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under the

Rainbow

For every question, every kid, There’s only one Rainbow.

AHEAD OF THE CURVE Sisters with scoliosis are as active as ever after spinal fusion surgery PAGE 8

Are you overscheduling your kids? PAGE 4

Your guide to sprains, strains and shin splints PAGE 5

Fall 2017

under the

Fall 2017

Rainbow w.

s only one Rainbo on, every kid, There’

For every questi

AHEAD OF E THE CURV sis are Sisters with scolio after as active as ever surgery spinal infusion PAGE 8

Are you overscheduling your kids?

Stories from our Facebook community

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ins, Your guide to spra ts splin strains and shin

In this issue PAGE 5

8/31/17 5:02 PM

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Emma and Abby Pappas, page 8

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3 Health briefs

UH Rainbow Babies & Children's #ThisIsRainbow

4 Are you overscheduling your kids?

“Our preemie triplets just turned 1! Ryder, Hailey and Brian Jr. were born six weeks early at UH MacDonald Women's Hospital. They were transferred to the step-down unit at UH Rainbow and received such good care that they were home in just two weeks. We are so grateful for the kindness and expertise of all the staff and can’t thank you enough for helping us bring our triplets home healthy and happy!” #MilestonesMonday #ThisIsRainbow bit.ly/UHRainbow — Kristyn Metelsky

5 Your guide to sprains, strains and shin splints 6 Measles outbreak is a reminder that vaccination is crucial 7 Getting on schedule: The benefits of well-child visits 10 Thriving as a single parent 11 Help your child develop a healthy body image

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Under the Rainbow is published by UH Rainbow Babies & Children’s Hospital. Articles in this publication 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. (FA17)

Ranked one of America’s Best Children’s Hospitals in nine specialties by U.S. News & World Report, including neonatology, orthopedics, pulmonology and cancer. Learn more at Rainbow.org/USNews.



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More online inspiration. Learn how the Angie Fowler Adolescent & Young Adult Cancer Institute at UH Rainbow is changing the face of cancer care for young adults. Go to Rainbow.org/AngiesInstitute. Under The Rainbow | Fall 2017

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Learn why we’ve been recognized for excellence again by U.S. News & World Report at Rainbow.org/USNews.

Among the best UH Rainbow Babies & Children's Hospital ranks in nine pediatric specialties, with four in the top 20. University Hospitals Rainbow Babies & Children’s Hospital once again earned high recognition in U.S. News & World Report’s Best Children’s Hospitals annual rankings. In total, UH Rainbow Babies & Children’s Hospital ranks among the nation’s top 50 children’s hospitals in nine medical and surgical specialties, including neonatology (#7), orthopedics (#12), neurology and neurosurgery (#16), pulmonology (#19), cancer (#21), diabetes and endocrinology (#27), nephrology (#42), GI (#43) and urology (#50). UH Rainbow Babies & Children’s Hospital has ranked among America’s Best Children’s Hospitals every year since 1991 – the inception of U.S. News & World Report rankings.

2017 – 18 rankings at a glance Ohio’s top-ranked NICU Ranked in nine children’s specialties Four specialties ranked among the most elite – top 20 in the nation Ranked in America’s Best Children’s Hospitals every year since the ranking’s inception

EXERCISE HELPS

University Hospitals and Medical Mutual of Ohio are expanding access to high-quality healthcare in Northeast Ohio by announcing that all UH facilities and providers will be in the Medical Mutual SuperMed network. This agreement reached between the two organizations means the following UH facilities will be added to the Medical Mutual SuperMed network for employer groups and individuals, as well as Medical Mutual’s Medicare Advantage network, effective Oct. 1, 2017: • UH Cleveland Medical Center, including MacDonald Women’s Hospital • UH Rainbow Babies & Children’s Hospital • UH Seidman Cancer Center Procedures performed at UH facilities will be covered for Medical Mutual members at their highest benefit levels. To make an appointment or ask questions about your insurance benefits, call 216-286-8000.

FLU SHOT

IS STILL BEST PROTECTION Still on the fence about the effectiveness of flu shots? A recent study published in Pediatrics found that the majority of children who die of the flu have not been vaccinated. The researchers reviewed information from 358 children ages 6 months through 17 years who died of the flu between 2010 and 2014. They found that only one in four of these children had received a flu shot before getting ill.

grow healthy bones Need another reason to get your family moving? According to a recent study, inactivity may be harmful to the bones of growing children. The researchers studied boys and girls ages 9 to 20 and found that those who got at least 60 minutes of physical activity each day had stronger bones than those who exercised for less than 30 minutes a day. Getting adequate exercise was especially important during puberty.

Rainbow.org | 216-UH4-KIDS (216-844-5437)

Attention Medical Mutual members

What about measles? See page 6.

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Are you overscheduling your kids?

P  MEET OUR DOC BARBARA ROWANE, MD Pediatrician, Rainbow Northeast Pediatrics, Willoughby Clinical Instructor, Case Western Reserve University School of Medicine

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arents often jokingly describe themselves as chauffeurs for their children. Between baseball practices, dance lessons and after-school tutoring sessions, the modern kid has many obligations. If it all feels like a little too much, it just might be.

Changing times

You likely grew up riding bikes with the neighbors, building forts and setting up tea parties for your dolls. It’s called unstructured play, and it develops imagination, creativity, dexterity, decision-making skills and even strength. Kids today do less of that. Now we’re encouraged to give our children access to technology and enroll them in enrichment activities. The busier they are, the more successful they’ll be – or so the theory goes. Old-fashioned toys like rattles for babies, blocks for toddlers and jump ropes for kindergarteners have been replaced by tablets and phone screens. Plus, some schools are

cutting back on recess in favor of more classroom study, leaving children with very little time to explore structure-free play. “There’s no doubt that activities do provide a developmental benefit, but not all kids thrive with a packed schedule,” says Barbara Rowane, MD, a pediatrician at Rainbow Northeast Pediatrics in Willoughby.

Spotting stressed-out kids

How do you know if your child is spread too thin? Kids won’t always speak up, especially if they feel like dropping an activity would disappoint you. According to Dr. Rowane, children who are being pushed beyond their comfort limits to the point of anxiety may show the following symptoms: „„Avoiding family and friends „„Lack of appetite „„Nervousness „„Disrupted sleep „„Headaches „„Stomach pain „„Depression

Paying attention to your child’s personality and behavior will help you determine what balance of activities is best for your family.

Less can be more

If your busy child seems frazzled instead of flourishing, don’t be afraid to try the “less is more” approach. Your child might be missing out on quality family time with no agenda, the kind where you make dinner together, work on an art project or just chat. Remember that not all downtime is unproductive – sometimes it’s just what the doctor ordered. Dr. Rowane says, “Creating a strong foundation for your kids doesn’t always mean putting them in every extracurricular program you can find. Modeling good behavior, providing guidance and showing love are all better ways to set them up for success.” • ❯❯ Check out our Better Living Blog

at Rainbow.org for answers to common parenting questions.

Under The Rainbow | Fall 2017

Your guide to

sprains, strains and shin splints

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ou can’t prevent every bump, scrape and bruise during childhood. But you can help reduce your child’s risk for sports injuries such as strains, sprains and shin splints. Mary Solomon, DO, a pediatric sports medicine specialist at University Hospitals Rainbow Babies & Children’s, advises, “Make sure your young athlete warms up properly before any game or practice and cools down after. Eating a healthy diet and staying in shape can also keep growing bones, joints and muscles safe.” When injury does strike, use this guide from Dr. Solomon to know what to do. Fast treatment helps children return to the activities they enjoy.

 MEET OUR DOC MARY SOLOMON, DO Pediatric Sports Medicine Specialist, UH Rainbow Babies & Children’s Associate Professor, Case Western Reserve University School of Medicine

SPRAINS Situation: Your child falls on, twists or gets hit on the knee, wrist, elbow or ankle. Symptoms: He or she may feel a pop or tear when the sprain – an injury to a ligament that connects and stabilizes joints – occurs. Pain, swelling and bruising often develop afterward. Smart start: Use the RICE method – rest, ice, compression with an elastic bandage and elevation. Signs to look for: If the swelling and pain are intense, if the joint is locked or unstable, or if your child can’t put any weight on the joint, take him or her to the emergency department.

STRAINS

SHIN SPLINTS

Situation: Your child twists, pulls or overstresses a muscle, such as when throwing a pitch or kicking a soccer ball.

Situation: Your young runner or dancer repeatedly stresses his or her legs by increasing the time spent training.

Symptoms: Strains are stretches or tears in muscles or tendons that connect muscles to bones. They cause pain, limited motion, swelling, cramping and muscle weakness.

Symptoms: Shin splints occur when muscles, tendons or the thin layer of tissue covering the shinbone become swollen and inflamed over time. Pain strikes the front lower leg.

Smart start: Reduce swelling and pain with ice and rest.

Smart start: Encourage less-intense activity for two to four weeks, followed by a gradual return to activity. Slow down the running pace, avoid hills, or try biking or swimming instead.

Signs to look for: If your child has pain in the neck or back, if numbness or weakness runs down an arm or leg, or if there are changes in skin color, see a doctor.

Signs to look for: If your child’s pain doesn’t subside after some time off, call a doctor. This could be a sign of a stress fracture, a small crack in the bone that often requires crutches to heal. •

❯❯ Have a question? Call our pediatric advice line 24/7 at 216-UH4-KIDS (216-844-5437) to get an answer from one of our pediatric experts.

Rainbow.org | 216-UH4-KIDS (216-844-5437)



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Measles outbreak

is a reminder that vaccination is crucial

 MEET OUR DOC SARA LEE, MD Pediatrician, UH Rainbow Babies & Children’s Hospital Assistant Professor, Case Western Reserve University School of Medicine

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n spring 2017, an outbreak of measles occurred in Minnesota. As of early June, the Minnesota Department of Health had confirmed 76 cases of measles. Of these, 73 were in children.

What is measles? Measles is a highly contagious disease caused by a virus. The virus lives in the nose and throat mucus of a person who’s infected. It’s spread to others through coughing and sneezing. Symptoms of measles include: „„High fever „„Cough „„Runny nose „„Watery eyes „„Rash In severe cases, measles can lead to serious complications,

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including pneumonia, swelling of the brain (encephalitis), permanent deafness and death.

Measles is preventable Measles is serious. However, it’s also preventable. “The MMR vaccine protects against three diseases – measles, mumps and rubella (German measles),” explains Sara Lee, MD, a pediatrician at University Hospitals Rainbow Babies & Children’s Hospital. “The vaccine is given in two doses. The Centers for Disease Control and Prevention recommends that children receive the first dose between ages 12 months and 15 months, and the second dose between ages 4 and 6. Receiving two doses of MMR is 97 percent effective at preventing measles.” Nearly all the confirmed measles cases in Minnesota

occurred in people who were unvaccinated or only partially vaccinated. “The measles outbreak is a reminder to check with your pediatrician about your child’s vaccination schedule,” says Dr. Lee. “Check with your own doctor to make sure you’re up-to-date on your vaccines, too.”

Stay up to date Vaccinations aren’t a one-time deal. Your child will need a variety of vaccinations during the childhood years – most with multiple doses. Make sure your child gets all the vaccines he or she needs at the right time. Go to Rainbow.org/Prevention to select an age range and view the recommended screenings and immunizations. •

Under The Rainbow | Fall 2017

Getting on schedule:

The benefits of well-child visits Some health conditions are hard to detect, but regular appointments can help answer questions and ease your mind.

Rainbow.org | 216-UH4-KIDS (216-844-5437)

chart to make sure your child is growing consistently, Dr. Tatka says. „„Inquiring about any health concerns or questions you have. „„Administering vaccines (when needed) to protect against serious illnesses and complications. For the kids who are scared about getting shots, Dr. Tatka says that he likes to point out that “vaccinations make us stronger.” He tells his young patients, “Many adults have gotten them, and, as a result, are now healthy and strong.” „„Checking vision, hearing, teeth and reflexes. „„Discussing age-appropriate developmental milestones and healthy eating and sleeping habits. Although you might prefer to wait until the start of school to book an appointment, Dr. Tatka says there are advantages in scheduling the exam around your child’s birthday instead. “Birthdays are a natural reference point that are easily remembered,” he says. “If you use your child’s birthday as a reference, you are much more likely to get a date and time on the schedule that is convenient for you, rather than trying to schedule around the rush that typically begins with the school year.” •



W

hen children feel sick, often the first call parents make is to the doctor. But well exams – or regularly scheduled doctor’s visits that occur when your child is not ill – are just as important to your child’s overall health and well-being, says Jason Tatka, DO, a pediatrician at Rainbow Portage Pediatrics in Ravenna. “Well visits provide an immeasurable degree of continuity of care,” says Dr. Tatka. “When you have that continuity of care, you get to really know the patient, which helps in diagnosing illnesses and prescribing the right medications later on.” At these visits, your child’s doctor also screens for developmental and growth delays in your child that, if found, are important to address as soon as possible. “Earlier intervention is always more effective than later,” Dr. Tatka says. And sometimes, your child’s academic problem at school might be solved simply by a new glasses prescription, which his or her doctor will pick up on during the vision screening part of a well visit. While most sick visits are spent talking about immediate health concerns, well visits present a great opportunity for you to explore any questions you have about your child’s overall well-being and development. “I tell parents to come to the appointment with any observations or concerns they have,” he says. “Well visits are a great time to chat about anything you are feeling unsure or worried about.” Although well visits are ostensibly checkups just for your child, many parents often leave the appointments feeling better themselves. According to Dr. Tatka, a typical well-visit exam includes: „„Checking your child’s body measurements (growth, weight and height). These measurements will be plotted on a growth

MEET OUR DOC JASON TATKA, DO Pediatrician, Rainbow Portage Pediatrics, Ravenna

❯❯ Time for a checkup?

The Rainbow Care Network offers more than 80 pediatric primary care and family medicine practices to provide care when and where you need it. Visit Rainbow.org/Network to find a practice near you.



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L to R: Emma and Abby Pappas at Cornerstone Farm in Medina, Ohio

Abby and her horse partner, Shannon

r v e u Ahead c of the Two sisters with scoliosis are as healthy and active as ever after undergoing spinal fusion surgery.

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oday, Emma Pappas, 15, is a 10th-grader who takes dance classes, runs and plays the cello. Her sister, Abby, 13, is an eighth-grader who enjoys horseback riding and 8

playing the violin, guitar and ukulele. Like most sisters, the Medina residents have shared many experiences. Unlike most, however, they both have scoliosis that required spinal fusion surgery. Under The Rainbow | Fall 2017

When Emma was in fifth grade, a routine screening at school revealed that she had a curve in her spine. Her parents, Jennifer and Pete, brought her to see her pediatrician, Elizabeth Hagen, MD, who referred them to George Thompson, MD, Chief of Pediatric Orthopedic Surgery at University Hospitals Rainbow Babies & Children’s Hospital, for a consultation. Since scoliosis can run in families, Dr. Thompson examined both girls and ordered X-rays, which revealed that they both had the condition. “With scoliosis, there’s a lateral curvature of the spine,” he says. “Some curves only progress a little and then stop. But if the curve continues, it can cause heart and lung issues due to the distortion of the chest.”

we were given a pager and received text updates on how things were going,” Jennifer says. “It was a big relief to have someone in the operating room letting us know that everything was OK.”

Setting things straight Abby and Emma’s surgeries were a success, their recoveries went smoothly and they were back to school three weeks after their procedures. “Both girls grew two to three inches after having their MEET OUR DOC spines straightened,” Jennifer says. “The X-rays GEORGE from before and after their surgeries show a THOMPSON, MD Chief, Pediatric Orthopedic remarkable difference.” Surgery, UH Rainbow Babies The sisters continued following up with & Children’s Hospital Dr. Thompson at his Medina office every few Professor, Case Western Reserve University School months after their surgeries and now visit him of Medicine for a yearly X-ray. “We can’t say enough good World-class care things about Dr. Thompson and the care his team At first, Dr. Thompson took X-rays and tracked has provided every step of the way,” Pete says. the curvature of the girls’ Today, both girls are as spines every few months. healthy and active as ever. It was a big relief to have “I’m able to do everything I For six months, Abby wore could do before the surgery,” a brace while she slept to someone in the operating Abby says. Emma has noticed slow the rate of the curve. room letting us know that that she feels stronger since “Even if we feel a child is everything was OK. having the surgery and her going to need surgery, we – Jennifer (Emma and Abby's mom) back doesn’t get sore like it try other things first, such used to. “Although my back as a brace, to either isn’t flexible anymore because of the rods, I’m prevent the need for surgery or hold off while able to move everything else freely,” she says. they’re still rapidly growing,” Dr. Thompson says. Whether they’re galloping on a horse, running Ultimately, both girls needed to undergo spinal down a track, making music in an orchestra or fusion surgery. Dr. Thompson performed Abby’s dancing across a stage, Emma and Abby haven’t procedure in December 2014 and Emma’s in skipped a beat. • January 2017. During the surgery, he implanted two rods along the curved part of their spines to bring them as close to straight as possible. While operating, he used a technique that was first developed at UH Rainbow Babies & Children’s World-renowned pediatric Hospital to monitor the function of the spinal spinal care is here cord and make sure it remained unaffected. “The invention of spinal cord monitoring changed the For more than 50 years, experts at our Pediatric Orthopaedic Spinal face of spine surgery in kids and adults Deformity and Scoliosis Center have been delivering leading-edge throughout the world,” he says. care for children and adolescents. “We have an international While Jennifer and Pete had complete faith in reputation for excellence and innovation in the management of spine Dr. Thompson and his team’s expertise, they were deformity,” Dr. Thompson says. on pins and needles throughout the lengthy procedures. “We were comforted by the fact that The program treats a wide range of pediatric spine conditions, such as back pain, scoliosis, spinal injuries, spinal tumors and more. Four fellowship-trained orthopedic surgeons – Jochen Son-Hing, MD, Rainbow experts are here. Annual Christina Hardesty, MD, Justin Mistovich, MD, and Dr. Thompson – screenings in fifth through eighth grade are important to offer a variety of surgical and nonsurgical treatment approaches, detect scoliosis early and begin treatment. If your child representing some of the latest advances in spine care available today. has an abnormal screening, call 216-UH4-KIDS to make an appointment with a pediatric orthopedic specialist. 





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Rainbow.org | 216-UH4-KIDS (216-844-5437)



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just 4 moms

Thriving

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1  MEET OUR DOC NATALIE WOODS, MD Pediatrician, Rainbow Heights Pediatrics, Cleveland Heights Clinical Instructor, Case Western Reserve University School of Medicine

as a single parent

aising your children on your own? You’re not alone. More than 9.7 million single mothers are currently heading up family households in America, according to the U.S. Census Bureau. These strategies can help you survive – and thrive:

Make time for family fun. Read a bedtime story, color a picture together, bake a batch of cookies or just relax for a few minutes as you all listen to music together. “Your love and attention are among the most important gifts you can give your children,” says University Hospitals Rainbow Babies & Children’s pediatrician Natalie Woods, MD.

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Laugh, be patient – and don’t sweat the small stuff. Who cares if the car needs to be washed or the floors weren’t swept today? As long as you’re meeting your top priorities (i.e., your children are healthy, happy, loved, and moving forward in school and life), don’t worry about the little things. Laugh more and try to be patient with your children.

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Do something special. Get out and enjoy each other’s company when you can. Spend an hour at a local playground, an afternoon at the town swimming pool or a day at the zoo, or simply make a quick trip for ice cream.

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Be consistent about daily routines. “Kids feel secure when they know what’s happening next,” says Dr. Woods. “Set up a schedule for meals, household chores and bedtime.”

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Reduce your stress. Find 15 minutes a day for yourself, or do one nice thing just for you every week, like having a cup of tea and reading a novel. Take charge of your finances, too. Create a budget and a system for keeping track of your income, bills and other expenses. “When tension rises at home, take a time-out instead of lashing out – leave the room and breathe calmly as you count to 10,” says Dr. Woods.

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Accept support. Say yes if trustworthy friends and family members offer to babysit so you can go shopping, catch a movie or just take a walk. It’s good to have a close friend you can talk with for emotional support, too. “Try not to rely on your children for the kind of comfort and sympathy you’d expect from an adult partner,” says Dr. Woods.

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Connect with local resources. “From play groups and parent-support meetings to free and low-cost counseling and health services, community programs have much to offer single parents,” says Dr. Woods. •

Get parenting tips and expert advice delivered monthly to your inbox. Sign up at UHhospitals.org/BetterLiving.

10 | UHhospitals.org/MacWomen | 1-866-UH4-CARE (1-866-844-2273)

Under The Rainbow | Fall 2017

Help your child develop a

healthy body image

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 MEET OUR DOC CAROLYN IEVERSLANDIS, PHD, CBSM Licensed Clinical Psychologist, UH Rainbow Babies & Children’s Professor, Case Western Reserve University School of Medicine

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Schedule an appointment today with a Rainbow pediatrician. Call 216-UH4-KIDS or make an appointment online at Rainbow.org.

very parent wants to raise a child who feels comfortable in his or her own skin. A key to achieving this is fostering a healthy body image. A positive body image means that you have a realistic perception of how your body looks and accept and appreciate your natural body shape. Believe it or not, problems with body image can begin as early as the preschool years. The good news is that you can do a lot to help your child develop a positive body image from a very young age. Be a role model. Consider the message your child may receive if you’re always talking negatively about your own features or if you are speaking regularly about stringent dieting and putting yourself through grueling workouts in an effort to change your appearance. Your child may begin to wonder whether he or she should be doing the same things. Instead, talk about and

Rainbow.org | 216-UH4-KIDS (216-844-5437)



treat your own body exactly how you’d like your child to talk about and treat his or hers. Emphasize health. In today’s world, there’s a lot of focus on weight, calories and dieting. You can change this conversation. “Rather than talking about weight, emphasize health, physical fitness and good nutrition, and the benefits they provide to your child,” advises Carolyn Ievers-Landis, PhD, CBSM, a licensed clinical psychologist at University Hospitals Rainbow Babies & Children’s. “For example, encourage your child to eat a tasty, nutritious meal so that he or she will have plenty of energy to play, or for older children to get homework done when also engaged in extracurricular school sports or clubs.” Foster a love for physical activity. Help your child discover that being active is about having fun. Support your

child’s interests in any physical activity that he or she enjoys, even if it’s different from what you’d choose. For some children, this may be soccer or hockey. Others may choose dance or karate. And still other children may enjoy walking or riding their bikes around the neighborhood. Allow your child to try many different activities until he or she finds those that feel like a fun and natural fit. Talk about it. It’s nearly impossible to avoid images of “perfect-looking” bodies in the media. Let your child know that these images are often retouched or changed in different ways to appear that way and they don’t represent the wide range of shapes and sizes that bodies come in. Dr. Ievers-Landis adds, “If you hear your child talking negatively about his or her own body, start a conversation about why your child feels that way. Talk about what you see that makes your child special. Ask your child what features he/she really particularly likes about his/her appearance (e.g., eye color, hair, etc.) and then also emphasize positive aspects of your child to focus on that are not about appearance (e.g., being artistic, being kind to animals).” It’s also important to find out if your child is being bullied or teased about his or her appearance at school, in the neighborhood or by other family members. Your child should know that you do not find this acceptable, and you will help your child find ways to address these issues. If concerns about body image continue, seek help from your child’s pediatrician, who might suggest a consult with a specialist in this area, such as a licensed professional counselor, social worker or psychologist. •

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Kids Kicking Cancer promotes healthy living Iris S. & Bert L. Wolstein’s Kids Kicking Cancer is a targeted program that encourages young patients and survivors of cancer and blood disorders to be active and recognize the benefits of physical activity and healthy eating. The Kids Kicking Cancer program is free and welcomes children and adolescents, either on or off treatment, no matter where they receive medical care.

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Learn more about Kids Kicking Cancer at Rainbow.org/KKC and by following us on Facebook.