Under the new guidance, students in early education and kindergarten through first grade will have no weekly classroom screen time. Students in grades 2 and 3 will be limited to 1 hour and 40 minutes per week, with those in grades 4 and 5 limited to 2 1/2 hours, students in grades 6 through 8 limited to 6 hours per week, and high school students limited to 10 hours per week.

The limits include time spent on screen-based homework.

“Screen time is literally changing the trajectory of brain development. It’s growing the visual cortex at the expense of the areas responsible for language, reading and social skills,” said Jane Tavyev Asher, MD, pediatric neurologist and director of the Division of Pediatric Neurology at Cedars-Sinai Guerin Children’s. “Parents should actually be very delighted that their kids are going to have less screen time in the school setting, and they should view the school as working as their partner in helping with their child’s brain development.”

As the new policy takes effect this school year, the Cedars-Sinai Newsroom spoke with Tavyev Asher about why reducing screen time can benefit children’s brain development—and how parents can reinforce healthy screen habits at home.

Why were these new screen time policies needed?

Research continues to show that excessive screen time can affect how children’s brains grow and develop. During childhood, the brain is building important skills for language, reading, attention and social interaction. We want the brain to develop for reading, language and social skills. And screen time is really growing the visual cortex at the expense of all of the other parts of the brain.

Sharply reducing screen time at school can help create more opportunities for students to have active learning, conversation and deeper cognitive development in the long run.

Now that schools are seeing the neuroscience behind what screen time does to the developing brain, many are beginning to embrace this research and implement limits. They want what’s best for students’ brain development, just as parents do. At the end of the day, we’re all working toward the same goal: helping our children learn, grow and thrive.

Why is limiting screen time especially important during early childhood?

Early childhood is a critical period for learning to speak, read, write and develop social skills. During these years, the brain’s auditory and language centers are rapidly developing through conversation and human interaction.

For example, speech development begins around age 1, when children start learning how to speak. This process depends on the development of nerve signals and the continued growth of the auditory cortex, which develops significantly during the first few years of life. The auditory cortex is also the part that builds not just language but also social interaction.

Excessive screen use may interfere with these processes by overstimulating visual pathways while reducing opportunities for face-to-face communication, language development and recognizing social cues such as facial expressions and body language.

How can screen use affect brain development in middle schoolers?

Higher-level cognitive functions really begin to take off around age 12. This is when intellectual curiosity starts to develop. It’s a stage where children naturally begin making connections between ideas, such as reading one thing, connecting it to something else they’ve learned, asking questions, and wanting to find the answers. That’s exactly how we want their brains to develop.

But if everything is fed to them passively through AI or excessive screen-based learning, that part of the brain isn’t being exercised in the same way. They’re consuming information rather than actively thinking, questioning and making connections. It’s wonderful that our schools are finally coming to this realization and changing the way the curriculum is given to our children.

What screen time advice do you have for parents of high schoolers?

For a high schooler, I would try to keep the same guidelines in the home that you’ve done for the younger children. The reason for that is they still have that developing brain, and screen time is still very addictive.

I think at this age, they really do have the understanding as to why screens are not ideal for them. By the time they’re in high school, teenagers can understand the logic behind reducing screen time. This is the time when their intellect is developing. They can read the studies about it. As parents, this is also an ideal time to expose them to the studies that are showing what screen time addiction is doing to the brain in the long run.

How should parents approach smartphones for middle and high school students?

The smartphone is really the worst form of screen time because it is so easily accessible in the pocket. It’s easier to become addicted to that. So, it’s important to monitor how children access and use their smartphones.

There is so much social growth that happens in middle school. If you can just get the kids over that hump without a phone, then you can keep them from getting addicted to that phone.

There’s a program called “Wait Until 8th.” It’s a movement where parents sign a pledge to delay giving their child a smartphone until at least the end of eighth grade or until they’re 13 years old. When families make this commitment together, it creates a community where fewer kids have smartphones early on, which helps reduce the peer pressure to get one before they’re ready. It gives parents support in setting healthy boundaries and makes it easier for children to wait alongside their friends.

If you need to be in touch with your teenager, give them a simple flip phone that has no internet access. This way, they can call who they need to call. In some phones, you can also program who they call or receive calls from.

How can parents set and enforce screen time limits at home?

Parents have a huge influence on how children develop their relationship with screens. It’s much easier to not introduce screens than to set limits or take it away later in life. Instead of focusing only on taking screens away, parents can help children discover other activities, like reading, creative play, spending time outdoors and connecting as a family.

It’s important to point out that parents should model habits they hope to see by practicing healthy screen use themselves, since children are more likely to follow behaviors they observe at home.

Firstly, implement a no-screen-time rule at least two hours before bedtime. This will help kids avoid bright lights right before bed, promoting deeper sleep. Secondly, avoid screens during mealtime. Mealtime is a great time for the family to sit together and have conversations. There are so many positive studies about what family mealtime does for children’s social development and for their cognitive development.

Read more from Cedars-Sinai Stories and Insights: A Family Guide to Teens, Screens and Social Media

But one of the unwanted consequences of spending lots of time in the water is ear infections, commonly known as swimmer’s ear. The Cedars-Sinai Newsroom spoke to Abhita Reddy, MD, a pediatric otolaryngologist and head and neck surgeon at Cedars-Sinai Guerin Children’s, about what causes swimmer’s ear, how parents can protect their children, and how physicians diagnose and treat the condition.

What is swimmer’s ear?

Swimmer’s ear, properly known as otitis externa, is an infection of the ear canal where you often have drainage. You can have fluid sitting in the ear canal. Sometimes it looks like fluffy tissue that drains. It can cause discomfort and can also cause hearing impairment if left untreated.

What causes swimmer’s ear?

Swimmer’s ear occurs most commonly in the summertime when people are swimming in contaminated water like lakes or rivers, even sometimes in the ocean. We also see it a lot when people go surfing or do water sports, or when kids are going under water frequently or diving deep. Swimming in chlorinated or saltwater pools is less likely to cause swimmer’s ear.

How do you know if your child has swimmer’s ear?

Parents usually know when their child is getting an external infection like swimmer’s ear when they see drainage coming out of the ear, not something brown that looks like wax, but oftentimes it’s white or yellow, and it can smell bad. Swimmer’s ear is often associated with children having pain in their ear, and sometimes it can be associated with small children not letting you touch their ear, so if you tug at their ear or pull their ear it hurts a lot.

How does swimmer’s ear differ from other ear infections?

The biggest difference between a middle ear infection, known as otitis media, versus an outer ear infection, known as otitis externa, or swimmer’s ear, is that middle ear infections, which are behind the eardrum, do not have drainage coming out unless your child has ear tubes. Usually when children have middle ear infections they tug or pull at their ears, which makes it feel better. They also may develop a fever. The opposite is true with swimmer’s ear, or otitis externa, which hurts when you tug on the ear.

How are these infections treated?

Swimmer’s ear is often treated with ear drops because it’s very easy for the drops to get to the area where the infection is. With middle ear infections we often must treat it with antibiotics because unless you have ear tubes, it’s very hard for the drops to reach the infected area.

How can you prevent swimmer’s ear?

When parents ask me how to prevent their kids from getting swimmer’s ear, it often has nothing to do with swimming at all. I just tell them not to use cotton swabs such as Q-tips in their kids’ ears. When you use Q-tips in your children’s ear, it can offset the pH balance inside the ear canal, or cause small breaks in the canal skin, which can then increase the risk of getting ear infections. It is also helpful to consider using earplugs or swim caps for children. Parents can also try to dry the ear if the ear is very wet after a swim. Parents can use a hair dryer around a shoulder length away from their child’s ear on the lowest setting for about 10 seconds at a time, and that can dry out the ear canal and help prevent swimmer’s ear.

Read more from Cedars-Sinai Stories and Insights: How to Treat Sleep Apnea in Children

Fires can leave behind more than visible damage. The lingering smoke and airborne contaminants from the recent warehouse fire in the Boyle Heights neighborhood in Los Angeles may continue to affect air quality for weeks or even months. Exposure to pollutants released during the fire and after it was extinguished can significantly increase the risk of developing respiratory problems and other health issues. 

While some people experience only temporary irritation, others, especially children, older adults, and those with underlying medical conditions or breathing issues, may face more serious or long-term health effects.

The Cedars-Sinai Newsroom recently spoke with Irina Dralyuk, MD, director of Pediatric Pulmonology at Cedars-Sinai Guerin Children's, about the health risks associated with fire and smoke exposure, who is most vulnerable and what people can do to protect themselves.

What are the health dangers following a fire like the warehouse fire in Boyle Heights?

Following a fire, air quality can be affected for an extended period of time. Fires release a variety of chemicals and fine particles into the air, and many of those substances may not be immediately identified as materials continue to burn and break down.

The first few weeks after a fire are generally the most concerning, but people should remain cautious for at least two to three months. For individuals with respiratory diseases, weakened immune systems or heightened sensitivity to environmental pollutants, the health effects can last much longer, potentially up to a year.

Who should be especially cautious following a fire?

Several groups are at higher risk, including infants and young children, especially babies born prematurely, older adults, people with weakened immune systems, and those with chronic lung conditions such as asthma, chronic obstructive pulmonary disease (COPD) or cystic fibrosis.

However, even people with healthy lungs should take smoke exposure seriously. Environmental hazards from a fire can trigger inflammation or respiratory problems in otherwise healthy individuals, so everyone should take steps to protect themselves when air quality is poor.

What precautions can people take after a fire?

One of the most effective ways to reduce exposure indoors is by using air purifiers. It's important to choose a purifier that's appropriately sized for the room and to replace filters regularly. Home HVAC [heating, ventilation and air conditioning] filters should also be changed according to manufacturer recommendations.

If possible, limit activities that bring smoky outdoor air into the home. During periods of poor air quality, consider using fans instead of air conditioning, as it typically draws outside air into your living space. When spending time outdoors, wear a well-fitting mask on days when air quality is poor, especially during the weeks and months following a fire.

When should people seek medical attention?

Even mild symptoms such as an itchy or scratchy throat, irritated eyes, or persistent coughing are signs that smoke may be affecting your body and should not be ignored.

People experiencing coughing, wheezing, shortness of breath or difficulty breathing should see a doctor or head to an urgent care. Depending on the symptoms, a doctor may recommend diagnostic tests such as a chest X-ray or lung function tests. Your doctor might also listen to the lungs and determine whether medications, including inhalers, nebulizer treatments or oral medications, are needed to reduce inflammation, open the airways and improve breathing.

Read more from Cedars-Sinai Stories and Insights: What Parents Should Know About Teen Vaping

At the crib side, a guitarist and singer serenades newborns hooked up to loud, beeping and flashing monitors. The sounds of gentle humming and guitar strumming do more than soothe a fussy baby—they stabilize vital signs, aid neurological and auditory development, and enhance the overall wellbeing of infants in the NICU.

“Music therapy is a clinical and evidence-based practice using music to address nonmusical goals,” said Laura Cellini, Guerin Children’s board-certified music therapist. “Listening to music can help lower and stabilize heart rate, improve oxygen saturation levels and support a more regulated, calming state for newborns.”

According to Cellini, research has shown that music therapy can also help reduce NICU stays by as many as 12 days.

During a typical session in the NICU, Cellini works one-on-one with each infant, tailoring the therapy to meet every baby’s individual needs. She carefully monitors each newborn’s response to the music, including signs of overstimulation, and adjusts her music accordingly.

The music therapy program was made possible through a generous donation from 14-year-old twins Joey and Ryder Corleto, who spent considerable time in the NICU at Cedars-Sinai shortly after birth. Wanting to give back to the Cedars-Sinai community, the siblings chose to dedicate their bar and bat mitzvah gifts to help launch the program.

Their mother, Melissa Corleto, vividly remembers the challenges of spending time in a noisy NICU with the twins.

“When they look back at pictures of themselves as babies, it’s hard for them to imagine that this is where they started—at just 2.5 and 3.5 pounds,” Melissa said. “The idea of giving back to the NICU really resonated with them. As a family, we decided this was the meaningful way they wanted to give back.”

Music has always played a major role in the twins’ lives. Ryder is an avid drummer, while Joey is a competitive dancer. The twins said it felt natural to use their funds to help launch a music therapy program, especially one designed to soothe babies and support early brain development.

The bedside therapy sessions are also a welcome change of pace for parents and medical staff.

“The NICU can be a very traumatic and stressful environment, and music therapy helps create a sense of calm for the babies, their families and even the staff,” said Ashley Richardson, RN, assistant nurse manager of the NICU at Guerin Children’s.

For Jason Park, whose son Logan Park has spent more than two months in the NICU, watching his baby remain calm and relaxed as Cellini sang and played music at his bedside brought a sense of much-needed comfort and relief.

“I think the music brings a lot of joy to parents, especially for families like ours who have been here in the NICU for a long time,” Park said. “When the session ended, I was actually sad to hear it stop.”

Read more from Cedars-Sinai Stories and Insights: Strengthening Children’s Health

The at-home monitoring device is designed to track early signs of asthma and provides clinicians with continuous or on-demand remote monitoring of lung sounds. The real-time data enables healthcare professionals to monitor a child’s condition between clinic visits and respond early if a child’s symptoms worsen.

The easy-to-wear device, called AeviceMD, was developed by Aevice Health, a Singaporean digital health company and a graduate of the Cedars-Sinai Accelerator program.

“I saw strong potential in this technology to support how we monitor and manage children with reactive airway issues like asthma outside of the clinical setting,” said Irina Dralyuk, MD, a pediatric pulmonologist at Guerin Children’s. “Being able to assess respiratory symptoms in real time, especially overnight, provides valuable information that can guide earlier intervention and help prevent more serious breathing complications.”

About 4.5 million children in the United States have asthma, making it one of the most common chronic pediatric diseases. Traditionally, doctors have monitored children with asthma through periodic clinic visits and caregiver-reported symptoms such as rapid breathing, chest congestion and breathing difficulties.

However, asthma symptoms often fluctuate widely between visits, and self-reported symptoms are often unreliable. This makes managing worsening symptoms between appointments very difficult.

The wearable stethoscope allows parents to utilize the device at home to record lung sounds and securely share recordings with their doctors. The data enables doctors to build a more complete picture of disease progression, track medication use and assess how patients’ symptoms evolve in response to their treatment plan.

“What we’re trying to do is prevent exacerbations, reduce hospitalizations and emergency department visits, and limit the need for interventions such as systemic steroid use to control asthma symptoms,” Dralyuk said. “Intervening early could decrease chronic inflammation and improve lung function and health over time.”

Children can wear the device, about the size of a half-dollar coin, on the chest for up to 10 hours a day. It is designed for use in children 3 and older.

“We built AeviceMD to make this kind of continuous symptom visibility possible. Having our technology deployed at a large, world-class health system like Cedars-Sinai validates our belief that there is a critical, unmet patient need,” said Adrian Ang, CEO of Aevice Health.

The device is the result of a multiyear collaboration with Cedars-Sinai that began in 2022 and included clinical input from physicians at Guerin Children’s. The collaboration included key regulatory milestones and a pilot program to evaluate the device’s effectiveness in pediatric respiratory monitoring. In 2023, the device received clearance from the U.S. Food and Drug Administration.

“This collaboration demonstrates the importance of providing clinical and operational support to help advance a company’s promising technology toward real-world patient benefit,” said Nirdesh K. Gupta, PhD, managing partner of Cedars-Sinai Intellectual Property Company. “It’s an exciting example of how innovation can directly impact care and improve the way we manage chronic conditions like asthma.”

Read more from Cedars-Sinai Stories and Insights: Common Breathing Problems in Kids and How to Treat Them

Neuro NICU is a specialized program that brings together multidisciplinary pediatric specialists to deliver advanced, coordinated care for newborns with complex neurological conditions. Housed within the Neonatal Intensive Care Unit at Cedars-Sinai, the program is designed to provide timely intervention during the crucial period of early brain development.

The Neuro NICU’s comprehensive, multidisciplinary model of care includes leading experts in neonatology, neurology, neurosurgery, neuroradiology and genomics. The staff also includes specially trained NICU nurses and social workers adept at deploying around-the-clock care tailored to the unique needs of newborns and their families.

“The newborn brain is fundamentally different from that of a child or an adult, which is why neurological care at this stage requires highly specialized expertise,” said David Rowitch, MD, PhD, deputy director for Research at Guerin Children’s. “Understanding how the developing brain responds to injury and how to interpret imaging in this context is critical. The Neuro NICU allows us to bring that expertise together in a coordinated way for each patient.”

The Neuro NICU team, led by co-directors Yolanda Brown-Madan, MD, and Xin Ye, MD, is equipped to treat patients with a wide range of neurological conditions, including neonatal seizures, stroke, severe congenital neurological disorders, brain malformations, as well as birth complications and traumatic injuries to the brain or the nervous system.

A defining feature of the Neuro NICU is the early integration of genomics, which allows the team to deliver precision gene therapies and genetic diagnoses to infants sooner. Guerin Children’s is among the first programs to offer rapid whole‑genome sequencing for babies in a NICU setting, with genetic results delivered in a matter of days.

Research at Guerin Children’s has shown that more than 40% of children seen by pediatric neurologists have an underlying genetic condition. Having genetic information readily available can directly influence clinical decisions and improve the ability to personalize care for vulnerable newborns.

“Our comprehensive approach in the Neuro NICU enables Guerin Children’s to deliver a seamless continuum of care as patients improve and grow beyond their stay,” said Shervin Rabizadeh, MD, MBA, chair of the Department of Pediatrics and deputy director of Guerin Children’s.

The Neuro NICU also employs state-of-the-art, infant‑specific technologies, including continuous video electroencephalography (EEG) monitoring, which provides real‑time data to help clinicians intervene quickly during critical moments.

That same level of technological capability extends beyond the unit. Designed to function as a regional center for neonatal neurological care, the Neuro NICU extends its reach to affiliated partners and hospitals in the greater Los Angeles area and beyond. Specialized neonatal transport services allow teams to initiate critical therapies before a baby arrives at Guerin Children’s.

“Our goal is to ensure that newborns receive the right care at the right time, regardless of where they begin their medical journey,” said Rangasamy Ramanathan, MD, director of the Division of Neonatology at Guerin Children’s. “Through advanced transport capabilities and virtual collaboration, the Neuro NICU allows us to support community hospitals and families across the region.”

Additionally, the program offers virtual consultations, enabling neurologists to guide care remotely and support physicians at referring hospitals.

“The launch of the Neuro NICU reflects Guerin Children’s’ commitment to advancing research‑driven, specialized, world-class pediatric care for the most vulnerable patients in greater Los Angeles and beyond,” said Ophir Klein, MD, PhD, executive vice dean of Children’s Health and executive director of Guerin Children’s.

Read more from Cedars-Sinai Stories and Insights: Making Strides in Treating the Smallest Heart Patients

annual meeting, April 24–27 in Boston.

The physician-scientists are available for interviews to discuss new research on improving care in neonatal intensive care units, quality improvement efforts and simulation training for neonatal transport and emergency newborn care.

“As Guerin Children’s continues to evolve as a premier destination for specialty pediatric care in Los Angeles, PAS 2026 is an important opportunity for our pediatricians to share scientific and clinical advances in lifesaving newborn medicine,” said Ophir Klein, MD, PhD, executive vice dean of Children’s Health and executive director of Guerin Children’s.

Simulation Workshops

Rangasamy Ramanathan, MD, MBBS, director of Neonatology at Guerin Children’s, and Mahmood Ebrahimi, MD, a registered diagnostic cardiac sonographer and clinical instructor in Pediatrics, will co-lead a hands-on simulation workshop on targeted neonatal echocardiography. The training focuses on using echocardiography to assess how patent ductus arteriosus, a congenital heart defect, affects blood flow in preterm infants. The workshop is scheduled for Friday, April 24, 10:30 a.m. to noon.

A second simulation workshop, co-led by Ebrahimi, will train clinicians in the use of point-of-care ultrasound (POCUS) for real-world neonatal emergencies and critical care scenarios. This session is scheduled for Friday, April 24, 6:30-8 p.m.

Guerin Children’s Experts Presenting Research at the Meeting

Manoj Biniwale, MD, director of NICU Clinical Research, Division of Neonatology at Guerin Children’s, will present research across multiple sessions on several topics, including clinical trial data evaluating different approaches to umbilical cord management in premature infants and a simulation training session to improve how healthcare providers learn and retain critical newborn resuscitation skills.

Kurlen Payton, MD, assistant director of Quality and Safety at Guerin Children’s, will present research on a multicenter quality improvement initiative that increased maternal breast milk use at discharge for very low birth weight infants, improving outcomes and health equity.

Kyle Willsey, DO, pediatric intensivist at Guerin Children’s, and Lauren Collins, RN, will present how simulation training and neonatal transport impact workload and outcomes among pediatric transport teams.

To arrange interviews with Guerin Children’s experts, contact Shishira Sreenivas at Shishira.sreenivas@cshs.org or 202-297-0220.

Pediatric interventional cardiology has had meaningful advances over the past decade that are changing how children with congenital heart disease are treated at

Congenital heart defects, which arise from abnormal or incomplete formation of the heart, valves and blood vessels, are among the most common birth defects worldwide. The condition affects approximately 40,000 babies each year in the United States.

From less invasive, catheter-based procedures to improved imaging and emerging technologies, innovations are helping reduce risk, shorten recovery times and expand treatment options for the smallest patients with heart problems.

The Cedars-Sinai Newsroom recently spoke with Stephen Nageotte, MD, MBA, an interventional cardiologist and director of the Congenital Catheterization Laboratory at Cedars-Sinai Guerin Children’s and the Smidt Heart Institute. Nageotte treats children and adults using minimally invasive procedures. He shared what’s new in the field and what families need to know:

What are the most significant advances you’ve seen in pediatric interventional cardiology in recent years?

Over the past five years, there have been major advances in three key areas:

• Premature patent ductus arteriosus [PDA] closure. It’s a congenital heart condition in which a connection between two blood vessels in an infant fails to close after birth. This can cause abnormal blood flow to the lungs and breathing difficulties, particularly in premature infants.
• Transcatheter pulmonary valve replacement, which is a minimally invasive procedure in which we replace a faulty heart valve using a catheter instead of surgery.
• PDA stenting. Sometimes babies have heart problems that limit blood flow to the lungs. We can keep a small vessel called the ductus arteriosus open by placing a tiny tube, or stent, inside it to improve blood flow.

All three procedures have evolved significantly and are allowing us to treat patients in less invasive ways, often replacing or delaying the need for surgery.

How has transcatheter PDA closure changed care for premature infants?

Transcatheter PDA closure has become an important option for premature infants with a hemodynamically significant PDA—meaning the vessel is causing strain on the heart and lungs. In fact, Evan Zahn, MD, of the Smidt Heart Institute, helped develop the device cardiologists use to close a PDA during a transcatheter procedure.

The procedure is quick and can be done at the bedside in the Neonatal Intensive Care Unit [NICU], which helps us avoid transporting fragile infants. Research also suggests many babies show respiratory improvement after closure, which may reduce complications associated with long‑term ventilation.

Who is typically a candidate for the transcatheter PDA closure?

These procedures are generally for premature infants who are showing signs that the PDA is affecting their health, such as needing increased respiratory support or showing enlargement of the heart. There’s no strict minimum weight requirement, and the focus is really on whether the PDA is having a meaningful impact on the baby’s heart and lungs. Transcatheter PDA closure is also performed on older kids and adults.

What impact has new device technology had on how these procedures are performed?

One recent advancement is an improved delivery system for PDA closure devices. The device, known as the Amplatzer Piccolo Delivery System, recently received FDA [Food and Drug Administration] clearance to treat premature infants with PDA, including babies weighing as little as 2 pounds. Previously, the procedure required exchanging multiple catheters during the case, which could introduce instability; the newer system allows physicians to navigate and deliver the device using a single, shorter, softer catheter, potentially improving patient stability and precision.

How has transcatheter pulmonary valve replacement expanded treatment options for patients?

The development of newer self‑expanding valves has significantly increased the number of patients who can receive pulmonary valve replacement through a catheter instead of surgery. These procedures are typically considered from late childhood through adulthood and are used for patients with pulmonary valve disease related to congenital heart conditions. Early outcomes have shown good durability and high success rates.

Imaging plays a big role in heart care. What improvements are making the biggest difference?

There have been significant advances in cardiac CT and MRIs. Imaging is faster, clearer and uses lower radiation doses than in the past. These tools help us better understand heart anatomy, blood flow and timing for interventions. There’s also growing interest in using virtual or augmented reality to create 3D heart models for procedure planning, allowing teams to better visualize anatomy before a procedure.

What should families know as they navigate a congenital heart diagnosis?

Early detection and screening are incredibly important, ideally before birth, so families can meet the care team and understand what to expect. At Cedars-Sinai we can identify a defect while a baby is still in the womb and will continue to care for the baby at birth, during childhood, and all the way through adulthood, so the patient never needs to transfer to another institution.

Congenital heart care is lifelong and truly a team effort. Families aren’t expected to understand every technical detail—our role is to guide them, answer questions and be there every step of the way. Building long‑term relationships with patients and families is one of the most meaningful parts of this work.

Read more from Cedars-Sinai Stories and Insights: Making Strides in Treating the Smallest Heart Patients

The discovery, published in Cell, has important implications for understanding how a wide variety of intestinal disorders may develop.

“Our research opens the door to treatments that focus on restoring key molecular signals in vulnerable regions of the colon,” said Ophir Klein, MD, PhD, executive director of Cedars-Sinai Guerin Children’s, executive vice dean of Children’s Health, and the David and Meredith Kaplan Distinguished Chair in Children’s Health. Klein is the senior author of the study.

Prior research has shown that the four sections of the colon—ascending, transverse, descending and sigmoid—have different functions and risks for disease, but it wasn’t clear why these variations exist.

In this study, the investigators showed that the identity of distinct regions of the colon are regulated by the gut microbiome. They identified nicotinic acid, a molecule produced by certain bacteria in the gut microbiome, as a main driver of these regional differences in the colon’s sections. Nicotinic acid, also known as niacin, part of the vitamin B3 family, helps the body convert food into energy and supports the health of cells.

The researchers compared laboratory mice with and without a microbiome. They found that production of nicotinic acid by bacteria in the upper colon activates a protective mechanism in colon cells. In mice without a microbiome, minimal nicotinic acid was produced, and cells in the upper colon became more vulnerable to damage and disease.

Investigators also studied human colon tissue samples. They found that the different sections of the human colon showed regional characteristics similar to patterns observed in mice. And in samples from human patients with Crohn’s disease— a type of bowel disease in which abnormal immune system activity causes inflammation—this protective mechanism was reduced.

“Our work highlights the importance of studying host microbiome interactions with careful attention to specific colon regions, rather than treating the colon as a uniform organ,” said Jeremie Rispal, PhD, a postdoctoral scholar at the University of California, San Francisco, and the first author of the study. “We learned that the microbiome controls regional differences and tissue protection.”

Further study will be needed to confirm the precise mechanisms behind this protective effect and to determine how these findings might be used in new therapies for intestinal disorders.

Additional Cedars-Sinai authors include Manasa Vegesna, Dedeepya Vaka, and Dario Boffelli .

Other authors include Jasmine R. Garcia, Brisa Palikuqi, Seung Woo Kang, Coralie Trentesaux, Juan Du, Nicola R. Realini, Paige N. Spencer, James M. Gardner, Annika Hausmann, Michael G. Kattah, and Ken S. Lau.

Funding: This work was funded by NIH U01DK103147 from the Intestinal Stem Cell Consortium (to O.D.K. and D.B.), RC2-DK140862 (to O.D.K. and D.B.), R01DK103831 (to K.S.L.), F31DK127687 (to P.N.S.), T32HD007502 (in support of P.N.S.), T32CA119925 (in support of S.K.), the Leona M. and Harry B. Helmsley Charitable Trust G-1903-03793 (to the VUMC Gut Cell Atlas of which K.S.L. is a member), the Stanley Cohen Innovation Fund (to K.S.L.), the Benioff Center for Microbiome Medicine (to J.R.), and the PZ00P3_223765 SNSF Ambizione grant (to A.H.). Organoid work was supported by funding from the Kenneth Rainin Foundation and NIH R01 DK14167. The Kattah Lab has received research support from Eli Lilly. J.R. was supported by the Bakar Aging Research Institute postdoctoral fellowship and the Bettencourt Schueller foundation.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

“The natal teeth were little paper-thin teeth that fell out right away, as they didn’t have well-developed roots. And, where I had natal teeth, I had no secondary teeth later in life,” said Graham, a retired professor of Medical Genetics and Pediatrics and former director of the Division of Clinical Genetics and Dysmorphology at Cedars-Sinai. “The condition is called tooth agenesis.”

Tooth agenesis can pose challenges such as difficulty breastfeeding, confidence issues due to missing teeth and costly out-of-pocket expenses for dental work.

Graham experienced those challenges firsthand. Correcting his missing teeth required extensive dental implants, procedures that continued well into adulthood. And as a teen active in sports, he frequently required repairs to fix chipped teeth.

The puzzling condition affected five generations of Graham’s family, beginning with his maternal grandfather. Graham’s mother wore false teeth for much of her life, and several of her siblings showed signs of the condition. Two of his three sons were born with natal teeth, and a granddaughter is also affected.   

Graham had a strong hunch that it was an inherited genetic condition. That curiosity ultimately shaped his career. Graham pursued genetics in medical school, driven in part by a desire to understand the condition affecting his family. Years later, he began a formal search for the responsible mutation.

After more than 12 years of research, the mystery has finally been solved.

In a study published in the International Dental Journal, a team of investigators led by Graham and his longtime Cedars-Sinai colleague Pedro Sanchez, MD, identified a mutation in the KDF1 gene as the likely root cause of natal teeth. While natal teeth are relatively common and occur in approximately 1 in every 1,000 newborns, KDF-1-related multiple natal teeth with tooth agenesis is quite rare.

Finding the Gene Mutation

Finding the mutation was not a simple task. For Graham’s first attempt in 2013, he ran tests on DNA samples he collected from affected and unaffected family members. But the genetic testing tools available at the time were not advanced enough to comb through the 20,000 genes in the human genome.

“In order to make a gene discovery, you have to know it's there, and you have to know what it does,” Graham said. “The same gene can give rise to different genetic diagnoses. And how it does that, it's not always clear.”

Years later, as Graham prepared for retirement, Sanchez, Graham’s mentee and director of Pediatric Medical Genetics at Cedars-Sinai Guerin Children’s, encouraged him to revisit the research.

Sanchez credits Graham with inspiring his own path into genetics. Over the years, the two developed a close professional and personal bond, even co-authoring medical textbooks.

“I know him, I know his family, and I'm the same age as his kids,” Sanchez said. “Knowing this condition had affected them for generations without closure, I felt there was a missing piece. The tools had evolved, and I believed we could work together and find an answer.”

A Detailed Look Into DNA

When Sanchez revisited Graham’s family data with fresh eyes and newer genetic tools, he took a more targeted approach and focused on collecting DNA samples from four family members: Graham and one affected son, as well as Graham’s wife and one unaffected son, who served as controls.

This time, Sanchez deployed whole genome sequencing, a comprehensive test that analyzes a person’s entire DNA sequence.

“I treated them just like a family we see in our clinic,” Sanchez said. “We ended up doing a focused exam, and we sequenced all four of them.”

The strategy worked.

The team pinpointed a mutation in the KDF1 gene, which is known to play a role in epidermal development, including structures like skin and teeth.

The finding doesn’t offer a cure for tooth agenesis, but it opens doors to earlier diagnosis, improved counseling for families and a pathway for research into potential treatments. It may also strengthen advocacy efforts for dental insurance coverage.

For Graham, however, the impact is more than scientific. After decades of questions, the answer is finally in hand, bringing a sense of closure to a family that dealt with this trait for generations. Sanchez said he’s honored to be part of the solution.

“Dr. Graham, as a mentor, taught me to be a physician,” Sanchez said. “It's really nice that he was able to share the findings with his family and finally give the gene variant that has affected them for generations a name.”

Read more from Cedars-Sinai Stories and Insights: How Do Your Genes Fit? Cracking the Code on Breast Cancer Risk

The new study, called BLOOMS (Babies’ Longitudinal Outcomes, Omics and Milestones Study), launched last year with the goal of recruiting approximately 1,000 infants admitted to neonatal intensive care units (NICUs) at Cedars-Sinai and another 1,000 infants admitted to NICUs across three National Health System (NHS) hospitals in the United Kingdom. In addition to Guerin Children’s, BLOOMS brings together an international research team led by investigators at the University of Cambridge in the U.K. and collaborators in Singapore from the Agency for Science, Technology and Research (A*STAR).

Using genomics to address urgent health needs of the sickest, most vulnerable babies in the NICUs, the research aims to predict future health complications that might affect children’s school readiness by age 5.

“The study is part of the ambition at Guerin Children’s to integrate genomics into care across the lifespan,” said David H. Rowitch, MD, PhD, the principal investigator of BLOOMS and deputy director of Research at Guerin Children’s. “With the support of the Wellcome Trust funding and global collaboration across three countries, we are opening new pathways to better understand the challenges associated with NICU admission so that we can effectively support every child’s full potential.”

While most institutions in the consortium can perform whole genome sequencing to identify genetic risks, Cedars-Sinai’s unique expertise in proteomics—advanced tools to study the structure and function of proteins in real time—provides further valuable insights. Cedars-Sinai investigators aim to use proteomics to identify early disease biomarkers that might predict health and neurodevelopmental conditions that affect school readiness.

Having early access to often overlooked yet vital information about at-risk NICU babies could significantly aid in mitigating future health and developmental challenges by understanding disease origins and in driving targeted treatments.

The study will incorporate the outcome of school readiness, a common assessment tool in the U.K. typically used to measure a child’s physical, cognitive, social and emotional development for integrating into the formal schooling system. This important predictor of early life-course trajectory may be positively influenced by early medical and educational interventions.

“By early identification of school readiness issues such as a learning disability—especially in NICU babies—we can enable medical teams to potentially implement timely interventions, including precision medicine approaches based on genetic makeup to improve the life trajectory for these children,” said Catherine Aiken, MD, chief lead investigator of the study and an academic clinical lecturer in the Department of Obstetrics and Gynaecology at the University of Cambridge.

The study will follow the recruited children until they reach the age of 5, with results expected to be reported by 2033.

“International collaboration is key to advancing research and solving global health challenges,” said Neerja Karnani, PhD, deputy director at A*STAR Bioinformatics Institute and senior principal investigator at the A*STAR Institute for Human Development and Potential (A*STAR IHDP).  

Singapore’s participation in BLOOMS, supported by A*STAR BII’s expertise in secure data analytics, will create opportunities to integrate and align early childhood development initiatives and strategies with the U.K.

By pooling diverse genetic data from the participating institutions, the investigators hope to initiate a paradigm shift in diagnosing and treating early childhood diseases, moving toward a more proactive approach to addressing pediatric health complications on multiple continents as early as possible. 

“The BLOOMS study is a testament to Cedars-Sinai's unwavering commitment to advancing pediatric care through leading-edge research,” said Shlomo Melmed, MB, ChB, executive vice president of Medicine and Health Sciences and dean of the Medical Faculty at Cedars-Sinai. “By participating in this global collaborative effort, we are enhancing our understanding of genomics and improving long-term health outcomes for newborns and their families.”

Read more from Cedars-Sinai Stories and Insights: A Map of Disease Beginnings

Pediatric epilepsy affects nearly 470,000 children in the United States, making it the most common childhood brain disorder. There are many types of epilepsy, including Dravet syndrome, a rare and severe form of the condition, caused by a specific genetic mutation that typically begins in the first year of life. It affects 1 in 15,700 children and significantly impacts quality of life.

“Dravet syndrome is the most common genetic epilepsy disorder we see in children that requires specialized care and attention,” said Deborah Holder, MD, program director of Pediatric Epilepsy at Guerin Children’s. “Awareness is critical so families and healthcare providers can recognize the early signs and seek the right interventions.”

With November marking Epilepsy Awareness Month, the Cedars-Sinai Newsroom recently spoke with Holder to learn more about Dravet syndrome, early signs of seizures to watch for, how genetics play a role and why increased awareness and early detection can be life-changing.

What is Dravet Syndrome?

Dravet syndrome is a type of epilepsy that presents in childhood. It's predominantly caused by a mutation in a gene, specifically a sodium channel gene called SCN1A, which is one of the genes that impact how the brain works. It usually starts with seizures in childhood. Most children have their first seizure, usually between one year and 18 months, although it can start as young as six months.

What are the Symptoms of Dravet Syndrome?

Patients with Dravet syndrome typically present with seizures triggered by high fevers, which can be caused by illness, infection or fever occasionally following vaccination. Early seizures are often hemiclonic, meaning they involve rhythmic motor activity on one side of the body. A seizure may occur on the left side of the body the first time and then on the right side of the body the next time. 

A doctor will see a patient come in with these very long, often prolonged seizures, which we call status epilepticus. Such seizures require significant intervention with lots of medications and hospital care.

Children with Dravet syndrome face multiple challenges, including developmental difficulties that may lead to behavioral disorders, delayed language and speech issues, nutrition and sleeping difficulties and abnormalities in gait and walking. Additionally, the condition can affect other parts of the body, such as the heart.

How is Dravet Syndrome Diagnosed?

Because Dravet syndrome is one of the most common genetic epilepsy disorders in children, it’s important to perform genetic testing early. Identifying the underlying mutation allows us to make an accurate diagnosis. Evaluating the child’s seizure patterns and seizure type also helps us gather the information needed to choose the right medications to bring seizures under control.

The challenge with Dravet syndrome lies in the way it affects a child’s genetics. Although patients may appear to have long focal seizures, the medications typically used for focal seizures can actually make their condition worse. This is why it’s really important that we make the genetic diagnosis so we can treat the gene mutation, instead of the seizure type. It’s also important to note that

Is Dravet Syndrome an Inherited Disorder?

Dravet syndrome is not usually inherited from the parents. Many people hear “genetic disorder” and assume it occurs when the gene is passed down from the mother or father, but most genetic epilepsies are what we call “de novo,” meaning the mutation occurs for the first time in the child and is not connected to family history. Even if the parents are completely healthy, a child can be diagnosed with Dravet syndrome. In other words, any baby could potentially be at risk.

How is Genetic Testing Performed for Dravet Syndrome?

Genetic testing now is very easy. We just do a cheek swab. We don't even have to do a blood test. For pediatric patients, we typically do what's called whole exome sequencing, which really sequences all of the genomes we're familiar with today. Instead of doing a panel where we look at the most common genes that cause epilepsy, we really sequence everything. This way, we don't miss any of the genes that we are currently aware of, including SCN1A, the gene that causes Dravet syndrome.

How Do You Treat Dravet Syndrome?

Several anti-seizure medications are specifically approved for Dravet syndrome, including cannabidiol (CBD), which has been formally studied and found effective to manage the condition. However, medications don’t work for everyone, so other approaches can help.

Diet therapy, such as the ketogenic diet—a high-fat, low-carb diet that puts the brain into ketosis—can be very effective. We typically combine medication and diet therapy for the best results.

Additionally, there are several devices and rescue therapies available to help stop prolonged seizures and reduce hospital stays for children with Dravet syndrome. The vagus nerve stimulator is a device commonly used for Dravet syndrome. We place a wire along the vagus nerve, which is a nerve that runs along the neck. The device is designed to continuously monitor the heart rate and, when it detects a rise in heart rate and seizure activity, it sends signals to the brain to both prevent and stop seizures in its tracks.

Currently, there are also a few clinical trials exploring gene-modifying therapies. These approaches aim to directly target the underlying genetic cause, potentially controlling Dravet syndrome more effectively and improving the quality of life for children.

Read more on the Cedars-Sinai Blog: Personalized Epilepsy Treatment for Each Child

To kick-start some Halloween magic, excited parents picked out outfits specially hand-sewn by Cedars-Sinai volunteers to accommodate the hospital’s littlest patients, bringing big smiles and a touch of normalcy in an otherwise stressful time.

“It’s hard to be in the NICU,” said Alva Pantig Gregorio, a clinical social worker who helps parents navigate their child’s stay in the NICU. “Celebrations can be difficult to keep up with when you’re at the hospital with a fragile baby. So, we bring the baby’s first Halloween to them.”

The babies’ costumes, all inspired by children’s books, included pumpkins, a watermelon, a snowman, a caterpillar, an ear of corn and a peanut, complete with a matching hat.  

Lauren Masciarelli’s son, Wesley, surprised everyone by being born two months early, and the doting mom was thrilled to pick out a classic first Halloween costume for her newborn.

“I always liked being a pumpkin as a kid, and I joked with my husband that his first costume next year could be a pumpkin. So, when I saw this, I had to go for it,” Masciarelli said. “This costume is the best quality costume I think he'll ever have in his life.”

Each outfit is lined with Velcro and tailored to accommodate the tubes, wires and other medical equipment. Parents get to take the keepsake costumes home to remember their baby’s first Halloween.

Dana Guerin, director of the Shapell Guerin Family Foundation, stopped by the NICU to join in on the fun celebration.  She was touched by the staff’s and volunteers’ dedication, exceptional care and attention to detail.

“It’s very clear that there is so much hard work and so much love that goes into this event,” Guerin said. “They go the extra mile to bring vulnerable babies, their families and the community together for a day to remember.”

Read more on the Cedars-Sinai Blog: Helmet Safety for Your Kids

The researchers will use stem cells to improve the effectiveness of oral tissue grafting—a procedure thousands of patients undergo each year in which tissue is transplanted from another part of the mouth to improve or repair trauma from significant tissue loss. In about 1 in 4 patients, the grafts fail due to various factors, including lack of blood supply to the graft, infection and poor healing.

The study is funded by a new five-year $5.7 million grant from the National Institutes of Health (NIH) and supports a multidisciplinary team from Guerin Children’s, Virginia Commonwealth University (VCU) and the University of California, San Francisco (UCSF).

"Our goal is to deepen our understanding of the oral mucosa and to learn how to enhance mouth tissue healing,” said Ophir Klein, MD, PhD, co-principal investigator of the study, executive director of Guerin Children’s and executive vice dean of Children’s Health at Cedars-Sinai. “We plan to turn stem cells into personalized oral tissue grafts that we hope will improve outcomes for patients.”

Oral mucosa is the soft tissue lining the inside of the mouth, including the cheeks, gums and tongue. It serves as a protective barrier against bacterial infection and injury, aiding in essential functions like speaking, chewing and swallowing.

For the preclinical research, the team will grow oral tissue in the lab using induced pluripotent stem cells—adult cells that are reprogrammed into cells that can be turned into virtually any cell type—from laboratory mice. The team hopes to be able to produce, in any needed amount, personalized living grafts with blood vessels that closely resemble natural oral tissue.

“Using advanced bioengineering tools, we can create complex tissues with tiny blood vessel networks that build themselves in a short period of time,” said Zev Jordan Gartner, PhD, co-principal investigator on the study and professor of Pharmaceutical Chemistry at the UCSF School of Pharmacy.

This method, Gartner said, will help the team design custom tissue grafts that could potentially be used in any part of the mouth.

Kevin Matthew Byrd, DDS, PhD, co-principal investigator on the study and assistant professor in the Philips Institute for Oral Health Research at the VCU School of Dentistry, said the research could potentially transform reconstructive care for head and mouth injuries.

“By customizing grafts to fit individual patient needs, we are advancing toward more personalized and effective dental treatments,” Byrd said. “This research has the power to notably improve care quality and establish new dental health standards.”

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

pediatric specialists will join their peers at the American Academy of Pediatrics (AAP) 2025 National Conference & Exhibition Sept. 26-30 in Denver and will be available to comment on breaking news from the conference.

“In just a few short years, Guerin Children’s has assembled a robust roster of world-class pediatric specialists,” said Ophir Klein, MD, PhD, executive vice dean of Children’s Health and executive director of Guerin Children’s. “In our state-of-the-art facility in the heart of Los Angeles, we’ve created a pioneering healthcare destination with physicians and scientists who deliver exceptional multidisciplinary care and drive innovative research to address childhood diseases—from the womb through adulthood.”

One of these experts, neonatologist Theodora Stavroudis, MD, will serve as chair-elect of the AAP Section on Simulation and Innovative Learning Methods. At the conference, Stavroudis will present original research on neonatal resuscitation.

Guerin Children’s will also have a booth in the exhibit hall—Booth 1738—to showcase the institution’s research, medical education programs and clinical innovations.

Some of the Guerin Children’s experts available for interviews include:

Adolescent Health
Michelle Escovedo, MD, adolescent health specialist

Behavior and Development
Cesar Ochoa-Lubinoff, MD, director of Developmental-Behavioral Pediatrics

Cardiology
Evan Zahn, MD, co-director of the Guerin Family Congenital Heart Program
Richard Kim, MD, director of Pediatric and Congenital Heart Surgery

Ear, Nose and Throat
Gene Liu, MD, director of Academic Otolaryngology at Cedars-Sinai

Epilepsy
Deborah Holder, MD, program director of Pediatric Epilepsy 

Gastroenterology
Shervin Rabizadeh, MD, MBA, chair of the Department of Pediatrics and associate director of Guerin Children’s

General Surgery
Eugene Kim, MD, pediatric surgeon-in-chief and deputy director of Guerin Children’s

Genetics 
Pedro Sanchez, MD, director of Pediatric Clinical Genetics
Saquib Lakhani, MD, director of Guerin Children's Early Detection Program
Mustafa Khokha, MD, director of Guerin Children's Genetics Research Center
Joyce So, MD, PhD, chief genomics officer at Cedars-Sinai

Infectious Disease
Priya Soni, MD, assistant professor of Pediatrics

Neurology
Jane Tavyev Asher, MD, director of the Division of Pediatric Neurology

Neurosurgery
Moise Danielpour, MD, director of Pediatric Neurosurgery

Oncology
Leo Mascarenhas, MD, director of Pediatric Hematology and Oncology

Orthopedics
David L. Skaggs, MD, director of Pediatric Spine and Pediatric Orthopaedics at Guerin Children’s

Plastic Surgery
Victor Chien, MD, director of Cleft and Craniofacial Surgery

Contact: 
To arrange interviews with Guerin Children’s specialists, contact Shishira Sreenivas at shishira.sreenivas@cshs.org or 202-297-0220.

So brings more than 15 years of leadership experience in research and clinical care to her new role. She will spearhead Cedars-Sinai’s growing genomics initiatives and serve as a strategic leader for the integration of genomics into clinical practice while overseeing genetics and genomics services across the Cedars-Sinai Health System.

“We are excited to welcome Dr. So to Cedars-Sinai, knowing her exceptional expertise and leadership in clinical genetics will be a significant asset to the burgeoning prenatal, pediatric and adult genetics programs,” said Shlomo Melmed, MB, ChB, executive vice president of Medicine and Health Sciences and dean of the Medical Faculty at Cedars-Sinai. “Her appointment will ensure Cedars-Sinai remains at the forefront of genomic endeavors, benefiting and transforming the lives of our patients.”

So has joined Cedars-Sinai from the University of California, San Francisco (UCSF), where she was chief of the Division of Medical Genetics and medical director of Adult Genetics. She was also director of the institution’s designation as a National Organization for Rare Disorders Rare Disease Center of Excellence. During her tenure, she developed a comprehensive genetics program that included the launch and rapid growth of UCSF’s Adult Genetics and Preventive Genomics Clinic; the expansion of multidisciplinary specialty services in cardiovascular, neurogenetic and cancer genetics; and the implementation of innovative e-consult and telehealth services to improve access to genetic care.

So earned her bachelor’s degree with high distinction in molecular biology and molecular genetics and her medical degree from the University of Toronto. She completed her medical genetics residency at the university’s Hospital for Sick Children and earned her doctorate in molecular genetics from the Max Planck Institute for Molecular Genetics in Berlin and completed a postdoctoral research fellowship in psychiatric genetics at the Centre for Addiction and Mental Health in Toronto.

“I am honored to join Cedars-Sinai as the inaugural chief genomics officer to advance the fields of genetics and genomics with the goal of enhancing patient care and health outcomes,” So said. “Together with our talented team of investigators and clinicians, we will push the boundaries of what is possible in genomic medicine for the benefit of our patients, their families and the wider community.”

So’s current research focuses on optimizing genetic diagnosis and treatment strategies for adults with complex neurodevelopmental, neuropsychiatric and neurological conditions. She also is deeply committed to quality and continuous improvement in the delivery of genetics and genomics clinical services.

“Dr. So’s appointment reinforces our commitment to advancing precision medicine and making leading-edge genomic care accessible to all our patients through all stages of life,” said Ophir Klein, MD, PhD, executive vice dean of Children’s Health and executive director of Guerin Children’s. “We are excited to expand our research and clinical capabilities under her leadership.”

Read more on the Cedars-Sinai Blog: Do Children Need Genetic Testing?

Cedars-Sinai experts recommend getting the flu shot starting in September before flu season begins as early as November. They say vaccination is the most powerful tool to avoid influenza-related hospitalizations or worse. As many as 130,000 people in the U.S. died from the flu last year, according to estimates from the Centers for Disease Control and Prevention.

“By getting the flu shot, you’re not only protecting yourself, you’re protecting your family and vulnerable members of the community who would suffer a more serious illness,” said Jonathan Grein, MD, director of Hospital Epidemiology at Cedars-Sinai and associate professor in the Department of Medicine.

Although vaccination is the best way to prevent the flu, Grein also recommends washing hands thoroughly and often, avoiding others who are sick, and wearing a mask when not feeling well to avoid spreading an illness to others.

The Cedars-Sinai Newsroom spoke with Grein and other Cedars-Sinai specialists about this year’s flu shot recommendations, how to manage flu symptoms and where to seek care during a flu illness.

Who Should Get the Flu Shot?

There are no significant changes to flu shot recommendations this year, Grein said. The vaccine is still advised for eligible adults, teens and children more than 6 months old, according to the Centers for Disease Control and Prevention. Those 65 and older are still encouraged to get a high-dose flu vaccine if available because it elicits a stronger immune response, and older adults’ immune systems weaken with age.

“If a high-dose flu shot is not available, older individuals should receive a standard dose, rather than skipping the shot,” Grein said. “It’s critical for older adults to protect themselves.”

Children 6 months to 8 years old who have never received a flu vaccine should receive two doses, spaced four weeks apart, said Priya Soni, MD, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s.

“Ideally, parents should vaccinate their children before the end of October to ensure protection before peak flu season,” Soni said.

Cedars-Sinai primary care physicians and pediatricians are now offering flu shots to patients during scheduled visits. Patients who have been treated by a Cedars-Sinai primary care provider in the past 16 months can schedule a vaccination appointment through My CS-Link at locations in Beverly Hills, Marina del Rey, Santa Monica, Los Feliz, Playa Vista and Tarzana.

How to Treat Flu Symptoms

Like other upper respiratory infections, flu symptoms include nasal congestion, fever, body aches, cough, sore throat and fatigue. Most people with mild symptoms will improve at home with fluids, a pain reliever such as Tylenol and rest, Grein said. Those at high risk of more serious infection—older adults, immune-compromised individuals and others with chronic health conditions—should speak with their physician soon after symptoms appear to find out whether an antiviral medication like Tamiflu would be right for them.

Those with more severe symptoms—a very high fever, loss of appetite or inability to keep fluids down—should see their physician or visit urgent care, said Jonathan Weiner, MD, chair of the Cedars-Sinai Medical Group’s Department of Primary Care and Acute Care Medicine.

Life-threatening symptoms like difficulty breathing should immediately be addressed in the nearest emergency department.

Flu Treatment for Children

Mild flu symptoms in children look similar to those of an adult and will likewise improve with fluids, rest, and Tylenol or ibuprofen, Soni said. She cautioned against giving children aspirin because of the risk of contracting Reye’s syndrome, a rare but serious illness linked to aspirin. Higher-risk children might need an antiviral treatment prescribed by a physician.

Soni explained that children 2 and younger run a high risk of dehydration, so their parents should make sure they drink and eat enough. She also advised parents to watch for signs that their child’s symptoms might be escalating.

“If a child is struggling to breathe, or showing signs of severe fatigue, vomiting or dehydration, they should be seen promptly by their physician or in the emergency department,” Soni said.

Where to Get Care for the Flu

For children and adults with milder symptoms, a virtual visit through a mobile app like Cedars-Sinai Connect is a great first step to get reassurance or guidance on the best treatment options, Weiner said.

“A physician or other provider can see you, assess how sick you appear and determine if you need to be seen in person or if you can manage your illness at home,” said Weiner, who treats patients in person and via Cedars-Sinai Connect. “If we determine that you need to see your Cedars-Sinai primary care physician or you need to go to urgent care for your symptoms, your provider will see the notes from your virtual visit in your chart because we all share the same Cedars-Sinai medical record.”

If a flu test is needed to rule out other illnesses or for a Tamiflu prescription, Cedars-Sinai Connect providers can order one through a streamlined visit at one of Cedars-Sinai’s urgent care locations. Patients also can get an over-the-counter test at their local pharmacy. Weiner said it’s good to know if you have the flu so you can avoid spreading the illness to others. People are contagious a day before symptoms start and up until their fever has resolved and symptoms are improving—as long as five to seven days after getting sick.

If symptoms do not improve, other causes of upper respiratory tract infections need to be ruled out, which could require in-person treatment, Weiner said. He emphasized that an in-person appointment also is recommended for patients with underlying conditions, high fever, trouble keeping food and liquids down, and for anyone who is having trouble breathing.

Read more on the Cedars-Sinai Blog: Flu and RSV: How to Protect Yourself Now

.

The Cedars-Sinai Newsroom recently spoke with Jane Tavyev Asher, MD, director of the Division of Pediatric Neurology at Cedars-Sinai Guerin Children’s, about how screens affect children and teens differently depending on their age, and what parents can do to set healthy boundaries for screen time.

What is the recommended amount of screen time for children in different age groups?

Before the COVID-19 pandemic, the American Academy of Pediatrics had fairly strict guidelines: no screen time at all for children under age 2, and minimal exposure for ages 2 to 5. Ideally, screen time should be under an hour a day. For ages 5 to 11 and older, less than two hours per day.

Since the pandemic shifted much of our education and social lives online, we've had to adapt those guidelines a bit. Still, research continues to support limiting screen time to less than two hours a day for older children as well. Exceeding that amount has been associated with increased risks of anxiety, depression and other emotional challenges.

How can excessive screen time affect young children’s developing brains?

The general consensus among developmental pediatricians is that children under age 3 should have little to no screen exposure. That’s because their brains are in a critical stage of development, with key processes like myelination, the biological process that speeds up the nerve transmission to the brain, and neural pathway formation actively taking place.

When a young brain is exposed to too much screen time, it can overstimulate the visual cortex—the part of the brain that processes images—at the expense of the auditory cortex, which is vital for developing social skills and language. Ideally, we want their early learning to be grounded in real-world, interactive face-to-face experiences—not passive viewing.

How does screen time via social media impact brain development in teenagers?

Adolescence is a time when the brain is deeply focused on social development and seeking acceptance from peers. Before social media, that feedback loop was limited to in-person interactions with a small group of peers. But now, through apps and platforms, teens are exposed to a constant, amplified stream of approval or disapproval on a much larger scale.

That amplification can be harmful. It places undue stress on the adolescent brain, increasing the risk of social anxiety, low self-esteem and even depression.

Does the type of screen make a difference?

Yes, the type of screen can make a difference. A lot of what’s called “educational content” is often just labeled that way for marketing purposes, without clear evidence that it's truly educational. Watching content on a TV screen is generally safer—it’s farther from the eyes and doesn’t strain the neck or vision as much as phones or tablets.

Also, the platform matters. Streaming services like YouTube often auto-play endless content using algorithms to keep kids hooked. There’s no clear stopping point. In contrast, traditional TV typically airs for a set duration, which naturally limits screen time and reduces the risk of overconsumption.

How does screen-based learning in school affect brain development?

We’ve found that when students read something from a book, they tend to retain the information better than when they read the same content on a screen. We don’t fully understand why that is, but it does suggest that traditional learning methods still hold an important place.

That said, screens can be very helpful when used purposefully. For example, watching a video demonstration of a complex science experiment can be far more effective than trying to imagine it from a textbook. In classroom settings, it’s best when screens are used collectively, as part of a group lesson with discussion led by the teacher, rather than having each student isolate on their own individual device.

Are some children more vulnerable than others to the negative effects of too much screen time?

Yes, certain children are especially sensitive. Children with attention-deficit hyperactivity disorder, or ADHD, symptoms can become overstimulated by video games and may struggle even more with attention. Similarly, children experiencing anxiety or depression, or children who face social challenges may be more prone to negative effects from screen exposure, especially if they’re using it as an escape or replacement for in-person interaction.

In these cases, screen time should be monitored closely, and alternative, healthy outlets should be prioritized.

What are some practical tips for parents to set healthy screen time limits?

One of the most beneficial things parents can do is to ensure their children get at least two hours of physical activity each day, ideally outside. This supports not only their physical health but also their energy levels, focus and even vision.

Another important tip is to delay giving your child a smartphone for as long as possible. There’s a movement called “Wait Until 8th” that encourages parents to hold off until at least after eighth grade. The longer you can wait, the more time your child has to build a strong foundation of social and emotional development without the added pressures of smartphone use.

Read more on the Cedars-Sinai Blog: Does My Child Need Growth Hormone Therapy?  

Wei Gao, PhD, director of Neuroimaging Research and professor of Biomedical Sciences and Imaging; Jane Tavyev Asher, MD, director of the Division of Pediatric Neurology at Cedars-Sinai Guerin Children’s; and David H. Rowitch, MD, PhD, deputy director of Research at Cedars-Sinai Guerin Children’s, sat down with the Cedars-Sinai Newsroom to talk about their work.

Mapping Infant Brain Development

Gao said that besides primary motor connections, social-emotional connections are among the first an infant’s brain makes, and that these connections ladder up to other levels of intelligence.

“The first year is where you need to pay very special attention to the social-emotional development of the baby,” Gao said. “You want to provide sensitive support to the baby so the baby can develop a secure attachment with you as a caregiver. That has long-term impacts to their later achievements and quality of life.”

Social-emotional development is the key piece that integrates the core hierarchy of brain development, Gao said. It starts with sensory and motor regions to ensure early survival, then progresses to higher-order cognitive areas to develop more sophisticated social and emotional regulation skills, which are critical for mental wellbeing, learning and adaptation.

Gao and his team previously created one of the first detailed maps of connections established between different regions of the brain during the first two years of life. They aim to better understand typical brain growth trajectories, as well as how risk factors—including maternal health, prenatal exposures to harmful substances, and family environment—can influence brain growth and a child’s development.

The investigators are now conducting the Healthy Brain and Child Development study, which will follow more than 7,000 children from birth to 10 years old. Regular conversations with caregivers and imaging of the children’s brains will help investigators correlate development of brain connections with other factors in a child’s life.

“We want to use advanced imaging as a tool to detect deviations as early as possible so that we can hopefully bring them back to the normal trajectory,” Gao said.

The Effects of Screen Time During Babyhood

Tavyev Asher is a pediatric neurologist who collaborates with Gao. She said a baby’s brain develops sensory abilities first, followed by language and social skills—a process that can be derailed by screen time.

Before the age of 12, the auditory and the visual areas of the brain are being fine-tuned, but looking at a screen develops only the visual cortex of the brain, Tavyev Asher said. The auditory cortex, which supports social interactions, develops through in-person interaction.

“Real life moves at a much slower pace than the rapidly flipping images on a device or screen,” Tavyev Asher said. “The brain is developing its communication patterns in those first few years of life, so you are training that brain exactly what it needs for its future. If you're exposing that brain to a screen, that brain thinks it needs to be able to pay attention to these rapidly changing images but not to the slower things of the real world.”

To make sure language, hearing and social skills develop, Tavyev Asher urged parents and caregivers to prioritize face-to-face interaction with their babies. She also said that early screen time can affect a child’s later learning skills, including reading and writing proficiency.

“Reading comprehension, reading speed, reading fluency and memorization are all going to be enhanced if you're reading from an actual book rather than on the screen,” Tavyev Asher said. “The single most important thing that parents can do for their children right now is to keep them off screens between the ages of 0 and 3.”

The Importance of Genetics

Rowitch, a neonatologist, developmental neuroscientist and expert on pediatric neurological disease, said that genetic tests developed over the past 10 years can analyze all 3 billion base pairs, the letters that make up a person’s genetic code. These tests can offer crucial information on an infant’s brain development as well as the child’s future mental and physical health.

“We find that almost 80% of babies with a genetic condition exhibit a neurological manifestation,” Rowitch said. “For example, that could be weakness of the muscles, seizures or a structural abnormality of the brain that we identify by MRI. It is important to understand and capture these conditions to ensure the correct diagnosis and treatment.”

Pairing genetic testing with a map of normal brain development such as the one created by Gao can help clarify how genetic conditions change development patterns, Rowitch said. This could be especially true for babies born preterm.

“We want to be able to anticipate future health or neurodevelopmental problems,” Rowitch said. “The earlier we detect alterations, the sooner we can intervene to improve the child's developmental trajectory.”

Detecting serious genetic conditions at birth also could have implications for a child’s school readiness and long-term health outcomes.

“Together, these studies emphasize the importance of early brain development. If we understand how genetics affects school readiness, that starts to open up another set of questions,” Rowitch said. “How can we make a child school-ready who might otherwise be in a high-risk category? If we can bring together genetics, brain mapping and cognitive assessment, we can create interventions that can help every child reach their potential.”

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

The prestigious national honor bestowed annually by the medical association recognizes Sanchez’s outstanding contributions to pediatric medicine, his leadership in advancing health equity and his unwavering dedication to the Hispanic community. And Sanchez himself credits his Hispanic cultural roots and values for leading him to a career in medicine.

“It is truly humbling to be recognized by the National Hispanic Medical Association,” said Sanchez, who is also the director of Pediatric Medical Genetics at Guerin Children’s. “Growing up in a Hispanic household, I learned that the foundation of healing is planted at home and nurtured by trust, respect, culture and faith. As a clinical scholar and physician-scientist, I am reminded every day that our work reaches far beyond the clinic.”

Sanchez will be recognized at the association’s 28th annual conference, “Uniendo Voces: Advancing the Future of Latino Health,” on June 7 in Anaheim, California. Established in 1994, the nonprofit organization represents more than 50,000 licensed Hispanic physicians in the United States.

“At Guerin Children’s, ensuring that children and families from California and beyond receive personalized, inclusive care is a top priority,” said Shervin Rabizadeh, MD, MBA, deputy director of Guerin Children’s and chair of the Department of Pediatrics. “Sanchez has played a leading role in developing culturally responsive pediatric genetic services.”

Sanchez said the award highlights the importance of integrating cultural understanding into every aspect of medical care.

“As pediatric geneticists, we care for some of the most vulnerable members of our community— children and families navigating rare and complex conditions,” said Sanchez. “By building trust, improving access and mentoring the next generation of clinicians, we help create a healthcare system that not only treats disease but honors the unique culture, stories and heritage of all patients.”

Sanchez’s leadership roles are wide-reaching. Most recently, he was named as the Advisory Committee Chair for the American College of Medical Genetics and Genomics Engage, Equip, and Empower (E3): Genomics Pathways Program. The program seeks to inspire and prepare the next generation of leaders in genetics and genomics by providing early exposure to the field to high school, community college and undergraduate students from underrepresented backgrounds.

“Sanchez’s work reflects Guerin Children’s mission to improve bench-to-bedside healthcare for all communities,” said Ophir Klein, MD, PhD, executive vice dean of Children’s Health and executive director of Guerin Children’s. “This award is a fitting tribute to his compassion, expertise and commitment to care for our youngest patients.”

Read more on the Cedars-Sinai Blog: Do Children Need Genetic Testing?

“For very young children, use simple explanations when answering their questions,” Hedrick said. “With older children, you want to be honest and open, directly answering questions and using as simple language as possible.”

Playtime can help children express themselves and feel a sense of control. One example, Hedrick said, is focusing on the positive aspects of knowing fire safety.

“For children who haven’t lost their homes but are affected by the fires, involve them in age-appropriate fire drills,” she said. “Or allow other types of play to be related to the fire, because a lot of times it’s easier for kids to express their feelings through play than by outwardly saying, ‘I'm feeling scared.’”

Building simple forts with pillows, blankets and sheets can be a beneficial play activity for children of all ages—even some middle schoolers, Hedrick said.

“The parent can get inside the fort with them and talk about feelings, as the child may feel safer there,” she said.

It also can be helpful for parents to model how to express feelings.

“A parent could say something like, ‘I noticed I was feeling a little scared today; are you feeling scared?’ This gives their child a chance to talk about feelings of fear, anger, sadness,” she said.

Alternatively, when the child says they’re angry, sad or scared, parents should acknowledge those emotions.

“It’s important not to say, ‘You don't have to feel sad or scared or angry,’” Hedrick said. “It's better to say, ‘Of course, that’s how you’re feeling and it’s perfectly normal. At the same time, there are things we can be grateful for—let’s talk about some of those.’”

Tweens and teens especially may find journaling helpful, as well as art, physical activities and supportive connections with their peers.

“Reminders that there is hope, and that the family will get through this together, are important,” Hedrick said.

Read more on the Cedars-Sinai Blog: Art Therapy Helps Children Cope With Trauma

The Cedars-Sinai Newsroom spoke to two infectious disease specialists—Jonathan Grein, MD, director of Hospital Epidemiology, and Priya Soni, MD, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s—to get the facts about how to protect yourself and your family.

Why is measles so dangerous?

Priya Soni, MD: Many people think that measles is just a rash, but it can be life threatening. One in 5 children who develop measles end up in the hospital. One in 20 children develop pneumonia, and this is the leading cause of measles-related deaths. In addition, 1 in 1,000 children can develop a rare complication of brain swelling—encephalitis—that can cause permanent brain damage.

How does measles spread?

Jonathan Grein, MD: Measles is one of the most infectious diseases that we know of, and it's spread very easily through the air, particularly for people who are not immune or have not received the vaccine. It's so infectious that you don't even need to be in the same room at the same time with someone who has measles to potentially get infected.

What are the telltale signs of measles?

Grein: The symptoms of measles can begin like any other viral illness. You may feel feverish, have muscle aches, headaches, very nonspecific symptoms. Patients may then go on to develop cough, runny nose, sometimes redness of the eyes. That all precedes the classic rash that you may be familiar with that typically starts on the face and spreads throughout the body. I think it’s important to know that it is possible to be infectious several days before that rash begins, which is one of the real challenges with trying to control measles from being spread person to person.

What should you do if you think your child has measles?

Soni: If you think your child has measles, the first thing to do is call your pediatrician, but do not go directly to their offices or the Emergency Department without speaking to someone on the phone first. The virus is extremely contagious, so you want to call ahead to let the healthcare providers know what’s going on. Showing up without calling ahead can cause other children in the waiting room to be infected. In addition, you should immediately isolate your child from other children, especially infants who are less than a year of age, as they may not have protection from the virus. You should also isolate your child from any immunocompromised family members.

How is measles treated?

Grein: The treatment for measles is solely supportive. There is no specific measles treatment, but you want to try to control the fever and make sure the patient is hydrated and resting in isolation.

How do we protect against measles?

Soni: Vaccination is the best protection against measles. The MMR vaccine, which is inclusive of measles, mumps and rubella, is 97% effective after two doses. It's one of the most effective vaccines that we have. And it protects children in outbreak situations and other vulnerable community members as well.

Typically, the first dose of the measles vaccine is given at 12-15 months of age. The second dose is given around 4-6 years of age.

If your child is 6-12 months old, they can receive an early dose of the measles vaccine if they're in a high-risk situation such as an outbreak or if they’ve been exposed to the virus. This additional dose that's given earlier than the recommended schedule does not count toward their two-dose series.

Do adults need to get vaccinated against measles?

Grein: Most adults will not need an additional booster dose if they were previously vaccinated. There is a small number of adults who may have received a different version of the measles vaccine between 1963 and 1967. This vaccine was later found to be less effective, and it doesn't provide as long-lasting immunity as the current vaccine. So if you did receive that vaccine, it is recommended that you receive a booster dose with the current MMR vaccine to achieve appropriate immunity.

Read more on the Cedars-Sinai Blog: Why Some Vaccines Last A Lifetime and Others Don't 

Like any typical 10-year-old, Brandon Bateman loved being outdoors and staying active. But when he complained of severe back pain and feeling winded after a short bike ride, his mother knew something was wrong.

“Everything seemed fine before then,” Brandi Bateman said of her son. “Brandon was a very active child. You know, he enjoyed roller coasters, bicycling, gymnastics, jumping off roofs into the pool. You name it, he did it. He loved it all.”

Five years ago, amid the COVID-19 pandemic, a pediatrician suggested genetic testing, which showed Brandon had Marfan syndrome. It’s a genetic disorder that affects connective tissue—the fibers responsible for providing structure and support to organs and tissues in the body. People with Marfan syndrome are often tall and lanky with unusually long limbs, and the condition affects various parts of the body, including the heart, lungs, blood vessels, eyes and skeleton.

February is Marfan Syndrome Awareness Month, highlighting the genetic condition that affects approximately 200,000 people in the United States. The symptoms can vary greatly from person to person. Some patients have mild symptoms, while others, like Brandon, face significant health challenges requiring medical intervention.

Surgery to Breathe Better

Marfan syndrome caused Brandon to develop severe scoliosis—a progressive condition that causes the spine to curve sideways and was the culprit behind his debilitating back pain.

“The scoliosis just got worse,” Bateman said. “It seemed like overnight.”

At the time of his diagnosis, Brandon’s spine was curved at 23 degrees. Four years later, in April 2024, the curve in his spine had nearly tripled to 62 degrees. A typical curvature is about 10 degrees. Brandon’s curvature was so extreme that spinal surgery was recommended.

Initially, Brandon and his family, who live in Tehachapi, California—102 miles from Cedars-Sinai—sought medical care closer to home. But after facing lengthy wait times to see specialists, the Batemans were referred to Kenneth Illingworth, MD, a pediatric spine surgeon at Cedars-Sinai Guerin Children’s.

“In Brandon's case, the scoliosis was so rapidly progressive that he actually started to have stretch marks, which is quite unique,” Illingworth said. “When you have big, big curves, which is not uncommon in kids with Marfan, they start to have long-term health consequences.”

Like most children and teens with Marfan syndrome, scoliosis wasn’t the only pressing issue. In addition to his progressive scoliosis, Brandon had a deep indentation in his chest known as pectus excavatum, a common condition associated with the syndrome that causes the breastbone to sink into the chest. The chest indentation required another surgery. 

“Brandon had a very deep pectus excavatum defect, where his sternum was heading back toward his spine and compressing the area where the heart would be. As a result, the heart was being squished and pushed over,” said Eugene Kim, MD, surgeon-in-chief and associate director of Surgery at Cedars-Sinai Guerin Children’s, director of the Division of Pediatric Surgery and vice chair at the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai.

To fix Brandon’s sunken chest wall, Kim, in collaboration with thoracic surgeon Nguyen Minh Le, MD, performed a minimally invasive procedure that involved creating two small incisions on either side of the chest. A thin, strong titanium bar was scooped underneath the breastbone and muscle, lifting and supporting the sternum and chest wall.

Kim said he placed two bars to spread out the pressure. The bars will stay in place for three years until the chest wall has set in its corrected position.

“My chest doesn't have that indent that it had. It's just straight. And it's like, I feel normal now,” Brandon said.

Kim also performed cryoablation, or freezing of the chest nerves that transmit pain signals to the brain, for pain control after surgery.

“It means kids need far less narcotics for pain after the surgery,” Kim said. “They are out of the hospital in one to two days as opposed to five to seven days.”

Brandon isn’t completely out of the woods. He will always have Marfan syndrome, which means he will need to remain vigilant for other associated complications, especially heart and eye issues related to the condition.

But Brandon and his mother are thrilled with the remarkable results the surgeries yielded and grateful for the multidisciplinary team of specialists who jumped on board to care for him.

“We want doctors who will carry on his care after he turns 18,” Brandon's mother said. “Cedars-Sinai is the best place for that. We have all the specialists he’ll need under one roof.”

Living Life to the Fullest

With successful surgeries and challenging recovery behind him, Brandon is back to being a teenager.

Today, at 15, he is doing the things he loves most—riding his motorbike, jumping on trampolines and living life to the fullest.

“Being able to do those things again feels amazing,” Brandon said. “I don’t feel like I’m limited by my condition anymore. I feel like I can do whatever I want.”

Read more on the Cedars-Sinai Blog: Seeking a Second Opinion for a Spine Condition

Raphael Louise Wasserman, who was born with a serious heart condition, has had more medical interventions in the first months of his life than some adults will ever have. But now, he and his family are looking forward to a life filled with more birthday celebrations than doctors’ appointments.  

Raphael and his twin sister, Antonia, who was born without a heart condition, celebrated their birthdays on Valentine’s Day, Feb. 14, at Cedars-Sinai Guerin Children’s. They were joined by their mothers, friends and family as well as the nurses, physicians and staff members who took care of them.

“Heart defects are the most common birth defect,” said Richard Kim, MD, director of Pediatric and Congenital Heart Surgery and surgical director of the Guerin Family Congenital Heart Program in the Smidt Heart Institute and Guerin Children’s. “Thankfully, we can now intervene early so babies and young children can get better quickly.”

Mothers Claire and Ashley credit the close attention their children received with getting Raphael the care he needed. Soon after he was born, a nurse noticed Raphael had a heart murmur. A couple of days later, he had open-heart surgery to fix the malformations that were preventing his heart from pumping blood properly.

But one issue remained: One of Raphael’s heart blood vessels had become so narrow it was affecting his heart. In August, Raphael became one of the first children to receive the first stent specifically designed for babies and children. The stent was studied at Cedars-Sinai, and Evan Zahn, MD, director of the Pediatric Congenital Heart Program at Guerin Children’s and the Smidt Heart Institute, helped develop it. The stent’s design allowed it to be placed during a minimally invasive procedure rather than through an open-heart surgery.

“It was so rewarding to care for Raphael, who had especially complicated structural heart defects,” said fetal and pediatric cardiologist Myriam Almeida-Jones, MD. “Thanks to our team-based approach and our latest advances, we were able to improve Raphael’s heart so he and his family can have many more milestones to celebrate.”

Read more on the Cedars-Sinai Blog: Q&A—Congenital Heart Defects

Diego Cruz told his healthcare team that his lifelong dream was to travel to Japan, which got Child Life Specialist Joanne Ordono thinking.

“Because of his physical condition, he can’t travel, but I thought, ‘Why not bring Japan to him?’ And that’s what we did,” Ordono said. “We brought both traditional and contemporary Japan to his hospital room.”

Thanks to the Japanese American Cultural and Community Center in Los Angeles’ Little Tokyo, Cruz had a traditional Japanese experience, starting with a tea ceremony performed by Hirokazu Kosaka, a tea ceremony master. Cruz sipped from a ceremonial bowl filled with matcha tea while Kosaka chanted. 

Next, Kuniharu Yoshida, a calligrapher, brought out his ink and brushes to create a traditional calligraphy scroll that reads, “May your wishes come true.” The calligrapher also helped Cruz write the Japanese character for “strength.” 

Then, musician Chester Ikei played a ukulele and sang traditional Japanese ballads describing the four seasons. 

Cruz, an anime fan, also received gifts from local shop Anime Station. Of course, no cultural experience is complete without food, and Cruz was able to taste mochi and Japanese cheesecake for the first time.

A visibly emotional Cruz took pictures with all his guests and his family members and fought back tears as he expressed his thanks.

“All the years that I’ve had chemotherapy, I missed out on all the things I wanted to do in life,” Cruz said. “While I saw others living a normal life, I’d be here in the hospital. I never thought I’d be able to do these things, so thank you. It means a lot to me.”

Ordono said the afternoon reminded her of the essence of healthcare.

“Obviously, taking care of the patients medically and clinically is super important, but we're treating the whole person,” Ordono said. “It's the emotional and the mental health that is also important, and I believe we got to bring a little bit more joy to this patient today.”

Read more from Discoveries: Innovation and Collaboration in Pediatrics at Cedars-Sinai Guerin Children's

The party featured a dancing gingerbread couple, Santa Claus and Los Angeles Rams cheerleaders, who got the crowd dancing. The children and their siblings got their faces painted and went home with kits to make gingerbread houses.

But the best part was meeting other families, said Benjamin Castillo, whose 5-year-old daughter, Camilla, is undergoing cancer treatments.  

“It’s nice to see other people going through the same thing we are going through,” Castillo said. “We are meeting people in the same situation and it’s good to see our daughter playing with other kids.”

The community came together to support the annual party. The venue was sponsored by the Beverly Hills Police Department, whose officers visit patients at Guerin Children’s every month. Sodexo and Love Catering donated the food.

As they have done for 20 years, students at El Segundo High School donated bags full of new toys.

The party was an especially happy occasion for members of the Guerin Children’s healthcare team who usually see these children in the hospital. 

“It brings out the inner child in me,” said Leo Mascarenhas, MD, MS, division chief and director of Pediatric Hematology/Oncology at Cedars-Sinai Guerin Children’s and medical director of the Sarcoma Program at Cedars-Sinai Cancer. “When I see all these kids having so much fun, it’s one of the reasons why I do what I do, so that kids can live their lives as children.”

Read more on the Cedars-Sinai Blog: Innovation and Collaboration in Pediatrics at Cedars-Sinai Guerin Children's

The research project brings together scientists from Cedars-Sinai, Baylor College of Medicine, the University of Michigan and Rutgers University. The investigators will study a process called fetal reversion, also known as developmental reprogramming, in mouse intestines to understand how adult tissues repair themselves, enabling the creation of a detailed map of healing processes.

“Our goal is to explore whether we can use what we learn about fetal reversion to identify a better way to repair and heal organs such as the intestine,” said Ophir Klein, MD, PhD, executive director of Cedars-Sinai Guerin Children’s and the David and Meredith Kaplan Distinguished Chair in Children’s Health.

The research team includes experts in basic science, regenerative medicine, intestinal physiology, virology, drug screening, and genomics and epigenomics. Their endeavor is called the “Consortium on Intestinal Regeneration and Fetal Reversion: from Atlas to Therapy.”

The Cedars-Sinai Newsroom recently spoke with Klein, the project’s coordinating principal investigator, to learn more about the five-year grant, the team’s research goals and how the grant will help advance our understanding of injury repair.

Can you provide a high-level overview of the team’s research interests and how this grant supports its ongoing work?

The fundamental question that we're interested in understanding is how adult tissues repair themselves. We are using the intestine as our model, and we believe that many elements of the repair processes we discover will be more generalizable beyond the intestine and have implications for other organs.

This grant from the NIH will provide the necessary resources for our research team to use this information to study how repair programs work in a mouse model and to find new ways to help the body heal. The data from our research will be shared online in a way that is easy to use, so the research community at large can explore it and come up with new ideas and treatments in the future. The insights we stand to gain could pave the way to a paradigm shift in our understanding of gut repair.

What is fetal reversion, and how will this grant help advance the understanding of injury and repair?

Fetal reversion is a regenerative response in which adult tissues reactivate behaviors from their developmental stage to heal from damage or injury, including those induced by infection, radiation treatment or inflammation.

Sometimes, the body heals perfectly well, while other times it doesn't heal at all. With the support of the NIH grant, we aim to understand how the healing process occurs and whether it involves processes used by the normally developing embryo. This understanding is important to lay a foundation for potential new treatments and drugs for wound healing.

How will the findings from this research potentially impact the development of new treatments for intestinal injuries and gut repair?

The fetal reversion process involves turning off aspects of normal gene expression programs and switching to a more fetal-like state. We don’t yet know if fetal reversion happens in all types of intestinal healing or if it occurs only during certain types of repairs.

It’s still a little bit of a mystery how the gut is able to repair itself after various injuries. One interesting approach is to compare intestinal regeneration across different organisms, and this hasn't been systematically studied. Our aim is to map intestinal injury and repair in mouse and human models, study repair programs and find new therapeutic targets using drug screening. A standardized approach to this study with the latest technologies will hopefully provide further insight into wound healing and fill gaps in our understanding of intestinal regeneration.

This is a historic grant for Cedars-Sinai Guerin Children’s. How will these funds advance the work being done in your laboratory and further advance Guerin Children’s commitment to bench-to-bedside care?

Receiving an NIH grant of this scope allows Guerin Children's to continue conducting leading-edge research, advancing the work of our physician-scientists who merge top-notch clinical care with translational and foundational research. At Guerin Children's, we focus on the entire health span and how pediatric medicine influences health beyond childhood. By learning from children’s health, we aim to improve health outcomes for adults. We are grateful to the NIH and our collaborators for helping us advance this science.

Read more on the Cedars-Sinai Blog: Six Questions With Ophir Klein, MD, PhD

Safaa, weighing just 1.1 pounds, was in the Neonatal Intensive Care Unit (NICU) at Cedars-Sinai Guerin Children’s.

“Shortly after Safaa was born, pandemic lockdowns were implemented and only one visitor was allowed in the hospital at a time, so we had to take turns visiting her in the NICU,” Cardello said. “We were not only scared of getting germs at the hospital, but we were scared of bringing germs into the hospital and harming Safaa.”

Safaa experienced a number of health challenges in those early days, including bronchopulmonary dysplasia, or premature lung disease, because her lungs were not fully developed. Additionally, her physicians discovered Safaa had an extremely narrow upper airway, making it difficult for her to breathe without medical intervention.

“I would honestly say Safaa had the smallest windpipe I’ve ever seen,” said Irina Dralyuk, MD, a pediatric pulmonologist at Cedars-Sinai Guerin Children’s and one of Safaa’s consistent care providers.

To bypass her narrow airway, Safaa’s doctors performed a tracheostomy, a procedure to create an opening in the neck that extends to the trachea, allowing easier breathing and enabling oxygen to reach the lungs.

Safaa graduated from the Cedars-Sinai Guerin Children’s NICU four months later, in July 2020, but her airway issues were not solved, so she went home with the tracheostomy tube in her neck.

Fixing Safaa’s Airway

“When I first met Safaa, her airway opening was only a couple of millimeters wide,” said Gene Liu, MD, director of Academic Otolaryngology for Cedars-Sinai Medical Center and a pediatric ear, nose and throat specialist for Cedars-Sinai Guerin Children’s. “And even though she was growing, her windpipe needed help to expand.”

Hoping to avoid a major surgical procedure on her neck that would come with additional risks, Safaa’s family and their care team opted for a less invasive approach using a balloon dilation to gradually widen her airway over time.

“Every few months, we would look at Safaa’s airway with a fiberoptic camera, and the balloon dilation procedure would gently push open the airway little by little until it became a very nice, normal-looking airway,” Liu said.

In March 2024, shortly after Safaa’s 4^th birthday, her tracheostomy tube was removed.

Becoming Like Family

Through four years of appointments and procedures, the Cardello family and Safaa’s Cedars-Sinai care team became quite close.

“Safaa got to know us really well and I think that helped when she would come in for her balloon dilation,” Dralyuk said. “I would always meet her and her family in pre-op and either Dr. Liu or I would carry her back to the procedure area. She’s a tough cookie. She and her parents have done an amazing job.”

Dralyuk said she especially loves to hear Safaa say her name. “Early on, we didn’t know what Safaa’s voice might sound like due to her narrow airway and whether there may be any residual damage to her vocal cords. Now when I see her, and I hear, ‘Hi Dr. Dralyuk,’ it is really special.”

Ahmadi Cardello said she and her family are thankful for the care and attention they received.

“The advice Drs. Liu, Dralyuk and all of Safaa’s other doctors gave us always felt like it was something they would recommend for their own child,” Ahmadi Cardello said. “We didn’t feel alone.”

What’s Next for Safaa

Now that her tracheostomy tube has been removed, Safaa and her parents are waiting patiently for the stoma, or the hole where the tube was previously located, to close. That typically happens on its own in a few months.

Prior to the removal, many things that would be normal for a toddler were risky for Safaa as they could cause infection of the stoma.

“I can’t wait to teach her how to swim,” Cardello said, “It’ll be fun to finally take her to the park and let her play in the sand. We haven’t been able to do that until now.”

Ahmadi Cardello is relieved. “Now that Safaa’s tracheostomy has been removed, I feel like we can all breathe a little easier,” she said.

Read more from the Cedars-Sinai Blog: Common Breathing Problems in Kids and How to Treat Them

“Donor milk plays a crucial role in improving the outcomes for our most vulnerable premature infants,” said Bevin Merideth, MSN, RN, associate director of the Neonatal Intensive Care Unit at Cedars-Sinai Guerin Children’s. “A diet comprised of human milk—whether maternal, donor, or a combination of both—has been shown to significantly decrease the incidence of necrotizing enterocolitis [NEC], an inflammation of the intestinal tract, which is the leading cause of death in premature infants,” Merideth said.

To participate in the breast milk drive, donors first register with the milk bank, share their health history and undergo a blood test.  

Wendy De Leon, Cedars-Sinai’s lead lactation consultant, said donors are helping the smallest patients.

“Babies digest human milk better than bovine protein and the antibodies from breast milk are greater than what babies would receive from formula,” De Leon said. “The availability of donor breast milk in our Neonatal Intensive Care Unit [NICU] is made possible through these generous donations of surplus breast milk to milk banks.”

Those who wish to participate in the upcoming milk drive should preregister and bring their frozen milk in a cooler to the drop-off. Frozen breast milk is good for approximately six months.

Mothers Milk Drive
When:       Sunday, Aug. 4, 11 a.m.-2 p.m.
Where:      Cedars-Sinai
Thalians Health Center 
8730 Alden Drive
Los Angeles, California 90048

Read more on the Cedars-Sinai Blog: Support for Nursing Parents 

But parents of premature babies often wait weeks or even months before they can do so. This is especially true if infants need a ventilator to help them breathe, a common issue for preemies, because lifesaving ventilator tubes and cords make it difficult to safely move a baby.

Cedars-Sinai joined with other hospitals across the state to find a solution and facilitate earlier skin-to-skin bonding for the tiniest babies and their parents. The project involves neonatal intensive care unit (NICU) specialists, including respiratory therapists, nurses and doctors. They figured out how to carefully move premature babies and respiratory equipment safely out of incubators and into parents’ arms.

“It is a three- to four-person job, and because the baby is so fragile, once the infant is moved, they remain in their parent’s arms for about two hours,” said clinical nurse specialist Amanda Williams, MSN, who led the Cedars-Sinai Guerin Children’s effort.

Emma and Tyler Beckett’s son, Owen, was born the first week of June at Cedars-Sinai at 24 weeks’ gestation, weighing just 1.7 pounds, and he was started on a jet ventilator in the Neonatal Intensive Care Unit at Cedars-Sinai Guerin Children’s.

“It’s so special,” Emma Beckett said. “The day that they told us we could start doing skin-to-skin, it was a surprise for us, and I just started crying immediately because I thought we were going to have to wait a long time—and to be able to do this now, it’s just amazing. Like we feel so much more connected to him.”

Courtney and Steven Fine also are getting an unexpected opportunity to bond with their daughter, Alia, who was born at 26 weeks’ gestation in mid-May and weighed 1.11 pounds.

“It's just nice to have her close to me,” Courtney Fine said. “I just really feel like I'm getting to bond with her more. It really does change my entire day and week.”

The reaction from parents has been universally positive, Williams said.

“We know how important skin-to-skin is for the babies and the parents, both emotionally and physically,” Williams said. “It’s so good for the baby. When they are skin-to-skin, we see their vital signs improving, including their respiratory and heart rates. It also helps mom with producing breast milk, and for both moms and dads, the bonding opportunity is key.”

Rangasamy Ramanathan, MD, MBBS, director of Neonatology and an innovator in neonatal and pediatric respiratory care, pioneered the new technique of nasal high frequency jet ventilation. That technique uses a nose tube called a RAM Cannula that was named for Ramanathan.

“There is so much benefit for the baby and the parents with skin-to-skin care that our approach is to make it possible with the use of jet ventilators as soon as possible in babies with breathing problems,” Ramanathan said.  

Tyler Beckett alternates with his wife, doing skin-to-skin with newborn Owen every other day. “I see his improving health and his improving strength,” Beckett said. “I am happy to think that I might be contributing in a small way, and it makes us feel better too. I am happier and calmer from the contact.”

The same is true for Steven Fine and his baby, Alia. “Skin-to-skin is our happy place,” Fine said. “It lets us not focus on any of the medical issues going on and just be with her and be present.”

Read more from the Cedars-Sinai Blog: Anxious About Breastfeeding? You're Not Alone

The 17-year-old actor, who has starred in popular shows and movies like Ghostbusters: Frozen Empire, The Handmaid’s Tale and Young Sheldon, brought specially designed movie-themed hospital gowns, coloring books and toys for the patients.

“It’s fun for me to be able to bring things and just talk to people and talk to kids and teens,” Grace said.

For the visit, Grace teamed up with nonprofit Starlight Children’s Foundation, a longtime partner of Cedars-Sinai that distributes hospital wear, games and supplies to make the inpatient experience more positive for children and their families.

“Hospitalization can be a scary and lonely experience,” said Richard Jardiolin, the foundation’s spokesperson. “Our goal is to transform hospital experiences so kids can enjoy the best parts of being a kid, no matter what they're going through.”

Grace has been through it herself. She had spine surgery performed by David L. Skaggs, MD, director of Pediatric Orthopaedics at Guerin Children's, to fix severe scoliosis. Now, fully recovered and back in action, she is able to bring joy to other patients still on their healthcare journey.

“Through visits from celebrities like Mckenna, whose sincerity and kindness were apparent throughout her visit, patients and families feel a personal connection with someone they may never have had the opportunity to meet,” said Sandie Sternberg, a certified child life specialist at Guerin Children’s.

During her visit, Grace gleefully swapped pet photos with one of the hospitalized teens and connected with another patient over their mutual love of video games.

“My visit today was great. I got to talk to a lot of kids. I got a new Roblox friend, and I also got invited to a senior prom,” Grace said. “So, I'd say overall, a very successful day.”

Read more on the Cedars-Sinai Blog: Five Deep Breathing Exercises for Kids and Teens

During labor, doctors alerted Hazelwood and her husband, Matteo Carletti, about the presence of meconium—a newborn’s first bowel movement—in the amniotic fluid in the uterus. However, the passing of meconium before birth is a fairly common issue that occurs in up to 22% of deliveries and is typically easy to manage.

But Vita Rose’s birth wasn’t typical.

Moments after Vita Rose’s debut, physicians and nurses rushed the newborn to the Neonatal Intensive Care Unit (NICU) at Cedars-Sinai Guerin Children’s. Soon, she was diagnosed with a severe case of meconium aspiration syndrome.

Unlike regular stool, meconium is a black, tarry and sticky substance. Typically, most babies pass meconium a few hours after birth. However, if ingested in utero or during birth, the viscous fluid could potentially coat the air sacs (alveoli) inside the lungs and block the airways, causing lung and heart problems.

“In a lot of cases, meconium aspiration is very mild because there's maybe not very much that gets deposited into the lungs. But in Vita Rose’s case, there was a significant amount, to the point that it caused significant lung damage,” said David Epstein, MD, director of Pediatric and Congenital Cardiac Intensive Care at Cedars-Sinai Guerin Children’s.

By next morning, Vita Rose’s complications had snowballed quickly, and her health had taken a turn for the worse.

ECMO to the Rescue 

Vita Rose was in respiratory lung and heart failure. With her life in jeopardy, the newborn was placed on a ventilator to help her breathe, and Guerin Children's physicians consulted with experts in the Smidt Heart Institute to devise a plan to strengthen the baby's heart and lungs. 

“In the initial chest X-rays that were taken within one hour [of birth], her lungs were already very opaque, which tells us that her lungs didn't have the ability to oxygenate her blood or to remove some of the carbon dioxide that all babies have,” said Richard W. Kim, MD, director of Pediatric and Congenital Heart Surgery and surgical director of the Guerin Family Congenital Heart Program in the Smidt Heart Institute and Cedars-Sinai Guerin Children’s.

“Gradually over the course of the next few hours, it became apparent that even our typical forms of invasive support, like a ventilator or a machine that can breathe for her, weren't going to be sufficient,” Kim said.

Time was of the essence. So, in addition to the ventilator, the doctors decided to put her on extracorporeal membrane oxygenation (ECMO). ECMO is a dual bypass life support machine that performs the function of the heart and lungs.  

Generally, patients are on ECMO for only three to five days to reduce the risk of blood clots, neurological issues, seizures and potential infections.

But Vita Rose’s condition was extremely critical. In order to keep her stable, doctors kept her on ECMO support for nearly a month and monitored her condition closely.

So did Vita Rose’s parents. The lifesaving machine and complex web of cords and tubes prevented the parents touching or holding their baby girl. All they could do was show up, pull up a chair next to the machine and talk to her. 

“We just prayed and showed up and showed up, and it was like really early on in the situation that we had to ask ourselves … is our kid going to live?” Hazelwood said.

It Takes a Village

Vita Rose was in the Guerin Children’s Pediatric Intensive Care Unit for more than 100 days, including nearly a month on ECMO.

Over the course of her stay in Guerin Children’s, Vita Rose required round-the-clock care and underwent multiple medical procedures to get her heart and lungs functioning without machines. Healthcare workers from numerous departments and specialties pitched in to meet Vita Rose’s changing needs.

“I think she's met every unit at the hospital except maybe dermatology,” Hazelwood said.

Epstein credits the hospital-wide team. “It's really like this cadre of individuals from all areas who are working with her to get her through this. So, it was a huge team effort, and it was one that I was just proud to be a part of because everybody just worked so well together,” Epstein said.

Kim agrees. “There were many dark days, but I think we never gave up. We were always very optimistic for her. And sure enough, that's the way it worked out in the end,” he said.

While the recovery was slow and steady, Vita Rose is already thriving, babbling and fixating on her favorite stuffed toys hanging over her crib, just like any other child her age.

“She's come a very, very long way,” Hazelwood said. “She is the strongest, most joyous, bravest little fighter we know. And we're just so, so grateful that God said she can stay.”

Read more on the Cedars-Sinai Blog: A High-Risk Pregnancy Lifeline

The S. Mark Taper Foundation Rabbit Garden is one of four gardens that make up a 5,000-square-foot outdoor area. The garden features rabbit-shaped seating and fresh greenery, providing a relaxing environment for inpatients and their families to enjoy.

“The impact of childlike touches at Guerin Children’s, like the S. Mark Taper Foundation Rabbit Garden, should not be underestimated,” said Arthur J. Ochoa, JD, senior vice president of Advancement and chief advancement officer for Cedars-Sinai. “The garden delights and uplifts the spirits of young patients every day—such a significant part of what we strive to do at Cedars-Sinai.”

Guerin Children’s is full of other whimsical touches, from a video wall and vibrant artwork to an interactive playroom.

Ophir Klein, MD, PhD, executive director of Guerin Children’s and executive vice dean of Children’s Services, said the garden is an example of the importance of balancing treatment with emotional support.

“Successfully caring for patients medically is just part of what we work so hard to achieve at Guerin Children’s,” said Klein, the David and Meredith Kaplan Distinguished Chair in Children’s Health. “We want children to be well physically, but also to be happy and hopeful, as they receive the best-quality, most compassionate care.”

Read more on the Cedars-Sinai Blog: How to Choose a Pediatrician

“It’s an honor to continue to serve COG, a research network that has contributed significantly to most children surviving cancer today,” said Mascarenhas, director of Pediatric Hematology and Oncology and a professor of Pediatrics. “I look forward to even more progress in the next five years and beyond, thanks to the research and therapeutic advancements from healthcare professionals at research institutions that are part of COG.”

COG is a National Cancer Institute-funded clinical trials network comprising more than 200 leading hospitals and cancer centers across North America, Australia and New Zealand. All members work to advance progress in treating pediatric and adolescent cancer patients. As such, it is the largest clinical trials group in the world.

COG notes that patient participation in clinical research from member institutions, including Cedars-Sinai, has led to a combined five-year survival rate of 85% for children with cancer.

Mascarenhas has been a member of COG for more than 25 years and a member of the COG voting body, composed of principal investigators from each member institution, for 17 years. As voting body chair, Mascarenhas appoints leaders, coordinates and oversees elections within COG, and serves as a liaison between various COG scientific and administrative committees advocating for and facilitating smooth and efficient conduct of COG trials at each member site.

“Dr. Mascarenhas’ reelection to voting body chair for Children’s Oncology Group is a testament to his outstanding leadership in the pediatric and adolescent cancer field,” said Ophir Klein, MD, PhD, executive director of Cedars-Sinai Guerin Children’s and the David and Meredith Kaplan Distinguished Chair in Children’s Health. “His service and that of his fellow clinicians and scientists is what will lead to more benefits for patients locally and globally.”

Mascarenhas is known for his expertise in treating sarcomas and pediatric solid tumors. Sarcomas are rare cancers that occur in bone or soft tissue. Mascarenhas has led and collaborated on several clinical trials that have resulted in key insights and improvements in treatments for these cancers.   

“Dr. Mascarenhas’ research is fueling critical learnings that continue to give new hope to pediatric cancer patients and their families,” said Shervin Rabizadeh, MD, MBA, chair of the Department of Pediatrics at Guerin Children’s. “His yearslong involvement with Children’s Oncology Group underscores that the most robust science often stems from dedicated experts around the world working together to answer the most challenging questions.”

 In addition to his roles with Guerin Children’s, Mascarenhas is a senior investigator in the Samuel Oschin Comprehensive Cancer Institute Cancer Therapeutics Program at Cedars-Sinai and medical director of the Sarcoma Program at Cedars-Sinai Cancer.

“We congratulate Dr. Mascarenhas on his reelection to Children’s Oncology Group voting body chair and commend him on his longtime commitment to the cancer field,” said Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer and the PHASE ONE Foundation Distinguished Chair. “Patients treated at Cedars-Sinai and beyond will continue to benefit as a result of Dr. Mascarenhas and all the physician-investigators in COG who are determined to save more lives.”

Mascarenhas’ second term as voting body chair began in April 2024 and will continue through March 2029.

Read more on the Cedars-Sinai Blog: When Your Child Has Cancer | Tips for Parents

Parents of children 3 to 17 years old can now access Cedars-Sinai healthcare providers for urgent issues, including cough, cold, flu or rash.

• Parents can choose on-demand visits 24/7 or a scheduled visit 7 a.m.-9 p.m. on weekdays and 8 a.m.-4 p.m. on weekends for their sick child.
• A child’s existing pediatrician is kept in the loop through the Cedars-Sinai electronic health record.

Spanish-speaking adults and parents of children 3 and older can now choose a Spanish-language app experience.

• Spanish-speaking healthcare providers are available for scheduled visits 7 a.m.-9 p.m. on weekdays and 8 a.m.-4 p.m. on weekends.
• Translators can support patients seeking on-demand care 24/7 if a Spanish-speaking provider is not available.
• Spanish-speaking adults can access primary care in their preferred language to manage chronic conditions, such as high blood pressure, anxiety, depression and obesity.

“Cedars-Sinai Connect has already helped thousands of new and existing patients easily access the high-quality care for which Cedars-Sinai is known, from home,” said Jill Martin, executive vice president of Cedars-Sinai Medical Network. “The platform is helping us extend that opportunity to even more people throughout California who are coming to Cedars-Sinai for convenient acute or chronic care. These patients also gain access to our broad network of specialists through referrals when appropriate.”

The new care options for children and Spanish speakers build on Cedars-Sinai Connect’s initial success. Since the platform launched in fall 2023, it has helped more than 8,000 patients from San Diego to Sacramento access Cedars-Sinai care through more than 10,500 virtual visits.

“Patients have come to rely on Cedars-Sinai Connect as a convenient way to access Cedars-Sinai expert care and a comprehensive primary care experience,” said Caroline Goldzweig, MD, chief medical officer of Cedars-Sinai Medical Network. “Our unique hybrid model not only offers high-quality virtual care, but it is fully integrated into a top-tier academic health system, making it easier to coordinate care and share a patient’s health records with all of their providers.” 

Cedars-Sinai Connect harnesses AI technology developed by K Health to reduce administrative burdens such as data entry, freeing doctors to focus more time on patient care. K Health helps patients manage their acute, chronic and preventive care needs through its platform that harnesses medical knowledge and real patient experiences.

“Cedars-Sinai Connect is one of the first integrated clinical care apps of its kind that is successfully using technology and care model innovation to address significant pain points—particularly access and quality—in healthcare in the U.S.,” said Ran Shaul, co-founder and chief product officer of K Health. “By combining K Health’s virtual care model with Cedars-Sinai’s high-quality clinical care, our partnership gives Cedars-Sinai greater digital capability while expanding access to expert care across California.”

Martin added that with pediatric care and Spanish-speaking doctors now available, “Cedars-Sinai Connect is furthering our collective goals of tying together in-person and virtual care, reducing wait times and addressing primary care needs for as many Californians as possible, helping Cedars-Sinai advance health equity.” 

Read more on the Cedars-Sinai Blog: Women’s Heart Health | The Virtues of a Virtual Second Opinion

“Dr. Pruetz is known for exemplary treatment and care in the high-tech, high-risk world of fetal and pediatric cardiology,” said Evan Zahn, MD, director of the Pediatric Congenital Heart Program at Guerin Children’s and in the Department of Cardiology at the Smidt Heart Institute. “In welcoming Dr. Pruetz, we give more families the opportunity to benefit from the latest innovations in fetal and pediatric heart interventions at Cedars-Sinai.”

Pruetz is an expert in using prenatal ultrasound to diagnose congenital heart defects in the fetus. He has also advocated for the use of risk stratification systems to create individualized care plans for babies born with a heart defect. He created a classification system known as Emergent Neonatal Cardiac Intervention for newborns with congenital heart disease diagnosed as critical.

In addition to his clinical work, Pruetz studies devices and procedures to treat life-threatening heart conditions in the womb. He was part of a multidisciplinary team that in 2015 developed the first pacemaker for fetuses with congenital complete heart block, a defect that affects the heart rate. This device is implanted in utero on the outer surface of the heart. In 2016, Pruetz helped perform the first fetal heart intervention in Southern California, which involved the successful opening of a blocked heart valve. He continues to study ways to improve the success of these fetal interventions.

Pruetz also studies disparities in the detection and care of congenital heart disease to uncover the social determinants that might account for these differences. He aims to increase the detection rate of congenital heart disease in the community.

“We’re thrilled to leverage Dr. Pruetz’s expertise, reputation and leadership in treating the most complex heart abnormalities in fetuses and newborns,” said Shervin Rabizadeh, MD, MBA, chair of the Department of Pediatrics at Guerin Children’s. “This allows us to expand state-of-the-art treatments for babies with congenital heart defects before they are born and well into childhood.”

Prior to joining Cedars-Sinai, Pruetz was medical director of the Fetal Cardiology Program at Children’s Hospital Los Angeles, and associate professor of Clinical Pediatrics and Clinical Obstetrics and Gynecology at the Keck School of Medicine of USC. He was also a pediatric cardiologist at Hollywood Presbyterian Medical Center in Los Angeles, Adventist Health in Glendale, and Huntington Health, an affiliate of Cedars-Sinai, in Pasadena.  

“Dr. Pruetz is a superb addition to the experienced pediatrics and cardiology teams at Cedars-Sinai,” said Ophir Klein, MD, PhD, executive director of Guerin Children’s and the David and Meredith Kaplan Distinguished Chair in Children’s Health. “I’m confident that the research efforts he is undertaking are going to lead to breakthroughs that further improve the lives of children born with heart abnormalities.” 

Pruetz earned a bachelor of science in microbiology and molecular genetics from UCLA. He earned his medical degree from Tufts University School of Medicine in Boston and completed his pediatric internship and residency in pediatrics at Cedars-Sinai. He completed his fellowship in pediatric cardiology at Children’s Hospital Los Angeles.

Pruetz is a member of numerous professional societies, including the American Society of Echocardiography, American Heart Association, American Institute of Ultrasound in Medicine, Society of Pediatric Echocardiography, and Fetal Heart Society, and he has received multiple medical awards. His research findings have been published and cited in more than 40 peer-reviewed medical journals, and he has presented his work at various national conferences, scientific sessions and symposiums.

Read more on the Cedars-Sinai Blog: How Congenital Heart Patients Can Move From Pediatric to Adult Care

The findings were published in Nature Cell Biology.

“By understanding how an embryo forms organs, we can start to ask questions about what goes wrong in children born with congenital malformations,” said Ophir Klein, MD, PhD, executive director of Guerin Children’s, the David and Meredith Kaplan Distinguished Chair in Children’s Health, and co-corresponding author of the study. “This work may lead to additional research into how birth defects are formed and can be prevented.”

Incisors are the sharp teeth at the front of the mouth that bite into food and cut it into smaller pieces.

Scientists know that during development, proteins called morphogens send signals to cells that coordinate tissue growth. This study showed how a signaling center—a cluster of specialized cells that regulate organ development by producing morphogens—is created.

The study is a collaboration between the laboratories of Klein at Cedars-Sinai Guerin Children’s and the University of California, San Francisco (UCSF), and professor Otger Campàs at the Physics of Life Excellence Cluster of TU Dresden in Germany and the University of California, Santa Barbara (UCSB).

“Using techniques that our lab developed to measure the mechanical changes that occur during embryonic development, we were able to understand how a pressure buildup in the tissue establishes the main signaling center of the developing tooth,” said professor Campàs, the managing director and chair of Tissue Dynamics at the Physics of Life Excellence Cluster of TU Dresden, and former associate professor of Mechanical Engineering at UCSB.

A human fetus starts to form gums at about six weeks of pregnancy. By roughly nine weeks, a fetus develops buds that will eventually sprout teeth. Investigators studied these processes in a laboratory mouse fetus, which develops similarly to a human fetus but in 21 days rather than nine months.

Investigators studied tissue samples containing the tooth bud of a laboratory mouse fetus over the period in which it develops an enamel knot, a signaling center specific to tooth formation.

The group performed several experiments to study the orientation of the cells within the tooth bud and what signals the cells send. They found the cells in the tooth bud start to grow and divide, which puts a mechanical pressure at the center of the tissue. The pressure causes the cells in the center to stop dividing and form the enamel knot.

“It’s like those toys that absorb water and grow in size,” said Neha Pincha Shroff, PhD, a postdoctoral scholar in the School of Dentistry at UCSF and co-first author of the study. “Just imagine that happening in a confined space. What happens in the incisor knot is that the cells multiply in number in a fixed space, and this causes pressure to build up at the center, which then becomes a cluster of specialized cells.”

This study builds upon the findings of another study by Klein and colleagues published in Nature Communications in 2016. The study found that a protein called YAP, which is involved in sensing mechanical signals, is required for formation of the enamel knot.

“What this latest work shows is that both mechanical pressure and molecular signaling play a role in organ development,” Klein said.

The investigators said future studies should investigate communication between molecular signals and mechanical pressure and how mechanical pressure may regulate the development of other organs.

Investigators Pengfei Xu (co-first author), Sangwoo Kim, Elijah Shelton, Ben Gross, Yucen Liu, Carlos Gomez, Qianlin Ye, Tingsheng Yu Drennon, Jimmy Hu and Jeremy Green also worked on the study.

Funding: The study was funded by the National Institute of Dental and Craniofacial Research, the Deutsche Forschungsgemeinschaft under Germany’s Excellence Strategy, and Physics of Life Excellence Cluster of TU Dresden.

Read more on the Cedars-Sinai Blog: Six Questions With Ophir Klein, MD, PhD

When Grace was 12, her father, an orthopedic surgeon, gave her a hug and noticed that something wasn’t quite right.

“I remember my dad hugged me and was feeling my back and said, ‘you have scoliosis,’ I didn’t even know what that was,” said Grace. “I didn’t think it was a big deal, I thought I was fine and thought he was just being weird, but it turns out I had scoliosis.”

Grace, who grew up appearing in popular shows and movies like The Handmaid’s Tale, Young Sheldon, I, Tonya and Ghostbusters: Afterlife, began to notice her physical appearance gradually morphing into someone else.

By the time Grace turned 16, her scoliosis began to affect her work. For red carpet events, she would have her dresses altered so that one side was longer than the other to camouflage her scoliosis. On stage and in front of the cameras, Grace would stand as straight as she could, but by the end of the day, she would be tired and in pain.

“I had started to notice just how crooked I was standing and so were people around me,” said Grace. “I'd get in trouble on set all the time. They'd always be telling me, ‘Stand up straight,’ ‘Stop slouching,’ ‘Mckenna, you're on your mark, but you're all the way over here,’ ‘We need you to stand up,’ and so on.”

As Grace's quality of life declined, her parents could not watch their daughter in pain and knew that if her career was to continue, surgical intervention would need to be considered. Grace’s father heard of the right surgeon for the job: David Skaggs, MD, director of Pediatric Spine and Pediatric Orthopaedics at Cedars-Sinai Guerin Children’s. 

When Grace met with Skaggs, her spine was at a 50-degree curve.

“What was unique about Mckenna is that her waist really looked asymmetrical, the layperson could see from across the room that something was going on,” said Skaggs. “When she bent forward she had a big hump on her back and she was becoming increasingly aware of it.”

With her rapidly deteriorating spine, Skaggs agreed that spinal surgery was the best option. The catch—she would need to heal and recover ahead of filming for the second Ghostbusters film.  

“She asked me, ‘is there any way I could have surgery and carry a 40-pound pack?’ I said, Of course you can. We'll get you back to filming.”

Skaggs and his multidisciplinary team got to work and performed spinal surgery, inserting metal rods, also known as spinal instrumentation, and screws across six vertebrates to straighten her spine.

“The reason we have surgery and care for these kids is so they can return to a normal life,” said Skaggs. “Now when we look at Mckenna, you can almost not tell that she ever had scoliosis or surgery. Mckenna’s body looks perfectly symmetrical and she’s over an inch-and-a-half taller.”

Following her successful surgery Grace took to social media to share her journey and encourage others.

“Mckenna was a rockstar,” said Elaine Butterworth, RN, pediatric nurse navigator and the director of Patient Experience and Education for the Pediatric Spine Program. “I remember her videotaping herself getting out of bed for the first time, when she was at her most vulnerable time and she not only recorded it but later posted it to help other kids.”

Back in the spotlight, Grace was standing tall and straight—just in time to walk the Ghostbusters carpet.

Read more on the Cedars-Sinai Blog: Supporting the Spine From Adolescence to Adulthood.

“She had all the odds stacked against her,” said Seth Langston, MD, a neonatologist at Cedars-Sinai Guerin Children’s who spoke at Ellyannah’s “graduation ceremony” to mark her progress.

“She needed help breathing with the ventilator. She needed antibiotics to treat infections. And she had challenges with feeding. But Elly knew she had the most caring and loving parents supporting her and rooting for her. And she could not and did not disappoint them,” Langston said. “Ellyannah has been mighty, and she has been courageous. She has overcome obstacle after obstacle and ignored the odds to get to this moment and has shown us all the true strength of a preterm baby.”

Ellyannah’s parents, Cecia and Boris Lopez of Gardena, spent every hour they could in the hospital with their baby, most of that time in the Neonatal Intensive Care Unit at Cedars-Sinai Guerin Children’s.

“I don’t think Elly would be going home if Cecia and Boris hadn’t been here every single day,” said nurse Joshua De Roboam, RN, who calculated that he personally spent 720 hours over the last year with Ellyannah. “She sometimes wouldn’t even settle down unless her parents were there to talk to her, hold her, care for her. It’s led to her development and being who she is today.”

Dressed in a pink graduation cap and gown, Ellyannah nestled calmly in her parents’ arms as they flipped the tassel on her cap to signify her graduating from the hospital. 

“Seeing Ellyannah so small was very traumatic, but also very miraculous,” said Cecia Lopez. “We had the opportunity to see her finish developing with the help of these amazing doctors and nurses. The NICU has been like family to us; we love them and respect them.” 

The feeling is mutual for the many healthcare workers who cared for Ellyannah over her journey.  “She’s a miracle and the strongest baby I’ve ever met,” De Roboam said. “She reminds us that miracles can happen every day and that we’re so lucky to do what we do.” 

Ellyannah is going home weighing 17 pounds. She has a feeding tube and needs extra oxygen, but her parents are confident of a full recovery.  

As they waved goodbye to their Cedars-Sinai Guerin Children's family, Cecia and Boris said this graduation will be the first of many for their baby, and they will teach her, “If you can graduate from the NICU, you can do anything in your life.”

 Read more on the Cedars-Sinai Blog: A High-Risk Pregnancy Lifeline 

, has an important message for parents whose children have been diagnosed with sarcoma, a type of cancer that develops in the bones or soft tissues.

“For many children, there are treatment options and even a cure,” said Mascarenhas, recently appointed as director of Pediatric Hematology & Oncology at Cedars-Sinai Guerin Children’s and as medical director of the Sarcoma Program at Cedars-Sinai Cancer.

He recently spoke with the Cedars-Sinai Newsroom about the clinical care and research he will lead at Cedars-Sinai.

When a child is diagnosed, what is the most important thing for parents to know?

It’s critical patients receive care from an expert team with extensive knowledge in diagnosing and treating sarcomas. A multidisciplinary team is crucial to a patient’s outcome because these diseases are complex. A typical sarcoma diagnosis requires expertise from an oncologist, surgeon, radiation oncologist, pathologist, radiologist, and, nowadays, a molecular geneticist.  All that information is used to make the best possible treatment plan.

These patients also need expert nurses, physical therapists and occupational therapists. Treatment for these conditions can be hard on patients and their families, so psychological support every step of the way and connection to a support peer group are really important.

What progress has been made in the diagnosis and treatment of pediatric sarcomas in recent years?

Treatment for sarcomas generally involves a combination of surgery, chemotherapy and/or radiation. However, we typically don't need to use all three modalities to treat pediatric patients. At Cedars-Sinai Guerin Children’s, we create a custom treatment plan for each patient, depending on the stage of their disease and how much tumor was removed during surgery.  

With the expanding knowledge of genetics and molecular genetics, we have learned that many sarcomas are actually driven by mistakes that occur with genes. Understanding the biology of how sarcomas grow and spread is an important aspect of how we can further advance new treatment approaches.

What have scientists learned from studying the genetics of sarcomas?

There is a unique sarcoma that primarily occurs in very young children, called NTRK fusion sarcomas. This is a type of sarcoma that occurs during development, when a gene called NTRK fuses with another gene. When we detect a fusion, it tells us what the exact diagnosis is—allowing us to recommend the best possible treatment combination for the patient to experience the best outcomes.

Today we utilize a drug called larotrectinib, which shrinks NTRK fusion sarcomas that are not responsive to chemotherapy. I was very fortunate to be involved with the development of that drug.

What will your research at Cedars-Sinai Guerin Children's focus on?

I’m looking forward to working with a large group of scientists here to see how to translate discoveries in the lab directly to the care of patients. I will lead clinical trials for sarcomas and certain pediatric solid tumors to see if potential new treatments are actually helpful. Since sarcomas are rare, we are collaborating with other researchers and scientists here at Cedars-Sinai, around the country and around the world to improve outcomes.

What progress is being made in treating sarcomas?

Sarcomas are tough cancers. If the disease has not spread, children have the best possible outcomes. For children whose sarcoma has spread to other organs, there are still treatment options.

Our treatment arsenal has improved greatly. We have techniques such as liquid biopsy, a simple blood test that may be able to tell us if your cancer is under control or not. Our hope in the future is that rather than waiting for scans to tell us how you are doing, perhaps a blood test will also tell us. Treating the cancer when it's still at a very low level in the body may allow the patient to actually be cured before the cancer manifests itself with symptoms that cause trouble.

We are also utilizing genomic medicine and immunotherapy to improve treatment options. I’m very hopeful—through collaborations at Cedars-Sinai, nationally and internationally—that we will be able to continue to fight this illness and improve outcomes for patients.

Read more on the Cedars-Sinai Blog: When Your Child Has Cancer | Tips for Parents

Globally, measles cases increased by 79% in 2023, according to the World Health Organization. In 2022, WHO estimated that measles killed more than 130,000—most of them children. 

In the U.S., during the first two months of 2024, nearly two dozen cases have been reported in California, Arizona and nine other states.

“Measles is a huge concern and directly related to declining measles vaccination rates,” said Priya Soni, MD, a pediatric infectious disease specialist with Cedars-Sinai Guerin Children’s. “Vaccine hesitancy, fueled during the pandemic by the anti-vaccine movement, has affected vaccination rates nationwide. In addition, because children were quarantined during the pandemic, many missed out on well-child visits and didn’t catch up on their vaccines. That has meant 61 million fewer doses distributed nationwide between 2020 and 2022.”

Measles is a contagious infection—even more infectious than COVID-19. While one person with COVID-19 can infect one to three others, one person with measles can infect as many as 18 other susceptible individuals. This airborne virus remains infectious for up to two hours after an infected individual leaves an area.  

“The big danger with measles is that it is one of the most unpredictable infections,” Soni said. “There is a very real risk of hospitalization, death or serious damage to the immune system. Even after you’ve recovered from measles, your immune system can be altered for up to three years and you become at risk for many other infections.”

Other potential complications include bacterial pneumonia and encephalitis, an inflammation of the brain. Measles carries the highest risk of complications in children 5 and younger and in adults 30 and older.

The measles vaccine, given as part of the MMR (measles, mumps and rubella) vaccine, is extremely effective, giving those vaccinated with just one dose up to 93% protection. The second dose confers up to a 97% lifetime protection rate.  

Although the first dose of the MMR vaccine is traditionally given to infants 12-15 months of age, and the second around a child’s fifth or sixth birthday, Soni said infants as young as 6 months can receive the first vaccine if they are traveling to areas where the measles infection rate is high.

For parents worried their child may have been exposed to measles, there are several telltale signs. One of the first is small white spots that appear inside the cheeks. Those spots—called Koplik spots—are unique to measles. Children also can develop a diffuse rash of small, red bumps that erupt on the face but then spread down the rest of the body, along with a high fever.

“Unfortunately, there are no antivirals or treatments for measles other than rest, staying hydrated and fighting the fever with cool baths and fever-reducing medications,” Soni said.

The good news about measles is that it is preventable with the vaccine, Soni said. But when collective MMR vaccination rates drop below 95% in a population, our “herd immunity” diminishes and this can lead to pockets of outbreaks with measles in certain communities and populations.  

“There is no scenario where getting the actual measles infection is somehow better for your child then getting the vaccine,” Soni said. “You are doing an incredible thing for your child and your family by getting them vaccinated.”

Read more on the Cedars-Sinai Blog: COVID-19 and Flu Shots Provide a Double Dose of Protection

opened a clinic today to provide specialized multidisciplinary care for children with Angelman syndrome, a rare and severe neurodevelopmental condition.

“Children with Angelman syndrome present significant difficulties in their communication, motor and overall development. They have a sensitive and loving temperament but struggle regulating their emotions and behavior,” said Cesar Ochoa-Lubinoff, MD, director of Developmental-Behavioral Pediatrics at Guerin Children’s, who will head the new clinic. “Our team of experts aims to help parents access the best interventions for their children and navigate the challenges of this syndrome the best way possible.”

Angelman syndrome occurs in 1 in 15,000 births. It is caused by the lack of expression of the mother’s UBE3A gene. (The father’s UBE3A gene is silenced at birth in the human brain.) This condition causes developmental delays and behavioral and emotional regulation problems.

The Angelman Syndrome Foundation, a nationwide parent advocacy organization, is providing a grant to support the Angelman Syndrome Clinic at Cedars-Sinai Guerin Children’s.

Caring for children with Angelman syndrome is complex. Children typically need to be seen by different specialists to meet their medical needs: gastroenterology, neurology, epilepsy, genetics, developmental medicine, diet and nutrition, speech therapy, and occupational and physical therapy. The Angelman Syndrome Clinic at Cedars-Sinai Guerin Children’s will make it possible for children and their families to consult with multiple experts in one place.

“We look forward to supporting families with the top-notch expertise we’re able to provide,” said Shervin Rabizadeh, MD, MBA, associate director of Cedars-Sinai Guerin Children’s and chair of the Department of Pediatrics.

In addition to providing care, the clinic will collect data to help investigators understand the trajectory of the disease. The data will eventually be used for clinical trials comparing the efficacy of new drugs designed to treat Angelman syndrome.

“This clinic is a prime example of how Cedars-Sinai melds clinical care with research,” said Ophir Klein, MD, PhD, executive director of Cedars-Sinai Guerin Children’s and the David and Meredith Kaplan Distinguished Chair in Children’s Health. “This work is promising not only for the specialized care and medical advances it will bring to Angelman syndrome patients but also because discoveries related to rare diseases can lead to advances for more common diseases and conditions.”

The Angelman Syndrome Clinic at Cedars-Sinai Guerin Children’s is located in the Cedars-Sinai Steven Spielberg Building at 8723 Alden Drive, Los Angeles, CA 90048.

Families may make an appointment with the clinic by calling 310-423-7779.

Read more on the Cedars-Sinai Blog: Understanding Rare Diseases

Follow Cedars-Sinai Guerin Children’s on X (formerly known as Twitter) for the latest pediatric news from Cedars-Sinai.

“We’ve had patients come into our clinics testing positive for both COVID and flu,” said Caroline Goldzweig, MD, chief medical officer of the Cedars-Sinai Medical Network. “Having one doesn’t protect you from the other.”

Goldzweig said Cedars-Sinai’s primary care and urgent care offices have seen a steady rise in respiratory viruses since November. Their percentage of positive COVID-19 tests has doubled since then, rising to 14% of tested patients by the end of December.

The percentage of positive influenza tests in Los Angeles County more than doubled to almost 23% by the end of December. RSV, which mostly affects younger and older patients, peaked late in November, but 10% of tests for the virus in Los Angeles County are still positive.

Cedars-Sinai Medical Center also has seen a steady rise of COVID-19 patients since Thanksgiving, although these patients still remain a fraction of those cared for in the hospital’s 915 beds. Flu has followed a similar pattern.

Priya Soni, MD, a pediatric infectious disease specialist with Cedars-Sinai Guerin Children’s, has treated many young children and infants who have not yet been vaccinated against COVID-19 and come to the hospital needing oxygen. She recommends that babies get the COVID-19 vaccine when they’re eligible, starting at 6 months of age.

RSV also is dangerous for young infants. Expectant mothers should consider getting not only the updated COVID-19 vaccine but the newly available RSV vaccine as well, Soni said, if they’re going to deliver during respiratory virus season “so that the antibodies can protect your infant during their youngest and most vulnerable few months of life.” This is especially important because a new RSV immunization for infants is in short supply.

Soni added that it’s not too late for people of all ages to get the updated COVID-19 vaccine, especially with the further increase in cases experts are predicting over the next couple of weeks. It’s also not too late to get the flu shot. This year’s formulation is very effective against circulating influenza strains. A new RSV vaccine is also available for adults over 60, with the greatest benefit for those who are at higher risk because of chronic medical conditions.

“Remember to mask,” Soni said. “It’s a really effective way to protect yourself in very crowded situations and when you have a vulnerable family member.”

But Wait, There’s More

If a tripledemic weren’t bad enough, a fourth illness—superimposed bacterial infection—has been exacerbating an already challenging virus season, landing vulnerable patients in the hospital, said Soniya Gandhi, MD, associate chief medical officer at Cedars-Sinai.

“When you have these viral infections, there is a risk of superimposed bacterial infection,” said Gandhi, an infectious disease specialist. “And we have seen a rise in pneumococcal pneumonia as a superimposed bacterial infection on top of the viral illness.” 

Still another culprit has been appearing in Cedars-Sinai’s outpatient clinics. Goldzweig said the staff members have seen many patients with viral gastroenteritis, a stomach bug causing nausea, vomiting and diarrhea. The virus spreads through contact, likely making the rounds at holiday meals. Avoid it by not sharing food and washing hands after eating or visiting the bathroom.

Get Tested, Get Treatment

Flu, RSV and COVID-19 all share similar cold-like symptoms—nasal congestion, headaches, fatigue—plus muscle aches and fever. But it’s important to get tested to determine which virus, or viruses, might be causing symptoms.

“There's no way to tell specifically what you have without getting tested, so it's incredibly important to get tested early on during your illness because there may be specific treatment options depending on what you have, as well as specific recommendations regarding isolation and keeping you and your loved ones safe,” Gandhi said.

Gandhi said patients with COVID-19 may qualify for Paxlovid, which needs to be taken within five days of symptom onset or as soon as possible to be effective. Similarly, those with the flu might be prescribed Tamiflu, which must be taken within 72 hours of diagnosis to be effective.

For those who don’t know whether their sniffles or sore throat require a trip to the doctor, a virtual appointment can be a convenient first step. Adult patients in California can use Cedars-Sinai Connect, a new mobile app that provides quick access to Cedars-Sinai experts, who are available 24/7 for urgent issues. Same-day appointments also are available on the platform for primary care 

Mild symptoms can be managed virtually, Goldzweig said. Providers might recommend using a self-testing kit for COVID-19 or refer a patient for in-person testing or labs. Or they can follow up with a prescription if needed or advise on supportive care (fluids, Tylenol) to help patients manage symptoms at home. Goldzweig said patients with more serious symptoms—ongoing inability to tolerate food or fluids or prolonged dizziness—should visit urgent care.

For parents who want to prepare ahead of time for the possibility of a sick child, Soni recommends keeping a few things on hand: a humidifier to ease congestion and cold-like symptoms and a nasal suction device and saline solution to help clear mucus from a viral infection.

And all season long, she says, we should all “hydrate, hydrate, hydrate.”

Read more on the Cedars-Sinai Blog: COVID-19 and Flu Shots Provide a Double Dose of Protection

Shervin Rabizadeh, MD, chair of Pediatrics at Cedars-Sinai Guerin Children’s, says vaccinating your child helps protect the whole family, including elderly grandparents.

“Vaccines are critical in preventing transmission of the virus that causes COVID-19, especially during upcoming holiday gatherings,” Rabizadeh  said. “You want to prevent and stop passage of the virus between individuals, and kids are often the vectors. They are the petri dishes that pass things on, so this [vaccination] is a great means of prevention.”

At a recent Cedars-Sinai COVID Clinic, healthcare workers distributed free Pfizer 2023-2024 COVID-19 vaccines to children 6 months to 4 years old and Pfizer updated COVID-19 vaccines to children 5 to 11 years old.

Alison Chen’s two children were among the more than 120 who joined the pop-up clinic.

“We’re traveling to see family for Christmas, and airplanes are a bit nerve-wracking,” Chen said. “We also want to make sure we’re as safe as possible before seeing our grandparents.”

Priya Soni, MD, Cedars-Sinai pediatric infectious disease specialist, said there are many important reasons children should be vaccinated against COVID-19.  

“While many children have milder infections than adults, some children develop severe lung infections from COVID-19 that require hospitalization,” Soni said. “Children also can develop bacterial pneumonia after recovering from COVID-19. Another complication is multisystem inflammatory syndrome in children [MIS-C], which can require care in an intensive care unit [ICU].”

During the COVID Clinic, some young children cried as they received their vaccines, but the parents, including Arturo Garcia, were smiling. Garcia brought his 19-month-old daughter, Anna Sofia, to the clinic.  

“It’s important to keep our children safe and healthy,” Garcia said. “It’s the best gift we can give our children.” 

Read more on the Cedars-Sinai Blog: Here Are the Back-to-School Vaccinations Your Kids Need

“Every day in clinic I see children who have had for years what many people call ‘funny spells,’” Holder said. “Sometimes I start talking to a parent and find out the parent has had ‘funny spells’ for years, but had no idea they were epileptic seizures.”

That’s because many people with epilepsy experience subtle symptoms, such as not being able to talk for a few seconds, Holder said. When the momentary symptoms disappear, people tend to forget to look for the source.

“Sometimes children experiencing seizures will see flashing lights or have temporary blurred vision, which leads them being misdiagnosed with migraine,” Holder said.

About 1 in 26 Americans are thought to have epilepsy, a neurologic condition in which a person experiences seizures, or episodes of abnormal electrical activity in the brain.

To mark National Epilepsy Awareness Month, Holder spoke with the Cedars-Sinai Newsroom about what seizures can look like—and why it is important that children get help as soon as possible.

What does a seizure look like?

A seizure can look like anything, depending on where in the brain the seizure comes from. A lot of people think a seizure is a convulsive seizure, where there's a loss of consciousness and the person falls down to the ground and the whole body experiences convulsive activity. That's actually the rarest type of seizure.

The most common seizures are barely noticeable. Sometimes a patient will just sit and stare and be unresponsive for three or four seconds. A child may have an uncontrollable motor activity, such as twitching of an arm or one leg or twitching of one side of the face that lasts for 30 seconds.

Patients may get a feeling of numbness or tingling in a part of the body, or get a funny smell or taste in the mouth that comes and goes. Sometimes they're not able to process language, and their speech is garbled.

If a child has the same feeling or sensation or behavior that happens over and over again, that is a sign the child might be having seizures.

How do you diagnose epilepsy in children?

We rely a lot on information we gather by talking to families. Often, we can make the diagnosis without any diagnostic test, although we still do an EEG, an electroencephalogram, to see if we can gather any further information. For this test, we place electrodes that look like little stickers on the head so that we can monitor brain waves.

How have smartphones changed how pediatric epilepsy is diagnosed?

I've been doing this for more than 20 years, and one of the things that has been most helpful to me is the advent of cell phones with video recording. I advise families, if you see a child having a funny spell, get it on a video camera. We are very good at being able to tell by looking at the recording if the event is a seizure or not.

What happens if a child is not diagnosed promptly?

Children are learning to read, write, think. Undiagnosed seizures can interfere with a child’s ability to learn and process information.

How do you treat epilepsy?

Most children are able to be seizure-free on medications alone. As the brain grows and develops, many children will outgrow seizures and not need to take medication long term.

More than a third of patients have seizures that are more difficult to control. For those children, we typically do advanced diagnostic testing to see exactly where the seizures are coming from. We then remove the part of the brain causing the seizures. Nowadays, this can be done by making a very small opening in the brain and treating the affected area with a laser. The opening is closed with just one suture and the patient usually goes home the next day.

Is epilepsy genetic?

Scientists have identified more than 500 genes that are associated with epilepsy. When we do genetic testing, we can tell not only what causes the epilepsy, but also which medications to use. We do genetic testing by swabbing the cheek. It takes five minutes.

We have a very strong genetics program at Guerin Children’s. The really exciting news is that we have, for the first time, a gene therapy in trials in patients with epilepsy. We may one day be able to treat children with this therapy.

Read more on the Cedars-Sinai Blog: Myths and Facts About Epilepsy

and were laid out in the NICU for parents to select. The baby costumes are all based on children’s books including pumpkins, ballerinas, a zebra, an eagle, a bat, and the popular dog Bluey. The costumes are made with Velcro, so they are easy to fit around the tiny infants without disturbing their tubing.

Cedars-Sinai volunteers have been creating the costumes for more than 20 years, and parents just love them. Oren Stevens is a new dad, and he and his husband picked out an owl costume for their baby.

“Having him in the NICU can be really scary so getting this full moment of joy is just a delight,” said Stevens. Plus, he said, “our son looks adorable.”

Sonya Young brought her mother with her to pick a costume for Sonya’s baby girl. The two were deciding between Angelina Ballerina and a little piglet, but ultimately went with a zebra because they fell in love with the ears and the tail.

“It’s bittersweet,” said Young. “It’s so fun to have her in her first costume, and I’m glad she’s here getting the best care.”

“Parents really love dressing their kids for Halloween,” said Bevin Merideth, RN, associate director of the Neonatal Intensive Care Unit. “It allows them to celebrate their child’s first Halloween, even if they are in the NICU, and then they take the costumes home as a keepsake to show their babies how much they’ve grown.”

Read more on the Cedars-Sinai Blog: Zombie Cells, Aging and Health

Huntington Health has added numerous highly respected and deeply rooted local physicians through the affiliation, enhancing and expanding local access to expert care and services in Pasadena and the San Gabriel Valley. Among these: cancer; cardiac, vascular and thoracic surgery; obstetrical and gynecological care; pediatric subspecialty services; and otolaryngology (ear, nose and throat).

“We chose to affiliate with Cedars-Sinai for many reasons, including their commitment to grow care at a local level to build healthy, strong communities,” said Lori J. Morgan, MD, MBA, president and CEO of Huntington Health. “Under this guiding principle, we’ve come a long way in two short years.”

Thomas M. Priselac, president and CEO of Cedars-Sinai Health System, credits the commitment of teams at both organizations for the affiliation’s early achievements.

“When we welcomed Huntington Health into the Cedars-Sinai family in August 2021, we were excited about the many opportunities to collaborate, as well as the opportunity to share resources and expertise,” Priselac said. “It is very gratifying that we already have up-and-running collaborations and new information-technology platforms in place that are benefiting patients.”

The accomplishments of the affiliation include:

• Patient care/patient experience—Huntington Health launched CS-Link, a secure, electronic medical records system that enables patients to communicate with their doctors, schedule appointments and access their personal health information. A newly created software system—designed to enhance and simplify the billing/payment experience for patients—also has been implemented.
   
• Cancer care—Huntington Cancer Center, an affiliate of Cedars-Sinai Cancer, has seen tremendous growth in dedicated personnel and services. Additional physicians have joined Huntington Health to expand the already expert roster of skilled clinicians who provide comprehensive cancer care—from diagnosis through surgery and recovery. There are expanded capabilities for infusion for chemotherapy and direct access to Cedars-Sinai Cancer clinical trials.
   
• Cardiac, vascular and thoracic surgery—Expert surgeons have joined the Cardiac, Vascular and Thoracic Surgery Program at Huntington Health to offer a wide range of lifesaving and life-enhancing surgeries to local patients. New, innovative treatment options include robotic valve repair, coronary artery bypass grafting, aortic root and arch surgery, surgical treatment of arrhythmias and minimally invasive thoracic surgery, making this a state-of-the-art program in the San Gabriel Valley. Cedars-Sinai is pleased that cardiac surgeon Robbin Cohen, MD, has joined the faculty and serves as director of the Cardiac Surgery Program at Huntington Health and professor of Cardiac Surgery in the Department of Cardiac Surgery at Cedars-Sinai.  
  
  These surgeons enable San Gabriel Valley residents to access the full spectrum of coordinated care offered by the Smidt Heart Institute at Cedars-Sinai. Cedars-Sinai is best in California and #2 in the U.S. for Cardiology, Heart & Vascular Surgery, according to U.S. News & World Report's "Best Hospitals 2023-24" rankings.
   
• Otolaryngology—Cedars-Sinai’s nationally recognized Otolaryngology Program is now available to adult and pediatric patients throughout the San Gabriel Valley who have conditions affecting the ear, nose and throat.
   
• OB-GYN—Fair Oaks Women’s Health, one of the most respected and longstanding obstetrical and gynecological practices in the San Gabriel Valley, joined Cedars-Sinai in May. With six specialists, it will provide patients access to an even greater network of specialized care.
   
• Pediatric care—Huntington Health’s Neonatal Intensive Care Unit and pediatric physicians now have access to Cedars-Sinai pediatric subspecialists via teleconsultations. The affiliation also enables direct transfers to Cedars-Sinai Guerin Children’s for the most complicated conditions. Outpatient pediatric care in endocrinology and cardiology is also now available at Huntington Health.

“We are so pleased with the progress this partnership has made over the past two years, and I’m confident that these strides point to continued success in the years ahead,” Priselac said.

Read more on the Cedars-Sinai Blog: Heart Disease | When to Get a Second Opinion

Flu season started early in the Southern Hemisphere, which typically gives experts some clues as to what we’ll experience here in the U.S. To avoid getting caught off guard, it’s important to get the flu shot in September or October, said infectious disease specialist Soniya Gandhi, MD, MPH, associate chief medical officer at Cedars-Sinai.

“Even a typical flu season can be deadly and can cause significant hospitalization,” Gandhi said, pointing to 58,000 deaths in the U.S. and more than half a million hospitalizations—all caused by last year’s flu. “We should do what we can to protect ourselves—and others—with the best tool we have: the flu vaccine.”

Cedars-Sinai primary care physicians and pediatricians are now offering flu shots to patients during regularly scheduled visits. Patients who have been treated by a Cedars-Sinai primary care provider in the past 16 months can schedule a vaccination appointment online through My CS-Link at clinics in Beverly Hills, Marina del Rey, Santa Monica, Los Feliz, Playa Vista and Tarzana.

In addition to the flu, COVID-19 and the respiratory syncytial virus (RSV) could again spike at the same time, triggering a “tripledemic,” Gandhi said. Last year, that same triple punch filled emergency departments across the country and strained children’s hospitals with young patients, who are vulnerable to RSV—a virus that can be serious, if not deadly, for infants and older adults.

But there’s a silver lining this year. In addition to the flu vaccine, new RSV shots are available for babies and adults over 60, and a new COVID-19 booster is coming this fall.

“These new shots and vaccines could really help protect us and our community during the upcoming season,” Gandhi said. “We need to preserve capacity in hospitals for those patients who really need that care.”

Help for Youngest and Oldest

RSV causes mild cold-like symptoms in most people, but it’s the leading cause for hospitalization among infants in the U.S. In babies, the virus can cause mild illness or it can cause dangerous inflammation in a child’s tiny airways.

“There's really no way to predict how your child would do even if they're completely healthy,” said Priya Soni, MD, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s. “If they do end up having a horrible course with RSV, they will likely need to be hospitalized for oxygen support, fluids and other supportive measures.”

Most children in the U.S. will be infected with RSV within the first year of their life, and almost all infants will have been exposed to the virus by the time they're 2 years old.

But parents of infants have a new way to protect their children. The U.S. Food and Drug Administration (FDA) recently approved an immunization—a monoclonal antibody treatment called nirsevimab-alip (Beyfortus)—that can be given as a single-dose shot to newborns and infants during their first RSV season. Children up to 19 months old who remain vulnerable to severe disease in their second RSV season also can get the shot.

Soni said she “100%” recommends the immunization because of strong clinical trials that yielded positive results.

The FDA also recently approved a Pfizer RSV vaccine for women who are 32-36 weeks pregnant to protect their infants at birth. The same vaccine also was approved for adults 60 and older, as was another vaccine from pharmaceutical company GSK.

For older adults, the Centers for Disease Control and Prevention (CDC) recommended these new vaccines only for those who are at highest risk of severe RSV, such as patients with asthma, diabetes or heart failure. Although both vaccines are considered safe, a very small number of cases of Guillain-Barre syndrome—a condition in which a person’s immune system attacks their peripheral nerves—were reported after vaccination.

More data is needed to determine whether these episodes may have been unrelated to the vaccine, according to the CDC. But the significant risk RSV poses to some older adults could outweigh the very low risk of developing potential side effects.

Sonja Rosen, MD, section chief of Geriatric Medicine at Cedars-Sinai, said that for now,  she recommends the RSV vaccine for older patients with lung disease, or for those who are otherwise immunosuppressed and therefore at higher risk for severe illness. “Patients should speak with their physician and make an informed decision about whether this shot is right for them,” Rosen said.

New Twist on the COVID-19 Booster

The new COVID-19 booster has been updated to include a sub-variant of Omicron called XBB, which was the predominant strain at the time the shot was approved by the FDA this summer.  The vaccine should provide protection from all the strains circulating in the U.S. right now, Gandhi said.

Thanks to the new booster, antiviral medications like Paxlovid and at-home tests, Gandhi is grateful that “we're in a very different position in 2023.” She encouraged the public to take advantage of the booster when it becomes available this fall, to keep themselves and their loved ones safe, especially when gathering throughout the fall and winter holidays.

“We know immunity wanes after the administration of the booster and that many individuals may not have had a booster for quite some time,” Gandhi said. “I think it will be incredibly important, particularly in those populations that are vulnerable to COVID illness, hospitalization and potentially even death, to ensure that they get the updated booster in a timely fashion.”

She said it’s safe to get the COVID-19 and flu vaccines together. For older adults who determine with their physician that the RSV shot is right for them, they should get that immunization alone and two weeks apart from the other vaccines, if possible, Gandhi said. 

Read more on the Cedars-Sinai Blog: Flu—When to Go to the ER

"Everyone knows that the first weeks of school can be stressful for students,” said Suzanne Silverstein, MA, founding director of Cedars-Sinai Share & Care, which provides counseling services to students who are experiencing emotional and academic challenges due to traumatic situations and stressors. “But it’s also a big source of stress for parents and families, so the start of the school year is a good time to strategize for success.”

Parents’ first step is to establish a routine, Silverstein said. For young children, that might mean making lunches and laying out the next day’s outfit before bedtime. For older children, parents could focus on establishing a consistent time for homework, dinner, bath and bedtime.

“Some children need to let off steam when they get home or have some quiet downtime; others need to do homework right away,” Silverstein said. “It’s important to know what will work best for your child and your family. Sticking to a schedule alleviates stress in the morning and sends children to school with a calm mindset.”

Screen Time and Social Media

Michelle Escovedo, MD, an adolescent medicine specialist at Cedars-Sinai Guerin Children’s, says back to school means back to rules about screen time and social media.

“It is typical for parents to relax those rules during the summer, but once school starts, parents and children need to have a conversation about limits on social media and screen time. Set agreed-upon rules,” Escovedo recently said in a virtual community conversation about the back-to-school season. “It could be as simple as no phones during dinner and homework.”

The start of the school year is a good time to renew a needed prescription and fill out school medication forms, Escovedo said, especially for children who take a summer break from ADHD medications. And she suggests parents and children go through their social media accounts together and stop following any that could be harmful, such as social media accounts that encourage eating disorders, cutting or sexual abuse.  

One of Escovedo’s most important strategies is for parents to be able to differentiate between regular teenage angst and a more serious situation like depression.

“If there is significant change in behavior or demeanor that persists for weeks, parents need to speak with a school counselor and pediatrician and possibly receive a referral for a therapist,” Escovedo said.

If a child is experiencing a mental health crisis or suicidal thoughts, Escovedo said parents should call a new hotline, 988, that immediately links callers with a mental health team.

Vaccination Season

For Priya Soni, MD, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s, back-to-school season is vaccination season.

“It’s a great idea to check in with your pediatrician now to ensure that your child is best protected as they enter the school year,” said Soni. “Over the course of the COVID-19 pandemic, we have seen a dramatic decrease in routine vaccinations for children as we were quarantining and social distancing early in the pandemic. This resulted in millions of missed doses of vaccines for U.S. kids. If there have been any gaps in your child’s vaccines being up to date, now is the time to take action to ensure the school year goes as smoothly as possible and your child is protected against vaccine-preventable illnesses.”

Some vaccines require a second dose between 4 and 6 years old, including the measles, mumps and rubella (MMR) vaccine as well as the vaccine against chickenpox. Preteens around 11 and 12 years old are due for meningococcal vaccines and the human papillomavirus vaccination, which protects against certain cancers. Older teens might need to get a second dose of their meningococcal vaccines.

In addition to the back-to-school vaccines, Soni reminds parents to get flu shots for their children before October, ahead of the winter flu surge.

In terms of COVID-19, any child who was vaccinated after April should be up to date. A new booster is expected, possibly as soon as late September.

“It may seem to parents that as soon as young children start school, they start catching colds and viruses, but there is no magic remedy to avoid that,” Soni said. “However, there are some commonsense actions, like hand-washing, eating a healthy diet and getting enough sleep, that can help.”  

Silverstein believes the best strategy for a successful academic year is for parents to be on top of their children’s mental and physical health. The more parental involvement, the better, Silverstein said.

“While all students may be anxious at the start of the school year,” said Silverstein, “it’s important to watch that the anxiety doesn’t spiral. For parents, communication with their children and with the teachers can help keep problems in check.”

Read more on the Cedars-Sinai Blog: Promoting a Positive Body Image in Children  

That’s where a pediatrician can help.

“Pediatricians are an important source of support for families as children return to school,” said Shervin Rabizadeh, MD, MBA, chair of the Department of Pediatrics at Cedars-Sinai Guerin Children’s. “Our clinical and support teams are on standby for everything from vaccine updates to emotional and psychological support.”

Part of this care team is Cesar Ochoa, MD, the new director of Developmental-Behavioral Pediatrics at Guerin Children’s. Ochoa spoke with the Cedars-Sinai Newsroom about how parents and caregivers can tell the difference between common back-to-school blues and symptoms of a more serious condition requiring a medical intervention.

If a child is having trouble adjusting to day care, preschool or grade school, when should parents and caregivers seek medical advice?

Anytime the school is expressing concerns, it is important to seek advice right away. Schools have a duty to evaluate children and provide support services—and a child’s pediatrician can help. A pediatrician can help families understand what might be going on and help them access publicly available services.

What behaviors should parents and caregivers be concerned about? 

When there are concerns from the school about disruptive behavior or emotional regulation difficulties, these are important to take note. When a child doesn’t want to go to school, that is also a red flag. Most children like school; it’s a place where they get to interact with other children and grow as individuals.

I would recommend keeping the pediatrician in the loop, so they can do an evaluation and, if needed, refer the child to a specialist. A specialist will try to understand the situation and come up with meaningful interventions.

For example, some children might struggle because of attention-deficit/hyperactivity disorder (ADHD), which affects 6% to 11% of children in the U.S. Sometimes the condition has obvious signs and can become apparent when a child starts day care or kindergarten. ADHD is popularly described as “bouncing off the walls” and quickly calls the attention of teachers.  

In some children, however, the signs of ADHD are different. They are not bouncing off the walls, but they might have trouble paying attention and daydream in class. Some children even figure out how to compensate for their condition and don’t show any academic troubles, but might experience anxiety or depression later on.

Ultimately, the toll ADHD can take on a child is great. This condition can affect a child’s self-esteem and lead to risk-taking behavior. Treatment is vital.

How does autism typically show up?

Autism is a heterogeneous condition that affects nearly 3% of children in the U.S. It is important to remember that autism affects everyone differently, which is why we refer to it as “autism spectrum disorder.” Some children present as being in their own world and other children with autism talk on time and meet all other developmental milestones on time. But the common denominator in all children with autism is that they struggle with social communication and reciprocal interactions and have difficulties interacting with other children. Examples of this include misreading or ignoring social cues and having difficulties establishing or maintaining eye contact.

How can parents and caregivers know when a behavior is something the child will grow out of, versus one that requires the help of an expert? 

There are a lot of gray areas. The best approach is maintaining close communication with the school about the intensity of the concern and how things are changing over time. If the same concern keeps coming up, continue reaching out to the pediatrician.

Read more on the Cedars-Sinai Blog: Here Are the Back-To-School Vaccinations Your Kids Need