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.

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.

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.
 

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 or injured when your pediatrician's office is close. Parents are left asking whether to head to the emergency room or an urgent care clinic.

Urgent care clinics are for illnesses and injuries that your child normally would receive care for at his or her doctor’s offices. Most often, urgent care locations are open when regular doctor’s offices are closed. In many cases, urgent care clinics will offer lower co-pays and shorter wait times than emergency rooms.

Your child may need urgent care for:

•    Ear infections with pain and/or fever.
•    Sore or strep throat.
•    Cold or the flu.
•    Mild asthma attacks
•    Vomiting and diarrhea, especially in babies and small children.
•    Non-severe bleeding.
•    Minor burns or cuts.
•    Minor head injury with no loss of consciousness.
•    Hives, rash or diaper rash.
•    Bruises or sprains.
•    Lice, scabies or ringworm.
•    Drug reactions such as hives or rashes.

The emergency room is for more serious illnesses and injuries. Emergency rooms are equipped to care for all patients, from those with minor illnesses to those with life-threatening injuries. Because of this, patients with a less severe problem usually will have to wait – sometimes hours – until the more critically ill patients are treated. For appropriate cases, urgent care clinics have shorter wait times.

Your child may need emergency care for:

•    Serious broken bones, such as the leg or arm.
•    Gun or knife wounds.
•    Severe or unusual bleeding that will not stop.
•    Heart attack or severe chest pain.
•    Suspected stroke.
•    Sudden inability to see, move or speak.
•    Choking or trouble breathing.
•    Possible poisoning.
•    Unconsciousness.
•    Fainting or syncope.
•    Convulsions or prolonged, repeated seizures.
•    Drug overdose.
•    Major injuries.
•    Severe pain.

Unfortunately, some childhood injuries and illnesses may require more immediate care. In emergencies, always call 9-1-1 for the most immediate care.

While arming yourself with information is one of the best things you can do as a parent, remember to trust your instincts. You know your child best.

For more information about Children’s Urgent Care locations call (414) 266-4800. For more information about the Children’s Hospital of Wisconsin Emergency Department, call (414) 266-2000.

FAST FACT: Children's Hospital of Wisconsin had more than 61,000 visits to its Emergency Department and six Children's Urgent Care sites last year.

Jane Chevako, MD, is the medical director of Children’s Urgent Care.
 

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.



 

As summer vacation draws to an end, it’s important to help children re-establish a healthy back-to-school sleep schedule.

Children need more sleep than adults. Children ages 5 to 12 require 10 to 11 hours of sleep each night, while teens should have at least nine hours.

Chronic sleep deprivation has many serious consequences, including poor school performance. Lack of sleep also can be linked to behavioral, developmental and mood problems in children. Drowsy teens who get behind the wheel of a car can suffer even more dire consequences.

Despite these facts, the National Sleep Foundation has found that only 20 percent of adolescents get enough sleep.

Parents can help children adjust their sleep patterns for the upcoming school year by following these guidelines:

• At least two to three weeks before school starts, set a bedtime and wake-up time. Children with bedtimes before 10 p.m. are much more likely to get enough sleep than children with later bedtimes. If necessary, the schedule can be adjusted at a gradual pace (about 15 minutes every two days) to ease the transition.
•  In the last days of summer, wake your children early. Emphasize activity and bright light in the morning. For example, send them outside to play, rather than allowing them to watch TV. 
• Be consistent with your children’s sleep schedules, even if they don’t have school the next day.
• Establish a relaxing evening routine. Avoid exercise or stimulating activities in the last few hours before bedtime.
• Create a sleep environment that is cool, dark, quiet and comfortable.
• Limit caffeine, especially after lunchtime.
• Avoid having a TV or computer in the bedroom. 
• Make sleep a priority and set a good example.

 Back to school means early to bed

FAST FACT: The National Highway Traffic Safety Administration estimates that drowsy driving causes at least 100,000 police-reported crashes and kills more than 1,550 Americans each year.

Nan Norins, MD, is a pediatric sleep specialist at Children’s Hospital of Wisconsin and an assistant professor of Pediatrics (Pulmonary/Critical Care Medicine) at the Medical College of Wisconsin. The Sleep Center at Children’s Hospital offers a full range of diagnostic and treatment services, including the state’s only pediatric sleep laboratory accredited by the American Academy of Sleep Medicine.

Proper hearing is essential to a child’s ability to develop speech and language skills, as well as his or her cognitive, social and emotional development. The first few years of a child’s life are particularly important. During this time, children learn to make sense of sounds via their ears, working in conjunction with their brains. The importance of these early years is what prompted many states to initiate hearing tests for all newborns. Early detection and appropriate intervention are key factors in eliminating or minimizing the negative impact of hearing loss.

Despite the importance of early intervention, on rare occasions parents still are told their child is too young for a hearing test. Very young children can be tested. Here are some of the more common tests:
 
Visual reinforcement audiology
This is a behavioral testing technique typically used with children between 6 months and 3 years old. In a special booth, the child is seated on a parent's lap with speakers situated on either side. An audiologist transmits speech and different pitches of sounds through the speakers. When the child hears the voice or sounds and looks in the direction of the sound, an animated, lighted toy appears. Using this type of visual reinforcement, the child eventually learns to look toward the source of the sound when he or she hears it, allowing the audiologist to evaluate the child’s hearing.

Conditioned play audiometry
This test typically is used for children between 3 and 5 years old. While wearing headphones, the child is encouraged to play a listening game. Different sound pitches are introduced through the headphones, and the child is taught to perform a task, such as putting a block in a bucket every time a sound is heard. If the child is willing and able, his or her ability to hear and understand speech also can be assessed by using a picture-pointing task or repeating words. By having the child wear headphones, the audiologist is able to determine the level of hearing in each ear.

Conventional audiometric testing
Most people are familiar with this test. It typically can be used with children age 5 and older. With headphones on, the child is asked to raise his or her hand every time different sounds or pitches are heard. In addition, the child’s ability to detect and understand speech is evaluated by having him or her repeat words.

Newborns, very young infants and some children with special needs, such as visual difficulties, cognitive or physical impairments, and/or behavioral issues, may not be able or willing to perform some of these tests. In these situations, audiologists rely on electrophysiological tests that do not require any responses from the child. These tests include auditory brain stem response evaluations and auditory steady state response testing. During these noninvasive and painless tests the child typically is sedated. Headphones generate a series of clicking sounds, and electrodes attached to the child’s head record neural responses. Using these tests, audiologists are able to obtain very good, objective estimates of a child’s hearing status.

If you have concerns about your child’s hearing, discuss them with your pediatrician. Masters Family Speech and Hearing Center at Children’s Hospital of Wisconsin offers comprehensive hearing tests by audiologists who specialize in working with kids.

FAST FACT: If you have concerns with your child’s hearing, don’t dismiss them just because he or she passed a newborn hearing screening. It is not uncommon for children to develop temporary hearing problems, such as fluid behind their eardrums, which require medical attention. On rare occasions, a progressive, possibly permanent hearing loss may develop that was not present at birth.

Catherine Holland, MS, CCC-A, is a pediatric audiologist with Masters Family Speech and Hearing Center at Children’s Hospital of Wisconsin.

 

Fourth of July activities can provide a fun-filled time for families. But, fireworks needlessly injure children every year.

Children ages 10 to 14 suffer from fireworks-related injuries more than any other age group. Sparklers, often considered the safest of fireworks, are most frequently linked to injuries among children age 5 and under.

To prevent accidents, keep these firework safety tips in mind during the Fourth of July:

• The best way for families to enjoy the holiday's festivities is to leave the fireworks to the professionals. Attend public firework displays where your whole family can watch the show from a distance.
• If your family has purchased fireworks, make sure your children do not use them, including sparklers.
• Discuss the dangers of fireworks with your children. Tell them never to purchase fireworks or accept them from friends, and to stay away from those who are using fireworks.
• Always have water handy–a hose or bucket of water–when using fireworks or sparklers.
• Never make your own fireworks.
• Don’t allow your child to pick up pieces of fireworks after an event. Some still may be ignited and can explode unexpectedly.

FAST FACT: Children, age 5 and younger, account for one third of all firework injuries. Keep your children away from fireworks, especially sparklers, because they can reach temperatures up to 1,800 degrees Fahrenheit.

Elizabeth Cleek, RN, MS, APNP, is an advanced practice nurse with the Trauma Program at Children’s Hospital of Wisconsin.