Is Blood Conservation the

Right Choice for Your Child?page 2

Prevention Is the Best

Medicine for Concussionspage 3

New Treatments

Straighten Out Scoliosis

page 5

Ask the Doctorpage 7

inside this issue:

SEARCH HEALTH INFO ONLINEFor easy access to Rainbow physicians and in-depth health information for you and your child — including a new symptom checker — visit us online:

www.rainbowbabies.org

T H E L A T E S T I N C H I L D R E N ’ S H E A L T H N E W S • S U M M E R 2 0 0 6

Rainbow’s experts are here to answer your health care questions!

You can contact us by phone at 216-844-RAINBOW

or e-mail us at ask@rainbowbabies.org, or visit

www.rainbowbabies.org

ask rainbow ...

U N I V E R S I T Y H O S P I TA L S O F C L E V E L A N D • R A I N B O W B A B I E S & C H I L D R E N ’ S H O S P I TA L

When Is Surgery an Option for Epilepsy?

Childhood epilepsy is a complex condition to manage. Some seizure disorders persist for

unknown reasons, which can be both frightening and hard for parents to understand.

Seizures that don’t respond to treat-ment by multiple medications are called

intractable, explains Rainbow Neuro-surgeon Shenandoah Robinson, MD. “Parents of a child who has had seizures for more than two years that are not well controlled by medicines should ask their pediatrician to see a neurologist who specializes in epilepsy,” she says.

Unfortunately, she says, many par-ents are still under the impression that their child will “outgrow” the seizures. Seizures may resolve spontaneously, but they sometimes don’t.

Children should be evaluated for epilepsy surgery if their seizures aren’t under control after trying two to three anti convulsant medications, Dr. Robinson advises.

“Seizures aren’t just an inconvenience,” she says. “Some parents think of epilepsy

as a manageable chronic condition similar to asthma or diabetes.” Uncon-trolled epilepsy, however, and the need for multiple medications, can negatively impact a child’s educational and social development.

Epilepsy also may worsen with time and become life-threatening. It has been documented that some children with poorly controlled epilepsy lose several IQ (Intelligence Quotient) points every few years.

On a positive note, Dr. Robinson says, about 75 percent of kids achieve excel-lent seizure control with medications. But for that remaining 25 percent, finding a solution should be pursued aggressively because earlier seizure control optimizes a child’s development.

Surgery for intractable seizures offers children the opportunity to have a sig-nificant reduction in seizure frequency or even cure them. Surgery also can decrease or eliminate the need for medi-cation. With better seizure control, children typically experience vast improvements in their ability to learn and interact with others.

At Rainbow, a dedicated pediatric epilepsy team cares for children under-going surgery for seizures in a family-centered environment, as part of the University Hospitals Comprehensive Epilepsy Center. Each child undergoes an individualized presurgical evaluation using the latest advances in clinical management and technology.

“Our comprehensive approach strives to obtain better seizure control, improve the child’s quality of life, and optimize the child’s future,” Dr. Robinson says. ■

CELEBRATING 140 YEARS of Caring for Cleveland.

SHENANDOAH ROBINSON, MD,

Neurosurgeon, Rainbow Babies & Children’s Hospital

You know that blood is vital, but it never seems more so than when your child may need blood due to an upcoming surgery, ongoing condition or medication.

At Rainbow Babies & Children’s Hospital, our Comprehen-sive Blood Conservation Program offers parents — through techniques that focus on minimizing blood loss, building up your child’s own blood supply, or both — the safest alternative to blood transfusions.

“There are various reasons why families may desire to avoid the use of donated blood products,” explains Medical Director Anthony Villella, MD. “This program is just one of Rainbow’s many innovative programs that blends in individ-ual values and beliefs. We hold in high esteem the right of every family to receive quality health care that respects their personal choices — whether for religious or health reasons.”

When a child needs a blood transfu-sion, Dr. Villella explains, it falls under one of three categories:■ Red blood cells, which transport oxygen■ Platelets, which stop bleeding■ Plasma, which supports circulating blood volume

“When any of these is low, it can have serious effects on the child’s heart, lungs, kidneys and brain,” he says. “Condi-tions such as anemia can weaken a child’s overall health and recovery.”

Treatment options offered by Rainbow’s Comprehensive Blood Conservation Program include medications to stimulate blood cell production, techniques to recycle blood during surgery and preparation for potential blood loss or blood production experience.

“No matter what the need, you can choose from among the alternate treatment options,” says Dr. Villella. “Your pediatri-cian can help you weigh the benefits and risks of each.”

Rainbow’s blood conservation program was the first established at a freestanding children’s hospital back in 1998. Today, it serves more than 150 outpatients and 20 inpatients each month, says Program Manager Amelia Baffa. “This includes preparing chil-dren for a blood loss experience, like

surgery, and supporting those who are either anemic or are undergoing therapy that affects the body’s ability to make red blood cells, such as chemotherapy and radiation therapy.” ■

How Does the Blood Conservation Program Work?

All new hospital patients are asked

whether they would like to participate

in the blood conservation program and

those registered are automatically

identified at any future point of entry

into the system. Patients also may

be registered in advance via phone.

A nurse will visit with your child to

make sure the resources are in place

to conserve blood. Once we identify

which conservation method is best,

we coordinate your child’s care with

the entire team, including your

pediatrician.

If your child is already at the hospi-

tal, treatments for blood conservation

will take place in your child’s room.

Outpatient and consultation treat-

ments will occur by appointment on

the main campus of the hospital.

Under the RAINBOW w w w. r a i n b o w b a b i e s . o r g

ANTHONY VILLELLA, MD,Medical Director,

Comprehensive Blood Conservation Program, Rainbow Babies & Children’s

Hospital

Your Child’s Own Blood Is Always the Right TypeWHAT PARENTS SHOULD KNOW ABOUT BLOOD CONSERVATION OPTIONS

If you would like more informa-tion or want to enroll your child in Rainbow’s blood conservation program, please call:216-844-3492.

TO LEARN MORE

2

It’s better to miss a game than a whole season. That’s the message from the U.S. Centers for Disease

Control and Prevention (CDC) about concussions.

A concussion is a broad term and can apply to a range of injuries, but Alan R. Cohen, MD, Chief of Pediatric Neuro-surgery and Surgeon-in-Chief at Rainbow Babies & Children’s Hospital, says it’s a brain injury associated with an immediate and temporary loss of normal brain func-tion. He says another name for concussion is a mild traumatic brain injury. The brain injury can range from mild to severe.

According to the American Academy of Pediatrics, 20 percent of the 1.5 mil-lion head injuries that occur in the United States each year are sports-related. An even more sobering statistic is that 20 per-cent of high school football players and 40 percent of college football players will suffer a head injury at some point in their career. Those who have a head injury are at two to four times greater risk of having another.

The brain is jelly-like and sits inside the skull — the protective armor. It is surrounded by clear, cerebrospinal fluid allowing the brain to float inside the skull. When someone is hit in the head,

Dr. Cohen says, the brain actually may move around inside the skull, opening it up for an array of injuries, including bruising and blood clots.

A CAT scan typically looks normal, but those who suffer a concussion can feel the consequences for days, weeks or even months. Symptoms can include a loss of consciousness, headache, dizziness, nausea, vomiting, balance problems, con-fusion, memory loss, tinnitus or amnesia.

“The hallmark of concussion is a sud-den and temporary impairment of brain function,” Dr. Cohen says. “Concussion represents a diffuse injury to the brain. The optimal treatment is to prevent the injury in the first place.”

Most concussions, Dr. Cohen says, are caused by car accidents or are sports-related. Using seat belts in cars and wear-ing the proper equipment while playing sports, including helmets, can help avoid a concussion. But even more problematic than a concussion is the so-called second impact syndrome — an injury caused by sustaining a second concussion.

While there are a variety of scales to measure when a child can return to full activity after a concussion, the general rule of thumb is if the symptoms are mild and transient, it’s usually safe to return to a game. If symptoms are severe and per-sistent, the child should be removed from the game.

The good news is the brain can repair itself. A concussion shakes up the signal-ing pathways of the brain, so it may take a period of days or weeks for everything to return to normal. A child who suffers a significant loss of consciousness, con-fusion or severe headache, should be checked out by a doctor immediately.

Symptoms that should raise red flags are persistent headache, nausea, vomit-ing or the sudden onset of weakness, seizure or abnormal pupil size.

“Most children make a good recovery and return to normal function. Some have persistent symptoms of headaches and dizziness; these symptoms tend to resolve over time,” Dr. Cohen says. ■

Head GamesMANY CONCUSSIONS ARE SPORTS-RELATED

3

Find a physician online: www.rainbowbabies.org/PhysicianFinder/

ALAN R. COHEN, MD, Chief of Pediat-ric Neurosurgery and

Surgeon-in-Chief at Rainbow Babies & Children’s Hospital

What to watch for after a

head injury:

Normal signs in the first two

days include:

1. Fatigue and desire for extra

sleep (but can be easily

awakened)

2. Fairly mild headache that

does not worsen

3. Occasional nausea and

vomiting

4. Problems with thinking, con-

centration and attention span

(may persist for a year or more)

Signs that immediate medical

attention is needed:

1. Marked change in personality,

often with confusion and

irritability

2. Worsening headache, espe-

cially if accompanied by

nausea or vomiting

3. Numbness, tingling or weak-

ness in the arms or legs;

changes in breathing pat-

tern; or seizure

4. Eye and vision changes,

including double vision,

blurred vision or unequal

pupil size

The American Academy of

Pediatrics divides concussions

into three categories:

1. Mild – confused but not

knocked out. May return to

play after 20 minutes if

symptoms completely clear.

2. Moderate – confused, with

memory loss. May play after

one week if all symptoms

clear completely.

3. Severe – knocked out. May

play after one month if all

symptoms completely clear.

The U.S. Centers for Disease

Control and Prevention lists

the following symptoms for

concussion:

■ Nausea (feeling that

you might vomit)

■ Balance problems or

dizziness

■ Double or fuzzy vision

■ Sensitivity to light or noise

■ Headache

■ Feeling sluggish

■ Feeling foggy or groggy

■ Concentration or memory

problems

■ Confusion

Concussions: Expert Advice

a GREAT OFFER! Rainbow is

offering free copies of the booklet Facts About Concussions and Brain Injury. Call

216-844-RAINBOW for your free copy today.

Irritable bowel syndrome (IBS) is a confusing, yet com-mon, gastrointestinal disorder that often is misdiagnosed. It can cause abdominal pain, bloating, gas, diarrhea and

constipation — and affects both girls and boys equally.“IBS is not a disease — it is a syndrome, or rather a group

of symptoms that occurs together,” explains Judy B. Splawski, MD, Interim Chief of the Division of Pediatric Gastro-enterology at Rainbow Babies & Children’s Hospital. “So while IBS can be uncomfortable, painful or embarrassing, it doesn’t damage the intestines like some other digestive conditions.”

In people with IBS, the muscles in the colon that contract regularly to move waste through the body don’t work smoothly. They are sensitive to triggers, such as particular foods or stress, which cause a flare-up of symptoms.

There isn’t a specific test to diagnose IBS, so a physician will usually make a diagnosis of IBS based upon a medical history and physical exam, Dr. Splawski says. Generally, the diagnosis is based upon having abdominal pain or discomfort plus any two of the following:■ The pain is relieved by having a bowel

movement.■ The onset of pain is associated with a

change in the frequency of stools.■ The onset of pain is associated with a

change in stool consistency.These symptoms also must be present for

at least 12 weeks out of the previous year for IBS to be likely.

While there isn’t a cure for IBS, Dr. Splawski says that changes in diet can help greatly.

“IBS symptoms often occur right after or even during meals,” she says. “Avoiding some of the common cul-prits, such as fatty or spicy foods and caffeine, may help. Triggers vary from patient to patient, so others will find relief avoiding other items like dairy or foods that contain gluten.” Eating smaller meals, adding more fiber to the diet and drinking more water also are recommended.

Stress also can play a role in IBS. “While stress doesn’t cause IBS, it can exacerbate flare-ups,” Dr. Splawski says. “You may want to help your child or teen re-examine their

lifestyle and see if learning some stress man-agement techniques would be useful.”

In more severe cases, laxatives and anti-diarrhea medications are sometimes used. But it’s best to work together with a physician to discuss what treatment is right for your child.

“Helping your child focus on keeping their symptoms under control is key,” Dr. Splawski says. “By learning as much as possible about their individual triggers, they can reduce flare-ups and maintain an active, healthy life.” ■

Hold the Latte? Is there any harm in kids jumping on the Starbucks® wagon?

A cup of coffee is a morning jump-start

for many adults. But with the rise in spe-

cialty drinks like iced caramel macchiatos,

more kids are heading to their local Star-

bucks® for their daily jolt.

As a parent, should you be concerned?

Rainbow dietician Adria Myeroff, RD, LD,

says there is no compelling evidence that

coffee stunts kids’ growth. Still, there are

reasons to moderate how many cups of

joe your child is consuming.

“Caffeine is a stimulant that affects the

central nervous system,” Myeroff explains.

“At lower levels, about two to three cups

per day, caffeine can increase alertness

and boost feelings of energy. But too

much caffeine can cause the jitters, upset

stomach, headaches, difficulty concentrat-

ing, interrupt sleep, and increase both

heart rate and blood pressure.”

Another concern about kids jumping on

the coffee bandwagon, Myeroff says, isn’t

related to the caffeine some of these gour-

met drinks contain — but the calories.

It’s also important to note, says Rainbow

endocrinologist Sumana Sundararajan, MD,

that coffee drinks are not the only source

of caffeine or empty calories in many kids’

diets. “Soda, energy drinks and iced tea

also need to be factored into the equa-

tion,” she says.

Clearly, the best choices for your child

are water, milk and 100 percent fruit

juice. But, she notes, if your child insists

on drinking coffee drinks, requesting a

decaf, skim milk and forgoing the whip

cream are smart options.

Under the RAINBOW w w w. r a i n b o w b a b i e s . o r g

Is It Irritable Bowel Syndrome?CHANGING HABITS CAN RELIEVE SYMPTOMS OF THIS DISORDER

JUDY B. SPLAWSKI, MD,

Interim Chief of the Division of Pediatric Gastroenterology at

Rainbow Babies & Children’s Hospital

Common symptoms of IBS include:■ Gas■ Pain■ Bloating■ Constipation■ Diarrhea■ Nausea■ Vomiting■ Mucus in the stool

SYMPTOMS

a GREAT OFFER! Rainbow is offer-

ing free copies of the booklet Living With Irritable Bowel Syndrome. Call 216-844-

RAINBOW for your free copy today.

4

For most of us, hearing the charge from our mothers made us throw our shoulders back and

stick our chests out. But for 4 percent of us, an unnatural curve in our spines can make it difficult to stand up straight.

Scoliosis is a sideways curvature of the spine that makes it look more like an “S” or “C.” It can cause the bones of the spine to turn so that one shoulder or hip looks higher than the other. The spinal deformity can run in families, but in most cases the cause is unknown. The curve can appear at any age, but is most commonly seen after age 10 or in early adolescence.

The incidence of scoliosis is about the same for boys and girls, but girls are five times more likely to require treat-ment. That being said, only about 7 per-cent of children with scoliosis require treatment, according to George H. Thompson, MD, Director of the Division of Pediatric Orthopaedics at Rainbow Babies & Children’s Hospital.

The vast majority of children with scoliosis, he says, are monitored by X-rays and regular trips to the doctor. Bracing can be moderately effective for

a growing child with a spinal curvature between 25 and 40 degrees. Plastic braces are worn at night for two to three years to prevent curves from worsening. If a curve is more than 45 degrees, surgery may be recommended.

A major problem is a severe defor-mity in a very young child. Braces are not very helpful, but a body cast can frequently control the curve for several years. When the child is older, growing rods can be very useful. Dr. Thompson has inserted two stainless steel rods in children younger than 2, but the average age is 5 or 6.

“What it really means is you have a long rod that attaches to the top and bottom of the spine,” Dr. Thompson explains. “Every six months you go in and loosen the hooks or screws and lengthen the rods again.”

Last fall, Rainbow researchers found the most effective surgical treatment for young children with severe scoliosis is the insertion of two growing rods. Tradition-ally, orthopaedic surgeons inserted only one rod, but the dual growing rods allowed better correction and improved growth of the spine with fewer complications.

Dr. Thompson launched the growing rods program at Rainbow about 10 years ago. The procedure enables young patients with severe spinal deformities to develop more normally and reduces the adverse affects of their spinal deformities on lung development and breathing.

Once a child reaches a suitable age or size — usually after age 10 for girls and 12 for boys — the pediatric growing rods are removed and adult-sized rods are inserted, offering another big boost

in correction, Dr. Thompson says. The spine, in the area of the rods, is fused and the correction is permanent.

While the dual growing rods are a superior treatment to the single rods for children with severe spinal deformities, Dr. Thompson says a great deal of work remains to be done in the field. Two areas his department continues to exam-ine are autofusion — when the spine spontaneously fuses — and crankshaft — where the front of the spine contin-ues to rotate and twist as it grows, even with the implantation of growing rods.

“Although we can control the defor-mity to a certain degree, patients still end up with a moderate deformity,” he says, adding that Rainbow doctors are constantly looking at ways to improve treatment outcomes for its youngest spinal patients. ■

Find a physician online: www.rainbowbabies.org/PhysicianFinder/

“Stand Up Straight!”SURGICAL AND NONSURGICAL TREATMENTS HELP STRAIGHTEN SCOLIOSIS

GEORGE H. THOMPSON, MD,

Director of the Division of Pediatric

Orthopaedics, Rainbow Babies & Children’s Hospital

5

SIGNS OF SCOLIOSIS

Scoliosis can go unnoticed in children because it rarely is pain-ful. Parents should watch for the following “tip-offs” to scoliosis beginning around 8 years of age:■ Uneven shoulders ■ Prominent shoulder blade

or shoulder blades ■ Uneven waist ■ Elevated hips ■ Leaning to one side Any one of these signs warrants an examination by the family phy-sician, pediatrician or orthopaedist. School screenings for scoliosis also can alert parents to the warning signs in their child. (American Academy of Orthopaedic Surgeons)

Scoliosis can cause the bones of the spine to turn so that one shoulder or hip looks

higher than the other.

READ ABOUT ONE GIRL’S TREATMENT AND RECOVERY FROM SCOLIOSIS. Log on to www.rainbowbabies.org/scoliosis.aspx to read “Scoliosis: Samantha’s Story.”

When your beautiful daughter turned 3 years old, you decided it was time for another addition to the family.

But this time, things aren’t going as planned. Why can’t you get pregnant again?

“Secondary infertility is the term used when a couple who already have a child can’t get pregnant or carry a pregnancy to term again,” explains University Hospitals MacDonald Women’s Hospital OB/GYN Susan Lasch, M.D. “It’s actually quite common — affecting about 20 percent of all couples.”

Its prevalence, however, doesn’t mean that it’s any less pain-ful or easier to accept. Couples facing secondary infertility face the same feelings of confusion, frustration, grief and depres-sion as couples that have primary infertility.

“It can be a shock to couples if they can’t get pregnant again, especially if they did so the first time without much trying — or perhaps any at all,” Dr. Lasch says.

People shouldn’t dismiss the grieving that accompanies infertility, even if they already have a child, says Francisco Arredondo, MD, a reproductive endocrinologist at MacDonald Women’s Hospital.

“A lot of people, including physicians, believe that people who have secondary infertility should not go through the same emotions because they already have a kid,” he says. “But emo-tionally, it’s the same. It’s not a matter of not being grateful for your first child, rather the fact that the dream you have for a larger family hasn’t become a reality.”

This emotional distress is compounded by the fact that there are no easy answers. “The causes of secondary infertility are just as varied as with primary infertility,” explains Stacie Weil, MD, a reproductive endocrinologist with MacDonald Women’s Hospital.

Your first plan of action should be a trip to your OB/GYN. If a couple has been struggling to get pregnant for

longer than a year, or six months if the woman is over 35 years old, they should be referred to an infertility specialist.

Dr. Weil says initial evaluations typically include a semen analysis, a blood test to evaluate ovarian function and an examination of the fallopian tubes — all of which are typically covered by insurance.

“Another important aspect is a thorough patient history to determine if anything has changed since the first pregnancy,” she adds.

After the couple has completed fertility testing, physicians can typically determine what is preventing couples from con-ceiving in about 90 percent of cases.

Treatments depend on the determined cause of infertility, Dr. Weil says. When the fertility problem is due to a female problem (in about 50 percent of cases), treatments can include medications to induce ovulation, surgery to repair damaged fallopian tubes or in-vitro fertilization. For male infertility, options can include intrauterine insemination to ensure only good quality sperm are used, as well as intracytoplasmic sperm injection for men with very low sperm counts.

Knowing that coping with infertility can be one of the toughest challenges couples face, Dr. Arredondo recommends that they develop a plan that addresses how much time, emo-tional and financial investment they’re willing to make in

having another baby.“While most couples with second-

ary infertility are successful in growing their family, determining how far you are willing to pursue treatments can help give couples a sense of control,” he says. ■

Why Now?You and your partner’s lives have no

doubt drastically changed since your first

pregnancy, and may include some health

factors that cause secondary infertility:

Age. As women reach their late 30s and

early 40s, fertility declines due to egg

quantity and quality.

Ovulation problems. Some women don’t

develop and release an egg monthly.

Reasons include stress, recent illness

and polycystic ovarian syndrome — a

condition in which women develop small

cysts on their ovaries.

Endometriosis. This condition, in which

the tissue that lines the uterus is found

elsewhere in the abdomen, can cause

infertility.

Fibroids. These usually noncancerous

tumors in the wall of the uterus can

cause infertility, depending on their size

and location.

Fallopian tube damage. Complications

during a first pregnancy or a recent pel-

vic infection can cause damage or block

the fallopian tubes.

Uterine adhesions. Bands of scar tissue

from a C-section can interfere with

conception.

Sperm count. Low sperm count, poor

motility or defects can all cause infertility.

Under the RAINBOW w w w. r a i n b o w b a b i e s . o r g

FRANCISCO ARREDONDO,

MD, Reproductive Endocrinologist,

University Hospitals MacDonald

Women’s Hospital

Trying TimesWHY AM I HAVING TROUBLE GETTING PREGNANT THE SECOND (OR THIRD, OR FOURTH) TIME AROUND?

6

“Secondary infertility is the term used when a couple who already have a child can’t get

pregnant or carry a pregnancy to term again. It’s actually quite common — affecting about

20 percent of all couples.”

For an appointment with a MacDonald Woman’s Hospital fertility specialist, please call216-844-1514.

TO LEARN MORE

Community CalendarRainbow Babies & Children’s Hospital is

proud to sponsor a variety of programs

throughout the year that foster learning

and encourage family fun. Be sure to mark

your calendars for the following events:

The Children’s Museum of Cleveland — Bridges to Our Community ExhibitWhen: Ongoing through Dec. 31, 2006

Where: Children’s Museum of Cleveland

10730 Euclid Avenue

Cleveland, OH 44106

Event Information:

www.clevelandchildrensmuseum.org

216-791-7114

3rd Annual Teddy Bear Day Presented by Rainbow Babies & Children’s HospitalWhen: Saturday, Sept. 30, 2006

11:00 a.m.–3:00 p.m.

Where: Cleveland Metroparks Zoo

Event Information:

www.clemetzoo.com

216-661-6500

Boo at the ZooWhen: Thursday, Oct. 19–

Sunday, Oct. 22, 2006

Thursday, Oct. 26–

Sunday, Oct. 29, 2006

5:30 p.m.–8:30 p.m.

Where: Cleveland Metroparks Zoo

Event Information:

www.clemetzoo.com

216-661-6500

QQ I’m confused about

what I hear on the news about West Nile

virus. Can my kids catch it from a mosquito bite?

A West Nile virus has spread rapidly across the United States in the

past four years, including north-east Ohio. It is one of several germs that can cause encephalitis, an infection and swelling of the brain.

However, says Rainbow Infectious Disease expert Ethan Leonard, MD, children are less likely to become ill with West Nile virus than adults. “The frequency of serious symptoms increases with age, peaking in those over 50 years old,” he says.

People who do get symptoms experience the follow-ing: a flu-like illness (fever, aches and pains), rash, eye redness, confusion, sleepiness, and neck and back pain. Dr. Leonard notes that most people infected with the virus have no symptoms – and only one in about 150 to 300 infected people become ill.

However, there are several precautions you can take to protect your family, he says. He suggests you limit outdoor activity during dusk — when mosquito activity is the highest — and wear long sleeves and long pants. You also should make sure your window screens are “bug tight” and drain or change standing water on your property. Lastly, he says, use DEET-containing insect repellents according to manufacturer’s instructions. ■

QMy daughter is fair-skinned and has freckles and moles. She loves to play outside all day

during the summer. What is the best way to protect her while she’s in the sun?

A “The majority of sun exposure occurs within the first two

decades of life, so it’s espe-cially important for parents to teach children sun safety,” says Rainbow pediatric dermatologist Joan E. Tamburro, DO.

Children with fair to light complexions, moles, freckles or a family history of skin cancer are even more vulnerable. But, Dr. Tamburro says, with the right precautions, all kids can safely play in the sun.

“Try to avoid her being in the sun between 10 a.m. and 4 p.m., when the sun is the strongest,” she advises. “Make sure to generously apply a sunscreen with an SPF of 30, even on cloudy days, a half hour before she heads outdoors. Be sure to reapply every two to three hours, or after swimming. It’s also a good idea to have her wear a hat and sunglasses, or even a loose long-sleeve T-shirt and longer shorts or pants. There’s even sun protective clothing now available. Or, you can add a sun protective laundry treatment to your regular wash, such as Rit Sun GuardTM, to boost her protection against harmful UV rays.” ■

ASK THE DOCTOR: HOW CAN I TRAVEL

SAFELY WITH MY KIDS THIS SUMMER?

Find a physician online: www.rainbowbabies.org/PhysicianFinder/

QWe’re preparing to take our first real vacation as a family with two young kids. Do you

have any travel tips?

A Traveling with kids is

both fun and challeng-

ing. But planning

ahead for safe travel can help you

avoid any potential health prob-

lems, says Grace McComsey,

MD, Chief of Infectious Diseases at Rainbow. “For a healthier vacation domestically or abroad,

parents should always bring along their child’s immu-nization record and medical history, including any medication or food allergies,” says Dr. McComsey.

For car trips, be sure to be equipped with a good supply of water and snacks, alcohol-based hand sani-tizer, hand wipes, sunscreen and insect repellent.

ETHAN LEONARD, MD, Infectious Disease Expert,

Rainbow Babies & Children’s Hospital

GRACE MCCOMSEY, MD, Chief of

Infectious Diseases, Rainbow Babies & Children Hospital

JOAN E. TAMBURRO, DO, Pediatric

Dermatologist,Rainbow Babies & Children’s Hospital

International trips require much more plan-ning, such as checking if your child needs vaccina-tions or medications to prevent diseases such as malaria. “If you’re unsure of what’s needed, the medical team at Rainbow’s Child Travel-ers’ Clinic (216-844-RAINBOW) is able to help families make certain their children have the proper pretravel care,” Dr. McComsey says. “We also give families desti-nation-specific advice on common diseases, as well as tips on safe eating and drinking habits. After your child has returned home, we can evaluate and treat your child for any post-travel concerns, if needed.” ■

7

ASK RAINBOW! Rainbow’s experts are here to answer your health care questions! You can contact us by phone at 216-844-RAINBOW or email us at ask@rainbowbabies.org.

NONPROFIT

ORG

U.S. Postage

PAIDPermit N. 694

Effi ngham, IL

University Hospitals of ClevelandRainbow Babies & Children’s Hospital11100 Euclid AvenueCleveland, Ohio 44106

Under the Rainbow is published by 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. ©2006 StayWell Custom Communications, 780 Township Line Road, Yardley, PA 19067, 267-685-2800. Some images in this publication may be provided by ©2006 PhotoDisc, Inc. All models used for illustrative purposes only. Some illustrations in this publication may be provided by ©2006 The StayWell Company; all rights reserved. (306)

If you are choosing your family’s health plan, remember there is no better place for children than Rainbow Babies & Children’s Hospital. Your health plan should provide a wide range of cover-age; allow options for care close to home; easy access to the care that you need; promote wellness; provide a comprehensive benefit for preventive care at a low or no cost; and have reasonable out-of-pocket costs. Most important, ask if your plan includes Rainbow. For clarification, call 216-844-7246 or log on to our website at www.rainbowbabies.org and click on the Ask Rainbow tab and link to insurance plans that include Rainbow.

Time to Choose?

Everyone’s always teasingly pinched Junior’s extremely pudgy cheeks and declared them

absolutely darling. But now that he’s a toddler, you’re starting to worry about his still-chubby frame. How can you tell the difference between healthy growth and an overweight child?

“Usually parents shouldn’t be too concerned about their child’s weight or restrict fat intake until they turn 2 years old,” says Rainbow Babies & Children’s Hospital Endocrinologist Mark Palm-ert, MD. “During that time, your child is still growing very quickly and needs fat for proper brain development.” However, in rare cases where early weight gain is very high, diet changes may be needed even before age 2.

After your child’s second birthday, you can more easily reduce the fat in his diet — for example, switching from whole to 2 percent milk. But, Dr. Palmert says, fat still remains important and should

make up 30 percent of the diet for most children, according to American Acad-emy of Pediatrics guidelines.

Carolyn Landis, PhD, a clinical psy-chologist who heads Rainbow’s Fit Futures program for young children who are overweight, emphasizes that the preschool years are an optimal time to teach healthy eating habits.

“Evidence shows that overweight children have a greater likelihood of becoming overweight adults,” Dr. Landis says. “So, it’s extremely important to lay the groundwork in these formative

years, when you still have a considerable say about what your child eats.” ■

When Is It No Longer Baby Fat?START TEACHING YOUR CHILD HEALTHY EATING HABITS DURING PRESCHOOL

■ Limit sugary snacks, excessive amounts of fruit juice, junk food and fast food.

■ Offer healthy foods. “Don’t be discouraged if they don’t immediately like carrot sticks or banana slices,” Dr. Landis says. “You will likely need to offer foods many times before they’ll accept them in their diet.”

■ Encourage plenty of physical activity.■ Set a good example. “If they see Mom or Dad snack-

ing on grapes or whole-grain crackers, they’re more likely to ask for some for themselves,” she adds.

TIPS TO PROMOTE HEALTHY GROWTH

MARK PALMERT, MD,

Endocrinologist at Rainbow Babies & Children’s Hospital

CAROLYN LANDIS, PhD,

Clinical Psychologist at Rainbow Babies &

Children’s Hospital

a GREAT OFFER! Rainbow is offering free

copies of the booklet

Healthy Snacking. Call

216-844-RAINBOW

for your free copy today.