1. Good nutrition makes a healthy child. Be sure your child eats regularly and has a variety of nourishing foods.

2. Everyone should buckle up in the car. If your child needs a car seat, make sure it is a proper size for his or her height and weight and that it is properly installed into the vehicle.

3. Help reduce tobacco use among children and adolescents. If you smoke, quit. If you cannot quit, smoke outdoors to protect your child against second-hand smoke.

4. Lower the risk of Sudden Infant Death Syndrome (SIDS). When infants are put down to sleep, place them on their backs (unless otherwise instructed by a physician).

5. Make sure your children visit the doctor regularly. Children should be immunized on time. It is the best defense against dangerous childhood diseases.

6. Give your home a safety check. Install smoke detectors, store poisonous substances out of your child’s reach and know how to reach emergency services.

7. Prevent violence by setting good examples for your child. Remember words can hurt, too.

8. Read to your child on a daily basis beginning at 6 months of age to enhance his or her early brain development.

9. Monitor what your child sees in the media. Children are affected by what they see and hear. Teach the difference between fantasy and reality.

10. Provide a nurturing environment in which your child feels safe and valued. Tell your child “I love you” every day.

Colleen Schultz is the education manager for Children’s Health Education Center. Learn more at www.BlueKids.org.

 

Happy holidays from all of us at Children's Hospital and Health System!

Attention-deficit/hyperactivity disorder, commonly referred to as ADHD, is a condition of excessive distractibility and impulsivity. Kids easily are drawn away from their tasks and make quick and sometimes poor judgments. They have difficulty waiting for rewards. You don’t have to be hyperactive to have the condition. In fact, you don’t even have to be a kid. Many adults now are diagnosed with ADHD.
 
Children are more frequently diagnosed with ADHD when they start school because the demands of paying attention at school are greater than at home. The problem occurs in the brain, where areas that control impulse are underactive. We know this from modern imaging studies, like MRIs. The main area that this occurs is in the frontal lobe. In addition to controlling impulses, the frontal lobe also is involved with our decision-making skills.
 
ADHD is common, occurring in about one in 25 kids. Boys tend to be more affected than girls. Girls often will have a lot of symptoms without being hyperactive. There are a few factors, such as prematurity, that can make ADHD more likely. For the most part, it is a condition that is present from birth. It is not caused by inappropriate parenting, the wrong diet (such as too much sugar) or stress. While genetics now are being tested, we know there is a strong family correlation. Other family members often have similar traits.
 
There are two main therapies for ADHD. One is behavioral. The other is medication.
 
Changing the school or home environment may help. Allowing for the strengths and weaknesses of each child is important as well. Working with schools and therapists can be beneficial.
 
Dietary measures usually do not change symptoms.
 
Most kids with ADHD do well with medication. There may be reluctance to use these medications, but with the proper dosage and administration they are safe and effective. There are several types of medications that can help. A health care professional can work with you to find the right one and the right dose.
 
Parents may wish to avoid labeling their child or, if diagnosed, use medication. This often leads to unnecessary school or social problems. Many physicians and other health care professionals have good questionnaire screening tools to help. If you are concerned, talk with your doctor.     

Paul Norton, MD, is a behavioral specialist at Children’s Medical Group-Greensquare Developmental Specialists.

FAST FACT: Children’s Medical Group physicians provide primary and behavioral care for children in 18 clinics throughout southeastern Wisconsin. In addition, the medical group oversees the School Nurse Program located in central city Milwaukee Public Schools, where Children's Hospital and Health System and private schools provide care for students. Find a local pediatrician at www.childrensmedicalgroup.org.

Age, maturity, equipment and supervision play a key role in helping kids participate safely in athletics. Parents can help make these activities a positive experience for children by knowing the causes of sports injuries and how to prevent them.

Physical checkups
Make sure your child is physically fit to participate in a particular sport. Your pediatrician should do a pre-participation physical exam, because he or she knows your child’s medical history best. Exams generally include height, weight and vital signs, plus checks of the eyes, nose, ears, chest and abdomen.

Start at the right age
Parents should allow children to participate based on:
•    Age.
•    Weight.
•    Physical development.
•    Emotional development.
•    Child’s interest in the sport.

Use proper equipment
Safety gear, including shoes, should be activity-specific, the correct size and fit well. Gear may include goggles, mouth guards, pads and helmets. For example, kids should wear helmets for baseball, softball, bicycle riding and hockey. They also should wear helmets while they’re skating or riding scooters.

Playing fields should be well maintained. High-impact sports, like basketball and running, should be done on surfaces like wooden basketball courts and tracks, which can be more forgiving than concrete.

Supervision is key to safety   
Qualified adults should supervise your child’s team sport or activity. It’s important that your child is taught how to play the sport before going out on the field.

Coaches should have training in first aid and CPR. Children should be prepared with warm-ups and training sessions before practices and games. Be sure the coach enforces playing rules and requires the use of safety equipment. A coach with a win-at-all-costs attitude may wrongly encourage kids to play through injury and not foster good sportsmanship.

Hydration
Children should drink fluids before, during and after each practice or game. To avoid stomach cramps from drinking large amounts of fluids at once, encourage your child to drink about one cup of water or sports drink every 15 to 20 minutes.

Injuries happen
It doesn’t matter what the sport or activity is, kids are at risk for injuries. A medical professional can offer guidance so you know when it’s safe for your child to return to regular activities. Children’s Hospital of Wisconsin offers the only full-service sports medicine program in the state that is just for kids, including a new Concussion Clinic where children who have sustained a concussion can be evaluated. For more information, visit www.chw.org/sportsmedicine.

FAST FACT: The American Academy of Pediatrics recommends that children begin participating in team sports at age 6, when they better understand teamwork.

Kevin Walter, MD, is program director of Pediatric and Adolescent Sports Medicine at Children's Hospital of Wisconsin, and an assistant professor of Orthopedics (Pediatrics) at the Medical College of Wisconsin. Dr. Walter also sees patients at Children's Hospital of Wisconsin Clinics-Greenway located west of I-894 and one block south of Oklahoma Avenue.

It’s a scary statistic, but true: by eighth grade, one in five young people has used an inhalant to get high, risking brain damage and death. Young people can get high on more than 1,000 legal, useful, everyday products.

Inhalants are chemicals that cause a person to feel "high” after inhaling or breathing them in. People might abuse inhalants because they feel pressure from peers. They’re also cheap and easy to find.

Common ways to abuse inhalants include:
• Huffing—Breathing in fumes from a cloth soaked in a chemical.
• Sniffing—Breathing in fumes from an open container or filling a closet or car with vapors.
• Bagging—Placing the substance in a plastic bag and holding it over the mouth and nose.
• Spraying—Spraying a substance directly into the mouth.

Signs of inhalant abuse may include:
• Red or runny eyes or nose.
• Spots or sores around the mouth.
• Unusual chemical breath odor.
• Drunk, dazed or dizzy appearance.
• Nausea, loss of appetite.
• Anxiety, excitability, irritability.
• Disappearance of household products.
• Discovery of chemical-soaked rags, socks or bags.

Abuse of inhalants may cause many harmful effects such as:
• Permanent damage to the nervous system, lungs, kidneys and other organs.
• Coma.
• Sudden cardiac arrest.
• Danger to unborn children when used by pregnant women.
• Poor judgment, vision and coordination, and loss of many other skills needed for safe driving and making safe decisions.
• Increased risk of major depression and suicide.

In addition, mixing inhalants with other drugs, especially depressants like alcohol or tranquilizers is hazardous.

Abused substances include everyday products found in the home. Below is a room-by-room list of examples.

Kitchen
• Butane.
• Cooking spray.
• Correction fluid.
• Lighter fluid.
• Whipped cream propellants.

Bedroom
• Hair sprays.
• Nail glues and polish remover.

Garage
• Gasoline.
• Kerosene.
• Refrigerants.
• Turpentine.
• Carburetor cleaner.

Workshop
• Aerosol sprays.
• Felt tip markers.
• Glues and adhesives.
• Enamel paint and paint thinners.
• Solvents.
• Spray paints.

Prevention is key
Talk with your children. Teach them the dangers of this abuse. Education must start at a young age. Inhalant abuse often begins in elementary school and can lead to further drug abuse, lifelong problems or even death. If you suspect inhalant abuse, consult a school counselor, doctor or drug counseling center.

FAST FACT: Substances commonly found in the home are the most likely agents to be involved in a poison exposure. Toxic products located in the home account for more than 90 percent of poison exposures.

Mark Kostic, MD, is the associate medical director of Wisconsin Poison Center, specializing in medical toxicology and emergency medicine. The Poison Center, located at Children’s Hospital of Wisconsin, provides 24-hour, toll-free poison information for all individuals in Wisconsin. Anyone who has had direct contact with a known or potential poison can receive immediate advice on what steps to take to prevent injury from that exposure by calling 1-800-222-1222. Translators are available.
 

Giving 'tweens and teens the human papillomavirus vaccine called Gardisil® before they are sexually active and exposed to HPV can cut the risk of cervical cancer by 70 percent, according to the American Academy of Pediatrics. With all of the media attention surrounding the vaccine, it is natural for parents to have many questions. Some of the most common questions include:

Which age group is recommended for the vaccine?
Girls and women age 13 to 25 who are not sexually active are encouraged to receive Gardisil®, which is given in a series of three injections over a six-month period.

Why is the vaccine recommended for 'tweens and teens?
The vaccine is most effective in girls who are not sexually active and have not acquired one of the 40 types of the HPV virus that are high-risk and associated with cervical cancer, as well as pharyngeal, or throat cancer. Gardisil® specifically targets these two types of cancers and two types of genital warts.

Why can’t boys receive the vaccine?
The vaccine has only been FDA approved for girls at this time.  Currently, studies are being done to look at the effectiveness of the vaccine in males as well.  If approved for use in males, it will have the benefit of preventing some types of throat cancer and decreasing the spread of genital warts to females.

Are there any side affects from receiving the vaccine?
There may be minor side affects from the vaccine such as local irritation, pain or fainting. Patients are monitored after the vaccine is injected to watch for fainting.

Gardisil® has been tested for five years. Because it has a lasting immunity, a booster shot is not recommended for children receiving the vaccine.

FAST FACT: The HPV vaccine is the first vaccine that specifically targets cancer.

Sarah J. Lerand, MD, MPH, is a physician in the Adolescent Health and Medicine Program at Children’s Hospital of Wisconsin. The program sees 'tweens and teens for issues related to nutrition, general physical development, concerns related to puberty, assessment for eating disorders, stress and anxiety, depression and developmental and transitional periods complicated by chronic illness, developmental or learning disorders.

Children's Hospital is Growing UP! Take a virtual tour at thisismychildrens.org. 

Before the school buses return to their routes, it is time to start thinking about your child’s back-to-school physical. The American Academy of Pediatrics recommends a yearly physical for all school-aged children. Many summer camps, schools and sports require that a physical card be updated every two years. Here are some things you can expect at the exam:

• Medical history. An important part of every check up is the medical history. Nutrition, diet and exercise should be discussed. The doctor should be made aware of activities your child is involved in to consider risks, physical maturity and readiness. This also is a good time to review ongoing medical problems, like asthma or allergies, refill medications and complete medication sheets for school. The doctor will likely need to spend some time alone with teens in order to review confidential information related to drinking, smoking, drugs, sexual activity and depression. Write down questions for the doctor beforehand. Common questions during the medical history include:
• Were there missed school days last year?
• Any serious or recurring sports injuries?  
• Any visits to the emergency room, urgent care or another medical specialist?
• Has your child started any new medications, vitamins or supplements?
• Has your child been successful in school and maintained friendships?
• Medical exam. The medical exam begins with height, weight, blood pressure and comparison to past measurements. A child’s growth is one of the best indicators of overall health. A head-to-toe exam should be performed. After the exam, the physician will determine if any laboratory, X-ray or other tests are necessary. Vaccination history should be checked and shots should be updated. Vision and hearing may be screened. Forms for school, camp or sports can then be completed.
  

A healthy childhood means balancing home life, school, social activities, sports and extracurricular activities. An annual visit to the pediatrician can help ensure your child is fit to participate and can head off illness or injury with guidance and treatment of ongoing medical issues.

FAST FACT: Children’s Medical Group physicians provide primary and behavioral care for children in 18 clinics throughout southeastern Wisconsin. In addition, Children’s Medical Group oversees school-based health centers located in central city Milwaukee Public Schools.

Mary Lehrmann, MD, FAAP, is a pediatrician at Children’s Medical Group-Westbrook Pediatrics.



 

It’s common for kids to be concerned about their looks—especially during the ‘tween and teen years. Unfortunately for a growing number of kids, that concern can grow into a weight obsession that can lead to serious physical and psychological complications. Eating disorders most commonly occur between the ages of 14 and 17 but may occur earlier or later. Females are affected most often, but males can be affected as well.

Warning signs of an eating disorder
•    Food clues: eating tiny portions, avoiding meals with other people, eating secretly or hiding food, refusing to eat, “not being hungry” at meal times, avoiding fat, sugar or meat, unusual food choices or cravings, unusual eating habits such as cutting food up into very tiny pieces, moving food around a lot on their plate, disappearing after eating, often to go to the bathroom.
•    Thought clues: like vocalization of intense fear of being or becoming fat, obsession about appearance and body or withdrawing from family or friends.
•    Activity clues: insisting on exercising every day,  feeling “stressed out” if a workout is missed, refusal to stop activity when injured and secretive exercise.
•    Physical cues: weight loss or frequent weight fluctuations, abdomen pain or bloating, irregular or loss of menstrual cycles, feeling cold much of the time, stress fractures or repetitive injuries.

It’s important to remember that eating disorders are caused by many factors. It also is very important for parents of children with eating disorders not to blame themselves. Families do not cause eating disorders, but they can help prevent them and are key to recovery if an eating disorder does develop.

What can parents do to help prevent eating disorders?
Model healthy eating behaviors at home.
•    Encourage family meal times. Research has shown that children in families who eat meals together most days of the week have better nutritional intake and a decreased risk for unhealthy weight control practices.
•    Offer balanced meals that incorporate whole grains, fruits and vegetables, proteins and heart healthy fats.
•    Replace sugary juices and soft drinks with low-fat milk and water.
•    Enjoy food. Desserts and other snacks are not bad when eaten in moderation.
Encourage an active but not overactive life style.
•    Make time for family walks, bike rides and active fun. 
•    Find activities your child enjoys.
•    Avoid over-programming your child in sporting events. Have them choose one sports team or activity at a time.
Avoid teasing about weight. Researchers have shown that kids who are teased about their weight are at higher risk for developing an eating disorder.
•    Become wise media watchers. Be aware of inappropriate messages about body image in the television shows your child watches.
•    Limit media use to one or two hours a day. Avoid putting a TV in your child’s bedroom.
•    Watch TV or look at magazines with your child and talk about what you are seeing.
•    Help your child appreciate and resist ways in which the media distorts the true diversity of human body types and imply “thinner is better.”

If you suspect your teen has an eating disorder, your pediatrician or family practice physician is a good judge of the physical symptoms and can call in specialists to help treat this serious disease. The Adolescent Health and Medicine Program at Children’s Hospital of Wisconsin specializes in assessment for eating disorders. For more information or to have your child evaluated, call Central Scheduling at (414) 607-5280.

An Eating Disorder Parent Support Group, hosted by the Adolescent Health Clinic, is open to any family of a child with an eating disorder. The group meets from 6 p.m. to 7 p.m. the first and third Tuesday of each month in the Adolescent Health Clinic, first floor, Children's Clinics Building connected to Children's Hospital in Wauwatosa. For more information call Pat Stoll, MSW, at (414) 266-2754.

Sarah J. Lerand, MD, is an adolescent medicine physician at Children’s Hospital of Wisconsin.

FAST FACT: The growing field of adolescent medicine specializes in caring for kids ages 10-21, with issues related to physical development, nutrition, body image and emotional well-being. Adolescent Medicine complements the care your pediatrician or physician provides. The team at Children’s Hospital of Wisconsin includes board-certified adolescent medicine physicians, nurses, a dietitian and social worker who work together to provide care in a team setting.