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Bite Into a Healthy Lifestyle! March is National Nutrition Month

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CHOC Children's Clinical Nutrition and Lactation ServicesBy Caroline Steele, MS, RD, CSP, IBCLC, director clinical nutrition and lactation services at CHOC Children’s

In honor of National Nutrition Month, join CHOC Children’s in encouraging everyone to adopt eating habits focusing on reducing excess calories from fat and sugar, reducing intake of processed foods, and making information food choices to help fight disease and promote good health.

With so much nutrition information available and so many food choices, deciding what to put on your dinner plate can feel daunting and time consuming. The United States Department of Agriculture’s MyPlate makes it easy. No matter how busy you are, one quick glance at your plate can show you if you are getting the variety you need to stay healthy.

Compare the foods on your plate with the MyPlate icon below. How does it compare? Are there food groups that you should be eating more of? Less of? All foods fit into a healthy diet — it’s just a matter of balance.

Some hints for a healthier table:

Balance Calories

  • Enjoy your food, but eat less.
  • Avoid oversized portions.

Foods to Increase

  • Make half your plate fruits and vegetables.
  • Choose whole grains whenever possible.
  • Switch to fat-free or low fat (1%) milk.
  • Choose lean sources of protein such as lean meats, chicken, fish and beans.

Foods to Reduce

  • Reduce your intake of processed foods. When choosing canned or frozen foods, choose those with lower amounts of sodium.
  • Reduce or eliminate sugary drinks—drink water instead!

Make it fun and use MyPlate as a family! Have kids draw the MyPlate icon then compare it to their own plates. Getting children involved in mealtimes and food choices can help them be healthier and make better nutrition decisions as they get older.

So, dig in! Good nutrition and healthy eating are as close as your plate.

For more information, go to MyPlate.gov for interactive tools and sample meals.

Or, go to eatright.org, the website of the Academy of Nutrition & Dietetics, for a variety of topics including nutrition for life and food safety.

Learn more about CHOC Children’s Clinical Nutrition and Lactation Services.

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Managing and Combating Test-Taking Anxiety in Children

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By Jonathan E. Romain, Ph.D.

Many parents know the disappointment of seeing their bright child score poorly on an exam even after hours of studying. girl with test-taking anxiety

“I knew the answers before the test!” and “My mind went blank when I saw the test!” are common refrains from these frustrated children.

These aren’t excuses. What these children are experiencing can likely be attributed to test anxiety, a real phenomenon that occurs when nervousness goes into overdrive, causing physical, behavioral and cognitive consequences that can impact test scores.

Fortunately for parents and children alike, test anxiety can be managed and even conquered.

When Anxiety Takes Over

Anxiety at its best provides a bit of nervousness that keeps people sharp and making sound decisions at key moments.

However, the problem occurs when anxiety becomes more intense than what is necessary for the situation. Many people – more than 30 percent – have difficulty keeping anxiety at a manageable level. For these people, excess anxiety can lead to poor performance, low self-esteem, and school avoidance and social isolation.

Anxiety symptoms usually first develop during the school-age years, when tests are introduced and awareness that classroom performance is monitored increases. During these formative years, children need good coping skills and strategies to manage anxiety.

Symptoms of Test Anxiety

To best manage test-taking and classroom anxiety, first identify the symptoms:

  • Physical symptoms include increased heart rate, trembling or a shaky feeling, muscle tension, and feelings of lightheadedness.
  • Behavioral symptoms include irritability, restlessness, rapid speech and fatigue.
  • Cognitive or thought-related symptoms include difficulty focusing and concentrating, memory problems, poor problem solving, and persistent worrying.

Test anxiety can also self-perpetuate or reinforce itself. So, if a child had a bad experience on one test, it’s likely they will have similar feelings again. After several experiences, the child may feel that all tests are miserable and to be avoided.

Managing Test Anxiety

Parents, teachers and students should work together to control anxiety.

Parents should reward success and reinforce good effort, but know that too high expectations and unrealistic goals may have a negative effect. They should also ensure they control their own anxieties, as children can sense emotions and model learned behaviors.

Parents and schools should work together to identify test-taking anxiety as it occurs and ensure realistic expectations. Teachers can modify time constraints and put equal emphasis on homework, projects and classroom tests. Additionally, they can grade more for effort than output. Less emphasis on grades can diminish anxiety and improve grades.

Finally, children can manage their anxiety by identifying symptoms and practicing progressive relaxation and other deep breathing techniques to calm down. They should also be encouraged to talk to parents and teachers when feel overwhelmed.

They can also try journaling: A recent study at the universities of Colorado and Chicago suggested that writing about anxiety before taking a test reduced anxiety’s impact on performance. The idea is that by writing about the anxiety, test takers let go of symptoms and can concentrate better on the task.

Anxiety has a protective factor in dangerous or life-threatening situations, and a reasonable dose of nervousness can help one perform at their peak. But it is essential to know the symptoms of anxiety and to keep them in check so they do not take over. Learning to manage anxiety in the school-age years is the first step to an anxiety-free adulthood.

Dr. Romain is a board-certified clinical neuropsychologist at CHOC Children’s. Dr. Romain completed his pre-doctoral internship at Franciscan Hospital for Children in Boston and a two-year American Psychological Association accredited fellowship in pediatric neuropsychology at Medical College of Wisconsin. Learn more about Dr. Romain.

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Learning Disabilities and Your Child

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Many children have learning disorders that affect everything from their reading comprehension to their math abilities. Learning disabilities affect the brain’s ability to receive, process, analyze, or retain information.

If your child has a learning disability, he’s certainly not alone; roughly 5 percent of children in public schools are receiving special education services for a learning disability, says Dr. Jonathan Romain, a CHOC Clinical Neuropsychologist.

Many dyslexic children also have another learning disability or neurological disorder, often Attention Deficit Hyperactivity Disorder (ADHD), says Dr. Romain, adding that ADHD and dyslexia should be treated separately when diagnosed. Medication and behavioral support and counseling, as well as helping your child to stay organized and have an organized environment, will help, he says.

Here are some tips from Dr. Romain on more ways parents can help their child with a learning disorder:

  • Get your child to read and read often! This can be challenging for parents of kids with ADHD, says Dr. Romain. “With ADHD, you don’t like to do the things that you don’t want to do, so this impacts the motivation, follow-through and determination to become a better reader. Parents should provide positive reinforcement. If Jimmy doesn’t want to read, have him practice reading for 10 minutes and then do something fun afterward. You want to tie positive outcomes with reading.” The goal is to get children with a reading disability and /or ADHD to be proficient enough at reading so they will find books or magazines they like and read them on their own.
  • Children may have a learning disability in relation to numbers or math. Parents should be aware if their child is having trouble in math and seek an evaluation for a learning disability in first or second.
  • Make sure your child has adequate exposure to the material (reading or math) before having him evaluated. First or second graders from low-income areas will often benefit first from more exposure to the material if they are having trouble. They can be evaluated more extensively if they are not making progress.
  • Watch out for your daughter! In the classroom, boys are identified as having a reading disability up to three times as frequently as girls, but in research studies, it’s evident that dyslexia is only modestly more common in boys. The conclusion is that girls tend to be underdiagnosed in the schools and this is also the case for other school-based struggles, including ADHD.
  • Public schools can evaluate a child to see if he or she needs special education support or accommodations if the problem impacts learning; a clinical evaluation will look for an underlying disorder, developmental delays, mood issues and other medical issues. Concerned parents can ask their school district or pediatrician as a starting point, and seek an outpatient evaluation or a second opinion if they want. If you seek a private evaluation for your child outside of the school district (possibly at your cost, since medical insurance may not deem this as a medically necessary), make sure it’s from a developmental psychologist or neuropsychologist familiar with educational development.

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Neurology Center at CHOC Has Moved to New Location

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We are now serving our neurology patients in a beautiful new location! The address is: CHOC Children’s Neuroscience Center (formerly CHOC Children’s Neurology Clinic), 505 S. Main Street, Suite 350, in Orange.

The new location features 15 exam rooms with large monitors for viewing test results; several team conference areas; a patient and family-friendly reception area with learning and gaming centers; and wider hallways and a plate- push front door in consideration of our patients and families using wheelchairs. The expanded space allows for future growth, including the upcoming launch of our tuberous sclerosis program.

Please note our hours of operation and phone numbers remain unchanged.

To schedule an appointment, please call the Patient Access Center (PAC) at 1-888-770-2462. Should you have any questions or concerns, please call 714-509-7601.

For a campus map, click here for English and Spanish. Please note the CHOC Children’s Neuroscience Center is located in the CHOC Commerce Tower (#13 on the map legend, with parking directly adjacent to the building.)

We look forward to seeing you in our new location.

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Former CHOC Patient is Cancer Free Thanks to Da Vinci Robotic Surgical System

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Julia Shenkman is a healthy and accomplished 17-year-old. She has a second-degree black belt in Taekwondo, is a member of her high school’s science team, and is fourth in her senior class in academics. Julia has another distinction: She’s a former CHOC Children’s patient who underwent a surgical procedure that involved the use of the then-landmark Da Vinci robotic surgical system.

In late 2003, CHOC became the first pediatric hospital in California to begin offering robotic surgery for children. The Da Vinci robot was an improvement over minimally invasive laparoscopic surgery because it gave surgeons a better view inside the surgery site and allowed them to more precisely manipulate instruments, which translated to less pain, fewer complications and shorter recovery time for patients.

In January 2006, Julia, then 8, was whisked to the emergency department at St. Joseph Hospital for severe abdominal pain and frequent vomiting. Blood work and X-rays for appendicitis turned up negative. It wasn’t until Julia’s doctor at CHOC, Mustafa Kabeer, pediatric surgeon, ordered an ultrasound that the cause of her distress was found: a large mass in her right ovary. Using the Da Vinci system, Dr. Kabeer operated on Julia and successfully removed the tumor, which was malignant. After three months of chemotherapy, Julia recovered and remains cancer free.

Julia with Dr. Mustafa Kabeer, CHOC Children's pediatric surgeon.

Julia with Dr. Mustafa Kabeer, CHOC Children’s pediatric surgeon.

Pediatric surgeons at CHOC have performed about 100 robot-assisted surgeries, says Dr. Kabeer, who before coming to CHOC helped implement the world’s first pediatric surgery robotics program at Children’s Hospital of Michigan in 2001. Recently, Dr. Kabeer started using the Da Vinci system to perform complex operations through one incision in the belly button, such as for removal of the gallbladder.

“This type of technology helps us perform a wide variety of surgeries — some of them very complex,” Dr. Kabeer says. “It takes time, commitment and vision to start and maintain such a program, but this is one of the unique things about CHOC: We want to do this, and we are committed to doing it.

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Wearing the Right Helmets the Right Way

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girl on a bikeMost serious head injuries to kids can be prevented if they wear a helmet, but it’s important for children to wear the right kind of helmet, and to wear it correctly.

Before you get there, however, parents have to make sure their kids will actually wear a helmet.

Michelle Lubahn, CHOC’s community education coordinator, says parents should insist upon it from Day One – no exceptions.

“Starting this habit from the very beginning is your easiest route. For older kids, let them pick out something they like,” she says, adding, “Take the scooter or bike away if they don’t wear their helmet.”

If children balk at wearing a helmet, ask them why. They may fear they will look like a “geek,” or that their helmet will be ugly or uncomfortable. Talking about it and letting them pick out their helmet or decorate it will help, says Lubahn. Also explain to your child that it’s the law. In California, anyone under the age of 17 must wear a helmet approved by the Consumer Product Safety Commission while riding a bike, scooter, skateboard, roller skates and inline skates.

The correct way to wear a helmet. Photo courtesy of the U.S. Consumer Product Safety Commission.

Pictured: the correct way to wear a helmet. It should have a snug but comfortable fit on the rider’s head. Photo courtesy of the U.S. Consumer Product Safety Commission.

Tips for buying and fitting a helmet:

  • The helmet should fit snugly and not slide around on the child’s head. Place two fingers above the child’s eyebrows and measure the circumference of the head there. Take that number with you when you go buy the helmet. When your child tries one on, place those two fingers above his eyebrow and the helmet should be resting there.
  • By law, the chinstrap must be buckled. If it’s not buckled, it’s likely to fly off. One of the child’s fingers should fit between the chinstrap and the chin.
  • If the helmet is on correctly, the straps should form a letter “V” below the ears.
  • Make sure the helmet meets federal guidelines set by the Consumer Product Safety Commission. If it’s approved, it should say so on the helmet.
  • Generally, most helmets shouldn’t be used again after a major impact or if the helmet gets cracked. If cracked, it should be replaced. Helmets also should not be tampered with for comfort or any reason.

Finally: all helmets were not designed for the same purpose. Your child needs to wear a helmet designed for the activity he or she is doing. For example, a child should not wear a bike helmet to play football or a hockey helmet for bike riding. “You want to use the right helmet for the right activity,” says Dr. Sharief Taraman, a CHOC pediatric neurologist.

To learn more about helmet safety, go to choc.org/health.

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Preventing High Blood Pressure in Kids

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Most people think high blood pressure (also called hypertension) affects only adults, but kids can have it too. While most children with hypertension don’t face the same immediate risks that adults do, high blood pressure can still put children at risk for serious health complications later in life.

Parents can do several things to reduce their child’s risk of developing high blood pressure, says Dr. Dorit Ben-Ezer, medical director of CHOC’s pediatric nephrology program and a specialist in high blood pressure and related issues. Keeping kids active and having them maintain healthy weights are important.

Parents should model healthy eating habits and engage in regular physical activity. “On the weekend instead of going to the mall, the family can go on a hike or a walk,” suggests Dr. Ben-Ezer, who also offers the following tips to prevent high blood pressure:

  • Diet: To help your kid maintain a healthy weight, make sure he eats plenty of fresh fruits and vegetables. Avoid foods with too much added sugar, fats and saturated fats. Control your child’s salt intake. Reducing salt intake helps lower the amount of fluid the body retains, which lowersing the blood pressure.  Cook with herbs or spices instead of salt. Be aware that caffeine and illicit drugs can elevate blood pressure.
  • Exercise and physical activity: Encourage your kids to be active and limit sedentary activity to two hours or less per day.
  • Children with kidneys problems or those born prematurely (especially if they suffered complications) have a higher risk of developing high blood pressure. Make sure these children get their blood pressure checked regularly.
  • To learn more about high blood pressure in kids, go to choc.org/health.

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February is American Heart Month — Cyrus’ story

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Just in time for American Heart Month, learn about our courageous patient, Cyrus, who underwent complex open heart surgery. His successful journey was met by much celebration from his family and his team of CHOC experts.

Hypoplastic Left Heart Syndrome (HLHS) is a rare congenital heart defect, which is 100 percent fatal if left untreated. Sunny and Jereme Brixey knew about their baby’s risks even before Cyrus was born in 2008, having been prenatally diagnosed.

Prior to Cyrus’ birth, the cardiac team at CHOC Children’s already had a plan of action: an approach involving three different open heart surgeries. Three days after he was born, Cyrus underwent complex open heart surgery. He had a second heart surgery at 4 months and a third at 4 years.

After the third procedure in 2013, Cyrus took a long time to recover in the hospital. After being in

Cyrus, with Dr. Michele Domico, medical director of CHOC Children's CVICU and Choco, at a CHOC Night at Angels Stadium event.

Cyrus, with Dr. Michele Domico, medical director of CHOC Children’s CVICU and Choco, at a CHOC Night at Angels Stadium event.

the hospital for nearly two months due to persistent drainage from a chest tube, Cardiovascular Intensive Care Unit (CVICU) physician Michele Domico, MD, suggested that Cyrus could be discharged home with a portable chest drain. He would be the first patient in the hospital’s history to be sent home with this device. The cardiologists and surgeons agreed and ordered the new portable chest drain for Cyrus, allowing him to go home.

At home, Cyrus’ parents took care of him and his chest drain so that he could heal, and the drain was able to be removed after a few weeks. This successful procedure was met by a large cheer from Cyrus’ entire CHOC team. For Sunny and Jereme, this expression of joy reflected the care Cyrus received every step of his journey. In addition to the clinical excellence of the medical team, the Brixeys believe the team’s positive, encouraging words, as well as the support extended to the entire family, were a huge factor in his recovery. Since then, the CVICU team has used the portable chest drain in several other patients with great success.

Learn more about the CHOC Children’s Heart Institute.

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