Cub Chat | Summer 2004

Cub

Chat Fall 2004

Metabolic Syndrome........2

Mini-thons.........4

Neonatal Screening Tests........6

Volume 10, Number 3

Oh, My Aching Back!

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arents, have you ever heard that exclamation as your children troop home from school? You are likely to if your child is carrying one of those backpacks that seems to weigh half of what the child does!

More and more health professionals are becoming concerned about the loads our children are carrying in their backpacks, and how that affects their health.

According to Barbara Ostrov, M.D., a Penn State Children’s Hospital pediatric rheumatologist, “This issue is even more important in children with arthritis and spine problems.”

According to an article in the PatriotNews (March 2000), kids are packing everything from Pokemon card collections and video games to gym clothes and shoes, and of course, books. Teens who consistently overpack are at risk of developing injuries such as tendonitis, and chronic neck and back problems later in life. In the children who carry heavy loads, the rate of lower back pain is approaching that seen in adults. Those at highest risk to overpack are between the ages of 11 and 13, particularly girls. In one study from Italy, most children were carrying more than 30 percent of their body weight at least once during the school week!

Common symptoms of overly heavy backpacks are tingling sensations or numbness in the hands, soreness in the neck and shoulders, muscle and lower back pain. The article and Dr. Ostrov recommend that no more than 5 to 10 percent of body weight be carried on

the back; any additional weight should be distributed across the front.

What to do There are some common-sense approaches to dealing with this problem. Obviously, decrease the load!

Children should carry only necessary items. The following table gives you some guidelines for weights: Child’s Weight

Maximum Backpack Weight

90 lbs.

80 lbs.

70 lbs.

50 lbs.

13.5 lbs.

12.0 lbs.

10.5 lbs.

7.3 lbs.

As cited in the Patriot-News article, these are some practical guidelines Dr. Ostrov suggests to follow: ■ Padded straps are most comfortable and don’t dig into shoulders.

■ Adjustable shoulder straps enable you to fit the backpack properly. Straps that are too loose may allow the pack to hang uncomfortably and result in more pain.

■ A pack with multiple compartments allows for better distribution of packed items.

■ Consider a backpack with wheels — they are more readily available these days and are becoming more affordable.

■ Limit the amount of weight. This may require some negotiation with teachers.

■ Use both straps rather than just slinging the pack over one shoulder. The heaviest items should be closest to

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the body to keep the center of gravity closest to the center of the pelvis.

Check your children’s posture once the backpack is on. They should be easily able to stand straight, not leaning forward or to one side or the other. ❖

Adapted from the American Juvenile Arthritis newsletter of the Central Pennsylvania Arthritis Foundation, Summer 2000.

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, increase your activity level and watch your cholesterol. Now, your teens’ doctor may be warning them to do the same.

The reason? “Syndrome X,” or metabolic syndrome — a set of cardiovascular risk factors that can lead to grave health problems down the road.

Nearly one million adolescents in the United States and far more adults have metabolic syndrome. Doctors think teens who have it face an especially high risk for the early onset of type 2 diabetes and heart disease. Metabolic syndrome exists if you have three or more of the following: ■ Abdominal obesity ■ High fasting blood levels of triglycerides (fats) ■ Low fasting blood levels of high-density lipoproteins (good cholesterol) ■ High blood pressure (higher than 130/85) ■ Insulin resistance “Additionally, the metabolic syndrome also may cause reproductive dysfunction in women, manifesting as irregular and

infrequent menstrual cycles in teenage girls,” says Christopher Houk, M.D., assistant professor of pediatrics at Penn State Children’s Hospital.

“The first thing that alerts us to metabolic syndrome in teenagers is obesity because it’s the easiest to spot,” says David Rosen, M.D., clinical associate professor of pediatrics at the University of Michigan Medical School. “Once that is established, we pay closer attention to lipids [cholesterol] and blood pressure.”

You can slow and even prevent the development of the metabolic syndrome if you catch it and intervene early.

“Metabolic syndrome seems to be related to weight and diet, and can be impacted in a positive way by physical activity and healthy eating,” Dr. Rosen says. Just losing 5 to 10 percent of your body weight can help.

“Because genetics are felt to play a strong role in the susceptibility to this syndrome, having another family member affected by type 2 diabetes or

the metabolic syndrome increases the risk for a teen to develop the metabolic syndrome at any weight,” says Dr. Houk.

As a team, you and your teens can find solutions. “My overall recommendation for parents would be to make it easier for kids to learn healthy eating habits and be physically active,”

Bone Up on Vitamin D A lot of kids need more; milk and sunlight can help Does 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. Too little “can potentially stunt children’s growth and not enable them to reach their peak bone density,” says Boston University medical professor Michael Holick, M.D., Ph.D. “A lack of vitamin D can cause rickets, muscle weakness, muscle pain and bone discomfort.”

The American Academy of Pediatrics says children should have 200 international units (IU) of vitamin D each day.

Putting skim or low-fat milk on fortified cereal is your best bet, says children’s dietitian Marilyn Tanner, R.D. Multivitamins or orange juice fortified with vitamin D also is a good option.

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“Read food labels to see if the vitamin D is in there,” says Ms. Tanner, an American Dietetic Association spokesperson. Serve lactose-intolerant kids lactose-free milk.

The sun helps activate vitamin D in skin. Dr. Holick suggests children spend five to 10 minutes in the sun with no sunscreen two to three times a week.

“For light-skinned individuals, it doesn’t take much sunlight to provide all the vitamin D your child needs,” says Steven J. Wassner, M.D., professor, pediatrics and chief, Division of Nephrology and Hypertension, Penn State Children’s Hospital.

But don’t let children burn in the sun — they’ll get some vitamin D even when they do wear sunscreen. Youths can gain vitamin D and build bones with outdoor weight-bearing activities like running, soccer and basketball.

Children in northern climates (who

[ health bits ] Make Way for Water Safety It only takes a few minutes for a child to drown in as little as a few inches of water. “It’s essential to ensure that at least one adult is taking responsibility for supervision at all times,” says Susan Rzucidlo, M.S.N., R.N., pediatric trauma clinical specialist and coordinator, Dauphin County SAFE KIDS Coalition at Penn State Children’s Hospital.

Swimming lessons are good to get your child comfortable around water, but don't let your guard down. Teach these water safety tips to your kids:

Dr. Rosen says. According to Dr. Houk, “Minimal changes in lifestyle, such as setting limits on the time spent watching television, and eliminating foods like sweetened soft drinks and frequent fast-food meals, can be a significant first step in helping your teen deal with obesity.” ❖

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Never swim with anything in your mouth.

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Never dive in shallow water.

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Never push or hold someone’s head under water.

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Always swim with a buddy.

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If you can’t swim, don’t rely on inflatable devices without a life jacket.

Teens’ Drug Use Dips Drug use fell 11 percent among eighth-, 10th- and 12th-grade students from 2001 to 2003, a survey shows. That translates to 400,000 fewer teen drug users. “The overall reduction in drug use by America’s young people is heartening,” says Nora Volkow, M.D., director of the National Institute on Drug Abuse. Her institute funds the Monitoring the Future survey, which is conducted by the University of Michigan. The 2003 survey found illicit drug use during the 30 prior days had fallen from 19 percent to 17 percent. Officials credit the messages teens have gotten from their parents about the dangers of drugs, as well as prevention efforts like the National Youth Anti-Drug Media Campaign.

Tuning Out Fruits and Veggies 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. According to Dr. Wassner, “while breastfeeding is best, dark skinned children who are entirely breastfed and swaddled are at higher risk for vitamin D deficiency.” Talk to your child’s doctor if you have questions. ❖

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

■ 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.

The more television teens watch, the fewer fruits and vegetables they eat, Harvard researchers say. They tracked the eating and viewing habits of 548 Massachusetts youths for 19 months. French fries excluded, the study found that for every hour of television teens watched, they ate 0.16 fewer servings of fruits or vegetables a day — one less serving every six days. The study, published in Pediatrics, concludes that commercials during children’s TV shows support unhealthy diet habits.

Asthma Drugs Limit Emergency Visits Children who use asthma medications make fewer visits to the emergency room for asthma than those who don’t have such medicines, according to a study by the University of Michigan Health System. The study of 19,000 children with asthma looked at the frequency of asthma-related emergency room visits, and how rates of those visits vary by age, gender, race, and prescriptions for fast-acting “rescue” medications or long-term preventive drugs.

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❖ ❖ a❖ ❖ ❖ with ❖ pediatric ❖ ❖ cancer ❖ ❖is a ❖ ❖School ❖ Key❖Club and ❖ asked ❖ if they ❖ would ❖ con❖ ❖ Having child❖diagnosed ❖ challenge ❖ ❖ that ❖ parents ❖ ❖never ❖ think ❖ about ❖ ❖having ❖ to❖face. ❖ sider ❖ initiating ❖ ❖the first ❖ high❖school ❖ mini-thon. ❖ ❖ Central Dauphin High School soon followed ❖ ❖ overwhelming ❖ ❖ ❖ time ❖ for❖the ❖ ❖ when ❖ they ❖ ❖Hershey’s ❖ lead, ❖ creating ❖ ❖ ❖effect, ❖ and❖the ❖ It is an entire❖family a ripple Four Diamonds mini-thon phenomenon ❖ suddenly ❖ ❖ realize ❖ that ❖ they ❖ have ❖ ❖ ❖ journey ❖ ❖ ahead ❖ of❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖began❖ a major to grow. ❖ ❖ how ❖ to ❖ prepare ❖ ❖for it, ❖ no❖definite ❖ road ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ them❖with❖no idea in middle schools and high schools, ❖ map, ❖ and ❖ no❖idea❖as to❖ how ❖ long ❖ the❖journey ❖ ❖ ❖ ❖ possessing ❖Students ❖ an ❖ ❖ philanthropic ❖ ❖ spirit ❖ and❖ will take. amazing ❖ ❖ ❖ ❖ ❖Fortunately, ❖ ❖children ❖ who ❖ are❖treated❖for ❖ ❖a desire ❖ to help ❖ children ❖ ❖with cancer, ❖ ❖accepted ❖ ❖ cancer at Penn State Children’s Hospital have the challenge of organizing mini-thons, which ❖ ❖ ❖ ❖ ❖ a unique ❖ ❖support ❖ system ❖ to❖help them ❖ through ❖ ❖ are❖generally ❖ held ❖ as ❖ ❖ dance ❖ marathons. ❖ ❖ 12-hour this difficult time—The Four Diamonds Fund, Planning and implementing an event of ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ this ❖ ❖ which is subsidized primarily by youth magnitude requires good organizational skills, ❖ ❖ ❖ ❖ ❖ throughout ❖ ❖ central ❖ Pennsylvania. ❖ ❖ ❖The Four ❖ ❖ creativity ❖ ❖and ❖ ❖ and ❖ the❖students ❖ do ❖ teamwork, Diamonds Fund was founded in 1972 by a an outstanding job of replicating the infamous ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ Lancaster County couple, Charles and Irma Penn State THON™. Total student participation ❖ ❖ ❖ ❖ ❖ Millard, ❖ ❖ ❖ to❖their❖son Christopher, ❖ ❖ ❖ and ❖ total❖money ❖ raised ❖ by the ❖ schools ❖ have ❖ ❖ as a tribute lost his❖battle❖with ❖ cancer❖at the❖age of❖14. ❖increased ❖ ❖ ❖ ❖ ❖who ❖ ❖ or❖even❖doubled ❖ over❖the past ❖ two❖ ❖ It provides comprehensive medical care, as well years. During 2003–2004, 13 schools through❖ ❖ ❖ ❖ ❖ as❖financial ❖ and❖emotional ❖ ❖ ❖ to children ❖ ❖ out ❖ central ❖ Pennsylvania ❖ ❖ participated ❖ ❖ in❖Four ❖ support, Diamonds mini-thons and and their families as they face the challenges of ❖ ❖ ❖ ❖ ❖childhood ❖ cancer. ❖ ❖ ❖ ❖ ❖ ❖ ❖more❖than ❖ ❖ ❖ collectively ❖ ❖ raised ❖ ❖ $224,000! ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ 2003–2004 ❖ ❖ Four ❖ Diamonds ❖ ❖ Mini-thons ❖ ❖ ❖ Annville-Cleona ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ High❖School❖ . . . .❖. . . .$20,090 ❖ ❖ Annville-Cleona Middle School . . . . . . .$2,346 ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ Central Dauphin High School . . . . . . . .$62,878 ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ Dover Area High School . . . . . . . . . . . .$26,458 ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ Garden Spot/Ephrata High Schools . . .$15,397 ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ Hershey High School Key Club . . . . . .$21,000 ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ Lancaster ❖ ❖ ❖ High ❖ School ❖ . . .❖. .$8,350 ❖ ❖ Mennonite ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ High❖School❖ . . . ❖ ❖ ❖ Northern . . . . . .❖ . . . .$10,000 . . . . . .❖.$16,000 ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ Springfield ❖ ❖High School ❖ ❖. . . . . ❖ ❖ ❖ Spring Grove Middle School . . . . . . . .$24,040 ❖Spring ❖ Grove ❖ Middle ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ Kids Helping Kids School Mini-thon ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ Susquenita ❖ ❖Middle❖School ❖ . . .❖. . . . . .❖. .$5,576 ❖ ❖ THON™ West Perry Middle School . . . . . . . . . .$12,000 _________________________________________ ❖ ❖ ❖ ❖ ❖ Just ❖ as The ❖ Four❖Diamonds ❖ ❖ ❖unique ❖ to ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ Fund is Total . . . . . . .❖. . . . .❖ .....❖ . . . . .$224,135 Penn State Children’s Hospital, so too is the ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ . .❖ ❖ ❖ ❖ profile of the majority of Four Diamonds ❖ ❖ ❖ ❖ ❖ donors. ❖ ❖ ❖ ❖to be❖kids of❖all ages. ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ They happen Several of the mini-thons have been introIn 1977, The Four Diamonds Fund partnered ❖ ❖ ❖ ❖ ❖with ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖to schools ❖ by ❖ Four❖Diamonds ❖ ❖ ❖ ❖ duced patients the Penn State IFC/Panhellenic Dance school❖ ❖ ❖ ❖ ❖ ❖ Marathon, ❖ ❖ affectionately ❖ ❖ known ❖ as❖THON❖™, ❖ or❖siblings ❖ of patients ❖ ❖in that ❖ particular ❖ ❖ district, or by peers who wanted to show their and since that time the Penn State students ❖ ❖ ❖ ❖ ❖have ❖raised❖nearly❖$30 million ❖ ❖with ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ their support of friends during this difficult time. ❖ ❖ ❖ ❖ ❖ annual ❖ 48-hour ❖ ❖event. ❖ ❖ ❖ ❖ ❖ Examples ❖ ❖of mini-thons ❖ ❖ initiated ❖ ❖ ❖ ❖ by siblings ❖ ❖ ❖ ❖ ❖Four❖Diamonds ❖ ❖Mini-thon ❖ ❖Phenomena ❖ ❖ ❖of Four ❖ Diamonds ❖ ❖patients ❖ are:❖Alison❖Good, ❖ ❖ Garden Spot High School/Ephrata High School In 1994, members of the Four Diamonds ❖ ❖ ❖ ❖ ❖ Advisory ❖ ❖Board❖approached ❖ ❖the Hershey ❖ ❖High ❖ Mini-thon, ❖ ❖ and❖Annie❖Johnson, ❖ Lancaster ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖4 ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖

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Mennonite High School Mini-thon. ❖ ❖ ❖ parents ❖ who ❖ have ❖ actively ❖ sup❖ Four Diamonds ported or initiated mini-thons are Anne Adams, ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ Central Dauphin High School Mini-thon and Sally Abma, ❖ ❖ Gettysburg ❖ ❖ High ❖ School ❖ Mini-thon, ❖ ❖ and Northern High School Mini-thon. Many of ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ our Four Diamonds families show their appreciation for ❖ ❖ the❖efforts❖of the❖students ❖ and ❖ come❖ out to support the various events.

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Benefits of Four Diamonds Mini-thons

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❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ The financial support and community awareness ❖provided ❖ by ❖ mini-thons ❖ ❖for the ❖ Fund ❖ and❖ Penn State Children’s Hospital are truly out❖ ❖ and ❖ for this ❖ we❖are extremely ❖ ❖ ❖ standing, grateful. ❖ But ❖ mini-thons ❖ ❖ provide ❖ additional ❖ ❖ ❖ benefits to those who participate in them. ❖ Since❖they❖are student-run ❖ ❖ events, ❖ ❖ mini- ❖ thons give every student in the school ❖ ❖ ❖ ❖ ❖ ❖ an ❖ ❖ opportunity to participate and showcase ❖ ❖ skill ❖ or❖talent❖to make ❖ the❖event❖ a particular a success. ❖ ❖Mini-thons ❖ ❖provide ❖ opportunities ❖ ❖ ❖ for students to assume leadership positions in ❖ ❖ a❖major❖fund-raiser, ❖ ❖sharpen ❖ their ❖ organizing organizational skills, develop new skills, use ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ their creativity to plan and implement a fun ❖ ❖ to❖work❖as a member ❖ ❖of a ❖ event,❖ and learn team for an important common ❖ ❖ ❖ ❖ ❖ cause ❖ —❖ ❖ conquering childhood cancer. ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ Faculty Members Share their Pride ❖ Clements, ❖ ❖faculty❖ member ❖ and ❖ mini❖ ❖ Ryan thon advisor for Annville-Cleona High School, ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ explains the impact these events have had on ❖ ❖“What❖I have❖discovered ❖ over ❖ the❖last ❖ students: couple of years is that the students have ❖ ❖ ❖ ❖ ❖ ❖ ❖adopted ❖ pride in themselves and their school in helping ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖

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The Four Diamonds Fund. One student and his ❖ ❖ ❖their home ❖ into ❖ a haunted ❖ ❖ family❖transformed house at Halloween for the community and ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ raised more than $1,300 toward our mini-thon total. Another ❖ ❖ ❖student ❖ organized ❖ ❖a local❖band❖ show and raised nearly $400. They have quickly ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ discovered that helping those in need and reaching out❖to their good, and ❖ ❖ community ❖ ❖feels ❖ ❖ these ❖ are feelings that they will carry with them ❖ life. ❖ Having ❖ so❖many❖of our❖students ❖ ❖ through help others ❖ ❖ has ❖ been❖rewarding ❖ and ❖ worthwhile.” ❖ ❖

Developing ❖ ❖ a❖partnership ❖ ❖between ❖ the❖stu- ❖ dents and members of the local community ❖ ❖ a positive ❖ ❖ ❖ of ❖ has had effect ❖ on the❖ students Dover ❖ Area ❖ High❖School. ❖ Jennifer ❖ Miller, ❖ ❖ ❖ faculty/mini-thon adviser says: “One of our ❖ ❖ organizing ❖ ❖a mini-thon ❖ ❖ ❖ ❖ goals in is to increase school and community spirit by facilitating ❖ ❖ ❖ ❖ ❖ ❖ ❖inter-❖ action between our students and the community. ❖ ❖money ❖ and❖soliciting ❖ donations ❖ ❖for the❖ Raising mini-thon ❖ ❖definitely ❖ encourages ❖ ❖ this❖interaction, ❖ ❖ and this year we were able to raise more than ❖ ❖ This ❖ event❖is one❖time ❖ ❖ $26,000. during❖ the year that students from every background can come ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ together and enjoy themselves in making a differ❖ ❖ of sick ❖ children.” ❖ ❖ ❖ ❖ ence in❖the lives

❖ Diamonds ❖ ❖ mini-thons ❖ ❖ teach ❖ students ❖ ❖ Four the importance of giving and community ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ involvement. Each school should be proud of ❖ that ❖ every ❖ penny ❖ raised ❖ on❖ its ❖ efforts,❖knowing behalf of The Four Diamonds Fund makes a ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ difference in the lives of children with cancer ❖ State ❖ Children’s ❖ ❖ Hospital. ❖ ❖ ❖ ❖ at Penn We truly appreciate all the students who continue to ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ dance for diamonds. ❖ ❖ ❖

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❖Dover❖Area ❖ ❖ ❖ High School Mini-thon Line Dance ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ Penny❖Challenge ❖ ❖ ❖ ❖ Brecknock Elementary ❖ ❖ ❖ ❖ ❖ School, located in Denver, ❖ ❖ ❖ ❖wel- ❖ Pa., enthusiastically to ❖ comed ❖ the❖opportunity ❖ ❖ participate in a Penny ❖ ❖ ❖ ❖ ❖ Challenge in support of The ❖ Four❖Diamonds ❖ Fund. ❖ The ❖ project was organized by ❖ ❖ ❖ ❖ ❖ Denise Longaberger, whose ❖ daughter ❖ Victoria-Lyn ❖ ❖ had ❖ recently ❖ ❖completed ❖ a❖year of❖ chemotherapy at Penn State ❖ Children’s ❖ ❖ ❖ ❖ Hospital. The 540 elementary ❖ ❖ students ❖ ❖were ❖ given four weeks to bring in ❖ ❖ ❖ ❖ ❖ 100 pennies each, which ❖ ❖ ❖ ❖ would ❖ be presented to ❖ Garden ❖ Spot ❖ and❖Ephrata❖ High Schools for their mini❖ ❖ ❖ ❖ ❖ thon. The students rose to ❖ the❖challenge ❖ and❖Mrs. ❖ Longaberger could hardly ❖ ❖ ❖ ❖ ❖ keep up with the number of ❖ pennies ❖ that ❖ filled❖the class❖ room containers! ❖ ❖ ❖ The❖ ❖ Brecknock students raised ❖ an amazing ❖ ❖$5,946.26! ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖

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What Screening Tests Does Your Newborn Baby Need?

Screenings can catch some little-known but serious threats

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ou may think your child’s first test will come in school, but it will actually happen before leaving your hospital’s newborn unit. Neonatal screening tests can find problems in healthy-looking babies before symptoms arise, prompting early treatment. “These screenings can sometimes mean the difference between a healthy start in life and disability, or even death, for a baby,” says Jennifer L. Howse, M.D., president of the March of Dimes.

Most screenings involve a blood test.

A few drops of blood, obtained from your baby’s heel, are sent to a laboratory that performs the tests required by state law. According to Dennis Mujsce, M.D., professor of pediatrics and medical director of the Neonatal Intensive Care Unit at Penn State Children’s Hospital, “Pennsylvania currently mandates screening for phenylketonuria, maple syrup urine disease, galactosemia, hypothyroidism, congenital adrenal hyperplasia and sickle cell anemia.” The results of these tests are communicated to your doctor, who will follow up with you as necessary. Numerous other metabolic tests also can be performed on this same blood sample. Newborn screening requirements vary by state. The March of Dimes, which wants to expand screenings in many states, recommends checking for:

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Biotinidase deficiency — an enzyme

deficiency that can result in physical and mental problems ■ Congenital adrenal hyperplasia — a lack of hormones that can cause shock, as well as problems with genital development and salt balance ■ Congenital hypothyroidism — a hormone deficiency that can slow growth and brain development ■ Galactosemia — an inability to metabolize galactose (a sugar in milk) which can cause physical and mental problems ■ Homocystinuria — an amino acid disorder that can result in mental or physical problems ■ Maple syrup urine disease — an amino acid disorder that can result in health or mental disorders ■ Medium chain acyl-CoA dehydrogenase deficiency — a disorder in which babies can’t burn fat when they run out of glucose (blood sugar) ■ Phenylketonuria — a disorder in which the amino acid phenylalanine (found in many foods and drinks) builds up in the blood, causing mental problems ■ Glutaric aciduria — an enzyme deficiency that can cause sudden deterioration of mental status in previously healthy infants ■ Sickle cell anemia — a hereditary blood disease, more common among African Americans, that prevents normal circulation of blood, leading to pain and poor health “In addition to blood tests, your baby’s hearing should be tested before discharge from the hospital," says Dr. Mujsce. Hearing loss can be detected by equipment that uses a microphone or earphone placed next to the baby’s ear. If hearing loss is diagnosed and treated with a hearing aid before six months of age, language problems can be avoided.

Dr. Howse says that the March of Dimes supports these tests because the disorders, although not common, can be treated to improve outcomes.

Talk with your doctor about the advisability of screenings that Pennsylvania does not require. Your doctor also may suggest other tests based upon your own family history. ❖ 6

Model used for illustrative purposes only.

Keep Kids Safe in the Car Car seats only work if you use them the right way In 2003, more than 150 children who had been victims of car crashes were treated at Penn State Children’s Hospital. Motor vehicle trauma is the leading cause of injury in Pennsylvania.

The pediatric trauma center staff has the expertise to treat injured children, but it is equally committed to preventing the injuries. The best prevention is for children under age 13 to travel in the back seat and be restrained in an age-appropriate manner. Older teens and parents are role models to younger children and should wear a seat belt on every ride.

In February 2002, Pennsylvania’s child passenger safety law was upgraded. The law requires that children under age 4 be restrained in a child seat and children between

Seek Help for Teen Depression Up to one in 10 teens will experience this condition

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octors once thought depression only struck adults. In fact, the risk for the condition starts in the early teens and rises through the mid-20s. One in 10 young people will have a bout of depression by the end of their teen years.

Richard L. Levine, M.D, professor of pediatrics and director of Adolescent Medicine & Eating Disorders Program at Penn State Children’s Hospital says, “Depression can be distinguished from simple teenage moodiness by the length of time of the symptoms, the severity of the symptoms and the effect of the symptoms on [teens’] usual functioning (for example, in school, with family and friends, activities, etc.). One of the most prominent symptoms of depression in teenagers is irritability — which is somewhat different than for adults.”

Children can face a lot of hurdles they’re not ready to handle emotionally: divorce, chronic illness, learning disabilities and abuse, for instance.

They feel powerless, and the effects may stay with them. Even a child who doesn’t face these trials can be depressed.

An inherited brain chemistry imbalance can also cause the problem.

Standard treatment is effective and safe. But young people with depression, their families and their friends may not know how to spot the problem or what to do about it. Failing to get help can have tragic results: Suicide is the third leading cause of death among people ages 15 to 19.

Any threat of suicide or suicide attempt should be taken very seriously. The adolescent needs professional assistance as soon as possible. Another significant problem is self-harm symptoms, such as cutting. “These teens also need to be evaluated and treated by professionals experienced with adolescents,” says Dr. Levine.

Choose a therapist who specializes in treating children. Find a new counselor if the one you visit makes your youngster feel ill at ease or doesn’t seem to grasp the child’s needs.

“A therapist who’s too formal or can’t establish good rapport with children will make your child more apprehensive,” says Sue Maisch, M.S.W., Child & Family Counseling Center, Glenwood Springs, Colo. “If possible, obtain a

recommendation from your family doctor, a school counselor or friend.”

The therapist may suggest talk therapy, medication prescribed by a physician or both. “Usually a combination of both will get the best results,” Ms. Maisch says. ❖

4 and 7 years old be restrained in a booster seat. Older children between 8 and 18 years old are to be restrained in a seat belt anywhere in the vehicle.

In the past year, many children have been safer traveling in cars. “There have been fewer serious injuries, especially to the booster seat-age children,” says Susan Rzucidlo, M.S.N., R.N., pediatric trauma program manager, Penn State Children’s Hospital, and coordinator, Dauphin County SAFE KIDS Coalition.

The American Academy of Pediatrics recommends these as best child passenger safety practices: ■ Place a child in a rear-facing infant seat or rear-facing convertible seat at least until the child is both 1 year old and weighs more than 20 pounds.

■ Install the car seat tightly per the manufacturer’s instructions. You shouldn’t be able to move the car seat more than an inch 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.

■ Place a child between 20 and 40 pounds in a forward-facing seat

with a harness using a combination booster seat or convertible seat.

Use a booster seat until your child can sit on the seat with her back all the way against the seat and knees bent comfortably over the edge. “In most cases, kids are ready for a vehicle lap belt and shoulder harness by age 8,

but it’s important not to move your child to the adult-sized seat belt prematurely,” Rzucidlo says.

For older children and adults, keep the lap belt snug on the upper thighs or hips, not against the soft abdomen, and the shoulder belt snug across the chest and collarbone. ❖

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Signs of Depression If five or more of these symptoms last more than a couple of weeks or cause a noticeable change in routine, seek help: ■ Feeling deep sadness or hopelessness; ■ Loss of pleasure or interest in activities that were once exciting; ■ Anxiety and panic; ■ Turmoil, worry and irritability; ■ Trouble organizing, concentrating or remembering; ■ Negative views of life and the world; ■ Feeling worthless, guilty or bad; ■ Sharp changes in appetite or weight; ■ Difficulty falling and staying asleep; ■ Sluggishness in talking, reacting and walking; ■ Avoiding friends and family; ■ Restlessness, such as acting up in class; and/or ■ Self-mutilation and suicidal thoughts.

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To learn more, visit the National SAFE KIDS Campaign at www.safekids.org, or call the Injury Prevention Program at 717-531-SAFE (7233) at Penn State Children’s Hospital with questions or to make an appointment with a certified child passenger safety technician for assistance with your car seat.

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New Web Site 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 web site, 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, by research on which they’re working, or by what clinical services in which they specialize. 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 web site 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.

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 or e-mail Vanessa Viozzi at vviozzi@psu.edu. pennstatechildrens.com

A. Craig Hillemeier, M.D. Chairman

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