justkids summer 2011
Children’s Hospital & Medical Center
Teaching Toddlers to Behave
• New Safety Guidelines for Car Seats • Create a Family Health History
Teaching Toddlers to Behave Teaching children how to behave must be done in two ways. You must teach your children both what you want them to do, and what you do not want them to do. For example, if you discipline your daughter when she mistreats her baby brother, she will learn what you do not like, but not how you want her to treat her brother. Therefore, if you see your daughter talking nicely to her baby brother, go to her right away and let her know that she’s doing something you like.
Offer Positive Reinforcement Try to catch your child doing something good, and then praise or give attention for that behavior: ■ Give your child a hug, a smile or a few words of praise like, “That’s a good boy!” or, “Mommy likes it when you eat all your peas.” ■ Set up a special activity like reading a book together or playing a game with Mom or Dad.
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■ Give a reward, such as stickers or a book. Make sure this positive praise is immediate, but keep it brief. Also, actively look for times to praise your child. Don’t fall into the trap that you don’t want to disturb or interrupt your child. Praise them for playing appropriately.
Ignore or Discipline? Ignoring is often used for minor misbehavior, such as interrupting, tugging at your clothes or for rude behavior like nose-picking, making faces or bad language. However, each parent needs to decide which behaviors are mildly irritating (and use ignoring) and which behaviors absolutely can’t be tolerated (and need time-out). Do not ignore a problem behavior that could be harmful to your children, such as running in the street or touching the stove. Use time-out instead.
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When you decide to ignore irritating behavior, do not interact with your children in any way while they engage in that behavior. Do not talk or even look at them. When the problem behavior stops, quickly look for a good behavior for which you can reward your children. Remember, do not tell your children you are going to ignore them. If you do, you are not ignoring, you are giving them attention for the irritating behavior. Sometimes, you may start out ignoring a behavior and find out that you simply cannot ignore it after all. If you find yourself nagging or lecturing, tell your children that from now on, they will have to go to time-out for that behavior and be sure to follow through.
Effective Time-Out Time-out basically involves placing your children in their playpen or other spot in the house for a short period of time following each occurrence of a negative
“Watch Your Fingers” Is Still Good Advice
behavior. This procedure has been effective in reducing problem behaviors like tantrums, hitting, failing to follow directions, jumping on furniture and other aggressive acts. Parents have found time-out works better than spanking, yelling or threatening children. Time-out is most effective for children ages 18 months through 3 years of age. When using time-out: ■ Decide which behaviors you will respond to using time-out ahead of time and discuss this with your children. ■ Don’t leave your child in time-out and forget about him or her. ■ Don’t nag, scold or talk to your child when he or she is in time-out (all family members should follow this rule). ■ Remain calm, particularly when your child is being difficult. ■ Don’t use time-out for every problem. After each time-out, start your child with a clean slate. It is not necessary to discuss, nag, threaten or remind your child about the inappropriate behavior.
Little fingers are constantly exploring— and getting in the way. When it comes to pinched fingers, accidents can be serious. According to a study published in Pediatrics, about half of all childhood amputations in U.S. emergency rooms occur to fingers that have been slammed or pinched in doors. Children ages 2 and younger are at greatest risk. Older children are vulnerable to door injuries, too. However, older children are more likely to be injured by a lawn mower. Prevent injuries with these tips: ■ Hang a towel over the top of doors and close to the hinges so they can’t close completely. ■ Purchase door stops or door guards to prevent doors from slamming. ■ Make sure all riding mowers have a no-mow-in-reverse (NMIR) feature to prevent injuries. ■ Be watchful when children play together. In one study, about half of door-related finger injuries occurred when another child shut the door. ■ Don’t let children use a push mower until age 12 or a riding mower until age 16.
Parenting U Raising children to be safe and healthy is a big job. That’s why Children’s Hospital & Medical Center is offering a helping hand. Our Parenting U series connects you with experts on hot topics in pediatric healthcare, including discipline. Visit our website at ChildrensOmaha.org/ParentingU, then click on the Parenting U Library link on the left side of the page to view our video collection of topics.
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New Safety Guidelines for Car Children are best kept in rear-facing car seats until age 2 or until they have reached the height and weight maximums set by the car seat manufacturer, according to new guidelines developed by the American Academy of Pediatrics. This is a significant change from the prior recommendations, which called for babies to stay in rear-facing seats until they were at least 1 year old and 20 pounds. Rear-facing seats offer more support to the head, neck and spine of infants and toddlers in a crash, said report author Dr. Dennis Durbin, a pediatric emergency physician at the Children’s Hospital of Philadelphia. While milestones in a child’s life are normally important and exciting, transitioning to the next stage in car safety seats should be prolonged as much as possible and not joyfully anticipated. The longer you extend each step, the safer your child will be. Most rear-facing child safety seats today can accommodate children to fit the new guidelines, the report noted. A 2007 study in the journal Injury Prevention found that children under age 2 are 75 percent less likely to die or be severely injured in a crash if they’re in a rear-facing car seat. Parents often have the misconception that children are uncomfortable if they are in a rear-facing seat and their legs are up against the vehicle seat, or that it poses a risk for broken legs in the case of an accident. This is not the case. There are no documented cases of children suffering broken legs in a car crash when in rear-facing seats.
Forward-Facing Seats The recommendations also say that a forward-facing car seat with a harness offers more protection than a booster seat, while a booster seat is better than a seat belt alone. Children should be kept in a forwardfacing car seat as long as possible, up to the highest weight or height allowed by the manufacturer of their child safety seat. Studies show that the car seats
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Seats reduce the risk of child injury up to 82 percent and the risk of death by 28 percent, compared to wearing seat belts.
Booster Seats Parents are also advised to keep older children in a booster seat, which properly positions the seat belt until the vehicle lap-and-shoulder seat belt fits properly. This typically occurs when the child has reached 4 feet 9 inches in height and is between the ages of 8 and 12. A booster positions the seat belt so that the shoulder belt lies across the middle of the chest and shoulder, and keeps it off the neck or face, while the lap belt fits low and snug on the hips and upper thighs, not across the soft tissue of the belly. Prior research shows booster seats can reduce the risk for injury by 45 percent in 4- to 8-year-olds compared to children of that age in seat belts. Children should ride in the back seat until they are 13 years old, since studies have shown this reduces the risk for injury by 40 to 70 percent, the AAP added.
Always Committed Children’s Hospital & Medical Center is committed to the health and well-being of all children. The Kohl’s Keeps Kids Safe program, a partnership between Children’s Hospital & Medical Center and Kohl’s department stores, is dedicated to reducing the number of accidental injuries in children. Since 2000, Kohl’s has donated more than $1 million in support of child injury prevention programs.
Exploring Your Genes: Create Your Family’s Health History You have your grandmother’s eyes, your father’s nose and your mother’s quick wit. But will you also get Aunt Linda’s cancer and grandpa’s heart disease? A family health history can help you assess your risk—and take action to prevent diseases you’re prone to developing.
Does It Run in the Family? Families share more than last names and traditions. Genetics can contribute to the risk of many common diseases, including heart disease, high blood pressure, diabetes and stroke. Rare conditions also travel through generations. These include hemophilia, cystic fibrosis and sickle cell anemia.
How to Get Started A complete family health history should include three generations. Start by making a list of all your relatives. The most important people to include are parents, siblings and children. For those whose health history you don’t know, pick a relaxed and quiet time to talk about it with your relatives. Explain what you are doing and why. Make a list of questions beforehand so you don’t miss anything. Ask: ■ Their age and date of birth ■ Whether they have any chronic conditions, such as heart disease ■ About other serious illnesses they’ve had, including cancer or stroke ■ The age at which they developed these conditions ■ Whether they’ve had problems with pregnancy or childbirth ■ What other family members passed away from ■ Where in the world your ancestors are from ■ Whether anyone in the family has had birth defects or learning disabilities.
Estimates say eight out of 10 child
“It’s nice to have extra information about family members’ heights and weights when they went through puberty when dealing with a child who has growth issues as well,” says Clancy McNally, a pediatrician with Children’s Physicians.
car seats are improperly installed.
Sharing the History
Keeping Children Safe But in a few minutes, you can learn how to install an infant or child car seat correctly. Visit our website at ChildrensOmaha.org. Simply click on “Health and Safety,” then on “Car Seat Safety” to watch our video.
Share your family health history with your doctor and your child’s doctor. You can write this information down or record it using a free online tool. The U.S. Surgeon General’s “My Family Health Portrait” is available at https://familyhistory.hhs.gov. These documents can be especially helpful for children. Chronic diseases like diabetes and heart diseases are rare in kids and teens. But symptoms may appear early in those with a strong family history. If your child’s doctor is aware of genetic risks, he or she can be on the lookout for these signs and take them seriously.
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Sheldon gears up for a metabolic exercise stress test, which measures the performance of his heart and lungs, during a recent follow-up visit to Children’s.
Lifesaving Care in the Clutch Ten-year-old Sheldon Dicks has logged more than 5,500 miles in round-trips to Omaha over the years. Sheldon visits during school breaks and summer vacation. While he and his family admit they like to stop by the zoo when they’re in town, their first destination is Children’s Hospital & Medical Center.
Immediate Emergency Sheldon, the son of John and Allison Dicks, was born with a life-threatening heart defect known as transposition of the great arteries. The main vessels circulating blood through Sheldon’s heart and lungs were switched; his aorta and pulmonary artery were each attached to the wrong side of the heart. When he was just 18 hours old, the newborn was flown from Minot, N.D.,
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to Children’s Hospital & Medical Center in Omaha. “When we arrived, we were greeted by Dr. Kim Duncan and his team. They explained what was wrong, and the procedure that they would need to perform,” remembers John Dicks. “The longer we talked, the better we felt. We knew we were at the right place at the right time.” Sheldon underwent open heart surgery at just one week of age. Dr. Duncan, cardiothoracic surgeon at Children’s, restored the vessels to their normal position. “The surgery went great, and we were home two weeks later knowing that his heart was going to be okay,” says John. But, Sheldon’s medical challenges were far from over. A condition unrelated to his heart defect caused a
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blockage that prevented food from leaving his stomach and going to the intestines. He was violently ill and losing time. Complications following surgery to correct the problem at a hospital closer to home further weakened the baby. The family knew they had to get back to Children’s.
Four-Month Stay “If anyone could help us, Children’s could,” says John. “We flew on an Air Force Medivac, but a terrible storm was preventing us from landing at Offutt. We were running out of time. Then, the co-pilot saw a hole in the storm that wasn’t on radar. They told us to ‘hold on,’ dove through the clouds, and made it to Offutt.” Sheldon was critically ill. A pediatric surgeon at Children’s and specialists in
Children’s Recognized in National Rankings pediatric intensive care did everything they could to help save the baby’s life. Each hour was a step in the right direction. Sheldon survived the first day, and then the second. Children’s became the family’s home for the next four months. “Without everyone at the hospital, in the PICU and at the Rainbow House, we wouldn’t have made it. They knew us by name and treated us like family,” John explains. During Sheldon’s hospital stay, the Air Force moved John and his family to Offutt Air Force Base as part of its exceptional family member program. Home was no longer hundreds of miles away. Once out of the hospital, Sheldon’s medical journey continued with a few minor surgeries and routine check-ups with his Children’s cardiologist, Dr. Carl Gumbiner. Determined to offer support and give back, the Dicks family also coordinated several holiday deliveries of teddy bears to patients.
The Place to Trust Now living in San Antonio, Texas, John is quick to point out that a distance of more than 800 miles (one way) will not keep them away from Omaha. “We are a military family, so moves and deployments are not uncommon. Sheldon is doing well, and we want to make sure that he will continue to do
well. We know that means coming back to Children’s,” he says. The family will return mid-summer for another heart surgery with Dr. Duncan. Fall brings fifth grade for Sheldon, an avid science student and a talented singer. Dad says when his son is playing basketball or soccer, you would never know he faced two life-threatening conditions before the age of one – and survived. Reflecting on those difficult days that, ten years later, still stir vivid emotions, John and Allison share a steadfast faith and warm confidence in the medical professionals who were there when they needed them the most. “Sheldon is such a blessing to us,” says John. “We know that without Children’s, we would not have him in our lives. He is our miracle and we are forever thankful to the wonderful doctors, nurses and staff at Children’s.”
Did You Know? Children’s Hospital & Medical Center performs more than 582 heart procedures each year and provides regular heart follow-up care during more than 4,600 clinic visits. Patients range in age from a few hours old to young adults who are living full lives thanks to significant advances in the treatment of congenital heart defects and disease.
Home Away from Home During Sheldon’s time in the hospital, the Dicks family stayed at the Carolyn Scott Rainbow House. Just a few short blocks away from the hospital, it provides a welcoming and reassuring environment for families of Children’s patients who live more than 60 miles outside of the Omaha metropolitan area. Hotel-style bedrooms are complemented by shared dining, family, and laundry rooms. Community groups often prepare meals in the kitchen, or help stock the pantry with food staples, paper products, laundry detergent and more. In 2010, the Rainbow House provided comfort and lodging for 1,715 stays.
Children’s Hospital & Medical Center has been ranked in two pediatric specialties in U.S. News Media Group’s Best Children’s Hospitals rankings. Children’s ranked number 41 in Orthopedics and number 47 in Cardiology and Heart Surgery. “We’re honored to receive this recognition, which helps to highlight Children’s Hospital & Medical Center on a national scale,” says Gary A. Perkins, FACHE, president and chief executive officer. “We’ve long known that we are a top provider of high quality pediatric health care. Being ranked among the Best Children’s Hospitals provides positive affirmation from an objective, outside source.” “We salute Children’s Hospital & Medical Center,” says Health Rankings Editor Avery Comarow. “The goal of the Best Children’s Hospitals rankings is to call attention to pediatric centers with the expertise to help the sickest kids, and Children’s is one of those centers.” The new rankings recognize the top 50 children’s hospitals in 10 specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology, and urology. Seventy-six hospitals are ranked in at least one specialty. The Best Children’s Hospitals survey asks hundreds of questions about survival rates, nurse staffing, subspecialist availability, and many more pieces of critical information difficult or impossible for parents to find on their own. The data from the survey is combined with recommendations from pediatric specialists on the hospitals they consider best for children with challenging problems. “Our pediatric subspecialists and care teams offer a great deal of experience and expertise that have a positive impact on the lives of children across the region,” says Carl Gumbiner, M.D., senior vice president of medical affairs and chief medical officer at Children’s Hospital & Medical Center. “At the end of the day, we can feel confident that we’re doing what is right and best for children.”
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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. © 2011. All rights reserved. Printed in U.S.A.
Gary A. Perkins, President and CEO Martin W. Beerman, Vice President, Marketing and Community Relations David G.J. Kaufman, MD, Medical Advisor Dannee Schroeder, Marketing Coordinator
Prevention Is the Key to Avoiding Flat Heads Nearly 15 years ago, the American Academy of Pediatrics (AAP) first recommended that parents put their babies to sleep on their back. That simple piece of advice cut the death rate from sudden infant death syndrome (SIDS) by more than half. An unexpected result has occurred, however—flattened heads.
Why Flattened Heads?
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The flattening—a result of babies’ spending so much time on their back—most often occurs on the back of the infant’s head and is usually more pronounced on one side. This flattening may broaden the head and face. In severe cases, the flattening may push forward one side of the face, creating an asymmetrical appearance. Not surprisingly, instances of flattened heads are on the rise. However, the benefits of babies sleeping on their backs
far outweighs the cosmetic, and often temporary, side effect.
Prevention Is Key To help prevent a flat head—the medical term is deformational plagiocephaly or positional plagiocephaly—try these tips: ■ Parents should still place babies on their back for sleep. ■ When babies are awake, put them on their tummy for a while. This eases pressure on the back of the head and helps babies build shoulder and neck strength. ■ Alternate which direction you place your child in the crib each night. Your child will then alternate which direction he or she looks out of the crib. ■ Pick up your child often. The more time your child is held in your arms, the less time he or she is lying down, with pressure to the head. ■ If your child develops a flat spot on the head, see your child’s physician.
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