Children's Hospital Colorado

Charting Pediatrics

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 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

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]

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

Tweetables: Share key takeaways on Twitter

"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 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

Tweetables: Share key takeaways on twitter

"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 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

Tweetables: Share key takeaways on twitter

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

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

Tweetables: Share key takeaways on twitter

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

Tweetables: Share key takeaways on twitter

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

Tweetables: Share key takeaways on twitter

"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, 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

Tweetables: Share key takeaways on twitter

"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, 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, 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 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, 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 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

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 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]

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

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


PRODWEBSERVER2