Author: Melissa Jeltsen

It’s the fastest growing developmental disability in the United States—and in the majority of cases, no one knows what causes it. According to the CDC, the prevalence is now one in 110 kids—an astounding 57 percent increase since 2002.

Despite the lack of concrete answers about autism, which is now seen as a spectrum of neurological disorders, characterized by deficits in social interaction, impaired language, and/or repetitive or restricted behavior, there is a consensus among clinicians that treatment should begin as early in life as possible. (Many experts suggest that there’s a crucial window of plasticity in the child’s developing brain when interventions are most effective.) That’s why getting a diagnosis as early as possible is important.

While children with autism are typically diagnosed around age 3 or 4, researchers have found that subtle symptoms can be detected much earlier in life, sometimes even before age 1. Now a new study affirms that the social disengagement that is typical of people with autism does appear in the second half of a baby’s first year of life. But, in a surprising twist, the study also found that parents usually don’t recognize the decline in their child’s behavior until well into his or her second year.

From the LA Times:

But while the reduced rates of face-gazing, vocalizations and social engagement were evident to researchers who systematically evaluated the babies every six months, 83 percent of the parents did not observe the changes chronicled by researchers — not, at least, in the first year they were happening.

At Children’s Hospital Boston, Charles Nelson, PhD, director of the Laboratories of Cognitive Neuroscience at Children’s Hospital Boston, studies the brain development of babies, with hopes of discovering early indicators that could be used to identify autism in infants. He says it’s very tricky to rely on behavioral measures to identify autism in infants. “There’s a fine line between deciding if something is abnormal or just different,” says Nelson. Development varies enormously from one child to another, and many of the early signs of autism, like being fussy and difficult to feed, are exhibited in typically developing kids. Some of the telltale behavioral indicators of autism, like not responding to one’s name when called, aren’t applicable until age 1. “The behavioral repertoire of a young infant is limited,” says Nelson. “But that doesn’t mean things aren’t going on upstairs.”

By using imaging tools to look directly at the brain, Nelson hopes to find subtle indicators of autism long before the disorder manifests behaviorally. “The development of language can be witnessed in an infant’s brain long before it is expressed,” says Nelson.

Read about Nelson’s most recent study, which looks at infants with a sibling with autism.

Nelson Aquino, a nurse anesthetist from Children’s, went to Haiti with a group of Children’s clinicians as part of a disaster response team. Now, after two weeks back in the United States, he reflects on the life-altering experience.

Haiti MissionHD Port Au Prince, Haiti 2010
Uploaded by nelsonjaquino. – Explore international webcam videos.

It has been two weeks since I have been back from our mission to Port Au Prince, Haiti, and I would like to take this opportunity to personally thank each and every one of you who have followed this blog and shared it with family and friends.  This blog was initially intended for the families of the CHB team, to inform them of our progress during the mission, but I am happy that many have taken an interest in Haiti and what can be done to help so many of those in need.

Two days after returning, things really started to hit me emotionally and I began to have overwhelming feelings of anxiety and withdrawal. I had never experienced anything like the situation in Haiti before, and the feelings that followed this experience frightened me. I needed to talk with someone who could understand what I was feeling. I needed to know if the feelings
were normal, or if it was a severe case of post-traumatic stress. I called a longtime colleague, and spoke with him about what I was experiencing. It was at that moment that it finally hit me: The mission in Haiti has forever changed my life.

After 10 days of running on adrenaline despite physical and emotional exhaustion, I was only then starting to process what really happened in Port Au Prince. I tried to “re-enter” into my daily routines, but the tragedies and horrors of all those we left behind haunted me every day. I would start speaking to someone I hadn’t seen in a while and I would get teary-eyed and all choked up. It didn’t really matter what I was talking about. It would just happen, and I know many who went on the mission came back feeling the same way.

Now that I am here, all I want to do is be back there (Haiti). There, nothing is wasted. Everyone is real. There, it didn’t matter what I was wearing; it didn’t matter what people were thinking; it didn’t matter what I owned. There, I was just one human being helping another.

“How was your trip?” “What was it like?” That’s what most people ask, and usually I answer: “It was life-altering, unfathomable, indescribable.” Other times, I didn’t know what to say or share. Should I just share the positive? Or do I talk about the corruption, describe the smell of death,
explain how it feels to see people starving, homeless, and injured knowing hundreds and thousands continue to die because of the lack of resources? The questions are difficult.

Going to Haiti is not about you. Going to Haiti is about THEM. It’s about helping people who need help. As these past weeks have progressed, I’ve found myself crying at odd times. I’ll be in the supermarket or walking down the hallway, and suddenly tears begin to fall. Until now, I’m not sure what triggers these moments, but something inside of me is different. It has been one month now since the earthquake. The shocking news is now old news. The Winter Olympics will now
be the main attraction. Many people who haven’t been to Haiti probably aren’t interested in hearing about it as much anymore. I know it’s human nature to be this way, but after seeing all those people suffering in Port Au Prince, it is hard for me to accept. The earthquake is not old news to the people in Port Au Prince. They are living with the devastation every day–and they will be living with it for many months and years to come.

The other day, my friend John Kimbrough, RN, returned from Port Au Prince after working at the General Hospital. I asked him if things had gotten any better. He said, “It is so disorganized and by any stretch of the imagination, people are still dying.”

I keep wondering how this is even possible with all the volunteers, donated supplies, and supposed financial aid? Still, the struggles the Haitians continue to face are so basic–getting water, food, medications. I hope after reading this some of my questions may inspire others. What do I do now? How do I not forget? What can I do to contribute if I can’t be there?

Here is what I am doing: I have started to learn more about Haiti. I am trying to become more aware of their struggles and what challenges face them now. When I am feeling helpless, I remember the good things I witnessed: the love the patients in the hospital had for one another, their amazing faith, their resilience, and their laughter despite the fact that they lost family
members, their home, their livelihood.

A group of us are also currently working on stories and pictures to share with colleagues, family, and friends. Some will be returning to Haiti this March with Dr. Meara and his team. Ultimately, we must not forget Haiti and continue to give Haiti some exposure and aid in whatever way we can. The people there need all the help they can get.

MRI of an anorexic patient's knee

There are an estimated 24 million Americans suffering from eating disorders, 90 percent of whom are women between 12 and 25. Identifying and treating eating disorders as early as possible is critical, as months or even years of malnutrition can take an immense toll on the body, and can result in osteoporosis, slowed growth, heart disturbances, loss of menstrual periods, depression and anxiety.

MRI of a control patient's knee

At Children’s Hospital Boston, researcher Catherine Gordon has dedicated the past two decades trying to understand the mechanism behind the bone loss seen frequently in girls with anorexia—and work out how to halt it. In a unexpected twist, her recent study found that people with anorexia nervosa have strikingly high levels of fat within their bone marrow. This finding, published in the Journal of Bone and Mineral Research may help explain why people with anorexia lose bone mass, sometimes to the point of developing osteoporosis and fractures.

“It’s counter-intuitive that an emaciated young woman with almost no fat would be storing fat in her marrow,” says Gordon, director of the Bone Health Program. “Bone formation is very low in girls with anorexia, and that’s a particular problem because they are growing adolescents who should be maximally forming bones,” says Gordon.

She’s currently planning follow-up studies to find out why this happens. One speculation is that it’s the body’s attempt to store energy and preserve warmth. Anorexics often develop hypothermia because of a lack of insulating fat, and are often hospitalized with extremely low body temperatures.

February 21 to 27 is Eating Disorder Awareness Week. Although the media often portrays eating disorders as a modern phenomenon, they’ve actually been around for centuries. “Medical history documents anorexia as far back as the 1600s, when women took fasting to the extreme,” says Sara Forman, MD, director of the Eating Disorder Program. “But the question is, were they doing it for the same reasons as teens do now?” No one really knows what causes eating disorders like anorexia and bulimia, but many, including Forman, believe it’s a mix of genetics, culture and individual circumstance. “We talk about the gun being loaded biologically or genetically, and the trigger being pulled by society,” says Forman.

Read other Thrive posts about whether yoga can fight eating disorders and if unrealistic media images contribute to eating disorders.

Sudden infant death syndrome (SIDS), which is the leading cause of death for infants between 1 and 12 months old in the United States, has long mystified doctors and researchers.

Now, after more than 20 years of research, researchers at Children’s Hospital Boston are taking the next step and have linked SIDS with low production of serotonin in the brainstem. The findings, published in the Feb. 3 issue of The Journal of the American Medical Association, may give a concrete approach to identifying babies at risk for SIDS.

In the brainstem, serotonin helps regulate some of the body’s involuntary actions, such as breathing, heart rate and blood pressure during sleep. The researchers, led by Children’s neuropathologist Hannah Kinney, MD, believe that a low serotonin level impairs the function of the brainstem circuits that regulate these activities, putting a baby at risk for sudden death from stresses such as rebreathing carbon dioxide when sleeping in the face down position.

The future goal of this work is to devise a test to identify infants with a serotonin brainstem defect early, and to develop preventive treatments that would correct the serotonin deficiency.

In 2006, Kinney and colleagues showed that SIDS is associated with abnormalities in the number of cells and receptors related to serotonin in the brainstem, but it wasn’t clear whether SIDS may be caused by overproduction or underproduction of the chemical.

“The baby looks normal during the day; there’s nothing that would tell you that baby is going to die of SIDS that night,” says Kinney, who has studied SIDS for more than 20 years. “There’s something about sleep that unmasks the defect, which we believe is in serotonin circuits: the baby experiences some kind of stress during sleep, such as rebreathing carbon dioxide in the face-down position or increased temperature from over-bundling, that cannot be compensated for by the defective brainstem circuits, and the baby then goes on to die.”

In a normal baby rebreathing carbon dioxide, serotonin pathways in the brainstem would stir the baby awake long enough to turn its head, allowing it to breathe fresh air, Kinney adds. A baby with low serotonin levels in the brainstem may never stir.

SIDS has puzzled doctors and families for decades, but once the medical community recognized that a baby’s position while sleeping affects the risk for SIDS, national awareness campaigns sprouted to persuade parents to place babies to sleep on their backs. However, such campaigns haven’t completely solved the problem, prompting ongoing research to find a biological component to SIDS.

While this study provides strong evidence for a biological cause of SIDS, it also shows that other risk factors, such as sleeping on one’s stomach, can aggravate the risk. Of the SIDS infants in the current study, 95 percent died with at least one risk factor, and 88 percent died with at least two.

The next step in this research is to find out what causes abnormally low serotonin levels in the first place. Genetic variations may be partly responsible, says neuroscientist David Paterson, PhD, in Kinney’s lab, a contributing author of the paper. Kinney’s lab is searching for such variations.

In the meantime, parents should remove unnecessary SIDS risk factors, Kinney says.

• During pregnancy, there is no safe level of alcohol a mother can drink and no safe level of smoking, both firsthand and secondhand.
• Until 12 months of age, babies should sleep on their backs in a crib with a firm mattress, and without toys, soft pillows, excessive blanketing or excessive clothing.

You can read more about the SIDS research from The Boston Globe and The Wall Street Journal. You can also listen to Kinney’s interview on NPR’s Morning Edition.

After returning from Haiti, Children’s Pediatrician-in-Chief, Gary Fleisher, trauma surgeon David Mooney and pharmacist Shannon Manzi are interviewed by WBZTV about the human suffering they witnessed during their medical mission.

Nelson Aquino, a nurse anesthetist from Children’s, is still in Haiti with a group of Children’s clinicians. He’s been sending us updates and photos almost daily. Here’s his most recent email:

A week later, many volunteers are starting to go home. I wonder who will come to replace them. Will it be surgeons, doctors, or nurses or all who will roll up there sleeves to take care of the sick.  We need many people to rehab the amputees, people to remove hardware, people to provide nursing care and antibiotics, and people to provide long term needs. It will take a long time for this country to be back to where it was prior to the earthquake. But it must be better than that, we must provide homes, a clean water supply and some revenue for this country.

What concerns me is that people may forget the devastation this country has experienced and yet I know I will never forget the images burned in my memory. There are no words to describe the devastation here from people who are sleeping in the rubble of their homes to protect their property and bury their dead.

The infrastructure of the country has almost been annihilated. I am unsure how the hospital will function after other groups start to return home. The ultimate goal is get the Haitian people to function independently with a higher standard of care. This end will require an unconditional commitment from the international community.

Despite what you may hear, there is a dire need of volunteers with expertise and versatility. And these volunteers need to teach and empower the Haitian people who remain proud and dignified.

Today, we cared for about 30 patients in the OR. One of patients cared for by Dr. Meara was the Bishop’s wife. Three of our sickest patients have been transferred to the USS Comfort today. The USS Comfort ship is off the coast of Haiti.  This 1,000 bed ship is staffed collaboratively by the US Navy and Project HOPE.

Besides doing anesthesia in the OR, my colleagues and I have been useful in providing anesthesia in the tents for the many extensive dressing changes done a day. I even was able to perform an ankle block for one of the patients in the PACU for a metacarpal removal.

One of the nurses met the 2 year old who was pulled from the rubble after 7 days. He is doing well and is heading to US to live with his aunt.

In midst of tragedy, the earthquake will hopefully at least be a catalyst for progress. Let us hope and be part of the change……

Special thank you to Liz, Lisa and Jay for their help with this entry. Special hello to Owen, Luke, Will and Wyatt Hartford from Uncle Nelson.

Nelson Aquino, a nurse anesthetist from Children’s, is in Haiti with a group of Children’s clinicians. He’s been sending us updates and photos almost daily. Here’s his most recent email:

As we almost reach our first week here in Haiti, I wanted to share that Port au Prince is slowly making some improvement. Each day seems like the people here are trying their best to move on and go on with living. Despite the devastation and tragedy, we have seen the Haitian people looking for work, selling food on the street, cleaning what’s left of their homes, dressing up for Sunday’s best, attending services and children smiling and playing.

This patient was so thankful her legs were not amputated that she prayed for Nelson Aquino.

The city is full of dust, has poor air quality, remains in shambles and is piled with trash. The people are eating, sleeping and living in these conditions. Crowds gather daily to look for work, see the envoy of volunteers and fill roads with traffic. It amazes me that it took a major disaster for us to finally get over here and help this very poor country. I hope we continue to realize that we need to support Haiti and countries like Haiti. I am amazed how the less fortunate are so happy despite having nothing.

One of the patients I anesthetized today woke up screaming in joy that we did not amputate her legs. She proceeded to place her hand on my head and said a prayer for me. The interpreter said it was some really heavy stuff she was saying. For me, I feel so blessed to be able give all I can as  RN, CRNA and human being.

Today in OR we worked extremely hard to complete about 20 plus cases. Dr. Meara and Dr. Rogers cared for many wounds and even had the opportunity to meet Wyclef Jean and his entourage. Jay Hartford, RN, was in charge of the PACU and worked hard with our colleagues at Mt. Sinai to make sure every patient had a home. Lisa Pixley, RN, and Terri MacDonald, RN, continued to follow each tent and make sure the post-ops were cared for. Our physicians from Partners in Health also worked so hard to make sure the tents were staffed day in and at night. In the OR, Stella Harrington, RN, Pam Gorgone, RN, Trish Powers, RN, Liz Sampson, RN, and Johanne Jocelyn, SST, did their magic in the OR.

Today, I stepped out of running the PACU and joined my colleagues, Craig MacClain, MD, and David Waisel, MD, in providing anesthesia care for the surgeries. I teamed up with a fellow nurse anesthetist, Brian Birner, and had a great time doing what I love! Oh, and a Happy Nurse Anesthetist Week to all my friends and colleagues!

In the OR, everyone is working so hard, we often try and take breaks to drink and eat what we can find. It is so tough sometimes because all the Haitian volunteers, workers and families have no food or water, and stare. Some beg and some just starve. Trish, RN, found a drinking station provided by the Spaniards and had the workers fill their bottles with clean water! The 82 Airborne found us boxes of donated food to eat. We were able to give the families the food that needed to be cooked.

Today one of the nurses walked by this building on campus that was demolished. It was the Nursing School and everyone in the building had died in the quake. The doors were not locked until today and the bodies still lie there.

I have received many emails from people asking where and who to donate too. I would have to recommend Partners in Health (PIH). Every bit goes to the Haitian people and even to the people caring for them. I cannot tell you how much PIH makes a difference in their lives. They have been working in Haiti for the last 20 years and are invested in their future.  Check out the book, Mountains beyond Mountains, and look at PIH’s Facebook page and Web site. Thank you in advance for donating!

Nelson J Aquino CRNA

Nelson Aquino, a nurse anesthetist from Children’s, is in Haiti with a group of Children’s clinicians. He’s been sending us updates and photos almost daily. Here’s his most recent email:

In the PACU today, we had a young boy screaming words in Haitian. We asked the interpreter whether he was having pain and where? The interpreter said he wasn’t having pain, but said he was calling out the names of all his dead family members and asking them to help him. My heart just dropped and I looked at him and rubbed his forehead, I didn’t know what else to do.

For every tragedy there is a miracle. Today I learned about a man I had cared for yesterday in a tent. This man was emaciated and rumor was he was found 10 days later in the rubble. I remember seeing him transported in when we arrived. I was giving him sedation for his dressing changes.

This man was found alive after spending 10 days in a morgue.

Later, I found out the real story. The man was actually found in the morgue. He was thought to be dead and pulse-less and placed with the other deceased. When workers opened the morgue doors 10 days later, they saw this man was moving his hands! He was immediately resuscitated and placed on a fentayl patch for hospice care. Well today he is alive and sitting up and drinking! The Haitians have now named him ” Black Jesus.” He even looks like that too. What an amazing story.In the OR today, our teams completed 15 operative cases and several same day procedures. It was nonstop from the moment we walked in at 7 a.m. until we left at 6 p.m. We had over 10 surgeons specializing in ortho trauma, plastics, general and vascular surgery. Our team had four working ORs and is the main center for surgery. At one point , our preop area was jammed packed. We had to ask the US military to guard the door and do some crowd control.

Overall, it was very busy and many patients were seen and cared for. We manged to have a team of doctors and nurses monitoring the tents and find teams to care for our patients overnight. One of teams was from Dartmouth Hitchcock in New Hampshire. This group consisted of an ER doc and all nurses. These people are amazing. They accepted all our patients and have the best reputation in the hospital grounds. We had an 82 airborne medic who asked to come and watch surgeries. We actually had him scrub in with his machine gun on his back! See the pic! These medics were so helpful putting in IVs, transporting and caring for all these injured people.

Nelson Aquino, Craig McClain and Dave Waisel taking a well-deserved break

Lastly, I need to share how unbelievable the Haitian people are. We have many volunteers translating for us, feeding us, driving us, protecting us, cleaning for us, shopping for us and just making us feel at home. Some of these volunteers have lost many family, their homes and everything they own. But they have not lost their spirit or pride. It amazes me how resilient people cam be in the midst of devastation. We have had so many experiences, many I have not been able to share. But all in all, our entire group is safe, healthy, grateful and humbled being here.

Tents erected for post-operation care

Nelson Aquino, a nurse anesthetist from Children’s, arrived in Haiti yesterday with a group of Children’s clinicians. We just received this email update and photo from his first day and night on the ground:

This evening, we headed back to the university hospital. We had three operating rooms going. Earlier today, two other groups joined our team to make the hospital run night cases for the first time since the quake. We had surgeons, doctors and nurses from MI and CA helping us. Most of the morning was spent organizing the night ORs . We had several aftershocks too and people were scrambling.

Driving through the city is surreal. Camps of people, lines of people, military everywhere, homeless people. I saw the palace ruined. It was eerie at night too with no electricity and seeing buildings ruined and the smell of corpses.

Tonight, I basically did pain management and sedation for the post ops. We used morphine and started many patients on PO narcs. For the many wound changes I used ketamine and my portable finger pulse ox! The ICU nurses and intensivists were great and we all utilized each specialty. Everyone loved that I had the narcotics and could do sedation!

The patients were so thankful, you could see in their eyes, the grief, pain and acceptance of what has happened. The kids and adults all were inspiring.

Challenges for me were dealing with a 8 month pregnant woman w/ tib fib fractures pain management. Also trying to get IVs in trauma renal failure dialysis patient post op… But we all did it! Dave Waisel was awesome and both him and Craig McClain did amazing work today with the ORs.

At the end of the night, a three-hour old baby came with rectal bleeding and we all worked together…A PA donated his own blood so the neonate could survive the night. Amazing what people do in these conditions and circumstances! John Meara and Craig McClain stayed overnight to watch the baby.

Now back at compound.. More volunteers arriving. The surge of help is now coming.. A week later but not too late.. So many people need surgery, wound care and have nowhere to go. It’s going to take months for the injured to be cared for.

I know I’m missing more but I am beat. Thank everyone for thoughts and support!

Nelson Aquino

Yesterday, Children’s very own Judith Palfrey, MD, FAAP, president of the American Academy of Pediatrics (AAP), got the opportunity to carry the Olympic torch through Canada. Below, she reflects on the once-in-a-lifetime experience:

On January 19, I had the enormous honor to accept the Olympic flame from a young man named Chris, from Manitoba, Canada, and then to pass it on in an unbroken chain to Debbie Fisher, a speed skating coach from Calgary.

Since mid-November when the flame arrived in Vancouver from Greece, each day it has been shepherded lovingly from one town to another, all over Canada. Torchbearers have carried it on horseback, in sailboats, on wheelchairs, on dogsleds and even by air when it went up to the Arctic Circle.

As my friend Susan Foley so aptly put it, the Olympics embodies “hope, aspiration and achievement.” The torch itself is the symbol of global togetherness, cooperation and communities working together.

I was chosen to carry the torch as one of 20 Americans selected by the Coca Cola Company to highlight community action and living positively. Among the group were two marvelous Olympians, Shawn Johnson and Steven Lopez, and 11 amazing teenagers whose community service projects touch the lives of thousands of people. Five of us represented American health organizations including the American Dietetic Association, the American Academy of Family Practice, the US National Heart Lung and Blood Institute, the American Association of Sports Medicine and the American Academy of Pediatrics. Two of the runners were Coca Cola employees who have volunteered extensively in their home community of Atlanta. The bios and stories of the group can be found here. The opportunity to be with this group of people for two days was inspiration enough. Running with them and the wonderful Canadians we met was a true gift.

People have asked ‘what was the experience like?’ To be honest, it was ‘like’ no other experience I have ever had nor probably will have. There was an element of pure joy….being sent off to the run by the Calgary Elementary School Band playing O Canada…running past lines of school children cheering me on shouting my name…sharing the flame with motorists stopped along side the road….seeing my family smiling and proud. And then there was a feeling of awe.  I kept looking at the flame (so did all the other torchbearers). The flame represents the human spirit, the ability to overcome, the importance of caring. To hold that flame for my country, for all countries, for children was an experience I will always treasure.

In the planning phases for the torch run, at the AAP, we had decided to use the visibility of the event to raise awareness about the needs of children around the world. The AAP has an international mission that focuses on disaster response, neonatal resuscitation and health promotion. The global community has all come together in the wake of the Haiti disaster and through the AAP we are receiving daily donations to support our pediatric colleagues in Haiti and the Dominican Republic as they cope with the aftermath of the horrible earthquake. The work of the AAP, NACHRI, Children’s Hospital Boston and all the children’s hospitals for the children of Haiti is the embodiment of the love, courage and commitment that the Olympic torch is meant to symbolize.

by Glenn Saxe, MD, director of Children’s Hospital Boston’s Center for Refugee Trauma

“ Into the bowl in which their wine was mixed, she slipped a drug that had the power of robbing grief and anger of their sting and banishing all painful memories”
-Homer, the Odyssey

Morphine and other opiates have been used by humans since the earliest times. The poppy has been a powerful cultural symbol for hundreds or, even, thousands of years. When a chemical agent has ‘traveled’ with humans for such a long span of time it usually means it has strong evolutionary value. A fascinating study just published in the New England Journal of Medicine suggests morphine has the power to blunt the emotional aftereffects of trauma in people who’ve been severely injured.

Military researchers examined the records of almost 700 soldiers with combat injury and found that those who received morphine in the field had nearly a 50 percent reduction in rates of PTSD, two years later. If such a finding is accurate, it opens the possibility that the risk of PTSD can be substantially reduced if opiates are administered close to the time of trauma. This observation may have considerable impact on clinical care.

I’m particularly excited by this finding because my research team, in coordination with a research team at Shriners Burns Hospitals in Boston, published a similar finding almost 10 years ago in a sample of children hospitalized with burn injury. In our study, we found that the more morphine that burned children were prescribed during their hospitalization, the greater the reduction in PTSD symptoms over six months following discharge.

So what’s going on here? How may a relatively short duration of treatment delivered in the wake of a trauma prevent a serious and debilitating psychiatric problem such as PTSD? First, it’s important to understand that PTSD is a disorder of important natural systems that prepare animals and humans to survive when faced with threat. These systems promote the accurate appraisal of threat, the engagement of bodily systems required to manage threat (e.g. fight, flight, freeze) and the prompt termination of the threat response when the threat signal abates.

Many of the symptoms of PTSD can be seen as expressions of the dysfunction of one or more of these systems (e.g. flashbacks, intrusive memories, dissociation, hypervigilance, avoidance).

So how may opiate treatment prevent PTSD? There are a number of possible mechanisms. First, we know that opiates diminish pain signals. Might they diminish the risk of PTSD by diminishing the perceived appraisal of threat at the time of trauma? Pain is a very important driver of threat perception while the trauma is occurring. Second, opiates are potent blockers of the norepinepherine system, which is responsible for consolidating memory. Might opiates prevent the consolidation of traumatic memory by blocking the system responsible for consolidating this memory? Many investigators have postulated that blocking the norepinepherine system may offer a way to secondarily prevent PTSD.  A third possible mechanism relates to the role of opiates in systems responsible for affiliative behavior. Morphine has a similar chemical structure as oxytocin, a well described chemical related to this system.

Although these findings are exciting and promising, we must use great caution before morphine is indiscriminantly prescribed to traumatized individuals in our emergency rooms and hospital units. Approximately 20 to 40 percent of traumatized individuals will develop PTSD. We don’t want to prescribe a powerful and potentially addictive substance to the 60 to 80 percent of traumatized individuals who won’t develop PTSD. Further, evolution has given us powerful natural systems to manage threat and trauma. We must be very cautions about using chemicals to interfere with these systems in those not at risk.

Research that points to an effective preventative intervention can–and should–have a major impact on clinical care. However, we must carefully consider how this information is used to guide the standard of care in our field.

The funeral is for a female college student who was crushed in the earthquake.

Children’s-affiliated pediatrician Lester Hartman, MD, who runs a clinic in Haiti’s Central Plateau, made his way to the country within days of the earthquake to offer much-needed medical care. He returned home at yesterday and emailed us about the widespread destruction–and the accompanying resiliency of the Haitian people–that he witnessed firsthand.

Hartman sponsors three students in Haiti, all of whom were in Port-au-Prince when the earthquake struck. They were lucky to survive the quake, and returned to the capital city with Dr. Hartman to help with relief efforts.

My daughter Sarah and I are back- got home about midnight last night. Sarah was a huge help in all ways, but being close to fluent in Spanish ,while we spent much time trying to cross the border, was a huge help. Also a huge help was the Dominican pharmaceutical distributor who gave of thousands of dollars of meds, the civil defense team from the DR that crossed the border to help, and the director of HOPEH, Marline Olivier, a small woman with an amazing spirit who got the trucks, food and led us down the mountain (I nominated her for CNN Hero-she is sure mine).

Dr. Hartman, his daughter and the Haitian students his family sponsors. After surviving the earthquake, the students returned to Port-au-Prince to help with relief efforts.

My focus is the people, not the destruction- there will be more of the physical devastation than you can imagine you can imagine. Let’s focus on the people. The three students our family sponsor saw death firsthand in Port-au-Prince. When I asked them to return to Port-au-Prince to help, they responded yes with no hesitation.

In the photo, the first person, from left to right, is Richardson, a high school student we sponsor, who dreams of a farm and a house. He calls my wife “Mom”.

Next is Paschal, who suffered the most. His university class in Port-au-Prince collapsed and he was sandwiched between 2nd and 3rd floor, with about a 18-24 inch crawl space. Twenty-three of 30 students died. He demonstrated courage by returning as a rescue worker with us! He is one of the smartest people I know and a most diligent student.The third is Jothson- he also calls my wife “Mom”. He was ill that day and missed his class, and all his classmates were killed.

My wife’s cousin’s son, Nathan Bean, was perfect for myself and the Haitian kids. He was the essence of Patch Adam in a disaster, and had those three students, who had seen all the devastation, singing Bob Marley songs in the truck all the way down the mountain!

We walked through not even tent cities around the airport but rather bed sheet cities looking for pregnant women, young children, elder and ill people regardless of age.  We brought up 40 people. They will be housed in a closed public school (who knows when that will open), fed for now with the $4000 to $5000 worth of groceries and clothed. Today, there’s expected to be a second wave of people, as a team goes back down.

Massive destruction occurred as we got closer to the fault line along the mountains edges. It was almost like the earth was liquid and those buildings at the crest of a wave were flattened. That is all I want to say about the scene, as sadly I have seen  my hometown of New Orleans have “Katrina Disaster Tours” to the Lower Ninth Ward- which has not been rebuilt despite all the bluster.

I’m proud to say our little team started delivering care and aid at about 141 hours from the time of the earthquake. But what I’m most impressed with is the resilience of this first free black republic. The Haitian people, while desperate, were gracious as we walked through these camps near the airport. It is their proud heritage that keeps them going and it will be that which rebuilds their country- a country which in its first 60 years was largely ignored by the US during slavery.

Give as much as  you can. Remember this will fade from memory when the press stops sending the headlines in the horribly devastated areas. When I visit New Orleans and Haiti, I see the parallel of aid workers going down to rebuild with the names of their aid organizations in bright green, blue or orange T-shirts.

I want to thank everyone for your support and prayers. Let these continue. Joy lies in the fight, the attempt, the suffering involved, not the victory (Gandhi). In my sadness, I find some of my greatest joy. Amen.

David Walton, MD, a physician with Partners in Health, arrived in Port-au-Prince within 48 hours of the earthquake. He met with Partners In Health and Zanmi Lasante (Partners In Health’s Haitian sister organization) leadership to pursue a coordinated strategy for medical relief.

In addition to providing desperately needed medical care and arranging relief effort logistics, Walton was able to document the scene with his camera.

View this photo gallery for a glimpse into the challenging and heartbreaking situation in Port-au-Prince right now.

Lester Hartman, MD, a Children’s-affiliated pediatrician who runs a clinic in the mountains of Haiti, made his way to the region within days of the earthquake. He’s been sending email updates about what he’s seeing on the ground. Last night he wrote:

Brought 40 people from sheet cities in Port-au-Prince – will house up in closed school near clinic. Several kids with fractures.
Our driver just informed girlfriend died. Be back midnight from Dominican Republic, pics to follow.

We’ll update you on Hartman’s progress and that of the Children’s team that has been trying to get to Haiti since last week as soon as we have more information.

Photo: Damon Winter/The New York Times

As a sign of how devastated Haiti is after the earthquake, the team of Children’s Hospital Boston employees, including Shannon Manzi, Emergency Department pharmacist, David Mooney, MD, MPH, director of Trauma Program and Gary Fleisher, MD, Children’s pediatrician-in-chief is still attempting to land with their supplies in Haiti; they left the United States more than 24 hours ago.

Their plane flew all the way to the airport in Port-au-Prince, the capital of Haiti, only to be turned away last night as there were no lights or traffic control to guide the aircraft safely. They were  diverted to the Turks and Caicos Islands to refuel, but the team hopes to make a second attempt today.

We’ll post updates as soon as we receive them, so keep checking back for the latest news.

Read some tips from Children’s psychiatrist Stuart Goldman, MD, about how to talk with your children about the situation in Haiti.

As aid and relief workers begin to flow into Haiti, Children’s Hospital Boston is sending its own disaster response team to the devastated country. On Tuesday, an earthquake hit 16 miles from Port-au-Prince, the capital of Haiti, affecting as many as 3 million people, with as many as 100,000 deaths likely, according to the International Red Cross.

From Children’s, Shannon Manzi, Emergency Department pharmacist, David Mooney, MD, MPH, director of Trauma Program and Gary Fleisher, MD, Children’s pediatrician-in-chief are currently en-route to Haiti. The photo (above) was taken by Manzi at 3 a.m. this morning as the team waited to hear when and where they would be deployed.

Manzi is providing updates via email when she can. This afternoon she wrote:

Everyone is loaded on 2 buses and awaiting transport to the airport. No one has had more than 1 hour of sleep since leaving yesterday afternoon and there is no sign of any sleep time soon. We are being met on the ground in Haiti by the Marines and will get our orders from there.

Lots of safety briefings about infectious diseases such as malaria, TB, and HIV which is endemic. We will all have to be extraordinary careful as there will be no sharps removal systems, etc.

Here’s an update from David Mooney, also traveling with Manzi (their plane is shown right, photographed less than an hour ago).

We’re about to take off to Haiti.  I’ve taken my malaria med and re-upped my tetanus just in case. We’ll be the first US medical team in and expect to get there before our medical supplies.  The chaos in the streets is scary, but we’ve got to get there before it’s too late.

We’re told there are lots of soldiers at the airport and our plan is to camp out there tonight. It’s really exciting and pretty scary.  We have to carry with us everything that we need, including food and water and have to assume that our bags down below won’t make it.  All of their systems are reported to be out.  When the stuff arrives we can self-sustain for 3 weeks, but will be a bit pinched until then.

We hope we can control the flow of humanity that we expect to flock to our site. It hurts to see the hurt kids on TV and not already be there.

We’ll keep you updated as we hear more about the mission.

For those in need of some New Year’s resolution inspiration, check out this op-ed in the Boston Herald by David Ludwig, MD, PhD, about how to change your eating habits for the better. Money quote:

So this year, resolve not to diet. Instead:

1. Eat three balanced meals a day. Have a healthy snack when hungry. Stop eating when full.

2. Eat only in designated eating areas and not in front of a screen of any type.

3. Eat foods that look like they come from nature, not a factory, with emphasis on vegetables, fruits and whole grains.

4. Drink unsweetened or minimally sweetened beverages, including water, effervescent mineral water, and tea or coffee with no more than one or two teaspoons of sugar.

5. If so inclined, have dessert every night, but keep it light (e.g., fruit, a few nuts or a small piece of something you really enjoy). Limit high calorie treats to once a week.

6. Do something physically active every day. Walk rather than drive and take the stairs rather than the elevator.

7. Follow items 1 through 6 for the rest of your life.

What a whirlwind of a year. Since launching this blog in July, we’ve had more than 230,000 visitors, many of whom have left thought-provoking comments on our posts.

We’ve enjoyed bringing you personal stories and expert insight about current pediatric health topics, and we hope you continue reading us in 2010.

What were our readers most interested in this year? Our most widely read stories range from a video series about defeating a milk allergy to a news report about the discredited Baby Einstein videos. Did you miss any of our most popular posts? We revisit them below.

• H1N1 was by far the most popular topic on Thrive. We posted 44 different articles on the subject. Our most read H1N1 blog asked the question, “Should my child get the swine flu (H1N1) shot?” This post triggered an outpouring of reader comments, from both hesitant parents weighing the pros and cons, and vocal vaccine proponents. To see a complete list of Thrive’s H1N1 stories, click here.

• This heartbreaking story written by a mother about her daughter and shaken baby syndrome was a wake-up call for us all. Readers were both sympathetic to her plight and also outraged; a sensitive topic, this post received a lot of passionate feedback.

• Brett Nasuti, an 11-year-old Children’s patient, was born allergic to 15 foods. Thrive readers got to tag along as he went through a milk exposure desensitization trial to cure his milk allergy—the first of its kind in the country— by watching this video series. Will Brett ever get to eat pizza and drink milk with his cookies? Watch the first of Brett’s video series here.

• Children’s media expert, Michael Rich, MD, MPH, addresses Disney’s precedent-setting move offering refunds on the Baby Einstein DVDs they claimed promoted better brain development in infants. A media expert, Rich contributes a weekly post about children and media.

• The Twilight phenomenon has hit teens and pre-teens worldwide. Claire McCarthy, MD, gives suggestions for how parents should address the main themes of this book series with their children. McCarthy, a pediatrician, writes regular posts for Thrive about everything from BPA to childhood stress.

• One mother tells the shocking story of how strep throat attacked her child’s brain, causing symptoms of obsessive compulsive disorder.  Many other parents wrote in to Thrive, saying they had experienced the same thing. It’s a scary story, but by sharing, this family helped others feel like they weren’t so alone.
• We also talked a lot about epilepsy this year. We recently shared the video and first-person story of a young woman whose seizures are being controlled by a novel brain stimulation technique. We also heard from neurologist Frances Jensen, whose work studying the causes and potential treatments of epilepsy was featured in a 60 Minutes story.

Is there anything we didn’t cover this year that you’d like us to? Please let us know!

It’s a sad fact that congenital heart disease, the most common group of birth defects, affects 35,000 to 40,000 U.S. infants born annually. Currently, most congenital heart defects have no known cause.

But researchers at Children’s Hospital Boston and Brigham and Women’s Hospital hope to change that. They were recently awarded a large, 6-year grant from the National Heart, Lung, and Blood Institute (NHLBI) to probe the genetic causes of congenital heart disease. The $4.19 million grant is part of the Pediatric Cardiac Genomics Consortium (PCGC), which seeks to identify genetic and epigenetic causes of human congenital heart disease and to ultimately find preventive strategies, targets for treatment, and better diagnostic and prognostic information for families.

Although a few genetic causes of congenital heart disease are already known, the researchers hope to zero in on novel, undiscovered genes. Because gene discovery research requires a high number of patient samples, a collaborative consortium such as the PCGC will aid research by allowing scientists to share patient samples, data and technology.

Leonard Zon, MD, the director of Stem Cell Research Program at Children’s Hospital Boston, is interviewed in this NPR story that recaps a decade of stem cell research.

So where does the science of embryonic stem cells stand after a decade of political wrangling? A lot of exciting basic research is being done with embryonic stem cells, says Len Zon, a stem cell researcher at Children’s Hospital in Boston. But using stem cells for therapy?

“I think that’s still a ways off,” Zon says. “Although there are some studies that the FDA is considering, I think we still have to figure out how to make these cells in a more efficient and effective way, and I think that’s going to take awhile. You have to remember that the stem cell field is only 10 years old at the moment.”

Zon points out that it’s frequently two decades or more before new medical technologies find their way into patients.

Check out this heartwarming story by The Boston Globe about Ray Ray, an infant who–after spending his first five months of life at Children’s Hospital Boston–was able to finally go home for the holidays.

Another family is counting their holiday blessings this year. Read this incredible story by The Boston Herald about how after a labor-intensive 13 hours, one mom gave birth to a stillborn daughter while her husband suffered a ruptured aneurysm just steps from the ER. Both survive in this amazing story.

Thanks to a Children’s Facebook fan — we were alerted to this amazing WBZ story, aired two years ago, about how these twins’ lives were saved by surgery before they were even born.