Healthy Kids - Spring 2021

SPRING 2021

T H E H E A RT O F T H E HOS P I TA L D E D I C AT E D N U R S E S C A R E F O R T H E C O M M U N I T Y ' S C H I L D R E N

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Looking Back, Moving Forward uring the past year we’ve faced a set of challenges unlike most of us have ever experienced, a journey that’s been difficult to chart and nearly impossible to predict. I continue to be inspired by the strength of the many thousands who have risen together with unyielding perseverance, their courage and compassion shining through and leading all of us forward. As the virus gained momentum, Rady Children’s found new ways to provide community leadership. A generous grant from The Conrad Prebys Foundation enabled us to forge a partnership with San Diego County government to ensure our region’s health care heroes had access to crucial personal protective equipment, securing more than 315,000 items for local hospitals, health centers and 150 human service agencies. We instituted the COVID-19 Collaborative for Children, providing ongoing testing, tracing and treatment for children and families, including those in underserved or vulnerable populations. And, as of early 2021, we have evolved this effort to become an active participant in reducing the spread of this devastating virus as an official County COVID-19 vaccination site. Our leaders, physicians and staff also quickly pivoted operations to address our new reality, all while ensuring our doors never closed and our community had uninterrupted access to care. Members of the Rady Children’s community were central to these efforts, and we could not have achieved what we did without their heartfelt support. The Helen and Will Webster Foundation 3D Innovations Lab transformed into a fast-paced production site for 3D-printed nasal swabs and face shields for use at Rady Children’s and at testing sites around the County. We also expanded our partnership with UC San Diego, forming a research group investigating and identifying solutions for multisystem inflammatory syndrome in children, a late- onset effect of the COVID-19 disease in some patients. Fifty-nine specialty areas, including pediatric urgent care, shifted to offer telemedicine visits to our patient families, and now serve thousands each month from the comfort of their homes. And when the second surge of the pandemic took hold, we reached beyond the scope of pediatric care for the first time in our history, to help ease the burden on nearby adult intensive care units. As we’ve strengthened our community to overcome COVID-19, we have proven how, when we work together, we can be prepared for whatever uncertainties tomorrow may bring. While the sacrifices have been many and the losses unfathomable, seeing what our community is capable of accomplishing gives me pause to feel immense gratitude and inspiration. My confidence for the future health of children and families in San Diego has never been greater, knowing that with the continued dedication of everyone at Rady Children’s, healthier tomorrows are just ahead. D

THANKS TO OUR CARING NETWORK!

@radychi ldrens Rady Children’s teamed up with the County of San Diego to provide COVID-19 vaccines to health care workers, first responders, community members age 65 and older, and others included in the first tiers.

@radychi ldrens Rady Children’s reimagined its annual Light the Way event so patients, families and staff could still enjoy from a safe distance.

STEPHEN JENNINGS Senior Vice President and Chief External Affairs Officer, Rady Children’s Hospital Executive Director, Rady Children’s Hospital Foundation

@teamrady Rady Children’s staff shows off the self-care baskets they made as a thank-you to health care workers caring for adult COVID-19 patients.

SPRING 2021 HEALTHY KIDS MAGAZINE 1

3020 Children’s Way San Diego, CA 92123 858-576-1700 RCHSD.org

Stephen Jennings Senior Vice President and Chief External Affairs Officer, 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 524-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 healthcare 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.

SPRING

HEALTHY HABITS Tips for sleep, social media and smart spending, plus how to teach your kids about fighting fair 05 Children’s share their stories and show what makes nurses so great 16 NURSES BY NATURE In honor of National Nurses Week, six nurses from Rady BREATHE EASY Airway obstruction and a heart defect put a toddler ’s life at risk, but an innovative procedure at Rady Children’s gave his grateful family hope 22

INSIDE RADY CHILDREN’S

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CHEERS FOR PEERS A dozen doctors were honored by their

colleagues for their dedication, competency and compassion

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STEP BY STEP An in-depth look at the HeathySteps primary

care and development program at Rady Children’s offices in Murrieta

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PAY IT FORWARD How one family ’s bake sale raised enough to

buy a holiday toy for every single kid at Rady Children’s Hospital

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Join the Rady Children’s Hospital Auxiliary

- Join an existing Unit, or form a new Unit - Attend an Auxiliary Event - 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: - 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

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 .

HEALTHY HABITS

It ’s been a whole year since the pandemic turned life on its head, and now that there’s light at the end of the tunnel, we’re more than ready to get outside and play. Spring is a time of renewal, and for us at Healthy Kids that means rethinking our old activities with safety in mind. In this issue, we’ve included ideas for at-home science projects, tips to ease back into spring sports and a few things you should watch out for, both in real life and online. Plus, since health care is still a big part of the conversation, we also have info on getting up-to-date with your child’s annual checkups. We’re ready to spring forward. Are you? Game On!

HEALTHY HABITS

Keep in Touch Annual wellness exams are important — for kids of all ages DEVELOPMENT

“We check height, weight, hearing, vision, blood pressure—we make sure they are physically well overall and we can identify things that may have gone undiagnosed without an annual exam,” Dr. Breslow says, adding that the American Academy of Pediatrics recommends continuing annual wellness exams for everyone ages 3–20. “As pediatricians, we offer a safe, nonjudgmental place to come get honest, factual information about your child’s health—not information you get off the internet or from your friends or what your parents told you 30 years ago. The best place to get this information is at an annual wellness exam.” Finally, for parents who may be concerned about taking their child for a well visit during the pandemic, Dr. Breslow offers reassurance: “There has been a general reluctance to come to a medical office this past year, but we want to reassure you that all of our offices are safe. Patients are screened prior to entrance; providers are screened to ensure they’re healthy and well for work; and the doctors, nurse practitioners and staff have been vaccinated. The offices are healthy and safe to visit.”

they do develop risky behaviors they won’t talk about with their parents but will share with their doctor. Pediatricians are adept at becoming advocates for young adults and opening up safe lines of communication so we can assess these behaviors, from sex to substance abuse to eating disorders.” In addition to assessing hormonal and behavioral changes during adolescence, pediatricians also provide mental health assessments to screen young patients for depression and other issues. They perform vaccinations for children ages 11–13 for HPV, meningitis, tetanus and whooping cough. They offer sports physicals, which involve a closer look at underlying heart and orthopedic issues that could be a concern for endurance athletes. And, of course, they cover all the basics.

IN THE FIRST FEW YEARS of a child’s life, parents often adhere to a strict schedule of pediatrician visits, tracking their baby’s progress and percentiles, keeping up with vaccines, and staying hyper-focused on their overall health. As the child ages, however, and reaches the tween and teen years, well-child visits often fall by the wayside. But the impor- tance of annual visits remains. Adam Breslow, MD, MBA, president and CEO of Children’s Primary Care Medical Group (CPCMG), explains why: “Parents often think that preteens and teenagers are at the healthiest point in their life and don’t need routine health care. That’s a myth.” “There are several basic things about tweens and teens that are different,” Dr. Breslow continues. “First, it’s a time of super-rapid growth, with changing hormones and sexual maturation. That’s something we pediatricians monitor. There are also a lot of behavioral factors at stake as kids get older. The reality is that teens may not have a lot of medical problems—the vast majority of deaths in that age group are from accidents and injuries, homicide and suicide—but

Teens can develop risky behaviors they won’t talk about with their parents but will share with their doctor ‘‘

THE USUAL SUSPECTS Four of the most common allergens Pollen Trees, flowers, weeds and grasses shed these seasonal spores, which are then picked up by the wind or by insects like bees. Mold This fungus can be found both indoors in bathrooms, kitchens and other areas regularly exposed to water, and outdoors on leaves and logs. Dust Though dust particles are the allergen vehicle, the actual culprit is the tiny mites that live on them. Pets Many adults and kids alike can have an adverse reaction to an animal ’s skin cells (dander) and saliva. Though some pets are marketed as such, experts say a 100 percent hypoallergenic pet doesn’t exist.

SEASONAL

All About Allergies

Springtime allergies are nothing to sneeze at

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To ease sneezy kids’ allergy symptoms, over-the-counter antihistamines (Claritin, Zyrtec, Benadryl and their generic forms) and decongestant or corticosteroid nasal sprays (Afrin, Flonase) can be effective alone or in combination. Some antihistamines can cause drowsiness, so Dr. Laubach suggests trying them on a weekend first. Limiting exposure to possible allergens can also help. Keep the windows closed at home and in the car and use air conditioning; if possible; use an air purifier at home, and have your child change clothes after spending time outside. Remember that pets can also bring pollen into the home on their fur; so weekly baths are a good idea for pets when people in the home have allergies. If over-the-counter options just aren’t cutting it, your child’s pediatrician or an allergy specialist can figure out what environmental materials—such as dust mites, pets, or pollen— are causing them discomfort and step up treatment with prescription medications. Allergy shots may be an option to help desensitize people with severe or year-round allergies.

ike clockwork, spring ushers in an array of colorful flowers, lush greenery and ... the sneezing, sniffling and itchy eyes that signal the start of allergy season.

Seasonal allergies, also known as hay fever or allergic rhinitis, can be triggered by a number of largely unavoidable springtime elements, like pollen and mold. With colds, flu and COVID-19 still kicking around and presenting similar symptoms, how can you be sure that what’s affecting your child is actually being caused by allergies? The telltale signs of an allergic reaction include clear nasal discharge, sneezing, an itchy, runny nose and watery or irritated eyes, says Susan Laubach, MD, an allergist in the Division of Allergy & Immunology at Rady Children’s Specialists of San Diego. Fevers, yellow or green mucus, and body aches are common with viruses, but are rare for allergies. Sore throats and fatigue can go either way, though a cold or the flu is the more likely cause, she says.

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HEALTHY HABITS

EDUCAT I ON

STEAM at Home

projects, investigate extreme weather phenomena, learn about insect life cycles and more. nationalgeographic.org PBS Kids Find science and engineering games featuring some of your child’s favorite characters. Join the Cat in the Hat for a lesson about art and engineering, or Sesame Street ’s Abby and Rudy for a study of seasons. PBS Kids apps are available for download, too. pbs.org The California Academy of Sciences’ Science @ Home program features crafts, hands-on experiments and other activities for kids ages 4–11. calacademy.org BrainVentures This program by the University of Michigan Center for Digital Curricula guides kids to explore using animation, video, stories, simulations and other learning modalities. cdc.engin.umich.edu California Academy of Sciences

Get techy with fun online activities

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ith distance learning the new norm, kids may be missing out on hands-on lessons in the lab. Fortunately,

introduction to coding and engineering. You’ll find instructions to help your child use a microcontroller to power different devices, plus a list of parts you’ll need and where to find them. thinkabitlab.com Museums Find online STEAM programming from hundreds of museums across the country and around the world, including the San Diego Children’s Discovery Museum, The New Children’s Museum and the Fleet Science Center. findachildrensmuseum.org fleetscience.org/virtual-activities

the internet is full of virtual science, technology, engineering, art and math (STEAM) projects and classes kids can do from home. Here are a few to try: San Diego Public Library Teens (or parents) with some extra time on their hands can browse free six-week online courses in everything from art and creative writing to computer programming and web design. All you need to start is a library card. sandiego.gov/public-library Qualcomm Thinkabit Lab Help spark your child’s interest in STEM fields with Qualcomm’s

National Geographic Learn how your family can participate in citizen science

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EXERC I SE Get Moving! (Safely) How to boost your motivation and keep your springtime activities injury-free

For athletes eager to get back in the game, Dr. Edmonds cautions to take it slow to prevent injuries. He says his clinic has seen an uptick in overuse injuries in kids and teens attempting to do too much, too soon. Muscles begin to atrophy over time, and their skills may not be as sharp as they used to be. It’s important to build up gradually. “With the pandemic, we have seen a decrease in participation in organized sports, but that’s going to change,” Dr. Edmonds says. “By having stopped completely, all of a sudden when it comes time to get back outside, kids are going to be a little bit deconditioned.” Start slow, stretch, cross train in an array of activities that use different muscle groups, and above all, find ways to have fun.

THE AMERICAN ACADEMY OF PEDIATRICS recommends that kids ages 6 and up get 60 minutes of moderate to vigorous physical activity a day, but as team sporting events were canceled and students switched to distance learning, squeezing that hour in got tough. Now that a return to more normal activities is in sight, you may be ready to ease back into it. The best way to get your kids moving is to get moving yourself, says Eric Edmonds, MD, director of 360 Sports Medicine at Rady Children’s: “Kids look up to their parents, whether parents think they do or not. And if parents are at home spending time on the computer or their phones, that’s what the kids are going to emulate.” Take advantage of San Diego’s excellent weather. Go to the beach, take a hike, take a family bike ride in your neighborhood, or just go outside and play. If you’re including people from outside your household, remember to keep your distance, wear a mask and practice hand hygiene.

THE BEST WAY TO GET YOUR KIDS MOVING IS TO GET MOVING YOURSELF

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HEALTHY HABITS

Surviving Sleep Training F I RST YEAR Tips from a Rady Children’s sleep specialist

Start trying to slowly encourage the child to fall asleep on their own before any sleep training officially begins. Start getting used to the idea of not rocking your child to sleep or nursing them to sleep. Try to wait until your child is good and drowsy to lay them down. The sweet spot is when they’re just moments away from falling asleep, says Dr. Bhattacharjee. Recognize that not every method works for every kid. Not all kids are equal when it comes to sleep training. Your child’s pediatrician can rule out any medical reasons for their sleepless nights and help find an individualized approach that works. Avoid medication, if possible. Dr. Bhattacharjee says that in developmen- tally typical children, sleep training is entirely behavioral. There are no FDA- approved sleep medications for children, so behavioral sleep training should be your first option. That being said, child- hood insomnia does exist and, if present, should be treated by a physician. For more tips, Dr. Bhattacharjee recommends babysleep.com , a website developed by physicians, psychologists and other experts in the field of pediatric sleep medicine.

“The goal is to have kids learn how to soothe themselves and minimize the interactions that are required at bedtime,” says Rakesh Bhattacharjee, director of sleep medicine at Rady Children’s. Whatever method you choose, Dr. Bhattacharjee recommends starting around 4–6 months of age when nighttime feedings become less necessary. Starting too late or not sleep training at all can leave a child with sleep associations that are harder to break later in life.

FOR MANY PARENTS , sleep training conjures images of sleepless nights and the guilty feelings that come with letting their baby “cry it out.” However, there are several methods to teach your baby to go to sleep or go back to sleep on their own. They run the gamut from “extinction”—aka crying it out—to no-cry methods that can be just as effective but require more patience.

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WHAT’S YOUR SLEEP TRAINING STYLE? Five popular techniques explained Extinction (aka the Ferber method) The classic cry-it-out method cuts your child off cold turkey. After putting them to bed, don’t check up on them again until morning regardless of how much they cry. Graduated Extinction Gradually reduce the attention you pay to your child at bedtime. For example, let your child cry for a set amount of time before stepping in to console them, and gradually increase those intervals. The Chair Method (A variation of graduated extinction) After putting your baby in their crib, park yourself in a chair positioned nearby. Gradually move the chair a little farther away each night until you’re eventually out of the room. Bedtime Fading Put your child to bed drowsy, if need be — delay their bedtime until they are moments away from sleep. This minimizes anxiety around bedtime. Once they ’re comfortable with being in bed, gradually return their bedtime to the desired hour.

AGES & STAGES

ot getting a good night’s sleep can have We know that kids need more sleep than adults, but just how much may surprise you N How Much Sleep Does Your Child Need?

MD, director of sleep medicine at Rady Children’s. “During those first 18 years, you’re going from about 15 hours to about eight.” Though there are many theories as to why we sleep, we can all agree that quality sleep is physically and mentally restorative, and is essential to a healthy lifestyle. So, how many hours should kids get a day? Experts like Dr. Bhattacharjee recommend the following:

repercussions that stretch far beyond a temper tantrum. Persistently poor sleep has been linked to mood disorders like anxiety and depression, trouble in school, obesity, a weakened immune system, and a host of other ailments. The telltale signs of sleep deprivation can include grogginess and falling asleep at inappropriate times, hyperactivity and restlessness, a lack of motivation, and even snoring. Good sleep is a prerequisite to good health at any age, though many parents wonder how much is enough. “Total sleep duration changes significantly throughout the pediatric lifespan,” says Rakesh Bhattacharjee,

n 0–3 MONTHS: 14–17 hours n 4–11 MONTHS: 12–15 hours n 1–2 YEARS: 11–14 hours n 3–5 YEARS: 10–13 hours n 6–13 YEARS: 9–11 hours n 14–17 YEARS: 8–10 hours

If your little one is having a hard time falling asleep or staying asleep, parents can do a few things to help. n Establish a nightly routine with a set bedtime and bedtime prep period. n Keep electronic devices out of your child’s bedroom. n Prioritize making time for sleep and ask children how they are sleeping. n Enlist the help of your pediatrician if sleep problems persist. n Respect sleep like you would respect other aspects of health, like diet and exercise.

Pick Up, Put Down In this self-explanatory style, the parent picks up and comforts a fussy baby until they ’re calm, over and over, until they ’re finally able to sleep.

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SOLUT I ONS

Fighting Fair

Conflict resolution tips for kids

onflict is a part of life, though that’s not necessarily a bad thing. Some arguments can be productive and lead to change, but using the right language and fighting fair is key. “Conflict is inevitable,” says Ben Maxwell, MD, interim director of Child and Adolescent Psychiatry at Rady Children’s. “The important part isn’t necessarily making sure every kid gets along with every other kid, but teaching kids conflict management skills.” These tips from Dr. Maxwell will help kids get their point across to their peers, siblings and even adults in a more productive way. (They work for grown-ups, too.) C

n Take a moment to regain your calm. n Determine what the conflict is really about. n Explain how you’re feeling. It can be empowering for kids to express how they feel. It helps to communicate that their emotions have meaning and are valuable. n Listen openly to how the other person feels. Conflict resolution is a two-way street. n Look for a solution. An ideal outcome is a win-win, where a similar situation can be avoided in the future. n Sometimes an apology is necessary. A sincere apology means one person takes ownership of their behavior and their mistake and can express regret for how it may be affecting the other person. n When all else fails, bail. If a workable solution is a no-go, sometimes just taking a break—giving each kid time to play on their own—is really a useful strategy. Kids can also decide when to walk away, for instance, when another child is persistently breaking the rules or making them feel bad. They can say something like, “I don’t like the way you are pushing me right now. I’m not going to play anymore.” n Follow up. Once there’s a clear understanding of what’s expected and how that differs from what happened, check in, stay consistent about that plan and follow through.

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The Dangers of Vaping I N DEPTH

Seeing through the smoke and mirrors

the 2020 National Youth Tobacco Survey, a cross-sectional, self-administered survey of U.S. middle school and high school students, nearly 20 percent of high school students (3.05 million) and 4.7 percent of middle school students (550,000) reported using an e-cigarette within 30 days of taking the survey. Of those, 22.5 percent of high schoolers and 9.4 percent of middle schoolers reported daily use. With nearly 3.6 million kids using e-cigarettes regularly, the problem has reached epidemic proportions—and shouldn’t be taken lightly. “Despite being advertised as not having nicotine, if you actually look at the products, they do,” says Dr. Inwards-Breland. In fact, the Centers for Disease Control and Prevention reported that 99 percent of e-cigarettes studied contained nicotine, which can be particularly harmful to the developing adolescent brain. “Not only can that lead to nicotine addiction, it can also cause major issues with anxiety and mood, and other medical and mental health issues. Vaping can lead to serious, sometimes deadly, respiratory illness. And today, there’s evidence that patients who are vaping and smoking have an increased risk of catching— and dying from—COVID-19, particularly if they’re in a minority population.” Because of the products’ inherently discreet design, it may be difficult to recognize whether your child vapes—but it’s certainly a topic worth discussing. “My recommendation to parents is to talk to your children—have the conversation,” Dr. Inwards-Breland concludes. “If you find a vaping apparatus, sit down and talk to your child about it. Why are they using it and how often? If you approach it like a conversation, rather than a confrontation, they’re more likely to talk about it. Then you can bring it up with their doctor and help them quit.”

E-CIGARETTES. YOU SEE THEM EVERYWHERE. Sleek devices that can look like a pen, a flash drive, or a liquid-filled cartridge. You may see adults puffing on them in the car next to you at the stoplight or even in your local grocery store. They’re so commonplace—and so discreet, often producing no visible clouds or odor, or even a pleasant aroma like peppermint or watermelon—you might think they’re harmless. In fact, they’re anything but. Plus, thanks to tobacco companies’ often- misleading tactics, e-cigarettes—or vapes, as they’re commonly called—are especially appealing to teens looking for a “safer” entry to substance use. “It’s widely known that cigarette smoking is bad, but some vaping products are advertised as having no nicotine. In the eyes of young people, it seems a healthier alternative to smoking,” explains David Inwards-Breland, MD, chief of the Division of Adolescent and Young Adult Medicine at Rady Children’s. “To teens, who see their peers using it and functioning just fine, it’s ‘cool’ to have a vaping machine. The smoke is cool. The apparatus is cool. There are different scents and tastes that make it easy to hide. And it’s an easy way to ingest both nicotine and marijuana. All of this is what makes it so dangerous.” Dangerous, yet shockingly prevalent. According to

Smoking e-cigarettes can lead to nicotine addiction, and it can also cause major issues with anxiety and mood

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HEALTHY HABITS

into an unsupervised computer world for school, which opens the door to the online world tenfold. We’ve set up a social construct to perpetuate the dangers of social media.” Dangers like cyberbullying, which can be both subtle and pervasive. Recent stats from StopBullying.gov say that 20 percent of American kids ages 12–18 experience bullying. Of those, 15 percent report being bullied online or via text. Mueller explains that while in-person bullying is more concrete and visible, cyberbullying can take many forms, from mean comments to unfriending to sharing private photos without permission. “The problem is that there’s no system of checks and balances,” she says. “It’s pretty rampant and can happen very easily.” So, too, is predatory behavior— ill-intentioned adults posing as minors on social media sites or as fellow players in popular video games. These predators are sophisticated, learning kids’ vernacular and eliciting information that makes them, in Mueller’s words, “walking prey.” “The issues of cyberbullying and predatory behavior really come down to who’s supervising, and at what age is it appropriate to give kids access,” she says. “In an ideal world, that’s 13 or 14. Kids develop abstract thinking around age 13, and that’s when they can really process what’s happening online.” Today, with parents trying to work from home while their children are in school in the next room, she admits that waiting till 13 isn’t realistic. Instead, it’s up to parents to add social media monitoring to their parenting tool kit. “It’s really about making social media regulation an active part of parenting—ensuring oversight of their child’s online world.” Mueller continues, “I call it ‘media hygiene,’ where a child doesn’t need to be on their phone 24/7 at any age. They can be given access for an amount of time that a parent sees as reasonable, and then they turn the phone in for the night. There is no passcode the parents do not have. And there’s a daily access check and restriction on what apps kids can and cannot have. If parents are not incorporating this, they’re setting their kids up to handle adult problems with a child’s brain.”

HOT TOP I C

Safeguarding Social Media Keep your eyes open to your kids’ online activity

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n today’s world, life is often lived online. But constant connectivity comes at a price—especially for kids—and it’s easy to get stuck in a worldwide web of trouble. From cyberbullying to online predators, social media can get murky, and parental guidance is paramount. “Kids’ access to social media has evolved over time,” explains Sandra Mueller, LCSW, senior director of behavioral health at Rady Children’s. In the early days of the internet, she says, “there was a lot of fear among parents, and they wouldn’t let their kids have a phone or computer until they were 12 or 13. But what’s happened is, that age has gotten younger and younger, and we have kids who are developmentally not old enough to handle what they see and hear online.” The pandemic and resulting virtual school setups have exacerbated the issue. “Now we’re asking them to step

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Recent statistics say that 20 PERCENT of American kids age 12–18 experience bullying. Of those, 1 5 PERCENT report being bullied online or via text.

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Money Matters Get your kids on the path to financial literacy DOLLARS & SENSE

“Sometimes the child might make a selection the parent knows they’re not going to actually like, but that’s an important lesson for the child to learn,” says Dr. Maxwell. “Making those mistakes as a 7-year-old is much, much better than making them when you’re 27.” Parents can also discuss with their child in an age-appropriate way how a savings account works and how interest is accrued, and how to set a budget. As kids get older, the discussion can move to early-adult decisions like buying a car, setting up a retirement account and how to responsibly use credit. For teens, parents can put ideas into action with a low-limit credit card that they supervise and monitor. “A lot of times, people in their early twenties get in trouble with credit card debt because they didn’t know how to manage it; no one ever talked about it,” Dr. Maxwell says. “Making sure that conversation happens before your child leaves home is really important.” A professional financial advisor or reputable online resources can also be of help with topics outside the parents’ wheelhouse. “A lot of adults in our country don’t have a great financial literacy,” Dr. Maxwell adds. “So part of the money management education of a child is doing a self-assessment of yourself as a parent.”

INSTILLING A FINANCIAL EDUCATION goes far beyond doling out a weekly allowance. Though a basic understanding of money management sets kids up for financial success in the future, a survey by small business financier Guidant Financial found that one in four parents never or very rarely discussed household finances with their kids. “We encourage parents to raise their children to be successful independent adults,” says Ben Maxwell, MD, interim director of Child and Adolescent Psychiatry at Rady Children’s . “So starting those sorts of lessons early on is critical.” The grocery store can be a great place for younger kids to start making decisions on how to spend money. Let them choose between two similar items, for instance cheddar or mozzarella cheese or chocolate or strawberry ice cream. They’ll learn about trade-offs and that with each decision, you might have to sacrifice one thing or another. As the child gets older, they become capable of making more complex decisions. An opportunity to earn money, say by doing chores around the house, will give them freedom to spend money how they’d like and build on that experience with purchase selection. And though it may be hard, it’s important for parents to not intervene and to allow children to make questionable decisions, in hopes that they’ll learn from their mistakes.

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HEALTHY HABITS

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Nurses by Nature

S p ot l i g h t i n g e v e ry d ay s u p e r h e ro e s

B Y C H R I S T I N A O R L O V S K Y P H O T O S B Y J E N N Y S I E G WA R T

E

very year, National Nurses Week is celebrated May 6–12, a week to honor the health care heroes who have dedicated their career to caring for others. No matter their specialty, their role, their unit or their shift, nurses are patient advocates. Bedside warriors.

Educators. Hand holders. Whether on the front line or behind the scenes, nursing professionals tackle tough issues and use critical-thinking skills to make difficult decisions. Day in and day out, often 12 hours at a time, nurses show up, step up and raise up their patients and their families in times of sickness and health. They may be officially celebrated for one week, but their dedication is on display 24 hours a day, seven days a week, 365 days a year. “Rady Children’s nurses are heroes every day— for the way they care for patients, families and each other,” says Mary Fagan, PhD, RN, NEA-BC, vice president of patient services and chief nursing officer at Rady Children’s. “With their unique blend of intelligence, skill and compassion, they support children and families through what can be some of the most challenging times of their lives. Today, in the age of COVID-19, our nurses have also demonstrated extraordinary flexibility, resilience and a willingness to do whatever it takes to care for our patients and the community.” With more than 1,900 nurses on staff at Rady Children’s, it would be impossible to highlight them all individually. We’ve selected six nurses for their excellence and their representation of the incredible diversity of roles in the nursing profession—from working in occupational health and keeping the Rady Children’s team safe, to supporting complex surgical procedures, to creating tools to better care for the Hospital’s most fragile children. “These nurses stand out for their commitment to helping others while also advancing the nursing profession,” Dr. Fagan says. With their passion, dedication and commitment to exceptional care, these six Rady Children’s nurses prove that not all heroes wear capes—in fact, many wear scrubs. “I love to watch my patients progress and grow.” For Mai Truong, RN, there is no step too small in her patients’ progress. As charge nurse in the Helen Bernardy Center for Medically Fragile Children; a skilled nursing and subacute facility for children and adolescents with multiple medical, physical and developmental delays; Truong cares for patients and families facing the most complex health challenges. Yet what she sees is not sadness—instead, she sees inspiration. “I work with long-term kids—highly vulnerable patients whose parents are often scared,” she says. “One of the things I really love is that I get to watch them progress and grow. I get to see a baby come in with a tracheostomy and a ventilator, and then three years later I get to see

MA I TRUONG , RN Charge Nurse, Helen Bernardy Center for Medically Fragile Children

them walk out and maybe even eat. To say that children are resilient doesn’t even do it justice. It’s amazing to be a part of that.” Truong has been a nurse for 12 years, nearly five at Rady Children’s. She’s currently enrolled in a master’s program in nurse leadership at University of San Diego, and is also teaching a pediatrics course for nursing students at the Hospital. “It’s my first time as a clinical instructor and I love it,” she says. “Some of the students are scared to work with kids, and I love helping them get experience in pediatric nursing. I’m proud to showcase everything Rady Children’s has to offer.” One of Truong’s recent successes is a project she initiated to improve the care of patients with gastronomy tubes, or G-tubes, which provide nutrition directly to the stomach of patients who can’t eat on their own. Used by more than 90 percent of patients at the Bernardy Center, G-tubes can cause irritation or erosion, which may require wound care, medication or even surgical revision. Truong knew there had to be a better way. The team got clothes with slots to allow easier access, got products to stabilize tubing, and created a G-tube assessment tool Truong hopes will be implemented throughout the Hospital.

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Truong won an award for the project and has been asked to present on it in various settings. For her, this is yet another way to tap into her love of teaching. “If you become an expert in something and keep it to yourself, that’s no fun!” she says. “You should share that knowledge and make it go far.”

surgery—a brief encounter that means the world to both her and her young patients. “In the OR, a lot of the kids are really scared about surgery. Part of my job is to quickly build a rapport with them,” she says. “I only have a short time with them, so I take that time to tell them it’s okay to be scared. One of my favorite things is when they ask me to hold their hand. That’s the best part, because I’m there to keep them safe. I don’t have kids of my own, so I tell parents I’m going to take care of your baby like they’re my baby.” One part hand holder, one part parent educator and worry easer, Witt takes pride in working hard and going the extra mile. She recently worked with the general surgery team, the NICU and the nurse educators to formulate a standard of care for NICU babies in the OR to ensure an optimal room setup for the Hospital’s most vulnerable newborns. Everything she does, she does with her mother in mind. “My mom always urged me to work to my fullest potential,” she says. “I work very hard. I spread myself around to make sure my coworkers are supported. I feel knowledgeable about my service and I take pride in my ability to do the extra role of scrubbing. My mom is the one who encouraged me to get my CNOR certification, and right after she passed away, I passed the CNOR exam. I wish she could see it, and that I could tell her that every day I keep going because I want to be like her all the time.”

“I’m providing care to the people who are providing care to pediatric patients.” Maureen Finnegan, LVN, has seen a lot of changes during the course of her 43-year nursing career, but one thing that hasn’t changed is the institution she’s called home—she has spent 42 of those years at Rady Children’s. “I knew as soon as I got out of nursing school that I wanted to work in pediatrics,” Finnegan says. “I applied at Children’s, which was at that time a small community hospital. I got a call from the blood lab, which back then needed help with brand- new instrumentation for premature babies. I took the position thinking it was my foot in the door, and ended up staying in that role for 25 years.” Finnegan trained countless staff members on how to draw blood and prepare specimens. At the time, the lab’s research was very new, and people with lab expertise were needed for various assignments. “It was always different and new, and I always thought I’d become a better nurse by knowing what was going on in the laboratory,” she says. Finnegan would eventually need to make a change, and in 2004 when the lab was restructured, she accepted a role in the Occupational Health & Safety Department. “Occupational Health is unique because our patients are the employees, so it’s a different type of nursing. We work with new hires, employee vaccinations and staff who have workplace injuries. My specialty is worker’s compensation—helping people navigate the system so they can get help if they get injured at work,” she says. Like many people, Finnegan had to pivot with the onset of the pandemic, focusing on employee risk and exposure, contact tracing, testing, results and clearance. “Our business went through the roof!” she says. “Occupational health has worked closely with infection control throughout, and now it’s finally coming full circle. With the vaccine here, there’s hope.” As she plans for retirement, Finnegan looks back fondly on the decades she’s spent at Rady Children’s, and time she’s spent learning the specialty of occupational health. “We really care about our employees and making sure they’re getting seen, being helped and staying healthy,” she says. “In an indirect way, that’s how we help the patients. It’s a trickle-down effect. I’m providing care to the people who are providing care to pediatric patients. We’re a little farther removed, but just as instrumental to the organization—because you can’t run an organization without employees.” “I’m going to take care of your baby just like it’s my baby.” Daniella Witt, RN, BSN, CNOR, always knew she’d be an operating room nurse. She had the most inspirational role model. “I got into nursing because my mother was an OR nurse. She was a guiding light for what I wanted to be in life,” she says. “She unfortunately passed away, and I wish I could share all of my accomplishments with her, but every day I strive to be the nurse she’d want on her team.” A nurse since 2008, Witt is currently the general surgery and gynecology service coordinator in the OR at Rady Children’s. In this role, she sees patients before they go into

DAN I ELLA WI TT, RN , BSN , CNOR General Surgery and Gynecology

Service Coordinator, OR, Rady Children’s Hospital

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RUSSELL GAGU I , RN - BC Supervisor and Educator, Rady Children’s Hospital

up, reducing turnover and so much more, it’s patient care that continues to drive him. “I’m always on the floor, because I don’t want to lose that connection with patients,” he says. “I’m looking forward to continuing to perfect what I do. There are a lot of bigger things that Rady Children’s is doing with mental health. I know I picked the right organization to work for, and it’s great to know there are exciting new things to come.” “I see great value in having direct-care bedside staff involved at the leadership level.” As an undergraduate, Daniel Roderick, MSN, RN, CNL, CPEN, had sports medicine and medical school on the brain. Life took him into nonprofit work instead, but when Roderick decided to go back to school, his heart led him to nursing and patient care. He entered a master’s program that afforded him two rotations in the Emergency Department at Rady Children’s, and he never looked back. “When I started, I enjoyed the opportunity to learn and see something different every shift, and I really liked being able to take care of a patient and their family and provide the education they needed,” he says. Roderick started at Rady Children’s in the NewGrad Residency Program, a one-year comprehensive education and training programdesigned to transition registered nurses from students to safe, competent and professional health care practitioners. He’s been a go-getter from the start. “Right away, I foundmyself getting involved in extracurricular activities on the job—different committees, councils and precepting, which I love,” he says. As a new grad, Roderick took advantage of an opportunity to represent the ED on a Hospital-wide Code Blue subcommittee. Ever since, he has looked for new chances to learn and grow, working with physicians and more experienced nurses, conducting his own research, helping create new processes, and pushing himself clinically. Two years ago, Rady Children’s revised their shared leadership model for nursing and patient care services. It is made up of a variety of Hospital-wide councils, two of which Roderick is a member. “This is a way to share ideas and resources to work toward quality improvement using the tools that are available to us,” he explains. All this shared leadership work is done on top of Roderick’s full- time job at the ED bedside—and he wouldn’t have it any other way. “I’ve always said I want to keepmyself close to the bedside for as long as I can,” he says. “Having staff that keep their finger on the pulse of both is crucial tomake sure change can be enacted in a way that makes sense. Everything I learn in leadership councils goes directly back tomy practice. I can take my learning back so that the next time I’m in the unit, I’m able to share that knowledge withmy peers, and together we can provide excellent patient outcomes.” “I love empowering nurses to be their best, to love coming to work every day and to deliver the best patient care.” Alissa Blankenship, BSN, RN, is a born educator. She initially earned a degree in English. But a volunteering trip to Tanzania, where she helped with HIV/AIDS education and the formation of an orphanage, inspired her to seek all her passions within one profession: nursing. “I wanted to have a skill that could help people, so within a week after I returned from Tanzania, I was enrolled in prerequisites at a community college,” she says.

“If we can reach patients when they’re younger, maybe they won’t have to be here when they’re older.” In a previous life, Russell Gagui, RN-BC, was a headhunter. It was lucrative, but he discovered that what kept him fulfilled wasn’t the money—it was helping people who were unhappy in their current job find happiness in a new one. Gagui knew all too well the devastating repercussions of long-term unhappiness. His roommate, who had been his first friend when he moved to San Diego, died by suicide. “That was a big reason why I went into mental health nursing,” he says. “Not knowing what he was going through, not seeing it and not understanding it, made me want to use my skills to help people.” Gagui started his new career path as a mental health worker in a privately owned facility with inpatient voluntary, inpatient acute and child/ adolescent units. He gained experience, got his nursing degree and started at Rady Children’s in 2012. He’s now the nurse supervisor and educator in the inpatient Child and Adolescent Psychiatry Services program. In this role, he took part in the opening of the Copley Psychiatric Emergency Department, and trained nurses from other departments as well as his own to staff it during the pandemic. Overall, he is grateful for the opportunity to grow the CAPS program to what it is today, to see patients improve in a short time and to see Rady Children’s increased commitment to providing a full range of mental health services for kids in need. “My joy is seeing that if we can reach patients when they’re younger, maybe they won’t have to be here when they’re older,” he says. “A lot of the kids that come here have been to multiple places and they hated it. My goal was to change that mindset. It’s great to watch them grow.” Although Gagui is now a supervisor and educator and is responsible for hiring staff, keeping morale

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