Memorial Day Traveling – Tips to Stay Safe

By Chris Vitale, Injury Prevention Manager, Children’s Hospital of Pittsburgh of UPMC

VITALE_C_RN_CAMEO_CHP_20100803Memorial Day marks the unofficial opening of the summer travel season. There will be many more vehicles on the road and more people as families embark on vacations and road trips. Please keep these important safety tips in mind so everyone can have a safe and enjoyable holiday.

  • Seatbelts are to be buckled on everyone in the car, every time. We can’t control everything that happens on the road. Even though we may be safe drivers, we are always still at risk. Seatbelts double your chances of surviving a car crash.
  • Never drink and drive. Always have a plan for a designated driver – alcohol changes your judgement so have a set plan before you drink.
  • Make sure all children are secured safely in an approved child passenger restraint system that is designed for their weight, size, and age. Read your vehicle manual and the car seat manual, installing all seats according to those directions. Laws may vary from state to state so be sure you are aware of laws as you travel. For more information, visit
  • Never leave a child or children alone in a car. Temperatures climb very quickly in the summer. Every year, children left unattended in cars can die from heatstroke.
  • Plan ahead with activities to keep children entertained and decrease the distraction to the driver.
  • Obey the rules of the road! Be sure your car is in travel condition prior to leaving – and, have a wonderful, safe trip!

For more information on safety tips, please visit

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Bedtime Resistance or Refusal?

By Hiren Muzumdar, MD, FAASM, co-director of the Pediatric Sleep Evaluation Center, and Melissa Milbert, MS, NCC, LPC, Behavioral Health Therapist, Children’s Hospital of Pittsburgh of UPMC

bedtimeChildren over the age of 2 who sleep in a bed, rather than a crib, and refuse or resist bedtime can ignite much family distress. Resistance to or refusal of bedtime can manifest very differently across different ages of children. The child might go to sleep while watching television with a parent, or he or she sleeps in the parents’ bed. In a milder form of bedtime refusal, a child stays in his bedroom, but delays bedtime with ongoing questions, interminable requests, protests, crying, or temper tantrums. The child is often tired in the morning and has to be awakened when it is time to get up for the day.

If the child occasionally comes to the parents’ bed because he is frightened or not feeling well, he should be supported. However, if the child postpones bedtime or tries to share the parents’ bed every night, he might be testing his limits, and not actually be fearful. In contrast, if the child expresses worries during the daytime, reports frequent nightmares, or is fearful of bedtime on a nightly basis, additional help may be required.

How can a parent end bedtime refusal?

These are a few ideas that apply to children who are manipulative at bedtime, not fearful.

  • Start the night with a pleasant bedtime ritual.

Provide a bedtime routine that is pleasant and predictable. Most rituals before bed last about 30 minutes and may include taking a bath, brushing teeth, reading stories, talking about the day, saying prayers, and other relaxing interactions. Try to keep the same sequence every night because familiarity is comforting for kids. Both parents should try to take turns in creating this special experience. Never cancel this ritual because of misbehavior earlier in the day.

Before you give your last hug and kiss and leave your child’s bedroom, ask “Do you need anything else?” Then leave and don’t return. It’s very important that you are not with your child at the moment of falling asleep; otherwise he or she will need you to be present following normal awakenings in the night.

  • Establish a rule that your child can’t leave the bedroom at night.

Enforce the rule that once your child is placed in the bedroom, he or she cannot leave that room, except to go to the bathroom, until morning. Your child needs to learn to go to sleep in his or her own bed. Do not stay in the room until your child lies down or falls asleep. Establish a set bedtime and stick to it. Obviously, this change won’t be accomplished without some crying or screaming for a few nights.

  • Ignore verbal requests.

Ignore ongoing questions or demands from the bedroom, and do not engage in any conversation with your child. All requests should have been dealt with during your pre-bedtime ritual.

When should a parent seek additional help?

Behavioral training takes time, effort, and consistency, and help from a trained professional may be very useful. If may be time to seek additional help if:

  • You have tried to stop your child’s refusal for several weeks and he or she still does not fall asleep within 30 minutes.
  • Your child’s lack of sleep is causing behavior problems at home or at school.
  • Your child has fears about bedtime.
  • Your child has frequent nightmares.
  • Bedtime problems are making your child sleepy during the day.
  • Your child has a change in sleep patterns and another medical or psychiatric problem.

Who can help?

Additional help can include working with a medical professional with specialized training in sleep.  At the Pediatric Sleep Program at Children’s Hospital of Pittsburgh of UPMC, we have a specialized team to help with a variety of sleep problems and disorders.

Melissa Milbert, a licensed professional counselor, is a new addition to the sleep medicine team with experience treating a variety of sleep problems, including sleep resistance and sleep refusal.  Melissa will work with children, adolescents, and their families around problems with nighttime anxieties, nightmares, and problems initiating and maintaining sleep.

For more information on the Pediatric Sleep Program at Children’s or to make an appointment, visit

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Strategies for Talking to Teens about Sexual Assault

By: Heather L. McCauley, ScD; Division of Adolescent and Young Adult Medicine, Assistant Professor of Pediatrics and Psychiatry

MCCAULEY_HEATHER_SCD_ADL_20140820_April is Sexual Assault Awareness and Prevention Month. And the bad news … adolescents and young adults are at highest risk for sexual assault, which includes rape, sexual coercion, and unwanted sexual experiences with and without physical contact. The recent national focus on sexual assault on college campuses is a welcome response. We know that one in five college women will experience sexual assault during this time. And sexual violence happens among younger teens, too. We need to create safe spaces for the young people in our lives to share their experiences.


What are some common myths about sexual assault?

Before we can have a conversation with our teens, it is important to understand common myths about sexual assault. We often think that sexual assault happens in a dark alley at the hands of a stranger. However, this is relatively rare. Adolescents and young adults are more likely to know the person who hurts them. They may even be dating this person. Many young people I work with think that that they are expected to have sex with someone if they are dating or going out with him or her. It is also common for young people to think that everyone else is having sex (even if that is not true), so when they are pressured to do something they do not want to do, they might not recognize this experience as sexual assault. Finally, many young people think that if they have been drinking or are wearing certain clothes, they are somehow responsible for being hurt. It is important to remind young people that it is never their fault and that there are safe adults who are there to help them.

How do I talk to my teen about sexual assault?

One strategy for talking to your teen about sexual violence is having a conversation with him or her about what a healthy relationship looks like. We can take this opportunity to emphasize that it is not normal for someone to make their child do something sexual he or she does not want to do and that affirmative consent is necessary when he or she is ready to have sex. That means, not just ‘No means no,’ but also that “Only ‘Yes!’ means yes.”

In these conversations, it is important for us to recognize the numerous pressures young people face from their peers every day regarding sex and substance use, for example, and listen to their concerns. You can also teach teens to be “upstanders,” which includes doing something or saying something to a trusted adult if they see someone hurting another friend.

What questions can I ask my teen if I am concerned?

Young people might feel scared to talk about what they experienced or they might think that what they experienced is a “normal” part of a dating relationship. In my research studies, I interview young women who have experienced some type of abuse. Many young women, though they experienced sexual assault, will not use those words to describe their experiences. So I changed the way I ask about their exposure to abuse. I might say, “Has anyone ever made you do something sexual you didn’t want to do?” or “Has anyone ever said something sexual to you or about you that made you feel uncomfortable?” This allows teens to talk about what they have experienced without having to label themselves. If someone discloses that he or she has been assaulted, you can say, “Thank you for sharing this with me. This is not your fault and you didn’t deserve this to happen to you.” In Pittsburgh, you can reach out to your health care provider in the Division of Adolescent and Young Adult Medicine for help with this conversation and connecting young people to important health care services. We can also help connect you to victim advocates in the community who are experts in working with survivors of sexual violence.

What is happening in Pittsburgh (and other resources) to prevent sexual assault?

Sexual violence is preventable. Preventing it requires us to challenge social norms that violence is acceptable, which gets easier the more we talk about it with teens. We need to stand up and speak out as a community that sexual violence is never acceptable. I work with Dr. Elizabeth Miller, who leads the Division of Adolescent and Young Adult Medicine at Children’s Hospital of Pittsburgh of UPMC, on prevention programs in our local middle and high schools and neighborhoods to reduce violence among our young people. Be on the lookout for us in your community. We invite you to become part of the conversation at — for information on prevention efforts in southwestern Pennsylvania.


  • Prevention Program: Coaching Boys into Men violence prevention program by Futures Without Violence (
  • Local resources: Pittsburgh Action Against Rape – 1-866-363-7273 and Center for Victims 1-866-644-2882
  • National resource: RAINN (Rape, Abuse, Incest, National Network) – 1-800-656-HOPE (1-800-656-4673)

For more information about the Division of Adolescent and Young Adult Medicine, call 412-692-6677 or visit

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Raising Awareness for Child Abuse

By Rachel Berger, MD, MPH, chief, Child Advocacy Center

Berger_RachelP_MD_9246webApril is National Child Abuse Prevention Month. I look forward to this month each year, both because it means that spring is finally here, and because I am often provided with opportunities to raise awareness about child abuse.

The past year has been an important one for vulnerable children in our community. On January 1, 2015, major changes to the child abuse laws in Pennsylvania went into effect. These laws were a direct result of the recommendations made by the Pennsylvania Task Force on Child Protection, a task force which was established, in large part, due to the Jerry Sandusky case and the inadequacies in the child protection system that this case brought to light. The new legislation has resulted in a wide range of changes to the Pennsylvania child abuse laws, including:

  • Updates to the definition of physical abuse
  • Expansion of the groups of adults who are considered mandated reporters
  • Establishment of a statewide database/central register of reports of abuse and neglect

A summary of these new laws can be found at

While these new laws will take some time to adjust and to incorporate into daily practices for Child Protective Services, mandated reporters, and others, they are a significant step forward in our goal of protecting Pennsylvania’s children from child abuse and neglect.

There has also been progress nationally. Last year, at this time, the Commission to Eliminate Child Abuse and Neglect Fatalities had met for the first time. According to a report from the United States Government Accountability Office, at least 1,500 children and perhaps as many as 3,000 children, die every year as a result of abuse or neglect. By comparison, the American Cancer Society reports that about 1,250 children younger than 15 years old are expected to die from cancer in 2015. Unlike treatment for cancer, which has greatly improved childhood survival over the past 20 years, there has been little, if any decrease over the 20 years, in the number of children dying from child abuse and neglect. In the past year, the Commission has met in Texas, Florida, Michigan, Colorado, Vermont, Pennsylvania, Arizona, and Oregon and has heard testimony from physicians, lawyers, child protective services workers, parents, and others. The ultimate goal of the Commission will be to develop policy recommendations for 2016.

Locally, the physicians, social workers, and nurses at the Child Advocacy Center at Children’s Hospital of Pittsburgh of UPMC have, unfortunately, had a busy year.

  • Our team of forensic specialists interviewed over 600 children who may be victims of sexual or physical abuse.
  • Our Child Protection team evaluated just under 500 children who were admitted to Children’s with concerns for abuse or neglect, including broken bones, brain injuries, toxic ingestions, and abdominal injuries.
  • Our physicians, nurse practitioners, and nurses evaluated close to 1,500 children in the ARCH (Advocacy Resources for Children) outpatient clinic, which is focused on providing primary care to children in foster care in the community, providing follow-up for children who have recently been admitted to the hospital for child abuse or neglect, and performing physical exams on children in the county who are entering or leaving foster care or moving between foster homes.

In addition, we have been preparing for the end of the month, when we will host the 10th annual Pittsburgh Conference on Child Maltreatment. More than 15 counties in Pennsylvania participate in this conference with participants including lawyers, child welfare workers, medical professionals, therapists, and those involved in the provision of services to children in the child welfare system. This year, we have received funding from the Pennsylvania Commission on Crime and Delinquency to provide scholarships to cover the registration costs for several members of our multidisciplinary team. This funding has also allowed us to improve our peer review process, purchase digital cameras to improve our photo documentation of injuries, and provide interpretation services and transportation for the families we serve.

When I talk with friends, family, and neighbors about what I do, they often ask how they can help support children in our community who are at the highest risk of abuse and neglect or who are already victims. There are many ways you can make a difference in the lives of children in our community, such as:

  • Volunteer at one of the many nonprofits in our county that serve these children and their families.
  • Encourage your state legislators to ensure that the Commonwealth provides sufficient funding to organizations that serve children who are victims of abuse or neglect.
  • Donate to one of the many organizations that provide services for at-risk children and families.

Perhaps most important are the things you can do every day in your community:

  • Volunteer to help a neighbor who is overwhelmed by the stresses of parenting.
  • Be available when a friend or colleague needs someone to listen and you can provide a few words of encouragement.
  • Give support to a stranger in the grocery store who seems to be having a difficult parenting day.

A colleague once told me that the best piece of parenting advice she ever got was to take a photo of her child whenever she found herself reaching the end of her patience. The time it takes to stop and take a photo is enough time to bring an adult’s stress level down. And from looking at a photo of a screaming, out of control toddler, is enough to make any adult smile. I have followed this advice a few times myself and I can tell you that it works. And perhaps, it makes it less likely that the parent on that day will lose his or her patience with a young child. This is how we can all help support children in our community every day.

Earlier this month, Pittsburgh City Councilwomen, Theresa Kail-Smith and DarleneIMG_0505 Harris, presented a proclamation commending the Child Advocacy Center. In addition to recognizing the tremendous work the center does, the proclamation recognized the staff for their dedication serving children and families in our communities. It also declared April 2015 to be Child Abuse Prevention Month in the City of Pittsburgh.

To learn more about the Child Advocacy Center at Children’s Hospital of Pittsburgh of UPMC, please visit and consider attending the 10th Annual Child Maltreatment Conference, which will be held April 23-24, 2015.

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Our Journey with Biliary Atresia

By Amber Fosler, mother to Elias Fosler

Discharge day 2 weeks post txWhen my husband and I welcomed our first child, Elias, 5 weeks early, we were terrified. He was a strong 6 pounds and despite developing jaundice, he was healthy. We took him home a few days later and tried to navigate being first time parents. We went every couple days to have his lab work monitored in our hometown of Columbus, Ohio. As he approached a month old though, the jaundice was getting worse, not better. When he was 5 weeks old, he was diagnosed with the rare liver disease, biliary atresia. When Elias was 7.5 weeks old, he underwent surgery to have a procedure done called a Kasai to create a passageway for the bile. The surgery went well and we tried to settle into life with a newborn. We knew the statistics were against us, with a very high percentage of biliary atresia patients needing liver transplants before they reach kindergarten. We tried to stay focused on living each day at a time.

On December 31, 2013, Elias came down with a fever. That one fever kicked off a scary, traumatizing three months. We spent more days in the hospital than at home. We knew we needed the best. At the end of January, Elias was flown from Columbus to Pittsburgh. He was evaluated by doctors at Children’s Hospital of Pittsburgh of UPMC and was added to the national liver transplant list. That began the longest wait of our lives. Elias was stable enough to return home to Columbus after his evaluation, but we still were in and out of the hospital.

By mid-February, Elias was in acute liver failure which was causing other life threatening complications.  He was a sickly shade of yellow. His skin sagged over his bones as he lost more and more weight yet his abdomen grew more and more distended. We were running out of time. His priority on the transplant list was elevated, but due to his small size, just 12 pounds at the time and rare blood type, we continued to wait while his health deteriorated. There simply were not enough registered donors that matched his needs.

Quietly in the background though, a gift was in the works. My husband’s cousin droveFirst heli ride to CHP for eval from Ft. Wayne, Indiana to Pittsburgh to be evaluated to be a living donor. He was a match! Surgery was scheduled for a few days later. We planned to drive to Pittsburgh, but Elias has never been one to follow a plan. We ended up back at the hospital in Columbus in the intensive care unit. They worked quickly to get the helicopter ready so we could take yet another trip to Pittsburgh. A few days later, on February 26, 2014, when Elias was 7 months old, our hero, Zac, donated a portion of his liver to our sweet Elias. The lead transplant surgeon was Kyle Soltys, M.D., with help from the transplant team of George Mazariegos, M.D., Rakesh Sindhi, M.D., and Geoffrey Bond, M.D., all within the Hillman Center for Pediatric Transplantation at Children’s.

Within 24 hours, Elias’s skin was pink and pale, as it should be! The whites of his eyes were actually white, a shade we had never seen on him before. Zac gave our son the gift of life and gave our family hope. None of that would have been possible without the skilled surgeons, doctors, nurses and everyone else at Children’s Hospital of Pittsburgh of UPMC that made this transplant a reality.

We spent two weeks in the hospital after the transplant and were then discharged to stay at the Ronald McDonald House until his transplant team felt he was stable enough to return to Columbus. We spent a total of 47 days in Pittsburgh for transplant and recovery. During that time, the staff at Children’s Hospital didn’t just take amazing care of Elias, they took care of our entire family.

Enjoying the sunroom on 7B post transplantIn the hours after the transplant, Elias was trying to fight through all the sedation. He was trying to roll over and pull out his breathing tube and drains. It was gut-wrenching to watch. But one very kind nurse in the Pediatric Intensive Care Unit sat down with me and my husband and carefully explained everything that was happening and reassured us that Elias was ok. I will never forget how kind he was.  And we want to give thanks to all of the nurses on the transplant unit. It was so comforting to know that the team of nurses understood liver disease and transplants. They are so skilled and experienced, yet incredibly compassionate. They treated Elias like he was their own. They celebrated the smallest of milestones, the first post-surgery bowel movement, to the biggest, which was normal liver function!

The Child Life Department was also a huge help during our time at Children’s. The team on the transplant unit was amazing. They understood our son’s age and limitations and brought him toys and bubbles that engaged and distracted him. They brought him mobiles for his crib, toys to play with, even a walker so he could sit up and check out the happenings at the nurses’ station and the sun room.

By far the most wonderful thing they did for Elias was enroll him in the Beads of Courage® program. Elias won’t remember the trauma of the first year and a half of his life, but through his beads, we will be able to share his story with him. But the beads aren’t just for him. They are for me and my husband and our families. All of us earned those beads too. We were with Elias for all of it. Child Life made it possible to turn a scary and terrible time in our lives into something beautiful! We have nearly 6 full necklaces of beads that are beautiful and empowering. We made it through all of that and will make it through whatever life has for us.

We returned to Children’s in October of last year for Elias’s abdominal wall closure surgery. It was a painful recovery for him and we had a new set of challenges caring for a toddler in the hospital instead of an infant, but once again, the hospital staff was amazing at helping us navigate those challenges. I think they were also happy to see Elias and how well he was doing post-transplant. They have been on this journey with us.

We spent around 30 days at Children’s last year and while I would love if Elias didn’t haveelias post to go through what he did, I am thankful we had the support of Children’s to make it a little easier. Elias is now a wild, happy, active 20 month old. You would never know that we came within days of losing him. The beautifully heartbreaking thing about it all is that he has no idea what he’s been through. He’s a fighter, yet he doesn’t know any different. And for that, I am thankful as we navigate a post-transplant, immunosuppressed world.

We are so thankful for Children’s Hospital of Pittsburgh of UPMC and the amazing people who have been a part of our journey. Thank you!  Without you, we wouldn’t have a sweet, thriving toddler to chase after!

Patient outcomes and experiences shared in this blog by families are not intended as typical or representative cases. Every family’s story is unique.

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Random Acts of Kindness – Down Syndrome Awareness

IMG_4306Emily Pratt, a patient at Children’s Hospital of Pittsburgh of UPMC, was required to do a senior project for her high school graduation and wanted to support Down Syndrome Awareness, so she decided to create handmade bracelets and sell them to family and friends.

The proceeds, which totaled around $1,200, were used to purchase 120 children’s books on topics such as colors, numbers, and the alphabet. These particular books each featured children with Down syndrome on every page.

Emily and her family came to Children’s Hospital  last week to present the books toIMG_4303 Kishore Vellody, MD, medical director of the Down Syndrome Center of Western Pennsylvania. With World Down Syndrome Day celebrated on March 21, it was a great tie in! The theme for World Down Syndrome Day was “random acts of kindness”, and Emily’s support definitely exemplified that.

Emily’s project will surely help families who visit here who have a baby with Down syndrome enjoy reading to their child. Each new parent packet at the Down Syndrome Center at Children’s will have a book, donated by Emily Pratt.

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Broken Crayons Still Color

By Katie O’Connor, MA, CCLS, Art Therapist, Children’s Hospital of Pittsburgh of UPMC

FullSizeRender1Some people are so badly broken that you cannot ever fix them. A professor announced this very pragmatically during my first counseling class of graduate school. I left feeling challenged, somewhat discouraged, and perplexed. Over the years, I developed a deeper understanding of that statement and now have the perfect response: “Broken crayons still color.”

Allowing children to safely explore and express their hospitalization through creative experiences are some of the moments I love most. Things like watching an anxious child tear paper into tiny shreds or smash Play-Doh® into the floor; seeing a smile spread across a child’s face as he creates purple by mixing red and blue for the first time; or hearing another giggle as mom squeals, “Eww, that’s so messy.”  These moments are indescribable.

Almost three years ago, as an art therapy extern here at Children’s Hospital of Pittsburghphoto3 of UPMC, I dreamt of starting an art therapy program for our patients and families. I feel incredibly grateful and privileged to be part of such an amazing team and for the opportunity to grow our art therapy program.

After starting as the first art therapist in November 2014, I have consulted with over 90 families.  Art therapy sessions are offered to our patients and families in the form of individual, sibling, family, and group sessions. Open studio art sessions are also scheduled in the Eat’n Park Atrium and are open for all patients and families to attend.

I’m looking forward to assisting patients to process their artwork and support them while working toward a healthier self.

For more information, please contact the Child Life Department at 412-692-5022.



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