Concussion Program Prescribes At-Home Exercises

Athletes and other adolescents with mild to severe concussions who experience symptoms such as dizziness, feeling unbalanced on their feet, blurred vision or trouble focusing on objects, may be good candidates for at-home visual and vestibular exercises recently designed by experts of the CHOC Children’s concussion program.

“Concussions are like puzzles, and every one is a little bit different,” says Dr. Jonathan Minor, a CHOC sports medicine specialist. “As many as fifty percent of concussed athletes may experience these symptoms and could benefit from these exercises that may get them back on the field or back in the classroom sooner.”

concussion exercises
Dr. Jonathan Minor models one of several at-home exercises recently designed by experts of the CHOC Children’s concussion program.

The convenient and self-explanatory exercises are ones that athletes and students can perform at home, but should only be started under the guidance of a concussion specialist, after an appropriate evaluation, and as part of an overall post-concussion treatment plan. These exercises are intended to enhance and improve a patient’s recovery from a concussion.

“Patients should be aware that beginning these exercises may stimulate some symptoms for a short period of time, such as trouble focusing, dizziness, nausea or headaches. But after just a few days of daily exercises, they may find that they can tolerate each exercise for a longer period of time,” says Minor, who is a lifetime athlete himself.

“We encourage our patients to only perform these exercises for the duration tolerated, rather than endure and push through worsening symptoms initially. Seeing a difference quickly with improved tolerance resonates especially with athletes, who are used to training and then seeing improved results.”

Download your copy of the vestibular/balance exercises and the visual concussion home exercises.

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Get Up and Grill!

By Amanda Czerwin, RD, CLEC, clinical dietitian at CHOC Children’s

Summer is here! And you know what that means- it’s time to get outside and start firing up the grill. Barbequing is a great way to bring your family and friends together and cook up a nutritious meal at the same time. Here are a few tips for your next grilling adventure in order to make a safe and tasty meal.

Before throwing your foods over the fire, make sure your grill is clean and ready to go. Consider using alternative products that may be safer for your environment. Then light up your barbeque and allow it to thoroughly heat up before cooking to kill any lingering bacteria.

Now comes the difficult task of deciding what to cook up! There are plenty of ways to get creative and try something different besides the typical hot dogs and hamburgers. If you’re looking to cook meat, then try choosing some leaner options such as chicken, fish, ground turkey or lean pork chops. It’s important to also avoid charring your meat as much as possible to prevent any carcinogenic compounds from forming. According to the Academy of Nutrition and Dietetics, one of the best ways to prevent this is by trimming any extra fat and skin off your meats before cooking. When fat drippings fall off meats, it can cause flames to flare up, causing extra charring. It’s also recommended to cook your foods over a longer period of time, at lower temperatures to avoid charring. You can also turn your food over frequently while cooking and scrape off any charred areas.

Brighten up your grill with colorful vegetables to add more flavor and nutrition to your meals. Put together delicious vegetable kabobs with veggies like zucchini, onions, cherry tomatoes, mushrooms and bell peppers. And who said burger patties had to be made out of meat? Switch it up one night and try grilling a black bean burger or making your own veggie patties using your favorite finely chopped vegetables.

You can even grill fruits too! Grill fresh pineapples slices and add them to a turkey burger or grill a colorful fruit kabob and add it to a fresh salad. Fresh grilled peaches or bananas added to angel food cake, low-fat ice cream, or whipped cream can also make a tasty treat.

Try cooking up this recipe at your next barbeque!

Quinoa Black Bean Burgers:


  • 1 (15 ounce) can black beans, rinsed and drained
  • 1/4 cup quinoa
  • 1/2 cup water
  • 1/2 cup bread crumbs
  • 1/4 cup minced yellow bell pepper
  • 2 tablespoons minced onion
  • 1 large clove garlic, minced
  • 1 1/2 teaspoons ground cumin
  • 1/2 teaspoon salt
  • 1 teaspoon hot pepper sauce (such as Frank’s RedHot Sauce)
  • 1 egg
  • 3 tablespoons olive oil


  1. Bring the quinoa and water to a boil in a saucepan. Reduce heat to medium-low, cover, and simmer until the quinoa is tender and the water has been absorbed, about 15 to 20 minutes.
  2. Roughly mash the black beans with a fork leaving some whole black beans in a paste-like mixture.
  3. Mix the quinoa, bread crumbs, bell pepper, onion, garlic, cumin, salt, hot pepper sauce, and egg into the black beans using your hands.
  4. Form the black bean mixture into 5 patties.
  5. Heat the olive oil in a large skillet.
  6. Cook the patties in the hot oil until heated through, 2 to 3 minutes per side.

Recipe via

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Meet Dr. Jennifer Ho

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Jennifer Ho, a pediatric hospitalist. Dr. Ho attended UC Irvine School of Medicine and completed her pediatric residency at CHOC. She has been on staff for six years and is a member-at-large of the Medical Staff Executive Committee and member of the Medical Staff Performance Committee at CHOC Children’s at Mission Hospital.

Dr. Jennifer Ho

Q: What are your special clinical interests?
Care of the hospitalized pediatric patient, infectious diseases, evidence-based medicine and optimization of the electronic health record.

Q: What are some new programs or developments within your specialty?
A: I am excited that the field of pediatric hospital medicine is growing and will soon be a nationally board-certified recognized specialty.

Q: What are your most common diagnoses?
A: Asthma, bronchiolitis, dehydration and seizures.

Q: What would you most like community/referring providers to know about you/your division at CHOC?
A: We now provide 24/7 attending coverage in the hospital at both CHOC Orange and CHOC Mission to ensure the highest quality of care for Orange County children. We pride ourselves on communication and are always available to help facilitate transition of care.

Q:  What inspires you most about the care being delivered here at CHOC?
A: As a mother of two young children, it is very comforting to know that if they ever need medical care, CHOC provides the highest quality of care in a family-friendly environment.

Q: Why did you decide to become a doctor?

A: I decided to become a doctor when I was diagnosed with a heart problem in high school. I thought the human body was fascinating and I wanted to be able to help patients through their problems and get the most out of life.

Q: If you weren’t a physician, what would you be and why?
A: I would own a used bookstore with an attached coffee shop and spend my days reading old books and drinking coffee.

Q: What are your hobbies/interests outside of work?
A: Being a mommy to my two little kids, being outside, reading and playing volleyball.

Q: What was the funniest thing a patient told you?
A: From a 3-year-old girl: “I want to be a doctor like you … but only for unicorns and fairies.”

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Should you talk to young children about tragic events?

When it comes to discussing tragedy with young children, honesty might not always be the best policy, a CHOC Children’s psychologist says.

“Shielding them from any exposure should always be the first effort,” Dr. Mery Taylor says. “Children can be unpredictable about how they may respond to information, and even events far away can trigger a stress response.”

Given the potential short- and long-term consequences of coping with a trauma, parents should consider the proximity of the event and whether the child truly must know about specific current events.

But sometimes shielding children from tragic events can be difficult. Dr. Taylor recommends that parents who are considering discussing a tragedy or trauma with a child consider some other factors:

  • Proximity of the event: When a tragedy occurs close to home, it may be more difficult to control what the child might see or hear. And even if unaware, children still might sense tension and anxiety from adults around them.
  • Your partner: Discuss together your concerns and plans to ensure consideration of the different angles, but also so that you both are on the same page and presenting a consistent message. You may want to involve grandparents or caregivers to ensure that your desired approach is followed by those involved in your child’s care.
  • Siblings and older playmates: If your young child is around much older children, consider the likelihood that she may hear something frightening. In these cases, it may be helpful to inoculate her by going ahead and giving her some minimal information while keeping her developmental age in mind. You can always go back and answer more questions as they come. It is not recommended to ask an older child (8 to 12 years old) to not talk about the event with their younger sibling. This would likely only pique their curiosity.
  • Your child’s personality: All children are different. You know your child best. Is she likely to be scared by tragic new more than most children? Or is she the kid who would likely go explain the event to her class? Let her personality help guide your decision.
  • Media: School, other children, television, computers and smartphones may lead to your children knowing more that you think. Be sure to ask about their day; let them know you are there for them; and notice changes in behavior or mood that might be an indication that they may have heard something that doesn’t make sense in their world.

Should parents opt to discuss tragic events with children, or should the child already be aware of the circumstances, Mental Health America offers ways parents can talk to their children about tragedy-related anxiety and help them cope:

Quick tips for parents

  • Children need comforting and frequent reassurance of their safety.
  • Let your child lead the discussion and only answer questions that they ask.
  • Be honest and open about the tragedy or disaster using age-appropriate language. This may take the form of very simple and concise language.
  • Encourage children to express their feelings through talking, drawing or playing.
  • Try to maintain your daily routines as much as possible.
  • Monitor your own anxiety and reactions to the event.

Preschool-aged children

  • Reassure young children that they’re safe. Provide extra comfort and contact by discussing the child’s fears at night, telephoning during the day, and providing extra physical comfort.
  • Get a better understanding of a child’s feelings about the tragedy. Discuss the events with them and find out their fears and concerns. Answer all questions they may ask and provide them loving comfort and care.
  • Structure children’s play so that it remains constructive, serving as an outlet for them to express fear or anger.

Grade school-aged children

  • Answer questions in clear and simple language.
  • False reassurance does not help this age group. Don’t say that tragedies will never happen again; children know this isn’t true. Instead, remind children that tragedies are rare, and say “You’re safe now, and I’ll always try to protect you,” or “Adults are working very hard to make things safe.”
  • Children’s fears often worsen around bedtime, so stay until the child falls asleep so he or she feels protected.
  • Monitor children’s media viewing. Images of the tragedy are extremely frightening to children, so consider significantly limiting the amount of media coverage they see.
  • Allow children to express themselves through play or drawing, and then talk to them about it. This gives you the chance to “retell” the ending of the game or the story they have expressed in pictures with an emphasis on personal safety.
  • Don’t be afraid to say “I don’t know.” Part of keeping discussion of the tragedy open and honest is not being afraid to say you don’t know how to answer a child’s question. When such an occasion arises, explain to your child that tragedies cause feelings that even adults have trouble dealing with. Temper this by explaining that adults will still always work hard to keep children safe and secure.


  • Adolescents may try to downplay their worries, so encourage them to work out their concerns about the tragedy.
  • Children with existing emotional problems such as depression may require careful supervision and additional support.
  • Monitor their media exposure to the event and information they receive on the Internet.
  • Adolescents may turn to their friends for support. Encourage friends and families to get together and discuss the event to allay fears.

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How to Avoid or Treat Bee Stings this Summer

As families spend more time outdoors during summer months, parents and other caregivers should be aware of the hazards related to bee stings, and how they can help prevent a child from being stung, a CHOC Children’s pediatric allergist says.

Bee stings can be quite common, and don’t usually lead to a serious reaction, says Dr. Wan-Yin Chan. However, there are several things parents can do to help prevent bee stings:

  • Keep food and drink containers closed when outdoors.
  • Wear shoes, socks and gloves when working outdoors.
  • Hire an exterminator to remove hives and nests around your home.
  • Avoid wearing brightly colored clothing or perfume.
  • Remain calm and walk away if you spot stinging insects.

If your child is stung by a bee, remove the stinger as soon as possible because venom can continue to be released for several seconds, says Chan. There is no special technique, but you can try flicking the stinger out as this prevents compressing the venom sac.

The most common reaction from a bee sting is a local reaction that consists of redness and swelling at the site of the sting that usually resolves within a few hours, but may last up to a day or two.

About 10 percent of people develop large local reactions, characterized by redness and swelling that increases in size over 1 to 2 days and can measure as large as 10 centimeters in diameter.  This type of reaction typically resolves over five to 10 days.

There are several ways to treat bee stings at home, says Chan. For small local reactions, try cold compresses.

For large local reactions, in addition to the cold compresses, you can elevate the limb if the sting is on an extremity.  Nonsteroidal anti-inflammatory drugs such as ibuprofen can help relieve pain, and oral antihistamines or topical steroids can help relieve itching.

Anaphylaxis, a severe and potentially life-threatening allergic reaction in response to insect stings, occurs in less than one percent of children and in three percent of adults.

Seek emergency medical attention if your child experiences any of the following symptoms of anaphylaxis:

  • Hives
  • Flushing
  • Swelling of the face, throat or tongue
  • Hoarse voice
  • Difficulty breathing
  • Shortness of breath
  • Wheezing
  • Dizziness
  • Nausea
  • Vomiting
  • Diarrhea
  • Loss of consciousness

Also seek immediate medical attention if there are any signs of infection, which include fever, redness, swelling at the sting site, or worsening pain three to five days after the sting. For infection, your child’s pediatrician might prescribe antibiotics.

For anaphylaxis, the patient will be given at least one dose of epinephrine, also called adrenaline, which can help constrict blood vessels in order to increase blood pressure, reduce wheezing, improve breathing, and work to reduce hives and swelling, says Chan.  A second dose may be required if the first dose is not effective. Because a severe allergy reaction can last for hours, patients should be monitored for several hours after administration of epinephrine.

A commonly prescribed epinephrine injection, is typically only prescribed when there is a history of anaphylaxis.  If the reaction was a local reaction, it is not necessary to carry an epinephrine injection.

If your child has a history of anaphylaxis to bee or other insect stings, ask your pediatrician about a referral to an allergist/immunologist, who can provide further evaluation and allergy testing.  If allergy testing is positive, patients may be treated with allergy shots, which can almost completely eliminate the chance of a severe reaction if they get stung again.

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Meet Dr. Andrew Mower

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Andrew Mower, a pediatric neurologist. Dr. Mower attended medical school at St. George’s University School of Medicine, completed a residency in pediatrics at Maimonides Medical Center, and another residency in child neurology State University of New York Downstate. He completed a fellowship in clinical neurophysiology at Columbia University. Dr. Mower sits on CHOC’s quality improvement committee and is part of CHOC’s ancillary and diagnostic services. He has been on staff at CHOC for two years.


Q: What are your special clinical interests?
A: Epilepsy and epilepsy surgery

Q: What are some new programs or developments within your specialty?
A: Stereotactic EEG for epilepsy surgery

Q: What are your most common diagnoses?
A: Epilepsy and headaches

Q: What would you most like community/referring providers to know about you or your division at CHOC?
A: We take on the most challenging epilepsy cases to search for cures, and, if not, at least an improvement in the child and family’s quality of life. We work together as a team to use all of our expertise to help the child and family.

Q:  What inspires you most about the care being delivered here at CHOC?
A: I feel that we offer families hope when hope had been abandoned before.

Q: Why did you decide to become a doctor?
A: I decided to become a doctor to help people in need. I chose neurology as my specialty because I had a fascination with the nervous system and wanted to break misperceptions that little can be done for patients with neurological problems.

Q: If you weren’t a physician, what would you be and why?
A: Farmer. I love the accomplishment of creating a garden and growing produce.

Q: What are your hobbies/interests outside of work?
A: Gardening, running and hiking

Q: What was the funniest thing a patient told you?
A: “I don’t eat apples, doctor.”


“Because they keep the doctor away, and I like you, Dr. Mower.”

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How New Tobacco Laws Affect Your Teen

Roche, Alexandra

By Dr. Alexandra Roche, CHOC Children’s pediatrician

Under recent legislation, California has raised the age of legal sale and use of tobacco products from 18 to 21 years of age, effective June 9 (with an exemption for military personnel). Other important changes to the current laws include aligning e-cigarette location use with that of regular cigarettes: schools K-12, restaurants, hospitals and work-places must be completely tobacco-free, and that includes e-cigarettes.

Already, California has some of the strictest tobacco regulations in the country, and one of the lowest rates of tobacco use (13 percent) among adults. However, nationwide over 40 million people smoke regularly, and tobacco accounts for one in five deaths every year. Nine out of 10 smokers started smoking before the age of 18. This is a crucial time for adolescent brain development, and the adolescent brain is particularly vulnerable to the addictive effects of nicotine. Every day, our teens are bombarded with advertisements highlighting the ‘cool’ factor of e-cigs and vaping; these images can easily be found in magazines, on the internet, on billboards, and in movies.

While traditional cigarette use by teens has decreased – a drop from 4.5 percent to 2.3 percent between 2011 and 2015- , statistics on e-cigarette use are quite sobering. In the same time period, e-cigarette use among teens jumped from 1.5 percent to 16 percent! Even more unsettling, 5.3 percent of middle schoolers are using e-cigarettes on a regular basis. Adolescents and pre-teens are easily persuaded by catchy advertising; with e-cigarette devices sold in a variety of rainbow colors and intriguing flavors such as gummy bear, juicy peach, and chocolate, it is easy to see why teens might be interested in these products, but the long term health effects can be devastating. While the new California regulations do not directly tackle advertising, they take a tremendous leap forward in limiting the access of these products to our youth.

Parents can also help their children make smart choices by modeling good behavior. If you smoke yourself, consider quitting. If you are using e-cigarettes as a way to cut back on your personal tobacco use, be sure to let your children know the harmful effects of nicotine and why you are trying to quit. Limit the use of these products when with your children, and be sure to store the liquids far away from young children’s inquisitive hands! You can seek help for yourself, or your child or teen, by speaking with your physician or calling 1-800-QUIT-NOW.

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What to Say to Your Kids About Politics

With election season here, it’s hard to miss the onslaught of media coverage and chatter about political issues and candidates. While this is an important time for our country, it can be a bit overwhelming for parents and even children.

According to, if you think your child is probably not interested in these issues, think again. More than 2,000 kids and teens throughout the United States were asked what they thought about recent presidential elections and how they might affect them. A whopping 75 percent of kids and 79 percent of teens answered “yes” when asked whether they thought that the outcome of an election would change their lives.

Mery Taylor, a CHOC Children’s pediatric psychologist, says it’s important to talk openly about the election with your kids in an age-appropriate way.

“Ask your kids what’s important to them,” says Dr. Taylor. “Above all, it’s important to be loving and reassuring.”

Dr. Taylor offers the following tips when talking about politics:

  • Acknowledge your children’s feelings. Ask what they feel and why. Listen closely and try to connect with your child’s emotions before problem solving. If they have concerns or fears about a particular issue or how it may affect your family, reassure them that they are safe and that your family will work out any issue together.
  • Keep the conversation light and positive. Focus on the positive aspects of a candidate or an issue. Take this opportunity to explain to your kids how to voice their opinions with respect, even when he/she doesn’t agree with someone else. Talk about what you believe and why in a respectful way, too.
  • Talk about the election process. Talk to your kids about the importance of voting and how the process works. Explain to them that everyone has a voice. While they may not be able to vote, encourage your kids to get involved at school or in the community, with issues that are important to them, such as the environment or the economy, for example. Let them know their contributions can make a big difference.

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Choosing the Right Over-the-Counter Medicine for your Child’s Allergies

By Melody Sun, clinical pharmacist at CHOC Children’s

Allergy season is a time of stuffy noses, itchy eyes, and lots of sneezing. When these symptoms cannot be managed with lifestyle habits, non-prescription or over-the-counter medications may help. However, there can be an overwhelming variety of over-the-counter medications for the same issue, so how do you choose one? Here are some tips on finding the appropriate non-prescription medication to manage allergy symptoms. For children, you should check with your provider or pharmacist prior to starting any new medication.

  1. How to read the Drug Facts label.

The Drug Facts label is the black and white box on the back of the packaging. The information is broken down into:

Section What does it mean?
Active ingredient(s) The medication name for specified symptoms.
Purpose This is the active ingredient’s action. For example, “antihistamine” helps with allergy symptoms.
Uses The product may help treat some of the general symptoms listed under this section. For example, sneezing and itchy eyes.
Warnings This includes when to avoid this medication. Certain activities or other substances require you to be more careful due to side effects of the medication, which are also listed in this section.
Directions Details on who, how much, and how often to take the product.
Other information How to store the medication appropriately.
Inactive ingredients These ingredients do not treat the symptoms. Avoid this medication if you are allergic or have restrictions to any of these components.
  1. What active ingredients are used for allergies?

There are oral products, nasal sprays, and eye drops that are available to manage allergy symptoms.

Active ingredient Purpose Symptoms treated
Itchy eyes Runny eyes Itchy nose Runny nose Stuffy nose Itchy throat
Oral products
Chlorpheniramine, Diphenhydramine Antihistamine

(more sedating)

Cetirizine, Loratadine, Fexofenadine Antihistamine

(less sedating)

Phenylephrine, Pseudoephedrine Nasal Decongestant
Nasal sprays
Oxymetazoline* Nasal Decongestant
Budesonide, Fluticasone, Triamcinolone Glucocorticoid, Allergy symptom reliever
Cromolyn sodium** Nasal allergy symptom controller
Eye drops
Ketotifen, Naphazoline with Antazoline/Pheniramine Antihistamine

*Prolonged use can lead to worsening congestion.

** Takes 4-7 days to work. Not for immediate relief of symptoms. Must be taken regularly.

  1. Choosing the product.

When reading the drug facts label, make sure that the listed active ingredients treat a symptom you have. Avoid selecting a product that contains an active ingredient for a symptom you are not experiencing. Depending on the extent of your symptoms, a certain type of product may be more useful. Oral products work throughout the body, whereas nasal sprays and eye drops are great for local symptoms. Additionally, if local symptom management (for example, eye drops) still does not control the itchy eyes, using both eye drops and oral products can be more helpful.

If you have questions about the product, talk to your doctor, pharmacist, or other health care professional.

For more information, visit Understanding Over-the-Counter Medications from the FDA.

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No more wire bristles! Keeping your family barbecue safe

With cook-out season in full swing, CHOC Children’s safety experts caution parents to be mindful of an unexpected danger lingering long after the hamburgers are eaten and the grill has cooled.

Bristles from metal brushes commonly used to clean grills can fall off onto the grate and later become lodged into food. Ingesting these tiny metal fragments can cause damage to the throat and digestive track, says Amy Frias, a CHOC community educator and Safe Kids Orange County coordinator.

If parents suspect their child has ingested these remnants, they should seek medical attention immediately.

Parents can avoid this risk by relying on alternate methods and tools to clean up after grilling, Amy says. A host of alternative products are available, including grooved wooden planks that scrape off char; brushes that use scouring pads; pumice stone-like cleaning blocks; and nylon-bristle brushes.

A more natural method uses a halved onion, Amy says. Pierce the vegetable with a barbecue fork and rub the onion’s flat end across a very hot grill. This method should easily remove debris and dirt.

Barbecue tools aren’t the only safety risks when it comes to grilling, Amy says. To ensure the entire family stays safe, she offers a few other tips:

  • Location: Keep the grill away from high-traffic areas and enclosed spaces, such as eaves, overhead tree branches and deck railings. Never grill indoors or in a tent.
  • Perimeter: Create a 3-foot child- and pet-free zone around the grill.
  • Heat sources: Keep matches and lighters away from children. Take caution when using lighter fluid, and never add more fluid to a lit fire.
  • Thorough cleaning: More than the grill’s grate needs to be cleaned. Periodically remove grease from the trays below the grill to prevent fires.
  • Supervision: Never leave cooking food unattended.
  • Tools: Use long-handled grilling instruments to keep the chef at an appropriate distance from flames.
  • Wardrobe: Close-fitting clothes and pulled-back hair are always fashionable and safe when grilling.

Get more safety and wellness tips and learn about education classes offered by CHOC’s community education department.

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