Kid Biz! - Northeast Rehabilitation Hospital Network

Northeast Rehabilitation Hospital Network
Kid Biz!
All that’s news in Pediatrics
Around the Network
Summer | 2014
Keep up with the latest happenings at NRH Pediatrics
Methuen
We are glad to welcome back our OT, Diem Nguyen from maternity leave. Thank you for
your patience with scheduling during her absence.
Lowell
We would like to welcome back our OT, Emmanuelle Langlais Flagg from maternity leave.
Congratulations on your beautiful twin girls!
Lawrence-Amesbury Street
We are happy to welcome Melissa Pierce M.S, CCC-SLP to our pediatrics team! Melissa is
fluent in Spanish and comes to us with experience using the It Takes Two to Talk Hanen
Program.
Feeding Your Creative Side
IN THIS
Issue
1 Around the Network
1 Painting as a Family
2 Ten Signs Your Child May Be
Gluten Intolerant
3 Diagnose Swallowing
Disorders
4 The Zones of Regulation
5 Great Summer Reading
6 Homemade Chicken Tenders
7 Sleep Hygiene for Children
Northeast Rehabilitation
Hospital Network
70 Butler Street
Salem, NH 03079
www.NortheastRehab.com
Painting as a Family Affair!
Are you looking for a fun, creative indoor activity for the whole
family? There are painting studios in southern New Hampshire
and northern Massachusetts which are great for Mom’s night
out, family time, or even kids’ birthday parties. The painting is
low pressure, fun, and really very simple. You are sure to leave
with something you love and feel proud of!
How it works: Approximately 10-30 people sit at long tables and
follow easy painting instructions step-by-step to create a canvas
masterpiece which you can take home the same day. While all
people are painting the same picture, no two paintings will look
the same. Experienced painters are also on-hand to help fix up
any large mistakes leaving for errorless painting fun!
The studios host painting sessions each week which are open
to the public and can be reserved easily online. The studio
websites provide information on specific dates/times, paintings
featured and when they are offering family time. Some painting
studios serve food and drinks which are available for purchase
while painting, others allow you to bring your own drinks and
snacks. Private parties and events are also available – prices and
discounts vary. Below is a listing of some local paint studios in
and around MA and NH.
Paint Party Art and Entertainment
www.paintpartynh.com
(603) 912-5441
63 Range Rd., Suite 202
Windham, NH 03067
Muse Paintbar
www.musepaintbar.com
(603) 421-6500
42 Hanover St.
Manchester, NH 03101
Images taken from
www.paintpartynh.com/
images.html
The Canvas Road Show
www.thecanvasroadshow.com
(603) 943-2103
176 South River Rd.
Bedford, NH 03110
Brush Strokes Art Studio
www.sandysbrushstrokes.com
(508) 572-0853
1445 Main Street Unit#3
1
Tewksbury, MA 01876
Kid Biz!
2
All that’s news in Pediatrics
10 Signs Your Child May Be Gluten Intolerant
Check to see
if your child
has these
symptoms
Gluten is a protein found in grains such as wheat, barley, and rye. A gluten-free diet is used
to treat symptoms of Celiac disease. Gluten intolerance in people without celiac disease is
a controversial issue. Gluten intolerance is diagnosed in up to 15 % of the US population,
although some doctors believe that up to 30-50% of the world’s population is affected. Not
all individuals with gluten intolerance have a diagnosed gluten allergy or Celiac Disease,
in that their bodies show immune responsive antibodies in the presence of gluten. Some
people will only display signs and symptoms of sensitivity or intolerance during the
digestion of gluten.
1. Digestive issues- Gas, bloating, constipation or diarrhea which improves when gluten is
removed from the diet.
2. Fatigue and brain fog- Unprocessed gluten can block your body’s mental and physical
energy.
3. Skin rash- Red, itchy or peeling skin or eczema within a few hours of gluten
consumption.
4. Keratosis Pilaris- This skin condition (small bumps that look like “goose bumps” on the
face, back of the upper arms, and thighs) occurs due to the malabsorption of fats and
resulting vitamin A and fatty acid deficiency which can be caused by gluten intolerance.
5. Dark Circles under his/her eyes- Food intolerance taxes the adrenals leading to lack of
proper nutrition absorption and dark circles.
6. Frequent colds and flus- The compromised adrenal response leaves a child’s immune
system vulnerable.
7. Runny nose that doesn’t clear up with the end of a cold- This is the body’s effort to rid
itself of excess mucous which can be due to undigested gluten.
8. Dizziness and imbalance- This can result from inflammation of the nervous system due
to the gluten intolerance.
9. Headaches and joint pain- This can be caused by inflammation to the body due to
gluten sensitivity.
10. Mood issues- While these conditions (anxiety, hyperactivity, mood swings, depression
and ADD) can be caused by a number of issues, if your child is displaying them, it may
be worthwhile to test for gluten allergy.
As always, if you are concerned about your child’s health, you should follow-up first with
your pediatrician before adapting a modified diet. While going gluten-free can be difficult
and expensive, one can consider reducing but not eliminating all gluten from the child’s diet
as well.
Sources:
http://realfitmama.org/blog/2013/10/21/10-signs-of-gluten-intolerance http://www.nlm.
nih.gov/medlineplus/ency/article/001462.htm
http://health.usnews.com/health-news/blogs/eat-run/2013/11/05/what-is-non-celiacgluten-sensitivity
Image from http://www.cnn.com/2011/HEALTH/04/12/gluten.free.diet.improve and http://
cakeandcarrots.wordpress.com/tag/intuitive-eating/
We hope you find these articles interesting and helpful. Have an idea for the
next Kid Biz? Email your article idea to kidbiz@northeastrehab.com
Modified Barium Swallow Studies
Diagnose Swallowing
Difficulties
Does your child have difficulty swallowing food or liquid? Does your child cough, choke, turn
colors, have teary eyes, or changes in breathing / congestion during meal times? Does your
child’s voice sound wet, gurgly immediately after drinking? Does your child have reflux /
vomit after eating, refuse to eat certain foods, or have frequent colds / respiratory infections /
Pneumonias?
The presence of these signs and symptoms may reflect aspiration, which occurs when food or liquid “goes down the
wrong pipe” and enters the lungs while eating and/or drinking. Aspiration can be the cause of serious chest infections
such as pneumonia and a health risk. If your child frequently aspirates food and/or liquid, they may have a swallowing
impairment and may require a modified diet until symptoms resolve.
The best test to help clinicians identify how a child is managing food and liquids throughout all stages of the swallow is
called a pediatric modified barium swallow (MBS) study. An MBS is an X-ray video of the mouth and throat that shows
how a child swallows foods and liquids. The study provides detailed information on how safely a child can eat and drink,
identifying on an X-ray during feeding trials if any food or liquid is moving toward or entering the child’s lungs.
What are the steps? First, a prescription from your child’s doctor is necessary to complete the feeding evaluation and
the MBS. Next, your child’s speech-language pathologist will complete a formal feeding evaluation to determine if
they are appropriate for the video swallow study. On the day of the MBS, your child will take a few bites / sips of foods
and liquids of various textures (thin liquid, puree, soft solid etc) coated in liquid or powered Barium, an element that
illuminates white on a black and white X-ray. You and your child’s therapist will be able to see your child’s swallow realtime and determine if your child is at risk for aspiration.
We are pleased to announce that Northeast Rehabilitation Hospital network has initiated its next exciting step in the
Feeding Program. We are now performing pediatric Modified Barium Swallow (MBS) Studies (also known as videofluoroscopic evaluations) at the main hospital in our Salem Pain Clinic’s radiology suite. Judith Mikami, Speech and
Language Pathologist, is training our clinical feeding team to complete formal swallow studies using video-fluoroscopy
in order to carry out comprehensive feeding evaluations and treatment programs for our clients with feeding /
swallowing disorders. For more information, please contact your child’s speech-language pathologist.
https://www.google.com/search?hl=en&site=imghp&tbm=isch&source=hp&biw=1440&bih=805&q=pediatric+sw
allow+study&oq=pediatric+swallow+study&gs_l=img.3..0i24.793.4158.0.4268.23.13.0.10.10.0.134.1276.8j5.13.0....0
...1ac.1.39.img..0.23.1346.xaWXwKH0DFM#facrc=_&imgdii=_&imgrc=EgKVJK0Xh-as1M%253A%3BmlZ9NWParkArM%3Bhttp%253A%252F%252F3.bp.blogspot.com%252F-8h3Arm-Z4C4%252FTXcP5Qh0GhI%252FAAAAAAAAIEI%
252Fbtr35-FfP4Y%252Fs400%252Fswallow%25252Bstudy.jpg%3Bhttp%253A%252F%252Foliverpalmer.blogspot.
com%252F2011%252F03%252Folivers-mri-and-pediatric-swallow-study.html%3B250%3B333
http://3.bp.blogspot.com/-8h3Arm-Z4C4/TXcP5Qh0GhI/AAAAAAAAIEI/btr35-FfP4Y/s400/swallow%2Bstudy.jpg
3
New Self Regulation Program for Students
The
Zones of
Regulation
Important Contact
Information
A new self-regulation program has
been adopted by many school districts
nationwide for use with all students. It
can be especially effective for children
with sensory or emotional regulation
challenges. It’s called The Zones of
Regulation, and was written by Leah
Kuypers, an occupational therapist.
The basic premise is to teach students
about various zones that describe
different states of being. The green zone
is the ideal zone for learning, reflecting
being focused, attentive and generally in
a good place. The other choices include
the blue zone, reflecting tired, bored or
sad, and the yellow zone, which means
starting to become agitated, silly or
unfocused. Finally, there is the red zone
which refers to being out of control,
aggressive or mean.
Once the students are able to recognize
their zones, they are taught to identify
various regulating activities which can
be done in school or at home to help
them stay or get into the green zone.
Examples of activities are animal walks
(crab, bear, bunny), jumping jacks,
getting a drink, running an errand or
doing chair or wall push-ups. Below is
Major Events in Month 2010: Dates and times are subject
to change Please check our website for latest information
some of the key vocabulary used with
the Zones of Regulation program.
Self Regulation: The ability to achieve
the preferred state of alertness for the
given situation. This includes regulating
one’s body’s needs as well as one’s
emotions.
Toolbox: A collection of calming and
alerting strategies a student can pull
from depending on the present need.
Tools or strategies: Used
interchangeably to refer to a calming or
alerting technique that aids the student
in self-regulation.
*Expected Behaviors: Behaviors
that give people around you good or
comfortable thoughts about you.
*Unexpected Behaviors: Behaviors that
give people uncomfortable thoughts
about you.
*What is the size of the problem? Is
this a Big or Little Problem? Questions
posed to help students measure
the size of the problem they are
experiencing. Big problems get big
reactions and little problems should
only lead to little reactions.
**Superflex thinking: A flexible
thinking pattern in which a person is
able to consider different points of view
or ways to do something.
**Rock Brain thinking: A rigid
thinking pattern in which a person
gets stuck on an idea and has difficulty
considering other options or ways to do
something.
Sources:
The Zones of Regulation by Leah Kuypers
(2011)
*Thinking About YOU Thinking About ME by
Michelle Garcia Winner (2007)
**Superflex: A Superhero Social Thinking
Curriculum by Michelle Garcia Winner and
Stephanie Madrigal (2008)
Great Summer Reading!
Good Books with Great Messages
Below are some beautifully written and
illustrated books that members of our
staff have read and that parents have
recommended.
More Than a Mom: Living a Full and
Balanced Life When Your Child Has
Special Needs
Heather Fawcett, Author
Amy Baskin, Author
MORE THAN A MOM explores how
women can lead rich, fulfilling
personal lives while parenting a
child with special needs. The authors’
skillful blend of research, personal
experiences, and feedback from over
500 mothers across North America
results in a book that is jam-packed
with practical strategies, advice, and
reassurance for mothers trying to
create more manageable and fulfilling
lives. MORE THAN A MOM addresses
the universal concerns and questions
of all mothers, coupled with the added
intensity of raising children with
disabilities. This how-to guide looks at
the challenges mothers face at home,
at work, and within themselves, with
special attention paid to:
•
•
•
•
•
•
•
•
•
•
Staying healthy both physically
and emotionally;
Keeping friendships;
Staying organized;
Maintaining your marriage;
Nurturing interests and goals;
Seeking flexible work options;
Changing careers or starting a
business;
Rejoining the workforce;
Finding specialized childcare;
Advocating for your child.
The mothers who were interviewed for
the book have diverse backgrounds
and family dynamics. Given their
differences, and the fact that their
children have such varied disabilities, it
is striking that these mothers face such
similar issues.
MORE THAN A MOM provides mothers
with many voices and solutions
that will resonate with their own
circumstances. Husbands, extended
family, friends, support organizations,
and service providers will also want to
read this insightful and fact-filled book.
(Amazon.com)
The Game of My Life: A True Story of
Challenge, Triumph, and Growing Up
Autistic
Jason J-Mac McElwain, Author
Daniel Paisner, Author
Here is the riveting true story of Jason
McElwain, better known as “J-Mac”, the
autistic student who made headlines
when he scored twenty points,
including a school record six threepointers, for his high school basketball
team in 2006. Including the revealing
perspectives of J-Mac’s family and
coach, this is McElwain’s inspiring
account of the challenges of growing
up autistic-- not only for himself, but
for his family. It’s also the tale of his
unlikely star turn, the difference it made
in his journey through life, and all the
heartbreaking and heart-lifting stops
along the way. (Amazon.com)
Baked Nuggets-The Healthier Choice
Homemade chicken
tenders that satisfy
almost any dietary
restriction
Crunchy chicken tenders are a snack loved by all ages. With so many children following a limited diet, finding a
recipe that meets all the requirements of a good chicken tender can be tricky. While browsing the internet, as I
often done when searching for recipes, I came across a plethora of recipes all claiming to be the perfect gluten
free chicken tender. After much debate, I settled on one from a website entitled “Gluten Free Mom” (www.
glutenfreemom.com). Not only is this a gluten free recipe, but corn, dairy, egg, and soy free as well.
Baked Chicken Nuggets
Ingredients:
2-4 chicken breasts
¼ cup canola or olive oil
1 teaspoon salt
gluten free bread crumbs
Instead of using chicken breasts and taking the time to pound them into thin strips I bought a package of tenders.
I also prefer a bit more seasoning so I added in some pepper and garlic powder, but feel free to season to your
family’s individual tastes. For the gluten free bread crumbs, I prefer the brand Glutino (www.glutino.com). They
become crunchy and toasted even giving the look of traditional chicken tenders.
Preparation:
1.
2.
3.
4.
5.
6.
Preheat the oven to 450 degrees.
Place chicken in a bowl, pour ¼ cup of canola or olive oil over tenders, mix.
Add salt and other seasons, mix until coated.
Add gluten free bread crumbs, roll up your sleeves and mix until evenly coated.
Place tenders on a lined, oiled baking sheet.
Baked for 15-20 minutes at 450 degrees, flipping halfway through and drizzling with a little extra olive oil to
help crisp.
With such a fast and easy recipe even the kids can help, let them get their hands messy mixing the chicken with the
bread crumbs. Select your favorite gluten free dipping sauce and enjoy!
*In addition to the never-ending gluten free recipes, the recipe website also provides suggestions to help ease the
transition towards a gluten-free lifestyle, gluten-free product reviews, travel tips, and how to dine out among other
things. After making this delicious gluten free recipe I highly suggest browsing the website.
Patient and Family Education
Sleep Hygiene for Children
Follow these tips to
help your child adopt
good bedtime
routines.
1. Keep consistent bedtimes and wake times every day of the week. Late
weekend nights or sleeping-in can throw off a sleep schedule for days.
2. Avoid spending lots of non-sleep time in bed – spending hours lying on
a bed doing other activities before bedtime keeps our brains from
associating the bed with sleep time.
3. Child’s bedroom should be cool, quiet and comfortable.
4. Those children who stare at clocks should have their clocks turned away
from them.
5. Bedtime should follow a predictable sequence of events, such as
brushing teeth and reading a story.
6. Avoid high stimulation activities just before bed, such as watching
television, playing video games, or exercise. Do not do these things
during a nighttime awakening either. It is best not to have video games,
televisions, or telephones in the child’s bedroom.
7. Having physical exercise as part of the day often helps with sleep time
many hours later.
8. Relaxation techniques such as performing deep, slow abdominal breaths
or imagining positive scenes like being on a beach can help a child relax.
9. Avoid caffeine (sodas, chocolate, tea, coffee) in the afternoons/evenings.
Even if caffeine doesn’t prevent falling asleep it can still lead to shallow
sleep or frequent awakenings.
10. If a child is awake in bed tossing and turning, it is better for them to
get out of bed to do a low stimulation activity (e.g., reading), then return
to bed later. This keeps the bed from becoming associated with
sleeplessness. If still awake after 20-30 minutes, spend another 20
minutes out of bed before lying down again.
11. Worry time should not be at bedtime. Children with this problem can
try having a “worry time” scheduled earlier when they are encouraged to
think about and discuss their worries with a parent.
12. Children should be put to bed drowsy, but still awake. Letting them fall
asleep in other places forms habits that are difficult to break.
13. Security objects at bedtime are often helpful for children who need a
transition to feel safe and secure when their parent is not present. Try to
include a doll, toy or blanket when you cuddle or comfort your child,
which may help them adopt the object.
14. When checking on a child at night, checks should be “brief and
boring.” The purpose is to reassure the child you are present and that
they are OK.
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Sleep Hygiene for Children
• Pulmonary and Sleep
Medicine
206-987-5072
15. If your child is never drowsy at the planned bedtime, you can try a
temporary delay of bedtime by 30 minute increments until the child
appears sleepy, so that they experience falling asleep more quickly once
they get into bed. The bedtime should then be gradually advanced earlier
until the desired bed time is reached.
• Your child’s
healthcare provider
16. Keep a sleep diary to keep track of naps, sleep times and activities to find
patterns and target problem areas when things are not working.
To Learn More
• www.seattlechildrens.org
Free Interpreter
Services
Robert Hilt, MD
Primary reference: A Clinical Guide to Pediatric Sleep by Jodi Mindell and Judith Owens
Used with permission.
• In the hospital, ask
your child’s nurse.
• From outside the
hospital, call the
toll-free Family
Interpreting Line
1-866-583-1527. Tell
the interpreter the
name or extension
you need.
• For Deaf and hard of
hearing callers
206-987-2280 (TTY).
Seattle Children’s offers interpreter services for Deaf, hard of hearing or non-English speaking patients, family
members and legal representatives free of charge. Seattle Children’s will make this information available in
alternate formats upon request. Call the Family Resource Center at 206-987-2201.
This handout has been reviewed by clinical staff at Seattle Children’s. However, your child’s needs are unique.
Before you act or rely upon this information, please talk with your child’s healthcare provider.
© 2011 Seattle Children’s, Seattle, Washington. All rights reserved.
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Pulmonary and Sleep Medicine
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