All posts by CHOC Children's

Year in Review 2019

Every year, CHOC Children’s growing team of physicians, nurses and staff have the privilege of caring for hundreds of thousands of babies, children, teens and young adults from Orange County and beyond. Celebrate with us as we revisit some milestones and other highlights from the past year. We look forward to serving your families for many years to come.

Year in review 2019

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Winter squash: Benefits, tips and recipes

By Kristen Miller, registered dietitian at CHOC Children’s

Winter squash appears in the supermarket during the fall and winter months. They come in many varieties and are often characterized by their thick, hefty rinds and bulky appearance. While the tough exterior may appear intimidating, it also gives the fruit a long shelf life. Winter squash can be stored in a cool, dry place for up to three months!

Various winter squash varieties share the health benefits of being  low in calories, fat and cholesterol and high in fiber, vitamins, minerals and antioxidants. Three common winter squash varieties found in most supermarkets include acorn squash, butternut squash and spaghetti squash. Here are some of my go-to tips for choosing the right squash and preparing it, as well as a favorite recipe.

Acorn squash

Acorn squash has a distinct acorn-like shape and has a mild, buttery-sweet flavor. Choose acorn squash with a dull dark green color, firm rind and smooth exterior. Avoid any that are yellow or orange. The fruit is packed with nutrients, and is specifically high in vitamin C, thiamine and magnesium.

If the rind is too tough to cut, try microwaving for a short time to soften the exterior. Acorn squash can be roasted, sautéed, made into soups or even baked into pies.

Butternut squash

Butternut squash can be spotted by its bell shape and has a sweet nutty flavor. Choose butternut squash that has a tan-yellow rind. If you want a slightly sweeter flavor, choose one that is darker orange. But be careful, darker means riper! Make sure to check for soft spots or bruising, as this would indicate rot. The fruit is high in vitamin A, vitamin C and magnesium.

To make butternut squash easier to maneuver, cut the neck and work with the two halves separately. If you want to avoid the knife and cutting board all-together, many popular winter squash varieties, including butternut squash, can be found pre-peeled and cubed. The versatile nature of butternut squash caters to both savory and sweet lovers.

Spaghetti squash

Spaghetti squash has an oblong shape and a very mild flavor. The common supermarket varieties have a yellow rind. Choose a firm spaghetti squash that does not have any bruising. Once cooked, the flesh of spaghetti squash can be fluffed with a fork to form noodle-like strands that resemble spaghetti. The fruit is a good source of vitamin C, manganese and vitamin B-6.

Use the “noodles” mixed with your favorite spaghetti sauce for a vitamin-packed pasta alternative, turn the squash into a burrito bowl, or use in casseroles. See the recipe below for a savory dish that requires minimal ingredients and very little prep work!

3-Ingredient Twice-Baked Spaghetti Squash Recipe

Ingredients

  • 1 spaghetti squash (medium size)
  • ½-1 cup pasta sauce (adjust according to preference)
  • ½- 1 cup shredded mozzarella cheese (adjust according to preference)
  • Salt and pepper (to taste)
  • Optional: fresh garlic (fresh chopped basil , dried oregano or Italian seasoning)

Instructions

  1. Preheat oven to 375 degrees F. Line a baking sheet with parchment paper.
  2. Carefully cut spaghetti squash in half lengthwise (before cutting, consider softening in microwave for a few minutes). Remove and discard seeds. Place spaghetti squash cut side down on baking sheet. Bake for 45 minutes or until a fork can pierce the shell easily.
  3. Remove from oven. With a fork, loosen and separate spaghetti squash strands from shell. Reserve shells.
  4. Place strands in a bowl. Mix strands with pasta sauce (and additional spices, if you wish). Spoon mixture back into the empty shell(s). Sprinkle with mozzarella cheese.
  5. Bake for 7-9 minutes or until cheese is melted, bubbly, and slightly browned. Spoon and serve directly from shell.

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When distress is something more

When is distress something more serious? When does it become something that warrants specialized help?

Everyone experiences distress from time to time. Children and teenagers can go through spells where they seem very upset. However, people who struggle with a mental health disorder tend to experience distress more regularly and more strongly. When should you think about going to a professional for guidance? Below are a few characteristics that can help in figuring out the extend of your child or adolescent’s distress. Note this is not intended to replace a specialized medical assessment. Always seek immediate help if a child engages in unsafe behavior or talks about wanting to hurt himself or someone else.

Typical distress: The upsetting symptoms should last a few hours or a few days. This may look like:

  • After a breakup, your adolescent cries for a few days.
  • He complains of a stomachache after eating too much ice cream.
  • She has a temper tantrum when she is tired.

Distress that may require professional guidance: The upsetting symptoms are persistent and last longer then a few days. This may look like:

  • Crying regularly and not knowing why
  • Complaining about frequent stomachaches or headaches, with no known medical, that keep them from attending school
  • Having frequent tantrums or being intensely irritable much of the time
  • Consistently not meeting milestones for his or her age, or you feel there could be a problem with their development

Typical distress: Difficulties take place in one setting such as school, home, with friends, or in the community. This may look like:

  • Before a test or presentation at school, your child gets the feeling of butterflies in her stomach.
  • Your son misbehaves at home, but follows the rules at school.

Distress that may require professional guidance: Difficulties are pervasive and take place in more than one setting. This may look like:

  • After a poor grade on an exam, your child feels worthless or helpless all the time (at school, at home and with friends) and does not engage in regular activities.
  • Your child doesn’t like to eat at parties and at school for fear of gaining weight.
  • He throws severe tantrums at home and at preschool.

Typical distress: Generally, your child is doing well across most settings (at school, with friends and family relationships, at work if applicable). This may look like:

  • Your son feels betrayed by a friend; however, he continues to hang out with your family, and school performance stays the same.
  • Your daughter is usually a good student, but experienced a recent decline in grades due to a change in teachers.
  • Your son has a few friends in the neighborhood and one friend at school, but hangs out with family members.

Distress that may require professional guidance: Your child’s distress interferes with normal functioning, and symptoms get in the way of everyday life, such as school, friends, family relationships and work). This may look like:

  • Your daughter is spending more and more time alone, and avoiding social activities with friends or family.
  • Your son has lost interest in activities he used to enjoy doing.
  • Your daughter is not interested in playing with other children, or has difficulty making friends.
  • Your son is experimenting or engaging with alcohol and drug use, and is not engaged with family and friends, or shows a decrease in school or job achievement.

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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My son’s journey with congenital pulmonary airway malformation (CPAM)

By Monica Cruz, mother of CHOC Children’s patient Tavik

When my fiancé Ryan and I found out we were having another baby, we were excited but also a little overwhelmed. Our firstborn son Raiden was barely a year old and very strong willed. We weren’t quite ready for another, but we knew we could manage.  We had no idea the journey that lay ahead of us and our new baby, but today we are so grateful that he’s healthy and happy.

Tavik_after_CPAM_surgery
I am so grateful that my son is happy and healthy, after surgery to remove his CPAM.

During an ultrasound when I was 26 weeks, my OB/GYN found a mass on the baby’s lung. They said it was likely congenital pulmonary airway malformation (CPAM). CPAM is a mass or lesions of abnormal lung tissue that forms during pregnancy. The mass or lesions can vary in size. It is usually only in one lung and does not function as normal tissue. We did two more ultrasounds to confirm the diagnosis, and then we were referred to a maternal-fetal medicine specialist (MFM).

Our MFM confirmed that our baby, who we named Tavik, had CPAM.  The cause of this condition is unknown and only 1 out of 25,000 pregnancies are affected. Research shows that this abnormality is not related to anything the mother did or didn’t do during pregnancy. Some think it may be caused by genetics, but there isn’t enough research to confirm this. CPAM was previously referred to as congenital cystic adenomatoid malformation (CCAM).

There was still a lot of time left in my pregnancy, so Tavik’s lungs had more time to grow—but so did the mass. On the ultrasounds, we could see that his heart had been pushed off to the right side. This was a lot to take in and made the next few months extremely stressful.

Babies in the womb who have CPAM are also at risk for hydrops fetalis, or hydrops. When a fetal lung mass pushes on the heart and blood vessels, the heart has trouble pumping blood. If the heart can’t keep up with the baby’s needs, fluid builds up around the lungs and in the belly, a condition called hydrops fetalis. After the baby is born, the fetal lung mass can cause problems because it can get infected (pneumonia) or take up room so that the healthy lung lobes can’t fill with air. I had ultrasounds every two weeks until Tavik’s due date.

Prenatal counseling

We knew Tavik would need care after he was born, so our MFM referred us to Dr. Peter Yu, a pediatric general and thoracic surgeon at CHOC who has special training and expertise in fetal conditions.

My fiancé and I went to CHOC and met Dr. Yu, who explained everything that was going on with the baby in utero, and what would happen after he was born.

The good news was that most babies with CPAM are born with no symptoms and can go home after a few days in the hospital. Surgery to remove the mass on the lung usually comes a few months later, when the babies are bigger, and better able to handle anesthesia. If CPAMs are not removed, they can cause breathing problems or serious lung infections, and sometimes they can even become cancerous later in life.

Dr. Yu was honest with us and educated us that there are some babies who do have complications at birth due to the CPAM and can need immediate surgery after delivery. Not knowing what that outcome would be was one of the hardest things I’ve ever had to process.

Dr. Yu was so knowledgeable and made us feel more at ease about our baby’s diagnosis. We knew that Tavik was in great hands.

Tavik’s birth

Tavik was born on Nov. 15, 2018 weighing 7 lbs., 10 oz. and 21 inches long. We were so lucky and beyond happy that he came out without any complications, and that he didn’t need immediate surgery. Unfortunately, later that night when the doctors came back to check in on us, they noticed he was working extra hard to breathe. They weren’t sure if this was related to his CPAM. He was admitted to the neonatal intensive care unit (NICU) at the delivery hospital and was given oxygen and put on CPAP (continuous positive airway pressure). CPAP delivers constant air pressure into a baby’s nose to help the air sacs in the lung stay open and prevent sleep apnea.

During our NICU stay, doctors performed a chest X-ray and ultrasound to get a better picture of the mass in his lung. They noticed he also had an abnormal blood vessel carrying blood to the lung mass.

Tavik spent eight days in the NICU before he was healthy enough to go home. The doctors determined that his breathing troubles at birth were not caused by the CPAM. He just had some residual fluid from the C-cection.

Two weeks later, we had an appointment with Dr. Yu so he could meet Tavik and we could make surgery plans. A few weeks after that, Tavik had a CT-scan so Dr. Yu could see exactly what was going on inside Tavik’s lung. That gave Dr. Yu a more precise roadmap for surgery.

Surgery day

When Tavik was three months old, he underwent surgery at CHOC Children’s Hospital. It was scary to hand over my baby for surgery, but looking back now, everything seemed to go so smoothly and quickly.

family before cpam surgery
Ryan and I with Tavik before surgery to remove his CPAM.

During the three-hour surgery, Dr. Yu removed the affected part of Tavik’s lung and repaired the blood vessel. While surgery was in progress, a member of Dr. Yu’s team came out to the waiting room every 30 minutes to provide an update to Ryan and me.

When surgery was over, Dr. Yu came out to let us know that he had removed half of Tavik’s left lung, sealed off the artery, and everything had gone smoothly. He showed us photos of what he had been looking at through his scope during surgery.  He did this to also give us a better understanding of what had been going on inside of our son. It was really neat to see.

Dr. Yu performed the surgery thoracoscopically, using minimally invasive instruments. Only three very small incisions had to be made in Tavik’s abdomen to remove the entire mass. Tavik only has three tiny incisions on his left side. It’s mind-blowing to think that you can safely remove half a baby’s lung through three tiny incisions. Since Tavik had this surgery as a baby, the remaining portion of his lung will be able to grow and compensate for what was removed as he grows.

Tavik_minimal scarring_cpam
Dr. Yu performed the surgery thoracoscopically, using a microscope and two tools. That means only three very small incisions had to be made to remove the entire mass.

Tavik spent only three nights in the hospital. The first two days after surgery were hard for Tavik; he was groggy from the anesthesia, and he made some sad sounds, which was a little heartbreaking for us to hear as parents. Thanks to the awesome rooms at CHOC I was able to stay with Tavik the entire time, both day and night. During this time, I stayed with Tavik, while Ryan and Raiden stayed close to CHOC at the Ronald McDonald House. We had stayed there during our unexpected NICU stay, and they invited us back during Tavik’s surgical stay. Without them, our family wouldn’t have been able to stay together and so close to Tavik.

By the third day after surgery, Tavik was alert, smiling and getting right back to his happy self. It’s seriously amazing how fast babies heal! I was a little nervous getting ready to leave on the fourth day. The doctors constantly reassured me by telling me that he was healing wonderfully and that he was in great shape to head home. They were right. By the next day, Tavik was doing even better—he had no pain or discomfort and his incisions were already fading. You would have never known that he just had a major surgery.

A few weeks later, we had a follow-up appointment with Dr. Yu, who confirmed everything still looked great and Tavik was now CPAM-free.

tavik-dr-yu-cpam-surgery
Tavik with his surgeon, Dr. Peter Yu.

Tavik today

Although Tavik underwent a major surgery as a baby, looking at him now, you’d never know what he had been through. You can barely see his scars, and he’s growing like any little boy should—he’s in the 80th percentile for height and weight. His prognosis is great, and we look forward to a normal life with him.

tavik-birthday-cake
Tavik enjoying cake at his first birthday party.

My son is such a sweet, loving, happy boy with a little bit of spice to his personality. He absolutely loves music and always wants to play in the water. He has so much fun going on walks with his older siblings Leila and Raiden.

Tavik is our little miracle baby! He has kept us on our toes since before he was born and continues to do so today. He’s always making us laugh and smile.

We are so blessed and are so grateful that he is healthy.

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    6 headache hygiene tips for children

    Headaches usually are brief and can be caused by many things, including too little sleep, stress, or a concussion. Some headaches last longer and come with other symptoms. Very rarely, headaches can be a sign of something serious. Learn more about different types of headaches in children, and what parents can do to help.

    dr-mary-zupanc
    Dr. Mary Zupanc, a pediatric neurologist and co-medical director of the CHOC Children’s Neuroscience Institute

    Dr. Mary L. Zupanc, a pediatric neurologist and co-medical director of the CHOC Children’s Neuroscience Institute, offers tips for parents on headache hygiene— or healthy habits to reduce the likelihood, frequency and severity of headaches.

    1. Maintain regular sleep habits

    If your child goes to sleep and wakes up at approximately the same time every day, Dr. Zupanc says, their likelihood of suffering from a headache decreases. Bedtime and wake-up times should not vary significantly from weekday to weekend. Adolescents have sleep phase delay, meaning their brains do not want to go to sleep until later at night and they want to sleep in. This is normal behavior, but school schedules rarely accommodate this adolescent neurobiology.

    1. Exercise regularly

    Children should get at least 30-40minutes of physical activity three to four days per week, she adds. However, the full 30-40 minutes doesn’t need to be all at once. You can break it down into smaller sessions.

    1. Eat a well-balanced diet. Avoid meal skipping.

    A child’s eating habits can have a direct effect on their susceptibility to headaches, Dr. Zupanc says. To encourage kids to eat healthy, including them in the food preparation process whenever possible—from meal planning to grocery shopping to prepping fruits and vegetables in the kitchen. Kids are more likely to eat what’s in front of them if they feel like they had a choice and hand in preparing it.

    Some foods may trigger headaches in children. Limit the intake of processed or fried foods. Overly restrictive diets may prompt an unhealthy relationship with food or body image. If you are unsure if certain foods may be triggering your child’s headaches, consult your pediatrician.

    1. Stay well hydrated.

    Headaches are commonly caused by dehydration. There is a link between increased water intake, decreased headache severity, and improved quality of life. At CHOC Children’s, we recommend that children drink the number of 8-ounce cups of water equal to their age, with a maximum of 64 ounces for children over age 8. This means your 1-year-old would drink one 8-ounce glass or water, your 5-year-old would drink five 8-oz glasses of water, etc.

    1. Limit caffeine intake

    Caffeine tolerance differs from person to person, but the general recommendation is 200 to 300 milligrams per day. A standard cup of coffee has around 100 milligrams of caffeine, compared to a large coffee drink that can have over 400 milligrams of caffeine. If you have too much caffeine, you can experience headaches, heart palpitations, elevated blood pressure, insomnia, or irritability.

    1. Play

    Yes, really! Kids are busier than ever these days, and an over-scheduled child is likely to suffer stress, which can lead to headaches, Dr. Zupanc says. Spending time outdoors, reading for pleasure, and playing sports for fun rather than in a competitive environment are all good ways to help cut down on stress, she says. In addition, screen time — including tablets and smartphones —should be limited. Learn more about screen time limits for kids.

    Mindfulness, or relaxation techniques, can help kids and teens build the coping skills they need to address issues like stress and anxiety, Zupanc adds. Learn more about mindfulness tips for your children.

    Studies have shown that cognitive behavioral therapy, in combination with preventive medication, has helped adolescents with chronic migraine headaches.

    1. Keep a journal

    If your child experiences frequent headaches, keep a journal to track their headaches so you can identify a pattern, and show this to your child’s pediatrician. 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?
    • Was the pain throbbing (pounding) or dull?
    • Were there any other signs or symptoms associated with the headache, such as a change in vision, tingling of an arm or leg, or weakness?
    • 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 doctor may adjust their diet, headache hygiene routine, or their over-the-counter pain relief regimen, Dr. Zupanc advises.

    There are some, albeit rare, situations where a child’s headache warrants a trip to the emergency department, Dr. Zupanc says, including:

    • A 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, changes in consciousness or awareness, or change in balance.
    • Blurred, double or loss of vision that persists after the headache resolves.

    Sporadic headaches rarely require brain neuroimaging, such as a CT scan or MRI scan of the brain.

    Frequent headaches that are increasingly severe can suggest an underlying brain problem. Brain imaging may be necessary. If your child experiences the following symptoms, ask your pediatrician for a referral to a pediatric neurologist for further evaluation and possible imaging:

    • Headaches associated with weakness or numbness in an arm or leg, or balance problem. In this case, immediate follow-up care is warranted.
    • Headaches that wake a child out of sleep
    • Headaches associated with projectile vomiting
    • Headaches that increase with Valsalva maneuver (such as bearing down for a bowel movement)
    • Headaches associated with a seizure
    VIDEO: Dr. Zupanc explains headaches

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      Headaches in children are not uncommon. Learn what to do if your child has a headache and how to establish good habits that can help keep headaches at bay.