Dayton Children's Growing Together Winter 2013

News for Families

Vol. 37, No. 1

The first breaths of life turn into a lifelong battle for one little boy Five-year-old Connor Block knows how critical air

Connor Block is now breathing easy, thanks to the pulmonary team at Dayton Children’s.

is to astronauts when they’re in space; he’s struggled to breathe his entire life. Due to a life-threatening condition, Connor was able to meet real astronauts at the Kennedy Space Center in Florida as part of A Special Wish Foundation. Connor’s journey started on March 3, 2007, when he was born.

Like most second-time mothers, Samantha, Connor’s mother, had no complications during pregnancy. “The minute Connor was born, I knew something was terribly wrong,” says Samantha. “There wasn’t a loud wail in the delivery room. Connor wasn’t breathing; he was bright blue and floppy.”

Continued on page 4

Put the brakes on distracted driving (Page 2) Ahhh choo! Get smart about antibiotics (Page 3) Photo taken at the National Aviation Hall of Fame, Dayton, Ohio.

Basketball player slam dunks asthma (Page 6)

Car seat safety… there’s an app for that!

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In today’s technology-driven world there seems to be an app for just about everything, and car seat safety is no exception. Thanks to the Kohl’s Cares for Kids® program, Dayton Children’s is proud to announce the launch of its car seat safety app.

With this free app, parents can enter their child’s height and weight to find out what type of car seat is best for their precious cargo. The app also has key facts on different types of car seats, car seat safety tips and installation help.

Scan this symbol with your smart phone to get the app.

The app can be used on iOS or Android and is available at http://kohlssafetyonthego.com.

Put the brakes on distracted driving continued from back cover…

Growing Together is published quarterly for parents and families in the Miami Valley area by The Children’s Medical Center of Dayton. The purpose of Growing Together is to show how Dayton Children’s and families are working together to keep all children healthy and safe. Additional copies of Growing Together are available by writing to Dayton Children’s, c/o Marketing Communications, One Children’s Plaza, Dayton, Ohio, 45404-1815 or by calling 937-641-3666. Your suggestions and comments are also appreciated.

For more information: Cert no. XXX-XXX-XXXX 937-641-3666 childrensdayton.org

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In fact, distracted driving has become a leading cause of crashes with approximately 16 percent of all distracted driving crashes involving drivers younger than age 20. Distractions may include talking on the phone or to passengers, texting, eating or drinking, reading, using a navigation system, or adjusting a radio or CD player.

“Texting is the most dangerous distraction because it involves manual, visual and cognitive distraction all at the same time,” says Thomas Krzmarzick, MD, medical director of the Soin Pediatric Trauma and Emergency Center at Dayton Children’s. “Sending or reading a text takes your eyes off the

road for approximately 4.6 seconds.

At 55 mph, that’s like driving the length of an entire football field, blindfolded.”

What can parents do to protect their teen? ●●Create ground rules for your teen, including curfew and the number of passengers allowed in the car at a time. ●●Make it clear that driving should

be done with minimal distractions. ●●Encourage the use of seat belts

and limit driving in bad weather. ●●Model safe driving behaviors

to show your teen that you are serious about limiting the number of distractions while driving.

What’s the law?

Teen drivers under age 18

In 2012, Ohio Gov. John Kasich signed a bill that makes it illegal for anyone younger than age 18 to use a wireless device for any reason while driving. Teens caught using a wireless device could be fined $150 and have their driver’s license suspended for 60 days.

What’s illegal for teens?

●●Talking on your cell phone,

Bluetooth, On-Star ●●Texting ●●E-mail ●●Using a laptop, computer or tablet ●●Using a GPS (unless it’s voice-

operated or hands-free) Adult drivers over age 18

It’s illegal for adults age 18 and older to write, read or send a text while driving in Ohio, which is punishable with a $150 fine.

For more information on Ohio laws on texting and driving, visit www.bmv.ohio.gov.

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Cert no. XXX-XXX-XXXX

Ahhh choo! Get smart about antibiotics Colds and infections tend to run

where treatment with antibiotics will not speed up improvement in the child’s health.”

Conditions or symptoms of viral infections, which do not benefit from antibiotics: ●●Cough, running nose with green or yellow mucus, fever ●●Chest cold or bronchitis in an

otherwise healthy child ●●Sore throat that isn’t strep ●●Fluid in the middle ear

Tips for treating a viral infection: ●●Rest ●●Staying hydrated

frightful, doesn’t mean kids have to stay inside. Outdoor exercise – even in the blistery chill of winter – can be fun and safe.

Make sure your child is properly dressed for winter activities, such as skiing, snowboarding and sledding.

Also, don’t discount using sunscreen in the winter months during outdoor sports activities. The sun’s rays can still cause a sunburn in the winter, especially when they reflect off of the snow.

Kids and teens should suit up in winter gear by sport: Ice hockey:

●●Helmet ●●Face mask ●●Mouthpiece ●●Shin pads, shoulder pads and

elbow pads ●●Safety glasses ●●Gloves that allow for mobility ●●Boys should add a supporter

and cup Skiing and snowboarding:

●●Helmet ●●Sunglasses or

goggles ●●Wrist and

knee pads

Seasonal Health Alert

●●Using a humidifier or

cool vapor mist ●●Avoiding secondhand smoke ●●Giving acetaminophen, ibuprofen

or naproxen to relieve pain or fever (used as directed).

Head-to-toe gear for winter sports safety Just because the weather outside is

3 healthbeat

rampant in the winter. Learn smart antibiotic use by recognizing the differences between a bacterial and viral infection.

If a child does not have a bacterial infection, antibiotics do more harm than good. Every time a child is given medication, their body’s tolerance to that medication builds, making it less effective. Therefore, the more frequently they are given antibiotics, the more ineffective antibiotics will be in fighting bacterial infections.

According to the U.S. Department of Health and Human Services, antibiotic resistance can cause significant danger for children and adults who have common infections that were once easily treatable with antibiotics.

“As the winter respiratory infection season begins, many parents tend to request antibiotics for their children when, in most cases, antibiotics are not needed,” says Sherman Alter, MD, medical director of infectious disease at Dayton Children’s. “Nearly all of these children will have viral infections

●●Waterproof gloves ●●Waterproof pants and jacket Ice skating:

●●Helmet ●●Gloves ●●Snow pants ●●Wrist and

knee pads, especially for beginners

Every breath you take COVER S TORY

4 “A child’s airways with 22q deletion typically improve as they get older,” says Gary Mueller, MD, pulmonologist at Dayton Children’s.

“Connor’s breathing has improved over time with treatment and medication.”

Connor was resuscitated and placed on a continuous positive airway pressure machine, which increases air pressure in the throat so the airway doesn’t collapse during breathing.

Connor was closely monitored before leaving the hospital. However, shortly after Connor was home from the hospital, it was evident his breathing was still a concern.

O

ver the next few weeks, he was failing to suck, swallow, and his breathing was almost like a wheezing,” says Samantha. “I felt like he was struggling to breathe every day, and he never cried because he wasn’t physically able to, which was terrifying.

At Connor’s four-week checkup, he still wasn’t back to his birth weight. Connor’s pediatrician, John Thomas, MD, at WrightPatterson Air Force Base where Samantha works, had concerns about his breathing. “My mother’s “

intuition kicked in and I took him to the emergency room at Dayton Children’s,” Samantha explains.

“Connor was admitted for failure to thrive, and that’s when his testing started with a swallow test.”

From the swallow test, Samantha learned what she suspected all along – Connor was aspirating.

When pulmonary aspiration occurs, food and liquid go into the lungs, which is often referred to as “going down the wrong pipe.”

“Connor was hardly able to eat,” says Samantha.” I had to literally take breast milk, put it in an oral

syringe and squirt it down his throat, since he had no suck reflex. Since he had so many problems swallowing, he would constantly gag.”

The pulmonary specialists at Dayton Children’s discovered Connor had tracheobronchomalacia, which is soft cartilage of the airways.

The soft cartilage keeps mucus in the lungs, which causes coughing, wheezing, infections, and in severe forms such as Connor’s, respiratory distress.

According to Gary Mueller, MD, pulmonologist at Dayton Children’s, healthy children cough up mucus,

breathing has improved over time with treatment and medication.”

However, thanks to the expert care at Dayton Children’s, Connor recently met a milestone – pulmonary specialists are no longer part of his regular care.

“Milestones for some children include a first sleepover,” says Samantha. “For Connor, it’s advancing so well with his respiratory problems, thanks to Dayton Children’s pulmonary team, he no longer has to be seen regularly.

That is something that’s definitely worth celebrating!”

At times, Samantha thought about moving back to Michigan where her family is from, but decided against it because of Connor’s

complex medical care. “If we moved back to Michigan, we would lose this invaluable care from Dayton Children’s that we have counted on,” says Samantha.

“From the moment Connor was born, we were thrust into caring for a critically-ill child who couldn’t breathe,” she shared. “It taught me that we didn’t have to drive hours to get the right care for Connor; we were fortunate that Dayton Children’s is right in our backyard.

They kept my son alive.”

5 DaytonChildren’s focus

but with the softening of Connor’s airways, he wasn’t physically able to cough and had extreme difficulty swallowing.

“Uncoordinated swallowing due to soft airways can cause someone’s diet to aspirate into their lungs, which can cause inflammation, damage and infection,” Dr. Mueller explains. “In turn, the infection can cause pneumonia, which can be extremely dangerous in small children. It’s a vicious cycle.”

“It was so frustrating because we knew things were wrong with Connor, but we didn’t have a name for his health issues,” Samantha shares. The pulmonary team referred Samantha to the genetics department at Dayton Children’s where she learned the cause of Connor’s severe respiratory distress was velocardiofacial syndrome, also known as 22q11.2 deletion syndrome. According to Dr. Mueller, pulmonary issues are rarely associated with 22q11.2 deletion.

“Connor’s soft airway cartilage was partially collapsing during his breathing cycle, which worsens when the lungs make more than normal amounts of mucus,” Dr. Mueller explains. “With infants, we use a percussion and postural drainage instrument, which gives high-frequency chest compressions to clear mucus from the lungs. We also use antibiotic therapy to avoid infections and breathing treatments as the child gets older.”

“In Connor’s first years of life, the pulmonary team at Dayton Children’s had to teach us how to keep him alive and educate our family on the signs of respiratory distress.”

According to Dr. Mueller, a child’s airways with 22q deletion typically improves as they age. “Now that Connor is age 5, the cartilage in his airways continues to firm and his

Today, Connor plays with friends, climbs trees and rides his bike like any other 5-yearold boy. Since birth, Connor had five cases of pneumonia, eight surgeries and countless hours of therapy.

2 2 q 11 . 2 D e l e t i o n F a c t s ●22q11.2 ● deletion syndrome is also referred to as velocardiofacial syndrome, DiGeorge syndrome, conotruncal anomaly face syndrome, Opitz G/BBB syndrome, CATCH 22 and Cayler cardiofacial syndrome. Multiple physician specialists initially described the condition, but genetic testing eventually revealed the same deletion on chromosome 22 was related to these conditions. ●22q11.2 ● deletion means there’s a small deletion or missing piece of chromosome 22 in the genetic makeup. ●22q11.2 ● is the second most common chromosome defect behind Down syndrome. ●22q11.2 ● is associated with more than 180 different symptoms and no two children have the same symptoms, making it difficult to diagnosis.

Basketball player slam dunks sports-induced asthma

6 Proper asthma medication before basketball helps Kristen Stryker, who plays post position at Franklin Monroe High School, breathe easy.

Kristen Stryker never thought she had asthma, she just assumed she was tired during basketball, until she collapsed one day during practice. Kristen, a sophomore at Franklin Monroe High School, is a starter for junior varsity basketball and is also a pitcher for varsity softball. But two years ago, she noticed she was short of breath during practice.

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“ t felt like I just couldn’t get enough air in my lungs,” Kristen says. “I thought I was just tired, so I asked my coach if I could step outside and cool down,” she shares. “When I walked outside into the cold air, I lost consciousness and collapsed.”

Kristen’s mother, Kathy, arrived at the high school just as the ambulance was pulling away. “In the ambulance, I couldn’t get her to respond to me,” Kathy says. “She looked right at me with tears running down her face.

Qu i c k t i p s f o r m a n ag i n g sp o r t s - i n duc ed a st hm a Sports-induced asthma doesn’t have to take kids out of the game. Sports-induced asthma occurs during aerobic exercising, such as running, playing football, basketball, soccer or other activities.

Symptoms include coughing, wheezing, chest tightness and shortness of breath, which are signs of an asthma attack. Symptoms usually worsen five to 10 minutes after stopping exercise – and can be “mild to severe.”

Tips for kids and teens with sports-induced asthma: zPlan z ahead. Many children and adolescents benefit from using a short-acting bronchodilator (rescue) inhaler 15 minutes before exercise. zTry z to avoid triggers. Exercising in air with high pollen and pollutant levels, smoke and strong fumes can cause an asthma attack (so can stress, respiratory problems and even the common cold).

zSteer z clear from cold. If the temperature is very cold, use a scarf to warm the air that’s breathed in. zWarm z up. Do warm-up exercises for 10-15 minutes. zTake z a break. Have breaks often, especially if the air outside is poor quality. zBreathe z through your nose. Children should practice breathing in and out of their nose, which warms, moistens and cleans the air. zGuzzle z often. Drink at least eight ounces (one cup) of water prior to exercise and for every 30 minutes of prolonged exercise. zWhen z to say stop. Stop exercising if asthma symptoms begin and use a rescue inhaler as directed by your doctor. zTake z it down a notch when the game is over.

It’s important to do cool down exercises and not stop exercising abruptly.

I have never felt so helpless and heartbroken because she looked so scared and I knew she was in pain.”

At Wayne Hospital where Kristen was transported after she collapsed, the Stryker family was initially told Kristen had acid reflux, which caused a panic attack. “Kristen never complained about acid reflux, which I thought was very odd,” Kathy shares. “When she was released from the hospital, she still didn’t feel ‘right.’ She couldn’t even walk up a flight of stairs without her chest hurting, so I took her the next day to our family doctor, Donald Pelsor, MD, who suspected she may have asthma and referred us to the pulmonary team at Dayton Children’s for further testing.”

According to Robert Fink, MD, pulmonologist at Dayton Children’s, children that have respiratory syncytial virus (RSV) before their first birthday have an increased risk of developing asthma later in life.

When Kristen was 5-months-old, she spent a week at Dayton Children’s with RSV, putting her at risk for developing asthma.

“The majority of adolescents, including Kristen, simply have asthma that’s triggered or aggravated by sports or exercise, which is why it’s referred to as ‘sports-induced asthma,’” explains Dr. Fink.

“Swimming in warm water causes the fewest symptoms, running in the cold air causes the most symptoms. Pediatric asthmatics usually have more frequent, severe attacks requiring emergency room and hospital care.”

According to Dr. Fink, sportsinduced asthmatics can have mild or severe symptoms, which include wheezing, chest tightness and pain, and a persistent cough, often in the middle of the night.

Dr. Fink put Kristen on a treatment plan, including a daily inhaler twice a day and an inhaler prior to exercise. “The treatment program for every asthma patient is individualized with the goal to control the asthma with the fewest side effects possible.”

Sports-induced asthma will be with Kristen for the rest of her life, Dr. Fink explains, and it’s not a condition that adolescents outgrow. “Adolescents with asthma can play competitive sports as well as anyone without asthma if their asthma is well managed.”

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newsbriefs

New physicians join the team Dayton Children’s welcomes two new physicians to our staff.

Daniel Shover, MD, joins Gastroenterology Pediatric

gastroenterologists are experts in the digestive system, liver or nutritional problems. ediatric gastroenterologists P generally provide treatment in a wide array of conditions from food allergies to reflux disease to nutritional problems, such as obesity or failure to thrive. Dr. Shover has more than 20 years of expertise in pediatric gastroenterology and is board certified in pediatrics and gastroenterology and nutrition.

Kristen, pictured with her mother Kathy, collapsed two years ago during practice due to an asthma attack. She’s rebounded thanks to the expert care at Dayton Children’s.

According to Kathy, having asthma hasn’t slowed Kristen down. “I’m grateful to Dr. Fink for helping Kristen manage her asthma so well. Sports is a big part of Kristen’s life and his treatment has helped her stay in the game.”

“Green” cleaning to minimize asthma triggers Asthma is the number one diagnosis for hospital admissions and a common reason for emergency room visits at Dayton Children’s, with more than 2,000 patients treated last year. “Minimizing exposure to asthma triggers in the home is the key to controlling asthma attacks,” says Belinda Huffman, pulmonary health and diagnostic coordinator. Use “green cleaning” as one way to avoid asthma attacks.

Four “green” cleaning tips: 1. Use your nose. Select cleaning products that don’t smell strong. Try to use as few cleaning products as possible.

2. Read labels. Avoid products marked “danger” or “poison,” and limit the use of products labeled “caution” or “warning.” Reduce the use of products containing volatile organic compounds (VOCs), which can irritate the lungs. These include aerosol sprays, cleaners, disinfectants, moth repellents and air fresheners.

3. Look for “green” products. Many products Make your own noncontain chemicals that children and adolescents toxic cleaners. Visit should avoid. our website for recipes 4. Make your own. Use inexpensive ingredients, for green cleaning. such as vinegar, baking soda, lemon juice, salt, soap and water.

Maryam Price, MD, joins Urgent Care – Springboro

Dayton Children’s welcomes Maryam Price, MD, to Urgent Care – Springboro, as the third pediatrician added, improving access to care after most physician offices are closed. Last year, the Urgent Care – Springboro treated more than 15,000 patients.

Examples of when to bring your child to Urgent Care – Springboro:

●●Cold or flu

●●Minor fractures

symptoms ●●Earaches ●●Fevers ●●Foreign object in the eye or nose ●●Migraines ●●Minor burns or bruises

●●Rash, poison ivy,

allergic reactions ●●Scrapes or minor

cuts ●●Sore throats ●●Sprains

Urgent Care – Springboro Address: 3333 West Tech Road Hours: Monday – Friday, 3:00 pm to 10:00 pm

Saturday and Sunday, 11:00 am to 8:00 pm

inside

this issue

3 Head-to-toe gear for sports safety

Nonprofit Organization U.S. Postage Paid Permit Number 41 Dayton, Ohio The Children’s Medical Center of Dayton One Children’s Plaza Dayton, Ohio 45404-1815

6 Basketball player slam dunks asthma

3 easy ways to donate now to Dayton Children’s!

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You can make a difference for kids right here in our region by donating.

1. Online www.childrensdayton.org/donate (or scan the symbol with your smart phone).

Tips for managing sports-induced asthma

2. Text “Kid Care” to 50555 to donate today.

3. Mail Dayton Children’s Development Department, One Children’s Plaza, Dayton, Ohio 45404-1805.

News for Families

Put the brakes on distracted driving Learning to drive is a rite of passage for many teens. However, with this new sense of freedom comes responsibility. According to the National Highway Traffic Safety Administration, teenagers are involved in three times as many fatal crashes as adult drivers. continued on page 2…

INSIDE:

Car seat safety... there’s an app for that! page 2 Get smart about antibiotics page 3

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