Category Archives: Featured

Mental health is a part of overall well-being

We move through the world as a unique, integrated, whole person. And so do the children for whom we care. (iStock photo)

We move through the world as a unique, integrated, whole person. And so do the children for whom we care. (iStock photo)

Mike Troy, Ph.D, LP

Mike Troy, Ph.D,

Mike Troy, Ph.D,

It’s good that we devote a month — May — to mental health. Through these efforts, the community works to build greater awareness about mental health, break down stigma and lend support and hope to those who deal with mental-health issues in their lives. Yet, I find myself hoping for a time when we don’t have a special month for mental health.

Why would a clinical psychologist who is encouraged by the progress that has been made in mental-health awareness over the course of his long career hope for that? Let me start to answer this way: In which month do we recognize medical health?

Obviously, there is no such month. And the reason is that society doesn’t need to be convinced that our physical health is tied to our overall well-being. We assume that flu will lead to missed time at school or work; we know that cancer will require treatment; and we recognize that continued lack of treatment of high blood pressure could result in a stroke or heart attack. And yet despite equally compelling evidence, we often fail to recognize that emotional and behavioral problems have a direct and profound impact on current and future well-being.

Indeed, our health care systems continue to be organized in ways that imply that we move through the world with separate identities — one physical and one psychological, with divided systems of care. But this division is artificial. In reality, we move through the world as a unique, integrated, whole person. And so do the children for whom we care.

While we have much more work to do, at Children’s we recognize that mental health care is health care. This understanding is being validated by a growing body of research that speaks to the powerful interaction of biological, psychological and social factors on the developing brain, gene expression and overall health. We know, for example, that significant and sustained adversity early in life contributes to a wide range of behavioral, learning and health problems throughout development. And there’s an abundance of scientific evidence linking behavioral disorders of childhood to poor physical health throughout the lifespan. Consequently, monitoring risk and responding with appropriate evaluation and treatment for emotional, behavioral and developmental problems is as important as it is for medical problems.

subscribe_blogThis is why we’re grateful that more than 4,000 families during the past year have turned to Children’s for help when confronted with the challenge of understanding and treating mental-health problems such as anxiety, depression, autism spectrum disorder and ADHD. Additionally, Children’s supports our mental-health professionals as they work to bridge psychological and physical health while working as members of clinical teams ranging from the feeding clinic to the hematology/oncology clinic.

While society still has a long way to go, I am hopeful that increasingly we are viewing and valuing mental health in a more enlightened way. Seldom am I met with skepticism when I speak to a medical audience about the impact of mental health on overall health. The pediatric health care industry is investing in more intensive and robust screening methods to identify potential issues earlier, as well as advancing models for delivering care that integrate mental- and behavioral-health services into medical settings.

I embrace this momentum, while also recognizing that much more work needs to be done before we no longer need a single month devoted to mental health. What will that look like? Children who struggle, for example, with depression will be treated with the same understanding, compassion, and support as those with cancer. Health care systems and insurers will view physical- and mental-health services as equal contributors to the developmental well-being of all of our community’s youth. And families will be able to access mental-health services as readily as any other essential health care services.

In the meantime, I join with others in recognizing this month as an opportunity to shine a light on mental health and a way of letting the children and families we see every day know that they have our support.

Mike Troy, Ph.D, LP, is the medical director of Behavioral Health Services at Children’s Hospitals and Clinics of Minnesota.

The ‘funnest’ place in the hospital

Grace Vokaty loves the Child Life Zone at Children's — St. Paul.

Grace Vokaty loves the Child Life Zone at Children’s — St. Paul.

Grace Vokaty

When I was 7 years old, I came to Children’s – St. Paul because I had type 1 diabetes. When I was in the hospital, I was sad because there isn’t a cure for my disease. But then I was invited to visit the Child Life Zone, which was made possible by Mr. Garth Brooks and his friends at Teammates for Kids. The Zone is so fun, and now whenever I see the doctor, I tell my parents that we have to stop and play.

subscribe_blogI enjoy coloring and painting, air hockey, video games, the photo booth and lots of other stuff. I like that it’s a fun place to go while I’m at the hospital. And when I’m not feeling happy, it cheers me up.

Plus it’s nice to meet other kids like me who are patients, too. Even my parents enjoy it because I can play there while they are taking classes and learning how they can help me with my diabetes.

In November, I had the chance to meet Mr. Brooks and to tell him thank you for building the Child Life Zone. I told him that it is the “funnest” place I have ever been and that he did a really great job. It makes me happy to know that people from all over care about kids at Children’s, and I hope that when other kids go there it makes them smile.

Grace Vokaty is a patient at Children’s Hospitals and Clinics of Minnesota.

The trouble with toe walking

Casts

If there’s limited motion in the ankle and a child is consistently toe walking, he or she is put in serial casts or carbon-fiber braces.

Toe walking can seem cute, at first. But if it persists after a child is about 20 months old, it can be a problem.

Toddlers develop a heel-toe walking pattern about 20 weeks after they begin walking alone and no longer should be toe walking, said Nicole Brown, DPT. If left untreated, toe walking can lead to future injury or pain in your child.

“I think with little ones, everyone thinks it’s adorable because you don’t know if it’s causing problems,” said Sara McGrane, whose daughter, Molly, started seeing Brown when she was 5 years old.

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CHILDREN’S GRAND ROUNDS: New evidence in toe walking

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At her daughter’s checkup when she was 3, the primary care physician told her parents they needed to encourage her to stop walking on her toes, McGrane said. When she was 4, the parents were told again to keep working with Molly. It was at her visit when she was 5 that her primary care physician noticed she was toe walking and referred her to the Children’s Rehabilitation Clinic in Minnetonka.

subscribe_blog“When she was little, it was cute,” she said. “She had always been a toe walker.”

Often, Brown doesn’t see patients until they’re 6 or 7 years old. There’s a misconception that kids will grow out of toe walking, she said. Those who are seen at 2 or 3 years old have a better prognosis, and treatment time generally is shorter. She has treated patients as young as 18 months and as old as 13.

“We want to get these kids in earlier,” she said. “By the time they’re 6 or 7, they can have structural damage to their foot.”

Treatment varies and depends on the severity of the condition. If Brown can see a patient before there’s limited range of motion, she can retrain the child to resume a normal walking pattern through physical therapy, which on average lasts six months, she said.

If there’s limited motion in the ankle and the child is consistently toe walking, he or she is put in serial casts or carbon-fiber braces, she said. The serial casts are like a typical fiberglass cast for a broken leg. They’re taken off every week and put back on to accommodate the new range of motion that was achieved. Once a child’s motion improves, Brown uses ankle braces. Physical therapy also is part of the prescription and on average lasts about a year.

In Molly’s case, her heel cord was tight enough that she required bracing, McGrane said. She met with Nicole for physical therapy for about 10 months.

“We were amazed at how quickly the process went,” McGrane said. “We are big believers in the program.”

What is toe walking?

Toe walking is a diagnosis in which a person walks with bilateral toe-to-toe walking pattern. There may be a medical cause or it may be idiopathic in nature.

How does Children’s treat patients who toe walk?

  • We offer serial casting, orthotic intervention and physical therapy treatment for treatment of toe walking.
  • Serial casting has been proven to be an effective intervention for toe walkers in treatment of tight heel cords to increase the range of motion and to also weaken the heel cord muscle to allow us to retrain the child’s walking pattern.
  • Children’s and Orthotic Care Services have designed a new type of solid ankle foot orthotic that mimics serial casts for treatment of toe walking.
  • The orthotic brace is a two-pull carbon-fiber solid ankle foot orthotic. The carbon fiber on the outer shell decreases the amount of available multi-planar ankle motion, which mimics the effects of serial casting through increasing range of motion through the heel cords as well as weakening the heel cords but allows the child more flexibility in that they can take off the brace to shower or participate in certain activities.
  • After serial casting or carbon-fiber-bracing intervention has been completed, children are then placed in a two-pull plastic ankle foot orthotic to retrain their gait pattern to allow for a consistent heel-toe walking pattern.

Children’s research in toe walking

We compared outcomes in treatment of toe walking gait with carbon-fiber-orthotic intervention and serial casting. Children were enrolled in this study, and results have shown good outcomes. The research study offers financial assistance as well as a team approach in the treatment of a child’s toe-walking pattern.

“Children’s Pedcast”: Dr. Doug Hyder on headache management

Doug Hyder, MD, medical director of pediatric neurology at Children’s Hospitals and Clinics of Minnesota, provides information about headaches, including the symptoms, how they originate, how they’re connected to our activities and different from migraines, and how they can be managed.

“Children’s Pedcast” can be heard on iTunes, Podbean, Stitcher, YouTube and Vimeo.

5 things you may not know about music therapy

Erinn Frees (right), a music therapist at Children’s, tells us five things you may not know about music therapy. At left is music therapist Kim Arter.

In honor of Music Therapy Week, music therapist Erinn Frees gives us a look at her job at Children’s Hospitals and Clinics of Minnesota.subscribe_blog

Stepping onto the Children’s elevators each day, guitars on our backs and instruments in hand, we tend to draw comments from fellow riders. They range from the typical “You must be the entertainment” to “Do you actually play all those instruments?” to “I wish I had your job.”

Although explaining the ins and outs of music therapy isn’t always possible by the time one of us gets off on the fourth floor, we do usually manage to smile and say, “I’m one of the music therapists.” After being in this field for almost seven years, I find that this doesn’t always provide a lot of clarification. So in no particular order, here are five things that you might not know about music therapy:

1. Music therapy isn’t just for fun. Don’t get me wrong, music therapy usually is funWhat kid or teen doesn’t enjoy music, especially when they get to play along on a shaker or fancy electronic drum set?  However, a casual observer may not notice that a music therapist has goals for each patient he/she works with, ranging from giving a 3-year-old an effective means of emotional expression when he doesn’t have the words, to giving a 15-year-old relaxation strategies using music during a procedure, to motivating a 10-year-old to get out of bed.  The point of music therapy is that we are using the musical experience as a means of reaching a non-musical goal.

2. A child doesn’t need to be a musician or have musical experience to benefit from music therapy. Our goal as music therapists is not to teach kids how to play an instrument, or sing better, or dazzle everyone with their harmonica stylings. Therefore, the child doesn’t need to be musical to benefit from music therapy. Even patients who are sedated can benefit from music therapy, as music therapy can lower heart rate and blood pressure, as well as increase oxygen saturations. Patients who are able to participate on a more active level can play drums, shakers, xylophones and even a special type of harp with little to no previous musical experience.  A music therapist may use teaching the guitar as a way to improve the child’s fine motor skills, or having a child blow through the harmonica as a way to encourage deep breathing, but learning skills on these instruments is never the goal of the session.

3. We always use patient-preferred music. Music therapists use music from all genres to effect positive changes in the patients we work with.  We wouldn’t use “Old MacDonald” in a session with a 16-year-old (unless he or she requested it!) and we probably wouldn’t use a song from the 1920s with a 5-year-old. One of the first things music therapists ask when getting to know a new patient is what kind of music the he or she prefers.  We then work to accomplish our goals using this or similar music. We can’t promise to know every song, (we’re not human jukeboxes!) but we can always use recorded music or find a similar song if need be.

4. Music therapists are not just musicians waiting to make our big break on “American Idol.” Across the board, the music therapists I know went into the field because they want to use their passion for music to make a difference in people’s lives. We went to school for four or six years to do exactly what we do: music therapy. We spent six full months doing an unpaid music therapy internship and worked hard for the jobs we have. Although some music therapists perform outside of their day jobs, we are not performing when we are working with patients. Just listening to us sing is not likely to accomplish very many therapeutic goals!

5. We don’t just sing and play instruments. We do a lot of singing and instrument play with kids, this is true. However, we also work with kids doing songwriting (for emotional expression, processing, or a way to “tell your story”), lyric discussion (again to process emotions, facilitate coping, or put a new perspective on problems), music-assisted relaxation, procedural support, recording, and CD compilation.

So let’s go back to the elevator, so we can finish those conversations:

“You must be the entertainment!” – No, I’m not a performer. I do get to spend the day making great music with courageous, insightful and amazing kids, though!

“Do you actually play all those instruments?” Yes, I can… but I’d rather have the kids playing them!

“I wish I had your job!” – Yes, it is a wonderful and rewarding profession, and I wouldn’t want to be doing anything else!

Meet Katie

What Katie loves most about Children’s is the music therapy program.

What Katie loves most about Children’s is the music therapy program.

When exploring the impact of supporting a child’s tomorrow, we went straight to the source: our patients. We asked several to share how Children’s has played a role in their life today, and what they look forward to in their tomorrow. This is what we learned.

Q4_mighty_buttonName: Katie

Age: 5

Hometown: Eden Prairie

Katie was rushed from Abbott Northwestern Hospital to Children’s after she was born 15 weeks early. She only weighed a pound and had to stay in the neonatal intensive care unit (NICU) for 99 days. According to her mom, she is now happy, healthy and doing wonderfully.

When Katie grows up, she wants to be a dancer. She loves to dance.

What Katie loves most about Children’s is the music therapy program. Her brother, a member of our Youth Advisory Council (YAC), even helped to design a music cart for the music therapists at Children’s.

Define safe boundaries for kids and play

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

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

Dex Tuttle

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

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

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

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

I began to notice this in her other activities as well. At dinnertime, we give her a plastic fork and spoon so she can work on her motor skills. If she’s unhappy with how dinner is going, she throws her fork and spoon on the floor in a fit of toddler rage. She is then immediately puzzled by how she’ll continue her meal now that her utensils are so far away.

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

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

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

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

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

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

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

Five Question Friday: Terrance Davis

Five Question FridayIt’s Friday, and what better way to celebrate the end of the week than with a Five Question Friday profile? Meet Terrance Davis, who works on our Environmental Services team within the Minneapolis Surgery department.

Terrance Davis has worked at Children's for 25 years.

Terrance Davis has worked at Children’s for 25 years.

How long have you worked at Children’s?

I have worked here for 25 years.

Describe your role.

I clean surgery rooms between cases and stock supplies.

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

I have a few favorites:

  • The surgery staff surprised me with a 50th birthday celebration.
  • Each annual craft show, which is so much fun
  • Gathering for the Environmental Services Week events

What do you think make kids great?

I have a couple answers for this one. First, they can smile at you and make your entire day better. Second, they have great energy, which can be contagious.

What is one interesting fact about you?

I was married in Las Vegas at the top of the Stratosphere tower with local TV personality “Fancy Ray” McCloney standing with me as my best man.

Five Question Friday: Kelly Patnode

Five Question Friday

Meet Kelly Patnode, patient access specialist at our St. Paul hospital, who has a love for the Minnesota State Fair.

When she isn't working in our St. Paul hospital, Kelly Patnode enjoys reading and helping out at the Minnesota State Fair.

When she isn’t working in our St. Paul hospital, Kelly Patnode enjoys reading and helping out at the Minnesota State Fair.

How long have you worked at Children’s?

I have worked at Children’s in St. Paul for 36 years.

What drew you to Children’s?

I started in St. Paul when it was on “the hill” (across the highway from our current location) as a volunteer at the age of 13. I was a volunteer for four years. I went to school for medical office occupations, but there were no openings at that time. When I was talking to someone at Children’s, they said there was an opening for a health unit coordinator. I asked what that person did, and they explained that person works at the main desk on the floors. I asked if that was similar to a ward secretary, and they said yes. I said, “Well, I have done that job for four years, so I think I could do it!”

Subscribe to MightyWhat is a typical day like for you?

My typical day starts with making a coffee. It is just the right way to start of the day. I then clean and restart all the computers, restock supplies and then either sit at the emergency room desk and start answering the phone, make calls for the providers, put together a chart or break down a chart or start with registering patients who come to be seen in the ER.

What do you love most about your job?

Every day is a different day. What I did yesterday at my job may be totally different than the day before or today. If I can get a smile out of a patient and their parents, it just makes the day better.

What do you enjoy doing outside of work?

Usually I read books. But during the summertime I am busy because I also work at the Minnesota State Fair, selling box-office tickets for grandstand shows and pre-fair tickets. I have been working there for 38 years. So when I am not working at the hospital, I am at the fair. I am actually taking vacation from the hospital to work full time at the fair this year.

Children’s, Twin Cities Moms Blog host #MNvaxchat

Subscribe to MightyAugust is National Immunization Awareness Month, and Minnesota’s new immunization requirements take effect Sept. 1. With that and back-to-school mode under way, we’ll be co-hosting a Twitter chat with our friends at Twin Cities Moms Blog.

Join us for the live chat, using #MNvaxchat from 8-9 p.m. Monday, that will feature Patsy Stinchfield, PNP, director of Infection Prevention and Control and the Children’s Immunization Project at Children’s Hospitals and Clinics of Minnesota. Children’s and Twin Cities Moms Blog will be there, too. Participants who use #MNvaxchat in tweets during the live chat qualify for a chance to win a $50 Target gift card.

ALSO: Read the Children’s vaccinations blog archive on Mighty.

UPDATE: Participation strong, informative on #MNvaxchat