Healthy Start | Fall 2004

Vo l . 1 0 N o . 4

C o o k C h i l d r e n ’s H e a l t h C a r e S y s t e m

Wi n t e r 2 0 0 4

Managing Bed-Wetting Most children grow out of the problem with age

C Cards for Kids is back for another holiday season to help spread holiday cheer and support Cook Children’s Medical Center. Proceeds from the cards are used to fund critical medical equipment and items that enhance the medical center’s childfriendly environment.

Packages of Cards for Kids can be purchased at a number of Tarrant County locations and at Cook Children’s website at www.cookchildrens.org.

For more information, call 682-885-4105. ❖

hildhood bed-wetting is a frustrating problem, but there’s hope for those upset about it: The problem declines with age.

Nighttime bed-wetting (or enuresis) affects about 40 percent of 3-year-olds, according to the American Academy of Pediatrics. By age 6, it’s down to about 10 percent, according to the National Institutes of Health. And by 12 years of age, only about 3 percent of children still wet the bed at night, says Shannon L. Watts, MD, a pediatrician for Cook Children’s Physician Network.

The exact cause of bed-wetting is unknown, though doctors know it’s more common in boys.

Children are prone to bed-wetting because they have inherited small bladders and because they are deep sleepers who do not awaken to the signal of a full bladder, says Dr. Watts. Some children wet the bed every night, while others wet the bed on occasion. Most children who wet the bed do so once a night. But some have the problem several times a night.

An impermeable mattress cover will make life easier. But there’s one thing you should know about bed-wetting. “You don’t cure this

disease; you grow out of it,” Dr. Watts says.

“Most children overcome the problem between 6 and 10 years of age.”

Pediatricians may offer medication if a child is 8 years old and still having a problem. After six months or so, doctors will begin to wean the child off medication to see if he or she has gained better control. ❖ Shannon L. Watts, MD, is a pediatrician with Cook Children’s Physician Network.

She practices in Granbury.

To Learn More American Academy of Pediatrics

www.aap.org/family/bedwet.htm National Kidney Foundation

888-925-3379 www.kidney.org/patients/bw/index.cfm

How To Manage Bed-Wetting: ■

Make sure your child uses the bathroom just before bedtime and encourage your child to get up during the night.

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Limit liquid intake by your child two hours before bedtime. Avoid caffeinated drinks in particular.

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Never scold your child for wetting the bed. Reassure your child and give small prizes for a dry night.

Car Seat Checks Work to Save Lives Most child car seats are incorrectly installed

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esearch shows that when families take holiday driving trips, it’s likely their young children are not properly protected.

According to experts, even though most parents think their child’s car seat

is correctly installed, more than 80 percent are not. Statistics show this can make a big difference when accidents occur. When car seats are correctly installed in passenger cars, studies show that the risk of hospitalization is

reduced by 69 percent for children ages 4 and under.

“Most car seat misuse occurs when parents select the wrong seat, do not tighten the harness snugly or turn the infant forward-facing too early,” says Ann Athey, RN, outreach nurse for Cook Children’s Advocacy Department.

“Infants should remain rear-facing in their car seats until they are 1 year old and 20 pounds.”

To help parents make sure that their child’s car seat is properly installed, Cook Children’s holds regular car seat checks at Cook Children’s Urgent Care and Surgery Center in Hurst.

Parents should bring the car seat and child using the seat. Expectant parents may also have seats checked. Certified child passenger safety technicians then spend approximately 30 minutes checking numerous details, like the tightness of the harness strap angle, proper use of anchors and tethers, whether the child’s seat should be rear-facing or forwardfacing and more.

To schedule an appointment to have your child’s car seat checked at the Hurst location, call 682-885-2634. ❖

Steer Clear of Sports Supplements More than a million youths use these risky substances, a study shows

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ig-name sports stars aren’t the only ones who use risky performance-boosting drugs or supplements. About 1.1 million youths ages 12 to 17 have tried them to gain strength, size or better looks, according to a 2004 survey by the Blue Cross and Blue Shield Association (BCBSA).

Two out of five high school senior athletes admitted using the supplement creatine in a separate survey reported in Pediatrics magazine.

In well-publicized cases, star athletes have suffered serious and even fatal harm from these drugs and supplements. The possible short and longterm threats include stroke, heart attack and cancer. Yet three out of four youths who have used steroids, ephedra and similar substances couldn’t name any of the side effects, the BCBSA survey found.

Even worse, some youngsters do know the risks — and they don’t care.

Youths see their sports heroes using what seem to be magic potions, and they want to do it, too.

“Pediatricians often say children are not small adults. They are unique and different. This is certainly true when it comes to sports supplements,” says Kim Pham Mangham, MD, of Cook Children’s Physician Network. “These supplements have not been well-studied in children and can possibly have serious health consequences.”

Experts say the answer is education.

In the BCBSA survey, most youths said they had received no information about these substances from their parents or sports teams. Parents, coaches and teachers must learn the dangers so they can teach children to avoid these unsafe substances. ❖ 2

Kim Pham Mangham, MD, is a pediatrician with Cook Children’s Physician Network. She practices in Keller at 1006 Keller Parkway.

Red Flags ■

Sudden bulking and muscling up

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Violent emotional swings

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Very severe and widespread acne

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Hair loss

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Breast enlargement in boys

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Facial hair in girls

[ health bits ] Put Milk Back in the Game A good diet is no game — or is it? The National Institute of Child Health and Human Development has added games to its “Milk Matters” website (www.nichd.nih.gov/milk/kidsandteens) to mix fun with learning. The site features games, puzzles and mazes. “Most girls and boys between the ages of 12 and 19 don’t get the daily calcium they need,” says the institute’s director, Duane Alexander, MD. That could raise their risk for broken bones in childhood and osteoporosis later in life. “Milk Matters” seeks to spread the word about the role of calcium in kids’ diets.

The games feature “spokescow” Bo Vine, a Holstein who loves milk.

Car Seat Safety Checks by child passenger safety technicians with Cook Children’s are periodically held at:

Cook Children’s Urgent Care and Surgery Center in Hurst 6316 Precinct Line Road

Teens’ Speeding Warns of Other Ills

At the intersection of Precinct Line Road and Mid-Cities Boulevard

Teens who break the speed limit are more prone than non-speeding teens to gamble, use drugs or drink alcohol, University of Florida scientists say. “The implications for parents are huge,” says Florida professor Mark Gold, MD. “Parents tend to view speeding as an island, rather than to say that it is a clue to other behaviors that could help them save their child’s life.” Researchers based their findings on phone interviews with more than 1,000 Florida teens 13 to 17 about gambling, alcohol and drug use, mental health and speeding.

Kids’ Smoking Linked to Asthma Childhood smoking and secondhand smoke account for about 15 percent of asthma cases among seventh- and eighth-graders, says a survey by the University of North Carolina at Chapel Hill. “Asthma is the most common chronic childhood illness,” notes co-author Jesse J. Sturm, MD. Of the asthma cases tied to tobacco, the survey of 128,568 North Carolina kids blamed about 7 percent on youths’ smoking and the rest on secondhand smoke. The link between youths who smoke and asthma had never been shown, the authors say. They urge efforts to curb smoking in children of all ages.

A Spray May Keep the Flu at Bay There’s hope for parents who fear the flu and kids who hate shots. Doctors now have a nasal spray flu vaccine for children ages 5 and up. “We should be able to increase coverage with this vaccine, since so many kids don’t like getting the shot,” says Paul Glezen, MD, a Baylor College of Medicine professor who ran the central Texas trials of the vaccine. Younger kids still face shots, though. The nasal vaccine isn’t approved for children under age 5. The Centers for Disease Control and Prevention urges flu shots for children ages 6 to 23 months, as well as anyone older than age 2 with a chronic disease.

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Helping Kids to Just Be Kids Cook Children’s child life specialists help kids become more comfortable in an unfamiliar environment

Away from home. Medical tests. Needles. There are many things about a hospital that make the thought of them unpleasant or something to fear for an adult, much less a child. But every day, one group of people — child life specialists — at Cook Children’s make it their job to break down any uneasiness that children and their families might have.

At Cook Children’s, child life specialists do this by providing fun activities, emotional and developmental support and honest information geared toward a child’s level of understanding. To help touch the lives of young patients, they are involved in a number of activities every day at Cook Children’s Medical Center. Some examples include: ★ Setting up playrooms and activities for young patients to help them understand their illness or injury and learn more about any fears or misconceptions they may have ★ Conducting pre-surgery tours for patients to help them learn more about procedures and become more familiar with the medical environment ★ Providing entertainment for patients by arranging activities with local organizations and appearances by special visitors and animals “There are a number of things about being in the medical environment that can create stress and anxiety for a child patient,” says Jill Koss, director of Child Life Services at Cook Children’s Medical Center. “But overall, we try to help them cope by giving them opportunities to play, have fun and just be kids.”

Working with all kinds of kids Cook Children’s sees a great range of kids, from those only hours old to those old enough to have a driver’s license. Kids of different ages react differently to being in a hospital environment, and child life specialists have to know and anticipate these differences.

For example, toddlers (1 to 3 years old) typically don’t understand what is happening, and they can be extremely

Katie Campbell, a child life specialist at Cook Children’s Medical Center, works with Jack, a cancer patient, to help him become more comfortable in the clinical environment.

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sensitive to an interrupted routine and separation from family. This can cause a child to regress or act younger. For example, children may suddenly have a need to be held or go back into diapers, even if they have not used them for some time.

This usually passes once the child leaves the hospital, but it can be a strange and unexpected change for parents.

In comparison, school-age children (6 to 12 years old) often have active imaginations that can cause them to misunderstand their illness or injury.

One fear is a loss of control over their bodies and emotions. Unlike smaller children, they want to please their parents and fear disappointing them if they cry or can’t hold still during a procedure.

“Every child has individual differences, but one of the things we see in many children is a fear of the unknown,” Koss says.

“Kids are visual learners, and educational tools like books and pre-surgery tours can really help them understand the medical environment better.”

Child life specialists arrange special visits for patients at Cook Children’s Medical Center, from members of the Dallas Cowboys during the holidays to trained therapy dogs from Paws Across Texas.

Child life specialists hold bachelor’s or master’s degrees in child life, child development, education or a related field. They also complete internships that provide special training in the needs of hospitalized children, and many are certified and affiliated with the national Child Life Council.

This helps with their diverse range of responsibilities to patients, siblings, parents and any other family members who may be present during the potentially stressful time.

“It’s important that we meet the needs of the whole family. In most cases, siblings need to be included,” says Carol Lowery, a child life department manager at Cook Children’s.

“Sometimes, parents try to protect siblings by limiting

the information they give them, and sometimes they give them too much information. We encourage families to find that fine line between involving siblings and yet allowing them to continue with their normal daily routine.”

Promoting the importance of play Central to the job of a child life specialist is spending time with patients, playing with toys or games, or reading together. These activities are not just for fun. They also hold a great deal of importance.

“We can learn so much about children just by playing with them,” Lowery explains. “So much of what we do is dependent on the relationship we build with them. We are able to spend time getting to know them and learn about their personalities, so we know best how to help each individual child.”

Through the use of developmentally appropriate tools, like special anatomically correct dolls and medical equipment, child life specialists help each

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child understand the hospital environment, his or her illness or injury and medical procedures that will be required.

Child life specialists also can play a big role helping patients discover coping techniques when they face a painful procedure or test. They do this through distraction (using pop-up books, magic wands or hand-held video games, for example), imagery, music, cognitive challenges (like counting or saying the ABCs), storytelling or just talking.

“I get satisfaction working with a child who is terrified and helping him or her become a well-adjusted child who copes well with the situation,” Koss says.

“We can’t make a diagnosis go away, but we can make it easier to handle.”

Overall, Koss says that she’s constantly reminded how resilient the children she works with are. “Everything we do, whether it’s playing or teaching coping skills, helps them discover the ability to take things in stride, which is a lesson they can apply throughout their entire lives.” ❖

Five Years After Columbine, Are Children Safe at School?

Programs seek to end bullying, which often lies behind violence

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rograms to end violence and bullying are standard in a lot of schools across America today. Yet parents and students still worry how safe schools are five years after two armed teens ravaged Columbine High School in Colorado, killing 12 students and a teacher before taking their own lives.

Such violence “is a wake-up call, and I think that we are only partly awake,” says California psychologist Jana Martin, PhD. “We need to be constantly vigilant and to provide resources to kids in school so that they can feel and be safe.”

Bullying has played a role in two out of three school shootings since 1974, according to the Journal of the American Academy of Child & Adolescent Psychiatry. About 8 percent of students say they have been bullied at school in the last six months, says the National Center for Education Statistics.

Although awareness is up, we must do a better job teaching students, parents and teachers how to cope with behaviors like bullying, says Sheryl Harmer, director of program development for the

Committee for Children. Harmer’s Seattle nonprofit group sets up school programs to curb bullying. She says schools must: ■ Set and convey clear rules that bullying and related acts won’t be tolerated.

■ Lay out clear procedures.

■ Provide the right training to spot and deal with the behavior.

“You can actually teach children to stand up straight, throw their shoulders back, look [the bully] in the eye and say ‘I’m not going to take this,’” she adds. ❖

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There’s usually little cause for concern

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osebleeds can be scary — but fortunately, they’re rarely cause for concern.

In kids, the most common causes of bloody noses are dry air (which dries out the lining of the nose), overzealous blowing and, all too often, picking.

Curbing School Violence ■

Taking the Punch Out of Nosebleeds

Warning Signs Know the warning signs that precede violence.

■ Frequent physical fights Serve as a role model by han■ Use of drugs or alcohol dling anger in a rational way.

■ Enjoyment of hurting animals Be accessible and listen ■ Fascination with weapons to your kids.

Encourage your child to report bullying ■ Frequent loss of temper to you and to a trusted person at school.

Coach your child on how to avoid a bully.

SOURCES: Talk with your child about violence psychologist and its consequences.

Jana Martin, PhD; Teach your child to solve problems without violence.

American Academy of Child & Adolescent Get involved in your child’s school life.

Psychiatry; U.S. Work with the school to make staff more responsive.

Department of Education 6

Award-Winning Singer Helps Raise Funds for Neurosurgical Technology Through Refuse to Lose, Dan Roberts hopes to bring intraoperative MRI to Cook Children’s

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s a professional singer, Dan Roberts is used to leaving home and traveling around the country. Now he’s helping keep some families in North Texas from doing the same when they need a certain medical procedure.

Physicians say that most nosebleeds are not serious and are caused by prominent blood vessels in the nose that tend to bleed when dry.

Remember not to become alarmed by the amount of blood: It usually only looks like a lot.

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Use a humidifier in your child’s room at night to help keep the nose moist.

Avoid blowing the nose or bending over for several hours after a nosebleed.

Don’t give your child aspirin.

When to worry If the bleeding is difficult to stop or occurs frequently, see your pediatrician.

Bleeding that continues after 15 to 30 minutes requires professional attention.

Call your doctor or visit the emergency room if: ■ Your child gets a nosebleed as a result of a blow to the head or a fall.

■ Your child has difficulty breathing.

■ There is bleeding from another place, such as the gums.

Frequent nosebleeds can signal an undiagnosed malignancy or bleeding disorder and should be checked. ❖ ■

Here’s what to do: Remain calm and reassure your child.

Sit the child upright and have him tilt his head forward.

■ Gently pinch both nostrils below the bridge between your thumb and index finger for 10 minutes (any less and the bleeding may begin again).

■ The pressure should stop the bleeding. Resist the temptation to peek.

■ Don’t lean your child back. This causes blood to flow down the back of the throat, which tastes bad and may cause coughing or vomiting.

If dry air seems to have caused the nosebleed, make sure your child breathes moist air from the shower or a humidifier.

“If you use a humidifier, make sure you clean it regularly,” says Sandra C. Peak, MD, of Cook Children’s Physician Network. “Otherwise, you are promoting the growth of mold or other allergens.”

A day or so after a nosebleed, use a ■ ■

cotton-tipped swab to gently dab petroleum jelly inside the nostrils at bedtime to prevent them from drying out.

To prevent nosebleeds ■ ■

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Prevent injury from nose picking by keeping your child’s nails short.

Following a nosebleed, discourage strenuous activity, which may increase pressure on blood vessels and start the bleeding again.

Keep your child’s nose moist with saline nasal spray.

Dan Roberts, with Austin in his studio, has dedicated a portion of the proceeds from his latest CD to the Refuse to Lose Fund.

Mr. Roberts, past winner of the Academy of Western Artists’ Male Vocalist of the Year, is leading Refuse to Lose, a fundraising campaign to purchase intraoperative MRI (magnetic resonance imaging) equipment to facilitate brain surgery at Cook Children’s Medical Center.

Two years ago, similar equipment at a

California hospital saved the life of his daughter, Austin.

In 2000, Austin was diagnosed with a brain tumor and underwent surgery at Cook Children’s. For two years, Mr. Roberts and his wife, Carol Roberts, hoped that Austin had beaten the illness, but in 2002, they learned that the tumor had reappeared. Surgically removing the tumor would be difficult because it was located on the part of her brain that controlled her ability to walk, talk and move; post-surgical paralysis was a possibility. Austin needed surgery using intraoperative MRI technology that would allow doctors to remove the growth safely, but that equipment was not available in North Texas.

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Sandra C. Peak, MD, is a pediatrician with Cook Children’s Physician Network.

She practices in Lewisville at 751 Hebron Parkway.

On June 3, 2002, Austin underwent a nine-hour procedure at UCLA Medical Center. She was back in school by fall, and by the following spring, tests showed no sign of the tumor. Austin’s progress inspired the family to raise $4.5 million to bring the neuroimaging technology to Cook Children’s. It is estimated that 150 to 200 North Texas children would benefit from similar technology each year.

“We’ve seen firsthand what this technology can do,” Ms. Roberts says. “We decided to team up with Cook Children’s to make that technology available for children right here in Fort Worth ... so they don’t have to go so far for treatment.”

“This is not so much about our story anymore. It’s about the next family that walks through the door and needs what Cook Children’s can provide,” says Mr. Roberts.

For more information about Refuse to Lose, contact Cook Children’s Health Foundation at 682-885-4105 or go to www.cookchildrens.org. ❖ Some comments in this article were originally broadcast on Mix 102.9 during the Fort Worth-Dallas Children’s Miracle Network Radiothon, February 2004.

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801 Seventh Avenue Fort Worth, TX 76104

For address changes or if you do not wish to receive these materials, please send updated information to: Cook Children’s Health Care System Attn: Public Relations 801 Seventh Ave. Fort Worth, TX 76104 or call 682-885-4242.

Children’s Hospital Research Saves and Improves Children’s Lives

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id you know that a physician at a children’s hospital was the first to identify AIDS in children and that the polio vaccine was first tested at a children’s hospital?

Pediatric research is an essential part of a children’s hospital’s mission. The National Association of Children’s Hospitals and Related Institutions (NACHRI) supports research conducted by children’s hospitals across the country by increasing public awareness of the benefits that pediatric research offers to all children.

One-third of children’s hospitals operate child health research centers that have advanced lifesaving discoveries

NACHRI National Association of Children’s Hospitals and Related Institutions

such as vaccines, gene therapies and specialized surgical techniques. Virtually all children’s hospitals participate in lifesaving clinical trials, and 70 percent perform basic science and health services research.

Children’s hospitals have also made important advances in fetal surgery, bone marrow transplants and the treatment of birth defects and heart conditions. That’s why NACHRI encourages continued federal funding for pediatric research in children’s hospitals.

But research into pediatric illnesses and conditions doesn’t just help children. Children’s hospital research has resulted in prevention and treatment discoveries for high-cost adult diseases that begin in childhood, such as osteoporosis, diabetes and obesity.

Children’s hospitals are also working together to test, study and increase the number and variety of drugs that are

approved for use in children. Without these studies, children are vulnerable to improper drug dosages and may miss out on new and more effective cuttingedge therapies that are being developed.

Pediatric research enables children’s hospitals to better serve all children with the latest discoveries and treatments taken out of the laboratory and provided directly to the young patients they serve.

For more information on what research the children’s hospital community is working on now, visit the NACHRI website at www.childrenshospitals.net. ❖

Articles in this newsletter are written by professional journalists or physicians who strive to present reliable, up-to-date information. But no publication can replace the care and advice of medical professionals, and readers are cautioned to seek such help for personal problems. ©2004 Health Ink & Vitality Communications, 780 Township Line Road, Yardley, PA 19067, 267-685-2800.

Some images in this publication may be provided by ©2004 PhotoDisc, Inc. Some illustrations in this publication may be provided by ©2004 The Staywell Company; all rights reserved.

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