CHOC Children’s Celebrates Completion of Mental Health Inpatient Center

CHOC Children’s leaders joined with mental health supporters today to celebrate the completion of our pediatric health care system’s Mental Health Inpatient Center, which will provide the first psychiatric inpatient beds in Orange County for children younger than 12 years old.

Set to open in April 2018, the 12,000-square foot, 18-bed facility will serve children ages 3 to 17. It is the only facility in California to offer all private rooms, as well as an option for parents to stay overnight with their children, as appropriate.

CHOC Mental Health Inpatient Center_hallway artwork
Hallway artwork in the CHOC Mental Health Inpatient Center.

One in five children experience a diagnosable mental health condition during childhood — about 150,000 children in Orange County alone. Previously, the absence of designated space to treat young patients and a shortage of beds for adolescents in Orange County meant that often children with serious mental health episodes remained in emergency departments for days at a time waiting for a bed in an outside county.

“For the first time, Orange County children younger than 12 experiencing a mental health crisis will have a place for care close to home,” CHOC President and CEO Kimberly Chavalas Cripe said. “The Center’s completion is evidence of CHOC’s commitment to ensuring that every Orange County youth receives the mental health care services they need in a safe and healing environment.”

The Center’s other unique features include two sensory rooms – one sensory-rich and the other low-stimulation to help children learn to manage strong emotions and calm themselves. In addition, the facility includes a 3,600-square-foot outdoor play area with sensory activities and a basketball court.

Mental Health Inpatient Center
The outdoor play area of the CHOC Mental Health Inpatient Center.

The Center’s innovative floor plan was designed with guidance from national experts and incorporates elements of several exemplary programs observed by CHOC staff. It was built with two primary goals in mind: patient safety and creating an optimal healing environment. The facility incorporates safety features such as shatterproof glass, special high-density materials, doors that open one at a time, and many other measures. The design includes elements of nature, curved features and a soothing color palette to promote healing and relaxation.

With pediatric psychiatrist Dr. Hoang “Wayne” D. Nguyen as its medical director, the Center will offer specialty programming to children 12 and younger. Patients will participate in therapeutic programming seven days per week, which is unique among inpatient facilities. During their stay, typically five to seven days, patients will also have access to medical specialists if assessments suggest a relationship between the mental health condition and an underlying health issue.

CHOC Mental Health Inpatient Center_activity room
One of several activity rooms in the CHOC Mental Health Inpatient Center.

CHOC broke ground on the Center in September 2016. The Center was announced in May 2015 as the centerpiece of a pediatric system of mental health care that would be scalable and replicable by other health systems nationwide.

“CHOC is committed to the truth that mental health is as important as physical health,” Cripe said. “Put simply, health is health. We want to create a system that others can replicate and help empower health systems across the country to support children’s mental health.”

CHOC’s broad and robust pediatric system of mental health care has been built to facilitate early diagnosis, intervention and treatment of pediatric mental health problems.

The system’s components include the ASPIRE® (After School Program Interventions and Resiliency Education) Intensive Outpatient Program at CHOC Children’s, designed to prevent psychiatric hospitalization and re-admission; mental health screenings in primary and specialty care settings; pediatric mental health training for community health care providers, school personnel and therapists; and a co-occurring clinic for patients with mental health challenges complicated by physical illnesses.

Other aspects include mental health triage at the Julia and George Argyros Emergency Department at CHOC Children’s Hospital; an early childhood mental health initiative set to begin in spring 2018 that is aimed at reducing behavior-related suspensions from child care and preschool settings; and faith community partnerships.

“While the Mental Health Inpatient Center at CHOC Children’s will support children and families while in crisis, we cannot meet all the needs for pediatric mental health care alone,” Cripe said. “By joining with our community partners, we are working together to ensure that children get the help they need when they need it and where they need it.”

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Is Your Child’s Headache Cause for Concern?

When your child complains of a headache, it can be anything from a plea to stay home from school in hopes of avoiding a test, to a sign of something more serious. But how can you tell the difference? And when is it time to see the pediatrician? Dr. Sharief Taraman, a pediatric neurologist at CHOC Children’s, offers advice on what parents can do to keep headaches at bay, the importance of identifying a pattern in your child’s headaches, options for treatment, and what types of headache warrant a trip to the emergency department.

sharief-taraman-choc-childrens-pediatric-neurologist-offers-advice-childs-headaches
Dr. Sharief Taraman, a pediatric neurologist at CHOC Children’s, offers advice for parents concerned about their child’s headaches.

First, it’s important to be able to identify what type of headache your child may be suffering from.

What type of headache does my child have?

Migraine symptoms in kids

At least 5 attacks that meet the following criteria:

  • Headache lasting 1 – 72 hours
  • Headache has at least two of the following features:
    • Pain on both sides or only one side of the head
    • Pain is pulsating
    • Moderate to severe intensity
    • Aggravated by routine physical activities
  • At least one of the following:
    • Nausea and/or vomiting
    • Sensitivity to light or noise

If your child has more than 15 headache days per month over a three-month period, and at least half of those are migraines, they may be suffering from chronic migraines.

It’s a common misconception to assume that only adults suffer from migraines, which isn’t true, says Dr. Taraman. If your child has migraines, they are not alone. About 1 out of every 20 kids, or about 8 million children in the United States, gets migraines. Before age 10, an equal number of boys and girls get migraines. But after age 12, during and after puberty, migraines affect girls three times more often than boys.

Tension headache symptoms in kids

  • Headache lasting from 30 minutes to seven days
  • Headache has at least two of the following characteristics:
    • Pain in two locations
    • Pressing or tightening feeling (not a pulsing pain)
    • Mild to moderate intensity
    • Not aggravated by routine physical activity such as walking or climbing stairs
  • No nausea or vomiting – many children experience a loss of appetite
  • Either sensitivity to light or sensitivity to sound
  • Tension headaches occur most often in children ages 9-12

Cluster headache symptoms in kids

  • At least five headaches that meet the following criteria:
    • Severe pain in one location: within the eye, above the eyebrow, or on the forehead, that lasts from 15 minutes to three hours when left untreated
  • Headache is accompanied by at least one of the following symptoms on the same side of the body as their pain:
    • Conjunctival injection and/or lacrimation
    • Nasal congestion and/or excess mucus in the nose
    • Eyelid swelling
    • Forehead and facial swelling
    • Droopy eyelid and/or small pupil
    • A restlessness or agitation
  • Cluster headaches usually start in children at around 10 years old

Post traumatic headache symptoms in kids

  • Acute post traumatic headache: lasts less than three months and caused by a traumatic injury to the head
  • Persistent post traumatic headache: lasts more than three months and caused by a traumatic injury to the head
  • Both acute and persistent headaches develop within one week of: the injury to the head, regaining of consciousness following injury to the head, or discontinuing medicine that impairs the ability to sense a headache following a head injury
  • Extended recovery risk factors:
    • Prolonged loss of consciousness or amnesia
    • Females
    • Initial symptom severity
    • Premorbid history of ADHD, mood disorders, and migraines

Sleep apnea headache symptoms in kids

  • Typically occurs in the morning
  • Pain is present on both sides of the head
  • Lasts more than four hours
  • Not accompanied by nausea, nor sensitivity to light or sound

Medication overuse headache symptoms in kids

  • Headaches on 15 or more days per month
  • Takes over-the-counter medication for headaches more than three times per week over a three-month period
  • Headache has developed or gotten worse during medication overuse
  • Pattern of headaches resolves or improves within two months after discontinuing the overused medication

What to do when your child has a headache

A variety of non-medical interventions can be helpful for children who are suffering from headaches. These non-medical interventions for headaches include: ice packs; warm baths; taking a nap in a cool, dark room; neck and back massage; and taking a walk.

Parents shouldn’t be tempted to immediately turn to medication such as ibuprofen or naproxen, says Taraman.  Over-the-counter pain medications (such as Tylenol or Motrin) should be limited to no more than three days per week with no more than two doses per day, in order to avoid medication overuse headaches. Follow the dosing instructions on the label and ask your child’s pediatrician or pharmacist any questions before beginning a treatment regimen. Follow dosage instructions given by your physician or pharmacist, or download a guide to ibuprofen and naproxen.

dosing-instructions-ibuprofen-naproxen

How to avoid headaches

There are a number of things parents can do to prevent headaches, says Dr. Taraman. These include:

How to talk to your pediatrician about your child’s headaches:

Keep a journal of your child’s headaches so you can identify a pattern, and show your child’s primary care physician. If you don’t have a primary care provider, find one near you. In your headache journal, keep track of:

  • Headache start date and time
  • What happened just before the headache?
  • How much did your head hurt, on a 0-10 pain scale?
  • Where did your head hurt?
  • What did you feel just before and during the headache?
  • What did you do to make yourself feel better?
  • Did you feel better, on a 0-10 pain scale?
  • Headache end date and time

Your child’s pediatrician may adjust your child’s diet, headache hygiene routine, or their NSAID regime. In some cases, your primary care provider may refer you to a pediatric neurologist, who have specialized training in the nervous system (brain, spinal cord, muscles and nerves), who work in tandem with imaging and other specialists and pediatricians as necessary.

Patients should immediately be taken to the emergency department for some headaches including:

  • Thunderclap headache: severe, sudden onset of pain that occurs anywhere in the head, and grabs your attention like a clap of thunder. Pain usually peaks within 60 seconds to a few minutes.
  • Any headache that comes with weakness or numbness on one side of the body, or changes in consciousness or awareness.
  • Blurred, double or loss of vision that persists after the headache resolves.

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How to Help Your Child Navigate the Emotional Aftermath of a Traumatic Event

By Dr. Sheila Modir, pediatric psychology post-doctoral fellow at CHOC Children’s

It’s difficult for adults to make sense of a tragedy, so consider how difficult it can be for children. To help parents support their children as they navigate trauma either in their own lives or process a tragic event they see on the news, consider the five E’s of helping a child navigate the emotional aftermath of a traumatic event: 

  • Explore what your child already knows in a gentle and calm manner. You can start with a neutral question inquiring about how their school day was or if anything happened while they were at school.
  • Explain what has happened in a way that your child can understand based on his/her age.
    • This is the time to address any misinformation your child might have picked up at school and help them understand that a scary thing did happen, but also reassure their sense of safety as schools and adults work hard to keep their children safe on daily basis.
    • Limit information that you provide to your child to the questions that they ask you, so that you avoid overwhelming them with information that they may not already have been exposed to.
    • You can provide examples of ways you and others in your community keep your child safe every day (i.e., how when you drop them off at school in the morning and you look both ways before crossing the road, how doctors are working hard to help the children that have been hurt).
  • Express to your child that feelings are normal and it is okay to feel sad, mad or angry when a tragic event occurs. Remember to reduce media exposure after a traumatic event, as repeated exposure to the event has been associated with psychological distress and intensifying already heightened emotions.
  • Emotionally model for your child healthy expression of feelings as children take their cues from their parents. Describe how you cope with your distressing emotions to your child (i.e., When I feel scared when something bad happens to me, I talk about it with someone who makes me feel safe or I take three deep breaths).
  • Ensure stability by continuing to adhere to your child’s daily routine. This will provide them with a sense of reassurance and safety during a chaotic time. Engaging in a daily routine is not meant to ignore what has happened, rather to continue to provide the child with structure, stability, and predictability.

If you are struggling to help your child process a traumatic event, or if you feel your child could benefit from additional support, ask your pediatrician for a referral to a pediatric psychologist or psychiatrist.

Below are a few additional resources on coping with trauma that I often share with my patients and their families:

Helping Children Survive the Aftermath– Florida International University

Mobile App: PTSD Family Coach– U.S. Department of Veterans Affairs

Responding to a School Crisis– The National Child Traumatic Stress Network

Resources for Parents and Caregivers– The National Child Traumatic Stress Network

Helping Traumatized Children: A Brief Overview for Caregivers– Child Trauma Academy

Tragic Events: Parent Resources – The Fred Rogers Company

Learn more about mental health services at CHOC

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