ChildrensOmaha.org
Winter 2012
JustKids
New Year’s Resolutions:
Ready, Set,
Goal! p4
CELIAC DISEASE
TEEN STRESS
FRUITS AND VEGGIES
Should Your Child Be Tested? 2
How Parents Can Help 6
Tips to Get Kids Eating Healthy 7
Contents ➍ Ready, Set, Goal! ➏ Help Your Teen Cope
Celiac Clinic is a Unique
➐ Turn Ew! Into Yum! ➐ Healthy Kohl’s Kids
Nicole Brownell knew late last year that something was wrong with her 3-year-old daughter, Anna. What at first had seemed to be minor changes in her health and personality were growing progressively worse. “She was so worn down,” Brownell says. “She wouldn’t play much. She wouldn’t talk much. She cried a lot and she slept a lot. She wanted nothing to do with Christmas, which isn’t normal for any child. And she only wanted to be with me.”
With Stress
Tackling Obesity
➑ New Advice on
Preventing SIDS
➒ Intensive Care for Newborns Gets New Standards
A Problem with Gluten
➓ Gentle Imaging
Brownell and her husband, who live in Dakota Dunes, S.D., were referred to Children’s Hospital & Medical Center’s new Celiac Clinic, the only pediatric clinic of its kind in the region. Here, Pablo Palomo, M.D., pediatric gastroenterologist with Children’s Specialty Physicians, diagnosed celiac disease, a digestive condition caused by sensitivity to the protein gluten. The gluten triggers an immune reaction, which causes the body to create antibodies to eliminate it. This can damage the small intestine and result in the reduced absorption of important nutrients and long-term complications. That was in January 2012. Within a week, Brownell says, small changes were apparent in Anna’s health and personality. By September, she says, the difference “was like night and day.”
at Children’s
Creating Happy, Healthy Holidays Together
Your Online Source for Health Info
The Road to Recovery “In nine months, she’d gained 10 pounds,” Anna’s mom reports. “Her face had filled out and she’s healthier. The change in her personality has been amazing. She talks with everyone. She plays, she’s happy and she smiles all the time. I have a new little girl.” The Celiac Clinic is just one facet of the Department of Gastroenterology, Hepatology and Nutrition at Children’s. The physicians and staff are experts in treating pediatric feeding and growth disorders like celiac disease. Once a disease is diagnosed,
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
2
To find a physician, call 1-800-833-3100
JustKids
ChildrensOmaha.org
Gary A. Perkins President and CEO Martin W. Beerman Vice President, Marketing and Community Relations David G.J. Kaufman, MD 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. © 2012. All rights reserved. Printed in U.S.A.
What’sNew? Regional Resource Have Celiac Disease Questions? To learn more, enter the search term “celiac disease” at our website at HealthLibrary.ChildrensOmaha.org.
the clinic at Children’s goes beyond the routine in explaining the nature of a glutenfree diet, as well as providing support and answering questions. Because about 10 percent of patients with celiac disease will have a first-degree relative who also has the disease, Anna’s 4-year-old sister, Olivia, was tested. She, too, has celiac disease, although she showed no symptoms before testing. Both girls are on gluten-free diets and are doing very well.
Pictured above: Nicole Brownell with her daughters Anna (front) and Olivia.
Going Gluten-Free At first, Anna’s mother says the need to go gluten-free was daunting. “There has been a lot of trial and error,” she says. “But Dr. Palomo and the clinic at Children’s have been a great help. They are very reassuring and patient in answering all my questions. They’ve really tried to make it a positive experience for us.” Besides Anna and Olivia, the clinic is currently following about 90 patients ranging from infants up to young adults. In addition to managing their treatment, the clinic is in the process of enrolling in research models regarding the diagnosis and treatment of celiac disease in the region, Dr. Palomo says. In Anna’s case, it is clear that the proper diagnosis and diet greatly improved the quality of her life, Dr. Palomo says. “When I first saw Anna, she was an unhappy, angry child,” he says. “After we started the treatment and I saw her again, the first thing she gave me was a smile.”
Should Your Child Be Screened for Celiac Disease? For those with celiac disease, eating gluten causes the immune system to attack the lining of the small intestine. Eventually, people have problems absorbing nutrients from food. They can starve even if they eat a lot. Celiac disease affects about 1 percent of all people. But for those with type 1 diabetes, the odds are about 5 percent
that they will develop this disease. Symptoms of celiac disease include: • Stomach pain, gas and diarrhea • Feeling very tired • Losing weight However, many people with type 1 diabetes and celiac disease have no signs of the celiac disease. Ask your
pediatrician if your child should be screened even if no signs are present. If your child has celiac disease, the only therapy is a strict gluten-free diet. A dietitian can help you learn to avoid gluten. People with celiac disease need to avoid wheat, rye, barley, most grains, pastas, cereals and many processed foods.
ChildrensOmaha.org
3
feature story
Ready, Set,
Goal!
Help Your Family Set New Year’s Resolutions
Each New Year provides a fresh start on setting resolutions and achieving goals. This year, take a family approach when creating wellness goals. Here are a few ideas.
4
To find a physician, call 1-800-833-3100
Tips for Success
Schedule Wellness Visits It’s important for every family member to visit a primary care physician once a year for a well-check. When you schedule well visits for yourself and family members, it sets a good example for everyone. Some benefits of an annual wellness exam include: • Counseling that may prevent some health problems • Catching health problems early when they are easier to treat • Tracking important numbers, such as blood pressure and weight; tracking these vital statistics is just as important for children as it is for adults • Reviewing that all vaccinations are up-to-date.
Even your healthy teenager should still visit the pediatrician annually. Teens have developed a relationship with their pediatrician over the years. This allows the pediatrician the opportunity to discuss potentially touchy subjects, such as behavioral difficulties, social stresses, drug and alcohol use, depression or anxiety disorders. Don’t forget to schedule dental visits for all family members as well. Babies need their first dental checkup six months after they cut their first tooth or by age 1, whichever comes first.
Keep Your Home Safe Falling furniture sends an average of 46 U.S. children to emergency rooms each day, researchers say. Many injuries take place as children pull over or climb on furniture. Children ages 6 and younger are most likely to be hurt—especially by televisions —but desks and cabinets also account for injuries. To minimize risks to children: • Place TVs close to the ground and toward the backs of stands. • Strap televisions and furniture to the wall with safety straps or L-brackets. • Install drawer stops on chests of drawers. • Buy furniture with wide legs or with solid bases. • Place heavy items on shelves near the floor. • Avoid placing items that might encourage climbing, such as toys, high on top of furniture. Other ways to keep little ones safe at home include using locks to prevent windows from opening more than 4 inches, installing a carbon monoxide detector in each level of your house and closing doors to extra rooms when not in use.
Exercise as a Family Both adults and children need about an hour of physical activity per day. Children learn by watching you. So plan ways to stay moving as a family. Exercise makes you stronger, keeps your weight in check, and improves your balance. Don’t think you have time to exercise? Think about all the things you do already, then find a way to fit in fitness. For instance, have everyone in the family pick out a favorite upbeat song. Then, dance to each song while preparing dinner. Turn off the TV after the family meal and go for a walk or rollerblade around the neighborhood. Ride bikes instead of driving to the library or when running errands. Taking your family’s workout outside gives you even more benefits. You can connect with nature and so can your children. You’ll be happier, less stressed and tuned in to the world around you. Need help promoting fitness in your family? We can help. Simply visit the website at HealthyKohlsKids.com/fitness.
Find the Right Doctor
Whether it’s for you or your children, here are some helpful tips for setting and achieving goals: • Think small. Break down large, difficult goals into smaller ones that are easier to keep. For example, if your family has been inactive but wants to get fit, start by vowing to take a brisk, 10-minute walk together three days per week. • Be realistic. Minor slip-ups are part of the process. Let’s say you resolved to increase the family’s consumption of veggies every day at dinner, but skipped Monday and Tuesday. Don’t beat yourself up. Just get back on track Wednesday. • Make it fun. For example: To eat healthier, try a healthy recipe the family can make together. Visit HealthyKohlsKids.com for recipe ideas! • Keep track. Each time the family meets a daily goal, circle the date on the calendar. Seeing tangible evidence of your progress is a great motivator.
Selecting a physician 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-Doctor service at 1-800-833-3100. ChildrensOmaha.org
5
Is Your Child Anxious? The Anxiety Disorders Clinic at Children’s offers specialized diagnostic services and treatment groups for children and youth who have fear or anxiety symptoms. If you think your child and family may benefit, call 1-800-833-3100.
Help Your Teen Cope with Stress Everyone feels stressed from time to time. You may vent to coworkers or call your spouse to talk. But stress is often worse for teens. When a teen is under pressure, he or she can feel alone in the world. You can’t make the pressures of life disappear. As a parent, however, you play a key role in helping your child cope.
Youth Under Pressure With so much beyond their control, it’s easy for young people to feel overwhelmed. Sources of adolescent stress include: • Schoolwork • Trouble with friends, boyfriends or girlfriends • Changes in their bodies • Peer pressure to engage in risky behaviors • Illness or death in the family • Wanting to fit in • Work and after-school activities. Stress can cause your child to feel edgy, tired, depressed or resentful. It can also bring on physical symptoms, such as stomachaches and headaches.
Successful Stress-Busting Strategies Studies show teens’ brains actually process stress differently. They have a harder time telling minor troubles from real threats. That’s why a parent’s perspective is so important.
6
To find a physician, call 1-800-833-3100
Talk openly with your teen. Let him or her know you’re there to listen and provide support. Together, work on ways to deal with stress, such as:
• Listing the things that cause your teen’s stress. Change the ones you can.
For instance, if your child’s too busy, consider reducing part-time work hours. • Living a healthy lifestyle. Eating right, exercising and avoiding drugs and alcohol reduce the effects of stress. • Recognizing accomplishments, instead of dwelling on failures. At the end of each day or week, help your teen think about all he or she has achieved. • Laughing. Turn on a sitcom, tell funny stories or search for silly videos online. Laughter produces good feelings that last beyond a quick chuckle.
Watch for Warning Signs Most teens find healthy ways to handle stress. Red flags include changes in weight or personality, a drop in grades, or talking about killing or hurting himself or herself.
Turn Ew! Into Yum! Five strategies to get your kids to love (or at least tolerate) veggies What parent hasn’t seen a child turn up his or her nose at healthy food? Faced with a green vegetable or unfamiliar dish, children are notorious for making a fuss. Unfortunately, most children today only eat half the recommended servings of fruits and vegetables. To encourage your child to eat the recommended 4.5 cups—without a fight—try these tips:
Healthy Kohl’s Kids Tackling Obesity 1 Be sneaky. Sneak fruits and veggies into foods your children already eat. Add pureed broccoli or cauliflower to pasta sauce. Chop up green peppers, carrots and celery and mix them with water-packed tuna and fat-free mayonnaise.
2 Make it easy. When it comes to snacking, kids will usually eat whatever food is on hand. Stock the front of the fridge with snack-sized baggies or clear containers of grapes, carrot sticks, bell-pepper slices and melons cut into bite-sized pieces. 3 Have some fun. Cut veggies into shapes (think hearts and stars) and serve them with low-fat dip.
4 Enlist their help. Children are more apt to eat meals they help prepare. Get their input on meal planning and then shop for and cook healthy foods together.
Childhood obesity is the top health issue affecting both children and adolescents in the Omaha metro area. Three out of 10 school-age children in the metro area are overweight or obese. Children’s Hospital & Medical Center and Kohl’s Department Stores have teamed up to change these findings with a program called Healthy Kohl’s Kids. The program is the newest chapter in a more than decadelong partnership between Kohl’s and Children’s. “We are extremely excited about the new Healthy Kohl’s Kids program,” says Gary A. Perkins, president and CEO of Children’s Hospital & Medical Center. “We look forward to this new program educating children and their families on how to eat better and exercise more for a healthier lifestyle.”
Join the Fun! 5 Be a role model. You’re not the only one who keeps tabs on what you eat. Your children also are eyeing your food choices. Set a good example by practicing what you preach.
Learn more about the Healthy Kohl’s Kids program at www.healthykohlskids.com. The website features how-to videos of young chefs making healthy meals and snacks, and it enables people to share recipe and exercise tips via Facebook, Twitter and Pinterest.
ChildrensOmaha.org
7
While not all SIDS deaths may be avoided, doing what you can to reduce your child’s risks may save his or her life.
New Advice on Preventing
SIDS
More Tips about SIDS! To learn more about SIDS, enter the search term “SIDS” on our website at HealthLibrary. ChildrensOmaha.org.
Two decades ago, doctors sent moms and dads a message: Put babies to sleep on their backs. In the years that followed, the rate of sudden infant death syndrome (SIDS) fell by half. Now there’s a new call to action: More can be done to save babies’ lives. Studies have found other risk factors that also raise a child’s risk of dying from SIDS.
The New Research Doctors can’t always tell the specific causes of SIDS, the sudden, unexplained death of a baby less than 1 year old. The foremost risk remains the same. Babies who sleep on their stomachs have double the chances of SIDS. Infants can be born with certain risk factors, such as being male, premature and having a mother who smoked or used alcohol while pregnant. But a study published in Pediatrics focused on other key risk factors. They include babies sharing a bed with an adult, sleeping on an adult mattress, being overdressed for the temperature, having their faces covered and being exposed to cigarette smoke.
8
To find a physician, call 1-800-833-3100
Other Steps to Take Avoiding the risk factors mentioned can help keep your baby safe from SIDS. So can taking these precautions: • Don’t put soft toys, pillows or loose blankets in the crib. • Breastfeed your baby. • Give your baby a pacifier. • Let your child’s doctor know if your baby ever goes limp, turns blue or appears to stop breathing for any period of time. • Give your baby tummy time when awake. A certain amount of tummy time while awake and being observed by a caregiver gives a baby motor development of the shoulders. While not all SIDS deaths may be avoided, doing what you can to reduce your child’s risks could save his or her life.
Fast Fact In 2011, the Children’s NICU cared for nearly 325 critically ill newborns. Scan this QR code to learn more about our NICU!
• The experience and expertise to provide surgical repair of complex congenital conditions including serious heart defects • The ability to transport critically ill newborns by ground, helicopter and fixed-wing aircraft • The ability to facilitate and provide outreach education.
New National Standards Define Intensive Care for Newborns Children’s Omaha is the only Level IV NICU serving a multi-state region New standards published by the American Academy of Pediatrics (AAP) establish Children’s Hospital & Medical Center as the only Level IV Regional Newborn Intensive Care Unit (NICU) serving Nebraska, western Iowa and South Dakota. Level IV is the highest level of care as defined by the AAP. The new standards were published in the September 2012 edition of the medical journal Pediatrics.
Children’s meets a number of strict criteria including: • Experience in the care of the most complex and critically ill newborns • The availability of pediatric-trained subspecialists on-site and available 24/7, including heart surgeons, pediatric surgical subspecialists and anesthesiologists
“The AAP has taken a significant step in redefining these classifications of care,” says Lynne Willett, M.D., clinical service chief of Neonatology at Children’s. “It’s important to understand all newborn intensive care units aren’t alike. As the only Level IV NICU in the state, Children’s is uniquely qualified to care for the sickest babies. Neonatologists, nurses, pediatric surgeons and specialists, and a skilled critical care transport team —we are all here and working together to give these newborns the most comprehensive care available.” Since 2004, Children’s had been recognized as a Level III-C unit, the highest level as noted by past AAP standards. The new classifications have been simplified and no subdivisions exist. Units are designated as one of the following: • Level I, Well Newborn Nursery • Level II, Special Care Nursery • Level III, Newborn Intensive Care Unit • Level IV, Regional Newborn Intensive Care Unit. “Children’s is widely recognized as a regional resource providing advanced diagnostics and treatments,” says Dr. Willett. “Patients come to our unit from other NICUs, hospitals and health systems across the state and beyond.”
ChildrensOmaha.org
9
Gentle Imaging a Picture of Safety and Comfort Physicians diagnose illness and injury each day, but it can be difficult diagnosing babies and very young children because they can’t verbally describe their symptoms. While x-rays, CT scans, MRIs or ultrasounds may be necessary to determine a child’s ailment, they can be extremely difficult to perform on a young child. Many young children don’t understand the words, “hold still,” and even more have trouble accomplishing it. That’s why the Radiology Department at Children’s Hospital & Medical Center offers a child-friendly environment, uniquely qualified staff and specialized equipment and procedures to help ensure the best diagnosis.
Child-Friendly Staff and Atmosphere The pediatric-trained specialists at Children’s Hospital & Medical Center in Omaha have extensive experience working with one patient population – children. We excel at making them feel comfortable in situations that can be a little unsettling, and we thrive on collaborating with your referring physician to determine the most effective way to image your child. Our staff physicians are fellowship-trained pediatric radiologists. They only read pediatric images and are specifically trained in disease processes that are only seen in children. Our radiologists have over 65 years of combined experience reading pediatric studies and have been recognized nationally for their efforts to
10
To find a physician, call 1-800-833-3100
minimize radiation exposure while providing diagnostic results.
Little Touches for Little Patients Any time a child has to go in for a procedure, it can be stressful for them and their parents. That’s why we encourage questions, foster open communication and assign each of our families a child life specialist, a professional who is trained to hold a child’s hand (literally and figuratively) through the process – from talking to them about IV’s to discussing what it feels like to be inside an MRI machine. Our two MRI scanners are child-friendly and unlike any other in the state of Nebraska. Not only are they decorated in a calming underwater theme on the outside, they are outfitted with a unique TV/video system on the inside. It’s technology you won’t find in any other MRI scanner in the state of Nebraska. With a movie playing, a child can, optimally, remain still and quiet during the 30-to-60 minute study without the need of a mild sedative. In other exam rooms, projectors throw pictures on the wall and ceilings for the sake of distraction, and many have televisions.
Imaging Gently: The Children’s Difference Children’s is committed to providing the safest and most effective radiology and imaging
services for your child. Whenever radiation is involved in a procedure at Children’s, our pediatric-trained specialists take every precaution to ensure that the amount of radiation used is the bare minimum necessary to achieve an accurate result. Our Radiology Department supports and adheres to the recommendations of the Image Gently Campaign, an initiative of the Alliance for Radiation Safety in Pediatric Imaging. The campaign goal is to increase awareness of the opportunities to promote radiation protection in the imaging of children. Children’s has been “imaging gently” since 2008, embracing guidelines from the American College of Radiology (ACR) and the motto of “as low as reasonably achievable” when it comes to the amount of radiation used in our studies. In addition, we only use CT scans when absolutely necessary (emergent trauma cases, for example), deferring to ultrasound or MRI, whenever feasible, to minimize radiation exposure. When CT scans are required, our CT doses are “child size,” carefully calculated to decrease the long term cancer risk to children. Children’s is also a national advocate for the use of sonography to diagnose pediatric appendicitis as another element in our effort to minimize childhood exposure to radiation.
at Children’s
Our MRI scanners are child-friendly. They are decorated in a calming underwater theme on the outside, and outfitted with a unique TV/video system on the inside.
For more information on the radiology department at Children’s, visit www.ChildrensOmaha.org/Radiology.
ChildrensOmaha.org
11
Non-Profit Org. U.S. Postage
Children’s Hospital & Medical Center has received accreditation or recognition from the following organizations for its delivery of extraordinary healthcare to children.
ChildrensOmaha.org
PAID
Children’s Hospital & Medical Center
8200 Dodge Street Omaha, NE 68114 402-955-5400
881M
Creating Happy, Healthy Holidays Together While the holidays can be a great source of lasting childhood memories, they can also be a time of stress and anxiety. As parents, it’s important for you to take control. The best way to do this is to plan ahead, stick to priorities and let your child come first.
Follow these tips to help ensure a happy holiday season: • Drive safely and follow fire safety rules. • Avoid latex balloons. An uninflated balloon can
•
•
• •
be easily swallowed, as can pieces from a popped balloon. If you have small children, avoid ornaments and decorations that resemble food or are breakable. Be sure to keep snacks and appetizers that could cause choking, like nuts, grapes and hard candies, out of reach of small children. Clear away ashtrays and alcoholic beverages at the end of a get-together. Don’t leave food requiring refrigeration out at room temperature for longer than two hours. Dispose of plastic bags as soon as you get home. Small children can suffocate using them.
eNewsletter Sign-Up
Don’t Toy Around with Safety Be sure to choose toys that are appropriate for a child’s age and abilities. Check the toy’s packaging for safety information and age guidelines. In addition: • Beware of pull toys with strings longer than 12 inches, which can pose strangulation hazards to young children. • Teach older children to keep their toys away from little siblings. • Don’t give younger children toys with sharp edges, small parts or sharp points. • If you give skateboards, bicycles, scooters, or inline skates to your children, make sure they always wear helmets and other safety gear, such as wrist, hand, and shin guards, when using them. Remember to take time for hugs and quiet family time during the holidays. A child’s wonder and delight are yours to share if only you take the time to enjoy it.
Subscribe Now To subscribe to health-e kids, our free monthly e-newsletter, visit ChildrensOmaha.org and click on the e-newsletter icon located on the right side of the home page.