All posts by CHOC Children's

Is it OK to skip your child’s checkup if they’re healthy?

The first few years of your child’s life are a major factor in their lifelong growth and development, which is why we recommend all well checkups for your child even if they’re healthy. During the COVID-19 pandemic, your CHOC pediatrician’s office is a safe, socially distant environment to keep your child and family safe while still delivering high quality preventive care.

These checkups, also known as well child checks, are an opportunity to track your child’s development, make sure they’re getting the care they need to stay healthy, and for parents to get answers to any parenting questions.

Under the current stay at home orders, it may be tempting to skip something called a “well child check” if your child is feeling healthy. Here are six reasons why it’s not OK to skip your child’s checkup, even if they’re feeling healthy.

dr-katherine-williamson
Dr. Katherine Williamson, a CHOC Children’s pediatrician

#1 Developmental screening

At every well checkup your pediatrician will be making sure that your child is meeting her or his developmental milestones, whether they are 4 months, 4 years, or 14 years old. For babies and toddlers, these milestones come rapidly as children’s brains are learning many new skills every day, from crawling to walking, and from first words to conversations. It is important to make sure your child is acquiring these necessary skills for brain development every step of the way. For older kids and teens, these milestones become less apparent, but are just as important, and are often reflected in a child’s ability to handle academics, relationship, and emotions. Your pediatrician is here to help at every stage of your child’s development.

#2 Relationship building

It’s important for your child to develop a rapport with their pediatrician. We are positive role models for young kids and help lessen their fear of going to the doctor. When your child is a teenager, parents are often asked to leave the exam room so the pediatrician can speak to the teen in private. Your child will feel more comfortable asking personal questions about their body and puberty later in life if their pediatrician has been a constant figure and steady resource since childhood.

#3 Mental health check up

Well checks also serve as a mental and behavioral health check-in. Your pediatrician can help evaluate your child’s mental health and wellbeing over time.

During well child checks amid the pandemic, mental health has been a bigger part of conversations during appointments than ever before. This is a chance for pediatricians to check on how the whole family is coping with stress related to COVID-19. They can share advice for how to talk to kids about COVID-19 and help them cope with COVID-19 anxiety as well as how to teach teens the importance of stay at home orders.

You can also talk to your pediatrician about how your child is coping with social distancing, or a lack of playdates and time with friends. They can offer advice on how to make this a positive time for your family.

#4 Enforcing healthy habits

Well child checks are a great opportunity to reinforce healthy habits. Often, kids will listen to their pediatrician more than their parents. We can remind children about the importance of eating healthy, doing their homework, brushing their teeth, wearing helmets—and listening to their parents!

Do you ever struggle with the question, “How much screen time is too much?” or find yourself battling your children over screen time limits? Your pediatrician can be a resource for you in helping reinforce screen time limits with your child. We can help explain to your children why their bodies need less screen time and more play, and how too much screen time affects their body and brain.

With children spending more time at home than ever, your pediatrician can be a resource on activity ideas for kids during COVID-19.

#5 Getting answers to questions you didn’t know you had

During many appointments in my office, my conversation with parents takes a turn from why they originally came in to see me. They might have an appointment to get a rash checked out, but then I’ll notice a mole on the child I hadn’t seen before, and they’ll realize they too were wondering about that, but just forgot to ask.

Pediatricians are resources for parents just as much as we are caretakers of your children. We’re here to help you get answers to your questions on acne, headaches, academic concerns and anything in between.

#6 A fresh perspective on parenting

Pediatricians specialize in taking care of infants, children and teens – but they can be there for you as a parent, as well.

Right now, parents have been asked to take on more than ever – working from home, overseeing their child’s distance learning curriculum, keeping kids entertained and engaged around-the clock, and more – and they are understandably overwhelmed.

Having a fresh set of eyes on a family’s situation may help troubleshoot what they are trying to figure out. Many of my patients’ parents are struggling with a seemingly never-ending to-do list. Their child’s pediatrician is someone they trust and respect, and I validate that they are doing their best.

Parents should congratulate and forgive themselves. At the end of the day they may be hard on themselves and wish they had done more, and that feeling compounds by the end of the week or month. What parents are juggling right now is Herculean. I applaud each and every one of you.

This article was updated on May 18, 2020.

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Activity ideas for kids during COVID-19

With social distancing guidelines in effect, many schools closed and some childcare options unavailable, many children are spending more time at home than usual.

Here’s a roundup of what parents and caregivers can do to keep kids occupied during this time.

Online learning

    • The Orange County Department of Education has created a roundup of free resources to help students supplement other materials that are being provided by their teachers.
      • OCDE also has a complete list of school districts providing grab-and-go meals at campuses across Orange County. See the full list here.
    • Many educational companies are offering free subscriptions in light of school closures. Here’s a guide.
    • Scholastic offers day-by-day projects to keep kids reading, thinking and growing.
    • PBS SoCal | KCET, in partnership with the Los Angeles Unified School District and in collaboration with California PBS stations, are offering broadcast programming and accompanying digital resources that adhere to California’s state curriculum. Learn more here.
    • Budding scientists can access Nova Labs at PBS, for video, animation and games on scientific topics like predicting solar storms and constructing renewable energy systems.
    • NASA’s Teachable Moments, offers a range of activities and lessons for grades K-12.
    • NASA’s Kennedy Space Center Visitor Complex has educational and fun Facebook videos where kids can learn from astronauts and other educators. For activities, instructions are available as free downloads.
    • Make any room a classroom with BrainPop, where curious learners can take units in science, social studies, math, engineering and tech, and more
    • Tynker is offering free premium coding courses during school closures.
    • Khan Academy offers free daily schedules for kids and teens ages 4-18 to keep stability and routine during this time. The online learning non-profit also offers a free downloadable app called Khan Academy Kids,that contains thousands of activities and books for children ages 2-7.
    • FunBrain.com offers hundreds of free games, books comics and videos for Pre-K through eighth grade.
    • National Geographic Kids offers free online quizzes on topics ranging from animals to planets to sports and food.
    • Cool Math 4 Kids offers games and lessons to make math fun for kids.
    • Math Game Time offers a variety of games, videos and worksheets for Pre-K through seventh grade.
    • Inspired by Dr. Seuss, Seussville has activities, crafts, printables and recipes to engage your child in playful learning.
    • Online  games that include K-12 curriculum.
    • Skillshare is offering two-month free trials for online classes that include animation, creative writing, web design and more.
    • Amazon is offering free computer science courses online for various grade levels.

YouTube channels

  • Crash Course Kids — bi-weekly shows on grade school science, including Earth, habitats, space and more.
  • Science Channel – learn about outer space, new technology and more.
  • SciShow Kids – every Tuesday and Thursday, the hosts explain fun, complex science concepts; do experiments and interview experts.
  • National Geographic Kids – videos feature animals, science, pets and more.
  • Free School – exposure to famous art, classical music, children’s literature and natural science in an age-appropriate and kid-accessible way.
  • GEOgraphy Focus – explore geography, maps, flags, culture, languages and travel.
  • TheBrainScoop – explore the work and research of natural history museums.
  • Kids Learning Tube – educate kids through music and animation.
  • Geek Gurl Diaries – videos on programming, computer science, logic, electronics and more.
  • Mike Likes Science – science-inspired music videos.
  • Science Max – large-scale science experiments.
  • SoulPancake – in addition to the well-known Kid President shows, this channels offers content that explores and celebrates the ways humans seek connection.
  • Course Hero – study guides and videos for various subject matters.

Story time

  • Here’s a list of podcasts — featuring stories, meditation, music and more — for ages 2 through 6.
  • Celebrities are taking to social media to read children’s books to little ones staying home during this time. The Los Angeles Times curated this roundup of these posts.
  • Audible, which has the world’s largest collection of audio books, is offering free stories — in six different languages —  for kids as long as schools are closed. Start listening here.
  • Here’s a list of authors doing read-alouds of their famous books, as well as books by their favorite authors.
  • Storyline Online, the SAG-AFTRA Foundation’s award-winning children’s literacy website, streams videos of celebrities reading aloud children’s books alongside creatively produced illustrations.

Music class

  • Carnegie Hall’s Music Explorer program offers a way to learn new musical genres and cultural traditions. Courses conclude in an interactive concert experience.
  • Chrome Music Lab lets kids learn music through a hands-on website.

Learn a new language

  • Learn a new language with Duolingo.
  • English52 allows users to strengthen English skills through video lessons and activities.
  • Fabulingua is an interactive app that teaches Spanish.

Virtual field trips

  • Google Arts & Culture has partnered with thousands of museums around the world to offer virtual tours from the comfort of your home. Here’s the complete list.
  • The San Diego Zoo offers 10 different webcams so animal lovers can keep up with a variety of their favorite creatures.
  • The Monterey Bay Aquarium also offers 10 different webcams for families to experience underwater life from anywhere.

Cook with your kids

  • CHOC nutrition experts have curated some of their favorite recipes and offer tips for how to get kids involved in the kitchen. “Children as young as 2 years old can help out in the kitchen. You can have your child wash fruits and vegetables or stir ingredients,” Shonda Brown, CHOC clinical dietitian, says. “Children are more open to trying new foods if they have opportunities to explore and learn about the food before they eat it.”

Opt outside

Kids can still benefit from nature while practicing proper social distancing. Even babies and toddlers can join a family nature walk. if you’re in a public space, keep them in a carrier or a stroller. If you’re in your backyard, they can explore more freely.

Children who spend more time outdoors have improved motor development and lower obesity rates. Playing outside promotes more curiosity, creativity, and critical thinking — especially essential with schools closed and extra-curricular activities canceled.

  • On a nature walk, collect twigs, leaves or rocks. Then, build a nature sculpture by sticking these items in play dough. Help your child notice the patterns created by different items.
  • Go on a family bike ride, while keeping a safe distance from others.
  • Nature scavenger hunts can be fun for the whole family. How many different kinds of plants, flowers, animals or birds can you see?
  • Playing soccer or catch is fine, but don’t share equipment with people outside your household.

Highlights@Home

The beloved classic kids’ magazine, Highlights, is posting twice-weekly online roundups of stories, puzzles, craft ideas and more to help children cope with being cooped up and help parents make the most of this time with their kids. Each installment has a different theme:

  • Celebrate reading — Reading can transport us somewhere else for a while, even when we’re stuck at home.
  • Pajama day — Showing your children affection with a hug, snuggling on the couch to watch a movie, or reading together in a cozy blanket tent are all ways you can be fully present with your child.
  • A never-ending pile of fun — Sequestering at home may actually provide you with the time to teach kids tasks like matching socks, folding clothes, and putting away clean laundry. Kids usually like to help, and when we make the chores fun, they’re often eager to pitch in.
  • We are (all) family — Whatever your family configuration, this week’s issue has ideas for strengthening your family bond.
  • Staying connected — Children are likely feeling the loss of connection with friends and extended family. This guide is full of ways you can help your kids feel more connected to people they love but can’t safely see right now.
  • Just keep dancing — What raises our spirits more or gives us a burst of energy like music and dance? These activities will help  your kids move their bodies, use their creativity, and improve their mood.
  • Shoot for the stars — Young or old, we’re all fascinated by space. What’s known is often mind-boggling, and what’s unknown leaves so much to the imagination.
  • Thank you teachers — Thanking teachers is not only a nice thing to do, but showing appreciation is a simple but important practice of gratitude.
  • Hooray for helpers — National Nurses Week presents an opportunity to expand your kids’ understanding of what it means to be heroic.
  • Let’s talk family — Someday, this quarantine will be a memory, and we hope your children will remember some of the family fun you’ve been enabling, and also the ways you are helping them focus on the things that really matter.
  • Cleaning up — A bundle of resources for making cleanup fun.
  • Celebrate the sun — Puzzles, stories, and activities related to growing gardens, having picnics, and taking nature hikes will remind your kids of some of the fun to be had in the sun. Sunny days together provide an opportunity to talk to your kids about optimism.

Other activities

This article was last updated on May 18, 2020.

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The most common summer injuries that bring kids to the emergency department

Summertime for many kids and adolescents means the excitement of water activities, fun in the sun and spending as much time as possible outdoors. Yet summer is also known as “trauma season” among pediatric experts like Dr. Ted Heyming, chair of emergency medicine at CHOC Children’s. According to Safe Kids Worldwide, a leading children’s safety organization, summer season represents millions of emergency room visits by children 14 and younger due to unintentional injuries, many resulting in death.

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Dr. Ted Heyming, chair of emergency medicine at CHOC Children’s

To help avoid unintentional injuries, Dr. Heyming recommends that parents and caregivers be on high alert and supervise children extra closely. The following are the top injuries Dr. Heyming and his team see in the Julia and George Argyros Emergency Department at CHOC Children’s Hospital during the summer season and tips to avoid summer injuries:

Head injuries
The risk of head injury is high in adolescents and especially common in the spring and summer months with popular outdoor activities such as bicycle riding, in-line skating and skateboarding. The injury can be as mild as a bump, bruise or laceration, or can be moderate to severe due to a concussion, deep cut or open wound, fractured skull bone(s), or from internal bleeding and damage to the brain. Parents should seek emergency medical attention for their children should any of the following occur after a head injury:

  • Vomiting more than once
  • Alteration in mental state
  • Increased irritability, fussiness
  • A seizure
  • Weakness in parts of the body, such as in an arm or leg
  • Bad headache

How to prevent head injuries:

Wearing a helmet whenever riding a bicycle, in-line skates, or a skateboard should be an automatic habit. Helmets should fit properly on your child’s head and also be fastened correctly. A helmet that fits and is fastened properly does not move around on the head. Worn properly, helmets are effective in preventing severe head injuries. Here’s a video with tips on how to properly fit a helmet.

Facial injuries 
Children may get minor cuts, wounds, and lacerations to the face while engaging in play or sports activities. Most of these injuries can be handled at home with simple first-aid treatment. Seek immediate medical attention for cuts and wounds on your child’s face if accompanied by any of the following:

  • Heavy bleeding that does not stop after 5 to 10 minutes of direct pressure
  • The injury involves the eyelids or eyes
  • Wound is gaping.
  • Injury is caused by a puncture wound, or dirty or rusty object or embedded with debris such as dirt, stones or gravel
  • The wound is caused by an animal or human bite
  • If your child indicates the wound is excessively painful, or if there’s a possibility of a fracture of the head or any other bone
  • Your child shows signs of infection such as increased warmth, redness, swelling or drainage

Help prevent facial injuries by teaching your child the following:

  • Not to poke or place objects in his ears or nose
  • Not to walk or run while holding an object in her mouth
  • Not to suck or chew on hard, sharp or pointed objects
  • Wear protective eye, ear, or face guards for sports activities that could cause injury

Wrist and elbow fractures
A fracture is a partial or complete break in the bone and can result from falls, trauma or a direct blow or kick to the body. Wrists, forearms and elbows are vulnerable to these injuries, and they are especially common among children ages 2 and older. Many occur with popular summer activities such as basketball, bicycle riding and skateboarding. The following symptoms in the injured area might indicate a fracture that requires immediate medical attention:

  • Pain
  • Swelling
  • Obvious deformity
  • Difficulty using or moving the injured area in a normal manner (unable to walk)
  • Warmth, bruising or redness

How to prevent wrist and elbow fractures this summer:

Although fractures are a common part of childhood for many active children, you can take steps to help prevent them through simple safety precautions such as making sure kids always wear safety gear like helmets and wrist guards when participating in sports.

Drowning

Summertime water activities are fun, but always present a risk for drowning. Drowning can happen without a sound. It is the leading cause of accidental death for children under the age of 5 and can happen in less than 2 inches of water. In 2018, Orange County had 36 drownings in children less than 5, and five of those were fatal.

How to prevent drowning

  • Never leave a child unattended near water in a pool, tub, bucket or ocean. There is no substitute for adult supervision.
  • Teach kids survival swimming skills.
  • Kids that are not strong swimmers should wear US Coast Guard-approved, well-fitting life jackets.
  • Make sure kids have constant supervision when they’re in or around water. Always designate at least one adult as a “water watcher.”
  • The home should be isolated from the pool with a fence at least 60 inches tall, with a self-closing, self-latching gate.
  • In 2015, Orange County created the Drowning Prevention Task Force, of which CHOC is a member, to develop recommendations on methods and strategies to improve drowning prevention efforts in Orange County. Learn more here.

Bringing your child to the emergency department

The emergency department is the best place for apparent life-threatening events. Not all emergency departments take care of children on a regular basis. It is best to go somewhere that specializes in children’s health with specialized training and equipment made just for kids.

This article was updated on May 15, 2020.

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I’m a pediatric dentist. Here’s what I want parents to know about dental care during COVID-19.

By Dr. Richard Mungo, chair of pediatric dentistry at CHOC Children’s

At CHOC Children’s, we know you want to give your child the very best care every day, especially during these uncertain times.

Kids are kids, even during a pandemic. They may trip playing hopscotch and crack a tooth or cause harm to the soft tissues of the mouth, have a toothache that prevents them from eating, or develop a dental abscess.

Oral health is a vital component of overall health. Proper oral health ensures one’s ability to eat and maintain proper nutrition – essential to a growing child’s overall health and development.

Many families feel anxious about seeking dental care during a pandemic. But not taking care of emergency dental issues can cause a moderate problem to develop into something much more serious, if it’s not corrected in a safe and timely manner. Here’s a guide on what qualifies as a dental emergency, and how your dental office may look different during this time.

Is it safe to go to the dentist during COVID-19?

The majority of dental practices are open for emergency care during this time. Practices will make every effort to ensure the dental visit is safe and comfortable for the patient, parent and staff present.

Dental offices in California follow safety and infection prevention guidelines from the Centers for Disease Control, California Dental Board, the California Division of Occupational Safety and Health (Cal/OSHA) and the U.S. Food & Drug Administration. During the COVID-19 pandemic, practices have been given additional recommendations from the California Department of Public Health.

If you need to make an emergency trip to the dentist during COVID-19, you will likely notice some differences from your last standard cleaning, including:

  • Scheduling changes — Necessary appointments are booked in a more limited manner, to ensure office staff have sufficient time to thoroughly clean and disinfect treatment areas between each patient. Therefore, the number of available appointments will be lower per day than in the past.
  • No crowds in the reception room — Patients should call the office when they arrive to the parking lot and stay in their car until a staff member comes to escort them into the office. The toys and books that usually populate the reception area of a child-friendly office will also have been removed for the time being. Once you are in the office, you will be taken to the treatment area immediately, which has been thoroughly cleaned and disinfected.
  • Fewer people in the office — Only one parent or guardian may accompany a child to the appointment, unless more are needed to assist a child with special needs.
  • Health screening — A staff member should take your temperature and ask several screening questions related to recent illness before you enter the office. If you have a recent history of COVID-19 exposure you may not be allowed in the office.
  • More masks — Masks should be worn by dental office staff at all times. Dentists, dental assistants and receptionists will be wearing personal protective equipment, also known as PPE, which may also include gowns or jackets, plus face shields, hair coverings and eye protection. Parents or guardians accompanying a child to an emergency appointment must also wear a mask.
  • Strong suction — Strong suction will be used to keep aerosolization particles as minimized as possible.

What qualifies as a dental emergency?

There are a number of potential dental problems that qualify as an emergency. Parents should be mindful of pain; infection; trauma; broken teeth, braces, retainers or fillings causing pain; or anything else in the mouth so difficult that it prevents eating or sleeping.

Children may have trouble verbalizing their dental pain or even pointing to a specific area that hurts or feels uncomfortable. It can be difficult for parents to see in a little mouth without good lighting, which can be a challenge in identifying the source of the pain. In these cases, contact your child’s dentist and ask for the possibility of a telehealth visit. This can help determine if your child should come into the office for care, or if the problem can be solved with a pain reliever, antibiotic or change in diet.

Other forms of dental emergencies affect children with medical complications or treatment, such as undergoing chemotherapy, radiation therapy or bone marrow transplantation. In these cases, they cannot have any form of infection present in their body in order to continue those treatments. Cavities are bacterial infections, and other oral soft tissue infections can also challenge the safety and success of cancer therapy. Children with co-occurring conditions may experience worsened medical conditions due to oral infections or difficulties.

There are other time-sensitive cases, including infants born with craniofacial abnormalities such as cleft lip and palate that require pre-operative dental care before their first plastic surgery.

Catching up on cleanings

Biannual dental visits are extremely important with children, who are growing and developing rapidly. With teeth coming in and falling out, it’s important to monitor their dental health regularly and keep an eye on cavities.

Pediatric dental offices perform a caries risk assessment, which consists of a questionnaire, examination and plan assigned to each patient. It identifies those who are at high risk and those who are at low risk for dental disease such as cavities and soft tissue problems.

If your child has had healthy check-ups and is a low risk for any dental problems, one missed dental checkup is probably OK. Once dental offices open up more broadly, schedule your child’s missed cleaning as soon as possible.

If your child is at high risk for dental problems, then some form of communication with their dentist should take place around the six-month interval. That could come in the form of a discussion between a parent or guardian with the dentist or clinical dental assistant over the phone. You can share photos with your child’s provider of any changes or areas of concern, or they could ask that you come into the office to address any concerns.

Practicing good oral hygiene at home

With stay-at-home orders in effect, many of us are spending more time at home than ever before. Sometimes, subtle changes in our diet take place that we are not necessarily aware of, and they can impact our dental health. If we’re snacking more and preparing more comfort foods, we should be mindful of sugar intake, and how that and sticky foods can harm our teeth and gums. Remind your children to practice proper teeth brushing. Here’s some tips and tricks for getting kids to brush their teeth.

When in doubt, call your dentist

Parents or guardians should feel comfortable seeking advice from their pediatric dentist’s office to determine whether or not their child needs immediate attention, or if can things safely be delayed until after the COVID-19 pandemic.

If your child’s dental condition is an emergency, call your dentist as soon as possible. Pediatric dental experts are also on call 24/7 at the Julia and George Argyros Emergency Department at CHOC Children’s Hospital.

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One nurse’s thank you letter to a former patient

By Amanda Paragas, registered nurse, CHOC Children’s cardiovascular intensive care unit

The CHOC Children’s RN Residency Program is a 17-week program that is specifically customized to meet the requirements of the new nursing graduate to be successfully transitioned to becoming a professional pediatric nurse. Here, a recent RN Residency Program graduate pens a thank you letter to a patient she had the privilege of caring for during the RN Residency Program — one who impacted her as a nurse.

To you, my sweet girl, I owe many thanks.

Thank you for showing me humility and grace.

Thank you for showing me what compassion and love looks like from your perspective. Thank you for letting me watch you grow and develop your wonderful personality.

Thank you for showing me, and everyone else, that you are capable of so much more than anyone ever gave you credit for.

Thank you for showing me how strong and resilient such a young patient can be, without even knowing it.

Thank you for always being mighty and always fighting for what you wanted.

Thank you for never giving up despite being faced with unthinkable circumstances.

Thank you for reminding me that life should not be taken for granted and that all of our time is limited here on Earth.

Thank you for challenging me to be a better nurse and to always strive for excellence when caring for others.

And most importantly, thank you for letting me defend your childhood.

The August RN Residency/Fellowship Program is scheduled to begin on August 17, 2020. Applications will be accepted: May 15, 2020 through May 19, 2020.

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