20+ tips for maintaining and strengthening a family bond during a hospitalization

We understand how important it is to visit loved ones during a hospitalization, especially a child’s. However, for the safety of our patients, families, physicians and staff, CHOC Children’s strictly enforces limited visitation on our campus during times such as flu season and the COVID-19 pandemic.

Our pediatric psychologists and child life specialists have teamed up to offer families the following creative ways to stay connected throughout a hospitalization:

  1. Phone calls and video chats are often the easiest ways to stay in touch with a hospitalized loved one. If a patient does not have access to a smart device, the Cherese Mari Laulhere Child Life Department can make special arrangements.
  2. Explore new apps to stay in touch – does the child or teen in your life love using WhatsApp, Messenger, Google Hangouts, Snapchat or other apps? Download their favorite app as an easy way to stay in touch their preferred way.
  3. Send an e-card to a patient at CHOC Children’s Hospital.
  4. Use the voice recorder on your smartphone to sing your child’s favorite song, read them a short story, or tell them goodnight or good morning. The parent or guardian who is at the child’s bedside can play the messages on your behalf.
  5. Write to each other in a journal. The child can write a note or draw a picture, and then send the notebook home with the visiting caregiver. Any family members who are at home and unable to visit the hospital can write messages or draw photos in the notebook, and the visiting caregiver can bring it back to the hospital for the child to read.
  6. Assign clinical family liaisons to update non-visiting caregivers or other family members on the patient’s status or call them during rounding.
  7. Family members who cannot be at a patient’s bedside may be comforted by visualizing the space their loved one is in. CHOC has a library of experience videos that can help family members – whether preparing for a visit themselves or not – learn more about CHOC.
  8. Setting up a CaringBridge page can help families share updates and photos with loved ones near and far.
  9. Use Zoom’s whiteboard feature to draw pictures together, write a story or play Pictionary.
  10. Use an online game sharing app to play your favorite board game together online. If a child doesn’t have a laptop available during their hospital stay, their child life specialist can help secure one to borrow.
  11. Pick a craft – anything from painting to decorating a coaster – that all family members can do together via Zoom or video call.
  12. Create a family gratitude journal, where each family member picks three things that they are grateful for every day. Share them with each other via a notebook that is carried from home to the hospital by the visiting caregiver, or with a free journaling app.
  13. Do a scavenger hunt via video chat with different family members. You can each try to find certain items in your spaces that start with a specific letter.
  14. Create coping boxes that kids can use when they feel sad or worried. Some items to consider adding are bubbles, coloring pages, Play-Doh and fidget spinners.
  15. Play a virtual game of Simon Says.
  16. Have family story time through video chat. You can do this at bedtime so family members not at the child’s bedside can participate in their bedtime routine.
  17. Have a virtual, interactive watch party for your favorite TV show or movie using Netflix Party or Disney+’s GroupWatch. These services allow you to synchronize your show or movie with friends and family, and chat while you’re watching.
  18. Create and send a personalized Build-A-Bear with a special “get well soon” message.
  19. Create virtual rooms together using Google Slides. Add furniture, people and links to different activities or games. There are many helpful and free tutorials online for creating these rooms.
  20. Create video diaries to keep each other updated on what you’re doing throughout the day – it could be something exciting or mundane. Share with each other via social media or use a free app to string together your video snippets throughout the day. There are also free apps that will allow you to create a calendar showing a photo of something fun or unique you did each day.
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How to celebrate Halloween safely during COVID-19

As temperatures begin to cool and the community prepares for Halloween celebrations, CHOC Children’s experts provide the following recommendations for how to celebrate Halloween safely amid COVID-19.

“Celebrating holidays such as Halloween is a treasured part of childhood, and we want all children and families to make special memories together. It’s important to heed safety precautions and celebrate safely,” says Dr. Jasjit Singh, a pediatric infectious disease specialist at CHOC Children’s. “While many people feel restless after months of stay at home orders and life looking so much different than it used to, now is the time to be as vigilant as ever in curbing the spread of COVID-19.”

These recommendations are meant to supplement, rather than replace, any local or statewide rules and regulations.

Celebrate virtually

Use technology such as FaceTime, Zoom or Skype to enjoy festivities such as costume contests, pumpkin carvings or festive meals together.

Or, have a virtual, interactive watch party for your favorite Halloween movie using Netflix Party or Disney+’s GroupWatch. These services allow you to synchronize your show or movie with friends and family, and chat while you’re watching.

Celebrating virtually is especially important if you are celebrating with family members over the age of 65, or those who are immunocompromised and have underlying conditions that put them at greater risk of complications from COVID-19.

Festive outdoor celebrations

Carving or decorating pumpkins outside with neighbors, from a safe distance, is considered a low-risk activity by the Centers for Disease Control and Prevention.

Families could also consider organizing a Halloween scavenger hunt where kids can search for festive items as they walk from house to house, admiring decorations from a distance.

If you visit a pumpkin patch or apple orchard, ensure the location requires frequent hand-washing or hand sanitizer use, masks are required and social distancing is maintained.

Wear a mask

It’s important to remember that a Halloween costume mask is not a substitute for a proper face covering, says Dr. Belinda Dao, a CHOC Children’s pediatrician. “Masks that do not meet the stated criteria from the CDC are not appropriate face masks,” Dr. Dao says.

Pediatrician Dr. Marnie Granados adds, “protective masks should cover a child’s nose and mouth, be secure under their chin, and fit snugly against the sides of their face.”

Learn more about the important of wearing a proper face covering this Halloween.

Trick-or-treating

Per the CDC, a moderate-risk activity is a one-way trick-or-treating path where individually wrapped goodie bags are lined up at the end of driveways or sidewalks for kids to grab and go while maintaining social distancing.

Anyone preparing goodie bags should practice proper hand-washing before and after.

Activities to avoid this Halloween

Traditional trick-or-treating where treats are handed to children who go door to do is not recommended by the CDC, nor are trunk-or-treat events where treats are given to children from trunks of cars lined up in parking lots. These celebrations don’t allow for proper social distancing.

Likewise, indoor events such as costume parties and haunted houses are not recommended during COVID-19.

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An innovative internship approach during COVID-19

A year ago, Jenae Vancura joined an elite group of college and high school students for a unique and innovative summer internship program at CHOC Children’s. The interns shadowed physicians, joined doctors on their rounds and attended meetings with a wide range of professionals in the medical field.

The days were long. The work was challenging.

And Jenae, a 21-year-old biology major from UC Santa Barbara, is back again this year, now serving as a lead intern for the Sharon Disney Lund Medical Intelligence and Innovation Institute  (MI3) summer internship program. She now helps guide a new group of students through the rigorous program.

“But this year is a little different,” Jenae says.

Now in its eighth year, the internship has been effectively reimagined as a virtual program, a pivot quickly executed at the onset of the global coronavirus pandemic.

virtual MI3 internship meeting
Jenae participates in a virtual meeting as part of the MI3 internship.

The COVID-19 crisis emerged just as CHOC leaders and physicians were gearing up for this year’s internship program. That meant that the 63 participating students would not be able to work directly with hospital staff or go on rounds to interact with patients as in years past.

Cancelling not an option

While many internship programs have been halted worldwide due to COVID-19, canceling the MI3 internship was simply not an option, organizers say. The experience was much too valuable and too many young had worked too hard to get this far.

“Many of our interns look to our program to affirm and motivate their decision to apply to medical school,” says Debra Beauregard, director of MI3. “Nearly all of the interns aspire to become physicians.”

So, with just weeks to go, the decision was made to recalibrate the program and put the whole curriculum online.

“The easy thing would have been to postpone or cancel,” says Dr. Anthony Chang, CHOC’s chief intelligence and innovation officer who launched the program eight years ago. “We wanted to give the students the same level of opportunity. To their credit, the team stepped up and made the internship rotation on par with previous years.”

Dr. Chang started the internship because he wanted to give young people an in-depth experience of the medical field.

“I felt like no one was really doing something like this,” he says. “The students were staying with one mentor doing one assignment. That sounds like a research assignment, not an internship. I wanted to give them access to something that gave them access to a hundred mentors.”

A rigorous pace remains

Even though the pandemic has restricted access to the hospital, it hasn’t slowed the  interns’ pace. Their work schedule starts early and, with a few breaks between, doesn’t end until the evening.

“We set up a lot of Zoom meetings,” Debra says. “Our interns have a full schedule. They participated in rounds and shadowed our physicians virtually. They were even able to remotely view multiple surgeries. This was a challenge, but everyone pulled together to provide what turned out to be a great summer program.”

a virtual session as part of the MI3 internship program
MI3 interns participate in a Zoom meeting as part of their virtual internship.

Dr. Chang says that while the interns are receiving the same level of instruction, what’s missing are some of the personal interactions that come with face-to-face contact.

“Not having one-on-one time in person and not having more intimate moments in small groups is difficult for us,” he says. “For instance, in past years they’ve had one-day retreats where they come to my house for breakfast and lunch. I wasn’t able to do that this year.”

But that doesn’t mean there isn’t room for a little fun.

“Our directors and lead interns made sure that all interns felt connected,” Debra says. “We included team-building exercises, interactive small group sessions, and even a virtual graduation ceremony. The leads even organized a virtual talent show and Zoomie Awards, in addition to a competitive team competition. Our leads have gone above and beyond to ensure that our interns had a meaningful and memorable experience.“

Dr. Sharief Taraman, internship co-director and pediatric neurologist at CHOC, has been part of the program almost since it started. He’s confident that this year’s group is better off than students anywhere else.

“They’re way ahead of their peers in terms of experience and what they can get out of the summer,” he says. “We have a lot of moving parts, so we had to pivot very quickly.”

And to ensure the interns get all the experience they can, they are being invited back next year when they are hopefully able to receive hands-on work.

“We have offered guaranteed spots for our interns next year, so they can have an in-person experience,” Debra says. “We are confident that most will be coming back.”

Student gratitude abounds

The interns themselves are grateful for the chance to continue their internships during these difficult times.

“When I thought it wouldn’t happen, I got very upset,” says 20-year-old Julia Keating from the Massachusetts College of Pharmacy and Health Sciences University. “It’s such a competitive internship.”

For Jessica Octavio, a 20-year old San Diego State student majoring in microbiology, going online was positive experience.

‘’We’re lucky,” she says. “They’ve been more than flexible. The biggest thing was learning this online interface, but as far as programming goes, it’s almost advantageous for us.”

While working on site would have been ideal, Luke Arnold says he appreciates all the work the health system staff have put into making this year’s program a success.

“It’s not ideal and obviously we’d like to have this in person,” says the 21-year-old biology major from Chapman University. “But being in quarantine has given us opportunities to work in group settings. We’re all in this together.”

For intern Nicole Fraga, working from home has had some surprising benefits.

“It can be a very rigorous process,” says the 22-year-old recent graduate from Brown University. “But ironically, I think they’re getting closer to the interns online because we are meeting in small groups. We are able to communicate on Slack and share memes. We have a smaller community.”

Dr. Chang calls the internship a “circular experience.” The health system staff, he says, learn as much from the students as the students do from the physicians.

“We’re grateful that the interns are even more inspired to go into medicine despite the pandemic,” he says. “It’s very heartwarming to hear. The future of medicine is in good hands. I see the interns push back against the temptation to give up. They have the idealism and no fear of failure.”

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Augustina’s heroic battle with COVID-19

When Augustina, then age 13, visited her doctor in early June because she wasn’t feeling well, she had no idea she’d be rushed to CHOC Children’s Hospital and spend the next two months fighting for her life.

“My doctor told my dad that we needed to get to CHOC right away,” Augustina says. “I don’t remember much right after that.”

Originally admitted to CHOC with respiratory distress, Augustina was soon diagnosed with COVID-19. She was initially on high flow nasal canula for supplemental oxygen. Eventually that was escalated to a BiPAP machine — bi-level positive airway pressure — a machine that pushes much-needed oxygen into a patient’s airway. Her condition continued to worsen, and she was put on a ventilator to increase her oxygen levels. She was medically sedated for most of her stay in order to tolerate the ventilator.

“She was in critical condition for a long time,” says Dr. Jason Knight, medical director of the Josie Y.S. Lee Pediatric Intensive Care Unit (PICU) at CHOC Children’s Hospital. “There were two different nights during her hospitalization when we thought we might lose her.”

Dr. Jason Knight
Dr. Jason Knight, medical director of the Josie Y.S. Lee Pediatric Intensive Care Unit (PICU) at CHOC Children’s Hospital

During this extended hospitalization, Augustina’s father Jose visited her every day. Although his daughter was sedated, he spoke messages of support and encouragement to her.

“‘Mama, just relax. Everything is going to be OK’ is what I would tell her,” Jose says. “Even though she was asleep, I knew she could hear me.”

Indeed, when Augustina finally woke up from sedation, she thanked her dad – and her nurses, who had shared similar messages in her ear – for that encouragement.

“I couldn’t  talk, but I could still hear them,” Augustina says.

At one point, her condition improved thanks to proning and nitric oxide.

Eventually, Augustina underwent a tracheostomy, where a surgeon created an opening in her neck to place a tube into her trachea, allowing oxygen to enter the lungs. Once her tracheotomy was in place, she was more awake and the team was able to wean her ventilator support.

Once she was off her ventilator, the next step was rehabilitation, in partnership with CHOC’s physical therapists. The first milestone was sitting up in bed, then standing next to her bed, then walking around a little bit at a time. That process took several weeks.

Working through physical challenges and coming to terms with all she had been through was an emotional experience for Augustina.

Dr. Knight recalls one particularly anxious day for Augustina. Doctors wanted to perform a small procedure and because she was now coherent, she felt anxious – even though the procedure was relatively small.

Dr. Knight shares how that anxiety lead to a pep talk and bonding moment for the physician and his patient.

Dr. Knight: Why are you so sad?

Augustina: I’m sick and I have a trach and I’m not going to get better.

 Dr. Knight: Are you kidding me?

 Augustina: What do you mean?

 Dr. Knight: Augustina, you beat COVID! You were near death twice. One of those nights, I was on call and I thought we were going to lose you. COVID has killed hundreds of thousands of people and you were going to be one of them and you said no. It’s OK to be upset that you have a trach, but you also have to know that there’s a lot of people who weren’t always sure you were going to make it.

 From then on, Augustina’s entire outlook changed for good.

Augustina leaving the pediatric intensive care unit
Augustina leaving CHOC’s PICU.

Send-off celebration

After 57 days in CHOC’s PICU, Augustina was ready to be discharged to a local rehabilitation facility as a step toward going home. Wanting to make sure Augustina felt celebrated in her journey and give her the hero’s send-off she deserved, child life specialists from the Cherese Mari Laulhere child life department sprang into action. They created signs, organized gifts and planned a cheer tunnel filled with her favorite staff members holding streamers. The celebration brought tears to Augustina’s eyes.

Finally home

After spending a few weeks – and celebrating her 14th birthday – at the rehabilitation facility, Augustina finally went home.

These days, Augustina is back in school – albeit virtually for now – and happy to be surrounded by family, whom she missed during her hospitalization.

Augustina leaving CHOC's PICU
Augustina leaving CHOC’s PICU, pictured with her physical therapists and child life specialists.

The impact she made on CHOC’s PICU team remains strong.

“It’s important for people in the PICU to have victories like Augustina,” Dr. Knight says. “We don’t get victories all the time. There can be sadness and disappointment in the PICU. Everybody in the PICU knew Augustina and took care of her. Everyone knew how serious her case was. Our PICU team put a lot of time and effort and love into Augustina. It’s safe to say the entire PICU team is celebrating her success.”

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What to expect from your child’s COVID-19 test at CHOC’s Outpatient Evaluation Center

CHOC Children’s outpatient evaluation center offers COVID-19 testing for children who have been exposed to COVID-19 or are experiencing symptoms associated with COVID-19, as well as children who require a test before an upcoming procedure.

We understand that having a child undergo a COVID-19 test can be stressful for parents, so we’ve prepared this guide on what to expect.

What to know before your appointment:

  • You will be notified in advance by phone of your appointment time at the outpatient evaluation center. Children with possible exposure or those experiencing symptoms will first have a telehealth visit.
  • The outpatient evaluation center is an outdoor area with large tents.
  • Wait in your car until a CHOC employee comes to check you in. Please ensure all vehicle passengers wear a mask.
  • Your child should stay seated in the car and wearing a seatbelt.
  • A nurse or respiratory therapist will ask you a few questions and take your child’s temperature before beginning the test.
  • They will wear yellow or white gowns, gloves, masks and face shields.

What to expect from your child’s COVID-19 test:

The COVID-19 test is done using a nasal swab. This might sound scary, but if your child can relax, the test takes just 5 seconds.

There are some things you can do to make the process easier:

  • Bring a small comfort item for your child to hold.
  • You can try sitting next to your child and holding their wrists, if necessary.
  • Parents may sit younger children in their laps and wrap their arms around them.
  • The provider can also help hold your child steady, if necessary.
  • After counting to 5, the provider will insert the swab into the back of the child’s nose, twist it and then pull it out. Inserting the swab this far into the nose is necessary to ensure the provider gets a proper specimen.
  • The test feels funny. It may feel similar to when water gets in your nose at the pool or beach. Your child might sneeze, and their eyes may water.

Waiting for your child’s COVID-19 test results:

Awaiting testing results can be worrying, and we want to clarify the process and what parents can expect.

If your child underwent a COVID-19 test before a scheduled procedure — and the test is positive, you will receive a telephone call by the end of the day or, in some cases, early the next morning. Any scheduled procedure will be canceled. If the test is negative, you will not be contacted.

If their test was negative, you should come for the procedure as scheduled. After the test, your son or daughter should stay at home until their procedure the next day to prevent COVID-19 exposure. Parents will not be tested for COVID-19. Instead, they must pass a health screening at the hospital upon arrival for their child’s procedure the next day. They must also wear a mask.

If your child underwent a COVID-19 test due to COVID-10 exposure or symptoms — you will receive a phone call with your child’s test results, which may take up to 14 days.

Even if the test is negative, the child should isolate at home for 14 days after contact with someone who has COVID-19. If the child has shown COVID-19 symptoms, they should isolate at home for 10 days after symptoms began and for at least 24 hours after a fever has resolved.

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