fall 2014
safety • health • injury prevention • nutrition • exercise
GETTING TO THE BOTTOM OF
BULLYING
You get the phone call every parent dreads — your child has been involved in a bullying incident at school. To your surprise, she was the aggressor. What do you do? Peer interactions often go awry. Accepting that your child may have acted out of line is difficult, but necessary. “Parents often believe being kind and respecting others is instinctual, but it’s not an automatic reaction,” said Natalie Walders Abramson, PhD, Pediatric Psychologist at Children’s Hospital Colorado. “What may be more instinctual is aggression, while kindness and respect require a conscious effort and coaching from adults.” If you learn your child is bullying others, remind him that bullying is never acceptable, and that any unkind or aggressive behavior has consequences. “Link the behavior with an appropriate consequence,”
Dr. Abramson said. “For example, if the bullying was online, a child should lose access to electronics or social media for an appropriate period of time. If the incident happened on the field, consult the coach and request your child be required to sit out a game or two as a consequence.” Talk with your child about what happened and help her walk through how she could have interacted in a different manner. Suggest other, more suitable ways of behaving, and encourage her to come up with non-bullying solutions that would have been a better alternative.
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AN OUNCE OF PREVENTION Dr. Abramson outlines four ways to take a proactive role in your child’s life to prevent bullying: •C onnect with the school. “Be a known presence in your child’s school. Make sure teachers and administrators are aware you want to know about any infractions, however minor, as soon as possible. Ensure that the school knows you care about your child’s social interactions as much as athletic and academic progress.” • Network with parents. “Stay in touch with parents of children in the same peer group. Notice conflicts that are emerging among the kids, and work with other parents to intervene at an early stage if relationships start to sour.”
• Watch your child. “Make sure your child knows you care about how he is interacting socially. There’s a careful balance between autonomy and regulating peer interactions online and in person, but keep a watchful eye within reason.” • Set an example. “It is important for parents to model what it means to be a good friend. Nurture adult friendships, and allow children to observe you being a good friend yourself, particularly when someone else is in need of more support.” To read more expert information about bullying, visit childrenscolorado.org/bullying.
“People tend to be reactive rather than proactive. If a child is on the receiving end of maltreatment, parents are likely quick to react. But if your child is the aggressor, that’s harder to face and takes strategic effort to address.” — NATALIE WALDERS ABRAMSON, PHD, Pediatric Psychologist at Children’s Hospital Colorado
The Main Offenders Bullying is any unwanted, aggressive behavior that involves a real or perceived power imbalance. There is a substantial range in the intensity and impact of bullying, from mild taunting to overt physical violence. The three most common types of bullying are: • Verbal — teasing, name-calling, inappropriate comments or threats of violence • Social or relational — excluding someone on purpose, telling other children not to be friends with someone, spreading rumors or embarrassing someone in public • Physical — hitting, kicking, pinching, spitting, tripping or pushing Bullying can happen after or during school as well as online. Online bullying, called cyberbullying, can be messages posted anonymously and sent quickly to many people. Once these messages have been sent, deleting any comments or pictures from the Internet is incredibly difficult, so discuss these dangers with your child as he or she becomes more technologically savvy. Moreover, monitor your child’s online interactions frequently and set limits on the amount of time he or she spends engaging in social media. Encourage more face-to-face peer interactions.
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Barton D. Schmitt, MD, FAAP, is a Board-Certified Pediatrician at Children’s Hospital Colorado and author of our free app, ChildrensMD, now available for iPhone and Android devices.
Written by Barton D. Schmitt, MD, FAAP, author of My Child Is Sick!, American Academy of Pediatrics, Denver, CO. Copyright 2000–2014.
TEMPER TANTRUMS:
Don’t Respond in Kind No matter how calm and gentle a parent you are, your child will likely go through a tantrum phase as a means of dealing with frustration.
A temper tantrum is an immature way of expressing anger. Teach your child that tantrums don’t work and that you won’t give in to his demands because of them. By 3 years of age, your child should be able to verbalize her feelings. For example, a parent should say, “You feel angry because...” and let the child complete the thought. Teach your child that anger is normal, but it needs to be kept in check. Also, be a good role model. When you’re angry, don’t yell or have adult tantrums.
TRY THE FOLLOWING RESPONSES TO DIFFERENT TYPES OF CHILDHOOD TANTRUMS. Frustration-related tantrums: Offer to help. A child may have a tantrum when he is frustrated by his limitations, such as being unable to assemble something. Put an arm around him and say, “This looks really hard. Do you want me to help?” Fatigue/hunger-related tantrums: Encourage a nap or snack. A child tends to have more tantrums when she’s tired. At these times, put her down for a nap. Hunger can also contribute to tantrums. If you suspect this, give her a snack. Temper tantrums also normally accompany sickness. Demanding tantrums: Ignore them. A young child may throw a tantrum to get his way. He may want to go with you rather than be left with the sitter, or want to empty your desk drawer. Tantrums can include whining,
screaming or flailing about. As long as your child stays in one place and is not too disruptive, you can leave him be. Move away, even to a different room. Don’t try to reason with your child. Once a tantrum has started, it usually can’t be stopped with words. When your child no longer has an audience, the tantrum will usually wind down. After the tantrum, be friendly and try to return things to normal. Refusal tantrums: Gently move your child. If your child needs to do something important, such as go to bed or to child care, she should not be able to avoid it by having a tantrum. Once a tantrum has begun, let your child carry on for a few minutes. Try to put her displeasure into words: “I understand you want to play some more, but it’s bedtime.” Then escort her to the intended destination (for example, the bed), helping her as much as is needed (including carrying her). Aggressive tantrums: Give a time-out. Aggressive behavior should never be ignored. When dealing with a forceful tantrum, send or take your child to his room for a time-out until he calms down. Examples of aggressive behavior that should not be tolerated include: • Hitting • Throwing something or damaging property • Following you during the tantrum Call your doctor during office hours if these tantrum tactics do not bring improvement within two weeks.
childrenscolorado.org | 3
a tiny
HEART,
A TON
t r o p p u S of
When Janelle Jackson and her husband, Mario, learned their son had a congenital heart defect, the Colorado Springs residents turned to the experts at Children’s Hospital Colorado to ensure he received the best start toward a healthy life. Just shy of Janelle’s 20th week of pregnancy, she and Mario received devastating news — a routine blood test revealed their son, Jadon, had a birth defect. The Jacksons were referred to Children’s Hospital Colorado at Memorial Hospital Central. There, Janelle saw Mark Alanis, MD, a maternalfetal medicine specialist, who recommended further genetic screenings to determine exactly what was wrong. “Following the blood test results, we suspected Jadon had Down syndrome,” Janelle said. “When Dr. Alanis delivered the results, however, he was accompanied by Dr. [Chad] Stewart [MD, Pediatric
Cardiologist at Children’s Hospital Colorado Outpatient Specialty Care at Briargate], who told us our son had a congenital heart defect known as tetralogy of Fallot.”
STEPS TO RECOVERY Tetralogy of Fallot is a congenital heart defect consisting of four heart abnormalities, including a hole between the ventricles — the two lower pumping chambers of the heart — and an obstruction or narrowing in the pulmonary artery, which delivers blood to the lungs. As a result, babies with tetralogy of Fallot have low oxygen levels, which can cause dangerous complications. To treat this condition, surgery is required.
Serving Colorado Springs In addition to Children’s Hospital Colorado at Memorial Hospital Central, a full-service hospital that provides pediatric and neonatal intensive care, Children’s Hospital Colorado also has an outpatient facility in Colorado Springs — Children’s Hospital Colorado Outpatient Specialty Care at Briargate. This facility provides south Colorado families like the Jacksons access to specialty care near their home. Specialties include pediatric cardiology, endocrinology, gastroenterology, hematology and oncology, neurology, urology, and physical and speech therapy.
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Caring for the WHOLE Family When Mario and Janelle Jackson arrived at Children’s Colorado on the Anschutz Medical Campus in Aurora for their son Jadon’s surgery, a hospital liaison greeted them immediately and helped them navigate the hospital. Following surgery, the Jacksons were impressed with the nursing staff who provided exceptional care, including postoperative education on how to bathe Jadon and care for his incision. “From day one, every member of the team was respectful and treated our entire family with compassion,” Janelle said. “As soon as we met the medical team, we had no doubt Jadon was going to be fine.”
At the Heart Institute at Children’s Colorado, physicians have specialized expertise managing a variety of congenital heart defects, including tetralogy of Fallot. Care begins before birth with more frequent imaging tests, including fetal echocardiograms to visualize the baby’s developing heart. Doctors also work closely with families to ensure parents understand the diagnosis and know what to expect following delivery. “Prior to Jadon’s birth, we performed multiple echocardiograms to determine if his prenatal growth, including overall heart function and lung development, was progressing as expected,” Dr. Stewart said. “During those visits, we also counseled the Jacksons on the type of surgery Jadon would need and when and where they should plan to deliver.” In Janelle’s case, doctors originally planned to induce her labor, but an unexpected problem with her umbilical cord required an emergency cesarean section. Jadon was born on March 11, 2013, at Children’s Colorado at Memorial Hospital. “Inducing labor meant the medical team would be present at the time of Jadon’s birth,” Mario said. “When Janelle’s cord prolapsed, the plan changed, but the team was still able to examine Jadon as soon as he was born and perform further measurements and tests to determine exactly when he would need surgery.” Following his birth, Jadon spent two weeks in the neonatal intensive care unit at Children’s Colorado at Memorial Hospital, where Dr. Stewart and his partners monitored his oxygen levels and performed another echocardiogram to confirm the diagnosis. Dr. Stewart continued to monitor Jadon’s condition closely following his discharge from the hospital until his surgery on Sept. 11, 2013. James Jaggers, MD, Chief of Pediatric Cardiac Surgery at Children’s Colorado, performed the open-heart procedure in Aurora on the Anschutz Medical Campus. It was a success, and Dr. Jaggers was able to close the hole between the ventricles in Jadon’s heart and enlarge the right ventricular outflow tract leading to the pulmonary artery, enhancing blood flow. Seven days after surgery, Jadon was able to return home to Colorado Springs, where he continues to see Dr. Stewart regularly. “Jadon has done remarkably well following his surgery,” Dr. Stewart said. “I expect him to lead a normal life, be able to play sports and do everything else boys his age like to do.” To learn more about the Heart Institute at Children’s Hospital Colorado and the conditions treated there, visit childrenscolorado.org/heart.
Why Do Outcomes Matter? At Children’s Hospital Colorado, outcomes for treatment of congenital heart defects consistently exceed national averages. That means that your child is likely to do better after surgery and go home sooner. Mortality rates measure deaths — either general or due to an identified factor — scaled to the size of a population per a set period of time. At Children’s Colorado, deaths following cardiac surgery are less than half the national expected mortality rates, and length of stay following surgery is shorter than expected. “Treatment of congenital heart defects is a highly specialized, complex area of medicine that requires providers skilled in cardiac surgery, anesthesia and critical care,” said James Jaggers, MD, Chief of Pediatric Cardiac Surgery at Children’s Colorado. “It’s important for families to understand the outcomes of each individual institution so they ensure the best outcome for their child. There are very few centers across the country that provide as good care as Children’s Colorado.”
childrenscolorado.org | 5
TAKING CONTROL OF FOOD ALLERGIES If your child has a food allergy, preparation is vital.
more than
TUMMY
TROUBLES? Edwin Liu, MD, Pediatric Gastroenterologist and Director of the Center for Celiac Disease at Children’s Hospital Colorado, answers common questions about celiac disease. Q: “I’m confused — is celiac disease an allergy, an ‘intolerance’ or something else?” Dr. Liu: There are many terms for gluten-related disorders. I prefer three categories: celiac disease, non-celiac gluten sensitivity (NCGS) and gluten allergy. Celiac disease is an autoimmune condition triggered by gluten and requires a strict gluten-free diet to manage. Q: “My child sometimes has abdominal pain and bloating. Is it celiac disease?” Dr. Liu: Mention these symptoms to your pediatrician or child’s primary care provider. There is a very good screening test for celiac disease. A positive result doesn’t necessarily mean your child has celiac disease, but rather that he or she should be evaluated further. Q: “My child has celiac disease, but rarely has symptoms. Is a glutenfree diet necessary?” Dr. Liu: Celiac disease not only
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causes overt symptoms — such as diarrhea, abdominal pain, bloating, vomiting and poor growth — but also more subtle, long-term effects such as osteoporosis, anemia, delayed puberty and even infertility. The diet — which is absolutely necessary — helps prevent these complications. Q: “I feel sure my child has celiac disease. Should I try a gluten-free diet on my own?” Dr. Liu: It is important to test first. The gluten-free diet is not inherently healthy, and when done incorrectly, it can lead to poor control of celiac disease or nutritional complications. A gastroenterologist should monitor celiac disease management for effectiveness and safety. Suspect gluten is the source of your child’s tummy troubles? The Center for Celiac Disease at Children’s Colorado can help. To learn more, visit childrenscolorado.org and search “celiac disease.”
When Jadin, 12, was given a cookie by a classmate, she was told it didn’t contain nuts. Unfortunately, Jadin and her friend didn’t realize it was a peanut butter cookie. After one bite, Jadin immediately felt an uncomfortable tingling in her mouth and throat followed by difficulty swallowing and a stomachache. Fortunately, Jadin had been prepared by her parents and had a Food Allergy Action Plan in place at her school that allowed immediate individualized treatment.
WHAT ARE FOOD ALLERGIES? Food allergies can cause itching of the mouth and throat, throat tightness, nausea, vomiting, abdominal pain, sneezing, wheezing, itchy skin, hives, and, in rare cases, death. Taking proper precautions and having a plan of action can aid in effectively managing this chronic condition. “By definition, accidents are always unexpected,” said Dan Atkins, MD, Allergy Section Chief at Children’s Hospital Colorado. “Having a personalized Food Allergy Action Plan and teaching children and their caretakers how to respond quickly to an accidental ingestion is an important part of keeping them safe.” A Food Allergy Action Plan is best developed with the child’s physician and distributed to all the child’s caretakers. The following information should be included: • Foods that present a risk • Possible symptoms • Which medicines and the dose to administer based on observed symptoms • Emergency contact information (physician and parents) Take control of allergies today. Learn more about the Children’s Hospital Colorado Allergy Program at childrenscolorado.org/ departments/allergy-program.
certificate for certificate being a good friend
for being a good friend presented to:
presented to: be a
for: signed by
date: "
by: Talk with your child about the signs of bullying and reward them for being a good friend. Download and print additional certificates at childrenscolorado.org/BeAFriend
SPEAK
UP if you are being bullied or see someone else being bullied Learn more about bullying and positive parenting at childrenscolorado.org. Many hands, one heart.
Stay with other kids and adults,
so you aren’t alone with a bully
Be a friend to people being bullied and don’t be afraid to ask your friends, parents or teachers for help if you need it
Nonprofit Organization U.S. Postage PAID Denver, CO Permit No. 4081
Anschutz Medical Campus 13123 East 16th Avenue Aurora, Colorado 80045
Children’s Hospital Colorado | (720) 777-1234 | childrenscolorado.org This publication in no way seeks to serve as a substitute for professional medical care. Consult your physician before undertaking any form of medical treatment or adopting any exercise program or dietary guidelines.
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