Category Archives: Gillette Experts
Gillette’s Center for Gait and Motion Analysis (Gait Lab) in St. Paul, Minnesota uses state-of-the-art computer technology to evaluate and develop effective treatments for walking problems.
Conditions involving the muscles, joints, nerves and bones frequently cause difficulty with walking and movement. Because movement issues are complex – and because every patient’s needs are unique – our team of experts uses a collaborative approach that puts families at the center of the care team. Our team includes technicians, engineers, physical therapists and orthopedic surgeons who are experts in the study of human movement.
An evaluation in our Center for Gait and Motion Analysis captures movements, muscle activity and forces that the eye can’t see. Although some people have similar walking patterns, the way their muscles and joints work together can be very different. Motion analysis helps a patient’s care team accurately identify problems specific to each patient, and therefore, be able to make recommendations regarding the best treatments for those problems. Options may include braces, medication, physical therapy and/or surgery.
Spring ahead! If you and your child are natural early birds, you might feel better rested this week. On the other hand, moving to daylight savings time can be a tough adjustment for natural night owls; they have the advantage in autumn, when the clocks “fall back.”
How do these twice-a-year changes affect sleep patterns for children and teens?
For teenagers, who on average are already sleep deprived from early school starting times, this week is a particular challenge! When the bell rings at school, their brains will be jet-lagged for another hour.
So, what helps?
Understand if you or your kids feel a bit “off-kilter” this week. We all might be a bit drowsier or crankier as our brains and bodies adjust. Light exposure resets our body rhythms. Using dim lights and room-darkening shades at bedtime, and eliminating screen time (television, computers and texts) an hour before bedtime, can help. In the morning, bright lights can help you get moving.
Two bits of good news: the majority of kids adjust within a few days to a few weeks. And spring is just around the corner!
Laurel Wills, M.D., is board-certified in general pediatrics, developmental-behavioral pediatrics and sleep medicine. She has joined the Gillette Sleep Health Clinic as a specialist in pediatric and adolescent sleep medicine, with a particular focus on caring for children and youth with developmental disabilities.
The Sleep Health Clinic at Gillette Children’s Specialty Healthcare is dedicated to meeting the needs of children, teens, and young adults who have disabilities. Our clinic offers comprehensive, family-focused care in a facility that is specially designed for children with complex conditions. Sleep disorders disproportionately affect children who have cerebral palsy, craniofacial conditions, attention deficit hyperactivity disorder, epilepsy, and other neurologic conditions. Often, these children may already have health issues that can be further complicated by sleep problems. Our pediatric sleep physicians work closely with families to resolve sleep disorders and achieve a better night’s rest.
On our Facebook page, we asked you to submit your sleep health questions for Dr. John Garcia to answer. You can read the questions and answers below. As always, we recommend you consult with your health care provider.
Q.What kind of affects can sleep apnea and obstructive breathing have on a child if it has gone untreated for many years? This child is not trached yet but is finally being treated at the age of 11. Can it affect other organs in her body?
A. I address this problem by systems. Untreated OS can cause difficulties with attention and can also lead to daytime sleepiness. If there is a history of seizures, it can make the seizures harder to control. From a pulmonary point of view, I can see increased incidence of pneumonia. Acutely untreated OSA can lead to sedation associated respiratory compromise. OSA can cause reflux. Untreated OSA can lead to right heart strain though this is quite rare. Untreated OSA can lead to metabolic diseases including insulin resistance, obesity, and lipid abnormalities.
Q. Some parents have wondered what to do about night terrors. Can Dr. Garcia provide some tips?
A. Night terrors are a subcategory of parsomanias which including sleepwalking, confusional arousals, and bed wetting. People who sleep too deeply are at increased risk for parasomnias. Good sleep hygiene is key to preventing night terrors. This means regular wake and bed times, predictable nap opportunities and a controlled sleep environment. If these episodes are occurring more than three times a week or are associated with injury then a sleep consultation is an option. Safety precautions including bells or buzzers on a child’s door and outside doors are another option.
Q. I have a sleep question. My son was born with congenital cytomegalovirus and he use to sleep good. Well the doc just diagnosed him with autism. He can go all day w/o a nap and go to bed at 8:00 pm and be back up by 11:00pm ready to go and is non stop until 3:00 am when he falls asleep again until 12:00 pm. I need help and sleep. I have tried to switch his sleeping around but he still is on the go. Please help.
A. About 86% of children with Autism have a sleep disorder, often insomnia. A sleep doctor would be a great place to start, who may recommend a trial of melatonin.
Q. Possible sleep apnea in a 13 year old boy with Downs. We haven’t been able to do a successful sleep test to determine if it is indeed sleep apnea. Any suggestions?
A sleep consultation should help to sort out whether a sleep study is needed. If there are symptoms consistent with OSA but a polysomnogram is not feasible, then overnight oximetry may help determine whether there is an associated severe oxygen desaturation. There are non-CPAP treatments available as well such as high flow if a 13 year old will not tolerate a CPAP
A board-certified sleep specialist, John Garcia, M.D., works with Gillette patients who have disabilities and associated sleep disorders. Such disorders include obstructive sleep apnea, sleepwalking, circadian rhythm disorders, and restless legs syndrome. He uses a combination of behavior management, medications, surgery and other therapies in his practice.
Dr. Garcia is a graduate of the University of Iowa School of Medicine. He completed a residency in pediatrics and one year of fellowship training in behavioral/developmental pediatrics at Riley Hospital for Children in Indianapolis, Ind. He then completed a sleep fellowship equivalent at the Minnesota Regional Sleep Disorders Center in Minneapolis. Dr. Garcia holds clinics at Gillette’s main campus in St. Paul and at the Burnsville Clinic.
His professional associations include the American Board of Sleep Medicine and the American Board of Pediatrics.
An Airplane Trip With Your Special Needs Child?
By Shalleen Nelson
I did it, and so can you! I am a proud mom to 5-year-old Sebastian, a longtime Gillette patient, who was born with Down syndrome and neurological issues. I’m also mother to Francesco, Sebastian’s typically-developing twin brother.
Sebastian loves to discover new places! Fortunately for our family, travel has become a smooth process with practice and preparation. Have a question for me? Please leave it in the “Comments” section below! I’ll continue to share advice on vacationing, from camping trips to hotel stays, in the months to come. I’ll begin by sharing my “Top Tips” on fun, and safe, airplane travel.
- Check-in online and print your boarding passes from home.
- Request to change your seating arrangements if necessary. You can do this before security at the check-in counter, or by speaking with an agent at the gate.
- Alert the gate agent of your special needs, and ask to be boarded first.
- Take direct flights (no layovers!) if possible, and aim for 3 hours maximum air time.
- There is always a handicap security line – just ask!
- Did you know children can leave their shoes on when going through security?
- Children in wheelchairs can often remain in their chair, so be sure to ask.
- You may bring more than the allotted carry-on fluid if it’s clearly labeled as a liquid medication for your child. Consider a physician’s note, in case of questions.
In the Air
- Keep drinks and snacks handy to help with cabin pressure changes during take-off and landing. Swallowing and chewing will help ease eardrum pain.
- Bring several options for entertainment – books, music, or a portable DVD with headphones – to keep your child busy.
Above all, remember to RELAX, take a deep breath, and remind yourself that you’re in no rush. You’ll be at your destination before you know it!
Last week, we asked you to submit questions about your child’s mealtime challenges for Tonya Rich, OT, feeding specialist at Gillette. Today, we’re sharing Tonya’s responses and advice. Have a question we didn’t answer? Leave a comment here. Or, contact Gillette’s Feeding Clinic directly. By working to resolve feeding issues that children may struggle with, our clinic’s goal is to make mealtimes a positive experience for kids and their parents.
Q. My 8 y.o. rarely eats anything other than rice noodles, rice or tortilla shell with sour cream and cheese for dinner. If the noodles aren’t over cooked, or she feels a crunchy (or what she perceives to be crunchy) noodle, she spits it out and leaves the table crying. Same thing with any crunchy part she might find on a soft, flour tortilla shell. She’s allergic to eggs, pork, chicken, turkey, strawberries and cashews. Is there something that could help her deal with these texture aversions?
A. It sounds like you’ve really worked hard to manage your daughter’s allergies while continuing to expand her food choices. You might want to think about trying a new food at snack time. That would allow you to maintain a more positive mealtime experience. Depending on how many flavors your daughter is able to tolerate, you might want to start by expanding the flavors that she’ll eat (noodles with a new sauce, cheese, or new red sauce).
Q. My 9 year old autistic boy is all about texture and color. He had a bad experience as a preschooler. They were righting letters with shaving cream and wont eat anything like it, mashed potatoes, cool whip. Wont eat lunch meat. No veggies. He only likes chicken nuggets, p.b. & jelly sands, most fruit (not strawberries or watermelon tho)any suggestions besides bribery?
A. Oftentimes we will start with what the child is most comfortable and then build towards stretching the child to new foods/experiences. You might want to start with changing the safe and less emotional parts of the meal such as the plates, tablecloths, utensils or having music on during the meal. It’s the same food but the environment has changed slightly. As your child is able to tolerate those changes, you can build towards tolerating having less desired foods on the table. I would also encourage safe non-food interactions with having your child look at pictures of food (google images works well) or read books about food/eating.
Q. My daughter who has Rett, has a hard time with pooling food in her mouth before swallowing, if she swallows it at all. We usually try mushy foods, or pasta, but have been trying pureed food too. Feeding time is for sure the most streeful time at our house.
A. Our therapists are able to help child learn how to manage food safely in their mouth. This could be by alternating a bite of pasta with a drink or some puree or placing the bite of food on the side of the mouth can be helpful for a child who is learning to eat as well.
Q. Five year old Naomi will eat noodles, tortillas and PB and honey, chicken nuggets with ketchup or honey mac and cheese and the occasional red sauce with pizza or spaghetti. Juice is the only was we can get any fruits or veggies. We thought she may have some allergies – but nope – just picky! She’s BASICALLY healthy weight wise and energy wise…but i long to give her a good salad or piece of fruit…..then again, not many kids dive on those I guess. In contrast her 2 year old sister eats Nori (seaweed) and hummus and peppers and oranges like she’s eating her last meal.
A. Family meals are one way to allow children to be exposed to a variety of sights, smells, and foods. Related to family meals, one strategy that can be helpful is encouraging children to participate in preparing meals and exploring food. This helps families to redefine what they mean when they say “try it” for their child. This could mean “trying it” is your daughter just starts out with looking at the other foods, helping to prepare them, tolerating them at the table or passing the dish to another person in the family. You can build up to her touching the food, having it on her plate, and hopefully steadily move towards her trying a new food.
Q. I’m having trouble getting my almost-two-year-old to eat squishy or wet foods. He is all about the crunchy. I really want him to eat more fruits and vegetables that aren’t pureed in a squeezable pouch. He has recently decided that cooked pasta is OK, so I have hope. Fresh or canned fruit is just out of the question, though.
A. It’s great that he will take the pureed fruits and vegetables! Now we can build off of that…Veggie sticks can be helpful for kids who like the crunchy. Sometimes engaging the child in making “food faces” on their plate with over-steamed vegetables can encourage a child to try a new food. That way they can touch a new food but it’s not too squishy or wet. Keep encouraging your child in play to explore wet/messy play (i.e. water table, in the bathtub, pudding painting, or finger painting).
Q. Any advice for parents whose kiddos overload on their preferred foods and then won’t eat them again for long periods of time?
A. Slow and steady wins the race. Keep offering a wide variety of foods. Children often need a significant number of exposures to foods and this can be done in a way to minimize anxiety (putting foods in the grocery cart, helping with cooking, helping with menu planning, all the way to using a divided plate.
When we ask patient families what they love most about Gillette, an answer we frequently hear involves our fantastic team of nurses. Did you know that, in addition to nurses that care for our pediatric patients, we also have a specially trained team dedicated to caring for adult patients who have disabilities?
Last fall, nurses on Gillette’s Adult Inpatient Unit began participating in Transforming Care at the Bedside (TCAB), a nursing initiative aimed at optimizing patient care by increasing the amount of time nurses spend at the patient’s bedside. The Adult Inpatient Unit is Gillette’s second inpatient nursing unit to implement TCAB, making improvements to supply organization and scripting for patient families, providing an information binder to families, and moving into a new location on the hospital’s 7th floor.
“After watching the TCAB process unfold on the Orthopedic/Surgical Unit, I knew I wanted the adult unit to be part of this exciting movement!” says JoAnn Pesek, manager of Gillette’s Adult Inpatient Unit. An early adopter of the TCAB initiative in Minnesota, Gillette’s nursing team plans to continue expanding TCAB in the future, and in May, will connect with Minnesota’s 24 other hospitals to share best practices.
Q. What are some of your hobbies outside work?
Q. Do you have any kids or pets?
A. My son is 21 months old and runs the house.
Q. As a child, which superhero did you admire? If you could have any superpower, what would it be?
A. I always wanted to be Superman, mainly because he was able to fly. Wind in your face, able to survey the world from above.
Q. What is your favorite book and/or favorite food?
A. Shogun by James Clavell – a fictional novel about a foreigner in Japan during the time of the samurai. I have read it numerous times. Vietnamese Fresh Spring Rolls (Goi Cuon).
Q. What was your favorite subject in school?
A. If you don’t count recess, it was Gym class, followed closely by Math.
Q. Who did you admire when you were a kid?
I know a lot of people say this but I truly admired my parents the most because of the hardships and sacrifices that they endured as refugees from Vietnam.
Q. What do you enjoy most about your job at Gillette?
The patients and families are incredibly grateful and the facilities are unmatched but the best part about working at Gillette is that everyone around me is so committed to taking care of our patients and making this place even better. Everyone is proud to be a part of this. Cheesy but true.
Walter Truong, M.D., is a pediatric orthopedic surgeon who specializes in treating children who have scoliosis, cerebral palsy, various hip pathologies or orthopedic trauma. He attended Ohio State University College of Medicine before completing his residency in orthopedic surgery at the University of Minnesota Medical School. He spent his fellowship year at the Hospital for Sick Children in Toronto, where he obtained a certificate from the University of Toronto Faculty of Medicine in pediatric orthopedic surgery. He will continue participating in research through the University of Minnesota Medical School’s Department of Orthopedics and Gillette Children’s Specialty Healthcare’s James R. Gage Center for Gait and Motion Analysis. He has made a number of professional presentations, and he is a member of the American Academy of Orthopedic Surgeons, Pediatric Orthopedic Society of North America, and he is a fellow of the Royal College of Surgeons of Canada. He is fluent in Vietnamese, is married and has a young son. When he is not working or spending time with his family, he can be found either on a basketball court or ski hill.
Whether it’s a lake, river, pool or waterpark, summer and water go hand-in-hand here in the Midwest. But sadly, it can also mean a rise in water-related accidents among kids. Parents, check out these tips from Mark Gormley, M.D., on making sure your child has a fun, and safe, time in the water this summer. As a doc AND a dad, Dr. Gormley knows how important water safety can be!
Do you have a water safety tip to share with other parents? Why not post a comment below? To see more advice from Dr. Gormley on topics ranging from teen driving to proper car seats for children, click here.