All Posts By



World Thrombosis Day

thrombosisThrombosis or blood clot does not occur often in children. However, a hospitalized child has a much higher chance of developing a blood clot, mainly due to the use of a small soft tube (central venous catheter) that is inserted into a vein to give medicines, nutrients, blood products, or fluids.

The Pediatric Thrombosis Program at Children’s provides comprehensive care to children who have blood clots. Our team includes physicians, pharmacists, nurse practitioners, nurses, school liaisons, social workers, child life specialists and other health care professionals committed to the care of infants, children and young adults affected by blood clots.

Q: What is a blood clot?

A: A blood clot forms when blood becomes solid rather than liquid. Blood clots happen mostly in veins or blood vessels that carry blood back to your heart from the rest of your body, but can happen in arteries too. Some common places for blood clots to form are arms, legs and lungs.

Q: What are symptoms of a blood clot?

A: Symptoms are different for each person and depend on where the blood clot is. If a blood clot is in your arm or legs (known as deep vein thrombosis or DVT), you may have pain at the site along with redness and/or swelling of affected area. If a blood clot forms in your lungs (known as pulmonary embolism or PE), you may have sudden chest pain that is worse when you take a deep breath. You may also feel short of breath and may cough up blood.

Q: What are causes of blood clots?

A: Anyone can get a blood clot.  Many things can make you more likely to have a clot. The most common risk factor in children is the use of a central venous catheter. Some other common risk factors include:

  • Increased estrogen (steroid hormones in the body)
    • Birth control (pills, patches, rings)
    • Pregnancy
    • Estrogen hormone therapy
  • Medical conditions
    • Cancer
    • Inflammatory conditions such as lupus, sickle cell disease and inflammatory bowel disease
  • Other
    • Obesity
    • Smoking
    • A family history of blood clots
  • Immobility
    • Hospitalization
    • Sitting too long (long car or plane rides)
  • Surgery/Trauma
    • Major surgery (hip, abdomen, knee)
    • Broken bone

Q: How are blood clots diagnosed?

A: When a blood clot is suspected, your doctor will start with a medical history and physical exam. Then imaging studies may be done to confirm there is a blood clot. The most commonly used imaging to diagnose DVT is a Doppler ultrasound. CT scan is the test of choice to diagnose a PE.

Q: How are blood clots treated?

A: The main treatment for blood clots is anticoagulant medication  or blood thinners. Blood thinners may be given as a pill by mouth, a shot into the skin or through a shot into a vein.  Your doctor will decide how long you need to be treated depending on why you developed a clot in the first place.

The goals of these medicines are:

  • To keep the clot from getting bigger
  • To stop the clot from breaking and going to other parts of your body (lungs/brain).
  • To stop a new clot from forming
  • To decrease long term effects of having a clot


For more information about our Pediatric Thrombosis Program, services we offer and conditions we treat, visit

Health and Safety

FAQS: 2019-2020 FLU SEASON

Q: What is influenza or flu?

A: Influenza (also known as the flu) is an infection of the respiratory tract. It is caused by a virus that spreads easily from person to person.  It spreads when people cough or sneeze out droplets that are infected with the virus and other people breathe them in. The droplets also can land on things like doorknobs or shopping carts, infecting people who touch these things.

Q: Is flu contagious?

A: The flu is very contagious. People can spread it from a day before they feel sick until their symptoms are gone. This is about one week for adults, but it can be longer for young children.

Q: How will I know if my child has flu and not just a cold?

A: The fall and winter months are cold and flu season. Both the cold and the flu can present similar symptoms, including cough, congestion and runny nose. In general, the flu hits a lot harder and quicker than a cold. When people have the flu, they usually feel worse than they do with a cold. Most people start to feel sick about two days after they come in contact with the flu virus.

Flu symptoms include:

  • fever
  • chills
  • headache
  • muscle or body aches
  • dizziness
  • loss of appetite
  • tiredness or fatigue
  • cough
  • sore throat
  • runny or stuffy nose
  • nausea or vomiting
  • weakness
  • ear pain
  • diarrhea or vomiting, ( more common in children than adults)

Q: Is it too late for my child to get this season’s flu vaccine?

A: There’s still time to get a flu vaccine this season. Flu season in the United States is from October to May. Vaccines are provided at most pediatricians’ offices. The American Academy of Pediatrics (AAP) recommends the flu shot for everyone over 6 months old.

Q: What is the treatment for flu?

A: Most children with flu get better at home. In the event a child does get sick, you can help mitigate symptoms. Make sure your child is drinking plenty of fluids. You can give appropriate doses of acetaminophen or ibuprofen to relieve fever and aches, and make sure they are getting plenty of rest.

Q: When should I seek medical treatment for my child if I suspect flu?

A: Bring your child to the doctor if you’re concerned about severe symptoms. Most of the time parents can care for their children with plenty of rest, fluids and extra comfort. Some children are more likely to have problems when they get the flu, including:

  • children up to the age of 5, especially babies
  • children and teens whose immune system is weakened from medicines or illnesses
  • children and teens with chronic (long-term) medical conditions, such as asthma or diabetes

Q: In addition to the flu vaccine, how else can we stay healthy during cold and flu season?

A:  The American Academy of Pediatrics (AAP) recommends the flu shot for everyone over 6 months old. Here are some other tips for staying healthy during cold and flu season:

  • Cover your cough and sneeze
  • Wash your hands
  • Clean living and working areas
  • Avoid crowds
  • Stay home from work or school if you are sick
  • Avoid touching your eyes, nose, and mouth

Q: How can we prevent the spread of germs in our house if my child is sick?

A: The flu virus spreads when people cough or sneeze out droplets that are infected with the virus and other people breathe them in. The droplets also can land on things like doorknobs or shopping carts, infecting people who touch these things.

Teaching children the importance of hand washing is the best way to stop germs from causing sickness. It’s especially important after coughing or nose blowing, after using the bathroom and before preparing or eating food.

There’s a right way to wash hands, too. Use warm water and plenty of soap, then rub your hands together vigorously for at least 15 seconds (away from the water). Children can sing a short song — try “Happy Birthday” — during the process to make sure they spend enough time washing. Rinse your hands and finish by drying them well on a clean towel. Hand sanitizer can be a good way for children to kill germs on their hands when soap and water aren’t available.

Cleaning household surfaces well is also important. Wipe down frequently handled objects around the house, such as toys, doorknobs, light switches, sink fixtures, and flushing handles on the toilets.

Soap and water are perfectly fine for cleaning. If you want something stronger, you can try an antibacterial cleanser. It may not kill all the germs that can lead to sickness, but it can reduce the amount of bacteria on an object.

It’s generally safe to use any cleaning agent that’s sold in stores but try to avoid using multiple cleaning agents or chemical sprays on a single object because the mix of chemicals can irritate skin and eyes.

Q: If my child has had flu, when can he return to school, child care, etc.?

A: Children with the flu should stay home from school and childcare until they feel better. They should only go back when they have been fever-free for at least 24 hours without using a fever-reducing medicine. Some children need to stay home longer. Ask the doctor what’s best for your child.

Find more information and resources at

Children's, Health and Safety

Poison Purse

There are many poison dangers that parents of small children need to be aware of, from the cleaning products found in the kitchen to medicine stored in a bathroom. But there’s a hidden danger you may not have considered. How many poisonous items can be found in your purse or the purses of any guests in your home? Ann Slattery is the Director of the Regional Poison Control Center at Children’s of Alabama. She says a woman’s purse can contain any number of poison dangers. “When people come into your home they may bring things that are harmful to your child in their pocketbook,” she says.

Some examples of dangerous items often kept in purses:

A non-childproof pill container: It could contain medications that are dangerous to a small child like heart medicine, an iron tablet, or a painkiller.

Toothpaste: May cause an upset stomach and possible fluoride poisoning.

Eye drops:  Especially the ones that remove redness could lower heart rate and blood pressure.

Hand sanitizer, hair spray, perfume: All contain alcohol and can cause intoxication, including the risk of respiratory arrest and death

Button batteries: Can get lodged and burn through the esophagus quickly

Hand lotion, nail polish, lipstick: All can be irritating to the stomach and potentially dangerous

Slattery says the dangers are especially present when small children five and under are the in home. She advises placing purses and bags, including your guests’ bags away. “For children five and under this would be something we would worry about, just keep it out of sight, out of reach,” she says. Likewise be mindful of the contents in your purse when you visit someone else’s home with small children.

If you suspect your child has ingested something poisonous, call the Regional Poison Control Center at 1-800-222-1222. The service is free and confidential, and health care providers are available to take calls 24 hours a day, seven days a week.



Children's, Health and Safety

Heat Illness

HeatExhaustion.jpgThe heat index in Alabama is expected to be very high at greater than 95 degrees over the next several days.  Dr. Hannah Gardner says, “kids are at risk for heat cramps, heat exhaustion and heat stroke if they play outside or have athletic practices in this hot, humid weather. It’s important for parents and coaches to be aware of the signs and symptoms of heat illness.”

Signs and Symptoms

Of heat exhaustion:

  • increased thirst
  • weakness and extreme tiredness
  • fainting
  • muscle cramps
  • nausea and vomiting
  • irritability
  • headache
  • increased sweating
  • cool, clammy skin
  • body temperature rises, but to less than 105°F (40.5°C)

Of heatstroke:

  • severe headache
  • weakness, dizziness
  • confusion
  • fast breathing and heartbeat
  • loss of consciousness (passing out)
  • seizures
  • little or no sweating
  • flushed, hot, dry skin
  • body temperature rises to 105°F (40.5°C) or higher

What to Do

If your child has symptoms of heatstroke, get emergency medical care immediately.

For cases of heat exhaustion or while awaiting help for a child with possible heatstroke:

  • Bring the child indoors or into the shade immediately.
  • Undress the child.
  • Have the child lie down; raise the feet slightly.
  • If the child is alert, place in a lukewarm bath or spray with lukewarm water.
  • If the child is alert and coherent, give frequent sips of cool, clear fluids.
  • If the child is vomiting, turn onto his or her side to prevent choking.

To help protect kids from heat illness

  • Teach kids to always drink plenty of liquids before and during activity in hot, sunny weather — even if they’re not thirsty.
  • Kids should wear light-colored, loose clothing on hot days and use sunscreen when outdoors.
  • On hot or humid days, limit outdoor activity during the hottest parts of the day.
  • Teach kids to come indoors, rest and hydrate right away whenever they feel overheated
Children's, Health and Safety

Preparing your child for Surgery

Has your child’s doctor said he or she will need to have surgery? This can be a scary time for the child and parent. But there are some things you can do to help ease your child’s anxiety and ensure a smoother experience.

Laura Lovell is a Child Life Specialist at Children’s of Alabama. She says the most important recommendation is to be honest with your child. “We encourage you to be honest with your child,”Lovell says. “We have a lot of families come in and the first thing they say is, ‘We didn’t tell them why we’re here.’This adds a lot of stress in addition to being in an unfamiliar environment.”Lovell says a lot of the anxiety can be lessened by talking with your child in advance about what they can expect.

Lovell recommends parents have honest conversations that are age appropriate for the child. For a younger child, she recommends looking for toys that are similar to what the child would see in the hospital. Most toy stores have doctor’s office toys that may include items like a stethoscope or a blood pressure cuff. Lovell encourages parents to engage younger children in role play, or encourage the child to play “doctor”with a stuffed animal.

Lovell also recommends a child bring a comfort item with them the day of surgery. “We do encourage them to bring something of comfort with them, whether that’s a blanket, or a stuffed animal or a toy, something they can have as they’re going back to the operating room and waking up in recovery,”she says.

Older children and teens can benefit from special attention as well. When preparing a teenager for surgery, Lovell says older kids can typically benefit from a little more detail. “We encourage the teens to ask questions,”she says. She adds that teens may want to bring an item of comfort too like a favorite blanket.

Children’s of Alabama and all pediatric facilities are especially geared to respond to the needs of children. “We cater to children, we have an amazing staff that will go through and explain everything to the child,”Lovell says. “We give them opportunities like choosing a flavor for their mask. There are choices they can make so they feel empowered to be part of their care.” If a child is especially anxious prior to surgery, parents can schedule a pre-surgery tour. Lovell recommends contacting the child’s pediatrician to request that tour through the Child Life Department.


Back to School Tips for Teens and Tweens


Back-to-school season is an exciting time for children and teens. As teens prepare to take harder classes and return to sports, here are some tips to make the back-to-school transition as easy as possible.


Teen Driving

The leading cause of death in teens is by car accidents. Fortunately, most of these accidents can be prevented. The list of guidelines below can help lower the chance of accidents behind the wheel.


  • No cellphones– using cellphones while driving is the leading cause of accidents with teen drivers. Texting and driving should never occur, and in many states is illegal. Teens should also know that even touching their phone while driving can put them at an increased risk.  Encourage safe driving by having strict guidelines regarding cell phone use and being a good role model by not using your phone behind the wheel.


  • Seatbelts– Using a seatbelt is the best way to increase your chance of surviving a motor vehicle crash. Seatbelts should be worn by all passengers, at all times, with no exceptions.


  • Distracted driving– First-time drivers can be easily distracted by using cellphones, eating while driving, listening to loud music and having friends in the car. Teens should not have passengers present in the car for the first 6 months after getting a license. They should also have volume limits for the radio and eat before getting behind the wheel.


Stress/Mental Health

While back to school time creates excitement for most students, the thought of advanced classes and standardized tests can create excess stress for teens. Try these tips to manage your teen’s stress levels.


  • Extracurricular Activities– Make sure your child has a reasonable schedule outside of school. Dance, sports, music and other activities tend to require a bigger time commitment as kids get older. Sticking to a few after school activities will ensure that your child does not add to his/her stress level.


  • Asking for help– middle school and high school can be tough. Teaching your child that it is normal to feel overwhelmed will make him/her more comfortable in asking for help.


  • Know when stress is serious– while certain levels of stress in children and teens is normal, some behaviors could indicate that your child might need help. If you notice that your child is not sleeping enough, is having anxiety or depression or is harming themselves, contact a counselor or mental health practitioner immediately.


Healthy Lunches

Your child may be packing a lunch or eating in the school cafeteria. Either way, they have more freedom to decide what they want to eat. Encourage them to make healthy decisions by:


  • Preparing healthy dinners with leftovers for school lunches– packing leftovers from favorite, nutritious dinners will allow them to eat a healthy lunch instead of grabbing something quick and unhealthy.


  • Having healthy groceries on hand– stock the fridge with fruits and vegetables instead of sugary snacks to give your child something wholesome to eat. Take grocery shopping requests from your child for healthy snack options.


  • Review the menu with your child– if your child is eating lunch in the school cafeteria, check out your school’s website to see the posted lunchroom menu. Planning with your child what they will eat everyday will prepare them to make good decisions before they step foot into the cafeteria.


Caffeine Use

Though the Food and Drug Administration (FDA) has not set guidelines for safe caffeine consumption for children, the American Academy of Pediatrics discourages caffeine use for children and adolescents. If you allow your child to occasionally drink caffeine, make sure he or she is getting enough sleep, making good grades and is not having anxiety and jitters.


E Cigarettes/Vaping

E-cigarette use among teens is on the rise, and studies show that teens often “vape” or “JUUL” (E-cigarette brand, pronounced jewel) on school grounds. This type of behavior usually happens in bathrooms, and may even occur in the classroom. Exposure to nicotine can harm brain development, in addition to raising the risk of future cigarette and drug use. Be sure your teen is ready to say “no” to the peer pressures of vaping by educating him/her on the dangers of nicotine use.


OPT IN for scoliosis screening

Schools play a vital role in early scoliosis detection. Alabama public schools offer free yearly scoliosis screening for students in the 5th through 9th grades (ages 11-14). Beginning in the 2019-2020 school year, students must return a signed parent permission slip to be screened. Ensure that your child is screened for scoliosis by signing the permission slip provided to your child.


Back to School Tips for Kids


‘BTS’ means ‘back to school’ season for children everywhere. Unfortunately, for some it means ‘back to sick’ season. After the summer ends, children and young students jump back in the routine of going to school, where they will share all of their fun summer memories. However, they could also be sharing germs. The sharing of bacteria and viruses can lead to the following illnesses and so much more:

  • the stomach flu
  • pink eye
  • sore throats
  • stuffy noses

Sometimes, taking steps in order to keep your child healthy are small and easy, but they make the biggest difference. Help your child stay well this back to school season with the following tips!

Make sure your child knows how to properly wash their hands

Germs are spread by touch. A child’s hand-washing habits can be a huge factor in whether or not a child becomes sick. Practice hand-washing techniques with your child at home. It is said that an individual should scrub their hands for at least 20 seconds under the sink.

Is sharing actually caring?

Children share so many things throughout a school day. It is important for children to know what is okay to share and what could lead to sickness later on. Kids may think they are being kind by sharing their snacks and supplies. However, objects such as these can hold germs that lead to sickness.

Encourage your child not to share personal items, especially those items that come in contact with the mouth, nose, etc.

Kids need rest too

It is important that your child gets the rest he/she needs. Getting the right amount of sleep can help their body fight off the bad germs that cause sickness. If it seems as if your child is not getting enough rest, check in with them and encourage good night time habits.

Know when to keep your child at home

It is important to give your child every opportunity to learn. However, it is also important to give your child the opportunity to get better when they are sick. Some questions you can ask yourself when deciding if you should send your child to school or not is:

  • Does he/she have a fever?
  • Does he/she seem too sluggish to benefit from a school lesson?
  • Do the symptoms seem like something contagious?

If even one of the answers to these questions is yes, take your child to see a doctor. It is always better to be safe than sorry.

Make sure contact information at child’s school is up to date

Ensure that the school your child is currently going to has the correct contact information for you and/or other friends and family.

In the instance that your child becomes ill at school, the faculty/staff can call you to come pick up your child. It is also smart to provide backup numbers as contact information as well.

Keep your child up to date on immunizations

Make sure your child is up to date on his/her vaccinations before the school year begins. It is always a good idea make your child an appointment with his/her pediatrician, before the start of a new school year to be up to date with your child’s health.

With this, it is also important for our parents and guardians of 5thgraders to OPT IN to scoliosis screening!


Partners in Kids Health – Asthma

Partners in Kids Health – Asthma

Asthma can be a scary diagnosis for a child and their parents. It’s a disease that makes it hard to breathe. This happens because airways in the lungs get swollen, smaller and filled with mucus. According to the Centers for Disease Control and Prevention, one in 13 people have asthma. Molly Bolton is the Asthma Program Nurse Practitioner at Children’s of Alabama. She says the common symptoms of asthma include coughing, especially at night time, as well as chest pain or chest tightness, and difficulty breathing or a wheezing, whistling sound when breathing.

Asthma Symptoms

  • Cough
  • Chest pain
  • Wheezing

There’s no cure for asthma, but it can be managed to prevent flare-ups. Bolton says, “Our goal is that children with asthma can run and play and do the things any other child can do.” There are multiple treatment measures that can be used in the management of asthma. These include quick relief medicines that help relieve asthma symptoms within minutes and controller medicines that manage asthma by preventing flare-ups. Controller medicine is taken every day, even when a child feels well.

Treatment of Asthma

  • Quick relief medicine
  • Controller medicine

If you’re concerned your child might have asthma, make a note of the symptoms and any “triggers” that are causing the symptoms and share with your child’s pediatrician. Notice if flare-ups occur inside or outside, or are they exercise-induced? Bolton advises, “Talk to your pediatrician about the symptoms that are concerning to you. Try to let them know what makes the symptoms worse or better.” It may help to keep a journal initially to record these observations.

Bolton says if your child is diagnosed with asthma, a pediatrician will probably recommend seeing your child every three to six months. “Asthma is chronic, long-term and may change over time,” she says. By partnering with your child’s pediatrician and following their recommendations for management of asthma and avoiding triggers, your child should be able to stay healthy and breathe well.


Scoliosis Screening in Grades 5-9

What is scoliosis?

Scoliosis, a condition estimated to affect 2 to 3 percent of the population, is a side-to-side curvature of the spine that can look like an “S” or a “C.” Scoliosis occurs when the vertebrae in the spine form a curved line instead of being straight. The vertebrae can also twist like a corkscrew.

Scoliosis curves are measured in degrees:

  • A mild curve is less than 20 degrees
  • A moderate curve is between 25 and 40 degrees
  • A severe curve is more than 50 degrees

Who should be screened?

Scoliosis can occur in people of all ages, but symptoms typically present in early adolescence, around age 10. While some cases of scoliosis present serious symptoms such as a protruding shoulder blade or an uneven rib cage visible when bending forward, scoliosis often goes undetected because of its painless onset.

Why is it important to be checked?

When detected early, treatment with a brace may prevent the progression of the curve and in turn prevent the need for surgery. Untreated cases of scoliosis may affect the function of other parts of the body, including the heart and the lungs.

Prevention and treatment

Schools play a vital role in early scoliosis detection and can help prevent permanent spinal deformity by offering a wide variety of screening programs. Alabama public schools offer free yearly scoliosis screening for students in the 5th through 9th grades (ages 11-14). Beginning in the 2019-2020 school year, students must return a signed parent permission slip to be screened.

Screening is performed by observing the uncovered spine, viewing the student from the back, side and front with the student bending forward. If a spinal problem is suspected, the child will be rechecked at a second screening. Parents of students found to have signs of a possible spinal abnormality will be asked to see their own physicians for further evaluation. Girls and boys are screened separately for privacy.

While there is no cure for scoliosis, early detection and treatment can prevent deformities that may lead to back pain and impaired posture. Ensure that your child is screened for scoliosis by signing the permission slip provided to your child.


Children’s Doctor Using Herpes Virus To Fight Brain Tumors

RS7963_greg_friedman-6 2

Each year more than 300 children and young adults in Alabama are treated for brain or central nervous system cancer at Children’s of Alabama.

May is Brian Tumor Awareness Month, and it’s particularly exciting that patients treated for brain tumors at Children’s are benefiting from a breakthrough in cancer treatment.

The process is known as viral immunotherapy, and it uses the herpes virus called G207, the same one responsible for the common cold sore, to treat brain tumors.

University of Alabama at Birmingham (UAB) and Children’s are the only places in the world where this type of virus has ever been used to help pediatric brain cancer patients.

Dr. Gregory Friedman, an associate professor, Pediatric Hematology-Oncology and director of Developmental Therapeutics at UAB who treats patients at Children’s, says it’s still early in the study, but it’s already showing major promise. Friedman’s team has treated 10 patients from across the U.S., and some internationally with promising preliminary results.

“We do get a lot of looks when we say we’re going to be using the herpes virus,” Dr. Friedman says, “but what we’ve learned is that we can engineer these viruses so that they’re safe and can actually be directed, targeted therapy to kill cancer cells.”

Here’s how it works.

Once a biopsy is done to confirm a recurrent tumor is present, doctors place catheters directly into the tumor. Then the catheters are externalized out through the patient’s scalp similar to an IV.

“Then the following day, the virus is infused over six hours through the catheters,” he says.

Doctors then remove the catheters, the patient is monitored for a few days in the hospital, and then followed intermittently in the outpatient clinic.

This one-time treatment is shown to not only kill cancer cells but also to stimulate the patient’s immune system.

Friedman noted that the primary purpose of this initial study is to demonstrate safety and thus far the virus has been safe and tolerable in children with progressive malignant brain tumors.

The following is a Q and A with Dr. Friedman about the study.

Q: What is pediatric virotherapy/immunotherapy as it relates to your research of recurrent brain tumors?

A: Virotherapy is a type of immunotherapy that utilizes a virus to kill cancer cells and to stimulate the child’s immune system to attack the tumor, providing a “one-two punch” at attacking the tumor. There are many different viruses that are being studied as possible cancer treatments. Some of the viruses do not typically produce disease in humans, and others, like the cold-sore virus that we are researching, have to be altered so that the virus cannot harm normal cells but can kill cancer cells. We think the cold-sore virus is an ideal virotherapy/immunotherapy agent for a number of reasons. It can infect and kill cancer cells while stimulating a robust immune response against the tumor. The virus has been studied extensively so that the essential and nonessential genes have been identified. Nonessential genes can be replaced with foreign human genes. As the virus replicates, the foreign gene can result in the production of substances that enhance the immune response against the tumor. Lastly, unlike other viruses, there are drugs available to treat infection in the unlikely event that the altered virus causes problems.

Q: Describe the attributes of children who are generally diagnosed with malignant brain tumors.

A: When a child is diagnosed with a brain tumor, the symptoms can vary depending on the location of the tumor. Commonly children will experience headache, nausea, vomiting, and difficulty with balance. Occasionally, a tumor can cause seizures, weakness, numbness, vision changes, or difficulty with speech or swallowing.

Q: What is a typical treatment plan for a child with malignant brain tumors?

A: The treatment depends on the type of tumor and location of the tumor, but in general, malignant brain tumors in children are treated with a combination of surgery, chemotherapy, and radiation. These therapies are very damaging to a child’s developing brain and can result in lifelong disability in survivors. Unfortunately, many children do not survive a malignant brain tumor. This is why novel, targeted therapies are greatly needed to improve outcomes and lessen toxic side effects of current therapies.

Q: What is the prognosis of someone with malignant brain tumors?

A: The prognosis depends on the type of malignant tumor, the location, and the molecular genetics of the tumor. Some tumor types, like brainstem gliomas and glioblastoma, have very poor outcomes with survival rates of 0–10%. Survival rates for medulloblastoma, the most common malignant brain tumor in children, range from 50–80%. Overall, malignant brain tumors are the leading cause of death from cancer in children.

Q: What happens when a patient relapses?

A: When a patient relapses with a malignant brain tumor, there are very few effective treatment options. If it is possible for the neurosurgeon to remove the recurrent tumor, surgery may be performed. If it has been a long enough interval from the initial course of radiation, another course of radiation may be used. There are a few traditional chemotherapy agents that can be used as a second line of treatment as well. Unfortunately, these type of treatments tend to only temporarily control the disease; recurrent malignant tumors are very rarely curable and almost always fatal over time.

Q: How has treatment for pediatric malignant brain tumors changed in the last 30 years?

A: The main changes to standard therapies have been improvements in surgical techniques, new strategies for delivering radiation, and a few new traditional chemotherapy agents. More recently, there has been a scientific boom in understanding the molecular characteristics of tumors, which has helped to define tumor behavior and provide new targeted avenues for treatment. This has led to the development of many different types of therapies, including antibodies, small molecule inhibitors, and immunotherapies.

Q: Why did you choose to research malignant brain tumors?

A: While overall survival rates for childhood cancers have improved greatly, unfortunately, outcomes for malignant pediatric brain tumors have lagged behind other types of cancer. Also, those that survive often suffer long-term disability from the treatments and the disease itself. There is an incredibly great need for new, targeted, less-toxic agents for this vulnerable population of patients, and that need is really what attracted me to research in this area.

Q: Are there any current research projects that are promising? If so, can you provide high-level/layperson details of the research?

A: To me, the most exciting and promising research projects currently are immunotherapies. Immunotherapies harness the patient’s own immune system to attack the tumor. There are many different approaches being tested, including antibodies to block proteins that tumors use to evade the immune system attack, tumor vaccinations, immune cellular therapies such as chimeric antigen receptor (CAR) T cells or natural killer cells, and virotherapy. Likely a combination of these approaches will be most effective. The first step is to get the child’s immune system to recognize the tumor as abnormal and to begin to attack it. Then the goal is to increase and maintain the attack on the tumor. Even if the immune system can just keep the tumor in check and keep it from growing, this would provide significant benefit for the patient.

Q: In lay terms, describe your research and the potential outcomes.

A: My overarching goal is to improve outcomes for children with brain tumors by developing and improving novel, targeted immunotherapies in the lab and then translating these therapies to clinical trials. We are currently studying a cold-sore virus that has been genetically altered so that it cannot harm normal brain cells but can infect and kill tumor cells while stimulating the patient’s own immune system to attack the tumor. Our first-generation virus is currently in a Phase 1 clinical trial for children with brain tumors and has shown great promise thus far. It has been safe and tolerable in all patients with evidence of efficacy in many, including a patient over two years out from the treatment without any additional therapy. We are taking what we are learning from the current clinical trial back to the lab (bedside-to-bench) to improve the therapy further by developing newer viruses, unique routes of delivering the virus, and unique combination therapies with the virus to maximize the anti-tumor response from the immune system. We will then take our discoveries from the lab back to the clinic (bench-to-bedside) to conduct new clinical trials to hopefully improve outcomes and lessen side effects for children in desperate need of better therapies.

Q: What have you learned from the patients with malignant brain tumors you have treated?

A: I have learned something from every patient I have treated. These lessons have ranged from how to handle adversity to communicating more effectively with children and families to managing unexpected side effects to considering and offering new treatment approaches. My goal is to treat each patient and family like I would want my own child and family members treated.

Q: Is there one child or family in particular about whom you could share a story of the way they impacted your passion to continue your research?

A: One of the first children with a brain tumor I took care of was a 3-year-old with a highly aggressive ependymoma. The tumor wrapped around the brainstem, and during the surgery to remove the tumor, the child suffered a brain injury and was in the ICU for months. The child lost the ability to talk and walk, and we were not certain if any recovery was possible. Against all odds, the child made a miraculous recovery, and through hard work and determination of the child and family, the child returned to walking, talking and playing. Unfortunately, the disease was a really bad disease, and the tumor returned. When it did, we lacked effective treatment options, and ultimately, the disease took the child’s life. This was incredibly difficult for everyone involved—to watch the child courageously fight back only to lose the battle against the disease. This definitely heightened my passion to fight for these children and their families and develop improved, targeted therapies.