Children's Hospital Colorado

Charting Pediatrics: Our Pediatric Podcast

Blue background with white letters that say "Charting Pediatrics Presented by Children's Hospital Colorado".

Charting Pediatrics from Children's Hospital Colorado is a weekly pediatric podcast for providers. In this series, we examine the latest treatments for the most common complaints in pediatric medicine.

Let us know if you have an idea for a future episode of Charting Pediatrics.

Hosts:
David Brumbaugh, MD, pediatric gastroenterologist and Associate Chief Medical Officer
Alison Brent, MD, Medical Director, Children’s Hospital Colorado Network of Care
Dan Nicklas, MD, pediatrician

Listen and subscribe on iTunes and Google Play.

Show notes: Read highlights from each podcast

Joining us today are Terry Fry, MD and Mike Verneris, MD to explore cellular therapy for the treatment of pediatric cancers.

Dr. Fry is the Robert and Kathleen Clark Endowed Chair in Pediatric Cancer Therapeutics and Dr. Verneris is the Barton Family Endowed Chair of Bone Marrow Transplant at Children's Colorado.

Key takeaways from this episode

  • A new immunotherapy known as cellular therapy, or specifically the chimeric antigen receptor T cell therapy (CAR-T cell), is bringing hope to pediatric patients with blood cancers.
  • Two breakthrough events in the field of immunotherapy made CART-T cell therapy possible:
    • Checkpoint inhibitors: a concept where agents can "take the brakes" off the immune, unleashing a sort of preexisting immune response against the tumor
    • Adult epithelia cancers
  • For cancers like pediatric tumors, mutations aren't present or aren't present at high enough levels for checkpoint inhibitors to work.
  • CAR-T cell therapy is different from checkpoint inhibitors in that the immune system, the T cells, are taken and essentially educated in a different way. The T cells are redirected so they can see the tumors that they weren’t naturally developed to see.
  • The FDA labor indication is refractory leukemia at the time of diagnosis, relapse or second relapse.
  • There is a 70 to 90% complete remission induction rate in phase one CAR-T therapy clinical trials in patients who had estimated durations of survival of only weeks to months.
  • The CAR-T cell approach may be considered an alternative to chemotherapy.
  • Side effects of CAR-T cell therapy include:
    • Patients become neutropenic, have low counts and are at risk for bacterial infection (because chemotherapy is given before cells are infused)
    • Cytokine release syndrome
    • Transient neurotoxicity, ranging from subtle neurologic changes to severe side effects like seizures or even coma
  • Because of leukemic resistance, half of patients that go into remission will relapse by year, in spite of a successful CAR-T cell treatment upfront.
  • The pros and cons of a bone marrow transplant (BMT) versus CAR-T cell therapy are:
    • BMT patients get mild oblation, likely face sterility, late complications, secondary malignancies and more. With CAR-T cells, patients get a single infusion and risk about a month of significant toxicity, but side effects are mitigated after that. The only long-term side effect is potentially a lack of b-cells.

In this episode, we discuss the management of and treatments for nocturnal enuresis, nighttime bedwetting. Joining us is pediatric urology nurse practitioner, Marguerite Korber, NP, who runs many of the enuresis clinics at Children's Colorado.

Key takeaways from this episode

  • At age 5, the primary care physician should make a formal diagnosis of nighttime wetting and give the family a proactive, therapeutic treatment plan.
  • It's recommended that families come to a urology specialist or enuresis clinic around age 7
  • The reasons for bedwetting may differ according to whether patient has primary or secondary nocturnal enuresis.
  • Before making a referral to urology, primary care physicians can perform an initial workup, evaluating:
    • If the child is ready to become potty-trained and, therefore, dry at night
    • Functional bladder capacity to see if nocturnal enuresis has anything to do with diabetes or UTI concerns
    • If their bladder is releasing earlier than it should and/or doesn't have the appropriate, expected capacity
  • Despite the parents' frustration, until the child is affected by their nighttime bedwetting, initiating them to be responsible for some of their behavioral modifications during the day will be difficult.
  • The important aspects to focus on in a physical exam are the abdominal exam, lumbar spine evaluation, neurologic evaluation and urethral opening evaluation.
  • Constipation plays a large role in nocturnal enuresis.
    • The abdominal exam will tell you whether or not constipation is a contributing factor, specifically in that descending colon. "If you can palpate stool, then you know that it's probably sitting in the rectum as well."
  • The urethral opening tends to be more of an issue for boys specifically.
  • Bedwetting enuresis management options include behavioral therapy, fluid shifting and addressing constipation.
  • How to effectively implement the use of alarm therapy as a bedtime wetting management option – and what parents need to know up front.
  • What criteria allows for using Desmopressin, a DDAVP, as the right option when pursuing pharmacologic therapy
  • Options for managing chronic nocturnal enuresis:
    • By changing any dysfunctional voiding components to their day time habits, patients will be better prepared for the natural progression of the night time to occur.
  • Providers need to provide alternative treatments for patients when cost is a barrier to care, such as with a bed alarm.
    • Pull-ups can be a cost effective solution to involuntary nighttime bed wetting.
  • Oftentimes with nocturnal enuresis, it's necessary to treat the whole family, helping parents to manage their frustration.

On today's episode, we're discussing the diagnosis and management of neck masses in children. Joining us is Melissa Scholes, MD, Director of the Pediatric Balance and Vestibular Disorders Clinic at Children's Colorado.

Key takeaways from this episode

  • Common presentations of neck masses in children
  • The questions pediatricians should be asking when they encounter a neck mass
  • The various locations and types of neck masses that can be found
  • How to evaluate and address the consistency of a neck mass
  • What information in the child's history is particularly important to look at
  • The increase in head and neck malignancies in children today
  • Possible lab tests and imaging for neck masses in children
  • When pediatricians should send children to an ENT clinic
  • Antibiotics and treatments to consider for infectious neck masses
  • Infectious lymph nodes and the possibilities of them going viral

Joining us is Ricky Mohon, MD to discuss the most common sleep disorders and sleep issues affecting pediatric and adolescent patients.

Dr. Mohon is Medical Director of Sleep Medicine and Program Director of Pediatric Pulmonology here at Children's Colorado, as well as a professor of pediatrics at CU Medicine.

Key takeaways from this episode

  • The prevalence of sleep disorders in children and how these issues have evolved
  • Answering "How much sleep should my child be getting?"
  • How to counsel family members on their teenager's sleep needs
  • The disruptive impact electronic devices have on children's sleep patterns
  • The most common sleep disorders Dr. Mohon sees in infants, children and adolescents
  • Whose responsibility is it to change the diaper in the middle of the night?
  • Behavioral changes that parents can make to limit continuous night calls
  • The full extinction technique: How and why parents should let baby learn to self-soothe
  • Managing sleep-related breathing disorders and snoring in children
  • The process of conducting pediatric sleep studies and what sleep specialists monitor
  • The effects of sleep apnea and insomnia on a child’s health and school life

Tweetables: Share key takeaways on twitter

"Teenagers are mostly chronically sleep deprived." – Ricky Mohon, MD [0:05:25.0] #ChartingPediatrics #SleepDeprivation #teenagers

"One of the bad habits that parents get into holding their baby until they fall asleep." – Ricky Mohon, MD [0:06:35.0] #ChartingPediatrics #parenting #SleepTips

Today, we're discussing celiac disease with guest Edwin Liu, MD. Dr. Liu is an international leader in the research and management of celiac disease, the Director of the Colorado Center for Celiac Disease at Children's Colorado and a professor of pediatrics at the CU School of Medicine.

Key takeaways from this episode:

  • How the prevalence of celiac disease has changed over time and what that means
  • The hygiene hypothesis and its role in infectious diseases
  • The ways that the clinical representations of children with celiac disease have changed
  • Untraditional symptoms and signs of celiac disease in children
  • The relationship between type 1 diabetes and celiac disease
  • An outline and definition of the non-genetic, environmental triggers of celiac disease
  • The tests to order if you suspect a child may have celiac disease
  • The populations that should be screened for celiac disease because of their risk factors
  • What distinguishes celiac disease from gluten sensitivity
  • The importance of and how to go about educating families on diet after their child is diagnosed with celiac disease
  • The answer of whether or not there's a chance that children can grow out of having celiac disease
  • Exploring the misconception of celiac disease as an "under dog" condition

Tweetables: Share key takeaways on twitter

"A gluten-free diet is not inherently healthy. It's only healthy if you make it that way." — Edwin Liu, MD [0:16:00.0] #celiacdisease #chartingpediatrics

"There is no cure for celiac disease; the treatment needs to be strict and lifelong." — Edwin Liu, MD [0:17:35.0] #celiacdisease #chartingpediatrics

In this episode, Stephanie Mayer, MD, joins us to share her insights on diagnosing hip pain in pediatric patients. We're discussing this issue from its symptoms and causes to how to manage hip pain.

Dr. Mayer is a pediatric orthopedic surgeon at Children's Colorado and an assistant professor of orthopedics at the CU School of Medicine.

Key takeaways from this episode:

  • The common hip pain causes to watch for in adolescents
  • Sports that lend themselves to hip pain
  • Practices for starting an evaluation of the patient and their injury
  • The importance of the patient history when dealing with and considering hip pain
  • The questions to ask, signs to look for and specifics to consider when diagnosing hip pain and differentiating between infection and oncologic hip injuries
  • Signs and factors possibly indicating a patient's hip pain is systemic or rheumatological and when it's time to look for Lyme disease
  • How to determine where hip pain originates from and the conditions to consider
  • The mechanical indicator that the cause of hip pain is slipped capital femoral epiphysis (SCFE)
  • Diagnosing and addressing other causes of hip pain such as Legg-Calvé-Perthes
  • Discussing urgency and when it's time to refer to an orthopedic specialist
  • When and why it's appropriate to order an MRI early on
  • The central role imaging plays in determining a proper hip pain treatment and when it's the right time to order an x-ray for hip pain
  • The benefits of getting images of the entire hip versus radiation exposure

Tweetables: Share key takeaways on twitter

"The most common causes of hip pain usually have to do with overuse." — Stephanie Mayer, MD [0:02:36.0] #chartingpediatrics #hippain #sportsmedicine

In today's episode we discuss autism spectrum disorder with Elizabeth Coan, PsyD. Dr. Coan is a doctor of psychology at the Neuroscience Institute at Children's Colorado and is an instructor of developmental pediatrics at the CU School of Medicine.

Key takeaways from this episode:

  • How a PCP can take the first steps towards diagnosing autism
  • How you can implement autism screening tools in your practice
  • How to sensitively discuss autism spectrum disorder with parents and families
  • Tips for managing screenings and referrals after diagnosing autism
  • The reason why there are things to celebrate once you've made an autism diagnosis
  • Tips PCPs can share with families to help develop the strengths of a child with autism
  • Counseling families on how they use the internet when researching autism

Tweetables: Share key takeaways on twitter

"There are a lot of things to celebrate about an autism diagnosis." — Elizabeth Coan, PhD [0:09:10.0] #chartingpediatrics #autism #ASD

"A lot of the social information that exists in the environment is not as accessible to those with autism." — Elizabeth Coan, PhD [0:15:00.0] #chartingpediatrics #autism #ASD

In this episode, we explore the stigmatized topic of physician burnout with Jenny Reese, MD, Director of the Resilience Program at CU Anschutz and Inpatient Medicine at Children's Colorado and Sonja O'Leary, MD, Medical Director of Denver Health's School-Based Health Centers Team.

Drs. Reese and O'Leary share their personal experiences with burnout and offer valuable insights on what physician burnout is, its effects and how hospitals can reduce burnout by implementing preventative measures.

Key takeaways from this episode:

  • Defining burnout and the golden measurement of burnout
  • The three main domains of burnout
  • The prevalence of burnout according to the numbers
  • The trends surrounding burnout over time
  • The effects and realities behind compassion fatigue and the second victim phenomenon amongst physicians
  • Outlining if and how burnout differs according to a physician's gender and parental role
  • Why it's important to implement reflective supervision in the workplace
  • Actions to prevent, normalize and reduce the stigma of burnout in medicine

Tweetables: Share key takeaways on twitter

"The #EHR is probably the single biggest driver of burnout." — Jenny Reese, MD [0:08:03.0] #physicianburnout #chartingpediatrics

"The rate of suicides among female physicians is 2.5 times greater than the general population." — Jenny Reese, MD [0:13:02.0] #physicianburnout #chartingpediatrics

"Sometimes, if you just ask the question, you won't believe what you'll get." — Sonja O'Leary, MD [0:20:28.0] #physicianburnout #chartingpediatrics

Our guest for this episode is Jessica Malmberg, PhD, the Clinical Director of Outpatient Services at the Pediatric Mental Health Institute and assistant professor of child psychiatry at CU School of Medicine.

Dr. Malmberg talks us through a common behavioral issues of school-aged children – school refusal – and provides insights, advice and tools to help prevent, manage and understand this behavior.

Key takeaways from this episode:

  • Outlining and identifying the underlying symptoms and signs associated with a child refusing to attend school
  • How primary care providers (PCPs) can assist parents who are experiencing guilt
  • Identifying the four most common reasons that children refuse to go to school
  • Exploring the effects of social media on children's behavior when it comes to school refusal
  • How a PCP should approach treatment of school refusal
  • The recommended frequency of follow-up care for kids who are refusing to go to school
  • The importance of connecting parents to community-based resources
  • Preventative practices parents can set up in the home to prevent this behavioral issue
  • What an excellent prognosis looks like for children experiencing school refusal
  • When it's time to refer to a mental health professional
  • PCPs in the Denver Metro Area can refer patients to the Children's Hospital Colorado Outpatient Psychiatry Clinic or to a local community mental health center

Resources for dealing with school refusal:

Tweetables: Share key takeaways on twitter

"25% of school-age children will refuse school at some point." — Jessica Malmberg, PhD [0:03:25.0] #chartingpediatrics #schoolrefusal #childanxiety

"The number one thing that families can do is set up a clear, consistent schedule and expectations." — Jessica Malmberg, PhD [0:23:20.0] #chartingpediatrics #schoolrefusal

Today we're discussing the serious topic of teen suicide with Jenna Glover, PhD, MS, BS, of the Pediatric Mental Health Institute at Children's Colorado. Dr. Glover is the Director of Clinical Psychology Training at Children's Colorado and an assistant professor of child psychiatry at the University of Colorado School of Medicine.

Mental health and suicide prevention resources from the episode:

Tweetables: Share key takeaways on twitter

"Teen suicide is the second leading cause of death in children 10 to 24 years of age." — Jenna Glover, PhD [0:02:45.0] #suicide #chartingpediatrics

"Talking about suicide directly actually lowers the risk." — Jenna Glover, PhD [0:09:20.0] #suicide #chartingpediatrics

In this episode we're discussing bronchiolitis with Monica Federico, MD, Medical Director of both the Asthma Program and Clinical Alignment at Children's Colorado. Dr. Federico is also an associate professor of pediatrics and pulmonary medicine at the University of Colorado School of Medicine.

Key takeaways from this episode

  • How to diagnose the classic presentations of bronchiolitis
  • How providers can identify the significant signs of respiratory distress
  • How to utilize the Bronchiolitis Clinical Pathway (.pdf) from Children's Colorado
  • When to use bronchodilators and steroids for treatment
  • Identifying children who are most likely to develop bronchiolitis

Tweetables: Share key takeaways on twitter

"Initially it is going to look like a cold to the families." — Monica Federico, MD [0:02:15.0] #bronchiolitis #chartingpediatrics

"Other than hydration and oxygen or suctioning when needed, we haven't seen any new miracle cures." — Monica Frederico, MD [0:23:10.0] #bronchiolitis #chartingpediatrics

Today on the podcast, we're discussing adolescent bariatric surgery with Thomas Inge, MD. Dr. Inge is the division head of Pediatric Surgery and the Director of the Bariatric Surgery Center at Children's Colorado, as well as a professor at the University of Colorado School of Medicine.

Key takeaways from this episode

  • Where bariatric surgery fits within available options for the morbidly obese adolescent patient
  • Common medical indicators that a patient could be a successful candidate for bariatric surgery, as they indicate general readiness and suitability to a primary care provider
  • Key contraindications for bariatric surgery
  • The impact of patient age and how to assess maturity, both skeletal and psychological
  • The types of bariatric operations that are suitable for adolescents
  • What the Multicenter Teen-LABS study, led by Dr. Inge, means for adolescents

Tweetables: Share key takeaways on twitter

"We realized that teenagers who were developing weight problems had no successful form of treatment." — Tom Inge, MD [0:01:15.0] #bariatricsurgery #chartingpediatrics

"For this surgery to be successful, it has to have a real assent by the teenager." — Tom Inge, MD [0:10:10.0] #bariatricsurgery #chartingpediatrics

Today on the podcast, Dave Scudamore, MD joins us to talk about neonatal jaundice. Dr. Scudamore is the Director of Inpatient Medicine for the Network of Care at Children's Colorado, and he is also an assistant professor of pediatrics in hospital medicine at the University of Colorado School of Medicine.

Key takeaways from this episode

  • The major risk factors for severe jaundice that can cause complications with neonates
  • How to assess mom and baby for the risk factors of neonatal jaundice by reviewing patient history and birth data
  • Difference between the risk factors for elevated bilirubin and the risk factors for neurotoxicity
  • The significance of the ratio between albumin and bilirubin
  • Standard protocols for bilirubin workups and monitoring for risk factors
  • How you can provide elevated patient care by using a patient-centered care approach and considering the context of the case
  • The way to utilize the Bhutani curve to assess risk and the AAP guidelines to initiate phototherapy
  • Understanding the importance of follow ups and their role in intervention

Tweetables: Share key takeaways on twitter

"Not all of the risk factors for elevated bilirubin are necessarily risk factors for neurotoxicity." — Dave Scudamore, MD [0:04:24.0] #neonataljaundice #chartingpediatrics

In this episode, Jeremy Prager, MD, talks us through a common issue in pediatric patients — noisy breathing. He outlines the underlying causes and presentations of, as well as available treatment options for noisy breathing. Dr. Prager is a pediatric otolaryngologist, Director of the Aerodigestive Program at Children's Colorado and associate professor of otolaryngology at the University of Colorado School of Medicine.

Key takeaways from this episode

  • How an ENT defines noisy breathing
  • Categorizing noisy breathing into age groups
  • The presentations of noisy breathing the infants and toddlers age group
  • The presentations of noisy breathing the school-age children age group
  • Audible examples of a stridor sound versus a stertor sound
  • Questions providers should ask when seeking the cause of noisy breathing
  • The relationship between pediatric obesity and sleep apnea
  • Diagnostic exams and tests that providers can run before a consultation
  • Treatment options available to a child with noisy breathing
  • The effectiveness of natural remedies and oxygen therapies

Today Robert Fuhlbrigge, MD joins us to discuss the 10 most common pediatric rheumatology diagnoses. Dr. Fuhlbrigge is the Chair of Rheumatology at Children's Colorado and professor of pediatrics and rheumatology at the University of Colorado School of Medicine.

Key takeaways from this episode

  • What swollen joints can indicate when assessing potential diagnoses in the realm of rheumatology
  • The most common identifier in determining a systemic problem
  • The role of morning stiffness in the differential diagnosis
  • The difference between mechanical pain and inflammatory disorders
  • Defining how helpful an elevated ANA is in treating a patient with Lupus
  • Outlining the best tests for inflammation: CSR, CSR and ANA
  • Why rheumatologists find unexpected fevers in children interesting
  • Unexplained weakness and what it means
  • Which rashes may indicate that it's necessary to refer to rheumatology
  • The role fatigue plays in the rheumatology world
  • Usefulness of radiology studies, MRI, CT and other imaging modalities
  • Helpful apps clinicians use for rheumatological diseases today
  • The role of genetics and development in rheumatological diseases

On today's episode, we're diving into the topic of international adoption and international adoption medicine best practices. We explore how primary care providers can support families who are expanding their families through international adoption.

Joining us is Gretchen Domek, MD, Director of the International Adoption Clinic and Senior Investigator for the Center of Global Health at Children's Colorado. Dr. Domek is also the assistant professor of pediatrics at the University of Colorado School of Medicine.

Key takeaways from this episode

  • Why pre-adoption reviews are critical for families
  • The importance of a post-adoption evaluation
  • Expectations and guidelines for conducting a follow-up consultation
  • Common health issues to look for in internationally adopted children
  • Behavioral problems that are common in internationally adopted children
  • Methods for adapting to culturally different feeding techniques
  • Common questions adoptive families may ask and how to respond
  • How a careful assessment can help you determine a child's age

Tweetables: Share key takeaways on twitter

"International adoption creates very unique challenges for children – their health, their growth and behavior." — Gretchen Domek, MD [0:01:20.0] #internationaladoption #chartingpediatrics

On today's episode, we welcome back Matthew Greenhawt, MD to discuss non-IgE related food allergies, including Food Protein-Induced Enterocolitis Syndrome (FPIES). Dr. Greenhawt is an associate professor of pediatrics and allergy at the University of Colorado School of Medicine.

Key takeaways from this episode

  • How non-IgE mediated food allergies most commonly presents in children
  • The fact that non-IgE food allergy symptoms appear more slowly
  • Identifying the various presentations and triggers of dietary protein-induced enterocolitis
  • The benefits of using extensively hydrolyzed infant formulas or amino acid-based infant formulas
  • Treating atopic dermatitis with a topical steroid versus allergy screening
  • Creating awareness of eosinophilic esophagitis in the primary care discipline
  • The importance of identifying family history patterns to diagnose allergies
  • How the presentation of FPIES differs between environments globally

Tweetables: Share key takeaways on twitter

"Most eczema is a skin disease and not a food allergy. We need to treat the skin disease first, rather than do widespread elimination diets and testing." — Matthew Greenhawt, MD [0:09:02.0] #foodallergy #chartingpediatrics

With us today is Matthew Greenhawt, MD, associate professor of pediatrics and allergy at the University of Colorado School of Medicine. Dr. Greenhawt discusses hot topics surrounding food-related allergies, including the early introduction of peanuts.

Key takeaways from this episode

  • What initial steps to take before referring patients to an allergist
  • The importance of getting a complete patient history to diagnose food allergies
  • Tools primary care providers can utilize in the diagnostic process
  • Why the presence of IGE may not be an effective marker for a food allergy
  • Understanding the cross-reactivity between different allergies
  • How to implement a food allergy action plan
  • Methods and recommendations for early introduction of the peanut
  • Where providers can find resources for on-going food allergy education
  • Recommendations on prescribing epinephrine

Links from today's episode

In this episode we discuss attention-deficit/hyperactive disorder (ADHD) medication management with Marissa Schiel, MD. Dr. Schiel is the Medical Director of the Outpatient Psychiatry Program at Children's Colorado and an assistant professor of child psychiatry at the University of Colorado School of Medicine. Also joining us is Danielle Stutzman, R.Ph., a clinical pharmacist at Children's Colorado with a special interest in psychiatry medication.

Key takeaways from this episode

  • The importance of getting a detailed history when assessing a child for ADHD
  • Understanding the spectrum of ADHD symptoms and how they affect a child's function
  • How to approach the medication management conversation when it comes to ADHD
  • The most common side effects that are associated with stimulants or psychotropic medication
  • Management strategies for dealing with potential medication side effects
  • The importance of screening a child for cardiac concerns before prescribing stimulant medications
  • Understanding the functional benefits of the two different classes of stimulants
  • The ideal target doses for specific ADHD medications
  • A recommended follow-up regime and titration strategy for patients
  • How to counsel families on medication management as the child ages
  • Medication recommendations to consider when trialing the non-stimulant class
  • Techniques to use in therapeutic relationships with ADHD patients

Tweetables: Share key takeaways on twitter

"For a diagnosis of ADHD, symptoms really must be happening across multiple vocations." — Marissa Schiel, MD #ADHD #chartingpediatrics [0:02:54.0]

"Stimulants are considered first-line treatment for the management of ADHD." — Danielle Stutzman, R.Ph. #ADHD #chartingpediatrics [0:06:44.0]

Our guest for this episode is Marcy Yonker, MD. We discuss headache and migraine management in primary care, including their prevalence, triggers and treatment options. Dr. Yonker is the Director of the Headache Program at Children's Colorado and visiting professor of pediatrics at the University of Colorado School of Medicine.

Key takeaways from this episode

  • The prevalence of headaches and migraines in children
  • Creating a differential headache diagnosis
  • When imaging should be used
  • Common medications prescribed for migraine headaches
  • Newer treatments for headaches and migraine
  • Natural remedies for headaches and migraines
  • Triggers for migraines in children and teenagers
  • The influence of family history on migraine prevalence
  • The role of psycho-psychology in migraine diagnosis
  • Other uncommon migraines
  • Using Botox as treatment for migraines

Tweetables: Share key takeaways on twitter

"From my perspective, there's been an explosion of children who present with headaches, especially migraines." — Marcy Yonker, MD [0:01:40.0] #chartingpediatrics

In this episode Taizo Nakano, MD, discusses the most common vascular anomalies in the primary care setting. Dr. Nakano is the Medical Director of the Vascular Anomalies Center at Children's Colorado and assistant professor of pediatrics, hematology and oncology and bone marrow transplant at the University of Colorado's School of Medicine.

Key takeaways from this episode

  • Common presentation of a vascular anomaly
  • The two major categories of a vascular anomaly
  • Defining the genetics lesions
  • Lab testing for vascular anomalies
  • Vascular emergencies and the features of a lesion that can be detrimental
  • Top 10 things to be concerned about with a vascular anomaly

Tweetables: Share key takeaways on twitter

"Lesions in the airway and ENT distribution are [vascular anomaly] red flags." — Taizo Nakano, MD [0:14:35.0] #chartingpediatrics #vascularanomalies

In this episode, Sean O'Leary, MD discusses vaccine safety and hesitancy from parents. He also suggests motivational interviewing techniques to use when talking with your patients and families. Dr. O'Leary is a pediatric infectious disease specialist at Children's Colorado and associate professor pediatrics and infectious diseases at the University of Colorado School of Medicine.

Key takeaways from this episode

  • How to help families identify the good information from misinformation regarding vaccines
  • The prevalence of vaccine resistance
  • Effectively and efficiently delivering vaccines information to parents
  • Using motivational interviewing techniques when talking with parents about vaccines
  • How to pivot the conversation when a parent is resistant to a care plan
  • Why asking permission is a key component to motivational interviewing
  • Understanding the differences between a recommended and alternate vaccine schedule
  • Techniques for communicating relative risks about vaccines
  • Working with parents who are vaccine resistant
  • Vaccines that receive the most resistance and hesitancy

Tweetables: Share key takeaways on twitter

"Less than 1% of parents are actually anti-vaccine." — Sean O'Leary, MD [0:02:22.0] #vaccines #chartingpediatrics

"Asking permission to share information with someone makes them more receptive to what you are going to say." — Sean O'Leary, MD [0:11:34.0] #vaccines #chartingpediatrics

In this episode Sumeet Garg, MD, discusses back pain management, including identifying characteristics and the relationship between scoliosis and back pain. Dr. Garg is a pediatric orthopedic surgeon at Children’s Colorado and associate professor of orthopedics at the University of Colorado School of Medicine.

Key takeaways from this episode

  • The incidence of back pain in kids, especially adolescence
  • Identifying what to look for on physical examination
  • When to obtain imagining
  • The challenge with MRI in younger kids
  • Suggestions for talking with patients and families about back pain
  • Tight hamstrings and weak core abdominal muscles as an underlying driver of back pain
  • What type of patients should see an orthopedic surgeon for back pain
  • The relationship between scoliosis and back pain in pediatric and adolescent patients
  • Bad posture as a habit and not a deformity
  • Scoliosis and what families can expect over time

Tweetables: Share key takeaways on twitter

"The best treatment [for back pain] is the one that your child is willing to do." — Sumeet Garg, MD [0:09:51.0] #chartingpediatrics #backpain

In this episode, Maya Bunik, MD, discusses common challenges and myths surrounding breastfeeding management and how to support new moms in your practice. Dr. Bunik is an executive committee member of the American Academy of Pediatrics (AAP) section on breastfeeding, Medical Director of the Child Health Clinic at Children's Colorado and a professor of pediatrics at the University of Colorado School of Medicine. Dr. Bunik is also the author of the AAP's breastfeeding telephone protocols and advice.

Key takeaways from this episode

  • Why breast is best
  • Approaches to working with a new mom who is struggling with breastfeeding
  • Identifying reasons why a mom is struggling with breastfeeding
  • Impacts of sleep deprivation on new moms and their milk supply
  • How to know whether a baby is getting enough milk
  • The importance of babies' weight checks
  • Ways to boost milk supply through milk removal
  • Power pumping
  • Indication of needing a lactation professional
  • When a mom should start pumping after delivery
  • Why breastfed babies need Vitamin D
  • Common myths associated with breastfeeding
  • Impact of cleft lip and palate with breastfeeding

Tweetables: Share key takeaways on twitter

"High cortisol levels and stress can have an effect on milk supply." — Maya Bunik, MD [0:05:48.0] #chartingpediatrics

In this episode, Amy Brooks-Kayal, MD, discusses acute seizure management. The conversation includes the importance of gathering a detailed history of a seizure event, identifying provocations of a seizure and options for anti-seizure and rescue medications.

Dr. Brooks-Kayal is the Chief of the Pediatric Neurology, Co-Director of the Translational Epilepsy Research Program and past president of the American Epilepsy Society.

Key takeaways from this episode

  • Responding to a patient's first seizure
  • Importance of a detailed history of a seizure event
  • Identifying provocations of a seizure
  • Neurological examination
  • Focal onset versus a generalized seizure
  • Chances of seizure reoccurrence
  • Anti-seizure and rescue medications
  • Managing the anxiety of families
  • Basic seizure safety
  • Current research into pediatric epilepsy

Tweetables: Share key takeaways on twitter

"The beginning moments [of a #seizure] are often most telling the cause." — Amy Brooks-Kayal, MD [0:03:01.0] #chartingpediatrics

"Study after study has shown us that treating with anti-seizure medications will not change the course of #epilepsy." — Amy Brooks-Kayal, MD [0:07:55.0] #chartingpediatrics

In this episode, Duncan Wilcox, MD, talks about acute scrotum management. The conversation includes the most common indications of acute scrotum and how to differentiate an incarcerated hernia and a hydroceles scrotal trauma.

Dr. Wilcox is the Chair of Pediatric Urology and interim Surgeon-in-Chief at Children's Colorado. He is also a professor of surgery at the University of Colorado School of Medicine.

Key takeaways from this episode

  • The most common indications of acute scrotum
  • The role trauma plays in acute scrotum
  • How to treat testicular torsion and urgent treatment
  • Differentiating an incarcerated hernia and a hydroceles scrotal trauma
  • Why an incarcerated hernia needs to be treated rapidly
  • The three groups of acute scrotum patients
  • Long-term outcome for patients living with one testicle

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"Torsion of the testes and the incarcerated hernia are something we need to pick up and treat very rapidly." — Duncan Wilcox, MD [0:13:10.0] #chartingpediatrics

In this episode, Robert Kramer, MD, talks about the dangers of kids and adolescents swallowing common household toys and a recent case involving ingested fidget spinner parts. Dr. Kramer is a pediatric gastroenterologist at Children's Colorado.

Key takeaways from this episode

  • Recent cases of patients ingesting fidget spinner parts
  • Dangers of ingesting button batteries and other small components
  • Why magnets represent a special threat for kids
  • Age groups impacted by incidental ingestion of objects
  • Batteries ingested into the gastrointestinal tract and how to manage them
  • Types of injuries that can occur beyond damage to the blood vessels
  • The importance of getting the battery out as soon as possible after ingestion

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"We worry most about children who are under 5 years of age who swallowed larger batteries." — Robert Kramer, MD [0:17:42.0] #chartingpediatrics

In this episode, Eliza Buyers, MD, talks about reproductive health in teenagers. Dr. Buyers is a pediatric and adolescent gynecologist at Children's Colorado and a senior instructor of obstetrics and gynecology at the University of Colorado School of Medicine.

Key takeaways from this episode

  • How to talk to teens and their parents about reproductive health
  • Implementing a universal screening approach in your practice
  • Dealing with push back from parents
  • Setting up one-on-one time with adolescent patients
  • Misconceptions about teens and their reproductive health
  • Long-acting reversible contraceptive (LARC) methods
  • Non-contraceptive benefits of LARC
  • Importance of hormonal therapy
  • Reversing long-term hormonal care and contraception
  • Talking to teens about screening for sexually transmitted diseases
  • When to send a patient to a specialist

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"Teens today make better informed decisions than ever before." — Eliza Buyers, MD [0:11:09.0] #chartingpediatrics

In this episode, Johannes von Alvensleben, MD, pediatric cardiologist and electrophysiologist at Children's Hospital Colorado and assistant professor of pediatrics at the University of Colorado School of Medicine, talks about heart arrhythmias. He discusses some of the most common heart arrhythmias in the primary care setting, including identifiable characteristics and treatments.

Key takeaways from this episode

  • Palpitations and syncope (commonly known as fainting) as symptoms for heart arrhythmia
  • Characteristics of common heart arrhythmias
  • Supraventricular tachycardia (SVT) in an infant versus a young child
  • Differences in children with syncope
  • Inherited heart arrhythmia syndromes
  • Importance of obtaining an electrocardiogram (ECG)
  • Co-morbidities in children that can impact diagnosis with arrhythmias
  • Drug-related arrhythmias in older children
  • Treatment options for heart arrhythmias in young children
  • The success rate of ablation for arrhythmia

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"If palpitations last for more than a hour, the patient needs to be seen." — Johannes von Alvensleben, MD [0:17:45.0] #chartingpediatrics

The host of this podcast is Dr. David Brumbaugh, pediatric gastroenterologist and Associate Chief Medical Officer at Children's Colorado. In this episode, Joel Friedlander, MD, pediatric gastroenterologist at Children's Colorado, addresses the management of constipation and the effects of leaving it untreated, especially in young children.

Key takeaways from this episode

Dr. Friedlander discusses:

  • Addressing constipation and uncomfortable stools early
  • Potential long-term complications associated with constipation
  • Two key components to focus on in the physical examination
  • Miralax, a common used laxative for the treatment of constipation
  • The use of lactulose for young children
  • Categorizing medications for constipation
  • Different medications with different adverse effects
  • Steps to behavioral modification
  • Constipation split between organic and functional
  • Why medication to treat constipation won't work without a change in behavior

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"If we do too many things at once, everything falls through the cracks." J. Friedlander, MD #constipationmanagement #chartingpediatrics [0:16:28.0]

The host of this episode is Dr. Alison Brent, pediatric emergency medicine physician at Children's Colorado. In this podcast, Bill Anderson, MD, co-director of the multidisciplinary Asthma Program at Children's Colorado and assistant professor of pediatrics at the University of Colorado School of Medicine, talks about asthma. He discusses challenges in the management of asthma, the effect of asthma on pediatric patients and treatment options now available.

Key takeaways from this episode

Dr. Anderson discusses:

  • Common challenges for managing asthma in pediatric patients
  • Factors that come into play when choosing controller medications
  • Why steroids are better suited for atopic patients
  • Teaching patients and families how to use a spacer
  • How co-morbidities affect children with asthma
  • The impact that psychosocial factors have on asthma
  • Working with social workers to help families overcome hurdles
  • Latest treatment options for treating pediatric asthma
  • Overcoming the adherence barrier using technology
  • Natural medications available to pediatric asthma patients
  • Advice for people with dog allergies

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"The biggest challenge is making sure you have the correct diagnosis." – Bill Anderson, MD #chartingpediatrics [0:02:40.0]

"Almost every pediatric condition has some psychosocial component to it." Bill Anderson, MD #chartingpediatrics [0:08:20.0]

The host of this episode is Dr. Alison Brent, pediatric emergency medicine physician at Children's Colorado. In this episode, Julie Wilson, MD, co-director of the Concussion Program at Children's Colorado and assistant professor of orthopedics at the University of Colorado School of Medicine, discusses pediatric concussions in sports. She also talks about the concussion recovery process, working with parents and coaches to return young athletes to play and the classroom, comorbidities that impact concussion recovery, and more.

Key takeaways from this episode

Dr. Wilson discusses:

  • The signs and symptoms of a concussion in a young or adolescent patient
  • Why grading scales for concussions no longer exist
  • Comorbidities that can impact concussion recovery
  • How long a patient needs to rest after a concussion
  • Current guidelines on concussions in sports
  • "Return to play" concussion protocol is and why it's important
  • How to address parent concerns in a treatment plan
  • The correlation between concussion rates and sports
  • How the primary care provider can address the whole patient as they treat for a concussion
  • Red flags in concussion treatment
  • How many concussions are too many
  • Latest treatment options for concussion management

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"A #concussion is a brain injury, and it's something we want to take seriously." Julie Wilson, MD #chartingpediatrics [0:07:54.0]

See our clinical care guidelines from Children's Hospital Colorado - for concussion (.pdf).

The host of this podcast is Dr. David Brumbaugh, pediatric gastroenterologist at Children's Colorado. In this episode, Daniel Searing, MD, Professor of pediatrics and allergies at Children's Colorado, talks about seasonal allergies and pollen. He discusses the effects of pollen, how to treat and alleviate allergies, and more.

Key points from this episode

Dr. Searing discusses:

  • Pollen and how it affects allergies
  • Why cottonwood trees are a big pollinator, especially in the springtime
  • Why rain and humidity shut down pollen levels
  • Why Colorado's climate makes people more susceptible to allergies
  • How allergy symptoms will vary from year to year
  • The importance of monitoring the quantitative level of pollen in the environment
  • How physicians should manage the initial approach to a child with allergy symptoms
  • Key features to look out for
  • Why treating pollen allergies with persistent treatment is more effective
  • What role the prescription drug Montelukast plays in treating allergic rhinitis
  • What you can do to help prevent pollen from spreading
  • Which medicines and therapies can help alleviate allergies
  • When to see a doctor for seasonal allergies
  • The approach of an immunotherapy treatment plan and the two phases of a typical treatment schedule

Tweetables: Share key takeaways on Twitter

“The more intermittent the symptoms are, the more affective, the better the chance that the antihistamine will actually work well.” — Daniel Searing [0:08:26.0]


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