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

Season two of our pediatric podcast

Join our hosts as they examine pediatric patient cases, clinical innovations and the nuanced art of pediatric medicine with leading experts.

In today's episode, we're examining a case that started in a primary care pediatrician's office and ended in the Children's Hospital Colorado Aerodigestive Program.

Joining us are the three physicians involved in the patient's care examine: Larissa Applegate, MD, a pediatrician at Pediatrics West in Wheat Ridge, Colorado; Ryan Caltagirone, MD, a pediatric emergency room physician at Children's Colorado; and Sven Streubel, MD, an otolaryngologist with Children's Colorado.

In this episode:

  • Our three guests examine their roles in the patient's care and share their key takeaways to inform other medical professionals
  • The origins of the case and how the patient, baby Rachel, first presented in the hospital
  • Steps taken once Rachel's respiratory struggles were evident and next steps to get her to the Emergency Department
  • Importance of clear communication between departments and with patient families in complex, multidisciplinary cases
  • Approaching a patient who presents with laryngomalacia from an ENT perspective
  • Using a bedside scope to determine the severity of the laryngomalacia
  • The various elements of Rachel's multidisciplinary care, including: admission procedure, observation of feedings, continued oxygen support and plan for next steps
  • Most common medical treatment plan for patients with laryngomalacia
  • Designing a long-term management plan for a child with laryngomalacia that supports the patient as well as their family
  • Accounting for comorbidities that come along with laryngomalacia
  • Update from patient and key takeaways from the case

Navigating the waters of child sexual abuse is difficult. This patient population necessitates a delicate approach. Andy Sirotnak, MD, Director of the Child Protection Team and nurse practitioner Denise Abdoo, PhD discuss adolescent and child sexual abuse, its indicators and how to approach and care for these patients.

In this episode:

  • How providers can normalize conversations around sexual abuse with patients and families
  • When concerns about child sexual abuse most commonly arise
  • Most common indicators and signs of sexual abuse in children
  • Why it is critical to teach children not to take photos of their bodies or keep secrets and good touch versus bad touch
  • What a pediatrician should do when a parent calls with concerns of possible child sexual abuse
  • Key components of a sexual abuse exam and the focus on external genitalia
  • The bathing suit concept for talking to children about private parts
  • Importance of building the family story and why having the parents' history is crucial for treating patients of childhood sexual abuse
  • The role of mental health issues in the spectrum of child sexual abuse
  • Recommended follow-up care and resources to help families through child sexual abuse

Resources for sexual abuse:

Scoliosis management will vary according to each patient's unique situation and presentation. Mark Erickson, MD, Rose Brown Chair of Pediatric Orthopedic Surgery and Medical Director of the Children's Colorado Spine Center, joins us to discuss the diagnosis and treatment of scoliosis.

In this episode:

  • The three primary types of scoliosis and their common presentations, symptoms, causes and treatments:
  • The key components of a physical examination for scoliosis
  • Recommended imaging to order for aiding a scoliosis diagnosis
  • Red flags that may indicate more serious problems and non-idiopathic scoliosis
  • Scoliosis surgery and treatment and its evolution
  • Risk factors for disease progression
  • The long-term prognosis for a child with scoliosis

Bart Schmitt, MD, telehealth pioneer and father of telephone triage pediatric protocols, discusses the role of telephone triage in the pediatrician's office. Dr. Schmitt is the Medical Director of General Pediatric Consultations at Children's Colorado.

In this episode:

  • Introduction to telephone triage and pediatric telephone protocols for nurses
  • The benefits and importance of having protocols for a call center and medical practice caring for pediatric patients
  • Why pediatricians offer telephone care and telehealth more often than other specialists
  • Why electronic protocols are better than a book
  • The importance of second-level physician triage for after-hours calls
  • How pediatric telephone triage protocols and resources like the symptom checker support patient-centered care

Telephone triage resources:

Treating STDs in adolescent patients can be a challenge for today's busy pediatrician. Eliza Buyers, MD of the Pediatric and Adolescent Gynecology team at Children's Colorado returns to our pediatric podcast to provide practical tools for preventing and treating sexually transmitted infections in teens.

In this episode:

  • Why STD rates are higher in adolescents and young adults
  • How PCPs can address teen reproductive health challenges
  • Why we need to consider age as the primary risk factor for STDs
  • Examining the issue of STD rates as a health disparity
  • Importance of conducting universal screening in sexually active adolescents
  • Expedited partner therapy (EPT) and its importance
  • Recommended STD and HIV screening periods for different populations
  • Screening guidelines for STD examinations in the absence of symptoms
  • Approaching one-to-one time with teen patients
  • Importance of promoting condom use to prevent STDs in teens
  • When to consider screening for less common STDs
  • Why it's crucial to know confidential screening clinics you can send your patients

STD management resources:

Feeding an infant brings about joys and challenges for every family. In this episode, we discuss the identification and treatment of feeding and swallowing problems in infants with Laura Pickler, MD and Nancy Creskoff Maune.

Dr. Pickler is the Chair of Family Medicine and Medical Director of the Feeding and Swallowing Program at Children's Colorado. Nancy is an occupational therapist in the program with an extensive background in the evaluation and treatment of infants and children with feeding and swallowing problems.

In this episode:

  • Recognizing the signs of pediatric feeding and swallowing problems
  • The most common presentations of feeding difficulties that primary care pediatricians encounter
  • Differentiating between feeding problems versus swallowing problems
  • The visual and auditory signs of swallowing problems
  • Referral criteria for a videofluoroscopic swallowing study (VFSS)
  • Different approaches to feeding and swallowing issues for breast-fed versus bottle-fed babies
  • Approaching feeding and swallowing problems in a breast-fed baby whose mom is returning to work
  • Questions to ask and what to look for to avoid missing the big problems
  • The importance of observing a feeding to evaluate meal-time behavior, stressors and physical findings
  • A primary care physician's toolbox of questions surrounding feedings
  • Recommended resources on feeding and swallowing for pediatricians

Caring for transgender, gender diverse and gender non-conforming patients is complicated, and it's made even more complex by the dynamic nature of gender itself. In this episode, Natalie Nokoff, MD, from the Children's Colorado TRUE Center for Gender Diversity, joins us to discuss healthcare for transgender and gender diverse patients.

In this episode:

  • Common gender terminology physicians may encounter when talking with gender diverse patients
  • How to communicate with pediatric patients about their gender identity
  • Proactive strategies pediatricians can use surrounding early gender issues
  • Understanding the relationship between puberty and gender or body distress (gender dysphoria)
  • When to refer young patients experiencing gender dysphoria
  • Why it's important to ask all teens questions about gender identity
  • Understanding the family dynamic and needs before referring gender diverse patients to a specialist
  • Ensuring a safe environment at school and in the community before gender transition
  • Hormone therapy and puberty blocking protocol and WPATH criteria for starting hormone therapy
  • Most common methods and forms of hormone therapy and the side effects pediatric primary care providers should be aware of
  • The unique mental health, social and emotional support needs of this patient population

Resources for transgender healthcare:

Caring for children with Down syndrome can be complicated. Francis Hickey, MD, Medical Director of the Sie Center for Down Syndrome, joins us to discuss primary care for kids and adolescents with Down syndrome (trisomy 21 syndrome).

In this episode:

  • Recommendations for making an initial Down syndrome diagnosis
  • The importance of congratulating parents on the birth of their child
  • Helpful tips for siblings of children with Down syndrome
  • What pediatricians should expect for growth and developmental milestones
  • The importance of early visual stimulation for children with Down syndrome
  • Why it's more important to focus on progress rather than on hitting specific goals
  • Common Down syndrome-related GI, ENT, pulmonary and orthopedic problems to watch for
  • The three most important screenings for Down syndrome patients: thyroid, vision and hearing
  • Endocrine challenges and the autoimmune cluster
  • How to recognize the onset of autism in children with Down syndrome
  • Significant concerns to watch out for when adolescents with Down syndrome move into puberty
  • Practical references available for primary care providers
  • Special accommodations and educational advocacy for children with Down syndrome in the public school system

Browse our Down syndrome resources to share with patient families.

HLHS care poses a unique challenge for pediatric primary care providers. Pediatric cardiothoracic surgeon James (Jim) Jaggers, MD joins us today to discuss the primary care, treatment and future for patients with hypoplastic left heart syndrome (HLHS).

Dr. Jaggers is Co-Director of the Heart Institute and the Barton-Elliman Chair in Pediatric Cardiothoracic Surgery at Children's Colorado.

In this episode:

  • Dr. Jaggers' approach to surgical intervention for HLHS
  • How pediatricians and family doctors can support their patients and families confronting an HLHS diagnosis
  • Ongoing and follow-up care for HLHS patients in the pediatricians' office
  • The long-term prognosis for HLHS patients
  • How the nation's leading pediatric hospitals are collaborating to provide solutions for patients with HLHS in a groundbreaking consortium
  • Future innovation and care for HLHS patients

Dan Hyman, MD, and Heather Howman join us today to discuss the four parts of the American Board of Pediatrics' Maintenance of Certification (MOC) program. Dr. Hyman is the Patient Safety Officer at Children's Colorado and Heather Howman is the MOC Program Manager at CU Medicine.

Listen in as they share their expertise on the MOC and quality improvement projects for the pediatric primary care office.

In this episode:

  • What is MOC?
  • Four parts of the Maintenance of Certification (MOC) for board-certified pediatricians and pediatric subspecialists
  • Achieving the credits that you need to maintain your certification
  • Choosing a quality improvement project for your office
  • Turning quality improvement into a team effort
  • The length of time to complete quality improvement projects
  • Barriers in a private office setting for these kinds of projects
  • Leveraging your EMR in your practice
  • Resources and tools to use in part four of ABP's MOC program
  • Consensus building strategies to use within your pediatric practice

Welcome to season two of Charting Pediatrics. In this episode we address the timely and serious topic of firearm safety with Eric Sigel, MD. Dr. Sigel is the Fellowship Director of Adolescent Medicine at Children's Colorado and professor of pediatrics at CU Medicine.

In this episode:

  • The AAP gun safety guidelines
  • Principles that implicate firearms in suicide deaths
  • The risks of having firearms in the home
  • What age to start addressing firearm safety with your patients and families
  • Approaches for addressing gun safety with parents and patients
  • Informing people of the importance of safe storage for firearms
  • Ways to become involved in the advocacy efforts around gun safety

Season one of our pediatric podcast

In season one of Charting Pediatrics, the multidisciplinary experts of Children's Colorado come to the mic to examine the latest treatment options, significant research and advances in pediatric medicine.

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.

In 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.

In 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.

In 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.

In 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

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.

In 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

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.

In 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

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.

In 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

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.

In 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

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.

In 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:

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:

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.

In 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

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.

In 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

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.

In 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

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.

In 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.

In 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.

In 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

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.

In 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

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.

In 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.

In 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

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.

In 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

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.

In 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

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.

In 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

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.

In 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

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.

In 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

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.

In 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

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.

In 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

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.

In 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

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.

In 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

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.

In 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

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.

In 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

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.

In 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

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.

In 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

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.

In 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
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