Author Archives: ChildrensMN

The first 1,000 days: Brains are built, not born

Maxine Hayes, MD, MPH, speaks to an audience at Children's Hospitals and Clinics of Minnesota in September.

Maxine Hayes, MD, MPH, speaks to an audience at Children’s – Minneapolis in September.

Maxine Hayes, MD, MPH

Maxine Hayes, MD, MPH

By Maxine Hayes, MD, MPH

The first 1,000 days, from birth to age 3, have the most pronounced impact on a person’s life-long health and well-being. I had the privilege of discussing strategies to make the most of these first 1,000 days when I visited Children’s Hospitals and Clinics of Minnesota in September.

Children born today face the prospect of growing up less healthy, living shorter lives and being less equipped to compete and lead in a world economy than previous generations. For the first time, we are expecting less of our children and letting them down. We should do better, and the good news is we can if we work together.

The opportunity resides in how we impact the first 1,000 days of every child’s life. We know more now than ever about brain science, which shows that by age 3, 80 percent of our brain is developed. We also know that:

  • Brains are built (not born) over time – prenatally to young adulthood.
  • Brain development is integrated. The areas underlying social, emotional and cognitive skills are connected and rely on each other.
  • Toxic stress, in the form of poverty, poor nutrition, inadequate housing, exposure to violence and limited positive and nurturing behaviors, disrupts brain development and can have a lifelong effect on learning, behavior and health.
  • Positive parenting and creating the right conditions can buffer toxic stress and build resilience.

Subscribe to MightyFrederick Douglass once said, “It is easier to build strong children than to repair broken men.”  This is a motivating principle behind many states’ efforts to bolster early child development through policy and practice. In the state of Washington, this is our mission. State leaders are using a collective impact1 initiative to provide a structure for cross-sector stakeholders, including state departments, foundations, social service agencies and pediatricians, to forge a common agenda around the shared vision that all children in Washington will thrive in safe, stable, nurturing relationships and environments, beginning with a focus primarily on the first 1,000 days.

It all begins with a conversation. That’s why the discussions convened by Children’s among pediatric clinicians and state leaders are so valuable. It sends a signal that pediatricians and primary care providers as well as policymakers have important roles to play in this work. By working together and focusing on our youngest at the most critical points in time, we can change the course of life and set our children on a path toward good health and academic success.

Maxine Hayes, MD, MPH, is clinical professor of pediatrics at the University of Washington School of Medicine.

Reference

1 Stanford social innovations review 2013, “How collective impact address complexity” — John Kania and Mark Kramer.

Managing your child’s sleep when the clocks ‘fall’ back in November

Bright light in the morning helps a child’s internal brain clock to maintain a good rhythm, which helps the body transition easier from wake to sleep that night. (iStock photo / Getty Images)

Bright light in the morning helps a child’s internal brain clock to maintain a good rhythm, which helps the body transition easier from wake to sleep that night. (iStock photo / Getty Images)

By Karen K. Johnson, RN, CNP

On Nov. 2, clocks are turned back by an hour, marking the end of Daylight Saving Time. Any disruption to the sleep patterns caused by the time change will be temporary. But if you want to be proactive to minimize the disruption to your child’s sleep pattern, here are a few things to consider.

For babies

Two weeks before the time change, start to put your children to bed 10 minutes later than usual, increasing by 10 minutes every other night until they are going to sleep about an hour later than their normal bed time. It often takes a few days for a new sleep pattern to establish itself.

Toddlers and older

  • Put them to bed a little later than usual the night of the time change. There are behavioral tools available to help with these schedule changes (Good Night clock).
  • If they wake up at their usual time (an hour earlier), you should encourage them to remain in bed until a set time. This may be a digital alarm clock or the visual cue of the night light.
  • When they remain in their bed until the “sun” appears on the clocks or when you inform them it is time to get up, they should be happily praised.
  • The following day, provide a generous amount of physical activity to tire them out and then put them to bed at the new earlier bed time.
  • The next morning, set the clock for the new morning wake time.

On the whole, it is easier for children to fall asleep in the winter months because it is darker and the environment is likely cooler at bedtime. The difference in light levels between day and night encourage the production of the sleep hormone melatonin in the evening when the light is dim, as there is a rise in melatonin and sleep is invited. Bright light in the morning helps a child’s internal brain clock to maintain a good rhythm, which helps the body transition easier from wake to sleep that night. Adjusting the sleep-wake cycle in November is easier to manage than when advancing the clocks forward in springtime.

In the spring, Mighty will have tips to manage your child’s sleep schedule when we “spring” the clocks forward March 8, 2015.

Karen Johnson is a certified nurse practitioner in the Children’s Sleep Center.

Children’s to host vaccination documentary screening

Subscribe to MightyChildren’s will host a screening of “Invisible Threat,” an award-winning documentary about understanding the science of vaccination and the misperceptions that lead parents to delay or decline life-saving immunizations, from 6-8:30 p.m. Thursday at its Minneapolis campus (2525 Chicago Ave. S.).

Parents, health care providers, staff and the public are invited. Flu vaccinations, courtesy of Kohl’s Cares, will be available for 150 people (between 6-7:30 p.m.) and administered by MVNA-qualified nurses. Healthy snacks will be served, and a panel discussion will take place after the film.

The 40-minute independent documentary, produced by high school student filmmakers, has earned praise from more than 50 organizations, including the Centers for Disease Control and Prevention, multiple children’s hospitals, and Every Child By Two, calling the documentary “powerful,” “fast-paced,” “well-balanced” and “impeccably produced.” The event is sponsored by the Minnesota Childhood Immunization Coalition.

Wisconsin girl hasn’t slowed 6 years after cancer diagnosis

Vanessa Achterhof was diagnosed with type 2 Wilms’ tumor six years ago in December, and since has had one of her kidneys removed.

Vanessa Achterhof, of Baldwin, Wis., continues to have checkups every six months at Children’s to monitor her kidney.

Vanessa Achterhof, of Baldwin, Wis., continues to have checkups every six months at Children’s to monitor her kidney.

The 15-year-old from Baldwin, Wis., had 18 weeks of chemotherapy followed by physical therapy. She continues to have checkups every six months at Children’s with Dr. Kris Ann Schultzto monitor her kidney.

Vanessa said three of her favorite nurses at Children’s helped her through the life-changing experience.

“Linda always makes my day and tells me I was one heck of a strong girl. She would always tell me how beautiful I was, even with no hair,” Vanessa said. “To this day, she remembers me and can still put a big smile on my face.

“Jody the social worker is a wonderful person as well. She was always so pleasant and talked to all of us. She had wonderful ideas to help us out and made our whole family feel special.There is one other nurse that I will never forget. I was in Children’s on Christmas Eve night and had a night nurse who told me I was a strong young girl who could push through anything. She was also a cancer survivor of Wilms’ tumor, and if she made it through it, she said I could, too. Unfortunately, we never got her name.”

Cancer hasn’t slowed Vanessa down – now or in planning for the future.

Subscribe to Mighty“I am involved in basketball, volleyball and 4H,” Vanessa said. “I love to show cattle, be a part of our home farm as much as I can and hang out with my friends.”

She is considering being a social worker, working with cancer patients.

“I would love to make their day, play games with them and make them feel special,” Vanessa said. She also wants to go into something to do with animals, specifically cows. She loves the outdoors and spending time on her father’s farm.

Even though Vanessa has been through a lot, she has emerged through it all a caring person with a heart of gold to help anyone in need.

Burnsville boy tops cancer, ready to take on kindergarten

With cancer in the past, Nolan Luther is ready for kindergarten at Sioux Trail Elementary School in Burnsville.

With cancer in the past, Nolan Luther is ready for kindergarten at Sioux Trail Elementary School in Burnsville.

Nolan Luther was diagnosed with rhabdomyosarcoma, a cancerous tumor of the muscles, on June 3, 2013.

He finished chemo in March and will have quarterly scans for the next two years before they become less frequent. He may undergo surgery to help reanimate the left side of his face. The tumor damaged Nolan’s facial nerve.

Nolan Luther

Nolan finished chemo in March and will have quarterly scans for the next two years before they become less frequent.

With cancer in the past, Nolan is ready for kindergarten at Sioux Trail Elementary School in Burnsville.

“Nolan is very curious. He asks about 400 questions a day,” his parents, Tara and Kevin, said. “He is a sensitive kid and shy at first, but once he is comfortable he is incredibly confident. Towards the end of treatment, Nolan would often direct his nurses on what type of drugs he should have and how they should administer his shots and access his port.”

School won’t be the only thing on his mind. Nolan loves soccer and gymnastics. This summer, he has been able to do more of both activities. He also is good with Legos. The Luthers recently put together a 1,200-piece Millennium Falcon from “Star Wars,” and Nolan did the majority of it by himself.

Subscribe to MightyNolan’s parents are thankful for the care throughout his treatment.

“The care Nolan received at Children’s was really top notch,” Kevin said. “We felt so confident and comfortable that Dr. Kris Ann Schultz was doing everything possible to ensure the best outcome for Nolan. We appreciated the long-term focus and proactive attention that Children’s provided. They started physical therapy early to give Nolan the best chance for a quick physical recovery.

“As crazy as it sounds to some people, we consider ourselves lucky. Maybe not in the normal sense, but lucky that we fell into this journey at Children’s and we found ourselves with an amazing team of specialists – not just the doctors, but nurses, physical therapists, social workers and child life specialists – that were able to provide fantastic care and support. We are fortunate to benefit from the experience of patients who have gone before us and the research that has gone into pediatric cancers.”

Serving up strategy at meal time

Kids are born wanting to eat. And they know when they’re hungry. It’s our job as parents to provide structure, support and opportunities.

Kids are born wanting to eat. And they know when they’re hungry. It’s our job as parents to provide structure, support and opportunities.

By Maggie Sonnek

We’ve tried peas. We’ve tried broccoli. We’ve even tried Brussels sprouts. Alas, our 2-year-old continues to ignore that pile of “green stuff” on his plate and reach for the carbs instead (just like his mother).

After chatting with Janie Cooperman, MS, RD, LD, CDE, Pediatric Clinical Dietitian at Children’s Hospitals and Clinics of Minnesota, I now can come to the table feeling a little more prepared to take on a toddler at dinnertime. (Sounds like a thrilling TV show, doesn’t it?). I feel so enthused with what I’ve learned that I just had to share. 

Keep offering

Cooperman suggests offering specific foods 12-15 times before retiring them from the household menu. That’s a lot of peas! She also touts variety when planning the weekly carte du jour. For example, instead of plain bread, try whole wheat tortillas or pita pockets.

Division of responsibility

Kids are born wanting to eat. And they know when they’re hungry. It’s our job as parents to provide structure, support and opportunities.

Cooperman sites Ellyn Satter, an expert on the topic of the division of responsibility in feeding. Basically, this means we the parents are responsible for what, when and where our kids eat. They’re responsible for how much and whether they eat.

Yep. I said “whether.”

Cooperman suggests offering three scheduled meals a day with two or three snacks in between. “Eventually the child begins to understand the schedule and expectations,” she said. “Since he is not receiving food other than at the scheduled meals and snacks, he will soon get hungry enough and realize that he has no other option but to eat what’s being offered.”

Subscribe to MightyMake it a non-issue

You know the old standby, “You can’t leave the table till your plate’s clean”? Well, turns out, forcing a clean plate prevents kids from learning to pick up on their own hungry and satiety cues. Apparently most of us unlearn the natural inclinations of when we’re full and hungry sometime between the ages of 3 and 5.

Cooperman suggests making the amount of food your child eats a non-issue. She dissuades from offering rewards for eating. “If they refuse to eat, let it go,” she said. “But keep offering it at future meals. Try not to let kids get power and control.” (Writer’s note: I’m totally guilty of bribing my son with a chocolate chip cookie for taking a bite of broccoli. Oops.) 

Eat mindfully 

Eating dinner together as a family has a lot of benefits. The Family Dinner Project, a grassroots movement driven by insights and experiences of families, says recent studies find regular family dinners can help lower rates of substance abuse, teen pregnancy and depression. Studies show that dinner conversation can help improve vocabulary more than reading.

But let’s focus on the obvious: eating together. Parents modeling healthy habits, like munching on fruits and veggies, provide a good example for kids. Cooperman touts the importance of eating mindfully.

“Slow down, connect and enjoy what you’re eating,” she said. “Appreciate the food and your time together; it’s a more-balanced way of eating and living.” 

Maggie Sonnek is a writer, blogger, lover-of-outdoors and momma to two young kiddos. When she’s not kissing boo-boos or cutting up someone’s food, she likes to beat her husband at Scrabble.

3-year-old aspiring ballerina stays busy despite cancer

Lydia Fisher is in the maintenance phase of treatment.

Lydia Fisher is in the maintenance phase of treatment.

All Lydia Fisher talks about is ballet.

The 3-year-old girl probably will get to take ballet, adding to her already busy list of activities which includes swimming lessons and gymnastics – all normal things for a friendly, outgoing little girl.

“She’s just really an active 3-year-old. When you meet her on the street, you’d have no idea she’s undergoing chemotherapy,” her mother, Jane Fisher, said. “She’s such a trooper.”

Lydia 1Like most families, Lydia’s cancer diagnosis caught her parents, Jane and Jeremy Fisher, off guard.

“She was diagnosed with acute lymphoblastic leukemia (ALL) on her second birthday,“ Jane said. “She had been sick with fevers and aches for 14 days before our pediatrician said we should get worked up at Children’s Hospital. We were admitted, and a couple days later it was confirmed that Lydia had ALL after a bone marrow biopsy was completed. You never really think that you are going to be ‘that family.’ Like others, we’ve tried to face it head-on.”

Jane, who works at Children’s Hospital in another department, and her family always knew it was a wonderful place for families to be treated. But seeing it from the other side of the fence has been eye-opening for Lydia’s parents.

Subscribe to Mighty“The whole staff is amazing,” Jeremy said. “From the doctors on down to the housekeeping staff, everyone is so good at their jobs. Everyone stops to visit with us, support us and make sure we are doing well. Many of them aren’t even caring for Lydia. Everyone gets that same treatment; we appreciate it.”

Lydia is seen at the Minneapolis campus, and her primary oncologist is Kris Ann Schultz, MD. Lydia is in the maintenance phase of treatment. Her family anticipates she’ll complete treatment in September 2015.

“This past year, I think we’ve really settled into (cancer) just being part of our life and being part of our family,” Jane said. “We try not to make it be the center of everything. We try to make her childhood as normal as it can be.”

Leukemia hasn’t slowed energetic Ike

Ike Yarmon is in the maintenance phase of treatment, and his care team hopes he will finish treatment in July 2016.

Ike Yarmon is in the maintenance phase of treatment, and his care team hopes he will finish treatment in July 2016.

A child’s birthday should be fun and carefree. But just three days before Ike Yarmon turned 5 last year, his family got mind-blowing news: Ike had cancer.

At first, it seemed like Ike had a run-of-the-mill ear infection. Then, he developed a rash all over his body. It originally was thought to be a reaction to amoxicillin to treat his ear infection. During each visit, Ike’s pediatrician had his blood drawn, which indicated alarming white blood cell counts. It could be leukemia, his pediatrician said, but Ike didn’t have any other symptoms.

After continued declining white blood cell counts and a stubborn rash, his pediatrician recommended Ike’s parents, Chelsea and Chad Yarmon, take Ike to the emergency department at Children’s Hospitals and Clinics of Minnesota.

Ike’s lab results perplexed the emergency department staff. Due to the possibility of having a serious viral infection, Ike saw Children’s infectious disease specialists. Further blood tests didn’t reveal a virus or inflammatory disease. Three days later, Ike underwent a bone marrow aspiration, which showed Ike had B-ALL leukemia.

Subscribe to MightyIke’s diagnosis has been life-changing for his family. It has shown them the “true meaning of living,” given them more purpose and brought them closer, Chelsea said.

“We fight so these children no longer have to endure these horrible treatments and so that no parent ever has to hear the life-altering words of ‘your child has cancer,’ ” Chelsea said.

Ike is in the maintenance phase of treatment, and his care team hopes he will finish treatment in July 2016. While his family counts the days until treatment is over, it hasn’t kept him from playing hockey and baseball, being outside and playing with his sisters and spending time with his family. He’s full of energy.

“We feel incredibly lucky and blessed that, even though Ike has cancer, he was diagnosed with a highly curable form and is handling his treatments like a true champ,” Chelsea said. “We know that his prognosis could be in a much different place, and for that we are truly grateful.”

Wisconsin girl perseveres through cancer relapse

Reagan completed her initial treatment April 1.

Reagan Robertson, of Frederic, Wis., completed her initial treatment April 1.

Like most little girls, Reagan Robertson of Frederic, Wis., has a healthy list of her favorite things. Not surprisingly, Disney princesses and baby dolls rank high on her list. But you can also add dance parties, horses, puppies, kitties, fingernail polish and bike rides with her dad to that list.

A brave, sweet girl, Reagan already has been through a lot in her young life.

It was Oct. 17, 2013, when doctors first mentioned “leukemia” to her parents, Alison Lake and Allen Robertson. When a subsequent bone marrow biopsy didn’t confirm the disease, the Robertsons stayed in the hospital for eight days while the doctors tried to pinpoint her exact condition. Eventually, the Robertsons were sent home with “pre-leukemia” until Nov. 8, when acute myeloid leukemia was confirmed.

Subscribe to MightyReagan completed her initial treatment April 1 (four rounds of chemotherapy with each round averaging 25 days inpatient and 12 days at home). Then, on May 16, she relapsed. She had an additional two rounds of chemo. If these rounds of chemo put her into remission, she’ll be getting a bone marrow transplant, hopefully, this month.

Alison is appreciative of the care they receive from Dr. Jawhar Rawwas and the staff at Children’s.

“I feel like the oncology team cares for Reagan,” she said. “When she relapsed, they were upset for us. The doctors and nurses are very attentive and do a good job in every aspect of care.”

Reagan’s lengthy hospital stays have had an impact on her. Alison figures Reagan will be a nurse when she grows up since she regularly helps the nurses do vitals, does dressing changes on her stuffed animals and takes alcohol wipes and cleans the lines. She always helps flush her g-tube and even refers to herself as “baby nurse.”

Reagan is a fighter and up to the challenges ahead of her.

“When she’s feeling good and not in the hospital, she is an absolute joy to be around,” Alison said. “She’s so happy and smiling and funny. She can be a tad grumpy in the hospital and sometimes people don’t really get to see her true nature. She is our ‘Rea of Sunshine.’ ”

Break for breakfast: Tips for a healthy start

With the school under way, your child may be in a hurry to get ready in the morning – and that includes trying to fit in time to eat breakfast and pack a lunch.

Since diet plays a huge role in childhood obesity, it’s important to make sure a child is eating right even when you’re not there to supervise or cook. Four out of five kids from 12 to 19 years old have “poor diets” – high in salt and sugar-sweetened beverages and low in fruits, vegetables, fiber and lean protein.

In Minnesota, nearly one out of four kids has weight problems. Among Minnesota adolescents ages 10 to 17, about 11.1 percent are obese.

Subscribe to Mighty“Beginning your day with a healthy breakfast is a good way to wake up your body and brain,” said Julie Boman, MD, a pediatrician at Children’s Hospitals and Clinics of Minnesota.

How do you make sure your child gets a healthy start? Boman weighs in with these four tips:

  1. Stock the cupboards and refrigerator with healthy choices. They can include whole grain cereal, fresh fruit, yogurt and eggs.
  2. Make it convenient. If you buy strawberries, wash and slice them up so they’re ready for your child to grab and go.
  3. Whenever possible, encourage your child to sit down and have breakfast.
  4. If your child is older, plan the menu for the week together.