Chest Pain – What Parents Should Know

In honor of American Heart Month, check out these important guidelines to help you determine whether your child’s chest pain could be associated with heart disease. In this Q&A, Dr. Pierangelo Renella, a pediatric cardiologist at CHOC Children’s, explains the signs and causes of this common condition, rarely associated with the heart.

Q: What causes chest pain in children?
A:  The most common cause of chest pain in children is pain in the muscles that make up the chest wall and not the heart itself.  This type of pain is usually referred to as “musculoskeletal pain.”  Another common cause of childhood chest pain is costochondritis, which is inflammation in the cartilages at the ends of the ribs.  Other causes may include respiratory infections, asthma, acid reflux (“heartburn”), or a partially collapsed lung, for example.  These are usually not life-threatening.  However, in rare situations, there are serious forms of heart disease that can cause chest pain, and these usually require a pediatric cardiologist’s assistance to diagnose and treat.

Q: How often is chest pain in children due to a heart problem?
A:  Although childhood chest pain is the second most common reason for referral to a pediatric cardiologist, it only rarely means the child has actual heart disease.

Q: How do I know when my child’s chest pain needs medical attention?
A:  Chest pain that occurs with, or immediately after, exercise should be evaluated further, starting with your child’s pediatrician.  In addition, for chest pain that is associated with fast heartbeat, dizziness, or fainting, or if there is a family history of sudden cardiac death, your pediatrician may refer your child to a pediatric cardiologist.

Q: How can I help prevent my child’s chest pain?
A:  Again, the vast majority of childhood chest pain is not heart-related.  Since the most common causes involve the muscles and bones of the chest wall, the pain should improve with rest and anti-inflammatory medications such as acetaminophen or ibuprofen.  If these treatments do not work, and if the pain is significant, worsening, or associated with other signs and symptoms such as dizziness, fainting, shortness of breath, fast heartbeat, or exercise, make an appointment with your child’s pediatrician immediately.

Learn more about the CHOC Children’s Heart Institute.

Related articles:

  • Causes of Chest Pain in Children
    February is American Heart Month. Check out these important guidelines to help you determine whether your child’s chest pain could be associated with heart disease. Dr. Pierangelo Renella, a pediatric ...

Be Good to Your Heart – And Your Children’s Too!

By Katherine Phillips RD MPH, clinical dietitian at CHOC Children’s

Did you know that heart disease is the leading cause of death for both men and women in the United States? In 2010, heart disease services, medications and lost productivity cost the United States $316.4 billion, making it an expensive yet very preventable disease. The most common type of heart disease is coronary artery disease, which can cause heart attack, angina, heart failure and arrhythmias. According to the Centers for Disease Control and Prevention, heart disease is the cause of death for one in every four adult Americans.

However, adults aren’t the only ones at risk. Children are now developing cardiovascular disease risk factors that were previously only seen in adults. Children who are obese are at a higher risk of cardiovascular disease risk factors such as high blood pressure, type 2 diabetes and elevated blood cholesterol levels. One study estimated that as many as 70% of obese children have at least one risk factor for cardiovascular disease.

Prevention and early action are the keys to decreasing your risk and your children’s risk of developing heart disease.  The highest risk factors for heart disease include inactivity, obesity, high blood pressure, cigarette smoking, high cholesterol and diabetes.  Here are some ways you can reduce the risk of heart disease in your family:

Know your family history
o Genetic factors can play a role in the development of heart disease.

Know your numbers (and your children’s numbers too!)
o High cholesterol, blood pressure and diabetes are three of the six top risk factors for developing heart disease, so keep them under control.
o New guidelines endorsed by the American Academy of Pediatrics state that all children, with or without a family history of heart disease, should have their cholesterol levels tested between the ages of 9 and 11, and then again between the ages of 17 and 21. Doctors think that this early testing and control of cholesterol levels in childhood can help reduce the risk of heart disease in adulthood.

Stop smoking
o Smoking increases the risk of cardiovascular disease by two to four times!

Improve your diet
o Diets high in saturated fats and cholesterol can raise blood cholesterol levels and promote atherosclerosis. High salt or sodium in the diet causes raised blood pressure levels.
o Choose lean meats, low-fat or fat- free dairy products; decrease foods high in saturated fat, cholesterol, sugar, and salt/sodium; and watch portion sizes.
o Increase fruit, vegetable and whole grain intake.
o Plan your meals ahead of time so you aren’t scrambling for something quick and unhealthy at the last minute.
o Do not use food as a reward for good behavior or good grades.
o Limit snacking and be aware of the snack foods your children are eating.
o Know what your child eats at school.
o Eat meals as a family so it is easier to know what and how much your child is eating.

Be active
o 150 minutes of moderate intensity physical activity every week (or just 20 minutes each day) can decrease your risk of heart disease.
o Aim for 60 minutes of physical activity for your child every day.
o Find fun exercise activities you can do as a family.
o Limit the amount of time you and your child spend watching TV and playing on the computer.

Control your weight
o Losing just 5–10 percent of your current weight over 6 months will lower your risk for heart disease and other conditions.
o If your child is overweight and there is no illness or condition causing the obesity, ask your doctor or a registered dietitian to provide you with some resources to help your child either lose weight or control their rate of weight gain while they grow.

Drink less alcohol
o Excessive alcohol use leads to an increase in blood pressure, and increases the risk for heart disease. It also increases blood levels of triglycerides, which contribute to atherosclerosis.
o Drink no more than one alcohol drink per day if you’re a woman and two alcohol drinks per day if you’re a man.

Be a good role model for your children. Parents who model healthy eating and physical activity can positively influence their children’s health.

For more information:
Harvard School of Public Health-The Nutrition Source:
Center for Disease Control and Prevention:
American Heart Association:

Related articles:

  • Infographic: Amazing Heart Facts
    What’s a better time than Valentine’s Day to learn more about the heart? This infographic will help you expand your heart smarts.
  • Electrophysiology Advances Restore Patient’s Quality of Life
    A teenaged patient’s longtime arrhythmia has been repaired and her quality of life dramatically improved thanks to emerging technology and the skill of a CHOC Children’s cardiologist. Lauren Flotman, 15, had ...
  • Meet Dr. Wyman Lai
    Just in time for American Heart Month, meet Dr. Wyman Lai, a nationally-recognized pediatric cardiologist with expertise in fetal cardiology and non-invasive imaging for heart disease in fetuses, and children ...

Easy Substitutions for a Healthier Heart

In honor of American Heart Month, try these smart substitutions recommended by the American Heart Association, for a healthier heart for the entire family.

When cooking your favorite recipes, you can use these lower-fat ingredients, which can help cut down on saturated fats and cholesterol, without having to substitute the taste:

Instead of butter (1 tablespoon) —   Use 1 tablespoon soft margarine (low in saturated fat and 0 grams trans fat) or 3/4 tablespoon liquid vegetable oil

Instead of whole milk (1 cup) —   Use 1 cup fat-free or low-fat milk, plus one tablespoon of liquid vegetable oil

Instead of heavy cream (1 cup) —   Use 1 cup evaporated skim milk or 1/2 cup low-fat yogurt and 1/2 cup plain low-fat unsalted cottage cheese

Instead of sour cream —   Use low-fat unsalted cottage cheese plus low-fat or fat-free yogurt; or just use fat-free sour cream

Instead of cream cheese —   Use 4 tablespoons soft margarine (low in saturated fat and 0 grams trans fat) blended with 1 cup dry, unsalted low-fat cottage cheese; add a small amount of fat-free milk if needed

Instead of Egg (1) —   Use 2 egg whites; or choose a commercially made, cholesterol-free egg substitute (1/4 cup)

Snack healthier, too, with these yummy substitutions:

Instead of regular potato or corn chips —   Enjoy pretzels or low-fat potato chips (reduced sodium version)

Instead of ice cream bars —   Enjoy frozen fruit bars

Instead of a doughnut —   Enjoy a bagel or toast

Instead of high-fat cookies and crackers —   Enjoy fat-free or low-fat cookies, crackers (such as graham crackers, rice cakes, fig and other fruit bars, ginger snaps and  molasses cookies)


The CHOC Children’s Heart Institute brings hope to children with heart disease and their families, providing state of the art diagnosis and treatment for an entire spectrum of cardiac conditions in newborns to adolescents. For more information on programs and services at CHOC Children’s Heart Institute, please visit:

Teaching Children Good Sportsmanship

It’s Super Bowl Time! – A great opportunity to spend time with friends and family, and to teach kids about the importance of good sportsmanship.

Parents and kids alike love sports, and it’s easy to get caught up in a game and become focused on winning. Yet there is much more to be gained from the sports experience than a winning record. When children and teens are involved in sports, they are able to learn and put into practice values that will stay with them for the rest of their lives.

Good sportsmanship is one of the life lessons that children can learn from sports. You can help your children understand and value good sportsmanship while making sure they have a safe and fun sports experience. Here are some important principles to instill in your children:

• If you lose, don’t make up excuses.
• If you win, don’t rub it in.
• Learn from mistakes and get back in the game.
• Always do your best.
• If someone else makes a mistake, remain encouraging and avoid criticizing.

Parents are important role models, so let your children see you upholding these principles, whether you play a sport yourself or root for your child’s team from the sidelines.

Good sportsmanship also includes following certain guidelines for good behavior. Share these concepts with your children:

• Avoid arguing. Stay focused on the game instead of giving in to anger with teammates, coaches, or referees. Always avoid using bad language and negative words.

 Everyone should have a chance to play. In youth sports, it’s important to encourage even those players who are the least skilled to have fun playing in the game. Parents, coaches, and even other players have an important role in allowing less talented teammates time to participate.

• Play fair. Good sportsmen want to win because they followed the rules and played the best game they could. Never support any effort to win that attempts to go around the rules. Cheating is not acceptable.

• Follow directions. Emphasize the importance of listening to coaches and referees and following their directions while on the field and involved in team activities.

• Respect the other team. Whether your team wins or loses, it’s important to show respect for the effort of the other team. If the other team wins, accept defeat, acknowledge their abilities, and move on. If your team wins, resist bragging—that’s what it means to be a gracious winner.

• Encourage teammates. Team sports work best when each individual supports the team. Praise teammates for what they do well and encourage them when they make mistakes. Avoid criticism and unkind actions. Parents should model this behavior for children by praising them for specific things they have done well, even if they made a mistake or may not have played as well as hoped.

• Respect the decisions of referees and other officials. These people are charged with making difficult decisions about plays in the game. Good sportsmanship requires that you accept a call, even if you disagree with it. Remember that it’s only one call in a long game—get back into play and focus on the game.

• End with a handshake. Good sportsmen enjoy sports and know how to end a game on a positive note, whether or not they won. Threats, anger, criticism, and other negative expressions are not acceptable.

Related articles:

  • Advice to Jiu Jitsu Parents: How to Prevent Cauliflower Ear in Your Child
    By Dr. Nguyen Pham, Pediatric Otolaryngologist In recent times, many parents have turned to martial arts to empower their children against the threat of bullying.  Many of these parents view Brazilian ...
  • Improving an Athlete’s Mental Game
    With the school year and spring sports season winding down, now’s the time when young athletes might need an extra edge over their competition. Additional drills and practices can help, ...
  • FAQ: Hydration for Young Athletes
    By Shonda Brown, RD, CNSC, CSP, CHOC Children’s sports dietitian Water is the most essential nutrient for athletes, yet it’s often forgotten when discussing adequate nutrition for physical activity and improving ...

Get Moving on the Latest Initiative to End Childhood Obesity

As the second anniversary of the “Let’s Move!” campaign approaches in February – an initiative launched by First Lady Michelle Obama, dedicated to fighting the battle against childhood obesity – we’re reminded that there are several, easy steps your family can take towards better nutrition and a healthier lifestyle.

The experts at CHOC recommend these easy tips to get your family “moving” on the right track:
• Plan the week’s menu and shop on the weekend.
• Cook large meals on Sunday afternoons for re-heating later in the week.
• Make a double batch of your favorite soup, casserole or stew and freeze part of it.
• Try a slow cooker recipe.
• Serve more fruits and veggies.
• Send children out to play right after school. Limit TV viewing until after 5 p.m., or when it gets dark.
• Limit screen time to no more than one or two hours per day.
• Choose an exercise the entire family can do together. Invite your children’s friends to come along.
• There a lot you can do indoors, too. Try running in place, push-ups or stretching.

For more helpful nutrition and obesity prevention guidelines from CHOC, please click here:

“Let’s Move!” includes giving parents helpful information and fostering environments that support healthy choices, providing healthier foods in schools, ensuring that every family has access to healthy, affordable food and helping children become more physically active. First Lady Michelle Obama is scheduled to appear on “The Tonight Show with Jay Leno” today, where she will discuss her initiative. She’ll appear on “The Ellen DeGeneres Show” later this week. To learn more about “Let’s Move!” please visit:

Related articles:

  • Quick Tips to Help Children Maintain a Healthy Weight
    In a recent report, the American Academy of Pediatrics (AAP) updated recommendations on childhood obesity prevention. Along with diet modifications and reducing screen time, the AAP encourages pediatricians to work ...
  • Childhood Obesity: Your Options
    “Looks can be deceiving. It can be hard for parents to tell if their child is obese,” says Dr. Vaquero Solans. “Parents who are overweight or obese might not ask ...
  • Fight Obesity with the Right Food
    Obesity in children is a major health concern in the United States: Almost 18 percent of children ages 6 to 11 are obese, a significant increase from the 7 percent ...

Protect Your Little Ones From Sun Damage

With more sunshine coming our way this weekend, it’s important to keep your family safe from the effects of over-exposure to the sun. We all need a little sunshine of course, it’s a source for vitamin D, which helps us maintain a healthy immune system and absorb calcium to maintain strong bones. However, excessive exposure to the sun’s ultraviolet rays can cause skin and eye damage, and can lead to the development of skin cancer.

A recent study published by the American Academy of Pediatrics, that examined data for more than 300 children, found that at least 50 percent of those children experienced sunburns before age 11. Melanoma is one of the two most common cancers of young Americans, and children who have had a sunburn at an early age are at a higher risk for developing melanoma in adulthood.
Check out these safety tips to help keep your family protected:

  • Use sunscreen with a SPF # of at least 30! Sunscreen not only protects against sun damage but also against wind damage by acting as a shield against irritants.
  • No tanning oils or salons! Tanning increases the risk of melanoma and accelerates skin aging.
  • Apply sunscreen every two hours to make sure you’re protected.
  • Remember the sun is everywhere, protect your entire body, even your hands, nose and ears.
  • Try to limit your time in the sun during the hours of 10 a.m. to 4 p.m.
  • Make sure your family drinks plenty of water throughout the day.

For more sun safety tips from the experts at CHOC, please click here:

Related articles:

  • 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 ...
  • A Pediatrician’s Tips for Sunburn Remedies
    Summer may be coming to a close, but in Southern California, sunburns can be a year-round issue in our sunny climate. Even though trips to the beach and afternoons spent ...
  • 6 Summer Sun Safety Tips
    As temperatures rise and school is out of session, your family could likely be spending more time outdoors than inside. The American Academy of Pediatrics recommends limiting sun exposure (and ...

Encourage Your Kids to Snack Healthy

Is eating better one of your family’s new year’s resolutions? Check out these healthy snacks below for every age group. When you offer the right snacks, and at the right times, snacks can play an important role in managing kids’ hunger and improving nutrition.

Toddlers – may not eat as much in one sitting and often get hungry before the next meal. They may need to eat five or six times a day — three meals and two to three snacks. Remember: don’t use sweets to reward good behavior. Try these snacks:

  • cut-up fruit (keep pieces soft and small enough to avoid choking)
  • graham crackers
  • cut, small cheese slices
  • yogurt
  • applesauce
  • low-sugar, whole-grain breakfast cereals

Preschoolers – are just learning to label their feelings. The commonly used “I’m hungry” at this age, could just mean they’re tired or in need of some attention. Figure out what your child really needs. Some may still need three meals and two snacks a day — usually one mid-morning and one after school. Try these snacks:

  •   cut-up fruit or applesauce
  •   sliced veggies
  •   yogurt
  •  whole-grain crackers topped with cheese

School-age kids: are busier and a little more independent. Some may still need three meals and two snacks per day — usually one mid-morning and one after school. The morning snack could become unnecessary depending on lunchtime at school. Try these snacks:

  •   low-sugar, whole-grain cereal with low-fat milk
  •   low-fat string cheese
  •   fruit smoothies made with low-fat milk or yogurt
  •   whole-wheat pita slices, cut-up veggies, and hummus
  •   whole-grain pretzels
  •   fruit slices dipped in low-fat flavored yogurt
  •   nuts and raisins

Teens – might still need a snack or two during the day. You can’t monitor what your teen eats, but you can encourage healthy snacking by keeping nutritious foods at home, that your teen is likely to take along. Try these snacks:

  • rice cakes with peanut butter and raisins
  •  fresh or dried fruit
  • veggie sticks with low-fat ranch dip or hummus
  •  low-fat granola bars
  •  air-popped popcorn
  •  trail mix
  •  hard-boiled eggs

For more tips on healthy eating, please click here:

Related articles:

  • Healthy Eating Tips for the School Year
    It’s time to head back to school, and with that comes a fresh opportunity to establish new habits with children and teens. As your family falls into a routine around ...
  • 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 ...
  • Warning Signs of Eating Disorders
    Parents encourage their children to develop healthy eating habits, but extreme changes in a child’s behavior or attitude towards food could be a warning sign of an eating disorder. In this ...

Talk to Your Teens About the Consequences of Binge Drinking

According to a recent report by the Centers for Disease Control and Prevention (CDC), new estimates show that binge drinking is a bigger problem than previously thought. More than 38 million U.S. adults binge drink, about 4 times a month, and the largest number of drinks per binge is on average 8. Binge drinking is defined as consuming four or more drinks for women and five or more drinks for men on an occasion. Drinking too much, including binge drinking, causes more than 80,000 deaths in the United States each year, making it the third leading preventable cause of death.

Furthermore, alcohol is the most commonly used and abused drug among youth in the United States – more than tobacco and illicit drugs. Although drinking by persons under the age of 21 is illegal, people aged 12 to 20 years drink 11% of all alcohol consumed in the United States. More than 90% of this alcohol is consumed in the form of binge drinks.

Make sure you talk to your kids openly about the consequences of this critical issue. Some of these consequences include poor or failing grades, legal problems, such as arrest for driving, unplanned and unprotected sexual activity, higher risk for suicide, alcohol-related car crashes and other unintentional injuries, abuse of other drugs, and death from alcohol poisoning. In addition, keep these helpful tips in mind:

  • Help your child or teen build their self-esteem. Emphasize and reinforce their strengths and healthy behaviors. They are more likely to say no to peer pressure when they feel good about themselves and proud about their healthy habits.
  • Be a good role model. Consider how your use of alcohol may influence your kids. Consider offering non-alcoholic beverages at parties and social events to show your kids that you don’t need to drink to have fun.
  • Teach kids to manage stress in healthy ways, such as by seeking help from a trusted adult or participating in a sport or hobby they like.
  • Look for signs, such as alcohol odor or alcohol disappearing from your home. Be mindful of a sudden change in mood or attitude in your child. This includes a change in attendance or performance at school, loss of interest in sports or other activities, and withdrawal from family and friends.

To learn more about binge drinking, click here for the report from the CDC:

Related articles:

  • Marijuana Edible Use Increasing Among Youth
    A recent survey by the National Institute on Drug Abuse showed teens now see fewer risks in smoking marijuana. Marijuana use continues to exceed the use of cigarettes. Further, marijuana ...
  • Teens and Drugs
    Prescription and over-the-counter drug abuse is the fastest-growing drug problem in the U.S. In South Orange County, the three most common drugs teens are experimenting with for recreational purposes are ...
  • Use of Cigarette-Like Devices Growing Among Teens
    Cigarette-like devices that could pass for a pen or marker are becoming more and more popular with teens. These devices are sold in tempting flavors such as apple, bubble gum ...

Tips to Manage Winter Allergies

Itchy eyes, runny nose, sneezing… can it be allergies? In the winter? Yes.

The sniffles are common during the winter months, and are not always the result of the common cold or flu. Some people who are sensitive to allergy triggers, such as dust mites and mold, can be just as miserable these months as they are in the spring and summer. Check out some common causes of winter allergies and ways to manage them in this Q&A with Dr. Sherwin Gillman, Emeritus Chief, Division of Allergy and Immunology at CHOC Children’s.

Q: What causes winter allergies?
A: In California, because of our temperate climate, we have things in the air year round that patients in areas of the country where there is frost, for example, don’t have to contend with. This includes mold spores, dust mites, pollens, and trees. Also, when the weather is damp and cooler, many families with outdoor pets tend to bring them in more, resulting in symptoms for those people who are allergic to animals, such as dogs and cats.

Q: What are the symptoms of winter allergies?
A: Some of the symptoms include sneezing, itchy nose and eyes, which are often red, and itchy throat and ears. Coughing and wheezing, as well as exertional limitation, especially if the outdoor air is cold and damp, are common in asthma patients. People with atopic dermatitis (eczema) are often allergic to things in the air, and because the indoor air is heated and dry, it makes their skin dryer and itchier. Patients with allergy to mold often feel worse one to two days after it rains, when the mold spores germinate. Allergies often interfere with getting a good night’s sleep, and with school or work performance.

Q: How are these symptoms different than cold symptoms?
A: People with colds usually have more malaise, body aches, headaches, sore throats, often fevers and usually end up with colored (yellow or green) mucous from their nose or lungs. Many times, they’ve had exposure to friends or family members who are ill with similar symptoms. In the first few days, however, it is often difficult to distinguish between colds and allergies, and the two may coexist. Evidence suggests that allergies may predispose individuals to infections, especially sinusitis, if not controlled.

Q: How can I treat my child’s winter allergies?
A: The most important thing parents can do is to find out what their child is allergic to. This can be done by allergy testing with a special blood test (usually done by their child’s pediatrician) or skin tests, which are usually favored by allergists. Once they have that knowledge, the best treatment is avoidance when possible, such as dust control for those who are allergic to mites, and keeping animals outside or in the garage when animals are the problem. Otherwise, there are excellent safe medications that are currently available to control the symptoms. Getting proper rest and a good diet are also helpful. We also recommend flu shots as another way of keeping an allergic child free from complications of influenza.

Related articles:

Fun and Easy Folate-Rich Snacks for Your Kids

In recognition of National Folic Acid Awareness Week (January 8-14), check out these facts about folic acid, as well as some fun and easy folate-rich foods, that your kids are sure to enjoy.

Folic acid (also known as vitamin folacin, folate, tetrahydrofolic acid, tetrahydropteroylglutamic acid, and THF) is a water soluble vitamin that plays an important part in cell division, the creation of cells in the blood-forming organs and bone marrow, and in the proper development of the fetal spinal cord and brain during pregnancy. The U.S. Public Health Service recommends that all women of childbearing age consume about 400 micrograms of folic acid each day.

Like many vitamins, folate is needed by children for proper growth and development. This critical nutrient is found in some green, leafy vegetables, most berries, nuts, beans, citrus fruits, and enriched grain foods such as cereal, bread, pasta and rice.

To ensure your kids are getting folate in their diet, try these easy snacks:

•  Cut up fresh vegetables and fruits such as broccoli, carrots, oranges and strawberries; serve with a yummy, low-fat dip.

•  Use kidney, pinto, or black beans in wraps or burritos. Have the kids create their own wraps!

•  Freeze orange juice and make juice pops.

•  Make a tasty salad. Include darker green lettuce or greens such as romaine, green leaf, or spinach.

•  Make a refreshing smoothie using orange and strawberries, among other fruits of your choice.

•  Make trail mix by combining a higher fiber cereal with folic acid, peanuts (if your child is not allergic to peanuts), and dried fruit such as raisins or banana chips.

Related articles:

  • Healthy Eating Tips for the School Year
    It’s time to head back to school, and with that comes a fresh opportunity to establish new habits with children and teens. As your family falls into a routine around ...
  • 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 ...
  • Warning Signs of Eating Disorders
    Parents encourage their children to develop healthy eating habits, but extreme changes in a child’s behavior or attitude towards food could be a warning sign of an eating disorder. In this ...