CHOC Included Among Nation’s Best Children’s Hospitals in U.S. News Survey

CHOC Children’s has been named one of the nation’s best children’s hospitals by U.S. News & World Report in its 2017-18 Best Children’s Hospitals rankings.

CHOC ranked in seven specialties: cancer, diabetes/endocrinology, neonatology, neurology/neurosurgery, orthopedics, pulmonology and urology, which earned a top 20 spot on the coveted list.

According to U.S. News, the Best Children’s Hospitals rankings were introduced in 2007 to help families of children with rare or life-threatening illnesses find the best medical care available.

The 11th annual rankings recognize the top 50 pediatric facilities across the United States in 10 pediatric specialties.

The U.S. News Best Children’s Hospitals rankings rely on clinical data and on an annual survey of pediatric specialists. The rankings methodology considers clinical outcomes, such as mortality and infection rates, efficiency and coordination of care delivery and compliance with “best practices.”

“At CHOC Children’s, we are steadfastly committed to delivering high-quality, safe and reliable health care to our patients,” said Dr. James Cappon, CHOC’s chief quality officer. “Recognition from U.S. News of our excellence in these seven subspecialties validates our efforts, but also provides our patients and families with even more assurance of our commitment to excelling in all areas of care.”

“The pediatric centers we rank in Best Children’s Hospitals deliver exceptionally high-quality care and deserve to be recognized for their commitment,” U.S. News Health Rankings Editor Avery Comarow said. “Children with life-threatening illnesses or rare conditions need the state-of-the-art services and expertise these hospitals provide every day.”

Learn more about survival rates, adequacy of nurse staffing, procedure and patient volume, availability of programs for particular illnesses and conditions and more. 

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U.S. News Names CHOC One of the Nation’s Best Children’s Hospitals

From treating the most complicated cases of epilepsy and repairing complex urological conditions, to curing cancer and saving premature lives, CHOC Children’s physicians and staff are committed to delivering the highest levels of safe, quality care. That commitment has earned CHOC its most recent accolade:  inclusion on the coveted U.S. News & World Report’s Best Children’s Hospitals rankings.   CHOC ranked in eight specialties: cancer, neonatology, neurology/neurosurgery, pulmonology, orthopedics, gastroenterology and GI surgery, diabetes and endocrinology, and urology, which earned a “top 25” spot.

U.S. news

According to U.S. News, the Best Children’s Hospitals rankings are intended to help parents determine where to get the best medical care for their children. The rankings highlight the top 50 U.S. pediatric facilities in 10 specialties, from cancer to urology. Of the 183 participating medical centers, only 78 hospitals ranked in at least one specialty. For its list, U.S. News relies on extensive clinical and operational data, including survival rates, clinic and procedure volume, infection control measures and outcomes, which can be viewed at An annual survey of pediatric specialists accounts for 15 percent of participants’ final scores.

“The Best Children’s Hospitals highlight the pediatric centers that offer exceptional care for the kids who need the most help,” says U.S. News Health Rankings Editor Avery Comarow. “Day in and day out, they offer state-of-the-art medical care.”

Dr. James Cappon, chief quality and patient safety officer at CHOC, points to the survey as an invaluable tool for him and his colleagues to evaluate programs and services, determining best practices, and making plans for the immediate and long-term future.

“CHOC is certainly honored to be recognized once again by U.S. News. But our dedication to serving the best interests of the children and families in our community is what truly drives us to pursue excellence in everything we do. Our scores, especially in the areas of patient-and-family-centered care, commitment to best practices, infection prevention, breadth and scope of specialists and services, and health information technology, for example, reflect our culture of providing the very best care to our patients,” explains Dr. Cappon. To hear more about CHOC’s commitment to patient safety and quality care—and what parents need to know— listen to this podcast.

CHOC’s culture of excellence has it earned it numerous accolades, including being named, multiple times, a Leapfrog Top Hospital. Additional recent honors include the gold-level CAPE Award from the California Council of Excellence; Magnet designation for nursing; gold-level Beacon Award for Excellence, a distinction earned twice by CHOC’s pediatric intensive care unit team; “Most Wired Hospital”; and The Advisory Board Company’s 2016 Workplace Transformation Award and Workplace of the Year Award. Inspiring the best in her team, CHOC’s President and CEO Kimberly Chavalas Cripe was recently named a winner of the EY Entrepreneur of the Year Award in the “Community Contributions” category.

Circumcision and Urinary Tract Infections

Some evidence shows that circumcised boys have a lower chance of developing urinary tract infections (UTIs) in their first years of life, but the added protectionCHOC Children's Urology Center  may be miniscule, say Dr. Elias Wehbi, a CHOC Children’s pediatric urologist, and Maryellen Kelly, CHOC Children’s nurse practitioner.

Learn more about circumcision’s possible effects on UTI rates and get answers to other questions about this common ailment in the following Q & A.

Q: Does circumcision help boys reduce the risk of UTIs?
A: One study that looked at the amount and type of bacteria around the penis before and after circumcision found a significantly greater amount of bacteria under the foreskin in uncircumcised boys. These bacteria are precisely the kinds of germs that can make their way into the urinary tract and cause an infection.

Some studies show a three- to ten-fold decrease in UTI rates in circumcised boys. However, because the rates of UTIs are already relatively low in boys, that finding means 50 to 100 boys would need to be circumcised to prevent one UTI in one boy, who might not have otherwise developed an infection.

Considering this, the decision to circumcise boys should be made with both the family and the physician working closely together to evaluate all the cultural and medical issues.

Q: Are UTIs more common in boys or girls?
A: During the first year of life, boys and girls get UTIs at about the same frequency. After age 1, females are more likely to have a UTI because of the channel from their bladder to the exterior, or the urethra, is shorter. Another theory for higher risk of infections in females is that increased moist tissue and folds of females’ genitals might allow bacteria to colonize the area more easily.

Q: What symptoms could indicate a UTI?
A: Identifying a UTI in young children can be difficult because they aren’t vocal. In many infants, a high-grade fever will be their first or only symptom. Older children might complain of abdominal pain; painful urination; burning when urinating; increased frequency and urgency of urination; blood in their urine; or urinary incontinence. These symptoms are the same for boys and girls.

Q: How are UTIs treated?
A: Children with UTIs should be treated with appropriate antibiotics that are specific to the bacterium that has infected their bladder. Following treatment, parents and children should receive education about preventing infections.

Baby boys with a very tight foreskin and recurrent UTIs may be offered a circumcision or a topical steroid cream to try to loosen their foreskin so that better hygiene can be conducted to reduce their risk or a another infection.

Q: How can UTIs be prevented in children?
A: Hydration is important in preventing UTIs. All children should drink at least one 8 ounce glass of water for each year of age until they are 8. For example, a 4-year-old should drink four glasses of water daily.

We also encourage children to urinate frequently, about once every two to three hours. Holding of urine is a major risk factor for more UTIs. Bacteria in a bladder doubles in quantity every 30 minutes, so it is important children don’t hold their urine for extended time periods.

Constipation is another risk factor. Families should focus on eating high-fiber foods and drinking plenty of water to help children achieve daily soft bowel movements that will reduce their likelihood of UTIs.

Learn more about urology services at CHOC.

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Urinary Tract Infections

“UTIs are very common in children. Kids can get them at any age as they grow,” says Dr. Khoury, medical director of pediatric urology at CHOC. “What’s important for parents to remember is that UTI is a generic term. The urinary tract starts with the kidney and goes all the way to the urethra opening where we urinate from. When we think about a UTI, there is a big difference between a child with a kidney infection versus a child with an infection of the bladder.” Dr. Khoury says the most common UTI in girls is a bladder infection, caused by bacteria in the bladder. The most serious is when the bacteria ascends to the kidney and causes kidney infections. These are associated with high fevers, and the children may become very sick and need intravenous antibiotics in the hospital.

It’s harder to diagnose a UTI in a baby who can’t talk versus an older child who can tell you what’s wrong. Noticing symptoms are important so you’ll know when to take your child to the doctor. Dr. Khoury says the most common symptoms of a UTI in a baby or child include: a fever of unknown origin; frequent urination; urgency of urination (or the child says he can’t hold it); a hot or burning feeling during urination; and occasionally, blood in the urine.

For children and adults, water is one of the most important parts of any diet. When we don’t drink enough water, our bodies can’t function at their best. When we get dehydrated, we feel tired and less able to think clearly, and our bodies can’t cool off as well either. Water is also an essential part of the diet to help prevent urinary tract infections. As a guideline, Dr. Khoury says children ages 1-8 should drink the same number of 8-ounce cups of water as their age. So, a three-year-old should drink three cups of water daily; a six-year-old should consume six cups. Kids 9 and older should drink 8 cups of water daily. (These guidelines are for water only and do not include other beverages a child may drink in a day.)


  • Risk of developing a UTI during childhood: Girls: 8% and Boys: 2%
  • Number of children who will visit a doctor’s office annually for a UTI: 1.3 million +
  • Percentage of children in the U.S. affected by UTIs annually: 3%

View the full feature on Kids and Urinary Tract Infections

Dr. Bixby
Dr. “Tony” Khoury
CHOC Pediatric Urologist


Dr. Khoury is the medical director of pediatric urology at CHOC and a world-renowned specialist in pediatric urology. Dr. Khoury completed his residency in urology at the University of Toronto in Canada. He completed a clinical fellowship and a research fellowship in pediatric urology at the Hospital for Sick Children in Toronto, followed by a research fellowship at the University of Calgary in Alberta, Canada, in the area of biomaterial-related infections.

Dr. Khoury’s philosophy of care: “I take a very analytical approach to the patient’s
medical issues and listen to the family. With that in mind, I tailor my diagnostic
studies and surgical intervention to the patient’s needs without putting them at risk for under-investigation or overtreatement.”

Ain Shams University Medical School in Cairo, Egypt


More about Dr. Antoine “Tony” Khoury

This article was featured in the Orange County Register on July 15, 2014, and was written by Amy Bentley.

Four Ways to Prevent Urinary Tract Infections in Children

Urinary tract infections are a common and painful ailment for children, but a few simple strategies can go a long way toward keeping the problUTI_Prevention_Tips_CHOCem at bay, says Dr. Antoine Khoury, medical director of urology at CHOC Children’s.

Dr. Khoury offers four measures parents and children can take to promote good urinary tract health in kids.

Drink lots of water

Parents should encourage children to stay hydrated.

“Water is really important,” explains Dr. Khoury. “Drinking water increases the volume of urine. This helps the child flush bacteria from their bladder out.”

A dehydrated body conserves water, which can prompt constipation and reduce the frequency of urination, and the flushing of bacteria, Dr. Khoury says.

“Constipation also stops the bladder from emptying completely,” he says. “This results in retention of some bacteria in there that will start multiplying as soon as the child stops peeing.”

Dr. Khoury also says that children should examine their urine to ensure proper hydration.

“If it’s yellow, it’s concentrated so they haven’t had enough water to drink,” he says. “It should be the same color as the water in the toilet bowl, which is clear.”

Urinate frequently

Ensure children urinate every two to three hours or at least seven times a day, which reduces the length of time that urine sits in the bladder and bacteria can grow, Dr. Khoury says

“Kids should go to the bathroom when they wake up; before going to school or at morning recess; at lunchtime; at afternoon recess or when they get home from school; before dinner; between dinner and bedtime; and before they go to bed,” he says.

Children also should be encouraged to use the toilet at school and not “hold it” until they get home, as some kids might do because they don’t want to give up playtime at recess.

To help encourage children to urinate regularly, parents can buy their kids a watch with multiple alarms or set a schedule, Dr. Khoury recommends.

“I tell kids, ‘I want you to be your bladder’s boss. You tell your bladder it’s time to go,’” he says.

Eat a healthy diet

Preventing and correcting constipation is an important factor in ensuring proper urinary tract health, children should eat plenty of fruits, veggies and foods rich in fiber, Dr. Khoury says.

Fiber-rich foods include cereals, whole wheat bread and Fiber One bars.

“I prefer water, but if parents have to give the kids juice, use cranberry juice or prune juice,” Dr. Khoury says.

Practice good hygiene

Cleanliness, good toilet habits and proper hygiene in the genital area helps prevent the introduction of bacteria into the urinary tract, Dr. Khoury says.

When using the toilet, girls should be taught to wipe from front to back to prevent the spread of bacteria, he recommends.

Uncircumcised boys should be taught to regularly clean their penis and foreskin in the bath or shower, Dr. Khoury advises.

More articles about urinary tract infections in kids:

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Urology: Then and Now

Urology_CHOCIt’s been fascinating to watch specialties evolve since I first became pals with CHOC Children’s – and urology is no different.

At CHOC, this special group of physicians, nurses and support staff care for children using a team approach and a patient- and family-centered care philosophy, all while striving for innovation.

More recently, CHOC’s urology team has developed a new technique that significantly reduces pain for children after urology surgeries. The technique incorporates a continuous infusion of local anesthesia following the procedure, and reduces the need for narcotic pain killers.

Even better, the anesthesia pump is a continuous drip contained in a pouch. That means that parents don’t need to worry about adjusting dosages and kids can move freely during recovery.

Also, CHOC offers the county’s only spina bifida clinic. It incorporates six specialties so that patients receive comprehensive care without having to schedule multiple appointments.


The CHOC Children’s Urology Center is committed to offering patients the very latest treatments in pediatric urology in a serene, healing environment. The team works closely with each child’s parents and specialists throughout CHOC to gain an overall perspective of a child’s diagnosis. In addition to being experts in pediatric urology, the team is dedicated to providing compassionate patient- and family-centered care.

What if My Child Isn’t Motivated to Work on Staying Dry at Night?

iStock_000011371901Small“The problem with bedwetting is not that the kidneys produce too much urine. The issue is: is the brain waking up in response to the full bladder and the urge to go to the bathroom when the bladder is full?” explains CHOC Pediatric Urologist Dr. Tony Khoury. “In a child with a bedwetting issue, the communication between brain and bladder is incomplete and inefficient. You need the brain and bladder talking to each other so that the child can awaken in response to that stimulus.”

Training the brain to respond to the need to urinate is the goal, so one treatment option is the use of an alarm. An alarm with sensors is placed on the child’s underwear and when wetness is detected by the sensors, a buzzer goes off and wakes the child.

“If the child isn’t ready, wait and when the child is ready, that will be the time to start talking to them about the alarm. It has to be used properly,” says Dr. Khoury.

Dr. Khoury suggests that parents not push their child to stop wetting the bed or use the alarm unless the child is ready and motivated to stop. To help motivate your child to work on staying dry and to work with the alarm, parents can try taking off the potty training pants and put the child in regular underwear. Parents also can have their child help do his laundry and change the sheets to get him more motivated, Dr. Khoury says.

In cases where the child isn’t ready or motivated and still wets the bed despite using the alarm, it’s not the alarm that is failing to work.

“The alarm requires them to wake up. The alarm is doing its job and buzzing when the urine is coming out but the child is not responding,” Dr. Khoury says. If this is the case, Dr. Khoury says, “Have a parent or older sibling sleep with the child the first few nights of using the alarm and the parent or sibling can make sure he is waking up. If the child fights this, then there isn’t enough motivation so wait a few months and try again. The problem is, families give up. Wait until the child is ready. The child has to want it. If he is ready to be dry, he will work very hard with the alarm.”

The success rate of wetness alarms is excellent – provided the child wakes up to the alarm. In fact, 75 percent of children in three weeks manage to respond to the alarm and wake up as they are wetting or right before they wet, and then they sleep through the night.

“They begin to wake up on their own to go to the bathroom,” says Dr. Khoury. “I tell parents to keep putting the alarm on for six months past the child’s last wet night.”

Parents can tell their child is motivated to stay dry if he starts to notice that he is wet in the morning and doesn’t like it, if he says he doesn’t want to wear potty training pants anymore, and if he avoids sleepovers he wants to attend.

View our Health Feature on Bedwetting.

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How to Cope with Bedwetting

Bedwetting that continues beyond the age of 5 can impact a child’s self esteem and create a sense of isolation, according to Christopher Link, post-doctoral fellow in CHOC Children’s Pediatric Psychology Department. Chris recently sat down with CHOC Radio host Bryan Mundia to talk about what parents can do to help their children cope with bedwetting.

First, it’s important to see a physician to rule out any medical causes for bedwetting occurring in older children. After medical issues have been addressed, there are some things parents can do, including limiting their child’s fluid intake before bedtime, making sure their child goes to the bathroom before getting under the covers, and avoiding caffeine.

Chris says parents need to understand that bedwetting is not a child’s fault; it’s not intentional. Instead of punishing children, parents need to reassure their children that they will grow out of it. For more helpful tips on this subject, tune into the show.

Enjoy the show!

Protect Your Kids’ Kidneys and Bladder This Summer With Lots of H20

If May’s unseasonable heat wave was any indication of the hot temperatures Orange County could face this summer, you’d better get your water bottle ready.

Children are especially vulnerable to dehydration during the summer. Kids who are active outdoors – whether they play sports or hit the beaches – need to remember that drinking plenty of water is critical to maintaining good health during the hot months.

The CHOC Children’s Urology Center treats many kids during summertime who suffer from urologic conditions related to poor water drinking, said Dr. Antoine Khoury, a pediatric urologist and the center’s medical director.

“It is remarkable how frequently children and their families forget to drink water. The fluid they take in is juice, soda and milk, and not water,” Dr. Khoury said.

A good way to tell if a child is hasn’t been drinking enough is to check the color of his urine. If it’s dark yellow, the urine is concentrated and the child needs to drink more. The urine should be pale in color or better still clear, this provides the child with immediate feedback to drink more water any time the urine is not clear. And, “Any time the child is thirsty he is already dehydrated,” Dr. Khoury said.

Drinking liquids other than water is not as effective in keeping the body hydrated, Dr. Khoury explained. Our bodies require “free water,” or water that is available to the kidneys so they can do their job filtering blood and extracting waste through urine. Giving the kidneys extra water helps them do their job.

Dehydrated children can face several serious urological problems. They include:

1) Kidney stones. Due to a lack of water intake, the urine becomes concentrated and overly rich in salts and crystals. Crystals can be a nidus for kidney stones formation. This can be a very painful condition.

2) Bladder infections. If a child’s body doesn’t make enough urine, the urine becomes concentrated. Children who don’t produce enough urine will not get the urge to urinate and tend to hold it in. Holding in urine for several hours accelerates bacteria growth and may cause a bladder infection.

3) Constipation and incontinence. The more water the colon absorbs from the food due to lack of water in the body, the harder and smaller the stool is. Children who don’t drink enough water can become constipated. The dysfunctional emptying of the bladder associated with constipation promotes incontinence and infections.

4) Urgent and frequent urination. A child’s urine can become so concentrated and loaded with crystals and salts that the bladder becomes irritated. This may lead to urgent and frequent urination.

Drinking Water Guidelines

Dr. Antoine Khoury, Medical Director of the CHOC Children’s Urology Center, recommends that children drink an 8-ounce cup of water daily for every year of age, up to the age of 8. (So a four-year-old should drink at least four cups of water daily). Kids over 8 and adults should drink 8 cups of water daily. This recommended water intake is in addition to any other fluids consumed. Finally, sports drinks are not a substitute for water!

If your child experiences a urological problem, call the CHOC Children’s Urology Center at 714-512-3919.

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One For the Books


“Your baby has no kidneys.”  That’s what Nicola and Clifford Vazquez were told when a prenatal ultrasound showed an abnormal mass where their baby’s kidneys should be. Just halfway through the pregnancy, they were also told that their baby would die shortly after birth. they were devastated.  The Vazquezes decided to get a second opinion, which ultimately led them to CHOC children’s pediatric urologist Antoine Khoury, M.D.  He saw things differently.

When Madison Vazquez was born last November, Dr. Khoury and his team were ready and waiting. Dr. Khoury used tiny, minimally invasive instruments to drain accumulated fluid that appeared to explain the abnormal  images on the ultrasound. But he sensed there was more to the picture. He decided to look further.

ar-2012-one-for-the-books2What Dr. Khoury found was a structural abnormality that was undetectable by ultrasound. It explained everything.  No one in the operating room had ever seen anything like it. But Dr. Khoury and his team used a combination of reconstructive techniques to correct the newly discovered abnormality. Their ingenuity  in the operating room saved Madison from having a more extensive surgical procedure that very same day.

“The first condition was so glaringly abnormal that it masked the primary condition,” Dr. Khoury said.  “We’ve checked the literature and haven’t found reports of anyone else using the combination of techniques that we brainstormed that day. We are submitting it for publication in hopes it may save other children from having more extensive procedures.”

Looking back over their ordeal, Nicola and Clifford have already found a silver lining. “If we had not gotten the misdiagnosis before Madison was born, we would not have met Dr. Khoury when we did, and he saved her life,” Nicola said.

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