All posts by CHOC Children's

Effects of Secondhand Smoke on Children

Growing children, whose lungs and hearts are still developing, are at risk for greater effects of secondhand smoke (SHS). Children exposed to SHS are essentially breathing in the same harmful chemicals as smoker themselves, says Dr. John Mersch, a CHOC Children’s pediatrician. These risk factors include poor lung development, lung cancer, heart disease, cataracts and respiratory problems such as asthma, bronchitis and pneumonia.

Secondhand smoke, a combination of the tobacco smoke exhaled by a smoker and the smoke emitted from the burning end of a cigarette, cigar, or pipe, is classified as a Group A carcinogen by the Environmental Protection Agency. It contains more than 4,000 hazardous chemicals known to generate cancer and heart disease which has been proven to kill over 41,000 young nonsmoking adults and more than 400 infants on a yearly basis, according to the Centers for Disease Control and Prevention.

“Harmful SHS chemicals cause a child’s blood platelets to become sticky,” explains Dr. Mersch. “This makes it harder for the blood to flow smoothly through their blood vessels and arteries. In turn, the child’s risk of heart attacks and future heart disease is immediately increased by 25-30 percent.”

The effects of SHS on infants are even more immediate. Tobacco toxins are known to have effects on the part of the baby’s brain that regulates breathing. Babies who die from Sudden Infant Death Syndrome (SIDS), the unexplained, unexpected death of an infant in their first year of life, are found to have higher concentrations of nicotine and cotinine, (signs of SHS), in their lungs as opposed to infants who have died from other causes.

The US Surgeon General has concluded that e-cigarette vapor contains harmful and possibly harmful chemicals including nicotine.

Although it is difficult to avoid all exposure to SHS, here are some helpful tips to protect yourself and your children from these harmful chemicals:

  • Never allow smoking in or near your house. Smoke lingers in the air for hours and in the smoker’s clothes. The best way to prevent exposure to these leftover chemicals is to have the smoker change clothes before interacting with children.
  • Never allow smoking in your car. Even with the windows rolled down, every passenger in that car is still exposed to those harmful chemicals.
  • Avoid known smoking areas as much as possible, even if there is no smoker present since harmful chemicals continuously float around in the surrounding air.
  • Send your child to tobacco-free daycares and schools.
  • Make every person aware of these rules before allowing them to come in contact with you child.
  • For smoking parents, the best way to prevent the effects of SHS in your children is to immediately quit smoking.

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The Appendix: 5 Common Questions

More than 700 kids are treated for appendicitis at CHOC Children’s every year. The appendectomy is one of the most commonly performed surgeries in the world. But just what is the appendix, and why does it send so many people to the emergency room with stomach pain?

Dr. Peter Yu, CHOC Children’s pediatric general and thoracic surgeon, explains everything you’ve ever wondered about the appendix, and more.

Dr. Peter Yu, pediatric general and thoracic surgeon at CHOC Children’s


  1. What does the appendix do?

The appendix is a small, finger-like projection that sticks out of the large intestine, located in the right side of the abdomen. It weighs about as much as an earthworm. In fact, its old-fashioned name is vermiform appendix, which means worm-like, Dr. Yu explains.

Everyone’s appendix is different. Some are long, some are short and stubby. But one thing they all have in common is that they are not necessary for a happy, healthy life.

“We are not sure if the appendix has a purpose. Some doctors don’t believe it does anything,” Dr. Yu says. “Some think it plays a role in the development of the immune system, and some believe it harbors ‘good bacteria’ that helps intestinal health. The bottom line, though, is that appendicitis is common, and patients do extremely well after removal of their appendix.”

  1. What causes appendicitis?

Bacteria naturally live in the large intestine and flow in and out of the appendix. Sometimes, the opening to the appendix gets blocked. Either constipation, a hard piece of stool called a “fecalith,” or enlarged lymph nodes cause these blockages.

The blockage traps the bacteria inside where it festers and multiplies. This leads to inflammation of the organ. If left untreated, the appendix can burst, releasing the infectious bacteria into the body.

Symptoms of a Burst or Inflamed Appendix

What are signs of appendicitis?

  • sudden severe pain
  • pain that starts near the belly button and moves to the lower abdomen on the right side
  • fever, nausea or vomiting

To diagnose appendicitis, the Julia and George Argyros Emergency Department at CHOC Children’s Hospital will check your child’s blood for signs of an infection and will do an ultrasound of the abdomen. While many hospitals use a CT scan to diagnose appendicitis, CHOC radiologists and sonographers have the training and experience to make a diagnosis using ultrasound, in order to minimize your child’s exposure to radiation. If the ultrasound is inconclusive, the radiologist may conduct a CT scan.

  1. How does the surgeon remove the appendix?

The surgeon will perform a procedure called a laparoscopic appendectomy to remove the appendix. A pediatric anesthesiologist will put your child to sleep using general anesthesia. The procedure takes about 30 minutes, though CHOC’s pediatric general surgeons can remove the organ in less than 10 minutes if needed.

During surgery, three tiny incisions are made on the abdomen. Carbon dioxide is blown into the belly to create a dome, giving the surgeon room to work. Small surgical tools are inserted in two of the incisions and a laparoscopic camera is inserted in the third. The appendix is identified, stapled or tied off, and removed.

The surgeon closes the incisions with surgical glue and dissolvable strips. In most cases, children will stay in the hospital for one day before the doctor discharges them. They should have no heavy activity or sports for two weeks after surgery and can usually return to school quickly, often even the next day.

  1. What do you do with the appendix after you take it out?

Pathologists then inspect the removed appendix in the pathology department under a microscope. This inspection is important because it will confirm the diagnosis of appendicitis and rule out other conditions such as ulcerative colitis, Crohn’s disease and carcinoid. Your surgeon will update you with the results during your follow-up appointment.

  1. What if my appendix bursts?

“Fortunately, perforated appendicitis is less common than non-perforated appendicitis, but it can happen,” Dr. Yu says. “For some, the appendix can burst quickly, and for others it does not burst at all. There are many factors that a surgeon will consider before deciding whether to operate immediately, or to wait.”

If your surgeon decides to wait, then treatment can include antibiotics, placement of a drain in the abdomen, and nutrition through an IV if needed. Most patients improve in several days, after which the doctor discharges them. Your surgeon will then schedule your child for an interval appendectomy, which is removal of the appendix 8-12 weeks later. This gives the body time to recover from the infection and inflammation, making surgery safer and less complicated.

The CHOC Emergency Department, equipped to treat appendicitis 24 hours a day, with pediatric surgeons ready for all situations is mainly for kids and teens.

Learn more about appendicitis in kids and teens

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What Every Parent Should Know About Emergency Departments During Flu Season

This year, thousands of people are packing their local emergency department during flu season. As the region’s only pediatric-dedicated facility, the Julia and George Argyros Emergency Department at CHOC Children’s Hospital is seeing an extremely high number of patients, from infants to teens. Our physicians and staff understand how anxious and scared parents and children can get when faced with a trip to the emergency department. They offer the following information and tips for parents coming to the emergency department during the busy flu season:

  • Be prepared to see a full lobby, including people seated in chairs down hallways and in additional areas throughout the department. Typically, the department gets busier as the day progresses. CHOC has added staff to help manage wait times.
  • Leave siblings and other family members at home, if possible. This will help ease crowding, but more importantly, keeps well children from being exposed to sick ones. Also, parents’ attention should be focused on their ill or injured children.
  • Patients are seen based on how sick or injured they are, not on the order they arrived in the emergency department. Please keep in mind there are patients who arrive in ambulances – admitted in an area beyond your view. Our staff must treat the sickest first. If you’ve been waiting and are concerned your child’s condition is getting worse, please ask a nurse to reassess her.
  • Hold off on giving food or drink to your child until she’s been seen by the doctor. A full stomach can delay procedures and the use of sedatives.
  • There are nurses and emergency medical technicians (EMT) who work in the lobby and have different roles. Nurses, dressed in maroon scrubs, help screen and assess patients; some will assist with lab work or X-rays. EMTs, dressed in tan scrubs, can only take vitals and measure height and weight. EMTs will notify the nurses in the lobby of any changes they observe in patients’ conditions.
  • Don’t expect a prescription for antibiotics, which aren’t always the answer. Antibiotics can only treat infections caused by bacteria. Cold illness caused by viruses can’t be cured with an antibiotic.
  • Try to stay calm. Children can pick up on their parents’ fear and anxiety. Take deep breaths for your and your child’s sake.
Download a checklist of what to bring to the emergency department

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What is a Clinical Trial?

Children with life-threatening conditions are often candidates for clinical trials. If your child has a serious illness, your doctor might talk to you about enrolling your child in a clinical trial.

Carefully conducted clinical trials are performed in human participants to provide answers to questions such as:

  • Does a treatment work?
  • Does it work better than the standard existing therapy?
  • Does it have side effects?

“Through clinical trials, doctors find new ways to improve treatments and the quality of life for people with disease. They also give children with rare or difficult-to-treat conditions, such as certain forms of cancer, access to innovative treatments,” says Dr. Van Huynh, a pediatric oncologist at the Hyundai Cancer Institute at CHOC Children’s, and the CHOC principal investigator for the Therapeutic Advances in Childhood Leukemia/Lymphoma Consortium, a group of children’s hospitals and universities that work to quickly develop and carry out clinical trials. The consortium develops phase I and phase II clinical trials of new therapies and novel therapy combinations in recurrent childhood leukemia and lymphoma.

Dr. Van Huynh, a pediatric oncologist at CHOC Children’s.

Clinical trials are standard practice in cancer treatment for children, adolescents and young adults. In fact, a higher percentage of newly diagnosed children with cancer and their families participate in clinical trials, perhaps more than in any other field of medicine, according to Dr. Huyhn. All clinical trials are voluntary and information collected is confidential. Participants can withdraw from a trial at any time, for any reason.

“Some clinical trials evaluate how well new medications work and whether they are safe to use. Other clinical trials explore whether we can use medications in new combinations or at different doses to improve survival or reduce short-term side effects,” says Winnie Stockton, investigational pharmacist at CHOC Children’s. “There are trials that focus on finding the best ways to minimize long-term side effects of certain treatments, and other trials that aim to determine the best dose to give children for medications that have successfully treated cancer in adults.”

Winnie Stockton, an investigational pharmacist at CHOC Children’s

Types of Clinical Trials

Clinical trials are categorized as Phase I to IV trials.

Phase I

Studies of a new drug are the first that involve people. Participants in these trials are usually the first to receive the new therapy. The drug is tested to evaluate the dosages of the treatment and how often the treatment can be administered. Drugs are given at gradually increasing dosages, and participants are monitored closely for side effects. The goal of a Phase I clinical trial is to find the dose that is best tolerated without causing severe side effects.

Phase II

Once a treatment is found to be safe in a Phase I clinical trial, it is then tested in a Phase II trial to determine if it works. The treatment targets the patients who responded most favorably in Phase I trials. In these trials, doctors may evaluate if the treatment works for a specific type of cancer or illness.

Phase III

Once a new therapy has been determined to be safe and effective, it is then moved to a Phase III clinical trial. These are the studies that most children with newly diagnosed illnesses or cancers will receive. These trials test whether the new therapy is better than the standard treatment.

Phase IV (also known as Post-Marketing Surveillance Trials)

Phase IV studies take place after the drug has received regulatory approval (market authorization) and are designed to provide broader effectiveness and safety information about the new medicine in large numbers of patients, and to compare or combine it with other available treatments. These studies are designed to evaluate the long-term effects of the drug.

When you take part in a clinical trial, you will only be in that one phase of the study. Treatments move through the phases, but patients do not.

“At CHOC, we believe it’s important to conduct research directly with children and adolescents in a facility that is devoted exclusively to the care, quality of life, rights and safety of children of all ages. If a parent is interested in having their child participate in a clinical trial, we currently have over 350 research studies in more than 30 specialties to provide children with the latest treatments,” says Dr. Huynh.

Learn more about research at CHOC

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7 Health Benefits of Oatmeal

By Jenna Long, clinical dietitian at CHOC Children’s

January is National Oatmeal Month, and there is no better time to explore the health benefits of oatmeal, and fun ways to prepare it as a way to mix up the breakfast options you’re offering to your family. Even though we live in sunny California, the temperature is starting to drop and many of us start are starting to crave warming breakfast options.

Beyond its warming properties, oats are packed with many health benefits:

  1. Naturally Whole Grain. This, therefore, means it contains all three original parts – the bran, germ, and endosperm (refined grains only contain the endosperm). Each part of the grain has valuable health benefits: brain is fiber-rich and keeps you feeling full while preventing constipation, germ is rich in B vitamins and healthy fats, and endosperm is the calorie-rich portion of the grain.
  2. Help lower LDL (or “bad”) cholesterol which specifically may help reduce the risk of heart disease.
  3. Increase satiety – that is to say you’ll feel full longer, which can help with busy work and school days and assist in weight maintenance.
  4. Help control blood sugar due to soluble fiber.
  5. Promote bowel regularity due to their fiber content. Try eating oats in their whole form, or for an extra boost add 1 Tbsp oat bran to hot cereal, applesauce, yogurt or smoothies.
  6. Contain unique polyphenols called acetamides, which have anti-inflammatory, anti-oxidant and anti-itching properties.
  7. Naturally gluten free. However, if you or your child are sensitive to gluten, look for certified gluten-free oats. Oats can become contaminated with gluten as they are growing and processed.

Old fashioned oatmeal, also known as “quick oats” is the most popular type of oat in the US. Steel cut oats require longer cooking time, about 20-30 minutes, but your patience will be rewarded. Steel cut oats create a rich and thick porridge with a nutty texture.

Try these easy to make, nutritious oatmeal recipes: 

Overnight Slow Cooker Apple Cinnamon Oats

Adapted from The Yummy Life


  • 2-3 Apples, cut into ½ inch pieces (~3 cups chopped)
  • 1 ½ cups milk (or non-dairy substitute)
  • 1 ½ cups water
  • 1 cup uncooked steel cut oats
  • 2 Tbsp pure maple syrup (optional, or may use other sweetener)
  • 1 ½ Tbsp butter, cut into 6 pieces
  • 2 tsp cinnamon
  • 1 tsp ground ginger (or 1 Tbsp fresh ginger, peeled and chopped small)
  • 1 Tbsp ground flax seed
  • Optional garnishes: Chopped walnuts, raisins, additional milk


  • Coat your slowcooker with cooking spray.
  • Add all ingredients (expect optional garnishes) to slow cooker and stir
  • Cook on low for about 7 hours
  • Wake up to a wonderfully smelling home, portion into bowls, add optional garnishes and enjoy!

Tips and fun facts:

  • It is important to not use old fashioned oats because the oatmeal will become overcooked.
  • Maple syrup is a sweetener, but also high in antioxidants.
  • Flaxseeds can be purchased in the bulk bin of your grocery store in small amounts. Be sure to choose ground over whole flax seeds, so your body can utilize its nutrients.
  • This recipe stores well in the refrigerator, which also makes meal prep for the week easy. It also freezes well.

 Oatmeal “Cookie Dough” Smoothie

Adapted from Running with Spoons


  • 1 medium banana, frozen
  • ¼ cup raw old-fashioned oats
  • 1/3 cup Greek yogurt
  • 1 tsp chia seeds (optional health boost)
  • ½ tsp cinnamon
  • 2 tsp vanilla extract
  • 1 Tbsp almond butter
  • ½ cup vanilla almond milk (or other dairy alternative)
  • 1 Tbsp chocolate chips (optional)


  • Place all ingredients in blender and blend until smooth

Tips and fun facts

  • This is a great recipe for those looking for an on the go breakfast
  • Try adding in ¼-1/2 cup of fresh or frozen fruit
  • Chia seeds, like oats, are rich in fiber. They are also high in heart healthy omega-3 fatty acids, antioxidants and calcium.

Healthy Homemade Granola


  • 5 cups old-fashioned oats
  • 1 Tbsp cinnamon
  • ¼ cup chopped walnuts
  • 2 Tbsp vanilla extract
  • ¼ cup honey*
  • 2 Tbsp canola oil


  • Preheat oven to 350 °F
  • Mix wet ingredients and dry ingredients in separate bowls, then combine.
  • Spread out thin on a large baking sheet and bake for 15-20 minutes until just golden

Tips and fun facts:

  • *Reminder: Do not introduce honey until your baby’s 1st birthday and speaking with your doctor
  • Adding granola and fruit to your yogurt can make a great well-balanced breakfast, but may store bought granolas are high in both sugar and fat. Making your own granola is easy, saves money and all in all allows you to control the amount of sugar and fat – plus you can experiment with fun combinations of dried fruit and nuts.
  • In addition try adding chia seeds to your granola after it has been cooked for a health boost.
  • Some of our other favorite things to add to granola also include: ground flax seed, dried blueberries, chopped pistachios, ground ginger, unsweetened coconut.

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