Parents who are concerned with their child’s speech and language development may not know what to do or where to go for help. With the help of a speech-language pathologist, it is possible to evaluate both receptive and expressive speech and language skills.

Receptive skills include a child’s ability to listen and understand, and expressive skills include a child’s ability to speak and use language, such as sounds, gestures and/or words.

Keep in mind that children learn at different rates. Watch for language skills that develop steadily, not whether they are fast or slow. Below is a list of basic speech and language milestones to look for, as well as some red flags, and the next steps to take if you are concerned.

A child’s common speech and language milestones include:

Six months
•    Babbles, laughs, coos.
•    Turns to look at new sounds.
•    Recognizes familiar people.

12 months
•    Uses simple gestures, such as waving, pointing and clapping.
•    Begins to understand the meaning of simple words and daily routines, such as eating and bedtime.
•    Follows some basic instructions.
•    Begins to imitate sounds and may say two or three words.

18 months
•    Uses 10 to 20 words.
•    Recognizes pictures of familiar people and objects.
•    Points out several body parts on self or a doll.

Two years
•    Has a vocabulary of at least 100 words.
•    Combines several words.
•    Understands simple questions and instructions.
•    Can be understood 50 to 75 percent of the time.

Three years
•    Sings simple songs and nursery rhymes.
•    Asks and answers simple questions.
•    Follows two- and three-step directions.

Four to five years
•    Identifies colors and shapes.
•    Can be understood 90 percent of the time.
•    Asks “who” and “why” questions.
•    Can retell a story.

When to seek help
Children who have one or more of the following issues may need to be evaluated by a speech-language pathologist.
•    No babbling, pointing or gesturing by 12 months.
•    Frequent ear infections with middle ear fluid.
•    No single words by 16 months.
•    Difficulty with or reluctance to imitate new sounds or words by age 2.
•    No two-word spontaneous phrases by 24 months.
•    Difficulty sucking, chewing or swallowing.
•    Poor voice quality.
•    Failure to answer simple questions and follow two-step directives by age 2½.
•    Stuttering that causes a child embarrassment, frustration or difficulty with peers.
•    Regression in language or social skills at any age.

Referral process
If you are concerned about your child’s speech-language development, discuss your concerns with your pediatrician. The Masters Family Speech and Hearing Center at Children’s Hospital of Wisconsin offers speech, language and hearing assessments for children from infancy through adolescence.

Susan W. Haessler, MS/CCC-SLP, is a pediatric speech-language pathologist at Children's Hospital of Wisconsin Clinics-North Shore.

FAST FACT: Parents don’t have to rely on the predictions of others or guess whether their child will be just like a friend’s and eventually catch up in language development. (“My son was slow, too. Now he won’t stop talking.”) If you are concerned about you child’s speech and language development, talk to your pediatrician or a speech-language pathologist.

Each year, more than 100 children age 14 and younger die, and 2.5 million are treated in emergency rooms for injuries from falls. Among children who die, more than half are younger than 4 years old.

There are many different ways children are injured from falls. They can fall from windows, down stairs, off furniture and from bikes or outdoor play equipment.

Fall-related injuries and deaths often are seasonal. Window falls peak during the spring and summer when people leave their windows open. Children also are outside playing on swing sets, jungle gyms and other playground equipment. Most playground injuries occur when children jump or fall from equipment to hard surfaces below. More than 70 percent of playground-related injuries involve falls to the surface.

Parents and caregivers can prevent falls in the home with supervision and safety products. To prevent falls at home:
•    Never use baby walkers.
•    Never leave young children alone on changing tables, beds, sofas or other furniture.
•    Always strap children into highchairs, swings and strollers.
•    Move chairs, cribs, beds and other furniture away from windows and draperies.
•    Install window guards that can be opened by adults on the first six floors of residential buildings. Install permanent window guards on floors seven and above.
•    Remember that children can fall from windows opened as little as five inches. Never rely on window screens to prevent falls.
•    Never let children play alone on fire escapes, high porches or balconies.
•    Use safety gates at the top and bottom of stairs.
•    Keep hallways and stairs well lit and     clear of clutter.
•    Never let kids play on stairs.

To prevent falls at play:
•    Check the surface under playground equipment. Avoid asphalt, concrete, grass and soil surfaces. Safer surfaces include mulch, pea gravel and shredded rubber at least nine to 12 inches deep and extending at least six feet in all directions around equipment. Work with local officials to clean up broken glass and trash to maintain safe playgrounds.
•    Insist children wear their helmets correctly every time they ride their bikes or skates. Only buy helmets that carry a sticker indicating they meet safety standards.
•    Make sure children wear protective gear including helmets, kneepads, elbow pads and wrist guards while inline skating or skateboarding. Skaters should take lessons, avoid skating at night and skate on smooth, paved surfaces free of motor vehicles.

Bridget Clementi is executive director of Children’s Health Education Center, CHEC is the lead agency of Safe Kids Wisconsin and Safe Kids Southeast Wisconsin coalitions. Each offer resources and programs for children, parents, teachers and caregivers to help keep children healthy and safe. Safe Kids Wisconsin and Southeast Wisconsin specifically work to prevent childhood accidental injuries, the leading cause of death among children ages 14 and younger.


FAST FACT: In 2007, more than 2,600 children ages 1 to 12 were treated in the emergency department at Children’s Hospital of Wisconsin for injuries they received from a fall.

Artistic expression often is used as a therapy to help people who have lived through traumatic experiences work through the grieving and healing processes. People of all ages experiencing behavioral, emotional and medical problems can benefit from art therapy by increasing self-awareness, resolving life-changing events, improving coping skills and expressing difficult feelings.

Children’s Hospital of Wisconsin art specialists use art in the hospital setting to help patients cope, and find it’s a wonderful way to help them express what they are thinking or feeling. But you don’t have to be ill or suffer a traumatic event to benefit from art or creating art.

Children of all ages benefit from self-expression through the artistic process. This can be as simple as finger painting for a 2-year-old or creating a multimedia collage with markers, paper, fabric and found objects for a 6-year-old. The experience of creating art offers a way for children to develop reasoning and to express their emerging thoughts and feelings. And, it’s fun!

This is YOUR Children’s Hospital
In spring of 2009, Children’s Hospital will open its new west tower. The 12-story, 425,000-square-foot expansion will increase the 236-bed hospital to 294 beds with space for 72 more beds in the future. The state-of-the-art facility also will include a larger Pediatric Intensive Care Unit and an expanded Herma Heart Center. Many people including physicians, nurses and our patients and families have been instrumental in the planning and design. In addition to the most cutting-edge technology and nationally recognized pediatric care, this expansion will offer a brighter and well-thought out environment with many amenities that will help children and families heal.

What does YOUR Children’s look like?
Last year Children’s Hospital cared for more than 250,000 children—many of whom live in your neighborhood or go to school with your own kids. Perhaps your family has been cared for by Children’s Hospital as an inpatient or in one of our outpatient clinics, by a Children’s Medical Group pediatrician or at a Children’s Urgent Care. We invite all children and adolescents ages 3-18 to share the story of their experiences with us through their art. We hope to use some of the submitted artwork in the following ways:
•    On the walls of Children’s Hospital.
•    Showcased in a Children’s Hospital coffee table book.
•    As part of a traveling art exhibit.
•    At a grand opening event for the new Children’s Hospital west tower.

Between now and June 13, 2008, submit artwork created on the entry form. Children can use crayons, colored pencils, markers, paint or pastels for their hospital artwork, be creative! All entries will be considered, and families will be notified if their child’s artwork has been selected. Four grand prize winners will receive a stay in Wisconsin Dells for four. We look forward to receiving your entries.

Download your entry form

Amy Phillips, MA, Fine and Decorative Arts, is an art therapist at Children’s Hospital of Wisconsin.

FAST FACT: More than 800 pieces of children’s artwork are hanging on the walls of Children’s Hospital and Health System facilities.
 

 

There is an outbreak of measles in our community right now. Following is information regarding measles and what you should do if you are concerned about a possible exposure in your family.

It is important to know that children and adults who have been fully immunized are not considered to be at risk.

What should I do if I’m concerned my child might have measles? Consult your pediatrician or family practice physician immediately. If you are being referred to Children’s Hospital for a blood test, your pediatrician should contact the Emergency Department prior to your arrival. Then, please go directly to the Children’s Hospital Emergency Department. A testing station has been set up in the Emergency Department to help screen for measles.

Please do not enter the hospital or clinics building and risk exposure of other patients and people.
_________________________________________________________________________________________________________________________________________________________

What is measles? Measles is an extremely serious and highly contagious viral disease that can be prevented by routine childhood vaccination.

How is measles prevented? The measles vaccine is usually given in combination with rubella and mumps vaccine (MMR). The current vaccination schedule suggests a first vaccine between 12 and 18 months of age. A second vaccine should be given between 4 and 6 years of age. If you are not sure if your child has received the MMR vaccine consult your pediatrician or family practice physician.

Who can get measles? Measles virus can infect any person of any age who has not previously had the disease or measles vaccine.

How is measles spread? Airborne droplets, from coughing or sneezing, spread the virus. It spreads easily and rapidly.

What are the signs and symptoms of measles? The disease begins with cold like signs and symptoms including a cough, runny nose high temperature and red, watery eyes. By the second day after onset, a red blotchy rash appears at the hairline and spreads down the body to the arms and legs. The rash disappears in the same order of appearance (head to foot) in about 5-6 days.

How soon do symptoms appear after exposure? It takes from 8-12 days for the cold-like symptoms to appear and 14 days for the rash.

How can parents be sure that their child’s illness is measles? The only sure way to determine if an illness is indeed measles is through a blood test.

When and for how long is a person able to spread measles? Measles can spread from one day before the onset of cold-like symptoms through the fourth day of the rash.

What are the complications associated with measles? Among children with measles, about 10 percent develop ear infections, about 5 percent develop pneumonia, about 0.1 percent  (1 per 1,000 cases) develop encephalitis (inflammation of the brain that can result in deafness or mental retardation) and in approximately 1 in 1,000 cases people die from it.

Is there a treatment for measles? There is no specific treatment for measles.

Can measles be prevented? Yes. Measles vaccine is recommended for all children at 12-15 months of age and again at 4-6 years of age. The two doses of vaccine normally provide life-long immunity.

For more information consult your pediatrician or contact your local public health department.

FAST FACT: A measles hotline has been established by the Milwaukee Health Department. Call (414) 286-3616.

The spring months bring sunshine, warmer weather and sometimes a trip or two to your pediatrician. A trip to the pediatrician’s office can be stressful, but knowing how to make the most of your time there can make visits run smoothly.

Offer information:
•    It’s important your doctor be aware of any change in your family’s health history, including grandparents, aunts and uncles. Cases of heart disease, diabetes, high blood pressure and cancer are examples of things your doctor should know.
•    Tell the doctor if someone else has seen your child for an illness or injury, such as a visit to an emergency room, urgent care or a specialist.
•    Bring a list of all the medications your child is taking. This should include over-the-counter medications, vitamins and herbal supplements, as well as prescription medication.
•    If your child is sick, write down timelines of what symptoms began when. This is especially helpful if your child has a chronic or long-standing illness.

The more information you can offer your child’s doctor, the better he or she will be able to understand, diagnose and treat your child.

Ask questions. At regular check-ups:
•    Ask what you might need to know about caring for your child between this visit and the next one. Make sure you know when the next scheduled visit should take place.
•    Ask what changes your child might go through before your next visit such as growth, development and feeding stages. Your doctor can provide helpful nutritional and safety advice no matter your child’s age.
•    Ask where else you can get good information on parenting, safety and other related topics, such as Internet sites, books and magazines.

It is helpful to come with questions written down so you don’t forget to ask them. Also, make sure you understand the answers and information your doctor gives you, and don’t be afraid to ask for further information or clarification. Remember, these questions are best for well-child visits. When your child is sick, that visit should be focused on the current illness.

Come prepared. Make sure you bring the following to every visit:
•    Health insurance information.
•    Any changes in demographic information such as address and phone number or emergency contact information.
•    A game, book or favorite toy that can help keep your child entertained if there is a wait in the office. This also can help comfort your child and ease some anxiety.
•    Antiseptic wipes if your child plays with toys or has contact with other children in the waiting room.
•    A blanket and extra diaper for infants.
•    Unfortunately, waiting to see the doctor often is inevitable. Ask front office staff if you can call before your visit to find out if appointments are running on time. Being on time is a mutual responsibility between the doctor and patient. Sometimes a little advanced planning can lessen frustration and help visits run on time.

Most importantly, enjoy the time with your pediatrician. The two of you are talking about the most precious, unique and wonderful gift – your child.

Michael Gutzeit, MD, is a pediatrician and chief medical officer at Children’s Hospital of Wisconsin. For more information about Children’s Hospital call (414) 266-2000 or visit www.chw.org.

 
FAST FACT: Did you know that Children's Hospital and Health System has 17 pediatrician practices throughout Southeastern Wisconsin? For more information about Children's Medical Group visit the Web site at www.childrensmedicalgroup.org. 

This time of year almost everyone gets the “common” cold. Symptoms can include:
•    Fever.
•    Cough.
•    Runny nose.
•    Poor sleep.
•    Decreased appetite.
•    Crabbiness.

Treating cold symptoms
Colds are caused by viruses. There are no medicines that kill viruses like antibiotics kill bacteria, so the best plan is to treat the symptoms. To treat symptoms of the common cold, try these suggestions:
•    Tylenol® and ibuprofen work as fever reducers. If your child has persistent fevers above 101 degrees, alternating doses of Tylenol and ibuprofen every four hours will help keep the fever down and make your child more comfortable.
•    For coughing and runny noses, use saline nasal drops and nasal suctioning for younger kids. For older kids use saline nasal spray and nose blowing. The saline loosens the mucus and makes suctioning and nose blowing more effective. For younger kids, suction one nostril at a time, first filling it with saline drops and waiting 15 to 20 seconds before using the bulb to suction the mucus. Repeat this process multiple times throughout the day. You are probably thinking, “There is no way my child will let me do this.” But if you are persistent, it will work, and your child will feel better.
•    At night, elevating the head of the bed will alleviate some of the post-nasal drip that contributes to nighttime coughing. Use an extra pillow for older kids and a phone book under the head of the mattress, elevating it to a 30 to 45 degree angle for younger kids. Running a cool-mist vaporizer at night will help, too. Most colds last for 10 to 14 days.

As always, call your doctor if you have concerns. For more information about treating the common cold, visit the Children's Hospital Web site at chw.org.

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

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

 

Spring cleaning is an annual ritual. This year, as you clean and organize your home, keep poison prevention in mind.

Wisconsin Poison Center answers more than 50,000 calls each year concerning potentially hazardous substances and situations. More than 90 percent of poisonings occur at home. Though unintentional poisoning can affect people of all ages, children age 6 and younger and elders who take multiple medications are at high risk. The most common hazards for children include: personal care products and cosmetics, household cleaners, plants and pesticides, and over-the-counter medications such as pain relievers, cough/cold products and multivitamins.

Here’s what to look for:
In the kitchen:
• Keep medications and cleaning products in their original containers with labels intact. Child-resistant caps help, but parents should not depend solely on these. Many children can open them.
• Do not store any medicines on the kitchen windowsill, countertop or top of the refrigerator where children can see or try to reach them.
• Make sure all household cleaning products are stored high, out of children’s reach.
• Install child safety devices on all cabinets as an added measure of protection.

In the bathroom:
• Throw out old medicines by tying them tightly in a nonsee-through bag. Take them straight out to the trash on pick-up day.

In the bedroom:
• Look for any flaking paint on furniture, walls and windowsills. Flaking paint may contain high levels of lead. When considering home renovations, make sure to protect yourself and your family from inhaling or eating leaded paint dust.
• Make sure all perfumes and cosmetics are stored out of reach.
• When guests stay over, ask them to keep their medications out of a child’s reach.

In the laundry room:
• Store soaps, detergents and other products in high, locked cabinets.
• Keep open products with you when using them. If the phone or doorbell rings, take the product with you.

Remember, there are hazards outside the home, too. Outdoor poison exposures increase in warmer months, when children are outside more often and are at greater risk of coming in contact with pesticides, toxic plants, insects and more.

If you suspect your child has come in contact with a poisonous substance, call Wisconsin Poison Center immediately at 1-800-222-1222.

David Gummin, MD, is the medical director of Wisconsin Poison Center, located at Children's Hospital of Wisconsin. The center 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 24 hours a day, seven days a week toll-free 1-800-222-1222. Translators are available.

FAST FACT: In 2007, the Poison Center answered a total of 52,834 calls for help and information. Nearly 85 percent of the calls were regarding a poison exposure. Accidental poisoning in the home accounted for 3 out of 4 cases.


 

Concussions in young athletes are common and often misunderstood. Many children sustain concussions but do not report them to parents or coaches for fear of being sidelined from activities. When kids get concussions, medical follow up is crucial before they return to normal activities.

What is a concussion?
A concussion is a brain injury that generally is caused by a direct blow to the head or face, such as a sports injury or bad fall from a bike.

Symptoms of a concussion
Parents should be aware of the signs that a child may have suffered a concussion:
Mental:  Headache, confusion, feeling mentally foggy, seeing stars or flashing lights, impaired consciousness, poor concentration and attention.
Physical:  Vacant or glassy-eyed stare, double or blurry vision, poor balance and coordination, dizziness, fatigue, nausea or vomiting, incoherent speech, ringing in ears.
Behavioral: Inappropriate play on the field (running the wrong way), mood swings, trouble sleeping, irritability, changes in personality, nervousness or sadness, impaired academic performance.
Depending on the severity, concussion symptoms may last anywhere from a 10 to 15 minutes to several months.

Treating a concussion
A medical professional should always see a child with a concussion. A child can have a normal CT scan and still have a concussion. Parents need to know what to expect and when a child needs follow up care—especially if he or she continues to have symptoms. Only a medical professional can offer guidance to help parents know when it’s safe for a child to return to regular activities. Returning your child to a normal routine too soon, even if he or she has a mild concussion, can prolong symptoms, potentially causing brain damage or more severe problems. Never allow an athlete to practice or play in a game if he or she has sustained a concussion.

If symptoms worsen, call a physician or go to the emergency room.

Preventing concussions
Approximately 300,000 children suffer sports-related concussions annually. Concussions can’t be prevented, but you can decrease the risk by teaching proper technique and wearing protective equipment, including:
•    Helmets, other headgear and mouth guards.
•    Ensuring equipment is properly fitted.
•    Enforce rules and adopt less dangerous styles of play. A good example is a ban on body checking in hockey for players age 15 and younger.

Each concussion brings greater risk for more serious injuries, including additional symptoms and/or longer recovery periods. Be sure your children have the proper safety equipment for their activities and never be afraid to seek the expertise of a medical professional.


Kevin Walter, MD, is a pediatric sports medicine specialist at Children’s Hospital of Wisconsin and an assistant professor of Orthopedics at the Medical College of Wisconsin. He also sees patients at the new Children's Hospital of Wisconsin Clinics-Greenway located west of 894 and one block south of Oklahoma Ave. Dr. Walter is one of fewer than 120 pediatricians in the country who are board certified in pediatrics and sports medicine.


FAST FACT: Never send young athletes with a concussion or symptoms of a concussion back into a game or practice. When in doubt, keep them out.

Parents often feel pressured to potty train their children. It seems everyone has an opinion. Our opinion is, it's best to take a relaxed approach. Like many things during the toddler years, potty training is, in part, a test of your patience. No matter how much you want to ditch the diapers, it probably will not happen overnight. In fact, it usually takes weeks or months to master.

Many children are ready to begin toilet training between 2 and 2 and a half years of age. But, behavior is a much better guide than age.

Look for the following signs that your child is ready:
•    Urinates on a regular basis.
•    Stays dry for two to three hours at a time.
•    Is aware that he or she needs to go to urinate or have a bowel movement and tells you.
•    Imitates older siblings and adults and wants to do things by him- or herself.
•    Follows simple directions.
•    Expresses interest in body functions, the potty or underpants. 

When signs indicate your child is ready to begin toilet training, introduce the process in three stages – telling, showing and trying.

Telling
•    Talk about body parts and what they do using language your child can understand.
•    Read books to your child about going to the potty.

Showing
•    Give your child his or her own potty.
•    Take your child into the bathroom with you. Encourage your child to sit on his or her potty with clothes on while you are on the toilet.
•    Have your child practice lowering and raising training pants. Point out “big kid” underpants and talk about how your child will wear them when he or she learns to use the potty.

Trying
•    Have your child try to go once each day at the same time.
•    Introduce underpants during the day and encourage regular visits to the bathroom.
•    Expect accidents and clean them up without blame, anger or punishment.

Make sure you choose a period when you can spend a lot of time with your child. Toilet training takes time. There are books and videos on toilet training you can find at the library or bookstore for additional information. Talk to your child’s doctor if you have concerns.

Marge Friedhoff, RN, MSN, APNP and Margo Kinservik, RN, MSN, APNP, are nurse practitioners in the Gastroenterology Center at Children's Hospital of Wisconsin.

FAST FACT: Many parents see their child’s ability to master potty training as a reflection on themselves when in reality, your child is the only person who can determine the pace for successful toilet training. The more willing you are to let your child direct the process, the more successful you both will be!
 

Sleep – we all need it, especially our children. Two-thirds of children age 10 and younger have sleep problems. Lack of sleep has been linked to poor school performance in adolescents and irritability and overall fussiness in infants and toddlers. Here are tips to help your child sleep:

Infants (newborn to 18 months)
Sleep needed: 10 to 18 hours of sleep a day (including naps).
• Develop daytime nap and bedtime schedules and stick to them.
• Create an enjoyable bedtime routine that you do every night with your child.
• Establish a safe sleep environment. The American Academy of Pediatrics recommends infants be placed on their backs in a crib without soft objects and bedding such as pillows, quilts and stuffed animals.
• Put infants to bed drowsy, but not yet asleep, to encourage them to fall asleep on their own.

Toddlers and preschoolers (19 months to 4 years)
• Sleep needed: 11 to 14 hours a day (including naps).
• Develop a bedtime routine such as having a snack or reading a story. Make sure the routine ends with your child in his or her own bed.
• Create a bedroom environment that is the same every night - cool, dark, quiet and comfortable.
• If your child is afraid, suggest a blanket or stuffed animal for company.
• If your child wakes in the middle of the night, try to redirect him or her back to bed with minimal interactions.

School-aged children (5 to 12 years)
Sleep needed: 9 to 11 hours a night.
• Talk to your school-aged child about healthy sleep habits and why they are important.
• Enforce consistent sleep schedules and bedtime routines, even on weekends.
• Make your child’s bedroom the best environment for sleep – dark, cool and quiet.
• Avoid having a TV or computer in your child’s bedroom.
• Balance your child’s schedule. Never let activities take the place of sleep.
• Teach your child to eat healthy and exercise regularly. Overweight children are at risk for sleep apnea, a serious sleep disorder.

Be a good role model and make sleep a priority for the whole family. Talk to your child’s doctor if you have concerns. Most sleep problems are treatable.

Children’s Hospital has the only pediatric sleep laboratory in the state that is accredited by the American Academy of Sleep Medicine. Children with sleep disorders can be evaluated in the pediatric sleep disorders clinic.  A pediatric sleep laboratory is available for children who need additional testing. If your child has a sleep problem, talk to his or her doctor or call (414) 266-2790.

By Nan Norins, MD, pediatric sleep specialist in the Sleep Center at Children's Hospital of Wisconsin.

FAST FACT: Sleep is the primary activity of the brain during early development. Throughout childhood and adolescence, sleep accounts for 40 percent of a child's average day. March 3-9 is National Sleep Awareness Week.

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.


 

Congenital heart disease patients benefit from long-term follow-up

If you turn the clock back 50 years, the harsh reality is that 8 out of 10 children born with congenital heart defects did not survive. Today, thanks to improved surgical and medical care, 9 out of 10 patients with congenital heart defects live to adulthood. In fact, it now is estimated that there are nearly 1 million adults in the United States living with a congenital heart defect, 15,000 of whom live right here in Wisconsin.

Congenital heart defects can have long-term complications, and “total correction” is not the rule. The vast majority of patients who underwent heart surgery as a child should have periodic evaluations for life.

Many non-cardiac problems arise as children grow that may require special attention. These include:
•    Learning disabilities.
•    Exercise restrictions.
•    Birth control.
•    Pregnancy.
•    Difficulties in obtaining health and life insurance.

Time and stress can put strain on a repaired heart, requiring specialized care. Many adult patients have a false sense of well being, so they stop seeing their cardiologist and stop taking their medications. Depending on the original defect, some patients can suffer sudden and serious problems. Early warning signs may include:
•    Heart racing.
•    Extra beats.
•    Exercise intolerance or reduction in stamina.
•    Easily exhausted, such as when walking up stairs.

The professionals in the Herma Heart Center's Adult Congenital Heart Disease Program are experienced and dedicated in helping patients deal with these issues.
The team provides state-of-the-art, comprehensive diagnostic and interventional cardiac care. Services offered include:
•    Diagnosis and follow-up including chest X-rays, echocardiography studies, EKG studies, stress tests and exercise physiology studies.
•    Medication management.
•    Catheterization procedures.
•    Surgical procedures.

If you or someone you know had heart surgery as a child, please seek or encourage follow-up care.

Michael G. Earing, MD, is a cardiologist in the Herma Heart Center Adult Congenital Heart Disease Clinic at Children’s Hospital of Wisconsin. He also is on staff at Froedtert Hospital, and is an assistant professor of Internal Medicine and Pediatrics at the Medical College of Wisconsin.

 
FAST FACT: Thanks to advances in pediatric surgery and cardiothoracic surgery there now are more adults with congenital heart disease living in the United States. As a result, a new specialty - Adult Congenital Heart Disease - has begun to treat this unique population, but very few physicians are trained. Two of the less than 40 physicians nationwide with this experience see patients at Children's Hospital of Wisconsin.
 

About 2.2 million school-aged children, and one in every 17 children younger than 3, have food allergies. Food allergies often are more common in individuals who have family members with allergies.

With a true food allergy, a child’s immune system will overreact to an ordinarily harmless food. Once the immune system decides that a particular food is harmful, it creates specific antibodies to it. The next time the child eats that food, the immune system reacts in order to protect the body.

Six foods account for 90 percent of food allergies:
•    Milk.
•    Eggs.
•    Peanuts.
•    Wheat.
•    Soy.
•    Tree nuts (walnuts, cashews, pecans are examples).

Symptoms of allergic reactions
The most common reaction to a food is hives. Asthma symptoms, such as coughing, wheezing or difficulty breathing also may be triggered by food allergies, especially in infants and children. Symptoms may appear within minutes or up to two hours after the child has eaten the food. As they get older, some children may tolerate foods that previously caused allergic reactions. However, less than 25 percent of individuals with peanut allergy will outgrow it.

Severe allergic reactions
In some cases, eating certain foods can cause a life-threatening allergic reaction called anaphylaxis. Symptoms of anaphylaxis are temporarily reversed by treatment with injectable epinephrine, antihistamines and other emergency measures. It is essential that anyone with symptoms of anaphylaxis gets immediate emergency treatment.

Staying safe
Be informed, check ingredients carefully. Following is a checklist to help avoid foods that may affect your child’s allergies:

•Always read labels. Ingredients can change unexpectedly.
•    To avoid eating a “hidden” food allergen away from home, always ask about ingredients when eating out. Taking the ingredient out of a dish that is about to served is not a solution. In addition, cross contamination may occur if the same utensil is used to prepare other foods. Food allergens also can be airborne, especially in steam.
•    Tell your family, friends and your child's school or daycare about your child’s food allergies. Remind them that strict avoidance is key when managing food allergies, and even one little bite can hurt.
•    If your child’s food allergies are severe, be prepared for emergencies. Carry and know how to use injectable epinephrine and antihistamines to treat unexpected reactions.

Diagnosis
If you think your child may have food allergies, an allergist/immunologist is the best-qualified professional to diagnose and care for your child.

Asriani Chiu, MD, is an allergist/immunologist in the Asthma and Allergy Center at Children’s Hospital of Wisconsin. Asthma and Allergy Center staff includes 12 allergists with international reputations in the fields of allergy, asthma and immunology, who treat both children and adults. Other clinic staff includes nurse practitioners, a nurse education specialist, registered nurses, licensed practical nurses and respiratory care practitioners.

FAST FACT:  Not eating the foods your child is sensitive to is the only proven therapy for food allergies.

Think about all the things you touch each day, or worse, think about all the things your child touches everyday. How many people may have touched them before you? We carry millions of germs on our hands. Most are harmless, but some cause illnesses such as colds, flu and diarrhea.

When we forget to wash our hands, or do not clean them properly, we can spread these germs to other people or give them to ourselves by touching our eyes, mouth, nose or cuts on our bodies. We also can pick up germs from objects such as doorknobs and stair railings, touched by other people who do not clean their hands properly.

Research results are clear; the single most important way to keep children healthy is to teach them to wash their hands. Help them start this important healthy habit when they are young. To reduce the risk of infection:
•    Wet hands with warm water to kill germs.
•    Place a small amount of soap in the palm of one hand.
•    Rub hands together quickly, rubbing soap between fingers, on backs of hands and lightly scratching fingernails on palms of hands. Rub for at least 10 seconds. Make it fun. Have your child sing a song while washing. Use Happy Birthday, the ABCs or your child’s favorite that takes at least 10 seconds to sing.
•    Rinse hands well with warm water, being sure to scrub while rinsing. Point fingers down in the sink. This will rinse germs off the hands.
•    Dry hands, making sure they are completely dry.    

Make sure your family has clean hands BEFORE you:
    •    Prepare or eat food.
    •    Treat a cut or wound.
    •    Tend to someone who is sick.
    •    Put in or take out contact lenses.
    •    Do any kind of activity that involves putting your fingers in or near your mouth and eyes.

Also clean your hands AFTER you:
    •    Go to the bathroom.
    •    Handle uncooked foods, especially raw meat.
    •    Eat.
    •    Blow or wipe your nose, cough or sneeze.
    •    Handle garbage.
    •    Tend to someone who is sick.
    •    Handle an animal.

And don’t forget to set a good example – clean your hands often and remind others to do the same. Good hand hygiene is one of the simplest and most effective ways to keep your family healthy.

Eileen Sherburne, RN, MSN, FNP, CRRN, is an advanced practice nurse at Children’s Hospital of Wisconsin.

FAST FACT: Children's Hospital of Wisconsin is expanding to meet the needs of our community. The 425,000 square foot addition will take the 236-bed hospital to 294 beds, with capacity for an additional 72 beds in the future. In 2005, patient days, a measure of hospital activity, exceeded levels projected for 2010. Hospital admissions, Emergency Department visits and outpatient visits all have significantly increased over the past five years. The new West Tower is scheduled to open in spring of 2009. For more information visit the Web site at www.chw.org.
 

Eczema is a common skin rash in children. The rash may be red, dry, bumpy and look swollen. It may come and go, but it often keeps coming back and is very itchy. In fact, the itching often is so bad that it interferes with sleep.

The exact cause is unknown, but many things can trigger an outbreak, including:
•    Heat and sweat.
•    Cold weather.
•    Dust mites.
•    Pet fur and dander.
•    Grass.
•    Wool and synthetic fabrics like nylon.
•    Fabric dyes.
•    Tobacco smoke.

There is no cure for eczema, which is also called atopic dermatitis, but it can be kept under control. There is no one treatment that works for all patients. Your doctor will select a treatment according to your child’s needs. Following are some tips for controlling eczema:

Moisturizers: Apply moisturizers twice a day and as quickly as possible after bathing, especially while the skin is still damp. Ointments such as petroleum jelly are good choices during the winter. Creams are usually white and thick and also are effective. Lotions are more liquid but the least helpful. Avoid products with added ingredients, such as vitamin E, witch hazel, menthol or acids.

Bathing: bathe your child daily in warm (not hot) water for no longer than 10-15 minutes. Use soap only in areas that get dirty, such as the groin, under the neck and armpits. Pat your child’s skin gently with a towel.

Laundry: Use laundry soaps that are free of fragrance and dye. Never use fabric softeners or dryer sheets.

Clothing: Dress your child in clothing made of soft, natural fibers such as cotton. Avoid wool, nylon and fabrics that feel hard when you touch them.

And, keep your child’s fingernails cut short to help avoid injury and infection from scratching.

Although the tendency to have sensitive skin can continue into adulthood, eczema usually improves and the rashes become less frequent as the child ages.

Valerie Lyon, MD, is a pediatric dermatologist at Children’s Hospital of Wisconsin. She also is an assistant professor of Dermatology at the Medical College of Wisconsin. In the Dermatology Clinic she emphasizes patient education and likes to work with families to adopt skin care routines that are tailored to the individual child.

FAST FACT: Did you know that Children's Hospital of Wisconsin has more than 70 outpatient specialty clinics like Dermatology for kids, including Asthma/Allergy, Orthopedics, Ophthalmology, Otolaryngology, Adolescent Health and Medicine and others? Find out more at chw.org.

They can travel at nearly 20 miles per hour, they have no brakes and kids love them. What are we talking about? Sleds, of course. Zipping along faster than an average bicycle, which travels at 10 to 15 miles per hour, a sled can pose a serious risk of injury for a child. Children's Hospital of Wisconsin's Emergency Department sees many kids for sledding-related injuries throughout the season, including broken bones, concussions and head trauma.

Nothing makes children happier than sliding down a hill blanketed with fresh snow. However, as caregivers, we need to be sure our kids are both happy and safe.

Here are a few tips to help keep children safe during sledding season:
•    Always supervise your child while he or she is sledding. Children don’t always understand the risks involved with activities.
•    Use designated sledding hills, which have no fixed objects such as trees or fences, are away from traffic and have up and down routes. A good sledding hill does not lead to a street, frozen body of water or busy gathering place.
•    Require your child to sled while sitting feet forward. Never allow him or her to ride headfirst.
•    Teach sled control, including how to steer, stop and safely fall off the sled.
•    Promote fair play and rules of the hill.
•    Helmets are recommended to protect against head injuries. Be sure your child’s helmet meets current standards set by the U.S. Consumer Product Safety Commission for sledding use.

When shopping for a sled, be sure to choose one that is appropriate for your child’s size and development. Inspect sleds regularly and avoid using sleds with sharp edges or ropes.  Well-constructed sleds that are easy to steer make the best choice for a fun winter season.

Bridget Clementi is the Injury Prevention Manager for Children’s Hospital and Health System. Children’s Hospital and Health System is the region’s only independent health care system dedicated solely to the health and well-being of children. Children’s Hospital of Wisconsin, the health system’s flagship member, is recognized as one of the leading pediatric health care centers in the United States. For more information visit www.chw.org.

Since the advent of the Internet, children have been able to expand their horizons beyond outdated encyclopedias and textbooks into new worlds. Now, kids can use the World Wide Web to play interactive educational games and learn about everything from puppy dogs to the Great Wall of China. But, due to the size of cyberspace and popular tools like instant messaging and social networking sites, children have become vulnerable targets for predators.

An estimated one in seven children ages 10-17 have been sexually solicited online. Fortunately, these solicitations easily can be avoided with the help of a parent. Here are a few ways parents can keep their kids safe while surfing the net:
•    Keep the family computer in a common area of the house where you can monitor your child’s Internet activities.
•    Invest in filtering software for your family’s computer.  This software enables parents to block their kids from visiting sites that are inappropriate.
•    Invest in monitoring software for your family’s computer. This software secretly records everything a child does on the computer, by taking screen shots of the monitor every few seconds.  That information is stored in an attachment and e-mailed to mom or dad for review.
•    Explain to your children that they should not place any personal information about themselves on the Internet. That includes their name, address, phone number, name of their school and school mascot. Children can be easily tracked down when this kind of personal and public information is shared.
•    Explain to your children the importance of not sharing their pictures on the Internet.
•    Maintain access to your child’s online account and randomly check his or her e-mail.

Parents also should watch for signs that their child may have fallen prey to an Internet predator:
•    Spending an unusually long amount of time on the Internet.
•    Using the Internet late at night when parents are asleep.
•    Losing interest in extracurricular activities.
•    Spending less time and energy on homework.
•    Minimizing the computer screen or turning off the computer when a family member walks into the room.
•    Exhibiting a short temper.
•    Using inappropriate language.

If your child has become a victim of an Internet predator, call local law enforcement or reporting the incident to the National Center for Missing and Exploited Children.

For more information about safe Internet usage, visit capfund.org or call the Child Abuse Prevention Fund at (414) 266-6300.

Jennifer Hammel is director of the Child Abuse Prevention Fund, a special fund-raising initiative of Children's Hospital and Health System. To learn more, visit www.capfund.org. Children’s Hospital and Health System is the region’s only independent health care system dedicated solely to the health and well-being of children. Children’s Hospital of Wisconsin, the health system’s flagship member, is recognized as one of the leading pediatric health care centers in the United States. For more information visit www.chw.org.