Marilyn Kubichek,M.D., pediatric neurologist, and patient.
 Children have different health care needs than adults - both medical and emotional. Pediatricians are trained to diagnose and manage most of the problems that affect children. However, if your child is not improving with routine care, or if his or her symptoms indicate a more complicate problem, then your pediatrician may choose to refer you to a pediatric subspecialist, a physician who has additional training in a specific area
of pediatrics. “Pediatric subspecialists have advanced training in the care of children with specialized health problems,” says Deborah Friedman, M.D., Chair, Department of Pediatrics at Saint Barnabas Medical Center.
“In addition to medical school and years of training in their specialty area, pediatric subspecialists are also boardcertified both in pediatrics and in their specialty. Their years of concentration in a single aspect of pediatric care play a major role in helping to make a diagnosis, selecting the appropriate therapy and achieving optimal results.”
THE PEDIATRIC SPECIALTY CENTER
The Pediatric Specialty Center at the Saint Barnabas Ambulatory Care Center (ACC) is the premier location in New Jersey for a variety of outstanding pediatric specialties, advanced technologies, and programs and services in an outpatient setting.
ALLERGY AND IMMUNOLOGY
The family of a preschool-age girl came to Joel Mendelson, M.D., pediatric subspecialist for allergy, immunology and infectious disease, with a medical
mystery. Every time their daughter entered a particular room at her nursery school she would develop hives within fifteen minutes. The child had been evaluated elsewhere, but the cause was never found. It was assumed
that she was eating or playing with something in the room that caused the allergic reaction.
Dr. Mendelson visited the nursery school and discovered the cause within minutes. This particular room was the only place where the children exercised. As the child ran around, hives appeared. The diagnosis was a condition known as exercise-induced anaphylaxis.
Allergy and immunology subspecialists treat food allergy, hay fever, eczema, insect allergy, asthma, hives and recurrent infections. Many of these conditions may be outgrown, says Dr. Mendelson, so re-evaluation is necessary. Skin and blood testing determine allergy level.
The most common food allergies for children are to wheat, soy and eggs. While these food allergies may disappear with age, children who are allergic to peanuts rarely outgrow it. Knowledge of allergy triggers leads to avoidance
and preparation should an exposure occur.
Unlike adults who experience eczema in patches, children get eczema over their entire bodies. Treatment begins with identifying the cause and using moisturizers and anti-inflammatory medication.
“We work hand in hand with pediatricians to find solutions when current treatments aren’t working or when the cause of the health problem is unknown,” says Dr. Mendelson.
CHILD DEVELOPMENT AND BEHAVIOR
A mother brings her three-year-old daughter to Vinod Goyal, M.D., neurodevelopmental pediatrician, for evaluation.
The child does not speak and the mother assumes she is just delayed. After a series of evaluative tests, Dr. Goyal diagnoses the child as having autistic spectrum disorder. The mother is understandably upset, but also relieved to learn that she has not done anything wrong to cause the child’s disorder. She also feels less alone with the team support provided by Dr. Goyal and knows her child will receive the best help possible.
Dr. Goyal evaluates pediatric patients with learning disabilities, Attention Deficit Hyperactivity Disorder (ADHD), autism, developmental delays, behavioral problems, mental retardation, cerebral palsy and various syndromes.
“Without proper diagnosis and assistance, children with developmental disorders fare poorly, struggling in school and in life,” says Dr. Goyal. “We help them to get a variety of much-needed support.”
The child’s test results and medical evaluation are sent to the child’s school to help with placement and to further appropriate assistance. Dr. Goyal’s report helps to eliminate the long waiting process a family might find if the
school evaluates the child. Dr. Goyal also matches the family with counseling services.
“We help children who may have become lost in the system to achieve their full potential,” says Dr. Goyal.
ENDOCRINOLOGY
In his years of practice, Henry Anhalt, D.O., FAAP, Director of the Division of Pediatric Endocrinology, has tackled obesity in children and the resulting medical conditions. His most severe cases have included a 5-yearold
girl with genetic and family problems who weighed 250 pounds, and a 12-year-old diabetic boy who weighed 360 pounds and needed gastric bypass surgery at 14 because his girth left him unable to breathe.
“We are dealing with conditions in children that stem from obesity, such as hypertension, high cholesterol, kids having difficulty walking and breathing,” Dr. Anhalt says. Obesity treatment for the child involves the cooperation of the entire family. To this end, Dr. Anhalt has created a behavioral-based pediatric obesity program that is familycentered.
Children are evaluated for other medical problems, then enrolled in group sessions focused on cognitive and behavior change.
The Division of Endocrinology also treats diabetes, thyroid conditions and hormone deficiencies. In the area of diabetes, Dr. Anhalt champions the use of insulin pump therapy in all children with diabetes, and he is a certified diabetes educator. Insulin pumps are small, computerized devices that deliver fast-acting insulin in precise amounts.
“An aggressive use of pump therapy is hands down the best form of therapy,” he relates. “Children take much less insulin with the pump versus the shots, and they come closer to normal blood sugar levels.”
GASTROENTEROLOGY
 Michele Pereira knew something was wrong when her normally active nine-year-old son became lethargic. When he began to bleed profusely from the rectum, Dominick was admitted to the Medical Center. His blood count dropped precipitously and Kenneth Nord, M.D., Director of the Division of Pediatric Gastroenterology, was called.
Although a laboratory test suggested that Dominick suffered from antibiotic-induced colitis, Dr. Nord’s experience led him to believe that the boy had ulcerative colitis, a condition that could explain the profuse bleeding. Dr. Nord treated Dominick for three different forms of colitis, and his intuition
proved correct when tests later confirmed the diagnosis of fulminant onset ulcerative colitis.
Dominick required six weeks of intensive hospital treatment, including complete intravenous nutrition. Today Dominick has returned to school and his traveling soccer team. While he still takes medications to control his colitis, Mrs. Pereira is thrilled by his improvement.
“If I could put a halo on Dr. Nord’s head, I would,” she says. The Division of Pediatric Gastroenterology treats infants and children with feeding discomfort, vomiting, reflux, food allergy, abdominal pain and inflammatory bowel disease
including Crohn’s disease and ulcerative colitis, peptic ulcer disease and celiac disease.
While stress is often mentioned when children experience stomach problems, Dr. Nord says it may or may not play a role. Once the nature of the disease is understood, the proper treatment can be given, depending on the disease’s severity.
“It is critical to have an understanding of the individual child and to be sensitive to the struggle the parent of that child in pain goes through,” says Dr. Nord.
GENERAL SURGERY
When a three-year-old patient with sickle cell disease needed surgery to remove his oversized spleen, he was brought to Saint Barnabas Medical Center. Pediatric surgeon Nishith Bhattacharyya, M.D., performed the delicate surgery.
Because the procedure was performed laparoscopically, the child was able to return home the next day. Pediatric surgeons at Saint Barnabas most frequently perform appendectomies, remove gall bladders, repair hernias
and correct newborn congenital anomalies. Surgeries may be scheduled, or can be emergency in nature. They are performed on either an inpatient or outpatient basis.
“Laparoscopic techniques have made operations much smaller and recovery much quicker,” says Dr. Bhattacharyya.
INFECTIOUS DISEASE
 Seven days after Veronica and Gyllermo Campos brought their twin girls home from the hospital, something went terribly wrong. Andrea and Angela developed high fevers and were taken to the Emergency Department at Saint
Barnabas. The newborns had meningitis, a potentially deadly disease. Two weeks after successful treatment, the babies returned home. It seemed that the young family was out of peril.
Suddenly, on the tenth day after discharge, Andrea developed 104º fever
and was rushed to the hospital again. Mysteriously, her spinal fluid and blood
work did not reveal the problem. Infectious disease subspecialist Jeremias Murillo, M.D., deduced that the baby had a brain infection in three intracranial abscesses that formed following the meningitis, a rare occurrence.
After surgery to drain the infection and eight weeks of treatment, Andrea
returned to health. Now almost a year old, Andrea is a gentle child who loves to swim and look at books. Her development following such a serious condition has greatly impressed physicians.
“It’s a double miracle that she survived that kind of deadly bacteria, and then developed so well, almost as if nothing happened,” says Mr. Campos. “We’re very grateful to those doctors who took care of our daughter.”
Infectious disease subspecialists treat complicated infections, pneumonia, gastrointestinal disorders and offer consultation for pediatric inpatients. Selecting the appropriate antibiotic for the condition and giving it in the correct way is vital in the age of bacterial resistance to antibiotics.
“It’s so satisfying to treat a patient who is seriously ill, apply knowledge, and
see a remarkable transformation,” says Dr. Murillo.
NEUROLOGY
Marilyn Kubichek, M.D., pediatric neurologist, treated a young boy who was diagnosed with ADHD. The child was failing in grade school and, without improvement, would be held back a grade. His impulsive behavior interfered with his ability to concentrate and focus during class.
Teachers had begun to classify him as a “behavior problem.” After treatment with Dr. Kubichek, the child not only improved and advanced to the next grade, but also was placed in the gifted program. Once the ADHD was addressed, he was able to concentrate and express his underlying abilities.
“He was way above grade level in his reading,” she relates. “His parents were thrilled. It had a huge impact on their homelife.”
Pediatric neurologists treat conditions that include epilepsy, migraine headaches, ADHD, neuromuscular conditions, developmental delays and movement disorders. They can perform a variety of neurological tests including brain mapping and neuroimaging with MRI or PET scans.
Epilepsy commonly occurs in the pediatric years and may be generalized or partial. The condition is treated with medications. Migraines are a very common childhood problem that may be overlooked.
Medications as well as lifestyle changes and sleep management are all a part of migraine treatment. Developmental or movement delay can be addressed with physical, occupational and speech therapy.
“The goal with any condition is improved quality of life,” says Dr. Kubichek. “When medications are used, we choose those with minimal side effects to normalize their lives.
PSYCHIATRY
Mark Faber, M.D., Director of the Division of Pediatric Psychiatry at Saint Barnabas, once treated a student who was experiencing such profound
depression that she could no longer remain at her Ivy League college.
After treatment, which included both behavioral and cognitive therapy
and medication, the student greatly improved and was able to return to
school. When the depression lifted, she became more focused in her
studies and was even able to conduct research in her field of study.
“After treatment, many young people remark that they didn’t know they could
feel this good,” relates Dr. Faber. “In my experience, there are very high success rates for children who receive treatment.”
Pediatric psychiatrists provide consultations and treatment for conditions such as ADHD, anxiety, depression and autism. If not treated at an early age, these conditions can persist and even worsen, says Dr. Faber. For example, anxiety in a child can manifest as a panic disorder in an adult.
Treatment varies by the condition. Dr. Faber employs counseling
and behavioral strategies for depression and anxiety, and may also prescribe medication. For ADHD, cognitive and behavioral therapies are used, as well as the appropriate medications, which often result in dramatic improvements.
“Every day I treat children with these conditions and assist pediatricians in finding an effective diagnosis and treatment,” says Dr. Faber.
PULMONOLOGY
 A 12-year-old girl was admitted to the Medical Center with a severe asthma attack. After an evaluation and treatment with Dorothy Bisberg, M.D., pediatric pulmonologist, the family discovered that medications were available which could normalize the girl’s life. The preteen’s activity had been greatly limited for years, and the family had assumed that her poor quality of life was irreversible.
With the help of medication, she was able to attend school regularly and
participate in activities. “It was like a miracle,” recalls Dr. Bisberg.
While there is no cure for asthma, pediatric pulmonologists can help
young patients to achieve greater health and independence. Anti-inflammatory
medications can prevent the progression of asthma and avoidance of
asthma triggers can help to stop it before it starts. Asthma triggers include infections, colds, allergies (such as pets), irritants (cigarettes, pollution), exercise, cold weather and weather change.
Symptoms of asthma include wheezing, coughing, tightness in the chest and difficulty breathing. Asthma has a genetic component–– children with an asthmatic family member are more likely to have it––and it may become less severe with age.
“It is exciting for young patients to learn that 11 percent of athletes in the 1984 Summer Olympics had asthma,” reports Dr. Bisberg. “Asthma need not prevent them from achieving success even at the highest levels of competition.”
RHEUMATOLOGY
 Four-year-old Victoria Bellafiore woke up screaming one night, clutching her knee in pain. She told her mother it felt like a candle burning in her knee. The pain came and went.
Weeks later, when the pain occurred in her ankle, she was taken to the pediatrician. For the first time, the words “possible juvenile arthritis” were mentioned. The terrifying possibility was later confirmed by Elizabeth Chalom, M.D., pediatric rheumatologist at the Arthritis and Rheumatic Disease Center, who is also one of only three pediatric rheumatologists in New Jersey.
“I remember being at a children’s party with a magician,” recalls Mrs. Bellafiore. “The magician called Victoria up. She collapsed and was screaming. She couldn’t walk for three days.”
Despite her painful condition, Victoria has improved with aggressive treatment by her pediatric rheumatologists. With new medications and therapies, she has achieved a degree of normal function and has been able to attend school and activities.
Her mother credits Dr. Chalom and her daughter’s courageous spirit. “She’s very, very brave and has been blessed with an outrageous, high-spirited
personality,” says her mother. “She embraces life.”
Pediatric rheumatologists treat a variety of conditions, including juvenile rheumatoid arthritis, Lyme disease, lupus and fibromyalgia.
“Arthritis in children is very different from arthritis in adults because the condition is much less destructive,” says Dr. Chalom, who is also Director of the Pediatric Lyme Disease Program. “Children also tend to handle Lyme disease better and have fewer long-term problems than adults. With lupus, however, the younger a person develops it, the worse it can be.”
Whatever the condition, rheumatologic diseases in children are rare. When they occur, it is essential to seek treatment by a subspecialist.
For an appointment with any of the pediatric subspecialists, please call
the Pediatric Specialty Center at (973) 322-7600.
For a complete list of pediatric services, please call 1.888.SBHS-123.
Regional Craniofacial Center
 Pictured with Diane
Schmerber (center),
a former patient of
the Saint Barnabas
Regional Craniofacial
Center who went on
to win the title of Mrs.
New Jersey, 1990,
are patients of the
Center (from left to
right); Alyssa Hatch,
6, Elizabeth Whipp, 15 months, and Alberto Aponte, 7.
Diane Schmerber was a newborn when she first went to Saint Barnabas
Medical Center’s Regional Craniofacial Center to be evaluated for cleft lip
and palate. She overcame the congenital malformation with the help of
medical experts and her winning spirit. As an adult, Diane was chosen as
Mrs. New Jersey in 1990.
“I feel fortunate to have had the resources of Saint Barnabas throughout
my lifetime,” she reflects. “My family did not come from means, but that
wasn’t an obstacle. The fact that help was out there for me and others
with craniofacial abnormalities at any income level is something I will
never forget.”
For more than fifty years the Regional Craniofacial Center, a state-designated
comprehensive evaluation and treatment facility, has provided expert
care for a broad range of craniofacial impairments. In addition to cleft
palates, the center treats pediatric patients with malformations of the hard
and soft tissues of the skull, face and jaw. Located in the Saint Barnabas
Ambulatory Care Center (ACC), the Center has grown to include a multidisciplinary team of specialists who work together to achieve improvements in function and appearance of patients with craniofacial abnormalities.
For more information, please call the Regional Craniofacial Center at
(973) 322-7123.
Speech and Hearing Center
The Speech and Hearing Center, composed of audiologists and speechlanguage pathologists, offers services to those with hearing, speech,
communication and feeding delays and disorders. Cochlear implants and
new digital hearing aides with directional microphones are available for
hearing-impaired patients. Speech and language therapies and auditory/
oral rehabilitation help patients with a variety of conditions.
“Early intervention is essential for children to achieve maximum benefit
from therapy,” says Lisa Barsky, Ph.D., Director of the Center.
Every baby born at the Medical Center is tested for hearing problems prior
to release from the Medical Center. Follow-up testing and therapies are
available at the ACC. The Center provides education for parents to guide
them to appropriate physicians, therapies and assistive devices for their
child.
For more information, please call the Speech and Hearing Center at
(973) 322-7100.
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