Kristen Bruno, MD
What happened in the course of schooling to influence you to choose your specialty?
I started medical school with plans to be a surgeon — actually a pediatric surgeon.
I loved working with kids and knew as a pediatric surgeon I would enjoy being able to treat children and make an impact their health
I was about halfway through my first year of surgery residency at University of Massachusetts, and realized I loved being around kids much more than I enjoyed the adult components of my surgical rotations. Around this same time I realized I wanted to have my own kids and a family life someday, so my priorities changed a bit. I knew I needed to be in a specialty where I could enjoy my patients and their families while keeping them healthy and also be able to have time for a family of my own. So pediatrics it was and I returned to St. Louis Children’s Hospital for residency in pediatrics.
What brought you back to Washington University?
After I graduated from medical school and completed my residency and pediatric training, I served as a pediatrician in the Air Force in Oklahoma for four years. It was there I had the privilege of taking care of the children of our active duty and retirees in the Air Force.
When I moved back to St. Louis from Oklahoma, I wanted to work with Washington University. St. Louis Children’s Hospital was the first place I looked, but at the time, it wasn’t the best fit for me. So I worked for a few years at two other area medical centers, but with the ultimate goal to get back to the roots of my training – which was Washington University.
After all these years, I’m very excited to be back at Washington University and working with the physicians I trained with – it’s like a coming home for me.
Which aspect of your practice is most interesting?
The most interesting and my favorite aspect of my practice is working with young families. I love being able to take the time to sit and talk with a new family about their new baby breastfeeding or their 5-year-old learning to ride a bike or what school is like for their 10-year-old.
It gives me the opportunity to share my knowledge, get to know the family better and hopefully make a significant difference in their lives. I really enjoy the education and preventative care aspect.
How do you make new parents and their children feel comfortable when they come to see you?
I tend to have a casual approach. I want my patients and their parents to feel like I am a friend, and not just their doctor that they are coming to see.
I want them to feel like they can open up and ask me anything — there is never going to be a silly question.
It is important to have a lot of fun during the visit. So when kids come in to see me, I tend to do most of my exams for the little ones on my hands and knees on the floor – rather than putting them up on the exam table.
What new developments in your field are you most excited about?
There are a lot of new developments in pediatrics. I am particularly excited with the Learning Early About Peanut Allergy (LEAP) Study. The study focused on the prevention of food allergy in children by introducing peanuts (and other foods that could potentially cause an allergic reaction) early (less than one year old), rather than later.
So what this means for pediatricians is that we can say to parents, “Breast feed your baby until he or she is six months old and then let’s give peanut butter, let’s give eggs, let’s give anything you want to feed your little one. If there is potential your baby could be allergic, let’s give those foods even earlier.”
How we are treating food allergies and addressing the introduction of solid foods to babies is changing so much — that is very promising.
Are the foods that could potentially cause an allergic reaction introduced under your supervision?
Based on the information that came from the LEAP study, it depends on the individual patient. For example, someone with moderate to severe eczema might be a patient you would want to have either in the office of the allergist or the pediatrician when introducing peanut butter.
But if we are talking about a patient who doesn’t have any history of eczema, and is otherwise just a healthy infant, that would be an infant could tell mom or dad to go ahead and introduce these foods at home.
Are there other developments that are exciting?
Many of my patients have attention deficit hyperactive disorder (ADHD). Treating mental health issues and ADHD is very fulfilling because I can make a lot of difference just sitting down and talking to a patient and family.
Non-stimulating medications as well as behavior modification are excellent alternatives to stimulants for treating ADHD. There are many fewer adverse side-effects if you can find a non-stimulant medication that works.
Many of the stimulant medications are also being developed with fewer adverse side-effects and with improved ease of administration. This is very exciting for families.
Breast feeding is another area that has a lot of potential, as well as a lot of growth. We continue to learn about the benefits to mom and baby from breastfeeding so it’s very important to be able to sit down and support a new family who wants to breast feed.
There are so many ways to help them work through the challenges in order to make breast feeding successful. If you take time to work with the new mom, it can make a big difference for everyone. And for new families who do not want to breast feed, we will support them in whatever they want to do.
What are the new developments in vaccines?
The big change in flu vaccines is that it is no longer available intranasal (mist through the nose), because studies found that particular vaccine was not effective. This means that all flu vaccines are now injections – which are much harder on our patients, because children are afraid of shots. So we have to prepare families for that difference when they come in to see us in the fall for flu vaccines.
Another development is that the HPV (human papillomavirus) vaccine can now be completed as a two-dose series (instead of a three-dose) — if the patient is younger than 15 years old to receive the first shot, and gets the second dose 6-12 months later. This two-dose recommendation by the CDC will make it simpler for parents to get their children protected in time.
What does the HPV vaccine prevent?
The HPV vaccine prevents the human papillomavirus virus and the different strains of the virus that can cause cervical cancer and genital warts. Teenagers or young adults can be exposed to the virus through sexual contact.
Someone might not even have any symptoms, but they could be a carrier. Vaccinating both girls and boys is the best way to prevent the spread of HPV.
Where are you from?
I am from the East Coast — just outside of Boston. All of my family is from Cape Cod, and I spend a lot of time there. St. Louis has become my second home.
Which particular award or achievement is most gratifying?
It’s the little things for me. It is most gratifying when I am able to treat a child successfully for ADHD. When a mom tells me that her child is getting A’s, is feeling better, has more confidence and the teachers are happy — that is a huge achievement for me.
Another achievement would be helping my breast feeding patients. If a mom comes in to see me and her baby won’t latch on, or isn’t gaining weight — we work on it and see them in the office every day. When the baby is thriving and everyone in the family is happy, I know the effort was worth it.
What is the best advice you’ve received?
The best advice I’ve ever received was during my first year at Washington University medical school in my pediatric rotation. We were told at our first lecture that “children are not little adults”. Children are different from adults – you can’t treat them the same, you can’t talk to them the same, and you can’t give them medicines the same.
If you weren’t a doctor, what would you like to be doing?
That’s easy. One of my favorite things about being a doctor is educating my patients and their families. I love to keep children healthy, I love preventative care and I like to take care of them when they are sick. But education is the most fun and most rewarding part of being a physician, so if I was not a physician, I would be a teacher.