Summer 2005
Detecting Dyslexia........2
How to Say
THON 2005.........4
Beating an Eating
Disorder........6
Volume 11, Number 2
No
Set limits, but be ready to talk about them as your child grows
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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 [often] if you make it a safe environment,” says Nancy Krebs, M.D., a professor of pediatrics at the University of Colorado. Ronald Williams, M.D., director of Penn State Children’s Hospital’s Multidisciplinary Weight Loss Clinic, says that it is important to continually teach children proper attitudes about food and portion size. “We as parents need to role model these good behaviors,” says Williams. “We must also remember that kids need to be kids, and find a healthy balance for some occasional ‘junk.’” 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
Lay Down the Law—Gently worse,” says Seattle pediatrician Donald Shifrin, M.D., 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,” 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, Shifrin says. “Just when kids seem to deserve love the least is when they need it most.” ❖
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Be relaxed, friendly and nonjudgmental when you talk about troublesome behavior.
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Offer choices, which help set limits but give kids a chance to exercise independence.
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Reward good behavior with praise, which promotes self-esteem.
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Be a good role model. Kids are great imitators.
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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.
Detecting Dyslexia Children can succeed with this condition. Early diagnosis can help your child’s self-esteem Writing letters or numbers backward is not necessarily a sign that your child has dyslexia. In fact, many experts say writing backward is a common phase children go through as they learn to read. But there are sure signs of dyslexia, and parents should watch out for them.
Warning signs Around age 5 or 6, children are able to match letters with the sounds they make. Many kids also will be able to rhyme and tell how many different sounds are in words such as ‘c-a-t.’” Children with dyslexia can’t make this distinction. They also have trouble mastering spelling rules and may have a hard time remembering numbers and facts. If you suspect a problem, ask your child’s school to do a formal evaluation. Early diagnosis and treatment is important and can help your child’s development and self-esteem.
What is dyslexia?
How to handle dyslexia
Dyslexia is a condition that affects the brain’s ability to process language. That causes reading, writing, and spelling difficulties. Dyslexia is not due to low intelligence, lack of motivation, or visual problems. Dyslexia occurs when the brain processes and interprets information differently than the brains of those without the condition. A study published in 2004 by the Journal of the American Medical Association “found gender differences in reading, with boys commonly having more reading difficulties than girls,” says coresearcher Julia Carroll, a British psychologist. The study looked at 9,799 children ages 7 to 15. About 20 percent of the boys had dyslexia, compared with about 11 percent of the girls. Still, she adds, “I wouldn’t want parents to dismiss reading difficulties in girls.”
Kids who have dyslexia need oneon-one help from a specially trained teacher, tutor, or therapist to help them develop a different way of learning. It helps if your child’s specialist can work together with the classroom teacher. You can also help children by encouraging them to pursue interests they enjoy. Many dyslexic people have special talents and have succeeded, such as designer Tommy Hilfiger and writer John Irving. ❖
To Learn More National Center for Learning Disabilities http://ncld.org International Dyslexia Society www.interdys.org.
Pain in the Abdomen May Mean Appendicitis There’s just one cure—surgery A normal appendix
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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 at school. It could be something your child ate. Or it could be appendicitis. Doctors call this ailment the great mimicker, says Laura Fitzmaurice, M.D., a member of the American Academy of Pediatrics executive committee for the section on emergency medicine. The appendix is a pinky-finger-size sac attached to the end of the colon on your 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 238 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. According to Jennifer Hubbell, M.D., Penn State Children’s Hospital, the symptoms parents should identify are
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.
severe right-sided abdominal pain, fever, vomiting (usually with diarrhea), and lack of appetite. “If these are present, it’s best to have the child examined by a physician,” Hubbell says. “Parents can anticipate the possibility of a blood 2
Once the appendix is reached, blood vessels and the colon’s link to the appendix are sealed off. Then the appendix is removed.
draw, urine tests, and perhaps a CT scan or surgical evaluation, if the doctor feels the child’s symptoms are suspicious for appendicitis.” “At first, abdominal pain may be diffuse, or at the navel, but as things
[ health bits ] Obesity: A Challenge for Us All 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, M.D., 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. Koplan led an IOM panel that studied the issue for Congress. Among the steps it urged:
progress, the pain usually becomes more site-specific, moving to the right side,” Fitzmaurice says. Blood and urine tests, and an ultrasound or CT scan can aid in diagnosis, she says. “Still, it’s the physical exam that counts most.” If you suspect your child has appendicitis, call your doctor at once or go to a hospital emergency department. “And whatever you do,” says Fitzmaurice, “don’t feed the child first.” 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 with a burst appendix or other complications, surgeons will use a larger, open incision, Fitzmaurice says. That can cause a child to miss school for seven to 10 days, or more. ❖
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Schools should set standards for the food and drink they offer and find more ways to keep students physically active.
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Industry should set rules for advertising and marketing aimed at kids.
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Restaurants should add more nutritious fare to menus.
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Parents should offer healthy foods at home and help keep kids active.
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Government should find ways to promote exercise and good nutrition.
Model used for illustrative purposes only.
Ronald Williams, M.D., director of Penn State Children’s Hospital’s Multidisciplinary Weight Loss Clinic, adds, “In addition, parental support is needed for our children to remain at a healthy weight.”
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. 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 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. Coaches, athletes, and parents must work to replace fluids before, during, and after activity.
Kids’ Alcohol Use Holds Steady 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 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. Teens who are treated at the Penn State Children’s Hospital after being injured are tested for alcohol and drug use. In 2004, out of 35 teens who were drivers, eight tested positive for alcohol and/or drugs. All teens are given information on avoiding drinking and driving, as well as counseling information. Parents are encouraged to talk to their teens about not drinking and driving, and not traveling in cars with teens who are drinking. 3
THON 2005: NO SITTING, NO SLEEPING, NO KIDDING
Dance for the Kids
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t Penn State University, when someone says the word “THON,” people will know—more likely than not—exactly what that person is talking about. The Penn State IFC/ Panhellenic Dance Marathon, or THONTM as it’s affectionately known, is the largest student-run philanthropy in the world. It is a 48-hour no-sitting, no-sleeping event that benefits The Four Diamonds Fund at Penn State Children’s Hospital in Hershey, Pa. Thousands of Penn State students devote countless hours to THON each year. Many of the students say they have been “bitten by the bug.”
Bitten by the THON bug The reason these students get bitten, so to speak, is because they know they are helping children who are battling pediatric cancer. Since 1977, THON has been the primary benefactor of The Four Diamonds Fund. The mission of The Four Diamonds Fund is to conquer childhood cancer by assisting children treated at
Funds Raised By THON Support: ■
Medical costs for patients who are not covered by insurance or other means
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Ancillary costs that a family may face while a child is going through treatment
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A comprehensive medical team specifically for Four Diamonds patients
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Research initiatives conducted at Penn State College of Medicine and the Four Diamonds Center for Pediatric Cancer Research
Penn State Children’s Hospital and their families through superior care, comprehensive support, and innovative research. The students at Penn State participate in yearlong fund-raising efforts to contribute to the THON total. The actual Dance Marathon is held every February, but several other events, which are sponsored by THON, are held throughout the year for Four Diamonds families. These events include a fall harvest day, a family reunion carnival, and a 5k walk/run. THON 2005 set a new record by raising $4,122,484 for The Four Diamonds Fund! This is the fifth consecutive year that the students have raised more than $3.5 million. Since 1977, THON has contributed more than $30 million to The Four Diamonds Fund. This year more than 700 students participated in THON as dancers, remaining awake and on their feet for the full 48 hours. The students were on their feet from 7 p.m. Friday, Feb. 18 until 7 p.m. Sunday, Feb. 20. Several of the dancers were pediatric cancer survivors, and some were even former Four Diamonds patients. In addition to the dancers, nearly 3,000 Penn State students were involved with THON as volunteers.
Dancing away the hours The students dance as a way to show their support in the fight against pediatric cancer. Many dancers have said the pain and exhaustion they felt during the weekend cannot compare to what a child must go through in battling cancer. More than 130 Four Diamonds families attended THON
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2005 to support the dancers and thank everyone involved with THON for all of their efforts. One dancer who participated in THON says, “After family hour, I was an emotional ball ... it was all different forms of happy. I was happy to be almost done; I was happy for Robbie, a Four Diamonds patient; I was happy for all of my friends making it so far; mostly, I was happy that I was given the opportunity to take part in one of, in my mind, the best events in the world.”
Families show appreciation One Four Diamonds family member says, “It’s hard to put into words how overwhelming it [THON] is ... to have all of those students giving their time, effort, and raising money to help my child. They
“Knowing the students are willing to sacrifice so much for people they do not even know is really moving.” —Four Diamonds family member
Four Diamonds Mini-thons Taking their cue from the annual Penn State IFC/Panhellenic Dance Marathon, middle schools and high schools throughout central Pennsylvania continue to provide significant financial support to The Four Diamonds Fund by organizing six- to 12-hour minithons. Many of the schools incorporate their own events, but also include events used at THON, such as color wars and a line dance. During the past four years, the number of Four Diamonds mini-thons has more than doubled, as well as the number of students involved with the annual events. During the 2004–2005 school year, 18 student-run mini-thons raised nearly $250,000 for the Four Diamonds Fund.
are so dedicated and loving, so willing to help in any way possible. I get very emotional even trying to talk about it. The students involved with THON are truly angels. Their families must be so proud.” “Knowing the students are willing to sacrifice so much for people they do not even know is really moving,” says another Four Diamonds family member. “I don’t think the dancers will ever realize how much what they do means to us.” Year after year the students involved with the dance marathon show compassion and care for Four Diamonds patients and their families. Through the tremendous effort of the students at Penn State University, Four Diamonds patients are able to receive world-class medical care at Penn State Children’s Hospital. ❖
To Learn More For more information about THON, please visit the web site at http://www.thon.org. Four Diamonds information can be found at http://www.fourdiamonds.org, or by calling (717) 531-6086.
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Participating schools that have embraced Four Diamonds mini-thons wholeheartedly have found that their partnership with the Fund has meant much more to their students than just raising money. The impact that mini-thons have on students can be summarized in the following statement by Ryan Clements, faculty member and mini-thon adviser for Annville–Cleona High School: “What I have discovered over the past couple of years is that the students have adopted pride in themselves and in their school in helping The Four Diamonds Fund. They have quickly discovered that helping those in need and reaching out to their community feels good, and these are feelings that they will carry with them through life. Having so many of our students help others has been rewarding and worthwhile.”
Beating an Eating Disorder Just dining as a family may help head off anorexia or bulimia
W Get Into the Swim of Things Safely Keep a constant watch on children at the pool to prevent drowning Quickly and quietly, hundreds of children will drown this year—often with adults just yards away. In fact, drowning is the number two cause of unintentional injury-related death among children ages 1 to 14, says the Centers for Disease Control and Prevention. It’s second only to traffic crashes. A lot of parents think a child is safe in the water when an adult is nearby. “Parents think just being nearby is sufficient to save their child,” says Susan Rzucidlo, M.S.N., R.N., Dauphin County SAFE KIDS coordinator and Penn State Children’s Hospital pediatric
trauma clinical specialist. “Generally, parents misperceive that drowning is a noisy event that takes a while. Actually, it happens suddenly and silently. When children are trying to gasp for air, they can’t scream because they don’t have enough air in their lungs. “We promote active supervision,” says Ms. Rzucidlo. “Designate someone as a water-watcher whose sole responsibility is to watch the children in the water for a distinct period of time, not talk to friends or supervise other kids.” Don’t be lulled into a sense of false security because your children can swim, she adds. “Your eyes should be constantly focused on your kids in the water.” ❖
ith eating disorders affecting girls at everyounger ages, a University of Minnesota study found that a surprisingly simple tactic might help: Dine as a family. Among 4,746 adolescents in the study, girls who ate five family meals per week had about one-fourth the risk for extreme weight-control practices. The meal lets parents model healthy eating habits to children, says epidemiology professor Dianne Neumark-Sztainer, Ph.D., R.D., the study’s main author. It also gives parents a chance to talk with their children. “Since society has so much influence on adolescents because of the high prevalence of obesity and the pressure to be skinny, many girls are turning to unhealthy ways of controlling their weight,” Neumark-Sztainer says. “Prioritizing structured family meals
Cross-Gender Play No Cause for Concern It’s OK for your 5-year-old son to play with dolls
More Pool Safety Tips From SAFE KIDS Led by the Penn State Children’s Hospital ■
Install a four-sided fence around the pool. The gate should be self-closing and have a lock.
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Keep a cell phone near the pool.
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Hold babies when they’re in the water. Inflatable armbands are swimming aids, not flotation devices.
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Clear the pool area of toys when you leave. Many young children who drown fall into a pool while reaching for a toy or ball.
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Enroll children between ages 4 and 8 in a swimming class with a certified instructor. SAFE KIDS says 74 percent of children who drown don’t know how to swim.
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Never leave a child alone near water, even in the bathtub. Children can drown in as little as 1 inch of water.
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Post CPR instructions and emergency phone numbers near a pool. Any adult supervising children near water should know how to swim and, ideally, be certified in CPR.
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Three-year-old Tommy likes to dress up as Cinderella. Four-year-old Sally barely glances at the dolls in her room. She favors toy trucks. Five-year-old Joey doesn’t want to play sports. He’d rather play house. Should their parents be concerned? No, say the experts. That’s what play is all about. “Gender identity develops early in life,” says Kathryn Crowell, M.D., assistant professor of pediatrics, general pediatrics, Penn State Children’s Hospital. “By age 21/2 years most children can correctly identify both themselves and others as to gender. Between the ages of 3 to
that take place in a positive environment can protect girls from destructive eating habits. “Eating disorders are increasingly common among young men and women in our society,” says Richard L. Levine, M.D., professor of pediatrics and director of the Adolescent Eating Disorders Program at Penn State Children’s Hospital. “I have seen some remarkable recoveries. I have seen young women conquer their fear of gaining weight, conquer their fear of eating, and with the help of their parents, recover. I have seen families pull together and grow more in their love than they ever thought possible. The common thread in recovery is compassion.” Anorexia and bulimia can cause nutritional deficiencies, organ damage, and, in rare cases, death. It’s vital to recognize and treat eating disorders quickly. Treatment involves mental health counseling, and nutritional and medical therapy. ❖
To Learn More National Eating Disorders Association www.nationaleatingdisorders.org or www.pennstateeatingdisorders.com
6 years, children develop through play an understanding of gender roles, that is, the behaviors and characteristics that are attributed to one gender or another. This is in large part culturally determined.” “Pretending to be the opposite sex is not a sign of gender confusion,” says Gayle Peterson, Ph.D., a California family therapist and author of Making Healthy Families. “It’s more likely to be
What to Look For Girls with anorexia: ■
Intensely fear being fat
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Feel fat despite extreme thinness due to a distorted body image
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Are typically perfectionists with low self-esteem
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Eat very little, count calories, and may weigh portions
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Often lose weight rapidly
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Deny feeling hungry and avoid eating in front of others
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May exercise compulsively
Girls with bulimia: ■
Eat huge amounts within hours, then “purge” their bodies by taking laxatives or vomiting
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Often make excuses to go to the bathroom right after meals
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May eat abnormally large amounts of food without gaining weight
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May have average or aboveaverage weights
a part of the process of finding their identity by trying on different qualities represented by the roles they play.” And “trying on” includes not only costumes, but also attitudes and behaviors. It’s common for preschoolers to switch back and forth between roughhousing “boy stuff” and sugar-and-spice “girl stuff.” As gender identity develops through early childhood, this is an 7
expected phase of healthy, even necessary, exploration, no matter how puzzling it might be for parents. And it doesn’t have to indicate anything other than a natural desire to experiment. So you should support a child’s desire or willingness to challenge gender stereotypes. “While disapproval is likely to undermine self-confidence,” warns Peterson, “accepting and supporting it will contribute to a sense of pride.” In recent years, we’ve blurred the lines between male and female roles to some degree. But those lines still exist. Kids learn what it means to be a boy or a girl from their environment, their playmates, and especially their role-model parents. So parents are usually advised to let children pursue their interests without being confined by gender straitjackets. A child shouldn’t have to choose between gender and natural inclination. The goal should be to raise sons and daughters who are secure in their gender without feeling restricted by it. “Remember,” says Peterson, “this is only play.” ❖
The Importance of Philanthropy to Children’s Hospitals
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very 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
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 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)
Cub Chat is a complimentary quarterly newsletter produced by the Office of Strategic Services at Penn State Children’s Hospital. For questions or additional copies, please call (717) 531-8606.
pennstatechildrens.com A. Craig Hillemeier, M.D. Medical Director and Chairman
CHI-1986-05