Pediagogy™

Purpura, stomach aches, joint pains, maybe blood in the urine? You better be thinking about IgA nephropathy. Learn more This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Gia Oh (pediatric nephrologist). 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 [email protected] Points:IgA vasculitis (formerly known as Henoch-Schonlein purpura/HSP) is a small vessel vasculitis that causes palpable purpura, abdominal pain, arthritis or arthralgias, IgA deposition on biopsy, and/or renal involvement.Management is mainly supportive with hydration and pain management. Steroids can be given for severe GI or renal involvement as well as immunosuppressants, plasmapheresis, or transplant if severe renal symptoms.IgA vasculitis symptoms typically resolve within 4-6 weeks but 1/3 of patients will have relapse or recurrence within 1 year. Monitoring for renal involvement is important.SourcesReid-Adam, Jessica. Pediatr Rev (2014) 35 (10): 447–449. https://doi.org/10.1542/pir.35-10-447AAP Grand Rounds (2005) 14 (6): 65. https://doi.org/10.1542/gr.14-6-65AAP Grand Rounds (2022) 47 (4): 42. https://doi.org/10.1542/gr.47-4-42

You’ve probably seen an infantile hemangiomas before but did you they can be associated with PHACE or LUMBAR syndrome? Learn about this and everything else about infantile hemangiomas in this week’s episode.This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Caitlin Peterman (pediatric dermatology). 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 [email protected] Points:Infantile hemangioma which are the most common benign tumor of infancy. Most will involute on their own after 4 months of age and self-resolveHemangiomas can affect nearby organs causing vision impairment, feeding difficulties, or airway compromise. Other complications include ulceration and disfigurementFirst line treatment includes oral propranolol for thicker lesions and topical timolol for superficial/thin lesions. Surgery or laser is reserved for select hemangiomas SourcesAAP Jan 2019: https://publications.aap.org/pediatrics/article/143/1/e20183475/37268/Clinical-Practice-Guideline-for-the-Management-of?searchresult=1

Ebstein's anomaly is a congenital heart defect that involves an abnormally developed tricuspid valve. Learn more about its effects on the heart physiology in today's episode.This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Daniel Cortez (pediatric cardiology). 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 [email protected] Points:Ebstein's anomaly is characterized by an abnormally placed tricuspid valve causing atrialization of the right ventricle. This can lead to single ventricle physiology.Wolff-Parkinson-White (WPW), right bundle branch blocks (RBBB), mitral valve prolapse, mitral valve dysplasia, bicuspid aortic valve, ventricular septal defect, and coarctation of the aorta can all be associated with Ebstein's anomalyTreatment of Ebstein's anomaly requires a patient to be stable enough to tolerate surgical correction like aortopulmonary shunting, PDA stenting, tricuspid valvuloplasty, and/or single ventricle palliation. Some patients will require inhaled nitrous oxide, Prostaglandin E, antiarrhythmics, and/or ECMO as wellSources:Truong et al. “Ebstein Anomaly in the Fetus: Preparing for the Perfect Storm”.Neoreviews (2011) 12 (5): e260–e269. https://doi.org/10.1542/neo.12-5-e260

If you've been getting a lot more questions about hepatitis B and vaccination from your patients and families and wondering where to find the answers, look no further than our episode today filled with useful information from evidence based sources.This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Dean Blumberg (pediatric infectious disease). 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 [email protected] Points:As of the time of this podcast publishing, the American Academy of Pediatrics still recommends Hepatitis B vaccination at birth, 1-2 months, and 6-18 months.Hepatitis B vaccination introduction decreased the lifetime prevalence of hepatitis B from 33% to 5% between 1988-2004.4 in every 1000 people with hepatitis B will go on to develop chronic hepatitis B which can lead to liver failure or hepatocellular carcinoma. Hepatitis B has an average incubation of 90 days meaning you might not have symptoms for the first few months of infection. 20-30% of people with hepatitis B do not have a clear source of infection which is why prevention is crucialSources:“Hepatitis B in Children”. Pediatr Rev (2008) 29 (4): 111–120.https://doi.org/10.1542/pir.29-4-111“Hepatitis B” Red Book chapterhttps://www.aap.org/en/patient-care/immunizations/vaccination-recommendations-by-the-aap/

Have patients asking you about aluminum in vaccines? Listen to this episode to learn about important facts so that you can answer their questions appropriately. This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Anh Nguyen (allergy and immunology). 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 [email protected] Points: Alumium is an immune adjuvant, it helps the body's innate immune cells recognize vaccine antigen and enhances the ability of the vaccine antigen to activate innate immune cells. Your body has a better response to vaccines with aluminum than without. This is especially important for infantsAluminum toxicity is mostly only seen in adult dialysis patients or chronic kidney disease patients due to aluminum in dialysis and total parenteral nutrition. There are no credible reports of aluminum toxicity linked to vaccinesThere are higher levels of serum aluminum after taking over the counter antacids used to treat GERD than after giving an intramuscular vaccine.Sources:“The Role and Safety of Aluminum Adjuvants in Childhood Vaccines”. Pediatrics (2025)https://doi.org/10.1542/peds.2025-074874

We're back with journal club to review a study evaluating the PECARN guidelines on febrile infants under 28 days of age and serious bacterial infections like meningitis. 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 [email protected] Points:Urinalysis, absolute neutrophil count, and procalcitonin are useful predictors of serious bacterial infectionIn this study, using urine studies, absolute neutrophil count, and procalcitonin were able to risk stratify patients into risk for meningitis and no cases of meningitis were missedSources:Burstein B, Waterfield T, Umana E, Xie J, Kuppermann N. Prediction of Bacteremia andBacterial Meningitis Among Febrile Infants Aged 28 Days or Younger. JAMA. Publishedonline December 8, 2025. doi:10.1001/jama.2025.21454Kuppermann N, Dayan PS, Levine DA, et al. A Clinical Prediction Rule to IdentifyFebrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMAPediatr. 2019;173(4):342-351. doi:10.1001/jamapediatrics.2018.5501

Dealing with a crying and moving child who needs sedation for a laceration repair? Intranasal midazolam is a good sedative option but what dose do you choose? Learn more in this journal club episode where we talk about a recent study that evaluated the most effective dosing of intranasal midazolam.This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Julia Marlow (pediatric hospitalist). 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 [email protected] Points:Intranasal midazolam is a good non-invasive sedative option. It has similar plasma concentrations as intravenous administration because it bypasses first pass metabolism unlike oral administration. Onset of action is 20-30 minutes and can last 30-60 minutes.Dosing of intranasal midazalam for children is 0.2 - 0.5 mg/kgBased on the results of this study, 0.4 - 0.5 mg/kg of midazolam was found to provide more effective sedation without increased adverse events for the studied patient population (6 months - 7 years old with simple laceration)Always critically think through studies! This study had limitations including the narrow patient population (did not include children with autism or developmental delay, did not include children less than 6 months old, and had a small study sample size with n = 101)Sources:Tsze DS, Woodward HA, McLaren SH, et al. Optimal Dose of Intranasal Midazolam for Procedural Sedation in Children: A Randomized Clinical Trial. JAMA Pediatr. Published online July 28, 2025. doi:10.1001/jamapediatrics.2025.2181 UpToDate “Pediatric procedural sedation: pharmacological agents”

Sometimes kids are FOS - full of stool! In today's episode, we talk about how to diagnose and treat functional constipation which is a common cause of abdominal pain in pediatrics and can be a pain in the butt, literally!This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Kelly Haas (pediatric gastroenterology). 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 [email protected] Points:Functional constipation is constipation not due to any other underlying conditions such as Hirschsprungs, spinal cord dysphraphism, or other disease. Functional constipation is defined as having at least 1 month of symptoms in kids younger than 4 years old (or) symptoms at least once per week for at least 2 months in kids older than 4 years old who do not meet IBS criteria. Symptoms include 2 or fewer stools per week, at least 1 episode of incontinence per week after toilet training is established, a history of excessive stool retention/retentive posturing/excessive volitional stool retention, a history of hard or painful bowel movements, the presence of large fecal mass in rectum, or a history of large diameter stools that may obstruct the toiletEncopresis is liquid stool that goes around large stool balls and is indicative of constipation rather than diarrheaPolyethylene glycol (PEG, miralax), lactulose, and enemas are all good treatment options for constipationSources:Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. Tabbers MM, et al. J Pediatr Gastroenterol Nutr. 2014;58(2):258-274. doi:10.1097/MPG.0000000000000266 Constipation. Neal S. LeLeiko, et al. Pediatr Rev (2020) 41 (8): 379–392. https://doi.org/10.1542/pir.2018-033

Tripoding and a thumb print sign on X-ray are your buzz words for epiglottitis that you don't want to miss as it can cause very rapid respiratory compromise requiring ICU care. We'll go over what to look out for and how to treat epiglottitis in this week's episodeThis episode was written by pediatricians Tammy Yau and Lidia Park with content support from Zachary Chaffin (pediatric critical care). 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 [email protected] Points:Epiglottitis can present with rapid onset fever, sore throat, difficulty breathing, and drooling. On exam, you might see stridor, retractions, and tripoding which is when the patient is leaning forward with their head tilted upward.Epiglottitis can lead to respiratory failure and may require intubationThe most common causes of epiglottitis are Staph aureus, Streptococcus pneumonoiae, and Haemophilus influenzae though the latter has decreased due to vaccination with the Hib vaccineTreatment for epiglottitis includes antibiotics like ceftriaxone and vancomycin for 7-10 days. Steroids and racemic epinephrine have not been shown to improve outcomes for epiglottitis. Sources:Croup and Epiglottitis. Mark Shlomovich, et al. Pediatr Rev (2025) 46 (7): 366–372. https://doi.org/10.1542/pir.2024-006420Epiglottitis Associated With Intermittent E-cigarette Use: The Vagaries of Vaping Toxicity. Pediatrics (2020) 145 (3): e20192399. https://doi.org/10.1542/peds.2019-2399Croup (laryngitis, laryngotracheitis, spasmodic croup, laryngotracheobronchitis, bacterial tracheitis, and laryngotracheobronchopneumonitis) and epiglottitis (supraglottitis). In: Feigin and Cherry's Textbook of Pediatric Infectious Diseases, 8th edition, Tovar Padua LJ, Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ (Eds), Elsevier, Philadelphia 2019. Vol 1, p.175.Up to Date: Epiglottitis: Management, Clinical Features and Diagnosis

Wondering how to best protect your patients or your own baby this winter from RSV? We'll go over the different preventative options against RSV in today's episode!This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Kenneth Yau (general pediatrics). 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 [email protected] Points:RSV immunizations can stimulate an immune response to create antibodies against RSV or can directly give antibodies to an individualThe RSV vaccine (Abrysvo) for adults can be given to pregnant individuals to provide passive immunity to infants after birth. It should be given at 32-36 weeks of gestational and 2 weeks prior to deliveryAfter birth, infants can be given an RSV immunization, either nirsevimab (Beyfortus) or clesrovimab (Enflonsia), which are RSV antibodies. These can be given to all infants less than 8 months old if the pregnant parent did not receive Abrysvo. High risk infants 8-19 months should also receive RSV immunization.Sources:CDC: https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/pregnant-people.htmlAAP Oct 2025: https://doi.org/10.1542/peds.2025-073923 AAP Patient Care: https://www.aap.org/en/patient-care/respiratory-syncytial-virus-rsv-prevention/rsv-frequently-asked-questions/?srsltid=AfmBOopMfpneGvJVfI8lZGHlZg5gtqU7AtrR2NbqYzVh9OINyVnrXqT- 

Measles cases are rising world-wide so now's the time to brush up on this previously rare life threatening and vaccine preventable illness.This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Ritu Cheema (pediatric infectious disease). 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 [email protected] Points:Measles is a highly contagious vaccine preventable viral infection. From 1 single person infected with measles, an average of 18 people can be infected compared to an average of 10 for Ebola and an average of 6 for COVID.2 doses of the live attenuated measles vaccine is 97% effective at preventing measles infectionHerd immunity prevents wide-spread measles outbreaks. The threshold needed to prevent large scale measles outbreaks is 95%. Only 92.7% of kindergarteners in the US received both MMR shots for the 2023-2024.Symptoms of measles includes cough, conjunctivitis, coryza (rhinorrhea), Koplik spots (white spots in the mouth), and rash spreading from the face down, Serious complications include death (1-3 deaths per 1000 cases), encephalitis (20% mortality), and subacute sclerosing panencephalitis (SSPE) which is almost universally fatal.Sources:“What’s Old is New Again: Measles”. Pediatrics (2025) 155 (6): e2025071332. https://doi.org/10.1542/peds.2025-071332“CDC Confirms Worst Year for Measles since 1992”. AAP News. Sean Stangland. Jul 9 2025.“Vaccines Matter: Measles and Its Complications”. Pediatrics (2025) 156 (1): e2025071622. https://doi.org/10.1542/peds.2025-071622Mina MJ, Metcalf CJE, de Swart RL, Osterhaus ADME, Grenfell BT. Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality. Science. 2015;348(6235):694–699. PubMed doi: 10.1126/science.aaa3662Mina MJ, Kula T, Leng Y, et al. Measles virus infection diminishes preexisting antibodies that offer protection from other pathogens. Science. 2019;366(6465):599–606. PubMed doi: 10.1126/science.aay6485Lin WH, Kouyos RD, Adams RJ, Grenfell BT, Griffin DE. Prolonged persistence of measles virus RNA is characteristic of primary infection dynamics. Proc Natl Acad Sci U S A. 2012;109(37):14989-14994. doi:10.1073/pnas.1211138109AAP Red Book: Measles Medical vs Nonmedical Immunization Exemptions for Child Care and School Attendance: Policy Statement. Pediatrics (2025) 156 (2): e2025072714. https://doi.org/10.1542/peds.2025-072714

Ever wonder what if the cafe au lait macule on your patient might be something more than just a benign birth mark? Learn more about neurofibromatosis 1 and other genetic disorders associated with cafe au lait macules in today’s episode. This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Suma Shankar (pediatric genomic 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 [email protected] Points:Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder with complete penetrance but variable expression.NF1 can be diagnosed clinically if a patient has the following features and meets the specific clinical criteria: cafe au lait macules, neurofibromas, freckling, optic gliomas, iris hamartomas, an osseous lesion, and/or a first degree relative with NF1Sources:Pediatrics, Miller et al (2019) 143 (5): e20190660. https://doi.org/10.1542/peds.2019-0660

Have you ever wondered if your patient pausing to breathe in their sleep is concerning or not? Learn about the signs of central sleep apnea and which medical conditions it is often associated with in pediatric patients in this episode.This episode was written by pediatricians Tammy Yau, Lidia Park, and Jessica Ahn, with content support from Ambika Chidambaram (UCD pediatric pulmonology). 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 [email protected] Key PointsCentral sleep apnea (CSA) occurs when the brain’s central respiratory drive can’t send proper signals to the muscles that are part of breathing.CSA is diagnosed by a polysomnogram if there are apneic episodes that last 20 seconds or longer or if they are associated with oxygen desaturations, arousals, or heart rate changes (specific criteria in footnote).Central apneas are considered normal during certain stages of sleep (onset, during REM, after arousal), in premature infants less than 37 weeks corrected gestational age, and when ascending to altitudes greater than 3500 m above sea level.Common pediatric conditions associated with CSA include congenital central hypoventilation syndrome, achondroplasia, and Arnold-Chiari malformations. Diagnostic Criteria for CSAApneic episodes last 20 seconds or longer ORThe apnea lasts at least the duration of two breaths during baseline breathing and is associated with an arousal or at least a 3% oxygen desaturation ORIf the event occurs in an infant younger than 1 years old, it has to last at least the duration of two breaths during baseline breathing AND be associated with a decrease in heart rate to less than 50 beats per minute for at least 5 seconds OR less than 60 beats per minute for 15 secondsDiagnostic Criteria for Periodic BreathingAt least three episodes of central pauses lasting for at least 3 seconds interspersed by less than 20 seconds of normal breathing. ReferencesGipson K, Lu M, Kinane TB. Sleep-Disordered breathing in children. Pediatrics in Review. 2019;40(1):3-13. doi:10.1542/pir.2018-0142McLaren AT, Bin-Hasan S, Narang I. Diagnosis, management and pathophysiology of central sleep apnea in children. Paediatric Respiratory Reviews. 2018;30:49-57. doi:10.1016/j.prrv.2018.07.005Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Journal of Clinical Sleep Medicine. 2012;08(05):597-619. doi:10.5664/jcsm.2172Javaheri S, Dempsey JA. Central sleep apnea. Comprehensive Physiology. Published online December 10, 2012:141-163. doi:10.1002/cphy.c110057Selim BJ, Somers V, Caples SM. Central sleep apnea, hypoventilation syndrome, and sleep in high altitude. In: Springer eBooks. ; 2017:597-618. doi:10.1007/978-1-4939-6578-6_33Fauroux B, AlSayed M, Ben-Omran T, et al. Management of sleep-disordered breathing in achondroplasia: guiding principles of the European Achondroplasia Forum. Orphanet Journal of Rare Diseases. 2025;20(1). doi:10.1186/s13023-025-03717-0

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 [email protected] Points:When describing a rash, include the basic morphology, size, color, location, distribution and configuration, and any secondary morphologyWhen 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.htmlAllmon 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 [email protected] 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 recommendedIf 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 NOWSSources:Neoreviews (2025) 26 (4): e223–e232. https://doi.org/10.1542/neo.26-4-010Hosp Pediatr (2025) 15 (3): e121–e125. https://doi.org/10.1542/hpeds.2024-008094Hosp Pediatr (2025) 15 (3): e99–e101. https://doi.org/10.1542/hpeds.2025-008332Kaltenbach 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.Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected] 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 PointsCDC 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 homePediatricians 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.2021-052138Maris 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, FAAPHeidi 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.26-4-131Henry Adam; Speech and Language Concerns. Quick References 2022; 10.1542/aap.ppcqr.396455ASHA 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=d0FGHFrMRXI10-12 month Old Communication Milestones https://www.youtube.com/watch?v=zYHpjZC2qCA19-24 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!Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected] 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 vaccineSources:Pediatrics (2016) 138 (3): e20162146. https://doi.org/10.1542/peds.2016-2146Pediatrics (2024) 153 (3): e2023065483. https://doi.org/10.1542/peds.2023-065483Desai 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.0b013e318270362cWakefield 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)11096-0Deer 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.c7001Pichichero 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.2006-3363Uhlmann 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.55.2.84Uptodate “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!Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected] 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 environmentAutism 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 autismSources: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.Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected] 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.  Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected]  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!Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected] 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 infectionIt cannot be wiped off the tongue as compared to milk residueTreat with topical nystatin solutionSources: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!Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected] 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 foldsCandidal diaper rashes involve the skin folds and have satellite lesionsDon’t forget in your differential: perianal strep, hand foot mouth syndrome, psoriasis, eczema, scabies, and Langerhans cell histiocytosisSources: 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!Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected] 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 musclesSymptoms include fever, sore throat, uvular deviation, trismus, voice changes, drooling, unilateral tonsillar swelling with deviation of the uvula to the contralateral sideDiagnosis 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. Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected] 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! Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bsky.social, and connect with us at [email protected] 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.Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bsky.social, and connect with us at [email protected] 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.Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bsky.social, and connect with us at [email protected] 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 PointsObstructive 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. ReferencesKrishna J, Kalra M, McQuillan ME. Sleep disorders in childhood. Pediatrics in Review. 2023;44(4):189-202. doi:10.1542/pir.2022-005521American 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.2020.110276Basha 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.Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bsky.social, and connect with us at [email protected] 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. Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bsky.social, and connect with us at [email protected] 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 dopplerPatients with sickle cell disease should receive annual screening for retinopathy and nephropathy around age 10Patients 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 splenectomySources: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.Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bsky.social, and connect with us at [email protected] 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 eyesSources:-   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! Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bsky.social, and connect with us at [email protected] 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 inmalabsorption or increased calories outincreased 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=AfmBOopMEVV0n6cZIAM4QHQ02RDREPeELIC107ONgdtSRS8bnrfZs4tPPediatrics in Review 2017, https://doi.org/10.1542/9781610021159-86AAP Books: Caring for the Hospitalized Child 2018, https://doi.org/10.1542/9781610021159-86Pediatrics 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 [email protected] 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 perforationSources: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 perforationSources:Pediatrics 2013, https://doi.org/10.1542/peds.2012-3488Stat 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 elbowImaging is not routinely indicated for highly suspicious nursemaid’s but should be considered if you have concern for fractureSources:Pediatrics in Review 2013, https://doi.org/10.1542/pir.34-8-366Pediatrics 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 twoPneumonia can be diagnosed clinically based on exam or with a CXR. Lab work is not always necessaryTreatment 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-315IDSA 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-clavulanateComplications include orbital or intracranial spread of infectionSources: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 KSources/Supplemental Information:AAP Pediatrics 2022, Hand: https://doi.org/10.1542/peds.2021-056036CDC 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 [email protected]. 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 [email protected]. 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 [email protected]. 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 [email protected] 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 acidSources:AAP 2017 https://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 [email protected] 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 infectionSources: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