Monthly Archives: June 2012

What the U.S. Supreme Court’s ruling on the Patient Protection and Affordable Care Act means for kids

This is a post by Children’s Health Policy and Advocacy team. They’re nonpartisan and proudly serve as child health experts and as a resource for our elected officials. Follow Children’s Policy and Advocacy staff on Twitter.

Today, the U.S. Supreme Court upheld most of the Patient Protection and Affordable Care Act (ACA).  In a 5-4 decision, the Court not only upheld the individual insurance mandate, but upheld a host of other provisions important to Children’s.

With ACA intact, private insurance reforms for children will remain, including: children with preexisting conditions will not be denied insurance coverage; children who undergo expensive procedures will not have to worry about annual and lifetime insurance caps; and young adults can stay on their parents’ insurance up to the age of 26.  The law also authorizes, though does not fund, the formation of demonstration Pediatric Accountable Care Organizations, which are designed to improve and streamline care.

It is still unclear at this time how the Court’s ruling will affect the temporary increases in Medicaid reimbursement rates for pediatricians and pediatric specialists, as well as maintenance of the current Medicaid and Children’s Health Insurance Program (CHIP) coverage for children through Sept. 30, 2019.

The most substantive change arising from this decision is around Medicaid.  Expansion of Medicaid has been limited, and is now largely left up to states to implement. States may maintain pre-expansion eligibility levels and receive current levels of funding, or they may comply with the federal expansion requirements and receive the corresponding federal funding. This decision will make it all the more important to make sure we protect Medicaid funding at a state level.

Water safety tips from Dr. Madhok

This is a post by Dr. Manu Madhok, director of the pediatric emergency medicine fellowship program at Children’s Hospitals and Clinics of Minnesota. He’s a board member of the Minnesota chapter of the American Academy of Pediatrics.

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 to 4. According to the Centers for Disease Control, most drownings among children ages 1 to 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 to 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.

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

Children ages 5-12

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

Open water

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

Backyard pool

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

While kids are our thing at Children’s, we prefer to see them healthy and not to see them in the Emergency Department. Follow these tips so your child doesn’t become a statistic this summer. For more information about injury prevention, please visit our Making Safe Simple website.

For additional resources:

Minnesota Department of Health swimming pool links

Minnesota Department of Health injury data

Centers for Disease Control unintentional drowning data

Water Safety and Young Children

Water Safety for Older Children

Summer Safety Tips – Sun and Water Safety

School re-entry program helps kids understand classmate’s cancer diagnosis

This is a guest post by Torey Kauth. His daughter Julia is a Children’s patient and participated in our school re-entry program, which is funded by Great Clips. It provides child life specialists to help educate students and staff about how an illness impacts a child’s life. The program helps patients make a smoother transition back into a school environment after treatment for a major illness.

Julia and her brother, Finn, hung out at the Great Clips Bubble-A-Thon on June 25 to help bring awareness to the school re-entry program.

Daughter, big sister, first-grader, avid reader, cancer patient, artistic, inquisitive child. While everything on that list described Julia in November 2010, one of them obviously doesn’t belong in the description of any child.

Over the course of a few weeks during fall 2010, a stomach ache in our 6-year-old daughter escalated into a cancer diagnosis – a Wilms’ tumor. While it’s a very treatable cancer, it flipped our world upside down. Within a week of her diagnosis, she underwent radiation and chemotherapy. The radiation was completed by the month’s end, but the chemo continued into June 2011. Julia’s stage 3 diagnosis called for her to get chemo once a week and to have four week-long hospital stays where daily chemo was administered.

Julia handled the first few months of treatment very well. But things went downhill in January and bottomed out in February. After losing too much weight, we elected to have a gastric feeding tube (or G-tube) inserted to allow us to give Julia nightly feedings directly into her stomach. It turned out to be a good decision. Her strength returned, and she was able to take meds directly through the tube as well. Julia also opted to get her hair cut short around this time in order to have an easier transition to baldness. By April, her hair was almost completely gone, but she acquired several fun hats so she always had an exciting accessory.

About a month after Julia’s diagnosis, her Child Life Specialist, Jodi, visited her first-grade class.  She explained what was going on with Julia and changes they might see. Cancer isn’t contagious. Julia’s hair might all fall out, and that means the medicine is helping her. Julia will miss some school when she’s not feeling well.

Julia’s classmates spent an hour learning about what she would experience during the months to come.  They were to be her advocates among other kids at the school who wouldn’t know as much as they did. The child life specialist’s school visit helped make Julia feel more at ease around her peers because she knew they would have a good understanding of what was happening.

At the end of June 2011, Julia finished her last chemo treatment. In the months that followed, her chemo port and stomach tube were removed.

Now, she is a soon-to-be third-grader, guitarist, an inspiration, an environmental advocate, a healthy child, and a survivor.

To read more about Julie and her family, visit their blog. You can also learn more about the program in this WCCO story.

Food for thought: 4 ways to avoid getting sick at a picnic

This is a post by Dr. Gigi Chawla, a pediatrician/hospitalist and the director of Medical and Surgical Services at our hospital in St. Paul. Dr. Chawla specializes in treating children with special needs.

Picnics, celebrations and holiday potlucks are some of the joys of summer – and, unfortunately, the source of infectious woes.

Consider your summer gatherings where food is a central component in a similar context to eating in a third-world country. Though the tastes may be spectacular, the hygiene issues around preparation may lack. This can lead to serious exposures and illnesses including E.coli, Salmonella, Shigella, Campylobacter, Hepatitis A, Norwalk virus, and a variety of viruses which may produce an upper respiratory tract illness or “cold.” That’s a mouthful!

The standard practices when traveling to a third-world country include using good hand hygiene and selecting foods that come whole, that can be peeled, and that are cooked or boiled before eaten.

The same practices apply to your summer gathering. They’re simple to follow but can be easily forgotten. Here are some reminders:

  1. Wash your hands: Keep your hands clean with soap and water or hand sanitizer while serving yourself at a picnic or eating food with your hands.
  2. Pick smart foods: Select foods that come whole and wash them well, foods that can be peeled, and foods that are cooked or boiled before eating. Well-cooked foods pose a lower risk than uncooked or undercooked foods. Although a pasta or garden salad may look appealing, thoroughly cooked lasagna may be the safer option.
  3. Keep food at a constant cold temperature: The temperature of foods that are placed on ice or in cool water to stay chilled, such as pasta or potato salads, can fluctuate. Ice melts. Cool water becomes tepid. This can lead to bacteria overgrowth.
  4. Bring multiple utensils: Avoid using the same utensil for handling raw meats, opening packages and cutting up fruit.

Have fun at your summertime food gatherings! Just think twice about the foods you place on your paper plate.

A Hero’s Journey: Discover your inner hero

This is a guest post by Daniela, a member of  Children’s Youth Advisory Council. 

As part of the Youth Advisory Council at Children’s, we get to let the staff know what kids really think about things. Recently, I got the chance to check out the A Hero’s Journey workshop to see what it was like. It was really fun!

It’s a project the Guthrie Theater is doing at Children’s to explore that whole idea of being a hero. Most people think of heroes being someone like Iron Man, but all of us have our own hero moments! When you stand up for someone or learn something new, your words and actions make you your own kind of superhero.

We got to play theater games and act out stories. Each person had a role and a line. That was a ton of fun! I really liked meeting new friends. The Guthrie teaching artists were so nice, caring and comfortable to be around.

If you like storytelling or acting, this would definitely be the thing for you!

A Hero’s Journey workshops are open to children and teens ages 8 to 14. The workshops are held one Saturday each month, with a morning and afternoon workshop that lasts two-and-a-half hours. Patients with chronic conditions, repeated hospitalizations or appointments, and those who have been hospitalized for at least three days are prime candidates. Children may be patients at any of Children’s locations, including outpatient clinics and our main hospitals.

Call the Child Life Department at 612-813-6259 for more information and to register. Children’s and the Guthrie are excited to help patients discover their inner hero!

Let’s play ball: Andy returns to baseball after blood clot

Andy Walerius

On a perfect spring day, Andy Walerius was crouched behind home plate hand signaling his pitcher and waiting for the next delivery. No one on the field that day could have imagined what was about to happen. Pale and not himself, Andy stood up to tell his dad that he wasn’t feeling well.

Suddenly, he collapsed. In an instant, Andy went from being just another kid on the baseball field to a boy in crisis. Whether there would be another game behind the plate in Andy’s future was less than clear.

Andy, 15, was taken by ambulance that night – May 2 – to Children’s Hospital in Minneapolis, where emergency room doctors ran a series of tests to determine what was wrong.

The next 24 hours would prove harrowing. More than 25 members of Children’s touched this boy’s life.  Andy had a new team.  They were doctors and technicians, nurses and therapists. They were in the pharmacy and at the phones. They screened his visitors and washed his linens. They embraced and informed his parents.

Andy’s care extended to Abbott Northwestern Hospital, our neighboring adult hospital, and ultimately he required the immediate deployment of our ECMO (extracorporeal membrane oxygenation) team to save his life.

“You’re almost better off having a heart attack than what he had,” said Dr. Stephen Kurachek, an intensivist at Children’s.

Shortly after Andy’s arrival, preliminary tests suggested he might have a blood clot in the lung. Typically, this diagnosis would have been confirmed with a CT angiogram, but Andy’s renal function was so poor that the dye required for the study would have injured his kidneys.

Other studies were performed.  Dr. Chris Hills, cardiologist, alerted Dr. Kurachek of a “potentially lethal” looking echocardiogram. Children’s nuclear medicine and venous doppler staff quickly ran tests.  Andy had a large blood clot in his right leg that created a “shower” of blood clots to both lungs as described by Dr. Sonya Wright, a radiologist at Children’s.

Cases like Andy’s are rare in kids. Limited clots to the lung occur in vulnerable children, but clots to both lungs in a healthy boy that critically impair heart function occur only once every few years, Dr. Kurachek said.

Immediately following the tests, Andy was taken to Abbott via an underground tunnel that connects the two hospitals.

At Abbott, a filter was placed to prevent additional clots from entering the lung circulation and medicine was injected directly into the lungs to dissolve the clots that were obstructing blood flow.  During the procedure, Andy’s heart slowed and then stopped — cardiac arrest. Children’s intensive care team and the Abbott resuscitation team performed full CPR on Andy for 10 minutes before his heart started beating again.

Like one of his nurses, Andy is a Pittsburgh Steelers fan.

Andy was returned to Children’s PICU (pediatric intensive care unit), where the ECMO team had assembled.  He was placed on bypass until his heart function recovered. Dr. Kurachek credits the care coordination among staff throughout Children’s and Abbott with saving Andy’s life.

“In retrospect, there was a cadence to all this. A rhythm. It was like poetry. On this particular day for this particular boy, it happened well,” Dr. Kurachek said.

Andy’s mom, Joan Walerius, agrees.

“I felt like they were two steps ahead of Andy,” she said. “This was a well-oiled machine.”

She’s grateful for the medical care her son received and how Children’s helped her family remain normal during an “abnormal” situation.

Andy’s family was able to stay at the Ronald McDonald House during his 21-day hospitalization. Joan and her husband, Ken, could go to the Family Resource Center to escape the beeps of Andy’s machines, write notes and use the computers to send emails – all while listening to soothing music. During recovery, the Geek Squad even helped Andy Skype with his friends.

“That was a gift,” she said, of the services.

It’s still unclear why blood clots formed in Andy. Months before he collapsed, he recalls having trouble breathing and he tired quickly during baseball. He has asthma and control during exercise was a concern, but he was being treated.

Blood clots can develop for several reasons. Sometimes people are born with a “clotting problem.” Sometimes a simple virus can stimulate the body to make proteins that promote clotting.  Our hematologists will monitor Andy very carefully during the next few months to make sure the clots don’t form again.

“He really escaped this,” Dr. Kurachek remarked. “In retrospect, had he died on the ball field that day, no one would have been surprised.”

Instead, Andy is back on the field with the team he should be with, and he’s healthy. He returned to baseball practice last week, and he played in his first game Monday night.

“Everything is pretty much the same except for the running,” Andy said. “I don’t run as fast.”

“As parents and as guardians of children, there are reasons why we pray,” reflected Dr. Kurachek. “This is one of them.”

To learn more about Andy and his story, visit his CaringBridge journal.

Children’s takes steps to minimize radiation exposure

MRI Scanner

There’s often a lot of information in the media and medical journals about CT scans (known as Computed Tomography) and how they expose children to radiation. Most recently, The Lancet, a medical journal, published a study that reports that children who get multiple CT scans are at increased risk of leukemia and brain cancer.

We know children are more sensitive than adults to radiation exposure and that CT scans are one of the most common and significant medical exposures of children to radiation. We also know that although the risk of radiation from a CT scan is low, it’s not zero. There can be a slight increased risk of cancer later in life.

“We take this seriously, and we do everything we possibly can at Children’s to minimize the level of radiation exposure to our patients while preserving the quality of the images we need,” said William Mize, MD, a pediatric radiologist.

Here’s how:

  • Our scan settings are adjusted according to your child’s size and age.
  • We work under the ALARA (as low as reasonably achievable) principle. Some of the steps we take include limiting the area of exposure to include only the area of specific medical concern and shielding sensitive areas such as breast shielding during chest CT.
  • We don’t recommend a CT scan as a diagnostic test unless it’s necessary. When appropriate, we suggest other imaging tests such as an ultrasound or MRI (or magnetic resonance imaging) which do not use radiation.
  • We continue to re-evaluate our protocols and explore new opportunities for reducing radiation.

For many medical problems in children, the CT scan is invaluable. Often, it’s the only test that can provide the information needed to optimally treat children. There are potential risks and benefits to all medical treatments and procedures.

The CT scan is capable of viewing all the internal organs, which may lead to a diagnosis that was previously only possible with surgery. When we recommend a CT scan, the benefits to a child’s health from the information obtained outweigh the minimal risk associated with the low dose of radiation.

Where kids are concerned, rest assured that their safety and health are our top priority.

For more information about our procedures involving radiology, click here.

To read the Society for Pediatric Radiology’s response to The Lancet article, click here.

Owen’s Orange Monkeys to walk for kids’ heart health

Paige and Jason Schram, parents of Owen, will participate in the HeartBeat 5000 on Saturday, June 23. They have named their team “Owen’s Orange Monkeys” after a toy their son received from his grandmother. The toy has distracted Owen and made him happy through some difficult times in his young life!

While pregnant with Owen, Paige Schram was referred to Children’s by Abbott Northwestern Hospital’s perinatal program after an ultrasound at 20 weeks showed Owen had a heart defect. Even before he was born, his parents Paige and Jason knew he had Hypoplastic Left Heart Syndrome, or HLHS, an underdeveloped left side of his heart. Knowing that Owen would be born needing heart surgery and would die in a few days without treatment, a stunned Paige and Jason were able to meet Children’s cardiology team and understand the surgery and treatment plan prior to the birth of their son.

Paige had a C-section at Abbott, and Jason accompanied Owen through the tunnel to Children’s. Jason raced back and forth between Abbott, where Paige recovered, and Children’s where Owen was being cared for in the NICU before his open heart surgery on his third day, as his mom was discharged from Abbott.  Owen was at Children’s for 46 days recovering from the surgery and complications before his first visit home.

His second of three necessary surgeries took place when Owen was 5 months old, a bit earlier than expected as his oxygen levels began to drop. His second recovery lasted 56 days. He will need his final surgery when he is 3 years old. Owen’s surgeries are re-routing his circulation to the right side of his heart and need to be spaced out to accommodate his growth and tolerance of the surgeries.

During his first winter, Owen didn’t go to the grocery store with his mom or out to the playground with his dad. He stayed home and has been lucky to stay healthy – free of colds, ear infections and other illnesses. But his parents look forward to when he joins other children who go to school, play groups, and sleep in their beds at home, even though they love Children’s!

Later this month, Paige and Jason will give back to the hospital. After reading about HeartBeat 5000, our annual 5k walk/run benefiting kids’ heart health, on our Facebook page, Jason knew his family needed to create a team for the event. The family is excited to raise awareness and funds for our life-saving cardiology programs.

To support Owen’s Orange Monkeys, click here.

 

 

Owen’s Orange Monkeys from Children’s of Minnesota on Vimeo.

Children’s earns high marks in U.S. News & World Report

Once again, Children’s has been recognized as one of the best pediatric hospitals in the country in U.S. News & World Report’s 2012-2013 Best Children’s Hospitals rankings.

For the sixth consecutive year, Children’s was ranked in neonatology, for the care that it provides to the youngest and most fragile patients. Children’s has been ranked in this category since U.S. News began ranking pediatric hospitals in 2007. For the second consecutive year, Children’s was ranked in cardiology and heart surgery, a program that is one of the largest in the region by patient volume.

“Children’s is honored to be recognized again by U.S. News. The listing is a tribute to our skilled and dedicated staff, who are deeply committed to providing children with the best possible care,” said Alan L. Goldbloom, MD, president and CEO of Children’s.

The rankings feature 50 hospitals in each of 10 pediatric specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology, and urology. Eighty hospitals across the country ranked in one or more specialties.

For the full rankings and methodology, visit www.usnews.com/childrenshospitals.

Sweet Dreams for Kids brings pajamas, smiles to Children’s

Wendy Berezovsky, founder of Sweet Dreams for Kids, and her family threw a pajama party at Star Studio on May 31.

Kids don’t always understand that sometimes it hurts to feel better. At Children’s, we believe that the small things can make a big difference to our patients and families.

Wendy Berezovsky knows firsthand from the time she spent at Children’s with her daughter, Dalya, who was born with cancer and spent much of her first year here, that a cozy pair of pajamas can bring a smile to the face of a young patient.

Wendy started Sweet Dreams for Kids, an organization that has donated more than 3,000 pajamas to patients in Minnesota hospitals and beyond and brought new pajamas to our patients for a super fun PJ Party-themed show in the Star Studio on Thursday, May 31. Kids tuned in from their hospital beds or came to the first-floor studio to join the slumber party games, stories and songs!

Thank you Sweet Dreams for Kids!

Check out the news coverage from WCCO and KSTP.