All posts by CHOC Children's

I’m a Pediatrician. Here’s What I Ask My Own Child’s Doctor.

By Dr. Sarah Kay Herrera, a CHOC Children’s pediatrician

Since I was 11 years old, I knew I wanted to be both a pediatrician and a mom. Today, I get to take care of children within the CHOC Primary Care Network at Sea View Pediatrics and be a mom to my 4-year-old daughter. You might think that being a pediatrician has its advantages as you become a parent yourself, but I often find myself worrying more. Just like the parents who come to my practice, I also turn to my pediatrician for an objective perspective to calm my mommy nerves and take care of my daughter.

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Dr. Sarah Kay Herrera, a CHOC Children’s pediatrician

Here are some of the questions I ask my child’s pediatrician, and what they’ve told me:

What are the best parenting books?

  • “Caring for Your Baby and Young Child, 6th Edition, Birth to Age 5” from The American Academy of Pediatrics
  • “Baby 411: Clear Answers & Smart Advice for Your Baby’s First Year, 8th Edition” by Dr. Ari Brown and Denise Fields
  • “Happiest Baby on the Block” DVD by Harvey Karp
  • “1-2-3 Magic: 3-Step Discipline for Calm, Effective, and Happy Parenting” by Thomas Phelan, PhD

How can I maximize my baby/toddler/preschooler’s development?

  • Toys must be age appropriate. Toys that are too small have the potential to be a choking hazard
  • All ages: sing, talk, dance, read
  • Newborn: colored toys with soothing music like baby gym, rattles
  • 6 months – 1 year: picture or texture books, musical toys, pots and pans, squeeze toys, peg toys, push/pull toys
  • 1-2 years: stacking toys, push/pull toys, household cleaning toys, musical instrument toys, telephone toys (no cords), toy cars
  • 2 -5 years: encourage them to begin using their imagination during this age. Puzzles, age -appropriate Legos, blocks, tricycles or scooters with a helmet, kitchen toys, balls, doctor’s kit
  • 5-9 years: encourage your child to develop new skills during this time. This can include biking with a helmet, playing sports or other games with balls, using blunt scissors or sewing kit under supervision, playing board games and puzzles.

What are some tricks to keep my picky eater eating healthy?

  • Use a plate with dividers: half the plate should be for fruits and vegetables, a quarter for protein, and a quarter for grains.
  • Give something you know your child will love as well as something new to try he may not like.
  • Eat the same thing your child eats at the table. This shows your child you enjoy your food.
  • Hide vegetables in soup or mix in dishes such as stir fry.
  • Consistency and positive experience is key.

How do you sleep train? What’s the deal with sleep regression?

  • Remember babies need to sleep on their back in their own crib.
  • Recommended book: Solve your child’s sleep problems by Dr. Richard Ferber
  • You can start sleep training when your baby is 4-6 months old but discuss a specific plan with your child’s pediatrician.
  • Place baby in crib still awake to train her how to self soothe. This is the same for toddlers as well. There will be crying, and that is ok.
  • some days will be better than others. this is a problem that all parents face.
  • For ages 1 and up, try a baby night light that changes color for bed time and when it’s time to wake up

Should I be concerned about my child’s fever?

  • Even if your child’s temperature is above the standard 98.6 degrees, we define fever as having a temperature of 100.4 degrees or greater. If your child has a fever for at least three to five days, it’s time to see the pediatrician. This rule doesn’t apply to babies less than one month old; any fevers for them are considered urgent and should be seen in the Emergency Department.
  • Try to give as many details to your pediatrician about your child’s illness and behavior as you can.

My child has a rash. Do they need to see the pediatrician?

Rashes should be examined by a pediatrician. During your appointment, tell your pediatrician about any other symptoms your child is experiencing along with their rash, how it started and how it is progressing. Photos can be helpful, but many times photos will not be enough for diagnosis alone. Your pediatrician needs to see and touch the rash and examine the child thoroughly.

Even though I’m a doctor, I trust my daughter’s pediatrician for an objective opinion. Don’t forget to schedule your well child checks as this is the perfect time to ask questions on development, diet, and overall well-being of your child.

Find a CHOC pediatrician near you

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5 Ways to Reduce Intake of Food Additives

By Jessica Brown, registered dietitian at CHOC Children’s

When buying packaged products, it’s important to limit our consumption of common food additives. Direct food additives are natural or synthetic substances added to foods during processing to help enhance flavor, texture, appearance or nutrition, or to extend shelf-life.

Well-known additives include high fructose corn syrup, a sweetener; sodium nitrates, a preservative; and monosodium glutamate or MSG, a flavor enhancer. However, there are nearly 4,000 direct food additives registered on the Food and Drug Administration database.

Food additives to look out for include:

Humectants and Anticaking Agents

  • What they do: Stabilize foods through moisture control to maintain texture, reduce microbial activity, and prevent clumping.
  • Commonly added to: grated cheese, marshmallows, baked goods, baking powder, flour and cake mixes.
  • Examples include: Sugar and salt are commonly used humectants. However, most anticaking agents are made from synthetic substances such as silicon dioxide and aluminosilicates.

Emulsifiers

  • What they do: Prevent separation, provide a smooth texture, and extend shelf-life.
  • Commonly added to: mayonnaise, salad dressings, peanut butter, chocolate, and ice-cream.
  • Examples include: Egg lecithin, monoglycerides and diglycerides (naturally present in seed oils), guar gum, and carrageenan. Synthetic forms include carboxymethyl cellulose and polysorbate 80.

Stabilizers, Thickeners, and Gelling Agents

  • What they do: Provide a consistent texture and mouth-feel.
  • Commonly added to: jams, yogurts, soups, sauces and dressings.
  • Examples include: Cornstarch, pectin, and lecithin. Although synthetic versions exist such as carboxymethyl cellulose and methyl cellulose.

Color Additives

  • What they do: Enhance the natural colors in a food, compensate for color variation in foods, or add color to an otherwise colorless food.
  • Commonly added to: candies, breakfast cereal, beverages, and snack foods.
  • Examples include: Synthetic colors such as Yellow No. 5 and Blue No. 1. Plant, animal or mineral colorants are also added to foods such as grape skin extract, annatto, beta-carotene, or cochineal extract.

The American Academy of Pediatrics recently published a policy regarding the emerging child health concerns related to the direct and indirect food additives.

5 tips to reduce your family’s intake of food additives:

  1. Read ingredient labels
    • Compare products while at the grocery store. Many manufactures are making comparable products with less food additives.
    • Identify hidden sources of food additives such as silicon dioxide in spices or polysorbate 80 in dairy products.
  2. Decrease intake of processed foods
    • Choose fruits, vegetables, whole grains, legumes, nuts and seeds, and animal products with minimal processing.
    • Make dishes from scratch when feasible to control which ingredients are incorporated into your food.
  3. Eat locally
    • Farmers markets or CSA (community supported agriculture) deliveries are a wonderful way to reduce food additives not only by choosing fresh fruits and vegetables, but in local canned and bottled products too.
  4. Make simple swaps
    • Make air-popped popcorn in place of microwaved popcorn
    • Swap blocked cheese for shredded cheese
    • Choose butter instead of margarine
    • Use maple syrup or honey in place of pancake syrup
    • Incorporate fresh herbs and spices instead of marinades and sauces
    • Choose plain chips and crackers more often than flavored options
    • Swap plain yogurt for flavored varieties and add your own toppings
  5. Get creative in the kitchen
    • Make your own salad dressing, dips, or taco seasoning
    • Use fresh citrus or herbs to flavor sparkling water

Use natural ingredients to decorate your cookies this holiday season. Use beet juice or powder for red icing, and wheatgrass juice or matcha powder for green icing

The U.S. Food and Drug Administration offers additional information on food additives.

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The Latest Guidelines on Cold and Cough Medicine for Kids

By Dr. Eric Ball, a CHOC Children’s pediatrician

When your child is sick, all you want to do as a parent is make them feel better. As a pediatrician and parent, I understand that frustration. Today, parents are inundated with countless over-the-counter products marketed as safe for kids. Unfortunately, we now know that these pediatric versions of adult medication may do more harm than good.

The U.S. Food and Drug Administration do not recommend over-the-counter medicines for cough and cold in children under 2 years old. For older children, consult your pediatrician or pharmacist before offering any over-the-counter medication. Do not give medicines containing codeine or hydrocodone to anyone under 18 years old. These are opioids and are not advised for children.

Why can’t I give my child cold and cough medicine?

There have been few studies that have actually looked at the effectiveness of cold and cough medications in alleviating cold symptoms in children. Of the studies performed, every study done since 1985 has shown no benefit to any of these medications compared to a placebo. In other words, each study showed that a sugar pill had the same effects as the cold medications. Cough medications did not stop coughs, decongestants did not make children less congested, and expectorants did not make mucous any more manageable. Even if the medications did work, they would only treat symptoms of a cold; they do not cure or shorten the duration of the illness. Children get better with time.

When the original dosing studies for these over-the-counter cough and cold medications were performed, safe dosages were established only for adults. The FDA licensed the medications for children in 1976 without any studies establishing safe doses for children. Pediatric dosing was extrapolated from adult dosing using a crude formula: half of the adult dose for children between 6 and 11 years of age and a quarter of the adult dose for children between 2 and 5 years of age. For children under 2 years of age, parents were instructed to ‘contact your doctor.’ These extrapolated doses are imprecise and potentially dangerous; it puts children at much higher risk for adverse effects and accidental overdose.

So, what can I do about a cough or cold?

There is no cure for the common cold, but there are some things you can do while the virus runs its course.

  • Make sure your child drinks plenty of fluids. This will serve to thin mucous and keep him well hydrated.
  • Saline drops or sprays can offer temporary relief of a stuffy nose.
  • A bulb syringe can be used for children too young to blow their noses.
  • A humidifier is often helpful for decreasing congestion at night.
  • Acetaminophen or ibuprofen (for children over six months old) are safe and effective in relieving pain or fever associated with a cold. CHOC offers downloadable guides on acetaminophen (Tylenol) dosing, as well as a guide on ibuprofen (Advil) and naproxen (Aleve).

Not every cough and cold warrants a trip to the pediatrician’s office. Here are a few warning signs that it’s time to make an appointment:

When to call the doctor for a cough or cold:

  • A fever in a baby less than 2 months old
  • A fever of 100.4 degrees or higher lasting more than three days.
  • Labored breathing including wheezing, fast breathing or shortness of breath
  • Dehydration along with not eating or drinking
  • Constant ear pain

The dangers of over-the-counter medicine for children

Since 2000, poison control centers have reported hundreds of thousands of calls related to over-the-counter cold medications in children. The FDA has reported 123 deaths related to decongestants and antihistamines since 1969. Since appropriate dosing has not been established, side effects tend to be more severe in children. Cough suppressants, which are derived from narcotic-type medications, often cause drowsiness, confusion, and other neurologic effects. Decongestants are related to amphetamine-type medications and cause agitation, insomnia, restlessness, and high blood pressure. Antihistamines, which are often marketed as bedtime medication, cause drowsiness in some children and agitation in others. Expectorants can cause gastrointestinal effects, such as nausea, vomiting, and diarrhea.

Find a CHOC pediatrician near you

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CHOC Children’s PICU Earns Gold Beacon Award Recognizing Exceptional Patient Care for Third Time

The American Association of Critical-Care Nurses (AACN) recently conferred a gold-level Beacon Award for Excellence in the pediatric intensive care unit (PICU) at CHOC Children’s Hospital. This is the third time CHOC has earned the gold-level distinction.

beacon-logo

The Beacon Award for Excellence recognizes unit caregivers who successfully improve patient outcomes and align practices with AACN’s six Healthy Work Environment Standards. Units that achieve this three-year, three-level award with gold, silver or bronze designations meet national criteria consistent with Magnet Recognition, the Malcolm Baldrige National Quality Award and the National Quality Healthcare Award.

“The Beacon Award for Excellence recognizes caregivers in stellar units whose consistent and systematic approach to evidence-based care optimizes patient outcomes,” explains AACN President, Clareen Wiencek, RN, PhD, ACNP, ACHPN. “Units that receive this national recognition serve as role models to others on their journey to excellent patient and family care.”

CHOC’s PICU earned a gold award, the highest designation, by meeting the following evidence-based Beacon Award for Excellence criteria:

  • leadership structures and systems;
  • appropriate staffing and staff engagement;
  • effective communication, knowledge management, learning and development;
  • evidence-based practice and processes; and
  • outcome measurement.

“This award is further validation of our entire pediatric intensive care team’s dedication to the highest standards of patient safety and care,” says Melanie Patterson, RN, MHA, DNP, vice president, patient care services and chief nursing officer, CHOC Children’s Hospital. “We are entrusted with caring for some of the sickest and most medically fragile patients, and our goal is to deliver the best possible outcomes for them and their families.”

Have you been inspired by a nurse at CHOC? Nominate them for the Daisy Award

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What We’re Thankful for This Year: 2018

The  physicians, nurses, staff and patients that make up the CHOC Children’s healthcare community have much to be thankful for this year. In addition to opening our Mental Health Inpatient Center and expanding our Primary Care Network, we’re grateful to be able to offer best-in-class care to kids in Orange County and beyond. A few members of the CHOC community share what they are most thankful for this year.

kimberly-chavalas-cripe
Kimberly Chavalas Cripe

Kimberly Chavalas Cripe, president & CEO, CHOC Children’s

“This Thanksgiving – and always – I am grateful for our mighty brigade of physicians, staff, volunteers, donors and community members who are committed to keeping childhood alive and well.  The holiday season is a time of wonderment for kids, and illness or injury shouldn’t dim the brightness of the holidays for our patients and their families.  Thank you to our team for working tirelessly to preserve the magic of childhood.”

chris-furman
Chris Furman

Chris Furman, chairman, CHOC Children’s Board of Directors

“This year, I am thankful for the opportunity to serve as the incoming chairman of CHOC’s board of directors. Our entire board is dedicated to furthering CHOC’s mission to nurture, advance and protect the health and well-being of children in Orange County and beyond. We are honored to support CHOC’s passionate team of physicians and staff and privileged to play a part in bringing world-class care to children and families.”

cynthia-neiman
Cynthia Neiman

Cynthia Neiman, chief marketing officer

“There are so many things that I am thankful for this year! I am so thankful to be working here at CHOC alongside a “mighty brigade” of passionate clinicians, associates, and my amazing team who are all dedicated to preserving the magic of childhood. I am thankful to wake up every morning and do something that I love with people who have a shared mission. This year, I am especially thankful for my family and that all of us will be together in the same city to enjoy the holiday together.”

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Dr. Maryam Gholizadeh

Dr. Maryam Gholizadeh, pediatric general and thoracic surgeon

“I am grateful for many blessings in my life. To name a few: I am thankful to be part of CHOC Children’s, one of the best children’s hospitals, and have the opportunity to do what I love the most, and that is to take care of children. Second, it is truly an honor and privilege to be a surgeon and have the trust of families with their most precious gifts on earth, their children. And finally, I am grateful for the support of my wonderful colleagues and all the staff at CHOC Children’s that allows me to do my job the best way I can.”

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Amanda Webb

Amanda Webb, emergency department charge nurse

“I am thankful to serve children and families who come to the Julia and George Argyros Emergency Department at CHOC Children’s. It’s my privilege to be a source of calm and care for our patients and families during a daunting and scary time. I’m also so grateful to work with a truly transformational leadership team, and alongside dedicated and compassionate staff who make up the best group I’ve collaborated with during my career.”

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Annette and Richard Symons

Annette and Richard Symons, CHOC Champions

“I am grateful that CHOC has given me the opportunity to build upon my parents’ legacy of giving. CHOC helped my husband and me realize our desire to establish a spiritual care endowment—walking alongside us throughout the entire process, putting our philanthropic goals first and working hard to make everything easy for us. As a long-time member of the Small World Guild, I’ve been fortunate to see the incredible healing and support that CHOC provides children and families. I’ve come to find that the more you get involved at CHOC, the more you learn just how amazing it is.”       -Annette Symons

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Dr. Charlie Golden

Dr. Charlie Golden, executive medical director, CHOC Children’s primary care network

“With each year that passes, all of us experience the many trials and blessings of life. As a father and a husband, I am truly thankful for my family, and am reminded every day by them of the true purpose of life. As a physician, I am thankful for my patients and staff, as they enlist me for advice, confide in me their most sacred concerns, and place their trust in me. As a physician executive, I am thankful for the skilled team of physicians and leaders that I work with who share a vision and work tirelessly to provide the highest quality healthcare to all children. Finally, I’m so very grateful for CHOC Children’s, and our vision to be a leading destination for children’s health.”

christian-bernabe
Christian and his dad Bernabe

Christian, age 8, patient

“I’m thankful for my dad for making my favorite foods. I’m thankful for my mom because when I can’t sleep she climbs in my bed and lays with me until I fall asleep.”

Bernabe, Christian’s dad

“Thank you to every doctor and nurse for the special care they provide to Christian. I’m thankful for Jody, an oncology nurse practitioner because my son lights up whenever she comes into his room to check on him. Jody and Christian have a special bond.”

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Mallorie Boeing

Mallorie Boeing, pediatric intensive care unit registered nurse, CHOC Children’s at Mission Hospital

“This year and every year for the past four years since I became a member of the CHOC organization, I am thankful for my CHOC Children’s at Mission Hospital family. From our unit assistants, electroencephalogram (EEG)  techs, child life specialists and volunteers, to our doctors and nurses both at CHOC Mission and Mission Hospital, I am thankful to be a part of such an amazing and passionate team of individuals. I am especially thankful this year for CHOC’s ability to provide tuition assistance while I obtain my master’s degree and for creating such a fun and positive work environment. I am also thankful for CHOC’s continued dedication to providing safe, high-quality, patient-and-family-centered care to all of Orange County’s smallest residents.”

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Dr. Kelly Davis

Dr. Kelly Davis, pediatric sports medicine specialist

“I was a resident at CHOC several years ago and am so thankful to be a part of the CHOC community again. I am thankful for all of my colleagues who help me continue to grow and learn as a physician. I am thankful for my patients who are the young budding athletes of the future. They entrust me with their pains and concerns and allow me to care for them and help them stay healthy while they achieve their sports dreams. Being at CHOC as a resident taught me so much and significantly shaped the doctor that I am today. I am most thankful to now be able to give back and pass on my love for teaching and our healthcare system to the next generation of doctors.”

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Dr. Joffre Olaya

Dr. Joffre Olaya, pediatric neurosurgeon

“I am so grateful for the privilege of working at CHOC Children’s and the chance to be part of a premiere clinical team within CHOC’s Neuroscience Institute. I take pride in working alongside such an incredible team of healthcare providers who understand that we care for the most vulnerable population. Shouldering this responsibility propels us to strive to deliver the best possible care to our patients facing neurological disorders. I’m humbled that parents entrust us every day with their children’s medical care.”

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Danielle Frausto with CHOC colleagues’ daughters

Danielle Frausto, registered nurse, neonatal intensive care unit

“CHOC has given me the opportunity to do what I love most. It is an honor to come to work every day and take care of our fragile patients.”

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Lisa Schneider

Lisa Schneider, nurse manager, mental health inpatient center

“I am very thankful for everyone who has warmly welcomed me into the CHOC family and also for CHOC’s dedication to pediatric mental healthcare. This is the first organization that I have encountered that is so passionate about de-stigmatizing mental illness and prioritizing mental health prevention, recognition and treatment in children. We are truly impacting the children in our area and are setting a higher standard for mental health care across the country.”

Support CHOC to show your gratitude this holiday season

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