Author Archives: ChildrensMN

Consequences of vitamin K refusal at birth devastating, irreversible

Lisa Irvin, MD

In the past few years, there has been an increase in parents refusing to have their children receive the vitamin K shot at birth. The result of this trend has been an increase in cases of vitamin K deficiency bleeding (VKDB).

Lisa Irvin, MD, is pediatrician at Children’s Hospitals and Clinics of Minnesota.

Lisa Irvin, MD, is pediatrician at Partners in Pediatrics.

Reasons usually cited for refusal are a fear of pain or stress for the baby due to the shot, or increased risk of leukemia. Many studies show there is no increased risk of leukemia, and the pain is minimal and brief.

Vitamin K is needed by our bodies for blood clotting. We’re born with blood-clotting factors, but vitamin K is needed for activation. Older kids and adults make vitamin K from the bacteria in their gut and from their diet.

Newborns, however, are born with little vitamin K, and fewer clotting factors than adults. Vitamin K doesn’t cross the placenta, and newborns don’t have bacteria in their gut yet to make it. Breast milk has low levels of vitamin K, so breastfed babies have low levels of the vitamin for a few weeks. Newborns are given vitamin K immediately following birth to activate these clotting factors and prevent hemorrhagic disease of the newborn, or VKDB. 

The 3 types VKDB 

  • The early type occurs in the first 24 hours and is uncommon. It usually is the result of the mother taking medication that interferes with vitamin K.
  • The classical type occurs between the second and seventh days of life, when vitamin K levels are the lowest in a newborn. Bleeding occurs most commonly in the intestines, umbilical cord, skin, nose, and circumcision site.
  • Late VKDB occurs when the infant is 3-8 weeks old and happens only in breastfed infants. These bleeds typically occur in the brain, intestines and skin. If bleeding occurs in the brain, the mortality rate can be as high as 20 percent.

subscribe_blogThe risks of VKDB are real and serious if vitamin K is declined at birth. Although it’s not a common event, the outcome can be devastating and irreversible. It’s preventable with one dose of intramuscular vitamin K at birth.

There are oral preparations of vitamin K that can be given, but because the absorption and compliance are variable, the recommendation for all infants is to receive the intramuscular dose.

Lisa Irvin, MD, is pediatrician at Partners in Pediatrics.

Back-to-school sleep tips: Getting kids’ sleep habits back on track

(iStock photo)

Once the school sleep schedule is set, keep that same sleep-wake schedule seven days a week. (iStock photo)

Karen Johnson, APRN, CNP

Summer is winding down, and the new school year is just around the corner. As we start to prepare students for going back to school, it is important to adjust to a regular sleep routine. Transitioning from a carefree summer schedule to a school schedule can be difficult. An adequate amount of sleep is beneficial to help your child be successful during the school day. Here are a few key tips that will to help your child ease into his/her school sleep schedule:

  1. About two weeks before school starts, begin to put your child to bed 15-30 minutes earlier and as well as waking him or her earlier; working toward a school wake time as the goal.
  2. Once the school sleep schedule is set, keep that same sleep-wake schedule seven days a week. Your child will be more alert and function better on a consistent sleep schedule.
  3. School-age children should avoid afternoon naps as this will disrupt the nighttime sleep schedule.
  4. No screen time 90 minutes before bed; this includes all electronic devices. The light from these devices keeps your child alert and awake at bedtime.
  5. subscribe_blogEstablish a relaxing and structured bedtime routine such as one to two books, a song and hug goodnight.
  6. Eat a healthy snack before bed and avoid caffeine.
  7. Make the sleep environment dark, comfortable and cool.
  8. Dim the lights in the evening before bedtime to promote sleepiness.
  9. Use bright light in the morning to wake easier: sunlight is the brightest source, so open the curtains and turn on a light.
  10. Provide your child with the opportunity to get the adequate amount of sleep to feel alert and refreshed for the school day.

Contact the Children’s Sleep Center at (651) 220-6258 for a sleep evaluation if you have concerns about your child’s sleep.

Sleep duration recommendationsKaren Johnson, APRN, CNP, is a certified nurse practitioner at the Children’s Sleep Center at Children’s Hospitals and Clinics of Minnesota.

The danger of overusing antibiotics

Overprescribing antibiotics has resulted in the development of resistant bacteria, which are bacteria that don’t respond to antibiotics that may have worked in the past. (iStock photo)

Every year, your family probably faces its share of colds, sore throats, and viruses. When you bring your child to the doctor for these illnesses, do you automatically expect a prescription for antibiotics?

Many parents do. And they’re surprised, maybe even angry, if they leave the doctor’s office empty-handed — after all, what parent doesn’t want their child to get well as quickly as possible? But your doctor could be doing you and your child a favor by not reaching for the prescription pad.

antibioticsHow antibiotics work

Antibiotics, first used in the 1940s, certainly are one of the great advances in medicine. But overprescribing them has resulted in the development of resistant bacteria, which are bacteria that don’t respond to antibiotics that may have worked in the past. Plus, whenever kids take antibiotics they run the risk of side effects, such as stomach aches and diarrhea or even a possible allergic reaction.

To understand how antibiotics work, it helps to know about the two major types of germs that can make people sick: bacteria and viruses. Although certain bacteria and viruses cause diseases with similar symptoms, the ways these two organisms multiply and spread illness are different:

  • Bacteria are living organisms existing as single cells. Bacteria are everywhere, but most don’t cause any harm — and in some cases may be beneficial. Lactobacillus, for example, lives in the intestine and help digest food. But some bacteria are harmful and can cause illness by invading the human body, multiplying, and interfering with normal bodily processes. Antibiotics are effective against bacteria because they work to kill these living organisms by stopping their growth and reproduction.
  • Viruses, on the other hand, are not alive and cannot exist on their own — they are particles containing genetic material wrapped in a protein coat. Viruses “live,” grow and reproduce only after they’ve invaded other living cells.Some viruses may be fought off by the body’s immune system before they cause illness, but others (colds, for example) must simply run their course. Viruses do not respond to antibiotics.

subscribe_blogWhy it’s harmful to overuse antibiotics

Taking antibiotics for colds and other viral illnesses not only won’t work, but also has a dangerous side effect: over time, this practice helps create bacteria that have become more of a challenge to kill.

Frequent and inappropriate use of antibiotics can cause bacteria or other microbes to resist the effects of antibiotic treatment. This is called bacterial resistance or antibiotic resistance. Treating these resistant bacteria requires higher doses of medicine or stronger antibiotics. Because of antibiotic overuse, certain bacteria have become resistant to some of the most powerful antibiotics available today.

Antibiotic resistance is a widespread problem, and one that the Centers for Disease Control and Prevention (CDC) calls “one of the world’s most pressing public health problems.” Bacteria that once were highly responsive to antibiotics have become increasingly resistant. Among those that are becoming harder to treat are pneumococcal infections (which cause pneumonia, ear infections, sinus infections and meningitis), skin infections and tuberculosis.

Taking antibiotics safely

So what should you do when your child gets sick? To minimize the risk of bacterial resistance, keep these tips in mind:

  • Treat only bacterial infections.Seek advice and ask questions. Letting milder illnesses (especially those thought to be caused by viruses) run their course to avoid the development of drug-resistant germs may be a good idea — but it’s still best to leave what constitutes a “mild illness” up to your doctor. Even if the symptoms don’t worsen but linger, take your child to the doctor. At the office, ask questions about whether your child’s illness is bacterial or viral, and discuss the risks and benefits of antibiotics. If it’s a virus, don’t pressure your doctor to prescribe antibiotics, but ask about ways to treat symptoms.

If your child is prescribed antibiotics, be sure to:

  • Use antibiotics as prescribed.
  • Don’t save antibiotics for next time.
  • Never use another person’s prescription.

Ask your doctor about ways to treat the symptoms that are making your child uncomfortable, such as a stuffy nose or scratchy throat, without the use of antibiotics. The key to building a good relationship with your doctor is open communication, so work together toward that goal.

Use the medication properly. Antibiotics are only effective against a bacterial infection if taken for the full amount of time prescribed by the doctor — and they take time to kick in, too, so don’t expect your child to feel better after taking the first dose. Most kids take one to two days to feel a lot better. Similarly, don’t let your child take antibiotics longer than prescribed.

And most important, never use antibiotics that have been lying around your home. Never take antibiotics that were prescribed for another family member or adult, either — doses for kids vary, and if your child did have an illness requiring antibiotics, you’d want to make sure you were treating it correctly.

Saving antibiotics “for the next time” is a bad idea, too. Any remaining antibiotic should be thrown out as soon as your child has taken the full course of medication.

Help fight antibiotic resistance by taking simple steps to prevent the spread of infections. Encourage hand washing, make sure your kids are up to date on immunizations, and keep kids out of school when they’re sick.

Doctors are aware of increasing antibiotic resistance and trying to solve the problem. New antibiotics might be on the horizon, but antibiotics will continue to need to be prescribed and used appropriately.

Material reviewed by Yamini Durani, MD; © 1995-2015 KidsHealth ®

Washburn Games allow kids to try multiple sports

Boy-with-soccerChildren’s is a proud sponsor of the Washburn Games, a non-competitive sports sampler for kids ages 4-12. Enjoy quality time with your family and help your child give back to the community.

Kids can try out rugby, soccer, lacrosse, cricket, karate, yoga and more to discover their favorite sport — before you sign them up for a season they don’t like! The event raises money for Washburn Center for Children, a Twin Cities nonprofit offering therapeutic care to kids struggling with depression, anxiety or other mental illnesses.

All participants receive a T-shirt, medal and goodie bag. Plus, there’s a chance to win a $1,000 educational scholarship.

subscribe_blogWhat: Washburn Games

When: 1:30-4:30 p.m. Saturday, Sept. 27

Where: Bryn Mawr Meadows, 601 Morgan Ave. S., Minneapolis

Cost: $10 registration fee

Registration: Visit to register.

View the flyer for more information.

HPV vaccine important to protecting your child

Patsy Stinchfield, PNP

HPV vaccination among U.S. teens remains low despite a slight increase from the previous year, according to the Centers for Disease Control and Prevention and the National Partnership for Women and Families.

Human papillomavirus (HPV) is a DNA virus from the papillomavirus family that is capable of infecting humans.

Human papillomavirus (HPV) is a DNA virus from the papillomavirus family that is capable of infecting humans.

As a parent and a practicing clinician, the fact that many of our children are missing an opportunity to get protected against HPV, short for the human papillomavirus (a common sexually transmitted disease) and related cancers concerns me. Since the introduction of the HPV vaccine in 2006, the number of cervical cancer cases has been cut in half. In half. That’s monumental. We know this vaccine works, and we need to use it to the fullest extent possible.

The vaccine is safe, too. In the more than 67 million doses given thus far, no serious safety events have occurred. The most commonly reported event is fainting, which happens with other vaccines given to teens, as well, leading to our usual practice of having teens sit for 15 minutes after vaccination.

HPV infects about 79 million Americans, 14 million of whom become infected each year. About 21,000 women are affected by cancer linked with HPV, and cervical cancer is the most common. More than 4,000 women, usually in child-bearing years, die of cervical cancer. It’s also associated with other cancers, such as those that affect the throat, tongue and tonsils, in men. But the infection that causes these cancers can be prevented with the vaccine series. What parent wouldn’t want his or her child to be protected against cancer?


Centers for Disease Control and Prevention: HPV FAQ


The HPV vaccines are given as a series of three shots over six months to protect against HPV infection and the health problems the infection can cause, according to the CDC. Two (Cervarix and Gardasil) protect against cervical cancers in women. One (Gardasil) protects against genital warts and cancers of the anus, vagina and vulva. Both vaccines are available for girls. Only Gardasil is available for boys.

subscribe_blogI recommend to families that children — both boys and girls — get the vaccine well before they’re sexually active to offer the best protection; typically, we suggest ages 11 or 12. And the full series — all three shots — need to be taken in order to be truly effective.

“We don’t wait for exposure to occur before we vaccinate with any other routinely recommended vaccine,” Dr. Thomas Frieden, director of the CDC, told CNN.

I sometimes hear from parents that they’re worried their son or daughter will be encouraged to have sexual relations because they’ve been vaccinated. While I understand their concern, there is no link between getting vaccinated and increased sexual activity.

Unfortunately, I’ve seen firsthand the devastation that vaccine-preventable diseases cause in children who haven’t been immunized. Let’s work together to take HPV-associated cancers off that list; it’s the right thing to do.

Patsy Stinchfield, infectious disease nurse practitioner, is the director of Infection Prevention & Control and the Children’s Immunization Project at Children’s Hospitals and Clinics of Minnesota.

Summertime scrapes open door for impetigo

Erin Dobie, DNP, CNP

Summer fun activities for kids usually involve a few scrapes and bruises. Any opening in the skin is an inviting spot for germs and bacteria.

Erin Dobie, CNP

Erin Dobie, DNP, CNP

Impetigo is a superficial bacterial skin infection of a sore, scratch or insect bite on the skin that spreads easily into multiple sores. The lesions open and become crusty and have a “honey color” appearance. It occurs when common bacteria, found normally on the skin, enter an open area on the skin’s surface.

The most common bacteria found on the skin are group A hemolytic streptococcus and staphylococcus aureus. The lesions start as a small red lesion then open up, drain and crust over with a honey-colored scab. The lesions spread easily with contact, so multiple lesions are common.

Wound care of even minor scrapes or wounds is important in preventing impetigo. Washing the cut or scrape with warm, soapy water multiple times per day and application of an over-the-counter antibacterial ointment (Bacitracin, neomycin, generic triple antibiotic ointment) is recommended. If impetigo occurs, often topical treatment is all that is needed if treatment is started early and there are only a few lesions. For a child with multiple lesions, oral antibiotics may be prescribed in addition to topical antibiotics.

subscribe_blogWhat can you do at home?

  • Everyone in the household should use proper hand-washing technique to help decrease the chance of spreading the infection.
  • Keep your child’s fingernails short to help decrease the chance of scratching and spreading the infection.
  • Avoid sharing garments, towels, etc., to prevent the spread of the infection.
  • Soak the affected area in warm water or use wet compresses to help remove the overlying scabs. Apply antibacterial ointment three times per day after washing.

Further medical care is needed if:

  • Sores continue to spread despite antibiotic ointment used as directed above.
  • Swelling and redness extending out significantly beyond the sores is present.
  • The child has a fever greater than 100.4 degrees.

Erin Dobie is a certified nurse practitioner at Children’s Hospitals and Clinics of Minnesota.

Trauma: When it’s critical, so is your choice

Why would you take your child to Children’s emergency room over any other hospital? Our team members are on staff, not on call. Your child gets treated immediately.

When it’s critical, so is your choice. Children’s Level I Pediatric Trauma Center, Minneapolis.


Define safe boundaries for kids and play

Encouraging the learning and exploration process will increase your child’s confidence and creativity, and defining safe boundaries and rules will keep you both happy. (iStock photo / Getty Images)

Encouraging the learning and exploration process will increase your child’s confidence and creativity, and defining safe boundaries and rules will keep you both happy. (iStock photo)

Dex Tuttle

One time I watched my toddler daughter, Quinnlyn, as she played with her favorite blocks. She picked one up, stacked it carefully on top of another, and repeated until she had a tower four or five blocks high. Without warning, she pummeled the tower while sounding her signature high-pitched battle cry, sending blocks flying in all directions. She immediately seemed to regret not having a tower and ran to pick up the blocks to start the process over.

Young children begin to understand their world by cause-and-effect experimentation. Psychologist Jean Piaget was one of the first to put this concept into organized thought.

This behavior is apparent with my daughter: “If I stick my hand in the dog’s water dish, my shirt gets wet. This pleases me and I must do this each morning, preferably after mommy helps me put on a clean shirt.”

Then, something occurred to me as I watched Quinnlyn build and destroy her tower; there is a trigger missing in her young mind that could change her behavior: She does not understand consequence, the indirect product of an effect.

I began to notice this in her other activities as well. At dinnertime, we would give her a plastic fork and spoon so she could work on her motor skills. If she was unhappy with how dinner was going, she threw her fork and spoon on the floor in a fit of toddler rage. She was then immediately puzzled by how to continue her meal with her utensils so far away.

subscribe_blogAs frustrating as toddler tantrums sometimes can be for parents, I would’ve loved to have been in my daughter’s shoes. Who wouldn’t want the satisfaction of taking all those dirty dishes that have been in the sink for two days and chucking them against the wall? That decision, of course, would be dangerous and reckless, and I have no desire to clean up such a mess. And, with no dishes in the house, I’d be forced to take a toddler to the store to shop for breakable things; not a winning combination.

There’s an important lesson here for safety minded parents: Kids will explore their environment in whatever way they can. It’s like the feeling you get when you find a $20 bill in the pocket of a pair of pants you haven’t worn in months, or when you discover the newest tool, gadget or fashion. For toddlers (and us adults), it’s fun finding new things and learning new skills; it’s motivating and creates a feeling of accomplishment. However, the cognitive skills of a toddler haven’t developed beyond that cause-effect understanding.

This is why we need to consider the environment in which our young children play. I recommend giving them plenty of space and opportunity to experiment without worry of the consequence:

  • Make sure stairs are blocked off securely and unsafe climbing hazards are eliminated; encourage kids to explore the space you define.
  • Create a space to explore free of choking hazards, potential poisons and breakable or valuable items; leave plenty of new objects for children to discover, and change the objects out when the kids seem to grow tired of them.
  • Allow children to fail at certain tasks; be encouraging and positive without intervening as they try again.
  • If possible, discuss their actions and consequences with them to help them understand the reason for your rules.

Encouraging the learning and exploration process will increase your child’s confidence and creativity, and defining safe boundaries and rules will keep you both happy.

At Children’s Hospitals and Clinics of Minnesota, we care for more pediatric emergency and trauma patients than any other health care system in our region, seeing about 90,000 kids each year between our St. Paul and Minneapolis hospitals. Children’s Hospital in Minneapolis is the area’s only Level I pediatric trauma center in a hospital dedicated to only kids, which means we offer the highest level of care to critically injured kids. When it’s critical, so is your choice – Children’s Level I Pediatric Trauma Center, Minneapolis.

Dex Tuttle is the injury prevention program coordinator at Children’s Hospitals and Clinics of Minnesota and the father of a curious and mobile toddler. He has a Master of Education degree from Penn State University.

19 tips for a better family camping experience

Camping can be an enjoyable activity to share with family and friends. (iStock photo / Getty Images)

Camping can be an enjoyable activity to share with family and friends. (iStock photo / Getty Images)

Luul Mohamed and Alicia Youssef

Camping can be an enjoyable activity to share with your family and friends. Take advantage of these tips to have a fun and safe trip:

Skin and eye protection

First and foremost, you must effectively protect your skin before engaging in any outdoor activity, regardless of the weather.

  • The sun’s harmful ultraviolet rays are the strongest between 10 a.m. and 4 p.m., so try to plan outdoor activities before or after those times.
  • Children 6 months and older should use sunscreen with a SPF (sun protection factor) of 15 or higher that protects against UVA and UVB rays. Do not use sunscreen on children younger than 6 months as they may ingest the sunscreen by sucking on their fingers or arms. Additionally, their skin is thinner and may absorb chemicals from the sunscreen. Instead, cover infants head to toe in clothing to keep them shaded at all times.
  • Wear sunglasses that go around the entire head that also protect against UVA and UVB rays.
  • Try to wear protective clothing that covers your arms and legs, wear a wide-brimmed hat and try to stay in the shade when you can.
  • Protect yourself from bug bites by applying bug repellent with DEET. The CDC recommends a 30-50 percent concentration of DEET to prevent the spread of pathogens carried by insects.
  • Sunscreen should be reapplied regularly, and bug repellent should not.

subscribe_blogPrepare yourself

  • Bring more than one first-aid kit.
  • Bring safe and healthy food with mostly nonperishable items and make sure all food is in waterproof containers and tightly packed.
  • Let others know where you’ll be going beforehand.
  • Avoid hypothermia by bringing insulated bedding and warm clothing for nights.
  • Stay well hydrated during the day by drinking plenty of water.

Water safety

  • Avoid swallowing water while swimming.
  • Always swim with a buddy and make sure there is an adult supervising at all times.
  • Whenever you are riding a water vehicle, always wear a U.S. Coast Guard-approved life jacket. Minnesota law requires children younger than 10 years old to wear a life jacket. We recommend that children older than that also should wear life jackets.
  • A life jacket should properly fit. You can determine the fit by a child’s weight.

Splish splash: The ins and outs of water safety (Twin Cities Moms Blog)

Fire/bonfire safety

  • When starting a fire, only burn dry, not damp, material and don’t use fire accelerants such as gas or lighter fluid.
  • Start the fire away from flammable things like trees and keep a bucket of water near.
  • Children should be supervised at all times and never near the fire.
  • Never burn containers that have foam or paint in them and never put pressurized containers into a fire. They may explode and release dangerous fumes.

For more information on camping safety, visit:

At Children’s Hospitals and Clinics of Minnesota, we care for more pediatric emergency and trauma patients than any other health care system in our region, seeing about 90,000 kids each year between our St. Paul and Minneapolis hospitals. Children’s Hospital in Minneapolis is the area’s only Level I pediatric trauma center in a hospital dedicated to only kids, which means we offer the highest level of care to critically injured kids. From the seriously sick to the critically injured, we’re ready for anything.

13 water safety tips for kids

A common misconception is that kids only drown in deep water. A child can actually drown in only a few inches of water. Always keep children within arm’s reach. (iStock photo)

Manu Madhok, MD

Manu Madhok, MD

Every summer, we read and hear about children who die due to accidental drowning. Sadly, this summer has been no exception in Minnesota.

Drowning is the leading cause of accidental death among children ages 1-4. According to the Centers for Disease Control and Prevention, most drownings among children ages 1-4 occur in the pool at home. Drowning remains the second-leading cause of unintentional injury-related death behind motor vehicle crashes among children 1-14.

While drowning is a tragedy, it’s one that can be prevented. I’ve compiled a list of tips I commonly share with parents and caregivers to make sure their kids are safe in and near the water.

Children ages 1-5

A common misconception is that kids only drown in deep water. A child can actually drown in only a few inches of water.

  • Always keep children within arm’s reach.
  • Inflatable aids are not substitutes for adult supervision.
  • Enforce pool safety rules. That means no running or pushing.

Children ages 5-12

  • Don’t allow horseplay.
  • Make sure your child never swims alone and always is within view of an adult.
  • Children should receive swimming lessons from a qualified instructor.

subscribe_blogOpen water

  • Never allow a child to dive in without first checking the depth.
  • Choose a swimming area that is under a lifeguard’s supervision.
  • A child always should wear a life jacket while riding in a boat.

Backyard pool

  • The pool needs to have a 4-foot-tall fence surrounding it on all sides.
  • Use a rigid cover for the pool.
  • Install compliant, anti-entrapment drain covers.
  • Pool owners should know CPR.

Children’s has one of the busiest pediatric emergency programs in the country, with about 90,000 visits each year. We love kids here at Children’s, but we’d rather see them safe at home. With warm weather upon us, we compiled a list of basic tips, with help from our injury prevention experts, to keep kids safe all summer. Together, we can make safe simple.

Additional resources

Manu Madhok, MD, specializes in pediatric emergency medicine at Children’s Hospitals and Clinics of Minnesota.