Children's hospitals across the region are sending workers into patients' homes to help save kids from frightening — and costly — trips to the emergency room. Coaching parents through changes at home may keep wheezing and inflammation at bay when doctors visits and medicine aren't enough.
South Philadelphia mom Victoria Harris sees her home with new eyes after working with health educator Carmen Perez.
"From the first visit she noticed the blinds are a no-no," Harris said.
"Blinds tend to collect a lot of dust and they are really difficult to clean," said Perez, who works for the Children's Hospital of Philadelphia's Community Asthma Prevention Program.
Perez suggested shades. And air-conditioning, she said, is better than rotating fans.
"Even if you clean the blades, there's always dust on the walls, and it will spread that dust around. So you really have to be cautious about fans," Perez said.
Perez looks for anything that can irritate a child and trigger an asthma attack. She said a big part of curbing flareups at home is an all-out assault on dust mites — the microscopic, eight-legged critters that feed on skin and shed into furniture and bedding.
Harris' children, Nehamiah, 6, and Samara, 4, both got mattress covers and a special pillowcase to contain dust-mite debris.
During her visit, Perez worried most about the carpeting in the children's room.
"We can vacuum the carpet daily, but still there's dust underneath that carpet, and that's where the problem is," Perez said. "The children are going to have difficulty when they are sleeping."
Besides advice, the Community Asthma Prevention Program provides basic supplies to make a home less allergy prone. If the Harrises pull up the carpet themselves, the program will give them vinyl, easy-to-install floor tiles that don't harbor dust mites.
Aiming to avoid emergency room
All this home improvement is supposed to help kids avoid missed school days and visits to the emergency room. Harris said she was terrified the last time she rushed Samara to the ER.
"A parent in ICU with a child getting stuff put up their nose, and IVs, it's very scary," Harris said.
All of the children's hospitals in the region now have home-visiting programs aimed at preventing asthma attacks. The newest is at Nemours in Wilmington.
Pediatrician Hal Byke says in cities especially, traffic pollution, crowded living, cockroaches and other pests increase the chance for asthma.
"If you are talking about some of the poorer patients, you can't just pick yourself up and leave," Byke said. "You are where you are, and if you have neighbors on both sides, who might not keep up their home -- and you do — you are impacted by them."
During the rush and worry of an urgent visit to the doctor's office, prevention tips sometimes get lost but Nemours Community Health Worker Shawna Lewis says she gets to the "nitty-gritty" of what patients need when things are more calm — once she's inside a family's home.
Getting an invite in can be tough.
Early on, about four families a week cancelled — or rescheduled — their home-visit with Lewis. Some patients worry about privacy. Lewis said other parents have complicated lives or simply take longer to realize how much home affects a child's health.
"A lot of times, it may take for their child to go into the ER," Lewis said. "And for me to reach out to them and work with them, to say, 'This is a major situation and see what happened, and if you continue on this route it could happen again, or more seriously death.'"
Small changes add up to big difference
At St. Christopher's Hospital for Children, health specialists identify children who need help controlling the lung disease, and then refer them to the Philadelphia Department of Health's "Healthy Homes" program.
Sixteen-year-old Diaralee DeJesus, a rising junior at Nueva Esperanza Academy Charter School in North Philadelphia, used to be a frequent flier in the ER.
"When my asthma wasn't controlled, it was practically like three or four times a month," Diaralee said. "If you go to St. Christopher's and ask for Diaralee DeJesus, everybody knows me that's how much I've been there."
These days, Diaralee rarely needs her rescue inhaler.
"My mom threw away all perfumes and all smelly things. All I have is body lotions, and things where the smell is not so high," she said.
Diaralee's grandmother, Arminda DeJesus, got rid of the candles and lavender-scented cleaners she loves. And "Healthy Homes" worker Alejandro Barreto suggested she use vinegar instead of bleach or disinfectants with harsh fumes.
"I did it very fast, because the main concern is the health of my granddaughter," DeJesus said through an interpreter. "So it wasn't difficult, because I had that in mind, I just wanted her to be in a good environment."
There's a whole handbook of dos and don'ts but Barreto said conversation is the best way to help his clients negotiate change. "What do you think are some the things that might be triggering your child," he asks clients. "What do you think might be different here?"
With funding from the U.S. Department of Housing and Urban Development, Barreto's prevention team helps families with bigger, more expensive changes that other programs don't offer. For example, when workers noticed water damage and mold, they replaced a drafty window and fixed the leaky roof at the DeJesus home.
Getting creative with prevention
Mom Victoria Harris said she's taken asthma-education classes offered at her pediatrician's office, but somehow learning the same information, this time, specific to her kids and in her own home made a difference.
"You got tricks, you got things to do," Harris said. "Preventive measures. It's helpful."
Harris even has a favorite tip for other mothers.
Once a week, she zips her children's stuffed animals into a plastic bag and stores them in the freezer to kill dust mites. When the toys come out of deep freeze, she says, don't just throw them back on the bed.
"You have to dust them off in case there's anything on the teddy bear," she said.
The "Designs on Health" series was conceived as a project for the Dennis A. Hunt Fund for Health Journalism, which is administered by The California Endowment Health Journalism Fellowships, a program of USC's Annenberg School for Communication & Journalism.