tips on home
dental care the importance of baby teeth, good brushing habits, flouride
They are the unsung heroes of early development: baby teeth, those gatekeepers of the early smile. They are the magnificent performers who make important contributions to the show, then leave the stage, right about the time they should be getting a huge round of applause. Baby teeth are crucial to aid in speech development in babies, and the molars and canines migrate through the gums in a way that helps create spacing for the second set of teeth. The key to good teeth care is to establish a consistent cleaning routine as soon as teeth begin to appear. “Theoretically, cavities are entirely preventable,” says Stephen Wilson, MD, director of the Division of Pediatric Dentistry at Cincinnati Children’s.
“The best advice for parents is to set a good example. Be that role model. Brush with your kids.” The most important factors, he says, are a healthy diet, fluoride, good brushing and flossing habits, and regular visits to the dentist. Baby teeth typically begin to emerge at four to nine months of age, although that varies. Parents should start brushing (very gently) those teeth as soon as they break through. Right before, and during, the emergence of baby teeth, infants will appear to be in discomfort from the teeth “cutting” through the gums. Some babies experience significant pain, other babies do not. Cool teething rings can help. n
Stephen Wil s on, MD, Director of the Division of Pediatric Dentistry at Cincinnati Children’s
“The best advice for parents is to set a good example. Be that role model. Brush with your kids.”
wisdom from dr. wilson On when to start flossing: There are five surfaces of the tooth and a toothbrush only gets to three, the top and tongue and cheek sides. It’s the sides between the teeth that need flossing. If the teeth are touching, you should be flossing, so that could be by two or three years of age. Getting a child to be comfortable in a dentist’s chair: I always have the dental light at their chest when I first turn it on and then I slowly move it up to the chin. But I never shine it in their eyes. I say, ‘pretend you are watching an airplane and look up at the sky.’ That way the light doesn’t scare them. I talk them through it. On the rotating tooth polisher with the high-pitched whiny sound: I tell them it’s just a toothbrush that’s round, and it tickles. On “candy-like” toothpastes that some kids prefer: The level of fluoride is the key, that’s the active ingredient. Otherwise there is no real difference. Manufacturers of toothpaste have figured out flavorings, so if you need to use those, that’s fine.
N ick DeBlas io, MD, Division of General and Community Pediatrics
Pediatric Primary Care Clinic at Cincinnati Children’s President, Cincinnati Pediatric Society
advocate for yo u r child’s h e 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.
Specia l N e eds Re sour c e Direct o ry Use this directory to find information, resources and advocacy strategies at www.cincinnatichildrens.org/ special-needs.
Join Sp e c i a l C onnec t i o ns Our new online community connects with others parenting a child with special healthcare needs: www.cincinnatichildrens. inspire.com.
What are the pros and cons of discontinuing my child’s ADHD medication over the summer break, and the best way to restart when school begins? ne of the challenges for parents of children on medications for Attention Deficit Hyperactivity Disorder (ADHD) is whether to discontinue use during the summer when schools are not in session. There are pros and cons, and different options work best for different patients. But one thing is certain: stimulant medications (such as Ritalin, Adderall and Concerta) may be discontinued periodically, but non-stimulant medications (such as Intuniv and Strattera) should not be stopped suddenly, because they take longer to work and longer to leave the body. Talk to your doctor before adjusting any medication. If you decide to discontinue medication, keep in mind: restart at least a week before the first day of school, to monitor for side effects. Two major side effects of stimulant medications are a diminished appetite and increased trouble sleeping, so taking a “holiday” from medication can be beneficial. If you aren’t comfortable stopping medications for an entire summer, some families stop for weekends, or a holiday period, and that can be helpful as well. Remember, too, that ADHD symptoms affect more than just school performance and can cause impairment in everyday life. For many children, the best option is to keep taking their prescriptions consistently. n
On finding the right prescription:
Facts about ADHD medications
Some families become frustrated in the beginning, and that’s understandable. It can sometimes take several months to find the right medication at the right dose. It really is a team effort between you, your child’s doctor and the school.
The primary symptoms of ADHD are difficulty paying attention, maintaining focus and hyperactivity, challenges that commonly arise in school.
On the question of stimulant vs. non-stimulant:
Stimulant medications are more widely used than non-stimulant medications. The stimulants have a short half-life, and they go in and out of the system fairly quickly. Non-stimulant medications can take several weeks to reach a level in the body that is effective.
About 3.5 million US children age 6-12 take stimulants such as Adderall, Concerta, Ritalin and Vyvanse. That’s about five percent of the kids in that age group. About half-a-million take nonstimulant prescription drugs such as Intuniv, Kapvay, and Strattera. Source: National Institute of Mental Health in Bethesda, MD
j oi n a
If you have a question for the pediatrician, email email@example.com.
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.
Does Your Child Have ADD or ADHD? 8- to 12-year-olds Needed for a Research Study
What: The purpose of this research study is to understand brain development in children with Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) compared to typical children who do not have ADD, ADHD or other behavioral conditions. The focus is on learning more about the brain’s abilities to control coordinated hand and finger movements. Who: 8- to 12-year-olds who have been diagnosed with ADD or ADHD, are righthanded AND, have no significant neurological, developmental or psychiatric diagnoses. Compensation: Families will receive up to $50 per day (for 2 days) for their participation. Details: Contact Cameron Laue at firstname.lastname@example.org or 513-803-7296. TechnoTeens Study Healthy Teen Girls 12 to 15 Years Old Needed for Internet Research Study
What: The purpose of this research study is to better understand the ways in which teen girls use different types of media and the Internet. Who: Healthy teen girls 12 to 15 years old may be eligible to participate. Compensation: Families will receive up to $390 for time and effort. Details: Contact Jackie Barnes at email@example.com. EEG Comparison Study Has Your Child Had a Recent Concussion?
What: This research study will compare the EEG (electro-encephalography - a noninvasive test which records the electrical activity along the scalp) pattern in the brain of children who have had a concussion with that of children who have not had a concussion. Who: Children and teens 8 to 17 years old who have had a concussion within the last 10 days may be eligible to participate. Details: Contact Kim Barber Foss at firstname.lastname@example.org or 513-636-5971.
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about thi s iss ue
s umm e r 2014
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focu s o n
protect your child's health
g o o d Eating H abits
th e Valu e o f
nutriti o n
“There are so many benefits, just getting kids outside in fresh air and working with their hands.” JILL KLEIN , MD, Pediatrician, Pediatric Primary Care Clinic at Cincinnati Children’s.
With rates of childhood obesity rising to epidemic levels nationally, the Cincinnati-based nonprofit Gabriel’s Place is trying to change that trend, one fresh vegetable at a time. Gabriel’s Place offers locally grown produce, health-oriented cooking classes and food-education programs.
incinnati Children’s is a neighbor and has sponsored programs at Gabriel’s Place. Jill Klein, MD, is a pediatrician in the Pediatric Primary Care Clinic at Cincinnati Children’s. She often focuses on obesity and nutrition issues with families, and believes what Gabriel’s Place offers is just the ticket for building better food choices. She advises that nutrition education should begin even before the baby is born. “Prenatal visits, that’s when we should start giving moms this information,” Klein says. “The infant and toddler years are especially important because parents still have control of what their children eat, with the exception maybe of day care. Later, kids begin to make their own decisions, so it’s important to have those habits ingrained.”
Source: US Centers for Disease Control
a bout k id s a n d w e ig h t child
O b esit y
Obesity rates have more than doubled in children and quadrupled in adolescents in the past 30 years. The percentage of US children ages 6 to 11 who are obese increased from 7 percent in 1980 to nearly 18 percent in 2012. In 2012, more than one-third of children and adolescents were overweight or obese.
Five-year-old Jayden Turner of Avondale is a shining example. Jayden and her grandmother, Anna Joiner, visit the Gabriel’s Place produce market each Thursday, and Jayden quickly launched into a list of her favorite things. “I know good healthy foods. I like vegetables,” she says. “I like broccoli and carrots and dip. Because you want to grow up to be big and strong. Oh also, yum, strawberries. And carrots. And tomatoes. And lettuce.” Jayden’s grandmother grows tomatoes in her Avondale front yard and Jayden helps out, which Klein applauds. Gabriel’s Place also has a garden where kids from the neighborhood can come to help grow food. “There are so many benefits, just getting kids outside in fresh air and working with their hands,” Klein says. “Also, it’s good psychologically because the kids are involved in the process, and they are more significantly likely to eat healthy foods that way.” Klein subscribes to the theory of 5-2-10 in a child’s daily diet. That’s five fruits or vegetables per day, less than two hours of TV and computer screen time, one hour of physical exercise that breaks a sweat, and zero sweet beverages and sugars. “The easiest component is the fruits and vegetables,” Klein says. “The hardest is probably the sweetened beverages and sugars. Kids are drinking far too much sugary juice and soda. Parents need to look at the sugar content on the label.” n
fo r p a r e n t s
fa s t f o o d n If you eat at fast-food restaurants, explore healthy options instead of burgers and fries (milk, apple slices, salads) n
portion size n Watch portion size, especially when eating out n
be a role model n Set a good example with eating choices
Above: Donovan Clifton and Jayden Turner, both 5, are learning how healthy food grows
fo r your
The most marvelous things about
you are contained in your brain. When your child rides a bike, scooter or skateboard, or even when she goes sledding in the winter, she should show her brain some love and wear a helmet.
Parents, that means you too. Since children often follow your example, modeling the appropriate behavior will increase the likelihood your child will wear a helmet. “Every time you get on a bike, it should be second nature for you to put your helmet on before riding. It’s the same as getting in your car and wearing your seat belt,” says Mike Gittelman, MD, an emergency medicine physician in the Division of Emergency Medicine at Cincinnati Children’s. A strong advocate of helmet use, Gittelman says head injuries are the most serious injury treated in connection with bike riding, and studies show only 30 percent of kids in Ohio wear a helmet while biking, skating or
riding a scooter. Apart from the automobile, bicycles are tied to more childhood injuries than any other consumer product, including trampolines, ladders and swimming pools. Wearing a helmet not only makes safety sense, it might also be the law where you live. Many cities, including Cincinnati, require all cyclists under the age of 16 to wear a helmet on all public properties. “By wearing a helmet, you can reduce the risk of head injury by 85 percent and severe brain injury by 88 percent,” Gittelman says. “Some families say they don’t want to fight with their kids. Kids say it’s not cool, but people used to say that about seat belts.”
Mike Gittel m an, MD, a physician in the Division of Emergency Medicine at Cincinnati Children’s
Ranked Top 3 in the nation, again
T i p s f o r finding th e
Pe r fect Fit ch e cking
Has CSA, ASTM, CPSC or SNELL label inside.
No cracks, dents or damage.
Experts say proper fit is crucial to a helmet’s effectiveness. That can be a challenge if a child is inheriting a “hand-me-down” helmet. The key is to make sure the helmet is certified*, that the pads fit the head at the front, back, sides and top, and that the chin strap is snug. The helmet should sit on top of your head in a level position and it should not rock back and forth or from side to side. Replace any helmet if the padding is worn down, the helmet has a crack or dent or has been involved in an accident in the past. Gittelman, who is co-director of the Comprehensive Children’s Injury Center, also emphasizes that cost need not be an obstacle. Although some kids might be drawn to a costlier model with a fancy design or colors, or more air vents, for daily use, Gittelman says, “there is little or no difference between an expensive helmet and one you can get for 10 dollars or less.” If you are looking for helmets at less expensive prices, the Family Resource Center at Cincinnati Children’s has them available. “You only have one head,” Gittelman says. “Protect it.” n
Pads touch head at front, back, sides and top.
Not too big or too loose.
Not too small or too tight.
Helmet sits level – about two fingers above eyebrows.
Chin strap is snug.Straps meet just below ears.
Vison and hearing are not blocked.
No hats or kerchiefs.
No hair in the way.
Infants and bike safety Babies younger than 1 year old have weak * A helmet is considered safe if it is certified neck structures and shouldn’t wear a helmet by the CPSC (Consumer Product Safety or travel on a bike. Commission). Check the inside of the helmet for the CPSC sticker. Check the outside Children younger than 1 year old should not of the helmet box to see if it is certified by ride on the back of a parent’s bike or ride in CPSC before purchasing. a trailer behind a bike.
Do not wear on back of head.
Introducing the myVisit mobile app for iPhones and Androids! Visiting any hospital can be an overwhelming and emotional experience, especially when it involves the health of your child. The Cincinnati Children’s myVisit mobile app is designed to help relieve your worries by providing the following:
3333 Burnet Avenue, MLC 9012 Cincinnati, Ohio 45229-3026
Step-by-step directions to destinations around the hospital, including clinics, cafeterias, restrooms, the Family Resource Center, playgrounds and more n
Information about divisions and programs
Cincinnati area amenities, including accommodations, restaurants that offer delivery, and a variety of local attractions n
To download the free Cincinnati Children’s myVisit app, visit the App Store for iPhones or the Google Play Store for Androids. Questions? Email us at myVisit@cchmc.org.
thi s issu e
c h i l d d e n ta l c a r e
Reduce the risk of head injuries. Learn the facts and get some helmet wearing tips.
Teaching good brushing habits at a young age can prevent problems in the future.
s umm e r
A guide to your child’s good health
Teaching children the value of making healthy choices about food
Published on Jul 7, 2014