spotlight on
preventive medicine
It’s n o t t o o l at e f o r t h at p e r f e c t h o li d ay gi f t
a flu vaccine Think of it as a gift to everyone else in your community, as well.
robert f r e nc k , md
Director of Infectious Diseases at Cincinnati Children’s
Even into the new year, a flu vaccine can help you ward off influenza, says Robert Frenck, MD, director of Infectious Diseases at Cincinnati Children’s. Consider how many kids your child is exposed to in the course of a school day. “Kids are known spreaders of infection, so immunizing them can have a big impact on the rate and severity of infection in the community,” Frenck says. Technically, getting a flu shot as late as early March can still provide potential benefit, but by then, you will have already risked months of exposure unnecessarily. It is best to get the vaccine when it is first available in the fall because it allows your body time to build up its immunity to the flu. Although it varies from person to person, Frenck says, it generally takes about two weeks to achieve the peak antibody response.
How is th e flu virus spread?
Flu season typically runs from December through April. Statistics from the national Centers for Disease Control and Prevention show that February has the highest rate of flu reports. “Flu is far more serious than the common cold,” Frenck says. “It makes you really sick, with high fever, body aches, and generally feeling miserable. Getting vaccinated not only reduces your risk, it also reduces your child’s risk of becoming seriously ill from a potentially preventable infection.” The most serious flu cases occur in children under age 2, as well as the elderly. Babies should get a single shot of the vaccine when they are 6 months old. For kids over age 2, there are two options: the flu shot or the live attenuated vaccine (LAIV) in a nasal spray mist form. The important thing is to get one or the other every year.
It is spread primarily by airborne droplets when infected people cough or sneeze. The droplets can travel up to about six feet. Infection occurs when a droplet lands in the mouth or nose of an uninfected person. A person Probert frenck, md also can get the flu by touching a surface or object that Director of Infectious Diseases has flu virus on it and then touching their mouth or nose. at Cincinnati Children’s
How contagious is the flu? Most healthy adults may be able to infect other people beginning one day before symptoms develop and up to five to seven days afterward. Children may pass the virus for longer than seven days. Symptoms start one to four days after the virus enters the body. That means that you may be able to pass on the flu to someone else before you know you are sick.
Source: The Centers for Disease Control and Prevention
1 1
ask the
pediatrician advocate for yo u r c hild ’s h ea lt h The Family Resource Center The center helps families, community providers and agencies find health resources and support. Call 513-636-7606 for assistance.
Use this directory to find information, resources and
If you consume just one can of soda per day, it could mean up to
advocacy strategies at www.cincinnatichildrens.org/ special-needs.
Join Sp e c i a l C onnec t i o n s Our new online community connects with others parenting a child with special healthcare needs: www.cincinnatichildrens. inspire.com.
15 e x t r a pounds
per year
2
Care Clinic, Cincinnati Children’s
Beverage choices available to kids are a tricky landscape of sugar, empty calories and super-sized portions
information, community
Specia l Ne e d s R esour c e D irect o ry
N ick De Blasio, MD
General and Community Pediatrics, Pediatric Primary
If you have a question for the pediatrician,
have Questions? email youngandhealthy@cchmc.org
The reason for those extra pounds is simple: many beverages that kids typically drink, especially soda and juice, are loaded with sugar. The correlation between weight gain and the amount of sugar in beverages should be a big concern to parents. Sugar is one of the root causes of childhood obesity that leads to a host of physical ailments, including type 2 diabetes, which is at epidemic levels in the U.S. Even juices with “no sugar added” contain “empty calories.” Excess juice intake can lead to diarrhea, poor nutrition and tooth decay. That last one surprises many parents, but based on the kids we see in doctor’s offices, juice is a significant factor in the poor health of kids’ teeth. Clever marketing has led some parents to think beverages for kids are healthier than they actually are. It is important to remember that eating actual fruit is so much better than drinking juice. The juice itself typically doesn’t contain the fiber and other nutrients that you get from eating the fruit. If you do give juice, it is important to keep it to a small amount. The American Academy of Pediatrics recommends no juice in the baby’s first year, no more than four to six ounces per day for kids ages 1 to 6, and for older kids, a limit of eight to 12 ounces daily. But even that, to me, seems generous. We talk about watering down juice to minimize sugar intake, but that’s not the best approach. The best approach is to just not give juice. Ideally, kids should drink 20 ounces of milk a day and everything else should be water. Drinking more than 20 ounces of milk a day can often lead to kids feeling full and not wanting to eat their regular diet, which can lead to nutritional issues. Furthermore, the iron that is in milk is poorly absorbed by the body, so drinking too much milk can actually lead to an iron deficiency anemia. We recommend parents provide whole milk for children from ages 1-2 years and then skim or one-percent milk after that. Figuring out the best beverages for your children can be tricky at times so it is always best to discuss the issue with your pediatrician to get important guidance.
join a
researchstudy
Researchers at Cincinnati Children’s conduct hundreds of studies each year to figure out why people get sick and what treatments might help them. Discoveries researchers make in the lab can lead to even better treatments and ways to prevent diseases from happening in the first place. Did you know you could be part of the process of helping our scientists solve medical mysteries? You can participate by joining a research study. Here’s what we’re recruiting volunteers for now.
HEALTHY TODDLERS 12 TO 23 MONTHS OLD
Bone Strength Study What: This research study will help us learn more about the bone strength of young children and their normal bone density ranges. Who: Healthy toddlers 12 to 23 months old may be eligible to participate. Pay: Families may receive up to $815 for time and effort. Contact: Ann at HealthyBonesStudy2@cchmc.org • 513-803-7282
6 to 12 YEAR OLDS W ITH LISTENING DIFFICULTIES
Listening Difficulties Study What: The purpose of this research study is to learn more about listening difficulties in children using MRI, listening and cognitive tests. We will compare brain structure and function of children with listening difficulties to that of typically developing children. Who: Children, 6 to 12 years old, who have a history of listening difficulties may be eligible to participate. Pay: Participants will receive up to $60 total for their time and travel. Contact: Stephanie Sieswerda at stephanie.sieswerda@cchmc.org • 513-803-4937 DOES YOUR CHILD HAVE CHRONIC MIGRAINE?
Prevention of chronic migraine in adolescents What: The purpose of this research study is to evaluate the safety and effectiveness of onabotulinum toxin A (BOTOX®) in preventing migraine in adolescents. Who: Children and teens, 12 to 17 years of age, who have a history of migraine and are currently experiencing 15 or more headaches per month (chronic migraine) may be eligible to participate. Pay: Qualified participants will receive all study-related medication, lab tests and neurological exams at no cost. Compensation for time and travel may be available. Contact: Laurie Vanderah at laurie.vanderah@cchmc.org • 513-803-0003
about this issue
w i n t e r 2014
produced by
The Department of Marketing & Communications Cincinnati Children's Hospital Medical Center 3333 Burnet Ave., MLC 9012, Cincinnati, OH 45229-3026 Phone: 513-636-4420 Advisers: Chris Peltier, MD, and Zeina Samaan, MD Editorial Consultant: Nick DeBlasio, MD Editorial Staff: Tom O’Neill/managing editor Photography: Tine Hofmann, tm photography Design: Christina Ullman & Alix Northrup, Ullman Design
@cincychildrens
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Young and Healthy is a quarterly publication from Cincinnati Children's Hospital Medical Center. For more health news and patient stories, subscribe to our monthly e-newsletter online at www.cincinnatichildrens.org/subscribe © 2014 Cincinnati Children's Hospital Medical Center
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spotlight on
touching lives
patient experience m e et
Ha nn ah Stoll
Hannah, the holidays and the close-knit family of newborn babies
Hannah, age 11, has chronic lung disease that resulted from her premature birth. She has made an enduring service project out of knitting caps for the newborns in the unit where premature babies spend their first days of life. That’s where Hannah started life, too. She spent her first five months in the neonatal intensive care unit, including Thanksgiving and Christmas. She’s now extended her mission to include healthy newborns. Hannah, as a premature newborn, with her mom, Jennie, and sister, Brianna.
““I just like to do it, it makes me happy.” “I like knowing I’m helping a family.”” — hannah stoll
In all, she’s knitted between 80 and 100 caps over the last couple of years. She and her mom, Jennie Stoll, deliver them to Cincinnati Children’s, but Hannah’s respiratory condition keeps her from being able to see the tiny people who benefit from her generosity. That doesn’t matter. She sees them in her heart. “I just like to do it, it makes me happy,” Hannah says. “I like knowing I’m helping a family.” She speaks in a low, raspy voice, less than a week before she is to undergo another surgery on her partially collapsed airway. Hannah was hospitalized in 2007 and her family was concerned that her stay would extend into Christmas Day, a special day in the Stoll home. Hannah was discharged just days before. Her mom thinks about all the hospitalized kids who are less fortunate. “As all these holidays are going by, it’s nice to know someone is thinking about the babies,” her mom says. “Hannah has a very big heart and has been through a lot herself. She doesn’t want any of those kids to feel alone.” Hannah’s passion for knitting caps started as a Girl Scouts service project with her older sister. Last year, the scouts held a bake sale. With the proceeds, they bought craft supplies, which they delivered to the Child Life Center at Cincinnati Children’s for hospitalized kids to use. “She loves doing stuff like that,” says her mom. “She’s developed so many friends.”
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The Stoll sisters, 16-year-old Brianna and 11-year-old Hannah.
spotlight on
creating hope
patient research 7 0 0 -mil e bik e ri d e rais e s f u n d s for H L H r e s e arch a n d
lifts hea rts i n the p roces s (Above) Chaplain MaryAnn Hegner and occupational therapist Jill Bakker, both employees at Cincinnati Children's, celebrate after crossing the finish line. (Left) Jovie Franklin, whose sister Aspen has HLH, is all smiles.
what is hlh ?
HLH is a rare, life-threatening condition, often caused by an inherited problem of the immune system.
Basically, cells of the immune system malfunction in destroying infected or damaged cells. The immune system then begins to damage the patient’s own tissues and organs, including the bone marrow, the liver and the brain. Often, a bone-marrow transplant is necessary.
The chaplain was among 20 cyclists who turned the corner at Cincinnati Children’s, greeted by a roaring crowd, having just pedaled 700 miles from Mississippi over a week’s time to raise money for medical research.
T
“Believe in the care of these doctors. Believe in their knowledge. Believe in yourself, and you’ll make it through this.” Sean Feltoe, ride participant and HLH survivor
ears clouded MaryAnn Hegner’s vision of the finish line. Hegner, a chaplain in Cincinnati Children’s Pastoral Care department, and the other riders made the “700 Miles to Hope” journey to support those battling a rare, lifethreatening immune disorder called Hemophagocytic Lymphohistiocytosis, or HLH. Among them were two other Cincinnati Children’s employees: Jill Bakker, an occupational therapist, and Ashish Kumar, MD, PhD, a physician and scientist. “So many people donated, sent me emails, and expressed love and support for me on this journey, so to see many of those people at the finish line brought me to tears,” Hegner recalls. “My daughters were there, my husband’s parents and his sister, many people from pastoral care and others from the hospital. I felt filled with joy and strength, and surrounded by love. I would do the ride again in a minute.”
The group included family members of those affected by HLH. The fundraiser was the inspiration of Justin and Kristin Akin, whose sons Matthew and Andrew died of HLH. Both parents rode this year. Through the donations of supporters, the Matthew and Andrew Akin Foundation presented a check for $350,000 to Cincinnati Children’s HLH Center of Excellence, a national leader in HLH research. A grateful Michael Fisher, president and CEO of Cincinnati Children’s, greeted the riders and praised their achievement. It was an emotional homecoming. Today, the Akins’ determination to honor their sons has comforted many patients and families – including survivors of the disease such as ride participant Sean Feltoe. “I’ve lived off this word and it is ‘believe,’” he says. “Believe in the care of these doctors. Believe in their knowledge. Believe in yourself, and you’ll make it through this.” This was the second annual “700-Mile Bike Ride to Hope” from Mississippi, and the second for Feltoe. It was the first for the three Cincinnati Children’s employees, including Kumar, a researcher in the Cancer and Blood Diseases Institute. He’d never undertaken a bike adventure this ambitious, he says, but he is an avid cyclist on weekends who also gets daily practice: the doctor commutes to work every day on his bike. 5
childhood disorders
kn o w th e s i g n s the sleepover
bl u es
Helping your child overcome bedwetting
D e nise D . Fer g uson C P N P, AP RN Nurse Practitioner in Urology at Cincinnati Children's
Sleepovers, slumber parties and going away to camp are wonderful childhood memories. Unfortunately, some children are reluctant to participate in these activities because of the fear that they may wet the bed.
Simple treatments to try
Bedwetting, or nocturnal enuresis, is a common childhood disorder. If your child wets the bed, reassure him or her that hundreds of children do, and most will outgrow it on their own. It is not completely understood why children wet the bed. It is known that bedwetting can be genetic and run in families. Bedwetting can be caused by a bladder capacity too small to hold the amount of urine that is produced during sleep. Sound sleeping, constipation, urinary tract infections and stress can also increase the risk of bedwetting.
drinking more in the early part of the day to decrease thirst at night
decreasing nighttime beverages
n n
Still wets the bed after age 6 or 7
Expresses an interest to become dry
Starts to wet the bed after being dry for six months or longer
n
for more help 66
There are also medications available to help with bedwetting. A physician or nurse practitioner can prescribe these medications for your child. Relapses are common after stopping medicines and even after successful training with the alarm, but the treatment can be restarted. An appropriate time to consider seeing a urology specialist is when your child:
Bedwetting can be a source of embarrassment, anxiety and stress for both the child and his family. Children do not wet the bed on purpose and should never be punished for it.
If you are interested in having your child see a specialist to help with bedwetting, you can make an appointment with the Healthy Bladder Clinic at Cincinnati Children’s at 513-636-4975.
If these techniques do not succeed, other therapies can be helpful. A bedwetting alarm is a very effective therapy. The alarm will sound and awaken your child when he begins to urinate. You might need to help your child if he does not wake when the alarm sounds. It can take up to 12 weeks of using the alarm before your child stays dry at night. The alarm gives the best long-term cure by teaching the sleeping brain to be aware of the bladder.
Has not responded to prior treatments for bedwetting
n
avoiding caffeine and carbonated drinks
urinating before bedtime
Has painful urination, daytime wetting or urinary tract infections along with bedwetting.
n
focus on
nutrition
Breakfast
n u tritio n
Breakfast is still the most important meal of the day, but there is a dizzying array of options these days for kids. Some are healthy. Many are best avoided.
A
s on-the-go teens continue to gravitate to non-traditional breakfast foods such as granola bars and yogurt, they also are faced with some poor-nutrition options that dot the fastfood landscape. For instance, several of the biggest names in fastfood offer healthy breakfast options, but also offer breakfast meals that exceed a staggering 50 grams of fat. With virtually all fast-food outlets now serving breakfast, beware menu items that begin with words such as “Extreme” and “Mega” and “Loaded.”
The key is to read labels and nutritional information carefully. “I say to parents, the old adage that breakfast is the most important meal of the day, there is a lot of data to support that,” says Chris Bolling, MD, a pediatrician who specializes in obesity and nutrition issues. “Those who eat a healthy breakfast tend to be more active in the morning hours so it’s important to get a good, healthy start.” A nutritious breakfast also is important to kids’ success in the classroom, and schools have expanded breakfast programs and seen the positive results. “The research shows that there are fewer behavioral
problems and kids do better,” Bolling says. “There is definitely a connection between breakfast programs and school performance.” A well-balanced breakfast should contain at least seven grams of protein and no more than 250 calories, which makes reading labels imperative. One great alternative is to include fresh fruit such as strawberries and a banana mixed in with yogurt or low-sugar cereal. Melons and apples are also great choices. Breakfast doesn’t have to be, as Bolling puts it, “the land of pancakes and sugary cereals.” Sales of cereal have been steadily declining in the past decade. A recent New York Times headline
Chris Bolling, MD
is a community pediatrician affiliated with Cincinnati Children’s. He practices at Pediatric Associates in Crestview Hills, Ky.
proclaimed: “Cereals Begin to Lose Their Snap, Crackle and Pop” – a reference to a Rice Krispies advertising campaign that began generations ago. With cereals, look for healthy ingredients such as whole grain, fiber and protein. Some kids skip breakfast altogether, which doctors caution against. “The issue is, if you hold off on breakfast,” says Bolling, “you’re ravenous later and just make poor choices.” Rates of childhood obesity climbed steadily in the 1990s and although they seem to have leveled off somewhat, he says, the U.S. still has an obesity epidemic in children. The cause, he says, was a “perfect storm” of factors: less active kids, more sedentary entertainment such as electronics and computers, fewer after-school health programs, more processed food laden with sugar – and big increases in portion sizes, especially beverages such as juice. One surprising note on breakfast health: good nutrition doesn’t always have to be the usual breakfast items. “A slice of turkey with cheese would be fine, and whole fruits are great,” says Bolling. “You don’t want to be overly reliant on breakfast bars. The important thing is to adhere to protein and calories.” 7
3333 Burnet Avenue, MLC 9012 Cincinnati, Ohio 45229-3026
Liberty Campus urg en t care opens
inside
thi s i s s ue
bedwetting
Learn tips to help your child overcome this common childhood problem.
f l u va c c i n e
Immunize your child to help ward off influenza and the spread of it.
winter
healthy
2014
young and
A guide to your child’s good health
Making a
difference
helping others in need creates hope and touches lives.