My journey with CHOC started on Dec. 18, 2016, when my dad and I were hit by a car. The weeks following the accident were terrifying, and my 18-month rehabilitation process afterward was physically and mentally challenging. Now, I’m doing incredibly well and so is my dad.
My dad and I were in a movie theater parking lot in South Orange County. We’d just seen the latest Star Wars movie. We were standing next to our car when a driver careened off a nearby road at 100 miles per hour and hit us. I was immediately knocked unconscious and flew into a nearby body of water. I was completely submerged and almost drowned. I suffered a traumatic brain injury, broken shoulder and multiple facial fractures. My dad and I were not initially expected to survive. I was rushed to CHOC Children’s at Mission Hospital. I underwent multiple tests, scans and procedures, including one to drain leaking cerebral spinal fluid.
I don’t remember much of my time at CHOC Mission – I was comatose for most of my first week there. I finally woke up on Christmas Eve, and over the next 10 days I made significant progress – sitting up and even taking a few steps.
During this time, my dad was recovering at Mission Hospital. Thanks to the partnership between CHOC Mission and Mission Hospital, my mom was able to go back and forth between my room and my dad’s room without even having to leave the building.
CHOC doctors and nurses exemplify kindness and caring. One of the kindest things they did for us was allow my dad and I to see each other. Once we were both awake and extubated, they brought my dad up to my room. The simple act of allowing a father and son to see each other and hold each other’s hand was instrumental in our healing process.
Dr. Gary Goodman, medical director of the pediatric intensive care unit at CHOC Mission, was incredible. He kept my parents well-informed about my care and progress. Every single nurse who treated me went out of their way to also ensure that my mom felt cared for. She was included in every conversation about his care.
My mom has been a nurse for 25 years. She works with the American Hospital Association and helps hospitals implement strategies to improve outcomes for patients and make care as safe as possible. Because of her clinical eye, she noticed everything that happened with every shift. Even during the holidays or shift changes, she always said my care at CHOC Mission was impeccable. This shows the entire team’s commitment to excellence.
Despite being incredibly complicated trauma patients, with high-alert medications and surgeries, neither my dad nor I experienced any adverse events during our hospitalizations. We both received perfect care.
My dad and I went home after around two weeks. Next, I started 18 months of rehabilitation through CHOC. I worked with an occupational therapist and a physical therapist. I had to relearn how to walk, hold a pencil, do math, read and remember things.
I also worked with Dr. Sharief Taraman, medical director of neurology at CHOC, and Dr. Jonathan Romain, a CHOC neuropsychologist, as part of CHOC’s concussion program. Even though I wanted to speed up my recovery so I could try and get back to playing baseball, Dr. Taraman and Dr. Romain made sure I was safe.
Before the accident, I was a lifelong baseball player. After the accident, no one imagined I would play baseball again. Not only did I return to baseball a few months after the accident, but I recently signed a letter of intent to play baseball for Ohio Christian University.
This journey has taught me so much. I really shouldn’t be alive right now. Now, I don’t let the small things get to me. I know I can get through anything.
Our family could never repay our gratitude to CHOC. We are so thankful for everything CHOC has done for us.
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.”
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.
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.
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.
Nausea or vomiting
Fatigue or drowsiness
Sensitivity to light or noise
Numbness or tingling
Dazed or stunned
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.
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.
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.
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:
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.
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.”
Athletes and other adolescents with mild to severe concussions who experience symptoms such as dizziness, feeling unbalanced on their feet, blurred vision or trouble focusing on objects, may be good ...
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.
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
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
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.
How to avoid headaches
There are a number of things parents can do to prevent headaches, says Dr. Taraman. These include:
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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Kids Health, delivered monthly, offers “healthful” information for parents:
By Dr. Nancy Shan, pediatric resident at CHOC Children’s
Headache complaints can be bewildering and frightening to many parents. Most are caused by a benign (simple) problem or primary headache disorder. ...
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 ...
When Rayaan was 16 months old, he caught a simple cold. He had a typical low-grade fever and slept more than normal. I figured he needed the rest and would feel better the next day. The next morning, he was having a difficult time waking up so I thought I should take him to his pediatrician. She recognized something was very wrong and described him as being “unresponsive.” He was immediately transported to CHOC Children’s via ambulance. CHOC’s emergency department team was waiting for our ambulance and ready to care for Rayaan as soon as we arrived. They quickly assessed him and then placed him on a ventilator as he was brought up to the pediatric intensive care unit (PICU).
His care team ordered an MRI of his brain and diagnosed him with Acute Disseminated Encephalomyelitis, also known as ADEM. This means there was widespread inflammation in his brain and spinal cord that damages the myelin, which is a protective covering for nerve fibers. ADEM had affected over two thirds of his brain. We didn’t know it yet, but we would be at CHOC for the long haul.
Over the course of the next six weeks, Rayaan received multiple types of treatment for ADEM. His care team was vast, and included many different specialties: Dr. Nguyen Pham, a pediatric otolaryngologist (ear, nose and throat specialist or ENT), Dr. Gregory Wong, a pediatric gastroenterologist, Dr. Sharief Taraman, a pediatric neurologist, in addition to infectious disease specialists, in-patient physical and occupational therapists, a respiratory therapist, and the feeding team. He was in a coma and on life support for three weeks. During this time, his doctors kept a very close eye not only on him, but also on our entire family. Dr. Nick Anas, CHOC’s physician-in-chief; Dr. Jason Knight, medical director of emergency transport services; Dr. Paul Lubinsky, associate PICU director; and critical care specialists Dr. Juliette Hunt, Dr. Anthony Cherin and all of our nurses became family to us. I remember when Dr. Anas came to check up on Rayaan and he asked me when was the last time I layed next to Rayaan, I replied it’s been a while, and he ordered the PICU staff to transfer Rayaan from a crib to a full-size bed immediately, so I could lay next to my son. Rayaan was connected to every machine and monitor you can imagine, but his doctor was keeping my feelings in mind.
During this extremely difficult time when we were waiting for him to wake up, we were fortunate to have a wonderful support system. The Ronald McDonald Family Room let us escape for a few minutes, occaisionaly breakfast and lunch was provided by generous donors, and my daughter who was only three years old at the time was taken care of by child life specialists, while a social worker and case manager were assigned to us to provide us with counseling. This period was the hardest thing we had ever dealt with in our lives.
After three weeks of being in a coma, Rayaan began showing signs of waking up. He began by slightly moving his hands and arms. A few days later, we noticed his eye partially open. It would take him almost two weeks to be fully awake. Although he had woken up from his coma, his journey was just beginning. The inflammation in his brain caused severe brain trauma and he lost his speech, and his ability to walk, eat, swallow and drink. While he was still in the hospital, a feeding tube was placed, as his oral muscles were to weak to swallow and chew. After his discharge, the rehabilitation team came in to ensure he would relearn the basics. Nicole Well, a speech language pathologist at CHOC, taught my son how to talk again. A feeding therapist named Polly provided electrical stimulation feeding therapy to make his muscles strong enough again to be able to eat, drink and swallow on his own.
Rayaan endured several surgeries and procedures during his hospitalization, and even more after his discharge and as well as multiple visits to the emergency department at CHOC. The CHOC specialists always worked so hard on Rayaan as if he were their own child. I am very grateful to CHOC for saving his life and I know that the comprehensive care we received at CHOC we wouldn’t have been able to get anywhere else.
Today, four years later, Rayaan is in Transitional Kindergarten and still undergoes multiple therapies in the effort to make a full recovery from his illness. He remains under the care of CHOC specialists. I am inspired every day by his strength and his courage to overcome so much at such a young age. Above all, our family is grateful for CHOC, who has provided him with the comprehensive medical care throughout his journey.
Rocio Macias was driving when her 4-year-old daughter, Isabella, coughed from the backseat.
“Are you OK?” Rocio asked.
“I’m OK,” Isabella answered with a giggle.
While likely mundane for many parents, this exchange ...
Navigating adolescence with a still-developing brain
Adolescents’ brains are not yet fully developed during their current stage of life. Physical development can start as early as 8 years old, but the tail end of brain development doesn’t occur until closer to age 25. The more your child is exposed to new things, skills or experiences, the more connections their brain will develop.
“The brain is constantly developing through young adulthood. Just like we wouldn’t expect a baby to be able to speak or a toddler to be able to understand certain consequences, we have to have appropriate expectations for our adolescents,” says Dr. Sharief Taraman, a pediatric neurologist.
This constant development can lead to experimentation and in turn, a healthy decision making process.
“On the one hand, adolescents are more apt to experiment and make poor choices because their brains are still developing, but they are also more able than adults to learn from their mistakes and alter their perspectives,” says Dr. Jonathan Romain, a pediatric neuropsychologist. “I see adolescence as a period of great potential for growth and development.”
A parent’s role in teen brain development
The consequences of teens’ actions can help them link impulsive thinking with facts. This helps the brain make these connections and wires the brain to make this link more often. Parents play a crucial role in helping teens talk through consequences and decision making.
“Part of a parents’ role during this time in their child’s life is understanding that adolescents are practicing new reasoning skills they haven’t used before,” says Dr. Alexandra Roche, a pediatrician who works with adolescents. “Having abstract thinking is one new reasoning skill they need to practice. When they are trying to make a decision, it’s helpful for parents to let them explore various consequences.”
The primary part of the brain developing during this time is the frontal lobe. As this area develops, teens are better equipped for abstract thinking and executive functioning, such as planning their day and making decisions. The frontal lobe is also involved with connections and how we socialize with people as well.
“They’re learning that if A happens, then B or C is going to happen after that. Parents get frustrated at how adolescents handle peer relationships and how extreme their feelings can be, but these may happen because those connections are being formulated. Talking through consequences helps good connections to form,” says Dr. Taraman. “Decision making takes practice. If you want to play guitar, you take lessons and practice, and it makes you better. If you only take one guitar lesson, you’re not going to learn how to play. Decision making is the same thing; it takes practice and it is never too early to start teaching our kids how to make good decisions.”
How to teach decision-making skills to your teen in an interactive way
Remember that you are a role model for your teen’s behavior. When it’s time to make a big decision, show them how to make a matrix, weigh the criteria of what is important to you and them, and teach the decision making process in an interactive way.
Modeling reasoning behavior with your teen will affect how they explore and understand downstream consequences, says Dr. Roche.
“If they approach you and want permission to do something, have them do research via respectable sources and find out what’s appropriate for their age. Involve them in the decision making process. That’s how you can give them good tools instead of just deciding things for them,” says Dr. Taraman.
Talking to your kids is essential in the digital age. It’s common for teens to want to be on their smartphone around-the-clock, but that can spur an extreme fear of missing out. Figuring out how to turn off both the devices and the need to be constantly plugged in is important.
“Try setting technology-free zones or times in your home, such as the dinner table. Take turns going around the table and sharing the highlight of your day. It can spark conversations about other things that happened during your day and how you dealt with them. Teens can learn by example,” says Taraman.
Your teen’s friends also play a crucial role in their development, but peer pressure is not always a bad thing.
“Peer pressure can be positive in many cases, like trying a new sport or joining a new club at school. Experimentation is the way adolescents learn how to interact with their environment and peers,” says Dr. Roche. “Kids should be curious and try different activities.” Helping them plan ahead for unexpected events, such as being offered drugs or alcohol, can help your teen make the right choice when it counts.
How to calm an overly emotional teen
When teens are overly emotional and fixating on a problem they feel is the end of the world, there are several things parents can do to calm them down so they can start talking through their emotions.
“It’s very common for teens to be very dramatic. Whatever is happening in their world can seem like it’s the most important thing that has ever happened to them,” says Dr. Roche. “Help them identify the emotion they are feeling, and what is making them angry or excited, for example. Identifying the root cause of the emotion and then connecting that back to how that affects their decision making is important.”
Dr. Romain encourages parents to give their teen some space but remind them that you are available to listen.
“Not every problem needs a solution. Sometimes they just need someone to listen to them in a safe space. Encouraging journaling can also be a productive way of getting thoughts and feelings out,” he says.
Listen first and then expand on their statement.
“If they express hurt or disappointment, try to get them to more openly explain why something hurt their feelings,” says Dr. Roche. “Did they misinterpret a conversation?”
Allowing them to solve their own problems teaches independence and prepares them for adulthood.
“If you fix all their problems for them as a teen, then when they go off to college they won’t know how to deal with problems. We don’t just give them a driver’s license and tell them to hit the road. First they drive under supervision of a parent or guardian, and then they gradually gain more independence and responsibility,” says Dr. Taraman.
The power of positive reinforcement
Remind teens that they are resilient and competent. They may have trouble remembering past times they have overcome obstacles.
“Positive reinforcement helps encourage certain behaviors you’d like your teen to model,” says Dr. Taraman. “If they want to go to their friend’s house after school and they ask if that’s ok, say “no problem, thank you for asking.” And if they instead tell you they are going, say “Don’t you need to ask permission first?”
Positive reinforcement will also help them develop strong self-esteem. As they develop their identity, encourage your child to reflect on successes as well as challenges.
“During adolescence kids are coming up with self-identify, personal morals and ethics. This all relates to self-esteem. Comparing yourself to others is common but it can also set unwieldy expectations. Identify their unique strengths (for instance music, but not math) and focus on encouraging them to pursue those,” says Dr. Roche.
When to seek help for your teen
Adolescents are prone to addictive behaviors. If they use certain chemicals such as drugs and alcohol, it can hard wire their brain in a certain way. If they are experiencing anxiety or depression and it is not acknowledged and treated, they are more likely to experience those into adulthood.
“It is important to keep an eye out for symptoms of depression and anxiety that extend beyond normal grief and loss. Check in with your child periodically and be aware of changes in behavior pattern. Persistent irritability, sadness, disrupted sleep, and lack of interest and isolation are some things to look out for that likely warrant a check-in with a counselor or psychologist,” says Dr. Romain.
A few days of emotional outbursts might just be a normal sign of adolescence, but if they are persistently practicing abnormal behavior, it may be a sign to seek additional help. Remind your child that you are there for them, says Dr. Taraman, but also empower your teenager to explore the resources available to them, with or without their parents’ help. Suicide hotlines (1-800-Suicide) or adolescent clinics can help them obtain resources without the help of their parents.
“Because adolescents have so many obvious physical changes, it’s easy to forget the cognitive changes going on in this phase. It’s the most exciting change for kids but can be very frustrating for parents,” says Dr. Roche. “Remember to enjoy the experience of watching your kid develop into an adult.”