I’m a Pediatrician. Here’s What I Ask My Own Child’s Doctor.

By Dr. Sarah Kay Herrera, a CHOC Children’s pediatrician

Since I was 11 years old, I knew I wanted to be both a pediatrician and a mom. Today, I get to take care of children within the CHOC Primary Care Network at Sea View Pediatrics and be a mom to my 4-year-old daughter. You might think that being a pediatrician has its advantages as you become a parent yourself, but I often find myself worrying more. Just like the parents who come to my practice, I also turn to my pediatrician for an objective perspective to calm my mommy nerves and take care of my daughter.

sarah-kay-herrera-md
Dr. Sarah Kay Herrera, a CHOC Children’s pediatrician

Here are some of the questions I ask my child’s pediatrician, and what they’ve told me:

What are the best parenting books?

  • “Caring for Your Baby and Young Child, 6th Edition, Birth to Age 5” from The American Academy of Pediatrics
  • “Baby 411: Clear Answers & Smart Advice for Your Baby’s First Year, 8th Edition” by Dr. Ari Brown and Denise Fields
  • “Happiest Baby on the Block” DVD by Harvey Karp
  • “1-2-3 Magic: 3-Step Discipline for Calm, Effective, and Happy Parenting” by Thomas Phelan, PhD

How can I maximize my baby/toddler/preschooler’s development?

  • Toys must be age appropriate. Toys that are too small have the potential to be a choking hazard
  • All ages: sing, talk, dance, read
  • Newborn: colored toys with soothing music like baby gym, rattles
  • 6 months – 1 year: picture or texture books, musical toys, pots and pans, squeeze toys, peg toys, push/pull toys
  • 1-2 years: stacking toys, push/pull toys, household cleaning toys, musical instrument toys, telephone toys (no cords), toy cars
  • 2 -5 years: encourage them to begin using their imagination during this age. Puzzles, age -appropriate Legos, blocks, tricycles or scooters with a helmet, kitchen toys, balls, doctor’s kit
  • 5-9 years: encourage your child to develop new skills during this time. This can include biking with a helmet, playing sports or other games with balls, using blunt scissors or sewing kit under supervision, playing board games and puzzles.

What are some tricks to keep my picky eater eating healthy?

  • Use a plate with dividers: half the plate should be for fruits and vegetables, a quarter for protein, and a quarter for grains.
  • Give something you know your child will love as well as something new to try he may not like.
  • Eat the same thing your child eats at the table. This shows your child you enjoy your food.
  • Hide vegetables in soup or mix in dishes such as stir fry.
  • Consistency and positive experience is key.

How do you sleep train? What’s the deal with sleep regression?

  • Remember babies need to sleep on their back in their own crib.
  • Recommended book: Solve your child’s sleep problems by Dr. Richard Ferber
  • You can start sleep training when your baby is 4-6 months old but discuss a specific plan with your child’s pediatrician.
  • Place baby in crib still awake to train her how to self soothe. This is the same for toddlers as well. There will be crying, and that is ok.
  • some days will be better than others. this is a problem that all parents face.
  • For ages 1 and up, try a baby night light that changes color for bed time and when it’s time to wake up

Should I be concerned about my child’s fever?

  • Even if your child’s temperature is above the standard 98.6 degrees, we define fever as having a temperature of 100.4 degrees or greater. If your child has a fever for at least three to five days, it’s time to see the pediatrician. This rule doesn’t apply to babies less than one month old; any fevers for them are considered urgent and should be seen in the Emergency Department.
  • Try to give as many details to your pediatrician about your child’s illness and behavior as you can.

My child has a rash. Do they need to see the pediatrician?

Rashes should be examined by a pediatrician. During your appointment, tell your pediatrician about any other symptoms your child is experiencing along with their rash, how it started and how it is progressing. Photos can be helpful, but many times photos will not be enough for diagnosis alone. Your pediatrician needs to see and touch the rash and examine the child thoroughly.

Even though I’m a doctor, I trust my daughter’s pediatrician for an objective opinion. Don’t forget to schedule your well child checks as this is the perfect time to ask questions on development, diet, and overall well-being of your child.

Find a CHOC pediatrician near you

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The Latest Guidelines on Cold and Cough Medicine for Kids

By Dr. Eric Ball, a CHOC Children’s pediatrician

When your child is sick, all you want to do as a parent is make them feel better. As a pediatrician and parent, I understand that frustration. Today, parents are inundated with countless over-the-counter products marketed as safe for kids. Unfortunately, we now know that these pediatric versions of adult medication may do more harm than good.

The U.S. Food and Drug Administration do not recommend over-the-counter medicines for cough and cold in children under 2 years old. For older children, consult your pediatrician or pharmacist before offering any over-the-counter medication. Do not give medicines containing codeine or hydrocodone to anyone under 18 years old. These are opioids and are not advised for children.

Why can’t I give my child cold and cough medicine?

There have been few studies that have actually looked at the effectiveness of cold and cough medications in alleviating cold symptoms in children. Of the studies performed, every study done since 1985 has shown no benefit to any of these medications compared to a placebo. In other words, each study showed that a sugar pill had the same effects as the cold medications. Cough medications did not stop coughs, decongestants did not make children less congested, and expectorants did not make mucous any more manageable. Even if the medications did work, they would only treat symptoms of a cold; they do not cure or shorten the duration of the illness. Children get better with time.

When the original dosing studies for these over-the-counter cough and cold medications were performed, safe dosages were established only for adults. The FDA licensed the medications for children in 1976 without any studies establishing safe doses for children. Pediatric dosing was extrapolated from adult dosing using a crude formula: half of the adult dose for children between 6 and 11 years of age and a quarter of the adult dose for children between 2 and 5 years of age. For children under 2 years of age, parents were instructed to ‘contact your doctor.’ These extrapolated doses are imprecise and potentially dangerous; it puts children at much higher risk for adverse effects and accidental overdose.

So, what can I do about a cough or cold?

There is no cure for the common cold, but there are some things you can do while the virus runs its course.

  • Make sure your child drinks plenty of fluids. This will serve to thin mucous and keep him well hydrated.
  • Saline drops or sprays can offer temporary relief of a stuffy nose.
  • A bulb syringe can be used for children too young to blow their noses.
  • A humidifier is often helpful for decreasing congestion at night.
  • Acetaminophen or ibuprofen (for children over six months old) are safe and effective in relieving pain or fever associated with a cold. CHOC offers downloadable guides on acetaminophen (Tylenol) dosing, as well as a guide on ibuprofen (Advil) and naproxen (Aleve).

Not every cough and cold warrants a trip to the pediatrician’s office. Here are a few warning signs that it’s time to make an appointment:

When to call the doctor for a cough or cold:

  • A fever in a baby less than 2 months old
  • A fever of 100.4 degrees or higher lasting more than three days.
  • Labored breathing including wheezing, fast breathing or shortness of breath
  • Dehydration along with not eating or drinking
  • Constant ear pain

The dangers of over-the-counter medicine for children

Since 2000, poison control centers have reported hundreds of thousands of calls related to over-the-counter cold medications in children. The FDA has reported 123 deaths related to decongestants and antihistamines since 1969. Since appropriate dosing has not been established, side effects tend to be more severe in children. Cough suppressants, which are derived from narcotic-type medications, often cause drowsiness, confusion, and other neurologic effects. Decongestants are related to amphetamine-type medications and cause agitation, insomnia, restlessness, and high blood pressure. Antihistamines, which are often marketed as bedtime medication, cause drowsiness in some children and agitation in others. Expectorants can cause gastrointestinal effects, such as nausea, vomiting, and diarrhea.

Find a CHOC pediatrician near you

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Should I Take My Child to the Pediatrician, Urgent Care or Emergency Department?

By Dr. Sarah Kay Herrera, a CHOC Children’s pediatrician

At CHOC Children’s, we know that parents want to be confident they’re giving their child the best care. In order to do that, you need to know where to bring them when they’re sick, but the problem is there are so many options: Do I bring them to the pediatrician’s office? Urgent care? Emergency department? This can make you feel overwhelmed and confused – especially with cold and flu season just around the corner.

We believe parents should have peace of mind they are getting their child the best care. We know it can be scary, stressful and sad to have a sick child. That’s why our Primary Care Network has 16 convenient locations throughout Orange County and beyond. CHOC Children’s Hospital in Orange offers the only emergency department in Orange County that’s just for kids. At the Mission Hospital Emergency Department, in partnership with CHOC Children’s at Mission Hospital, kids and families have access to pediatric-trained nurses, physicians and specialists.

To help you make decisions about where to go for care, consult this guide:

1. Pediatrician

Your pediatrician’s office is not only a place for check-ups, but your primary resource for sick visits as well. Your child’s pediatrician is the doctor who already knows your child’s medical history.

  • You will need to set an appointment for a sick visit, which could include symptoms like fever, runny nose, cough, ear pain, headaches, sore throat, rashes or abdominal pain.
  • If your child is experiencing a chronic lingering issue such as abdominal pain or headaches, it is best to see your pediatrician as they can provide ongoing care and find a pattern in the symptoms, which is important for more complex illnesses.

Here’s a helpful guide of what to bring to the pediatrician’s office.

2. Urgent care

  • Urgent care offices are usually open after business hours, which is typically after 5 p.m. and weekends.
  • Most are walk-in clinics and do not take appointments. This means you can usually expect long wait times. This is the best place to go for acute illness such as fevers, ear pain, runny nose, cough, sore throat, vomiting, diarrhea, minor falls, and stitches.
  • Sometimes your pediatrician or an urgent care provider may decide your child is too ill to go home and they may send you to the emergency department for further treatment or testing.

Emergency department

  • In some cases, it’s best to go straight to the emergency department for apparent life-threatening events, which could include rapid and fast breathing, head trauma, trauma with loss of consciousness or vomiting, motor vehicle accidents, severe abdominal pain or dehydration.
  • An infant less than 28 days old with a fever of 100.4 degrees or higher is considered an emergency and should be taken directly to the ED.
  • Here’s a helpful checklist of what to bring to the emergency department.
  • Not all urgent care clinics and emergency rooms take care of children on a regular basis. It is best to go somewhere that specializes in children’s health. Pediatric-focused facilities have specialized training and equipment to offer the best care for your child.
  • Most pediatrician offices have a phone triage line to help parents decide which place may be best for their child.
Looking for a pediatrician? Find one near you.

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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 it’s not ok to skip your child’s checkup even if they’re healthy. 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. Families are busier than ever these days, so it may be tempting to skip something called a “well child check” if your child is feeling healthy. Here are five 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 Children’s pediatrician

#1 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 they’re a teenager, parents are often asked to leave the exam room, so the pediatrician can speak to them 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.

#2 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.

#3 Screen time discussion

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.

#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!

#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, parenting skills, academic concerns, and anything in between.

Find a CHOC pediatrician near you

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Meet Dr. Charles Golden

CHOC Children’s wants its patients and families to get to know its physicians. Today, meet Dr. Charles Golden, a board-certified pediatrician who serves as executive medical director of the CHOC Children’s Primary Care Network.

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Dr. Charles Golden, a board-certified pediatrician who serves as executive medical director of the CHOC Children’s Primary Care Network

Education and training

I earned a Bachelor of Science in Biology at University of California, Riverside. After completing my undergraduate studies, I attended Western University of Health Sciences College of Allied Health and earned a certificate as a physician assistant. I worked at Southern Orange County Pediatric Associates (SOCPA) as a physician assistant until I started medical school at Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, in Pomona. I completed my internship and residency, including a year as chief resident, at Children’s Hospital Los Angeles.

Special clinical interests

I love all aspects of clinical medicine, but get energized when I have the opportunity to teach. I believe that every encounter with a patient is an opportunity to teach them something about the body and explain why we make the decisions that we do in medicine. I’m also passionate about teaching medical students and residents, as they continually challenge me to stay up to date with new research. I love the feeling I get from contributing to the development of their careers as physicians.

New programs and developments within CHOC’s Primary Care Network

In the near future, we plan to open an after-hours clinic for the entire community. By the end of this summer, we’re planning on implementing a single electronic health record (EHR) for all of our primary care offices so that all of our providers chart on patients in the same record, and a patient’s medical information can securely be available to whoever they see in our group. This will continue to improve communications within the practices.

We’re also growing our comprehensive adolescent medicine services. We will be hiring another adolescent medicine specialist to address this unique, complex patient population

We’re also working on the use of digital vision screening devices to look for problems with vision in children younger than 4 years old, who are often too young to read a visual acuity chart.

As a component of CHOC’s mental health initiative, we’re working closely with CHOC’s chief psychologist, Dr. Heather Huszti and her team to provide a mental health professional in each of our primary care offices to help the medical team screen for and address mental health issues.

What I want patients and families to know about CHOC’s Primary Care Network

For many people, bringing your child to seek medical care can be a stressful event. There are many sources of information out there regarding children’s health, and in some cases those sources may contribute to more confusion and anxiety. I would like patients and families to know that when they choose a CHOC pediatric provider, they can trust that the care being delivered is state of the art, up to date and based on clinical and scientific evidence, combined with years of expertise. They will be greeted by empathic staff who are skilled in making children feel comfortable, and providers who are not only skilled at diagnostics, but bring a warm and compassionate touch to the visit. Further, our pediatricians are partners with our specialists, and through this partnership they share knowledge, collaborate in patient care, and help to create a sense of calm for patients and their families.

What inspires me about the care being delivered at CHOC

Every day pediatricians, pediatric specialists, nursing staff, technicians and so many other professionals come to CHOC to make a difference in the lives of children in need. It’s a calling, and they’re passionate about it. You can feel it when you walk through the door, whether it’s from the smiles and greetings from the folks at the information desk, or when you see a security guard assist a family. Perhaps it’s when you see an associate go out of their way to offer hospitality to a random person in an elevator, or the cutting edge surgical and medical treatments that are happening every day. To try to answer what inspires me most about the care being delivered by CHOC would do a disservice to every little thing that occurs on our campus that makes CHOC a special place. I’m incredibly proud to be a part of it!

Why I decided to become a doctor

I fell in love with science as a teenager. Around the same time, my father had a heart attack. I remember going to the hospital and learning about his heart and how the medicine was working to provide care for him. I was fascinated by it all and never looked back.  If I wasn’t a doctor, I would probably be a general contractor. I’ve always enjoyed working with my hands.

Learn more about CHOC’s Primary Care Network

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