Dr. Miladys Palau-Collazo is the only pediatric endocrinologist between the Palm Beaches and Melbourne. She opened her practice in Port St. Lucie in July 2020 after having worked at a hospital in Palm Beach Gardens for seven years. “I treated a lot of patients from the Port St. Lucie area while I was in Palm Beach Gardens and realized that there was no doctor on the Treasure Coast specializing in hormonal imbalances in children, so I wanted to fill that void,” explained Dr. Palau-Collazo. “Children dealing with thyroid issues, puberty disorders, obesity, diabetes and genetic disorders feel so isolated and confused that it affects their social life. My goal is to diagnose and control the problem so they can have a normal childhood.”
As children grow, hormonal imbalances can affect their growth and sexual development, which in turn has dramatic effects on their physical and emotional well-being. Imagine having your 6-year-old child show signs of early puberty and how confusing it would be for them to understand what is happening and why they are different from their peers. Where does a parent turn to get answers?
The first stop would be to see your child’s pediatrician, who would in turn refer you to a pediatric endocrinologist specializing in treating children with endocrine and metabolic conditions from birth through adolescence – someone like Dr. Palau-Collazo.
As a medical student at the University of Puerto Rico/Medical Science, Dr. Palau-Collazo attended a diabetes summer camp where she quickly became aware of the obstacles a diabetic child faces.
“I naively thought that they could take a shot and live a normal life” she said. “But instead, I heard campers taking bets on when they thought they’d lose a leg or go blind. I realized that they had a very small view of what their future would look like. That’s when I decided to go into pediatric endocrinology so I could help these children and their parents understand that with the right medication and diet, they can have a normal life without worrying about such catastrophic things.”
A native of Puerto Rico, Palau-Collazo completed her pediatric residency at New York Presbyterian Hospital and Weill Cornell Medical Center in New York City and her fellowship in pediatric endocrinology at Yale-New Haven Hospital/Yale School of Medicine in Connecticut.
About 25 percent of Dr. Palau-Collazo’s patients come in with diabetes issues, a chronic health condition that affects how the body turns food into energy. It occurs when blood sugar is too high and the body either does not make enough insulin or cannot use the insulin it makes as well as it should to turn the blood glucose into energy.
Type 1 diabetes is an autoimmune condition where the body attacks itself by mistake and stops making insulin – a hormone that regulates the movement of sugar into your cells.
Generally, there is no family history for this type of diabetes. Warning signs are excessive drinking, urination, abdominal pain and vomiting. Type 1 diabetes cannot be prevented or cured, and the patient will have to monitor their blood sugar often, count their carbohydrates and give insulin accordingly via an injection or through an insulin pump.
“I’ve had patients as young as 10 give themselves their own injections but most of the time the parent needs to be involved in the process,” Dr. Palau-Collazo said. “My own opinion is that if they aren’t old enough to drive, they aren’t old enough to be responsible for administering their own medication.”
Type 2 diabetes is a condition where the body does not use insulin well or produce enough insulin, and cannot keep blood sugar at a normal level. Often there is a family history with this type of diabetes.
“Type 2 diabetes used to be known as adult-onset diabetes, but today more children are being diagnosed with the disorder, probably due to the rise in childhood obesity,” according to Mayo Clinic. “There’s no cure for type 2 diabetes, but losing weight, eating well and exercising can help manage the disease. If diet and exercise aren’t enough to manage your blood sugar well, you may also need diabetes medications or insulin therapy.”
“I’ve had patients as young as 8 with type 2 diabetes,” said Dr. Palau-Collazo. “But, typically, this occurs in adulthood. Unfortunately, type 2 is aggressive and research has shown that if it is not treated the patient will need insulin within two years of onset. We want to prevent that from happening, so the earlier the diagnosis the better. We can change things around through healthy diet and exercise.”
One of the hallmark signs of insulin resistance which causes people to develop type 2 is acanthosis nigricans, or a darkening of the skin in body folds and creases like under the arms and around the neck and groin areas. “Parents think it’s dirt, but it’s actually the body telling us that it is having problems with sugar and if we don’t fix it, the child will develop type 2 diabetes,” said Dr. Palau-Collazo.
Childhood obesity can lead to diabetes, high blood pressure and high cholesterol. Currently, 20 percent of children are considered obese, mainly because of poor diet and overeating. “I’ve seen children as young as 1 or 2 who are obese,” Dr. Palau-Collazo said. “I don’t put kids on a strict diet but instead subscribe to portion control. Eating in moderation is the key. A simple rule of thumb is to make the servings of rice and pasta the size of your fist and servings of protein the size of your hand. Eat lots of fruits and vegetables, limit sodas and juices, and get plenty of exercise.”
An imbalance of other hormones in children can lead to problems with growth and development, metabolism, reproduction and sexual characteristics. “I’ve seen children as young as 5 already in puberty,” said Dr. Palau-Collazo. “We can medicate to arrest the process and once they are older, at a more acceptable age, we can stop the medication so they can continue to progress at a normal rate. This allows them to be little kids for a while longer.”
According to Dr. Palau-Collazo, the average age of puberty in girls is 10 ½ to 11 ½ and for boys it’s 11 ½ to 12 ½. Early puberty is identified in girls before the age of 8 and boys before the age of 9.
“For puberty and growth issues I administer a bone-age X-ray on the left hand which tells me how old the body thinks it is. Just as science teaches you that in order to know how old a tree is you have to cut the trunk and measure the rings, in order to know how old our body thinks it is we need to look at the bone X-ray,” she explained.
“If the patient is growing too quickly or going into puberty too early, their bones are going to look older than their chronological age. If a child’s growth is stunted, the bones will look younger than their age.” By comparing the bone X-ray to an atlas that shows the bone at different ages, she can figure out a diagnosis and treatment.
Children can also be diagnosed with genetic disorders caused by a change in the DNA frequency away from the normal sequence. They can be caused by a mutation in one or multiple genes, environmental factors or by damage to the chromosomes. Dr. Palau-Collazo sees a full spectrum of conditions and treats each one with professionalism and compassion.
“I always try to educate the parents, because treating a child is very different from treating an adult,” she explained. “What works in adults won’t necessarily work in children and they require individualized care and treatment.
“Their treatment becomes a family effort, so everyone needs to be involved.”
Dr. Palau-Collazo said the best advice she can give to parents is to keep up with the scheduled pediatrician appointments because the earlier a problem is detected, the earlier it can be addressed. Be your child’s best advocate. Ask questions. Seek advice. Knowledge is power and you as a parent have the power to help your child.
Dr. Palau-Collazo can be contacted at the Pediatric Endocrine Metabolic Center of Florida located at 9401 SW Discovery Way, STE 102, Port St. Lucie. The phone number is 772-834-7362.