Just Kids S H A R I N G O U R PA S S I O N F O R C H I L D R E N A N D FA M I L I E S
The Power of 3D Doctors at Children’s use 3D printed models to deliver precisely targeted treatment
INSIDE The Value of a Good Night’s Slumber Fend Off Spring Ailments Safe Natural Remedies
CHILDRENSOMAHA.ORG SPRING 2019
ONLINE RESOURCES For the latest information and news, support, events, patient stories and perspectives from our physicians, check out our online resources. Facebook “f ” Logo
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welcome COMPASSIONATE CARE
Facility dogs provide comfort and affection to patients
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RICHARD G. AZIZKHAN, M.D.
President & CEO MARTIN W. BEERMAN, MHA, APR
Vice President, Marketing & Community Relations
Sansa and Sven
Children’s Hospital & Medical Center welcomed a new member to its staff last fall. She is a cream-colored Goldendoodle named Sansa. Sansa joins her facility dog counterpart Sven, a golden retriever, in helping to provide unique, specialized therapy to young patients at the hospital. Both canines assist certified Child Life specialists in
CELIA FERREL, MHA, APR
Director, Marketing & Public Relations DAVID G.J. KAUFMAN, M.D.
Medical Adviser LINDA EGGERSS
Senior Editor Just Kids is published by Children’s Hospital & Medical Center to provide general health information. It is not intended to provide personal medical advice, which should be obtained directly from a physician. © 2019. All rights reserved. Printed in U.S.A.
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Contents
offering support, comfort and normalization in the hospital setting, as well as various therapeutic interventions. Child Life specialists help patients and families address the emotional and developmental aspects of a child’s hospital visit and prepare them for certain procedures. Sansa works alongside specialist Debbie Snyder, and Sven assists specialist Britta Carr. Like many full-time employees, they work 40 hours a week — and meet infection control guidelines. “These dogs provide so much love and affection to children who need it most,” Carr says. “They light up every room they enter.” The interaction with a certified therapy dog can have a positive impact on children’s quality of life, making them feel more relaxed and less anxious, and even enhancing recovery following a serious illness. Besides offering an emotional boost, among the dogs’ responsibilities are demonstrating positioning for certain procedures, such as how and where to lie down during a CT scan. Sansa, whose first day on the job was Nov. 12, comes to Children’s with a year and a half of training in medical and service settings, while Sven has been on staff since November 2016. Canine Assistants of Georgia trained both dogs.
DOG DAYS Learn more about Child Life (From left) Debbie, Sansa, Sven and Britta
specialists and the pet therapy program, and watch a video featuring Sven at ChildrensOmaha.org/ChildLife.
TRENDING More services at Lincoln Specialty Pediatric Clinic Learn the law: Child safety seat protection now in effect The importance of a good night’s rest Steps to prevent spring illnesses PLUS:
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CARE ESSENTIALS New program helps children with autism spectrum disorders Join the online community at Children’s and provide feedback
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SPECIALTY CARE In 3D: Models help doctors plan and prep for procedures
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PREVENTION Home remedies that are safe for infants Kick the junk food habit
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LAST WORD Upcoming Parenting U classes
Trending IN THE NEWS
community
NEW LOCATION FOR PEDIATRIC ENDOCRINOLOGY Children’s Pediatric Endocrinology Clinic is now located at 8552 Cass St. in Omaha. The expanded space offers more exam rooms, family education classrooms and tablet technology for a smooth check-in experience. More providers are on hand to care for young patients and their families.
Expanded Offerings Multiple specialty services available at Lincoln clinic Children’s Hospital & Medical Center has expanded services at its Lincoln Specialty Pediatric Clinic. Now, Lincoln-area families do not have to drive to Omaha to access Children’s pediatric specialists.
Sports Medicine. Specialists help young
athletes get back into the game after an injury. Concussion care, splinting and bracing, surgical assessments and home exercise plans are among the orthopedic services offered in Lincoln.
Sleep Medicine. Children who experience sleep
issues, such as difficulty falling asleep, pauses in breathing while sleeping, sleepwalking, nightmares or other symptoms can see a specialist in Lincoln to help restore healthy sleep.
Telemedicine. Videoconferencing allows
virtual visits with a child’s health care provider. Visits are private and confidential, and provide care without time-consuming travel to a distant office. Patients check in at
the clinic in Lincoln, and a nurse sets up the videoconferencing equipment in a private room. When a patient speaks with a care provider at Children’s, a nurse follows up with any additions to the electronic medical record, tests or prescriptions. Initially, virtual visits are available for three specialties: pulmonology, rheumatology for selected return patients with amplified musculoskeletal pain and cardiology for adults with congenital heart conditions.
Other Specialties. The clinic also offers
the following: cardiology, child advocacy, endocrinology, gastroenterology, genetics, HEROES weight management, neurology, neurosurgery, pediatric surgery, pulmonology, rheumatology and urology. VISIT US!
Children’s Specialty Pediatric Clinic is located at 2121 S. 56 St. in Lincoln. Hours are Monday– Friday, 8 a.m.–4:30 p.m. Call 402.486.1500 for appointments or information.
Buckle Up Child safety seats provide more protection A new law went into effect this year to keep kids safe while riding in personal vehicles. These rules were put in place by the Nebraska Legislature based on medical and scientific findings about child passenger safety, according to Children’s Hospital & Medical Center Injury Prevention Coordinator Travis Hedlund. Here are the rules: • All children must ride rear-facing until age 2, or until they reach the upper weight or height limit allowed by the car seat’s manufacturer. After they outgrow their rear-facing seat, children should ride in a forward-facing car seat until they reach the upper height or weight limits of the seat. • After outgrowing a forward-facing car seat, children must ride in a booster seat until age 8. If they outgrow a booster seat before age 8, they will need a note from their medical provider to allow them to ride without one. • After outgrowing a booster seat, children ages 8–18 must ride with a safety belt properly secured. If the safety belt has a shoulder strap, it must go across the chest, rather than being placed under the arm pit or behind the back, as this is unsafe. • All children up to age 8 must ride in the back seat, as long as there is a back seat equipped with a seat belt and is not already taken by other children under 8 years of age. Hedlund adds that all car manufacturers recommend having children ride in the back seat until age 13. SPRING 2019 CHILDRENSOMAHA.ORG
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trending IN THE NEWS
Sleep Tight
Why children need regular z’s
Sleep apnea affects about 1–4 percent of kids. 4
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It’s not unusual for a child to toss and turn at bedtime or wake up often in the night. “Sleep problems are very common for children,” says Casey J. Burg, M.D., pediatric sleep specialist and director of Children’s Hospital and Medical Center’s Sleep Lab. “Difficulty falling asleep affects about 35 percent of kids. It is the same percentage for those not getting enough sleep.” Not getting enough sleep may cause a host of problems. For example, when kids’ sleep gets interrupted, they also could wet the bed because it takes continuous slumber for the body to release the hormone that prevents it. With too little sleep, they end up napping during the day. “Insufficient sleep and intentionally not having a regular sleep schedule contribute to sadness and depression for kids,” adds Dr. Burg. “They also can have symptoms that resemble those of ADHD—hyperactivity and difficulty concentrating, which can lead to a misdiagnosis.” One possible cause of poor sleep is sleep apnea, characterized by snoring or taking long pauses between breaths, especially through the mouth. Sleep apnea affects about 1–4 percent of kids. It’s due to a natural blockage in the airways. For kids ages 3–8, the blockage is usually because tonsils or adenoids become enlarged, “part of the normal process of building up the immune system,” says Dr. Burg. Sleep apnea also can be
due to obesity, which can weaken the airway muscles. To find out if a child has sleep problems and to learn about an appropriate treatment, parents may be referred to the Sleep Disorders Center at Children’s. There, an overnight sleep study could reveal other symptoms. Meanwhile, it’s important to be aware of how many hours of sleep per night a child needs. “The normal amount depends on the child’s age,” says Dr. Burg. “In general, a 10-year-old needs 10 hours and an 18-year-old needs nine. In between those, someone age 14 needs 9½ hours. Under the age of 10, it’s variable, but often, a 5-year-old needs 11 hours. Children under age 5 might need up to 14 hours of sleep.” Dr. Burg offers these five tips to foster a child’s best sleep:
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schedule.
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bed—no screen time.
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PERMIT ONLY A light bedtime snack, if any, and one without caffeine.
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healthy weight.
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SET A CONSISTENT
sleep-wake time
INSIST ON RELAXING
activities before
ENCOURAGE WHOLESOME MEALS
STRESS DAYTIME EXERCISE
and nighttime sleepiness.
for a
for overall health
When children get the sleep they need, parents will sleep better, too! REST UP Learn more about the Sleep Disorders
Program at Children’s. Visit ChildrensOmaha. org/Sleep.
trending IN THE NEWS
When Spring Fever Strikes The post-winter time is a period of renewal. But it is also a season of sneezing, painful throats and sore tummies. Here are some common spring illnesses and how to avoid them
THE FLU
THE COMMON COLD
Symptoms: Similar to a cold but likely more severe, symptoms are: sore throat, fever, headache, muscle aches, soreness, congestion and cough. Ways to prevent it: Just because winter has passed does not mean the flu has. The best defense is an annual flu shot. As with other highly contagious illnesses, washing hands often and not touching the mouth, eyes and nose can help ward off the virus. Eating healthy foods with protein, vitamins and fibers helps strengthen immune systems, along with getting enough sleep at night.
Symptoms: The big ones are sore throat, runny nose, congestion, cough and possible fever. Ways to prevent it: As a cold is easy to catch, frequent handwashing, especially in public places, is a must. Also, advise children not to touch their mouth, eyes and nose.
STREP THROAT Symptoms: Typical ones are swollen lymph nodes, throat pain and discomfort and fever—but no cough, which is more characteristic of a cold. Ways to prevent it: Avoid the sharing or using of objects that contain traces of saliva from an infected individual with strep throat. It is important to wash hands often, and keep hand sanitizer and disinfectant wipes within easy reach at home. Also, if your child has had strep throat, replace the toothbrush to avoid recontamination.
GASTROENTERITIS (STOMACH BUG) Symptoms: Vomiting, diarrhea and stomach pains are the usual indicators. Ways to prevent it: Norovirus, a form of gastroenteritis, passes easily through day care centers and public schools. Proper hygiene for handwashing, therefore, is critical. Nutritious and vitamin-rich meals also help to build up children’s defenses. And with stomach bugs, it’s important to cut out fatty and sugary foods for the time being.
CONJUNCTIVITIS (PINK EYE) Symptoms: These include rubbing of the eyes, redness and inflammation, along with draining and discharge. (Note: Allergies may produce similar symptoms; pink eye is contagious and needs to be treated right away.) Ways to prevent it: Because it spreads easily through schools, it’s important to practice frequent handwashing along with refraining from touching the eyes.
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care essentials EVERYDAY HEALTH
AUTISM
ADDRESSING
A distinctive program helps families and health professionals provide comprehensive, patient-centered care
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Coming into a medical setting—whether it’s an emergency or a routine appointment—can increase anxiety for children and caregivers. But for those who are diagnosed with an autism spectrum disorder, even a standard checkup can feel acutely stressful. That’s because certain physical or environmental stimuli may make children with autism feel uncomfortable. For example, certain sounds may raise anxiety, or the feel of a medical ID bracelet around the wrist can increase stress. Knowing those triggers can help ease stress for both patients and families. That’s why Children’s has implemented a new, unique program called PATCH (Patient Assistance Team at Children’s Hospital & Medical Center).
For example, if a child loves bubbles, yoga poses or red toy cars, those can be used when administering an IV or prepping for an MRI. The program collects data about each child’s preferences and accommodation needs so that modifications can be made to any care plan, according to Mike Vance, Ph.D., director of Children’s Behavioral Health. “Every parent is an expert about their own children; they know what works and what doesn’t,” Vance says. “This program gives them a voice; it makes them part of the care team so that we can all work together for the best possible outcome for each child.” MAKING THE CONNECTION When a child with an autism spectrum disorder has a planned procedure, someone from PATCH reaches out to ask if the family would like to participate in the program. If the family agrees, a Child Life specialist talks with the child’s parents, collects numerous specifics on the child and writes up an adaptive care plan. Currently in its pilot phase, the program has had approximately three dozen patients, and the results have been amazing. “The
response we’ve gotten from families is that kids don’t mind coming back; they almost look forward to it,” Vance notes. “That’s a huge change, and it shows what a difference thoughtful care and small details can have.” For example, if a child loves bubbles, yoga poses or red toy cars, those can be used when administering an IV or prepping for an MRI. That way, the patient experiences less anxiety, and the procedure is often done faster and with a higher level of cooperation. LOOKING AHEAD Since PATCH information becomes part of a child’s medical record, health care professionals can accommodate individual patient needs at any appointment, even during emergency visits. That’s a major shift from the past, says Nikki Walker, Child Life Services supervisor. “Previously, staff would work with children and make adjustments, but it’s incredibly valuable to have this information ahead of time,” she says. “That helps reduce anxiety levels for both the children and their parents. It creates a teamwork approach, so everyone feels more at ease.” The program has been so successful that it will be rolled out to different areas of the hospital, and additional staffing will be provided. “This optimizes care for children with autism, and that’s beneficial for everyone,” Walker says. “So, we’re excited to do even more in the future.”
Join Our Online Community and Offer Your Thoughts! We need your input! Join our new online community for parents and guardians of patients, and help us provide the best possible care and experience for your family and families like yours. The purpose of the community is to get your thoughts and ideas on a wide range of topics that impact the patient and family experience at Children’s Hospital & Medical Center. VISIT
ChildrensOmaha. org/Share to see
if you qualify to participate.
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specialty care TECHNOLOGY
3D The Power of
Doctors at Children’s use 3D printed models to deliver precisely targeted treatment
Physicians and radiologists work together to decide which cases are optimal for 3D models. 8
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Doctors are accustomed to treating patients with the help of 2D scans such as MRIs, X-rays and CTs. But now, thanks to cutting-edge technology at Children’s Hospital & Medical Center, doctors are treating patients using 3D printed models of body parts. “Physicians think in 3D, and they operate in three dimensions,” says Lincoln M. Wong, M.D., a radiologist at Children’s. “But as radiologists, we look at scans in two dimensions, slice by slice, and we’ve had to translate that into a report that the surgeon reads. Three-D imaging and 3D printing fills in that gap.” A DETAILED PROCESS Dr. Wong says many of the 3D models created at Children’s are for tumors. Physicians and radiologists work together to decide which cases are optimal for 3D models. Once the doctor and radiologist have decided a case will benefit from 3D printing, the Radiology Department prints the tumor in relation to the other organs and vessels around it. For example, if the tumor is close to the liver, they’ll print the tumor, the liver, the kidneys, the blood vessels and any other organs that will be involved in the surgery.
“We use software that converts the CT or MRI scans—the twodimensional images—into 3D models,” Dr. Wong says. This process can take anywhere from three to five days. Once the 3D model is printed, it has myriad uses, according to Gabe Linke, a cardiac CT-MRI imaging coordinator at Children’s who works with Dr. Wong to create the models. Many doctors use the 3D model for surgical planning and teaching. Some even bring it into the operating room with them. “I have heard of cases that should have taken six hours but that we’ve completed in three hours because the surgeon can operate so much faster with the model in sight,” Linke says. In addition, some physicians at Children’s use the models to explain prospective surgeries to patients and families. “It’s much easier to show families a model and explain what you’re going to do rather than show a scan, which is kind of abstract art,” Dr. Wong says. “They often don’t understand what’s going on with a two-dimensional scan, but they really understand a three-dimensional model.”
“ It’s much easier to show families a model and explain what you’re going to do rather than show a scan, which is kind of abstract art.”—Lincoln M. Wong, M.D. ENDLESS POTENTIAL Children’s began using 3D models in 2016 after cardiologists saw a need for them in the pre-operative planning and treatment of congenital heart defects. Since then, the Radiology Department has created over 100 3D models. “After we printed a few of those hearts, we quickly realized the potential it could have to help patients in other specialties, so we started branching out into general surgery, orthopedics, craniofacial surgery, urology and ENT,” Dr. Wong says.
Many hospitals across the country haven’t adopted 3D modeling yet, putting Children’s at the forefront of this breakthrough technology. Dr. Wong can’t emphasize enough how beneficial 3D models are when treating patients. “It allows physicians to see specific patient anatomy and specific disease processes of the patients they’re going to operate on,” he says. “They can be confident in the approach that they’re going to use prior to surgery, even before touching the patient.”
LEARN MORE Discover more about
radiology services at Children’s by visiting ChildrensOmaha.org/Radiology or calling 1.800.833.3100.
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prevention IDEAS FOR HEALTHY LIVING
Natural Alternatives
Five home remedies that are safe for infants
Babies often catch a common cold. This can mean runny noses, congestion, coughing and sneezing. When a baby has a cold or other minor ailment that doesn’t require medical attention, parents can try one of the following safe, doctorapproved home treatments.
Turn the bathroom into a steam room. If baby is congested, try turning the shower to hot, closing the door and letting the room fill with steam. Hold the infant in the bathroom (not in the shower) for 15 minutes to ease the little one’s congestion.
Keep babies hydrated. Sick babies need lots of fluids. If your infant is 6 months or older and has a stuffy nose or minor cough, push more fluids (like water and Pedialyte) than normal. If your baby is under 6 months old, provide extra breast milk or infant formula. PROCEED Suction out the mucus. Babies who
are congested might have trouble feeding. Before breastfeeding or giving the baby a bottle, use a suction device to remove mucus from the nose. These over-the-counter suction devices are called bulb syringes or nasal
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aspirators. Use saline nose drops before suctioning to help loosen the mucus.
Hydrate dry skin with an oatmeal bath. Babies with dry, itchy skin from
the cold weather could benefit from an oatmeal bath. To make an oatmeal bath for an infant, grind oats into a fine powder and add it to warm water until it forms a soft, smooth paste. Add this substance to a tub or sink full of warm water. Let the baby sit in the bath for 15 to 20 minutes.
Fight constipation naturally. If your little one is constipated, it may not be necessary to turn to medication quite yet. Consider purchasing prunes (if baby is on soft foods already) and adding small pieces of them to the infant’s baby food. Prunes can serve as a healthy, natural laxative for babies.
WITH CAUTION
Some home remedies previously thought to be beneficial have been debunked and deemed unsafe for babies. Make sure to avoid these potentially dangerous natural remedies: HONEY FOR A COUGH—Some recommend honey as a home remedy for a cough. Although it can be safe, it shouldn’t be used in children under age 1, as it can lead to a dangerous condition called infant botulism. ALCOHOL FOR TEETHING BABIES—Do not use alcohol to soothe a baby’s sore gums, as any amount can be harmful to infants. Consider using diluted chamomile tea instead. TOOTHPASTE OR ADULT FACE WASHES FOR NEONATAL ACNE—Some infants will have acne, which is totally normal. There is no need to put things like toothpaste or adult face wash on a baby’s face, as these products contain chemicals, and the acne will likely clear up on its own.
Ditch the Junk
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Choose healthy snacks over salty, sugary treats Junk food and sugary treats are everywhere. While it’s convenient to grab burgers and fries to go, these items, as well as candy, cookies and pop are full of empty calories. “They’re ‘fast sugars’ in that they are quickly absorbed without any nutritional elements for the brain and metabolism,” says Cristina Fernandez, M.D., pediatrician with Children’s Physicians. “Eating junk foods stimulates the ‘hunger hormone,’ ghrelin, which leads to craving more unhealthy food.”
THERE ARE PLENTY OF REASONS TO CURB THE JUNK FOOD HABIT. The resultant
blood-sugar spike likely revs up a child, who then crashes into fatigue. A child might also feel irritable, stressed out and bloated. Regularly eating sweets and junk food results in unnecessary weight gain, risking obesity. This can lead to fatty liver disease, kidney problems, elevated cholesterol and triglycerides, diabetes, sleep apnea, chronic headaches, depression and other health issues as children get older, says Dr. Fernandez. Cristina Fernandez, M.D.
Nearly
in
children in America is overweight or obese.
EVEN COST IS A FACTOR. While it may seem that unhealthier foods are easier on a budget, some junk foods cost more than the healthy alternative. Unhealthy processed foods also are higher in calories, salt, added sugars, carbohydrates, fats (trans and saturated) and other harmful ingredients. TO HELP INSTILL HEALTHY EATING HABITS WHILE CHILDREN ARE YOUNG, START THIS HABIT AS EARLY AS POSSIBLE. For an infant,
choose baby foods carefully, paying attention to added sugar amounts in each brand. Whatever the age, the more children eat healthier foods, the more likely they’ll prefer them and enjoy the benefits of less added sugar.
tip
HEALTHY LUNCH Stock the refrigerator
with lunch items by category (fruit, vegetable, grain, dairy) and let children help pack their own lunches.
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Be a Student of Parenting U Free classes on popular parenting topics
When it comes to parenting, having the job doesn’t mean having all the answers—or having to “go it alone.” At Children’s Hospital & Medical Center, caring for children is all we do—and we love sharing our expertise with moms and dads. Join us for Parenting U—free classes on popular parenting topics to help you gain the skills to get through those all-important first years. Call 1.800.833.3100 or log onto ChildrensOmaha.org/ ParentingU to register today. Following are upcoming classes: Topic: Preparing for Your Newborn LOCATION: Baby Love at Baxter Arena, 2425 S. 67th St., Omaha, NE 68182
Topic: Breastfeeding Basics LOCATION: Baby Love at Baxter Arena, 2425 S. 67th St., Omaha, NE 68182
DATE:
Sunday, April 28, 10:30 a.m. Lars E. Vanderbur, M.D., Children’s Physicians
DATE:
EXPERT:
EXPERT:
Topic: Breastfeeding Basics LOCATION: Baby Love at Baxter Arena, 2425 S. 67th St., Omaha, NE 68182 Sunday, April 28, 11:30 a.m. EXPERT: Ann Schuchardt, RN, IBCLC DATE:
Topic: Preparing for Your Newborn LOCATION: Baby Love at Baxter Arena, 2425 S. 67th St., Omaha, NE 68182 Sunday, April 28, 12:30 p.m. Melissa St. Germain, M.D., Children’s Physicians DATE:
EXPERT:
Sunday, April 28, 1:30 p.m. Ann Schuchardt, RN, IBCLC
Topic: Preparing for Your Newborn LOCATION: Children’s Hospital & Medical Center, 8200 Dodge St., Omaha, NE 68114 Monday, June 24, 6 p.m. Katie Vollmuth, M.D., Children’s Physicians DATE:
EXPERT: