ChildrensOmaha.org
Spring 2012
JustKids Do Your Kids Get Enough ZZZ’s? p5
CHOKING HAZARDS
MENINGITIS
URGENT CARE CENTERS
Keep Your Child Safe 4
Get the Facts 6
Two Convenient Locations 7
Contents ➍ Choking Hazards:
Keep Your Child Safe
Children’s and Kohl’s Committed to Injury Prevention
➎ Lack of Sleep Can
Harm a Child’s Health
➏ Meningitis: Act Fast! ➐ Pediatric Urgent Care ➑ Your Infant’s Teeth ➒ Pediatric Dental Care
Unintentional and preventable injuries are the leading causes of death for children younger than the age of 14. Many people are unaware that 80 percent of car seats are not properly installed, nor do they realize that fastening a seat belt or wearing a bike helmet can be the difference between life or death for a child. 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 and Kohl’s department stores, is dedicated to reducing the number of accidental injuries in children. Kohl’s Cares® earmarks net profits from the sale of its $5 books and plush toys for initiatives such as injury prevention, immunizations and education programs for diabetes, asthma and childhood obesity, among others. Since 2000, Kohl’s has raised more than $150 million to support children’s health and education initiatives nationwide. Kohl’s has donated more than $1.2 million to Children’s Hospital & Medical Center in support of child injury prevention programs. Every time you purchase a plush toy and accompanying book offered at Kohl’s Department Stores in the Omaha area, Kohl’s shares the sales proceeds from this merchandise with Children’s Hospital & Medical Center.
Offered at Children’s
➓ Peanut Allergy Is
Serious Business
Children’s Transport Team Marks Milestone
Your Online Source for Health Info
On the Web Learn more about this season’s merchandise at www.kohls corporation.com/communityrelations/Community02.htm. Or just use your smartphone to scan this Microsoft Tag. Visit www.ChildrensOmaha.org/2DCode to learn how to use tags.
For the latest information and news, support groups, events, patient stories and perspectives from our physicians, check out these online resources: Facebook.com/ ChildrensOmaha
JustKids
YouTube.com/ ChildrensOmaha Twitter.com/ChildrensOmaha
2
To find a physician, call 1-800-833-3100
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? Children’s Experts Offer Helpful Tips with Free Parenting U Classes With the arrival of a child, there are some things you learn automatically, like how little sleep an adult actually needs to function, the importance of sippy cups, and that polar bears may be hiding in your closets. For other lessons—including the skills to get through those all-important first years—there’s Parenting U from Children’s Hospital & Medical Center. These are FREE classes given by professionals known for their knowledge of children. Along with a new topic each week, we’ll provide food, child care and prizes.
Free Parenting Classes Call 800-833-3100, or log onto ChildrensOmaha.org/ParentingU to register today.
Parenting U Upcoming Dates 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/ParentingU to register today. Tuesday, June 26 Preparing For Your Newborn Rachel McCann, M.D., F.A.A.P., Children’s Physicians
Tuesday, October 2 Mastering Potty Training Katie Anglim, M.D., F.A.A.P. Children’s Physicians
Tuesday, September 11 Preparing For Your Newborn Steven Sindelar, M.D., F.A.A.P., Children’s Physicians
Tuesday, October 23 Childhood Obesity Prevention & Management Cristina Fernandez, M.D., F.A.A.P., Children’s Weight Management Clinic Jennica Cornine, M.P.A.S., P.A.-C., Children’s Weight Management Clinic
Tuesday, September 18 Baby’s First Years Michelle Mogenson, D.O., F.A.A.P., Children’s Physicians Tuesday, September 25 Effective Time-Out Techniques Ashley Harlow, Ph.D., N.C.S.P. Children’s Behavioral Health
ChildrensOmaha.org
3
The CPSC recommends the following steps to prevent battery ingestion: • Discard button batteries carefully. • Do not allow children to play with button batteries. • Keep remotes and other electronics out of the reach of children if the battery compartment does not have a screw to secure it. Use tape to help secure the battery compartment. • If a button battery is ingested, immediately seek medical attention.
If Your Child Swallows Something
Choking Hazards: Take Steps to Keep Your Child Safe Christopher Columbus used a compass, but babies have other means of exploration—like their mouths. Young children ages 6 months to 3 years often put objects in their mouths, and sometimes they swallow odd things. Fortunately, there are some things parents can do to lower their child’s risk of choking.
Identify Choking Hazards To prevent your child from inhaling or swallowing potentially dangerous items, follow these steps: • Place small items, such as toys with tiny removable parts or common household objects, in places that toddlers can’t access. Remember to hide the usual suspects—pins, needles, coins, latex balloons, pen caps, marbles and tiny balls. Also, don’t forget atypical items like high-powered magnets; these small magnets are fun stress relievers for adults to keep on their desk, but can also be choking hazards for young children or even teens who use them to mimic piercings.
4
To find a physician, call 1-800-833-3100
• Avoid giving young children foods that can cause choking. Keep little ones younger than age 4 away from seeds and nuts; sticky, gummy or hard candy; peanut butter chunks; popcorn; hot dogs; whole grapes; big chunks of cheese or meat; raw veggies and raisins. • Monitor children closely when they play and eat. • Get down on your hands and knees and experience your house like a baby does. Look for unsafe objects your child might find, and baby proof the house accordingly.
Button Batteries Pose Extra Risk In addition to being a choking hazard, round button batteries, when swallowed, can cause dangerous internal chemical burns in children. Damage can occur in as little as two hours after ingesting. According to the U.S. Consumer Product Safety Commission (CPSC), children most often gain access to button batteries directly from games, toys, calculators, remote controls and other common household items.
While most swallowed objects, other than batteries, pass through a little one’s digestive system symptom-free, it may take up to one month for the item to pass. Parents should check their child’s stools to ensure that the item has been expelled. Objects that get inhaled and lodge in the windpipe can put your child’s life at risk. Swallowed items may also get caught in the digestive track or obstruct the esophagus. Here are the symptoms to look for: • Constant coughing with no obvious cause • Chest or stomach pain • Hoarseness or drooling • Vomiting • Pain or difficulty when swallowing If your child has any of the above symptoms, seek prompt medical attention. If your child suddenly starts to choke, wheeze or has trouble breathing after swallowing, handle it as a medical emergency. Perform the Heimlich maneuver, and immediately call 911 or your local emergency number.
Protect Your Child from Choking To learn more, enter the search term “choking hazard” at our website at HealthLibrary.ChildrensOmaha.org.
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 children’s shut-eye at every age.
A study in Pediatrics found that childhood sleep deficiencies may be linked to future problems, too. Among them: 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.
Sleep’s Deep Effects on Children
Help Cultivate Your Teen’s Dreams
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, 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 children do in school. It also impacts a child’s physical well-being. The body releases hormones during sleep that aid growth, build muscles and repair cells and tissues.
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.
How to Help Your Child Sleep Well Help your child get a good night’s sleep with these steps: • Encourage a consistent sleeping and waking schedule. • Ban the use of computers, TVs, music players and phones close to bedtime. • Help your child 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, sleep apnea causes pauses in breathing during sleep and leads to daytime tiredness. If you think a sleep disorder may be affecting your child, talk with a doctor.
Suspect a Sleep Problem? Are you concerned that your child isn’t getting proper rest? If so, talk with your child’s primary care provider. To find a physician for your child, call the Children’s Find-A-Doctor service at 1-800-833-3100.
ChildrensOmaha.org
5
Have Questions About Meningitis? To learn more about meningitis, visit HealthLibrary.ChildrensOmaha.org and enter the search term “meningitis.”
Meningitis Requires Fast Action • • • •
Red or purple rash Fatigue or extreme sleepiness Seizures Irritability, lethargy and poor feeding, which may be the only symptoms in infants
A physical exam and a history of symptoms help tell a doctor if meningitis is likely. A blood test and a spinal tap can determine whether a virus or bacteria are causing the infection, which determines treatment. Viral meningitis, which isn’t as severe, usually goes away on its own. Doctors treat bacterial meningitis with intravenous antibiotics. Serious cases may require intensive care.
Take Steps to Prevent Meningitis
Meningitis can strike fast and hard. Some forms of this disease can kill a healthy child in as little as 24 hours. Meningitis is an inflammation of the membranes that cover the brain and spinal cord. A virus or a bacterium usually causes meningitis. It’s important to try to find out as quickly as possible what’s causing the illness. That’s because the treatment and the severity differ depending on the cause. You can help by learning the signs and symptoms of meningitis and having your child evaluated as soon as possible. Prompt diagnosis and treatment give your child a better chance for complete recovery.
6
To find a physician, call 1-800-833-3100
Bacterial meningitis—a more severe form of the illness—can have very serious complications, such as brain damage, hearing loss and learning problems. Even with treatment, there is still a risk for death. You can prevent many forms of meningitis by having your child vaccinated as recommended.
The Symptoms of Meningitis If your child has any of these symptoms, contact your doctor immediately: • Stiff neck • Fever • Headache • Nausea and vomiting
The Centers for Disease Control and Prevention (CDC) recommends that children be vaccinated against bacterial meningitis. These vaccines are safe and effective, the CDC says. Different vaccines are given to infants and young children, preteens and teens. College freshmen need a second vaccination unless they have already received two doses. Some forms of bacterial meningitis are contagious and can be spread through coughing, kissing and sneezing. Anyone in the same household, day care center or other site who has been in close contact with someone with these forms of the disease should receive antibiotics to prevent infection. There are no vaccines for viral meningitis. However, you can reduce your risk for infection by washing your hands thoroughly and often. You should also avoid kissing or sharing glasses or eating utensils with someone who is sick.
Life doesn’t stop after 6 p.m.
Neither Do We. Children become sick. Teens are injured playing sports. And, children will be children, so sometimes accidents happen. When your child has an illness or injury that’s not serious enough for the emergency room, but can’t wait until tomorrow, visit one of the two Children’s Hospital & Medical Center Urgent Care locations. When your doctor’s office is closed, Children’s Urgent Care Centers are open. Hours of operation are Monday through Friday from 6 to 10 p.m., and weekends and holidays from noon to 10 p.m. Children’s two Urgent Care Centers are staffed by pediatricians and pediatric nurses from Children’s Hospital & Medical Center. No appointment is necessary.
What Our Urgent Care Offers • The only pediatric urgent care centers in the area
• Board certified pediatricians and pediatric nurses
• Digital X-ray and lab services on site • Treatment of cuts and lacerations • Treatment of sports injuries, minor injuries and illness
1 2
Two Locations for Children’s Urgent Care Centers Both Children’s Urgent Care Center locations are open Monday through Friday from 6 to 10 p.m., and weekends and holidays from noon to 10 p.m.
Val Verde 9801 Giles Road, Suite 1 (96th and Giles) 402-955-7200
West Village Pointe 110 North 175th Street, Suite 1000 (175th and Burke) 402-955-8300
ChildrensOmaha.org
7
Dental Care
Protect Your Infant’s Teeth Healthy teeth can last a lifetime. So teach children good dental care at an early age. Even before the first teeth appear, wipe milk or juice off your baby’s gums with a clean gauze pad.
8
To find a physician, call 1-800-833-3100
Before your infant goes off to sleep at the end of the day, you should do more than kiss the little one good night. Make sure your baby’s developing teeth are not at risk from nursing or bottle tooth decay. That happens when juice or milk stays in the mouth while a baby sleeps, especially when sucking on a bottle all night. The sugars in the mouth are metabolized by bacteria, which produce acid that eats away the enamel
of the teeth. This results in cavities. Cavities must be repaired before they extend into the pulp—commonly called the nerve—of the tooth, requiring either a root canal or the tooth to be pulled. When your baby is awake, saliva bathes the teeth, removing much of the sugar from foods and keeping the bacteria in check. But while your baby sleeps, saliva production lessens, and the decay rate increases.
Establish Good Habits Early in Life Healthy teeth can last a lifetime. So teach children good dental care at an early age. Even before the first teeth appear, wipe milk or juice off your baby’s gums with a clean gauze pad after every feeding. When teeth do appear, brush them with a soft toothbrush after the last feeding before bed and again in the morning. Start flossing your child’s teeth as soon as any two teeth touch. Once children begin brushing their own teeth, supervise them to make sure they are doing a good job. Because letting food sit on the teeth promotes tooth decay, teach children to brush after meals.
Healthy Teeth Tips for Babies Experts recommend that by the time babies are a year old, they should drink from a cup. If the bottle helps a baby settle down, fill it with plain water. Never put a baby to bed with a bottle of milk, juice or sugary drink. The American Dental Association (ADA) makes these recommendations: • Begin to clean your baby’s mouth during the first few days after birth. Use a soft washcloth or damp gauze and gently wipe along the gum. • When teeth begin to appear, the cloth can still be useful, or use a soft-bristled toothbrush without toothpaste. • Talk with your pediatrician about dental care for your baby. The ADA recommends that children receive their first dental visit within six months of eruption of the first tooth and no later than 12 months of age. Practitioners can start your child on a lasting program of dental care.
More Baby Teeth Tips! To learn more about caring for your infant’s teeth, visit HealthLibrary. ChildrensOmaha.org and enter the search term “baby teeth.”
Pediatric Dental Care Offered at Children’s For the first time ever, dental care is available for children on the Children’s Hospital & Medical Center campus. The UNMC Pediatric Dental Clinic at Children’s is located in the hospital’s state-of-the-art Specialty Pediatric Center (SPC) located at 84th and Dodge Streets. While new to Children’s, the clinic represents an expansion of pediatric dental services offered by the University of Nebraska Medical Center (UNMC) College of Dentistry.
Better Access to Dental Care “This is an exciting collaboration with real benefits for families. The ability to offer this service in our Specialty Pediatric Center improves access to dental care, particularly for those children who have a great need due to a chronic condition or illness,” says Justin Bradshaw, vice president of ambulatory services at Children’s. Because the pediatric dental clinic is physically located in the Specialty Pediatric Center, the other clinics in the facility have a dentist on the team for the first time. This is incredibly beneficial for those programs that treat children with complex conditions, as well as for the patients and families. Take the Osteogenesis Imperfecta (OI) Clinic, for example. Also called brittle bone disease, OI affects a child’s bones, including the teeth. Children treated in
the OI Clinic now benefit from a dentist on staff to collaborate with the multidisciplinary team to improve treatment. In addition, dentists will coordinate with other pediatric specialists and do general dental work on a patient while the child is under general anesthesia for another medical procedure.
All Children Are Welcome While the pediatric dental clinic is a benefit for children with complex medical conditions, it treats all children, including those with no other medical condition, or those who do not have other medical conditions treated at Children’s. John Reinhardt, dean of the UNMC College of Dentistry, sees this clinic as a great step forward for UNMC, the Omaha community and the college. “Having a new, modern postgraduate pediatric dentistry clinic located at the Children’s Specialty Pediatric Center, surrounded by pediatric medical specialists, is definitely good for all. Our clinical service and educational programs will rise to an even higher level of excellence through this opportunity.”
Dental Clinic Hours The dental clinic is open during weekdays from 7:30 a.m. to 4 p.m. It is closed on weekends. For more information, call 800-833-3100.
ChildrensOmaha.org
9
feature story
Peanut Allergy Is serious business Children’s state-of-the-art care saves boy’s life A party at school turned into a life-threatening situation for 7-year-old Max Roseland. Celebrating a movie and snack day, the kids were encouraged to bring their favorite stuffed animal to school, wear pajamas and bring snacks to share with the class. While this seems like harmless fun, things took a serious turn when Max took a bite of a peanut butter chocolate chip granola bar. You see, Max has a severe peanut allergy. And that little bite started a series of events that led to Max fighting for his life in a pediatric intensive care hospital bed.
Peanut Allergies Common Peanut allergy is the most common type of food allergy among school-aged children, and reactions can often be severe. While some children may only experience hives or vomiting, others experience life-threatening throat swelling, difficulty breathing and other serious complications. In addition, reactions tend to worsen over time.
10
To find a physician, call 1-800-833-3100
Max had suffered reactions twice before. The first as an infant, which prompted his parents to have him tested, and the second a year and a half ago. That time, he was rushed to the emergency department and immediately given epinephrine. This time was a little different. “I got the phone call from Max’s teacher a little after noon,” says Amy Roseland, Max’s mom. “I sent a snack with Max that day, and his teacher had me come in that morning. I approved two snacks for Max to eat. One was mini marshmallows and one was a bag of Vic’s caramel popcorn.” But somehow, in the dark classroom things got mixed up. The granola bar had unknowingly come out of someone’s lunch. Max asked his teacher if he could eat the granola bar and was told everything was safe for him to eat. After one bite, his tongue immediately felt itchy. He went to the school nurse, who gave him a dose of Benadryl and monitored his vitals. Things seemed fine by the time Amy got to the nurse’s office. Max was breathing and hadn’t broken out in hives.
TAKE FOOD ALLERGIES SERIOUSLY To learn more about food allergies, visit us online at HealthLibrary.ChildrensOmaha.org and enter the search term “food allergy.”
Max
As Amy and Max left the school, however, Max started crying hysterically and saying that his stomach hurt. Amy called Max’s pediatrician, who instructed them to head straight to Children’s Hospital & Medical Center. While in the Emergency Department, Max broke out in hives on the back of his neck, face and down his body. He started coughing and wheezing. Soon, he couldn’t breathe. Max was experiencing a delayed allergic reaction. “They gave him two shots of epinephrine and three vials of prednisone, and then they started doing breathing treatments,” says Amy. “But he was so far gone that nothing was working. Max was begging that he couldn’t breathe. They sedated him to insert a tube down his throat, but when they went to insert the tube, his heart stopped.” Staff at Children’s immediately started CPR. After a minute of chest compressions, his heart rate went back up. They intubated him, then rushed him upstairs to Children’s Pediatric Intensive Care Unit (PICU).
The Children’s Difference
2011 Max Roseland was having fun at a school party until a peanut butter chocolate chip granola bar accidentally got mixed into his bag of treats. A delayed allergic reaction turned into an emergency situation. Fortunately, Max got the care he needed at Children’s Hospital & Medical Center.
Children’s PICU is the only pediatric intensive care unit in the region to offer 24/7 in-hospital coverage by board-certified physicians trained in pediatric critical care. The PICU is also continuously staffed by nurses and respiratory therapists trained in the care of critically ill and injured children. It’s also the only hospital in the area that provides ECMO (extracorporeal membrane oxygenation) support for all patients, from newborns to adults. ECMO is a potentially life-saving procedure that provides mechanical oxygenation and cardiac support for patients in cardiac, pulmonary or cardiopulmonary failure. The procedure normally involves removing blood from the body and bypassing the heart and lungs. This allows a machine to oxygenate the blood and rest of the heart before returning the blood back to the body. In Max’s case, his heart was fine, but his lungs were in trouble. So, pediatric intensivists at Children’s used a type of ECMO, called veno-venous ECMO, to combat his failing health. The pediatric specialists at Children’s are the only professionals in the area who perform this type of ECMO. “The PICU staff saved his life,” says Amy. “I can’t thank them enough for their hard work. It takes a certain type of person to do that job. We’ll be forever grateful to them for saving our Max.”
A Community Issue While Max’s story has a happy ending – he was off the ventilator the next day and home soon after, his mom, Amy, wants people to know that peanut allergies are serious business. “I want parents to understand how important it is to not send peanut treats to school when they’ve been warned not to, even in their own child’s lunch,” says Amy. “You really need to pay attention to that and be aware of and sensitive to others with food allergies. That is our vision.”
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.
PAID
Children’s Hospital & Medical Center
8200 Dodge Street Omaha, NE 68114 402-955-5400
ChildrensOmaha.org
881M
Children’s Transport Team Helps 1,000 Patients Children’s Hospital & Medical Center welcomed 2012 with high expectations for a growing program. Children’s Critical Care Transport Service logged a record 1,000 patient transports in 2011. The milestone was achieved on Saturday, Dec. 31. Children’s Transport team went by ambulance to northeastern Nebraska to assist with twins who needed additional care. The infants were admitted to Children’s Hospital & Medical Center.
Service Still Growing “Our transport service has experienced tremendous growth over the past five years. We’ve expanded in size and in our capability to travel, so critically ill infants and children from across the region have access to specialized pediatric care,” says Rob Chaplin, M.D., medical director of
eNewsletter Sign-Up
Children’s Transport Service. Ground transportation is the top mode of travel. Children’s dedicated ambulance accounted for 898 of the 1,000 transports. Eighty-five trips were made by helicopter, while the team hopped on board fixed-wing aircraft for 17 patient trips. The greatest distances traveled took Children’s to Rapid City, S.D. and St. Louis, Mo. “We completed more than 600 transports in 2010 and with such a large increase last year, we know there is a significant need for this service,” says Dr. Chaplin. “Our team provides crucial intervention that can dramatically improve a child’s outcome.”
Improving Capabilities Recent highlights for Children’s Transport Service include the debut of fixed-wing aircraft in August 2011, through a partnership
with Air Ambulance Specialists, Inc. (AASI) and Crow Aviation; a 2010 partnership with LifeNet, in association with AirMethods Corp., for helicopter travel; and the introduction of a customized Children’s ambulance equipped exclusively for pediatric patients with American Medical Response (AMR), in the fall of 2009. The Children’s Critical Care Transport Service is available 24/7. It is activated by physician request.
Above: Children’s transport team members load an infant into the helicopter. Top photo: Members of Children’s transport team pose with the program’s fixed-wing aircraft.
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.