways to keep your child and their medications safe.

All syringes and tubings used for enteral feeding and medication admission are changing this year.

This change will impact ALL families and clinicians caring for children with feeding tubes.

This change will prevent accidental connections to IV catheters.

The following changes will occur: the end piece of the feeding tubes where the feeding bag tubing connects, the feeding bag pointed end and the syringes used to put medicines in the tubes.

Ruba Abdelhadi, MD is here to discuss all the changes and what it means to your family.

Children’s bodies are more sensitive to radiation so it is imperative that they are exposed to the least amount of radiation as possible to avoid a lifetime of cumulative damage.

Research conducted at Children’s Mercy showed the hospital uses up to 80% less radiation than community imaging centers for some procedures.

The hospital’s protocols are based on the child’s size and weight, and take into consideration the body part to be imaged.

In addition, a PhD medical physicist helps calibrate imaging equipment to provide high quality images using the least amount of radiation.

In addition to following national Image Gently guidelines, Children’s Mercy offers additional services such as Child Life specialists, sedation and anesthesia to help keep children calm so high quality images are achieved without the need to rescan.

Doug Rivard, DO is here to discuss how Children’s Mercy is leading the way toward reducing the radiation your child is exposed to and answer any questions about keeping your child safe.