CHOC recognized as one of nation’s best children’s hospitals

best-childrens-hospitals-7specialtiesCHOC Children’s is one of a select number of pediatric facilities nationwide to have been ranked today as a best children’s hospital by U.S. News & World Report.

The following CHOC specialties are honored in the 2020-21 Best Children’s Hospitals rankings: neonatology; cancer; diabetes and endocrinology; neurology and neurosurgery; orthopaedics; pulmonology; and urology. Both orthopaedics and diabetes and endocrinology earned a “Top 20” spot. 

“At CHOC, we are committed to the highest standards of care, safety and service – and this honor reflects that unwavering dedication,” said Dr. James Cappon, CHOC’s vice president, chief quality and patient safety officer and interim chief medical officer. “Not only does this recognition of our excellence in these subspecialties, including two on the top 20 lists, validate our efforts, but it also offers our patients and families additional assurance of our commitment to their health and safety.”

The Best Children’s Hospitals rankings were introduced by U.S. News in 2007 to help families of children with rare or life-threatening diseases find the best medical care available. Only the nation’s top 50 pediatric facilities are distinguished in 10 pediatric specialties, based on survival rates, nurse staffing, procedure and patient volumes, reputation and additional outcomes data. The availability of clinical resources, infection rates and compliance with best practices are also factored into the rankings.

The U.S. News Best Children’s Hospitals rankings rely on clinical data and on an annual survey of pediatric specialists. The rankings methodology factors in patient outcomes, such as mortality and infection rates, as well as available clinical resources and compliance with best practices.

Learn more about Best Children’s Hospitals rankings.

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6 headache hygiene tips for children

Headaches usually are brief and can be caused by many things, including too little sleep, stress, or a concussion. Some headaches last longer and come with other symptoms. Very rarely, headaches can be a sign of something serious. Learn more about different types of headaches in children, and what parents can do to help.

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Dr. Mary Zupanc, a pediatric neurologist and co-medical director of the CHOC Children’s Neuroscience Institute

Dr. Mary L. Zupanc, a pediatric neurologist and co-medical director of the CHOC Children’s Neuroscience Institute, offers tips for parents on headache hygiene— or healthy habits to reduce the likelihood, frequency and severity of headaches.

  1. Maintain regular sleep habits

If your child goes to sleep and wakes up at approximately the same time every day, Dr. Zupanc says, their likelihood of suffering from a headache decreases. Bedtime and wake-up times should not vary significantly from weekday to weekend. Adolescents have sleep phase delay, meaning their brains do not want to go to sleep until later at night and they want to sleep in. This is normal behavior, but school schedules rarely accommodate this adolescent neurobiology.

  1. Exercise regularly

Children should get at least 30-40minutes of physical activity three to four days per week, she adds. However, the full 30-40 minutes doesn’t need to be all at once. You can break it down into smaller sessions.

  1. Eat a well-balanced diet. Avoid meal skipping.

A child’s eating habits can have a direct effect on their susceptibility to headaches, Dr. Zupanc says. To encourage kids to eat healthy, including them in the food preparation process whenever possible—from meal planning to grocery shopping to prepping fruits and vegetables in the kitchen. Kids are more likely to eat what’s in front of them if they feel like they had a choice and hand in preparing it.

Some foods may trigger headaches in children. Limit the intake of processed or fried foods. Overly restrictive diets may prompt an unhealthy relationship with food or body image. If you are unsure if certain foods may be triggering your child’s headaches, consult your pediatrician.

  1. Stay well hydrated.

Headaches are commonly caused by dehydration. There is a link between increased water intake, decreased headache severity, and improved quality of life. At CHOC Children’s, we recommend that children drink the number of 8-ounce cups of water equal to their age, with a maximum of 64 ounces for children over age 8. This means your 1-year-old would drink one 8-ounce glass or water, your 5-year-old would drink five 8-oz glasses of water, etc.

  1. Limit caffeine intake

Caffeine tolerance differs from person to person, but the general recommendation is 200 to 300 milligrams per day. A standard cup of coffee has around 100 milligrams of caffeine, compared to a large coffee drink that can have over 400 milligrams of caffeine. If you have too much caffeine, you can experience headaches, heart palpitations, elevated blood pressure, insomnia, or irritability.

  1. Play

Yes, really! Kids are busier than ever these days, and an over-scheduled child is likely to suffer stress, which can lead to headaches, Dr. Zupanc says. Spending time outdoors, reading for pleasure, and playing sports for fun rather than in a competitive environment are all good ways to help cut down on stress, she says. In addition, screen time — including tablets and smartphones —should be limited. Learn more about screen time limits for kids.

Mindfulness, or relaxation techniques, can help kids and teens build the coping skills they need to address issues like stress and anxiety, Zupanc adds. Learn more about mindfulness tips for your children.

Studies have shown that cognitive behavioral therapy, in combination with preventive medication, has helped adolescents with chronic migraine headaches.

  1. Keep a journal

If your child experiences frequent headaches, keep a journal to track their headaches so you can identify a pattern, and show this to your child’s pediatrician. 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?
  • Was the pain throbbing (pounding) or dull?
  • Were there any other signs or symptoms associated with the headache, such as a change in vision, tingling of an arm or leg, or weakness?
  • 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 doctor may adjust their diet, headache hygiene routine, or their over-the-counter pain relief regimen, Dr. Zupanc advises.

There are some, albeit rare, situations where a child’s headache warrants a trip to the emergency department, Dr. Zupanc says, including:

  • A 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, changes in consciousness or awareness, or change in balance.
  • Blurred, double or loss of vision that persists after the headache resolves.

Sporadic headaches rarely require brain neuroimaging, such as a CT scan or MRI scan of the brain.

Frequent headaches that are increasingly severe can suggest an underlying brain problem. Brain imaging may be necessary. If your child experiences the following symptoms, ask your pediatrician for a referral to a pediatric neurologist for further evaluation and possible imaging:

  • Headaches associated with weakness or numbness in an arm or leg, or balance problem. In this case, immediate follow-up care is warranted.
  • Headaches that wake a child out of sleep
  • Headaches associated with projectile vomiting
  • Headaches that increase with Valsalva maneuver (such as bearing down for a bowel movement)
  • Headaches associated with a seizure
VIDEO: Dr. Zupanc explains headaches

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    Think only grown-ups get migraines? Think again. This painful neurological condition is also common among children. In fact, one in 20 children – or about 8 million children nationwide – experience ...
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6 do’s and don’ts of concussion

If your child experiences a concussion, it can be scary to think about the effects on their developing brain. The good news is, more than 85% of concussions heal well if managed properly early on.

“Early, appropriate treatment prevents kids from having to come see me as a neurologist,” says Dr. Sharief Taraman, pediatric neurologist and director of the CHOC Children’s Concussion Program. “It’s important to do as much as we can to prevent kids from getting a concussion, prevent reinjury, and treat them as aggressively and appropriately as possible in the early intervention stages.”

sharief-taraman-pediatric-neurologist-choc-childrens
Dr. Sharief Taraman, a pediatric neurologist at CHOC Children’s.

Follow these do’s and don’ts for proper prevention and treatment of concussion. If your child does sustain a concussion, be sure to see your pediatrician as soon as possible.

  1. Do protect a young brain

Athletes should be taught safe playing techniques, equipment maintenance and to follow the rules of the game. Always wear a helmet while playing contact sports like football, hockey and lacrosse, and during activities like horse riding, biking, skateboarding or snowboarding. Helmets should fit correctly and be in good condition.

  1. Don’t miss the signs

A concussion isn’t always obvious. Watch for these signs in your child or teen, especially while they are participating in sports. Symptoms may take up to a day to appear after an incident.

  • Headache
  • Nausea or vomiting
  • Balance problems
  • Dizziness
  • Visual problems
  • Fatigue or drowsiness
  • Sensitivity to light or noise
  • Numbness or tingling
  • Dazed or stunned
  • Irritability
  • Sadness
  • More emotional
  • Nervousness
  • Trouble falling asleep
  • Feeling mentally “foggy”
  • Feeling slowed down
  • Confused about recent events
  • Sleeping less or more than usual
  • Difficulty concentrating or remembering
  • Forgetful of recent information or conversations
  • Answers questions slowly or repeats questions

Seek emergency care immediately if your child or teen has experienced unconsciousness for any amount of time or has changes in alertness, convulsions or seizures, muscle weakness, persistent confusion, repeated vomiting, unequal pupils, unusual eye movements or walking problems.

  1. Do sit on the sidelines

The most important thing your child should do if they are injured during a sports activity is to immediately stop playing. It’s crucial that they avoid more hits, jolts, shakes or bumps to the head or spine. Getting back in the game is not worth the risk. Remember, the signs of concussion aren’t always clear, so when in doubt, sit it out.

Athletes may not want to tell their coach if they had a concussion. Encourage them to come forward if they have an injury, or if they notice a teammate is injured. Young athletes should never ignore a head injury or impact to the head.

  1. Don’t skip treatment

Even a mild concussion should be evaluated by a doctor. Get in to see your child’s pediatrician as soon as possible.

When a concussion is severe or symptoms won’t go away, talk to your doctor about a referral to the CHOC Children’s Concussion Program, which includes pediatric sports medicine specialists, neurologists, neurosurgeons, neuropsychologists and rehabilitation therapists who are all trained in concussion management.

  1. Don’t rush recovery

Rest is important immediately following a concussion. For 24-48 hours, your child should stay home from school and get plenty of quiet time and mental rest. This includes limiting activities like:

  • Television
  • Texting
  • Social media
  • Reading
  • Driving
  • Doing homework
  • Social interaction
  • Attending loud events

After the first 24-48 hours, light activities may help speed up recovery. Most children should be able to tolerate some school after a few days. If they need to miss more school than that, contact the school and your doctor to help intervene with short-term adjustments. Before returning to sports, be sure that symptoms have resolved and get medical clearance from your child’s doctor.

  1. Do prevent future injury

Parents, coaches and athletes should be extra cautious to prevent future concussions. One concussion is rough enough, but additional injury is even worse. Research has shown that repeated jars to the head can have long-lasting effects on the brain. And, if a child or teen suffers a second concussion before the first concussion heals, they are at risk for Second Impact Syndrome, a life-threatening condition.

“The CDC has called concussions an epidemic in the United States,” Dr. Taraman says. “Kids really do get into trouble if a concussion is not recognized, and if we don’t take the proper steps to get them better and avoid those second injuries, which can be catastrophic.”

Download 5 questions to ask an injured athlete

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Sudden unexpected death in epilepsy: What parents should know

By Dr. Lily Tran, pediatric neurologist and epileptologist and medical director of CHOC’s comprehensive epilepsy center

dr-lily-tran-choc-childrens

Sudden unexpected death in epilepsy (SUDEP) occurs when someone with epilepsy suddenly dies unexpectedly and the cause is not related to an accident or seizure emergency. A seizure emergency could include status epilepticus, where someone has a seizure lasting more than five minutes, or two or more seizures within a short period of time without the person returning to normal in between. Aside from epilepsy, this person is otherwise considered healthy, and no other cause of death can be found. Each year, one in 1,000 people in the U.S. die from SUDEP.

There are several risk factors for SUDEP. These include:

  • Poorly controlled seizures, especially tonic-clonic seizures, characterized by a loss of consciousness and violent muscle contractions
  • Seizures, especially tonic-clonic seizures, that tend to occur in sleep or at night
  • Not taking medications regularly or as prescribed
  • Stopping or changing medications suddenly
  • Young adult age

The exact cause of SUDEP is unknown. More research is needed to understand its cause. Some research suggests that seizures lead to changes in the brain and/or heart’s ability to function, and related breathing difficulties may lead to SUDEP.

For anyone with epilepsy, the ultimate goal is always to minimize seizures as much as possible and strive to become seizure-free. There are several other things people with epilepsy can do to help prevent SUDEP, including:

  • Take your anti-epileptic medications as prescribed. Do not stop medications abruptly without talking to your doctor.
  • Stay healthy by eating a well-balanced diet and getting regular exercise.
  • Avoid potential seizure triggers.
  • Make sure your family members and/or caretakers understand seizure first-aid

Although seizure-alert devices are on the market, there is no scientific data to support the idea that these devices help prevent SUDEP. More evidence is needed to show they can accurately detect seizures and prevent SUDEP.

VIDEO: A CHOC neurologist explains epilepsy vs. seizures

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CHOC recognized as one of nation’s best children’s hospitals

CHOC Children’s is one of only 50 pediatric facilities in the nation to earn recognition as a best children’s hospital by U.S. News & World Report. The following CHOC specialties are honored in the 2019-20 Best Children’s Hospitals rankings: diabetes/endocrinology, cancer, neonatology, neurology/neurosurgery, pulmonology and urology. Cancer ranked in the “top 20.”

“The national recognition for CHOC’s cancer program is well-deserved. There’s nowhere else I’d rather have gone through treatment than CHOC,” says 17-year-old Sydney Sigafus, CHOC patient and cancer survivor. “Everyone who works at CHOC cares about you as a person, not just a patient. I was included in every decision and conversation about my care.”

The Best Children’s Hospitals rankings were introduced by U.S. News in 2007 to help families of children with rare or life-threatening diseases find the best medical care available. Only the nation’s top 50 pediatric facilities are distinguished in 10 pediatric specialties, based on survival rates, nurse staffing, procedure and patient volumes, reputation and additional outcomes data. The availability of clinical resources, infection rates and compliance with best practices are also factored into the rankings.

us-news-best-childrens-hospitals-6specialties

“We understand how scary it can be for parents whose children are dealing with life-threatening illnesses or injuries. That’s why we are committed to the highest standards of care, safety and service,” says Dr. James Cappon, CHOC’s chief quality officer. “While we are proud of our accolades, including being named a best children’s hospital, we remain focused on preserving the magic of childhood for all kids, whether they are seriously ill or healthy, or somewhere in between.”

Learn more about the Best Children’s Hospitals rankings.

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