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At Renown Health, we live by a core set of values. We are caring and compassionate. We demonstrate respect and integrity. We build relationships and collaborate with patients, families, clinicians and communities. We strive for excellence in all we do. Those values extend beyond patient care to the way we support our employees. We have worked hard to create an environment that empowers each person to learn, grow and thrive. Here are just a few examples of the ways we do that: Establishing a mentorship and leadership development program that provides insight, expertise and learning opportunities. Forming employee committees that improve health and well-being both at work and in our community that complement Renown’s work-life balance programs. Recognizing and rewarding team members for living our values. Providing paid time each quarter to support employee volunteerism and giving back to our community. Offering a variety of education programs, including tuition reimbursement, student loan repayment and a professional advancement bonus program, to help employees achieve their higher education goals. Hosting the largest Graduate Nurse Residency program in the state, which is also one of the largest in the nation. We strive to inspire, educate and help nurses shine, and in return, we know they will make a positive impact on the lives of their coworkers and the people we serve.

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The Healthy Nevada Project (HNP) is one of the most visible genomic studies in the United States, and guess what? Renown Health powers it! The Healthy Nevada Project (HNP) aligns with Renown's goal to do the best for our patients. The genomic study is at no-cost for Nevadans and gives participants insight into different genetic traits, including results on three prevalent and serious health conditions known as CDC Tier 1 conditions. CDC Tier 1 Conditions Include: Hereditary Breast and Ovarian Cancer Syndrome (HBOC) Lynch Syndrome Familial Hypercholesterolemia (FH) Not only does HNP give participants insights into their genetic background, but it also facilitates Renown's ability to study population health. Research lays the foundation for the future of medicine, and Renown's HNP is on the cutting edge of genetic research. We do this by providing skilled researchers access to studies for the diseases that currently have limited treatment, including nonalcoholic steatohepatitis liver disease or NASH. For example, the observational NASH study helps researchers understand genetic links to the disease. Make an Appointment to Get Screened If you haven't already, join the over 55,000 HNP participants and make an appointment to have yourself screened. You can schedule a screening appointment through MyChart. Click “Schedule an Appointment" and select Research Appointment - Genetic Screening. Prior to your appointment, please complete e-Check-in and complete your consent form.

Read More About What is the Healthy Nevada Project?

On March 19, 2020, Renown Regional admitted the first patient in need of care while sick with COVID-19. Our providers navigated two years of a pandemic and overcame many challenges while providing the best care for our patients and the community. Anicia Beckwith’s series “The Art of Healing” captured Renown Health during this time. Let's take a look back on the last two years. February 2020: Standing Up the Hospital Incident Command System (HICS) On February 25, 2020, leaders at Renown Health stood up Renown’s Hospital Incident Command System (HICS), a standardized system used to organize response personnel and resources and manage response operations during emergencies and crises. March 2020: Temporary Deployable Medical Structure Placed Outside Renown Regional Emergency Department On March 12, 2020, Renown set up a deployable medical facility to serve as a respiratory illness screening center for emergency room patients at Renown Regional. A similar tent was also set up outside the emergency room at South Meadows Medical Center. This proactive measure helped our teams care for community members with respiratory illness symptoms while protecting patients and staff in the emergency department and other areas of the hospital. Check out photos of the tent here. Read the Reno Gazette Journal Article about the tent here. April 2020: Alternate Care Site at Mill Street Parking Structure at Renown Regional Renown’s HICS team decided to create an Alternate Care Site (ACS) in the Renown Regional Medical Center Mill Street parking structure. The ACS served additional hospitalized patients and allowed caregivers to remain on campus and still have access to existing hospital infrastructure such as lab, pharmacy, imaging, food services and other critical services. After just 10 days of construction, the ACS was completed on April 3, 2020 with space to hold up to 1,400 patients. Check out photos of the ACS under construction here. On Nov. 12, 2020, Renown opened the ACS to serve additional hospitalized patients diagnosed with COVID-19 who were clinically stable or improving. Healthcare workers at Renown cared for hundreds of patients at this site. In early Jan. 2021, the remaining patients returned home. Check out the video of Connie, a patient who received care in the ACS. April and July 2020: The LOVE Sculpture Placed at Renown Regional On April 16, 2020, during a time of darkness and uncertainty, Artown loaned Renown the LOVE sculpture, a one-ton aluminum piece of art created by artist Laura Kimpton and fabricated by Jeff Schomberg. The structure, which originally debuted at Burning Man, was lit up Renown Regional's main entrance on Mill St. Watch a video about the LOVE sculpture’s debut at Renown Regional. On July 13, 2020, thanks to the support of former board chair and community supporter Blake Smith and the Keyser Foundation, the LOVE sculpture is now a permanent fixture at Renown Health. Throughout the pandemic, it has served as a source of inspiration, hope and positivity for our community and care providers. Check out a video of the LOVE is Here to Stay celebration. June 2020: Renown Offers In-House COVID Testing In June 2020, the Renown laboratory team sprang into action to help meet the growing demand for COVID-19 testing amongst Washoe County residents and businesses. Renown invested in expanded staffing and in-house testing capabilities that ensured our teams could swab and process up to 1,000 COVID-19 tests for patients each day. All with results returning within hours. November 2020: Renown Introduces “Hospital At Home” Remote Monitoring In November 2020, six patients at Renown Regional Medical Center and Renown South Meadows Medical Center diagnosed with COVID-19 were outfitted with a remote Hospital at Home monitoring system. Renown clinicians plan to continue using this system to monitor upwards of 1,000 hospitalized patients and lower acuity patients from their homes. December 2020: Renown Administers COVID-19 Vaccines to Health Care Employees On Dec. 17, 2020, Renown began to vaccinate its healthcare workers. Among those receiving the first vaccines was Luis Martinez, a technician on Renown’s Clinical Decision Unit who cared for patients recovering from COVID-19 in the Alternate Care Site field hospital. Read the Reno Gazette Journal article about the COVID-19 vaccine rollout at Renown. January 2021: Renown Administers COVID-19 Vaccines to Community After several weeks of successful employee and volunteer drive-thru vaccination events, Renown supported the Washoe County Health District and the state in vaccinating Washoe County community members. Click here for a playlist of videos featuring Renown Health employees and patients talking about the importance of the COVID-19 vaccine. February 2021: Local Widow Inspires Renown to Change Visitor Supporter Policy Darlene Randolph’s husband Dave spent 17 days hospitalized at Renown Regional Medical Center before losing his battle with COVID-19 on December 13, 2020. Darlene wrote a passionate letter to Renown Health asking for the visitor policy that allowed patients with COVID-19 to receive visitors. In February 2021, Renown hospitals were among the first in the country to lift visitor restrictions for patients with COVID-19 to encourage families to be at the patient's bedside. Read Darlene’s full story here. May 2021: Renown Celebrates Volunteers, Partners and Community Who Aided in Vaccine Efforts In May 2021, Renown administered the last dose of COVID-19 vaccines to community members in Renown’s drive-thru clinic. Between January and May 2021, over 80,000 doses were administered at the drive-thru. View drone footage of this effort here. Click here to see pictures of vaccine volunteers and employees. November 2021: Renown Offers Vaccine for Children Ages 5+ In November 2021, Renown vaccinated children in the Reno-Sparks community with the 2-dose series in a limited round of weekend clinics. The vaccine clinics featured therapy dogs, local mascots and donuts donated by Doughboy’s Donuts. Click here to see pictures of the children’s vaccine clinics and watch a video about the clinics here.

Read More About Two Years We Won't Forget: COVID-19 at Renown Health

Once upon a time … in Incline  This issue’s featured member began writing the latest chapter of her life story by retiring on Lake Tahoe’s north shore in Incline Village, NV.  “I had several criteria when selecting a place to retire,” says MaryBeth. “And a healthy lifestyle was number one. The people who have settled in Incline are very active with both their minds and their bodies. It’s not a stagnant population, it is unusually robust. I’ve made wonderful friendships here and we really watch out for each other, which means the world to me.” “I also wanted four seasons a year,” she continues. “And most importantly, I wanted a place that my son, Addison, would love to visit and share with me – and world-class skiing just minutes away scored extra points with both of us!” Zürich and Beyond  Skiing was something MaryBeth and Addison took to with a passion while living in Zürich, Switzerland. A business move to the land of the Alps (and Swiss chocolate) provided the perfect opportunity for an international education for her son and a culturally eye-opening experience for the family.  “I was unprepared for what it was going to be like living in a foreign place, and I learned a lot about empathy as a non-native and the kindness of strangers, or not. Our seven years there gave us many easily available travel adventures on the other side of the globe, and the friendships I made with people around the world have been lifelong.” “Divas” of the Garden  “Tall and showy” is how MaryBeth lovingly describes the “Divas” of her garden, aka the delphiniums. Located in the sunny part of her yard, the plants explode in a variety of colors that accentuate her home’s landscaping and are a well-earned reward for her mountain gardening challenges. “The very first thing you must do when creating a new garden is amend the soil,” explains MaryBeth. “It’s not sexy, but it’s necessary! And that’s when you learn that every shovelful of “mountain” dirt is loaded with rocks of every size – it’s fantastic exercise!” And her neighbors appreciate the hard work. “I’ve made so many friends of all ages in the neighborhood while working outside in my garden,” shares MaryBeth. “They stop, chat, inquire about the plants and take photos all the time.” Then with a smile, she adds, “You could call it my art.” Aging-In to Life with Medicare At 64 and on the cusp of Medicare eligibility, MaryBeth recently tasked herself with learning what she could about the plans and options that would soon be available to her and was overwhelmed. “I made the mistake of entering my phone number on a Medicare website for “wanting more information” and had no less than 15 calls a day from health insurance brokers – from all over the country!” she exclaims. “What one person would tell me would then be questioned by the next. I eventually quit answering the phone.” However, finding a Medicare plan that meets all of her needs is still a priority. “First and foremost, since I am a traveler (at least before the pandemic) I want to have a healthcare plan that will cover me in any state,” MaryBeth explains. “I would also like a policy that allows for alternative treatments, such as acupuncture – which I’ve had great success with in the past. I know that getting a good Rx plan now will save me money down the line, and I also want to be able to see a specialist without seeing a provider first for a referral.”

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We get it – the entire world has been overwhelmed with COVID-19 vaccine information, questions and celebrations around vaccines developed to combat COVID-19 induring the past several months. It’s hard to know where to start in digesting all this news and information. But one thing is clear: healthcare experts agree that the authorized COVID-19 vaccines are safe, effective and recommended to help end this pandemic. If you are passionate about stepping up in your community to encourage the vaccination efforts, we’re offering a few ideas on how you can be an ambassador. Find the Facts Content on the vaccine is abundant, but and there’s a few resources that we can all rely on to help digest the information: The Centers for Disease Control (CDC) updates its website content around the vaccine regularly, and also offerings information in Spanish. Health departments across the U.S. are leading the way in distribution logistics planning, and partnering with other providers, like such as hospitals and pharmacies, to distribute give people doses. Their websites are great resources to understand options where you live. Locally, check out washoecounty.gov/health/programs-and-services/environmental-health/covid-19-guidance for vaccine updates in Washoe County. Many providers like Renown Health and other providers are sharing content around their recommendations for the vaccine. Get answers about the vaccine types from one of our pharmacists, read common concerns addressed by experts and view videos from many doctors and other specialists on our YouTube Channel.

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Unfortunately, many in our community go to bed hungry. Thanks to the support of the Food Bank of Northern Nevada and other local partners, Renown’s food pantry is helping meet the food needs of homeless and low-income individuals in our community. Patients who qualify for the “Food is Medicine Prescription” can receive a bag of food for themselves and each member of their immediate family every week through a free assistance program. This project started last year when Renown began giving food support to hospital and emergency room patients who expressed the need. Food is also given out at the Healthcare Center, which provides affordable access to care for anyone in our community. Those who receive care at the Healthcare Center are also eligible for food assistance. Working Alongside the Community After receiving food deliveries from the Food Bank of Northern Nevada, Renown’s community health team collects an assortment of fresh produce, donated from local grocery stores and other community organizations. Then they put together one bag for each family filled with healthy foods, such as: Whole grain cereals Shelf stable milk Kid-friendly snacks (granola bars, popcorn, graham crackers Proteins (low-salt soups, stews, peanut butter) Seasonal produce Food is Medicine Prescriptions Continue Amidst the Pandemic Throughout the COVID-19 (coronavirus) pandemic, Renown’s community health workers have been working remotely. They continue to reach out to patients who need groceries from the Food is Medicine Prescription program. With this in mind, the food pantry staff is currently coordinating outpatient deliveries to those with a Food is Medicine Prescription. At present, Renown is working to get more refrigeration, shelving and staffing to expand the service to more Renown Medical Group patients in need of food.

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“You’re gonna be a dad!” Whether you’ve been waiting years to hear those words or still think you’re too much of a kid to have a kid, the reality of impending fatherhood can be terrifying for any first-time, soon-to-be-dad. But not to worry, Best Medicine has some timely tips to help calm those bundle-of-joy fears and help you rock your new role as a brand-new, baby daddy.   Winter is Where Babies Come From Fact: More babies are born in September than any other month, with spill over (and spit-up) into October. Subtract ten months for the typical 40-week, bun-in-the-oven baking time and early winter stands out as the top baby-making part of the year. Is it the cozy nights before a fire as people avoid the snowman-friendly temperatures outside? Possibly. There could be any number of reasons, both seasonal and otherwise, for what will eventually arrive in the fall and immediately steal your heart — and untold hours of your sleep. Though moms carry most of the baby burden traditionally (and literally for three trimesters), that’s no excuse for the soon-to-be-dad not to step up to the plate and take a swing at being the best partner and father on the planet. Below is a list of tips and resources to help you do just that. So read on, daddy-o.  Tip #1: Don’t Freak Out Ok, you’re probably going to freak out even if we tell you not to. But once you calm down, consider this: human beings have been having babies for millions of years, and many of those soon-to-be-dads had it much tougher than we do today. And guess what? The human race is still going strong. Those first moms and dads did a good job — and you will too, with a little help. Tip #2: Take a Class Knowledge is power. In this case, it's diaper-changing, swaddle-wrapping, 2 a.m.-feeding power. And for you and your partner, taking a parenting class or two should be a no-brainer. You'll both learn what to expect and prepare for as you support each other and bond with your baby even before he or she arrives.   Tip #3: Learn From Other Dads If the thought of sitting in a room full of full-bellied women and their partners makes you uncomfortable, you may opt to stick with bros for your lesson plan. Dad-only classes and soon-to-be-dad support groups — taught and led by seasoned fathers with tales to tell and words of wisdom to share — are available online and in cities and communities around the country. Dad-focused sites also offer advice for new and still-learning proud papas. Here are a few options to check out:  Boot Camp for New Dads City Dads Group Wilderdad.com Fatherly.com Fathers.com  Tip #4: Babies are Required Reading Haven't read a good book lately? Well, if you're expecting a baby, now is the time to flip through a few pages that could make your life a whole lot easier in a few months. There's no such thing as being too-well-read when it comes to your fast-approaching, adorable little poop machine. The least you can do is read a book or two, or seven.  We're Pregnant! The First Time Dad's Pregnancy Handbook From Dude to Dad: The Diaper Dude Guide to Pregnancy We're Pregnant! The First Time Dad's Pregnancy Handbook  What to Expect When Your Wife Is Expanding Be Prepared: A Practical Handbook for New Dads  The New Dad's Survival Guide: Man-to-Man Advice for First-Time Fathers What to Expect When You're Expecting  Tip #5: Be a Prepared Soon-To-Be-Dad Tips 1 through 4 are meant to help alleviate some of your jittery, new-dad anxiety. And we hope they do just that. But if you really want to hold that "Best Dad Ever" coffee mug starting on day one, there are also some practical things you can do to prepare. Check these items off your list now to make life with baby more baby-, mommy- and daddy-friendly from the get-go.  Buy a baby/child car seat. Three out of four car seats are installed incorrectly. Protect your children by ensuring they are riding in a properly secured and age-appropriate car seat. Renown Children’s Hospital Car Seat Station is staffed by certified technicians who provide child vehicle safety restraint education, inspection and installation. Set up the baby's nursery early, including furniture  Stock up on diapers and baby supplies  Cook and freeze 2 weeks of food for nights when no one wants to cook  Research family healthcare  Agree upon a shared diaper-changing/feeding schedule  Ask about paternity leave from work  Get bills and finances up-to-date or pre-pay to avoid late charges   Give the home a thorough cleaning before the baby arrives

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Medical emergencies like strokes and heart attacks still happen, even in a pandemic. That’s why Renown Health is always ready to provide emergency care to patients in need, and being admitted at Renown does not put patients at risk of getting COVID-19. When to Get Emergency Care Resources like Renown Virtual Visits have allowed us to stay home while making routine visits with our primary care physician. But, if you are feeling any of the following symptoms, please call 911 or have someone you know take you to the emergency room. Symptoms that may require emergency care: Heart attack Stroke symptoms Difficulty breathing Chest pain Seizure Sudden loss of consciousness Severe abdominal pain Serious allergic reaction Fighting the Good Fight for Our Patients Renown Health provides a clean and safe environment 365 days of the year, 24 hours a day. Alongside regular sanitation practices, Renown is dedicated to protecting patients from infectious disease while providing emergency care. Staff, Care Providers and Visitors Wear Masks Every staff member, care provider and visitor is wearing a mask. Additionally, providers are following guidelines from the Centers for Disease Control (CDC) on wearing protective equipment, such as masks and gloves. Respiratory Illness Screenings for Everyone Care providers and staff members are participating in respiratory illness screenings. Therefore, any care provider or staff member with a fever, cough, difficulty breathing or severe respiratory illness is not on a Renown campus. Visitor Restrictions are in Place Visitor restrictions are in place to prevent the spread of infectious disease by practicing physical distance. Because of these restrictions, Renown is only allowing one visitor per patient for with extenuating circumstances. Staying healthy and safe means caring for yourself in emergency situations, too. Please do not hesitate to call 911 when you or a loved one are in need of emergency medical care. Virtually Visit a Renown Urgent Care Login to MyChart to “get in line” for a virtual urgent care visit between 8:30 a.m. to 10:30 p.m. Monday-Friday and 9:30 a.m. to 4:30 p.m. Saturday and Sunday. Login to MyChart

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You probably know testosterone (T) plays an important role in how boys physically develop into men. But is that all you know? What happens when a man's T levels are off? Are there symptoms men should look for? And what are the treatment options? Dr. Bobby Kahlon, MD, Renown Medical Group provides answers in a Testosterone Q&A.   What does testosterone do for men?  "Testosterone is known as the 'manly hormone' for a reason," says Dr. Kahlon. "Though women also naturally produce small amounts of it, men produce testosterone at much higher concentration levels. And it affects men in more physical and obvious ways. How much hair a man has on his chest, how deep his voice is, or how muscular he is are all attributable in some way to testosterone. It's also responsible in large part for sex drive and bone strength and affects how men think, learn and experience their surroundings."  Testosterone in men:   Powers virilization (male physical characteristics) and sexual function Builds muscle mass and strength  Supports bone density  Improves cognition  T Trivia: Discover Magazine reveals that “manly” testosterone and other sex hormones evolved long before we did — 500 million years ago — from the ultimate “female” hormone, estrogen. Can you have too much or too little testosterone?  Though high testosterone isn't a concern for most men, low testosterone or low T occurs more frequently and develops for two primary reasons.  Dr. Kuhadiya explains, "Subnormal testosterone concentrations occur either due to pituitary or testicular failure and the causes for each need to be discussed with your physician."  Pituitary failure: Approximately one-third of men with obesity, type 2 diabetes, or metabolic syndrome (which includes increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels) have low free — or "bioavailable" — testosterone. These health conditions can cause the pituitary gland to "fail" to release follicle stimulating hormone (FSH) and luteinizing hormone (LH) which are essential for triggering testosterone and sperm production. And that can cause low testosterone (hypogonadism). Testicular failure: Though less common than pituitary failure, testicular failure may also be responsible for low T. It's caused by diseases or illnesses affecting the testicles, injury or trauma to the testicles, or certain medicines and treatments such as chemotherapy or opioid pain medication. Providing your complete medical history to your doctor is always the first step toward a proper diagnosis.  What are the symptoms of low T?  The following indicators could be a sign that you have low T, say the doctors.  Lack of motivation and determination, including mild depression  Loss of physical endurance and muscle strength  Loss of or diminished early morning erections  Reduced libido (sex drive)   Erectile dysfunction (ED — difficulty achieving or maintaining an erection)   Gynecomastia (male breasts)  Small testes  T and Time: T levels in men naturally begin to decline by about 1% a year starting at age 30.  How do you test for low T?  "There are different methods for testing testosterone levels," says Dr. Kuhadiya. "Each approach uses a blood sample to evaluate total testosterone, which includes free and attached testosterone that combines with proteins albumin and sex hormone-binding globulin (SHBG). For the most accurate results, testing is based on samples collected in the morning after fasting, and from tests on two different days."  What treatment options are available?  "Well, your best natural option may be YOU," says Dr. Kahlon. "Men with pituitary failure are often able to treat their low T by losing weight to increase levels of the hormone. And even if you don't lose weight, exercise can help boost your testosterone. Unfortunately, if you have testicular failure, weight loss and exercise may not have the same effect."  So, are there other options? "You may want to consider Testosterone Replacement Therapy (TRT)," says Dr. Kuhadiya. "TRT is only available to men who are hypogonadal — with a clinical diagnosis of low T. Injection, gel, skin patch and nasal spray are available TRT options. The best option is the one that works best for the patient. Convenience, insurance coverage and cost are all factors to consider." Dr. Kahlon's TRT preference? Daily gel treatments, which are applied directly to the skin. On the other hand, Dr. Kuhadiya recommends intramuscular injections, which take place once a week or every two weeks.  But both doctors agree on this: physicians and their patients need to weigh the benefits and risks of TRT before proceeding with treatment — especially if your low T condition may require lifelong treatment. "In my clinical practice, I have seen some very good long-term results with an improved quality of life," says Dr. Kuhadiya. "However, in certain situations, TRT may increase the risk of heart disease and is not recommended for men with a history of prostate cancer." Dr. Kahlon adds, "Patients receiving any type of hormone therapy need to be closely monitored throughout the treatment process for any changes in their health."   How do you feel about steroids and T boosters?  "I don't recommend them, certainly not for hypogonadism," advises Dr. Kahlon. "There is no evidence to support anabolic-androgenic steroids or testosterone boosters as a safe or effective treatment for low T in men."  "In fact, there continues to be emerging evidence they may lead to side effects that could potentially harm the liver and the pituitary and endocrine functions of the body," warns Dr. Kuhadiya. "And that damage may be irreversible."

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Car seat technicians often find parents are moving their child to their next car seat stage too soon, as they get older. Here are a few reminders of when to transition your child from their booster seat to a seat belt. Moving to a booster seat too soon According to Safe Kids Worldwide, nearly 9 in 10 parents remove children from their booster before they’ve reached the recommended height, weight, or age of their car seat recommendations, which leaves the seat belt in a position on the child that could injure them. If the child is not the proper height, the seat belt can rise up on the belly, instead of the hips where it’s supposed to sit, which can lead to spinal cord damage or whiplash in the event of a car crash. Solution: You can switch from a car seat to a booster seat when your child has topped the weight allowed by the car seat manufacturer; typically 40 to 80 pounds (18 to 36 kilograms). Remember, however, that your child is safest remaining in a car seat with a harness for as long as possible. Booster seats must always be used with a lap and shoulder belt — never a lap-only belt.  Transitioning to a safety belt too soon Older children need booster seats to help ensure the seat belt stays properly positioned on their body. The lap belt should lie low across the child's hips and pelvis with the shoulder belt crosses the middle of the child's chest and shoulder, so that in the event of a crash, the forces are applied to the hip bones and not the abdomen. If the lap belt is not positioned properly then it could lead to injuries to the spinal cord and abdominal organs.  Solution: Most kids can safely use an adult seat belt sometime between ages 8 and 12. Always use a booster seat until the child passes the 6-step test Your child reaches a height of 4 feet, 9 inches (nearly 1.5 meters) Their back is flat against the seat back. Knees bend over the edge of the seat and feet are flat on the floor. The shoulder belt sits on their shoulder and chest (not face or neck.) The lap belt sits low on their hips and touches their upper thighs (not on their stomach.) Your child can sit comfortably this way for the entire trip.   The American Academy of Pediatrics reminds us that the back seat is the safest place for children younger than age 13.

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Parents often struggle with installing and choosing car seats for their children. Picking out a car seat for your child is a never-ending battle. Safe Kids Washoe County has made it simple for you to understand the types of car seats that will work for your child. Types of Car Seats Rear-Facing Only Seat. Your baby's first car seat is often used from 5 to 40 pounds. People usually buy this type of seat because it is portable. Convertible Car Seat. This seat is larger and stays in the car; it may be rear-facing until your child is two years or more. After that, it can change to a forward-facing seat. Forward-facing-only car seat. This type of seat is used in one direction and has a 5-point harness and top tether.  Combination seat. This is a forward-facing seat with a 5-point harness and top tether and can change into a booster seat when you remove the harness.  3-in-1 car seat. This seat also stays in the car. You can use it rear-facing, forward-facing, and then later, as a booster seat. Booster seat.  It boosts the child for a safer and more comfortable fit of the adult seat belt. Make sure your child has outgrown the weight or height limits allowed in the forward-facing car seat. The seat belt must lie flat across your child's chest, on the bony part of the shoulder, and low on the hips or upper thighs. Most children will be between the ages of 8 to 12 years old before they are ready for the seat belt alone. Have a trained car seat technician check your installation Why: 3 out of 4 car seats are installed improperly, with some studies show that the misuse rate is 90%, with the average car seat having three mistakes. Solution: Ensuring that your child's car seat is installed correctly by a certified car seat technician will ensure your child's safety.

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Posture is important, but for those children diagnosed with scoliosis (spinal curvature) it can be a difficult issue. The Washoe County School District Student Health Services Department screens 7th grade students for scoliosis as growth spurts often reveal the condition and, if diagnosed early, scoliosis can stop progressing. We asked Michael Elliott, MD, head of the Department of Pediatric Orthopedics and Scoliosis to answer some frequently asked questions about scoliosis. What is scoliosis? There are many types of scoliosis: early onset (occurs before age 10), congenital scoliosis is when the bones of the spine do not form correctly, neuromuscular scoliosis which is due to children’s neurologic and muscle disease, and the most common is Adolescent Idiopathic Scoliosis. The term “idiopathic “ means the exact cause is unknown, although we do know it runs in families. This type of scoliosis occurs in 2-3 percent of adolescents and is mainly seen during their growth spurt. This is why middle school screenings are recommended. Both genders get scoliosis but girls are 8 times more likely to have their curves progress and become larger. What are the signs that my child may have scoliosis? A few signs for parents to watch for are: One shoulder might be higher than the other. One leg may seem longer. A hip may be higher or look more prominent. The waist may not look the same from side to side (asymmetry). The trunk or rib cage may be more prominent on one side or shifted. When they bend forward they may have a bump on their back. How is scoliosis diagnosed? It can be noticed by a pediatrician at a physical, school screening nurse, PE teacher or parents. Once the curve is suspected the child is usually referred to a pediatric orthopedic surgeon scoliosis expertise. At the initial visit the doctor will perform a thorough physical including a complete neurologic exam to assess the amount of curvature. Once the exam is completed the physician will determine if a spinal x-ray is needed. The curve on the x-ray is measured utilizing the cobb angle (a measurement in degrees) which helps guide the treatment. What are common treatments for scoliosis? The treatment depends on the size of the spinal curve and the amount of growth the child has remaining. An x-ray of the child’s hand is used to determine the amount of growth remaining. This allows the determination of the child’s bone age, and based on the hands growth plates it can determined if the child is in their rapid phase of growth. Treatments include: Observation - For curves less than 20-25 degrees. This entails visits every 6-9 months with a repeat scoliosis x-ray. Since scoliosis curves increase only 1-2 degrees per month, and variations in measurements can be 3-5 degrees, an x-ray is not recommended before 6 months. If the curve remains less than 25 degrees the child is followed until their growth is completed (usually age 16-18). Progressing Curve - If growth is finished and the curve is less than 40 degrees, the risk of more curvature into adulthood is small. If growth is completed and the curve is over 45 degrees, the child is followed for several years as these curves can progress into adulthood. If the patient is still growing and the curve has progressed greater than 25 degrees but still in the non-operative range (less than 45-50 degrees) bracing is used to stop the progression of the curve. Bracing - Indicated for curves over 25 degrees but less than 45 degrees. If a brace is required you will be referred to an orthotist (bracing specialist). The orthotist assesses your child, reviews the x-ray and then fits the brace. (Having a brace made usually takes 2-3 weeks.) Once the brace is fit, your child will visit the scoliosis specialist for an x-ray in the brace to ensure it fits correctly. The primary goal of bracing is to halt progression of the curve and prevent the need for surgery. The brace must be worn for about 16 hours per day to be effective. In a recent bracing study 72% of the patients who wore their braces as prescribed prevented the need for surgery compared to the group who did not wear their brace. Surgery: When a curve reaches 45-50 degrees, and a child is still growing, surgery is usually recommended because the curve is likely to continue progress. If a curve is over 50 degrees and the child is done growing surgery also may be recommended. This is because when curves are over 50 degrees they tend to increase 1-2 degrees per year for the rest of your life. As curves get larger the amount of lung function tends to decrease which could cause breathing problems later in life. The goals of surgery are to stop the progression of the curve and safely correct any misalignment. This is accomplished by attaching implants (rods, screws, hooks and bands) to the spine. Bone graft is then placed around the implants to encourage the spine to fuse (grow together). This then forms a solid column of bone with metal rods in place, preventing the curve from changing. Most patients are back to their regular sports and activities six months post surgery.

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