Students with ASD: How to adjust to a new routine this school year

By Megan Swinford, social worker, Thompson Autism Center at CHOC Cphildren’s

Speak to any parent, and you’ll gain insight into the roller-coaster ride they’ve been on the past several months during the COVID-19 pandemic. Parents have adapted to having their children at home full-time while balancing their own work schedule, virtual learning, and have essentially transformed themselves into teachers.

Parents of children with autism spectrum disorder (ASD) or special needs have had even more barriers to overcome, since Applied Behavior Analysis (ABA) therapy that children usually receive with a therapist in their home has declined due to the pandemic. Now that the school year is upon us, how can you prepare your child with ASD to return to school and adjust to the new normal?

Regardless of which structure your child’s school district offers, your child’s success in school will depend on their ability to adapt and be flexible to an ever-changing environment. This is no simple request considering students with ASD may have challenges with flexibility. The good news is there are ways that parents and teachers can work together to help ease their student’s anxiety:

  • Talk to the teacher about your child’s triggers for anxiety. If your child had virtual learning at home last spring, you’ve probably become more aware of their frustrations and triggers. Triggers may range from sensory issues to unstructured time to virtual interfacing with classmates or their teacher. Whatever their triggers are, it will be key for you to communicate these with your child’s teacher.
  • Create social stories with help from a behavioral analyst and/or teacher. Before in-person learning begins, reach out to your child’s therapy providers and have them practice social stories such as hand-washing, personal space and mask-wearing. This will help normalize some of the new procedures that your child will be faced with this year and prepare them for a better outcome. As a parent, getting involved in these therapy sessions, and understanding how you can translate and practice these social stories at home, will also be helpful.
  • Prepare a schedule—as best as you can. If your child will attend in-person learning this fall, get a copy of your child’s schedule and see if you’re able to visit the classroom before school is in session to build familiarity. Ask their teacher what health precautions will be enforced so that you can practice them. If your child’s school will continue with remote learning, follow these tips: try to have a start/end time each day, incorporate physical breaks that are planned for both you and your child, and create visual schedules.
  • Award flexibility with lots of praise and rewards. Make sure to award or praise even the smallest progress with your child’s flexibility toward new situations. This will encourage your child to respond positively to changes they may not be able to control. Since children with ASD can struggle without a consistent and dependable routine, teaching and reinforcing flexibility will be a strong skillset to develop.
  • Practice flexibility and openness yourself. Try to be open to unexpected outcomes, as hard as that can be. This will help model behavior for your child to follow. Flexibility and openness will be key in the next year, as schools adjust to putting new protocols in place to safeguard their students.
Explore the Thompson Autism Center at CHOC Children's

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The importance of well-checks during COVID-19

An upcoming well-check appointment for her teenage son had slipped Courtney Berney’s mind until her CHOC Children’s pediatrician called her one day with a reminder.

“I didn’t even remember that we had a well-check,” she says. “I did ask if we should still go, even with COVID-19 happening.”

Dr. Eric Ball gave Courtney an overview of the steps CHOC’s Primary Care Network had taken to keep patients, families and staff safe during the pandemic.

dr-eric-ball-choc-childrens-pediatrician
Dr. Eric Ball, a CHOC Children’s pediatrician

Reassured, Courtney and her son, Jackson, headed to the appointment. Upon arrival, they both wore masks, had their temperatures checked and were asked about symptoms and possible COVID-19 exposure. The waiting room was kept largely empty and all staff wore masks.

“It felt very safe,” Courtney said. “I was impressed.”

A routine visit takes an unexpected turn

Including tracking growth, checking in on mental health and ensuring current immunizations, the well-check continued like every other routine visit 15-year-old Jackson had experienced before.

But then, Dr. Ball detected an inguinal hernia during his physical exam.

These can occur when the inguinal canal, which extends down the groin, doesn’t close on its own shortly after birth. If this opening is large enough in these cases, the intestine can come into the canal and create a bulge in the groin region.

This can grow dangerous if the part of the body that protrudes from the hernia becomes stuck, which can compromise blood flow to the trapped body part.

“Apparently, Jackson was born with it and always had it and he didn’t know,” Courtney says. “He’s had this exam every year since, but this year it felt different. I wouldn’t have known that, and he wouldn’t know it without having this visit.”

Because inguinal hernias should be repaired by surgery, Dr. Ball referred Jackson to CHOC’s pediatric general and thoracic surgeons for a follow-up appointment, and Jackson recently underwent a successful outpatient procedure to repair the hernia.

“Inguinal hernias are common but should be taken care of promptly,” says Dr. Ball. “They’re also something that often only a doctor can detect during a physical examination, which underscores the importance of regular well-checks for kids – even when they’re healthy.”

Taking a personal approach

Knowing that parents may be wary of healthcare settings during a pandemic but also how critical seeking both sick and well care remains, Dr. Ball and his colleagues earlier into the COVID-19 emergency made personal phone calls to families. Today, Dr. Ball still regularly has conversations with families about the measures in place to keep families safe.

“I’m happy to connect with them and personally reassure our families about the safety of our office,”  Dr. Ball says. “We want to ensure our patients and families know that we are here for them – during a pandemic and otherwise – and how critical it is to seek both routine and regular care.”

Here’s a look at other ways CHOC is ensuring its primary care practices are safe during COVID-19:

  • separated offices, waiting rooms, exam rooms and times/days for sick visits and well visits;
  • masking for staff, patients ages 2 and older and families;
  • enhanced cleaning practices;
  • screening of all patients for COVID-19 risks, by phone when families make appointments, and upon arrival for well and sick visits;
  • in-vehicle evaluation of children symptomatic or exposed to COVID-19; and
  • limiting the number of people who can accompany a patient to an appointment to one family member.

These extra steps helped reassure Courtney that it was safe to seek routine care for her children, even during a pandemic – and she’ll be coming back.

“My son is really healthy too, but I wouldn’t pass up a well-check,” Courtney says. “I know it might be scary and new, but I trust the doctors. I have to book my appointment for my other son in a couple weeks too.”

Find a CHOC pediatrician near you

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Breastfeeding during COVID-19

We understand how stressful it can be to navigate life as a new parent. With the added anxiety brought on by COVID-19, we want to share trusted information to breastfeeding mothers who are COVID-19 positive or suspected positive, on whether their milk is still safe and beneficial for their baby.

COVID-19 is a new disease and researchers are still studying how the disease spreads. However, breast milk remains the best source of nutrition for most infants.

Current guidance from the Centers for Disease Control states that a mother who has been confirmed or suspected to have COVID-19 should take all precautions to avoid spreading the virus to her infant. These steps include:

  • Washing hands with soap and water for 20 seconds before touching the infant, pumping equipment or feeding supplies.
  • Wear a face mask when breastfeeding, pumping or handling the baby.
  • If using a breast pump, washing hands before touching the pump and following CDC recommendations for cleaning the pump after each use.
  • Follow current CDC guidelines for proper breastmilk handling and storage.
  • If bottle feeding pumped breast milk, have someone who is well feed the baby, if possible.

“Although there’s limited research available on whether COVID-19 is transmitted via breastmilk, studies on similar viruses did not find the virus in the milk,” said Dr. Reshmi Basu, a CHOC Children’s pediatrician. “A mother’s milk does contain specially made antibodies, produced by the mother’s body to protect her and her child from various viruses. These antibodies are transferred in breastmilk.”

Cindy Baker-Fox, registered nurse and certified lactation consultant at CHOC, explains how these antibodies make breastmilk a good source of nutrition for infants.

“Lifesaving antibodies in breastmilk protect babies from many illnesses and are one of the many unique properties found in human breast milk, making it not only a good source of nutrition but also valuable medicine for newborns and infants.”

If you have specific questions about breastfeeding and your baby, contact your pediatrician.

This article was updated August 5, 2020.

Get more information on Coronavirus (COVID-19)

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How donating plasma after COVID-19 can help others

For Steve Emfinger, donating his blood plasma at CHOC Children’s was fast, painless and a way to give meaning to his battle with COVID-19.

“It was very simple,” he said. “And to know it’s helping kids is very cool.”

Registered with the U.S. Food and Drug Administration, the CHOC Children’s Blood Bank is available to collect and process blood plasma donations from COVID-19 survivors. These donations are used to help patients at CHOC and throughout the community.

“We’re still learning about COVID-19, but it’s possible that those who have recovered from the disease have produced antibodies to protect them from the infection,” says Dr. Antonio Arrieta, a pediatric infectious disease specialist who is studying the use of convalescent COVID-19 plasma at CHOC. “If so, their blood plasma would contain these antibodies and may be helpful in the treatment of COVID-19 disease in others.”

Since CHOC began collecting and processing blood plasma donations from recovered COVID-19 patients this spring, more than a dozen CHOC patients have benefited.

And as the number of cases of COVID-19 continues to rise in Orange County and fall approaches, the need for blood plasma donations will only grow at CHOC, Dr. Arrieta says.

A surprising diagnosis

Usually an early riser with boundless energy, Steve just felt zapped in late winter. Attributing the lethargy to two back-to-back trips he had recently taken, he decided to work from home.

Though his symptoms – including a slight cough and dizziness – were minor, Steve’s energy shift was so abnormal that he decided to go to a hospital near his home. He was tested for the flu and strep throat and had a chest scan, but all came back negative.

Steve had one more test – for COVID-19. A couple days later, he got word the test was positive.

Steve hunkered down at home, and notified any friends, family and neighbors he’d been in contact within the weeks before his diagnosis. Some days he felt good – able to work remotely and cook meals – and other days were much more challenging.

All in all, though, Steve felt fortunate to have mild symptoms, never experiencing a fever, body aches or significant respiratory problems, despite a lifelong mild case of asthma.

“I think I’m blessed to know that I had minor symptoms and was able to get through it and my family didn’t get sick,” he says.

Steve’ cases of COVID-19 occurred early on in the pandemic’s spread in Southern California, and he was initially reluctant to share his story with a broader network of friends, family and colleagues. But as he got more comfortable, Steve’s decision to tell others about his experience with COVID-19 ultimately opened the door to the community.

A friend who worked at CHOC told Steve about the COVID-19 convalescent plasma program and how badly donations were needed.

“I had heard that blood plasma was needed, but I didn’t know where to find a donor center,” he said. “I called CHOC the next day to make an appointment.”

CHOC_plasma_donor
Steve during his plasma donation appointment at the CHOC Children’s Blood Bank.

Steps to donate

Potential donors must meet some criteria to be eligible:

  1. Donors must show laboratory test proof of their COVID-19 diagnosis either through a diagnostic test (nasopharyngeal swab) at the time they were sick, or a positive serological test for SARS-CoV-2 antibodies after they recovered.
  2. Donors must have been symptom-free for at least 14 days before they donate.
  3. Donors must meet all other health requirements for blood donors.
  4. Though donors may be male or female, female donors will need to meet some additional requirements. The Blood Bank team will help explain this further to potential donors.

Confirming these requirements takes about a week. Once donors are confirmed and at the Blood Bank, the simple donation process takes about two hours. Donors can return every 28 days to donate again.

Steve is already on his second donation at CHOC and plans to continue in the future – in addition to donating blood and platelets.

“To help someone else makes it all worth it,” he says.

To schedule an appointment or learn more, call the CHOC Children’s Blood Bank at 714-509-8339.

Related posts:

  • Students with ASD: How to adjust to a new routine this school year
    By Megan Swinford, social worker, Thompson Autism Center at CHOC Cphildren’s Speak to any parent, and you’ll gain insight into the roller-coaster ride they’ve been on the past several months during ...
  • The importance of well-checks during COVID-19
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CHOC teen advisers encourage peers to wear masks during COVID-19

Months into the COVID-19 pandemic, some teens are struggling with staying home more than usual, disappointment over canceled events, and wearing masks.

The Centers for Disease Control and Prevention recommends the use of cloth face coverings in public for those over age 2. The governor of California has mandated that face coverings be worn by the general public when outside the home. Read the full order, including exemptions, here.

Being a teenager isn’t easy. Sometimes it’s helpful to get advice from a parent or trusted mentor, but sometimes as a teenager you just want to hear straight from other teens.

CHOC’s teen advisory council – a group of outstanding teens who are active in their community, committed to academic success and support CHOC’s mission – share their perspective on why wearing masks during COVID-19 is important, and their advice for other teens struggling with this aspect of the pandemic.

Noah
Noah, a CHOC Children’s teen adviser, in a photo taken before the COVID-19 pandemic

Noah, age 16

My mom works at CHOC Children’s Hospital, so I understand why face coverings are required. I believe it is important to wear a mask because it has proven to help slow down the spread of COVID-19. People should take responsibility and wear a mask, so hopefully we can go back to our daily lives.

None of my friends have the same medical background as my mom does, so they don’t understand why masks are required and how they help slow down the spread. It is obvious that my friends do not like wearing masks, but they wear them when they have to.

I would say to teens or people in general that they should take responsibility and just wear the mask because they are either helping slow down the spread or keeping themselves safer than when they aren’t wearing a mask. In this case, helping yourself is helping the needs of others.

lauren
Lauren, a CHOC Children’s teen adviser, in a photo taken before the COVID-19 pandemic

Lauren, age 15

Wearing a mask is essential to protecting not only yourself, but others around you. It is extremely important to be courteous of others to wear a face mask to save lives. The COVID-19 pandemic is particularly dangerous for those with underlying health conditions so wearing a mask and taking necessary precautions (limiting outings, frequently washing your hands thoroughly or using hand sanitizer, etc.) to stay healthy will help flatten the curve!

Some of my friends are really passionate about preventing the spread of COVID-19 and have gone the extra mile to make and sell masks or make stickers to continue spreading awareness.

To teens who don’t feel like it’s important to wear face coverings in public, I would tell them that by not wearing a face covering, it is putting everyone around them at risk. Not wearing a face covering compromises the safety and health of everyone that they interact with, especially the elderly and/or those with underlying health conditions. It is vital for everyone to do their part during this pandemic to prevent the spread of COVID-19.

andei
Andei, a CHOC Children’s teen adviser, in a photo taken before the COVID-19 pandemic

Andei, age 17

Masks have become the new normal and as uncomfortable as they are it is required again. We have to make the best of it. As much as I would love to stop wearing them, it is what is best for the time being. For now, all we can do is do what’s best for our nation and our loved ones around us. Let keep fighting strong and with hope there is a solution in sight.

Hopefully in the near future we can actually see each other’s faces and beautiful smiles.

Carina
Carina, a CHOC Children’s teen adviser, in a photo taken before the COVID-19 pandemic

Carina, age 17

I feel it’s important to wear a mask because it helps ensure that others who may be vulnerable, like grandparents or the immunocompromised, are not put at risk. Wearing a mask also reassures me that I am keeping the ones I love safe by doing my part, which is very fulfilling considering how small the action of wearing a mask may seem. I feel that wearing a mask shows your consideration for others while also slowing the spread of COVID-19.

My friends do wear masks while going out, whether it be to go grocery shopping or just for a drive around the block. The idea of wearing a mask isn’t a polarizing issue between my friends since they understand it’s for their protection and the protection of others. Some of my friends also have relatives that live with them who may be at greater risk which makes them more inclined to wear a mask when going out.

To teenagers that do not feel it’s essential to wear a mask in public, I would encourage them to think about all the other people they could possibly affect without even realizing if they don’t wear a mask.

choc-childrens-teen-advisor-zoe
Zoe, a CHOC Children’s teen adviser, in a photo taken before the COVID-19 pandemic

Zoe, age 16

I believe masks are essential because they are proven to be very effective in slowing the spread of COVID-19. If I knew someone was not wearing a face covering in public, I would show them statistics of how the virus impacts people who wear face coverings versus those who do not. I found those numbers to be very eye opening.

I think that masks are quickly becoming a new way to simultaneously accessorize and slow the spread of COVID-19. I find masks to be a fun and interesting new way to express yourself.

Sam
Sam, a CHOC Children’s teen adviser, in a photo taken before the COVID-19 pandemic

Sam, age 13

By wearing face masks, we are doing our part in slowing the spread of COVID-19 and showing courtesy to others.

For the sake of everyone, please wear a mask out in public. Not only does this slow the spread, but it shows courtesy and respect to others around you.

christian
Christian, a CHOC Children’s teen adviser, in a photo taken before the COVID-19 pandemic

Christian, age 17

I believe it is extremely important that everyone participate in wearing a mask. We are all in this pandemic together and we will only overcome it if we all work together in stopping the spread.

Wearing a mask shows respect for others’ well-being and helps reduce the spread of COVID-19. We all must take this pandemic seriously and heed the guidance of scientists and medical professionals who understand the virus and the best way to overcome this pandemic.

To other teens who don’t feel like wearing a mask is important, I would try to convey the importance of wearing a mask to stop the spread of the virus. Leading health agencies have advised us to wear masks; we should practice their recommendations. Wearing a mask is a public health issue that can save lives.

This article was updated on July 22, 2020.

Get more information on Coronavirus (COVID-19)

Related posts:

  • Students with ASD: How to adjust to a new routine this school year
    By Megan Swinford, social worker, Thompson Autism Center at CHOC Cphildren’s Speak to any parent, and you’ll gain insight into the roller-coaster ride they’ve been on the past several months during ...
  • The importance of well-checks during COVID-19
    An upcoming well-check appointment for her teenage son had slipped Courtney Berney’s mind until her CHOC Children’s pediatrician called her one day with a reminder. “I didn’t even remember that we ...
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