Category Archives: Health Tips

Break for breakfast: Tips for a healthy start

With the school year over, your older child may be spending more time on his or her own – and that includes having to be responsible for breakfast and lunch.

Since diet plays a huge role in childhood obesity, it’s important to make sure 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.

“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 4 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.

This post also appeared in the Star Tribune kids’ health section.

6 tips for preventing, identifying and treating lice

During the summer, kids share everything. Pool towels, hats and, yes, even lice. It’s an itchy subject, but anyone can get lice! It’s totally treatable, and there are no long-term effects.

We spoke with Molly Martyn, MD, a pediatrician at Children’s Hospitals and Clinics of Minnesota, about how to prevent, identify and treat it.

1.  What are some signs of lice?

Lice are most often seen rather than felt.  Most children do not have symptoms when they have lice.  In some cases, they can develop itching from an allergic reaction to the lice saliva.

The head louse is about 3 mm long (about the size of a sesame seed) and is a grayish-white color.  Lice move by crawling, not by flying. Females lay eggs (commonly called “nits”) at the base of hair shafts.   The eggs hatch after a week and leave the remains of their white case in the hair. The eggs are firmly attached to the hair, so they move away from the scalp as hair grows.

The best way to look for live lice is to comb the hair with a fine-toothed nit comb. Hair should be wet with a conditioner. With a fine- toothed comb, start touching the scalp and comb through to the end of the hair, looking for lice or nits after each stroke.

Nits (eggs or the empty egg cases) can stay in the hair for some time even after active infestation is cleared.

2.  How do lice spread?

Lice spread through contact, most commonly from contact with the head of a person with lice. Lice can also transfer through shared clothing, hats, combs, hair brushes, headbands and hair ties, headphones, towels, pillows, beds, etc.

It is important to remember that lice can happen to anyone, and is not a sign of being dirty or having poor personal hygiene.

3.  What is the difference between dry scalp and lice?

This can be a surprisingly difficult thing to tell by just looking at a scalp.  Nits can be confused with dry scalp, residue from hair gels or sprays, or fungal infections of the scalp.  Nits are usually more firmly cemented to the base of the hair and are difficult to dislodge.  Your child’s pediatrician or family doctor can help you distinguish between dry scalp and lice.

4.  What are things parents can do to prevent their child from getting lice at summer camp?

Before your child goes to summer camp, it is a good idea to have a conversation about things they shouldn’t share such as hats, hair brushes, hair styling items, head phones, towels, and bedding.

If you are concerned, ask the camp about whether or not they have had issues with lice in the past.  Your child may be required to bring their own bedding.  If able, you should send them with their own pillow and towels.

You can also ask if children will be participating in activities requiring helmets and send your child’s own helmet if they have one that is appropriate for the activity.  Wearing appropriate head protection should never be avoided, even if it is shared.

5.  If a child acquires lice at camp, what should a parent do?

Dealing with lice can be a very stressful thing for families.  Given that it spreads by contact, many families end up treating not just one child, but multiple family members.

There are a number of different approaches to treating lice and you can always ask your child’s doctor for advice.  It is most often treated with a topical lotion or shampoo that helps to kill the lice when applied to the scalp.  The exact instructions on use will vary depending on the type of treatment used.  Some types of treatment are repeated at seven to 10 days because they kill only the adult lice, not the eggs.  Follow instructions closely, as the topical medications can have serious side effects if misused or overused.

Some families may choose not to use a topical medication and instead remove lice through processes such as repeated “wet combing.”  This is also a good option for children who are too young to use the topical medications.

If one member of your family is diagnosed with lice, it is important to check all family members.  Bedding, towels, and clothing should all be washed in hot water and heat-dried.  You should also vacuum your home to remove any hairs that were shed with nits attached.  Throw away combs and brushes used by the infected person or soak them in hot water greater than 130 degrees for 10 minutes.

We have many visits and calls to our clinic regarding lice, and have a standard way of helping families to treat and get rid of lice. We are happy to help!

6.  Where can I find out more about lice such as how to do the wet combing method?

The Centers for Disease Control and Prevention (CDC) has a terrific website with information on how to recognize, treat, and stop the spread of lice: http://www.cdc.gov/parasites/lice/head/index.html .

A Q-and-A on emergency contraception, safe sex

News came out last week that the Food and Drug Administration approved the sale of the emergency contraceptive pill without a prescription to girls 15 and older.

Specifically, the agency approved Plan B One-Step, an emergency contraceptive intended to reduce the possibility of pregnancy following unprotected sexual intercourse – if another form of birth control like a condom was not used or failed, the FDA said. It’s a single-dose pill that is most effective in decreasing the possibility of unwanted pregnancy if taken immediately or within 72 hours after unprotected sexual intercourse.

“Research has shown that access to emergency contraceptive products has the potential to further decrease the rate of unintended pregnancies in the United States,” said FDA Commissioner Margaret A. Hamburg, M.D. “The data reviewed by the agency demonstrated that women 15 years of age and older were able to understand how Plan B One-Step works, how to use it properly, and that it does not prevent the transmission of a sexually transmitted disease.”

This presents a timely opportunity to talk to your child about safe sex. Think your kid isn’t having sex? That may be true. But, that doesn’t mean you should avoid talking about it.

We spoke with Children’s physicians Dr. Dave Aughey, medical director of adolescent health, and Dr. Rachel Miller, a pediatric gynecologist, about safe sex.

How/when do I start talking about sex with my child? How often should I have the conversation?

Dr. Miller: A 2011 national survey of high school students found that 19 percent of female and 24 percent of male ninth-grade students were sexually active. The percentage increases to 51 percent of female and 44 percent of male high school seniors. Rates of sexual activity, pregnancies and births among adolescents have continued to decline during the past decade to historic lows, however many adolescents remain at risk of unintended pregnancy and sexually transmitted infections (STIs). The United States has the highest rate of unintended teen pregnancy of any industrialized nation and adolescents acquire half of all STIs in the country each year.

Dr. Aughey: Parents should look for every opportunity to talk and encourage discussions with sons and daughters about feelings, emotions, friendships and relationships. In general, boys have fewer of these opportunities and a lower comfort level than girls.  Use these discussions to reinforce expectations and values. Ground these discussions in their lives — their music, movies, games, schoolwork. Frequent conversations build comfort and trust. Mothers have a particularly strong influence on their daughter’s sexual attitudes and behaviors.

Realize that most teens have their first sexual experience between 16 and 18.  If the current generation of adolescents ends up marrying, it’s not likely to be until their mid- to late ’20s.  So, the “sex talks” need to include protecting oneself from Chlamydia, dating violence, exploitation, getting drunk, and using condoms in addition to the risks of unplanned pregnancy or fathering a child.  Scare tactics never work.  But being responsible includes all of this and more.  Young men, in particular, need to hear these messages more than ever.

Parents hope their children will delay these things as long as possible. But it won’t be forever. The longer your child knows someone, the stronger their feelings, the more in love they are, the more the bets are off. Rather than being scared about the physical aspect of sex, parents should prepare their children to be prepared emotionally, spiritually, and if needed, contraceptively.

My child says he’s not having sex. Should I make protection available anyway – just in case?

Dr. Miller: Condom education and availability programs improve use of condoms, delay sexual initiation of youth and reduce the incidence of STIs and pregnancy. It has been shown that an advanced prescription increased the use of emergency contraception and decreased time to use. No randomized study has shown an increase in sexual activity or decrease in ongoing contraceptive use in adolescents given advanced access to emergency contraception.

Dr. Aughey: Be honest with yourself. You’ve known your child for at least the last 15 years.  What do you think? When teenagers fall in love, everything changes.  It’s not hormones. It’s human nature. It pains me when a patient tells me her mother found her birth control pills and threw them away. Or threw his condoms away.  Really…is this logical? In 25 years, I’ve never encountered a teenager who, in this situation, has said, “I’ve seen the errors of my way…I will break up with my lover.”

What are the most effective forms of protection for my child?

Dr. Miller: It is not only the use of contraceptive method but also the type of method used that can significantly impact unintended pregnancy. Long acting reversible contraceptives demonstrate the greatest success in reducing unintended teen pregnancy. Examples are the subdermal implant and intrauterine systems. I always recommend dual use of a condom to protect against STIs.

Dr. Aughey:With few exceptions, contraception is safe for adolescents, much safer than is pregnancy, by comparison.  That’s not even factoring in all the economic and social perils of unplanned pregnancy or fatherhood.  Long-acting methods like the intrauterine device (IUD) or implant are best as it is difficult for anyone to consistently use pill, patches, rings or condoms.

Plan B is “emergency” protection.  It is never as good as an ongoing method of birth control.  It’s most effective taken as soon as possible.  It needs to be easily accessible to the teen for “emergency” use.  This doesn’t mean calling a clinic the next day, waiting for a prescription, getting it filled, finally taking it and hoping for the best. Ideally it’s taken within 12 hours.

I know my daughter is sexually active. If she needs emergency contraception, where can she get it?

Dr. Miller: Emergency contraception is available at most every pharmacy. One dose usually costs $40 plus tax. Comparatively:

  • Four months of oral contraceptives are $9 per month. Without insurance, it’s about $36 plus tax at some local retailers.
  • 120 Lifestyles Ultra Thin condoms (3 40-count boxes) are about $33 plus tax.

For more information on talking to your child about sex.

Five Question Friday: Dr. Dave Aughey

Meet Dr. Dave Aughey, MD, medical director of adolescent medicine.

What drew you to adolescent medicine? This will sound cliché, but I was quite ill as a pre-teenager.  My recovery overlapped with the magical time of puberty, and it was an emotional and a physical transformation.  From this time on, I knew I wanted to work with teenagers.  I couldn’t decide if I wanted to be a pediatrician or a psychologist.  I was drawn to Adolescent Medicine because I could do both.

Dr. Dave Aughey

Are there any trends you’re seeing right now in adolescent medicine and, if so, what are they? Nationally, about 600 pediatricians are certified as Adolescent Medicine specialists. In the last 10 years, only about 225 of these have gone through the three-year post-residency training and certification. Most of these pediatricians practice in academic centers and not in community settings. The field is struggling to find its niche and to attract new practitioners. The good news is that adolescents are now being recognized as having unique health needs, which are best served by a “psychosocial” care model.  This model embraces the “health” needs of adolescents and young adults, not just the physical dimensions. Many other primary care providers also now recognize these special needs and are effectively providing care and guidance.

What do you enjoy most about your job? I view myself as a pediatrician who specializes in being a primary care provider for adolescent and young adult patients and their families (and sometimes their friends). I have opportunities to be a dermatologist, counselor, gynecologist, sports medicine doctor, psychiatrist or pediatrician on any given day. I really enjoy being able to provide this range of care to patients. It makes relationships with patients and families very rich and gratifying.

What is your favorite memory from working at Children’s? After 25 years, it’s impossible to pick a favorite memory. I’ve had the honor of working with extremely compassionate and caring colleagues. Patients have been inspiring, especially those who overcame challenges and adversities that would have bewildered me. I remember patients who proudly shared their accomplishments with me.  Former patients who’ve brought their babies to show off. Patients who’ve stopped me on the street. “You don’t remember me, but….” These memories are all warm and heart-felt.

If you weren’t working in medicine, what do you think you’d be doing? My fall-back plan early on was going to be that I would run a hardware store. In retrospect, given the emergence of the big boxes, that would have not gone well. I still would love to teach high school and be around adolescents in another capacity.  In the deepest, darkest corner of my soul, I dream about being a woodworker or a dancer. Or a photographer. Or maybe an engineer…

Q-and-A with Dr. Troy: How to talk to children about death

During the past 12 months, we’ve been rattled by the tragedies we’ve read and heard about in the news.

In July 2012, 12 people were killed and 58 others were injured in an attack in an Aurora, Colo., movie theater shooting.

Twenty children and six adult staff members were shot to death in December 2012 at Sandy Hook Elementary School in Newtown, Conn.

Closer to home, an insanity trial is underway for a man who admitted to murdering his three daughters this past summer. Last weekend, a woman and her two children were found dead in their home after authorities say she drowned them and then committed suicide.

As parents, we want to protect our children from these horrors. It’s hard to comprehend discussing the unthinkable – a mother or father taking the life of their child – with our own kids. Do we bring it up? How do we respond when they come to us looking for answers?

We spoke with Dr. Michael F. Troy, Ph.D., L.P., our medical director of behavioral health services, in an attempt to answer some of those questions:

How do I explain death to my child in an age-appropriate way?

Dr. Michael F. Troy

There are important differences between explaining the death of an important person in your child’s life and talking about a tragic death in the news. The former is likely to be a challenging, but near universal, role for a parent.  Eventually, all families will face the loss of a loved one requiring parents to share sad news with their child. While it is typical for parents to find these junctures difficult, this does not mean that they are unable to do so with skill and sensitivity.  Parents are used to explaining things to children in developmentally appropriate ways. Whether it’s why they have to have a shot at a doctor’s office or why they need to move to a new community, parents generally know – by instinct and knowledge – how to do this. Talking about death, while less common and inherently sad, is not an entirely different kind of task. Parents should think of it as being like other kinds of sad or disappointing news they might have to discuss with their child.  The specifics, for example, the closeness of the person who died, whether it was an expected loss, and the age of the child, will determine what is communicated.  But the general point, that parents actually do have experience in talking about difficult things and that they should rely on that experience, is most important.

Talking about deaths reported in the news is a different situation. While there are always exceptional circumstances, it is generally best to wait and see if your child raises the issue.  Whether they are aware of a news story is likely to depend on factors such as their age, how routinely they are exposed to the news, and how direct the event in the news is to their day-to-day lives.  If they don’t have knowledge of the story, raising the issue with them is unlikely to be a helpful. If they do raise the issue, it’s important to first find out what they have learned and what specific questions they have (there is no need to respond with answers to questions they don’t have). Additionally, it is important to keep your feelings and thoughts about the news story separate from the actual, specific concerns your child has. Your job as a parent is to help your child understand the event in a way that’s consistent with their developmental level, as well as to reassure and comfort them as necessary.

How do I explain why a parent killed his/her child?

You can’t really explain what you may not understand yourself. If you find the news of a parent killing her children and then herself perplexing and distressing, then it is OK to say that you are confused and upset by it. At the same time, you can also provide reassurance of your child’s safety and, if necessary, of your own ability to take care of them. If you feel you have some understanding of the event, for example, if it was the result of the mother’s severe mental illness, do your best to explain this briefly and in developmentally appropriate ways and with an emphasis on how rare such events are. You might also want to communicate empathy for those most affected by the loss.

Should I talk about the mental health of the parent? How do I do that?

You should talk about the mental health of the parent if your child asks about it, or if you feel that it’s important and appropriate for you to include in your response to the specific questions your child has asked. It’s unlikely that we would actually know the mental health status of a parent taking the violent and tragic actions reported in these recent cases, especially in the immediate aftermath of the tragedy when it is most likely to be in the news. Consequently, you might note that questions regarding mental health issues have been raised – and what this might mean – without suggesting that you know for certain what led to act of violence. It may also be important for you to note that while mental health issues are sometimes linked to violent acts, the vast majority of people with a mental health diagnosis are not violent.

At what age is it appropriate to approach my kids about this topic? Should I always wait for him/her to bring it up?

Unless you have specific reason to anticipate your child encountering discussion of these issues, it is generally better to wait and see if your child raises such concerns with you. Of course, the older children are, the more likely they are to both hear about and initiate questions about news of a tragic event. Similarly, the older your child is, the more reasonable it likely is to bring up the issue.

Are there things I can say or do to make my child feel safe and at ease?

First, it’s worth remembering that our goal as adults caring for children is to help them feel safe without needing frequent reassurance. If such reassurance is necessary, then the most important thing to emphasize is just how incredibly rare these types of events (school shootings, parents killing their children) are. They are extremely upsetting to hear about, and terribly tragic for the families affected, but also quite unlikely to happen. Because they are so rare and so dramatic, they tend to receive intense media coverage. But it also this pervasive media coverage that can make it seem as if these tragedies are more common than they really are. Consequently, it is almost always reasonable to reassure children that they are safe and that there are many adults in their lives looking out for their wellbeing. Some children will have specific concerns requiring specific reassurance. Younger children are likely to need you to talk about the ways in which their own home and school are safe places, while older children might need help understanding the rarity of these events through comparison to other types of risks.  For example, you might point out that while there are people struck by lightning every year, the odds of any given individual beings struck is exceedingly low.

My child has a fever. What should I do?

By Erin Dobie, CNP

Fever is one of the most common reasons parents seek medical attention for their child or infant. All kids get fevers at some point. Studies reveal parents are most worried about fevers due to the fear that they can cause brain damage or even death. But, there is no evidence to support these concerns.

As a nurse practitioner in the Emergency Department at Children’s Hospitals and Clinics of Minnesota, I frequently see kids with fevers. The questions from parents are usually the same. I wanted to answer some of those questions here.

What is a fever? Fever is defined as a body temperature greater than 100.4°F (38°C). It is part of the body’s natural defense mechanism and a normal body response to fight infection. Fevers help the body fight infections by stimulating the immune system. Fevers slow the growth and reproduction of the virus or bacteria. They also increase production of antibacterial substances in the immune system.

Should I treat a fever? Otherwise healthy children and infants (3 months and older), whose temperature is between 100.4 and 102°F (38.0-38.9°C), do not require any medication to reduce the fever unless the child is uncomfortable. Consider how your child is acting before treating with medication. Is he/she still playful? Drinking and urinating? These lower grade fevers help the body fight off illness. Fevers greater than 102°F do not always indicate a more serious illness. Does your child have other specific symptoms or complaints that are concerning or need medical attention? It’s important to remember to treat the child, not the fever.

When should I call my child’s health care clinician? You should call your child’s physician or nurse practitioner if your child is:

    • younger than 3 months old with a rectal temperature of 100.4°F or higher
    • crying and can’t be consoled or extremely irritable
    • somewhat difficult to wake up
    • refusing to drink fluids
    • experiencing painful urination
    • not vaccinated

If your gut tells you something wrong or if your child has a chronic condition, then you should also call.

When should I call 911? Pick up the phone if your child has:

    • trouble breathing
    • purple spots on skin
    • extreme difficulty waking up

Which medication should I use to treat my child with a fever? Acetaminophen (Tylenol) and Ibuprofen (Motrin or Advil) are two fever-reducing medications recommended for children and infants. Do not give Ibuprofen to infants younger than 6 months. Do not give Aspirin to children of any age. Be aware that many other over-the-counter medications often contain acetaminophen. Therefore, please read the labels carefully to reduce the risk of overdosing your child. Medication dosages are unique for children based on your child’s weight.  See Fever Dosage Charts for more information.

Remember, treating the fever with these medications doesn’t treat the illness causing the fever so when the medications wear off, the fever will most likely return until the body is done fighting off the illness.

A night in the ED with a child life specialist

A 3-year-old girl needs her bottom lip sutured. A 2-year-old sibling is bored to tears – literally – while she waits for her brother to be released so they can go home. A 7-year-old needs an IV start for blood draws and medicine.

Who are you going to call? The child life specialist.

Mindy Teele, child life specialist

On a recent weekday night in the Emergency Department, Mindy Teele, a certified child life specialist at Children’s Hospitals and Clinics of Minnesota, is in demand. A patient is about to have an IV start, so an RN asks Teele to explain the procedure ahead of time. In another exam room, a patient is waiting for results, so Teele brings toys. A few minutes later, she returns to the patient with the IV start to distract the patient during the procedure.

“Child life specialists focus on the psychosocial and developmental needs of children to minimize their fears, clarify misconceptions, build coping abilities and enhance understanding when kids are in the hospital,” said child life manager, Sheila Palm. “Being better prepared improves long-term adjustment to medical conditions, increases cooperation and reduces pain during procedures.”

Children’s deploys certified child life specialists throughout the hospital – to the medical-surgical, pre-surgery, critical care, and cancer and blood disorders units. Child life specialists work in home care and hospice, too. Children’s also has child life associates who help on some of the units and in the Sibling Play Area. Philanthropy helps support child life specialist services; their work is not reimbursable.

In the ED, Teele helps reduce the stress of what can be a traumatic visit by providing age-appropriate information, coping strategies and parent coaching, Palm said. Gaining cooperation from the patient and family can reduce the time of the procedure, need for sedation and need for an extended ED stay.

A 2008 Children’s study in the ED compared parental satisfaction with their child’s experience during a laceration repair in the presence and absence of child life services. Overall, there was greater satisfaction when a child life specialist was involved.

Patients experienced less anxiety when they left the ED when a child life specialist was involved in their care. Child life specialists received a significantly higher rating than other providers in their efforts to relieve anxiety. Children’s also received a rating of excellent from families more often when a child life specialist was present.

“I find the presence of child life services in our ER to be a tremendous asset. The care that they provide in alleviating the apprehension and pain of the sick and injured children we care for on a daily basis is wonderful. I appreciate working alongside such caring individuals and see their effect in many of the patients I come across during my shifts,” said Dr. Mark Schnellinger.

Teele has worked at Children’s for 13 years, 12 of which she’s spent in the ED. “I feel like my personality fits this environment,” she said. “I like the instant gratification.”

In the ED, time is not on Teele’s side. She often only has minutes to explain and prepare patients and families for a procedure. So she relies on analogies to explain them. Instead of calling herself a child life specialist, she tells patients she’s a teacher – a term kids can understand.

“Anyone can go into a room and tell a child what’s about to happen,” Teele said.

But, a child life specialist is able to assess the child and take him or her through the experience on their terms, she said. If a child needs a CT and loves princesses, Teele might develop a scenario from “Snow White.” If the child is obsessed with video games, Teele explains the procedure like it’s a video game with various levels for advancing.

On this recent weekday night, a little boy is minutes away from having a needle inserted into his hand for an IV and blood draws. Teele explains that the RN will use a J-tip, which helps minimize pain with needles, to make the area feel soft. An RN will then use “soap” to clean the skin. Using the same tools for the procedure, she shows him what everything is supposed to feel like. She shows him the “straw” and explains that, unlike a juice box straw, it will give him medicine to make him feel better.

Later in the evening, she’s called in to help during an IV start with another patient. The ED has run out of J-tips. Armed with a Disney book, Teele holds it up for him and together they identify the characters while the RN inserts the needle, draws blood and then gives the boy medication. Distraction works. The patient remains calm the entire time.

“I think I have a very rewarding job,” Mindy said.

You can make it possible so that every family at Children’s can benefit from the support of this and many other invaluable programs. Please make a donation today.

Sharing knowledge: National Women and Girls HIV/AIDS Awareness Day

Today is National Women and Girls HIV/AIDS Awareness Day. Women and girls now make up almost a quarter of people living with HIV in Minnesota, and over 70 percent of these are women and girls of color, according to the Minnesota Department of Health.  Women of color have been especially hard hit, accounting for the majority of new infections occurring among women in the United States.

The United States has made great strides in efforts to eliminate the spread of HIV from mother to child, and the number of children perinatally (around birth) infected with HIV in the United States has declined over 90 percent since the epidemic began. We’ve also seen a significant – 21 percent – decrease in new infections among women in recent years. But, the fight is not over.

As the largest provider of care to HIV-infected infants, children, and youth in Minnesota, Children’s Hospitals and Clinics of Minnesota provides medical care to about 75 to 80 children, adolescents and youth infected with HIV and their families annually. Children come to us from all over Minnesota and surrounding states (North and South Dakota, Iowa, Michigan, and others), and all over the world. Many of the children in our care have been adopted from countries in Asia, Africa, Eastern Europe, and the Caribbean.  Many more are first or second generation refugees and immigrants.

In addition to specialized medical care, families can access specialized support services, including education and family case management funded through the federal Ryan White CARE Act program and referrals to additional programs and services throughout the state.

With modern advances in HIV care, women and girls are living longer, healthier lives, and many men and women affected by and infected with HIV are choosing to start to add to their families.

Without medical intervention, about one in four children born to HIV-positive mothers will become infected, but by following current treatment and prevention guidelines, women can reduce their risk of transmission to 1 to 2 percent. Despite this success, however, the prevention of perinatal HIV infection remains complex and requires access to specialized, competent medical care and prevention support services.

Children’s houses the Minnesota Perinatal HIV Program, which exists to eliminate the transmission of HIV from mother to child in Minnesota and ensure men and women living with HIV can give birth to healthy babies, born free of HIV. Our specialized services are open to HIV-infected pregnant women and HIV-negative pregnant partners of HIV-infected men at-risk of acquiring HIV infection.

We provide nursing care coordination, case management, and education services to women, their partners, and their providers during pregnancy and up to six months following birth. In partnership with community providers, we also offer preconception counseling and guidance for couples wishing to conceive safely and prevent HIV transmission. During 2003 to 2012, the program provided services to more than 390 women, 75 percent of whom came from racial and ethnic minority populations and almost 40 percent were African-born.

Women and girls are EMPOWERED by knowledge and actions to change the course of HIV.

Prevention tips:

1. Get tested, know your status! HIV testing is recommended as a routine part of medical care.  Talk to your provider about testing.

2. Educate yourself about your risks! Learn how to prevent HIV infection and how to keep yourself safe.

3. Get connected, get support! If you are living with HIV, find out about the programs and services offered in your area to help you stay healthy and support you and your family in dealing with your disease.

Has the flu reached your home? Here’s the 411.

By Patsy Stinchfield

Patsy Stinchfield

Flu season arrived early this year and with more severity than in recent years. According to the U.S. Centers for Disease Control and Prevention (CDC), 48 states had reported influenza during the week of Jan. 6-12. There were nine influenza-related pediatric deaths during that week, bringing the total to 29.

We have seen a record number of influenza cases at Children’s Hospitals and Clinics of Minnesota. We’re seeing lab-confirmed influenza cases at rates higher than our highest week during H1N1. We’ve taken steps here to help prevent spreading the flu, including updating our visitor guidelines.

The No. 1 way to prevent the flu is to get vaccinated. And it’s not too late for that. We have more tips on preventing the flu here. In case the flu has reached your family, here are some helpful tips for taking care of your child.

What’s the difference between the cold and the flu and how can I tell?

Sometimes it’s hard to know whether a child has a cold or the flu because she may cough, have a runny nose, sore throat and fatigue with both. With the flu, a child tends to have a high fever. It comes on more suddenly with more severe fatigue and body aches.  Colds come on more gradually, and many kids may feel well enough to keep playing and going to school. Clinics use a rapid nose swab test to determine if someone has influenza.

What should I do if I suspect influenza?

Most cases of influenza are mild and can be managed at home with rest, plenty of fluids, and fever-reducing medicines.  Tender-loving care is good medicine, too. Most over-the-counter “cough and cold” medicines do not help a sick child get better faster and won’t have much effect on influenza. Sometimes, the flu can make a child very ill and a visit to the clinic or emergency room is necessary.

When should I take my child to the Emergency Department?

Take your child to be checked if there is difficulty breathing (fast, grunt-sounding, noisy breathing or small breaths), the color looks bad (pale or bluish), they aren’t drinking fluids often or urinating at least once every eight hours or just aren’t themselves and you’re worried.  Signs of dehydration are dry lips, sunken eyes, sleepiness or crankiness.  Children who seem like they’re getting better and then suddenly get worse should be taken to the Emergency Department immediately.  This could mean they have another infection in addition to the flu.

What are the best ways to get my child’s fever down when she has the flu?

Fever is one of the tools our immune system uses to kill germs.  However, children with high fever can feel quite miserable, get crabby, have trouble waking up and may drink less fluids causing dehydration. If you can’t keep the fever down with a fever-reducing medicine such as Tylenol or Ibuprofen, then the child should be taken to the clinic or Emergency Department.

Is there anything else I can do to help make my child more comfortable?

You can keep your child home from day care, school, sports or other activities and have them rest early in their illness and until they show signs of getting back to “their normal.” If your child doesn’t want to eat regular meals, don’t insist, but do make sure they drink small amounts of fluids every hour to prevent dehydration.

Is there anything I can do to help my child recover more quickly?

There is an anti-viral medicine called Tamiflu that can be given to children as young as 2 weeks of age. This is used if the child has moderate or severe influenza and works best if given in the first two days of illness.  Tamiflu usually cuts the severity and number of days of illness in half.

How long will my child be contagious?

Influenza is most contagious the day before symptoms present through about day five of illness. Your child should stay home from school during this time. After viral illnesses, kids can have lingering muscle or body aches and really do need time to rest and recover before rushing back to school. Depending on the severity of the flu, this may be a few days to a few weeks.  Most kids recover within a week. Most schools require that your child be fever-free (without the help of medicines) for two days before returning to school or day care. For more information, visit the CDC.

Patsy Stinchfield is a nurse practitioner and the director of the Infectious Disease Division at Children’s. Follow her on Twitter and watch her videos on Clear.MD.

 

Supporting kids after trauma

By Lizzi Kampf

As adults, we often face a variety of difficult emotions in the face of tragedy. The impact of a traumatic event can be substantial, whether it’s a natural disaster such as a hurricane or tornado, one that is man-made as we saw last week with the horrific mass shooting in Connecticut, or even one that is within a family, such as a car accident or the sudden death of a loved one. Our strong emotional reactions stem from an assault on our basic sense of safety and security. Children can experience these same emotions; however, their young brains aren’t yet fully developed and able to process them in the same way.

Many children express symptoms and feelings of helplessness and fear following a traumatic event. They may become unusually quiet, have problems sleeping, or be weary of separating from caregivers. They may react with agitation, or be unusually restless or aggressive. They may voice more worries or concerns about their own health, the health of others, and their general safety. Some children regress to behaviors they haven’t had since early childhood, such as sucking their thumb, wetting their bed, or baby talk. The good news is that children are naturally resilient and tend to return to whatever level of functioning they were at prior to the event.

Here are some things parents can do to support their children following a traumatic event:

  • Children live their lives through play. Utilize dolls, drawing, or role-playing games to help them express themselves and talk about what happened. Most kids want to talk about what they’ve experienced. Sometimes scary events need to be played out to be worked through. It helps them process what has occurred and use problem-solving skills.
  • Allow your children space to talk about their feelings. They may need to express their fears multiple times and be reassured of their safety frequently. Validate the feelings they are having and assure them that it is “normal” to feel the way they do.
  • Maintain as much structure and daily routine as possible. It can be difficult if your home is unlivable, you have to attend a funeral, or general daily life is disrupted. As much as possible, do the things your family enjoyed prior to the event, such as particular bedtime routines. Children also still need to have rules and discipline; this gives them a sense of order in the chaos.
  • Stay in check of your own reactions. It’s okay for children to witness parents having their own emotions, but they also need to hear an adult talk about how they manage those emotions. Model good self care for your child, making sure to take care of your own physical and mental health.

If you or your child is struggling following a tragedy and feel you need additional assistance, seek professional help through local crisis resources, a mental health counselor, or your doctor.

Lizzi Kampf is a Licensed Independent Clinical Social Worker who works primarily in the Emergency Department on the St. Paul campus of Children’s Hospitals and Clinics of Minnesota. She is also a volunteer with the Red Cross and recently returned from a deployment to New Jersey. As part of the Disaster Mental Health team, she worked to provide brief therapeutic services to individuals and families who had been affected by Superstorm Sandy.