1. Summer 2006
Playing It Safe for More Summer Fun
Preventing burns, bugs and boo-boos ■ An interview with David Tejeda, M.D., pediatrician
★
E
ach summer brings an influx of children’s injuries
to the pediatrician’s office and hospital emer- ALL AGES
gency rooms. While many of these injuries
occur while boating, swimming, bicycling or skate-
boarding; others come from burns caused by barbecues
and fireworks. Parents can avoid having these hazards
ruin their children’s summer vacation by educating them- INSIDE:
selves about the potential dangers of common activities. 2 Kids and fiber
3 Treating a
Water safety child’s allergies
“Drowning is a leading cause of unintentional death from
4 Kindergarten
injury among young people,” says David Tejeda, M.D., medi- readiness
cal director of Ambulatory Pediatrics at California Pacific
5 Sports physicals
Medical Center. “Whenever you are in or near the water,
you should supervise young children at all times, especially if 6 Car trips with
they are non-swimmers. It is imperative to enclose outdoor pools children
within a locked fence. Using flotation devices is fine, but you 7 Infant massage
should never rely solely on them to protect a child from therapy
drowning. No one, not even an adult, should ever swim alone.
Dr. Tejeda also suggests making sure the water is deep
enough when your children are diving — especially in
lakes or rivers where the bottom cannot be seen. “It’s
also important to have your children wear life pre-
servers while waterskiing, boating or rafting,” he adds.
“And, of course, you need to watch out for the undertow
when swimming at the beach.”
Sun exposure
“Sunburns are not only very painful, but also can lead
to the development of skin cancer in later years,” Dr. Tejeda
notes. “To protect your child, you should apply sunscreen
continued on page 5
www.cpmc.org
2. Women & Children’s Campus
Planned for Early 2007
Our family-centered facility is growing. ■ by David Tejeda, M.D., medical director,
Ambulatory Pediatrics, and Oded Herbsman, M.D., medical director, Pediatric Unit
C alifornia Pacific Medical Center has started
renovations to its facility at 3700 California St.
in anticipation of our new Women & Children’s
first Pediatric Emergency Room in San
Francisco. This Emergency Room is
something our pediatricians are very
excited about, as care will be tailored to
Campus, which will open in early 2007. At this time, the specific needs of children and their
families. Many other renovations are
all pediatric and obstetric care will be in one loca- occurring throughout our current facility,
tion, in the Laurel Heights area of San Francisco. resulting in an improved environment
that best serves both our maternity and
Construction has already occurred to pediatric patients.
expand the Medical Center’s Neonatal We will keep you informed about the
Intensive Care Unit (NICU) by 10 beds. new Women & Children’s Campus at
In June 2006, this new unit opened California Pacific in future issues of this
with 36 newborn intensive care beds. newsletter. We look forward to growing
With the new Women & Children’s with you and providing the compassionate,
Campus, California Pacific will have the family-centered care that you expect. ★
The Doctor Is In ★
TODDLERS
Your questions about child health answered ■ by Brock Bernsten, M.D., pediatrician
Q: What is a sufficient amount of
fiber that a 3-year-old should
get? If a child doesn’t like eating vegeta-
fruits also are a good source of fiber as
well. If a child won’t eat vegetables, you
may want to consider a children’s multi-
bles, are there any supplements you’d vitamin as a supplement. ★
recommend for that age group?
To Learn More High Fiber Foods
If you have a child’s health
A: The American Academy of Pedi-
atrics (AAP) recommends that a
child’s fiber consumption (in grams) be
Food Grams of Fiber
question that you want Fruits
equivalent to the child’s age plus 5. In this
addressed in a future Pear with skin 4.6
case, a 3-year-old would require 8 grams
Raspberries (1 cup) 5.1
issue of HealthyKids, of fiber per day, and a 7-year-old would
Vegetables
e-mail it to us at: require 12 grams per day. These recom- Good sources of fiber
Broccoli (1 stalk) 5.0
bosquejp@sutterhealth.org, mendations start at age 2. Good sources for kids who do not
Carrots (1 cup) 4.6
of fiber for kids who do not enjoy veg- enjoy vegetables include
or visit www.cpmc.org/ Beans (cooked)
etables include multigrain breads, oat
pediatrics. Due to space Kidney beans (1/2 cup) 7.4 oat cereals.
cereals (such as Cheerios), refried beans,
limitations, we cannot Lima beans (1/2 cup) 2.6
some energy bars and popcorn for chil-
Whole Grains
guarantee that all questions dren older than age 3. Children who
Whole-wheat cereal (1 cup flakes) 3.0
will be answered. don’t like vegetables may eat them in
Whole-wheat bread (1 slice) 1.7
soups, on pizza or in pasta. Unpeeled
Source: AAP
2 www.cpmc.org
3. Allergies: How to Spot Them,
How to Treat Them
Differentiating between a summer cold and allergies ■ An interview with
Russell Leong, M.D., allergist
I ★
f your child is sneezing and has a runny which is characterized
nose and watery eyes, how do you know by difficulty in breath-
ALL AGES
ing or swallowing,
whether it’s a summer cold or allergies? swelling of the lips or
Although colds and respiratory aller- tongue, and perhaps
gies can produce similar symptoms, dizziness or fainting.
colds are more prevalent during fall and If your child shows any
winter months and generally last only of those symptoms,
one or two weeks. Allergies are more it is imperative to seek
common in the spring and summer and immediate medical
can last longer — as long as your child help.”
is exposed to whatever is causing the “The three forms
allergic reaction. of treatment (see below)
“Allergies are reactions of the body’s are not mutually
Russel Leong, M.D., immune system to various organic pro- exclusive,” Dr. Leong
allergist teins called allergens,”says Russell observes. “Immuno-
Leong, M.D., an allergist at California therapy, although a
“
Allergies are more
Pacific Medical Center. “The immune time-consuming process, works well for
Treatment for common in the spring
system overreacts and produces anti- long-range relief. If your child suffers
bodies to ‘attack’ the allergens. Many chil- from severe allergies — including and summer and can
allergies includes
dren suffer from seasonal respiratory systemic reactions to bee stings — you last as long as your
avoidance child is exposed to
allergies caused by pollen from plants. may consult an allergist about therapy
of allergens, Those seasonal allergies often are com- that may include immunotherapy or whatever is causing
medications to pounded by reactions to perennial aller- desensitization injections.” ★ the allergic reaction.
ease symptoms, gens such as dust mites, molds and pet
dander. One way to determine whether
and immuno- Allergy Treatments
your child’s symptoms are due to aller-
therapy to reduce gies is to conduct skin or blood tests to
sensitivity. determine whether there are specific
antibodies to specific allergens.” Treatment for allergies falls into three general categories:
” Dr. Leong notes that the tendency
to develop allergies often is inherited,
Avoidance. Avoid contact with the specific
substance causing the allergic reaction.
so children whose parents have allergies
Medications. Antihistamines, decongestants
have a higher likelihood of being allergic.
In addition to respiratory allergies caused and nasal sprays can provide effective
by airborne “environmental” allergens, treatment. Anti-inflammatory drugs and
many children also have allergic reactions bronchodilators may be used for asthma.
to various foods, chemicals, medicines, Epinephrine, delivered by injection, is used to
or insect bites and stings. treat anaphylaxis or severe allergic reactions.
“Allergies produce multiple symp-
Immunotherapy. A series of injections of
toms, including itchy eyes and nose,
hives or rashes, sneezing or wheezing, small amounts of allergen, in gradually
nausea, diarrhea and, rarely, vomiting,” increasing doses, allows the body to build up
Dr. Leong says. “In rare cases, a severe a tolerance over time.
allergic reaction may cause anaphylaxis,
www.cpmc.org 3
4. Is Your Child Ready for Kindergarten?
Age isn’t always an indicator of readiness ■ An interview with Suzanne Giraudo, Ed.D.,
director, Child Development Center at California Pacific Medical Center
★AGES 4-6
I n California, children must be 5 years old on or Proficiency in dressing, including put-
ting on shoes, zipping zippers and
before Dec. 2 of the school year to be eligible for putting on a coat and buttoning it
kindergarten. But just because your child is old
Social skills
enough, does that mean he or she is really ready? Ability to obey rules
“Parents need to look at their children’s Willingness to share
developmental age, rather than chrono- Capacity to work and play in a group
logical age, when determining whether or Command of language skills sufficient
not they are prepared for kindergarten,” to communicate well with others
says Suzanne Giraudo, Ed.D., director
of the Child Development Center at Attention span
California Pacific Medical Center. Ability to listen to someone reading a
“You can have two 5-year-olds, born 15-minute story from start to finish
on the same day, and one is ready while
the other is not,” she explains. "Kids
Capable of sitting in a chair for 20 to
25 minutes at a time
“
If you push your
develop at their own pace. Some chil- Willingness and ability to attend to child too hard
dren may be academically precocious, teacher instructions
in kindergarten,
Dr. Giraudo suggests yet lack the social skills necessary for
kindergarten. Others may be adept at Fine-motor skills you may
that parents evaluate
a checklist of various
social skills but haven’t mastered the Facility with pencils and crayons encounter
fine-motor skills required. It is often the Adept at using scissors behavioral or
kindergarten-
case that boys, especially, may not be
readiness skills educational
quite ready for school at age 5.” Pre-academic proficiency
before sending their Ability to recite the alphabet and problems in
child to school. Kindergarten readiness skills recognize letters later years.
Dr. Giraudo suggests that parents Ability to count and recognize
evaluate a checklist of various
kindergarten-readiness skills:
numbers
Familiarity with shapes and colors
”
Suzanne Giraudo,
Indication of interest in books and Ed.D., director of the
Self-care reading Child Development
Ability to use the bathroom unaided Competence in listening to and Center
and mastery of bladder control following instructions
“It’s a good idea for parents to visit
the school and observe kindergarten
classroom activities to see if their child
will be able to handle the demands,”
Dr. Giraudo notes. “If your child can
already read, but can’t sit still, you
might want to consider other means of
educational enrichment.
“If you push your child too hard in
kindergarten, you may encounter
behavioral or educational problems in
later years,” she adds. “The best thing
you can do if your children are not
ready for kindergarten is give them the
gift of time — wait another year before
enrolling them in school.” ★
4 www.cpmc.org
5. Playing It Safe continued from page 1
with an SPF of 15 or above about 15 to
20 minutes before going outdoors. It is
important that any sunscreen protect
against both UVA and UVB rays, and be
reapplied at least every two hours and
after swimming.” Since kids younger
than 6 months of age should not wear
sunscreen, alternatives such as long-
sleeved white shirts, a hat with a visor
or brim and avoidance of direct sunlight
Sports Physicals: ★
can provide adequate protection.
AGES 4-6 Fire safety
“Summer campfires and barbecues
A Winning Game Plan are frequent sources of burn injuries, so
it’s important to keep small children
away from all sources of fire, including
matches, lighters and hot barbecue
Medical exam helps ensure children are ready for athletics ■ An interview grills,” Dr. Tejeda warns. “Remember,
with Robert Langston, M.D., pediatrician, California Pacific Medical Center too, that fireworks are not only illegal,
but also very dangerous. Be sure your
N ews headlines about the sudden collapse of a young athlete children attend only professionally
managed fireworks displays.”
on the playing field are enough to strike fear into the heart
of any parent whose child participates in recreational athletics.
Fortunately, the incidence of major the heart, checking blood pressure
injuries, sudden collapse or death and pulse, evaluating muscle mass
among young athletes is extremely and flexibility, assessing all the joints
low. Nevertheless, a pre-participation for strength and range of motion, and
sports physical exam is a good idea testing for vision or hearing prob-
to help determine whether it’s safe lems,” Dr. Langston explains.
for your child to participate in a sport. “It’s also important to consider Biking and skating safety
“A sports physical can help ascer- the child’s physical and emotional “Wearing a helmet is the single most
tain whether or not a child has any maturity to make sure the sport is important safety factor in bicycling and
particular health problems that would appropriate for the child’s level of skating, because severe head injuries —
preclude participation in various sports development. Young boys who want although not common — can be deadly,”
activities,”says Robert Langston, M.D., to play football, for example, may not Dr. Tejeda warns. “Another word of
a pediatrician at California Pacific have sufficiently developed muscles advice is to make sure your children fol-
Medical Center. and joints for a high-contact sport. low the rules of the road, such as riding
Dr. Langston notes that the doctor Likewise, behavioral immaturity may on the right side of the street and mak-
should ask detailed questions about impinge on the child’s ability to par- ing a complete stop at stop signs and
your child’s medical history, including: ticipate in group activities,” he says. stoplights. Finally, remind your children
Previous injuries Children with chronic health prob- that people driving cars often have trou-
Chronic conditions such as asthma lems such as obesity, diabetes, asthma ble seeing bicycle riders and skaters. My
or diabetes or heart conditions require special brother once cautioned me to look out
Congenital heart problems attention and may be referred to a spe- for cars at intersections, rather than just
History of fainting, especially if cialist for further evaluation, Dr. Lang- watching for the light to turn green. It’s
during or shortly after exercise ston says.“Their health problems may not the light that’s going to hit you.”
Family history of cardiovascular not preclude all sports activities,” he By paying attention to these potential
disease, unexplained sudden death adds.“For example, the physician might hazards, you and your children can
or fainting during or shortly after recommend swimming — as opposed enjoy the pleasures of summer without
exercise. to a contact sport — for a child who the worry of injuries. If you have further
“The physician also should perform has exercise-induced asthma or who is questions, please talk to your pediatri-
a thorough physical exam, listening to seriously overweight.” ★ cian about these and other safety tips. ★
www.cpmc.org 5
6. Traveling With the Tots
Planning and preparedness help ease family trips ■ By Colleen Panina, M.D., pediatric hospitalist
★AGES 2-8
W hether traveling to the beach or mountains,
we have all experienced the thrill and agony
of traveling with children. Phrases such as, “Are we
there yet?” or “I’m bored” seem to reverberate in If the seat belt does
not fit your child
parents’ ears until the destination is reached.
correctly, he should
To make your travel experience more
safe and enjoyable, the American Academy stay in a booster seat
of Pediatrics (AAP) offers tips for parents. or a forward-facing
The bottom line is that good planning safety seat until the
and preparedness can make a great trip. adult seat belt fits.
Packing essentials Remember, seat belts are made for
Before the trip, plan on packing fun adults. If the seat belt does not fit
snacks, rounding up favorite “comfort your child correctly, he should stay
objects” and mapping out mandatory in a booster seat or a forward-facing
Colleen Panina, M.D., stops to stretch legs and smooth fraz- safety seat until the adult seat belt fits.
pediatric hospitalist
zled nerves. This is usually when the child reaches
Pack a bag stocked with essentials: about 4 feet 9 inches in height and is
“
Set a good extra absorbent diapers, wipes, “com-
fort objects” (blanket, stuffed animals,
from 8 to 12 years of age.
The AAP and the Federal Aviation
example — pacifiers), change of clothing for child Administration (FAA) now recom-
always wear your and an extra shirt for parent in case mend that all passengers have their
own seat belt. of spills. own seat on an airplane. For safest
Provide toys, stickers and books to travel, a child less than 2 years old
Help your child
entertain the kids, as well as a wrapped should no longer sit on an adult’s lap
form a lifelong surprise gift or two. A portable DVD but be restrained in her own car safety
habit of player can work wonders. seat on the airplane.
buckling up. Dried fruit, such as apricots or banana Set a good example — always wear
chips, travels well. Mandarin oranges your own seat belt. Help your child
” are also small, tasty and easy to carry.
Pita bread makes a delicious snack.
form a lifelong habit of buckling up. ★
And because it’s already flat, it can’t
Other Resources for Travel Safety Tips:
squish.
Travel safety tips www.cdc.gov/travel/child_travel.htm — This Web site
Safety during the trip is essential. provides information about vaccine recommendations for inter-
Your child’s safety seat should be prop- national travel, management of travelers’ diarrhea and insect
erly secured and be comfortable.
protection, and provides a health kit for the pregnant traveler
The safest place for all children to ride
(see the CDC’s Yellow Book mentioned on the site).
is the backseat.
All infants should ride rear-facing www.aap.org/advocacy/releases/summertips.htm — The
until they have reached at least 1 year AAP outlines policy statements ranging from lawn mower and
of age and weigh at least 20 pounds. firework safety to boating safety.
That means if your baby reaches www.faa.gov/passengers or 800-FAA-SURE — The FAA
20 pounds before her first birthday, provides information about air travel with children, including
she should remain rear-facing until possible discounts available for parents traveling with children
she turns 1 year old. under 2 years of age.
6 www.cpmc.org
7. Massage Therapy Soothes ★INFANTS
Newborns and Infants
It’s relaxing for parents and babies alike ■ An interview with Cherry Jones, M.F.T.
C hances are you’ve enjoyed the benefits of
therapeutic massage. The soothing strokes
ease your tensions and promote a sense of inner
calm. Now, through classes offered by Newborn
Connections at California Pacific Medical
Center, you can learn how to give
your baby that same blissful experience.
“Massage allows parents and their
babies to slow down, relax and enjoy
the bonding experience,” says Cherry
Jones, a marriage and family therapist
who also is certified in infant massage.
“Research on infant massage indicates
it lowers the baby’s level of the stress
Massage Classes
Newborn Massage
(up to five weeks old)
One-time class session held first
Monday of every month
10:30 a.m.–noon
Infant Massage
“
Massage allows (six weeks to 10 months) hormone cortisol and enhances the
level of the calming hormone oxytocin.
Research on infant
One-time class session held second
parents and their Massage also has physical benefits for massage indicates it
Sunday of every month, lowers the baby’s
babies to slow babies — muscle stimulation and devel-
2:30–4 p.m. opment of both soft tissues and the level of the stress
down, relax and
All classes are at the California brain. In addition, massage helps babies hormone cortisol
enjoy the bond- Campus of California Pacific Medical with digestive problems such as gas or and enhances the
ing experience. Center. Classes are open to mothers, colic and may bolster the immune
level of the calming
system.”
”
Cherry Jones,
fathers and other family members, as
well as expectant women and their
Newborn Connections’ classes pro-
vide hands-on instruction in proper
hormone oxytocin.
infant massage partners. The $50 class fee covers the techniques for newborn and infant
instructor, Newborn entire family. Pre-registration is required. massage. “Parents learn how to under-
Connections
For more information or a class schedule stand their babies’ tolerance for varying
and registration form, call Newborn levels of simulation,” Jones explains. “It
Connections at 415-600-2229. also helps relieve new parents’ anxieties
and relaxes them, as well!” ★
www.cpmc.org 7
