There is no cure, but your child’s symptoms can be managed effectively Denise Warrick, MD A pediatrician in General and Community Pediatrics at Cincinnati Children’s
6 ti ps Paren t s Can use to
limit your child’s exposure
Solutions for
spring allergies Spring is in the air. For kids with seasonal allergies, that’s a challenge. April through June can be a tough time of watery eyes, runny noses and endless sneezing. The key culprits are the tiny, airborne pollen grains that come off trees, weeds and grasses. Another allergy trigger, outdoor mold spores, is found everywhere. Pollen and mold are hard to avoid when you want to go outside and play, but there are numerous ways to alleviate allergy symptoms. “Over-the-counter medications can be helpful, but it’s important to know which kind to use and how long to use them,” says Denise Warrick, MD, of General and Community Pediatrics at Cincinnati Children’s. The best option for allergies is antihistamines, which come in either oral pills/liquid or nasal spray. They target a chemical called histamine, which your body produces as a reaction to an allergen like pollen and mold. Look for a non-drowsy formula, which
won’t adversely affect your child’s schoolwork or normal sleep patterns. Some over-the-counter pills and nasal sprays may also contain a decongestant. Look for a “D” after the name. Decongestants are effective in cutting down on the fluid in the lining of the nose, which makes breathing easier, but they are strictly for short-term relief. After about three days they begin to have a “rebound” effect that causes swelling and makes breathing more difficult. Over-the-counter antihistamine medications work for most kids, but if they don’t, don’t hesitate to call your pediatrician. He or she can prescribe a nasal steroid spray or eye drops that contain antihistamine. For more severe cases, allergy shots might be warranted.
Minimize your child’s outdoor
Check mold and pollen
activities when pollen counts
readings for your city which
are high, which is typically in
are readily available online at:
the morning and night.
www.cincinnatichildrens.org/pollen.
Keep your home windows
keep things your children come
closed during pollen season.
in contact with washed regularly.
This not only keeps allergens
Wash bedding in hot, soapy
from getting in, but also keeps
water once a week. Change
the dust and mold already
and wash clothes worn during
inside your home from getting
outdoor activities.
kicked up by the breeze.
Limit close contact with
Make sure your children bathe and
pets that spend a lot of
shampoo their hair daily before
time outdoors.
going to bed, to rid pollen from their hair, skin and pillow.
a l l e r g y fa c t s n Grass is the most common cause of pollen allergy, or what some folks call “hay fever.” Ragweed is also a frequent source. n Plants release pollen grains into the air to fertilize other plants of the same species. n Plants fertilized by insects, like roses and some flowering trees, like cherry and pear trees, usually do not cause pollen allergy. n
Allergy shots have been around for more than 100 years! 1
Jillian Klein, MD
ask the
Pediatrician, General and Community
pediatrician
Pediatrics at Cincinnati Children’s
Can an infant’s weight impact childhood obesity? Yes! Nature and nurture are both factors, but food moderation should start with your baby’s first feeding A growing body of research has helped us better understand the developing bodies of newborns and infants. Healthy eating habits, including portion control, begin at birth. In her debut as our “Ask the Pediatrician” expert, Jillian Klein, MD, of General and Community Pediatrics at Cincinnati Children’s, emphasizes the importance of good nutritional educational for moms and dads during pregnancy and the early years of a child’s life. Klein says studies show that overfeeding of newborns and introducing solids too early can have long-lasting effects on children’s appetite, sense of fullness and gastrointestinal tracts. Babies under 4-to-6 months of age should only be fed breast milk and/or formula (no solid foods or juice). Their total daily intake should be about two-and-a-half ounces for every pound they weigh, so a 10-pound baby will take about 25 ounces in a 24-hour period – split into smaller feedings, about two-and-a-half to three ounces every three hours.
jo i n a
research
did you know?
By that age, severe obesity can be predicted using a simple body mass index (BMI) measurement, according to a new study led by researchers at Cincinnati Children’s. n The study is believed to be the first to show that weight gain during infancy differs in those who eventually develop obesity. BMI testing is currently not recommended for children under age 2. n “But we say it should be because we now know it predicts obesity risk later,” says Allison Smego, MD, a fellow in Endocrinology and lead author of the study.
s t u dy
Investigational Medication R esearch Study
Has your child or teen had a moderate to severe head injury? Do they have trouble with concentration or staying focused? What: We want to learn more about how a medication that helps with attention problems can help children who have had a moderate to severe head injury. Who: Children and teens, 6 to 17 years old, who have had a moderate to severe head injury at least six months ago and now have attention difficulties may be eligible for participation in the FOCuS study. Pay: Participants will be paid up to $200 for their time and travel. Contact: Jessica King at jessica.king1@cchmc.org or 513-636-9631. 2
Obesity can be predicted when babies are as young as 6 months old
Attention Study
Teens with attention problems or ADHD needed for study. What: A study to learn more about how sleep impacts functioning in adolescents with ADHD. Who: Teens 14 to 17 years old who have attentional problems. Pay: Families will receive up to $220 for time and effort. Contact: The study coordinator at adhdsleep@cchmc.org or 513-803-0771.
have Questions?
If you have a question for the pediatrician, email youngandhealthy@cchmc.org.
@cincychildrens
facebook.com/cincinnatichildrensfans
t u mm y c a pa c i t y f o r i n fa n t s
1-2 days
3-6 days
1 wk - 6 mths
6 mths - 1 yr
the size of a grapefruit the size of a cooked chickpea
the size of a grape
Adult the size of a small cantaloupe
the size of a strawberry
youtube.com/cincinnatichildrens
development and protection from illnesses. Most breastfed babies are fed on demand – about every two-to-three hours until we start adding solid foods. If moms are unable to breastfeed, we recommend formula for the first four-to-six months. Solid foods (baby foods) are then started and should be added slowly to monitor for food allergies. Q: What one thing about a baby’s stomach
would most surprise parents?
A: The size. A good gauge for the size of
7-13 ml
1-2 oz
2-3 oz
Q: Why is early prevention so important? A. We are already seeing severe obesity
in pre-school age kids, which can lead to many medical problems in school-aged children that have previously only been seen in adults (blood pressure problems, type 2 diabetes, etc.) Eating habits are already developed in the infant and toddler years. In infants, we can already see their weight deviating from healthy levels as early as 6 to 12 months of age.
Q: Are childhood weight issues related to
genetics or learned behavior like eating habits?
3 oz 2 cups
4 cups
A: Both. Some families do have a
disadvantage with their genes, making them more likely to become obese and have related health problems. But if your genetics didn’t give you a good starting place, that just makes it more important to develop healthy eating habits. Kids who have parents who are obese are three to four times more likely to be obese as well.
a baby’s stomach is the baby’s own fist – they’re pretty similar in size. In the first few weeks of life, it’s even smaller. This just shows that newborns don’t need to be eating four to six ounces of formula at a time – this leads to feeding problems, spitting up, etc.
Q: What if the baby is still fussy/crying after
feeding? Does he or she need more food?
A: Some babies just need extra sucking (not
an extra bottle) between meals or after a feed. They use sucking as a comfort mechanism. Check for other reasons for fussiness – a dirty diaper, needs burping. Not all crying and fussing is because of hunger. If you’re concerned, ask your pediatrician.
cincinnatichildrensblog.org
Helpful tips
How to Help Your Baby with Reflux/ Spitting Up n
Do not overfeed.
Make sure to burp the baby frequently during feeds – every 1-2 ounces.
n
Keep your infant upright and calm for 2030 minutes after each feeding, preferably by holding them.
n
Do not place your infant in a car seat or swing while feeding because it can increase pressure on their belly.
n
Keep your baby away from tobacco and other chemical smoke.
n
Q: What should newborns be eating? A: We recommend breastfeeding exclusively
for the first six months of life. It provides many health benefits related to nutrition,
FETAL (Family an d Environm ent in the Timing of Ab normal Labor) Study
Have you had a premature baby or are you at risk to do so? What: This is a research study to determine if there is a pattern in some families of mothers giving birth prematurely, and if so, to explore a possible genetic link. Who: Women who have given birth to a premature baby (more than one month before their due date) or are at risk for giving birth prematurely may be eligible to participate. Pay: Participants will receive between $50 and $100 for their time. Details: Contact Dr. Louis Muglia at louis.muglia@cchmc.org or 513-803-7902. Or to take a survey to see if you are eligible for this study, by visiting www.cincinnatichildrens.org/fetalstudy.
abou t t h i s i s s u e
s p r i n g 2016
Young and Healthy is a quarterly publication from Cincinnati Children's Hospital Medical Center. For more health news and patient stories, subscribe to our monthly e-newsletter online at www.cincinnatichildrens.org/subscribe © 2016 Cincinnati Children's Hospital Medical Center produced by
The Department of Marketing & Communications Cincinnati Children's Hospital Medical Center 3333 Burnet Ave., MLC 9012, Cincinnati, OH 45229-3026 Phone: 513-636-4420 Advisers: Chris Peltier, MD, and Zeina Samaan, MD Editorial Consultant: Jillian Klein, MD Editorial Staff: Tom O’Neill, managing editor Photography: Tine Hofmann, tm photography Design: Christina Ullman & Alix Northrup, Ullman Design 3
emotional
understanding the warning signs in teens
h e a l th
online l e a r n m o r e ab o u t the program http://www.cincinnatichildrens. org/service/s/surviving-teens/ suicide-prevention-program/
n
80 percent of teens
who die from suicide dsplay warning signs.
P r ev e n t i n g t ee n s u i c i de : Emotional health of teens is complicated, but these tips will help parents better understand the warning signs - and what to do about them. Research about teens who die from suicide shows that while some do not show outward signs of their emotional state, most do. In fact, it’s about 80 percent. Cathy Strunk, a suicide prevention expert at Cincinnati Children’s, encourages parents to know the difference between a teen’s serious emotional instability and the usual mood-swings or temporary blues that all teens experience at some point. It can make for some tricky navigation for moms and dads.
A pare nt’s g uid e
Strunk, MSN, RN, says the most important thing a parent can do is look for, and listen for, warning signs that often show up in combination. “Look for a cluster of symptoms that are occurring within the same two-week period or longer,” Strunk says. “Suicide is highly complex and cannot be attributed to a single cause.” Often, she says, it occurs when teens who have an underlying mental health condition encounter stressors that are beyond their abilities to cope. Schools, and the pressure to excel both academically and socially, can be a contributory risk factor for suicide, too, according to the American Association of Suicidology in Washington.
“Look for a cluster of symptoms that are occurring within the same two-week period or longer. Suicide is highly complex and cannot be attributed to a single cause.” Cathy Strunk, MSN, RN, Child and Adolescent Psychiatry
4
In a typical classroom of 30 students, three teens will have already attempted suicide. Strunk often cites that statistic while teaching her Surviving the Teens® / Suicide Prevention Program at Cincinnati Children’s. “It’s an alarming number and it is very real,” she says. Today, many kids are connected into the online world at earlier ages than ever, sometimes well before middle-school. Parents often struggle with finding a balance between “snooping” too much and keeping their child from digital dangers. “Although it is important for parents to respect teens' privacy,” Strunk says, “they need to also ensure their teens are practicing online safety.” She recommend this online source of insight for parents: www.awiredfamily.org. Above all, it is important to communicate with your child consistently. “Of course,” Strunk says, “parents can always consult their child's doctor about any questions or concerns.”
n
Cathy Strunk, M SN, RN
A suicide prevention expert at Cincinnati Children’s, she developed the “Steps to LAST” tips as a part of the Surviving the Teens® / Suicide Prevention Program.
t o p 10 warning s ig n s
of teen suicide: Looking for ways to die such as online researching of methods or means, like trying to buy guns, ropes, pills or knives.
1.
A Parent’s Guide to Listening
Making direct or indirect statementsabout death, suicide, or suicide ideation/plan.
2.
Listen for these warning si gns of depression an d suicide:
l is ten w ithout showing shock or surprise or expressing judgment. Accept feelings without shaming the person.
Writing about death, suicide or dying when this is out of the ordinary.
3.
l is ten w ithout interrupting and allow
the person to talk.
Sudden and extreme changes in mood or behaviors such as changes in routine, appearance or grooming habits.
4.
5.
l is ten to the person’s feelings and
encourage him to express those feelings. This will help him process his thoughts. Imagine how the teen feels to say what he’s saying, or to have gone through what she has gone through, and speak to the teen about those feelings.
Increased substance abuse.
Excessive or dangerous risk-taking.
6.
Seeking revenge for a real or imagined victimization or rejection.
a pa ren t 's guide
7.
Signs of severe depression including erratic sleep patterns, intense anxiety or panic attacks, irritability, uncontrolled anger, and losing interest in things or the ability to experience pleasure.
8.
to help
I f y o u n o t i c e t hat your teen is exhi bitin g so me of t h e me n t i o n e d warnin g si g ns:
Take your teen to see a doctor or call a crisis line volunteer at 1-800-273-TALK. n
If he or she refuses help, saying things like, “I love you and don’t want to lose you,” or “A professional will be able to help us work this out,” may persuade your child to seek help with you.
n
If you believe your teen is in immediate danger or is feeling like they may hurt themselves, take your child to an emergency room. You can also call 911 if you need immediate assistance. n
9. Expressions of feeling
trapped, humiliated, being a burden to others, and losing hope or self-worth.
10. Visiting, calling or texting people to say goodbye.
Our Psychiatric Intake Response Center (PIRC) staff can help direct you to the mental health services that best meets your need. The number is 513-636-4124. The email address is psychiatryresponse@cchmc.org. The PIRC is staffed 24 hours a day, seven days a week, year-round.
n
a paren t's guide to Cincinnati Children’s Visit the Surviving the Teens® / Suicide Prevention website at: www.cincinnatichildrens.org/service/s/ surviving-teens/Dealing-with-Depression/
5
behavior
ADHD solutions
management
the evolution of a dh d solutions
Cincinnati Children’s 7-week program a perfect blend of intensive treatment and summer-camp fun, sports, crafts and more
Cincinnati Children’s is again offering an innovative program for kids who have Attention Deficit Hyperactivity Disorder (ADHD), after a successful debut last year. The Summer Treatment Program is a summer camp for children ages 8 to 12, providing intensive behavioral interventions within a fun-filled camp setting. Children learn to improve social skills, manage frustration, and follow instructions while participating in sports and classroom activities. The program will be held on the campus of Xavier University from June 13 through July 29. Sessions are Monday through Friday from 8:30 a.m. to 4:30 p.m. The application process includes a 90-minute clinical assessment to determine eligibility. Program evaluations are offered at the Center for ADHD, which is located at Cincinnati Children’s Oak Campus, 2800 Winslow Ave., fifth floor, suite 5200, Cincinnati. Currently, this program is not approved for health insurance coverage as a mental health expense. Health Saving/Flexible Spending Accounts may be eligible to be used. Tuition is $4,500.
6
What are the symptoms? Inattention: A child who wanders off-task, lacks persistence and struggles to sustain focus. These are different from simply being defiant or lacking in comprehension. n
n Hyperactivity: A child who seems to move about constantly, or who fidgets, taps and talks excessively. n Impulsivity: A child who makes hasty actions without thinking through the consequences or risk of harm, who may be socially intrusive or excessively interrupts others.
What is the cause? The exact cause is still unknown, but research into the development of the condition shows a combination of genes and environmental factors likely plays a role.
Our Center for ADHD offers: ADHD assessment: We explain the evaluation process for children and adolescents. Parenting interventions: We offer several behaviorallybased group therapy programs to empower parents. Family therapy: Parents and caregivers will receive individualized training to manage ADHD behaviors.
Adolescent education support: Designed for children ages 12 to 15, we strive to help them achieve success in school. Frustration management: Designed for children ages 8 to 11, we will help your child more effectively cope with frustration and negative emotions.
To learn more about available services, visit our website at: http://www.cincinnatichildrens.org/service/c/adhd/services/default/
for m ore information contact ADHDSTP@cchmc.org or call at 513-803-7708.
Frequently Asked Questions
What is unique about the progr am ? 1 of only 13 evidence-based, award-winning STP programs in the U.S.
n
Provides intensive behavioral interventions with two-to-one student-to-counselor ratio
Treatment is tailored to each child and emphasizes positive reinforcement through a point system and daily camp-home communication
n
n
Counselors are trained and supervised by a licensed psychologist specializing in ADHD treatment who is on-site each day
n
Who is the program designed for? Children ages 8 to 12 years who have a primary diagnosis of ADHD.
n
Parents are encouraged to attend weekly group training sessions provided throughout the program to better manage their child’s behavior.
n
Management techniques to improve compliance and promote their child’s ability to more independently complete age-appropriate tasks at home and school.
a typical
day at the camp
n
Your child will enjoy a consistent, daily schedule filled with fun, recreational and educational activities: n Academic learning centers
All activities are designed to develop and improve: n Effective social skills including listening, cooperating, and conflict resolution
n
Sports and swimming
n
Following classroom rules
n
Arts and crafts
n
Managing frustration
n
Computer lab
n Teamwork and good sportsmanship
How do I sign up my ch ild? Availability is limited to ensure your child receives the individualized care and attention he or she deserves. Eligibility appointments will be available through the end of May, but consideration will be made later if space is available.
7
inside
this issue
3333 Burnet Avenue, MLC 9012 Cincinnati, Ohio 45229-3026
preventing teen suicide Tips will help parents better understand the warning signs and what to do about them.
adhd management Learn about Cincinnati Children’s 7-week summer program.
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spring 2016
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A guide to your child’s good health
providing seasonal allergy
solutions
Learn about options to help manage your child's symptoms.