All posts by CHOC Children's

6 do’s and don’ts of concussion

If your child experiences a concussion, it can be scary to think about the effects on their developing brain. The good news is, more than 85% of concussions heal well if managed properly early on.

“Early, appropriate treatment prevents kids from having to come see me as a neurologist,” says Dr. Sharief Taraman, pediatric neurologist and director of the CHOC Children’s Concussion Program. “It’s important to do as much as we can to prevent kids from getting a concussion, prevent reinjury, and treat them as aggressively and appropriately as possible in the early intervention stages.”

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Dr. Sharief Taraman, a pediatric neurologist at CHOC Children’s.

Follow these do’s and don’ts for proper prevention and treatment of concussion. If your child does sustain a concussion, be sure to see your pediatrician as soon as possible.

  1. Do protect a young brain

Athletes should be taught safe playing techniques, equipment maintenance and to follow the rules of the game. Always wear a helmet while playing contact sports like football, hockey and lacrosse, and during activities like horse riding, biking, skateboarding or snowboarding. Helmets should fit correctly and be in good condition.

  1. Don’t miss the signs

A concussion isn’t always obvious. Watch for these signs in your child or teen, especially while they are participating in sports. Symptoms may take up to a day to appear after an incident.

  • Headache
  • Nausea or vomiting
  • Balance problems
  • Dizziness
  • Visual problems
  • Fatigue or drowsiness
  • Sensitivity to light or noise
  • Numbness or tingling
  • Dazed or stunned
  • Irritability
  • Sadness
  • More emotional
  • Nervousness
  • Trouble falling asleep
  • Feeling mentally “foggy”
  • Feeling slowed down
  • Confused about recent events
  • Sleeping less or more than usual
  • Difficulty concentrating or remembering
  • Forgetful of recent information or conversations
  • Answers questions slowly or repeats questions

Seek emergency care immediately if your child or teen has experienced unconsciousness for any amount of time or has changes in alertness, convulsions or seizures, muscle weakness, persistent confusion, repeated vomiting, unequal pupils, unusual eye movements or walking problems.

  1. Do sit on the sidelines

The most important thing your child should do if they are injured during a sports activity is to immediately stop playing. It’s crucial that they avoid more hits, jolts, shakes or bumps to the head or spine. Getting back in the game is not worth the risk. Remember, the signs of concussion aren’t always clear, so when in doubt, sit it out.

Athletes may not want to tell their coach if they had a concussion. Encourage them to come forward if they have an injury, or if they notice a teammate is injured. Young athletes should never ignore a head injury or impact to the head.

  1. Don’t skip treatment

Even a mild concussion should be evaluated by a doctor. Get in to see your child’s pediatrician as soon as possible.

When a concussion is severe or symptoms won’t go away, talk to your doctor about a referral to the CHOC Children’s Concussion Program, which includes pediatric sports medicine specialists, neurologists, neurosurgeons, neuropsychologists and rehabilitation therapists who are all trained in concussion management.

  1. Don’t rush recovery

Rest is important immediately following a concussion. For 24-48 hours, your child should stay home from school and get plenty of quiet time and mental rest. This includes limiting activities like:

  • Television
  • Texting
  • Social media
  • Reading
  • Driving
  • Doing homework
  • Social interaction
  • Attending loud events

After the first 24-48 hours, light activities may help speed up recovery. Most children should be able to tolerate some school after a few days. If they need to miss more school than that, contact the school and your doctor to help intervene with short-term adjustments. Before returning to sports, be sure that symptoms have resolved and get medical clearance from your child’s doctor.

  1. Do prevent future injury

Parents, coaches and athletes should be extra cautious to prevent future concussions. One concussion is rough enough, but additional injury is even worse. Research has shown that repeated jars to the head can have long-lasting effects on the brain. And, if a child or teen suffers a second concussion before the first concussion heals, they are at risk for Second Impact Syndrome, a life-threatening condition.

“The CDC has called concussions an epidemic in the United States,” Dr. Taraman says. “Kids really do get into trouble if a concussion is not recognized, and if we don’t take the proper steps to get them better and avoid those second injuries, which can be catastrophic.”

Download 5 questions to ask an injured athlete

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How teens can deal with bullying: Teen advisers weigh in

One in five students age 12-18 in the U.S. have experienced bullying, according to the National Center for Education Statistics and Bureau of Justice. More than 70% of young people say they have seen bullying in their schools. Kids and teens who are bullied can experience physical and mental health issues, and problems at school.

CHOC Children’s teen advisers share their own experiences observing and dealing with bullying, and what they do to cope. CHOC experts also weigh in on what parents can do to support a child who is being bullied.

Talk openly about bullying

One of the best ways to protect your child from bullying is to talk openly about it, says Dr. Heather Huszti, CHOC’s chief psychologist.

Dr. Heather Huszti
Dr. Heather Huszti, chief psychologist at CHOC Children’s

“Have a discussion about why some kids might be bullies. You can explain that most bullies have low self-esteem and that they bully other people to try to feel better about themselves,” she says.

CHOC teen adviser Heather Bisset, age 14, has seen this play out firsthand.

“When someone bullies another person, it is often because they are insecure and do not know how to emotionally handle it,” she says. “A bully does and says things to make others feel hurt or down, and if you do not show a response, they will most likely leave you alone.”

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Heather Bisset, a CHOC Children’s teen adviser

Dr. Huszti also recommends parents ask open-ended questions of their children such as, “Is there anything going on at school?” or “Is there anything I can help you with?”

She adds that this approach usually works better than firing off a list of specific questions and can facilitate a bond between parent and child that will encourage them to open up to you when something is affecting them.

Find a trusted adult to talk to

CHOC teen adviser Zoe Borchard, age 15, knows the benefits of having someone to talk to when you have been bullied.

“At a high school football game, a girl that I don’t even know called me stupid along with a bunch of other nasty words behind my back. When I heard what she had said, I thought it wouldn’t affect me at first, but it started to eat away at me. I walked away to a quieter area during halftime and called my mom. I told her what happened, and it made things a million times easier to process and even let go,” she recalls. “To this day, I’ll call my mom every time I need help. If you can find someone you trust to share your problems with, it lightens your emotional load and gives you room to breathe and feel better.”

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Zoe Borchard, a CHOC Children’s teen adviser

Teens can look beyond their parents in finding someone to talk to.

“The best advice I could give someone who is being bullied is to talk to an adult you trust and know is willing to help you,” says CHOC teen adviser Carina Alvaro, age 16. “This could be a teacher who has openly expressed willingness to help, or another trusted adult who can help you resolve these problems.”

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Carina, a CHOC Children’s teen adviser

Teens and cyberbullying

Nearly 15% of high school students have experienced cyberbullying, according to the Centers for Disease Control. Cyberbullying can include text messages, instant messaging and other apps, social media or gaming.

CHOC teen advisers see a clear link between social media and bullying.

“Social media plays a part in bullying because it’s a lot easier to target someone and attack them online,” says Sanam Sediqi, age 16, a CHOC teen adviser. “On social media, everyone is hiding behind a phone or computer screen, so they more freely throw out hurtful comments towards the victim, often without actual consequences.”

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Sanam, a CHOC Children’s teen adviser

CHOC teen adviser Layla Valenzuela, age 14, agrees.

“Having the power of technology comes with responsibility. When you send a message, people can’t see your face or hear your voice, so there is no way of conveying sarcasm or playfulness,” she says. “A simple joke could be interpreted in an unintentional, harmful way. Being responsible for everything you do online is a huge part of being considerate and staying away from bullying.”

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Layla, a CHOC Children’s teen adviser

Social media and technology use contributes to a rising number of mental health concerns in young people, says Dr. Christopher Min, a CHOC Children’s psychologist.

“Technology is great, but it has consequences, especially on our younger population,” he says. “it’s made teenage culture very unstable.”

Tips for staying safe online

Dr. Min offers the following tips for parents on how to keep kids safe online:

  1. Monitor teens’ social media use
  2. Encourage teens to get together in person
  3. Remember that parents control access to social media

For teens, his advice includes pausing before posting.

“When you’re ready to post something, pause for five to 10 seconds to consider your actions, the post’s meaning and the possible consequences,” he says. “This will help you avoid posting things you don’t want cemented on the internet forever.”

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Dr. Christopher Min, a pediatric psychologist at CHOC Children’s

What to do if your child is being bullied

There are several things parents can do if they learn their child is being bullied, Huszti says, including:

  1. Inform your child’s school about bullying
  2. Talk to the bully’s parents about the behavior
  3. Help your child build up their self-esteem. The more solid their self-esteem, the less impact a bully’s behavior will have on their overall well-being.
  4. Monitor your child’s online activity.
  5. Remind your child of the trusted adults in their lives in whom they can confide.
  6. Pay attention to signs in your child that show something is wrong, such as acting withdrawn, irritable or sad; or changes in appetite or sleep. Some children will show none of these signs, so an open dialogue with your child is key.
  7. If your child needs additional support, ask your pediatrician for a referral to a pediatric psychologist.

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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From patient to advocate: Trinity’s journey with cleft lip and palate

After a normal pregnancy and healthy delivery, Trinity was diagnosed at birth with cleft lip and palate, birth defects that occur when a baby’s lip or mouth do not form properly during pregnancy.

Her parents, Krisha and Jason, didn’t know much about these conditions at the time. They were quickly referred to the CHOC Children’s Cleft and Craniofacial Program, which includes a team of multidisciplinary specialists including plastic surgeons, otolaryngologists (ear, nose and throat), dentists, and more. Krisha and Jason relied on their CHOC team for help, education and resources regarding their daughter’s diagnosis.

Trinity underwent her first in a long series of surgeries when she was just 10 weeks old. Although it’s been a decade since that day, her parents still remember waiting for Trinity to emerge from that first surgery.

“In that first surgery, minutes felt like hours,” says Krisha. “Having to give up your 10-week-old baby knowing that they’re going to look different when they come out—it was a scary situation.”

Although Krisha and Jason knew their little girl was in good hands at CHOC, they were understandably worried about her surgery. What helped was memories of Jason’s own experience as a CHOC patient when he was a child.

“It’s been over 30 years since I was a CHOC patient, but I still remember that CHOC took really good care of me,” he says. “Even then, I remember CHOC being a really neat place. It’s so family-oriented.”

trinity-at-choc
Trinity at CHOC Children’s Hospital, before a surgery.

Over the last ten years, Trinity has returned to CHOC for more surgeries, check-ups and other care. This has included surgeries to improve the appearance and function of her lip and palate, multiple ear tube procedures, and a palate expander. She’s also undergone multiple bone grafts where bone is taken from her hip and grafted into her mouth and gum line. She has had multiple ear tube procedures, a palate expanded etc. Future surgeries include jaw surgery, nasal surgery, orthodontia, and potentially additional lip and palate repairs.

“People assume that cleft lip and palate is just a cosmetic deformity, but it’s so much more than that,” Krisha says. “Trinity sees a wide variety of specialists, including a craniofacial plastic surgeon, a craniofacial orthodontist, an otolaryngologist (ENT), a speech pathologist, an audiologist, and more.”

Becoming part of her own care team

As Trinity has gotten older, she’s taken a more active role in her care—especially when interacting with Dr. Daniel Jaffurs, medical director of plastic surgery and craniofacial services at CHOC.

“Dr. Jaffurs acknowledges Trinity first when he walks in the room, before he speaks to us as parents. He explains everything on her terms, and then he will address us as parents.”

This confirms to Krisha that Dr. Jaffurs knows that Trinity is the most important person in the room and has helped foster the bond between doctor and patient.

“Dr. Jaffurs is my favorite doctor,” Trinity says. “He’s really nice. When I was little, I was afraid of doctors, but I’m not afraid anymore.”

A lifelong love of music

Children with cleft lip and palate often have trouble speaking clearly because the structure of their mouth and nasal cavity makes it hard to produce certain sounds. Although Trinity underwent speech therapy when she was younger to normalize her communication abilities, anytime she sang, it always came out clear. She also taught herself to play piano when she was just 8 years old.

“Whenever I have surgery and I don’t feel good right after, I put on music and then I start to feel like my normal self again,” Trinity says.

Always the performer, Trinity also participates in school musicals and dreams of being a professional musician someday.

A budding advocate

Trinity has become an advocate for other craniofacial patients.

“She’s always made her story known,” says Krisha. “She’s had situations in school where other kids ask questions about how she looks, and instead of getting mad, she brings in her baby book and says, ‘I’m going to tell you why I’m different.’”

Before performing a song at an annual picnic that brings together craniofacial patients and families, she gave an impromptu speech about confidence to the 400-person crowd.

“If someone makes fun of you because of how you look, get back up again and don’t let them bother you anymore,” she told the crowd. “You are special, and you were born exactly who you were supposed to be.”

This message was in line with what her parents have been telling her since she was born.

“I never wanted her to forget where she came from,” Krisha says. “Even though she was undergoing all these surgeries, I wanted her to know that she was beautiful and perfect the way she was born.”

Trinity continues to increase craniofacial awareness in her community. She often shares her story with her classmates and once even spoke to her school board about her surgeries.

trinity-and-family
Trinity with her family.

Trinity and her family find value in connecting with other craniofacial families. Their decade-long relationship with CHOC’s craniofacial team has given them an inside look on how CHOC and the department have evolved.

“The craniofacial program at CHOC has grown so much in the past 10 years. It’s incredible to see what they can do,” says Krisha. “This program has changed our lives for the better.”

The importance of community support

Support from their community means the world to Trinity and her family.

trinity-playroom-choc
Trinity paints a picture frame in a playroom at CHOC Children’s while recovering from surgery.

“Donors have a big role. They help CHOC be up to date on everything,” says Jason. “CHOC is constantly evolving and in terms of the latest technology and procedures. It’s neat to see everybody coming together to make all this accessible for families like us.”

To Trinity’s family, CHOC is an essential part of the community.

“It changes families’ lives,” says Krisha. “It definitely does. It changed our lives.”

Trinity plans to keep on singing, inspiring others and returning to CHOC to continue her treatments.

“Hands down, CHOC makes everything better,” she says. “CHOC is the friend you never knew you had.”

Learn more about CHOC's Cleft and Craniofacial Program

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Back to school anxiety remedies

Transitioning from carefree summer days into a structured school day can be stressful for children. From a change in environment to new names and faces, heading back to school can be a stomachache-inducing, palms-sweating time for many kids and teens.

Many parents wonder if kids are faking these feelings to get out of going, but back-to-school anxiety is a real phenomenon, says Dr. Christopher Min, a pediatric psychologist at CHOC Children’s. Back to school anxiety occurs when nervousness goes into overdrive, causing physical, behavioral or cognitive consequences that can impact a child’s mindset and ability to perform in school.

“It’s easy for us as adults to forget what it’s like to be a kid,” Min says. “It can be really scary.”

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Dr. Christopher Min, a pediatric psychologist at CHOC Children’s

A child’s job is to go to school, Min says, and their workload doesn’t simply include academics. School is where they learn and practice everything from social skills with peers and authority figures, to learning boundaries and appropriate behavior, to practicing physical activity, to selecting food on their own and eating without their parents.

“The likelihood that at least one of these things will create apprehension or anxiety in kids is great,” Min says. “So many things are packed into one environment.”

It’s important for parents to remember that children are just starting to learn these life skills when they’re in school.

“Not only are kids asked to encounter a multitude of new situations at school, but they’re still developing the skills necessary to succeed,” Min says. “They don’t have mastery of these skills yet; they’re still learning them.”

For parents struggling to determine whether their child is creatively avoiding school responsibilities or dealing with legitimate back-to-school anxiety, Min suggests looking for patterns in behavior.

Look back at their history with school, he says. What tends to happen in the weeks or days leading up to a new school year? How does your child adapt to changes? Does the behavior dissipate as the school year progresses?

“I like to empower parents and remind them that they are the expert on their children,” Min says. “Parents know their own children best. They know what their children do in provoking situations.”

Children are at increased risk for anxiety-based school refusal during periods of transition, such as when they start kindergarten, or move to a new school for junior high or high school, Min says.

“Every kid deals with school-based anxiety differently,” Min says. “However, boys tend to externalize their behavioral, such as acting out. Girls tend to internalize their behavior, which can be interpreted as being moody.”

Once their behaviors are identified, Min encourages parents to help their children cope with their anxiety by practicing easing into the school year.

“As adults, we wouldn’t go into a presentation at work, or show up for a marathon without preparing,” he says.

Kids tend to have a different sleep schedules and less structure during summer months, so in the weeks leading up to the first day of school, start to adjust their sleep and wake schedules.

Min also encourages graduated exposure, where parents can slowly introduce new routines in their child’s day.

“Practice their morning routine before school starts. You can even practice driving to school and show them where you will drop them off and pick them up,” he says.

Making small adjustments at home to help them prepare for the new school year will help them ease into the other transitions that come when school starts.

Although it can be stressful for parents to see their child struggling with a school transition, they shouldn’t immediately jump in to “rescue them,” Min says.

“With school avoidance, if you “rescue” a child or keep them home, that is detrimental because it reinforces their anxiety, and teaches their brain that school is a threat and something to be avoided.”

He encourages parents to partner with their child in managing their anxiety— while still going to school —and over time the anxiety will decrease with repeated exposure.

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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I’m a pediatrician. Here’s what I want you to know about vaccines.

By Dr. Katherine Williamson, a CHOC Children’s pediatrician

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Dr. Katherine Williamson, a CHOC Children’s pediatrician

Proper vaccination is important for all people, but especially infants and babies. When children follow the recommended immunization schedule outlined by the American Academy of Pediatrics (AAP), they are better protected against potentially life-threatening diseases.

As a pediatrician, I get a lot of questions about baby vaccination and vaccines for children. In observance of national immunization month, here are the most common questions I get about vaccines.

Are vaccines safe?

Vaccines are one of the most important things we can do to help protect our children’s health. Vaccines and proper handwashing, more so than all other interventions, have proven to be the most safe and effective ways to prevent disease.

What is the proper vaccine schedule?

The current immunization schedule outlined by the AAP and Centers for Disease Control & Prevention has been researched and proven to be the most effective and safest way for children to be vaccinated against potentially fatal diseases. It’s important to know that no alternative schedule has been shown to be as safe and effective.

I get frequent questions from expectant and new parents who are concerned about the number of vaccines given to kids at one time under the recommended schedule. The amount of antigen (protein) in the vaccine that is put into your child’s body is 100,000 times less than if your child has a common cold, so there’s no concern about overwhelming their immune system when they get their vaccines.

Do I really need a flu shot every year?

Yes. Influenza causes a higher number of death and illness over any other disease annually in the US, and your best chance of preventing influenza is the flu vaccine. Symptoms of influenza include high fevers, chills, muscle aches, and respiratory symptoms that can lead to pneumonia and respiratory failure. Children under 2 years and adults over 60 years of age are at the highest risk of becoming seriously ill if they are exposed to influenza.

The CDC recommends an annual influenza vaccine for everyone 6 months of age and older. You should be vaccinated as soon as the influenza vaccine becomes available. Although flu season peaks between December and February, it can start as early as October and last through May.

What can I do to make my child more comfortable while receiving a vaccination?

Studies have shown that preparing your child for vaccinations should ideally include three components” explaining what will happen, how it will feel, and strategies for coping with any related stress or discomfort. Here’s more tips on how to make shots less stressful.

Find a CHOC pediatrician near you

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