Dayton Children’s Medical Center - Growing Together Newsletter

News for Families

The Children’s Medical Center of Dayton

Fall 2008

Vol. 32, No. 3

2 Five tips for active kids

Back to school – Four areas that need your attention

4 Making the best choice for emergency care

6 Taking care when taking pictures

1. Making the first day easier Whether going Seasonal to a new school Health Alert or just having back-to-school jitters, kids will need your help in making the change easier. ● Remind your child he or she is not the only child feeling uneasy the first day of school. Teachers know that students are anxious and will work hard to put kids at ease. ● Point out the fun things back to

● If it helps your child, consider

driving your child or walking with him or her the first day.

2. Backpack safety ● When shopping for backpacks, choose one with wide, padded shoulder straps and a padded back. ● Pack light. Organize the back-

pack to use all compartments. Put heavier items closest to the center of the back. The backpack should not weigh more than 20 percent of your child’s body weight.

3. School bus, bike and walking safety School bus

● Wait for the bus to stop before

approaching the curb. ● Do not move around on the bus. ● Always check for traffic before

crossing the street. ● Make sure the bus driver can

see you and you can see him or her before crossing.

Bike

● Always wear a bicycle helmet,

school brings – seeing old friends, making new friends, activities your child enjoys.

● Always use both shoulder straps.

Using just one shoulder strap can cause back problems.

● Find another child in the neigh-

● Ride on the right in the same

● How about a rolling backpack?

direction as traffic.

If your child does not have to go up stairs, this may be a good solution.

continued on page 2…

borhood or a friend your child may ride the bus or walk with.

even if it’s a short ride to and from school.

Back to school

2

continued from page 1…

● Use correct hand signals so driv-

ers know what you are doing. ● Wear bright clothing so drivers

can see you. ● Follow the rules of the road.

Walking to school

FREE e-news Sign up for Dayton Children’s e-newsletter FamilyWise to receive FREE health and safety information.

Join hundreds of other parents receiving this monthly newsletter by e-mail.

Go to www. childrens dayton.org; click on “E-newsletter.”

If you prefer, call 937-641-3620.

Growing Together is published quarterly for parents and families in the Miami Valley area by The Children’s Medical Center of Dayton, One Children’s Plaza, Dayton, Ohio, 45404-1815.

Visit our website at www. childrens dayton.org – your online source of child health and safety information.

● Make sure your child’s walk to

Five tips for active kids There’s no question that physical activity is good for kids. Despite kids’ full schedules these days, it’s apparent many do not include physical activity in those schedules.

James Ebert, MD, a physician in Dayton Children’s lipid clinic, believes there are many ways families can work physical activity into their daily schedules.

“Maintaining a healthy weight requires lifestyle changes that include good nutrition and activity,” he says. “These lifestyle changes affect the entire family.”

Dayton Children’s joins Kohl’s Department Stores in bringing you this information from the Kohl’s A Minute for Kids campaign.

1. Make it challenging Children love competition. You can make activities challenging to them by having contests. If you are watching TV, see how many sit-ups or pushups they can do during a commercial. Make a game out of common tasks like cleaning up the backyard.

Incorporate little fitness challenges into daily activities.

2. Create opportunities Some kids

may not like team or group activities, but may excel in activities such as

active video games. Look for creative ways for your child to be active – both individually and in groups.

3. Get outside Simply getting outside and breathing fresh air is a great way to spend time with your family and become more active.

Walk the dog, go to the park, take a hike or a bike ride as a family. Spend the time you do have as a family outside doing something a little out of the ordinary.

4. Play During the last days of summer, kids don’t want structure.

Remember that being active doesn’t always require a structured schedule.

Choose activities that your children will enjoy and that fit their interests.

5. Be a role model Parents need to

lead by example. Remember, your children are always watching you.

Make sure that you are also participating in competition and playing with your children. If they see you having an active lifestyle they will want to do the same.

For more health and safety tips, visit the Dayton Children’s website. Click on Health Topics and/or Safety Tips. We also offer podcasts on key topics.

For more health and safety tips, including seasonal health alerts, visit our website at www.childrensdayton.org. Go to Health Topics and Safety Tips.

Join FamilyWise to receive monthly health and safety tips by e-mail.

school is a safe route. Well-trained adult crossing guards should be present at every intersection. ● Know your child’s skills. Young

children can be impulsive and unaware of traffic dangers. Be sure your child is mature enough to walk to school alone. Talk to your child’s doctor if you’re not sure. ● Bright-colored clothing will help

drivers see your child.

4. Bullying When one child repeatedly picks on another, this is bullying. Help your child respond to a bully. ● Tell your child to look the bully in the eye. ● Stand tall and stay calm. ● Walk away. ● Teach your child to say • “I don’t like what you are

doing.”

• “Please do not talk to me like

that.” ● Teach your child when and how

to ask for help. ● Encourage your child to make

friends with other children. ● Support activities that interest

your child. This will strengthen his or her self-esteem. ● Let school officials know if there

is a problem.

These tips were provided by the American Academy of Pediatrics and approved by the experts at Dayton Children’s.

Six rules for bunk beds Kids love bunk beds, but if your

● 93.5 percent of injuries occurred at

child is using one, Dayton Children’s joins the Consumer Product Safety Commission in improving bunk-bed safety.

to climb into bunks, not chairs or other furniture. Never allow children to jump from the top bunk.

home.

Six bunk-bed safety tips 1. Keep kids younger than 6 years in the bottom bunk.

to help your child see when getting out of the bunk during the night.

● Half of all bunk-bed injuries happen

5. Keep bunks away from ceiling

to children younger than 6 years old.

4. Consider a nightlight or flashlight

2. Always use two side guardrails on

fans or light fixtures.

the upper bunk – even when your child gets older.

Dayton Children’s Regional Pediatric Emergency and Trauma Center treated 45 children last year for bunk-bed injuries. Nationally, 572,580 children and adolescents were treated for injuries from bunk beds.

How are kids injured? ● Head and neck injuries are the most common injuries in all age groups. ● Most – 72.5 per-

cent – of injuries were caused by falling out of bunk beds.

Is your house paint safe?

During the summer and fall, many families are making home improvements. One of these may be painting your house. Whether you do it yourself or hire a professional, be aware of the following dangers: ● Houses built before 1978 may have paint that contains lead. Chipping and peeling paint may be swallowed by young children. If you rent, let your landlord know about peeling and chipping paint. ● Clean up paint chips immediately. ● If removing lead-based paint from

your house: • Keep everyone away from work

areas. Change your sleeping, cooking and living areas if work is being done there.

• Seal off work areas with plastic

so dust does not go throughout the house.

• Keep pets safe too. They can

also be affected by lead.

• Have the workers use a separate

pathway to the work area.

• Turn off forced air heating or

air conditioning while work is being done.

Talk to your child’s doctor if you live in an older home. He or she may suggest your child should be tested for lead poisoning. A special blood test is the only way to know for sure.

The laboratory at Dayton Children’s offers lead testing.

● Incidents outside the home occur in

dorms and other public facilities. Half of those injuries involved individuals 18 – 21 years old.

Visit Dayton Children’s website for more information on bunk bed safety.

Go to Safety Tips.

3 healthbeat

3. Teach children to use the ladder

When children share your bike Before heading for the bike path with your youngster riding tandem, be aware of the safety concerns about this practice.

A young passenger on an adult’s bike makes the bike unstable and increases braking time. And that increases the risk of an accident. The American Academy of Pediatrics recommends young children ride in a bicycletowed child trailer.

Remember – ● Only adult cyclists should carry young passengers. ● Ride with passengers on bike paths, in parks or on quiet

streets. Avoid busy streets and bad weather. ● Infants younger than 12 months are too young to sit in

a rear bike seat and should not be carried on the bicycle.

Do not carry infants in backpack or front packs while riding a bike. ● Children who are old enough

(12 months to 4 years) and sit well unsupported can be carried in a child trailer or rear-mounted seat if they are wearing a lightweight helmet. These small Styrofoam helmets that meet Consumer Product Safety Commission standards are readily available. ● Strap the child into a

rear-mounted seat with a sturdy harness.

4

When your child needs emergency care:

Making the

best choice

Angie Davidson of Hamilton with daughter Kadie, who is recovering from a head injury after a fall from bed.

Five reasons to choose Dayton Children’s ED 1. Specially trained and experienced staff 2. Life-saving equipment to fit children of all ages and sizes 3. We are the Regional Pediatric Trauma Center.

4. Access to pediatric specialists 5. Child life specialists help put kids at ease

Choosing emergency care for your child is not a decision to make during an emergency. Instead, the experts at The Children’s Medical Center of Dayton recommend you learn about your options before an emergency occurs.

W

hen Angie Davidson’s infant daughter Kadie fell off the bed during a diaper change, she first headed for the family doctor. After an examination, the Hamilton, Ohio mother and child were sent to Dayton Children’s Specialty Care Center in Middletown for x-rays.

Images revealed a skull fracture, and the Davidson’s were sent to the hospital’s Regional Pediatric Trauma and Emergency Center where a CT scan revealed a blood clot on Kadie’s brain. Laurence Kleiner, MD, a pediatric neurosurgeon at Dayton Children’s, performed surgery to remove the clot.

“With a 5-month-old, it’s hard to tell something is wrong,” Angie recalls. “Kadie seemed fine to me.”

“Children respond differently to illness, injury and treatment than adults,” says Tom Krzmarzick, MD, medical director of Dayton Children’s Regional Trauma and Emergency Center. “The closest emergency care may not always be most appropriate for children.”

Families who are a significant distance from a pediatric hospital are advised to go to the nearest emergency department. The staff there can stabilize their child and have Dayton Children’s transport team take the child to Dayton Children’s.

What do parents need to think about?

1. Before an emergency comes up, choose an emergency department (ED) that is child-friendly. Dayton Children’s has the doctors, nurses and other staff who know how to treat, comfort and reassure children and their families. The ED at Dayton Children’s has life-saving equipment in different sizes and our staff can quickly talk to other pediatric specialists in order to give your child the best care possible. This makes a difference in an emergency.

2. Call your child’s doctor. He or

she can tell you whether to go to the hospital or urgent care right away or if you can wait for an office visit. The doctor can also help you treat your child at home.

3. Understand what services your

insurance plan will cover. Your plan may ask that you call your child’s doctor first in order for services to be covered.

4. Know the fastest route to the ED.

5

It is difficult to think clearly in an emergency.

5. Do not give your child anything

6. Leave other children at home if

possible. Your sick child will need your full attention.

What should I bring with me?

1. Your insurance card.

2. Money. Your cell phone may not

work in all areas of the hospital, so you may need to use a pay phone.

3. A list of your child’s medications,

allergies and medical history. By putting this together ahead of time, there is no delay in an emergency.

This is very important if your child has a chronic condition such as asthma or special needs.

4. Your child’s favorite toy, blanket

or game. Depending on your child’s situation, there may be a wait.

What do I do when I bring my child to the ED? 1. Check in. A specially trained nurse (triage nurse) will talk to you about your child’s condition. It is important to give this nurse as much information as you can to determine how soon your child can be seen.

2. Understand that the sickest chil-

dren are seen first. Because Dayton Children’s is a trauma center, ambulances and air transport will bring children in for treatment. Because they come directly to the trauma center, you will not see them arrive. If you think your child is getting sicker, please talk to a nurse right away.

3. If your child is very sick and

rooms are available, he or she will go to an exam room right away. Many times, you and your child will stay in the waiting area until called back.

4. The ED staff works hard to keep

families together during treatment.

Distraction techniques are just one way the staff in Dayton Children’s emergency department help kids feel more comfortable during treatment. (L-R, Elizabeth Briscoe, PCA, Olivia Balsamo, Sasha Mosel, RN, and Melissa Balsamo)

Generally, two people are permitted in the exam rooms with the child.

5. If your child needs tests, these

will be ordered. Depending on the time of day and tests needed, this could take awhile.

6. If your child needs to be admitted

to the hospital, the ED doctor will talk to your child’s doctor. If your child’s doctor agrees with the ED doctor, the admission process begins.

How can I help with my child’s care?

1. Tell the doctors and nurses everything you know about your child’s situation. The more information you can provide, the better they can treat your child.

2. Ask about ways to ease your

child’s pain. Dayton Children’s has ways to make procedures pain-free or less painful.

3. Ask questions, especially about

continuing care at home. During your visit or before you leave be sure to ask: ● What is my child’s main problem? ● What do I need to do? ● Why is it important that I do this?

4. Comfort your child. Let your

child know what is going on. Help distract your child by playing games or deep breathing. A child life specialist works in the ED during busy hours. She can provide distraction therapy to kids and help them prepare for any procedures.

DaytonChildren’s focus

to eat or drink in case your child will need to be sedated or have tests done.

5. Talk to your child’s doctor after

the emergency visit. Your child’s doctor will want to know the diagnosis and to put this information in your child’s medical file.

The staff in the Regional Pediatric Trauma and Emergency Center treated more than 52,900 sick and injured children last year.

This level of experience is unmatched in our region.

“Every member of our team has special training and experience in treating infants, children and teens, whether they are a doctor, nurse, child life therapist or social worker,” says Dr. Krzmarzick. “We are here 24/7 so that children get the best emergency care available.”

Angie Davidson of Hamilton is grateful for the care Kadie received.

“This was the scariest thing in my life, but you guys did a great job.”

Other things to remember If your child has special needs or if others will be caring for your child (relatives, for example), there are forms that will help your child get the best care in an emergency.

Go to: www. childrensdayton.org, Patient & Visitor Info – Forms. These forms are listed in the center of the page.

6

When doing medical imaging, Dayton Children’s is

Taking care when taking pictures Nathan Ormsby of Beavercreek has undergone more imaging tests than many children his age. The 5-year-old is a regular in the medical imaging department at Dayton Children’s since being diagnosed in August 2006 with stage IV neuroblastoma (a cancer of the peripheral nervous system that appears as a solid tumor).

O

n this rainy afternoon, Nathan shows off his dinosaur umbrella to the staff before turning it into a sword and having some typical 5-year-old sword play. He is at Dayton Children’s with his mother Rachel for just one of the tests he is having this week.

Earlier in the week he had a CT scan and chest x-ray. Today, he receives an injection as part of the MIBG scan that will be done tomorrow. This scan uses radioactive meta-iodobenzylguanidine (MIBG).

The MIBG attaches to neuroblastoma cells after going into the bloodstream and helps doctors determine if the tumor has spread.

“Nathan has had CT scans, x-rays, MRI*, ultrasound, bone scans, nuclear medicine tests. I think he’s had every imaging procedure you have here,” Rachel says. For that reason, she is grateful that Dayton Children’s takes care to minimize radiation doses.

Katie Lasance, nuclear medicine tech, explains a test to Nathan Ormsby and his mother Rachel.

For FAQs about medical imaging safety, visit our website at www.childrensdayton.org. Go to Services – Medical Imaging.

* Note: MRI does not use radiation, so it is a good alternative to discuss with your child’s doctor if imaging tests are needed.

NATHAN’S STORY Since being diagnosed with stage IV neuroblastoma in August 2004, Nathan Ormsby has been treated by Mukund Dole, MD, in Dayton Children’s hematology/oncology department.

Neuroblastoma is the most common solid tumor (besides brain tumors) in children. It is often diagnosed before a child is 1 year old. It accounts for about seven percent of childhood cancers.

Since being diagnosed, Nathan has had at least 14 rounds of chemotherapy, MIBG treatment (this procedure uses a high-dose of MIBG to treat neuroblastoma), radiation, bone marrow transplant and antibody treatment. Dr. Dole coordinates Nathan’s care, which has included special treatments at other facilities.

Dr. Dole says that Nathan’s disease is now stable, but he will continue with ongoing therapy as his condition is monitored.

7 DaytonChildren’s focus

“The actively growing tissues in children are more sensitive to radiation,” says Elizabeth Ey, MD, medical director of medical imaging at Dayton Children’s. “Because a child’s life expectancy is longer compared to an older adult, the effects of radiation exposure last longer in a child. Doctors who image children should make sure they receive child-sized doses. More is not always better.”

Lower radiation doses is not the only reason children should be treated at a pediatric facility.

The Ormsby’s occasionally use an adult facility for a specialized treatment.

“It’s hard for kids to be around sick adults,” says Rachel. “We notice there are not the same smiles, the patience with children or the toys.

The staff at Dayton Children’s expects kids to be kids. That’s huge!”

She explains that the staff has let Nathan look at his scans “because he wanted to see them. They know kids are curious.” Nathan’s care requires that the medical imaging staff work with others in the hospital such as the lab or the hematology/oncology clinic. It’s a benefit that everyone is close by.

“The medical imaging department is awesome. They are on their game. Everything is in order when we arrive and if it’s not, they make it right,” Rachel says.

While Nathan and Rachel wait for today’s test, Nathan finds two trucks to play with, pours his own apple juice and agrees to share a piece of advice for other kids coming to Dayton Children’s.

“Don’t be afraid,” he says. “The doctors and nurses are nice and there are lots of things to play with.”

Community child health needs Every three years, Dayton Children’s conducts a community health assessment to determine the child health needs in our area. The 2008 study, funded by the Dayton Children’s Foundation Board, shows great strides in the area of safety as a result of some strong awareness and education programs. However, it also points to some continuing areas of concern about the health of the region’s children: Almost 1 in 4 children are overweight – caused by a lack of proper nutrition and physical activity. ● Allergies or asthma continue to affect almost 1 in 5 area children; over 1 in 10 children have been diagnosed with developmental delays/learning disabilities. ● Nearly 1 in 10 children ages 6 to 14 has not had a dental visit within the past year. ●

For complete findings, visit our website. Click on Advocacy.

The Children’s Medical Center of Dayton One Children’s Plaza Dayton, Ohio 45404-1815

8

Please deliver to current resident.

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, 454041815 or by calling 937-641-3666. Your suggestions and comments are also appreciated.

David Kinsaul, FACHE President and Chief Executive Officer Vicki Giambrone Vice President, Marketing and External Relations Susan A. Brockman Editor Tom Suttman Photographer

newsbriefs Technology protects newborns’ brains Dayton Children’s is

one of just 28 hospitals in the country offering the Olympic Cool-Cap System to prevent or reduce the severity of neurological injury in newborns.

Until now, there were few options for treating the results of reduced blood flow and oxygen to the brain.

“Selective head cooling with CoolCap is a welcome innovation to the Regional Newborn Intensive Care Unit at Dayton Children’s,” says M. David Yohannan, MD, medical director of newborn medicine. Go to our website – Media Center – Media Releases – for more information.

Pain Busters helps children cope A program to reduce pain dur-

ing procedures will be started soon at Dayton Children’s. Pain Busters is the result of a multidisciplinary team examining best practices in pain relief during procedures.

“At Dayton Children’s we believe no child should suffer when his or her pain can be relieved,” says Amit Vohra, MD, critical care medicine. “If a child has a good experience with a procedure, he or she will be less anxious if future procedures are needed.”

Best practices include distraction during uncomfortable procedures and

positions of comfort – proven ways of holding a child that will reduce pain and anxiety.

Sedation and topical medications are also important options. Staff will continue to use a pain scale to help children identify their level of pain.

New specialists join staff Paul S. Potter, MD, has joined the

department of anesthesiology at Dayton Children’s.

Dr. Potter is board certified in anesthesiology. He received his anesthesiology training from the United States Naval Hospital and Harvard Medical School. Dr. Potter has been in practice for 18 years.

Patrick A. Sobande, MD, joined the department of pulmonary medicine after completing a fellowship in pediatric pulmonary medicine. He is board certified in pediatrics and was recently selected to the Consumers’ Research Council of America’s top pediatricians.

One of his special interests is asthma treatment.

Mark Warren, DO, joined the medical imaging department after completing his fellowship in pediatric radiology.

He is board certified in diagnostic radiology and has a certificate of added qualification in pediatric radiology.

Dr. Warren has a special interest in interventional radiology.

Coming to your neighborhood Dayton Children’s will be opening new locations in Vandalia and Springboro.

Nonprofit Organization U.S. Postage Paid Permit Number 323 Dayton, Ohio

Outpatient Care Center – Springboro will open in the fall of 2008. The center will be located just off the future Austin Road exit from I-75 on West Tech Road near the Dayton General Airport. Urgent care, lab, medical imaging and rehabilitative services will be offered. The hospital is seeking LEED (Leadership in Energy and Environmental Design) certification from the U.S. Green Building Council for this building. This is one more way we are working to promote the health and well-being of children and families. Watch us grow – visit www.childrensdayton.org/springboro.

Outpatient Testing Center – Vandalia will open in late 2008 for the convenience of families north of Dayton. This center will offer lab and medical imaging services. The center will be located just off I-75 at the Northwoods Boulevard exit.