All posts by CHOC Children's

5 tips for most effectively communicating with your child’s doctor

Considering the time off work, travel and other factors, getting a sick or injured child to a doctor’s appointment can be stressful. So, once you’re at the appointment, we know you want to make the most of your time with the physician.

After treating pediatric patients for more than 40 years, Dr. Mary Zupanc, co-medical director of the CHOC Children’s Neuroscience Institute, understands this desire among parents and caregivers.

Dr. Mary Zupanc, co-medical director of the CHOC Children’s Neuroscience Institute

To help, she offers these five tips for most effectively communicating with your child’s doctor of any specialty:

  1. Develop your child’s personal story beforehand.

Finding a clinician who will take the time to hear your child’s personal story is critical. Have your story ready before your appointment, and include these elements:

  • A written timeline of signs and symptoms
  • A note of when you or someone else first noticed that something was different or unusual
  • A note about what specifically concerned you
  • Any relevant photographs or videos

2. Practice two-way communication.

Not only should a clinician want to hear your story, but they should also draw out more details through conversation and asking questions. Here’s what you should expect and how you can do your part:

  • A good clinician will take the time to listen to the story you have to tell.
  • They will ask questions but avoid interrupting you.
  • They will ask you to clarify parts of your story, such as the timeline or details about symptoms.
  • They should ask you about your questions. Write these down in advance and don’t be timid about asking.

 3. Remember that doctors and nurses are scientists who like facts.

Clinicians are like detectives who search for clues. You can help them by providing key factual details. Before your appointment, take some time to draw up some key facts:

  • Information about other previous diagnostic tests and their results
  • Information about previous medication trials
  • A detailed medical history, which includes a mother’s pregnancy, labor and delivery history; other illnesses; current and past medications; and recollection of similar symptoms in other family members.

4. Visual communication is also key for providers.

In addition to hearing from you, the clinician will want to observe the child to see for themselves what’s happening.

  • A physical examination, as well as a neurological examination, can provide important clues to the diagnosis.
  • A good clinician will provide initial impressions and ask for your input.

5. Strategies are available to help make communication even better.

A good physician will work diligently to effectively and sensitively communicate with their patients and families. But here are other ways to further enhance communication:

  • Bring along another family member or advocate.
  • Prepare a list of questions ahead of time with specific requests about further diagnostic studies.
  • Bring your own research to the clinic visit about diagnosis and management strategies.

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Music therapy in a mental health setting

Music therapy has been part of CHOC Children’s specialized therapeutic programming for more than 10 years. The program has grown recently, due to increased awareness of its effectiveness and a growing need among CHOC patients. We sat down with Kevin Budd, a board-certified music therapist in CHOC’s Mental Health Inpatient Center, to discuss the benefits of music therapy in an inpatient psychiatric setting.

Q: Music therapy is more than just listening to music. What encompasses this practice?

A: Music therapy is the clinical and evidence-based use of musical interventions to accomplish individualized goals. This occurs within a therapeutic relationship between a credentialed professional who has completed an approved music therapy program, and a patient. During music therapy, we address physical, psychological, cognitive and/or social functioning challenges for patients of all ages. Essentially, we utilize evidence-based, musical interventions for non-musical outcomes; meaning music is the tool which helps support a patient’s non-musical need or goal.

Q: How does music therapy support clinical goals?

A: A patient’s clinical goal is the starting point for determining which musical intervention will be most effective. In the Center, these goals could include: mood regulation, self-expression, self-esteem, anxiety, interpersonal effectiveness, treatment motivation, positive coping skills, and more. There’s no one-size-fits-all treatment when it comes to music therapy within mental health. We might work towards their goals several different ways, including: focused music listening, songwriting, song discussion, group instrument playing, music and relaxation, singing, and many others.

For example, if a patient’s clinical goal is to increase identification of positive coping skills, we might work on lyric analysis within the patient’s preferred style of song. We could discuss triggers, resilience, and negative life situations in the song. During this lyric analysis, I can help navigate the discussion to include the patient’s interpretation of the musician’s experience and how it might relate back to their own life. After this discussion, we could rewrite the chorus of the song including identification of a negative situation and a positive coping skill to help address it. The patients can then be encouraged to share what they created— by singing, spoken word, or other creative means.

Within this exercise, not only has the patient identified a negative situation and how to better cope with it within a creative medium, they have experienced the active utilization of a positive coping skill, built up confidence after completing and sharing their creation, felt more connected with others in the group due to being vulnerable and feeling validated, improved their mood from the positive experience, and formed a sense of increased treatment motivation.

Music therapists utilize assessment, treatment planning, and evaluation to determine whether a patient’s current methods of music therapy are meeting their needs. Without treatment goals, there could be no effective music therapy.

Q: What kind of impact have you seen in mental health patients who have participated in music therapy?

A: In any setting, music has an instantaneous effect on our bodies — mentally, physically and behaviorally.

Patients have shared several stories about how music therapy has helped them with their clinical goals. It’s amazing how one musical intervention can address multiple goals.

Sometimes it’s hard for patients to verbalize past trauma or express their current struggles. But with music therapy, they can discuss a song that may relate to their current life situation— whether that be bullying, family problems, feeling hopeless, having anxious thoughts, or another stressor. During this process, patients may be able to process and verbalize more, since the lyrics are an easier gateway for expression.

During group instrument playing, patients who might have difficulty with interpersonal relationships are able to cohesively and successfully play music together in a positive and supportive space without the need to talk.

During group ukulele playing, patients can work on distress tolerance and problem-solving skills while persevering through a challenging task — and by the end, they have improved self-esteem.

Q: What is unique about music therapy in an inpatient psychiatric facility?

A: Music therapy can look different in the inpatient psychiatric setting than in other areas of the hospital.

Within the Center, goals for music therapy are focused on combatting the reasons why a patient is admitted— these could include suicidal ideation, depression, anxiety or other factors that keep these youth from participating in a healthy way in daily life. The goal of the MHIC is to stabilize these patients and provide them with as many resources as possible to cope with their mental health challenges.

Music therapy does just that and provides opportunities for patients to learn, process, practice and discover new skills through tailored music interventions such as group instrument playing, songwriting, music listening, song discussion, beat-making, singing, rapping, and many other techniques. The MHIC offers opportunities for group work, that allows for a diverse group of kids and teens to come together and express themselves in a supportive, safe and validating environment. Individual music therapy sessions are available to patients in the Center who need additional one-on-one support to complement their other treatment.

Q: Why did you want to become a music therapist? Why a mental health setting specifically?

A: I’ve gone through my own mental health challenges throughout my life, and I always found that music validated my journey. Music helped me distract myself and process my feelings. Music met me where I was in the moment and gave me hope. It also gave me a platform to express myself in ways I didn’t know how to otherwise.

When considering career paths, I wanted to find a way to harness the role music had played in my life in a therapeutic way. After receiving my undergraduate degree in music, I developed a special interest where psychology and music intersect—the space where music therapy truly breathes. I pursued my graduate degree in music therapy, and then became a board-certified music therapist.

I feel humbled and fulfilled to be able to support kids and teens at CHOC with the tool of music. By creating an authentic therapeutic alliance, I can support them through a harsh and challenging time in their lives. I am thrilled to be on the front lines of the music therapy program at CHOC Children’s and I look forward to supporting its growth and success in treating pediatric patients.

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative and to receive tips and education from mental health experts.

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How to help your child develop a healthy relationship with food

By Amanda Regan, registered dietitian and certified lactation educator-counselor at CHOC Children’s

In a culture filled with fad diets and mixed food messages, it can feel confusing to try and be healthy. Today, we find so many labels on food telling us how we should already feel about what we’re eating —good, bad, clean, or guilt -free. These mixed messages about food can feel even more confusing for young children and teens.

Those at a vulnerable age can be more susceptible to triggers, such as product labeling, that could negatively affect their relationship with food or even contribute to the development of an eating disorder. Unfortunately, eating disorders have become increasingly more prevalent among all kids of different genders, race, shapes and sizes. Eating disorders also have the highest mortality rate out of any mental illness.

We as parents have an opportunity to help our children develop a positive relationship with food. A person’s relationship with food starts as young as infancy, so it’s important to make mealtimes as pleasant as possible from the very beginning. Here are some tips on how to help your child not only feel good about everything they eat, but also feel good about themselves.

Avoid putting your child on a diet

Research shows that dieting behaviors are most commonly linked to eating disorders in kids. Growing children should not be put on a diet unless it is deemed medically necessary. According to the American Academy of Pediatrics, if a child is overweight, the recommendation should be to encourage a healthy lifestyle, rather than focusing on weight. Although we don’t always realize it, our children are always listening to us. So, try not to talk about weight, calories, or dieting in front of your child. Even if you, yourself, are on a diet.

Avoid attaching labels to food

Try not to think of food as either bad or good, but instead focus on nourishment for you and your child. Labeling food is a way of telling your child how they should already feel about the food they are eating, instead of letting them decide for themselves. Let your child know that all food can fit in a healthy diet, as long as the majority of their diet is a balance of all the food groups. This means that yes, even treats can have a place in a healthy diet.

 Refrain from body talk

Avoid talking about appearance or body image in front of your child. Your child’s body is constantly changing and developing — especially during the adolescent years — and it can leave them feeling awkward and self-conscious. Children are sensitive to comments about body image.

 Have family meals

Frequently eating meals together has been shown to prevent disordered eating behaviors such as restricting, binging and purging. Family meals provide opportunities for you to model healthy behaviors in front of your child. They have also been associated with overall improvement in dietary quality. When having family meals, try to provide the same food for everyone and avoid making separate meals.

 Know your role in the feeding relationship

With food, your role job as a parent is to provide nutritious food for your child; their job is to decide how much they eat. Try not to pressure your child in any way when it comes to eating. Helping your child build a positive relationship with food involves trust. Trust in your child to finish their meal when they are full and eat more when they are hungry. Force feeding or restricting food intake can turn mealtimes into a battle ground.

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Talk Openly To Your Kids About Bullying

Bullying continues to make headlines around the country.  In particular, cyberbullying has become an increasingly common and serious issue largely due to the easy access, and in some cases the anonymity, of digital devices.

CHOC Children’s offers the following tips to help you start a conversation with your child around bullying, and guidelines to help you and your child combat bullying.

Dr. Heather Huszti, chief psychologist at CHOC, says one of the best ways to protect your children from bullying is to talk openly about it. “Have a discussion about why some kids might be bullies,” she says. “You can explain that most bullies have low self-esteem and that they bully other people to try to feel better about themselves.”

Dr. Heather Huszti
Dr. Heather Huszti, chief psychologist at CHOC Children’s

Dr. Huszti suggests asking your child open-ended questions such as, “Is there anything going on?” or “Is there anything I can help you with?” This approach usually works better than firing off a list of specific questions.

If you learn your child is being bullied, here are some additional steps you can take:

  • Inform your child’s school about the bullying.
  • Talk with the bully’s parents about the behavior.
  • Help your child build up his or her self-esteem. The better your child feels about herself, the less effect a bully will have on her overall well-being.
  • Be mindful of your child’s online activity.
  • Have a plan. Talk about what your child might do if he or she is bullied, including who to tell.
  • Pay close attention to signs from your child that may show something is wrong, such as acting withdrawn, sad or irritable, or changes in their sleep or appetite. Keep in mind however, that sometimes kids will not display any signs at all so it’s important to keep an open dialogue with your child.
Learn more about CHOC’s commitment to mental health

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What it’s like to live with cystic fibrosis

Kaleb chronicles life with cystic fibrosis

By Kaleb B., 18-year-old CHOC Children’s patient

I was born with cystic fibrosis (CF), an inherited life-threatening disorder that damages the lungs and digestive system. For years, I blamed myself for having CF. It made no sense to blame myself for something I was born with, but I couldn’t stop. I now understand that CF isn’t my fault.

What is cystic fibrosis?

CF is a disease caused by a missing protein in your genes. In a person with CF, the body produces mucus that is thicker and stickier than it should be. Everyone’s body makes mucus, and a person without CF can get rid of that mucus by coughing. But for someone with CF, the thick mucus is harder to expel, so the bacteria get trapped in the body, which leads to infections. This can also damage and scar the lung tissue. If left untreated, it could end up causing organ failure.

What does this mean for the rest of the body? The thicker mucus doesn’t move as easily, and it clogs passages in many of the body’s organs. Mucus buildup leads to complications ranging from mild or inconvenient to detrimental. The digestive system and lungs are the two systems CF hits the hardest. It can cause difficulty processing food, but the worst consequence of mucus buildup is the infections that can stem from it.

CF is a cyclical journey. I’ll be healthy for a while, but then I’ll catch something new, and my body will respond well to antibiotics. Then I’ll come down with something else, or the infection I’m fighting will become resistant to a medication that used to work. When I get really sick, I have to be admitted to the hospital for IV medication to try and get my health back on track.

Great strides have been made to cure the genetic mutation that causes CF, but for now, the infections caused by thickened mucus are dangerous and hard to treat.

There is no cure for CF. As little as two decades ago, most people with CF wouldn’t live to see their 18th birthday. Now, statistics show that nearly 40% of people living with CF in the U.S. are 18 years or older. More than half of people with CF will live into their thirties.

Learning to accept your cystic fibrosis diagnosis

There are limitations to what I can do daily because of my health and medicines that affect me. For example, my energy level isn’t consistent—some days I can make it through the day with ease, and other days I run out of steam fast. It’s frustrating, but I am trying to work with it and accept it.

It’s not my fault that my body works this way; I just have to work with what I have.

Despite having CF, there’s still a lot I can do— like writing articles such as this one, sharing my experience with CF.

Cystic fibrosis is a team sport

Over the last year, I’ve had more health challenges than ever, including unexpected infections and too many antibiotics to count. For a while, I was losing hope and felt overwhelmed, but I kept pushing on— and people around me helped keep me going. Their support was crucial to me being able to persevere, and now I’m on the other side.

Your disease doesn’t define you

What I’ve learned over the past year, through these health issues and my success despite them, is that disease doesn’t define me. It’s what you do despite disease that shows who you truly are. It’s how you fight through those battles that reveals your character.

It’s never easy to deal with a chronic illness. But now, I can separate my disease from my self-worth. My CF has never been tied to how valuable I am. Although it is an enormous part of my life and a strong force behind many of my frustrations and insecurities, CF is not who I am. My identity isn’t tied to my disease. I can’t change that I have it, nor the effects it has on me physically. I can only approach how I adapt to living with it.

Myths of living with cystic fibrosis

CF isn’t all medication and hospitalizations; there are some benefits to CF. For example, you usually get to eat a lot of high calorie and tasty food without worrying about gaining weight, which is nice! Enduring treatments usually isn’t too bad either, since you can play games or read while you do them, in order to multitask and make it more enjoyable. There’s a lot of ways to keep a good mood and stay thriving during the mundane parts of living with CF, so being creative with that can be helpful!

Questions I’ll hear a lot about CF usually relate to how “sick” I am or if I’m contagious. Rest assured I’m not contagious. I’ll catch illness a bit easier than others, but usually I’m not that sick, as long as I keep up with my meds. If the infections get bad enough, I’ll need a tune-up in the hospital with some stronger meds. But luckily, I’ve been taking pretty good care of myself lately!

To other teens with CF, I would say take every day and make the most of it. Live your life and enjoy it while you have breath in your lungs! Don’t let CF stop you from living.

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