Fall 2005
Taking ACTion........2
New Pediatric Ambulance.........4
Preventing Window Falls........6
Volume 11, Number 3
Blood Pressure Rising Among Children Problems turn up as young as age 2. Genetics and poor nutrition play a role
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he next time you hear folks talking about their blood pressure, take a look. They may be kids. Yes, children can have high blood pressure, and experts say the number of kids with the problem is on the rise. “We estimate about 10 percent of children between 2 and 18 have high blood pressure,” says pediatric heart specialist Reginald Washington, M.D., cochair of the American Academy of Pediatrics
Task Force on Obesity. “A lot of these kids have not even been diagnosed.” “We’re learning many behaviors children learn during infancy contribute to their overweight status during early childhood,” says Ian Paul, M.D., Penn State Children’s Hospital. High blood pressure has joined type 2 diabetes and high cholesterol on a list of ailments that once struck only adults but now afflict children. “We believe we’ll see heart disease and stroke at earlier ages if we can’t get this under control,” Washington warns. The increase in children with high blood pressure is directly tied to lifestyle, though genetics plays a role. Watch children for these risk factors: ■ Weighing too much ■ Poor nutrition (too much fast food and junk food) ■ Lack of physical activity ■ Cigarette smoking ■ Family history of high blood pressure “The majority of kids don’t need to be put on medication,” Washington notes. “Easily, 80 percent of the kids I see for high blood pressure can do well with lifestyle changes alone.” Paul says fortunately behaviors can be modified, but we need to begin our interventions early in life to stop the obesity epidemic. “Riding a bike is good exercise, but riding a bike across the street to your friend’s house to play video games does
not constitute exercise,” Washington adds. “Kids need a total of 60 minutes of exercise daily.” And some kids, he says, go three or four days without eating any fruit or vegetable except french fries. “Kids need a minimum of five servings of fruits and vegetables daily.” ❖
The increase in children with high blood pressure is directly tied to lifestyle choices, such as a lack of physical activity.
Start to Check at Age 3 Doctors should start to check kids’ blood pressure by age 3, according to 2004 guidelines published by the American Academy of Pediatrics. Screening should start younger for some high-risk children, such as premature or low-birth-weight babies.
Taking ACTion at Penn State Children’s Hospital
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he Advisory Council of Teens (ACT) at Penn State Children’s Hospital works on various projects throughout the year to help improve Children’s Hospital, from the patient’s perspective. The 11-member group made up of current and previous patients has made positive changes for Penn State Children’s Hospital. One of the most notable changes in the past year is the tiger-print pajamas now being seen around the seventh floor. These pajamas became available for our younger patients in March 2005 and have gotten a great response! ACT members also had a chance to share
their thoughts and opinions about hospital food with Ed Winne, director of guest services. They contributed a number of suggestions and requests to meet regular and special diet needs. ACT members had an opportunity to share their experiences and accomplishments from the past year at this year’s Children’s Miracle Network Telethon in June. Members of ACT love to hear suggestions, which may be placed in the ACT mailbox located in the north hallway on the seventh floor between the teen lounge and the ACT bulletin board. Or you can call the Child Life office at (717) 531-8366. ❖
Why I Became A Member of ACT “I chose to become a member of ACT because it is such a great thing! We are not only trying our best to improve the hospital based on our knowledge; we are also representing the patients, in the way that we listen to their complaints and try to fix them. I live to help others and meet new people. So far I am having a great time in ACT!” —Whitney “I chose to become a member of ACT because I have been a patient at the Children's Hospital many times. I believe that these experiences have given me insight into what pediatric patients are experiencing. I chose to join ACT because I wanted to make conditions for pediatric patients and their families more comfortable.” —Katie
Help Girls Stay Active as Teens Adolescent girls often skip exercise, putting their health at risk The teen years often bring a sharp drop in physical activity—especially for girls. But girls who trade tennis for television or volleyball for video games could face a future of obesity and poor health, experts say.
Research shows physical play plummets after age 9. While 72 percent of adolescent boys play hoops, hockey or some other activity for 60 minutes a week, a recent survey found just 57 percent of girls are that active. Inactive adolescents turn into inactive adults, says researcher Penny Gordon-Larsen, Ph.D., assistant professor of nutrition at the University of North Carolina. But you can steer your daughter toward a healthier course. Change her focus to skating, running, softball, skateboarding—anything that gets her away from the remote and the keyboard. Building activity into girls’ lives before adolescence could help stave off disease. Coupled with too many fries and sodas, a dearth of exercise leads to obesity, diabetes, heart disease, and other ailments. “Obese kids are more likely to become obese as adults,” says Gordon-Larsen. Exercise doesn’t just burn calories—it builds strong bones, says Thomas A. Lloyd, Ph.D., director of the Penn State Young Women’s Health Study, professor of health and evaluation sciences at Penn State College of
2 Penn State Children’s Hospital, www.pennstatechildrens.com
Medicine, Penn State Milton S. Hershey Medical Center. While calcium and vitamin D are important, his research shows exercise is the key to healthier bones from about ages 12 through 17. After that, the body no longer adds the bone strength that later fuels resistance to osteoporosis. According to Elizabeth Reid of Penn State Children’s Hospital’s Eating Disorders Program, providing the right fuel for activity may help keep girls moving. “Research has reinforced what Mom always said, ‘breakfast is the most important meal of the day.’ Starting the day with breakfast helps prevent the afternoon energy slump a teen may experience after school that can make her want to flop in front of the tube or computer with any snack food that’s handy. Eating breakfast helps promote a more even mood over the course of the day, better mental performance, and better food choices later in the day. Breakfast is also a usual source of nutrients that are especially important for teen, such as calcium and vitamin D.” If your teen feels too rushed in the morning for a bowl of cereal with milk,
[ health bits ] “I chose to become a member of ACT because I feel obligated to give back to the hospital that saved my life. Also, because I am honored to be able to help improve the lives of the patients at the hospital. Being a member of ACT has helped educate me on other departments and areas of the hospital, and has given me an even more positive outlook on the community and the wonderful people in it.” —Katie “I chose to become a member of ACT because I wanted to help make a difference. I want to give useful information to others, and make other kids feel safe and comfortable during their hospital stay.” —Emily
Moms Urged to Breastfeed Breastfeeding can do a lot of good for babies and moms, says the American Academy of Pediatrics (AAP). In a breastfeeding policy that came out in February, the AAP cited studies showing that breastfeeding can lessen or ease diarrhea, ear infections, and bacterial meningitis in infants. Some studies suggest breastfeeding may help head off sudden infant death syndrome, diabetes, obesity, and asthma, the AAP adds. Research also shows breastfeeding can cut a mother’s risk for some medical problems. Among them: ovarian and breast cancer. The AAP recommends moms nourish babies solely through breastfeeding for about six months. It also backs breastfeeding for the first year and beyond—as long as the mother and child both want it to go on.
Crimes Against Students Drop
How to Get Your Daughter Moving ■
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Start by turning off the television, GordonLarsen says. Find things she likes to do. “Your daughter may not want to play soccer, but she may enjoy dancing,” Gordon-Larsen says.
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If your streets aren’t safe, organize neighbors to watch girls and boys at play, or while they walk to school.
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Join with her to set small goals, such as walking for 30 minutes a day, three days a week.
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Give her a role model—you—who’s excited about skiing, yoga, swimming, biking, or hiking. That may be the most inspiring step of all.
try this recipe for a fruit shake that can be eaten on the run: Mix 1/2 cup low-fat or nonfat vanilla yogurt with 1/2 cup orange juice in a blender. Add a ripe banana and 1/4 cup of frozen berries, such as blueberries and raspberries. Blend until smooth and enjoy. ❖
The rate of violent crime against students ages 12 to 18 in school fell by half in the last decade, says a report from the U.S. Education and Justice departments. There were 24 crimes for each 1,000 students in 2002, compared with 48 in 1992. Other key findings: ■
The number of students in grades 9 to 12 who said they had brought a weapon to school
in the past 30 days fell from 12 percent in 1993 to 6 percent in 2003. ■
Urban students ages 12 to 18 were most likely to report gangs in schools (31 percent).
Eighteen percent of suburban students and 12 percent of rural students reported gangs. ■
In 2003, 7 percent of students ages 12 to 18 said they had been bullied at school. That compares with 5 percent in 1999 and 8 percent in 2001.
Obesity Up Among Preschoolers At least one out of 10 preschoolers weighs too much, says the American Heart Association (AHA). The number of overweight children ages 2 to 5 has risen from 7 percent in 1994 to 10 percent in 2002, the AHA says. More than 15 percent of children ages 6 to 19 are overweight or obese. “Childhood risk factors carry over into adulthood, and may eventually translate into heart disease and other medical problems such as diabetes,” says AHA President-Elect Robert H. Eckel, M.D. “Obesity is a major risk factor for heart disease that should be controlled early in life.”
Vaccine Cuts Pneumococcal Disease A vaccine introduced in 2000 has been “highly effective” in cutting pneumococcal disease in children under age 5, a study shows. In April 2000, Northern California Kaiser Permanente began routine use of the pneumococcal conjugate vaccine (PCV). By March 2003, 157,471 children in that large health system had received at least one PCV dose. In the year ending March 2003, the system saw no cases of the illnesses the vaccine aims to prevent in children under 1 year old. In the years before PCV use, the system treated up to 34 such cases each year in that age group. The system saw similar benefits in children under 5. Penn State Children’s Hospital, www.pennstatechildrens.com 3
CHECK OUT PENN STATE CHILDREN’S HOSPITAL’S
New Pediatric Ambulance
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hanks to generous support from Children’s Miracle Network, Penn State Children’s Hospital is now home to the only on-site dedicated pediatric mobile intensive care unit and crew in central Pennsylvania. Now, neonatal and pediatric patients at other hospitals can be transported efficiently and comfortably to Penn State Children’s Hospital through the use of the new pediatric ambulance.
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Refrigerator—A refrigerator is provided
to store and transport medicines. Television—While being transported, children may be more relaxed because they can now watch a video on the minitelevision in the new ambulance en route to Penn State Children’s Hospital. ■ Two isolettes—This provides the ability to transport more than one child at a time, a parent and a child, or up to four infants. ■ Five seats—The new ambulance has five seats for pediatric critical care/ advanced life support providers to ensure that the patient will receive the best possible care while in transport. ■ Quad cab—The quad cab enables family members to ride safely with the patient. This includes access to the rear of the vehicle as well. ■
Which medical staff members travel with the pediatric patients? The pediatric critical care/advanced life support team
So what makes this new pediatric ambulance so great? Safety and comfort for the smallest of patients: ■ Hydraulic lift—This feature prevents neonatal babies from being hand-lifted off the ground, and allows them to be safely transported without disruption. ■ Generator—The generator enables the pediatric ambulance to run independently of the engine in emergency situations when necessary.
4 Penn State Children’s Hospital, www.pennstatechildrens.com
The pediatric critical care/advanced life support team has an average of nine years of experience in each of their specialized fields. The team is made up of an emergency medical technician driver, registered nurse, paramedic and neonatal/ pediatric intensive care specialist. When not out on a call, the team can be found assisting in the emergency department, the neonatal intensive care unit, and the pediatric intensive care unit. Each child transported by the new pediatric ambulance will receive a stuffed plush replica ambulance from the team members to help comfort him for the ride, and then take home with him. ❖
Penn State Children’s Hospital is home to the only on-site dedicated pediatric mobile intensive care unit and crew in central Pennsylvania.
The quad cab enables family members to ride safely with the patient. This includes access to the rear of the vehicle. The new ambulance has five seats for pediatric critical care/advanced life support providers.
Thank You The pediatric mobile intensive care unit was purchased with donations from the Children’s Miracle Network (CMN) 2004 Radiothon. Thanks to everyone who contributed! For more information on CMN, visit the CMN web site at www.pennstatecmn.com.
Penn State Children’s Hospital, www.pennstatechildrens.com 5
Plastic Surgery Is Up Among Youths But doctors warn parents that these procedures aren’t right for all kids
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s shown by TV series like The Swan and Extreme Makeover, cosmetic surgery is all the rage. And that’s true even for children and teens. In 2004, says the American Society of Plastic Surgeons (ASPS), doctors performed nearly 81,000 cosmetic surgeries on those 18 and younger. Those surgeries included: ■ Nose reshaping for about 52,000 teens as young as 13 ■ Protruding ear tucks for more than 13,000 children as young as 6 ■ Breast implants for more than 3,900 teen girls ■ Breast reduction for about 3,000 teen boys “Teens tend to have plastic surgery to fit in with peers—to look similar—while adults tend to have plastic surgery to stand out from others,” says Julia Corcoran, M.D., assistant professor of clinical surgery at Northwestern University. Teens can gain self-esteem and confidence when what they view as physical problems are fixed. But plastic surgery is not for every youth. For some procedures, the child must reach milestones in age, growth, and physical maturity. Also, most reputable surgeons won’t operate unless the child shows emotional maturity and sensible expectations. “Sometimes it’s the parents who want the surgery,” says former ASPS President James H. Wells, M.D., a California plastic
Protect Your Child From Window Falls The danger is more real than you may think When the temperature outdoors goes up, so do the windows in many homes. We all enjoy the fresh air and cool breeze. But it’s important to keep in mind that open windows can be dangerous to children. “Falls of all kinds are the second leading cause of death from unintentional injury in the United States,” says Kathryn R. Crowell, M.D., Division of General Pediatrics, Penn State Children’s Hospital. Each year, about 18 U.S. children die from injuries caused by falls from
surgeon. “To hear honestly what the patient wants, I separate them from the parents. Their wishes often don’t jibe.” An 18-year-old girl with enlarged or uneven breasts can be a suitable candidate for surgery. But Wells frowns on giving your daughter breast implants as a high school graduation present. “You’re starting a lifetime of surgery, every 10 or 15 years, for the rest of her life,” he says. “It’s a serious decision.” ❖
A Plastic Surgery Primer Finding a surgeon: Talk to your doctor and hospital. Seek an American Society of Plastic Surgery–certified surgeon who does the procedure often. When surgery is done outside a hospital, ask if the surgeon has admitting privileges if something goes wrong. Counseling: You or your surgeon might first want your child to
speak with a psychologist or psychiatrist. Physical health: Insist your child first get a complete physical from your family doctor to ensure she is fit for surgery. Complications: Swelling, bleeding, and infection can take place.
The end result might not be what you and your child expect. Insurance: In most cases, cosmetic surgery is not covered. Check
to see if your policy covers subsequent treatment if complications crop up. Many insurers don’t, Corcoran says.
6 Penn State Children’s Hospital, www.pennstatechildrens.com
Despite Our Antidepressant Fear, Depressed Kids Need Help A new label on some antidepressants warns that they may make kids feel more suicidal. But that warning shouldn’t stop parents from seeking help for depressed teens, psychiatrists say. “Depression interrupts a youth’s normal emotional development, undermines self-esteem, interferes with learning in school, and undermines friendships with peers,” says Laurence Greenhill, M.D., who chairs an American Academy of Child and Adolescent Psychiatry initiative on drugs that affect children’s minds. In short, he says, teen depression is a serious illness. The benefits of taking drugs to fight it far outweigh the potential risks.
In an Emergency If your child falls from a window: ■ Call
911 or your local emergency number.
■ Don’t
move an injured child unless she is in direct danger.
■ Stay
windows. About 4,700 more children wind up in hospital emergency rooms after such falls. “Children are more likely to die or be severely injured from window-related falls than falls associated with any other product,” says Angela Mickalide, Ph.D., program director for the National SAFE KIDS Campaign. That’s why it’s important for you to take steps to protect your child. Window falls cluster in the summer months, presumably because windows are more likely to be open during warmer weather. Children under age 5, as well as those who live in cities and apartment
Model used for illustrative purposes only.
The so-called “black box” warning on some antidepressants says suicidal thoughts are more likely in the first
with the child until help arrives.
buildings, are at an increased risk. To reduce the risk for window falls and injuries, take these actions: ■ Never leave children unattended around an open window. ■ Safeguard your windows by installing operable window guards or stops that permit release in case of fire. ■ Do not rely on modern window screens as a barrier to falls. They are designed solely to keep insects out. ■ Open windows from the top, not the bottom, when possible. ■ Keep furniture (and anything children can climb on) away from windows.
Teach children not to play near windows. If possible, place shrubs and grass under windows to cushion falls. Be sure to take safety measures with all windows. “As a rule,” Crowell says, “the greater the height a child falls, the more severe the injury. However, even firstfloor windows can present a real danger. The nature of the surface onto which the child falls and the degree to which the fall is broken modify the pattern and severity of injury.” “A child who falls even 10 feet is at risk of spinal cord injury and paralysis,” Mickalide says. ❖
few weeks of use or when dosages are changed. Psychiatrists say the warning was meant, in part, to alert other doctors to the need for closer monitoring. “Suicidal thoughts are very common in adolescents,” says David Fassler, M.D., a child psychiatrist who teaches at the University of Vermont. “At least one in six thinks about it, and about half of all kids with depression will attempt suicide.” Luckily, few succeed. “Usually, they won’t tell anybody about it, and that’s what we worry about.” Studies involving about 4,400 depressed kids led to the new warning. Those who took antidepressants were twice as likely to express suicidal thoughts as those who took placebos (sugar pills). The numbers were small—4 percent for those on the drugs vs. 2 percent on placebos. There were no actual suicides, Fassler says. A clinical trial involving about 440 adolescents with major depression showed that about 70 percent responded well to a combination of Prozac and talk therapy. That was double the rate for youngsters on placebos.
“The key is, if you think your child might have depression, don’t worry about trying to define what it is, just get it checked out,” says Fassler. “Get to a mental health professional and get a comprehensive evaluation. The good news is that if it is depression, we really can help most of these kids.” ❖
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Signs of Depression ■ Thoughts
of hurting themselves or
others ■ Agitation
or extreme restlessness
■ Major
changes in behavior, such as irritability or fighting
■ Staying
in their room and avoiding friends or family
■ Loss
of interest in favorite activities
■ Trouble
organizing, concentrating, or remembering
■ Loss
of appetite, trouble sleeping, or sluggishness
Penn State Children’s Hospital, www.pennstatechildrens.com 7
Children’s Hospitals Work to Insure America’s Children
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nsuring America’s children is a top public policy priority for children’s hospitals. Children with a consistent source of health insurance receive routine checkups and stay healthier than children without coverage. That’s why the National Association of Children’s Hospitals, the public policy affiliate of NACHRI, advocates strengthening Medicaid and the State Children’s Health Insurance Program (SCHIP) for children. Two-thirds of the 8 million uninsured children in the United States are eligible but not yet enrolled in these programs. Introduced 40 years ago, Medicaid insures roughly one out of every four children—making it the country’s
NACHRI National Association of Children’s Hospitals and Related Institutions
largest children’s health coverage program. It provides 22 million low-income and disabled children with essential health care benefits. Children reliant on Medicaid come from working families who do not have access to health insurance through their employers. In 1997, Congress enacted SCHIP. The program allows states to expand Medicaid to uninsured children of low-income families, create alternative insurance programs for them, or both. All states now have implemented SCHIP. For family friendly information on Medicaid and SCHIP, visit http://coveringkidsandfamilies.org. Even for privately insured families, Medicaid is important because it plays a critical role in the ability of children’s hospitals to care for all children. Children’s hospitals benefit all children by providing clinical care, training the
nation’s pediatricians, conducting pediatric research, and advocating public health protections. On average, 40 to 50 percent of children’s hospitals’ revenues comes from Medicaid. Without Medicaid, children’s hospitals cannot fulfill their mission to serve all children. ❖
To Learn More To learn more about the importance of Medicaid and SCHIP to children’s health and children’s hospitals, visit www.childrenshospitals.net or contact your local children’s hospital.
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. (305)
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. www.pennstatechildrens.com
A. Craig Hillemeier, M.D. Medical Director and Chairman
CHI-2476-05