A Biannual Publication of the Children’s Hospital of Georgia
GEORGIA KIDS FIRST
SPRING 2015
SPRING 2015 georgia kids first
CHAIRMAN’S NOTE
DEAR READERS,
The spring edition of Georgia Kids First is simply brimming with news of research, clinical services, and other advances intended to enhance pediatric care statewide and beyond. A particularly exciting announcement is the launch of CHOG’s new Pediatric Research Unit, a consolidated space on the fifth floor of the hospital offering virtually everything needed to conduct pediatric clinical trials. The unit is certainly a boon for health care providers conducting the studies, but the true beneficiaries are patients and families. Never has it been so easy and convenient to participate in a clinical trial. We are confident our patients’ participation will benefit not only their health, but the health of countless children who suffer from their conditions. Please take a moment to learn more about how the unit can serve you and your patients.
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Also included in this edition are articles about our Bloodless Medicine Program (one of only 150 nationwide), an intriguing link between asthma and depression, and an update on our cannabidiol study to treat intractable seizures. We are also pleased to highlight Dr. Gianluca De Leo, a GRU faculty member who has combined his expertise in business, engineering, and health to create apps targeting conditions including autism and cerebral palsy. The multidisciplinary work unfolding in his office represents astonishing and ever-growing applications of technology to improve the quality of life of countless children worldwide. Even as these accomplishments are unfolding, rest assured we are working hard to keep raising the bar. Faculty recruitment is unfolding at a rapid clip, and I will take great pleasure soon in introducing you to a fresh crop of clinicians, researchers, and educators devoted to keeping children as healthy as they can possibly be. Thank you for taking the time to better acquaint yourselves with what we have to offer. The list keeps growing, which is just the way we like it. Best, Dr. Charles Linder Chairman, Department of Pediatrics Medical College of Georgia
IN THIS ISSUE SPRING 2015
New Unit Consolidates Pediatric Clinical Trials______________________4 Cannabidiol Study Targets Intractable Seizures_______________5
Georgia Kids First is published biannually by the Medical College of Georgia Department of Pediatrics and the Georgia Regents University Division of Communications and Marketing. Please direct comments or questions to Editor Christine Hurley Deriso at cderiso@gru.edu or 706-721-2124.
Bloodless Medicine Program Broadens Options at CHOG_________6 Researcher Taps Into Technology to Transform Lives_________________7 Healthy Habits are Worth Reinforcing Year-Round___________8 Immunization Serves Vital Role in Health____________________________9 Research Shows Asthma/Depression Risk in Girls_________________________10
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SPRING 2015
GEORGIA KIDS FIRST
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New Unit Consolidates Pediatric Clinical Trials Pediatric research at GRU has never been easier, thanks to a new Children’s Research Unit. This consolidated space – where blood can be drawn, vital signs can be measured, laboratory work can be conducted, surveys can be completed, literature can be reviewed, and other steps in clinical trials can take place in a single area – is a boon for the health care providers conducting the studies. But patients and families are the biggest beneficiaries, thanks to streamlined convenience and easy access. The unit is housed on CHOG’s fifth floor.
ing those laboratory findings in actual patients – thus expediting their incorporation into widespread patient care – is one of the defining characteristics of a teaching hospital, explains Dr. Charles Linder, Chairman of the Department of Pediatrics. “CHOG doesn’t just provide cutting-edge treatment,” he says, “it creates cutting-edge treatment. Our basic scientists discover new or improved treatments, then our clinicians invite eligible patients to participate in the final testing phase. It’s a cycle of research that enhances health care for everybody, offering continuous and ongoing improvements.” Some of the research represents degrees of improvement – say, a cancer drug that has milder side effects than those of the conventional treatment. Others represent sea changes – new drugs that save lives, for instance, or offer vast improvements in quality of life. Patients’ participation in clinical trials, of course, is completely voluntary and rigorously monitored to ensure their well-being. But many families, Linder notes, are happy to help advance science while at the same time likely improving their own children’s health. GRU’s job is to make the process as easy and convenient as possible – a commitment exemplified by the new unit, Linder says. “We wanted to provide a facility close to where the pediatricians are,” says Tingen, who holds the Charles W. Linder, M.D. Chair in Pediatrics. “We proposed using existing space in CHOG. We are thankful that [Medical College of Georgia Dean Peter F.] Buckley agreed to fund it. The unit has taken on a life of its own.” To further optimize the service, Sarah Long, Manager of the Division of Clinical and Translational Sciences, is
“We’re providing a safe environment where children’s research can be performed,” says Dr. Martha Tingen, Research Director of the unit. The unit is some five years in the making. “The Department of Pediatrics is very passionate about patient care and education, but faculty members were frustrated at the lack of resources to conduct clinical research,” says Mary Ann Park, who as Manager of the Clinical Trials Office coordinates some 128 studies campuswide. Clinical studies are the last phase of research that has proven effective in the laboratory. The means of validat-
Drs. Charles Linder and Martha Tingen
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helping implement ILAB – an electronic lab management system – that will track the studies’ revenues and expenditures. “It will help us know where to invest future dollars and ensure that our efforts are strategic,” Long says. The unit’s website (gru.edu/ research/cru) offers a form for principal investigators of studies to request space or other assistance. The first study unfolding in the unit is one determining how to help families better adhere to sickle cell treatment. Dr. Cindy Neunert, Assistant Professor of Pediatrics, is recruiting patients to use a medication with an electronic cap that records every time it is opened. The medication, hydroxyurea, is well-established to help prevent the pain crises and other complications common in sickle cell disease, a condition characterized by abnormally shaped red blood cells. “Hydroxyurea gets the body to make more fetal hemoglobin, which is protective against cellsickling,” Neunert says. However, if not taken daily, the pain crises will likely return. “With the electronic cap, we’ll know for sure whether the medication is being taken every day,” Neunert says. “That way, we can offer feedback at appointments – praising those who take it regularly or using it as an opportunity for better education for those who don’t. We’re offering solutions about how to work together as a team to try to improve their adherence.” Neunert has begun recruiting participants for the study and is thrilled to have the Children’s Research Unit as a resource. “I think we’re going to learn a lot about how to interact with our patients – how to support them and really make a difference,” she says.
cannabidiol study targets intractable seizures
A public-private partnership between the state of Georgia, GRU, and GW Pharmaceuticals is exploring the effectiveness of cannabidiol in treating intractable seizures. Cannabinoids are a family of complex chemicals that lock on to various receptors in the body. Humans have been using cannabis plants for medicinal and recreational reasons for thousands of years, but it wasn’t until the late 1980s that researchers found the first cannabinoid receptor and, later, found that the body produces its own cannabinoid-like chemicals, called endocannabinoids. Those chemicals bind to one of two cannabinoid receptors, CB1 or CB2. CB1 is mostly found on cells in the nervous system, including certain areas of the brain, while CB2 receptors are mostly found in cells from the immune system. Scientists believe endocannabinoids and cannabinoid receptors are involved in a vast array of functions, including helping to control brain and nerve activity.
Preston Weaver, one of Georgia’s first cannabidiol patients, with mom, Valerie, and Dr. Yong D. Park
GW Pharmaceuticals, a United Kingdom-based company that has spent a decade sponsoring and publishing CBD research, produces a CBD-derived drug, Epidiolex®, that has been studied at 12 U.S. sites on over 300 children. GRU became the most recent study site when Georgia Gov. Nathan Deal announced his support last April of clinical CBD research and rigorous data collection to “inform and expand the scientific community’s understanding of potential treatments for difficult-to-treat forms of childhood epilepsies.” Around 466,000 U.S. children have epilepsy and about 20 percent of those have seizures that resist treatment, according to Dr. Yong D. Park, Director of the CHOG Pediatric Epilepsy Program. “For these children, it really seems hopeless. There are other options, like alternative diets, but existing medications don’t work.” The GRU trial began in December in Augusta with planned expansion to Savannah and Atlanta.
CBD’s Effects on the Brain GW Pharmaceuticals, the company partnering with GRU in the cannabinoid study, cites several benefits of the drug. Specifically, its decade-long research findings suggest that CBD: n Modulates the flow of ions in and out of cells, especially calcium, which may contribute to its anti-convulsant effects and restrict the intensity and spread of a seizure. n Targets the underlying brain inflammation associated with seizures. n Exhibits neuroprotective qualities, unlike anti-convulsants that are thought to impede cognitive function by reducing useful neural plasticity. “Our hope is that CBD’s early promise of [seizure control and mild side effects] in children with drug-resistant epilepsy may be born out in the formal regulatory studies being undertaken,” says Dr. Geoffrey Guy, Chairman of the GW Pharmaceuticals Board of Directors.
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SPRING 2015
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bloodless medicine program broadens options at CHOG CHOG patients are in exceedingly good hands when circumstances require bloodless surgery: GRHealth, which oversees GRU’s clinical facilities, is one of only 150 health care facilities nationwide – and one of only 200 in the world – to offer a Bloodless Medicine and Surgery Program. Bloodless medicine procedures minimize blood loss during surgery and ensure optimal medical care without the use of donor blood or blood products. Medications are also available to escalate the production of red blood cells, which, in turn, increases hemoglobin, reducing the need for transfusion. “For patients motivated by religious convictions and those who are simply concerned about blood-borne illnesses, our Bloodless Medicine Program offers viable alternatives, including cell preservation and blood management,” says Dr. Colville Ferdinand, GRHealth’s Trauma Chief and Medical Director of the Bloodless Medicine Program.
Fast Facts
About Blood from the n Blood carries oxygen and nutrients throughout the body, fights infections, and helps heal wounds. n The human body manufactures 17 million red blood cells per second and can produce up to seven times that amount if needed. n One pint of blood can save up to three lives. n More than 41,000 blood donations are needed daily in the United States. n A total of 30 million blood components are transfused each year in the United States. n Blood cannot be manufactured; it can come only from generous donors.
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“Every patient is unique. We respect their individual needs; if they desire a transfusion-free procedure or surgery, we will do what we can to honor their wishes.” The program is particularly vital considering that blood products are in increasingly short supply as blood utilization and blood costs are accelerating nationwide, Ferdinand says. The price of a pint of blood has almost doubled over the last few years. The alarming data related to blood usage: n In the United States alone, someone needs a blood transfusion every two seconds, and one in three people will require a transfusion in their lifetime. n Blood transfusion is the most common hospital-based procedure in the United States. n About 14 million units of blood are transfused annually; the average cost of transfusing a single unit of red blood cells is approximately $1,200. n Blood donor pools are shrinking due to an aging population and stringent donor qualifications. n If blood usage trends continue, the U.S. transfusion demand is projected to exceed collections by 2020. GRHealth is committed to blood conservation, observing the Society for Advancement of Blood Management’s principles to serve patients’ best interests – applying evidencebased medical and surgical concepts to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss – while preserving the blood supply and reducing costs. This requires making concerted efforts to minimize blood loss, encouraging interdisciplinary blood conservation interventions, and promoting patient-centered decisionmaking.
researcher taps into technology to transform lives
A Georgia Regents University faculty member has piggybacked onto multiple kinds of cutting-edge technology – videos, computer software, smartphone apps – to improve the lives of children with cerebral palsy, autism, diabetes, and other conditions. Dr. Gianluca De Leo, Chairman of the Department of Clinical and Environmental Health Sciences, relishes combining his bioengineering and bioelectronics PhD with an MBA to optimize his expertise and reach. “Technology gives us the opportunity to reach out to different populations, to everybody who needs it,” says De Leo. “I am interested in doing research that impacts the lives of people now.” For instance, before joining GRU, he and his colleagues at Old Dominion University created software enabling children with cerebral palsy to rescue a princess from a dragon by walking a virtual path on a computer screen. What they were actually walking on was a treadmill, but the dazzling and exciting virtual world unfolding on the computer screen in front of them – a world in which they were the star – kept them engaged and motivated. “We used simple technology,” De Leo says. “All you needed was a DVD player, a television, and a treadmill.” The result? “The children’s ambulation improved,” he says. “If you can motivate the child to walk for nine hours every two weeks or so, we found that the ambulation skills improved significantly.” Yet another application was creating an automated telephone call center to help educate, monitor, and assist
Dr. Gianluca De Leo
I Click I Talk Testimonials
Editor’s note: These testimonials are paraphrased from iclickitalk.com.
“I just wanted to tell you that I am in LOVE with this program.” –Kara, Speech Therapist, Williamsburg, Virginia
“This software is unbelievably easy!” –Jenny, Speech Therapist, Norfolk, Virginia
“I Click I Talk helped my son, who has a diagnosis of autism and severe dysphasia. I was able to add familiar images and change the text to Czech.” –Monika, Czech Republic
“As an SLP working in three autistic classrooms ranging from K to grade six, this application is a definite musthave.” –Shelly, Speech-Language Pathologist, Portsmouth, Virginia
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people with diabetes and their families. But nowhere has the smartphone proved as invaluable as in helping children with autism and other communicative limitations. In 2010, De Leo and his colleagues launched an app called I Click I Talk. The app, also available as software for computer pads, laptops, and desktops, presents a screen with images representing various categories – food, for instance. The child drags images from the screen to create sentences. De Leo has expanded greatly on the concept to keep adding new features and functionality, such as using the parent’s, teacher’s, or child’s own voice; tracking progress; creating “memory” to determine which images are used most often; and enabling the software to be customized with personal photographs. “When I go to schools and present this, I keep changing it and adding more functionality based on what teachers and parents want,” he says. “It can be used with any language, and it’s flexible enough that anybody can use it, including those with traumatic brain injuries. You can even find people in Saudi Arabia using it.” The technological hurdle, he notes, was the biggest factor in bringing his innovations to the masses. “[Virtually] everybody has a cell phone,” he says. “Before, it was more difficult to reach out to various populations, but now, the potential is incredible. And these tools are becoming increasingly affordable.”
SPRING 2015
GEORGIA KIDS FIRST
SPRING 2015 georgia kids first
healthy habits are worth reinforcing year-round So how are your New Year’s resolutions holding up? If you’re like most people, they came and went as quickly as the fireworks that heralded the occasion. But a few good habits are worth reinforcing year-round. “Parents tend to set personal goals, but they are not as quick to set or contemplate goals for their children,” says Dr. Charles Linder, CHOG PediatricianIn-Chief and Chairman of Pediatrics at the GRU Medical College of Georgia. “But there are things you can focus on to improve wellness and
“We hear about so many accidents involving guns in the home, and these are preventable tragedies.” n Live tobacco-free. Smoking and secondhand smoke are harmful to you and your family, as are other tobacco products and electronic cigarettes. Make this the year to quit. n Be physically active. Encourage your kids to be active for at least one hour every day. Include activities that raise heart rates and strengthen muscles and bones. “Find fun, safe activities that you can do as a family, like walking or riding bikes,” advises Linder. n Get some sleep. How you feel and perform during the day is related to how much sleep you get the night before. “Sufficient sleep is increasingly being recognized as an essential aspect of chronic disease prevention and health promotion,” says Linder. “Sleep needs vary from person to person and from adults to children, so make sure you’re getting the sleep required for you and your children.” n Maintain routine checkups. “Go to the doctor regularly. Don’t just go when you are ill,” Linder urges. Routine checkups, including dental and eye exams, help identify ways to stay healthy, enable preventive care, and often uncover health problems early when treatment is most effective. n Stay current on immunizations. “Nobody really likes getting a shot, especially children, but timely immunizations help prevent diseases and save lives,” says Linder. (See page 9 for more information.) Keep a record of your family’s vaccinations and ask about vaccinations for shingles, pneumonia, and other illnesses that require boosters in adulthood.
quality of life for both you and your family year-round.” Here are 10 resolutions that CHOG physicians recommend reinforcing to parents and other caregivers to optimize a healthy lifestyle: n Provide a safe environment. Make sure your environments are child-friendly and safe. Use car seats and seat belts for appropriate ages and sizes. Keep hazardous materials and objects in locked areas and out of your children’s reach. “Keep medications and weapons locked away,” Linder says.
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n Maintain a healthy diet.
Serve healthy meals and snacks to your family and teach children to choose their foods wisely. Linder recommends snacks that require washing, peeling, and/or slicing, such as raw fruits and vegetables. “If it comes in a bag, box, can, bottle, or wrapper, it’s probably not healthy,” says Linder. Watch portion sizes, too. n Monitor your children. Know who your children spend time with, what they’re doing, and if the activities are appropriate. Limit TV and nonessential computer time. “And carefully monitor or limit social media activity if you allow your children to participate,” Linder stresses. n Nurture your family. Kids need the support and love of family and friends. Converse with your children regularly and show them you care about what’s going on in their lives. Respond to their physical and emotional needs. “It’s important for kids to grow in a safe, loving, and secure environment,” Linder says. “Examine your schedule. If you are overextended, streamline so you can spend quality time with your family.” n Practice what you preach. Model a healthy lifestyle and teach children to make wise and healthy choices every day, including fastening seat belts, wearing helmets, using sun protection, practicing proper hygiene, and treating others with kindness and respect. “Your children learn best when you model the good behavior you wish them to show,” says Linder. “If you steer your children toward healthy resolutions now, they’re more likely to carry these healthy habits into adulthood,” he says.
immunization serves vital role in health
Car seats, baby gates, bicycle helmets, football pads – these are all examples of how to protect children as they grow. One of the most important ways to protect them is by getting them vaccinated, says Dr. Dennis Murray, CHOG Chief of Infectious Diseases. “Many life-threatening diseases have been practically eliminated today in the United States because of the development and implementation of vaccines,” says Murray. “Polio and smallpox are examples.” But according to the Centers for Disease Control and Prevention, nearly 1 million American children aren’t fully immunized, resulting in a recent resurgence of measles in several states. “Children should be immunized,” advises Murray, and here are four reasons why: n Immunizations can save your child’s life. Because of advances in medical science, your child can be protected against more diseases than ever before. “Vaccines are really one of the greatest discoveries in modern medicine,” says Murray. Some diseases that once injured or killed thousands of children have been eliminated completely, and others are close to being gone – primarily due to safe and effective vaccines. n Immunizations protect others you care about. Serious vaccine-preventable diseases still occur. Unfortunately, some babies are too young to be completely vaccinated and other people may not be able to receive vaccinations due to allergies, illness, weakened immune systems, or other reasons. “It is important that you and your children who are
Immunizations are an important part of wellchild care. In addition, many adults need periodic boosters. Put simply, immunizations save lives.
For more information, visit
cdc.gov/vaccines
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able to get vaccinated are fully immunized in order to prevent the spread of these diseases to more vulnerable friends and loved ones,” says Murray. n Immunizations can save time and money. A child with a vaccine-preventable disease will likely be kept out of school or daycare. Likewise, a prolonged illness can take a financial toll because of lost time at work, medical bills, and/or long-term disability care. In comparison, getting vaccinated against these diseases is a good investment and almost always covered by health insurance plans. The Vaccines for Children program, a federally funded program, provides vaccines to children at no cost. n Vaccinations are safe and effective. Vaccines are carefully studied and reviewed by scientists, doctors, and health care professionals before they are approved for use. Immunizations may cause pain, redness, or tenderness at the injection site, but these risks are minimal compared to the symptoms and dangers of the diseases themselves. Also, groups including the American Academy of Pediatrics, the Institute of Medicine, the National Institutes of Health, and the Centers for Disease Control and Prevention agree that vaccines are not responsible for autism despite myths to the contrary.
SPRING 2015
GEORGIA KIDS FIRST
SPRING 2015 georgia kids first
research shows asthma/depression risk in girls
Teen girls who live in rural areas are more likely than their male counterparts to have undiagnosed asthma and often are at a higher risk of depression, according to MCG researchers. Data collected during a three-year trial of an asthma program tailored to teens revealed that the prevalence of asthma – both diagnosed and undiagnosed – is comparable in both rural and urban areas. But more girls had undiagnosed asthma than boys. “Maybe it’s because boys are more likely to get a sports physical for athletics and they catch it then,” says Dr. Jeana Bush, an MCG Allergy and Immunology Fellow. “Or maybe it’s because girls attribute asthma symptoms to something else, like anxiety. That needs further study.” Bush also found that the overall rate of depression among asthmatic teens living in rural areas exceeded national averages. Of the 332 rural boys and girls with asthma
Dr. Jeana Bush
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identified in the study, 87, 67 of whom were girls, screened positive for depression. “The overall percentage of depression is higher than has been shown in the literature for other chronic diseases, including inflammatory bowel disease, diabetes, congenital heart disease, and even cancer,” Bush says. “That was staggering.” Scientists are still studying the link between asthma and depression, she says, but they know depression is a potential barrier to diagnosis and treatment of the disease.
CHOG PEDIATRIC CONSULTATION Allergy/Immunology 706-721-3531 William Dolen, MD Betty Wray, MD Child Abuse/Neglect 706-721-2456 Maureen Claiborne, MD General Pediatrics and Adolescent Medicine 706-721-2456 Reda Bassali, MD Lynnette Bauza, MD Alice Little Caldwell, MD Maureen Claiborne, MD Davidson Freeman, MD Lisa Leggio, MD Charles Linder, MD Kathryn McLeod, MD Donna Moore, MD Lauren Newhall, MD Robert Pendergrast, MD Nirupma Sharma, MD Leila Stallworth, MD Christopher White, MD Pediatric Cardiology 706-721-2336 Zahid Amin, MD William Lutin, MD PhD Kenneth A. Murdison, MD William Strong, MD Henry Wiles, MD Pediatric Endocrinology 706-721-4158 Chris Houk, MD Traci Scott Pediatric Gastroenterology 706-721-4724 Dennis L. Murray, MD, Interim Chief Vita Goei, MD Joyce Dorman Pediatric Genetics 706-721-2809 Carolyn Lovell
Pediatric Hematology/Oncology/ Sickle Cell 706-721-3626 Afshin Ameri, MD Theodore Johnson, MD Colleen McDonough, MD David Munn, MD Cindy Neunert, MD Betty Pace, MD Beth Fisher, RN, CPNP Pediatric Infectious Diseases 706-721-4725 Fred Cox, MD Chitra S. Mani, MD Dennis L. Murray, MD Christopher White, MD Pediatric Neonatal Follow-up Clinic 706-721-2331 Chantrapa Bunyapen, MD Pediatric Nephrology 706-721-0177 Luis Ortiz, MD, Chief Obioma Nwobi, MD
Pediatric Ophthalmology 706-721-1150 Stephanie Goei, MD Pediatric Orthopedic Surgery 706-721-2849 Styles Bertrand, MD David Cearley, MD Pediatric Otolaryngology 706-721-6387 Anthony Hughes, MD George Harris, MD Pediatric Plastic Surgery 706-721-2198 Jack Yu, MD Pediatric Surgery 706-721-3941 Robyn Hatley, MD Charles Howell, MD Walter Pipkin, MD Christian Walters, MD Diane Bairas Pediatric Urology 706-721-0982 Ronald Lewis, MD Durwood Neal, MD
Pediatric Neurology 706-721-3371 Yong Park, MD Elizabeth Sekul, MD Pediatric Pulmonology 706-721-2635 Valera Hudson, MD Kathleen T. McKie, MD Nicole Wimmer, RN, MSN, CPNP Pediatric Rheumatology 706-721-8950 Rita Jerath Pediatric Cardiothoracic Surgery 706-721-0982 Anatasios Polimenakos, MD Pediatric Neurosurgery 706-721-3071 Ian Heger, MD Cole Giller, MD (Pediatric Epilepsy)
Other Pediatric Services NICU 706-721-2331 Jatinder J.S. Bhatia, MD Chantrapa Bunyapen, MD James Holcomb, MD Azif Safarulla, MD Brian Stansfield, MD Triven Bashaumbu, MD PICU 706-721-4402 William Cagle, MD Lyle Fisher Jr., MD Renuka Mehta, MBBS Mary Lynn Sheram, MD Pediatric Radiology Office: 706-721-5201 Reading Room: 706-721-5209 Kristopher Lewis, MD
Introducing a new physician referral tool making it simple for you and your patients–
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CHOG Blog Want to learn the latest CHOG news in a snap? Check out our new blog at blog.gachildrens.org for tips and information about nutrition, safety, parenting, and many other topics related to children’s health. It’s a fast, fun way to stay abreast of cutting-edge findings, age-old wisdom, and everything in between related to nurturing the little ones who count on us to keep them healthy and safe. And let’s keep the conversation going; the CHOG blog welcomes your input. We want this site to be as dynamic and helpful as possible for referring physicians, parents, and anyone else with a vested interest in our most precious natural resource: kids.