Under the Rainbow | Summer 2006

U N I V E R S I T Y H O S P I TA L S O F C L E V E L A N D • R A I N B O W B A B I E S & C H I L D R E N ’ S H O S P I TA L

T H E

L AT E S T

IN

C H I LDRE N ’ S

SHENANDOAH ROBINSON, MD, Neurosurgeon, Rainbow Babies & Children’s Hospital

When Is Surgery an Option for Epilepsy?

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hildhood epilepsy is a complex condition to manage. Some seizure disorders persist for unknown reasons, which can be both frightening and hard for parents to understand.

Seizures that don’t respond to treatment by multiple medications are called

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Rainbow’s experts are here to answer your health care questions!

You can contact us by phone at 216-844-RAINBOW or e-mail us at ask@rainbowbabies.org, or visit www.rainbowbabies.org

intractable, explains Rainbow Neurosurgeon Shenandoah Robinson, MD. “Parents of a child who has had seizures for more than two years that are not well controlled by medicines should ask their pediatrician to see a neurologist who specializes in epilepsy,” she says.

Unfortunately, she says, many parents are still under the impression that their child will “outgrow” the seizures.

Seizures may resolve spontaneously, but they sometimes don’t.

Children should be evaluated for epilepsy surgery if their seizures aren’t under control after trying two to three anticonvulsant medications, Dr. Robinson advises.

“Seizures aren’t just an inconvenience,” she says. “Some parents think of epilepsy

H E A LTH

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SUM M ER

as a manageable chronic condition similar to asthma or diabetes.” Uncontrolled epilepsy, however, and the need for multiple medications, can negatively impact a child’s educational and social development.

Epilepsy also may worsen with time and become life-threatening. It has been documented that some children with poorly controlled epilepsy lose several IQ (Intelligence Quotient) points every few years.

On a positive note, Dr. Robinson says, about 75 percent of kids achieve excellent seizure control with medications. But for that remaining 25 percent, finding a solution should be pursued aggressively because earlier seizure control optimizes a child’s development.

Surgery for intractable seizures offers children the opportunity to have a significant reduction in seizure frequency or even cure them. Surgery also can decrease or eliminate the need for medication. With better seizure control, children typically experience vast improvements in their ability to learn and interact with others.

At Rainbow, a dedicated pediatric epilepsy team cares for children undergoing surgery for seizures in a familycentered environment, as part of the University Hospitals Comprehensive Epilepsy Center. Each child undergoes an individualized presurgical evaluation using the latest advances in clinical management and technology.

“Our comprehensive approach strives to obtain better seizure control, improve the child’s quality of life, and optimize the child’s future,” Dr. Robinson says. ■

CELEBRATING 140 YEARS

of Caring for Cleveland.

2006

inside this issue: Is Blood Conservation the Right Choice for Your Child? page 2

Prevention Is the Best Medicine for Concussions page 3

New Treatments Straighten Out Scoliosis page 5

Ask the Doctor page 7

SEARCH HEALTH INFO ONLINE For easy access to Rainbow physicians and in-depth health information for you and your child — including a new symptom checker — visit us online:

www.rainbowbabies.org

Under the R AINBOW

How Does the Blood Conservation Program Work?

All new hospital patients are asked whether they would like to participate in the blood conservation program and

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ANTHONY VILLELLA, MD, Medical Director, Comprehensive Blood Conservation Program, Rainbow Babies & Children’s Hospital

those registered are automatically identified at any future point of entry into the system. Patients also may be registered in advance via phone.

A nurse will visit with your child to

Your Child’s Own Blood Is Always the Right Type WHAT PARENTS SHOULD KNOW ABOUT BLOOD CONSERVATION OPTIONS

make sure the resources are in place to conserve blood. Once we identify which conservation method is best, we coordinate your child’s care with the entire team, including your pediatrician.

If your child is already at the hospital, treatments for blood conservation will take place in your child’s room.

Outpatient and consultation treatments will occur by appointment on the main campus of the hospital.

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ou know that blood is vital, but it never seems more “When any of these is low, it can have serious effects on so than when your child may need blood due to an the child’s heart, lungs, kidneys and brain,” he says. “Condiupcoming surgery, ongoing condition or medication. tions such as anemia can weaken a child’s overall health At Rainbow Babies & Children’s Hospital, our Comprehen- and recovery.” sive Blood Conservation Program offers parents — through Treatment options offered by Rainbow’s Comprehensive Blood Conservation Program include medications to stimulate techniques that focus on minimizing blood loss, building up your child’s own blood supply, or both — the safest alternative blood cell production, techniques to recycle blood during surgery and preparation for potential blood loss or blood to blood transfusions. production experience.

“There are various reasons why families may desire to “No matter what the need, you can choose from among the avoid the use of donated blood products,” explains Medical alternate treatment options,” says Dr. Villella. “Your pediatriDirector Anthony Villella, MD. “This program is just one of cian can help you weigh the benefits and risks of each.”

Rainbow’s many innovative programs that blends in individRainbow’s blood conservation ual values and beliefs. We hold in high TO LEARN MORE program was the first established at a esteem the right of every family to freestanding children’s hospital back receive quality health care that respects If you would like more informain 1998. Today, it serves more than their personal choices — whether for tion or want to enroll your child in Rainbow’s blood conservation 150 outpatients and 20 inpatients each religious or health reasons.” program, please call: month, says Program Manager Amelia When a child needs a blood transfu216-844-3492. sion, Dr. Villella explains, it falls under Baffa. “This includes preparing chilone of three categories: dren for a blood loss experience, like surgery, and supporting those who are either anemic or are ■ Red blood cells, which transport oxygen undergoing therapy that affects the body’s ability to make red ■ Platelets, which stop bleeding blood cells, such as chemotherapy and radiation therapy.” ■ ■ Plasma, which supports circulating blood volume

Find a physician online: www.rainbowbabies.org/PhysicianFinder/

Head Games MANY CONCUSSIONS ARE SPORTS-RELATED

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t’s better to miss a game than a whole season. That’s the message from the U.S. Centers for Disease Control and Prevention (CDC) about concussions.

A concussion is a broad term and can apply to a range of injuries, but Alan R. Cohen, MD, Chief of Pediatric Neurosurgery and Surgeon-in-Chief at Rainbow Babies & Children’s Hospital, says it’s a brain injury associated with an immediate and temporary loss of normal brain function. He says another name for concussion is a mild traumatic brain injury. The brain injury can range from mild to severe.

According to the American Academy of Pediatrics, 20 percent of the 1.5 million head injuries that occur in the United States each year are sports-related. An even more sobering statistic is that 20 percent of high school football players and 40 percent of college football players will suffer a head injury at some point in their career. Those who have a head injury are at two to four times greater risk of having another.

The brain is jelly-like and sits inside the skull — the protective armor. It is surrounded by clear, cerebrospinal fluid allowing the brain to float inside the skull. When someone is hit in the head,

ALAN R. COHEN, MD, Chief of Pediatric Neurosurgery and Surgeon-in-Chief at Rainbow Babies & Children’s Hospital

a GREAT OFFER! Rainbow is offering free copies of the booklet Facts About Concussions and Brain Injury. Call 216-844-RAINBOW for your free copy today.

Dr. Cohen says, the brain actually may move around inside the skull, opening it up for an array of injuries, including bruising and blood clots.

A CAT scan typically looks normal, but those who suffer a concussion can feel the consequences for days, weeks or even months. Symptoms can include a loss of consciousness, headache, dizziness, nausea, vomiting, balance problems, confusion, memory loss, tinnitus or amnesia.

“The hallmark of concussion is a sudden and temporary impairment of brain function,” Dr. Cohen says. “Concussion represents a diffuse injury to the brain.

The optimal treatment is to prevent the injury in the first place.”

Most concussions, Dr. Cohen says, are caused by car accidents or are sportsrelated. Using seat belts in cars and wearing the proper equipment while playing sports, including helmets, can help avoid a concussion. But even more problematic than a concussion is the so-called second impact syndrome — an injury caused by sustaining a second concussion.

While there are a variety of scales to measure when a child can return to full activity after a concussion, the general rule of thumb is if the symptoms are mild and transient, it’s usually safe to return to a game. If symptoms are severe and persistent, the child should be removed from the game.

Concussions: Expert Advice

The good news is the brain can repair itself. A concussion shakes up the signaling pathways of the brain, so it may take a period of days or weeks for everything to return to normal. A child who suffers a significant loss of consciousness, confusion or severe headache, should be checked out by a doctor immediately.

Symptoms that should raise red flags are persistent headache, nausea, vomiting or the sudden onset of weakness, seizure or abnormal pupil size.

“Most children make a good recovery and return to normal function. Some have persistent symptoms of headaches and dizziness; these symptoms tend to resolve over time,” Dr. Cohen says. ■

blurred vision or unequal

The U.S. Centers for Disease

pupil size

Control and Prevention lists

What to watch for after a

Signs that immediate medical

The American Academy of

the following symptoms for

head injury:

attention is needed:

Pediatrics divides concussions

concussion:

Normal signs in the first two

1. Marked change in personality,

into three categories:

■

days include:

often with confusion and

1. Fatigue and desire for extra

irritability

sleep (but can be easily awakened) 2. Fairly mild headache that does not worsen 3. Occasional nausea and vomiting 4. Problems with thinking, con-

2. Worsening headache, especially if accompanied by

you might vomit)

1. Mild – confused but not knocked out. May return to

■

Balance problems or dizziness

play after 20 minutes if symptoms completely clear.

Nausea (feeling that

■

Double or fuzzy vision

■

Sensitivity to light or noise

memory loss. May play after

■

Headache

ness in the arms or legs;

one week if all symptoms

■

Feeling sluggish

changes in breathing pat-

clear completely.

■

Feeling foggy or groggy

■

Concentration or memory

nausea or vomiting 3. Numbness, tingling or weak-

tern; or seizure

centration and attention span

4. Eye and vision changes,

(may persist for a year or more)

including double vision,

2. Moderate – confused, with

3. Severe – knocked out. May

problems

play after one month if all symptoms completely clear.

■

Confusion 3

Under the R AINBOW

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Hold the Latte?

Is there any harm in kids jumping on the Starbucks® wagon?

A cup of coffee is a morning jump-start for many adults. But with the rise in specialty drinks like iced caramel macchiatos, more kids are heading to their local Starbucks® for their daily jolt.

As a parent, should you be concerned?

Rainbow dietician Adria Myeroff, RD, LD, says there is no compelling evidence that coffee stunts kids’ growth. Still, there are reasons to moderate how many cups of joe your child is consuming.

a GREAT OFFER! Rainbow is offer-

“Caffeine is a stimulant that affects the

ing free copies of the booklet Living With

central nervous system,” Myeroff explains.

Irritable Bowel Syndrome. Call 216-844-

“At lower levels, about two to three cups

RAINBOW for your free copy today.

per day, caffeine can increase alertness and boost feelings of energy. But too much caffeine can cause the jitters, upset stomach, headaches, difficulty concentrating, interrupt sleep, and increase both

Is It Irritable Bowel Syndrome?

CHANGING HABITS CAN RELIEVE SYMPTOMS OF THIS DISORDER

heart rate and blood pressure.”

Another concern about kids jumping on the coffee bandwagon, Myeroff says, isn’t related to the caffeine some of these gourmet drinks contain — but the calories.

It’s also important to note, says Rainbow endocrinologist Sumana Sundararajan, MD, that coffee drinks are not the only source of caffeine or empty calories in many kids’ diets. “Soda, energy drinks and iced tea also need to be factored into the equation,” she says.

Clearly, the best choices for your child are water, milk and 100 percent fruit juice. But, she notes, if your child insists on drinking coffee drinks, requesting a decaf, skim milk and forgoing the whip cream are smart options.

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rritable bowel syndrome (IBS) is a confusing, yet comWhile there isn’t a cure for IBS, mon, gastrointestinal disorder that often is misdiagnosed. Dr. Splawski says that changes in diet can help greatly.

It can cause abdominal pain, bloating, gas, diarrhea and “IBS symptoms often occur right constipation — and affects both girls and boys equally. after or even during meals,” she says.

“IBS is not a disease — it is a syndrome, or rather a group of symptoms that occurs together,” explains Judy B. Splawski, “Avoiding some of the common culprits, such as fatty or spicy foods and MD, Interim Chief of the Division of Pediatric GastroJUDY B. caffeine, may help. Triggers vary from enterology at Rainbow Babies & Children’s Hospital. “So while SPLAWSKI, MD, patient to patient, so others will find IBS can be uncomfortable, painful or embarrassing, it doesn’t Interim Chief of the Division of Pediatric relief avoiding other items like dairy damage the intestines like some other digestive conditions.”

Gastroenterology at or foods that contain gluten.” Eating In people with IBS, the muscles in the colon that contract Rainbow Babies & smaller meals, adding more fiber to the regularly to move waste through the body don’t work Children’s Hospital diet and drinking more water also are smoothly. They are sensitive to triggers, such as particular recommended. foods or stress, which cause a flare-up of symptoms.

Stress also can play a role in IBS. “While stress doesn’t There isn’t a specific test to diagnose IBS, so a physician cause IBS, it can exacerbate flare-ups,” Dr. Splawski says. will usually make a diagnosis of IBS based upon a medical “You may want to help your child or teen re-examine their history and physical exam, Dr. Splawski says. Generally, the lifestyle and see if learning some stress mandiagnosis is based upon having abdominal agement techniques would be useful.” pain or discomfort plus any two of the SYMPTOMS In more severe cases, laxatives and antifollowing: Common symptoms diarrhea medications are sometimes used. But ■ The pain is relieved by having a bowel of IBS include: it’s best to work together with a physician to movement.

■ Gas discuss what treatment is right for your child.

■ The onset of pain is associated with a ■ Pain “Helping your child focus on keeping their change in the frequency of stools.

■ Bloating symptoms under control is key,” Dr. Splawski ■ The onset of pain is associated with a ■ Constipation ■ Diarrhea says. “By learning as much as possible change in stool consistency.

■ Nausea about their individual triggers, they can These symptoms also must be present for ■ Vomiting reduce flare-ups and maintain an active, at least 12 weeks out of the previous year for ■ Mucus in the stool healthy life.” ■ IBS to be likely.

Find a physician online: www.rainbowbabies.org/PhysicianFinder/

“Stand Up Straight!”

SURGICAL AND NONSURGICAL TREATMENTS HELP STRAIGHTEN SCOLIOSIS

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or most of us, hearing the charge from our mothers made us throw our shoulders back and stick our chests out. But for 4 percent of us, an unnatural curve in our spines can make it difficult to stand up straight.

Scoliosis is a sideways curvature of the spine that makes it look more like an “S” or “C.” It can cause the bones of the spine to turn so that one shoulder or hip looks higher than the other. The spinal deformity can run in families, but in most cases the cause is unknown. The curve can appear at any age, but is most commonly seen after age 10 or in early adolescence.

The incidence of scoliosis is about the same for boys and girls, but girls are five times more likely to require treatment. That being said, only about 7 percent of children with scoliosis require treatment, according to George H. Thompson, MD, Director of the Division of Pediatric Orthopaedics at Rainbow Babies & Children’s Hospital.

The vast majority of children with scoliosis, he says, are monitored by X-rays and regular trips to the doctor.

Bracing can be moderately effective for

SIGNS OF SCOLIOSIS Scoliosis can go unnoticed in children because it rarely is painful. Parents should watch for the following “tip-offs” to scoliosis beginning around 8 years of age: ■ Uneven shoulders ■ Prominent shoulder blade or shoulder blades ■ Uneven waist ■ Elevated hips ■ Leaning to one side Any one of these signs warrants an examination by the family physician, pediatrician or orthopaedist.

School screenings for scoliosis also can alert parents to the warning signs in their child. (American Academy of Orthopaedic Surgeons)

a growing child with a spinal curvature between 25 and 40 degrees. Plastic braces are worn at night for two to three years to prevent curves from worsening. If a curve is more than 45 degrees, surgery may be recommended.

A major problem is a severe deformity in a very young child. Braces are not very helpful, but a body cast can frequently control the curve for several years. When the child is older, growing rods can be very useful. Dr. Thompson has inserted two stainless steel rods in children younger than 2, but the average age is 5 or 6.

GEORGE H. THOMPSON, MD, Director of the Division of Pediatric Orthopaedics, Rainbow Babies & Children’s Hospital

Scoliosis can cause the bones of the spine to turn so that one shoulder or hip looks higher than the other.

“What it really means is you have a long rod that attaches to the top and bottom of the spine,” Dr. Thompson explains. “Every six months you go in and loosen the hooks or screws and lengthen the rods again.”

Last fall, Rainbow researchers found the most effective surgical treatment for young children with severe scoliosis is the insertion of two growing rods. Traditionally, orthopaedic surgeons inserted only one rod, but the dual growing rods allowed better correction and improved growth of the spine with fewer complications.

Dr. Thompson launched the growing rods program at Rainbow about 10 years ago. The procedure enables young patients with severe spinal deformities to develop more normally and reduces the adverse affects of their spinal deformities on lung development and breathing.

Once a child reaches a suitable age or size — usually after age 10 for girls and 12 for boys — the pediatric growing rods are removed and adult-sized rods are inserted, offering another big boost

in correction, Dr. Thompson says. The spine, in the area of the rods, is fused and the correction is permanent.

While the dual growing rods are a superior treatment to the single rods for children with severe spinal deformities, Dr. Thompson says a great deal of work remains to be done in the field. Two areas his department continues to examine are autofusion — when the spine spontaneously fuses — and crankshaft — where the front of the spine continues to rotate and twist as it grows, even with the implantation of growing rods.

“Although we can control the deformity to a certain degree, patients still end up with a moderate deformity,” he says, adding that Rainbow doctors are constantly looking at ways to improve treatment outcomes for its youngest spinal patients. ■

READ ABOUT ONE GIRL’S TREATMENT AND RECOVERY FROM SCOLIOSIS. Log on to www.rainbowbabies.org/scoliosis.aspx to read “Scoliosis: Samantha’s Story.”

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Under the R AINBOW

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Why Now?

Trying Times

You and your partner’s lives have no

WHY AM I HAVING TROUBLE GETTING PREGNANT THE SECOND (OR THIRD, OR FOURTH) TIME AROUND?

doubt drastically changed since your first pregnancy, and may include some health factors that cause secondary infertility: Age. As women reach their late 30s and early 40s, fertility declines due to egg quantity and quality.

Ovulation problems. Some women don’t develop and release an egg monthly.

Reasons include stress, recent illness and polycystic ovarian syndrome — a condition in which women develop small cysts on their ovaries.

Endometriosis. This condition, in which the tissue that lines the uterus is found elsewhere in the abdomen, can cause infertility.

Fibroids. These usually noncancerous tumors in the wall of the uterus can cause infertility, depending on their size and location.

Fallopian tube damage. Complications during a first pregnancy or a recent pelvic infection can cause damage or block the fallopian tubes.

Uterine adhesions. Bands of scar tissue from a C-section can interfere with conception.

Sperm count. Low sperm count, poor motility or defects can all cause infertility.

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hen your beautiful daughter turned 3 years old, you decided it was time for another addition to the family.

But this time, things aren’t going as planned.

Why can’t you get pregnant again?

“Secondary infertility is the term FRANCISCO used when a couple who already have ARREDONDO, MD, Reproductive a child can’t get pregnant or carry a Endocrinologist, pregnancy to term again,” explains University Hospitals University Hospitals MacDonald MacDonald Women’s Hospital OB/GYN Susan Women’s Hospital Lasch, M.D. “It’s actually quite common — affecting about 20 percent of all couples.”

“Secondary infertility is the term used when a couple who already have a child can’t get pregnant or carry a pregnancy to term again.

It’s actually quite common — affecting about 20 percent of all couples.”

longer than a year, or six months if the woman is over 35 years old, they should be referred to an infertility specialist.

Dr. Weil says initial evaluations typically include a semen analysis, a blood test to evaluate ovarian function and an examination of the fallopian tubes — all of which are typically covered by insurance.

Its prevalence, however, doesn’t mean that it’s any less pain“Another important aspect is a thorough patient history to ful or easier to accept. Couples facing secondary infertility face determine if anything has changed since the first pregnancy,” the same feelings of confusion, frustration, grief and depresshe adds. sion as couples that have primary infertility.

After the couple has completed fertility testing, physicians “It can be a shock to couples if they can’t get pregnant can typically determine what is preventing couples from conagain, especially if they did so the first time without much ceiving in about 90 percent of cases. trying — or perhaps any at all,” Dr. Lasch says.

Treatments depend on the determined cause of infertility, People shouldn’t dismiss the grieving that accompanies Dr. Weil says. When the fertility problem is due to a female infertility, even if they already have a child, says Francisco problem (in about 50 percent of cases), treatments can include Arredondo, MD, a reproductive endocrinologist at MacDonald medications to induce ovulation, surgery to repair damaged Women’s Hospital. fallopian tubes or in-vitro fertilization. For male infertility, “A lot of people, including physicians, believe that people who have secondary infertility should not go through the same options can include intrauterine insemination to ensure only emotions because they already have a kid,” he says. “But emo- good quality sperm are used, as well as intracytoplasmic sperm injection for men with very low sperm counts. tionally, it’s the same. It’s not a matter of not being grateful Knowing that coping with infertility can be one of the for your first child, rather the fact that the dream you have for toughest challenges couples face, Dr. Arredondo recommends a larger family hasn’t become a reality.” that they develop a plan that addresses how much time, emoThis emotional distress is compounded by the fact that there are no easy answers. “The causes of secondary infertility tional and financial investment they’re willing to make in having another baby. are just as varied as with primary “While most couples with secondinfertility,” explains Stacie Weil, MD, TO LEARN MORE ary infertility are successful in growing a reproductive endocrinologist with For an appointment with a their family, determining how far you MacDonald Women’s Hospital.

MacDonald Woman’s Hospital are willing to pursue treatments can Your first plan of action should be a fertility specialist, please call help give couples a sense of control,” trip to your OB/GYN. If a couple has 216-844-1514. he says. ■ been struggling to get pregnant for

Find a physician online: www.rainbowbabies.org/PhysicianFinder/

Q

ASK THE DOCTOR: HOW CAN I TRAVEL SAFELY WITH MY KIDS THIS SUMMER?

Q

My daughter is fair-skinned and has freckles and moles. She loves to play outside all day during the summer. What is the best way to protect her while she’s in the sun?

A

JOAN E. TAMBURRO,

“The majority of DO, Pediatric Dermatologist, sun exposure occurs Rainbow Babies & within the first two Children’s Hospital decades of life, so it’s especially important for parents to teach children sun safety,” says Rainbow pediatric dermatologist Joan E. Tamburro, DO. Children with fair to light complexions, moles, freckles or a family history of skin cancer are even more vulnerable. But, Dr. Tamburro says, with the right precautions, all kids can safely play in the sun.

“Try to avoid her being in the sun between 10 a.m. and 4 p.m., when the sun is the strongest,” she advises.

“Make sure to generously apply a sunscreen with an SPF of 30, even on cloudy days, a half hour before she heads outdoors. Be sure to reapply every two to three hours, or after swimming. It’s also a good idea to have her wear a hat and sunglasses, or even a loose long-sleeve T-shirt and longer shorts or pants. There’s even sun protective clothing now available. Or, you can add a sun protective laundry treatment to your regular wash, such as Rit Sun GuardTM, to boost her protection against harmful UV rays.” ■

Q A

We’re preparing to take our first real vacation as a family with two young kids. Do you have any travel tips?

Traveling with kids is GRACE MCCOMSEY, both fun and challengMD, Chief of Infectious Diseases, ing. But planning Rainbow Babies & ahead for safe travel can help you Children Hospital avoid any potential health problems, says Grace McComsey, MD, Chief of Infectious Diseases at Rainbow.

“For a healthier vacation domestically or abroad, parents should always bring along their child’s immunization record and medical history, including any medication or food allergies,” says Dr. McComsey.

For car trips, be sure to be equipped with a good supply of water and snacks, alcohol-based hand sanitizer, hand wipes, sunscreen and insect repellent.

Community Calendar

International trips require much more planning, such as checking if your child needs vaccinations or medications to prevent diseases such as malaria. “If you’re unsure of what’s needed, the medical team at Rainbow’s Child Travelers’ Clinic (216-844-RAINBOW) is able to help families make certain their children have the proper pretravel care,” Dr. McComsey says. “We also give families destination-specific advice on common diseases, as well as tips on safe eating and drinking habits. After your child has returned home, we can evaluate and treat your child for any post-travel concerns, if needed.” ■

Q

I’m confused about what I hear on the news about West Nile virus. Can my kids catch it from a mosquito bite?

A

Rainbow Babies & Children’s Hospital is proud to sponsor a variety of programs throughout the year that foster learning and encourage family fun. Be sure to mark your calendars for the following events:

The Children’s Museum of Cleveland — Bridges to Our Community Exhibit When: Ongoing through Dec. 31, 2006 Where: Children’s Museum of Cleveland 10730 Euclid Avenue Cleveland, OH 44106 Event Information: www.clevelandchildrensmuseum.org 216-791-7114

3rd Annual Teddy Bear Day Presented by Rainbow Babies & Children’s Hospital When: Saturday, Sept. 30, 2006 11:00 a.m.–3:00 p.m.

Where: Cleveland Metroparks Zoo Event Information:

ETHAN LEONARD, MD, Infectious Disease Expert, Rainbow Babies & Children’s Hospital

West Nile virus has spread rapidly across the United States in the past four years, including northeast Ohio. It is one of several germs that can cause encephalitis, an infection and swelling of the brain.

However, says Rainbow Infectious Disease expert Ethan Leonard, MD, children are less likely to become ill with West Nile virus than adults. “The frequency of serious symptoms increases with age, peaking in those over 50 years old,” he says.

People who do get symptoms experience the following: a flu-like illness (fever, aches and pains), rash, eye redness, confusion, sleepiness, and neck and back pain.

Dr. Leonard notes that most people infected with the virus have no symptoms – and only one in about 150 to 300 infected people become ill.

However, there are several precautions you can take to protect your family, he says. He suggests you limit outdoor activity during dusk — when mosquito activity is the highest — and wear long sleeves and long pants.

You also should make sure your window screens are “bug tight” and drain or change standing water on your property. Lastly, he says, use DEET-containing insect repellents according to manufacturer’s instructions. ■

www.clemetzoo.com 216-661-6500

Boo at the Zoo When: Thursday, Oct. 19– Sunday, Oct. 22, 2006 Thursday, Oct. 26– Sunday, Oct. 29, 2006 5:30 p.m.–8:30 p.m.

Where: Cleveland Metroparks Zoo Event Information: www.clemetzoo.com 216-661-6500

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University Hospitals of Cleveland Rainbow Babies & Children’s Hospital 11100 Euclid Avenue Cleveland, Ohio 44106

NONPROFIT ORG U.S. Postage PAID Permit N. 694 Effingham, IL

ASK RAINBOW! Rainbow’s experts are here to answer your health care questions! You can contact us by phone at 216-844-RAINBOW or email us at ask@rainbowbabies.org.

When Is It No Longer Baby Fat? START TEACHING YOUR CHILD HEALTHY EATING HABITS DURING PRESCHOOL

E MARK PALMERT, MD, Endocrinologist at Rainbow Babies & Children’s Hospital

CAROLYN LANDIS, PhD, Clinical Psychologist at Rainbow Babies & Children’s Hospital

veryone’s always teasingly pinched Junior’s extremely pudgy cheeks and declared them absolutely darling. But now that he’s a toddler, you’re starting to worry about his still-chubby frame. How can you tell the difference between healthy growth and an overweight child?

“Usually parents shouldn’t be too concerned about their child’s weight or restrict fat intake until they turn 2 years old,” says Rainbow Babies & Children’s Hospital Endocrinologist Mark Palmert, MD. “During that time, your child is still growing very quickly and needs fat for proper brain development.”

However, in rare cases where early weight gain is very high, diet changes may be needed even before age 2.

After your child’s second birthday, you can more easily reduce the fat in his diet — for example, switching from whole to 2 percent milk. But, Dr. Palmert says, fat still remains important and should

make up 30 percent of the diet for most children, according to American Academy of Pediatrics guidelines.

Carolyn Landis, PhD, a clinical psychologist who heads Rainbow’s Fit Futures program for young children who are overweight, emphasizes that the preschool years are an optimal time to teach healthy eating habits.

“Evidence shows that overweight children have a greater likelihood of becoming overweight adults,” Dr. Landis says. “So, it’s extremely important to lay the groundwork in these formative years, when you still have a considerable say about what your child eats.” ■

a GREAT OFFER! Rainbow is offering free copies of the booklet Healthy Snacking. Call 216-844-RAINBOW for your free copy today.

TIPS TO PROMOTE HEALTHY GROWTH ■ Limit sugary snacks, excessive amounts of fruit

juice, junk food and fast food.

■ Offer healthy foods. “Don’t be discouraged if they don’t immediately like carrot sticks or banana slices,” Dr. Landis says. “You will likely need to offer foods many times before they’ll accept them in their diet.”

■ Encourage plenty of physical activity.

■ Set a good example. “If they see Mom or Dad snacking on grapes or whole-grain crackers, they’re more likely to ask for some for themselves,” she adds.

Time to Choose?

If you are choosing your family’s health plan, remember there is no better place for children than Rainbow Babies & Children’s Hospital.

Your health plan should provide a wide range of coverage; allow options for care close to home; easy access to the care that you need; promote wellness; provide a comprehensive benefit for preventive care at a low or no cost; and have reasonable out-of-pocket costs.

Most important, ask if your plan includes Rainbow.

For clarification, call 216-844-7246 or log on to our website at www.rainbowbabies.org and click on the Ask Rainbow tab and link to insurance plans that include Rainbow.

Under the Rainbow is published by Rainbow Babies & 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. ©2006 StayWell Custom Communications, 780 Township Line Road, Yardley, PA 19067, 267-685-2800. Some images in this publication may be provided by ©2006 PhotoDisc, Inc. All models used for illustrative purposes only.

Some illustrations in this publication may be provided by ©2006 The StayWell Company; all rights reserved.

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