For many children, going into a hospital for a procedure or surgery is a scary, unknown experience. But for children on the autism spectrum, it is often a traumatic event. Not only do they not understand what’s going on, but they enter an environment where triggers are all around them leading to extreme agitation. Their only way of coping is to act out in an effort to try and make the intense stimulation go away. Traditionally, the only answer to help these children calm down has been to prescribe medication in the pre-operative environment.

But in 2017, a group of surgery employees including Sean Antosh, MD, anesthesiologist; Katelyn Shellabarger, CCLS, child life; and Robin Lawson, RN, pre-operative nursing liaison, started looking at ways to create a more relaxed, sensory friendly environment to distract kids with autism before surgery. 

Dr. Antosh knows firsthand that medicine plays an important role in surgery. However, if a child remains calm in the pre-operative area beforehand without the use of medication, they tend to wake up post-surgery in the same way, which leads to a better recovery. He tapped into other resources. Katelyn is the first child life specialist dedicated to surgery and Robin is retired special education teacher who worked with autistic kids in elementary and middle school.

The result: a dedicated sensory focused pre-operative room for kids with autism that can be individually tailored to the child’s needs.

“If we can take out the triggers and insert activities and items that sooth and distract the patient, it’s was a win for everyone,” Dr. Antosh explains. “It allows the patient to remain calm while the medical team does what we need to do to prepare the child for surgery. Let’s save the medication for when it’s truly necessary – back in the operating room itself.”

Prior to this program 49 percent of children with special needs received pre-anesthesia calming medication. Now only 36 percent do.

Katelyn in child life greets the patient and family in the room, prepares their masks and helps with the coping plan. “Surgery can be a traumatic experience for children with special needs, which is painful for parents, too,” Katelyn says. “The coping plans allow us to be proactive and get to know the child more so we can care for the patient in a more holistic way.”

With Robin’s help, the rooms are individualized for each patient prior to arrival at the hospital.

“Patients with autism are not like every other child,” Robin says. “We had to figure out away where we could meet them where they are. We truly are changing the way care is delivered.”

Providing innovative care for kids is just one reason Parent’s Magazine named Dayton Children’s as one of the top 15 children’s hospitals in innovation and technology in 2020.

The article features our sensory-friendly surgery experience. When kids come in on surgery day, they enter a space with familiar music, LED lighting in their favorite color, color changing floor tiles, headphones, fidget spinners or weighted blankets. They can even drive our remote-controlled airplane off to surgery!

Today there are three sensory-friendly rooms in preoperative services at our main campus. 

Dayton Children’s is uniquely prepared to care for your child before, during and after surgery

Kids are not “little adults” and deserve care designed for them. When your child has surgery at Dayton Children’s, they’re being treated by a team of healthcare professionals that are specifically trained to care for children. This is especially important when your child requires anesthesia for their surgery or procedure. All of the anesthesiologists at Dayton Children’s are pediatric board certified and only take care of children. Pediatric anesthesiologist Sean Antosh, MD, explains why this is important and why Dayton Children’s is uniquely prepared to care for your child before, during and after surgery. 

Why is it important for kids undergoing surgery to be treated by a pediatric anesthesiologist?

Children have very different physiology as they grew from infants to adults. Therefore, they need an anesthesiologist who is trained in their special needs and how their bodies react differently to medications typically used during surgery. 

What are potential risks associated with using an anesthesiologist that does not typically treat kids? 

While most anesthesiologists are capable of taking care of all patients, pediatric anesthesiologists are acutely aware of the common heart and breathing issues that may arise during surgery. We are able to accurately diagnosis and treat these issues before they become an emergency. 

What education and training are required to be a pediatric anesthesiologist? 

Board certified pediatric anesthesiologists have been through four years of undergraduate education, four years of medical school, four years of general anesthesiology and critical care training, and an additional one to two years of pediatric anesthesiology fellowship. After all of this training, they then complete board certification for general anesthesiology, as well as an additional certification for pediatrics. 

What does Dayton Children’s do to make kids that have to undergo anesthesia more comfortable? 

As pediatric anesthesiologists, we interact with the patients and their parents to find out what the child likes and dislikes to help avoid anxiety. Sometimes we play games, use distraction devices (such as an iPad) or use remote controlled airplanes to take them to the operating room. Occasionally, we will have to give a drinkable medication to help them relax during the process. 

For our autism spectrum and special needs patients, we have one of a kind sensory rooms that patients can relax in prior to surgery. We also have a pediatric acute pain service, which provides nerve blocks for common orthopedic and general pediatric surgeries to help decrease discomfort and need for pain medications postoperatively. 

Summer is in full swing! Kids are playing outside and staying active. This sometimes results in a broken bone and ultimately the dreaded cast. At Dayton Children’s, we know a kid’s summer lifestyle is not suited for a traditional cast. Traditional plaster casts are bulky, itchy, non-adjustable and not meant for water. With this heat, kids want to swim. That’s why we offer waterproof casting to keep kids being kids!  

Waterproof cast liners allow kids to bathe, shower, and even swim while wearing a fiberglass cast. The liner is an advanced cast padding that contains tiny pores that stop the passage of water, but allows water vapor to pass through. Water does not wet the liner, only the skin. 

benefits of waterproof casting

Besides the obvious benefit of being able to swim and shower while wearing the cast, there are other benefits as well! 

1. Less itch and smell. Because of the material waterproof casts are made of, they don’t cause as much itching or mold or mild dew build up from moisture which often causes an awful smell.  
2. More durable. Often because of the material type, waterproof casts are more durable and can even allow athletes to return to sports while wearing the cast. 
3. Fun colors! We offer every color under the rainbow and even glitter.  

is it broken?

First things first – when in doubt, get it checked out.

The only sure-fire way to know if a bone is broken is to get an X-ray. You’ll feel better hearing from a professional. However if you are a “wait and see” kind of parent, then here a few tidbits of info may help you decide what to do.

If you are like many people, you probably do not pay a lot of attention to the color of your urine. Or you may not have even realized that your urine can come in a variety of colors. But did you know that urine color can potentially reveal some important information about your health? 

“Changes in the color of your urine can be related to non-worrisome things like recently consumed foods, medications or food dyes, but could potentially be related to more serious health problems,” says Dr. Christopher Brown, MD, pediatric urologist at Dayton Children’s.

Wondering what these colors could be and what they mean? Dr. Brown is here to answer our questions!

why do we urinate and what is a normal color?

Urine is one way for our body to get rid of the waste it produces. It is made up of water and different waste products (such as salt, urea, uric acid or urochrome, which gives urine its color). When your body is functioning normally and you are getting an appropriate amount of fluid in your diet, your urine should be a faint yellow color and have a minimal odor.

what isn’t normal?

Most any other color of urine is not normal and could indicate there is a problem. Darker yellow or orange urine often indicates that you are dehydrated. Red or pink urine raises the possibility of blood in the urine, which in children is most commonly due to kidney stones, urinary tract infections, kidney disease or self-limited irritation of the lining of the urinary tract. Red urine can also be seen after an intense exercise session due to muscle breakdown. Other colors of urine (brown, blue, green, purple) are much rarer.

are there ways to fix your urine color at home?

The first step is to think back to recent food, fluid and medicine intake. If you notice that your urine changes colors after eating certain foods, fluids or medications, avoid these substances (if possible) for a period of time and monitor for change in your urine color. If you notice you have dark yellow urine, or it has a strong odor to it, start by drinking one to two glasses of water to address any dehydration. 

when should we see a doctor or specialist?

Donate today through the Dayton Foundation to support the Montgomery County Imagination Library. Click the link and use fund name: 1614 Montgomery County Imagination Library. 

join us in celebrating this milestone

If you have any urinary symptoms (pain or burning with urination, change in urinary frequency) associated with a change in urine color, or persistent change in urine color or odor, contact your primary care physician. They can troubleshoot some of the more common issues related to abnormal urine color, arrange for a urine test and help determine if (and how urgently) seeing a specialist is necessary.

New urology patients are now able to book an appointment online. Click here to make an appointment with a Dayton Children’s urologist.

Dr. Meyer shares the secret formula

Do you ever feel like overnight your child has grown out of their clothes?! I always notice the difference in my kids growth when I look at last year’s holiday card compared to this years! As an endocrinologist, I may monitor my children’s growth a little more than the typical parent, but you would too if you spent a good part of your day discussing normal vs. abnormal growth patterns!

After the age of 2 years, children grow at a more steady and predictable pace. Children under 2 years, may grow slower or faster as they move toward their genetically determined height. This is because length at birth and growth over the first months to a year of life is more dependent on nutrition and intrauterine environment than true growth potential.

how can I estimate my child’s height?

Wondering your child’s growth potential? Here is a good way to estimate this based on mom and dad’s adult height.

For Boys:

• Add 5 inches to mom’s height and average this with dad’s
• Ex: if mom is 5’4” you would add 5 inches to make 5’9” and then average with dad’s height of 5’11” and your little boy’s predicted genetic height is 5’10”

For girls:

• Subtract 5 inches from dad and average with mom’s height.
• Ex: In the above scenario you would average 5’4” with 5’5” which is dad’s height minus 5 inches to get 5’4.5”

Now these are of course only estimates and there can be up to 4 inches variability up or down but most children without any other extenuating circumstances will end up within 2 inches of this prediction.

So now that you know your child’s growth potential, how do you monitor if they are on track to reach this. The easiest way to monitor your child is by plotting and reviewing them on a standard growth curve. This tells you your child’s growth over time. Under the age of 2 years, children may move on the growth chart as they fall or climb toward their genetic potential, but after the age of 2 years, children should track yearly on the same growth curve percentile. This is something your doctor can show you at each yearly check up to help monitor. Of course, many things can alter that tracking especially timing of puberty, so it’s important to discuss any deviations with your doctor to determine if the cause for a change in percentiles is a problem or just a normal variation. Your doctor may recommend evaluating further with blood testing or an x-ray of the hand to look at the age of the bones.

If you don’t have access to your child’s growth curve but have been measuring diligently at home, here are some guidelines for typical growth in childhood.

• From 0-1 year of life: typical growth is 10 inches
• From 1-2 years of life: typical growth is 4 inches
• From 2-4 years of life: typical growth per year is 3 inches
• Above 4 years until puberty: typical growth is 2 inches per year.

From one mom (who is an endocrinologist) to another, growth is something you can and should be monitoring in your child. Time for growth is limited and can be the first indication in children of an underlying health concern. If concerns arise regarding growth discuss this with your doctor sooner rather than later as the best outcomes occur when issues are discovered early!

view our Facebook LIVE discussion with Dr. Meyer

Please note that we had some technical difficulties at the beginning of this broadcast. Fast forward to minute 2:45 to begin the conversation with sound.