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 ...
Under the R AINBOW                       w w w. r a i n b o w b a b i e s . o r g

    When Is
    Urgent Care a
Find a physician online: www.rainbowbabies.org/PhysicianFinder/

When a Friend or Family Member Has Cancer
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
Find a physician online: www.rainbowbabies.org/PhysicianFinder/

Chore Wars
Under the R AINBOW                           w w w. r a i n b o w b a b i e s . o r g

Find a physician online: www.rainbowbabies.org/PhysicianFinder/

University Hospitals of Cleveland                                                                                         ...
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  1. 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 B 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 KERCSMAR, MD, “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 Hospital 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 ask@rainbowbabies.org, 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. 2. Under the R AINBOW w w w. r a i n b o w b a b i e s . o r g When Is Urgent Care a Good Option? CAROL ROSEN, MD, 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. Hospital 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,” GREGORY says Amy Maneker, MD, Medical Direc- GOLUNKA, MD, 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 T 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 quickly read. “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.” Rainbow is in your neighborhood, call 216-844-RAINBOW. 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.” ■ 2
  3. 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 W 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 by cancer. “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. 3
  4. 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 immunodeficiencies 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 Immunologist, 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 N 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 one year 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.” ■ 4
  5. 5. Find a physician online: www.rainbowbabies.org/PhysicianFinder/ Chore Wars STRATEGIES FOR GETTING YOUR SPOUSE TO PITCH IN AROUND THE HOUSE I 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, MacDonald Women’s spouse sits on the couch, magazine in upon your schedules and responsibilities Hospital 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. 5
  6. 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 M 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. Center 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 Washington, D.C. 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.” ■ 6
  7. 7. Find a physician online: www.rainbowbabies.org/PhysicianFinder/ Q ASK THE DOCTOR: WHEN IS IT OK FOR MY CHILD TO STAY HOME FROM SCHOOL IF HE’S SICK? Q A 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, DO, Pediatric Dermatologist, Rainbow Babies & Children’s Hospital 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 Q 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 A examine whether this may be the cause of your child’s discomfort Making friends is an important Hospital and to discuss a treatment plan.” developmental task for children, which requires learning specific Q 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- A 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. ■ 7
  8. 8. University Hospitals of Cleveland NONPROFIT Rainbow Babies & Children’s Hospital ORG U.S. Postage 11100 Euclid Avenue PAID Cleveland, Ohio 44106 Permit N. 694 Effingham, IL ASK RAINBOW! Rainbow’s experts are here to answer your health care questions! You can contact us by phone at 216-844-RAINBOW or email us at ask@rainbowbabies.org. Detecting Diabetes Early RECOGNIZE THE RISKS AND SYMPTOMS W hen you consider the threat was the only instance of diabetes in chil- of diabetes to your family, dren,” says Sumana Sundararajan, MD. you might be concerned for “Children with type 2 diabetes, which your parents, great-aunts and uncles or occurs when the insulin produced by the yourself. The last members you may body does not work correctly, have consider at risk are your kids. increased from 2 to 4 percent of diabetes Unfortunately, a growing number of patients in the early 1990s, but now make SUMANA SUNDARARAJAN, children are being diagnosed with type 2 up over 25 percent of those patients MD, diabetes each day. today. While genetic susceptibility may Endocrinologist, “Type 1 diabetes, which is caused by play a role, environmental, social and Rainbow Babies & a defect in the immune system, used to behavioral factors seem to have the Children’s Hospital be called ‘juvenile diabetes’ because it greatest impact.” This increase of type 2 diabetes in chil- problems, such as nerve damage, heart medications that can help the body SCREENING DIABETES dren is a global trend, and obesity is the disease and stroke increase the longer respond better to its own insulin. “The The following signs may indicate consistent, leading cause. Overweight chil- you have diabetes,” Dr. Sundararajan most important thing you can do to that your child is at high risk: dren produce too much insulin on a reg- says. help your child avoid, or live with, dia- ■ Frequent urination ular basis, so when they need more, they Type 2 diabetes can be prevented in betes is to set a good example,” Dr. ■ Continual thirst can’t produce more. Choosing healthy kids the same way it is prevented in Sundararajan says. “By making some of ■ Extreme fatigue foods for your child to snack on and adults. Screenings are necessary to deter- the lifestyle changes yourself, you can ■ Development of dark skin around planning at least 30 minutes of exercise mine if your child is at high risk because improve the whole family’s health and the neck, groin, and armpits or for your child each day can help them the symptoms are not always obvious. eliminate some controllable causes of between fingers and toes control their weight and decrease the The various approaches to treating diabetes.” ■ ■ For girls, infrequent or skipped possibility of insulin resistance. type 2 diabetes include weight manage- periods or facial hair growth are TRY OUR GREAT RECIPE FOR “This is critically important because ment with attention to diet and lifestyle NUTTY CHOCOLATE CHIP also indicators the risk for developing other health modifications along with one or more COOKIES, CREATED FOR KIDS WITH TYPE 2 DIABETES. Visit http://www.rainbowbabies.org. Time to Choose? If you are choosing your family’s health plan, remember there is no better place for children than Rainbow Babies & Children’s Hospital. Under the Rainbow is published by Rainbow Babies Your health plan should provide a wide range of cover- & Children’s Hospital. Articles in this newsletter are written by professional journalists or physicians who age; allow options for care close to home; easy access strive to present reliable, up-to-date information. But to the care that you need; promote wellness; provide a no publication can replace the care and advice of comprehensive benefit for preventive care at a low or medical professionals, and readers are cautioned to seek such help for personal problems. ©2006 StayWell no cost; and have reasonable out-of-pocket costs. Custom Communications, 780 Township Line Road, Most important, ask if your plan includes Rainbow. Yardley, PA 19067, 267-685-2800. Some images in For clarification, call 216-844-7246 or log on to our this publication may be provided by ©2006 PhotoDisc, Inc. All models used for illustrative purposes only. website at www.rainbowbabies.org and click on the Some illustrations in this publication may be provided Ask Rainbow tab and link to insurance plans that by ©2006 The StayWell Company; all rights reserved. include Rainbow. (406) *Free offers: Limit two (2) copies per caller.