justkids spring 2010
Children’s Hospital & Medical Center
Who’s the Boss?
You! • Common Questions About Kids’ Rashes • Lifesaving Care for the Tiniest Patients
Who’s the Boss? You!
Parents can take steps to make sure they’re in charge Who runs the show at your house? If your children dictate what they’re going to eat for dinner, whether they’ll put their toys away or when they’ll go to bed, then they rule the roost. But here’s the rub—that lack of structure results in a chaotic home environment and doesn’t teach them how to accept that they won’t always be in charge in life. The bottom line is that consistent rules from loving parents teach children how to behave appropriately. Kids do best when daily routines are consistent and predictable. Here are some tips to help you set boundaries and take control as a parent: ■ Make family policies and enforce them. Explain to children what happens when they follow a rule and the consequences when they don’t. Once you set a rule, stick with it. If you’re inconsistent, children may try to test you and see what they can get away with. ■ Provide positive reinforcements. Praise your children when they follow your rules and behave well. Strong praise reinforces positive behavior by providing your attention to your child as a reward. This may be one of the most meaningful and valued rewards to your child.
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■ Time for a time-out. If your children break your rules, don’t have a debate. End the discussion and send them to a time-out. Engaging your child in a debate not only reinforces the behavior with your negative attention, but it also gives children the sense they have some power in the situation. “While sometimes it is appropriate to give our children choices in a situation, we also need our children to grow up understanding some situations are non-negotiable,” says Kimberly Levering, Ph.D., a psychologist with Children’s Behavioral Health. “Breaking rules needs to consistently result in a consequence.” ■ Remove attention and access to fun. Use a place in your home with no distractions, such as a chair in the living room corner. Stand firm and don’t respond to questions, outbursts, promises, pleas or excuses. And don’t apologize for correcting your children. They may sense you have mixed feelings about enforcing the rules. ■ Take immediate action. When children break a rule, address it quickly so they clearly understand what they have done wrong. Waiting until hours later to handle a problem or enforce a consequence may simply confuse the child.
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■ Remain unemotional. If you respond to a tantrum by losing your temper, you’re likely to draw defiance and disrespect. When you react to an outburst, you’re rewarding bad behavior with extra attention. ■ Give respect to get respect. If children break rules, don’t call them names or humiliate them. To receive respect from children, treat them with respect and handle punishments calmly. Never spank or hit children. This sends the message that it’s OK to solve problems using violence. “Staying calm and unemotional during a discipline interaction not only makes you more effective, but also models appropriate skills for your child that will help them when they are in difficult situations,” says Levering. If you’re worried about your child’s behavior, speak to your child’s primary care provider, who can offer you advice or refer you to a specialist. Need a physician or behavioral specialist for your child? Call the Children’s Find-A-Doctor service at 1-800-833-3100 anytime, day or night.
Lack of Sleep Can Harm a Child’s Health When children are young, we tuck them in at night and see them off to school in the morning. As they turn into teenagers, though, it gets harder to track how much time they actually spend asleep. Now a growing body of research shows we need to watch kids’ shut-eye at every age.
Sleep’s Deep Effects The average child sleeps 13 months during the first two years of life. All this sleep helps a baby’s brain develop. As children grow older, they need fewer hours of sleep: 10 to 12 hours a night for preschoolers, and at least nine for school-age children and teens. But the importance of sleep doesn’t diminish. Sleep helps us solve problems, react quickly, form memories and learn. Inadequate sleep affects how well kids do in school. It also has an impact on a child’s physical well-being. The body releases hormones during sleep that aid growth, build muscles and repair cells and tissues. A study in Pediatrics found that childhood sleep deficiencies may be linked to future problems, too, including decreases in mental functioning that begin as early as adolescence. Increasing evidence also suggests that poor sleep contributes to major health problems, such as obesity.
Cultivate Teen Dreams Researchers say children’s sleep problems shouldn’t be ignored. While parents are often involved in the sleep schedules of young children, they tend to step back in high school. Because sleep is so critical, however, you should stay involved. First, recognize the signs that your teen isn’t getting enough sleep. Two key signs: changes in mood and a slide in motivation. Sleepy teens have trouble waking up in the morning, are irritable late in the day, sleep extra long on weekends and doze off during the day. Next, understand what’s keeping your teen awake. Many factors may play a role, and some—such as early school start times—you can’t control. But some you can.
■ Help your kid create a good sleep environment—a place that’s quiet and dark. ■ Limit teens’ caffeine intake, especially energy drinks. Sometimes, a sleep disorder is responsible for poor rest. For example, some teens may suffer from sleep apnea, which is abnormally long pauses in breathing during sleep. This condition may lead to daytime tiredness. Contact your teen’s physician if you suspect your teen may have sleep apnea to determine the cause and appropriate treatment.
What You Can Do Help your child get a good night’s sleep with these steps: ■ Encourage a consistent sleeping and waking schedule. ■ Ban the use of computers, televisions, music players and phones close to bedtime.
Sleep is critical to your child’s growth and development. If you’re concerned about your child’s sleep issues, visit with your child’s primary care provider, who can refer you to a specialist like those with the Sleep Disorders Center at Children’s Hospital & Medical Center. Here, medical professionals through our Sleep Disorders Clinic, Behavioral Sleep Disorders Clinic, Sleep Lab and more can diagnose and treat a wide variety of childhood sleep issues. Need a physician for your child? Call the Children’s Find-A-Doctor service at 1-800-833-3100.
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Play It Safe on the Playground
Playing at the playground can be one of childhood’s greatest pleasures. But more than 200,000 children and young adults are injured every year on playground equipment. The National Program for Playground Safety (NPPS) suggests that before children head out the door for the playground, be sure they follow the S.A.F.E. program.
Supervision The NPPS strongly urges parents and adults to take an active role in playground supervision. This includes checking children’s clothing for dangling strings that can get caught on playground equipment. Make sure the child is wearing skid-resistant shoes and do not allow children to wear bicycle helmets on the playground. Helmets can get caught in between playground poles and peek holes.
Age-Appropriate Equipment Not all playground equipment is
appropriate for all ages of children. According to the NPPS, if you have to lift a child onto a piece of equipment, it’s a good sign that the equipment is not developmentally appropriate for that child. Equipment is designed for two groups: ages 2 to 5 and ages 5 to 12. Look for an age-appropriate guideline sticker. If there is no sticker, experts advise that children younger than age 5 should not play on equipment taller than 4 feet.
Fall Surfacing While there is no perfect playground surface, experts recommend never placing playground equipment on asphalt, cement, dirt, grass or rocks. Good materials to use include wood fiber, wood chips, chopped rubber, sand and pea gravel. If the playground equipment is over 8 feet in height, use at least 12 inches of uncompressed loose-fill material. Nine inches of loose-fill material works
best for equipment under 8 feet in height.
Equipment Maintenance Your first visual impression of a playground is important. Does it look safe and well maintained? Look to see if fences, hedges or open spaces prevent children from running into traffic or parking areas. Look for loose nuts and bolts, broken or missing parts and exposed concrete. Wood equipment should be free of splinters, large cracks or signs of deterioration. In addition to following the S.A.F.E. guidelines listed above, remember a couple other important safety tips: ■ Test for hot surfaces. Metal playground equipment in direct sunlight can cause serious burns within seconds. ■ Check openings in guard-rails or between ladder rungs. They should be either less than 3.5 inches or more than 9 inches wide to avoid trapping a child’s head.
Always Committed to Safety Children’s Hospital & Medical Center is committed to the
2000, Kohl’s has donated more than $700,000 in support of
health and well-being of all children. The Kohl’s Keeps Kids
child injury prevention programs. For more information on
Safe program, a joint venture between Children’s Hospital &
safety programs sponsored by Children’s Hospital & Medical
Medical Center and Kohl’s department stores, is dedicated to
Center, visit ChildrensOmaha.org. Simply click on Health
reducing the number of accidental injuries in children. Since
and Safety, then on SafeKids.
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| To find a physician, call 1-800-833-3100
Common Questions About Kids’ Rashes Q. How can I prevent and treat diaper rash? Keep your baby’s bottom clean, cool and dry. Here’s how: ■ Change baby’s diaper at least every two hours. Let him go diaper-free sometimes to air-dry skin. ■ Clean with warm water and mild soap. Avoid wipes with scent or alcohol. ■ Pat skin dry—don’t scrub it. ■ Apply a thick layer of zinc oxide or petroleum, not steroid creams, between diaper changes. Don’t scrub to remove this coating. ■ Avoid plastic pants and diapers with plastic edges. They hold in moisture. ■ Consider a new brand of wipes, diapers or soap.
Q. Is my child’s rash hives or eczema? Eczema—a scaly, itchy rash—may first appear on a baby’s face, scalp, bottom, elbows or knees. Some kids inherit a bigger risk for eczema. One study found that having a cat in the house worsens this risk. “Children with eczema need a lot of moisture added to their skin,” says Melissa St. Germain, M.D., a Children’s Physicians pediatrician. “Fragrance-free lotions or ointments like Eucerin, Aquaphor or petroleum jelly should be applied at least twice a day. If this isn’t helping, it’s time to see your doctor.” You can ease your child’s eczema by: ■ Applying cold compresses and moisturizing creams ■ Using mild soaps ■ Avoiding sudden temperature changes ■ Dressing her in cotton. Hives are red, itchy swollen spots that can appear anywhere on the body and typically disappear quickly. Children’s hives may result from an allergy or from a virus such as a cold. A study in the Annals of Allergy, Asthma and Immunology found that nonsedating antihistamines, like Claritin or Zyrtec, helped relieve kids’ allergic hives.
Q. Can I catch poison ivy from my child? Have questions about a rash not talked about in this article? Speak with your child’s primary care provider. Need a physician or specialist for your child? Call the Children’s Find-A-Doctor service at 1-800-833-3100.
The skin rash of poison ivy isn’t contagious. But the oil is, so clean all clothing and anything else— shoes, for example—that may have touched the leaves. Never burn the plant. The smoke carries the offending oil. To soothe the itch, quickly rinse skin with lukewarm water and soap.
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Intensive Care for Newborns: Lifesaving Care for the Tiniest Patients Carolyn Schuver didn’t want to relocate to Iowa for a job opportunity for her husband, Jeff. “I fought moving to Cherokee because I’m from Phoenix,” says Carolyn. Cherokee is a town of just over 5,000 residents located in northwest Iowa. Turns out, moving was one of the best decisions of her life. Carolyn and her husband, Jeff, had lost pregnancies while living in Phoenix. So they were understandably nervous when they became pregnant again while living in Cherokee. “The pregnancy losses came at 22 and 23 weeks,” says Carolyn. “When we found out this last pregnancy was a girl, it was a comfort to us because we were told that girls’ lungs develop faster than boys.” Another comfort was the fact that the specialized medical care Carolyn needed was available in Omaha, just a few short hours away. So was the care that
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the baby would need as well. Carolyn and Jeff’s daughter, Brenna, was born four months premature at just 24 weeks gestation and spent the next four months in the Newborn Intensive Care Unit (NICU) at Children’s Hospital & Medical Center. “She was born at 1 pound, 5 ounces, and she was 11 inches long,” says Carolyn. “She was just a little munchkin.” At first, the Schuvers lived day by day wondering if Brenna was going to make it. But she was in good hands with the medical professionals working in the NICU. The unit is a Level IIIC NICU, which means it provides the most advanced level of neonatal care available. Staff has immediate 24-hour access to all pediatric specialists and surgeons. The unit offers young patients intensive therapies, such as ventilators (respirators), medications that can be
| To find a physician, call 1-800-833-3100
given only under close medical supervision, as well as central venous and arterial lines. The Level IIIC designation also means the unit offers advanced medical therapies, such as extracorporeal membrane oxygenation (ECMO). ECMO is essentially a heart/ lung bypass for children whose heart or lungs have temporarily stopped functioning. “Brenna kept pulling her tube out,” says Carolyn. “After she pulled the tube out of her throat, she took a turn for the better. They found out she had some sort of pneumonia that they were able to treat. Thankfully, she was always able to take her food on her own, and to this day, this girl has never had a problem eating.” The NICU team is dedicated to the tiny patients, as well as the anxious parents, offering support and hope in a caring and compassionate atmosphere.
We Know Children
Brenna Schuver, who celebrated her first birthday in February, proudly shows off her new dress as she prepared for the Easter holiday.
“The nurses would make these scrapbooking pages for us. At times I didn’t want to chronicle any of this, but they did,” says Carolyn. “It was hard. But they would say, ‘oh, you’ll want to look back,’ and they were right. Looking at those scrapbook pages, you can tell they care so much for her. And coming in to see her every day, it gave me hope.” “They were so helpful. This was our first baby and she was so fragile, but they would tell us, ‘get in there and bathe her,’ or ‘get in there and change her diaper,’ and we needed that. They were very patient with us and helped us through everything,” says Carolyn. The Schuvers come back to Children’s periodically to visits specialists through Children’s NICU Follow-Up Clinic. Research shows that babies who receive care in a NICU are at risk for some degree of developmental delay. The NICU Follow-Up Clinic specializes in identifying neurodevelopmental delay
problems early on and provides early intervention therapies to reduce long-term developmental issues. The clinic provides a more in-depth developmental assessment than most pediatricians or family physicians normally provide. “I just love them all,” says Carolyn. “Every time I visit, I get so emotional. I would never want to be anywhere else but Omaha. I’m grateful for every day.”
Saving the Tiniest Patients
When you signed on for parenting, you relinquished afternoon naps and disposable income. You found it requires skills and knowledge never mentioned in Algebra 101 or American Lit. Fortunately, there’s Parenting U from Children’s Hospital & Medical Center, FREE classes given by professionals known for their knowledge of children, to help you through some of a parent’s most challenging times. Along with a new topic each week, we’ll provide food, child care and prizes. Each session will be held in the Glow Auditorium at Children’s Hospital & Medical Center from 6 to 7 p.m. Call 800-833-3100 or log onto ChildrensOmaha.org to register today. Tuesday, June 29 Preparing for Your Newborn Elizabeth Walenz, M.D., Children’s Physicians
To learn more about the NICU at Children’s Hospital & Medical Center, visit ChildrensOmaha.org and click on NICU under Featured Services. Or, call us toll-free at 1-800-833-3100.
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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. © 2010. All rights reserved. Printed in U.S.A.
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Children’s Launches New Online Newsletter
Subscribe Now To subscribe to health-e kids, our free monthly e-newsletter, simply visit ChildrensOmaha.org and click on the e-newsletter icon located on the right side of the home page.
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When you have health questions today, you go online. Children’s Hospital & Medical Center will meet you there with health information that’s not only educational, but easy to find. One way we’re reaching out is through our new online newsletter, health-e kids. This free e-newsletter offers monthly articles on relevant health topics, plus links to further information, recipes, quizzes and more. All this information
is available with the click of a mouse and delivered to your inbox each month. Our e-newsletter is just one way Children’s is there for you online. Our Web site, ChildrensOmaha.org, offers a streamlined navigation system that makes the site user-friendly when you’re looking for the right physician or specialist for your child, or need helpful information on a particular health topic. Our online chat service, available 24/7, connects parents with physician expertise, and you can connect with us through Facebook and Twitter. Our streamlined mobile site allows you to access all the helpful information from our main Web site, but in a format suited for mobile phones—perfect for busy families on the go. We’ve been fortunate to care for children for over 60 years, and we’ll continue to improve ways to stay your trusted source for health information— online, anytime.
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