Children In Boston Research Articles

Contracture Release and Full-Thickness Skin Graft to Volar Index Finger with K-Wire Insertion

Watch this full-length, narrated surgical video of a contracture release and full-thickness skin graft to volar index finger with K-wire insertion performed at Shriners Hospitals for Children in Boston

Towards an ethics of compassionate care in accompanying human suffering: dialogic relationships and feminist activist scholarship with asylum-seeking mothers

ABSTRACT In the face of forced migrants’ urgent needs and ongoing human rights violations endured within and across borders, scholars note the ‘dual imperative’ (Jacobsen and Landau 2003) of documenting these realities while also responding through humanitarian advocacy and/or political activism. This article documents one such experience, that is, an action research process that began with the first author’s accompaniment of Central American asylum-seeking mothers and children in Boston and included witnessing to and documenting these mothers’ narratives in a context of systemic injustice, while contributing to the creation of a humanitarian grassroots network. The latter supported migrants’ needs while advocating for their right to asylum. Reflecting on these experiences, we explore how research that creates knowledge while acting in the world, demands what we herein describe as feminist activist scholarship grounded in dialogic relationality and compassionate care. The latter moves beyond empathetically feeling for or documenting the suffering of others, towards mutual accompaniment to engage in concrete actions to alleviate that suffering. The dialogic relationships of care in which scholars accompany and act with those at the margins have the potential to transform conventional, post-positivist knowledge production strategies from distancing or objectifying processes towards mutual accompaniment and activist scholarship.

An African School for African Americans: Black Demands for Education in Antebellum Boston

AbstractThis article examines Black parents’ efforts to establish and secure quality education for their children in antebellum Boston, Massachusetts. It situates the African School, a Black-owned cultural institution, within Black nationalist politics and reveals how the schoolhouse became a site of political tension between Black Bostonians and the Boston School Committee. Analyzing petitions, school records, and newspapers, this essay finds that the African School cultivated Black citizenship ideologies that prioritized political activism. This study invites new understandings of the political intersections of education and citizenship, and it illuminates the utility of Black nationalism in antebellum Boston.

Using mobile clinics to deliver care to difficult-to-reach populations: A COVID-19 practice we should keep

In the United States, mobile health clinics are an important method for delivering care to medically underserved populations. Mobile clinics have long been used in pediatric primary care, but there is little published to help pediatricians disseminate this practice more widely. During the COVID-19 pandemic, reduced in-person medical visits and subsequent declines in routine pediatric vaccination rates highlighted the importance of using a variety of care delivery models to reach patients. To improve vaccination coverage among young children in Boston during summer 2020, Mattapan Community Health Center and Codman Square Health Center deployed mobile clinics as an adjunct to their in-person preventive pediatric clinical services. In total, the health centers completed 17 mobile clinic sessions and served 50 unique patients, 77% of whom were African-American/Black and 75% of whom were under the age of two. A total of 146 vaccine injections were administered. A quality improvement survey of participating families demonstrated high levels of patient satisfaction and a high likelihood of using mobile services again in the future. The mobile clinic model was most valuable in reaching families who avoided in-person care due to COVID-19 transmission concerns or faced barriers to in-person care. The health centers fostered trust and demonstrated cultural competency during this novel initiative by leveraging established patient-provider relationships, using interpreters, and involving staff who reflected the diversity of the communities. Although there are challenges to implementing mobile health clinics, this initiative demonstrates the value of mobile clinics in delivering high quality pediatric preventive care to difficult-to-reach populations.

Reported Asthma Control Predicts Future Visits, Independent of Guideline-Based Control Measures

SR Kochis, T Grant, W Phipatanakul. J Allergy Clin Immunol Pract . 2019;7(5):1516–1521.e1 This study assessed how a caregiver’s perception of their child’s asthma control might impact the child’s risk for having future urgent visits for asthma care. Two cohorts of low income, ethnic minority children in Baltimore or Boston from the Mouse Allergen and Asthma Cohort Study (MAACS) and the Mouse Allergen and Asthma Intervention Trial (MAAIT) with persistent asthma, aged 5 to 17 years were included. The MAACS study correlated mouse exposure with asthma features, while the MAAIT study evaluated …

Family-centered Outcomes that Matter Most to Parents: A Pediatric Feeding Disorders Qualitative Study.

The purpose of this study was to examine the perspectives of caregivers of children with feeding disorders. We sought to understand their child's feeding impairment through the lens of caregivers, including the impact impairments had on daily life and social participation, what outcomes matter most to caregivers, contextual determinants that affect achieving desired outcomes, and how treatment approaches can optimally support families. We interviewed caregivers of children, ages 2 to 5 years, who received care at the Center for Feeding and Nutrition at MassGeneral Hospital for Children in Boston, MA. All children had a feeding disorder diagnosis, defined as an impairment in oral intake. We analyzed interview transcripts using principles of immersion-crystallization. We reached thematic saturation after interviewing 30 caregivers (25 female). 66.7% of the children were white, 13.3% Asian, 10.0% black, and 10.0% were more than 1 race. Thirty percent were Hispanic. We identified four themes: feeding impairments impact the daily life and social participation of children; improving their child's health and quality of life is most important to caregivers; child, caregiver, and community factors are facilitators of achieving desired outcomes; whereas time, financial, access, and knowledge factors are barriers; and caregivers prefer treatment approaches that incorporate principles of family-centered care. Given the daily life and social participation impacts of pediatric feeding disorders, treatment approaches should be family-centered, focus on functional and meaningful outcomes to improve the health and quality of life of children and their families, and address modifiable sociocontextual determinants.

Effects of maternal homelessness, Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and prenatal PM2.5 exposure on birthweight in a multi-ethnic and low-income urban community

TPS 741: Adverse birth outcomes 2, Exhibition Hall, Ground floor, August 28, 2019, 3:00 PM - 4:30 PM Background/Aim: Low birthweight is a leading cause of neonatal morbidity and mortality. Maternal factors, socioeconomic status, and ambient air pollution have been independently associated with low birthweight, but no studies have examined homelessness and Special Supplemental Nutrition Program for Women, Infants and Children (WIC) with air pollution. Our aim was to examine the associations and interactions between prenatal maternal homelessness, participation in WIC, and exposure to fine particulate matter (PM2.5) on birthweight in an urban cohort of low-income children in Boston. Methods: We included children recruited to the Boston-based Children’s HealthWatch cohort from 2007 through 2015 (n=3,619). Birthweight was obtained from electronic medical records. Information on maternal homelessness and WIC participation during pregnancy were provided via questionnaire. Prenatal PM2.5 exposures were calculated for each trimester. We built linear regression models adjusting for maternal age, body mass index (BMI), race/ethnicity, nativity, education, smoking, insurance, marital status, child gestational age and sex, seasonality, and median household income. We also examined interactions between PM2.5 and each of the covariates. Results: Being homeless during pregnancy was significantly associated with reduced birthweight (-45.5g, 95% CI: -85.4g, -5.5g), while participating in WIC was associated with increased birthweight (22.7g, 95% CI: -18.4g, 63.7g). Average PM2.5 during the second trimester was the most significant risk factor for reduced birthweight (-14g, 95% CI: -24.3, -3.6) compared to other PM2.5 exposure windows. The effect of PM2.5 during the second trimester on lower birthweight was stronger among immigrants, Hispanic or non-Hispanic Black mothers, single mothers, and mothers with lower educational attainment. Conclusions: Our study emphasizes the individual and synergistic roles of social and environmental stressors on birthweight, particularly the potential protective effect of participating in WIC. These findings can be used to direct interventions and policy to maximize a healthy start in life.

Maternal Place of Birth, Socioeconomic Characteristics, and Child Health in US-Born Latinx Children in Boston

ObjectiveAmong US-born children of Latina US (USB) and Latina foreign-born mothers (FBM), to determine whether 1) household and child characteristics differ; 2) child health outcomes differ; 3) these differences diminish for children of FBM with longer duration of residence in the United States; and 4) these differences can be explained by food insecurity (FI) or by Supplemental Nutrition Assistance Program (SNAP) participation. MethodsCross-sectional survey of 2145 Latina mothers of publicly insured US-born children 0 to 48 months old in a Boston emergency department (ED) 2004 to 2013. Predictors were FBM versus USBM and duration of residence in the United States. Outcomes were mothers’ report of child health, history of hospitalization, developmental risk, and hospital admission on the day of ED visit. Multivariable logistic regression adjusted for potential confounders and effect modification. ResultsFBM versus USBM households had more household (31% vs 26%) and child (19% vs 11%) FI and lower SNAP participation (44% vs 67%). Children of FBM versus USBM were more likely to be reported in fair/poor versus good/excellent health (adjusted odds ratios 1.9, 95% confidence interval [1.4, 2.6]), with highest odds for children of FBM with shortest duration of residence, and to be admitted to the hospital on the day of the ED visit (adjusted odds ratios 1.7, 95% confidence interval [1.3, 2.2]). SNAP and FI did not fully explain these outcomes. ConclusionWhen providing care and creating public policies, clinicians and policymakers should consider higher rates of food insecurity, lower SNAP participation, and risk for poor health outcomes in Latinx children of FBM.

Split-Thickness Skin Graft for Scar Release; Permanent Pigment Transfer; and Fractional CO2 Laser Therapy

This case focuses on the treatment of an 8-year-old male with scars from burn wounds he sustained at the age of 2 that have resulted in areas of scar contracture, stiffness, and hypopigmentation. Dr. Daniel Driscoll at Shriners Hospitals for Children in Boston performs a scar release, a split-thickness skin graft, a permanent pigment transfer, and a scar tissue softening procedure that uses a fractional CO2 laser.

Asthma in the USA: the good, the bad, and the disparity

Asthma in the USA: the good, the bad, and the disparity

In Memoriam: Herbert L. Needleman

In Memoriam: Herbert L. Needleman

Child Age and Gender Differences in Food Security in a Low-Income Inner-City Population

A long literature in economics concerns itself with differential allocations of resources to different children within the family unit. In a study of approximately 1,500 very disadvantaged families with children in Boston, Chicago, and San Antonio from 1999 to 2005, significant differences in levels of food allocation, as measured by an indicator of food “insecurity,” are found across children of different ages and genders. Using answers to unique survey questions for a specific child in the family, food insecurity levels are found to be much higher among older boys and girls than among younger ones, and to be sometimes higher among older boys than among older girls. Differential allocations are strongly correlated with the dietary and nutritional needs of the child. However, the differences in allocation appear only in the poorest families with the lowest levels of money income and family resources in general, and most differences disappear in significance or are greatly reduced in magnitude when resources rise to only modest levels. Differences in food insecurity across different types of children therefore appear to be a problem primarily only among the worst-off families.

Person of the Month: Erik Erikson (1902-1994)

Erik Homburger Erikson was a German-born American developmental psychologist and psychoanalyst who pioneered in the world of child psychology by giving his development theory with his ‘eight psychosocial stages’. He was born in Frankfurt in unusual circumstances in which his mother did not conceive him through her husband but he never got to know who his biological father was. It is said that the history of his birth is something that triggered the need in him to pursue the concept of identity and it is how he gave the world the psychological term ‘identity crisis’, a major contribution to the world of psychology and psychoanalysis. He grew up in Germany and came in contact with the world of psychoanalysis when he met Sigmund Freud’s daughter Anna Freud. He studied psychoanalysis at the Vienna Psychoanalytic Institute but Nazi invasion of Germany led to his emigration to America. In America, Erikson found a wide scope to practice psychoanalysis on children in Boston and worked at various medical institutes, including the Harvard University and California University. He studied the psychology of children from various social structures, environments, emotional and psychological issues and compiled his observations in the most prominent book of his career, ‘Childhood and Society’. Erikson is also credited with being one of the originators of Ego psychology, which stressed the role of the ego as being more than a servant of the id. According to Erikson, the environment in which a child lived was crucial to providing growth, adjustment, a source of self-awareness and identity. Erikson won a Pulitzer Prize and a U.S. National Book Award in category Philosophy and Religion for Gandhi’s Truth (1969), which focused more on his theory as applied to later phases in the life cycle.

Discrepancy in Initial Pediatric Burn Estimates and Its Impact on Fluid Resuscitation

One of the fundamental aspects of initial burn care is the ability to accurately measure the TBSA of injured tissue. Discrepancies between initial estimates of burn size and actual TBSA (determined at the burn unit) have long been reported. These inconsistencies have the potential for unnecessary patient transfer and inappropriate fluid administration which may result in morbidity. In an effort to study these inconsistencies and their impact on initial care, we evaluated the differences between initial TBSA estimates and its impact on fluid resuscitation at an American Burn Association-verified pediatric burn center. A prospective observational study of 50 consecutive burn patients admitted to Shriner's Hospital for Children in Boston, Massachusetts, between October 2011 and April 2012 was performed. Data collected included age, mechanism of burn injury, type of referral center, referring hospital TBSA, and volume of fluid administration as well as admission TBSA and volume of fluid administration. Determination of over or under resuscitation was based on comparing the amount of fluids received at the referral center to that received at the pediatric burn center. A total of 50 patients were admitted during the 7-month study period. The average age was 4.1 years old (25 days-16 years) and the average TBSA was 2.5% (0.25-55%). There were significant differences in the TBSA calculations between referring centers and the pediatric burn center. Overestimation of scald and contact burn size (P < .05) was noted with no difference in flame burn size estimation. Community referrals were more likely than tertiary centers to overestimate TBSA (P < .05 vs P = .29). Overall, 59% of study patients were administered more fluid at the referring hospital than would have been expected by the burn size calculated at our facility. Inconsistencies with the estimation of TBSA burn between referring hospitals and tertiary referral centers remains a problem in pediatric patients and may lead to inappropriate resuscitation. This study highlights the continued need for educational outreach programs and for the provision of novel resources to initial burn providers. Additional support through online resources (eg, Lund-Browder diagram) and remotely assisting providers during their TBSA measurements are potential options which may help to improve the initial care of burn patients.

A Short Circular History of Vitamin D from its Discovery to its Effects

The discovery of vitamin D.It was as early as the mid-1600s that Whistler (1) and Glisson (2)independently published scientific descriptions (in Latin!) of rickets, caused, we now know, by a vitamin D deficiency. However neither treatise recognised the crucial role of diet or exposure to sunlight on the prevention of this disease. Around 200 years later, in 1840, a Polish physician called Sniadecki realised that cases of rickets occurred in children living in the industrial centre of Warsaw but did not occur in children living in the country outside Warsaw. He surmised that lack of exposure to sunlight in the narrow, crowded streets of the city where there was considerable pollution due to the burning of coal and wood, caused the disease. Such a view was poorly received at the time as it seemed inconceivable that the sun could have any useful benefit on the skeleton. The prevalence of rickets increased as industrial processes and labour expanded and, by the end of the nineteenth century, this bone disorder was estimated to affect more than 90% of children living in such urban polluted environments in Europe. Similarly, as Boston and New York City grew in the late 1800s, so did the number of cases until, in 1900, more than 80% of children in Boston were reported to suffer from rickets.

Genetic testing using array comparative genomic hybridization may benefit newborns with congenital heart disease

rray comparative genomic hybrid-ization (aCGH) should be offered as a first-tier genetic test in seriously ill newborns with congenital heart disease (CHD), according to a recent study.CHD is a birth defect that affects nearly 1% of live births and is frequently identified in surveillance programs [Reller et al., 2008]. Genetic factors often cause CHD, but newborns and older children with the condition who could benefit from genetic testing do not always receive it [Connor et al., 2013]. For patients with CHD in cardiac intensive care units (CICUs) who do, aCGH is preferable to chromosome analysis because it can detect more potential genetic causes, write researchers at the University of Pittsburgh in Pennsylvania [Bachman et al., 2013].In their study, Bachman and colleagues found that aCGH detected disease-causing mutations in 26.2% of 45 newborns with CHD admitted to the hospital’s CICU, while chromosome analysis found such mutations in just 9.4%, a difference of 22%. Additionally, aCGH testing detected 10 copy number variants that chromosome analysis did not.“Comparative genomic hybrid-ization has become our standard of care for babies with heart defects admitted to CICU,” says senior author Suneeta Madan-Khetarpal, Associate Professor of Pediatrics at the University of Pittsburgh School of Medicine.

From Baghdad to Boston

A large portion of the casualties admitted to military hospitals on the battlefield in Iraq consists of children, of whom 13% had burns. The U.S. Army Combat Support Hospital (CSH) in Baghdad, faced with an influx of such patients, successfully transferred selected burned children by commercial airlines to the Shriners Hospital for Children in Boston, Massachusetts (SHC-B). The authors aimed to document this process, from both an ethical and a procedural standpoint. Care was conducted in six phases: (1) admission to the CSH; (2) selection for transfer; (3) burn care at the CSH; (4) travel to the United States; (5) burn care at the SHC-B; (6) return to Iraq. Transfer and SHC-B care were funded by charitable organizations. A review of patient records was performed. Eight acutely burned pediatric patients participated in this program. All were successfully transferred, treated at SHC-B, and returned to Iraq. They ranged in age from 1.7 to 17 years and in burn size from 6 to 53% of the TBSA. At SHC-B, the hospital length of stay was 14 to 132 days; up to 23 visits to the operating room were performed for acute and reconstructive burn surgery. The cost of war includes the care of injured civilians, and includes burned children. For selected patients, transfer out of the combat zone is one method of fulfilling this obligation.

Neighborhood Disorder, Social Support, and Self–Esteem: Evidence from a Sample of Low–income Women Living in Three Cities

Although several studies show that self–esteem varies according to neighborhood context, few have directly examined potential mediators of this association. In this paper, we use longitudinal survey data from the Welfare, Children, and Families project (1999, 2001) to examine the association between perceived neighborhood disorder and self–esteem among low–income urban women with children in Boston, Chicago, and San Antonio, testing for city heterogeneity. Building on social disorganization theory and previous research, we examine the mediating influence of social support. Our longitudinal models show that higher levels of disorder at baseline are associated with lower levels of social support and self–esteem. We also observe that increases in disorder over the study period are associated with concurrent losses in social support and self–esteem. Our mediation analyses suggest that perceived neighborhood disorder may undermine self–esteem by limiting opportunities for social support. Reducing signs and perceptions of disorder by improving the social and physical landscapes of neighborhoods may uniquely contribute to self–worth of low–income urban women with children.

Burn Victim

Burn injury is one of the most catastrophic injuries that the human body can sustain and still survive. Burn injuries are extremely costly to individuals, communities, and employers. Severe burns in children can result in prolonged suffering, disfigurement, and impaired physical and mental development. The goals of burn rehabilitation include helping the patient return to the highest level of function and independence possible while improving the overall quality of life, physically, emotionally, and socially. Children in Ukraine with severe and debilitating burn injuries often do not receive needed medical treatment because of limited resources in Ukrainian hospitals and/or the cost of treatment. Doctors Collaborating to Help Children is a nonprofit organization that works to improve the care of burn-injured children in Ukraine. In the past 5 years, we have been able to bring 14 children from different regions of Ukraine to Shriners Hospital in Boston for treatment. Alex S. is one of the burn victims who is thriving as a result of his care. He had an accident 7 years ago when he went fishing in Ukraine. His fishing rod touched a power line, and he was hit with 10,000 V of electric shock. He was holding a fishing rod with his right hand, which was touching his right shoulder. Alex had a high voltage electrical burn injury third and fourth degrees, 25% TBSA involving his right upper and lower extremities, head, and trunk. His right forearm had to be amputated. He spent 2 months in the intensive care unit in critical condition. Alex went through prolonged treatment and prosthetic rehabilitation of his right arm at Shriners Hospital for burned children in Boston. He had more than 20 surgical procedures and is now able to resume normal life. Currently, Alex is a high school junior in Massachusetts. His interests include rowing, martial arts, web design, and painting. Alex started to paint with his nondominant left hand and has received a lifetime scholarship to the Museum of Fine Arts (Figures 1 and 2). He maintains and designs the Web site for Doctors Collaborating to Help Children (www.dctohc.org).

Higher Environmental Relative Moldiness Index (ERMI) Values Measured in Homes of Asthmatic Children in Boston, Kansas City, and San Diego

Objective. Mold in water-damaged homes has been linked to asthma. Our objective was to test a new metric to quantify mold exposures in asthmatic children’s homes in three widely dispersed cities in the United States. Methods. The Environmental Relative Moldiness Index (ERMI) metric was created by the US Environmental Protection Agency, with assistance by the Department of Housing and Urban Development (HUD), to quantify mold contamination in US homes. The ERMI values in homes of asthmatic children were determined for the three widely dispersed cities of Boston, Kansas City, and San Diego. Results. Asthmatic children in Boston (n = 76), Kansas City (n = 60), and San Diego (n = 93) were found to be living in homes with significantly higher ERMI values than were found in homes randomly selected during the 2006 HUD American Healthy Homes Survey (AHHS) from the same geographic areas (n = 34, 22, and 28, respectively). Taken together, the average ERMI value in the homes with an asthmatic child was 8.73 compared to 3.87 for the AHHS homes. In addition, Kansas City homes of children with “Mild, Moderate, or Severe Persistent Asthma” had average ERMI value of 12.4 compared to 7.9 for homes of children with only “Mild Intermittent Asthma.” Aspergillus niger was the only mold of the 36 tested which was measured in significantly greater concentration in the homes of asthmatic children in all three cities. Conclusion. High ERMI values were associated with homes of asthmatic children in three widely dispersed cities in the United States.