Healthy Start | Summer 2004

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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

Your Online Children’s Health and Information Resource From asthma to zits, Cook Children’s website at www.cookchildrens.org offers a range of children’s health and safety information. To access the information from Cook Children’s home page, click on Health Information — Conditions and Diseases.

On the website, visitors also will find quizzes, stories from Cook Children’s patients, information on a variety of Cook Children’s charitable programs, a secure format allowing visitors to make charitable donations with their credit card and much, much more.

Fall 2004

Texas Starts New Public School Nutrition Policy Policy to try to limit fats and sugars kids eat at school

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hen children across Texas return to school this year, they may find some changes in the cafeteria.

On Aug. 1, 2004, a new nutrition policy became effective in all Texas public schools participating in the National School Lunch Program, School Breakfast Program and the After School Snack Program. Many hope it will help fight the growing childhood obesity problem.

Overall, the new policy may limit the amount of fats and sugars school children consume each week, but some changes will affect elementary, middle and high school differently. Among them are: ■ Foods with minimal nutritional value, like candy, will not be available in elementary schools and can only be available at certain times and places in middle and high schools.

■ Servings of french fries in all schools cannot exceed three ounces and can only be purchased one serving at a time. In elementary and middle schools, french fries cannot be offered more than three times a week.

■ By the beginning of the 2005–2006 school year, no more than 30 percent of beverages in high school vending machines can be sugared, carbonated soft drinks.

“It is now estimated that for the first time in U.S. history, today’s children will not live as long as their parents because of the medical problems caused by obesity,” says Tom Rogers, MD, of Cook Children’s Physician Network. “Schools are attempting to help by mandating lower-calorie foods in smaller proportions in cafeterias, but the major impetus toward better nutritional health has to be done at home.

“We are faced with a difficult task, since most of us have been trained to overeat and portion sizes and fat content in foods have progressively increased.” ❖

Tom Rogers, MD, is a pediatrician with Cook Children’s Physician Network.

He practices at 3200 Riverfront Dr. in Fort Worth.

For tips on a variety of Back-To-School topics, turn to page 4.

Metabolic Syndrome Puts Teens at Risk A mix of factors can signal future health problems

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our doctor may have told you to lose weight and watch your cholesterol. Now, your teens’ doctor may be warning them to do the same, but the reason might be more complicated than common childhood obesity.

The reason? Metabolic syndrome, commonly called insulin resistance, is a condition that can lead to grave health problems down the road.

“Metabolic syndrome is commonly known as pre-diabetes and something for which school nurses now screen,” says Paul Thornton, MD, medical director of Cook Children’s Endocrinology Services. “If your child is at risk, you may notice a rash on the back and sides of the neck that looks like he or she did not scrub there. This is a sign of insulin resistance and a warning that the child needs to start a program of healthy eating and exercise.”

Nearly a million U.S. adolescents, and far more adults, have metabolic syndrome. Doctors think teens who have it face a high risk for the early onset of diabetes and heart disease.

Metabolic syndrome exists if you have three or more of the following: ■ Abdominal obesity ■ High blood levels of triglycerides (fats) and low-density lipoproteins (bad cholesterol) ■ Low blood levels of high-density lipoproteins (good cholesterol) ■ High blood pressure (more than 130/85) ■ Insulin resistance Obesity can be one of the first things to alert physicians to the possiblity of metabolic syndrome. Doctors can then confirm their suspicions by paying closer attention to lipids (cholesterol) and blood pressure.

You can slow metabolic syndrome if

you catch it early. Lifestyle changes may even stop it. Just losing 5 to 10 percent of your body weight can help.

As a team, you and your teens can find solutions, like making it easier for kids to learn healthy eating habits and be physically active. ❖

Save That Tooth!

Quick action can prevent it from being lost forever

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s a parent, you might know what to do or what to say when your child loses one of his or her baby teeth. But if your child ever lost one of his or her permanent teeth, would you know what to do?

Should this ever happen, a quick response is necessary and among the things you should remember include: ■ Comfort your son or daughter, but move quickly. According to the American Academy of Pediatric Dentistry, time is a critical factor in saving the tooth.

■ Find the tooth and treat it with care.

Make sure you hold it by the crown.

That’s the enamel-covered part of the tooth above the gum line.

■ Rinse it in cool water. Don’t scrub it.

You don’t want to wash away essential tissue fragments. Place it firmly into the socket if you can.

■ If your child’s mouth is injured and 2

you can’t put the tooth back, put it in milk or a small cup of the child’s saliva. Cool water and saline are both okay to use.

■ Take your child and the tooth to the dentist immediately. If it’s after hours, call the emergency number. If your dentist is unavailable, go to the emergency room.

“It’s very important to get care for a tooth that has been knocked out of the mouth within an hour; after that, the chances of the tooth being able to replant decrease,” says Tonya Fuqua, DDS, program director of Save a Smile, a community collaboration dedicated to providing dental care to low-income children in the Fort Worth area. “If the tooth cannot replant, the child will need a bridge, partial implant or other extensive dental work to help maintain a healthy mouth.” ❖

Bone Up on Vitamin D A lot of kids need more; milk and sunlight can help

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Paul Thornton, MD, is medical director of Endocrinology Services at Cook Children's Medical Center.

oes your child come home, grab a soda and plop down in front of the TV or computer? Shunning milk and the sun is more and more common for children — and the result is a lack of vitamin D. Vitamin D helps the body absorb calcium and keeps bones strong. The U.S. Department of Agriculture recommends two servings of dairy products for children ages 2 to 6 each day. Putting skim or low-fat milk on fortified cereal is your best bet; orange juice fortified with vitamin D is also a good option.

“Besides fortified milk, fish, liver and egg yolks are also good sources of vitamin D,” says Sharon Jackson, MD, of Cook Children’s Physician Network.

The sun also helps activate vitamin D in skin. Kids should spend five to 10 minutes in the sun two to three times a week, but don’t let them burn.

They’ll get some vitamin D even if they wear sunscreen. You can also gain

vitamin D and build bones with outdoor weight-bearing activities like running, soccer and basketball.

Children in northern climates (who get less sun) and dark-skinned youths (whose bodies don’t make as much vitamin D) are more at risk than others for a lack of vitamin D. “Because the content in human milk is low, deeply-pigmented breast-fed infants and infants who receive inadequate sunlight can receive vitamin D as a supplement. Parents should speak to their pediatrician if interested in this option,” says Dr. Jackson. ❖

Sharon Jackson, MD, is a pediatrician with Cook Children's Physician Network. She practices at 350 Westpark Way in Euless.

MILKING IT If your child doesn’t drink plain milk, get creative!

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How to Avoid Tooth Loss Wearing a mouth guard is the best way to prevent tooth loss. Many injuries occur during sports, and not just football or hockey. Tooth loss occurs in basketball, softball and baseball, and even while riding a bicycle.

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Use milk in place of water when you make oatmeal or soup.

Make fruit smoothies with milk.

Serve chocolate milk.

Prepare hot chocolate or pudding with milk.

Use fortified soy milk.

Back to School

The return of the school year is probably the biggest change in a family’s everyday routine. With it also comes a ton of preparations, health physicals, immunizations and shopping for new clothes and supplies to help kids get on the right foot back to school. Here are several tips to help kids overcome milestones in their lives, stay healthy and safe and make the transition as easy as possible.

Selecting the Right Backpack Help keep their load from becoming a pain

Sending Your Kindergartener to School Work to reduce some of their anxiety ... and maybe some of yours It’s a moment many parents can anticipate years in advance and never quite prepare for. Starting kindergarten can be an anxious time for a child, and it can be even more so for parents. There are some things you can do to help ease this change in your child’s life.

These include: ✔ Read books with your child to help him or her understand what’s going to happen. ✔ Try to answer your child’s questions about what he or she will experience as honestly and as accurately as possible to ease uncertainty.

✔ Get your child into the routine of waking up, preparing for school and eating breakfast before leaving for school prior to the first day. ✔ Try to arrange to have your child meet his or her teacher before school begins. Also, discuss where to meet after school or, if your child is attending an after school program, explain how to get there. ✔ Once the school year begins, try to keep your child’s routine normal and try not to introduce too many changes while he or she makes the adjustment. ❖

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Homework can already give your kids a headache, but how they carry it between home and school can possibly give them backaches. According to the American Academy of Orthopaedic Surgeons, children carrying too much in backpacks can result in muscle fatigue, strain, poor posture or excessive slouching. In a recent year, it is estimated that more than 13,000 injuries related to backpacks were treated in hospital emergency rooms. Among the things your child can do to keep backpacks from becoming a sore spot include: ✔ Use a backpack with padded, wide straps to ease the burden on shoulders and the collarbone. For heavier weights, use a hip strap. ✔ When putting on the backpack, teach kids to use proper lifting techniques by bending the knees — instead of bending over. ✔ When packing, place heavier items close to your back and try to keep items in place. ✔ Make frequent trips to lockers between classes to replace books, rather than carrying too much at one time. ✔ Consider buying a backpack with wheels. ❖

Fall Sports Safety Be extra mindful about concussions Youth sports offer a number of benefits for children and improved health and regular exercise are just the beginning.

Recreational activities can also raise self-esteem and help foster teamwork with teammates. However, sports can increase your child’s chances of injury.

An estimated 11 to 13 million children in the U.S. are treated for sports-related injuries annually.

Help Make Their Play Smart and Safe Supervision is the key to playground safety Whether it’s at school or at an afterschool program, playing at a playground might be the favorite part of your child’s day. Playground activity is an essential part of children’s healthy development because it allows them to develop motor, cognitive and social skills. Unfortunately, playgrounds can also be the site of unintentional injuries. Some safety features that parents should pay special attention to on the playground include: ✔ A surface of wood chips, mulch, shredded rubber or fine sand at least 9 inches in depth should extend at least 6 feet around all equipment.

be your playground’s most important safety feature.

If your child’s playground equipment is not well maintained or safety hazards exist, report it to the organization or individual responsible for the playground site. This might be a school, city council, park authority or neighbors. ❖ For more information on playground safety, call the Tarrant County SAFE KIDS Coalition at Cook Children’s Medical Center at 682-885-4244.

✔ Swings should be at least 24 inches apart and in groups of two — not three — to allow safe exiting.

No matter what sport your child plays, the National Youth Sports Safety Foundation offers several tips to help prevent injuries. These include having a physical exam before participating in a new sport, wearing all required safety gear and warming up and stretching prior to practicing or participating in games. Parents should also check to make sure first aid is always available for their child at games and practices.

As the fall sports season arrives, parents with children in the following fall sports should pay attention to some additional details: Football — The most common football injuries are sprains and strains. As players get older and stronger, serious injuries — like knee injuries, broken legs and concussions —- can become more common. Parents should make sure coaches and trainers on their child’s team are familiar with the signs of concussion because they can become serious or deadly if repeated.

Volleyball — In addition to concussions, common volleyball injuries can include dislocations, wrist or finger sprains, and fractures. Players should get in the routine of calling for the ball, which reduces the chances of colliding with their teammates. Equipment that can help protect volleyball players includes kneepads and lightweight shoes with ankle and arch supports. ❖

✔ Slides should be no more than 6 feet high with side rims at least 4 inches high. ✔ Climbing equipment should have slip-resistant surfaces and grips. ✔ Good supervision. A lack of supervision is associated with 40 percent of playground injuries. Having an adult around to make sure rules are followed and equipment is used correctly can

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Urgent Care Centers Help Treat Bumps, Bruises, Colds and More An option for your child’s non-emergency health needs

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any parents know that if their child has an emergency, like a broken bone, severe bleeding or breathing problems, they should call 911 and/or go to an emergency room. But parents also have an option for minor injuries or illnesses, like an urgent care center. In an emergency room patients with the greatest medical need get attention first, so an urgent care center usually can make it possible for your child to receive aid for his or her non-emergency needs faster.

Examples of urgent care injuries or illnesses include: ■ Colds ■ Minor respiratory complaints ■ Diarrhea ■ Earaches ■ Sore throats ■ Rashes ■ Pinkeye ■ Flu If possible, you should call your pediatrician when your child becomes ill or injured to determine where to go for treatment. If you have a health plan, you should be familiar with its requirements for treatment at an urgent care center.

Then before going to one, you should bring your health plan identification, a photo I.D., a list the medications your child might be taking and a list of your child’s allergies. This can help procedures move more smoothly for you and your child once you arrive at the urgent care center. ❖

Cook Children’s offers two urgent care centers for children: ■

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Cook Children’s Northeast Center. Located at 6316 Precinct Line Road in Hurst, this Urgent Care Center can provide convenient care for families living in the MidCities. The Urgent Care Center is open from noon to 11 pm daily.

Cook Children’s Medical Center Campus. Located south of downtown Fort Worth and across the street from the front entrance of Cook Children’s Medical Center, this center is open Monday to Friday, from 4 pm to 2 am and on Saturday and Sunday from noon to 2 am.

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How to Find Good Child Care Know your options, visit the sites and ask questions

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lot of firsts in your child’s life will make you smile: first laughs, first steps, first words.

One first that isn’t as appealing is the first day you have to leave your child with someone else.

But preparing yourself by learning the options and choosing the best care can make that day less stressful.

There are three main kinds of child care: ■ In-home care lets your child get one-on-one attention from a caregiver who comes into your home.

That gives you a flexible schedule, but you’ll need a plan for times when the caregiver isn’t available.

Spare Your Baby From Diaper Rash A quick change can head off problems

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iaper rash may be more common than you think.

Experts say that more than half of babies 4 to 15 months old get diaper rash at least once in a two-month span. Although most cases are not serious, they can be if not treated at home or by a physician.

“Diaper rash is caused by prolonged contact with moisture and friction,” says Marcus Ozaeta, MD, of Cook Children’s Physician Network. “It can be best treated by changing diapers frequently and using barrier creams or ointments that contain zinc oxide.”

A simple case of diaper rash should clear up in three to five days, but if you let moisture and skin irritation continue, your baby can develop raised skin bumps that look like pimples and possibly blisters from a yeast or bacterial

infection. Infection can spread to the baby’s mouth — and to the caregiver or another child. That’s why it’s vital to wash your hands well with soap and warm water after each diaper change.

Parents should contact their pediatrician if the problem does not resolve itself it a week or two, or it worsens sooner. A physician who sees an infection will prescribe an antifungal or anti-bacterial cream and, in some more severe cases, oral medication. ❖

Marcus Ozaeta, MD, is a pediatrician with Cook Children's Physician Network. He practices at 6210 John Ryan Drive in southwest Fort Worth.

Questions to Consider ■

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Family child care takes place in the house of the person caring for your child. This person often has a young child of his or her own. Experts say family child care works best in small groups (no more than six kids).

Center-based care handles larger groups of children, who are usually grouped by age. Group care often

has a consistent schedule and several staff members.

When you’re considering a provider, visit the site. “It’s worthwhile to casually watch the children and whoever is supervising them and get a sense of whether there is more of a positive, negative or neutral interaction,” says Kerry English, MD, a member of the American 7

What kind of experience and training does the caregiver have?

Is the facility or home licensed or accredited?

How is food prepared and where will the children eat?

Is the facility clean and well kept?

Are there proper safety features such as smoke alarms and outlet covers?

Can the children play outside safely?

How many adults are there for each child?

Academy of Pediatrics’ National Committee on Early Childhood, Adoption and Dependent Care.

Before your visit, come up with questions. “Questions to Consider” (above) is a start, but add your concerns, too. This exercise will help you find a great place for your child to grow. ❖

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For address changes or if you do not wish to receive these materials, please send updated information to: Cook Children’s Health Care System Attn: Public Relations, 801 Seventh Ave. Fort Worth, TX 76104 or call 682-885-4242.

New Website Nets Parents News and Knowledge Visit www.childrenshospitals.net

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ll children need children’s hospitals, and all parents need the new NACHRI website, www.childrenshospitals.net.

On the site, a visit to the “Parents Community” provides you with all the information you need on children’s health in one place — so you can spend less time online and more time with your kids. You’ll find daily news on research, wellness and prevention in “Today’s Headlines,” as well as recent updates on legislation working to keep all children healthy.

Want to help advocate for the bills you’re reading about but don’t know how? The “Parents Community” directs you to contact information for your members of Congress and provides easy-to-understand summaries of issues important to children’s wellness and safety.

But keeping kids safe begins at home.

Did you know unintentional injuries are

the leading cause of death in children under age 14? That’s why children’s hospitals lead efforts to prevent both unintentional and intentional injuries in their communities. The “Parents Community” provides families with comprehensive articles and links on

topics such as car seat safety and child abuse prevention.

Looking for a simple way to find out what outreach projects your children’s hospital and others across the country are working on? “Hospital Search” lets you explore a database of more than 180 children’s hospitals by what community programs they offer, research they’re working on, or what clinical services they specialize in. You can even find a comprehensive list of camps for children with special health care needs.

Just as children’s health care needs grow and change daily, so do the resources on www.childrenshospitals.net.

Bookmark the website today, for your child’s healthier tomorrow. ❖

NACHRI National Association of Children’s Hospitals and Related Institutions

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. ©2004 Health Ink & Vitality Communications, 780 Township Line Road, Yardley, PA 19067, 267-685-2800.

Some images in this publication may be provided by ©2004 PhotoDisc, Inc. Some illustrations in this publication may be provided by ©2004 The Staywell Company; all rights reserved.

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