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My Dad, the Horse, And I: How to Create a Culture of Safety

safetyby Janet Brooks
Child Advocacy Manager

One day in my early youth, I wanted to ride our family horse. Bay Scoot was a huge bay gilding with a mind of his own. My dad, a very experienced “cowboy” and father of seven, agreed that I could ride but he was also in a bit of a hurry. He hoisted me up into the saddle and led me around the corral for a few minutes and then left the reigning to me.

Shortly after, he headed to the house to freshen up for an evening of work selling life insurance. He said that I would be fine riding alone but emphasized the need to keep Bay Scoot in the corral and to not let him head into the barn. I did my best to obey my father but my “ride” had a different goal in mind – FOOD! Very quickly Bay Scoot turned for the barn where hay and oats stood ready for his evening meal. Try as I might, I could not keep him out of the barn that had a very low, corrugated metal roof. It was plenty high enough for Scoot to enter but not with a rider (me) on his back! In he trotted, ready to engulf a hearty meal. All the while, I tugged on the reins as hard as I could and bent as far forward over the saddle horn as possible only to be rewarded with a deep layer of flesh peeled from my back by the edges of the sharp metal roof!

Now, as a professional in the injury prevention world, I look back on that day and liken it to thousands of other people’s experiences where children have been injured. The questions always flood forth after a tragedy or even a minor incident as to how and why it occurred and what could have been done to prevent it? It is generally easy to understand how things happened, but the “why” is the operative word.

Most people assume that injury is a routine part of growing. But I would like to suggest an entirely different approach on the whole matter. Creating a “culture of safety” is a conscious effort to make safety a priority in my family and society. Taking complete ownership of my environment and making it safe for those in it is now an uncompromising priority. That environment may be my home, yard, vehicle, open space, or where ever I am. Supervising my children, grandchildren and those around me is the number one priority. My caregiver strategies now include:

  • Knowing that unexpected and bad things happen and could happen to me.
  • Active supervision. This means being physically and mentally present, and may include holding a child or holding their hand.
  • If a child is missing, check around water sources first, and in the vehicle second.
  • Not assuming that others feel the same way about safety that I do. Provide all of the safety devices (car and booster seats, life jackets, helmets, etc.), instructions and expectations, and other resources that will keep your family safe whether you are present or not.
  • Remembering that SUPERVISION goes hand in hand with SAFETY and should trump all else when it comes to fun and simply living life to the fullest!

I don’t want to be too critical of the wonderful dad and the spunky horse I had. Now, as an adult, I can look back on my impressionable experience and understand several things that could have been done differently to prevent my scary (and painful!) mishap. Hindsight is always present after close calls and our thoughts are often filled with “what ifs.” I will simply conclude that perhaps my father thought I was far more capable of something than I was. His constant supervision, my better riding skills and good body armor could have prevented my injuries. Do I love dad or Bay Scoot any less for what happened? Goodness no! I just need to remember that horses love food more than kids!

Janet has worked as the Child Advocacy Manager at Primary Children’s for 17 years. She manages the Hold On To Dear Life® educational and advocacy campaign. Janet is a Child Passenger Safety Technician Instructor and an instructor in transporting children with special health care needs. She enjoys spending time with her family, including her husband, five children, three in-laws, and six beautiful grandchildren.
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Fireworks Safety for an Injury-Free Holiday

fireworksJuly 24th is a special day in Utah to commemorate the pioneers, and enjoy warm weather and family events. But before your family celebrates, make sure everyone knows about fireworks safety.

If not handled properly, fireworks can cause burn and eye injuries in kids and adults. The best way to protect your family is not to use any fireworks at home — period. Attend public fireworks displays, and leave the lighting to the professionals.

Lighting fireworks at home isn’t even legal in many areas, so if you still want to use them, be sure to check with your local police department first. If they’re legal where you live, keep these safety tips in mind:

  • Kids should never play with fireworks. Things like firecrackers, rockets, and sparklers are just too dangerous. If you give kids sparklers, make sure they keep them outside and away from the face, clothing, and hair. Sparklers can reach 1,800°F (982°C) — hot enough to melt gold.
  • Buy only legal fireworks (legal fireworks have a label with the manufacturer’s name and directions; illegal ones are unlabeled), and store them in a cool, dry place. Illegal fireworks usually go by the names M-80, M100, blockbuster, or quarterpounder. These explosives were banned in 1966, but still account for many fireworks injuries.
  • Never try to make your own fireworks.
  • Always use fireworks outside and have a bucket of water and a hose nearby in case of accidents.
  • Steer clear of others — fireworks have been known to backfire or shoot off in the wrong direction. Never throw or point fireworks at someone, even in jest.
  • Don’t hold fireworks in your hand or have any part of your body over them while lighting. Wear some sort of eye protection, and avoid carrying fireworks in your pocket — the friction could set them off.
  • Point fireworks away from homes, and keep away from brush and leaves and flammable substances. The National Fire Protection Association estimates that local fire departments respond to more 50,000 fires caused by fireworks each year.
  • Light one firework at a time (not in glass or metal containers), and never relight a dud.
  • Don’t allow kids to pick up pieces of fireworks after an event. Some may still be ignited and can explode at any time.
  • Soak all fireworks in a bucket of water before throwing them in the trash can.
  • Think about your pet. Animals have sensitive ears and can be extremely frightened or stressed by fireworks. Keep pets indoors to reduce the risk that they’ll run loose or get injured.

If a child is injured by fireworks, immediately go to a doctor or hospital. If an eye injury occurs, don’t allow your child to touch or rub it, as this may cause even more damage. Also, don’t flush the eye out with water or attempt to put any ointment on it. Instead, cut out the bottom of a paper cup, place it around the eye, and immediately seek medical attention — your child’s eyesight may depend on it. If it’s a burn, remove clothing from the burned area and run cool, not cold, water over the burn (do not use ice). Call your doctor immediately.

Fireworks are meant to be enjoyed, but you’ll enjoy them much more knowing your family is safe. Take extra precautions over this long weekend and your holiday will be a blast!

This information is part of Primary Children’s KidsHealth website. This resource features information on a variety of health topics for you and your children.

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Orthopedics by the Numbers

orthonewThe world of pediatric orthopedics has come a long way since the days of heavy, archaic leg braces as seen in Forrest Gump. Now, its people’s perceptions of orthopedic medicine that have to catch up, says Dr. Alan Stotts, Orthopedic Surgeon at Primary Children’s Hospital.

From the most basic orthopedic problems, to the most complex conditions, our nationally renowned team works to provide children and teens with the best treatment available using the latest technology and research.

Our Orthopedics Program is staffed by University of Utah Orthopedists that are trained in a variety of pediatric orthopedic sub-specialties, including sports medicine, fractures, scoliosis, and malalignment of limbs. We are well represented in all areas of pediatric orthopedics and treat everything from common breaks and sports injuries to complex spinal deformities and bone cancers.

Some of our commonly seen conditions include:

  • Congenital musculoskeletal defects
  • Common and complex fractures
  • Hand surgery
  • Musculoskeletal trauma
  • Sarcoma
  • Scoliosis
  • Neuromuscular conditions
  • Sports injuries

Having access to all of these pediatric orthopedic services under the umbrella of Primary Children’s Hospital is a huge benefit to patients with complex problems. Additionally, the services of physicians with specialties in anesthesia, plastic surgery, interventional radiology, PICU, pulmonology, and more are also available.

In addition to our main location at Primary Children’s Hospital, we also provide outpatient services at Riverton Hospital.

The Facts and Figures

• Last year, we saw over 18,000 outpatients between our two locations.

• We perform over 350 spine surgeries per year.

• Our Fracture Clinic Model has been presented on nationally.

• Primary Children’s Hospital is one of the few teaching sites for VEPTR Implementation

• We see close to 200 fracture patients a week during the summer.

• The Eight-Plate is one of the most commonly used orthopedic implants in the world for limb deformities and was developed by one of our physicians, Dr. Peter Stevens.

• People come from all over the world to learn from Dr. John Smith, a renowned pediatric orthopedist at Primary Children’s Hospital.

• We were recently ranked #12 Best Children’s Hospitals for Orthopedics by U.S. News & World Report – up 13 spots from last year.

National Ranking

The Orthopedics Program at Primary Children’s Hospital is consistently named among the top orthopedic programs in the nation by U.S. News and World Report, and moved up 13 spots from last year to a #12 ranking. Dr. Stotts said they are honored to rank so highly, especially in light of the growing level of detail used to evaluate each program. “Our improvement this year is really a reflection of our division’s commitment to continuous improvement and program development and was only possible with the support of the many pediatric providers with whom we are fortunate to work.”

In addition to our focus on excellent outcomes, we also want to provide the best patient experience possible. Patients can be referred to Primary Children’s Hospital from their primary care provider, call and make an appointment, or request an appointment through MyHealth Patient Portal.




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Patient Engagement: The New Vital Sign

patientengagementby Janet Craig RN, MS, PNP
Clinical Nurse Specialist

Don’t be surprised if your doctor starts pushing you to be more “engaged” in your child’s care. What does that mean? Patient engagement means you:

  • Keep track of medical information
  • Are on top of chronic conditions, even if your child has several
  • Become familiar with medications, diagnoses, and test results
  • Stay informed of treatment plans
  • Seek preventive care

Studies have shown that those who do all of the above see better outcomes, incur lower costs, and can help prevent mistakes and oversights in your child’s care. Unfortunately many of us lack the knowledge, skills, and confidence to become engaged. No medical tests are more important than your ability to express your concern to your child’s doctor. Don’t be afraid to speak up. Your doctor will appreciate your involvement.

How to Stay Engaged in Your Child’s Care

So what can you do? Here are some tips to become and stay engaged in your child’s care.

  • Become familiar with your child’s medical records. Use resources to access your child’s medical data like My Health (an Intermountain Healthcare website) if possible.
  • When taking your child to see the doctor, make a list of your health concerns in advance.
  • Write down your questions, keep a journal, and list your child’s medications–even herbal therapies and homeopathic treatments.
  • Communicate your child’s symptoms as accurately as possible, and provide a timeline of events.
    • Take along a written list and read them in order. Which symptom came first? How long did it last? How often did it occur? Suspected causes? (This is where a journal can help you keep track of dates, times, frequency, etc.)
    • Ask your child questions so you can describe things as specifically as possible. “What does it feel like?” “How long does it last?” “What makes it better or worse?”
    • Be honest. If you fear the worst, tell your child’s doctor so your worries can be addressed.
  • Disclose everything.
    • Have you been to other doctors or specialists?
    • What tests have you had? Traditional medical tests and those not so traditional.
    • What you have learned from friends, family, the internet
    • What confuses you?

For those of you who are tech savvy, there are a lot of apps that can be used to help manage your health care.* And, remember: practice makes perfect. If you use these tips every time you see your child’s doctor you will become more engaged. And we all know that healthcare engagement leads to … a happy healthy relationship!

Additional Resources:

Kids Health – An educational resource with information about illness, parenting, and many other health topics.

Health Hub – Intermountain Healthcare’s New App that helps you find clinics, save your place in line, manage prescriptions, learn about symptoms, and more.​

Top 10 Apps Physicians Recommend to their Patients – from Medical Economics.

Symptom Checker – by HealthyChildren.org (from the American Academy of Pediatrics)

* The FDA is actively involved in monitoring the development of mobile medical apps. They work closely with experts to determine safety and accuracy. Some apps are for patients and some are for healthcare providers. Remember, the apps are merely tools to help you. For any decisions regarding your health care, you should still speak with your provider. Learn more.

Janet graduated from nursing school in 1976 and completed her Master’s of Science in Nursing at the University of California San Francisco in 1990. She went on to complete her Pediatric Nurse Practitioner course work at UCSF in 1992. She has worked as a PICU Nurse, Educator, PICU Clinical Nurse Specialist, and as a Pediatric Cardiology and Pediatric Cardiothoracic Surgery Nurse Practitioner. She is currently one of the Pediatric Acute Care Clinical Nurse Specialists at Primary Children’s Hospital. She enjoys hiking, skiing, gardening, camping/backpacking and traveling.
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How to Help Kids Cope With Peer Pressure

peerpressureboysby Sara Jackson, CSW
Center for Safe & Healthy Families

As children grow older, they are bound to develop deeper, more meaningful friendships. It is natural and healthy for children to have friends and to rely on them as they mature. Friendships also create the possibility of peer pressure–both positive and negative. For instance, peers can pressure one another positively to develop new interests such as playing a musical instrument or joining a sports team. Negative peer pressure is more worrisome as it can lead to immature, dangerous or illegal behaviors and activities.

Some children may give in to peer pressure because they want to fit in, be liked or they may worry that if they don’t go along with the crowd, they will be left out, made fun of or ostracized. Here are some tips for parents on how to help your children cope with peer pressure.

  • Promote your child’s self-esteem: Children who are confident and have positive self-worth are less likely to cave to peer pressure and are more likely to stand up for their own needs/wants; make sure to praise your child and enjoy his/her successes
  • Bond with your child: If you have a good relationship with your child and he/she feels that you are supportive, he/she will be better able to resist peer pressure and to talk to you when he/she is feeling pressured, etc.
  • Set a good example: If your child sees that you are confident and assertive and don’t need to cave to peer pressure, he/she will be more likely to follow your good example
  • Talk about peer pressure: Talk to your child about peer pressure and let your child know that you understand how difficult it can be. Encourage your child to make decisions for his/herself and to understand that someone who is pressuring them to do something they don’t want to do may not be a true friend
  • Don’t overreact: Try to listen to your child without judgment and without overreacting. If you overreact about peer issues, he/she may be less likely to come to you with problems in the future
  • Don’t sweat the small stuff: Kids may want the same cellphone or the same brand jeans as their friends…make sure to choose your battles wisely and only challenge your child on the things that are really important such as high-risk behavior. If you’re constantly nagging your child, he/she is less likely to take seriously the important conversations
  • Promote autonomy: Just as it is important to encourage your child to make his/her own decisions, it is also important for him/her to learn to trust his/her own instincts and to think through a situation including possible consequences. Encourage your child to develop his/her own responses to peers but feel free to offer suggestions or help construct appropriate responses
  • Get to know your child’s friends: Encourage your child to invite friends over; this will show him/her that you take an interest in his/her social life and that you trust the friends he/she brings into your home
  • Make a backup plan: Talk about backup plans that can help your children get out of dangerous or scary situations. For example, you can let them know you will always come to pick them up if they feel unsafe, etc.

Peer pressure can be very stressful for kids to deal with, but parents can help their children cope with peer pressure by being a positive role model, encouraging open dialogue and setting clear expectations.

Additional Resources

Peer Pressure

10 Ways You Can Help Your Child Cope With Peer Pressure

Sara graduated with her Master’s in Social Work from Portland State University, and is a Certified Social Worker. She is currently working towards becoming a Licensed Clinical Social Worker. She moved to Salt Lake City and has been enjoying getting to know the Southwest. In her free time, she loves hiking, biking, running, taking her dogs to the park, speaking Spanish, learning about other cultures, cooking, and creating self-serve frozen yogurt creations.
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How the VEPTR Device Improves Lives for Patients with TIS


Depiction of a VEPTR device.

Advances in medical technology continue to open new possibilities for more effective treatments for all types of conditions. One of these innovations has dramatically improved care for children with thoracic insufficiency syndrome (TIS), a congenital condition in which severe deformities of the chest, spine, and ribs prevent normal breathing, lung growth, and lung development. In the past, treatment for this complex condition involved permanent spinal fusions and rib separation, but the development of the Vertical Expandable Prosthetic Titanium Rib (VEPTR) device changed all that.

The VEPTR device is a curved metal rod that’s attached to a child’s ribs near the spine using hooks on both ends of the device. VEPTR helps straighten the spine, separate the ribs, and support the chest—allowing the lungs to operate and grow. The length of the VEPTR device can be expanded or contracted as the patient grows, with adjustments made approximately every six months through a small incision in the patient’s back (typically during outpatient surgery).

The goal of VEPTR is to allow children with TIS (and its associated problems), to live a normal life—to be able to breathe, play, and enjoy physical activity. The outcomes have been positive. Following a VEPTR procedure, patients usually experience increased lung expansion, easier breathing, reduced discomfort, improved quality of life, and a slowing progression—or even reversal—of chest deformities. VEPTR also indirectly corrects and/or improves scoliosis in many cases. Primary Children’s patients who have undergone a VEPTR procedure have greatly improved the quality of their lives. Many of our patients can now do things like skiing, rock climbing, and any number of physical activities that, without VEPTR as a treatment option, would most likely have been impossible.


The implantable device is designed to stabilize and lengthen certain deformities of the spine and torso, allowing normal lung development and offering correction for some spinal conditions.

Dr. John T. Smith, VEPTR Pioneer and Industry Leader

Dr. John T. Smith, one of Primary Children’s most distinguished pediatric orthopedic surgeons, was a VEPTR pioneer. His national reputation for spine care led to Primary Children’s being selected as one of seven medical centers in the United States to take part in the initial evaluation study of the device in 2002. Since then, Dr. Smith and other physicians at Primary Children’s have initiated treatment with the VEPTR device on over 100 patients—making the hospital one of the busiest and most experienced VEPTR sites in the country. Dr. Smith has become such a VEPTR expert that he was part of the design and development team for VEPTR 2, an upgrade that made the device more modular and gave physicians the ability to provide patients with enhanced treatment options. He has traveled all over the United States and around the world, including visits to New Zealand, Australia, China, Japan, and many European countries, to train physicians on VEPTR.

Of course, the push continues for better and better technologies, and at Primary Children’s Hospital we are constantly searching for more effective treatments. There is some exciting VEPTR news to report: a new-and-improved device is in the works. VEPTR 3 will use magnets to expand the length of the device, thus reducing or eliminating the need for follow-up surgeries to lengthen the titanium rods.

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A Healthy Look at Bone Tumors

bonetumorpicAt the turn of the 20th Century there was a large-scale scientific study that focused on the benefits to growing children of adding fluoride to drinking water. As anticipated, the study showed that approximately one in three children involved in the study had a non-ossifying fibroma (a kind of tumor) in their bones. To avoid submitting more children to the harmful radiation of x-rays, no additional studies have been done, but bone tumor specialists estimate that perhaps up to a third of children and teens under the age of 20 have a Non-Ossifying Fibroma (NOF) or fibrous cortical defect.

Because most people associate tumors with cancer, this information may sound frightening. And while it should be taken seriously when a child shows symptoms of a bone tumor or cyst, parents need to understand that NOFs—and the vast majority of other types of bone tumors and cysts—are benign (non-cancerous). These tumors don’t become cancerous and they don’t spread. In fact, very few children who have an NOF or other type of growth somewhere in their bones will ever show any symptoms. Bone tumors and cysts are often discovered by chance when a patient requires X-rays for another reason, such as a sports injury. Common sites for bone tumors and cysts in children are the knees, shoulders, pelvis, arms, and legs. In most cases, no treatment is necessary because the tumor typically goes away on its own when a child is fully grown. Kids have an incredible capacity to heal, since their bones have the unique ability to regenerate and return to normal.

warningsignsWith this knowledge, you should not panic over a suspected bone tumor in your child. Sometimes, though, a growth does cause pain or other problems that need to be corrected by surgery or another means, so it’s important to look for warning signs to know when your child should be checked by a physician.

The procedure to remove a growth is typically an outpatient surgery. Usually, your child will be able to go home the same day as the surgery and will be back to full activity in a few short weeks or less. Once treated, most benign bone tumors do not re-grow or show up in other places in the body. On rare occasions, some tumors recur or persist despite treatment and may require multiple operations, but it helps to remember that benign NOFs don’t spread.

A diagnosis of cancer is extremely rare. Bone cancers account for less than one percent of all cancers. And while Primary Children’s Hospital treats thousands of patients with bone tumors, we diagnose and treat only 10 to 20 new cases of bone cancer each year—that’s just 10 to 20 children in the entire intermountain area.

Even when bone cancer is diagnosed, we’re here to help you through it. Primary Children’s is one of the top hospitals in the country in both orthopedics and cancer care. US News & World Report ranks Primary Children’s 12th in Orthopedics and 19th in Cancer Care, so we’re well-equipped to treat patients with a bone cancer diagnosis.

To treat bone cancer, Primary Children has a nationally recognized, highly specialized team consisting of sarcoma surgeons, pediatric oncologists, and radiation specialists, when necessary, along with a full support staff of physician assistants and nurses. Together with the patient and parents, we develop a treatment plan that, depending on the location and type of sarcoma, may include surgery, chemotherapy, and/or radiation treatments.

Primary Children’s also has two internationally recognized researchers conducting research on children’s bone problems—and specifically focused on Ewing Sarcoma. This means that Primary Children’s can provide your child with the most up-to-date and advanced care available. As a national leader in pediatric orthopedics and cancer care, we specialize in innovative, family-centered care that supports you at every step on your child’s journey to health.

Primary Children’s was recently ranked by the U.S. News and World Report as one of the best children’s hospitals in eight different areas including Orthopedics. For more information, visit our website.

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