P L U S S A F E T R AV E L T I P S , S U M M E R R E A D I N G P I C K S , T E E N T R O U B L E S A N D M O R E
SUMMER 2021
T H E BIG SHOTS R A DY C H I L D R E N ' S H AS B E E N A K E Y P L AY E R I N T H E F I G H T AGA I N S T C OV I D - 1 9 F R O M T H E S TA R T
A PUBLICATION BY
CREATE THE FUTURE SHE DESERVES
Your investment in future generations will see us through unimaginable discoveries, cures, vaccines and prevention. Join our efforts and name Rady Children’s as a beneficiary of your IRA or other retirement account. It is simple, tax smart and makes a lasting impact on childhood health. 1. Download the beneficiary designation form from your IRA provider’s website 2. Choose a percentage of the account you wish to gift to Rady Children’s 3. Sign and return the form to your administrator 4. Without having to part with your money today, you know that you are making a gift larger than you thought possible
To learn about additional ways to make a gift through your will, trust or estate plan, visit giftplanning.radyfoundation.org or call 858-966-5804
Thank you for investing in Rady Children’s and helping the children of tomorrow.
On the Road to Recovery
THANKS TO OUR CARING NETWORK!
W
ell, San Diego, we’re doing it. We’re starting to return to life as we knew it before COVID-19. Our local vaccination rates are excellent, with nearly 70 percent of County residents inoculated with at least one dose at the time I’m writing this to you. I continue to be immensely proud of Rady Children’s role in this progress, with active participation in research initiatives to bring solutions to pediatric patients and the administration of more
@radychi ldrens Audiologists Keri Colio, Julie Strickland, Janina Woodman, Kristen Baisley and Julie Purdy test out new masks that allow patients who are deaf or hard of hearing to read their lips.
than 100,000 vaccine doses representing just a few of many highlights. I am also proud of how our community continues to come together to support one another. Even through one of the toughest years we’ve collectively lived through, your compassion and generosity was stronger than ever, and Rady Children’s reached one of our most successful fundraising years on record in terms of amount raised, number of gifts and number of donors. We also launched “Tell Them Yes,” our first-ever advertised fundraising campaign, which was an amazing part of a less-than-typical holiday season. Thank you for being a part of that, and I look forward to the opportunity to outdo ourselves once again in the coming months and years. One such opportunity lies in the mental health of the region’s children and teens. Although the influences of COVID-19 on daily life are beginning to fade, its effects on mental and emotional well-being sadly linger. During the pandemic, local psychiatric distress calls to 911 increased significantly for this age group, and our Hospital’s Emergency Department saw an average of 400 such admissions each month—up from just 40 in 2010. Rady Children’s has worked with our community and partners to enhance our capacity to offer an array of psychiatric and psychological care options, through efforts including the incredible Copley Psychiatric Emergency Department and our initiative to train primary care physicians to screen and ensure continued care for arising mental health conditions in their patients. But we’re ready to do even more. We’re collaborating with the County to develop a state-of-the-art mental health facility adjacent to our main campus, with services ranging from acute emergent care to outpatient therapy. We’re also working on exciting projects in research, in continued staff training and in ensuring every local child, no matter where they live, has access to excellent mental health care and the ability to live to their highest potential. It brings me great joy to see how far we’ve come together, and great excitement for what’s to come.
@radychi ldrens A teen rolls up his sleeve for a nurse at the Rady Children’s vaccine clinic. He says it didn’t hurt at all!
STEPHEN JENNINGS Chief External Affairs Officer and Senior Vice President, Rady Children’s Hospital; Executive Director, Rady Children’s Hospital Foundation
@radychi ldrens Awesome occupational therapists like the trio seen here help kids work on their balance, coordination and confidence.
SUMMER 2021 HEALTHY KIDS MAGAZINE 1
3020 Children’s Way San Diego, CA 92123 858-576-1700 RCHSD.org
PEDIATRIC URGENT CARE SERVICES Many urgent health care needs occur after-hours, when your child’s primary care provider may not be available. Turn to Rady Children’s pediatric urgent care services with extended hours and locations across San Diego County.
Stephen Jennings Chief External Affairs Officer and Senior Vice President, Rady Children’s Hospital and Executive Director, Rady Children’s Hospital Foundation
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
Assistant Chief Strategy/Marketing Officer Traci Stuart, MBA Vice President, Human Resources Cathy Nugent Vice President and Chief Information Officer Albert Oriol Vice President, Government Affairs Barbara Ryan Vice President and General Counsel Angela Vieira Vice President, Operations Chris Abe, RN, CIC, HEM Vice President, Strategic and Organizational Planning Meredith Lurie, MPH Chair, Rady Children’s Hospital Board of Trustees Doug Hutcheson Chair, Rady Children’s Hospital Foundation Board of Trustees Bridgett Brown 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 a 505-bed pediatric care facility providing the largest source of comprehen- sive pediatric medical services in San Diego, southern Riverside and Imperial counties. Rady Children’s is the only hospital 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 rchsd.org. Healthy Kids magazine includes third-party content, advertising and/or website hyperlinks fromoutside busi - nesses 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 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.
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SUMMER
HEALTHY HABITS Summer safety, travel tips, help for parents of picky eaters and tips to get through the tough teen years 05 VAX TO THE MAX How Rady Children’s has been on the front lines of San Diego’s vaccination efforts since day one 16 care can be difficult, but telemedicine lets patients connect with their doctors closer to home 22 THE DOCTOR WILL SEE YOU NOW Commuting for medical
INSIDE RADY CHILDREN’S
HIGH-TECH CARE COMING SOON Once completed, the Dickinson Image-Guided 27
Intervention Center will provide leading-edge cardiac care for kids
31
AWARDS OF EXCELLENCE Recognizing staff, volunteers and physicians who’ve gone above and beyond for their patients, coworkers and community PAY IT FORWARD San Diego gamers show off their skills to raise money to help ill and injured kids 32
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Join the Rady Children’s Hospital Auxiliary
- Join an existing Unit, or form a new Unit - Attend an Auxiliary event
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 19 units actively advocate for the health and well-being of children, increasing community awareness of Rady Children’s and fundraising. To learn more about joining the Auxiliary or how to get involved, visit radyfoundation.org/auxiliary.
- Raise awareness of the Auxiliary on social media In addition to making a difference in the community and forming friendships, members of the Auxiliary enjoy the following: - Monthly education seminars hosted by Rady Children’s clinicians - Opportunities to donate in-kind items to the Emergency Department, Chadwick Center, and Alexa’s PLAYC - Hospital decorating - Subscription to the Auxiliary newsletter, Chaux Talk
HEALTHY HABITS
Silver Linings
As we dip our toes into the waters of normalcy, we’re faced with the possibility that summers won’t ever be exactly the same. But that ’s not necessarily a bad thing. We’re moving forward with our eyes open and focused on health—both physical and mental. In this issue of Healthy Kids , you’ ll find tips to stay safe outdoors, summer reading picks and advice to get through those tough teen years. There’s also help for parents of picky eaters, a protein-packed pancake recipe and more. Let ’s dive into summer fun, together.
HEALTHY HABITS
Saturday of each month, Rady Children’s child passenger safety technicians are available to inspect, educate and ensure correct installation and safe fit for your child. For more information or to schedule an appointment, visit driventosafety.org . Children must remain in a rear-facing car seat until they’re at least two years old, but best practice is to keep children rear-facing until they reach the maximum weight and height of the car seat. Avoid the temptation to move your kid to a seatbelt too early. Children are required to use a booster seat until age 8, however, they must be able to sit back in the seat with their feet touching the ground and the seatbelt across their chest and hips. On the road, the same safety rules you’ve been following at home apply: Practice good hand hygiene, wear a mask when you’re outside your vehicle, and bring your own food and drinks to cut down on possible exposure. If you have to stop at a restaurant, dine outside if possible. In the Air Being in close quarters with people outside your household is unavoidable on an airplane. Wipe down high-touch surfaces like tray tables and armrests, use hand sanitizer, and wear a mask. Medina advises choosing a direct flight when possible, to help limit the number of people you’re exposed to. And although it’s an added cost, Lynn recommends booking an extra seat if you’re flying with an infant or toddler, to accommodate their carrier or convertible/ combination seat. “If you put them in their own seat that they’re used to, they often just fall asleep and are much more comfortable,” she says. It also protects against accidental falls during turbulence or rough landings. Find out the current COVID-19 case rate and test positivity percentage at your prospective destination so you can make an INFORMED DECISION
VACAT I ON
Safe Travels Keep health and safety in mind while away from home
N
ow that summer travel possibilities are starting to open up again, families are planning vacations to make up for lost time. Whether you
departments, the Centers for Disease Control and Prevention, and Johns Hopkins University’s online Coronavirus Resource Center are great resources for up-to-date information. Also, it’s imperative that you stay home if you, your child or someone else in your party becomes ill beforehand. “People never want to cancel a trip, but if someone isn’t feeling well, it’s best to stay home and avoid having contact with other people who might be at higher risk,” Medina says. On the Road If you’re planning a road trip with your little ones, car seat safety is key. Lorrie Lynn, manager of Injury Prevention Programs at Rady Children’s Center for Healthier Communities, says that about 70 percent of car seats are installed incorrectly. On the first and third
have a road trip or a destination getaway in mind, “it is really important that people continue to take all the same precautions that we’ve been doing up until this point,” says Megan Medina, RN, an infection preventionist at Rady Children’s. Before You Go First of all, if you can get vaccinated, do so before traveling. Find out the current COVID-19 case rate and test positivity percentage at your prospective destination so you can make an informed decision. Look for areas with lower rates, and if you choose an area where rates are high, prepare to be extra-vigilant. Local health
6 HEALTHY KIDS MAGAZINE SUMMER 2021
READ I NG Book Smart Engage your budding bibliophile with these fun, educational picks
The Girl Who Thought in Pictures (Amazing Scientist series) by Julia Finley Mosca and Daniel Rieley The Proudest Blue by Ibtihaj Muhammad Explore Nature and Science We Are Water Protectors by Carole Lindstrom and Michaela Goade The Hike by Alison Farrell Bones by Steve Jenkins Creature Features by Steve Jenkins and Robin Page National Geographic Kids (series) Build Social-Emotional Skills Grumpy Monkey by Suzanne Lang and Max Lang A Thousand No’s by DJ Corchin and Dan Dougherty Jabari Tries by Gaia Cornwall The Rabbit Listened by Cori Doerrfeld The Couch Potato (series) by Jory John and Pete Oswald
WHAT BETTER WAY TO SPEND THE SUMMER than with your head in the clouds and your nose in a book? Take a break from all the screen time with these picks from Nora Camacho, a behavior specialist from Rady Children’s Alexa’s Playful Learning Academy for Young Children (PLAYC), that encourage kids to use their imagination, ponder different perspectives and most of all, have fun. “This is a great time to reignite our children’s interest in reading,” she says. “It is so important that we encourage young learners to spend time interacting with books: reading on their own, exploring illustrations, telling themselves the stories from memory and being read to. So much amazing learning can occur from simply opening a book. Sometimes one sentence or illustration can spark a child’s interest in an idea that results in hours of exploration.”
Use Your Imagination If I Built a … (series) by Chris Van Dusen Imagine! by Raúl Colón Parker Looks Up by Parker Curry Yayoi Kusama Covered Everything in Dots and Wasn’t Sorry . by Fausto Gilberti Understand Diversity and Inclusion Julián Is a Mermaid by Jessica Love Eyes That Kiss in the Corners by Joanna Ho and Dung Ho Laxmi’s Mooch by Shelly Anand Sulwe by Lupita Nyong’o
HEALTHY HABITS
OUTDOORS Stay Safe This Summer
REMEMBER THE RATTLESNAKE RULES Of all the common critters you’d expect to see while spending time outside, few are as frightening as the rattlesnake. Venomous rattlers can be found just about everywhere in San Diego. These slithery serpents do wonders for the environment by controlling rodent populations, but they ’re a hazard to hikers and other outdoor enthusiasts. Protect your family members (both two- and four-legged) with these tips from the county Department of Animal Services. You’ll often hear a rattlesnake before you see it, but not always. Not that you’d want to get that close, but rattlesnakes are also distinguishable by their wide, triangle-shaped head and thinner neck. Non-venomous snakes’ heads are about the same width as their bodies. Many species of rattlesnake also have diamond, chevron or blotchy markings on their backs or sides. Rattlesnakes are cold-blooded and like to sun themselves in mild weather. During the hottest parts of the day, they ’ ll be hiding out underground, under rocks, in the brush or in the shade. Stay on marked trails and avoid tall grass, weeds and brush where snakes may be hiding, and check for snakes before picking up rocks or wood. Don’t startle a snake. If you hear one, stand still until you’ve spotted it, then walk away slowly. If the rattler gets spooked, it will strike. Wear protective hiking boots and consider carrying a walking stick. A rattlesnake could go for the stick instead of you, your child or your pet.
Tips to avoid preventable summer accidents, heat illness and more
WHEN IT COMES TO SPENDING TIME IN THE GREAT OUTDOORS, the benefits are many. According to the American Academy of Pediatrics, kids and teens who regularly enjoy nature are less stressed, have better impulse control, are more engaged in learning and are physically healthier. With beaches, bays and mountains all within a short drive, San Diego kids have an abundance of options for outdoor recreation. However, none of them come without risks. “We’re pretty well aware of social distancing, but we forget that there are other things we have to do to avoid injuries,” says Lorrie Lynn, manager of Injury Prevention Programs at Rady Children’s Center for Healthier Communities. Water safety is among the biggest concerns, since the county’s 70 miles of coastline consistently draw visitors all summer long. When at the beach, be sure to always swim near a lifeguard station and assign an adult to watch the children at all times. Also, enter the water with
8 HEALTHY KIDS MAGAZINE SUMMER 2021
Pests and Plants More bummers to watch out for this summer
the children, as currents can be unpredictable. Children who are not strong swimmers should wear a Coast Guard–approved life jacket until
they are able to do the following on their own: Jump into the water and return to the surface
Tread water and/or float Locate the exit in a pool Swim at least 25 yards to safety Get out of the water safely
It may be surprising to learn that most drownings occur in pools. Continue designating an adult to be the “water watcher” even after children have mastered the water competencies listed above. Also, smaller kids and those who aren’t good swimmers should wear a life jacket in the pool. “Water watchers, water competency and life jackets will reduce the risks and increase the fun around water,” Lynn says. For adventuring on dry land, appropriate and properly fit helmets can help prevent serious injury. Helmets should be worn on bikes, scooters and skateboards—it’s against the law for riders under 18 to go without—and all-terrain vehicles, which are popular in mountainous areas. In 2020, Rady Children’s saw 102 ATV-related trauma cases— more than in the three years prior combined—and more than 40 percent of those patients weren’t wearing helmets. Kids are most likely to develop a good helmet habit if they see the adults in their family wearing them, too. If hiking is your summer activity of choice, make sure your child has well-fitting shoes appropriate for the trail conditions, and don’t overestimate their hiking ability. Avoid planning outdoor activities during the hottest part of the day, from noon to 4 p.m.; dress kids in light-colored, lightweight clothing; and make sure they’re drinking plenty of water. And in any situation that puts kids at risk for injury, a well-stocked first aid kit and a charged cell phone are essential.
FIGHT THE BITE While you’re enjoying summer barbecues and picnics, ticks, mosquitoes and other creepy-crawlies lurk in the background, ready to ruin a good time. The Centers for Disease Control and Prevention has a few tips to prevent pest bites and stings. Don’t let mosquitoes make a meal out of your family. Dress kids in clothing that covers their arms and legs and cover car seats and strollers with mosquito netting. Use a chemical insect repellent (DEET and picaridin are considered safe for kids over two months) or try a natural remedy like lemon eucalyptus oil. Also, clear your yard of standing water weekly. If your kids get bit, wash the area with soap and water, apply an ice pack for 10 minutes, then slather the bite with an over-the-counter anti-itch cream. Ticks can ruin a hike. Wear long pants and high socks while walking in brushy or wooded areas and while camping or gardening. Protect your kids with permethrin- treated clothing and gear (do not apply directly to skin). After spending time outdoors, check your and your kids’ clothes, bodies and gear, and shower within two hours. If you find a tick, remove it carefully with tweezers. If a fever or rash develops in the next few weeks, consult a physician. Bees , wasps and hornets are known to frequent areas with flowers and where sweet food and drinks are present. If a single one is nearby, stay calm and it will likely leave you alone. If you encounter a swarm or hive, run. If you or your child gets stung and the stinger remains in the skin, scrape with a fingernail or credit card to remove it (do not use tweezers, which may squeeze more venom into the wound). Then wash the area with soap and water, and apply ice. Watch for signs of an allergic reaction. LEAVES OF THREE, LET IT BE San Diego County is crawling with poison ivy, oak and sumac. An oil called urushiol, found in the leaves of this terrible trio, causes an itchy and sometimes painful rash that lingers for up to three days. Know what to look for and spare your kids (and yourself) the misery. You can spot poison ivy by its distinctive arrangement of three leaflets, with one in the center and one on either side. The shine on the leaves is also a giveaway. Poison oak leaves also come in threes, but are bigger and have toothed edges like an oak tree leaf. It can grow as a shrub or climbing vine. The leaves on a poison sumac shrub each have seven to 13 smooth leaflets and reddish stems.
SUMMER 2021 HEALTHY KIDS MAGAZINE 9
HEALTHY HABITS
REC I PE Cottage Cheese Pancakes Start the day on a healthy note with these protein-packed pancakes DIRECTIONS
1. Place the eggs, cottage cheese, vanilla extract and honey in a bowl and whisk. 2. In a separate bowl, whisk together the flour, baking powder and salt. 3. Add the dry mixture to the wet mixture and stir until just combined. 4. Heat a large sauté pan or griddle over medium heat, lightly coat with cooking spray and pour in about 1 tablespoon of batter for each pancake. 5. Cook for about 2 minutes, or until bubbles rise to the surface of the pancake and begin to pop. Flip and cook the other side until set and golden brown. 6. Repeat with the remaining batter.
MAKES 10 PANCAKES
INGREDIENTS 3 eggs 1 cup cottage cheese 1 teaspoon vanilla extract 2 tablespoons honey 1/2 cup flour 1 teaspoon baking powder 1/4 teaspoon salt Cooking spray (can substitute for butter or oil)
Recipe courtesy of Rady Children’s Center for Healthier Communities. Find more kid-friendly recipes at rchsd.org.
FOOD F I GHT
Six Tips for Parents of Picky Eaters
Encourage kids to explore food. Let them investigate: poke it, cut it open and so on. The goal is to become more comfortable with a food so the next time they encounter it, it won’t be as scary. Limit distractions. Toys, TVs and tablets take kids’ attention away from the meal and the people they’re sharing it with. Get kids involved in the kitchen. Give them age-appropriate tasks to help prepare a meal, such as stirring batter, cracking eggs or snapping off the ends of green beans. Kids can learn about foods and how they change in the cooking process without the pressure of having to eat them. Kids can be involved in growing or buying food, too. It’s a great way to make them feel like they have a little bit of control over the situation. No tricks. It’s okay if a child doesn't always know every ingredient in a dish, but if you intentionally sneak something unfavorable in and they find out, their trust will decrease. Adding chopped-up broccoli to spaghetti sauce won’t get them any closer to eating plain broccoli.
Master these skills to minimize dinner table tantrums
D
ealing with picky eaters can be tricky. On the one hand, parents know kids can’t survive on chicken nuggets forever,
new over and over again before they're going to feel comfortable.” Bhattacharjee has a few tips to help curb food frustrations. Change the way you talk about food. If a child hears he or she “doesn’t eat that” enough times, it tends to stick. Try “we’re working on this food” instead. The same goes for referring to certain foods as “kid foods.”
but on the other, you don’t want to risk the whining that often comes with laying down the law about foods kids have labeled “gross.” It’s true that some kids are just naturally picky due to heightened sensitivities, but there are a few things parents can do to encourage kids to branch out and become a little more adventurous. “Kids should never be forced to ‘just take a bite,’” says Emily Bhattacharjee, a clinical dietitian at Rady Children’s. “There are steps that we all go through; some of us can go through all of the steps really quickly, and some people have to be exposed to something
Eat together as a family. Mealtime is an opportunity for
parents to set a good example. Offer kids smaller portions of the healthy foods you’re eating. A good rule of thumb is to fill three-quarters of your child’s plate with what they like to eat and the other 25 percent with what the rest of the family is eating.
SUMMER 2021 HEALTHY KIDS MAGAZINE 11
HEALTHY HABITS
So what can parents do now to help get their kids back on track? With some families still feeling the socioeconomic impact of the pandemic, the usual summer activities may not be as feasible. However, kids do have opportunities to increase socialization and decrease isolation outside of school. Younger kids and those with ADHD or other developmental conditions may benefit from structured camps, classes or day programs, such as those at the Fleet Science Center and YMCA, or at organized private outings for small groups. “There are certainly children that have fallen behind enough that summer school is a really important option, but there are also experiential learning opportunities,” says Kristin Gist, advisor in Developmental Services and Transforming Mental Health at Rady Children’s. She believes we ought to focus less exclusively on remediating the areas where children are falling behind, in favor of identifying the subjects they enjoy and spending the summer working on their strengths. “That gives them more power to feel confident going back to school.” Older kids who tuned out during their distance-learning days may need to refocus on their academic goals, which requires some stress management and reassurance on the parents’ part. “High school kids are going to have the most pressure on them to catch up, because the academics are not as forgiving as they are in the primary grades,” Mueller says. Student athletes may also feel behind, because most sports saw their season schedule postponed or canceled during the pandemic. Gist says that parents usually encourage their child’s interest in sports to keep them active and social, but “they didn’t have an opportunity for a year, so they’ve fallen more behind.” Another way parents can set kids up for success as summer transitions to fall is to stay positive in the face of uncertainty. Warning them that the first year back after the pandemic may be tougher, though true, does nothing for their confidence. A more positive spin could include assurances that they’ll have time to catch up, and that it’ll get easier the more they keep at it. “Those are two different ways to say the exact same thing,” Mueller says, “and how a child hears that is going to be how they perceive coping in the months ahead.” Summer will be an anxious time for kids if they don’t have a positive, healthy outlook on the academic year to come.
EDUCAT I ON
Looking Ahead Summer is here, but the start of the school year is just around the corner
EE
very summer, kids get a couple months’ reprieve from the stresses of schoolwork. But between distance learning, COVID-19 rules and restrictions, and the uncertainty
KIDS DO HAVE OPPORTUNITIES TO INCREASE SOCIALIZATION AND DECREASE
that still remains during this particular summer, many parents are left wondering what comes next. Research shows that when kids have longer breaks from school, some of the knowledge they’d gained to that point is lost. Time will tell what that will look like after a year when students weren’t getting the in-person support, structure and supervision they were used to. “Summer typically brings excitement for wrapping up the school year and anticipation of summer plans with family, friends and activities out in the community,” says Sandy Mueller, senior director of Behavioral Health Services at Rady Children’s. “I think what we’re concerned about is what that looks like for this summer, and what kids and families anticipate moving into the fall. Summer months, which are normally a carefree time, have this sort of storm brewing.”
ISOLATION OUTSIDE OF SCHOOL
12 HEALTHY KIDS MAGAZINE SUMMER 2021
I N-DEPTH The Brain-Diet Connection How food can be used to control epilepsy in children
off the diet after several years. He is now considered cured, and his family created the Charlie Foundation for Ketogenic Therapies to promote awareness, training and research. Rady Children’s has had its own share of success stories like this. One is Hilary Hansen. At age 5, Hilary began having up to 40 seizures a day that couldn’t be quieted by medications. Her neurologist and dietitian at Rady Children’s put her on a ketogenic diet. It took a lot of adjusting—Hilary’s mother had to carefully measure everything she ate and keep her from childhood celebrations for fear she’d consume sugar—but the results were undeniable. After just three weeks, the seizures stopped. At Rady Children’s Comprehensive Epilepsy Center, patients throughout Southern California with treatment-resistant epilepsy have access to the highest level of medical and surgical care. The excellence in care delivered also benefits from clinical and laboratory research that the team conducts. Rady Children’s pediatric epileptologists, neurosurgeons, neuroradiologists, neurodiagnostic technologists, nurses and neuropsychologists work closely with families to design individual treatment plans for each patient. As an addition or alternative to medications and various forms of the ketogenic diet, specialists may also employ
SINCE THE DAYS OF HIPPOCRATES, physicians have known that what we eat greatly impacts our overall health. Now, doctors like Jong M. Rho, MD, division chief of neurology at Rady Children’s and a professor of neurosciences and pediatrics at UC San Diego School of Medicine, are working to understand how certain eating patterns can help manage and, in some cases, even cure diseases and disorders in children, like epilepsy. “Every time you eat or drink, you’re either feeding disease or fighting it,” he says. Dr. Rho has been building on research showing that the low-carb, high-fat ketogenic diet can prevent seizures in patients with forms of epilepsy that don’t respond well to medications. The ketogenic diet was developed around a century ago, after doctors observed that fasting helped control seizures in patients with epilepsy. Medical scientists discovered that a ketogenic diet could mimic fasting without necessarily depriving a patient of calories, which is a crucial consideration for infants and children. Dr. Rho says the research shows that, worldwide, around 60 to 70 percent of patients for whom epilepsy medication had proven ineffective responded significantly better to a ketogenic diet—and a third of them actually became seizure-free. The most publicized case is that of Charlie Abrahams, son of Airplane! director Jim Abrahams. At less than a year old, Charlie was diagnosed with a severe form of epilepsy that did not improve with medication or even after brain surgery. The ketogenic diet was eventually prescribed and within a few days of starting, the toddler became seizure-free. He never had another seizure and was transitioned
investigational drugs, brain and nerve stimulation, special implanted devices to block seizure activity, or minimally invasive thermal laser ablation.
To learn more about epilepsy treatment at Rady Children’s, visit rchsd.org.
HEALTHY HABITS
GROWI NG UP Teen Talk Communication is key when it comes to tough teen topics
and doing the opposite of what they’re told, they’re actually exerting their individual identity and independence. The mistake parents often make is to mirror this when interacting with their defiant teen and engaging in a back- and-forth “verbal judo match,” says Mueller. The behaviors characteristic of teenage rebellion—ranging from being argumentative to using drugs or alcohol and having sex at an early age or in an irresponsible way—can stem from conflict with parents or breakdowns in trust, respect or communication. “It’s easy to become reactive to what you’re seeing in front of you,” she adds, “but it’s important that
RAISING A TEENAGER CAN BE DAUNTING. Many parents are left wondering who replaced their sweet child with the angsty, emotional person currently residing under their roof. Though the raging hormones and boundary testing that come with the territory are normal and largely unavoidable, maintaining open communication as your teen develops can go a long way. “There is nothing that shakes a parent’s confidence in their ability like adolescents do,” says Sandy Mueller, senior director of Behavioral Health Services at Rady Children’s. As frustrating as it may be, when adolescents are questioning authority, talking back, arguing
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TEENS AND THE HPV VACCINE Many parents aren’t comfortable thinking about the day their children will become sexually active, but reckoning with this normal part of their development and being proactive about their health now can help protect them—and might even save their life down the line. The HPV vaccine prevents some forms of a sexually transmitted infection called human papillomavirus, which can cause genital warts and several forms of cancer. HPV is incredibly common—according to the Centers for Disease Control and Prevention, about 14 million Americans contract it each year, and almost everyone will have it at some point in their lives. In most cases, the virus is asymptomatic and goes away on its own. However, lasting infections may also be asymptomatic and detectable only with screening. A simple vaccine can stop HPV before it starts. Of the estimated 36,000 cases of cancer each year caused by HPV, 32,000 could have been prevented by the vaccine. It ’s recommended that children of any gender receive the vaccine as young as age 9, though the more common age is 11–12. Children younger than 15 need only two doses, while teens 15 and older and young adults need three doses. The HPV vaccine is safe and effective. Infections of the types of HPV that cause cancer and genital warts have dropped 86 percent in teen girls since the vaccine’s inception, and cervical cancer in vaccinated women has fallen 40 percent, according to the CDC. It may be an awkward topic to bring up, but it ’s in your teen’s best interest to talk to them and their physician about the HPV vaccine.
parents see these behaviors are the symptoms of a parenting conflict, not the root cause.” If you’ve been a little lax in setting boundaries and expectations, it’s time to have a serious conversation and express exactly what you expect from your teen and what they can expect of you. Outline what the child is allowed to do and what you expect in return for their evolving freedom. When it comes to more “adult” behaviors like having sex or drinking alcohol, a simple “just say no” won’t do. Talk about the real- world consequences. For instance, alcohol use can be detrimental to a developing brain and can magnify the danger of other risky behaviors, like driving or engaging in sexual activity. According to the American Academy of Pediatrics, alcohol use can also cause memory loss, suppression of the immune system, pancreatitis, alcoholic hepatitis and hormonal deficiencies. Family values also come into play in conversations about sex and substance use, and Mueller says these can both help and
impede a child’s development. Your kids likely already know which activities go against your values; however, their developing brains struggle with foresight and impulse control, so it falls upon parents to stress the potential impact of that instant gratification mindset. You may express your wish that your children follow your values, but if they end up choosing not to, it would be best for them to have a healthy knowledge of safer sex practices and a robust understanding of consent— especially that consent given under coercion or while under the influence isn’t good enough. Parents must also find balance in their parenting style between being excessively authoritative and being too permissive. If your teen confesses that they tried alcohol and your knee-jerk
“The parent must understand that
these children aren’t our possessions, that they are their own person and they’re DEVELOPING THEIR OWN IDENTITY .” — SANDY MUELLER
reaction is punishment, they’ll be hesitant to come to you in the future. Instead, open a dialogue about why they felt the need to experiment. This can lead to a larger conversation about peer pressure and how to handle new challenges, which they will face in abundance as young adults. Even sharing your own experiences can help kids learn to make better decisions. “The parent must understand that these children aren’t our possessions, that they are their own person and they’re developing their own identity,” Mueller says. “The parent is responsible to be a guide, a mentor and a teacher—not their friend.” Mueller also stresses that open communication should be established long before your child enters their teens, so they won’t be afraid to bring up tough topics or to ask for help. Every step in a child’s development is a step toward independence. She warns: “There’s never a parent that has come to me and said, ‘I was so angry that my child called me for a ride home when they were drunk’”—but there are parents who say “I wish they would’ve called” when their child experiences the ramifications of a poor choice.
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HEALTHY HABITS
VAX TO
R ady C h i l d r e n ’ s i s on t h e f ron t l i n e s o f t h e f i gh t ag a i n s t COV I D - 1 9 THE MAX
B Y C H R I S T I N A O R L O V S K Y
ady Children’s has long been the region’s premier pediatric health care facility, so there’s seldom been any reason for adults to consider it for their own care. That’s all changed over the past year, thanks to the Hospital’s monumental efforts to vaccinate as many people against COVID-19 as possible. As
“In March 2020, we set up several lab systems to do COVID-19 testing. We started with employees, physicians and patients, and then the County asked us to test first responders because of the shortages of certified labs for testing. We started with our health care workers and it expanded from there.” The first doses were allocated for Hospital staff. Abe says, “When the vaccine first rolled out, it was available for people who met certain eligible criteria and was initially focused on health care providers, who were at the highest risk of contracting the virus. We had risk-stratified our staff: The clinical staff in the Emergency Department, the pediatric intensive care unit and the surgical intensive care unit were first. Clinical staff included everyone who was at highest risk for exposure in those departments, like housekeeping, transport, nurses, physicians, translators and more.”
the first hospital in San Diego County to receive a batch of the Pfizer vaccine, on Dec. 15, 2020, Rady Children’s has played a key role in the fight against the virus, working closely with the County government and all local stakeholders to administer the vaccine to even the most vulnerable populations. “Our vaccine rollout was parallel to our testing rollout,” explains Chris Abe, RN, CIC, HEM, vice president of operations at Rady Children’s.
Rady Children’s received the first batch of COVID-19 vaccines in San Diego County on Dec. 15, 2020
Rady Children’s vaccinated 110 workers the first day and 500 the next. It set up the step-down neonatal intensive care unit as its main internal vaccination site, because it was empty during the pandemic. Within a week, County authorities reached out asking the Hospital for help vaccinating medical first responders. Rady Children’s answered the call. “That was the beginning of our community involvement,” Abe says, “and in the very beginning we were doing anything from 500 to 1,000 vaccines daily between Rady Children’s employees and community responders. We identified everyone in high-risk areas, and by January, almost 75 percent of our employees had been vaccinated. We’re proud that we were able to hit that milestone in just six to eight weeks. As the community need continued to expand due to eligible criteria, we continued to expand as well, focusing on the elderly and those at highest medical risk.” The Rady Children’s vaccine clinic continues to serve all eligible patients, now with the benefit of months of experience honing its procedures. The Hospital has partnered with local schools to vaccinate eligible students and athletes, including Francis Parker School, Hoover High School and University of San Diego.
THE RADY CHILDREN’S VACCINE CLINIC HAS BEEN THE BRIGHTEST LIGHT WE’VE SEEN IN A DARK YEAR . EVERYONE IS SO HAPPY AND THANKFUL. —CHRIS ABE, RN, CIC, HEM, VICE PRESIDENT OF OPERATIONS AT RADY CHILDREN’S
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Rady Children’s was an integral part of the community vaccination response from the beginning of the COVID-19 pandemic
VACCINE MILESTONES December 15, 2020: Rady Children’s is the first hospital in San Diego County to receive the Pfizer vaccine. The first shipment includes 1,049 doses. Emergency department nurse Brittanee Randle is the first San Diegan civilian to receive the vaccine.
As the clinic continues hitting milestones and vaccinating up to 1,700 people a day, Abe reflects on the Hospital’s involvement and the impact it’s made on the entire community. “We’ve received some of the most beautiful cards from patients expressing their gratitude for keeping them safe,” she says. “I can’t tell you how cool it was to vaccinate a 100-year-old patient, or my 98-year-old former father-in- law. There are so many great little stories like that.” She remarks on how amazing it’s been to be a vital part of the community response when the adult hospitals were full: “The Rady Children’s vaccine clinic has been the brightest light we’ve seen in a dark year, and it started to show us that we are actually going to get out of it. It’s so positive— everyone is so happy and thankful. This vaccine is the first proactive tool to help mitigate or eliminate the virus.” TACKLING HEALTH EQUITY To Gail Knight, MD, MMM, Rady Children’s senior vice president and chief medical officer, building trust within underserved communities was a calling. She remembers her mother telling her about the Tuskegee Study and other research when she was a child, and was inspired to pursue medicine so she could assuage fears relating to health care and combat historical inequities with compassion and education. Once the pandemic struck, Dr. Knight recognized she could use her position and unique background to build trust in the face of vaccine hesitancy among lower-income and underrepresented communities. Her great-nephew died of COVID-19 in November 2020, and this personal loss further magnified the urgency to reach those disproportionately affected by the illness. A conversation with Chris Abe about significant gaps in the diversity of people being vaccinated led to a grassroots effort to reach vulnerable San Diegans in the South Bay. “Being part of a trusted health care system gives me a sense of responsibility that I take very seriously,” she says. Dr. Knight’s approach to the COVID-19 fight was hands-on. She made phone calls—to other physicians and people she knew were active in community churches and service organizations—and she coordinated with Keri Carstairs, MD, Rady Children’s chief population health officer, and her team to personally call elderly residents. “We are a children’s hospital, and we’re used to speaking to people in a compassionate way—it’s what we do every day,” Dr. Knight says. Soon enough, word began to spread that Rady Children’s was making vaccination appointments available to people with otherwise limited access. The effort launched by Dr. Knight and Dr. Carstairs reached at least 1,000 people, many who had no phone or computer and had been cut off from their families because of the pandemic.
May 4, 2021: Rady Children’s administers its
100,000th dose of the COVID-19 vaccine. The lucky recipient is a 16-year-old local high school student.
May 5, 2021: Rady Children’s recognizes clinical nurse Kathy Houston as the top vaccinator in the Hospital ’s COVID-19 vaccine clinic, having administered more than 3,000 doses.
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UNDERSTANDING MIS-C One rare but serious COVID-19 complication that ’s arisen is multisystem inflammatory syndrome in children (MIS-C). According to the Centers for Disease Control and Prevention, MIS-C is “a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs. Children with MIS-C may have a fever and various symptoms, including abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, or feeling extra tired.” While there is no known cause for MIS-C, the link to COVID-19 is clear. “MIS-C appears to be a late effect of being infected with the COVID-19 virus,” explains Mark Sawyer, MD, an infectious disease specialist at Rady Children’s and professor of clinical pediatrics at UC San Diego School of Medicine. “It ’s really different from anything we’ve seen before, but it ’s most similar to Kawasaki disease in appearance. At this point, we don’t understand why it happens, as it ’s not been described with any other respiratory virus.” MIS-C symptoms typically last for a few days to a week or more, and require special treatment to decrease inflammation and pacify the immune response. While MIS-C is associated with COVID-19, it can appear “seemingly out of the blue,” Dr. Sawyer says. The child may not have shown symptoms for COVID-19, “but when we test them, we find evidence that they were infected. The usual time period is a few weeks before the MIS-C symptoms turn up.” While there’s nothing specific that parents can do to prevent MIS-C, other than the COVID-19 precautions we’ve been practicing already, vaccination against COVID-19 and early detection are both key. “At any point, if your child has persistent fever, diarrhea or abdominal pain, they need to be evaluated,” Dr. Sawyer says. “Those could be early signs of MIS-C, and like most things, the earlier we start treating it, the better.”
Dr. Knight found joy in connecting with the people they served—for instance, the group of churchgoers who wanted to “adopt” the population health team, and the 63-year- old man who was terrified of needles but excited to get a dinosaur bandage—and the satisfaction of knowing she made a difference. “I’m forever grateful to Rady Children’s for the visibility I have, and the opportunity to influence lives across all races, ethnicities and ages,” she says. “It has been truly special to be part of this effort.” WE ARE A CHILDREN’S HOSPITAL, AND WE’RE USED TO SPEAKING TO PEOPLE IN A COMPASSIONATE WAY. IT’S WHAT WE DO EVERY DAY . IT HAS BEEN TRULY SPECIAL TO BE PART OF THIS EFFORT. — GAIL KNIGHT, MD, MMM, RADY CHILDREN’S SENIOR VICE PRESIDENT AND CHIEF MEDICAL OFFICER
Dr. Knight (center) led a grassroots effort to vaccinate high-risk community members
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Nurses, physicians and volunteers from throughout the Rady Children’s community stepped in to help immunize San Diegans
Between her time at Petco Park and Rady Children’s main campus, Dr. Boiko has lost count of how many hours she’s spent volunteering. But she hasn’t lost track of the special stories that make it all worth it—from the two teenage girls, strangers who were both wearing cheerleading sweatshirts, uniting in a spontaneous cheer of positivity; to running into an adult melanoma patient she once cared for years ago; to the waves of elderly patients who remember her parents from their days of teaching at Francis Parker. Each day there’s been something new and special in store, and Dr. Boiko has embraced it all. “People say, ‘How do you have so much energy?’” she says. “To me, talking to people is energizing, and we all leave feeling more hopeful and excited than we were when we came in.” LOOKING AHEAD As the COVID-19 vaccines become available to younger age groups, Rady Children’s is easily shifting back to its mission to protect the health and wellness of the region’s youth. As of press time, the Food and Drug Administration has authorized the Pfizer vaccine for children age 12 and up, and ages 2 to 11 are likely next on the horizon. Studies are underway on children as young as 6 months old, with Rady Children’s researchers participating in some clinical trials. Doctors are optimistic about the future and encourage parents to vaccinate their children as soon as the opportunity arises, emphasizing the importance and safety of vaccination for kids of all ages. “First of all, we’re talking about the same vaccines for kids as for adults—there’s no difference,” explains Mark Sawyer, MD, an infectious disease specialist at Rady Children’s and professor of clinical pediatrics at UC San Diego. “From the beginning, the Pfizer vaccine was authorized for children ages 16 and up. There have been no additional side effects reported in kids, and it’s as perfectly safe to give to adolescents as it is for adults. We’ve now given more than 100 million doses in the United States and many more worldwide—we know a lot now, and there’s no reason to be nervous. While the belief is that children are not as affected by COVID-19 as adults, they do at times get severe cases—it’s not a benign infection for kids—and they can spread it to others.” Dr. Sawyer concludes, “The bottom line is that the vaccine is important. Children are part of the equation of community spread. The best way to protect your whole family is getting as many people vaccinated as possible. It will not only help your family’s health, but it will also help your kids get back to school and their regular activities.”
The Food and Drug Administration has authorized the Pfizer COVID-19 vaccine for children age 12 and up, and ages 2 to 11 are likely next on the horizon MAKING CONNECTIONS For Susan Boiko, MD, a Rady Children’s dermatologist, the vaccine clinic was a way to connect with the community and make them smile after a year that was fraught with fear and worry. She first volunteered at the Petco Park vaccination station, then brought her radiant energy to Rady Children’s and has been putting smiles on patients’ faces ever since. “My job is to alleviate the fear and make getting vaccinated a pleasant, memorable and exciting experience for everyone,” she says. Dr. Boiko takes this job very seriously—or as seriously as one can when they’re leading crowds in the chicken dance or making up silly songs with lyrics like “Pfizer, Pfizer, makes you wiser.” Easing patients’ fears, answering their questions, or simply helping to pass the time during the 15 minutes’ observational period after they receive the shot, “Dr. Sue” has become a familiar face at the clinic. She enjoys the camaraderie of fellow physician volunteers, the rapport with the cafeteria workers who now sing the chicken dance when she walks in, and, of course, the connection with the community.
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