JustKidsSpring 2013ChildrensOmaha.org

SLEEP PROBLEMSCommon in Springtime 8

hEaLthy kOhL’S kidSNutrition and Fitness Resources 10

FaMiLy FitNESSMake Time for It 11

HELP CHILDREN OF ALL AGES FACE THEIR FEARS p6

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JustKids is published by Children’s Hospital & Medical Center to provide general health information. It is not intended to provide personal medical advice, which should be obtained directly from a physician. © 2013. All rights reserved. Printed in U.S.A.

➍ In Self-Harm, Children Embrace Pain

➎ Patient Profile: How Malicka Found Stardom

➏ Help Children Face Their Fears

➑ Lack of Sleep Is a Common Springtime Problem

➓ Healthy Kohl’s Kids Offers Resources

Make Family Fitness a Walk in the Park

Upcoming Parenting U Classes

Contents

ChildrensOmaha.org JustKids Gary A. Perkins President and CEO Martin W. Beerman Vice President, Marketing

& Community Relations David G.J. Kaufman, MD Medical Advisor Dannee Schroeder Senior Editor

2 To find a physician, call 1-800-833-3100

What’sNew?By the Numbershere’s a closer look at the numbers for pediatric trauma at Children’s:

5,900 patients of all ages are

seen each year in the Children’s

Emergency department with a

trauma-related diagnosis.

349 patients under the age of

15 were admitted to Children’s for

trauma-related injuries in 2012.

339 patients under the age of

15 were admitted to Children’s for

trauma-related injuries in 2011.

PLaygROuNd EquiPMENt

FaLLS represent the greatest

percentage of trauma-related

injuries for patients underthe age of 15 admitted

to Children’s for observation

and/or treatment.

Concussions and fractures

RELatEd tO SPORtS are the

2nd highest cause of

trauma hospitalizations, followed

by non-accidental trauma.

The trauma center at Children’s Hospital & Medical Center has been verified as a Level

II Pediatric Trauma Center by the Verification Review Committee, an ad hoc committee

of the American College of Surgeons Committee on Trauma (ACS-COT). Children’s is

the first and only hospital in Nebraska, and the only hospital serving western Iowa

and northwest Missouri, to receive pediatric trauma verification.

Meeting the “Gold Standard”ACS standards are considered the “gold standard” for trauma centers. Verification is

a voluntary process that requires an intensive review conducted by outside trauma

and medical professionals. ACS-COT Level II Pediatric Trauma Verification recognizes

Children’s pediatric expertise and immediate, 24/7 access to specialists who can

provide the best, most appropriate care for children who suffer an injury.

Better Care, Shorter Stays“Children’s ability to undergo the scrutiny of the verification process and successfully

‘pass’ demonstrates that we are the best place in our region for taking care of pediatric

trauma,” says Shahab Abdessalam, M.D., Children’s pediatric surgeon and co-medical

director of the hospital’s trauma program.

“ACS-COT Trauma Verification is a huge accomplishment,” says Thomas Deegan, M.D.,

Children’s emergency department physician and co-medical director of Children’s trauma

program. “The ACS sets the standards for trauma care and has a very rigid review process.”

Verified pediatric trauma centers are associated with improved trauma survival rates,

fewer surgeries and shorter lengths of stay.

Children’s Is State’s Only Level II Pediatric Trauma Center

Children’S reCeiveS pediatriC trauma verifiCation

ChildrensOmaha.org 3

They may slice their arms and burn their

legs, bang their heads against walls and hit

themselves. And they do it to feel better.

An alarming number of children respond to

their anger and anxiety, depression and general

distress with something called nonsuicidal

self-injury (NSSI). They purposely damage their

skin or body without intending to take their

lives. During or after the act, they often feel

emotional relief.

Forms of NSSI may include cutting,

branding, friction burns (i.e., with an eraser),

skin picking, hair pulling, hitting (with a

hammer or other object), multiple piercing or

tattooing (if pain or stress relief is a factor) or

drinking harmful chemicals. Cutting typically

appears on wrists, forearms, legs, stomach,

hips, thighs and even the chest area.

Children who self-injure have trouble talking

about their feelings, suffer from low self-esteem

or feel hopeless or unworthy. Nearly 8 percent

of sixth- through eighth-graders and up to

21 percent of high-schoolers engage in NSSI,

studies show.

Who’s At Risk?Ninth-grade girls are three times more likely

to engage in NSSI than boys their age. Often

thought to affect mainly teens and young

adults, NSSI is also seen in younger children

at a rate similar to that of early adolescents.

Girls tend to cut or carve their skin. Adolescent

boys hit themselves, as do younger children.

Those who self-harm typically experience

some relief from negative feelings or thoughts

after the act—but not for long. Most are

plagued with shame or guilt as soon as they

realize what they’ve done, and for most, the

urge is frequent.

Watching NSSI videos on YouTube or

reading about it on social networking sites

makes some children want to do it more,

or experiment with it in the first place.

Most videos tell the facts of NSSI without

discouraging it. Many show wounds and

bruises or people cutting or hitting themselves.

NSSI can lead to more serious

psychological problems, including

suicidal thoughts and actions.

Meanwhile, razor blades and

burning cigarettes leave marks

that become permanent scars that

children feel compelled to hide

out of embarrassment or fear.

Why Do Kids Hurt Themselves?Typically, adolescents talk about

engaging in NSSI after some form

of emotional pain or stressor in an

attempt to:

• Externalize pain so it can heal

• Communicate emotional pain

to others (“I need help”)

• Self-soothe

• Regain a sense of control

• Self-punish

The problem is that self-harming

has addictive qualities and is

habit-forming. In addition,

self-harm “works” in the sense

that it can provide temporary

relief, and it may be socially

acceptable in some of their

peer group circles.

Steps Parents Can TakeIf you think your child is engaging in NSSI,

what can you do?

• Watch for signs that your child

may be covering up injuries or scars

(wearing long sleeves or pants in

the summer, covering wrists with

multiple bracelets). Some will damage

tissues that you would not ordinarily

see, such as on the stomach, hips

or thighs.

• Encourage him to share his feelings.

Listen without judgment.

• Help her consider the pros and cons

of self-injury.

• Help him learn positive ways to manage

stress and self-soothe.

• Don’t hesitate to find her a mental

health professional. Children’s Hospital

& Medical Center’s behavioral health

specialists can help you and your child

tackle these difficult issues. If you need

a behavioral health specialist, call the

Children’s Find-A-Doctor service at

800-833-3100.

• Any child engaging in NSSI should

receive an assessment for suicidal

thoughts, as the two can sometimes

become linked.

Self-harm hurts. But with your help, your child can heal.

In Self-Harm, Children Embrace Pain

4 To find a physician, call 1-800-833-3100

MaLiCka’S hEaRtHow Children’s Helped This Kindergartner

Go from Struggles to Stardom

Six-year-old Malicka Taffa loves the camera, so the sassy

Children’s heart patient was excited to take part in the

hospital’s latest advertising campaign. Now that

she’s seen the finished product in use, Malicka

loves her newfound fame.

“She thinks she’s a star,” says her mom,

Nafi Dieuguene. “At the school, all the kids

recognize her!”

Not a bad way to go into your

kindergarten year. However, kindergarten

is just one of many milestones that

Malicka’s mom wasn’t always sure

she’d get to experience.

Hidden Health IssueMalicka was born in November 2006, and her

mom remembers it like it was yesterday.

“She was barely 5 pounds—a little bitty

baby,” says Nafi.

While she may have been a little

bitty baby, she was otherwise healthy,

or so Nafi thought, until she noticed

that Malicka’s hands and feet would

turn purple. Malicka also was

colicky and often gasping for air.

After four months of

inconclusive diagnoses, doctors

led them to Children’s, where

cardiologist David Danford, M.D.,

discovered baby Malicka had tricuspid atresia, a heart defect

in which the heart chamber that should pump blood to the

lungs doesn’t develop. Not enough blood was able to flow

from her one remaining chamber to her lungs. Surgery

was her only option.

Heart surgeon Kim Duncan, M.D., operated

to redirect blood flow through her lungs to allow

her to survive with just one pumping chamber.

Malicka’s surgery was successful, leaving mom

and daughter forever grateful for Children’s

intervention in their lives.

“They definitely comforted me. This is the best

place for kids, without a doubt,” says Nafi.

A Happy KindergartnerMalicka and her mom have gone through a lot in

six years. Nafi knows her little girl is a fighter

and says the scar on her chest should serve

as a reminder of the battle fought and won

at Children’s.

Today, Malicka visits Dr. Danford once

a year, but is otherwise occupied with

being a normal, busy 6-year-old. Not only

does she love kindergarten, she loves

being a “celebrity” ambassador for

Children’s.

“She knows the hospital saved

her life,” says Nafi.

ChildrensOmaha.org 5

feature story

Childhood fears are nothing to be afraid of—once you realize they’re a normal part of your child’s development.

6 To find a physician, call 1-800-833-3100

any children are afraid of monsters under their

beds. Some are panicked by spiders. Others are

consumed with dread that a natural disaster is

headed their way.

While children’s reactions to their fears

may worry parents, the good news is that most

children go through the same thing. Learning

to master their fears in childhood can help

them deal with greater and more damaging

concerns as adults.

By understanding the basis of childhood

fears, you can help your children face—and

conquer—them.

Age-Related FearsSome fears tend to occur at specific stages of

childhood. For example:

• Infants up to 1-year-old—loud noises, strangers

• 1- to 2-year-olds—separation from parents

• 3- to 4-year-olds—animals, monsters, dark

• 7-year-olds—movie and TV scenarios,

performance in school, dark spaces

• 8- to 9-year-olds—trouble in school,

judgment by friends, disease

• 10- to 12-year-olds—being bullied, criminals,

disasters, parental fury

• 13- to 18-year-olds—body changes, sex,

loneliness, global and national events.

Calming FearsThe most important factor is for parents to

model appropriate behavior. A parent who

models fearful behavior in front of a child

is teaching that child to be fearful. Instead,

parents should try to model calm behavior and

face, rather than avoid, fears. Your children’s

ages, temperament and other factors

will determine the strategies

you use to help them

overcome their fears.

Consider the following suggestions:

•Don’t make fun of your children or disregard

their fears. Acknowledge their concerns and

tell children you can help them.

• Maintain a predictable routine. Knowing

what to expect helps children build confidence.

• Don’t pressure your children to face a fear

before they’re ready. Letting them go at their

own pace gives them a sense of control.

• Provide an explanation of the feared thing

or situation. For example, thunder is a loud

noise, but it can’t hurt you.

•Tell your children how you’ve overcome

some of your own fears.

“Parents should avoid becoming angry with

a fearful child,” says Loren Conaway, Ph.D., a

pediatric psychologist with Children’s Behavioral

Health. “While the parent is aware that the fear

‘does not make sense,’ it is likely very real to the

child. The most loving parent can become

frustrated with childhood fears, but parental

anger only increases a child’s anxiety and distress.

Parents need to remain calm and remember that

most typical childhood fears do fade over time.”

If you know in advance about a situation that

will most likely be emotionally upsetting to

your child, plan ahead. For example, if you’re

taking a vacation without your children, make

sure the babysitter comes to the house a lot

before the vacation.

Easing NightmaresBad dreams and fear of going to bed are

common in childhood, especially among

preschoolers. In fact, they’re a normal stage of

development that reflects a child’s growing

imagination and understanding of the world.

It’s not possible to know for sure the reason a

child has a particular nightmare. Common causes

include going through a scary experience (such as

being in or witnessing a car accident), watching a

frightening or violent TV show or movie or being

sensitive to ongoing family conflicts or tensions.

To ease a young child’s nightmare fears:

• Install a night-light or keep the child’s

door ajar. Sometimes just having a little

light in the room is enough to banish fear.

• Provide a security blanket or soft toy.

Having something familiar to hold on to

helps many children through the night.

• Have your child tell you what she wants

to dream about before bed. Good thoughts

can help positively influence dreams.

• Teach your child some relaxation

exercises. Deep breathing or visualizing

a safe and relaxing place can ease anxiety.

• Play games in the dark. Playing with a

flashlight or using a particular air freshener

to dispel monsters can help make a dark

room less frightening.

• Reassure children that they’re stronger

than the monsters under the bed or in

the closet. Join them in a show of strength

to banish the monsters by yelling at them

or ordering them out of the room.

Listen and acknowledge worries, but help

your child maintain a normal routine. For

example, night-lights are good as long as they

are helpful, rather than disruptive, to sleep,

and your child continues to sleep in his or

her own bed. Fears become a greater concern

when they are controlling a child’s or family’s

routine, and additional intervention may

be necessary.

IS YOuR CHIlD ANxIOuS? The Anxiety Disorders Clinic at Children’s offers specialized diagnostic services and treatment groups for children and youth who have fear or anxiety symptoms. If you think your child and family may benefit, call 1-800-833-3100.

ChildrensOmaha.org 7

Many families like to blame the time change for

those irritable mornings and repeated attempts to

wake up the kids. There’s no doubt that lack of sleep

can be a common springtime problem for children,

adolescents and teenagers.

“This time can be considered a high-risk period

when it comes to sleep deprivation for our children,”

says psychologist Brett Kuhn, Ph.D., a behavioral

sleep medicine specialist at Children’s Hospital &

Medical Center in Omaha. “They are busy with

activities and with the nicer weather and extra hour

of sunlight in the evening, kids tend to go to bed

later. Yet, they still have to be up at their regular

time in the morning for school.”

He calls the next two months—through the end

of the school year—a “challenging time” for parents

and says it can be difficult to make sure our children

are getting enough sleep.

“We make sure our children are vaccinated, and

that they have good nutrition and exercise, but we

tend to forget about sleep as a significant factor in

growth and development. We need to make sleep

a priority,” he reminds families.

Chronic sleep deprivation can affect mood and lead

to a lack of focus. It also can weaken the immune

system’s ability to fight off illness. Behavioral

problems can become worse in children already

prone to having emotional outbursts or other issues.

How Much Is Enough?Average sleep requirements differ by age.

• 2-year-olds need about 12.5 hours of sleep,

nighttime and naps combined.

• 10-year-olds should get 10 hours of sleep

per night.

• Adolescents need about 9.25 hours.

“The large majority of teenagers need a little more

than nine hours of sleep per night, but research

suggests they are getting much less—seven to

seven and a quarter hours of sleep on school

nights,” says Dr. Kuhn.

Here are some ways to help your children

get the sleep they need:

• Make bedtime quiet time. Relaxing before

bedtime helps sleep come more easily.

Have your child read or take a warm bath.

• Turn off the TV and videos at least one hour

before bedtime.

• Do not allow children to have foods or drinks

that contain caffeine, such as soda and

chocolate. They can interfere with sleep.

While things like television, video games and

computers can interfere with or delay sleep,

Dr. Kuhn points out that a consistent wake-up

time, even on weekends, can be helpful when

it comes to managing better sleep routines.

“It is okay to sleep in some on the weekends,

but we want to try and maintain a reasonable

wake-up time. This is how we help our bodies

adjust to schedule changes and stay in sync,” he

explains. “It is okay to have a brief nap later in the

day. This is better than excessive oversleeping.”

The Snoring FactorA study of grade-school children showed that

those who snored most nights were at least

twice as likely to have trouble academically.

They scored lower on tests and report cards

than did non-snorers.

Why? For one thing, a child who snores may

not sleep well. A tired child may misbehave, have

a short attention span or fall asleep during class.

Children who snore also are more likely to have

trouble hearing. The root of the problem is often

swollen adenoids or tonsils—a source of snoring,

as well as constant ear infections in many children.

better sleep

DOES YOuR CHIlD HAVE SlEEP PROBlEMS?

Children’s hospital & Medical Center offers a Sleep disorders

Center specifically focused on children and adolescents

with serious sleep issues. For more information visit

Childrensomaha.org/SleepCenter.

Need More Sleep?Lack of Sleep is a Common Springtime Problem for kids

8 To find a physician, call 1-800-833-3100

ChildrensOmaha.org 9

live well

When it comes to eating right and exercising, making healthy choices can be

a tough task for children and parents alike. But with tools and support from

the new Healthy Kohl’s Kids program, that challenge just a got a little easier.

What Is Healthy Kohl’s Kids?Healthy Kohl’s Kids is a partnership between Children’s Hospital & Medical

Center and Kohl’s Department Stores focused on educating children and

families on the importance of good nutrition and fitness. The program’s

website, www.HealthyKohlsKids.com, features up-to-date fitness and

nutrition information and advice for children and parents. The site also

contains an extensive library of healthy recipes with how-to videos of

young chefs making nutritious meals and snacks.

Children and parents are encouraged to explore the site together to share

the joy of cooking and to establish positive lifestyle habits that children

can take with them as they grow. Visit the site often—new fitness tips

and nutrition ideas are added regularly.

Navigating the Healthy Kohl’s Kids recipe library is easy. Under the

Recipes tab, simply choose from one of the categories, which include recipe

ideas for everything from snacks to vegetarian options, or use the search bar

to find a specific dish. Click on “How 2 Cook” for videos containing cooking

lessons and tips for your young chef.

Building CommunityHealthy Kohl’s Kids invites parents to engage via social media on Facebook,

Pinterest and Twitter (@HealthyKohlsKid). Share your own healthy recipes,

activity ideas and fitness- and nutrition-related links, and receive updates

about future Healthy Kohl’s Kids events.

The Healthy Kohl’s Kids van will make a number of visits this spring

and summer to Omaha-area Kohl’s Department Stores to promote healthy

lifestyles among families. The stops will include fun giveaways for children

to help encourage them to be active and exercise. Watch the Healthy Kohl’s

Kids website for times and locations of upcoming Kohl’s store visits.

Healthy Kohl’s Kids Gives You Nutrition and Fitness Resources

10 To find a physician, call 1-800-833-3100

MakE FaMiLy FitNESS a WaLk iN thE PaRk

Pricey gym memberships. Boring treadmills. Muscle-bound weightlifters. If that’s your idea of exercise, think again.

Picking berries, flying a kite and going to family day at the park are all fun outdoor activities that double as workouts. Doing them regularly can help your family stay healthy.

Families Should Play TogetherYour children need about an hour of physical activity per day. They learn by watching you. So, plan ways to stay moving as a family.

You might not think your family has time to exercise. But think about all the things you do instead. Then, find a way to fit in fitness. For instance, turn off the TV after dinner and go for a walk. Bike instead of drive to get library books.

Enjoy the Great OutdoorsExercise makes you stronger, keeps your weight in check, and improves your balance. Taking your family’s workout outside gives you even more benefits. You can connect with nature and so can your children. You’ll be happier, less stressed and more tuned in to the world around you.

You don’t have to spend a lot of money to have fun outside. Some of the best activities are free. Try taking a hike through your local park. Or organize a game of tag in your front yard. Watch local calendars for family-friendly events.

JOIN THE FuN!Learn more about the healthy kohl’s kids program at www.healthyKohlsKids.com. the website features how-to videos of young chefs making healthy meals and snacks, and it enables people to share recipe and exercise tips via Facebook, twitter and Pinterest.

ChildrensOmaha.org 11

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tuesday, april 9 Surviving the trying 2sMichelle Mogenson, d.O., F.a.a.P. Children’s Physicians

tuesday, april 16Sibling rivalryamy Lacroix, M.d., F.a.a.P. Children’s Physicians

tuesday, april 23 preparing for Your newbornJennifer Smith, M.d., F.a.a.P. Children’s Physicians

tuesday, april 30mastering potty trainingkatie anglim, M.d., F.a.a.P. Children’s Physicians

Here for You: Parenting U Classes This SpringWith the arrival of a child, there are some things you learn automatically, like how little sleep an adult actually needs to function, the importance of sippy cups and that polar bears may be hiding in your closets.

For other lessons, including the skills to get through those all-important first years, there’s Parenting u from Children’s hospital & Medical Center, FREE classes given by professionals known for their knowledge of children. along with a new topic each week, we’ll provide food, child care and prizes.

Each session will be held in the glow auditorium at Children’s hospital & Medical Center from 6 to 7 p.m. Call 1-800-833-3100, or log onto Childrensomaha.org/parentingu to register today.

PaRENtiNg u uPCOMiNg datES