Pediagogy: Recent Episodes
Lidia Park and Tammy Yau
Pedagogy is the art and science of teaching. In this same regard, Pediagogy was created with the goal of teaching on-the-go medical students, residents, and any other interested learners about bread-and-butter pediatrics. Pediagogy is an evidence-based podcast, reviewed by expert specialists, and made by UC Davis Children’s Hospital residents. Let’s learn about kids!
Wondering how you describe the rash of measles, molluscum contagiosum, hand foot mouth, or chickenpox? Learn how in today’s episode!
This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Aruna Venkatesan and Gabriel Molina (dermatologists at Santa Clara Valley Medical Center). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.com
Key Points:
- When describing a rash, include the basic morphology, size, color, location, distribution and configuration, and any secondary morphology
- When taking photos, try to have natural light and make sure the rash is in focus. If taking a close up photo, make sure to have a photo further away so that the location of the rash is clear.
Sources:
- Stanford Medicine: https://stanfordmedicine25.stanford.edu/the25/dermatology.html
- Allmon A, Deane K, Martin KL. Common skin rashes in children. American family physician. 2015 Aug 1;92(3):211-6.
- CDC Measles: https://www.cdc.gov/measles/data-research/index.html
How do you know when a head injury can be observed or if more work-up needs to be done? Find out in this episode!
This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Julia Magana (pediatric emergency medicine). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.com
Key Points:
- Low risk head injuries do not need head imaging. The criteria for low risk head injuries are those where the patient’s GCS is 15 without altered mental status and do not have signs of skull fracture. If any of these signs are present, head imaging with a head CT is recommended
- If the head injury includes history of loss of consciousness or vomiting, a non-frontal scalp hematoma (ie parietal, temporal, or occipital), a severe mechanism of injury, or a severe headache, then generally observation is still recommended but a head CT can be obtained based on clinical decision making.
Sources:
- Stat Pearls. Pediatric Head Trauma. Micelle J, et al. February 2024: https://www.ncbi.nlm.nih.gov/books/NBK537029/
- Pediatrics. Abusive Head Trauma in Infants and Children: Technical Report. Sandeep Narang, et all. February 2025: https://publications.aap.org/pediatrics/article/155/3/e2024070457/201049/Abusive-Head-Trauma-in-Infants-and-Children
Opioid use disorders affect babies and children in all ways. In newborns, it can present as neonatal opioid withdrawal syndrome (also known as NOWS). Learn how hospital systems are managing infants with NOWS with the Eat, Sleep, Console protocol in our episdoe today!
Key Points:
- Eat Sleep Console (ESC) focuses on non-pharmacological intervention first before initiating medication. This includes limiting excessive stimulation, keeping the room dark and quiet, swaddling, rocking, swaying, and giving babies a pacifier or feeding.
- Compared to using the Finnegan scoring system, ESC results in shorter or equal length of hospital stay for infants with NOWS. However, some critics of ESC raise the concern for undertreating infants with NOWS.
- Morphine, clonidine, and phenobarbital are common agents used to treat infant with NOWS
Sources:
- Neoreviews (2025) 26 (4): e223–e232. https://doi.org/10.1542/neo.26-4-010
- Hosp Pediatr (2025) 15 (3): e121–e125. https://doi.org/10.1542/hpeds.2024-008094
- Hosp Pediatr (2025) 15 (3): e99–e101. https://doi.org/10.1542/hpeds.2025-008332
- Kaltenbach K, O'Grady KE, Heil SH, et al. Prenatal exposure to methadone or buprenorphine: Early childhood developmental outcomes. Drug Alcohol Depend. 2018;185:40-49. https://doi.org/10.1016/j.drugalcdep.2017.11.030
- Rees P, Stilwell PA, Bolton C, et al. Childhood Health and Educational Outcomes After Neonatal Abstinence Syndrome: A Systematic Review and Meta-analysis. J Pediatr. 2020;226:149-156.e16. https://doi.org/10.1016/j.jpeds.2020.07.013
Learn about language and speech development, potential etiologies of speech delay, and early interventions for speech delay.
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This episode was written by pediatricians Lidia Park and Tammy Yau as well as UCD pediatrics resident Elaine Ho, with content support from Anisha Srinivasan (UCD child development and behavioral pediatrician). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points
- CDC and AAP have created updated 2022 developmental guidelines that includes changes in speech and language milestones for childrens and have added guidelines forage ages 15 months and 30 months
- Differential for speech delay is broad and includes hearing loss, global developmental delay, autism, and isolated language disorders
- Interventions include speech therapy services and exercises at home
- Pediatricians play critical role in surveillance, evaluation, and management of speech delays to allow for earlier intervention and improved outcomes
Sources
- Jennifer M. Zubler, Lisa D. Wiggins, Michelle M. Macias, Toni M. Whitaker, Judith S. Shaw, Jane K. Squires, Julie A. Pajek, Rebecca B. Wolf, Karnesha S. Slaughter, Amber S. Broughton, Krysta L. Gerndt, Bethany J. Mlodoch, Paul H. Lipkin; Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics March 2022; 149 (3): e2021052138. 10.1542/peds.2021-052138
- Maris Rosenberg, MD, Nancy Tarshis, MA, MS, 2016. "Speech and Language Concerns (Chapter 195)", American Academy of Pediatrics Textbook of Pediatric Care, Thomas K. McInerny, MD, FAAP, Henry M. Adam, MD, FAAP, Deborah E. Campbell, MD, FAAP, Thomas G. DeWitt, MD, FAAP, Jane Meschan Foy, MD, FAAP, Deepak M. Kamat, MD, PhD, FAAP, Rebecca Baum, MD, FAAP, Kelly J. Kelleher, MD, MPH, FAAP
- Heidi M. Feldman; Evaluation and Management of Language and Speech Disorders in Preschool Children. Pediatr Rev April 2005; 26 (4): 131–142. https://doi.org/10.1542/pir.26-4-131
- Henry Adam; Speech and Language Concerns. Quick References 2022; 10.1542/aap.ppcqr.396455
- ASHA Communication Milestones and Age Ranges https://www.asha.org/public/developmental-milestones/communication-milestones/
Audio Clips: From Youtube Channel “Pathways”
The 4 to 6 Month Baby Communication Milestones to Look For: https://www.youtube.com/watch?v=d0FGHFrMRXI
10-12 month Old Communication Milestones https://www.youtube.com/watch?v=zYHpjZC2qCA
19-24 Month Communication Milestones: https://www.youtube.com/watch?v=-2C--4gay2c
Vaccines are life saving medical treatments. Like all medicine, there are benefits and risks to vaccines. Learn how to address common concerns about vaccines and combat misinformation in this episode!
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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Dean Blumberg (UC Davis pediatric infectious disease). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- Vaccine benefits largely outweigh risks.
- Vaccines do not cause autism. The frequently cited study that reportedly links vaccines to autism was funded by an anti-vaccine group and only looked at 12 children.
- Thimerisol is a preservative that is not used in routine vaccinations other than certain influenza vaccines. Anti vaccine groups raise the concern for ethylmercury toxicity from thimerisol but studies looking at mercury levels after vaccination with thimerisol containing vaccines showed the peak mercury levels to still be within the normal EPA range.
- Oral rotavirus is associated with an increased risk of intussusception. A history of intussusception is a contraindication to the rotavirus vaccine
Sources:
- Pediatrics (2016) 138 (3): e20162146. https://doi.org/10.1542/peds.2016-2146
- Pediatrics (2024) 153 (3): e2023065483. https://doi.org/10.1542/peds.2023-065483
- Desai R, Cortese MM, Meltzer MI, et al. Potential intussusception risk versus benefits of rotavirus vaccination in the United States. Pediatr Infect Dis J. 2013;32(1):1-7. doi:10.1097/INF.0b013e318270362c
- Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children [retracted in: Lancet. 2004 Mar 6;363(9411):750. doi: 10.1016/S0140-6736(04)15715-2. Lancet. 2010 Feb 6;375(9713):445. doi: 10.1016/S0140-6736(10)60175-4.]. Lancet. 1998;351(9103):637-641. doi:10.1016/s0140-6736(97)11096-0
- Deer B. Secrets of the MMR scare. The Lancet's two days to bury bad news. BMJ. 2011;342:c7001. Published 2011 Jan 18. doi:10.1136/bmj.c7001
- Pichichero ME, Gentile A, Giglio N, et al. Mercury levels in newborns and infants after receipt of thimerosal-containing vaccines. Pediatrics. 2008;121(2):e208-e214. doi:10.1542/peds.2006-3363
- Uhlmann V, Martin CM, Sheils O, et al. Potential viral pathogenic mechanism for new variant inflammatory bowel disease. Mol Pathol. 2002;55(2):84-90. doi:10.1136/mp.55.2.84
- Uptodate “Autism spectrum disorder and chronic disease: no evidence for vaccines or thimerisol as a contributing factor”
- https://www.aap.org/en/news-room/fact-checked/fact-checked-vaccines-safe-and-effect-no-link-to-autism/?srsltid=AfmBOopWG_rQ1lTaaOvgJLyTk6VdbCN3ypSErxFzhVRjkQ2A4Fet9d
With increasing awareness and diagnosis of autism, there has also been an increase in misinformation regarding autism. The goal of today's episode is to provide a brief overview on autism and provide evidenced based information to better inform listeners!
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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Kathleen Angkustsiri (UC Davis developmental and behavioral pediatric specialist). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- Autism diagnostic criteria have changed to increase detection of milder cases. Asperger's is included in autism.
- Per the DSM-5, autism is a condition with impairments in social communication (social and emotional reciprocity, non-verbal communication, and relationships) and restrictive and repetitive behaviors.
- Autism diagnosis also requires 2 out of 4 restrictive or repetitive behaviors: 1. Restrictive or repetitive patterns of behavior, interests, or activities 2. Insistence of sameness, inflexible adherence to routines, ritualized patterns 3. Highly restricted, fixated interest abnormal in intensity or focus. 4. Hyper or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
- Autism can present as regression of social and/or language skills.
- The Modified Checklist for Autism in Toddlers – Revised with Follow-up (MCHAT-R/F) is the most widely known and validated screening tool for autism for ages 16-30 months. A score of 8 or more is high risk for autism
Sources:
- Pediatrics (2020) 145 (1): e20193447. https://doi.org/10.1542/peds.2019-3447
Ever get caught in a sticky ethical situation regarding genetic testing? You're not alone. Join us as we try to navigate these real life issues.
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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Video Jhaveri (UC Davis neonatology fellow). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
- Genetic testing may seem relatively benign and non-invasive but is actually fraught with unforeseen issues such as surprise consanguinity and non-paternity.
- Racial and economic disparities are prevalent with genetic testing and their interpretation. For example most test value interpretations are based on people of European and Asian descent.
- We cannot easily predict outcomes and prognosticate even with genetic testing. Prognosis is often fraught with the issue of promoting "ableism".
Sources:
Katharine P. Callahan, Ellen W. Clayton, Amy A. Lemke, Bimal P. Chaudhari, Tara L. Wenger, Allison N. J. Lyle, Kyle B. Brothers; Ethical and Legal Issues Surrounding Genetic Testing in the NICU. Neoreviews March 2024; 25 (3): e127–e138. https://doi.org/10.1542/neo.25-3-e127
Osteomyelitis is an infection of the bone and is often a delayed diagnosis given the ambiguity of the signs and symptoms. Listen in on how you might be able to better detect and treat osteomyelitis without delay.
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This episode was written by pediatric resident Victoria Tran Toft and pediatricians Tammy Yau and Lidia Park with content support from Natasha Nakra (UC Davis pediatric infectious disease). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
- Osteomyelitis can present as limp or hesitancy with movement; this can occur with or without fevers and localizing signs.
- Main diagnostics include CRP, which also aids in assessing treatment response.
- Treatment is a long course of antibiotics. Typically, starting empiric IV antibiotics in the hospital and then transitioning to oral agents.
Sources:
- PIDS/IDSA Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics. Published 8/5/2021. Journal of the Pediatric Infectious Diseases Society. https://doi.org/10.1093/jpids/piab027
Want to know how to differentiate a normal white patch on the tongue vs a not normal white patch? Learn about thrush in this week’s episode!
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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Julia Froud (UC Davis pediatrician). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- Thrush is due to candida yeast infection
- It cannot be wiped off the tongue as compared to milk residue
- Treat with topical nystatin solution
Sources:
- Pediatric in Review, 2007: https://publications.aap.org/pediatricsinreview/article/28/1/15/34605/Oral-Conditions
- Thrush Pediatric Patient Education (2024) https://doi.org/10.1542/ppe_schmitt_240
AAP Redbook, 2021, Candidiasis: https://doi.org/10.1542/9781610025782-S3_025
Wondering why your patient’s diaper rash won’t go away? Pay attention to this video to learn if there’s something else going on!
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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Lisa Rasmussen (UC Davis pediatrician). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- Typical diaper rash is an irritant contact dermatitis due to excess moisture, pH imbalance, and excessive friction. It can be a red patch or red macules and papules in the diaper region that spares the skin folds
- Candidal diaper rashes involve the skin folds and have satellite lesions
- Don’t forget in your differential: perianal strep, hand foot mouth syndrome, psoriasis, eczema, scabies, and Langerhans cell histiocytosis
Sources:
- Pediatrics in Review, January 2021, Helms and Burrows: https://publications.aap.org/pediatricsinreview/article/42/1/48/35437/Diaper-Dermatitis
Uvula deviation, sore throat, fever? Learn all about peritonsillar abscesses in this episode!
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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Dean Blumberg (UC Davis pediatric infectious disease). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- Peritonsillar abscess (PTA) is a suppurative infection of the tissue between the palatine tonsil capsule and the pharyngeal muscles
- Symptoms include fever, sore throat, uvular deviation, trismus, voice changes, drooling, unilateral tonsillar swelling with deviation of the uvula to the contralateral side
- Diagnosis can be clinical but imaging is often obtained
- Treat with antibiotics (empiric amoxicillin, cephalosporin, or clindamycin but adjust based on cultures) and incision and drainage
Sources:
- A Clinical Approach to Tonsillitis, Tonsillar Hypertrophy, and Peritonsillar and Retropharyngeal Abscesses. R Bochner, et al. Pediatrics in Review (2017) 38 (2): 81–92. https://doi.org/10.1542/pir.2016-0072
Marijuana, cannabis, THC, and CBD are among the many common words and forms of cannabis that pediatric patients are being exposed to in our current day and age. Keep up to date about the official AAP policy and recommendations with today's episode.
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This episode was written by pediatricians Tammy Yau and Lidia Park. Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- At the time of this episode release, marijuana is considered a schedule I drug at the federal level meaning here is high potential for abuse, no medical use, and/or lack of safety with using this drug. The official AAP stance is to avoid cannabinoid use in most children. More studies need to be done to determine the long term effects.
- Cannabis plants generally have both THC and CBD which are types of cannabinoids. THC can cause intoxication, analgesia, and antiemesis. CBD is less intoxicating and anxiolytic.
- Cannabis intoxication can cause tachycardia, hypertension, red eyes, dry mouth, orthostatic hypotension, increased appetite and thirst, drowsiness, insomnia, anxiety, short term memory loss, ataxia, stroke, nystagmus, hypothermia, hypotonia, and rarely respiratory depression. Treatment is supportive.
- THC can be detected in breastmilk. There is not enough information about long term safety and implications of THC exposure in utero or while breastfeeding.
- In children, epidiolex is the only plant derived cannabinoid FDA approved for use of severe seizures in children.
Sources:
- Ammerman S, et al. The impact of marijuana policies on youth: clinical, research, and legal update. Pediatrics. 2015 Mar 1;135(3):e769-85. doi: 10.1542/peds.2014-4146
- Hale’s Medications & Mothers’ Milk 2023: A Manual of Lactational Pharmacology
- Fischedick J, Van Der Kooy F, Verpoorte R. Cannabinoid receptor 1 binding activity and quantitative analysis of Cannabis sativa L. smoke and vapor. Chem Pharm Bull (Tokyo). 2010;58(2):201-207. doi:10.1248/cpb.58.201
Don't miss this cause of anemia in your differential in today’s episode about autoimmune hemolytic anemia!
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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Anjali Pawar (UC Davis pediatric hematology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- Autoimmune hemolytic anemia is an extravascular hemolysis
- Symptoms can include pallor, fatigue, lightheadedness, jaundice, tachycardia, acrocyanosis, dark urine, splenomegaly, and gallstones with labs showing anemia with schistocytes, reticulocytosis, hyperbilirubinemia, elevated LDH, elevated AST, and positive Coombs testing.
- AIHA can be triggered by infections, underlying autoimmune diseases, malignancy, immunosuppression, and medications.
- Treatment is steroids or rituximab for warm AIHA and avoiding the cold for cold AIHA. In refractory cases, splenectomy or stem cell transplant may be needed. Transfusions are generally not recommended due to ongoing hemolysis unless anemia is severe.
Sources:
- Voulgaridou A, Kalfa TA. Autoimmune Hemolytic Anemia in the Pediatric Setting. J Clin Med. 2021;10(2):216. Published 2021 Jan 9. doi:10.3390/jcm10020216
- Noronha, Suzie A. "Acquired and congenital hemolytic anemia." Pediatrics in Review 37.6 (2016): 235-246. doi: 10.1542/pir.2015-0053
Plan ahead for the flu season with our episode today where we talk about how to treat the common flu, also known as influenza.
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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Dean Blumberg (UC Davis pediatric infectious disease). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- The influenza vaccine is important every flu season!
- Anti-viral neuraminidase inhibitors like oseltamivir/Tamiflu (oral), zanamavir (inhaled), and peramavir (IV) prevent the flu virus from fusing with infected cell membranes preventing the release of the virus
- Baloxivir is a endonuclease inhibitor that inhibits mRNA synthesis that can be given as a one time dose to treat influenza infections.
- Otitis media, PNA, retropharyngeal abscesses, Pott puffy tumors, empyema, meningitis, encephalitis, GBS, acute cerebella ataxia, transverse myelitis, myositis, pericarditis, and myocarditis are all serious complications that can occur with influenza infections
Sources:
- O’Leary ST, et al. Recommendations for Prevention and Control of Influenza in Children, 2024–2025: Technical Report. Pediatrics. 2024 Oct 1;154(4). doi: 10.1542/peds.2024-068508
- AAP Red Book, 2023. doi:10.1542/9781610025782-S3_068
- Moscona, A. Neuraminidase Inhibitors for Influenza. N Engl J Med 2005;353:1363-1373. 2025 Sept 9. doi: 10.1056/NEJMra05074
Have you ever wondered if your patient's snoring is concerning or not? Learn about how we screen for obstructive sleep apnea in pediatric patients in this episode.
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This episode was written by pediatricians Lidia Park, Tammy Yau, and Jessica Ahn with content support from Ambika Chidambaram (UCD pediatric pulmonology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points
- Obstructive sleep apnea (OSA) occurs when there is either complete or partial narrowing of the upper airway during sleep that causes an awakening from sleep and/or results in at least 3% drop in oxygen saturation and lasts 2 breath lengths.
- Symptoms of OSA can include episodes of apnea, gasping, choking, frequent awakenings, sleep enuresis, attention difficulties, behavioral problems, daytime sleepiness.
- On physical exam, watch out for enlarged tonsils and/or adenoids, micrognathia, retrognathia, or hypotonia.
- Untreated OSA is an independent comorbid factor for many conditions such as failure to thrive, obesity, and cardiovascular diseases like insulin resistance, fatty liver disease, and hypertension.
- Disorders associated with OSA include Down syndrome, Duchenne Muscular Dystrophy, Prader Willi, achondroplasia, hypothyroidism, and acromegaly.
- The gold standard for diagnosis of OSA is polysomnography and is based off of AHI scores: 1-5 is mild, 6-10 is moderate, and 11 or greater is severe.
- First line treatment for most children is adenotonsillectomy. If this fails, second line treatment is CPAP or BiPAP.
References
- Krishna J, Kalra M, McQuillan ME. Sleep disorders in childhood. Pediatrics in Review. 2023;44(4):189-202. doi:10.1542/pir.2022-005521
- American Academy of Sleep Medicine. Obstructive Sleep Apnea.; 2008.https://aasm.org/resources/factsheets/sleepapnea.pdf. Accessed October 29, 2024.
- Benedek P, Balakrishnan K, Cunningham MJ, et al. International Pediatric Otolaryngology group (IPOG) consensus on the diagnosis and management of pediatric obstructive sleep apnea (OSA). International Journal of Pediatric Otorhinolaryngology. 2020;138:110276. doi:10.1016/j.ijporl.2020.110276
- Basha S, Bialowas C, Ende K, Szeremeta W. Effectiveness of adenotonsillectomy in the resolution of nocturnal enuresis secondary to obstructive sleep apnea. The Laryngoscope. 2005;115(6):1101-1103. doi:10.1097/01.mlg.0000163762.13870.83
Join us for part 2 of our 2 part series on sickle cell disease. In this episode, we’ll go over the acute complications related to sickle cell disease and their management.
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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Anjali Pawar (UC Davis pediatric hematology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- Consider acute chest syndrome in a patient with cough, fever, hypoxemia, and new infiltrate on CXR
- Acute pain episodes should be treated with IV hydration, oxygen as needed, and adequate pain management.
- Chronic complications often result from chronic vascular blockage and inadequate oxygenation such as splenomegaly, avascular necrosis, retinopathy, nephropathy, and ulcers.
Sources:
- Pediatrics 2024, A. Yates. https://doi.org/10.1542/peds.2024-066842
In part 1 of this 2 part series on sickle cell disease, we’re going to discuss the general pediatric management of a patient with sickle cell disease including what special precautions and additional routine health maintenance they need.
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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Anjali Pawar (UC Davis pediatric hematologist). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- Patients with sickle cell disease should receive penicillin prophylaxis from 2 months old til 5 years old or until pneumococcal vaccine series is completed
- For patients with HbSS or sickle beta zero thalassemia, offer hydroxyurea at 9 months of age, even if they don’t have clinical symptoms. They should also receive stroke risk screening with an annual transcranial doppler
- Patients with sickle cell disease should receive annual screening for retinopathy and nephropathy around age 10
- Patients with sickle cell disease should receive an additional pneumococcal (20 or 23) vaccine and the meningococcal ACWY vaccine at age 10 and men B after age 10 if they have functional asplenia or a splenectomy
Sources:
Pediatrics 2024, A. Yates. https://doi.org/10.1542/peds.2024-066842
Wondering how to get pesky eczema under control? Listen up in today’s episode.
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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Smita Awasthi (UC Davis pediatric dermatology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
● Daily moisturization, cotton clothing, avoiding allergens and irritants like dust mites help prevent eczema flares
● For eczema flares, treat with a topical steroid, lower potency on the face and higher potency elsewhere on the body
● Look out for superimposed bacterial infections from Staphloccocus aureus or group A streptococcus and treat with topical or oral antibiotics depending on the spread (local vs extensive)
● Eczema herpeticum is due to HSV and should be treated with acyclovir, sometimes requiring hospitalization if severe or close to the eyes
Sources:
-
AAP Patient Care Atopic Dermatitis:https://www.aap.org/en/patient-care/atopic-dermatitis/treatment-of-atopic-dermatitis/
-
Pediatrics in Review, April 2018, Waldman et al,https://doi.org/10.1542/pir.2016-0169
What does it mean for a child to “fail to thrive”? No, it’s not a performance evaluation. Learn when and how to evaluate an infant for faltering growth in this episode!
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This episode was written by pediatricians Lidia Park and Tammy Yau as well as pediatrics resident Megan Branson, with content support from Kelly Haas, pediatric gastroenterologist. Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- To diagnose with Faltering Growth (aka Failure to thrive): the infant must fall below weight-for-age or weight-for-length percentile or have rate of weight gain decline across 2 major percentiles.
- There are three categories to think about when evaluating the etiology of faltering growth:
- insufficient calories in
- malabsorption or increased calories out
- increased metabolic requirement
Sources:
- AAP. (2022, May 31). https://www.aap.org/en/patient-care/newborn-and-infant- nutrition/growth-faltering-in-newborns-and-infants/?srsltid=AfmBOopMEVV0n6cZIAM4QHQ02RDREPeELIC107ONgdtSRS8bnrfZs4tP
- Pediatrics in Review 2017, https://doi.org/10.1542/9781610021159-86
- AAP Books: Caring for the Hospitalized Child 2018, https://doi.org/10.1542/9781610021159-86
- Pediatrics in Review 2016, https://doi.org/10.1542/pir.2014-0122
Ever wonder why babies receive erythromycin eye ointment at birth and if it’s really necessary? We’re going to answer that and many other EYE-opening questions in today’s episode!
Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bsky.social, and connect with us at pediagogypod@gmail.com
This episode was written by pediatricians Lidia Park and Tammy Yau with content support from Dean Blumberg (UC Davis pediatric infectious disease). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- Erythromycin eye ointment is given to newborn babies to prevent against gonococcal infection, it does not cover chlamydia infections. 10% of babies who are exposed to gonococcus can still get eye infections even when given erythromycin
- Gonococcal eye infections (ophthalmia neonatorum) can cause ulcers, rupture, and blindness. Disseminated infections can cause arthritis, bacteremia, and meningitis
Sources:
- Red book “Gonococcal infections”, “Chlamydia”, “Neonatal ophthalmia prevention” chapters
- Kapoor VS, Evans JR, Vedula SS. Interventions for preventing ophthalmia neonatorum. Cochrane Database Syst Rev. 2020 Sep 21;9(9):CD001862. doi: 10.1002/14651858.CD001862.pub4. PMID: 32959365; PMCID: PMC8524318.
- Neoreviews (2022) 23 (9): e603–e612. https://doi.org/10.1542/neo.23-9-e603
- Commentary From the AAP Section on Ophthalmology: Century of Changes | Pediatrics | American Academy of Pediatrics
What do petting zoos, river swimming, and hamburgers have in common? All have been linked with the spread of Shiga-toxin producing E. coli or STEC O157:H7, which is a strain linked with hemolytic uremic syndrome (HUS).
This episode was written by pediatricians Lidia Park and Tammy Yau with content support from Stephanie Nguyen (UC Davis pediatric nephrology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- Hemolytic uremic syndrome is a microangiopathic hemolytic anemia caused by Shiga toxin producing E. coli.
- Symptoms include anemia, thrombocytopenia, and uremia
- Treat HUS with hydration (but not too much as that can lead to fluid overload), blood transfusion if needed for severe anemia, and close monitoring as some patients progress to needing dialysis
Sources:
- Peds in Review, 2020. Pediatr Rev (2020) 41 (4): 213–215. https://doi.org/10.1542/pir.2018-0346
- AAP Grand Rounds (2023) 49 (5): 55. https://doi.org/10.1542/gr.49-5-55
- AAP Grand Rounds (2024) 52 (1): 6.https://doi.org/10.1542/gr.52-1-06
- Ho, Erin. “Factors associated with Actionable Gastrointestinal Panel Results in Hospitalized Children”. Hospital Pediatrics Nov 2023
Unequal blood pressures in the extremities and unequal brachial vs femoral pulses? Consider coarctation of the aorta. What’s that? Learn more in today's episode!
This episode was written by pediatricians Lidia Park and Tammy Yau with content support from Jay Yeh (UC Davis pediatric cardiologist). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- Coarctation of the aorta is narrowing of the aorta near the ductus arteriosus (which closes and becomes the ligamentum arteriosum). Most cases occur in the first month of life.
- Symptoms of coarctation of the aorta are tachypnea, poor feeding, fussiness, and sweating with feeds. Blood pressure is elevated in the right upper extremity compared to the lower extremity. Babies can develop congestive heart failure which can lead to shock.
- CCHD does not always catch coarctations of the aorta!
Sources:
- Raza S, Aggarwal S, Jenkins P, et al. Coarctation of the Aorta: Diagnosis and Management. Diagnostics (Basel). 2023;13(13):2189. Published 2023 Jun 27. doi:10.3390/diagnostics13132189
- Salciccioli KB, Zachariah JP. Coarctation of the Aorta: Modern Paradigms Across the Lifespan. Hypertension. 2023;80(10):1970-1979. doi:10.1161/HYPERTENSIONAHA.123.19454
- Parker LE, Landstrom AP. Genetic Etiology of Left-Sided Obstructive Heart Lesions: A Story in Development. J Am Heart Assoc. 2021;10(2):e019006. doi:10.1161/JAHA.120.019006
Does your child have a barking seal like cough? You better be thinking of croup! Join us on this resident-led episode today.
This episode was written by pediatric resident Anjali Doshi and pediatricians Lidia Park and Tammy Yau with content support from Alexis Toney (UC Davis pediatric hospitalist). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
- Croup, acute laryngotracheitis, a viral infection causing respiratory inflammation, bark like cough, and inspiratory stridor
- Westley score can be used to determine severity of croup
- Treatment for mild symptoms is humidified air and supportive care
- Treatment for moderate/severe symptoms is racemic epinephrine breathing treatment and IV dexamethasone
- Imaging can be considered to rule out bacterial tracheitis or epiglottitis if history and physical exam cannot narrow down the differential to croup
- Antibacterials not normally given unless concurrent infection
Reference:
- AAP Point of Care Quick Reference, Retzke, 2021. https://doi.org/10.1542/aap.ppcqr.396247
- Russell KF, Liang Y, O'Gorman K, Johnson DW, Klassen TP. Glucocorticoids for croup. Cochrane Database Syst Rev. 2011;(1):CD001955. Published 2011 Jan 19. doi:10.1002/14651858.CD001955.pub3
- Cochrane Database Syst Rev. 2018;10:CD006822. Epub 2018 Oct 29.
- Juliette Anderson. “Baby with Croup Stridor Barking Cough Visual & Audio Sound - When to Hospitalize.” YouTube, 14 Apr. 2011, www.youtube.com/watch?v=Qbn1Zw5CTbA. Accessed 3 Oct. 2024.
Don’t miss this “ear”-resistible episode on outer ear infections, also known as otitis externa or swimmer’s ear!
This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Lena van Der List. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- Think otitis externa when your patient has ear pain, ear drainage, decreased hearing, and swelling or debris in the ear canal.
- Treat otitis externa with otic aminoglycosides (neomycin, polymyxin B, trimethoprim-sulfate) when you have an intact tympanic membrane or fluoroquinolone (ciprofloxacin, ofloxacin) if you can’t visualize the tympanic membrane or there is a perforation
Sources:
Pediatrics in Review 2013, https://doi.org/10.1542/pir.34-3-143
Get a real ear-full of information today when we talk about the 2nd most common diagnosis in the pediatric emergency department, acute otitis media (AOM)!
This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Lena Van der list. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- Ear pain with a red bulging tympanic membrane and decreased tympanic membrane mobility is our diagnosis for acute otitis media.
- AOM can be due to bacteria (S. pneumoniae, H. influenza, and Moraxella) and viruses (influenza, adenovirus, human metapneumovirus)
- Treat AOM with high dose amoxicillin (cephalexin or azithromycin if penicillin allergy) or amoxicillin-clavulanate. Avoid complications like mastoiditis or tympanic membrane perforation
Sources:
- Pediatrics 2013, https://doi.org/10.1542/peds.2012-3488
- Stat Pearls 2023, https://www.ncbi.nlm.nih.gov/books/NBK470332/
- World Journal of Pediatrics 2024, https://doi.org/10.1007/s12519-023-00716-8
- University of Illinois Chicago: https://dig.pharmacy.uic.edu/faqs/2022-2/december-2022-faqs/what-evidence-supports-the-recommendation-for-high-dose-amoxicillin-in-children-with-acute-otitis-media/
In today’s episode, you’ll learn how to recognize and reduce this common pediatric orthopedic injury on your own and even teach parents if needed!
This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Emily Andrada. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- Nursemaid’s elbow, subluxation of the radial head, or annular ligament displacement all refer to the same injury of the elbow that occurs most often when a child’s arm is pronated and pulled.
- Treatment of a nursemaid’s is through reduction - either by supinating and flexing the elbow (or) pronating, hyperextending, and then flexing the elbow
- Imaging is not routinely indicated for highly suspicious nursemaid’s but should be considered if you have concern for fracture
Sources:
- Pediatrics in Review 2013, https://doi.org/10.1542/pir.34-8-366
- Pediatrics 2002, https://doi.org/10.1542/peds.110.1.171
Eur J Emerg Med 2009, https://doi.org/10.1097/MEJ.0b013e32831d796a
Learn how research continues to change our ability to detect and treat pediatric patients with hepatitis C in today’s episode.
This episode was written by Dr. Lidia Park and Dr. Tammy Yau with content support from Dr. Daniel Dodson. Drs. Lidia and Tammy take full responsibility for any errors or misinformation.
Key Points:
- Perinatal hepatitis C exposure is the most common cause of pediatric hepatitis C infection
- NAT testing for hepatitis C RNA can be done as early as 2 months of life to detect hepatitis C infection in pediatric patients rather than waiting until 18 months of life when hepatitis C antibody testing can be done
- Hepatitis C positive moms can still breastfeed but should halt breastfeeding temporarily if breasts are cracked or bleeding
Sources:
- CDC: CDC Recommendations for Hepatitis C Testing Among Perinatally Exposed Infants and Children — United States, 2023 | MMWR
- AAP Red Book 2024: Hepatitis C
Ever wonder what CCHD meant on a newborn discharge summary? Learn about how we screen for Critical Congenital Heart Defects in newborns (and which ones we miss!) in this episode.
This episode was written by Dr. Lidia Park and Dr. Tammy Yau with content support from Dr. Heather Siefkes. Drs. Lidia and Tammy take full responsibility for any errors or misinformation.
Key Points:
- Critical Congenital Heart Defects (CCHD) screening looks for heart defects that can be life threatening in infancy such as coarctation of the aorta, single ventricle defects like hypoplastic left heart syndrome, Tetralogy of Fallot (ToF), pulmonary atresia, total anomalous pulmonary venous return (TAPVR), transposition of the great arteries (TGA), and tricuspid atresia (TA).
- CCHD screening does not detect atrial septal defects (ASD), ventricular septal defects (VSD), or atrioventricular septal defects (AVSD)
- CCHD screening is performed by checking the pulse oximeter of the right hand and either foot of a newborn. SpO2 less than 90% is an automatic fail. SpO2 differences of 3% or more or SpO2 91-95% should be repeated twice before counting as a fail. Failed CCHD’s should be followed up with an echocardiogram.
Sources:
- CDC: Clinical Screening and Diagnosis for Critical Congenital Heart Defects | Congenital Heart Defects (CHDs) | CDC
- BMC Pediatric 2021, Jullien S. Newborn pulse oximetry screening for critical congenital heart defects. doi:10.1186/s12887-021-02520-7
- Pediatrics 2011, Kemper AR, Mahle WT, Martin GR, et al. Strategies for implementing screening for critical congenital heart disease. doi:10.1542/peds.2011-1317
Did you know that if you exercise while you have a fever, you probably meet SIRS criteria? The new Phoenix sepsis scoring systems aims to better categorize sepsis through specific categories based on the patient’s vitals, labs, and medications. Learn with us as we walk through this new scoring system in today’s episode.
This episode was written by Dr. Lidia Park and Dr. Tammy Yau with content support from Dr. Alexis Toney. Drs. Lidia and Tammy take full responsibility for any errors or misinformation.
Key Points:
- The Phoenix sepsis score is based out of 13 points. 2 or more points meets sepsis criteria. The score is based on 4 categories: respiratory, cardiovascular, coagulation, and neurologic.
- The Phoenix sepsis score is better at predicting mortality than SIRS criteria but does not predict morbidity
Sources:
- JAMA 2024, Schlapbach,“International Consensus Criteria for Pediatric Sepsis and Septic Shock”: doi: 10.1001/jama.2024.0179.
- Hospital Pediatrics 2023, Kusma, “Effect of Viral Illness on Procalcitonin as a Predictor of Bacterial Infection in Febrile Infants”: doi: 10.1542/hpeds.2022-007070
Learn how to classify and manage pneumonia in today’s episode!
This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Natasha Nakra. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- Pneumonia can be due to bacteria or viruses and there is no reliable way to distinguish the two
- Pneumonia can be diagnosed clinically based on exam or with a CXR. Lab work is not always necessary
- Treatment of bacterial pneumonia depends on if you think it is community acquired (first line amoxicillin), atypical (first line azithromycin), or nosocomial/hospital acquired (consider antibiotics for pseudomonal or MRSA coverage)
Sources:
- AAP 2023, Pinto: https://doi.org/10.1542/aap.ppcqr.396216
- Pediatrics in Review 2017, Messinger: https://doi.org/10.1542/pir.2016-0183
- Pediatric Care Online 2016, Light: https://publications.aap.org/pediatriccare/book/348/chapter/5785224/Pneumonia-Chapter-315
- IDSA 2013: https://doi.org/10.1093/cid/cir531
Prolonged viral upper respiratory symptoms or is it actually sinusitis in disguise? Join us as we discuss all things sinusitis in this episode!
This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Natasha Nakra. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key Points:
- Acute bacterial sinusitis can be clinically diagnosed based on persistent respiratory symptoms lasting more than 10 days without improvement, worsening or new respiratory symptoms after initial improvement, or severe symptoms at onset lasting more than 3 days.
- First line antibiotic treatment for acute bacterial sinusitis is with amoxicillin or amoxicillin-clavulanate
- Complications include orbital or intracranial spread of infection
Sources:
- Pediatrics in Review 2013, Demuri and Wald: https://doi.org/10.1542/pir.34-10-429
- AAP Pediatrics 2013, Wald et al: https://doi.org/10.1542/peds.2013-1071
- Pediatrics 2024, Conway et al: https://doi.org/10.1542/peds.2023-064244
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Lisa Rasmussen. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
- Vitamin K is important in preventing early and late onset bleeding in newborns (up to 6 months of age), most importantly, intracranial bleeding.
- Intramuscular vitamin K is most effective but oral vitamin K regimens are used outside of the US and are better than not giving any vitamin K
Sources/Supplemental Information:
- AAP Pediatrics 2022, Hand: https://doi.org/10.1542/peds.2021-056036
CDC Vitamin K Handout: https://www.cdc.gov/ncbddd/vitamink/vitamin-k-fact-sheet-general.html
Can someone with HIV breastfeed their child? You might be surprised at the answer!
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com.
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Laura Kair. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
- New guidelines from the CDC recommend allowing mothers with HIV on antiretroviral therapy (ART) with an undetectable viral load to breastfeed their child if they desire, whether or not they live in a developed or underdeveloped country. The risk for HIV transmission through breastmilk in these cases is 0.6%
- In the US, you can call the national perinatal HIV/AIDS hotline at 1-888-448-8765 for advice
-
Sources
- CDC 2023 Infant Feeding for Individuals with HIV in the US: https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/hiv.html
Stay up to date with new research on shortening antibiotic treatment duration for urinary tract infections (UTIs) with our episode today where we review a recently published randomized control trial (RCT). Learn how to critically analyze study data and what key points we take away.
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com.
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Michelle Hamline. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
- A single RCT found similar risk of UTI recurrence in children who received a 5 day course vs 10 day course of antibiotics within the first 30 days
Sources
- Pediatrics 2024, Montini et al: https://doi.org/10.1542/peds.2023-062598
- BMJ 2007, Montini et al: https://doi.org/10.1136/bmj.39244.692442.55
- Cochrane Rev 2012, Altamimi et al: https://doi.org/10.1002/14651858.CD004872.pub3
- JAMA Ped 2021, Pernica et al: https://doi.org/10.1001/jamapediatrics.2020.6735
- JAMA Ped, 2022, Williams et al: https://doi.org/10.1001/jamapediatrics.2021.5547
Ever seen a tuft of hair over the lower back or a sacral dimple? Learn how to recognize and manage normal vs abnormal back and spinal findings in our episode today.
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com.
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Laura Kair. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
- Spinal dysraphism is the incomplete fusion of the spine during development.
- Not all spinal dysphraphisms will have abnormal cutaneous manifestations that you can see on exam
- Diagnose spinal dysphraphisms with spinal ultrasound in young children and MRI in older children
- Sacral dimples can be normal but should be worked up if they are larger than 5 mm at the base, above 2.5cm from the anus, not midline, or if there are multiple dimples
Sources
- Pediatrics in Review 2019, Holmes and Li: https://doi.org/10.1542/pir.2018-0155
- Peds in Review 2011, Zywicke and Rozzelle: https://doi.org/10.1542/pir.32-3-109
- Hospital Pediatrics 2020, Aby et al: https://doi.org/10.1542/hpeds.2019-0264
Toxoplasmosis is a parasitic TORCH infection that is often associated with cats but did you know owning a cat is not associated with increased prevalence? Learn more on how the disease is actually acquired and how to prevent infection in this episode!
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com.
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Ritu Cheema. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Cats, undercooked meat, and raw seafood can lead to toxoplasmosis infection
-Findings of toxoplasmosis infection in utero include scattered intracranial calcifications and chorioretinitis
-Treat toxoplasmosis infection in neonates with pyrimethamine, sulfadiazine, and folinic acid
Sources:
AAP 2017https://publications.aap.org/pediatrics/article/139/2/e20163860/59988/Diagnosis-Treatment-and-Prevention-of-Congenital?autologincheck=redirected
Learn about how the virus that causes cold sores can also cause serious complications in infants.
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Ritu Cheema. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-First time HSV infection in pregnancy is higher risk to infants than reactivation of previous infection
-Symptoms of neonatal HSV infection include seizures, vesicles, and irritability
-Diagnose HSV with viral culture or PCR of bodily fluids
-Use acyclovir to treat infants and pregnant people with HSV infection
Sources:
AAFP 2022 https://www.aafp.org/pubs/afp/issues/2002/0315/p1138.html
Redbook 2021 https://publications.aap.org/redbook/book/347/chapter-abstract/5752755/Herpes-Simplex?redirectedFrom=fulltext
Neoreview 2018 https://publications.aap.org/neoreviews/article/19/2/e89/87448/Neonatal-Herpes-Simplex-Virus-Infection
Despite widespread vaccination, there are still breakthroughs of varicella (commonly known as chicken pox). Let's dive into this episode of our TORCH series.
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com
This episode was written by Dr. Tammy Yau and Lidia Park, with content support from Dr. Ritu Cheema. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Transplacental varicella transmission can lead to congenital varicella syndrome which includes dermatomal rash, cicatrix, limb hypoplasia, microcephaly, and cataracts
-Use Acyclovir to treat neonates and pregnant people with active varicella infection. Congenital varicella syndrome does not require treatment.
-Varicella immunoglobulin can be used to prevent infection in certain cases including exposed neonates 5 days before delivery and 2 days after delivery.
Sources:
VZV in Newborns: Neoreviews (2016) 17 (9): e507–e514. https://doi.org/10.1542/neo.17-9-e507
TORCH infections: Pediatr Rev (2011) 32 (12): 537–542. https://doi.org/10.1542/pir.32-12-537
This week on our series on TORCH infections, we are discussing syphilis, an increasingly prevalent disease in the pediatric population.
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Elizabeth Partridge. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Most congenital syphilis is asymptomatic. Less commonly will present with rash, snuffles, hepatosplenomegaly, anemia, and jaundice.
-Untreated disease can cause neurosyphilis and bone defects
-Compare mother's RPR titers to baby's and look for findings consistent with syphilis.
-Workup is based on whether mother was adequately treated and includes CBC, LP, skeletal survey, and LFTs.
-Treatment is with IV penicillin G for 10 days.
Sources:
AAP Red Book Syphilis chapter
Sankaran D, Partridge E, Lakshminrusimha S. Congenital Syphilis-An Illustrative Review. Children (Basel). 2023 Jul 29;10(8):1310. doi: 10.3390/children10081310. PMID: 37628309; PMCID: PMC10453258.
Fang J, Partridge E, Bautista GM, Sankaran D. Congenital Syphilis Epidemiology, Prevention, and Management in the United States: A 2022 Update. Cureus. 2022 Dec 27;14(12):e33009. doi: 10.7759/cureus.33009. PMID: 36712768; PMCID: PMC9879571.
https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf
Part 2 of our TORCH series discusses CMV, the most common infectious cause of hearing loss in the US.
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Dean Blumberg. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Findings include blueberry muffin rash, microcephaly, periventricular calcifications, sensorineural hearing loss, and jaundice.
-Infection persists lifelong and treatment with valganciclovir is meant to prevent long term sequelae
-Monitor for myelosuppression with treatment.
-Frequent hearing screening is needed.
Sources:
AAP Red Book CMV chapter
Fowler KB, Boppana SB. Congenital cytomegalovirus infection. Semin Perinatol. 2018 Apr;42(3):149-154. doi: 10.1053/j.semperi.2018.02.002. Epub 2018 Mar 2. PMID: 29503048.
We are starting our mini-series on TORCH infections with congenital rubella, a rare disease nowadays in the US but prevalent still worldwide.
Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Dean Blumberg. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Think of this disease in infants of immigrant or under-immunized mothers.
-Findings include cataracts, retinopathy, PDA, hearing loss, blueberry muffin rash
-Treatment is supportive, with patients needing to isolate for at least several months.
-There is little evidence for immunoglobulin to prevent disease
Sources:
AAP Red Book chapter on Rubella
Lambert N, Strebel P, Orenstein W, Icenogle J, Poland GA. Rubella. Lancet. 2015 Jun 6;385(9984):2297-307. doi: 10.1016/S0140-6736(14)60539-0. Epub 2015 Jan 8. PMID: 25576992; PMCID: PMC4514442.
AAP 2010 Pediatrics in Review
https://publications.aap.org/pediatricsinreview/article-abstract/31/3/129/33128/Rubella?redirectedFrom=fulltext
In this shocking episode, we discuss identifying and managing sepsis and septic shock in the pediatric population. This episode features two of our 2nd year pediatric residents, Victoria and Kat. We are so excited to have them join us and teach us about this very common chief complaint, especially for patients getting admitted to the hospital.
Follow us on Twitter/X @Pediagogypod and Instagram/Trheads @pediagogy and connect with us at pediagogypod@gmail.com
This episode was written by Drs. Victoria Tran, Katrina Marks, Tammy Yau, and Lidia Park, with content support from Dr. Moonjoo Han. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points
- Defining and differentiating SIRS, sepsis, and septic shock. Identifying the symptoms of sepsis is important for appropriate patient triage.
- SIRS comprises of constellation of symptoms. For SIRS criteria, 2 or more criteria must be met, which include hyper/hypothermia, leukocytosis/leukopenia, tachycardia/bradycardia, tachypnea.
- SIRS + infectious source = sepsis
- Initial management of sepsis includes broad-spectrum antibiotics and fluid resuscitation with isotonic fluids (typically 10-20 cc/kg)
Sources:
Weiss, Scott L. MD, MSCE, FCCM (Co-Vice Chair) et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatric Critical Care Medicine 21(2):p e52-e106, February 2020. | DOI: 10.1097/PCC.0000000000002198
Link: https://journals.lww.com/pccmjournal/Fulltext/2020/02000/Surviving_Sepsis_Campaign_International_Guidelines.20.aspx
Menon, Kusum et al. “A Prospective Multicenter Study of Adrenal Function in Critically Ill Children.” American journal of respiratory and critical care medicine: an official journal of the American Thoracic Society, medical section of the American Lung Association. 182.2 (2010): 246–251. Web.
In this episode, we have some special guests, Dr. Daniel Dodson, and one of our medical students, Aneri Patel, talk to us about Kawasaki disease. Special thanks to Dr. Natasha Nakra for content review.
Key points:
-Vasculitis with the clinical features in the mnemonic CRASH and Burn
-Incomplete Kawasaki has lab features including elevated ESR and CRP, thrombocytosis, hypoalbuminemia, anemia, elevated ALT, leukocytosis, and sterile pyuria.
-Treatment is to prevent coronary artery aneurysms with IVIG and aspirin.
References:
AAP Pediatrics in Review
https://publications.aap.org/pediatricsinreview/article/39/2/78/35139/Kawasaki-Disease?autologincheck=redirected
Infliximab and Kawasaki
https://www.sciencedirect.com/science/article/pii/S2352464221002704?via%3Dihub
Principles and Practices of Infectious Diseases, 6th edition
Let’s briefly discuss the new 2023 AAP obesity guidelines in this episode.
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This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Sean Munoz. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Obesity is now the most common chronic disease of childhood
-Children 10 years of age and older with obesity should have lipid, A1c, and ALT checked.
-Children ages 2-9 with obesity should have lipid checked and potentially ALT
-Treatment is multimodal and includes lifestyle modification, medications, and surgery.
AAP 2023 obesity guidelines:
https://publications.aap.org/pediatrics/article/151/2/e2022060640/190443/Clinical-Practice-Guideline-for-the-Evaluation-and
NPR: AAP’s new childhood obesity guidance raises worries over the risk of eating disorders
https://www.npr.org/2023/02/15/1155521908/eating-disorder-obesity-guidance-risk-weight-loss
USA Today: Weight loss drugs and surgery- for kids? Why new obesity guidance is drawing scrutiny
https://www.usatoday.com/story/news/health/2023/01/19/aap-childhood-obesity-guidelines-scrutiny/11039166002/
2012 Dyslipidemia Screening
https://publications.aap.org/pediatrics/article/146/1_MeetingAbstract/636/4732/Pediatric-dyslipidemia-screening-by-pediatricians
Want to quickly become a pro at family centered rounds? Learn the basics as well as the tips and tricks on how to navigate presenting in a patient-first and family-friendly way.
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This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Jessica Witkowski. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Family centered rounds should involve the patient, family, and all relevant medical team members. Allow space for everyone to be heard and opportunity for questions.
-Make sure to include all the same important information as a traditional presentation, but without medical jargon. Direct your presentation at the patient and family
Sources:
- 2021 AAP Hospital Pediatrics: https://publications.aap.org/hospitalpediatrics/article/11/7/679/179865/Implementing-Family-Centered-Rounds-in-Hospital?autologincheck=redirected
- 2018 AAP Pediatrics: https://publications.aap.org/pediatrics/article-abstract/141/3/e20171883/37598/Families-Experiences-With-Pediatric-Family?redirectedFrom=fulltext
2022 Michigan Medicine: https://www.ncbi.nlm.nih.gov/books/NBK582289/
Help my kid has a UTI! Does cranberry juice have any benefit for UTIs? Find out with us in today’s episode about urinary tract infections (UTIs)!
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This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Natasha Nakra. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-A fever may be your only symptom in a young child with a UTI
-If you think it’s a UTI, get a clean specimen for culture. A positive culture has more than 50k CFUs/ml on a catheter sample and more than 100k CFUs/ml on a clean catch/void sample.
-Most common bacteria causing UTIs are E. coli, Klebsiella, Proteus, Enterococcus, and Enterobacter
-Simple cystitis may only need 3-10 days of treatment depending on age, whereas pyelonephritis needs 10-14 days.
Sources
- 2021 AAP UTI Management: https://publications.aap.org/pediatrics/article/147/2/e2020012138/36243/Contemporary-Management-of-Urinary-Tract-Infection
- 2016 AAP Reaffirmation of Clinical Guideline: https://publications.aap.org/pediatrics/article/138/6/e20163026/52686/Reaffirmation-of-AAP-Clinical-Practice-Guideline
- UTI risk calculator: https://uticalc.pitt.edu/
- CDC Urine Culture Stewardship: https://www.cdc.gov/hai/prevent/cauti/index.html
- 2023 UTI treatment duration: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2806198
- 2012 Cranberry Juice for UTIs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027998/
- 2020 Comparative Effectiveness of Antibiotic Treatment Duration in Children With Pyelonephritis: https://pubmed.ncbi.nlm.nih.gov/32364593/
Seizures can be scary and fevers aren't fun but we'll teach you why simple febrile seizures aren't so bad in this episode!
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This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Shannon Liang, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Simple febrile seizures are generalized, less than 15 minutes, and occur no more than once in a 24-hour period.
-No work-up or treatment is recommended for simple febrile seizures
Supplemental information
2011 AAP Pediatrics guidelines: https://publications.aap.org/pediatrics/article/127/2/389/65189/Febrile-Seizures-Guideline-for-the-Neurodiagnostic
2019 AAP Pediatrics - Post Vaccination Febrile Seizure Severity and Outcome https://publications.aap.org/pediatrics/article/143/5/e20182120/37133/Postvaccination-Febrile-Seizure-Severity-and
2010 AAP Pediatrics - MMRV Combination Vaccine and the Risk of Febrile Seizures: https://publications.aap.org/pediatrics/article/126/1/e1/68346/Measles-Mumps-Rubella-Varicella-Combination
Learn about management of newborn jaundice in our 2-part series.
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This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Daphne Say, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Unconjugated bilirubin is fat soluble so can cross the blood brain barrier and cause kernicterus
-Check bilirubin levels at least every 24 hours while a newborn is first hospitalized
-New AAP guidelines on hyperbilirubinemia management raised phototherapy and exchange transfusion thresholds
-Transcutaneous bilirubin monitoring has a +/- 3 margin of error
Supplemental Information
2022 AAP Pediatrics Guidelines: https://publications.aap.org/pediatrics/article/150/3/e2022058859/188726/Clinical-Practice-Guideline-Revision-Management-of?autologincheck=redirected
2012 Journal of Perinatology – Hyperbilirubinemia in Infants < 35 weeks gestation: https://www.nature.com/articles/jp201271#Tab1
2014 AAP Pediatrics - Transcutaneous Bilirubin After Phototherapy in Term and Preterm Infants https://publications.aap.org/pediatrics/article/134/5/e1324/75870/Transcutaneous-Bilirubin-After-Phototherapy-in?autologincheck=redirected
In the first installment of this 2-part episode, we break down the causes of unconjugated (indirect) and conjugated (direct) hyperbilirubinemia.
Follow us on Twitter @Pediagogypod and connect with us at pediagogypod@gmail.com
This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Daphne Say, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Unconjugated hyperbilirubinemia causes are due to increased bilirubin production, decreased liver conjugation, or decreased clearance
-Conjugated hyperbilirubinemia can be due to outflow or transport problem, infection, metabolic disorders, liver dysfunction, and parenteral nutrition
-Always consider biliary atresia in a newborn with pale white stools. The earlier the surgical treatment, the better outcomes
Supplemental Information
2017 Pediatrics in Review - Jaundice: Newborn to Age 2 months https://publications.aap.org/pediatricsinreview/article/38/11/499/35001/Jaundice-Newborn-to-Age-2-Months?autologincheck=redirected
Join us today where we discuss one of the most common causes of microcytic anemia in pediatric patients.
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This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Anjali Pawar, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Excessive milk consumption inhibits iron absorption. Limit to 16-24 oz/day
-Iron supplementation dosing depends on gestational age and major food source. Prevention vs treatment dosing also differ.
-Mentzer index greater than 13 indicates iron deficiency anemia
Supplemental information
2010 AAP Pediatrics guidelines: https://publications.aap.org/pediatrics/article/126/5/1040/65343/Diagnosis-and-Prevention-of-Iron-Deficiency-and?autologincheck=redirected
2020 JAMA Network – vitamin C and irom deficiency anemia: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772395#:~:text=Vitamin%20C%20is%20the%20only,shown%20to%20promote%20iron%20absorption.&text=Iron%20absorption%20occurs%20predominantly%20in,small%20intestine%20mucosal%20epithelial%20cells
2017 AAP Pediatrics in Review – infant nutrition: https://publications.aap.org/pediatricsinreview/article/38/10/449/32000/Updates-in-Infant-Nutrition
2014 Neuropsychiatric Disease and Treatment – iron deficiency anemia and cognitive function: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235202/
In this hot topic summer episode, listeners will learn about the management of infectious gastroenteritis.
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This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Christopher Kim, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.
Key points:
-Gastroenteritis is a major cause of pediatric morbidity annually due to dehydration
-Learn about oral rehydration with balanced electrolyte solutions vs water or sports drinks
-Understand why we avoid testing and antibiotics
-Other supportive measures that are available
Supplemental information
2012 AAP Pediatrics in Review: https://publications.aap.org/pediatricsinreview/article/33/11/487/34685/Acute-Gastroenteritis?autologincheck=redirected
Key points: -Remember the 4-2-1 rule for calculating maintenance fluids in children -Use of hypotonic fluids is based on historical data in healthy children -Data now supports use of isotonic fluids like NS or LR to reduce risk of hyponatremia and SIADH -Newer data may support LR over NS
Supplemental information AAP 2018 Maintenance Fluid Guidelines: https://publications.aap.org/pediatrics/article/142/6/e20183083/37529/Clinical-Practice-Guideline-Maintenance
Key points: -DKA presents with hyperglycemia, ketosis, and anion gap metabolic acidosis, which if severe can cause cerebral edema and CNS dysfunction -Initial management includes fluid resuscitation and IV insulin -Learn about the 2 bag system for DKA -There is a rule to correct for hyponatremia in hyperglycemia -Learn about how to manage potassium, bicarbonate, and phosphorus in DKA
Supplemental information: Pediatrics in Review 2019 DKA: https://publications.aap.org/pediatricsinreview/article-abstract/40/8/412/35321/Diabetic-Ketoacidosis?redirectedFrom=fulltext
Key points: -Bronchiolitis is seen in kids under the age of 2 and caused by RSV -Treatment is supportive including fluids, oxygen, and suction -Learn about palivizumab and other new preventive therapies against bronchiolitis
Supplemental Information: AAP 2014 guidelines: https://pediatrics.aappublications.org/content/134/5/e1474 Day of Illness and Outcomes in Bronchiolitis Hospitalizations: https://publications.aap.org/pediatrics/article/146/5/e20201537/75296/Day-of-Illness-and-Outcomes-in-Bronchiolitis
Key points: -New strategies for management of febrile infants depending on age (1-3 weeks, 3-4 weeks, or 4-8 weeks) -Inflammatory markers like CRP and procalcitonin help to determine if LP is needed in older patients. -Learn about common bugs that cause infection in infants and the antibiotics we use to treat them -Observation of febrile infants is now reduced from 48 hours to 24-36 hours
Supplemental information: AAP guidelines 2020: https://pediatrics.aappublications.org/content/148/2/e2021052228 Yale Observation Scale Score in febrile infants 60 days and younger: https://publications.aap.org/pediatrics/article/140/1/e20170695/37958/The-Yale-Observation-Scale-Score-and-the-Risk-of
Key points: -First line management is insulin when in DKA -First line management is lifestyle modification and metformin when not in DKA -Consider adding insulin and GLP-1 agonists if still in poor control
Supplemental Information AAP guidelines 2013: https://publications.aap.org/pediatrics/article/131/2/364/31847/Management-of-Newly-Diagnosed-Type-2-Diabetes AAFP guidelines 2018: https://www.aafp.org/afp/2018/1101/p590.html ISPAD guidelines 2018: https://www.ispad.org/page/ISPADGuidelines2018
Key points: -There are specific clinical criteria for diabetes -There are some differences to help distinguish between type 1 versus type 2 diabetes -Learn about how to manage diabetes on the inpatient floor, including how to calculate total daily insulin dose, correction factors, and carbohydrate ratios.
Supplemental information: Pediatrics in Review 2013: https://publications.aap.org/pediatricsinreview/article-abstract/34/5/203/34790/Type-1-Diabetes-Mellitus?redirectedFrom=fulltext American Diabetes Association 2018 Position Statement: https://diabetesjournals.org/care/article/41/9/2026/40739/Type-1-Diabetes-in-Children-and-Adolescents-A
Key points: -Ask about common triggers for asthma like smoke or allergens as well as medication adherence -Asthma is a clinical diagnosis but ancillary tests like PFTs may help -Symptom frequency and severity can help you classify the asthma as intermittent versus persistent -Learn about controller/maintenance therapy, including the new SMART therapy -Learn about steroid use for acute exacerbations as well as next line medications like magnesium, ipratropium, and epinephrine
Supplemental information: NIH 2020 guideline updates: https://pediatrics.aappublications.org/content/147/6/e2021050286 Peds in review 2019: https://pedsinreview.aappublications.org/content/40/11/549 Asthma control test: https://www.greenhillspeds.com/wp-content/uploads/2015/12/Asthma-Control-Test-4-to-11-years.pdf GINA 2020 Pocket Guide: https://ginasthma.org/wp-content/uploads/2020/04/Main-pocket-guide_2020_04_03-final-wms.pdf NIH Guidelines 2007: https://www.nhlbi.nih.gov/health-topics/guidelines-for-diagnosis-management-of-asthma JAMA 2021 guideline update summary: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2780356