Miranda was riding home from school on a motorized minibike when he was hit by a vehicle and then dragged by a semitruck, resulting in catastrophic injuries. Initially rushed to a nearby Level II trauma center to be stabilized, Miranda had injuries so extensive and life-threatening that physicians there decided the best chance to save his life was to transfer him to Cedars-Sinai.  

“As a Level I trauma center, Cedars-Sinai is prepared to deal with highly complex cases like Albert’s,” said Galinos Barmparas, MD, medical director of Trauma in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai. “Even with our team’s extensive resources and expertise, it’s still a miracle Albert is alive, with the injuries he sustained.”

Major crush injuries to Miranda’s left leg required an amputation up to his hip. He also had a broken pelvis, a damaged urethra, and he battled severe infections from wounds he suffered after he was dragged on the road. Miranda required more than 20 surgeries and the expertise of physicians across multiple specialties, including trauma, orthopedics, plastic and reconstructive surgery, urology, pediatrics, physical therapy, and more.

“I never thought I'd be in a situation like this in my entire life, but here we are,” Miranda said. “But after, like, a long way coming, I've met new people here who've treated me well. And I'm actually glad that they wanted to work with me. ... So it made [Cedars-Sinai] feel like home.”

Barmparas said more than 100 healthcare workers helped Miranda get to this point.

“Patients may survive the initial hit and the initial surgeries,” Barmparas said. “But if they don't have the specialists and the resources, they may not be able to make it.”

Electric and gas-powered bikes that can travel upward of 25 miles per hour, like the one Miranda was riding at the time of his accident, are a safety concern for Barmparas, who oversees trauma surgery at Cedars-Sinai.

“These vehicles are dangerous. I can tell you that I see motorized bike, e-bike and electric scooter injuries in the trauma bay on a regular basis,” he said. “Patients come in all the time with traumatic brain injuries, facial fractures and other life-altering trauma.”

The accident occurred in late September, so Miranda spent the winter holidays, as well as his 17^th birthday, in the hospital. But in that time, he has made tremendous strides in his recovery and has regained some mobility with the assistance of a wheelchair and walker.

“It feels a little surreal, I think, the progress that we have seen from him,” said Romina Kim, MD, a pediatric hospitalist with Cedars-Sinai Guerin Children’s. “From not even being able to get out of bed to now walking with the walker. He’s a completely different kid from the one that we saw six months ago. It’s quite a miracle.”

Now, after more than five months in the hospital, Miranda is finally being discharged from Cedars-Sinai to continue his recovery at a rehabilitation center.

“Next is actually the rehab,” Miranda said. “I don't know how long I'll be there, but I hope it's a short amount of time so I can just get home already.”

The Cedars-Sinai team recently celebrated Miranda’s discharge with a celebration walk and send-off tunnel, waving pompoms and cheering him on as he made his way down the hallway of Cedars-Sinai Guerin Children’s. His physicians are encouraged by his resilience and how far he’s come not only with his physical, but also mental recovery from this traumatic event.

“He has a lot of dreams and aspirations,” Kim said. “And with the kind of attitude that he has, he can really become whatever he wants. I think he's going to do great things.”

As for Miranda, he is looking forward to getting stronger so he can get back to his normal routine and spend time with his friends. Still, he says he’ll miss his Cedars-Sinai care team.  

“Everyone has been so supportive and that's what keeps me positive,” Miranda said. “You know, if they want something good for me, I want something good for me as well.”

Read more from Cedars-Sinai Stories and Insights: Stop the Bleed Courses at Cedars-Sinai

The Cedars-Sinai Newsroom sat down with Sabrina Renteria, MD, a child and adolescent psychiatrist in the Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences, and Romina Kim, MD, a pediatric hospitalist with Cedars-Sinai Guerin Children’s, to discuss stress and burnout symptoms and what parents can do to help.  

What are some of the main causes of stress and burnout in children and teens?

Renteria: Some of the top causes of stress and burnout for this age group stem from academic pressures with high expectations and heavy workloads. High achievers, in particular, tend to overwhelm themselves with extracurricular activities in addition to their schoolwork, leaving insufficient time for rest and relaxation, which can be exhausting both physically and mentally. Additionally, social stress is often a contributing factor, especially in the age of social media where kids are constantly online. Bullying, peer pressure and difficulties navigating social relationships can all lead to severe emotional distress.  

What do stress and burnout look like in this age group?

Renteria: Burnout and stress in children and teens can manifest in various ways. This can look like snappiness or irritability, lack of energy or tearfulness. Depression and withdrawing from friends and family can be common as well. Children might even express frustration or that they feel like giving up.

Kim: Physically, stress can show up as things like headaches, gastrointestinal issues, unintended weight loss due to loss of appetite, tics and other generalized pain. In severe cases, some patients can experience what’s known as functional neurologic disorder, which is characterized by physical symptoms that cause distress and impair function without a structural or neurologic abnormality. In these cases, while nothing seems to be physically wrong with the child, they may experience various physical manifestations, including the inability to walk, muscle weakness or even seizures. With proper treatment, along with time and patience, most of these ailments are reversible.

How do doctors determine if a child’s physical ailment is stress-related, versus physiological?

Kim: It’s our role as doctors to do our due diligence. We always start by obtaining a detailed history from the patient and their family. This subjective information is our first step to piece together the puzzle. We also obtain objective data, such as physical exams, lab work, imaging studies and more to help support a possible diagnosis. Once we narrow things down, we often bring in additional experts, such as our neurology or psychiatry teams to help us confirm the diagnosis and address the problem to get the patient firmly on a path to recovery.

What signs of stress or burnout should parents or guardians look for in their children?

Renteria: Parents know their children best and should look out for significant changes in their behavior and mood. If your child starts to have a drop in grades, is increasingly irritable or constantly in a bad mood, those could all be signs they are under too much stress. Kids may also lose interest in their previously cherished pastimes or hobbies. Another red flag may be sleep issues, like trouble falling or staying asleep, or even sleeping too much.

Kim: When kids are burned out or feeling too much stress, they tend not to be able to cope with their emotions. Often, even the smallest inconvenience can trigger a big reaction. It’s important that parents don’t automatically dismiss what may be an unusual behavior for their child as them just being a “moody teenager,” when there may be much more to it than that.

How can parents or guardians help their kids manage significant stress or burnout?

Renteria: It’s OK for kids to be active and busy, but it’s all about striking a balance. It is important to find the right amount of organized activity and free time to help promote social and emotional growth and development in your child. Parents can help children combat burnout by encouraging them to engage in physical activity, maintain a healthy diet, get enough sleep, establish a daily routine, set realistic goals, practice relaxation techniques, limit screen time and seek professional help if needed.

Kim: By building an open, communicative relationship with their children early on, parents can create a foundation in which a child feels comfortable being able to talk openly about any stress or anxiety they’re experiencing. Another important thing for parents to remember: If they are not modeling good self-care and coping skills themselves, it is that much more difficult for their children to learn these habits. By setting an example of healthy balance for yourself, you can help set your kids up for success as well.

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