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How to help a child who feels COVID-19 burnout

By Dr. Diana Graham and Dr. Christopher Min, pediatric psychologists at CHOC

For many of us, the COVID-19 pandemic has created a “new normal” as efforts to curb the spread of the virus have changed what day-to-day life looks like. It can be difficult to balance maintaining our physical and mental health while also supporting one another.

Over the last several months, many parents and guardians have tried their best to think of creative ways to help children understand the dangers of COVID-19 while also trying to limit its interference with their children’s quality of life. Kids and teens alike are struggling with the challenge of increased isolation from friends, barriers to traditional academic instruction, and uncertainty about the current events of the world, all without their usual outlets of fun and stress relief. This may result in children becoming burnt out during the era of COVID-19.

As a parent you may notice signs of the following symptoms in your child who feels burnt out by the COVID-19 pandemic: increased irritability, changes in sleep and/or appetite, less motivation to engage in things that used to interest them, withdrawal from others at home and/or increases in levels of reassurance they need due to uncertainty of current events.

Here are some things you can do to help your child if they are struggling with their mental health during COVID-19.

  1. Help them engage in a consistent routine: Having structure and routine most days can help reduce your child’s reliance on screens, their anxiety related to COVID-19 uncertainty and changes, and increase their feeling of purpose during a time that typical go-to activities may be restricted.
    • Start with thinking about what a typical day looks like for your child. Do they have online schooling or a hybrid of in-person and online schooling? What types of chores do they need to get done? Do you want them to get some physical activity each day?
    • Next, decide whether it would be most helpful to schedule by the hour or in chunks of time (e.g., 9 a.m.-noon) in their routine. Be careful to not overschedule (e.g., every 30 minutes), as this may be too difficult for both you and your child to follow long-term.
    • Scheduling in sleep and meal routines can help your child remain on a schedule similar to the one they follow during a typical school year. Having consistent sleep, wake and meal schedules can also help your child regulate their mood and manage stressful situations.
    • Make these schedules visual for your child to see and follow. Put the schedule in a place that your child will most likely see, such as on the bathroom mirror, making it more likely to become their norm.
  1. Schedule flexibility into your routine: While it is important to have consistency, it is also very important to be flexible with routines because, as we all know, life can get in the way! Having this flexibility allows your child to have an element of control during a very uncertain time, which can often help with managing anxiety. Here are some small ways to build flexibility into your child’s schedule:
    • First, choose a couple of activities in your child’s schedule that allows for several choices to pick from. They can choose what food they want for lunch, or pick what to play during game time. Here’s a roundup of activity ideas for kids during COVID-19.
    • Make lists of a three to four different choices available throughout the day for the activities on your schedule. For example, your child may have lunch at the same time every day but can have a list of different food options to choose from.
  1. Keep your child moving: We are staying at home now more than ever, making it difficult to stay active and get “brain breaks.” However, we know that being more active can have a positive impact on our mood, ability to manage stress, and ability to focus. Here are some tips to include physical activity into your child’s daily schedule:
    • Schedule in time for a physical activity to ensure that your child’s brain is getting the break it needs, especially from screens. Research has shown that recess at school can help children to stay on task and increase sustained attention.
    • Keep a varied list of COVID-19-friendly physical activities that your child can choose from to help decrease sedentary behavior. Examples may include jumping jacks, YouTube yoga, a household dance party, and even taking a walk around the block while listening to music. Remember to practice physical distancing if exercising outdoors.
    • Although physical activity is beneficial throughout the entire day, studies show that exercise between 4 p.m. and 6 p.m. can help a child’s ability to fall asleep and stay asleep. If your child is having sleep difficulties, time your child’s exercise activities to help promote more restful sleep.
    • It can be challenging to motivate your child to be active when they are feeling burnt out. If your child seems uninterested in engaging in a physical activity, try to schedule it at a time when another person in the household can participate so that it can feel more fun and socially engaging rather than punishing. Or, they can take an online yoga class with a friend. As this becomes a more regular part of your child’s routine, it will likely become easier. For school-aged children and teenagers, it can also be helpful to collaborate with them on the list of choices for physical activity to increase their engagement when it becomes time to be active.
  1. Normalize not always being OK: Kids learn from those around them. Let your child know that it’s OK to feel uneasy about how things are right now.
    • You can do this by modeling good coping skills when you make a mistake or don’t have the answer to something and recognizing the uncomfortable emotions that might come along with this experience.
    • Sometimes labeling emotions is enough to help validate your child’s experiences. By showing and discussing all the different emotions you may be experiencing during a difficult situation, it will help normalize this type of emotional processing for your child too.
    • Create opportunities with your child to discuss how challenging COVID-19 is for so many people, the different ways these challenges may show up in our daily lives, and to brainstorm ideas on how to cope. This can build a pattern of communication in which your child notices warning signs of burn out sooner and can let you know when they need help.
  1. Learn how to cope together: Engaging in family activities together can be a good way to decrease the likelihood of experiencing feelings of social isolation and give you and your child shared goals. By learning these coping skills together, it models for your child that it is OK if we do not feel happy all the time and there are ways that we can help manage challenging feelings.
    • Consider regular family game nights where each person gets a turn choosing the game. Other examples may include an at-home scavenger hunt or a puzzle that the family takes time to work on each day. This provides both consistency and flexibility, in addition to social interaction.
    • One fun idea can be to set family challenges each week. You may have a week where each day involves practicing a different coping skill (e.g., deep breathing, guided imagery, stretching or journaling) or a week where each person shares something that they are grateful for. Whoever can complete the most challenges during the week gets a reward, such as choosing Saturday night dinner or the next movie for family movie night. If there is a tie, then you can always split up portions of the fun night that each person gets to choose, such as one person choosing the movie and another choosing the meal.
  1. When is this all not enough? Let’s face it, we don’t always have all the resources to implement every strategy whenever we need it. Or, you may encounter situations where you try every recommendation and still notice concerning changes in your child. Either way, it is OK to ask for help.
    • Be aware that you are only one person and many of us are forced to function without our typical support networks such as extended family and childcare centers because of COVID-19 restrictions. Consider some other avenues of support that may be helpful for you and your child to decrease burn out and help manage coping during the pandemic.
    • Reach out to your child’s teacher or school counselor for support. Are they able to check in with your child more often? Have they noticed any changes in your child’s school engagement beyond what they think is typical right now? They may be able to provide more frequent or regular support.
    • If you become concerned about your child’s mental health, contact your primary care physician. You can also call your insurance company for a list of in-network mental health professionals or do a search online for local mental health providers.

Here are additional mental health resources for your child during COVID-19

  • CHOC’s mental health toolkit has resources for parents, kids and teens, and schools.
  • CDC Parent Resources are organized by type of activity and age group, including directions for an At-Home Scavenger Hunt.
  • Helplines
    • Substance Abuse and Mental Health Services (SAMHSA) Disaster Distress Helpline
      • Toll-Free: 1-800-985-5990 (English and Español)
      • SMS: Text TalkWithUs to 66746
      • SMS (español): Text “Hablanos” al 66746
      • TTY: 1-800-846-8517
      • Website — English| Website — Español
    • National Suicide Prevention Lifeline: 1-800-273-8255
    • Crisis Text Line: Text HOME to 741-741
    • Orange County Crisis Assessment Team:
  • Helpful apps
    • MindShift: a cognitive behavior therapy-based app from Anxiety Canada that helps kids to learn about and track anxiety, as well as coach them through coping skills
    • Headspace: A mindfulness app for everyday life
    • Smiling Mind: An app that guides helpful coping skills based on age
Get more information on Coronavirus (COVID-19)

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Healthy snack ideas for the whole family

By Kelsey Childs, clinical dietitian at CHOC Children’s

Does it seem like your children are snacking all the time? Do you find yourself snacking more during the pandemic as you work from home during COVID-19? You are not alone. With families spending more time than ever at home during the pandemic, many people have noticed an uptick in snacking.

Snacks aren’t always a bad thing

Snacks play an important role in the diets of growing children. Snacks provide energy to sustain children between mealtimes. According to research, snacks may provide around 30% of a child’s daily caloric intake. In general, children should consume three meals per day and up to two or three snacks per day. However, if children are consuming more than three snacks per day, or if they are snacking multiple times between meals, this can lead to reduced appetite and intake at mealtimes.

Many snack foods advertised toward children are high in sugar and low in fiber and protein. Without fiber and protein, these snacks may not keep children full and satisfied until the next mealtime, which can lead to even more snacking.

If you’re looking for new ideas for healthy snacks that are great options for the whole family, here are some important health benefits to keep in mind and my favorite healthy snack ideas. And if you’re looking to get kids involved in the kitchen, here’s some tips.

Look for snacks that are good sources of protein, including:

  • Greek yogurt
  • Hummus
  • Nuts or nut butter (peanut butter, almond butter, sunflower seed butter, etc.)
  • Eggs
  • Cheese
  • Milk
  • Turkey or ham slices

It’s also important to offer snacks that are great sources of fiber, including:

  • Fruits —apples, bananas, berries, pineapple, peaches, pears, oranges, grapes, melon, etc.
  • Vegetables —carrots, cucumbers, bell peppers, broccoli, zucchini, celery, etc.
  • Whole grains —whole-wheat bread, whole grain crackers, whole grain cereal, etc.

To provide a healthy, satisfying snack, aim to include a source of protein and fiber at each snack opportunity. Below are healthy snack ideas that are rich in protein and fiber:

  • Veggie sticks with hummus
  • Whole wheat pita bread slices with hummus
  • Banana topped with nut butter
  • Greek yogurt served with fruit
  • Cottage cheese topped with fruit or tomato slices
  • String cheese and strawberries
  • Apple slices served with a hard-boiled egg or a small handful of nuts
  • Cooked egg with a side of fruit
  • Whole grain crackers topped with turkey slices
  • Smoothie made from Greek yogurt, milk, frozen fruit and spinach leaves

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Navigating an epilepsy diagnosis and surgery: Geni’s story

Life was proceeding right on schedule for self-described “drama kid” Genevieve Masson. The 16-year-old, who goes by “Geni,” went to class, hung out with friends and spent time rehearsing musical theater at her high school.

“It was really a normal, not-so-exciting life,” she says.

school photo before epilepsy diagnosis
Life looked typical for Geni, pictured here in her eighth grade photo, before her first seizure.

But two years ago, when Geni was 14, something changed. A small lesion that had been in her brain since birth began making itself known. One night, she woke up and couldn’t move. She figured she was caught in a moment of sleep paralysis and didn’t give it too much thought.

Things quickly turned far more serious. A few days later, Geni was feeling tired at school and decided to take a nap in her coach’s office. That’s when she had her first full-on seizure.

Geni has no memory of what happened next, but those around her became alarmed as her body shook uncontrollably. A teacher called 911 and the next thing Geni knew, she was in an emergency room.

An MRI revealed nothing, as did visits to pediatricians. But not only did the seizures continue, they were occurring more often. The more severe ones occurred at night, while less noticeable ones were happening many times a day. Ultimately, she was diagnosed with epilepsy, but she wasn’t receiving the expert care she needed at nearby hospitals.

“I remember the day she had her first seizure. It was December 18,” says Susan Masson, Geni’s mom. “By that January, there were a couple more. It got to be about 15 to 20 a day. We knew we needed to be at CHOC. We needed to be at a place where we could be with an epileptologist.”

The Massons felt lucky to live fairly close to CHOC, home to one of the nation’s premier epilepsy centers for young people. CHOC’s Comprehensive Epilepsy Program was the first in California to be named a Level 4 epilepsy center by the National Association of Epilepsy Centers, the highest level available. That distinction means that CHOC has the professional expertise and facilities to provide the highest level medical and surgical evaluation and treatment for patients with complex epilepsy.

It was at CHOC that the Massons met Dr. Maija-Riikka Steenari. A pediatric neurologist, Dr. Steenari is an epilepsy specialist, also known as an epileptologist.

dr-maija-steenari-epileptologist-choc
Dr. Maija Steenari, pediatric epileptologist at CHOC

“It’s a fascinating field,” Dr. Steenari says of pediatric neurology and epilepsy. “The combination of working with brains and kids together is the best fit for me.”

What exactly is epilepsy? Basically, parts of the brain go haywire and emit unwanted electrical signals that can cause convulsions and seizures of varying strength. As Dr. Steenari describes it, it’s “a clump of brain cells that don’t quite work the way they’re supposed to, or a cluster of cells in the wrong place. They’re really irritable. They’re known to cause trouble.”

Epilepsy can be the result of brain injury, stroke or, in Geni’s case, a slight anomaly that was present since birth.

November is National Epilepsy Awareness Month, a time to remind people that epilepsy is both fairly common — nearly 25% of the population will experience recurring seizures in their lifetime — and it’s often treatable.

Like others diagnosed with epilepsy, Geni’s first option was medication. She was prescribed anti-seizure medicines, but they didn’t work.

Geni undergoes EEG monitoring at CHOC
Geni underwent EEG monitoring at CHOC to measure electrical activity in her brain.

“Medication works about 60 to 70% of the time,” Dr. Steenari says. “But adding more medications doesn’t always work. A second medication only works about 10% of the time. So, can we do something else to help them with their seizures? That’s where surgery comes into play.”

Having seizures meant that Geni was missing a lot of school, would not be able to drive and couldn’t be left alone. But her family and friends rose to the occasion and helped when they could. And Geni did her best to be a regular teenager.

“I was trying to lead a normal life,” she says. “I would still go to rehearsals.”

Geni needed two surgeries, the first one to determine exactly where the problem was. Dr. Joffre Olaya was her pediatric neurosurgeon.

Geni’s hospital room before epilepsy surgery
When Geni spent time at CHOC, her friends made special decorations for her room to show their support and cheer her up.

“We have these grids that we can put on the surface of the brain,” Dr. Steenari says. “We can map where the seizures are coming from within a few millimeters. We could make a very detailed map.”

The lesion was right next to the part of Geni’s brain that controls language. If her surgeon didn’t have an exact spot to operate, she could lose the ability to speak or write. But Geni was willing to take the risk. Each seizure could cause more damage to her brain and Geni wanted them to stop.

“The doctor said each seizure would do damage to my brain,” Geni said. “I don’t like having constant damage to my brain done. If surgery can take me back to where I can’t write or speak well, I was willing to take the chance.”

Geni prepares for surgery
Geni was all smiles leading up to her second epilepsy surgery.

The second surgery came a few weeks later. Doctors successfully removed the lesion, but Geni faced a number of challenges after surgery that her family was told ahead of time were possibilities. there were some complications. Geni lost automatic movement of her right hand, so she couldn’t do with her right hand what other people do without thinking about it. She was 15 at the time, so before surgery, she had long ago mastered writing without thinking about how to shape each letter. After surgery, she knew how letters should look, but she couldn’t make them. She also couldn’t tie her shoes, brush her hair or teeth, button or zip her clothes, or feed herself.  But Geni and her family treated these more like challenges than setbacks, and occupational therapy helped.

welcome home signs epilepsy surgery
To welcome Geni home after epilepsy surgery, her siblings decorated her bedroom.

“A few weeks after surgery, we went to the library and we got some preschool books on how to write. It was quite frustrating, but luckily, my brain still knew how to do it. It just needed to create new pathways. As soon as I did it, it got easier,” Geni says.

workbooks to help regain skills after epilepsy surgery
Preschool workbooks helped Geni re-master writing after epilepsy surgery.

Talking was hard after surgery, too. Geni would know what she wanted to say, but finding the right words took a little more time than it used to.

“Surgery had knocked over her file cabinet of words,” Susan explains of her daughter’s struggles post-surgery, which got better with speech therapy.

Geni’s family was with her every step of the way. It was heart-wrenching for her parents to see their daughter suffer, but they’re proud of how she handled her journey.

“I cry every time I remember how hard this was, and then I laugh at how much Geni thought it was simply annoying what she had to relearn. These kids are fearless little warriors,” Susan says of her daughter. “She’s a bubbly, vibrant, friendly girl. People love her. I don’t think it ever occurred to her that there was another way to manage through this. The limitations of life when you’re living with epilepsy can be staggering, but we didn’t have time to realize them. As soon as it came up, it ended. We got hit by a Mack truck and then it ended.”

Geni and family in 2019 before surgery
Geni and her family on vacation in 2019 before her epilepsy surgery.

Today, Geni has been seizure-free for 14 months. And while her right arm tires easily and she still sometimes has trouble finding the right words to say, someone meeting her for the first time wouldn’t notice.

Geni back on stage after epilepsy surgery
Geni was back on stage a few months after epilepsy surgery.

“I have my driver’s permit and I’m learning how to drive,” Geni says. “That’s where I am right now. I’m working on a project for my film class and also an online play “Clue.”

Geni should continue to improve with time.

“She’s made remarkable recovery,” Dr. Steenari says. “She’ll continue to get better. If we had let those seizures continue, she would have ended up being much worse in the future.”

Learn more about the CHOC Epilepsy Program

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What we’re thankful for this year: 2020

Despite the countless challenges brought on by 2020, the physicians, nurses, staff, patients and donors that make CHOC a world-class pediatric healthcare system have retained a sense of gratitude. Several members of the CHOC community share what they are most thankful for this year.

Kim Cripe_CHOC president and CEOKim Cripe, CHOC president and CEO

“There are no words to fully express how thankful I am to the physicians, nurses, and staff who have worked so tirelessly and sacrificed so much these past nine months of the pandemic.  I have always been proud of our team and how well we support one another on a daily basis. Yet, our ability to rally in a crisis, particularly as long as this one has been (and will continue to be), has truly left me in awe. I am enormously grateful to everyone at CHOC across all departments, geographies and locations for the way we are not only tackling this challenge together, but also supporting the children and families we serve.” 

chris-furman

Chris Furman, chairman, CHOC board of directors

“I continue to be grateful for serving as chairman of CHOC’s board of directors.   Especially during these challenging times, I am incredibly honored to help CHOC’s physicians, staff, volunteers and donors protect the health and well-being of children in Orange County and beyond.” 

dr-jasjit-singh

Dr. Jasjit Singh, pediatric infectious disease specialist

“Despite all the challenges and changes this year has presented, I feel grateful to be part of the CHOC community. At the beginning of this experience, when there were still so many unknowns, I saw nurses, doctors and all the staff put aside their own fears and rise to the challenge in order to take care of their patients. And I have been watching them continue to do that every day since. It has been inspiring. I am grateful to my colleagues, and their commitment to implementing the latest guidelines and regulations to serve our patients and their families, and for their much-needed detective work on complicated cases. I’m grateful for CHOC parents and my patients – for sharing their strength, resilience, humor and hope with us every day. And last but not least, I owe gratitude for my wonderful family & the fact that we are in a place that allows us to serve our community.”

Dr. Terrence Sanger, chief scientist at CHOC Children's

Dr. Terence Sanger, vice president for research and chief scientific officer

“In a year that has been filled with unprecedented challenges, I am thankful for the opportunity to have joined CHOC’s mighty brigade in February 2020 to help the organization continue to go beyond. I am grateful to be working alongside such amazing colleagues who are committed to the mission of elevating the cutting-edge work being conducted at CHOC’s Research Institute.” 

CHOC Hospital_Outpatient evaluation center

Kelly Navarro, RN, BSN, CPN, CHOC outpatient evaluation center 

“After working at CHOC for 10 years, I am so grateful to have had the opportunity to serve CHOC patients and families in a new way this year at our outpatient evaluation center. CHOC quickly established these outdoor, drive-through facilities at the onset of the COVID-19 pandemic to offer our patients a safe and convenient way to be evaluated by a pediatric medical provider, receive treatment when necessary, and undergo COVID-19 testing. The center gives us the ability to ensure continuity of care for patients having surgery, as well as those needing sleep studies and many other necessary procedures. I am grateful for the privilege of serving as a constant for our patients and their families: that they can always count on CHOC for safe, high-quality and convenient care.”

Allison, age 12, CHOC patient

Dr. Mike Weiss

Dr. Michael Weiss, vice president of population health

“At a time in our lives when we have never felt more distant from our friends, neighbors and loved ones, I’m grateful that CHOC was able to deepen our “connection” with our patients and families and provide high-quality medical care through telehealth technology. This service has proven to be a true lifesaver for many children and families. From primary care to sub-specialty care and mental health to speech therapy, CHOC has provided over 55,000 telehealth visits since mid-March. Our patient satisfaction scores have remained over 90% and the subjective feedback we receive is overwhelmingly positive. In addition, this technology has allowed us to support a broader community of patients and families as well as our Orange County schools by providing COVID-19 support and education when and where it is most needed. Connecting is always important, but it has never meant more to our community, and to us, than it does now!”

Grace Magedman

Grace Magedman, executive director of pharmacy

I am very proud of and extremely grateful for everyone involved in launching our prescription delivery service during the state’s spring lockdown. The flexibility, compassion and innovation demonstrated by staff across multiple departments and by our supporters, Hyundai Motor America and Russell Westbrook Hyundai of Anaheim, resulted in a valued resource that helped safeguard the community we serve, especially the most medically fragile members. 

christopher-min-pediatric-psychologist-choc-childrens

Dr. Christopher Min, pediatric psychologist

Despite the challenges that 2020 has brought, I find myself even more thankful than years past. I am so very thankful for my wife and two little girls, as well as the little furball we recently welcomed into our family. I am also grateful for each of my team members who have come together to offer mental health services in a primary care setting; for fighting the front lines against mental illness in children; and for the way they have grown in their hearts of service, all amidst a global pandemic. I am reminded of the strong bonds that I have with trusted partners at CHOC across mental health, primary care, clinical staff, and CHOC at Mission Hospital. And I am most grateful for the privilege of serving the most vulnerable among us, our children.”

Korbin, age 6, CHOC patient

CHOC clinical associate

Ashlynn Graham, clinical associate

After a year of uncertainties and a new normal, it can be hard to find the good in what 2020 has thrown our way. This year and every year, I am blessed with my family and our health. I am grateful that I have had the ability to work at both CHOC Hospital, and CHOC at Mission Hospital. I am also thankful for all the first responders that have continued to give to those in need during these unthinkable times.

Clavis Foundation

Clavis Foundation’s Tusdi Vopat and Stuart McClure. Tusdi is also a member of CHOC Foundation’s Board of Directors

“We are extremely blessed and grateful for many things, including the privilege to work with CHOC. Their tireless commitment and dedication to the health and well-being of our children is what inspires us all to strive and support such a great institution. Never before has CHOC, or anyone, been met with such extreme challenges as the COVID-19 pandemic. Yet, CHOC and its staff continues to put patients first, keeping families and healthcare workers safe, and understanding the increased challenges of mental health during this time. We are honored to be part of this amazing team and look forward to a stronger and brighter future ahead for all of us.”

Colleen Smith CHOC nurse

Colleen Smith, manager of clinical programs, CHOC at Mission Hospital

“As I walked through the CHOC at Mission Hospital doors the morning of Sept. 11th, 2020 I took out my phone to text my hiring manager, still a longtime friend, to say, ’20 years ago today I walked through these doors for the very first time thanks to you.’ I had no idea all those years ago what my nursing career would look like so many years later. I am filled with gratitude every day, not only for the opportunities I have been given but, also for the joy I feel working at CHOC at Mission. Not everyone can continue to say they love what they do 20 years later. I consider that a true blessing! Thank you, CHOC at Mission and the entire CHOC healthcare system,  for always believing in me and growing me into the nurse I am today. I feel honored to be a pediatric nurse in my community”

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5 ways to spread joy to CHOC patients this year

Illness and injury shouldn’t dim the brightness of the holidays for kids. Help us preserve the magic of childhood – year-round – for our patients by supporting CHOC the following ways this holiday season:

  1. Donate: By donating to CHOC’s greatest needs fund, you will support patients like Grant, who received life-saving care at CHOC. Your gift will be matched dollar-for-dollar by Extra Life, a Children’s Miracle Network partner of CHOC! Learn more about Grant, and CHOC’s greatest needs fund.
  2. Bring smiles through our Virtual Toy Drive: Although we can no longer accept in-person toy donations, you can help us brighten our patients’ and families’ holidays a few other ways: donating, giving through our Amazon Wish List, or creating your own Virtual Toy Drive. See our wish list here.
  3. Register for Virtual CHOC Walk: Take part in a celebration of CHOC by joining our Virtual CHOC Walk presented by Disneyland Resort. Register here.
  4. Shop for CHOC: Many stores and restaurants will give back a portion of your purchase to CHOC. Give back while you shop by finding participating stores.
  5. 12 Days of Gaming: Starting December 1, CHOC is asking you to level up your commitment during December and turn your virtual holiday party, secret Santa gift exchange, or ugly sweater day into another cool opportunity to give the gift of health through Extra Life. Setup your holiday themed Game Day today.
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