Kid's Health Blog

This is a post by Amy Moeller. Amy is a therapist who has worked with children and adolescents for 25 years. She works in the Adolescent Health Department at Children’s Hospitals and Clinics of Minnesota and treats teenagers experiencing depression, anxiety, social struggles and chemical dependency. In addition, Amy co-founded The Family Enhancement Center in south Minneapolis 17 years ago. She works at the center part time with children and families who have been affected by physical abuse, sexual abuse and neglect. Amy is married and the mother of three children.

It’s that time of year again. It’s time for your teen to go back to school and juggle activities, homework and sleep.

As a therapist who works with teens, I know sleep and homework can present significant challenges. Between pressures of being involved in sports and other activities and being social, sometimes sleep and academic work take a backseat. We all know that sleep is critical for kids. But did you know that the average teen needs around nine-and-a-half hours of sleep each night, according to the American Sleep Disorders Association? Studies show teens generally get fewer than seven-and-a-half hours of sleep.

From the moment their alarm sounds, teens go, go, go. But here are some ways you can help your teen catch more z’s and stay on top of school work.

Sleep

  • On a school night, set a time for lights out. While this is tough during the school year with activities, it’s better to set a time at the beginning than a mid-year change. Also, lights out means all electronics should be stowed away. 
  • Establish a reasonable time to go to bed and wake up. 
  • Help your teen develop a night-time routine that helps him/her slow down. Reducing commotion for an hour before bedtime will help your teen relax.
  • Cut caffeine consumption and encourage daily exercise more than two hours before bedtime. 

Homework

  • Create an environment geared toward your teen. Some teens need privacy and quiet; others prefer to be around people. Find space in your where your teen is most comfortable. Have the tools they need to get the work done. 
  • Pick a time for homework and stick to it. Routine makes your teen feel safe and secure. When they feel safe and secure, they’re at their best. Be available to help if your teen needs it. 
  • Don’t let them get overwhelmed. When kids enter high school, they have a platter of activities from which to choose. Some teens want to do it all. This is a good opportunity to talk about “too much of a good thing.” See how they handle the responsibility of one activity before allowing them to take on another. 
  • Get on top of a situation before it becomes a problem. During the first week, meet with your teen’s teachers or attend open houses to talk about expectations for your teen and your teen’s goals. This will send a message to your teen and the teachers that you care about your teen's education.
  •  Keep your sanity. I know it’s easier said than done. Parents of teenagers often have trouble distinguishing between when to step in and help and when to back off. The grades they earn are their responsibility. We give them the space and the tools, and they need to do the learning. This doesn’t mean we ignore grades or stop caring. It means we push our teen toward taking the responsibility they need to become a successful adult. 

Here’s to a well-balanced school year! Good luck, parents!

What advice do you have for other parents to prepare for the upcoming school year?

This is a post by Dr. Rod Tarrago, a pediatric intensive care physician at Children’s Hospitals and Clinics of Minnesota. He is also the Chief Medical Information Officer and is proud to admit he’s a computer geek. He’s been helping improve the care at Children’s through the use of technology and spends most of his time helping other clinicians improve their understanding of the computer system. He’s the proud father of two young boys and future computer geeks.

For nearly three years, the Pediatric Intensive Care Unit (PICU) at Children’s has been using a time-tested technique to improve care of patients: a safety checklist. It’s well known that it’s very difficult — if not impossible – for the human brain to truly multitask.

Unfortunately, in an ICU environment, where patients are sick and their illnesses complex, clinicians have to integrate a lot of information and make many decisions on a daily basis. There are also many “typical” tasks that need to be accomplished for every patient, every day.

In order to help the team remember to address all of these items, we’ve been using a safety checklist as part of our work since 2010. In St. Paul, we go through this checklist during patient rounds. In Minneapolis, since the unit is larger and busier, we do special “Safety Rounds” later in the workday.

On both campuses, the entire care team, including physicians, nurses, pharmacists, respiratory therapists, and nutritionists, comes together every day to go through the “standard list” of 23 safety items. These include reminders to check the need for IV and bladder catheters, make sure that antibiotics are needed, and order new labs each day. Each clinician specialty “owns” individual items and then brings them to the group for daily discussion, making sure that everyone is on the same page. Initially, we started this project by using a laminated paper checklist that was placed at each bedside. After losing too many checklists, we moved to an electronic checklist that is embedded in each child’s electronic medical record or EMR.

We recently examined 21 months’ worth of data after using the checklists and found some exciting results:

  • By asking whether we really needed catheters, we reduced the use of these catheters by anywhere from 25 to 45 percent. We also found that we used those catheters less. 
  • By asking ourselves whether any medications can be given either orally or through a feeding tube instead of through an IV, we cut costs to families. We examined one medication, a diuretic, and found that by using the checklist, we used an IV 46 percent of the time instead of 77 percent of the time. 
  • By using IV catheters less often, we reduce the risk of catheter infections. It’s also less expensive to give a medication orally compared to through the IV. We saved patients’ families more than $64,000 over the study period by making these changes. 
  • By simply discussing the need for antibiotics each day making sure that we identified ahead of time how long the antibiotics should last, we lowered our use of antibiotics. In fact, by entering this information into the patient’s EMR, we found that we gave one less dose per patient each day. 
  • Prior to the checklist, we ordered labs several days in advance. Now, the checklist reminds us to order them each day and discuss the need for each lab. By doing this, we reduced the number of labs we ordered by almost six labs per patient per day. This saves a family $500 a day in lab charges. 

You may use a checklist at home or to run errands. In medicine, it’s a relatively new concept that’s only beginning to grow in popularity. But in our PICU, it’s the standard.

John, Nancy, Mike and Emma Johnston recently traveled to Washington, D.C., for Family Advocacy Day. In its eighth year, the Children’s Hospital Association 2012 Family Advocacy Day brings children’s hospitals patients and their families to tell their stories to lawmakers on Capitol Hill. In 2011, Mike, a Children’s patient, was diagnosed with a cancerous Germinoma tumor.

Upon his family’s return from a whirlwind tour of our nation’s capital, John answered a few questions about his family’s experience participating in Family Advocacy Day.

Q: Why did you share your story on Capitol Hill?

A: We shared our story because it was important for our legislators to put a face with a budget line item. Our family does not want any other child to suffer waiting to receive care. We as a nation can’t afford to balance our budget on the backs of children.

Q: Do you think your story caught lawmakers’ attention?

A: Our story was very compelling. We had to wait for Mike to see a specialist for several months before we were ultimately told to go to Children’s. Every legislator we spoke with agreed that this was unacceptable. It is important for them to see the human impact of budget changes or cuts.

Q: What kind of reception did you get from the Minnesota delegation?

A: The Minnesota delegation was wonderful. The four specific legislators we met with were; Reps. Betty McCollum and Eric Paulsen and Sens. Al Franken and Amy Klobuchar. They were all up on the issues and understood our dilemma as parents. They all agreed that this is an extremely important issue, and they vowed to keep up the fight. The staffers we met also gave us ample time to share our story. Rep. Paulsen commented on the trading card Mike gave him, so it was very important to leave something behind with our lawmakers.

Q: In addition to taking in the incredible sights of Washington, D.C., did you take anything away from your experience?

A: For our family, it was amazing to see how our government actually works. It is very inspiring to know that a single family can make a difference in public policy. We’re a family that gives back to our community and have already offered our services at the state level. We must stand up for children since they are our future. We know all too well the importance of excellent, timely care. With any cuts to these programs, lives can be at risk. We met so many wonderful people at Family Advocacy Day and would strongly urge others to do the same. Our lives have been forever changed in a very positive way because of the role we were able to play.

John blogged before his family traveled to Washington, D.C. To read that post, click here.

At Children’s Hospitals and Clinics of Minnesota, we encounter life-and-death situations every day.

Earlier this summer, Leah Mickschl, a Children’s RN, experienced a crisis outside our walls. She was at a private neighborhood pool in Lakeville when a 4-year-old boy was discovered at the bottom of the pool.

She was in the right place at the right time.

Mickschl, who works at Midwest Children’s Resource Center, called upon her training and performed CPR on the boy. He had been under water for approximately two minutes, she said. But within seconds of having CPR performed on him, he sputtered water and regained consciousness. The boy recovered, and today, he’s active and healthy.

In July, the Lakeville City Council honored Mickschl for her life-saving efforts. She appreciates the honor and wants to use it as an opportunity to remind people of aquatic safety.

On the day of the boy’s near-drowning, the pool was filled with people – children and adults, she said. No one saw him go under; Mickschl’s own children were only a few feet away.

“Drowning is silent. It’s not like in the movies where you’re thrashing about and calling for help,” Mickschl said.

Unfortunately, drowning is the leading cause of accidental death among children ages 1 to 4, according to the Centers for Disease Control and Prevention. It remains the second leading cause of unintentional injury-related death behind motor vehicle crashes among children 1 to 14.

Mickschl encourages people to check out these water-safety tips from Children’s Dr. Manu Madhok before they head to the pool or lake. She also suggests getting CPR-certified.

“Prevention should always be the goal, but you never know when those skills might be needed,” she said.

This is a post by Dr. Rob Payne, a pediatrician and neonatologist with over 30 years of experience here at Children’s Hospitals and Clinics of Minnesota. He previously worked as a neonatologist at our Minneapolis hospital and now is Medical Director of Quality.

Children’s has always believed that providing high-quality surgical services was central to our mission. We thought that our services met this goal, but now we have proof.

Children’s is one of 43 hospitals from around the country that submits data to the American College of Surgeons‘ database on pediatric surgical outcomes (NSQIP). Our Health Information Management staff selects cases and verifies the data according to stringent criteria and subject to periodic audits. These are the most accurate and comprehensive data available on pediatric surgical outcomes. We recently received our report for 2011, which showed:

1. Outcomes do not vary in most areas of measurement among the 43 participating hospitals. Since these hospitals all volunteered to be measured and compared, one could assume that only organizations with a high level of commitment to excellence would participate in the program. These are probably the best hospitals for pediatric surgery in the country.

2. Children’s was among the 10 hospitals in the database with the (6th) lowest rate of complications from all types of surgery after adjusting for risk factors. This is a tremendous compliment to everyone in our organization who works with surgical patients. It is a particularly high accolade for the surgeons, anesthesiologists and perioperative staff. Children are less likely to suffer a complication from their surgery here at Children’s compared to other excellent hospitals in the database.

3. Children’s had the lowest rate of complications in newborn infants with abdominal surgery of any hospital in the database. This did not quite achieve statistical significance but was so close as to indicate that Childrens’ is almost certainly better in this area.

Congratulations to the surgery and neonatal staff for their superb work on these very ill patients. When you see any of the perioperative staff, anesthesiologists or surgeons, please compliment them for their excellent work.