Pediagogy Podcast | Department of Pediatrics | UC Davis Health

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 Lidia Park and Tammy Yau with content support from Heather Siefkes. 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

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 

In this episode, we have some special guests, Daniel Dodson, and one of our medical students, Aneri Patel, talk to us about Kawasaki disease. Special thanks to 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

In this episode, listeners will learn about the intricacies of how the AAP guidelines came to be on maintenance intravenous fluids for pediatric patients. Get ready to learn about the 4-2-1 rule and breakdown some misconceptions about fluids based on adult data!

This episode was written by Tammy Yau and Lidia Park with content support from Alexis Toney, Lena van der List, and Su-Ting Li. Tammy and Lidia take full responsibility for any errors or misinformation.

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

Let’s briefly discuss the new 2023 AAP obesity guidelines in this episode.

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This episode was written by Tammy Yau and Lidia Park, with content support from Sean Munoz. 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

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, and 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 Staphylococcus 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

Join us as we go through this “sweet” episode on diabetic ketoacidosis (DKA) causes, presentation, and management, while learning a fun UC Davis hospital historical fact!

This episode was written by Tammy Yau and Lidia Park with content support from Nicole Glaser, Lena van der List, and Su-Ting Li. Tammy and Lidia take full responsibility for any errors or misinformation.

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 IV fluid system for DKA
• Correct for hyponatremia in hyperglycemia
• Learn about how to manage potassium, bicarbonate, and phosphorus in DKA

Supplemental Information:

• Pediatrics in Review 2019 DKA

Learn how to be a mini-endocrinologist as we talk about how to differentiate Type 1 from Type 2 diabetes and how to create a starter insulin regimen, among other things in today's podcast!

This episode was written by Tammy Yau and Lidia Park with content support from Nicole Glaser, Lena van der List, and Su-Ting Li. Tammy and Lidia take full responsibility for any errors or misinformation.

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 - Type 1 Diabetes 2013
• American Diabetes Association 2018 Position Statement

Got diabetes? Well, which one? With rising childhood obesity rates, we’re getting more of a mix of both! Today we talk about type 2 diabetes and how management can include both medications and lifestyle management.

This episode was written by Tammy Yau and Lidia Park with content support from Nicole Glaser, Lena van der List, and Su-Ting Li. Tammy and Lidia take full responsibility for any errors or misinformation.

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 - Type 2 Diabetes 2013
• AAFP guidelines 2018
• ISPAD guidelines 2018

In this hot topic summer episode, listeners will learn about the management of infectious gastroenteritis.

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This episode was written by Tammy Yau and Lidia Park, with content support from Christopher Kim, Lena van der List, and Su-Ting Li. 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

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

Join us today where we discuss one of the most common causes of microcytic anemia in pediatric patients.

This episode was written by Tammy Yau and Lidia Park, with content support from Anjali Pawar, Lena van der List, and Su-Ting Li. 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
• 2020 JAMA Network – vitamin C and iron deficiency anemia
• 2017 AAP Pediatrics in Review – infant nutrition
• 2014 Neuropsychiatric Disease and Treatment – iron deficiency anemia and cognitive function

In the first installment of this 2-part episode, we break down the causes of unconjugated (indirect) and conjugated (direct) hyperbilirubinemia.

This episode was written by Tammy Yau and Lidia Park, with content support from Daphne Say, Lena van der List, and Su-Ting Li. 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

Learn about management of newborn jaundice in our 2-part series.

This episode was written by Tammy Yau and Lidia Park, with content support from Daphne Say, Lena van der List, and Su-Ting Li. 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
• 2012 Journal of Perinatology – Hyperbilirubinemia in Infants < 35 weeks gestation
• 2014 AAP Pediatrics - Transcutaneous Bilirubin After Phototherapy in Term and Preterm Infants

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

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/

Learn how to classify and manage pneumonia in today’s episode!

This episode was written by Tammy Yau and Lidia Park with content support from Natasha Nakra. 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

Part 2 of our TORCH series discusses CMV, the most common infectious cause of hearing loss in the US.

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This episode was written by Tammy Yau and Lidia Park, with content support from Dean Blumberg. 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.

Learn about how the virus that causes cold sores can also cause serious complications in infants.

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This episode was written by Tammy Yau and Lidia Park, with content support from Ritu Cheema. 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

We are starting our mini-series on TORCH infections with congenital rubella, a rare disease nowadays in the US but prevalent still worldwide.

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This episode was written by Tammy Yau and Lidia Park, with content support from Dean Blumberg. 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

This week on our series on TORCH infections, we are discussing syphilis, an increasingly prevalent disease in the pediatric population.

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This episode was written by Tammy Yau and Lidia Park, with content support from Elizabeth Partridge. 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

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!

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This episode was written by Tammy Yau and Lidia Park, with content support from Ritu Cheema. 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 2017 https://publications.aap.org/pediatrics/article/139/2/e20163860/59988/Diagnosis-Treatment-and-Prevention-of-Congenital?autologincheck=redirected

Despite widespread vaccination, there are still breakthroughs of varicella (commonly known as chicken pox). Let's dive into this episode of our TORCH series.

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This episode was written by Tammy Yau and Lidia Park, with content support from Ritu Cheema. 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

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.

Listen up! Today we talk about the management of well-appearing febrile infants aged 8-60 days old including work-up algorithms and treatment. It's a lot of information so pay close attention and you might even want to pull up the AAP guideline diagrams to follow along!

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This episode was written by Tammy Yau and Lidia Park with content support from Nathan Kuppermann, Lena van der List, and Su-Ting Li. Tammy and Lidia take full responsibility for any errors or misinformation.

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

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 Lidia Park and Tammy Yau with content support from Daniel Dodson. 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 Recommendations for Hepatitis C Testing Among Perinatally Exposed Infants and Children — United States, 2023 | MMWR
• AAP Red Book 2024: Hepatitis C

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 pediagogypod@gmail.com

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), zanamivir (inhaled), and peramivir (IV) prevent the flu virus from fusing with infected cell membranes, preventing the release of the virus.
• Baloxavir is an endonuclease inhibitor that inhibits mRNA synthesis, which 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

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 Tammy Yau and Lidia Park, with content support from Michelle Hamline. 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

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

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 Lidia Park and Tammy Yau with content support from Alexis Toney. 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

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/Threads @pediagogy and connect with us at pediagogypod@gmail.com.

This episode was written by Victoria Tran, Katrina Marks, Tammy Yau, and Lidia Park, with content support from Moonjoo Han. 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.

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 Tammy Yau and Lidia Park with content support from Natasha Nakra. 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

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)!

Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com.

This episode was written by Tammy Yau and Lidia Park, with content support from Natasha Nakra. 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/uti/hcp/clinical-guidance/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/

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 pediagogypod@gmail.com

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

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.

Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com.

This episode was written by Tammy Yau and Lidia Park, with content support from Jessica Witkowski. 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=fulltext2022
• Michigan Medicine: https://www.ncbi.nlm.nih.gov/books/NBK582289/

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 pediagogypod@gmail.com

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

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.

Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com.

This episode was written by Tammy Yau and Lidia Park, with content support from Jessica Witkowski. 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=fulltext2022
• Michigan Medicine: https://www.ncbi.nlm.nih.gov/books/NBK582289/

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 Tammy Yau and Lidia Park with content support from Emily Andrada. 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

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

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!

This episode was written by Tammy Yau and Lidia Park, with content support from Shannon Liang, Lena van der List, and Su-Ting Li. 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
• 2019 AAP Pediatrics - Post Vaccination Febrile Seizure Severity and Outcome
• 2010 AAP Pediatrics - MMRV Combination Vaccine and the Risk of Febrile Seizures

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 Tammy Yau and Lidia Park, with content support from Laura Kair. 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

Today we talk about BRUE – brief, resolved, unexplained, events – and try to breakdown what it is and what we do for low-risk versus high-risk cases.

This episode was written by Tammy Yau and Lidia Park with content support from Eunice Kim, Lena van der List, and Su-Ting Li. Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• Brief, resolved, unexplained events in patients <1 year of age with color change, tone change, abnormal breathing, or altered level of consciousness.
• BRUE can be classified as low versus high risk based on age of patient, frequency of events, and exam or history findings
• Only brief observation is needed in low risk BRUE.
• High risk BRUE requires more extensive workup.

Supplemental Information:

• AAP 2016 guidelines for low-risk infants
• AAP 2019 guidelines for high-risk infants

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

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 Tammy Yau and Lidia Park, with content support from Laura Kair. 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-special-circumstances/hcp/illnesses-conditions/hiv.html

This episode was written by Tammy Yau and Lidia Park, with content support from Lisa Rasmussen. 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, Handout: https://doi.org/10.1542/peds.2021-056036
CDC Vitamin K Handout: https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/diet-and-micronutrients/vitamin-k.html

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 pediagogypod@gmail.com

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

Learn about asthma management in the outpatient and acute setting including 2020 NIH guideline changes.

This episode was written by Tammy Yau and Lidia Park with content support from Rory Kamerman-Kretzmer, Lena van der List, and Su-Ting Li. Tammy and Lidia take full responsibility for any errors or misinformation.

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 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
• Peds in review 2019- Asthma
• Asthma control test
• GINA 2020 Pocket Guide
• NIH Asthma Guidelines 2007
• JAMA 2021 asthma guideline update summary

Listen to this episode’s topic on bronchiolitis and how we manage it in the hospital!

This episode was written by Tammy Yau and Lidia Park with content support from Rory Kamerman-Kretzmer, Lena van der List, and Su-Ting Li. Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• Bronchiolitis is seen in kids under the age of 2 and most commonly 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
• Day of Illness and Outcomes in Bronchiolitis Hospitalizations