justkidsWinter 2008

Healing Small Hearts

Expert Advice on Car Safety Seats

The Facts About the Cervical Cancer Vaccine

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Children’s Hospital, Omaha, NE

Chi ld ren ’s Hosp i ta l o f Omaha | Win ter 2008

Parents Spotlight

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Children with HLHS suffer from an abnormality where a large portion of the left side of the heart is either missing or too small to function properly. After the three operations, the child’s rebuilt heart allows the right side of the heart to perform the functions of the missing or defective left side. The first of the three operations is called the Norwood procedure.

Daniel Vance underwent the Norwood procedure in March 2005

when he was just a week old. “Our insurance company kept

trying to get us to go to Boston because there was a hospital

there with a specific pediatric unit for kids with heart defects,” says Cori Vance, Daniel’s mom. “But we knew that we had a terrific hospital here in Omaha, too. I don’t know how we could have gotten better care anywhere else than we did at Children’s.”

Healing Small Hearts: Cardiothoracic Surgery at Children’s Hospital

A heart defect that just 20 years ago offered little hope of survival is being treated today with impressive success at Children’s Hospital. Through a

series of three operations, cardiothoracic surgeons at Children’s are able to treat children born with hypoplastic left heart syndrome (HLHS) by rebuilding the child’s

heart and offering a chance at life.

Cori Vance with her son Daniel prior to his third surgical procedure. Daniel had surgery at Children’s to correct HLHS.

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HigH SucceSS rateSThe survival rate from the Norwood

procedure is considered to be a good measurement of a hospital’s overall pediatric cardiac surgery program. At Children’s Hospital, the Norwood procedure success rate ranks among the highest in the country.

“Recent national reviews of survival with the Norwood procedure were about 70 percent,” says James M. Hammel, MD, a pediatric cardiothoracic surgeon with Children’s Hospital and assistant professor of surgery with the University of Nebraska Medical Center. “At Children’s, the survival rate over the past two years has been 100 percent on 11 patients having their standard stage one Norwood procedures under the care of our team.”

Dr. Hammel attributes this success to more than just the work that he and fellow pediatric cardiothoracic surgeon Kim Duncan, MD, do in the operating room. Dr. Duncan serves as the medical director of Children’s Cardiothoracic Surgery Department, as well as the cardiothoracic surgery section chief at the University of Nebraska Medical Center.

Both surgeons credit the rest of the cardiothoracic surgery team, as well as the team working on the Pediatric Intensive Care Unit (PICU) at Children’s Hospital.

“The doctors and nurses in the PICU are really well-trained to deal with heart patients before, during and after the heart surgeries,” says Cori. “They’re excellent. We felt like we could ask questions and if the doctors or nurses didn’t have an answer, they would go above and beyond to find the answers for us.”

tHe expertiSe of SpecialiStSThe Cardiothoracic Surgery

Department at Children’s includes Drs. Hammel and Duncan, as well as physician assistants and advanced practice nurses who specialize in the evaluation and surgical care of children with heart problems. In addition, patients benefit from the expertise provided by dedicated pediatric cardiac anesthesiologists and perfusionists, cardiac operating room and intensive care unit nurses and around-the-clock care from pediatric critical care specialists.

“I love that Children’s is a small enough hospital where everyone knows you by name and you are part of a family,” says Cori. “Yet they have every technological advance available to take care of your child. And if for some reason they don’t have it—they’ll get it.”

Cori says that while it was hard going through the surgery and healing process with Daniel’s Norwood procedure, the hardest time was the period after Daniel’s procedure and before his second surgery.

“There’s so much more to worry about after the surgery,” she says. “We had to be careful about feeding, monitoring and even body positions, all of which could cause problems for Daniel. But they take care of all of it at Children’s Hospital. We really feel that Children’s shines like a star because they’re really well-equipped to help the kids and the families deal with all the baggage that comes with getting from stage one to stage two.”

Children’s Hospital doesn’t just excel with Norwood procedures when it comes to pediatric heart issues.

“A physician or a parent anywhere in the region shouldn’t hesitate to send a baby to us, whether the heart defect appears to be minor or complex,” Dr. Hammel says. “Our survival rates and familiarity with surgery for complicated heart defects mean there is no reason to send a child anywhere else in the country. Our results show we rank among the best.”

Cori echoes those thoughts when she says, “I wouldn’t take my kids anyplace else—ever.” ✷

Stay informedinterested in reading more patient stories like daniel’s while staying on top of the latest information in pediatric health care? then sign up for your own free subscription to Just Kids. Simply call 402-955-6950 or e-mail dhartley@chsomaha.org.

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Daniel and his 5-year-old triplet sisters (from left) Christine, Lindsey and Sara enjoy a day at the zoo.

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Chi ld ren ’s Hosp i ta l o f Omaha | Win ter 2008

s a parent, there’s nothing worse than seeing your child sick or in pain. And when your child has a serious medical emergency, you want nothing less than the best care available. That’s why bringing your child to Children’s Hospital, which has the state’s only Emergency Department (ED) designed especially for kids, is a good decision. There, Children’s physicians and nurses provide your child with top-quality care and offer you peace of mind.

expert carePediatric EDs are specially designed and

staffed to handle children’s medical emergencies. Doctors and nurses receive extra training in pediatric emergencies that may require unique techniques or procedures, or use special equipment, and

Dav

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they must pass a test that certifies them as specialized in pediatric emergency medicine. Also, they have expertise in easing the pain and anxiety that come with children’s emergencies.

“Our staff is superior,” says David Tolo, MD, medical director of Children’s ED and assistant clinical professor at both Creighton University and University of Nebraska Schools of Medicine. “We’re all dedicated to treating kids. That’s why we practice pediatric medicine.”

Children’s ED is staffed by 10 pediatric emergency physicians, 24 hours a day, seven days a week. In addition to the 10 physicians, Children’s ED has a team of 32 pediatric emergency nurses, three advanced practiced registered nurses (APRNs) and two physician assistants.

Children’s Spotlight

emergency care Designed for Kids

Kid-Sized and Kid-friendlyChildren’s ED is specially outfitted

with kid-sized equipment, beds and supplies, including:■ Lifesaving defibrillators customized for

children ■ Child-sized blood pressure cuffs ■ Systems that quickly identify equipment

and medicines appropriate for a child’s age and weight. All this helps to make your child

comfortable and makes it easier for doctors and nurses to provide care. What’s more, the waiting areas, hallways and examining rooms are decorated and designed to be kid-friendly and put your child at ease.

urgent care centerSIn addition, Children’s Hospital operates

two Urgent Care centers that are available evenings, weekends and holidays to serve patients with minor medical conditions. The Urgent Care centers are staffed by the board-certified pediatricians and pediatric nurses from Children’s Hospital. While no appointment is necessary, you can call ahead to receive wait times at either location. ✷

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No Matter the Emergency, We Can HelpChildren’s Hospital has the only dedicated pediatric Emergency Department in the region. It provides services around the clock. Call 402-955-5150 to learn more.

The Urgent Care centers are located just north of 144th and West Center Road (402-955-7200) and at 138th and West Maple Road (402-955-3600). Hours are Monday through Friday from 6 to 10 p.m., and weekends and holidays from noon to 10 p.m.

We’re all dedicated to treating kids. That’s why we practice pediatric medicine.

— David Tolo, MD

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Choosing, installing and using a car seat can be confusing, but it’s an important part of keeping children safe.

“An easy rule to remember is that the safest car seat for your child is the one that properly fits your child and your vehicle,” says Tracy Rouse, Children’s Hospital injury prevention coordinator. “Also, always read your vehicle and child restraint manuals for proper installation.”

infant rear-facing SeatSInfants should face backward in the

back seat until they’re at least 1 year old and weigh at least 20 pounds. Make sure the harness straps are at or below the shoulders and that the baby’s head is below one inch from the top of the car seat. You can choose between an infant-only seat and a convertible seat. However, you should never place infants in rear-facing seats in front of an airbag.

Some Expert Advice on car Safety Seats

forward-facing SeatSOnce your child is at least 1 year old

and weighs at least 20 pounds, she can ride forward-facing. With a convertible seat, though, she’s safest riding rear-facing until reaching the seat’s height and weight limits. If you decide to turn a convertible seat to face forward, you’ll need to adjust the shoulder strap slots, seat position and seat belt path. Weight limits and installation instructions vary depending on the safety seat model. Check the owner’s manual for specific information on your particular seat.

BooSter SeatSYour child’s ready for a booster seat

when one of the following is true: ■ He reaches the weight and height limits

for his seat.■ His ears reach the seat top.■ His shoulders are above the harness slots.

A seat belt alone won’t protect your

Are You Using Safety Seats Correctly?

Automobile accidents are the leading cause of death in children 1 year of age and older. Many of these injuries and deaths could be avoided by simply using child safety seats and seat belts correctly. To help make sure you’re using your safety seat correctly, visit our website at www.chsomaha.org. Simply click on “Health Information,” then “Pediatric Hints” to view more information on safety seats or browse our entire collection of online parenting topics.

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child until he stands about 4’9” tall and is at least 8 years old. Until then, use a booster seat. Remember, belt positioning boosters must be used with both the lap and shoulder belt. Also, make sure the lap belt fits low and tight across the upper thigh area and snug at the shoulder between the neck and arm.

Safety tipS for inStallation and uSe

For proper installation, always read your vehicle and child restraint manuals. Also, make sure the seat is buckled in tightly. Tighten the seat belt if the seat moves more than one inch from side to side or toward the front of the car. Every time you put your child into a safety seat, buckle your child in snugly. That means using the right harness slots and tucking blankets in only after adjusting the harness straps. ✷

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Chi ld ren ’s Hosp i ta l o f Omaha | Win ter 2008

he HPV vaccine approved by the U.S. Food and Drug Administration gives women a better shot at protecting themselves from cervical cancer. Get the facts about the vaccine with these answers to frequently asked questions.

How doeS tHe vaccine worK? The vaccine keeps women from

contracting certain human papillomavirus (HPV) strains. HPVs are a group of about 100 viruses. HPV infections are very common. In fact, almost 27 percent of women ages 14 to 59 have an HPV infection, according to data from the Journal of the

American Medical Association. Infections from certain HPV strains may lead to cell changes in the cervix, resulting in genital warts or cancer. The vaccine protects against HPVs known to cause these conditions.

wHo iS it recommended for?The vaccine is approved for young

women ages 9 to 26. Women in their late teens and 20s are more likely to have an HPV infection. Experts recommend women receive immunization before being exposed to infection. The government’s Advisory Committee on Immunization Practices recommends:■ A series of three vaccinations for girls

that should begin around ages 11 to 12

■ A catch-up series of vaccina-tions for girls 13 to 26 who weren’t immunized at an earlier age. Talk with your doctor before

getting any vaccination to see if it’s right for you or a loved one.

“The vaccine works best when given at a younger age,” says Jillyn Kratochvil, MD, a

pediatrician with Children’s Physicians. “That’s why I would not wait until she is sexually active to administer it.”

Dr. Kratochvil also states that researchers are currently working on getting the vaccine approved for men to help prevent the spread of infection.

wHy are pap teStS Still neceSSary?The vaccine doesn’t shield against all

cancer-causing HPVs. It also can’t offer protection for women already infected with certain HPV types. As a result, all women need to continue with regular Pap tests as advised by their doctors. This test is still the best method for detecting precancerous cells. ✷

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to learn more about the cervical cancer vaccine, visit our website, www.chsomaha.org.

The Facts About the cervical cancer vaccine

Should Your Child Take a Sick Day?

It’s almost time to leave for the bus, and your child is complaining of a headache and sore throat. What should you do? Knowing when to send your student off to school and when to keep her home can be a tough judgment call—especially in the rush of a weekday morning. When you’re wondering how sick is too sick for school, a few general guidelines can help. You may want to keep your child home if she has any of the following symptoms: ■ Diarrhea■ Repeated vomiting■ Fever■ Severe sore throat■ Thick discharge from the eye ■ Mouth sores accompanied by

drooling■ Wheezing■ Uncontrolled or severe coughing■ Unusual fatigue■ Difficulty breathing■ Weakness■ Dry mouth■ Unexplained irritability ■ Skin problems, including discol-

ored skin, rashes or itchiness■ Decreased appetite.

Jilly

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MD

Want to know more?

Babies often become ill during their first year of life, and many of these illnesses will cause a fever. A fever simply means that your baby’s body temperature is above normal. Your child has a fever if his axillary (armpit) temperature is over 99.5 F (37.2 C), or his rectal temperature is over 100.4 F (38 C).

Remember, a fever is a symptom, not a disease. It is the body’s normal response to infections. A fever helps fight infections by turning on the body’s immune system. All children will develop fevers. The usual fevers, which range in temperature from 100 to 104 F, or 37.8 to 40 C, are not harmful. However, your child’s age and how high the fever is determine whether a fever is serious or not.

Any child younger than 2 months who develops a fever needs a physician’s attention. In addition, you should call your child’s physician if the fever is:■ 100.5 F or higher for infants younger

than 2 months■ 101 F or higher for babies ages 3 to 6

months old■ 103 F or higher for children older than

6 months.

Also, watch your child for any symptoms of illness that might accompany the fever. These include sluggishness, persistent crying, breathing problems, a stiff neck or purple spots on the skin. If any of these appear, contact your child’s physician.

taKing a temperature“Babies younger than 6

months should have their temperatures taken with a rectal thermometer,” says Kody Moffatt, MD, a Children’s Physicians pediatrician. “Rectal thermometers give the most accurate body temperature.”

Do not use a mercury thermometer when taking your baby’s temperature; use a digital thermometer. Mercury is a known pollutant, and even the quantity found in a thermometer is enough to become a serious environmental hazard. If a mercury thermometer breaks, call your local poison control center or health department for help or advice. The best advice, however, is to invest in a digital thermometer, which is available at most pharmacies. ✷

Shop Online at the Children’s Hospital Gift Shop Want to send an item to a loved one staying at Children’s Hospital? All it takes is the click of a mouse! The Children’s Hospital Gift Shop offers a large online selection of stuffed animals, candy bouquets, coloring and activity books, games and gifts for babies. In addition, you can purchase cafeteria vouchers for families of patients. While the gift shop carries hundreds of items, only a few are shown on the website. If you have a special request and don’t see exactly what you want online, call the gift shop during regular business hours and a staff member will be happy to act as your personal shopper.

All proceeds from gift shop sales are donated back to Children’s Hospital to help promote programs and services so that all children may have a better chance to live.

What Can You Do if Your Infant Has a Fever?

Kody

Mof

fatt

, MD

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The Children’s Hospital Gift Shop is open weekdays from 9 a.m. to 8:30 p.m., Saturdays from 9 a.m. to 5 p.m., and Sundays from 12:30 to 5 p.m. To place an online order, visit www.chsomaha.org, and click on “For Patients and Visitors.” Or call the gift shop at 402-955-4150 or 800-642-8822 during regular store hours. .org

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Visit our website at www.chsomaha.org.

recent study showed that most parents of overweight children do not recognize their child’s weight problem. Some parents may think an overweight child will “grow out of it.” The older an obese child is, however, the more likely that child will stay obese into adulthood.

wHen SHould you Be concerned aBout your cHild?

Consult your pediatrician if you think your child is overweight. At the checkup, the physician will look at body mass index (BMI) and growth charts to determine if your child is within healthy weight limits. Children are considered overweight if their BMI is at or above the 95th percentile. They are at risk when the BMI is at the 85–95th percentile.

Many children who are overweight also

Childhood Obesity: A “weighty” Problem

just kids is published by Children’s Hospital to provide general health information. It is not intended to provide personal medical advice, which should be obtained directly from a physician. © 2008. All rights reserved. Printed in U.S.A.Gary A. Perkins, President and CEOMartin W. Beerman, Vice President, Marketing and Community RelationsDavid G.J. Kaufman, MD, Medical AdvisorDannee Hartley, Public Relations Coordinator

Printed on Recyclable Paper 881M

justkidsChildren’s Hospital has received accreditation or recognition from the following organizations for its delivery of extraordinary health care to children.

are obese. Obesity can lead to diabetes, high blood pressure and high cholesterol. Plus, obese children are more likely to develop serious health problems, such as heart disease, as adults.

wayS to HelpYou can help your child keep off extra

pounds. Here are some suggestions:■ Encourage healthy eating habits,

including cutting out snacks with little nutritional value and replacing them with healthier choices like whole-grain crackers, low-fat cheese, yogurt, fruits or vegetables. In addition, limit soda, sugary fruit drinks and juice. Offer skim milk, 1 percent milk or water instead if your child is older than 2.

■ Promote daily physical activity. Doctors recommend children exercise 60 minutes a day most days of the week, but that doesn’t necessarily mean 60 minutes in organized sports. “Free play is a great way to maximize the amount of time children spend actively moving, and it encourages creativity,” says Rita M. Berthelsen, PhD, RD, LMNT, Healthy Futures director.

■ Increase family activity time by sharing physical exercise and talking about positive health behaviors.

■ Limit inactive pastimes, such as watching TV, sitting at a computer and playing video games. Recommendations include not more than two hours of screen time per day.

■ Avoid rewarding children for eating, and don’t use food as a reward for good behavior. ✷

Children’s Healthy Futures Program Helps Overweight Kids The Healthy Futures program at Children’s Hospital is a 12-week, dynamic and interactive program that promotes healthy food choices and overall fitness for overweight children and their families. Children participating in the program will have a good time as they learn healthy eating habits and the importance of exercise.

Designed by experts at Children’s Hospital, the program helps children gradually attain their genetic body build, which may range from willowy to a more rounded shape. The program strives to improve a child’s self-esteem and help families enjoy the improved health benefits of regular exercise. The program requires a physician referral. An information night for the next session will be held Tuesday, January 29 at 6 p.m. at Children’s Hospital. Learn more about Healthy Futures by calling 402-955-6950 or visiting our website, www.chsomaha.org. Simply click on “Programs and Services.”

Postmaster: Please deliver between January 21 and 25.