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Preventing Hearing Loss in Kids

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Excellent hearing is crucial to a child’s health and development. Poor hearing, even if mild, can cause problems in communication, learning, speech, and social skills. There are multiple reasons a child may develop hearing loss, including chronic ear infections, trauma, certain medications, and vaccine-preventable serious brain infections like meningitis.

In 2023 the American Academy of Pediatrics released a policy statement concerning one of the most preventable causes of hearing loss—excessive noise exposure, calling this a “largely unrecognized … serious public health hazard”. This type of hearing loss can be temporary or permanent. Over 12% of kids aged 6-19 years and 17% of adults under age 70 have permanent hearing damage from loud noise exposure.

Because children have smaller ear canals, higher frequency sounds are more intense and potentially more damaging. Think of noise as ‘dose-related’; the longer the exposure, the more risk even if just slightly louder than what is considered safe. Sounds over 75 dB for older children and adults can cause damage, depending on length of exposure. Noises we consider routine like city traffic, TV, and lawnmowers can harm children’s hearing. Concern has also been raised about infant sound machines used to help babies fall asleep. Since infants can have damage beginning at 60 dB, it is recommended to keep a noise level at 50 dB or lower, but sound machines may exceed this.

Depending on your child’s age, hearing loss can present differently. They may not meet developmental milestones. A 3-month-old should alert to a sound and babble back and forth. By 6 months, you should hear some consonants (“mamamama”, “dadada”, etc.). A 1-year-old will follow simple directions like, “Look at Mommy!”. Toddlers and older kids with hearing loss may have unclear speech, say “Huh?” a lot, and want the volume of TV or music turned up. Acute loud noise exposure can also cause ear pain and ringing in the ears (“tinnitus”).

Personal listening devices (PLDs) such as iPods, smartphones with earbuds, and headphones for watching TV can magnify the risk. The World Health Organization estimates 1.5 billion people worldwide are risking hearing damage from ‘unsafe listening practices’.

We can start early to protect our child’s hearing. Checking decibels in your child’s environment is helpful although decibel apps on phones are not 100% accurate. Anything over 85 dB can harm an adult’s hearing, and over 70 dB can impact a child. The louder the noise, the faster it can cause damage. 

Infant sound machines should be at least 7 feet away from a baby and at 50 dB max. Consider avoiding loud noise exposure (concerts, fireworks, etc.) but if unavoidable, younger children can wear sound protecting earmuffs (plastic cups connected with a headband) over their ears. Ear plugs are safe for older kids and there are different types; ‘musician earplugs’ dampen volume yet preserve audio quality better than foam earplugs from the drugstore.

Be a good role model by setting good rules for hearing protection and wear ear plugs yourself when appropriate. Set clear expectations for protecting every family member’s hearing. Loud background noise can also be distracting, worsen a child’s mood, and disrupt learning, so routinely having a quiet home at times can be a benefit. If you have concerns, talk to your child’s health care provider about getting a formal hearing evaluation by an audiologist.

more about The contributor

Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Indoor Activities with Your Child

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It is great for everyone to get outside daily but sometimes we are stuck inside, often due to stormy weather or extreme cold temperatures. It may be easy to default  to ‘screens’ like video games, iPads, and scrolling on smartphones, but there are lots of things your child can do that involve creativity, brainpower, and just simple play. Use your judgement with the following activities depending on the age of your child.

Art- In addition to drawing and painting, don’t forget Play-doh (home-made Play-doh recipe on-line), cut or torn paper, collages, etc.

Baking (with good supervision of course)

Crafts- Local craft and dollar stores have inexpensive materials appropriate for different ages. “C” can also be for ‘Charades’, the classic guessing game.

Dancing- Put on the classic music you grew up with and rock out with the kids!

Eggs- Use paints or markers to decorate the shells of hard-boiled eggs.

Fort- Let you child get creative making a fort of boxes, blankets, chairs, etc.

Giggling- Tell jokes, riddles, do hand clap routines, etc.

Hair- Have fun with wacky hair styles for the kids (and maybe for you—let them play hairdresser!).

Indoor scavenger hunt- Give kids a list of colors, shapes, and specific items to look for in one room or small area of the house.

Jump rope- This is great indoor exercise if you have enough space.

Kitchen duty can be fun when kids come up with a (simple) menu and you prepare food together.

Listen to music- Consider exploring music of different cultures and parts of the world.

Make music- Use real instruments or pots and pans, shaking a jar of beans, etc. Have a musical parade through the house- noisy but fun!

Necklace– Dye tube-shaped pasta using a small amount of food coloring mixed with white vinegar and let dry. Thread on yarn for a cute necklace (make big enough to go over the head).

Obstacle course-Your child can create a course with cardboard boxes, towels as ‘water’ to be jumped over, a length of string as a ‘tightrope’, throw pillows as rocks to be stepped on with the floor as ‘hot lava’, etc.

Pretending- Kids love to pretend, whether it is acting out a fairy tale or pretending to be a teacher. Endless options!

Quiet activities like puzzles and Legos are a nice way for your child to play independently.

Reading- The reader (either you or your child) can use funny voices and exaggerated emotions which make it very entertaining. Or try Racing in unusual ways: crab-walk, bunny hopping, while holding a big spoon of water, etc.  

Seal, swan, snake- Take turns acting like different animals and see if others can guess which critter is being imitated. Also do some ‘Science experiments’—you can find many ideas on-line.

Tell stories about when your kids were little or make up stories together about adventures their stuffed animals might have. There is a lot of guidance on-line for storytelling.

Uno or other kids’ card games are simple, fun and can encourage good sportsmanship.

Vet office for stuffed animals- Set up a pretend animal clinic- use a flashlight and other household items as ‘instruments’ to examine the ‘patients’.

Writing letters- Teach your kids this ‘lost art’ and let them experience how happy the recipients will be to get an actual letter!

X marks the spot- create a simple map of one room in the house and hide ‘treasure’ (small things like fridge magnets) and put an X on the map for their location. See how your treasure hunters do without too much help.

Yarn- Kids can learn finger knitting, crocheting, or standard knitting with on-line instruction.

Zinnia seeds- Plant zinnia or other (small) flower/ herb seeds in cups with seed or potting mix. A small UV light or a spot on a sunny windowsill will be needed once the seeds sprout.

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Medicare Advantage Plans

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Medicare and Medicare Advantage can feel overwhelming to navigate. While the monthly premium for a Medicare Advantage plan might be lower, if you get sick, need to be hospitalized, have surgery, or require specialized care, you may end up paying more compared to Original Medicare with a supplement.

Unlike Original Medicare, which is widely accepted, Medicare Advantage plans usually work in a narrow network, with a limited number of specialists. Medicare Advantage plans direct you to only those doctors they have contracts with. These specialists may not be your first choice, or your doctor’s first choice, and may require you to travel significant distances for care that is available locally.

Another difference is that Original Medicare rarely requires prior authorization for services. With Medicare Advantage plans, the insurance company often requires approval for care before it can be scheduled. Kittitas Valley Healthcare (KVH), and many other healthcare providers, have found it difficult to get these approvals from the insurance company. Your care has a higher chance of being delayed or even denied, with Medicare Advantage. A 2022 report from the U.S. Department of Health and Human Services Office of Inspector General (OIG, 2022) found that many Medicare Advantage plans denied necessary medical services that should be covered under Medicare rules.

Finally, Original Medicare offers the same coverage nationwide. However, Medicare Advantage plans may only provide specific coverage in certain areas. If you move to a new area or travel outside your current service area, your Medicare Advantage plan might not have providers available.

The Medicare Open Enrollment period runs from October 15, 2024, to December 7, 2024. We encourage you to explore all your options, including returning to Original Medicare. While Kittitas Valley Healthcare is contracted with a few Medicare Advantage plans, we recommend that our Medicare-eligible patients choose Original Medicare with a good supplemental insurance plan.
Selecting the right Medicare plan can be complicated and confusing, but there are excellent insurance brokers in Ellensburg who can help. We suggest using a local medical insurance broker for any questions you may have.
You can also find assistance by navigating to: www.insurance.wa.gov/about-shiba-services.

KVH is committed to providing health care services to all persons in need of medical attention regardless of ability to pay. You can find our full Financial Assistance Policy on our website at www.kvhealthcare.org. If you have any questions, please reach out to our Patient Financial Services Department at 509.933.8657. Thank you for choosing KVH at Your Home for Health.

Michele Wurl
Kittitas Valley Healthcare
Chief Communications Officer

Mealtime without Screens

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Contributor Dr. Elise Herman

Mealtime should be a time to connect with our kids and enjoy healthy food in a stress-free environment. This idealized version is not always the case, and for many reasons, kids may end up eating in front of the TV, laptop, iPad, or smartphone. There are multiple problems with this—for both adults and kids.

Obesity:  In general, kids eat more in front of a screen. Some parents are happy to see their child (especially if they are a picky eater) eating more but being distracted while eating means eating mindlessly. This can lead to overeating in the long run since kids don’t pay attention to feeling full and therefore overeat. Research has shown that children who watch a screen during meals are more likely to be overweight.

Digestion: Digestion is aided by really noticing the aromas, the preparation and the sight of food. If attention is more on the screen than the food, digestion can suffer.

Missed social opportunities: When eating alone and watching a screen, kids miss out on connection with others over a meal, learning to make conversation and basic etiquette (taking small bites, not talking with your mouth full, etc.). Mealtime is a chance to slow down, enjoy our food, and socialize. You can model all of this to your child if you eat together, undistracted—powerful stuff!

Exposure to commercials: Commercials during kids’ programming are often for fast food or processed foods high in sugar and calories and aimed specifically at children. Not surprisingly, screen time during meals is associated with increased junk food consumption.

So how to change this behavior in your house? Anticipate that it may not be easy (for either of you) to break this habit, but keep in mind how important this is and stay with it. Here are some suggestions:

Make change gradual: Target one meal at a time, either eliminating screens altogether for that meal or decreasing the time. Substitute music, conversation, or reading books to your child (not having an app read a book). Starting with a no-screen snack is an easy way to begin.

Adults adopt the change, too: No screens for adults as well at mealtimes, not even to text. You can tell your child this is hard for you, too, but you know how important it is for everyone to make this change. Explain your plan to other adults who may provide meals (childcare, sitters, grandparents) so they are also on board with this—consistency is vital for success.

Follow a schedule: Eliminate screens at one meal or snack every 1-2 weeks and you will accomplish the overall goal within 1-2 months. Talk about how different mealtimes are now that you are connecting and eating more mindfully.

Be firm: Don’t give in to tantrums or your child eating less. This behavior will be short-lived, so don’t let it throw you off track. You can however have some occasional exceptions such as snacks while watching sports, but these should be infrequent.

Children age 8-12 in the US look at screens for 5 ½ hours daily and teens spend an average of 8 hours a day on their devices—pretty stunning statistics. Kids who watch a screen during mealtime spend more time on devices overall. Changing this behavior is a good place to start to take control of the excessive screen use in most of our lives.

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Returning to School After an Illness

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Contributor Dr. Elise Herman

As kids head back to school and are together in classrooms again, parents know their child may pick up some illnesses. There are times when it is appropriate to keep sick children home, both for their own recovery as well as protecting fellow students and school staff. Students should be showing signs of improvement before returning to the classroom. Below are helpful guidelines for different illnesses your child may encounter as we move into fall and winter.

Fever: In general, kids should stay home if they have a fever over 100.4 degrees Fahrenheit. They may return to school if it has been about 24 hours without a fever (and no fever-reducing medications like Tylenol or Ibuprofen given).

Colds, RSV (Respiratory Syncytial Virus), COVID, and Influenza: if cough and congestion are mild and there is no fever, kids may stay in school. If they have a fever, follow the above guidelines. If your child has a more persistent cough or is very fatigued, keep them home until they are improving. When they return to school, kids should wear a mask for up to 5 days after becoming sick to protect others.

Gastroenteritis (Vomiting and Diarrhea): Kids should stay home if stools are very watery and hard to control (this may depend on the age of your child). If it has been hours since the last vomiting episode and the child is now keeping down liquids and solids, they may return to school.

Strep Throat: Children diagnosed with strep throat may return to school if it has been 12-24 hours since starting antibiotics and they are feeling better. Make sure they are drinking and eating adequately, too.

Pinkeye (conjunctivitis): If eye discharge is thin and watery with pink eyes, this infection is most likely due to a virus and no treatment is needed. This should resolve on its own within 5-7 days and your child may stay in school (be sure to review good hygiene to prevent spread). If eye discharge is thick, green/ yellow and eyes are very red, call your child’s provider since antibiotic drops or ointment may be appropriate if the cause is bacterial. Kids can return to school about 24 hours after starting this treatment.

Chickenpox (varicella): Chickenpox is less common now with effective vaccination, but if it occurs, all sores should be dry and crusted before returning to school.

Impetigo: This common skin infection may be treated with topical antibiotic cream or oral antibiotics. Kids can be in school once treatment has been started.

Hand, Foot, and Mouth Disease: This viral illness causes painful sores in the mouth and small blisters on the palms and soles. There often is fever and a body rash, too. Children should stay home till they are drinking and eating well and fever-free x 24 hours; the rash does not need to have resolved since that can take 1-2 weeks.

Lice, scabies, and ringworm (tinea): These infections are very common in school-age kids, and children may return to class after treatment is begun. Kids do not need to be ‘nit-free’ to be in school.

Make sure your child is up to date on vaccines to prevent common and potentially dangerous illnesses, including COVID-19 and influenza. Remind your child about handwashing and good hygiene– and be a good role model with this! Call your child’s healthcare provider if you have concerns about your child’s illness and return to school. Policies about returning to class may differ between school districts; many school districts post their policy online. Your child’s school nurse is an excellent source of information if you still have questions.

Resource

https://www.cdc.gov/orr/school-preparedness/infection-prevention/when-sick.html

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Safe Sleep Initiative

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Watch video in Spanish

Cribs for Kids supports families in need nationwide in obtaining separate, safe sleeping spaces for their babies. To serve communities nationwide, we partner with local agencies to distribute Cribs for Kids Cribette Portable Cribs to their communities. If you or someone you know is in need of a safe space to sleep for their baby, search on the map below to find the closest Cribs for Kids Partner in your area. 

Local Resource

Kittitas County Coroners‘ Office has partnered with Cribs for Kids® National Safe Sleep Initiative to Help Prevent Infant Mortalities since 2020. Please visit Cribs for Kids website (https://cribsforkids.org/) for more information.

Find a Crib Provider

Obtain a Cribette portable crib from a Cribs for Kids Partner in your area.  

Resources

How to Help Your Child Make Friends

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Contributor Dr. Elise Herman

As kids head back to school, it is easy to focus on the academics, but the social side of school, including friendships, is very important to a child’s development and overall success. You can help your child with the skills of making friends, keeping friends, and being a good friend, all vital to building social connections at school and beyond.

As the parent, you can be a good role model. Be friendly and social when you are out and about (and put away the phone, of course). Make conversation and express curiosity when interacting with others. At home, encourage conversation at the dinner table, taking turns asking and answering questions (again, no phones around). Having family game night or doing chores together teaches kids how to interact within a group. Let your child know that bragging and teasing will push other kids away.

Some kids need help reading others’ facial expressions; this is a skill that you can teach your child and practice at home. Active listening makes the other person feel heard and can be achieved with eye contact and verbal affirmations such as “uh-huh”, “yes”, and “tell me more”. Kids should also take turns speaking and let someone finish before jumping in and interrupting.  Role playing with your child for greetings, introductions, and conversation can help them feel more confident in social situations.

Bonding over a common interest or activity happens naturally, so encourage participation in clubs, sports, and other groups.  Arranging a playdate at a park or some other ‘neutral’ location is a great way for kids to build relationships. If there is a fellow student your child has mentioned positively, you may be able to reach out to their parent at school drop-off or a school event and discuss a get-together.

Help your child work on emotional regulation so interactions with other kids are positive and without anger or tantrums. Communicating calmly about feelings and stepping away briefly if upset are helpful strategies. Remind your kiddo to ‘let little things go’ and avoid being petty. Explain that annoying behaviors such as poking, imitating, and not respecting personal space can be very off-putting.

It is said that the best way to have a friend is to be one. Ask your child what they would want in a friend—and have them brainstorm how they can be that special person for someone else. Be positive about their efforts to master the important social skills needed to create friendships; this comes easier to some kids more than others. If your child is really struggling in this area, you may want to speak with your child’s health care provider or counselor.

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Healthy Habits: Healthcare is evolving to meet the needs of patients

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Written by: Michele Wurl, Chief Public Relations Officer at Kittitas Valley Healthcare

As healthcare demands rise, organizations like Kittitas Valley Healthcare are developing innovative models to serve communities more effectively.

The Partnering Physician Model is one such innovation, designed to address the shortage of healthcare providers while enhancing patient care.

This model centers on a team of physicians and Advanced Practice Clinicians (APCs), including Nurse Practitioners and Physician Assistants, collaborating to care for patients.

In addition to the Partnering Physician Model, Kittitas Valley Healthcare (KVH) has implemented community-based care programs, specifically tailored for those unable to visit traditional healthcare settings. These programs provide support to some of the most medically complex homebound or home-limited patients in society. These patients typically have no continuous follow-up care, which continues the cycle of poor health management and is even more expensive and exhaustive for patients and their caregivers.

For family caregivers, it brings support and peace of mind. Caregivers often say that it is very reassuring to know that a caring home-based primary care provider is one phone call away, versus having to call 911. In Kittitas County, the community-based care programs include Home-Based Primary Care, Home Health, and Hospice care.

Home-Based Primary Care brings medical services directly to home-bound patients at their personal residence, or in skilled nursing facilities, assisted living, or adult family homes. This program covers a range of services from managing chronic conditions to end-of-life counseling, emphasizing continuity of care. It is a lifeline for vulnerable patients, ensuring they receive comprehensive medical care despite their limitations.

Home Health is another essential program, offering treatments and rehabilitation to homebound patients as ordered by their primary care provider. This service helps patients recovering from surgeries, accidents or chronic illnesses regain independence.

The Home Health team includes registered nurses, home health aides, and therapists, who work together to offer various services such as medication management, physical therapy and patient education. With 24/7 on-call nursing, patients and their caregivers can rely on constant support.

Hospice Care rounds out KVH’s community-based offerings, focusing on patients with terminal illnesses. This compassionate service emphasizes palliative care and enhancing the patient’s quality of life in their final days.

Hospice care also provides critical support to families, including bereavement counseling, spiritual care and respite services. The multidisciplinary team approach ensures that patients and their loved ones are cared for holistically, with services that range from pain and symptom management to spiritual support.

These programs reflect KVH’s commitment to meeting the evolving healthcare needs of the community. By bringing care directly to patients, KVH alleviates some of the pressures faced by traditional healthcare facilities, while ensuring that vulnerable populations continue to receive high-quality, personalized care.

As the healthcare landscape continues to change, innovative models like the Partnering Physician approach and community-based programs will be essential in addressing the growing demand for medical services. KVH is leading the charge in Kittitas County, showing how healthcare can evolve to meet the needs of patients wherever they are.

Home Again: The old Cle Elum Hospital operating lamp’s journey back to Upper County

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On September 27, 2022, a large crate with the words, “FRAGILE” imprinted on the side arrived at the KVH loading dock. So large that it had people guessing what could be inside. An item of this size wasn’t expected to arrive. Affixed to the outside of the pallet was a small 4×6 photograph of the contents…a large operating lamp from the old Cle Elum Hospital. As it was carefully opened, there was a handwritten note inside with such penmanship as was hard to distinguish every letter. It read, “Our family is so pleased to donate this piece of Cle Elum history to your hospital. The Fassero family were pioneers in Cle Elum…Peter Fassero was born there in 1905. After raising a family with his wife, Mary (children Delona & Donn) Peter retired and sold his Economy Grocery Store and Wrote weekly columns in the Tribune.”  The lamp had been a gift to the family upon Peter’s retirement. After his passing, the family felt it was only right to donate it back to its home. As layers of bubble wrap, shrink wrap, and many, many layers of tape were moved aside, a beautiful operating lamp from the 1930s was discovered.

The lamp was long and slender with a bulbous counterbalance on one end. This was to help keep the lamp steady during procedures as it was hung from the ceiling. Along the slender metal body, were found two switches protruding from metal casing looking every bit of their nearly 100-year-old age. At the base of the long, slender portion, it began to branch out, almost like tree branches but looking more alien as the moments went along. A large lamp surrounded by what looked like a metal colander was the centerpiece. On either end of this lamp was a framework that supported three individual mirrors angled just so, making six mirrors in all. Inside the center lamp was an intricate series of small mirrors that seem to be angled to refract the most amount of light from a single light bulb as possible. One can imagine it hanging in place and providing enough refracted light for the surgeon to see even the tiniest detail while miners, loggers, and farmers were lying on the table as families hoped everything was going to be alright.

The lid was carefully closed, and the crate was moved to storage, tucked away for safekeeping. Kittitas Valley Healthcare had a large, cast iron, vintage operating lamp with no immediate plan.

In 2024, the KVH Family Medicine – Cle Elum decided to revamp its lobby. This plan involved updating the wall hangings and removing the too-faded photographs that had become hard to distinguish, to hang posters that share the KVH values reminding patients and visitors that we all have a unified goal across all clinics, and to make it feel warm and inviting once more. With the posters hung, and old faded photographs from the area removed, the clinic was missing something. It was missing the people. It was missing the people and places that brought life to the Upper County in the first place. Turning our attention towards bringing the history back to the walls, the Central Washington University Archive was contacted. They supplied hundreds of images from all of Upper County. Combing through these images was like being transported back to a time when people worked hard out in the elements every day, where large parades celebrated culture and holidays, where boys and girls basketball teams played after school, where new inventions were tried out, and where the culture of the Upper County began.

Two large frames were secured to the walls with many photographs from that time, courtesy of the CWU Archive. They are like stepping back in time and reconnecting to the life that is rooted in that place. But something was still missing, the operating lamp. With careful planning and approval, the lamp made its way back to Cle Elum where it oversaw so many medical moments in the history of Upper County. It was headed back to where it belonged. On July 24, 2024, the lamp made its journey to its destination. After some unique engineering, it was suspended from the wall right next to the archive photos of people who may have seen it long ago. It points towards every patient who walks into the clinic doors welcoming them to take a step back in time. To the Fassero family, we thank you. We will be good stewards of this donation. To the community, our clinic is feeling just a little more complete today. The lamp has made its way home at Your Home for Health. 

Kristl Densley, Marketing Coordinator
Kittitas Valley Healthcare