CHOC Children's Blog - The official blog for CHOC Children's

Thank you CHOC Doctors!

The nation will formally recognize physicians on Doctors’ Day later this month – March 30, to be exact – but not a day has gone by in the last 50 years that I don’t think about all the wonderful doctors at CHOC Children’s who patched me up after falling from that tree.

And even all these years later, I still see one of the doctors I met during my 1964 hospital stay: Dr. Melville Singer, who is still on staff at CHOC.

Dr. Singer, 87, remembers the hospital’s opening on Oct. 5, 1964 well. A pediatrician who had been practicing in Orange County for about 10 years prior, Dr. Singer served on a committee that helped guide the hospital’s planning.

“The opening was something I was looking forward to for a long time – the need was there,” he says.

New hospital, new specialty

Dr. Singer was one of three cardiologists on staff during CHOC’s opening, a time when pediatric cardiology was still in its infancy. But changes came quickly, and they haven’t stopped since.

In the few years after the hospital’s opening, CHOC established a cardiac catheterization lab, where new techniques were introduced. Imaging processes were enhanced so that Dr. Singer no longer needed to drive to Los Angeles to get film developed. And the entire hospital continued to grow.

“It didn’t take long until we needed to expand,” he says, recalling CHOC’s original construction, which was attached to St. Joseph Hospital.

CHOC’s growth steady

Indeed, in his 50 years on staff at CHOC, Dr. Singer has watched the hospital make great physical changes, but he says the growth was well-planned, prudent and needs-based.

“As things grew and things developed, the course that the hospital leaders took to encourage future growth was appropriate and not out of bounds,” Dr. Singer says.

But no matter CHOC’s physical stature, the hospital’s significance to the community has always remained constant.

“We put all of our faith in CHOC and its system to manage the complicated patients,” he recalls. “Whenever there were patients who needed hospitalization, they were brought to CHOC. It didn’t take long to establish CHOC.”

New Orange County roots

Born and raised in the Midwest, Dr. Singer settled in Orange County after finishing his fellowship and residency at Children’s Hospital in Cincinnati. He loved the weather and the work, and stayed put.

“What’s not to like?” Dr. Singer asks.

He and his wife, Beverly, who is active in the CHOC-fundraising Lamp Lighter Guild, have four children. Three of the Singer children are in fields related to medicine, including one son who is a family physician, Dr. Singer says.

Today, Dr. Singer is a physician emeritus. He no longer treats children, but instead teaches electrocardiography and other skills to residents at CHOC. He is still involved in an adult congenital heart clinic at CHOC, where he frequently sees former patients who thank him for his help.

He can count me among them. On behalf of all CHOC patients, past and present, I thank Dr. Singer and all physicians on staff.

Choco Bear

Almost 50 years ago, the good doctors, nurses and staff at CHOC Children’s took good care of me after an unfortunate tree-falling incident. I have been their biggest fan (and official mascot) ever since. This post is part of my 50 weeks of gratitude tour. Learn more at http://www.choc.org/thxCHOC.

Advancing Information Technology in Health Care

Posted on March 11, 2014 by CHOC Children's Posted in Health & Safety Leave a comment

Electronic health records (EHR) document a patient’s medical history, but its data and the technology behind it provide a multitude of future possibilities, says CHOC Children’s Chief Medical Information Officer.

CHOC Children’s began moving to the EHR in 2002, and more technological developments will be forthcoming at a rapid pace in the next few years, says Dr. William Feaster.

“You can never catch your breath the rate of change in healthcare information technology is so rapid,” he says. “Whether it’s because of new government mandates, regulatory requirements or clinical needs, there’s always something new and challenging around the corner. You can’t stop or you fall behind. My job is to help our organization navigate all of this change.”

CHOC’s EHR system is called “CUBS,” an acronym for Connecting Users and Building Safety and a play on the hospital’s Choco Bear mascot. Physicians are now working to find ways to better use and analyze EHR data to be proactive.

“One of our current initiatives is to take the data we collect and analyze it,” Dr. Feaster explains. “For example, an endocrinologist will soon be able to review all their patients with diabetes in his or her practice and see who has had all the right screening tests, who has made appointments and who hasn’t, and who has their diabetes under control.”

Dr. Feaster’s goal is to use data proactively. After all, an early intervention with patients who haven’t met required care guidelines can help avoid unnecessary complications, he says.

“Our goal should be to use technology to help keep all children healthy or as healthy as they can be if they have a chronic disease,” he says. “We’re trying to avoid unnecessary hospitalizations and Emergency Department visits in these higher-risk populations.”

Mobility will also be an important element as information technology advances at CHOC, Dr. Feaster says.

“We’re moving to mobile technologies, just like patients and parents,” he says. “Our goal is to give the doctors and nurses more time to directly interact with patients and parents, and spend less time entering data. We want to make working at CHOC as efficient as possible so we can free up more time for clinicians to provide patient care.”

Tips for Avoiding Pediatric Sleep Disorders and Coping with Daylight Saving Time

Posted on March 10, 2014 by CHOC Children's Posted in Health Features Leave a comment

By Dr. Anjalee W. Galion, CHOC Children’s neurologist

Losing an hour of sleep as we “spring forward” to daylight saving time can wreak havoc on sleep schedules this week, especially children who already struggle with sleeping problems. Due to their developing brains, children can be particularly sensitive to sleep deprivation.

According to the National Pediatric Sleep Foundation, about 71 percent of infants wake at least once, and 21 percent of infants wake up three or more times per night. Thirty percent of parents report their children have difficulty with sleeping – - across all ages.

Signs and symptoms of pediatric sleep disorders

Dr. Anjalee Galion, CHOC Children's Neurologist

Dr. Anjalee Galion, CHOC Children’s Pediatric Neurologist

Sleep -deprived children exhibit symptoms differently than adults. Adults usually experience general daytime sleepiness, whereas children tend to display sleepiness in a variety of ways, such as showing traits of inattention and hyperactivity that are sometimes mistaken for ADHD. Additionally, sleep deprivation in children causes physical stress, which can contribute to difficulty initiating and maintaining sleep. Many parents might recognize this trend when trying to keep their children awake until late at night, which can actually lead to children having trouble staying asleep and waking up earlier than normal.

Turn off the TV

The blue light emitted by all screens (TV, computer, smart phones, tablet devices, etc.) can interfere with the way the brain identifies day and night. The brain uses the eyes to give cues to lightness and darkness to set the body’s internal clock, also known as the circadian rhythm. Having “screen time” throughout the day, and especially at night makes it difficult for the body to identify day and night and can cause significant difficulty falling asleep or staying asleep.

The National Sleep Foundation found that children with TVs in their rooms are most likely to be among the worst sleepers. The presence of the screen, even if it is turned off, activates the brain and makes it more difficult to go to sleep and stay asleep. Children who get more sleep are more likely to read books as part of their bedtime routines, instead of time in front of a screen. It’s best to encourage children to enjoy reading in the few hours before bedtime.

Daylight saving time tips

Adhering to a consistent sleep schedule – as close as possible to a child’s normal routine – is particularly important during this time. As easy as it may be to permit kids, who don’t feel sleepy or can’t sleep as a result of the longer days, to stay up later, such a habit will disrupt sleep patterns. The use of blackout shades and a timed night light can serve as consistent cues for little ones, letting them know when it’s time to sleep and time to wake up.

Dr. Anjalee W. Galion is a CHOC Children’s pediatric neurologist who is also fellowship trained in sleep medicine. She is actively involved in pediatric sleep medicine research having completed National Institutes of Health – National institute for Neurologic Disorder and Stroke clinical trials fellowship. She has also developed protocols to improve sleep in children with autism. Dr. Galion is also trained in cognitive behavioral therapy for sleep disorders and has authored a book chapter on the evolution of insomnia from children to adults. She is actively involved with reading sleep studies and in the comprehensive diagnostic evaluation of children with all types of sleep disorders.

Kids and the Immune System

Posted on March 10, 2014 by CHOC Children's Posted in Health Features

THE IMMUNE SYSTEM
“Our immune system is a series of cells, tissues and organs that, throughout our lifetime, protects us from different invading pathogens and keeps us healthy and able to resist many repeated infections,” says Dr. Ashouri, a pediatric infectious disease specialist at CHOC. “When babies are infants, they get immune cells from mom through the placenta and breast milk, if they are breastfeeding. Over time, the baby’s system becomes mature and can fight off infections. A healthy lifestyle that includes getting enough rest, low stress and a balanced diet plus exercise helps to strengthen the immune system in people of all ages.”

BOOSTING BABY’S IMMUNE SYSTEM
“Breastfeeding is probably one of the best ways to help support a baby’s immune system when it’s developing,” explains Dr. Ashouri. “Getting babies the recommended vaccines at the scheduled times also helps to protect them from the different infections they are at risk for at that age. We recommend that parents and children also get a flu shot each year and are up-to-date with their Tdap vaccine to protect kids from pertussis (whooping cough). The
more people in the community who are vaccinated, the better it is for everyone. In pockets of areas where vaccine rates have fallen, there have been outbreaks of measles, whooping cough and other preventable diseases.”

KIDS AND COLDS
“Proper hand-washing is important to prevent the spread of colds and the flu virus and other types of infections. When kids can’t wash their hands, they should use a hand sanitizer to kill germs. Getting kids vaccinated against the flu also prevents kids from getting the flu,” Dr. Ashouri says. She adds, “Over time as the immune system recognizes certain viruses, it will get better at preventing infection, especially if the person has a balanced diet and good lifestyle. Taking vitamins won’t hurt either but they don’t replace a well-balanced diet.”

FAST FACTS

Number of infants who died in California’s 2010 Pertussis (Whooping Cough) outbreak. It was the worst outbreak in 60 years. More than 9,000 cases were reported: 10
Percent of the U.S. population that gets the seasonal flu (Influenza) each year: 5 to 20
Number of children hospitalized in the U.S. each year with respiratory infections: 500,000

View the full feature on Kids and the Immune System

Dr. Negar Ashouri
CHOC Pediatric Infectious
Disease Specialist

PHYSICIAN FOCUS: DR. NEGAR ASHOURI

Dr. Ashouri completed her residency at CHOC, followed by a year as chief resident. After completing a fellowship in pediatric infectious diseases at Children’s Hospital of Los Angeles, she returned to CHOC. She is also a clinical instructor of Pediatrics at the UC Irvine School of Medicine.

Dr. Ashouri is involved in many research projects dealing with bloodstream infections and drug trials. She is also part of the Collaborative Antiviral Study Group. To further her research, Dr. Ashouri maintains an ongoing database of blood cultures and can frequently be found looking back through patient data and charts as she investigates how vaccines impact infections and specific risk factors for high-risk groups.

EDUCATION:
St. George’s University School of Medicine, Grenada, West Indies

BOARD CERTIFICATIONS:
Pediatric Infectious Disease

More about Dr. Ashouri

This article was featured in the Orange County Register on March 9, 2014 and was written by Amy Bentley.

Athlete Nutrition Fit for a Champ

Posted on March 7, 2014 by CHOC Children's Posted in Health & Safety Leave a comment

The new spring sports season means rearranging schedules and picking up extra equipment, but parents of young athletes should also examine their meal plans to ensure young athletes are eating enough.

“They absolutely need to eat more,” says Dr. Jacqueline Winkelmann, a CHOC Children’s at Mission Hospital pediatrician who works to provide nutrition tips and guidance in youth sports.

“Young athletes are still growing, and their metabolic demands are so high,” she says. “They need to take in the necessary amount of calories for growth and whatever the sport demands.”

How much, when to eat

Parents can estimate the amount of calories a child’s activity burns by using this tool. That number can help guide the week’s menu and ensure a consistent healthy diet – a key factor for top athletic performance, Dr. Winkelmann says.

“It isn’t true that if you eat badly all week and have one good meal before you play, you’ll be fine,” she said.

Here’s why: Glycogen is an energy source that fuels exercise in humans, but it’s built days before use, Dr. Winkelmann explains. That’s why eating well in the days preceding a game is crucial to optimal performance.

Pre-game eating particulars

Nonetheless, both the timing and type of food an athlete eats right before a game is also important. Whether a snack or a meal, she advises that pre-game fuel should be about 70 percent carbohydrates, 25 percent protein and 5 percent healthy fats. Carbohydrates are a key source of energy for children, adolescents and teens, Dr. Winkelmann advises.

“A meal can be anything from a whole wheat sandwich, a wrap, or chicken noodle soup with bread,” she says. “But if you have less than two hours before competition, focus on a snack that will fill up your tank, and then wait until after the game to eat a full meal.”

Post-game eats matter too

Indeed, what’s eaten after the game is also important. After vigorous activity, the body’s muscles can absorb more nutrients and can produce glycogen two times faster than normal. Dr. Winkelmann calls this time the “golden window.”

“We want to take advantage of it,” she explains. “That’s what your body will soak up. It’s important to have the right kind of fuel at that time.”

To that end, Dr. Winkelmann recommends food with a carbohydrate-to-protein ratio of three-to-one:

Chocolate milk
Fruit with cheese cubes
Yogurt and granola
Pretzels and nut butter

Tips for tournament eating

An athlete’s road tournaments also present new challenges for healthy eating, but a little preparation can go a long way, Dr. Winkelmann says.

Try traveling with a cooler so that healthy foods like yogurt, cheese, fruit and nut butters are always nearby. Technology can also help track down healthy fast food and restaurant options. For example, www.healthydiningfinder.com finds eateries nearby that offer healthy choices, Dr. Winkelmann says.