This verification means Cook Children’s has the best possible system in place for surgery in children. From our Level IV Neonatal Intensive Care Unit, Level II Trauma Center, state of the art equipment and surgery rooms to advanced training in pediatric subspecialties, Cook Children’s has invested everything it takes to make its medical center in downtown Fort Worth, Texas the preeminent place for pediatric surgery.

“This recognition means families can be assured their children are in the best possible hands when they turn to Cook Children’s for surgical care,” said Eric Hubli, M.D., FACS, medical director of Children’s Surgery at Cook Children’s. “We are proud of the incredible surgical staff who work tirelessly to make Cook Children’s the best possible place to heal, and of our leadership team who continuously invests in us because they know every child’s life is sacred.”

To put this recognition in perspective, there are more than 200 children’s hospitals in the United States. Cook Children’s is one of an elite group of 22 that holds the distinction of being a Level I Children’s Surgery Center.

“Kids are not small adults,” said Dr. Hubli. “They have unique diseases and medical issues that can only be treated by specially-trained professionals.”

Cook Children’s has certified physicians and nurses in pediatric surgery and anesthesia available 24 hours a day, seven days a week. In addition, Cook Children’s Teddy Bear Transport team is dedicated to getting the most medically fragile children and neonates, often in need of surgery, to our award-winning medical center quickly and safely. All of this is part of the essential criteria that was observed and evaluated by the American College of Surgeons, leading to the verification as a Level I Children’s Surgery Center.

To read Cook Children's press release on the Level I Children’s Surgery Center verification, click here. 

But these patches of darkened skin called acanthosis nigricans may also be a sign of something more serious, said Joel Steelman, M.D., an endocrinologist at Cook Children’s.

The exact cause for acanthosis nigricans appearance is not yet known, but current scientific research suggests over-growth in the outer layer of the skin lead to the darkened, rough, velvety patches of skin seen in the condition.

Common body areas where patches of acanthosis nigricans may be seen include the neck, knuckles, armpits, elbows and knees. It can be more widespread and impact areas like the face, chest or belly. In severe situations, it can even be seen in the lips or cheeks.

The condition appears equally between boys and girls and seems to be more common in Hispanics, African Americans and Native Americans, compared to other ethnic groups. One recent study found about five-fold higher likelihood of acanthosis in blacks or Hispanics, compared to whites.

Dr. Steelman said in an overall healthy child, the most likely cause of acanthosis nigricans is a higher level of the hormone insulin in association with obesity. Insulin helps the body grow and store energy from food. That growth effect from too much insulin is thought to be the reason in most obese children causing the skin to develop acanthosis nigricans.

“Since, the main cause for acanthosis nigiricans is linked strongly to obesity and a higher risk for diabetes, I recommend that parents first take steps at home to manage their child’s weight,” Dr. Steelman said. “These steps which include making improvements in the diet and encouraging more physical activity pay off in so many ways.”

The changes Dr. Steelman recommends should be something that the whole family does together. He says this will benefit parents, grandparents and others in the family. If there is a strong family history of diabetes or their child is considerably overweight, parents may want to bring their child to their pediatrician for a checkup. Labs may be ordered to search for higher risk findings for diabetes or metabolic syndrome. Also, more detailed kinds of investigation may be needed in children who don’t have the usual medical history seen with acanthosis nigricans risk.

The skin condition itself doesn’t usually cause too many problems for the child, other than causing the child to be itchy in a few cases. Topical treatments applied to the skin like moisturizers, bleaching creams, and exfoliating creams are used in situations where the person is bothered by the appearance of the acanthosis.

“But the main treatment begins with a talk about obesity and weight,” Dr. Steelman said. “I think the discussion has to be framed in a way to discuss the reward and minimize the negative. It may sound pretty trite, I know, but it really means a conversation about, ‘Let’s get healthy.’ Getting healthy means a lot more than just looking good. It means feeling better, achieving more, etc.”

Read more about acanthosis nigricans here.

- Credit to KidsHealth® for photo.

Get to know Joel Steelman, M.D.

Dr. Steelman is an endocrinologist at Cook Children's. He trained in endocrinology at the University of Colorado Children’s Hospital in Denver, where the magnificent setting turned Dr. Steelman into a lifelong outdoor sport enthusiast, with a strong desire to lead a healthy life. On his rare days off, he could be found skiing, mountain biking and trail running. He loves to go back to the Rockies as often as possible, and just a few years ago, he ran the Pike’s Peak ascent half marathon. He continues to run for exercise regularly. 

During his tenure in Colorado, where he met his future wife, Dr. Steelman trained at the internationally renowned Barbara Davis Diabetes Center, one of the world’s largest and most esteemed diabetes medical facilities for adults and children, specializing in type 1 diabetes research. Along the way, he discovered another strong research interest in the area of bone disorders, and Dr. Steelman began to treat children with osteogenesis imperfecta, or brittle bone disease-- a rare, crippling malady. After completing his training, Dr. Steelman left the West to enter academic medicine at Vanderbilt Children’s hospital in Nashville, Tennessee. Over the next seven years he focused on research projects and medical education.

As a self-described ‘techie,’ Dr. Steelman has a keen interest in the wise use of technology to improve medical care. Since 2001, he has helped implement electronic medical recordkeeping in two endocrine practices. He still loves to write, and he is a regular contributor to Checkup Newsroom.

Surprised? Lisa Elliott, Ph.D., clinic manager of Cook Children's Behavioral Health in Denton, Texas, isn't. Elliott, a licensed psychologist, says parents and teachers often have an outdated view of what a victim looks like.

"The general public has always perceived that children who are vulnerable to bullying have some sort of social deficit, physical handicap or learning disability," Elliott said. "While this is true, socially adept kids are equally vulnerable to bullying, especially when they attempt to climb the social ladder."

Last year, the American Sociological Review published the "Casualties of Social Combat" study, which examined more than 4,200 middle- and high-school students and found that the more popular students became, the more vulnerable they were to bullying.

Snakes and (Social) Ladders

For several years, Elliott has given presentations on bullying to the local community. She says parents are surprised when they hear a popular student can be both a bully and a victim at the same time. According to Elliott, the danger comes when a child tries to gain more status in a social clique that is emotionally aggressive or manipulative. Signs of this nonphysical bullying can be subtle and easily mislabeled as "drama."

Jockeying for position

According to the study, bullying is more likely to occur within a social group, between two "friends" who are on the same level in social heirarchy. On the outside, this may simply look like typical relationship drama. What's actually happening may be subtle but serious bullying.

How to Stop the Cycle 

No child is bully-proof. According to Elliott, the key is to to make sure your child can spot an unhealthy friendship before it goes too far.

"We should communicate to our children what true friendship is, and what it isn't," Elliott said. "This will help them discern which peers they can trust and which ones are trying to manipulate them."

Elliott offers parents the following talking points when speaking to their child about bullying:

• Even people who say they're your friends, can bully you.
• You should confront your friends when they're being hurtful to you or others.
• Retaliating may feel good temporarily, but refusing to stoop to the bully's level will win you more popularity in the long run.
• When you hear a false rumor, just ignore it and be yourself.
• You're most likeable when you respect yourself and others.
• Bullies usually have their own insecurities. Returning meanness with kindess is the best way to break down their defense.

Warning signs

If you worry your child is being bullied, look for the following signs:

• Sudden change in friendships.
• Unexpected drop in grades.
• Irritability or moodiness.
• Reluctance to go to school.
• Avoidance of social situations.
• Faked illnesses or complaints of feeling sick.

Get to know Justin Smith, M.D.

Justin Smith, M.D., is a pediatrician in Trophy Club  and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. Dr. Smith is an experienced keynote speaker for a variety of topics including pediatric/parenting topics, healthcare social media and physician leadership. If you are interested in having Dr. Smith present to your conference or meeting, please contact him at thedocsmitty@cookchildrens.org.

He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” open now. Click to learn more. To make an appointment, call 817-347-8100.

The American Academy of Pediatrics (AAP) released a statement recently encouraging pediatricians to talk with their families about the importance of daily, out-loud reading to your children (Literacy Promotion:  An Essential Component of Pediatric Primary Care Practice). Sometimes, when the AAP releases statements like this, that seem like common sense, I have to resist the urge to roll my eyes and tell myself, “Ok, thanks for stating the obvious.”

This one, while perhaps common sense, is very important. 

Why?

Despite the fact that I think most parents would agree with the importance of reading to your children, studies show that only about ½ of children are read to aloud every day.  In addition, reading to children sets the stage for their speech development which helps them do better in school. So what are the reasons for not reading to your child?

1. I don’t have time.

We aren’t asking that you read “War and Peace” every night with your 6 month old.  I’m hoping for about 5-10 minutes of reading (1-2 short books).  Ultimately, if you don’t have that much time then just read for the amount of time that you can, any amount is better than none.  Our kids really like to read during meal times as well, it tends to keep them eating and moving and keep their fighting about food to a minimum.  If you routinely watch TV during meals, it’s a much better alternative.

2. If they don’t understand, it doesn’t matter.

Reading to your children even before they are speaking is an important part of teaching them language.  Babies learn the sounds of language long before they know any words.  The number of words a child hears before they start kindergarten is a strong predictor of how well they will do in school. This is why it’s not only important to read to them, you should also spend time talking with them all throughout the day.

3. It is so boring.

This one I can really sympathize with. There are nights where I feel like I deserve an Oscar for my dramatic performances … but there are also nights where I drone on in monotone and doze off between pages. It is important to really engage your children as best you can, based upon their age. Have them help you count objects, letters or words on the page.  If it’s a book you’ve read 1000 times, read the wrong word and let them correct you (“Ohhhh … daaaadd, you’re so silly!”).  You can be selfish here.  Do whatever it takes to make it interesting for you, it will make it easier for you to do it and it’s likely that your child will enjoy it more as well.

4. They don’t even seem to enjoy it.

Let’s face it … sometimes they don’t even seem like they care. Your 12 month old is crying because he or she is tired but doesn’t want to go to bed. My 2 year old would rather chew on a book than have you read it.  My 5 year old would often rather be reading his own book than listening to me. But, I press on. Reading is not only beneficial for the language development, but studies show that it helps to develop more nurturing parent-child relationships.  Perhaps more importantly, is what it does for me. After a hard day at work, getting home to refereeing the boys fights for 2 hours, it’s nice to have some one-on-one time with each child to remember that I still like them.

5. No one ever told me it was important.

Well, you can’t use this one anymore can you?  Just in case you missed the message, it’s important.

Start by making a plan to read to your child every day for the next month.

Get a calendar out and mark off the days. 

I promise it will benefit your child for years to come.