Tag Archives: raising arizona kids

It’s Diabetes Alert Day: Take the test

It’s the fourth Tuesday in March, which means it’s time for Diabetes Alert Day.

Held by the American Diabetes Association, Alert Day is a one-day “wake-up call,” asking Americans to take the Diabetes Risk Test to find out if they are at risk for developing type 2 diabetes.

Diabetes affects nearly 26 million children and adults in the United States. About one-quarter of them—7 million—do not even know they have it.

An additional 79 million, or one in three American adults, have prediabetes, which puts them at high risk for developing type 2 diabetes.

What is prediabetes?

Pre-diabetes, says  Dr. Floyd Shewmake, M.D., J.D., senior medical director for Blue Cross Blue Shield of Arizona (BCBSA), refers to a blood sugar level which is higher than normal but not yet high enough to result in the diagnosis of diabetes.  Almost all type 2 diabetics go through a period of time when they meet the criteria for pre-diabetes.

The only way to determine if you are pre-diabetic is to have a fasting blood sugar test done, he adds.  Pre-diabetes has no symptoms but there is evidence that even at this early stage damage to critical organs such as the heart and kidneys can begin.

So, who’s at risk?

Adults and children who have one or both parents diagnosed with type 2 diabetes are at a higher risk for developing type 2 diabetes, says Shewmake.

Women who developed elevated blood sugars during pregnancy are also at a higher risk of type 2 diabetes as they get older, and should be monitored more closely for diabetes.

Shewmake says that the risk for developing diabetes can be delayed, or even avoided. Healthy dietary habits, maintaining a normal weight, and an active lifestyle with regular exercise can help.

Type 2 diabetes occurs more often in adults with high blood pressure, so Shewmake encourages regular checkups to make sure that blood pressure stays in the normal range.

What’s normal blood pressure?

Recent research shows a link between type 2 diabetes and the development of colon cancer.  This association has been identified in several studies though it is not yet understood exactly why this link exists.

Colon cancer screening is important for all adults, says Shewman, and especially important for individuals with type 2 diabetes because of this link.

“We have known for years that the better the sugar is controlled, says Shewman, “the less likely secondary complications such as heart, vascular and kidney diseases will occur.” New drug therapies developed over the last ten years are helping type 2 diabetics better control their blood sugars.

Blue Cross Blue Shield of Arizona encourages families to follow the “5-2-1-0” plan for staying healthy and active. Aim for:

FIVE fruits or vegetables per day

TWO hours or less of screen time

ONE hour of physical activity

 ZERO sweetened drinks.

More on BCBSA’s school-based health education program Walk On!

Helping college kids cope with diabetes

Creating a safe learning environment for kids with diabetes

Understanding pediatric sudden cardiac arrest (SCA)

Would you recognize the warning signs of pediatric sudden cardiac arrest (SCA)? If not treated in minutes, SCA can result in death.

In a new policy statement to be published online on Monday, March 26, the American Academy of Pediatrics (AAP) provides guidance for pediatricians on underlying cardiac conditions that may predispose children to SCA.

Although the risk for SCA increases when children with underlying cardiac disorders participate in athletics, SCA can occur at very young ages and also when a child is at rest.

Research supports the need for a SCA registry, says the AAP. A registry would help experts gain a better understanding of the nuances of the condition.

Plus, many cardiac disorders are known to be genetic, so the evaluation of family members, even if asymptomatic, could be a critical step in the overall diagnosis of disorders predisposing to pediatric and young adult SCA.

We asked Arizona Pediatric Cardiology Consultants (APCC), members of the Arizona Chapter of the American Academy of Pediatrics, to weigh in on what parents need to know about SCA.

How common is SCA?  

According to the Centers for Disease Control, each year 2,000 individuals less than 25 years of age will die suddenly with the majority of these having a cardiac etiology.

What causes SCA?

Pediatric sudden cardiac arrest and sudden cardiac death can occur with various types of cardiac causes, including conditions in the heart muscle (such as hypertrophic cardiomyopathy), unusual positioning of a coronary artery, or an electrical disturbance within the heart. (Long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia).

More on genetic cardiac conditions from the Sudden Arrhythmia Death Syndrome Foundation (SADS)

How are family members evaluated, and what symptoms may be indicators that a child is pre-disposed to this? 

Signs that may suggest an increased risk for SCD include fainting or seizure with exercise, excitement, or startle, significant dizziness with exertion, unusual and consistent shortness of breath or chest pain with exercise.

If a family member has died suddenly or unexpectedly at a young age, has unexplained seizure disorder, died at a young age from a heart problem, or has a history of fainting, then screening is appropriate.

How do doctors determine if a child is at risk? What tests are performed?

Evaluation by a pediatric cardiologist will include a thorough individual and family history, ECG, physical exam and perhaps an echocardiogram, an exercise stress test, and genetic testing if necessary.

Would automatic external defibrillators (AED) on playing fields and in schools help?

A great majority of these deaths relate to a life-threatening arrhythmia, ventricular fibrillation. CPR and use of an AED may be life saving.  AEDs are often found in airports, casinos, and government buildings.

However, there is no law in Arizona currently requiring AED within schools, recreational sports fields, or other private facilities.

Are efforts being made to increase the availability of AEDs?

The decision about whether to have an AED on location is left up to the individual organization.  APCC’s electrophysiologists are making an effort to educate schools, sports organizations, and families regarding the importance preparation to prevent SCD.

The role of an ECG in all sports physicals remains a debated topic within the United States.  It is, however, very important to ask specific questions (use the attached screening tool) for risk factors and then refer to a pediatric cardiologist for further assessment.

What should parents or caregivers do if they believe a child might be at risk?

Once an individual is identified as having any of the conditions listed above, it is very important for first degree relatives to also be evaluated by a pediatric cardiologist even if they are not experiencing symptoms.

Sudden Cardiac Death is devastating to not only the families of those affected but to the communities in which they live.  Educating  families, schools, sports leagues, and primary care providers about quick and effective screening for children at risk for SCD is a first step in prevention.

Increased community awareness and the availability of AEDs in schools and sporting venues will help avert a tragedy.

Karen S. Eynon, RN, MSN, CPNP, MATS,  compiled these answers with support from Mitchell Cohen, MD, Andrew Papez, MD, and Jennifer Shaffer, RN, MS, CPNP, all of Arizona Pediatric Cardiology Consultants along with information from SADS.org.  

Check with your child’s physician if you are concerned about risks for SCA.

More from Parent Heart Watch, a network of parents and partners dedicated to reducing the effects of SCA.

 

Coping with dementia: a workshop for kids and families

It’s tough to deliver the news that a beloved grandparent has Alzheimer’s disease. But no one ever expects to have to tell his or her own children that a parent has been diagnosed with dementia.

But it happens.

About 10% of people under 65 will have a dementia, says Jan Dougherty, RN, director of Family and Community Services for Banner Alzheimer’s Institute.

More on Alzheimer’s disease and dementia

With the number of parents having children over 40, adds Dougherty, chances are that if a parent does develop early onset dementia, they may have adolescents or teens in the home.

No matter if it is a parent or a grandparent, kids are embarrassed by the changes they are seeing, says Dougherty, so finding others who are in similar situations can be very helpful.  Children and adults can become easily overwhelmed by the disruption that a dementia diagnosis can cause.

It’s important for parents and caregivers to be open and honest with children in any situation where rapid and significant change, such as memory loss, is likely to occur, says Cardon Children’s Child Life Specialist Courtney Kissel. That helps to maintain a trusting relationship.

Explaining a diagnosis to younger children about a parent- or a grandparent – can be a challenge.

One of the tips Kissel recommends is to ask the child to picture the memories that the person has in list form, written on a chalkboard that will, over time, be erased. The more recent memories at the top of the chalkboard will disappear first, and the memories from the early years of life at the bottom of the chalkboard will be the last to fade away.


A workshop, sponsored by the Banner Alzheimer’s Institute, aims to help families to come together to learn more about dementia and how to cope with the changes.

Dougherty hopes that her team will identify some ways to keep kids and families connected on an ongoing basis –so they won’t feel alone.

Kids, Families and Dementia Workshop
Saturday, March 31
8:30am-12:30pm
Franciscan Renewal Center, 5802 E. Lincoln Drive, Scottsdale, AZ

Families participating in this workshop with their children will gain age-appropriate information about Alzheimer’s disease/related dementias, explore methods to provide age-appropriate support for kids living with a person with dementia, identify ways for adults and children to stay connected to the person with dementia, join with others in like situations and explore ongoing ways to stay connected and supported.

Cost:
Individual: $10
Family of 3 or more: $25

TO REGISTER:
Pre-registration is required for the conference. The deadline is March 26. Call: 602-839-6850 or email deidra.colvin@bannerhealth.com.

Additional information, including the workshop schedule of activities.

Car seat safety check this Saturday

Wondering if your car seat still fits your child? Confused about when to turn your child from rear-facing to front facing? Need the eye of a trained professional car seat fitter to make sure your safety system works the way it should?

On Saturday, March 24, the Governor’s Office of Highway Safety Car Seat Check Event takes place at the Target store located at  1525 W. Power Road in Mesa.

Cardon Children’s Medical Center Safety and Injury Prevention staff will have 100 car seats to give out to families who need one.

Four out of five car seats are used incorrectly, according to the American Automobile Association. Don’t make these tragic mistakes!

Families can have a child’s car seat recertified, learn how to install a seat correctly or get a free car seat.

More RAK Resources on vehicle safety seats

Watch this video to see what a safety check event looks like:

 

Breastfeeding and the milk supply over time

This story has been relocated. Find it at raisingarizonakids.com.

An increase in synthetic marijuana use among teens

Synthetic versions of marijuana are sending some teens to the hospital, says a case report to be released in the April issue of Pediatrics.

The drugs, created in uncontrolled settings and sold in gas stations and convenience stores, consist of herbs sprayed with chemicals that mimic the

Courtesy DrugFreeAZ.org

psychoactive properties of THC, Continue reading

Breastfeeding: debunking that “not enough milk” myth

Human babies have survived on their mother’s milk for millions of years, just like all other mammals, says Laurie Jones, MD, IBCLC. And a woman’s ability to make milk and nourish her baby is not based on a fragile system.

The majority of mothers are quite capable of feeding their young.  In fact, Jones says that 95 to 99 percent of mothers make enough milk for their baby.

Well check: Dr. Laurie Jones and one-month-old Sophia Gulbis and her mom, Stephanie Gulbis

When it comes to feeding a new baby, there were no other options but breastfeeding  until the relatively recent past. “We all forget that, says Jones, an AzAAP chapter member who practices at St. Joseph’s Hospital and Medical Center.

But today, says Jones, many mothers believe that when they have a baby, they won’t be able to make enough milk. “So many of their friends or family have planted the seeds of doubt.”

Modern hospital practices tend to inhibit built-in mechanisms for bountiful milk production, says Jones. “New mothers are bombarded with advertising for formula ‘supplements,’ and their doctor or hospital may give them free formula samples ‘just in case.’”

More on how Arizona hospitals are helping new moms to meet breastfeeding goals

And that perpetuates the myth that they won’t make enough.  “Our modern culture, beliefs, medical practices, and artificial substitutes have given rise to a false epidemic of not enough milk.”

Baby Sophia has been exclusively breast-fed since birth and now weighs 10 lbs.

It’s a combination of factors that lead a mother to begin feeding both breast and formula in the first days and weeks after her baby is born, says Jones, and that’s what leads to a reduced milk supply.

“That’s the number one reason mothers stop breastfeeding and do not reach the recommended 12 months,” says Jones. “It’s because of perceived — or real –low milk supply.”

What works

In the first few weeks when the mother’s body is figuring out how much milk to make, it is critical that she is given unrestricted access to her baby with no rules or limits on feeding.

“Many parents mistake a newborn’s constant need to suck as a sign of being underfed,” she says. “But babies are programmed to suckle frequently to bring in a mother’s full milk production.”

Dr. Jones examines Sophia's mouth and palate.

Babies have long been wired that way — because it ensures a safe, close proximity to their mothers. The amount of suckling in the first 5 days is a predictor of the supply for the following six months.  Anything that stands in the way of this natural regulation will prevent a mother from exclusively breastfeeding.

Jones, a pediatrician who is also an International Board Certified Lactation Consultant, helps educate medical professionals on how critical the first few days after birth can be for a new mother to get off on to a good start in establishing her milk supply.

From the moment the baby is born, says Jones, the only thing a new mom needs to do is be close to the baby to allow the mother-baby dance to unfold. Milk production will increase dramatically around the third day post partum.

More on skin-to-skin contact

It sounds simple, and natural, keeping a new mother and her baby close, those first few days right after birth.

But that’s not always what happens for women who deliver in the hospital. Jones points to research showing that on the very first day after birth — post-partum day one –there are an average of 54 interruptions to a mother’s hospital room, with each interruption averaging 17 minutes in length.

Jones sees women start giving formula in the hospital after their baby is born because they think they don’t have enough milk right after delivery. That’s not true, says Jones.

Facts on milk supply from Dr. Jones:  

  •  A woman only needs ONE breast to feed ONE baby. Expectant women begin making milk around 16 weeks in to a pregnancy.
  •  The baby’s stomach can hold about 7 to 15 milliliters comfortably in the first day of life.
  • The average volume of a feeding is 7 to 10 milliliters – about a teaspoon and a half.

    A spoonful of milk is about 7 milliliters

    “It’s amazing how nature delivers the perfect amount to the baby,”  says Jones.

When mother and baby are kept in direct contact with minimal interruptions, the baby will nurse frequently.  A minimum number of feedings is about 8 to 12 per 24 hours.  

  •  How do you know the baby is getting enough? Count wet (W) and stool (S) diapers:  Day 1 (1W, 1S), day 2 (2W, 2S), day 3 (3W, 3S), day 4 (4W, 4S), and day 5 to one month — about 6 to 8 of each.
  •  Pacifiers can steal time at the breast and lower milk supply when used in the first two weeks, too.
  •  Topping off with formula after breastfeeding will decrease a mother’s milk supply, and no formula should be given to a breastfeeding infant without a true medical indication and for a short therapeutic intervention.
  • If the baby won’t latch onto the breast for some reason in the first days after birth, the simplest fastest option is to hand express the milk in the mother’s breast and feed it to the baby on a spoon.
  • Pumps cannot get the colostrum milk out as easily as a mother can by hand, and there is a lot of set up and cleaning and time distraction involved in pumping.
  • Bottles of pumped milk should be avoided in the first 3 to 4 weeks when the fast flow of the bottle can create breast refusal.

More breastfeeding facts from Dr. Jones: Size doesn’t matter

  1. Women with small and large breasts make the same volume of milk per day.
  2. The rare 1 to 5% of mothers with true insufficient glandular tissue (IGT) who cannot make an exclusive milk supply should have a full medical evaluation before they are given that diagnosis.
  3.  The condition would not become apparent until a few weeks after the baby is born, and the infant is exclusively breastfed with inadequate growth.
  4.  Low milk supply is a medical condition that should be evaluated by a team,

Baby Sophia was treated for tongue-tie in the first few days after birth, which helped Stephanie to meet her breastfeeding goals.

including the mother’s obstetrician, baby’s physician, and an IBCLC.   There are maternal hormonal causes of a reduced supply, and some infant conditions, like tongue-tie, that can reduce supply.

Many of these issues can be reversed with the right information and support, and even those rare women with IGT can provide 100% at breast feeds with a combination of their own milk and supplementer tubing-fed donor milk or formula.

You can’t see it…but it’s there!

There’s a misperception that a mother should produce more milk over time, says Jones. But studies show that the milk supply is pretty much the same from month one to month twelve. Jones says that is “shocking to most people who are used to seeing bottle-fed babies take higher and higher volumes over time.”

But the same volume of milk grows a human baby beautifully from month one to month twelve for two reasons: (1) the fat and calorie content of human milk changes from day to day and month to month and (2) breastmilk-fed infants burn fewer calories per day than formula-fed infants.

What to ask a prospective pediatrician about breastfeeding

Drinking cow’s milk formula is an inefficient process that makes an infant require more volume over time, and the caloric content of formula is the same every day of the infant’s life.

Breastfeeding is an elegant, mother-baby biological connection, says Jones, yet several barriers today stand to put a wrench in a system that has nurtured humans throughout history.

“Mothers doubt their own bodies, doctors unnecessarily supplement, hospitals separate mother from baby for convenience, pacifiers are given to quiet the baby, culture dictates a baby be on a schedule, insurance won’t pay for lactation support after hospital discharge.”

There are many forces that attempt to undermine an essential biological process, says Jones, “but a mother with the commitment to breastfeed can overcome all these barriers with the right information and support.”