Kapi`olani Kids | Spring 2005

` Kapi`olani

kids

` T H E L AT E S T I N C H I L D R E N ’ S H E A LT H F R O M K A P I ` O L A N I C H I L D R E N ’ S H O S P I TA L

VOLUME VOL 1. ISSUE 3. ISSUE 1 1. MAY 2005

Speech, Language and Hearing Development Checklist This checklist is a helpful guide for parents of young children to help ensure their child is developing at an appropriate rate for his age. “Parents know their children best and will often be the first to notice if there is a problem. Early detection and intervention will help a child continue to progress at a healthy rate,” says Jeffrey Okamoto, M.D., Kapi‘olani pediatric developmental specialist. Kapi‘olani’s comprehensive rehabilitation program includes diagnosis and treatment for speech, hearing and developmental problems. For further information Jeffrey Okamoto, about our services, M.D. call 808-983-8235.

0–3 Months ❏ Startled by loud sounds (hand clap at 3–6 feet away) ❏ Calmed by mother’s voice ❏ Makes throaty sounds: Whimpers, squeals, chuckles

3–6 Months ❏ Turns eyes and head to sound ❏ Quiets to mother’s voice ❏ Babbles, makes a variety of sounds: “Ooh,” “ba-ba,” “ga-ga,” “ma” ❏ Enjoys making sounds ❏ Enjoys sound-making toys

Common Insect and Marine Bites and Stings: What to do and when to be concerned

“Common bites and stings from insects and marine animals can usually be managed readily at home,” says Alson Inaba, M.D., FAAP, PALS–NF, Kapi‘olani pediatric emergency medicine physician and University of Hawaii associate professor of pediatrics. “Only a small percent will experience an allergic reaction, which requires immediate medical attention,” Dr. Inaba adds.

When to seek medical care ■ Seek immediate medical care if your child is experiencing: – Difficulty breathing – Swelling of the lips and tongue – Difficulty swallowing or any type of throat discomfort – Hives/welts spread over other areas of the body that were not affected by the bite or sting – Symptoms of shock, such as chest pain, palpitations, abdominal pain, feeling faint, light-headedness, dizziness ■ Seek medical care if you think that the bite/sting site is getting infected.

■ Stings around the eyes, mouth and neck may require medical attention.

Take precautions Patients with previous allergic reactions should always carry the following items: ■ An anaphylaxis emergency treatment kit (Anakit) or an epinephrine autoinjector (Epipen) ■ A medical alert bracelet Treating bites and stings at home Portuguese man-o-war stings

The majority of man-o-war stings that we see in Hawaii are due to the smaller species, which typically only produce continued on page 7

Kapi‘olani Children’s Miracle Network Telecast

“Medicine, Miracles and Aloha”

continued on page 6

KITV–4, Saturday, June 14, 2005, 8 p.m.

An exciting look at the miracles of Hawaii's only children's hospital. Learn about the latest treatments available for everything from loss of hearing to life-threatening illnesses such as cancer.

Find out how Kapi‘olani benefits our island keiki.

The Red Hot Alert Get the facts on fevers Is it a fever?

Body temperature is remarkably wellregulated, staying within 2 degrees Fahrenheit, above and below, the average of 98 F. This means the normal temperature is not a single number but a range between 96.5–100.4 F (35.84–38 degrees Centigrade or Celsius). Therefore, fever begins at a temperature of 100.5 F. Temperatures in the 99–100 F range are completely normal.

A fever by itself is not dangerous A fever is the body’s reaction to infection with virus or bacterial germs. “Fever by itself is not an illness,” explains Marian Melish, M.D., pediatric infectious disease specialist. “It’s a symptom of an underlying problem.”

The germ or illness Marian Melish, causing the fever may M.D. be mild or severe. The temperature does not necessarily correlate with the seriousness of the illness. Some very mild illnesses, such as roseola, or baby measles, can cause very high fevers (over 105 F), while some very serious illnesses may result in just a slight rise in temperature, such as to 101 F. Fever is not caused by teething or tantrums.

Fevers can be a positive sign that the body is fighting an infection, because fever stimulates certain defenses, such as white blood cells, which attack and destroy invading bacteria.

“Most fevers are caused by viral infection. Fever can be a sign of problems such as respiratory illnesses, pneumonia, ear infections, influenza and severe colds,” says Dr. Melish. “It’s important to be attuned to other symptoms your child is experiencing, such as changes in eating Michael Sia, M.D. habits, vomiting or diarrhea, difficulty breathing, tugging or complaining about ears, or changes in skin color.”

“Fever due to infection rarely goes over 106.2 F, says Michael Sia, M.D., pediatrician 2 Kapi‘olani Children’s Hospital 808-983-6000

and chairman of Kapi‘olani’s Department of Pediatrics. “I tell parents not to worry, as these high temperatures are not harmful. Also, seizures (convulsions) due to fever in children ages 4 months to 6 years, are most often associated with an abrupt rise in temperature, rather than an extremely high fever,” explains Dr. Sia. Although seizures may be frightening for a parent to witness, those due to fever are usually short (less than five minutes), and are rarely harmful to the child’s brain.

“All children will be fussy and appear tired when the fever is high, but children with mild illnesses will be happy and playful when the fever is lower. In contrast, children who are really sick will remain tired and fussy even when their temperature is lower. So, if your child is running around happily, it’s probably not anything serious,” says Dr. Melish.

When to call your child’s doctor Drs. Melish and Sia advise parents to watch for behavioral changes and consider the child’s age and health history to determine if and when to call your doctor. “If the child is newborn to 6 weeks old, I want parents to call immediately, because any fever in a young infant is a major concern, since they may not show serious signs of infection until it’s too late,” says Dr. Sia. “Once a child is 2 years or older, parents begin to rely on their personal knowledge of the child and how she communicates how she is feeling,” says Dr. Sia. If a child this age gets a fever for more than three days, call your child’s doctor for follow-up.

If your child looks ill despite taking medication, especially if there are complaints of sudden headache and mental changes, neck or back stiffness, or rashes, take your child to the emergency room right away.

Taking your child’s temperature The gold standard is to take a child’s temperature with a digital thermometer, in the rectum (okole) in infants and toddlers, and by mouth in children from 3 years if she can hold the thermometer in a closed mouth for 2 to 3 minutes.

Your doctor will appreciate if you take at least one accurate temperature reading before calling to report a fever. Once you know your child has a fever, ear thermometers, which are not as accurate but easier to use, can be used to “trend” the fever, or to determine if and by how much the temperature fluctuates after the initial reading.

Treating a fever ■ Never give children aspirin for a fever.

Aspirin has been linked to Reye’s syndrome, a condition that can be debilitating or even fatal in children.

■ Acetaminophen and ibuprofen are the two medications that help fight fever. Follow the instructions or ask your doctor to be sure you give the appropriate dose. It is advisable to give one or the other, but usually not both.

Don’t worry if the fever stays up despite these anti-fever medicines, unless the child also appears ill.

■ Bathing your child with lukewarm water will help bring down fever. This is rarely needed and may make your child feel worse. Never use cold water or alcohol to bathe your child because it may cause shivering and increase the temperature.

■ Dress a child in light, comfortable clothing.

■ Increase fluid intake but do not push solid foods. The body chemicals that cause fever decrease appetite. Don’t worry about your child starving, she will eat again when the illness is over.

Help Your Kids Quit Smoking Every day, about 3,000 U.S. teenagers start smoking. If you’re a parent of a young smoker, you can take steps to help your child quit. “First of all, it helps to understand why teens smoke,” says Kapi‘olani adolescent specialist Robert Bidwell, M.D. “When you understand the reasons, you can make a more convincing case for quitting and support your child in breaking the habit.”

Why kids smoke ■ Much of cigarette advertising focuses on getting teens to smoke. If asked, most teens say tobacco ads don’t influence them, yet one study showed they generally smoke the three most advertised brands — Camel, Marlboro and Newport. Studies also found that youth smoking increased by 73 percent during the 10 years following the introduction of the Joe Camel cartoon.

■ The unconscious mind can be conditioned. Advertising and entertainment figures give the impression cigarettes give pleasure and can make you popular — especially with the opposite sex.

■ They think smoking will make them look more grown-up.

■ They believe smoking will reduce their appetite and help them control their weight.

■ Smoking reduces stress. Many teens find this an especially appealing factor during the stressful adolescent years.

Studies show that nicotine not only reduces stress, but also eases pain and increases mental alertness. Nicotine’s significant drawback as a drug, however, is its extremely addictive quality. It’s also the number one cause of lung cancer.

■ They think they won’t become addicted. When asked why they smoke, teens generally respond, “I just like to smoke,” or “I can quit anytime I want.” In reality, however, studies have shown teens can become addicted to nicotine after smoking as few as three cigarettes. Other

TEEN CORNER

How to Help Them Quit

studies have shown nicotine addiction is as hard to break as heroin or cocaine addiction, making quitting difficult.

What you can do Although you may think that your kids only have ears for what they hear in movies and on TV, parents still have the greatest influence on their adolescents’ lives, experts say.

■ Talk to your kids about the risks of using tobacco. Don’t cover up the fact that a relative or family friend died of a tobacco-related illness.

■ If you smoke, quit if you can. Don’t smoke around your kids, and don’t leave your cigarettes where they can get to them. Parental smoking is the largest risk factor for kids smoking.

■ If you have younger children, talk to them as early as age 5 and keep up the talking through high school. Statistics show that many kids who start using tobacco begin by age 11; many are addicted by age 14.

■ Discuss ways your kids can refuse tobacco from their friends.

■ Talk about tobacco advertising and how it falsely glamorizes smoking and tobacco use.

Quitting Resources The following organizations can provide information, cessation programs, and online or telephone support to teens trying to quit smoking: American Cancer Society . . . . . . . . . . . . . . .www.cancer.org American Lung Association . . . . . . . . . . . . .www.lungusa.org American Heart Association . . . . . . . . . . . . .www.americanheart.org Nicotine Anonymous . . . . . . . . . . . . . . . . . .www.nicotine-anonymous.org QuitNet . . . . . . . . . . . . . . . . . . . . . . . . . . . . .www.quitnet.org

Teens stand the best chance of quitting if they get some help. New studies have found smokers who don’t use any smoking-cessation aids have a 96 percent chance of lighting up again within a year.

But smokers who use over-the-counter nicotine patches or other nicotinereplacement products have a 26 percent success rate after one year.

People who use a cessation aid and seek counseling have an even higher likelihood of quitting permanently.

Be sure to talk to your doctor before letting a child use an aid. Confirm it’s age-appropriate and won’t interfere with any medications the child takes.

Support from family and friends also helps. The child should tell people she is trying to quit and may be grouchy or edgy for a few days. The child also should ask smokers not to smoke around her.

Help your child find positive ways to reduce stress, such as participating in sports or noncompetitive activities, such as walking, hiking or yoga.

Finally, be aware that relapses do occur. To prevent discouragement, remind your child Robert Bidwell, that few people M.D. successfully quit smoking the first time they try.

Rather, most try four or five times before they quit permanently.

www.kapiolani.org 3

Kapi‘olani Offers Cochlear Implants New hope for children with severe hearing loss COCHLEAR IMPLANTS, the latest treatment for children and adults with severe to profound hearing loss, are now available at Kapi‘olani Medical Center for Women & Children. Until now, Hawaii’s children had but two choices: continue to live in a world of silence, or seek treatment on the mainland.

Now, thanks to Kapi‘olani’s newly organized cochlear implant team, these children can enter the world of sound without ever leaving Hawaii.

“It can make a big Lenh Anh Tran, difference in a child’s M.D. life, to go from a child who doesn’t have any hearing and has to use sign language to a child who hears and communicates verbally,” says Lenh Anh Tran, M.D., an ear, nose and throat specialist at Kapi‘olani who performs this state-of-the-art procedure.

Cochlear implants are not hearing aids, which just amplify sound. The implants, which are surgically placed under the skin behind the ear, employ exciting new technology. By converting sound to electrical current, the implant performs the function of the child’s damaged or missing auditory hair cells, which transmit sound from the ear to the brain.

Each implant has four basic parts: A microphone, which picks up sound from the environment ■ A speech processor, which selects and arranges the sounds ■

Kapi‘olani Kids is printed by Kapi‘olani Medical Center for Women & Children. This is the May 2005 issue. Kapi‘olani Kids is published twice a year as a service to parents in the community served by Kapi‘olani Medical Center for Women & Children, 1319 Punahou, Honolulu, HI 96826. The information is provided as education about physical, mental and psychosocial health. It is not intended as a substitute for consultation with a physician. If you have questions or concerns about specific items that appear in Kapi‘olani Kids, please contact your child’s doctor. To advise us of changes to your mailing address, please contact us at 808-535-7554.

4 Kapi‘olani Children’s Hospital 808-983-6000

A transmitter and receiver/stimulator, which receive signals from the speech processor and converts them into electric impulses ■ Electrodes, which collect the impulses from the stimulator and send them to the brain ■

To be a candidate for a cochlear implant, a child must meet the following criteria:

Severe to profound hearing loss in both ears ■ Little or no benefit from hearing aids ■ Lack of progress in developing auditory skills ■ Poor test results on age-appropriate materials ■

For children with significant hearing problems, Dr. Tran first tries hearing aids for three to six months. If that fails to improve hearing, the child might be a candidate for a cochlear implant. Each member of Kapi‘olani’s cochlear implant team — Dr. Tran, as well as an audiologist,

a speech/language pathologist, a clinical psychologist, a social worker, a physical and occupational therapist and, depending on the child’s age, a liaison with the child’s school — evaluates the child to make sure he is an appropriate candidate — physically and psychologically — for the procedure.

And that’s just the beginning of the team’s involvement. After the surgery, the child undergoes several weeks or months of rehabilitation with team members to

A Miracle When he was 41/2 months old, an ear infection destroyed both Emerson Goo’s eardrums and his hearing.

Profoundly deaf in both ears, he didn’t benefit from hearing aids.

“It was devastating,” says his mother, Jadie Goo. “Fortunately, we had a lot of support from professionals, family and friends.”

To regain his hearing, Emerson’s only recourse was a cochlear implant.

But the procedure wasn’t available in Hawaii at the time, so his family had to take him to Los Angeles. He was just about a year old. There he underwent pre-screening, surgery to repair his eardrum, implant surgery, and the first programming of his implant device.

4

Three months after the surgery, with intensive auditory and speech therapy, Emerson said his first word, “Mama.”

Thanks to this new technology, Emerson now has what’s classified as mild to moderate hearing loss. In a quiet room, he can hear a whisper. He

What Every Parent Should Know

make sure the implant is programmed correctly and the child is adapting appropriately.

“We want to get to the point where the child is hearing sounds without having any discomfort,” says Dr. Tran.

“Thanks to our newborn hearing screening program, we are identifying children with hearing impairments earlier,” she adds. “If hearing aids aren’t sufficient, having a team right here at Kapi‘olani that can provide cochlear implant services locally — instead of having to go to the mainland — represents a huge emotional and financial uplift for patients and parents, as well as the community and insurers.”

Says Jadie Goo, whose son Emerson had to travel to Los Angeles for his cochlear implant four years ago, “It’s great that the whole package — pre-evaluation, the surgery and follow-up therapy — is now available in Hawaii at Kapi‘olani.”

For more information on cochlear implants, contact Kapi‘olani’s Rehabilitation Department at 808-983-8235.

We talk a lot about how to keep your children healthy, and signs and symptoms of illness. But could you also use some assistance with parenting? Are your children beginning to test their boundaries? Is disciplining your child, managing tantrums, school and boyfriends proving to be a handful?

Don’t wait until you’re in a crisis to seek help. Learn parenting techniques that really work to help keep you in the driver’s seat. All classes are video-based with an excellent book that is yours to keep. Call 808-535-7000 for schedule information and to register.

PARENTING CLASSES 1, 2, 3, 4 … Parents! (1–4 years) Get your child started on the right foot. This course identifies reasonable age-appropriate abilities and helps you discover how to set routines and rules. Learn how to give choices and prevent problems. Most importantly, learn how you can encourage positive behaviors you want repeated, and eliminate behaviors that are not acceptable.

Fee (includes book): $50 per person Four-week series Meets once a week for two hours

Active Parenting (5–10 years) Have fun instead of fights. Most of us are ill-prepared for the challenges and constant testing this age group demonstrates.

Through mutual respect, and improving our listening and communication skills, you can achieve quick results and dramatically improve your relationship with your child.

Fee (includes book): $75 per person; $105 per couple Six-week series Meets once a week for two hours

Active Parenting of Teens (5th grade and up) Get the fear and frustration out of one of the hardest times in your life as a parent. You can formulate better relationships through proven techniques like family brainstorming meetings, mutual respect, active listening, when–then statements, logical consequences, group support, practice, encouragement, effort and consistency.

Learn how you can begin to experience amazing improvements in your family.

Fee (includes book): $75 per person; $105 per couple Six-week series Meets once a week for two hours

BREATHE EASY Asthma Management Strategies for Parents and Caregivers

is a kindergartner, and a top performer in his class. His language is appropriate for his age, and he reads far above his age level. Says his mother: “He’s doing great; we’re very happy with where he is now.”

“The device is a miracle. It has re-opened the hearing world to Emerson.”

While Hawaii has the highest rate of pediatric asthma in the United States, studies have shown with appropriate management, children can lead active lives. We will share the information and tools to keep your child on the playground and out of the emergency room (ER). If you would like to see your child living a more active life or are feeling frustrated by repeat visits to the ER, join us for this free workshop. Kapi‘olani respiratory therapists conduct small group sessions for parents and caregivers. Covers signs and symptoms, anatomy, causes, treatment goals, proper use of nebulizers and meter dose inhalers, medication, common concerns and beliefs.

Free Every Tuesday, 6–7:30 p.m.

Registration is required.

www.kapiolani.org 5

[ health bits ]

Development Checklist continued from page 1

6–9 Months ❏ Responds to own name

Active Kids Are Less Depressed

❏ Understands “no,” “bye-bye”

Middle-school students who become more physically active show fewer signs of depression, researchers say. In a study of 4,594 Minnesota students, more physical activity at the start of seventh grade was tied to less depression. And among students who increased activity over the two-year study, symptoms of depression fell, says coauthor Rod K. Dishman, Ph.D., of the University of Georgia. The research appeared in the journal Psychosomatic Medicine. Depression tends to rise in early adolescence, Dr. Dishman warns. That means parents and educators should keep children as active as they can.

❏ Imitates speech and non-speech sounds (cough, tongue clicks, lip smacking)

Sibling Rivalry Can Pay Off Children who grow up with siblings get along better with kindergarten classmates than only children, an Ohio State University study shows. Researchers asked teachers to rate more than 20,000 children. “Children without siblings were consistently rated as having poorer social skills,” says study coauthor Douglas Downey, Ph.D. “Siblings fight with each other; they have conflicts, but they also figure out how to resolve those conflicts. That probably helps them deal with other children when they go to school.” The study appeared in the Journal of Marriage and Family.

You Can Get Help With Dental Care Kids miss more than 51 million hours of school a year due to dental illness, says the Academy of General Dentistry (AGD). Yet nearly half of tooth decay isn’t treated in low-income children. “Dental diseases grow progressively worse without treatment,” says AGD spokesman Mark Ritz, D.D.S. Your child’s health could suffer — and the cost of fixing the problem will only get worse. “However, most oral health problems can be prevented,” says Dr. Ritz. Routine dental exams and oral health education can help. You can get help if you can’t afford dental care for your child, the AGD says.

Among the options: Medicaid (http://cms.hhs.gov), state children’s health insurance programs (www.insurekidsnow.gov) and dental school clinics.

❏ Plays with sound by repeating sound sequences: “la-la-la-la” ❏ Says “da-da” or “ma-ma” ❏ Sits well

9–12 Months ❏ Turns head toward loud and soft sounds (rattle, whisper, spoon in dish) ❏ Babbles in response to human voice ❏ Uses speech to get attention ❏ Gives toys on request ❏ Understands “no,” “bye-bye,” and other common words

12–18 Months ❏ Identifies body parts, people, and toys on request ❏ Locates sound in all directions ❏ Indicates wants by naming items ❏ Uses jargon (sounds like sentences, but few understandable words) ❏ Uses a few words (“mama,” “dada”) ❏ Walks by self

18–24 Months ❏ Follows simple commands ❏ Speaks in two-word phrases (25 percent understandable) ❏ Identifies common household toys and objects ❏ Recognizes environmental sounds (car, dog, vacuum, doorbell) ❏ Vocabulary of 20 words or more

24–30 Months

Kids’ Alcohol Use Holds Steady

❏ Refers to self by name

After peaking in the late 1970s, the underage drinking rate has held steady since the early 1990s, a study shows. The National Institutes of Health (NIH) found that about 20 percent of eighth-graders and about 49 percent of 12th-graders say they’ve used alcohol in the past 30 days. More than 12 percent of eighth graders and nearly 30 percent of 12th-graders reported having five or more drinks at one sitting in the past two weeks. Those numbers have changed little in a decade. “Stable is better than up,” says researcher Vivian B. Faden, Ph.D., of the NIH’s National Institute on Alcohol Abuse and Alcoholism. But she wants “to get those numbers moving down again.”

❏ Makes most speech sounds correctly; no longer uses baby talk

6 Kapi‘olani Children’s Hospital 808-983-6000

❏ Vocabulary of 50 or more words used in two-to-three-word phrases ❏ Uses negative (“not go”) ❏ Answers yes/no questions about familiar events

Keep Kids Safe in the Car

■

Car seats only work if you use them the right way ■

All 50 states have a combination of laws that require drivers to restrain children in car seats, booster seats and seat belts.

Specifics vary by state, based on the child’s age and size. But one fact stood out in a National SAFE KIDS campaign study of 9,600 children in vehicles at 174 sites: Of children 14 and under, 14 percent were unrestrained and an additional 33 percent were improperly restrained.

“At local car seat checkups, more than 80 percent of the car seats were being improperly used.”

— Kenn Saruwatari, M.D. “It takes a while to change people’s attitudes about child car restraints,” says pediatrician Kenn Saruwatari, M.D. “But one look at the numbers shows why improved attitudes would help.” The federal government says 1,621 children ages

Bites and Stings continued from page 1

a burning pain and reaction at the site of the sting. The pain typically subsides within an hour without treatment.

Anaphylactic reactions (often severe and sometimes fatal allergic reactions) are rare, and there have been no reported deaths due to man-o-war stings in Hawaii.

First aid: Carefully remove tentacles and rinse area well with water. Do not rub the area with sand. Although old remedies such as vinegar, urine, meat tenderizer, baking soda and papain have all been used in the past, there are no studies that prove any benefit from these home remedies. Although previous treatments have recommended ice for pain relief, some patients report better results with the application of warm water. Persistent itching may be treated with topical 1-percent hydrocortisone cream or oral Benadryl.

Box jellyfish stings

Box jellyfish stings are significantly more painful than man-o-war stings, and the pain may last up to eight to 10 hours.

A red hive-like welt or lines may last up to a few days. Severe and/or extensive stings

14 and under died in automobile crashes in 2002, while 256,000 more were hurt.

“At local car seat checkups, more than 80 percent of the car seats were being improperly used. Improper installation in the vehicle and incorrect adjustment of the harness are the most common errors,” adds Dr. Saruwatari.

■

■

Place a child between 20 and 40 pounds in a forward-facing seat with a harness, up to the car seat’s maximum.

Use a booster until your child can sit on the seat with his back all the way against the seat back with his knees bent comfortably over the edge of the seat.

Keep the lap belt snug on the upper thighs or hips, not against the soft abdomen.

Keep the shoulder belt snug across the chest and collarbone.

Recommended child car restraint practices: ■ Place a child in a rear-facing infant seat or rear-facing convertible seat for as long as possible — at least until the child is both 1 year old and weighs more than 20 pounds.

■ Install the car seat tightly. You shouldn’t be able to move it more than an inch when tugging from side to side.

■ Make the child’s harness snug. You should only be able to fit a finger or two between the harness and the child.

“In most cases, kids are ready for a lap belt and shoulder harness by age 8, but it’s important to observe your child in your car,” Dr. Saruwatari says.

may cause chest pain, chills, abdominal pain and vomiting.

First aid: To prevent the undischarged stingers from injecting more venom into the skin, immediately flush the area with household vinegar. Do not rub sand on the skin. Although the application of ice has been recommended for pain relief, many patients have found relief by applying warm water.

Centipede bites

Bee stings

Bee stings cause an immediate painful red bump or welt at the site of the sting.

There may also be swelling around the affected area. The pain typically subsides after two hours without any treatment.

First aid: Remove the stinger as quickly as possible. Pulling the stinger out by pinching the stinger between your fingers may inject more venom into the wound. Therefore, scraping the stinger off may help to minimize the reaction.

Application of ice may help to relieve the pain. Although the application of meat tenderizer has been a popular home remedy for pain relief, studies have shown no benefit. Topical 1-percent hydrocortisone cream may provide some relief. Oral Benadryl may ease the itching, swelling and redness.

Get your car seat checked Kapi‘olani offers free car seat checks every Wednesday by appointment.

Please call 808-983-6800.

Kenn Saruwatari, M.D.

Centipedes typically come out after a heavy rain, after which they are commonly found in the home or even people’s shoes. They also can be found under rocks, piles of wood and other hiding places in the yard. Centipede bites are recognizable by two small puncture marks, along with immediate intense pain, which can last for a few hours. There may be redness and swelling around the site for up to 48 hours.

Allergic reactions to centipede bites are rare and much less common than allergic reactions to Alson Inaba, M.D., bee stings.

FAAP, PALS–NF First aid: Application of ice may reduce the pain. Oral Benadryl may reduce the swelling and itching.

Occasionally, pain may be severe enough to require medical attention.

If your child requires immediate medical attention, Kapi‘olani’s emergency room is open 24 hours a day, with a specially trained pediatric emergency team. www.kapiolani.org 7

The Importance of Philanthropy to Children’s Hospitals Every day children’s hospitals across the country provide compassionate, personal and sophisticated care to children and their families. Because children’s hospitals provide this care to all children, regardless of ability to pay, 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,

NACHRI National Association of Children’s Hospitals and Related Institutions

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. ❖ research, advocacy and education.

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

For more information on the services children’s hospitals provide, visit www.childrenshospitals.net.

To learn more about how you can help, call Kapi‘olani Health Foundation at 808-535-7100.

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)

Would you like to continue to receive this newsletter?

Please be sure that you’re on our subscriber mailing list. There’s no charge. Look at the mail panel to the right. If it says, “Call 535-7000 to subscribe,” you are not on our permanent mailing list. Please visit www.kapiolani.org or call 808-535-7000 to sign up.

1319 Punahou Street Honolulu, HI 96826

Non-Profit U.S. Postage PAID Permit No. 733 Effingham, IL