As a child with spina bifida grows, complications associated with the disease may surface and potentially deteriorate some of their physical and mental functional abilities. The goal of treatment is to monitor for these issues and try to prevent them.

By Pamela Murphy, MD, pediatrician

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As a pediatrician, I am asked frequently about childhood vaccinations. Are they safe? Do they cause one disease while trying to prevent another? As a parent or guardian, it’s our responsibility to provide safe care for our children and asking questions and getting the facts from credible sources are part of that responsibility.

U.S. public health officials and physicians have been combating misconceptions about vaccine safety for more than twenty years. Despite these efforts, childhood immunization rates have fallen in the past two decades resulting in resurgences of vaccine-preventable diseases such as whooping cough (pertussis) and measles. For example, in 2010, California saw more cases of whooping cough than any year since 1947, according to research published by the American Academy of Pediatrics.

August is Immunization Awareness Month. Let’s look at what childhood vaccinations are recommended when and address the most common misinformation about childhood vaccinations.

Recommended Childhood Vaccinations

The Centers for Disease Control and Prevention (CDC) has easy to review children’s vaccines schedules by age group on their website. Most pediatricians and primary care providers (PCP) have these vaccinations available and can administer during a scheduled appointment.

Early Childhood: Birth to Age 6

• Chickenpox/varicella
• Hepatitis A
• Hepatitis B
• Diphtheria, tetanus, and pertussis (DTaP)
• Haemophilus influenzae type b (Hib)
• Influenza (flu): recommended annually from age six months and on
• Measles, mumps, and rubella (MMR)
• Pneumococcal conjugate disease (PCV13)
• Polio (IPV)
• Rotavirus (RV)

Children: Ages 7-18

In addition to any vaccines missed that were recommended during early childhood, the CDC recommends the following vaccines for kids ages 7-18:

• Flu (annually)
• Human papillomavirus (HPV)
• Meningococcal conjugate (MenACWY)
• Tdap (the DTaP booster)

If your child has certain health conditions that put them at increased risk for serious diseases, your pediatrician may also recommend the following vaccinations be administered:

• Pneumococcal
• Serogroup B meningococcal (MenB)

COVID-19 Vaccine

The CDC also recommends children ages six months and older receive the COVID-19 vaccination, and children ages five and older also get the booster. The COVID-19 vaccination is not available at all pediatrician/PCP offices. For more information on COVID-19 vaccinations for children, including locations providing these vaccinations, visit the Maricopa County Public Health website.

Childhood Vaccinations: Debunking the Myths

 According to PublicHealth.org, the following are the top three myths about childhood vaccinations.

Myth #1: Vaccines increase the risk of autism.

This hypothesis originated in 1997 from study by a British surgeon who concluded that the MMR vaccine was increasing autism in children in the United Kingdom. The article “has since been completely discredited due to serious procedural errors, undisclosed financial conflicts of interest, and ethical violations.” The physician author lost his medical license, and the paper was retracted.

Myth #2: Infant immune systems can’t handle so many vaccines.

The cells in the immune system are constantly being replenished, making it near impossible for a baby’s immune system to be overwhelmed by immunizations. In fact, babies are exposed to numerous bacteria and viruses every day; vaccines are minor in comparison.

Myth #3: Natural immunity is better than vaccine-acquired immunity.

While in some cases, catching a disease and getting sick (i.e., “natural immunity”) results in a stronger immunity to the disease than a vaccination, the risks outweigh the benefits. For example, if a child were to catch the measles, they would face a one in 500 chance of death from symptoms; in contrast, having a severe allergic reaction to the MMR vaccine is less than one-in-a-million according to the CDC.

As families travel more, especially internationally, the risk of contracting vaccine-preventable diseases increases. Even if the disease is not prevalent in the United States, it may be in other countries. COVID-19 gave us a strong example of how quickly a virus can spread from one continent to the next.

If you have questions about childhood immunizations, talk with your child’s pediatrician/PCP. We’re here to help you keep your child healthy and happy.

By Troy Nelson, MD, medical director and pediatrician

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March is Developmental Disabilities Month.  According to the Centers for Disease Control and Prevention (CDC), the United States has experienced an increase in children with developmental disabilities.  Developmental disabilities would include:

• Attention-deficit/hyperactivity disorder (ADHD)
• Autism spectrum disorder (ASD)
• Cerebral palsy
• Moderate-to-profound hearing loss
• Learning disability
• Intellectual disability (ID)
• Recurrent seizures in the past 12 months
• Stuttering or stammering in the past 12 months
• Visual impairment
• Any other developmental delay

The same CDC study also revealed that some groups of children were more likely to have a developmental disability than others, such as:

• Boys compared to girls
• Non-Hispanic white and non-Hispanic black children compared to Hispanic children or non-Hispanic children of other races
• Children living in rural areas compared to children living in urban areas
• Children with public health insurance compared to uninsured children and children with private insurance

The CDC found that 17% of children 3–17 years-old had a developmental disability, and this percentage increased over the two time periods compared (2009–2011 and 2015–2017).  Specifically, diagnoses increased for ADHD, ASD and ID.

One of the potential reasons for the documented increase is improved awareness, screening, diagnosis and service accessibility. Healthcare providers and parents/guardians are having more conversations about symptoms (called “developmental delays”) of developmental disabilities early, allowing for improved diagnosis and early intervention.

What is a Developmental Delay?

Parents or guardians are in the best position to detect a developmental delay in an infant or toddler.  Developmental delays fall into five categories:

• Adaptive development: The ability level of a child related to age-appropriate life skills, such as self-care (feeding, dressing, etc.)
• Cognitive development: How children think, explore and figure things out, including knowledge and understanding and problem solving
• Communication development: The skills to understand and express thoughts, feelings and information
• Physical development: Motor skills defined as children’s abilities to use and control their bodies, including vision and hearing
• Social or emotional development: How children start to understand who they are, what they are feeling and what to expect when interacting with others

If you sense a developmental delay in your child, surface your concerns to your child’s primary care provider (PCP) immediately.  Your child’s PCP will assess your child through a developmental screening and engage the right specialists and support, as needed, to optimize early intervention.

Benefits of Early Intervention

“Early intervention” describes services and support that help babies and toddlers (from birth to three years of age, in most cases) with developmental delays or disabilities. Early intervention may include speech therapy, physical therapy, behavioral health support and other types of medical services based on the needs of the child and family.

According to the CDC, intervention is likely to be more effective when it is provided earlier in life because:

• Connections in a baby’s brain are most adaptable in the first three years of life.
• Services can change a child’s developmental path and improve outcomes for children and their families.
• Families are better able to meet their child’s needs at an early age and throughout their lives.

If you have questions about your child’s development, schedule an appointment with your child’s pediatrician or PCP. If you have not established care for your child with a PCP, DMG is here for you; our team includes pediatricians and primary care providers across the Valley to support the health of children of all ages.

By Troy Nelson, MD, medical director and pediatrician

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Did you know November is American Diabetes Month?  According to the American Diabetes Association, more than 34 million people in the United States have diabetes, and more than seven million of those people are undiagnosed. About 210,000 Americans under age 20 are estimated to have diagnosed diabetes.

Type 1 Diabetes: Diagnosed at Younger Ages

According to the Centers for Disease Control and Prevention (CDC), type 1 diabetes accounts for approximately 5-10% of diabetes cases in the United States.  Symptoms of type 1 diabetes often develop quickly. It’s usually diagnosed in children, teens and young adults.

Type 2 Diabetes: Increasing Pediatric Cases

Type 2 diabetes is the most common type and is generally diagnosed in middle age or older.  However, the incidence is on the rise in children, because more children are becoming obese.  Being overweight or obese increases the risk of developing type 2 diabetes, regardless of age.

Symptoms of Type 2 Diabetes in Children

Your child may develop type 2 diabetes so gradually that there are no noticeable symptoms. Sometimes, the disorder is diagnosed during a routine check-up, which is why regular well-child exams are important.

Symptoms of type 2 diabetes in your child may include:

• Blurry vision
• Darkened areas of skin, especially around the neck and armpits
• Fatigue
• Frequent urination
• Increased thirst

Type 2 Diabetes Risk Factors in Children

• Age and sex: Many children develop type 2 diabetes in their early teens. Adolescent girls are more likely to develop type 2 diabetes than are adolescent boys.
• Family history
• Inactivity
• Overweight, especially in the abdomen
• Pre-term birth (before 39-42 weeks)
• Race or ethnicity: Black, Hispanic, American Indian and Asian American people are more likely to develop type 2 diabetes

Preventing and Managing Pediatric Type 2 Diabetes

You can help decrease the risk of your child getting type 2 diabetes as well as help manage it if your child has been diagnosed.

• Get an annual well-child exam with your child’s pediatrician or family medicine provider.
• Eat healthy foods as a family; encourage your child to participate in meal planning and preparation.
• Ensure your child gets plenty of physical activity; identify activities you can do as a family, like hiking or walking the dog.
• Help your child maintain a healthy weight.

DMG includes pediatric and young adult providers, pediatric and adult endocrinologists and other medical specialists to support your child and your family. We are committed to educating you and your child and developing treatment plans to optimize your child’s health and long-term wellness.

By Troy Nelson, MD, medical director and pediatrician

Did you know September is Newborn Screening Awareness Month?  Newborn screening allows identification and treatment of a disease before symptoms even emerge.  A newborn may appear healthy but still have a serious condition that cannot be seen.  If left untreated, these conditions can lead to slow growth, blindness and/or intellectual disability and may be life threatening. Early detection and treatment can help prevent these serious problems, which is why newborn screenings are critical.

Based on published research by Dr. Robert Guthrie in 1963, newborn screenings have evolved with newborns now being screened for more than 25 conditions within days of birth; screenings involve just a few drops of blood.  According to the National Institute of Health, newborn screening detects a treatable condition in about 1 in 300 babies born each year, a total of about 12,500 cases each year. In Arizona, approximately 100 babies annually are found to have a serious condition identified through newborn screening.

Providers in Arizona are required by law to order newborn screening tests for all newborns.  Arizona requires newborns to be screened twice to help ensure accuracy, as some conditions are easier to detect on a subsequent screen.  In addition, approximately 98% of all infants born in Arizona are screened for hearing loss prior to hospital discharge.  The first screening sample will be taken before the newborn leaves the hospital and the second will be taken between 5-10 days after birth or at the first well-baby visit, whichever comes first. For those newborns born at home, the healthcare provider present at the birth will collect the first screen.

DMG includes pediatricians that do newborn screenings and identify other medical specialists, as needed, to provide specialized treatment for a variety of pediatric conditions detected during screening. With early detection, intervention and treatment, your baby can thrive to the maximum of their abilities.

By Linda Thunn, DPT, physical therapist

CRS partners with SBAAZ to encourage best mobility in young patients

SCOOOT provides an early experience of independence for kids with mobility challenges. It frees them to explore their home, play, chase and race friends and siblings without any help. Expert clinicians, designers and engineers worked hard to create a device that will help kids discover new skills as well as new pals. The potential for physical and cognitive development was a key factor in every element of the design.

Spina Bifida Association of Arizona Inc. (SBAAZ), an organization committed to enhancing the lives of those affected by spina bifida in Arizona, was awarded a grant from the PayPal Gives Corporate Advised Fund at Silicon Valley Community Foundation. The grant was recommended by PayPal’s employee-volunteer led Chandler, AZ GIVE Team.

The SCOOOT program idea was presented to the SBAAZ by CRS’s Myelomeningocele Planning Clinic Lead Physician Pamela S. Murphy, MD, FAAP. The program was coordinated by Sharri Runnels, executive director of the SBAAZ, along with SBAAZ board member Linda Thunn, PT, DPT who is also the Myelomeningocele Planning Clinic physical therapist at CRS.

The CRS Myelomeningocele Planning Clinic occurs every Friday, and they see approximately seven patients for all day clinic, visiting up to 13 different providers, having blood work drawn, and if necessary they will get casted for their orthotics and/or have X-rays. SBAAZ provides lunch and signs people up for their medical alert bracelets. Free Arts of AZ is there for the kids to create projects at lunch time.

The SCOOOT program involves readiness assessments, equipment placement, activities and progress checks that will empower ‘toddlers’ to keep pace with their siblings and peers as they establish a sense of mastery over their world. The mobility device, resembling a toy more than a piece of medical equipment, allows children to reach items from the floor, ambulate, and enter/exit the seat safely at will.

“CRS is a great partnership for SBAAZ as we are able to share resources with clients and assess needs over lunch with families that are served by the fantastic care team brought together by District Medical Group,” stated Runnels, “SBAAZ is very grateful for the relationship with DMG and wanted to share the first SCOOOT placement with their staff as they pour so much into the kiddos!”

Spina bifida (Myelomeningocele) is a birth defect in which the spinal canal and the backbone don’t close before the baby is born. This type of birth defect is also called a neural tube defect.

The SCOOOT Earliest Mobility Program kicked off was on Friday, November 10, 2017 with placements being made at the CRS Myelomeningocele Planning Clinic.