Does My Child Have a Sleep Disorder?

Healthy sleep is critical for children and teens. Sleep disorders, such as problems falling asleep and sleep apnea, affect your child’s ability to get the sleep needed for good growth, development and overall health. Even infants may have sleep disorders. However, a pediatric sleep disorder can be treated with the help of a sleep specialist.

In this episode of CHOC Radio, Dr. Neal Nakra, a pediatric pulmonologist and sleep specialist, and Dr. Marni Nagel, a psychologist, discuss:

  • The difference between medical and behavioral sleep problems and how to recognize them
  • When it may necessary to see a sleep specialist
  • How many hours of sleep your child needs
  • How sleep problems can affect health
  • The importance of sleep for teens and school start times

Hear more from CHOC experts in this podcast.

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How to Treat Poison Oak this Summer

Contrary to a common misconception, poison oak is a different nuisance than its counterpart, poison ivy. In southern California and throughout the West Coast, outdoor explorers can expect to find poison oak in wooded, brushy areas. In the northeast, you will find poison ivy, and in the southeast, poison sumac.

The best way to avoid poison oak is to stay on a path when outdoors this summer, since poison oak can be hidden in brushy areas. Wear long pants and socks, and avoid off-roading, advises Dr. Katherine Roberts, a CHOC Children’s pediatrician.

Poison oak causes a contact dermatitis that is spread onto the skin from the plant oils. A rash and itchy irritation are common side effects of a poison oak exposure. These plants cause a delayed reaction, so symptoms may appear anywhere from a few hours to a few days later, potentially creating confusion on their cause. The itching may last for a few days, and the rash may be apparent for up to two weeks. Unfortunately, while nothing will make the  red weepy rash go away faster, says Roberts, but topical calamine lotion may provide relief from the intense itching, which can last for a few days. Hydrocortisone cream may also alleviate symptoms, and can be used in conjunction with topical calamine lotion, she adds. For severe cases, oral antihistamines can help. Consult your pediatrician on specific questions related to any medication regimen.

If you think you have been exposed to poison oak, it is important to thoroughly wash anything that may be have been exposed to the plant oils which can spread to the skin if touched again:

  • Wash yourself and the clothes you were wearing at the time of exposure
  • Use soapy water to wash down your shoes, including laces
  • Wash or wipe down coat

It’s important for parents to remember that poison oak dermatitis, although inconvenient, is not contagious, so there is no reason to keep kids home from school if they have poison oak.

If the affected area becomes puffy, painful or at-home remedies do not alleviate itching, consult your pediatrician, as those may be signs of a skin infection. Topical or oral antibiotics may be prescribed. In rare cases, oral steroids may be needed.

Learn more safety tips to protect your family this summer.

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U.S. News Names CHOC One of the Nation’s Best Children’s Hospitals

From treating the most complicated cases of epilepsy and repairing complex urological conditions, to curing cancer and saving premature lives, CHOC Children’s physicians and staff are committed to delivering the highest levels of safe, quality care. That commitment has earned CHOC its most recent accolade:  inclusion on the coveted U.S. News & World Report’s Best Children’s Hospitals rankings.   CHOC ranked in eight specialties: cancer, neonatology, neurology/neurosurgery, pulmonology, orthopedics, gastroenterology and GI surgery, diabetes and endocrinology, and urology, which earned a “top 25” spot.

U.S. news

According to U.S. News, the Best Children’s Hospitals rankings are intended to help parents determine where to get the best medical care for their children. The rankings highlight the top 50 U.S. pediatric facilities in 10 specialties, from cancer to urology. Of the 183 participating medical centers, only 78 hospitals ranked in at least one specialty. For its list, U.S. News relies on extensive clinical and operational data, including survival rates, clinic and procedure volume, infection control measures and outcomes, which can be viewed at http://health.usnews.com/best-hospitals/pediatric-rankings. An annual survey of pediatric specialists accounts for 15 percent of participants’ final scores.

“The Best Children’s Hospitals highlight the pediatric centers that offer exceptional care for the kids who need the most help,” says U.S. News Health Rankings Editor Avery Comarow. “Day in and day out, they offer state-of-the-art medical care.”

Dr. James Cappon, chief quality and patient safety officer at CHOC, points to the survey as an invaluable tool for him and his colleagues to evaluate programs and services, determining best practices, and making plans for the immediate and long-term future.

“CHOC is certainly honored to be recognized once again by U.S. News. But our dedication to serving the best interests of the children and families in our community is what truly drives us to pursue excellence in everything we do. Our scores, especially in the areas of patient-and-family-centered care, commitment to best practices, infection prevention, breadth and scope of specialists and services, and health information technology, for example, reflect our culture of providing the very best care to our patients,” explains Dr. Cappon. To hear more about CHOC’s commitment to patient safety and quality care—and what parents need to know— listen to this podcast.

CHOC’s culture of excellence has it earned it numerous accolades, including being named, multiple times, a Leapfrog Top Hospital. Additional recent honors include the gold-level CAPE Award from the California Council of Excellence; Magnet designation for nursing; gold-level Beacon Award for Excellence, a distinction earned twice by CHOC’s pediatric intensive care unit team; “Most Wired Hospital”; and The Advisory Board Company’s 2016 Workplace Transformation Award and Workplace of the Year Award. Inspiring the best in her team, CHOC’s President and CEO Kimberly Chavalas Cripe was recently named a winner of the EY Entrepreneur of the Year Award in the “Community Contributions” category.

Common Little League and Softball Injuries in Children

Overuse injuries can plague athletes of all ages and sizes, and youth softball and baseball competitors are no exception, a CHOC Children’s sports medicine specialist says. Two of the most common injuries that affect youth competing in either of these sports are commonly referred to as ‘Little League Shoulder’ and ‘Little League Elbow,’ says Dr. Jonathan Minor, a CHOC pediatrician who specializes in sports injuries, injury prevention, and concussion management.

Dr. Jonathon Minor

‘Little League shoulder’ is a fracture of the growth plate in the shoulder. A warning sign is often pain that comes with throwing, without any preexisting injury. ‘Little League elbow’ is a small growth plate injury on the inside part of the elbow. Many will eventually hear or feel a ‘pop’ on the inside of the elbow, which often is a small piece of bone being pulled away from the elbow, at which time you should seek medical evaluation urgently, says Minor.

With either injury, pain tends to be gradual. Initially the shoulder or elbow may feel sore after games for players in heavy throwing positions such as pitchers, catchers or outfielders. For example, for pitchers, the shoulder or elbow may feel sore after pitching, but often after one to two weeks of continued throwing, they may experience pain during the game as well.

“Forty percent of the speed of the ball comes from the arm and shoulder, and the rest comes from the core, legs and hips,” says Minor. “Proper form is essential to preventing injuries. This also means that having strong lower body and core muscles, not just a strong upper body, is imperative. Working with a throwing mechanics coach can be very helpful at utilizing each of these different muscle groups.”

Other preventative measures include adhering to the sporting organization’s rules for pitch counts and rest requirements between pitching appearances. Athletes also should not be allowed to switch from one heavy-throwing position to another during the game, such as playing catcher after pitching for several innings. Remind your child to do a proper warm-up and cool down before and after practices and games. Consider loosening up arm muscles with a heating pad prior to practice, as tight muscles are more prone to injury.

Athletes at this age are developing their skills as well as their sense of competitiveness, but that doesn’t mean they should be playing through the pain, he adds.

Leagues often encourage players to recognize when and where their pain occurs. Consult a physical therapist or athletic trainer initially, and if basic treatments like rest, ice, and basic medication such as ibuprofen, are not helping, ask your pediatrician about a referral to a sports medicine specialist.

Since a major contributing factor to these all-too-common injuries include throwing mechanics, Minor often recommends athletes work with a physical therapy program that has experience with athletes in their chosen sport, in order to work on proper form.

Recommendations for treatment are made on a case-by-case basis says Minor, but may include rest, X-rays or other imaging, or changing positions in the game to a position less strenuous to their injury.

Since these pains are often gradual, they may get more severe as the season progresses. As playoffs commence, athletes may fear that speaking up about an injury could prevent them from participating, or result in other consequences. Encourage your young athlete to be honest about how they’re feeling, since identifying an injury and seeking treatment sooner rather than later, can allow them to return to competition earlier.

“Southern California is such a great place to live- the weather is very conducive to playing baseball and softball for twelve months out of the year. But every athlete, especially ones who throw often, should have a few months off per year to prevent overuse injuries. Try playing another sport that doesn’t involve throwing, or focus on conditioning work, particularly hips, legs and core that all too often get neglected during the season,” says Minor.

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Concussion Program Prescribes At-Home Exercises

Athletes and other adolescents with mild to severe concussions who experience symptoms such as dizziness, feeling unbalanced on their feet, blurred vision or trouble focusing on objects, may be good candidates for at-home visual and vestibular exercises recently designed by experts of the CHOC Children’s concussion program.

“Concussions are like puzzles, and every one is a little bit different,” says Dr. Jonathan Minor, a CHOC sports medicine specialist. “As many as fifty percent of concussed athletes may experience these symptoms and could benefit from these exercises that may get them back on the field or back in the classroom sooner.”

concussion exercises
Dr. Jonathan Minor models one of several at-home exercises recently designed by experts of the CHOC Children’s concussion program.

The convenient and self-explanatory exercises are ones that athletes and students can perform at home, but should only be started under the guidance of a concussion specialist, after an appropriate evaluation, and as part of an overall post-concussion treatment plan. These exercises are intended to enhance and improve a patient’s recovery from a concussion.

“Patients should be aware that beginning these exercises may stimulate some symptoms for a short period of time, such as trouble focusing, dizziness, nausea or headaches. But after just a few days of daily exercises, they may find that they can tolerate each exercise for a longer period of time,” says Minor, who is a lifetime athlete himself.

“We encourage our patients to only perform these exercises for the duration tolerated, rather than endure and push through worsening symptoms initially. Seeing a difference quickly with improved tolerance resonates especially with athletes, who are used to training and then seeing improved results.”

Download your copy of the vestibular/balance exercises and the visual concussion home exercises.

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Get Up and Grill!

By Amanda Czerwin, RD, CLEC, clinical dietitian at CHOC Children’s

Summer is here! And you know what that means- it’s time to get outside and start firing up the grill. Barbequing is a great way to bring your family and friends together and cook up a nutritious meal at the same time. Here are a few tips for your next grilling adventure in order to make a safe and tasty meal.

Before throwing your foods over the fire, make sure your grill is clean and ready to go. Consider using alternative products that may be safer for your environment. Then light up your barbeque and allow it to thoroughly heat up before cooking to kill any lingering bacteria.

Now comes the difficult task of deciding what to cook up! There are plenty of ways to get creative and try something different besides the typical hot dogs and hamburgers. If you’re looking to cook meat, then try choosing some leaner options such as chicken, fish, ground turkey or lean pork chops. It’s important to also avoid charring your meat as much as possible to prevent any carcinogenic compounds from forming. According to the Academy of Nutrition and Dietetics, one of the best ways to prevent this is by trimming any extra fat and skin off your meats before cooking. When fat drippings fall off meats, it can cause flames to flare up, causing extra charring. It’s also recommended to cook your foods over a longer period of time, at lower temperatures to avoid charring. You can also turn your food over frequently while cooking and scrape off any charred areas.

Brighten up your grill with colorful vegetables to add more flavor and nutrition to your meals. Put together delicious vegetable kabobs with veggies like zucchini, onions, cherry tomatoes, mushrooms and bell peppers. And who said burger patties had to be made out of meat? Switch it up one night and try grilling a black bean burger or making your own veggie patties using your favorite finely chopped vegetables.

You can even grill fruits too! Grill fresh pineapples slices and add them to a turkey burger or grill a colorful fruit kabob and add it to a fresh salad. Fresh grilled peaches or bananas added to angel food cake, low-fat ice cream, or whipped cream can also make a tasty treat.

Try cooking up this recipe at your next barbeque!

Quinoa Black Bean Burgers:

Ingredients

  • 1 (15 ounce) can black beans, rinsed and drained
  • 1/4 cup quinoa
  • 1/2 cup water
  • 1/2 cup bread crumbs
  • 1/4 cup minced yellow bell pepper
  • 2 tablespoons minced onion
  • 1 large clove garlic, minced
  • 1 1/2 teaspoons ground cumin
  • 1/2 teaspoon salt
  • 1 teaspoon hot pepper sauce (such as Frank’s RedHot Sauce)
  • 1 egg
  • 3 tablespoons olive oil

Directions

  1. Bring the quinoa and water to a boil in a saucepan. Reduce heat to medium-low, cover, and simmer until the quinoa is tender and the water has been absorbed, about 15 to 20 minutes.
  2. Roughly mash the black beans with a fork leaving some whole black beans in a paste-like mixture.
  3. Mix the quinoa, bread crumbs, bell pepper, onion, garlic, cumin, salt, hot pepper sauce, and egg into the black beans using your hands.
  4. Form the black bean mixture into 5 patties.
  5. Heat the olive oil in a large skillet.
  6. Cook the patties in the hot oil until heated through, 2 to 3 minutes per side.

Recipe via www.allrecipes.com

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Meet Dr. Jennifer Ho

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Jennifer Ho, a pediatric hospitalist. Dr. Ho attended UC Irvine School of Medicine and completed her pediatric residency at CHOC. She has been on staff for six years and is a member-at-large of the Medical Staff Executive Committee and member of the Medical Staff Performance Committee at CHOC Children’s at Mission Hospital.

Dr. Jennifer Ho

Q: What are your special clinical interests?
Care of the hospitalized pediatric patient, infectious diseases, evidence-based medicine and optimization of the electronic health record.

Q: What are some new programs or developments within your specialty?
A: I am excited that the field of pediatric hospital medicine is growing and will soon be a nationally board-certified recognized specialty.

Q: What are your most common diagnoses?
A: Asthma, bronchiolitis, dehydration and seizures.

Q: What would you most like community/referring providers to know about you/your division at CHOC?
A: We now provide 24/7 attending coverage in the hospital at both CHOC Orange and CHOC Mission to ensure the highest quality of care for Orange County children. We pride ourselves on communication and are always available to help facilitate transition of care.

Q:  What inspires you most about the care being delivered here at CHOC?
A: As a mother of two young children, it is very comforting to know that if they ever need medical care, CHOC provides the highest quality of care in a family-friendly environment.

Q: Why did you decide to become a doctor?

A: I decided to become a doctor when I was diagnosed with a heart problem in high school. I thought the human body was fascinating and I wanted to be able to help patients through their problems and get the most out of life.

Q: If you weren’t a physician, what would you be and why?
A: I would own a used bookstore with an attached coffee shop and spend my days reading old books and drinking coffee.

Q: What are your hobbies/interests outside of work?
A: Being a mommy to my two little kids, being outside, reading and playing volleyball.

Q: What was the funniest thing a patient told you?
A: From a 3-year-old girl: “I want to be a doctor like you … but only for unicorns and fairies.”

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Should you talk to young children about tragic events?

When it comes to discussing tragedy with young children, honesty might not always be the best policy, a CHOC Children’s psychologist says.

“Shielding them from any exposure should always be the first effort,” Dr. Mery Taylor says. “Children can be unpredictable about how they may respond to information, and even events far away can trigger a stress response.”

Given the potential short- and long-term consequences of coping with a trauma, parents should consider the proximity of the event and whether the child truly must know about specific current events.

But sometimes shielding children from tragic events can be difficult. Dr. Taylor recommends that parents who are considering discussing a tragedy or trauma with a child consider some other factors:

  • Proximity of the event: When a tragedy occurs close to home, it may be more difficult to control what the child might see or hear. And even if unaware, children still might sense tension and anxiety from adults around them.
  • Your partner: Discuss together your concerns and plans to ensure consideration of the different angles, but also so that you both are on the same page and presenting a consistent message. You may want to involve grandparents or caregivers to ensure that your desired approach is followed by those involved in your child’s care.
  • Siblings and older playmates: If your young child is around much older children, consider the likelihood that she may hear something frightening. In these cases, it may be helpful to inoculate her by going ahead and giving her some minimal information while keeping her developmental age in mind. You can always go back and answer more questions as they come. It is not recommended to ask an older child (8 to 12 years old) to not talk about the event with their younger sibling. This would likely only pique their curiosity.
  • Your child’s personality: All children are different. You know your child best. Is she likely to be scared by tragic new more than most children? Or is she the kid who would likely go explain the event to her class? Let her personality help guide your decision.
  • Media: School, other children, television, computers and smartphones may lead to your children knowing more that you think. Be sure to ask about their day; let them know you are there for them; and notice changes in behavior or mood that might be an indication that they may have heard something that doesn’t make sense in their world.

Should parents opt to discuss tragic events with children, or should the child already be aware of the circumstances, Mental Health America offers ways parents can talk to their children about tragedy-related anxiety and help them cope:

Quick tips for parents

  • Children need comforting and frequent reassurance of their safety.
  • Let your child lead the discussion and only answer questions that they ask.
  • Be honest and open about the tragedy or disaster using age-appropriate language. This may take the form of very simple and concise language.
  • Encourage children to express their feelings through talking, drawing or playing.
  • Try to maintain your daily routines as much as possible.
  • Monitor your own anxiety and reactions to the event.

Preschool-aged children

  • Reassure young children that they’re safe. Provide extra comfort and contact by discussing the child’s fears at night, telephoning during the day, and providing extra physical comfort.
  • Get a better understanding of a child’s feelings about the tragedy. Discuss the events with them and find out their fears and concerns. Answer all questions they may ask and provide them loving comfort and care.
  • Structure children’s play so that it remains constructive, serving as an outlet for them to express fear or anger.

Grade school-aged children

  • Answer questions in clear and simple language.
  • False reassurance does not help this age group. Don’t say that tragedies will never happen again; children know this isn’t true. Instead, remind children that tragedies are rare, and say “You’re safe now, and I’ll always try to protect you,” or “Adults are working very hard to make things safe.”
  • Children’s fears often worsen around bedtime, so stay until the child falls asleep so he or she feels protected.
  • Monitor children’s media viewing. Images of the tragedy are extremely frightening to children, so consider significantly limiting the amount of media coverage they see.
  • Allow children to express themselves through play or drawing, and then talk to them about it. This gives you the chance to “retell” the ending of the game or the story they have expressed in pictures with an emphasis on personal safety.
  • Don’t be afraid to say “I don’t know.” Part of keeping discussion of the tragedy open and honest is not being afraid to say you don’t know how to answer a child’s question. When such an occasion arises, explain to your child that tragedies cause feelings that even adults have trouble dealing with. Temper this by explaining that adults will still always work hard to keep children safe and secure.

  Adolescents

  • Adolescents may try to downplay their worries, so encourage them to work out their concerns about the tragedy.
  • Children with existing emotional problems such as depression may require careful supervision and additional support.
  • Monitor their media exposure to the event and information they receive on the Internet.
  • Adolescents may turn to their friends for support. Encourage friends and families to get together and discuss the event to allay fears.

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How to Avoid or Treat Bee Stings this Summer

As families spend more time outdoors during summer months, parents and other caregivers should be aware of the hazards related to bee stings, and how they can help prevent a child from being stung, a CHOC Children’s pediatric allergist says.

Bee stings can be quite common, and don’t usually lead to a serious reaction, says Dr. Wan-Yin Chan. However, there are several things parents can do to help prevent bee stings:

  • Keep food and drink containers closed when outdoors.
  • Wear shoes, socks and gloves when working outdoors.
  • Hire an exterminator to remove hives and nests around your home.
  • Avoid wearing brightly colored clothing or perfume.
  • Remain calm and walk away if you spot stinging insects.

If your child is stung by a bee, remove the stinger as soon as possible because venom can continue to be released for several seconds, says Chan. There is no special technique, but you can try flicking the stinger out as this prevents compressing the venom sac.

The most common reaction from a bee sting is a local reaction that consists of redness and swelling at the site of the sting that usually resolves within a few hours, but may last up to a day or two.

About 10 percent of people develop large local reactions, characterized by redness and swelling that increases in size over 1 to 2 days and can measure as large as 10 centimeters in diameter.  This type of reaction typically resolves over five to 10 days.

There are several ways to treat bee stings at home, says Chan. For small local reactions, try cold compresses.

For large local reactions, in addition to the cold compresses, you can elevate the limb if the sting is on an extremity.  Nonsteroidal anti-inflammatory drugs such as ibuprofen can help relieve pain, and oral antihistamines or topical steroids can help relieve itching.

Anaphylaxis, a severe and potentially life-threatening allergic reaction in response to insect stings, occurs in less than one percent of children and in three percent of adults.

Seek emergency medical attention if your child experiences any of the following symptoms of anaphylaxis:

  • Hives
  • Flushing
  • Swelling of the face, throat or tongue
  • Hoarse voice
  • Difficulty breathing
  • Shortness of breath
  • Wheezing
  • Dizziness
  • Nausea
  • Vomiting
  • Diarrhea
  • Loss of consciousness

Also seek immediate medical attention if there are any signs of infection, which include fever, redness, swelling at the sting site, or worsening pain three to five days after the sting. For infection, your child’s pediatrician might prescribe antibiotics.

For anaphylaxis, the patient will be given at least one dose of epinephrine, also called adrenaline, which can help constrict blood vessels in order to increase blood pressure, reduce wheezing, improve breathing, and work to reduce hives and swelling, says Chan.  A second dose may be required if the first dose is not effective. Because a severe allergy reaction can last for hours, patients should be monitored for several hours after administration of epinephrine.

A commonly prescribed epinephrine injection, is typically only prescribed when there is a history of anaphylaxis.  If the reaction was a local reaction, it is not necessary to carry an epinephrine injection.

If your child has a history of anaphylaxis to bee or other insect stings, ask your pediatrician about a referral to an allergist/immunologist, who can provide further evaluation and allergy testing.  If allergy testing is positive, patients may be treated with allergy shots, which can almost completely eliminate the chance of a severe reaction if they get stung again.

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Meet Dr. Andrew Mower

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Andrew Mower, a pediatric neurologist. Dr. Mower attended medical school at St. George’s University School of Medicine, completed a residency in pediatrics at Maimonides Medical Center, and another residency in child neurology State University of New York Downstate. He completed a fellowship in clinical neurophysiology at Columbia University. Dr. Mower sits on CHOC’s quality improvement committee and is part of CHOC’s ancillary and diagnostic services. He has been on staff at CHOC for two years.

Dr.Andrew_Mower_0699_2

Q: What are your special clinical interests?
A: Epilepsy and epilepsy surgery

Q: What are some new programs or developments within your specialty?
A: Stereotactic EEG for epilepsy surgery

Q: What are your most common diagnoses?
A: Epilepsy and headaches

Q: What would you most like community/referring providers to know about you or your division at CHOC?
A: We take on the most challenging epilepsy cases to search for cures, and, if not, at least an improvement in the child and family’s quality of life. We work together as a team to use all of our expertise to help the child and family.

Q:  What inspires you most about the care being delivered here at CHOC?
A: I feel that we offer families hope when hope had been abandoned before.

Q: Why did you decide to become a doctor?
A: I decided to become a doctor to help people in need. I chose neurology as my specialty because I had a fascination with the nervous system and wanted to break misperceptions that little can be done for patients with neurological problems.

Q: If you weren’t a physician, what would you be and why?
A: Farmer. I love the accomplishment of creating a garden and growing produce.

Q: What are your hobbies/interests outside of work?
A: Gardening, running and hiking

Q: What was the funniest thing a patient told you?
A: “I don’t eat apples, doctor.”

“Why?”

“Because they keep the doctor away, and I like you, Dr. Mower.”

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