All posts by CHOC

Checking in on your mental health: How are you doing, really?

At this point in the Check-in Challenge, you’ve checked in on the mental health of caregivers and strong friends. Now, it’s time to check in on the person you know best: yourself!

Yes, you!

Checking in with yourself helps to assess how you are really doing. It also helps you be kind to yourself, and stay connected to who you really are inside.

father and his son meditating together on a couch at home

Spend some time this week really considering how you are doing. You can use these prompts in a journal or contemplate them mentally while in a quiet place:

  1. How am I feeling today, really? Physically and mentally?
  2. What do I need at this moment?
  3. What does my body need?
  4. What are my emotional needs right now?
  5. What’s taking up most of my headspace right now?
  6. What am I grateful for today?
  7. Who am I connecting with today?
  8. What “expectations of normal” am I letting go of today?
  9. How am I getting outside today?
  10. How am I moving my body today?
  11. What beauty am I either creating, cultivating or inviting in today?
  12. How can I be gentle with myself?
  13. What can I do to change the way I feel?
  14. What am I tired of?
  15. What can I do about it?
  16. What can I let go of that is getting in the way of my health and well-being?
  17. How would it help me if I contacted a professional who could help me feel better?
  18. Am I prepared to offer support if someone asks for it?

Meditation, deep breathing, stretching and a light walk are all great ways to check in with yourself. Listening to music can help too! This playlist was created by Kevin Budd, a board-certified music therapist in CHOC’s Cherese Mari Laulhere Mental Health Inpatient Center.

Get mental health resources now.

Inspiring hope through healing: National Hospital Week 2021

Every year, National Hospital Week presents an opportunity to highlight the innovative ways healthcare workers, hospitals and health systems support the needs of patients and families.

But this past year has been unlike any other.

Across CHOC’s entire health system – two hospitals, multiple primary and specialty care sites, and staff working remotely from their homes – the entire team’s dedication to patients and families has been a bright light during challenging times. Further, the team’s response to the pandemic has underscored CHOC’s innovation, excellence, collaboration, perseverance and compassion.

In recognition of this year’s National Hospital Week theme, “Inspiring Hope through Healing,” four members of the CHOC family share in their own words what about their work is so inspiring and why they are so committed to CHOC’s mission:

Maria Carrillo, CHOC environmental services aide 

“I make small simple designs out of toilet paper at the Cherese Mari Laulhere Mental Health Inpatient Center at CHOC because it’s something nice for the patients and their parents to see while they’re here.

This past year, I saw a lot of ups and downs on the unit. The patients are worried about COVID, their families, their school, their friends. I want to give them even more special attention than what we would give already. The toilet paper designs don’t take much time at all, but people really seem to like them.

I’ve worked at CHOC for 16 years in many areas, but this unit is very special and very different. I have so much more interaction with patients here. In other units, I might come in and out of the room to clean and say hello and goodbye if the patient was awake. Here though, patients tell me how they feel and how they passed the night. They draw me pictures and write notes. I get to know them better even though they don’t stay very long on the unit.

To me, the work here is so much more than cleaning. I try to put special attention into everything they touch and see. Cleaning and disinfecting is always important, especially during the pandemic, but safety is a top priority for us. A big part of my job is paying close attention to stray items or anything that might be a safety risk.

Everyone on our team is doing their own part to keep our patients safe and healthy. All the staff on the team are unidos – united – and all working together in a special environment with special patients. We check in on each other, asking if they need water or have taken a break.

In my Hispanic culture, there can be a stigma around mental illness and many feel shame in seeking help. Working in the unit for two years has opened my eyes to all the treatment available for people in need, and I wish I knew that sooner. Some people have misunderstandings about what it’s like in an inpatient mental health unit and what happens there. I tell them that our patients are brave, smart kids who are coming forward to face their problems with the help of a caring team.”

Lauren Schwarz, certified child life specialist at CHOC Hospital’s pediatric intensive care unit

“One of the great honors of my job is that I get to be present for patients and families during their most challenging moments in the hospital, but also their lightest and most joyful. In the pediatric intensive unit, the patients are normally intubated or sedated or can’t talk. So, I end up having a lot of great relationships with siblings and parents. That obviously looked different last year. To keep everyone safe, only one parent at a time could be at the bedside, unless the patient was really critical or at end-of-life. Those days without many visitors reminded me that it is a privilege to be present on this floor where I can provide a safe space for families to share their feelings and process their experiences.  

In October, we had two sisters— Izabella, 5, and Itzayana, 10 months—with the same genetic condition. One was already on hospice care and the other was heading in that direction. The two were totally reliant on their medical care team and their parents. They also had two older sisters at home. It was just a lot for this family to be here. I would often check in with Yuriana, their mom, and had become close to her, but in this specific moment, all of us didn’t know how much time these sisters had. I wanted to be a listening ear and help her process this information. She off-handedly mentioned that she had always wanted to have family photos taken, but just never got around to it.

With the help of our department and the CHOC Foundation, I was able to secure a photographer and a gift card so the family could get some outfits for the photos. The photo shoot was done at home where they were most comfortable. Yuriana and the older girls had their makeup done, coordinating outfits were planned and all the girls had their fingers and toenails painted.  

Izabella passed away shortly after that photo shoot. I just thought, ‘Thankfully, we were able to capture this for them.’  Itzayana and Yuriana were back in the hospital just a few days ago. I stopped by their room to see how they were. I spotted on a table the photo of their complete family in a frame.”

Lulu Torres, patient service representative, CHOC Hyundai Cancer Institute

“I’ve been at CHOC for 32 years. I started here in 1989 in primary care. I moved to oncology when the Hyundai Cancer Center opened. My job here is to greet patients and schedule appointments. That’s basically it. 

I’m the first person that patients and parents see when they walk through the door. Many of them call this ‘Lulu’s Clinic.’ The kids come in so sad and scared, and I just try to calm them down. I cry with them and laugh with them. I’m a very happy person. Everybody has their days, but I try my best. I’m always laughing. Everybody says my laugh is contagious. I see between 20 and 40 kids per day. When a patient comes to our clinic for the first time I know it’s rough, so I try to be positive and tell them, ‘You’ve got this.’ I try to show them the attitude that they’re going to be OK. 

I serve on the committee for the CHOC Oncology Patient Ball presented by the J. Willard and Alice S. Marriott Foundation, and over the years, that event has really stood out as an inspiration to me. It’s amazing. Some of the kids will come in limousines. The girls will wear gowns and the boys will wear tuxedoes. And all the vendors who help with the food, and the volunteers who put up the decorations, and the celebrities who show up – the kids absolutely love it. For many of them, it’s really a first happy memory. For a while, they get to forget about their illness.

A lot of people ask me, ‘How can you do this job?’ They tell me it takes a special person to do it. But I don’t think too much about it. I really appreciate all the patients. Last year was tough. The COVID-19 pandemic forced us to do a lot of video conferencing. I’m a big hugger, and it was very hard to refrain from hugging people. There are a lot of times when hugs are necessary. Despite the challenges of COVID, we all worked together as a team to continue serving our patients, and we are looking forward to things getting back to somewhat normal. I’ve always loved working here and the people I work with. During COVID, I’ve done my best to remain positive. A mother told me, ‘I always can see you smiling behind that mask.’” 

Chris Venable, nursing supervisor, CHOC at Mission Hospital 

“I started with CHOC in 1996 when my daughter was only 4 months old. I feel so fortunate to work somewhere that was so close to home, supportive of my needs as a mom and to be able to do what I love. As my fellow nurses and I were all raising kids around the same age, we all worked together to cover each other so we could be moms and nurses. It was super important that I was able to be involved in my daughter’s activities and sports and I can happily say I don’t think I missed an event. I’m proud to see her grow into a lovely young lady, graduate from college and to be doing what she loves. Working at CHOC at Mission really helped us make that happen. 

Most of our nurses have been here for over 15 years and I feel that says a lot about our workplace. When I was in college, I would visit Orange County and would drive by CHOC and thought it would be great to work at a hospital dedicated to children. When I moved this way, I found out about CHOC at Mission and have been here ever since. 

This job is all about the people – patients, families and my colleagues. My passion is to make sure we do right by the patients and the families. My goal is safety and always making sure that the patients and the families know what’s going on and that we follow CHOCs values in caring for them. This past year has been the most challenging. COVID has been beyond nerve wracking. CDC guidelines were literally changing daily, and we all tried hard to keep up. I was very appreciative of our updates from our CHOC Command Center, which I know worked hard to keep us all up to date. The protection of our nurses and healthcare team was always front and center. We really did an excellent job to support each other. 

In December, when CHOC received the vaccines for staff, our chief nursing officer asked, ‘Do you want to help with the rollout of the vaccines?’ I’m a flu vaccine champion at CHOC at Mission and knew I wanted to help with the vaccines in any way. I was able to help with the scheduling of nurses to administer the vaccine and am beyond thankful for all those who stepped up at the last minute to help staff get vaccinated. I was also fortunate to help with vaccinating in the Orange County super pods at the Disneyland Resort and Soka University. 

Finally, one of the things I’m most proud of at CHOC at Mission is what we have done with asthma education. One of my colleagues took an asthma education course and said, ‘You need to do this.’ I really didn’t want to initially but did and it has really become one of my main passions. We now have eight asthma educators who are on our team and during normal times provide education to over 250 families a year. 

Our nurses are like family to me and I really feel beyond proud to be able to be a part of the team at CHOC at Mission, providing care to the patients and families of south Orange County and beyond.” 

Teens, kids 12-15 and the COVID-19 vaccine: What parents should know

With children ages 12 -15 years and teens ages 16 years and older now eligible to receive the COVID-19 vaccine, parents may have questions about the vaccine and what to expect afterward. Here, Dr. Angela Dangvu, a pediatrician in the CHOC Primary Care Network, answers some common questions about the vaccine, teens and kids.

Dr. Angela Dangvu, a CHOC pediatrician
What vaccine will my teen or child receive?

At this time, the Pfizer vaccine is the only vaccine authorized for use in teens ages 16 and older and children ages 12-15 to prevent COVID-19. It is administered in two doses three weeks apart, injected into the arm muscle.

The Pfizer vaccine, as well as the Moderna vaccine, which is authorized for people ages 18 years and older, is an mRNA vaccine. When the vaccine is injected, mRNA – a strip of genetic material – enters a body’s cell and prompts the cell to build copies of spike proteins. These spike proteins are the bumps that protrude from the surface of coronavirus particles. The body’s immune system then learns to spot these spike proteins and produces antibodies that block the virus from entering healthy cells in the future.

Studies show that vaccine recipients achieve immunity about two weeks after receiving the vaccine’s second dose. Scientists are still learning about how long that immunity will last.

I have younger children. What is the status of vaccine research in children younger than 12 years old?

To date, Pfizer and Moderna have enrolled children as young as 6 months in clinical trial studies. Janssen and Astra Zeneca also have plans to study their vaccines in younger age groups.

Is the vaccine safe for teens and kids? Are there other risks for teenagers and children that might not be present for adults?

The Pfizer vaccine is absolutely safe for children ages 12-15 years and teens ages 16 years and older. In clinical trials, enough teens and children participated to show that the vaccine is safe for 12-year-olds and older. We have no reason to expect that children would tolerate the vaccine less favorably than adults would.

If children and teens are less likely to get sick from COVID-19, why do they need a vaccine?

Even though it is rare for children to get seriously ill from COVID-19, children who are 12 years and older have needed hospital care for COVID-19. This is especially true for children and teenagers with underlying health conditions such as weakened immune systems, obesity or chronic lung conditions. Having the vaccine may also give parents, teens and kids alike peace of mind to return to more typical activities like in-person instruction and participating in sports, which is great for mental health.

Are there any teens or children who shouldn’t get the vaccine? Should I talk to my pediatrician before scheduling the appointment?

There is no category of children or teenagers who shouldn’t get the vaccine, unless they have a known allergy to one of the vaccine’s components. Because it isn’t a live vaccine – a vaccine that uses a weakened form of a germ to prompt an immune response – people with weakened immune systems, either from illness or medication, may still receive the vaccine. There have been reports allergic reactions to the vaccine, but these occurrences are very rare. Vaccine recipients are monitored for 15 minutes after receiving the injection in case of any allergic reaction, and anyone with a history of severe allergic reactions to foods or medications (who carry an epinephrine auto-injector) are monitored for 30 minutes. Children and teens with other types of allergies beyond any vaccine component can feel safe receiving the vaccine.

Children or teens who recently received other vaccinations should wait two weeks before seeking the COVID-19 vaccine.
Parents are always encouraged to speak with their teen’s or child’s pediatrician if they have any questions or concerns.

Will the COVID-19 vaccine affect my child’s fertility?

Definitely not. Because it is an mRNA vaccine (see explanation above), the vaccine does not get incorporated into or change the DNA of the body’s cells in any way. There is no reason to worry that the vaccine will affect fertility or future offspring.

The COVID-19 vaccine was developed quickly. Should I be concerned about that?

No. The vaccine was developed quickly because scientists received additional money and resources to support from the government. This allowed scientists to follow all the typical processes but overlap some steps, which sped up the process. Also, it was easy to find volunteers to participate in clinical trials because many were excited by the possibility of receiving the vaccine. None of these factors compromised the quality of the trials, and the same processes for safety and effectiveness was followed. 

I’ve read about COVID-19 variants. Will the vaccine protect my teen or child against them?

We are still learning about how effective the vaccine is against variants. While there may be some decrease in immune response, the vaccine is still largely protective. An important step in fighting variants is to ensure as many people as possible get the vaccine. The more people who get sick – even mildly – with COVID-19, the more opportunity is presented for the virus to continue to mutate.

My teenager or child already had COVID-19. Should they have the vaccine?

Yes. We don’t know how long the immunity lasts from natural illness, and the vaccine is made to create a longer lasting immune response.

What if my teenager or child has COVID-19 now?

Your child or teen should wait until they are feeling better and no longer need to isolate based on guidelines from the Centers for Disease Control.

What if my child has received convalescent plasma treatments?

Your child or teen should wait 90 days to get the vaccine after receiving convalescent plasma or monoclonal antibody treatments. Your child’s pediatrician can help you determine when it’s appropriate to get the vaccine.

Can my child take their normal medications before the COVID-19 vaccine?

Your child should continue to take their normal medications as prescribed.

Can my child take acetaminophen, ibuprofen or an antihistamine before the COVID-19 vaccine to offset any potential side effects?

No. It is best to avoid preventatively administering these medications – either before the vaccination or right afterward if no side effects are present – because there is a chance they can decrease the immune response.

Do I need to accompany my child to the vaccination?

Yes. Anyone under 18 must have a parent or legal guardian present to receive the vaccine.

What should we bring to my teen’s COVID-19 vaccination appointment?

Bring photo ID, such as one from school or the government, and a document verifying your child’s date of birth, such as a birth certificate or a medical visit summary with their name and date of birth. There’s no need to bring your child’s vaccine records, as they will receive a card specific to the COVID-19 vaccine. It would be helpful if the teen or child wears a short-sleeved shirt, as the injection is administered into the arm.

What should my child expect at the COVID-19 vaccination appointment?

After checking in and taking care of paper work, the teen or child will be asked some questions about their health. The shot will be administered into the arm. After receiving the shot, the teen or child will be monitored for 15 minutes to ensure no adverse reactions. They will also receive a card indicating when they received the vaccine and information about the vaccine.

What should I do with their vaccination card?

Take a picture of it just in case and store in a safe place. There is no need to laminate it.

Do we really need to come back for a second COVID-19 vaccine?

Yes. Clinical trials that led to the Pfizer vaccine’s licensing incorporated two doses. So, the determined efficacy is based on two doses and we don’t yet know how effective one dose alone is. The Johnson & Johnson/Janssen vaccination is administered in one dose, but at this time it is only approved for people ages 18 and older.

What are the side effects of the COVID-19 vaccine? Are there any different side effects for kids?

The most common side effects are fever and feeling achy or tired. Any side effects should be relatively short-lived and ease within 24 hours. Because teens and children have more robust immune systems, it’s possible that they may feel these side effects more strongly than adults would. This is a sign that their immune system is mounting a response against the virus.

If side effects do appear after the COVID-19 vaccination, what can I use to treat them?

It is fine to treat side effects once they surface with over-the-counter pain medicine. Either ibuprofen or acetaminophen is fine, so long as the child hasn’t had previous reactions to these medications.

Should my child stay home from school after the COVID-19 vaccine?

If they have a fever, the teen or child should stay home. Beyond that, so long as they are feeling well, there is no need to limit activities.

What if my child is exposed to COVID-19 after they’ve been vaccinated?

Once two weeks have passed since their second dose, they have reached full immunity and there is no need to self-isolate after exposure to someone with COVID-19. Monitor them closely, however, to ensure they aren’t developing symptoms. If COVID-19 symptoms surface, begin self-isolation and contact your pediatrician.

After receiving both COVID-19 vaccine doses, can my child stop wearing a mask?

No. It’s important that they continue to take precautions against COVID-19. Though they are highly effective, the vaccine is not 100 percent effective, and while among a group of people, it’s impossible to know who is and who isn’t vaccinated.

How will the COVID-19 vaccine change socializing for my child?

Teens, children and families alike can definitely have more peace of mind about the safety of resuming more typical activities, which will be wonderful for mental health. In group activities, kids ages 12-15 and teens 16 and older should still continue to wear masks. In one-on-one activities where a child or teen and their friend are fully vaccinated, they can feel comfortable removing their masks so long as no one in either household is high-risk and unvaccinated.

Should I be concerned about having my older vaccinated teen or child around their younger siblings who are not vaccinated?

No. These children were already interacting with each other in the same household before one received the vaccine. The entire family can take comfort in knowing that one more person in household who has been vaccinated offers more protection for the whole family.  

Get more information from CHOC experts about COVID-19 and kids.

5 practical ways to help reduce stigma around mental illness

A stigma is a lingering poor perception or attitude associated with a set of circumstances, characteristics or people – and despite progress in recent years, a stigma around mental illness persists.

The results of stigma around mental illness can be stubborn misperceptions or harmful stereotypes, the avoidance or isolation of people with mental illness, and the possibility that someone might not seek the care and support they need.

This feels big and heavy – and it is, but we can all make small shifts in our day-to-day lives that can go a long way toward reducing stigma and showing more sensitivity to people with mental illness.

Here, Dr. Alexander Tan, a CHOC pediatric neuropsychologist shares 5 actions you can take today to support people experiencing mental illness and help chip away at the stigma:

Adjust your thinking

Instead of wondering what’s wrong with a person, try reframing your thoughts to ask what happened to a person.

This shift considers how a person’s life experiences and circumstances, much of which may be outside their control, influences their health, behaviors and outlook. It also removes a value judgement about their possible diagnosis or the implication that they are to blame for their illness. Instead of devaluing someone’s suffering, be open to the idea that someone has experienced life differently than you.

It’s also important to ask what’s right with a person: This is a reminder that individuals are whole people made up of much more than their illness – physical or mental – and have many wonderful qualities, skills, roles and perspectives.

Choose words carefully

What we say and how we say it matters. Making small changes to how we talk – about mental illness and in general – can go a long way toward decreasing stigma.

For example, consider how often you hear “crazy” used in casual conversation about something strange or to add emphasis. Hearing this word used as a catchall description – and one with a negative connotation – might make someone experiencing mental illness feel embarrassed or reluctant to seek help.

So, instead of saying, “Work is crazy right now” or “Work is crazy busy right now,” phrase it differently: “Work is slammed right now” or “Work is very busy right now.”

Other words and phrases about mental illness sometimes creep into conversation and can be stigmatizing. Sometimes they may even be used as jokes. Here are some others to avoid: psycho, nuts, mental, loony, wacko, insane, split personality and deranged.

Related, try to avoid using mental illness diagnoses as casual descriptors because it stigmatizes actual mental illness. For example, instead of saying, “Kevin is so OCD about this project,” try “Kevin is focused on the project’s details,” or even better, “Kevin’s great attention to detail is so beneficial for this project.”

It’s also important to be mindful about how we talk about suicide, which is complex and often has many factors. Instead of saying someone “committed suicide,” say they “died by suicide.” The word “committed” implies a crime has occurred.

Remember that people are more than their diagnoses

Humans are complex and a person’s illness is just one small part of who they are. When it comes to mental health, we may use language that unintentionally defines someone’s identity by their diagnosis. Using “people-first language” recognizes that by avoiding describing someone as their diagnosis.

For example, instead of saying “Rosa is schizophrenic,” try “Rosa has schizophrenia.”  Also, “Quan has bipolar disorder,” not “Quan is bipolar.” Instead of “Anorexics often have distorted body images,” say, “People with anorexia often have distorted body images.”

This small shift says a lot by acknowledging that Rosa and Quan may also be a friend, an athlete, a volunteer or many other roles beyond only someone with a mental health diagnosis.

Educate yourself and others about mental illness

Being informed can help with educating others and getting them the help they need. You don’t need to be an expert – after all, we are all continually learning. To learn more, check out CHOC’s mental health toolkit, which has a host of resources for children and teens, parents, healthcare providers, educators and more.

Show compassion and dignity

What people who are experiencing mental illness often need most is someone to listen with empathy and support without judgment, and they are unlikely to seek help if they think they may be stigmatized. Let them know you are an ally and available for support by offering compassion and dignity through your thoughts, words and actions.

Get mental health resources now.

13 ways to check in on strong friends’ mental health

We’re on week no. two of our Check-in Challenge, our month-long effort to check in on the mental health of people in our world to ask how they are doing – and really listen!

This week, we’re going to check in on our strong friends, the people in your life you might look to for strength. But while they’re strong for others, who is checking on them? Here are some ways to do just that:

  1. Acknowledge that your friend is a support for you and for others. Say, “I see you and all you do for me and for others.”
  2. Express your gratitude for the way your strong friend enhances your life. Gratitude has been shown to combat feelings of loneliness. It’s not only good for your friend, but it’s good for you.
  3. Ask, “How are you feeling today, really? Physically and mentally.”
  4. Text, email or leave a voicemail like, “No need to respond, but I just wanted to say hi!”
  5. Ask, “What’s keeping you going right now?”
  6. Ask, “Would you like to talk? I’m here to listen.”
  7. Text or email a meme, an old photo of the two of you or an article they might like and say, “This made me think of you. How have you been?”
  8. Say, “Like you are here for others, I’m here for you.”
  9. Ask, “What’s something you’re looking forward to in the next few days?”
  10. Say, “I’m available to chat at these times. When are you around?”
  11. Designate a “need help” emoji. Pick an emoji that you can both use when you need uplifting or the other’s help. Maybe it’s a parachute or a colored heart. One suggestion is green, which represents mental health awareness.
  12. Instead of asking how they are, try asking, “What did you do today that made you feel good, proud or happy?” It is usually the little things that brighten our day or made us proud. Sharing these small joys or victories can open someone up one step at a time.
  13. Ask, “What’s something that we could do together this week, even if we are apart?” If you need suggestions, these are all COVID-safe:
  • Virtual trivia nights
  • Group movie or television streaming screenings
  • Virtual fitness classes or meditations
  • TikTok face-offs
  • Crafting online tutorials
  • Instagram story games
  • Virtual paint night
  • Virtual coffee, lunch and dinner “meet ups”
  • Group check-ins

Get mental health resources now.