An Insider’s Guide to Surviving Your Child’s Hospital Stay

By Elizabeth Nelsen, MD, FAAP

young girl in hospital bed with teddy bear

As a pediatrician, I take care of children that sometimes need to go to the hospital. I’m often in a position to explain to them what will happen when they are there. As a parent, I recently experienced what it is like when my daughter was admitted to the hospital after surgery. While we were there, I recognized some points that may be helpful if your own child is admitted to the hospital.

  1. Be an advocate. You know your child better than anyone else. If you recognize that your child needs rest, it’s ok to say no to family members that want to visit. If your child is uncomfortable, ask the nurse and child life specialist what can be done to help (for example, pain medication or a toy or video to help with distraction).
  2. Keep things normal (as best you can). If you have a younger child who takes a regular nap or two at home, try to have them nap at their regular time. Also try to keep the bedtime routine as consistent as you can. You might not be able to do everything you would at home, but ensuring that your little one gets to bed around the same time they do at home will help create a sense of normalcy. If your child has a favorite stuffed animal or toy, consider bringing that with you. If they have a favorite cup they drink from at home, bring that as well. It may help especially if your child is having some difficulty eating and drinking because things are unfamiliar or if they are recovering from something painful.
  3. Rest when you can. It’s hard to sleep in the hospital, even with the pull out chairs and love seats in the patient rooms. Plus, you are very focused on your child and how he or she is doing. It’s crucial that you eat, drink, and get your rest so that you can help to care for your child.
  4. Take notes. You will likely be tired and frazzled during your stay. This can affect your memory and concentration. Writing down questions you have for the nurses or doctors when you think of them will help you to remember what your concerns were when they come back to check on you and your son or daughter. You should also jot down their responses – again, just to help you keep track or if someone else asks you the same question about your child.
  5. Breathe. You’re in the best place possible for your child. Caring for a child that needs to stay in the hospital is not easy. The doctors, nurses, and staff at Upstate Golisano Children’s Hospital understand this and go above and beyond every day to provide excellent care for you and your child. Take a deep breath and know you’re in the best hands.

Brief bio: Elizabeth Nelsen, MD, FAAP, is an assistant professor of pediatrics at SUNY Upstate Medical University and Upstate Golisano Children’s Hospital. She is also an associate program director for the pediatric residency program.

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To Tell or Not To Tell?

By Janice Nellis, MS, CCLS

child life specialist with young patient before surgerySo your child is having surgery.  As a parent you are feeling anxious and have multiple questions running through your head.  How successful will the surgery be?  Will my child make it through the surgery ok?  Will my child be able to do the things they could do before surgery?  How much pain will there be?  Will I be able to be with my child when they go to sleep?  Will I be able to stay at the hospital with my child?  How do I talk to my child about the surgery?  Do I tell them at all?

This is all normal!  It is important for parents to talk with their child’s caregivers prior to the day of surgery and have all their questions answered.  The better prepared you are as a parent, the less anxious you will feel about the whole experience.  The less anxious you feel as the parent, the less anxious your child will feel.

As far as answering the question “how do I talk to my child about the surgery or do I tell them at all,” you can contact a Child Life Specialist to help you with this.  A Child Life Specialist is trained to help prepare children of all ages for their surgery experience.  Honesty really is the best policy.  Although it may be difficult to tell your child that they need to go to the hospital and have surgery, if we don’t tell them what to expect we run the risk of losing their trust.  At Upstate Golisano Children’s Hospital, the Child Life Program offers a pre-admission program to pediatric patients and their families.

At a pre-admission preparation visit, you and your child will be provided with the information that will help you feel ready for the day of your child’s surgery.  You will be able to see where you will be going on the day of your surgery and meet some of the staff that may be taking care of you.  Children are given the opportunity to learn about the hospital/surgery experience through play involving the use of medical equipment as well as view a movie about having surgery.  This hands on learning helps them to gain control over their situation and learn techniques to cope with their surgery.  Your Child Life Specialist will walk you through the events of the day of surgery and give you a tour of the Children’s Hospital if your child will be staying in the hospital after surgery.

Research has shown that “most children prepared for medical procedures experience significantly lower levels of fear and anxiety as compared to children who are not prepared. Preparation also promotes long term coping and adjustment to future medical challenges.”  (Preparing Children and Adolescents For Medical Procedures, Child Life Council, 2007)

For further information about how to talk to your child about surgery or to schedule an appointment for a pre-admission visit, contact the Child Life Program at 315-464-7506.

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Vegetarian Awareness Month

By Amy Merwarth, RD, CDN

October is National Vegetarian Awareness Month!  A well planned vegetarian diet can meet the needs of all ages of people.  When people talk about a vegetarian diet they typically talk about a diet that is free of meat, poultry or fish.  But there are different kinds of vegetarian diets. Take a look at the chart below for the various types of vegetarianism. 

Type of Vegetarian Diet

Excludes

Includes

Lacto-Vegetarian

Meat, Fish, Poultry and Egg Containing Products

Dairy Products

Lacto-Ovo Vegetarian

Meat, Fish and Poultry Containing Products

Dairy Products and Eggs

Ovo-Vegetarian

Meat, Poultry, Seafood and Dairy Containing Products

Eggs

Vegan

Meat, Poultry, Fish, Eggs and Dairy Containing Products

The key to a healthy vegetarian diet, just like any other diet, is to consume a variety of foods.  No single food can provide all the nutrients our body needs.  The more restrictive and limited your diet is, the more challenging it can be to get all the nutrients you need.  Vegetarians should pay attention to the following nutrients.  Look at the chart below to see which key nutrients are important, what their function is and what foods to find them in. 

Nutrient

Function

Sources

Calcium

Builds and maintains strong teeth and bones.

Milk and dairy products are the highest.  It can also be found in dark green vegetables such as turnip and collard greens, kale and broccoli when eaten in sufficient quantities.  You can also get calcium fortified products such as juices, cereal, soy milk, soy yogurt and tofu.

Iodine

Helps regulate metabolism, growth and function of key organs.

¼ Teaspoon of Iodized Salt.

Iron

Important component of red blood cells. 

Dried beans and peas, chickpeas, baked beans, lentils, soybeans, tofu, pumpkin seeds, black strap molasses, enriched cereals, whole grain products, dark leafy green vegetables and dried fruit (raisins, figs).  Iron isn’t easily absorbed from plant sources.  Therefore, the recommended amount of iron from vegetarians is almost double that of non-vegetarians.  To help better absorb iron it should be taken with foods high in Vitamin C, such as strawberries, citrus fruits, juices, tomatoes, cabbage and broccoli.  

Omega-3 Fatty Acids

Important for heart health.

Canola oil, soy oil, walnuts, ground flaxseed and soybeans are good sources.  However, because the conversion of plant based omega 3 to essential fatty acid in humans is inefficient, you may want to consider fortified products and/or supplements. 

Protein

Maintains healthy skin, bones, muscles and organs.

Eggs and dairy products are good sources.  Plant based sources include soy products, tofu, beans, peanut butter, meat substitutes, legumes, lentils, nuts, seeds and whole grains. 

Vitamin B-12

Produces red blood cells to help prevent anemia. 

This vitamin is found almost exclusively in animal products, so it can be difficult to get enough B12 on a vegan diet. Vitamin B12 deficiency may go undetected in people who eat a vegan diet because their diet is high in folate, which may mask a B12 deficiency.  Therefore, it is important for vegans to consider vitamin supplements, vitamin enriched cereals and fortified soy products. 

Vitamin D

Important for bone health.

Vitamin D is added to cow’s milk, some brands of soy and rice milk and some cereals and margarines.  If you don’t eat enough fortified foods and have limited sun exposure, you may need a Vitamin D supplement (one derived from plants).

Zinc

Essential component of many enzymes and plays a role in cell division and formation of proteins.

Zinc is not easily absorbed from plant sources as it is from animal products.  Cheese is a good option if you eat dairy products.  Plant sources include whole grains, soy products, tofu, tempeh, legumes, nuts and wheat germ. 

If you are not following a vegetarian diet but are thinking of trying it, here are some tips and ideas to help you get started.  Ramp Up: each week increase the number of meatless meals you already enjoy.  Learn to Substitute: take favorite recipes and try them without meat.  You may be surprised to find many dishes only require a few simple substitutions.  Branch Out: browse the internet for vegetarian menus, buy or borrow vegetarian cookbooks, check out ethnic restaurants to sample new vegetarian cuisines.  The more variety you add to your vegetarian diet, the more likely you will be able to meet your nutritional needs. 

Hearty Vegetable Lasagna

Ingredients:
1 (16 ounce) package lasagna noodles                         
2 (26 ounce) jars pasta sauce
1 (15 ounce) container part-  skim ricotta cheese
1 pound fresh mushrooms, sliced                                              
1 tsp dried basil
¾ cup chopped green bell pepper                                            
¾ cup chopped onion                                                                
3 cloves garlic, minced                                                 
4 cups shredded mozzarella cheese
2 Tbsp vegetable oil                                                                 
2 eggs
½ cup grated parmesan cheese
Directions:

  1.  Cook the lasagna noodles in a large pot of boiling water for 10 minutes, or until al dente.  Rinse with cold water, and drain.
  2. In a large saucepan, cook and stir mushrooms, green peppers, onion and garlic in oil.  Stir in pasta sauce and basil; bring to a boil.  Reduce heat, and simmer 15 minutes.
  3. Mix together ricotta, 2 cups mozzarella cheese and eggs.
  4. Preheat oven to 350 degrees F.  Spread 1 cup tomato sauce into the bottom of a greased 9×13 inch baking dish.  Layer ½ each, lasagna noodles, ricotta mix, sauce and parmesan cheese.  Repeat layering, and top with remaining 2 cups mozzarella cheese.
  5. Bake, uncovered, for 40 minutes.  Let stand 15 minutes before serving. 

Sources:  Mayoclinic.com, Teenshealth.org, Colorado State University Extension, Allrecipes.com.

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Safe Sleep

By Robert V. Hingre, M.D,  Assistant Professor of Pediatrics, Board Certified Neonatologist, Director of Newborn Medicine Teaching Program 

baby in crib on backEach year, Sudden Infant Death Syndrome (SIDS) claims the lives of more than 2,000 infants annually in the U.S.  The good news is that the death rate from SIDS has decreased by more than 50% since 1992, when the American Academy of Pediatrics (AAP) first made the controversial recommendation that infants be placed on their backs (in the supine position) for sleep.  This message was reinforced during a national educational program started in 1994, which was promoted as the “Back to Sleep” campaign.  The bad news is that SIDS rates have not experienced any further decline over the past decade, and we now need to focus on other risk factors to continue to lower SIDS risk and save the lives of current and future infants.

Since 2012 was the twentieth anniversary of the original AAP supine sleep recommendations, many organizations have tried to refocus their educational efforts on reinforcing additional (and expanded) safe sleep guidelines.  Parents and child care providers need to be ever vigilant about practicing safe sleep guidelines, and this is reinforced by the fact that currently 20% of SIDS cases occur when the infant is not in the care of one of the parents.  It is often a relative serving as an occasional babysitter who doesn’t know about safe sleep practices or someone who is using outdated information.  We now realize that such a practice is even more dangerous than ignoring the back to sleep recommendations entirely.  Occasional, or unaccustomed prone sleep on the abdomen places a young infant at an 18 times greater risk of SIDS, as they have not developed protective mechanisms for breathing while sleeping in a prone position.

The other troubling statistic is that while the number of SIDS deaths has been cut in half, infant deaths from Accidental Suffocation and Strangulation in Bed (ASSB) have quadrupled over this time period.  One of the most tragic scenarios leading to an infant death from ASSB is co-sleeping with a parent, and in many cases it is a mother who is exclusively breastfeeding her baby.  After analyzing all of the available research, the AAP has found that proximity sleeping/room sharing (having the infant in the same room as the parents) reduces the risk of SIDS by around 50%.  However, having the infant sleeping in the same bed alongside a full grown adult body is an extremely dangerous situation and the risks far outweigh any perceived benefits.  The infant can be brought into the bed for nursing, while mother remains awake, but he/she should be returned to their crib or bassinet to provide them with a separate, and protected sleeping space.

While there are numerous, and often costly, devices marketed to promote “safe co-sleeping”, the AAP has specifically stated there is no evidence that they have been proven to be truly safe. Whether these devices attach directly to the bed frame, or sit separately on the surface of the bed, we are told to assume that the risk of infant death from ASSB outweighs any convenience derived from parents sharing a sleep surface with their baby.

The other single most important factor that can further reduce the risk of SIDS is smoking cessation during pregnancy.  Researchers believe that around one-third of the current deaths from SIDS could be prevented if maternal smoking during pregnancy could somehow be eliminated.  This is now considered to be an extremely important area to focus our public health educational resources upon.   We also continue to recognize that exposure of infants to second hand smoke is a major risk factor for SIDS.

To ensure that an infant has a safe sleep environment, the AAP reminds parents of the following additional guidelines:

  1. infants should always be put to sleep supine (on their back) on a firm sleep surface until one year of age
  2. there should be no loose blankets, pillows, stuffed animals, or crib side bumpers
  3. avoid overheating and head covering during sleep
  4. cribs should have slats that are less than 2 3/8 inches apart, and those with drop-down sides are no longer considered safe, as they could lead to infant entrapment and suffocation
  5. sleep positioning devices (like wedges or side-sleep wraps) advertised to help infants with acid reflux and to prevent “flat head syndrome” are not recommended and have been linked to infant deaths during sleep
  6. when an older infant is developmentally able to roll from a supine to prone position, she/he does not have to be repositioned by parents

In addition to the aforementioned things to avoid, there are also two things that we should encourage to help lower an infant’s risk of SIDS.  Breastfeeding has long been recognized to have a protective effect, and recent estimates are that the risk of SIDS can be reduced by around 36% if an infant is breastfed after birth.  Exclusive breastfeeding for at least one month after birth has been found to reduce the risk of SIDS by more than 50%.

More recent information has brought the infant pacifier back into the limelight.  Regular pacifier use during sleep (with naps and at bedtime) has been shown in many different populations of infants to reduce the risk of SIDS by more than 50% – 60%.  The protective effect of the pacifier persists even after it falls out, so it does not need to be replaced by the parents.  To ensure that early pacifier use does not interfere with successful breastfeeding, many experts recommend delaying introduction of a pacifier until 2 to 4 weeks after birth, when a mother feels that successful nursing has been established.

It is now apparent that our educational message has to be expanded, and that it is not enough to simply preach “back to sleep” in an effort to reduce the risk of SIDS.  A number of other safe sleep recommendations should be promoted as part of our educational mission, if we are to try and further lower global SIDS rates and save additional lives of future infants. 

For more information, visit: A Parent’s Guide to Safe Sleep”.

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Breakfast Gets High Grades

By Roseanne Jones, MS, RD, CDN 

Do you eat breakfast? If no, what is your excuse?  Not enough time?  Not hungry in the morning (could be the late night snacks)?  Don’t like breakfast foods?  If there is one single best healthful habit, it has to be eating breakfast!

Here’s why everyone needs to eat breakfast:

  • After a night of sleep your body goes into starvation mode and the metabolism slows down.  Without breakfast to kick start the metabolism the body will stay at the lower metabolic rate and continue to burn less calories until it gets food.
  • Studies show that Americans who skip breakfast are 4 ½ times more likely to be overweight.
  • Adolescents who eat breakfast make better food choices throughout the day.
  • Children who eat breakfast get higher grades in school and are less likely to be depressed, anxious or irritable.
  • Breakfast eating children also behave better in school, have a better attitude toward school and are more likely to stay alert.
  • You just plain feel better! When you start the day with a healthful meal it sets the tone for how you will eat for the rest of the day.

If you’re just starting a breakfast habit you can start out slow by eating something small like a piece of fruit, a glass of milk or a cup of yogurt then build up to a healthful habit of including both protein and fiber that can fight off hunger until lunchtime.

Mornings can be hectic so here are a few ideas for a quick breakfast:

  • Leftovers from last night’s dinner – What?!  No one said it had to be breakfast food!
  • Instant oatmeal made with milk, add some chopped apples and cinnamon for flavor
  • Toasted frozen waffles with cut strawberries and whipped cream served with a cup of milk
  • Cold cereal and milk, sprinkled with blueberries
  • Peanut butter on an English muffin topped with slices of banana
  • Yogurt parfait: layer fruit, yogurt then granola
  • Quick Breakfast Burrito, recipe from Incredible Edible Egg:              

               1 flour tortilla (6-inch)
               1 egg
               1 Tbsp. shredded cheese blend
               1 Tbsp. salsa and/or avocado

To cook in the tortilla:

Place tortilla on a plate and microwave for 5 seconds.  Line a 2-cup microwave-safe cereal bowl with microwave-safe paper towel. Press the tortilla into bowl.

  • Break the egg another bowl and beat with a fork until blended.  Pour the egg into the tortilla. Add salt and pepper if desired.
  • Microwave on HIGH for 30 seconds. Gently stir and microwave until egg is almost set, 15 to 30 seconds longer.
  • Remove tortilla with paper towel liner from bowl to flat surface. Top egg with cheese and salsa. Fold bottom of tortilla over egg, then fold in sides.

Tips: Substitute with whole wheat flour tortilla and low fat shredded cheese. Look for > 2 gm of Fiber in grain products and don’t forget that using canned and frozen fruit and vegetables is a good option too.

What are some ways you plan to make your breakfast better?

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