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JustKidsWinter 2012ChildrensOmaha.org
CELIAC DISEASEShould Your Child Be Tested? 2
TEEN STRESSHow Parents Can Help 6
FRUITS AND VEGGIESTips to Get Kids Eating Healthy 7
new Year’s resolutions:
ready, Set, Goal! p4
Your Online Source for Health InfoFor the latest information and news, support groups, events, patient stories, recipes and perspectives from our physicians, check out these online resources:
Facebook.com/ ChildrensOmaha
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Twitter.com/ChildrensOmaha
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JustKids 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. © 2012. All rights reserved. Printed in U.S.A.
➍ Ready, Set, Goal!
➏ Help Your Teen Cope With Stress
➐ Turn Ew! Into Yum!
➐ Healthy Kohl’s Kids Tackling Obesity
➑ New Advice on Preventing SIDS
➒ Intensive Care for Newborns Gets New Standards
➓ Gentle Imaging at Children’s
Creating Happy, Healthy Holidays Together
Contents
ChildrensOmaha.org JustKids Gary A. Perkins President and CEO Martin W. Beerman Vice President, Marketing
and Community Relations David G.J. Kaufman, MD Medical Advisor Dannee Schroeder Senior Editor
Nicole Brownell knew late last year that something was wrong
with her 3-year-old daughter, Anna. What at first had seemed to
be minor changes in her health and personality were growing
progressively worse.
“She was so worn down,” Brownell says. “She wouldn’t play
much. She wouldn’t talk much. She cried a lot and she slept a lot.
She wanted nothing to do with Christmas, which isn’t normal for
any child. And she only wanted to be with me.”
A Problem with GlutenBrownell and her husband, who live in Dakota Dunes, S.D., were
referred to Children’s Hospital & Medical Center’s new Celiac
Clinic, the only pediatric clinic of its kind in the region. Here, Pablo
Palomo, M.D., pediatric gastroenterologist with Children’s Specialty
Physicians, diagnosed celiac disease, a digestive condition caused
by sensitivity to the protein gluten. The gluten triggers an immune
reaction, which causes the body to create antibodies to eliminate
it. This can damage the small intestine and result in the reduced
absorption of important nutrients and long-term complications.
That was in January 2012. Within a week, Brownell says,
small changes were apparent in Anna’s health and personality.
By September, she says, the difference “was like night and day.”
The Road to Recovery“In nine months, she’d gained 10 pounds,” Anna’s mom reports.
“Her face had filled out and she’s healthier. The change in her
personality has been amazing. She talks with everyone. She plays,
she’s happy and she smiles all the time. I have a new little girl.”
The Celiac Clinic is just one facet of the Department
of Gastroenterology, Hepatology and Nutrition at Children’s. The
physicians and staff are experts in treating pediatric feeding and
growth disorders like celiac disease. Once a disease is diagnosed,
CELIAC CLINIC IS A UNIqUE REGIoNAL RESoURCE
2 To find a physician, call 1-800-833-3100
What’sNew?CELIAC CLINIC IS A UNIqUE REGIoNAL RESoURCE
the clinic at Children’s goes beyond the
routine in explaining the nature of a gluten-
free diet, as well as providing support and
answering questions.
Because about 10 percent of patients with
celiac disease will have a first-degree relative
who also has the disease, Anna’s 4-year-old
sister, Olivia, was tested. She, too, has celiac
disease, although she showed no symptoms
before testing. Both girls are on gluten-free
diets and are doing very well.
Going Gluten-FreeAt first, Anna’s mother says the need to go gluten-free was daunting.
“There has been a lot of trial and error,” she says. “But Dr. Palomo and the
clinic at Children’s have been a great help. They are very reassuring and
patient in answering all my questions. They’ve really tried to make it a
positive experience for us.”
Besides Anna and Olivia, the clinic is currently following about 90
patients ranging from infants up to young adults. In addition to
managing their treatment, the clinic is in the process of enrolling in
research models regarding the diagnosis and treatment of celiac disease
in the region, Dr. Palomo says.
In Anna’s case, it is clear that the proper diagnosis and diet greatly
improved the quality of her life, Dr. Palomo says. “When I first saw
Anna, she was an unhappy, angry child,” he says. “After we started the
treatment and I saw her again, the first thing she gave me was a smile.”
Should Your Child Be Screened for Celiac Disease?
For those with celiac disease, eating gluten causes the immune system to attack the lining of the small intestine. Eventually, people have problems absorbing nutrients from food. They can starve even if they eat a lot.
Celiac disease affects about 1 percent of all people. But for those with type 1 diabetes, the odds are about 5 percent
that they will develop this disease.Symptoms of celiac disease include:
• Stomach pain, gas and diarrhea• Feeling very tired• Losing weight
However, many people with type 1 diabetes and celiac disease have no signs of the celiac disease. Ask your
pediatrician if your child should be screened even if no signs are present.
If your child has celiac disease, the only therapy is a strict gluten-free diet. A dietitian can help you learn to avoid gluten. People with celiac disease need to avoid wheat, rye, barley, most grains, pastas, cereals and many processed foods.
To learn more, enter the search term “celiac disease” at our website at HealthLibrary.ChildrensOmaha.org.
HAve CeliAC DiSeASe QueSTiONS?
Pictured above: Nicole
Brownell with her daughters
Anna (front) and olivia.
ChildrensOmaha.org 3
feature story
Ready, Set,
Goal! HELP YoUR FAmILY SET
NEw YEAR’S RESoLUTIoNS
Each New Year provides a fresh start on setting resolutions and achieving goals. This year, take a family approach when creating wellness goals. Here are a few ideas.
4 To find a physician, call 1-800-833-3100
tipS for SucceSS
whether it’s for you or your children, here are some helpful tips for setting and achieving goals:
• THiNK SMAll. Break down large, difficult goals into smaller ones that are easier to keep. For example, if your family has been inactive but wants to get fit, start by vowing to take a brisk, 10-minute walk together three days per week.
• Be ReAliSTiC. minor slip-ups are part of the process. Let’s say you resolved to increase the family’s consumption of veggies every day at dinner, but skipped monday and Tuesday. Don’t beat yourself up. Just get back on track wednesday.
• MAKe iT FuN. For example: To eat healthier, try a healthy recipe the family can make together. Visit HealthyKohlsKids.com for recipe ideas!
• KeeP TRACK. Each time the family meets a daily goal, circle the date on the calendar. Seeing tangible evidence of your progress is a great motivator.
Keep your Home Safe Falling furniture sends an average of 46 U.S.
children to emergency rooms each day, researchers
say. Many injuries take place as children pull over
or climb on furniture. Children ages 6 and younger
are most likely to be hurt—especially by televisions
—but desks and cabinets also account for injuries.
To minimize risks to children:
• Place TVs close to the ground and toward the
backs of stands.
• Strap televisions and furniture to the wall
with safety straps or L-brackets.
• Install drawer stops on chests of drawers.
• Buy furniture with wide legs or with solid bases.
• Place heavy items on shelves near the floor.
• Avoid placing items that might encourage
climbing, such as toys, high on top of furniture.
Other ways to keep little ones safe at home
include using locks to prevent windows from
opening more than 4 inches, installing a carbon
monoxide detector in each level of your house
and closing doors to extra rooms when not in use.
FiND THe RiGHT DOCTOR Selecting a physician who’s a good fit for your family is important. You—and your child—should feel comfortable with the physician. To find the right one for your family, call Children’s Find-A-Doctor service at 1-800-833-3100.
exercise as a Family
Both adults and children need about an hour
of physical activity per day. Children learn by
watching you. So plan ways to stay moving as a
family. Exercise makes you stronger, keeps your
weight in check, and improves your balance.
Don’t think you have time to exercise? Think
about all the things you do already, then find a
way to fit in fitness. For instance, have everyone in
the family pick out a favorite upbeat song. Then,
dance to each song while preparing dinner. Turn
off the TV after the family meal and go for a walk
or rollerblade around the neighborhood. Ride
bikes instead of driving to the library or when
running errands.
Taking your family’s workout outside gives you
even more benefits. You can connect with nature
and so can your children. You’ll be happier, less
stressed and tuned in to the world around you.
Need help promoting fitness in your family?
We can help. Simply visit the website at
HealthyKohlsKids.com/fitness.
Schedule Wellness Visits It’s important for every family member to visit a
primary care physician once a year for a well-check.
When you schedule well visits for yourself and family
members, it sets a good example for everyone.
Some benefits of an annual wellness exam include:
• Counseling that may prevent some health problems
• Catching health problems early when they are
easier to treat
• Tracking important numbers, such as blood
pressure and weight; tracking these vital statistics
is just as important for children as it is for adults
• Reviewing that all vaccinations are up-to-date.
Even your healthy teenager should still visit the
pediatrician annually. Teens have developed a
relationship with their pediatrician over the years.
This allows the pediatrician the opportunity to
discuss potentially touchy subjects, such as behavioral
difficulties, social stresses, drug and alcohol use,
depression or anxiety disorders.
Don’t forget to schedule dental visits for all family
members as well. Babies need their first dental
checkup six months after they cut their first tooth
or by age 1, whichever comes first.
ChildrensOmaha.org 5
Everyone feels stressed from time to time.
You may vent to coworkers or call your
spouse to talk. But stress is often worse
for teens. When a teen is under pressure,
he or she can feel alone in the world.
You can’t make the pressures of life
disappear. As a parent, however, you play
a key role in helping your child cope.
Youth under PressureWith so much beyond their control, it’s
easy for young people to feel overwhelmed.
Sources of adolescent stress include:
• Schoolwork
• Trouble with friends, boyfriends
or girlfriends
• Changes in their bodies
• Peer pressure to engage in
risky behaviors
• Illness or death in the family
• Wanting to fit in
• Work and after-school activities.
Stress can cause your child to feel edgy,
tired, depressed or resentful. It can also
bring on physical symptoms, such as
stomachaches and headaches.
Successful Stress-Busting StrategiesStudies show teens’ brains actually process
stress differently. They have a harder time
telling minor troubles from real threats. That’s
why a parent’s perspective is so important.
Talk openly with your teen. Let him or
her know you’re there to listen and provide
support. Together, work on ways to deal
with stress, such as:
• listing the things that cause your
teen’s stress. Change the ones you can.
For instance, if your child’s too busy,
consider reducing part-time work hours.
• living a healthy lifestyle. Eating right,
exercising and avoiding drugs and
alcohol reduce the effects of stress.
• Recognizing accomplishments, instead
of dwelling on failures. At the end of
each day or week, help your teen think
about all he or she has achieved.
• laughing. Turn on a sitcom, tell
funny stories or search for silly
videos online. Laughter produces
good feelings that last beyond
a quick chuckle.
Watch for Warning SignsMost teens find healthy ways to
handle stress. Red flags include
changes in weight or personality,
a drop in grades, or talking about
killing or hurting himself
or herself.
iS YOuR CHilD ANxiOuS?
The Anxiety Disorders Clinic at Children’s offers specialized diagnostic services and treatment groups for children and youth who have fear or anxiety symptoms. If you think your child and family may benefit, call 1-800-833-3100.
Help Your Teen Cope with Stress
6 To find a physician, call 1-800-833-3100
Healthy Kohl’s Kids Tackling Obesity
Childhood obesity is the top health issue affecting both children and adolescents in the omaha metro area. Three out of 10 school-age children in the metro area are overweight or obese.
Children’s Hospital & medical Center and Kohl’s Department Stores have teamed up to change these findings with a program called Healthy Kohl’s Kids. The program is the newest chapter in a more than decade-long partnership between Kohl’s and Children’s.
“we are extremely excited about the new Healthy Kohl’s Kids program,” says Gary A. Perkins, president and CEo of Children’s Hospital & medical Center. “we look forward to this new program educating children and their families on how to eat better and exercise more for a healthier lifestyle.”
JOiN THe FuN!Learn more about the Healthy Kohl’s Kids program at www.healthykohlskids.com. The website features how-to videos of young chefs making healthy meals and snacks, and it enables people to share recipe and exercise tips via Facebook, Twitter and Pinterest.
What parent hasn’t seen a child turn up his or her
nose at healthy food? Faced with a green vegetable or
unfamiliar dish, children are notorious for making a
fuss. Unfortunately, most children today only eat half
the recommended servings of fruits and vegetables.
To encourage your child to eat the recommended
4.5 cups—without a fight—try these tips:
TURN Ew! INTo YUm!Five strategies to get your kids to love (or at least tolerate) veggies
1 Be sneaky. Sneak fruits and veggies into foods your
children already eat. Add pureed broccoli or cauliflower to
pasta sauce. Chop up green peppers, carrots and celery and
mix them with water-packed tuna and fat-free mayonnaise.
2 Make it easy. When it comes to snacking, kids will usually
eat whatever food is on hand. Stock the front of the fridge
with snack-sized baggies or clear containers of grapes, carrot
sticks, bell-pepper slices and melons cut into bite-sized pieces.
3 Have some fun. Cut veggies into shapes (think hearts and
stars) and serve them with low-fat dip.
4 enlist their help. Children are more apt to eat meals they
help prepare. Get their input on meal planning and then
shop for and cook healthy foods together.
5 Be a role model. You’re not the only one who keeps tabs
on what you eat. Your children also are eyeing your food
choices. Set a good example by practicing what you preach.
ChildrensOmaha.org 7
Two decades ago, doctors sent moms and dads a message:
Put babies to sleep on their backs. In the years that
followed, the rate of sudden infant death syndrome
(SIDS) fell by half.
Now there’s a new call to action: More can be done to
save babies’ lives. Studies have found other risk factors
that also raise a child’s risk of dying from SIDS.
The New ResearchDoctors can’t always tell the specific causes of SIDS, the
sudden, unexplained death of a baby less than 1 year old.
The foremost risk remains the same. Babies who sleep
on their stomachs have double the chances of SIDS.
Infants can be born with certain risk factors, such as
being male, premature and having a mother who
smoked or used alcohol while pregnant.
But a study published in Pediatrics focused on other
key risk factors. They include babies sharing a bed
with an adult, sleeping on an adult mattress, being
overdressed for the temperature, having their faces
covered and being exposed to cigarette smoke.
Other Steps to TakeAvoiding the risk factors mentioned can help keep your
baby safe from SIDS. So can taking these precautions:
• Don’t put soft toys, pillows or loose blankets in
the crib.
• Breastfeed your baby.
• Give your baby a pacifier.
• Let your child’s doctor know if your baby ever
goes limp, turns blue or appears to stop breathing
for any period of time.
• Give your baby tummy time when awake.
A certain amount of tummy time while awake and
being observed by a caregiver gives a baby motor
development of the shoulders.
While not all SIDS deaths may be avoided, doing
what you can to reduce your child’s risks could save
his or her life.
While not all SIDS deaths may be avoided, doing what you can to reduce your child’s risks may save his or her life.
MORe TiPS ABOuT SiDS!
To learn more about SIDS, enter the
search term “SIDS” on our website
at HealthLibrary.ChildrensOmaha.org.
New Advice on Preventing
SIDS
8 To find a physician, call 1-800-833-3100
New standards published by the American Academy of Pediatrics (AAP) establish Children’s Hospital
& Medical Center as the only Level IV Regional Newborn Intensive Care Unit (NICU) serving
Nebraska, western Iowa and South Dakota. Level IV is the highest level of care as defined by the AAP.
The new standards were published in the September 2012 edition of the medical journal Pediatrics.
Children’s meets a number of strict criteria including:• Experience in the care of the most complex and critically ill newborns
• The availability of pediatric-trained subspecialists on-site and available 24/7, including heart
surgeons, pediatric surgical subspecialists and anesthesiologists
• The experience and expertise to provide
surgical repair of complex congenital
conditions including serious heart defects
• The ability to transport critically ill
newborns by ground, helicopter and
fixed-wing aircraft
• The ability to facilitate and provide
outreach education.
“The AAP has taken a significant step in
redefining these classifications of care,” says
Lynne Willett, M.D., clinical service chief of
Neonatology at Children’s. “It’s important to
understand all newborn intensive care units
aren’t alike. As the only Level IV NICU in
the state, Children’s is uniquely qualified to
care for the sickest babies. Neonatologists,
nurses, pediatric surgeons and specialists,
and a skilled critical care transport team
—we are all here and working together to
give these newborns the most comprehen-
sive care available.”
Since 2004, Children’s had been
recognized as a Level III-C unit, the highest
level as noted by past AAP standards. The
new classifications have been simplified
and no subdivisions exist. Units are
designated as one of the following:
• Level I, Well Newborn Nursery
• Level II, Special Care Nursery
• Level III, Newborn Intensive Care Unit
• Level IV, Regional Newborn Intensive
Care Unit.
“Children’s is widely recognized as a
regional resource providing advanced
diagnostics and treatments,” says Dr.
Willett. “Patients come to our unit from
other NICUs, hospitals and health systems
across the state and beyond.”
New National Standards Define Intensive Care for NewbornsCHILDREN’S omAHA IS THE oNLY LEVEL IV NICU
SERVING A mULTI-STATE REGIoN
FAST FACTiN 2011, THe CHilDReN’S NiCu CAReD FOR NeARlY 325 CRiTiCAllY ill NeWBORNS.
Scan this qR code to learn more about our NICU!
ChildrensOmaha.org 9
Physicians diagnose illness and injury each
day, but it can be difficult diagnosing babies
and very young children because they can’t
verbally describe their symptoms. While
x-rays, CT scans, MRIs or ultrasounds may be
necessary to determine a child’s ailment, they
can be extremely difficult to perform on a
young child.
Many young children don’t understand the
words, “hold still,” and even more have trouble
accomplishing it. That’s why the Radiology
Department at Children’s Hospital & Medical
Center offers a child-friendly environment,
uniquely qualified staff and specialized
equipment and procedures to help ensure the
best diagnosis.
Child-Friendly Staff and AtmosphereThe pediatric-trained specialists at Children’s
Hospital & Medical Center in Omaha have
extensive experience working with one patient
population – children. We excel at making them
feel comfortable in situations that can be a little
unsettling, and we thrive on collaborating with
your referring physician to determine the most
effective way to image your child.
Our staff physicians are fellowship-trained
pediatric radiologists. They only read pediatric
images and are specifically trained in disease
processes that are only seen in children. Our
radiologists have over 65 years of combined
experience reading pediatric studies and have
been recognized nationally for their efforts to
minimize radiation exposure while providing
diagnostic results.
little Touches for little Patients Any time a child has to go in for a procedure, it
can be stressful for them and their parents.
That’s why we encourage questions, foster
open communication and assign each of our
families a child life specialist, a professional
who is trained to hold a child’s hand (literally
and figuratively) through the process – from
talking to them about IV’s to discussing what it
feels like to be inside an MRI machine.
Our two MRI scanners are child-friendly and
unlike any other in the state of Nebraska. Not
only are they decorated in a calming underwater
theme on the outside, they are outfitted with a
unique TV/video system on the inside. It’s
technology you won’t find in any other MRI
scanner in the state of Nebraska. With a movie
playing, a child can, optimally, remain still and
quiet during the 30-to-60 minute study without
the need of a mild sedative.
In other exam rooms, projectors throw
pictures on the wall and ceilings for the sake of
distraction, and many have televisions.
imaging Gently: The Children’s DifferenceChildren’s is committed to providing the safest
and most effective radiology and imaging
services for your child. Whenever radiation is
involved in a procedure at Children’s, our
pediatric-trained specialists take every
precaution to ensure that the amount of
radiation used is the bare minimum necessary
to achieve an accurate result.
Our Radiology Department supports and
adheres to the recommendations of the Image
Gently Campaign, an initiative of the Alliance
for Radiation Safety in Pediatric Imaging. The
campaign goal is to increase awareness of the
opportunities to promote radiation protection
in the imaging of children. Children’s has been
“imaging gently” since 2008, embracing
guidelines from the American College of
Radiology (ACR) and the motto of “as low as
reasonably achievable” when it comes to the
amount of radiation used in our studies.
In addition, we only use CT scans when
absolutely necessary (emergent trauma cases,
for example), deferring to ultrasound or MRI,
whenever feasible, to minimize radiation
exposure. When CT scans are required, our CT
doses are “child size,” carefully calculated to
decrease the long term cancer risk to children.
Children’s is also a national advocate for the
use of sonography to diagnose pediatric
appendicitis as another element in our effort
to minimize childhood exposure to radiation.
A PICTURE oF SAFETY AND ComFoRT
Gentle imaging at children’s
10 To find a physician, call 1-800-833-3100
Gentle imaging at children’s
For more information on the radiology department at Children’s, visit www.Childrensomaha.org/radiology.
Our MRi scanners are child-friendly.
They are decorated in a calming
underwater theme on the outside,
and outfitted with a unique Tv/video
system on the inside.
ChildrensOmaha.org 11
Non-Profit Org.U.S. Postage
PAIDChildren’s Hospital & Medical Center
8200 Dodge StreetOmaha, NE 68114402-955-5400
881M
While the holidays can be a great source of lasting
childhood memories, they can also be a time of
stress and anxiety. As parents, it’s important for
you to take control. The best way to do this is to
plan ahead, stick to priorities and let your child
come first.
Follow these tips to help ensure a happy holiday season:• Drive safely and follow fire safety rules.
• Avoid latex balloons. An uninflated balloon can
be easily swallowed, as can pieces from a
popped balloon.
• If you have small children, avoid ornaments
and decorations that resemble food or are
breakable.
• Be sure to keep snacks and appetizers that
could cause choking, like nuts, grapes and hard
candies, out of reach of small children. Clear
away ashtrays and alcoholic beverages at the
end of a get-together.
• Don’t leave food requiring refrigeration out at
room temperature for longer than two hours.
• Dispose of plastic bags as soon as you get home.
Small children can suffocate using them.
Don’t Toy Around with SafetyBe sure to choose toys that are appropriate for a
child’s age and abilities. Check the toy’s packaging
for safety information and age guidelines. In
addition:
• Beware of pull toys with strings longer than
12 inches, which can pose strangulation
hazards to young children.
• Teach older children to keep their
toys away from little siblings.
• Don’t give younger children toys
with sharp edges, small parts
or sharp points.
• If you give skateboards, bicycles,
scooters, or inline skates to
your children, make sure
they always wear helmets and
other safety gear, such as wrist,
hand, and shin guards, when using them.
Remember to take time for hugs and
quiet family time during the holidays.
A child’s wonder and delight are
yours to share if only you take
the time to enjoy it.
ChildrensOmaha.org
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Children’s Hospital & medical Center has received accreditation or recognition from the following organizations for its delivery of extraordinary healthcare to children.
CREATING HAPPY, HEALTHY HoLIDAYS ToGETHER