It’s All About Comfort in CHOC’s Fully Integrated Operating Rooms

A child life specialist and young boy interact in the main lobby of the Tidwell Procedure Center, on the third floor of the Bill Holmes Tower.
A child life specialist and young boy interact in the main lobby of the Tidwell Procedure Center at CHOC Children’s Hospital.

Comfort comes in many forms at CHOC Children’s, and not all of them involve a prescription pad. And that’s important because pain management is highly complex and must be individualized for each patient’s physical, developmental and emotional needs.

Did you know the same distraction techniques used to re-direct children’s behavior are often used to enhance our patients’ comfort? That’s why an engrossing game of Mario Kart or a visit from a friendly pet therapy dog may be just what the doctor ordered.

“Our goal is to keep our patients as comfortable as possible,” said Dr. Paul Yost, a pediatric anesthesiologist at CHOC. “And sometimes we can use distraction in a way that is much more beneficial to our patients than pain medication. Distraction and other non-medication techniques may allow patients to leave the hospital sooner, with less discomfort and fewer complications.”

At CHOC you will find state-of-the-art inpatient and outpatient surgical care provided within a compassionate, family centered, all-pediatric environment. Our pediatric anesthesiologists are experts in the many techniques that provide comfort, while promoting faster healing and recovery.

Additionally, CHOC offers pain management consultation for all patients around the clock. Our pain management team includes Dr. Hai Nguyen, a fellowship-trained pediatric pain management specialist, and Cheryl Deters, a nationally certified pediatric nurse practitioner.

One of seven operating rooms in the Tidwell Procedure Center.
One of seven operating rooms in the Tidwell Procedure Center.

“For a child, fear and anxiety equal pain,” Dr. Yost said. “The mind plays a very important part in how the body responds to comfort, so we work very hard to minimize fear.”

Using a multi-disciplinary approach, the pain management team works closely with CHOC Psychology, Child Life and other medical specialties. In addition to distraction, non-medication pain management techniques may include guided imagery, traditional Chinese medicine, acupuncture, acupressure, massage, and art and music therapy.

“We have the skills and tools to help our patients cope, including many options that only a children’s hospital can provide,” Dr. Yost said. “Choosing to bring a child here is the most important decision a parent can make. We have the expertise to get our patients through situations as safely and comfortably as possible.”

To learn more about surgery services at CHOC, please click here.

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Hernias in Children: What Parents Should Know

CHOC_HerniasSpotting a lump or bump on a child’s body would be scary for any parent, but mom and dad can rest assured: Hernias are common and their repair is among the most common procedures performed on kids, a CHOC Children’s pediatric general surgeon says.

Just in time for national Hernia Awareness Month, Dr. Mustafa Kabeer offers detailed information on this common ailment.

Hernias occur when part of an organ or tissue pushes through an opening or a weak spot in the abdominal wall and creates a protrusion which is visually present. Children with hernias are often born with them, and when a hernia is first noticed depends on when enough pressure is generated to allow other tissues to protrude through the weakened area, Dr. Kabeer says.

“Families or kids might see big or little bumps, and, in most cases, near the belly button or groin,” he says. “Sometimes in premature babies, we see hernias right when they’re born, and sometimes we don’t see them until the child is older.”

Though there are many varieties of hernias, Dr. Kabeer recommends that parents of young children make themselves aware of three types.

Epigastric hernias

First, epigastric hernias occur when a tiny portion of fat protrudes through the abdominal wall in the midline between the belly button and chest, creating a tiny bump a few millimeters wide.

“They can cause some discomfort and they don’t go away on their own,” Dr. Kabeer says. “When we find them, we fix them.”

Inguinal hernias

Secondly,inguinal hernias occur when part of a child’s intestine protrudes between the abdominal muscles and is seen as a bulge in the groin. Girls born with this type of hernia are more likely to have a protrusion on both sides.

This type of hernia is very common, especially in premature babies. This type of hernia should be repaired in a timely manner because, if left unfixed, they can cause discomfort and, on rare occasions, lead to the intestine being stuck in the hernia. This could cause obstruction and require a more urgent operation, says Dr. Kabeer.

“We want to fix these soon,” he says.

CHOC_Hernias2Umbilical hernias

Finally,umbilical hernias appear in babies born with a weakness in the belly button. This type of hernia is very common, and not something that should concern parents, Dr. Kabeer says.
Present when a baby cries, strains or coughs, these hernias cause no discomfort and rarely prompt larger problems, he says.

Dr. Kabeer estimates that 85 percent of umbilical hernias go away with time. That said, if a child still has a protrusion by age 3 or 4, CHOC surgeons will repair the hernia, Dr. Kabeer adds.

Physician can advise treatment

Parents who notice a hernia on their child’s body – particularly those near the groin or between the belly button and chest – should make an appointment with their pediatrician to help determine the type and course of treatment.

Though often harmless, some hernias prompt concern because the protruding organ or tissue can get stuck in the opening, which can compromise blood flow, Dr. Kabeer says. This can damage the protruding part, such as the intestines or even an ovary in girls.

Aside from the obvious bulge, symptoms of hernias can include pain and swelling. Babies who have an obstruction often exhibit abdominal distention, vomiting, redness and pain. If this occurs, parents should seek emergency treatment immediately, Dr. Kabeer cautions.

Short surgery, recovery

Should surgery be required to repair a hernia, the short procedure is performed under general anesthesia and requires no hospital stay, he says.

Recovery is also relatively fast following hernia repair surgery, Dr. Kabeer says. School-aged children are back to normal after about a week, and younger children recover even faster.

Learn more about surgery at CHOC Children’s.

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Kids and Surgery

Parents should understand and work through their concerns, because if the parents are scared, the child will be scared; if the parents are calm, the child will be calm too, says Dr. David Gibbs, a CHOC Children’s Pediatric
Surgeon. “I try and listen to what the family has to say. I need to know what the family is afraid of and what is bothering them,” Dr. Gibbs says. “I try to make the parents realize they are doing the right thing and we will help you through this.” CHOC allows parents to stay with their child in their hospital room during the entire surgery hospitalization period but are not allowed in the operating room.

Dr. Gibbs recommends that parents have their hospital bag packed the night before surgery so they will arrive at the hospital on time. Also, parents should not eat in front of their child because the child won’t be allowed to eat. “I recommend promising the child some kind of special treat or gift after the surgery. I think it’s fine to say, ‘After we go through this, we’re going to get you some toy or thing you wanted and celebrate you having gone through this.’ Have the child bring a favorite blanket, special outfit, stuffed animal or toy, something that reminds him of home. It makes the child feel a little more comfortable.”

Preparing your child in advance and planning ahead for surgery will help make your child feel more comfortable about the surgery and recover better and faster, says Dr. Gibbs. “Don’t plan a trip to Disneyland a week after the surgery. Do whatever it takes to make your child calm, relaxed and pain-free. This will help him heal better and faster and he will be more compliant. This is not just about making him feel better. It’s about making him recover faster. If the child feels that he or she is a part of the experience with some degree of control, then they will get better faster.”


  • The number of children under the age of 18 admitted for surgery as inpatients in the U.S. annually: 450,000
  • Number of inpatient surgeries performed at CHOC in 2013 (Orange and Mission Campuses): 3,591
  • Number of outpatient surgeries performed at CHOC in 2013 (Orange and Mission Campuses): 4,990

View the full feature on Kids and Surgery

Dr. David L. Gibbs
Dr. David L. Gibbs
CHOC Children’s
Pediatric Surgeon


Dr. Gibbs is a pediatric surgeon,
president of the medical staff at CHOC Children’s and the CHOC Children’s Specialists Division Chief of Pediatric Surgery.

Dr. Gibbs completed his internship and residency at Massachusetts General Hospital in Boston, followed by fellowships in pediatric surgery at the UCSF Fetal Treatment Center in San Francisco, the Long Island Jewish Medical Center, Schneider Children’s Hospital/Pediatric Surgery in New Hyde Park, New York, and the Hospital for Sick Children in Toronto, Canada. His clinical interests include pediatric laparoscopic surgery and neonatal surgery.

Dr. Gibbs’ philosophy of care: “When a child needs surgery, it can be just as scary for the parents as it is for the child. We treat the entire family with the greatest compassion and understanding.”

Ohio State University

Adult and Pediatric General Surgery

More about Dr. Gibbs | CHOC Children’s Pediatric Surgery

This article was featured in the Orange County Register on May 12, 2014, and was written by Amy Bentley.

12 Questions to Ask Before a Child’s Surgery

questions_before_kids_surgeryWhen a child faces surgery, the procedure can be just as scary – or even scarier – for a parent.

The good news is that CHOC Children’s practices patient- and family-centered care, and works to ensure parents and patients are informed.

Parents with a child facing surgery should ask plenty of questions to learn as much as possible about their child’s surgery and post-operative care – and CHOC’s surgical services team is ready with answers.

“You have to do whatever you need to do so you feel like you are being a good parent,” says Dr. David Gibbs, a pediatric surgeon and president of CHOC’s medical staff.

Dr. Gibbs recommends that parents ask the following questions before a child’s surgery:

  1. How will this operation help my child?
  2. Is the surgery an inpatient or outpatient procedure?
  3. How long will my child need to be in the hospital?
  4. What type of incision will be used?
  5. What medications will he need?
  6. What are the risks of the surgery and the anesthesia?
  7. What type of post-surgery care will the child need afterward?
  8. How will my child’s pain be managed?
  9. When will my child be fully recovered?
  10. What limitations will my child have after surgery, and for how long?
  11. When can my child eat and drink after surgery?
  12. Is there anything else you think we need to know about this surgery?

Learn more about the Tidwell Procedure Center and surgery at CHOC.

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Kids and Heart Surgery


“In the newborn population, there are many [heart] conditions that may need surgery. One of the things to remember is that these types of surgery that are being done in the newborn period are relatively new, at least in the past 10 to 20 years,” says Dr. Starr. “Because of the technology,  now we’re able to perform complex surgeries.”


“When a baby is born with what’s called transposition of the great vessels, the two major arteries that come out of the heart are switched around,” says Dr. Starr. “The artery that’s supposed to go to the body is going to the lungs and the one that’s supposed to go to the lungs is going to the body. So the blood is mixed and the patient is blue, and that requires surgery in the newborn period.”


“Congenital heart disease is a defect that forms while the baby is in the womb and the child is born with it, as opposed to an adult, who has coronary artery disease that’s acquired,” says Dr. Starr. “We usually separate out the disease into two categories: those who have enough blood flow to the lungs and those that do not,” says Dr. Starr.


Before, during and after your child’s heart surgery, CHOC’s specialized team of doctors and nurses prepare parents for what to expect, including what their child will look like. Many parents wonder if their child will be like other kids after surgery. “Very frequently  the answer is yes,” says Dr. Starr. “They may have special needs, but if you go to a playground you won’t know the difference  between a child that’s had heart disease and a child that hasn’t,” she says.


  • The number of congenital heart disease cases that CHOC handles yearly: 200 – 300
  • Number of hours heart surgery can last: 3 to 4 hours
  • Number of beds in CHOC’s Cardiovascular Intensive Care Unit: 12

View the full feature on Kids and Heart Surgery

Dr. Joanne Starr
Dr. Joanne Starr
CHOC Congenital
Cardiothoracic Surgery Specialist


Dr. Starr is a member of the Society for Thoracic Surgeons and the Congenital Heart Surgeons Society. She previously served as director of the cardiac surgery program at Children’s Hospital of New Jersey and as an associate professor at the New Jersey Medical School.

Dr. Starr’s philosophy of care: “Each patient is different and you have to treat each patient as a unique patient. It’s not just about the heart, it’s about the whole child and their family.”

New York Medical College

General and Thoracic Surgery

More about Dr. Starr

This article was featured in the Orange County Register on December 10, 2013 and was written by Shaleek Wilson.