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RAINBOW
Like many couples, Renee and Alex Cooper struggled with fertility. Renee had a common condition that affects about
7 percent of all women of childbearing age. Fortunately, the problem was corrected with medication, and the Coopers
recently welcomed their first child, Nora, in August 2013.
Finding help to start a family
Inside this issue:
Identifying a behavior disorder............... page 2
T
here were times, Renee Cooper admits, when she was not sure whether she and her husband, Alex, would
ever have a baby. And she is not alone. Infertility is a common issue that affects 8 to 10 percent of all
couples, according to Brooke Rossi, MD, an OB/GYN who specializes in reproductive endocrinology and
infertility at University Hospitals Fertility Center.
“People expect that when they are ready to start a family, everything will work smoothly,” Dr. Rossi says.
“When nothing happens after a few months, it can be very frustrating.”
For couples facing this challenge, there is a wide range of options available, from medication to in vitro
fertilization. A consultation with a UH Fertility Center specialist can help to relieve some of the frustration that
surrounds fertility issues.
continued on page 3
UH Rainbow Care Network:
Pull out and save this map..................... page 4
Group prenatal and parenting
programs benefit moms and babies....... page 7
Ask the expert about
acetaminophen................................... page 10
Moody or more? Identifying a childhood
behavior disorder
Felipe Amunategui, PhD
Child and Adolescent Psychologist,
UH Rainbow Babies & Children’s
Hospital
Assistant Professor, Case Western
Reserve University School of Medicine
A
s most parents can attest, it is not unusual
for a child to occasionally be emotional
or strong-willed. But frequent temper
tantrums and consistent refusal to follow requests
may be signs of a deeper problem. When a child is
persistently defiant and aggressive, it could be a
sign of disruptive behavior disorder (DBD).
“Children with DBD may react intensely
whenever presented with a limit or given a
directive,” explains Felipe Amunategui, PhD, a
child and adolescent psychologist at University
Hospitals Rainbow Babies & Children’s Hospital.
Youths with DBD are likely to behave
inappropriately and to vehemently deny
responsibility for their actions. Commonly, adults
familiar with the child will likely observe:
nFrequent temper tantrums
nArguments with adults
nDeliberately annoying others
nBlaming others for mistakes or misbehavior
nBeing resentful, spiteful or vindictive
nBeing aggressive toward peers, with angry or
disruptive behaviors
toward adults
Signs of a problem
Dr. Amunategui explains that distinguishing DBD
from normal behavior often involves assessing the
nature and extent of the problem. “Children with
DBD typically exhibit problematic behaviors on
an almost daily basis – behavior that is clearly
disruptive to the children’s family or classroom,”
he says. According to the current Diagnostic and
Statistical Manual of Psychiatric Disorders, DBD
should be suspected whenever the problematic
behaviors are disruptive in two settings and they
are not appropriate for the child’s age.
Before puberty, DBD is more frequently
diagnosed in boys. After puberty, it is diagnosed
almost equally among boys and girls. There are
different types of DBD, and the causes are poorly
understood. The behaviors appear to arise from a
combination of genetics and maladaptive parentchild interactions or environmental factors that
begin in early childhood. Dr. Amunategui adds,
“Children with DBD often have difficulty making
friends because they underestimate the impact of
their behavior while they also misinterpret peers’
behavior as hostile and respond aggressively.”
treated,” says Dr. Amunategui. In addition,
untreated DBD has shown evidence to facilitate
the development of significant conduct problems
and substance use disorders.
Parents who are concerned that their child may
have DBD should seek help from a primary care
doctor, pediatrician, child psychologist or child
behavior expert. Diagnosing a DBD can be
difficult and should be handled by a professional
with a clinical background and experience with
the disorder.
Advanced behavioral
health services
UH Rainbow Babies & Children’s Hospital offers
expert behavioral health care for children and
teens with a variety of emotional and behavioral
conditions, such as:
nAggression
nAnxiety
nConduct disorders
nEating disorders
nMood disorders
Treatment is key
The earlier a child is diagnosed with DBD, the
better the outcome. “Treatment is important
because a child’s development, relationships and
education are at risk if the disorder is not
nSocial problems
To schedule an appointment or learn more, call
216-UH4-KIDS (216-844-5437) or request an
appointment online at RainbowBabies.org.
A closer look at conduct disorder
Conduct disorder is a behavior disorder, sometimes diagnosed in childhood, that is
characterized by antisocial behaviors that violate the rights of others and age-appropriate
social standards and rules. Children and adolescents with conduct disorders often have other
psychiatric problems that may contribute to the development of the conduct disorder.
The antisocial behaviors may include:
nA
ggressive conduct toward others, such as bullying or physical fights
nD
eceitfulness, such as lying or theft
nD
estructive conduct, such as vandalism or arson
nV
iolation of rules, such as truancy, running away or very early sexual activity
2
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Find a physician online: RainbowBabies.org/PhysicianFinder
f in d in g h e l p t o s tart a fa m i ly
continued from page 1
Brooke Rossi, MD
OB/GYN, University Hospitals
Fertility Center
Clinical Associate Professor, Case
Western Reserve University School
of Medicine
James Goldfarb, MD
Medical Director, University
Hospitals Fertility Center
Clinical Professor, Case Western
Reserve University School of
Medicine
After losing their 5-week-old son to a rare genetic disorder, Nicole and Brian Hardman realized that in vitro
fertilization was their only chance at having a healthy baby. Thanks to UH Fertility Center’s advanced treatment
capabilities and some crucial financial help, their daughter, Callie Rose, was born in March 2013.
Noninvasive treatment
After visiting with Dr. Rossi, Renee was
diagnosed with polycystic ovary syndrome, a
condition in which the ovaries do not release an
egg every month.
“The egg does not get released, so it is difficult
to conceive,” Dr. Rossi explains. “It is a common
condition that affects about 7 percent of all
women of childbearing age. Fortunately, it usually
can be corrected with oral medication.”
Renee started to take an oral medication that
helps induce ovulation in August 2012. In tandem
with artificial insemination, it worked. The couple
conceived and welcomed their first child, Nora, in
August 2013.
Like many couples who visit UH Fertility
Center, the Coopers’ fertility problem was
corrected with a noninvasive solution.
“The solution is often very minimal, like using
oral medications,” Dr. Rossi says. “Only a minority
of our patients end up having to do something
more invasive, like in vitro fertilization (IVF).”
A more involved answer
For Nicole and Brian Hardman of Avon Lake,
however, IVF was their only chance. In 2011, the
couple lost their 5-week-old son, Lucas, due to
epidermolysis bullosa (EB), a group of rare genetic
connective skin tissue disorders that affects one
out of every 20,000 live births in the U.S. EB
causes the skin to blister and tear with even the
slightest friction and, in severe cases, can cause
internal blisters in the nose, mouth, esophagus,
stomach and lungs.
Geneticists told the Hardmans that there was a
one in four chance that any future children they
had would be born with EB, most likely the same
type as Lucas.
“We thought, ‘We cannot have any more
children,’” says Nicole. “If you had seen the
nightmare that Lucas went through, even
1 percent was too big of a chance.”
On the advice of their geneticist, the Hardmans
met with James Goldfarb, MD, Medical Director
of UH Fertility Center, for an initial consultation.
The center offers preimplantation genetic
diagnosis, which determines whether a genetic
condition carried by a parent is handed down to
the embryo.
A partnership that fits
In vitro fertilization and genetic testing can be
expensive: The average cost is almost $20,000.
When the Hardmans realized that they would not
be able to afford the procedure, Dr. Goldfarb
referred them to Partnership for Families. Started
by Dr. Goldfarb and family friend Nancy Lerner
Fisher in 2004, the program provides financial
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assistance for IVF to qualified individuals and
couples who have genetic concerns, cancer
diagnosis or previously unsuccessful IVF attempts.
Since its inception, the program has provided
around 280 financial awards, mostly to couples
who do not have biological children together and
cannot afford a second IVF attempt.
With crucial financial help from Partnership
for Families, the Hardmans began IVF in early
2012. By June 2012, they had seven healthy,
EB-free embryos, of which two were implanted.
Five remain frozen for future use. Blood tests
soon confirmed that Nicole was pregnant. Their
daughter, Callie Rose, was born March 9, 2013.
“It is amazing how many things we have
experienced already that we were not able to
experience with Lucas,” Nicole says. “Callie wears
regular clothes and can wiggle and play without
giving herself blisters. And, most importantly, I
can cuddle her and kiss her as much as I want,
and it does not hurt her.”
Taking the first step
Whether fertility issues are complex or common,
UH Fertility Center doctors are able to help.
“People are sometimes nervous that they are
going to find out there is something wrong,” says
Dr. Rossi. “Sometimes people are afraid of the
costs. Usually the problem will be something that is
easily manageable, but you cannot start working
on the problem until you know what it is.”
To learn more about the Cooper and
Hardman families, watch videos of their
stories at UHhospitals.org/Fertility.
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3
UH Rainbow Care Network:
Our experts. Your neighborhood.
Pull ou
t
and sav
e!
Keep this
map han
dy.
It will m
ake find
in
ga
close-to
-home fa
cility eve
n
easier fo
r you!
The most trusted name in pediatric care, University Hospitals Rainbow Babies & Children’s Hospital,
has an expansive pediatric care network with more than 100 locations – including pediatric primary
care, family medicine, medical and surgical specialty clinics, urgent care, emergency services and neonatal
and high-risk pregnancy care. That means your family has access to nationally recognized pediatric and
obstetric specialists no matter where you live in Northeast Ohio.
Pediatric practices
Ashtabula Pediatrics
Medina Pediatrics
1 1527 West 19th Street, Ashtabula, OH 44004
bm 4001 Carrick Drive, Medina, OH 44256
2 167D West Main Road, Conneaut, OH 44030
ck 13201 Granger Road, Garfield Heights, OH 44125
cl 6001 Landerhaven Drive, Mayfield Heights, OH 44124
cm 9075 Town Centre Drive, Broadview Heights, OH 44147
cn 8819 Commons Boulevard, Twinsburg, OH 44087
Northeast Pediatrics
bn 4212 State Route 306, Willoughby, OH 44094
Chardon Pediatrics
3 13241 Ravenna Road, Chardon, OH 44024
Zane Saalouke, MD
Partners in Pediatrics
Children’s Medical Group
bo 960 Clague Road, Westlake, OH 44145
4 5603 Darrow Road, Hudson, OH 44236
5 370 East Market Street, Akron, OH 44304
Pediatric & Adolescent Health Professionals
Columbro Group
6 960 Clague Road, Westlake, OH 44145
Comprehensive Pediatrics
7 2001 Crocker Road, Westlake, OH 44145
8 20455 Lorain Road, Fairview Park, OH 44126
Healthy Kids Pediatrics
9 9480 Rosemont Drive, Streetsboro, OH 44241
Kids in the Sun
bk 6909 Royalton Road, Brecksville, OH 44141
bl 18181 Pearl Road, Strongsville, OH 44136
co 5850 Landerbrook Drive, Mayfield Heights, OH 44124
Sandusky Pediatrics
cp 1218 Cleveland Road, Sandusky, OH 44870
bp 18660 Bagley Road, Middleburg Heights, OH 44130
Suburban Pediatrics
Pediatric Cardiology
cq 3461 Warrensville Center Road, Shaker Heights, OH 44122
cr 34055 Solon Road, Solon, OH 44139
bq 4135 Boardman-Canfield Road, Canfield, OH 44406
Pediatric Practice at UH Rainbow Babies &
Sundaresh
Children’s Hospital
cs 26250 Euclid Avenue, Euclid, OH 44132
11100 Euclid Avenue, Cleveland, OH 44106
Pediatric Services
L AKE
br 4065 Center Road, Brunswick, OH 44212
bs 6707 Powers Boulevard, Parma, OH 44129
dm
bn
PediatriCenter
bt 8185 East Washington Street, Chagrin Falls, OH 44023
dlem
cp
dt
el
dncs
L OR AI N
cm bk
bl
5
Inpatient pediatric services
bm
Neonatal/high-risk pregnancy services
M E DI NA
Outpatient pediatric surgery center
Pediatric emergency services
Specialty clinic
UH Rainbow urgent care
 Primary care pediatric practice only
 Locations with various services
Under the RAINBOW Winter 2014 | RainbowBabies.org
|
216-UH4-KIDS (844-5437)
3
ct
GEAUGA
9
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Primary care pediatric practice
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Key:
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C UYA H O G A ck
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SUMMIT
P O RTA G E
UH Geauga Medical Center
Lake West Medical Center
ct 13207 Ravenna Road, Chardon, OH 44024
ek 36000 Euclid Avenue, Willoughby, OH 44094
UH Otis Moss Jr. Health Center
Mercy Allen Hospital
dk 8819 Quincy Avenue, Cleveland, OH 44106
el 200 West Lorain Street, Oberlin, OH 44074
University PediatriCenter of Lorain
Mercy Regional Medical Center
dl 3600 Kolbe Road, Lorain, OH 44053
em 3700 Kolbe Road, Lorain, OH 44053
University Premier Pediatricians
Rainbow Physicians & Surgeons – Canfield
dm 9000 Mentor Avenue, Mentor, OH 44060
dn 18599 Lakeshore Boulevard, Euclid, OH 44119
do 7500 Auburn Road, Concord Township, OH 44077
dp 11100 Euclid Avenue, Cleveland, OH 44106
dq 8055 Mayfield Road, Chesterland, OH 44026
dr 22750 Rockside Road, Bedford, OH 44146
en 4137 Boardman-Canfield Road, Canfield, OH 44406
Hospitals and health centers
Crocker Corporate Center
ds 2055 Crocker Road, Westlake, OH 44145
Firelands Regional Medical Center
dt 1111 Hayes Avenue, Sandusky, OH 44870
2
1
Awarded
a top
hospital
honor
Southwest General Brunswick Medical Center
br 4065 Center Road, Brunswick, OH 44212
University Hospitals Rainbow Babies & Children’s Hospital is
Southwest General Health Center
only one in northern Ohio – to receive the Top Children’s
one of only 13 children’s hospitals in the country – and the
eo 18697 Bagley Road, Middleburg Heights, OH 44130
Hospital distinction from The Leapfrog Group. This national
St. John Medical Center
recognition honors UH Rainbow Babies & Children’s Hospital
ep 29000 Center Ridge Road, Westlake, OH 44145
for its exemplary performance in patient safety, quality
initiatives and highly reliable care.
TriPoint Medical Center
UH Rainbow Babies & Children’s Hospital was selected as
eq 7590 Auburn Road, Concord Township, OH 44077
a Top Hospital out of a record number of 1,324 hospitals
UH Ahuja Medical Center
participating in The Leapfrog Group’s annual survey. The list
er 3999 Richmond Road, Beachwood, OH 44122
includes 22 Top Rural Hospitals, 55 Top Urban Hospitals and
13 Top Children’s Hospitals. The selection is based on the
UH Chagrin Highlands Health Center
es 3909 Orange Place, Orange, OH 44122
results of The Leapfrog Group’s annual hospital survey, which
UH Concord Health Center
quality, focusing on three critical areas of hospital care: how
measures hospitals’ performance on patient safety and
do 7500 Auburn Road, Concord Township, OH 44077
patients fare, resource use and management structures in
place to prevent errors.
UH Geauga Medical Center
For more than 125 years, UH Rainbow Babies & Children’s
ct 13207 Ravenna Road, Chardon, OH 44024
Hospital has been a leader in innovation, research and
UH Landerbrook Health Center
A S H TA B U L A
specialty care for babies and children. In June 2013,
co 5850 Landerbrook Drive, Mayfield Heights, OH 44124
UH Rainbow Babies & Children’s Hospital was once again
UH Lyndhurst Surgery Center
ranked one of America’s Best Children’s Hospitals by U.S.
et 29017 Cedar Road, Lyndhurst, OH 44124
News & World Report in nine children’s specialties, including
#2 in the nation for neonatology, #7 for pulmonology and
UH Medina Health Center
#13 for endocrinology and neurology/neurosurgery.
bm 4001 Carrick Drive, Medina, OH 44256
UH Mentor Health Center
dm 9000 Mentor Avenue, Mentor, OH 44060
To view the results of The Leapfrog
Group’s annual survey, visit
UH Parma Medical Center
LeapfrogGroup.org/CP.
fk 7007 Powers Boulevard, Parma, OH 44129
TRUMBULL
UH Rainbow Babies & Children’s Hospital
11100 Euclid Avenue, Cleveland, OH 44106
UH Solon Health Center
cr 34055 Solon Road, Solon, OH 44139
Go online to find a
pediatrician or specialty
location near you
UH Sharon Health Center
fl 5133 Ridge Road, Wadsworth, OH 44281
MAHONING
bqen
UH Twinsburg Health Center
To find a pediatrician or UH Rainbow Care Network specialty
cn 8819 Commons Boulevard, Twinsburg, OH 44087
care location near you, call 216-UH4-KIDS (216-844-5437)
or visit RainbowBabies.org/Network.
UH Westlake Health Center
bo 960 Clague Road, Westlake, OH 44145
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5
women s
HEALTH CORNER
Cervical dysplasia: Pay attention
to a positive Pap test
Why a Pap test is essential
Dysplasia usually has no symptoms. In fact, you may have an HPV
infection that can potentially cause dysplasia for many years without
knowing it. Usually your immune system fights off the virus, and the
infection goes away.
But in some women, dysplasia progresses to cervical cancer, according to
Kimberly Gecsi, MD, an OB/GYN at University Hospitals MacDonald
Women’s Hospital. “That is why it is considered ‘precancerous,’ and why
regular Pap tests to examine cervical cells are critical,” explains Dr. Gecsi.
Dysplasia can clear up on its own. If not, doctors may treat it by removing
the abnormal tissue. “Women with dysplasia will likely need to have a
colposcopy or repeat Pap test to monitor the condition,” says Dr. Gecsi.
How you can reduce your risk
Dr. Gecsi says women face a higher risk for dysplasia and cervical cancer
if they:
nHave sex before age 18 or with multiple partners
nSmoke
nExperience a persistent high-risk HPV infection
nDo not get regular screenings
nTake immune-suppressing medication or have an illness that suppresses
the immune system
Kimberly Gecsi, MD
OB/GYN, University Hospitals
MacDonald Women’s Hospital
Assistant Professor, Case Western
Reserve University School of
Medicine
A
phone call from your doctor about your Pap test can be
worrisome. But abnormal results rarely mean cancer. More likely,
the abnormal cells on the surface of your cervix signal a condition
called cervical dysplasia.
Doctors do not know all the causes of cervical dysplasia, which is most
common in women ages 25 to 35. Certain types of human papillomavirus
(HPV) are responsible for most cases of severe dysplasia. These same HPVs
can also cause cervical cancer.
Using condoms, remaining smoke-free and limiting sexual partners can help
women avoid cervical dysplasia. Women ages 26 and younger can be
vaccinated against certain types of HPV. Two vaccines – Gardasil and
Cervarix – are available.
Dr. Gecsi points out that regular screening is also important. The United
States Preventive Services Task Force suggests that most women ages 21 to
65 should have a Pap test once every three years. Women ages 30 to 65 can
choose to instead have a Pap test once every five years along with a human
papillomavirus (HPV) test. “Women older than 65 who have had normal
screenings and do not have a high risk for cervical cancer do not need Pap
tests,” advises Dr. Gecsi. “Speak with your doctor about the schedule that is
best for you.”
Need help determining whether you are
due for a Pap test?
Schedule an appointment with a UH MacDonald Women’s Hospital OB/GYN
today. Visit UHhospitals.org/MacDonald and click “Request an Appointment”
or call 1-866-UH4-CARE (1-866-844-2273).
6
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Empowered by education, support
Group prenatal and parenting programs benefit moms and babies
Celina Cunanan, CNM, MSN
Division Director of Nurse Midwifery,
UH MacDonald Women’s Hospital
Clinical Assistant Professor, Case
Western Reserve University School
of Medicine
A
s a mother, you want to give your baby
the very best start. But sometimes it is
difficult to know exactly how. University
Hospitals MacDonald Women’s Hospital is
helping women have healthy pregnancies through
the Centering Pregnancy Program. This unique
program not only empowers women to take
control of their health but also gives them the
knowledge to help their child grow.
The Centering Pregnancy program, which is
offered at UH MacDonald Women’s Hospital and
UH Ahuja Medical Center by the Division of
Nurse-Midwifery, is an innovative prenatal
program. This care model combines prenatal
health assessment, education and psychosocial
support all together in a group setting. Pregnant
women whose babies are due around the same
time are placed in groups of about 10 – 12
participants and begin these sessions between
16 – 20 weeks of pregnancy. Each woman is
encouraged to bring one support person with her,
whether it be the father, husband, significant
other, or a friend or family member.
Better than routine prenatal care
“The program takes the place of regular office
appointments,” explains Celina Cunanan, CNM,
MSN, Division Director of Nurse Midwifery at
UH MacDonald Women’s Hospital and program
leader. “We do everything we would normally do
in an office visit, including ordering necessary
tests, reviewing lab results and conducting belly
checks. In addition, women are involved in selfcare activities, such as checking their own weight
and blood pressure, which really helps empower
them to take control of their health during their
pregnancy. Then we gather for a facilitated group
discussion to give these women the opportunity to
learn from each other about the incredible
changes that are happening to them as they
grow this new life.”
Group education and guidance
A new topic is introduced at each of the
program’s 10 sessions, which help educate
women on issues such as nutrition and
healthy weight goals, relationship issues,
what to expect during labor and birth, how
to care for the baby afterward, postpartum
depression and much more. They may also
include activities such as prenatal exercise and
healthy recipe exchanges.
“As health professionals, we are able to spend
so much more time with our patients by working
in a group setting. Each session is about two
hours, allowing us more face-to-face contact with
our patients to answer questions and provide more
in-depth information than in a busy office setting,”
says Cunanan. “In addition, by going through
their pregnancies together, these women mentor
each other and create a strong supportive network.
Through this shared journey, it is really amazing to
watch how these women from all different walks
of life bond and support each other through this
life-changing time in their lives.”
UH MacDonald Women’s Hospital began the
program in 2010. Since then, it has positively
impacted the lives of more than 800 expectant
mothers and has shown better outcomes for both
moms and babies than in traditional prenatal care,
especially for those moms who are considered atrisk. The Centering Pregnancy Program has a preterm birth rate of 10 percent and low birth weight
rate of 9 percent, both of which are better than
state and national averages. It has also been shown
to increase visit compliance, breastfeeding rates
and patient satisfaction with their care while
decreasing postpartum depression rates.
Program expansion
Due to the success of the group care model,
UH MacDonald Women’s Hospital recently began
Sugar Mamas – a prenatal group specifically
designed for the unique needs of high-risk
pregnant women with diabetes. This includes
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those who had diabetes before pregnancy as well
as those who developed it during pregnancy. This
program is being offered by the Division of
Maternal Fetal Medicine under the direction of
Stacey Ehrenberg, MD.
In 2012, the hospital also started Centering
Parenting, in conjunction with the Department of
Family Medicine. “The Centering Parenting
Program naturally grew out of the pregnancy
groups. These women spent much of their
pregnancy together and wanted to see and
support each other as new moms,” says Cunanan.
The Centering Parenting Program groups innercity mothers and infants together for baby’s first
15 months of life. The program provides wellbaby visits, including scheduled immunizations as
well as postpartum care and birth control for new
moms. More importantly, it also provides
parenting skills to both moms and dads and gives
them tools to help them succeed as parents.
“These programs empower women to take
control of their health and pregnancy and give
their baby the best start,” explains Cunanan.
“They change lives.”
Are you expecting?
Call 216-844-7403 to learn more
about the Centering Pregnancy or Centering
Parenting programs. And sign up to receive our
FREE new and expectant parent e-newsletter at
RainbowBabies.org/UnderTheRainbow.
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7
Getting tweens and teens
the care they need
T
hey have stopped playing with dolls and
toy trucks, and now they need a weekend
curfew. They are tweens and teens.
Neither children nor adults, adolescents are
dealing with important physical and emotional
changes. Their health care needs are changing,
too, as they cross that bridge from pediatrician to
adult-care physician.
Troubling transitions
Unfortunately, that journey is often a bumpy one.
A significant number of pediatricians responding
to a recent national survey indicated they do not
provide transition support services for
adolescents who are moving to adult providers.
As a result, many adult-care physicians feel
unprepared to accept some of these patients,
particularly those with complex conditions.
Rina Lazebnik, MD
Chief, General Pediatrics and
Adolescent Medicine, UH Rainbow
Babies & Children’s Hospital
Professor, Case Western Reserve
University School of Medicine
Enter the specialist
As medical doctors certified in internal medicine
or pediatrics, adolescent medicine specialists have
extra training in adolescent health issues and
provide all aspects of care – from physical exams
and treating illness to attention problems and
nutrition. They specialize in the physical, sexual,
psychological and social development of patients
ages 11 to 21.
Rina Lazebnik, MD, Chief of General
Pediatrics and Adolescent Medicine at University
Hospitals Rainbow Babies & Children’s Hospital,
is board-certified in adolescent medicine and in
general pediatrics. She says, “Adolescent medicine
specialists work with other physicians and
parents to help patients switch smoothly from
pediatric care to a more adult setting. The goal is
to help adolescents become more independent in
their own health care decisions. And gain
understanding of their medical problems.”
Clued-in on adolescents’ concerns
Adolescent medicine specialists like Dr. Lazebnik
are well-trained in the health issues so common to
tweens and teens, including:
n Acne
n Allergies
n Eating disorders
n Menstrual disorders
n Birth control and pregnancy
n Sexually transmitted diseases
n Growth problems
n Eye and ear disorders
n Learning disabilities
n Sports-related injuries
n Substance abuse
n Depression
n Fatigue
According to Dr. Lazebnik, fatigue is a common
concern. “Many teens often feel so exhausted that
they miss school and cannot play sports or go out
with friends,” she says.
For many tweens and teens, some of these
issues are hard to talk about with adults. But
adolescent medicine specialists are there for them
and their families. “We know how to make them
feel comfortable and are able to facilitate
improved communication between themselves and
their parents,” says Dr. Lazebnik.
Be there for your child
Do you feel that your child could benefit from an
adolescent medicine specialist? Ask your primary
care physician for a referral to one. Work with
this new doctor and your child as a team.
Together you can take steps to help your tween or
teen gain control and independence in managing
his or her health care.
Specialized care is just a phone call away
To schedule an appointment with an adolescent medicine specialist at UH Rainbow Babies & Children’s
Hospital or an adolescent gynecologist at UH MacDonald Women’s Hospital, call 216-844-5437. Or request an
appointment online at RainbowBabies.org.
8
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216-UH4-KIDS (844-5437)
Find a physician online: RainbowBabies.org/PhysicianFinder
Battling childhood obesity:
How to keep your kids
trim and healthy
Naveen Uli, md
Medical Co-Director, Healthy Kids,
Healthy Weight, UH Rainbow Babies
& Children’s Hospital
Associate Professor,
Case Western Reserve University
School of Medicine
A
s your child grows out of the toddler
years, excess weight can become a serious
concern – perhaps putting him or her at
risk for some very grown-up health problems.
When should you be concerned about your child?
At your child’s regular checkups, the doctor will
look at body mass index (BMI) and growth charts
to determine if he or she is within healthy weight
limits. Children are usually considered overweight
if their BMI is at or above the 85th percentile.
Children with a BMI in the 95th percentile or
higher are considered obese.
No laughing matter
If your child is overweight, or crossing percentiles
and trending toward overweight, it is important
for you to address the problem, according to
Naveen Uli, MD, Pediatric Endocrinologist and
Medical Co-Director of Healthy Kids, Healthy
Weight™ at University Hospitals Rainbow Babies
& Children’s Hospital. Dr. Uli says that is because
overweight kids are at risk for developing
typically adult health problems, including:
n Type 2 diabetes
n High cholesterol
n High blood pressure
Plus, unlike their slimmer peers, they are much
more likely to develop serious health problems
down the road, such as heart disease.
The skinny on childhood obesity
Just how serious a problem is childhood obesity?
Consider these facts and figures:
n Over the past three decades, the childhood
obesity rate has more than tripled.
n Today, about 17 percent of children and teens
ages 2 to 19 are obese.
n Children with a high BMI are more likely to
have enlarged hearts, putting them at risk for
heart disease later in life.
n According to one study, 70 percent of obese
children have at least one heart disease risk
factor, such as high cholesterol or blood
pressure, and 39 percent have two or more
risk factors.
n Type 2 diabetes, previously seen mostly in
adults, is increasingly common among
children. Experts believe childhood obesity is
the cause.
n Overweight children are more likely to
develop metabolic syndrome, which is really a
group of health problems, including high
blood sugar, high blood pressure, and low
levels of “good” cholesterol, which put kids at
risk for diabetes and heart disease.
Eating right
“Focus on providing nutritious meals and snacks
and teaching healthy food choices,” says Dr. Uli.
That means:
n Cutting out snacks with little nutritional
value, like potato chips
n Offering whole-grain crackers, low-fat cheese,
yogurt, fruits and vegetables
n Limiting soda and sugary fruit drinks and
giving them skim milk or water instead
Overcoming childhood
obesity
Childhood obesity can become a vicious cycle of
weight gain, inactivity and a cascade of health
consequences. UH Rainbow Babies & Children’s
Hospital’s Healthy Kids, Healthy Weight program is
breaking the cycle – getting families back on track
for better health.
Learn how Healthy Kids, Healthy Weight staff is
helping families in and around Cleveland to be
more active, eat well and maintain a normal
Get them moving
Dr. Uli recommends that children exercise at least
60 minutes a day most days of the week, but
that does not necessarily mean 60 minutes in
organized sports.
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weight through community education. For details
or to enroll in the program, call 216-844-1966.
Reference these growth charts to determine your
child’s BMI: www.cdc.gov/growthcharts/
clinical_charts.htm.
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9
Ask the expert
Am I giving my child the right dose
of acetaminophen?
acetaminophen on hand that has the old
concentration. If this medicine has not expired,
it can be used – but carefully read the label to
ensure the correct dose is given.
Douglas Hackenberg, MD
Pediatrician, Children’s Medical
Group in Akron and Hudson
Clinical Instructor, Case Western
Reserve University School of
Medicine
Q
Q How can I tell the difference between
the older and newer concentrations
of acetaminophen?
What should I know about
acetaminophen dosing?
It is now a little easier to give your child the
A right dose of acetaminophen. That is
because the amount, or concentration, of
acetaminophen in liquid forms is now the same,
whether the bottle says it is for infants or older
children. The bottles for infants usually come with
a syringe, though, instead of a dosing cup.
“In the past, medicine designed for the
youngest children – often sold with a dropper –
was much more concentrated than the liquid for
older children,” explains Douglas Hackenberg,
MD, a pediatrician at Children’s Medical Group
in Akron and Hudson, part of the UH Rainbow
Care Network. “Parents who are unaware of the
differences in amounts of acetaminophen could
accidentally give a child either too much or too
little medicine.”
Parents should not completely let down their
guard, however. They may still have some liquid
The older medicine will refer to
A “80 mg/0.8 mL” or “80 mg/1 mL” on
the label. The newer medicine will have
“160 mg/5 mL” on the label.
As a parent, you want your child’s health in the hands of
professionals who are experienced in pediatric care. You also
value this trusted care when it is offered in a location close to
home. That is why University Hospitals Rainbow Babies &
Children’s Hospital is introducing inpatient pediatric services
for children and teens with general medical and surgical needs
at University Hospitals Ahuja Medical Center.
Launching in April 2014, the new inpatient pediatric
services are an extension of the nationally ranked UH Rainbow
Babies & Children’s Hospital, offering advanced, familycentered care in a secure, child- and family-friendly
environment and an onsite team of board-certified
pediatricians, surgeons, pediatric nurses, child life specialists
and other pediatric-trained experts – all backed by the full
resources of the region’s most trusted name in pediatric care.
Designed to support children’s unique medical, comfort
What is the right dosage of
acetaminophen for infants?
Q
Introducing inpatient
pediatric services at
UH Ahuja Medical Center
and safety needs, the new inpatient pediatric services will
adhere to the quality protocols, clinical care pathways,
“While the new formula is helpful to
parents,” explains Dr. Hackenberg,
“most labels do not include the dosage for
children younger than age 2.” Dr. Hackenberg
and the American Academy of Pediatrics say
parents should take a child age 12 weeks or
younger to the doctor if he or she has a fever
instead of trying to treat the fever at home.
The only exception to this is for children
8 weeks of age or older who have a fever
following a vaccination.
A
comfort measures, communication and evidence-based
patient care standards of UH Rainbow Babies & Children’s
Hospital, including:
n
Multidisciplinary approach to clinical care with
subspecialty collaboration
n
Highly coordinated care and comprehensive
discharge planning
n
Inclusion of the family in the child’s individualized
care plan
nSleeping accommodations for parents by the bedside
n
Specialized metrics for pediatric care quality, safety
and satisfaction
UH Ahuja Medical
Center is located
near the intersection
Follow these dosage guidelines:
of I-271 and Harvard
Road in Beachwood,
Older formula of
acetaminophen
(dropper)
Infants’ or
children’s liquid
(syringe)
Children’s
Chewable
tablets
Junior Strength
Chewable
tablets
(80 mg/0.8 mL or
80 mg/1 mL)
(160 mg/5 mL)
(80 mg)
(160 mg)
6 – 11 lbs.
0.4 mL
1.25 mL
—
—
12 – 17 lbs.
0.8 mL
2.5 mL
—
—
18 – 23 lbs.
1.2 mL
3.75 mL
1 ½ tabs
—
24 – 35 lbs.
1.6 mL
5 mL
2 tabs
1 tab
Child’s
weight
Dr. Hackenberg recommends that families keep a centralized record for ANY medication given to children to prevent
accidental double dosing.
10
Under the RAINBOW Winter 2014 | RainbowBabies.org
|
216-UH4-KIDS (844-5437)
Ohio. Participating
with all major
insurance plans in
the region.
We have answers
Submit your pediatric health-related question
at RainbowBabies.org/AskRainbow and get an answer
from one of our pediatric experts within 48 hours.
Can weather make you feel sick?
Hey, k
id
This p s!
age
is for
you.
Bocorner
s
F
rightful weather can make you feel extra worse if you have asthma.
When it is cold, wet or windy outside, or when the weather changes
very quickly, you might have more symptoms.
Do not let Old Man Winter or his friend Jack Frost get you down. Here
is how you can feel better, rain or shine.
Dress up. When it is cold, wear clothes that keep you warm. Cover
your face with a ski mask. Or wrap a scarf around your face and nose
to keep from breathing in cold air.
Change your plans. Skiing, ice-skating or running outside might be
fun. But if they make you feel bad, ask your friends to do something
else. Try going for a dip in an indoor pool. The warm, wet air is good for
your lungs.
Talk with an adult. Tell your parents or another trusted grown-up if
you are outside and do not feel well. If you have trouble breathing,
cannot stop coughing, or have a tight feeling in your chest, speak up.
❜
Picture postcards
Most of the time, you probably call or email your friends and family to
keep in touch when you are apart. Why not brighten a friend’s day with
an extra-special “hello” and mail him or her a picture postcard instead?
Instructions:
1. Cut out pictures from magazines.
2. G
lue the pictures onto one side of a postcard-sized piece of poster board.
You can also use a 4x6-inch blank index card.
Keep your medicine handy. Your doctor will explain how to use your
inhaler and spacer. Take them along with you into the great outdoors.
3. Turn the card over. On the left side, write your message. In the middle of
the right side, write your friend or family member’s name and address.
4. S tick a stamp on the upper right corner.
Care Bears™ and related trademarks ©2014 Those Characters From Cleveland, Inc.
Learn more about Bo at RainbowBabies.org/Bo.
5. Mail your postcard!
Playing outside? Stay safe
Lots of kids can hurt themselves during skiing, snowboarding,
sledding or skating. Follow these tips from Bo the Take Care
Bear to stay safe:
1. Wear a helmet, warm clothes, goggles or wrap-around
sunglasses, and gloves or mittens.
2. If you are sledding, stay clear of trees, poles or benches that
you might run into. Make sure that your path does not lead to
streets or highways, either.
3. If you are skating, skate in the same direction as the crowd at
all times – and never skate alone. Do not chew gum or eat
while skating.
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Take Car win a Bo the
e Bear p
lus
Rainbow
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rg/Bo.
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11
University Hospitals of Cleveland
Rainbow Babies & Children’s Hospital
11100 Euclid Ave., MSC-9160
Cleveland, OH 44106
Under the Rainbow is published by
UH Rainbow Babies & Children’s
Hospital. Articles in this newsletter
are written by professional
journalists or physicians who strive
to present reliable, up-to-date
information. But no publication
can replace the care and advice of
medical professionals, and readers
are cautioned to seek such help
for personal problems. All models
used for illustrative purposes only.
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Ranked one of America’s Best
Children’s Hospitals in nine children’s
specialties by U.S. News & World Report
– including neonatology, pulmonology
and orthopaedics.
Learn more at RainbowBabies.org/
USNews.
visit us online
On the Web: RainbowBabies.org
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Lack of sleep can harm a child’s health
Carol Rosen, MD
Medical Director, Pediatric Sleep Center,
UH Rainbow Babies & Children’s
Hospital
Professor, Case Western Reserve
University School of Medicine
W
hen children are young, we tuck them in
at night and see them off to school in the
morning. As they turn into teenagers,
though, it gets harder to track how much time they
actually spend asleep. Now a growing body of
research shows we need to watch kids’ shuteye at
every age.
Sleep’s deep effects
“The average child needs between 12 and 18 hours of
sleep per day during the first year of life,” says Carol
Rosen, MD, Medical Director of the Pediatric Sleep
Center at University Hospitals Rainbow Babies &
Children’s Hospital.
All this sleep helps a baby’s brain develop. As
children grow older, they need fewer hours of sleep:
10 – 12 hours a night for preschoolers, at least nine
hours for school-age children and eight to nine hours
for teens. But the importance of sleep does not fade.
“Sleep helps us solve problems, react quickly, form
memories and learn. Inadequate sleep affects how well
kids do in school. It also impacts a child’s physical
well-being,” she says. “The body releases hormones
during sleep that aid growth, build muscles and repair
cells and tissues.”
A study in Pediatrics found that childhood sleep
deficiencies may be linked to future problems, too.
Among them: decreases in mental functioning that
begin as early as adolescence. Increasing evidence also
suggests that poor sleep contributes to major health
problems, such as obesity.
sleep schedules of young children, they tend to step back
in high school. Because sleep is so critical, however, you
should stay involved.
First, recognize the signs that your child is not getting
enough sleep. According to Dr. Rosen, two key signs are
changes in mood and a slide in motivation. Sleepy teens
have trouble waking up in the morning, are irritable late
in the day, sleep extra long on weekends and/or doze off
during the day in school.
Next, understand what is keeping your teen awake.
“Many factors may play a role, and some – such as early
school start times – you cannot control. But some you
can,” says Dr. Rosen.
What you can do
Dr. Rosen recommends following these steps to help
your child get a good night’s sleep:
nEncourage a consistent sleeping and waking schedule,
weekdays and weekends.
nTurn off/collect/remove electronic media and games
(computers, television, cell phones and text messaging)
when it is near time for bed. Kids can check them
back out in the morning after a peaceful night’s sleep.
nHelp your kid create a good sleep environment – a
place that is quiet and dark.
nLimit teens’ caffeine intake, especially energy drinks.
Sometimes a sleep disorder is responsible for poor rest.
For example, sleep apnea causes pauses in breathing
during sleep and leads to daytime tiredness. If you
think a sleep disorder may be affecting your child, talk
with a doctor.
Find resources online that
support a good night’s sleep
The Pediatric Sleep Center offers a variety of online resources for children
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Cultivate teen dreams
Researchers say children’s sleep problems should not
be ignored. While parents are often involved in the
and parents, including age-appropriate sleeping tips and a step-by-step
guide to prepare you and your child for a sleep study. Learn more at
RainbowBabies.org/Sleep.