Rocky Mountain Kids
Specia l
T een & t w een Issu e
Winter 2011
page 8 ACL Injuries: An Uneven Playing Field
When It’s More Than a bump on the head page 4
s ’ n e e T r u o Y Protect 6
g n i e B l l e W
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Presbyterian/St. Luke’s Medical Center North Suburban Medical Center Rose Medical Center Sky Ridge Medical Center The Medical Center of Aurora Swedish Medical Center
Reginald Washington, MD, FAAP, FACC, FAHA Chief Medical Officer Rocky Mountain Hospital for Children
A Note from Dr. Washington
Has Your Child Outgrown the Pediatrician? As kids get older, they may not feel comfortable visiting their childhood doctor. Though some pediatricians have special areas or office hours for teens, not all do. Waiting rooms decorated with cartoon characters and filled with
Dear Parents,
crying kids may be uncomfortable for older children.
I’m pleased to introduce this special issue of Rocky Mountain Kids, specifically focused on the health of your preteen and teen children. Sometimes we need a reminder that as children
A family doctor may be a better fit for some kids and teens. These doctors treat patients of all ages. Like pediatricians, family doctors must complete three years of training after medical school. They learn about
grow into adolescence, they are not simply “small
all areas of medicine and focus on preventing diseases.
adults,” but have health and wellness concerns
Regular preventative care can be especially important for
unique to their age and stage of development. Even
teens, since many adult diseases begin in the teen years.
as they grow into their teen years, our children are
The right care can help detect and prevent these problems.
still developing mentally, physically and emotionally. Pediatricians, family medicine physicians and
Family doctors are well-qualified to provide care for children and teens. They can:
pediatrics are all skilled in caring for kids in this age
• Provide routine care, including screenings and shots • Offer advice to reduce risky behaviors, such as alcohol,
range. Many of the doctors affiliated with Rocky
tobacco and drug use
Mountain Hospital for Children have a special
• Recommend eating and exercise habits • Check for mood problems such as depression
doctors in the newer specialty of internal medicine/
commitment to care for children as they grow into adolescence because they have followed their
Family doctors are also trained in well-woman care.
patients’ growth and development since they
They can help address girls’ issues, such as heavy or
were born.
irregular periods. With help from a family doctor, young
Let's always remember that our young people need our love, guidance and support to develop into their full potential, whatever it might be.
women can learn to take responsibility for their health. Selecting a doctor who is a good fit for your family is important. You — and your teen — should feel comfortable with a doctor. Regular health checkups can build a lifelong partnership between your child and a family doctor.
Our Physician list at your fingertips
You can download a list of Physician Resources at Rocky Mountain Hospital for Children at www.RockyMountainHospitalForChildren.com. Click on “Download a Pediatric Specialty Referral List” at the right.
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Winter 2011
Rocky Mountain Kids
Snowboar di ng and Sk iing Sa fe ly Colorado is home to some of the nation’s most popular ski resorts, and our community has a growing number of young athletes who have a passion for skiing and snowboarding. Children often begin these sports at very young ages. Before your kids hit the slopes, make sure they have the right gear, technique and knowledge of safety rules. Prepare Your Kids Children should be outfitted with proper cold-weather gear and prepared for rapid changes in conditions. All equipment should be age-appropriate and fitted and adjusted properly. Practicing off the slopes can help kids transition to lessons. Helmets are a must, and parents can lead by example by wearing helmets themselves. Eight Safety Rules 1. Learn the sport. Qualified instructors can teach children the proper skills to participate safely and avoid injury. 2. Practice falling. Teach children to land on their bottom, not their hands. Instructors can demonstrate how to fall safely. Teach them to avoid getting up until they have
h! c u O . . . s p Oo t? a h W w o N
come to a complete stop. 3. Do not ski or snowboard alone. Children need to have adult supervision. 4. Be in control. The key to successful skiing and snowboarding is control. To exercise control, one must learn proper skills, be aware of other skiers and snowboarders and be able to adjust to changing snow conditions. 5. Know children’s limits. When on a slope that is too difficult, teach children to remove their equipment and sidestep down the slope. 6. Wear sun protection. Altitude and glare from snow make sun damage more likely. 7. Pay attention to fatigue and nutrition. Skiing and snowboarding are hard work and require rest and adequate nourishment. 8. Know the code. The National Ski Areas Association endorses a responsibility code for skiers and snowboarders. Familiarizing young athletes with the code can help prevent
accidents and injury. These seven safety rules are prominently displayed at ski resorts: • Always stay in control and be able to stop or avoid other people or objects. • People ahead of you have the right-of-way. It is your responsibility to avoid them. • You must not stop where you obstruct a trail or are not visible from above. • Whenever starting downhill or merging into a trail, look uphill and yield to others. • Always use devices to help prevent runaway equipment. • Observe all posted signs and warnings. Keep off closed trails and out of closed areas. • Prior to using any lift, you must have the knowledge and ability to load, ride and unload safely.
Accidents and sports injuries happen, and teens may be especially prone. When you need emergency medical care, you can count on our pediatric emergency services. Learn
more at www.RockyMountainHospitalForChildren.com and www.youthsportsmed.com.
RockyMountainHospitalForChildren.com
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WHEN IT’S MORE THAN A BUMP O THE HEAD Changing the Culture of How Concussions Are Treated
The Center for Concussion opened
education and community collaboration
this summer at the Rocky Mountain
commence immediately.
Hospital for Children Youth Sports
The REAP program works on the premise that concussion is best managed by a multidisciplinary team that includes the child, the family, various members of the school team and the medical team. The unique perspective from each of these teams is essential to managing the concussion after injury.
Institute as one of just a handful of pediatric concussion centers nationwide. The Center for Concussion grew out of a pilot project last year between the Rocky Mountain Hospital for Children HealthONE Emergency Departments and four Colorado school districts. A team approach REAP — which stands for Reduce, Educate, Accommodate and Pace — is a community-based model for concussion management in young athletes.
When a child with a concussion is seen at any Rocky Mountain Hospital for Children Emergency Department, REAP is set in motion. After leaving the emergency room, families, schools and community medical professionals are quickly contacted by the REAP program, and 4
Winter 2011
Rocky Mountain Kids
“The developing brain from the adult brain.” with all high schools in the state as one suggested model for concussion management. Dr. McAvoy has also been contacted by other state leaders to develop similar programs for their district schools. REAP Program Reaps Rewards During the 2009–2010 school year, the REAP program received more than 150 referrals for student athletes who were
Even if a child hasn’t been seen at a Rocky Mountain Hospital for Children Emergency Department, he or she can still be seen at the Center for Concussion, and REAP can be put into effect.
evaluated for concussion in a Rocky
Karen McAvoy, PsyD, director of the Center for Concussion and author of the REAP guidelines, volunteered hundreds of hours this past summer teaching REAP to coaches, parents, school districts and club sports organizations.
concussion management.
The Colorado High School Activities Association has shared REAP guidelines
Mountain Hospital for Children Emergency Department. The REAP program expects to surpass that number this school year, as more school districts receive training on
As doctors are developing a clearer picture of how children and teens are affected by concussion, newer guidelines recommend that children should be treated much more conservatively than adults when it comes to this condition. The developing brain is very different from
E ON is very different
—Karen McAvoy, PsyD
the adult brain; it is much more likely to show symptoms later and have longerterm problems when injured, especially if the child doesn’t have a chance to rest and recover properly. Care for each child needs to be individualized. The Center for Concussion, through
ImPACT Baseline Test: A Better Look at
Brain Function
its groundbreaking, community-based management approach to concussion
Concussions affect the function of
a way to assess brain function.
in children, will continue to develop
the brain, not the structure. That’s
The ImPACT baseline test takes
recommendations for concussion
why routine tests like CT scans and
a “snapshot” of the brain under
MRIs fail to show the effect of a
healthy conditions. After a student-
concussion. The ImPACT test was
athlete has been diagnosed with a
developed at the University of
concussion, the baseline test is
Pittsburgh Medical Center to provide
used as a basis for comparison.
management in children.
Follow-up ImPACT tests, when
Join us for a free semi nar!
compared with the baseline test, help doctors monitor how well the
The Center for Concussion offers educational seminars for parents, students and athletic
brain is recovering. The Center for
coaches. Call 720-979-0840 to get upcoming dates and times.
to the community in 2011. The test
Concussion will offer baseline testing will be available to student-athletes older than age 11. To learn more, visit www.youthsportsmed.com. RockyMountainHospitalForChildren.com
5
Protect Your Teen’s
The teen years can be a battleground for many families. Staying close to your teen can help you win the war.
wellbeing
Being a teen and being a parent have never been more complicated. Along with the usual risks and temptations, today’s families face an uncertain economy and job market. And now there are even more opportunities for distraction and mischief via social networking sites, texting, YouTube and Twitter. “Even though the challenges are different for this generation
raise their kids, teens will still make mistakes because their judgment doesn’t develop until the mid-20s,” Dr. Peck says. “The changes of puberty increase the risk for all mental problems during adolescence.”
of parents, the solutions to guiding young people through these difficult years remain very much the same — staying close, continuing
What warning signs should I be aware of?
to listen and seeking help when a problem arises,” says Michael Peck,
A teen with a mental disorder may have these symptoms:
PhD, a psychologist in private practice in Los Angeles.
Chronic sadness or hopelessness
Answers to the following questions can help you recognize a problem and get help for your teen if needed.
Persistent nightmares Declining interest in and performance in school Alcohol or drug use
How many American children have mental
Loss of interest in things he or she once enjoyed
health problems?
An unbalanced relationship with food
In any given year, 10 percent of U.S. children and adolescents suffer serious mental disorders that cause significant problems in
What can I do to help my teenager?
how they function at home and in school. Even so, only 20
There’s no substitute for spending time with your teen. Keeping
percent of children with mental disorders are diagnosed and
the lines of communication open is one of the most important
treated appropriately. Untreated mental disorders can lead to
things a parent can do. When kids hit 12, 13 or 14 — just when
school failure, family conflicts, drug abuse and suicide.
they need help the most — many start to withdraw from their moms and dads. “Knowing this can help parents to continually
What causes teens’ mental health problems?
make contact with their teens,” Dr. Peck explains.
Similar to adults, mental health problems in teens are caused by biology and environment. Biological factors include imbalances in
What should I do if there is a problem?
brain chemistry and inherited risks for certain conditions, such as
If you suspect a problem, talk with your child. “Don’t ignore
depression. Environmental factors include substance abuse and
warning signs in the hope that the problem will go away,” Dr. Peck advises. “Act on them early by getting your child to a mental health professional — his or her future depends on it.”
being the victim of rape, physical abuse or violence.
“Parents also need to know that no matter how well they
Busy? Get the health information you need fast with our customizable Parents Pages. Tailor pages based on your child’s age and topics that are relevant to you. Visit www.RockyMountainHospitalForChildren.com and click on the green banner at the top of the page.
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Winter 2011
Rocky Mountain Kids
Parents: Share this page with your kids!
Teens: It’s Never Too Early To Be Healthy! Got milk?
Avoid Tobacco
Girls, you’re already stronger than you know.
Don’t start smoking, which can cause cancer, heart disease and lung disease. Chewing tobacco can lead to oral cancer, gum disease and an increased risk for heart attack.
By the time you turn 18, you’ll have 90 percent of your adult bone mass. That means the stronger your bones are as a teen, the stronger they’ll be when you get older. But experts say more than 85 percent of girls ages 12 to 19 don’t get enough calcium, a mineral that helps build bone. If you don’t build enough bone now, you’re more likely to suffer from osteoporosis (weak bones) later in life. Very weak bones can break easily from mild stresses, like coughing or bending over.
To build bones that stay strong all your life, follow these tips now: • Instead of soda, drink low-fat milk. Crave a sweet drink? Have chocolate milk or calcium-fortified orange juice. • At snack time, reach for dairy products like yogurt, cheese cubes or pudding made from low-fat milk. • Dairy isn’t the only source of calcium. Figs, almonds and broccoli also contain bone-building vitamins and minerals. • Exercise makes your bones stronger, too. Any activity that involves jumping, walking or running — like basketball, jumping rope or dancing — is good for your bones.
Build Your Bones Good health habits can help you build and maintain break-resistant bones. Get 1,300 mg of calcium a day and do weight-bearing activities like basketball or jogging.
Ask for Help Eating disorders like anorexia and bulimia usually start in the teen years. If not treated, stomach, heart and other health problems may result. Reach out to an adult right away if you or a friend might have an eating disorder.
Eat Well and Exercise Doing so can help you maintain a healthy weight and avoid type 2 diabetes, which if left uncontrolled can raise your risk for early heart disease.
Protect Your Skin Don’t tan. UV light from tanning beds poses the same risks as the sun’s rays — skin cancer, eye damage and premature aging of the skin.
RockyMountainHospitalForChildren.com
7
acl
injuries:
An Uneven Playing Field Playing sports and exercising helps kids become healthier and more fit. But young athletes may be subject to injuries that can cause long-term damage. One injury — the ACL tear — is on the rise, especially among girls. ACL injuries are damage to the anterior cruciate ligament (ACL) in the knee. The ACL is one of four ligaments that keep the knee from wobbling or giving out when you move. It’s often injured during sports that involve starting, stopping, pivoting and turning with speed, such as:
know exactly why it’s happening, but there
• Basketball • Soccer • Volleyball • Football • Field hockey • Skiing • Lacrosse
within one to two months.
Winter 2011
muscle strength, coordination and hormonal differences.” A child’s ACL tear is more difficult to treat than an adult’s, Dr. Polousky says. This is because surgeons must avoid injuring the growth plates on children’s bones above and below the knee. If surgery is performed, the child will be on crutches for about a week and will need physical therapy. Children can typically resume some activities
Our pediatric orthopedic team is a leader in caring for children with a wide range of orthopedic conditions. Visit www.youthsportsmed.com to meet our team.
Knee Know-How ACL injury prevention programs focus on keeping their knees straight over their changing the way athletes train. Children feet and practice pivoting inwards while can practice stopping and starting while bringing their feet with them.
Bigger Gamble for Girls Girls are four to six times more likely to injure their ACLs than boys, according to John Polousky, MD, orthopedic surgeon with the Rocky Mountain Youth Sports Medicine Institute at Rocky Mountain Hospital for Children at Presbyterian/ St. Luke’s Medical Center. “It’s almost reaching epidemic proportions,” says Dr. Polousky. “We don’t
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are a variety of factors including anatomy,
Rocky Mountain Kids
You Run Like a Girl! Why are ACL injuries so prevalent in girls? A lot of research has looked into that same question. After puberty, female athletes tend to remain more upright with their knees less bent than their male counterparts, putting the ACL in a vulnerable position. To prevent injury, encourage young athletes to try the following activities for 15 minutes, several times a week: • Stop and start, keeping the knee straight over the foot. • Stand on a block and jump, landing with the knee straight over the foot. • Improve muscle balance with hamstring-strengthening exercises.
Tackling Teen Acne No parent wants to see a child suffer with acne. This common skin condition affects nearly eight in 10 teens, and some adults, too. For many parents, having a child with acne brings back painful reminders of their teen years, when they suffered embarrassment and ridicule from their peers. While acne may be an unfortunate rite of passage for many teenagers, your child doesn’t have to suffer. “We’ve made many advances in skin treatments in the past few years, and there’s plenty that can be done to get rid of acne,” says Lisa Swanson, MD, a pediatric dermatologist with Rocky Mountain Hospital for Children. “It doesn’t need to be part of growing up anymore.” Acne Is Treatable Whether your child has blackheads, whiteheads or painful cysts, if he or she is
bothered by acne, a dermatologist can help. Medicine has become more sophisticated, and today’s acne treatments have fewer side effects than in the past. “I think the real message for parents and kids is that acne doesn’t go away overnight, but we can make it go away,” Dr. Swanson says. “No one needs to suffer with acne.” What Kids Can Do Good skin care can help some kids escape major breakouts. Your child should wash his or her skin every morning and night with gentle soap and water. If your children play sports that require wearing a helmet, Dr. Swanson recommends carrying facial cleansing wipes to practice and games so that they can wipe their faces as soon as they take their helmets off.
That will prevent the dirt and sweat from getting trapped against their pores.
Meet Our Doctor Lisa Swanson, MD, pediatric dermatologist. She was born in New Orleans, La., and raised in Scottsdale, Ariz. She attended college at the University of Colorado at Boulder, graduating with honors as an English major. After that, she obtained her medical degree from Tulane University School of Medicine in New Orleans. She performed her internship at Mayo Clinic in Scottsdale, and went on to complete her dermatology residency at Mayo Clinic in Rochester, Minn. She recently completed a fellowship in pediatric dermatology at Phoenix Children’s Hospital in Arizona.
Clearing Up Acne Myths Myth: Acne is caused by poor hygiene. Fact: Vigorous scrubbing can actually irritate the skin and make acne worse. The best approach is to gently wash your face twice a day with mild soap and pat skin dry. Myth: Acne is caused by junk food such as chocolate, soda, pizza, fries and other high-fat foods. Fact: Extensive scientific research has found no link between food and acne. Myth: Sun exposure reduces acne. Fact: Overexposure to sun can cause dry skin and rashes. This is especially true for teens. Myth: Acne just needs to run its course. Fact: The truth is, acne can be cleared up. If acne products haven’t worked, consider having your child see a dermatologist. Get the facts on acne and its causes, treatments and myths at www.skincarephysicians.com.
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Parents Are Key to Safe Teenage Drivers The American Academy of Pediatrics (AAP) recently updated its policy regarding teenage drivers. Citing numerous studies that show teenage drivers to be some of the most dangerous drivers on the road, the AAP stresses the important role parents play in keeping their teenagers safe behind the wheel. safety belts, distractions and other factors also playing a role.
safe driving habits and buckle up. • Be strict and enforce rules and punishments. Risky driving behaviors, Protecting Teenage Drivers traffic tickets and crashes are less To help protect teenage drivers — and common among teenagers whose Why So Dangerous? everyone else on the road — the AAP parents control access to the vehicle Motor vehicle crashes are the number one encourages parents to: and set strict limits. cause of death among 16- to 20-year-olds. • Serve as positive role models behind the • Write and sign a parent-teenager A lot of research points to sheer wheel. Parents with poor driving records driving contract. A contract is a great inexperience as the main reason for this are more likely to have teenagers who are way to ensure everyone understands frightening statistic, with failure to use involved in crashes. Always demonstrate expectations and rules.
Make a pact with your teen driver. Download a Parent/Teen Driving Contract from the Colorado Department of Transportation at www.coloradodot.info/programs/colorado-teen-drivers/new-documents/parent-teen-driving-contract.pdf.
Big Kids Need vaccines, Too Before your kids become teens, take them to the doctor for preteen vaccines. The Centers for Disease Control
and Prevention recommends that kids ages 11 or 12 get these shots: • MCV4, to protect against meningitis • HPV for girls, to prevent types of human papillomavirus that commonly cause cervical cancer • Tdap, a booster against tetanus, diphtheria and whooping cough • Yearly influenza shots Even when they reach their teens, kids need to visit the doctor once a year. During these visits, the doctor will make sure teens stay up-to-date on their vaccines.
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Winter 2011
Rocky Mountain Kids
In the : In Know the Know:
He alth Br iefs for Pa re nts
How to Keep Your Teens Active
Sound Advice to Prevent Hearing Loss Noise-induced hearing loss was once considered a job-related hazard. But as more children and teens use personal music players, they are experiencing the same hearing problems as adults. Two factors contribute to hearing loss: sound level and length of exposure. Either or both may lead to irreversible damage in the inner ear, resulting in diminished hearing. Pay attention to the volume of your children’s personal music players, as well as the amount of time they spend listening to music. If the music is painful to your ears, it’s likely harmful to theirs. Use a noise limiter to prevent excessive volume. A level of 80 to 85 decibels is considered safe. Consult a doctor if your child has symptoms of hearing loss, including ringing in the ear (tinnitus), need for excessive TV volume and poor school performance. To learn about our rehabilitation and audiology programs, visit www.RockyMountainHospitalForChildren.com.
Even video game experts need fresh air. Not every child is an athlete, but every child can have fun moving without recreating drills from gym class. Aerobic exercise is perfect for independent teens who like variety. Some possibilities include power walking, running, in-line skating, cycling, swimming, tennis, basketball, dancing, kickboxing, hockey, soccer, racquetball, handball, ice-skating and trampoline. Plus, exercise can help improve your teen’s mood and concentration, and give him or her loads of energy. Studies show that support from family and friends has been consistently and positively related to teenagers keeping up with regular physical activity. So shut off that television and get them moving!
8,000,000 or more Could Your Teen Have Bulimia? with bulimia generally go on eating binges, then purge people in the United States People with laxatives or vomiting. They may also exercise obsessively. have an eating disorder. Other potential warning signs include: 90 percent are female. • Reddened, calloused or scarred fingers from inducing vomiting • Swollen cheeks or neck glands Eating disorders usually • Teeth that look clear or are decayed from stomach acid start in the teens but may Irregular menstrual periods in girls of diuretics or water pills begin as early as age 8. Use Strict dieting and a preoccupation with calorie counting Source: National Association of Anorexia Nervosa and Associated Disorders
Intense fear of gaining weight • Frequent use of the bathroom after meals
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Rocky Mountain Kids
Presorted STD US Postage
PAID
Rocky Mountain Hospital for Children
Rocky Mountain Kids is published by Rocky Mountain Hospital for Children’s family of hospitals from HealthONE. The information is intended to educate the public about subjects pertinent to their heath, not as a substitute for consultation with a personal physician. Beverly Petry Editor Rocky Mountain Kids welcomes feedback from our readers. To offer feedback, please go to www.RockyMountainHospitalForChildren.com and click on “Contact Us.” ©2011 Rocky Mountain Kids. All Rights Reserved. Permission to reprint or quote excerpts granted by written request only. 10427M
Emergency Care Just for Kids, Close to Home As a parent, you never want your child to have a medical emergency. But if the unthinkable does happen, you can rest assured that expert care is just around the corner. Rocky Mountain Hospital for Children delivers high-quality pediatric emergency services at seven locations throughout the region. Each emergency department is
staffed with board certified pediatric emergency physicians — doctors who specialize in treating medical emergencies in infants, children, teens and young adults. We know that kids are unpredictable, and not all emergencies happen during regular hours. That’s why the emergency departments at two RMHC locations — Presbyterian/St. Luke’s Medical Center
at 19th Avenue and High Street in Denver and Sky Ridge Medical Center at I-25 and Lincoln in Lone Tree — are open 24 hours a day, seven days a week, every day of the year. That means you and your child have direct and immediate access to experts in every pediatric subspecialty should an emergency arise.
For all your kids’ health care needs … RMHC is now part of all HealthONE hospitals providing you with the long-standing commitment to quality and safe care for children. Wherever the RMHC name is attached to the local hospital’s pediatric service, children and parents can count on the same level of clinical and service excellence you’ve come to know and deserve! Clip, post and save!
✁
RMHC Emergency Locations Presbyterian/ St. Luke’s Medical Center
19th Avenue and High Street Denver, CO 80218 ER: 720-754-4115 Open 24/7 The Medical Center of Aurora
Potomac and Mississippi Aurora, CO 80012 ER: 303-695-2780
Rose Medical Center
Swedish SW ER
9th and Clermont Denver, CO 80220 ER: 303-320-2455
Wadsworth and Bowles Littleton, CO 80123 303-932-6911
Sky Ridge Medical Center
I-25 and Lincoln Lone Tree, CO 80124 ER: 720-225-1900 Open 24/7 Swedish Medical Center
North Suburban Medical Center Hampden and Logan
Grant and Thornton Parkway Thornton, CO 80229 ER: 303-450-4519
(three blocks east of Broadway) Englewood, CO 80113 ER: 303-788-6911
24/7
emergency
at two RMH C
Presbyteria
c a re
locations —
n/St. Luke's and Sky Rid ge