C H I L D R E N ' S H E A LT H
preventive measures
nicotine’s danger to kids lurks everywhere
MELINDA MAHABEE-GITTENS MD, MS,
is a physician in the
Emergency Department at Cincinnati Children’s.
New Cincinnati Children’s research shows the potential risk of “third-hand” smoking
W
Kids who were brought to the emergency department at Cincinnati Children’s for an illness possibly related to second-hand smoke exposure, like difficulty breathing.
WH O:
hen kids touch items or surfaces contaminated by cigarette smoke, they may carry significant levels of nicotine on their hands. Even when no one is actively smoking at the time.
Melinda Mahabee-Gittens, a doctor who works in Emergency Medicine at Cincinnati Children’s.
That’s the main finding of a study by researchers at Cincinnati Children’s and San Diego State University. It’s the first study to show that “third-hand” smoke is a danger to kids. It was published in the journal Tobacco Control.
Researchers found that children with significant nicotine on the hands even showed evidence of tobacco exposure in their saliva.
“Parents may think that not smoking around their child is enough, but this is not the case,” says lead researcher
How the study was done
“These findings emphasize that the only safe way to protect children from smoke exposure is to quit smoking and ban smoking in the home,” she says.
According to the U.S. Centers for Disease Control and Prevention, exposure of this kind can lead to all sorts of harm to kids’ health, including ear infections and asthma attacks.
AGE:
The average was 5 years old.
WH Y AT-RISK: All of the children had parents who were smokers. All parents consented to the study. WH EN :
April to September, 2016
Researchers used specially designed hand wipes to extract nicotine from the kids’ hands, and took saliva samples to look for corresponding levels of cotinine, a metabolite connected to tobacco exposure.
TH E TEST:
All of the children had detectible nicotine levels on their hands and all but one had detectable cotinine in saliva. N EXT STEP: Researchers want to explore how much secondary exposure to smoking affects children’s health. They also want to look at preventive measures for better protecting children from overall tobacco exposure.
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K ATE McGOV E R N , MD ,
ASK THE
is a pediatrician at Anderson Hills
pediatrician advocate F OR YO UR CHIL D’S HE A LT H
Pediatrics and is affiliated with Cincinnati Children’s.
The motion in emotional health
THE FAMILY RESOURCE CENTER
How stressful is a child’s world? The answer might surprise some parents
The center helps families, community providers and agencies find health information, community resources and support. Call 513-636-7606 for assistance.
When Kate McGovern, MD, addresses a child’s physical health, she’s also got her eyes and ears open to their emotional health. McGovern, of Anderson Hills Pediatrics, says that when she started her practice, she was a little surprised at how prevalent mental health issues were. She says it’s not only a huge component of her work schedule, but also one of doctors’ biggest challenges. The key, she says, is asking insightful, conversational questions – and listening carefully to kids’ answers. This is especially true for teens. McGovern shares her insights into caring for kids’ emotional health.
SPECIAL NE EDS RESOU R CE DIRECT O RY Use this directory to find information, resources and advocacy strategies at www.cincinnatichildrens.org/ special-needs.
J OIN SP ECI A L CON NEC TI ONS Our online community connects with others parenting a child with special healthcare needs: www.cincinnatichildrens. inspire.com.
JOIN A
research
A: For kids that I see in my office, it seems
to be schoolwork, disagreements with friends, relationships with significant others and family stressors (health of a family member, money concerns, divorce, etc.).
Q: Are parents often surprised by kids’
answers and explanations?
A: Parents are often caught off-guard by the
reality of how depressed their child truly is. For example, a break-up may not seem like a big deal to a parent, but to the teenager it defines their whole life in that moment.
Kids will often divulge stories of suicidal thoughts and feeling sad all the time with their parent having no idea that it was “that bad” because the parent didn’t press them any farther and thought “it’s only a teenage relationship.” Sometimes we only pick up these types of depression with mental-health screening questions.
S T U DY
CAN RESEARCH REALLY CHANGE THE FUTURE OF AUTISM? YOU CAN SPARK RESEARCH WITH ONE CLICK
SPARK: Simons Foundation Powering Autism Research for Knowledge What: SPARK is a national online autism research study designed to give researchers the information they need to speed up research and advance our understanding of autism to help improve lives. Who: Individuals of all ages who have a professional diagnosis of autism, live in the United States, and can read and understand English may be eligible for participation. Both biological parents will also be asked to participate. What's involved: Participation can be done entirely at home—registration and surveys can be completed online and the DNA sample can be provided using a saliva collection kit mailed to the home. There is no cost to participate. Pay: Families that participate with two biological parents will receive gift cards valued up to $50 for their participation. Contact: 513-636-0523 | autism@cchmc.org | www.sparkforautism.org/cincinnatichildrens 2
Q: What are the most common sources of kids’ stress and anxieties?
TEEN SLEEP STUDY
Healthy teens 14 to 17 years old What: A study to learn more about how changes in sleep affect the health-related behaviors of teens Who: Healthy teens 14 to 17 years old who are of normal weight may be eligible. Each teen and a parent will come to Cincinnati Children’s three Saturday mornings in a row, during the summer. Pay: Families may receive up to $285 for their time and travel. Contact: Catharine Whitacre catharine.whitacre@cchmc.org 513-636-5360
HAVE QUESTIONS?
If you have a question for the pediatrician, email youngandhealthy@cchmc.org.
@cincychildrens
facebook.com/cincinnatichildrensfans
youtube.com/cincinnatichildrens
cincinnatichildrensblog.org
Q: Does social media play a role in creating
stresses, such as cyberbullying?
A: The answer is an overwhelming yes.
Whether we like it or not, a social media presence for teens and young adults is now the norm. Without it, kids are seen as “weird” and with it these kids are faced with all of the possible negative aspects such as gossiping and cyberbullying. Suddenly there is no place for that quiet kid to get away from a bully after school because online communication with that child can occur at any time. The stress that children face today from maintaining an online presence is very real. I would say that the largest components affecting issues with friends and classmates is social media. Arguments played out on social media take it to a whole new level of stress when everyone can publicly watch it unravel.
Q: What is the role of reassuring kids that
they aren’t alone?
A: It plays a huge role in my narrative to
kids. Statistically, 1 in 5 children ages 13-18 have, or will have, a mental illness. I tell kids that I have 1- to 2-hour mental health appointments in my schedule per week and they are always filled, sometimes weeks out. The need is clearly there because the problem is so widespread.
ON LI N E R E S O U R C E S National Alliance of Mental Illness. A national mental health organization that provides education, advocacy, awareness and free information on mental health referrals and support including a free helpline. Website: www.NAMI.org
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The Psychiatric Intake Response Center (PIRC) at Cincinnati. By calling 513-636-4124, parents and providers alike can get 24-hour triage in a mental health emergency situation as well as recommendations for outpatient referrals and next steps in treatment. Website: www.cincinnatichildrens. org/service/p/psychiatry/programs/intake-response
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Cincinnati Children’s has also partnered with the University of Cincinnati to provide care and services at the Lindner Center of Hope in Mason. Website: www.lindnercenterofhope.org
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ABOUT TH I S I S S U E
ADD/ADHD STUDY
For teens 16 to 19 years old What: A research study to test training programs to see if they might help teens with ADD or ADHD become safer drivers Who: Teenagers 16 to 19 years who have a history of ADD or ADHD and a valid driver’s license (and a parent will also participate) Pay: Families may receive up to $250 for their time and effort. Contact: The study coordinator 513-803-1343 | ADHDdriving@cchmc.org
S P R I N G 2017
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 © 2017 Cincinnati Children's Hospital Medical Center 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: Kate McGovern, MD Editorial Staff: Tom O’Neill, managing editor Design: Christina Ullman & Alix Northrup, Ullman Design 3
S TAY I N G S A F E
avoiding risk and injury
being prepared
Outdoor safety for kids: A PA RENT’ S GUID E
As a local pediatrician, Courtney Larke sees the result of risks children take when they’re playing outside – especially when they are unsupervised. But it doesn’t have to be that way. Larke, MD, says many of the safety tips she gives parents and kids are just old-fashioned common sense. Chief among them: helmets. (That also goes for bike-riding parents, too!) The most common injuries Larke treats during the spring and summer at Glenway Pediatrics
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Common sense and old wisdoms go a long way in avoiding the risk of injury
and Western Ridge Pediatrics are sprains, broken bones and head injuries from falls. “It is extremely important,” Larke says, “to teach your children to play safely while outside, especially if unsupervised by an adult.” Helmets on not for bikes alone. Think scooters and skateboards, too. Head injuries can have a terrible impact on kids. After all, their heads contain the most important thing they’ve got: their brain.
S A F E TY T IPS
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C O U RTN E Y L A R K E, MD ,
is a pediatrician at Glenway Pediatrics and Western Ridge Pediatrics. She is affiliated with Cincinnati Children’s.
Things to always keep in mind about safety n KNOW YOUR CHILD’S SURROUNDINGS
“Helmets are the only thing protecting kids’ brains while riding, so it is extremely important that all children have a properly fitted helmet no matter how experienced the rider.”
Inspect all outdoor play equipment and play areas. Trampolines should have safety nets. Check playgrounds for dangers like sharp objects, hard surfaces and slides that may be too hot from the sun for exposed skin.
n REVIEW YOUR FAMILY’S SAFETY PLANS
During family trips to amusement parks, the zoo or other public places, remember to review what your child should do if he or she were to become separated from you. Talk to your kids about stranger rules and how to spot a safe adult if they get lost. Be sure your child knows your cell phone number or carries it with them.
n
SUNSCREEN
It’s important to lather all kids up with sunscreen (at least SPF
“Head injuries are extremely common this time of year,” she says. “Helmets are the only thing protecting kids’ brains while riding, so it is extremely important that all children have a properly fitted helmet no matter how experienced the rider.” Even if your child is careful, a helmet is essential because too often, kids don’t see approaching dangers. “Kids can’t predict when another rider, car, or stick in the road may cause them to crash,” she says. “So they should stay protected at all times.” Adult supervision is even more important when it comes to another potentially dangerous place for kids: water. Pools, lakes, rivers, even creeks. “Water safety and adult supervision are of paramount importance for children who are not well-established swimmers,” she says. “Accidents can happen in the blink of an eye, so parents should be within an arm’s length of any child in the water who does not know how to swim.”
30) and sun protective clothing (hats, sunglasses, swim shirts) if they will be exposed to sun for a prolonged period. And don’t forget that sunburns can occur even on somewhat cloudy days!
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LIVE AND
Healthy living for parents and children
learn
WENDY STEUERWALD, AUD,
is an audiologist and clinical manager in Audiology at Cincinnati Children’s
Earbud safety 101 MODERATION IS THE KEY WHEN SETTING THE VOLUME LEVEL ON KIDS’ LISTENING DEVICES
There are least 1.1 billion reasons why parents should monitor how much loud music their kids are exposed to. That’s the number of young people the World Health Organization estimates could be at-risk of hearing loss. And a big culprit is earbuds, one of the most popular ways kids listen to music. Earbuds can be dangerous because they go inside the ear canal, near delicate hairs, and they don‘t block out much external noise. That just makes some kids pump up the volume – without realizing the potential harm. Headphones, on the other hand, are safer because they go over the ear and provide some space between the music and the inner ear.
“My advice for parents with kids who want to listen to music while in noisy environments is to invest in noise-cancelling headphones,” she says. “Many times we use earbuds to listen to music under headphones to reduce external noise. With earbuds alone, people too often turn the music up to unsafe levels to block out the background noise. This won’t happen with noise-cancelling headphones “With noise-cancelling headphones,” she says, “the noise is greatly reduced.” Hearing loss builds slowly, so often kids don’t realize it’s occurring until it’s too late.
The ear is a really delicate place Think of it like an injury to the hair cells in the Best option: noise-cancelling headphones inner ear. And that hearing loss can be permanent. Steuerwald likens noise exposure to daily or noise cancelling earbuds caloric intake, because it’s a good way for kids to If you want to listen to music on a noisy train allocate their time for music-listening. or watch TV in an airplane, these are essential. Steuerwald has family members who are They reduce external environmental sounds so that hearing impaired, and her boys see first-hand you can hear your music clearly without cranking how frustrating hearing loss can be. She keeps ear up the volume. plugs and over-the-ear hearing protection readily For listening to music in situations where noise available. is loud enough to damage hearing, the smartest “I remind my boys endlessly to use them,” she option might be a combination of earplugs and says. “If I enter their room, and can hear the sound headphones, according to Wendy Steuerwald, an through their headphones, the volume is too audiologist at Cincinnati Children’s. She’s also the loud. My son, William, says it’s tough having an mom of three boys who each listen to music with audiologist as a mom!” earbuds. (But with a twist.)
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tips to improve hearing safety F OL L OW TH E 60/ 60 RUL E Have your child set the volume at no louder than 60% of the maximum volume, and limit listening to 60 minutes at a time. The loudness of some MP3 players and phones go all the way up to 110 decibels (dB). That’s too much. Even at 60 dB, the ears need a break after an hour.
AV OI D BA C K GROUN D N OI S E WH I L E L I S TE N I N G We see it see all the time – someone mowing the lawn with earbuds in. This is a double-whammy. A lawn mower produces about 106 dB of noise. For comparison, any sound 85 dB or higher is considered dangerous if the exposure lasts too long.
FOCUS ON
teaching coping skills
c h il d w el l - b e i ng
Vitamin R RICHARD GILMAN, PHD,
Teaching kids resiliency will help them navigate life’s ups and downs Psychologists working with youth often talk about resiliency – and with good reason.
A
dversity is an inevitable part of being a child. Sometimes, it’s because of a potentially life-changing situation like experiencing a loss, or a major illness. Most times, it’s more common experiences such as peer or family relationships, or difficulty at school. Challenges in life are normal and can sometimes shape how we view ourselves, others, and our futures. Being resilient means having the skills and strengths to overcome tough times. That’s where research comes in. Studies show that skills such as social competence, optimism, problem solving, and emotional control can be taught, and the earlier the better. Some people think it’s a generational thing, and that kids these days differ from when their parents faced the same childhood challenges. That they’re less able to cope with setbacks. Richard Gilman, PhD, a psychologist in Child and Adolescent Psychiatry at Cincinnati Children’s, is a skeptic about that. “There is no data to suggest this,” Gilman says. “While the context may change, the skills to cope and overcome these stressors have been quite consistent.” Research also shows that – regardless of the generation – resilient children report more favorable mental health, do better in school, and have more positive social relationships than nonresilient children. And that helps them a lot in adulthood. Gilman is both a psychologist and a dad. “To a degree, but I've been working with parents far longer than I have been a father,” he says. “It's more of understanding the science and art of family systems, communication, and motivations that has helped me.”
is a psychologist in Child and Adolescent Psychiatry at Cincinnati Children’s.
TOP 4 TIPS TO ENCOURAGE RESILIENCY IN KIDS
1 2 3 4
Let your kids fail — within reason The sweet spot for resiliency is learning how to bounce back from a failure. It teaches them to adjust and improve. For instance, if your child really wants to make new friends but doesn’t know how, practice greeting skills with your child. They’ll learn from the experience. You can then talk about what your child did well and what to try next time. Feelings of discomfort are OK One key to resiliency is independent problem-solving. Yet sometimes, kids need help. These instances can lead to frustration and a tendency to “give up.” Rather than solving the problem for your children, it is more helpful to support their decision and to remind them that failure happens to everyone. Even their parents! Once these feelings are validated, this strategy goes a long way in developing emotional control and self-confidence. Focus on acceptance and positivity Certain situations in children’s lives are simply out of their control (same goes for adults!) There’s no sense in worrying about it or trying to change it. Sometimes, this can lead to anxiety, stress, depression or even worsening of symptoms. But what can be controlled is how they think about it. Focus on what’s going well versus what’s not.
Model resiliency Think about how you react to certain adverse life events. If you’ve made a mistake at work, for instance, tell your kids about it. Describe to them your feelings of discomfort but also what you learned and how you intend to fix it. Tell them you’ve thought through all of the options and you’re optimistic about your plan to make it right.
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EARBUD SAFETY 101 The harmful effects of loud music with kids and how to monitor their exposure.
sign up CHILDHOOD STRESS Kate McGovern, MD, shares her insights into caring for kids’ emotional health.
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SPRING 2017
healthy
young and
A guide to your child’s good health
Outdoor Safety, children and third-hand smoking, emotional health, earbud dangers and teaching resiliency