2017 Gifts for good

Looking for a way to support OHSU Doernbecher Children’s Hospital this holiday season?

First of all – thank you! We put together a list of ways you can help that will directly benefit patients and families at our hospital. We invite you to consider the items below as you finish up your holiday shopping to make your gifts count!

Vote for OHSU Doernbecher
…to win up to $15,000 from First Tech Fed in their Season of Giving campaign. It only takes two clicks! (Ends Nov. 30, 2017)

AmazonSmile
With every purchase of products through AmazonSmile, you’ll donate a percentage of the purchase to OHSU Doernbecher! Learn how it works here, or simply start your Amazon shopping at smile.amazon.com, then select Doernbecher Children’s Hospital Foundation – it’s the one listed as “Hospital (Specialty).”

Cards for Kids
This program, now in its 25th year, transforms artwork collected from OHSU Doernbecher patients, siblings and professional artists into classic cards for every occasion (not just the holidays). Purchase online or by phone – start shopping here. Our committee is also looking for new artwork – if you know a current or former OHSU Doernbecher patient or friend, family member or professional artist, invite them to submit their work here!

Child Life wish list
Patients make more than 140,000 visits to OHSU Doernbecher every year. Our wonderful Child Life team consistently needs new books, toys, art supplies and other items to help patients and families feel more welcome, so they put together this Wish List to help guide your shopping. Items purchased for adolescents and teens are particularly appreciated! Please call ahead if you have a large donation: 503 418-5388. If you’d prefer to shop online and have items shipped directly to OHSU Doernbecher, we have an Amazon list set up here.

Friends of Doernbecher – Dru’s Chapter Ornament Sales
New this year: an ornament featuring Dolly Doernbecher and beloved Hospital Facility Dog Hope! Just what your tree needs! Order here.

Make a donation
For 90 years, OHSU Doernbecher Children’s Hospital has provided the best, most comprehensive pediatric health care services in the region – saving countless kids’ lives. Your support makes that possible! Please consider making a tax-deductible gift here.

 

 

The power of immunization

I am a millennial, and as a member of the generation that includes the children of baby boomers, I’ve been spoiled. Our generation hasn’t seen the kids wearing braces as a result of polio. We haven’t seen the devastating neurologic effects of a measles infection. We’ve been spared the agony of watching haemophilus influenza B (HIB) meningitis drain the life out of a child. We haven’t seen these diseases, and we forget how lucky we are. Most of us don’t acknowledge the incredible and powerful impact that immunizations have had on us because they’re doing exactly what they’re supposed to be doing: preventing horrible diseases. Our success has allowed us to forget.

Vaccines, at their best, cause nothing. It’s a beautiful thing. As kids, we go through vaccination schedules, experience the typical ups, downs, colds and sports injuries as expected, and grow up into adulthood. It’s easy to ignore the silent protection our immunizations give to us, the absence of harm that they make possible. In this case, it’s a boatload of disease that has been successfully kept at bay by immunizations.

So over time, we’ve gotten lulled into complacency by this beautiful void by the epidemic of health and well-being that’s been created. Maybe this allows us the time to ponder things we see, and things we know we should be scared about. We know that immunizations can hurt and cause babies to cry. Often, there are multiple pokes in multiple extremities in one visit. And then there are the components of the vaccines, some of which have been linked to scary things. Despite the substantial body of evidence that has never found a connection to autism or brain damage or cancer, the fears seem to linger. We’re given lots of paperwork with long lists of possible side effects and adverse reactions. It’s complicated. Then there’s the cornucopia of blogs, some reputable and evidence-based, many not, at our fingertips as soon as we Google “immunization” or “vaccine” or the name of any disease we’re trying to prevent. This is a dangerous world that we live in, with so many people and entities trying to take advantage or take our rights or take control.

The problem is, when we are seemingly inundated with these thoughts and doubts and concerns, we don’t readily see the most powerful argument against all of that. And it’s one thing to know that there were millions of hours of research, testing and science behind immunizations, but this isn’t enough.

The real power is in the absence of disease. It’s the infant making it to toddlerhood without needing to be in the intensive care unit with a breathing tube to get through a bout of pertussis. It’s the grandmother who blows out candles on her 90th birthday because she didn’t get influenza. It’s the man who just became a new father because he never got mumps. There are so many things that can bring someone into a hospital that are unavoidable. But we need to remember the things we can prevent, and keep fighting to keep those diseases a memory instead of a reality.

 

Emily Houchen-Wise, M.D.
Resident in Pediatrics
OHSU Doernbecher Children’s Hospital

 

 

Demystifying headaches: Kids suffer from migraines, too

This article was written by Scott Henjum and originally appeared in the Portland Monthly 2017 Kids’ Health Annual magazine.

Like adults, children can suffer from migraine headaches. 

“Migraines are the leading cause of recurring headaches in kids,” says Dr. Yoon-Jae Cho, a pediatric neurologist at OHSU Doernbecher Children’s Hospital. “There are signs and symptoms of migraine headaches that differentiate them from other types of headaches. These include aversion to bright lights and loud noises, nausea and sometimes vomiting, and chronic abdominal pain.”

Dr. Cho adds that migraines tend to run in families. Boys tend to develop migraines at a younger age – around 5 to 10 years old – and they often grow out of them. Girls, however, tend to develop them when they are a little older, often in adolescence, and have migraines into adulthood.

“When kids have migraines, they usually want to go to their room turn off all the lights, put a pillow over their head, and sleep it off, which often helps. Unfortunately, that takes kids out of their normal routine and often results in missed school,” Dr. Cho says.

Children, like adults, can get relief from migraines with medications.

Over the past two decades, several drugs have been developed that are quite effective at treating migraines, and some of these have been approved for use in children.

People often have specific triggers for their migraines, says Dr. Cho. “For some, it might be consumption of certain foods, such as sharp cheeses or dark chocolate, or additives such as MSG,” he says. “For others, it might stress, or not getting enough sleep.”

It is often very informative for patients to keep a headache journal and make note of dietary and other activities the day of, or prior to, suffering from a headache.

Kids who claim to be experiencing the “first and worst” headache of their lives should be evaluated, says Dr. Cho. Other red flags include headaches and vomiting that only occur first thing in the morning and improve throughout the day, as well as associated changes in personality or problems with strength, balance or coordination.

Children may also experience tension headaches, which can be common among school-age kids. The primary symptom of a tension headache is aches on both sides of the head, which can be caused by stress, eye strain and poor posture.

To avoid both types of headaches, Dr. Cho recommends staying hydrated, eating healthfully, exercising regularly and getting plenty of sleep.

 

If your child is experiencing headaches, talk with your pediatrician or call OHSU Doernbecher Children’s Hospital at 503 346-0644.

Matters of the heart

This article was written by Scott Henjum and originally appeared in the Portland Monthly 2017 Kids’ Health Annual magazine.

To test or not to test? 

Parents of teen athletes face this question every year as they debate whether to sign up their children for heart screenings along with pre-season physical exams. Also known as electrocardiograms, EKGs measure the electrical activity of the heart in order to identify heart defects, but results are rarely conclusive.

The number of heart screening clinics has grown over the past decade as media attention has spotlighted sudden death in athletes. Along the way, the debate about the accuracy and efficacy of the EKG testing has intensified.

“EKG testing can generate false positive and false negative results,” explains Dr. Seshadri Balaji, a pediatric cardiologist at OHSU Doernbecher Children’s Hospital. “An athlete may have an underlying heart problem, but the EKG can miss it. In other cases, the EKG may show something that looks abnormal, and the athlete is subjected to a battery of tests that are risky and expensive, only to generate results that show the heart is normal.”

Dr. Balaji notes that sudden death rates in teens and teen athletes are minuscule, especially compared to deaths from other causes like car accidents or suicide.

Two prominent medical organizations, the American Heart Association (AHA) and the American College of Cardiology (ACC), don’t support EKG screening of young athletes. They contend that no accepted standards exist for what constitutes an abnormal EKG in young athletes, and that there is no evidence that EKG screenings would lower mortality rates.

Dr. Balaji says it’s critical for teen athletes (and all teens) to disclose to their medical providers if members of their family have heart conditions, especially if anyone has died from a sudden or unexplained death at an age younger than 35.

Athletes who experience fainting, lightheadedness or shortness of breath should also be examined by a medical provider, Dr. Balaji says. These symptoms could be explained by asthma, but heart conditions need to be considered as well.

What’s not up for debate, however, is the usefulness of automatic external defibrillators (AEDs). Instead of EKG testing of young athletes, the AHA and ACC recommend wider distribution of defibrillators that can treat an athlete in sudden cardiac arrest. Defibrillators have proven effective in saving young lives on the athletic field and elsewhere.

 

If you are unsure about whether your child should be screened for a heart defect, talk with your pediatrician or call OHSU Doernbecher Children’s Hospital at 503 346-0640. 

A “magic” approach to scoliosis

This article was written by Allison Jones and originally appeared in the Portland Monthly 2017 Kids’ Health Annual magazine.

Early detection and new treatment methods help doctors treat the spinal condition using magnets – and fewer surgeries. 

Some curves in life are great – the curve on a mountain road that leads to a great view, or curveballs from a star baseball pitcher – while other curves, like a spine that bends from side to side, can mean trouble for a growing body. And while some cases of scoliosis are congenital (meaning children are born with vertebral curves) or neuromuscular (stemming from cerebral palsy, spina bifida or other conditions), about 80 percent of scoliosis cases are idiopathic – doctor speak for “we don’t really know why it occurs” – and tend to develop during puberty.

According to Dr. Christina Sayama, pediatric neurosurgeon at OHSU Doernbecher Children’s Hospital, both parents and primary care physicians should be on the lookout for markers of this condition, which impacts up to 9 million Americans.

“Early detection is key to avoiding surgery or complications with the heart and lungs,” says Dr. Sayama.

Scoliosis tends to run in families, so be sure to speak to your pediatrician about any family history of spinal conditions, and watch for the development of uneven shoulders or hips, an unusual gait or a spine that curves to one side when a child bends over.

“Once scoliosis is suspected, the gold standard of diagnosis is an upright spinal X-ray – and anything greater than 10 degrees of curvature is considered scoliosis,” explains Dr. Sayama. “Up to 20 degrees is considered mild; between 20 and 40 degrees, many neurosurgeons and orthopaedic doctors will recommend using a brace; and I will recommend surgery for a curve greater than 45 degrees.”

For growing bodies with mild scoliosis, Dr. Sayama often recommends physical therapy and core strengthening in addition to the proven strategy of wearing a brace.

“The longer a child wears the brace every day, the more likely they are to succeed in keeping the curve from progressing and needing surgery,” she explains.

And what about when surgery is necessary? In the past, a severe scoliosis diagnosis meant multiple surgeries – every 6-9 months – to lengthen growing rods that guided the spine into a healthier position. Thankfully, a new treatment is drastically reducing the number of surgeries necessary for little ones. Called the Magec Growing Rod System, the technique requires an initial surgery to implant temporary growth rods that can be lengthened by magnets from outside the body until a child reaches skeletal maturity. That means less time in the hospital, and more time practicing those curveballs.

 

If you’re concerned your child may have scoliosis, talk with your pediatrician or call OHSU Doernbecher Children’s Hospital at 503 346-0640

 

 

How to beat bedwetting

This article was written by Scott Henjum and originally appeared in the Portland Monthly 2017 Kids’ Health Annual magazine.

First, the good news: Most kids grow out of it. 

If your child can’t seem to stop wetting the bed, it may reassure you to know that bedwetting is not typically a medical problem, and usually resolves with time. Even more reassuringly, there are a number of effective therapies to help your child transition to dry nights.

“We know that bedwetting is a frustrating and exhausting challenge for parents,” says Dr. Casey Seideman, pediatric urologist at OHSU Doernbecher Children’s Hospital. “For a child, it’s embarrassing and emotionally taxing. The key things to do as a parent are to be patient, set short-term goals and to commit the whole family to work with a bedwetting family member.”

Dr. Seideman says that up until age 5, wetting the bed is simply a part of potty training. For older children, Dr. Seideman advises parents to provide active encouragement, such as a sticker or other small reward for every dry night, and a larger reward for multiple dry nights. This behavioral therapy is most effective if a child is highly motivated, a light sleeper and has no family history of bedwetting.

If rewards don’t do the trick, it’s time to try a bedwetting alarm, a bedside device that establishes a mind-body connection to let the child know that they are about to wet the bed. The device has a sensor that goes off when a child starts to urinate, triggering an alarm that will wake the child to use the bathroom. These alarms are highly effective, but if your child is still wetting the bed after six months of use, it’s time to pursue other options.

“The last line of therapy for bedwetting is medical therapy,” says Dr. Seideman. The drug Desmopressin decreases urine production. The medication is effective for about one-third of patients, and can also be good for short-term goals, such as keeping dry on a sleepover or camp. Another option is treating a child with antidepressants, which relax the bladder muscle.

Children who do not respond to the therapies may need specialized care and further evaluation for conditions like sleep apnea, constipation and diabetes. But chances are good that they’ll grow out of it in time – especially with plenty of parental support.

If your child has difficulty with bedwetting, talk with your pediatrician or call OHSU Doernbecher Children’s Hospital at 503-346-0640. 

Lice do’s and don’ts

This article was written by Allison Jones and originally appeared in the Portland Monthly 2017 Kids’ Health Annual magazine.

Six tips for treating the itchiest of childhood problems from OHSU Doernbecher Children’s Hospital pediatrician Dr. Ellen Stevenson.

DON’T share combs, brushes, hats, ribbons or barrettes.
Beware the dress-up corner! Avoid sharing capes, hats, dresses and coats if there are lice in the classroom.

DON’T keep information to yourself.
The evidence is clear – getting head lice is not related to cleanliness and doesn’t reflect badly on parents. The sooner you tell teachers and parents when you notice nits or lice, the easier it is to stop the itchy cycle.

DO let there be light.
Make sure you can see what you’re doing by picking in good light – many parents find sunlight particularly helpful for finding nits.

DON’T give up the hunt too soon.
Lice lay up to 10 eggs a day! Check back every one to three days during an active infection, and again in two to three weeks.

DO think beyond the scalp.
To help limit the spread, wash bedding and clothing in hot water, vacuum couches and car seats, and seal stuffed animals and pillows that can’t be washed in plastic bags for a few weeks.

DO get help when necessary.
For ongoing concerns, discuss treatment options with your health care provider. Also, an entire industry has popped up around lice removal – if you’re not able to eradicate the bugs on your own, you can still consider professional nit-picking.
Parents and caregivers – do you have any additional tips to share? Leave a comment below! 

The vaccine low-down: Protecting your children against chickenpox, meningitis and more

This article was written by Katelyn Best and originally appeared in the Portland Monthly 2017 Kids’ Health Annual magazine.

From DTap to measles, mumps and rubella, the list of vaccinations children are advised to get can seem overwhelming. And with fears about side effects, allergic reactions and even autism on the wind, it might seem better to cut down on those shots or skip them altogether.

But is that hesitation justified? In short, no.

Dawn Nolt, M.D., M.P.H., pediatric infectious disease specialist at OHSU Doernbecher Children’s Hospital, recommends talking through any concerns with a trusted medical provider; however, she also emphasizes that “vaccines are very safe and very effective, and that serious diseases can occur if your child or family are not immunized.”

These serious diseases range from scary stuff like polio to seemingly more prosaic infections like chickenpox. But even if an illness doesn’t seem severe, that doesn’t mean it’s safe to skip immunizations. Even the common flu can lead to serious complications, such as a secondary infection or superinfection.

“When you combat viruses, your immune system gets distracted, and some bacteria that normally are held in check can surge up,” Dr. Nolt explains. Vaccines eliminate that risk.

If your own child’s health weren’t reason enough to vaccinate, there’s a bigger issue at play: herd immunity (otherwise known as community immunity). As Dr. Nolt explains, “An infection in one person can’t be spread to the population if there’s no one else vulnerable to that infection.”

That community-level protection is important, because not everyone can make the choice to get immunized, including infants and folks with certain medical conditions.

Once you’ve decided to vaccinate, how do you know what the right schedule is? 

“We encourage all families to have a discussion with their medical provider about the best care their child should have,” Dr. Nolt says. The list of shots required by Oregon schools is a start, but it doesn’t cover everything. The human papillomavirus (or HPV) vaccine, for instance, isn’t on that list, but doctors recommend both boys and girls get it by age 11 or 12 years. HPV is a sexually transmitted virus that can cause cancer years or even decades after exposure.

Another important series of shots not required by Oregon schools are the meningococcal vaccines, which protect against some strains of bacteria that can cause meningitis. There are three different bugs to cover here: Kids should be immunized against the first two by 15 months of age. The vaccine against the third one, Neisseria meningitidis – which Dr. Nolt says is the rarest but “most devastating” – is given to teens and young adults.

What if all those shots seem like a little much? Can you skip some, or delay them until later?

Nope, says Dr. Nolt. “The CDC meets every year to assess the effect vaccinations have had on our pediatric patients,” she explains. “The types of vaccines, and have they’re given, have been meticulously studied.”

Learn more about the HPV vaccine here.

Baby in a box? What you need to know about safe infant sleep

Every day, 10 babies in the United States die from unsafe sleep. That’s more than the number of children who die from cancer. It is a staggering number, and one that is much higher than I ever though it would be. While it is unlikely that we’ll ever be able to get this number to zero, we do know a tremendous amount about how to protect babies from sleep-related death.

As a pediatrician and a parent to three kids, I know firsthand how hard sleep can be for parents of infants. Some babies sleep wonderfully from the beginning, but most wake more often, or take much more effort to get to sleep, than most parents ever imagined. Infant sleep is a huge deal, and everyone searches for the magic answer. We know that the safest thing to do is to have infants sleep:

  • On their back, not their side or their tummy
  • Alone, with no blankets, bumpers, bears or anything else
  • In their own space (for example, in a bassinet or crib)

The U.S. National Institute of Child Health and Human Development’s “Back to Sleep” (now “Safe to Sleep”) message has resulted in a significant decrease in deaths from Sudden Infant Death Syndrome (SIDS), resulting in half as many tragedies. What has not changed as significantly are sleep-related deaths from strangulation and suffocation related to objects in sleep spaces, or from sleeping in unsafe places and positions.

A safe place for a baby to sleep is a flat surface, on an approved, firm mattress, in an approved sleep product. In the U.S., these products are all approved by the Consumer Product Safety Commission (CPSC), based on careful testing and monitoring. A crib, bassinet or play yard (for example a Pack ’N Play) with the original, approved mattress is the only safe place for a baby to sleep through his or her first year of life.

Unfortunately, a quick Google search about infant sleep will yield a number of products that have not been evaluated or approved by the CPSC as safe. These include baby boxes, angled sleep spaces and “breathable” mattresses. All of these products have several things in common:

  • They all market a solution to sleep problems that families face
  • They all claim to have been tested for safety
  • Almost none of them have actually undergone assessment by the CPSC, and therefore are not to be trusted!

At first blush, these products may seem like a good idea, but they are really preying on the anxiety and exhaustion of parents and caregivers. Let’s look at the baby boxes as an example.

In Finland, the Finnish government has distributed sleeping boxes to all families with newborns. This was done as a public health measure to ensure all babies had a safe place to sleep.

In the past few years, American companies have begun manufacturing and aggressively marketing similar boxes. I remember thinking that it felt like a disruptive idea, and a potentially easy, low-cost approach to dealing with our epidemic. I had many questions about how they would work, what they were made of, and how we knew they would be safe for babies in this country.

I now think differently. We are not Finland. They are a country of 5.5 million people, a country with universal health care, including prenatal care, early-infancy home visiting support programs and a much more homogenous populace, both in terms of economic and racial/ethnic characteristics. It’s not safe to assume that what works in Finland will work in the U.S.

Simply put, I am scared of baby boxes. I’m scared because I have no idea how safe they are, specifically how they compare to other established sleep spaces. To date, there are no standards that apply to the boxes; they are being marketed with no peer reviewed information about their safety, and no assurances that they are not harmful. If I cannot be certain, I am not willing to take risks with something so potentially devastating.

Right now, there are thousands of boxes being given to families of newborns across the United States, free of charge. This is because the for-profit companies that make them are giving them to hospitals to establish a market. We do not allow formula companies or drug manufacturers to do that, so why are we OK with the box makers? Companies are giving away a product that has no established safety standards, when we have plenty of alternatives that are safe and proven.

The boxes are made of cardboard, and come with a mattress. In using them, the infant simply sleeps in the box as they would a crib or bassinet (both of which must meet strict CPSC standards). Where does one put a box with a baby in it? On the floor? On a bed, table, couch? I am not sure any of those places are ideal. What happens if the box gets wet? Babies spit up and leak out of diapers, after all. What happens when a baby can roll to their side or tummy? This occurs between 3-6 months, which is also the highest risk period for SIDS.

A bassinet that meets CPSC standards can be purchased for a price similar to the cost of the boxes. They also can be used until the baby can roll, and they have a proven safety record when used correctly. Portable play yards are only slightly more expensive than the commercial boxes, meet stringent CPSC standards, and can be used for babies for well beyond a year or two of life.

As a pediatrician, my job is to do what’s best for kids. I do that through application of the best available science, and partnership with parents and caregivers. The science tells me that unsafe sleep is among the leading causes of death for babies, and we know the safest ways for infants to sleep are alone, on their back, in a safe place. Until I have science that shows that the boxes are a safe place, I would urge parents and caregivers to use what we know to be safe. It is simply not worth the risk.

The OHSU Doernbecher Tom Sargent Safety Center partners with the Cribs for Kids program, an evidence-based non-profit that helps distribute CPSC-certified play-yards for sleep at cost. We ensure that every sleep space that we distribute comes with face-to-face education about proper use and safe sleep. We hope to be able to reach a broader cross section of the Portland community, and will be working with community-based groups with moms in need to get the safe sleep message out there, and cribs into the homes of families that have no safe place for their babies to sleep. If you need help, let us know. If you have questions or concerns, please feel free to contact us.

Ten babies a day. How can we do anything other than what we know to be the safest?

Ben Hoffman, M.D. 
Medical Director, OHSU Doernbecher Tom Sargent Safety Center
Professor of Pediatrics
OHSU Doernbecher Children’s Hospital

Raising a reader in digital days: Comics galore!

Following up on his blog post about summer reading, Dr. Craigan Usher extols the benefits of reading comic books and makes some recommendations for families looking to dive into the world of comics.

Connecting with (and through) comics

For reluctant readers, comics (also called sequential art) can be read in bite-size pieces, rather than whole chapter meals. Because they’re less text dense, comics can be read in one sitting or over the course of a few days. Further, comics can be shared among kids while on trips – with younger children perhaps enjoying “reading” the images, while more mature readers engage with the text.

Since large comics (often referred to as graphic novels) can be ready very quickly, the price can add up. This inspires young readers and families to share with one another or to borrow from the library. This is a great excuse to connect with people in your neighborhood or make your way to the local library.

Comics invite readers to be transported into the story in a way that animated features may not. Simply put, most comics invite readers to imagine what occurs in the space between panels – requiring less intense effort than pure text formats, but certainly more than TV and movies.

Encouraging empathy

Comics encourage empathy by spelling out the ways we experience the world, with cognition as thought bubbles, verbal communication as speech bubbles, reactions creatively marked by stomach butterflies or sweat beads flying off one’s face, and so on. Further, graphic literature has blossomed to include many titles that help school-age kids imagine how to successfully negotiate bullying or deal with “drama,” and they encourage children to consider the thoughts, feelings and experiences of others who may be different than themselves. These include titles like Raina Telgemeier’s tale Smile, which depicts her struggles with dental trauma. Jennifer Holm and Matthew Holm’s Sunnyside Up about a young girl sent to live with her grandfather in Florida is also particularly moving. Finally, even space and otherworldly adventures like Ben Hatke’s Zita the Spacegirl, Jeff Smith’s Bone series or Kazu Kibuishi’s Amulet adventures help readers consider the often conflicted emotions and motivations behind character’s actions.

Storytelling through comics

Reading comics often inspires us to draw our own, working through exciting moments by distilling these BIG experiences into brief, but short stories. For example, a child might take a fun experience they had over the summer and want to remember it to tell friends or a teacher about it later. However, some of the usual ways we commemorate trips or experiences may fall short. For example, your child may not want to journal capturing all of the details of a particular experience and maybe you didn’t want to buy the commemorative tchotchke. What better way to preserve the experience than to distill a fun trip to the river than to draw a three-panel comic? One fun activity I encourage parents to do is to sit and write these with their children. For example, you might set a timer for 10 minutes and, sitting alongside your child, both write your own 3-4 panel comics with various prompts:

  • “The best thing about this summer was…”
  • “One thing I wish I could have changed about this summer…”
  • “The summer of 2017 will always make me think about…”

After you complete your comic, share them with another and put them up on the fridge or wall for a sequential art show.

We’d love to hear your thoughts! Was this helpful? What comics are you and your children reading? Leave a comment below to let us know!

 

Craigan Usher, M.D.
Clinical Associate Professor of Psychiatry
Program DirectorChild & Adolescent Psychiatry Training

 

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