Monthly Archives: June 2014

Five Question Friday: Kris Ann Schultz, MD

Five Question FridayIn this week’s Five Question Friday, we catch up with Kris Ann Schultz, MD, as she talks about her work in our Cancer and Blood Disorders program and the many memories she has made working with children and their families.

During her first two years in college, Kris Ann Schultz, MD, wanted to be editor of Ranger Rick magazine or a pediatrician.

During her first two years in college, Kris Ann Schultz, MD, wanted to be editor of Ranger Rick magazine or a pediatrician.

How long have you worked at Children’s?

I’ve worked at Children’s for six years.

What are some of the conditions you treat?

I care for children with cancer and blood disorders, usually brain tumors, solid tumors such as kidney or ovarian tumors, and leukemia.

You are the principle investigator for the International Ovarian and Testicular Stromal Tumor Registry. Can you tell us more about that project?

We started the International Ovarian and Testicular Stromal Tumor (OTST) Registry in December 2011 to try to understand more about what causes these rare tumors in children and young adults around the world, and how to best treat them. We suspected that these tumors were related to another kind of rare tumor we study here called pleuropulmonary blastoma (PPB). We knew we needed to understand more about that connection to help us find both kids of tumors in their earliest and most curable form.

Editor’s note: The OTST and PPB registries were recently featured in an NBC News story about a baby whose lung tumor was found early thanks to the research of the registries and the bravery of his mom.

Do you have a favorite memory from working at Children’s?

My favorite memories at Children’s are all about the kids and families I’ve cared for. I love watching the kids have fun at the Pine Tree Apple Tennis Classic to raise funds for children’s cancer research. I love watching doctors, hospital staff, parents and siblings shave their heads in honor our young heroes at our annual head shaving event to support St. Baldrick’s. Both the Pine Tree Apple Tennis Classic and St. Baldrick’s Foundation support the OTST and cancer research at Children’s.

Subscribe to MightyWhat’s one interesting fact about you?

During my first two years in college, I wanted to be either editor of Ranger Rick magazine or a pediatrician. I decided that I wanted to be a doctor when I was in a small village in rural Tanzania. I was studying giraffe during the day and spending time in the village in the afternoons and evenings when it was too hot to track giraffe. Working with the amazing people there made me realize I wanted to work with people in a direct “hands-on” way and pediatric oncology has been a great way to do that.

At home, I love spending time with my family, my husband and our three kids.

Laser in action: See how Gavin’s tumor met its match

Gavin Pierson (left) and Joseph Petronio, MD, visit during a photo shoot at Children's – St. Paul on Monday, June 16, 2014.

Gavin Pierson (left) and Joseph Petronio, MD, visit during a photo shoot at Children’s – St. Paul on Monday, June 16, 2014.

In the two years since Gavin Pierson’s brain tumor, which he calls “Joe Bully,” was discovered, he has undergone 17 surgeries. A combination of craniotomies and the Pfizer drug, palbociclib, had been managing the growth of Joe Bully, but not decreasing its size. Gavin and his family were growing tired and frustrated with invasive surgeries, and Gavin wasn’t bouncing back as well as they hoped.

Enter Visualase.

Visualase is a laser used for neurosurgery and is guided by MRI images to precisely target areas of the brain that were previously thought inoperable. After making a 3-centimeter incision, Joseph Petronio, MD, and his team guided a small laser fiber directly to Gavin’s tumor. Children’s is the only pediatric hospital in the Midwest using Visualase, and Gavin is the only patient in the country to use this technology to treat a mature teratoma brain tumor.

Learn more about how Dr. Joseph Petronio used the Visualase laser:

Subscribe to MightyNot only did this technology target and dissolve a significant portion of Gavin’s tumor, it’s also prohibiting re-growth – stopping Joe Bully in its tracks. The laser is so targeted that the brain tissue surrounding the tumor was unharmed, making for a quick recovery. Within 12 hours, Gavin was sitting up, eating and laughing with his siblings and parents. Gavin went home the next day and was back to school within four days.

These types of minimally invasive surgeries have incredible benefits for Children’s patients. Since obtaining Visualase in October 2013, Children’s has treated patients as young as 12 months for epilepsy and other types of brain tumors. Tools like Visualase are making tumors we once thought were inoperable – operable.

Making magic happen: The infant-toddler brain

Anna Youngerman is the director of advocacy and health policy at Children's Hospitals and Clinics of Minnesota and a proud parent of her 2-year-old son.

Anna Youngerman is the director of advocacy and health policy at Children’s Hospitals and Clinics of Minnesota and a proud parent of her 2-year-old son.

By Anna Youngerman

For many parents, sleep-deprived might be how we choose to describe the first three years of a child’s life — at least it has been for me. But as I look through the haze of too few hours of sleep, there’s also magic to these early years. I frequently find myself in a state of awe and wonder at my growing child. The first time your baby catches your eye and holds your gaze, the first time he says “mommy,” the cobbling together of phrases to describe his day and even the frustration-driven tantrums — those are all magical moments.

It turns out there’s a reason the awe-inspiring moments come fast and furious during these earliest years. The brain wiring is on hyper-drive:

  • 80 percent of brain development happens by the time a child is 3 years old.
  • 700 new neural connections are made every second in the first few years of life.

This naturally occurring development can serve as a springboard for a productive, healthy life. Yet, just as a magician must carefully prepare for a trick so it appears both astonishing and seamless, helping every child realize the powerful potential of these years also requires intentional support.

Inspiring action

Though our paper, “Foundation for Life: The Significance of Birth to Three,” we want to inspire more robust discussion and action around the value of investments in and attention to our youngest children. We want to invite the tough questions and – more importantly – be part of answering them:

  • What can we do, collectively, to reach the most vulnerable children?
  • How do we mitigate toxic stress factors that tear away at a child’s potential?
  • What’s the community’s role in ensuring that no child lacks the positive relationships so crucial to healthy development?
  • How do we build a coordinated system that focuses on what a child needs and not what the system needs?
  • Subscribe to MightyHow do we reach children at an age (0-3) when they often are cared for by family, friends and neighbors and not always tied to existing systems?

These aren’t easy questions, but just because they’re tough doesn’t mean we shouldn’t take them on and figure out how to work together toward getting answers. The stakes are just too high and the opportunity too great.

Like most parents, I’ll gladly navigate my sleep deprivation in exchange for giving my kiddo every opportunity he deserves. That’s the hope and dedication we want to inspire. I hope you’ll join us.

Anna Youngerman is the director of advocacy and health policy at Children’s Hospitals and Clinics of Minnesota and a proud parent of her 2-year-old son.

Gavin vs. Joe Bully: First-of-its-kind laser surgery shrinks tumor by more than 40 percent

The Piersons (from left), Steve, Gavin, Nicole, Grace and Gage, have been through a lot in the past two years.

The Piersons (from left), Steve, Gavin, Nicole, Grace and Gage, have been through a lot in the past two years.

If you’ve been following 8-year-old Gavin Pierson’s story, you know he and his family have been through a lot. In 2012, Gavin was diagnosed with a mature teratoma brain tumor.

Since then, he has undergone numerous craniotomies and he and his family have dealt with big drug companies to fight his brain tumor, which Gavin refers to as “Joe Bully.” Unfortunately, Joe Bully is a particularly tough tumor, located in an area that is difficult to operate on and comprised of hard, “concrete-like” tissue. While Gavin’s prior treatments made progress, Joe Bully kept growing back.

give_gavin_blogBut it appears that Gavin’s neurosurgeon, Joseph Petronio, MD, may have found Joe Bully’s weak spot. Over the past eight months, Gavin has undergone two Visualase laser surgeries, an MRI-guided procedure designed to incinerate the tumor. He’s the first patient with a mature teratoma to ever use Visualase – and it may have stopped Joe Bully in its tracks.

Children’s and the family also successfully petitioned pharmaceutical company Pfizer to grant Gavin access to an experimental drug, palbociclib, to help control the tumor’s growth. Gavin is the youngest patient to use palbo.

We’re happy to announce that a recent MRI scan showed Gavin’s formerly peach-sized tumor has shrunk more than 40 percent. Even better? There are no signs of regrowth.

Gavin’s courage and strength inspire us every day. Thank you, Gavin, and congratulations.

Learn more about Gavin’s story and surgery:

Meet Red-Vested Rockstar Debbie Closmore

Debbie Closmore is a St. Paul volunteer with nearly 200 hours of service.

Debbie Closmore is a St. Paul volunteer with nearly 200 hours of service.

Children’s volunteer Debbie Closmore truly lights up a room with her laughter and positive energy. She isn’t afraid of a challenge and loves stepping up to the ever-changing needs in the surgery department.

Why she rocks

Debbie is a volunteer on the St. Paul campus; she was a float volunteer and currently serves as a peri-operative escort in our surgery department. She’s energetic and fun. Debbie serves as a trainer for new volunteers, passing on her knowledge and expertise. See why she got into volunteering at Children’s:

“I got into volunteering with hopes to ease the anxiety for children and their families during a stressful time,” Debbie said. “Spread a little joy!”

What’s your favorite thing to do outside of volunteering?

“I love spending time with my husband, family and friends. I also enjoy biking, hiking, yoga and walking, staying active.”

Do you have any kids or pets of your own?

“I have a stepson, daughter-in-law and five grandchildren.”

If you could create a new candy bar, what would be in it and what would you name it?

“My candy bar would be made with raw pecans, dates, figs, sunflower seeds and dark chocolate. I would name it ‘Healthy Me.’ ”

Share a favorite volunteer experience or story.

“I spent many hours rocking and holding an infant boy. Every week I went to his unit to rock and talk with him; we really had a connection. When he smiled at me, my heart sang.”

Thank you, Debbie, for your bright, positive energy and true commitment to Children’s Hospitals and Clinics of Minnesota!

Tech Spotlight: A look at Visualase, a minimally invasive laser surgery system

Visualase's workstation interfaces with an MRI to allow temperature control and monitoring in real time during a treatment.

Visualase’s workstation interfaces with an MRI to allow temperature control and monitoring in real time during a treatment.

Gavin Pierson, now 8, of Ramsey, Minnesota, underwent two Visualase procedures in October and February.

Gavin Pierson, now 8, of Ramsey, Minnesota, underwent two Visualase procedures in October and February.

The story of Gavin Pierson, the 8-year-old Ramsey, Minnesota, boy battling a brain tumor, includes a number of key players: his doctors, parents, siblings and care team, and the thousands of people who have followed his two-year fight against the aptly nicknamed “Joe Bully.”

But one of Gavin’s most important allies doesn’t have a degree, voice or personal Facebook page.

Visualase, an MRI-guided, minimally invasive laser system, has been the Kryptonite to Gavin’s tumor since he became the first person with a mature teratoma brain tumor to undergo the procedure. His first laser surgery took place on Oct. 29, 2013, at Children’s Hospitals and Clinics of Minnesota and his second four months later on Feb. 20, 2014.

“There are many things that make this procedure unique. One is the use of MRI, which allows us to monitor the temperature of both the tumor and the normal brain during the laser treatment,” said Joseph Petronio, MD, medical director of pediatric neurosurgery at Children’s and the doctor who led Gavin’s Visualase procedures. “The composition of (Gavin’s) tumor is unusual, including elements of bone and skin that makes it conduct heat very broadly. By being able to monitor temperature that closely, we are able to target the tumor more precisely without damaging other tissue.”

Founded in 2005, Visualase, Inc.’s system is a minimally invasive laser procedure that allows surgeons to pinpoint and treat lesions and tumors with extreme precision.

So, how does Visualase work?

  • Visualase Cooled Laser Applicator System: The system features a disposable fiber optic catheter with a built-in cooling mechanism that prevents overheating near the surface of the applicator. This laser catheter is placed through a small opening in the scalp and skull and into the center of a tumor using advanced MRI technology. Laser energy is then used to heat the tumor carefully. The system was engineered to allow for the use of higher laser powers to destroy tumors with shorter exposure times.
  • Laser generator: The generator produces light energy that is used to thermally ablate, or destroy, soft tissue.
  • Workstation: The workstation interfaces with an MRI to allow temperature control and monitoring in real time during a treatment. It also provides on-screen visuals of the tissue as it turns into a solid or semi-solid state. Because of the in-depth monitoring, the procedure results in a high level of precision and control.
  • Temperature: The time it takes to destroy parts of the tumor depends on the temperature of the laser. When set to 113-140 degrees Fahrenheit, tumor cells eventually get destroyed. Cells and tissue are destroyed immediately when the laser is between 140-212 degrees. Anything above 212 degrees, though, can cause water in the tissue and areas inside a cell to vaporize, and leads to ruptured cells and tissue components.
  • According to Visualase, once soft tissue is destroyed, or ablated, it is considered non-viable and is reabsorbed, leaving little evidence that a tumor or burn existed.

After getting its start in treating liver and prostate problems, the Visualase Thermal Therapy Subscribe to MightySystem was cleared by the Food and Drug Administration in 2007 for the ablation of soft tissue in neurosurgery. Visualase’s first minimally invasive neurosurgical procedures were performed in 2006 in Paris as part of a study for treating brain tumors.

The Visualase laser system is in use at more than 40 hospitals, nationwide, including 15 pediatric hospitals. In pediatric patients, including at Children’s Hospitals and Clinics of Minnesota, Visualase has also been used to address brain lesions that cause epilepsy.

“What’s exciting to me is the path this technology opens to areas of the brain that were closed to us before,” said Petronio. “To think we could reach a day when the term ‘inoperable brain tumor’ in children is obsolete is extraordinary.”

Source: visualaseinc.com

How to prevent and treat bug bites and stings

By Erin Dobie, CNP

Minnesota summers bring warm weather and opportunities for our kids to go outside exploring and playing in nature. Pesky insects often irritate or interrupt summer fun. Learn how to prevent insect bites, treat bites when they do occur, remove ticks and how to know when you should seek medical attention for your child.

How to treat bites

Insect bites and bee stings react because of venom injected into the skin. The severity of reaction depends on your child’s sensitivity to the venom. Most reactions are mild, causing redness, local swelling and irritation or itching. These usually will go away in two to three days. Calamine lotion or any anti-itch gel or cream may help soothe the itching.

Bee stings cause immediate pain and a red bump, but usually the discomfort lessens within 15 minutes. More than 10 bee stings at once (extremely rare) may cause a more-severe reaction with vomiting, diarrhea and headache. Allergic reactions to bee stings can be severe and quickly get worse. These reactions include difficulty breathing, swelling of the lips, tongue or throat, or confusion. Children who have a severe reaction need immediate medical attention, and you should call 911. If the child has a known bee allergy and an Epi-pen is available, the Epi-pen should be administered in addition to calling 911. If a stinger is present, try to rub it off with something flat such as the edge of a credit card. Do not try to squeeze the stinger out or try to dig it out. If it does not come out easily, soak the area in water and leave it alone to come out on its own.

Tick bites don’t often cause much of a local reaction. They’re primarily concerning because they can transmit infectious diseases. Ticks are prevalent in Minnesota. They’re generally found on the ground in wooded or heavily bushy areas. Ticks can’t jump or fly. Generally they climb grass and climb onto someone to attach as we brush up against them. Ticks are most active during the spring and summer months.

There are a few different infectious diseases that can be transmitted by ticks, but the most common one found in the Minnesota-Wisconsin area is Lyme disease (Borrelia burgdorferi). To infect a person, a tick typically must be attached to the skin for at least 36 hours. The incubation period, the time from infection to being symptomatic, is anytime between three and 30 days.

Lyme disease can present in many different stages. Early localized stage often includes a red ring-like rash (or may resemble a “bull’s eye” target) that slowly expands. Other symptoms include headache, fever, joint or muscle aches and overall not feeling well or excessively tired. If your child develops these symptoms within a few days to weeks after tick exposure you should seek medical attention to evaluate for Lyme disease. Lyme disease is evaluated by medical history, physical examination and sometimes a blood test. It may take the body several weeks to develop antibodies and the blood test may not show up positive early in the disease. Most cases of Lyme disease are easily and successfully treated with a few weeks of antibiotics.

How to prevent a bite

Prevention is the key to avoiding insect bites. I recommend insect repellent that contains at least 20 percent DEET. The higher concentration of DEET does not indicate better repellent; it just means that the repellent will last longer. Most repellents can be used on infants and children older than 2 months. Other effective repellents contain permethrin, picaridin, oil of lemon eucalyptus and IR3535. Permethrin-treated clothing is an option if the child will be camping or on wooded hikes. Finally, showering or bathing soon after exposure to tick areas is important to check for and remove ticks. Parents should pay close attention and check children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist and especially in their hair on their scalp. Dogs should be treated for ticks, but also checked as the ticks can ride into the home on the dogs then attach to a person later.

How to remove a tick

If you find a tick attached to your child’s skin, there is no need to panic.

  1. Use a fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible.
  2. Pull upward with steady, even pressure. Do not twist or jerk the tick, as this often can cause the tick’s mouth to break off and remain in the skin. If the mouth breaks off: try to remove it. If it cannot be removed easily, don’t dig it out; just wash and allow it to fall out on its own.
  3. After removing the tick, clean the skin with soap and water or rubbing alcohol.

Five Question Friday: Janay Moore

Senior talent acquisition assistant Janay Moore has been with Children's since February 2012.

Senior talent acquisition assistant Janay Moore has been with Children’s since February 2012.

Janay Moore, senior talent acquisition assistant, has a job she loves – helping others find jobs they love at Children’s! Get to know Janay in this week’s Five Question Friday.

How long have you worked at Children’s?

I started working at Children’s as a contractor in August of 2011 but I applied for a regular position and was hired in February 2012. Therefore, I just celebrated my two-year anniversary in February.

Describe your role.

I’m a senior talent acquisition assistant. My primary responsibilities include: recruitment for the clinical support associate positions, the MNA internal bidding process, pre-boarding our RN travelers, and supporting our new grad training program and external nursing recruitment.

What’s your favorite memory from working at Children’s?

My favorite memory working at Children’s is an ongoing one. As a part of the Talent Acquisition Team we are involved in a number of student internships in the community. It’s a blast to see the growth of our student interns from Cristo Rey, Project Search and the Step-Up program mature into young working professionals. Just another reminder of why we do the things we do.

Subscribe to MightyWhen you were a kid, what did you want to be when you grew up?

Funny enough when I was a kid I always thought I wanted to be a veterinarian. As I matured, I realized that I loved the idea of working with animals but couldn’t live with the idea of working with ailing or dying ones. It’s important to know your strengths and weakness and emotionally it was too much for me.

How do you spend your time outside of work?

I love spending time with my husband and our two daughters, Aarylin, age 6, and Milaya, age 3. We really enjoy going to the park, shopping and traveling!

The road to recovery: Pediatric cancer services

Each year, close to 12,500 children in the U.S. are diagnosed with cancer. Among them who live in the Upper Midwest, more than 70 percent are treated by Children’s Hospitals and Clinics of Minnesota. This week we shared Jenna Carnes’ cancer journey on Twin Cities Moms Blog. Jenna is one of many teens we see in Children’s Cancer and Blood Disorders Clinic each week, and just like every pediatric cancer patient, her journey is a unique one.

Jenna Carnes (left) and her mother, Barbara, enjoy a Minnesota Twins baseball game at Target Field in Minneapolis. (Photo courtesy of Barbara Carnes)

Jenna Carnes (left) and her mother, Barbara, enjoy a Minnesota Twins baseball game at Target Field in Minneapolis. (Photo courtesy of Barbara Carnes)

“Like all of our patients, we want Jenna to still be a kid and not to have to grow up too quickly because of the disease she’s dealing with,” said Dr. Joanna Perkins, Jenna’s treating physician in the Cancer and Blood Disorders Clinic at Children’s. “With the suite of treatment options we offer, Jenna’s been able to get back to being a normal teen.”

Beginning with the Child Life department, Jenna utilized many of Children’s support services to help her in her healing journey. From how to talk about cancer with her friends at school to going to surprise Minnesota Twins baseball games with her family, Jenna said her child life specialists made each day that she was at the hospital just a little easier. This was a welcome relief for her family.

“What makes Children’s different than any other hospital are the services we offer that go above and beyond standard inpatient care,” said Dr. Perkins. “From the supportive care – ranging from physical therapy, psychology and nutrition specialists, music therapy, massage and pain and palliative care – to special events geared towards the whole family, we try to make the time kids and families have to spend in the hospital as good as it can be. A lot of kids appreciate the simple things, too – big TVs and video games.”

In addition to Children’s in-house services, many patients (including Jenna) go to Camp Courage in Maple Lake, Minn., to “just be a kid” for a week each summer. The camp also provides patients’ families with a much-needed break. With Children’s staff physicians and nurses, onsite, to administer medication and keep close watch on their patients, patients and their siblings take part in time-honored camp traditions and let loose for the week.

“Kids of all ages are there, and we’re all going through something really similar,” said Jenna. “There are no strange looks.”

As Jenna and her family prepare to celebrate the end of her chemotherapy treatments, Jenna’s care team at Children’s will be by her side, cheering her on at her end-of-treatment party on June 12. Soon, Jenna will be a part of Children’s Destination STAR (Surveillance and Testing After Recovery) Clinic, which assists her with the transition to life after cancer therapy. She’ll work with Children’s Health and Wellness Team, consisting of staff members from oncology, nutrition services, physical therapy, psychology and child life, as well as her primary care physician for wellness visits to make sure the cancer does not return.

“Going to the hospital for cancer treatments will never be fun,” said Jenna. “But, I’m honestly going to miss coming to Children’s – it’s almost become a second home.”

Visit Children’s Hospitals and Clinics’ Cancer and Blood Disorders Clinic for more information. Children’s first annual Shine Bright Bash on Sept. 13 is to celebrate and support the advancements in pediatric cancer and blood disorder care.

Animals are great family members, except when they’re not

Teach kids to respect your animal’s space. (iStock photo / Getty Images)

By Dex Tuttle

Even before the pitter-patter of toddler feet, our house was plenty busy. My wife and I jokingly referred to our dog, Sprocket, and cat, Harvey, as training for parenthood. By the time our daughter, Quinnlyn, came around, we already had learned to keep valuables out of reach and close the doors to the rooms where we didn’t want roaming paws. And we quickly learned the value of eating our meals after distracting the animals to avoid begging eyes.

In addition to providing safety challenges, animals have an uncanny way of creating rules for your house, with or without your approval. Regardless of your expectations of them, they almost always get their way. (Those with toddlers will recognize the similarity here.) In our case, for example, we insisted that Sprocket not be allowed on the furniture – and he most definitely would not be allowed to sleep in our bed. He had different plans, though, and now I’m regularly curled up in the only free corner of our king-sized bed and rarely leave the house without fur-covered pants.

After we introduced the pets to Quinnlyn, Harvey disappeared for what seemed like the better part of a year while Sprocket was quite concerned about losing out on time with us. What remained to be seen was how these interspecies siblings would get along once Quinn became more mobile. We had two animals who thought they owned the house and a new queen who demanded nearly all of our attention. Naturally, there was some ruffled fur.

Recently, Sprocket was lying comfortably on the couch while I was typing away in the recliner near him. Quinn recognized the quiet, relaxing vibe and felt it needed a little chaos. She grabbed her step stool, crawled up on the couch and tried to climb up on Sprocket’s back, hoping to get a free doggie ride. Sprocket alerted me with the warning signs – he first tried to move away then let out a little growl before licking Quinn’s face. Thankfully, I was able to intervene before he got increasingly upset, but his behavior understandably is confusing to Quinn, so she continued to try to climb aboard.

Therein lays the challenge: No matter how well trained, animals are instinctual beings that are territorial, protective and usually inflexible on changing the rules they created. Young children are curious beings who discover their world by poking, prodding, throwing, climbing and chasing. Pairing children and pets can be simultaneously developmentally rewarding and potentially dangerous.

Here are some tips to help keep your kids safe around dogs:

Household pets

  • Dogs typically don’t like hugs and kisses, particularly when it’s not on their own terms. Teach kids to respect your animal’s space.
  • Don’t stare at a dog in close proximity to its face as this can be interpreted as an act of aggression.
  • Dogs that are tied up, cooped in or curled up (sleeping or relaxing) may be more agitated if approached – they either want to get out or be left alone.
  • Know that dogs don’t only attack when they’re angry (growling, barking, hair standing up); they can attack because they’re scared; a dog with its mouth closed, eyes wide and ears forward may indicate that it’s scared or worried.
  • Recognize these behaviors in your family dog to know it’s time to stop playing and give your pet some space:
    • Avoidance – hiding behind something or someone or turning its head away
    • Submission – rolling on its back, licking, or leaving the room; even though the dog is giving up now, it may not some day
    • Body language – tail between legs or low with only the end wagging, ears in a non-neutral position, rapid panting, licking its chops, or shaking out its fur
    • Acting out – tearing up or destroying personal possessions such as toys or other items your family uses frequently, or urinating or defecating in the house; these may be signs that your dog should be seen by a behavioral professional – don’t delay!

Pets outside of your family (tips courtesy of Children’s Hospital of Michigan)

  • Always ask an adult’s permission before approaching or petting a dog. Start by letting the dog sniff you, then gently pet under its chin or on top of its head, but never its tail, back or legs.
    • Never run or scream if a dog comes up to you
    • Never try to ride a bike away from a dog; they can run faster than you can bike
    • Always be calm around dogs and don’t look them in the eye; they may see this as an act of aggression
    • Stand still like a tree or rock and let the dog sniff you. If a dog starts biting, put whatever you have (backpack, stick, toy, etc.) in its mouth.
      • Avoid dogs that are eating, playing with toys, tied up in a yard, or behind a fence; also avoid dogs who look ill or angry
      • Never tease a dog by throwing things at it, barking at it, etc.

Dex Tuttle is the injury prevention program coordinator at Children’s Hospitals and Clinics of Minnesota.