Monthly Archives: October 2012

Common questions about bacteria, viruses and vaccines during pregnancy

By Dr. Deb Krahl

Dr. Deb Krahl has been a practicing OB/GYN for 16 years. She received her medical degree from the University of Minnesota before completing her residency training at the University of California-Irvine. She has been with Aspen Medical Group for the last nine years and is currently the lead OB/GYN physician there. She is excited to be among the OB/GYN’s delivering at The Mother Baby Center.

Another glorious Minnesota winter is just around the corner – yay! Experiencing the first snowfall, sledding with hot cocoa and spending the holidays snuggled up with family are wonderful winter thoughts. Unfortunately, winter is also associated with colds, coughs, strep throat and the flu. That makes it a relevant time to go over possible viruses and infections – weather-related and otherwise – that I always like to discuss with my patients.

Influenza

If you’re pregnant during the winter, the most important thing you can do is GET A FLU SHOT! Children, the elderly, people with chronic medical problems and pregnant patients are the high risk groups that should get the flu vaccine. Don’t think “I never get sick” or “I don’t want the flu shot because I might get sick from it.”  If you get the flu while pregnant, you could become extremely ill, have severe respiratory problems or even die, so please get your flu shot.

Pertussis

Whooping cough or pertussis has made a comeback nationally. The Tdap vaccine (tetanus/diphtheria/pertussis) is strongly recommended during pregnancy if you haven’t had this vaccine in the past 10 years. This vaccine is important for both you and your baby. It protects your baby against whooping cough from birth to 2 months when the baby gets his or her first pertussis vaccine as a newborn.

Varicella (chickenpox)

Most people have had chickenpox. But if you’re unsure, please tell your OB provider at the first visit. Blood work can be done to check your immunity. If not immune, you should get the chickenpox vaccine after delivery.

Herpes virus

Genital herpes is very common, and it’s important to discuss this with your OB provider so they know your history. Anyone with a history of herpes should be on daily medication the last month of pregnancy to prevent this infection from being passed to the baby in labor. If someone has an active herpes infection in labor, she would need a Cesarean section so the virus does not pass to the baby while going through the birth canal.

Toxoplasmosis

Avoid changing or touching cat litter and eating uncooked meats to avoid this infection during pregnancy.

Listeria

Don’t eat any unpasteurized milks or cheeses, which could cause this infection during  pregnancy.

Parvo virus (Fifth disease)

This virus is most common in young children so teachers, daycare providers and mothers of little kids are most likely to encounter it. If you’re exposed to this in pregnancy, call your OB provider to get blood work done to check your immune status. If you are not immune, repeat blood work will be done to see if an exposure has occurred.

HIV and hepatitis B

All OB patients are encouraged to have these tests done at the first OB visit. If a patient is a hepatitis B carrier, it is crucial the baby gets the hepatitis B vaccine and immune globulin immediately after delivery. If a patient has HIV, treatment during pregnancy is essential to reduce the chances that HIV will be passed to the baby.

Common bacterial infections

Strep throat, sinus and ear infections, bronchitis and pneumonia are all common winter illnesses. Most antibiotics used to treat these conditions are safe in pregnancy, so don’t be afraid to take medication if cleared by your OB doctor.

As winter creeps up on us, get your flu shot, find a bigger winter coat to grow into and make sure to have comfortable winter boots so you don’t slip on the ice…and let the snow fall!

Check out The Mother Baby Center on Facebook and visit the website.

Kids experience stress differently — how parents can help them cope

This is a post by Lizzi Kampf. She’s a Licensed Independent Clinical Social Worker in the Emergency Department at Children’s Hospitals and Clinics of Minnesota in St. Paul. She specializes in working with adolescents and children in acute behavioral crisis.

Children and teenagers today encounter more situations that can introduce stress into their world. Reactions to stress can vary based on a child’s background, coping skills, and their developmental level. Because children and teens tend to exhibit stress in very different ways than adults, challenges arise for parents trying to interpret and address what is really bugging their kids.

Children and teens tend to experience stress from many of the same situations that adults do, whether it is conflict with peers, pressure at school or in sports, family dynamics, or troubles with romantic partners. The difference is their minds are still developing the ability to process, interpret, and cope with these stressors. They also lack the life experience to know that they can make it through tough times and the confidence that they do have the ability to manage these difficult situations.

So what can parents do?

  • Encourage communication – Let your kids know that you are there to talk about what’s happening in their life and want to be a part of what is going on for them. Keep open lines of communication, giving them the ability to come to you and trust that you will listen.
  • Normalize feelings – Kids have an innate desire to fit in and can react strongly if they feel they are alone or different. Help them name the feelings they are having and let them know they are not the only one who has ever felt this way.
  • Model adaptive strategies – Kids learn from their parents how to deal with difficult situations. Show them that you can tolerate distress, and they will learn they have that ability as well.

For example, when your pre-adolescent is getting upset over not being able to complete a challenging math assignment you can say, “You seem like you are frustrated. I feel like that when I have a task that is difficult to finish, even though I am trying my best. Sometimes it is helpful for me to try something else for a while and then come back to it later.”

Finally, monitor your child for increasing stress levels. Kids who are becoming withdrawn from family or friends, having difficulty sleeping, or are missing a lot of school may need additional intervention. If it seems like they are not able to cope with challenges they face daily, or are having difficulty managing the stress in their life it may be time to seek professional help. Call your pediatrician or speak with a counselor at your child’s school if you need assistance getting referrals for a mental health professional.

 

Four reminders to prevent the flu

Flu season. It’s that time of year when we duck for cover in Minnesota. We all know someone who has battled the flu.

The flu is a serious respiratory illness, and the symptoms can be downright nasty – sudden onset of fever, cough, congestion, sore throat, achy muscles, fatigue, occasionally pneumonia, and, in extreme cases, death.

Each year, an average of 20,000 kids under 5 are hospitalized because of flu-related complications, according to the Centers for Disease Control and Prevention. Influenza causes more hospitalizations among young children than any other vaccine-preventable illness.

“Don’t think of influenza as ‘just the flu.’  For infants and children especially, it can be a scary, very severe disease.  Prevent it,” said Patsy Stinchfield, nurse practitioner and director of infectious disease at Children’s Hospitals and Clinics of Minnesota.

Here are some easy reminders to keep your family and you healthy during flu season:

  1. Get vaccinated against the flu. All people 6 months of age and over need an annual flu vaccine.  While flu vaccines are not perfect (100 percent effective), not getting one provides zero protection.
  2. Wash your hands with soap and water. At Children’s, we wash ‘em proud. You should wash your hands before and after eating, after using the restroom, after blowing your nose and sneezing.
  3. Cover your cough and sneeze. If you’re visiting Children’s, we ask that you wear a mask if you have a cough. We ask staff and visitors to stay home if they are ill and if they have a cough to wear a mask to prevent the spread of such things as influenza and other infections to our vulnerable patients.
  4. Sick? Please, stay home from work or school. If your child is sick, keep him/her home from school and daycare, too.
Visit our flu prevention website for more information.

Kohl’s Cares and Children’s Flu Prevention Tips from Children's of Minnesota on Vimeo.

Choosing a midwife, from her point of view

Forty years ago in her home country of Iran, Nahid Shokohi Razmpour became a midwife. She’s been delivering babies ever since.

Shokohi Razmpour, part of HealthPartners Medical Group and delivers at Abbott Northwestern Hospital and will work at The Mother Baby Center when it opens in February, loves being a midwife.

“I have a special passion to be with the woman during labor,” she said. “I love to help the woman.”

Last week was National Midwifery Week – the celebration of a profession that’s dear to her.

Nahid Shokohi Razmpour

Of the 4,000 babies born at Abbott Northwestern each year, 600 to 700 are delivered by a midwife, according to Shokohi Razmpour. And the number of women choosing a midwife is growing in Minnesota. Between 1989 and 2008, deliveries that involved a midwife increased from 3.2 percent to 7.5 percent, she said.

“Women feel more comfortable with a female provider,” she said.

Shokohi Razmpour took time recently to chat about what factors to consider when evaluating what kind of practitioner to see for prenatal care and childbirth.

So what should you consider when evaluating whether to choose an obstetrician-gynecologist (OB-GYN) versus a midwife?

From Shokohi Razmpour’s point of view:

  • Whenever possible, a midwife involves the partner on day one.
  • A midwife spends more time with the mother during labor.
  • Because a midwife spends significant time with the mother during labor, relatively few patients require intervention. The midwife encourages medication-free deliveries.
  • A midwife suggests showers, bathing, massage, homeopathy, changing positions and using a birthing ball instead of intervention like medication. However, if pain medication is needed during labor, she supports this choice, as well. She recognizes each person’s birthing experience individually.
  • A midwife counsels the mother during the pregnancy about diet, exercise and emotional support.
  • A midwife also prepares the parents for the arrival – from what to buy to what to bring to the hospital.

“I give (expectant moms) what they want – part of that is service, part of that is love,” she said.

She wants the birth experience to be what the expectant mom wants it to be – an easy and positive experience in her life.

When things don’t go as planned, Shokohi Razmpour doesn’t leave the expecting mother’s side. In the case of a Caesarean section, “I scrub in right away…I stay with my patient as a supporter.”

Post delivery, she doesn’t leave the mother’s side. She encourages breastfeeding and stays with the mother after the birth to assist.

“We take great pride in making the experience more personal,” she said.

Learn more about The Mother Baby Center by visiting its Facebook page.

31-day photo challenge: What makes kids and Children’s great?

Editor’s note: We’ll announce the winner of the glow sticks every day of the challenge here on the blog. We’ll also reach out directly to the winner. Thanks for participating! *For those days in which there was no winner, we did not receive entries from new participants.

To view the photos that have been shared on Instagram, click here.

Nobody knows kids better than we do, and nobody treats kids better than we do, either. But we can’t do it without your help. That’s why we’ll participate again in Give to the Max Day on Nov. 15. On this day, thousands of Minnesota nonprofits come together to raise money for their important missions.

Starting on Oct. 15, we want to celebrate what makes Children’s Hospitals and Clinics of Minnesota and kids GREAT in the 31 days leading up to Give to the Max Day. You can help. We challenge you to take a photo a day that captures some of that greatness. It’s really pretty simple.

  1. Follow the word list below in order and snap a picture that matches the theme of the day.
  2. That day, upload the photo into Instagram or share it on Twitter or both. Just make sure you include the hashtag #ChildrensMN and the theme of the day.
  3. We know your pictures will be awesome! Each day, we’ll pick one participant to receive a pack of Children’s glow sticks. Pretty rad, right?
  4. We’ll also highlight some of your snaps every Friday on Facebook during the challenge.

Need inspiration? Then you should meet Alannah. She’s a 7-year-old Children’s patient who was diagnosed in August with Stage IV neuroblastoma. Alannah is sweet, courageous and generous. For so many reasons, we think she’s pretty great!

What do YOU think makes kids great? Show us over the next 31 days!

Photo themes:

Oct. 15 Star

Winner: @jenboss

Oct. 16 Happy

Winner: @ElinMarieH

Oct. 17 Playful

Winner: @1girl2boys

Oct. 18 Excitement

Winner: @puddingpop77

Oct. 19 Determination

Winner: @ashlybacon

Oct. 20 Red wagon

Oct. 21 Wonder

Winner: @jaboss

Oct. 22 Heart

Oct. 23 Fearlessness

Oct. 24 Fighter

Winner: @Jorn_K

Oct. 25 Imagination

Winner: @southsidecreepn

Oct. 26 Energy

Oct. 27 Hope

Oct. 28 Smile

Winner: Jenny Traun-Severson

Oct. 29 Perspective

Oct. 30 Sweet

Oct. 31 Trick

Winner: @steveasp7117

Nov. 1 Soul

Nov. 2 Toys

Winner: Joe Roelofs

Nov. 3 Pet therapy

Winner: @creller19

Nov. 4 Freedom

Winner: @jennifermackey6

Nov. 5 Courage

Winner: @BeckyBoudreau

Nov. 6 Love

Winner: @GinaJay1

Nov. 7 Curiosity

Winner: @ingridarnold

Nov. 8 Humor

Winner: @carsolina99

Nov. 9 Chapstick flavors

Nov. 10 Strong

Nov. 11 Balloon

Winner: Tanya Juarez-Sweeney

Nov. 12 Passion

Nov. 13 Inspiration

Nov. 14 Generosity

Winner: @danjmiller

Alannah: A girl with heart

Alannah Gillis Photo: Shari Fleming

God doesn’t give me more than I can handle.

That’s what 7-year-old Alannah Gillis said when she found out she had Stage IV neuroblastoma. And that’s what she had printed on custom rubber wristbands. Wristbands that she went on to sell in an effort to raise money for the Star Studio at Children’s Hospitals and Clinics of Minnesota. That act of kindness would prove to be the first of many for this amazing and generous young girl.

“I like to be nice,” Alannah said.

Through treatment, which has subsequently stripped Alannah’s head bald, prevented her from riding a bike because of low blood counts and kept her from enjoying first grade while she spends extended periods hospitalized, Alannah is thinking of others first.

“She is just beyond thoughtful. The word ‘thoughtful’ doesn’t even cover it,” said her mom, Angela Peterson.

A mother’s persistence

Alannah’s diagnosis didn’t come easily, or quickly.

At the end of the school year, she came home one day complaining about leg pain, Peterson said. Her eyes were ashen underneath. Instead of playing outdoors on the trampoline or riding her bike, she was inside using the family’s gaming system.

“It was like she never slept. She was always tired,” Peterson said. “This was not my child.”

Alannah dared The Dude from the Star Studio to bungee jump at the Minnesota State Fair. He accepted the challenge.

So began Peterson’s quest for answers. Alannah saw three different providers who had different diagnoses. None were cancer.

The first treated Alannah for a bladder infection. The second said she had anemia and recommended supplements and to return in six weeks to be re-tested.

Peterson wasn’t convinced. She took Alannah to a third provider and asked her – mom to mom – to figure out what was wrong. A series of blood tests indicated Alannah’s blood counts “were out of whack,” Peterson said.

They were told to go to Children’s – more than two hours away from their Wisconsin home – stat. After a series of tests, Peterson got the answer she needed but no mother wants for her daughter. She had cancer.

“Knowing is so much better than having questions,” Peterson said.

Alannah has retained her sense of humor through it all.

While Vicki Schaefers, Alannah’s nurse practitioner, talked with Peterson about the need for a blood transfusion, Alannah quipped, “You do know I am highly allergic to platelets!”

She has “intelligence that belies her age,” Schaefers said.

Acts of kindness

In the weeks since learning she has cancer, a community where many hadn’t heard the word neuroblastoma has rallied around Alannah, Peterson said.

On Sept. 22 – the day after Alannah’s seventh birthday – three casinos in her county raised approximately $98,000 to help pay for medical bills, a car for Peterson because she doesn’t have one, and a trip for Alannah’s family, Peterson said.

Approximately $20,000 will go to a county program for holiday gifts for children, Peterson said. Alannah insisted.

Alannah Gillis Photo: Shari Fleming

“Since her diagnosis, she has received more things than she could have imagined, but it has not changed her attitude toward others. She thinks of them first and foremost,” Schaefers said. “She is all about giving back, and this is only the beginning. She is an inspiration to all of us, and we will talk about her for years to come!”

A few days after the benefit, good news was in store for Alannah.

She returned to Children’s for a bone marrow biopsy and more chemo. During her stay, she got her biopsy results. Fifteen percent of Alannah’s cells were cancerous, down from 100 percent when she was diagnosed, Peterson said.

“The best news yet,” Peterson said.

Hours within getting the news, Alannah sat in her hospital bed awaiting more medicine. Her face was painted in shades of pink, purple, green and gold to resemble her favorite animal – a cat.

The warm, lovable, funny little girl got serious for a moment.

“I wish I knew why this happened,” she said.

No one knows, Peterson answered.

“It’s one thing when it’s happening to an adult who’s lived a long life; it’s another when it’s happening to a child who’s just beginning their life,” Peterson said.

That’s why they’ve agreed to participate in research that might help other kids and create better outcomes, Peterson said.

It’s yet another act of kindness.

“She has the biggest heart of any kid and adult I know,” Peterson said.

Bullying, your child and you

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. 

“Being bullied is not just an unpleasant right of passage through childhood,” said Duane Alexander, M.D., former director of the National Institute of Child Health and Human Development. “It’s a public health problem that merits attention. People who were bullied as children are more likely to suffer from depression and low self esteem, well into adulthood, and bullies themselves are more likely to engage in criminal behavior later in life.”

I recently attended the production of Mean, an original drama performed by the Youth Performance Company on bullying. The production was timely – it’s National Anti-Bullying Awareness Month. The performance gives us a view into the lives of students being bullied and introduces us to several forms of bullying including bullying at school and cyber bullying.

Cyber bullying can take on many forms. Sending mean messages or threats via text message. Spreading rumors online or through text messages. Posting hurtful or threatening messages on social media sites like Twitter or Facebook. Pretending to be someone else online to hurt another person. Taking unflattering pictures and sending them through cell phones or online. “Sexting” or circulating sexually suggestive messages about a person.

Who’s affected?

In Minnesota, we’ve had several instances of cyber bullying reported in the media. This behavior touches all schools and students from all backgrounds.

According to the I-SAFE Foundation:

  • More than half of adolescents and teens have been bullied online, and about the same number have engaged in cyber bullying.
  • More than 1 in 3 young people have experienced cyber threats online.
  • Over 25 percent of teens have been bullied repeatedly over through text messages or the Internet.
  • Well over half of those who’ve experienced bullying don’t tell their parents.
  • Bullying generally begins in elementary school, peaks in fifth through eighth grades and persists into high school, with very little variation between urban, suburban and rural areas.

The Cyberbullying Research Center reports that over 80 percent of teens use a cell phone regularly, making it the most popular form of technology and a common medium for cyber bullying.

About half of young people have experienced some form of cyber bullying and 10 to 20 percent experience it regularly. Girls are at least as likely to be cyber bullies or their victims. Boys are more likely to be threatened by cyber bullies than girls. Cyber bullying affects all races, and the victims are more likely to have low self-esteem or to consider suicide.

What is bullycide?

Tragically, the set of MEAN is peppered with names and pictures of youth who have committed suicide after being bullied. What an incredibly unsettling idea that we have a name for this. The definition of bullycide is suicide caused from the results of being bullied.

Children and teens who are bullied live in a constant state of fear and confusion. Many feel the only way to escape rumors, insults, verbal abuse and terror is to take their own lives.

Suicide is the third leading cause of death among young people resulting in 4,400 deaths every year, according to the Centers for Disease Control and Prevention. Bullying victims are between two and nine times more likely to consider suicide than non-victims. A staggering 160,000 kids stay home from school every day for fear of being bullied.

New bullying statistics in 2010 indicate there is a strong connection between bullying, being bullied and suicide, according to a new study from Yale School of Medicine. Suicide rates continue to increase among adolescents, and have grown more then 50 percent in the past 30 years.

What to do if you suspect your child is being bullied?

  • Get your child’s input. You need to be a confidant your child can turn to for help in dealing with bullying. Help your child see it’s not their fault.
  • Talk to school authorities. Often, bullying takes place in unsupervised areas such as bathrooms, the playground, or school buses. Make school personnel aware.
  • Teach your child to avoid the bully. Your child doesn’t need to fight back. Walk away and go find a teacher or other trusted adult.
  • Encourage your child to be assertive. Your child doesn’t need to fight back, but they can stand up straight and tell the bully to leave them alone.
  • Practice with your child. It’s beneficial to role play and practice what they are going to say to a bully.
  • Teach your child to move in groups. A good support system can be an effective deterrent against bullies. Have your child go to school and other places with trusted and true friends who can support them against bullies.

There are many activities on bullying this month in the Twin Cities. I recommend taking your child to MEAN and, while there, learn about the many resources in the Twin Cities aimed at keeping our children safe from the insidious evil that bullying is.

The YPC will perform Mean through Oct. 14 at the Howard Conn Fine Arts Center in Minneapolis. For more information, visit the website

A mom’s story: The power of walking

This is a guest blog post by Liz Keating. She’s a Family Advisory Council member at Children’s Hospitals and Clinics of Minnesota and a mom of three.

I had to be largely off my feet while pregnant with my first two kids. That was tough. Although I’ve never considered myself an athlete, my body and my brain had grown accustomed to an active lifestyle. Being forced to slow down was a bummer. So it was a real blessing when I was able (and encouraged) to stay active to a much greater degree while expecting our third child. Every pregnancy truly is different.

Staying active while pregnant wasn’t fancy. Our garage has accumulated quite an array of sports equipment over the years—bikes, scooters, in-line skates, ice skates, running shoes, cross county skis, snowshoes, even a four-person toboggan that doubles as a make-shift snowboard—all of which gathered dust during my pregnancy.

I had no regimented workout routine, gym membership, orspecialized equipment. Rather, the core of my daily activity was walking my eldest to and from school – about two miles in all. I added distance on some days and got outside with my family on weekends once the fatigue of the first trimester diminished. But how far I walked was never the point. The most important thing was to get outside and do SOMETHING.

I benefited a lot from staying active. I was able to face the physical and mental rigors of pregnancy with greater strength and stamina. My lower back hurt less. I slept better. Fresh air lessened my nausea somewhat. I recovered faster from delivery. Through walking, I learned to listen to my body.  I never “glowed,” but I coped better. But the greatest benefit, and the most unexpected, was the amazing connection I made with neighbors and others in my community.

Each day while walking my regular route I was greeted with smiles and waves from people passing by in cars, riding their bikes, or walking their dogs. The smiles and waves kept me going and seemed to increase as my due date approached. And now, when I am out walking the girls to school, I am stopped regularly by those same people who smiled and waved wanting to meet the baby they’d been rooting for. Having a new baby can be somewhat isolating, and making those unexpected connections helped take the edge off.

Read more about health for expecting moms. You can also visit The Mother Baby Center’s Facebook page.