Ask the Expert

10 resolutions for every family

Children's Hospital — Tue, 23 Dec 2008 18:45:00 GMT

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!

Keep your cool around a crying baby

Children's Hospital — Mon, 15 Dec 2008 13:01:00 GMT

It’s 2 a.m. and cries from the room next door begin again for the third time tonight. You have tried everything but nothing seems to work. You are at the end of your rope and pleading for just a few moments of sleep before you have to begin another long, stressful day. Will the crying ever stop?

Crying is a normal part of an infant’s everyday life. In fact, most infants cry two to three hours every day as a way to communicate with their caregivers. Up to 30 percent of otherwise healthy infants cry even more, a condition often called colic. In contrast, some babies cry much less than two to three hours a day. Many infants cry because they are hungry, sick, hot, cold, tired, in pain or in need of a diaper change. Sometimes, infants cry even though all of their needs have been met.

It is common for parents and caregivers to become frustrated, angry or feel inadequate when caring for a crying infant. These negative feelings often intensify during times of stress or if a parent or caregiver tries unsuccessfully to comfort a crying child. While frustration is a normal emotion for caregivers to experience, it is important to manage this frustration in a healthy and safe way.

Here are a few tips to help you keep your cool when the crying just won’t stop:

Put the child in a safe, secure place, such as a crib, and leave the room. Give yourself space to cool down, but never leave the child unattended.
Pick up the phone and call a friend, neighbor, relative or parent helpline. In many cases, these people will be willing to come to your home and offer assistance. If that is not the case, just talking to another adult can help calm your nerves.
Walk with or carry the child to a trusted neighbor’s home and ask for help.

For the safety of your child, it always is important to monitor his or her caregivers. If you know someone who has difficulty managing anger or who handles children roughly, do not put your child in his or her care. If your caregiver reports excessive frustration with your child or an inability to deal with your infant’s crying, listen and make other arrangements for your child’s care.

A searchable directory of community-based resources for families is available on the Child Abuse Prevention Fund’s Web site at www.capfund.org.

FAST FACT: Children's Hospital of Wisconsin has seen an alarming record number (28) of cases of shaken baby syndrome this year. If you know a new parent who is tired or stressed, please share this information with them and help them find support. Shaken baby syndrome is devastating and can be avoided.

Lynn K. Sheets, MD, is the medical director of Children’s Hospital of Wisconsin’s Child Protection Center.

Keep your kids moving this winter

Children's Hospital — Thu, 11 Dec 2008 12:04:00 GMT

Cold winter days now have replaced the warmth and activity of summer. With winter come the holidays – stuffed with festivities, fun and food – lots of food. Childhood obesity is on the rise across the United States, which is why keeping your kids physically active year round is so important.

Staying active can be a challenge when your kids are stuck inside. The winter months are a good time to take advantage of resources in your community, including local community centers or the YMCA. Both offer programs for your whole family to stay active together.

Research shows physical activity decreases stress levels and promotes family time. At home, create obstacle courses. While watching TV, perform physical activities during commercial breaks, or get your kids moving to age-appropriate exercise videos.

Just because it’s winter outside, your kids don't have to stay inside. Make the most of winter and have fun participating in outdoor activities like:
•   Ice-skating.
•   Snow shoeing.
•   Playing hockey.
•   Cross-country skiing.
•   Building a snowman or snow fort.
•   Sledding.

Another way to make exercise fun is to create an activity chart. Set weekly or monthly goals and when your kids achieve those goals, reward them with things other than food.

Remember to limit “screen” time (TV, video games, computer games and even phone time) to less than two hours a day. Kids should get 60 minutes of exercise or physical activity every day. It’s important to note, however, that exercise for an adult is not the same as exercise for a child. Physical activity should be packaged into smaller increments for kids.

No matter what time of year, it’s important for parents to get involved and be active with their kids. Be a role model for your children and set a positive example. Kids will respond to that. The key is to make exercise fun, be creative and lead by example.

Stacy Stolzman, PT, is a physical therapist at Children’s Hospital of Wisconsin.

Scald burns on the rise

Children's Hospital — Thu, 04 Dec 2008 00:53:56 GMT

Last year, 64 percent of patients with burns admitted to Children’s Hospital of Wisconsin were hurt as a result of a scald injury. Scald injuries occur from hot liquid contact to the skin. Young children frequently are injured when they pull a container of hot liquid onto themselves or are left unsupervised in the kitchen. Older children can be burned during food preparation, especially from food heated in the microwave.

Hot food and beverage warnings
Hot food and beverages often cause more severe scald burns than tap water, because they generally are heated to higher temperatures. Food and beverages such as coffee, cocoa, oatmeal, soup with noodles and oil also have a thicker texture that sticks to the skin and causes a deeper injury.

Here are a few tips to prevent scald burns:

Children should not play close to the stove or sink.
Place high chairs and playpens at least 24 inches away from counters, tables and stove tops to ensure that children cannot reach hot liquids, be splattered by an accidental spill or come in contact with hot surfaces.
Never drink or carry hot liquids while holding or carrying a child.
Never put hot liquids on low tables. Place hot foods or beverages in the center of the table, at least 10 inches from the edge.
Turn pan handles in toward the stove, and cook on the back burners.

Microwave oven injuries
Microwave ovens heat food and liquids to very high temperatures and can cause scald burns from spills, splashes and release of steam.

To prevent microwave scald injuries:

Be sure the microwave is at a safe height for users. Your face always should be higher than the door of the microwave.
Never allow children younger than age 7 to use the microwave unsupervised.
Never heat bottles of formula or milk in the microwave. Remember to test the temperature before giving the food or beverage to a child.
Follow microwave popcorn package directions. Prevent steam scalds by cooling the bag briefly before opening. Open the bag away from your face.

Tap water warnings
A scald burn can occur quickly if your home’s water heater is not properly set. To prevent tap water scald injuries:
•   Set your water heater to 100 degrees Fahrenheit or 38 degrees Celsius. This is the safest bathing temperature for children.
•   Never leave the bathtub unattended while it’s filling.
•   Do not allow young children to adjust the water temperature in the bathtub. Face children way from the faucet during bath time so they don’t accidentally increase the water temperature.

Stacy Barry Coffey, PT, is a pediatric physical therapist, and Colleen Baughn, OT, is a pediatric occupational therapist. They see patients in the Burn Clinic at Children’s Hospital of Wisconsin, which is staffed with specially trained medical professionals who provide treatment for all levels of burn injuries.

Keep your children safe from holiday poisons

Children's Hospital — Tue, 25 Nov 2008 15:30:00 GMT

The holidays have arrived, and can be a joyous time for children and adults alike. But often decorations, entertaining and other festivities can distract parents from taking proper child-safety precautions, especially when it comes to dangerous holiday poisons.

Parents should be aware of these holiday dangers and ways to prevent them:

Food
Food poisoning is very common over the holidays due to large amounts of food around the house. Hot foods should be kept hot, and cold foods should be kept cold. Remove food from the serving table as soon as the family or guests have eaten. Leftovers should be put in small containers in the refrigerator in order to cool quickly. Food poisoning is difficult to diagnose without a laboratory test, but symptoms could include nausea, vomiting and diarrhea, which can lead to dehydration in small children. These symptoms usually develop six to eight hours after the spoiled food has been consumed. Making your child vomit or using over-the-counter anti-vomiting or anti-diarrhea medication is not recommended.

Alcohol
All types of alcohol are poisonous. After a holiday party is over, be sure to empty all glasses so your child does not sip any alcoholic beverages.

Medications
If holiday guests stay overnight, make sure their medications are out of reach from your children. Heart and diabetic medications are extremely dangerous because these may be swallowed without any obvious outward symptoms.

Tobacco
Tobacco is very toxic. Make sure children cannot get their hands on any guests’ tobacco or cigarettes. Be sure to empty ashtrays promptly, too.

Lead in toys
There is a possibility that lead could be found in children’s toys. Be aware of toy recalls due to the presence of lead.

Plants

Holly’s bright red berries may intrigue children. Make sure your children do not swallow any of the berries.
Mistletoe’s berries also can be extremely poisonous. Keep mistletoe out of your children’s reach.
Poinsettias are not a highly poisonous plant, but if eaten, can cause choking, nausea or vomiting.

Decorations

Angel hair, a type of garland, consists of spun glass similar to fiberglass and can cause injury to the eyes, skin and even the digestive system, therefore, children should not play with this decoration.
Artificial trees are not poisonous, but they can be a choking hazard if a piece is swallowed.
Bubble lights are filled with a liquid such as alcohol or a solvent. Beware of burns and broken glass if a child bites into the bulb.
Candles can cause serious injuries when swallowed. Most of the scents, colorings and waxes in candles are nontoxic, however, melted wax can cause burns.
Ornaments primarily are made from thin plaster, glass or Styrofoam® and do not necessarily pose a poison hazard if swallowed. However, if your child puts a piece of ornament in his or her mouth, remove any portion immediately to prevent choking.

To prepare for any holiday poison incidents that could occur, place Wisconsin Poison Center’s toll-free number, 1-800-222-1222, by all phones. Also, make sure babysitters know how to reach you. If you suspect your child has come in contact with a poisonous substance, call the poison center immediately. For more poison prevention information, visit www.wisconsinpoison.org.

Cathy Smith is coordinator of Wisconsin Poison Center at Children’s Hospital of Wisconsin, which is the poison control center for adults and children for the state of Wisconsin.

The hottest new toy: Creativity!

Children's Hospital — Thu, 20 Nov 2008 19:32:00 GMT

These days, it seems parents and their children are bombarded with many images pointing to the hottest new toy. Not advertised is the latest toy craze that is inexpensive, fun and good for your child: creativity.

Play for a child should be about the process, not the actual toy. Sometimes, the simpler the toy, the better. Activities that let children explore their creative sides help them learn. For kids, play is work – it’s how they learn who they are, what their roles are, what skills they have and how to get along with others.

Creative activities should be “open-ended.” In other words, let the child decide where the activity should go. A few thoughts to inspire creative play include:

Tupperware containers or other household items that can teach sorting or grouping.
Playdough or clay, which is an excellent activity for developing fine motor skills.
Watercolors, which are easy to clean up.
Reading, followed by making puppets or pictures to describe the story they just heard or read.
Exercise is a benefit of participating in outdoor adventures and games.

Another way to spark creativity is to have an area set up in your house just for your child. Keep it stocked with crayons, markers and other materials so that your child feels welcome to explore and play there any time.

Save items around the house such as an old sheet, a cardboard box or even toilet paper rolls. They can come in handy for a variety of activities.

If you have trouble coming up with creative ways to use things around the house for unique activities, there are many resources on the Internet to help you. A few of these include:

Parents shouldn’t feel they have to buy their children the latest and greatest toy on the market. There also is such a thing as too much television or video games. Children’s Health Education Center recommends a maximum of two hours total per day for children to be on the computer, watching television or playing video games. Televisions and computers also should be in areas where the family gathers and where the child can be monitored, not in the child’s room.

Overall, your family should strike a balance in activities to make sure there are enough creative options. Creativity benefits the emotional health of children, encourages them to think on their own and celebrates their uniqueness – plus, it can be fun for the whole family!

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

Learn about ADHD

Children's Hospital — Wed, 12 Nov 2008 22:23:00 GMT

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.

3-2-1-0 Blast Off to a Healthier Family!

Children's Hospital — Wed, 05 Nov 2008 14:15:00 GMT

Looking for some tools to skyrocket your family to better health? Check out Children's Hospital of Wisconsin's 3-2-1-0 Blast Off to a Healthier Family! program that helps families like yours achieve better health. We know obesity continues to be an epidemic problem in both adults and children. And, as the obesity numbers in children rise, so do the number of children diagnosed with type 2 diabetes.

Adult diabetes on the rise in kids

Historically, children were diagnosed with type 1 diabetes, a condition that usually is due to genetics, in which the body does not produce insulin. Type 2 diabetes, formally known as adult onset diabetes, is more directly the result of unhealthy lifestyle behaviors. Usually, this condition would take years to develop, but with today’s access to fast food, sweetened beverages and highly processed foods, in combination with sedentary activities such as video games, cable and cell phones, type 2 diabetes has started to affect people at a younger age. Children are being diagnosed with type 2 diabetes as young as 6 years old.

3-2-1-0 Blast Off!

Making better meal and snack choices, as well as being physically active, can help prevent obesity and potentially type 2 diabetes. 3-2-1-0 Blast Off to a Healthier Family! Can help launch healthier habits for your family. This program, developed by the NEW (Nutrition, Exercise and Weight Management) Kids Program at Children's Hospital helps families to make healthy choices every day.

3 - Eat three meals a day. Many families today are busy and look for quick and convenient ways to provide meals. This often means stopping at fast food restaurants or buying prepared, processed foods. These meals tend to provide inadequate fiber and are higher in fat, sodium and calories.

2 - Allow less than two hours of sedentary activity per day. Limit the amount of time children are involved in screen time activities. This includes watching television, playing video games, using the computer and talking or texting on the phone.

1 - Aim for at least one hour of physical activity each day. Encourage your children to participate in activities they enjoy. This can include riding a bike, playing tag, jumping rope, running, family walks and basketball. Make this a family event!

0 - Eliminate sweetened beverages. Choose beverages that have less than three grams of sugar per serving. Sweetened beverages can provide empty calories that add up very quickly.

Family Meals. Try to have as many meals as possible together as a family. This provides a great opportunity to learn about the events of the day and make you more conscious of how quickly and how much you are eating.

A new section of Children's Health Education Center's Bluekids.org Web site offers interactive games for kids, meal and activity tracking sheets, parenting information and more at www.bluekids.org. Introduce your kids to characters like "Skipper" (skips meals), "Hypnotica" (encourages kids to watch TV and play video games) and "Buzz" (cons kids into drinking sweetened juices and sodas). Fun, interactive activities teach kids how to battle these "aliens" to good health.

Fast Fact: About 151,000 people below the age of 20 have diabetes in North America.

Brian Fidlin, PsyD is the program director of the NEW (Nutrition, Exercise and Weight Management) Kids Program at Children’s Hospital of Wisconsin. Heather Fortin, RD, CD, CSCS, CLC is a registered dietitian with the NEW Kids Program at Children’s Hospital of Wisconsin.

Snacking our way to obesity

Children's Hospital — Wed, 29 Oct 2008 23:03:15 GMT

Childhood obesity is increasing at an alarming rate in the U.S. As a pediatrician and a parent of two boys, I find this epidemic alarming.

According to the Centers for Disease Control, obesity in children is defined as having a body mass index at or above 95 percent. Obesity is associated with significant health problems in children, such as:
•   High blood pressure.
•   High cholesterol.
•   Type 2 diabetes.
•   Asthma.
•   Obstructive sleep apnea.
•   Depression.
•   Low self esteem.
These problems can continue into adulthood.

Children today are eating less fruit, vegetables and fiber. They are consuming too much fast food, soda, juice, sugar-sweetened sports drinks and cereals, cookies, crackers, chips, snack cakes/bars and treats.

However, healthy snacks are an important part of good nutrition for active children. Michelle Smith-Beckley, RD, CD, dietitian at Children’s Hospital of Wisconsin, recommends that snacks be provided to children only if there are going to be more than four hours between meals and the children are expressing hunger. Snack time should be used as a time to include foods children often do not get enough of: low-fat dairy, fruits and vegetables.

If your child participates in organized activities where snacks are offered, you can advocate for your children by talking to the adults involved. Talk about decisions regarding:
•   When snacks are and are not appropriate.
•   What types of snack and drink should be offered.
•   If snacks will be skipped after the activity.
•   If siblings should be offered the snack.
If your team decides to offer a snack, it should be about 100 to 200 calories per serving. Water is the best choice for children to rehydrate since sports drinks have added sugar.

As parents, we want to promote healthy eating patterns by offering nutritious snacks, role model healthy food choices and encourage moderation rather than over consumption. Promote regular physical activity, including unstructured play at home and in the community, and limit television/computer/video game time. YOU are your child’s role model so set a good example!

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

Healthy eating resources:
•   Food guide pyramid
•   SNACKS (Simple Nutrition Advice for Cool Kids)
•    American Academy of Pediatrics
•    www.eatright.org (Snacks for Kids)

Healthy snack suggestions for kids:
•    Animal crackers (up to 15).
•   Apple slices with peanut butter.
•   Applesauce.
•   Canned fruit cups (packed in own juice).
•   Celery with peanut butter or low-fat cream cheese and raisins.
•   Cheese slices, cubes or shapes.
•   Cottage cheese and fruit.
•   Dried fruit (1/4 cup).
•   Fig Newton cookies (up to 2).
•   Fresh fruit, such as apples, oranges, bananas, grapes, peaches, pears, melons or strawberries. Try sliced combinations or offer yogurt for dipping.
•   Frozen fruit popsicle made with 100 percent fruit juice.
•   Frozen yogurt bars.
•   Fruit or vegetable juice (100 percent juices limited to 6 ounces a day).
•   Fruit smoothies made with low fat yogurt and fresh/frozen fruit.
•   Graham crackers.
•   Granola or cereal bars (look for ones with at least 3 grams of dietary fiber).
•   Half of a bagel with low fat cream cheese.
•   Half sandwiches, such as peanut butter and jelly, ham or turkey, cheese or hummus.
•   Hard boiled eggs.
•   Jell-O with fruit.
•   Low fat or fat free yogurt or yogurt drink.
•   Low fat or non-fat white milk.
•   Low fat popcorn.
•   Low fat pudding.
•   Low sugar, whole grain cereal with fresh fruit.
•   Mozzarella cheese sticks (string cheese).
•   Nuts (Note: possible choking hazard for kids younger than age 3).
•   Pita triangles with hummus, cheese or peanut butter.
•   Pretzels.
•   Raw vegetables, such as baby carrots, celery sticks, cherry tomatoes, sweet peas, broccoli, cauliflower or cucumbers. Try plain or with low fat dressing for dipping.
•   Whole grain mini waffles with fruit.
•   Whole grain muffins or breads.
•   Whole wheat crackers with cheese.

Sports injuries can be prevented

Children's Hospital — Thu, 23 Oct 2008 16:46:41 GMT

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.

Make sure your little ghosts and goblins are safe and seen this Halloween!

Children's Hospital — Thu, 16 Oct 2008 20:05:00 GMT

Soon your neighborhood will be filled with ghosts, goblins, witches and more as they take to the streets in search of tricks and treats. Although children look forward to the festivities and traditions surrounding Halloween, the excitement can cause them to forget to heed safety precautions, which can lead to unintentional injuries.

Check out these Halloween safety tips for a fun and safe Halloween.

Streets
• Pedestrian injury remains the second leading cause of unintentional injury-related death among children ages 5 to 14. Children are twice as likely to be hit by a car on Halloween.
• Make sure drivers can see your kids’ costumes in the dark. Be original with a glow-in-the-dark costume or a reflective trick-or-treat bag. Children should use a flashlight or glow stick when walking at night.
• Trick-or-treat in a group, not alone. Kids younger than 13 should go with an adult. Older kids always should go with buddies and follow a preplanned route.
• Remind your kids to cross streets at crosswalks and intersections, stop at street corners, look left, right and left again before crossing. They should not cross between parked cars or step into the street without looking to see if a vehicle is coming.

Motorists
Drivers also need to do their part to keep trick-or-treaters safe from harm.
• Be especially alert. Remember that popular trick-or-treating hours are during the typical rush-hour period, between 5:30 p.m. to 9:30 p.m.
• Drive more slowly. Slow down ¬– expect a lot of pedestrian traffic.
• Lights on. Drive with your full headlights on so you can spot children from greater distances.

Treats
• You should check your kids’ treats before they eat them. Tell your kids to pick only wrapped candy when they trick-or-treat.
Costumes
• Make certain your kids’ costumes fit properly. Costumes should be large enough to allow the child to wear warm clothes underneath, but short enough to prevent tripping. Do not allow children to wear adult shoes or boots.
• Use facial paints and cosmetics in place of masks. If a mask is used, make certain the eye and nose openings do not restrict vision or breathing. Children should remove masks in between trick-or-treating stops.

Other
• Children should trick-or-treat only during your community’s predetermined hours.
• Kids should only visit homes of people they know and to only accept treats at the door.

FAST FACT: More than 93 percent of children, age 12 and younger, will go trick-or-treating.

Lisa Klindt Simpson is coordinator of Safe Kids Southeast Wisconsin Coalition, a member of Safe Kids Worldwide. Safe Kids Southeast Wisconsin works to prevent accidental injuries, the leading cause of death among children 14 years of age and younger. Children’s Health Education Center is its lead agency.

Is your home safe from fire?

Children's Hospital — Thu, 09 Oct 2008 12:08:00 GMT

Children in homes without working smoke detectors are at a greater risk for fire-related injury and death. Take these simple steps to prevent fires, prepare your home for a fire and teach your child fire safety. They could save your child’s life.

Preventing fires
To help keep a fire from starting, closely inspect your home to eliminate potential hazards.
• Keep matches, lighters, candles and other heat sources locked and out of children’s reach.
• Keep children away from cooking and heating appliances.
• Never smoke in bed.
• Extinguish all candles and cigarettes before leaving home or going to bed.
• Avoid plugging several appliance cords into the same electrical socket.
• Replace old or frayed electrical wires and appliance cords, and keep all cords on top of rugs.
• Store all flammable liquids, such as gasoline, outside of the home and locked out of children’s reach.

Preparing your home
• Install smoke alarms in every sleeping area and on every level of your home.
• Test and clean smoke alarms monthly.
• Maintain alarms by replacing batteries at least twice a year – when you change your clocks, change your batteries (unless it is a newer smoke alarm that uses 10-year lithium batteries).
• Replace smoke alarms every 10 years.
• Plan and practice two escape routes out of the house and each room.
• Designate one outside meeting place to make sure all family members are accounted for quickly.
• Sleep with bedroom doors closed. This prevents smoke, gas and heat from entering.
• Keep furniture and other heavy objects out of the way of doors and windows so they won’t block an escape.
• Place space heaters at least three feet from curtains, papers, furniture and other flammable materials. Make sure heaters are stable, and use protective coverings.

Teaching safety
Children need to be taught what to expect in a fire so they can act quickly. Teach children:
• Leave the house immediately if they hear the smoke alarm, smell smoke or see flames. Stay low and crawl – the best air is by the floor.
• Always feel doors before opening them. If hot, do not open and find another way out.
• Never go back into a burning building. Children should be reminded not to stop or return for toys, pets or to call 9-1-1 from inside the burning building.
• Call the fire department from a neighbor’s house or cell phone outside the home.
• Do not hide in closets, under beds, in bath tubs or in other areas of the home.
• When firefighters arrive, immediately tell them if someone is inside or missing.

FAST FACT: Playing with matches and lighters is a leading cause of fire deaths for children ages 5 and younger.

Lisa Klindt Simpson is coordinator of Safe Kids Southeast Wisconsin Coalition, a member of Safe Kids Worldwide. Safe Kids Southeast Wisconsin works to prevent accidental injuries, the leading cause of death among children 14 years of age and younger. Children’s Health Education Center is its lead agency.

Is your child abusing inhalants?

Children's Hospital — Thu, 02 Oct 2008 14:38:00 GMT

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.

Urgent care or emergency room: Which should I choose?

Children's Hospital — Thu, 25 Sep 2008 14:36:52 GMT

Ear pain, sore throats, the cold and flu, minor burns and cuts. For some children, childhood is marked by more than just a few visits to the local emergency room or urgent care clinic. Invariably, like Murphy's Law, it seems that your child is sick...(read more)

Beat the flu this season

Children's Hospital — Wed, 17 Sep 2008 21:38:00 GMT

Influenza (the flu) is a contagious disease. It is caused by the influenza virus and can be spread through coughing, sneezing or nasal secretions. Anyone can “catch” the flu, but children and the elderly are at higher risk for developing a more severe case and side effects.

For most people, symptoms include fever, cough, sore throat, headache, chills, muscle aches and fatigue. For some, influenza can lead to pneumonia, endangering people with heart or breathing conditions. It can cause high fever, diarrhea and seizures in children. The flu virus is estimated to cause hospitalization for more than 20,000 children each year in the U.S.

The single best way to protect your child from influenza is to have your child receive the flu vaccine each year.

When is the best time to get children vaccinated?
The best time to get vaccinated is between September and November. Because flu viruses change every year, the vaccine is changed yearly. It is important to have your child vaccinated annually. Children 6 months to 9 years of age getting the flu vaccine for the first time will need two doses of vaccine in the first year they are vaccinated.

Who should get the flu vaccine?
Children 6 months or older are recommended to receive the vaccine. Family members of children younger than 6 months also should receive the vaccine. Children ages 6 months to 4 years and those with chronic medical problems, such as heart disease, sickle cell anemia, diabetes, asthma or other lung problems, are at greatest risk for more serious disease and consequences.

Who should not receive the vaccine?
Anyone who is allergic to eggs should not receive the vaccine.

What kinds of flu vaccines are there?
There are two types of vaccines that protect against the flu. The flu shot is given with a needle, usually in the arm. The nasal spray flu vaccine, FluMist®, is inhaled through the nose.

What is the difference in the two vaccines?
The flu shot is inactive, which means that it contains killed flu virus. The shot is approved for people 6 months or older, including those with chronic medical conditions. FluMist® nasal spray flu vaccine contains weakened live viruses. The nasal spray currently is approved for people 2 to 49 years old. Children and adults with respiratory, pulmonary or cardiovascular conditions or those who are pregnant may not receive the FluMist® vaccine. FluMist® nasal spray may offer an advantage of better protection when the flu strain in the community does not match what is in the vaccine. Contact your pediatrician or family practice physician to make your child’s appointment.

FAST FACT: About two weeks after vaccination, antibodies that provide protection against influenza virus infection develop in the body.

Michelle Linsmeier, MD, FAAP, is a pediatrician at Children’s Medical Group-Bayshore Pediatrics.

Safe sleep for babies

Children's Hospital — Wed, 10 Sep 2008 00:13:34 GMT

Babies spend a great deal of time sleeping. Parents and others who care for infants should be aware of ways they can help protect sleeping babies from injury and death.

Sudden Infant Death Syndrome is the sudden unexplained death of an infant younger than 1 year of age. This syndrome is rare and its cause is unknown. However, there are measures you can take to help reduce the risk of SIDS and to prevent other injuries.

One of the most important things you can do to reduce the risk of SIDS is to put babies on their backs to sleep in a safe sleep environment.

Co-sleeping is not recommended. An infant sleeping in an adult bed is dangerous and can result in death. Sleeping with a baby is especially dangerous when the adult is impaired by alcohol, drugs or fatigue.

Take these other sleeping tips into consideration:
•   Always place your baby on his or her back to sleep, for naps and at night.
•   Place your baby on a firm sleep surface, such as a safety-approved crib mattress, covered by a fitted sheet.
•   Keep soft objects, toys and loose bedding out of your baby’s sleep area.
•   Do not allow smoking around your baby.
•   Keep your baby’s sleep area close to, but separate from, where you and others sleep.
•   Consider using a clean, dry pacifier when placing your child down to sleep.
•   Do not let your baby overheat during sleep.
•   Avoid products that claim to reduce the risk of SIDS. Most have not been tested for effectiveness or safety.

FAST FACT: According to the Infant Death Center of Wisconsin, 15 Milwaukee children died from unsafe sleeping arrangements from January 2008 to June 2008.

Anne Harvieux is the program administrator for the Infant Death Center of Wisconsin. The center is a statewide program administered through Children's Hospital of Wisconsin.

Why does my baby's head appear flat?

Children's Hospital — Thu, 04 Sep 2008 00:27:00 GMT

The birth process may cause your baby’s head to appear slightly misshapen during the few days or weeks after he or she is born. This generally is normal because a baby’s skull is made up of several separate bones that are not yet fused together. The shape should improve within six weeks of birth. If you’ve noticed that your baby is developing a persistent flat spot or is born with a flat spot that does not improve, it could be a sign of positional plagiocephaly, also known as flat head in infants.

Positional plagiocephaly most often occurs when a baby sleeps or rests his or her head in the same position repeatedly. Other common causes include:
•    Decreased space in the womb, such as multiple births or breech position.
•    Premature birth.
•    Torticollis (tightness of neck muscles causing the head to tilt and/or turn one way more than the other).

What does positional plagiocephaly look like?
An infant’s skull may get flat along the back, one of the sides or may bulge out at the forehead. If you look at your baby from above, one of his or her ears may seem more forward than the other. From the front, the eyes, jaw and cheeks may be uneven between the left and right side.

How can positional plagiocephaly affect my baby?
Small differences are normal, but severe flatness may cause future problems. Since the jaw is connected to the skull bones, the jaw can become uneven as the skull gets flat. This could cause pain in the jaw and make it hard to chew and eat. Uneven eyes may cause vision problems. Uneven head shape makes it difficult for glasses and safety helmets, such as a bike helmet, to fit correctly.

Can I prevent positional plagiocephaly?
Fortunately, positional plagiocephaly usually is easy to treat. With appropriate intervention, it should be corrected by the time your child is 1 year old. Parents may try the following suggestions:
•    Alternate the direction your baby’s head is turned each time he or she sleeps.
•    Encourage your baby to look in all directions when he or she is awake.
•    Alternate the arm you use to feed or hold your baby.
•    Consider moving your baby’s crib to a different area of the room. If there’s something in the room that’s catching his or her attention, moving the crib will coax your child to look at it from another position.
•    Use items like bouncy seats and swings as little as possible. Use the car seat only in the car, not as a carrier or for sleeping.
•    Use an upright carrier (ex: Snugli® or Baby Bjorn®) instead of a stroller when out for walks.
•    Be sure your baby gets plenty of supervised “tummy time” during the day. Tummy time helps promote normal shaping of the back the head. In addition, it helps babies learn to push up on their arms, which helps develop the muscles needed for crawling and sitting up. It also helps to strengthen the neck muscles.

As babies grow, they typically begin to reposition themselves naturally. Talk to your pediatrician if you see your baby turning or tilting his or her head more in one direction or if you notice head flatness developing.

FAST FACT: Always place your baby on his or her back to sleep. This decreases the chance of SIDS by 40 percent.

Micki Klawes, MPT, is a physical therapist at Children’s Hospital of Wisconsin.

Dealing with morning madness

Children's Hospital — Wed, 27 Aug 2008 18:18:00 GMT

Yes, it's that time again. After a long summer of sleeping late, playing outside and flexible schedules, children and parents can be overwhelmed adjusting to busy back-to-school routines. But every morning does not have to turn into madness. The tricks to a stress-free morning are planning ahead and sticking to schedules.

Keep these tips in mind as you get your kids ready for school:

To avoid last minute scrambling in the morning, keep book bags, stocked with completed homework assignments and other school necessities, near the door along with coats and shoes.
Give your child a bath and choose his or her outfit the night before. Have the clothing pressed and ready to go.
Decide on breakfast and lunch foods ahead of time, and have those foods easily accessible for cooking or packing in a lunch box. You may even want to make your child’s lunch the night before and refrigerate.
Avoid distractions such as TV or video games. They only will captivate your child’s attention and cause him or her to rush later.
Build cushions into your family’s schedule so you don’t feel frazzled.
Keep your child from being rushed by providing gentle reminders. For example, “The school bus will be here in 10 minutes, so you’ll need to put your shoes on.”
Avoid unnecessary morning chores like emptying the dishwasher.
Hang the family calendar in a place where everyone can see it. Older children can be proactive and place their musical instrument or uniform next to the door.
When you feel stressed, your family can sense it. Wake up 15 minutes earlier so you can have some alone time to wake up and feel energized before the rush.

Taking these tips into consideration can make your mornings run more smoothly. Here's to a great school year!

FAST FACT: 55 million students across the nation are enrolled in grades K-12 this fall. They will be taught by 6.8 million teachers.

Colleen Schultz is the education manager at Children’s Health Education Center. She is a certified health education specialist with a bachelor’s degree in community health. She also has a master’s degree in education. For more information on parenting tips, or for information about community education classes, call Children’s Health Education Center, a member of Children’s Hospital and Health System, at (414) 765-9355.

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Dry nights and sweet dreams

Children's Hospital — Wed, 20 Aug 2008 19:26:00 GMT

Staying dry at night is a major milestone in a child’s physical and social development. Bedwetting is children is very common, but it can be embarrassing for your child and frustrating for you.

Bedwetting should not be considered abnormal until a child has reached 5 or 6 years of age. It is important to understand bedwetting is not done on purpose or because the child is lazy. Bedwetting many times is an inherited problem. If both parents wet the bed when they were children, there is an almost 80 percent chance that the child also will wet the bed.

Sometimes children who wet the bed have smaller bladder capacities than others, or their bodies do not produce enough of the hormone that decreases the amount of urine made at night. Controlling the bladder while asleep is complex and the timeline for physical development of this process varies from one child to the next.

If a child begins to wet the bed after having been completely dry for at least six months or more, a medical problem such as a bladder infection, diabetes or kidney disease should be ruled out. Sometimes an emotional issue is responsible, such as a school stress, or a problem with peers or family.

Parents can take their children to a pediatrician to rule out any medical problems that may be causing bedwetting. If there are no medical problems, there are many things that parents can do to help their child achieve dry nights:
•    Stay positive, and help your child keep a positive attitude. Tell your child to visualize getting up to go to the bathroom and having dry nights.
•    Limit foods and beverages that contain caffeine, especially after dinner. Caffeine causes the body to make more urine.
•    Have your child use the toilet just before he or she goes to sleep.
•    Put a nightlight in the bathroom.
•    If your child wets the bed, have him or her take off wet sheets and put them in the laundry. Explain that this is not a punishment. It helps him or her take charge of the situation.

Where to go for help
If the bedwetting continues or you are concerned, talk to your child’s doctor or seek help from professionals with the Voiding Improvement Program at Children’s Hospital. This program provides comprehensive evaluation, diagnosis and treatment for children and teens with daytime and nighttime wetting or other voiding problems. Health care professionals can help improve self-esteem by educating families, children and teens about their condition and helping them choose and implement a plan that fits their needs.

FAST FACT: Bedwetting affects 15 to 20 percent of 6-year-olds, 5 percent of 10-year-olds and 1 to 2 percent of teenagers and adults. There are many ways that you can help your child overcome this problem. The most important way is to offer love and support, so your child can have dry nights and sweet dreams. Remember, punishment does not help bedwetting.

Patti Ring, RN, is a certified pediatric nurse practitioner with the Voiding Improvement Program at Children’s Hospital of Wisconsin.

Protect your child from bullying

Children's Hospital — Thu, 14 Aug 2008 19:09:00 GMT

With the school year fast approaching, it's important for parents to think through some of the possible situations that could come with the new year. With new surroundings and new faces comes the possibility of bullying. Whether it’s physical, emotional or verbal in nature, your child could find himself or herself in unfamiliar territory and unsure of what actions to take, which can be very stressful.

Here are some tips that will help your child be better prepared to handle a bullying situation:

1. Prepare your child.
Talk over any feelings of nervousness and anxiety he or she may have about the new school year. This will help uncover any issues your child may be experiencing and even identify any possible past bullying incidents that may have occurred.

2. Explain bullying.
It’s important for children and adults to be aware of the different forms bullying can take, regardless of whether the child is a victim or a bystander of verbal or physical bullying. Bullying even can take place through text messaging, instant messaging and Web site blogging.

3. Determine who can help.
Without a parent readily available, your child will need to know who he or she can reach out to for help. It is important that your child knows that teachers, principals and other grown-ups at school are there to help them, and to not be afraid to ask for help when they're in trouble.

4. Ask questions.
When communicating with your child, listen closely. If your child is avoiding questions, sounds nervous and angry or is completely silent, these all may be warning signs your child is in an uncomfortable situation.

5. Offer solutions.
When faced with a bullying situation, teach your child to ACT. (Action, Care, Tell). By doing nothing, the victim is allowing the bully to gain power and the situation may become repetitive or escalate into more violent territory. Instead, let your child know it’s important to act on the situation. Caring and showing compassion for others is a way to diffuse bullying by demonstrating that you understand where the other person is coming from. Finally, explain the difference between “telling” and “tattling.”

FAST FACT: Technology bullying via the internet often is a serious and hurtful form of bullying, and one not to be dismissed.

Colleen Schultz is the education manager at Children’s Health Education Center. She is a certified health education specialist with a BS degree in community health. She also has a master’s degree in education.