Ask a CHOC Doc: How Can I Avoid Seasonal Asthma Triggers?


What are seasonal asthma triggers that I should be aware of? How can I avoid them, or treat symptoms of them? -Anonymous


While seasonal allergies occur typically in the spring and fall, and are difficult to avoid, it is important to avoid playing outside when pollen counts are high, such as after the grass is freshly cut. Again, the flu vaccine can reduce flu-related asthma symptoms in the fall and winter months. Keep in mind also that the avoidance of indoor allergens, such as house dust mites, by using pillow and mattress impermeable covers, can reduce the effect of outdoor allergens, and non-allergic triggers.

-Dr. Stanley Galant, pediatric allergist at CHOC Children’s and medical director of CHOC’s Breathmobile

Dr. Stanley Galant, a pediatric allergist at CHOC Children’s, specializing in asthma.
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Ask a CHOC Doc: How Can I Help Manage My Child’s Asthma Year-Round?


How can I help manage my child’s asthma year-round? -Anonymous


In the CHOC Children’s Breathmobile program, we strongly emphasize the importance of taking measures to avoid potential indoor allergens such as house dust mites, cat and dog dander, cockroaches and mold. We also recommend avoiding non-allergic triggers such as environmental tobacco smoke, and high levels of air pollution. Respiratory viral infections such as influenza can also be a trigger, so getting the flu vaccine in the early fall is a must for all people who suffer from asthma.

Dr. Stanley Galant, a pediatric allergist at CHOC Children’s, specializing in asthma.

The appropriate use of medication also plays a major role in managing asthma. This includes the use of a medication such as albuterol for asthma symptom relief and for preventing exercise induced asthma if given 15 minutes beforehand. In patients with more ongoing chronic asthma symptoms or severe asthma exacerbations, referred to as persistent asthma, a preventive approach, which will require daily controller medication for months as determined by your provider, is necessary.

Dr. Stanley Galant, pediatric allergist at CHOC Children’s and medical director of CHOC’s Breathmobile

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Ask a CHOC Doc: How can my athlete daughter learn vital nutrition?


Mine is an interest. I’m looking to learn more about how my teenager, dealing with orthorexia eating disorder, can continue to play high school sports and learn vital nutrition techniques, like how to refuel the calories that have been burned. -Anonymous


Health care providers always support teens and families focusing on healthy nutrition choices such as a balance of fruits and vegetables, whole grains and lean proteins. Sometimes, however, a nutrition plan overly focused on the ideals of healthy eating can actually result in significant nutritional lapses with both short term and long-term consequences to your health – this is what is commonly referred to as orthorexia. Persistent fatigue, prolonged muscle aches, dizziness, mood changes, and loss of periods are all signs that your teen should be evaluated by their pediatrician as soon as possible, and with the right interventions hopefully we can prevent nutritional imbalances and medical complications.

In order for your teen to perform in their sport at their most optimal level, they need the right balance of carbohydrates, protein, and fat in addition to supportive vitamins and minerals, and adequate fluids.

  • Carbohydrates are the body’s primary fuel source and should be a significant part of all meals and snacks. All athletes need energy!
  • Protein is important for muscle growth, and repair of muscle breakdown after exercise. Athletes should consume a protein and carb snack within 30 minutes after exercise to help refuel their body’s and aid in recovery. Pairing protein and carbohydrates actually lets the body use the protein better. It is important to note that the body can only utilize 30grams of protein at any one time.
  • Fats are the body’s “reserve tank” for fuel, and are especially important in any type of endurance sport.
  • Vitamins and minerals help unlock the energy stored in food, and Calcium and vitamin D are essential for bone health.

Checking with your doctor is always important to make sure there are no early signs of an eating disorder or complications from imbalanced nutrition. Seeing a sports nutritionist can help identify the exact nutritional components your teen needs, and the best choices to meet those needs. Great websites for additional information and resources include and (sports, cardiovascular, and wellness nutrition section of the Academy of Nutrition and Dietetics).

-Dr. Alexandra Roche, pediatrician specializing in adolescent medicine and Amanda Czerwin, nutritionist at CHOC Children’s

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Ask a CHOC Doc: Can Kids Get Heartburn?

Dr. Scott Gaitan, a CHOC Children’s pediatrician

By Dr. Scott Gaitan, a CHOC Children’s pediatrician

Q: Can kids get heartburn? What should I do if my child has heartburn? -Anonymous

A: Yes, kids can get heartburn too. To understand why, it’s helpful to understand what heartburn really is, and what it isn’t.

Heartburn is a burning sensation that occurs in either the lower part of the chest, behind the sternum, or in the upper area of the stomach. Despite its name, the burning feeling does not come from the heart, but rather the esophagus ― the long tube that connects the mouth to the stomach. A tight band of muscles known as the lower esophageal sphincter (LES), lay at the base of the esophagus. When these muscles relax, they allow food entry into the stomach. When the LES becomes weak and relaxes, it causes stomach acid to rise up into the esophagus resulting in irritation. We then perceive this sensation as heartburn.

There are a number of triggers for heartburn, but the most common cause is food. Acidic beverages such as coffee or orange juice have been known to relax the LES, resulting in the release of stomach acid. Foods high in oils and fats, anything deep fried, acidic foods such as lemons and oranges, as well as spicy foods are known triggers. However, tomatoes, garlic, onions and peppermint are the most commonly recognized foods that spark the infamous burning sensation.

Extra pressure placed on the stomach also commonly triggers heartburn. This may include eating too much food, obesity or constipation.

Aside from the burning trademark, there are a few other symptoms related to heartburn that parents should be aware of. The most common ones include a sour taste in the back of mouth or throat, as well as dysphagia, which is the sensation of food being stuck in the throat accompanied by difficulty swallowing.

Over-the-counter (OTC) medication is a quick, affordable remedy to treat these symptoms that usually works for most people. Heartburn medications fall into three main categories:

· Antacids, which neutralize existing stomach acid

· Medication that lessens the production of stomach acid

· Medication that puts a stop altogether to the production of stomach acid.

However, if any of these OTC medications fail to work and the heartburn is accompanied with shortness of breath, radiation in the arms or neck, or severe pain, seek medical attention immediately. These may be symptoms of a more serious medical condition.

There are also several at-home remedies I recommend to parents. Monitoring the type of food your family intakes, as well as the amount of intake. I recommend five to six smaller meals with high protein and low fat along with the avoidance of trigger foods. Waiting a couple hours before lying down after eating is useful since that particular body position may cause the LES to relax.

Overall, leading a healthy diet, with reasonable exercise in a healthy, stress free environment are key factors in keeping heartburn out of your life.

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