Young & Healthy Winter 2013
Bringing you healthier, happier holidays from Cincinnati Children's.
TIPS ON HOME child safety All button batteries are small enough for a young child to swallow. The batteries emit electrical current that can burn the esophagus and stomach if they get stuck. If you think your child has swallowed a battery, play it safe and go to the emergency room. W EN D Y P O M ERA N T Z, MD, MS Professor of Clinical Pediatrics, Division of Emergency Medicine at Cincinnati Children's Hospital Medical Center T HE D A NGERS OF TINY M A GNETS A ND Those tiny magnets that hold reminders to your fridge can cause big harm to a child who swallows them, says Wendy Pomerantz, MD, an emergency physician with Cincinnati Children’s. The magnets can stick to each other across the bowel wall and cause an obstruction or perforation that requires emergency surgery. Likewise, the small toy magnets called “buckyballs” should be kept far from little ones who like to put things in their mouths. And many parents aren’t aware that the small button batteries that play music when you open a holiday card can cause serious harm to a child if swallowed. So can the batteries that power grandpa’s hearing aid. Or your wristwatch. Or your TV’s remote control. The injuries occur when kids swallow the batteries – many are no bigger than a fingernail, some are as large as a coin. Much of the time, they pass through the body without problems. But when they don’t, you need to take prompt action. The batteries can emit an electrical current that burns. “If the battery gets stuck in the esophagus or stomach, it can take as little as two hours before it starts to erode and cause damage,” says Pomerantz. If you think your child has swallowed a battery, don’t take chances. Get to the emergency room right away. n button batteries UN-BUTTON your home Don’t leave musical greeting cards or storybooks around for little ones to tear open or chew on. n Throw away any toys that are powered by button batteries unless they have covers that screw in place to keep the battery secure. n Hunt through cabinets and drawers and move any button-battery items out of the reach of little hands. n Remind grandparents and older family members not to leave hearing aids lying around. n 1 ASK THE JO H N BRUNS, MD , is a community pediatrician affiliated with Cincinnati Children’s. He practices at Queen City Physicians in Groesbeck/Ross-Hamilton and is president of the Cincinnati Pediatric Society. pediatrician advocate F OR YO UR CHIL D’S HE A LT H THE FAMILY RESOURCE CENTER The center helps families, community providers and agencies find health information, community resources and support. Call 513-636-7606 for assistance. Which should I give my child for fever – acetominophen or ibuprofen? G I VI NG THE RI G H T dose The charts below are professional dosage schedules for administering acetaminophen and ibuprofen. It is extremely important that you use either the dropper, syringe or medicine cup that is provided with your medicine to dispense to your child. More information can be found at www.cincinnatichildrens.org/ health/f/fever SPECIA L NEEDS RESOU R CE DIRECTORY Use this directory to find information, resources and advocacy strategies at www.cincinnatichildrens.org/ special-needs. J OIN SP E CI A L CON NEC TI ONS Our new online community connects with others parenting a child with special healthcare needs: www.cincinnatichildrens. inspire.com. Administer every 4-6 hours, do not exceed more than 5 doses in a 24 hour time period. Infant's Infant's Oral Suspension Suspension & Original (New Drops (Old Concentration) Concentration) 80mg/0.8ml 160mg/5ml dropper 0.4 ml 0.8 ml 1.2 ml 1.6 ml syringe Children’s Suspension Liquid and Elixir 160mg/5ml teaspoon Children’s Chewable Tablets 80mg each tablet Junior Strength Chewable Tablets/ Caplets 160mg each tablet/caplet Children’s Tylenol (acetaminophen) with New Concentration 2011 WEIGHT 6-11 lbs 12-17 lbs 18-23 lbs 24-35 lbs 36-47 lbs 48-59 lbs 60-71 lbs 72-95 lbs 96 lbs & over AGE 0-3 mos 4-11 mos 12-23 mos 2-3 yrs 1.25 ml 2.5 ml 3.75 ml 5 ml 1 /2 tsp /4 tsp 2 3 4 5 6 2 2 1/2 3 4 3 1 tsp 1 1/2 tsp 2 tsp 2 1/2 tsp 3 tsp 4-5 yrs 6-8 yrs 9-10 yrs 11 yrs 12 yrs 2 HAVE QUESTIONS? If you have a question for the pediatrician, email email@example.com JOIN A RESEARCHSTUDY A s we approach cold and flu season, I commonly get questions about the use of acetaminophen and ibuprofen to manage fever. As parents, we don't like to see our children sick and uncomfortable. And though many people worry about fevers, they are a natural part of our body’s defense. While monitoring the temperature is important, as or more important is the behavior of the sick child. A child with a low fever who is breathing fast, irritable and acting sick concerns me more than the active, playful child who has a fever of 103. Acetominophen and ibuprofen both work to make children more comfortable, and are generally viewed as safe when you follow dosing guidelines. Infants under 2 months, however, require special consideration since they may not give any indication of the cause of their fever. Call your doctor if your young infant is running a fever over 100.5 or is acting sick. As with all medications, be careful in using acetaminophen and ibuprofen. Each has a limited dose recommendation for a 24-hour period. I recommend keeping a log with the name, time and dose of medication given to prevent duplication and overdosing. If you give your child additional meds, read labels carefully, since multi-symptom cold medicines may already have acetaminophen in them. Too much acetaminophen can damage the liver. Ibuprofen may alter the blood flow to the kidneys and should not be used in dehydrated children or children with kidney disease. Due to its association with Reye’s Syndrome, we don’t recommend using aspirin to treat fever symptoms. n Researchers at Cincinnati Children’s conduct hundreds of studies each year to figure out why people get sick and what treatments might help them. Discoveries researchers make in the lab can lead to even better treatments and ways to prevent diseases from happening in the first place. Did you know you could be part of the process of helping our scientists solve medical mysteries? You can participate by joining a research study. Here’s what we’re recruiting volunteers for now. 2- TO 12-YEAR- OLDS WITH PSORIASIS NEEDED FOR A RESEARCH STUDY What: We want to learn how the study drug, an ointment applied two times a day, is handled by the body in children with psoriasis. Who: Children, 2 to 12 years old, with plaque type psoriasis, may be eligible for participation. Pay: Participants may receive up to $600 for completing all of the study visits. Contact: Laurie Vanderah at firstname.lastname@example.org • 513-803-0003 HAVE YOU HAD OR ARE YOU AT RISK TO HAVE A PREMATURE BABY? FETAL (Family and Environment in the Timing of Abnormal Labor) Study 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. Contact: For more information, contact Dr. Louis Muglia at email@example.com • 513-803-7902. To take a survey to see if you are eligible for this study, go to www.cincinnatichildrens.org/fetalstudy. Children’s Motrin/Advil (Ibuprofen Suspension 100 mg/5ml) 6-11 mos 12-23 mos 2-3 yrs 4-5 yrs 6-8 yrs 9-10 yrs 11-12 yrs Adult lbs 13-17 18-23 24-35 36-47 48-59 60-71 72-95 96-154 kg 6-7.9 8-10.9 11-15.9 16-21.9 22-26.9 27-31.9 32-43.9 44-70 1 Administer every 6-8 hours, do not exceed more than 4 doses in a 24 hour time period. AGE WEIGHT DOSE 10 mg/kg /2 tsp (50 mg) ABOUT THIS ISSUE PRODUCED BY W I N T E R 2013 | VOL 26 ISSUE 4 1 tsp (100 mg) 1 1/2 tsp (150 mg) 2 tsp (200 mg) 2 1/2 tsp (250 mg) 3 tsp (300 mg) 4 tsp (400 mg) 4 tsp (400 mg) 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: John Bruns, MD Editorial Staff: Mary Silva/managing editor Photography: Tine Hofmann, tm photography Design: Christina Ullman & Alix Nothrup, Ullman Design 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 eNewsletter online at www.cincinnatichildrens.org/subscribe © 2013 Cincinnati Children's Hospital Medical Center @cincychildrens facebook.com/cincinnatichildrensfans youtube.com/cincinnatichildrens cincinnatichildrensblog.org 3 FOCUS ON protect your child's health nutrition D E A L I N G WI T H D U R I N G T H E H O L I D AY S food al l e rg ies Gatherings at this time of year almost always involve food. For parents of kids with food allergies, that can mean added worry about what they’re exposed to. I f you are unsure about whether your child is allergic but he has shown some signs of a food allergy, pediatrician Charlie Cavallo, MD, says to talk with your pediatrician and have your child tested. “It’s important to take food allergies seriously,” Cavallo says. “Even if your child has only had a mild reaction to a certain food one time, the next reaction could be severe. Reactions can be unpredictable. The safest thing is to avoid the food altogether until you can get your child tested.” Testing by an allergist can determine specifically what a child is allergic to, especially if he’s had a reaction after eating several foods and you’re not sure which one was the cause. Do not try to test it yourself by giving a child small amounts of the suspected food, Cavallo says, and don’t assume that cooking or baking the food will make a difference. Skin or blood testing by an allergist is the only true way to tell. n CHARLI E CAVALLO, MD. General Pediatrician with Pediatric Associates of Northern Kentucky foo d all e rg y TIPS FROM THE P E D I AT R I C I A N When planning for the holidays, whether for parties outside your home, school or daycare activities, or even going to a restaurant, here are some tips from pediatrician Charlie Cavallo, MD: n Know what your child is allergic to. Always carry an EpiPen®. Inform your child’s school or daycare n If you’re visiting, let your host know in advance. At a restaurant, tell the waiter. From an early age, make sure your child online n n For more information go to AAAAI.org American Academy of Allergy, Asthma and Immunology Foodallergy.org. Go to Cincinnati Children’s blog to read about one mom’s experience with food allergies during the holidays. n n teachers about his allergy. knows what she is allergic to and why not to eat that food. 4 PA R E N T I N G A D V I C E F O R children with special needs online Go to http://support.autism-society.org to download a PDF of holiday guidelines. KEEPING HOLID AYS Regardless of what traditions your family celebrates, for a child with an autism spectrum disorder, the break from routine that holidays bring is especially challenging. Here are just a few ideas to help make holidays more enjoyable for your child, and your family. calm JUDY REINHOLD, RN, MSN, CPNP Kelly O' Leary Center at Cincinnati Children’s n PREPARING IS KEY n DECORATIONS n TIPS FOR TRAVEL A little preparation goes a long way toward keeping things calm, says Judy Reinhold, RN, MSN, CPNP. Reinhold works with families at the Kelly O’Leary Center for Autism Spectrum Disorders at Cincinnati Children’s. “During the holidays, routines go out the window,” Reinhold says. “Parents know best what their child will enjoy and what will be a struggle, so they should plan accordingly.” Reinhold says one good way to prepare a child for holiday gatherings is with “social stories” – creating a story with pictures to prepare the child for what to expect in various situations. Lights and decorations, music – even new foods and smells – can be overwhelming to a child with autism. Limiting changes in routine and introducing new things gradually, whenever possible, can help your child get comfortable with them. n GIVING AND RECEIVING GIFTS Bring your child’s favorite foods, books or toys along. This is especially helpful if there are delays. If you are flying for the first time, you might bring your child to the airport in advance to help him see what it is like. Or use stories and pictures to rehearse what will happen when boarding and flying. n Practice giving gifts and taking turns opening gifts. Role play with your child to prepare him for receiving a gift he does not want. Keep familiar toys nearby. n ENGAGE FAMILY MEMBERS FEELING OVERWHELMED If you are having visitors, designate a quiet, safe place in the house where your child can go when feeling overwhelmed. If you are away from home, ask your host to identify a spot where your child can go when things get hectic. Don’t shield your child from extended family. With some help from you, family members can understand the challenges you face, and can even be a source of support. n ABOVE ALL, TRUST YOURSELF The most important thing, says Reinhold, is to trust what you know about your child. n 5 CHILD LIFE AND psychology LYNN SANNE R Child Life Specialist and Educator, Department of Child Life at Cincinnati Children’s Decide What’s Important to You “Most of us are already leading very full lives just taking care of our work and our families,” says Sanner. “The holidays can add another layer of responsibility to what we already do.” Talk with your family about what is most meaningful and beneficial about your holiday observance, she suggests. “Choose two or three things about the holiday that your family cares about most, and limit your activities to those things.” we’ve made or words we give to people,” she says. A handmade note to a teacher from your child about something he really enjoyed doing in school, or doing something thoughtful for a neighbor or friend, can be precious gifts. HOLIDAYS Most people love celebrating holidays – time to be with family and friends, enjoy special foods and observe family traditions. But holidays can also bring the pressure to do more and spend more than we are willing or able. If holidays leave you feeling stressed out, there are ways to set limits and make the time more meaning ful, says Lynn Sanner, a child life specialist and educator in the Department of Child Life at Cincinnati Children’s. Putting more meaning into your Volunteering Take Time for Your Health Sanner says it’s especially important to take time for healthy activity during the holiday season. “Eating well, exercising, getting enough sleep – all of those things are threatened if we overdo it during the holidays,” Sanner says. And make sure kids stick to predictable routines and regular schedules, especially while school is in session. “School holiday concerts and parties can be great fun, but they can also be disruptive to homework and home routines.” Giving back to the community is a great idea. “But agencies get a lot of offers of help at holiday time, and what they need is help in August,” she says. “For a young child, it is probably most effective to provide service specifically at holiday time. Older children may be happy to consider what they can do later in the year.” Give Kids an 'Out' To help children set limits during the holidays, a little creative license may be in order, says Sanner. You may help your child decline invitations to become too busy, perhaps by using a response such as “My mom says I’m not allowed to.” “This phrase provides a really good shelter for kids,” Sanner says. It Doesn't Last Forever Rethink Your Giving Everyone enjoys giving gifts to those they care about. Gifts can take many forms, says Sanner. “The most valuable gifts come from creativity – things Most important, she says, “Know that whatever you do for your family’s holiday is enough. Enjoy the parts of your holiday that you care about the most and let go of the things that don’t really matter.” n 6 TIPS holiday FO R A S A F E Seeing holidays through the eyes of a child is one of life’s great joys. Help keep your holidays joyful by taking a few precautions. “It’s difficult to imagine that some of the fun and festive things we do could pose risks to young children, but they can,” says Melissa Klein, MD, a pediatrician in the Division of General and Community Pediatrics at Cincinnati Children’s. Klein offers a few tips to help keep children safe and holidays happy. ME LI SSA K LE I N, MD. General Pediatrician, Division of General and Community Pediatrics at Cincinnati Children’s Hospital Medical Center Poinsettias are not poisonous, as is commonly believed, but mistletoe berries are. It’s a good idea to keep all flowers and greenery out of reach of children. Wrapping paper, ribbons, and bows can be choking and suffocation hazards. And watch out for foam peanuts and other plastic items used in packaging. decorations H O L I D AY KITCHEN Busy, crowded kitchens are part of most holiday households. “Burns and scalds are a major holiday hazard,” says Klein, so be extra cautious when cooking and carrying hot foods or liquids from one room to another – especially if there are little ones in the house. safety TREE If your holiday traditions include a tree, be sure to secure it from tipping over. If you have an active toddler, you might want to think about blocking the tree from little hands with a safety gate. Don’t place ornaments or lights on the bottom portion of the tree, where toddlers (and pets) can reach them. safety LIGHTING candles If your holiday traditions involve lighting candles, keep the lit candles out of reach of children. Avoid placing lit candles on tablecloths that can be pulled down. In fact, pass on tablecloths altogether – crawling toddlers can tug at them, sending dishes, hot food, and candles flying. TOY Pay attention to age-appropriate labels on toys, and keep a special hazards POISON CONTROL hotline lookout for tiny parts from older siblings’ toys that babies might swallow. See the article about button batteries and magnets on page 1. If you’d rather be safe than sorry, keep the poison control phone number handy. The Drug and Poison Information Center at Cincinnati Children’s has a 24-hour hotline, 1-800-222-1222. 7 CINCINNATI CHILDREN’S LAUNCHES WKID 33 3333 Burnet Avenue, MLC 9012 Cincinnati, Ohio 45229-3026 Our newly-opened Seacrest Studio will make it possible for Cincinnati Children’s patients to enjoy kid-friendly music, game shows, celebrity interviews and more, right from their hospital rooms. The closed-circuit television and radio station WKID 33 operates from the multimedia broadcast facility on our Burnet campus, developed in partnership with the Ryan Seacrest Foundation. THIS ISS UE inside ALL IS CALM Helping children with autism enjoy the holidays. S A F E AT H O M E Tips on keeping your child safe during the holidays. young and A guide to your child’s good health healthy meaningful WINTER 2013 VOL 26 ISSUE 4 making holidays How to make the most of seasonal celebrations with your child.