How to Get Kids to Brush Their Teeth

February is Children’s Dental Health Month, and we are brushing up on tips for healthy teeth, and examining the causes of halitosis, or bad breath.

What is halitosis and how can you avoid it?

Some bacteria in the mouth are odor-producing, which can lead to halitosis (bad breath.) If you don’t floss and brush regularly, these bacteria can build up. Mouthwash is a temporary fix, but if you do choose to use one, opt for an antiseptic one, which kills the germs that cause bad breath. A plaque-reducing mouth wash should have a seal of approval from the American Dental Association. For small children use an alcohol-free mouthwash. Your dentist can provide specific recommendations.

What is the cause of bad breath if you are brushing twice per day? There can be many reasons, but you may not be brushing long enough, says Dr. Richard Mungo, chair of pediatric dentistry at CHOC Children’s. Each brushing should last for two minutes, but the average person only brushes for about 45 seconds, Mungo says. Try setting a timer for the full amount of time or using one of the many Apps that are available on the internet to help children brush longer and have fun. Using electric toothbrushes are another way to ensure a proper brushing, he says. Electric brushes can be more efficient and many are programmed to stay on for the required two minutes, assuring a good brushing of all surfaces.

how to get kids to brush their teeth
Dr. Richard Mungo, chair of pediatric dentistry at CHOC Children’s

If bad breath persists despite proper brushings and flossing and regular trips to the pediatric dentist, your child may have post nasal drip or other sinus problems, contributing to the halitosis. If there are cavities present or inflamed gums, these difficulties must be attended to. Consult your pediatric dentist or pediatrician who can determine if something else is causing the bad breath.

How to get kids to brush their teeth:

It can be tricky to get kids to brush and floss regularly, but building healthy oral hygiene habits early in life is important. Dr. Mungo offers tips to getting little ones on board with brushing and flossing:

  • Play your child’s favorite song while they are brushing to get them used to brushing for the full two minutes.
  • Be a good example. If your children see you brushing and flossing regularly, they are more likely to model your behavior.
  • Let children choose their own toothbrush and toothpaste, from choices recommended by your dentist.
  • Create a positive attitude towards going to the dentist. Your child’s first visit should be at age one, or when the first tooth erupts into the mouth. That first early visit will introduce you to proper oral health care, emergency services that are available and proper dietary concerns for your children. Children can often pick up on parents’ anxiety, so be a good actor when present with the child, so they can be comfortable and confident that going to the dentist is fun.

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Infographic: Amazing Heart Facts

What’s a better time than Valentine’s Day to learn more about the heart?

This infographic will help you expand your heart smarts.

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Get tips on how to keep your child's heart healthy




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Electrophysiology Advances Restore Patient’s Quality of Life

A teenaged patient’s longtime arrhythmia has been repaired and her quality of life dramatically improved thanks to emerging technology and the skill of a CHOC Children’s cardiologist.

Lauren Flotman, 15, had experienced irregular heartbeats for years before Dr. Francesca Byrne, a pediatric cardiology specialist, diagnosed her with supraventricular tachycardia, or SVT, and Dr. Tony McCanta, a pediatric heart rhythm specialist, repaired the condition through radiofrequency ablation.

The episodes first surfaced when Lauren was about 8 years old and they began increasing in frequency as she aged. They’d occur without warning or pattern.

For Lauren and her family, the sudden attacks caused great concern. Not only was she drained and tired after an episode, but Lauren dreaded them happening, especially during a pep squad routine when her teammates were depending on her.

Lauren was elated to finally have a name for her condition.

“It was a huge relief for sure to have a diagnosis,” she says. “I always had to just describe the feeling because I didn’t have a name. Now I can say I have SVT.”

Lauren’s diagnosis was reached after a Holter monitor captured her heart racing at 220 beats per minute. Dr. Byrne referred Lauren to Dr. McCanta to discuss treatment options, which included anti-arrhythmic medications or an ablation procedure.  After reviewing their options carefully, the Flotmans decided to pursue ablation.

For Lauren’s ablation, Dr. McCanta used a new technology called an intracardiac echocardiogram, or ICE, to create a three-dimensional map of the inside of her heart without using fluoroscopy (X-Ray radiation), enabling a catheter to apply radiofrequency energy to the precise location in her heart causing her SVT.

ICE technology involves a tiny ultrasound probe imbedded into a catheter that is advanced through the vein directly into the heart, allowing for very clear, accurate image quality. These ultrasound images then integrate with a three-dimensional electroanatomical mapping system, which acts like a GPS (global positioning system) for the catheters within patients’ hearts, to provide an accurate real-time shell of the inside of the patient’s heart. This allows the doctor to safely move catheters inside the beating heart without using radiation.

electrophysiology
Dr. McCanta and the electrophysiology team at CHOC were among the first in the world to routinely utilize intracardiac echocardiography in pediatric and adolescent patients.

While radiofrequency ablation has become a safe and common treatment for SVT in children and adolescents since the mid-2000s, intracardiac echocardiography (ICE) has not traditionally been used in pediatrics due to the large-sized catheters. But when a smaller catheter was created, which was more suitable for the size of young patients, Dr. McCanta and the electrophysiology team from the CHOC Children’s Heart Institute were among the first in the world to routinely utilize the new technology in pediatric and adolescent patients.

“For a young, healthy patient like Lauren, increasing safety and minimizing the use of radiation are extremely important, while still being able to provide a cure for her arrhythmia with ablation” says Dr. McCanta.

After a few days of taking it easy following the procedure, Lauren felt back to her usual self – only without the constant fear her heart would suddenly begin racing.

electrophysiology
Lauren’s longtime arrhythmia has been repaired and her quality of life has dramatically improved, thanks to the electrophysiology team at CHOC.

“Our team loves utilizing advanced technologies like ICE and three-dimensional mapping to help children, adolescents, and young adults with heart rhythm problems,” says Dr. McCanta, “Seeing patients like Lauren get back to all of the things they love doing is why we do this!”

Since the procedure, Lauren has been vocal at church to educate her peers about being conscious and vocal about their health.


Get the facts about CHOC's advanced electrophysiology program



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Two Oncologists with Special Interest in Immunotherapy Join Hyundai Cancer Institute at CHOC Children’s

Two oncologists have joined the team of nationally-recognized specialists of the Hyundai Cancer Institute at CHOC Children’s. Dr. Josephine HaDuong and Dr. Ashley Plant were both fellowship trained at two of the country’s top cancer programs, and share research interest in immunotherapy and targeted therapies.

Dr. Josephine HaDuong is board-certified in pediatric hematology and oncology, and was drawn to the Cancer Institute for what she refers to as its gold standard of care.

“The Hyundai Cancer Institute is a growing center that strives to be among the best. The team provides patients access to cutting-edge clinical trials that may lead to breakthroughs in pediatric cancer,” says Dr. HaDuong.

Her research is driven, in large part, by her clinical interest in caring for patients with solid tumors. A published author and principal investigator in a number of studies, Dr. HaDuong’s major research activities include exploring developmental therapeutics in solid tumors using immunomodulatory and targeted agents, as well as functional imaging in bone and soft tissue sarcomas using magnetic resonance spectroscopy.

Following medical school at the University of Pittsburgh, where she earned a full tuition merit scholarship, Dr. HaDuong completed her residency and pediatric hematology/oncology fellowship training at Children’s Hospital Los Angeles. She was honored with the Fellow of the Year, Excellence in Teaching Award.

She is a member of numerous professional associations, including American Society of Clinical Oncology, American Society of Pediatric Hematology and Oncology, and North American Consortium for Histiocytosis. In addition to English, she speaks Spanish and Vietnamese.

Raised in Orange County, Dr. HaDuong is thrilled to be back in her hometown. “I have always wanted to return home to serve the children and families in Orange County. I look forward to being a part of an incredible team who works relentlessly to end cancer,” says Dr. HaDuong.

Dr. Ashley Plant is committed to growing CHOC’s neuro-oncology treatment program, and eager to bring new therapies to patients with brain tumors. “I look forward to collaborating with academia and industry to bring early clinical trials to CHOC, especially in the area of immunotherapy. I am also excited to partner with my new colleagues to advance the work the Cancer Institute has been doing to reduce the long-term toxicities of cancer therapy,” says Dr. Plant.

Dr. Plant is a published author whose research interests include early phase clinical trial design for pediatric brain tumors. Her most recent project is a phase 1 clinical trial for a neo-antigen heat shock protein vaccine for diffuse intrinsic pontine glioma, a fatal brain tumor. She hopes to enroll patients in this trial within the next year. She considers herself fortunate to have worked under world-renowned immuno-oncologists Dr. Glenn Dranoff and Dr. Jerome Ritz at Dana Farber Cancer Institute in Boston. There, she won the Young Investigator Award for a project evaluating clonality of T cell receptors in pediatric gliomas.

Following medical school at Stanford University, Dr. Plant finished her residency at University of California, Los Angeles. Her fellowship training in pediatric hematology/oncology was completed at Boston Children’s Hospital. She received additional training in clinical trials and public health at Harvard Chan School of Public Health.

“I was attracted to CHOC because the hospital prioritizes excellent clinical care of patients above all else,” says Dr. Plant. “The hospital’s commitment to patient-and-family-centered care is something I wholeheartedly support. Cancer affects everyone in the family – physically, emotionally, psychologically and sometimes even financially. If we fail to address these issues, we are not completely caring for our patients and their families.”

Learn more about the Hyundai Cancer Institute at CHOC Children’s.

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Meet Dr. Wyman Lai

Just in time for American Heart Month, meet Dr. Wyman Lai, a nationally-recognized pediatric cardiologist with expertise in fetal cardiology and non-invasive imaging for heart disease in fetuses, and children at CHOC Children’s. Dr. Lai is the new medical director of echocardiography at CHOC and co-medical director of the CHOC Heart Institute.

Dr. Wyman Lai
Dr. Wyman Lai, medical director of echocardiography at CHOC and co-medical director of the CHOC Heart Institute.

“CHOC has a fabulous mix of state-of-the-art care, community presence, and academic achievement. I thoroughly enjoy working with my colleagues, who strive to provide the very best care available. The administrative staff at CHOC has also been extremely supportive. Together we are building a pediatric service that rivals any in the region, and we have our sights on even higher goals,” says Dr. Lai.

Dr. Lai’s passion for helping others inspired him to become a doctor. His original plan was to go into academic primary care pediatrics – a teaching and research position, and he majored in maternal and child health for his Master of Public Health degree. Early in his training, he became fascinated with what pediatric cardiologists were doing, and he switched to pediatric cardiology.

“The heart is an amazingly complex organ; it starts off as a simple tube, and it’s a wonder that it develops into a four-chambered pumping organ that delivers oxygen efficiently throughout our body,” says Dr. Lai. “In pediatric cardiology, we are able to make a profound difference in the lives of our patients. With our surgical colleagues, we have made incredible advances in life-saving therapies over the past five decades.”

Dr. Lai attended medical school at the Alpert Medical School of Brown University. He completed his residency at UCLA Ronald Reagan Medical Center, followed by a pediatric cardiology fellowship at UCLA Medical Center, and much later, a pediatric cardiology MRI fellowship at Boston Children’s Hospital.

Since joining CHOC, Dr. Lai has been treating patients with complex congenital heart disease. He is also treating patients with the full spectrum of heart conditions, from heart murmurs to chest pain and syncope.

Dr. Lai’s approach towards his patients and their families is to treat them like family members.

“As with all families, however, not everyone is the same,” he explains. “Some patients and parents want more medical information and some less. Some want to be very involved in the decision-making process and some not so much. My practice is to provide them with enough information and support, so they feel comfortable with the decisions they are making.”

Along with Drs. Nita Doshi and Pierangelo Renella, Dr. Lai is helping to build a great program in fetal cardiology at CHOC. He is also working with Dr. Renella to grow the congenital cardiac MRI program, including the use in non-invasive imaging for creating 3D heart models.

“We recently used a 3D cardiac MRI dataset to print several heart models that were used to assist in the planning of care for a child with complex congenital heart disease. Another area of innovation is our purchase of new patient monitoring software in the cardiovascular ICU that will help us to identify patients at risk for acute deterioration before it happens,” Dr. Lai says.

In his spare time, Dr. Lai loves spending time with his family. He also enjoys swimming, biking and running. He hopes to run in this year’s Boston and New York marathons, which he has participated in the past. He is also attending classes for a health care executive MBA at UC Irvine.





Learn more about CHOC fetal cardiology




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Jesse’s 200 Mile Run

Jesse’s 200 mile run will raise money for CHOC Children’s. He hopes to inspire others to pursue healthy lives. Learn more about the ultramarathon runner who is inspired by the strength of CHOC patients.

Q: What inspired you to start this tradition?

A: I had always been a runner, but reading the  book called Ultramarathon Man in my junior year of high school opened my eyes to longer distance running and I thought, “Wow I could do this!”

When I told my parents about my goal, they suggested doing it for charity. Having grown up in Orange County I knew about CHOC Children’s, but I had never needed treatment here. I did some research and got to learn more about what CHOC did for kids in the community, and all the wonderful things that happen there, and I decided to raise money for CHOC via this run.

Before that I had only run 15-20 miles at a time. I figured if other people were doing it, why couldn’t I?

I completed it in 23 hours and raised $7,000 for CHOC. I had a desire to run far and help people, and I’ve been lucky to be healthy and able to run. But I know there’s many kids out there who maybe want to run, but can’t. I feel like it’s my responsibility to help.

Jesse's 200 mile run
The course for Jesse’s 200 mile run

Q: What inspired you to double the distance of your first run?

This will be third attempt at ultramarathon running. After the first run, I decided I wanted to do it again but run farther, raising even more awareness and funds for CHOC.

In January 2007, I set out to run 200 miles and raise $20,000 for CHOC. At 20 or so miles, my legs just didn’t feel right. At about 89 miles, I changed my route and moved to a track to help my legs. After another 30 miles my temperature started to drop and by that point I had been running over 30 hours continuously. My crew sat me down at mile 124 and said it was time to stop. Crew sat him down at mile 124 and said it was time to stop.

I had promised CHOC two things- I accomplished my primary goal of raising money, shattering my goal by raising $50,000.But I never finished that 200 miles. I always knew I wanted to attempt it again, but never knew the right time.

It’s been 10 years since I first attempted my 200-mile run. In the past decade I’ve gone to school, started working, gotten married, and I have a son on the way. I decided this was the right time.

After that failed run I was devastated. I thought I left everyone down. It took me awhile to realize I did not fail. There’s no guarantee I will finish this 200 miles, but if I don’t, I will attempt again.

Q: How do you train for such an intense physical challenge?

A: I try to run every night after work for an hour or two, and save my long training runs of up to 100 miles for the weekend. My goal is to finish the 200 mile route in 48-60 hours nonstop. I do have to stop and obey traffic laws, but I hydrate and eat power bars, energy bites and granola bars on the route. In some food there is caffeine to help me stay awake. It’s all a mental game. The first 50 miles is physical and the rest is mental.

My crew is made up of family and friends who ride in an RV alongside me. Some friends take shifts running with me to keep me awake and make sure I’m feeling healthy.

Q: What inspires you about the patients and doctors at CHOC?

A: I’m inspired by the patients at CHOC. They are my motivation for doing this. I fight for 48-60 hours on this run, but they can be fighting for their lives. Running such a long distance is painful and it hurts at times, but they pain can last longer.

I don’t make a lot of money, but I can use my abilities to help these kids. I want to help people understand that they don’t have to go out there and run 200 miles. Just do the little things you can do to make your community better – especially younger kids.

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How to Keep your Healthy New Year’s Resolutions

By Alexia Hall, registered dietitian at CHOC Children’s

At CHOC, we view nutrition as a cornerstone of health, healing and well-being. In response to a staggering number of overweight children in our community, we’ve implemented a new nutrition philosophy. It includes reducing added sugars, reducing pre-packaged items, increasing freshly prepared items, and providing a greater variety of fruits and vegetables.

We know that many families in our community have made New Year’s resolutions to make health a priority- and we want to support you! It’s easy to make resolutions each year and plan to kick start the year on a healthy note, but it can be hard to stick to them even if you have the best intentions.

How can you become successful and follow through on your goals?  Try these 4 essential tips to follow through on your own resolutions:

  1. Simplify your goals
  2. Manage your thoughts
  3. Manage your environment
  4. Manage your biology
  1. Simplify Your Goals:

Simplify and fine-tune your goals. Choose one or two things to focus on and add others as you master each one. For example, instead of a broad goal such as “I will increase my family’s vegetable intake,” be more specific by stating “I will start by offering 2 one-half cup servings of vegetables every day for 30 days.”  Put your planning skills to work by writing down a list of vegetables you like and placing two on your planner every day. Follow up by putting those on your grocery list. If you don’t succeed, analyze why. Maybe time or taste is an issue. If so, take advantage of the pre-cut items in the grocery store. Maybe you don’t like the taste. Try new seasonings, recipes and ideas. Never give up and seek daily positive inspiration along the way.

  1. Manage Your Thoughts:

To impact the way you think, you must manage what you hear and read. Remind your children that proper nutrition is essential to fuel their growing bodies. It can be as simple as choosing to read the Facebook posts on healthy items and skimming by the ones that are not. Pay attention to the messages that are going on around you and your children, focusing on the ones that will help you fulfill your goals.

Your internal messages may be even more important that the messages around you. Telling yourself positive thoughts, such as you are beautiful, smart, kind, and are worth it, will help you to be successful. There are even new apps that will text daily positive thoughts – surround yourself with them!

  1. Manage Your Environment:

Enlist the help of those around you. Explain what you are doing and ask that your family and friends join with you. Realize that what may work for one family member, may not work for another and be flexible. Clear your home of the food that will trip you up and fill the refrigerator with fresh whole food that is convenient and ready-to-go. Plan your meals, snacks and lunches in advance.  It is also very important to plan out your day for success. Here are some examples:

  • Think about time crunches in your day that can create opportunities to break your resolve. For example, if you find yourself exhausted and grumpy once arriving home from a full day of work, you will likely find it difficult to summon energy to cook a healthy dinner. Planning a light snack such as almonds for the car ride home can go a long way in strengthening that resolve.
  • If you are trying to build a workout into a day with the kids, plan a beach or park outing and bring the Frisbee or a ball.
  • Make shopping for healthy food part of a fun family weekend by visiting farmers markets or fun food destinations such as apple picking or fruit farms.
  • Proper amounts of rest and fun are critical to good decision making, so aim to be kind to yourself first.
  1. Manage Your Biology:

Eating unhealthy food creates more craving for unhealthy food, a cycle that is difficult to break. Scientists have been uncovering information for some time that shows sugar is addictive. Eating large amounts of fresh fruits and vegetables along with a low sugar diet and healthy plant based fats can create a healthy bowel environment. New evidence is showing that a healthy set of gut bacteria can positively affect your emotions, further controlling the choices you make. A person who feels physically and mentally well is more apt to make positive lifestyle choices.

Studies show it can take at least 30 days to instill a change in habit, so hang in there even if it is challenging to keep your resolution.  The benefits will come and it will get easier!  Give your family the best physical and mental environment by eating foods that will give you a sense of well-being and increased energy to stick firm to your health resolutions.

If you have any concerns related to your child’s nutritional intake or eating habits, speak to your child’s pediatrician. They may refer you to a pediatric nutrition expert for further consultation.

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Heart Disease Medications for Children

 By Melody Sun, clinical pharmacist, & Dr. Nita Doshi, fetal cardiologist at CHOC Children’s

About eight in every 1,000 babies in the US are born with a heart defect. In some cases there are known risks such as pregestational or first trimester maternal diabetes, a previous child with congenital heart disease, mother or father with history of congenital heart disease, certain genetic syndromes, or certain prenatal medication exposures. Many cases, however, do not have a known reason. The heart is formed by week 12 of pregnancy, but sometimes, the usual developmental stages of the heart do not occur. Your prenatal care team may refer you to a fetal cardiologist for additional testing and monitoring. Sometimes, the defect does not significantly impact the quality of life, and the child can grow into adulthood without restrictions. It is when the defect causes severe consequences that the child may require surgery and/or long-term medications.

With advancing imaging technology, the majority of significant congenital heart defects may be detected during pregnancy. The state of California’s newborn screening program mandates newborn pulse oximetry screening for detection of congenital heart disease. If diagnosed with significant congenital heart disease, young patients may exhibit the following warning signs and symptoms:

  • Difficulty with feeding and/or poor weight gain
  • Difficulty with breathing
  • Turning blue inside or around the mouth, or in certain areas of the face
  • Cool arms and legs
  • Tiring quickly with exertion or activity

In severe cases of significant congenital heart disease, medical, minimally-invasive (catheterization-based), or surgical therapy may be considered by your child’s cardiology team. Medications may be started before and after the surgery to improve heart and lung function.

Examples of medications that may be recommended to treat a patient with heart disease include:

Medication Intended Use
Aspirin Decreases the risk of clot formation
Furosemide (Lasix), chlorothiazide (Diuril) Reduces the heart’s workload by decreasing the amount of blood volume the heart has to handle
Spironolactone (Aldactone) Helps counteract the loss of potassium from diuretics and may help support heart function
Sildenafil Reduces elevated pressure in the lung arteries
Captopril/enalapril/lisinopril Reduces the resistance and heart’s afterload to improve the heart’s function or to help reduce certain types of valve leakage
Propranolol, Digoxin, Sotatol, Amiodarone Treats rhythm disturbances due to abnormal electrical signals through the heart cells

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By the Numbers: CHOC Children’s Heart Institute

The CHOC Children’s Heart Institute offers state-of-the-art diagnosis and treatment for an entire spectrum of cardiac conditions, and we are the only Orange County facility to perform neonatal and pediatric open-heart surgery and cardiac catheterization.

In honor of American Heart Month, learn more about the institute.

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Occupational Therapy Celebrates 100 Years

By Lauren Francis, occupational therapy at CHOC Children’s

Occupational therapy is turning 100! The specialty’s roots formed in 1917 as “reconstruction aides” who helped rehabilitate wounded soldiers returning from battle in World War I. Today, occupational therapists apply a holistic approach to help children and adults engage in meaningful activities.

Occupational therapists are experts in addressing any and all areas that “occupy” one’s time. For infants and children, occupational therapy (OT) includes play, learning to move and explore, feeding and eating, and bonding with parents and caregivers. For children and teenagers, this can include gaining independence with self-care, being successful in school, and playing with friends. Pediatric OT sessions often look like play to the untrained eye – most children really enjoy therapy!

CHOC’s occupational therapists (OTs) are highly skilled and trained to help children of all ages who have unique needs. Some key components of OT are:

Feeding Specialists

For a variety of reasons, children may have trouble getting the nutrition they require to grow and develop. CHOC’s occupational therapists help treat a wide range of feeding issues, including babies who have trouble with breast and bottle-feeding, children who have oral motor or sensory difficulties and cannot manage textures of food, and teenagers who may have had an injury or procedure that affected their ability to eat. OTs at CHOC are also highly skilled in specialty therapies such as feeding tube weaning and swallowing therapy.

Sensory & Developmental Specialists

CHOC’s occupational therapists have advanced expertise and techniques to offer children and families with an assortment of developmental challenges as well. From supporting a child to stay strong and active through chemotherapy to helping a child recover from a neurological disorder or brain injury, occupational therapy can be a crucial part of a multidisciplinary care team. Children who have difficulty with sensory processing, learning delays, challenges with self-care, visual motor or visual perceptual deficits, difficulty coordinating their arms and hands, or who aren’t meeting developmental milestones, can all be excellent candidates for occupational therapy intervention.

Parent/Caregiver Collaboration

Perhaps one of the greatest roles occupational therapists play is working with the parents and families of the children we serve. Parent education and involvement in therapy is an essential component to ensuring a child meets his or her goals. Through CHOC’s commitment to patient- and family-centered care, our OTs closely partner with parents to create individualized treatment plans, offer customized home programs unique to each child’s needs, and engage them in all aspects of care.

Preventative Care

CHOC OTs work tirelessly as part of an advanced team to screen children who may be at risk for developmental delays. They apply years of clinical experience and expertise along with standardized testing to assess a child’s movement, mobility, hand use, interaction with the environment, and feeding skills. For children who require a long hospital stay, OTs help provide developmentally appropriate stimulation to help each child continue to grow and develop during their hospital stay.

If you think your child would benefit from occupational therapy, speak to your child’s primary care doctor.

Learn more about rehabilitation services at CHOC.

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