Quiz: How much do you know about teen alcohol and drug use?

Each year, the National Institutes of Health observes National Drug & Alcohol Facts Week in an effort to dispel myths about alcohol and drug abuse, and educate teens on dangers of use and addition. Take this quiz to test your knowledge of alcohol and drug use among teens, including what may be a warning sign.

    1. Teens may abuse alcohol and drugs for a variety of reasons. Choose all that apply.
      1. Negative peer pressure
      2. Family tensions
      3. Access to cash, alcohol and drugs
      4. Trauma
      5. Pressure to perform at school, in the home, or in extracurricular activities
    2. True or false: One-third of high school students have consumed alcohol in the last 30 days.
    3. Cigarette-like devices have gained popularity in recent years. Which are true about the danger of e-cigarettes? Choose all that apply.
      1. E-cigarettes may sometimes contain less nicotine than conventional cigarettes, but the addictive substance is still present.
      2. Non-users can be affected by emissions through second- and third-hand exposure.
      3. E-cigarette and conventional cigarette use have comparable levels of exposure to formaldehyde (a carcinogen).
      4. Because using e-cigarettes mirrors the dangers of cigarette use, the best way to quit cigarettes is to promote alternatives including gums and patches.
    4. True or false: Over-the-counter medications are harmless since they do not require a physician visit or a prescription.
    5. In 2014, the nonmedical use of prescription drugs was highest among young adults. What can parents due to properly store medication in the home, helping prevent prescription drug abuse?
        1. Throw expired or unused prescription medications in the trash as soon as possible.
        2. Store prescription medications in a purse or nightstand, out of sight of kids and teens.
        3. Include education on the dangers of prescription drug abuse as part of your safe storage practices.

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Putting a Stop to Opioid Related Hospitalization in Children

By Grace Lee, Sakina Hussain and Alice Kim, clinical pharmacists at CHOC Children’s

Opioids are a type of medication used to treat pain by blocking pain signals to the brain and decreasing the body’s perception of pain. When used appropriately under the supervision of a physician, prescription opioids are safe and effective medications. However, they are not without potentially serious side effects.

“The past two decades have seen a medical industry-wide emphasis on recognition and treatment of pain. This may have resulted in greater customer satisfaction, but it has led to more opioid products available in more homes than ever before,” says Dr. James Cappon, CHOC’s Chief Quality and Patient Safety Officer. “There are local and national increases in both accidental ingestions and poisonings in children and adolescents, and intentional overdoses in adolescents, too often with serious or even fatal results.”

Examining the Increase in Opioid-Related Hospitalization in Kids and Teens

A recent research study from the Yale School Medicine confirms this observation. Over a 16-year period from 1997 to 2012, a total of 13,052 hospitalizations for prescription opioid poisonings in children were identified. The number of young children aged 1-4 years admitted for opioid-related hospitalization (ORH) doubled, while a similar increase was seen among teens aged 15-19 years.

The reasons for these hospitalizations also varied by age group: children ages 1 to 4 were hospitalized primarily for accidental ingestion, while a majority of teenagers took the drugs with the intent to commit suicide or unintentionally overdosed when taking the drugs for recreational purposes, according to the study.

Side effects of opioid use and abuse

Commonly prescribed opioids for moderate pain include hydrocodone, oxycodone or morphine. Potent opioids such as fentanyl are used to treat severe pain related to cancers and other chronic illnesses.

Opioids can cause severe constipation, nausea, stomach upset, rash, drowsiness and confusion. If taken in excess, there is potential for dependence. Opioid overdose can result in dangerously slow breathing, low blood pressure and coma. In particular, opioids and alcohol are a notoriously deadly mixture.

Safeguarding our children

This study underscores the dangers of prescription opioids, which can often be more accessible than street drugs. “While greater awareness around reducing opioid dependence and prescribing is developing in the medical community, it is extremely important that our patients and families partner in keeping our children safe,” says Dr. Cappon.

Safeguarding our children starts with education and developing a healthy respect for these powerful pain killers. Precautions should be taken to store these medications away from children. Parents can also learn to identify signs and symptoms of opioid overdose to in order to seek help as soon as possible. Some practical tips include:

  • Safe storage – keep all medications away from your child’s reach and sight. Store in locked cabinets, if possible.
  • Safety cap – when filling prescription medications at pharmacies, request child resistant caps to be placed on the medication bottles to prevent easy access.
  • Safe administration – when giving medication to you child, double check the directions on the medication label. Liquid medications should be measured accurately when giving to your child. Keep track of how much medication is left over.
  • Safe disposal ­– expired medications or those that are no longer needed should be disposed of properly. The Food and Drug Administration recommends disposing some medicines, including opioids, by flushing them down the toilet or sink. If you are not sure whether your unused medication can be safely flushed, please check online for community drug take back days in your area.
  • Be aware of medication side effects – be familiar with common side effects of opioids such as nausea, vomiting, constipation, urinary retention, dizziness, drowsiness and confusion.
  • Recognize signs and symptoms of overdose – overdose is life-threatening. If you notice any of the following symptoms, call 911 immediately:
    • Pale face
    • Clammy skin
    • Limp body
    • Blue/purple lips and fingernails
    • Choking or gurgling noises while asleep
    • Cannot be awakened or are unable to speak
    • Slow/no breathing or heartbeat
  • Recognize signs and symptoms of inadequate pain control – it is important to control your child’s pain adequately with the right medications. Besides discomfort, inadequate pain control can lead to drug-seeking behaviors. Talk to your provider about the addition of non-opioid medications that can help with pain.
  • Be aware of your child’s physical and mental health ­– studies have shown that there is an increased risk of substance abuse (including opioids) in children with psychiatric disorders. Be involved with your child’s health and have an open discussion to prevent abuse.

For reference, a list of opioids and their brand names:

Opioid Brand Name
Fentanyl Actiq, Duragesic, Subsys, Lazanda, Fentora, Abstral
Hydrocodone Lortab, Vicodin, Norco  Hysingla ER, Zohydro ER
Hydromorphone  Dilaudid
Methadone Dolophine
Meperidine Demerol
Morphine MS contin, Kadian, Avinza, Embeda (with naltrexone)
Oxycodone Percocet, Oxycontin, Roxicodone, Oxecta, Xtampza ER, Oxaydo

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Is My Child a Candidate for Ear Tubes?

Many children suffer from ear infections, often between six months and two years of age. Lifestyle factors may lead to more frequent ear infections in some cases, like attending group daycare or secondhand smoke exposure. Children with chronic or recurrent ear infections, or those for whom hearing loss or speech delay are suspected due to fluid behind the ear drum, may be candidates for ear tube surgery.

“If your child has had three or more ear infections in the last six months, or four or more infections in the last year, with the most recent one being in the past six months, they may be a candidate for ear tube surgery,” says Dr. Kevin Huoh, a pediatric otolaryngologist at CHOC. Consult your pediatrician and ask about a referral to a pediatric ear, nose and throat specialist.

candidate for ear tubes
Dr. Kevin Huoh, a pediatric otolaryngologist at CHOC, discusses who may be a candidate for ear tubes.

“Children who have experienced hearing loss as the result of chronic fluid behind the ear drum will benefit from improved hearing as a result of ear tube surgery,” says Huoh. “For children with speech delay or at-risk for speech, language, or learning disorders, we may recommend ear tube placement at an even earlier time.”

Along with improved hearing, parents and caregivers may notice increased development of speech and language abilities. For children with frequent ear infections, ear tubes will decrease the incidence of these infections.

Ear tubes are tiny cylinders about 1 millimeter long, about the size of a grain of rice. They are surgically inserted into the eardrum to create a ventilation system for the middle ear, and also to prevent fluid from accumulating behind the ear drum, says Huoh. Audiograms, non-invasive hearing tests, are performed before and after the operation.

“After ear tube surgery, we often see patients experience an improved quality of life, including improved sleep and decreased fussiness, improved balance and improved school performance,” says Huoh.

Recovery from the routine procedure is usually very easy, he adds. Children are usually back to their normal selves within a day. Biannual checkups help care teams monitor the status of the ear tubes.

Typically, ear tubes remain in place for six-12 months before falling out on their own. If they come out prematurely, the ears will be observed for return of infections, or fluid that may require replacement.

CHOC Children’s perform this common procedure hundreds of time per year, says Huoh.

Learn more about otolaryngology services at CHOC.

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Carbon Monoxide in the Home: What Parents Should Know

Parents understand the importance of having working smoke detectors in the home to protect their family in case of fire, but sometime carbon monoxide detectors fly under the radar, says Amy Frias, a community educator at CHOC Children’s and coordinator of Safe Kids Orange County.

Carbon monoxide is a gas you cannot see, taste or smell, and it can be extremely dangerous to children when they’re exposed to unhealthy levels.

Fuel-powered devices that aren’t properly functioning can emit dangerous levels of carbon monoxide into the home with no warning unless you have a working carbon monoxide detector, says Frias. Faulty furnaces or heaters, portable generators, water heaters, clothes dryers, or cars left running in the garage, can all result in carbon monoxide poisoning.

It’s important for parents to know what can create high levels of carbon dioxide in the home and avoid these activities, says Frias.

  • Don’t use a grill indoors
  • Don’t leave a car running in the garage even if the doors are open
  • Never use the stove or oven to heat your home
  • Ensure vents (stove, furnace, fireplace, stove) are free or debris
  • Store gasoline properly: keep it in a locked location away from children and living spaces, in a well-ventilated area away from any heat sources.

Children process carbon monoxide differently than adults and can experience harsher side effects. Early symptoms include headache, nausea and vomiting. Each year, carbon monoxide exposure results in 15,000 emergency department visits, according to the Centers for Disease Control.

Frias offers tips on how to prevent carbon monoxide poisoning in your home:

  • Make sure you have a carbon monoxide detector. Install one on every level of your home, particularly in bedrooms, and keep them 15 feet away from fuel-burning appliances.
  • Remember that carbon monoxide detectors are not a substitute for smoke detectors.
  • Detectors only detect high levels of carbon monoxide when they are properly functioning. Check the batteries often and replace the unit every five to seven years depending on manufacturer’s recommendations.
  • Ensure alarms are linked throughout the home so when one sounds, they all sound.

If you experience symptoms of carbon monoxide poisoning, or your alarm detects a hazardous level, leave the area immediately and get fresh air, and call 911.

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CHOC’s Fresh Take on Nutrition Provides Healthier Options to Patients, Staff and Visitors

By Caroline Steele, registered dietitian and director of clinical nutrition and lactation services at CHOC Children’s

According to the Centers for Disease Control and Prevention (CDC), one in three children in the United States are obese. Obesity rates in children have quadrupled and rates in teens have tripled since the 1980s. In California, 38 percent of children are overweight or obese and in Orange County alone this translates to 830,000 children and teens.

Because of these trends, healthcare experts have looked for ways to help families with lifestyle and behavior changes, including nutrition choices, to improve health. To help improve trends in our own community, CHOC Children’s is pleased to launch a new formal food and nutrition philosophy.

Our Philosophy

CHOC Children’s embraces nutrition as a cornerstone of health, healing and well-being. We believe that food can be therapeutic and that real people need real food. Choosing from a plentiful variety of fresh, wholesome foods will strengthen a healthy lifestyle. Healthy eating can be tasty and flavorful with just a little creativity!

choc food philosophy
To help improve trends in our own community, CHOC Children’s is pleased to launch a new formal food and nutrition philosophy.

CHOC is more than a place to receive excellent care and more than a restaurant. We are a resource of health and nutrition information—not only for our patients, but for their families, our staff, visitors to our campus, and our community. We are committed to being a role model and setting an example of optimal nutrition at every opportunity within our organization.

We understand that embracing a food and nutrition philosophy is more than just changing the foods we serve. We support our philosophy by:

  • Promoting food quality, balance, lifestyle changes and mindful eating rather than fad diets.
  • Using portion sizes, product placement and presentation, pricing and education to promote better choices.
  • Understanding individual unique needs and that an individual’s eating pattern, nutrient needs, and food group amounts will vary based on age, weight, height, activity level and medical needs.

Taking Action:

On our Orange campus, we are increasing the range and availability of healthy food and drink options, while reducing the number and amount of unhealthy options in our cafeterias, vending machines, and on our patient menus. We will provide more freshly made items and reduce processed and pre-packaged foods for an emphasis on quality and taste as well as health. Our goal is to make it easier and tastier to make the healthy choice!

choc food philosophy
CHOC is more than a place to receive excellent care. We are a resource of health and nutrition information for our patients, their families, our staff, visitors, and our community.

Our new farmers’ market will allow staff, families, and visitors the opportunity to take fresh produce and other items home to their families.

We are excited to embrace these changes and help those in our community find delicious ways to improve health by providing information and helpful hints as well as showing examples with the food we offer. Savor the flavor of healthy eating and join us on our journey to a fitter future!

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6 Things Your Pediatrician Wants You to Remember in 2017

The new year is a great time to kick start healthy habits with your children that can be practiced all year long. We spoke to Dr. Reshmi Basu, a CHOC Children’s pediatrician, who offered the following tips:

Dr. Reshmi Basu discusses 6 things your pediatrician wants you to know this year.
1. Get your flu shot

If you haven’t received your flu shot this season, it’s not too late. Remember, the nasal flu vaccine is not recommended this season. The flu can make you much more sick than a regular cold and can have more complications, like pneumonia, so it’s important that everyone in the household over 6 months old receives it. If there is a new baby in the family, you can protect the baby by making sure anyone in contact with the baby has received the flu vaccine.

2. Wash hands often to keep germs away

Proper handwashing is especially important during cold and flu season. And remember to wash for at least 15-20 seconds and make sure to scrub between fingers and under nails.

3. Protect your child’s skin

During the winter it’s important to moisturize frequently throughout the day, especially after baths or showers, to treat and prevent dry skin. And, if you’ll be out in the sun, don’t forget the sunscreen. It’s best to apply it 15-30 minutes before sun exposure and reapply often.

4. Make well-child appointments and stay up-to-date on vaccinations.

 When children are young, there are frequent well checks with the pediatrician and these appointments usually include vaccines. As children get older (after 5 years old) and vaccines are not a part of every visit, it is easy to forget the well checks. They are still important, however, to see how your child is growing, how she is doing in school, and discuss any concerns. It’s also a good opportunity to get the flu shot (depending on the time of year) and make sure all other vaccines are up to date. Download CHOC’s  guide to making shots less stressful for kids.

5. Stay active.

The American Academy of Pediatrics recently lifted their rule on no screen time for kids under 2, with some limitations. Find time to be active. Make it a family activity– go on a hike, ride bikes together, or play in the park.

6. Read aloud to young children, starting at birth.

Try to read together for at least 15 minutes every day. Reading to your kids from a young age can help them with their speech development, communication skills, and even academic performance. And it’s a fun way to spend time together!

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Becoming a Blood Donor

January is National Blood Donor Month, but at CHOC, blood donations are needed all year long.  All donations made at CHOC stay here to help patients in need. Learn more about becoming a blood donor below, and call 714-509-8339 to reach Blood & Donor Services to make an appointment.

blood donor



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When to See the Pediatrician This Season

As soon as the school year begins, pediatricians start seeing more infectious diseases because these illnesses are more communicable in a classroom setting. Poor weather enhances that communicability, so these ailments become even more prevalent during winter months. It can often be difficult for parents to decide which infections can be treated at home and which require a trip to the pediatrician.

We spoke with Dr. Michael Cater, a CHOC Children’s pediatrician, about what ailments parents should keep a close watch for this season, and how to tell when it’s time to make an appointment with their child’s doctor.

when to see pediatrician
Dr. Michael Cater, a CHOC Children’s pediatrician, offers advice on when to see the pediatrician this season.

Influenza season tends to pick up in late December or early January, Dr. Cater says, but its prevalence in the community depends on how many people get immunized. The Centers for Disease Control recommends that everyone over the age of 6 months receive an influenza vaccine. However, for this season, the nasal flu vaccine is not available.

Sometimes it is difficult for parents to decide which illnesses can be treated at home and which ones require a trip to the pediatrician. Dr. Cater offers tips on when it’s time to make an appointment:

  • Many infectious diseases in children are associated with a fever. If a fever of 100.4 degrees or higher lasts longer than three days, then a visit to the pediatrician is needed for future evaluation.
  • Labored breathing that doesn’t respond to home remedies. This could be an indication of a more serious respiratory infection.
  • If a child is vomiting and does not respond to dietary restriction.
  • Cases of diarrhea when the child doesn’t respond to dietary restrictions.
  • Sore throat associated with a fever and tenderness in the neck. This could indicate Strep throat, requiring antibiotics for the most effective treatment.
  • Ear pain in conjunction with an upper respiratory infection such as a cold, especially if the ear pain begins four or five days after the onset of the cold. This is highly suggestive of an ear infection, requiring antibiotics for the most effective treatment.

To avoid common infections this season, remember to get your family vaccinated against influenza, and practice proper hand washing technique. Children should wash their hands:

  • Before eating
  • After going to the bathroom
  • After blowing their nose
  • After playtime

Use hand sanitizer when you’re on the go and think your child may have touched something contaminated with germs, but use actual soap and water when you see dirt. Spend at least fifteen seconds vigorously washing hands front and back, and between the fingers.

Download this guide to personal hygiene to help prevent the spread of germs this season.

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New Car Seat Laws: What It Means for Your Family

Echoing longtime recommendations from CHOC Children’s and the American Academy of Pediatrics, children in California are now required to ride in rear-facing car seats until age 2, under new state legislation.

As of January 1, 2017, the law extends the former requirement that children face backward until age 1. The new law does not apply to children who weigh more than 40 pounds or are 40 inches or taller.

CHOC community educators, however, continue to recommend more stringent guidelines for children and rear-facing seats. They encourage parents to keep in mind the following tips:

  • Facing the rear is the safest way for a baby or toddler to ride.
  • Keep toddlers in a rear-facing convertible car seat at least until age 2 or until they reach the maximum weight and height for their seat.
  • The harness straps should be snug and placed at or below the shoulder level.
  • Children have outgrown their current car seat when there is less than one inch of space between the top of their head and the top of the car seat.

Motor vehicle crashes are the leading cause of death for children ages 1 to 14 in the United States. According to a 2007 study in Injury Prevention, children younger than 2 are 75 percent less likely to die or be severely injured in a crash when they’re riding in rear-facing car seats. They are also a major cause of permanent brain damage, epilepsy and spinal cord injuries. Many of the deaths and injuries can be prevented with the proper use of child restraints and seat belts.

CHOC child passenger safety technicians are available to answer car seat questions regarding current laws, how to select an appropriate seat for your child, and what you need to know to install and use the child restraint correctly.

For more information on child passenger safety, visit CHOC’s community education page.

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A Pediatrician-Approved Checklist for Teens Heading Off to College

By Peter Schoettler, pediatric resident at CHOC Children’s

Going off to college, or back for another semester, is an exciting time for teenagers, and for many this is their first experience with true independence. For many adolescents, this will be the first time they are managing their health care on their own! Preparation can help ensure a smooth transition for those leaving home. Preparing your teen will help them access the best care when needed. Here are some tips to make the transition to college successful.

  • Review health insurance needs with your teen. They may need to sign up for their college’s health plan or still utilize your family’s health insurance. Be sure to provide them with a copy of their insurance card, as well as the contact information for their prior doctor.
  • Make sure they have a complete list of all medications that they take, including over-the-counter medications, as sometimes these can react with new prescriptions.
  • Having a list of chronic medical conditions is essential, as well as a list of any specialists that your teen sees. Your teen needs to be knowledgeable about any significant illnesses or surgeries they have had in the past.
  • This is a great time to review your entire family’s health history, and discuss how healthy lifestyle choices can prevent many chronic illnesses, such as diabetes, liver and heart disease.
  • Always have an extra copy of your immunization record! It will likely be required for college entry, but it’s also good for you and your teen to be familiar with the vaccines they have received in the past. Common vaccines needed before college include meningitis, tetanus and pertussis. Speak to your teen and their pediatrician about the HPV vaccine. Also remind them to get a flu shot every year. If you are planning on studying abroad, contact your physician or your school’s travel health center prior to traveling to other countries as many countries have illnesses not seen in the US and require extra vaccines.
  • Have an open and honest dialogue about complex issues they may face related to drugs, alcohol, and sex. Be aware of potential warning signs of alcohol and drug abuse in teens. These vices become more accessible away from home, and having clear expectations with your teen is important. Continue to have conversations about peer pressures, good decisions, and consequences. Identify on-campus resources for reproductive healthcare and mental health.

Once your teen is settled into college, keep in touch with them as they transition into their new routine and responsibilities. It is common for adolescents to experience feeling sad or homesick. However, if these feelings persist for more than two weeks, it is essential to seek out help. Learn how to start the conversation about mental health. Each college should have specially trained counselors who are there to provide help and support. By acknowledging these issues before they arise, your teen is more likely to come to you for help if it is needed.

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