Blank Children’s HospitalJanuary 2018 Update

000058-3 01/18 CS

Lifestyle modifications in the management of headachesBy Amanda Croxton, DO

Headache is a frequent and common complaint among children and adolescents, with the most common primary headache being migraine and tension type. Headaches can persist into adulthood and account for greater than $30 billion in healthcare costs. They are also a significant burden for children resulting in frequent missed school and extracurricular activities, as well as emergency room visits and specialist care. Though there are a variety of pharmaceutical options for headache treatment, there are also a number of modifiable lifestyle factors that contribute to altering the frequency and intensity of primary headaches. Optimal management of headaches includes evaluating and adjusting these lifestyle factors.

In particular, there are six common areas which can greatly impact headache burden:

• Good sleep hygiene• Limiting or abstaining from caffeine• Eating regular meals• Adequate hydration of 6-8 cups of water per day• Limiting rescue medications to no more than 3 days per week• Exercise of 40 minutes, 3 times per week

Studies have shown when children were counseled to practice sleep hygiene guidelines, the frequency and duration of headaches significantly decreased compared with children that were not counseled.1 Daily caffeine use is also a known risk factor for worsening primary headaches, whereas gradual withdrawal and abstinence of caffeine results in decrease in overall frequency of headaches.2 Caffeine management is the only area of dietary alteration that is recommended, as there are no other particular foods or food additives consistently shown to trigger headaches. Rather, eating a well-balanced, nutritious diet at regular intervals, including breakfast,

throughout the day tends to mitigate headaches. Of course, if individuals do identify a dietary trigger, they are encouraged to avoid that food or drink. Along those lines, increasing daily hydration by adding one liter per day, or 4 cups of water, leads to decreased frequency and severity of headaches.3

Other risk factors that contribute to worsening primary headaches include medication overuse and sedentary lifestyle. Headache patients should be encouraged to limit rescue medications, including over-the-counter analgesics, triptans and prescription pain medications to no more than 3 days in a week. Taking medication more frequently can trigger medication overuse headaches, also known as rebound headaches, which make treating underlying headaches more difficult. Lastly, sedentary lifestyle can contribute to increased frequency of headaches. Recent studies suggest that getting aerobic exercise about 40 minutes per day, at least 3 days a week, is equally efficacious to taking a daily preventative medication.4

There are a number of lifestyle choices that can contribute to worsening headaches and many children may have multiple areas needing improvement. It is most helpful to focus on adjusting one or two areas at a time so kids are not overwhelmed and stay motivated to continue working toward their headache goals. Of course, some children may still require preventative medications despite these lifestyle changes, but these are great ways to start taking steps toward headache control.

1 Bruni O., Galli F., Guidetti V. (1999) Sleep hygiene and migraine in children and adolescents. Cephalalgia19(Suppl. 25): 57–59.2 Hering-Hanit, R. and Gadoth, N. (2003), Caffeine-induced headache in children and adolescents. Cephalalgia, 23: 332–335. doi:10.1046/j.1468-2982.2003.00576.x3 Spigt, M. G., Kuijper, E. C., van Schayck, C. P., Troost, J., Knipschild, P. G., Linssen, V. M. and Knottnerus, J. A. (2005), Increasing the daily water intake for the

prophylactic treatment of headache: a pilot trial*. European Journal of Neurology, 12: 715–718. doi:10.1111/j.1468-1331.2005.01081.x4 Varkey E, Cider Å, Carlsson J, Linde M. Exercise as migraine prophylaxis: A randomized study using relaxation and topiramate as controls. Cephalalgia.

2011;31(14):1428-1438. doi:10.1177/0333102411419681.

Copyright ® 2018 UnityPoint Health. All Rights Reserved. ® SM trademarks of UnityPoint Health.

2018 Education Opportunities• April 19 to 20 – Annual Pediatric Spring Conference

• May 16 to 17 – Breastfeeding Conference

• July 19 – School Nurse Conference

• September 18 – Injury Prevention Conference

• September 25 – Cooperative Caregiving (Mother Baby) Conference

• November 6 – Pediatric Nursing Conference

To learn more and find other continuing education, visit blankchildrens.org/classes.

We welcome any questions or story ideas for consideration in future issues. Please submit

them to cassie.norman@unitypoint.org.

Blank Children’s Neurology Clinic1215 Pleasant Street, Ste. 116Des Moines, IA 50309(515) 241-6544

Pulmonary Clinic receives national honor from Cystic Fibrosis FoundationBlank Children’s Pulmonology Clinic received an Outstanding Partnership Award from the Cystic Fibrosis Foundation at their national meeting in the fall 2017. Three centers nationwide receive the award, which is categorized based on the size of the center. The Pulmonology Clinic was recognized in its group for collaborating with the Cystic Fibrosis Foundation to give great care to patients and having proven success demonstrated in the past year.

2017 New Providers at Blank Children’s Hospital• Debra Borcherding, DO

Pediatric Emergency Department

• Amanda Croxton, DO Neurology Clinic

• Andrew Cyr, MD Pediatric Hospitalist

• Joseph Falco, DO Pediatric Hospitalist

• Salim Hommeida, MD Gastroenterology Clinic

• Katie Scott, DNP STAR Center

• Amy Yuska, ARNP Developmental Center

International Travel Clinic — Q&ATraveling abroad increases one’s risk of acquiring diseases that are not normally encountered at home. Whether families plan to soak up the sun in Mexico, tour the Taj Mahal or go on safari in Kenya, the Travel Clinic is a good resource.

What is the International Travel Clinic?

The Travel Clinic uses national and international travel expertise to

provide current, country-specific recommendations on relevant vaccines, preventive medications appropriate for children and travel advice in general. The goal of the clinic is to help keep children healthy and safe while they travel.

Who should visit the clinic?

Any child who is traveling abroad can come to the clinic. The physicians will provide education and immunizations

depending on the countries they are traveling to.

When should parents make an appointment?

We recommend that they make an appointment 4 to 6 weeks before the anticipated travel date. However, it is never too late to be seen and we can fit children in as our schedule allows.

It is estimated that 5 in 100 children and infants in the US are failure to thrive, a medical term associated with low weight and poor weight gain.

Veena Ramachandran, MD and Amaran Moodley, MD can answer questions and provide recommendations for children who are traveling

The team at our Growth and Nutrition Clinic (formerly the Failure to Thrive Clinic) understands that a child’s growth and nutrition play an important role in their lifelong health and well-being. Poor weight gain may be associated with developmental delay and cognitive deficiency. Children seen at the Growth and Nutrition Clinic have low weight or poor weight gain for a variety of reasons. Our team of experts includes a pediatrician, nurse, pediatric dietitian, and advocate that helps families provide nutrition to children who are struggling with gaining weight and growing.

Services provided at the clinic include developmental assessment, medical evaluation, dietary evaluation, evaluation for social support, nutritional counseling, ongoing growth monitoring, and intervention. Children up to 18 may be seen at the clinic, and they are followed until they have established age-appropriate growth and the family feels comfortable with meeting the nutritional needs of their children.More information can be found at blankchildrens.org/STARCenter.

Growth and Nutrition Clinic prioritizes the growing health of children

Quality Partner earns patient experience certificationToni Clark recently achieved the Certified Patient Experience Professional (CPXP) designation. Toni currently serves as Quality Partner at Blank Children’s Hospital. With this certification, she joins an elite group of approximately 500 healthcare professionals internationally who are committed to ensuring the best in experience for all they care for and serve. The certification, awarded by Patient Experience Institute (PXI), signifies that Toni possesses the qualities of a leader who influences the systems, processes, and behaviors that cultivate consistently positive experiences with knowledge and practical experience necessary to pass a rigorous examination. In addition, achievement of certification highlights a commitment to the profession and to maintaining current skills and knowledge in supporting and expanding the field of patient experience. Once certified, a CPXP must maintain his or her certification every three years and remain active in the field.

International Travel Clinic — Q&ATraveling abroad increases one’s risk of acquiring diseases that are not normally encountered at home. Whether families plan to soak up the sun in Mexico, tour the Taj Mahal or go on safari in Kenya, the Travel Clinic is a good resource.

What is the International Travel Clinic?

The Travel Clinic uses national and international travel expertise to

provide current, country-specific recommendations on relevant vaccines, preventive medications appropriate for children and travel advice in general. The goal of the clinic is to help keep children healthy and safe while they travel.

Who should visit the clinic?

Any child who is traveling abroad can come to the clinic. The physicians will provide education and immunizations

depending on the countries they are traveling to.

When should parents make an appointment?

We recommend that they make an appointment 4 to 6 weeks before the anticipated travel date. However, it is never too late to be seen and we can fit children in as our schedule allows.

It is estimated that 5 in 100 children and infants in the US are failure to thrive, a medical term associated with low weight and poor weight gain.

Veena Ramachandran, MD and Amaran Moodley, MD can answer questions and provide recommendations for children who are traveling

The team at our Growth and Nutrition Clinic (formerly the Failure to Thrive Clinic) understands that a child’s growth and nutrition play an important role in their lifelong health and well-being. Poor weight gain may be associated with developmental delay and cognitive deficiency. Children seen at the Growth and Nutrition Clinic have low weight or poor weight gain for a variety of reasons. Our team of experts includes a pediatrician, nurse, pediatric dietitian, and advocate that helps families provide nutrition to children who are struggling with gaining weight and growing.

Services provided at the clinic include developmental assessment, medical evaluation, dietary evaluation, evaluation for social support, nutritional counseling, ongoing growth monitoring, and intervention. Children up to 18 may be seen at the clinic, and they are followed until they have established age-appropriate growth and the family feels comfortable with meeting the nutritional needs of their children.More information can be found at blankchildrens.org/STARCenter.

Growth and Nutrition Clinic prioritizes the growing health of children

Quality Partner earns patient experience certificationToni Clark recently achieved the Certified Patient Experience Professional (CPXP) designation. Toni currently serves as Quality Partner at Blank Children’s Hospital. With this certification, she joins an elite group of approximately 500 healthcare professionals internationally who are committed to ensuring the best in experience for all they care for and serve. The certification, awarded by Patient Experience Institute (PXI), signifies that Toni possesses the qualities of a leader who influences the systems, processes, and behaviors that cultivate consistently positive experiences with knowledge and practical experience necessary to pass a rigorous examination. In addition, achievement of certification highlights a commitment to the profession and to maintaining current skills and knowledge in supporting and expanding the field of patient experience. Once certified, a CPXP must maintain his or her certification every three years and remain active in the field.

Blank Children’s HospitalJanuary 2018 Update

000058-3 01/18 CS

Lifestyle modifications in the management of headachesBy Amanda Croxton, DO

Headache is a frequent and common complaint among children and adolescents, with the most common primary headache being migraine and tension type. Headaches can persist into adulthood and account for greater than $30 billion in healthcare costs. They are also a significant burden for children resulting in frequent missed school and extracurricular activities, as well as emergency room visits and specialist care. Though there are a variety of pharmaceutical options for headache treatment, there are also a number of modifiable lifestyle factors that contribute to altering the frequency and intensity of primary headaches. Optimal management of headaches includes evaluating and adjusting these lifestyle factors.

In particular, there are six common areas which can greatly impact headache burden:

• Good sleep hygiene• Limiting or abstaining from caffeine• Eating regular meals• Adequate hydration of 6-8 cups of water per day• Limiting rescue medications to no more than 3 days per week• Exercise of 40 minutes, 3 times per week

Studies have shown when children were counseled to practice sleep hygiene guidelines, the frequency and duration of headaches significantly decreased compared with children that were not counseled.1 Daily caffeine use is also a known risk factor for worsening primary headaches, whereas gradual withdrawal and abstinence of caffeine results in decrease in overall frequency of headaches.2 Caffeine management is the only area of dietary alteration that is recommended, as there are no other particular foods or food additives consistently shown to trigger headaches. Rather, eating a well-balanced, nutritious diet at regular intervals, including breakfast,

throughout the day tends to mitigate headaches. Of course, if individuals do identify a dietary trigger, they are encouraged to avoid that food or drink. Along those lines, increasing daily hydration by adding one liter per day, or 4 cups of water, leads to decreased frequency and severity of headaches.3

Other risk factors that contribute to worsening primary headaches include medication overuse and sedentary lifestyle. Headache patients should be encouraged to limit rescue medications, including over-the-counter analgesics, triptans and prescription pain medications to no more than 3 days in a week. Taking medication more frequently can trigger medication overuse headaches, also known as rebound headaches, which make treating underlying headaches more difficult. Lastly, sedentary lifestyle can contribute to increased frequency of headaches. Recent studies suggest that getting aerobic exercise about 40 minutes per day, at least 3 days a week, is equally efficacious to taking a daily preventative medication.4

There are a number of lifestyle choices that can contribute to worsening headaches and many children may have multiple areas needing improvement. It is most helpful to focus on adjusting one or two areas at a time so kids are not overwhelmed and stay motivated to continue working toward their headache goals. Of course, some children may still require preventative medications despite these lifestyle changes, but these are great ways to start taking steps toward headache control.

1 Bruni O., Galli F., Guidetti V. (1999) Sleep hygiene and migraine in children and adolescents. Cephalalgia19(Suppl. 25): 57–59.2 Hering-Hanit, R. and Gadoth, N. (2003), Caffeine-induced headache in children and adolescents. Cephalalgia, 23: 332–335. doi:10.1046/j.1468-2982.2003.00576.x3 Spigt, M. G., Kuijper, E. C., van Schayck, C. P., Troost, J., Knipschild, P. G., Linssen, V. M. and Knottnerus, J. A. (2005), Increasing the daily water intake for the

prophylactic treatment of headache: a pilot trial*. European Journal of Neurology, 12: 715–718. doi:10.1111/j.1468-1331.2005.01081.x4 Varkey E, Cider Å, Carlsson J, Linde M. Exercise as migraine prophylaxis: A randomized study using relaxation and topiramate as controls. Cephalalgia.

2011;31(14):1428-1438. doi:10.1177/0333102411419681.

Copyright ® 2018 UnityPoint Health. All Rights Reserved. ® SM trademarks of UnityPoint Health.

2018 Education Opportunities• April 19 to 20 – Annual Pediatric Spring Conference

• May 16 to 17 – Breastfeeding Conference

• July 19 – School Nurse Conference

• September 18 – Injury Prevention Conference

• September 25 – Cooperative Caregiving (Mother Baby) Conference

• November 6 – Pediatric Nursing Conference

To learn more and find other continuing education, visit blankchildrens.org/classes.

We welcome any questions or story ideas for consideration in future issues. Please submit

them to cassie.norman@unitypoint.org.

Blank Children’s Neurology Clinic1215 Pleasant Street, Ste. 116Des Moines, IA 50309(515) 241-6544

Pulmonary Clinic receives national honor from Cystic Fibrosis FoundationBlank Children’s Pulmonology Clinic received an Outstanding Partnership Award from the Cystic Fibrosis Foundation at their national meeting in the fall 2017. Three centers nationwide receive the award, which is categorized based on the size of the center. The Pulmonology Clinic was recognized in its group for collaborating with the Cystic Fibrosis Foundation to give great care to patients and having proven success demonstrated in the past year.

2017 New Providers at Blank Children’s Hospital• Debra Borcherding, DO

Pediatric Emergency Department

• Amanda Croxton, DO Neurology Clinic

• Andrew Cyr, MD Pediatric Hospitalist

• Joseph Falco, DO Pediatric Hospitalist

• Salim Hommeida, MD Gastroenterology Clinic

• Katie Scott, DNP STAR Center

• Amy Yuska, ARNP Developmental Center