Monthly Archives: April 2013

Five Question Friday: Dr. Rod Tarrago

Meet Dr. Rod Tarrago, MD, an intensivist and chief medical information officer at Children’s Hospitals and Clinics of Minnesota.

You have two roles at Children’s. Can you describe them? Having two different but complementary roles at Children’s is one of the best things about my job. I spend about half of my time as a pediatric critical care physician in both pediatric intensive care units. This is where we take care of the sickest kids, ranging in ages from just a few days old up to “kids” in their twenties. While it can be challenging, it’s also extremely rewarding because truly, most kids do get better.  The other half of my time is spent as Childrens’ Chief Medical Information Officer, where my job is to be the “go-between” for Children’s physicians and providers, and the IT department.  I work to make the electronic medical record more efficient, safer, and easier to use.  I also often find myself answering questions and working on technologies that don’t really have anything to do with the electronic medical record such as the online call system and even helping people get their email set up on their iPhones!

Dr. Rod Tarrago

What fascinates you about the intersection of medicine and technology? In this day and age, there really is no separating medicine and technology. One could argue that being comfortable using the electronic medical record is just as important as knowing how to use a scalpel or knowing which antibiotic to use. We are now moving into an age where we are relying more and more on electronic data to tell us about our patients, and tell us how well we are doing in treating our patients. That is one of the most exciting aspects of my job — being involved with technology has really opened doors to many opportunities to improve our quality and safety.

What drew you to pediatrics? From the time I decided to go into medicine, I knew I was going to do pediatrics.  Even when I was a teenager and young adult, I was always drawn to kids.  During holiday dinners, I preferred to sit with the kids. It was just a lot of fun. For me the difficult decision initially was which area of pediatrics to pursue.  I entered my pediatrics residency with the intention of becoming a general pediatrician. That changed my second month of residency when I got to do my first PICU rotation. On my first day, I got to take care of a really sick little kid. By the end of the day, my head was spinning, but I knew exactly what I wanted to do with my career — I wanted to become a pediatric intensivist.

What do you enjoy most about your job? For me, the best part of my job is the variety. One day, I can be taking care of a child with a life threatening infection. The next day, I can be standing next to a geneticist teaching her how to enter orders more efficiently. The next, I might be attending the hospital’s quality meeting talking about how to make medication use safer. Most days, I get to do a combination of all of these. It’s challenging, but very rewarding and never boring.

If you weren’t working in medicine, what do you think you’d be doing? This is a tough one. I’ve always loved math and science, so I’m sure I’d be doing something involving these fields. My major in college was biochemistry, so there’s a chance I’d either be working in a biotech company, or maybe even teaching science to kids. After all, it was my high school chemistry teacher who took a child of the 80′s who wanted to be an investment banker and turned me into a science and computer geek (or at least brought out my inner geek)!

Five things you may not know about music therapy

In honor of music therapy week, Erinn Danielson, music therapist, gives us a peek inside her job at Children’s Hospitals and Clinics of Minnesota. 

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 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!

 

Five Question Friday: Dr. Dave Aughey

Meet Dr. Dave Aughey, MD, medical director of adolescent medicine.

What drew you to adolescent medicine? This will sound cliché, but I was quite ill as a pre-teenager.  My recovery overlapped with the magical time of puberty, and it was an emotional and a physical transformation.  From this time on, I knew I wanted to work with teenagers.  I couldn’t decide if I wanted to be a pediatrician or a psychologist.  I was drawn to Adolescent Medicine because I could do both.

Dr. Dave Aughey

Are there any trends you’re seeing right now in adolescent medicine and, if so, what are they? Nationally, about 600 pediatricians are certified as Adolescent Medicine specialists. In the last 10 years, only about 225 of these have gone through the three-year post-residency training and certification. Most of these pediatricians practice in academic centers and not in community settings. The field is struggling to find its niche and to attract new practitioners. The good news is that adolescents are now being recognized as having unique health needs, which are best served by a “psychosocial” care model.  This model embraces the “health” needs of adolescents and young adults, not just the physical dimensions. Many other primary care providers also now recognize these special needs and are effectively providing care and guidance.

What do you enjoy most about your job? I view myself as a pediatrician who specializes in being a primary care provider for adolescent and young adult patients and their families (and sometimes their friends). I have opportunities to be a dermatologist, counselor, gynecologist, sports medicine doctor, psychiatrist or pediatrician on any given day. I really enjoy being able to provide this range of care to patients. It makes relationships with patients and families very rich and gratifying.

What is your favorite memory from working at Children’s? After 25 years, it’s impossible to pick a favorite memory. I’ve had the honor of working with extremely compassionate and caring colleagues. Patients have been inspiring, especially those who overcame challenges and adversities that would have bewildered me. I remember patients who proudly shared their accomplishments with me.  Former patients who’ve brought their babies to show off. Patients who’ve stopped me on the street. “You don’t remember me, but….” These memories are all warm and heart-felt.

If you weren’t working in medicine, what do you think you’d be doing? My fall-back plan early on was going to be that I would run a hardware store. In retrospect, given the emergence of the big boxes, that would have not gone well. I still would love to teach high school and be around adolescents in another capacity.  In the deepest, darkest corner of my soul, I dream about being a woodworker or a dancer. Or a photographer. Or maybe an engineer…

Cold peanut sesame noodles

 

I first came across these noodles in China’s Sichuan province. It’s a simple, approachable dish with complex flavors that speak to kids and adults. Topped with fresh cilantro, scallions and crunchy-cool cucumbers, these cold peanut-sesame noodles have become a favorite meal in the Zimmern household. The savory sauce is so delicious I’d suggest making extras to use as a salad dressing or dipping sauce for grilled chicken. — Andrew Zimmern

Photograph by Madeline Hill

Ingredients

1 tablespoon minced fresh ginger

1/3 cup soy sauce

3 tablespoons toasted sesame oil

3 tablespoons natural, unsweetened, salted peanut butter

3 tablespoons sugar

3 tablespoons rice vinegar

2 tablespoons mirin (available in the ethnic section of most grocery stores)

1 small garlic clove, minced

3 tablespoons Chinese sesame paste or tahini

1 small shallot, minced

5 tablespoons roasted peanut oil (see Note)

1 pound dried Chinese egg noodles

1/2 large seedless cucumber—peeled, halved lengthwise, seeded and cut into fine matchsticks

4 scallions, thinly sliced

small handful Cilantro sprigs for garnish

Instructions

Active: 30 min
Total Time: 1 hr 30 min
Servings: 4 to 6

In a blender, combine the ginger, soy sauce, sesame oil, peanut butter, sugar, vinegar, rice wine, garlic, sesame paste, shallot and 3 tablespoons of the peanut oil and puree until smooth. Transfer the sauce to a bowl and refrigerate for 45 minutes.

In a large pot of boiling water, cook the noodles until al dente. Drain and rinse under cold running water until chilled. Shake out the excess water and blot dry; transfer the noodles to a bowl and toss with the remaining 2 tablespoons of peanut oil. Add the peanut-sesame sauce and toss well to coat. Garnish with the cilantro, cucumber and scallions.

MAKE AHEAD: The peanut-sesame sauce can be refrigerated for up to three days.

NOTES: Roasted peanut oil, as opposed to neutral peanut oil, smells richly nutty. Boyajin’s Fragrant Peanut Oil is available at specialty markets and from mingspantry.com.

For more great recipes from Andrew Zimmern, visit his website.

Mason’s story: How to cope when your sibling is the patient

By Mason Stoltz

My brothers and I were not expecting to be without a mom and dad for 99 days. But that’s sort of what it felt like when my sister was born extremely prematurely. Suddenly, our world was turned upside down and we had to take on a lot more responsibility than we were used to. When my parents weren’t at work or asleep, they were at Children’s. So, as you can imagine, it dramatically changed things for the three of us kids who were at home.

Mason holds his sister, Katie, for the first time.

Here are some of the ways we learned to cope with our “new normal”:

  • My older brother met with a counselor at school. This gave him someone to talk to at school who really knew what was going on in our family. This person was able to offer suggestions on how to deal with stress and still stay on top of things at school.
  • We read books as a family that helped us all to understand what was going on in the neonatal intensive care unit (NICU) where my sister was and a little bit more about the challenges she was facing.
  • We visited Children’s often and took advantage of the awesome services that are designed for siblings and family members. For example, did you know there is a Sibling Play Area at the Minneapolis location loaded with fun toys and activities for siblings to play with? It is open to siblings of a Children’s hospital or clinic patient, ages 2 years and up.  Siblings can be checked in for up to 1 ½ hours, twice a day. The staff there was super nice and had really great activities and crafts for us to do.
  • We would make things for my sister.  All patients at Children’s have their own private room and it is meant to be their “home away from home.” We had a lot of fun drawing pictures and making get well posters that we could hang in my sister’s room. I hope it cheered her up and let her know we loved her. I think the nurses and doctors were able to get a better insight into our family by personalizing her space a bit.
  • During my sister’s hospitalization, we had a plastic box at our house that we pretended was an isolette (like the one my sister was in at the NICU). My 4-year-old brother liked to pretend he was a doctor and took care of his teddy-bear patient, the way the doctors and nurses were taking care of my sister. If you want more ideas about how to creatively and simply teach kids about the complex issues and procedures that happen at a hospital, talk to a Child Life Specialist. They are a wealth of information and some of the most valuable people at the hospital, in my opinion!
  • I liked having my own picture album of my sister that I could show to my teachers and friends. It almost became a morning ritual in my classroom for me to share the latest developments with my sister. It felt nice to be able to educate my friends about her situation and I felt their support as a result.

I hope these suggestions might come in handy for you if you have a sibling in the hospital. Just remember, even though your sibling might look different in the hospital, they are really the same person.The more you can do to still interact with them the way you would if they were at home, the more comfortable you both will feel. Many times you can still play a game, watch a favorite show, share jokes over the phone, make paper airplanes, do a craft, celebrate a birthday, and make a memory even while they are going through something difficult. You can be a part of their prescription back to health.

Mason, 13, is a member of our Youth Advisory Council

Five Question Friday: Sheralee Leonard

Meet Sheralee Leonard, one of our social workers at Children’s Hospitals and Clinics of Minnesota.

Sheralee Leonard

What does a typical day look like for you? Being one of the social workers in the neonatal intensive care unit (NICU) on the St. Paul campus, my daily routine includes meeting with parents and extended family members of medically fragile and sick infants. I provide ongoing support while the baby remains hospitalized.

We often talk about ways they are making connections with their infant and how they are feeling about the experience, as attachment can be more difficult with a baby who is in an isolette, connected to wires, and may not be able to be held or tolerate much stimulation. I also listen to the families tell their stories and explore ways for them to cope in a healthy and healing manner.

Assessment for postpartum depression is also crucial in the NICU. Mothers and those they are getting support from are both educated on the risks and symptoms of postpartum, and I check in with mothers regularly on how they are coping.

Families can often have unexpected financial stressors related to needing to be away from work so they can be here at the hospital. I help families to connect with various community programs that may be able to assist them in getting baby items, or help with a rent or mortgage payment.

Considering no one day is like the other in the NICU, there are many other aspects to my job. Child protection reports are made when a baby tests positive for a reportable drug.  Behavior contracts are made and discussed with family members when unsafe behavior occurs in the hospital. This is in collaboration with security and our NICU nurse manager. I also provide grief support to families, related to their hopes and dreams for their baby which may be altered because of a medical diagnosis affecting their child’s long term functioning.  I also support families when their baby dies.

And not to underestimate the value of team, I am collaborating and communicating with the various members of the healthcare team in the NICU. We work closely together on ways to help support these families. Without the many caring and dedicated staff in the NICU, families would not be able to get the family-centered care and respect that is seen in the NICU.

What drew you to Children’s? My first experience working in a hospital was at United Hospital as a weekend/on-call social worker.  At that time, United Hospital provided on-call and weekend coverage to Children’s as well. I soon discovered how much I loved the work at Children’s, and whenever a referral came up at Children’s, I offered to take it. The connections with families, the diversity of the types of work I could do, and the collaborative relationship between the different disciplines in the hospital all drew me to Children’s.  Soon I was able to work there full time, and I haven’t left.

What do you enjoy most about working here? I truly feel honored to be allowed to accompany and offer emotional support to families going through a difficult experience related to their baby’s health.  The compassion I have seen from families, and the extent of caring from members of the NICU healthcare team, has touched my heart and soul.

What do you think makes kids great? Children are amazing! They are so intuitive and honest in their perceptions. Children possess such strength, and given a nurturing environment can flourish and get through some very stressful and difficult situations. I have been very impressed by the children and families I have worked with here at the hospital, learning more about the aspects of hope, healing and the desire for a better life.

If you could travel anywhere in the world, where would it be and why? When I was younger I traveled to Europe. I think it would be great to return. It would be fun to be among the beauty of the mountains in Switzerland, enjoy the city life in Paris, and be able to get on a train and travel to new places.

Do you have a recommendation for a Children’s employee who should be featured on Five Question Friday? Send your suggestions to Brady at Brady.Gervais@ChildrensMN.org.

Why I march for babies

By Jana Cinnamon

I vividly remember the first time I held Sadie. She felt like she weighed no more than the purple blanket she was wrapped up in. It wasn’t at all what I imagined it would be like to hold my baby for the first time.

We sat together in a rocking chair. I was nervous to move, afraid that any movement I might make would trigger an alarm from one of her monitors. After some time, I bravely leaned down to kiss her little head and then I started to sing quietly to her.

“You are my sunshine, my only sunshine.
You make me happy, when skies are gray.
You’ll never know dear, how much I love you.
Please don’t take my sunshine away.”

With tears in my eyes and a lump in my throat, the last line of the song became my cry out to God. Please Lord – do not take her away from me.

Sadie’s early arrival was a complete shock to my husband and me. We were readying ourselves to become parents, but nothing could have prepared us for becoming parents to a preemie. Sadie’s first seven weeks on this earth were spent in the neonatal intensive care unit (NICU) at Children’s Hospitals and Clinics of Minnesota. I remember walking the halls, seeing pictures and reading stories of other babies that had been born early. There were tremendous success stories of babies that had been born decades ago at a time when the survival rates of premature and low-birth weight babies like Sadie was not nearly what it is today.

Sadie

Although I still had uncertainty about Sadie’s future, reading those stories gave me an overwhelming feeling of gratefulness. I became thankful for the advances in medicine and the access we have to superior health care. I became thankful that Sadie’s prematurity and small size was not the end of her story. And I became thankful for the work of the March of Dimes.

Prior to Sadie’s birth, I had heard of the March of Dimes, but was not familiar with their mission or work. Since I became a mom to a miracle, I have learned a lot from the March of Dimes. Most of all, I learned I was not alone. In the United States, one in nine babies is born prematurely.  Yes, there can be comfort in numbers, but this is not a comforting statistic. The March of Dimes is actively working to reduce the number of premature births in the United States. Additionally, they are funding lifesaving research to support healthier babies.

Today, Sadie is five years old and has no lasting effects from her premature birth.

This spring, my family, friends and I will be walking in the March for Babies. This event is a major fundraiser for the March of Dimes and this year, in particular, is exciting as they celebrate their 75th anniversary. Participating in this event has brought me hope and healing. My favorite part of the walk is the last mile – “Mission Mile” – where signs are posted along the street featuring babies that entered this world too early.

My daughter, born 10 weeks too soon and weighing 1 pound, 9 ounces, is a fighter. She has inspired me to fight for healthier babies. Will you walk with me?

Find more information at www.marchforbabies.org. Children’s is proud to sponsor the Twin Cities March for Babies Walk on April 28.

Mom to shave the day for childhood cancer

Adrian

No mom should have to hold her child’s hand and tell him that his cancer has returned – after having his kidney removed, undergoing seven days of radiation and getting 25 weeks of chemo treatment.

But that’s exactly the position Stephanie Merfeld found herself in recently. Her son, Adrian, 11, was diagnosed with a Wilms’ tumor in October 2011. He immediately underwent extensive treatment. Three months later, his scans were clean. Six months later, tests showed the cancer had returned. Adrian went back on chemo. In March, his tumors had grown despite chemo. He’s undergoing daily radiation, except for weekends, for the next three weeks, Merfeld said.

“It sucks big time and naughty words go through my head all the time. It is what it is, and you put one foot in front of another and you walk,” Merfeld said. “You have to be strong for your kid. It’s scary. I’m scared. I don’t want to lose him.”

Merfeld is determined to keep other families from experiencing what hers has during the past 18 months. On April 11, she’ll go bald to help raise money for childhood cancer research – an area she says is critically underfunded.

“These kids need help, and they need help now,” she said.

You can shave a head and help save lives, too. Join Merfeld and us on our Minneapolis campus on Thursday from 5 p.m. to 8 p.m. to help raise money for the St. Baldrick’s Foundation, whose mission is to cure childhood cancer. Shavees show their support by shaving their heads voluntarily, and inspiring friends and family to donate money to support childhood cancer. Sign up here.

Video: Dr. Steve Haun, who works in our pediatric intensive care unit (PICU), already shaved his head for St. Baldrick’s. Will you?

Video: Watch last year’s shavees.

Five Question Friday: Tanya Juarez-Sweeney

You may already know Tanya Juarez-Sweeney, a member of the Star Studio’s production team, from  our very own Channel 13. But we think you’ll learn a little bit more about this star staff member at Children’s Hospitals and Clinics of Minnesota in this week’s Five Question Friday. Enjoy!

What does a typical day look like for you on the Star Studio production team? Live TV makes every work day different and exciting! Some days I find myself helping plan a show or event, or co-hosting a show with the Dude, or helping in the tech booth, or maybe I’m coordinating our community partnerships with local actors and college students, or I might be promoting shows to our patients out on the units. Just about every day I am designing a flyer, sending out an email about a show, and posting to our Star Studio Facebook page.

Tanya Juarez-Sweeney in Star Studio

You’ve worked at Children’s for eight years and in Star Studio for the last five years. What is your favorite show and why? I call “Unfair question!” :) I can’t play favorites. Each of our shows offers something really cool for patients, their families, and staff. Guests, co-hosts, and our interactive audience truly make every show unique and fun.

What drew you to Children’s? Children’s is a perfect fit for me. I have a business degree, and I was a nurse in the Army Reserves, but most importantly I love kids! I also strive to live my life in a way that I hope leaves a positive footprint. I want my work to be a part of something bigger that makes a difference in the world. At Children’s, we do amazing work, and I am so proud to be a part of this organization.

What do you enjoy most about working here? By far, our patients. How lucky we all are to be able to be a small chapter in the lives of the extraordinary souls that we treat here at Children’s. Every small moment I have with a patient brightens my day and touches my heart.

Do you have a favorite memory from working here? Having my head shaved by our patients during the St Baldrick’s event last year will always be one of my fondest memories of Children’s and in my life overall. It was an honor to stand in solidarity with our hematology oncology patients. I have so much admiration for the brave kids who fight cancer and all of the other “yuck” we see at Children’s. The 2012 Children’s St Baldrick’s event is a beautiful and fun memory that I will always cherish. I am looking forward to watching the 2013 shavees on April 11!

Q-and-A with Dr. Troy: How to talk to children about death

During the past 12 months, we’ve been rattled by the tragedies we’ve read and heard about in the news.

In July 2012, 12 people were killed and 58 others were injured in an attack in an Aurora, Colo., movie theater shooting.

Twenty children and six adult staff members were shot to death in December 2012 at Sandy Hook Elementary School in Newtown, Conn.

Closer to home, an insanity trial is underway for a man who admitted to murdering his three daughters this past summer. Last weekend, a woman and her two children were found dead in their home after authorities say she drowned them and then committed suicide.

As parents, we want to protect our children from these horrors. It’s hard to comprehend discussing the unthinkable – a mother or father taking the life of their child – with our own kids. Do we bring it up? How do we respond when they come to us looking for answers?

We spoke with Dr. Michael F. Troy, Ph.D., L.P., our medical director of behavioral health services, in an attempt to answer some of those questions:

How do I explain death to my child in an age-appropriate way?

Dr. Michael F. Troy

There are important differences between explaining the death of an important person in your child’s life and talking about a tragic death in the news. The former is likely to be a challenging, but near universal, role for a parent.  Eventually, all families will face the loss of a loved one requiring parents to share sad news with their child. While it is typical for parents to find these junctures difficult, this does not mean that they are unable to do so with skill and sensitivity.  Parents are used to explaining things to children in developmentally appropriate ways. Whether it’s why they have to have a shot at a doctor’s office or why they need to move to a new community, parents generally know – by instinct and knowledge – how to do this. Talking about death, while less common and inherently sad, is not an entirely different kind of task. Parents should think of it as being like other kinds of sad or disappointing news they might have to discuss with their child.  The specifics, for example, the closeness of the person who died, whether it was an expected loss, and the age of the child, will determine what is communicated.  But the general point, that parents actually do have experience in talking about difficult things and that they should rely on that experience, is most important.

Talking about deaths reported in the news is a different situation. While there are always exceptional circumstances, it is generally best to wait and see if your child raises the issue.  Whether they are aware of a news story is likely to depend on factors such as their age, how routinely they are exposed to the news, and how direct the event in the news is to their day-to-day lives.  If they don’t have knowledge of the story, raising the issue with them is unlikely to be a helpful. If they do raise the issue, it’s important to first find out what they have learned and what specific questions they have (there is no need to respond with answers to questions they don’t have). Additionally, it is important to keep your feelings and thoughts about the news story separate from the actual, specific concerns your child has. Your job as a parent is to help your child understand the event in a way that’s consistent with their developmental level, as well as to reassure and comfort them as necessary.

How do I explain why a parent killed his/her child?

You can’t really explain what you may not understand yourself. If you find the news of a parent killing her children and then herself perplexing and distressing, then it is OK to say that you are confused and upset by it. At the same time, you can also provide reassurance of your child’s safety and, if necessary, of your own ability to take care of them. If you feel you have some understanding of the event, for example, if it was the result of the mother’s severe mental illness, do your best to explain this briefly and in developmentally appropriate ways and with an emphasis on how rare such events are. You might also want to communicate empathy for those most affected by the loss.

Should I talk about the mental health of the parent? How do I do that?

You should talk about the mental health of the parent if your child asks about it, or if you feel that it’s important and appropriate for you to include in your response to the specific questions your child has asked. It’s unlikely that we would actually know the mental health status of a parent taking the violent and tragic actions reported in these recent cases, especially in the immediate aftermath of the tragedy when it is most likely to be in the news. Consequently, you might note that questions regarding mental health issues have been raised – and what this might mean – without suggesting that you know for certain what led to act of violence. It may also be important for you to note that while mental health issues are sometimes linked to violent acts, the vast majority of people with a mental health diagnosis are not violent.

At what age is it appropriate to approach my kids about this topic? Should I always wait for him/her to bring it up?

Unless you have specific reason to anticipate your child encountering discussion of these issues, it is generally better to wait and see if your child raises such concerns with you. Of course, the older children are, the more likely they are to both hear about and initiate questions about news of a tragic event. Similarly, the older your child is, the more reasonable it likely is to bring up the issue.

Are there things I can say or do to make my child feel safe and at ease?

First, it’s worth remembering that our goal as adults caring for children is to help them feel safe without needing frequent reassurance. If such reassurance is necessary, then the most important thing to emphasize is just how incredibly rare these types of events (school shootings, parents killing their children) are. They are extremely upsetting to hear about, and terribly tragic for the families affected, but also quite unlikely to happen. Because they are so rare and so dramatic, they tend to receive intense media coverage. But it also this pervasive media coverage that can make it seem as if these tragedies are more common than they really are. Consequently, it is almost always reasonable to reassure children that they are safe and that there are many adults in their lives looking out for their wellbeing. Some children will have specific concerns requiring specific reassurance. Younger children are likely to need you to talk about the ways in which their own home and school are safe places, while older children might need help understanding the rarity of these events through comparison to other types of risks.  For example, you might point out that while there are people struck by lightning every year, the odds of any given individual beings struck is exceedingly low.