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Help us celebrate the holiday season by sharing joy with our Children’s Infusion Services team!  Thinking about blood can make any of us squeamish, and seeing it can be even more intimidating to the children in our lives. Being treated for a condition that requires blood transfusions or chemotherapy infusions is no easy feat, especially during the holiday season. This time of year, we are proud that we can offer our pediatric patients the power of proximity and excellence by having access to high level care close to home.  The Children’s Infusion Services (CIS) department at Renown Children’s Hospital is committed to bringing the gift of quality care to our community’s youngest patients. Whether they are caring for a child with a blood disorder or giving expert infusion care for a child battling cancer, no team does what they do better than these expert nurses, medical assistants, intake coordinators and physicians.  ‘Tis the Season to Bring Hope As the only pediatric oncology and hematology program in the region, the CIS department has a lot of responsibility on their shoulders. From inpatient chemotherapy to outpatient infusion services, this team treats a long list of pediatric blood conditions including:  Pediatric cancers Anemias Immune-mediated blood disorders Sickle-cell disease Bone marrow failure syndromes Bleeding disorders  “Our team provides a large variety of services from labs draws, sedations for procedures, infusions for diagnoses such as Crohn's disease, blood transfusions, as well as chemotherapy,” said Jen Torres, RN.  “Our team works extremely well together. We try to go above and beyond for our patients every day. It may be something as simple as a hug to comfort a parent or a special birthday gift for a patient.”  “My job allows me to work with several departments and providers when coordinating care for our littlest of patients,” added Jane Strawn, Intake Coordinator. “I assure proper authorizations are in place for the care that is needed, I communicate with our families when scheduling appointments, I organize End of Treatment Celebrations, as well as birthday shout outs and work closely with our Child Life team to help make the challenging appointment little easier.”  To best serve their patients, the team thrives on being expert multitaskers. Central line care, chemotherapy administration, blood transfusions, medication management, preventative injections, lab draws, lumbar punctures, biopsies, imaging – you name it, they do it. And they do it all with the utmost focus on safety and support.  “Our days have a lot of variation, as we perform a number of different services,” said Meagan Bertotti, RN. “We provide infusions for patients with chronic or acute medical conditions and chemotherapy/biotherapy treatment to patients undergoing cancer treatments. Overall, though, we work as a team to make these difficult procedures and treatments as easy as possible for the patients and families by providing engagement and support.”  “While we handle a lot of chemotherapy treatments for pediatric patients, we also do other infusions and transfusions as well such as blood and platelet transfusions, enzyme replacement therapies, different types of injections such as Rabies vaccine or Synagis for high-risk babies who need that extra protection during the RSV season, and lab draws,” said Chelsea Angues, RN. “We care for patients that get their therapies from outside hospitals, but the patient lives within the Reno area. We receive orders from those outside hospitals to care for those patients, so they can still be with their families and not have to travel.”  As members of the Children’s Oncology Group, a highly-regarded clinical trials group where over 90% of pediatric cancer patients across the U.S. receive treatment, teams like CIS in Renown Children’s Hospital deliver the highest standard of care. This partnership is a true testament to the devoted collaboration and relationship-building this team commits to on behalf of their patients every day.  "One of the biggest accomplishments of our team is the fact that we became a member of the Children’s Oncology Group, and the Children's Infusion Center and Pediatric Oncology became one unit,” said Shelby Nolte. "Instead of being a clinic on one side and an infusion center on the other, we really came together to make it a whole unit that collaborates on almost everything.”  “We've put much time into trying to understand other departments, their flow, their rationales and their processes so we can come to a solution that benefits our patients the greatest,” added Tiffany Macie, RN. “We've taken the last few years to really build our relationships with our pharmacy staff, our lab staff and our central supply resources. Our relationship building extends beyond the walls of the Renown building as well and out to the community providers too. In the past few years, we've been able to build relationships with the providers in the community where they trust they can send us their patients for treatment and lab draws. Finally, we've spent much time working on the relationships as a team. It's emotional work we do on our unit, and these families become our family. It's important to us that we take the time to be together outside of our shifts to enjoy one another and laugh!”  In the compassionate realm of pediatric healthcare, CIS knows that the complexities of a cancer or blood disorder diagnosis can take an emotional toll on their patients and families. The team firmly believes that emotional support can be as important as the physical and medical support throughout each patient’s unique care journey, striving to be a comforting presence during daunting times.  “The most important part of my day is collaborating with the Children's Infusion team to make life manageable for the families that are going through this experience,” added Shelby Nolte, Senior Medical Assistant. “We work as a team to make life easier for the blow of a cancer diagnosis.  We are there for our families in every way.  If they need a shoulder to cry on, an ear to listen or just someone to play cards with or tell a funny story too, we are there.”  “One of the things our team does extremely well to help our patients and their families with new diagnoses is to simply meet them where they are,” said Tiffany Macie. “That looks different for every family and every patient. We work in an environment where can build relationships with our patients and their families. This allows us the unique opportunity to really get to know them. We learn their fears, their joys, their worries, what their family lives are like, and we learn how to best meet them where they are.”  Transcending the conventional boundaries of care, the CIS department closely supports each patient, offering them solace tailored to the unique fabric of each family's life.

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In today's fast-paced society, it is understandable for parents to want to take shortcuts in caring for their little ones. A s a result, It is tempting to leave a sleeping infant in a car seat or swing after a long day of errands or when you need a moment to catch your breath. But, as convenient as these devices may be, they pose a serious risk to your child's safety. Why Car Seats and Swings Pose Risks for Infant Sleep Car seats, swings, and bouncers are quick and convenient ways to feed, hold, and sleep an infant. Not out of malice or discontent, but again from the need for quick and easy access to baby care in an already busy lifestyle. However, the risks outweigh the benefits. The American Academy of Pediatrics (AAP) states that “infants should be moved to a crib, bassinet, or play yard for sleeping as soon as is practical.” If a parent must use a car seat or other sitting device, they should only do so for a short period of time and never as a substitute for a proper sleeping environment. Leaving a sleeping infant in a sitting device, such as a car seat or swing, can create unsafe sleeping conditions. The American Academy of Pediatrics (AAP) warns that doing so increases the risk of sudden infant death syndrome (SIDS) and positional asphyxia. This is because infants can easily slump over or become entangled in the straps, blocking their airway, and causing suffocation. Car seats, swings, and bouncers are quick and convenient ways to feed, hold, and sleep an infant. Not out of malice or discontent, but again from the need for quick and easy access to baby care in an already busy lifestyle. However, the risks outweigh the benefits. The AAP states: Infants should be moved to a crib, bassinet, or play yard for sleeping as soon as is practical. If a parent must use a car seat or other sitting device, they should only do so for a short period and never as a substitute for a proper sleeping environment. Leaving a sleeping infant in a sitting device, such as a car seat or swing, can create unsafe sleeping conditions. The AAP warns that doing so increases the risk of sudden infant death syndrome (SIDS) and positional asphyxia. In addition, infants can easily slump over or become entangled in the straps, blocking their airways and causing suffocation.

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If you’re expecting a new baby, you may have been given the advice to hire a doula. You may have seen statistics of improved outcomes among those who’ve had a doula attend their birth. Perhaps you’ve heard that the etymology is from the Greek word meaning “to serve.” But how does a doula serve their clients? A doula is a non-medical birth professional who will guide you through labor, birth, postpartum and beyond. Your doula can discuss your options with you so you can make informed decisions, as well as provide emotional and physical support to ease your experience. While each doula offers their own style, there are certain services that most doulas will provide for their clients. Typically, a birth doula will provide at least one prenatal visit, one postpartum visit and continuous support during active labor. A postpartum doula usually provides support during the 12 weeks immediately following birth, sometimes referred to as the “fourth trimester,” but some will continue care after that as well. Simply put, a doula provides informational, physical and emotional support during the childbearing year(s). Let’s take a closer look at these three ways a doula can support you. The Basics If you don’t know your options, you don’t have any. This is a common phrase in the world of birth work. When you’re in labor, you’re exhausted, in pain and there’s often urgency inherent or implied in any choices you make. So, when an intervention is offered, many birthing people accept it without question. One method that can help the decision-making process is to check your BRAIN: Benefits: What are the benefits of the proposed intervention? Risks: What are the risks of the proposed intervention? Alternatives: What are the alternative options? Intuition: What does your intuition tell you? Nothing: What if we do nothing? What if we wait? When you’re in active labor, you might have difficulty remembering this acronym; that’s where your doula comes in. At your prenatal visits, you can ask your doula for guidance in preparing your birth plan, which can include contingencies for certain potential interventions. And as choices arise during labor, your doula can guide you through the benefits and risks and can provide you with alternative options you might not otherwise be aware of that are available to you. Your doula can remind you to check in with your intuition and can help you quiet your mind so you can listen to your instincts. The Body Although we tend to see depictions of people giving birth on their backs with their feet in stirrups, this is only one of many ways to give birth. Walking and dancing can speed up early labor. Side-lying or hands-and-knees can prevent tearing during the pushing stage. Sometimes labor stalls, and a change of position is often helpful to get things moving again. Your doula can suggest positions depending on your stage of labor. Some labor positions might require the support of another person – your doula could fill this role or assist your partner in doing so. Some doulas also provide massage or even acupressure, and most will do the “hip squeeze” that so many laboring people swear by. If your baby is presenting posterior, or “sunny side up,” your doula can apply counter pressure to alleviate back pain during labor. Some postpartum doulas will do light housework while you rest and bond with your newborn. Others might care for your baby through the night so you can catch up on sleep. Many doulas have also gone through additional training to offer breastfeeding support and may be able to assist you with latch issues and nursing positions. The Mind Pregnancy, birth and postpartum periods can be some of the most emotional times in a person’s life. A doula will hold space for you and help you process your emotions before and after birth. It’s normal to feel apprehensive, or even fearful, about labor and birth, and discussing these feelings is the first step. A doula can help you navigate your concerns in a safe space so you can be prepared emotionally for your upcoming labor. Many doulas will also guide you through writing your birth plan, which can lessen anxiety about the unknown. If you have a history of trauma, your doula can assist in communicating this, so you don’t have to relive the experience every time you meet a new medical provider. Most people will experience some form of what’s often called the Baby Blues in the immediate postpartum period. The third day after birth tends to hit hard, as hormones attempt to regulate, but the Baby Blues can continue for weeks for some new parents. A postpartum doula’s support can be incredibly valuable during this time. When the baby blues last longer than a few weeks, it could considered a mood disorder. Most doulas will recognize signs of postpartum mood disorders and will have resources available for additional support. Choosing the Best Doula for You With so many wonderful doulas in northern Nevada, you might wonder how you could ever choose just one to attend your birth. Some expectant parents are unfortunately restricted by cost. With so many expenses related to a new baby, it can be difficult to budget doula services as well. Thankfully, Nevada Medicaid now covers doula care, and some commercial insurances are following suit. Check with your insurance company to find out if they might cover part of the cost for hiring a doula. If your insurance doesn’t cover doula services, some doulas offer a sliding scale based on income. You may want to interview multiple doulas to find the right one for you. If you’re the kind of person who wants all the information you can get, a more detail-oriented doula might be the best choice. But if you tend to feel overwhelmed by too many options, you might prefer a doula who only offers additional information as the situation calls for it. If you want massage or acupressure during labor, you might want to hire a doula with those certifications. Or maybe informational and physical support are not as important to you as emotional support, in which case your best choice could be a doula who has experience with postpartum mood disorders or trauma support. Regardless of who you hire, be sure to clearly communicate your desires and expectations – not just for your birth, but also for your doula. The most important thing when choosing your doula is trusting your gut. You need to feel comfortable with your doula, as they’ll be tending to you at one of the most vulnerable times in your life. When you find a doula that you click with, who listens to you and supports your choices, you have found the best doula for you.

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Most babies weigh just one pound and are roughly the size of an eggplant when they reach 24 weeks of development inside the womb. It is a crucial stage when internal organs begin functioning, and the babies' respiratory and central nervous systems are still developing.     So, in November 2021 when Kallie Johnson experienced a premature rupture of amniotic fluid around this point in her pregnancy, her care team in Winnemucca decided to transport her via Care Flight to Renown Regional Medical Center. The team at Renown Children’s Hospital immediately began discussing the risks of delivering at 24 weeks with the Johnson family.  Moving Forward with Hope Knowing the stakes, Kallie remembers never feeling rushed to decide about delivering her baby preterm. “I felt educated and supported by my care team at Renown throughout our entire stay, starting with the education they provided about what it meant to deliver my baby early,” Kallie said. “The team really helped me make the best decision for myself and my family.”    Together, Renown employees and the Johnson family moved forward with a healthy set of nerves and a powerful feeling of hope.  Weighing in at one pound 11 ounces, Sloan entered the world on Nov. 19, 2021, via emergency Cesarean section. Her birth was classified as a micro preemie because she was born before week 26 of pregnancy and so small that she fit inside the palm of her father Sterling’s hand. A full-term pregnancy is classified as reaching 39 weeks.   A Fighting Chance  Called a fighter by many Renown Children’s Hospital care team members, Sloan spent over five months in the neonatal intensive care unit (NICU). She was placed on a ventilator, fed through a feeding tube and monitored 24/7, overcoming daily challenges with the Renown team and her family.  As a result of being born prematurely, Sloan developed a grade one brain bleed and a congenital heart defect called patent ductus arteriosus, a persistent opening between two major blood vessels, causing too much blood to flow to the lungs and heart.   To meet the oxygen needs of her tiny lungs, Sloan was intubated and developed a severe oral aversion and high-arched palate as a result. The effects would lead to difficult developmental and physical challenges that she still conquers today. Yet, with the help of her care team – including physical, occupational and speech therapists, dieticians and doctors – Sloan continues to make progress every day.

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March is National Child Life Month. Join us in recognizing our Child Life team at Renown Health!  The hospital environment can be a daunting and confusing place for a child. Whether they are admitted to the hospital themselves or have a family member who is currently undergoing treatment, they undoubtedly bring along a lot of overwhelming questions and concerns.  No one would be better to guide them through the process than the Child Life department at Renown Health. Our devoted Child Life Specialists and Child Life Assistants dedicate themselves to helping our youngest patients and children of relatives in the hospital cope with their anxieties and fears. With the smiling faces of the Child Life team on their side, children at Renown have a sense of solace while they are in the hospital with a team to cheer them on every step of the way.  Offering a Hand to Hold  From the first moment of a child’s visit to Renown, they are never alone. The Child Life team, which is made up of three specialists and two assistants, is here to provide a helping hand throughout the entire hospital process, explaining each test, procedure and process every step of the way and creating the best possible plan for each patient – all while fostering and maintaining a safe and supportive environment.  “We are specifically trained to help patients and families throughout their healthcare experiences,” said Amanda Cleary, MS, CCLS, Child Life Specialist. “This looks different for every family. We are trained to tailor our services to meet individual family and cultural needs based on our assessment.”  “It does not take long for a Child Life Specialist to create a safe relationship with a pediatric patient,” added Angie McEvers, CCLS, CFLE, Child Life Specialist. “The Child Life department can help any care team do their job by redirecting a child’s focus and distracting them from painful interventions, and this is a win-win for both the patient and the care team.”  This team’s primary goal is to make talking to doctors and undergoing tests a little less intimidating for our youngest patients. Interaction is a crucial part of a child’s healthcare journey. Our Child Life Specialists are masters at procedure preparation, surgery preparation, trauma support and diagnosis education while meeting each child where they are at developmentally.  “A day in the life of a Child Life Specialist is never the same, and every child is different,” said Jennifer Nunzir, CCLS, Child Life Specialist. “To make sure patient care is possible, I make sure I am here mentally for the patients and families. I am ready with a smile to greet them and try to make them comfortable from the start. We are always present to support a patient and family with a new diagnosis, talk to children when there has been a tragic accident, make memories for families and giving children a distraction from tests and procedures.”  “One of the biggest benefits to our job is our ability to provide emotional support and communicate with families in a way that makes them feel seen and heard,” added Amanda Cleary. “We listen to the family’s past medical experiences and work on building rapport by building those connections. When you get a child to open up, you see who they are as an individual, and we build from there.”  The efforts of the Child Life team go beyond helping children with coping skills. They also jump in with activities to keep kids of all ages engaged – from arts and crafts to pet therapy.  “Bringing children smiles through play and giving them fun things to do – whether it’s watching a movie, playing a game, doing an art project, going for a wagon ride or taking them to the Children’s Healing Garden – makes me feel I am making a difference,” said Jennifer Nunzir. “If I can get the child and family to at least smile or laugh, I feel I have already eased some fear and anxiety. It truly is the best feeling to get them smiling and laughing.”  “Through play, conversation, distraction or relaxation techniques, patients cope better, and families are calmer,” added Angie McEvers.  Teaching Every Step of the Way  Education is a crucial aspect in this department. Each Child Life team member works closely with their patient’s care teams to break down “doctor speak” with age-appropriate explanations.   “Children come into the hospital for all sorts of reasons, from a broken bone to cancer; our background in child development and psychology helps us collaborate with the patients’ providers and explaining what each part of the care journey is depending on a child’s developmental level,” said Amanda Cleary. “For example, we can explain what a brain tumor is with playdough and help a child with a new diabetes diagnosis understand what it means to balance sugars using play food. It's all about providing family-centered support so that they feel more in control. I can’t tell you how many times I’ve seen parents’ eyes light up when the kids play. They are all coping, learning and growing together.”  To Help with the Happy and the Sad  When healthcare journeys don’t go as planned, support from care teams is crucial for families facing grief or loss. The Child Life Specialists are one of the first on the scene to provide support for children and their families, providing education on how to talk to children about death and helping families preserve the memories of their loved ones for years to come.  “One of the most difficult things we do is provide bereavement support,” said Angie McEvers. “Not only do we provide support for families of pediatric patients but also adult patients who have children. Our team takes the time to help families with memory making with handprints, journals, books, the list goes on. No one should have to go through this process alone, and we make sure that doesn’t happen.”  Above all else, the Child Life team are here, first and foremost, for the patients and their families. They are the drive that keeps them going – and helps them reinvigorate that passion for their work every day.  “I have met some of the most amazing children and families, and they definitely are what keep me here at Renown,” said Jennifer Nunzir.  The Road to Child Life  The journey to becoming a Child Life Specialist looks different for every team member, and many of them discovered the field while pursuing careers in other healthcare areas. Beyond their passion for children and families – and their Certified Child Life Specialist credential – our Child Life team members are also highly educated in the fields of human development, nursing and psychology, knowledge that benefits them greatly in their career.  Amanda Cleary had the unique experience of pursuing a Child Life career at Children’s Hospital of Los Angeles before she arrived at Renown last year, implementing her knowledge from her bachelor’s degree in human development and family studies into a clinical child life internship and a robust career in Child Life.  “While at Penn State, I learned about the Child Life career path through the Children’s Miracle Network Dance Marathon,” said Amanda. “I knew that this was the path I wanted to take. I did a 600-hour internship, and from there I was hired at Children’s Hospital of Los Angeles, where I stayed for 11 years. As a lifelong learner, I knew I wanted to pursue more – so I achieved my master’s degree online in child life leadership and advocacy at the Erickson Institute in Chicago, and what I learned in that program continues to serve me well in my career at Renown.”  Other Child Life Specialists, like Angie McEvers and Jennifer Nunzir, had already been with Renown for several years in other departments and built up a wealth of healthcare knowledge before discovering their passion for the mission of Renown’s Child Life program.  “I have been here for 23 years; I always knew I wanted to work with children in the hospital because I love kids, and although I originally wanted to be a nurse, I realized that I actually wanted to be on the other side of helping,” said Jennifer. “At the time, I didn’t know there was a job like the Child Life Specialist out there, and I feel so lucky to have found this career. Over the years, as Reno has grown, so has our program, which is very exciting. I knew Renown would be the place where I could grow as well."  “This year is my 24th year with Renown,” added Angie. “Before I worked here, I was an Advanced EMT/Firefighter while pursuing my nursing degree. In working with the medical team from Children's Hospital of Oakland in pediatric hematology/oncology, I was able to see first-hand the benefit of Child Life. I was driven to finish my human development degree and passed my certification testing, and ever since then, I’ve been with Pediatrics, PICU and the Children’s ER.”   We could not have said it better ourselves – this is a field that is constantly evolving and progressing, and while not everyone is familiar with it, our Child Life Specialists are ready to change that narrative.  “There is a lot of opportunity here to continue to grow the Child Life program,” said Amanda. “Not all hospitals have a Child Life program, but we are lucky that Renown does. Any aspiring Child Life Specialist should consider coming here, as it has been a great experience. It is a familial feeling here, and I definitely feel like I am in the right place.”  There is Strength in Numbers  It takes a village to serve the emotional needs of the many children and families that walk through the doors of Renown Children’s Hospital, and our Child Life Specialists are considered some of the key leaders of that village.   The outpouring of support for our Child Life program is astonishing. Not only have our patients and employees made generous donations, but members of the greater Reno-Sparks community are always there ensure kids in the hospital can be kids. The Nevada Wolf Pack, SCHEELS, Great Reno Balloon Race and Atlantis Casino are just a few of the many generous organizations that have donated both toys and time to our youngest patients.  To support any child dealing with a serious illness, especially cancer, Beads of Courage steps in to help children “visually record, tell and own their stories of courage” using beads as a symbol. Representatives from Beads of Courage volunteer their time to help our youngest patients keep track of their valiant fight against their illness, adding a bead to their necklaces after every step in their care journey.  “We rely on our generous community and donations that come in, and we see a lot during the holiday season – we definitely can benefit from this year-round,” said Amanda.  The donations allow the Child Life team to expand their play, coping and distraction opportunities for patients and families, allowing them to reach more children within their small, mighty and growing team of five.   “Our goal as a team is to work with as many pediatric patients and children of relatives seeking treatment as possible, so the opportunity to grow our team would be awesome,” said Amanda.  And grow they will! The team recently welcomed two dedicated Child Life Assistants, Marissa Arriaga and Sydnee Patterson, during Child Life Month. These team members work alongside the Child Life Specialists to help provide opportunities for developmental play, both in the playroom and at the bedside. Marissa and Sydnee ensure that the kids can still be kids, even while they are in the hospital.  Additionally, the Child Life department is currently hiring more Child Life Specialists. If this line of work speaks to you or someone you care about, they are strongly encouraged to apply, because in the end:  "We do it all for the kids,” closes Jennifer Nunzir.

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By taking our pregnancy and birth class, you will gain the tools necessary to have a safe and empowering birth experience for both you and your baby. Chris Marlo, Childbirth Educator at Renown Health explains why birth classes are important. For questions regarding classes or tours, contact Chris Marlo: chris.marlo@renown.org 775-982-4352 What is a Certified Childbirth Educator/Doula? If you are expecting a baby, Renown has a wide variety of classes to help prepare you for birth. Classes are taught by certified childbirth educators and doulas. A certified childbirth educator is a trusted resource who has a passion for educating expecting parents about childbirth, and will provide you with non-biased, evidence-based information. A doula is a professional labor assistant who provides physical and emotional support during pregnancy, childbirth and postpartum. As you prepare for birth, our certified educators will guide you each step of the way and ensure you receive the quality care you deserve.

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