Premie and NICU Picnic

For over twenty years, we've celebrated the amazing people and families that we meet in the Tucson Medical Center/TMC for Children Neonatal Intensive Care Unit at an annual picnic.
Join us tomorrow at the Annual Premie Picnic at Reid Park from 11am -2pm in Ramada 1 and 2, close to the duck pond and zoo. Anyone who has been a patient in the TMC NICU is invited to this fun event. There will be jumping castles, pony rides and more. Call 324-1480 for more details.

These beautiful images were taken by photographer Jill Torrance, this month. Enjoy.

Hello Fall aka Hello Croup Season

Elsewhere in the country the landscape is awash with brown, orange and red leaves as Summer begins to give way to Fall. Not so much in Tucson. Still the change in seasons are evident, the temperatures are less blistering for a start and in this Tucson family's home the first day of Fall was marked by a loud barking cough. Croup. 

Four-thirty in the morning we woke to the characteristic barking cough of croup. Our child had not seemed sick the night before, maybe a little sniffle, but now between the coughing there was sobbing. The immediate reaction was to go outside and see if the cool night air would ease the cough, but of course this is Tucson in September and the air was not that cool or humid. We ran the shower steaming up the bathroom and hung out in there, cradling our not so small child and waiting for the cough to subside. By about fifteen minutes the cough had begun to subside, by thirty minutes it was gone. She went back to sleep and we kept a close eye on her to make sure that her breathing remained stable and kept her home from preschool. The next night we had the same experience, but earlier in the morning. By the third night we were in the clear. No coughing. No croup. 

The most common cause of croup is the same viruses, human parainfluenza viruses, that cause the common cold. The characteristic barking croup cough is caused by swelling around the vocal chords (laryngotracheobronchitis) and other parts of the upper and middle airway. In young children, under the age of five, their voice box, windpipes and tubes leading to the lungs are not mature and so swelling around them can make it difficult for a child to breath and why potentially croup can be very dangerous if not treated appropriately. As children get older their lungs and windpipes mature, widen and they are less likely to get croup. However, most of the time the croup is not serious and can be dealt with at home. 

From our TMC Health Encyclopedia which you can access any time night or day, here are some suggestions for dealing with croup:

• Try to stay calm during an attack, and soothe your child. Crying can make the swelling in the windpipe worse and make it even harder to breathe.
• Breathing in moist air seems to help during a croup attack. Fill your bathroom with steam from the hot water faucets, and sit in the room with your child for 10 minutes. 
• Breathing cool night air also seems to help sometimes. Dress your child in warm clothes, and go outside for 10 minutes. 
• If symptoms improve with these methods, put your child back in bed with the humidifier blowing nearby. 
• Do not smoke, especially in the house. 
• If the symptoms happen during the middle of the night, it is a good idea to sleep in or near your child's room until morning. 
• Be sure to keep your child well hydrated. Offer water, flavored ice treats (such as Popsicles), or crushed ice drinks several times each hour.

If your child has severe croup or has not responded to home treatment, medicines may be used to decrease airway swelling. These are usually given in a doctor's office or an emergency room. In rare cases, a child needs to stay in the hospital for treatment. If your child’s symptoms don't get better after 30 minutes, call or see your doctor. If the attack is in the middle of the night and you are very worried, consider taking your child to the emergency room. 

If your child has severe difficulty breathing, call 911 or other emergency services immediately.

• Breathes very fast or grunts with each breath. 
• Appears anxious or exhausted during feeding or is unable to nurse or take a bottle. 
• Uses the neck, chest, and abdominal muscles to breathe, causing a "sucking in" between or under the ribs (retractions).
• May flare the nostrils when breathing in. 
• May need to sit up and lean forward or tilt the nose up as if sniffing the air. 
• May fight any attempt to change his or her position. 
• Has pale, gray, or bluish skin (especially the tongue, lips, earlobes, and nail beds), or the skin is mottled (patchy pale and blue pattern).

Call 911 or emergency services if these signs are present.

Resources

http://www.healthwise.net/tmcaz/Content/StdDocument.aspx?DOCHWID=hw31906

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001955/

Hush Little Baby - Sleep Safely

When we first bring our babies home, in those early days post birth, we worry about every.little.thing. Is it too hot? Too cold? Are they eating enough? Too much food? Are they having enough bowel movements, or not enough? I think I charted for weeks feedings, BM and diaper changes. What parent among has us not checked on their child sporadically through the night to watch the rise and fall of their chest? A friend assures me that I am not alone in neurotic checking of my sleeping preschooler's breathing; they still check at night on their twenty-something year old child when they return from college.

While it doesn't feel like it to new parents, newborn babies spend most of their time sleeping, albeit sporadically. Providing a safe environment for a baby to sleep in is of the utmost importance. A horrifying two-thirds of injury related deaths of infants are from suffocation, many during sleep. So how to prevent this?

Safe Sleep-
Note: Suffocation and Sudden Infant Death Syndrome are not the same thing, but many of the following recommendations are made with both issues in mind.  These recommendations are not meant to replace your pediatrician's advice or be all inclusive. 


The American Academy of Pediatrics encourages room-sharing where the infant is in close proximity to their parents, rather than bed-sharing which presents more variables in safety consideration.


1. Always put your child down to sleep on their back on a firm mattress. Babies placed on their back are less likely to die from Sudden Infant Death Syndrome.  1, 2

2. Keep your infant, especially those under 6 months in the same room with you within arm's reach. Research studies indicate that parental proximity is a positive thing, encouraging breastfeeding and sensory awareness of the baby's breathing and needs.  1, 3

3. The bedding should be tightly fitted to the mattress. Use fitted sheets rather than loose sheets so that the baby doesn't become entangled or strangled by the sheets. No bumper pads on the crib, no pillows or blankets or stuffed toys in the bed. Nothing other than the baby in their bed.  1

4. Keep the room temperature comfortable and take care to make sure the baby doesn't overheat. Consider using sleepers, sleep sacks or wearable blankets to maintain an appropriate temperature.

5. Make sure that any sleep environment meets current Consumer Product Safety Commission standards. These are independent federal regulatory agency standards for baby sleep environments, most adult beds would not meet these standards:

• No more than 2-3/8 inches between the crib slats so a baby’s head or body cannot fit through the slats; no missing or cracked slats.
• A firm, tight fitting mattress so baby cannot get trapped between mattress and crib. Mattress should fit snugly - less than the width of two fingers between the edge of the mattress and the side of the crib.
• No missing, loose, broken, or improperly installed screws, brackets, or other hardware on the crib or mattress support.
• No corner posts over 1/16th inch high so a baby’s clothing cannot catch.
• No cutouts in the headboard or foot board so a baby’s head cannot get trapped.

6. Keep your sleeping baby away from adults who are smoking (exposure to smoke has shown to be a SIDS risk), using drugs, alcohol or medications that can cause sleepiness or are overtired.

7. Do not have your baby sleep in a bed with other children even if you are present. Young children are not aware of the dangers of suffocation.

8. Never leave your baby alone in an adult bed or sleep on a waterbed, pillow or sofa.


September is Baby Safety Month. If you would like more information about baby safety topics please visit www.safekids.org. Safe Kids Tucson works to prevent unintentional childhood injury, the leading cause of death to children ages 1 to 14. Safe Kids Tucson is a coalition with a broad base of community partners and is a member of Safe Kids Worldwide, a global network of organizations dedicated to preventing unintentional injury. Safe Kids Tucson is led by Tucson Medical Center, TMC for Children.

1. American Academy of Pediatrics: Task Force on Infant Sleep Position and Sudden Infant Death. Changing Concepts of Sudden Infant Death Syndrome: Implications for Infant Sleeping Environment and Sleep Position. Pediatrics. 2000; 105:650-656.

2.Hauck FR, Herman SM, Donovan M, et al. Sleep Environment and the Risk of Sudden Infant Death Syndrome in an Urban Population:  The Chicago Infant Mortality Study. Pediatrics. 2003; 111:1207- 1214.

3. Tappin D, Ecob R, Stat S, Brooke MA. Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: A case-control study. J Pediatr. 2005; Jul; 147 (1): H3, PMID 16027679

A Little Girl's "Big Girl" Shot

The news has been all a-buzz as of late about the HPV (human papillomavirus)vaccine as politicians have weighed in on the value or appropriateness of the HPV virus for girls age 11 or older.  Sorting through the sound bites and politics to the researched scientific facts and making a parenting choice based on those facts is important for all our medical decisions. Medical decision making is even more fraught with emotion when talking about medical decisions for our children.

Human papillomavirus is a sexually transmitted virus that can lead to an abnormal Pap smear or cervical cancer later in life. The HPV vaccine is on the list of recommended childhood immunizations for girls age 11 or older and protects against two of the most common types of HPV that cause cervical cancer.

As parents and guardians we have to make a decision about this "big girl" shot for our girls way before we imagine they will be sexually active. We know that making a decision about an immunization related to your daughter's sexuality takes more information, time, and thought than you can get in a sound bite from a news story. Here's an (objective) interactive tool that can help with that decision and help you talk with your doctor about your choices.

Protecting the Under Six-Month Crowd

The crazy thing about influenza is that the very infants, those under six months old, that are most vulnerable can't receive the influenza vaccine. So how do you protect your little one?


Dr. Jessica Schultz shared some thoughts on how to protect infants under six months from influenza: 

• Vaccination for those who can. All family members over the age of 6 months and any caregivers should receive the influenza vaccine as soon as it is available to them.  By decreasing the chance of influenza in the family or daycare setting, the young infant is less likely to be exposed. Have you had your flu shot or flu mist yet?
  
• Wash your hands and those of your older children frequently.  Use warm water and soap for 20-30 seconds.  To keep kids washing, sing “Row, row, row, your boat” or the Happy Birthday” song at least twice.  If water and soap aren’t available, use an alcohol-based hand sanitizer.
  
• Cough or sneeze into your elbow or sleeve, not your hand, or use a tissue.  Throw any tissues used to blow your nose away immediately and then wash your hands
  
• Avoid Crowds For infants less than 6 months of age, avoid large groups or areas where they may be easily exposed to influenza.
  
• Establish a routine when people enter your home When older siblings come home from school, leave backpacks and other bags at the door and have everyone wash their hands before doing anything else
  
  
• Minimize contact or use a mask if you're ill. While anyone in the family has flu-like symptoms, they should minimize contact with young infants in the family and if contact is necessary, wear a mask and wash your hands every time before you hold the baby or come within 3-6 feet of the infant. 

Flu.gov provides this guidance to breastfeeding mothers: 

"Mothers who are breastfeeding should continue to nurse their babies while being treated for the flu. Breast milk passes on antibodies from the mother to a baby. Antibodies help fight off infection. 

• If possible, only adults who are not sick should care for infants, including providing feedings.
  
• If you are too sick to breastfeed, pump and have someone give your milk to your baby.
  
• Be careful not to cough or sneeze in the baby’s face; wash your hands often with soap and water."

Finally, be watchful for signs of flu in your child  and call your doctor right away if you notice any. If you don't have a doctor you can find one here. 

Dr. Jessica Schultz is a member of the Children's Medical Center team, a pediatric practice affiliated with TMC for Children. Dr. Schultz is also one of the founders of the Grow 2B Fit Foundation which aims to help families live happier healthier lives through exercise and nutrition education.

Resources
CDC 

TMC Healthwise 

Flu.gov

September is Baby Safety Month

"Making the decision to have a child is momentous. It is to decide forever to have your heart go walking around outside your body."
--Elizabeth Stone

Becoming a parent must be among one of the most exhilarating and humbling experiences there is. What parent among us has not had a moment where we realize, amid the joy this new life brings, how daunting the responsibility of keeping that new life safe is. Our hearts are now outside the bounds of our bodies and  substantially harder to protect. So how do you protect your child, how do you keep them safe.


Every month is Baby Safety Month at TMC for Children, but in September there is a national push to focus on keeping infants safe from accidents. Safe Kids Tucson shares that knowing what the leading causing of accidental deaths are, and taking measures to prevent them is the first step. For children under a year the leading causes of death are:

• suffocation
• motor vehicle crashes
• drowning
• home fire or burn injuries
• falls
• poisoning

Over the next few weeks we'll be talking about what steps we can take to reduce the risks to our children.

Roll up Your Sleeves. It's that Time of Year Again.

It's that time of year again. The packages have arrived, they've been unpacked and the doctors, nurses and staff at pediatric doctors' offices across town are readying themselves for the flu clinics. I know, I know, it was just Labor Day. Temperatures are still over 100. How can it be time for the flu shot already?

Why get the flu shot now? Isn't flu season in the winter?
It takes about two weeks after receiving the shot for your body to produce antibodies to the virus. Getting the influenza vaccine now provides time for your body to produce the antibodies needed to protect you before the start of the flu season. Flu season may start as early as October. Tragically, we have already had one case of influenza that has claimed a child in Arizona.

Cold, flu what's the difference?
Colds and influenza are both caused by viruses and have some similar symptoms. They're both illnesses of the respiratory system, but influenza tends to be much more severe, having other health complications and can even be fatal. Fever, fatigue, dry cough tend to be more typical and extreme with influenza whereas a runny nose is symptomatic of a cold.

I've had the flu shot before and still got the flu! Why bother?
The seasonal flu shot is designed to protect against the three main groups of flu strains that are most prevalent that particular year. Across the globe, scientists track what strains are particularly virulent, and based on that information each country decides which components to include in the seasonal flu shot. While the flu shot will help to protect you from the main flu strains any particular year, if you are exposed to a different variety you may develop that variety. Remember you may well have been saved from another bout of a different variety if you were vaccinated.

I never get sick with the flu, nor do my kids why should I bother?
Even healthy people can spread influenza. The people within your community who are unable to receive the vaccination are often the very ones who will suffer the most by exposure to the flu, children under 6 months or those with compromised immune systems. As influenza morphs each year you are not fighting the same viruses each year. This year might be the year that you're exposed to an influenza strain that you're unable to fight off. Why take the chance?

Okay, okay. You've convinced me. Should everyone get a flu shot? Where would I get one?
Everyone over 6 months old* should get a flu vaccination every year. If you have a fever the day you may have to delay getting the shot until another day, or if you have a severe egg allergy you may not be able to have the vaccination. Check with your doctor. Don't have a doctor? Find one here.

I think my child has the flu. When do I need to take them to the Emergency Room?
The Centers for Disease Control offers the following emergency warning signs for the flu.

In children, emergency warning signs that need urgent medical attention include:

• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough 

*We'll be following up shortly with a post about how to protect infants under six months of age. 

Resources 
Centers for Disease Control and Prevention http://www.cdc.gov/flu/

Flu.Gov http://www.flu.gov/

Arizona Department of Health Services - Infectious Disease and Epidemology Program http://www.azdhs.gov/phs/oids/epi/flu/

Heat Stroke Still A Deadly Concern After Labor Day

Safe Kids Tucson Reminds Caregivers the Dangers of Unattended Children in Cars

Never Leave Your Child Alone in a Vehicle

Tucson, AZ - Although Labor Day signals the end of summer for many, there will still be several weeks of warm weather and parents must continue to be diligent and never leave children alone in vehicles.  So far this year, at least 24 children have died from hyperthermia while unattended in vehicles in states all across the country. For national statistics, please visit. http://ggweather.com/heat/hyperthermia2011.htm

"We know from past experience that these fatalities can continue to occur in September and October, when temperatures are still warm enough to cause danger in many parts of the country," said Yomy Diaz, Safe Kids Tucson Coordinator. “In past years, as many as twelve deaths after September 1.

It doesn’t have to be the middle of the summer for a child to get overheated.  Even with seemingly mild temperatures outside, the inside of a car can rise 20 degrees in as little as 10 minutes.   What some do not realize is that a car acts like a greenhouse, a place no child should be alone.  Children’s bodies heat up 3 to 5 times faster than adults, making them more susceptible to heat stroke and more likely to suffer from heat stroke.    

 “Don’t be fooled into thinking that this can never happen to you.  Unfortunately, I did.” says Reggie McKinnon, a father who accidently left his 8-month-old in a vehicle last year during a work day.  “Before this accident, every time I would read of a child dying in a parked car of Hyperthermia, I too would ask, ‘how could they forget their child?’  I would never do that.  That only happens to people who are uneducated, drunk, drug-addicts, not me.”

Kristie Reeves, a mother who lost her child to hyperthermia this year believes that “good communication between parents and teachers is the key to child safety and prevention of the devastating effects of hyperthermia.”  Reeves said that, “One phone call can save a child's life."

Safe Kids Tucson expressed continued support for the National Highway Traffic Safety Administration's focus on reducing unattended child hyperthermia deaths in vehicles. "We commend NHTSA Administrator David Strickland's emphasis on educating the public about this problem and on conducting a broad coordinated national prevention campaign in 2012," Diaz stated.

Too many children have lost their lives to this completely preventable, heartbreaking tragedy.  There are steps you can take to help save lives and remember one phone call can save a life. 

Here’s what parents and caregivers need to know and why.

·       Lock cars and trucks.  Thirty percent of the recorded heat stroke deaths in the U.S. occur because a child was playing in an unattended vehicle.  These deaths can be prevented by simply locking the vehicle doors to help assure that kids don’t enter the vehicles and become trapped.

·       Create reminders.  Many child heat stroke deaths occur because parents and caregivers become distracted and exit their vehicle without their child.  To help prevent these tragedies parents can:

Ø     Place a cell phone, PDA, purse, briefcase, gym bag or something that is needed at your next stop on the floor in front of a child in a backseat. This will help you see your child when you open the rear door and reach for your belongings. 

Ø     Set the alarm on your cell phone/smartphone as a reminder to you to drop your child off at day care. 

Ø     Set your computer calendar program to ask, “Did you drop off at daycare today?”  Establish a plan with your daycare that if your child fails to arrive within an agreed upon time that you will be called within a few minutes.  Be especially mindful of your child if you change your routine for daycare.

·       Dial 911 immediately if you see an unattended child in a car.  EMS professionals are trained to determine if a child is in trouble.  Check vehicles and trunks FIRST if a child is missing.

For more information on preventing child heat stroke deaths, please visit www.ggweather.com/heat and www.safekids.org/nlyca.

Safe Kids Tucson works to prevent unintentional childhood injury, the leading cause of death to children ages 1 to 14. Safe Kids Tucson a coalition with a broad base of community partners and is a member of Safe Kids Worldwide, a global network of organizations dedicated to preventing unintentional injury. Safe Kids Tucson is led by Tucson Medical Center, TMC for Children. 

Young School Athletes at Risk for Sports-Related Injuries, including Heat Stroke

     Heat Stroke is One of the Leading Causes of Sudden Death in Sports 

-        Safe Kids Tucson Encourages Parents and Coaches to Protect Young Athletes On and Off the Field

Tucson, AZ-- With many young school athletes working hard this month to prepare for fall sports, Safe Kids Tucson is encouraging parents and coaches to keep children safe on and off  the field and prevent sports injuries, including heat-related illnesses.  Nearly 3/4 of U.S. households have at least one child who plays organized sports.  Unfortunately, about 3.5 million children receive medical treatment for a sports-related injury each year, and as many as half of these injuries are preventable according to the Centers for Disease Control and Prevention.

“With scorching high temperatures and vigorous practice sessions underway for school age children, parents and coaches have an even greater role to play in keeping children safe and injury free,” said Yomaira Diaz, Safe Kids Tucson. “It’s vitally important to set realistic expectations for children about sports and understand how to help them prepare properly, prevent injuries and play safely.”

In a nationwide education campaign, supported by its founding sponsor Johnson & Johnson, Safe Kids USA coalitions have hosted more than 150 Youth Sports Safety Clinics for parents and youth coaches since April.  

According to the American Journal of Preventive Medicine, the number of heat-related injuries from 1997 to 2006 increased 133 percent. Youth accounted for the largest proportion of heat-related injuries or 47.6 percent.

“Over the past five years, the number of heat stroke deaths from exertion in youth sports is higher than in any five-year period in the past 35 years,” said Douglas J. Casa, PhD, ATC, FACSM, FNATA, and chief operating officer with the Korey Stringer Institute, Neag School of Education, for the University of Connecticut. “A coach needs to have the knowledge to prevent the condition, recognize the signs or symptoms, and then rely on athletic trainers or emergency response personnel to implement the life-saving treatment strategy."

A national survey commissioned by Safe Kids USA, funded by Johnson & Johnson, confirmed parents and coaches need more youth sports safety information.  In fact, just 29 percent of parents surveyed feel coaches have the necessary skills to identify and prevent injuries and just 40 percent feel confident in their own abilities.

According to recent studies in sports injuries, the rate and severity of sports related injuries increases with a child's age.  Children ages 5 - 14 years of age account for nearly 40 percent of all sports-related injuries treated in hospital emergency departments with collision and contact sports associated with higher rates of injury.  In fact, the Consumer Product Safety Commission (CPSC) reported in 2009 an estimated 216,232 children age 14 and under were injured playing football, 88,789 were injured in soccer. For children 14 years and younger playing baseball or softball, there were 115,133 injuries in 2009.

The most common types of sport-related injuries in children are sprains, muscle strains, bone or growth plate injuries, and heat-related illness.  Although very rare, brain injury is the leading cause of sports-related death to children. 

Dr. Gerard Gioia, Director of the SCORE Concussion program, for Children’s National Medical Center, has treated children with brain injuries for more than 20 years.  He is working to develop similar neurocognitive computerized testing tools that the NFL and NHL mandate for players but  for younger children and teenagers, who may have sustained a concussion.

“We know that participation in sports is very important to the child’s overall development.   At the same time, the child’s brain is their future and unrecognized concussions in sports can threaten that future,” said Gioia. “We must do everything we can to equip parents, coaches, and our youth to recognize concussions and respond appropriately to them. Youth sports are not equipped in the same way as the professional players, but we can still find effective ways to safeguard our kids.”

Safe Kids Tucson encourages parents to understand how to prevent the most common causes of preventable sports injuries in young athletes including overuse injuries, heat-related illness, concussions and injuries caused by pre-existing medical conditions. Safe Kids encourages parents to have consistent communications with their child’s coach in order to take a proactive role in keeping their child safe while playing sports.

Pre-Participation Physical Evaluations 

Safe Kids USA and the American Academy of Pediatrics (AAP) recommend every child receive an annual pre-participation evaluation (PPE), which will help determine his/her readiness to play sports and may uncover any underlying conditions that could limit participation or increase the risk for injury or a medical emergency.  Parents should talk to their child’s doctor and ask them to perform the full pre-participation evaluation, which was recently updated by the AAP.

Dehydration/Health Related Illness

Young athletes need to be encouraged to drink water before, during and after practice, in order to prevent dehydration and the risk of a more serious heat-related illness such as heat exhaustion and heat stroke.  Athletes should start practice/play fully hydrated, and drink water for every 20 minutes of play.

Overuse Injuries

An overuse injury is difficult to diagnose and treat because they are usually subtle and occur over time. Fatigue, burnout or playing while injured can lead to overuse injuries such as repetitive motion injuries as well as acute injuries including sprains (mostly ankle), muscle strains, bone or growth plate injuries. Warming up and stretching before play is essential to preventing sports related injuries.  This helps athletes avoid injuries such as muscle tears or sprains by stretching and releasing any muscle tension. 

Concussion

Children who do not wear or use protective equipment are at greater risk of sustaining sports-related injuries.  Parents can reduce their child’s risk of minor or serious injuries such as concussions by making sure their child wears the appropriate and properly fitted sports equipment during practice and competitive play and knowing the signs and symptoms of a concussion.

-more-

About Safe Kids Tucson

Safe Kids Tucson works to prevent unintentional childhood injury, the leading cause of death and disability to children ages 1 to 14. Its members include Tucson Medical Center, Drexel Height Fire District, Rural Metro Fire, Golder Ranch Fire, Southwest Ambulance, Tucson Police Department, Pima Community College Police, Pima County Department of Transportation and others. Safe Kids Tucson is a member of Safe Kids Worldwide, a global network of organizations dedicated to preventing unintentional injury. Safe Kids Tucson as founded in 2007 and is led by Tucson Medical Center.