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Here for You All Year
ummertime can make us all feel like kids again. Enjoying long, warm days at the beach or in the backyard. Ice cream and swimming pools to keep cool. Bike rides, barbecues and adventures close to home or far afield. Of course, you watch your kids carefully while they’re in the pool or the ocean, apply sunscreen despite their complaints, and soothe their
@radychildrens Singer and activist Adam Lambert paid a visit to the Center for Gender- Affirming Care and made a donation to support its patient family resource room.
bruises and bug bites. You want your kids to be safe and well—and so do we.
That means we’re here for you and your children no matter what kind of care you need. Sometimes that means truly trailblazing medical care is required. In this issue, we introduce you to 13-year-old Nemo, who recently received a dual heart and kidney transplant—a first for Rady Children’s. We also recently performed our first fetal MRI procedure at the new Dickinson Image-Guided Intervention Center, providing noninvasive, detailed imaging of a fetus’ tiny heart. And you’ll read about the exciting ways that Justin Ryan, PhD, is using 3D printing, virtual reality and other technologies at the Helen and Will Webster Foundation 3D Innovations Lab to help surgeons prepare for procedures and much more. Children’s mental health is critically important too—and because we’re seeing crisis levels of depression, anxiety and other concerns, in this issue we share ways to talk to your teens about the challenges they’re facing in life. You’ll also learn about the ways Rady Children’s is ensuring that mental health resources are available close to home in primary care offices. At Rady Children’s, we’re dedicated to keeping your kids healthy all year and giving them the finest care if illnesses or injuries happen. In this issue, you’ll find tips to keep your family healthy this summer—and help all of you have fun while kids are out of school. We’re constantly innovating care for your family, now and always.
@radychildrens The teachers at Alexa’s Playful Learning Academy for Young Children in San Diego and Murrieta are a special bunch. Thanks for all you do!
STEPHEN JENNINGS Chief External Affairs Officer and Senior Vice President Rady Children’s Executive Director Rady Children’s Hospital Foundation
@rchabaypark The Bay Park unit of Rady Children’s Auxiliary raised $24,000 for the Sam S. and Rose Stein Emergency Department at its Cheers for Good Health event.
SUMMER 2022 HEALTHY KIDS MAGAZINE 1
3020 Children’s Way San Diego, CA 92123 858-576-1700 RCHSD.org
Stephen Jennings Chief External Affairs Officer and Senior Vice President, Rady Children’s Hospital and Executive Director, Rady Children’s Hospital Foundation
Rady Children’s Hospital Auxiliary has been supporting Rady Children’s since 1953 - one full year before the Hospital opened its doors. Today, nearly 1,100 members across 20 units actively advocate for the health and well-being of children, increasing community awareness of Rady Children’s and fundraising. JOIN THE RADY CHILDREN’S HOSPITAL AUXILIARY
President and Chief Executive Officer Patrick Frias, MD President and CEO, Rady Children’s Institute for Genomic Medicine Stephen Kingsmore, MD, DSc Senior Vice President and Chief Operating Officer Chief Medical Officer Gail Knight, MD, MMM Physician-in-Chief and Chief Scientific Officer Gabriel G. Haddad, MD Senior Vice President and Chief Financial Officer James Uli Senior Vice President and Chief Administrative Officer Jill Strickland Nicholas Holmes, MD, MBA Senior Vice President and Senior Vice President, Care Redesign and Managed Care and Chief Operating Officer, Rady Children’s Specialists of San Diego Charles B. Davis, MD Senior Vice President, Executive Director, Rady Children’s Specialists of San Diego and President, Children’s Specialists of San Diego Robin H. Steinhorn, MD
Vice President of Patient Services and Chief Nursing Officer Mary Fagan, PhD, RN, NEA-BC Vice President, Strategic Marketing Irena Boostani Vice President, Government Affairs Clara Evans Vice President, Foundation Fundraising Jean Ford Keane Chair, Rady Children’s Hospital Board of Trustees Paul J. Hering, CPCU Chair, Rady Children’s Hospital Foundation Board of Trustees Douglas M. Arthur Chair, Rady Children’s Institute for Genomic Medicine David F. Hale Chair, Rady Children’s Hospital Foundation Board of Advisors Erik Greupner
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Rady Children’s Hospital-San Diego is the largest children’s hospital on the West Coast and one of the nation’s top pediatric health care systems. Consistently ranked in all 10 pediatric specialties by U.S. News and World Report , Rady Children’s includes a 511-bed pediatric hospital that serves as the largest provider of comprehensive pediatric medical services in San Diego, southern Riverside and Imperial counties. With more than 40 locations, Rady Children’s is the only health system in the San Diego area dedicated exclusively to pediatric health care and is the region’s only designated pediatric trauma center. Rady Children’s is a nonprofit organization that relies on donations to support its mission. For more information, visit www.rchsd.org. Healthy Kids magazine includes third-party content, advertising and/or website hyperlinks from outside businesses and organizations. Their placement in this publication is not an endorsement for these businesses or organizations or their products, materials, services or resources, nor does it reflect the views/policies of Rady Children’s Hospital-San Diego. Healthy Kids magazine and its affiliates shall not be liable to any party as a result of any information, services or resources made available through this publication. Rady Children’s complies with applicable state and federal civil rights and nondiscrimination laws. See www.rchsd. org/nondiscrimination for more information. Language assistance services are available to patients and visitors free of charge. Call 858-966-4096 / TDD: 858-627-3002 for more information.
Learn more about joining the Auxiliary or how to get involved:
HEALTHY HABITS A summer safety guide, five foods to add to your grocery list, raising socially responsible kids and more 05 organ transplant. Rady Children’s is working to give them a second chance. 16 TRANSPLANTING LIFE Hundreds of children are on the waiting list for an DOUBLY BLESSED How a dual organ transplant at Rady Children’s saved the life of a 13-year-old Arizona boy 24
INSIDE RADY CHILDREN’S
AWARDS OF EXCELLENCE Rady Children’s recognizes outstanding employees and volunteers who shine in their commitment to the Hospital’s mission, vision and values 30 STAFF SPOTLIGHT Justin Ryan, PhD, directs the Helen and Will Webster Foundation 3D Innovations Lab at Rady Children’s 28
PAY IT FORWARD Maria Platis’ unique way to honor her son’s
memory and raise money for the Heart Institute at Rady Children’s
TRANSPLANTGAMES2022 Coming to San Diego for the first time ever in summer 2022!
July 29 to August 3, 2022 Register or sign up to be a donor www.transplantgamesofamerica.org July 29 to August 3, 2022 Register or sign up to be a donor www.transplantgamesofamerica.org
It doesn’t get much better than summertime in San Diego. But whether you’ll be spending it at the beach or in the backyard, basic safety precautions can help your kids make it through the season pain-free. We’ve got you covered with ways to protect your little ones from sun, water, bugs and more, plus nutrition tips to help keep them healthy from the inside out. You’ll also find info on common childhood conditions, decoding teenage behavior and how you can help your kids get involved in giving back. Let us help give your family more reasons to smile this summer.
Summer Survival Guide There’s more to summer than fun in the sun. Ensure your children are safe with these tips from Lorrie Lynn , manager of the Injury Prevention Center at Rady Children’s and coordinator of Safe Kids San Diego.
Although it’s not a fan favorite, sunscreen or sunblock is vital for anyone living in San Diego, especially children. And it’s important to read the label to know what you’re applying to your child’s skin. Typically, any sunscreen or sunblock with an SPF of 50 is a safe bet. But whatever the number, you’ll still need to apply regularly, since no sunblock or sunscreen will last all day. “Reapply any time a kid gets in the water then out, because the water will wash away the sunscreen,” Lynn says. “Even if your child isn’t in the water, but is sweating, reapply. I typically recommend reapplying every hour to make sure kids are protected.” Other ways parents and supervising adults can keep children protected from the powerful California sun include wearing hats and lightweight, long- sleeved shirts. And while we’re on the topic of water, remind kids to hydrate. “It’s a good lesson to teach your kids to stop to drink water,” Lynn says. “Hydration is also important when you’re going in and out of the pools because water play causes dehydration.” SUN SAFETY 101
watch. It’s always important to have a responsible adult watching the children.” For pool play, basic water competency is a must. Make sure your child knows how to float, locate the exit and swim at least 25 yards. For children who don’t yet have those skills, outfit them with a Coast Guard–approved life vest rather than just water wings. When it comes to ocean water, these skills are essential, and Lynn recommends also staying near a lifeguard station and asking about the swimming conditions. “You can always ask the lifeguard if there is anything you should be aware of,” she says. Other tips include having a plan in place if an incident occurs, knowing CPR and having a cell phone handy in case you need to call 911.
DROWNING IS THE LEADING CAUSE OF DEATH among San Diego County children ages 14 and under, and children who survive a non-fatal drowning can face lifelong injuries. These facts are proof positive that it’s imperative to always keep a close watch on your kids—no matter their age or competency level in the water. So what’s the best way to keep your kids safe during water play? “I recommend assigning someone to watch, using the Water Watcher tag,” Lynn says. “Always have an adult responsible for keeping an eye on the kids. That adult can then hand the Water Watcher tag to another adult to keep
Get your Water Watcher tag at a local San Diego County fire station or the Prevent Drowning Foundation.
6 HEALTHY KIDS MAGAZINE SUMMER 2022
Stay Cool H
ydration is the ultimate key to summer safety, Lynn says: “It’s really sunny in San Diego and it gets hot. I’ve seen people have heat strokes, and it’s scary.”
She says parents should give children plenty of opportunities to rest in the shade and drink water during outdoor activities. She recommends having a cooler stocked with water and hydrating snacks, like oranges or sugar-free, fruit-based ice pops any time you plan an outdoor trip. If your child is an athlete, hydration is even more important. Athletes should drink plenty of water before a sport or activity, as well as after, to ensure their safety. “Overexertion is the No. 3 reason for emergency room visits for kids ages 10 to 14,” Lynn says. “It’s mostly from being out in the heat and not drinking enough water.” Adults should also stay aware of rising temperatures and know when to have children take a break from the sun.
DON’T LET THE BUGS BITE Banish the creepy- crawlies spoiling your summer fun
“As with anything, read the label.” She also recommends wearing pants and long-sleeved shirts to increase your protection against pests. Finally, read up on the areas you’ll be visiting to know what to expect. For example, areas with tall grass will likely have ticks that could put a real damper on your trip.
Mosquitoes have a bad rap but in San Diego, it’s actually ticks you need to look out for. Lynn says ticks are prevalent here, especially in inland areas such as the woods or mountains. So be prepared if you take your kids on a nature walk or hike. She recommends purchasing a bug repellent that’s effective against ticks but safe for children:
For more tips on how to keep your children safe this summer, visit safekids.org/coalition/safe-kids-san-diego .
SUMMER 2022 HEALTHY KIDS MAGAZINE 7
A SAFE SPACE
for Patients on the Autism Spectrum
What’s the best way to provide top care for children? Give them a space where they feel comfortable and safe. At Rady Children’s, that was the goal for Lisa Miller, manager of clinical informatics and central support on the patient care services team, and Kristin Gist, former senior director of Developmental Services, who formed a team to implement a questionnaire for parents to complete prior to medical visits. The Autism Friendly Questionnaire asks parents questions like “What is the best way to communicate with your child?” and “What might cause your child to be anxious and/or agitated?” By knowing what might trigger discomfort (such as lights or loud noises) for a child on the spectrum, providers can create a safe space prior to the child’s arrival. With roughly 20,000 visits from children on the spectrum each year, providers at Rady Children’s have received positive feedback about the questionnaire and are looking into expanding their support for patients and their families even further.
Creating a Lifetime of Health
Rady Children’s adds developmental specialists to the primary care team
CARING FOR A CHILD extends well beyond checking their vitals. Rady Children’s has a unique approach, called HealthySteps, where well-child visits for patients in Southwest Riverside County include screening for a long list of concerns, including mental health. Sarah Nolan, HealthySteps’ program manager, says it “provides tailored support for common and complex concerns that providers often lack time to fully address, such as behavior, sleep, feeding, attachment, parental depression, social determinants of health, and adapting to life with a baby or toddler. HealthySteps allows us to help providers care for the whole family.” The program, which relies on grants, provides universal screening for families with children through age 5. It’s been crucial during the past two years “when families were isolated, children were not in school, and parents and caregivers lacked the support they would’ve had from friends and extended family,” Nolan says. “First- time parents were alone, learning to navigate sleeplessness and caring for their baby without the support of their own parents, which led to a higher risk of postpartum depression.” It’s important for parents to understand that mental health challenges can arise at any age. “In babies and young children, we talk about
mental health in terms of their behavior and social-emotional health,” Nolan says. “This may look like extreme fussiness, inconsolable crying or tantrums, but it can also look like changes in sleeping and eating habits or be reflected in physical symptoms, such as poor weight gain or delayed language development.” It’s also important to know that the mental health of a child and a parent are intertwined. “If a new parent is feeling unusually sad, irritable or worried, or feels like they’re not bonding with their baby or have upsetting thoughts they can’t stop thinking about, it’s time to ask for help,” Nolan says. “A parent may not think to tell the pediatrician of concerns about their own mental health, but this affects their baby. In a HealthySteps office, the specialist can support the provider and the parent.” If parents need support or have concerns, it’s never too soon to ask for help. “If you have concerns about your baby or young child’s development or behavior, or feel very sad or worried yourself, reach out to your pediatric provider,” Nolan says. “By identifying concerns or challenges early and preventing others from happening through early intervention, young children have a strong foundation for a lifetime of healthy development, learning and growth. In HealthySteps, we are there to help.”
8 HEALTHY KIDS MAGAZINE SUMMER 2022
Symptoms, diagnosis and treatments for the common condition All About ADHD HOT TOPIC
ccording to the Centers for Disease Control and Prevention, roughly 6.1 million kids in the US have been diagnosed with attention deficit hyperactivity disorder, one of the most common neurodevelopmental conditions in children. Though the cause of ADHD is currently unknown, the effects are many. ADHD has been linked to higher incidences of mood disorders like anxiety and depression, as well as learning disabilities, problems at home and at school, and a whole host of detriments if the condition is left untreated into adulthood. There are three types of ADHD, explains Lauren Gist, MD, a developmental-behavioral pediatrician at Rady Children’s. Kids with the first, the inattentive type, struggle with attention and focus, have difficulty concentrating, are forgetful, and have trouble completing tasks and following directions. Hyperactive-impulsive ADHD can present as excessive energy and restlessness, not thinking before acting and challenges in the school setting. There’s also the combined type, which most people with ADHD have, meaning they show symptoms of inattentive and hyperactive-impulsive ADHD. Many children may present symptoms of ADHD, but that doesn’t mean all who do necessarily have
can have all the symptoms, but if they’re not causing a problem, then it’s not a disorder.” Most of the time your child’s primary care doctor can diagnose ADHD and make treatment recommendations. Kids with more complex presentations can also be evaluated by developmental pediatricians, psychiatrists or at Rady Children’s developmental evaluation clinic. A big part of treating ADHD is behavioral management in the home, says Dr. Gist. A specific technique called parent-child interaction therapy is especially effective in younger children. Children with ADHD tend to do well if they have some type of motivation, so a token economy system, for instance, might help: They earn tickets once they finish a task that they can use toward a prize or another kind of reward system. With the right accommodations, kids with ADHD can achieve their academic goals, too. Behavioral health conditions are becoming less stigmatized, though a structured school setting may be challenging and your child may need to learn differently. Multisensory learning is important, as is having a distraction-free area for studying and tests and, if needed, extra time for or modified assignments. “Structure matters,” says Dr. Gist. “Because a lot of children with ADHD struggle
it. Dr. Gist says that to be considered a disorder, the behaviors the child is exhibiting must cause dysfunction. “It really is about how much symptoms interfere with functioning,” she says. “You
with internal structure, often that has to be external, and then when
they’re young, often that has to be environmental. Parents or teachers have to help with that.”
Peer pressure can affect people of all ages, so it’s best to learn how to handle it early on. Dr. Jenkins says just acknowledging the situation “can help adolescents not feel judged for experiencing it.” “One of the important first steps is to identify and label peer pressure for what it is,” she says. Once the teen recognizes that, they can decide whether to go along with it or decline to participate. Teens who are confident are more likely to go against their peers without fear of social consequences. It also helps if they have more than one social circle and an open and honest relationship with you as a parent. Along with an open dialogue, you can help your teen prepare for different scenarios with role play. Give them the words they need to practice declining peer requests. The other side of the coin, Dr. Jenkins says, is making sure your child learns to respect others’ decisions and isn’t the one applying the pressure. HANDLING PEER PRESSURE
Having a teen can be tough. Moodiness, defiance and other growing pains can leave a parent practically pulling their hair out. Here, Willough Jenkins, MD, a behavioral health psychiatrist at Rady Children’s and inpatient medical director of its Child and Adolescent Psychiatry Services, gets to the bottom of some seemingly bizarre behaviors and gives tips on how to support developing teenagers with several common concerns.
Alcohol and Teens Don’t Mix
THE RESEARCH IS CLEAR: Alcohol has a bigger impact on a teen’s ability to learn and remember than it does on an adult. The exact reasons why are still unknown, but it is known that one neurotransmitter located in the frontal lobe, gamma-aminobutyric acid, doesn’t mature until up to age 25. “The frontal lobe of the
Dr. Jenkins encourages parents to talk to their teens about alcohol use, especially if they suspect their child is already drinking. “Asking them about their use, what aspects of alcohol they enjoy and what aspects they don’t like, allows for an open conversation about the risks
and benefits,” she says. “Providing education about the risks of alcohol use—and also the impact on their health—can be helpful. However, the more impactful technique in my practice has been to identify the need that alcohol is filling and then look for alternative, more healthy ways of coping with that need.” Parents should also seek support from their pediatricians or primary care providers as needed.
brain is the ‘brake for impulses,’ and is responsible for planning and decision-making,” Dr. Jenkins says. Alcohol has other negative effects on teenagers. Early use of alcohol increases one’s risk of a substance use disorder later in life, and some of the signs of alcohol intoxication make it harder for young people to stop using and easier for them to binge.
THE FRONTAL LOBE, WHICH IS RESPONSIBLE FOR PLANNING AND DECISION-MAKING , DOESN’T MATURE UNTIL UP TO AGE 25.
10 HEALTHY KIDS MAGAZINE SUMMER 2022
Parenting doesn’t end when a child turns 18—it still plays a role even for adult children. There’s no one-size-fits-all approach to helping your teen prepare to leave the nest, but Dr. Jenkins does offer this checklist of recommendations. Consider it a starting point, which can be edited to fit your teen’s unique personality, needs and circumstances. Set expectations around communication, especially at the beginning of the transition. For example, ask your teen for a text check-in every day or a phone call on Sundays. Have an emergency plan in place if your teen gets in trouble, and review basic safety procedures. Review basic financial literacy— for example, how to budget a weekly allowance. Make sure your teen knows how to access mental health and general health services . Tell your teen not to be afraid or reluctant to ask for help . Remind them that everyone makes mistakes, but you’ll be there to support them no matter what. WHAT’S NEXT?
Tackling Eating Disorders
Some signs of an eating disorder include preoccupation with food or weight, skipping meals, irregular eating and fluctuations of weight. “Most parents don’t realize that eating disorders, particularly anorexia nervosa, have one of the highest mortality rates of all mental health disorders and need to be addressed very seriously from the start,” Dr. Jenkins says. Call your pediatrician or primary care provider immediately for any concerns or questions.
f you notice that weight loss, dieting or control of food has become prevalent in your teen’s life, it’s imperative to address it as soon as possible. “Talk to your pediatrician if you are concerned about your child’s eating,” Dr. Jenkins says. “We know that early recognition and intervention have much better outcomes for eating disorders. Also, if you intervene early you can prevent some of the long-lasting consequences of malnutrition both on the brain and the rest of the body.”
TEEN NIGHT OWLS
Did you know evening melatonin production in teenagers is delayed by about 90 minutes, which in turn delays sleep? Encourage your teen to prepare for sleep earlier by turning off their screens. Teens should be getting about nine to 10 hours of sleep a night.
Why Rady Children’s? Rady Children’s is the go-to resource for Southern California families because of the spectrum of services it offers. Aside from emergency services and primary care support, the Hospital offers specialized adolescent medicine doctors who focus on the health of teens.
SUMMER 2022 HEALTHY KIDS MAGAZINE 11
a dollar,” he explains. “When you cook at home, you save money, and in return you’re eating healthier and spending more time with your kids.” Plus, kitchen time provides an opportunity to talk that might not be so common in your day-to-day life. Making Cooking Fun When you involve your kids in the kitchen, their ages and ability levels are important considerations. Young children can do simple tasks like stirring, rinsing produce and tearing lettuce. As they get older, they can read recipes, use their math skills to count and measure ingredients, and even use a knife. Zakaria, who has worked in professional kitchens for more than 25 years, offers these tips for fun and successful cooking endeavors. n Get kids involved from the beginning. For example, Zakaria brings his kids to the grocery store,
Involving kids in the kitchen helps them learn important skills and brings families closer together Ready, Set, Cook! H ow to ride a bike. How to swim. How to tie their shoes. As a parent, you’ve taught your kids many skills. Here’s one more to add to your lesson
where he lets them pick out the healthy foods they want to eat.
“Google some recipes and pick the ingredients together,” he suggests. n Choose colorful foods. Kids love color, and when you pick fresh fruits and vegetables that are in season, they can see the vibrant colors and taste the rich flavors. n Let them dress the part. Consider providing your cooking kiddos with an apron and chef’s hat. “That’s ownership for them; they feel proud to be in the kitchen with you.” n Make sure they aren’t just watching. This isn’t a demonstration. “If you want your kids to be in the kitchen, they have to be involved ,” he advises. n Keep it easy. Start with simple ingredients your kids recognize and easy-to-follow instructions. That will help hold their interest longer and allow their confidence to grow. Zakaria suggests involving your kids in the cleanup as well, but ultimately, the mess isn’t important. “At the end of the day, you’re spending time with them,” he says. “That’s the most important thing. They’ll remember that.”
new flavors, and research shows that eat - ing at home is healthier than eating out. “If you introduce your kids only to prepackaged meals and fast food, that’s all they will understand,” Zakaria says. “And once they fall into the trap of eating unhealthy foods, you risk them continuing to go down that path. If you start cooking with your kids at a young age, then you’re instilling in them that it’s possible to make great food at home.” As a father of four, he also believes it’s important to cook at home as much as possible for budgetary reasons. “For me it’s about teaching kids the value of
plan—cooking. It’s a skill you can start teaching at any age, and it can have a significant impact. Benefits of Cooking with Kids When you teach your kids the basics of cooking, you’re helping them grow into independent adults, says Mo Zakaria, executive chef at Rady Children’s. Plus, cooking is a chance to let them explore
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5 Healthy Foods for Your Grocery List NUTRITION
CREAMY COLESLAW with Tahini Dijon Dressing
MAKING HEALTHIER CHOICES for your family can be confusing when the most common diet advice we get is about what not to eat. Removing individual foods or entire food groups can leave you prone to missing out on major nutrients—and getting bored of your meals. Instead, let’s shift the focus toward what types of nourishing foods to add . By creating space for nutrient-dense foods, you’re more likely to fill up on these good- for-the-body foods while still enjoying the good-for-the-soul foods in smaller portions. This can be as simple as including a veggie- forward snack between meals, adding a dollop of natural peanut butter to pair with crackers or slicing up some tomatoes and cucumbers with an olive oil drizzle for a dinner side. Mitra Nowroozi , registered dietitian at Rady Children’s, offers this list of suggestions for your next grocery trip:
n Juice from 1 lime n 1/2 cup tahini n 1 tablespoon Dijon mustard n 1/3 cup water n 2 teaspoons apple cider vinegar n 2 teaspoons liquid sweetener, such as agave, maple or honey Salad: n 5 cups shredded green cabbage n 2 medium carrots, shredded n 1/2 medium leek (the white part), thinly sliced n 1/2 medium daikon radish, shredded n 1/2 cup roasted sunflower seeds INSTRUCTIONS 1. Blend all the dressing ingredients in a blender on high, stopping occasionally to scrape down the sides. Continue until creamy. If a blender is unavailable, simply whisk all the ingredients together in a bowl. 2. Toss all the salad ingredients and the dressing in a large bowl. Allow the salad to sit for at least 15 minutes for the cabbage to soften. Serve and enjoy!
Tahini Made from ground sesame seeds, tahini is packed with healthy polyunsaturated fats and is a good source of calcium. Use tahini for Mediterranean dips like hummus or baba ghanoush or blend it into a salad dressing for added creaminess.
Frozen salmon burgers Salmon is a good source of omega-3 fatty acids, which are beneficial for brain health. Having frozen salmon burgers on hand to quickly toss onto a barbecue makes for a quick and delicious meal. Don’t like salmon? Pick a frozen turkey or veggie burger instead, and remember to check the nutrition label for a lower-sodium option when possible.
Leeks This mild relative of the onion can be a great way to add a leafy green vegetable to stir-frys, quiches or homemade pizza. Thanks to their inulin content—a type of prebiotic—leeks help promote healthy gut bacteria.
Unsweetened sparkling water Given all of the flavor options available, sparkling water is a fantastic substitute for soda, which typically contains high amounts of added sugars. Combine sparkling water and sliced cucumbers or lemons with a splash of your favorite juice for a refreshing summer drink that cuts the overall added sugar to a fraction.
Canned beans: rotate varieties Having canned beans on hand is great for convenience, but ever find yourself reaching for the same can every week? While all beans are a fantastic source of protein and fiber, each kind has a unique set of nutrients, and changing up the variety provides us with a wider set of them. Next time, try cannellini, pinto or fava beans.
SUMMER 2022 HEALTHY KIDS MAGAZINE 13
Raising Socially Responsible Kids PARENTING A lifetime of philanthropy begins in childhood
“Parents with a family foundation or who are considering making a donation of any size can help their kids get into philanthropy by involving them in the process,” Loker says. “Let them know where the money is going and how it could help. Allow kids to ask questions and see their parents being smart about donating. Looking at a cause from a business perspective and becoming invested themselves are also great ways to foster a child’s entrepreneurial spirit.” It also helps for families to think big. For instance, Rady Children’s, a nonprofit hospital, serves 92% of San Diego kids and leverages philanthropy to plan special events, visits from special guests and outings for patients, many of whom stay for long periods of time and spend birthdays and holidays in hospital beds. Donating, volunteering or attending one of the Hospital’s community happenings can have a positive impact locally in a very real way, though fundraising is generally the most effective. Donors can direct funds toward areas such as research, mental health services, Child Life Services (see next page for more info) or purchasing toys for patients. “The fact that you can fundraise for the
t’s our job as parents to raise good humans. Social responsibility is a big concept, but it’s really not that complicated. It just means acting in a way that leaves a positive impact or benefits the greater good. That could be anything from championing causes you care about, cleaning up in the community or looking out for those less fortunate, to helping ensure that all San Diego kids have access to quality health care. And with your guidance, your little ones will be well on their way in no time. Alexandra Loker, vice president of philanthropy, corporate and community development at Rady Children’s, says starting early is key to inspiring the next generation of do-gooders, who make giving back a lifelong ambition and inspire others to do the same.
“Expose children to different types of causes and encourage them to set aside a portion of their allowance or gift money to donate—or let them come up with their own way to help,” she says. Letting children come up with their own ideas about how to make a difference
whole at Rady Children’s or a specific area that you care about gives families a great deal of ability to make an impact where they want,” Loker says.
will prepare them long-term toward developing a business sense and social responsibility, short-term toward seeing an immediate positive in what they’re doing.
Special Support at the Bedside Child life specialists are a critical part of the care team at Rady Children’s
A HOSPITAL STAY OR AN OPERATION can be scary, especially for a kid. But having a compassionate, caring and knowledgeable ally by their side can go a long way toward easing little minds. Rady Children’s has a special kind of employee, called a “child life specialist,” who helps patients and their families understand exactly how a procedure will go, provides emotional support and helps bolster coping skills. Child life specialists work throughout the Hospital, including in the intensive care units, Emergency Department, surgical units, and the Peckham Center for Cancer & Blood Disorders. Lead Child Life Specialist Taylor Keightley has spent much of her seven years at Rady Children’s helping young patients prepare for surgical procedures—ranging from the simple, such as inserting ear tubes, to the most complex cardiac cases, craniotomies or spinal surgeries. She explains the surgery beforehand in a developmentally appropriate way, using a tablet to show and explain the sequence of events and sensory information of the surgery process. This promotes familiarization, mastery, control and understanding. Keightley also helps lessen kids’ anxiety about anesthesia masks by making them fun—with stickers, other decorations or even bubbles. “One thing I like to do with the mask is dip it in bubble solution on the outside; that way, when they breathe
through the mask, they blow bubbles,” she says. “That really would help them do those big, deep breaths. It was just a fun little way for them to feel like they have more power and control over the situation.” Sometimes when a child is especially anxious, Keightley accompanies them back to the operating room and plays games or watches cartoons with them until the anesthesia kicks in. “I love doing what I do because I get to see kids overcome their biggest fears and their stressors,” she says. “Giving them the tools to do it and then see them overcome it is the most rewarding thing to me.” Child life specialists also plan special events to put a smile on patients’ faces. Though the pandemic has affected the programming, they still plan discharge parades for kids who’ve been in the Hospital long-term, visits from special guests, bonding activities, holiday giveaways, and more. And like everything the child life specialists do, it’s funded by philanthropy. “We wear many hats—a lot of different professions do, but our job is very encompassing,” says Keightley. “Every situation, every day is different, and that is something I’ve always loved about the job. You never know what you’re about to walk into. We want to take any stress that we can off that child and also their families, because it’s really stressful as a parent to have a sick child.”
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Rady Children’s ranks among the nation’s best hospitals for pediatric organ transplants
B Y CHRISTINA ORLOVSKY
16 HEALTHY KIDS MAGAZINE SUMMER 2022
Nineteen hundred. That’s the number of children on the national organ transplant waiting list. More than 500 of them are between 1 and 5 years old . The need is great, but so is the effort of the multi-organ transplant team at Rady Children’s, which has been recognized as one of the nation’s best hospitals for pediatric organ transplants.
The Rady Children’s Heart Transplant Center Under the direction of John Nigro, MD, cardiothoracic and heart transplant surgeon, chief of cardiac surgery, director of cardiac transplantation and the mechanical assist program, and director of Rady Children’s Heart Institute, the Rady Children’s Heart Transplant Center is a leading referral center for all of Southern California, as well as parts of Arizona, Hawaii and the South Pacific. The Hospital has developed a program that can provide heart transplants for every patient with congenital heart disease, from infancy through adulthood, under the care of a multidisciplinary team that consists of Dr. Nigro and a transplant cardiologist, transplant nurse or nurse practitioner, pharmacist, social worker, financial coordinator, dietitian, child life specialist, pathologist, physical therapist, occupational therapist, psychiatrist, psychologist and spiritual care worker. With incidence of pediatric heart failure on the rise, there’s never been a greater need for the work this team is doing to save the lives of children with serious heart disease. “We’re seeing an increase in serious heart failure in children, resulting in more patients being candidates to benefit from heart transplant or advanced heart therapy, like left ventricular assist devices, or LVAD,” explains Dr. Nigro. “The number of patients at risk has increased, and at the same time, the technology has advanced to help stabilize their condition and get them
to transplant. Additionally, there’s been an increased recognition about the benefits of transplant—especially for children. Now we have more substantial data that show that pediatric patients can appreciate long-term survival after transplant, which is a little different from the adult world. Some patients have been able to survive for decades, while being able to do all normal activity.” While Dr. Nigro explains that these are heart trends that exist nationally, the growth of the Rady Children’s Heart Transplant Center locally is due to increased recognition of these factors and increased effort to create a world-class program to help pediatric patients in critical need. “We have recognized all those factors and tried to aggressively understand and interpret these trends in the context of our patients,” he says. “We’ve been actively working to provide access to more heart transplantation. “We’ve expanded our team of transplant surgeons, our overall program and our collaborative relationship with UC San Diego. We’ve expanded criteria and donor selection so our patients will get transplanted sooner and not languish on the list. We’ve been innovative in the technical aspects of the surgery and the way we use mechanical support, like extracorporeal membrane oxygenation and LVAD. And we’ve made changes internally to identify patients early on and start following them closely. Finally, we have a very advanced patient transport program. All these things have allowed us to have a broader referral network and increase the number of patients we’ve seen.”
JOHN NIGRO, MD Cardiothoracic and Heart Transplant Surgeon, Chief of Cardiac Surgery, and Director of Cardiac Transplantation
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collaboration and teamwork she’s proud exists at Rady Children’s. “We are proud of the multiple organ system transplantations we’re able to do at Rady Children’s,” she says. “We can do hearts and kidneys, and we’re getting our liver program up and running. If kids need a single organ, it’s here for them. Now, if they need more than one, it’s also here—all thanks to the ability of our teams to work together. This takes precise management and excellent communication to pull off—and we have that at Rady Children’s.” Looking to the Future Excellence in management and communication is evidenced by a milestone achieved earlier this year: Rady Children’s first dual organ transplant. Surgeons saved the life of 13-year-old Nehemiah “Nemo” Maldonado by performing heart and kidney transplants over two consecutive days (see the story on page 24). Both Dr. Ingulli and Dr. Nigro are optimistic that the success of these surgeries will lead to more happy outcomes for young transplant patients in the future. “This gives us lots of options,” Dr. Ingulli says. “Before, there were kids we maybe couldn’t accept for transplantation: They couldn’t survive with just a new heart—they needed a heart and a kidney, and we couldn’t do it. Now that we can, it opens up the possibility of us providing lifesaving surgery to more kids. This really shook us up and tested our thinking. That makes us better physicians. It makes us a better kidney program and a better heart program.” Dr. Nigro agrees: “What does this imply for us? Number one, it shows that we’ve demonstrated the ability to do combined transplantation, which may be necessary for more kids in the future. The most important thing is that through our transplant program, we’ve been able to take care of patients who are very ill, get them through surgery and get them home.”
The Rady Children’s Kidney Transplant Program
In addition to its comprehensive heart transplant program, Rady Children’s is also a leading destination for kidney transplants. In 2001, UC San Diego brought its established pediatric abdominal transplant program to Rady Children’s to help provide patients with specialized pediatric services. Since that time, the team at Rady Children’s has performed more than 100 kidney transplants and maintained outcomes well above the national average. The Kidney Transplant Program is part of the Division of Nephrology, which provides comprehensive care to all patients with kidney disease, ranging from general kidney problems to dialysis and transplant. The division is routinely recognized as one of the best in the country by U.S. News & World Report. Under the direction of Elizabeth Ingulli, MD, a pediatric kidney transplant specialist, the program has seen exceptional growth. In the first four months of 2022 alone, the team performed eight transplants—a number that Dr. Ingulli says demonstrates the “exploding” need for transplantation. “While there is some backlog from COVID, the main factor for this growth is that there’s more illness, more severity of illness and more kids surviving with a level of kidney function,” she explains. “There are more children born with some level of kidney function who still need a new organ sooner rather than later. Treatments have allowed for survival of illnesses that haven’t been survivable before. There’s more and more need from that point of view. Our growth is related to these factors, plus the fact that other centers are seeing our success, so our referrals have increased and so has our need for donor organs.” This is a trend Dr. Ingulli expects to continue—and a need she and her team aim to fulfill, thanks to the
ELIZABETH INGULLI, MD Pediatric Kidney Transplant Specialist
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Philanthropy Matters To be successful, the transplant program requires both the donation of organs as well as the generosity of philanthropic donors who earmark funds for it. Monetary donations support critical research that allows Rady Children’s to stay on the forefront of advancements in transplant medicine. Contact Rady Children’s Hospital Foundation at radyfoundation.org for more information.
The Ultimate Gift
There is no greater gift than the gift of life—and it can be given through organ donation. The process differs for different organs, and the need is great for people to become donors, either while living (for kidneys) or upon death. Dr. Ingulli explains that living donors, either relatives or altruistic strangers, are preferable for kidney transplants, as they often result in a better outcome. “With a living donor, the organ survives a little longer,” she says. “You have to be a very healthy person to be able to donate a kidney. Those super-healthy kidneys are going to last longer than the ones that have been through trauma. We would always opt for that for kids, because we’re looking for them to last for decades and decades. I’m always looking for the best donor option for these kids’ organs to be healthy for a long, long time.” Known donors can be relatives—a sibling, parent or other living family—or non-relatives, such as a spouse, in-law or friend. Altruistic donors are strangers who simply want to give of themselves to save someone’s life. The main requirement to begin the process is blood compatibility. Once the donor goes through tests to ensure they’re in optimal health, the transplant can take place. The average kidney transplant takes three hours and is most often done laparoscopically to minimize pain and recovery time. In most cases, the donor spends between two and five days in the hospital and is then on limited activity for approximately six weeks. For hearts, the process is quite different, since the organ must
come from a deceased donor of relatively the same age and size as the recipient. A child in need of a new heart is placed on a national transplant list through the United Network for Organ Sharing, which matches donor organs to adults and children awaiting transplantation in the United States. How soon the child receives a donor heart is based on a number of factors, including medical urgency, blood type, the size of their own heart and their time on the wait list. Once a suitable donor heart can be provided, a team that includes a pediatric heart surgeon from Rady Children’s travels to the donor hospital to retrieve it. The heart is carefully transported back to Rady Children’s for the transplant surgery and the surgeon places the child on a heart-lung machine that pumps and oxygenates their blood for the duration of the procedure. The child’s heart is removed, and the new donor heart is sutured into place. For children who haven’t previously had open-heart surgery, the operation typically takes six to eight hours. Either living or deceased, donors and their families truly save lives and ensure their organs live on in a child in need, which is why Dr. Nigro and the transplant team are constant advocates for organ donation. Dr. Nigro says: “We encourage people to consider donation. While it’s a time of great sorrow and grief, it can also result in an amazing impact on the patient as well as the entire community. When you look at it, there’s a whole community affected by a child. This is what we hope people will keep in mind when considering organ donation.”
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B Y SARAH SAPEDA
Kidney donation created an unbreakable bond between these San Diego siblings
A household accident that landed Cesar Zuniga in the hospital in 2019 likely saved his life. A routine blood test run during assessment of an elbow injury indicated that the 20-year-old’s immune system had been attacking his kidneys to the point they were failing. He’d been feeling more tired than usual, but in the absence of any extreme symptoms, he thought nothing of it. Cesar had no way of knowing he was about to embark on a life-changing journey.
free diet and no more than two bottles of water per day. He also needed nightly eight-hour-long dialysis sessions, meaning he was largely immobilized for a third of the day. “My family would watch movies in the living room, and I wouldn’t be able to go unless I was connected in the living room. But if I was connected in the living room, I would have to sleep there,” he says.
“The way I found out was pretty funny,” he says. “Running down the hall here at my house, I actually hit my elbow on the light switch and it got swollen. I went to the ER and they drew blood and that’s when they told me my kidneys weren’t working.” Cesar was diagnosed with acute renal failure. He was blindsided. As the news sunk in, confusion turned to fear. The next several months were filled with doctor’s appointments, a special salt-
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