just kids | spring 2008

justkidsSpring 2008

Teaming Together to Save Lives

The Facts About Vaccines and Autism

Have Fun in the Sun Safely

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Children’s Hospital, Omaha, NE

Chi ld ren ’s Hosp i ta l | Spr ing 2008

Parents Spotlight

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Concentration runs high as a team of nearly 30 fills the operating room, ready to help a critically ill baby who hasn’t even been born. In a few minutes, months of planning will be put into action.

While it appears to be a routine C-section, this delivery is much, much different. The multidisciplinary team has a carefully choreographed plan in place to perform an Ex Utero Intrapartum

Treatment, more commonly called an EXIT procedure, on the new baby.

What Is EXIt?With a classic EXIT procedure, the baby is only partially delivered. His head, upper

chest and arms are visible outside of the uterus while the rest of the body remains inside.

“We plan for an EXIT procedure when a mass, tumor or other abnormality is detected in a place that could interfere with the baby’s ability to breathe on his own,” explains Dr. Robert Cusick, pediatric surgeon at Children’s Hospital and assistant clinical professor of pediatric surgery at the University of Nebraska Medical Center. “This means we want that baby to continue being supported by mom for at least a short time after birth.”

Dawn Walsh’s baby had a large growth on his neck, and doctors worried that he

Breakthrough Procedure Offers Survival for Unborn Babies

Teaming Together to Save Lives

Braydon and Dawn Walsh holding their infant son, Landon. When a growing neck tumor raised significant concern before Landon was born, certified pediatric surgeons at Children’s Hospital coordinated a complex EXIT procedure to help the baby breathe on his own after delivery.

stay informed Interested in reading more patient stories like Landon’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 1-800-833-3100 or visit ChildrensOmaha.org.

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Chi ld rensOmaha.orgTo f ind a phys ic ian , ca l l 1-800-833-3100

might not be able to breathe on his own.“One of my first thoughts was that

there were so many people in the delivery room,” remembers Walsh. “But, I knew they were there to help and to make our situation better in any way they could.”

spECIaLIzEd CaREAs the only medical center in Nebraska with the full depth and breadth of pediatric subspecialists readily available, Children’s is uniquely prepared for these challenging cases. Several of these procedures have been successfully performed in the last year.

For Dawn and her husband, Braydon, that knowledge and experience helped calm early fears. Yet they waited anxiously as the delivery began, not knowing how severely their son might be affected by the mass that had grown steadily throughout the last half of Dawn’s pregnancy.

Once the delivery process begins, the team has to move quickly.

“Partially delivering the baby allows us to maintain volume in the uterus and prolong placental support, meaning mom is still breathing for the baby through the umbilical cord,” says Dr. Robert Bonebrake, perinatologist at Methodist Hospital in Omaha.

Even with a partially-delivered baby, placental support usually lasts for 30 minutes or less.

“Our goal is to establish an airway and help the newborn breathe on his own,” says Dr. Cusick. “Without this immediate

intervention, the baby could suffer loss of oxygen and brain damage or even death.”

smaLL CRy, hugE RELIEF“When Landon came out, he gave a little cry and both Braydon and I just broke into tears,” says Dawn. “It was a huge relief. We knew at that point he would be OK.”

The small cry sent a big signal to the medical team. Knowing that baby Landon did have at least some capability to breathe, physicians cut the umbilical cord, and Landon was immediately rushed to a connecting room where doctors inserted a breathing tube.

The newest member of the Walsh family spent six weeks in the Newborn Intensive Care Unit at Children’s Hospital. Because of the large tumor that spread into his airway and the back of his tongue, baby Landon has undergone multiple surgeries with more to come in the months ahead.

Still, mom and dad keep a positive attitude.

“I am just so excited to be a mom,” shares Walsh. “His tumor was a completely random thing; there’s nothing we could’ve done to prevent it. Landon is such a calm and happy baby. We’re so lucky to have him.” ✷

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Pay Your Bills —Online!Hospital bills and health insurance matters can be complex and time consuming, but parents can turn to the Children’s Hospital website for help. Simply log on to ChildrensOmaha.org and click on “My Account” to learn how to get in touch with Children’s staff who can walk you though the billing and insurance process. In addition, My Account gives you options to:

■ Pay your bill online■ Update your address■ Update your insurance information■ Request an itemized statement for

your hospital services

Through My Account, you also can learn more about our billing policies and our financial assistance program, and find answers to frequently asked questions.

If after visiting My Account you still have questions, you may call our patient account representatives toll-free at 1-866-535-3412 Monday through Thursday from 8 a.m. to 5 p.m., or Fridays from 8 a.m. to 4 p.m.

“”

One of my first thoughts was that there were so many people in the delivery room, But, I knew they were there to help and to make our situation better in any way they could. — Dawn Walsh

stay informed Interested in reading more patient stories like Landon’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 1-800-833-3100 or visit ChildrensOmaha.org.

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mmunizations protect your child. In fact, they are considered the single most important preventative intervention for children’s health. Yet, immunization rates continue to lag well below recommended levels. Many parents are reluctant to immunize their children because they fear immunizations may cause autism.

What Is autIsmAutism is a neurological disorder that affects the development of play, social skills and communication skills. Signs emerge within a child’s first three years. While certain behaviors are typical of the disorder, autism can appear quite differently among children. In general, children with autism have trouble integrating information from their senses to understand their experiences and have difficulty interacting with people.

sEaRChIng FOR a CausEUntil the 1940s, there wasn’t even a name for autism, and researchers continue to search for possible causes, including biological and environmental factors. They know that children with autism have differences in the shape and structure of their brain and have an abnormally high level of the neurotransmitter serotonin.

There also seems to be a genetic component, because some families have a pattern of developmental disorders. In recent years, several genetic defects that lead to autism spectrum disorders have been identified.

thE VaCCInE mythThere has been controversy about whether a mercury-based vaccine preservative called thimerosal, or the measles-mumps-rubella (MMR) vaccine, are linked to autism in

Children’s Spotlight

Get the Facts About Vaccines and autism some children. After intense investigation, multiple respected health organizations, including the American Academy of Pediatrics, the Centers for Disease Control and Prevention and the Institute of Medicine, state that there is no evidence to support a link.

In fact, over the past several years, the Food and Drug Administration has worked with vaccine manufacturers to eliminate thimerosal or reduce its levels to trace amounts in childhood vaccines. Despite this, diagnoses of autism are growing at a rate of 10 percent to 17 percent per year, according to the Autism Society of America (ASA).

It’s not clear whether autism is becoming more common or people are getting better at recognizing it. Currently, as many as one out of every 1,000 children born will develop autism.

dIagnOsIng a dELayIf you suspect a child has autism, a pediatrician can perform a basic screening simply by watching the child interact and listen, and by asking the parents or caregivers questions to evaluate the child’s progress based on various typical age milestones. If any concerns arise, specialists, such as neurologists, psychologists and speech/language therapists, may need to do a more specific

evaluation. ✷

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to learn more about the importance of vaccines, visit our website,

ChildrensOmaha.orgsimply click on health Information, then

pediatric hints and Immunizations.to find a pediatric infectious disease

specialist, call 1-800-833-3100.

As the temperature climbs and school gets out, children race outside for some fun in the sun. Whether you’re enjoying a picnic, a pool party or a trip to the lake, spring and summer are wonderful seasons to spend outdoors with family and friends, as long as you do it safely.

pLay It smaRt by thE WatERThe most important water safety tip is to never leave children alone, not even for a few minutes. Adults should not be involved in any other distracting activity—such as reading or talking on the phone—while supervising chil-dren, but do keep a phone handy in case of an emergency.

If you have a pool at home, accident-proof it. Be sure it’s fully enclosed by a fence and has a self-locking gate. Small children can drown in even shallow amounts of water, so empty wading pools when not in use.

“Keep in mind that a pool that is not enclosed by its own separate fencing is not necessarily safe,” says David Kaufman, MD, a pediatrician with Children’s Physicians. “Children are well known for getting out of the house through doors, even when the doors are locked. That’s why it’s so important to empty your wading pools after use.”

In addition:■ Don’t assume that just because a child knows how to swim that

he or she is safe in the water. ■ Children should use appropriate flotation devices, such as a life

jacket approved by the U.S. Coast Guard. Never use a water toy for this purpose.

■ Make sure children never dive into shallow water.■ Learn cardiopulmonary resuscitation (CPR). Because of the

time it might take for paramedics to arrive, your CPR skills could save a life.

stEER CLEaR OF sunbuRnA child’s skin needs protection from the sun’s harmful UV rays. According to the Centers for Disease Control and Prevention, just a few serious sunburns can increase your child’s risk of skin cancer later in life. While you don’t have to stay indoors all

summer to be safe, you can follow a few guidelines:■ Avoid the midday sun. The sun’s UV rays are strongest and most

harmful during midday, so plan indoor activities during this time.■ Slather on the sunscreen. Use sunscreen with at least SPF 15

and UVA/UVB protection every time your child goes outside.■ Hats are important. Hats that shade the face, scalp, ears and

neck are a key source of protection. Baseball caps are popular among kids, but they don’t protect their ears and neck. Be sure to protect exposed areas with sunscreen.

■ Don’t forget the eyes. Sunglasses protect your child’s eyes from UV rays, which can lead to cataracts later in life. Look for sunglasses that wrap around and block as close to 100 percent of both UVA and UVB rays as possible. ✷

Have Fun in the Sun Safely

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Save Lives. Learn CPR be able to help a child in trouble by learning the life-saving skills of cardiopulmonary

resuscitation (CpR), designed especially for infants and children. to register, call 1-800-833-3100 or visit our website,

ChildrensOmaha.org, and simply click on health Information, then on Friends and Family CpR – Infant and Child.


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ndergoing a medical procedure can be especially frightening for children. But research has shown that when children are given age-appropriate information about a stressful event, they are better able to cope.

This is why Child Life Specialists at Children’s Hospital are such important members of the care team. Child Life Specialists are board-certified professionals with a degree in child development, psychology or a related field who have the skills needed to help families with the hospital experience.

“Our Child Life Specialists provide developmental expertise,” says Terry Patterson, Family Resources manager. “They communicate with children on a level that is appropriate for that child’s age and in a way the child understands. This helps the child prepare, reduces anxiety and makes them a better patient.”

Children’s Hospital has the largest Child Life staff in the state, with eight full-time and four part-time specialists, an art therapist, teacher and child life volunteers. These team members provide a variety of services, including:■ Normalization of the hospital environment ■ Preparation for medical procedures,

including emotional support and distraction

■ Therapeutic medical play ■ Sibling preparation and support■ Grief support and resources■ Developmentally appropriate play

activities in playrooms or at the bedside“We assess patients to see what they already know,” says Child Life Specialist Nikki Tenski. “We find out about past experiences and explain the procedure, including what they might see or feel, based on their age levels. We address fears, accompany them for invasive procedures and help carry out their coping plan”

Tenski works closely with radiology, where the entire department strives to recognize each child’s needs.

“We’ve implemented one-voice procedures,” she says. “Even though several people may be in the room, we don’t have everyone talking at once. We have one voice directing the procedure, which is much less stressful for the patient.”

Families can benefit from child life services at Children’s before ever becoming patients. Through Operation Learn, child life specialists lead children scheduled for upcoming surgeries through a question and answer session and conduct tours of the surgical services area.

Child Life also conducts a hospital-wide bingo game, played with medical instruments instead of numbers. The numbers are broadcast through an internal TV channel, and will soon be enhanced with doctors and

nurses explaining what the instruments are and how they’re used. A prize cart then travels throughout the hospital, offering prizes for the winners.

In one day, Child Life staff can wear many different hats. But no matter the role, they make a positive impact by empowering patients and families to make informed decisions about the child’s care.

“A lot of the parents will comment that our help made things so much easier, both for their children and for them.” says Tenski. ✷

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Making It Easier to Be in the HospitalChild life specialists

to learn more about the services provided by our Child Life department,

visit our website,

www.ChildrensOmaha.orgsimply click on departments and

services, then hospital services to choose the Child Life services option.


Amedical device the size of a dime is helping physicians at Children’s Hospital better diagnose and treat children with digestive or intestinal issues. The device, called PillCam®, looks like a large vitamin with a camera, light, transmitter and batteries contained inside the “capsule.”

Through a procedure called a capsule endoscopy, a child wears sensor patches on the torso and carries a tiny recorder in a bag around the waist. The child then swallows the PillCam, which snaps two pictures per second as it travels through the digestive tract. These images are then sent to the recorder, where they are later downloaded on a computer that compresses the photos into a video.

“Capsule endoscopy tends to be extremely helpful in cases where patients have chronic abdominal pain,” says Dr. Thomas Attard, medical director of the pediatric gastroenterology clinic at Children’s Hospital and associate professor of pediatrics with the University of Nebraska Medical Center and Creighton University. “It provides more detailed information, especially when a traditional endoscopy doesn’t show anything or when you need more data.”

Because patients have to swallow the PillCam, capsule endoscopies are normally performed on children ages 10 and older, or those who are able to swallow the device. It also should not be used on patients with blockages. The PillCam takes about 8 hours to travel throughout the digestive tract, but patients don’t have to be hospitalized the entire time. Since there’s no sedation needed, patients only need to be at the hospital to put on the sensors and recorder and swallow the pill. They then return eight hours later to turn over the recorder.

The PillCam has proven to be a great new diagnostic tool, especially for patients who would normally require an extensive amount of tests. The amount of pictures taken throughout the entire digestive tract enables physicians to eliminate the need for multiple tests. Plus, a capsule endoscopy is less painful and safer than traditional endoscopies. And there’s no recovery time.

The images received from a capsule endoscopy are helping physicians make more accurate diagnoses.

“We are seeing a lot of people newly diagnosed with Crohn’s disease who in the past may have been diagnosed with irritable bowel syndrome,” says Dr. Attard. “Inaccurate diagnoses provide a real disservice to patients because you’re not treating the correct problem. With a capsule endoscopy, we get the correct diagnosis.”

And that’s a dose of medicine that’s easy to swallow.

A Dose of Medicine That’s Easy to Swallow

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The PillCam (left) can help doctors diagnose intestinal or digestive problems. Above, Caleb Parker, a patient in the GI Clinic at Children’s Hospital.

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Learn more about the services offered through the pediatric gastroenterology clinic at Children’s hospital on our website,

www.ChildrensOmaha.orgClick on programs and services, then on Outpatient services.

to find a pediatric gastroenterologist, call our physician Referral Line at

1-800-833-3100.


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8200 Dodge StreetOmaha, NE 68114402-955-5400

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PAIDChildren’s Hospital

Visit our website at ChildrensOmaha.org.

How to Keep Summer Pests Away

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, Marketing 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.

hether you’re planning a trip to a lake or a camp ground, or simply having fun in your own back yard this summer, watch out. You may have uninvited guests, and you need to be prepared.

mOsquItOEs Mosquitoes are a prime summer pest because they can carry the West Nile virus. Taking measures to avoid mosquito bites can decrease exposure to West Nile by about 50 percent. To reduce your risk:■ Drain any standing water outside your

home, including in gutters, on pool covers and in open receptacles.

■ Use a repellant containing a 10 percent solution of DEET. Never apply to a child’s face, hands or irritated skin, and avoid using on an infant.

■ Light citronella candles at night. A small number of people bitten develop West Nile fever. Symptoms include mild fever, headache, body aches, skin rash and swollen lymph glands.

Less than 1 percent develop a form of West Nile that enters the brain. It can cause high fever, headache, stiff neck, lethargy, confusion, tremors and difficulty breathing. If you’ve been recently bitten by a mosquito and experience troubling symptoms, see a doctor immediately.

stIngIng InsECtsStinging insects include bees, wasps, yellow jackets, hornets and fire ants. Stinging insects favor bushes, rotting fruit and decaying logs or stumps. It helps to:■ Consume sweet-smelling foods and drinks

inside because these attract insects. Skip sweet-smelling colognes, soaps and lotions.

■ Avoid floral prints, bright clothing and

Postmaster: Please deliver between May 12 and 16.

shiny jewelry.■ Design your garden to be less attractive

to bees, which like yellow and white but dislike reds.

Up to 3 percent of stings cause severe allergic reactions. Call 911 if you are stung in your mouth or if you experience hives, trouble breathing, tightness in the throat, swelling on the face, nausea or fainting.

tICksTicks are blood-sucking insects that can be as small as poppy seeds and are easily mistaken for a freckle or speck of dirt. Ticks make their home in wooded areas and attach in hairy areas on the body, such as the scalp and underarms. A small number of ticks can carry Rocky Mountain spotted fever or tularemia (rabbit fever).

Initial symptoms of Rocky Mountain spotted fever include fever, nausea, vomiting, severe headache, muscle pain and loss of appetite. Later symptoms include a rash, abdominal pain, joint pain and diarrhea. Symptoms of tularemia include sudden fever, chills, headaches, diarrhea, muscle aches, joint pain, dry cough and progressive weakness. People suffering from tularemia can also catch pneumonia and develop chest pain, bloody sputum and can have trouble breathing.

Quick tick removal is key because it may take an extended attachment to transmit a disease. If you find a tick, use tweezers to slowly pull it out. Avoid squeezing the tick’s body. Afterward, wipe the bite area with antiseptic.

Anyone who experiences these symptoms should see a doctor. Antibiotics are extremely effective in treating both diseases.✷

just kids | spring 2008

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