Miscellaneous | Pediagogy Podcast | Department of Pediatrics | UC Davis Health

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

What does it mean for a child to “fail to thrive”? No, it’s not a performance evaluation. Learn when and how to evaluate an infant for faltering growth in this episode!

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This episode was written by pediatricians Lidia Park and Tammy Yau as well as pediatrics resident Megan Branson, with content support from Kelly Haas, pediatric gastroenterologist. Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• To diagnose with Faltering Growth (aka Failure to thrive): the infant must fall below weight-for-age or weight-for-length percentile or have rate of weight gain decline across 2 major percentiles.
• There are three categories to think about when evaluating the etiology of faltering growth:
• insufficient calories in
• malabsorption or increased calories out
• increased metabolic requirement

Sources:

• AAP. (2022, May 31). https://www.aap.org/en/patient-care/newborn-and-infant- nutrition/growth-faltering-in-newborns-and-infants/?srsltid=AfmBOopMEVV0n6cZIAM4QHQ02RDREPeELIC107ONgdtSRS8bnrfZs4tP
• Pediatrics in Review 2017, https://doi.org/10.1542/9781610021159-86
• AAP Books: Caring for the Hospitalized Child 2018, https://doi.org/10.1542/9781610021159-86
• Pediatrics in Review 2016, https://doi.org/10.1542/pir.2014-0122

Want to quickly become a pro at family centered rounds? Learn the basics as well as the tips and tricks on how to navigate presenting in a patient-first and family-friendly way.

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This episode was written by 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 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

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

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

Have you ever wondered if your patient's snoring is concerning or not? Learn about how we screen for obstructive sleep apnea in pediatric patients in this episode.

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This episode was written by pediatricians Lidia Park, Tammy Yau, and Jessica Ahn with content support from Ambika Chidambaram (UCD pediatric pulmonology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points

• Obstructive sleep apnea (OSA) occurs when there is either complete or partial narrowing of the upper airway during sleep that causes an awakening from sleep and/or results in at least 3% drop in oxygen saturation and lasts 2 breath lengths.
• Symptoms of OSA can include episodes of apnea, gasping, choking, frequent awakenings, sleep enuresis, attention difficulties, behavioral problems, daytime sleepiness.
• On physical exam, watch out for enlarged tonsils and/or adenoids, micrognathia, retrognathia, or hypotonia.
• Untreated OSA is an independent comorbid factor for many conditions such as failure to thrive, obesity, and cardiovascular diseases like insulin resistance, fatty liver disease, and hypertension.
• Disorders associated with OSA include Down syndrome, Duchenne Muscular Dystrophy, Prader Willi, achondroplasia, hypothyroidism, and acromegaly.
• The gold standard for diagnosis of OSA is polysomnography and is based off of AHI scores: 1-5 is mild, 6-10 is moderate, and 11 or greater is severe.
• First line treatment for most children is adenotonsillectomy. If this fails, second line treatment is CPAP or BiPAP.

References

• Krishna J, Kalra M, McQuillan ME. Sleep disorders in childhood. Pediatrics in Review. 2023;44(4):189-202. doi:10.1542/pir.2022-005521
• American Academy of Sleep Medicine. Obstructive Sleep Apnea.; 2008. https://aasm.org/resources/factsheets/sleepapnea.pdf. Accessed October 29, 2024.
• Benedek P, Balakrishnan K, Cunningham MJ, et al. International Pediatric Otolaryngology group (IPOG) consensus on the diagnosis and management of pediatric obstructive sleep apnea (OSA).International Journal of Pediatric Otorhinolaryngology. 2020;138:110276. doi:10.1016/j.ijporl.2020.110276
• Basha S, Bialowas C, Ende K, Szeremeta W. Effectiveness of adenotonsillectomy in the resolution of nocturnal enuresis secondary to obstructive sleep apnea. The Laryngoscope. 2005;115(6):1101-1103. doi:10.1097/01.mlg.0000163762.13870.83