Sunday, 4 March 2012

February at IPWSO



February has been busy, as usual.  We have had several requests for help and been able to send information and network with other professionals in a bid to help our families across the world.

A 26 yr old woman with PWS living in Kuwait who has had little or no support throughout her life.  At this time we don’t have educational material in Arabic, so we contacted one of our consultants in the States who is now following this case and supporting the medical professionals.  We had a similar case in Sudan which has brought up the same problems of having no educational material in Arabic available yet.

We sent information to a doctor in New Delhi about bariatric surgery in PWS, and supported another enquiry from India with a free diagnosis at BIRD for a 20 year old patient with a clinical diagnosis of PWS.  Our professional delegates in Lithuania and also Guatemala requested instructions on sending blood samples to our lab in Italy for a suspect case of PWS. 

In Malaysia, we were delighted to learn of the first gathering of PWS families in Kuala Lumpur on 19th February.  This coincided with a new contact from Malaysia needing help and we were able to put them in contact with our professional delegate, and the new family gathering.  They were delighted and relieved as the only information they’d been able to receive was in Singapore, which meant the financial cost to the family was quite high.  

We had a request for information for medical references from an English family living in Dubai, butthis is another area where we are in the early stages of trying to build professional networks.  We sent her our packages of information.  Other educational and support information was sent to Porto Rico where they are keen to establish a parent support group in her country, and educational information was sent to the PWS Association in Colombia.
Our parent delegate in Spain put us the following question: ”We have problems here in Spain because some doctors do not allow GH therapy on several children with PWS that are only 11-14 years old. What is happening in the rest of Europe or the world? Do you know?”  His request was sent out to most of our member who immediately replied to him.

On Leap Day, February 29th, BIRD organised a wonderful event in a beautiful theatre in Vicenza (Italy) to celebrate the International Rare Diseases Day.  Over 1,000 students and their teachers from local high schools participated.  Giorgio gave a short talk about his experience as a parent, then sang "Ich Auch" (listen here) at the end, with great success!
 
Finally, we are indebted to our wonderful supporters who have lit candles to help IPWSO continue its work across the world – we thank you so much for your graciousness and generosity.  You can check on the candles by going to our Light A Candle for IPWSO page.

 


One of IPWSO's three information packages:  General Awareness, Medical Awareness, and Crisis Intervention



Invoices for membership fees 2012 have been sent out, and the following member countries are now subscribed for this year:
  • Australia
  • Finland
  • France
  • Germany
  • New Zealand
  • Norway
  • Slovakia
  • USA

Friday, 17 February 2012

What we do...

 
I think it is so interesting to see that the problems we may face with our own child, are often exactly the same as those all over the world.  Proving that we are one big family, I thought you would like to see the contacts our CE (Giorgio Fornasier) made during last year.  The list is long, and it will always be endless, but by contacting us here at IPWSO we can find someone, somewhere in the world who will be able to help...

Argentina:
A desperate mother from Mendoza (Argentina) with a daughter with severe obesity and behaviour problems contacted our office. We copied her message to PWSA Argentina and asked Dr. Linda Gourash to help. She was very kind, contacting the mother in Spanish and sending her articles. Also Fernando Briones, President of Madrid PWS Association, contacted this mother and offered assistance and information material in Spanish.
Brazil:
We assisted a mother in Brazil asking for information and sent her all files we have about PWS in Portuguese. After ESPE a doctor from Brazil contracted us and accepted to be the professional delegate for his country.. This can be a good start to try to get this important and complicated country organised again:
Bulgaria:
We received a request from our professional delegate and sent her all files included in our educational packets by email, which were duly received. We hope they are going to translate them in Bulgarian.  We assisted Dr. Violeta Iotova from Bulgaria and gave her information about GH through our Scientific Advisory Board.
China:
It is good to know that we keep our contacts in China active and doctors representing IPWSO do appreciate the scientific articles we send them by email almost every month.  We have the Medical Alerts booklet available in Chinese in pdf format now and will probably print a few hundred for distribution at next ESPE in September 2012.
Colombia:
We received positive news from Colombia, as there are new mothers who seem very active in their support group or association. We sent them some articles in Spanish and put them in contact with our friends in Spain.  Our parent delegate in Colombia needed urgent assistance for a couple of cases she had and our advisors helped her promptly, together with the precious help of Madrid PWS Association as well.
Georgia:
Georgia is a new IPWSO member. We have been following this country for a long time and assisted with providing free blood samples through BIRD.
Hong Kong:
Hong Kong is a new IPWSO member.  We have been following a very positive contact with a family through PWSA USA. We are lucky, because both parents are also physicians so they can cover both delegates’ positions, as we have in Cuba and Mexico.
Hungary:
Our parent delegate in Hungary informed us that they participated to a transmission on PWS that was broadcast by national TV. Dr. Aurelia Szekely from the Romanian PWS Association accepted their invitation to give the short live report in the studio. On 23.07.2011 we received an email with a lovely group picture saying that they were very happy to inform us that they established the Hungarian Prader-Willi Association.  A doctor from Hungary came to our booth at ESPE in Glasgow and delivered 11 blood samples of 11 patients to make free methylation tests at BIRD.
Iran:
PWSA USA copied our office a message they received from a lady in Teheran, who was very worried about her step-daughter’s behaviour. We sent her some articles on PWS and copied her message to our professional delegate in Teheran for further assistance. Dr. Linda Gourash assisted her directly and we mailed this mother a copy of the DVD “Food & Behaviour”.
Jamaica:
We received a message from a doctor in Jamaica saying that she is following an 8 year old child that has many clinical features of PWS. She informed us that unfortunately the methylation test is not available in Jamaica.
Japan:
We had several contacts with Japan after the earthquake and Tsunami they suffered. We expressed our solidarity and copied our delegates the many messages we received from all over the world.
Libya:
We received an email from a desperate mother in Tripoli. Due to the civil war there, we could only give her the name and address of our professional delegate in Tripoli.
Macedonia:
We had a case of a girl with PWS in Macedonia who needed urgent treatment in a rehabilitation centre in Europe. We gave her first assistance and asked for help from Norbert in Germany.  The young girl was able to go to Germany for some months and Norbert’s organisation covered all her expenses. Her mother is now our parent delegate in this country.
Montenegro:
Following a contact with PWSA USA, we assisted a mother in Montenegro who needed a doctor speaking Serbian to follow her daughter. We had several emails and we understood each other using the Google translator. Our professional delegate in Bosnia Herzegovina was very helpful too.
Russia:
We received an email from Russia from a father saying they have a confirmed diagnosis of Prader-Willi syndrome. In Russia there is not enough literature about this rare disorder so he asked us to provide as much information as possible (in English) about the treatment of diabetes mellitus II and morbid obesity for patients with PWS. We sent him all material we have in Russian and gave him the address of our professional delegate in St.Petersburg .
Saudi Arabia:
We established good contacts with a doctor who works at the Obesity Research Center of King Saud University, located in Riyadh, Saudi Arabia. In their clinic they have seen many patients with PWS. They are now starting a local support group and asked if we can guide them or give them some advice and assistance.  We also assisted Dr. Suzan Mushcab from Saudi Arabia who asked about a center in Europe that can handle hypothalamic obesity post craniopharyngioma surgery.
Serbia:
Through PWSA USA we got in touch with a mother from Serbia who needed information and assistance in her language. Our professional delegate in Bosnia Herzegovina Dr. Alma  
Toromanovich offered to help.

I know many of us will remember the time before email and that we actually hand-wrote letters and posted them, but I don't know where we would be today if we never had that wonderful invention of @.

Sunday, 5 February 2012

It's always about the food...

Here it is, Sunday early afternoon, and I hear, "Is someone coming down for lunch, or are we just not eating today?"  It's my daughter, the one with PWS.  I know I won't be able to finish this blog until she's had lunch... so...

Later:   This week has been a little tiring insomuch as food has been even higher on the list of priorities.  We've had a wedding and a baptism to attend and, of course, this is always around food in one way or another.  I remember when she was very little, before she was diagnosed, we went to Church one Sunday, and I took her up to Communion whereupon she thrust out her hand to the Vicar and demanded to be fed, "I want bread!  I want bread!".  Unfortunately, at the same time, she upset the chalice of red wine all down his white cassock.  I didn't know quite where to put myself and quickly carried her down the aisle to our seat, with her demanding very loudly all the way back, "I want bread! I want bread!"  I don't think it went down all that well with either the Vicar or the congregation.

Trying to avoid food issues is a huge struggle for most of us: parents, caregivers, family or friends - whoever the person with PWS is with, and it is quite possibly the most tyrannical issue to deal with.  Society demands that food is a natural part of socialising.  As our sons/daughters get older, they know this and adapt their tactics accordingly... they know that in a crowd of people, parents are less likely to refuse them food as the thought of a socially embarrassing outburst is not what they want.  My daughter, particularly.  What's more, she's extremely adept at manoeuvering her way out of sight, and picking her times when I'm deep in conversation. I find social events a huge trial and would rather stay home than face the test!

Last week as we were struggling to reach 35 lengths (walking) up and down the pool, the chief topic of conversation was, yes, food.  It's all about what she wants me to buy, whether I have this, or that on the grocery list, when I'm going to get it, what looks as though it's about to run out etc.  Whenever she comes shopping with me, and this is something I do try to avoid if at all possible, I notice that she always puts two of whatever into the shopping trolly.  Two packets of this, two packets of that.  I always take one out, saying we won't starve and the car won't break down, so we can always come back.  But she seems to harbour this inate fear of running out of food and won't stop her habit of storing.  She also has a cat which is here with us at the moment - that cat has such a backup of food that I swear we could feed all feral cats within several miles.

I asked her the other day whether she felt full after her meal.  She said she did.  She knows the difference between feeling hungry and feeling full, or even just feeling ok.  She can even hold off and wait for a meal if she's busy doing something else.  Once all the food has been cleared away and cupboards locked, she doesn't food-seek or ask for food until she judges it time for her meals.  But she is a fully-fledged opportunist and should any opportunity for accessing food arise, she will take it.  So, it's always a situation of being 'on guard', locks secured, guests warned, and situations scanned for any weak spots. 

I know it will never go away and I know I will never hear the truth about what happened to the packet of biscuits left out on the bench, and I know there will still be slip-ups with who's got the key, and I realise I will never get the better of the social situations either, but it's amazing how quickly you learn to to use those eyes in the back of your head, practice your own sleight of hand, and to lie, yes, outright bareface lie, about things to do with food.

Monday, 23 January 2012

In Hindsight...

IPWSO's work around the world continued to expand throughout 2011, with hundreds of emails, requests for information and for help, particularly from countries where no help is available.  This meant that IPWSO's offer of free diagnoses was taken up by countries such as Algeria, Cyprus, Hungary, India, Iran, Morocco, Nicaragua, Pakistan, and Paraguay.  It is one of the best services IPWSO can offer - and we follow this through with information and support.  We also try to encourage new countries to become associate members and appoint a professional and parent adviser.   Thus, in  2011, our membership reached 97 countries.
With this expansion, we appointed two new board members: Anil Choubey from India and Jose Garcia from Chile.  Having such a widespread board means we can reach further into countries where help is needed - plus, it gives the board about 8 different languages!
Every cloud has a silver lining - so they say... well, IPWSO's biggest cloud was the decrease in financial support from major sponsor,  Pfizer.  We knew it was going to happen "one day", but finding global funders is extremely difficult - more so in this economic climate.  It was suggested that we do our own fundraising, "Light a Candle for IPWSO" and, to our great delight and endless gratitude, we have received fantastic support - you can see for yourselves just who has been 'lighting our candles' for us - this was our silver lining!

Suzanne Cassidy, President IPWSO


In May, 2011, the board held an extra-ordinary general meeting, mostly to set our budget and priorities for this year, and to look at how we can continue to support our member countries.  Pfizer still supports IPWSO at global ESPE conferences where we have an information booth  -  this is where we pick up our new member countries, spread the PWS word and make new and valuable contacts, and this will continue, but IPWSO will no longer be able to cover the costs for board members or officers or other experts to travel as much as before, until our financial situation improves. 
Giorgio & Janalee at an ESPE booth
This year IPWSO was present at two ESPE meetings, one in Scotland and the other in Czechslovakia.  These booths are very well attended - for two reasons, one, because information on PWS is very much sought after, and two, because Giorgio is so well-known that he is greeted as an old friend.  Everyone stops by to say 'hello', to catch up with new information, and to offer their support.  With Janalee's medical expertise and knowledge, IPWSO is unique and can continue to make its presence felt, thanks to Pfizer's continued support for this project.
As 2012 starts to get a grip on things, we can welcome in the Year of the Dragon which is supposed to be one of the most financially propitious years ever, full of drive, vigour and energy!  We're looking forward to that already! 

Tuesday, 20 December 2011

Twelve Days of Christmas

On the first day of Christmas,
my daughter said to me,
"Just when are we putting up the tree?"

On the second day of Christmas,
my daughter said to me,
"I need some cash,
and when are we putting up the tree?"

On the third day of Christmas,
my daughter said to me,
"You won't be on my list,
I need some cash -
and when are we putting up the tree?"

On the fourth day of Christmas,
my daughter said to me,
"Take me to the shops,
or you won't be on my list,
I need some cash -
and when are we putting up the tree?"

On the fifth day of Christmas,
my daughter said to me,
"What can I do......
take me to the shops,
you won't be on my list,
I need some cash -
and when are we putting up the tree?"

On the sixth day of Christmas,
my daughter said to me,
"I hope we have some turkey,
but what can I do.....
take me to the shops,
you won't be on my list,
I need some cash -
and when are we putting up the tree?"

On the seventh day of Christmas,
my daughter said to me,
"I also want some pudding,
I hope we have some turkey,
but what can I do.....
Take me to the shops,
you won't be on my list,
I  need some cash -
and when are we putting up the tree?"

On the eighth day of Christmas,
my daughter said to me,
"There'd better be some icecream,
I also want some pudding,
I hope we have some turkey,
but what will I do.....
take me to the shops,
you won't be on my list,
I need some cash -
and when are we putting up the tree?"

On the ninth day of Christmas,
my daughter said to me,
"I hope we're having jelly,
There'd better be some icecream
I also want some pudding,
We'd better have some turkey,
but what will I do......
take me to the shops,
you won't be on my list,
I  need some cash -
and when are we putting up the tree?"

On the tenth day of Christmas,
my daughter said to me,
"Why are you tired,
You'd better get some jelly,
There'd better be some icecream,
I also want some pudding,
We must be having turkey,
but what will I do.....
Take me to the shops,
you won't be on my list,
I  need some cash -
and when are we putting up the tree?"

On the eleventh day of Christmas,
my daughter said to me,
"Mum, you can't lie down,
Why are you so tired,
You'd better get some jelly,
There'd better be some icecream,
I also want some pudding,
We must be having turkey,
but what will I do......
Take me to the shops,
you won't be on my list,
I  need some cash -
and when are we putting up the tree?"

On the twelfth day of Christmas,
my daughter said to me,
"What is Santa bringing,
Mum you can't lie down,
Why are you so tired,
You'd better get some jelly,
There'd better be some icecream,
I also want some pudding,
We must be having turkey,
but what will I do......
Take me to the shops,
you won't be on my list,
I need some cash -
and WHEN ARE WE PUTTING UP THE TREE?"

Saturday, 17 December 2011

“If you fight for your dream, one day, the dream will fight for you, too….”


Dorica Dan

NoRo - The story of a project

This is the story of one mother's fortitude and strength that literally took her around the world and ended with her establishing not only the wonderful partnership between Romania, her country, and Norway, but also her strongly commited work with EURODIS.

Dorica is also on the board of directors of IPWSO.  Her commitment through her daughter is not only extremely courageous, but an example for us all...


It’s interesting to tell the story of a project that is very close connected to your own life project… It is certain that our approach to others is more because of sharing the same thoughts and less about the way of living. We make ​​friends not because we all necessarily meet  on the same intellectual level,  but because they responded positively to a set of questions considered relevant to follow up a friendship. We did not even ask if they want to be our friends. We talked with them, we met, we shared the pain and joy, and so we tied our lives together.

It was the same when we got to the conclusion that we could really do this, here with this center in Zalau with the support of the Norwegian partners. Not because of some theoretical principles, not because someone or some institution has declared their support, but because this project created the same enthusiasm and belief in us and in partners. To believe in something does not mean you always are convinced by an amount of information, and sometimes I'd say that we even ignore part of the information to keep the dream alive…

Only if you follow your dream, can you reach it!

It is a very interesting feeling to analyze how it happened and which facts concurred to the achievements you had in your life. As a person that never believed in having any kind of “leadership” skills, I think that now I am doing a pretty good job for the team that we have created in this project…

But, let’s start with the beginning!

My daughter was diagnosed with Prader Willi Syndrome when she was almost 18 years old and we wanted that nobody else to face an unknown diagnose any more. As a result of the struggling to find information about the diagnosis and to trace other families having member with this diagnose I created the Romanian Prader Willi Association – RPWA in May 2003.

In 2004 I attended my first international conference on Prader Willi Syndrome in New Zealand. It was a “life” experience, going at the end of the world to learn how to cope with my daughter’s disorder! It was my first trip by plane, and my first contact with parents from all over the world facing the same problem as I do.

It was not easy getting there. First it was a matter of money was solved by a grant that I received through the German Association for PWS. Then, when this problem was solved, I realized that I needed a visa from London, as we had no Embassy in our country… and to get this visa, I needed a visa for England, too. Very complicated. I couldn’t solve it without a good friend in Cambridge that helped me make this dream a reality. The travel was not easy at all, as I went by car to Frankfurt, slept in the car and the next evening I took the plane for more than 30 hours.  It was a real adventure…        
  
In New Zealand I met wonderful people that helped me think that I could really do the mission that I wanted so badly to do for Romanian patients. I met Ragnhild Arnesen from the Prader Willi Association Norway, I met Pam Eisen the President of the International Prader-Willi Syndrome Organization (IPWSO) and found out that Pam’s father was born in FelsÅ‘bánya - Baia Sprie (which I believed was in Hungary and then I realized that it was in fact in Romania and very close to my town).

I made friends and I was looking forward to meet them again at the next conference in Germany. Also, I had the opportunity to be in a workshop chaired by a special person, Christian Aashamar from Frambu – Resource Centre for Rare Disorders, Norway. His presentation about Frambu kept my attention and remained as a dream for me because it seemed something impossible to be done in our reality.

                Nothing happens in your life by mistake.

Things began to develop rapidly. The German Association decided not to host the following conference and in a “crazy” moment I decided that we can do it… and we did it in 2007! The conference included 388 participants from 38 countries, including Norway and we managed to organize the arrangements to everybody’s satisfaction! As from that moment we were more self-confident in our organizational capacity. Also, in the same year we had established the Romanian National Alliance for Rare Diseases, we started to work for the National Plan for Rare Diseases and organized 2 conferences for rare diseases. I would say that it was the major step forward for our organization.

In the same year I was elected in the board of IPWSO and EURORDIS (The Organization Rare Diseases Europe).

In 2008, a call for proposals from Norway Grants was opened and I remembered the presentation about Frambu from New Zealand (sometimes you keep something in your heart and you don’t even realize that it is still there) and I decided to try. I approached PWA Norway and asked for partnership for the seed money project and they agreed  to prepare the project and to ask Frambu for partnership.

                Everything became possible because of two mothers, one from Norway and one from Romania that have met once in New Zealand… and when we lose our strength we are carried by hope…

We prepared a partnership agreement and a presentation of the project and met at Frambu in November 2008. At that time, all the information on Frambu’s website was in Norwegian, so I based my application on the memories and my own dream. To be honest, I’ve been most impressed by the way Frambu approaches the entire family and community to improve the quality of life for the person affected by rare diseases. This is why the RPWA’s vision was the “Norwegian reality” so …I don’t know why and when we convinced them to be our partners (after the first day, I told to Dr. Puiu that they probably will not accept our offer…), but, I assume there were some important elements that caught their attention: Ragnhild Arnesen from PWA Norway, the vision and my belief that we can do it in a very different reality as Romania. The director of Frambu saw this and signed the agreement the next day.

We wrote the project and we won it!

The implementation of the project was not easy as we wanted to achieve as much as possible for a better future for patients with rare diseases in Romania. The expertise of our partners was essential – the team and volunteers involved (Lisen, Tove, David, Kaja, Ragnhild, David Oziel, Christel, Anja, Nina, Rob, Romanian professionals and patients involved in the National Committee for Rare Diseases) were outstanding and the entire support from additional partners and friends helped us to do a good project.

As a result,  a day care center for children with rare diseases from autistic spectrum disorder has been established where they are provided with educational activities and different therapies (behavior, sensorial, physical therapy, massage, electro therapy, speech therapy, hydro therapy, weight management and recreational activities). Also provided is counseling and support groups for parents. The beneficiaries in the day care center will come mainly from our town. We can also organize training sessions for families (and professionals) from other towns for a certain period of time in order to provide them with the knowledge on this area.

Secondly, is the training part of the center, taken from the Frambu model in Norway.  This is a residential programme designed for 12 placements at a time.                  The experience of our partners was essential in our project!
  • Groups of patients from all over the country will attend training activities for 5 days, learning how to cope with their diseases and disabilities;
  • Groups of young adults with rare diseases (trial for flight) will come for consecutive weekends for training in “life skills”;
  • Families with newly diagnosed children can also come to the center for a period time for assessment and training of the family;

If you want to know more about how this project works and the model we have used, please click here... NoRo Partnership programme

 

Sunday, 4 December 2011

Eating our way through the holidays...

So... we are coming up to Christmas, or Hanukka, or just holiday time, and our kids are either off school for weeks, or coming home for the holidays and we experience that panicky feeling of "how can I make this go right!" 

Janalee Heinemann has written some great Holiday Tips which I thought deserved repeating here...  In fact, I would go so far as to suggest you print this out and hand it to all members of the family well in advance.

The holidays are typically a food fest in many countries – and can be a time of stress for our PWS families.  With good planning, it is possible to make it a happy holiday for all. 

Christmas, Hanukkah, Lunar New Year, etc.  

·        If you will be with relatives, carefully plan ahead of time and communicate the importance of food control with all involved. Make sure all attending know the “rules of engagement” and agree to cooperate.

·        See that someone at all times is clearly in charge of your child with PWS.  Clearly define when you are “changing guards”.  As Dr Linda Gourash states, “When everyone is in charge – no one is in charge.”  

·        If your child is old enough, rehearse the “rules” before the special  day and come to a mutual agreement on what your child will be allowed to eat.  You can barter, i.e. “Do you want a little extra turkey and dressing, or do you want a piece of pie as your special treat?”

·        It is okay to request that Grandma and other relatives tuck away tempting items during your visit and to discreetly check with you prior to offering your child a treat. 

·        Make sure you know what everyone is bringing, so there are no surprises on what the choices will be. 

·        Grandpa and Grandma, or aunt and uncle may want to bring a special gift toy to compensate for the food they have to deny your child. 

·        Go over with the hostess or your family on how to contain the accessibility of food.  See to it that where your child is sitting there will not be a lot of bowls of food, rolls, or condiments nearby (many people do not consider how many calories our children can consume with the extras – sugar, butter, catsup, etc.) 

·        After eating, when people are just visiting, see to it that if the food cannot all be put away, someone is responsible for guarding it. 

·        Your child must have the security of knowing you will be strong in your commitment to keep them protected from food – in spite of themselves.  Giving in, even once, means several battles ahead.  I know you get tired of hearing it, but consistency is the key. 

Of course, each family must judge their own situation based on their child’s food drive and their own regulations on treats.  Some families are raising their children to never have any sweets – no exceptions.  Others (like ours) just go by calories and the weight of the child, trying to keep the diet less in quantity yet similar to others in variety.  Often, the most important thing is to prevent food sneaking or food demands.   There is a large variance in the food drive of children with PWS.  Some will ask or beg for more food, but make no significant attempts to sneak food.  On the other hand, some will go to great extremes to get food, and are incredibly clever at doing so. 

HOLIDAY WARNING        

The holidays have an extra risk factor for our older children and adults with PWS.  In the USA, four individuals with PWS were reported to have died of gastric rupture and necrosis. Furthermore, 4 additional individuals were suspected to have gastric dilatation and perforation, but without autopsy evidence. Some of these were over the holidays or special events and due to a food bingeing episode that led to necrosis (deadening of the tissue) of the stomach wall and a perforation (tear) in the stomach.  In most of the deaths, the person with PWS was relatively slim, so there was no great concern about weight gain.  Keep in mind that a person with PWS who is slim still does not have total food control.  When one also has many opportunities for food ingestion, the lack of feeling full, the high pain threshold, and a weak vomiting reflex – then one has the potential of filling the stomach dangerously full.  Because there are many food bingeing episodes of our children and adults with PWS, most not having such disastrous results, we think there are probably other factors that play into this life-threatening situation that we are currently researching.  One hypothesis is that due to prior food binges, and stomach muscle weakness, certain areas of the stomach wall become thinner putting this area at risk.  

Please see that this holiday season, the safety and security that your child deserves is provided.