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Winter 2016
JustKids
Children’s Ambassadors:
Sharing Our Dedication to the Best Possible Care p6
Iowa Clinic
CHILD SKIPPING LUNCH?
NEW YEAR IDEA
Now Open Every Day 2
Five Reasons Why – And What to Do 4
Baby-Proof Your Home for 2016 10
Contents ➍ Five Reasons Your
Child Skips Lunch — and How to Fix Them
➎ Healthy Kohl’s Kids ➏ Children’s Dedication
Children’s First Iowa Clinic Offers Expanded Hours of Service
to Best Possible Care Impacts Lives of Children’s Ambassadors
➑ Pulmonary Hypertension: Treating a Complex Condition Through Collaboration
➓ Baby-Proof Your Home for the New Year
Choose the Right Pediatrician Fend Off the Flu
Your Online Source for Health Info For the latest information and news, support groups, events, patient stories, recipes and perspectives from our physicians, check out these online resources: Facebook.com/ ChildrensOmaha YouTube.com/ ChildrensOmaha Twitter.com/ChildrensOmaha Pinterest.com/ChildrensOmaha ChildrensOmaha.org
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Iowa families no longer have to cross the Missouri River to receive specialized pediatric care from the experts at Children’s. This fall, Children’s Physicians opened its first Iowa clinic, and 13th location overall, at 1022 Woodbury Avenue. “Children’s Physicians is excited to lead this expansion into Iowa for Children’s,” says Steve Burnham, senior vice president of Physician Networks and president of Children’s Physicians and Children’s Specialty Physicians. “We’ve launched a new model of
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care in this new market that will improve access to quality care for Iowa families, and could become the model of care for the future.” This new blended model of care accommodates both scheduled appointments and walk-in (urgent care) visits seven days a week, including holidays. The expansion of hours is part of Children’s Physicians’ patientcentered medical home philosophy. A patientcentered medical home is an approach to providing comprehensive primary care where the health team works with the family on all
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Richard G. Azizkhan, M.D. President & CEO Martin W. Beerman Vice President, Marketing & Community Relations David G.J. Kaufman, M.D. Medical Advisor Dannee Schroeder Senior Editor
JustKids is published by Children’s Hospital & Medical Center to provide general health information. It is not intended to provide personal medical advice, which should be obtained directly from a physician. © 2015. All rights reserved. Printed in U.S.A.
What’sNew? aspects of a child’s well-being, including medical, behavioral, physical and social needs. Improving access to care is one of the tenants of medical home, which is why the Council Bluffs office offers expanded hours to be available for families whenever needed. This clinic is open for scheduled appointments weekdays from 8 a.m. to 8 p.m. and Saturdays from 8 a.m. to noon. Walk-in or urgent care visits are welcome Mondays through Saturdays from 8 a.m. to 10 p.m., and Sundays and holidays from noon to 10 p.m. In addition, the office offers radiology, behavioral health and certain lab services onsite. “Our presence in Council Bluffs allows us to better serve children and families in Iowa,” Burnham says. “Families can expect highquality care that’s convenient, accessible and focused exclusively on kids.” Beyond offering hours not available at other Council Bluffs clinics, the Children’s Physicians, Council Bluffs office offers the benefit of a patient care coordinator. The patient care coordinator works in collaboration with the Children’s Physicians pediatrician to make sure a patient’s – and family’s – entire medical and non-medical needs are met. They also work with schools, community organizations, behavioral health and pediatric specialists the child may see. Children’s Physicians further provides convenience to families through a free, online health portal called Children’s Connect. Anytime day or night, parents can schedule or request appointments online, message their
child’s health care team or access and print test results, immunization records, growth charts and much more. Nicole Villarreal, M.D., FAAP, will practice at the Council Bluffs office. Dr. Villarreal received her medical degree from Creighton University School of Medicine and completed her pediatrics residency through the CreightonNebraska Universities Health Foundation Pediatrics Residency Program. She has been a practicing physician since 2008, with the past four years at Methodist Physicians Clinic at Jennie Edmundson in Council Bluffs. Several non-physician providers will work with Dr. Villarreal to provide both primary and urgent care services for patients, including nurse practitioners Amy Jorgenson, Cheryl Calabro, Tara Goodman and Chelsey Turner, and physician assistant Kelsey Stoysich. From the specialized staff to the state-of-the-art services to the expanded hours of care, Children’s newest clinic proves it is the best place for kids in Council Bluffs.
For more information on the Children’s Physicians, Council Bluffs office or to schedule an appointment for your child, call 800.833.3100 or visit www.ChildrensPhysiciansOmaha.org.
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healthy eating
5
Reasons
Your Child
Skips Lunch—
And How to
Fix Them
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To find a provider, call 1.800.833.3100
You spend hours finding and preparing just the right mix of healthy, kid-friendly foods. You slice off crusts and use cookie cutters to turn sandwiches into hearts and stars. But still, at the end of the school day, you open your child’s backpack and find lunch unopened. Many factors can lead kids and teens to snub their midday meals. Some of these reasons have nothing to do with taste or even presentation. We’ve identified five reasons home-packed lunches go uneaten – and how to pack the box or brown bag to ensure your child consumes a full, nutritious meal.
“Consuming a nutritious lunch benefits kids in many ways, including keeping their bodies healthy and giving them the energy to power through the school day,” says Kirstin Grahn, M.D., Children’s Physicians. “It is critical to instill healthy eating habits in young children as this carries with them through their lifetime.”
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The issue: Loose or missing teeth
Around age 6, kids start shedding their baby teeth. Wobbly or missing canines and incisors can make some foods difficult to bite. The fix: Choose easier chews Try chopping foods up into smaller pieces – say, wedges instead of whole apples. Steer clear of sticky items like raisins and dried apricots. And cut back on sugary beverages, hard candies and caramels. They cause cavities in both baby and permanent chompers.
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The issue: Quitting meat
At about age 6 or 7, kids start to understand where food comes from and what it means to eat animals. Some may suddenly turn vegetarian. The fix: Pack alternate proteins Regardless of whether they follow it for a day or a lifetime, kids can get all the nutrients they need from a meat-free diet. Just swap out that turkey sandwich for a veggiefriendly protein source. Healthy, portable options include hard-boiled eggs, peanut butter sandwiches and cartons of Greek yogurt.
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The issue: Fear of weight gain
Preteen and teen years bring peer pressure to a whole new level. Suddenly, adolescents become aware of their weight and body image in an entirely new way. Some start cutting calories or food groups. The fix: Straight talk Don’t mess around with this one. Fad or overly restrictive diets can deprive your child of the nutrients needed to grow and develop. Keep tabs on your child’s eating, and speak to your child’s physician if you have concerns about your child regularly skipping meals or unhealthy weight loss.
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Kirstin Grahn, M.D. Children’s Physicians
The issue: Feeling forced
You might have gone out of your way to choose all your kid’s favorite foods. Still, kids who don’t have a hand in deciding what goes into a meal are less likely to consume it. The fix: Offer options Agree on some basic ground rules. For instance, each lunch should contain a protein, a whole grain, a fruit and a veggie. Then let your child select the specifics. Even better, involve young hands and minds in making the shopping list, filling the cart or stacking and packing the bag or box.
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The issue: Spoilage
Nothing ruins lunch more quickly than sour meat, rotten veggies or a moldy cheese wedge. Perishable foods require proper chilling. Otherwise, you risk making your child sick from food poisoning. The fix: Use cool tools If you pack lunch the night before, keep it in the fridge overnight. Send it off in a thermos or an insulated lunch bag with an ice pack. Or use a frozen water bottle as an ice pack – when it melts, it doubles as a healthy beverage.
Learn More Online with Healthy Kohl’s Kids ealthy Kohl’s Kids is a partnership between Children’s H Hospital & Medical Center and Kohl’s Department Stores focused on educating children and families on the importance of good nutrition and fitness. The program’s website, www.HealthyKohlsKids.com, features up-to-date fitness and nutrition info, and advice for children and parents. Healthy Kohl’s Kids invites parents to engage via social media on Facebook, Pinterest and Twitter (@HealthyKohlsKid).
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success stories
Children’s Dedication to Best Possible Care A budding dancer. An outgoing artist. A three-sport athlete. Their passions vary, but they share one very important distinction – each affirms the high quality, pediatric care that distinguishes Children’s Hospital & Medical Center and makes a difference in the lives of children and their families. Campbell, Femi and Lawson are Children’s patients who now serve as Children’s ambassadors. Nominated by the physicians, nurses and health care professionals who care for them, they represent the three specialty areas in which Children’s received a national ranking by U.S. News & World Report’s Best Children’s Hospitals for 2015-16.
Campbell — Gastroenterology & GI Surgery Playing with her friends and dancing – those are two of Campbell’s greatest joys. But life hasn’t always been graceful for this rising star. Diagnosed with Crohn’s Disease and autoimmune hepatitis as a toddler, 5-year-old Campbell has been partnering with Ruben Quiros, M.D., clinic service chief for Gastroenterology, and the entire GI team at Children’s to keep her healthy. They lend expertise and steady reassurance; Campbell takes her medication several times a day and comes in for her regular checkups. “We love the doctors and the nurses,” says Breann, Campbell’s mother. “They’re all very understanding, caring people. When we have a setback, Dr. Quiros shares our pain with us and understands. He is very personable and reassuring.”
Staffed with pediatric specialists, certified pediatric nurse practitioners, nutrition specialists and registered nurses, the Gastroenterology Department at Children’s offers comprehensive diagnostic procedures to aide in diagnosis and long-term treatment plans for patients like Campbell. The department also features sub-specialty clinics unique to Nebraska, including clinics for food and hypersensitivity disorders, liver disease and inflammatory bowel disease. At one point, Campbell wasn’t growing quite as fast as she should be – but now she’s back on the charts, and her sense of humor and signature dance moves are in full effect. “She’s very happy,” Breann says. “She loves being around people and playing with her friends.”
Find the Right provider Selecting a provider who’s a good fit for your family is important. You — and your child — should feel comfortable with the physician. To find the right one for your family, call Children’s Find-A-Provider service at 1.800.833.3100 or visit ChildrensOmaha.org/FindAProvider.
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Impacts Lives of Children’s Ambassadors Femi – Cardiology & Heart Surgery Outgoing and chatty, 11-year-old Femi loves to read and do crafts, but her real passion is painting – a swirl of strokes and color: red for energy, yellow for joy and green for renewal. Femi says she used to get dizzy and pass out frequently. That’s before she came to Children’s and was diagnosed with hypertrophic cardiomyopathy, a common cause of sudden cardiac arrest. Careful consultation with Femi’s cardiology specialist, Robert Spicer, M.D., clinical service chief of Cardiology, led to the pivotal phase of Femi’s treatment and recovery – a heart transplant in July 2014. Launched more than two years ago, Children’s pediatric heart transplantation program is the only one of its kind in the region. Dr. Spicer says it has been nothing but successful. “That’s a testament not only to the families, but to the
workers who do the ‘day-to-day’ in the transplant program and everyone at Children’s who has been a part of this process,” Dr. Spicer says. “I know that we will continue to provide the highest quality, most personalized care to these sick and complex patients.” Aside from not being able to run long distances, Femi’s parents say the budding artist gets along beautifully. She continues to come to Children’s for regular follow-up and has heartfelt praise for a cardiac care team that includes extensively trained and highly skilled cardiac surgeons, dedicated pediatric anesthesiologists, experienced nurses and operating room staff and a passionate and knowledgeable team of nurse practitioners and physician assistants. “They really do know kids and how to treat them,” Femi says. “They become part of your family. They didn’t keep any secrets from me, and they told me what was happening.”
Lawson – OrthopAedics From a baby born with clubfeet to a super-active young man, it’s been quite a journey for 8-year-old Lawson – even if he doesn’t remember all of it. The third grader from Seward, Nebraska, started seeing Children’s orthopaedic surgeon Brian Hasley, M.D., as a baby. They went through braces, surgery and casts together. “Dr. Hasley did a great job of relieving any fears. He and the entire team gave us hope that Lawson would be an active, fully functioning little boy,” says Melissa, Lawson’s mother. The Orthopaedics team at Children’s is the largest and most comprehensive group in the region, specializing in the diagnosis and customized treatment of orthopaedic
conditions in all children, infants through teens. That experience and pediatric training is critical to the healing and health of developing children, ensuring continued growth and a successful outcome free of long-term problems. Today, Lawson is fully recovered – and doing awesome. He plays baseball and basketball, and is down, set and “psyched up” to add flag football to his athletic resume. His parents say the experience was very eye-opening, emotional and positive for them, but Lawson hardly remembers it now. “It isn’t even an issue. It was addressed at the beginning of his life, so he has nothing that hinders him,” Melissa says.
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patient care
Pulmonary Hypertension: Treating a Complex Condition Through Collaboration
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Fifteen-year-old Briana is, in many ways, your typical high school freshman. She likes to sleep and hang out with her friends. And like her peers, she carries an IV infusion pump with her at all times and isn’t allowed to participate in organized sports. Typical teenage stuff. Not quite. The truth is – beyond the sleeping and the hanging out – Briana is not very typical. Diagnosed with pulmonary hypertension three years ago, she receives regular follow-up care at the collaborative Pulmonary Hypertension Clinic at Children’s Hospital & Medical Center. Before her diagnosis, she had the prominent red flags: shortness of breath and fainting. “I would faint all the time,” Briana says. “I remember I fell on the gym floor while we were playing a game. I got dizzy, and I fainted.” Her sister Rosa adds, “She couldn’t walk far distances. We would enter the mall and five minutes later, she would be really tired.” The theory, at first, was that Briana wasn’t eating properly. Further investigation revealed pulmonary hypertension (PH), a type of high blood pressure that affects the arteries in the lungs and the right side of the heart. The condition is difficult to diagnose. First, patients undergo an echocardiogram, an ultrasound-based test that estimates pressure in the heart’s right ventricle. Once PH is suspected, the gold standard is cardiac catheterization – a thin, flexible tube inserted into the heart through blood vessels – to directly measure pressure in the pulmonary arteries. “If we get to patients early on, we have a much better chance of keeping them from progressing to the severest forms of the disease,” says Scott Fletcher, M.D., medical director of Children’s Cardiovascular MRI and Exercise department. He launched the clinic with Paul Sammut, M.D., clinical service chief, Pediatric Pulmonology – two specialists collaborating in a crucial space where cardiac and pulmonary care intersect. The Pulmonary Hypertension Clinic team also includes a pulmonology nurse and a cardiology nurse. The premise is straight-forward: collaborative expert care, intense follow-up and the use of advanced medications to improve outcomes for a complex class of patients. Briana visits the clinic every three months. Her appointments include an echocardiogram, a six-minute walk test to gauge her progress and a joint meeting with Drs. Fletcher and Sammut, a reflection of the cardiac-pulmonary partnership that makes the specialty clinic so unique. “Dr. Sammut and I visit the patients together. Families hear us speak one after another. I’m listening to Dr. Sammut and Dr. Sammut is listening to me as the family is listening to both of us,” says Dr. Fletcher.
“We speak with a more common voice, and our care is much more coordinated than it would be if there was one cardiologist seeing patients independently and one pulmonologist seeing patients independently. That is not optimal. Teamwork is critical.” In addition to shortness of breath and fainting, red flags for PH include a family history of the disease, a diagnosis of pulmonary veno-occlusive disease or certain forms of congenital heart disease, and cases in which infants born with chronic lung disease do not show a typical pattern of improvement. Although PH is not curable, current treatments can minimize symptoms and improve quality of life. Drs. Fletcher and Sammut are managing Briana’s condition with a variety of medications, including prostanoids administered through her ever-present IV infusion pump. Briana says she feels more active since she began her treatments. Her doctors are encouraged by her progress. “They say they want to take it slowly,” she says, “step by step.”
Scott Fletcher, M.D.
Paul Sammut, M.D.
Have a Health Question? If you have questions about children’s health topics, you’ll find a variety of information on our website. Visit ChildrensOmaha.org/HealthAndSafety.
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Baby-Proof Your Home for the New Year
With the New Year upon us, families are busily setting household goals for 2016. Start the year off right by making it your resolution to ensure there are no hazards for your baby or toddler within your home. Parents should check their homes at least once a year for basic safety precautions. The first step in childproofing your home is to explore every room at a child’s eye level. Get down on your hands and knees and crawl around your home like a baby. Imagine how your infant will see things for the first time: electrical outlets, dangling tablecloths, cabinet pulls and more. “Household injuries are one of the most common reasons for Emergency Department visits in children under age 4,” says Chandrika Rizal, M.D., Children’s Physicians. “Baby proofing your home, along with supervision, plays a very important role in providing a safe household environment as babies grow, develop and explore the world around them.” As you see hazards, get rid of them. Here are tools and gadgets that can help: • Safety latches and locks. Use these on all cabinets and drawers to keep baby away from poisons and other harmful substances, including medicines and cleaners.
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• Safety gates. Install hardware-mounted
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gates at the top and bottom of every stairway to prevent falls. Doorknob covers and locks. Use these to keep baby out of rooms that are off-limits. Also use knob protectors on the stove knobs. Secure furniture. Larger pieces of furniture, such as bookshelves or dressers, should be strapped to the wall to avoid tipping. Additionally, no matter the size of television, secure it to a wall or anchor it to a dedicated TV stand with an anti-tipping strap specifically designed for that purpose. Window guards. Don’t rely on window screens to prevent falls from upper-story windows. Install safety bars or window guards. The bars should be no more than four inches apart. Corner and edge bumpers. These keep baby safe from falls against sharp edges on tables and other furniture. Anti-scald devices. Control your water temperature to prevent accidental burns. Make sure the thermostat on your hot water heater is set below 120°F. Outlet covers and plates. To prevent electrical shock and electrocution, install protectors on all unused outlets. The covers should not be easily removed by tiny fingers.
• Blind and curtain cord safety devices. Look for safety tassels for miniblinds and tension devices for vertical blinds and curtains to keep dangling cords and curtains away from baby. • Doorstops and door holders. These prevent little fingers and hands from getting pinched or crushed in doors and hinges. • Smoke and carbon monoxide detectors. Install smoke detectors in the hallways between all bedrooms and test them each month. If you cook or heat with natural gas or oil or have an attached garage, install a carbon monoxide detector near sleeping areas. Safety comes first, even if childproofing each room is time consuming. With a childproofed home, parents should take comfort knowing that they’ll have many more New Years to ring in with their family safely by their side.
Dr. Chandrika Rizal Children’s Physicians
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Choose the Right Pediatrician As a parent, you want the best health care available for your child. Choosing the right provider can be a difficult task. However, with a little legwork, you’ll be able to find the pediatrician that’s right for you and your child. In order to help make this decision easier, first understand the benefits of using a pediatrician for your child’s care. According to the American Academy of Pediatrics, pediatricians spend anywhere from three to six years in pediatric residency training after medical school, whereas other doctors can spend as little as three months in pediatric training. Because they care only for children, pediatricians have the skills to treat a wide range of ailments, and they are experienced not only in the physical, but also in the emotional and social development of children. Knowing the benefits a pediatrician can offer your child is only the start. Next, you must decide which pediatrician to trust with your child’s care. The following tips can help guide your choice: • Start with recommendations. Ask your own doctors, family members, coworkers and friends for recommendations for a good pediatrician. In addition, check with your health insurance provider to see which pediatricians are covered under your plan. • Do your research. Check to see if the doctor is board certified, if he or she has an independent practice or belongs to a network of physicians. Also see which hospitals or other medical facilities the doctor is associated with and where the doctor’s office is located. • Meet pediatricians face-to-face. Schedule a “get-to-know-you” meeting with any prospective pediatrician. Interview as many pediatricians as necessary until you find one that is trustworthy, compassionate and shares similar views and philosophies on caring for your child. By following these guidelines, you will help ensure that your child receives the best health care available.
Find the Right Pediatrician For more information on how to choose the right pediatrician for your child, call Children’s Find-A-Provider service at 1.800.833.3100.
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Fend Off the Flu The flu is no fun. That’s why it is important to protect your child from it with a flu vaccine every year. “Giving your child a flu vaccine every year is a simple step for families to take that can make a significant difference as flu season begins,” says David Kaufman, M.D., Children’s Physicians. “We recommend that all children starting at 6 months of age receive a yearly flu vaccination. Since the vaccine is not approved for younger infants, we also encourage the parents of these babies and their caregivers to be vaccinated to better protect the youngest ones. It is especially beneficial for breastfeeding moms to receive a flu vaccine.” Since the flu season can occur anytime from November through April, it’s still not too late to have your child receive the vaccine in January. Children under 9 years of age who have never received a flu vaccine will need two doses in their first year of influenza vaccination to maximize effectiveness during the year. Winter also means it’s the time of year for sniffles and sneezes. Colds often spread throughout the family, although different members of the family may experience
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different symptoms. If your child has a persistent fever for more than three days, or a fever that reaches 103 to 104°F, you should contact your physician. In addition to the flu vaccine, remind your child about these everyday precautions to help prevent catching or spreading illnesses: • Wash your hands well and often. • Cough and sneeze into your elbow, rather than your hands. • Keep hands off your eyes, nose and mouth. • Avoid contact with others who have a cold or the flu, if you can. The best treatment for an illness is prevention. A well balanced diet, plenty of fluids and rest also should help to keep your little ones healthy this winter.
David Kaufman, M.D. Children’s Physicians
Selecting a provider who’s a good fit for your family is important. You—and your child—should feel comfortable with the provider. To find the right one for your family, call Children’s Find-A-Provider service at 1.800.833.3100 or visit ChildrensOmaha.org/FindAProvider.