1. U N I V E R S I T Y H O S P I TA L S O F C L E V E L A N D • R A I N B O W B A B I E S & C H I L D R E N ’ S H O S P I TA L
T H E L AT E S T I N C H I LD RE N ’ S H E A LTH N EW S • FALL 2006
Control the Symptoms of an Epidemic inside this issue:
HOW TO HELP YOUR CHILD BATTLE BACK-TO-SCHOOL ASTHMA ATTACKS
Getting Your Baby to Sleep
ack-to-school season brings the page 2
usual return to pencils, books
and homework. But for the Help Kids Cope When
5 million U.S. students who suffer from Cancer Strikes a Loved One
asthma, it also can mean a surge in sea- page 3
sonal asthma attacks.
This phenomenon, often called the CAROLYN M. Win the War on Fashion
“September Epidemic,” is probably page 6
Co-Chief of the Divi-
caused by a host of factors that together sion of Pulmonology
cause a perfect storm, says Carolyn M. and Director of the Ask the Doctor
Kercsmar, MD, Co-Chief of the Division Children’s Asthma page 7
of Pulmonology and Director of the Center at Rainbow
Babies & Children’s
Children’s Asthma Center at Rainbow
Babies & Children’s Hospital.
“The onset of the fall viral season,
ragweed season, mold from falling sufferers and result in a greater number “Parents and students also should keep SEARCH HEALTH
leaves and rainy weather are each indi- of asthma attacks. the lines of communications open with INFO ONLINE
vidual asthma triggers,” Dr. Kercsmar “Some children also stop their asthma school teachers and administrators and For easy access to Rainbow physicians
explains. “But on top of that, students medications in the summer, which is typ- discuss ways to minimize your child’s and in-depth health information for
returning to school for the year also are ically a season when asthma sufferers exposure to allergens as much as possible,” you and your child — including a new
exposed to additional classroom aller- find the most relief,” Dr. Kercsmar says. Dr. Kercsmar says. For example, grade symptom checker — visit us online:
gens or irritants — such as chalk dust, Although all of the factors that school teachers should be advised that a
dust mites, potted plants, classroom cause the September Epidemic aren’t task such as cleaning chalkboard erasers www.rainbowbabies.org
pets or fumes from building repairs.” entirely avoidable, there are several steps or caring for a classroom pet could likely
These irritants can spark the inflam- you can take to help your child breathe trigger an attack.
matory process in the airways of asthma easier when the new academic year “With asthma, the tendency for flare-
kicks off. ups is always there,” she says. “However,
Dr. Kercsmar recommends that stu- taking a proactive approach can help
dents do not take a “summer vacation” minimize exacerbations.” ■
ask rainbow ... from their asthma medications, or at
Rainbow’s experts are here to least begin taking them again before a GREAT OFFER!
Rainbow is offering free copies
answer your health care questions! going back to school. Any change in
of the booklet Childhood
You can contact us by phone at asthma medications always should be Asthma, Treating Asthma at
216-844-RAINBOW discussed with your child’s doctor. School. The booklet contains
or e-mail us at Good hand washing is the best defense a convenient chart for your
email@example.com, or visit against the common cold, which is a child’s school nurse to fill
www.rainbowbabies.org out. Call 216-844-RAINBOW
common asthma trigger, she adds.
for your free* copy today.
CELEBRATING 140 YEARS of Caring for Cleveland.
2. Under the R AINBOW w w w. r a i n b o w b a b i e s . o r g
Urgent Care a
Good Option? CAROL ROSEN,
Whether it’s an ear infection, fever or Medical Director
an injury, there are times when your of Pediatric Sleep
child gets sick or hurt in the evening, Services, Rainbow
Babies & Children’s
on a weekend or during a holiday.
Instead of thinking “emergency
room,” think “Rainbow Rapid Care.”
Rainbow Rapid Care is a quicker,
more convenient way for your child to
get the highest-quality urgent care.
“The most common things we see are
fevers, stomach flu and ear infections,”
says Amy Maneker, MD, Medical Direc-
tor of Rainbow Rapid Care at University Pediatrician,
Hospitals. “But we also see lots of kids University Hospitals
with minor cuts requiring stitching, as
well as sprains.”
Children at Rainbow Rapid Care are
seen by nurses and pediatricians who
Why Won’t My Baby Sleep?
specialize in pediatric urgent care
needs. If the illness is more serious
he alarm goes off and the last thing you want to do is in sleep. We all wake up briefly four to five times a night, usually
than first indicated, they will be sent
climb out of bed. But this is no ordinary alarm. It is as we cycle between dream and nondream sleep. Trying to
to the pediatric specialists in Rainbow’s
your baby crying in the night — again. comfort her might wake her up entirely. However, if the cries
adjacent emergency department.
How can you help your new bundle of joy, as well as your- continue after a few minutes, it is OK to check on your baby.
Additionally, on-site lab and radiology
self, get rest so you can enjoy every moment of parenthood? “If your baby wakes up during the night, leaving her to cry
services are available 24 hours a day,
Let her cry it out, nurse her, give her a pacifier or rock and herself back to sleep for prolonged periods of time is not a
allowing tests to be performed and
sing her back to sleep? solution because she may feel deserted and lonely,” says
“During the first three or four months, the nightly awaken- University Hospitals pediatrician Gregory Golunka, MD.
“Parents can feel assured that their
ings are natural and will become less frequent over time,” says “Instead, if light crying continues after a few minutes, keeping
child will be seen promptly and receive
Carol Rosen, MD, Medical Director of the lights low, quietly check to make sure
the most expert care — backed by all
Pediatric Sleep Services at Rainbow “Rather she is not wet, sick, or too hot or cold,
of the resources of Rainbow Babies &
Babies & Children’s Hospital. “Your baby and remedy these situations quickly and
Children’s Hospital,” Dr. Maneker says.
will begin to sleep for longer periods of than pick- quietly. Rather than picking her up, gen-
TO LEARN MORE time, and you can help your infant learn ing her up,
a GREAT tly rub her back or give her a pacifier so
to sleep through the night. As your OFFER! that she knows she is safe, and allow her
To find a Rainbow Rapid Care infant approaches four to six months,
gently rub to fall back to sleep on her own.”
in your neighborhood, call
teach her that night time is for sleeping her back
offering free* For toddlers and young grade-schoolers,
by laying her in her crib before she is copiesgive creating a positive bedtime routine, with
or of the
asleep.” CD Symphony of Dreams to the first your child’s input, can help him learn to
But getting your baby to fall asleep is 250her a pacifier so that she
callers at 216-844-RAINBOW. prepare for sleep. Turn off the TV and
only half the battle. When your baby is other stimulating devices, give him a bath,
very young, she will need to eat in the middle of the night to read a bedtime story and make sure the sleeping environment
grow. As your baby gets older and doubles her birth weight, is dark and quiet. A small night light is fine for the child who
these night feedings become less important for growth. In the is more fearful of complete darkness.
meantime, nightly awakenings might have you out of bed four “One mistake parents often make is trying to wear their child
or five times a night. out in order to make him tired,” Rosen says. “By skipping naps
Although you may want to run to your baby at the first sounds or stimulating him close to bedtime, he can actually become
of distress, some of her cries may just be during transition times overtired, which makes falling asleep more difficult.” ■
3. Find a physician online: www.rainbowbabies.org/PhysicianFinder/
When a Friend or Family Member Has Cancer
HOW TO HELP KIDS UNDERSTAND AND COPE WITH A LOVED ONE’S BATTLE
hether it’s a friend, parent, “Give your child an opportunity to
grandparent, brother or sister, talk about their feelings, rather than
it can be a very confusing and keeping them bottled up inside,” says
difficult experience for a child to learn that Rainbow social worker Sharon McLain.
someone close to him or her has cancer. “Accept your child where he or she is at
The very word “cancer” itself strikes emotionally, and assure him or her that
a feeling of unease or even fear in most it’s normal to feel scared and worried.”
adults. So, it’s that much more under- Dr. Anderson adds, “Young children
standable how hard it can be for a child may not be able to do so in words, but it
to grasp exactly what is happening to a can help to see adults modeling expres-
loved one who has been diagnosed with sion of feelings. It also can help to offer
this disease. a label for a child’s feelings to help them
With that in mind, parents can help get started, such as by saying, ‘Your face
children and teens cope by having ongo- is looking a little worried today.’ ”
ing and open discussions with them, says
Rainbow psychologist Jennifer Anderson, “Children should understand
PhD, who works with families affected
that nobody knows why the
“Children should understand that person they love got cancer.
nobody knows why the person they love They should be assured that
got cancer,” Dr. Anderson says. “They
should be assured that there is nothing there is nothing they did, “Age-appropriate discussions about If cancer treatment isn’t helping his or
they did, or their loved one did, to get or their loved one did, to get cancer and care can help erase the mys- her loved one, your child will face addi-
cancer — and that cancer isn’t conta- tery and make things not seem so scary,” tional challenges. “Support groups or
gious. Children should be assured that
cancer — and that cancer McLain says. However, it’s helpful to have counseling may be helpful so that chil-
their loved one is receiving the special isn’t contagious.” caring adults guide this review of infor- dren don’t feel so alone or isolated,” Dr.
medical help he or she needs. When the mation since there is so much out there. Anderson says. “Talking to others can
—Jennifer Anderson, PhD
affected person is a close family mem- Knowing how to interact with their help them understand how life changes
ber, such as a parent or sibling, having Both children and teens should be friend or loved one while they are under- and how to deal with grief. It can be help-
the child see the place where treatment taught that people do survive cancer. Older going treatment also may be tricky for ful to be in contact with the psychosocial
occurs can be helpful to his or her children may benefit from learning more children. Discussing how to be thoughtful team at the hospital that is treating your
understanding.” through books or the Internet about can- and stay involved can help, Dr. Anderson loved one. They can help get you con-
It also is important to explain that cer and what advances researchers are says. “Assure them that it’s best to simply nected with resources that can be helpful
it’s OK to be upset or sad. discovering to beat the disease. be themselves,” she suggests. during such a challenging time.” ■
Helping Survivors of Childhood Cancer
With support from the Lance Armstrong encompasses research, clinical care, a GREAT OFFER!
Foundation, Rainbow now offers additional patient advocacy and education, serves To help kids cope when
help to patients and families touched by childhood cancer survivors from all over a friend or loved one
cancer through its Center for Survivors of Northeast Ohio. has been diagnosed
Childhood Cancer. For more information, call 216-844-3070 with cancer, Rainbow
The new Center is dedicated to the or visit http://www.rainbowbabies.org/ is offering free* copies
advancement of survivorship and well-being OurServices/CentersAndPrograms/SZ/ of the coloring book Sammie’s New Mask.
in children and young people with cancer. SurvivorsofChildhoodCancerCenterfor/ Call 216-844-RAINBOW for your free
This comprehensive program, which tabid/176/Default.aspx. copy today.
4. Under the R AINBOW w w w. r a i n b o w b a b i e s . o r g
New PI Center Opens
Raising awareness of primary
Rainbow is now one of only 25 centers
in the world focusing on the diagnosis,
care and treatment of adults and chil-
dren suffering with primary immunodefi-
ciencies (PI) through the Jeffrey Modell
Diagnostic Center for Primary Immuno-
deficiencies at Rainbow Babies & Chil-
dren’s Hospital. MELVIN BERGER,
The new center, headed by Rainbow MD,
allergist and immunologist Melvin Allergist and
Berger, MD, was made possible this
Rainbow Babies &
spring thanks to the Jeffrey Modell Children’s Hospital
Foundation, in partnership with global
biotherapeutics leader ZLB Behring.
This new partnership reaffirms a com-
mitment to raise awareness and increase
diagnosis of PI globally. The Center at
Rainbow also will serve as a resource of Primary Immunodeficiency
expertise in the subcutaneous administra-
WHEN IT’S MORE THAN A STRING OF BAD INFECTIONS
tion of IgG (antibodies that PI patients
cannot make themselves), an alternative
early every child does battle with the common cold, PI includes more than 120 diseases caused by an immune sys-
to intravenous IgG, which was intro-
ear infections, sinus infections or bronchitis. But fre- tem that does not function properly. Failure to diagnose PI can
duced by Dr. Berger.
quent infections and other problems that are unusu- lead to serious chronic illness, permanent damage to health
For more information about the Jeffrey
ally hard to cure could be a sign a more or even death. In many cases, PI diseases
Modell Diagnostic Center for Primary
serious problem. WARNING SIGNS may become apparent only in mid-life,
Immunodeficiencies at Rainbow, please
Primary immunodeficiency (PI) is a so they should be considered in adults
call 216-844-RAINBOW. Correct diagnosis begins with rec-
defect in the immune system that affects as well as children.
ognition of the 10 warning signs of
10 million children worldwide. primary immunodeficiency. Chil- When PI is suspected, Dr. Berger
PI is an inherited condition that dren who have two or more of the says, tests should be ordered promptly
affects males and females of all ages, following symptoms should be seen find out if PI is indeed the problem.
but the most severe forms are frequently by a physician to discuss the pos- “Early recognition and diagnosis of
detected in children, explains Rainbow sibility of PI: PI can save lives and improve the health
■ Eight or more new ear infections
allergist and immunologist Melvin of many patients,” Dr. Berger says.
within one year
Berger, MD, head of the new Jeffrey ■ Two or more serious sinus infec- Treatment for PI can include treating
Modell Diagnostic Center for Primary tions within one year recurring infections with low or moder-
Immunodeficiencies at Rainbow Babies ■ Two or more months on antibiot- ate doses of antibiotics to prevent per-
& Children’s Hospital. ics with little effect manent damage. Other patients may
■ Two or more pneumonias within
“Symptoms of PI often are over- require immunoglobin therapy or bone
looked because they appear to be com- marrow transplants, as appropriate.
■ Failure of an infant to gain
mon childhood illnesses such as sinus weight or grow normally Stem cell transplants done in the first
infections, pneumonia, fever and bron- ■ Recurrent, deep skin or organ month of life can now cure most forms
chitis,” Dr. Berger says. “For this reason, abscesses of severe combined immune deficiency
families and doctors often are unaware ■ Persistent thrush in mouth or (SCID), or “bubble-boy” disease.
that the troubling conditions they are elsewhere on skin, after age 1 “Cutting-edge research and treat-
■ Need for intravenous antibiotics
dealing with are actually rooted in a ments are now making life-changing
to clear up infections
defect in the immune system.” Frequently, ■ Two or more deep-seated advancements possible,” Dr. Berger
an underlying, smoldering infection infections notes. “Today, patients with PI have
continues when acute episodes seem ■ A family history of PI ever-increasing options available to help
to have resolved after antibiotics. them lead a healthy, normal life.” ■
5. Find a physician online: www.rainbowbabies.org/PhysicianFinder/
STRATEGIES FOR GETTING YOUR SPOUSE TO PITCH IN AROUND THE HOUSE
t’s 8 p.m. You’ve finished making angry — the things that are obvious to
dinner, giving the kids a bath, read- you as chores to be done,” she says. A
ing bedtime stories and tucking good way to start is by wiping the slate
them in for the night. clean and dropping all assumptions.
When you walk downstairs, piles of “Talk about your expectations,” she
dishes remain on the counter. Grease-filled recommends. “Explain your idea of
pans are strewn on the stove. Remnants of what a clean house means and how you SHERYL A.
taco cheese and sour cream are smeared think chores should be split — whether KINGSBERG, PhD,
on the kitchen table. And there your that’s 50–50 or some other ratio, based Clinical Psychologist,
spouse sits on the couch, magazine in upon your schedules and responsibilities
hand, apparently oblivious to the mess outside the home.”
that remains. Once you’ve come to an agreement, it’s
Are there any strategies for sharing also best to clearly spell out the requested
housework with your spouse that can tasks that you want your spouse to do.
help head off World War III? “Don’t be vague. Simply saying you
“Splitting up chores fairly between want more help with the housework
spouses is a significant source of tension or with the kids isn’t good enough,”
in many households,” acknowledges Sheryl Dr. Kingsberg says. Instead, specify if
A. Kingsberg, PhD, clinical psychologist it’s having the laundry washed, dried,
with University Hospitals MacDonald folded and put away, or having the
Women’s Hospital. “Left unchecked, this dishes cleared from the table, washed,
issue can breed anger and resentment in dried and put in the cupboards. while your spouse is beginning to pitch for your help!’ This also may encourage
a marriage. That is why it is best to take This approach can help sidestep nag- in with the agreed-upon chores. your spouse to help more.” ■
a proactive approach and discuss the ging, which only breeds discontent for “A spouse is much more likely to
division of labor with your spouse — both parties. It also, however, is the time to engage in new, helpful behavior if a GREAT OFFER!
when you’re not already fuming.” decide your priorities. You should decide he or she is positively reinforced,” Learn how to reduce
This is critical, Dr. Kingsberg says, what you can live with — and without. Dr. Kingsberg says. “You may think the amount of stress
because your unhelpful spouse probably “If the litany is too long, your that the task is so small that it doesn’t in your life. Rainbow
doesn’t see the world (and what needs to spouse will feel overwhelmed and warrant mention, or that it’s only fair is offering free* copies
be done) the same way you do. While resentful. Then he or she won’t do it,” that your spouse complete the chore. of the booklet Staying
cleanliness may be next to godliness for she explains. But, if the ultimate goal is to maintain On Top Of Stress. Call
many, others take a less ambitious “it’s New habits also take time to estab- the behavior, you should forget the fair- 216-844-RAINBOW
doing no harm” approach. lish. Use positive reinforcement — which ness and offer positive feedback — such for your free copy
“Help them see — without getting works much better than punishment — as a heartfelt, ‘Honey, thanks so much today.
The Great Divide
HOW DO YOU MEASURE UP?
So, how does your household measure up in various activities, found that on an aver- Nineteen percent of men reported doing
to the national average when it comes to age day in 2004, 84 percent of women housework — such as cleaning or doing laun-
how household chores are shared? and 63 percent of men spent some time dry — compared with 54 percent of women.
According to the U.S. Department of doing household activities, such as house- Thirty-five percent of men did food prepara-
Labor’s 2004 Time Use Survey, women work, cooking, lawn care or financial and tion or cleanup, versus 66 percent of women.
still outrank men in the amount of time other household management. For men and women, and overall, the
spent on daily household chores. Women who reported doing household amount of time spent doing household
The survey, which tracked the average activities on the diary spent 2.7 hours on activities did not vary greatly by the pres-
hours 14,000 Americans reported spending such activities, while men spent 2.1 hours. ence or age of household children.
6. Under the R AINBOW w w w. r a i n b o w b a b i e s . o r g
Fighting Over Fashion
HOW AND WHEN TO ADDRESS DESIGNER-LABEL DEPENDENCE
om’s annoyance grows into
frustration as her sulking
11-year-old makes derogatory
comments about the pair of athletic shoes
she intends to buy for him. They seem
perfectly priced and fashionable to her.
To him, the shoes are a potential object
of embarrassment because they do not
meet the fashion requirements set by
marketing campaigns and his peer group.
Ranked Sound familiar? This scenario and its
endless variations play themselves out in
#4 in the Nation homes and stores across America. In
addition, it probably peaks around the
and time school starts again at the end of
the summer. So, what is a parent to do?
#1 in the When does a child’s interest in wearing
fashionable apparel become problem-
Midwest atic? It depends.
“There is no one-size-fits-all answer
to when a child’s interest in wearing
1. Children’s Hospital of Philadelphia
fashionable clothing becomes problem-
2. Children’s Hospital of Boston
atic,” says Felipe Amunategui, PhD, of
3. Johns Hopkins Hospital, Baltimore
Rainbow’s Division of Child and
Adolescent Psychiatry. “However, par-
4. Rainbow Babies & ents can use some simple guidelines to
Children’s Hospital, decide where to draw a line.”
First, the basics: All children need ade-
Cleveland quate nutrition, shelter, seasonally appro-
5. Texas Children’s Hospital, Houston priate clothing, physical and moral safety,
6. New York Presbyterian Univ. Hospital and others to speak with on a regular
of Columbia and Cornell basis, Dr. Amunategui says. “Notice that
7. Children’s Hospital, Denver the clothing requirement specifies that garments have to be sea- “Ensure that inappropriate behaviors such as demanding,
sonally appropriate, not fashion-compliant,” he says. whining and sulking do not result in the child getting the
8. Cincinnati Children’s Hospital Medical
Parents should ask themselves if they’re meeting these five product he or she desires,” Dr. Amunategui says.
essentials. If the answer is “yes,” then they ought to question Instead, give the child the opportunity to earn the extra
9. Children’s National Medical Center,
the behaviors associated with the child’s interest in wearing money that it would cost to purchase the brand-name item
garments with specific brand names. he or she desires.
10. Children’s Memorial Hospital, Chicago
For example, does the child’s concern about the brand of Children who aren’t old enough to hold a job can always
apparel frequently result in parent-child conflict? Does this earn extra money doing odd jobs around the house, he sug-
Rainbow is proud to have climbed to
interest interfere with aspects of the daily routine such as getting gests. For teens who have their own income and appear to be
Number 4 in the nation — up from its
ready for school? Is this interest associated with school or peer spending an excessive amount on fashion expenditures, par-
previous ranking of Number 6 — while
problems in any way? Does the child limit participation in ents may consider requiring the teen to save a percentage if
remaining the Number 1 children’s hos-
social activities because of the clothing he or she has to wear? his or her income.
pital in the entire Midwest. These rank-
“Problems in functioning in any of these areas may indicate that “When under pressure from your youngster, keep in
ings are based on a reputational score
parents should address the issue directly,” Dr. Amunategui says. mind that neither a child’s development or achievement are
given to hospitals by pediatricians from
In doing so, there are a couple of things to keep in mind. influenced by fashion,” Dr. Amunategui says. “Also, keep
across the country.
Set consistent expectations and consequences, both positive in mind that parenting frequently involves making unpopu-
and negative, he says. lar choices.” ■
7. Find a physician online: www.rainbowbabies.org/PhysicianFinder/
ASK THE DOCTOR: WHEN IS IT OK FOR MY CHILD
TO STAY HOME FROM SCHOOL IF HE’S SICK?
My daughter has small bumps
covering both sides of her face. I
first thought it was acne, but they
look more like goosebumps that don’t go
away. Could it be something else?
Yes, bumps don’t always equal
acne, says Rainbow pediatric der-
matologist Joan E. Tamburro,
DO. What you describe sounds like another
common skin disorder characterized by
small bumps called keratosis pilaris.
JOAN E. TAMBURRO,
Rainbow Babies &
home. If your child doesn’t appear to be as ill as
he or she professes to be, other causes for school
avoidance should be sought, Dr. Dickert-
Leonard says. “For example, is your child the
victim of bullying or suffering from test anxiety?
If the answer is yes, those issues need to be
addressed,” she says. “In most cases, and espe-
cially when no clear source of stress can be elic-
ited, your child should usually be sent to
school.” “Get out of school” passes should be
doled out judiciously, since rewarding the avoid-
ance behavior will often reinforce it without
This condition results from the buildup of adherent skin cells in addressing the underlying issues, she says.
the openings of hair follicles. This causes small, rough bumps on
the skin — mostly found on the arms, face and thighs. My 10-year-old says she
“Keratosis pilaris isn’t harmful, but can be bothersome,” Dr. doesn’t have any friends, but
Tamburro says. “It tends to get aggravated when the skin is dry, like she’s involved in several school
in the winter months.” Treat-ment includes exfoliation and keeping activities and seems to have buddies.
the skin hydrated. However, even with proper treatment, it can be I don’t know if this is a self-esteem
stubborn to resolve. “Although the cause of keratosis pilaris isn’t problem or some type of complex. CARIN CUNNINGHAM,
known, it does appear to be hereditary and some children do out- Should I be concerned? PhD, Pediatric
grow it in their late teen years,” she says. “Talk to your doctor to Psychologist, Rainbow
Babies & Children’s
examine whether this may be the cause of your child’s discomfort Making friends is an important
and to discuss a treatment plan.” developmental task for children,
which requires learning specific
When is it OK for my kid to social skills such as making eye contact, cooperating, listening to
stay home from school if he others and sharing. A child’s ability to form and maintain friend-
says he’s sick? ships depends on how capable the child is using these skills and
“reading” social cues from others, explains Rainbow pediatric psy-
In general, the answer to this ques- chologist Carin Cunningham, PhD.
tion should be “When they are LYN HOLLIS “These skills are typically learned naturally in settings such as pre-
sick!” Unfortunately, as any parent DISKERT-LEONARD, school, elementary school and by participating in extracurricular activ-
of a school-age child will tell you, it is not MD, Pediatrician,
ities such as scouts, sports teams or in art classes,” Dr. Cunningham
always so straightforward. University Hospitals
Medical Practices says. “Some children learn these skills effortlessly, while others need
Any child with signs or symptoms of obvi- pediatrician special guidance. Your daughter’s perception of not having friends
ous contagious illness should be kept home, reflects a lack of confidence in her social skills.”
advises Lyn Hollis Dickert-Leonard, MD, a University Hospitals You can help your daughter improve these social skills by work-
Medical Practices pediatrician with offices in Solon and Shaker ing with her to understand her social problems in a supportive way,
Heights. These symptoms include, but aren’t limited to fever, signifi- free from criticism or judgment. “Identify which behaviors need to
cant diarrhea (more than two to three times a day,) red or draining be worked on,” Dr. Cunningham suggests. “The most effective way
eyes, or a new rash associated with other symptoms such as headache is to observe your daughter in social situations. Does she need to
or sore throat. “It’s also a good rule of thumb that if you wouldn’t share or listen more — or hit, interrupt or tease less? Is she appro-
want your son or daughter to be sitting across from a classmate with priately responding to peers’ social cues?”
your child’s symptoms, he or she should probably not attend school Explain, model and role-play social skills. Coach these skills in
that day,” Dr. Dickert-Leonard says. “A child with a disruptive cough, real-life situations, practicing regularly. It takes time for new skills
nausea or headache may not be able to benefit much from school to become comfortable and regular, she says. “Making friends and
instruction, and a day’s absence may also be in his or her best interest.” learning to interact well with others is hard work and a difficult
The more difficult situation is when symptoms are vague — “I skill for some children to learn; however, the rewards will be great
don’t feel good” — or mild, but your child expresses a desire to stay for both you and your daughter,” Dr. Cunningham says. ■