NIGhtmAReS vS. SleeP teRRoRS cAR SeAt SAfety SPoRtS ...

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vS. SleeP teRRoRS
cAR SeAt SAfety
SPoRtS INjuRIeS
tReAtING youR
chIlD’S DePReSSIoN
SPRING 2008 • www.childrens.com

Sleep & Safety
The chilDreN’S Sleep
DiSorDerS ceNTer iS
The oNly NaTioNally
accreDiTeD proGraM
iN NorTh TeXaS
ThaT offerS peDiaTric
paTieNTS coMpreheNSive
DiaGNoSTic evaluaTioN
aND full-Service
TreaTMeNT.
Things that Go Bump in the Night
NightMares vs. sleep terrors – UNderstaNdiNg
the differeNCe is Key to CalMiNg yoUr Child
If you’ve awakened in the wee hours
to the sound of your child’s frightened
cry, you know how disconcerting nighttime
fears can be for young children.
Occasional nightmares, or scary dreams,
are normal after 6 months of age.
However, some children also have
sleep terrors — very alarming sleep events
that children rarely remember.
“With sleep terrors, children appear to be
in a state of profound fear and panic,” says
Dr. Kamal Naqvi, medical director of the
Children’s Sleep Disorders Center — the
only North Texas pediatric sleep center
accredited by the American Academy of
Sleep Medicine. “Their eyes are open,
they’re disoriented and inconsolable and
their expression is one of total fear. It’s very
compelling, even terrifying, for the adults
who witness these events.”
How to tell tHe Difference
Nightmares:
n Involve little body movement other than
rapid eye movement (REM).
n Usually happen in the second half of sleep.
n Typically are caused by recent events or
2
Children’s Medical Center
n
n
Kamal Naqvi, m.D.
Medical Director, Sleep Disorders
center, children’s Medical center
a specific anxiety-producing situation.
Are frequently recalled and involve detailed
plots that often are related to the child’s
experiences and developmental stage.
Make return to sleep difficult for the child.
Sleep Terrors:
n Involve screaming, being fearful, kicking,
sleepwalking and sleep talking.
n Happen at fairly predictable times during
the first half of sleep.
n Often are related to a lack of sleep.
n May be associated with a single frightening
image, but the whole event rarely is
remembered by the child.
n Are usually outgrown with age.
n Allow the child to return to sleep more
easily, compared with nightmares.
ways to Help
When a child experiences sleep terrors, parents
should gently get the child back into bed
and not mention the episode in the morning.
“Asking a lot of questions and telling the
child all about it doesn’t help,” says Dr. Naqvi,
also an assistant professor of Pediatrics at
UT Southwestern Medical Center. “It can be
very disconcerting to a child to be told he did
things he has no recollection of.”
Eliminating sleep terrors can be as simple
as making sure your child gets more sleep.
Developing and maintaining bedtime routines
seven days a week is helpful. If the timing of
the episodes is predictable, parents can gently
wake the child 15 minutes beforehand and
reassure him or her that everything is fine.
seeking expert care
If you think your child is experiencing sleep
problems, ask your pediatrician if a sleep
study is needed. The Sleep Disorders Center
at Children’s Dallas and the dedicated center
at the Children’s Legacy Ambulatory Care
Pavilion in Plano offer inpatient and outpatient
sleep studies to evaluate children for a variety
of disorders and sleeping problems. n

Be Driven to car Seat Safety
proper iNstallatioN redUCes risK of iNjUry
it’s bad enough when 98 percent of all
child car seats are used the wrong way.
It’s worse when 100 percent of all
parents think they’re using them
correctly. Motor vehicle injuries continue
to be the greatest risk to a child’s health.
As a parent, you need to do more
than just buckle up your child. It also
matters how you buckle up your children
and where they sit in the vehicle.
DiD you know?
n Texas law says all kids younger than
15 must be buckled up.
n Traffic accidents are the leading
cause of death for children in the
Dallas area.
n The safest place in the car for a child
is the back seat.
n A car seat with a five-point harness
offers the best protection.
infants — rear facing
Infants should always be placed in a
rear-facing car seat in the back seat of a
vehicle. Never place an infant in a rearfacing
car seat in front of an air bag.
If a baby is riding facing forward
during a crash, the infant’s soft spinal
column can stretch and the cord can be
damaged. The baby could die or be paralyzed
— even babies with strong neck
muscles and good head control.
Infants should face the back of the car
as long as possible, until they are at least
1 year old and weigh at least 20 pounds
(preferably 30 pounds). If your baby
weighs more than 20 pounds before
age 1, a convertible car seat, certified
to face the rear and hold up to 30
pounds, should be used.
toDDlers — forwarD facing
Children older than 1 year and between
20 and 30 pounds can use convertible
car seats in the rear-facing position,
but children between 30 and 40 pounds
should be in a forward-facing car seat.
The straps should be snug, and the top
of the retainer clip should be positioned
at the child’s armpit level to keep the
harness straps in the correct position.
The best place for a toddler’s car seat
is the back seat of the vehicle.
cHilDren — Booster seats
Children are ready for a high-back
booster seat when they weigh 40
pounds, and they should remain in the
seat until they are about 80 pounds.
Booster seats raise the child up to
a position at which the seat belt fits
properly — low over the hips and snug
over the shoulders and chest.
Never use just a lap belt across a child
sitting in a booster seat. Do not use
pillows, books or towels to boost a child. n
Go to www.childrens.com for an interactive guide
on how to properly install your child’s car seat and
information on free car seat checks.
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www.childrens.com
StAte’S oNly
PeDIAtRIc hoSPItAl
wIth A level I
tRAumA ceNteR
Whether they’ve fallen off a
bike or been in a car accident,
thousands of children and
their families each year rely on
the pediatric trauma experts
at Children’s Medical Center
Dallas.
In February, the American
College of Surgeons and the
Texas Department of State
Health Services renewed the
hospital’s Level I trauma
designation.
Children’s became the first
freestanding pediatric hospital
in the Southwest to qualify
for Level I trauma status in
2005. To maintain this status,
trauma services must be
reverified every three years.
To receive Level I trauma
status a hospital must provide:
n 24-hour coverage by trauma
surgeons, pediatric emergency
medicine specialists,
anesthesiologists and operating
room staff.
n Prompt availability of
care in specialties such as
orthopedic surgery and
neurosurgery.
n Immediate availability of
the trauma intensive care
unit and critical care
physicians.
n Comprehensive radiology,
including interventional
radiology.
n 24-hour availability of the
laboratory and blood bank.
n Substance abuse and
alcohol screening.
Children’s is one of only
14 pediatric facilities in the
country with Level I status.
It also is one of the largest and
busiest. In 2007, the hospital
saw more than 13,000 trauma
cases.

Injury preventIon
To learN More
aBouT SporTS iNjury
preveNTioN, viSiT The
chilDreN’S WeB SiTe
www.chIlDReNS.com.
Mix it up
Severe injuries are on the rise in
young athletes, and studies have
shown that a year-round focus
on a single sport may be partly
to blame.
“Intense, full-time efforts in
one sport can lead to a lot of overuse injuries
in children,” says Dr. Philip Wilson,
an orthopedic specialist at Children’s Medical
Center and assistant professor of orthopedic
surgery at UT Southwestern Medical Center.
“We never used to see this damage until they
were in late high school or even college.”
Young athletes are still growing. That means
they face a higher risk for harm than adults.
4
Children’s Medical Center
Philip wilson, m.D.
orthopedic Specialist,
children’s Medical center
foCUsiNg oN oNe sport CaN lead to overUse iNjUries
Research shared at the 2007 meeting of the
American Academy of Orthopaedic Surgeons
found that sports injuries are responsible
for two of five emergency room visits
by children ages 5 to 14.
otHer finDings:
n Some students, not yet in high school, are
hurting their shoulders so badly they need
surgery once reserved for older athletes.
n Injuries to the anterior cruciate ligament
(ACL) are now seen in younger children.
The ACL links the upper and lower leg
bones at the front of the knee.
n Arm injuries are on the rise in young
pitchers. Experts blame poor throwing
motion.
wHy is year-rounD play at fault?
“We’re not seeing the selective stress distributed
about their body like we used to see in
childhood athletes, where they played baseball
for fun one month and the next month,
basketball, and next season, football,”
Dr. Wilson says.
Experts say players, parents and coaches
must heed the needs of growing bodies. Training
should match the child’s stage of growth.
“Stress should be placed in different areas of
the child’s body, allowing time for recovery,”
Dr. Wilson says. “There is widespread overtraining
of children.”
Strength training in 12-year-olds works
against the child’s natural development.
That is an age for working on coordination
and speed, which are best improved by a
variety of activities rather than one specialized
activity. n

Sports injury prevention and
first aid resources at the
click of a Button
if your child injured an ankle while
playing soccer or sustained a head
injury on the football field, would
you or your child’s coach know how to
respond?
Children’s supports North Texas
families and coaches with injury prevention
workshops and a comprehensive
online health library on the Children’s
Web site, www.childrens.com.
The Children’s Web site provides
detailed information and easy-tounderstand
medical illustrations for
numerous sports injury prevention
and first aid topics, including:
n Normal heart and breathing rates.
n Spine injuries.
n Bleeding injuries.
n Tooth loss.
n Eye lacerations.
n Moving an injured athlete.
In addition, orthopedic surgeons
and emergency medicine specialists at
Children’s are among the experts
featured on the hospital’s speaker’s
bureau. This group is focused on prevention
and evaluation of sports-related
injuries and other health topics of
interest to coaches, parents and student
athletes.
Since 2003, nearly 45,000 coaches
have attended workshops hosted by
specialists on the Children’s medical staff.
Topics range from evaluating muscle
sprains and strains to preventing
dehydration. n
A handy injury assessment reference
chart that can easily be attached to
clipboards or placed in sports-equipment
bags is available on the hospital’s web site
www.childrens.com/Patients_families.
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www.childrens.com
SKIN INfectIoNS
moRe commoN
AmoNG AthleteS
Staphylococcus aureus,
commonly known as staph,
is becoming more and more
common among athletes who
participate in contact sports
such as football and wrestling.
Most staph infections can be
treated easily, but some staph
infections lead to more serious
illness.
Infections known as methicillin-resistant
Staphylococcus
aureus, or MRSA, are resistant
to certain antibiotics, making
them harder to treat.
Good hygiene and proper
treatment and covering of cuts
and scrapes are essential to
preventing the spread of the
bacteria that causes staph.
The national Centers for
Disease Control & Prevention
provides the following tips on
preventing the spread of staph:
n Keep cuts and scrapes clean
and covered with a bandage
or don’t participate in practice
or competitions until
skin infections heal or can
be covered adequately. Don’t
touch cuts or bandages on
another person.
n Practice good hygiene. Wash
your hands frequently or
use an alcohol-based hand
sanitizer and shower with
soap, hot water and clean
towels after all practices
and competitions.
n Don’t share towels, clothing
or personal items such as
razors.
n Clean equipment regularly.
n Learn first aid for wounds
and how to recognize
potential skin infections.
n Tell your coach or athletic
trainer if you think you
have a skin infection.
Coaches and athletic trainers
should regularly check
athletes for skin lesions.

HealtH & Safety
DepreSSioN TreaTMeNT
opTioNS for chilDreN
May raNGe froM
SupporTive TreaTMeNT
To Specific TherapieS
or aNTiDepreSSaNTS.
Treating Depression in children
A
recent study reported that
youth suicide rates in the
United States and the
Netherlands increased after
a decline in the number
of prescriptions written
for antidepressants. This report and other
depression-related information in the news
may have parents confused about treatment
options for their child.
While there is no one answer to treating
depression in children, individualized assessment
and care can lead to effective results.
When a child is showing signs of depression
and/or suicidal thinking, an assessment by a
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Children’s Medical Center
qualified primary care physician or mental
health professional should be a family’s first
concern, says Dr. Graham Emslie, chief of
psychiatry at Children’s Medical Center and
chief of Child and Adolescent Psychiatry at
UT Southwestern Medical Center.
Following a professional assessment and
correct diagnosis of depression, the recommended
treatment options for the child may
range from supportive treatment to specific
therapies or antidepressants.
The choice to use antidepressant medications
to treat children and adolescents will
then be an individual decision based on a
collaborative discussion among the healthcare
professional, family and patient.
proper assessment
“The risk of not treating your child for depression
is great,” Dr. Emslie says. “If there is
a risk from these medications, it would be
small. Adequate assessment and monitoring
of their medication and mood is crucial.”
Dr. Emslie pioneered the treatment of
depressed children and adolescents with the
drug fluoxetine — the only drug approved by
the FDA for that use — although physicians
may prescribe other antidepressants in children
and adolescents.
The use of antidepressants should be
closely monitored since a child’s depressive
symptoms can worsen even with medication.
However, the most recent medical literature
finds that the benefits of using antidepressants
appear to be much greater than the risks from
suicidal thinking and self-harming behaviors.
There are no simple formulas for the treatment
of depression, Dr. Emslie says. “But with
proper assessment and treatment, children
with depression can be helped.” n
To learn more about the pediatric psychiatry department or to schedule an appointment,
call 214-456-5900 or go to www.childrens.com.
model used for illustrative purposes only.
Graham emslie, Ph.D.
chief of psychiatry,
children’s Medical center
aNtidepressaNts CaN Be effeCtive, BUt iNdividUalized
Care is Needed for yoUNg patieNts

elyse tyler
registered Dietitian,
children’s Medical center
Get Kids Moving to Burn calories
and feel Better
things have changed since your
childhood — recess and gym are
no longer a given in some schools.
Kids are more likely to spend their free
time playing video games than playing
outdoors.
“Parents would be surprised to know
how little physical exercise their kids
are actually getting each day,” says
Elyse Tyler, a registered dietitian and
program manager for the Dean Foods
LEAN (Lifestyle Exercise and Nutrition)
Families program at Children’s. “It’s
much less than kids were getting 30
years ago.”
Government guidelines say children
ages 2 to 19 should get at least 60 minutes
of moderate to vigorous physical activity
a day. Staying fit helps kids maintain a
healthy weight. That’s vital since one in
three U.S. children is overweight or obese.
Activity also builds kids’ self-esteem.
Any activity is great, but what burns
the most calories? Find your child’s weight
on the chart below to get an estimate of
the calories he or she burns by participating
in the activities listed. n
the hospital’s Dean foods leAN
families program provides comprehensive
weight-management therapy for children
and their families. to learn more about
this program, go to www.childrens.com/
services/leanfamilies.
cAloRIeS BuRNeD IN AN houR At A chIlD’S weIGht
Activity 50 lbs. 70 lbs.
child’s weight
90 lbs. 110 lbs. 130 lbs.
Aerobic dancing 152 213 274 335 396
Backpacking 164 230 295 361 426
Bicycling (stationary) 164 230 295 361 426
Bicycling (outdoor) 187 262 337 412 487
Bowling 70 98 127 155 183
Dancing 105 148 190 232 274
Jogging (5 mph) 187 262 337 412 487
Jumping rope 234 328 422 515 609
Racquetball 164 230 295 361 426
Running (8 mph) 316 443 569 696 822
Skating (ice- or roller-) 164 230 295 361 426
Swimming 141 197 253 309 365
Tennis 164 230 295 361 426
Volleyball 70 98 127 155 183
Walking (2 mph) 59 82 105 129 152
Source: Mayo Foundation for Medical Education and Research. These figures are approximate.
The exact rate depends on a child’s gender, height and stage of puberty.
7
www.childrens.com
tIPS foR heAlthy
ShoPPING
Involving children in food
choices and grocery shopping
is a creative way to help them
improve eating habits, teach
them about nutrition and expose
them to new foods. These
tips can help:
eat Before you sHop
Hunger while shopping is a
sure-fire recipe for ending up
with impulse items in your
cart – at any age. Consider
shopping after breakfast or
in the morning, when kids’
tummies are full and they are
well-rested. Also, allow children
to munch on a healthy snack
while food shopping to help
curb the desire to put sugary or
high-fat snacks into the cart.
recruit little Helpers
Letting the kids help can speed
up the shopping trip and they
will appreciate the freedom.
Keeping them busy and focused
on their shopping tasks also
helps them forget to beg for
junk food. Let them have a
voice in choosing their own
cereal, after-school snacks and
drinks. Teach cost comparison
skills by making them give you
an update on their choices and
why it was the best deal.
teacH tHe aBcs of proDuce
Teaching your children to
navigate the produce section
significantly contributes to the
development of healthy eating
habits. Let your children pick
a food they have never tried
before and help you prepare it
at home.

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Dallas, TX 75235
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Children’s
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Your community now has the one
outpatient care facility with
the most pediatric specialists.
The Children’s Legacy Ambulatory Care Pavilion now offers the largest suburban
group of pediatric specialists in the nation. Which means all your child’s outpatient
needs, from ENT and urology to orthopedics and cardiology, can now be handled in one
close and convenient location by specialists from UT Southwestern Medical Center. You’ll
also have access to imaging and laboratory services. For a full list of available services
and more information about this new state-of-the-art facility, visit childrens.com.
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. All models
used for illustrative purposes only. (SP08) 6208M
The physicians who treat patients at Children’s Medical Center Dallas
are not employees or agents of Children’s. They are either (i) independent
physicians engaged in the private practice of medicine who have staff
privileges at Children’s; (ii) independent physicians who are independent
contractors and have staff privileges at Children’s; (iii) physicians who are
employed by The University of Texas Southwestern Medical Center
at Dallas or another institution who have staff privileges at Children’s;
or (iv) physicians participating in the care of patients as part of a postgraduate
medical education program.
Children’s Legacy
Ambulatory Care Pavilion
7906 Preston Rd., Plano, TX 75024
childrens.com or 972-730-KIDS