Hepatitis A is an infection of the liver. It can be passed easily from contaminated food, water or close contact with an infected person.

"Hepatitis A can cause outbreaks in day care which infect many children and last for several months,” Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases. “Good hand washing techniques can prevent outbreaks and decrease the spread of the disease, but the best protection for your child is to have them vaccinated.”

Hepatitis A usually goes away on its own within two months. There are no lasting effects in most once the infection passes. Symptoms include:

• Tiredness
• Loss of appetite
• Fever
• Nausea and vomiting
• Abdominal pain or discomfort
• Yellowing of the eyes and skin—jaundice
• Darker colored urine
• Light or chalky colored stools
• Rash

Medical treatments that may help prevent infection include:

• Immune (Gamma) Globulin—temporary protection from hepatitis A. It can last about 3-6 months. It must be given before exposure to the virus or within 2 weeks after exposure.
• Hepatitis A vaccine—highly effective in preventing infection. It provides full protection 4 weeks after the first injection. A second injection provides long-term protection. The vaccine should be considered for:

• All children aged 12-23 months.
• Children aged 24 months or older who are at high risk and have not been previously vaccinated.
• People traveling to areas where hepatitis A is prevalent (The Centers for Disease Control and Prevention's http://wwwnc.cdc.gov/travel/ shows which areas have a high prevalence of hepatitis A).
• People with chronic liver disease.
• People with blood-clotting disorders, such as hemophilia. 
• People who desire immunity to hepatitis A.

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

Richard Roberts, M.D., a neurosurgeon at Cook Children’s, wonders what it’s worth for your child to play sports with a reputation for head trauma.

“I think the fact that when the NFL players sued the league initially and won, the judge said the settlement (more than $700 million) wasn’t big enough,” Dr. Roberts said. “That says a lot about this growing issue more so than anything else.”

The issue discussed in the NFL cases has been CTE (chronic traumatic encephalopathy), a progressive, degenerative brain disease that has been found in some athletes with repetitive brain trauma.

Research is currently being done to study just how playing contact sports such as football mainly, but also soccer, can cause damage to an athlete’s head. But is it worth it for parents to wait for the results of this work.

“Amateur sports are different than professional sports because no one is feeding their family with the activity that they are doing,” Dr. Roberts said. We need to look beyond the short term and really understand what could happen in the long term. That potential for long term problems should be the primary thought, not the secondary thought.

“What is the actual incidence? We don’t know. But if it was your kid, how much would you be willing to risk? Even if it was 1 in 10, would you roll the dice on your own kid?”

Dr. Roberts has previously worked at Children’s Hospital in Philadelphia and Charity Hospital in New Orleans. While he saw concussions at the other hospitals, he’s never seen parents argue with him about concussions as he has seen at Cook Children’s.

“Part of what I’ve seen which is different here than other places is that I do get push back from parents who I think underestimate the severity of some of these injuries,” Dr. Roberts said. “Some of it is that they want their kids to play and I think some of it is the short term nature of some concussions.”

Children get concussions and they do well relatively quick, so opposed to having a broken arm which is in a cast or needing surgery and having stitches for three weeks, kids hurt their heads, they are knocked unconscious for five minutes, but then feel essentially better soon after. This apparent sign of improvement makes it difficult for some parents to grasp that their child may have a fairly significant brain injury.

“The more we understand concussions and the more we see people who have hurt their heads for various reasons, soldiers, professional athletes, anyone who has suffered a head injury, I think that we are seeing that in adulthood they are starting to have more cognitive issues,” Dr. Roberts said. “Now the science is not perfect yet. We can’t say to a football player you had three concussions and that’s why you have dementia. We can’t say to the soldier you were exposed to be a bomb blast and that’s why you have dementia because it could be multifactorial. It could be that you have the right genes to make you this way later on. But the percentage seems higher in people who have had traumatic brain injuries.”

Dr. Roberts says parents should be concerned after head injury one. He knows you have to let kids live their lives and be kids, but the brain wasn’t made to get beat up like happens sometimes in sports.

It’s not known for sure that after one concussion, people are more likely to get more, but Dr. Roberts’ suspicion is that it is likely the case.

And when does he have a serious heart-to-heart with the parents and the athlete?

“After two. We discuss no longer participating in the activities which could cause further injury because the likelihood of you having a head injury in your lifetime is still pretty high,” Dr. Robert said. “You are going to hit your head on a tree branch or you are going to fall off your bicycle or someone is going to run into you. You are going to be stepping out of the car and slip or walking across ice and fall down. My opinion after behavior has shown us that you are going to get injuries in a particular sport, you should probably not be playing in that sport because you are not able to protect your head.”

Dr. Roberts has seen strong reactions from both the parents and the kids after being told he or she should quit playing their respective sport. And it’s not just football as most people expect. It’s with the gymnast who has fallen off the bars and knocked herself out or the soccer player who has headed the ball and gotten knocked unconscious.

But football still remains king in Texas – in popularity and in concussions.

So what can be done about it?

Dr. Roberts is not sure there’s a good answer to that question. Building better equipment helps, but then armoring players probably makes them feel invincible and they hit harder. If you take away the facemasks or hard shell football helmets, he expects you will return to the old days – less concussions, but more skull fractures and in the process, immediate deaths on the playing field.

For now, Dr. Roberts wants parents to monitor their kids closely and to take the recommendations from their doctor closely. If they say it’s time to stop – stop!

“All the steps that sports are taking to make it safer are positive,” he said. “I think that everybody involved has to think less about return to play and more about long term health.”

About the source

Richard Roberts, M.D., is a neurosurgeon at Cook Children's. When a child with a neurological disorder requires surgery, the experts at Cook Children's Medical Center offer comprehensive care and state-of-the-art technology. With the help of such state-of-the-art equipment as the revolutionary intraoperative MRI (iMRI), our neurosurgeons are able to determine effectiveness of surgical procedures for cranial and spinal nerve disorders and tailor the treatment to each child's unique needs.

Unfortunately, it’s also a troubling trend among today’s high school athletes.

Cook Children’s pediatrician David H. Goff, M.D., FAAP, calls overstressed, busy children a huge problem – both in the classroom and on the playing field. In his Denton office, Dr. Goff sees patients who suffer from a variety of symptoms like chronic abdominal pain, anxiety and depression.

“I see this over and over. I look in the child’s eyes. They are exhausted. I say to the parents, ‘You need to cut back,’” Dr. Goff said. “And it is amazing to me. They say, ‘We can’t. No way. We have a tournament this weekend.’ For any successes we have, we have 100 more burnouts.”

The American Academy of Pediatrics agrees with Dr. Goff. A group of eight organizations, including the AAP, released a consensus statement regarding their concern with today’s high school athlete.

The AAP states, “Student athletes report higher rates of sleep disturbances, loss of appetite, mood disturbances, short tempers and inability to concentrate than non-athletes.”

The recommendations focused on the importance of educating students, parents and coaches on mental disorders in student-athletes; the stress involved with today’s athletes and ways to monitor their behavior.

Concerns of the AAP included the injuries and stress related to student athletes training year round, which doesn’t give them time to rest and recover.

The AAP said these athletes also face stress from poor performance on the playing field, injuries, concerns about getting cut from the team and trouble keeping up with school work, along with their extracurricular activities.

Because of the stress involved, student-athletes may suffer from “a pattern of lack of sleep and under-recovery” and chronic fatigue that puts him or her at risk for anxiety and depression. Other issues include:

• Physical (Physical conditioning, injuries, environmental conditions)
• Mental (Game strategy, meeting coaches’ expectations, attention from media and fellow students, time spent in sport, community-service requirements, and less personal and family time)
• Academic (classes, study time, projects, papers, examinations, attaining and maintaining the required grade point average to remain on the team, and earning and maintaining a collegiate or academic scholarship).

David Gray, M.D., medical director of Cook Children’s Orthopedics and SPORTS, agrees with Dr. Goff that too much activity can simply be harmful to a young person.

With the advent of select sports and recreational leagues, Dr. Gray said children now play the same sport year round without getting a break from those activities. He wants young athletes to have variation in their activities. If not, the repetitive nature of the same sport creates stress and strain especially on growing bones.

Dr. Gray and his colleagues see children who never have a break during the year sometimes playing on two or three different teams during the same season. He said it’s too much stress on their growing skeleton, causing muscle aches, strains and pain.

Both Dr. Gray and Dr. Goff stress children, especially before they reach high school, should focus on participating in several different sports to prevent using the same muscles year round. They say it also helps the child avoid getting burned out on that specific sport.

“For kids, sports are great and you learn a lot from them, but they should be fun,” Dr. Gray said. “Kids need to enjoy them too. You don’t really want a 12 or 13 year old performing to the point where they are having injuries that could actually impact them as an adult.”

Dr. Goff admits this subject quickly places him on his soapbox. But it’s because he sees so many of his patients facing stress and are simply not happy.

He sees them come in with dark circles under their eyes and behind closed doors and just one-on-one with him, they admit to a different story than what they have been telling to their parents.

Far too often, Dr. Goff hears the regrets of parents, but only when it’s too late. The child has gone off to college and the parent wishes they had taken a trip to the Grand Canyon with their family, instead of racing off to another game.

“I ask the parents to leave the room so I can talk to the child,” Dr. Goff said. “I ask, ‘Do you really want to do this?” They say, ‘No I’m tired.”

The scary part of this story is that far too often the parents are trying to do what’s best for their child, but in reality they are doing harm.

Dr. Gray said he is beginning to see injuries in children as young as 8 years old with ACL injuries. Injuries that were once thought not to happen until children were much older.

“Another problem is that the really good, young kids are getting left behind,” Dr. Gray said. “They are burned out because they are pegged to be the superstar and they get over worked, over trained and over pushed. Some get burned out and pushed to the wayside and other kids, who were not as big, catch up by the time they are in middle school. They have more passion and they are not burned out. And they pass them by.”

Both Dr. Gray and Dr. Goff also see phantom injuries – muscle aches or headaches. Anatomically there seems to be nothing wrong with the child. In reality it’s the child hinting he or she needs a break.

So what should a parent do? Here’s a start:

• During the year give the child down time and a chance to recuperate. This is the case physically for sports and mentally for school.

• Vary the child’s routine to avoid burnout

• Give your children an opportunity to tell you if they are enjoying themselves.

“It’s easy to succumb to parental peer pressure,” Dr. Gray said. “Parents are afraid if they don’t do something their child will be left behind. What’s most important is that your children enjoy sports, or enjoy their activities and has a good mental outlook on life. It’s hard for parents to not live vicariously through their children. It’s a hard lesson for parents. You want the best for your child and want your child to be successful. But sometimes less is more.”

Even skilled physicians may not be on the lookout for something as uncommon as CHI in newborns, which could be the difference in preventing irreversible damage and improving the quality of a child’s life.

That may all change following an article published in the Journal of Pediatrics titled, “Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants and Children.”

Paul Thornton, M.D., medical director of Cook Children’s Congenital Hyperinsulinism Center and Endocrine and Diabetes program and an Endowed Chair, led the team of experts from around the world in creating new screening for physicians to recognize and manage neonates at increased risk for a persistent hypoglycemia disorder.

“Infants with uncontrolled hypoglycemia caused by CHI are at risk for seizures or permanent brain damage without early identification and screening,” Dr. Thornton said. “These new guidelines will help physicians who recognize these symptoms shortly after birth and then provide the specialty care which may make the difference on whether this child has a productive and fulfilling life.”

The article states that “failure to investigate a neonate, infant, or child with suspected hypoglycemia increases the risk of delaying a definitive diagnosis and instituting effective treatment.”

But quickly identifying the specific cause of hypoglycemia allows for timely and appropriate treatment to begin and decreases the risk of permanent brain injury from persistent and recurrent severe hyperglycemia.

Dr. Thornton was chosen as the principal author of the article because he’s internationally known in the field of CHI. He leads a highly skilled team of specialized physicians and supporting specialists to treat hyperinsulinism.

Cook Children’s Hyperinsulinism Center is the only one of its kind in the Southern U.S. and the second in the country.

Davelyn Hood, M.D., president of the CHI Board of Directors said her organization “is thrilled beyond words” that long-awaited hypoglycemia guidelines have been published this month in the Journal of Pediatrics.

“We consider this a sentinel moment in time for the entire congenital hyperinsulinism community,” Dr. Hood said. “Many patients born with this congenital HI are discharged from newborn nurseries without adequate study of their hypoglycemia, often with tragic consequences. These guidelines give us hope.”

Dr. Hood said she believes the guidelines will save countless lives and improve the well-being of HI children everywhere. She also praised Dr. Thornton for all of his work for CHI patients.

“He cares for children across Texas and the U.S. with one of only two dedicated Hyperinsulinism Centers in the country,” Dr. Hood said. “He speaks to clinicians around the globe about the proper management of hypoglycemia and leads HI research to better understanding of the disease and best treatment options. Most importantly, Dr. Thornton, brought the HI research community together, took all of their collective knowledge regarding hypoglycemia and its underlying causes, and articulated that into clear guidelines for clinicians of all types that care for neonates, infants and children. Dr. Thornton is a definitely a ‘CHI Super Hero.’”

More about Cook Children's Hyperinsulinism Center

One of only two such programs in the nation Cook Children's Hyperinsulinism Center uses a specialized team approach to treat this rare disease. Hyperinsulinism affects many areas of the body, so to truly treat the disease, each child is seen by top physicians, nurses, researchers and specialists in the field. These medical professionals have spent additional years of intense study and have dedicated their practice to focusing on hyperinsulinism so that your child will has access to the medical care that treats all the symptoms. It is this level of treatment that has helped earn our program a distinguished international reputation for extraordinary care and achieving positive results.

We cannot give into fear. We need to be prepared. Know the signs. Have a plan.

Before the storms even start it is important that you have a plan for your family’s safety.

You need to pick a safe room in your home where your family can gather. The safest place is a basement or storm cellar but these are pretty rare in North Texas so you need to pick an interior space in your house on the bottom floor like a closet, bathroom or hallway where there are no windows. You want to put as many walls between you and the storm. The biggest source of injury in a tornado occur from being struck with flying debris so if you can pull a mattress into your shelter space or cover with heavy blankets or sleeping bags you will increase your protection. Contrary to popular belief you do not have to pick an area in the southwest corner of your house. Just pick the safest area in your house. Also you do not have to open or crack windows to equalize the pressure in your house. You are just increasing your risk of getting hit by flying debris.

If you live in a mobile home get out! People are 15 times more likely to die in a mobile home than any other location. Try to take shelter in a permanent structure if you can. As a last resort if you cannot find a permanent structure for shelter then go to a low lying area like a ditch and cover your head.

If you are at work, take shelter in an interior room, stairwell, or bathroom on the first floor and away from windows. Your office should have an inclement weather plan and remind employees of it twice a year.

If your child is at school they will be instructed to follow the school’s tornado plan. Schools will go on lockdown mode and move the children to the safest area possible. Follow your school’s tornado and inclement weather plan. It is the best way to ensure your child’s safety as well as your own. Your child has gone through numerous safety drills at school and knows to follow the schools plan. Reassure them that this is the safest thing to do. Remind your children to follow what their teachers have taught them. The best way to reassure your child is to help them understand the importance of following the direction of the adults who are caring for them.

If you are outside, try to find shelter in a permanent location. If you cannot find structural shelter get in a low lying area and cover your head with your hands and arms. Try to pick a spot away from trees and other potential projectiles.

If you are in your car and cannot get to a structural shelter, the American Red Cross recommends staying in your car. They recommend pulling off the road. Leave your seat belt on and crouch down away from the windows. Try to cover your face and head with a coat or blanket is possible. They do not recommend trying to take shelter under an overpass or bridge. Do not try to flee a tornado that is moving toward you. They also note if your car is near a low-lying ditch or culvert it may be safer to leave your vehicle and get to the lowest point possible. Always remember to cover your head with your hands and arms.

It is important to know the difference between a TORNADO WATCH and a TORNADO WARNING.

TORNADO WATCHThis means that the conditions are present that make a tornado possible over the next several hours. This does not mean a tornado is about to occur. It is a caution to be vigilant as you go through your day.

TORNADO WARNING

This means an actual tornado has been spotted or that meteorologists have picked up rotation on their Doppler radar. Your city’s safety alert siren will sound if a tornado warning is occurring. This is a sign to go to your safe area.

I highly recommend you get the American Red Cross app for your phone. This is a free app that will alert you if a TORNADO WARNING is occurring in your area. It also has excellent tips about tornado preparedness and the ability to set up a blast message you can send to friends and family to let them know that you are safe. It will send the message via email, Message, Twitter, and Facebook.

It is a good idea to create an emergency- preparedness kit. The American Red Cross recommends you include the following basics:

• Water – at least a 3-day supply. One gallon per person per day.
• Food – at least a 3 day supply of nonperishable easy to prepare food
• Flashlight with batteries
• Battery powered or hand crank radio
• First aid kit
• 7 day supply of all necessary medications
• Copies of personal documents
• Family and emergency contact information
• Extra set of clothing and study shoes
• Sanitation and personal hygiene items

You have a Plan.You know the signs. Be safe. Have Faith.

Sandra C. Peak, M.D.

Learn what you shouldn't do during a tornado here.

Even highly competitive and high intensity training can be healthy, but can it become unhealthy?

One of the dangers of intense training can be a lack of food intake to keep up with the demands of the sport. Have you seen the pictures of food in front of Olympic swimmers? They often eat up to 10,000 calories per day. Yet, our young teenage athletes, in an attempt to manage their weight or achieve a particular body image sometimes cut calories to levels even below their less active peers.

This is when their health could be in danger.

Certain sports may put athletes at higher risk to engaging in unhealthy behaviors. Think about those where body image plays a large role such as dance or gymnastics. Those competing in sports that classify participants based on weight class can also be at risk. Even participants in sports that don’t fall into these categories can have pressure put on them to “lose a few pounds” in order to improve.

These problems can arise in boys and girls, but girls can have particular health consequences that need to be considered.

What is the female athlete triad?

• Energy deficiency (not eating enough food)
• Loss of periods
• Low bone mass (osteoporosis)

Energy deficiency -This can be the result of simply not consuming enough food or it can be a conscious method to decrease calorie intake for weight loss. In more severe cases it can be the results of an abnormal body image or an eating disorder.

Loss of periods -The calorie deficiency can lead to decreased production of hormones that help periods to be regular. This can lead to missed periods or for periods to stop altogether. Missed periods are often the symptom that brings attention to the overall problem. Because of this, I recommend you check in with your athletes intermittently about their periods. Despite the weird and embarrassed look on faces (it translates, “Mom, can you believe he’s asking this?”), I ask at every check-up.

Low bone mass - Decreased hormones and intake of calcium can lead to thinning of the bones. When severe, this can cause stress fractures, which are fractures that occur with very little or no trauma. In addition, girls are supposed to building up bone density in this time frame and the long term implications of not doing so could have severe consequences.

What can you do?

Pay attention to your athletes and their eating habits.

If you see any of the following, set up a visit with your pediatrician to address your concerns:

1. Weight loss or disorder eating habits.
2. Irregular periods or no periods.
3. Injuries from mild activity or that tend to linger.

Together you and your pediatrician can gather a team around your athlete to ensure their health for now and into the future.

Some potential members of the team could include a:

1. Pediatrician
2. Dietician
3. Counselor
4. Coach or trainer

Ailments run the gamut from respiratory and fever issues (RSV and influenza) to gastroenteritis with vomiting, diarrhea and severe dehydration. And while there’s not one illness that stands out, one thing is for sure – children in the ED are sicker than they’ve ever been.

“Our ED is running beyond full capacity and has been since December. But in the last few weeks we’re seeing a larger number of very ill children than even during flu season.” said Corwin Warmink, M.D., assistant medical director of the Emergency Department at Cook Children’s. “The sicker the child, the longer it takes to diagnose, treat and properly care for them.”

In December, 20 to 30 kids were admitted for treatment per day from the Emergency Department, but by February, those numbers jumped to about 40 to 50 children a day.

The Emergency Department is averaging nearly 400 patients per day, and during its busiest times a patient will check in every two minutes.

Overall, children appear to be sicker this year. Compared to this time last year, Cook Children’s has seen a 60 percent increase in the percentage of children who need critical care.

As the number of patients admitted and treated in the ED increases, so does the time physicians spend with each child, which contributes to the much longer waiting times.

Depending on the severity of the illness or injury, it could take 4 to 6 hours to care for a child. But it’s not just one physician treating that child. Nurses and health care providers may be brought in too.

“Many of the children we see are dealing with very serious emergencies and they receive immediate care,” Dr. Warmink said. “We use all necessary resources and manpower to care for those children. Unfortunately, that means longer wait times for the families in the waiting room.

“Families could spend anywhere from 5-10 hours or longer in our waiting room, depending on the day they visit. We are actively bringing in extra doctors, nurses and support staff to try and improve these times.”

Dr. Warmink advises parents that Sundays and Mondays are the busiest days of the week in the ED. Evenings after 5 p.m. seem to be popular too.

Families with sick kids who aren’t experiencing emergencies do have other options. The first line of defense is your child’s pediatrician. Making an appointment with a child’s doctor may help avoid a long wait at the ED. Cook Children’s also has several Urgent Care Clinics for non-emergent needs.

Previous articles on this topic:

• More flu, longer waits in the ED
• Emergency? 6 signs from an ER doc
• Cook Children's to build new South Tower on main campus
• Is it RSV?
• 8 flu myths I wish would go away

Liam lived from March 25 to Nov. 1, 2013, and spent much of his brief life at Cook Children’s with critical issues ranging from an operation to repair his intestines, to heart problems, to feeding concerns.

He seemed to be constantly fighting until it was too much for his little body to overcome.

Now a little over a year later, Vickie Phathaphone, Liam’s mother, looks back on her time at Cook Children’s with an emotion that may be surprising to some – gratitude.

Recently, Phathaphone reached out to Cook Children’s Facebook page. She wanted to thank the staff who treated her little boy.

“My family and I, including Liam, loved the medical staff at Cook Children’s and you guys gave us the most amazing experience and educated us well,” Phathaphone said. “The staff at Cook Children’s helped my family and me by teaching us how to not be afraid to hold our little Liam.”

Phathaphone said doctors and nurses updated her family every day and Cook Children’s updated her by cellphone as needed. She said the NICU nurses taught her so much, ranging from the importance of breast milk and how to pump it, to how to carefully bathe, feed and hold her fragile baby.

“Although being a parent is natural, with Liam’s condition it was quite frightening,” Phathaphone said. “We did not want to hurt him, but we were reassured by the nurses what not to do and what to do. I loved how the staff treated Liam, as he was a part of their family, and I am thankful that Liam was under such amazing care.”

After letting a group of the physicians know about the letter, they were appreciative of Phathaphone’s kind gesture and began to reflect on the loss of not only Liam, but other children who have died too soon.

Surgeons Vincent Tam, M.D., James Miller, M.D., and Lisa Roten, M.D., a cardiologist, share with us what their life is like after the loss of a child.

Dr.Tam

He tries to stay in control as he fights back the tears.

But on this day, as hard as he tries, Vincent Tam, M.D., a pediatric heart surgeon at Cook Children’s, struggles to keep his composure. He’s thinking about Liam.

Dr. Tam performed two heart operations on Liam. All the procedures were successful, but other underlying problems were simply too much for the baby, who was born premature, to overcome.

In practice for 23 years, Dr. Tam copes with the death of a patient by compartmentalizing the loss. He tries his best not to dwell on it, so it won’t impact his performance in the operating room or his role as husband and father. Then, every once in a while, he receives a note or hears from a parent whose child has died, like the one from Phathaphone. The parents don’t want to express grief or even anger, but simply to say thanks.

“It’s hard because if somebody dies or somebody has a bad complication, I think, ‘Oh gosh, could I have done something differently?” Dr. Tam trails off and after a long pause continues to speak. “There’s all kinds of questions that you can ask as a Monday morning quarterback, but personally I’ve dealt with it in a way that I feel like I’ve … um …”

Again, a long pause as he composes himself. “I do the best I can with every surgery and that’s all I can do.”

Dr. Miller

Shortly after Liam’s birth, James P. Miller, M.D., a pediatric surgeon at Cook Children’s, operated on him to repair gastroschisis, a condition where the baby is born with the intestines on the outside of the body.

Even after 17,000 surgeries and 27 years as a surgeon, it only takes a quick glance at a child’s chart for the memories to come flooding back. He remembers Liam and his mom. He says he knew from being around her for a short period of time and the love and compassion she always showed to her child, Phathaphone would be a great mom.

Dr. Miller has gotten to know some patient families well over the years. Throughout his career, he’s been to many of their weddings, but he’s also seen death.

“It can devastate you for weeks,” Dr. Miller said. “It can be like reopening a wound when you realize it’s the first anniversary of a child’s death. You hope you have somebody in the hospital that you have helped or made a difference in their lives, just to get out of your rut. I don’t think people realize how much doctors do feel. When you do what we do with these kids, you do get attached to them.”

Dr. Roten

For the patient families who are cared for by Lisa Roten, M.D., a cardiologist who specializes in fetal echocardiography at Cook Children’s, they see someone who cares deeply for her patient families. But they also may be surprised to know that she understands Dr. Tam’s need for compartmentalization.

“The truth is, you have to do that,” she said. “You wouldn’t be a physician if you couldn’t do that. We have a work life and we have a personal life. I can’t carry that home with me. I do talk about the loss of my kids, but with the people who can empathize with me. I talk to my colleagues and staff, the other doctors and nurses, who cared for the child.”

Still, Dr. Roten admits to developing a special bond with most of her families and says a gesture like the one from Phathaphone and other parents means a lot to her. As much as the families sometimes need closure by writing a note or speaking to the doctors, Dr. Roten also needs to find a way to say thank you to the parents for entrusting their child’s care to her and goodbye to the children.

Dr. Roten makes every effort to reach out to families who have had a child pass and to go to the funerals whenever possible. It allows her to complete the circle of care.

“At the end of the day, we’re all humans. We are people who have families and we are touched by these families we see,” Dr. Roten said. “Even after the child dies, they never really leave our lives. There are ways that we continue on together. We take our cues from the family. If they ever want to reach out or touch base with us, that’s comforting to us. It is the end of a relationship that sometimes you’ve had for years and years with families and sometimes like in Liam’s case, it’s been shorter.

“But they are all so special to us.”

Most of the time there’s nothing to be concerned about, but I want to give you the reason why they happen and what you should worry about.

In-toeing

The most common cause is that the lower leg bone tilts outward. This might not be noticed until the child starts to walk, when parents will only notice because the foot turns inward. In addition some of the bones might be slightly rotated because of a tight fit in the womb.

These causes rarely result in problems walking. The complaint of, “My 18 month old falls all the time” is really hard to evaluate. We can generally wait a little bit to see if things improve. As the child walks, things will generally, slowly straighten out. The changes are so painfully slow that you may not notice any difference. Take pictures or videos of your child walking as these can be helpful.

As always, bring any concerns to your pediatrician but here are some warning signs:

1. Does not resolve by age 3.
2. Has a limp or complains of pain.
3. Developmental delays (walking or other).
4. Problems seem to be getting worse, not better.

Bowlegged

Another common question (usually in the first year of life) is a child who is bowlegged. This can be noticed early on but, like in-toeing, is often identified after the child starts to walk. Because of the way that babies are squeezed into the uterus almost all have some degree of “bowleggedness” at birth. Usually both legs and both the upper and lower legs are affected. This will almost always start to improve as bones remodel when the child starts to walk.

Again, take any concerns to your pediatrician, but here are the warning sign for bowed legs:

1. Is not resolved by age 2.
2. One leg is more affected than the other.
3. Child’s length/height is not growing normally.
4. The knee seems to shift outward with walking.

Most of you can rest assured that your child’s pigeon toes or bowed legs are normal. If you have questions or concerns, contact your Cook Children’s pediatrician.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page. He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

“Palpitations” is a word that we use when we become aware of the beating of our own hearts. Like many things in medicine, palpitations can be both normal and abnormal. Who of us cannot remember feeling our heart race after we have been scared or excited? This sensation is typically normal. Our bodies respond to emotional stimuli by secreting hormones and activating nerves that tell our hearts to beat faster and harder (perhaps to get ready to run away from danger).

However, palpitations are not always normal sensations. Palpitations can also be felt when we experience an “arrhythmia.” The heart’s beating is controlled by electricity. Typically, the electrical impulses start in a specific location in the top chambers of the heart (the “sinus node”) before traveling down specialized conduction pathways (like “wires”) to activate the rest of the heart. Most arrhythmias in children come from a short circuit in the wiring of the heart. Instead of the sinus node dictating how fast the heart beats, it is the characteristic of the circuit that dictates how fast the heart beats.

Palpitations occur frequently in kids. Older children and adolescents typically have no problem describing their symptoms (feeling that their heart is “racing”, or “beating out of their chests”). However, young children cannot often accurately describe what they are feeling. Some may say “my heart is beeping,” but others might indicate that their chest or heart is “hurting” or “feeling funny.” It is not uncommon for children to “feel their heart beat in their neck.” Babies, of course, cannot tell us anything about the way they are feeling. Frequently, all that we notice in babies with arrhythmias are actually signs of heart failure (which occurs after about 24-48 hours of arrhythmia), such as poor feeding, trouble breathing, lethargy or fussiness.

How can we know the difference between normal sensations and those of an arrhythmia? Here are a few tips:

1.Onset and termination: Because arrhythmias are “short circuits,” they tend to start and stop suddenly. Often patients can remember the exact moment when the sensation started and stopped. Palpitations that come from anxiety, fear, excitement, etc. tend to start and stop more gradually.

2.Heart “beating in the neck:” Many arrhythmias alter not only how fast the heart beats, but how it squeezes, making it less efficient. Instead of all of the blood traveling forwards, some may travel backwards to the blood vessels in the neck, causing this strange sensation.

3.Associated symptoms: Arrhythmias are frequently accompanied by symptoms such as chest pain, shortness of breath, and dizziness.

4.Signs of heart failure in babies: Poor feeding, trouble breathing, lethargy, or fussiness could indicate an arrhythmia in babies and should prompt parents to seek immediate medical attention.

However, even with these tips, the difference between normal sensations and those coming from arrhythmias can be difficult to tease out. The only way to know for sure is to monitor the electrical activity of the heart (using an “electrocardiogram” or “EKG”) during symptoms. There are now many types of devices that can aid diagnosis in this way, and your cardiologist may send you home with one.

The good news-arrhythmias in children are typically very treatable-either with medicines or with a procedure called an “ablation.” Either way, the goal is for the child can carry on with normal life … without a beeping heart.

Ensure school-age children know when to wash - before eating and after playing on a playground at recess, using the restroom, and coming into contact wiht friends and classmates. Teach kids that it's important not to chew their fingernails or touch their faces.

"Hand-to-mouth transmission is a major way children are infected by viruses," said Vanessa Charette, M.D., a Cook Children's pediatrician in Fort Worth. "Keeping hands out of the mouth is a difficult behavior for certain children to master, but it's important that they do."

Little hands can pick up a lot of germs. At any given time, you have close to 150 different bacteria living on your hands, and 80 percent of illnesses are spread by direct human contact. For kids, stomach bugs, strep throat and other bacterial illnesses can spread quickly, particularly in environments such as schools and day cares.

"I also tell young children to keep their hands below their neck. They don't rub their eyes, such their fingers or pick their nose," said Kim Mangham, M.D. a Cook Children's pediatrician in Keller. "Kids can have all the germs in the world living on their hands, but they don't put their hands in their mouth, nose or eyes, they won't get sick."

Having trouble convincing your children to get with the hand hygiene program? Let them know that fighting the spread of germs can be pretty cool. A recent study published in the American Journal of Infection Control concluded that fist bumping transmits far few bacteria than handshaking.

Moisturizing children’s skin during the winter is important and that includes wearing protective lip balm.

“When children get chapped lips, they tend to scratch their lips with their tongues, which can lead to infection if there are germs on the skin,” said Frank McGehee, M.D., a Cook Children’s pediatrician. “Children should apply lip balm two to three times per day.”

Dr. McGehee recommends parents purchase an inexpensive variety of lip balm because many children are prone to lose small items like lip balm frequently. He also suggests the lip balm have sunscreen in it.

Speaking of sunscreen, people in warmer climates are especially susceptible to winter sunburn because it’s tempting to stay outdoors longer when the stifling heat of summer passes and the temperature is milder. Dr. McGehee said children should wear and reapply sunscreen every 60 to 90 minutes when they’re outside.

That information should last until next year, when we’ll probably forget again. After all, who wants to get used to this cold weather.

About the source

Frank McGehee, M.D., continues a Cook Children's legacy that began more than 70 years when took over the office at 1129 Sixth Avenue in Fort Worth, near the medical center. For an appointment, visit here or call 817-347-6859. 

I can’t tell you how many times I’ve heard this from anxious parents as their child is having his echocardiogram done. In reality, a murmur is something that is heard, not seen.

In a normal heart, the valves make noises as they close, the classic “lub-dub” attributed to normal heart sounds. A murmur is an extra sound, “lub-shhh-dub.” Most of the time the murmur is innocent or functional, some may call it benign.

Innocent murmurs are simply sounds we hear as blood flows through a normal heart. More than two-thirds of children with normal hearts will have a murmur at some point in their life. There are classic innocent murmurs that occur at various times throughout a child’s life, and usually they go away on their own over time.

Aside from these are the pathologic murmurs, or sounds that occur because there is a problem with the heart, maybe a valve that isn’t working properly, a hole in the heart, or a vessel that is narrowed.

Typically there are characteristics that help distinguish innocent murmurs from pathologic murmurs. Louder, more harsh murmurs are more characteristic of pathologic murmurs. The timing that the murmur is heard is also important. Innocent murmurs are typically heard when the heart is squeezing (this is a systolic murmur). In the case of innocent murmurs, there is usually no need for further evaluation. Innocent murmurs don’t “progress” to pathologic murmurs. There is no need for activity restrictions and no need for antibiotics when the child goes to the dentist. In the case of pathologic murmurs, follow up, activity restrictions, and whether the patient needs antibiotics when he or she goes to the dentist all depend on what is causing the murmur.

Having said this, not all systolic murmurs are innocent. Murmurs heard when the heart is relaxing (diastolic murmur) are usually pathologic.

An echocardiogram is a test that helps us evaluate the heart in the event that the murmur sounds concerning. The probe, or camera, sends ultrasound waves toward the heart . This time it is about what we see. The waves bounce off solid structures and the machine organizes the returning signals into a 2D picture, which is displayed on the screen. The study also uses color signals to help determine the direction of flow, and Doppler signals to determine how fast the blood is traveling across different areas of the heart.

The cardiologist uses all of this information to determine if there is a problem and a treatment plan for the child begins. And to think it all begins with those first anxious moments of listening to a child’s heart.

About the author

Deborah Schutte, M.D., is the medical director of Cardiology at the Cook Children's Heart Center. The cardiology team at Cook Children's has extensive experience in the diagnosis and treatment of pediatric heart care. They know the unique requirements of treating the growing hearts of children, including those with extremely rare and difficult conditions. Our areas of expertise include cardiac surgery,interventional cardiology, adult congenital cardiology, electrophysiology, cardiac testing and imaging,echocardiography, fetal echocardiography and cardiac anesthesiology.

It is so interesting to note that maternal food preferences (what moms eat, why we eat, and how much we eat) strongly influences the eating behavior of our children. Like so many areas of parenting, our kids will do what we do way more readily than they will do what we say.

As we approach the Thanksgiving holiday, it is a great time to give thanks for our own health and for the health or our children. It is a great time to reflect on the self-care we model for our own children. Studies suggest that toddlers may need to taste a food 10-15 times before they decide it is something they want to eat. Maybe, just maybe, as grown-ups we should try some new foods as well.

Here are some healthy Thanksgiving ideas from Theresa Nash, director of Food and Nutrition Services at Cook Children’s:

1. A sweet potato casserole can be prepared in a healthy manner, and because of their sweetness may be enjoyed by children.

2. Disguising a vegetable in a mixture of children's other well accepted food is a way to get them to later choose them prepared in other ways: ex: broccoli and rice or yellow squash casserole.

3. Try something more unique and unexpected like Brussel sprouts.

As for me, I will work on giving lima beans another 8-10 chances …

After she gave us her tips. Theresa gave us a fun Brussel sprouts’ recipe. She said this is one she loves and she’s still making for her “grown” kids today:

Roasted Brussels Sprouts-Kids “and Parents” will Enjoy

• 1 pound fresh brussels sprouts
• 3 Tbsp olive oil
• 3 Tbsp honey
• 1 tsp garlic powder
• Salt & Pepper to taste: optional
• 1/4 cup dried cranberries or golden raisins
• 1/4 cup grated Parmesan cheese

1. Preheat oven to 450 degree F.
2. Cut the ends of the brussels sprouts and cut each in half.
3. Whisk olive oil, honey, garlic, (salt and black pepper) in a bowl. Toss in Brussels sprouts and stir to coat.
4. Spread on a baking sheet and sprinkle with dried fruit and Parmesan cheese.

Bake for 15-20 minutes until golden brown. Enjoy!

About the author

Kim Mangham, M.D., is a Cook Children's pediatrician at 1601 Keller Parkway in Keller, Texas. She earned her medical degree at University of Texas Southwestern Medical School in Dallas. She completed the pediatric residency program at University of Oklahoma Health Sciences Center in Oklahoma City. Her interests include breastfeeding education as well as disease and injury prevention. Dr. Mangham is board certified in pediatrics.

Cutting back on the candy 

Trick or Treat alternatives at Halloween have become more popular over the years. Fun games and other events replace some of the candy focus. Head off to the nearest Fall Festival or other child-friendly Halloween party instead of the usual neighborhood Trick or Treat candy run. Children with diabetes may need to substitute the candy they receive for a healthier snack or a lower carb snack, depending on their exchange value. 

Better choices with the candy. 

Not all candy is created equal. Some candies pack much higher sugar and calories per fun size serving than others. A quick Internet search has a number of articles and references on nutrition breakdown on different Halloween candies. Strategies such as choosing the “healthier” candy and limiting the amount of candy collected make progress towards a healthier Halloween. Also, stretching out the eating of Halloween candy over a week or more may help with candy becoming an after meal dessert or even being forgotten. Kids with diabetes may want to save their treats for meal time when they would normally get a dose of insulin. This prevents the need for adding extra insulin doses or shots. 

Hit the road 

Walking door to door in the neighborhood is not always possible, but when possible, it offers some calorie burn to soften the sugar rush of the Halloween haul. Practically, walking means fewer doorbells will be rung and probably less candy collected. It’s important to not have too much candy during this time of year, but enjoy Halloween. And of course, feel free to share any extra Kit-Kat bars with your favorite pediatrician, especially if he’s an endocrinologist who happens to be writing this particular blog. 

Enjoy the treats.  

Joel

I’m always on the lookout for the latest news about developments in my field. In fact, I sometimes learn about the most up-to-date information by searching the news before I read about them in a medical journal.

A new diabetes technology under development caught my attention. The innovative technology developed at Stanford University uses a microchip for detection of type 1 diabetes.  A small sample of blood is placed on the microchip. The testing procedure detects auto-antibodies commonly found in those with Type 1 diabetes. The hope is that this new device can rapidly identify children who are at a high risk for developing Type 1 diabetes.

Illness symptoms of Type 1 diabetes, sometimes severe, are almost uniformly present at the time of diagnosis. It is frustrating both to me and parents that no easy screening is available to detect Type 1 diabetes earlier in its course when there are more possibilities of intervention. This new technology excites me as a way to overcome this barrier and expands intervention research opportunities in those in the early phase of type 1 diabetes. 

Screening for Type 1 diabetes is only currently done in large research studies such as the Trialnet Pathway to Prevention Study  and only in children who have a parent or sibling with Type 1 diabetes. It is possible that this new microchip will allow for wider, faster screening. The promise of an inexpensive, rapid test may help the growing number of children in countries with limited resources receive a prompt diagnosis and proper care for their Type 1 diabetes. 

The incidence of Type 1 diabetes continues to rise worldwide, and those of us in pediatric endocrine and other medical fields continue in efforts to better understand this mysterious condition. I believe a cure will come one day, but in the meantime, technology tools such as this microchip will form the new wave of innovation in Type 1 diabetes. 

If you are having even the slightest trouble, questions or concerns regarding your child’s safety in the car, certified child passenger safety technicians are able to help or even double check your work.

For those of you in the Tarrant County area, you can call Safe Kids Tarrant County, led by Cook Children’s, at 682-885-2634.  Also visit this site for a quick car seat checklist with the top 5 things to do to check your seat. 

1. When can my child change from rear-facing to forward-facing?

The American Academy of Pediatrics (AAP) recommends children ride rear-facing until at least 2 years old or until they reach the maximum height and weight for their seat. Keeping children in a rear-facing position better protects their heads, necks, and backs. Seats will indicate on the side labels what the rear-facing weight/height limit is and you can also check the manual of the seat. Parents often worry about the safety of a child’s legs when the child is growing taller and is still rear-facing.  Studies show that a child’s legs are actually injured less often when a child is rear-facing.  Both of my children were in the 90+ percentiles for height at age 2 and both remained rear-facing past 2 years old.

2. When can my child use a booster seat instead of a harness forward-facing seat?

The AAP recommends children ride in car seats with a harness until at least 4 years old, however they should continue to use a 5-point harness up to the highest weight or height allowed by the manufacturer of the seat.  Moving from a 5-point harness to a booster seat is a step down in safety, so a child should remain in the harness seat as long as possible.

3. When does my child no longer need to use a booster seat?

Texas law requires children to remain in booster seats until at least age 8, unless the child reaches a height of 4 feet, 9 inches before age 8 (which is extremely uncommon). 

Recommendations state a child should remain in a booster seat until at least age 8 or until the seat belt fits correctly. Most children are 9 years or older before they reach 4 feet, 9 inches, which is when the seat belt will usually fit them correctly without the booster seat. You can use the “Safety Belt Fit Test” to help you determine if your child is ready to use the seat belt alone without a booster seat:

1. Have your child sit all the way back on the vehicle seat.  Do the knees bend at the front edge of the seat?  If no, then your child should stay in a booster seat.  If yes, then go to No. 2.
2. Buckle the seat belt.  Does the lap belt lie on the upper legs or hips (not the stomach)?  If no, then your child should stay in a booster seat. If yes, then go to No. 3.
3. Does the shoulder belt rest on the shoulder or outer collar bone (not the neck)?  [Note- Never put the shoulder belt under a child’s arm or behind a child’s back.]  If no, then your child should stay in a booster seat.  If yes, then go to No. 4.
4. Can your child maintain the correct seating position for as long as you are in the car without slouching or moving positions causing the belt to move improperly to the neck or stomach?  If no, then your child should stay in a booster seat.  If yes, and you answered yes to all 4 questions, then your child is ready to use a seat belt without a booster seat.

4. When can my child sit in the front seat?

Children should not ride in the front seat until age 13. The safest place for a child in the car (or any person for that matter) is the back seat, particularly since the most common crash is a frontal crash.  Air bags deploy with such force that they can cause severe head and neck injuries to a child.

5. Do car seats and booster seats expire?

Yes, all car seats and booster seats expire. Usually they last about six years, but be sure to check for an expiration date on the seat label.

For more information:

• Car safety
• Is your child's car seat safe?
• FREE car seat checks
• Never leave your child alone in a car
• Look and lock
• Spot the tot
• From the car seat to the driver's seat
• Resources

About the author

Nicole Wineriter, M.D., is a Cook Children's pediatrician at the Heritage Trace Clinic. She is a Fellow with the American Academy of Pediatrics and a member of Safe Kids Tarrant County, led by Cook Children's, and a certified child passenger safety technician. 

The anger and subsequent anxiety I felt after hearing about “The Newborn Sleep Book” surprised me. I am not a “crunchy” pediatrician by any means. I have taught families to sleep. This is why the feeling I got in my stomach is unexpected.

The book is written by two pediatricians in New York who happen to be brothers, Lewis and Jonathan Jassey. The premise is that, through proper training, you can space a newborn’s feeds out to every 4 hours, resulting in them being able to sleep through the night. Their recommendations include: allowing them to cry until their scheduled feeding time, using Benadryl^® for sleep disruptions and increasing feeding volumes during the day to enable skipping nighttime feeds. It’s not the fact that they recommend sleep training; it’s their method that I find upsetting.

This goes against everything you are likely to hear from your pediatrician (certainly me), including the American Academy of Pediatrics. The AAP says some newborns feed as often as every 1.5 hours, while others about every 3 hours. The AAP also says breastfed newborns will feed 8-12 or more times per 24 hours once a mom’s milk has come in.

Oh and here’s something else important from the AAP: “If your baby isn't waking on his own during the first few weeks, wake him if 3-4 hours have passed since the last feeding.”

So that’s a group of 62,000 pediatricians’ recommendations who I tend to agree with on most things and two pediatricians who I couldn’t agree with less.  But I’m not finished making my case. Here are 8 myths I found particularly bothersome in the book:

1. MYTH: The authors have “continually researched and practiced (their) method, adjusted, and practiced some more.”

FACT: The best report of their results is this: a “ballpark estimate is that, since we started coaching parents …over 15 years ago, nine out of 10 parents who have followed through have been successful.” My scientific mind is not satisfied and neither should yours. I am not asking for a randomized, double-blind placebo trial, a simple survey would have been better than a “ballpark” estimate.Very few things in medicine have a 95 percent success rate. So, if you have the research, prove it … if not, it would not be that hard to get.

2. MYTH: Their method is the best way to get your child to sleep through the night.

FACT: The results I do see reported in the book are underwhelming. Their testimonials of patients who began to sleep through the night, included children with ages ranging from 6 weeks to 3 months.  A 2010 study in Pediatricsshowed that 37 of 75 babies were sleeping through the night during their third month. If you took testimonials of parents from that study (which are often the best case scenario), I would imagine you would find plenty of babies who would be sleeping through the night just as early as the Jassey families, many with no fancy plan.

3. MYTH: The authors are Ok with saying that their method may not work for everyone.

FACT: They go on to say later, “sleep training is by no means selfish on the part of the parents. In fact, since its benefits to both baby and family are undeniable, we might say that not sleep training…is a more selfish choice.” First of all, “undeniable?” Not so fast. That is still up for debate. I guess everyone has the right to make their own choices, even if they don’t mind making selfish choices, by not sleep training their children. It’s like saying; there really are no dumb questions, unless you ask a dumb question.

4. MYTH: Scheduling, even from a very early age poses no risk to babies.

FACT: Scheduling from birth as they suggest is dangerous and puts babies at risk, period. Not feeding on demand puts moms at risk for lactation failure. Their recommended 8-12 feedings (for 1-2 days) on demand is not enough for many moms to establish good milk supply. Ask any lactation consultant or pediatrician who understands milk production and they will either laugh or cry at the suggestion that scheduling this early will not affect milk production. In addition, infrequent feeding places babies at risk for increased weight loss and more severe jaundice, which requires further treatment and testing. If you are my patient, please do not schedule your baby from birth!

5. FACT: Crying babies are not all hungry (I actually agree with them, up to a  point …)

MYTH: You should never feed a baby before the time you have scheduled for them.

FACT: The authors state that our first response to a crying baby should not always be to feed them (again, I agree). However, I feel that we can go through our usual steps to comfort them (change diaper, pacifier (if a family chooses), rocking, etc.) and if they do not work, it is reasonable to attempt to feed.

6. MYTH: The authors state that they do not endorse formula feeding over breastfeeding.

FACT: Their method involves careful measuring of volume to ensure your baby gets enough each day don’t “have” to feed at night. Breast feeding simply does not work this way. A breastfeeding mom can’t simply feed a little bit longer… when the breasts are empty, they’re empty. So, while they may not endorse formula feeding, their method could push families toward formula feeding.

7. MYTH: If your baby’s sleep is disrupted for any reason (teething, vaccines, etc.), a combination of Tylenol^®, Benadryl^® and Motrin^® will help to “reset their clock.”

FACT: Uhhh, not for my patients. If your baby is fussy and you think it might be pain from teething, I am Ok with giving a dose of Tylenol or Motrin, but not along with Benadryl. The benefit is slim and the risk of an adverse event (whether appropriately or inappropriately dosed) is too high. Of course, they also mention using teething gels and you should know how I feel about them. There is no reason to treat a normal developmental stage with medicine.

8. MYTH: Feeding your child on their schedule means they will not “become hungry at inconvenient times-like 2 a.m.”

FACT: Parenting is about facing inconveniences. are ways to help your child fit into your life better than others, the very premise of this statement offends me. I’m sorry if your little baby woke up and tried to bother you at night for something to eat. I hope it wasn’t too much of an inconvenience.

The authors do address a concern in their book. It happens to be about co-sleeping, but that’s not important to them:

“We are inherently suspicious of any parenting technique that is so obviously weighted to the parents’ wants over the potential benefits to the child.”

Huh? Me too. This is why I would never recommend their book to my parents.

The

I understand the fear. Ebola is a terrifying disease. Symptoms start off similar to flu and progress to liver and kidney failure, followed by internal and external bleeding and then often times by death (about 60 percent of the cases).

So, I get it, it’s scary. The way people die from Ebola is very unpleasant which makes it even scarier. But it shouldn’t be the scariest infectious disease to us. Here are three reasons why:

Reason No. 1 – It’s actually not that contagious.

Ebola is transmitted via blood and body fluids. Contrast that with measles and flu, which are spread via droplets. Obviously, doctors are using extreme caution when treating patients with Ebola and I agree with that. However, the likelihood of catching Ebola from being in the same room with a person with it is not that high. If someone with measles or flu coughs or sneezes near you, it’s very possible that you will contract the disease.

Hepatitis A is another virus that can spread quickly because it is spread via a pathway called the fecal-oral route (yes, it’s as gross as it sounds). It causes vomiting and in severe cases, liver failure. Outbreaks of Hepatitis A often occur when a food worker unknowingly spreads the disease by handling the food with contaminated hands.

Meningococcal meningitis is another illness that commonly spreads quickly and anyone who has been in the room with an infected person is at risk. Outbreaks used to occur commonly on college campuses prior to the introduction of universal vaccination. Health care workers who are exposed to a patient with meningitis have to undergo treatment to try to prevent contracting the disease. So remember that when the person next to you in a room looks sick; it’s probably not Ebola, but it could be any of these other scary things.

Reason No. 2 - People with Ebola are not contagious until the affected person is sick.

Because patients with Ebola are very sick, they are unlikely to be walking around infecting everyone in their path. There will not be people walking around looking fine, unknowingly spreading the disease to everyone they meet. This is not the case for many other infections. See my example for Hepatitis A above.

Pertussis, or whooping cough, is another disease where many infected people (usually adults) can walk around contagious for weeks at a time coughing the bacteria on everyone they meet. Pertussis is not that serious in adults (aside from an occasional broken rib here and there), but it can be deadly in small babies. Despite being sick, many people with flu suck it up and trudge into work or school because they think flu isn’t that big of a deal. The problem is that while one person may not have trouble with flu, they may have contact with small infants, pregnant women or older adults who can have significant complications from it.

Another disease that affects 1/3 of sexually active teenagers and adults is human papilloma virus (HPV). Most often boys and girls who carry HPV do not know they are infected and thus spread it to their sexual partners. HPV by itself is a troubling problem, but even more troubling is the fact that HPV is the leading cause of cervical cancer (about 99.7 percent of cases).

Reason No. 3 - Ebola is not that common and has not been transmitted in the United States.

The world-wide, all-time death total from Ebola sits in the thousands … the world-wide death toll from measles was 122,000 in 2012 alone. Ebola has a very high rate of death and severe illness, much more so than measles, but because measles is much more common it affects many, many more people. There has never been a case of Ebola transmitted from person to person in the United States. There have been over 600 cases of measles in the United States thus far in 2014. What about deaths? Fortunately, there were no deaths from measles, but in 2012 there were 52 deaths from the flu just in pediatric patients. It’s a simple reminder that we sometimes forget how dangerous things are when we have not heard about them for a while.

Now what?

If you aren’t convinced that many of these other infectious diseases are a more immediate concern for you than Ebola, I understand. When things are new and sound scary they tend to take over your mind. But after reading all the points I’ve made above, know there is something you can do to protect your child from the other diseases I’ve mentioned …

Every single bolded disease has a vaccine! While vaccines are not perfect and getting a vaccine in some cases does not protect you 100 percent, they significantly decrease your chances of contracting any of these diseases. In many cases, if vaccines don’t completely prevent the disease, they make the case milder and less serious. If you agree with my concerns about these other diseases, give your child the best chance by having them vaccinated.

I hope I’ve addressed all of your questions or concerns. Maybe, you still have questions about the diseases mentioned here or the vaccines to fight them? If so, please talk to your pediatrician.  

Part 2 - Elementary and Middle School

I'd guess the titledidn't fool as many of you as it did in Part 1. I probably would've clicked angrily on the link and went to disprove the fact that homeschooling is for everyone too, but I assume that the rest of you who clicked on today are actually interested in how you can help your child learn. Remember these posts are all about the fact that despite the fact that we delegate a lot of our role of educating our children to the school we choose to send them to, the responsibility of their education still falls on us, the parents.

I thought of two different things to post about. First I considered writing about feeding your child breakfast. Several studies show that doing so will increase their grades and especially their ability to pay attention throughout the morning. So, feed your child breakfast. Moving on.

One of the major predictors of success in school and in the future for our children is our involvement in their school and their education.

The school will do what they can, but they are limited by many factors:

1)   Your child is not the only child in class. Vying for the teacher's attention can be difficult.

2)   Your child may learn faster or slower than the average person in class and adjustments are often difficult.

3)   Schools have limited financial and personnel resources that don't allow for curriculum to be differentiated for each student.

So, how do we compensate for each of the above deficiencies? We get involved. More specifically, we get involved in the right way. A study done at the University of New Hampshire showed that it would take $1,000 per student per year of extra spending for the school  to achieve the same results as parent involvement.

A comprehensive review of parent involvement was released by the National Center for Family and Community Connections with Schools in 2002 called "A New Wave of Evidence." I know it's 10 years old, but it's so comprehensive, I couldn't imagine using anything else.

So, how does parental involvement improve performance?

Here are just a few of the ways (New Wave of Evidence-pg 13):

•      Earn higher grades and test scores, and enroll in higher-level programs.
•      Be promoted, pass their classes, and earn credits.
•      Attend school regularly.
•      Have better social skills, show improved behavior, and adapt well to school.
•      Graduate and go on to postsecondary education.

But, how do you do it right?  As with anything, you can even mess up being involved in your child's school and education if you don't think about what you're doing.

Here's what studies say actually works (New Wave of Evidence-pg 87):

     1) Provide a stimulating literacy and material environment.

     2) High expectations and moderate levels of parent support and supervision.

     3) Monitoring of TV viewing and homework completion.

     4) Joint learning activities at home.

     5) Emphasis on effort rather than ability.

     6) Promoting of independence and self-reliance.

Let's go through each for a little discussion:

1) Provide a stimulating literacy and material environment - Have stuff around that stimulates your child to want to learn. This is simple in all stages of life but you just have to be careful to provide it. Keep books easily accessible in the current reading level and one reading level above your child so that they can explore what’s next. Read in front of them (no child is going to read in the room where you are watching TV). Keep art supplies, building toys and other items easily accessible and limit screen time so that your kids have time to play with them.

2) High expectations and moderate levels of parent support and supervision - Don't hover over their shoulder the whole time they are doing homework but check in frequently to make sure they are on task and don't have questions for you. I usually get my son started on something and then walk away and come back a few minutes later. He gets a lot more done when I'm not standing there and he doesn't rely on me to help him along the way.  My favorite thing to see him do is when I come back and he says, "I had a little trouble with this one so I moved on to the next one till you could help me." “Awesome, bud, let’s do it.”

3) Monitoring of TV viewing and homework completion - Set a rule for the TV and homework completion.  I guess it doesn't have to be, but I would think that having the same rule for all the children in the house would be helpful.  You could choose to have no TV until homework is complete or maybe one show (15-30 minutes) before you start.  Sometimes that break can be a refresher for a kid who is worn out from a long day at school but for other kids is impossible to get them back on task.  You need to decide what works best for your family and stick to the plan.

4) Joint learning activities at home - This is where you get to be creative. You can read my post called: Your Child is Gifted to get more advice on how to do this well.

5) Emphasis on effort rather than ability - You can see my entire post about this: You're So Smart.

6) Promoting of independence and self-reliance  -Remember that your goal is to get your child to be independent and ready to move off and do something else when they finish high school. It's hard to remember to think about it when they are young but giving them opportunities to be independent now when you are still close by is a great way to teach them to make better decisions later.

While we're at it, here are some things you should not do whenever it comes to being involved with your child's education:

1) Don't do their homework or projects for them. It's OK to help them if they are choosing wisely but it's also OK to let them make a bad grade if they are relying on you to do it all for them.

2) Don't ever tell you child's teacher that they are "bored" because the class is to easy. It may be completely true, but after saying it, you have eliminated almost any chance you had of working to get a solution to the problem.  Some other things you could say: How can we challenge him/her? Is there some way we could change x/y?

3) Don't go above your child's teacher to the principal unless you've tried to work with the teacher first. It actually causes a problem for everyone involved. The principal doesn't like it, the teacher doesn't like it and you're unlikely to get the results you desire.

4) Don't reward solely for grades. Everyone handles grades a little differently. Some families dole out huge money for good grades, some none and others everywhere in between. Rewarding for grades alone sets them up to choose easier classes and cut corners (cheat?) to get better grades.

Let’s be involved with our kids’ schools, but do it in the right way. The results could be amazing!

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

We moved into a new home about three weeks ago. Amid the chaos of boxes and a not quite finished remodel job, I hear the laughter of my kids upstairs. I head up to check on them and realize they are “playing nicely.”  What is interesting is that we have had no access to TV for three weeks. Could there be a connection between my kids getting along and no TV?  What are the results of being unplugged?

The American Academy of Pediatrics recommends no TV for kids under 2 and less than 2 hours per day of media time for kids older than 2 years of age. Why? Because too much media is associated with aggression, inattention, anxiety, depression, sleep problems and obesity in our kids.

We call it TV head at my house. It is a lazy Saturday morning. The kids lounge in front of the TV for a few hours watching a movie. The next thing I know there is fighting, yelling and disagreement between my children. My son never quite recovers the rest of the day. He is a little “fuzzy headed” and a little grumpy.

Many of my patients have found harmony at home by decreasing media time. My parents have returned with true amazement at the difference in their kids once they have unplugged, especially in the evenings. They have reported healthier and happier kids. A number of my families have decided to unplug for the summer, which in all honesty, is probably the hardest time to do so, especially when it is hot outside and not much to do inside. Enter Mrs. Aubrey Conklin, one of the most fun and down to earth moms I have ever met.  I discussed the benefits of decreased media with her at the recent well-child exams for her three children. She is open minded enough to try it, and kind enough to let us join her on this journey.

Watch for Aubrey’s blogs this summer. She will be reporting in on how she and her family are doing cutting back on screen time.

I hope everyone had a great Father’s Day. I'm sure there were no fights between fathers and their teenage children.

Maybe, you had barbecue and ugly ties mixed with good feelings and love all around. But now back to reality.

Because of that, you can consider this a post for all the other weeks of the year when there might be more "disagreements" between fathers and teenagers. Most of you might be able to file this away under the Common Sense tab of your brain but I think it is a good reminder.

What is the best way for a teenager to resolve a fight with his/her dad?

Find someone else to support them through dealing with the conflict in a healthy way.

Jeff Cookston from San Francisco State University studied almost 400 families asking them questions about how they handled father-child conflict. He released a study in the March edition of the Journal of Research on Adolescence.  

The most common people that teenagers talked to were mothers, then friends and occasionally a stepfather or father (if conflict is with stepdad).

The study compared two positive ways the support person could discuss the problem with the teenager: giving an explanation for dad's behavior and assigning responsibility for the conflict.

So, to make the adolescent happy, just take his or her side and assign all the blame to the father, right? Actually, you may be surprised to learn that’s not true.

In fact, a real discussion about the reasons for dad's opinion and a fair assessment of the responsibility of the conflict left children feeling better about themselves and their fathers in the long run.

So, how does this play out in a real life situation?

Conflict #1:

"But, dad, I really want to go to this party and it won't even get started going strong until 11!"

"Sorry, it's just not going to happen this week."

Bad support:

"That's just how your dad is, he's always been overprotective."

Good support:

"I'm sure your dad is just concerned about you being safe and remember what happened the last time you went to a party and came home hours after your curfew."

Conflict #2:

“But, dad you can’t take away my Xbox!”

Bad support: 

“He’s just being dumb.  You can always play after he goes to bed.  I’ll try to convince him to give it back.”

Good support:

“I think he’s concerned because we’ve noticed that your grades have been dropping and you are having a hard time getting out of bed in the morning.  Maybe if you show him that you can show more responsibility, we can talk about getting it back.”

Give the father in your life the best gift you can give them this year, support your teenager in a way that helps them feel better about themselves and their Dad. (The ugly ties can wait until next year.)

Dr. Aaron spent her morning on Thursday, July 24, doing interviews with newspaper, radio and three local TV stations.

“I’ve never been one to reach out to the media or certainly get in front of the camera,” Dr. Aaron said. “I’ve had those times where I’ve been asked to be on camera and needed to do that. This is the first time where I’ve ever picked up the phone and called our team and said, ‘Guys, we need to do something. We need to reach out because three in one week … that’s just too many.’”

The mother of a 2-year-old son, the swimming deaths hit way too close for Dr. Aaron. All three children who died were between the ages of 2 to 4 years old. The teams at Cook Children’s involved in the three drowning events met with Cameron Brown, a member of Cook Children’s Pastoral Care and a firefighter, who is specially trained to lead caregivers through a critical incident stress debriefing. To put it simply, they were heart broken.

“This is what we do. This is our profession, but it impacts us,” Dr. Aaron said. “We’ve had great sorrow. That is minimal to what we sense must be happening with these families and close friends. It’s unusual for us to have three cases in one week ... and we still have many weeks of summer left.”

What makes the deaths even more tragic is the fact that most drownings are preventable. Dana Walraven, Cook Children’s Community Health Outreach manager and Safe Kids Tarrant County coordinator, also spent the day with media to discuss drowning prevention steps. Texas has the highest incidence of swimming pool- and spa-related childhood drownings in the United States. All three children who died were pool related incidents.

Drowning is the leading cause of unintentional deaths for children 1 to 4 years of age. The common myth of children splashing, waving their arms around and yelling is simply not true.

“In many drowning situations, an adult was just a few feet away from the pool and didn’t realize anything was wrong because he or she didn’t hear any sounds of distress, such as splashing or yelling,” Walraven said. “Drowning is a silent event that can occur in the time it takes to send a text message. Should supervision fail for any reason, having multiple layers in place helps protect your child.”

Walraven offers these drowning prevention basics:

• Have your children take swim lessons.
• Have the entire family taking swim and safety lessons.
• Learn CPR.
• Provide 100 percent supervision without distractions.
• Use pool and child alarms to alert you if your child gets in the water without you.
• Isolate your pool from the rest of your backyards with a permanent, four-sided fence with self-latching gates to prevent kids from accessing the pool area without adult supervision.

“We realize that it could happen to anyone,” Dr. Aaron said. “It happens very, very quickly. We’re not being judgmental. We feel so strongly about this and knowing how it impacts us we wanted to reach out and raise awareness to the community.”

For more information:

• Drowning prevention
• Water safety
• Vento family story
• Cookchildrens.org/safety
• Backyard and Pool: Household Safety Checklist
• Household Safety: Preventing Drowning

Stop screaming in the car!

That's enough!

Just stop!

I'm the “out-of-home” worker in our family, while my wife is able to do her job mainly from the house. Therefore, I usually have:

1. brief periods of time alone with the 3 kids.
2. time at home when the duties are shared between my wife and me.

Because of Mother's Day Weekend, I got to spend more time alone with the 3 littles this weekend (all under 5).

As the weekend wore on, there were more moments of frustration.  I'd like to think they were just particularly crazy this weekend but I'm sure that would just be lying to myself and trying to justify my frustration.

Finally, on the way to get some tortillas for dinner Sunday night, after repeated attempts to get my kids in the car, listening to them scream at each other and seeing my 3 year old more or less punch my 5 year old in the face....

"Stop screaming in the car!

That's enough!

Just stop!"

I didn't REALLY yell at them. They weren't physically threatened. But, there were three pair of scared eyes looking back at me in the rear-view mirror.

Fortunately, a week before, I'd listened to Michael Hyatt's Podcast: 4 Difficult Sentences for Leaders.

In it, he outlines a four-sentence method for apologizing:

Sentence #1: I am sorry.

Sentence #2: I know that hurt.

Sentence #3: I was wrong.

Sentence #4: Will you please forgive me?

He also reminds us to avoid using terms like if and but...

So, I had the 5 minute drive home to think about it. The kids were quiet by now. They had either forgotten about it, they were too terrified to speak or Thomas the Tank Engine^™ just got much more interesting.

But when we got home, here's how it went:

"Guys, I'm sorry I yelled at you. I know that was scary. I should not have done that. Will you please forgive me?"

Some tips:

1. Apologize specifically for what you did, recognize how they felt, apologize again and ask forgiveness.
2. Don't use ifs or buts.  It was very tempting to say, "I'm sorry I yelled at you guys, but you should have come quicker and you shouldn't have been screaming and you shouldn't..."  But, then I'm not truly acknowledging the fact that I shouldn't have raised my voice.

There has been talk in the media and blogging world lately about how forcing your kids to apologize doesn’t actually teach them to apologize. I’ve seen this to be true in my family, they barely get the “I’m sorry” out before they are running off to do something else and very likely to come back and do the same thing two minutes later.

However, there are many reasons to apologize to your kids. First, modeling that one should apologize when they are wrong is a better method of teaching your children the power of apology. Another benefit is what it does for you. After apologizing, I was back in the right frame of mind to go back inside and parent more positively and with more patience rather than continuing to be angry and letting my kids suffer the ongoing consequences. It sure didn’t hurt that I heard this in return:  

5 yo: Of course, we forgive you.

3 yo: Yeah, we wuv you dad.

Almost 2 yo: Go, go; pway, pway; hungy!!

Well, 2 out of 3 isn't so bad.

"My mom used to say, 'When God closes a door, He always opens a window.' I have found that to be true many times in my life. My life as a pediatrician is a result of crawling through an open window when the door I thought I was supposed to walk through was closed to me."

Jason Terk, M.D., Keller, Keller Parkway

"Florinda Peak, the most amazing Mommy in the world, to 5 year old Dr Sandra Peak who did not want to practice reading… 'You have to learn how to read…because when you do the whole world opens up to you!'”

Sandra Peak, M.D., Lewisville

"The best advice my mother ever gave me was to give to others without expecting anything in return. (She also told me to never go outside with wet hair because I’d catch a cold, but medical school later disproved that. Sorry mom.)"

Diane Arnaout, M.D., Willow Park

"The best advice my mother ever gave me was, “never miss the chance to use a perfectly good bathroom” when you are out of the house."

Audrey Rogers, M.D., Fort Worth, Forest Park

Nicole Wineriter, M.D., Keller, HeritageTrace

"My mom told me to respect (be nice) to the nurses because they can either make or break your day."

Samuel Sheng, M.D., Arlington Neighborhood Clinic

"Encourage others. She always wrote notes to people for accomplishments, during sad times and just because."

Justin Smith, M.D., Lewisville

And finally, our favorite advice ...

"Marry Joan."

Tom Rogers, M.D., Forest Park. Dr. Rogers and his wife Joan have been married 59 years and today, she is a proud mother. "Joan worked to pay my way through medical school, gave me two great kids who are both pediatricians, and has allowed me to work without having to pay attention to small things like finances, maintenance of our house and yardwork. I couldn't be where I am today without her," Dr. Rogers said.

Happy Mother's Day from all of us at Cook Children's ...

1. Have you ever fainted, passed out, or had a seizure suddenly and without warning, especially during exercise?
2.  Have you ever had exercise-induced chest pain or shortness of breath?
3. Are you related to anyone with sudden, unexplained, and unexpected death before the age of 50?
4. Are you related to anyone who has been diagnosed with a sudden death-predisposing heart condition like Hypertrophic Cardiomyopathy and Long QT syndrome?

Early detection could save your child’s life. Cook Children’s will offer free EKGs during the month of February. An EKG is non-invasive and takes less than five minutes. The EKG shows how fast the heart is beating, the heart’s rhythm and the timing of the heart’s electrical signals. Any child can get one with a referral from a primary care doctor. Just ask your child’s pediatrician to order a “sports EKG.” Results are sent back to your pediatrician.

For more information, please call the Heart Center office at Cook Children’s at 682-885-2140.

"Salmonella infection can cause bloody diarrhea, severe stomach pain, cramping, vomiting and fever," said Mark M. Shelton, M.D., board certified physician with Cook Children's specializing in infectious disease. "It can be very dangerous in infants and toddlers whose immune systems are still developing, and salmonella requires hospitalization once symptoms become life-threatening."

Many parents are unaware of the harm associated with giving live animals as pets for Easter. Watching your child kiss, cuddle or hold an adorable baby chick or bunny makes for a picture-perfect moment, but it can be dangerous to the child and incredibly stressful for the animal, too. It's easy to forget these delightful, tiny creatures will mature in fewer than 90 days and require long-term care and attention.

Once Easter is over, thousands of rabbits are surrendered to animal shelters or rescues, while chickens and ducks are often turned into backyards or fields to tend for themselves. The Humane Society of the United States recommends buying children a toy stuffed animal or chocolate bunny in place of a live animal.

"Holidays such as Easter - along with petting zoos and farm-yard exhibits - expose children to a whole host of dangerous bacteria," Dr. Shelton said. "Children pet the animals then put their hands in their mouths, rub their nose and eyes, and can become infected on contact. There are hundreds of E. coli (Escherichia coli) strains and even potentially deadly bacteria and germs that can cause children severe illness or even permanent damage to the brain or kidneys."

Dr. Shelton recommends parents ensure children wash their hands thoroughly after touching and playing with any animal.

"We don't want to prevent children from enjoying and learning about animals," Dr. Shelton said. "But it is important they stay healthy by taking the proper hygienic measures."

I, and I’m sure many others who care for children, were excited by the news. It was with great interest that I read the news article and began to examine the story more closely. The news while exciting deals with a relatively small number and specific population of children.

The study examined obesity rates in pre-school children, age 2-4 years old whose families received WIC assistance (The Special Supplemental Nutrition Program for Women, Infants, and Children). Not all of the states submitted information. Of the 41 participating states, 18 states showed modest declines in the number of obese preschoolers from information collected from 2008-2011. The remainder of the 41 states showed no change or even increases in obesity rates.

The challenge is understanding what this information means and placing it in the proper perspective. Experts in the field of childhood obesity believe the positive numbers reflect changes in the WIC program beginning in 2008. The program was changed in an effort to increase fresh fruits and vegetable purchases as well as other health options such as whole grains and low fat foods. Additionally, encouragement of breastfeeding is thought to help contribute the improvements.

The news validates the central importance of healthy eating in weight management. I believe that fresh ingredients and home preparation of meals is a major key in overall health and weight management. I have slowly continued reading the book, Salt, Sugar, and Fat, and am increasingly convinced of this belief.

As discussed in the article, challenges remain. One in eight pre-schoolers remain obese. And unfortunately, the likelihood is high for these children that obesity will persist into adulthood.

For more information:

• Cook Children’s Endocrinology and Diabetes Program
• Obesity where we live
• The Center For Children’s Health
• Checkup Kitchen
• Overweight and Obesity
• Keeping Portions Under Control
• How Can Families Be Healthier?

About the author

As a self-described ‘techie,’ Joel Steelman, M.D., 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 the Physician Perspective page on the Cook Children’s Web site.

Turner syndrome is a common genetic condition occuring in 1 in every 2,500 girls born. It is caused by missing all or a portion of one of the X chromosomes. The condition varies in severity but has physical and psycho-educational impacts.

Care of the girls with Turner syndrome is an integral part of the practice of the pediatric endocrine group at Cook Children’s. The majority of girls affected will have short stature and early failure of the ovaries. Growth hormone treatment is prescribed and monitored by pediatric endocrinologists to treat short stature. The task of monitoring puberty and timing of estrogen replacement is equally important to insure overall health.

As I said, new insights were gained by me at this meeting. I have cared for girls with Turner syndrome from infancy to adolescence. The concept of transition medicine is a growing, important areas in the lives of both of pediatric physicians and the children treated by us with chronic medical conditions. The medical treatments offered currently, have led to vastly improved life quality and long life expectancy.

A new challenge has emerged for physicians, families and emerging adults with a chronic condition – how to live life with the unique challenges of their particular diagnosis. Learning from experiences in education, employment and health shared by young adult women with Turner syndrome during Q&A in my talk was very enlightning.

I was very pleased to spend some tiem at this year’s meeting and learn more about the society. The Turner Syndrome Society, like many other organizations devoted to support and advocacy for a specific condition, provides a forum for families and women with Turner syndrome throughout the stages of life. The education and social support provided by this organization at the national meetings is admirable, and the atmosphere of learning can only benefit girls and women with Turner syndrome in the future.

About the author

As a self-described ‘techie,’ Joel Steelman, M.D., 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 the Physician Perspective page on the Cook Children’s Web site.

Occasionally, I’ve been lucky to know someone personally whose life has benefitted from such progress which was the case this past month. Multiple news outlets reported dramatic results of a new therapy for infantile hypophosphatasia. Hypophosphatasia is an extremely rare genetic condition affecting less than 20,000 people in the U.S. The condition is due to defective action on a vital bone enzyme known as alkaline phosphatase which is necessary in the formation of bone. There is a spectrum of severity tied to how active the enzyme is. Those with some to modest enzyme activity have symptoms appearing in childhood or adulthood, including weakness in bones that causes them to break more easily and premature loss of teeth.

Babies with the severe infantile form of hypophosphatasia progressively weaken as bones dissolve away. Movement and eventually the vital function of breathing become progressively more difficult. Toll of the disease is terrible with half of babies with infantile hypophosphatasia dying of respiratory failure in the first year of life. Progressively fewer live to see subsequent birthdays.

The news stories reported specifically about one patient, Janelly Martinez. Janelly’s parents watched helplessly as their daughter followed the typical grim course of infantile hypophosphatasia, requiring escalating levels of medical care to survive. For a time, I shared in the family’s struggles as a member of the endocrine team at Vanderbilt University that diagnosed and cared for Janelly.

Janelly’s parents faced the prospect that she would not survive the scarce few months until her third birthday. Her parents needed a medical miracle. For Janelly and her family, the miracle came. A new experimental therapy with the drug Asfotase alfa, a synthetic form of alkaline phosphatase became available in 2008. The results were dramatic for Janelly and other babies receiving the drug. New bone began to grow. Treatment results were dramatic, appearing within six month. Some older toddlers were able to stand for the first time.

I am deeply touched by the new life Janelly has received from this treatment. From struggling to breathe with mechanical assistance to now bearing some weight, Janelly has made remarkable progress. The prospects for an average childhood for Janelly even with treatment remain unknown. She is nearing 7 years old but remains the size of a toddler. Her contribution and her family’s contribution to medical discovery will endure.

It doesn’t matter how many years I’ve been in medicine, I continue to be impressed with advancements in modern medicine. I’m amazed at the science of it all and so thankful that it can helps special little children like Janelly.

About the author

As a self-described ‘techie,’ Joel Steelman, M.D., 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 the Physician Perspective page on the Cook Children’s Web site.

Did you know the beginning of April marked national public health week? Probably not. The observance which began officially in 1995 doesn’t garner much in the way of public attention. Still, it serves to highlight public health achievements as well as talk about ongoing public health issues.

Many of the numerous accomplishments of public health are now considered basic services not recognized for the benefit they have given us all in health improvement. The newborn screening program was one of the accomplishments highlighted this year. This program has in particular greatly impacted my specialty of pediatric endocrinology, and I think it is important to acknowledge its important place in public health history.

Every year, newborn screening efforts test nearly every baby born in the U.S. for serious health conditions. Early detection of these conditions allows prompt medical treatment and potentially prevents disability, suffering, and death. In particular, testing the 4 million infants born every year for congenital hypothyroidism costs $5 per newborn and is estimated to prevent 160 cases of intellectual disability associated with untreated hypothyroidism.

I’ve written in the past about congenital hypothyroidism. The condition refers to a specific type of hypothyroidism diagnosed in newborn babies. This serious condition occurs in roughly 1 in every 4,000 newborns and can have devastating effects if not detected and promptly treated. Eighteenth century medical literature described the mental retardation and physical effects of untreated congenital hypothyroidism, cretinism. But only in the last 30 years have doctors been able to detect these issues prior to birth, allowing for parents to be prepared and physicians and family members to lay out a plan for the child’s future.

The Texas state newborn screening for congenital hypothyroidism has been active since 1980. It is estimated that 120-150 newborns in Texas with hypothyroidism are identified annually by screening. The program is a cornerstone in Texas public health and continues to grow. Today, the program tests newborns for 30 life-threatening issues including sickle cell disease and cystic fibrosis. Congenital adrenal hyperplasia screening represents another important life-threatening condition with pediatric endocrine ties that are screened by the state.

There are many other accomplishments in public health largely unrecognized by us. Thankfully, the U.S Centers for Disease Control & Prevention has compiled a list of the 10 great public health achievements in the 20th century.

Many other Cook Children’s specialties besides endocrinology rely on newborn screening to identify at risk babies early. Many of the conditions tested by newborn screening are rare metabolic conditions. The metabolic genetics program offers evaluation and treatment of these inherited metabolic conditions to help families understand and cope with their child’s diagnosis. A visit to that program can help with a more accurate diagnosis and appropriate treatment, while also helping families determine the best short- and long-term care.

About the author

As a self-described ‘techie,’ Joel Steelman, M.D., 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 the Physician Perspective page on the Cook Children’s Web site.

I was immediatley interested when I chanced on a recent radio interview with the author, Michael Moss, who has written a new book about the inner workings of the processed food industry. The book deals specifically with the reasons that these companies use three key additives – salt, sugar and fat – in the processed food they create and market.

The term processed foods sounds somewhat sinister, but some of the ways that food is processed such as pasteurization or freezing are quite beneficial to people for both health reasons and convenience. The primary goal in most processing of foods is creation of a food product that is near ready to eat and is stable on the shelf or in our homes for a long period of time. This particular goal and the goal of making tasty processed foods according to Mr. Moss is where the problem begins.

In the book, Moss interviews food scientists in many of the large processed food companies. These scientists are tasked with making tasty food products that apeal to a large group of people. Moss describes the use of the three key additives to mask odd or bitter flavors that develop during manufacturing and to hook consumers on taste.

Moss argues that company pressures to create new appealing snacks, grow market share and improve profitability often result in unhealthy foods that contribute to the U.S. and global obesity epidemic.

The interview concluded with the debate about what steps can be taken to reduce these activities and make healthier foods. The debate no doubt will continue between different philosophies of strict government regulation and independence of consumer choice.

I’ve downloaded the eBook and look forward to learning more and examining different viewpoints. In the meantime, my family and I will continue to see fresh ingredients and discover new recipes.

More information is available if you are interested with links to the NPR interview and the book.