Getting your Little Patient to Follow Medication Directions

By Grace Lee, clinical pharmacist at CHOC Children’s

Grace Lee
Grace Lee, clinical pharmacist at CHOC Children’s, offers tips on getting children to follow medication directions.

Medication compliance is defined as how well a patient follows the directions written on a prescription. In a perfect world, we would follow the instructions ordered by our doctors all the time. However, there are many reasons why this doesn’t always happen. Poor compliance can lead to the failure of a treatment plan in many diseases. Also, if the doctor assumes that a patient is taking his or her medications as directed when they actually aren’t, this may lead to unnecessary dose adjustments since the doctor thinks the medication is not working.

Maintaining perfect compliance is difficult but not impossible. While all of us are prone to forget a dose of medication here and there, there are ways to improve our chances of remembering. Consider these tips on improving medication compliance:

  • Try linking medication doses to other daily activities, such as eating meals, brushing your teeth, or going to bed.
  • Create a medication schedule on paper or use a pillbox that contains days or a week’s worth of medication. This is an especially good idea when multiple care takers are involved, or if the child spends time in more than household. Refill the box at the same time every week.
  • Alarms on your watch or smartphone are another way to remind yourself when it’s time to take or give medicine. Many smartphone apps allow you to set reminders to take or give a dose, obtain refills, and even provide drug information.
  • Sign up for automated refill reminders at your pharmacy or consider a mail-order service that can deliver up to 3 months of medication at a time so you don’t run out.
  • If the cost of your medicine makes it difficult to afford refills, speak with your doctor or pharmacist about generic or alternative options.
  • Since compliance dramatically decreases with the complexity of the medication regimen, ask your doctor or pharmacist if the regimen can be simplified by using combination products, longer acting formulations, or if certain drug can be eliminated.

Non-compliance could also result from not understanding the importance of taking the medicine or disliking the side effects.  Having a trusting, open relationship with your health care provider is the best way to overcome these concerns. Be honest with your doctor – if it is unclear why you need a certain medication, clarify it with your prescriber. Often there are other medications that can be tried if a side effect is unbearable. Do not take alternative or herbal medicines, assuming they are safer than your prescription medications, without consulting with your doctor or pharmacist first.

The teenage years are an especially challenging time to maintain medication compliance. Often time parents want to hand over the responsibility of administering medicines to their teen, but they may be forgetful or feel embarrassed to take their medications in front of their peers. Smartphone apps are especially good for this age group. Setting up a support system involving the school nurse or close friends can be useful when you are not around to monitor. If embarrassment is a concern, encourage them to take the medications privately. For parents who want to monitor how well their child is doing keeping up with medications, there are bottle caps that count the number of times a bottle is opened, or devices that record how many times an inhaler has been used. Remind them of the positive rewards to staying healthy, such as the ability to participate in sports, go out with friends, and even drive.

For a higher fee, there are pill bottles that can be programmed to flash or make noises when a dose is overdue, or personalized rolls of presorted medications that come in a dispenser.  Like any habit-forming behavior, the tips on improving medication compliance that will work for an individual or family will vary. The important thing is to develop a plan and stick with it. With the help of your doctor and pharmacist, strong compliance is achievable!

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Inside the Small Baby Unit: Ryan’s Story

Danielle McLeod was looking forward to an easy second pregnancy and ultimately caring for her infant son as a confident and assured second-time mom.

But that expectation changed when little Ryan was born three months early this past winter after just 27 weeks gestation and weighing only 2 pounds and 1 ounce.

small baby unit
Patient Ryan shortly after his birth and before he was transferred from another hospital to the Small Baby Unit at CHOC Children’s.

“His head wasn’t much bigger than a pacifier,” Danielle recalls. “He was the littlest baby I had ever seen. He was so skinny, and was all arms and legs. I was amazed at how active he was for such a little person. Like many preemies, he was a fighter from the start.”

And fight Ryan did inside CHOC Children’s Small Baby Unit (SBU), a portion of CHOC’s neonatal intensive care unit (NICU) dedicated to the care of babies born with extremely low birth weights. These patients are born at less than 28 weeks gestation and weighing less than 1,000 grams, or about 2 pounds and 3 ounces.

In the SBU, “micro-preemies” like Ryan receive coordinated care in a developmentally appropriate environment. A trailblazer in neonatal care nationwide, the unit is saving babies who just decades ago wouldn’t have likely survived.

“With its coordinated care in an environmentally appropriate location, the Small Baby Unit is designed to care specifically for babies like Ryan,” says Dr. Kushal Bhakta, Ryan’s neonatologist and medical director of the SBU. “When he came to the unit, he required significant ventilator support due to an ongoing infection, and he had a long road ahead of him.”

Danielle’s breezy pregnancy took a sudden turn early in her second trimester when her doctor found in her womb a subchronic hematoma, an indicator that she might deliver her baby early.

 Danielle was put on bed rest, but a few weeks later, bleeding and signs of labor showed. At the hospital, doctors were able to stop the labor and admitted Danielle to keep it from beginning again too early. But about six weeks later, Danielle’s water broke and she underwent an emergency cesarean section.

On Valentine’s Day, after two weeks of ups and downs, Ryan was transferred to the SBU at CHOC and the McLeod family began their four-month journey.

“I don’t think people understand the pain that comes with having a child and not being able to hold him immediately or not being able to take him home shortly after delivery and share him with the world,” Danielle says.

small baby unit
Ryan was born at 27 weeks gestation and spent 17 weeks in CHOC’s small baby unit before going home.

She continues, “It was difficult knowing that there were many obstacles for Ryan to overcome before he could even think about coming home. Simple things like eating by mouth, a task that should come naturally, are challenging for babies born premature.”

During that time, while also focusing on growing, Ryan also battled chronic lung disease and a brain bleed, and learned to eat and breathe on his own. Meanwhile, Danielle and husband, Jared, learned how to care for a baby born more than three months early.

“I’ll never forget our first day at CHOC,” she says. “I was so overwhelmed, scared, and nervous. Once Ryan was settled in the SBU, his nurse came in to do his very first set of cares. I sat and watched, afraid to touch him. He was so fragile.”

She continues, “His nurse said, ‘Get in there, mama. You can do it.’ She had me put my hand on him, my hand covering his whole little torso. She talked me though what to do when caring for an extra small baby. From then on, I felt confident to be close to my little fighter.”

small baby unit
Members of Ryan’s care team included Dr. Kushal Bhakta, medical director, and Ryan’s mom Danielle.

After 17 weeks in the SBU, Ryan finally went home to join his parents and brother. He still receives oxygen treatment and undergoes physical therapy twice a week, but is doing well.

It takes a village of physicians, nurses, therapists, social workers and other clinicians to help bring babies like Ryan home — and every one on the care team partners with patients’ families.

“During his stay in the unit, Ryan overcame great obstacles, thanks to the partnership between his care team and his parents,” Dr. Bhakta says. “Our goal in the unit is to get our patients home with the best possible outcomes. Today, Ryan is doing well and has a bright future ahead.”

small baby unit
At CHOC, parents are valued members of the care team. Here. Ryan’s dad holds him for the first time in the small baby unit.

Small but mighty, Ryan is rolling over and pushing himself up well, and is working toward sitting up by himself.

“He also loves smiling and laughing, especially at his big brother,” Danielle says.

small baby unit
After graduating from CHOC’s small baby unit, Ryan has been enjoying being home with his family and playing with his older brother.

“We’re moving in the right direction,” she says. “We are so grateful to all the wonderful nurses and doctors who cared for Ryan. I know he is doing so well because of the amazing care he received while in the SBU. We love our little fighter. He’s such a good baby. He is truly a miracle and we are blessed to be able to witness this little guy’s journey.”

Related posts:

  • Meet Dr. Kushal Bhakta
    In recognition of prematurity awareness month, we’re highlighting Dr. Kushal Bhakta, medical director of CHOC Children’s Small Baby Unit (SBU). The Small Baby Unit – the first of its kind – ...
  • Neonatology by the Numbers
    November is Prematurity Awareness Month. In honor of this observance, we share an inside look at our neonatologists and services they provide to care for babies daily in Orange County. ...
  • Small Baby Unit Before and After
    In observance of Prematurity Awareness Month, meet a few graduates of the Small Baby Unit (SBU) at CHOC Children’s. The only of its kind in Orange County, the SBU focuses on ...

Living with Diabetes: One Child’s Perspective

In honor of American Diabetes Month, CHOC Children’s patient Ava Hata sheds insight on living with the disease. Ava, who is 11, was diagnosed with Type 1 diabetes when she was just 18 months old. She and her mom Rebekah, who founded TIDModsquad, are active advocates for patients and families, with Ava striving to be a positive role model for others.

How did you learn to manage your disease?

I remember the first time I pricked myself. I was about 4 years old, and I hated being dependent on other people to prick my finger. I snuck into my bedroom and did it based on what I had observed my parents doing. After that day, the momentum of learning to do it all by myself really took off. And now, after living with Type 1 diabetes for many years, I have an instinct for what I need to do. And while it may seem absurd at times, my instinct has worked in my favor. I have learned what to do and when to do it.

What do you like about your CHOC team?

I love being treated at CHOC by its endocrinology and diabetes team. The nurses are a pleasure to talk to, and Dr. Reh is the best!  She is and always will be my favorite endocrinologist. She’s been taking great care of me since I was little.

What are your hobbies?

I love being around animals. I ride horses and train diabetic alert dogs. I have my self-trained diabetic alert dog, Bruin, who has opened so many doors of opportunity. One cool moment was when I took my dog to see Dr. Bhangoo and got to spend time telling him how Bruin gives alerts on my highs and lows.

tips for kids with Type 1 diabetes
CHOC patient Ava and her self-trained diabetic alert dog, Bruin, share tips for kids with Type 1 diabetes.

In addition to training, I love to show dogs. Other interests include history and literature, as well as building all sorts of objects, from playhouses to terrariums.

How do you manage pursuing all of your interests in spite of living with a chronic condition, and what advice do you have for others?

Honestly, I believe you will always find a way to do what you love. Just keep walking forward, and everything will work out.

What else would you want people to know about living with diabetes?

First of all, people need to understand that it’s not simple and although you think there is a “control” with diabetes, there isn’t — and won’t be until there’s a cure. I’d also really like people to know that I am just like them in the sense that each of us has our differences, including responsibilities. It’s important to accept others and not discriminate against them.

I also want people to know there are numerous support groups, including the one my mom and I founded. It’s nice to connect with others who are going through something similar. You become an instant family!

tips for kids with Type 1 diabetes
Ava and her self-trained diabetic alert dog Bruin.

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Skin Reactions to the Sun

By Ara Jamasbi, pediatric resident at CHOC Children’s

Living in Southern California, we are lucky to experience beautiful sunny weather practically year round. While we’re all aware of the dangers of sunburns, there are other skin reactions to the sun to be mindful of as well.

Photosensitivity is abnormal or adverse skin reactions to the sun. and If your child develops a sunburn reaction, swelling, or intense itching after limited exposure to sunlight or shows a rash or scarring in a sun exposed area (ie. face, V of neck), they may actually have photosensitivity.

Polymorphous light eruption, also known as “sun allergy” or “sun poisoning” is the most common photosensitivity. It occurs 1-2 days after intense sun exposure. It may range from small red dots to clear fluid-filled dots (vesicles), eczema-looking dry patches, large plaques/papules, or target-like lesions. The commonly involved areas include the face, neck, arms and hands where there was sun exposure. In children, it starts as dry patches on the face with red small dots, with severe itching. Lesions disappear in 1-2 weeks spontaneously if no further sun exposure occurs.

Solar urticaria is another type photosensitivity characterized by itching and redness usually after about 30 min or less of sun exposure. After several hours, the skin returns to normal. The cause is unclear, but antihistamines, corticosteroids and limited sun exposure have all been beneficial.

Phytophotodermatitis occurs when UV light reacts with certain chemicals on the skin. These chemicals can come from common foods such as limes, carrots, parsley and celery. The rash typically appears 24 hours after the exposure, and can take weeks to months to completely resolve. It may appear as a red itchy rash, but sometimes may even blister. It is usually in the pattern of exposure to the food causing the reaction, such as spattering or drips from a squeezed lemon

Don’t forget basic sunscreen practices. It is important to use a water-resistant, broad spectrum sunscreen (protecting against both UVA and UVB rays) with SPF 30 or higher. The higher the SPF, the more protection, with SPF 50 giving maximal protection. Sunscreen should be applied 15-30 minutes before going outside and re-applied every two hours, but more often if the child is swimming or sweating. Throw away sunscreen that is older than three years or passed the expiration date. Don’t forget to put sunscreen on often-forgotten areas such as the tops of the feet, ears and back of the neck and scalp.

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Meet Dr. Kushal Bhakta

In recognition of prematurity awareness month, we’re highlighting Dr. Kushal Bhakta, medical director of CHOC Children’s Small Baby Unit (SBU).

Dr. Kushal Bhakta
Meet Dr. Kushal Bhakta, medical director of the small baby unit at CHOC Children’s

The Small Baby Unit – the first of its kind – opened in 2010. The special 12-bed unit within our neonatal intensive care unit (NICU) is designed for babies born at less than 28 weeks gestation or who weigh less than 1,000 grams. The space is designed to aid in babies’ development with dim lighting and low noise levels, mimicking the womb’s environment as closely as possible. The unit is also nurturing for patients’ families. Since they are going through many of the same experiences, families are able to bond and support one another.

“It’s an amazing blessing to be part of these families’ lives. So many parents write to us and send pictures long after they’ve left the hospital. There is a mutual respect, and they become part of our extended family,” Dr. Bhakta says.

Board certified in pediatrics and neonatal-perinatal medicine, Dr. Bhakta is part of a specialized, highly trained team at CHOC. He owes the success of the unit to his team, he says.

“It’s inspiring to see the team’s passion for the lives of these babies,” Dr. Bhakta says. “From nurses to respiratory therapists, and all other disciplines, everyone on the team takes care of our patients like they were their own children.”

The highly committed team is improving quality and outcomes in extremely low birth weight infants. Impressive outcomes from the two years before and four years after the SBU’s opening in March 2010 include:

  • Significant reduction in chronic lung disease of prematurity.
  • Significant reduction in the rate of hospital-acquired infections.
  • Significant reduction in infants being discharged with growth restriction . These factors are linked to cognitive and physical disabilities.
  • Reduction in the average number of laboratory tests and X-rays per patient.

Dr. Bhakta’s vision for the SBU is to be recognized nationally and beyond as the premier destination for the care of extremely preterm infants. Dr. Bhakta and his team have hosted many hospitals interested in modeling their units after CHOC’s SBU. As leaders in their field, the team hopes to continue to improve patient outcomes.

“We’ve come so far in how we treat this patient population, he says. “We don’t want to only adapt knowledge, but create the knowledge and help set standards of care for these patients.”

Dr. Bhakta received his medical degree from Baylor College of Medicine and completed his pediatric residency and neonatal-perinatal fellowship training at Baylor College of Medicine and Texas Children’s Hospital, in Houston, Texas. He later joined the faculty at Baylor College of Medicine/Texas Children’s Hospital as assistant professor of pediatrics, where he also obtained an advanced certificate in teaching through the Educational Scholars Fellowship Program.

Dr. Bhakta has received several awards throughout his career, including “Super Doctors Southern California Rising Stars” in 2014 and 2015.

In his spare time, this dedicated physician enjoys spending time with his wife and two daughters.

Learn more about CHOC Children’s Small Baby Unit.

Related posts:

  • Inside the Small Baby Unit: Ryan’s Story
    Danielle McLeod was looking forward to an easy second pregnancy and ultimately caring for her infant son as a confident and assured second-time mom. But that expectation changed when little Ryan ...
  • Neonatology by the Numbers
    November is Prematurity Awareness Month. In honor of this observance, we share an inside look at our neonatologists and services they provide to care for babies daily in Orange County. ...
  • Small Baby Unit Before and After
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CHOC Children’s Physicians, Staff Share What They’re Thankful For This Thanksgiving

In celebration of Thanksgiving, members of the CHOC Children’s family express what they’re most grateful for this year.

thanksgiving at chocMary Green 

Registered nurse in the Hyundai Cancer Institute at CHOC Children’s

“I could list 100 reasons why I am thankful for CHOC. I’m thankful to work at a place with such visible growth: in the number of available treatments, in the percentage of children that are surviving cancer, in relationships between patients, family members and staff; and growth visible in children as they begin to believe how strong they truly are. Even more so, I am thankful that CHOC is passionate about celebrating growth and takes pride in celebrating all of the little things.”

thanksgiving at chocDr. Joanne Starr

Medical director, cardiothoracic surgery

“I’m grateful to be part of an innovative pediatric hospital and for CHOC’s commitment to providing patients and families with access to the best neonatal and open-heart surgery in Orange County.”

thanksgiving at chocDana Sperling

Social worker, NICU

“I am thankful for two amazing teams I am privileged to be a part of:  the social services team and the Neonatal Intensive  Care Unit (NICU) team.  The compassion and dedication of both teams makes me proud to work along side them day after day, delivering outstanding care to patients and families.”

 

thanksgiving at chocDr. Kenneth Grant

Chair of gastroenterology 

“I am thankful to be working for an organization that creates an environment where our patients become our family. I am also grateful that CHOC Children’s has the foresight to invest in the innovative ideas we have to improve the health care we provide. ”

thanksgiving at chocDr. David Gibbs

Medical director of trauma services

“I am thankful for the trust of our patients and families. With the strong support of the hospital and the community, our Level 2 Trauma Center is proud to care for children in Orange County.”

thanksgiving at chocJoani Stocker

Volunteer

“I am so thankful for the opportunity to bring smiles and laughter to our patients through Turtle Talk and the playrooms. Laughter is medicine to the bones, and I am humbled to be a part of the healing. My cup is overflowing with joy when I see a patient giggle and play.”

thanksgiving at chocDr. Daniel Mackey

CHOC Children’s pediatrician

“I am thankful for the opportunity to be partnered with an excellent children’s hospital. I am also thankful for the pleasure of working with other positive people who provide outstanding care to the children of Orange County. Together we work to improve the care and services we deliver to our most important resource…our children.”

thanksgiving at chocDr. Gary Goodman

Medical director of the Pediatric Intensive Care Unit, CHOC Children’s at Mission Hospital

I am most grateful to the people behind the scenes at the hospital that do all the invisible jobs that are so important to keep CHOC Children’s running: the housekeepers, lab and x-ray technologists, bio-medical engineers, pharmacy technicians, scrub technicians, security guards and maintenance staff that work tirelessly, 24-hours a day.”

thanksgiving at choc

Dr. Raymond Wang

Metabolic disorders specialist

“I am thankful that CHOC cares for families and children with rare disorders by supporting clinical trials and translational research, and the staff who care for these families, to find treatments and cures for their conditions.”

thanksgiving at chocEric Mammen

Lead music therapist

“I am grateful that I get to witness the transformative powers of music with amazing patients and families everyday here at CHOC. So very grateful for the generous donors that continue to support our growing music therapy program. Without them we would not be able to impact the families and help them face incredible challenges with courage, smiles, and a song. Super grateful to be apart of writing a powerful song with a patient in response to his medical diagnosis- “To Life Live To The Fullest!” Happy Thanksgiving and I hope you get to spend some extra time with your loved ones around you.”

Matt Gerlachwhat choc is thankful for

Executive vice president and chief operating officer

“At this time of Thanksgiving, I am thankful for CHOC Children’s and the wonderful service we are privileged to provide for the communities we serve. I am thankful for the dedication and commitment of our physicians, associates and volunteers, who give the very best they have to give— their knowledge, skills, abilities, care and compassion— to make CHOC’s mission to nurture, advance and protect the health and well-being of children a reality for so many in need, every day. I am also thankful for those that stand behind our physicians, associates and volunteers— their loved ones, who support our CHOC Children’s team to be the best that they can be, both at work and at home. I wish all of our CHOC Children’s family a happy and healthy Thanksgiving.”

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After Years of Seizures, Overcoming Epilepsy

Deena Flores has her sights set on a big party next spring for her daughter, Mareena.

It’s not for her birthday, but rather an anniversary of sorts. By May 2017, Mareena will have lived without seizures longer than she endured them.

It’s a milestone that once seemed unreachable for the Flores family, who finally got relief from years of seizures when they found help from CHOC Children’s Neuroscience Institute.

“The seizures flipped our family. We didn’t go anywhere. We wouldn’t want to leave her with anyone. It was a deep dark hole for a few years,” Deena says. “To see her flourish and open her wings and experience life now is amazing.”

epilepsy surgery
Mareena is flourishing after epilepsy surgery.

Now 9, Mareena began experiencing seizures at around 10 months old. After a normal birth and infancy, she suddenly started rolling her eyes backward and going limp.

For years, the family went from hospital to hospital and doctor to doctor, looking for an explanation.  Walking, talking and developing normally, Mareena would grow out of it, physicians told the family.

By age 4, Mareena was enduring up to 20 seizures a day, mostly linked to sleep. Medications were not working. Deena and her husband would take turns sleeping in their daughter’s room, desperate to record every seizure in hopes of finding a pattern.

Mareena’s parents reached their breaking point in fall 2011. One morning while eating breakfast, Mareena seized, fell from her chair and hit her head on the tile floor. That was enough.  Mareena needed help badly, and they turned to Dr. Mary Zupanc  and CHOC’s comprehensive epilepsy program.

epilepsy surgery
Dr. Mary Zupanc, director of the comprehensive epilepsy program and chair of neurology at CHOC Children’s

“Within the first five minutes of the appointment, Dr. Zupanc told us that Mareena’s medication wasn’t working, and because epilepsy is a progressive disease, it was critical that we find a new solution quickly,” Deena recalled.

Mareena began undergoing extensive testing, including long-term video electroencephalogram (EEG) monitoring to determine seizure type and seizure frequency. During that time, Dr. Zupanc first broached the subject of surgical intervention to help Mareena.

“The idea of brain surgery was scary,” Deena recalled. “But at the same time, it was a relief, especially after all the years we lost while trying to convince doctors that something was wrong”.

In May 2012, the family began the process for surgical intervention, including an MRI scan of the brain to look for subtle structural changes in the brain and a PET scan, which looks at glucose metabolism in the brain.

Mareena’s case was then reviewed by a group of CHOC physicians. The physicians, including Dr. Zupanc, were in agreement that Mareena should have epilepsy surgery.  However, in order to identify the exact seizure focus, invasive EEG monitoring was required. This means that electrodes had to be placed directly on the surface of the brain. Over a series of days, Dr. Zupanc and the other epilepsy specialists determined that the seizures were coming from the brain’s left temporal lobe. Next, surgeons removed that portion of the brain.

Mareena has been seizure-free ever since. She still takes one low-dose of antiepileptic medication, but her visits with Dr. Zupanc have reduced significantly. She no longer requires long-term video EEG monitoring or other studies.

Mareena is now headed for third grade.  Though she does have some mild cognitive delays—due to the underlying cause of her epilepsy and her prior high seizure frequency, she is thriving and doing very well. Deena says people are shocked when they learn about Mareena’s history.

“She’s a walking miracle,” Deena says.

Learn more about epilepsy surgery.

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Antibiotics Aren’t Always the Answer

By Tuan Tran, infectious disease pharmacist at CHOC Children’s

The Centers for Disease Control’s annual recognition of Antibiotics Week, November 14- 20, is a good opportunity to review basic safety practices of antibiotics and educate yourself so that you can protect yourself and your family. Don’t forget:

  • Antibiotics can have reactions and side effects. Harmful effects from antibiotics, such as side effects and allergic reactions, cause 1 in 5 emergency department visits for adverse drug events and lead to 50,000 emergency department visits in children each year
  • Antibiotic resistance is growing. An estimated 2 million illnesses and 23,000 deaths occur each year in the U.S. due to antibiotic-resistant infections. Overuse and misuse of antibiotics are the main drivers of resistance.
  • Antibiotics can only cure infections caused by bacteria. For example, cough and cold illnesses caused by viruses would not be cured by an antibiotic

Parents are an essential part of a child’s care team. You should feel comfortable asking the following questions to your child’s provider when considering an antibiotic:

  • What is the best treatment for my child’s illness? Antibiotics aren’t needed for common illnesses like colds, most sore throats, the flu, and even some ear infections, which are often caused by viruses and do not respond to antibiotics. Sometimes the best treatment is over-the-counter symptom relief.
  • Is this the right antibiotic for the type of infection my child has? If an antibiotic is needed, it’s important to use an antibiotic that is designed to fight the bacteria causing your child’s specific illness. Ask your healthcare professional if it’s the most targeted drug to treat the infection while causing the least side effects
  • What can I do to help my child feel better? Pain relievers, fever reducers, saline nasal spray or drops, warm compresses, liquids, and rest may be the best things to help your child feel better. Ask your healthcare provider or pharmacist what symptom relief is best for your child.
Illness Usual cause: virus Usual cause: bacteria Antibiotic needed?
Cold/Runny nose  NO
 Bronchitis/Chest cold* NO 
 Whopping cough YES 
Flu NO 
 Strep throat YES 
 Sore throat (except strep) NO 
 Fluid in the middle ear** NO 
 Urinary Tract Infection YES 

*In otherwise healthy adults

**Otitis media with effusion

When your doctor prescribes an antibiotic, it’s essential that you take it exactly as prescribed. Follow the directions of your physician and pharmacist, do not skip doses or share the medication, and finish the prescription even if you feel better. Do not save it for later.

There are several things you can do to help prevent infections- starting with receiving an influenza vaccine every year. Aside from getting your flu shot, hand washing is the single most effective way to prevent the spread of pathogens. Scrub for at least 15 seconds when using soap and water. When necessary, cough into a tissue or elbow.

Clinicians at CHOC are committed to optimizing antibiotic use. A multidisciplinary team reviews and monitors antibiotic use to ensure optimal selection, dosing and duration. This reduces adverse events and improves patient outcomes, and slows an emergence of resistance.

Related stories:

  • Getting your Little Patient to Follow Medication Directions
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15-Year CHOC Employee Donates Wedding Dress to Create Angel Gowns

Having worked as a community educator at CHOC Children’s for 15 years, Amy Frias knows that all CHOC employees pour their hearts into their work, and would do anything they could to help a child or comfort a family.

Last spring, she saw a post on social media about a group of women dedicated to transforming donated wedding dresses into bereavement gowns for babies who are born prematurely and pass away. Amy knew immediately that she’d found the perfect use for the beautiful wedding dress she’d worn a decade ago and had been sitting in storage ever since.

donate wedding dress, angel gowns
CHOC community educator Amy Frias donated her wedding dress, shown here on her wedding day, to create angel gowns.

“That dress was beautiful, and it was worn during very happy times,” Amy says. “It’s my hope that the angel gowns created from it will bring a little bit of comfort and perhaps even peace to families in need.”

The volunteer seamstresses at Angel Gown Project of California were able to create more than a dozen angel gowns from Amy’s wedding dress. Each angel gown takes approximately two hours to create.

The angel gowns were recently delivered to the Neonatal Intensive Care Unit (NICU) at CHOC. As a community educator, Amy has worked with a variety of families across many units in the hospital, but she’s always had a special place in her heart for NICU patients and their families.

“I often have the privilege of working with NICU families when they’re getting ready to leave the hospital and finally take their baby home, and we teach them things like car seat safety and CPR,” Amy says. “But I know that sometimes despite having the very best care, not all babies make it home.”

Dana Sperling, a social worker in CHOC’s NICU, sees this heartbreak firsthand.

“Neonatologists and specially trained nurses in the NICU do everything in their power and use the most advanced technology available to care for premature infants, but unfortunately, the reality is that not all babies make it home,” Dana says. “Anything we can do to help our families make this heartbreaking experience more cherished, we will. We’ll do whatever we can to help them.”

donate wedding dress, angel gowns
More than a dozen angel gowns were created from Amy’s wedding dress. They will go to NICU families in need.

Bereavement gowns are often the last thing on a parent’s mind when they’re faced with immense grief over the loss of a child and they are unable to focus on all the details that must be tended to.

“Some of these parents have never had the chance to dress their babies themselves due to their level of illness. Parents are so appreciative of these gowns and are quick to notice the love and energy that went into making them,” Dana says. “We are helping parents make memories at a very sacred time and it is important to remember that what we do at CHOC to save a life is just as important as what we do when a life cannot be saved.”

Learn more about the Angel Gown Project of California.

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Seizure-Free at Five, Thanks to Epilepsy Surgery and ROSA Robot

Five-year-old Ian Higginbotham recently enjoyed his best summer yet. He experienced his first family vacation. He learned to swim and ride a bike. He got himself ready for kindergarten. These are milestones most kids and parents, alike, eagerly welcome. But there was a time when Ian’s parents weren’t certain their son, who was born seemingly healthy, would enjoy such happy pastimes.

Ian began talking and walking in his sleep as a toddler. When the episodes, including night terrors, increased in frequency and severity, his mom Lisa made an appointment with the pediatrician. One day, Lisa knew something just wasn’t right and didn’t want to wait for the appointment to get Ian checked out. She and her husband Derek took him to the Julia and George Argyros Emergency Department at CHOC Children’s Hospital. To her surprise, doctors diagnosed her son with epilepsy.   Ian’s “sleepwalking” and “night terrors” were actually seizures.

The family was referred to CHOC’s comprehensive epilepsy program. A national leader in pediatric epilepsy care, CHOC’s comprehensive epilepsy program offers cutting-edge diagnostics, innovative medical approaches and advanced surgical interventions. CHOC was the first children’s hospital in the state to be named a Level 4 epilepsy center by the National Association of Epilepsy Centers, signifying the highest-level medical and surgical evaluation and treatment for patients with complex epilepsy.

Ian’s neurologist Dr. Andrew Mower suspected he was experiencing complex partial seizures, which was confirmed by video EEG monitoring. Complex partial seizures start in a small area of the temporal or frontal lobe of the brain, and quickly involve the areas of the brain affecting alertness and awareness. The pattern of Ian’s seizures suggested they were originating from the right frontal lobe. Dr. Mower knew Ian and his family were in for a tough journey.

“I really don’t think the general public understands the impact epilepsy has on a child and his family. Its effects are multifaceted and extensive. Our team’s goal is to reduce or eliminate our patients’ seizures, helping improve their quality of life,” explains Dr. Mower, who placed Ian on a series of medications.

The medications reduced Ian’s seizures, but did not control them. Dr. Mower was concerned about the seizures affecting Ian’s development, and presented his case to the epilepsy team.  The multidisciplinary team agreed Ian was a candidate for epilepsy surgery. For children who fail at least two medications, surgery may be considered early in treatment versus as a last resort. Surgery can result in an improvement in seizure control, quality of life, and prevent permanent brain damage. Ian’s surgery was going to be performed by CHOC neurosurgeon Dr. Joffre Olaya.

epilepsy surgery
Ian recovering from epilepsy surgery at CHOC.

While the thought of surgery was frightening to Lisa and her husband, they were confident in the team and comforted to know their son was going to benefit from innovative technology, like the ROSA™ Robot. Considered one of the most advanced robotized surgical assistants, ROSA includes a computer system and a robotic arm. The computer system offers 3D brain mapping to aid surgeons in locating the exact areas they need to reach and planning the best surgical paths. The robotic arm is a minimally invasive surgical tool that improves accuracy and significantly reduces surgery/anesthesia time.

Dr. Olaya used ROSA to accurately place electrodes in the area of Ian’s brain suspected to be the source of his seizures. By using the robot, Dr. Olaya avoided performing a craniotomy (surgery to cut into the skull, removing a section called a bone flap, to access the brain).

“ROSA is an amazing tool that yields many benefits for our patients, including less time under anesthesia in the operating room. It reduces blood loss and risk of infections. Patients tend to recover faster than they would if they had craniotomy,” says Dr. Olaya.

Lisa was amazed at the outcome. “I couldn’t believe how great Ian looked after the placements of the electrodes with ROSA. He wasn’t in any pain, there was no swelling. It was wonderful!”

She and her husband were also amazed at how well Ian did following his epilepsy surgery.

“We got our boy back,” says Lisa. “There were no more side effects from medication and, more importantly, no more seizures!  He started developing again and doing all the things a child his age should do.”

epilepsy surgery
After epilepsy surgery, Ian has been able to do things other kids his age are doing, like riding scooters.

Ian’s care team isn’t surprised by his recovery.

“Children are resilient, and their brains are no different. In fact, the plasticity of a young brain allows it to adapt to changes and heal more easily than an adult brain,” explains Dr. Mower.

Learning to ride a bike and swim were among the first of many milestones Ian quickly reached following surgery. He enjoys playing with his younger brother and his friends. And, whether inspired by his experience with ROSA or not, Ian loves robots.

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