During a cardiac ablation for an arrhythmia at Advocate Lutheran General Hospital in Park Ridge, Ill., Mikayla Kutil, then age 10, suffered a myocardial infarction. Afterward, she became a cardiac rehab patient.
Since children and adults respond differently to the same treatment, the staff and family felt there was a need for a pediatric cardiac program.
For example, adult patients understand the necessity of the rehabilitation program and the lifestyle changes that can improve their health, but a child doesn’t really understand the need, says Mikayla’s mother, Conni Kutil, RN, a pediatric ICU nurse at another hospital.
When Mikayla started the traditional 12-week rehab program, both her mother and the healthcare providers at Lutheran General were challenged to motivate her to complete the exercises three times per week.
The other patients were older, many in their 70s, and the music that accompanied the program was suited to adults, as well. Mikayla was unable to wear her iPod and choose her own music because she had to be able to hear and communicate with those helping her with the exercises. Motivating her to continue with the program became difficult.
For a fifth-grader, using treadmills and stationary bicycles, especially when hooked up to a heart monitor, can get boring. Also, some of the machines don’t fit children’s bodies properly. To alleviate the hurdles Mikayla was experiencing with the adult program, Lutheran General staff developed a new exercise program.
Shawn Schueman, MS, an exercise physiologist, helped design the program for Mikayla and says during her 13 years at the hospital, she has seen only one other pediatric cardiac rehab patient, a 12-year-old girl who used the stationary bike.
“Mikayla was excited to be there with the adults the first two weeks, but then she got bored,” Schueman says. “She began to ask to stop early and found excuses not to be there.”
Terri Drummond, RN, BSN, MA, nurse clinician 3, found that only two pediatric cardiac rehab programs exist in the country. Then she contacted a nurse practitioner who works with Jonathan Rhodes, MD, at Children’s Hospital Boston, which has a pediatric rehab program for congenital heart disease patients. Rhodes provided her with program guidelines and statistics about the epidemic of heart disease and diabetes in children because of lack of exercise and a poor diet.
Cardio for Kids
A team of six people at Lutheran General created the pediatric rehab program. They brought in a Hula-Hoop, Skip It, a basketball for dribbling and passing, an electronic dance mat, and a punching bag to get Mikayla’s heart rate up.
Before beginning the new program with Mikayla, the team put safety standards in place, used guidelines for pediatric advanced lifesaving, and informed all departments they would be working with a pediatric patient.
Other than exercise, the Lutheran General program also includes homework assignments on nutrition and diet based on the MyPyramid.gov program for 6- to 11-year-olds. The team helped Mikayla look at calorie counts and fat content on foods and asked her to check the labels on the food in her school vending machines.
“We tried to help her understand important health issues, such as blood pressure, nutrition, and weight management,” Schueman says.
Drummond underscores the importance of educating children on these topics.
“We are starting to see diabetes and high cholesterol in kids as young as 6 to 8, and we are urging parents to set the example and watch their children’s weight and food choices and be sure they get exercise,” she says.
Mikayla liked the modified program better and completed it successfully. She also built relationships with the older patients, whom she now considers her grandpas and grandmas.
Good for Grown-ups, Too
Janet Duval, RN, BSN, manager of noninvasive cardiovascular diagnosics, was part of the team that created the pediatric program.
“The program helped the adult patients, too, because they realized that people don’t have heart disease just because they are old,” she says. “Everyone has to work hard to maintain his or her health.”
At the end of the 12 weeks, Mikayla was cleared by her doctor to play softball.
Recently, she underwent another procedure to ablate all pathways that were causing the arrhythmia, which was a success with no complications.
Mikayla’s mother says she appreciates all that was done for her daughter at Lutheran General.
“They gave me the freedom to have input into how the program was going,” she says. “At the time, it was difficult, and we didn’t know exactly how it would turn out for Mikayla because of her age. But everyone wanted to be sure that every tool to maintain her health was available.”
Since Mikayla is only the second pediatric cardiac rehab patient Lutheran General has treated, the hospital does not have plans to expand the program.
“We would be more than happy and very prepared to accommodate any age child who needed cardiac rehab,” Duval says. “The volume is just not there to have a formal pediatric program at this point.”