ChildrensOmaha.org
Spring 2013
JustKids
HELP CHILDREN OF ALL AGES FACE THEIR FEARS p6 SLEEP PROBLEMS
healthy kohl’s kids
FAMILY FITNESS
Common in Springtime 8
Nutrition and Fitness Resources 10
Make Time for It 11
Contents ➍ In Self-Harm,
Children Embrace Pain
➎ Patient Profile:
How Malicka Found Stardom
➏ Help Children
Face Their Fears
➑ Lack of Sleep Is a
Common Springtime Problem
➓ Healthy Kohl’s Kids Offers Resources
Make Family Fitness a Walk in the Park Upcoming Parenting U Classes
Your Online Source for Health Info 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
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JustKids
ChildrensOmaha.org
Gary A. Perkins President and CEO Martin W. Beerman Vice President, Marketing & 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. © 2013. All rights reserved. Printed in U.S.A.
What’sNew? Children’s Receives Pediatric Trauma Verification
By the Numbers Here’s a closer look at the numbers for pediatric trauma at Children’s:
5,900 patients of all ages are seen each year in the Children’s Emergency Department with a trauma-related diagnosis.
Children’s Is State’s Only Level II Pediatric Trauma Center The trauma center at Children’s Hospital & Medical Center has been verified as a Level II Pediatric Trauma Center by the Verification Review Committee, an ad hoc committee of the American College of Surgeons Committee on Trauma (ACS-COT). Children’s is the first and only hospital in Nebraska, and the only hospital serving western Iowa and northwest Missouri, to receive pediatric trauma verification.
Meeting the “Gold Standard” ACS standards are considered the “gold standard” for trauma centers. Verification is a voluntary process that requires an intensive review conducted by outside trauma and medical professionals. ACS-COT Level II Pediatric Trauma Verification recognizes Children’s pediatric expertise and immediate, 24/7 access to specialists who can provide the best, most appropriate care for children who suffer an injury.
Better Care, Shorter Stays “Children’s ability to undergo the scrutiny of the verification process and successfully ‘pass’ demonstrates that we are the best place in our region for taking care of pediatric trauma,” says Shahab Abdessalam, M.D., Children’s pediatric surgeon and co-medical director of the hospital’s trauma program. “ACS-COT Trauma Verification is a huge accomplishment,” says Thomas Deegan, M.D., Children’s emergency department physician and co-medical director of Children’s trauma program. “The ACS sets the standards for trauma care and has a very rigid review process.” Verified pediatric trauma centers are associated with improved trauma survival rates, fewer surgeries and shorter lengths of stay.
349 patients under the age of 15 were admitted to Children’s for trauma-related injuries in 2012.
339 patients under the age of 15 were admitted to Children’s for trauma-related injuries in 2011. Playground equipment falls represent the greatest percentage of trauma-related
under the age of 15 admitted
injuries for patients
to Children’s for observation and/or treatment. Concussions and fractures related to sports are the
2nd highest cause of trauma hospitalizations, followed by non-accidental trauma.
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In Self-Harm, Children Embrace Pain They may slice their arms and burn their legs, bang their heads against walls and hit themselves. And they do it to feel better. An alarming number of children respond to their anger and anxiety, depression and general distress with something called nonsuicidal self-injury (NSSI). They purposely damage their skin or body without intending to take their lives. During or after the act, they often feel emotional relief. Forms of NSSI may include cutting, branding, friction burns (i.e., with an eraser), skin picking, hair pulling, hitting (with a hammer or other object), multiple piercing or tattooing (if pain or stress relief is a factor) or drinking harmful chemicals. Cutting typically appears on wrists, forearms, legs, stomach, hips, thighs and even the chest area. Children who self-injure have trouble talking about their feelings, suffer from low self-esteem or feel hopeless or unworthy. Nearly 8 percent of sixth- through eighth-graders and up to 21 percent of high-schoolers engage in NSSI, studies show.
Who’s At Risk? Ninth-grade girls are three times more likely to engage in NSSI than boys their age. Often thought to affect mainly teens and young adults, NSSI is also seen in younger children at a rate similar to that of early adolescents. Girls tend to cut or carve their skin. Adolescent boys hit themselves, as do younger children. Those who self-harm typically experience some relief from negative feelings or thoughts after the act—but not for long. Most are plagued with shame or guilt as soon as they realize what they’ve done, and for most, the urge is frequent. Watching NSSI videos on YouTube or reading about it on social networking sites makes some children want to do it more, or experiment with it in the first place. Most videos tell the facts of NSSI without discouraging it. Many show wounds and bruises or people cutting or hitting themselves.
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NSSI can lead to more serious psychological problems, including suicidal thoughts and actions. Meanwhile, razor blades and burning cigarettes leave marks that become permanent scars that children feel compelled to hide out of embarrassment or fear.
Why Do Kids Hurt Themselves? Typically, adolescents talk about engaging in NSSI after some form of emotional pain or stressor in an attempt to: • Externalize pain so it can heal • Communicate emotional pain to others (“I need help”) • Self-soothe • Regain a sense of control • Self-punish The problem is that self-harming has addictive qualities and is habit-forming. In addition, self-harm “works” in the sense that it can provide temporary relief, and it may be socially acceptable in some of their peer group circles.
• Help him learn positive ways to manage
Steps Parents Can Take
• Don’t hesitate to find her a mental
If you think your child is engaging in NSSI, what can you do? • Watch for signs that your child may be covering up injuries or scars (wearing long sleeves or pants in the summer, covering wrists with multiple bracelets). Some will damage tissues that you would not ordinarily see, such as on the stomach, hips or thighs. • Encourage him to share his feelings. Listen without judgment. • Help her consider the pros and cons of self-injury.
health professional. Children’s Hospital & Medical Center’s behavioral health specialists can help you and your child tackle these difficult issues. If you need a behavioral health specialist, call the Children’s Find-A-Doctor service at 800-833-3100. • Any child engaging in NSSI should receive an assessment for suicidal thoughts, as the two can sometimes become linked.
stress and self-soothe.
Self-harm hurts. But with your help, your child can heal.
Malicka’s heart How Children’s Helped This Kindergartner Go from Struggles to Stardom Six-year-old Malicka Taffa loves the camera, so the sassy Children’s heart patient was excited to take part in the hospital’s latest advertising campaign. Now that she’s seen the finished product in use, Malicka loves her newfound fame. “She thinks she’s a star,” says her mom, Nafi Dieuguene. “At the school, all the kids recognize her!” Not a bad way to go into your kindergarten year. However, kindergarten is just one of many milestones that Malicka’s mom wasn’t always sure she’d get to experience.
Hidden Health Issue Malicka was born in November 2006, and her mom remembers it like it was yesterday. “She was barely 5 pounds—a little bitty baby,” says Nafi. While she may have been a little bitty baby, she was otherwise healthy, or so Nafi thought, until she noticed that Malicka’s hands and feet would turn purple. Malicka also was colicky and often gasping for air. After four months of inconclusive diagnoses, doctors led them to Children’s, where cardiologist David Danford, M.D.,
discovered baby Malicka had tricuspid atresia, a heart defect in which the heart chamber that should pump blood to the lungs doesn’t develop. Not enough blood was able to flow from her one remaining chamber to her lungs. Surgery was her only option. Heart surgeon Kim Duncan, M.D., operated to redirect blood flow through her lungs to allow her to survive with just one pumping chamber. Malicka’s surgery was successful, leaving mom and daughter forever grateful for Children’s intervention in their lives. “They definitely comforted me. This is the best place for kids, without a doubt,” says Nafi.
A Happy Kindergartner Malicka and her mom have gone through a lot in six years. Nafi knows her little girl is a fighter and says the scar on her chest should serve as a reminder of the battle fought and won at Children’s. Today, Malicka visits Dr. Danford once a year, but is otherwise occupied with being a normal, busy 6-year-old. Not only does she love kindergarten, she loves being a “celebrity” ambassador for Children’s. “She knows the hospital saved her life,” says Nafi.
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feature story
Childhood fears are nothing to be afraid of—once you realize they’re a normal part of your child’s development.
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Is Your Child Anxious?
any children are afraid of monsters under their beds. Some are panicked by spiders. Others are consumed with dread that a natural disaster is headed their way. While children’s reactions to their fears may worry parents, the good news is that most children go through the same thing. Learning to master their fears in childhood can help them deal with greater and more damaging concerns as adults. By understanding the basis of childhood fears, you can help your children face—and conquer—them.
Consider the following suggestions:
• Don’t make fun of your children or disregard their fears. Acknowledge their concerns and tell children you can help them. • Maintain a predictable routine. Knowing what to expect helps children build confidence. • Don’t pressure your children to face a fear before they’re ready. Letting them go at their own pace gives them a sense of control. • Provide an explanation of the feared thing or situation. For example, thunder is a loud noise, but it can’t hurt you.
• Tell your children how you’ve overcome some of your own fears.
Age-Related Fears Some fears tend to occur at specific stages of childhood. For example: • Infants up to 1-year-old—loud noises, strangers • 1- to 2-year-olds—separation from parents • 3- to 4-year-olds—animals, monsters, dark • 7-year-olds—movie and TV scenarios, performance in school, dark spaces • 8- to 9-year-olds—trouble in school, judgment by friends, disease • 10- to 12-year-olds—being bullied, criminals, disasters, parental fury • 13- to 18-year-olds—body changes, sex, loneliness, global and national events.
Calming Fears The most important factor is for parents to model appropriate behavior. A parent who models fearful behavior in front of a child is teaching that child to be fearful. Instead, parents should try to model calm behavior and face, rather than avoid, fears. Your children’s ages, temperament and other factors will determine the strategies you use to help them overcome their fears.
“Parents should avoid becoming angry with a fearful child,” says Loren Conaway, Ph.D., a pediatric psychologist with Children’s Behavioral Health. “While the parent is aware that the fear ‘does not make sense,’ it is likely very real to the child. The most loving parent can become frustrated with childhood fears, but parental anger only increases a child’s anxiety and distress. Parents need to remain calm and remember that most typical childhood fears do fade over time.” If you know in advance about a situation that will most likely be emotionally upsetting to your child, plan ahead. For example, if you’re taking a vacation without your children, make sure the babysitter comes to the house a lot before the vacation.
Easing Nightmares Bad dreams and fear of going to bed are common in childhood, especially among preschoolers. In fact, they’re a normal stage of development that reflects a child’s growing imagination and understanding of the world. It’s not possible to know for sure the reason a child has a particular nightmare. Common causes
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.
include going through a scary experience (such as being in or witnessing a car accident), watching a frightening or violent TV show or movie or being sensitive to ongoing family conflicts or tensions. To ease a young child’s nightmare fears:
• Install a night-light or keep the child’s door ajar. Sometimes just having a little
light in the room is enough to banish fear.
• Provide a security blanket or soft toy. Having something familiar to hold on to helps many children through the night.
• Have your child tell you what she wants to dream about before bed. Good thoughts can help positively influence dreams.
• Teach your child some relaxation exercises. Deep breathing or visualizing a safe and relaxing place can ease anxiety. • Play games in the dark. Playing with a flashlight or using a particular air freshener to dispel monsters can help make a dark room less frightening.
• Reassure children that they’re stronger than the monsters under the bed or in the closet. Join them in a show of strength
to banish the monsters by yelling at them or ordering them out of the room. Listen and acknowledge worries, but help your child maintain a normal routine. For example, night-lights are good as long as they are helpful, rather than disruptive, to sleep, and your child continues to sleep in his or her own bed. Fears become a greater concern when they are controlling a child’s or family’s routine, and additional intervention may be necessary.
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better sleep
Need More Sleep? Lack of Sleep Is a Common Springtime Problem for Kids
Does Your Child Have Sleep Problems? Children’s Hospital & Medical Center offers a Sleep Disorders Center specifically focused on children and adolescents with serious sleep issues. For more information visit ChildrensOmaha.org/ SleepCenter.
Many families like to blame the time change for those irritable mornings and repeated attempts to wake up the kids. There’s no doubt that lack of sleep can be a common springtime problem for children, adolescents and teenagers. “This time can be considered a high-risk period when it comes to sleep deprivation for our children,” says psychologist Brett Kuhn, Ph.D., a behavioral sleep medicine specialist at Children’s Hospital & Medical Center in Omaha. “They are busy with activities and with the nicer weather and extra hour of sunlight in the evening, kids tend to go to bed later. Yet, they still have to be up at their regular time in the morning for school.” He calls the next two months—through the end of the school year—a “challenging time” for parents and says it can be difficult to make sure our children are getting enough sleep. “We make sure our children are vaccinated, and that they have good nutrition and exercise, but we tend to forget about sleep as a significant factor in growth and development. We need to make sleep a priority,” he reminds families. Chronic sleep deprivation can affect mood and lead to a lack of focus. It also can weaken the immune system’s ability to fight off illness. Behavioral problems can become worse in children already prone to having emotional outbursts or other issues.
How Much Is Enough? Average sleep requirements differ by age. • 2-year-olds need about 12.5 hours of sleep, nighttime and naps combined. • 10-year-olds should get 10 hours of sleep per night. • Adolescents need about 9.25 hours. “The large majority of teenagers need a little more than nine hours of sleep per night, but research
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suggests they are getting much less—seven to seven and a quarter hours of sleep on school nights,” says Dr. Kuhn. Here are some ways to help your children get the sleep they need: • Make bedtime quiet time. Relaxing before bedtime helps sleep come more easily. Have your child read or take a warm bath. • Turn off the TV and videos at least one hour before bedtime.
• Do not allow children to have foods or drinks that contain caffeine, such as soda and chocolate. They can interfere with sleep.
While things like television, video games and computers can interfere with or delay sleep, Dr. Kuhn points out that a consistent wake-up time, even on weekends, can be helpful when it comes to managing better sleep routines. “It is okay to sleep in some on the weekends, but we want to try and maintain a reasonable wake-up time. This is how we help our bodies adjust to schedule changes and stay in sync,” he explains. “It is okay to have a brief nap later in the day. This is better than excessive oversleeping.”
The Snoring Factor A study of grade-school children showed that those who snored most nights were at least twice as likely to have trouble academically. They scored lower on tests and report cards than did non-snorers. Why? For one thing, a child who snores may not sleep well. A tired child may misbehave, have a short attention span or fall asleep during class. Children who snore also are more likely to have trouble hearing. The root of the problem is often swollen adenoids or tonsils—a source of snoring, as well as constant ear infections in many children.
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live well
Healthy Kohl’s Kids Gives You Nutrition and Fitness Resources When it comes to eating right and exercising, making healthy choices can be a tough task for children and parents alike. But with tools and support from the new Healthy Kohl’s Kids program, that challenge just a got a little easier.
What Is Healthy Kohl’s Kids? Healthy Kohl’s Kids is a partnership between Children’s Hospital & Medical Center and Kohl’s Department Stores focused on educating children and families on the importance of good nutrition and fitness. The program’s website, www.HealthyKohlsKids.com, features up-to-date fitness and nutrition information and advice for children and parents. The site also contains an extensive library of healthy recipes with how-to videos of young chefs making nutritious meals and snacks. Children and parents are encouraged to explore the site together to share the joy of cooking and to establish positive lifestyle habits that children can take with them as they grow. Visit the site often—new fitness tips and nutrition ideas are added regularly. Navigating the Healthy Kohl’s Kids recipe library is easy. Under the Recipes tab, simply choose from one of the categories, which include recipe ideas for everything from snacks to vegetarian options, or use the search bar to find a specific dish. Click on “How 2 Cook” for videos containing cooking lessons and tips for your young chef.
Building Community Healthy Kohl’s Kids invites parents to engage via social media on Facebook, Pinterest and Twitter (@HealthyKohlsKid). Share your own healthy recipes, activity ideas and fitness- and nutrition-related links, and receive updates about future Healthy Kohl’s Kids events. The Healthy Kohl’s Kids van will make a number of visits this spring and summer to Omaha-area Kohl’s Department Stores to promote healthy lifestyles among families. The stops will include fun giveaways for children to help encourage them to be active and exercise. Watch the Healthy Kohl’s Kids website for times and locations of upcoming Kohl’s store visits.
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Make Family Fitness a Walk in the Park Pricey gym memberships. Boring treadmills. Muscle-bound weightlifters. If that’s your idea of exercise, think again. Picking berries, flying a kite and going to family day at the park are all fun outdoor activities that double as workouts. Doing them regularly can help your family stay healthy.
Families Should Play Together Your children need about an hour of physical activity per day. They learn by watching you. So, plan ways to stay moving as a family. You might not think your family has time to exercise. But think about all the things you do instead. Then, find a way to fit in fitness. For instance, turn off the TV after dinner and go for a walk. Bike instead of drive to get library books.
Enjoy the Great Outdoors Exercise makes you stronger, keeps your weight in check, and improves your balance. 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 more tuned in to the world around you. You don’t have to spend a lot of money to have fun outside. Some of the best activities are free. Try taking a hike through your local park. Or organize a game of tag in your front yard. Watch local calendars for family-friendly events.
Join the Fun! 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.
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Here for You: Parenting U Classes This Spring 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, 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. Each session will be held in the Glow Auditorium at Children’s Hospital & Medical Center from 6 to 7 p.m. Call 1-800-833-3100, or log onto ChildrensOmaha.org/ParentingU to register today.
Parenting U Upcoming Dates
eNewsletter Sign-Up
Tuesday, April 9 Surviving the Trying 2s Michelle Mogenson, D.O., F.A.A.P. Children’s Physicians
Tuesday, April 23 Preparing for Your Newborn Jennifer Smith, M.D., F.A.A.P. Children’s Physicians
Tuesday, April 16 Sibling Rivalry Amy Lacroix, M.D., F.A.A.P. Children’s Physicians
Tuesday, April 30 Mastering Potty Training Katie Anglim, M.D., F.A.A.P. Children’s Physicians
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.