Web Exclusive to “Raising Healthy Children”
Access to healthcare
Barriers to activity can come from lack of recreational facilities in a community, or concerns that it’s not safe for children to be outside by themselves in their neighborhoods. And busy families often feel they lack the time to cook or to engage in an activity.
Donna Potter, associate for Strategic Initiatives with Kentucky Adult Education, mentions that parents with low levels of literacy have a hard time navigating the healthcare system and understanding doctors.
“Lots of times, no matter how educated you are, if you’re not in a medical field, you get lost in the weeds of what they’re saying,” Potter says. And the medical conversation often comes at a stressful moment, more so if your child is seriously ill. And for the literacy-challenged, Potter says, the reading required to follow signs in parking garages or to locate a particular department in a hospital can be confusing and intimidating.
Dr. Steve Houghland, chief medical officer for Passport Health Plan, notes that the obstacles to convenient access to medical care aren’t only geographic, they’re temporal as well. “Is the care available at the time when people need it?” he asks rhetorically. “The reality is, that’s often not the case.” Often, caregivers’ hours don’t match up with parents’ work schedules—or rather, they match too well. There are often very few opportunities for parents to take their children to a doctor or dentist without missing work.
So what solutions might there be to the health problems of Kentucky children? What resources might exist to help?
Houghland believes in community-based initiatives (as opposed to more universal solutions). “Each community has its own strengths and weaknesses and has resources they best understand, and has needs that they best understand,” he says. He wants a system that “encourages the community to become engaged, and to try to help determine what is their best path, what is their best solution.”
His model is the Asheville Project, in Asheville, North Carolina, which brought together city government, physicians, pharmacists, and hospitals in a coalition to attack diabetes. It gave municipal workers diabetes education, supplied them with free medicines and testing supplies, and connected them with a pharmacist/coach. The patients showed improved health and the city reduced its insurance costs. (The model has since been adapted to other chronic conditions and replicated in other cities and health plans.)
Houghland also says that some medical practices are now adjusting their hours to accommodate working parents—opening earlier, staying open later, or offering weekend hours. He adds that many private health plans are using tele-health technologies—via phone, computer, or smartphone app—that will connect after-hours calls with specialists.
As far as combating inactivity, Andrea Bennett of Kentucky Youth Advocates mentions two initiatives her organization has undertaken to expand the chances for kids (and others) to get moving. One is encouraging so-called “shared-use” agreements for schools to open their facilities to other members of the community. “It really is a chance for schools in Kentucky to be more like community recreational centers when they’re not in session,” Bennett says, “to allow for families and after-school programs, such as basketball leagues, to use those facilities and provide access to recreation.” (A 2010 bill passed by the General Assembly paved the way for shared-use by clarifying some of the liability issues that might arise.)
The other initiative, Complete Streets, encourages communities and transportation agencies to build new streets and roads with an eye to accommodating walkers and bike riders, including features such as sidewalks, crosswalks, wide paved shoulders, and in some instances bike lanes.
“The data shows that people are more active when these things are implemented,” Bennett says.
As for teeth, a 2008 law requires children to receive a dental screening before entering school (although in the first school year it was in effect, 2010-2011, a screening was reported for only 46 percent). A state initiative called Healthy Smiles Kentucky has targeted eastern Kentucky, with funding for pediatric education for dentists and mobile dental equipment; it also will supply fluoride varnishes to 25,000 children.
Allergies and the environment
Dr. Doug Tzanetos, a Lexington-based allergist, says that one theory why allergic diseases have increased is the “hygiene hypothesis”—the idea that in today’s society people live in a more sanitized environment with less exposure to infections and germs in childhood, which may actually lead to an increased allergic response, Tzanetos says,
“There is intriguing evidence for this in that in smaller families with fewer siblings swapping colds and other respiratory diseases, children are more likely to develop allergies.”
Other factors, he says, might be increased use of antibiotics (including their use in cattle) and more people growing up in city or suburban settings—”a more sanitized, more industrialized, Westernized environment.”
Tzanetos says there’s some evidence that living in a rural environment, with exposure to farm animals, results in increased exposure to inflammatory particles in bacteria called endotoxins. This exposure can change how a child’s immune system develops so that ultimately they are less likely to become allergic.
The most depressing health threat to Kentucky’s children is child abuse. The following tips to combat it come from the Partnership to Eliminate Child Abuse.
• Crying is normal in young babies and is also usually a daily part of toddlerhood. Most children do not gain the ability to stop crying on demand until at least 4 years of age or even older—depending on the reason the child began to cry.
• Remember, it is normal to feel frustrated when a baby or young child cries—but NO ONE should EVER shake or harm a baby or young child.
• If you are feeling frustrated or angry, take a break. It’s okay to leave the baby in a crib or other safe place while you take a moment to regroup.
• If you are caring for a child, keep a list of phone numbers on hand that you can call for support. This can include friends, family, neighbors, members of the faith community, mental health, or other healthcare providers.
• Use care when deciding who can watch your child. If you don’t have total and complete trust in the person, then don’t trust him or her with your child. Brand new relationships, intimate partner violence, or a boyfriend who is mean to pets or swears at mom or child are warning signs not to leave the child with that person.
• Caring for a baby or young child is hard work! It requires patience, self-control, a basic understanding of the child’s needs, and some specific skills. Make sure that anyone who cares for your child is PREPARED to watch your child and WANTS to watch your child.
• The American Academy of Pediatrics does not recommend spanking or other physical discipline at any age. Research has shown that its effectiveness wears off over time, and the risk of inadvertently causing an injury far outweighs any potential benefits. Research also tells us that children who are spanked or physically disciplined have a higher rate of aggressive behavior toward adults and other children.
• One way to help support families in your community: If you have experience and skill in caring for babies or young children, offer to provide a few hours of childcare to friends or family in need of a break.
• Substance abuse is commonly associated with child physical abuse. Caregivers of babies and young children should be clear-headed and able to make sound decisions.
• Intimate partner violence is often associated with child physical abuse. If your partner has hit, kicked, shoved, or threatened you with physical violence—he/she should NOT be caring for your child.
• Bruising is an important warning sign for child abuse for infants and children. For a nonmobile infant, bruising of ANY KIND is not normal. For a child of any age, bruising to the ears, neck, torso, buttocks, or genitals should raise concerns. If you see this kind of bruising, seek immediate medical attention for your infant or child.
• Burns on a young baby or child, such as those caused by cigarettes or immersion in hot water, also are warning signs for child abuse. If you see burns on a young baby or child, seek immediate medical attention.
• Many abusive events in toddlers occur in response to toilet training accidents. Most children are not fully potty-trained until after 3 years of age, and even after that accidents are common. Having unrealistic expectations for a toddler can increase frustration for the caregiver.
FOR MORE INFO, help, and resources on child abuse, contact Prevent Child Abuse Kentucky at (859) 225-8879, (800) CHILDREN/(800) 244-5373, or go online to www.pcaky.org.
IF YOU SUSPECT CHILD ABUSE contact the state or national hotline 24 hours a day. Call the Kentucky Child Protection Hotline at (877) KYSAFE1/(877) 597-2331. Or call the Childhelp National Child Abuse Hotline at (800) 4-A-CHILD/(800) 422-4453.
To read the Kentucky Living November 2012 feature that goes along with this Web Exclusive, go to Raising Healthy Children.