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News for  Families

Vol. 35, No. 1

Taking the initiative to

control diabetes The summer of 2010 is a distant memory for most of us after the long winter months, but for Ken Luke of Beavercreek, it seems like another lifetime. It was in June 2010 that the 17-year-old finally learned the cause of some disturbing symptoms he had been experiencing.

Continued on page 4

Baby’s fever: When should you worry? (Page 3) Taking control of diabetes Growing up too early

(Page 4)

(Page 6)

Excellent care: Trauma center reverified; new specialists join staff (Page 7)

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RSV: Kids get sicker than adults

2

For you, an RSV infection may

Test your child safety IQ Keeping your child safe shouldn’t be guesswork. Find out how much you know. Take our childproofing quiz today. Go to childrensdayton. org/story. Enter the keyword “quiz.”

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●● Thick nasal discharge ●● Worsening cough or a cough with

yellow, green or gray mucus ●● Signs of dehydration For more on preventing and treating RSV, visit childrensdayton.org/story. Enter “RSV” as the keyword.

Immunizations: Three key changes to be aware of continued from back cover…

Growing Together is published quarterly for parents and families in the Miami Valley area by The Children’s Medical Center of Dayton. The purpose of Growing Together is to show how Dayton Children’s and families are working together to keep all children healthy and safe. Additional copies of Growing Together are available by writing to Dayton Children’s, c/o Marketing Communications, One Children’s Plaza, Dayton, Ohio, 45404-1815 or by calling 937-641-3666. Your suggestions and comments are also appreciated. For more information: Cert no. XXX-XXX-XXXX 937-641-3666 childrensdayton.org

seem just like the common cold – stuffy or runny nose, sore throat, mild headache, cough, fever and general sick feeling. But in a child, it could be a very different story. “RSV infects the lungs of children, so major symptoms are rapid breathing or wheezing,” says Sherman Alter, MD, director of infectious disease, Dayton Children’s. “RSV is more serious for children, especially those with risk factors such as asthma or prematurity.” According to Dr. Alter, almost all children get RSV at least once

as an infant. If a child has had RSV once, he or she can still catch it again, but the symptoms may be milder than before. Call your child’s doctor if your child has any of these symptoms: ●● High fever and looks sick

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Cert no. XXX-XXX-XXXX

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8 recommendations to make note of 1. All persons aged 6 months and older should receive influenza vaccine annually.

girls 11-12 years of age with catch-up vaccination for those aged 13-26 years who were not previously vaccinated. HPV vaccine may be given to males aged 9-26 years.

2. Children at 12-23 months should

7. Adolescents aged 11-18 years who

be vaccinated with hepatitis A virus vaccine. 3. All infants should receive rotavi-

rus vaccine to protect against diarrhea caused by this virus. 4. Children must receive two doses

of varicella (chickenpox) vaccine (12-15 months and 4-6 years) with catch-up vaccination for others who have not been fully vaccinated. 5. Meningococcal conjugate vaccine

(meningitis vaccine) should be given routinely at age 11-12 years with a booster dose of the vaccine given at age 16 years. If given to unvaccinated adolescents aged 13-15 years, then a booster dose is given at age 16-18 years. 6. The human papillomavirus (HPV) vaccine series (three immunizations) should be administered to

have completed the childhood DTP or DTap (diphtheria toxoid , tetanus toxoid and pertussis) vaccine series and adults aged 19-64 years should receive a single dose of Tdap vaccine (Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) Children aged 7-10 years not fully vaccinated with DTap at a younger age should receive a single dose of Tdap. Importantly, adults (parents, grandparents, child care providers) who have or anticipate having close contact with an infant aged less than 12 months should receive a single dose of Tdap vaccine. 8. Infants and young children

receiving the pneumococcal vaccine (PCV7) should complete the vaccine series with the new vaccine (PCV13) that affords additional protection

against serious infections caused by this germ. Infants starting the vaccine series should be vaccinated with PCV13. No autism and MMR link If you’ve been watching the news, you know that often-cited British study by Andrew Wakefield, MD, has been denounced as fraudulent. This study linked the MMR vaccine to autism in children. In the United States, more cases of measles were reported in 2008 than in any other year since 1997, according to the Centers for Disease Control and Prevention (CDC). More than 90 percent of those infected had not been vaccinated or their vaccination status was unknown, the CDC reported. The diseases that are prevented by the MMR vaccine can have serious and even deadly side effects. For example, mumps can lead to sterility in males, and rubella (German measles) can cause miscarriage or serious birth defects if a pregnant woman is infected.

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Are teens hurting their hearing? You’re not the only one wondering

●● The volume on iPods and other

turer’s maximum volume setting is safe. It is not.

music devices can exceed 100 dB (decibel), the same as standing next to a pneumatic drill.

●● Listening to ear buds or in-ear

headphones for 90 minutes at 80 percent volume is probably safe, but softer is always better.

●● The risk of permanent hear-

ing lost can increase with just five minutes of listening to music at full volume. If you fear your child might have a hearing loss, an audiometric evaluation is available in Dayton Children’s audiology department. Talk to your child’s doctor about making a referral. If you have questions or need information, call audiology at 937-641-3253.

To read more about hearing loss and testing, go to childrensdayton.org/story. Enter the keyword “hearing.”

Help your teen be a safe driver… before starting to drive

Baby’s fever: When should you worry?

relations manager at Dayton Children’s and Safe Kids Greater Dayton USA in equipping teens ages 13 to coordinator. According to Saunders, 14 and their parents with important “Motor vehicle crashes are the numinformation to use before the teen ber-one killer of teens, with driver is driving legally. Resources such as inexperience and distractions as the a parent-teen passenger agreement main causes of teen crashes.” and easy-to-use web-based tools Visit Countdown2Drive.org to are offered through a new program read about learners’ permits, get help called Countdown2Drive. establishing family driving rules and “Our goal is to help young teens guidelines, access targeted safety transition from passengers to drivers,” information and more. says Jessica Saunders, community

A sure sign our immune system is

Dayton Children’s joins Safe Kids

3 healthbeat

if teens are hurting their hearing by listening to music through ear buds or in-ear headphones. A group of researchers at Colorado University and Children’s Hospital in Boston wondered the same thing and recently published results of a study looking at iPod-related hearing loss. According to Linda McGinnis, a Dayton Children’s audiologist, she and her staff use the research findings to educate teens and their parents about hearing loss. ●● Teens tend to play music louder than adults and are often unaware of how loud they’re playing it.

●● Teens often assume the manufac-

working as it should is a fever. In normal, healthy children and babies older than 3 months of age, a fever up to 102 degrees F is not something to be too concerned about. Child health experts reassure parents that a fever itself causes no harm and can actually be a good thing, as it’s often the body’s way of fighting infections. Febrile seizures – those caused by a high fever – can be scary for parents, but are a relatively common and harmless side effect of fevers in young children, according to the American Academy of Pediatrics (AAP). They do not mean your child has a seizure disorder and do not cause brain damage. It is still a good idea, however, to let your doctor know if your child experiences a febrile seizure. Finally, if a febrile seizure lasts longer than five minutes or if your baby is younger than 3 months old and has a fever, call your child’s doctor right away. For more information on fever, taking your child’s temperature, treatment and side effects, go to childrensdayton.org/story. Enter the keyword “fever.”

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Endocrine care at Dayton Children’s Exceptional care and the latest treatments for diabetes and endocrine disorders are available at Dayton Children’s. Each board-certified pediatric endocrinologist is an expert in diabetes, growth hormone therapy, thyroid and other endocrine disorders. Dayton Children’s offers the advanced insulin pump program, which helps children and young adults better manage their diabetes and allows our doctors to remotely monitor important indicators. We offer superior care through our inpatient program for kids newly diagnosed with diabetes. Our endocrine clinic is held five days a week, providing care for children with diabetes, growth hormone, precocious puberty, thyroid and other endocrine disorders. Your child’s doctor can make a referral if needed by calling our central scheduling number – 937-641-4000.

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COVER S TORY

Taking control

diabetes diagnosis

after a

Insulin pump records help the endocrinology care team evaluate how well Ken Luke’s diabetes is being managed.

Ken made an appointment with his family doctor because he had been drinking six gallons of water a day and was up six to eight times during the night to use the bathroom. Then he started losing weight. “I got to the doctor and he didn’t seem too concerned. He took some blood and said they would call me in a day or two with the results.

I

t was the middle of summer. I was having a good day just rockin’ out. I literally just walked in the door after getting home from the doctor and the phone was ringing. It was the doctor’s office,” Ken recalls. “The doctor told me ‘You need to go to Dayton Children’s emergency department right away. There’s a team waiting for you.’” His doctor suspected diabetes. Ken discovered that his blood sugar was 880 – the normal range is 80-150 for a person his age. The diabetes team delivered insulin to him through an IV, and he was admitted

to the hospital for three days to get his blood sugar levels normalized and to learn about type 1 diabetes. This is when he met Yelena Nicholson, DO, a pediatric endocrinologist at Dayton Children’s, and a diabetes expert. Ken quickly learned how to use a syringe to inject insulin, to check his blood sugar several times a day and to monitor his intake of carbohydrates. “The team did a great job educating me about diabetes – everyone was helpful and nice. For being in the hospital, it was a rather enjoyable stay,” he says.

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insulin pump also allows Dr. Nicholson to remotely monitor data uploaded to the Medtronic website from Ken’s pump. When Ken comes in for an office visit, the first thing the nurse does is download data from his pump, which is presented as a graph of his blood sugar levels and other key indicators over the time period since his last visit. “I really respect Dr. Nicholson,” Ken says. “She has life experience – a family member has type 1 diabetes – but she also has book experience. It’s been really helpful to be able to communicate with her by e-mail. I feel like she really stays on top of everything.” “Ken is a patient I would call his own advocate,” says Dr. Nicholson. “He always takes the initiative to ask me about new technologies and learn new things by researching on the internet. I think one of the great things about Ken is that he was not scared to learn how to care for his diabetes in a different way. He wanted to try the pump and judge for himself if it was right for him.” Ken has taken his diabetes diagnosis in stride. His one regret is that he is no longer eligible for military service. “I was a little disappointed, but they say God works in

mysterious ways, so maybe it’s for the best.” He now attends Sinclair Community College and hopes to go into engineering. “My advice to anyone diagnosed with diabetes is to listen to the people taking care of you, but to learn as much as you can on your own. It’s easy to manage if you pay attention and don’t let it get away from you,” Ken says. Talk to your child’s doctor if you suspect your child might have diabetes. He or she can make a referral to Dayton Children’s pediatric endocrinologists. To learn more about the symptoms, diagnosis and treatment of both type 1 and type 2 diabetes, go to childrensdayton.org/story. Enter the keyword “diabetes.”

5 DaytonChildren’s focus

After leaving the hospital, Ken began seeing Dr. Nicholson in the diabetes clinic at Dayton Children’s. Immediately after his diagnosis, Ken was still using needles to inject his insulin, but within four months, Dr. Nicholson talked to him about switching to an insulin pump. “Ken was a good candidate for the insulin pump because he was motivated to improve control of his diabetes, which is the main benefit of the pump,” she says. He was also willing to wear a pump device (attached under the skin), check his blood sugar four times a day, learn how to count carbohydrates and insulin doses, and receive education and training on using the insulin pump. With Dr. Nicholson’s recommendation, Ken was approved for a Medtronic insulin pump. Ken explains that a device inserted under the skin on his leg communicates wirelessly with the insulin pump, which is about the size of a typical cell phone. “It’s been interesting learning about the disease and how to use technology to better control my diabetes. Checking my blood, adjusting my insulin – it’s all second nature to me now.” Besides helping patients achieve better control of their diabetes, the

Type 1 and type 2 diabetes: What’s the difference? According to Yelena Nicholson, DO, type 1 diabetes used to be thought of as a childhood disease, but now we know that a person can get it at any age – even 99. “The most common age of onset is still around 9 years old, but we have seen a big increase in younger kids – newborn to 5 years old,” she says. About 10 percent to 20 percent of kids diagnosed are like Ken – 16 to 18 years old. Type 1 diabetes is caused by a destruction of the insulinproducing cells of the pancreas, which is unrelated to sugar consumption. Type 2 diabetes results from the body’s inability to respond to insulin normally. Although the tendency to get type 2 diabetes is genetically inherited in most cases, eating too much sugar (or foods with sugar, such as candy or regular soda) can cause weight gain, which can increase the risk for developing the disease.

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6

Growing up too early Most of the time, reaching a milestone early is a cause for celebrating with your child. Early puberty, however, is not a typical milestone. A recent US study found that girls are reaching puberty increasingly early. What’s going on?

Precocious puberty: Know the symptoms In girls, any of the following before 7 or 8 years of age could indicate early puberty:

F

inding the cause of this increase has been the focus of recent research. Links to the food we eat, the environment and exposure to plastics have all been mentioned in the media as possible causes for children, particularly girls, “developing early.” The link that has gained the greatest acceptance among experts, however, is the link between obesity and precocious puberty in girls. There does not appear to be this same link in boys. About five percent of boys with precocious puberty inherit the disorder. “What initiates the start of puberty is still unknown,” says Moira Pfeifer, MD, a pediatric endocrinologist at Dayton Children’s. “There are many theories, but nothing is 100 percent accepted. We do know that puberty is starting earlier in girls and not in boys. There appears to be a link between an elevated BMI and

zzBreast development

zzPubic or underarm hair

zzRapid height growth

zzStarting her period zzAcne zz“Mature” body odor In boys, watch for the following before 9 years of age:

zzEnlarged testicles or penis

zzPubic, underarm or facial hair

zzRapid height growth

zzVoice deepening zzAcne zz“Mature” body odor Talk to your child’s doctor if you notice any of these signs. He or she may refer your child to a pediatric endocrinologist for further testing and treatment.

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E a r ly p u b e r t y : N o t c au s e d by fa s t f o o d You’ve probably heard friends theorize that all the hormones in fast food are causing kids to start puberty earlier than before. While that hasn’t been proven, your friends are right about one thing: Children are going through puberty sooner than ever before. It’s the “why” of early puberty that is much more complex. Possible causes from the experts: zzObesity. Excessive body fat increases the levels of estrogen that play a role in breast development. zzEnvironmental factors such as chemicals known as estrogen disruptors. These are naturally occurring compounds or man-made chemicals that interfere with the production or activity of hormones. Chemicals can be found in plastics,

cosmetics, detergents, toys and more. You’ve probably heard the most about bisphenol A (BPA) and phthalates. zzExcessive ingestion of soy products has been linked to early puberty. Unless a child has an underlying medical problem such as a tumor or genetic disorder, the exact cause of precocious puberty remains unknown. The pediatric endocrinologist will screen for tumors or other disorders because precocious puberty is caused by a brain tumor 50 percent of the time in boys and 10 percent of the time in girls. Fortunately, even when the cause is unknown, precocious puberty can be successfully treated by pediatric endocrinologists – doctors who specialize in growth and hormonal disorders in children.

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precocious puberty in girls.” The more? Because the body releases horearly release of hormones may trigmones in cycles, giving a large dose ger breast development in girls and or bolus of this hormone causes the enlarged testicles in boys, among body’s hormone receptors to ‘down other symptoms (see box). The age at regulate.’ This means that the body which this occurs is key. recognizes this bolus as ‘too much’ “If we see breast development and stops responding to pubertal in a girl 6 to 8 years old, we would hormones,” Dr. Pfeifer explains. evaluate the child for precocious You may wonder why it is imporpuberty. Any breast development in tant to treat precocious puberty. “In girls before age 6 is concerning. In addition to the social stigma and boys, the first sign of puberty is enlarged If you have concerns about your testes. If this occurs child’s development, first talk to before age 9 years, your child’s doctor. He or she may the patient must immediately be make a referral to Dayton Chilevaluated by a physidren’s board-certified pediatric cian. This is because endocrinologists for testing and precocious puberty possibly further treatment. is due to a brain For more tumor 50 percent of informathe time in boys. A brain tumor is the tion, go to cause of precocious childrenspuberty in a girl 10 dayton.org/ percent of the time,” story. Enter Dr. Pfeifer explains. the keyword If doctors suspect “puberty.” your child is starting puberty early, your child may be referred to a pediatric endocrinoloemotional upheaval from hormones, gist for further testing. According to early puberty will cause the child’s Dr. Pfeifer, testing consists of blood growth plates to fuse, and the child work to check hormone levels and an will stop growing,” Dr. Pfeifer says. x-ray of the hand to determine bone The result is that the child will be a age. “Advanced bone age is concerntall fifth-grader, but an extremely ing because the child is losing height short adult, which carries its own set potential,” she says. An MRI may be of emotional difficulties. done to evaluate the cause of precoOne mother, whose 7-year-old cious puberty. was treated for precocious puberty at If testing confirms puberty has Dayton Children’s, has been pleased started early, the child will be treated by their family’s experience in the with hormone injections. Every 28 endocrinology department. days, the child will get an injection “Everyone caring for my daughter of leuprolide, which is a synthetic has been so nice. The nurse who gives hormone that initiates and drives the monthly injections has really pubertal progression in children. connected with her. The staff have “It sounds counterintuitive – if helped me talk to my daughter about a child’s body is already releasing this condition, and we have always hormones, why give him or her been open and honest with her.”

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newsbriefs

7

Region’s pediatric trauma center reverified The excellent care provided in Dayton Chil-

dren’s trauma center has been confirmed by the news that our center has been reverified by the American College of Surgeons. This verification is a significant accomplishment. The trauma center is part of the Soin Pediatric Trauma and Emergency Center, which saw 66,750 visits last year; that’s more than 180 children per day. Urology services expanded The depart-

ment of urology, in collaboration with Nationwide Children’s Hospital, is expanding urology services for infants, children and teens. Venkata R. Jayanthi, MD, is providing care at Dayton Children’s every Tuesday, including clinic and surgical services. Dr. Jayanthi is a full-time pediatric urologist, is board certified in urology and has an added qualification to practice pediatric urology. He joins Donald Nguyen, MD, director of urology at Dayton Children’s. New specialists join Dayton Children’s; best doctors named

●● Navjyot Vidwan, MD, joined the infectious

disease department. Dr. Vidwan is board certified in pediatrics and has a special interest in maternal-child health, global health and community outreach. ●● Hemanth Lingadevaru, MD, a pediatric intensiv-

ist, joined the department of critical care medicine. Dr. Lingadevaru is board certified in pediatrics and has a special interest in sedation and analgesia. He joins four other physicians in our state-of-the-art PICU – the only PICU in our region staffed by board-certified pediatric intensivists. ●● Jeanne Bohrer, MD, joins Ranjana Sinha, MD,

and Laura Hutchison, MD, in caring for infants, children and teens at Dayton Children’s Urgent Care – Springboro. The center offers short waits, easy parking and is conveniently located just off State Route 741; easily accessible from the Austin Boulevard exit on I-75. ●● Several physicians on Dayton Children’s pro-

fessional staff have been named “Best Doctors in America” for 2011-2012. This list is published every year by Best Doctors, who note that only about five percent of physicians practicing in the United States can claim.” Dayton Children’s had 19 physicians make the list. Go to childrensdayton.org/story and enter the keyword “best doctors.”

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inside

this issue

3 Are teens hurting their hearing?

The Children’s Medical Center of Dayton One Children’s Plaza Dayton, Ohio 45404-1815

4 Taking control of diabetes

6 Growing up too soon

News for Families

Immunizations: Three key changes to be aware of Every year, the Centers for Disease Control and Prevention (CDC) releases an updated child and adolescent immunization schedule in collaboration with the American Academy of Pediatrics and the American Academy of Family Physicians. This year’s schedule was released February 1. Sherman Alter, MD, director of infectious disease at Dayton Children’s, notes there were several changes to the immunization schedule, but there are three of particular interest to parents. “Parents and families should talk to their child’s doctor about the flu vaccine, Tdap recommendations and the meningococcal (meningitis) vaccine. These three are important,” he says. continued on page 2…

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RSV: Kids get sicker than adults / Test your child safety IQ / Help your teen be a safe driver…before starting to drive

Start on page

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Dayton Children's Medical Center - Growing Together Winter 2011