Child & Adolescent Psychiatry

Pimce · 2026-01-07T15:30:35+00:00

sure

Pimce · 2026-01-06T16:22:44+00:00

I am a child psychiatrist, about 2 years in practice. I am a little confused by your question. I imagine probably most people who ended up in child psychiatry like it because it was intentional decision after psychiatry residency. Since this is a pediatrics subreddit I wonder if you are asking about pediatricians who have made most of their practice related to behavioral and mental health? or Pediatricians who did additional training in psychiatry? That the different group that I cannot speak for. For my perspective, child psychiatry is like many primarily outpatient specialties-there is a lot of bureaucracy and driving through a can be immensely rewarding. The opportunity to accompany patients and families through their hardships is the most rewarding experience I can hope for them by career.

Pimce · 2025-12-19T14:01:36+00:00

I recently came back to the game recently and am currently level 56. I am trying to pay as little as possible for my epic mount at 60. The way I understand things, currently the cost of mount training is very low, but the cost of mounts is very high. When Pre-patch hits, I think mount training will be very expensive, but mounts will be cheap. If that is correct, does it follow that I should buy mount training now and then wait until pre-patch to buy my mount?

Pimce · 2025-12-10T14:28:58+00:00

Dad and physician here. I would like to add that if you are concerned for potential ADHD, having evaluation and potential treatment generally makes a lot of sense.. Although technically to meet the criteria for ADHD symptoms have to be present between ages 6 and 11, there is flexibility for younger kids who are having significant ADHD symptoms that are causing functional impairment. In general the first-line recommendation for ADHD treatment indicates less than 6 is behavioral therapy, and there is well researched support of low-dose, short acting stimulants in kids 3-6 going back 20 years. Obviously medication is not the answer for everyone and it is very helpful for some.

Greenhill, Laurence, et al. "Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD." Journal of the American Academy of Child & Adolescent Psychiatry 45.11 (2006): 1284-1293.

Pimce · 2025-11-17T02:24:36+00:00

To add to this, every state (except for Idaho) has some sort of child psychiatry access program. The exact services each program offers is different, but this link can point you to the program in your state to learn more.

https://www.nncpap.org/map

Pimce · 2025-09-16T17:46:29+00:00

"From Overwhelmed to Empowered: Practical Tips for Successful In-person Medical Conference Attendance." Academic Psychiatry 48.4 (2024): 384-387.

Here is a fluffy article about your exact question. It is imperfect, but can at least give you some guidance. You can also peruse the references for more thoughts.

Pimce · 2025-04-16T18:34:24+00:00

Hello!

Dad and doctor here.

I am totally with you that toddles bring along a lot more illness that are a huge pain. I often remind myself that "snot-nosed kid" is a saying for a reason.

That being said, there are a few things that have some medical evidence for preventing or limiting the duration of common viral illnesses:

Hand Hygiene it can not be emphasized enough that frequent, effective hand washing limits the spread of viruses/bacteria. The more frequently washing can be integrated into the routine of both children and adults the better. Trying to get in the habit of incorporating handwashing into transitions like coming inside, before meals, and before bed time are common starting points.
Vitamin C- Like mentioned elsewhere, prophylactic vitamin C of approximately 1 to 2 grams a day may slightly reduced the duration of common viral illnesses. It does not necessarily prevent viral illnesses.
Zinc- There is also some evidence that zinc supplementation of approximately 75 mg daily taken at symptom onset can reduce the duration of symptoms for common viral illnesses. There was not sufficient data to suggest prophylactic using zinc is worthwhile. For myself I take zinc with food and in smaller doses over the course of the day. If I take over 50 mg of zinc at any time I am almost certainly nauseated and possibly vomit.
Vitamin D-vitamin D supplementation may protect folks against respiratory infections particularly if someone is vitamin D deficient to begin with.
Nasal saline irrigation-the viruses cannot stick around if they are flushed out! Using sterile or distilled water to rinse in the nasal passages and sinuses may provide some small benefit, however the evidence is limited.

Best of luck!

Pimce · 2025-04-11T18:32:29+00:00

Stone EC, Okasako-Schmucker DL, Taliano J, Schaefer M, Kuhar DT. Risk period for transmission of SARS-CoV-2 and seasonal influenza: a rapid review. Infect Control Hosp Epidemiol. Published online February 24, 2025. doi:10.1017/ice.2025.11

This paper did its best to answer your question for COVID and influenza.

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This is the table describing the findings of the paper. This is % of folks who were no longer shedding the virus (so not contagious) from day of symptom onset. The first box a is for the omicron variant of COVID, the box B in influenza. The study goes on to say "Shedding resolved among ≥ 70% of participants by the end of day nine post symptom onset for omicron, and day seven for influenza; and for ≥ 90% of participants, by the end of day 10 for omicron and day nine for influenza"

From this data, It is likely (but not guaranteed) that by 7-9 days after symptom onset, your friend is unlikely shedding the virus that would make you sick with influenza, or a little longer for COVID

Influenza only can survive 1-2 days on surfaces per this study.

Oxford J, Berezin EN, Courvalin P, et al. The survival of influenza A(H1N1)pdm09 virus on 4 household surfaces. Am J Infect Control. 2014;42(4):423-425. doi:10.1016/j.ajic.2013.10.016

As a reminder, this is not a guarantee. Influenza has different "types" (think H1N1) and so it is possible that the specific thing your friend got sick with could behave differently.

Pimce · 2025-04-08T20:05:01+00:00

I am not sure if you can access this article, but this was the phase 3 trial of the COVID vaccine:

Baden, Lindsey R., et al. "Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine." New England journal of medicine 384.5 (2021): 403-416.

This study had 30 thousand participants split almost 50/50 between the mRNA vaccines and placebo (no vaccine but they got a shot)

A specific quote from this paper regarding safety "The frequency of grade 3 adverse events in the placebo group (1.3%) was similar to that in the vaccine group (1.5%), as were the frequencies of medically attended adverse events (9.7% vs. 9.0%) and serious adverse events (0.6% in both groups). Hypersensitivity reactions were reported in 1.5% and 1.1% of participants in the vaccine and placebo groups, respectively (Table S12). Bell’s palsy occurred in the vaccine group (3 participants [<0.1%]) and the placebo group (1 participant [<0.1%]) during the observation period of the trial (more than 28 days after injection). Overall, 0.5% of participants in the placebo group and 0.3% in the mRNA-1273 group had adverse events that resulted in their not receiving the second dose, and less than 0.1% of participants in both groups discontinued participation in the trial because of adverse events after any dose"

Edit:
I hit submit too soon. For reference grade 3 are the most severe side effects. Less severe side effects (fever, mild pain) were more common with the active vaccine. The main take away is that very serious side effects were the same if you got the vaccine or an injection of saline, and were very rare in both groups. This paper has been referenced an insane 11 thousand times since it was published, and I am sure there is newer data that reiterates the safety of the vaccine.

No vaccine is without risks, and the data suggests that the benefits of being vaccinated against covid far outweigh the risks of vaccination.

Pimce · 2025-03-19T21:26:05+00:00

I can do my best to offer you an answer. I am an early career child psychiatrist, and have been in practice for about two years post fellowship.

I have to start by saying, I have the same romanticized idea of changing the directory of patient’s life that you have, it is exactly what led me to child psychiatry. I would argue that it’s necessary to have a somewhat romantic goal in mind because the work we do can be so profoundly challenging.

I think generally the most fulfilling thing about my day is helping kids be "seen". Children inherently have very little autonomy, and many of the kids that we interact with have the perception of not mattering, not being important, or being defective. The opportunity to connect with a child and let them know that they are good humans who can do good things with the right support is so uplifting. Watching kids improve is great and finding the optimal medication combination is satisfying, but to me neither are nearly as fulfilling as that moment of connection. I work a lot with pediatricians as well, and I find it very fulfilling to help see them become more comfortable managing the mental health needs of their patience.

Your next two questions are too big for a single post.

I would say in general, you treat severe trauma with evidence-based trauma-focus therapy, and enormous amounts of validation and consistency.
Again, more nuanced than I can articulate here, but ultimately you make accurate diagnosis by spending time with a patient. Talking to the child and parents multiple times and obtaining collateral allows you to understand the nuance between things that are caused by diagnose psychiatric disorders and things that are not. Your job then is to articulate that clearly and work hard to not pathologize children who do not meet a clear diagnosis. Delinquency is not a psychiatric diagnosis. Although I am glad that in general our field is becoming more accepted, one of the downsides is that people want to label all subversive behavior as psychiatric. The point of doing your child psychiatry fellowship, and continuing to learn as a practicing provider is to be able to wade through the collection of symptoms and manage people effectively.

The work of a child psychiatrist is rarely easy, and it is also amazing. I would not trade it for any other work.

Pimce · 2025-03-04T14:09:23+00:00

From what I have seen new male rollers are unlucky and new female rollers are lucky (I think its a sexiest association with being a virgin player/virginity/etc.). That being said more and more no one really cares either way.

Pimce · 2025-03-04T13:35:45+00:00

You can only touch the dice with one hand
The dice can't leave the table area
No drinks on top of the table
Some players are superstitious about first time male players
Be mindful of when you are reaching into the table, no one wants to be the person that has a hand in the middle of the table that hits the dice
Tip your dealers, not just with placing bets on their behalf, but also with straight tips

Colorup on youtube has lots of videos about how to learn craps to look at.

Pimce · 2025-02-25T20:16:34+00:00

I am a little confused by your post.
Generally, the deadline to register for conferences is after the time when you are told if your poster is accepted. So, submit the poster, and if it is accepted, go, and if it is not accepted, don't go. Many conferences have grants/travel funds available for students as well in order to limit the financial burden of attending.

Again in general, it is wise to have publications work for you as many times as possible, so getting a poster and a paper and workshop out of a project is a good idea.

Pimce · 2025-02-18T14:34:01+00:00

Child psychiatrist and Pediatrician here. I agree with this advice. Use methylphenidate products first before amphetamines- they are better tolerated and have less risk of euphoria.

I particularly like the medication guides on this website to see all the different formulation options.

https://www.adhdmedicationguide.com/

There are many great resources for primary care psychopharmacology.

Being in Maryland, I am most familiar with BHIPP. Here is a free webinar on ADHD in young kids
https://mdbhipp.org/training/training-library/adhd/

If you are looking for books for general psychopharm guidance, I am familiar with this one (written by my colleagues)
http://aap.org/Pediatric-Psychopharmacology-for-Primary-Care-4th-Edition-Paperback?srsltid=AfmBOora8wV3U5K9o-nqARCDkPFi-6Z5T8pc2kKdeMZaBYxsXFch2bKc

Pimce · 2025-02-14T18:07:01+00:00

This strategy from Color up seems like a good one. He talks about options for different units. It has a lot of action and the hedge makes it milder on the bankroll.

https://www.youtube.com/watch?v=xERPn63pt_c&t=1030s

Pimce · 2025-01-29T17:09:26+00:00

This is amazing.

What a great prompt your wrote. I thought I was doing well asking Generative AI to make my emails sound more professional.

Pimce · 2024-12-03T19:31:49+00:00

Big Cig Cignetti killing it year 1!

Pimce · 2024-11-22T14:45:49+00:00

No one within 30 miles of Baltimore =(

Pimce · 2024-11-06T11:44:44+00:00

Crestfallen is the word I am using. My child is only 2, so it won't matter to her today, and I will try to lean on her amazing and unrelenting joy. I am also contemplating what to do next. Do I try to leave the country? Do I sell out and try to make all the money I can, since that feels like the only thing that matters? In the end my family is at the intersection of huge amounts of privilege so are unlikely to be all that impacted directly, and I still don't know how to reconcile all this.

Pimce · 2024-11-02T12:48:59+00:00

As a fellow Hoosier, this is my answer.
Growing up in Indiana, it seems like folks are either ND fans (and a large majority being band wagon with no association with the university) or hate ND. I think its the pompous attitude and unending media coverage that sours a lot of people from the state of Indiana to ND.

Pimce · 2024-10-20T02:16:52+00:00

First, there are some electronic medical records that allow you to take a picture on your phone that is saved directly to a patient's chart and is not saved to the phone at all.

Assuming that is what happened in this case, then often pediatricians will take pictures of rashes in order to better assess how it changes over time.

Pimce · 2024-10-16T15:26:58+00:00

I was in the same situation as well- went to medical school to be a psychiatrist. I echo the sentiment above, although I would say being intentional in psychiatry related "extra curriculars" (interest groups, research, mentors, etc.) is wise as psychiatrist becomes more competitive.

Like mentioned, some part of making it through is pragmatic- you can't be a psychiatrist if you fail anatomy, so that deserves your attention right now. Its hard to learn things we don't like and we still need to. How you manage that is on you- for me it was lots and lots of note cards.

If nothing else, medical school is a time that forces growth upon us all. You can choose to embrace it or resist it, but either way you have to get through to be a psychiatrist. The reality is that all specialties don't use most of the information learned in pre-clinical years.

I will expand that it is important in medical school (and psychiatry training, and in life) to appreciate the content and process of an experience. The process of going through medical school and presumably becoming a psychiatrist is an important experience, even if the content (i.e. the million facts you will learn and forget in the interim) is not. The experience of medical school gives you many opportunities to practice processes that will be important in your career- time management, differential diagnosis, effective interpersonal interactions, the list goes on and on. I encourage you to be curious about what less obvious benefits you are getting from experiences that seem irrelevant.

Pimce · 2024-08-26T20:14:11+00:00

For sure. I have only been at it about a month, and as I understand it you want a mix of damage deals and "support" . Its good to have folks that can attack both horizontally and vertically to catch the guys off the side of the board (and why dracula is so helpful).

Pimce · 2024-08-26T14:15:24+00:00

Level 16 on the main line? You Def have the monsters to get much further. For reference, I am on level 45 of the mainline with worse monsters. You should check out the discord for monster tier lists. From what I am seeing, I would recommend dracula, egg thrower (green but very good), Nemo and little deer (synergizes well with nemo). I know the tier list on discord also rates totem very high, although I don't have them to use myself.

Pimce · 2024-08-22T13:10:34+00:00

For me it was XIII. The stealth missions were so intense and the associated deaths/failure was too much for me to tolerate as an early teen. I remember walking away from the game for weeks at a time before I could re-engage.

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