Kids and Emergency Care

Kid with thumbs upCAREFUL CARE?

When it comes to children, a level of unique and specialized care is necessary. “There are a number of  considerations in children you have to focus on, whether dealing with an infant, a neonate (less than 28 days  old), a child or an adolescent,” says Dr. Pierog. “There are many different features that are obvious, as well as  those from a physiological standpoint that determine how their systems function,” says Dr. Pierog.


“Kids are much more prone to have facial and intracranial (brain) injuries than adults because of their larger head-to-body size. Because of their propensity to fall, we see a higher number of upper extremity injuries such as wrist and elbow fractures,” says Dr. Pierog. In addition, because they have a higher hydration requirements, children need two to three times as much fluid than do adults.


“Children require special treatment, not just for their size, but also when it comes to the equipment needed to treat their conditions,” says Dr. Pierog. CHOC’s emergency department has all the bases covered, including master’s prepared child-life specialists who are trained to understand and treat the emotional and physiological needs of little ones. “There are a number of features that pediatric emergency physicians are aware of and prepared to treat, including respiratory, gastrointestinal, and environmental conditions, such as pesticide exposure from children putting items in their mouths.”


For adults, medication dispensing is generalized, but not for children. To ensure parents are giving the right amount, pay attention to the levels. “The dosages of common medications are going to be on a weight-based formula,” says Dr. Pierog.


  • What is the decrease in childrens illnesses because of the use of vaccines: 90%
  • What is the amount of body fluids children turns over: 25%
  • What is the average number of colds an adolescents get each year: 2 to 4


CHOC Children’s contracts with most major public and private health care programs including Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs.) Click here for a list of hospital contracted health plans. You are advised to check with your health plan or insurance network to confirm that CHOC and your physicians are contracted providers. For questions regarding your insurance or eligibility, please contact the CHOC Admitting Department at (714) 509-8400. When you choose your physician and medical group, call the office and make sure they refer to CHOC.

View the full feature on Kids and Emergency Care

Dr. James Pierog
Dr. James Pierog
Emergency Medicine


Dr. Pierog is the medical director of emergency medical services at CHOC Children’s. He completed his internship in internal medicine and his residency in emergency medicine at the University of Southern California, Los Angeles County Medical Center. He served in the United States Army, achieving the rank of Captain as a General Medical Officer.

Dr. Pierog’s philosophy of care: “Giving cutting-edge care to the children of Orange County. To, protect, nurture, and develop them in an optimal setting.”

University of California, Los Angeles Medical School

Emergency Medicine and Pediatric Emergency Medicine

More about Dr. Pierog

This article was featured in the Orange County Register on October 7, 2013 and was written by Shaleek Wilson.

Splash Course: Kids and Drowning

This article was featured in the Orange County Register on August 12, 2013 and was written by Shaleek Wilson. View the full feature article and more at

CHOC_08-13-2013_drowning_halfBathtubs and Buckets

A common misconception about drowning is that kids are only in danger in big bodies of water. Not true. It only takes 1 inch of water for a child to drown, making common household containers like buckets, bathtubs and large pet water bowls a hazard.

To Avoid a Life-Threatening Incident, Make the Following a Habit:

  • Never leave a child alone in the bathroom, not even for a minute
  • Empty containers with liquids
  • Close bathroom doors and install child-proof door locks
  • Keep toilet seats closed or locked

Water Safety 101

When school is out, there’s nothing children love more than to splash around in the pool. But before the fun begins, safety should come first. “If you’re a parent, you need to be trained in CPR,” says Dr. Anas. Whenever your child is in the water, assign a “Water Watcher,” to monitor the water and the child.

Floaties and Fences

Flotation devices are not a substitute for watchful eyes. If a child cannot swim, they’re at risk for drowning, says Dr. Anas. More than 1,000 children die each year from unintentional drownings.

Pool owner safety:

  • Install a four-sided, non-climbable fence with self-latching gate
  • Use pool covers; power-operated options are best
  • Alarm doors and windows leading to pool

Look Out!

Known as the “silent killer,” drowning happens quietly, quickly, and usually out of sight. When your child is in the water, someone should always be assigned to watch. “What frequently happens is someone watching a child gets distracted and the child wanders off into the pool,” says Dr. Anas. “By the time the caretaker notices, it’s too late.” Make sure you and your child’s caregiver are aware of potential pool hazards.

Fast Facts

  • The time it takes for a child to lose consciousness after water submersion: 120 Seconds
  • Percentage of drowning victims who are out of their caregiver’s sight for 5 minutes or less: 75%
  • Percentage of children who drowned aged 4 and younger: 46%


Dr. Nick Anas
Dr. Nick Anas
CHOC Children”s Pediatrician-in-Chief


Dr. Anas is CHOC’s Pediatrician-in-Chief. He serves as clinical Professor for Pediatrics for the David Geffen School of Medicine at the University of California Los Angeles and as Associate Clinical Professor, Pediatrics, at UCI School of Medicine. He completed a fellowship at the University of Rochester in Pediatric Pulmonology and Critical Care. Dr. Anas’ philosophy of care: “There’s no place for ‘good’ or ‘average’ care. Families in our community have to be able to go to sleep at night knowing their children are safe.”

West Virginia University School of Medicine

Pediatric Critical Care and Pediatric Pulmonology

More about Dr. Anas


Learn more about Drowning Prevention and Emergency Services at CHOC Children’s.

OC’s First “Kids’ ER” Opens in March

Staffed around the clock by our world-class team of pediatric emergency medicine physicians, pediatric nurses and other specially trained healthcare professionals, the Julia and George Argyros Emergency Department opens in March 2013 in our new state-of-the art patient tower at CHOC Children’s Hospital. It will be Orange County’s first and only exclusively pediatric emergency department, providing advanced, leading-edge care within a kid-focused, family-centered environment.

Thanks to the Argyros family’s generous $5 million gift, every inch of our new 22,000-square-foot emergency department will be designed and equipped to meet the special needs of babies, kids and teens.“Children are not merely miniature versions of adults,” said Frank Maas, R.N., director of the Julia and George Argyros Emergency Department at CHOC Children’s. “Physiologically, developmentally and emotionally, their needs are quite different. They require a sophisticated level of specialized care, especially in an emergency situation.”

From Left to Right – Kimberly Chavalas Cripe, President and CEO, CHOC Children’s; Julia and George Argyros; Stephanie Argyros, CHOC Children’s Foundation Board of Directors member, and her children.

Located on the first floor of the new patient care tower, the Julia and George Argyros Emergency Department will  feature:

  • 31 treatment rooms
  • 14 rapid medical exam rooms
  • Three triage suites

The Julia and George Emergency Department is among many new services being offered in CHOC’s new tower. For the first time in CHOC’s history, all patient care services will be provided within an all-pediatric environment under one roof. This includes advanced operating rooms, laboratory, pathology and imaging services. These capabilities, along with enhanced patient and family amenities, will create the most serene, healing environment possible for the youngest members of our community.



Advanced Patient Care, Safety Features
Featuring leading-edge advancements in technology and patient safety, our new seven-story tower will position CHOC as a premier children’s hospital, including:

Lower Level —Laboratory, Blood Bank, support services

1st Floor — Julia and George Argyros Emergency Department, main lobby, admitting, radiology

2nd Floor — Patient and family amenities, including in-house radio station and multimedia center, public and patient outdoor area, Meditation and Prayer Center, Family Resource Center, Café

3rd Floor — Robert L. Tidwell Surgical Center, CHOC Children’s Heart Institute

5th Floor — Hematology and Oncology, including 28 new beds

4th, 6th, 7th Floors — Shelled space for future needs

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Top Summer Injuries that Bring Kids to the Emergency Room

Summertime for many kids and adolescents means the excitement of water activities, fun in the sun and outdoor sports! Yet summer is also known as “trauma season” among pediatric experts like Dr. James Pierog, emergency medicine specialist, CHOC Children’s emergency department. According to Safe Kids Worldwide, a leading children’s safety organization, summer season represents millions of emergency room visits by children 14 and younger due to unintentional injuries, many resulting in death.

Dr. James Pierog, emergency medicine specialist, CHOC Children’s emergency department

To help avoid unintentional injuries, Dr. Pierog recommends that parents and caregivers be on high alert and supervise children extra closely.  The following are the top injuries Dr. Pierog and his team see in the CHOC Children’s emergency room (ER) during the summer season:

Head Injuries
The risk of head injury is high in adolescents and especially common in the spring and summer months with popular outdoor activities such as bicycle riding, in-line skating and skateboarding. The injury can be as mild as a bump, bruise or laceration, or can be moderate to severe due to a concussion, deep cut or open wound, fractured skull bone(s), or from internal bleeding and damage to the brain. Dr. Pierog sees many head injuries resulting from soccer balls, baseballs and softballs directly hitting the head. In addition, head injuries are common among toddlers due to their uncoordinated muscle mass. Dr. Pierog advises a child receive immediate medical attention should the following occur:

• Vomiting more than a few times
• Alteration in mental state
• Increased irritability, fussiness
• A seizure
• Weakness in parts of the body, such as in an arm or leg
• Headache

Prevent head injuries:

Wearing a helmet whenever riding a bicycle, in-line skates, or a skateboard should be an automatic habit. Helmets should fit properly on your child’s head and also be fastened correctly – a properly-fastened and fitting helmet does not move around on the head. Worn properly, helmets are effective in preventing severe head injuries. For tips on preventing brain injury and how to properly fit a helmet, check out this video.

Facial Injuries 
Children may get minor cuts, wounds, and lacerations to the face while engaging in play or sports activities. Most of these injuries can be handled at home with simple first-aid treatment. Seek immediate medical attention for cuts and wounds of the face if:

• Bleeding heavily and do not stop after 5 to 10 minutes of direct pressure.
• If the injury is on the eyelids or involve the eyes.
• Wound is deep or longer than 1/2 inch.
• Injury is caused by a puncture wound, or dirty or rusty object or embedded with debris such as dirt, stones or gravel.
• Caused by an animal or human bite.
• Excessively painful, or if there’s a possibility of a fracture or head or bone injury.
• Showing signs of infection such as increased warmth, redness, swelling or drainage.

Prevent facial injuries by teaching your child the following:

• Not to poke or place objects in the ears or nose
• Not to walk or run while holding an object in his/her mouth
• Not to suck or chew on hard, sharp or pointed objects
• Wear protective eye, ear, or face guards for sports activities that could cause injury

Wrist and Elbow Fractures
A fracture is a partial or complete break in the bone and can result from falls, trauma, or a direct blow or kick to the body. Wrists, forearms and elbows are vulnerable to these injuries, especially common among children ages 2 and older. Many occur with popular summer activities such as basketball, bicycle riding and skateboarding. The following symptoms in the injured area might indicate a fracture that requires immediate medical attention:

• Pain
• Swelling
• Obvious deformity
• Difficulty using or moving the injured area in a normal manner
• Warmth, bruising or redness

Prevent fractures:

Although fractures are a common part of childhood, prevent them by taking simple safety precautions, such as making sure kids always wear safety gear such as helmets and wrist guards, when participating in sports.

Although it’s impossible to keep kids out of harm’s way all the time, following safety guidelines can help avoid a visit to the emergency room.

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