challenges of puberty - wakemed · overtime manufacturing growth and sex hormones. a restful sleep...

A P u b l i c a t i o n o f Wa k e M e d C h i l d r e n’s

S P R I N G 1 2

Challenges of Puberty

ORGANIZED SPORTSLYME DISEASE

2 F A M I L I E S F I R S T s p r i n g 12

By Nicole Parkerson, MD, FAAP

The first signs of puberty beginunnoticeably in children, mostly atnight, while they are fast asleep. It’s

during this time when the brain and bodykick into high gear, producing growth and

sex hormones that will usher our little boysand girls into adulthood.

F I R S T S I G N S O F P U B E RT YThe majority of girls go through pubertal

changes earlier than boys. With girls, you mightbegin to see changes as young as seven or eight.

Generally the first sign in girls is breast budding –usually before age 11, but can be as young as eight.In boys, it may be an increase in testicle size aroundage 10 or 11. In addition, there may be some bodyodor.

Growth spurts (height and weight) usuallyaccelerate in girls a little before age 12. Boys, onthe other hand, will have a growth spurt fromaround 13 years of age – peaking closer to 14.

Healthy diet and regular exercise is key tocoasting through puberty. Here are some tips to

getting through this stage:

• Enforce – and model – healthy eating andexercise and lifestyle habits. Cut the juices, sodas,

and sports drinks and replace with waters and anykind of calcium-fortified milk (cow, almond, soy, etc).

Calcium at this age is of utmost importance.

• Replace processed foods with fresh fruits and vegetables,some meat, beans, and whole grains. Limit or losealtogether the processed and packaged products. Not onlywill fresh foods help your child grow into his or her bodyand maintain a healthy weight, but they will keep the bodyfinely tuned from the inside out. It also ensures that thebrain and other organs that produce hormones areabsorbing the nutrition they require to regulate moods andgrowth patterns during this important time.

LET’S ASK THE DOCTOR: My 10-year-old daughter has a pea-sizedlump underneath one nipple, and she complains of soreness in thatbreast. Should I be concerned? “Most likely not,” advises Dr. NicoleParkerson. “This is most likely a breast bud – a tiny bump underneath

T H E C H A L L E N G E S O F

puberty

P A R E N T I N G

1 0 1 A

3A P U B L I C A T I O N O F W A K E M E D C H I L D R E N ’ S

• Eating a good protein-filled breakfast is essential. Fueling up first thing in themorning not only helps balance blood sugar levels, it will also fortify your childfor the entire day.

• Limit TV, video games, and other sedentary activities to no more than one to two hours a day – just for some down time. Parents should remove TVs and video games from the kids’ bedroom and have their kids “check in” their cellphones before bed.

• Encourage your kids to engage in activities which offer aerobic benefits and you’llnotice an improved body image, enhanced academic performance, healthier self-esteem, and less moodiness.

• Ten to eleven hours of sleep each night is recommended. Adolescent children stillneed a good restful sleep each night. During sleep the body and brain workovertime manufacturing growth and sex hormones. A restful sleep will also helpequalize any mood swings associated with hormones and augment kids with thestaying power they need to endure today’s very busy academic, athletic, and socialschedules. Inadequate sleep during adolescence can lead to headaches and fatigue,which can further exacerbate the emotional symptoms of puberty.

W H AT S H OU L D YOU , A S A PA R E N T, D O D U R I NG T H I S

T I M E F R A M E ? Becoming an adolescent, and parenting an adolescent, is hard. This is a time similarto when your kids were toddlers. Remember when they first started to walk and run,and they would test you by toddling away bravely…only to look back to make sure youwere still there and then toddle faster and further away? Puberty is similar. Yourchildren are feeling their independence, yet they want to know they still have thesecurity of your love, encouragement, and support. But, as you did when they wereescaping little toddlers, maintain supervision without hovering. Permit them a littlemore privacy, yet keep the communication going. Keep talking and talking – andalways keep listening and listening.

Physical • menstruation for girls and

ejaculation for boys• growth spurts in height and

weight• body odor, deepening voices,

shoulders will become morepronounced, and girls willbegin to develop breasts andhips

Emotional• mood swings – highs and lows• more sensitive than usual• more self-conscious• self-esteem may wax and wane• increased awareness of their

own sexuality• confusion about becoming an

adult and wanting to remain achild

Social• need for more privacy• need to establish their own

identity• desire for more independence• more apt to compare self with

peers• more apt to be influenced by

peers• more aware of the opposite sex• more apt to test boundaries

and limits

the nipple, which is one of the first outward signs of breast development ingirls. Breast budding can result in tender and even somewhat painful breastsand is probably nothing to worry about.” However, if she feels that it gets worseor continues to bother her, please contact your daughter’s physician.

WHAT OUTWARD SIGNS SIGNAL THE PROGRESSION OF PUBERTY IN BOYS AND GIRLS?

q

H E A L T H

F E A T U R E


DID YOU KNOW? About 30 million childrenand teens participate in some form oforganized sports in the US. The mostpopular team sport is basketball.

H OW YOUNG I S TO O YOUNG TOB E G I N O R G A N I Z E D S P O RT S ?No matter the age of the child or the sport, physicalactivity offers many benefits, including:

• establishment of long-term healthy living habits

• improved physical fitness

• increased confidence

• helping to build friendships

• increased attention span

• enhanced academic performance

• better sleep

• helping children learn about winning and losing

This is just the short list. Yet, the age at which manychildren are beginning “organized” sports seems to beyounger and younger. At what age should parentsbegin to consider enrolling their children in sportingactivities?

Melissa Bieber, PT, MPT, suggests that, while thereare developmental norms for children, “There are nomedical signs that a child is at the appropriate age fororganized sports. However in general, childrenyounger than seven or eight should be encouraged toengage in more ‘free play’ activities, which fosterphysical activity, creativity, social skills, andcoordination,” she advises.

B A S I C S K I L L S C O M E F I R S TChildren can start learning the fundamental skills ofthrowing and catching, kicking and hitting a ball,jumping, running, and swimming at an early age.The focus at this age and stage however should be onfun and physical activity outdoors. Once they begin tomaster these skills, then they can progress to learn

more about rules and regulations of more organizedplay, begin to compete, and continue to advance their skills.

Beginning a child in organized sports too young canbe frustrating for the child and the parents. Thedemands of a sport may be too physiologically andpsychologically challenging for a younger child, andthe child may not have the proper tools to effectivelylearn the rules and skills necessary for the sport.When the child is uninterested or physically not ableto perform, the parents can get frustrated and thewhole experience can be unfulfilling for everyoneinvolved. Children are not able to acquire skills fasterjust because they learn them sooner. They must be atthe right stage developmentally first.

When the child is ready for sports, it should beappropriately aligned with his current abilities andinterests. Since each child is different and each sportis different, parents will need to consider eachsituation on a case-by-case basis.

B E M I N D F U L O F S PE C I A L I Z I NG

I N O N E S P O RTMelissa Bieber also cautions parents to be careful notto "specialize" their child in a particular sport tooearly. Playing one sport all year round at a young agelends itself to many overuse injuries.

If parents let their children have fun and not getoverly competitive and specific too early, the resultsare more likely to be a win-win for both parents and kids.


fuel their play

H E L P F U E L T H E I R P L AY

As they grab their uniforms, cleats, rackets,helmets, sneakers, etc., make sure your kidsgrab healthy snacks to keep their energy highand their minds nourished. And, if you’rethe parent in charge of snack, it’s importantto bring something that will keep all the kidsmovin’!

Here’s a list of go-to snacks that will surelybe team-pleasers. Be sure to offer at leasttwo options – a carb and a protein.

• Low-fat cheese, string cheese

• Greek yogurt

• Apples, bananas, pears, oranges (fresh or dried)

• Carrots, sugar snap peas, cucumbers

• Hummus and pita

• Trail Mix (be aware of nut allergies)

• Plain popcorn, pretzels, baked chips

• Granola Bars (watch the sugar and fat)

• Almond butter or peanut butter mini-sandwiches (again, be allergy aware)

• WATER

With all the on-the-go packaging availablethese days, providing these healthy options isnot only good for them – it’s easy to keepstocked! If you’re feeding the team, going tomembership stores (Costco, Sam’s, BJs) is agreat place to find favorite snacks in bulk atgreat prices.

L I P S M AC K I N ' T R A I L M I X

Ingredients

• 2 cups granola

• 3/4 cup coarsely chopped pecans

• 3/4 cup coarsely chopped walnuts

• 1 (3 1/2-ounce) can flaked coconut (1 1/2 cups)

• 1/2 cup sunflower seeds (remove shell)

• 1/2 cup wheat germ

• 1 teaspoon ground cinnamon

• 1 teaspoon salt

• 1 (14-ounce) can sweetened condensedmilk

• 1/4 cup vegetable oil

• 1 cup banana chips (optional)

• 1/2 cup dark raisins

• 1/2 cup golden raisins

• 1/2 cup dried cherries

• 1/2 cup dried apricots, diced

Preheat oven to 300º F.

In large mixing bowl, combine allingredients except banana chips, raisins,cherries and apricots. Mix well. Spreadevenly in an aluminum foil-lined bakingsheet. Bake 55 to 60 minutes, stirring every15 minutes. Remove from oven; stir inbanana chips, raisins, cherries and apricots.Cool thoroughly. Store tightly covered atroom temperature.

* Recipe courtesy of foodnetwork.com

T Y K EB I T E Su

x H O S P I T A L

H I G H L I G H T


MEET BETSY CASANAVE DIRECTOR AND CHIEF OF WAKEMED’S MOBILE CRITICAL CARE SERVICES

What initially led you to become a member of MCCS?

I began mynursing career inthe emergencydepartment andintensive careunit beforemoving on tobecome a ground

transport nurse (the nurse who rideswith you in the ambulance). I enjoyedthis position and eventually beganworking as a flight nurse (on a helicopter)in 2001. WakeMed’s CEO, Dr. BillAtkinson, asked me if I’d consider starting aflight program for WakeMed in 2004. Onething led to another, and here I am today,overseeing 135 employees who include nurses,respiratory therapists, paramedics, EMTs, pilots, and mechanics in MCCS. Over the years, my role has changed from the day-to-day nursing to more of a coaching role for my employees.

What do you enjoy most about this particular line of work? Right now I get my biggest reward from my team. Theymake such a big difference in our patients’ lives, andwe transport about 50 patients every day. Recently myteam transported a really, really sick child. It was one ofthose unforgettable days when you just know you arevery instrumental in helping save a child’s life. Jobsatisfaction doesn’t get any better than that.

Do you have a special memory from your years as a transport nurse? Right after I started as a flight nurse, we transported avery ill 12-year-old boy who needed a heart transplant.Three or four months later, that very appreciative boycame back to visit us, see the helicopter, and express hisgratitude. I’ll never forget how I felt as a result of thisgesture – just knowing I helped this boy live.

What’s thecraziest jobyou've ever had? My first job was a manager of The Ice Cream Factory. I was a great banana split maker – and I was allowed toeat the mistakes!

Favorite hobby? I am an avid reader. I enjoy whodunit mysteries andbiographies.

Any advice to kids who may want to pursue this line of work? I can’t promote education enough. In addition to theusual nursing education, most flight nurses have aprofessional certification to become a flight-registerednurse. I would also advise to stay out of trouble. Listento your parents. And it helps to have a genuine interestin helping others – as more often than not, we areputting other people’s needs before our own.

SO

ME

DA

Y I’D

L

IK

E T

O. .

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B E I N V O LV E DI N PAT I E N TT R A N S P O R T


twinkle timesA R T I C L E S , G A M E S , P U Z Z L E S A N D A C T I V I T I E S J U S T F O R K I D S !

FamiliesFirst Aid KitKids! Grab your loved ones and put together this first aid kit totake with you to the park, on ahike, or just leave it in the car. It’s always better to be prepared.

Here are the items you need. Many may be on-hand at home oryou can buy them at your localpharmacy.• Antiseptic Wash• Band-Aids• Antibiotic ointment • Gauze pads• Scissors• Adhesive tape• Instant cold pack• Latex gloves• Tweezers• Sting/bite treatment• Bottle of water• List of emergency phone

numbers• If traveling, don’t forget your

prescriptions and pain relievers.• Waterproof bag for all the items

F A M I L I E S F I R S T s p r i n g 12

K I D S

F I R S T

8

Twinkle visited thehospital today. He met a verynice doctor that helped him

feel better. Can you colorTwinkle and the doctor?

hospital helpersTry our crossword puzzle.

ACROSS

1. Where you go when you aresick; a place where people helpyou get well.

5. All the people who work in thehospital to help you get well.

7. When you don't say no, you say_____.

9. They work with the doctor totake care of you.

10. Kind of meat that rhymes withjam.

11. Hospital workers that work withthe nurse to aid in your care.

14. You fly this in the air and hold itwith a string.

17. What you use to write on ablackboard.

18. The person who tells you howyou can feel better.

DOWN

1. How you feel when you have abig smile on your face.

2. While you wait in the hospitalwaiting room, you ___ in a chair.

3. A special dessert, sometimesserved in a cone.

4. People in the hospital kitchen fixyour breakfast, ___ and dinner.

6. To clean your hands, you washwith ____ and water.

8. When you are finished reading abook, you are at the ____.

12. When the lights get turned off, itis ____.

13. What you use in the snow to godown hills.

15. Children in the hospital playroomplay with ____.

16. When you have a fever, you feel____.

Unscramble these hospital words:

serun leende dentiacc

lipl mealnbaucisscthet

cpottsohsee trocod goesnru

iaareefct

LAUGHTER IS GOOD MEDICINE!“Doctor, Doctor I keep thinking I’m a dog.”

“Sit on the couch and we will talk about it.”

“But I’m not allowed up on the couch!”

1

7 8

11

10

17 18

13

16

14 15

2 3 4

9

5 6

12


X S R A Z I H T T R O P P U SK G E B O G H N K R E U S D UE N D P B U K E O G L I K C CO U D Y L E C D N S R C E U TJ L A C O I E I E E A N O M IY Q L N O Y R C N T I M R S OJ O A E D Y W C T C R O T B NN X T G S T Q A I C F H M T YC Y I R U L T D X I G M O R JV G P E G R E T N I U K R O XX E S M A M B U L A N C E F MJ N O E R W C M D U F C F M KG I H O G R O A S T X B K O IS T V L L A F I R E T R U C KE J I U H O E E W N I Z G B X

ACCIDENT

AMBULANCE

BLOOD

COMFORT

EMERGENCY

FALL

FIRE TRUCK

HEART

HEART ATTACK

HOSPITAL

LADDER

LIGHTS

LUNGS

MEDICINE

OXYGEN

PULSE

SIREN

SUCTION

SUPPORT

SYRINGE

UNIFORM

SCRAMBLE ANSWERS: nurse, needle, accident,pill, ambulance, stitiches, stethoscope, doctor,surgeon, cafeteriaCROSSWORD ANSWERS: Across: 1. hospital, 5.helpers; 7. yes; 9. nurses; 10. ham; 11. aides; 14.kite; 17, chalk, 18. doctor. Down: 1. happy; 2. sit; 3.in cream; 4. lunch; 6. soap; 8. end; 12. dark;13. sled; 15. toys; 16. hot

to the rescueCan you help the ambulance

find the hospital?

search & rescueSee how many of these words you can find:.

How many words can you think of that rhyme with these?

heightgown play

slippers

blood chart crib

weigh

START

WS A F E K I D S

C O R N E R

Acetaminophen, which is available both genericallyand under the brand name Tylenol, is a medicationused to reduce fever and control pain. Historically, ithas been available as infant drops, 80 milligram (mg)per 0.8 milliliter (ml), and for children 2 years andolder as a liquid, 160 mg per 5 ml (or one teaspoon).

Now, the new dosage for both infant and children’sliquid acetaminophen is 160 mg per 5 ml (or oneteaspoon).

The reason for the change isthe hope that the singleliquid concentrationproduct will reduce dosingerrors. Acetaminophen isgenerally safe when given inreasonable doses, however,each year children aretreated at WakeMedChildren’s Hospital foracetaminophen overdoses.An overdose has the

potential to cause liver toxicity and liver damage iftaken over a long period of time or given at too highof a dose.

C H E C K , D OU B L E C H E C K , A N D C H E C K AG A I N

While the new 160 mg per 5 ml concentration is nowavailable on store shelves, much of the older, moreconcentrated 80 mg per 0.8 ml versions are too, andmay still be in people’s medicine cabinets. If yourpediatrician recommends a certain dosage, make sureyou ask if that is for the new or old product. Then,check your dosing chart on the acetaminophenproduct you have at home to ensure you and yourprovider are talking about the same product.

Consider discarding the old product you may have athome, in your diaper bag, or other places, andreplace with the new. Make sure, however, you areactually buying the new product, as the bottles of theold and new may look similar. The new infant 160 mgper 5 ml product will now come with a dosing syringerather than a dropper. Always contact a healthcareprovider such as your pharmacist, nurse, or physicianif unsure of the appropriate dose.

The FDA suggests:

• Read the “Drug Facts” label on the package verycarefully to identify the concentration of the liquidacetaminophen, the correct dosage, and thedirections for use.

• Look for the “Active ingredient” section of the DrugFacts label usually printed on the back of an over-the-counter (OTC) medication package.

• Do not depend on a package banner proclaimingthat the product is “new.” Some medicines with theold concentration also have this headline on theirpackaging.

• Use only the dosing device provided with thepurchased product in order to correctly measure theright amount of liquid acetaminophen.

• Consult your pediatrician before giving thismedication and make sure you’re both talking aboutthe same concentration.


Important numbers incase of a suspected

dosage mistake:

Carolinas PoisonCenter: 1-800-222-1222(open 24/7 every day)

Consult yourpediatrician - Most

are on-call 24/7

New Infant AcetaminophenDosages – Don’t Confusewith Old Dosages

Brand and generic reformulation to newconcentration.

NEW: 160 mg per 5 ml bottles, which have a restrictiveflow bottle and may be packaged with a syringe.

OLD: 80 mg per 0.8 ml in 15 and 30 ml bottles, which have amedicine dropper.


ADVISORY PANEL

Jerry Bernstein, MD, Raleigh Pediatric Associates, PA

Janice Frohman, RN, Administrative Director, WakeMed Emergency Services

Melissa Johnson, PhD, Pediatric Psychologist, WakeMed Faculty Physicians, Pediatrics/Neonatology

Courtney Mann, MD, Wake Emergency Physicians

Mark Piehl, MD, Medical Director, WakeMed Children’s Hospital

Elizabeth Rice, RN, Director, Women's and Children's Services

Debra Z. Laughery, Vice President of Public Relations

Michele Jonczak, Editor

Leesa Brinkley, Design

Published by the WakeMed Public Relations Department. Call 350-8120 with comments or suggestions.

WakeMed Health & Hospitals3000 New Bern Avenue Raleigh, North Carolina 27610

© WakeMed, 2012 Children’s

True or False? We don’t have to worry about ticks until the weather warms up. False. Because of North Carolina’stemperate climate, tick season is yearround – 365 days a year.

True or False? I’ve heard there is Lymedisease in North Carolina and WakeCounty? True. Other tick-borne diseases have also been foundin North Carolina, including erlichiosis and RockyMountain spotted fever. Lyme disease can cause life-long debilitation, suffering, and even death if nottreated promptly and properly with antibiotics.

If a tick has attached, how should I remove it?According to the CDC, the goal is to remove the tickincluding its head and mouth. Using tweezers, gently

but firmly grasp the tick as close to your skin aspossible. Pull the tick straight up – do not twist orturn as this may cause the head to detach and remainunder the skin. Immediately wash your hands andthe tick bite with warm soapy water, alcohol, or aniodine scrub.

What are the signs and symptoms of Lyme disease? • Red, expanding rash called erythema migrans

(EM)

• Fatigue, chills, fever, headache, muscle and jointaches, and swollen lymph nodes

Some people may experienceall or some of these

symptoms which canappear three to 30 days after thetick bite.

True or False? We don’t have any wooded areas in our yard, so I shouldn’t be concerned. False. Ticks live in grass, shrubs, trees, woodpiles,etc. Be aware of the potential for ticks when planting,spreading mulch, mowing the lawn, playing outdoorsor even during a family cookout.

Get in the habit of doing a tick check when yourchildren are exposed to tick-infested habitats. Checktheir scalp, especially the nape of the neck, ears, armpits, behind the knees, and belly button – ticks lovewarm moist areas where there’s ample blood flow.

Children ages two through 12 are at a higher risk fortick bites. If they do become infected, they may notbe able to express the symptoms they feel. Inaddition, they may appear well and continue to bephysically active. If you have removed a tick fromyourself or from your child and are concerned there’san infection, contact your healthcare provider.

For more detailed information, such as various waysto repel ticks, visit http://www.cdc.gov/ticks/.

T E ST YOU R K NO W L E D G E O F T I C K S A N D LY M E D I S E A S E

DID YOU KNOW? Ticks have no wings and no antennae but have four pairs of legs. They cannot fly orjump, so they make their way on to a host by falling or crawling. A tick’s diet consists solely of blood.

NonprofitOrganizationU.S. PostageP A I DRaleigh, NCPermit NO. 1307

A P u b l i c a t i o n o f Wa k e M e d C h i l d r e n’s Wa k e M e d 3 0 0 0 N e w B e r n A v e n u e R a l e i g h NC 27 610

A D D R E S S S E R V I C E R E Q U E S T E D

Families First is publishedperiodically for members of theFamilies First Club. Reproduction oruse, without permission, of editorialor graphic content in any manner isprohibited. Information in thispublication is not a substitute formedical advice or treatment. Pleasesee your doctor if you have anyquestions about your medical care.

Comments or request for removalfrom the mailing list may be sent to:WakeMed Public Relations3000 New Bern Ave.Raleigh, NC 27610or email [email protected]

S A T U R D AY, A P R I L 2 1

St. Timothy's School 7th Annual Spring Sprint 5K RUN/WALK & 1 MILE FUN RUNBenefiting WakeMed Children’s Diabetes & EndocrinologySt. Timothy’s School, RaleighTo sign up or for information about the race, visit www.sportoften.com.

S A T U R D AY, A P R I L 2 8

Spring Daze Arts and Crafts Festival9 am to 5 pmFred G. Bond Metro Park, Carytownofcary.orgEnjoy arts, crafts, food andentertainment, and participate inWakeMed’s Passport to Fitness.

S A T U R D AY, M AY 5

Apex Peak Fest9 am to 5 pmDowntown Apexapexpeakfest.org

S A T U R D AY, M AY 5

Meet in the Street10 am to 4 pmDowntown Wake Forestwww.wakeforestchamber.org

M AY 1 9 & 2 0

Artsplosure – The Raleigh Arts Festival Moore Square/City MarketDowntown Raleighwww.artsplosure.orgThis year’s festival will feature more than 170 artists, local and nationallyrecognized musicians on two stages, and interactive art and activities for theentire family.

F R I D AY & S A T U R D AY, J U N E 1 & 2

Celebrate Fuquay-Varina10 am to 4 pmDowntown Fuquay-Varinawww.celebratefv.com

C A L E N D A R

O F E V E N T SA

12SP

RI

NG

challenges of puberty - wakemed · overtime manufacturing growth and sex hormones. a restful sleep...

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