The team of child life specialists at CHOC Children’s strives to “normalize” the hospital environment for patients and families. By making things like medical procedures and equipment less foreign, patients can focus on what’s important: feeling better.
Their work includes surgery preparation and support; therapeutic medical play; new diagnosis education and support; developmental stimulation; sibling support; and specialized therapeutic programs like pet, art and music therapy.
This week, during Child Life Week, CHOC celebrates our fabulous and dynamic child life team, and the role they play in our commitment to patient and family-centered care. Watch this video for a glimpse into CHOC’s child life services.
Parents know that breakfast is the most important meal of the day, something that is true for the whole family, but especially for kids. Their brains, bones and muscles need extra nutrients in order to grow and develop properly, says Stephanie Prideaux, a dietetic technician, registered, in CHOC Children’s clinical nutrition and lactation services department.
Breakfast eaters are more productive, have better problem-solving skills, and increased mental clarity, says Prideaux. This sets up children for better success in school. Eating a well-balanced breakfast can also help children keep their weight under control, and have lower cholesterol levels.
While eating something in the morning is better than nothing, says Prideaux, there are certain nutrients that can give kids an extra boost at school. Foods rich in whole grains, fiber and protein, while also low in added sugar may boost kids’ attention span, concentration and memory, which they need to learn in school. Children who skip breakfast are unlikely to make up those missed nutrients to meet their daily requirement, says Prideaux. Learn more about the daily nutrients your child needs. Good sources of these nutrients include:
Carbohydrates: whole-grain cereals, brown rice, whole-grain breads and muffins, fruits, vegetables
Fiber: whole-grain breads, waffles and cereals; bran and other grains, fruits, vegetables, beans, nuts
If kids aren’t hungry early in the morning, be sure to pack a breakfast they can eat later on, in the car or before class, says Prideaux. Portable ideas for breakfast include: a peanut butter and banana sandwich on whole-grain bread, or fresh fruit with nuts or dry cereal. Think outside the box when putting together breakfasts for your family, and don’t stick to traditional American breakfast foods, Prideaux says, which may be high in sugar and fat. As long as kids are getting the nutrients they need, breakfast can be anything—even last night’s leftovers.
Try some of these make-ahead recipes to make sure your kids get the nutrients they need, even on busy mornings, to be successful at school all day:
Smoothies: blend fruit with yogurt and peanut butter or oats in the evening, and grab one when you’re headed out the door
CHOC Children’s has long been committed to providing patient- and family-centered care. This includes letting patients define their own family, inviting family members to be active members of the patient’s care team, and fostering open communication and information sharing between physicians, nurses and families.
CHOC’s newest Patient & Family Centered Care Coordinator Marla Dorsey will allow CHOC’s customer service team to further deliver on the hospital’s commitment to provide this high level model of care and service to patients and families. Marla’s service will be based upon the four guiding principles to patient- and family-centered care: dignity and respect, information sharing, participation, and collaboration.
“I want patients to remember that CHOC is a family too,” says Marla. “No matter what role you play at CHOC, every member of the CHOC family is committed to supporting every member of your family.”
Marla’s role includes making rounds to different units in the hospital to check in on parents and families. “Sometimes families just need someone to talk to, a break from medical conversations. Maybe their child is nonverbal and they just want to share about their own needs, so for a little while they can forget they’re in a hospital,” she explains.
Marla will also oversee the Family Resource Center, which features a library for patients and families as well as multimedia stations for entertainment or to research pediatric illnesses. She’ll also coordinate parent education opportunities with CHOC’s Family Advisory Council, a group that meets regularly to provide input, from a family’s perspective, on decisions and initiatives at CHOC.
Although Marla is new to CHOC’s customer service department, her journey at CHOC started many years ago. She visited regularly as a young child when a family member was a patient. Later, when her daughter was diagnosed with Type I diabetes, she found herself back at CHOC. “I had this sense of familiarity when my daughter was referred to the endocrinology team here,” Marla says. “Choco’s been in my life for such a long time, and CHOC has grown so much in what they do to support patients and families since I began my health journey here with my daughter over 15 years ago.”
After her daughter’s diagnosis, Marla began volunteering with the PADRE Foundation (Pediatric-Adolescent Diabetes Research Education), of which CHOC is a partner. She then moved into a full-time position in CHOC’s clinical education department, before moving to her new role in customer service.
“I keep moving closer and closer to the heart of the hospital, where the kids are,” says Marla. “These are the kids who are going to be the most amazing leaders in our community. Look at what they’re accomplishing every day by fighting for their health when they’re here at CHOC!”
Zac McNeese laced up his first pair of hockey skates before his third birthday. By the time he turned 7, his competitive team was traveling all over the country and being coached by former professional players. A series of concussions prematurely ended his time as a nationally ranked hockey player at the age of 14 and kept him out of school for months. Thanks to holistic care treatments through CHOC Children’s integrative health services, working in partnership with CHOC’s concussion program, Zac is back in school and getting the chance to be a normal teenager again.
Three Concussions in Two Years
Zac’s first concussion occurred during a hockey tournament in Canada. A hit to the head with a hockey stick rendered him unconscious for a short time, followed by short-term memory loss. He was taken to the nearest emergency room for evaluation. After a six-week stint out of school and sitting out of hockey for another few months, he returned to the sport he loved.
But three games into his return he suffered a whiplash-style concussion. Although this one was milder than the first, its proximity to the last injury concerned Zac’s doctors. His family was familiar with the medical benefits of acupuncture, so his parents convinced him to give it a try in hopes of relieving chronic headaches and back pain that was lingering from his second concussion.
“It took some time for me to warm up to the idea of acupuncture, but my older brother had these treatments done when he was a patient at CHOC, and I knew how much they had helped him, so I finally decided to try it for myself,” says Zac. “Over time I saw results and could feel it helping my neck and back problems.”
He began acupuncture treatments with Ruth McCarty, director of Chinese medicine and acupuncture at CHOC.
“The goal of acupuncture treatments is to improve the quality of life for our pediatric patients with diverse medical problems by providing benefits that complement their other medical treatments. Acupuncture isn’t invasive or scary, and it helps you relax.” explains Ruth. “If you can’t relax, it’s impossible to start healing your other ailments.”
The National Institutes of Health have critically evaluated clinical studies and concluded that acupuncture is effective for a variety of medical problems including management of pain and headaches, added Ruth.
Other treatment methods Zac benefitted from include massage, aromatherapy, herbal supplements, yoga and meditation helped improve Zac’s headaches and depression, says Zac’s mom Dana.
A year later Zac suffered another, more serious concussion. During a hockey game, he got hit from behind and was knocked unconscious while mid-air, then fell and hit his head. He was paralyzed from the waist down for 36 hours and doctors ran numerous tests to scan for permanent damage. After a few days of observation, he was sent home to rest in a neck brace, but wouldn’t return to school for several more weeks.
A New Normal
Zac’s care team said he could not play hockey again, for risk of future injury. The news was devastating to the young man who had given up countless social activities over the years to dedicate himself to hockey.
“When my doctors said I couldn’t play hockey ever again, at first it just felt like a break, like my season had ended and I would be back on the ice soon with my teammates,” says Zac. “But after six months of not playing, it finally hit me that I was never going back to the sport I loved and had played for almost my entire life.”
Zac struggled with chronic anxiety and bouts of depression while he dealt with this news. He also struggled with acclimating to high school. He’d been a straight-A student for years, but he now had trouble concentrating. He also experienced hyperreflexia, meaning his reflexes were overactive and his legs often twitched and bounced.
He decided to try home-schooling as he continued working on his recovery, which included more frequent sessions with Ruth and ongoing monitoring by neurologists in CHOC’s concussion program.
That break from school turned out to be as beneficial for his health as it was for his mind.
“Now I want to help other kids going through this. When I got my concussions, I didn’t know anyone else who had gone through it,” Zac says. “But I want to encourage other kids to be open minded about talking to someone about how you’re feeling, and don’t be stubborn about alternative treatments.”
To fill the void, Zac has taken up lower-impact sports like tennis and golf. He now has time to explore his new interests, like playing guitar and piano. He remains under the care of a CHOC neurologist and continues weekly treatments with Ruth.
“He’s a very resilient kid, but he wouldn’t be where he is today and be back in school without being open to alternative medicine and being able to talk to someone about his sense of loss, and how he was going to move forward,” says Dana.
CHOC Children’s multidisciplinary team of concussion experts can help prevent and treat concussions, as well as help patients ease back in to school and sports. Careful supervision is essential for ...
By Stephanie Prideaux, dietetic technician, registered
Good food is a powerful thing. Take a moment, if you will, to remember the last time you had a bite of something truly amazing. Maybe it was your mom’s apple pie, Abuelita’s Christmas tamales, or something you only eat at the county fair. Did time seem to stop? Did you almost cry? Did it seem to nourish your soul (or inner child)?
This National Nutrition Month®, the Academy of Nutrition and Dietetics is calling on all of us to celebrate food traditions and all the simple pleasures they add to our lives. Eating right is not only delicious and a smart way to live, but something that can be done with infinite creativity. There are more foods and combinations of flavors around the world than we can imagine. Taking part in the traditions of other cultures is easy and very healthy.
Benefits of Intercultural Foods
It is well known that a balanced and varied diet provides benefits throughout life. Foreign foods are no exception. In fact, many ingredients used worldwide are great sources of micronutrients, antioxidants, and other phytochemicals that protect health.
Used extensively in Indian, Middle Eastern and Southeast Asian cooking, the yellow spice turmeric is a good source of manganese and iron. It is currently being researched for its anti-inflammatory properties.
Hibiscus flower tea (or punch) is consumed in Mexico, the Caribbean, southern Europe, the Middle East, India, the Philippines and some parts of Africa. This drink) is high in iron and vitamin C as well as being a good source of vitamin A. The tea’s purple-red color reveals the antioxidant content. It has some documented effectiveness in treating mild hypertension.
Where to Go
When looking to try new flavors, Orange County is an incredible place to start. Many residents have no idea about the cornucopia of flavors, ingredients, and social experiences waiting to be discovered—often right down the street! Check out the list below for a few of the great types of markets in our community where you can explore new flavors.
Mexican Markets- great for fruits, vegetables, herbs, meats, and bulk dried beans, chilies, and flowers.
Asian Markets- great for exotic fruits, vegetables, herbs, meats, seafood, vegetarian items, pickled foods, rice, and noodles.
Middle Eastern Markets- great for fruits, vegetables, fresh beans, bulk spices and nuts, exotic dairy products, lamb, and goat.
Try this easily customizable hibiscus punch recipe for refreshing and sugar-free hydration:
Agua De Jamaica (Hibiscus Water)
2 cups of dried hibiscus flowers (flores de Jamaica) Found in bulk or in packets at Mexican markets.
3 quarts water
Optional Ingredients (to taste):
Fresh ginger slices
Allspice berries, ground or whole
Boil all ingredients, and then reduce to a simmer.
When water is a deep red, strain liquid into a pitcher to remove the flowers—pressing out as much liquid as possible.
Add ice and refrigerate to cool or overnight for best flavor.
Hear more from Dr. Nguyen and Dr. Roche in this podcast.
If you have concerns regarding your child’s eating habits and/or weight, talk to your pediatrician. Ask about the possibility of an eating disorder, and request a referral to a psychologist. CHOC partners with a number of organizations to make sure all our patients’ and families’ needs are met.
In recent times, many parents have turned to martial arts to empower their children against the threat of bullying. Many of these parents view Brazilian Jiu Jitsu as the ideal self-defense method, as it teaches children to use leverage and guile to protect themselves from larger attackers without the need for excessive violence such as punching or kicking.
Unfortunately, like any martial arts activity that involves physical contact, Brazilian Jiu Jitsu increases the risk of a child developing a cosmetic deformity called cauliflower ear. However, contrary to popular belief, cauliflower ear is completely preventable.
Cauliflower ear is caused by direct impact and shear force to the outer ear. This can happen when a child is accidentally struck in the ear by an opponent’s head or elbow. A common result of this injury is damage to the perichondrium on a child’s ear. The perichondrium is a thin layer of tissue that surrounds the cartilage on the outer part of the ear. It is important because it provides the cartilage with its necessary blood supply and nutrients. Injury to the perichondrium also damages the perichondrial blood vessels, resulting in blood filling the space between the perichondrium and the cartilage. This pool of blood creates a problematic condition called an Auricular Hematoma. If this hematoma is not urgently drained, permanent damage to the cartilage will occur. The cartilage will then become thickened and scarred and start to look like the cauliflower vegetable; hence the term cauliflower ear.
Fortunately, there are two effective ways to protect your child from developing cauliflower ear. The first way is through preventive techniques, and the second way is through recognizing the signs of an auricular hematoma.
In terms of preventing cauliflower ear, parents should require their children to wear ear protection at all times during any type of Jiu Jitsu or wrestling activity. Most sporting goods stores sell grappling or wrestling ear guards that provide children with solid protection against any type of ear trauma.
Parents and martial arts instructors should also learn how to immediately recognize signs of an auricular hematoma, which looks like a soft bulge of skin on the front surface of the ear. When pressed, this soft bulge feels like a moderately filled water balloon. The overlying skin on this bulge is often red or purple in color but can also be normally colored.
If an auricular hematoma is recognized, the next step is to have it drained by a surgeon. After drainage occurs, it is important to closely monitor the ear for the re-accumulation of blood, which can happen if the perichondrium does not heal properly after the injury. It is important for the perichondrium to heal so that it can reattach to the cartilage and resume providing the cartilage with its necessary blood supply and nutrients.
To ensure that the perichondrium heals completely, a compression dressing should be applied to the injured ear for one week following the drainage of the hematoma. In addition, the child should avoid engaging in Jiu Jitsu training for at least two weeks. These steps will allow the ear to completely heal.
By Shonda Brown, RD, CNSC, CSP, CHOC Children’s sports dietitian
Water is the most essential nutrient for athletes, yet it’s often forgotten when discussing adequate nutrition for physical activity and improving ...
It can be frightening to hear that your newborn or child has a congenital heart defect and needs surgery. Congenital heart defects are relatively common, affecting about one in every 100 newborns in the United States. Your child’s doctor will often refer you to a heart surgeon if your child needs surgery. But, how do you know if the hospital where the surgery will be performed offers the best heart program for your child?
Not all hospitals that perform pediatric heart surgery are created equal. Infants and children who have heart defects or require heart surgery need to be cared for by a team of highly trained specialists in a facility that is designed to meet their needs. It’s best to do research on the hospital’s heart program, even if the surgeon or hospital has been referred by your child’s doctor.
One of the first things to look for in a pediatric heart program is to determine if the hospital has a specialized program and team of care providers who care exclusively to cardiac patients. Your child needs more than just a general pediatric surgeon and nurses, and adult heart surgeons typically don’t operate on children.
“Surgeons will be the first to tell you that pediatric heart surgery is a team effort,” said Dr. Richard Gates, surgeon-in-chief and medical director of the CHOC Children’s Heart Institute. “When looking for a heart program, look for an intensive care unit devoted entirely to pediatric heart patients, and if there are pediatric heart-focused nurses, anesthesiologists and perfusionists.”
A reputable, high-performing children’s heart program will use only specially trained and board-certified pediatric cardiologists, thoracic surgeons and anesthesiologists, as well as cardiac nurses and perfusionists (people who operate the heart-lung machine during surgery). The program should also have more than one heart surgeon in case an emergency arises and your child’s surgeon is not available.
Also, does your child’s heart program have a dedicated pediatric cardiovascular intensive care unit (CVICU) staffed with board-certified intensivists? A board-certified, pediatric cardiac intensivist has additional training in caring for critically ill children in the CVICU, and specialized CVICUs have been shown to improve patient outcomes and reduce complications.
When researching a heart program, be sure to also check if the hospital reports its heart surgical outcome rates. A reputable hospital will report their outcome rates to the Society of Thoracic Surgeons (STS) for the public to see. STS rates will often be displayed on the hospital’s website, but you can also access these numbers directly from the STS website. Remember, you want your program’s rates to be above the national survival rates.
Other designations to look for are hospital safety awards, such as Top Hospital designation by the Leapfrog Group. Leapfrog’s Top Hospital award is widely acknowledged as one of the most prestigious distinctions any hospital can achieve in the United States. Top Hospitals have lower infection rates, better outcomes, decreased length of stay and fewer readmissions. In 2015, only 12 children’s hospitals in the nation and only two in California earned the respected award.
The CHOC Children’s Heart Institute offers state-of-the-art diagnosis and treatment for an entire spectrum of cardiac conditions. We have assembled an expert team of board-certified pediatric cardiologists, surgeons, intensivists, anesthesiologists, perfusionists, cardiovascular nurse practitioners, respiratory therapists, dietitians, social workers, child life specialists and case managers — all with specialized training and expertise. Learn more about heart surgery at CHOC.
Even through intense water polo training and games, Ashley Klein had never experienced as much as a flutter inside her chest. And suddenly, emergency department staff were using words like heart failure, bypass, transplant and pacemaker.
A routine sports physical showed Ashley had an elevated heart rate, and CHOC Children’s cardiologist Dr. Anthony McCanta ultimately diagnosed her with ventricular tachycardia, a condition wherein her heart beat too fast and pumped blood in a dyssynchronous, or disorganized, way. This caused her heart muscle to weaken and enlarge, a second diagnosis called tachycardia-induced cardiomyopathy.
Though she felt perfectly fine, unbeknownst to Ashley, she’d had a ticking time bomb inside her chest.
“When you read about those poor kids who die suddenly at sports practice, this is that,” Ashley’s mother, Lisa, said. “It was really frightening.”
Ashley’s heart was only pumping out about 13 percent of the blood in its left ventricle. This measurement is called ejection fraction, and a normal heart should pump at least 55 percent. Ashley was at great risk for heart failure, and Dr. McCanta needed to work quickly.
After trying anti-arrhythmic medications, Dr. McCanta opted to correct the problem through radiofrequency ablation. By inserting catheters through Ashley’s leg and up into the heart, he would destroy cells in Ashley’s heart that were misfiring and causing the problem.
But in Ashley’s case, this procedure was especially complicated because of the location of the problem inside her heart.
Dr. McCanta and his team used catheters to create detailed 3-D maps of the inside of Ashley’s heart. The maps revealed the abnormality that was causing the rapid heartbeat was in the ventricle, but near the atrioventricular (AV) node, which sends electrical signals between the upper and lower portions of the heart.
Harming the AV node during the ablation would have resulted in Ashley needing a pacemaker. However, not correcting the ventricular tachycardia would almost certainly increase her risk of severe heart failure and lead to the possibility of needing a heart transplant, Dr. McCanta said.
“This was a risky procedure with very high stakes. Precision was even more important than it usually is,” he said. “During the procedure, I discussed the risks of potential AV node injury versus worsening heart failure with Ashley’s family, and they decided it was more important to take care of it. So, we fixed the problem in a safe way.”
To ensure total accuracy, Dr. McCanta relied on the detailed 3-D heart mapping and a precise radiofrequency burn to ablate the problematic cells. The technology is used in CHOC’s state-of-the-art cardiac catheterization lab.
Within days of her procedure, Ashley’s heart function was almost completely restored and her ejection fraction had increased to about 48 percent.
“Her recovery has been remarkable,” Dr. McCanta said.
After taking the summer off from sports to recover, Ashley, 16, re-joined her water polo team this past fall.
“We are so grateful Ashley was at CHOC,” Lisa said. “Throughout the whole ordeal, we had complete faith in her doctor and knew that, regardless of the outcome, she was being given the best care by the best doctors and nurses. We would not have wanted to be anywhere else.”
Lisa added, “We want to stress the importance of sports physical, which we used to consider tedious. It literally saved our daughter’s life.”
By Janelle Sanchez, RD, clinical dietitian at CHOC Children’s
Whether they are mashed, roasted, baked, or served as pancakes, hash browns, or scalloped, potatoes are a delicious comfort food perfect for this winter season! Today the potato is produced in more than 100 countries and is the fourth largest food crop worldwide, following wheat, corn, and rice.
With more than 4,000 potato varieties, the debate continues as to which is the best.
Russets are classically used for baking, french fries, hash browns, mashed potatoes, and potato pancakes because of their ability to hold together. Waxy potato varieties are best for making chowder, potato salad, and scalloped potatoes. Learn more about cooking with different varieties.
You may be asking, “Are potatoes healthy?” Of course they are! Let’s take a look at their composition:
Carbohydrates– Despite the common misconception that carbohydrates make you gain weight, we know a balanced diet without excessive intake of any food or food group is healthy. That being said, potatoes are primarily composed of carbohydrate, your body’s most important source of energy.
Potassium– Potatoes with skin are packed with potassium, an essential element your body needs. Diets high in potassium may reduce the risk of hypertension and stroke.
Vitamin C– This is important for healthy skin and gums, and may also help support the body’s immune system.
Vitamin B6 –Some of the functions in this extremely versatile vitamin include converting food into glucose to be used for energy, maintaining normal nerve function, and contributing to protein metabolism.
Antioxidants Substances like carotenoids and anthocyanins help prevent the damaging effects of oxidation on cells throughout your body. It is best to include an assortment of colors and kinds of potatoes in your diet, as the amount and types of antioxidants are dependent on the potato variety.
Calories vary depending on the potato variety. For example a large russet potato provides about 300 calories, versus a large sweet potato at 160 calories.
There are a few ways to create a health-conscious potato dish. Choose to bake instead of fry those sweet potato fries, french fries and tater tots. Brush potatoes with a little olive oil and seasonings or herbs to flavor instead of butter. When picking out toppings or additives, select low-fat or nonfat dairy products including cheese, sour cream, cream cheese.
Try these tasty recipes for a healthy way to incorporate potatoes into your family’s diet.
Out with the French Fries, in with the Oven Fries:
2 large Yukon Gold Potatoes, cut into wedges
4 teaspoons extra virgin olive oil (just enough to lightly coat)
½ teaspoon salt
½ teaspoon dried thyme
Preheat oven to 450°F.
Toss potato wedges with oil, salt and thyme (if using). Spread the wedges out on a rimmed baking sheet.
Bake until browned and tender, turning once, about 20 minutes total.
Recipe makes servings. Per serving: 102 calories; 5 g fat (1 g sat, 4 g mono); 0 mg cholesterol; 13 g carbohydrates; 0 g added sugars; 2 g protein; 1 g fiber; 291 mg sodium; 405 mg potassium.
1 (15.5-ounce) can navy beans or other small white beans, rinsed and drained
Heat oil in a Dutch oven over medium-high heat. Add pancetta; sauté 3 minutes. Add onion and garlic; sauté 3 minutes. Add squash and next 6 ingredients (squash through thyme), stirring to combine; cook 4 minutes, stirring occasionally. Add tomatoes; cook 2 minutes. Stir in broth; bring to a boil. Reduce heat; simmer 8 minutes. Add kale; simmer 5 minutes. Add beans; simmer 4 minutes or until potato and kale are tender.
Recipe makes 4 servings. Per serving: 349 calories; 10.4 g fat (3.3 g sat, 4.6 g mono, 1.4 g poly); 10 mg cholesterol; 55 g carbohydrates; 14.4 g protein; 10.5 g fiber; 405 mg potassium