Vo l . 11 N o . 2
C o o k C h i l d r e n ’s H e a l t h C a r e S y s t e m
Summer 2005
How to Stop A Crying Baby Pick the baby up, turn on some white noise and take a stress break
Y Water Watcher Tags Aid Parental Supervision Whether it’s the playground, the swimming pool or any other place children gather, parental supervision is the number one way to prevent childhood injuries and deaths. To help parents make sure one adult is always in charge of watching children in or around water at social events and other activities, the Tarrant County SAFE KIDS Coalition has free water watcher tags. To have a water watcher tag sent to you and for more water safety tips, call 682-885-4244. ❖
ou’ve fed, burped, changed and rocked your baby, but he or she is still crying. And crying. Your nerves are frayed, your sleep is wrecked and you’re losing confidence as a new parent. Now what? Some babies cry for long stretches at 3 and 12 weeks of age during steps in development when their sleep is less settled. A baby is considered colicky when he or she cries for more than three hours a day, more than three days a week. “A possible cause of colic is a combination of the baby being highly sensitive to his or her environment and having an immature nervous system,” says Vanita Shori, MD, of Cook Children’s Physician Network. “Before taking a crying baby to the doctor, parents should take note of when he or she cries, eats and sleeps, as well as the pattern of bowel movements.” Once your doctor has ruled out any underlying medical reason for crying, give these tear-stopping techniques a try: ■ Wrap the child tightly. Swaddling babies snugly in a soft blanket helps keep their arms and legs from flailing and can switch on relaxation. ■ Wear your baby. Babies who are carried more cry less, studies show. Skin-to-skin contact is best (and bathing together is ideal). But wearing baby in a sling for several hours a day also cuts crying and provides the constant sound, temperature and motion that signal comfort. ■ Switch on white noise. A running shower, a whirring fan, a white noise machine or a recording of the vacuum cleaner (watch the volume) helps block outside stimulation and may mimic the steady sounds of the womb.
■
Get moving. A spin in the car, motion swings or dancing are especially helpful at the dinner hour, when fussy babies tend to kick it up a notch. ■ Drape the infant. Draping your baby along your forearm with the head in the crook of your elbow provides warmth and pressure to relax a tense, colicky belly. ■ Take a stress break. Have your spouse, family or neighbor take over while you walk, bathe and calm yourself so you can better handle crying. A colic support group can help you cope until your baby outgrows crying. (And they all do!) ❖
Vanita Shori, MD, is a pediatrician with Cook Children’s Physician Network. She practices at 1600 Lancaster Drive in Grapevine.
New Web Service to Help Patients and Families Keep in Touch CarePages lets users create webpages to update family members and receive support SM
T
hrough a new service, Cook Children’s Medical Center is helping patients and families stay in contact with one another and receive support through the Internet. CarePages, a free service overseen by Cook Children’s Pastoral Care Department, lets families create their own webpages featuring information about their child. The new service, available in Spanish and English, makes it possible to add photos and information and receive letters of support online. CarePages also notifies families and relatives when new information is added to each family’s webpage, allowing parents to constantly update loved ones without making numerous phone calls. “CarePages is one way Cook Children’s is using new technology to help our
patients and their immediate families, as well as extended family members living far away,” says Nancy Cychol, RN, MSN, president of Cook Children’s Medical Center. “We are constantly looking for new ways to care for our families and improve patient satisfaction.” “The support of a caring community of family and friends can play an essential role in comforting sick and injured children and ease the stress of their parents,” adds Ann Miller, PhD, director of Pastoral Care Services.
“CarePages will especially benefit the families of children who are frequently in the hospital and families of patients
Pain in the Abdomen May Mean Appendicitis There’s just one cure — surgery
S
ay your child has pain in the abdomen, a slight fever, a loss of appetite and perhaps vomiting. It could be a stomach bug making the rounds. It could be something your child ate. Or it could be appendicitis, an ailment that some doctors call the great mimicker. The appendix is a pinky-finger-size sac attached to the end of the colon on the right side. It has no known purpose. When it becomes inflamed, that’s appendicitis. The treatment is clear — surgery to take it out. Every day, more than 200 children have an appendectomy, the Agency for Healthcare Research and Quality says. That makes this the most common surgical procedure for children other than newborns or pregnant teens. If you suspect your child has appendicitis, call your doctor at once or go to a hospital emergency department. “Not every vomiting child needs to
A normal appendix
When problems occur
Small intestine
Removing the appendix Blood vessels sealed
Colon
Colon’s link to appendix sealed off
Inflamed appendix
Appendix
Appendix removed
The small intestine brings liquid waste to the colon and appendix. The waste can easily pass in and out of a normal appendix.
An inflamed appendix is blocked by a hard piece of stool. Liquid waste cannot pass. As a result, the appendix may become infected.
see a doctor, but if the child doesn’t eat or drink anything for a couple of hours and the problem continues, parents should seek medical attention so that a 2
Once the appendix is reached, blood vessels and the colon’s link to the appendix are sealed off. Then the appendix is removed.
doctor can determine if appendicitis is a possible concern,” says James Wheeler, MD, a pediatrician with Cook Children’s Physician Network.
[ health bits ] Obesity: A Challenge for Us All with a new or serious diagnosis.” Web users can access Cook Children’s CarePages sites by going to Cook Children’s website at www.cookchildrens.org. At Cook Children’s Medical Center, computers are available for families to create and update their CarePages sites in several playrooms and the hospital’s family resource center. CarePages is made possible through contributions from the Kohl’s Cares for Kids program. Kohl’s sells seasonal plush characters, books and music items at Fort Worth-area stores and donates the net proceeds to Cook Children’s. In the past three years, the Kohl’s program has contributed more than $365,000 to Cook Children’s Medical Center. ❖
Schools, families, communities, industry and government must join to fight childhood obesity, says the Institute of Medicine (IOM). “We must act now and we must do this as a nation,” says Jeffrey Koplan, MD, former head of the Centers for Disease Control and Prevention. The IOM is part of the National Academy of Sciences, created by the federal government to act as an independent adviser on science. Dr. Koplan led an IOM panel that studied the issue for Congress. Among the steps it urged: ■
Schools should set standards for the food and drink they offer.
■
Schools should find more ways to keep students physically active.
■
Industry should set rules for advertising and marketing aimed at kids.
■
Restaurants should add more nutritious fare to menus.
■
Parents should offer healthy foods at home and help keep kids active.
■
Government should find ways to promote exercise and good nutrition.
TM
Model used for illustrative purposes only.
Air-Powered Guns Can Maim and Kill If appendicitis is a possibility, doctors also recommend that you don’t feed the child to avoid problems with anesthesia. Surgeons don’t like to operate on the abdomen until a patient is free of food for six hours and drink for four hours. But if the appendix is perforated (torn or burst), that’s an emergency, so surgeons may operate at once. In most cases, surgeons can use special tools to take out the appendix through tiny incisions. That means less pain for your child after surgery and a quicker recovery. Kids go back to school in about three days. But a burst appendix or other complications can cause a child to miss school for seven to 10 days or more. ❖
A gun doesn’t need gunpowder to hurt a child or teen. Powerful “nonpowder guns” that use compressed air — BB guns, pellet guns, air rifles and paintball guns — can injure, disable and even kill, according to a report by the American Academy of Pediatrics (AAP). The Consumer Product Safety Commission (CPSC) lists 32 nonpowder gun-related deaths of children ages 15 and younger from 1990 to 2000. The CPSC and the Centers for Disease Control and Prevention say emergency rooms treated 21,840 injuries linked with nonpowder guns in 2000 alone. Lack of supervision may play a role in injuries, the AAP report says. It also says parents shouldn’t view air-powered guns as toys.
Many Teens Shun Sunscreen Only a third of America’s teens use sunscreen on sunny days, Boston researchers say. And most teens say they’ve been sunburned — often more than once, according to the study published in Pediatrics. The study covered 10,079 12- to 18-year-olds. Doctors know skin cancer is tied to too much ultraviolet light exposure, often before age 18. “Yet despite this knowledge, the number of skin cancers continues to rise each year,” says James M. Spencer, MD, an American Academy of Dermatology spokesman. “Even more disheartening is the fact that teens continue to tan despite the known health risks.” Using sunscreen, wearing a hat and avoiding the sun from 10 a.m. to 2 p.m. are easy ways to help prevent skin cancer.
At Sports Camps, Think About a Drink James Wheeler, MD, is a pediatrician with Cook Children’s Physician Network. His office is located at 2716 Tibbets Drive in Bedford.
If your kids go to a sports camp this summer, make sure they drink enough. A study found two out of three kids at soccer camps were dehydrated even when they had access to water and sports drinks, the American College of Sports Medicine says. The study involved 58 boys and girls in four-day camps in Pennsylvania. The 10- to 14-year-olds played three times a day. By the last day, tests showed 59 percent of boys and 70 percent of girls were dehydrated. “The good news is that it is preventable,” says lead researcher Douglas Casa, PhD. Coaches, athletes and parents must work to replace fluids before, during and after activity. 3
he last day of school is one that kids eagerly await for months and a day that can make many parents anxious. Summertime often brings changes to your child’s daily schedule, including travel and outdoor activities that can lead to insect bites, sunburn or other injuries. To help prepare for the final school bell, here are some things to remember to help make this summer as healthy and safe as possible for your kids.
Traveling safely in the neighborhood or around the world Summer is a time many families hit the road and take to the skies. No matter if the trip is just around the block or across the country, parents should take riding in a motor vehicle very seriously. With an estimated 1,800 deaths and more than 280,000 injuries
includes making sure: A newborn under 1 year of age (or below 20 pounds) is in a properly-installed rear-facing car seat. ■ A child between ages 1 and 4 (or below 40 pounds) is in a properly-installed forward-facing car seat. ■ A child between ages 4 and 8 (and below 80 pounds) is in a booster seat. ■ A child 8 years and older (or above 80 pounds) is in the routine of always wearing a seat belt while riding. One thing you can do to reinforce this is to set a good example by wearing your own seat belt. When traveling on airplanes, parents should check their rear or forwardfacing car seat to see if it is approved for use in airplanes. Children who weigh more than 40 pounds can ride in an airplane safely just wearing their seat belt. ❖
each year, motor vehicle crashes are the leading cause of unintentional injuryrelated death in children. The best thing parents can do while riding in the car is to make sure their children are properly restrained according to their age. That
■
4
Learn More If you are traveling abroad, make sure your child is up-to-date on all needed immunizations. Travel to some parts of the world may require your child to be vaccinated for diseases native to that region, such as yellow fever in many parts of Africa, Central America and South America. For more information, contact your child’s pediatrician or contact Cook Children’s Infectious Disease Services at 682-885-1485.
Keeping bugs from ruining the fun Whether it’s participating in sports, going swimming or just playing at the park, outdoor enthusiasts love Texas summers. Unfortunately, the climate is quite agreeable for many insects, too. Any outdoor event can be spoiled by flies, ticks and other bug bites. In Texas, parents should pay extra attention to mosquitoes and fire ants. Mosquitoes have received lots of attention over the past few years because they can
carry West Nile Virus. Although the risk of contracting the illness is low (only 108 cases of human exposure in Texas in 2004), the best way parents can protect their children is keep mosquitoes from biting. To do this, children should avoid playing outdoors at dawn and dusk when mosquitoes are most active. Dress children in long sleeves and pants for further protection. Children can also use bug repellents with DEET
(N,N-diethyl-meta-toluamide on the label), but the American Academy of Pediatrics asks parents not to allow any repellent that is more than 30 percent DEET on any child. DEET should never be used on newborns under 2 months of age. Fire ants can also pose a particular danger because each colony can have hundreds of ants that respond aggressively to threats. A fire ant bite can cause immediate swelling and irritation around the affected area; a white pustule can appear after two or three days. To relieve the swelling, put ice or a cool washcloth on the affected area for 10 minutes at a time. In rare cases, an ant bite can also trigger allergic reactions. If your child shows signs of an allergic reaction, including hives on the skin around the bite, swelling in the face or difficulty breathing, take your child to an emergency room or call 911. ❖
Keeping kids active and safe at home For many working parents with older children, summer vacation can cause a power struggle. Although many children want to assert their independence, parents may fear for their children’s safety and worry how to keep them active. One solution experts recommend is for parents to create a safe home environment and allow children to make some of their own decisions regarding free time and activities. That way, parents can give kids some freedom and slowly allow them to gain more responsibility.
in the neighborhood whom they can turn to in case of a sudden emergency at home. Children should also get in the routine of calling parents to let them know daily plans, when they’re going to a friend’s house, leaving the house and returning home. Make a first-aid kit available that includes bandages, medications and thermometers. Periodically inspect the kit, discard expired medications and replace items when needed. Parents should also teach children how to use its contents. ❖
For their children’s protection, parents should introduce them to several adults
5
Slip! Slop! Slap! Wrap! Chill the threat of sunburn Protecting themselves from the sun is an important habit for children to develop. Sun exposure is the cause of most skin cancers, and it is estimated that 80 percent of lifetime sun exposure takes place before age 18. To keep from getting pink, the American Cancer Society recommends that parents remember Slip! Slop! Slap! Wrap! Slip on a shirt, slop on sunscreen, slap on a widebrim hat and wrap sunglasses over eyes. Experts also recommend putting on sunscreen half an hour before going outdoors and reapplying it every two hours. Many pediatricians recommend that parents keep children under 6 months old out of the sun because they can burn easily, and newborns should avoid some sunscreen ingredients. If an infant is outdoors, parents should be extremely cautious and should cover the child with protective, light-colored clothing. ❖
How to Say
No
Set limits, but be ready to talk about them as your child grows older
W
hen kids are young, it’s easy to set limits on conduct that may put their health or safety at risk. If the seat belt is unbuckled, the car doesn’t start. If the helmet isn’t worn, the bike stays in the garage. That can even work with behavior that may lead to obesity, such as eating too much and exercising too little. “Get the junk food out of the kitchen. Keep TVs out of kids’ rooms. You have to say no a lot less if you make it a safe environment,” says Nancy Krebs, MD, a professor of pediatrics at the University of Colorado. But as children grow older, risks get more complex and restrictions harder to enforce. That’s especially true when working parents can’t always be around to play disciplinarian. “What works for young children doesn’t work for preteens. And being overcontrolling can make the problem worse,” says Seattle pediatrician Donald Shifrin, MD, a fellow of the American Academy of Pediatrics. “Kids of 9 or 10 are entering a phase of independence. You can’t say to them, ‘The doctor says you’re
overweight, so we’re never going to have sweets again.’ They’ll just go over to a friend’s house,” Dr. Shifrin says. “The key is moderation. You’ve got to reinforce the good decisions and be able to discuss, calmly but appropriately, the not-so-good decisions.” It’s the same with a whole range of temptations, from cigarettes to sex. You have to be approachable, Dr. Shifrin says. “Just when kids seem to deserve love the least is when they need it most.” ❖
Lay Down the Law — Gently ■
Be relaxed, friendly and nonjudgmental when you talk about troublesome behavior.
■
Offer choices, which help set limits but give kids a chance to exercise independence.
■
Reward good behavior with praise, which promotes self-esteem.
■
Be a good role model. Kids are great imitators.
■
With older kids, let minor mistakes result in natural consequences. Step in only when their actions are dangerous, illegal or harmful to themselves or others.
Cook Children’s Epilepsy Center Works to Find Answers for Families in Need Center is one of four in Texas to offer highest level of care for children with this illness
I
t is estimated that 40 in 100,000 children have epilepsy, a disorder that causes repetitive unprovoked seizures that can lead to the loss of consciousness, convulsions or other life-threatening complications. Epilepsy can be particularly stressful for families of children with the disorder, especially when its cause is unknown and the seizures have not been effectively controlled through medication.
Sharing a Bed With a Baby May Carry Risks Some studies link bed-sharing to SIDS
S
haring a bed with your spouse may be a no-brainer. But when it comes to your newborn, choosing the sleeping arrangements isn’t so clear. Some experts say sharing your bed with your baby can be safe and beneficial. Yet other research says bedsharing may raise the risk of sudden infant death syndrome (SIDS). “We can’t be hard and fast to say do or don’t do it,” says John Kattwinkel, MD, who chairs the American Academy of Pediatrics’ SIDS task force. “This is a
6
Angel Hernandez, MD, medical director of Cook Children’s Comprehensive Epilepsy Program, with Corban Herrian, 6, who was up and around playing just days after undergoing brain surgery to treat his epilepsy. The epilepsy program’s team discusses surgical, nonsurgical and investigational medication alternatives with families to help achieve seizure control and improve quality of life. Epilepsy Program. “Our goal is to achieve complete seizure control and improve quality of life so that children can live healthy lives without seizures. “By offering a place that families can turn to for treatment and answers, our epilepsy program offers the same medical expertise in a kid-friendly environment that Cook Children’s has offered for years to children with cancer, heart problems and many other conditions.” ❖
The Cook Children’s Comprehensive Epilepsy Program has become a place that parents can turn to for help in controlling their child’s seizures. The program is one of only four places in Texas that offers the highest level of specialty
care for children with epilepsy. The program’s epileptologists, neurologists, neurosurgeons, neuroradiologists and neuropsychologists work together to identify the origin of the seizure and then offer various treatment options for families. “Depending on the results of the evaluation and team recommendations, surgical, nonsurgical and investigational medication alternatives are then discussed with families,” says Angel Hernandez, MD, medical director of Cook Children’s Comprehensive
society in which people need to make their own decisions knowing the risk.” Research shows that soft, sagging surfaces, such as pillows, waterbeds or couches, can cause breathing difficulties and raise the odds of SIDS, Dr. Kattwinkel says. He points out that the risk is much greater if infants sleep on their stomachs. Infants can also suffocate if they roll into tight spaces between the bed and the wall, headboard or footboard. And if you smoke, take sedating drugs or sleep deeply, your bed can be a dangerous place for a baby. Even if you get rid of those risks, SIDS can still strike — because doctors don’t know just how it happens. Many now think that some infants’ brains haven’t developed enough to wake them if they aren’t getting enough oxygen. But the sound of a nearby mom breathing and the feel of her movements can stimulate the infant’s brain and prevent the type of deep sleep that can lead to SIDS. “Even though the babies don’t wake
up, their arousal levels are altered when they are bed-sharing,” says researcher Christopher Richard, PhD. He just did a study at the University of California at Irvine showing that the heart beats faster in infants who sleep with mom. To stay on the safe side, Drs. Richard
and Kattwinkel recommend that your infant sleep in a crib or bassinette next to your bed. You’ll be able to breastfeed longer and nurture a child who is more independent. You’ll also spend less time running to your infant’s room and more time sleeping. ❖
7
Learn More For more information on Cook Children’s Comprehensive Epilepsy Program, please call 1-800-934-COOK (2665) or go to Cook Children’s Web site at www.cookchildrens.org.
801 Seventh Avenue Fort Worth, TX 76104
Cook Children’s Physician Network is the
largest nonprofit pediatric
network in North Texas with more than 200 physicians,
physician
including primary care physicians and
pediatric subspecialists in more than
30 locations
in Tarrant, Denton and Hood counties. To
find a pediatrician near you
or for a referral,
www.cookchildrens.org
please call our toll-free number. 1-800-934-COOK
The Importance of Philanthropy to Children’s Hospitals
E
very day children’s hospitals across the country provide compassionate, personal and sophisticated care to children and their families. To make this all possible, philanthropy plays an important role in the support of children’s hospitals and the many vital services they offer communities. Fund raising is so important to children’s hospitals that nearly 80 percent have a foundation dedicated to the task. Almost all children’s hospitals are notfor-profit organizations that depend on grants and donations from individuals, the federal government and private foundations to help accomplish their fourfold mission of clinical care, research, advocacy and education.
NACHRI National Association of Children’s Hospitals and Related Institutions
Children’s hospitals especially depend on fund raising to support the many programs and services that are not reimbursed by private or public health insurance. The National Association of Children’s Hospitals, the public policy affiliate of NACHRI, provides children’s hospitals with information that helps them in their grant-seeking efforts. The Children’s Hospital Grants Opportunities Project
gives children’s hospitals access to breaking news on grant deadlines, analysis of grant opportunities and research on current funding opportunities. Individual donations, major gift and planned giving activities, and a variety of special events, ranging from golf tournaments and fashion shows to art contests and parties, also help ensure children’s hospitals can continue to provide highly specialized care to children. Whole families can participate in many of the events. Contact your local children’s hospital to find out how you can help. ❖
To Learn More For more information on the primary, preventive and specialty services children’s hospitals provide to all children, visit www.childrenshospitals.net.
Articles in this newsletter are written by professional journalists or physicians who strive to present reliable, up-to-date information. But no publication can replace the care and advice of medical professionals, and readers are cautioned to seek such help for personal problems. ©2005 Health Ink Communications, 780 Township Line Road, Yardley, PA 19067, 267-685-2800. Some images in this publication may be provided by ©2005 PhotoDisc, Inc. All models used for illustrative purposes only. Some illustrations in this publication may be provided by ©2005 The Staywell Company; all rights reserved. (205)