justkids Winter 2007
Published by Children’s Hospital, Omaha, NE
Children’s Hematology/ Oncology Department Treats Entire Family Children’s Eating Disorders Program Offers Individual Attention Sibling Fights: Strategies to Defuse Childhood Conflicts
I n s i d e | N u r s i n g a t C h i l d r e n ’ s H o s p i t a l : A P r o f e s s i o n a l Te a m A p p r o a c h | P a g e 6
c h i l d r e n’s s p o t l i g h t
Children’s Hematology/Oncology Department Treats Entire Family
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Shahab F. Abdessalam, MD
he hematology/oncology department at Children’s Hospital provides leadingedge treatment options for pediatric cancer patients, while providing emotional support for the entire family. Staffed by skilled and experienced healthcare professionals, including hematologists/oncologists, pediatric nurses, neurosurgeons, social workers, child life specialists and others, the department creates an environment where patients feel like they are part of one large family.
ExpErt pEDiatriC CanCEr CarE The hospital is a member of the Children’s Oncology Group (COG), a nationwide network of pediatric healthcare organizations specializing in the treatment of children with cancer. This group provides valuable information on the latest studies and treatment options for pediatric cancers, as well as access to other leading experts for consultations. In addition, Children’s recently welcomed Shahab F. Abdessalam, MD, a pediatric surgical oncology specialist, to its continued on page 3
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Dr. Abdessalam’s arrival makes Children’s Hospital one of only three hospitals in the country to have a pediatric surgical oncology specialist. staff. A pediatric surgical oncology specialist is skilled and trained in the diagnosis and surgical care of children with tumors and growths. Dr. Abdessalam, assistant professor of surgery at the University of Nebraska Medical Center, works in association with pediatric surgeons Stephen Raynor, MD, and Robert Cusick, MD, at Children’s Hospital to meet the surgical needs of children throughout the Heartland. Dr. Raynor serves as an assistant clinical instructor of the Creighton University School of Medicine department of surgery and associate clinical professor of surgery and pediatrics at the University of Nebraska Medical Center. Dr. Cusick serves as an assistant clinical professor of surgery and pediatrics at the University of Nebraska Medical Center.
New & Evolving Field Pediatric surgical oncology is a relatively new and rapidly evolving field. In fact, Dr. Abdessalam’s arrival makes Children’s Hospital one of only three hospitals in the country to have a pediatric surgical oncology specialist. “Cancer is a disease that if not appropriately handled, both when making the diagnosis and during surgical treatment, will obviously have less favorable outcomes,” says Dr. Abdessalam. “At Children’s Hospital, we have all the specialists here to make the best decisions and provide the best treatments without families having to travel long distances.” Advances in knowledge and technology have helped healthcare professionals achieve a pediatric cancer cure rate of over 80 percent, with even more breakthroughs on the horizon. And the staff at Children’s Hospital will be helping to lead the way. ■
When Your Child’s Friend Has Cancer When a childhood friend develops cancer, your child may be scared, angry and confused. Here’s how you can help your child during this difficult time. ■ Be ready to answer any questions your child may have, including, “What is cancer?” To young children, you might explain cancer as a disease in which small building-blocks of the body called cells become “bad” and grow. Use terms that fit your child’s age, such as “medicine” instead of “chemotherapy.” ■ Make sure she understands that her friend didn’t do anything to cause the cancer. ■ Reassure your child that she cannot “catch” cancer from her friend. ■ Your child may wonder if her friend will die. Although you may want to protect her, be honest. Tell her that cancer is serious. But also let her know that doctors have helped other children get better. ■ Persuade your child to keep busy at school and in her other activities. She shouldn’t feel bad for enjoying what her friend may not be able to do for a while. ■ Even if your child doesn’t know how to act around her friend, encourage her to visit or call her buddy if possible. Help her be a good friend.
New Site Provides Easy Access to Health Information Almost everywhere you turn today, you can find pediatric health information, but how do you sort through it all to get what you need? Simply turn to the new Children’s Hospital website at www.chsomaha.org. Unveiled in January 2007, the new site’s user-friendly layout allows parents to easily navigate through a variety of up-to-date pediatric health information. Whether you need information on a recent diagnosis or a virtual tour through one of our many departments, you can find it at www.chsomaha.org. The enhanced “Find a Physician” feature allows you to search through an extensive database of Children’s pediatric specialists and subspecialists to find the precise expert needed for your child. You also can view and pay your bill online with our new online account services, send a card to a Children’s patient through our new online gift shop or find out what’s new and exciting at Children’s with our spotlights features.
“This improved website adds a new dimension to the way we serve our community,” says Gary A. Perkins, Children’s president and CEO. “We’re committed to improving the health of children and families throughout the Heartland, and this new resource will give them easy access to the current health information that matters most to them. This knowledge can help them make more informed decisions about their health.” As part of the new website, Children’s Hospital introduced My Health Newsletter, a free, personalized online health information resource that provides parents with valuable information to help answer health questions. My Health Newsletter helps you sort through a world of health information to find just what you need. You choose the health topics you want to see, and each month, My Health Newsletter delivers to your e-mail up to three current articles from more than 350 of the nation’s top publications on the subjects you choose. Visit the new Children’s Hospital website at www.chsomaha.org. Health knowledge made easy for you is only a click away!
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parenting pointers
Children’s Eating Disorders Program Offers individual attention Research shows that eating problems are common in children and adolescents, mainly among girls and young women.
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t age 12, Tara began dieting because of an early growth spurt that came much sooner than most of her friends. She “felt fat” compared to them. First, she stopped eating desserts; then, she stopped eating lunch by throwing her sack lunch away at school. Soon, Tara began restricting foods with fat in them, started eating smaller portions and, eventually, skipped some meals altogether. She began withdrawing, avoiding meals with friends and family, and exercising. Tara is suffering from an eating disorder, and she’s not alone. More than 11 million Americans struggle with eating disorders. Research shows that eating problems are common in children and adolescents, mainly among girls and young women. In fact, as many as three percent of young women suffer from an eating disorder. Boys and young men also can struggle with eating disorders, but less frequently than females. However, research indicates that the prevalence of eating disorders in both groups may be rising.
Eating DiSOrDErS prOgram at CHilDrEn’S HOSpital In response to this need, Children’s Hospital offers an eating disorders program that specializes in the care of children and adolescents up to age 21. Located at Children’s Hospital in Omaha, the program is the only one of its kind in the region and offers an individualized treatment plan that addresses the psychological, medical and family problems associated with eating disorders. Due to its smaller size, the eating disorders program at Children’s Hospital is able to offer more individualized attention and care compared to other eating disorders programs. tYpES OF Eating DiSOrDErS ■ Anorexia nervosa is an illness characterized by self-starvation and often by over-exercise. Someone suffering from anorexia has a disturbed body image, an intense fear of becoming obese and an inability to maintain normal body weight. ■ Bulimia nervosa is an illness characterized by recurrent episodes of
social worker. A nutritionist, a recreational exercise therapist, nurses and a teacher are also part of the team. This team works together to make a diagnosis based on various assessments, and a treatment recommendation is made.
binge eating followed by purging. A bulimic individual tends to binge on high-calorie, easily ingested foods and is preoccupied with body shape and weight. Regular purging behavior (such as self-induced vomiting, use of laxitives or diuretics) or rigorous exercise in order to prevent weight gain accompanies this disorder. As Tara’s eating disorder progressed, she began running three hours per day, then started adding other exercises like crunches and leg lifts. Her exercise regime soon became very ordered and, if she were interrupted in the middle, she would start over again. By the time Tara was 14, she began to feel weak and lost interest in exercising. She also began to spend most of her time alone. When Tara’s parents intervened, she told them her stomach hurt. Her parents took her to her pediatrician, where they learned that Tara had lost 20 pounds in a year. After a battery of tests, Tara’s pediatrician referred her to a psychotherapist, who in turn referred her
to the eating disorders program at Children’s Hospital. By then, Tara’s blood pressure and pulse were very low and the results of an EKG were abnormal. Individualized Treatment Plan Because an eating disorder is an illness that requires careful evaluation and comprehensive treatment, the eating disorders program at Children’s Hospital is focused on rapid symptom control. This approach concentrates on enhancing physical and psychological development to prevent children from suffering from the effects of eating disorders as adults. The program provides treatment for uncomplicated eating disorders, and complex, hard-to-treat problems, all while stressing family involvement as an essential component of the treatment plan. The eating disorders program at Children’s Hospital is distinguished by a high staff-to-patient ratio. Each patient’s treatment team includes a board-certified child and adolescent psychiatrist, a boardcertified pediatrician, a psychologist and a
Treatment Results Tara was placed in inpatient treatment where she was helped by a multidisciplinary team of experts. Because Tara had lost so much weight, she lost bone tissue and suffered from symptoms of malnutrition. This factored into the decision to determine how much exercise Tara was allowed to perform during her treatment. Tara’s turning point came during her group therapy sessions with other patients in the program. Her peers told her she had a problem, but that she also had the strength and courage to control it. As Tara realized her parents and friends supported her, she wanted to get better. She began to eat healthy foods and realized this gave her energy. During her participation in art therapy, she drew a picture of her eating disorder—a big monster covering the entire page. Tara called her eating disorder “big monster Ed,” a creature she feared and was battling. Before leaving the eating disorders program, Tara told the staff that because of them, she was no longer afraid of Ed. ■
For more information on the eating disorders program at Children’s Hospital, call 402-955-6190, or visit the website at www.chsomaha.org and click on “Eating Disorders Program.”
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Nursing at Children’s Hospital: A Professional Team Approach 11 were from Children’s Hospital. Of the six category winners, three of them were nurses from Children’s Hospital.
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hildren have special medical needs that require unique, specialized care. The nurses at Children’s Hospital understand these needs. This understanding, combined with specialized training in pediatric care, enables Children’s nurses to set a new standard of care for patients and families. Children’s nurses understand that when children are ill, they heal faster in environments that closely mimic the routines and atmosphere of home. That’s why Children’s nurses make every effort to ensure children in their care are comfortable, eat meals on their own schedule and play whenever and wherever the opportunity arises. In addition, Children’s nurses make sure parents are actively involved in their child’s care and understand the medical diagnosis and treatment plan.
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This commitment to excellence in patient care and safety has not gone unnoticed. In fact, nurses at Children’s Hospital have received numerous awards and honors celebrating this passion and dedication to pediatric care. Children’s currently has 111 nurses who have earned professional certifications above their job requirements, with more earning certification each year. These nurses continue to earn scores on the exam that are well above the national average. rEgiOnal rECOgnitiOn Children’s nurses also have been recognized regionally for their excellence in practice. Nursing Spectrum magazine recently announced its annual Nurse Excellence Awards. Thirty finalists from a nine-state region were announced in six categories. Of the 30 finalists named,
lEaDErS in patiEnt CarE rESEarCH anD EDuCatiOn Nurses at Children’s Hospital have conducted studies in the area of patient care and safety. Their participation in a central line infection study determined that the caregiver starting the line is the key to preventing infection in IV lines. The results from this study helped create “best practice” policies on preventing central line infections. Nurses at Children’s Hospital are currently conducting a nipple study to determine a premature infant’s acceptance of nipples designed for use in oral feeding, as well as a study that focuses on feeding strategies at home for infants with complex congenital heart conditions. Children’s Hospital nurses are also leading the way in patient education. Our nurses have written several curricula for the training of critical care nurses. This curriculum is used by children’s hospitals across the country during critical care orientation for neonatal and pediatric intensive care unit nurses. Other curricula written by Children’s Hospital nurses include newborn care for temperature management, blood sugar stabilization in the newborn, surgical care of newborns, skin care for infants, respiratory failure in the pediatric patient and much more. The team of nurses at Children’s Hospital continues to set the bar for patient safety and excellence in service to help further the mission of Children’s Hospital: “So that all children may have a better chance to live.” ■
Sibling Fights:
Strategies to Defuse Childhood Conflicts
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onflicts between siblings happen in many families. Such conflicts often stem from competition between children for the love, approval and attention of parents—or what’s known as sibling rivalry. The age of a child when a new baby arrives is one of the best predictors of sibling rivalry. Children younger than age 4 are often the most distressed by a new sister or brother. This is a very selfcentered time of life, and young children have trouble “sharing” their parents. Fortunately, parents can minimize sibling rivalry and help prevent fights between children with some practical strategies. anD BaBY makES… ■ Prepare your child for the new baby. For instance, read books aloud about the arrival of a new baby, or give your child a “baby” doll to care for. ■ Refer to the baby as “our” baby—not “Mom and Dad’s baby.” ■ After the baby arrives, ask your child to help bathe the baby or change the baby’s diaper. BEFOrE FigHtS Can BrEak Out ■ Avoid comparing children to each other. Also, try not to praise one child too much in front of the other. ■ Don’t expect children to play together all the time. Separate activities can help reduce conflicts. ■ If you sense a fight about to break out, try distraction. For instance, suggest a new toy or activity children can enjoy together or by themselves. ■ Provide healthy ways for children to get their aggressions out. For instance, take them outside to run around and play. ■ Model kindness and compassion—to your children and to others.
WHEn FigHtS OCCur “Parents should avoid refereeing their children’s disagreements because it is often difficult to sort out who did what,” says Thomas Reimers, PhD, licensed clinical psychologist with the Family Support Center at Children’s Hospital. “Rather, parents should focus on the negative behavior and apply an appropriate consequence to both children. Parents who try and determine the facts of a conflict and guess wrong run the risk of diluting their authority.” In addition: ■ Urge children to resolve their own conflicts—as long as they are not physically hurting each other. Let the children know that if they can’t resolve the problem on their own, the parents will resolve it for them in a fair manner. ■ When siblings are constantly fighting—or becoming too aggressive— separate them for a “time out.” ■ When children act cruel, let them know right away. But focus on the act, not the child. Instead of saying, “You’re a mean girl,” say, “What you did to your brother was mean.” Sometimes, families need help resolving sibling fights, especially when they escalate to abuse. If a child is physically or verbally abusive, talk to your child’s
physician or a mental health professional. The Family Support Center at Children’s Hospital offers psychological evaluations and counseling services to children of all ages Thomas Reimers, PhD and their families. These professionals can help you build a better relationship with your child. Call 402-955-3900 for a referral. ■
Discipline and Your Young Child: time Out for good Behavior This colorful brochure is a valuable tool for any parent looking for helpful hints about disciplining a child. It stresses the importance of a consistent discipline plan and explains the “time-out” method of correcting behavior and how to use it successfully. Call 402-955-6950 today to receive your free copy.
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Childhood Fever: When Is It Cause for Concern? Alka Desai, MD
justkids just kids is published by Children’s Hospital to provide general health information. It is not intended to provide personal medical advice, which should be obtained directly from a physician. © 2007. All rights reserved. Printed in U.S.A. Gary A. Perkins, President and CEO Kathy English, Executive Vice President and COO David G.J. Kaufman, MD, Medical Advisor Dannee Hartley, Public Relations Coordinator
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fever is usually a good sign. It means that your child’s immune system is fighting off an infection. But fevers can be uncomfortable for children and worrisome for parents. Knowing when your child needs a doctor’s attention—or just some loving care—can help ease everyone’s anguish. Most fevers are caused by viruses and usually last 3 to 5 days. They often improve on their own with simple home treatment. However, if the fever is caused by a bacteria, your child’s physician may prescribe antibiotics.
HOW HigH iS HigH? Your child’s age and how high the fever is determine whether a fever is serious or not. Any child younger than 2 months who develops a fever needs a physician’s attention. Therefore, you should call your child’s physician if the fever is: ■ 100.5 degrees F or higher for infants younger than 2 months ■ 101 degrees F or higher for babies ages 3 to 6 months old ■ 103 degrees F or higher for children older than 6 months. “Babies younger than 6 months should have their temperature taken with a rectal thermometer,” says Alka Desai, MD, a Children’s Physicians pediatrician. “Rectal thermometers give the most accurate body temperature.” In all cases, watch your child for any symptoms of illness that might accompany the fever. These include sluggishness, persistent crying, breathing problems, a stiff neck or purple spots on the skin. If any of these appear, contact your child’s physician. HOW tO rEliEvE a FEvEr When your child has a fever, offer comfort and relief. Here are some soothing strategies: ■ Give your child acetaminophen or ibuprofen, but never give aspirin to children because it can cause Reye’s syndrome. ■ Offer plenty of fluids to replace those your child will lose as the body temperature rises. Good choices are water, soup or flavored gelatin. ■ Keep the room cool and dress your child in light clothes. ■ Sponge your child with lukewarm water. ■