It’s trauma season

Spring 2009 Vol. 33, No. 2

News for Families

The Children’s MedicalCenter of Dayton

continued on page 2…

Spring 2009

Kohl’s A Minute for Kids – Preventing scalds and dog bitesPreventing scalds and dog bites is the focus of the Kohl’s A Minute for Kids health and safety educa-tion campaign during the coming months. Check out the following tips from the experts in Dayton Children’s Regional Pediatric Trauma and Emergency Center.

Scalds – children 4 and younger at greatest risk

Scalds from hot foods and water can be devastating and painful, explains Cindy Asher, RN, clinical nurse specialist, Dayton Children’s. “Because children’s skin burns more easily than an adult’s, their burn injuries are often deeper and more serious,” she explains. Risk is greatest in the kitchen and bathroom.

5 kitchen safety tipsKeep hot foods away from the 1.

edges of tables and counters. If you’re holding something hot, 2.

don’t hold your child, too.Keep children out of the kitchen 3.

when you are cooking.

In this issue of Growing Together, we include plenty of tips and advice for protecting your child during the spring and summer months that are considered “trauma season” at Dayton Children’s. While serious injuries can occur anytime, our Regional Pediatric Trauma and Emergency Center usually sees an increase as children start spending more time outdoors.

During trauma season, the staff in our trauma center will treat

children who have suff ered injuries from bicycle accidents, car crashes, playing sports, playground accidents, poisonings, drownings and near drownings. Although we don’t see large numbers of children injured by

lawn mowers, we off er prevention tips in this issue to help you protect children

from what can be serious and life-changing injuries.

Take a moment to review the safety information in this section, including the Kohl’s A Minute for Kids information on dog bites and scalds.

Are you on facebook?

Wally is! Be sure to become friends with Wally B. Bear, Dayton Children’s mascot, on his Facebook page. Check it out today.

SeasonalHealth Alert

It’s trauma season

Protect children’s ears while swimming

Swim molds designed to fi t your child’s ears will help your child get ready for water activities. The audiologists at Dayton Children’s will make custom, fl oatable swim molds in just fi ve to seven minutes. This service is available at Dayton Children’s Outpatient Care Center – Spring-boro. Custom molds cost just $40 a pair; cash, check and major credit cards are accepted. Call 937-641-5725, option 2, to make your appointment.

2

The power lawn mower is one of the most dangerous tools around the home, according to the Ameri-can Academy of Pediatrics. Take a moment to learn how to protect your child during lawn-mowing season.

Check the yard for objects before 5. starting to mow. Anyone using a mower should wear hearing and eye protection.

Keep children indoors or at a safe 6. distance away from the area you are mowing.

Blade settings should be done 7. by an adult with the mower off and spark plug removed or disconnected.

Start and refuel the mower out-8. doors – not in a garage or shed. � e motor should be turned off and cool.

Do not pull the mower backward 9. or mow in reverse unless absolutely necessary. Carefully look for chil-dren before backing up.

Always turn off the mower and 10. wait for blades to stop completely before removing the grass catcher, unclogging the discharge chute or crossing gravel.

continued from page 1…

Lawn-mowing safetyThe top 10

Try to use a mower with a control 1. that stops the mower from moving forward if the handle is released.

Children younger than 16 years 2. should not use ride-on mowers. Children younger than 12 years should not use push mowers.

Do not allow children to ride as 3. passengers on any kind of mower.

Sturdy shoes – not sandals or 4. sneakers – should be worn for mowing the lawn.

Test heated foods and liquids 4. before serving them to a child.

Watch for dangling appliance 5. cords.

3 bathroom safety tipsTest how hot your hot water is. Let 1.

the bathtub water run 3-5 minutes. Use a hot water gauge or liquid crys-tal bath thermometer. Water should be no hotter than 120 degrees F.

Always check the water tempera-2. ture before placing your child in the tub.

Supervise children while bathing. 3. Children should not be allowed to turn on the water themselves.

Keep safe around dogs

Many dog bites can be prevented if children are taught how to behave around dogs. Tom Krzmarzick, MD,

director of the Regional Pediatric Trauma and Emergency Center at Dayton Children’s, points out “� e majority of dog bites seen in the emergency department are infl icted by dogs the children know.”

6 things to teach kids about dogsAlways ask the dog’s owner if you 1.

may pet the dog.Approach a dog from the front 2.

or side. Hold your hands low and allow the dog to smell you.

Don’t bother a dog that is eating 3. or sleeping.

Don’t grab a dog’s special toys. 4.

Respect a dog’s space. Don’t put 5. your hand through a dog’s cage, fenced yard or car window.

Do not run from a dog. � e dog’s 6. natural instinct is to chase you.

For more information on these and other topics as well as teaching curriculums, go to kohlsminutes.childrensdayton.org.

Growing Together is published quarterly for parents and fami-lies in the Miami Valley area by The Children’s Medical Center of Dayton, One Chil-dren’s Plaza, Dayton, Ohio, 45404-1815.

Visit our website at www. childrensdayton.org – your online source of child health and safety information.

healthbeat

3The dangers of pickup trucksWhile pickup trucks have become increasingly popular, transporting children safely requires a little extra attention. � e pediatric experts at Dayton Children’s join the Ameri-can Academy of Pediatrics (AAP) in providing this safety information.

Cargo areas

Children and teenagers should never travel in the cargo area of a pickup truck, even if it has a camper shell. � ese areas are not designed to protect passengers.

Children and teens riding in cargo areas may sustain serious injuries or be killed if ejected – one

Swimming and boating are popular summer activities. Dayton Chil-dren’s experts join the American Academy of Pediatrics in off ering these water safety tips.

Pool safety

Never leave children alone in or ●

near a pool – even for a moment.Keep rescue equipment (shep- ●

herd’s hook and life preserver) and a portable phone near the pool.

If children are missing, search the ●

pool or body of water fi rst.Infants and toddlers in or around ●

water should always be within touching distance of an adult.

Boating safety

Children should wear life jackets ●

at all times when in a boat or near bodies of water.

Make sure the life jacket is the ●

right size for your child. Wear as instructed with all straps belted.

Blow-up water wings, toys, rafts ●

and air mattresses should never be used as life jackets or life preservers.

of the key risks. � is can occur even if the vehicle does not crash. Just swerving or stopping suddenly has caused serious injuries to cargo area passengers. � e risk of death is eight times higher for those riding in the cargo area than for those properly restrained in the cab.

Camper shells do not off er ade-quate protection in a vehicle crash. In addition, carbon monoxide poi-soning, which may result in death, is another risk to those riding in an enclosed cargo area.

If you use your pickup truck for traveling with kids, remember:

No passengers in the cargo area. ●

Make sure all children in the cab ●

can be properly restrained.Infants in rear-facing car seats ●

should not be placed in the front passenger seats if the airbag is turned on.

Keeping children safe around waterAdults should wear a life jacket ●

to keep them safe if their child needs help and to set a good example.

Make sure your teen does not use ●

alcohol when boating or ride with someone who is.

For more health and safety tips, including seasonal health alerts, visit our website at childrensdayton.org. Go to Health Topics and Safety Tips.

U S I N G F I R E W O R K S S A F E L Y

Parents should remember all fi reworks are dangerous, even sparklers. To help everyone enjoy the summer holidays, the pediatric experts at Dayton Children’s offer these safety tips for fi reworks displays.

Never allow children to play with or light fi reworks. ●

Sparklers are not safe. They can reach temperatures above ●

1000 degrees F and can burn users and bystanders.

Follow the law. In Ohio the only legal fi reworks are ●

sparklers, trick noisemakers and novelties.

Keep a bucket of water or fi re extinguisher handy in case of fi re. ●

Many families have their own fi reworks displays. “These displays can be dangerous and should be avoided,” says Dayton Children’s clinical nurse specialist Cindy Asher, RN. “However, if you decide to set off fi reworks on your own, keep children at a safe distance from the fi reworks as they are launched.”

When your child’s doc-tor’s offi ce is not open, you may need to take your child to an urgent care center or emergency department. Making the best choice depends on your child’s situation.

man Shalash of Miamisburg knew her daughter Layal was not feeling well. � e 3-year-old, who is being treated for

low iron, was fussy and seemed to be having problems with her ear. Eman contacted her pediatrician Kim-berly Khosla, MD, at Cornerstone Pediatrics, who told Eman to take her daughter to Dayton Children’s Urgent Care in Springboro.

Although Layal’s situation was not serious and Eman was able to confer with her child’s doctor, there may be times when parents cannot reach the doctor or the situation is more serious.

“Certain situations such as sei-zures, serious head or neck injuries and loss of consciousness should be treated in the emergency depart-ment,” says Mark Schaff er, MD, a pediatrician at Dayton Children’s urgent care center.

“We treat a number of children, but not all children should come to the urgent care center,” he says. He points out that an urgent care is not the same as an emergency depart-ment. “Sometimes we have to call 911 because of the seriousness of a child’s situation. If a child has swal-lowed pills or poison, the emergency department is the best place for that child to be treated after you have called the poison center.”

When choosing urgent care or emergency care for children, it is important that the doctors treating your children have special training and experience, and that the center is designed with the comfort and safety of children and families.

Care is provided by board-certifi ed pediatricians from Day-ton Children’s Regional Pediatric Trauma and Emergency Center and nurse practitioners. Like all patient care areas at Dayton Children’s, the urgent care center is fully equipped with everything needed to care for children of all ages and sizes. More than 27,500 children were treated in Dayton Children’s two urgent care locations last year. � is level of experience in caring for children is unmatched in our region.

In addition to the top medical care available, it’s a comforting and fun place for kids.

“Layal didn’t want to leave the urgent care center,” Eman says. “� ere were toys, games, movies and little chairs. � e people at the urgent care were so nice to her.” Dayton Children’s Urgent Care in Spring-boro is also a “green” building.

“A key benefi t of our LEED certifi cation is improved indoor air quality over most buildings, which

4

Children’s Urgent Care – Springboro offers the following benefi ts

• Walk-in service; no appointment necessary

• Convenient evening and weekend hours

• Prompt, cour-teous service in a child-friendly atmosphere

• Follow-up referral back to your child’s primary care doctor

• Only 6 miles from Centerville and 10 miles from Kettering

For hours, services and directions, go to www.chil-drensdayton.org/springboro.

Get free health and safety updates by e-mail. Sign up today at childrens-dayton.org – FamilyWise e-newsletter

Urgent situations, Careful decisions

E

will help both staff and patients with respiratory problems or sensitivities. Getting treatment for respiratory conditions such as asthma or bron-chiolitis is one of the top reasons kids come to Dayton Children’s,” says Edd McGatha, director of facilities for the medical center.

“I would defi nitely recommend Children’s Urgent Care in Spring-boro to other parents. Everyone was very nice and helpful, plus it was clean and comfortable,” Eman says.

Helping you make the best choice� e following information will help you determine the best course of action when your child’s doctor is not available.

When should I go to the urgent care?

If your doctor tells you to ●

Colds, cough, fl u ●

Minor cuts (lacerations) or head ●

injuriesMinor injuries such as a sprain ●

Vomiting and/or diarrhea ●

Asthma with mild to moderate ●

wheezing

When should I go to the emergency department?

If your doctor tells you to ●

Uncontrollable bleeding ●

Severe diffi culty breathing and/or ●

respiratory distressFall from a height ●

Serious head or neck injuries ●

Any loss of consciousness ●

Eye injuries ●

Injuries from a motor vehicle ●

crash, whether the child is a pedes-trian or a passenger

Swallowing a harmful substance ●

AFTER calling the poison center at 1-800-222-1222

Obvious fractures or swollen, ●

painful jointsMajor cuts (lacerations) ●

Acute infections ●

Signifi cant pain ●

Seizures ●

Anything needing fast treatment ●

to prevent major disability or death

Dr. Schaff er reminds parents to call 911 if your child is not breathing, having trouble breathing, is seriously injured, is bleeding heavily, or has a life-threatening condition. Do not try to drive the child to the hospital yourself.

Whether you take your child to the emergency department or urgent care, you may have to wait. Bring your child’s favorite books, games or toys to help them relax and pass the time more easily.

At both places it’s important to remember that children are not seen in the order they arrive. � e sickest or most seriously injured children are seen fi rst.

“� e most important concern, especially in a true emergency, is not the cost or the wait,” says Dr. Schaf-fer. “Don’t be afraid of overreacting. Making sure your child gets neces-sary treatment when sick or injured is most important.”

DaytonC

hildren’sfocu

s5

(L-R below) Layal Shalash in the waiting room at Children’s

Urgent Care – Springboro…with Dr. Mark Schaffer…exam by

Dr. Schaffer and nurse Cindy Watson, RN…Cindy Watson, RN

going over Layal’s treatment…going home – with a Popsicle!

Coming to Dayton Children’s Urgent CareWhat should I bring with me?

• Your insurance card

• A list of your child’s medications, allergies and medical history. By putting this together ahead of time, there is no delay in an emergency. This is very important if your child has a chronic condition such as asthma or special needs.

• Your child’s favorite toy, blanket or game. Depending on your child’s situation, there may be a wait.

6

says Dr. Canessa. He explains that Noah’s bladder does not function normally by holding urine until the bladder is full, then releasing the urine out of the body. In Noah’s case, the urine “backfl ows” into the kidneys, which over time leads to kidney damage.

Noah also has what is known as a neurogenic bladder. If everything is working properly, the muscles and nerves of the urinary system work together to hold urine in the bladder and release it at the right time. With neurogenic bladder dysfunction, the nerves that are supposed to carry these messages do not work properly.

Because of massive refl ux and a neurogenic bladder, a vesicostomy was performed last year by Dr. Nguyen. � is involved creating an opening from the bladder to the outside of the body, allowing urine to fl ow freely with no backup.

“Noah takes care of himself throughout the day,” says Chris. “I

Noah Daugherty of Lewisburg is known to his family as “the-cup-is-always-full man,” according to his mother Chris Daugherty. “He has such a positive attitude about everything he has to endure. I’m not sure I could do it,” she says.

The 9-year-old suff ers from very high-grade vesicoureteral refl ux

with massive hydronephrosis. In everyday language, this means Noah has backfl ow of urine into the kidneys and a swollen bladder. Noah became a patient of Leonardo Canessa, MD, director of pediatric nephrology, in September 2007 after Noah’s primary care doctor noticed dilatation of his kidneys during a routine evaluation. At Dayton Chil-dren’s, Noah has also been treated by Donald Nguyen, MD, director of urology.

“Our primary treatment goal is to protect Noah’s kidneys and to allow his life to be as normal as possible,”

Staying positive with kidney disease

Dr. Canessa and Noah

are working together

to protect Noah’s

kidneys and make life

as normal as possible.

Chris Daugherty

and her son Noah

of Lewisburg

have seen the

good results

possible when

physicians and

families work

together.

7D

aytonChildren’sfo

cus

am so proud of how he is handling this.” She explains that she talked to Noah’s teachers and school nurse after the surgery last year to make sure they discreetly accommodate Noah’s frequent restroom breaks. “� ey have been wonderful. Now Noah doesn’t even have to say any-thing – they just make eye contact when Noah needs permission to leave the classroom.”

Although this was diffi cult for Noah at fi rst, he knows why it is important: “I do it to save my kid-neys,” he says. Fortunately, his eff orts have paid off . A recent ultrasound showed signifi cant improvement. Dr. Canessa was pleased to see that Noah’s kidneys looked almost normal since the refl ux had been eliminated.

“It’s important for families in this situation to know that good results can be achieved when the patient, family and doctors are all working together,” he says. “Although Noah will deal with this his whole life, there are ways to make his life as normal as possible.”

Noah takes two medicines every day. An antibiotic to reduce the risk of kidney and bladder infections and another to keep his bladder from contracting, allowing it to become more fl exible. Noah has even created a rhyme to help him take his medi-cines: “If I don’t take the pills, I get the ills.”

“Our next goal is to surgically re-establish Noah’s anatomy and close the opening near his belly button that now allows the urine to drain freely,” Dr. Canessa says.

Dr. Nguyen explains that this involves reimplanting the ureters so urine can fl ow from the kidneys to the bladder and then from the bladder out of the body and correct the backup that occurs now. Until Noah’s bladder can function nor-mally, he will have to self-catheterize

through his penis or a surgically cre-ated opening to empty his bladder. � is will allow him to be dry and continent.

Noah will eventually have a bladder augmentation to increase the capacity of his bladder and to make the bladder more compliant. � is will also decrease the pressure in his bladder to protect his kidneys. Dr. Nguyen explains that part of the intestine is used for this procedure.

Noah and Chris also appreci-ate the eff orts of Sara Conley, RN, nurse practitioner, who assists Drs. Canessa and Nguyen. “She has been instrumental in Noah’s care, going above and beyond to make sure his needs are met. Sara cares about how Noah is doing at school and home as well as his medical care,” Chris says.

Facing a life-long medical con-dition can be scary and depressing to the child aff ected and his or her family. Chris has experienced fears and anxiety about dealing with

Noah’s situation, but has found ways to cope.

“Just take things as they come,” she advises. “It can be overwhelming to think too far ahead. Focus on doing what’s best for your child and take things one day at a time. Find doctors you trust and take their advice.”

Chris emphasizes that the whole family as well as the child aff ected need “mental health” days. “Do something fun every now and then. We always try to do something special on the days Noah has to go to the hospital for tests or appoint-ments. It makes things a little easier.”

Noah, a third-grader at Tri-County North in Lewisburg, just fi nished playing for his school’s bas-ketball team and is looking forward to starting baseball – his favorite sport. For the most part, Noah does everything he wants to do.

His advice to other kids?“If I can do this, you can do it.

It’s really good to help your body.”

K I D N E Y D I S E A S E A N D T H E D O C T O R S W H O T R E A T I T

There are many types of kidney disease that can affect infants, children and teens. If your pediatrician or family doctor believes your child has a kidney disease, he or she can refer your child to pediatric nephrology at Dayton Children’s. The nephrology team includes two pediatric nephrologists, a clinical nurse practitioner and other staff specially trained and experienced in working with children and families.

Nephrologists and urologists frequently work together on a child’s treatment. Noah Daugherty’s care is provided by both Leonardo Canessa, MD, a pediatric nephrologist, and Donald Nguyen, MD, a pediatric urologist. Pediatric nephrologists such as Dr. Canessa diagnose and medically treat urological conditions and diseases of the kidney such as vesicoureteral refl ux, which affects Noah. Pediatric urologists such as Dr. Nguyen diagnose urological conditions and, when necessary, perform surgically corrective procedures.

Our nephrologists and urologists care for children at the main campus on Valley Street. Our nephrology services are also available at St. Rita’s Medical Center – Lima and Dayton Children’s Specialty Care Center – Warren County. Visit our website – childrensdayton.org – Services. You can learn more about nephrology or urology staff and services. The neph-rology site contains numerous information sheets on kidney disease, tests and treatment.

Leonardo Canessa, MD

Donald Nguyen, MD

� e Children’s Medical Center of DaytonOne Children’s PlazaDayton, Ohio 45404-1815

Nonprofit OrganizationU.S. Postage PaidPermit Number 323Dayton, Ohio

newsbriefsGrowing Together is published quarterly for parents and families in the Miami Valley area by The Children’s Medical Center of Dayton. The purpose of Growing Together is to show how Dayton Children’s and families are working together to keep all children healthy and safe. Additional copies of Growing Together are available by writing to Dayton Children’s, c/o Marketing Communica-tions, One Children’s Plaza, Dayton, Ohio, 45404-1815 or by calling 937-641-3666. Your suggestions and comments are also appreciated.

For more information:937-641-3666childrensdayton.org

Neurosurgeon joins staff David Knierim, MD, has joined the neurosurgery department at Dayton Children’s. Dr. Knierim completed a fellowship in pediatric neurological surgery at the University of Toronto, � e Hospital for Sick Children. Dr. Knierim is board certifi ed and has 25 years experience in pediatric surgery.

Surgery clinic now offered in

Springboro Dayton Children’s sur-gery clinic will now off er evaluation and follow-up care at the Dayton Children’s Specialty Care Center – Warren County. In addition, pediat-ric experts can now perform minor surgical procedures at this location. For more information about these services, talk to your child’s doctor.

Genetics department offers

testing, counseling � e medical genetics department at Dayton

Children’s provides services to help individuals and families who are at risk for hereditary conditions or birth defects. Questions about services? Call medical genetics at 937-641-3800.

We’ve been recognized!

Farhat Khan, MD, ● pediatric gas-troenterologist at Dayton Children’s, has been chosen as a Fellow of the American Gastroenterological Associa-tion, the highest level of recognition.

Nursing. ● Several nurses in Dayton Children’s Regional Pediatric Trauma and Emergency Center have been recognized by the Board of Certifi ca-tion for Emergency Nursing (BCEN) and the Pediatric Nursing Certifi cation Board for their advanced knowledge and abilities.

MRI accredited. ● � e medical imaging department was recently accredited for magnetic resonance imaging (MRI) by the American College of Radiology (ACR).

Comfort Line offers support

to families Families and care-givers facing end-of-life issues now have another resource for support thanks to the Ohio Pediatric Palliative Care and End-of-Life Network (OPPEN). Dayton Chil-dren’s is a member of this network. � e Comfort Line is staff ed by pediatric palliative care physicians and advanced practice nurses to help answer medical questions related to pediatric pain and symp-tom management; answer questions about pediatric palliative care, hospice, chronic illness or end-of-life issues; refer you to palliative care or hospice providers; and provide information on community agencies and resources. Comfort Line is available toll free at 1-866-315-6327, 8:00 am – 4:30 pm, Monday through Friday.

10 things to know about lawn mower

safety

2

Need urgent care? How to choose

4

Lewisburg family living with kidney

disease

6

insidethis issue

Dayton Children’s has opened new locations in Springboro and Vandalia.

Outpatient Care Center – Springboro The center is located just off the future Austin Road exit from I-75 on West Tech near the Dayton General Airport. Urgent care, lab, medical imaging and rehabilitative services are available. The “green” building is LEED (Leadership in Energy and Environmental Design) certifi ed by the U.S. Green Building Council. This is one more way we are working to promote the health and well-being of children and families. Learn more – visit www.childrensdayton.org/springboro.

Outpatient Testing Center – Vandalia is available for the convenience of families north of Dayton. This center offers lab and medical imaging services and is located just off I-75 at the Northwoods Boulevard exit.

The Children’s MedicalCenter of Dayton

N O W O P E N I N Y O U R N E I G H B O R H O O D