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Trauma 101: What it means to be a Level I pediatric trauma center

Our pediatric specialists in Minneapolis are on site, not on call, so they can get to children immediately.

Children’s pediatric specialists in Minneapolis are on site, not on call, so they can get to children immediately.

On the surface, it may be difficult to distinguish one hospital from another. Each one has doctors, nurses and operating rooms. Every place has an emergency room, and all ERs are the same, right?

Not exactly.

So then what does it mean when you’re told that Children’s Hospitals and Clinics of Minnesota has a Level I pediatric trauma center in Minneapolis?

Established in June 2013, Children’s Level I Pediatric Trauma Center in Minneapolis received the American College of Surgeons’ verification by meeting the highest standards of expertise and level of preparation to care for critically injured children, which increases Children’s commitment to families throughout the region. Children’s – Minneapolis was designated by the Minnesota Department of Health as the first and only pediatric-only hospital in the state with ACS Level I recognition.

Children’s can accept injured kids directly from the site of the traumatic injury via ambulance or helicopter instead of being transferred from another hospital after being stabilized.

Children’s can accept injured kids directly from the site of the traumatic injury via ambulance or helicopter instead of being transferred from another hospital after being stabilized.

Trauma

Trauma is the leading cause of death and disability in children. The first hour after an accident, the golden hour, is critical. Children’s can accept injured kids directly from the site of the traumatic injury via ambulance or helicopter instead of being transferred from another hospital after being stabilized.

Children’s – Minneapolis’ transformation from Level III status to Level I took three years, a process that was sped up with help of $17.5 million grant and ongoing philanthropic partnership from Minnetonka-based UnitedHealthcare, a UnitedHealth Group company, in 2010, making the UnitedHealthcare Pediatric Emergency Department and Level I Trauma Center a reality.

The emergency department at Children’s – St. Paul, which is Level III, has been renovated, and its staff go through the same training as those in Minneapolis.

At its Minneapolis and St. Paul hospitals, Children’s receives more than 90,000 visits annually and treats nearly 40 percent of Twin Cities pediatric trauma cases.

At its Minneapolis and St. Paul hospitals, Children’s receives more than 90,000 visits annually and treats nearly 40 percent of Twin Cities pediatric trauma cases.

Level I standards

At its Minneapolis and St. Paul hospitals, Children’s receives more than 90,000 visits annually and treats nearly 40 percent of Twin Cities pediatric trauma cases. When it comes to ACS-verified Level I attributes, Children’s has:

  • More than 150 emergency department staff, including board-eligible or board-certified pediatric emergency physicians, nurse practitioners, nurses and more
  • 24/7 in-house pediatric trauma surgeon; Children’s pediatric specialists in Minneapolis are on site, not on call, so they can get to kids immediately
  • Two large trauma bays, resuscitation rooms, a helipad and dedicated orthopedic room for fractures, featuring advanced X-ray capabilities
  • Research programs and performance improvement efforts to ensure that each patient experience leads to the best possible outcome
  • Injury prevention efforts such as Making Safe Simple, Children’s public education program designed to arm the community with basic safety and injury prevention tips

subscribe_blogPlan for the unplanned

You plan everything out for your kids (classes, camps and nutrition). It’s important to have a plan in case they’re in a serious accident. If your child has an emergency, know where to go. Program Children’s ER contact information into your phone. Children’s Hospitals and Clinics of Minnesota are located in Minneapolis (2525 Chicago Ave. S.) and St. Paul (345 N. Smith Ave.)

When it’s critical, so is your choice — Children’s Level I Pediatric Trauma Center, Minneapolis.

Kangaroo Care a tranquil experience for parent, child

Newborn Azarias has skin-to-skin contact with his mother, Veronica Engel, as part of a Kangaroo Care exercise. May 15 is International Kangaroo Care Day.

This month, the Neonatal units in St. Paul and Minneapolis are celebrating the importance of Kangaroo Care, a technique where an infant is held skin to skin with mom or dad. Kangaroo Care promotes bonding, provides comfort for the baby and parent and has potential to improve a baby’s medical condition. In honor of International Kangaroo Care Awareness Day, May 15, a mother shares her experience holding her newborn son skin to skin.

Veronica Engel of Chippewa Falls, Wis., holds newborn son Azarias skin to skin as part of Kangaroo Care.

Veronica Engel

My husband and I found out at my 10-week ultrasound that we were having a baby boy, but we also found out that our son, Azarias, had a birth defect called gastroschisis.

Due to his condition, doctors informed me that I wouldn’t be able to hold Azarias until after his surgery. This had me worried because I was afraid of missing out on that special bonding time that you immediately have with your newborn. When he was born, I was able to put him on my chest momentarily but then he had to be rushed off in an isolette to be prepared for his stay at the hospital until the doctors could perform the surgery he needed.  He was staying in the neonatal intensive care unit (NICU) at Children’s – St. Paul, which has private rooms. I am grateful for this because it allowed me to stay in the room with him around the clock.

subscribe_blogI wasn’t able to hold him for the first week of his life due to his condition; however, I was able to hold his hands and feet or rub his head. After his surgery, I was able to hold him the next day. This was special because I got to hold him skin to skin; I held him for three hours straight. It was relaxing and soothing for both of us to be able to have this closeness, which we weren’t able to do at the beginning of his life. I continued to stay with Azarias in the NICU, and each day I would hold him once or twice using skin-to-skin – anywhere from an hour to three hours at a time.

The doctors told me that he was doing excellent for his condition. Not only was he gaining weight at a good pace, but he also was moving along quickly for what he was able to consume and digest.

When I’m holding Azarias skin to skin, I don’t even notice the time fly by; it’s such a relief to be able to help calm and comfort him just by this simple action. Kangaroo Care truly is a tranquil experience for parent and child and has helped us build a lasting bond with each other. I believe that being here and holding him skin to skin has made a difference in Azarias’ ability to recover and heal from this whole ordeal.

Children’s promotes “brain breaks” for kids in Minnesota schools

subscribe_blogNow there’s a way for kids to fit more fun into their school days. GoNoodle is a program that offers “brain breaks” to kids as part of their class curriculum. Children’s Hospitals and Clinics of Minnesota sponsors GoNoodle in 336 Twin Cities-area elementary schools.

According to GoNoodle, 84,874 students in Minnesota participated in GoNoodle activities for more than 3.5 million minutes in April.

Gigi Chawla, MD, Children’s senior medical director of primary care, joined WCCO Mid-Morning’s Kylie Bearse and Jason DeRusha to talk about the program and its benefits.

Twin Cities to celebrate its first 22q at the Zoo

Roya Kebriaei, 3, is the daughter of Meysam Kebriaei, MD, and Amy Kebriaei, DDS. (Photo courtesy of the Kebriaei family)

Roya Kebriaei, 3, is the daughter of Meysam Kebriaei, MD, and Amy Kebriaei, DDS. Roya was born with 22q, a chromosome deletion syndrome that can cause a wide range of recognizable health and developmental problems. (Photo courtesy of the Kebriaei family)

A little-known chromosome deletion syndrome called 22q will be the reason for an upcoming celebration in the Twin Cities. For the first time in Minneapolis-St. Paul, an official group will gather May 17 for “22q at the Zoo” in honor of 22q Worldwide Awareness Day.

Also known as velocardiofacial and DiGeorge syndrome, 22q is a genetic syndrome that can affect every system in the body and cause a wide range of recognizable health and developmental problems. Though little known in some circles, 22q is nearly as common as Down syndrome, affecting 1 in 2,000-4,000 children born, 1 in 68 kids born with heart disease and 5 percent to 8 percent of children with cleft palate.

subscribe_blogThe fifth annual worldwide event, which takes place each year on the third Sunday in May, will be officially recognized at the Minnesota Zoo, 13000 Zoo Boulevard in Apple Valley, one of more than 100 zoos worldwide participating. The event is scheduled for 1-2:30 p.m. and includes a kids’ party, networking for parents and a guest speaker.

Children’s Hospitals and Clinics of Minnesota pediatric neurosurgeon Meysam Kebriaei, MD, and his wife, Amy Kebriaei, DDS, established a local 22q support group made up of teams from Children’s, Gillette and University of Minnesota Masonic children’s hospitals. The couple’s 3-year-old daughter, Roya, was born with 22q.

RSVP to the event by contacting Amy Kebriaei at (218) 349-4050 or [email protected]. Go to 22q.org for more information and to order the official red 22q at the Zoo T-shirt. Proceeds benefit the International 22q Foundation.

Allergies in full swing in spring; asthma a year-round concern

Although allergies can develop at any age, they most commonly show up during childhood or early adulthood.

Winter exits, spring enters, and with it come irritants in the environment that can trigger allergies in children and adults. In the U.S. alone, more than 50 million people (1 in 5) are affected by allergies — which are caused by an overactive immune system — according to the American Academy of Pediatrics.

Allergies in springtime often are a trigger for asthma — May is National Asthma and Allergy Awareness Month — but asthma is a year-round concern for children, said Gigi Chawla, MD, Children’s senior medical director of primary care. Keeping refills for controller and rescue medications, especially with traveling, outings and school, up to date is important. Parents should ensure they’re making asthma checkups with their clinicians, at least yearly, in order to keep kids happy, healthy and under control.

Allergies and asthma are the most common chronic diseases among children in the U.S., according to the AAP. Many aspects of allergies, eczema and asthma are not fully understood. But advances in the diagnosis and treatment of these disorders are helping millions of sufferers.

subscribe_blogWhat are allergies?

Many people mistakenly use the word “allergy” to refer to a disease or almost any unpleasant or adverse reaction. In reality, allergies are reactions that usually are caused by an overactive immune system. These reactions can occur in a variety of organs in the body, resulting in diseases such as asthma, hay fever and eczema.

Your immune system is made up of a number of different cells that come from organs throughout the body — principally bone marrow, the thymus gland, and a network of lymph nodes and lymph tissue scattered throughout the body, including the spleen, gastrointestinal tract, tonsils, and the adenoid (an olive-shaped structure that is located at the top of the throat behind the nose).

Normally, it’s the immune system that protects the body against disease by searching out and destroying foreign invaders, such as viruses and bacteria. In an allergic reaction, the immune system overreacts and goes into action against a normally harmless substance, such as pollen or animal dander. These allergy provoking substances are called “allergens.”

Allergy symptoms for ear, nose, throat and mouth

  • Red, teary or itchy eyes
  • Puffiness around the eyes
  • Sneezing
  • Runny nose
  • Itchy nose, nose rubbing
  • Postnasal drip
  • Nasal swelling and congestion
  • Itchy ear canals
  • Itching of the mouth and throat

Lungs

  • Hacking dry cough or cough that produces clear mucus
  • Wheezing (noisy breathing)
  • Feeling of tightness in the chest
  • Low exercise tolerance
  • Rapid breathing; shortness of breath

Skin

  • Eczema (patches of itchy, red skin rash)
  • Hives (welts)

Miscellaneous

  • Headache
  • Feelings of restlessness, irritability
  • Excessive fatigue

Where does asthma fit?

Although allergies can trigger asthma and asthma often is associated with allergies, they are two different things. In simple terms, asthma is a chronic condition originating in the lungs, whereas allergies describe reactions that originate in the immune system and can affect many organs, including the lungs. Many different substances and circumstances can trigger an asthma attack—exercise, exposure to cold air, a viral infection, air pollution, noxious fumes, tobacco smoke, and for many asthma sufferers, a host of allergens. In fact, about 80% of children with asthma also have allergies. Although allergies are important in triggering asthma, severe asthma exacerbations are often set off by the good old common cold virus, totally unrelated to allergy.

In the summertime, exercise and humidity often are triggers. In late summer-early fall, ragweed is a trigger. Come fall, weather changes and back-to-school exposure to illness can be a trigger for asthma exacerbation, and illness is the usual culprit in the winter.

Source: Guide to Your Child’s Allergies and Asthma (Copyright © 2011 American Academy of Pediatrics)

Boy honors sister’s life through fundraising, head-shaving event

Brady German (right), of Bell Plaine, Minn., shaves his head annually at the St. Baldrick's Foundation's "Shave the Day" event at Children's in honor of his sister, Emma. Emma died in September, four years after being diagnosed with neuroblastoma. She was 7. (Photo courtesy of the German family)

Brady German (right), of Belle Plaine, Minn., shaves his head annually at the St. Baldrick’s Foundation’s “Shave the Day” event at Children’s and raises money for cancer research in honor of his sister, Emma. Emma passed away in September, four years after being diagnosed with neuroblastoma. She was 7. (Photo courtesy of the German family)

Emma German, of Belle Plaine, Minn., passed away in September, four years after being diagnosed with neuroblastoma. Her brother, Brady, continues to raise money for cancer research and shave his head in her honor through the St. Baldrick’s Foundation’s annual “Shave the Day” event at Children’s – Minneapolis.

Brady Gervais

In the small town of Belle Plaine, Minn., everyone knows about Emma. A “girlie girl,” Emma was diagnosed with neuroblastoma in 2010 when she was 3. She loved fashion, sparkles, makeup and accessories. The more glitter, the better. She loved to dance and sing, play piano and do arts and crafts. She and her older brother, Brady, entertained their family with weekly skits and dances.

Emma was so adored that in 2013, she was invited to be a “celebrity shaver” at a St. Baldrick’s Foundation head-shaving event at Children’s that raises money for cancer research. While watching Emma shave heads, Brady was spurred to help, too. Emma’s doctor offered to donate to St. Baldrick’s if Brady became a shavee. He agreed and then challenged his mom to donate, too. Earlier that day, his mom had received an anonymous cash gift. She donated the money for the cause.

Later that night, Brady told his mom that he wouldn’t cut his hair until the following year, when people would shave the day again for St. Baldrick’s at Children’s. As his hair grew throughout 2013 and early 2014, people commented on his long locks. Whenever they did, Brady told them that he was raising money for pediatric cancer research, his sister was undergoing cancer treatment and he wanted to help kids like Emma get much-needed medicine. He raised more than $4,000.

Emma hugs big brother Brady shortly after she helped shave his head during the 2014 St. Baldrick's Day event.

Emma hugs big brother Brady shortly after she helped shave his head during the 2014 St. Baldrick’s Day event.

After spending four years in and out of the hospital, Emma passed away Sept. 24, 2014. She was 7. But her story doesn’t end there; it lives on in her big brother. This year, after Emma’s death, Brady has aspired to do much more.

“Brady loves and misses his little sister terribly, and it hurts him SO much to do this without her,” their mom, Keriann, said. “But raising money to help fund clinical trials that can hopefully help find treatments that can save other children battling cancer is a great way to honor someone we have lost to the disease.”

Brady recruited eight of his classmates from his fourth-grade class at Oak Crest Elementary and his favorite teacher, Mr. Don Fraser, to commit to shaving their heads and raising money, too. Brady named his team “Emma’s Acorns” — a tribute to his sister and school. He tells his friends that he wants to “help the doctors and scientists find better medicines for kids with cancer so that other kids don’t have to lose a brother or sister to cancer like he did.”

Brady (in green) recruited eight classmates and his teacher to raise money for cancer research and shave their heads this year. The group has raised more than $10,000.

Brady (in green) recruited eight classmates and his teacher to raise money for cancer research and shave their heads this year. The group, “Emma’s Acorns,” has raised more than $10,000.

subscribe_blogAt the St. Baldrick’s event at Children’s on Thursday, Brady’s friends will wear pink, a color they unanimously picked to honor Emma. Their moms will wear purple, another favorite of Emma’s. So far, Brady and his friends have raised more than $10,000. And each one has told Keriann that they plan to shave their heads and raise money annually to honor Emma.

“I know that Emma is the reason Brady is doing this,” Keriann said, “and his friends are proud to support him in his efforts to raise money and awareness of the importance of funding clinical trials for pediatric cancer.”

Learn more about how you can “Shave the Day” on Thursday.

Brady Gervais is an annual giving officer in the foundation at Children’s Hospitals and Clinics of Minnesota.

St. Patrick’s festivities to alter traffic in St. Paul

subscribe_blogThose traveling to or near Children’s – St. Paul on Saturday and Tuesday are encouraged to allow extra time or find alternate routes that avoid the traffic from the LuckyPalooza (Saturday) and St. Patrick’s Day (Tuesday) events.

LuckyPalooza will be held on West Seventh Street from 2-11 p.m. During that time, West Seventh Street will be closed between Walnut Street and Kellogg Boulevard for this event, which includes music, tent parties and a stunt-bike performance.

The St. Patrick’s Day celebration and parade on Tuesday is expected to draw many extra visitors to downtown and the area near the Children’s – St. Paul.

Prepare your child’s sleep for daylight saving time

Four days before daylight saving time starts, get your child to bed 15 minutes earlier the first night. (iStock photo)

Four days before daylight saving time starts, get your child to bed 15 minutes earlier the first night. (iStock photo)

Karen Johnson, APRN

Preparation is the key to minimize the impact of daylight saving time on your child’s sleep patterns. It’s a good idea to get your child into bed a little earlier in the week leading up to the time change.

subscribe_blogChange the child’s body clock

Four days before daylight saving time starts — it takes place at 2 a.m. Sunday, March 8 — get your child to bed 15 minutes earlier the first night. Your child may not actually go to sleep earlier, but by getting him or her to bed sooner, you are encouraging the body to relax earlier than usual. This will lead to falling asleep earlier, too. Make the child’s bedtime progressively earlier by 15 minutes each of the four nights before daylight saving time until it adds up to an hour the night of the time change.

Daylight saving time sleep tips

Make sure that the bedroom is dark. The big challenge for parents during daylight saving time is having the child go to bed when the sun is out. Sleep is influenced by having a dark environment, as this allows for the natural secretion of melatonin that is needed to invite sleepiness.

Calm bedtime routine

Take extra care to ensure that the bedtime routine is calm and as relaxing as it can be. A calm and regular bedtime routine is best, without debates and arguing to promote sleep.

Waking too early

Ensure that your child understands that it’s not time to get up for the day. Encourage him or her to go back to sleep. Some parents put a clock beside their child’s bed and explain what time it has to be before the child can get up for the day. If you have a toddler or young child, use a sleep clock such as the Good Nite Lite. The light is a cue that informs your child to stay in bed until the sun shines on the clock in the morning. This isn’t just effective for time changes; it also can help you train an early riser not to wake Mommy and Daddy too early in the morning and may help with bedtime battles.

Get some sun

Besides making sure to get the proper amount of sleep, early morning bright light exposure also can help set a regular sleep-and-wake pattern called a “circadian rhythm.” Eating breakfast in a bright part of your house or going for an early morning walk outside in the sun will help you and your child wake easier as well.

Daily physical activity is recommended for all children, but don’t try to wear your child out in an effort to get him or her to sleep earlier. Overtired children often take longer to fall asleep and may even resist sleep completely.

Be consistent

While your child is getting used to the new sleep schedule, stick to your usual bedtime rules and routine.

Be patient during this time adjustment as you may have a tired and grumpy child on your hands in the days after the time change. It generally takes about a week after the clocks have changed to be in a new sleeping pattern. Prepare to feel unfocused in the days after you set clocks forward. You might want to keep your family’s schedule more open in the days after daylight saving time in case you aren’t well rested.

Other tips

  • Newborn babies usually are not affected by the start and finish of daylight saving time.
  • Change clocks Saturday evening before going to bed.
  • Check the smoke alarms. Changing the batteries as a good safety rule.
  • If your child has difficulty sleeping, please contact the Children’s Sleep Center.

Karen Johnson, APRN, is a certified nurse practitioner at the Children’s Sleep Center.

When to vaccinate against measles

Joe Kurland, MPH

Our infection prevention and control team has received questions about the measles, mumps and rubella (MMR) vaccine from a number of concerned parents since measles and vaccinations began dominating national news coverage. Here we highlight the number of recommended doses and the times to receive the vaccine.

I want to protect my child. What is the recommendation for the MMR vaccine in Minnesota now?

Children’s Hospitals and Clinics of Minnesota, like most medical centers, follows the guidelines for vaccination as recommended by the Centers for Disease Control and Prevention (CDC) and Minnesota Department of Health (MDH).

  • Every child should receive two doses of MMR vaccine, with the first dose given between 12 and 15 months of age and second dose between ages 4 and 6 years old. The second dose can be given earlier as long as it comes at least 28 days after the first dose.
  • If a child will be traveling outside of the U.S., he or she may be given a single dose of MMR if the child is between 6 and 12 months old. However, any dose given before the first birthday will not count towards the regular schedule, and the child still will need the two doses as outlined above.
  • If an older child is unimmunized and wants to “catch up” on his or her immunization schedule, the child will need two doses of MMR vaccine separated by at least 28 days.

subscribe_blogAs with all medical decisions, you should discuss your concerns and plan with your clinician. Currently, the CDC is not urging earlier-than-usual vaccinations, even for young children traveling within the U.S. or attending daycare. But as the measles outbreak changes, new guidance may become available. Please continue to check Children’s and CDC websites.

The Minnesota Department of Health reported an international-travel-related measles case on the University of Minnesota campus Jan. 28. To date, there have not been any additional cases in the greater community, and children are not at increased risk.

A few additional points to remember:

  • Two doses is all that is required, and after that the child is considered immune.
  • Blood testing for immunity (or titer levels) is not recommended by the CDC.
  • If adults are unsure of their vaccine status, they should get at least one dose of MMR.

If you have been hesitant to vaccinate your children, take this as a wakeup call. Vaccine-preventable diseases such as measles are active outside of the U.S. and may be just a plane ride away. You can and should protect your children; immunize them.

Joe Kurland, MPH, is a vaccine specialist and infection preventionist at Children’s Hospitals and Clinics of Minnesota.

Get screened for type 1 diabetes at Twin Cities walk

The McNeely Pediatric Diabetes Center at Children’s – St. Paul is part of an international research network called Type 1 Diabetes TrialNet. It currently is screening relatives of individuals with type 1 diabetes (T1D) to see if they are at risk for developing the disease.

subscribe_blogThe TrialNet research study offers a blood test that can identify an increased risk for T1D up to 10 years before symptoms appear.

TrialNet offers screening to:

  • Anyone ages 1-45 with a parent, brother, sister or child with T1D.
  • Anyone age 1-20 with a niece, nephew, aunt, uncle, grandparent, half-brother/sister or cousin with T1D.

Children’s will host a free screening event from 7:30-10:30 a.m. Feb. 21 at the JDRF Walk to Cure Diabetes at the Mall of America. For more information or to refer eligible families, contact Brittany Machus, clinical research associate, at [email protected] or (651) 220-5730.