World Diabetes Day - Wearing Blue and Taking Action

Today is World Diabetes Day. Have you donned blue today? 

Diabetes action groups are asking folks to get dressed in blue today to bring awareness to growing health issue of diabetes.  


Diabetes is a metabolism disorder, a problem with how you process digested food for growth and energy. People with Type 1 Diabetes do not produce the insulin needed to move sugar, glucose, into the body's cells so that they may function and help us grow and  move. The sugar stays in the blood stream. We don't know what causes Type 1 Diabetes and there is no cure. Type 1 Diabetes usually presents when you're a child. 


People with Type 2 Diabetes are unable to produce enough insulin or their bodies are unable to utilize it properly to move the glucose into the cells. Type 2 Diabetes use to be considered an illness of adulthood, but increasingly Type 2 is seen in children too. We don't know exactly what causes Type 2 Diabetes, but it is closely linked to weight and exercise and can be prevented and treated with good nutrition and exercise 

As parents and caregivers to children we can respond to the call in many ways. Today we're asking you to do two things: 

1. Know the symptoms of Type 1 Diabetes which can appear even in infants. Recognizing these symptoms could save a life. 

Warning signs (these may occur suddenly):
Extreme thirst Frequent urination Sudden vision changes Sugar in urine Fruity, sweet, or wine-like odor on breath	Increased appetite Sudden weight loss Drowsiness, lethargy Heavy, labored breathing Stupor, unconsciousness

2. Resist the temptation to turn on the television after dinner. Go take a walk as a family. Exercise and good nutrition can help prevent diabetes and help those living with diabetes. 

For more information on Diabetes in Children check out our Health Encyclopedia on Type 1 Diabetes and Type 2 Diabetes. Join us and take action on diabetes.

RSV Season is Here

If you had asked me five years ago if I'd heard of RSV I would have shrugged by shoulders. RSV? Is that some special SUV? Then I had children and suddenly I did know what RSV was. RSV, or Respiratory Syncytial Virus is similar to the common cold, the symptoms are very similar, how it is transmitted is the same and by the age of two practically all children have been infected with RSV.

Babies ages 2 to 7 months of age have the highest incidence of RSV infection affecting the lower respiratory tract. Later reinfections are usually less severe than the first infection. While most children get over it in the same way they recover from a cold and within one to two weeks, some children, especially the very young, can be severely infected.  It is a common way that children may develop more serious respiratory illnesses such as broncholitis or pneumonia and while most infants will not require hospitalization, RSV accounts for 150,000 hospitalizations of children every year.

What does RSV look like? Symptoms:
-coughing, sneezing, runny nose, fever, decrease in appetite
- may cause irritability
- difficulty breathing and/or wheezing
-decrease in appetite

Transmission
RSV is highly contagious, spreading easily and is near impossible to avoid. Babies who are in child care facilities, or have an older sibling in child care or at school, or are in public places a lot are more at risk for catching RSV. Sharing food, touching objects that are contaminated with the virus, and not washing hands can lead to RSV infection.

With a preschooler and an infant in the house we're washing our hands constantly, for 15 to 20 seconds with soap and water, but it is still difficult to contain as it persists on surfaces. Teaching and also practicing the sneeze or cough into the elbow, or sneezing like an elephant as my preschooler refers to it,  can aid in lowering transmission of respiratory diseases such as RSV. 

Our TMC Health Encyclopedia shares this information about when to seek medical help:

When to call a doctor:
Call 911 or other emergency services immediately if your child is having difficulty breathing, indicated by:

• Breathing very fast (more than 60 times a minute)
• Making a grunting noise. 
• Being unable to speak, cry or make sounds, sometimes with drooling.
• Flaring nostrils or lifting the shoulders when inhaling.
• Having a gray mottled, or blue color to the skin (look for skin color changes in the fingernail beds, lips, or earlobes).
• Wheezing that lasts over 1 hour in a baby younger than 3 months who also appears sick.   

See your doctor right away if your baby or child has moderate difficulty breathingindicated by:

• Breathing 40-60 times a minute
• Tiring quickly during feeding. The child either stops eating or sucks in air to catch a breath. The child loses interest in eating because of the effort involved. 
• Using the stomach muscles when breathing. 
• Having unusual color. The child's face, hands, and feet are pale to slightly gray or lacelike purple and pale (mottled), but the tongue, gums and lips remain pink

See your doctor if your child shows signs of a lower respiratory infection, indicated by:

• Wheezing
• Appearing extremely tired
• Showing little interest in food or surroundings.
• Showing signs of an ear infection, such as irritability, difficulty sleeping, and tugging on or rubbing the ear. 
• Having a fever of 100.4 degrees F or higher when younger than 3 months old (This temperature should be taken rectally. Underarm temperatures are lower than rectal temperatures. 

Call a doctor if your child:

• Breathes slightly faster than normal and seems to be getting worse. Most healthy children breathe less than 40 times a minute. 
• Has cold symptoms that become severe or other problems arise.
  

Our Interactive Health Symptom Checker is a useful tool if you are unsure about what actions to take, although it does not substitute for actual medical advice.

Whether it is RSV, Influenza or the common cold lets try to mitigate the impact of these viruses this season with plenty of proper hand-washing, covering coughs and sneezes, disinfecting contaminated surfaces  and minimizing exposure to infected older children or adults. Be healthy, be safe. 

Kids who Run

Photo - Everybody Runs

Where does all that boundless kid energy come from? If only we could bottle it up and sell it. Until that time take the kids out and lets run together.

This Sunday is the 7th Annual Fleet Feet TMC Half Marathon & Saguaro Physicians 5K Run & TMC for Children Fun Run. Join us with your children for a gentle lope on the picturesque, relatively flat course along the neighborhood streets of the Catalina Foothills. The race starts and finishes at Sabino High School. The TMC for Children Fun Run has been specifically designed for children. We'll be providing child care for free and there will be free after race massages and food. For more information and registration check out the Everybody Runs website.

Talking about Death to Children

This weekend Tucson non-profit Many Mouths One Stomach hosts what has become a favorite Tucson event, the All Souls Procession.

"The Procession is a sanctuary for community members from all walks of life to express their grief and loss in a celebration of creative energy and a rejoicing of living."
Part of the events this weekend is the Procession of Little Angels. An opportunity for children to create and to celebrate the lives of loved ones that have died in a way that makes sense to them. When someone dies many of us struggle to explain death to our young children. Sometimes we might even try to avoid the topic.  Death is a universal experience, it is fact of life that our children are exposed to from an early age, in many classic storytales, in nature, and in our families. When we talk with children about death, both when it is abstract and when it hits closer to home, we can explore what they understand about death, perhaps address fears and worries about death.  Child Life Specialist, Jolene Eggert, gave this advice about talking about death with children :
·         Always be honest with your children and talk to them at their developmental level (with terms they understand) as well as at their eye level.
·         Avoid terms which seem confusing.  Such as “passed on” or “taken from us” which can give mixed messages.  Children think in concrete terms.  Often times, hugs and just sitting close by can say a lot.
·         When a child dies ask for support from families and friends for surviving siblings.
·         Don’t be afraid to show emotion.
·         Include children in an end of life memorial.  Have them assist with picking out pictures, writing letter/drawing pictures for their loved one.
Jolene recommends the following book and DVD for preschoolers (a Sesame Street production): When Families Grieve. The program discusses the loss of a parent.
Remembering Crystal by Sebastian Loth is a gentle book with no religious input perfect for the preschool audience.
The National Institute of Health share this document which explores what to consider when talking to children about death. 

Countdown to a Safe Halloween

Like many households with young children the countdown to Halloween in our home actually started when the stores began to deck everything in orange and black. Pumpkin decoration, costumes, candy and staying up late, what is there not to love about Halloween from a child's perspective? This year, our family is actually venturing out into the neighborhood to trick or treat, but from a parent and caregiver perspective Halloween presents some significant risks. The number of the child fatalities while walking are double on Halloween night any other night of the year. It makes horrible sense if you think about it, large numbers children are out after dark, wearing costumes that are often dark, costumes that may obscure their view and they may in their excitement not be using good road sense. What can we all, parents, kids and motorists do about this? Safe Kids has a host of fabulous suggestions and a strong reminder that whether or not you talk about pedestrian safety with your children usually, you should on Halloween. 


Some of my favorite suggestions, along with the basic pedestrian safety are those that make use of costumes to increase visibility:

• Decorate costumes and bags with reflective tape or stickers and choose light colored costumes to improve visibility.

• Choose face paint and make-up instead of masks, which can obstruct a child's vision. Look for non-toxic designations when choosing Halloween makeup.

• Have kids carry glow sticks or flashlights in order to see better, as well as to be seen by drivers.

Check out the rest of the suggestions here and over the next week on TMC for Children's Facebook page and Twitter feed.

An additional suggestion for drivers, as you're turning in or pulling out of your driveway be especially aware of small children who might not be where you expect them. Perhaps before pulling out of your driveway make sure you have a clear view with no children on the driveway, or within a house or two of yours on either side.

Have a happy and safe Halloween.

Big Brother, Big Sister

Our family just got bigger.  To help with the transition to being a family of four I registered our preschooler in the Big Brother, Big Sister class at Tucson Medical Center. Adjusting to the needs and joys of a newborn impacts the whole family, and amid all the excitement and craziness of a new baby in the house, older siblings can feel a little left out. My preschooler and I recently spent a Saturday morning in the company of six other soon-to-be older siblings learning some skills to aid in the transition.

Nikki, a TMC for Children's Child Life Specialist, led the ninety minute class, energetically involving the participants in play as they learned how to swaddle, feed, diaper and hold a baby. Nikki skillfully coaxed the children to discuss their feelings, excitement and concerns, about a new sibling as the children made bookmarks. Nikki highlighted the special role that siblings have for their new infant siblings, making them laugh, playing gently to encourage them to interact using jingle bells and rattles. The class was perfectly pitched to my near five-year old and engrossed her for the full ninety minutes. My daughter left excited to try her new found skills on her new sibling, well all except the diapering. She still isn't convinced about changing a dirty diaper. 

The Big Brother, Big Sister class is offered every month for just $15, you can find out more here.

When the NICU is Home

Madison, a two-week-old premie, smiles as she rests in her mother's arms in the Tucson Medical Center's Neonatal Intensive Care Unit, Monday, October 3, 2011. Madison was six and a half weeks early and now weighs four pounds and 20 oz.

With all births we hope for a gentle entry of a new being into the world, but sometimes that isn't the way it happens. When your child arrives early or there are complications, the Neonatal Intensive Care Unit (NICU) becomes your home. Melissa, a Tucson mother, shares her perspective about how friends and family can help when your baby has to be in the NICU for an extended time period. Melissa's baby M arrived quite a bit earlier than expected and is now a fabulous preschooler. 

 What can friends and families do to help? 

• Say congratulations first.  When your little one arrives early, no-one congratulates you on the birth.  Welcome that baby to the world!  
• Show up with a pint of Ben and Jerry's and two spoons.  If you don't know what to say, try, "I don't know what to say, but I am here for you" and listen without judgement. 
• If the parents are like us, they are at the NICU 24 hours a day - Bring meals to the hospital.
• Offer to take care of pets at home, get mail, water plants, etc.
• If baby arrived early, they may not have got car seats, cribs, diapers, etc., yet.  Offer to pick up things or to have things shipped to your address so someone doesn't need to be home to sign for them.  
• Offer to take the car and car seat to a certified installer to make sure it is installed correctly.  That one was on my list of things to do that I never got to.   

Esteban, a one-week-old premie, stretches his legs in the Tucson Medical Center's Neonatal intensive care unit, Monday, October 3, 2011. He was born five weeks early.

The one piece of -- well, not really advice, but just support, that I will always remember was from a coworker that I barely knew and had rarely communicated with.  It arrived via email two days after M was born.  He wanted to let me know that he and his wife were once brand-new parents to a preemie girl who started her life in the NICU and he understood what we were experiencing.  He also wanted to let me know that he was writing from California, where they attended USC's winter commencement and watched their preemie graduate with her MBA.  :-)  I really appreciated his sensitivity to my acute fears -- what does the prematurity mean to my child's future?  He nailed it right on the head without having to say something cliche, like "everything will be fine.  

Each family's experience is different. If your child has been in the NICU what could or did friends and family do to support you?