It's About Children - Winter 2006 Issue by East Tennessee Children's Hospital
Board of Directors
James S. Bush
Debbie Christiansen, M.D.
Lewis Harris, M.D.
Jeffory Jennings, M.D.
A. David Martin
Christopher Miller, M.D.
Bill Terry, M.D.
Lewis Harris, M.D.
Chief of Staff
David Nickels, M.D.
Vice Chief of Staff
Lise Christensen, M.D.
Chiefs of Services
John Buchheit, M.D.
Chief of Medicine
Alan Anderson, M.D.
Chief of Surgery
Laura Barnes, R.N., M.S.N., C.N.A.A.,B.C.
Vice President for Patient Care
Vice President for Human Resources
Joe Childs, M.D.
Vice President for Medical Services
Vice President for Operations
Vice President for Finance
A quarterly publication of East Tennessee
Children’s Hospital, It’s About Children is
designed to inform the East Tennessee
community about the hospital and the
patients we serve. Children’s Hospital is a
private, independent, not-for-profit pediatric
medical center that has served the East
Tennessee region for almost 70 years
and is certified by the state of Tennessee as
a Comprehensive Regional Pediatric Center.
Director of Community Relations
Director of Development
“Because Children are Special…”
...they deserve the best possible health care given
in a positive, child/family-centered atmosphere of
friendliness, cooperation, and support - regardless
of race, religion, or ability to pay.”
...their medical needs are closely related to their
emotional and informational needs; therefore, the
total child must be considered in treating any illness
...their health care requires family involvement,
special understanding, special equipment, and
specially trained personnel who recognize that
children are not miniature adults.”
...their health care can best be provided by a facility
with a well-trained medical and hospital staff whose
only interests and concerns are with the total health
and well-being of infants, children, and adolescents.”
Statement of Philosophy
East Tennessee Children’s Hospital
August 1, 2006
Dear Children’s Hospital,
My daughter, Isabella, is a Neonatal Intensive Care
Unit graduate, and we are very grateful for all that
East Tennessee Children’s Hospital did for us. She
was born on 1/25/05 and discharged on 4/25/05.
Isabella was born at 27 weeks and weighed 1 pound,
5.7 ounces and was 12 3/4 inches long. We are
blessed that she had none of the major complications
that are associated with being an extreme preemie.
In honor of her first birthday, we requested
donations of scrapbook materials for the NICU and
were able to donate over $700 of these items to the
NICU. We can’t say enough good things about the
care she received and the staff at the NICU. Many
thanks, and we hope to be able to continue in our
own small way.
Tammie and Chuck Humphrey
Special thanks from Children's Hospital
Children's Hospital would like to extend its
appreciation to The Pool Place, Kingston Pike in
Knoxville, for graciously allowing us to shoot our
cover and patient story photos for the Winter 2006
It’s About Children magazine at their Christmas store.
August 7, 2006
Dear Children’s Hospital,
My name is Melissa Voorhies. My daughter, Riley
Voorhies, was born May 19, 10 weeks early. We had to
visit the Neonatal Intensive Care Unit, and they were
great. My husband was deployed in Iraq when our little
girl was born, so they [the NICU nurses] acted like my
family and kept my spirits up when I was down. They
did an awesome job. Riley got to come home one night
before Daddy had to go back to Iraq. Now she is 11
weeks old and probably weighs over 8 pounds! Thanks
The Voorhies Family
On The Cover: Meggi Weeks is ready for Christmas! Read her story on pages 4-5.
On January 1, 2007, the Children’s Hospital
Auxiliary will change its name to Children’s
All volunteers will automatically become
members of the organization, which raises funds to
support some of the important services throughout
the hospital such as the Clothing Closet.
Throughout the year the volunteers host various
sales and coordinate an annual holiday greeting
card sale, which is their largest fundraiser.
The group recently made some adjustments in
their by-laws, policies and procedures, including
the name change, to strengthen the organization.
HELPING CHILDREN IS ‘IN THE CARDS’ THIS HOLIDAY SEASON
Children’s Hospital Auxiliary Annual Holiday Cards Now Available
With the holidays quickly approaching, people throughout East Tennessee are starting to make
gift lists and plan family get-togethers. The East Tennessee Children’s Hospital Auxiliary has an
easy way to check one important task off that holiday “to-do” list – purchase the just-released
2006 Children’s Hospital Auxiliary Holiday Card, and help the
area’s children at the same time.
This is the 42nd year Children’s Hospital’s Auxiliary has sold
holiday cards to benefit the hospital.
Artist and Children’s Hospital Auxiliary member Jan Church
designed this year’s unique holiday card especially for
Children’s Hospital. Titled “Up on the Housetop,” this
season’s card features a snowy rooftop scene with Santa’s sleigh
overflowing with nostalgic holiday toys that stirs feelings of
excitement and anticipation for the arrival of Saint Nick. The
message inside the card is “Sending Good Wishes Your Way.”
The Children’s Hospital Auxiliary’s holiday cards are $1
per card, can be sold in any quantity including box sets of 12
cards for $12, and personalization is available on bulk orders.
The cards are appropriate for both business and personal use.
Proceeds from the holiday cards will be used to support a
variety of the Auxiliary’s programs at Children’s Hospital, all
of which help to make a child’s hospitalization more
For more information or to place an order, send an e-mail
request to email@example.com or call the Volunteer Services
Department at Children’s Hospital at (865) 541-8136.
The Auxiliary Board of Directors also recently
approved a $50,000 gift to Children’s Hospital from
Gift Shop proceeds. The gift is being distributed as
follows: $15,000 to the Fantasy of Trees, $15,000 to
the Children’s Miracle Network Telethon, $11,500 to
the laboratory for a Aggram Modular System, $4,185
to the library for partial funding for an annual
subscription to CINAHL, $3,000 to Community
Relations for portable signage for special events and
$1,315 for the Open Door Endowment Fund.
By Bethany Swann, student intern
Auxiliary changes name, gives gift to hospital
Imagine being invited to a friend’s
birthday party and not being able to eat the
party food. Or going out to a restaurant and
not being able to order off the regular menu.
Or having to pack a lunch for school every
day instead of ever buying a cafeteria lunch
like your friends.
For a child with gluten intolerance (also
called celiac disease), this is a daily reality.
Ten-year-old Megan Weeks – Meggi – has
been living this way for just over a year,
since her October 2005 diagnosis.
Now a fourth-grader at Knoxville’s West
Hills Elementary School, Meggi had
experienced a variety of health issues since
birth. A happy, energetic baby, she struggled
with reflux as well as frequent ear infections
that tended to progress to sinus infections
and even pneumonia. By age 5 she appeared
to have outgrown some of the early
problems but was diagnosed with asthma.
She began seeing pediatric pulmonologist
Eduardo Riff, M.D., at Children’s Hospital
for management of her asthma. When it did
not improve and Meggi (now age 7) began to
develop some digestive problems, Dr. Riff
suspected a connection to her earlier reflux and
suggested they have this problem re-examined.
The Weeks chose to wait a little while to see if
the problems would improve. Later, because
Meggi was not showing improvement, her
pediatrician, Gregory Swabe, M.D., of
Knoxville Pediatric Associates, referred her to
Youhanna Al-Tawil, M.D., pediatric
gastroenterologist at Children’s to see if she still
had reflux. Testing revealed stage two reflux.
Dr. Al-Tawil prescribed medication and dietary
changes, which helped but did not eliminate
Meggi’s digestive problems.
For the next two years, Meggi usually saw a
nurse practitioner in Dr. Al-Tawil’s office.
According to her mother, Alisa Weeks, “I didn’t
think my child was seriously ill. At Dr. Al-
Tawil’s office, we often saw children who were
very seriously ill.” The family felt Meggi’s
problems with reflux were minor and could
easily be treated without seeing Dr. Al-Tawil,
enabling him to devote more time to his
seriously ill patients.
But one time they were scheduled instead
with Dr. Al-Tawil, and he was concerned that
Meggi continued to have so many problems.
He ordered a battery of new tests – six vials of
blood were drawn in the Children’s Hospital
Laboratory, according to Meggi – to check for
celiac disease, diabetes and a host of other
Because of these tests, Meggi was diagnosed
with gluten intolerance and was immediately
started on a gluten-free diet. The family worked
with (and continues to work with) Mary Sue
Walker, Ph.D., R.D., L.D.N., a clinical
nutrition specialist in Dr. Al-Tawil’s office, to
learn about and practice the gluten-free diet.
Within two weeks of her dietary changes,
her stomach aches and other digestive problems
had improved, her migraine headaches had
decreased in frequency and severity, and she felt
substantially better overall. Only her asthma
continued to be a problem.
Gluten is a protein that is found in wheat,
rye, barley and possibly oats (until recently, oats
were a definite no-no for the gluten-intolerant,
but recent studies suggest it may be OK,
although the Weeks family keeps oats on their
banned list for now). Gluten is found in many
unexpected places – not just food but also
cosmetics such as lipstick and school supplies
such as Play-Doh. “At first, it seems like gluten
is found in everything, but there are many
things that it is not in. I often say it is in almost
everything, but there isn’t anything we cannot
have,” Mrs. Weeks said.
The keys to living gluten-free are avid label
reading and becoming familiar with products
and brands. Once you learn what is safe, you
can cook anything, Mrs. Weeks said. Because
Meggi was diagnosed in October, the holidays
were fast approaching, and that required some
significant adjustments. “Thanksgiving is
actually easy,” Mrs. Weeks said. “It’s just the
bread and stuffing that need adjusted, and last
year we had crustless pies. Christmas is harder
because of all the parties and social events –
they are wonderful to attend, but we must
prepare our own food for each occasion. It’s
already a busy time, and this makes us even
busier.” (The Weeks have shared some gluten-
free holiday recipes on the next page.)
When Meggi was first diagnosed, the Weeks
household went completely gluten-free. That
meant that everyone – mom Alisa, dad Bill and
big sister Ali (age 14) – only ate what was safe
for Meggi. After about three months, they
relaxed the household rules a bit. One day Bill
was preparing to go grocery shopping and asked
if anyone wanted anything in particular. Meggi
said, “Get Ali some Pop-Tarts.” They were all
surprised that Meggi would be comfortable
having something in the house she couldn’t eat,
but Meggi said she was ready. Ali returns the
favor by being sensitive to Meggi – “Ali
won’t eat something Meggi can’t have in
front of her without asking Meggi if it’s
OK,” Mrs. Weeks said.
Gluten intolerance is a genetic
disorder, and Mrs. Weeks believes she is
the parent who carries the affected gene.
She has not been tested because she
follows the gluten-free diet so strictly
that the test result would not be accurate.
But she’s confident she’s the carrier for a
very simple reason – she had for many
years experienced digestive problems of
her own with a different diagnosis, but
the problems ended and she ceased to
require medication when she began
following the gluten-free diet. Like
Meggi, Mrs. Weeks follows the diet at
all times, and all family meals are gluten-
free. Mr. Weeks and Ali opt not to
follow the diet outside of the home.
Purchasing gluten-free products is
both difficult and costly, although in just
the past year it has become easier because
new federal laws about food labeling
require the eight major allergens to be
listed on labels of products that contain
those allergens. Because wheat, one of
the eight allergens, is also off-limits to
those with gluten intolerance, this new
labeling system has proven very helpful
to families such as the Weeks.
Many foods must be cooked from
scratch; gluten-free convenience foods
(such as baking mixes and frozen items)
currently are available only in a limited
supply, although such products are
increasing in number. Many gluten-free
items cost more than their gluten-
containing counterparts. The Weeks
shop at such specialty stores as
EarthFare, where a store employee took
them on a tour to show them how to
find the special shelf labels identifying
gluten-free products; Go Nutrition,
which also uses a special labeling system;
and Nature’s Pantry, which stocks all
gluten-free items together in one aisle.
Food City in Bearden and Kroger in
Knox Plaza are two major grocery stores
that have begun to carry a number of
gluten-free items, but they do not yet
offer a labeling system to make it easy to
identify the safe products.
Restaurants pose an entirely different
challenge because there are no labels to
read and the responsibility is placed in
someone else’s hands. The restaurant
chains Outback Steakhouse, Carrabba’s
Italian Grill, Bonefish Grill and P.F.
Chang’s China Bistro all offer gluten-
free menus and knowledgeable staff, so
these are where the Weeks typically eat
out. Of course they are not inexpensive,
nor are they fast. Some other chains –
both fast food and casual dining – offer
gluten-free menus on their websites, but
employees in the individual restaurants
typically are not well-trained in gluten-
safe food preparation, so the risk of cross
contamination is a problem.
After going so long on a gluten-free
diet, Meggi can tell when she has eaten
something that does contain gluten —
she is much attuned to the symptoms.
She also clearly remembers how poorly
she felt just a year ago, so she is careful
and conscientious to stick to her diet.
The Weeks are thankful for a great
deal of support from their extended
family (all family functions are now
gluten-free), several friends and the
Celiac Support Group, sponsored by Dr.
Al-Tawil’s office (visit www.celi-act.com
for more information).
Meggi remembers some friends who
came to see her shortly after her
diagnosis. They brought her a bag of
non-food gifts with a note that said,
“There’s more fun things to life than
food!” It’s a sentiment Meggi believes in.
They are also thankful for Dr. Al-
Tawil and Dr. Riff and their office staff
members; their pediatrician, Gregory
Swabe, M.D., of Knoxville Pediatric
Associates; and Children’s Hospital.
“It is an amazing place of positive,
caring, patient people,” Mrs. Weeks said.
“Children’s Hospital has been wonderful.
Everyone is extremely kind to all of us
when we go there.”
What is gluten intolerance?
Gluten intolerance (also called celiac
disease) is a digestive disorder that damages
the small intestine and interferes with
absorption of nutrients from foods containing
a protein called gluten.
What are the symptoms
of gluten intolerance?
Symptoms vary from person to person —
one person might have diarrhea and
abdominal pain, while another person may
be irritable or depressed. In fact, irritability
is one of the most common symptoms in
children. Symptoms can include:
• Gas •Recurring abdominal
• Delayed growth bloating and pain
• Chronic diarrhea •Pale, foul-smelling,
• Osteoporosis or fatty stool
• Fatigue •Unexplained anemia
• Bone or joint pain •Weight loss or gain
• Muscle cramps •Behavioral changes
• Seizures •Recurrent miscarriage
• Missed menstrual periods
(often because of excessive weight loss)
• Failure to thrive in infants
• Tingling numbness in legs (from nerve damage)
• Pale sores inside the mouth,
called aphthous ulcers
• Tooth discoloration or loss of enamel
• Itchy skin rash called dermatitis herpetiformis.
Source: The National Digestive Diseases
Information Clearinghouse, a service of the National
Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK). The NIDDK is part of the
National Institutes of Health under the U.S.
Department of Health and Human Services.
Old-Fashioned Pumpkin Pie
2 eggs One 16-ounce can pumpkin
3/4 cup sugar 1/2 teaspoon salt
2 teaspoons pumpkin pie spice
1 1/2 cups cream or nondairy substitute 1 cereal crust (recipe follows)
In a large mixing bowl, beat the eggs slightly. Add pumpkin, sugar, salt and
spice. Stir together. Add the cream and mix thoroughly. Pour into the unbaked
crust. Bake in preheated 425° oven for 14 minutes. Reduce temperature to
350° and bake another 45 minutes or until knife inserted in the center of the
pie comes out clean. Cool.
Serve cold with whipped cream or whipped nondairy topping if desired.
Makes 6 to 8 servings.
Source: Bette Hagman cookbook, The Gluten-Free Gourmet, Living Well
2 cups Gluten Free Cornflake, crushed (4 rounded cups before crushing it)
1 teaspoon cornstarch 1/2 cup melted butter
1/3 cup sugar 1 teaspoon vanilla
Put all the ingredients together in a food processor, and mix until all flakes
are crushed. Pat on two 9” pie plates, sprayed with Pam, and bake 8 to 10 min.
at 350°F. Makes 2 crusts.
Old-Fashioned Sugar Cookies
1 1/2 cups sugar 1 1/2 cups potato starch flour
1 cup Butter Flavor Crisco 2/3 cup cornstarch
4 egg yolks 2/3 cup tapioca flour
1 teaspoon dried orange peel or vanilla 2 teaspoons baking powder
1 teaspoon salt
In a large mixing bowl, blend the sugar and shortening. Add egg yolks and
flavoring. Mix flours, baking powder and salt together and add to the first
mixture. This will seem crumbly, but work the dough with your hands until
you can form balls.
Roll out dough on wax paper to about 1/8-inch thick. Cut into desired
shapes and transfer to greased cookie sheets. Bake in pre-heated 375° oven for
8 to 10 minutes. When cool, frost if desired. Makes 6 dozen 2-inch cookies.
Note: Don’t be afraid to handle this dough. It does not toughen with handling.
Source: Bette Hagman cookbook, The Gluten-Free Gourmet, Living Well
Rice Bread Stuffing
1 large onion, minced 1 cup diced celery
6 T (3/4 stick) butter or margarine 1 to 1 1/2 tsp poultry seasoning
2 T minced parsley 6 to 8 cups gluten-free bread,
1 to 1 1/2 cups chicken broth crumbled **
Salt to taste
Sauté the onion and celery in butter until clear; add the poultry seasoning
and parsley. Pour this mixture over the bread in a large mixing bowl. Stir until
blended, then add the broth, a little at a time, until the dressing is as moist as
you prefer. Add salt to taste. Makes enough to stuff a 10-12 pound turkey.
Seasoned Bread: If you are baking your gluten-free bread near the holiday
season, try putting the 1 to 1 1/2 teaspoons poultry seasoning directly into the
dough for at least one loaf before you bake it. Try adding some dried minced
parsley, also. This seasoned bread will make excellent stuffing.
**The Weeks family uses Bob’s Mill gluten-free bread mix for this recipe, making
the bread in a bread machine and adding the seasonings to the bread mix.
Source: Bette Hagman cookbook, The Gluten-Free Gourmet, Living Well
1960s tree lighting at Miller’s Department
Store on Henley Street each December. The
nightly tree lighting began in 2004 at the
event’s 20th anniversary in honor of the
Knoxville tradition. Local television and radio
personalities will join a hospital
patient to light the tree each
Fantasy visitors will also have
the opportunity to win a
beautifully decorated seven-foot
tree or one of five $500 gift cards
donated by Target Stores of
Knoxville. The raffle tree will be
surrounded by a variety of
electronics, children’s toys and
games, holiday goodies and much
more, valued at $5,000. Raffle
tickets are only $5 each and will be
available at the Fantasy of Trees
beginning Wednesday, November
22, at 9 a.m. They will be sold
through 4 p.m. on Sunday,
November 26. Winners will be
drawn immediately after ticket
selling ends on Sunday afternoon.
Since 1985, Children’s Hospital
has received overwhelming
community support for its annual
Fantasy of Trees fund-raiser. Again
this year, hundreds of businesses
and individuals have participated
in the Sponsor Program, which is
invaluable to the success of each
Special events at the Fantasy of
Gala Preview Party
Tuesday, November 21,
Dance the night away at the season’s first and
most festive party! Enjoy cocktails, an evening
buffet, a private preview and sale of designer
trees and holiday accessories, and shopping in
the Holiday Marketplace. Festive attire is
requested at this black-tie-optional event.
Tickets are $150 per person and must be
purchased in advance. Call the Volunteer
Services and Resources Department at (865)
541-8385 to purchase tickets. The gala is
In 2006, it’s time for “O Christmas Treats”
at the Knoxville Convention Center from
November 22 to 26 for the 22nd annual
Fantasy of Trees. The convention center’s
exhibit halls will be filled with sweet holiday
treats in a magical
featuring more than
holiday shops and
Fantasy of Trees
visitors can stroll
forest of holiday trees,
as well as enjoy
looking at holiday
mantles, swags, door
created and donated
by local students.
Guests can also
marvel at an array of
delicious creations in
Village, crafted with a
variety of edible
building materials by
area bakers, chefs and
perform at the
Fantasy Theater. Singers, dancers and other
entertainers will help visitors celebrate the
season by sharing their talents each day. While
enjoying the trees, decorations, activities and
entertainment, visitors also can shop at the
Holiday Marketplace, where they will find
holiday items ranging from children’s gifts and
toys to clothing and accessories to holiday
A family-oriented event, the Fantasy of
Trees offers activities and fun for children of all
ages, including favorites such as the beautiful
30-horse carousel and visits with Santa. This
year several new activities are featured,
including Christmas Plates (children can
decorate a small holiday plate); Coaster Art
(kids can color, paint and create holiday
pictures on tiles for decorating their house);
and Gingerbread Chef Wands (children can
decorate their own magical gingerbread chef
wand). New holiday boutiques have been
added for adults, making it easy to shop for
everyone on your Christmas list.
Each evening the Fantasy of Trees will light
a Christmas tree commemorating the nostalgic
22nd Annual FFaannttaassyyooffTTrreeeess
to kick off holiday season November 22-26
sponsored by the Cazana Family and
Commercial and Investment Properties
Babes in Toyland Parade
Wednesday, November 22, 7 p.m.
Don’t miss the first and only indoor holiday
parade of the season as children from area child
care centers show off their colorful costumes
while parading to the sounds of a marching
band. The parade’s grand finale features Santa
Claus and indoor “fireworks” provided by Pyro
Shows, Inc. The parade is broadcast live on
WVLT-TV Volunteer News at 7 p.m. and is
sponsored by Dollywood.
Santa’s Senior Stroll
Friday, November 24, 9-10 a.m.
Seniors and walkers of all ages can enjoy a
one-mile walk through the splendor and sparkle
of this year’s Fantasy of Trees. Tables will be set
up at the end of the walk with information on
health topics of interest to seniors. Best of all,
seniors 55 and over get a half-price admission
of $4 to enjoy all of the Fantasy of Trees when
they arrive during Santa’s Senior Stroll. (This
discount cannot be combined with any other
discounts.) Santa’s Senior Stroll is sponsored by
Baptist Senior Health Centers and Knoxville
Kris Kringle’s Kiddie Party
Friday, November 24, 10:30-11:15 a.m.
and 11:30 a.m.-12:15 p.m.
Join us for a free party just for preschoolers
at the Fantasy Theater, expanded to include
two fun sessions this year. Your little ones will
enjoy children’s activities and entertainment
from Music-N-Motion, have photos made
with Shoney Bear, enjoy snacks and receive a
holiday gift. The party is sponsored by
Knoxville Pediatric Associates.
The funds raised at the Fantasy of Trees this
year will purchase a variety of equipment for a
new surgery suite at Children’s Hospital. Over
the past 21 years, the Fantasy of Trees has
raised nearly $4 million for the hospital.
This spectacular holiday event would not be
possible without the more than 148,000
volunteer hours that make the Fantasy of Trees
a reality year after year. Children’s Hospital
would like to thank everyone who has helped
make this event a success, ensuring Children’s
Hospital can continue to provide the best in
pediatric health care to all of East Tennessee’s
For more information about the 2006
Fantasy of Trees, visit our Web site at
2006 Fantasy of Trees co-chairs Stephanie Jeffreys and Linda Redmond and assistant co-chair Sarah Beth Carlon (l-r).
Fantasy of Trees
Wednesday, November 22
9 a.m. to 9 p.m.
Thursday, November 23
3 to 9 p.m.
Friday, November 24
9 a.m. to 9 p.m.
Saturday, November 25
9 a.m. to 9 p.m.
Sunday, November 26
Noon to 6 p.m.
Scott Brice, M.D.
Age – 35
Family – Wife, Sarah Brice; children Luke
(7), Anna (4) and Janie (1)
Name of Pediatric Practice – Knoxville
Pediatric Associates, Clinch Avenue office
Personal Interests – running, biking and all
Academic Background/Prior Experience
B.S. – Wofford College, Spartanburg,
M.D. – University of South Carolina,
Columbia, S.C., 1998
Internship – University of Tennessee,
Residency – UT-Knoxville, 1999-2001
Other – Practiced pediatrics from
2001-06 in Greenwood, S.C.
Why Pediatrics? I enjoy watching children
and adolescents grow physically and
developmentally. Pediatrics gives me an
opportunity to work with patients and their
Greatest Influence – My father. He has
always been a source of encouragement for
me. He has a great passion for his work and
maintains a positive attitude. His integrity
is without question. Those are all qualities
of his that I have tried to emulate.
Philosophy – Each child is a special and
unique gift and, as such, should be treated
with care and respect.
Proudest Moment as a Pediatrician – I don’t
have any particular moment that stands out.
I’m proud to have the opportunity each day
to do something I enjoy.
Rob Schaerer, M.D.,
Age – 30
Family – Wife, Nikki; son Calvin (2) and
a baby on the way
Name of Pediatric Practice – Loudon
Pediatric Clinic, Loudon
Personal Interests – songwriting and music
performance, golf, cooking and the Big
Academic Background/Prior Experience
B.S. – University of Tennessee,
M.D. – University of Tennessee,
Residency – University of South Florida,
Tampa and St. Petersburg, 2001-04
Other – Board certification from the
American Board of Pediatrics, 2004
Why Pediatrics? Every day allows me the
opportunity to care for and encourage our
next generation. Their innocence, energy
and honesty are refreshing, amidst a busy
world and hurried days.
Greatest Influence – An unsuspecting
patient at St. Jude Children’s Research
Hospital, whose gleaming eyes showed me
my future during a tour prior to medical
Philosophy – Always let our patients and
their families know how much we care,
maintain a fun and friendly office
environment, and never stop learning.
Proudest Moment as a Pediatrician –
Being asked by close friends to care for
There is no such thing as a “typical” day in a hospital.
Day in and day out, patients enter our doors for care, but
each child is unique, and each experience is different.
However, within each day at Children’s Hospital, there
are some common threads. One common thread is the
training and experience of the hospital’s staff — no
matter what situation arises, our staff is skilled and
prepared to meet the challenge. For the next several issues
of It’s About Children, we will profile some of our staff
and highlight all our clinical areas. We hope it will give
you a glimpse into life at Children’s Hospital.
Children’s Hospital meets a wide range of
pediatric surgical needs, from common outpatient
procedures such as tonsillectomies to more
complicated procedures, such as reconstructive
surgery and neurosurgery. Children’s Hospital’s
Surgical Services includes Outpatient and Inpatient
Surgery (both located on the hospital’s Fourth
Floor), and Anesthesia, Post-Anesthesia Care Unit
(also known as the PACU, “wake up” room or
recovery room) and the Operating Rooms (all located
on the hospital’s Sixth Floor).
These departments work together to make sure
each child’s surgery and recovery is as quick and
painless as possible. The physicians, nurses and other
surgical staff are trained in pediatric care.
Depending on the individual department’s
function, staff in the Surgical Services departments
include R.N.s, L.P.N.s, patient care assistants
(PCAs), transporters, unit secretaries, surgical
technologists, sterile processing assistants, nurse
anesthestists (C.R.N.A.s) and anesthesia technicians.
Graduating with a degree in Physical Education
and playing basketball at the University of Tennessee
may have been an unlikely starting point for Pediatric
Nurse Liza Graves. Graves wasn’t sure what career
she wanted to have when she graduated, but she
knew it wasn’t teaching or coaching. But shortly after
graduation Graves found her home at Children’s
Hospital; a friend suggested she consider a job at
Children’s, and 25 years later, she’s still here.
Graves first worked as an emergency tech while
going back to school to earn a Bachelor of Science in
Nursing from UT. After receiving her BSN, she
moved into Surgery, where she plans to stay until she
retires. As an operating room nurse, Graves primarily
works with neurosurgery and plastic services but is
able to assist with all types of surgeries and is on-
call at times.
One of Graves’ favorite memories is of a patient
in the Hematology/Oncology Clinic, which
formerly was part of the Emergency Department.
“All of the children really touch your heart, but one
in particular, Brad, will always have a special place
in mine,” Graves said. “He considered himself a
‘country boy,’ and the rest of the patients were ‘city
slickers,’ as he called them.”
Traonna Smith chose to work as a patient care
assistant/transporter at Children’s Hospital for many
reasons, but most importantly because she loves
working with children. “I entered into this field
because I’m a people person, and I enjoy helping
people,” Smith said.
Smith is a certified PCA/transporter in the
PACU who is constantly improving her knowledge
and skills through various training. She participates
in in-services, CPR training and NetLearning
(online employee continuing education programs).
It’s Smiths’ primary task to assist the PACU nurses
with patients during the recovery period, and then
transport the patients back to their rooms when
they are awake enough to leave the PACU. It is
important to Smith to do her best to comfort and
care for “the little ones,” as she likes to call her
When Tracey Jackson began thinking about what
career she wanted to pursue, she knew she wanted a
profession that would keep her interest and
continuously challenge her. Nursing was a perfect
fit. Jackson graduated from nursing school ten years
ago with an Associate of Science Degree in
Nursing. While continuing to complete her degree,
Jackson worked as a medical assistant. Critical care
was Jackson’s first interest and she began working as
an ICU nurse at St. Mary’s Medical Center. “I loved
it, but I couldn’t get a schedule that was suitable for
home,” Jackson said.
The desire for a more flexible schedule led
Jackson to apply for a position at Children’s
Hospital. Although pediatric nursing was not an
area Jackson ever expected to be in, she was hired in
2000 and now it is her “home.” Jackson enjoys being
able to have fun while working hard in an
environment of “teamwork” to provide the best care
possible for Children’s Hospital’s patients and
families. “I work with a wonderful group of people,
including management… I can’t imagine doing
anything else,” Jackson said.
One of Jackson’s favorite memories is of the first
critically ill child she cared for. Jackson worked with
this patient through a long and stressful recovery
and became very attached to him and his supportive
family. “It was rewarding for me to see him go from
being so critical to recovering without complications
at all,” Jackson said.
Jackson now works as a Shift Leader on 4East
Inpatient Surgery. She maintains and increases her
skills and knowledge through Net Learning and
annual competency skill days.
Amber Wilson, a unit secretary for Outpatient
Surgery, chose a career in pediatric health care
because of her love for children. Wilson wanted to
take part in providing health care for children and
helping in every way that she could. “Every child
who comes in is as special as the next. They all need
lots of love and special care,” Wilson said.
Wilson chose Children’s because she knew it
would be a wonderful place to work; prior to her
current position, she worked as a pharmacy
technician in the Children’s Hospital pharmacy.
“The people who work at the hospital are angels.
I believe you have to be an angel to take care of sick
kids,” Wilson said.
By Amandalynn Thomas and
Bethany Swann, student internsLiza Graves with Jay Lucas, M.D.
lifeA day in the of Children’s Hospital
In August, leaders from Holston Valley
Medical Center in Kingsport announced a
reinvigoration of children’s services within the
Holston Valley Regional Children’s Hospital and
The centerpiece of the sweeping initiative is a
groundbreaking alliance with Children’s Hospital,
the pediatric referral hospital for the region and
the only state-designated Comprehensive
Regional Pediatric Center in East Tennessee.
Because of this new alliance, 17 board-certified
pediatric specialists will establish an office and
begin seeing patients at Holston Valley.
“Every year, 2,500 children from our region are
referred to Children’s Hospital for expert care
that, until now, has been unavailable in Northeast
Tennessee and Southwest Virginia,” said Dr.
Richard Salluzzo, Wellmont Health System’s
president and chief executive officer. “Now,
instead of asking children and their parents to
drive two hours or more for care, we’re bringing
the pediatric specialists to these children. Working
with the outstanding pediatricians, neonatologists
and pediatric specialists already on the Holston
Valley staff, these physicians will deliver
comprehensive pediatric care that is unmatched in
Specialists in pediatric endocrinology, pediatric
gastroenterology, pediatric hematology/oncology,
pediatric neurology, pediatric pulmonology and
pediatric surgery will make regularly scheduled
visits to see patients at Holston Valley. The
specialists’ office will be located within the
hospital, and appointments will be available by
referral from a pediatrician or family-practice
“At Children’s Hospital, we are committed to
making sure every child gets the medical attention
necessary when faced with illness or injury,” said
Bob Koppel, president and CEO of Children’s
Hospital. “For many years, Children’s Hospital
has seen children who have been referred to us
from Upper East Tennessee. This alliance with
Holston Valley will allow us to assist even more
children as we bring our talented and dedicated
pediatric subspecialists to Upper East Tennessee
and allow us to see children where they live and
help them with unique medical needs. We are
excited about the opportunities that this brings
to help the children in this area live happier,
Dr. Stephen Combs, a board-certified
pediatrician and president of the Holston Valley
medical staff, said “Through the new
relationships we’ve announced, Holston Valley
is affirming its commitment to the children of
our region. As a pediatrician, I can think of no
better investment for any hospital than an
investment in the health of our children.
“I know I speak for all the physicians of
Holston Valley and East Tennessee Children’s
Hospital when I say I’d move mountains to
make life better for just one child,” Dr. Combs
added. “How wonderful it is, then, that the
alliances we’ve formed and the programs we’ve
developed will ease the pain and restore the
smiles of countless children in our community.”
Children’s Hospital forms alliance with Holston Valley
Children’s Hospital and Children’s Hospital
Home Health Care were awarded a renewal of
their three-year accreditation following a
successful survey by the Joint Commission for
the Accreditation of Healthcare Organizations
(JCAHO) during the week of August 21.
The JCAHO surveyed Children’s Hospital
(including the Children’s Hospital Rehabilitation
Center in West Knoxville) as well as Children’s
Hospital Home Health Care in Farragut over a
The JCAHO is a private, not-for-profit
organization that seeks to improve the quality
of health care through the accreditation of
health care organizations. It began hospital
inspections in 1918, and today, the Joint
Commission surveys hospitals, health care
networks, long-term care pharmacies,
laboratories and organizations specializing in
long-term care, ambulatory care, behavioral
health and home care.
In its preliminary report, the Joint
Commission survey team recommended a
three-year accreditation — the longest period
offered by the JCAHO — for the hospital and
Home Health Care.
The surveyors were extremely
complimentary of our organization, staff and
the care we provide to our patients and families.
The Children’s Hospital Laboratory had a
separate, successful survey in August.
2006 Joint Commission survey a success
Dr. Stephen Combs (left), President of the Holston Valley Medical Center medical staff, and Children’s
Hospital President Bob Koppel (right) at the Holston Valley press conference with Tony and Cari
Crawford and their children, Jake and Gracie. Both Crawford children were born prematurely at
Holston Valley and have frequently sought pediatric specialty care at Children’s Hospital.
The quest for quality
Children’s Hospital has a history of providing a
high quality of health care to our patients. But
exceptional quality requires exceptional effort. At
Children’s, the quality of care is a priority
throughout our medical center.
For that reason, Children’s Hospital places a
great deal of emphasis on instilling a “culture of
quality” in physicians and employees. According to
Laura Barnes, M.S.N., C.N.A.A.,B.C., Vice
President for Patient Care Services, with employees,
it begins with the hiring process. “We hire the right
people with the right skills and goals,” she said.
Then it continues with the new employee
orientation process, with all areas of the hospital
working continually to mentor the new employees
with the goal of improving patient care.
Although the employees providing leadership
and support in quality improvement at Children’s
Hospital are Quality Management Department
Director Alzena Abernathy and her staff, all hospital
staff members play a role in quality improvement.
Quality issues can be identified by anyone – a
physician, a nurse, a tech, a housekeeper, anyone
who observes something that could be done better
or more safely. They report their suggestion, and
if it is approved for action, a team is selected to
implement the plan. The suggestions most
frequently pertain to quality and safety for our
patients, but enhancing safety for our staff is
also a priority.
At Children’s Hospital, quality improvement
goes beyond casual observation of something that
can be improved. Children’s Hospital constantly is
monitoring quality in a number of ways, looking for
trends, new services, equipment or processes
available elsewhere. Departments develop their own
quality improvement (QI) plans annually to help
them continuously search for areas to improve.
One key element of the quality initiative at
Children’s Hospital was the establishment earlier
this year of the CSI team. CSI – not the network
TV series – stands for Children’s Safety Initiative.
The CSI team members, representing all hospital
departments, meet monthly to review safety and
quality issues and report to their peers. They provide
education opportunities, poster presentations and
other activities to help hospital staff remain up-to-
date on policies, standards and expectations.
The Joint Commission for the Accreditation
of Healthcare Organizations, which surveyed
Children’s Hospital in August, encourages hospitals
to have ongoing readiness by doing surveys on an
unannounced basis (the hospital knows only the year
in which the survey will take place, but not the day
or even the month). Barnes said the goal of the
JCAHO’s new unannounced surveys is, “Instead of
preparing for the next survey, you are preparing for
the next patient.” When the JCAHO surveyed
Children’s Hospital in August of this year (see page
10 for information on the survey), one question the
surveyors frequently asked employees was, “What
have you done to improve care over the last year?”
The Medical Staff members of Children’s
Hospital also are very integral to the QI program.
They are involved in QI processes, in examining how
we deliver care to make sure it is of the highest
quality, and serving on various Medical Staff
committees that monitor the quality of care rendered
to our patients. The committees have a variety of
functions (including Trauma, Infection Control,
Pharmacy/Therapeutics, Acute Care, Department of
Medicine and Department of Surgery) and they all
include QI. They all report monthly to the Medical
Staff QI Conference, currently chaired by John
Little, M.D., pediatric otolaryngologist.
Dr. Little said the community might be unaware
of the degree to which Children’s Hospital works to
enhance quality. “We watch for national alerts and
trends from other hospitals, especially children’s
hospitals, and we act on them to prevent problems
here,” he said. “We also encourage and solicit input
from hospital staff and the Medical Staff to identify
problems or potential problems.
“We try to be proactive, not reactive,” he added.
“We work to prevent things from occurring or
recurring when possible. It’s better to learn from
other hospitals’ problems or mistakes, rather than
responding only when they occur at our institution.
That’s why when we receive national alerts, we take
preventive measures” to avoid similar problems at our
The hospital also actively “benchmarks” itself,
which is something of a report card where we
compare ourselves to other hospitals, particularly to
other children’s hospitals. In neonatal care, Children’s
Hospital uses the Vermont Oxford scale, which
examines a wide variety of neonatal indicators at
various NICUs. We’re also part of BENCH, which
stands for Benchmarking Effort for Children’s
Hospitals. This is a group of about 30 children’s
hospitals across the country that benchmark against
each other and learn best practices from each other.
Locally, Children’s participates in Knoxville Area
Healthcare 21 initiatives, where area hospitals share
practices and work together to develop best practices.
One example of an initiative from Healthcare 21 was
the development of protocols for ventilator care to
decrease ventilator-associated pneumonia. In
addition, this group advanced the development of
Rapid Response Teams (RRTs) to identify and
address changes in patient status before the patients
reach a critical state. All area hospitals have
implemented the teams. (See sidebar for more
information on the Rapid Response Team at
Children’s Hospital). Both of these Healthcare 21
projects have been recognized by the state for
improving patient safety.
The hospital’s Board of Directors is ultimately
responsible to ensure that the QI process is thorough
and complete. The Quality Management Committee
of the Board meets quarterly to hear reports about
the processes and results of QI and make
recommendations for improvement. The board also
provides for resources and support necessary for the
implementation of plans, helps to evaluate plans’
effectiveness and identifies 8-10 QI priorities
annually for the hospital.
better care for
Rapid response teams (RRTs)
represent one way Children’s Hospital is
working to provide the best care possible
for each patient. In the past if a patient’s
condition reached a critical state, a staff
member alerted a “code team” to race to
the bedside and care for the patient (a
“code” is a life-threatening event for a
patient). Since December 2005, rapid
response teams have been available at
Children’s Hospital to intervene
BEFORE a patient requires
If a staff member is concerned and
thinks a patient may be developing a
problem, or if that staff member needs
assistance in evaluating a patient, the
rapid response team is called to assess
the patient and begin basic interventions
to slow or even prevent deterioration in
the patient’s condition. The rapid
response team then notifies the patient’s
physician, reports its assessment of the
patient’s condition and receives
additional orders from the physician.
At Children’s Hospital rapid response
teams are composed of a nurse from the
Pediatric Intensive Care Unit and a
Respiratory Care professional. Each
team member brings extensive expertise
in pediatric critical care to the bedside
with the goal of preventing emergencies.
The teams are available 24 hours a day,
seven days a week not only for response
but also to provide education and
support to other hospital staff. The
availability of the teams is reassuring to
nursing staff members, who know that if
they feel the need for additional help
with a patient, it is readily available.
Hospitals around the country, such as
Children’s, that have implemented RRTs
have seen a decrease in their rates of
life-threatening events (“codes”).
by Meghan Alcorn, student intern
Dates: December 9, January 6 and 20
Time: 9 a.m. to 3 p.m.
Safe Sitter is a national organization that teaches young adolescents safe and
nurturing babysitting techniques and the rescue skills needed to respond
appropriately to medical emergencies. Instructors are certified through Safe
Sitter nationally. Participants must be ages 11-14. This course is $18 per person.
Dates: December 4 and January 15
Time: 6:30-9 p.m.
This class will teach caregivers cardiopulmonary resuscitation and choking
maneuvers. This class also gives general home safety advice and tips. This course
is $18 per person.
Class size is limited, so preregistration is required. All classes are offered in
the Koppel Plaza at Children’s Hospital, unless otherwise noted. For more
information or to register for any of these classes or to receive our free Healthy
Kids parenting newsletter, call (865) 541-8262.
Additional classes are being scheduled for 2007. Announcements about
upcoming classes can be seen on WBIR-TV 10 and heard on area radio
stations. Or visit our Web site at www.etch.com and click on “Healthy Kids
Education and News.”
Children’s Hospital’s Healthy Kids Campaign, sponsored by WBIR-TV
Channel 10 and Chick-Fil-A, is a community education initiative of the
hospital’s Community Relations Department to help parents keep their children
knowing when NOT to do-it-yourself
in your estate plans.
Join the ABC Club.
For more information,
call (865) 541-8441.
Please send the free brochure titled “Personal Information Record.”
City___________________________ State_______ Zip_____________ Phone#(______)___________
Please call me at the phone number below for a free confidential consultation concerning planned giving.
Please send me more information about deferred giving.
I have already included Children’s Hospital in my estate plan in the following way:
Please send me information about the ABC Club.
Children’s Hospital Development Office • (865) 541-8441
Americans are a self-sufficient group. We take
pride in our homes, with many people doing repairs
or enhancements themselves. Home improvement
stores sell the needed materials and offer classes and
self-help books on topics ranging from building a
deck to landscaping your yard.
But there is also a time you should not “do-it-
yourself” – when you are preparing your will. That is
the time you need the advice and counsel of your
lawyer. No preprinted form, “Will Kit” or computer
software can take into account all of your individual
needs; only your lawyer can do that. Here is a brief
list of some things you can accomplish with your will:
• Name the person(s) you trust enough to carry out
all your instructions after you are gone – your
Executor, sometimes called your Personal
• Specify whether your Executor is required to post
a bond and file reports with the probate court.
• Document your wishes about a guardian to take
custody of your minor children.
• Instruct the guardian(s) how to use your money
for their benefit:
° Should they sell everything and put the
proceeds in a trust to provide living and
° You can give a specific asset – home, securities,
° After all other bequests, you can leave some or
all of the remainder to a charity.
° You can name someone special to be honored
or memorialized by your gift.
Perhaps this list gives you an appreciation for the
task and helps you understand why the cookie cutter
approach of a “Will Kit” cannot meet all your needs.
This is why your lawyer is so important to the
process. Your lawyer can prepare a document that
precisely accomplishes each of your wishes.
Remember the amount you spend on legal fees is
small compared to the comforting security of a
sound plan and the great peace of mind you will
have when your will is complete.
We have a complimentary Personal Information
Record booklet that will help you gather the
information your lawyer needs to begin working
on your will. Please use the form below and the
business reply envelope in this issue to request your
copy. Or you can call Teresa Goddard, Senior
Development Officer, or David Rule, Director
of Development, at (865) 541-8244.
° What type of expenses do you wish to cover and
what would you prefer not to spend money on?
° Are there certain items of sentimental value you
would like the guardian to keep and give to your
children when they reach a certain age?
° If there is money left after raising and educating
your children, should it be turned over to them
when they reach a certain age? If so, what age?
And how should it be divided?
° Do you have special needs children who will
require support into adulthood or perhaps for
the remainder of their lives?
• Specify how you would like to dispose of
everything you have accumulated over your
° Your home and any other real property
° Your personal property – clothing, furnishings,
china, family memorabilia, artwork, vehicles,
firearms, quilts, etc.
° Your cash and investments
• Name the people you wish to benefit and specify
what each person is to receive.
• Name the charities you wish to support and
specify the amount going to each.
° You can list a certain dollar amount.
Upcoming Community Education ClassesUpcoming Community Education Classes
CCAALLEENNDDAARR OOFF EEVVEENNTTSS
JAMMIN’ IN YOUR JAMMIES
Jammin’ in Your Jammies is an annual event
designed to “cure those winter blues” and give
young families a weekend of affordable fun.
The event will take place January 26-28 at the
Holiday Inn Select, Cedar Bluff, and all the
proceeds from the event will benefit Children’s
Hospital. A family of four can enjoy an
overnight stay beginning with registration
at 5 p.m. on Friday and concluding with a
scrumptious Saturday morning brunch, OR
they can register at 5p.m. on Saturday and
conclude their weekend with a Sunday
In the evening, families may participate
in many activities, including games, a pajama
contest, dancing to music, and swimming in the
indoor pool. The Jammin’ event wraps up the
following morning with brunch. The cost is
$125 for a family of four, and additional guests
in a family are $25 each. This price includes
one hotel room for one night, dinner, snacks,
breakfast and all of the entertainment and
games. Star 102.1 radio will provide music for
the event. Call (865) 541-8608 for more
information or to register.
University of Tennessee students will dance
the night away at the 2007 Dance Marathon
February 23-24 at the Tennessee Recreational
Center for Students (TRECS). Dance
Marathon is completely run by students and
is the largest philanthropy on the UT campus.
Each year Dance Marathon raises around
$100,000 for the Hematology/Oncology Clinic
at Children’s Hospital.
Students will enjoy live music from local
bands and learn a Dance Marathon dance to
perform at the end of the 14-hour celebration.
Dance Marathon also features a children’s
carnival for Children’s Hospital Hematology/
Oncology patients. Before the event each year,
prospective dancers raise funds for Dance
Marathon. For more information, call
(865) 541-8745 or visit www.utkdm.com.
STAR 102.1 RADIOTHON
The sixth annual Star 102.1 Radiothon
will take place March 1 and 2 at West Town
Mall. Marc, Kim and Frank from Star 102.1’s
morning show will host the live event from
6 a.m. to 6 p.m. each day and encourage
listeners and those who stop by to make a
personal pledge to help Children’s Hospital.
Another way to help is to place a bid
during the Radiothon silent auction, which
will feature a variety of items from local and
national companies and retailers. All funds
donated will benefit Children’s Hospital
Home Health Care and fund the CarePages
service on the Children’s Hospital Web site.
Call (865) 541-8457 for more information.
“CUTEST LITTLE BABY FACE”
The 17th annual “Cutest Little Baby Face”
contest will kick off March 10 at Belz Factory
Outlet World in Pigeon Forge. The contest is
open to children ages 6 and younger, with
Gary Woods Photography in Sevierville taking
photos of participating children. Contestants
may pre-register by completing a registration
form at the outlet mall or by calling the
Children’s Hospital Development Department
at (865) 541-8745.
The entry fee for pre-registration is $5,
and registration at the event is $7. The fee
includes a 5x7 portrait
of the participating
child taken by Gary
Pictures will be taken
on March 10 and 11.
Voting will take place at
Belz on March 23 and
24; $1 donation to
Children’s Hospital will
count as 100 votes. The
child with the most
votes wins and will be
announced on March
24 during the “Baby
B97.5 CHARITY BREAKFAST
Join B97.5 for a delicious breakfast,
entertainment and silent and live auctions
benefiting Children’s Hospital. Local and
national celebrities will provide entertainment
for the event. The spring date and location are
to be announced. Tickets are $10 at the door
for adults and children ages 13 and over; $5 for
children ages 8-12; and free for children ages 7
By Amandalynn Thomas, student intern
U P C O M I N G E V E N T S T O B E N E F I T C H I L D R E N ’ S
Mark your calendars now for several upcoming events to entertain families and benefit Children's Hospital.
Thanks to the generous people of East Tennessee who host and participate in these events, Children's Hospital
can continue to provide the best pediatric health care to the children of this region.
CCAALLEENNDDAARR OOFF EEVVEENNTTSS
It’s time to buy a Children’s
Hospital license plate!
The Children’s Hospital specialty license plate is in
danger of being abolished by the state due to low
numbers of plate holders.
The minimum number to maintain a specialty plate
formerly was 500 license plates, but the state increased
the minimum in 2005 to 1,000. Currently, only 800
Children’s Hospital plates are registered.
Children’s Hospital must reach and maintain at least
1,000 active registrations (plates) by July 1, 2007, or our
plate will be abolished. If this happens, the hospital will
have to wait three years before it can pursue another
specialty plate through a lengthy process.
If you have purchased one of the plates, we hope you’ll
renew the plate when it comes due. This is an easy way
to help Children’s Hospital on an ongoing basis.
If you have been thinking about purchasing the
hospital plate, there has never been a better time! The
plate is available continuously through each County
Clerk’s office, and the cost of the plate is $35 in addition
to each county’s renewal fee. Fifty percent of the revenue
generated from the specialty plates directly benefits
If you have any questions about the specialty
Children’s Hospital license plate, contact your local
County Clerk’s office or the Development Department
at (865) 541-8467.
Has childhood obesity become more common in
recent years? If anyone took a minute to look
around at our day-to-day lives, most would
answer “Yes” to that question, and that response
would certainly be correct. The extent of this
growing issue and its dangerous health
consequences may be less obvious and a harder
topic for us to understand.
Statistics from the Centers for Disease
Control and Prevention are alarming. In the
1960s and 1970s, four to five percent of
children and teens in this country were
overweight or obese. In the 1999-2002 survey,
that rate had risen to 16 percent. When the
number of children who are “at risk” for obesity
(those who are borderline overweight) is
included, the rate rises to a staggering 30
percent. In addition, the obesity epidemic is
reaching younger and younger children; current
information indicates that 10 percent of
children ages 2-5 are now overweight.
Dr. David Nickels, pediatric endocrinologist
at Children’s Hospital, shares surprising
statistics and results about the increasing rate of
childhood obesity and its relationship to Type 1
and Type 2 diabetes.
QQ:: The increasing rate of obesity in children
and teens is alarming. What are the
medical concerns for these children and
AA:: The real worry is the danger to health that
comes along with this early obesity. Type 2
diabetes, high blood pressure, sleep apnea
and stress on the heart leading to early
heart failure or heart attack are all much
more common in children, teens and
young adults who develop obesity in
childhood years. My biggest concern now
is that because of this new severity in the
obesity epidemic, we are seeing more
Type 2 diabetes onset in children and
adolescents before they reach young
QQ:: There is much more information available
about Type 1 diabetes, but what about
Type 2? What are the symptoms and
consequences of Type 2 diabetes?
AA:: Formerly, Type 2 diabetes was known as
“adult onset diabetes,” and that has
definitely changed in recent years. Type 2
diabetes is a serious chronic health
problem that results in many life-
threatening complications, such as kidney
failure, blindness and early onset of heart
attack and stroke, and will shorten the lives
of many children. It has been suggested in
recent years that at the current rate of
increase in obesity, this generation of
children will be the first in history to have
shorter overall life expectancy than their
QQ:: What is the difference between Type 1
and Type 2 diabetes? What are the main
causes of each?
AA:: With Type 1 diabetes, which is not related
to weight, the pancreas loses the ability to
produce insulin because of an attack by the
immune system against the pancreas cells
that make insulin. The insulin-producing
cells are eventually all lost, and without
insulin, the rest of the body cannot take up
glucose from the bloodstream and
metabolize it. Therefore, blood glucose
levels rise higher and higher.
People with Type 2 diabetes develop
high blood sugars for a different reason,
primarily because the body becomes less
responsive to the insulin that is being
produced. The pancreas still can produce
insulin, but because of obesity over time,
the body tends to become resistant to the
normal effects of the insulin. As this
worsens, blood glucose eventually rises. In
children and young adults, the pancreas
initially tries to compensate for this
resistance to insulin and tries to produce
extra insulin to keep blood sugar levels
down. It may be able to do this for a while
but eventually this becomes hard on the
pancreas and stresses the pancreas cells,
which then start to fail. As insulin levels
then become lower in the face of insulin
resistance, blood sugars rise, and diabetes
Although there are some genetic
influences on who develops insulin
resistance and at what age, the single
biggest risk factor is obesity. Because so
many young people become overweight at
earlier and earlier ages, we are seeing this
process of developing Type 2 diabetes
occur in these adolescents, sometimes even
as young as nine or 10-years-old.
QQ:: As a physician, why do you think obesity
is on the rise?
AA:: The reasons are clear – children and teens
are eating more unhealthy foods more
often and getting less physical activity.
Hours spent in front of the TV, video
games and computer screens add up and
take their toll. Children who watch the
most TV have the highest obesity rates.
Surveys also tell us that only five percent
of school children have daily physical
education. Most who have any P.E. in
school only have it once or twice a week.
Children also play outside less and rarely
walk to school.
QQ:: What other factors contribute to the
Type 2 diabetes onset problem?
AA:: Nutritional issues are a major factor in the
increase in Type 2 diabetes in children.
Over-consumption of highly processed,
high calorie foods and high sugar drinks
while watching TV or doing homework
can result in children consuming more
calories than they need. Fast food intake,
and restaurant food intake in general, is at
an all-time high, and this almost always
results in higher calorie intake on average
than if children ate meals prepared at
home. Intake of soft drinks and other
high sugar drinks is up and milk intake is
down significantly over the last 30 years.
The problems are not just in the home
setting. Schools often rely on vending
machine sales of soft drinks and high
calorie snack foods, candy and chips for
income, and they often resist efforts to
remove these machines from schools.
Finally, constant daily exposure to
advertising for unhealthy foods, drinks,
and fast food marketing aimed directly at
children with prizes, games and cartoon
characters is increasing.
QQ:: What can parents, teachers, health care
providers and the community do to help?
AA:: The problems are not going to be fixed
overnight. However, small steps made by
all of us on a daily basis can have a very
powerful effect. Here are several ideas to
get families started in making changes:
Limit television and other “screen”
time with your children, starting at a very
young age. An hour or two a day is
plenty. No matter what children end up
doing when the TV or video game is
turned off, it almost always involves
burning more calories than watching TV
or playing video games.
Increase outdoor playtime by 30-45
minutes per day, every day. Take family
walks more often. Parents and
grandparents must take the time to
actively play with their children, and they
must resist the use of the TV or video
games as a “babysitter” for an unlimited
time each day.
Improve your family’s eating habits
with a few simple changes. Work on
reducing high sugar drinks and highly-
processed, high-calorie snack food in your
household, such as snack cakes, candies
and chips. Eat out less often, especially
fast foods, and prepare meals with more
“unprocessed” foods such as fruits,
vegetables, whole grains and low-fat dairy.
Avoid higher calorie frozen convenience
foods at home.
Start early. Children who learn from an
early age how to live healthier will be
more likely to avoid obesity. We all know
that changing habits later in life is much
harder. Prevention of obesity in children
will be more effective than trying to get
children who are already obese to lose
weight, and prevention efforts must start
Finally, talk as often as you can with
community leaders and school officials
about the importance of making changes
that will encourage healthier living.
Incorporating brief exercise breaks in the
classroom, removing vending machines
with unhealthy foods and drinks, and
limiting advertisement of unhealthy foods
and drinks aimed at children could be
important changes that will help all
children live healthier lives.
Health care providers can begin educating
parents about these healthy lifestyle goals
beginning even during well baby exams in
infancy. Previous efforts by the American
Academy of Pediatrics to push safety and
injury prevention education by pediatricians
have been effective, and similar campaigns
can work for obesity prevention. This needs
to be a priority for all pediatricians and
Obesity rates in children, teens and
subsequently adults can be lowered, and our
children’s prospects for healthier lives can be
increased. We owe them our best efforts in
We all have busy schedules and lots of
demands on our lives, which can make these
efforts hard to achieve. But when we think of
the potential consequences to our children
and grandchildren, it is hard to think of
anything that could be more important.
Compiled by Janya Marshall,
public relations specialist
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The Pediatric Endocrinology Department at
Children’s Hospital, under the direction of Dr. David
Nickels, has received certification and authorization
from the Type 1 Diabetes TrialNet coordinating center
at George Washington University to begin enrollment
in the Natural History Study.
The Natural History Study is part of an international
network of clinical trials under Type 1 Diabetes
TrialNet. Launched in March 2004, TrialNet is a
collaborative network of 18 international clinical centers
along with affiliated diabetes researchers in many other
locations. The program is dedicated to testing new
approaches to understanding, treating and preventing
Type 1 diabetes. This study will screen relatives of
people with Type 1 diabetes for autoantibodies
associated with the development of the disease.
“We know that children, siblings and other first-
degree relatives of people with Type 1 diabetes have
increased risk of getting the disease,” Dr. Nickels said.
“The risk of getting Type 1 diabetes is about 1 in 300
for the general public; however, this risk increases to
about 1 in 20 for first-degree relatives.”
To be eligible for a no-cost screening test in the
Natural History Study, volunteers must meet one of
the following criteria:
• between one and 45 years of age and have a
first-degree relative (child, parent or sibling)
who has Type 1 diabetes.
• between one and 20 years of age and have a
second-degree relative (cousin, aunt/uncle,
niece/nephew or grandparent) who has
Type 2 diabetes.
Children’s Hospital’s Pediatric Endocrinology Office
is currently enrolling patients and first-degree family
members for the Natural History Study. Phase 1
includes an initial blood test. After the sample results
are returned, participants will either be sent to Phase 2
for further testing or will be told they do not carry the
autoantibodies associated with Type 1 diabetes and
will be released from the study.
Also, TrialNet has now begun enrolling subjects
age 12 years and older with newly diagnosed Type 1
diabetes in treatment studies looking at two different
medication regimens. These regimens may help stop or
slow the autoimmune attack on the pancreas and
preserve some of the residual insulin production that is
often still present temporarily at the time of diabetes
diagnosis. Patients interested in participating in these
treatment/intervention studies can be initially screened
for eligibility at Children’s Hospital, and if qualified,
would travel to the University of Florida for enrollment.
For more information or to participate in the studies,
call the Children’s Hospital Pediatric Endocrinology
Office at (865) 971-7400 or visit the TrialNet Web site
By Janya Marshall, public relations specialist
David Nickels, M.D.
2018 Clinch Ave. • P.O. Box 15010
Knoxville, Tennessee 37901-5010
We always try to stay current with friends of the hospital.
If for any reason you should receive a duplicate issue,
please notify the hospital at (865) 541-8257.
PA I D
The 25th annual Children’s Miracle Network Telethon to benefit
Children’s Hospital is quickly approaching. This year’s telethon has
been moved to Sunday, January 28, and will be broadcast live from
3:30 p.m. to midnight on WBIR-TV.
This year’s telethon again offers viewers the convenience of
donating to Children’s Hospital online during the broadcast. Those
watching the broadcast on WBIR-TV can log on to www.etch.com
and click on “Make A Donation” on the left side of the home page
to make their contribution.
Last year’s 24th annual CMN broadcast raised more than
$1.8 million for Children’s Hospital. This total represents the
tremendous generosity of the people of East Tennessee and their
ongoing commitment to Children’s Hospital.
The success of this year’s Children’s Miracle Network telethon is
crucial in helping Children’s Hospital grow. Funds raised during the
telethon will be used to purchase new and sophisticated medical
equipment for various hospital departments. Support from the community
throughout the telethon helps ensure that each child who comes to Children’s
Hospital, now and in the future, is able to receive the care he or she needs.
Children’s Hospital is a charter member of the Children’s Miracle
Network. In 1983, the hospital participated in the first telethon that raised
$95,487 in East Tennessee, all of which remained at Children’s Hospital for
the direct benefit of its patients. Since its inception, the telethon has raised
more than $23 million for our pediatric medical center. For more
information about the Children’s Miracle Network broadcast, or if you would
like to volunteer at the telethon, call (865) 541-8441 or visit www.etch.com.
By Amandalynn Thomas, student intern
t e l e t h o n d a t e h a s c h a n g e d
Children’s Miracle Network Telethon is January 28