Seamless primary and specialty care: Lea’s story

For parents of children who need specialty care on top of their typical visits with pediatricians, CHOC’s growing Primary Care Network offers seamless integration with more than 30 specialty areas represented by CHOC’s mighty brigade of pediatric specialists.

Lea, age 4, has seen a CHOC specialist since before she was born. Lea was diagnosed in utero with hydronephrosis – a treatable condition in which urine gets trapped in the kidney and drains slower than it should into the bladder. A routine ultrasound flagged fluid in Lea’s kidney, and her mom was referred to CHOC’s urology program for a fetal consultation.

Dee Dee, Lea’s mom and a longtime CHOC employee, knew her daughter was in good hands.

“The urologist explained everything in a way that was easy to understand,” Dee Dee recalls. “I was comforted knowing that this condition was common, my daughter would be OK, and that they would continue to monitor her and manage the condition after she was born.”

Dee Dee chose to deliver at St. Joseph Hospital in Orange for its proximity to CHOC. Doctors weren’t concerned that Lea’s hydronephrosis would cause her any immediate harm, but it gave the first-time mom peace of mind knowing that CHOC was right across the street.

Specialty care with CHOC’s urology program

Lea returned to CHOC’s urology program after she was born for additional testing and monitoring.

baby ultrasound
When she was 1 month old, Lea returned to CHOC for an ultrasound.

Urologists confirmed the prenatal diagnosis and also diagnosed Lea with vesicoureteral reflux or VUR, where urine flows backward. Lea’s VUR is due to wide ureters – tubes located between the bladder and kidney, and essential to proper urine flow – and valves that are too small to efficiently direct urine flow.

Some children with VUR grow out of it without the need for medical intervention. This is less common in children with higher grade openings between the kidney and bladder, as is Lea’s case. Doctors explained to Dee Dee and her husband Pat that over time, VUR can lead to infections in the kidneys. Eventually, a high number of these possible infections can lead to kidney damage.

After receiving Lea’s diagnoses, Dee Dee and Pat switched their daughter’s pediatrician to one in CHOC’s Primary Care Network.

“We realized that if we were going to need specialty care for our daughter, we wanted a pediatrician in the CHOC network to fit into that puzzle,” Dee Dee says. “CHOC is the best partner in caring for our child.”

MRI prep
At age 1, Lea underwent an MRI in preparation for her Deflux injection. Before her MRI, she played with her dad.

Lea has remained under the care of CHOC urologists, who continue to monitor her VUR. This has included two voiding cystourethrograms (VCUG). With this test, doctors insert a catheter and dye to fill Lea’s bladder, then take X-rays of fluid flowing in real time. Tests of any kind can be stressful for young kids, so child life specialists from CHOC’s Cherese Mari Laulhere Child Life Department have been present for each of these tests with Lea. Child life specialists are experts in normalizing the hospital environment for kids, but by being an extra source of comfort, they often put parents at ease, too.

“Child life has been amazing with Lea,” Dee Dee recalls. “During one VCUG, the child life specialist asked about Lea’s favorite song. At the time, it was “Wheels on the Bus” so that’s what she sang with Lea. I joined in the song, and before I knew it, every single clinician in the room was signing along to “Wheels on the Bus.” I remember thinking that even though the radiologist was so smart and so focused on performing the test, he was not above singing this song. He knew that is what my daughter needed in that moment to feel comfortable.”

Shortly after Lea’s first birthday, she underwent a procedure called a Deflux injection, where, under anesthesia, doctors injected a protein or ureter material to make the wall of Lea’s ureters thicker, hoping to close the gap and ensure proper urine flow, helping to continue avoiding UTIs.

Lea’s care team – including her parents – remain on high alert for a urinary tract infection or UTI, as a high number of these can contribute to kidney damage. Lea took preventive antibiotics until she was potty trained to help avoid UTIs.

age 3 ultrasound
Lea and her mom Dee Dee take a selfie during a recent visit to CHOC for an ultrasound

Lea sees her urologist Dr. Heidi Stephany a couple times per year, and they’re able to seamlessly communicate with Lea’s CHOC pediatrician, Dr. Katherine Williamson.

Primary care network

As part of CHOC’s growing health system, pediatricians in CHOC’s Primary Care Network not only have full access to any medical records from their patients’ specialty care visits, they can also see notes from recent visits to other providers, meaning they have the latest information on their patients’ medical history.

This coordination was especially beneficial for Lea and her parents on a recent weekend when Lea had a suspected UTI. Although common in children, with Lea’s VUR, potential UTIs are cause for concern.

Thanks to Saturday morning hours at Lea’s pediatrician’s office, they were able to get a last-minute appointment.

“With Lea’s condition being relatively rare, I’m used to explaining it to people,” Dee Dee says. “But when we saw Dr. Ball, he already knew her medical history and was very familiar with her condition. We typically see Dr. Williamson in that office, and she is well-versed in Lea’s health, but seeing Dr. Ball was seamless. It was such a relief not to have to explain anything to a new-to-us provider.”

A urine sample is a routine and necessary part of testing for UTI. These can be hard for children and parents alike, but Dee Dee felt grateful that Dr. Ball and his staff were patient with Lea.

“The whole staff was really patient with us, even though we were the last appointment of the day. They just kept coming in and checking on us to see how we were doing,” Dee Dee says. “The office also felt very safe during COVID-19; everyone was masked, and everything was clean.”

Ultimately, Dee Dee and Lea headed home with instructions to drink more fluids to help Lea produce a urine sample, and a plan to head to CHOC’s urgent care in Orange when Lea was ready. During this time, Dee Dee called CHOC’s urology team to confirm their course of action.

“I called the urologist on call, and even though it wasn’t Dr. Stephany, who we typically see and who is most familiar with Lea, the doctor who called us back had already looked at Lea’s chart and read Dr. Ball’s notes from that morning,” Dee Dee says. “He reassured us we were doing the right thing and validated my choice to bring her to CHOC’s urgent care.”

Lea continued drinking fluids to help produce a urine sample. When Dee Dee and Lea got to CHOC’s urgent care, they saw Dr. Vivi Tran, a CHOC pediatrician. Dr. Tran likewise could see Lea’s complete medical history and Dr. Ball’s notes from that morning, as well.

“I didn’t need to explain a thing,” Dee Dee recalls. “Dr. Tran was already up to speed, and that was such a weight off my shoulders.”

CHOC pediatricians know kids, and they know that rushing a child – especially to do something like produce a urine sample – will often have the opposite effect. Dr. Tran checked in with Dee Dee and Lea periodically, and even brought Lea an apple juice to help her produce a urine sample.

“CHOC made this as stress-free as possible for Lea and me. We were there for three hours trying to get Lea to produce a urine sample, and never once did I feel rushed,” Dee Dee recalls.

Lea’s UTI test was ultimately negative, and she had a regularly scheduled appointment with her urologist the next week.

birthday party
Lea recently celebrated her 4th birthday.

“The seamless coordination of care between Lea’s pediatrician’s office, her specialist and urgent care was unmatched. We could never find that anywhere else. I didn’t have to bring anyone up to speed on what was happening or my daughter’s medical history. They had access to her records and the latest information on her case,” Dee Dee says of her daughter’s experience. “I also know our positive experience wasn’t just because I’m a CHOC employee; everyone receives a high level of care.”

Mom’s perspective

Since joining CHOC’s marketing department in 2013, Dee Dee has had a firsthand look at CHOC’s patient- and family-centered care and has worked closely with a number of CHOC specialists. This recent experience with her daughter gave her a greater understanding of and appreciation for CHOC’s system of care.

“We write about various conditions every day and provide education on CHOC’s coordinated system of care. I already knew these things were true because of my job, but then I experienced it myself as a mom and I truly understood how beneficial these things are,” Dee Dee says. “It seems like the scariest thing in the world, to have a child who needs CHOC’s care, but it’s actually the most comforting thing.”

I’m a pediatrician. Here’s what I want you to know about vaccines.

By Dr. Katherine Williamson, a CHOC pediatrician

dr-katherine-williamson
Dr. Katherine Williamson, a CHOC pediatrician

Proper vaccination is important for all people, but especially infants and babies. When children follow the recommended immunization schedule outlined by the American Academy of Pediatrics (AAP), they are better protected against potentially life-threatening diseases.

During the COVID-19 pandemic, your CHOC pediatrician’s office is a safe, physically distant environment to keep your child and family safe while still delivering high quality preventive care.

As a pediatrician during COVID-19, I get a lot of questions about baby vaccination and vaccines for children. Here are the most common questions I’ve gotten about vaccines during COVID-19– and why maintaining your child’s immunization schedule is more important than ever.

Can I delay my child’s vaccines during COVID19?

Getting vaccinated on time is important because even though we have the threat of COVID-19 to contend with, all the diseases that we can prevent easily with vaccines are still a threat. These diseases — such as whooping cough and measles — are ready to emerge at any time that we don’t have the majority of our kids vaccinated.

Recent data released by the World Health Organization and the Centers for Disease Control and Prevention showed that measles deaths worldwide reached the highest level in 23 years last year. Although no measles deaths were reported in the U.S., the number of measles cases nationwide were at their highest point since 1992. Public health experts have linked the increases in measles cases to insufficient vaccine coverage.

If we don’t keep our kids protected against measles and other fatal diseases, the risk for further emergence is going to be very high. While we are waiting for a COVID-19 vaccine to stop the pandemic, it is up to us to keep our kids safe and prevent any future epidemics by using the tools we already have to prevent disease.

Do I really need a flu shot every year?

It’s important that each member of your family get their flu shot every year. This is especially true this year, amid the COVID-19 pandemic. Since both influenza and COVID-19 can have overlapping symptoms, it may be difficult for doctors to determine which virus is behind your symptoms based on a clinical exam alone, according to pediatric infectious disease experts at CHOC.

These overlapping symptoms may include, but are not limited to:
Fever or chills
Cough
Shortness of breath
Fatigue
Sore throat
Runny or stuffy nose
Muscle pain or body aches
Headache

Learn more about why getting a flu shot is more important than ever this year.

Are vaccines safe?

Vaccines are one of the most important things we can do to help protect our children’s health. Vaccines and proper handwashing, more so than all other interventions, have proven to be the most safe and effective ways to prevent disease.

What is the proper vaccine schedule?

The current immunization schedule outlined by the AAP and Centers for Disease Control & Prevention has been researched and proven to be the most effective and safest way for children to be vaccinated against potentially fatal diseases. It’s important to know that no alternative schedule has been shown to be as safe and effective.

Is it better to do multiple vaccines at one time or space them out?

The safest way to keep your child safe from vaccine-preventable diseases is to get all their vaccines on time. There is no advantage to spacing them out, and instead the longer you wait, you increase the risk of them catching one of the preventable diseases before you protect them.

The amount of antigen (protein) in each vaccine is so tiny that your immune system can process multiple vaccines at one time and build an antibody “army” to protect your child for each of those potentially fatal diseases. In fact, the amount of antigen (protein) in each vaccine is 100,000 times less than if your child has a common cold, so there’s no concern about overwhelming their immune system when they get their vaccines.

What can I do to make my child more comfortable while receiving a vaccination?

Studies have shown that preparing your child for vaccinations should ideally include three components: explaining what will happen, how it will feel, and strategies for coping with any related stress or discomfort. Here’s more tips on how to make shots less stressful.

This article was updated on Nov. 16, 2020.

Is it OK to skip your child’s checkup if they’re healthy?

The first few years of your child’s life are a major factor in their lifelong growth and development, which is why we recommend all well checkups for your child even if they’re healthy. During the COVID-19 pandemic, your CHOC pediatrician’s office is a safe, socially distant environment to keep your child and family safe while still delivering high quality preventive care.

These checkups, also known as well child checks, are an opportunity to track your child’s development, make sure they’re getting the care they need to stay healthy, and for parents to get answers to any parenting questions.

Under the current stay at home orders, it may be tempting to skip something called a “well child check” if your child is feeling healthy. Here are six reasons why it’s not OK to skip your child’s checkup, even if they’re feeling healthy.

dr-katherine-williamson
Dr. Katherine Williamson, a CHOC pediatrician

#1 Developmental screening

At every well checkup your pediatrician will be making sure that your child is meeting her or his developmental milestones, whether they are 4 months, 4 years, or 14 years old. For babies and toddlers, these milestones come rapidly as children’s brains are learning many new skills every day, from crawling to walking, and from first words to conversations. It is important to make sure your child is acquiring these necessary skills for brain development every step of the way. For older kids and teens, these milestones become less apparent, but are just as important, and are often reflected in a child’s ability to handle academics, relationship, and emotions. Your pediatrician is here to help at every stage of your child’s development.

#2 Relationship building

It’s important for your child to develop a rapport with their pediatrician. We are positive role models for young kids and help lessen their fear of going to the doctor. When your child is a teenager, parents are often asked to leave the exam room so the pediatrician can speak to the teen in private. Your child will feel more comfortable asking personal questions about their body and puberty later in life if their pediatrician has been a constant figure and steady resource since childhood.

#3 Mental health check up

Well checks also serve as a mental and behavioral health check-in. Your pediatrician can help evaluate your child’s mental health and wellbeing over time.

During well child checks amid the pandemic, mental health has been a bigger part of conversations during appointments than ever before. This is a chance for pediatricians to check on how the whole family is coping with stress related to COVID-19. They can share advice for how to talk to kids about COVID-19 and help them cope with COVID-19 anxiety as well as how to teach teens the importance of stay at home orders.

You can also talk to your pediatrician about how your child is coping with social distancing, or a lack of playdates and time with friends. They can offer advice on how to make this a positive time for your family.

#4 Enforcing healthy habits

Well child checks are a great opportunity to reinforce healthy habits. Often, kids will listen to their pediatrician more than their parents. We can remind children about the importance of eating healthy, doing their homework, brushing their teeth, wearing helmets—and listening to their parents!

Do you ever struggle with the question, “How much screen time is too much?” or find yourself battling your children over screen time limits? Your pediatrician can be a resource for you in helping reinforce screen time limits with your child. We can help explain to your children why their bodies need less screen time and more play, and how too much screen time affects their body and brain.

With children spending more time at home than ever, your pediatrician can be a resource on activity ideas for kids during COVID-19.

#5 Getting answers to questions you didn’t know you had

During many appointments in my office, my conversation with parents takes a turn from why they originally came in to see me. They might have an appointment to get a rash checked out, but then I’ll notice a mole on the child I hadn’t seen before, and they’ll realize they too were wondering about that, but just forgot to ask.

Pediatricians are resources for parents just as much as we are caretakers of your children. We’re here to help you get answers to your questions on acne, headaches, academic concerns and anything in between.

#6 A fresh perspective on parenting

Pediatricians specialize in taking care of infants, children and teens – but they can be there for you as a parent, as well.

Right now, parents have been asked to take on more than ever – working from home, overseeing their child’s distance learning curriculum, keeping kids entertained and engaged around-the clock, and more – and they are understandably overwhelmed.

Having a fresh set of eyes on a family’s situation may help troubleshoot what they are trying to figure out. Many of my patients’ parents are struggling with a seemingly never-ending to-do list. Their child’s pediatrician is someone they trust and respect, and I validate that they are doing their best.

Parents should congratulate and forgive themselves. At the end of the day they may be hard on themselves and wish they had done more, and that feeling compounds by the end of the week or month. What parents are juggling right now is Herculean. I applaud each and every one of you.

This article was updated on May 18, 2020.

How parents can deal with COVID-19 stress

With schools and many businesses closed amid the COVID-19 pandemic, parents have been tasked with more than ever and many are dealing with COVID-19 stress. Their homes are now distance learning facilities, daycares, activity centers, remote offices and more.

The American Academy of Pediatrics (AAP) urges parents during this uncertain and difficult time to practice self-care, ask others for help, and use healthy discipline techniques when necessary.

How parents can practice self-care

“It’s more important than ever for parents to take care of themselves first,” says Dr. Katherine Williamson, a CHOC pediatrician and president of the Orange County chapter of AAP. “Unless parents are themselves well nourished, well-rested and maintaining healthy relationships, they won’t be able to provide the care or environment their kids need right now.”

There are several ways for parents to practice self-care while juggling their added responsibilities:

  • Eat a balanced diet
  • Exercise
  • Get enough sleep
  • Maintain social connections with friends and family via phone or video chat. These relationships are an important source of support during trying times. Discussion forums and online communities of other parents can be especially helpful.
  • Use your helpers. If you have a new baby at home, older siblings can help in developmentally appropriate ways.
  • Speak with your healthcare provider about your mental health. Many doctors and mental health providers are offering telehealth visits.

Healthy discipline techniques

Children have also had their lives disrupted by COVID-19. Schools are closed, and they can’t have play dates with friends. When children are bored or frustrated, they are more likely to act out.

“When children misbehave, effective discipline teaches them to regulate their emotions and helps them gain a better understanding of rules and expectations,” Williamson says.

The AAP recommends the following techniques when children feel stressed:

  • Engage kids in constructive activities. Here’s a roundup of activities for kids during COVID-19.
  • Help kids sort through their fears. Kids old enough to understand the news may be scared someone they love will die. Acknowledge their fear and share all the things your family is doing to stay safe, like washing your hands and staying home. Here’s a pediatric psychologist’s advice on helping kids cope with COVID-19 anxiety.
  • Call a time-out. Warn children they will get a time-out if their current behavior continues. Remind them what they did wrong in as few words with as little emotion as possible. Remove them from the environment for a pre-set amount of time. One minute per year of age is a good guide.
  • Know when not to respond. If your child isn’t doing something dangerous and gets plenty of attention for good behavior, an effective way to stop bad behavior can be just ignoring it.
  • Catch them being good. Point out good behavior, and praise children for their good tries and success. This is especially important in the disruption of children’s normal routines and friends.
  • Give them your attention. The most powerful tool for effective discipline is attention—to reinforce good behaviors and discourage others. Remember, all children want their parent’s attention. When parents are trying to work at home, this can be particularly challenging. Clear communication and setting expectations can help, particularly with older children.

“Corporal punishment – like spanking or hitting – can harm children and hinder brain development long-term. It is also not effective in teaching kids self-control,” Williamson says.

The AAP also cautions caregivers never to shake or throw a child. Tips for calming a fussy baby:

  • Check to see if your baby’s diaper needs changing.
  • Swaddle your baby in a large, thin blanket. Your child’s pediatrician can show you how to do it correctly to help her feel secure.
  • Feed your baby slowly, stopping to burp often.
  • Offer your baby a pacifier.
  • Hold your baby against bare skin, like on your chest, or cheek-to-cheek.
  • Rock your baby using slow, rhythmic movements.
  • Sing to your baby or play soft, soothing music.
  • Take your baby for a walk in a stroller.
  • Go for a ride with your baby in the car (remember to always use a car seat).

Most babies get tired after crying for a long period of time and then fall asleep. If your child continues to cry, call your pediatrician to discuss your concerns and stress. There may be an underlying medical reason for your child’s tears.

This article was last updated on April 14, 2020.

Teen advisers offer tips on avoiding peer pressure to vape

The dramatic rise in vaping among teens is alarming to pediatricians and parents alike. It’s common for teens’ first exposure to vaping to come as an effect of peer pressure, says Dr. Katherine Williamson, a CHOC pediatrician.

“The rate at which vaping has increased over the last several years see is really scary for me to see as a pediatrician,” Williamson says.

CHOC teen advisers, a group of teens active in their community, committed to academic success, and who support CHOC’s mission, offer their advice for teens struggling to deal with peer pressure to vape.

It’s just not worth it

“My freshman year of high school, I was offered the opportunity vape more than 10 times. In these situations, it’s your choice how to respond. Vaping is simply not worth it. Do not be guilted or tempted by those around you.” – Andei, age 16

Consider the long-term consequences

“You may not feel it at first, but as you vape, your lungs are being damaged. You could end up in the hospital as a result of vaping. Turn down the offer to vape and walk away from the situation.” – Sam, age 12

Offer a valid excuse

“My parents always told me that to get out of a peer pressure situation, I could tell a white lie and blame it on them. I could say something like, “My parents are super strict and will drug test me, so I can’t. Or, I remove myself from situations by saying I have to get to volleyball practice or have another commitment.” – Noah, age 17

Complications of addiction

“Teens endure tremendous social pressure, which makes it easier for teens to fall victim to vaping. Avoiding peer pressure to vape might not be an easy task, but it’s far easier than having to withdraw from addiction.” – Christian, age 17

Health consequences

  • “Always think about the serious health consequences of vaping. It’s very addictive, causes breathing difficulties and increases your risk of cancer or even death.” – Lauren, age 15
  • “Although it is marketed as a safer alternative to cigarettes, they contain addictive chemicals. It’s a newer trend, and some teens may not be as educated on the dangers of vaping.” – Layla, age 14
  • “Vaping can change your life in an unhealthy way. Not only can you damage your lungs, but it can impact your life in others way, too. You could be punished by your school and parents, as well.” — Carina, age 15

Re-evaluate your friend group

“Walk away from the situation and stop hanging out with friends who are pressuring you. That means they don’t care about you. Find new friends who do.” –Trevor, age 15

Social/school consequences

“Schools take vaping seriously. They can take away your ability to participate in activities, sports or dances.” – Jorian, age 15

Harmful effects of vaping

As more teens develop an addiction to vaping nicotine or CBD oil, Williamson has treated more and more teens with lung problems, agitation and anxiety.

Vaping hasn’t been around long enough for us to know its long-term effects on the body. But health experts are reporting serious lung damage in people who vape, including some deaths.

E-cigarettes also:

  • Irritate the lungs
  • May cause serious lung damage and even death
  • Can lead to smoking cigarettes and other forms of tobacco use

Some people use e-cigarettes to vape marijuana, THC oil and other dangerous chemicals. Besides irritating the lungs, these drugs also affect how someone thinks, acts and feels.