2B
Saturday, May 29, 2021
The Observer & Baker City Herald
Prescription for children in pain
from pandemic: read them a story
Amina Khan
Los Angeles Times
If you know or have kids who’ve been
suffering from the disruption of the pan-
demic, there may be a pharmaceutical-
free way to alleviate their pain and stress:
Read them a story.
Scientists in Brazil who studied the ef-
fect of storytelling and riddle-based games
on children hospitalized in an intensive
care unit found that stories lowered the
young patients’ stress hormone levels, re-
duced their self-reported pain scores and
resulted in them speaking more positively
about hospitals, doctors and nurses.
“Our fi ndings provide a psychophysi-
ological basis for the short-term benefi ts
of storytelling,” the study authors wrote in
the Proceedings of the National Academy
of Sciences.
The results offer a simple and inex-
pensive intervention that could ease
the physical and psychological pain of
hospitalized children, the authors said.
And they hint that storytelling could have
a powerful effect on children’s well-being
beyond the hospital setting — including
for those whose home and school lives
have been left in disarray by the corona-
virus.
The pandemic has “some kind of
similarity to the ICU context, in the sense
that we are locked in, we are extremely
anxious, afraid of being sick, and you
don’t know when [things] are going to
get better,” said lead author Guilherme
Brockington, a physicist at the Federal
University of ABC in São Paolo, Brazil.
Humans love stories, whether it’s tell-
ing them or hearing them. This is true
from childhood to old age, and across lan-
guage and culture. Studies suggest that
love of the narrative may have played a
critical adaptive role in human society
and allowed us to infl uence our emotions
and forge connections with one another.
Psychologically, stories allow us to pull
meaning out of a sometimes chaotic world
and to learn the intricacies and pitfalls of
social interactions through the safety of
vicarious experience.
Mentally stimulating activities from
childhood through old age seem to provide
a “cognitive reserve,” scientists say.
Researchers have a hypothesis for why
stories have such an effect, an idea called
“narrative transportation.” By weaving a
tapestry of language, text and imagina-
tion, stories immerse heart and mind.
And as the story world becomes more
immediate, more “real,” the actual world
becomes slightly more remote, or harder
to access — at least for a little while.
“If you’re listening to a story, your mind
is transported to another place, away
from the hospital and into this sort of
imaginary realm,” said Raymond Mar, a
psychologist at York University in Toronto
Georges Gobet/AFP-Getty Images/TNS
A child looks at books in a library in a street of the Bel Air district in the city
of Rennes, France. A study in Brazil found that stories lowered children’s
stress hormone levels and reduced their self-reported pain scores.
who was not involved in the study.
“These narrative transportations and
mental simulations can help reframe per-
sonal experiences, broaden perspectives,
deepen emotional processing abilities,
increase empathy and regulate self-mod-
els and emotional experiences,” the study
authors wrote.
Storytelling, in other words, seems like
a powerful tool that can be harnessed for
good. That’s why it’s common for hospitals
around the world to have storytelling
programs for young patients.
Still, their benefi ts have remained
largely anecdotal. For this study, Brock-
ington and his colleagues wanted to build
a case based on scientifi c evidence.
To do so, the researchers focused their
efforts on children in intensive care, who
are already dealing with the hardship
and pain associated with their illnesses.
On top of that, being removed from home
and school deprives them of routines that
bring comfort and security, can interrupt
their development and can affect them
in other ways long after they’ve left the
hospital.
The scientists recruited 81 children
who had been admitted to the ICU at
Rede D’Or São Luiz Jabaquara Hospital
in São Paulo. They ranged in age from 2
to 7 and suffered from similar conditions,
such as respiratory problems brought on
by asthma, bronchitis or pneumonia.
The children were randomly split into
two groups. In the experimental group,
41 participated in a program in which a
trained volunteer read a children’s tale
for 25 to 30 minutes. The patients were
able to choose from one of eight stories
typically found in Brazilian children’s
literature. (They could ask at any time to
change stories or have one reread.)
In the control group, the volunteer took
on a different role, spending the same
amount of time asking the remaining 40
children to solve amusing riddles. The
idea was to control the amount of time,
attention and social interaction each
child would receive, regardless of whether
they were getting riddles or stories.
The study team examined the chil-
dren’s responses on multiple levels. The
researchers collected saliva samples from
each participant before and after sessions
to track changes in levels of cortisol (a
hormone associated with stress) and
oxytocin (a hormone linked to empathy
and emotional processing).
The children also took a subjective
test to report the level of pain they were
feeling on a scale of 1 to 6, before and
after each activity. Finally, they partici-
pated in a verbal free-association task
by describing their impressions of seven
cards depicting relevant subjects: nurse,
doctor, hospital, medicine, patient, pain
and book.
Across the board, the riddles and the
stories had a positive impact. Cortisol
levels dropped, oxytocin levels rose, and
subjective pain reports eased.
There was one key difference: The
stories appeared to be roughly twice as
effective as the riddles. Oxytocin lev-
els rose ninefold after the storytelling
intervention, versus a fi vefold increase
after the riddles. Cortisol levels dropped
by about 60% for the children who heard
stories, compared with a drop of 35% for
those who worked on riddles.
As for pain, children who heard stories
saw their average scores fall from 3.85 to
1.15 (a drop of 2.7 points), while the aver-
age pain scores for those with riddles fell
from 3.72 to 2.18 (1.54 points).
Safe sleep for babies
Nicole Villalpando
Austin American-Statesman
In the 1990s, the Nation-
al Institute of Child Health
and Human Development’s
safe sleeping campaign
reminded us all “back to
sleep,” as in put your baby
on her back when you put
her to bed.
It worked. More parents
put their babies on their
backs and the rates of sud-
den infant death syndrome
went down from 130.27 per
100,000 live births in 1990
to 33.3 per 100,000 live
births in 2019, according
to the Centers for Disease
Control and Prevention.
Rates of accidental suf-
focation and strangulation
in bed for infants have
increased in the same time
period. Those rates went
from 3.44 per 100,000 live
births in 1990 to 25.5 per
100,000 per live births in
2019.
Unexplained causes
of death in bed also have in-
creased slightly from 20.87
per 100,000 live births
to 31.3 per 100,000 live
births. The three — SIDS,
unexplained deaths, and
suffocation and strangu-
lation — are considered
sudden unexpected infant
deaths.
There are some factors
that increase a baby’s risk
factor for SUID, including
being born prematurely or
at a low birthweight or hav-
ing a mother who smoked.
Another big risk factor
is where the baby is put to
bed.
A new report from the
American Academy of Pedi-
atrics found of the incidents
that were entered into the
CDC’s Sudden Unexpected
Infant Death Case Registry
from 2011 to 2017, 72 per-
cent happened in an unsafe
sleeping environment, and
75 percent of those that
were caused by suffocation
happened when the baby’s
airway was blocked by soft
bedding.
Dr. Shyam Sivasankar,
a pediatric emergency
medicine physician at St.
David’s Children’s Hospital,
says when babies come into
his emergency room not
breathing, or after having
had a near fatal suffocation
event, the fi rst thing he
says is “tell me where they
are sleeping.”
Often the baby is co-
sleeping with an adult, he
says, and the baby gets
caught in adult blankets or
pillows.
That’s when he’ll reiter-
ate how important it is to
put baby to sleep in a crib
with nothing in it.
Sivasankar recommends
that exhausted parents
who are getting up with
babies in the middle of the
night for feedings should
set an alarm on their
phones as a reminder to
put baby back into the crib
and not fall asleep with
them in bed, on the sofa, in
a chair or wherever they
are feeding them.
Sometimes the suf-
focation or strangulation
happens to a baby who is
in a crib with a blanket or
something else soft like a
stuffed animal. Sivasankar
often hears that parents
think their baby is cold
and so they give them a
blanket. He recommends
using warmer clothing or a
wearable blanket or sleep
sack to keep them warm
instead of something that is
separate and loosely fl oat-
ing around the crib.
Having babies sleep in
an empty crib with just
a fi tted sheet needs to be
followed for the fi rst year of
life, Sivasankar says. Even
tools like wedges, which are
used for babies with refl ux,
shouldn’t be used unless
doctor recommended.
Babies who fall asleep in
car seats, swings, strollers
or on a parent, should be
moved as soon as possible
to their crib rather than
allowing them to nap
or sleep in one of those
places, which are not a
recommended safe sleeping
environment.
Car seats, strollers and
swings also should be free
of toys and blankets or
other suffocation hazards
in case a child falls asleep
in one of those devices.
These deaths are “an
unfortunate situation,” be-
cause they are preventable.
“The parents who
experience this, they go on
to educate and promote
these safe sleep practices,”
Sivansankar says.
Biscupid aortic valve: how much should I worry?
Mayo Clinic News Network
DEAR MAYO CLINIC: I consider
myself to be in good health. I work
out several times a week, but recently
I began experiencing episodes of
shortness of breath after going up
and down the stairs in my home.
After running on the treadmill a few
weeks ago, I got dizzy and fainted. I
went to my doctor who told me that I
have a bicuspid aortic valve. Can you
share more about what this is and if
it can be fi xed? Also, I have children.
Are they at risk for this condition?
ANSWER: It can be a shock to
receive a diagnosis that you have
a heart condition. The good news
is that you should be able to live a
healthy and active lifestyle with the
right care.
As a reminder, the heart has four
major valves. The two valves on the
left side of the heart are the aortic
valve and the mitral valve, and the
two valves on the right side are the
pulmonary valve and the tricuspid
valve. The aortic valve is the main
“door” out of the heart. Blood fl ows
through the aortic valve to exit the
heart, and supplies oxygen and
nutrients to the rest of the body.
The normal aortic valve has three
leafl ets, also known as cusps. Some
people can be born with one, two
or even four cusps of their aortic
valve. The most common of these
abnormalities is an aortic valve with
two cusps — thus, a bicuspid aortic
valve.
A bicuspid aortic valve is a
common cardiovascular condition,
affecting about 1% of the general
population. Bicuspid aortic valves
are more common in men, but also
affect women. A bicuspid aortic valve
is a congenital condition, meaning
that people are born with two rather
than the normal three cusps on
their aortic valve. Although bicuspid
aortic valves can occur sporadically
without any inheritance pattern, the
condition also can run in families.
Many people can live with a bicus-
pid aortic valve for their entire life,
but there are those who may need to
have their valve surgically replaced
or repaired.
When people are born with a
bicuspid aortic valve, the bicus-
pid valve typically functions well
throughout childhood and early
adulthood. When people reach mid-
dle age, bicuspid aortic valves can
begin to degenerate. Degeneration
is normal for aortic valves as people
age, but occurs at a younger age in
bicuspid aortic valves compared to
normal aortic valves.
Degeneration occurs in two
forms: narrowing, also known as
stenosis; or leaking, also known as
regurgitation. People do not feel any
symptoms of bicuspid aortic valves
until the narrowing or leaking
becomes severe enough to affect
heart function. At that point, people
with bicuspid aortic valves may
notice shortness of breath, diffi culty
exercising, lightheadedness or chest
pain. This sounds like what hap-
pened in your situation.
If heart function becomes signifi -
cantly impaired, people can develop
heart failure — the symptoms of
which include fl uid retention, weight
gain, swelling in the legs, substantial
breathing diffi culty and, potentially,
even syncope, which means passing
out.
Health care providers usually
diagnose bicuspid aortic valves
with an ultrasound of the heart
called an echocardiogram. CT scan
and MRI also can detect bicuspid
aortic valves. Bicuspid aortic valves
often make characteristic sounds
when health care providers listen to
hearts.
In addition to early valve degen-
eration, people with bicuspid aortic
valves carry a risk for enlargement,
or aneurysm development, of the
ascending aorta, which is the main
blood vessel that carries blood out
of the heart. People with bicuspid
aortic valves rarely can have nar-
rowing, or coarctation, of the aorta.
Echocardiogram, CT scan and MRI
can detect aneurysms and coarcta-
tions of the aorta. Your health care
provider may want to monitor you
with scans at different intervals.
Bicuspid aortic valves are more
prone to infection than normal aortic
valves. Infection of a heart valve is
called infective endocarditis. It can
have devastating consequences.
Infective endocarditis can occur from
bacteria that are a normal part of the
human mouth. People with bicuspid
aortic valves in addition to dental
abscesses or other mouth infections
carry a higher risk of infective endo-
carditis. It is critically important that
people with bicuspid aortic valves
undergo regular dental cleanings
and maintain excellent oral hygiene.
People with bicuspid aortic valves
need to have examinations from
their health care provider and tests
to monitor the valve and aorta on a
regular basis. Echocardiograms are
the most common tests to monitor
people with bicuspid aortic valves,
but CT scans and MRIs also can
serve that purpose. The frequency of
monitoring depends on the degree
of valve stenosis or regurgitation,
ascending aorta enlargement, and
a person’s family history. Tests may
be necessary as frequently as every
six months to as rarely as every fi ve
years. Because bicuspid aortic valves
can run in families, all fi rst-degree
relatives (i.e. children, siblings and
parents) of people with bicuspid
aortic valves should have an echo-
cardiogram to check for a bicuspid
aortic valve and an ascending aortic
aneurysm.
There are no medications to
treat a bicuspid aortic valve. The
only treatment is surgery to repair
or replace the aortic valve if the
stenosis or regurgitation becomes
bad enough, or if the ascending aorta
becomes too large.
Not all patients with bicuspid
aortic valves will need heart surgery.
Studies suggest that up to 75% of
people with bicuspid aortic valves
will require intervention at some
point in their lives. If people with
bicuspid aortic valves have regular
monitoring and prompt treatment,
their lifespans are similar to the
general population.
People diagnosed with a bicuspid
aortic valve should understand that
they will require regular monitoring
and may eventually require valve
replacement or repair. They should
otherwise live an active, healthy and
normal lifestyle.
— Dr. Michael Cullen, Cardiovascular
Medicine, Mayo Clinic, Rochester,
Minnesota