By JOHN MORROW Earlier this month USNews and World Report released their annual list of America’s Best Hospitals. This list is terribly misleading and is a disservice to the readers of that magazine, in my opinion. The fine print is…

By LYGEIA RICCIARDI Last week I heard uber marketer Seth Godin speak about the power of fear. Fear is one of the strongest human emotions, based in the core of our brain–the “lizard brain” that evolved prior to our higher…

There’s still time this summer to hit the road or take to the skies for a family trip. Whether it’s a short visit to grandma’s house or a trip across the country, traveling with children can be challenging. When embarking on a family trip, consider selecting a destination that’s geared toward children.

Whether you are traveling by car, plane, train or bus, the key to an enjoyable trip with your child is to plan ahead. Advanced planning will ensure a successful, fun vacation and reduce the stress associated with traveling as a family.

Here are some things you can do to ensure you and your children have an enjoyable and memorable experience:

• Talk to your child about the trip. Tell your child where you are going, who you will see and how long you will travel. Order brochures and get visual aids to help explain the trip to your child.
• Visit the library and check out children’s music tapes, books on tape and DVDs for portable DVD players.
• Allow your child to choose the toys he or she wants to take on the trip.
• Create a travel art kit. Fill a large zip-top bag with art supplies, such as crayons, stickers, paper and coloring books.
• Pack plenty of healthy snacks for the trip. Keep in mind Transportation Security Administration (TSA) restrictions for items you plan to take on a plane. Visit the TSA website at www.tsa.gov/311.
• Make goody bags. Collect items from dollar stores or party stores such as small toys, games and snacks to surprise your child when boredom or irritability set in.
• Keep your child’s sleeping and eating routine as normal as possible. Children will behave better if they follow their regular routines.

If you’re taking a trip by car with small children, remember to allow extra time to reach your destination. Also, stop often to let your child stretch or use the bathroom. You can plan fun stops along the way such as visiting a park.

If you’ll be flying to your destination, carry a current photo of your child in case he or she wanders away from you. Plan activities during the flight in 10-minute segments. This is the approximate length of a child’s attention span. Be sure to bring enough activities to cover delays and time in the airport.

-LaKesha Knighten, Children’s Service Society of Wisconsin, Parklawn Family Resource Center supervisor.

The new regulations for public schools prohibit fryolators in the preparation of competitive foods. This line, from Massachusetts’ new school nutrition bill, is enough to make nutrition activists jump with joy. Fried foods will be just one of the unhealthy items stricken from Mass. schools after Governor Deval Patrick signs the bill today (full text of the bill here).

“This bill is certainly not a panacea for the childhood obesity epidemic, but it is an important step in creating healthier environments for children,” says Lisa Mannix, manager of State Government Relations at Children’s Hospital Boston, who points out that, on average, children consume two-thirds of their total daily calories while at school. Mannix, along with a number of Children’s clinicians and child health advocates, played crucial roles in advocating for and shaping the legislation.

While this bill regulates “competitive foods”—items in vending machines and al la carte items—it does not regulate food sold as part of the School Lunch Program, which falls under federal jurisdiction.

The bill directs the Department of Public Health (DPH) to establish nutritional standards for snacks and beverages sold in vending machines, school stores and cafeteria ala carte lines—items which are currently unregulated and are typically fat- and sugar-laden. Food and drinks that don’t meet the new standards will get the boot. “Schools could decide to remove vending machines entirely, or they could replace junk items with granola bars and other things that are healthier,” says Mannix. “For some schools, this is going to be a big change.”

Schools will also be required to offer fresh fruit and non-fried vegetables at any location where food is sold (not including vending machines). “This is a huge victory but it’s the tip of the iceberg in some ways,” says Elsie Taveras, MD, MPH, pediatrician at Children’s. While this bill regulates “competitive foods”—items in vending machines and al la carte items—it does not regulate food sold as part of the School Lunch Program, which falls under federal jurisdiction.

As well as go healthy, the bill requires Massachusetts’ schools to “go local.” Schools are strongly encouraged to pursue contracts with local farmers, whenever possible. The bill also eliminates barriers so it’s simpler for schools to purchase directly from smaller-scale farmers.

The bill also suggests school nurses have access to increased development and training on childhood obesity and type 2 diabetes. “The hope is that nurses could improve screening for these condition and referral students to the appropriate resources,” says Taveras.

While the rate of obesity may well be leveling off for the nation’s children, it’s an epidemic with widespread health and economic implications. “One in four teens in Massachusetts is overweight or obese,” says Taveras. “We know that obesity increases a child’s risk for developing a host of chronic illnesses, including heart disease and stroke. We need to do what we can to increase access to healthy foods and get rid of the junk.”

Amy, one week prior to visiting Children's Hospital Boston

As a high school sophomore, Amy Rucki was admitted to Children’s Hospital Boston with a brain tumor. She was followed by ABC camera crews, who were taping for the medical documentary, Boston Med (tune in tonight at 10 p.m. on ABC). Though she wasn’t included in the final cut of the show, you can watch exclusive mini-episodes about her experience online (part one here, part two here). Below, Amy reflects on being a teen, brain surgery and her long road to recovery.

In the spring of 2009 I began feeling sick, on and off, for seemingly no reason. My blood pressure was higher than normal, my heart would occasionally palpitate and every now and again I’d get strong flu symptoms. It was confusing and slowed me down some, but for the most part I was a just another high school sophomore, finishing up the school year and anxiously awaiting prom. (I went to my first one that May). The dance was great, but just one week later my whole world changed forever.

I woke that morning with an extreme headache. I’ve had headaches in the past, but nothing like this. I laid flat on the couch in a dark room for hours, but when the pain refused to go away my mom asked if I wanted to go to the ER. “No way I’m going to the ER for a headache,” I said. “They’ll look at me like I have three heads.” Turns out I was wrong.

The next morning I saw my pediatrician and he sent me to the local ER to have fluids pumped into my body in case my headaches were caused by dehydration. The fluids didn’t work, so they took the conservative approach and did a CT scan of my head to see if they could locate the problem. The doctor then called my mom into a room and said they found something on the scan, that’s when I heard the words: “We are calling an ambulance and transferring you to Children’s Hospital Boston.” I got to the ED at Children’s and had another scan. My doctor, Dr. Elisabeth Ashley, came in and told us I had a mass in my brain.

My mom asked Dr. Ashley if she had a name for the “mass,” but Dr. Ashley said that they wouldn’t be able to identify it for sure until after a biopsy. When she returned from caring for another patient, I let everyone in the room know that I had my own name for the brain mass – I named it “Fred.” Naming this foreign thing growing in my brain made it somewhat easier to talk about, but not any more welcome, so I told everyone that Fred had to go. From that point on, everyone, including my doctors, referred to the mass as Fred and made it their mission to help me get rid of “him.”  It may sound crazy, but after this experience I understand why people tell you to name your fear; it truly does make it easier to conquer. (We even called Tylenol, which I took for the headaches, “Fred food” and “fed” it to him when he was “cranky.”)

Ed Smith, MD

I was admitted to the Children’s neurosurgery floor that night, and, as it was my first hospital admission, I was terrified. I didn’t sleep at all at first but the nurses were the sweetest people I have ever met in my life. By the next day the medication made the pain go away and I was up and about, talking to people and visiting with friends and family who had come to see me. Later that day, my parents and I met with Ed Smith, MD, who would become my neurosurgeon. He was amazing- everything I pictured a neurosurgeon to be plus more. He made us feel so confident that everything would turn out OK. However, he did explain to us that there was a chance I would have some left-sided weakness after the surgery due to the location of my tumor. Surgery was then scheduled for a week later, and I was stable enough to be discharged until the operation.

I managed to fit a lot of fun things into that week, but when my parents woke me up early the morning of my surgery, the reality of the situation pulled me back to earth. I was nervous, but honestly, it is scarier for me now to write about preparing for brain surgery than it was to go to pre-op. Everyone is so wonderful at Children’s that you almost don’t have the time or need to worry about what’s happening at the time. After seven and half hours of surgery I was awake and talking in the ICU. Soon after we got the pathology reports that assured us that “Fred” was benign – I would not need any further treatment.

It was great news, but my journey wasn’t over yet. Not by a long shot.

I don’t exactly remember when it was that I first discovered I didn’t have movement on my left side. I knew the possibility of having left-sided weakness after the operation was there, but I never had imagined that I would be paralyzed. But that’s exactly what happened.

“The best advice I could give to anyone dealing with chronic illness or hardship is to never stop smiling and always stay optimistic. This probably sounds cliché, but laughing really is the best medicine.”

Having no function on my left side made it hard to do pretty much everything. I was no longer an independent teenager- I now relied on my mom to do everything for me, from rolling me over in bed to getting me dressed every day. I never knew how much I used both hands in day-to-day things until I could only use one.

I spent some time at Spaulding Rehab center, but soon after, I started getting headaches again so I went back to Children’s so they could keep an eye out for any infections on my brain.

Back at Children’s, my therapy continued with my new physical therapist Andrea Plant, who I would soon learn was to become a very important member of my medical team. Usually my mom came with me to every PT session, but one day I told her I’d go through the session alone and that she should get some rest and maybe a well deserved hot shower.  That day’s therapy was particularly good, and Andrea and I decided my mom deserved a pleasant surprise. With Andrea coaxing me on, I handed her my cane and I rounded a corner to meet my mother, walking on my own two feet for the first time since my surgery. I can still remember my mom’s face because I could tell she was just as surprised at what I could do as I was. The only person not surprised was Andrea; she had all the faith in the world in me and I will never forget her. She would always tell me how great I was doing and that I could never give up. In return I worked harder because I wanted to show her the best I could do. I will never again take walking, or even moving, for granted.

Amy's aunt made hats stating the family's stance on "Fred"

One year after surgery, I still continue with both physical and occupational therapy.  At times, I get frustrated that I am still wearing a brace on my leg and  that I don’t have full function in my arm and hand, but then I remember how far I’ve come. Not long ago I couldn’t feed myself, roll over in bed unassisted, or even give people a full smile. Now, I can do all that plus a lot more. I still can’t play sports and have had to put getting my license on hold, but I don’t think too much about those things because I am alive and healthy.

The best advice I could give to anyone dealing with chronic illness or hardship is to never stop smiling and always stay optimistic. This probably sounds cliché, but laughing really is the best medicine. Children’s staff always referred to my room as the “party room” because they could always hear us laughing and having fun. My friends and family played a huge part in how I overcame my illness. I know that their constant support and my mom staying by my side for the whole thing is the reason why I succeeded as well as I did.

This is definitely not a ride that I would have signed on for, but I lived it and in the process I met some great friends and had some surprisingly wonderful experiences.  Ever since I was little I wanted to work in health care, but now I have the nurses at Children’s to thank for helping me decide to pursue a career in nursing. Children’s saved my life and I hope to return the favor someday day by becoming a nurse and helping someone else.

Little if anything. H/T to Med Rants.

Nice update from the Renal Fellow Network.

This is a request for modest financial help, directed to my hospital colleagues.

In recent years, we have seen a burgeoning of small patient-run organizations. They are working hard to improve the quality, safety, and responsiveness of the health care system. Many of these organizations arose out of personal tragedy or injury, like Linda Kenney’s MITSS. A common characteristic is that the founder has been able to get past the trauma and anger of his or her medical experience and has devoted time and effort to education, training, and advocacy.

But many of these organizations are tiny and do not have the financial wherewithall to reach their potential. So a small group of us have decided to try to help, under the auspices of the Institute for Healthcare Improvement.

Here’s how it will get started. IHI wants to invite 35 to 50 patient advocates to its Annual Forum this December in Orlando, FL. The invitees will attend a special session at the beginning of the conference, and then they will attend the entire Forum as the week progresses. Their conference fee and travel expenses will be completely borne by IHI.

Our hope is to provide these folks with a terrific educational experience, but also use this first get-together as an organizational session for a “trade association” of patient advocacy groups. With planning and luck, we think we will be able to build an organization that will provide technical, educational, and marketing support to these small non-profits.

Here’s the pitch. We need about $100,000 to get this up and running, and I am asking hospital CEOs across the country to consider making a contribution of $5 or $10 thousand from their hospitals towards the cause. BIDMC will do its part, and I am hoping that ten or twenty others of you will do the same. This is surely a good way to demonstrate our commitment to patient-run organizations.

If you are interested in joining in, please contact Sara Kolovitz at skolovitz [at] smithbucklin [dot] com. Thanks for considering this.

A friend decided to help settle the dilemma-dilemna question below by sending a note to the etymologist at the Oxford English Dictionary. Here is her note:

To: Anatoly Liberman
Oxford Etymologist
Oxford University Press

Dear Mr. Liberman,
Reading your delightful blog makes me wonder this: many Americans — highly educated ones — between the ages of 50 and 65 were taught to spell dilemma with an n, “dilemna.” It appears to be most common in the Northeast.

Do you have any idea why? Or thoughts?
Curiously yours,

The reply:

I Googled for DILEMNA!

My goodness! DILEMNA is known all over the English speaking world, from America to Australia, and no one has an idea where it originated. On the other hand, I am not alone: lots of people have never heard that this idiotic spelling exists.

By Ida Strom Seljeseth In this brief interview at the Health 2.0 Goes to Washington conference June 10, 2010 Executive Chairman of Araxis Health, Patrick Soon-Shiong, talks about the Health Transformation Institute.

By ROGER COLLIER One thing about a democracy, everyone is entitled to publish their predictions about the future, and on the costs (or savings) of the Patient Protection and Affordable Care Act over the 2010-2019 decade, there are enough to…

By Anthony Cirillo

When Lowe’s Home Improvement recently announced that all employees who needed cardiac surgery would go to Cleveland Clinic, it made me pause. Living just miles from Lowe’s headquarters (near Charlotte, N.C.) and surrounded by very good major medical centers, I would have liked to be a fly on the wall when local hospital officials heard the news. The announcement must have sent shock waves through them.

[More:]

Lowe’s realizes that while the initial cost may be higher (or not), they are paying for the Clinic’s quality and betting that overall costs (fueled typically by possible readmissions, etc.) will be lower because their employees will be taken care of right the first time.

I have been working in medical tourism since my first trip to Dubai in 2004. I have continually tried to bring the message back home to U.S. hospitals that medical tourism does not just mean going overseas or for that matter going to the Cleveland Clinic. Yet my warnings always fall on deaf ears.

Niche Thyself

Hospitals continually want to be all things to all people. They can’t. People will start self-selecting based on their “shopping” experiences. Yes, there are varied opinions about how much consumers pay attention and research the ratings that are out there. And more are coming. Take Nevada, whose draft bill would require hospitals to report preventable injuries. And there are increasing calls to document patient experience well beyond the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).

Here’s the thing. Boomers WILL travel for their health care using planes, trains, and automobiles. So if my new knee can be done more cheaply with better quality and a great experience (think joint camp) then I am driving three counties or states over to get it. You can bet those employers will be looking at this well before the consumer!

Market Differently

Which brings us to the next point. Healthcare marketing must change. Your audience is not just the primary, secondary, and tertiary coverage areas. Your audience also consists of caregivers 3,000 miles away looking out for mom and dad, corporations, and educated consumers. So please ditch the mass media. The way to reach this audience will be by leveraging social media, SEO, and through influential blogging that conveys a point of view about what healthcare should really look like.

Experiences Matter

Which leads to my third point that probably should be my second point. The total experience matters, as Fred Lee showed us in his book, If Disney Ran Your Hospital. So please marketing, leverage great experiences and stories. But do not try to take the lead on managing experiences. Rather, manage expectations, then make sure you exceed them when people come. And do not promise what you cannot deliver.

I think there will be a backlash from consumers who may opt out of traditional insurance, pay the penalties, carry catastrophic coverage and then shop for everything else. Critical access hospitals may find that those who had no insurance in the past, now with a newly minted insurance card, may decide to go not to the only place that would take them in the past, but to the place that will provide the best care.

So take local medical tourism to heart and think differently about pretty much every strategy you have employed to this point.

So how does all this “move” you? Send me an email at Cirillo@4wardfast.com and let’s continue this discussion.

Anthony Cirillo, FACHE, ABC, is president of Fast Forward Consulting, which specializes in experience management and strategic marketing for healthcare facilities.

By Nancy Cawley Jean

In any given webinar or lecture on social media, you’ll hear that if used correctly, it can be an incredible tool for hospitals that want to build a conversation with our patients and the community, hearing what people want and how we can improve our services, offering health information for the general public, communicating timely information in a crisis, building loyalty for our brand and even supporting fundraising efforts.

For the past year, the hospitals of the Lifespan health system have maintained Twitter and Facebook accounts, as well as a YouTube channel for the system as a whole. Along the way, we’ve found things that are successful and some things that don’t work so well.

[More:]

On Twitter, we’ve learned to be less self-promotional, almost to the point of really not promoting ourselves. Instead, we are doing things that will engage more people, like asking questions to start a conversation, responding to conversations, finding people to follow who share common interests, retweeting good health information, and recommending people to follow the Twitter #FollowFriday tradition in which Twitter users on Fridays recommend people to follow for good information.

On Facebook, we are engaging our fans by being much more personal, asking questions, wishing them good weekends, and asking for personal stories. We have found that this really is working to increase engagement with our fans and followers because THAT is the social side of social media. And engagement is the true measure of success, not the number of fans or followers you might have.

As non-profit hospitals, we’ve had some fundraising events that we were promoting through these avenues. Of course it was slow going for a while, but a recent event for Hasbro Children’s Hospital taught us a lesson: not only can you gain more awareness of an event through social media, but in return you are more actively engaged with the community and you gain more fans/followers with whom you can engage. That’s a nice outcome that we didn’t see coming!

Each year, Hasbro Children’s Hospital holds a radiothon in partnership with the Children’s Miracle Network and a fantastic local radio group, Citadel Broadcasting. We of course tweeted the event in advance and posted updates and teasers on our Facebook page. During the event, we were live tweeting, posting photos, and doing regular updates with photos on our Facebook page. Of course we were also linking to the streaming broadcasts of the radiothon on the three radio station websites that were involved in the radiothon and sending those out via Twitter and Facebook.

So what were the results?

This year, the total raised increased by about $50,000 over last year’s total before we launched our Twitter and Facebook accounts.

Can we attribute the growth directly to social media? Well, no, but we can guess that it certainly helped. The more interesting results came with the impact to our social media accounts. While we suspected our social media efforts might help to increase awareness of the radiothon, we didn’t expect that the radiothon would impact our engagement within social media. During the month of the radiothon, the hospital’s Twitter account saw 60 new followers (an 8 percent increase) and had one of its highest months of engagement to date.

More surprising was the Facebook account for the hospital. That month, we increased our fans by 1,077, a 70 percent increase, with 80 percent of those new fans joining us during the radiothon or in the days immediately following it. The personal stories, “thank you’s” and other comments began flooding our fan page, and from that, we have already lined up media stories and potential patient stories for next year’s radiothon.

The biggest gain is the connection we are making with real people. People who have experienced what it is like to have a child who needs the care of a pediatric hospital are telling their own stories honestly and openly. It is no longer about a brand, it’s about people. And that, in a nutshell is what social media is all about–connecting with people.

It’s not always easy to dive into social media, especially for a relatively conservative industry like health care. More hospitals are joining the ranks, and there are some clear leaders out there, but we’re all learning together. And while we can use social media outlets to promote our fundraising events, the return on investment is exponential when you consider that you’re actually meeting the people you care for, and getting a better understanding of why you’re really here–to help people.

So now I’m curious. If you’re using social media, what has your experience connecting with your fans and followers been like? And, if you’re not using social media, what’s holding you back?

Nancy Cawley Jean is a senior media relations officer for Lifespan in Providence, RI, where she oversees social media for Lifespan’s five partner hospitals and also manages the national media relations for research at Rhode Island Hospital and its Hasbro Children’s Hospital. Find her at @NancyCawleyJean on Twitter.

As part of her Let’s Move! campaign, Michelle Obama is reaching out to software developers and technology innovators to create engaging games and mobile phone applications that encourage children to take a more proactive role in healthy nutrition and exercise. Ben Reis, PhD, of Children’s Hospital Informatics Program, is leading a team from Children’s determined to answer the first lady’s call, with a new app called Food Hero.

Players choose a character and decide what he or she eats for the day. After their virtual character has eaten, they’re asked to engage in physical activities like biking, running and swimming. If the character eats too much, it becomes slow and sluggish; if it eats too little, it becomes too weak and tired to finish its exercise in time. Only a properly nourished character has the strength and stamina needed to complete the physical challenges in record-breaking time.

Food Hero is one of only 95 apps competing for the Popular Choice Award. The app that receives the most votes will win a cash grant and be honored at a special ceremony held at the White House this fall. There are only a handful of apps ahead of Food Hero in the voting, so Thrive is calling on you to register with appsforhealthykids.com and help propel Food Hero to the front of the race!

Voting is a simple, two-step process:

1. Click here to register as a voter, then access your email and confirm your enrollment by clicking on the link you’ve received.

2. Come back to Thrive and click here to be redirected to Food Hero’s voting page!

In this meta-analysis, patients who experienced delirium were almost twice as likely to die or be institutionalized within about 2 years, even after adjusting for confounders. Although delirium is temporary, it is important to discuss (with the patient or family) the implications of prognosis in those that experience it (abstract)

In this large survey of 1891 physicians, only 2/3 completely agreed that they should report colleagues who are impaired or incompetent, and 17% had direct personal knowledge of an incompetent or impaired colleague. We need to ensure that seamless processes are in place to report and act upon incompetent or impaired physicians (abstract).

Public Policy Contributor Brad Flansbaum writes…
I follow the literature on Accountable Care Organizations (ACO) because of its topical nature and its promise, as well as how it may fast track needed change in our healthcare delivery system.  I have written on this subject once before, and wish to return to it.
A Google search of ‘Accountable [...]

Apparently they’re not as romantic about their own health care system as Berwick is according to this government white paper (H/T to Dr. Wes). Arguments that the NHS is a model health care system are falling apart at the seams as is, apparently, the NHS itself.

In several earlier posts I said that Berwick’s detractors as well as his supporters take a simplistic approach about his positions. A nuanced view of Berwick would be that his statements on health care are,at least on the surface, incoherent. How, for example, does he reconcile his contradictory positions, favoring rationing and central control on the one hand while at the same time espousing

By Matthew Holt In final panel at Health 2.0 Goes to Washington the reactor panel, Will Yu (ONC), Esther Dyson (EDventure) and Chris Schroeder(Healthcentral) discussed health issues, and innovation in the healthcare system with Matthew Holt.

By Matthew Holt SUBTEXT:After being a panelist at the Health 2.0 Goes to Washington Conference, Esther Dyson, Chairman of EDventure Holdings, gave a backstage interview. She talked about the three markets that influence Health 2.0; the market for healthcare, bad…

During my tenure here, I have always been able to count on Helen Fuller, RN, to send me emails when she saw things that were awry or could be done better — either for patients or members of the staff. For example, she pointed out a need for an automatic door between two of our buildings because the ramp connecting them was making it difficult for patients in wheelchairs to open the connecting door. (We installed the door.) She also noticed that we were having fewer town meetings than we should to keep nurses informed. (We scheduled more sessions.) She was inevitably on target, the ultimate “caller-outer” who made life better for all.

Here is a note recently sent by Helen to our chief nursing officer that codifies her view of the world. We are so lucky to be in a place with people like her!

Dear Marsha,

I am about to retire. My last day is July 30. I will have missed 54 years by one month, and I must say the last ten years have been my best.

I have done many aspects of nursing and enjoyed every minute. I can never remember thinking “Why am I a nurse?” I always knew why. I was always proud of what I did, I always felt I was contributing to the well being of others, both staff and patients. I learned a long time ago that people respond to you as you respond to them.

I must say, you as administrators should be so proud of your staff. They are the greatest. It is truly a family. I was privileged to have had a party given in my honor last evening and as I looked around, I couldn’t help but think, I am going to miss these friends. I am going to miss what they have given me through the years.

People look at retirement as a time to go off, enjoy and have fun. Oh, I will do that, but my heart will always be with the Case Management Department, the Farr 6 CIVCU staff, and with the folks I met in the corridors of BIDMC.

I will always cherish the 10 years I spent here and the people I have met. No one can match their wisdom, their ability to care for others and their fun loving ways. This includes all departments, from housekeeping to administration.

Thank you for letting me be a part of it.

Helen Fuller, RN, case management.

It has been a long time since I have updated the links I post on this blog. Yes, over there —-> on the right.

If you know of any, including your own, that would be of general interest to readers here, please let me know. I am particularly interested in expanding the category of patient-centered blogs.

As a pregnant mother, there’s always something to worry about. You worry about the health of the baby. You worry about what you should or shouldn’t do (because you are worried about the health of the baby). You worry about the delivery. You worry about paying for everything a child needs. You worry about finding good childcare. You worry about whether you’ll be a good parent.

Now there’s a study in the journal Pediatrics telling us that pregnant mothers have something else to worry about: the worrying itself.

Researchers in the Netherlands measured the stress and anxiety of 174 pregnant women using questionnaires as well as by measuring their cortisol levels (certain kinds of elevations of this hormone are associated with stress). After the babies were born, they got information every month from the mothers about the health of their babies. What they found was that the babies born to mothers who were stressed and anxious during pregnancy had more illnesses than those born to less stressed and anxious mothers.

It’s a small study, and it’s not like there was a huge difference in the numbers of illnesses. I’m also a little suspicious of the results; it seems to me that mothers who are more stressed generally might be more likely to interpret a sniffle as an illness than mothers who are happier and calmer.

With the inherent stresses of pregnancy, moms need to take time out for themselves.

But it’s a study worth paying attention to. This isn’t the first time that a connection has been made between maternal stress during pregnancy and the health of the baby. Previous studies have connected stress with prematurity and lower birth weight. And we certainly know that stress can handicap the immune system.

It’s worth paying attention also because I worry sometimes that pregnancy has become more stressful. Advances in medicine have led to more screening tests during pregnancy, which is mostly a good thing. But sometimes the results are unclear, or confusing, which can be very stressful for parents. And the mere existence of the tests, and the waiting for results, is stressful. It can be hard to just be happy about being pregnant—you have to wait and see what all the tests show.

Add to that the information explosion brought by the Internet. There are hundreds (maybe thousands) of web sites out there telling you exactly what you should (or should not) do during pregnancy, exactly what you should feel, exactly what you should weigh or look like—and many contradict each other. It was bad enough when you just had your friends and relatives giving you advice (sometimes unwanted). Now, with a few keystrokes, hundreds of other people can join in. Yikes.

Some pregnancies are indeed stressful, like when the mother or baby has a health problem, or when things like homelessness, violence, or other trauma are involved. In these cases, health care providers need to work closely with the mother to find supports and resources.

But most pregnancies aren’t that way (thank goodness). In most pregnancies, stress can be managed—if you take control of it. I realize I may be making that sound easier than it is, but it’s worth trying. Here are some suggestions:

• If your health care providers say that you’re having a healthy pregnancy, believe them. It’s hard, but try not to second guess them. Definitely let them know if you have a question or concern, but trust the people you’ve chosen to care for you.
• Take an inventory of your worries. Seriously. Write them down. And then make a plan for each one. For example, if there are any medical worries, talk to your doctor or midwife (talking to them early and often about delivery worries is a good idea, too). If you have financial worries, make a budget and see where you can cut expenses. If you’re worried about childcare, start looking early (get ideas from friends). Worried about parenting? Buy books on parenting that resonate with you, or pick them up at your local library. Not that making a plan necessarily takes away all the worry, but it can turn what feels like a cloud around you and the pregnancy into something much more manageable.
• Take care of yourself. Get some exercise. Pamper yourself whenever you can. Try out a prenatal yoga class—or if that sounds like too much work, devote a little time each day to doing exactly what you feel like doing. Which may be nothing at all, or a nap.

If none of this works, and you’re frequently feeling stressed, let your doctor or midwife know. Let someone help you. Counseling can make a real difference, as can medication (there are many that are safe in pregnancy).

Getting ready for a new baby should be a happy, wonderful thing. Let it be that way. Do it for yourself—and do it for your baby.

Teen swimmers are more likely to engage in high-risk behaviors

Lois Lee, MD, MPH, works in Children’s Emergency Department Injury Prevention Program

As a physician, there are certain patients’ stories that stay with you long after you’ve treated them. The dog days of summer remind me of when I was a resident and treated a teenager who nearly drowned in a lake. The patient survived, but only after suffering severe brain damage. He was part of a larger group of kids who went to a nearby lake to escape the heat and blow off some steam, but one of them couldn’t swim well and got in trouble. My patient saw him struggling and bound out into the deep waters to help.

The drowning boy was rescued, but while others were attending to him, my patient went under the water. Because they were so preoccupied attending to the first boy, it took some time for the others to notice that he was missing. Once they realized, they quickly pulled him out of the water, but by that time the damage to his brain had already been done. After a prolonged stay in the intensive care unit he went home, unable to walk, talk or feed himself. He and his family were never the same again.

As a resident, it was a chilling reminder that drowning usually doesn’t look like it’s portrayed in the movies– where swimmers splash around and make a lot of noise before they’re fully submerged in the water– drowning in real life is often a silent event. It also made it abundantly clear that teenagers’ tendency to show off, or push their own boundaries, is extremely dangerous in swimming scenarios.

Kids that age have a natural urge to want to impress their peers and test their own limitations, so it’s not surprising they’re more likely than younger kids or adults to try to swim harder, farther or beyond their own abilities. Unfortunately, once water is involved, the consequences of their bravado can be devastating.

Most media coverage on water safety centers on toddlers, but teenagers, particularly males, are also at high risk for drowning. Teens are far more likely to swim alone or with others their own age, and do so without adult supervision. So unlike toddlers, who should be closely monitored at all times near water, if a teenager or older child becomes submerged in the water it’s likely that far more time may lapse before someone notices he or she is missing.

“Teenagers’ tendency to show off, or push their own boundaries, is extremely dangerous in swimming scenarios.”

Teenagers are also far more likely than younger kids to use drugs or alcohol in the vicinity of water, which can both impair their ability to swim and may increase their risk taking behavior. All parents know they have to warn their children about the dangers of drinking and driving, but the serious consequences of drinking and swimming should be discussed as well. And just like driver’s education is required for new drivers, teens who can’t swim well should take classes taught by trained professionals before they go near water.

Lois Lee, MD, MPH

In my opinion, any teen who plans on spending time around water should also take an official CPR training class. Few interventions can improve outcome after a significant water submersion event, but the rapid initiation of CPR in the field has been shown to improve a drowning victim’s chance of survival.  And if your child will be on a boat any time this summer, the importance of life jackets, or personal flotation devices (PFDs), must be emphasized as well.

In the end it doesn’t take long to discuss water safety with your teen—but it can go a very long way in keeping them safe.

Here’s a video that demonstrates the basics of pediatric CPR. While it’s good for you to watch and learn from this video, it’s important to note that viewing it doesn’t constitute formal CPR training. Any parent or caregiver who plans on having their child around water this summer is strongly recommended to take an official CPR training course.