Summer safety tips from your pediatrician

Kids are still kids, even during a pandemic – they play, they get sick and sometimes they get hurt. We spoke to Dr. Angela Dangvu, a CHOC Children’s pediatrician, about what parents can do to keep kids safe this summer.

dr-angela-dangvu
Dr. Angela Dangvu, a CHOC Children’s pediatrician

COVID-19 precautions

With no vaccine currently available, the best way to prevent illness is to avoid being exposed. In addition to practicing proper handwashing, people should watch for symptoms and avoid going out if they feel ill. When outside the home, people should physically distance from others whenever possible, and wear a face covering. 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.

Be safe around water

A child can drown in as little as 2 inches of water – so keep an eye on all bodies of water like bathtubs and ice chests, in addition to pools. Assign a “water watcher” who knows how to swim and can provide constant, uninterrupted supervision. Learn more about water safety.

Wear your sunscreen

Everyone over 6 months should wear sunscreen when they’re outdoors. Infants younger than 6 months should be kept out of the sun.

Apply a sunscreen with SPF 30 at least 15-30 minutes before you go outside. Reapply every two hours or after swimming or sweating. Wide-brimmed hats and sunglasses offer extra protection. Limit time spent outside between 10 a.m. and 4 p.m. to minimize down on sun exposure. Also be aware that surfaces like sand and water reflect sunlight, so it’s possible to get burnt even when you’re in the shade. This is especially true for infants.

Review family emergency preparedness plans

Emergencies are not on pause just because there is a pandemic. Create and practice a fire escape plan with your family. Double-check smoke alarms and carbon monoxide detectors.

Practice poison precautions

Avoid household poisoning hazards and save the Poison Control Center’s phone number in your cell phone: 1-800-222-1222 for serious emergencies or simple questions. Store medicine and vitamins up high and out of sight. Remind children that medicine is not candy.

Helmet safety

Most serious head injuries can be avoided by wearing a properly fitting helmet. By law in California, everyone under 18 years of age must wear a Consumer Product Safety Commission-approved helmet while bicycling, riding a scooter, skateboard, or using roller-skates or in-line skates. Parents should enforce this rule even when kids are riding in areas where they don’t expect to encounter vehicles.

Learn more about the most common summer injuries that send kids to the emergency department – and how to avoid them.

If your child is ill or injured during the COVID-19 pandemic, rest assured that it is safe to seek the care they need. Here’s a guide on deciding where to go for care during COVID-19.

This article was updated July 22, 2020.

Find a CHOC pediatrician near you

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Reducing childhood obesity during the COVID-19 pandemic

We know that all parents want to keep their children healthy and safe. Although COVID-19 affects different people in different ways, research has shown that obesity puts children – and adults – at increased risk of severe illness.

According to 2016 data from the Let’s Get Healthy California task force, 20.2% of children age 0-5 were overweight for their age, 12.9% of children age 6-11 were overweight, and 40.7% of adolescents age 12 to 17 were overweight or obese.

Following your doctor’s advice on nutrition and physical activity can help protect you from severe illness associated with COVID-19 – in addition to physical distancing, washing your hands frequently and wearing a facial covering.

Here are some healthy eating and exercise tips for your family. If you have questions about your family’s health, call your doctor.

Healthy eating tips

Limit the amount of added sugar your child eats or drinks.

  • The American Heart Association recommends that children ages 2 to 18 should have less than 25 grams of added sugar per day, and drink less than one 8-ounce sugary drink per week.
  • 25 grams of sugar equals 6 teaspoons, or about 100 calories. The average American child consumes 19 teaspoons of added sugar daily, or more than 300 extra calories.
  • Here’s tips from a CHOC registered dietitian on limiting added sugar in your family’s diet.

Eating healthy does not have to be expensive. A CHOC registered dietitian offers these tips for parents who want to follow a balanced diet and stay on budget:

  • Plan before you shop. Compare prices and read grocery flyers to determine what’s on sale. Create a menu for your family for a week at a time, building on foods you already have at home
  • Eat before you shop. Going shopping hungry can lead to spontaneous and unhealthy purchases.
  • Prepare double or triple batches of meals you can freeze and eat later on days you will be too busy to cook a healthy meal.
  • Here’s more tips on eating healthy on a budget.

Is your toddler a picky eater? Dr. Eric Ball, a CHOC Children’s pediatrician, offers these tips:

  • Don’t let toddlers decide what food they are served. Parents control the quality of food offered to children. Toddlers control the quantity that they eat.
  • It’s normal for toddlers to have meals – or even days – when they eat little.
  • Mealtime will be more successful if you avoid letting your toddler fill up on liquid calories or snacks. At snack time, give your toddler two acceptable options.
  • Here’s more tips from Dr. Ball on how to deal with a toddler who is a picky eater.

When life gets busy, planning and making homemade meals can easily fall to the bottom of your to do list. These healthy meal prep tips for busy parents, from a CHOC registered dietitian, can help.

  • The USDA’s Choose MyPlate program is a great place for recipe ideas. It also offers tips for meeting your nutritional goals. Find tips to incorporate each food group into your diet, and what foods to limit, such as salt and saturated fat.
  • The website also offers the MyPlate Plan – parents can enter the gender, weight, height and activity for their children and get specific energy needs. Then, you can choose the calorie level and servings and suggestions for each food group to meet your child’s calorie needs. Here’s an example MyPlate Plan.
  • Learn more about the healthy eating benefits of the Choose MyPlate program.

Get kids involved in the kitchen

  • Preparing meals together can help children develop healthy eating habits. Talk about the ingredients, and how they smell, taste, look and feel. Be creative when offering new foods. You can make bugs with fruit kabobs or faces with vegetables on homemade pizza.
  • Children learn by example. If they see parents and siblings preparing and trying healthy food, they are more likely to accept a new food.
  • Make mealtimes family time. Children who eat meals with their families at home have higher quality diets and higher intake of fruits and vegetables.
  • Here’s more tips on developing healthy eating habits in kids.

Drink enough water

How much water should children drink every day? We recommend they drink the number of 8-ounce glasses equal to their age, with a maximum of eight glasses for children age 9 and older. For example, a 3-year-old should drink three 8-ounce glasses of water per day. Here’s a helpful chart to keep track of this advice.

Promote physical activity

Daily exercise helps keeps kids fit. Try to get at least one hour every day. This doesn’t need to be all at once. It can be short bursts of activity for 15 minutes at a time.

Be active with your children. They are more likely to stay active when they are having fun with their parents. Tap into activities or sports they’re already interested in, that you can do while respecting physical distancing, such as waking the dog, playing catch, soccer, riding a bike, or setting up an obstacle course in your backyard.

Limit screen time

Screen time is considered watching TV, playing video games or using a computer, tablet or smartphone. The American Academy of Pediatrics offers these screen time recommendations for kids:

  • 18 months or younger – no screen time is best. An exception is live video c hat with family and friends.
  • 18 months to 2 years – limit screen time and avoid solo use. Choose high-quality education programming and watch along with your kids to ensure they understand what they’re watching.
  • 2 to 5 years – limit screen time to an hour per day. Parents should watch with their kids to make sure kids understand what they’re watching and can apply it to their world.
  • Age 6 and older – parents should place consistent limits on screen time. Don’t let screen time affect sleep, exercise or behavior.

Call your doctor

If you have questions about your child’s weight, speak to your doctor. Doctors use body-mass index charts, based on age and gender, to determine a range of healthy weight for kids.

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Telehealth for ophthalmology visits: What parents should know

By Dr. Rahul Bhola, pediatric ophthalmologist and medical director of ophthalmology at CHOC Children’s

Like many physicians continuing to offer care during the COVID-19 pandemic, I have transitioned many appointments to telehealth, so patients can still get the care they need while practicing social distancing. At CHOC Children’s, we adjusted our policies and practices to maintain a safe environment for our patients and families who need in-person appointments.

For in-person appointments, we require masks and practice proper hand hygiene to protect the health of everyone we serve. Before entering our building, CHOC nurses screen all visitors and staff. Screenings include a temperature check and asking symptom and exposure-related questions. In line with CHOC’s limited visitor policy during the COVID-19 pandemic, only one parent/guardian may accompany the child for their appointment. Our clinic is taking other necessary precautions such as thoroughly disinfecting clinical areas and rearranging seating in our lobby to ensure social distancing.

Since March, my office has successfully completed over 900 telehealth visits, on top of non-elective in-person appointments.

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Dr. Rahul Bhola, pediatric ophthalmologist and medical director of ophthalmology at CHOC Children’s

Since telehealth is new to many families, here’s an overview of what parents can expect at their first virtual appointment, plus answers to parents’ most common questions on telehealth for ophthalmology.

A synchronous (live audio-video) CHOC ophthalmology telehealth appointment is divided into four components. I call them the four C’s: Contact, Connect, Consult and Care.

  1. Contact
    Our front desk reaches out to the family to confirm their contact information. We send a Zoom link to the family, along with information about how to connect to Zoom and download a Visual Acuity app that we use during appointments to check vision.

 

  1. Connect
    As the appointment day approaches, our technician connects with the family to resolve any technical issues before the physician consultation. The technician also goes over the at-home visual acuity check and evaluates basic medical history.

 

  1. Consult
    On the actual day of the telehealth appointment, the physician connects with the family to go over the relevant medical history and visual acuity and performs focused examination including external and ocular motility exam. If needed, pictures and videos from the family can be sent to the physician for further evaluation. This enables us to diagnose a majority of anterior segment ocular issues, visual acuity concerns like amblyopia, refractive errors and ocular motility disorders.

 

  1. Care
    During the telehealth appointment, we discuss the treatment care plan and review any medical issues or concerns the patient is experiencing. Throughout this process, we can fulfill their needs ranging from prescription refills or broken glasses, without them having to step outside the comfort of their home.

Our office will then schedule a follow-up visit depending on the medical necessity.

How do your patients and families feel about telehealth?

I have found that many patients love telehealth! Our families feel supported and secure, since there was no interruption in their child’s care plan. I’ve also found that our families feel grateful that during this time of uncertainty, their physician was able to connect with them and address any urgent issues, and then follow them in clinic as needed.

Due to the positive response we have received from our families, we plan to continue offering telehealth appointments in the future.

Does telehealth compromise quality of care?

No. We carefully scrutinize the kind of visits that can safely be performed via telehealth without compromising on quality of care. If your ophthalmologist decides your child’s visit can safely be conducted via telehealth, rest assured your child will still receive the high level of care you’re used to receiving in person. After the telehealth appointment if we feel the need for an in-person appointment, we will work with our families to schedule that appointment promptly and safely.

Sometimes, an exam conducted via telehealth reveals something requiring an in-person appointment. In those cases, we work with our families to schedule appointments promptly and safely.

Ger more information on telehealth

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Activity ideas for kids during COVID-19

With social distancing guidelines in effect, many schools closed and some childcare options unavailable, many children are spending more time at home than usual.

Here’s a roundup of what parents and caregivers can do to keep kids occupied during this time.

Online learning

    • The Orange County Department of Education has created a roundup of free resources to help students supplement other materials that are being provided by their teachers.
      • OCDE also has a complete list of school districts providing grab-and-go meals at campuses across Orange County. See the full list here.
    • Many educational companies are offering free subscriptions in light of school closures. Here’s a guide.
    • Scholastic offers day-by-day projects to keep kids reading, thinking and growing.
    • PBS SoCal | KCET, in partnership with the Los Angeles Unified School District and in collaboration with California PBS stations, are offering broadcast programming and accompanying digital resources that adhere to California’s state curriculum. Learn more here.
    • Budding scientists can access Nova Labs at PBS, for video, animation and games on scientific topics like predicting solar storms and constructing renewable energy systems.
    • NASA’s Teachable Moments, offers a range of activities and lessons for grades K-12.
    • NASA’s Kennedy Space Center Visitor Complex has educational and fun Facebook videos where kids can learn from astronauts and other educators. For activities, instructions are available as free downloads.
    • Make any room a classroom with BrainPop, where curious learners can take units in science, social studies, math, engineering and tech, and more
    • Tynker is offering free premium coding courses during school closures.
    • Khan Academy offers free daily schedules for kids and teens ages 4-18 to keep stability and routine during this time. The online learning non-profit also offers a free downloadable app called Khan Academy Kids,that contains thousands of activities and books for children ages 2-7.
    • FunBrain.com offers hundreds of free games, books comics and videos for Pre-K through eighth grade.
    • National Geographic Kids offers free online quizzes on topics ranging from animals to planets to sports and food.
    • Cool Math 4 Kids offers games and lessons to make math fun for kids.
    • Math Game Time offers a variety of games, videos and worksheets for Pre-K through seventh grade.
    • Inspired by Dr. Seuss, Seussville has activities, crafts, printables and recipes to engage your child in playful learning.
    • Online  games that include K-12 curriculum.
    • Skillshare is offering two-month free trials for online classes that include animation, creative writing, web design and more.
    • Amazon is offering free computer science courses online for various grade levels.

YouTube channels

  • Camp YouTube — a digital learning experience to help parents recreate the fun of summer camp at home.  Summer camp themes include arts, adventure, sports, STEM and more
  • Crash Course Kids — bi-weekly shows on grade school science, including Earth, habitats, space and more.
  • Science Channel – learn about outer space, new technology and more.
  • SciShow Kids – every Tuesday and Thursday, the hosts explain fun, complex science concepts; do experiments and interview experts.
  • National Geographic Kids – videos feature animals, science, pets and more.
  • Free School – exposure to famous art, classical music, children’s literature and natural science in an age-appropriate and kid-accessible way.
  • GEOgraphy Focus – explore geography, maps, flags, culture, languages and travel.
  • TheBrainScoop – explore the work and research of natural history museums.
  • Kids Learning Tube – educate kids through music and animation.
  • Geek Gurl Diaries – videos on programming, computer science, logic, electronics and more.
  • Mike Likes Science – science-inspired music videos.
  • Science Max – large-scale science experiments.
  • SoulPancake – in addition to the well-known Kid President shows, this channels offers content that explores and celebrates the ways humans seek connection.
  • Course Hero – study guides and videos for various subject matters.

Story time

  • Here’s a list of podcasts — featuring stories, meditation, music and more — for ages 2 through 6.
  • Celebrities are taking to social media to read children’s books to little ones staying home during this time. The Los Angeles Times curated this roundup of these posts.
  • Audible, which has the world’s largest collection of audio books, is offering free stories — in six different languages —  for kids as long as schools are closed. Start listening here.
  • Here’s a list of authors doing read-alouds of their famous books, as well as books by their favorite authors.
  • Storyline Online, the SAG-AFTRA Foundation’s award-winning children’s literacy website, streams videos of celebrities reading aloud children’s books alongside creatively produced illustrations.

Music class

  • Carnegie Hall’s Music Explorer program offers a way to learn new musical genres and cultural traditions. Courses conclude in an interactive concert experience.
  • Chrome Music Lab lets kids learn music through a hands-on website.

Learn a new language

  • Learn a new language with Duolingo.
  • English52 allows users to strengthen English skills through video lessons and activities.
  • Fabulingua is an interactive app that teaches Spanish.

Virtual field trips

  • Google Arts & Culture has partnered with thousands of museums around the world to offer virtual tours from the comfort of your home. Here’s the complete list.
  • The San Diego Zoo offers 10 different webcams so animal lovers can keep up with a variety of their favorite creatures.
  • The Monterey Bay Aquarium also offers 10 different webcams for families to experience underwater life from anywhere.

Cook with your kids

  • CHOC nutrition experts have curated some of their favorite recipes and offer tips for how to get kids involved in the kitchen. “Children as young as 2 years old can help out in the kitchen. You can have your child wash fruits and vegetables or stir ingredients,” Shonda Brown, CHOC clinical dietitian, says. “Children are more open to trying new foods if they have opportunities to explore and learn about the food before they eat it.”

Opt outside

Kids can still benefit from nature while practicing proper social distancing. Even babies and toddlers can join a family nature walk. if you’re in a public space, keep them in a carrier or a stroller. If you’re in your backyard, they can explore more freely.

Children who spend more time outdoors have improved motor development and lower obesity rates. Playing outside promotes more curiosity, creativity, and critical thinking — especially essential with schools closed and extra-curricular activities canceled.

  • On a nature walk, collect twigs, leaves or rocks. Then, build a nature sculpture by sticking these items in play dough. Help your child notice the patterns created by different items.
  • Go on a family bike ride, while keeping a safe distance from others.
  • Nature scavenger hunts can be fun for the whole family. How many different kinds of plants, flowers, animals or birds can you see?
  • Playing soccer or catch is fine, but don’t share equipment with people outside your household.

Highlights@Home

The beloved classic kids’ magazine, Highlights, is posting twice-weekly online roundups of stories, puzzles, craft ideas and more to help children cope with being cooped up and help parents make the most of this time with their kids. Each installment has a different theme:

  • Celebrate reading — Reading can transport us somewhere else for a while, even when we’re stuck at home.
  • Pajama day — Showing your children affection with a hug, snuggling on the couch to watch a movie, or reading together in a cozy blanket tent are all ways you can be fully present with your child.
  • A never-ending pile of fun — Sequestering at home may actually provide you with the time to teach kids tasks like matching socks, folding clothes, and putting away clean laundry. Kids usually like to help, and when we make the chores fun, they’re often eager to pitch in.
  • We are (all) family — Whatever your family configuration, this week’s issue has ideas for strengthening your family bond.
  • Staying connected — Children are likely feeling the loss of connection with friends and extended family. This guide is full of ways you can help your kids feel more connected to people they love but can’t safely see right now.
  • Just keep dancing — What raises our spirits more or gives us a burst of energy like music and dance? These activities will help  your kids move their bodies, use their creativity, and improve their mood.
  • Shoot for the stars — Young or old, we’re all fascinated by space. What’s known is often mind-boggling, and what’s unknown leaves so much to the imagination.
  • Thank you teachers — Thanking teachers is not only a nice thing to do, but showing appreciation is a simple but important practice of gratitude.
  • Hooray for helpers — National Nurses Week presents an opportunity to expand your kids’ understanding of what it means to be heroic.
  • Let’s talk family — Someday, this quarantine will be a memory, and we hope your children will remember some of the family fun you’ve been enabling, and also the ways you are helping them focus on the things that really matter.
  • Cleaning up — A bundle of resources for making cleanup fun.
  • Celebrate the sun — Puzzles, stories, and activities related to growing gardens, having picnics, and taking nature hikes will remind your kids of some of the fun to be had in the sun. Sunny days together provide an opportunity to talk to your kids about optimism.
  • Alone together — Games, played alone or together, are great for practicing reading, math, and strategic thinking. They also help build memory, focus and interpersonal skills.
  • Soar into summer — Activity ideas to help imaginations take flight.
  • We’re going on a scavenger hunt — Encourage children to sharpen their powers of discovery and plan their own hunt.
  • Be nice, be kind, be you — Reinforce the messages of being sensitive to others’ feelings and that kindness is never wasted.
  • Blaze a trail — Ideas on connecting with nature, sparking creativity and thinking of others.
  • Be the best BFF — Cultivating friendships helps foster kids’ social-emotional development. The qualities we seek in friends—kindness, positivity and shared interests—are found in friends who  may look like us, or in those who may look different.
  • Celebrate your superpower — This bundle will help your children see themselves as having the ideas and abilities —superpowers, if you will — to do good in the world.
  • Pack a picnic — Menu and game ideas that will let kids show off their creativity.
  • Camp out or camp in — Ideas for making a backyard or living room campground memorable.
  • Welcome to summer — Activity and bonding ideas to promote relaxation, enjoyment and memory making.

Programming to help explain COVID-19 to kids

  • This CNN/Sesame Street town hall offers reminders on how children can help protect themselves against COVID-19.
  • PBS KIDS will air a special episode of Daniel Tiger’s Neighborhood August 17 that addresses challenges and disappointments children and their families may be facing during the COVID-19 pandemic. Learn more here.

Other activities

This article was last updated on July 20, 2020.

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9 ways to protect immunocompromised children from COVID-19

We know how frightening the COVID-19 pandemic may be for parents – especially parents of immunocompromised children.

At this time, the full impact of COVID-19 on children, especially those with compromised immune systems, is unknown. However, limited information so far shows that most healthy children with the virus have done well.

Here are some recommendations for steps to take to help protect immunocompromised children from COVID-19:

  1. Call your provider

Call your child’s care provider first if your child has a runny nose or cough. Go to the emergency department if a cough or runny nose is accompanied by fever, or if you are advised to by your doctor, or you believe the situation is emergent.

  1. Follow through with medical appointments

If you have medical appointments that are important to your child’s care, you should attend them. Many providers are offering telehealth appointments. Call your provider’s office to see if this is available, and if your appointment can be conducted through telehealth.

  1. Practice good handwashing

Everyone in the home should consistently wash their hands with soap and water for at least 20 seconds. This is one of the most effective ways to stop the spread of illness. If you don’t have access to soap and water, hand sanitizer is a good alternative.

  1. Cover coughs and sneezes

Cough and sneeze into your inner elbow – and teach children to do the same. It’s also important for everyone to avoid touching their mouths, noses and eyes.

  1. Disinfect high-touch surfaces

It is important to disinfect surfaces that are commonly touched such as the cell phones, tablets, game controllers, doorknobs, light switches, tables and counters.

  1. Practice social distancing

Orders from the governor of California for all state residents to stay home — except for essential needs, such as if your work supports the continuity of critical infrastructure sectors, or if you need to access essential services like food, pharmacies, banks or laundromats – are in place until further notice.  Read more here.

If you must leave your home, wear a mask and maintain at least 6 feet of distance from other people whenever possible.

  1. Follow guidance around face masks

The Centers for Disease Control and Prevention (CDC) recommends wearing cloth face coverings in public settings like grocery stores and pharmacies where social distancing measures can be difficult to maintain. These face coverings can slow the spread of COVID-19 and help people who may have the virus and do not know it from transmitting it to others. It is not necessary for children under the age of 2 to wear cloth face coverings.

The governor of California has mandated that face coverings be worn by the general public when outside the home. This applies to high-risk situations such as entering public spaces; obtaining medical attention; riding public transit; certain work settings; and while outdoors in public spaces when maintaining a physical distance of 6 feet from persons who are not members of your household is not feasible. Exemptions include children age 2 and younger; persons with a medical condition, mental health condition or disability that prevents them from wearing a face covering; the hearing impaired or those communicating with them; persons seated at restaurants while eating or drinking, provided they maintain physical distancing; and those engaged in outdoor work or recreation alone or with household members while maintaining physical distancing from others. Read the full order here.

The CDC offers guidance on how to properly wear a cloth face covering, as well as tutorials on how to make your own mask. See these resources here.

N-95 or surgical masks are not recommended for public use, as supplies are needed by healthcare workers and first responders.

  1. Avoid non-essential travel

We recommend following the CDC’s guidance for travel.

If someone in your family has recently traveled to an area with high COVID-19 activity and is showing symptoms of respiratory illness, it is best for you and your child, immunocompromised or not, to avoid contact with the person for at least 14 days.

  1. Maintain enough medical supplies

Ensure you have necessary medical supplies and prescription medications on hand, check levels of all your medications and let your provider know if you need refills.

This article was updated on July 16, 2020.

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