All posts by CHOC Children's

CHOC Celebrates Child Life Week

The Cherese Mari Laulhere Child Life Department at CHOC Children’s strives to normalize the hospital environment for our patients and families. “Normalizing” the hospital experience is the process of making things like medical equipment and procedures feel less strange or foreign. By doing this, patients and their family members can feel more at ease while at the hospital and will be able to focus on what is most important: feeling better.

Patients, families and staff were treated to a week-long celebration of special activities and visitors. Take a look inside the specialized therapeutic programs that are just one part of this special area of CHOC.





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Is It a Cold, Sinus Infection or Allergies?

By Fionna Lam and Tran Nguyen, clinical pharmacists at CHOC Children’s and Dr. Jonathan Auth, CHOC Children’s pediatrician

With the winter season nearing the end and spring season already here, many of us are experiencing nasal symptoms related to the common cold, a sinus infection, or seasonal allergies. Since all these conditions share overlapping signs such as sneezing, nasal discharge and congestion, distinguishing between them may be the first step to selecting the proper over-the-counter remedy for symptomatic relief.

The common cold usually peaks during cold weather and is caused by a viral infection. While children may feel crummy for a few days, most cold symptoms can be managed with over-the-counter medications. Sinus infections, on the other hand, can bring about headaches and facial pain. It can happen after a prolonged common cold when the body is more vulnerable to bacterial or viral infections. Some children may be more susceptible to sinus infections than others due to structural abnormalities in the nose.

Sneezing, nasal congestion, and/or watery eyes are the hallmark symptoms of seasonal allergies. These are due to the body’s immunologic reaction to irritants in the air. This condition usually peaks during spring time when the highest amount of pollens from trees, grasses or weeds are present in the environment. Other common allergens include dust and mold.

The following table compares some common signs and symptoms of common cold, sinus infections and seasonal allergies:

Symptom Common Cold Sinus Infection Seasonal Allergies
Fever/chills +/- * +/-
Sneezing + +/- +
Stuffy/runny nose + + +
Color/consistency of sinus discharge Clear and watery, or thick and colored Thick, yellowish or greenish Clear and watery
Sore/itchy throat + +/-
Cough + ** +/-**
Chest congestion +
Headache/facial pain +
Stiff neck +
Watery eyes +

+    present

+/-  may or may not be present

*Fever and/or chills are more common in children than adults

**Cough may present if post nasal drip present

It’s important to be aware of how long each symptom has been present. Cold symptoms usually start to show improvement in most children in 7-10 days. Sinus infections usually have longer lasting symptoms without treatment, around 10-14 days. Allergies are usually present for weeks or more.

When an infection or allergy occurs, the blood vessels in your child’s sinuses dilate and the tissues tend to swell up, which can lead to pain around the eyes, cheeks and forehead. Mucus production increases during an infection and can cause further discomfort. Small microscopic hairs in our nose called cilia help sweep bacteria and particles from our nose, but when dry air enters our nose, it can damage the cilia by drying them out.

Before resorting to medications, non-pharmacological strategies can be tried first such as introducing moist air with a humidifier, taking warm showers or drinking hot fluids like tea and soup. Keeping the air moist will help prevent drying out the nose passage and prevent mucus buildup.   Applying a warm compress to the face may also help alleviate congestion pain.

A variety of over-the-counter medications can provide targeted symptomatic relief. See the chart below for active ingredients and their role in cold and sinus infections. Learn what to look for when choosing the right over-the-counter medication for your child. While combination products offer the convenience of addressing many symptoms at once, they often contain more than one ingredient. When multiple over-the-counter remedies are taken together, the risk of toxicity increases due to duplication of active ingredients or doubling up on drugs in the same drug class. For example, acetaminophen (Tylenol) is commonly found in many over-the-counter cold and cough medications. Inadvertent overdoses have occurred when parents gave these medications along with Tylenol. To minimize this risk, single ingredient products are recommended whenever possible. Download this guide to acetaminophen for children.

Remember that over-the counter medications are not completely safe and do come with risk of side effects and toxicity if not taken correctly. Talk to your child’s pediatrician or pharmacist before starting a medication regimen.

Active ingredient Purpose Symptoms Treated
Mucous Cough Pain Fever Runny Nose Stuffy Nose
Acetaminophen Pain reliever + +
Ibuprofen, Naproxen Pain reliever + +
Phenylephrine*, Pseudoephrine* To relieve nasal congestion + +
Dextromethorphan** Cough suppressant +
Guaifenesin To loosen up phlegm + +
Saline spray To relieve nasal congestion + +
Mentholated topical ointment To relieve nasal congestion + +
Fluticasone, Triamcinolone (Nasal Spray) To relieve nasal congestion + +
Oxymetazoline*, Phenylephrine*(Nasal Spray)  To relieve nasal congestion  + +

+ present

*Do not use decongestant for more than 3 days as it might make you more congested.

**Discretion should be used when using dextromethorphan as a cough suppressant as high doses can cause hallucinogenic effects and be abused.

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How RSV Changed the Way I Parent

By Alexandria Salahshour, CHOC parent and mom of Andre, four months

This story is about my son who got sick with Respiratory Syncytial Virus (RSV) at three weeks old and was hospitalized at six weeks. I’m sharing our story so other parents are aware of the dangers of RSV and know what to look for. It’s important to always follow your own instincts no matter what. YOU know what’s best for your child. You are your child’s voice.

RSV
Andre, diagnosed with RSV at three weeks old and hospitalized at six weeks, was treated at CHOC Children’s at Mission Hospital.

What is RSV?

RSV is a highly dangerous respiratory infection. It can be a potentially deadly virus if not taken care of in time. Most children will catch RSV by their second birthday, but the younger they are, the worse it can be. RSV is primarily spread through child care centers and preschools due to being in close proximity to many children. For most children, RSV will cause nothing more than common cold-type symptoms, but for some  children like my son Andre, it can lead to more serious life-threatening problems such as bronchiolitis, pneumonia, collapsed lungs, respiratory failure, airway inflammation and even death.

The early signs of RSV

This roller coaster started when Andre was three weeks old. Before Andre was born, I made everyone in my family get the whooping cough vaccine along with the flu shot if they planned on touching Andre. Paranoid? No. Proactive? Yes. When Andre came it was so exciting! It was the best day of our lives.

Though we allowed people to hold the baby, I would always say “Don’t forget to wash your hands first.” After Andre got sick, I realized that the REAL questions I should’ve been asking were “Are you sick? Have you recently had a cold? Are your children sick? Are people at your work sick? Are children you are around sick?”

When Andre got sick with RSV, it came as a shock. How did he get so sick so fast? I had a healthy pregnancy, and Andre was born healthy. At three weeks old, he became congested and his breathing sounded off. It wasn’t wheezing, but more like a grunting sound. The morning after he started showing symptoms, we brought him to his pediatrician. I brought recorded videos of Andre’s breathing so the doctor could hear the congestion and grunting.

Our pediatrician didn’t think there was anything going on. He advised us to run the humidifier and to use saline drops. He thought Andre would be just fine, but told us to come back if he got worse, or got a fever with wheezing. Andre never ran a fever. We did the saline drops and humidifier, but it didn’t seem to be getting any better.

That night after our first pediatrician appointment while Andre was sleeping, we had noticed that would choke on his phlegm, be uncomfortable and would occasionally stop breathing. We continued to follow our pediatrician’s recommendation of using the humidifier and saline drops, but it wasn’t helping. I knew that there was something more serious going on.

A few days later, Andre started to wheeze and have breathing problems in his sleep. We rushed him to the hospital where I had delivered him. It was scary to be there because we didn’t know what was wrong with our baby. I had never heard of RSV before, but when I researched his symptoms it kept coming up. The doctor tested Andre for RSV and it came back positive. We were discharged with the same instructions his pediatrician had given, and told to come back if it got worse.

A couple of days went by, and Andre wasn’t getting any better. We took him back to the pediatrician for an after-hours appointment. He was their first RSV patient of the season. The pediatrician let us know that RSV is like a roller coaster, especially in someone so young like Andre. We were once again told to use saline drops, a humidifier and aspirations, but Andre continued to get worse.

Caring for a sick baby during the holidays

At this point the holidays were right around the corner, and my family had arrived from Dubai. This vacation meant the world to me, but unfortunately, it was short-lived. As soon as my uncle held Andre for the first time, he could tell something was seriously wrong. He felt vibration sounds through Andre’s back, almost as if whatever he had was in his lungs.

Suddenly, Andre took a turn for the worse. He was starting to sleep a lot more and just seemed so “out of it.” We decided to take Andre back to the hospital. We took him to the closest hospital to where we were at the time. I told the nurse that Andre was diagnosed with RSV about a week ago, and we were told he would get better, but that he was getting worse. I told him that his retractions were so bad you could see his ribs, and that he was congested, looked like he couldn’t breathe, and had been choking on his phlegm. The doctor said he no longer had the virus and that he may have caught a different virus that was causing this to happen. Even though his retractions and wheezing were so bad, she didn’t see it as anything alarming. They did an X-ray to be sure to make sure it wasn’t pneumonia, and thank God it wasn’t

The next day I saw that Andre’s hands were pale and extremely clammy. Even his lips looked somewhat discolored. I didn’t want anyone to think I was crazy or a hypochondriac, especially because every time we went to the doctor for this virus, we were sent home and told it would get better.

The nightmare begins

Two days before Christmas, our nightmare really began. We woke up in the morning and it was as if Andre had somehow taken another turn for his worse. He seemed so out of it, wasn’t eating well, and had zero interest in breastfeeding. Andre stayed asleep a majority of the day, and didn’t have as many wet diapers as he normally did. By the end of the day he looked beyond lethargic, and almost lifeless.

I did more research about RSV and found that a baby should have 50-60 breaths per minute. Andre was only at 40 breaths per minute. We called the after-hours number for our pediatrician, which is initially probably what saved my son’s life. They immediately connected us with the on-call doctor: Dr. Barbara Petty, a CHOC Children’s pediatrician.

I didn’t know this pediatrician at the time, but I’ve told myself that one day I’ll make an appointment with her just to thank her. She got on the phone and was so kind and soft-spoken, she seemed so concerned and you could tell that she probably has the most incredible bed side manner. She was giving us the most information we have heard thus far. Luckily, while on the phone with Dr. Petty, she was able to listen to Andre, heard the way he sounded and listened to how much he was struggling.

She told us that we needed to get to the hospital right away. We let the doctor know that we’ve already gone to two different hospitals, and she told us that we should take him to CHOC Children’s at Mission Hospital. When we got off the phone with her we couldn’t thank her enough. That phone call will forever mean the world to me.

I remember it was raining that night. We quickly rushed out of the house and went to CHOC at Mission. It was a busy night in the emergency department and there were doctors and nurses everywhere. Our nurse checked Andre’s oxygen levels and found it was only at 70. A healthy, full-term baby’s level should be closer to 100!

RSV

The doctor came in looked at Andre and just kept saying everything was going to be alright and that they were going to take care of him. He told us that it was good we brought him in because his oxygen was so low. They gave Andre an IV, hooked him up to a heart monitor, and gave him oxygen. It was incredible how quickly a team can work to get a baby stable.

A diagnosis at last

He tested positive for RSV again, but he was also diagnosed with bronchiolitis, rhinovirus and respiratory failure. Finally, Andre was in a relaxing state hooked up to the monitors, oxygen, IV fluids and tons of steroids. When the doctor came in and let us know what was going on, he said that because Andre was so young he needed help breathing to fight off this virus. The doctor admitted Andre into the pediatric intensive care unit (PICU) so that they could keep a close  watch on him. When we got into our room, three nurses immediately came in to help care for our baby boy.

Celebrating Christmas at CHOC

The next day was Christmas Eve, our first Christmas as a family, and we were still in the hospital. It was sad being in the PICU and seeing our son struggle in the state that he was in, but we knew Andre was in the BEST place he could be and getting the best care.

Thankfully, Christmas Eve was special at CHOC. A dog named Piper from their pet therapy program visited all the children. We woke up in the PICU on Christmas morning and there was a big bag full of presents for Andre. The tag read “To: Andre, From: Santa.” It was the kindest thing I’ve ever seen.

RSV
Even though Andre and his parents spent his first Christmas at CHOC due to RSV, Santa still managed to find him.
RSV
Andre’s presents from Santa were delivered to his room in the pediatric intensive care unit despite his hospital stay due to RSV.

Though we were in the PICU, CHOC did an incredible job at making a not-so-normal Christmas feel normal. We were so thankful for CHOC and all of the wonderful donated presents from incredible people. Andre got so many toys for Christmas! Because of these kind people, this became a Christmas we will never forget and forever be SO thankful for. It still brings tears to my eyes every time I think about our experience at CHOC Children’s.

When the nurses came in on Christmas, they told us that Andre was doing better and we could start the process of slowly weaning him off the oxygen. His oxygen level was stable, his heart was stable and his retractions were better. It was so nice to see improvements on our little guy!

The next day he tolerated more weaning, and we got to leave the PICU for a room in the regular pediatrics unit. GREAT NEWS! He continued to improve as the days went by. A new doctor came in to give us a run down on what was going on and gave us so much helpful information.

He explained that this virus usually comes from day cares, preschools, and school-aged children and then it’s quickly passed on to others. He let us know that this virus is a roller coaster; it gets bad and then gets better, it gets bad and then it gets better. There’s really no way of telling you when the virus will expel from the baby’s body, especially when they are so young. The doctor told us because he’s so young, the virus can last in his system up to a month!

Bring our boy home

Andre was still doing great and had life back in him. He even smiled for the first time! It was so special and it was the sweetest smile I’ve ever seen. I’ll never forget it. His care team was continuing to wean him off oxygen.

RSV
While he was hospitalized for RSV, Andre smiled for his parents for the very first time.

As they got closer to letting him breathe on his own, I was so nervous  since that would decide if we got to go home or not. The night went by and our little champion did amazing! I was scared to bring him home but the nurses and doctors knew best, and I knew I had to learn to trust their decision since they’re professionals Before we were discharged, the nurses came in and asked us if we had any questions. They let us know that if Andre started to decline, to come back right away. The hospital was great. They had an incredible staff and we were treated so well! When we left, they gave us a few extra pacifiers, a bunch of swaddles, a nice blanket with bears on it, and a pack of diapers. It was nice to have stuff to go home with in case we were out of anything.

Thankful for CHOC

I can never thank the staff at CHOC at Mission enough for taking care of Andre the way that they did. They made us feel like we were at home, even though we weren’t. Everyone was so comforting and understanding. If we ever have another emergency, which hopefully we will not, we’ll be returning to this hospital.

I hope that no one else’s child has to go through what our baby went through. But just in case, parents should know the symptoms of RSV, be prepared and trust your instincts.

RSV
Today, Andre is a happy and healthy three-month-old baby, after his bout with RSV.




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Are Laundry Packets Really That Dangerous?

A recent study published in the medical journal JAMA Ophthalmology stated that an increasing number of toddlers are suffering eye burns as a result of coming into contact with laundry packets. We spoke to Dr. Kenneth Kwon, director of pediatric emergency services at CHOC Children’s at Mission Hospital, about what parents should know about this hidden household danger.

Q: Are laundry packets a serious danger to children? Should parents be concerned?

A:  Yes, they are a serious danger. The colorful and candy-like appearance of these packets makes them particularly attractive and dangerous to children.

Q: There are many products in a typical home that could be harmful if accidentally ingested. Where do laundry packets fall on the scale?

A:  On a scale of 1 to 10, with ingesting cyanide or a poison causing death in minutes considered a ten, the chemicals in these laundry packets would be an 8. Standard liquid household detergents, such as bleach, would be considered a 3 or 4. However, due to the concentrated nature of the chemicals in these laundry packets, they are much more likely to cause serious injury in a very short period of time if ingested. These liquids are alkali in nature and are considered caustic substances, similar to acidic chemicals. The public may be under the misconception that alkali chemicals are less dangerous than acidic chemicals, but when ingested, alkali chemicals tend to cause much deeper and serious injuries to the esophagus and gastrointestinal tract than acidic substances.

Q: Another common injury stemming from laundry packets is eye burns. Why are eyes so susceptible to damage? What treatment can parents do at home?

A:  Eyes are particularly susceptible because children tend to bite into or try to open these packets, and contents can very easily splash into the eyes causing burns to the cornea and surrounding parts of the eye. The cornea, which is the top layer of the eye, has little to no blood supply, which can impair or limit healing, leading to permanent vision problems. The most common symptoms of an eye burn are pain, redness, tearing and vision problems. If you suspect that your child may have an eye burn, irrigate the area under cold running water for at least ten minutes and then take the child immediately to the ED for further irrigation and treatment.

Q: Children often get into laundry packets, or other household chemicals, when left unattended only for a moment. What are the warning signs parents should be aware of that their child has ingested something dangerous?

A:  Commons signs include difficult or painful swallowing, drooling, oral pain, chest or abdominal pain, vomiting, excessive crying, or breathing or speech problems.

Q: How can parents know what to treat at home versus when to seek emergency medical care?

A:  If known or suspected exposure to laundry packets with any symptoms, bring your child immediately to the ED. If the eye is involved, irrigate with running water for at least 10 minutes before transport. Administration of a neutralizing or diluting agent is not recommended for a suspected ingestion. If possible exposure to an opened packet with no symptoms, call Poison Control at 800-222-1222 for further direction.

Q: What can parents do to prevent their children from getting their hands on laundry packets or other chemicals or medication in the home?

A:  The best prevention is elimination of laundry packets from the home. Since there are so many cleaning detergent alternatives available, why even introduce laundry packets into the home at all if you have small children?  If these packets are in the home, make sure to keep them high up in overhead cabinets in the laundry room out of reach of children. Certainly avoid storing these packets in the kitchen or pantry area, as they can easily be mistaken for food or candy. Lastly, periodically check your house to make sure that dangerous medications and chemicals are safely out of reach of toddlers and children. Childproofing the home should occur as regularly as cleaning your home.

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Meet the Pet Therapy Team: Magnolia

Stacey always had a soft spot for animals, dogs in particular. She had a family dog growing up, but never imagined they could be anything more than a beloved family pet. That all changed when her dad lost his vision 15 years ago.

Magnolia, a friendly and energetic golden retriever, joined her family shortly thereafter. The puppy immediately took a liking to Stacey’s father, who found that the dog’s energy lifted his spirits and comforted him.

“We could see how she made him feel. He didn’t know that the rest of our family would stare at the two of them together, but we could see it working,” Stacey says. “Being around animals can be soothing for many people. It’s nice to see her be able to give that love away to people. It’s a very simple thing to put a dog on a bed, but it can have a powerful impact.”

pet therapy
Magnolia posing with her mom Stacey who is a CHOC volunteer, and her grandpa who was the inspiration behind her becoming a pet therapy dog.

Her father was already familiar with the pet therapy program at CHOC Children’s, and urged Stacey to pursue it as a “career” for Magnolia. As part of The Cherese Mari Laulhere Child Life Department, not only does the pet therapy program aim to minimize stress and anxiety for patients at CHOC, but it also offers a “normal-life” experience that lets hospitalized kids be kids.

“My dad knew how much time I love spending with Magnolia, and we had the opportunity to give back. CHOC saved my life when I got spinal meningitis at age four, and joining the pet therapy program is my way of giving back,” says Stacey, who still has the Choco bear she was given as a patient 43 years ago.

All pet therapy dogs at CHOC are extensively trained, and then later certified by Pet Partners, a national organization that registers the human/pet team once they pass an obedience test.

Having been a teacher for over 25 years, Stacey was familiar with sticking to a lesson plan and providing special one-on-one tutoring for a student needing extra help with a tricky subject. She just never imagined that her student would be her dog! She did all of Magnolia’s training leading up to her obedience test.

Now a certified pet therapy dog and proud member of the CHOC team, Magnolia makes 24 visits per year to CHOC Children’s Hospital. She spends her time at CHOC visiting patients in various inpatient units and the emergency department, but is on her best behavior whenever one of those patients happens to be one of Stacey’s kindergarten students.

“Magnolia is very different at the hospital than she is at home or with the kids in our neighborhood,” Stacey says. “She is energetic and silly at home. But as soon as she goes through the front doors of CHOC, she knows she is at work. She knows it is time to be mellow and calm.”

When she’s not at work, Magnolia enjoys running leash-free in the desert; shopping at dog-friendly malls; and watching bunnies, squirrels and ducks.





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Importance of Stretching for the Young Athlete

By Victor Araiza, physical therapy assistant at CHOC Children’s

Stretching can often take a back seat to your general exercise routine and sport-related activities, but these are an essential part of any conditioning or physical therapy program. Stretching decreases the risk of injury or re-injury and promotes wellness.

Why is stretching so important?

Stretching the right way will help improve flexibility and make it easier for you to move. Stretching properly can increase and improve motion in your joints, increase blood flow, and decrease feelings of stiffness. Other potential benefits of stretching can include reducing delayed onset muscle soreness, increasing athletic performance and reducing the risk of tendon or muscle tears.

It is important to stretch correctly and know which muscle groups you want to stretch. Often, the muscles that tend to be tight are the hamstrings, hip flexors, quadriceps, calves and chest muscles. If proper technique is used when stretching, it will help improve flexibility and increase range of motion. This will increase blood flow and decrease stiffness, in turn decreasing the risk of injury or reinjury.

When to stretch

It is recommended that you perform static stretches after exercising, engaging in strenuous physical activity or participating in an athletic event. Static stretches target specific muscles based on the position you are in with the intent to elongate just past the point of a moderate pulling sensation. The static stretch should be held in the same position for 30-60 seconds and repeated two to three times. For an athlete, it is common to perform a dynamic warm-up prior to sport related activities and static stretches after activities. The American College of Sports Medicine guidelines recommends stretching activities be done at least two days per week. It is also important to know and understand which stretches would benefit you based on your limitations and desired activity participation.

Stretching is encouraged:

  •  When range of motion is limited.
  • Prior to or after vigorous exercises.
  • As a component of your sport-specific conditioning program, team warm-up/cool down and before/after a participation in a sporting event.

When is stretching not encouraged?

  • When someone has excessive movement in their joint(s)
  • An athlete who has experienced a recent fracture
  • After sudden onset of inflammation or swelling
  • When you feel a sharp pain when attempting to stretch

 Tips on how to stretch

It is important to remember that just because you perform stretches doesn’t mean that you will never get injured. Stretching won’t prevent an overuse injury that is predominant in sports that involve the repetition of similar movement patterns. There are other important factors such as strength and endurance training, essential to reducing the risk of injury. Please consult your pediatrician for a referral to physical therapy if you and your child need assistance with an exercise and stretching program.

Learn more about rehabilitation services at CHOC.

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A Parent’s Guide to Understanding the Teen Brain

The mind of a teenager can be at times mysterious and illusive. A pediatric neurologist, a pediatric neuropsychologist and a pediatrician who works with adolescents at CHOC Children’s offer advice for parents on how to better understand and connect with their teen.

Navigating adolescence with a still-developing brain

Adolescents’ brains are not yet fully developed during their current stage of life. Physical development can start as early as 8 years old, but the tail end of brain development doesn’t occur until closer to age 25. The more your child is exposed to new things, skills or experiences, the more connections their brain will develop.

“The brain is constantly developing through young adulthood. Just like we wouldn’t expect a baby to be able to speak or a toddler to be able to understand certain consequences, we have to have appropriate expectations for our adolescents,” says Dr. Sharief Taraman, a pediatric neurologist.

Dr. Sharief Taraman offers advice on the teen brain
Dr. Sharief Taraman, a pediatric neurologist at CHOC Children’s

This constant development can lead to experimentation and in turn, a healthy decision making process.

“On the one hand, adolescents are more apt to experiment and make poor choices because their brains are still developing, but they are also more able than adults to learn from their mistakes and alter their perspectives,” says Dr. Jonathan Romain, a pediatric neuropsychologist. “I see adolescence as a period of great potential for growth and development.”

Dr. Jonathan Romain comments on the teen brain
Dr. Jonathan Romain, a pediatric neuropsychologist at CHOC Children’s

A parent’s role in teen brain development

The consequences of teens’ actions can help them link impulsive thinking with facts. This helps the brain make these connections and wires the brain to make this link more often. Parents play a crucial role in helping teens talk through consequences and decision making.

“Part of a parents’ role during this time in their child’s life is understanding that adolescents are practicing new reasoning skills they haven’t used before,” says Dr. Alexandra Roche, a pediatrician who works with adolescents. “Having abstract thinking is one new reasoning skill they need to practice. When they are trying to make a decision, it’s helpful for parents to let them explore various consequences.”

Dr. Alexandra Roche comments on the teen brain
Dr. Alexandra Roche, a pediatrician who works with adolescents at CHOC Children’s

The primary part of the brain developing during this time is the frontal lobe. As this area develops, teens are better equipped for abstract thinking and executive functioning, such as planning their day and making decisions. The frontal lobe is also involved with connections and how we socialize with people as well.

“They’re learning that if A happens, then B or C is going to happen after that. Parents get frustrated at how adolescents handle peer relationships and how extreme their feelings can be, but these may happen because those connections are being formulated. Talking through consequences helps good connections to form,” says Dr. Taraman. “Decision making takes practice. If you want to play guitar, you take lessons and practice, and it makes you better. If you only take one guitar lesson, you’re not going to learn how to play. Decision making is the same thing; it takes practice and it is never too early to start teaching our kids how to make good decisions.”

How to teach decision-making skills to your teen in an interactive way

Remember that you are a role model for your teen’s behavior. When it’s time to make a big decision, show them how to make a matrix, weigh the criteria of what is important to you and them, and teach the decision making process in an interactive way.

Modeling reasoning behavior with your teen will affect how they explore and understand downstream consequences, says Dr. Roche.

“If they approach you and want permission to do something, have them do research via respectable sources and find out what’s appropriate for their age. Involve them in the decision making process. That’s how you can give them good tools instead of just deciding things for them,” says Dr. Taraman.

Talking to your kids is essential in the digital age. It’s common for teens to want to be on their smartphone around-the-clock, but that can spur an extreme fear of missing out. Figuring out how to turn off both the devices and the need to be constantly plugged in is important.

“Try setting technology-free zones or times in your home, such as the dinner table. Take turns going around the table and sharing the highlight of your day. It can spark conversations about other things that happened during your day and how you dealt with them. Teens can learn by example,” says Taraman.

Your teen’s friends also play a crucial role in their development, but peer pressure is not always a bad thing.

“Peer pressure can be positive in many cases, like trying a new sport or joining a new club at school. Experimentation is the way adolescents learn how to interact with their environment and peers,” says Dr. Roche. “Kids should be curious and try different activities.”  Helping them plan ahead for unexpected events, such as being offered drugs or alcohol, can help your teen make the right choice when it counts.

How to calm an overly emotional teen

When teens are overly emotional and fixating on a problem they feel is the end of the world, there are several things parents can do to calm them down so they can start talking through their emotions.

“It’s very common for teens to be very dramatic. Whatever is happening in their world can seem like it’s the most important thing that has ever happened to them,” says Dr. Roche. “Help them identify the emotion they are feeling, and what is making them angry or excited, for example. Identifying the root cause of the emotion and then connecting that back to how that affects their decision making is important.”

Dr. Romain encourages parents to give their teen some space but remind them that you are available to listen.

“Not every problem needs a solution. Sometimes they just need someone to listen to them in a safe space. Encouraging journaling can also be a productive way of getting thoughts and feelings out,” he says.

Listen first and then expand on their statement.

“If they express hurt or disappointment, try to get them to more openly explain why something hurt their feelings,” says Dr. Roche. “Did they misinterpret a conversation?”

Allowing them to solve their own problems teaches independence and prepares them for adulthood.

“If you fix all their problems for them as a teen, then when they go off to college they won’t know how to deal with problems. We don’t just give them a driver’s license and tell them to hit the road. First they drive under supervision of a parent or guardian, and then they gradually gain more independence and responsibility,” says Dr. Taraman.

The power of positive reinforcement

Remind teens that they are resilient and competent. They may have trouble remembering past times they have overcome obstacles.

“Positive reinforcement helps encourage certain behaviors you’d like your teen to model,” says Dr. Taraman. “If they want to go to their friend’s house after school and they ask if that’s ok, say “no problem, thank you for asking.” And if they instead tell you they are going, say “Don’t you need to ask permission first?”

Positive reinforcement will also help them develop strong self-esteem. As they develop their identity, encourage your child to reflect on successes as well as challenges.

“During adolescence kids are coming up with self-identify, personal morals and ethics. This all relates to self-esteem. Comparing yourself to others is common but it can also set unwieldy expectations. Identify their unique strengths (for instance music, but not math) and focus on encouraging them to pursue those,” says Dr. Roche.

When to seek help for your teen

Adolescents are prone to addictive behaviors. If they use certain chemicals such as drugs and alcohol, it can hard wire their brain in a certain way. If they are experiencing anxiety or depression and it is not acknowledged and treated, they are more likely to experience those into adulthood.

“It is important to keep an eye out for symptoms of depression and anxiety that extend beyond normal grief and loss. Check in with your child periodically and be aware of changes in behavior pattern. Persistent irritability, sadness, disrupted sleep, and lack of interest and isolation are some things to look out for that likely warrant a check-in with a counselor or psychologist,” says Dr. Romain.

A few days of emotional outbursts might just be a normal sign of adolescence, but if they are persistently practicing abnormal behavior, it may be a sign to seek additional help. Remind your child that you are there for them, says Dr. Taraman, but also empower your teenager to explore the resources available to them, with or without their parents’ help. Suicide hotlines (1-800-Suicide) or adolescent clinics can help them obtain resources without the help of their parents.

“Because adolescents have so many obvious physical changes, it’s easy to forget the cognitive changes going on in this phase. It’s the most exciting change for kids but can be very frustrating for parents,” says Dr. Roche. “Remember to enjoy the experience of watching your kid develop into an adult.”





Learn more about Adolescent Medicine




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How Much Do You Know About the Brain?

There’s no better time than Brain Awareness Week to get a little more familiar with your melon. Test your knowledge about the brain with this quiz.

  1. Which part of the brain is responsible for reasoning, planning, speech and movement, emotions and problem-solving?
    1. Frontal lobe
    2. Parietal lobe
    3. The spinal  cord
  2. This part of the brain handles the perception of stimuli like touch, pressure, temperature and pain.
    1. Temporal lobe
    2. Occipital lobe
    3. Parietal lobe
  3. The perception and recognition of sounds and memory are the responsibility of this part of the brain.
    1. Occipital lobe
    2. Temporal lobe
    3. Cerebellum
  4. Which part of the brain oversees vision?
    1. Spinal cord
    2. Cerebellum
    3. Occipital lobe
  5. Which is false about the brain stem?
    1. It’s responsible for the brain’s highest level of thinking and perception.
    2. It controls the flow of messages between the brain and the body.
    3. It consists of three parts: the medulla oblongata, pons and midbrain.
  6. What is true about the cerebrum?
    1. It’s named after its bell-like shape.
    2. It plays a large role in motor control.
    3. Common signs of cerebellum damage are related to vision.

Check your answers below!

brain quiz

 

  1. Which part of the brain is responsible for reasoning, planning, speech and movement, emotions and problem-solving?
    1. Frontal lobe. This is one of the brain’s four lobes, which comprise the cerebrum.
    2. Parietal lobe
    3. The spinal  cord
  2. This part of the brain handles the perception of stimuli like touch, pressure, temperature and pain.
    1. Temporal lobe
    2. Occipital lobe
    3. Parietal lobe- also responsible for understanding someone’s position in their environment.
  3. The perception and recognition of sounds and memory are the responsibility of this part of the brain.
    1. Occipital lobe
    2. Temporal lobe- also responsible for language and emotion.
    3. Cerebellum
  4. Which part of the brain oversees vision?
    1. Spinal cord
    2. Cerebellum
    3. Occipital lobe- the smallest of the brain’s four lobes. 
  5. Which is false about the brain stem?
    1. It’s responsible for the brain’s highest level of thinking and perception. False- while the upper parts of the brain tackle higher level matters, the brain stem is responsible for the most basic of body functions like breathing, food digestion and blood circulation. 
    2. It controls the flow of messages between the brain and the body.
    3. It consists of three parts: the medulla oblongata, pons and midbrain.
  6. What is true about the cerebrum?
    1. It’s named after its bell-like shape.
    2. It plays a large role in motor control. The cerebellum has some other minor roles, but it is chiefly tasked with movement and coordination. 
    3. Common signs of cerebellum damage are related to vision.

Learn more about neurology at CHOC  Children’s.

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What Parents Need to Know About Hand, Foot and Mouth Disease

Hand, foot, and mouth disease (HFM) is a viral illness that usually affects infants and children younger than 10 years old, specifically those 1 to 5. We spoke to Dr. Jonathan Auth, a CHOC Children’s pediatrician on what to expect with this common condition.

hand foot and mouth disease
Dr. Jonathan Auth, a CHOC Children’s pediatrician, explains hand, foot and mouth disease

Q: Is HFM contagious?

A: Yes, it can be spread through contact with feces, saliva, or mucus. The virus is common year round but tends to cluster in the summer and fall.

Q: What are the symptoms?

A: A fever is usually the first sign of the virus, followed by a reduced appetite and sore throat, which can cause a child to feel achy and irritable. After a few days, painful sores (red-yellowish blisters) develop in the back of the roof of the mouth. A skin rash with red spots may appear in the palms of the hands and soles of the feet, as well as on the knees, elbows and buttocks area.

Q: What should a child with HFM eat?

A: Make sure your child drinks plenty of fluids, such as water or milk, to stay hydrated. How much water should your child drink? At CHOC Children’s, we recommend that children drink the amount of 8 ounce cups of water equal to their age, with a maximum of 64 ounces for children over the age of 8. Most children do not have much of an appetite during this time. Cold or soft foods, such as popsicles, ice cream, yogurt or jello, are the most soothing given the sores on the throat.

Q: How is HFM treated?  

A: HFM usually clears up within a week. While there is no medical cure or vaccination for HFM, your child’s pediatrician can recommend ways to make your child more comfortable while the illness runs its course. Acetaminophen or ibuprofen can be given to ease painful mouth sores or discomfort from the fever. Download a parent’s guide to acetaminophen for children.

Children with blisters on their hands, feet or rest of the body should keep the areas clean and uncovered. Wash the skin with lukewarm soap and water, and gently pat dry.

Everyone in the family should wash their hands often, especially after using the toilet or changing a diaper, and before preparing food. Shared toys should be cleaned often, as viruses can live on objects for a few days.

Call your child’s pediatrician if your child is sluggish, can’t be comforted or seems to be getting worse.

Q: Are there any complications?

A: Complications are rare. Occasionally, some complications could arise, such as dehydration, due to a child not eating well, or not being able to swallow enough liquids because of painful mouth sores. Sometimes the rash or sores on the body can be infected if there are breaks in the skin.

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Female Physicians, Hospital Leaders Observe International Women’s Day

As the world celebrates International Women’s Day, we are highlighting a few of our female physician and hospital leaders. They offer insight and words of encouragement to women seeking to pursue careers in medicine.

international women's day

Kerri Schiller, senior vice president and chief financial officer

Don’t ever be afraid to take a leap – work hard and do your best.  You can be and have whatever it is you strive for – you just have to be willing to work for it.

Find yourself a mentor – someone who you trust and admire.  Keep in touch and reach out when you need advice or just to say hello.

Striking a balance between career and family can be very difficult. Healthcare, in particular, is a profession where the dedication to the well-being of others is of great importance. Having good friends and/or a partner who accepts your role and who shares and supports responsibilities  allows for greater satisfaction both at home and at the job. And, of course, working with people you enjoy and like is critical to your ability to perform your job and love what you do.

Accept the fact that some days will be hard.  I keep a small folder of mementos, including expressions of thanks or acknowledgement I have received from others through the years.  Going through that folder reminds me of times of accomplishments and success, as well as recognition.  There are going to be days when you feel like there’s no one in your court; that’s the day to pull out your file and give yourself a boost.

international women's day

Dr. Maria Minon, vice president of medical affairs and chief medical officer

It is my hope that women professionals in healthcare and other career fields will use Women’s Day as a reminder to exceed expectations and aspire to excellence as the Professionals they are – measuring themselves against all their peers – not just a select group.

A favorite quote of mine is from Eleanor Roosevelt, “One’s philosophy is not best expressed in words; it is expressed in the choices one makes… and the choices we make are ultimately our responsibility.”

I encourage women to take responsibility for themselves and their choices and to rise above to become the great individuals they desire to be.

international women's day

Dr. Mary Zupanc, chair of neurology and director of the pediatric comprehensive epilepsy program

Reach for the stars!  Go for it!  Whatever you want to do, follow your passion and your heart.  Don’t settle for less.  Money should not be the significant driver.  Money does not buy happiness or satisfaction.  In medicine and other careers, it is about making a difference, making the world a better place.

international women's day

Dr. Georgie Pechulis, hospitalist

Follow your instincts. Block out anyone trying to convince you otherwise. At times, you may feel like you have to prove yourself as a woman. Persistence, focus, and determination will allow you to reach your goal, no matter how unattainable it seems.  Failure and picking yourself up to overcome is part of the process. Be patient and respectful, but also respect yourself. Always make time to do something good for yourself. Surround yourself with other strong women to reach out to.

international women's day

Dr. Christine Bixby, neonatologist and medical director of lactation services

My advice for women pursuing a career in medicine is that practicing medicine is a great joy and privilege. The hard work is well worth it. Having a medical career and family can be challenging but finding the right balance can be done with good planning and a great partner.

Go for it! Find what is your passion. Put your head down, do the work and you will definitely succeed.

When I began my career, I wish I would have known that I would find a group of wonderful, smart and supportive women who are always there (even at 2 a.m.) to pick you up and raise you up on the tough days.

Learn more about exploring a career at CHOC Children’s.





Explore career opportunities at CHOC.




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