All posts by CHOC Children's

Tips for traveling with picky eaters

By Sarah Kavlich, registered dietitian at CHOC Children’s

When you’re a parent dealing with a picky eater, childhood and picky eating can seem synonymous. It’s easy to cater to the pickiness in an effort to avoid a struggle at mealtimes. However, this can sometimes worsen their habits. With summer just around the corner and as we move into warmer months filled with fun, travel and a break from school, parents can use this opportunity to try some new and interesting foods with their picky eater. Whether you’re traveling or staying at home, this time of year can offer an opportunity to experience a new culture through food.

Tips for introducing new foods to toddlers

Remember that kids are learning to eat so consider changing your mindset before heading into meals. Remember that they won’t necessarily eat much of a new food the first time they try it. Repeated exposure to that new food will help them become more comfortable with the food over time. Research suggests it can take up to 20 encounters with a food before someone develops a preference. So, if it is a food you would like to be a mainstay in your child’s diet, don’t give up right away but also don’t force it. Maintain structure by letting your child know that everyone in your family eats the same meals, and there are no separate kids’ meals. This can be a tough pattern to break but offering a small amount of the new food alongside a few familiar foods or a favorite dipping sauce during the meal can help.

Tips for traveling with picky eaters

Exposing your children to new foods while at home, in a lower pressure environment, can help expand their palate before traveling. Start by offering just a small taste test of the new food alongside some familiar foods that your child already feels comfortable eating.

Talk about your upcoming adventure and some of the things your family might experience there, including testing new food together. Kids learn by example and often model the behavior of the people they are closest to, so make sure you have an open mind as well. It’s ok for children to have different food preferences than their parents.  If your child shows interest in a new food that you may not enjoy, go ahead and let them try it without assuming they won’t like it.

On your trip, pack a few of your child’s favorite foods or snacks that travel well like bars, dry cereal or crackers, or pick up some fruits, vegetables, yogurts, or cheese at a local market to help ease them into the new cuisine. Healthy snacks will also help your child from becoming overly hungry between meals. Use words like “exploring” and “adventure” as you offer new foods to promote a more enjoyable atmosphere. Most importantly have fun as you learn together and create lasting memories with your family.

At home before a trip, set the stage by offering some of the foods you might experience on your upcoming travels, like this healthy recipe:

Rice with Lemongrass and Green Onion from

(Serves four)

2 tablespoons vegetable oil

2/3 cup finely chopped onion

1/4 teaspoon turmeric

1 cup long-grain white rice

1 3/4 cups water

2 12-inch-long lemongrass stalks, cut into 2-inch-long pieces

1/2 teaspoon salt

1 large green onion, chopped


Heat 1 1/2 tablespoons oil in heavy medium saucepan over medium heat. Add 2/3 cup onion and turmeric and sauté 5 minutes. Mix in rice. Add water, lemongrass and 1/2 teaspoon salt and bring to simmer. Cover, reduce heat to medium-low and simmer until rice is tender and liquid is absorbed, about 18 minutes. Remove from heat; let stand covered 10 minutes. Discard lemongrass.

Heat remaining 1/2 tablespoon oil in heavy large skillet over medium heat. Add green onion and sauté 1 minute. Add rice and stir until heated through. Season to taste with salt.

Get important nutrition tips like these sent straight to your inbox

Kids Health, delivered monthly, offers “healthful” information for parents.

Related posts:

  • How to read a food label
    Eating healthy can be confusing with all the choices available in your grocery store. Learning how to read a food label is key to making the best choices.
  • Spring clean your family’s eating habits
    Spring is not simply a good opportunity for traditional spring cleaning, but also an ideal time to make positive changes to your eating habits.
  • Family-Friendly Healthy Eating on a Budget
    Eating healthy on a budget doesn’t have to be expensive or time consuming. By following these tips, you can be on your way to a balanced diet and budget! ...

What parents need to know about mood hygiene

It’s important to teach children how to keep their minds and
bodies healthy. Learning healthy living skills in childhood and adolescence can
help children manage stresses as they grow into adulthood.

The following strategies can help prevent problems with
depression, anxiety and other difficult mental health symptoms. For those
children and adolescents who have mental health symptoms already, these
strategies can help manage symptoms and lessen some of the challenges they may


Lack of sleep can lead to some of the same symptoms as
mental health problems, including: problems with concentration, fatigue and low
mood. Too little sleep can exacerbate a mental health diagnosis.

Children and adolescents need more sleep than you might
think. The American Academy of Pediatrics recommends the following sleep
schedule by age:

  • Age 3-5 years: 10 to 13 hours, including naps
  • Age 6-12 years: 9 to 12 hours
  • Age 13-18: 8 to 10 hours


Exercise can be a very effective tool in helping to decrease
symptoms of depression and anxiety. Children’s bodies are made to move.
Children should have at least 60 minutes of activity per day, which could
include running, playing outdoors, or playing a sport. Without this activity,
children can have symptoms that may look like a mental health problem or have
their mental health symptoms get worse.


Bodies of children and adolescents continue to grow, and
they need a well-balanced diet to support their development. When people feel
depressed or anxious, they often crave foods that are high in carbohydrates,
sugars and/or fat. In the end, those foods end up leaving kids feeling more
depressed and anxious as their bodies process those foods. Having a more
balanced diet will help children feel more comfortable and energetic.

Coping skills

Teaching children and adolescents healthy coping skills can
be helpful in decreasing mental health symptoms. These skills can include:

  • How to identify, name and talk about their
    feelings. All feelings are ok, it’s just what you do with them that can be
  • How to take deep, full breaths to help their
    bodies calm down.
  • How to solve problems. Let the children tell you
    what they might do, and guide them, rather than tell them.
  • Giving targeted positive feedback to your
    children when you see them using positive skills or developing good social
    skills. This helps them know what they should be doing.
  • Identifying healthy ways to deal with anger,
    such as drawing an angry picture, playing with clay, using words to express
    self, going outside to run around.
  • Mindfulness and yoga can be helpful coping
    strategies as well. Learn
    more about mindfulness.

Screen time

Excessive screen time can lead to weight gain and other
physical and mental problems. The American Academy of Pediatrics recommends the
following limits for daily screen time:

  • Children age 2-5 years: limit screen time to one
    hour per day of high-quality programming. Parents should co-view media to help
    them understand what they’re watching.
  • Children age 6 and older: consistent limits
    should be set on the time and types of media. Parents should ensure screen time
    doesn’t interfere with sleep, physical activity, and other behaviors essential
    to health.

Social media

Social media can help teens connect to peers and communities that are important to them, but too much time spent online can lead to increases in feeling down and/or anxious. Teens can sometimes walk away from social media feeling much worse about themselves. Parents should monitor their children’s use of social media and have a conversation about how they feel after using it. Don’t be worried about limiting their usage if you see it causing problems.

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.

Related posts:

Why I support CHOC: One uncle’s story

By Julian Giacobbe, CHOC Children’s supporter

My niece Isabella will be 12 in a couple of months. There will be the mandatory cake and candles, I’m sure, along with family, food, noise, the usual. We will look at those family photos later, and we will all know that there are dozens of people missing from every single picture ― all the doctors and nurses at CHOC who are responsible for our Isabella turning 12 that day ― just like they had a hand in her turning 11 the year before, and 10 before that, and… you get the idea.

As a toddler, Isabella was diagnosed with stage 3 kidney cancer. Today she’s cancer-free. But it wasn’t an easy road in between. For two seemingly unending years, her childhood was spent at CHOC Children’s Hospital in Orange. There were many exams, all kinds of tests, several surgeries, and then some more exams. Even after leaving her hospital room for the last time and finally going back home, there were follow-up visits to CHOC multiple times a week for another year and a half. Throughout it all, it was those fantastic doctors and nurses at CHOC that kept Isabella going, figuratively and literally.

We knew even in the midst of her treatment that this was a
unique, life-changing event for our family.  I have so much respect for the staff at CHOC who
does amazing work every single day for hundreds of children and their families.

I wanted to give back to CHOC to say thank you for everything they did for my niece. I joined Moustaches for Kids OC (M4KOC), a national community of mustache growers who make up local chapters and raise money for a children’s charity in their area. For 30 days, the chapter’s growers work tirelessly to grow and display mustaches. When asked, “What’s with the stache?” it’s an opportunity to raise awareness and funds for a worthy cause.

Julian shows off his mustache progress halfway through the annual campaign.

This is not just another fundraising effort for me. It’s very personal. My family owes CHOC more than we could ever pay back. When Isabella gives the camera the inevitable eye roll that most 12-year old girls would on their birthday, we know who to thank.

Discover other ways to support CHOC

Related posts:

How to read a food label

By Janette Skaar, clinical dietitian at CHOC Children’s

Trying to
eat healthier may be
a goal you’ve set for your
family this year. Even with
the best intentions, it may seem
confusing with all the choices
available in the aisles of
your favorite grocery store.
Shoppers today have more options
than ever before.
Sorting through food labels and
checking prices may seem
like a daunting task. Understanding food labels is key to
making the best choices for you and
your family.

Natural: The USDA allows the term “natural” to be used
on meat
and poultry that contains no artificial ingredients
or added
color. It must also be minimally processed.
It does not address food
production methods, such
as use of growth hormones or pesticides, or potential
health or nutrition benefits. The FDA has
not provided any formal definition
or regulation of the term
“natural” on food or beverage labeling.

Processed or unprocessed:
These terms may
easily misunderstood. We generally
think of anything “processed” as being
unhealthy, with lots of additives,
like boxed mac and cheese or potato chips. “Unprocessed” foods may be
healthier, since they are not in
a package, frozen or canned.

The USDA defines processed as a
food that has had a change in character. Roasted nuts, pre- washed spinach, and whole wheat bread are also processed, as well as anything
we cut, cook or
bake. Pasteurized milk is processed
with heat to 161 degrees for 20 seconds to kill listeria,
salmonella and E. coli, which
reduces the risk of serious
illness from these bacteria.
 Some foods
are made
more nutrient dense,
for example when milk
and juices are fortified with
calcium and Vitamin D.

This means not all processed
food is unhealthy.
However, we should aim to do more food
prep at home, when possible, and select minimally processed foods, such as cut vegetables or frozen
fruit, rather than heavily processed
foods like pizza and microwave dinners.
Eating too many heavily
processed foods adds
hidden sugar and sodium to our diets that may increase
the risk for diabetes and
heart disease.

Whole foods: There
is no regulated definition of this term,
but it generally refers to foods that are
in their simplest
form, that are not
processed and do not
have added ingredients.

100% whole grain: There is
a difference between the phrases “100% whole grain”
and “made with whole grains.” Whole grains contain the
entire grain kernel and
include whole wheat flour, bulgur
or cracked wheat, oatmeal, whole
cornmeal, and brown rice. Refined
grains refer to grains
that have been processed to
remove the gran and germ. A food may have a
very small percentage of whole
grains in the ingredients and
still carry the
label “made with whole grains.”
The Whole Grains
Council developed the 100% Whole Grain
Stamp and the Basic Stamp
to help shoppers identify which foods are
good sources of whole grains, and not just white bread
disguised as whole grains.
Check the list of ingredients. Since manufacturers must list the
ingredients in descending order, the first ingredient should start with the word whole,
such as whole wheat flour or
whole grain rye flour.

Buying locally grown and in-season
fruits and vegetables means eating
foods that taste fresher, have
retained more of their nutrients,
and cost

The terms
local and locally grown refer to the
distance between farm and market
and may mean
less than 100 miles, or even 450 miles, if you
are a large grocery store chain.
Buying local is becoming
more important to shoppers concerned
about their carbon
footprint and their desire
lessen the impact of food
production and transportation on the environment, while
supporting local farmers and communities. Farmer’s markets offer the opportunity
to talk to local growers and ask questions about their farming
methods. Some use a mixture
of organic and conventional methods.

Organic: This term has the most specific
and legal meaning.
 The term organic means
crops are grown with
fewer pesticides, no synthetic fertilizers or genetically modified
organisms and farm animals
raised without
the use of routine
antibiotics and are given organic feed

There are three
tiers to the USDA
labeling standards. To display the USDA’s organic
seal of approval,

product must meet the top two requirements:

  • “100% organic” which means it contains 100% organic
  • “Organic” indicating it contains
    at least 95% organic
  • “Made with organic
    (ingredient)” indicates it contains
    at least 70% organically
    produced ingredients

The USDA organic
seal is a simple way to know if you are purchasing
a primarily organic food

Conventionally grown: You won’t find
this term on your
fruits and vegetables, but it refers to the growing
and production of foods with traditional farming practices, which may
include chemical pesticides, herbicides and
fertilizers to enhance
growth. Livestock
may be given antibiotics and hormones to improve their growth and
prevent disease.

vs Conventional
? There is research support for organic foods having
lower pesticide levels, as well as organically
raised animals less likely to be contaminated with
drug resistant bacteria. The verdict on long term health
outcomes of eating
organic vs conventional
foods is still out.

If the price of organic
produce is a concern, families can use
shopper’s guides provided
by Consumer Reports
or the Environmental Working Group to help them
choose conventional foods with
lower pesticide residue. These are
commonly referred to as the
Dirty Dozen and the Clean

Dirty Dozen: Strawberries, spinach,
kale, nectarines, apples, grapes,
peaches, cherries, pears, tomatoes, celery, potatoes

Clean Fifteen: Avocados, sweet corn,
pineapples, sweet peas (frozen),
onions, papayas, eggplant, asparagus,
kiwi, cabbage, cauliflower, cantaloupe, broccoli, mushroom, honeydew melon

Whether choosing organic or conventionally grown foods, increasing your intake of fresh fruits, vegetables, and whole grains is recommended. Focus on eating a variety of foods, including those with rich colors.

Get important nutrition tips like these sent straight to your inbox

Kids Health, delivered monthly, offers “healthful” information for parents.

Related posts:

A day in the life of a child life specialist

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

But just because we’re a children’s hospital, doesn’t mean we only treat little kids. CHOC child life specialists work with teen and young adult patients, too. Follow along for a day in the life of Karlie, an oncology child life specialist.

6:00 a.m. – My alarm goes off and I quickly push snooze. I lay in bed for a bit longer as I am still trying to master the art of getting out of bed as soon as the alarm tells me to. After a few more moments of relaxing I get up, ready to take on the day. I get ready, make some breakfast, pack my lunch and my workout clothes, and head out the door by 7 a.m. to get to work on time.

8:00 a.m. – After making it through infamous Southern California traffic, I arrive at work. During my drive, I usually listen to some sort of motivational worship talk or devotional and once I park, I say a quick prayer to help me be ready for the day. I walk into my office and greet my fellow child life specialists. The office is full of smiling faces, and despite the early hour, it’s already bustling with colleagues talking about various patients and their needs. I work on the hematology/oncology unit, but we have child life specialists embedded in practically every unit and area of the hospital. Our team is filled with energetic, gracious and positive people trying to provide the best support possible to the patients and families that we serve. I feel so grateful and able to take on the day with them by my side.

8:15 a.m. – To start the day, I get a copy of the patient census—an overview of the current patients admitted to the hem/onc unit. I also check the surgery schedule to know what surgeries or procedures my patients have that day.

8:30 a.m. – I head to a meeting with the oncology multidisciplinary team which consists of the medical and psychosocial team. We discuss various patients and their plans of care. We also discuss what psychosocial needs have already been met and what support they still need. We make sure to communicate with each other so that as a team we can ensure we’re meeting our patient’s physical, emotional, spiritual and mental health needs.

10:00 am – I head up to the hem/onc unit and check in with the bedside nurses, so I know what the plan for the day is for each of the patients that are on the unit. We discuss how we can work together to best help each patient. I talk to one nurse about a 17-year-old patient that was just admitted last night with a new diagnosis of leukemia. She tells me that he is feeling nervous about a procedure he’s scheduled for later that day. We go over my plan to support him and I tell her I will keep checking in and keep her updated with how the patient is feeling. I then go into his room and introduce myself and tell his family more about what child life has to offer in terms of “normalizing” the hospital environment. We also talk about what he likes to do, his favorite sports teams and who makes up his family. After we have built some rapport and trust, we talk about his upcoming procedure and I explain it in a way he’ll understand, and it helps ease his anxieties. We talk about why the doctors want him to get some tests done and what these tests will tell the doctors. We talk about the roles of each staff member he will meet, and how they will help him. We set up a hospital tour for later that day. In the meantime, I call my volunteers to drop off a soccer Xbox video game for him to play in his room while he waits.

10:30 a.m. – I get a call to come and help one of my long-time patients with her port access. A port is a medical device surgically placed under the skin in the chest that can be accessed with a needle for infusions and lab draws. When she was first admitted, we worked on coping techniques including medical play, and now she doesn’t get as anxious for procedures. She’s been in treatment for six months, but she still prefers me to be there, and I enjoy seeing her and being there for her. We play her favorite iPad game together while the nurse does the procedure. During the procedure I remind her of each step of the process as it comes, to help her feel empowered and ready. During the needle poke, we do deep breathing exercises together to breathe away any pain or discomfort, and she squeezes my hand. As soon as the poke is done we go back to playing on the iPad and laughing at inside jokes we’ve developed over the last few months. I applaud her for how well she has been doing with her port needle accesses and tell her how proud I am of her.

11:00 a.m. – I take the time to check in on some more patients that I know, and make sure they have everything they need for the day, including some fun activities to look forward to. A few of my longtime patients are in the middle of long hospital stays, so I come up with a plan for something fun and different for them to do that day to help make the most of every day they are there.

11:30 a.m. – I check in on my new 17-year-old patient and find that he is ready for his tour. We start by walking around the hem/onc unit and I show him the gym and the teen room. He loves air hockey, so I show him the air hockey table in the playroom as well.  On our tour, we cross paths with a pet therapy dog, so we stop to spend some time with him, and we all laugh as the dog does one of his famous tricks that he has practiced for a doggy treat. We then head down to the second-floor lobby to check out the amenities it has to offer. We check out Seacrest Studios (our in-house radio station), the movie theater, another teen room, Turtle Talk, and two outdoor patios. Child life organizes a lot of special events for patients, and today we are hosting several baseball players from the Angels. We stop by that event while we’re on the second floor and check out the games going on, crafts, giveaways and my patient snags a few photos with his favorite players before I escort him and his family back up to their room.

12:00 p.m. – I take time for a quick lunch break with my fellow child life specialists. I work with some of the kindest, strongest, most giving and selfless people that I know. We enjoy some great conversation about work and about our lives outside of work. My coworkers are my greatest support on the job and I feel grateful to be able to work alongside them and the other wonderful staff at CHOC. I am thankful every day for the wonderful coworkers I have that are also some of my closest friends!

1:00 p.m. – I head back up to the 5th floor to take part in one of the best parts of my job. Today we’re celebrating the final chemotherapy treatment of a 22-year-old patient. I have a trophy and a sign that reads “Happy Last Chemo!” I gather the nurses, clinical assistants, nurse practitioners, and any other available staff to join in. We parade into the patient’s room cheering, and sing the “Happy Last Chemo” song to the tune of “Happy Birthday.” As I look around the room, I see that the patient, her family, and all the staff have tears of joy in their eyes. We are so happy for this patient reaching the end of her treatment. This is definitely something worth celebrating.

2:00 p.m. – I get a call from the front desk that some special visitors are waiting for me. I know it is the surprise we have in place for another patient. This patient, a 13-year-old girl, has been in the hospital for a while and I know she could definitely use an emotional boost. Today is her golden birthday, which is the perfect time for a big surprise.  I reached out to a local jewelry store and asked for their help. They agreed to bring some cute gold jewelry items for this patient to help celebrate her golden birthday. I feel so grateful for our community partners that are so generous and willing to help our patients. Seeing my patient’s face light up warms my heart. She knows that she was thought of individually and that people wanted to make her day brighter.  I am so grateful to be able to help provide these special and meaningful experiences to a patient like her that is so kind, strong, and such an example of perseverance.

2:30 p.m. – I return to the room of my 17-year-old patient and take him down to the pre-operative unit for his scheduled procedure. We talk about new questions and concerns that he has thought of since this morning, but we also talk about the things in his life that are important to him; his friends, family, sports, school, and fast food. When it’s go-time, I stay with him as his parents go wait in the lobby. Before he receives anesthesia, I stay with him as we listen to his favorite artist and talk about what songs he likes. I’m a terrible singer, but we sing together to take his mind off the procedure. We continue doing this while the wonderful team of nurses, technicians, physicians and anesthesiologists get everything ready. The patient and I continue to talk, and I interject every once in a while, to let him know what the procedure staff is doing as we go along. It is time for him to receive his anesthesia and I talk with him until he falls asleep. Afterwards I thank the procedure room staff and doctors for all that they do and I exit the room for the procedure to begin.

3:00 p.m. – Afterwards I head back up to the hem/onc unit for a planning meeting for our biggest event of the year. Each year, the CHOC Children’s Oncology Ball presented by The J. Willard and Alice S. Marriott Foundation is a chance for oncology patients and their friends to celebrate their life and all they’ve been through. This event is part of the Adolescent and Young Adult (AYA) treatment program. Our team spends months planning this event so that every patient, no matter their age, can feel like Prom King or Queen for the day.

4:00 p.m. – After that brainstorm meeting, I check in on the family of a newly diagnosed 2-year-old boy. As I enter the room I see that the patient is napping but that his big sisters have come to visit. I talk with the siblings and educate them about what they see in the room and help them understand their younger brother’s diagnosis through a medical play activity. I help them understanding what the nurses and doctors are doing to help him get better. We talk about how they are feeling and concerns and fears that they have. One sister thinks this diagnosis happened because she once got really mad at her brother for taking her toy. I assure her that her brother’s cancer is nobody’s fault, and that there is nothing anyone did wrong that made this happen. We talk about how they can help their brother while he is in the hospital. They can play with him, draw him pictures, give him hugs, wash their hands so he doesn’t get germs, and help mom and dad around the house. I want them to know that as siblings they are important too, and I am here to provide support to them as well. I remind them that every fun thing in the hospital is for them too! With their parents’ permission, I take them down to Seacrest Studios to hang out with the staff there. Seacrest Studios music and programming is broadcast to every patient’s room, and the girls get to help host the daily game of Bingo. To see them feel special and get the attention they need warms my heart. Illness really does affect the whole family and taking the time to acknowledge and be there for each family member is so important.

5:00 p.m. – After leaving the siblings in the excellent care of the staff in the Seacrest Studios I head back to my office to gather my things and head home for the day. On my drive, I call my mom who lives in Utah. I talk to my mom about my day as much as I can without breaking patient confidentiality. I enjoy talking to my parents and know they will always give me sound advice. My mom hands the phone over to my youngest brother, who is a senior in high school and we catch up on his day. I love hearing about my siblings’ lives. I am one of ten children!

5:30 p.m. – I arrive at the gym for my workout. Exercise is a great time to decompress from the day and relieve any stress I may be feeling from whatever sad or difficult situation that may have happened that day. I absolutely love my job, but it can be hard to watch these patients and families go through such difficult things― patients feeling sick, losing their hair, hearing that their cancer came back, having to get a poke for blood, and the reality of sometimes losing a patient to cancer, all takes a big toll on our staff. In addition to support from my colleagues, I also try to find things outside of work that help me cope, and working out is one of those things. Today was not one of those really difficult days, but running on the treadmill and doing some weight training definitely helps me decompress and transition out of work.

6:30 p.m. – I head home and make dinner while I talk to my roommates. We talk about our days and then we have friends come over for a fun game night.  It is a great night spent relaxing and connecting with friends.

10:00 p.m. – Time for bed so I can give tomorrow all the energy it needs! I count my blessings, especially being able to spend every workday with the most amazing kids, teens and young adults who are fighting their illnesses with grace, positivity, joy, strength, wisdom and the desire to make the most of every day. I look forward to tomorrow, and the opportunity to offer each patient and family member I come across my best care and support to make their day even a little bit brighter.

Learn more about CHOC's child life services

Related posts:

  • Olivia’s Journey with Music Therapy
    Olivia was unexpectedly born two months premature and spent the first seven months of her life in the CHOC Children’s neonatal intensive care unit (NICU). The more music therapy sessions ...
  • What We’re Thankful for this Year: 2017
    In celebration of Thanksgiving, members of the CHOC Children’s pediatric health care system express what they’re most grateful for this year.
  • The Power of Music Therapy: Darlyn’s Story
    The 7-month-old’s daily music therapy sessions in the NICU, conducted in tandem with occupational therapy, have helped her make progress on clinical goals.