Know the Signs:n Trouble falling asleep, sleeping too much or too little

n Eating too much or too little

n Poor concentration

n A drop in school performance or in sports participation

n Irritability, anxiety or depression can emerge when stress is poorly managed

n Headaches, stomach aches, rapid heartbeat or other cardiac symptoms

stressis it getting the

best of your teen?

untangling the stressin teens’ lives

Stress is just a part of life; managing it well keeps it in its place Better. Faster. Smarter. Busier. Many teens feel the need to be all those things – and more.

With higher expectations to perform well in school, excel in extracurricular activities and respond to social media, it’s no wonder a recent American Psychological Association survey found that teens feel just as stressed as adults. Maybe more so.

Lynne Merk, PhD, is a psychologist in Behavioral Medicine and Clinical Psychology at Cincinnati Children’s. She teaches our teen patients key techniques for navigating stressful times. And she reminds us of the important role parents can play.

“If your teen is with you and you’re feeling stressed, talk about it,” she urges parents. “Say something like, ‘I am going to take a few deep breaths and then problem-solve.’”

Lynne Merk, PhDPsychologist in behavioral Medicine and Clinical Psychol-ogy at Cincinnati Children’s.

Merk says that eliminating stress entirely is not realistic, or even helpful. “Stress plays an important role in our lives,” she says. “If your teen is feeling little to no stress, she may be bored and have very little motivation to do anything at all.”

The key, Merk says, is finding that “happy medium.”

1. DeterMine what’s in your chiLD’s controL Help your teen prioritize commitments. Are they required or optional? For many teens, it’s a volume issue.

2. reinforce the basics A daily routine, with breaks, and a consistent bedtime (including weekends) are important. Teens need to eat regular, healthy meals and exercise consistently.

3. brainstorM stress-reLieving Distractions Encourage your teen to play a musical instrument, shoot hoops, paint, pray, or just take a moment to quietly reflect while petting the dog. “Down time” has its place.

4. LiMit sociaL MeDia Teens are messaged, texted and tagged day and night. Set limits such as a break from social media from 5-6 p.m. or no phone during homework. Many teens will shudder at first but feel unburdened later. Also, avoid screen time (TV, computer, electronics) an hour before bed to facilitate better sleep.

5. offer PersPective Practice rationalizing stressful thoughts. When a teen is stressed because she’s running late to an activity, remind her to think about the ramifications of being a few minutes late. What’s the worst that can happen? Surely nothing catastrophic.

if stress rises to the point of interfering

with your teen’s daily functioning, talk to his

doctor or schedule an appointment

with an adolescent psychologist. for

most teens, therapy is very effective.

seeking help

five important tips for parents 6

psychologyC h i l d l i f e a n d

1

p e d i a t r i c i a nASK THE Denise warrick, MD

Pediatrician, General and Community Pediatrics at Cincinnati Children’s.

2

the faMiLy resource center The center helps families, community providers and agencies find health information, community resources and support. Call 513-636-7606 for assistance.

sPeciaL neeDs resource Directory Use this directory to find information, resources and advocacy strategies at www.cincinnatichildrens.org/ special-needs.

Join sPeciaL connectionsOur new online community connects with others parenting a child with special healthcare needs:www.cincinnatichildrens.inspire.com.

advocatefor your Child’s health

Seasonal allergies associated with outdoor mold and pollen can be a challenge, because kids want to go out and play as the weather warms up.Kids who are allergy-prone can and should play outside as much as possible. Parents just need to monitor outdoor conditions and set limitations. Mold and pollen readings for your city are readily available online at: www.cincinnatichildrens.org/pollen. Levels typically rise in mid-March and subside by May or June. They re-emerge in the early fall.

Allergies or a cold?

Spring into action to ease your child’s allergiesspringtime is the season of blooming trees and flowers, new grass, sunshine – and unfortunately for some children – allergies.

Allergies cause watery eyes, sneezing and an itchy, runny nose with clear nasal secretions. The common cold can cause similar symptoms but also may include discolored nasal secretions, a sore throat and body aches.

Over-the-counter medications can be helpful for allergies, but it’s important to know which kind to use and how long to use them. Most now come in a non-drowsy formula, so they shouldn’t affect your child’s schoolwork or normal sleep patterns.

With over-the-counter medications, look for antihistamines or decongestants for allergies. As always, read labels carefully and talk with your child’s doctor if you have any questions.

Antihistamines, available in either oral pills/liquid or nasal spray, target a chemical called histamine, which your body pro-duces as a reaction to an allergen. They are most effective if given before the onset of symptoms.

Some over-the-counter pills and nasal sprays may also contain a decongestant. You’ll see a “D” after the name.

Decongestants are good only for short-term relief. They cut down on the fluid in the lining of the nose, which makes breathing easier, but after about three days they begin to have a “rebound” effect that causes swelling and makes breathing more difficult.

Besides seasonal (outdoor) allergies, there are also perennial (indoor) allergies, caused by conditions in the home such as mold, dust, dust mites and pets.

One home hint: opening up windows to let in fresh air can be tempting but also detrimental. It invites in pollen and mold from trees and grass and also kicks up the dust and other allergens (in-cluding pet dander and saliva) in the home. The most important room to be allergen-free and pet-free is your child’s bedroom.

If over-the-counter antihistamine medications don’t alleviate symptoms, call your pediatrician. Other treatment options that can be prescribed by your pediatrician include nasal steroid sprays or eye drops that contain antihistamine. For more severe cases, allergy shots might be warranted.

Medication Tips Indoor Allergies

3

rESEArCHstudyj O I n A

researchers at Cincinnati Children’s conduct hundreds of studies each year to figure out why people get sick and what treatments might help them. Discoveries researchers make in the lab can lead to even better treatments and ways to prevent diseases from happening in the first place. Did you know you could be part of the process of helping our scientists solve medical mysteries? You can participate by joining a research study. Here’s what we’re recruiting volunteers for now.

Do you or a LoveD one have sickLe ceLL Disease?Cardiac MRI and Sickle Cell Disease Research StudyWhat: We want to learn more about how sickle cell disease (SCD) affects the heart and lungs. We also want to figure out the best way to look at the heart and lungs by comparing two tests: an echocardiogram (or “echo”) and a magnetic resonance imaging of the heart (or cardiac MRI).Who: Those eligible to participate are children, teens and adults who are 6 years of age and older and have SCD.Pay: Participants may receive up to $600 for completing all study visits as reimbursement for their time and effort.Contact: Courtney Little at courtney.little@cchmc.org • 513-803-0226

If you have a question for the pediatrician, email youngandhealthy@cchmc.orgHAvE Questions?

AbOUT this issue SPrInG 2015

young and healthy is a quarterly publication from Cincinnati Children's hospital Medical Center. for more health news and patient stories, subscribe to our monthly e-newsletter online at www.cincinnatichildrens.org/subscribe

© 2015 Cincinnati Children's hospital Medical Center

PRODuCeD BY

the department of Marketing & CommunicationsCincinnati Children's hospital Medical Center3333 burnet ave., MlC 9012, Cincinnati, oh 45229-3026Phone: 513-636-4420

advisers: Chris Peltier, Md, and Zeina samaan, Mdeditorial consultant: denise Warrick, Mdeditorial staff: tom o’neill/managing editorPhotography: tine hofmann, tm photographyDesign: Christina ullman & alix northrup, ullman design

facebook.com/cincinnatichildrensfans youtube.com/cincinnatichildrens cincinnatichildrensblog.org@cincychildrens

How do pet allergies work?The culprit is not your dog or cat’s hair. It’s dander and saliva. Dander is tiny bits of skin shed by pets that can become airborne and can settle in your child’s nose and throat. Saliva contains a tiny protein that is sticky and so light it too can become airborne, clinging to your hair, clothes and items around the house. Dried saliva containing this allergen can flake off from an animal's fur.

Reigning cats and dogsAbout a third of American homes have a dog, and slightly fewer have a cat. But cats are two times more likely to prompt an allergic reaction. According to the American Lung Association, there is little difference between short-haired and long-haired pets, and no breed of dog or cat is immune from spreading allergens.

P e t allergies

chiLDren who DayDreaM, are sLow Moving anD/or seeM to be ‘in a fog’ Children’s Attention Problems StudyWhat: This is a research study to learn more about how children with specific attentional difficulties differ from other children, in their cognitive and sleep functioning.Who: Children 8 to 12 years old who daydream, are slow moving, and/or seem to be “in a fog” may be eligible.Pay: Families may receive up to $100 for time and effort.Contact: The study coordinator at CTADHD@cchmc.org • 513-803-0771

chiLDren anD teens 5 to 18 years with aLLergiesA Study about the Role of Our Genes and EnvironmentWhat: This is a research study to learn more about the role that genes and the environment play in determining why some children develop certain disorders or symptoms and others do not.Who: Children and teens 5 to 18 years old who have allergies (sneezing, runny, stuffy nose; itchy, watery eyes) but do NOT have asthma may be eligible to participate.Pay: Families may receive up to $50 for their time and travel and may receive allergy test results at no charge.Contact: Kelly Bryan at kelly.bryan@cchmc.org • 513-803-0672

4

We figured the artwork would be very good. We were wrong. The artwork was fantastic and poignant.Through their drawings, the kids revealed so much about themselves and the reason why we believe our mission of healthy children is so important.

They drew everything from DNA strands and flying wheelchairs to rainbows and microscopes. They drew smiling families and busy playgrounds. They drew themselves.

Cincinnati Children’s decided to integrate a new element into our 2014 annual hospital report: artwork by kids.

http://www.pinterest.com/cincychildrens/children-contribute-art-to-2014-annual-report/

To view all 185 pieces of arTwork visiT:

the darnede st th ings

some kids are current or former patients. some attend the Children’s for Children daycare center for Cincinnati Children’s employees.We also enlisted kids from two local schools: the 3rd-grade art class at our partner school, rockdale academy in Cincinnati, and the 5th-grade advanced and Creative talents class at Mason intermediate school in Mason, ohio.other than a few prompts, such as “draw the future of medicine” and “draw what it feels like to be happy,” it was pretty open-ended. We just let the children create from their imaginations: what they see, how they feel.

CliCk on “like” if you see one that speaks to your heart.

KIDS DRAW

5

the key to a heaLthy chiLD:

Sleep is one of the main ingredients of a healthy child, but few get as much as they need.

especially teenagers.For parents, the best recipe for

ensuring their kids get sufficient rest is limiting their evening access to electronics and snacks.

“It’s a very common thing, kids not getting enough sleep,” says Sarah Selickman Heidt, MD, a pediatrician affiliated with Cincinnati Children’s. “That’s especially true for teens; they’re busy with sports and school. For most, I recommend eight and a half to nine and a half hours, but very few are getting that.”

Selickman Heidt says dinner should typically be the last meal of the day, to give kids a chance to properly digest their food and begin the process of easing into good, restful sleep. If they eat anything in the evening, “keep it to fruits and veggies, high-fiber things,” she says. “Stay away from the sweets.”

The other dietary villains – particularly for teens – are energy drinks and soda, which are often packed with caffeine and can wreak havoc on sleep patterns many hours later.

“energy drinks can definitely impact sleep, even when they’re consumed earlier in the day,” Selickman Heidt says.

Numerous medical studies emphasize the negative impact of caffeine on children. The American Academy of Pediatrics recommends limiting caffeine as much as possible in food and drinks for adolescents, and restricting it completely with children.

It’s not easy because caffeine is everywhere: an eight-ounce coffee contains 135 milligrams (mg); a 12-ounce soft drink, 22-55 mg; an eight-ounce energy drink, 75-80 mg; and one ounce of bittersweet chocolate contains 5-35 mg.

A warm bath or shower before bed can help kids wind down. Selickman Heidt and other doctors encourage parents to adhere to a tough-love rule: “Bedrooms should be an electronics-free zone,” she says.

Some kids will insist they need their device because one of its functions is an alarm to wake them in the morning.

Selickman Heidt has a ready solution: “Go to an old-fashioned alarm clock.”

Limiting night eating and electronics will help refresh their bodies, minds; caffeine will not

sarah seLickMan heiDt, MDis a community pediatrician affiliated with Cincinnati Children’s. she practices at Pediatric associates of Mt. Carmel.

a good night’s sleep

sl e e p h e a l thfOCUS On changing behaviors

n infants (2 – 12 months) ......................... 13 to 17 hours

n toddlers (1 – 3 years) ............................ 12 to 14 hours

n Preschoolers (3 – 5 years) ..................... 11 to 13 hours

n school-age children (6 – 12 years) ........ 10 to 11 hours

n adolescents (13 – 18 years) .................. 8.5 to 9.5 hours

d oes my ch il d ne ed ?

h o w m u c h s l e e p

6

here are the key questions MaDsen encourages Parents to think about:

Dr. Nicolas MaDseN, MD, MPH

Cardiologist at Cincinnati Children’s

Twitter: @MadsenNicolas

Was my child injured recently?even heavy lifting or intense aerobic exercise can strain the rib muscles. it will subside in time.

Is my child stressed?school pressure, relationships with other children or teachers, or problems at home can all cause chest pain. “it’s hard to measure,” Madsen says, “but in a large percentage of cases we see, stress is a source.” think of it like a stress-related headache in adults: the pain won’t last but is very real.

When does it hurt?talk to your doctor if chest pain only occurs during or immediately after moderate to vigorous activity, like running or sports.

How long has it been hurting?Chest pain caused by cardiac disease is either so severe that no child could cover it up or ignore it, or it is progressive and associated with other problems such as passing out or worsening fatigue.

How painful is it? Mild-to-moderate chest pain isn’t a cause for big concern, but pain that is sudden or severe can be a sign of pericarditis, a rare inflammation of the heart. if your child has sudden severe pain that is continuous and coincides with an illness – contact your pediatrician that same day.

As a cardiologist in the Heart Institute at Cincinnati Children’s, Nicolas Madsen, MD, MPH, sees a lot of children with chest pain. The good news is that less than one percent of cases involve an underlying heart condition. Typically, the cause is a viral illness, stress, an inflammatory condition or old-fashioned growing pains.“The pain is real, so parents should not minimize how much it hurts,” says Madsen. “Some kids are near tears, so I’m always reassuring. But it doesn’t mean it’s heart-related.”

Children age 7 to teens are most likely to complain of chest pain. One common cause is costochondritis, or inflammation in the joint between the breastbone and ribs. It’s usually the result of a virus or frequent, forceful coughing. It’s not a serious concern and Ibuprofen or a prescription anti-inflammatory should ease symptoms.

Chest Pain Can Be Scary

Common causes are stress, coughing, inflammation, and yes, even growing pains

“If that alarm bell of parenting is going off, go to your pediatrician

and think about these five questions,” Madsen says. “We just want families

to feel less anxious.”

B u T R A R e L Y I S

H e A R T - R e L A T e D

pain symptomsk n o W i n g t h e s i g n s

Most chest pains in children are not serious and can be caused by many things, including stress and normal growing pains.

7

insidethis issue s L e e P A n D H E A lT H

before-bed activities can affect your child's sleep. learn how to ensure restful sleeping habits.

g r o w i n g PA I n SKnow the difference between

chest pain symptoms and serious heart conditons.

3333 burnet avenue, MlC 9012Cincinnati, ohio 45229-3026

Tips for parents to help ease seasonal allergiesSpring into action

S P r I n G

2 0 1 5

A guide to your child’s good health

healthyyoungand

a feature of our 2014 annual report

see more inside on page 4

k id s 'artwork