A HEALTH NEWS AND EDUCATION RESOURCE GUIDE FOR NEW AND EXPECTING September – December 2006

Raising a Special Child with Special Building Strength, Endurance During Pregnancy Needs PPH Offers Prenatal and Postnatal Therapies Learn how PPH for New Moms can help Successful Products, Services and Support for Nature’s Way to Feed Your Baby Tips for Traveling with Tots Plan now for a stress-free holiday : A Crime of Secrecy Learn to recognize the signs of abuse Class Locations

Poway San Marcos Volume 2 – Issue 3 Pomerado Hospital The HealthSource September – December 2006 15615 Pomerado Road 120 Craven Road Poway, CA 92064 Suite 103 Executive Editor 858.613.4000 San Marcos, CA 92069 Janet Gennoe Director of Marketing & The HealthSource Women’s Health Connection Escondido [email protected] Gateway Medical Building Palomar Medical Center 15725 Pomerado Road Content Editors Suite 100 555 East Valley Parkway Poway, CA 92064 Escondido, CA 92025 Mary Coalson 858.613.4894 760.739.3000 Health Education Specialist [email protected]

Tammy Chung Assistant to The HealthSource [email protected] Off-site classes are also available for groups, businesses and other organizations that Contributors would like instruction on a particular Gustavo Friederichsen health topic. Call 858.675.5372 for more information. Chief Marketing & Communications Offi cer [email protected]

Tami Weigold Marketing Manager [email protected] Numbers to Know Kathy Lunardi, R.N. Community Nurse Educator Keep these important numbers handy for use in the event of an emergency. [email protected]

Emergency Crisis Hotlines – 24-Hour Service CeCe Wilkens Wilkens Communications Fire, Police or Emergency 911 Jennifer Decker Arevalo Poison Control 800.222.1222 PSY/MED Media

California Missing Children Hotline 800.222.3463 Design/Production California Youth Crisis Hotline 800.843.5200 Chase Design [email protected] Child Abuse Hotline 800.344.6000 Rape/Crisis Hotline 888.272.1767 Trina Hinch Marketing Project Manager Domestic Violence Hotline 888.385.4657 [email protected] Missing, Abused & Exploited Children 888.818.4673 Mark Seal National Runaway Switchboard 800.621.4000 Rush Press

Vanished Children’s Alliance (VCA) 800.826.4743 Photography Domestic Violence & Rape Crisis Hotline 760.757.3500 Linda O’Neill Linda O’Neill Photography Youth Crisis Hotline 800.448.4663

Suicide and Crisis Counseling 800.479.3339 Janet Gennoe Director of Marketing & The HealthSource San Diego Police Department 619.531.2000

2 SEPTEMBERSEPTEMBER – DDECEMBERECEMBER 22006006 wwww.pph.orgww.pph.org SPECIAL FEATURES Inside this Issue … SPECIAL FEATURES 4 - 5 Raising a Special Child with Special Needs Raising a child with a physical or mental disability can be stressful and overwhelming, but help is just a phone call away. Discover how Palomar Pomerado Home Care Services made a difference in the lives of a boy and his family. 8 Welcome Home Baby! Palomar Pomerado Health’s unique program for building strong and healthy families earns national recognition.

8 Building Strength, Endurance During Pregnancy Don’t be discouraged by the hormonal and physical changes experienced during pregnancy. Learn how two new PPH services can help keep you comfortable and fi t. 10 Playing it Safe with Toys Discover tips to help you choose the right toys for your child.

11 Watching Baby Grow: Four to Six Months They grow up so fast! Learn more about the developmental milestones to look for during months four through six of your baby’s life.

11 Tips for Traveling with Tots It takes stamina to travel with children. This year, plan ahead and Finding a Physician take reasonable precautions to protect your children and yourself To select a Palomar Pomerado Health physician from holiday stress. for your pre-pregnancy and pregnancy care, or 12 - 13 Understanding a Crime of Secrecy: Child Abuse to register for a PPH class, please call Three million children are reported abused or neglected each year. The HealthSource at 800.628.2880. Learn to recognize the signs of abuse and take steps to stop it.

EDUCATION

6 Childbirth Preparation Classes The birth of a baby will be one of the most important moments in your family’s life. Palomar Pomerado Health offers a wide variety of classes and services to help you and your partner prepare for pregnancy and delivery. Stork Club Tours Call for dates, times and locations. 6 Meet the Instructor Tours of the Birth Centers at Palomar Certifi ed Childbirth Educator Sherry Simmons helps new moms Medical Center and Pomerado Hospital are and dads to prepare for baby. available by appointment only. If you are 9 Breastfeeding Classes and Lactation Services taking a childbirth class at the Women’s Health Connection or Palomar Medical 10 - and Toddler-Care Classes Center, there is no need to take this tour as well. Tours of the Birth Center at Palomar 14 Sibling Education, Young Adult, CPR and First Aid Classes Medical Center are available in Spanish on the 2nd and last Wednesdays of each month The HealthSource retains the right to cancel a community education class if minimum from 7 to 8:30 p.m. enrollment is not met. If you have a disability, please notify us 72 hours prior to the event so that we may provide reasonable accommodations. FEE: Free

For a physician referral, or to register for a class, call The HealthSource at 800.628.2880. 3 Raising A Child with

While most parents realize their dream of raising healthy,healthy, curiouscurious and active children who grow into self-suffi cient adults, there are hundreds of parents throughout North County who are raising children with physical and mental disabilities – forcing them to learn new skills and redefi ne priorities. “When a child has a disability, it shatters the dreams parents have held for a long time,” says Cleo Ariosta, community resource specialist for Palomar Pomerado Home Care Services. “Suddenly, the family is faced with learning as much as possible about the disability, available resources for treatment and how to meet the special needs of their child. It’s very stressful and overwhelming.” According to the March of Dimes, about 120,000 babies (1 in 33) in the U.S. are born each year with birth defects. Palomar Pomerado Home Care (PPHC) helps parents by providing specialized services for children with disabilities. Children served Learning About Autism include those with autism, meningitis, Down syndrome, cerebral • Autism is the fastest growing developmental disability palsy, spinal muscular atrophy, epilepsy, traumatic brain injury in the U.S. and other severe medically or physically disabling conditions. • More than 1.5 million individuals in the U.S. have “Among the many children we take care of is a six-year-old girl been diagnosed with autism or another form of who had respiratory failure and requires a ventilator for breathing,” pervasive development disorder. Ariosta says. “She uses a wheelchair for mobility and our licensed • Males are four times more likely than females to be diagnosed with autism. Treatment Options Living with Autism: The Autism Society of America recommends that parents Joshua Strengthens His Family’s Faith learn as much as possible about autism and treatment options because there are many different approaches including auditory Joshua Stansell, now 12, was three years old when he was training, vitamin therapy, anti-yeast therapy, facilitated diagnosed with autism. But his suspected something was communication, music and art therapy, occupational therapy, wrong long before that. physical therapy and sensory integration. These approaches “I knew much earlier because he didn’t look others in the eye,” can generally be broken down into three categories: Desiree Stansell says. “He started to withdraw socially soon after • Behavioral & Communication he had a scheduled vaccination. I had to push for a diagnosis • Biomedical & Dietary because I know it’s vitally important to get help early.” • Complementary (art or music therapy, etc.) Autism is a complex developmental disability that affects the normal functioning of the brain and impacts social interaction and Source: Autism Society of America, www.autism-society.org communication skills. It affects each individual differently and to different degrees, which is why early diagnosis is so important. While there is no known single cause for autism, it is generally believed that it is caused by abnormalities in brain structure or function. The link between vaccines and autism continues to be debated among scientists.

Desiree Stansell shares a Some of the many autistic behaviors include resistance to change, laugh with her 12-year- diffi culty expressing needs, tantrums, actions that are self- old son, Joshua, who has injurious or hurtful to others, repeating words, being unresponsive, autism and diabetes. aggressiveness and communication diffi culties. Parents are left guessing what their child needs: is he crying because he’s hungry, sick or thirsty? Not knowing the answer leaves both the child and the parents exhausted and frustrated.

4 SEPTEMBER – DECEMBER 2006 www.pph.org Coping with Special Needs Unique Worries vocation nurse attends school with her and provides total carecare forfor Families, including siblings and grandparents, who are raising the child. Our services help the child and give parents important a child with special needs may be worried by: time to spend with their other children, with each other or just to • Financial concerns due to the expense of evaluations have some time for themselves.” and various therapies or services. PPHC helps by providing direct client services and referral to • Feelings of isolation from feeling uncomfortable taking an array of community resources that help families manage the their child into the community. challenges of caring for their special child. • Grief from the loss of having a “typical” child. The Private Duty division of PPHC specializes in a variety of services for adults and children, provided by a staff that consists “We know it can be overwhelming and we’re here to help of registered nurses, licensed vocational nurses and certifi ed families manage,” says Cleo Ariosta, community resource home health aides. A care plan is developed following a thorough specialist for Palomar Pomerado Home Care Services. “A assessment of needs and consultation with the child’s physician. multitude of resources, from speech therapy to social workers, The PPHC team manages and coordinates skilled nursing services are available from Home Care. We can also refer to appropriate such as ventilator, feeding tube and tracheotomy care. Support resources in the community for fi nancial assistance, special services (personal care, bathing, meal preparation, medication education and factual information about the disability.” reminder and housekeeping assistance) and short-term respite Community resources and information can be found at these care are also available. web sites. From here, you will fi nd additional links. For more information, please call 800.525.3528. San Diego Regional Center, www.sdrc.org National Dissemination Center for Children with Disabilities, www.nichcy.org March of Dimes, www.marchofdimes.com California Developmental Disabilities Council, www.scdd.ca.gov Palomar Pomerado Home Care, 800.525.3528 or www.pph.org.

Walker attends a private special education school with Joshua each day where she regularly checks his blood sugar levels and PPH licensed vocational nurse Liza Walker attends school provides insulin if required. “Now that his sugar is managed, he with Joshua Stansell to monitor his blood sugar and provide pays more attention in school and has been able to accelerate insulin if needed. Joshua has autism and diabetes. his learning,” Walker says. Joshua now eats a wider variety of foods, although he still Joshua has several of those behaviors, but has made tremendous has food sensitivities. The family, which includes his parents progress in recent years thanks in large part to Liza Walker, a Desiree and Mark plus sisters Christiana and Michaela, have licensed vocational nurse (LVN) with Palomar Pomerado Home adopted a healthy diet that largely eliminates processed foods Care (PPHC). However, it wasn’t because of autism that her while emphasizing lots of fresh food. services were needed. Rather, Joshua was diagnosed with Type I “What I learned from Liza about nutrition and portions was diabetes, which requires frequently checking blood sugar levels invaluable,” Desiree says. “Joshua’s doctor has been surprised and injecting insulin. As a child with autism, he is not able to at how near perfect his blood sugar has been. His health is self-manage the diabetes. incredible; it’s pretty miraculous.” “Suddenly, we were responsible for monitoring his diabetes 24- Because of his health improvements, Joshua now enjoys hours-a-day and helping Joshua manage his autistic behaviors, family outings that include movies and occasional trips to on top of trying to home school our two daughters,” Stansell Disneyland. says. “When Joshua developed diabetes, we knew we needed more help and called Home Care Services.” “While Joshua has gotten better, thanks to Liza and the continuity of her service, he still requires a lot of attention,” “Everyone was worried because this was new and Joshua was a Desiree says. “We’re fortunate because we have our faith in God picky eater,” Walker says. “I spent a lot of time educating his and each other. Our family and friends love and support Joshua parents about the proper diet and portion control, which is so and that has been pivotal. There is always hope.” important to managing diabetes.”

For a physician referral, or to register for a class, call The HealthSource at 800.628.2880. 5 the Classes Childbirth Preparation PreparationPreparation fforor CChildbirthhildbirth ““InIn a WWeekend”eekend” 9 a.m. – 3:30 p.m. (Saturdays) Preparation for Childbirth 10 a.m. – 3:30 p.m. (Sundays) Five-Week Series Women’s Health Connection (Poway) 6:30 – 9 p.m. Choose one of the following four classes: Women’s Health Connection (Poway) September 16 – 17 Choose from one of the following fi ve-week series: October 7 – 8 Mondays, September 18 – October 16 November 4 – 5 Mondays, November 6 – December 4 December 2 – 3 Wednesdays, September 6 – October 4 Palomar Medical Center (Escondido) Wednesdays, October 25 – November 29 Choose one of the following four classes: (No class November 22) Wednesdays, December 20 – January 17, 2007 September 9 – 10 October 14 – 15 Palomar Medical Center (Escondido) November 11 – 12 Choose from one of the following fi ve-week series: December 9 – 10 Tuesdays, October 17 – November 21 (No class October 31) Our weekend class includes the same information covered in our Wednesdays, October 4 – November 1 fi ve-week series, but takes only two days to complete. A tour of the Wednesdays, November 15 – December 20 birth center is included. We recommend early registration for this (No class November 22) popular class. Prepare for a safe and satisfying birth experience with this fi ve-week FEE: $70/mom or couple (includes childbirth manual) childbirth preparation series held at the Women’s Health Connection in Poway and Palomar Medical Center in Escondido. Small classes Cesarean Birth Lecture ensure personalized instruction focusing on the signs and stages Call for dates, times and locations of labor, hospital procedures, medication options and Cesarean birth. A general overview of labor-coping techniques is provided, and Expectant parents who anticipate a Cesarean birth and choose newborn characteristics, infant feeding and postpartum adjustments not to enroll in a childbirth class may attend a one-hour lecture are discussed. A tour of the birth center is included in this class. about Cesarean birth that is part of our regular childbirth series. Information covered includes indications for a Cesarean birth, pre- FEE: $70 /mom or couple (includes childbirth manual) operative procedures, medications, the birthing process, and post- operative and recovery procedures. Meet the Instructor: FEE: $10 /mom or couple Sherry Simmons, Certifi ed Childbirth Educator

Sherry Simmons has a green thumb in the garden, but her passion is in the classroom teaching childbirth classes at Palomar Pomerado Health. “I absolutely love teaching childbirth. There is nothing else I’d rather do,” says Simmons, a certifi ed childbirth educator who has helped new moms and dads prepare for delivery for more than four years. “I feel very fortunate because I look forward to going to work.” A mid-life decision to return to school opened the doors to Simmons’ rewarding career, and she is furthering her education and teaching opportunities by enrolling in the Lactation Educator/Counselor Program at the University of California, San Diego. In addition to teaching childbirth classes, Simmons has served on the board of directors for the Childbirth Educators’ Association. She currently leads a support group for fi rst-time moms and their babies through the Welcome Home Baby! program (see story on page 8) where she frequently reunites with new moms who attended her childbirth classes.

A busy mom of two teenagers, Simmons manages to fi nd some time for her gardening hobby. 6 SEPTEMBER – DECEMBER 2006 www.pph.org Our Birth Center features a I ndeed, the babies aren’t the only ones here concierge service, private rooms with silver spoons in their mouths. and a comfy robe for mom. Part maternity, part resort. That’s the feeling you’ll get when you enter our Birth Center. Luxurious amenities keep new moms comfortable and relaxed, while a state-of-the-art Neonatal Intensive Care Unit (NICU) and around-the - clock anesthesiologist keep you confident and reassured. The birth of your child is already an amazing experience. Choosing to have your baby here just makes it that much better. To scheduleschedule a tourtour ofof thethe BirthBirth CenterCenter atat Pomerado Hospital, call 800.628.2880.

www.pph.org • 800.628.2880

BREASTFEEDING CLASS - $5 OFF FREE NURSING or 5% OFF

Prepare for a positive breastfeeding experience with Make the experience of breastfeeding your baby easy and comfortable our "Successful Breastfeeding" class. Call The HealthSource with our extensive line of Medela® breastfeeding products. Visit the Women's at 800.628.2880 to enroll and receive $5 off the Health Connection Boutique and receive a free Medela® Comfort Bra regular $25 fee. with any breast pump purchase.Or, take 5% off the purchase of any breast pump. Call 858.613.4894 for details. Offer not valid with any other discount. Coupon must be referenced Offer not valid with any other discount or for previous purchases. at the time of registration. Discount not valid for previous enrollments. Limit one coupon per person. Coupon must be presented at the time Expires 1/31/07 of purchase. Expires 1/31/07

Basic Training for Dads Mommies in Motion

BasicBasic TTrainingraining fforor DDadsads PrenatalPrenatal EExercisexercise CClasslass Women’s Health Connection Four-Week Series 9:30 a.m. – Noon 6 – 7 p.m. Saturday, December 9 Women’s Health Connection Are you a fi rst-time “dad-to-be” in need of some basic training? Thursdays, October 12 – November 2 Your life is about to change drastically and if you don’t know what Take steps now to stay in shape, feel your best and maximize to expect, this is your opportunity to gain some informal, hands- your total well-being during pregnancy. This four-week series on experience. This class is intended for expectant fathers in the promotes physical fi tness and good health through education second or third trimester of their baby’s pregnancy. It is a “fathers and exercise. “Mommies in Motion” is suitable for women of only” class featuring special guests – Veteran Dads (BT graduates) any stage of pregnancy or fi tness level. A signed physician and their newborn babies. Learn what to expect during the last consent form is required, and participants trimester of pregnancy, birth and the fi rst few should bring an exercise mat or large weeks at home. Plus, discover practical tips towel to each class. on diapering, feeding and soothing the newborn. Leave the class with a boost FEE: $40 / participant of confi dence to be the best dad you can be! FEE: $35 / dad

For a physician referral, or to register for a class, call The HealthSource at 800.628.2880. 7 Exercises to Strengthen, Build Endurance During Pregnancy As if morning sickness, blotchy skin and weight gain weren’t enough. During pregnancy, intense hormonal and physical changes may also result in back pain, loss of balance, urinary stress incontinence or loosening joints. Two services from Palomar Pomerado Health’s (PPH) Rehabilitation Services are designed to help expectant maintain their health and wellness during pregnancy. Mommies in Motion is an exercise class designed specifi cally for pregnant women. Exercises focus on preparing the mother for labor and delivery by building cardio-respiratory endurance, Welcome Home Baby! and stretching and strengthening muscles. Participants learn Award-Winning Program Expands Throughout County about posture and body mechanics, pelvic fl oor muscle awareness and relaxation techniques. This has been a banner year for the Palomar Pomerado Health “This fi tness class is a wonderful way to minimize pregnancy- (PPH) Welcome Home Baby! program. In addition to receiving a related discomforts by improving strength and fl exibility,” says $6.9 million four-year grant from the First 5 Commission of San Michelle Thompson, MPT, certifi ed prenatal and postnatal Diego, it has earned national recognition by ADVANCE for Nurses fi tness instructor. news magazine. Welcome Home Baby! won the magazine’smagazine’s “Best in Adaptability” award in its annual Best Nursing Team Contest. PPH’s Rehabilitation Services also offers individual physical therapy sessions tailored to the specifi c needs of pregnant “We are committed to building strong and healthy families from women. “During pregnancy, the center of gravity shifts the very beginning,” says Annamarie Martinez, R.N., director of because of the growing fetus,” Thompson says. “This can Welcome Home Baby! “It’“It’ss an exciting time for families. WWee want result in back pain, poor posture and other aches & pains. We to provide them with all the education and support needed to design a specifi c program to address individual needs.” raise a healthy and happy child.” Prenatal and postnatal physical therapy starts with a thorough Welcome Home Baby! is a unique collaboration organized by PPH assessment of individual needs and includes manual therapy and funded solely by the First 5 Commission of San Diego. The with education and therapeutic exercises designed to: grant provides registered nurse home visits for fi rst time parents in fi ve of the six health and human service regions countywide, • Promote improved posture including 10 area hospitals. It also provides additional funding • Increase awareness of correct body mechanics for Welcome Home Baby! to offer its fi rst weekly bilingual • Prepare lower body for physical changes breastfeeding support group at no cost in collaboration with Neighborhood Health Care. • Improve awareness & control of pelvic fl oor muscles The “Best in Adaptability” award refl ects the success of Welcome • Maintain abdominal function Home Baby! in adapting to program changes and the individual • Prepare upper body for the physical demands of needs of their clients. Clients may live in impoverished or highly infant care affl uent areas; they may speak one of many languages; they are all ages with high or low levels of education. “Other adaptations • Promote & maintain cardiovascular fi tness include the increase in the number of dads and adoptive parents • Improve relaxation skills who participate,” says Cynthia Linder, R.N., North Inland regional A physician referral is required for physical therapy. coordinator for Welcome Home Baby! Each visitation brings new challenges, but the nurses know that For more information, each family shares the common goal of learning to care for their visit www.pph.org or call babies. The HealthSource at “I think it’s rewarding when you go to a house and a mom is in 800.628.2880. tears because she has no clue what to do with this little bundle and I can help her,” says Cindee Phillips, R.N., lactation educator. “The baby may not be nursing and is losing weight, but when you leave, the baby nurses well, and the mom wants you to stay. I leave feeling like I made a difference in a life.” For more information, call 877.504.BABY (2229), or contact your obstetrician or child’s pediatrician.

8 SEPTEMBER – DECEMBER 2006 www.pph.org Breastfeeding Successful Breastfeeding Lactaatition SERVICES 6:30 – 9 p.m.

Women’s Health Connection Palomar Pomerado Health’s certifi ed lactation consultants provide Choose one of the following four classes: telephone, inpatient and outpatient consults for new mothers who Tuesdays choose to breastfeed their babies. Breast pumps are also available September 5, October 3, November 7 or December 5 for sale or rental through the PPH Women’s Health Connection Palomar Medical Center Boutique, along with a wide variety of breastfeeding supplies and Choose one of the following two classes: literature. Following is a directory of lactation services available through Palomar Pomerado Health. Mondays October 9 or December 11 Palomar Medical Center 760.739.2434 Breastfeeding is “nature’s way” to feed a baby, but it doesn’t always 555 E. Valley Parkway, Escondido, CA 92025 come naturally. Enhance your opportunity for a positive breastfeeding Breastfeeding classes; inpatient and outpatient lactation experience with this informative class led by a certifi ed lactation consults; telephone advice warmline; other related services. consultant. Classes are offered at the Women’s Health Connection in Poway and Palomar Medical Center in Escondido. Topics include Pomerado Hospital 858.613.4605 the benefi ts of breastfeeding, breast anatomy and physiology, getting 15615 Pomerado Road, Poway, CA 92064 off to a good start, common diffi culties and solutions, and returning Breastfeeding classes; inpatient and outpatient lactation to work. consults; telephone advice warmline; other related services. FEE: $25/mom or couple Women’s Health Connection Boutique 858.613.4894 15725 Pomerado Road, Suite 100, Poway, CA 92064 Medela breast pumps for rental or purchase; pump kit accessories; nursing ; breast-care products; breastfeeding Mothers of classes; support group meetings.

To register for a breastfeeding class, please call Twins Triplets Club The HealthSource at 800.628.2880.

Have you been blessed with multiple bundles of joy? The Mothers of Twins and Triplets Club meets monthly and provides a forum for friendship and support for families, or expecting families, with twins or triplets. Speakers and special programs help parents deal with the pressure of raising multiple-birth children.

For more information, call 858.451.8612.

Breastfeeding Support Group The Women’s Health Connection Tuesdays and Fridays 1 – 2:30 p.m. The HealthSource, San Marcos Thursdays, 1 – 2:30 p.m. Meet with a certifi ed lactation consultant and other new moms to share information and learn new ideas during these weekly group sessions. Call the Women’s Health Connection at 858.613.4894 for more information. FEE: Free

For a physician referral, or to register for a class, call The HealthSource at 800.628.2880. 9 Infant and Toddler Care Baby-Care Basics Infant Massage 12:30 – 3 p.m. Women’s Health Connection Choose one of the following four classes: Two-Week Series 6:30 – 7:30 p.m. Saturdays September 23, October 21, November 18 or December 16 Women’s Health Connection Wednesdays Since babies don’t come with instructions, this class will provide you October 11 and 18 with the guidance needed to experience a more confi dent beginning. Topics include basic physical care skills, growth and development, Touch is the primal language normal daily activities/habits, safe-proofi ng your home, nutritional needs and management of illnesses. of newborns. That’s why infant massage has become an increasingly FEE: $30/mom or couple popular method of bonding and relaxation between a baby and . Designed for babies’ ages 1 to 6 months, infant massage incorporates touch, massage, and refl exology in a loving, fun, one- Baby Sign Language on-one interaction – providing nourishment for a newborn’s healthy 6:30 – 9 p.m. development. Women’s Health Connection Palomar Pomerado Health will host a special infant massage class Tuesday, October 24 during two one-hour sessions at the Women’s Health Connection. Starting as early as 7 months, before verbal Led by Certifi ed Infant Massage Instructor Wendy Morris, this skills are developed, your baby can begin to unique class will explore the many advantages of infant massage learn to express his or her wants or needs and provide hands-on instruction using a variety of easy-to-learn through the art of signing. Studies have shown massage techniques. Please bring your baby to both one-hour that signing babies may learn to speak earlier, sessions. Babies recently immunized should not participate. Register develop larger vocabularies, have stronger parent/child , show today, as space is limited for this class. more interest in books, engage in more sophisticated , have less FEE: $35/couple and baby frustration, crying and tantrums, and have increased IQ scores. Palomar Pomerado Health will present special sessions on Baby Sign Language at the Women’s Health Connection in Poway. Monta Briant, a Sign2Me Certifi ed Instructor, will teach 50 to 60 signs Playing it Safe with Toys during the class and provide couples with a copy of her book, “Baby Sign Language Basics.” Please note that this class is for parents It may be child’s play, but keeping your child safe during and caregivers only. Space is limited so register today! play requires attention and planning. These tips can help you choose the right toys for your child to enjoy. FEE: $40 / couple • Select toys suited to your child’s age, abilities and interest level. Labels often include age guidelines. A Child’s Response to Love • Check the label for safety information. A UL mark on a toy means that the product has been thoroughly tested by this independent, third party organization and found Women’s Health Connection to meet all relevant safety requirements. 10 – 11:30 a.m. • Include helmets and pads for use with bicycles, scooters Saturday, November 11 skateboards or inline skates.

Raising a child is a challenge in • Avoid unintentional injuries by avoiding the best of circumstances. The toys with small parts, sharp edges successes of the early years of or cords, especially for development are refl ective of the and toddlers. care and guidance of the parents, • Check the noise level, which grandparents and day-care providers. may damage young ears. If Boundaries and rules are necessary but it’s too loud for you, it’s too above all, children need and will thrive in unconditional love. Join loud for your child. Janet Nast, author of “You Can’t Love Your Children Too Much,” as she discusses her passion for her children and how she meets the many • Check toys regularly for challenges of . wear and tear. Repair or discard damaged toys. FEE: $3 / individual, $5 / couple

10 SEPTEMBER – DECEMBER 2006 www.pph.org Watching Baby Grow: Tips forTraveling Months 4–6 with Tots It’s time to have some fun with your little one! While listening to music – sing, clap It takes a lot of stamina to travel with young children, especially and dance with your baby. during busy holiday times. Talk with your son and repeat Turn this year’s festivities into fun memories by planning ahead his noises; he’s and taking reasonable precautions to protect your children and beginning to enjoy hearing his yourself from holiday stress. own voice and communicating his needs and wants. Since Travel your daughter’s close vision • Avoid air travel during peak times. Try to fl y mid-week and is now well established, make funny faces at each other and never take the last fl ight of the day, when delays are more share a good laugh! likely. If you haven’t already joined a play group, now is the time. • Allow extra time to get through security. Not only is it healthy for parents and babies to get out of the • Entertain and exercise. Bring new toys and snacks for the house and play,play, it’sit’s also a great opportunity to observe other fl ight and help toddlers release energy by running with babies and interact with new parents. them in the airport while waiting to board. Every child develops at his or her own pace; you and your • Carry suffi cient and clothes to cover delays. pediatrician are in the best position to note your child’schild’s • Encourage your infant to nurse or suck on a bottle during development. Here are some developmental milestones to descent to decrease ear pain. Chewing gum or blowing look for when your baby is between 4 and 6 months old. balloons works for older children. Age-appropriate acetaminophen or ibuprofen may be used. Safety By the end of their fourth month, most babies: • Before visiting relatives, ask them to consider installing • Sit up straight if • Place objects in gates on stairs, electric outlet covers and safety locks propped mouth for lower cabinets. Remind them that prescriptions and • Raise head 90 • Have beginning eye- household cleaners should be stowed out of reach. degrees when placed hand coordination • Keep young children away from pets that may cause harm. on stomach • Make several • Let your family know of any food allergies and be prepared • Roll from back to one consonant sounds to fi x any special meals your child may need. side • Anticipate feeding • Designate a responsible adult to serve as a child watcher. • Reach for objects with when able to see a Switch off periodically, so everyone can share in the fun. hands bottle (if bottle-fed) Maintain Familiar Routines • Grasp rattle with both • Show signs of memory • Your baby will be happier if you can maintain close to the hands normal at-home schedule. A familiar blanket or toy will By the end of their sixth month, most babies: comfort your infant, as will favorite foods. • Plan activities around your • Touch hands together • Bear some weight on child’s naptime, if possible. At a legs when held under • Turn head toward minimum, take some quiet time the arms sounds with your child during the day. • Support body weight • Roll over from • Children may need to be on outstretched stomach to back or fed earlier than adults. hands when lying on vice versa Put infants to sleep stomach before the evening meal. • See small objects, If you want to include such as crumbs young children at the Source: www.aap.orgwww.aap.org dinner table, consider serving a healthy Missed the fi rst part of our series on developmental milestonesmilestones?? dessert for them while VisitVisit wwwwww.pph.org.pph.org for an online version of previous issues of the adults eat. The BabySource. Look for more developmental milestones for your baby in the next issue of The BabySource.

For a physician referral, or to register for a class, call The HealthSource at 800.628.2880. 11 Understanding a Crime of Secrecy: Grim statistics from the American Academy of state that approximately three million children are reported abused or neglected in the U.S. each year and three children die each day from abuse and neglect. Commonly, the abuser is a member of the child’s family or household or someone they know. Child molestation is a crime of secrecy and it is generally people who know these children well and who are privy to that alone time,” says Catherine McLennan, MSW, supervisor of the Child Abuse Program (CAP) within the Forensic Health Department at Palomar Pomerado Health (PPH). “There is no way to identify a potential child molester by appearance, conduct or social status.” News stories report about child abuse cases involving people children are taught to trust: relatives, teachers, clergy, soccer coaches, dentists and medical providers. “It is extremely important for parents to understand that, while no child is exempt from child abuse, there are steps that can be taken to protect their child,” McLennan says. She recommends that parents use ‘teachable moments’ to talk with their child about the issue of molestation. For instance, if your child has spent the night at the home of a friend for the fi rst time, ask your child about that experience: Where did you sleep? Who lives there? What did the parents or older siblings do while you were there? If an adult paid an inexplicable amount of attention to your child, try to fi nd out whywhy.. Signs of Abuse • Increased absence from school Uncovering the Truth • Unexplained bruises, broken bones The Forensic Health Department at Palomar Pomerado Health “Law enforcement will proceed with the investigation based on the consists of the Child Abuse Program (CAP) and Sexual Assault information the child provides,” says McLennan. “Once complete, • Withdrawal, depression Response Team (SART). Last year, CAP evaluated more than 300 a report is submitted to a district attorney who decides if the children; ninety percent involved sexual abuse. case can be prosecuted. Although we often have a compelling • Behavior changes in school, sleep or appetite statement from a child, sometimes we are unable to prosecute When a child abuse case is reported, local law enforcement or because no other corroboration exists. Our staff testifi es in court • Sexual acting out Child Protective Services (CPS) refer the child and family to CAP, if a case does go to trial.” • Stealing where a multi-disciplinary team performs a medical evaluation and interview. CAP works closely with the Chadwick Center for Children and • Sudden inattention Families at Children’s Hospital to maintain a treatment program The CAP team includes a medical director, nurses trained in child on-site for trauma counseling. CAP staff refers children and development and a bilingual forensic interviewer. families to a victim advocate at Chadwick who helps them gain Trained child interview specialists question children behind a access to mental health services. one-way mirror so that law enforcement, CPS and sometimes “This is a great example of resource sharing that allows us to the district attorney can observe. The interview is videotaped to provide a needed service to our North County clients,” says reduce secondary trauma to the child that comes through repeated McLennan. “The goal of all the team members– PPH, law questioning. enforcement, medical, prosecution and interviewers– is to share “The goal of a forensic interviewer is to develop non-leading information and hopefully enhance the chances of truth fi nding questions that are defensible in court,” says Catherine McLennan, and prosecution, if appropriate.” MSW, CAP supervisor. “The questions are geared to the CAP staffers are available to answer questions from the public development and skills of each child to assure they understand or take requests for group education, parent prevention talks or the question.” center tours. Call 760.739.2150 for more information.

12 SEPTEMBER – DECEMBER 2006 www.pph.org Understanding a Crime of Secrecy: CHILD A BUSE “Be involved in your child’s activities” McLennan says. “Reduce the number of people who have access to your child. It’s not wise to trust relatively new acquaintances to be left alone as caretakers. If your child tells you something has happened, believe them and check it out.” McLennan says protection includes teaching children that even if the person who touches them inappropriately is a close and loving family member, it is wrong and should be reported to a parent. An American Academy of Pediatrics-endorsed book, Caring for Your School-Age Child: Ages 5 to 12 states that risk factors are greater in families with: • Financial, job or marital stress • Poor parenting skills • No source of emotional and physical support because they are isolated from family or community • Anger management issues • Adults or children who have physical or mental health issues • Children who have learning or behavioral problems • Alcohol or drug abuse CAP staffers are available to answer questions from the public or take requests for group education, parent prevention talks or center tours. Call 760.739.2150 for more information. Types of Abuse TakesTEAMWORK • Physical: when a child is hit, slapped, beaten, burned, or otherwise physically harmed The Forensic Health Department at Palomar Pomerado Health “Law enforcement will proceed with the investigation based on the consists of the Child Abuse Program (CAP) and Sexual Assault information the child provides,” says McLennan. “Once complete, • Sexual: when a child engages in a sexual Response Team (SART). Last year, CAP evaluated more than 300 a report is submitted to a district attorney who decides if the situation with an adult or an older child children; ninety percent involved sexual abuse. case can be prosecuted. Although we often have a compelling • Emotional/Psychological: when a child is regularly statement from a child, sometimes we are unable to prosecute When a child abuse case is reported, local law enforcement or threatened, yelled at, humiliated, ignored, because no other corroboration exists. Our staff testifi es in court Child Protective Services (CPS) refer the child and family to CAP, blamed or otherwise emotionally mistreated if a case does go to trial.” where a multi-disciplinary team performs a medical evaluation • Neglect: when a child’s basic needs, such as and interview. CAP works closely with the Chadwick Center for Children and food, shelter, clothing, cleanliness, emotional Families at Children’s Hospital to maintain a treatment program The CAP team includes a medical director, nurses trained in child support, love and affection, education, safety on-site for trauma counseling. CAP staff refers children and development and a bilingual forensic interviewer. and medical and dental care are not met families to a victim advocate at Chadwick who helps them gain Trained child interview specialists question children behind a access to mental health services. Source: www.aap.org one-way mirror so that law enforcement, CPS and sometimes “This is a great example of resource sharing that allows us to the district attorney can observe. The interview is videotaped to provide a needed service to our North County clients,” says reduce secondary trauma to the child that comes through repeated McLennan. “The goal of all the team members– PPH, law questioning. enforcement, medical, prosecution and interviewers– is to share “The goal of a forensic interviewer is to develop non-leading information and hopefully enhance the chances of truth fi nding questions that are defensible in court,” says Catherine McLennan, and prosecution, if appropriate.” MSW, CAP supervisor. “The questions are geared to the CAP staffers are available to answer questions from the public development and skills of each child to assure they understand or take requests for group education, parent prevention talks or the question.” center tours. Call 760.739.2150 for more information.

For a physician referral, or to register for a class, call The HealthSource at 800.628.2880. 13 Young Adult Classes Sibling Education Babysitting Basics* Becoming a Big Brother/Big Sister 6 – 9 p.m. 10 – 11:30 a.m. Women’s Health Connection Women’s Health Connection Choose one of the following two classes: Choose one of the following two classes: Fridays, October 20 or December 1 Saturdays, September 23 or November 18 The HealthSource, San Marcos Friday, November 17 Palomar Medical Center Saturday, October 28 This three-hour babysitting course is designed for boys and girls ages 10 to 14. Topics covered include babysitter responsibilities, caring This 90-minute class offered at the Women’s Health Connection for children, overview of fi rst-aid, safety and accident prevention, in Poway and Palomar Medical Center in Escondido will help big handling emergencies and calling 911, playing with children, brothers and sisters prepare for the new baby’s arrival. Activities behavior management, and tips for a professional babysitter. Those include safe ways to interact with the new baby, special art projects completing the course receive a certifi cate of completion to present and diapering and feeding their “own” baby (please bring a doll or to prospective employers. stuffed animal). This class is designed for children ages 3 to 5. FEE: $20 / boy or girl (includes course materials) FEE: $15 / family Becoming a Young Woman* 7 – 8:30 p.m. CPR & First Aid Classes American Heart Association Life Support and Women’s Health Connection HeartSaver First Aid Courses Choose one of the following two classes: Call 800.628.2880 for dates, times locations and registration information on the following classes. Fridays, September 22 or November 17 CPR for Family and Friends This informative class helps young women 10 to 12 years old explore This course teaches basic life saving techniques including how to the emotional and physical changes of puberty. Emphasis is placed on relieve an obstructed airway. It is suggested for the lay rescuer such as how each girl experiences changes in her own special way. Additional new parents, grandparents, babysitters, caregivers or anyone who is topics include challenges with competition and development, preparing to help others in distress but does not need certifi cation. communicating with parents, menstruation, purchasing personal FEE: $25 / participant female items, cramps and other common menstrual discomforts, and emotional changes and hormones. Mothers are encouraged to HeartSaver First Aid attend and share this unique time with their daughters. Please note This four-hour class includes instruction on the general principles of there is no discussion on sex. fi rst aid, as well as medical, injury and environmental emergencies. FEE: $10 / daughter and mother Topics covered include choking, chest pain, fainting, seizures, low blood sugar, bleeding, burns, shock, bites, stings, poisoning and more. *The “Babysitting Basics” and “Becoming A Young Woman” classes This course complies with OSHA regulations and is open to anyone. are available for off-site instruction upon request. Please call 858.675.5376 for more information. FEE: $40 / participant HeartSaver Pediatric First Aid – NEW! This new four-hour class includes instruction on fi rst aid basics, medical and injury emergencies, environmental emergencies and optional topics. It meets state-specifi c requirements and is designed for child-care professionals, education and recreation staff, new parents, guardians and other caregivers who are responsible for children’s health. FEE: $40 / participant The American Heart Association strongly promotes knowledge and profi ciency in BLS, ACLS, and PALS and has developed instructional materials for this purpose. Use of these materials in an educational course does not represent course sponsorship by the American Heart Association, and any fees charged for such a course do not represent income to the Association. For information on additional CPR and First-Aid Classes offered at Palomar Pomerado Health, please see page 13 of this issue of The HealthSource.

14 SEPTEMBER – DECEMBER 2006 www.pph.org YouYou dodo allall youyou cancan toto protectprotect youryour lovedloved ones.ones.

ButBut accidentsaccidents cancan stillstill happen.happen.

It seems like children always find a way to hurt themselves. Which is why we make sure we’re always ready. Our Emergency Department has a superior team of physicians and nurses, very short wait times and advanced technologies t hat rival some of the best in t he county. Also, with a patient satisfaction score in the 99 th percentile among hospitals surveyed nationwide, you can feel comforted knowing we’ll treat your family like they ’re our own. We know you can handle the bumps and bruises that occur in everyday life. However, if something more serious ever comes up, our Emergency Department is just around t h e corner and ready to help.

www.pph.org • 15615 Pomerado Road • 858.613.4000

For a physician referral, or to register for a class, call The HealthSource at 800.628.2880. 15 PRST STD The HealthSource U.S. POSTAGE 15255 Innovation Drive PAID San Diego, CA 92128 SAN DIEGO, CA PERMIT NO. 2838

Palomar Medical Center 555 East Valley Parkway Escondido, CA 92025 760.739.3000

Pomerado Hospital 15615 Pomerado Road Poway, CA 92064 858.613.4000

Women’s Health Connection (WHC) 15725 Pomerado Road, Suite 100 Poway, CA 92064 858.613.4894

The HealthSource - San Marcos 120 Craven Road, Suite 103 San Marcos, CA 92069

For a physician referral, or to register for a class, call The HealthSource at 800.628.2880.

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