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What Parents Need to Know about Teens and Emergency Contraception

By Dr. Terez Yonan, adolescent medicine specialist at CHOC Children’s and Razleen Brar, pediatric resident at CHOC Children’s

Compared to other industrialized nations, the U.S. still has one of the highest teen birth rates in the world. Fortunately, these rates have decreased significantly in the last 20 years – this is largely due to the increased availability and ease of prescription birth control.

Another resource available to help prevent unintended pregnancy, emergency contraception (EC) is clouded in misinformation and myths. EC comes in three different forms, all of which help prevent pregnancy when used correctly. The most important things to know about EC are that these methods do not harm an existing pregnancy, do not cause abortion, and do not protect against sexually transmitted diseases.

There are many reasons why one may need EC to prevent unintended pregnancy:

  • after unprotected vaginal sex
  • condom slippage or breakage that leads to semen exposure
  • contraceptive failure
    • in the first week of starting a new birth control method if a backup method (condoms) is not used
    • missing three consecutive doses of active birth control pills (not placebo or “sugar” pills)
    • replacing birth control patch late or patch falling off for more than 24 hours
    • forgetting to replace the vaginal birth control ring or leaving it out for more than three hours
    • delayed or missed birth control injection
    • IUD or hormonal implant (Nexplanon ®) dysfunction
  • sexual assault

With each of these instances, EC should be used as soon as possible or within 72-120 hours (3-5 days). EC can also be safely used by transgender men while on testosterone, as testosterone can decrease ovulation but does not work as a birth control method; EC should not alter treatment with testosterone.

Emergency Contraceptive Options:


The levonorgestrel pill (1.5mg oral pill: Plan B ®, Plan B One Step ®, Next Choice ®, commonly referred to as “the morning after pill”) is very effective in preventing pregnancy. This method carries limited side effects. This EC is available in most medical offices and by prescription at any age. It is also available over-the-counter without a prescription at any pharmacy to females 17 years or older or males 18 years or older (with proof of age provided). Over-the-counter costs range from $30-60. A pregnancy test is not needed before the use of levonorgestrel.

This pill is about 89 percent effective at preventing pregnancy. It is most effective in the first 72 hours (3 days), but can be used up to 120 hours (5 days) after sex to prevent pregnancy. Its effectiveness is also decreased in those who are overweight or obese. Alternative methods, listed below, are recommended for those whose BMI is over 25.

The effectiveness of levonorgestrel also decreases when someone has had multiple episodes of unprotected intercourse and has used  the pill multiple times in the past. EC is not a good option for birth control. Talk to your medical provider about finding an effective method of birth control that meets your needs.

Ulipristal (Ella ®)  is more effective than the levonogestrel pill for preventing pregnancy and is an option for those who are overweight or obese (BMI over 25). This EC requires a pregnancy test and a prescription. Ulipristal has increased potential adverse side effect including nausea, vomiting andabdominal pain compared to the levonorgestrel method. If you’re taking this form of EC because your primary method of birth control has failed, the pill, patch, or vaginal ring has to be paused (not taken or used) for five days, as these methods can interfere with this EC’s effectiveness in preventing pregnancy. On day six, birth control can be restarted with condoms as a backup method.

Before the levonogestrel pill or ulipristal were perfected, people were encouraged to use their prescribed oral birth control pills to prevent pregnancy when they needed EC. This was called the Yuzpe method. Medical providers no longer recommend increasing doses of the birth control pill as an EC as this was found to cause uncomfortable side effects, and there are now more effective methods.

Intra-uterine Device

The copper intra-uterine device (Paragard ®) is the best option for EC as it is over 99 percent effective at preventing pregnancy when EC is needed, and it provides long-term pregnancy prevention for up to 12 years. It can be used as EC when placed within five days of unprotected sexual intercourse. This IUD is placed by a trained medical provider during an outpatient procedure. Close follow up with your medical provider is a must.

The side effects of this method are few, but include: uterine cramping (which feels like bad menstrual cramps) during and up to 24-48 hours after the IUD is placed, and heavier menstrual bleeding and menstrual cramps for the first two or three menstrual periods after placement. Ibuprofen and heating pads are recommended at-home treatments for these side effects.

Talk to your doctor for more information and for any questions regarding safe sex practices, sexually transmitted infection testing, birth control options, and emergency contraception. See your medical provider immediately after under protected or unprotected sexual activity for emergency contraception. Your medical doctor may also provide a prescription for emergency contraception to use as instructed in the future.

Learn more about Adolescent Medicine

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CHOC Launches Mental Health Intensive Outpatient Program

CHOC Children’s is offering teenagers experiencing symptoms of a mental health condition a new source of hope in a validating, supportive environment staffed by experts in adolescent mental health. The ASPIRE® (After School Program Interventions and Resiliency Education) Intensive Outpatient Program at CHOC Children’s will bring solutions to teens and their families who show moderate to severe symptoms of anxiety, depression or other mental health problems.

Participants ages 13 to 18 attend after-school programming for three hours a day, four days a week in sessions that span eight weeks total.

Run by experienced, licensed clinicians who specialize in working with teens, ASPIRE incorporates therapy, mindfulness exercises, coping and problem-solving skills, art therapy and other expressive therapies to help teens develop and practice healthy behaviors and learn how to manage their feelings, emotions and personal interactions.

Parents or guardians also participate in family counseling and skills groups two days a week in the late afternoon and early evening.

A board-certified adolescent psychiatrist is also available for consultations and medication management, as is case coordination with other medical providers and the teen’s school, and crisis support.

Teens who could benefit from the program may exhibit a range of behaviors:

  • Moderate to severe symptoms of anxiety and depression
  • Extreme emotional outbursts
  • Significant conflict with family or friends
  • Suicidal thoughts
  • Decreases in functioning at home or school
  • Self-harming behaviors

The program’s primary goal is to promote emotional wellness of young people. While in the program, youth will be provided a validating, supportive environment where they can focus on improving their emotional heath:

  • Improvement in symptoms of anxiety, depression and anxiety
  • Improved functioning at home, in school and with friends
  • New skills to cope with stress
  • Decrease in unsafe thoughts and behaviors

ASPIRE® is a component of CHOC’s landmark pediatric mental health system of care launched in spring 2015 to ensure children, adolescents and young adults with mental illness get the health care services and support they need.

The system of care also includes outpatient support for patients whose physical conditions are complicated by mental health challenges; mental health screenings for all 12-year-olds at their well child visits with CHOC pediatricians; and an increased presence of psychologists and social workers in the Julia & George Argyros Emergency Department at CHOC Children’s Hospital.

The cornerstone of the wide-ranging effort is the CHOC Children’s Mental Health Inpatient Center.  With 18 beds, it will be the first unit in Orange County to accommodate children younger than 12.

Learn more about ASPIRE

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CHOC Sibling Gives Back Through Dance Marathon

Growing up, Jessica heard countless stories of the “miracle workers” at CHOC who saved her twin brothers’ lives after they were born. Today, she’s giving back to the hospital that helped keep her family whole.

Justin and Ryan were born ten weeks early due to twin to twin transfusion syndrome, a rare but serious condition that can occur when identical twins share a placenta, and blood and other fluids do not flow evenly between the two babies, resulting in poor fetal growth.

Among other complications at birth, neither of the boys had fully developed lungs. The boys were rushed from the delivery hospital to the neonatal intensive care unit (NICU) at CHOC Children’s Hospital, and their parents were told the odds of survival were very low. Justin’s blood was too thick to pass through his body, and Ryan needed several blood transfusions.

After six weeks of testing and growing stronger in the NICU, the boys were strong enough to go home. That was 18 years ago, and today they’re both healthy, straight-A seniors in high school who are looking forward to attending college next year.

Jessica with her brothers, shortly after they graduated from the NICU at CHOC Children’s.

Ever since, CHOC has had a special place in the family’s hearts― including the time one of the boys fell and broke his arm at age five.

“We were about twenty miles away from CHOC when it happened, but I remember my mom saying, ‘We are not going anywhere besides CHOC,’” Jessica recalls. “It didn’t matter that we had to drive past other hospitals to get there. My parents have always trusted CHOC in everything they do.”

When Jessica, a lifelong dancer, entered her freshman year at California State University- Fullerton, she heard about Dance Marathon, and realized it was the perfect opportunity to combine her passion for dance and desire to give back to CHOC.

Miracle Network Dance Marathon is a movement uniting college, university and high school students across North America. Students involved in a campus’ Dance Marathon organization spend a year gaining leadership, teamwork, and nonprofit business experience while raising funds and awareness for their local Children’s Miracle Network Hospital.

The year culminates with an eight-40-hour event (the dance marathon) on each campus where students get to meet patient families treated at their local hospital, participate in games and dancing, enjoy entertainment, and reveal their annual fundraising total.

As an active member of the CSUF Dance Marathon organization, known as TitanTHON, community outreach team, Jessica is responsible for reaching out to on- and off-campus groups to spread awareness of the event and assist with fundraising efforts.

Since 2014, TitanTHON has raised over $113,000 for CHOC Children’s, CSUF’s local Children’s Miracle Network hospital.

“Dance Marathon is one of my favorite nights of the year. It always falls around mid-terms, so it’s nice to take a night off from studying and spend time dancing with friends and taking advantage of different crafts and activities,” Jessica says. “It’s an honor to meet some of the families who are benefitting from the funds we raise each year. Last year I got to dance with one CHOC patient, and everything came full-circle. I realized that my fundraising is actually doing good work in my community.”

Jessica, who is studying kinesiology and wants to pursue a career as an adaptive physical education teacher for children with special needs, feels a special connection to the siblings of patients she meets at TitanTHON every year.

“TitanTHON is special to me because there are families and older siblings who have younger siblings being treated at CHOC, just like I did,” she says. “I want them to be able to have the same resources and be as blessed as I was, to have my brothers end up safe and healthy. It’s nice to know I am helping give CHOC the resources it needs to care for other children in my community.”

Learn more about TitanTHON

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Meet Dr. Laura Totaro

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Laura Totaro, a pediatric hospitalist at CHOC Children’s, as well as CHOC Children’s at Mission Hospital. After attending Loma Linda University Medical School, Dr. Totaro was part of the first pediatrics residency class through the University of California Irvine and CHOC. She has been on staff at CHOC for three years.

Dr. Laura Totaro, a pediatric hospitalist at CHOC Children’s, as well as CHOC Children’s at Mission Hospital.

Q: What are your administrative appointments?
A: I am the hospitalist representative for both the CHOC Children’s at Mission Hospital Intensive Care Committee and the CHOC Children’s Infection Prevention Committee.

Q: What are your special clinical interests?
A: I am most interested in infectious disease and autoimmune disorders.

Q: What are your most common diagnoses?
A: Seizures, asthma, bronchiolitis, pneumonia, and gastroenteritis/dehydration.

Q: What would you most like community/referring providers to know about you or your division at CHOC?
A: In an effort to better facilitate transfer of care, we now offer 24/7 hospitalist coverage at both CHOC campuses.

Q:  What inspires you most about the care being delivered here at CHOC?
A: The CHOC community provides a unique focus on healthcare for kids that goes beyond just the basics. The entire care team including the doctors, nurses and additional staff who strive to provide personalized care that not only treats a physical illness but also addresses the needs of the entire family. I am inspired by the culture of physicians and nurses that are constantly learning and trying to provide the best care they possibly can. It is such a pleasure to work in a place where everyone seems to truly enjoy their job and are trying to find ways to be even better at them.

Q: Why did you decide to become a doctor?
A: I grew up in a healthcare-focused community where I was exposed to medicine from a young age. I was inspired by the doctors around me and was fascinated by the human body. I also wanted a career that would allow me to help others here in my immediate community and abroad.

Q: If you weren’t a physician, what would you be and why?
A: I would run a travel blog and be a food critic.

Q: What are your hobbies/interests outside of work?
A: Travel, exploring new restaurants, art, and music.

Q: What’s the funniest thing a patient has ever told you?
A: I was examining the mouth of my patient when he proudly showed me his loose tooth and whispered to me that his family had a secret. He then excitedly admitted that his mom was the tooth fairy!  His mother looked at me quizzically and then burst out laughing when she realized what had taken place. Earlier she had admitted to him that she played the role of tooth fairy at home but her son took this quite literally and believed it to actually be her secret full time job for all children.

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Is Your Child’s Headache Cause for Concern?

When your child complains of a headache, it can be anything from a plea to stay home from school in hopes of avoiding a test, to a sign of something more serious. But how can you tell the difference? And when is it time to see the pediatrician? Dr. Sharief Taraman, a pediatric neurologist at CHOC Children’s, offers advice on what parents can do to keep headaches at bay, the importance of identifying a pattern in your child’s headaches, options for treatment, and what types of headache warrant a trip to the emergency department.

Dr. Sharief Taraman, a pediatric neurologist at CHOC Children’s, offers advice for parents concerned about their child’s headaches.

First, it’s important to be able to identify what type of headache your child may be suffering from.

What type of headache does my child have?

Migraine symptoms in kids

At least 5 attacks that meet the following criteria:

  • Headache lasting 1 – 72 hours
  • Headache has at least two of the following features:
    • Pain on both sides or only one side of the head
    • Pain is pulsating
    • Moderate to severe intensity
    • Aggravated by routine physical activities
  • At least one of the following:
    • Nausea and/or vomiting
    • Sensitivity to light or noise

If your child has more than 15 headache days per month over a three-month period, and at least half of those are migraines, they may be suffering from chronic migraines.

It’s a common misconception to assume that only adults suffer from migraines, which isn’t true, says Dr. Taraman. If your child has migraines, they are not alone. About 1 out of every 20 kids, or about 8 million children in the United States, gets migraines. Before age 10, an equal number of boys and girls get migraines. But after age 12, during and after puberty, migraines affect girls three times more often than boys.

Tension headache symptoms in kids

  • Headache lasting from 30 minutes to seven days
  • Headache has at least two of the following characteristics:
    • Pain in two locations
    • Pressing or tightening feeling (not a pulsing pain)
    • Mild to moderate intensity
    • Not aggravated by routine physical activity such as walking or climbing stairs
  • No nausea or vomiting – many children experience a loss of appetite
  • Either sensitivity to light or sensitivity to sound
  • Tension headaches occur most often in children ages 9-12

Cluster headache symptoms in kids

  • At least five headaches that meet the following criteria:
    • Severe pain in one location: within the eye, above the eyebrow, or on the forehead, that lasts from 15 minutes to three hours when left untreated
  • Headache is accompanied by at least one of the following symptoms on the same side of the body as their pain:
    • Conjunctival injection and/or lacrimation
    • Nasal congestion and/or excess mucus in the nose
    • Eyelid swelling
    • Forehead and facial swelling
    • Droopy eyelid and/or small pupil
    • A restlessness or agitation
  • Cluster headaches usually start in children at around 10 years old

Post traumatic headache symptoms in kids

  • Acute post traumatic headache: lasts less than three months and caused by a traumatic injury to the head
  • Persistent post traumatic headache: lasts more than three months and caused by a traumatic injury to the head
  • Both acute and persistent headaches develop within one week of: the injury to the head, regaining of consciousness following injury to the head, or discontinuing medicine that impairs the ability to sense a headache following a head injury
  • Extended recovery risk factors:
    • Prolonged loss of consciousness or amnesia
    • Females
    • Initial symptom severity
    • Premorbid history of ADHD, mood disorders, and migraines

Sleep apnea headache symptoms in kids

  • Typically occurs in the morning
  • Pain is present on both sides of the head
  • Lasts more than four hours
  • Not accompanied by nausea, nor sensitivity to light or sound

Medication overuse headache symptoms in kids

  • Headaches on 15 or more days per month
  • Takes over-the-counter medication for headaches more than three times per week over a three-month period
  • Headache has developed or gotten worse during medication overuse
  • Pattern of headaches resolves or improves within two months after discontinuing the overused medication

What to do when your child has a headache

A variety of non-medical interventions can be helpful for children who are suffering from headaches. These non-medical interventions for headaches include: ice packs; warm baths; taking a nap in a cool, dark room; neck and back massage; and taking a walk.

Parents shouldn’t be tempted to immediately turn to medication such as ibuprofen or naproxen, says Taraman.  Over-the-counter pain medications (such as Tylenol or Motrin) should be limited to no more than three days per week with no more than two doses per day, in order to avoid medication overuse headaches. Follow the dosing instructions on the label and ask your child’s pediatrician or pharmacist any questions before beginning a treatment regimen. Follow dosage instructions given by your physician or pharmacist, or download a guide to ibuprofen and naproxen.


How to avoid headaches

There are a number of things parents can do to prevent headaches, says Dr. Taraman. These include:

How to talk to your pediatrician about your child’s headaches:

Keep a journal of your child’s headaches so you can identify a pattern, and show your child’s primary care physician. If you don’t have a primary care provider, find one near you. In your headache journal, keep track of:

  • Headache start date and time
  • What happened just before the headache?
  • How much did your head hurt, on a 0-10 pain scale?
  • Where did your head hurt?
  • What did you feel just before and during the headache?
  • What did you do to make yourself feel better?
  • Did you feel better, on a 0-10 pain scale?
  • Headache end date and time

Your child’s pediatrician may adjust your child’s diet, headache hygiene routine, or their NSAID regime. In some cases, your primary care provider may refer you to a pediatric neurologist, who have specialized training in the nervous system (brain, spinal cord, muscles and nerves), who work in tandem with imaging and other specialists and pediatricians as necessary.

Patients should immediately be taken to the emergency department for some headaches including:

  • Thunderclap headache: severe, sudden onset of pain that occurs anywhere in the head, and grabs your attention like a clap of thunder. Pain usually peaks within 60 seconds to a few minutes.
  • Any headache that comes with weakness or numbness on one side of the body, or changes in consciousness or awareness.
  • Blurred, double or loss of vision that persists after the headache resolves.

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