Preparing Your Child for an Active Shooter Scenario

Chances are you have taught your children what to do in emergencies, such as fires and earthquakes.  But what about an active shooter scenario?  According to Deputy Mike Perez, SWAT Team Leader in the Orange County Sheriff’s Department, parents should teach their children, particularly older kids who may not always be supervised, what to do if they are faced with an active shooter.  While details will vary based on a child’s developmental age, parents need to be honest and consider the basic premise of Run, Hide, Fight, says Perez.


Teach children to do anything they can to quickly get away from the situation.  Leave belongings behind.  Families should agree on a word that promptly gains the attention of children, who should drop whatever they are doing and follow mom and dad. Perez encourages parents of teens to talk to them about ignoring any tendencies to explore loud noises or disturbances.  “In today’s world of camera phones, teens tend to gravitate to situations they think make for great video footage or social media fodder, when they should really be removing themselves from any potential harm,” explains Perez.


If children are unable to run away, the next best option is to hide. If possible, take extra precautions to create the appearance of a deserted area by turning off lights or closing blinds. Lock doors and create barricades.  If there’s no hiding place, stay as low to the ground as possible and remain still.

Turn cell phones on silent and turn down the screen brightness. Even a vibration could give away a hiding place. Leaving the phone on allows the user to communicate to law enforcement, if it’s safe to do so.


As a last resort— and only if in imminent danger— individuals who are physically able to should attempt to disrupt or incapacitate the shooter, says Perez.

Other tips for parents:

Be aware of the emergency plan at your child’s school, and make sure your child knows what to do. For safety reasons, administrators may not be able to provide all details of the plan, but should be able to provide you with enough to feel confident. Ask local law enforcement if the school’s plan coincides with what they recommend.

Kids and teens should be aware of their surroundings at all times, and notice if anything stands out. If something looks suspicious or just doesn’t feel right, they should alert a trusted teacher or adult.

Teach children to always look for the nearest exits.  Knowing this information for frequently visited locations may actually reduce fear and anxiety when emergencies arise, shares Perez.

No matter their location, tell kids to remember that help will be on the way.

For more information, watch a short video by the Department of Homeland Security.

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Controlling Seizures with the Ketogenic Diet

Some children who have uncontrolled seizures may benefit from a special way of eating called the ketogenic diet. The diet consists of foods that are high in fat and low in carbohydrates, a combination that helps the body produce ketones which can help minimize seizures. The treatment is very specific and carries some risks, so a child should be monitored closely by a dietitian while on the ketogenic diet.

In this episode of CHOC Radio, clinical dietitians Jessica Brown and Lindsay Rypkema explain:

  • How the ketogenic diet works and who may benefit from it
  • Ways to maintain adequate nutrition while on the diet
  • Sample recipes and ways to alter favorite meals to the plan
  • Current research that considers whether other conditions, like tumors, could be managed by the ketogenic diet
  • How CHOC is assisting families in adapting the ketogenic diet for their child.

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When Animals Attack: Preventing, Treating Pet Bites

On average, at least one patient is treated daily at the Julia and George Argyros Emergency Department at CHOC Children’s for household pet bites, and those numbers are expected to increase when warmer weather arrives, a CHOC clinical educator says.

Activities often associated with the spring and summer months such as outside play, more frequent trips to dog parks and visits to other areas with different wildlife make animal bites more common this time of year, says Sheryl Riccardi, registered nurse and clinical educator.

Though the force of a dog’s jaw and bite can be very damaging, cat bites are especially dangerous, she says. Their threat is often underestimated given felines’ smaller physical sizes, but cat bites are more prone to infection because felines’ mouths have greater quantities of bacteria.

pet bites

But no matter the animal or bite size, parents of children who are bitten should see their pediatrician or emergency department immediately after thoroughly washing the wound with soap and water, Riccardi says.

“Bites can cause cellulitis, which is an infection,” she says. “Infection causes swelling and increased pressure on the tissue, which could possibly lead to more serious tissue injury.”

While at the pediatrician’s office or ED for bite treatment, patients and families can expect clinicians to further wash the wound to prevent infection, as well as the possibility of stitches, if needed. Depending on the type of animal, antibiotics may be administered.

And if parents or clinicians have any reason to suspect the offending animal has rabies, preemptive care will be administered. Treatment entails a series of shots over the course of several days.

Snake bites should be handled in the same manner as those from cats or dogs, Riccardi says: Clean the wound, seek immediate medical attention, and administer basic first aid while awaiting help. Do not attempt to remove the venom from a wound.

Like all injuries, prevention is critical when it comes to animal bites. Be watchful for snakes while outside, paying special attention during dusk, dawn and evening hours when the nocturnal animals may be stirring.

Parents must teach children to exercise caution around all animals – even those in their family. Respect animals’ personal space and moods to prevent bites.

“Don’t let your child get in your dog’s face,” she says. “The bottom line is that dogs and cats are animals. It’s unfortunate, but they are unpredictable and can bite.”

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Living with Hemophilia: Nick’s Story

Nick Carebetta is an active 31 year old.  When he’s not busy managing a restaurant, he’s surfing, running or hiking.  The athlete has completed numerous half marathons and three Spartan races.  To friends and family, he’s the picture of perfect health.  In fact, people may be surprised to know Nick has hemophilia A.

A disease that prevents blood from clotting properly, hemophilia A is caused by a deficiency of a clotting protein called factor VIII.  Nick’s case is considered severe.  Patients like Nick bleed longer after an injury, and may have frequent spontaneous internal bleeding episodes in their joints and muscles.

Diagnosed with the disease when he was 3 months old, Nick experienced several bleeding episodes in his left ankle.  The pain and inflammation impacted his mobility, which left him dependent on crutches for much of his childhood.

When he was 13, he underwent a procedure called radioactive synovectomy. A small amount of Yttrium, a radioactive material, was injected into Nick’s ankle to reduce the number of cells in the joint lining.  This reduction leads to decreased inflammation, and hopefully less pain and more movement.  Yttrium is used due to its low radioactive energy levels and its ability to leave the body quickly. Nick had the procedure performed twice.  About four months after the second injection, Nick’s bleeds stopped; his pain dissipated; and his mobility returned.

Today, Nick manages his disease with help from CHOC Children’s hematology team.  During his annual check-ups, he meets with a physician, physical therapist, psychologist and nurse coordinator.

“I am so impressed with the compassionate and comprehensive care I receive at CHOC.  From the physicians, who are highly regarded in their field, to the psychologists, who care about my mental well-being, the entire team is dedicated to making sure their patients live happy, healthy and fulfilling lives, despite their disease,” says Nick.

Living with hemophilia

There is currently no cure for hemophilia.  Treatment includes clotting factor replacement therapy.  Nick gives himself shots of a clotting factor, called factor VIII, three times a week.  Depending on his level of activity, he may adjust his dose.  He also follows instructions from his CHOC care team to preserve his joint mobility and core muscle strength.  He doesn’t let his treatment or his disease interfere with his life.

“Nick is setting an example for all of our patients that hemophilia does not define who he is.  He chooses to be more,” says Dr. Amit Soni, CHOC hematologist.  “In addition to his active lifestyle, he is passionate about theater and the arts, and is leading the restoration effort of a historic theater.  He’s also incredibly altruistic in his efforts to give back to the community, whether through participating in clinical trials to advance hemophilia care for the next generation to raising money by joining in the CHOC Walk.”

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Social Services Available to CHOC Families

In honor of National Social Work Month, we spoke to Mitzi Bennett, manager of the social services department at CHOC Children’s. Mitzi has been a social worker at CHOC for more than 20 years and, with her team, works directly with patients and families in a variety of settings.

Q: What should patients and families know about social services?

A: People seek out our services for a variety of reasons depending on their unique needs, but many aren’t aware of the full spectrum of ways we can help them. We offer supportive counseling, crisis intervention, we collaborate with medical team and community services, and we provide support groups, referrals, advocacy and education.

Q: Why did you want to become a social worker?

A: Most social workers found the field of social work because they were interested in helping and caring for others.   The compassionate and knowledgeable social services team at CHOC is able to help people that are struggling with the unexpected.  We see families at some of their most worrisome and stressful times.  Social workers are able to help support patients and families through difficult or scary situations.

Q: What part of being a social worker are you most passionate about?

A: The social workers at CHOC really value being an integral member of the multi-disciplinary patient care team. We partner with physicians, nursing, child life specialists, and other specialists at CHOC who value the importance of a team approach. Each of our different specialties work together to help each patient, and the diverse perspectives we bring to the team help accomplish that.

Q: How does our social services team support CHOC’s commitment to Patient & Family Centered Care?

A: Supporting patients and their families is at the cornerstone of our philosophy as social workers. We partner with families to find out what is most important to them.  We help facilitate change in a patient’s situation that will ensure their safety and well-being.  We promote communication between the patient and family and the treatment team.  We value and respect each family, and promote care and understanding that is respectful.

Q: What advice would you offer someone considering pursuing a career in social work?

A: At our core, we must be very understanding and patient. We understand that someone may be having a very difficult or traumatic experience that led them to come to CHOC, and we are respectful of all patients’ unique situations. Our student program trains and educates new social workers coming into the field. Second year graduate students learn from our staff and then work directly with patients and families under the guidance and direction of their field instructor.  They are able to work and learn in different areas of the hospital.

Learn more about CHOC’s social services department. Any member of the health care team, a patient, or their parent/caregiver can request a social services consultation by calling 714-509-8521.


What’s Causing your Child’s Headaches?

By Dr. Nancy Shan, pediatric resident at CHOC Children’s

Headache complaints can be bewildering and frightening to many parents. Most are caused by a benign (simple) problem or primary headache disorder. Very rarely are headaches a sign of a serious underlying condition. Headaches are more common in boys than girls under 7 years of age, but the gender prevalence changes around puberty.

Headaches are often referred to as either primary or secondary. Primary headache disorders include migraines, tension headaches and chronic headaches. Tension headaches are the most commonly diagnosed type in children. Chronic daily headaches are defined as at least 15 days of headache in one month.

Secondary headaches are those caused by an underlying medical issue. Of children who are seen in the emergency department for headaches, the most common culprit is an acute febrile illness, like the common cold, the flu, or sinusitis. Typically, these headaches will go away when the illness resolves. Rare causes of secondary headaches occur when there is elevated pressure in the brain, which can be due to increased cerebrospinal fluid (CSF), a space occupying process (infections and brain tumors), pseudotumor cerebri, and low intracranial pressure (from leakage of CSF). Medication overuse headaches are due to excess use of medication to manage headaches. It is recommended that patients use medications such as ibuprofen or acetaminophen no more than three times per week to help prevent overuse headaches.

Children with uncorrected vision can experience headaches due to prolonged eye strain. After age 6, children with vision screens worse than 20/30 should be referred to an optometrist, who can conduct an evaluation to see if the child requires glasses. If it is recommended that your child wears glasses, make sure they do so regularly!

Other possible causes of recurrent headaches are listed below, and can be remembered with the mnemonic “SMART,” which was created by pediatric neurologist Dr. Heidi Blume:

  • S is for sleep. Not enough sleep and too much sleep (or any disruption to a regular sleep schedule) can cause headaches. Children in school should get between 8-10 hours of sleep every night
  • M is for meals and eating at least three full meals a day. As children get older and school starts earlier, many begin to skip breakfast. If there is no time for a sit-down breakfast, having a granola bar, a cup of yogurt or even some fruit on the go is better than nothing. Hydration is also important. A simple way to check hydration is to look at urine color: it should be clear.
  • A is for activity, and believe it or not, too little or too much activity can lead to headaches, although typically it is the former that ails children. Children should be getting at least one hour of physical activity (outside of school regulated gym class) every day.
  • R is for relaxation. High schoolers begin to experience an exponential amount of stress from schoolwork, peer pressure, and post-high school planning.
  • T is for avoiding any known triggers, which can be specific foods, smells or environments.

Typically, the cause of headaches will not be found at the initial doctor’s visit. After a careful history and a thorough physical exam to exclude any causes of secondary headaches, children and families are encouraged to keep a headache diary. Entries should be as specific and descriptive as possible regarding each headache episode.  The diary should then be brought to follow-up appointments, usually within 2-3 weeks of the initial examination. Between visits, patients are encouraged to use the “SMART” mnemonic to optimize their daily routines.

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Trisomy Awareness Month: What Parents Should Know

In honor of National Trisomy Awareness Month, we spoke to a team of genetic counselors from CHOC Children’s Metabolic Clinic.  ‘Tri’ refers to three, and ‘somy’ refers to ‘body’ or in this case chromosome- therefore, individuals with a trisomy have an extra chromosome in some or all of their cells, which affects development. Trisomies can occur on any chromosome, and are named for the chromosome for which the extra copy appears. The most common trisomies are Trisomy 21 (Down syndrome), Trisomy 18 (Edwards syndrome) and Trisomy 13 (Patau syndrome).

Healthy babies have 23 pairs of chromosomes, tiny rod-shaped structures in the nucleus of almost every body cell. Each parent contributes half of their child’s 46 total chromosomes. Sometimes random genetic events occur during the formation of eggs and sperm in healthy parents and lead to a child getting an extra copy of a certain chromosome, for a total of 47 chromosomes.

A trisomy is not usually passed down from generation to generation, but rather is the result of two chromosomes sticking together at the time of cell division. This is called non-disjunction, and leads to the baby having an extra chromosome for a specific chromosome pair. Chromosome trisomies can be detected during pre-natal diagnostic testing, but may be detected in the baby’s blood after birth as well, says Kate Partynski, a board-certified genetic counselor in CHOC’s Metabolic Clinic.

CHOC’s genetic counselors, geneticists and other specialists are equipped to help these patients and their families, by providing information, resources and support.

Trisomy 21- Down syndrome

The most common trisomy is Down syndrome, which occurs in one in 733 births. Children with Down syndrome require multidisciplinary care teams to address their unique health care needs and developmental challenges that may include heart defects, intestinal malformations, visual impairment, hearing loss or other conditions.

Because Down syndrome is associated with mild to moderate intellectual ability, early intervention is essential to maximizing the potential of each child, says Karen Leydiker, a board-certified genetic counselor in CHOC’s Metabolic Clinic.

CHOC’s Down syndrome program bridges community services and clinical specialists to ensure the unique needs of each patient are met. The program works in tandem with the Down Syndrome Association of Orange County to provide parents and families access to a comprehensive range of resources, including parent mentors, information for expectant parents and sibling support groups.

Trisomy 18- Edwards syndrome

Trisomy 18, also known as Edwards syndrome, is the second most common human trisomy and occurs in 1 out of every 6,000 pregnancies. This is caused by having three copies of chromosome 18 instead of two. Half of these affected pregnancies will survive to term, and approximately 10 percent of children born with this condition may survive until 1 year of age, with the majority passing away within the first few weeks of life. The high mortality rate is due to complications from brain abnormalities, congenital heart defects, kidney defects and other congenital anomalies, according to Leydiker. For those babies who do survive their first year, it does become a possibility that they can live for several years, but will be expected to be severely developmentally delayed and require multiple organ system support.

Trisomy 13- Patau syndrome

The third most common human trisomy, Patau syndrome, occurs once in every 10,000 births and is caused by having three copies of chromosome 13 instead of two. Babies with this condition have severe structural brain abnormalities, cleft lip, cleft palate, eye abnormalities, heart defect, and due to the severity of the condition rarely live beyond the first few weeks of life. A small percentage of children with this trisomy will survive their first year but are all severely developmentally delayed and require multiple organ system support.

Support Organization for Trisomy provides resources for expectant parents, sibling support, and grief resources for families of children with Trisomy 18 or Trisomy 21.

Genetic counseling resources

CHOC genetic counselors are available to meet with families expecting a child with a genetic condition. “Parents may need time to grieve the loss of the child they thought they would have, and prepare themselves for a different parenting journey than they originally expected,” says Leydiker.

Genetic counseling appointments are not limited only to parents, but are open to family and friends who may have questions about their soon-to-be family member’s condition, or want to learn more.

“A genetic counselor’s role is to provide information and support to parents during what can be a confusing and challenging time,” explains Leydiker. “We try to meet parents where they are emotionally, and provide support and resources in a safe, non-judgmental environment.

“As part of our counseling sessions, we often share a poem with parents called ‘Welcome to Holland’ that tells the story of someone who expected their vacation to take them to Italy, a place they had long dreamed of going. But the plane drops them off in Holland, which is just as beautiful, but very different than what they expected.”

To make an appointment with a genetic counselor, visit the National Society of Genetic Counselors website and select the “Find a Genetic Counselor” tool to find genetic counselors and genetics clinics in your area.

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Overcoming the Struggles of Picky Eating

Picky eating is very normal for children, particularly in toddlers who have a natural fear of new foods. In fact, research shows that most kids get appropriate nutrition regardless of their eating habits. But that may not ease the minds of parents who struggle daily with a picky eater or who worry their child isn’t getting the right nutrition.

In this episode of CHOC Radio, clinical dietitian Jessica Brown and social worker Leigh Volker explain:

  • When picky eating is normal and when it is cause for concern
  • How parents can make sure their children are meeting their nutritional needs
  • Techniques for getting kids to try new foods
  • How to make meal times less of a struggle
  • Ways to overcome eating problems that remain after a related medical condition is resolved.

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Local Businessman Shares Why CHOC Follies Is A Must-See Show!

Known as one of Orange County’s most unique and popular fundraisers, the CHOC Follies is back again with the newest musical production, “Carly and the Choco Factory: An Orange County Musical of Sweethearts, Swindlers and Swashbucklers!” benefiting CHOC Children’s.

Featuring a talented cast of local social and business leaders, who graciously donate their time rehearsing for the show and fundraising for CHOC, the humorous production promises to be a crowd pleaser yet again.

We talked to Michael Velasco, a new CHOC Follies cast member and vice president of fulfillment services at Meridian in Tustin, about the upcoming show.

Mike Velasco

Q: How did you get involved with the show? Why is this important to you?

A: I’ve been a long-time supporter of CHOC, and have worked as a partner with CHOC Marketing and Communications and the CHOC Foundation for many years. This is important to me because I care about people, especially children. We are a community and are all one family, and should help each other. The Meridian team and I like to support all the good work that CHOC does.

Q: What character will you play in the show?

A: I don’t play a main character, but participate in all group acts. I’m happy to support awareness of CHOC Follies and the philanthropic goals raised by the cast members. I’m in awe of the cast and their skill sets. We’ve been rehearsing since January, twice a week. This is new and challenging for me, but I’m having a good time!

Q: What is your favorite part of the show so far?

A: The cast and everyone involved. This is a group of genuinely great human beings. The cast camaraderie and support of each other are admirable. You can’t participate and fly solo. You have to trust in the directors and cast, and they have to trust in you. I’m humbled by and grateful for this experience.

Q: Who should come to the show?

A: Everyone – family, friends and coworkers!

Q: What’s going to surprise people about the show?

A: The CHOC Follies directors and cast do an outstanding job of creating a high-quality musical. It’s going to be an exciting performance. Come see us, make time to relax and recharge!

“Carly and the Choco Factory” will be held on March 31-April 2, at the Robert B. Moore Theatre at Orange Coast College, in Costa Mesa.

Purchase tickets and learn more hereOr, call the CHOC Foundation at 714-509-8690.

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What Parents Need to Know About Patient Safety

8054-0182-Award-Logos_TH-CHILDCHOC Children’s is one of only 12 children’s hospitals in the nation and just two in the state to be named a 2015 Leapfrog Top Hospital. In episode No. 48 of CHOC Radio, Dr. James Cappon, CHOC’s chief quality and patient safety officer, offers insight about the coveted award and the hospital’s ongoing commitment to the highest standards of patient safety and care. In addition, he addresses the importance of parents and patients partnering with the care team.

The Leapfrog Hospital Survey is considered the gold standard for comparing hospitals’ performances in the areas of safety, quality and efficiency. It’s focused on a nationally standardized and endorsed set of measures by which participants benchmark each other. In this poadcast, Dr. Cappon shares CHOC’s reasons for participating in the rigorous survey, as well as CHOC’s organizational-wide commitment to patient safety.

In addition, Dr. Cappon helps parents understand how safety is part of the fabric at CHOC; what drives physicians and staff to continue to push the limits of what is possible; and what parents can do to partner with their child’s care team to advance safe, quality care. He also lets parents know what questions they should never be afraid to ask. Hear more about how parents can be safety advocates for their children by listening to episode No. 48.

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