Annie O'Neill, Post-Gazette Lincoln Phillips' mother Anna, of Saegertown, Crawford County, holds Lincoln during a recent stay at Children's Hospital of Pittsburgh. Lincoln, who is now 9 months old, has earned 927 Beads of Courage from his two open heart surgeries and is now reported as doing well. Click photo for larger image. Online video See a video, "Beads of Courage," that explains the program. More information For more information about the Transplant Recipients International Organization, see www.trioweb.org. For Beads of Courage: www.beadsofcourage.net.

Brittany Grimm, 11, of Erie, sat quietly in a waiting room holding her three strings of beads. Her mother, Colleen, said out of her 289 beads, the big green one is Brittany's favorite. It was her "discharge" bead after her last visit to Children's Hospital.

After having a May 4 heart transplant, Brittany had been back in the hospital following a heart biopsy June 1 showed some rejection of the heart. That disappointing setback was cleared up, she was discharged June 4 and was just in the waiting room for follow-up blood work, echocardiogram, electrocardiogram and to see her doctor.

"[The doctors] said it was common, they just put her on medicine and she'll be fine," Mrs. Grimm said. All patients are continually monitored for rejection with biopsies. Follow-up visits also include echocardiograms. By the number of beads Brittany has, you know she's been through a lot.

There's a bead for every poke and prod a child receives through the Beads of Courage program at Children's, according to Dr. Peter Wearden, pediatric cardiothoracic surgeon. He first became familiar with a similar program called Bravery Beads while he was finishing his fellowship program at the Hospital for Sick Children in Toronto.

Dr. Wearden said he had wanted to begin the program because he saw the happiness it brought the children in Toronto. The beads distract children from the various pokes they receive and allows them to look back at their surgery as a series of accomplishments.

"I have four kids, and I know they like to collect things," he said. He and Amy Cashdollar, the administrator of Children's Hospital Heart Center, then implemented a program at Children's in December 2006.

"Amy took the project on with gusto and located the Beads of Courage organization as a provider of the beads," Dr. Wearden said.

Children's is the first hospital to use the beads program in the heart center, said Mrs. Cashdollar. Other hospitals have used the program for children in treatment for cancer. Mrs. Cashdollar said she hopes to expand the program to other centers in the hospital.

The Transplant Recipients International Organization, known as TRIO, sponsors the program, though the hospital also uses donations made to the heart center to purchase the beads. A hospital's starting kit of beads and bead journals is roughly $3,000, Mrs. Cashdollar said. More than 100 children are currently enrolled in the program, with costs of about $20 per child, she said.

Brittany, like the other children, started out with beads spelling out her name, a bead from TRIO and a bead from the heart center after the consent forms had been signed. When the child comes in for his or her surgery, parents can hold the beads while they wait.

Parents keep track of what their child goes through in the bead journal, and a volunteer comes three days a week to hand out the beads. Each bead means something different: An inpatient admission bead is yellow and a test bead is light green. Children can pick out their own milestone beads, which are meant for transplants, a birthday while they're in the hospital, when they get discharged or other events.

Jean Baruch, president of Beads for Courage, runs her company from Tucson, Ariz. She began the program about four years ago based on experiences working with children being treated for cancer in Phoenix, Ariz.

"The kids go through all this suffering, and all you can give them is a sticker," she said. "As a nurse, it's very frustrating."

Brittany needed the new heart because the lower part of her old heart didn't expand to let blood in, according to her mother. She had another biopsy on June 12 and her degree of rejection is getting better, according to Dr. Wearden. He said at this stage, children are usually seen every two to four weeks. A biopsy is done every four to six weeks; more often if a child has a rejection episode.

During each step of the transplant process, her father, Butch Grimm, said, "The beads gave her something to look forward to."