The area of children’s medicine has seen a number of advancements in recent years, ensuring that high-quality and highly personalized care is available to the region’s youth across a range of specialties.

Just as every facet of medicine benefits from modern advancements, new technologies and breakthrough discoveries, pediatrics has also seen its share of promising progress.

Caring for the region’s youngest patients is both an art and a science, as Central Florida health care providers are quick to point out that it takes a certain approach and gentle demeanor to effectively care for children who might be afraid of the medical professionals helping to establish a lifetime of good health care habits at a young age.

“[Our behavioral health consultants] will not only help them deal with this fear, but understand where it’s coming from and how to adjust for the future,” explains Chelimer Miro, enterprise mental health program manager for First Choice Pediatrics. “We help them understand the fear. Part of the job is increasing awareness of how they feel, why they feel like that. … As soon as they see what we’re teaching them is helping, they are in general reacting a little bit better to that fear and feel more comfortable about receiving the help that we’re providing.”

Those same providers cite the incredible emotional payoff of knowing they play a role in local youngsters blossoming into the happiest, healthiest version of themselves, thanks to both a youth-appropriate bedside manner and the continued evolution of medical capabilities.

General Pediatric Care

Knowing that children aren’t just little adults but rather emotionally complex humans still understanding the world they inhabit is an important element to lead with. Getting a clearer understanding of that child psychology at play can help pediatricians get the most from their young patients’ visits.

“We go through a very lengthy, thorough process to make sure that these clinicians are the best of the best and they are safe to serve the pediatric population. They need to have passion to serve children,” Miro adds.

At West Orlando Pediatrics, Drs. Kevin O’Brien and Barry Yarckin also understand that making the children in their care feel safe and comfortable yields the best, most effective results, allowing them to personalize the treatment each child receives.

“Individualized treatment has always been a cornerstone to our approach to patient care,” they say. “One tenant of medical care that is emphasized during training is treating mind, body and spirit. People from different backgrounds have different beliefs, and in many cases they can help guide medical care.”

They note that recent advances in the RSV vaccine stand “to significantly lower the burden of this illness that lands up to 80,000 children in the hospital each year in the U.S.,” and also point to the advancements benefiting children beyond the exam room.

“Two relatively recent developments have improved the ability to monitor sick children at home: the ubiquity of telemedicine and more affordable pulse oximeters. For infants and toddlers diagnosed with bronchiolitis, symptoms can worsen before improving and there is occasionally a need for hospitalization. Reliable pulse oximeters can now be found for the price of a temporal artery thermometer, and the home use of this technology can save a family a follow-up trip to the office. [We have] found the use of telemedicine to be greatest for children and teens with sinus infections, orthopedic concerns, and mental health follow-ups, [and] young adults who have medical needs while in universities outside of town are frequent utilizers of telemedicine in our practice.”

Advancements in Youth Ophthalmology

Dr. Luis León-Alvarado, a board-certified, fellowship-trained vitreoretinal specialist at Florida Retina Institute who treats many of the practice’s pediatric patients, emphasizes that healthy kids have a better chance of growing up to become healthy adults.

“A lot of the diseases that we treat in adulthood stem from certain things that happen during childhood. One of the big ones is proper eating habits, like staying away from diets high in the carbohydrates and sugars that could increase the possibility of obesity, which could turn into diabetes down the road,” he explains, noting that diabetes’ overall impact extends to the eye to the point that blindness  can become a risk. “If children’s conditions are treated in time, that can help us identify resources to help these younger patients, like getting accommodations at school that could potentially help them continue having success in life.”

Dr. León-Alvarado adds that there are some cases where even the best habits are no match for genetics, but one injectable advancement has him especially optimistic about finally gaining an advantage.

“The big thing is the advent of new research and treatments for inherited retinal diseases,” he says. “The FDA approved this medication—Luxturna—which is basically a prescription gene-therapy product that’s used for the treatment of inherited retinal diseases for patients who have a subtype of retinitis pigmentosa associated with a specific gene. … With the treatment of injections into the eye back in the day, we had to do it with a laser, which was very destructive. Now, with these injections, we have been achieving similar or better results, thus preserving vision in pre-term or premature infants that would have otherwise completely lost their eyesight.”

Accessible Mental-Health Support

While the days of lockdown are steadily retreating into the past, COVID’s effects still ripple through society, especially in terms of the widespread damage its ensuing chaos, tragedy and challenges dealt to an uncountable number of individuals’ mental wellness. The light it shone on the necessity of making mental health support and resources more readily available and accessible is among the few positives to emerge in its wake.

The December 2021 creation of the AdventHealth for Children Mental Health Program, spearheaded by two AdventHealth for Children psychiatrists—Dr. Lalit Chaube, medical director of pediatric and adolescent mental health, and Dr. Tina Gurnani, child and adolescent psychiatrist—took some inspiration from urgent care’s on-demand service.

“This whole model is basically that we’re seeing kids who are either in crisis or haven’t been able to get the care they’ve been trying to access for a while but couldn’t make it work, whether it was finding an appointment availability, finding someone who will take their insurance or even finding a place where they make the age cutoff,” says Dr. Gurnani.

As so many care providers do, the professionals at the center closely collaborate with a patient’s other doctors, their families and their schools to get the most complete picture of the youth in their care. Contextualizing patients’ challenges and needs helps the team to not only best understand where they’re coming from, but also tailor their approach in a way that further combats the negative societal associations of receiving mental health treatment.

“There’s a lot of barriers for kids getting mental health care, and most of that has to do with the shortage of child psychiatrists and other mental health professionals nationally, but even more so in Central Florida,” Dr. Gurnani notes. “And then you have the initial barrier of the stigma against getting psychiatric care in the first place. A lot of times, it’s just about getting kids to feel safe talking about these things and saying, ‘I need help.’ On top of that, there’s insurance and usually a really long waitlist to get into most places.”

While Dr. Gurnani reports already seeing promising results and receiving positive feedback, this is just the beginning of the team’s vision for what’s to come. That’s slated to include adding “more clinicians so that we can reach more patients” as a top priority, as well as offering specialized group therapy focused on the likes of similar age groups and shared diagnoses.

A Childhood Cancer Breakthrough

When the Zika outbreak came to U.S. soil in 2016 and 2017, Florida was among the hardest hit, given its proximity to the South American epicenter of the mosquito-borne illness; among its myriad other impacts, Zika’s ensuing viral infections targeted a developmental protein that caused serious birth defects. But, in 2018, Drs. Tamarah Westmoreland and Joseph Mazar at Nemours Children’s Health co-wrote a paper observing that those devastating effects might actually have one beneficial application: winning the fight against a rare childhood cancer.

In a lab setting, the doctors studied mice with neuroblastoma tumors, injecting the disease into half of those mice and giving the other half a saline solution. After careful monitoring, the doctors observed that all the mice injected with the Zika virus experienced a near-total loss of tumor size, with a Nemours pathologist confirming that the highest dosage resulted in complete tumor elimination—all of which demonstrated no worrisome side effects.

“Our lab worked on this mouse study for approximately three years. It has gone quite well, and that’s what led to the publication [of the paper],” Dr. Westmoreland notes. “We are currently repeating some of these experiments in mice with humanized or human-like immune systems, because the majority of cancer research in mice has to use mice with some form of deficient immune system so that the tumor itself will grow. … We are still ongoing in our research, with the goal of marching towards a Phase I trial.”

While she does point out that the intersection of medicine and science moves at a deliberately careful pace, it allows for both exhaustive collaboration of experts combining their strengths and their painstaking research to be conducted as thoroughly as possible to ensure accuracy. And, eventually, that work could deliver promising results to the 6% of childhood cancer patients diagnosed with neuroblastoma.

“I think it really demonstrates the importance of basic science research translating in actual human patients: You’ll see the initial studies a lot of times start in the petri dish, in the cell culture … and it’s fascinating!” says Dr. Westmoreland. “There are times when you have a setback and you have to stop and rethink it, re-experiment and keep going. I and my lab are very careful in making sure that we have all of the necessary controls, and that can take time. It’s not one-and-done: It is repeated multiple times—there were about 64 experiments in our studies with mice. … And yes, it is 99% mice, but we do have a human sample in the paper from a child with high-risk neuroblastoma. A portion of the child’s tumor was taken to my lab, we treated that with Zika virus, and it killed the tumor within five days. So it’s not in a Phase I trial yet but we have used a direct patient sample, which is very encouraging.”

Resources

CHILDREN’S HEALTH SYSTEM NETWORK
AdventHealth for Children
Orlando
(407) 303-KIDS
AdventHealthForChildren.com

DENTAL CARE/ORTHODONTICS
Lach Orthodontic Specialists
Oviedo: (407) 359-1960
Lake Nona: (407) 502-2345
Lach-Ortho.com

Maitland Pediatric Dentistry
Maitland
(407) 398-0510
MaitlandPediatricDentistry.com

New Pediatric Dental Care
of Greater Orlando
Orlando & Oviedo
(407) 208-0288
PediatricDentalCareOrlando.com

Baptiste Dentistry for Kids
Apopka | (407) 992-8400
BaptisteDentistryforKids.com

Baptiste Orthodontics
Apopka: (407) 801-7775
Orlando: (407) 294-1560
Windermere: (407) 217-2927
BaptisteOrthodontics.com

Fravel Brewer Orthodontics
Ocoee | (407) 656-0001
FravelBrewer.com

MyFamily Orthodontics
Orlando & Windermere
(407) 258-3262
MyFamilyOrtho.com

Winter Garden Smiles
Winter Garden | (407) 614-5955
WinterGardenSmiles.com

DEVELOPMENTAL & BEHAVIORAL SUPPORT SERVICES
Help Me Grow Florida
Early Learning Coalition Lake County
Lake County | (352) 315-6670
ELCLC.org/Help-Me-Grow

GENERAL PEDIATRIC CARE
Community Health Centers
16 locations
(407) 905-8827
CHCFL.org

Doctor Q Pediatrics
Orlando
(407) 275-5700
DrQPediatrics.com

First Choice Pediatrics
Multiple locations
(407) 249-1234
FCPediatrics.com

Central Pediatrics
Apopka: (407) 703-7884
Ocoee: (407) 290-5533
CentralPediatrics.com

Community Health Centers
16 locations
(407) 905-8827 | CHCFL.org

First Choice Pediatrics
Multiple locations
(407) 249-1234
FCPediatrics.com

West Orlando Pediatrics
Ocoee  | (407) 290-9355
WestOrlandoPediatrics.com

OPHTHALMOLOGY

Florida Retina Institute
Multiple locations | (877) 357-3846
FloridaRetinaInstitute.com

PRESCRIBED PEDIATRIC EXTENDED CARE
BrightStart Pediatrics
Winter Garden: (407) 545-2773
Southchase: (407) 857-1212
Sanford: (407) 321-9570
BrightStartPeds.com