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THE MAG A ZINE OF THE CHILDREN’S HO S PITA L FOR THE HUD SON VALLE Y

WINTER 2014

MENDING A GIRL’S HEART A 12-YEAR-OLD’S IMMUNESYSTEM FIX FIGHT THE FLU — AND OTHER BUGS TOO!

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welcome

FrOM Our pHysICIAN–IN–CHIEF pa rt of t h e m i s sion of

inside:

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welcome letter

The latest technology, the finest clinical expertise and the deepest compassion are often required in healing kids.

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a story to warm your heart

One family moved to the Northeast from Florida just to find the right care for their child. They’re glad they did.

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a boy’s ‘normal’ life begins

Thanks to an astute diagnosis and an innovative stem-cell treatment, a 12-year-old says goodbye to chronic illness.

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great fun, but high risk

Don’t just follow the law when it comes to protecting your children around all-terrain vehicles. Exceed the law!

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Maria Fareri Children’s Hospital is to advocate for the health and for the safety of our region’s children of all ages. These twin aims come together clearly on the playing fields of our schools and towns. In this edition of Shining Stars we focus on stories of a few of the many young athletes we have helped return to the sports that they love after overcoming serious medical challenges.

We also hear from some of the experts on our staff who work every day to keep our children safe doing the activities that mean so much to them. As with all the pieces we present in every edition of Shining Stars, we hope that by reading these stories you are able to gain insight into the role of this unique institution in the fabric of our region.

As summer fades into the Hudson Valley’s most beautiful season, fall, we hope that you have the chance to travel about the area and, if your travels bring you nearby, that you will stop by and see firsthand how we fit into the life of the Hudson Valley and Eastern Connecticut. For nearly 10 years Maria Fareri Children’s Hospital at Westchester Medical Center has been here to help families meet the medical and surgical needs of their children.

We welcome your visit to see how we get that done and we thank you for your continued support, which enables us to keep meeting those needs.

beware of falling tvs

Ever y year, ill-secured T V sets fall and injure children.

Michael ge wit z, M. D. p h y s i c i a n - i n - c h i e f, m a r i a fa r e r i c h i l d r e n ’ s h o s p i ta l at w e s t c h e s t e r m e d i c a l c e n t e r

watch out for those other winter bugs Does your preventive action to protect your kids this season stop with the flu? The ha zards out there don’t.

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keep kids safe on washday

Make sure toddlers and young children steer clear of today’s small, super-convenient detergent packages.

S h i n i n g S t a r s i s p u b l i s h e d b y wa i n s c o t m e d i a , m o n t v a l e , n.J. © 2013. all rights reserved. material contained herein i s f o r i n f o r m a t i o n a l p u r p o s e s o n l y. i f y o u h a v e m e d i c a l concerns, seek the guidance of a healthcare professional.

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For one Family, Finding the right hospital For a baby with cardiac deFects was worth a move From a distant state.

In OctOber 20 08, JesenIa colon and her husband, Luis cintron, packed up their three daughters and their household belongings and said goodbye to their life in Florida. their destination: connecticut, where Jesenia’s father lived and where they soon sought advanced heart care for their youngest, Yasmine, fve months old. the move most likely saved their baby’s life.

Jesenia and Luis knew that Yasmine had been born with a hole in her heart and pulmonary stenosis, a defect of the heart’s pulmonary valve. both congenital defects had been diagnosed following a

Markus Erb, M.D.

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Suvro Sett, M.D.

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sonogram performed when Jesenia was fve months pregnant.

“I was told that there was a 50-percent chance she might be stillborn, and that I might want to consider termination of the pregnancy, but I refused,” she recalls. after her birth on May 5, 2008, Yasmine spent two weeks in a Florida hospital’s neonatal intensive care unit. there it was recommended that as long as her medical condition was stable, she should—after a bit more growth and weight gain—have surgery to repair her heart. However, two weeks before the scheduled operation in October, Yasmine developed breathing problems, which the Florida hospital frst incorrectly diagnosed as asthma. (she was eventually diagnosed with respiratory syncytial virus and pneumonia.) surgery was postponed pending her recovery.

“I felt this was God’s way of telling me to fnd other medical care for my daugh-

ca r i n g F o r yo u n g h e a r t s Maria Fareri children’s Hospital’s advanced pediatric heart care services include: fetal cardiology electrophysiology interventional cardiology and cardiac catheterization echocardiography and cardiac imaging heart and vascular surgery pediatric cardiovascular anesthesia exercise stress testing preventive cardiology cardiovascular research

ter because I wasn’t happy with her treatment in Florida,” says Jesenia.

Upon their arrival in connecticut, the cintrons rushed Yasmine to a local hospital’s emergency room, as she was in respiratory distress. Once stabilized, the little girl was transferred by ambulance to Maria Fareri children’s Hospital at Westchester Medical center for further evaluation and specialized cardiac care. at the children’s Hospital, a parent is welcome to stay in a child’s private room. the nearby ronald McDonald House at Westchester Medical center allowed the cintrons to stay close to Yasmine and avoid a 45-minute commute from their new

courtesy of westchester medical center and the colon/cintron family

A story to wArm your heArt

Shining stars

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courtesy of westchester medical center and the colon/cintron family

home in Brookfeld, Connecticut, during her hospitalizations.

“From the minute we walked into Maria Fareri Children’s Hospital, it was a world of difference from the Florida hospital,” remembers Jesenia. “I felt we were fnally getting the right answers about Yasmine’s heart problems from the doctors, nurses and staff, who surrounded us with love and support.”

Drawing upon the expertise of Markus Erb, M.D., Director of Pediatric Cardiac Intervention and head of the adult congenital heart-disease program, Yasmine’s heart defects were fully diagnosed. In addition to the hole in her heart and pulmonary stenosis, the little girl had been born with a rare condition called heterotaxy syndrome. If the surgery in Florida had been attempted prematurely, she might have died.

“To sum it up, her heart and other organs in her chest and abdomen were in the wrong place,” explains Dr. Erb. “The results of this major defect were that she had two right ventricles in her heart, instead of a right and left, so that essentially only the right side of her heart was pumping. She had severe mitral stenosis, a condition that made the mitral valve so small that blood could not fow properly through her heart, and her lungs did not receive a normal amount of oxygenated blood. She had an interrupted inferior vena cava, so the blood from her lower body improperly joined the blood in her upper body before it returned to her heart. She also had problems with her heart’s electrical system.”

From 2008 to 2013, Dr. Erb and Chief of Pediatric Cardiac Surgery Suvro S. Sett, M.D., performed several cardiac catheterizations and three major heart surgeries to repair Yasmine’s heart defects, reroute blood through her heart and lungs, and enable her to breathe normally. Dr. Sett worked to repair the hole in her heart and created a bypass over her too-small mitral valve to bring blood from the right side of her heart through her aorta and out to the rest of her body.

In 2009, in a 10-hour procedure called a Kawashima repair, Dr. Sett did further necessary reconstruction of Yasmine’s circu-

★

5 k e y a dva n tag es o f ca r d i ac ca r e at m a r i a fa r e r i c h i l d r e n ’ s h o s p i ta l When a child needs treatment for congenital heart diffculties, parents want to fnd a treatment facility in which they have full confdence. To fnd that for their baby daughter, Jesenia and Luis Cintron moved all the way from Florida to take advantage of the services available at Westchester Medical Center’s Maria Fareri Children’s Hospital (see main article). For those fortunate enough to live nearby already, here are six reasons to feel good about choosing Maria Fareri Children’s Hospital for pediatric cardiac care: an advanced protocol for reducing infections a fully equipped Pediatric Intensive Care Unit an advanced technology called ECMO (extracorporeal membrane oxygenation) to assist severely ailing hearts and lungs

participation in a multicenter study to reduce chest infections in children having congenital heart defects repaired a home monitoring program for newborns at high risk for heart problems

for more information on pediatric cardiac care, visit westchestermedicalcenter.com/pediatric-cardiology.

latory and pulmonary systems. And just this year—with a view toward the future—he connected hepatic veins from her liver to arteries in her lungs to reduce her risk of developing hypertension in her lungs. He also put a small plastic shunt into her heart to relieve fuid buildup and placed electrical leads inside the heart in case there is a need someday to connect them to a pacemaker to correct any heart-rhythm disorders she may develop.

“Yasmine’s recovery from this last surgery took place over her ffth birthday,” says Jesenia. “Dr. Sett and the nurses made it special with cake and gifts.”

As Yasmine approaches her sixth birthday, the little girl is in kindergarten. She is allowed 10 minutes of activity at recess, but must be watched for any signs of breathing problems. She loves Hello Kitty, Dora the Explorer and her books and iPad. She sees Dr. Erb every few months for a checkup and testing and will be followed by the adult congenital cardiac program at Westchester Medical Center once she turns 21.

“Because of the complexity of her heart defects, Yasmine may one day need a heart transplant,” says Dr. Sett. “But she is doing well and so we will face each challenge for her as it comes.”

To see Yasmine alive, thriving and at-

tending school makes Jesenia certain she and Luis made the right decision to come north and seek out Maria Fareri Children’s Hospital. “So we traded our swimsuits for parkas,” she says. “But what mother wouldn’t do that for her daughter?” ★ after treatment for complex congenital heart defects, yasmine cintron now feels like a superhero.

1.877.wmc.docs westchestermedicalcenter.com/mfch 1.877.wmc.docs

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a stem-cell treatment banished a host of medical problems for gabriel sanchez, 12, shown here with his doctor, the pioneering researcher mitchell s. cairo, m.d.

What is a stem cell?

Stem cells are the building blocks of the body, which mature into cells in bones, blood, muscles, nerves and other body tissues. Stem cells used in transplants can come from bone marrow, peripheral (circulating) blood, or the blood found in newborn umbilical cords. at Maria Fareri Children’s hospital, all types of stemcell transplants are performed: autologous (patient’s own healthy stem cells); syngeneic (stem cells from a twin); and allogeneic (stem cells from a related donor, most often a sibling, or unrelated donor.

Chief of hematology, oncology and Stem Cell transplantation Mitchell Cairo, M.D., has pioneered umbilical cord blood transplants and haploidentical (halfmatched) transplants that involve donated stem cells from a patient’s mother or father, which contain half of the child’s genetic material.

For more inFormation on pediatric hematology and oncology services, visit westchestermedicalcenter. com/pediatric oncology.

A boy’s ‘normAl’ life When you’re 12, you Want

to run around and be active. that’s why 12-year-old Gabriel Sanchez of the Bronx is especially grateful to an extraordinary team of Maria Fareri Children’s hospital experts in pediatric immunology, hematology and stem-cell transplantation. they collaborated to unravel the cause of his persistent medical woes and cure him with a stem-cell transplant. today, says his mother, angelique, Gabriel is “starting to live normally” as he awaits an oK from his doctors that may fnally allow him to play on a sports team. as a young child, Gabriel was plagued by skin ailments and gastrointestinal illnesses,

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including cradle cap, lactose intolerance, bowel troubles and skin abscesses on his neck. “almost every month, he’d be on antibiotics for something, whether it was strep or a tonsil infection, or little skin ailments on his nose or ears, or abscesses on his neck containing staph infections that had to be drained,” angelique recalls. “until 2011, this was Gabriel’s life. We simply got used to it.”

But in September 2011, Gabriel had a fever that shot up to 105 degrees F. and was doubled over with stomach pains. angelique and her husband, rafael, rushed their son to the emergency room at Maria Fareri Children’s hospital, where a Ct (computed tomography) scan showed three abscesses

on his liver. he was admitted, and surgery to drain the abscesses was scheduled. “the liver transplant team even came in to discuss a high-risk surgery that would remove the parts of his liver that contained the abscesses,” recalls angelique. however, Gabriel’s history of liver abscesses and other symptoms made Maria Fareri Children’s hospital immunologist Subhadra Siegel, M.D., suspect a rare genetic disorder called chronic granulomatous disease (CGD). People born with CGD have a faulty gene in their bone marrow that makes their neutrophils—white blood cells of a type that is manufactured from stem cells inside bone marrow—unable to do their normal job

shutterstock

begins

thanks to a stem-cell transplant, a youngster With a rare genetic disorder gets a brand-neW immune system.

shining stars

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photo courtesy of westchester medical center

shutterstock

of killing and consuming fungi and bacteria that most of us can carry without any problems. When infections arise in people with CGD, they can cause abscesses, enlarged lymph glands, unusual pneumonias, or bone infections. The fact that these infections can also cause chronic infammation of the bowels leads many health care practitioners to suspect Crohn’s disease.

A California lab confrmed Dr. Siegel’s diagnosis: Gabriel had a type of CGD called autosomal recessive. This type is not the most dangerous, because his neutrophils were at least functioning at 47 percent capacity. Hence, he was able to fght off some infections over his lifetime, but any one of them could have been fatal.

“We received the lab results just as Gabriel was being prepared for surgery,” says Angelique.

The good news for the Sanchez family was that there was a potential cure—a stem-cell transplant—that would “wipe the slate clean” and give Gabriel a brand-new immune system with neutrophils that functioned normally. Maria Fareri Children’s Hospital’s Chief of Pediatric Hematology, Oncology, and Stem-Cell Transplantation, Mitchell Cairo, M.D., approached Gabriel’s parents with the option.

“It took us about 60 seconds to say ‘yes,’” says Angelique with a laugh. “Dr. Cairo’s 30 years of experience in the feld and his comforting manner made us know that Gabriel was in the right place with the best doctors. To imagine a life for Gabriel without constant medications was incredible.”

Dr. Cairo and his team at Maria Fareri Children’s Hospital have built one of the country’s foremost programs in stem-cell transplantation for children with hematologic cancers of the blood, solid cancerous tumors, nonmalignant blood disorders and metabolic diseases. It is New York State’s leader in performing stem-cell transplants in babies and children with nonmalignant conditions, including immunodefciencies such as the one Gabriel had, and bone-marrow failure syndromes.

“New York’s major initiative to screen newborns for immunodefciencies reduces medical complications and mortality for these babies and enables us to start

them on the transplant process as early as four weeks of age,” notes Dr. Cairo. “If this had been around when Gabriel was born, he would have been spared all those years of infections.”

Gabriel’s road to a new immune system was rough, starting with several laparoscopic surgeries to drain the liver abscesses and then six weeks of recovery at Maria Fareri Children’s Hospital in late 2011. “He didn’t walk, was very thin and weak, and didn’t talk or eat much,” notes Angelique. “The nurses and child-life specialists were wonderful, helping him to walk and to focus on his bright future. He never complained.”

By the end of February 2012, Gabriel had recovered, and an unrelated donor match was found with stem cells removed from a baby girl’s umbilical cord blood. The newborn’s mother had generously chosen to donate the baby’s unnecessary cord blood to the National Marrow Donor Program.

Then, in mid-April, Gabriel was admitted to Maria Fareri Children’s Hospital and began seven days of chemotherapy that destroyed his malfunctioning immune system to prepare his body for his stem-cell transplant. He settled into a private room with an air-fltration system and rigorous infectioncontrol rules of handwashing, gloves, and masks for all visitors, and he was put on immunosuppressants and other medications to reduce the risk of side effects. “Day 0,” when the new stem cells were transplanted into Gabriel’s blood through a transfusion, was April 25, 2012.

“Then we held our breath until June 13, when tests showed that the donated stem cells had fully engrafted in his bone marrow and were producing normal blood cells,” recalls Angelique. “Dr. Cairo and his doctors, the nurses, and all the staff were phenomenal. Gabriel had lost his hair, his skin was dark, and he didn’t talk for about seven

in the bad old days, because of a rare genetic disorder, Gabriel required treatment for many infections.

days, but he held strong.”

The boy experienced one complication: His lungs had been invaded, probably years before, by an infection caused by a common mold called aspergillus. This mold is usually harmless but can be dangerous to those with CGD or other immune system disorders. Intravenous antifungal medications were prescribed, but Gabriel never finched.

“Gabriel is an inspiring young man who touched the hearts of all his caregivers,” says Dr. Cairo.

On June 21, Gabriel came home to a newly redecorated room. Through the 2012–2013 school year he was tutored at home. Finally, in September 2013, he returned to St. Raymond Elementary School in the Bronx, where he was given a rousing welcome. As he approached his 12th birthday at Christmastime 2013, he was free of all medications except the anti-fungals for the aspergillus.

“Gabriel is cured of CGD, and I have every reason to believe that he is well past the time of being at risk for any serious complications,” says Dr. Cairo. “I expect him to live a long, happy life.” ★

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GrEat FUN bUt hiGh risk Parents should understand the Potential danger all-terr ain vehicles Pose

gustavo stringel, M.D., M.B.A.

Janice glover, R.n., M.s.n.

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2013 in our trauma center, we have treated 28 patients for atv injuries, nine of them children,” says dr. stringel.

Physicians who treat atv injuries are so concerned about their increase that three major medical organizations—the american academy of Pediatrics, the american college of surgeons—and the american academy of orthopaedic surgeons—have released strong statements urging that children under 16 should not be allowed to operate an atv.

“We’ve treated head trauma, severe lacerations, broken bones and injuries to major internal organs,” says Janice glover, r.n., M.s.n., Pediatric trauma coordinator for Maria fareri children’s hospital. despite their hazards, atvs are legal in new York state, and a driver’s license is not required to operate one. the law even allows children younger than 10 to drive one if they are under adult supervision. no supervision is legally required if they are driving one on property owned or leased by a parent or guardian.

“We cannot change the law,” says dr. stringel, “so educating parents and chil-

dren about how to ride safely is crucial to reducing one’s risk of injury or death.” glover and dr. stringel offer these safety tips, which apply to all ages but are particularly important for parents to heed in keeping their kids from harm: Wear a motorcycle helmet. use eye protection (goggles and face shield).

Wear a long-sleeved shirt or jacket, long pants, and over-the-ankle boots.

Make sure the vehicle you ride is the right size for your age and is properly maintained. do not carry passengers on a oneseat atv. never ride on public roads, only on designated trails or private property. do not drive under the influence of drugs or alcohol. do not drive after dark. take an atv safety course given by the department of Motor vehicles (dmv.ny.gov). “as with any other potentially dangerous product, make sure you follow the safety instructions and warnings posted on the vehicles,” concludes dr. stringel. ★

thinkstock; courtesy of westchester medical center

an all-terrain vehicle (atv) or a snowmobile can be used safely for recreation or for work tasks such as farming. however, children under age 16 rarely have the physical strength, maturity, judgment and hand-eye coordination to operate an 800-pound vehicle that can easily roll over, explains gustavo stringel, M.d., surgeon-in-chief at Westchester Medical center’s Maria fareri children’s hospital. and that makes atvs and similar vehicles incredibly dangerous to children, he warns. the safety institute reports that atvs kill and seriously injure about 40,000 children under age 16 every year. in the past decade, hospitalizations of children from atv injuries have increased 109 percent. “from september 2012 to august

sumer Product safety commission reports that atv driving has the highest risk of hospitalization among 33 sports and activities in which children routinely participate—including bike riding, snowboarding, wrestling and scooter riding. the risk of serious injury associated with driving an atv is 61 percent greater than the activity with the next highest risk (football).

riding without a helmet, as this youngster is doing, increases the danger of serious injury.

to the young.

in the hands of an adult,

the atV danger the con-

shining stars

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beware of falling tv s

eVery year, ill-secured teleVision sets fall and injure children.

shutterstock; Photo courtesy of westchester meDical center

thinkstock; courtesy of westchester meDical center

whAT’S ThAT giAnT holidAy gift in the corner—the one that’s too large for any wrapping but a bright red bow? if it’s a new family television set, understand that along with hours of viewing pleasure it may also bring a potential danger. injury or even death can result when a large, poorly secured TV falls on a child—and it’s happening more often these days. A study in the journal Pediatrics reports that in 2011, 12,300 children in the U.S. received emergencyroom treatment for TV-related injuries, compared with 5,455 in 1990. Awareness of this common household danger isn’t as great as it should be, and it’s especially critical at this time of year when kids are indoors most of the time.

Each year, six to eight such injuries are seen in the Pediatric Emergency department at Maria Fareri Children’s hospital at westchester Medical Center, says darshan Patel, M.d., who heads the department. As a referral center providing advanced pediatric care for community hospitals throughout the lower hudson Valley, his department treats the most severe, traumatic cases. “over the past few years we have seen an increase in injuries of this kind,” he reports.

Flat-screen sets have Darshan made the problem Patel, m.D. worse, he says. “The

older sets were bigger and heavier, so their weight and bulk tended to make them more stable,” he says.

“These newer plasma and lCd TVs are lighter, but paradoxically that increases the danger.” Also, says the Pediatrics report, many families who have acquired flat-screen sets for living-room use have consigned older sets to use in the bedroom, where there may be placed on furniture unsteadily. A chest of drawers, for example, can be a dangerous perch, because children may try to open the drawers and use them as stairsteps to climb to reach a TV set.

Today’s television sets can still be two to three times the weight of a small child. “we are seeing younger kids with a higher proportion of head and neck injuries such as skull fractures or brain hemorrhages,” says dr. Patel. The American Acadamy of Pediatrics recommends that pediatricians discuss home safety with parents when a child reaches 6 months of age, because “that’s right before the child starts to cruise,” dr. Patel says. As children grab onto things to move about, it’s important for parents to make sure an ill-secured TV

5 TiPS To KEEP yoUr ChildrEn SAFE Follow these safety tips in any home where children live or visit: Anchor furniture and place the TV on top of it, as far back on the furniture as possible. .

Place TVs on sturdy, low bases.

Keep remote controls, toys and other items that might be attractive to children off TV stands or furniture.

Keep TV and cable cords out of children’s reach.

Supervise children in rooms where these safety tips have not been followed.

Source: Consumer Product Safety Commission

set isn’t one of those things. The CPSC has suggestions for anyone who has young children or welcomes small children as guests. (See “5 Tips to Keep your Children Safe,” above.) But dr. Patel says the best way to kid-proof a home is to get down on the child’s level and see the environment from that perspective. ★

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In the cold-weather months when children spend most of their time indoors, we’re all conscious of the danger posed by the influenza virus— the flu. But other viruses also threaten kids, and they’re easily spread in classrooms, day care centers, dormitories and other settings where young people convene.

Unlike the flu, these viruses aren’t effectively targeted by a large-scale vaccination program. and while parents may be tempted to reach for antibiotics to combat symptoms caused by these “bugs,” that won’t help, because antibiotics work only on bacterial infections, not viral ones:

resPIratorY sYnctIal VIrUs (rsV ): this bug can infect the lungs and breathing passages, and it’s a key cause of respiratory illness in children.

It can be spread through coughs and sneezes and can live on doorknobs and countertops. rsV infections often occur in epidemics—usually from late autumn through early spring. almost all children are infected with rsV by age 2, but for

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The flu isn’T The only danger.

ProTecT your kids againsT These viruses Too. most of them the symptoms are simply those of the common cold. cornwall-on-hudson residents Jodi and John cabrera—a guidance counselor and a teacher, both 33—weren’t so lucky. two of their three children— five-month old daughter lila and, later, one-month old son Jack—had to be airlifted by helicopter to maria Fareri children’s hospital for oxygen treatment in the Pediatric Intensive care Unit after the rsV virus made them dangerously ill. “the kids’ pediatrician—who was also mine when I was a child—said he’d never seen a case of two children in the same family getting so sick from the same virus,” says Jodi. “each of them was really struggling to breathe.” the kids are fine now, but their experience points a lesson: while rsV isn’t severe for most children, it can be serious for babies, who sometimes require monitoring in the hospital for breathing difficulties. rsV can usually be detected with a nasal swab at your pediatrician’s office, and a baby with rsV should be given fluids at frequent intervals. (that can be a challenge, because they may

not want to take them.) two key take-home lessons here? one is that all kids should be taught to wash their hands thoroughly and frequently—especially after any contact with another child with a cold. another is to take special care within families to keep rsV from being spread: If junior brings it home from kindergarten it may give him only a sneeze and a sniffle but put his infant sister in real danger.

rhInoVIrUses: there are hundreds of rhinoviruses, and together they account for 10 percent to 40 percent of common colds. they can also cause viral pneumonia and trigger asthma attacks and lung problems in the lower respiratory tract in children with chronic lung diseases, such as asthma or cystic fibrosis, or in those with compromised immune systems.

Using saline nose drops, a cool-mist humidifier, mouthwash and a syringe nose bulb can usually provide relief from symptoms. “we don’t recommend overthe-counter cough medicines for young children because they haven’t been proved effective and there are risks

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watch out for those other winter bugs

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associated with some of their active ingredients,” says Sheila Nolan, M.D., Chief of Pediatric Infectious Diseases at Maria Fareri Children’s Hospital.

Frequent handwashing, using a tissue or elbow to “catch” a sneeze, and resting at home will help stop the spread of rhinoviruses, says Dr. Nolan.

NOROVIRUSES: Known colloquially as stomach bugs, noroviruses are a major cause of gastrointestinal illness.

Sheila Although most common in the Nolan, M.D. Northern Hemisphere during cold months, when children and adults are more likely to be inside, noroviruses can strike at any time of the year.

Highly contagious and spread through food, water or a surface that has been exposed to fecal matter, noroviruses can cause vomiting, diarrhea and stomach cramps for up to 48 hours after infection.

Additional symptoms may include weight loss, fatigue and a low-grade fever.

Most noroviruses run their course within several days. Drinking plenty of fluids (water, breast milk, broth, non-sugary clear soda) is crucial to preventing life-threaten-

ing dehydration.

“Your child’s pediatrician may recommend an oral rehydration fluid to replace minerals lost,” says Dr. Nolan. “But don’t use a sugary sports drink or juice.”

Seek medical attention if your child’s symptoms do not go away within several days or if he or she is experiencing severe vomiting, bloody stools, abdominal pain or dehydration.

Because noroviruses can withstand hot and cold temperatures, alcohol hand gels and most disinfectants, the best defense is old-fashioned handwashing with soap and water. Common areas touched by many children and adults, such as changing tables and lunchroom surfaces, should be cleaned with chlorine bleach that has been left on the surface for at least 10 minutes.

Here in the Northeast, rhinoviruses and RSV are more prevalent in cold weather, notes Dr. Nolan, because they replicate better at lower temperatures. But do they ever go away?

“No,” she says. “They are always circulating somewhere in the world.” ★

pediatric serVices at Maria Fareri children’s hospital Maria Fareri Children’s Hospital at Westchester Medical Center is the children’s hospital for the Hudson Valley and Fairfield County. Our list of advanced care pediatric services includes:

MEDICAl • • • • • • • •

•

Adolescent Medicine Cardiology Developmental Pediatrics Emergency Services Endocrinology Gastroenterology General Pediatrics Hematology/Oncology and StemCell Therapies Infectious Diseases Medical Genetics Nephrology Pediatric Intensive Care Unit Psychology Pulmonology Regional Neonatal Intensive Care Unit Rheumatology

• • • • • • • • • • • • •

Burn Cardiothoracic Craniofacial General & Minimally Invasive Neurological Ophthalmology Orthopaedics Organ Transplant Otolaryngology Pediatric Gynecology Plastics Trauma Urology

• • • • • • •

SURGICAl

Vigilance against sepsis Westchester Medical Center and its Maria Fareri Children’s Hospital recently adopted new clinical guidelines to improve recognition and early assessment of severe sepsis—a potentially life-threatening complication of infection in the blood—so that treatment can begin as early as possible. The Medical Center’s new procedures meet New York State Department of Health requirements enacted in 2013.

Sepsis occurs when the body launches an overwhelming response to an infection, usually bacterial. If untreated, sepsis attacks major organs and eventually can lead to a deadly condition called septic shock.

“Diagnosing sepsis early can be difficult because some of the early signs—such as fever, high heart rate and decreased urine output—are nonspecific to sepsis,” says Robin Altman, M.D., Maria Fareri Children’s Hospital’s Chief of General Pediatrics and Pediatric Hospitalist Medicine.

The Medical Center’s sepsis recognition program includes: early assessment of risk factors for sepsis and vital signs at point of entry and other key points of contact for all patients; repeat assessments and vital sign checks at frequent intervals determined by the patient’s clinical status; and Robin electronic alert to identify at-risk patients and an electronic Altman, M.D. order set to facilitate testing and treatment.

To schedule an appointment with one of our pediatric specialists, dial 877.WMC.DOCS. learn more about Maria Fareri Children’s Hospital at westchestermedicalcenter.com/ mfch.

1.877.wMc.docs westchesterMedicalcenter.coM/mfch

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Some of the brightly colored items this child holds would taste yummy; others would poison him.

Can you tell the difference at a glance?

A toddler can’t.

KEEP KIDS SAFE ON

WASHDAY PUT YOURSELF IN A TODDLER’S shoes, and those new, brightly colored packages look pretty alluring. They’re small. They’re handy. They look like candy.

An adult knows they’re really highly concentrated laundry detergent “pods,” or gel packs, a relatively new packaging innovation aimed at convenience—and certainly they take up less space, and are easier to carry, than a heavy jug. But a chorus of reports from the nation’s emergency rooms suggests that that convenience comes at the price of danger to small children.

“On average in the Westchester Medical Center Trauma Center, we see about two cases each month of children exposed to pods,” says Darshan Patel, M.D., Chief of Pediatric Emergency Medicine at the Medical Center’s Maria Fareri Children’s Hospital. “This is a significant number for such an emergency.”

So far, the Hudson Valley area has had no known deaths of children from laundry detergent pods. But Florida hasn’t been so lucky. In August, a seven-month-old boy there reportedly perished after swallowing a candy-colored liquid laundry packet his mother had left in a laundry basket on a bed where the boy was sleeping. The woman had left the room for only a few moments.

If a youngster swallows one of the laundry pods, saliva quickly causes the pod’s water-soluble plastic covering to dissolve, allowing detergent to spew into the child’s esophagus, where it can cause irritation, burns and blisters. The child usually also experiences vomiting and diarrhea. Ingesting a pod can also cause coughing, an inflamed airway, and breathing problems from direct exposure to the lungs. And even if a child simply handles a pod, it can burst when squeezed, spraying detergent

into the eyes or onto the skin.

The American Association of Poison Control Centers reports that there have been almost 6,700 exposures to detergent pods in the United States in children under age 5 in 2013 alone. Due to the dangers of pod poisoning, some detergent manufacturers have begun to change their packaging. Dr. Patel says that because of these changes, he hopes cases of exposure will decrease.

“Pods are convenient and easy to use, so they are not going away,” he says. “As with any other household product, parents must supervise their children when using pods and keep them out of reach and locked up at all times. We recommend that if possible, parents do their laundry when their child is napping or resting, so there is no possible risk of becoming distracted and having a pod lying in a laundry basket or on a table where it can be picked up by little hands.” ★

COURTESY OF WESTCHESTER MEDICAL CENTER

CONVENIENT ‘PODS’ OF DETERGENT POSE A DANGER TO THE YOUNG.

WHAT TO DO If you believe your child may have eaten or handled a detergent pod, act quickly, says Darshan Patel, M.D., Chief of Pediatric Emergency Medicine at Maria Fareri Children’s Hospital. Call the national Poison Control Center’s hotline at 800.222.1222 and heed the advice you’re given, which may include the following: If detergent splashes into a child’s eyes, rinse them with water for at least 15 minutes.

If detergent spills onto clothes and skin, remove the contaminated clothing and rinse the skin well with water. Seek medical attention from your child’s pediatrician or at an emergency room.

If your child swallows a pod, have him or her drink a full glass of water or milk and get the child to an emergency room as fast as possible, calling 911 if an ambulance seems the fastest option. Dr. Patel cautions parents: “Do not induce vomiting, because that can bring the liquid up again and further harm the esophagus.”

Most emergency rooms are equipped to treat pod exposures, he notes. But if your child swallows a pod and is in severe respiratory

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distress and can’t breathe, is choking, is vomiting severely, or has an altered mental state and is lethargic, call 911,” he adds. “It may be necessary to treat the child at a trauma center or tertiary care emergency room, where your child can receive intravenous medication and fluids and ventilator support if necessary.”

Maria Fareri Children’s Hospital at Westchester Medical Center has a full roster of pediatric subspecialists who are skilled in handling severe cases of poisoning and exposure to dangerous contaminants. The hospital’s Pediatric Intensive Care Unit and specialized pediatric inpatient units provide child-friendly places for monitoring and advanced treatment during recovery.

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The children’s hospital for the Hudson Valley.

Westchester Medical Center The most pediatric specialties in the region. The only comprehensive cardiovascular, neurosurgery and cancer care programs for children.

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