State-Of-The-Art Fertility Options Available at CHOC

Oncofertility is a relatively new field that studies how cancer treatments affect fertility. After all, chemotherapy and radiation may be crucial tools for beating cancer. However, they can also damage reproductive organs. One of the biggest problems cancer survivors face is fertility preservation. Some of the most advanced oncofertility services in the world are available right here in our community – at CHOC Childrens’s, as part of its Adolescent and Young Adult (AYA) Cancer Program.

The program has long offered fertility solutions for males. Female patients, however, face a more difficult challenge. “For a long time, we didn’t understand how chemotherapy affected the ovaries,” says Leonard Sender, M.D., medical director of CHOC Children’s Cancer Institute. “Over the last few years, however, the science has advanced considerably.”

One option for older adolescent patients is egg harvesting, similar to that used for standard infertility treatments. However, the procedure takes at least two to three weeks, before chemotherapy can begin. Most teens (who often have aggressive cancers) can’t wait that long.

Fortunately, there’s a new option for female patients who have started their period (typically 12 years old): ovarian cryopreservation. Here, doctors remove and freeze one of the ovaries. In the future, the ovary may be re-implanted and then “jump-started” to begin producing eggs again. It sounds like science fiction, but the procedure has been successful in older women. As part of an ongoing research program with the national Oncofertility Consortium, CHOC now offers this option to AYA patients.

“These young girls may only need to think about fertility 10 years from now, but in that time the technology will improve, and re-implantations will be even more successful,” says Dr. Sender. “What we know is that we have this brief moment before we start chemotherapy to preserve a patient’s fertility. We are very excited to be participating in this cutting-edge research, and I believe it will become a major part of our survivor program.”

To find out more about the oncofertility program at CHOC, please call 714-456-8025.

Melanoma Begins In Childhood

Did you know melanoma – the most common and deadliest form of skin cancer – is linked to excessive sun exposure during childhood? Studies indicate that as few as four severe sunburns before age 16 greatly can increase the risk of melanoma in later life.

The number of reported cases of melanoma is rising in epidemic proportions, says oncologist Leonard Sender, M.D., Medical Director of the CHOC Cancer Institute. The disease is being increasingly diagnosed in younger adults.  Given the popularity of tanning among young people, it is important that parents educate their children about too much exposure to the sun and the effects of tanning beds.

A new study from the University of Minnesota, featured on the American Cancer Society’s website, found that people who use tanning beds are more likely to develop melanoma, than those who don’t. The study also found that the risk of getting melanoma is associated more with how much a person tans and not the age at which a person starts using tanning devices. Risk rises with frequency of use, regardless of age, gender, or device.

Fortunately, there’s quite a lot you can do about it. Sunscreen is very important, but it does not completely protect your child from the sun. To fully protect your child, long sleeves, pants, sunglasses and a broad-brimmed hat are a must. Try to avoid outdoor activities between 10 a.m. and 4 p.m., the brightest part of the day.

Also, Dr. Sender advises parents to make sunscreen a morning habit, rain or shine, every day of the year. Apply it liberally to the face, top of the ears, back of the neck, and then to any other parts of the body that will be exposed. At the beach or the pool, reapply sunscreen whenever your child comes out of the water. For more sun safety tips, click here:
To learn more about CHOC Children’s Cancer Institute, click here:

Keep Your Kids Active This Summer

Although the official first day of summer is still a couple weeks away, kids in Orange County are already gearing up for summer, with school out starting next week! For parents this could mean trying to keep your little ones busy throughout their vacation. For some kids, summer can also be a time for packing on extra pounds if they don’t keep active.

A recent study suggests that for the youngest students, summer months may be worse than the school year when it comes to weight gain. Researchers think children may eat more during the summer, when the days are less structured. Also, physical education during the school year may help kids burn extra calories.

Just like adults, kids need to balance the calories they eat with the calories they burn to prevent extra pounds. That means healthy eating and an hour of physical activity on most days of the week.

Luckily, summer’s sunshine offers the chance to get out and get moving. Follow these tips to help keep your kids happy – and healthy – this summer:

  • Plan active vacations. Take a trip to the mountains and hike. Or, bike around your neighborhood.
  • Limit screen time—including TV and video games—to two hours a day or less. Encourage your kids to go outside and play. Hopscotch, swimming, tag and hide-and-go-seek all count as exercise.
  • If they’re interested, sign your kids up for a summer sports league.
  •  Walk with your family instead of driving to visit friends or run errands in the neighborhood.
  • To help strengthen your muscles, try working in the garden together.

Hello Hospital Program Helps Reduce Patient Fears Prior to Surgery

Did you know CHOC Children’s has a “Hello Hospital” program designed to help children and parents learn what to expect when a child is scheduled for a procedure or surgery at CHOC?

Through a tour, a Recreation Therapist/Child Life Specialist will introduce future patients and their families to the hospital environment, procedures, and equipment with the goal of reducing the child’s anxieties.

CHOC understands that the experience of your child undergoing surgery can be stressful. The Hello Hospital program provides a non-threatening way for children to become familiar with CHOC before hospitalization. To learn more, click here:

How to Decrease Performance Anxiety in Young Athletes

Q & A with Dr. Nadia Torres-Eaton, Pediatric Psychologist at CHOC Children’s

Q: What is performance anxiety in sports? Could this have an effect on my child’s physical performance or well being?

A: Performance anxiety is related to what we know as “stage fright.” This is often used to describe the anxiety, fear, or persistent phobia, which may be induced in an individual by the requirement to perform in front of a crowd. In sports, the worry or fear is directly related to being evaluated about his/her performance in competitive sports. Some people describe it as that moment when the athlete freezes. The fear of failure becomes so overwhelming that the skill level of the athlete appears to diminish because they feel nervous or insecure.

It is important to remember that a normal degree of anxiety will be present in children whenever they participate in competitive sports. However, some common causes of sports performance anxiety are being very critical and making comparisons. Overly critical parents and coaches can place extra pressure on the child and lead them to believe that they are not very good. When children hear coaches or parents comparing them to other players it can cause children to feel as if they disapprove of their performance.

Common symptoms include: refusal or fear of participating, low self-esteem, making negative comments about their skills, saying that they don’t belong on the team.

Q: Do girls differ from boys in the way they cope with performance anxiety?

A: Research shows that girls tend to report more anxiety than boys and that they have slightly more elevated sports performance anxiety than boys. These differences tend to be present in older children. 

In general, younger children have limited sports skills, make mistakes more often and showcase less worry. However, once they become more aware of other’s skills and they begin to compare themselves then it is possible to begin seeing anxiety symptoms.

Studies have shown that boys tend to seek out information to help them take direct action about how to cope with the stressful event. Girls on the other hand, tend to avoid appraising the situation, which can lead to not doing anything about the situation. If the athlete does not learn coping strategies for these symptoms, regardless of gender, the athlete could experience “burn-out” and may ultimately quit sports.

Q: What advice do you have for parents to help their young athletes cope with performance anxiety?

A: Praising children for the good things they do rather than focusing on the things they do wrong and avoiding comparisons are two common ways to combat performance anxiety. Witnessing the progress they make is invaluable to children and is a self-esteem builder. Encouraging children to have fun and being on a team that has a strong bond and team spirit can also help.

Parents and coaches should also set reasonable expectations and try seeing the game through the eyes of the child. Surveys of kids in all age groups and sports showed that winning was actually the last reason they participated in sports. Keeping this information in mind could help parents maintain their child’s perspective rather than focusing on winning.

If you have concerns about your child’s behavior, or feel that the symptoms mentioned appear to be having a serious effect on your child, please talk to your child’s pediatrician, who may then refer you to a pediatric psychologist.

To contact CHOC Children’s Psychology Department, please call 714-532-8481.

Common Surgeries in Children – What Parents Should Know

Facing surgery can be a scary time for children and their parents. Dr. Ali Kavianian, M.D., surgeon-in-chief at CHOC Children’s explains what some of the most common surgeries in children are, and when to know when your child may need surgery.

Inguinal Hernia

An inguinal hernia is one of the most common conditions in infants and children, and it is usually more common in boys, according to Dr. Kavianian.

A hernia occurs when part of the abdominal organ pokes through a weak area of abdominal wall muscles. Dr. Kavianian says an inguinal hernia can be present from birth to adulthood and usually does not cause any symptoms except for a bulge in the groin or scrotum.

When the hernia content gets caught and can’t return to the abdomen, it is called incarcerated. If this happens, you should take your child to the emergency room immediately. Alarming signs include severe pain at the hernia site. Younger infants usually just cry.

If you discover a lump or bulge in or around the groin area, you should see your child’s pediatrician as soon as possible. A simple outpatient surgery by a pediatric surgeon can resolve the problem.


Appendicitis occurs when the appendix, a small tubular-shaped organ that is connected to the large intestine, becomes swollen and infected. Pain usually starts in the middle of the abdomen and then moves to the right side and lower part of the abdomen. The child may develop a fever and start vomiting.

If you think your child has appendicitis, take him or her to the pediatrician or emergency room without delay. If the operation is done before the appendix is ruptured, surgery is minor. A ruptured appendix usually requires five to seven days in the hospital.

Necrotizing Fasciitis

Necrotizing fasciitis is becoming more common so parents should be aware of this serious condition. It starts with a red pimple which can be seen around the buttocks or belly and can be mistaken for a diaper rash. But, within a very short time it becomes very red, swollen, and painful, and the child will develop a fever.

If you observe such a condition, take your child to the emergency room immediately. He or she will then likely be admitted to the hospital. Good hygiene, including frequent hand washing, can reduce the risk for this infection.

Learn more about surgery at CHOC by visiting

Immunize To Protect Your Children Against Disease

It’s National Infant Immunization Week, April 24-May 1, and CHOC Children’s would like to remind parents about the importance of getting their babies fully immunized by age two.

According to the Centers for Disease Control and Prevention (CDC), infants and young children need to be immunized because the diseases prevented by vaccination can strike the unprotected at an early age. These diseases can be far more serious among infants and young children.

Although children receive the majority of the vaccinations, adults also need to stay up-to-date on certain vaccinations, including tetanus and diphtheria.

This week, the American Academy of Pediatrics (AAP) launched “Protect Tomorrow,” an awareness campaign that educates parents on the importance of childhood immunizations. To view the AAP’s public service announcement, click here:

To make sure that your child is protected against all vaccine-preventable diseases, call or visit your child’s pediatrician to find out if your child’s vaccines are up-to-date. Also, check out these resources below:

For more on immunizations, and to hear what CHOC’s experts are saying, please click here:

For a schedule of immunizations from the CDC, please click here:

Celebrate Earth Day – April 22!

It was forty years ago when the first Earth Day was celebrated, and today it has remained a time to join together and stand up for our planet! Getting your kids involved in helping the environment is not only good for the planet—it’s also good for your family’s health. Talk to your kids about recycling, source reduction, and other simple ways to help battle the issues affecting our planet today.

To get your family started, here are a few, easy tips:

  • Avoid waste by letting your child pick out a favorite lunch box and thermos to reuse every day at school.
  • Turn off the tap! Turning off the water while you brush your teeth can save up to 8 gallons of water per day, which equals to 240 gallons a month.
  • Use reusable shopping bags instead of plastic bags.
  • Save energy (and money!) by replacing incandescent bulbs in your home with an Energy Star qualified compact fluorescent light bulb (CFL).
  • Walk more. If possible, walk your child to school or to after school activities.
  • Set up a recycling center in your home. Have your child decorate labels for separate bins for glass, plastics and paper. 
  • Plant a garden with your child. Whether inside or outside, plants clean the air.
  • Turn used tires (not steel-belted) into children’s swings or other playground equipment.
  • Turn a giant cardboard box into a child’s playhouse.
  • Transform a plastic ice cream tub into a flower pot.

Let us know what green or waste-free ideas your family is doing to protect our environment!

Sprained Ankle, When to Call the Pediatrician

I think my child has sprained her ankle. How can I tell when to call the pediatrician? – A common question for many parents. Did you know that the ankle is the most commonly sprained joint, followed by the knee and wrist? This may seem like an innocent injury, but in some cases, the symptoms, which can include swelling, inability to walk or bear weight – ouch! –  can be quite painful and uncomfortable.

According to the American Academy of Pediatrics (AAP), sprains are injuries to the ligaments that connect bones to one another. A sprain occurs when a ligament is stretched excessively or torn. In a mild sprain, the ligament is overstretched. More severe sprains can involve partial tearing of the ligament, or complete tearing.

Signs and Symptoms
The signs and symptoms of sprains in young children include: pain; swelling around the joint; inability to walk, bear weight, or use the joint. Please note that the symptoms of a sprain may resemble those of a fracture or other conditions. Be sure to consult your child’s physician for a diagnosis.

When to call the Doc 
Make sure to call your child’s pediatrician if your child has a joint injury and has excessive swelling or pain. The pediatrician will examine your child, and your child may then undergo x-rays – to determine that it’s not a fracture or break; magnetic resonance imaging (MRI); and/or other procedures. 

Specific treatment for a sprain will be determined by your child’s physician based on your child’s age, extent of injury, medical history, overall health, etc. Initial treatment may include R.I.C.E. (rest, ice, compression and elevation). Other treatment options may include: splint/cast, crutches/wheelchair, or physical therapy, among other options.

Most mild sprains will heal within two weeks without consecutive complications. Your child’s physician should be called any time a joint injury fails to heal or swelling recurs. Disregarding these signs could result in more severe damage and long-term disability.

For more information about sprains and strains, check out CHOC’s health library, or click here:

Refueling After a Workout – What Every Young Athlete Should Know

Refueling after a hard work-out or competition is vital to every athlete to maximize outcomes.  Consuming carbohydrate with a little protein is the ideal recovery snack, recommends CHOC Children’s pediatric clinical dietitian, Jessica Brown. Timing is important – maximum recovery is accomplished when carbohydrates are consumed within 30 minutes after exercise.

“After a hard workout, athletes should take in 0.5-0.7 grams of carbohydrate for each pound of body weight.   Snacks that include 10-20 grams protein can enhance recovery,” says Jessica.

Consider the following examples for different sized athletes:

120 lb
8oz chocolate milk
1 med Banana

150 lb
4 fig newtons
6oz fruited low-fat yogurt

175 lb
8oz Orange juice
4oz Bagel
2T peanut butter
Keep Hydrated
Maintaining hydration is also important for recovery, explains Jessica.  Muscles are 70-80% water, so focus on hydration for peak performance.  A good way to determine adequate hydration throughout exercise is to measure pre & post weights.  For every pound of body weight lost, consume 2-3 cups of liquid for complete rehydration after exercise.

It is ideal to maintain body weight within 1-2% of usual body weight throughout exercise to prevent fatigue.  Drinking fluids in short intervals is best.  For an average-sized athlete, 5-10 fluid ounces every 15-20 minutes is recommended.  Consuming a sports beverage during exercise lasting longer than an hour will replenish carbohydrate and electrolytes needs.   Not all sports drinks are created equal.  Choose drinks that contain 14-20 grams of carbohydrate and at least 100mg of sodium in every 8 fluid ounce serving, such as Gatorade, Powerade, or Accelerade.

For more information go to or

Learn more about CHOC’s Clinical Nutrition and Lactation Services.

Hopefully, with these easy tips, your young athlete will be on his way to a succesful work-out and season!