CHOC Walk in the Park 2017: Why I Walk – Team Miranda

Seven years ago, Miranda woke up screaming in the middle of the night from unbearable head pain. She couldn’t move or recognize her parents, and then she collapsed.

Miranda’s parents rushed her, a 10-year-old at the time, to a local hospital. Physicians there initially told them to wait three days for observation.

Dr. Jason Knight, a CHOC Children’s pediatric critical care specialist and medical director of CHOC’s emergency transport services, was on call at that hospital that day, and met with Miranda’s parents, Regina and John.

An Emergency Transport to CHOC

“Dr. Knight explained what was happening better than anyone else at the hospital,” Regina remembers. “He suggested we transport her to CHOC so she could be seen by pediatric specialists. We were scared to move her, so we asked Dr. Knight if he would transport Miranda if she were his own daughter. He said yes, and we trusted him.”

choc walk
Dr. Jason Knight, critical care specialist, chair of the department of medicine, and medical director of emergency transport services at CHOC Children’s

Dr. Knight recalls, “As the physician covering the local hospital that day, it was my responsibility to assure that Miranda received the appropriate care in a timely manner. As soon as I assessed her condition and reviewed the CT scan of her brain, it was clear to me that Miranda needed to be transferred to CHOC immediately. I contacted Dr. Michael Muhonen, a pediatric neurosurgeon at CHOC, and coordinated Miranda’s transfer to CHOC.”

Scans revealed she had an arteriovenous malformation (AVM), a tangle of weakened blood vessels that had ruptured and started to bleed in her brain. Upon arrival at CHOC, Miranda immediately underwent neurosurgery with Dr. Muhonen, medical director of the neuroscience institute at CHOC.

“Miranda was critically ill upon arrival to CHOC. She reminded me of my own three daughters― innocent, beautiful and vulnerable. It was with this in mind that I approached her operation― do what it takes to keep her brain alive and functional,” recalled Dr. Muhonen.

choc walk
Dr. Michael Muhonen, medical director of the neuroscience institute and director of neurosurgery at CHOC Children’s

After a successful four-hour surgery, Miranda was placed in a medically-induced coma for several days. Her parents didn’t know if she would survive.

“When Miranda was in a coma, I told Dr. Knight that I wanted to take a photo of her so that I could show her when she woke up, but that I didn’t want to take it if she wasn’t going to make it,” recalls Regina. “For a few days, he wouldn’t let me take the photo because he wasn’t sure if Miranda was going to survive. Then one day, Dr. Knight told me it was ok to take a photo of her, and I knew that meant she was going to make it.”

John adds, “My family is intact today because of wonderful doctors like Dr. Knight, Dr. Muhonen and their teams. It’s just amazing what CHOC does. We are so blessed.”

The Long Road to Recovery

Miranda’s recovery process included child life specialists, physical therapy and rehabilitation. She spent one month at an inpatient rehabilitation facility followed by an additional three months of outpatient care learning how to walk and talk again.

The first year after surgery was critical. Miranda saw Dr. Muhonen every few months for checkups to monitor her brain, as well as a CHOC ophthalmologist to make sure her sight was progressing.

“The AVM and the clot were removed successfully, and Miranda has recovered with minimal long-term deficit,” says Dr. Muhonen. “My reward is not only seeing a disease-free brain on the post-operative MRI, it is the omnipresent smile and effervescent personality that Miranda still has, despite her near-death experience.”

Everything came back except her sight. She lost 25 percent of her vision in both eyes, but that hasn’t stopped her from dancing, her favorite activity since age 8. Miranda’s parents had to supervise her at all times for the first year after surgery to make sure she didn’t have a seizure (a possible side effect of brain surgery), which meant that her mom went to every dance practice and every pool party to ensure her daughter’s continued safe healing.

Giving Back to CHOC

A few months after Miranda’s surgery, her family was invited to participate in CHOC Walk in the Park by friends.

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Miranda and her family at their first CHOC Walk in the Park, just a few months after her emergency neurosurgery

“After what we went through, we felt closely tied to CHOC. We walked that year and fell in love with the event. We realized this was an affordable way to give back to CHOC,” recalls John. “My favorite memory was our very first CHOC Walk. Miranda walked alongside us, which was a huge accomplishment. A couple months before that, we weren’t sure if she was ever going to walk again. To see her walk on her own was the most memorable moment for me.”

The family’s first CHOC Walk was especially impactful for Miranda herself.

“I will never forget attending my first CHOC Walk one year after my surgery. I remember seeing other patients participating in the walk with their own team just like me, only they needed walkers or wheelchairs to have the capability of walking the entire distance. Seeing other patients that were struggling to do the simple task of walking, something that people take for granted, made me reflect back to being a patient at CHOC, where I once struggled with relearning how to walk during physical therapy,” recalls Miranda. “From that moment on, I promised myself I would always participate in the CHOC Walk and give back as much as I could, not only to represent the patients who couldn’t recover as fast as I did, but also for the patients that don’t make it. I am reminded every day by the scar on the back of my head of how blessed I am to have been a patient at CHOC.”

choc walk
Every year since her emergency surgery, Miranda’s family rallies dozens of friends to participate in CHOC Walk in the Park.

Every year since then, Miranda’s parents gather dozens of friends, family and co-workers to join Team Miranda, the CHOC Walk team they formed in honor of their daughter. They formed their team with the help of the Littlest Angel Guild, a philanthropic group that raises funds to support the mission of CHOC.

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Miranda and her family at the 2012 CHOC Walk in the Park

“We encourage people we meet to participate in CHOC Walk to help provide the best medical care for the children in our community. You never know if or when CHOC’s services will be needed for your children, for your friend’s children, for your neighbor’s children, or even a stranger,” says John, whose employer, Hill Brothers Chemical Company also sponsors CHOC Walk, in addition to the other philanthropic events benefiting CHOC. “We learned firsthand how much everyone at CHOC cares – the doctors, the nurses, the administrators, and staff throughout CHOC all genuinely care about the children and their families.”

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Team Miranda at the 2013 CHOC Walk in the Park

Experience at CHOC Inspires Future Career

Now a senior in high school, Miranda is preparing for graduation and heading off to college. Inspired by her experiences at CHOC, she is planning to major in psychiatry and dreams of becoming a pediatric optometrist.

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Year-Round Hydration Tips for the Whole Family

Summer may be around the corner, but hydration is an important part of your family’s health year-round. Keep in mind these easy hydration tips to ensure your family gets the fluid intake they need.

What is dehydration?

Dehydration is a condition that occurs when someone loses more fluids than he or she takes in. Infants and children are especially vulnerable because of their relatively small body weights and high turnover of water and electrolytes. They’re also the group most likely to experience diarrhea, a common cause of dehydration. Vomiting, fever, excessive heat/sweating, and increased urination can also lead to dehydration.

Symptoms of dehydration include:

  • Dry, sticky mouth
  • Sleepiness or tiredness- children are likely to be less active than usual
  • Thirst
  • Decreased urine output
  • No wet diapers for three hours for infants
  • Few or no tears when crying
  • Dry skin
  • Headache
  • Constipation
  • Dizziness or lightheadedness

What does proper hydration look like?

Staying healthy means staying hydrated, since our bodies depend on water to survive. Every cell, tissue and organ in your body needs water in order to work correctly. For example, your body uses water to maintain its temperature, remove waste and lubricate joints. Water is needed for good overall health.

Some of the top beverages I recommended to my patients for hydration include: water, low-fat or fat-free milk, and 100 percent fruit juice.

Keep in mind these tips for choosing healthy beverages:

  • Avoid drinking your calories
  • Avoid drinks that are high in sugar, such as soda, fruit drinks, punch, sweet tea, etc.
  • Choose beverages that have low or no added sugar
  • Remember that water is the source for hydration
  • Read nutrition labels and choose a beverage with less than 6 grams of sugar per serving
  • Be sure to double-check the serving size and number of servings in a bottle.

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Summer Snack Ideas and Safe Food Tips

By Stephanie Nathanson, registered dietitian at CHOC Children’s

With summertime approaching, it’s time to grab your sunscreen, your beach towel, your picnic basket, and hiking boots and get outdoors! There are countless opportunities for outdoor activities, especially during the summer heat, but packing meals and snacks can be a bit of a puzzler. What can I bring that will keep me satisfied for an action-packed day, without spoiling rotten or getting mushy in my backpack?

Not only should you consider what to pack up for a full day in the sun, but how do you keep foods safe? One important consideration is to keep hot foods hot, and cold foods cold. Most bacteria do not grow rapidly at temperatures below 40 degrees, and above 140 degrees. The temperatures in between are known as “the danger zone” because bacteria multiply quickly and can reach dangerous levels after two hours, or after only one hour if it’s toastier than 90 degrees outside.

When planning a daylong hike or outing, pack enough food for one meal plus snacks. Aim for primarily non-perishable items. To keep cold foods cold, consider freezing a water bottle or juice box to use as an ice pack. After you eat your snack you’ll have a refreshing, cold drink.

snack ideas

Snack and meal ideas for summer days:

  • Peanut butter sandwich with sliced banana and honey
  • Protein/energy bars
  • Beef jerky
  • Individual nut butter packs
  • Canned tuna or chicken – mix with avocado instead of mayonnaise to eliminate the risk of bacterial growth
  • Dried fruit and nuts
  • Homemade trail mix recipes:
    • Almonds, walnuts, peanuts, cashews, pecans, raisins
    • Walnuts, pumpkin seeds, sunflower seeds, cinnamon, nutmeg, sea salt, dried apricots, dried cranberries
    • Cashews, brazil nuts, dried mango, coconut flakes, banana chips
    • Create your own mix and match of nuts and seeds + dried fruits including: almonds, cashews, walnuts, pecans, pistachios, brazil nuts, hazelnuts, sunflower seeds, pumpkin seeds, apples, mango, blueberries, cranberries, cherries, goji berries, figs, dates, apricots, pineapple, raisins, banana chips. *Caution with adding chocolate bits as they may melt in the heat.

Weekend camping trips

For longer trips, you will need to pack a cooler filled with ice for meat and other perishable items. An ice block will last longer than cubes, unless you are located near a convenience store to replenish your ice supply each day. Remember to pack a thermometer to ensure cooking temperatures are satisfactory within FDA standards.

  • Cook burgers made of raw ground beef, pork, lamb and veal to an internal temperature of 160°F
  • Heat hot dogs and any leftover food to 165°F
  • Cook all poultry to a minimum internal temperature of 165°F
  • Cook all raw beef, pork, lamb and veal steaks, chops and roasts to a minimum internal temperature of 145°F
  • All cold food items should be below 40°

The rule of thumb for day outings and overnight camping trips is to plan ahead. Decide beforehand what you are going to eat and how you are going to prepare it, including the equipment you will need.

  • Bring a cooler if needed, especially for overnight trips.
  • Keep raw foods separate from other foods.
  • Bring a cold source, such as ice packs or frozen juice boxes, to keep cold foods, such as meat and dairy products, cold.
  • Don’t forget your biodegradable soap for dishwashing.
  • Bring bottled water for drinking and teeth brushing, or check out in advance if you will have access to a filtered water source.

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The Latest Guidelines for Introducing Solids to Babies

Many parents are familiar with this scene: It’s dinner time, and your baby is eyeing every bite of food you put in your mouth. Is it time for baby to try solid foods?

Solid foods can be introduced as early as six months of age, according to guidelines from the American Academy of Pediatrics and the World Health Organization. That’s when a baby’s digestive system is developmentally ready for food. Prior guidelines recommended starting solids at four months, but research has shown that introducing solid foods earlier could increase the chances of developing diabetes, obesity, allergies and eczema, according to Vanessa Chrisman, a pediatric dietitian at CHOC Children’s.

Age is not the only requirement for solid foods. A baby should also show the following signs of readiness: they can hold their head up, they can sit up without support, they can close their mouth around a spoon, and they no longer reflexively push things out of their mouth with their tongue.

“If a baby spits the food back out with her tongue every time a parent offers food, she’s probably not ready for solids yet,” says Chrisman.

At first, solid foods are more for practice and exposure to new flavors and textures, rather than for nutrition. A baby’s main source of nutrition will continue to be breast milk or formula up until one year of age. As a baby eats larger amounts of solid food and approaches the one year mark, they may begin to drink less breast milk or formula.

Introducing Solids to Babies

Solid foods are traditionally introduced in puree form. Single foods are blended to a smooth consistency and fed by spoon. As a baby eats larger volumes and tries more foods, parents can move on to a thicker texture: mashed foods. At around nine or 10 months old, a baby may start eating finger foods in small pieces.

Baby Led What?

Another method of introducing solid foods to babies is called baby-led weaning (BLW). This method has been popularized in the United Kingdom over the last decade and is starting to gain popularity in the United States.

“Baby-led weaning is a way of introducing solid foods beginning with whole but manageable pieces, and skipping purees and mashed foods,” Chrisman says.

Babies are offered foods that the rest of the family is eating, except for choking hazards such as whole grapes, hot dogs, raw carrots, popcorn, nuts, raisins and very tough meat. Parents can cook and spice the food as they normally would for themselves.

BLW teaches baby to feed themselves, helps them develop motor skills and gives them control over how much food they want and if they want it. “If they’re the ones deciding when to stop eating, it can help them regular their appetite later,” Chrisman says.

A recent study by the AAP determined that babies are not at a higher risk of choking from BLW than they are with traditional purees. Regardless of the food method, it’s always a good idea for parents to know infant CPR, Chrisman says.

As with puree-fed babies, BLW babies must meet the same signs of developmental readiness before starting solid foods. One thing a baby doesn’t need, though, is teeth. “Babies have strong gums that can soften food, along with their saliva,” says Chrisman.

Chrisman recommends that parents choose the method that fits their baby’s personality. An independent baby may take to BLW more than a baby who prefers to be spoon-fed. The key to remember is that every baby is different: “What might work for your friend’s baby might not work for your baby,” Chrisman says.

Straight from a Pediatric Dietitian

Chrisman offers these expert tips to parents as they introduce baby to solid foods:

  • Introduce simple foods one at a time, such as individual fruits, vegetables and proteins. Wait at least three to four days before introducing another food, to watch for adverse reactions. “Don’t go too fast, too soon,” Chrisman says. “Your baby has their whole life to eat all these foods.”
  • As solid foods are introduced, give baby a variety, which will help ensure they will like a variety of foods later in life.
  • Don’t add salt or sugar to baby’s foods. Not only could this cause baby to develop a taste for these strong flavors, it also prevents baby from experiencing the true flavor of a food.
  • Model healthy eating habits. Include a variety of healthy foods on your own plate so baby will learn to imitate your behavior. Encourage your family to sit at the table together and put away distractions so baby understands what meal times should be like.
  • “Make sure feeding time is a relaxing time, not stressful,” Chrisman says. Don’t force baby to eat more than they want and pay attention to their signals. If they are throwing food off their tray, pushing food away or turning their head away, they are done.
  • Feed baby solid foods in between their regular mealtimes, when they’re only somewhat hungry. A hungry baby won’t have the patience for solid foods to reach their tummy.
  • Avoid honey for babies under age one. Honey can carry spores that cause botulism, which is dangerous for infants.
  • Avoid fruit juice before age one. A recent change in AAP policy says fruit juice should not be given unless a doctor recommends juice to manage constipation. The high sugar content in juice may increase a child’s risk of obesity and teeth problems.
  • Avoid cow’s milk before age one. Cow’s milk should not be given on its own, according to the AAP, though it may be fed in other foods, such as whole fat yogurt.
  • Don’t give up on foods that baby rejects a few times. It could take up to 15 times of trying a food before they like it.
  • If baby isn’t eating any solids or purees by 10 months of age, talk to your pediatrician. There could be a feeding issue that needs extra help. Some babies may have an oral aversion to foods, oral motor dysfunction, textures issues and/or poor muscle tone.

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CHOC Walk in the Park 2017: Why I Walk – Team Brave Boyle

Lizzie Boyle is mom to CHOC Children’s patient and cancer warrior Ella, age 6 and serves as team caption for CHOC Walk’s Team Brave Boyle

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There are many ways that grateful families can support CHOC. Why do you participate in CHOC Walk every year?

Walking was the most crucial part in Ella’s recovery. As she braved her 14 rounds of chemotherapy, multiple surgeries, and many scans and procedures under anesthesia, I knew as a mom that it was important to get her moving. CHOC encouraged us as parents to be active participants in Ella’s recovery, and how crucial it was that she must get out of bed and walk the halls of the hematology/oncology unit to survive. The CHOC Walk is a direct reflection of what happens inside that unit at CHOC. Get up, survive, and walk alongside people who you may never know by name. We learned that the power of being together, all for the purpose of knowing someone in their lives was affected by this hospital, is a tremendous feeling.

What inspired you to become part of CHOC Walk? How long have you been participating?

The CHOC Walk was always been something we knew about within our community, however not until my daughter was a patient herself did we walk. Last year, my sister Caitlin and brother-in-law Rhett took it upon themselves to create Team Brave Boyle, and by the grace of God and many other hands we were able to walk that day. Some members of our team have participated for years in support of the care their own children received years ago, but much of our team was experiencing it for the first time. The phrase I heard the most from our team that day was, “We will do this every year. This is amazing.”

What is your favorite memory from a previous CHOC Walk?

Well that is a tough one to answer! I will say it was when we were in a holding pattern waiting to walk down Main Street. The Brave Boyle team was stretched out five people wide and at least 40 feet back. I looked ahead of us and saw a group of our oncology nurses; I looked behind me and saw my sisters; I looked around me and saw Ella’s classmates sprinkled around with their parents. To see the sacrifices that so many of our supporters made to be there that day was humbling,  and I felt so sad that Ella wasn’t able to walk with us that day. Then I looked to my right and there was a large group holding a sign for their daughter who is now an angel. I quickly became overwhelmed with emotion. Just then, over the Disneyland speaker, “Shake it Off” by Taylor Swift started playing. The entire group began to sing, and it brought me back to day one of Ella’s treatment when we started the tradition of singing that song for her. It was exactly what we needed at that very moment.

choc walk

What would you say to a community member to encourage them to participate in their first CHOC Walk?

It is an experience that allows you to celebrate all life, and your support system—the child, the sibling, the grandma…the people who hold us up. The day is beyond a fundraiser, it changes your entire outlook on what a hospital represents.

What inspires you most about the care being delivered at CHOC?

In our 12 months living off and on at CHOC, my daughter walked onto that 5th floor each time to be greeted as if, ‘Welcome Home.’ In the same respect, days later as we were discharged, they celebrated, praised her, and said, ‘Say hi to your sister!’ They knew Ella Grace Boyle, and every 5-year-old should feel that love no matter what they are facing.

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Meet Dr. Alyssa Saiz

CHOC wants its patients and families to get to know its specialists. Today, meet Dr. Alyssa Saiz, a postdoctoral fellow in pediatric psychology and neuropsychology.

Q: What is your education and training?
A: I attended Pepperdine University to complete my doctorate in clinical psychology. My clinical internship was at the University of Health Science Center San Antonio. I am currently near the completion of my two-year postdoctoral fellowship in pediatric psychology and neuropsychology.

Q: What are your special clinical interests?
A: My clinical interests are working with children and teens with depression and self-harming behaviors, as well as somatic symptom and related disorders. I also am developing my specialty in pediatric neuropsychology. I love being able to help people during the most confused and vulnerable time in their life, and hope to give them a future they can thrive in.

Q: How long have you been on staff at CHOC?
A: Three years.

Q: What are some new programs or developments within your specialty?
A: CHOC is in the process of building both an intensive outpatient program and Mental Health Inpatient Center for children and teenagers through the Mental Health Initiative. This is very exciting because the services provided by both of these programs are greatly needed in our community and will help us provide even better comprehensive and intensive mental health care.

Q: What are your most common diagnoses?
A:  Somatic symptom disorders, depression, and anxiety.

Q: What would you most like community/referring providers to know about you or your division at CHOC?
A:  As a department, we are growing and evolving with the community, working on research developments and supporting CHOC’s mental health initiative – all for the happiness of the population here. We are here to serve them, and working hard with them in mind each day. For me personally, I would love for people know how much of a passion this is for me – I’m here doing this work because I truly love it, and admire the courage of my patients and coworkers.

Q:  What inspires you most about the care being delivered here at CHOC?
A:  The aspiration to always give more and provide better services to the children and families we work with, as well as the commitment to training the future generations of medical and mental health professionals.

Q: Why did you decide to become a doctor?
A: I am insatiably curious and always wondering how to improve a situation. I also love to connect emotionally with people and understand their journey. So naturally, I was always drawn to psychology as an area of study and found myself looking for opportunities to work with children and teenagers who were experiencing hardship or mental health concerns.

Q: If you weren’t a physician, what would you be and why?
A: I would be a florist or have a ranch for rescued animals. Both very different paths, but in the end they’re creating beauty to enhance someone else’s life and provide joy.

Q: What are your hobbies/interests outside of work?
A: I love to cook (usually anything pasta or cheese-filled) and be outside (hiking, walking my family’s dog, and being in the sun). I am also currently learning Spanish, which I am very excited about!

Q: What is the funniest thing a patient has ever told you?
A: When I told a young patient I was going to get her mom from the waiting room, she replied, “Well, she’s probably getting coffee. She can’t live without coffee!” I can relate. Kids hear and take in everything!

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative.

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Meet Dr. Elisa Corrales

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Elisa Corrales, a pediatric psychologist.

Dr. Elisa Corrales
Dr. Elisa Corrales, a pediatric psychologist at CHOC Children’s

Q: What is your education and training?
A: I completed my bachelor’s degree at the University of California, Davis where I majored in psychology. I earned my master’s and doctorate degrees in clinical psychology at The University of Rochester in New York. While there, my research interests included studying factors of resilience in maltreated Latino children and identyfying patterns of neuroendocrine functioning and behaviroal outcomes in maltreated and non-maltreated populations. After graduate school, I completed both my predoctoral internship and postdoctoral fellowship at Childrens Hospital Los Angeles (CHLA), where I gained specialized training in parent-child interaction therapy, individual child and family therapy, and the diagnosis and treatment of children with various developmental disabilities including autism spectrum disorders. At CHLA, I also completed the Leadership Education in Neurodevelopmental Disabilitites (LEND) Training Program and gained vast experience working with interdisciplinary teams and pediatric populations.

Q: What are your administrative appointments?
A: Currently, I am working as a pediatric psychologist in CHOC’s co-occurring clinic, which specializes in working with children who face both a chronic medical condition and mental health concerns. I recently joined one of our primary care pediatricians in a clinic focused on ensuring the safety and well-being of children and families in Orange County who have been referred to social services often for suspected child abuse or neglect. In this clinic, I provide needed mental health consultation, psychoeducation, case management and support.

Q: What are your special clinical interests?
A:  Throughout the years, I have specialized in working with children who often present with difficult or severe behavioral issues. I also specialize in treating children who have been victims of trauma or child maltreatment.

Q: How long have you been on staff at CHOC?
A:  One year.

Q: What are some new programs or developments within your specialty?
A:  As part of CHOC’s mental health initiative, the psychology department will be starting the intensive outpatient program within the next year. This program will be dedicated to working with children who are struggling with complex issues. The aim of the program is to prevent re-hospitalization.

Q: What are your most common diagnoses?
A: The majority of children I work with are often stuggling with issues of depression and/or anxiety.

Q:  What inspires you most about the care being delivered here at CHOC?
A: A few years ago, my youngest child suddenly and unexpectedly became very ill and I found myself living at CHOC for approximately two weeks. It was one of the most frightening and emotionally difficult times in my life, but I was able to experience firsthand the amazing care provided by both the CHOC medical and mental health teams. Despite the fact that we were one family among many in the unit, my family was always treated with compassion and sensitivity; everyone who walked in the room was dedicated to helping my family. I am forever grateful for the support I received, and after that experience I decided that the CHOC team was without a doubt one that I wanted to join.

Q: What excites you most about CHOC’s mental health initiative?
A: I am excited that we will be able to help even more children in Orange County and provide specialized care to populations of children in critical need.

Q: Why did you decide to become a doctor?
A:  Before I applied to graduate school, I was working as a probation officer in the Sacramento County juvenile hall. I worked with children on a daily basis who were in need of mental health treatment and not incarceration; after this experience, I was committed to working with struggling youth.

Q: If you weren’t a physician, what would you be and why?
A:  I would love to be a chef or attend culinary school.

Q: What are your hobbies/interests outside of work?
A: I love dancing —salsa and cumbia are my favorite. I also love cooking.

Q: What have you learned from your patients?
A: Never underestimate resilience in children. In the face of extreme adversity, many children can succeed and will accomplish just about anything.

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative.

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Mindfulness Tips for Teens

Teens’ mental health is as important as their physical health. It’s not always obvious when a teen is struggling emotionally, but recognizing the symptoms and seeking early and effective mental health services are important to prevent more serious mental health issues.

Parents should talk to their teens and foster a relationship based on open communication. Seek to understand how your child is feeling, without judgment, before you try to fix the problem.

As a pediatric psychologist at CHOC Children’s Hospital, Dr. Mery Taylor helps teens and their families who are facing a variety of mental health challenges. Typical concerns or issues teens seek treatment for include:

  • Anxiety
  • Depression
  • Difficulty coping with stressors such as: chronic illness, a life or family change, a social or school concern, and grief and loss
  • Disruptive behavior disorders, including attention deficit/hyperactivity disorder (ADHD) and oppositional defiance disorder (ODD)
  • Eating disorders

“Throughout my ten years at CHOC, a majority of teens I have worked with have come to me for pain issues, anxiety, depression, eating disorders and difficulty coping with stress,” says Taylor. “I have also seen an increase number of transgender youth and parents seeking services.”

mindfulness
Dr. Mery Taylor, pediatric psychologist at CHOC Children’s

What is mindfulness?

Practicing mindfulness, or relaxation techniques can help teens build coping skills to address issues, such as anxiety disorders. It’s very easy to get wrapped up in our emotions and not see our way out of them, says Dr. Taylor.

“The more we attend to the fear, the more power it gets and we can become paralyzed about what to do, or avoid aspects of our life in attempt to manage the anxiety. We can get stuck on a cycle of trying to avoid our anxiety and forget to live life. At times, we allow our negative thoughts and emotions to dictate our actions without stopping to assess if they are valid and irrespective of the consequences. For example, we might avoid going to school because we don’t feel we have studied enough for a test and then end up missing out on important instruction for another class. Mindfulness makes us stop for a minute and check in with ourselves,” says Dr. Taylor. “Mindfulness asks us to be curious of our thoughts and feelings without judgment or action—to just be in the moment. Developing acceptance and compassion for the painful parts of our inner emotional life can weaken the power of the anxiety. Once weakened, we can better manage our fears.”

Tips for practicing mindfulness:

  • When something is bothering you, shift that attention to yourself, rather than what you’re reacting to.
  • Stop for a moment to center yourself, by addressing and labeling those sensations (fear, worry, anger). Validate these feelings to ourselves can help to lessen our fight or flight reaction.
  • Now turn to your attention to your body. Identify the sensations going on in your body. All emotions are experienced as sensations in our body.
  • If you find yourself attending to the thoughts or feeling again, gently bring your focus to your body sensation (e.g., muscle tension, heartbeat, etc.).
  • Practice relaxation techniques to calm the nervous system, to stop the nervous reaction and respond more cognitively. For example:
    • Autogenic relaxation. Autogenic means something that comes from within you. Visualize a peaceful setting. You can repeat a phrase such as, “I am relaxed” to invoke muscle tension release. Focus also on breathing slowly and evenly.
    • Progressive muscle relaxation. In this relaxation technique, you focus on slowly tensing and then relaxing different muscle groups in your body. You can start with clenching your hands into a fist and then relaxing them. Focusing on the difference between muscle tension and relaxation, will help you become more aware of physical sensations.
    • Form a mental image of a place that find to be peaceful and calming. To relax imagine yourself exploring this place. Try to incorporate as many senses as you can, including smell, sight, sound and touch on your journey. If you imagine relaxing at the beach and feel the cool sand on your felt, and sound of the crashing waves
    • You probably already know other things that calm you (e.g., listening to music, taking a shower, walking your dog, etc.). You can do those things too.

Parents can help facilitate mindfulness.

“Being non-judgmental is a big part of mindfulness,” says Taylor. “It’s important to accept that we do what we can, and that we have limitations. It’s important to acknowledge everything you have going on in your life that’s happening at once, and to give yourself a break.”

“A parent might acknowledge and normalize the anxiety associated with college applications as a way to show compassion and thereby minimizing the urgency that the teen feels. Once more calm, the teen can focus on the college application, instead of attending to the distressing thoughts and feelings.”

Parents hoping to teach mindfulness practices to their teens are also encouraged to model the behavior themselves, says Taylor. Remind teens that practicing mindfulness can also improve concentration at school and improve performance.

CHOC believes mental health treatment should be fully integrated with physical health treatment. Our psychology team works closely with patients’ medical teams to attend to emotional, behavioral and developmental needs through inpatient and outpatient therapy. Our goal is to foster the whole well-being of the teen and family.

CHOC psychologists have recorded a library of guided imagery audio tracks to help children and teens relax, manage pain, ease fears and anxiety, fall asleep easier and more:

Experience guided imagery as a healing tool

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Healthy Meal Prep Tips for Busy Parents

By Elise Harlow, registered dietitian at CHOC Children’s

When life gets busy, making homemade meals can fall to the bottom of your to-do list. Drive-through or take-out dinners may sound more appealing and time-friendly! While there is nothing wrong with the occasional fast-food meal, by cooking meals at home you can reduce the amount of added fat and sodium, and have control over the types of ingredients going into your family’s food.

To increase the amount of homemade meals you have on hand during busy times, meal planning and meal prepping can be your best friend. This can also be a great way to involve your kids in the kitchen and increase their interest in healthy foods.

Meal planning: this means taking one day out of the week to sit a down with a planner and plan out your meals for the upcoming week. After your meals are planned out, make a grocery list for all the ingredients you will need for the week.

Helpful tip: use leftovers from dinner for lunch the next day. For example, a roasted chicken for dinner can become a chicken salad sandwich for lunch the next day

How to involve your children: Let your children help you in planning meals by letting them choose what is for dinner one night a week. Maybe one day they can choose a meal that they know they like, and one day they get to pick a new food that they would like to try. You can even bring your children along with you to the grocery store to help pick up the ingredients needed for the week. Children tend to be more likely to try new foods when they have some sort of say in what they are eating.

Meal prepping: this means that once a week you pre-cook whatever meals from your meal plan that allow for this. For example,  roasting a chicken on Sunday and using the chicken in dishes for the rest of the week, or making lasagna on Sunday for dinner during the week, or portioning out yogurt and fruit in single-serving containers for easy grab-and-go breakfasts each day of the week.

How to involve your children: assign your children age-appropriate tasks that they can do on their own. Again, this will increase their interest in the food and could make them more likely to try new foods. Some ideas include scrubbing vegetables, counting ingredients, measuring, or mixing ingredients together.

A crock pot or slow-cooker can be your best friend during busy times. The beauty of a crock pot is that you can throw the ingredients in the crock pot in the morning on your way out the door to work and arrive home to a warm, homemade meal for you and your family. Looking for ideas? Below is a recipe for steel cut oats, that could even be cooked overnight, which means waking up to warm cooked breakfast!

Slow Cooker Steel Cut Oatmeal

Recipe adapted from CookSmarts.com
Ingredients
2 cups steel cut oats
6 cups water

2 cups milk of any type
2 tablespoons butter
2 to 3 peeled apples
¼ cup honey
2 teaspoon salt
1 tablespoon cinnamon
Optional add ins: flax seed, chia seed, almonds, pecans, shredded coconut, hemp seeds, pepitas, etc.

Directions

  1. Spray the slow cooker with cooking oil or brush with cooking oil to prevent sticking.
  2. Put all ingredients into the slow cooker. Cook on low for 8 hours or high for 4 hours.
  3. Top with optional add-ins of your choice.

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Meet Dr. Esther Yang

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Esther Yang, a pediatric psychiatrist.

Dr. Esther Yang
Dr. Esther Yang, a pediatric psychiatrist at CHOC Children’s

Q: What is your education and training?

A: I attended UCLA for my undergraduate studies, Loma Linda University for medical school, and University of California, Irvine for both my psychiatric residency and child and adolescent psychiatry fellowship.

Q: How long have you been on staff at CHOC?

A: Two months.

Q: What are your special clinical interests?
A: I am interested in cultural psychiatry, the integration of mental health and spirituality, and implementing a holistic approach in treatment by working with therapists and other providers to integrate care. During fellowship training, I received a grant from the Substance Abuse and Mental Health Services Administration to work with minority communities in building awareness about mental health.

Q: What are your most common diagnoses?

A: Depression, anxiety and ADHD. It seems to be much harder today to be a teen than it was ten years ago with social media, bullying and increased responsibilities.

Q: What would you most like community/referring providers to know about you/your division at CHOC? 

A: In the psychiatry clinic at CHOC, virtually every patient that we see is also seen by a therapist in the same clinic, making it possible to integrate care, and all of our doctors are fellowship trained in child and adolescent psychiatry. There are many resources and more on the horizon with the opening of the inpatient unit and the intensive outpatient program.

Q: What excites you most about CHOC’s mental health initiative

A: It’s an exciting time at CHOC with the upcoming opening of the inpatient mental health unit, programs such as the intensive outpatient program and new clinics – all coming at a time when there continues to be a shortage in providers and services in psychiatric care. It inspires me to work at a place that is committed to the treatment of children and advancing mental health care.

 Q: What inspires you most about the care being delivered at CHOC? 

A: I love the concept of a hospital that is dedicated to the treatment of children and that every single person shares that dedication. I’ve had personal experiences with my children being patients at CHOC prior to working here and it was a very positive experience where we felt genuinely taken care of. I knew that if I ever had the opportunity to work here, it would be a privilege.

Q: Why did you decide to become a pediatric psychiatrist? 

A: I decided to become a pediatric psychiatrist my senior year in high school after hearing a psychiatrist talk about mental health and the great stigma that exists in minority communities during a lecture at our church. I’ve never regretted this decision and it’s been an incredible journey. I enjoy listening to everyone’s unique stories and working to break stigmas and barriers to access to care, which continue to exist.

 Q: If you weren’t a physician, what would you be and why?

A: Honestly, I would probably be a stay-at-home mom. I love spending time with my family, doing crafts with my kids and cooking. I also believe that the key to healthy kids starts in the home, and my skills as a psychiatrist are sometimes useful at home when it comes to training and discipline.

 Q: What are your hobbies and interests outside of psychiatry? 

A: I enjoy reading, baking, and crafting.

 Q: What was the funniest thing a patient told you?

A: I told my therapy patient that I would have to transfer his care to another doctor because I was going on maternity leave. He replied, “Oh, I thought you were fat or something.” I was nine months pregnant.

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