Friday, March 27, 2015

Get Psyched Friday: Lessons Continue Long After "Frozen" Release


In her latest Get Psyched Friday post, psychologist Eleanor Mackey, PhD, talks about the lessons and teachable moments from "Frozen."
 
Recently, WTOP asked me why “Frozen” is such a phenomenon among kids, even a year and a half after the initial release. This topic is familiar to me since my 3- and 6-year-old girls are as obsessed as the rest of the world. In fact, both of my daughters dressed up as Elsa for Halloween this year.

This year, my older daughter had a number of health concerns and, as a result, had to have surgery and stay in the hospital. Her “Baby Elsa” doll is her beloved companion and has been through it all with her. When my daughter woke up from surgery, she found that the medical team had prepped her Elsa doll for surgery so that she and Elsa could go through it together. Having someone, with whom my daughter identified, to do this with her was a lifesaver.  

Lessons we can learn from "Frozen"

So, what is it that makes the movie so special for kids – boys and girls – and what especially makes Elsa so beloved? I see some of the answers lying in my daughter’s response to the movie, which has helped her through a tough time this year.  

It’s cool to have a sibling.

 “Frozen” shows kids that family will be there for you no matter what, and it is in fact cool to have a sister. My oldest daughter was not convinced of this fact prior to seeing the movie. The movie emphasizes that when you are having a difficult time, love from those who love you most can get you through. This is a very powerful message for kids, that what you really need is something you already have.  

Being different isn’t bad

The second key message is that there is something different about Elsa, which makes her scared and alone. There are some good and some bad things about that difference. My daughter has been different from her classmates this year because of her health. She connects with Elsa whose difference, when she embraces it and learns to manage it, is something special that can be used for good. For any child who feels different, this is a wonderful message that what makes you scared can set you free and makes you unique.

How to Use “Frozen” for Teachable Moments

If your child loves "Frozen," use the movie as an opportunity to talk about some of the movie’s key messages or use examples from the movie to help your child through difficult times. For example, if your child has difficulty learning in school, you can talk about how his or her brain works differently, and like Elsa, it is okay to be different. Sometimes being different is scary, but if kids learn how to get help from their family, find other things they do especially well, and embrace their differences, they may feel better about their unique difference.

Wednesday, March 25, 2015

Urge Kids to Buckle Up and Buckle Up the Right Way

Author Shireen Atabaki, MD, MPH, is a physician in Children’s National’s Emergency Department. She is an Associate Professor of Pediatrics and Emergency Medicine at Children’s and the George Washington University School of Medicine and Health Sciences.  Her area of expertise is in concussion and knowledge translation.

When it comes to car safety, one of the most important things you should do is make sure your child is buckled in properly.

Safety in Seat Belts

Seat belts are one of the most important elements of a safety system in motor vehicles, and when worn properly they prevent serious injuries, in adults and children. Unfortunately – and too often – they are forgotten by busy parents. And as kids get older, they also may not buckle up without reminders from parents.

The use of lap and shoulder restraints reduces the risk of fatal injuries in occupants age 5 or older by 45 percent and the risk of moderate to critical injury by 50 percent.

Launching the First-Ever National Tween Seat Belt Campaign

This month, the U.S. Department of Transportation (DOT) launched its first-ever “national tween seat belt advertising campaign,” aimed at parents of children ages 8 to 14, to make sure they are consistently and properly wearing their seat belts every time a car is moving.

I think it’s terrific to target this age group because motor vehicle crashes are among the most common causes of brain injury. Kids at this age really need role models; from parents, family, friends, and caregivers, to properly use seatbelts, which – it can’t be stressed enough – saves lives.

Researching Traumatic Brain Injury Caused by Motor Vehicle Crashes

As a member of the division of Emergency Medicine and Trauma Services at Children’s National, I have specialized in examining concussion, trauma, and other issues.

In a recent New England Journal of Medicine study, my colleagues and I found that traumatic brain injury in children under 12, were most frequently caused by assaults, sports activities, and, you guessed it, motor vehicle crashes.

Unfortunately, as kids get older they are more unlikely to buckle up, according to the U.S. Department of Transportation (DOT).

Over the past five years, 1,552 kids between the ages of 8 and 14 died in car, SUV, and van crashes – and of those who died, almost half were not wearing a seat belt, the DOT states.

But seat belts can offer good news. Seat belts have prevented injuries in children in some of the worst accidents, such as rollover collisions that could have resulted in serious injuries or even death to drivers and passengers.

Buckling Up the Right Way



U.S. Transportation Secretary Anthony Foxx was spot on in his message to get children to wear seat belts. “Buckling up is an important habit to instill in children at a young age,” Foxx said. “As parents, we need to lead by example and reinforce the message to make sure it sticks.”

I found these recommendations from DOT on seat belt safety:
  • Use Seat belts. Teach your kids to look for a seat belt, and also tell them not to tuck their belt under their armpits, even if they think it is more comfortable that way.
  • Never Share Seat belts. Two kids should never buckle up as a pair even if it seems like fun.
  • Young Kids Should Sit in the Backseat. Children under 13 years of age should always ride in the backseat, because this protects them from possible injury when a passenger side airbag deploys.
  • “Play it Cool.” Kids should understand the importance of staying calm and low-key in the back seat.
Not only should kids buckle up, but they should buckle up the right way.

As part of the Pediatric Emergency Care Applied Research Network,  I have conducted studies on seat belt issues, including one that focuses on “seat belt signs,” in which when seat belts are worn improperly, they can cause abrasions in children as well as adults.

The correct positioning of lap belts for children means low across the thighs and not across the abdomen. That’s important to reduce injuries.

So, it’s always wise to buckle up for safety, and do it the right way!

Friday, March 20, 2015

What Parents Need to Know About a Fever

Author Dr. Daniel Felten, Complex Care Specialist at Children’s National, explains why fever is an important part of the body’s immune system and when to treat a fever in children. 

It can be frightening when your child wakes up in the middle of the night with a fever, but fever is actually an important part of the body’s immune system. It is almost always a sign that the body is responding to and fighting off a bacterial or viral infection.

Fevers Fight Illness

Bacteria and viruses that cause illness prefer to live at usual body temperature. Therefore, the body increases its temperature to create a more hostile environment for the bacteria or virus causing the infection.

Higher body temperatures weaken the infectious agent and help the body’s immune system more effectively fight off the infection. The body raises temperature through shivering, limiting blood flow to hands and feet, and increasing energy use inside the body.

Should Parents Wait to Treat a Fever?

Because fever is an important part of the body’s immune system, parents do not need to immediately treat a fever. Parents should really treat the child instead of the fever, so if a child is fussy, acts weak or tired, or feels uncomfortable, parents should take steps to help him or her feel better.

It’s important to remember that treating a fever does not treat the underlying infection and that giving a child fever-reducing medication is only a temporary measure that will decrease a child’s body temperature. The fever will return once the medication wears off until the body has successfully fought off the illness.

Do’s and Don’ts to Make Children More Comfortable

While fever is important in helping your child fight off an infection, it can make children feel uncomfortable. To treat the fever and make children feel more comfortable, parents can:
  • Encourage plenty of fluids and rest. Dehydration is one of the main risks for children with a fever so parents need to ensure that the child is drinking adequate amounts of fluid.
  • Use fever-reducing medications. Fever-reducing medications such as ibuprofen or acetaminophen are probably the most effective and safest way to treat a fever, but it is important for parents to give the correct dose of medication at the correct time interval. Correct dosing and schedule can be found on the packaging for the medication or can be obtained from the child's primary care provider. Some parents will try to alternate ibuprofen and acetaminophen, but it is better to choose one or the other.
Fever-reducing medications work by decreasing the signals to raise body temperature and, therefore, reduce the work the body would be doing to raise temperature.

However, I do not recommend external techniques, such as removing clothing or cool baths, unless the child feels that these interventions make him or her feel better. Since the fever is generated by the body to raise body temperature, efforts to cool the body externally will actually make the body work harder to raise temperature and require the body to increase energy use.

Can a High Fever Cause Brain Damage?

Parents tend to worry that a high fever can cause brain damage. Fever can be a sign of a serious infection that can cause damage to the brain or other organs, but that damage is usually caused by the infection and not by the fever.

When to Visit Your Child’s Pediatrician or a Local Emergency Department

Any child with a fever, who doesn’t improve after being given a fever-reducing medication, not drinking liquids, not easily awoken, or acting strangely, should be seen by a doctor immediately. If a child aged 3-12 months is acting well, drinking normally, and comfortable (with or without fever-reducing medications), I usually recommend that parents wait at least 24 hours before deciding to visit the pediatrician, and 48 – 72 hours for older children.

Babies do not have well-developed immune systems and are at risk for serious bacterial infections. Any baby that is younger than 2 months of age with a temperature higher than 100.4°F should be taken to the Emergency Department.

If an infant is 2 to 3 months old, with a temperature more than 100.4°F and acting well, parents can call their child’s pediatrician to decide whether the child needs to be seen immediately.

Talk to Your Child’s Pediatrician

Talk to your child’s pediatrician to learn how to set your own guidelines on how to treat your child’s fever and when to take them to see a pediatrician.

Monday, March 16, 2015

Children’s Pediatricians & Associates Open New Practice in Capitol Hill

As the Children’s National Health System continues to grow, we are constantly looking for new ways to provide better care for our patients and their families. One way that this happens is through primary care. Our primary care physicians look forward to watching an entire family grow as they receive care and so Children’s Pediatricians & Associates, LLC (CP&A) has opened a new practice in Capitol Hill.

“We chose to open a practice here [Capitol Hill] because at Foggy Bottom, we were bursting at the seams. We did our research and found where the most demand is,” Ellie Hamburger, MD said. “We wanted a location that would be more convenient and provide easy access for the majority of our patients.” Dr. Hamburger has been working at CP&A at Foggy Bottom for 12 years and is happy that the practice can provide care that is more convenient to patients and families.

Soleak Sim, MD, recently started working for CP&A in Capitol Hill after practicing in Chicago for 9 years. She is very excited to be in Washington, DC, and likes taking care of children at all ages. Dr. Sim enjoys seeing the whole family grow up while they are her patients.

“It’s important to develop relationships with families and that families get to know their providers because you take care of patients through different phases of life,” Dr. Sim said.

So far, she has enjoyed working for the CP&A and loves the affiliation with Children’s National and their support network.

“Everyone just cares so much about our patients. We go home and we still think of them, we don’t leave work at the door,” Dr. Sim said. “Plus, everyone brings their children here, so that’s a testament to how much we trust the care here.”

New Facility Provides Care in Capitol Hill

 The Capitol Hill office is now accepting new patients and will do and provides the following:

  • Open Monday to Friday from 8 am - 5 pm, Saturday morning appointments are available at Foggy Bottom office (Call the office for Saturday appointments - no walk-ins!) 
  • Care for patients infant to 21
  • Well-child visits
  • Urgent care availability
  • Paid parking available with entrance on C Street and Eastern Market metro access

The Capitol Hill office is located at 650 Pennsylvania Ave SE, Suite C-100, Washington, DC 20003. Call 202-833-4543 to make an appointment.

Thursday, March 12, 2015

How to Navigate the Decision to Breastfeed

Authors Sahira A. Long, MD, IBCLC, Jennifer A.F. Tender, MD, IBCLC, Division of General and Community Pediatrics and Lactation Consultants offer breastfeeding advice to new mothers.

When your baby is born, there are plenty of things to think about, and one of the first is how to feed your infant.

And that raises the question of breastfeeding.

We know you hear all kinds of advice, from relatives, friends, and neighbors. So many opinions are coming in your direction and really fast. Some people feel very strongly about the need for breastfeeding, and sometimes those who don’t breastfeed at all are the loudest, saying they felt it was uncomfortable or they didn’t have a convenient place to do it. As mothers ourselves, we have heard it all.

At Children’s National, we advocate for breastfeeding and are here to help support you if you are questioning what to do or how to navigate breastfeeding and the issues that may come with it. Somewhat concerning to us as advocates, our hometown of Washington, DC, lags behind the rest of the country in breastfeeding rates.

According to the 2014 Breastfeeding Report Card, the Centers for Disease Control and Prevention reported that about 79 percent of babies in the U.S. were breastfed, while the rate of breastfeeding in Washington, DC, is about 78 percent. In the District of Columbia, the rates of breastfeeding are much lower for African-American women and women living in poverty. The Report Card also revealed that the nation’s capital falls behind in the number of Certified Lactation Counselors with only 1.5 per 1,000 births versus the national average of 4 per 1,000 births.

Below you’ll find some of the benefits of breastfeeding, some of the issues you may have to navigate when choosing to breastfeed, and how you can find local support.

Benefits of breastfeeding
American Academy of Pediatrics (AAP) recommends breastfeeding because mother’s milk is the perfect food for the baby and gives the infant a healthy start in life. A word like “perfect” seems pretty strong, but research into breastfeeding supports this claim.

Good for your baby

Let’s start with the baby and his or her future health. Breastfeeding reduces the risk of childhood obesity, which is associated with other medical problems such as diabetes, high blood pressure, and high cholesterol levels. It also can reduce the risk of childhood infections, asthma, and even neonatal death.

Good for you
For moms, it reduces your risk of breast and ovarian cancer. Studies have proved that for every year of breastfeeding, a woman decreases her chances of getting breast or ovarian cancer by 4.3 percent.

The AAP recommends breastfeeding exclusively for the first six months of life and continued breastfeeding after solid foods are introduced to the diet until at least 12 months. This may seem like a long time to breastfeed; there are a number of societal pressures to stop breastfeeding earlier, particularly if you are a working mom, but keep in mind how good this is for not only your baby but also for you. We recommend setting short-term goals for breastfeeding and celebrating each one you reach; for example, making it through the first three weeks, then the first two months, and so on. We encourage and support any amount of breastfeeding.

Breastfeeding support in the Washington, DC, area

At Children’s National, we understand the importance of breastfeeding but also some of the difficulties that come with it, and we want to provide you with the caring support, knowledge, and encouragement you need.

We offer community lactation support services free of charge at the East of the River Lactation Support Center, a collaboration program between Children’s National, the Women Infants and Children Program (WIC), and the DC Breastfeeding Coalition. The lactation center is located at the Children’s Health Center at Good Hope Road. A lactation consultant or breastfeeding peer counselor can help you navigate through any discomfort you may be feeling, provide suggestions on how to help your baby feed, and advise on what to do if you feel you are not producing enough milk.

Other supportive organizations include the DC Chapter of the American Academy of Pediatrics, the Academy of Breastfeeding Medicine, and Reaching Our Sisters Everywhere.

Where can you breastfeed?
When you breastfeed, the area where you choose to do it should be as comfortable and convenient for you and the baby as possible. And that’s where it gets uncertain sometimes, particularly in the workplace and public places. No matter where you are, we want you to know there are national and local laws to protect your right to breastfeed. If you have any questions about breastfeeding, please let us know in the comments section below.

We were breastfeeding moms, too, and are really happy that we did. Now you have the tools to make an informed decision for yourself and your baby. We can’t emphasize enough the importance of breastfeeding to nurture strong, healthy babies.

Tuesday, March 10, 2015

New Program Makes Emergency Department Visits Easier for Children with Autism

Children with autism often have trouble communicating or understanding their medical care. For these children, a visit to the hospital–especially to the Emergency Department–can be a scary, stressful, or traumatic event.

To address this, Children’s National Health System has rolled out a new program to help ease anxiety in children with autism during visits to the Emergency Department at the Sheikh Zayed Campus for Advanced Children’s Medicine. The Help Keep Me Calm program was developed by Child Life Specialists with a grant from Autism Speaks, a leading autism science and advocacy organization.

The Help Keep Me Calm program at Children’s National has three components:
  1. Questionnaire: During the child’s initial assessment in the Emergency Department, parents of a child with autism will be asked to fill out a questionnaire. It includes questions on how the child  communicates, previous experiences he or she has had in the hospital, any triggers or sensitivities, what the child finds calming, and more. This information will be kept with the child’s chart so that all of our providers in the emergency room–and in other units, if the child is admitted–can review the information and use it to tailor their approach when caring for your child.

  2. Communication Boards: Child Life partnered with our speech therapists to create pictorial boards to help children with autism communicate pain or basic needs and prepare them for procedures. The boards include an image of the body so that a child can point to where they’re having pain, and a pain scale with facial expressions to indicate how severe the pain is. It also includes pictures to represent basic needs–like thirst, pain, or needing to use the bathroom–and step-by-step illustrations to show some of the most common Emergency Department procedures. 

  3. Toolkit: Toys with repetitive movements or ones that provide particular sensory inputs are soothing for children with autism. The Emergency Department now has several “toolkits” with these toys for children to play with to keep them engaged and entertained.
“We want this program to support multiple components of care for children with autism,” explains Catherine Boland, CCLS, Child Life Specialist. The communication boards were rolled out last year, and the grant from Autism Speaks allowed for additional resources to expand the program to its current three-pronged approach. “We plan to continually evaluate and adjust this program going forward to best suit our patients’ needs,” Boland says.

Emergency Department staff are being trained to offer these resources, but parents are encouraged to ask about the program or to let the Emergency Department staff know that their child has autism when they arrive at Children’s National. 

“We want to be able to offer this support from the very beginning of your visit, to create a better experience for you and your child,” says Annalise Walker, CCLS, Child Life Specialist.

The Help Keep Me Calm program also will be expanded to the Emergency Department at United Medical Center in the next year.

Thursday, March 5, 2015

How Child Life Specialists Make Hospitals Less Scary for Patients

In observance of Child Life Month, Terry Spearman, Manager of Child Life Services, and Child Life Specialist, Katie Webb, explain how Child Life Specialists help children cope with being admitted to the hospital and talk about their roles at Children’s National.

For many children, a hospital stay can be very scary, particularly if the child does not understand what is happening to them. Child Life Specialists at Children’s National focus on supporting the patient and his or her family in coping with the stress of their illness, injury, or hospital stay. By working closely with the medical team, we are able to provide therapeutic interventions to children visiting or staying at the hospital.

Training helps us prepare kids for a hospital visit

Universities now offer undergraduate and advanced degrees in Child Life. Child Life Specialists specialize in child development and receive training to be able to explain procedures and treatment at a level that a child, at almost any age, can easily understand and comprehend.  Our goal is to ease anxiety so that he or she has a sense of control that they may not have previously had.

Offering support to patients in isolation

While we work with families and children throughout the hospital, patients in isolation are one of our top priorities. These patients are often unable to interact with family members and friends and some have been out of school for days or even weeks. We offer patients in isolation opportunities to play game systems or board games, knit, participate in arts and crafts activities, or watch interactive closed circuit television.

“We try to provide opportunities for them to socialize, to play and connect with their families and classmates who may not be able to see them in person,” Webb added. “We want to help patients address their feelings about being in isolation.”

Helping the whole family understand treatment

The hospital can be a stressful environment, so it is important that we not only support our patients, but their families too. Siblings may not understand what’s going on with their brother or sister and it’s just as important to us that they understand as much as our patients. We offer resources to parents and are available to support and answer any questions brothers or sisters may have in a child-friendly way. We encourage the family to spend time with the patient the way they would at home.

We provide activities and events that patients and their families can do together. Our regular Thursday “Bingo” event is a big hit with our inpatients. It’s an activity that siblings and even parents look forward to each week.

What it means to be a Child Life Specialist

It’s hard to find a Child Life Specialist who does not absolutely love what they do.

“One of the benefits of our job is that we get to watch the transformation of a patient who is scared whenever someone walks into the room, to one who is friendly and outgoing,” Webb said. “It’s rewarding when a parent tells us that their child is behaving the way they would at home.”

Learn more about our team of Child Life Specialists.