Charting Pediatrics

Earlier this year, new guidelines were released to improve the diagnosis of pediatric sepsis and septic shock. For the first time, the novel Phoenix Sepsis Criteria provides an objective and data-driven approach to aid in the identification of these life-threatening conditions, including prediction of mortality in children with suspected or confirmed infection. Sepsis is one of the leading causes of death among children worldwide, and these guidelines could be a major step in changing outcomes. To help us understand these guidelines and apply them to your practice, we are joined by two experts who have been at the forefront of this new research. Tell Bennett, MD, specializes in pediatric critical care at Children's Hospital Colorado. He is the Vice Chair of Clinical Informatics, as well as a professor of biomedical informatics and pediatrics at the University of Colorado School of Medicine. Halden Scott, MD, is the Director of Research for the section of emergency medicine at Children's Colorado. She is also an associate professor of pediatrics at the University of Colorado School of Medicine. Some highlights from this episode include: How to diagnosis sepsis under the new guidelines How these criteria can be applied to primary care practices What treatment options are and why time is of the essence For more information on Children's Colorado, visit: childrenscolorado.org.

Newborn screening has expanded dramatically over the last decade as our detection methods improved and new treatments became available for rare diseases. One of those rare diseases is adrenoleukodystrophy, otherwise known as ALD. ALD is an example of a rare disease where, thanks to expansions in newborn screenings, we are now able to make a precise genetic diagnosis very early in life and offer therapies far in advance of the onset of symptoms. Early detection and treatment of this can potentially spare a family a lifetime of devastating health impacts. In December 2013, New York became the first state to require newborn screening for ALD. Currently, 43 states and Washington, D.C. are testing babies for ALD. To help us understand the role of newborn screening, we are joined by Kevin Ess, MD. He is the Ponzio Family Chair of pediatric neurology and is the section head of neurology at Children's Hospital Colorado. He is also a professor of pediatrics at the University of Colorado School of Medicine. Some highlights from this episode include: The pathophysiology of ALD. The clinical manifestations of ALD that make it the perfect model for newborn screening. The specifics of diagnosing and treating ALD. The long-term impact newborn screening can have for the lifetime of children with ALD. For more information on Children's Colorado, visit: childrenscolorado.org.

Artificial intelligence (AI) has the potential to transform healthcare and disrupt the field of medicine in significant ways. We have already seen remarkable progress in areas such as diagnostics and data analysis, but what could broader use in patient care looks like? A little over a year ago, the arrival of ChatGPT got everyone talking about AI — how realistic it is, how well it understands certain concepts and, specifically in medicine, how it can benefit our care systems. In this episode, we explore the overarching needs for AI in pediatrics and medical education, as well as where we stand in implementing it. We are joined by two guests from Children's Hospital Colorado who are leading the way in understanding how AI could be incorporated into pediatric care. Jim Barry, MD, specializes in neonatal/perinatal medicine at Children's Colorado and is an associate professor of pediatric neonatology at the University of Colorado School of Medicine. He is also the Medical Director of the UC Health NICU. He co-founded NeoMIND-AI, a learning collaborative for neonatologists and data scientists interested in AI within neonatal and pediatric critical medicine. Sarah Milla, MD, specializes in pediatric radiology and is the John D. Strain Endowed Chair for Radiology, Chief of Pediatric Radiology and Vice Chair of Radiology at Children's Colorado and the University of Colorado School of Medicine. She is also a visiting professor. Some highlights from this episode include: Examples of how AI is currently being used in medicine Ways providers can get started with AI Ideas on how we can advance care in the future with this tool For more information on Children's Colorado, visit: childrenscolorado.org.

Over the last decade, we've watched childhood obesity emerge as a major health concern, taking over news stories and social media posts worldwide. The evaluation and treatment of children with obesity has evolved, and how we handle these diagnoses today is different than in years past. What's important to emphasize is that obesity is a chronic disease, and the medical community needs to treat it as such. To learn more about this important topic and highlight an impressive woman in medicine, we are joined by Ihuoma Eneli, MD. She is the Section Head of Nutrition at Children's Hospital Colorado and a visiting professor of pediatrics at the University of Colorado School of Medicine. She is an internationally recognized expert on pediatric obesity and serves in leadership and advisory roles for many organizations. Some highlights from this episode include: A discussion of the new AAP obesity guidelines Genetics and how clinicians can reframe their understanding of obesity Suggestions for motivational interviewing with patients and families Treatment options that are available to patient-families The stigma around fault versus genetics New drugs and their future impact For more information on Children's Colorado, visit: childrenscolorado.org.

Hirschsprung disease. Anorectal and colorectal malformations. These are some of the most challenging surgical problems encountered in young children. The precision of surgical technique required to achieve optimal outcomes takes many years, if not decades, to develop. Colorectal surgery has become a subspecialty in pediatric surgery, requiring close collaboration with other specialists. At Children's Hospital Colorado, we offer this care through our International Center for Colorectal and Urogenital Care, and our surgical team has some of the most experience in the world. In this episode, we are joined by Andrea Bischoff, MD, and Luis De la Torre-Mondragon, MD. They both specialize in pediatric surgery at Children's Colorado and are associate professors of surgery and pediatrics with a specialty in colorectal surgery at the University of Colorado School of Medicine. Dr. Bischoff is also the Medical Director of the International Center for Colorectal and Urogenital Care here at Children's Colorado. Some highlights from this episode include: The importance of pediatric colorectal programs. A discussion of when surgical intervention is necessary. A look at what procedures are offered at Children's Colorado and how they work. The role primary care providers can play as it pertains to identification, referral and care of patients who might need colorectal surgery. For more information on Children's Colorado, visit: childrenscolorado.org.

Sleep problems can occur at any age, but when toddlers, children or young adults are the ones experiencing them, they can have a big impact on the entire family. Specifically, one to five percent of children, from newborns to teenagers, experience obstructive sleep apnea. While the effects may be significant, many children are not diagnosed or treated due to insufficient access to testing. A team at Children's Hospital Colorado has been preparing a recommendation on how and when to use home sleep apnea testing in kids. To explore this topic, we are joined by Antoinette Burns, DO, who specializes in pediatrics and sleep medicine at Children's Colorado. She is also an associate professor of clinical practice, Department of Pediatrics-Pulmonary Medicine, at the University of Colorado School of Medicine. Some highlights from this episode include: An explanation of obstructive sleep apnea. New modalities for sleep apnea testing. Barriers for accessing testing and how to combat them. Suggestions on what primary care providers should do when they think their patient might have obstructive sleep apnea. For more information on Children's Colorado, visit: childrenscolorado.org.

Knowing something is wrong with your child is terrifying for any parent, but the mystery becomes more frightening when the symptoms even puzzle the experts. In 2018, at a peak in cases of acute flaccid myelitis, also known as AFM, otherwise healthy kids experienced debilitating paralysis. Researchers of this perplexing illness braced for a surge in 2022 that never came, and now there is talk about a possible increase of AFM this year. To break down the past and prepare for the future, we are joined by two experts. Kevin Messacar, MD, and Hai Nguyen-Tran, MD, both specialize in pediatric infectious disease at Children's Hospital Colorado. Dr. Messacar is an associate professor and Dr. Nguyen-Tran is an assistant professor at the University of Colorado School of Medicine. Some highlights from this episode include: What the history of AFM tells the medical community Why it's so tricky to diagnose and identify How primary care providers can properly prepare For more information on Children's Colorado, visit: childrenscolorado.org.

In just the United States, more than 15,000 children are diagnosed with cancer each year. Globally, that number is greater than 300,000. As difficult as those numbers may be, there is good news: Our cancer therapies continue to improve. In the 1960s, only about 5% of children survived leukemia. Today, that number is 90% or better. Many more pediatric oncology patients are now transitioning into survivors of childhood cancer and have the opportunity to achieve their hopes and dreams as adults. This means primary care providers are caring for these patients in increasing numbers. What's important to know about this group of kids? In this episode, we discuss how to best integrate survivorship care with pediatric care. The Children's Hospital Colorado HOPE Cancer Survivorship Program is one of the longest running survivorship programs in the nation. Leading that charge is Jenna Demedis, MD, who specializes in pediatric hematology and oncology. Dr. Demedis completed her training at Children's Colorado and is currently an assistant professor at the University of Colorado School of Medicine. When a patient can transition into survivorship How to keep patient families engaged in these programs How primary care providers can partner with survivorship programs For more information on Children's Colorado, visit: childrenscolorado.org.

The mouth is a fundamental part of the human body. It allows us to eat, drink, breathe, speak, smile and express ourselves. Naturally, that means oral health is connected to our broader physical health, but in the United States, medical and dental care are structurally separate. Despite their connections, the two have entirely different systems of professional training schools, insurance coverage and care networks. This is referred to as the dental divide, and it results in varied levels of access and health outcomes. The repercussions of these barriers are significant, especially for children in our most vulnerable communities. To discuss this important topic, we are joined by Patricia Braun, MD. Dr. Braun is a primary care pediatrician at Denver Health, as well as a professor of pediatrics at the University of Colorado School of Medicine. She is the immediate past chair of the Section on Oral Health for the American Academy of Pediatrics, and her research focuses on oral health outcomes and program evaluation. She also currently directs the Rocky Mountain Network for Oral Health Integration. Some highlights from this episode include: How to understand the dental divide Ways this divide leads to poor oral health for children Options for the medical community to combat these barriers What primary care providers can look for in their visits with patients For more information on Children's Colorado, visit: childrenscolorado.org.

When you work in neonatology, you are surrounded by babies. You're regularly meeting new parents in the Neonatal Intensive Care Unit, some who are living the best days of their lives, and others who are experiencing the very worst. But as a doctor, you never expect to become the patient. We go beyond the white coat in this episode with a story of tragedy and personal discovery from Laurie Sherlock, MD, that changed how she interacts with her patients and practices medicine. "I've been gifted through the accident and my son's death. I've been gifted so much compassion for what our families are going through. I think my bandwidth is so much higher because it's so easy for me to put myself in their shoes," says Dr. Sherlock. Dr. Sherlock specializes in neonatal and perinatal pediatric medicine at Children's Hospital Colorado and is an assistant professor of pediatrics and neonatology at the University of Colorado School of Medicine. Mostly importantly, she is a survivor who is using her own narrative to help others. Some highlights from this episode include: Dr. Sherlock's personal story and the impact it's had on her career Using personal experience to be a better doctor Tapping into compassion at the bedside Advice for patients and families experiencing tragedy For more information on Children's Colorado, visit: childrenscolorado.org.

Innovations and techniques to enhance spinal surgical care, and support patient- centric outcomes, have made big strides in the last decade. Technology like surgical robots, 3D printed models customized to the patient, and a new procedure called vertebral body tethering are just a few examples of the many incredible advancements. Two leading experts on scoliosis surgery at Children's Hospital Colorado join us to discuss these impressive changes and how they are impacting patient care. Mark Erickson, MD, is the medical director of the Children's Hospital Colorado Spine Program, as well as a specialist in orthopedic surgery. He's also a professor of pediatrics at the University of Colorado School of Medicine. Sumeet Garg, MD, a pediatric orthopedic specialist, is the quality and safety director for the Spine Program, as well an associate professor at the University of Colorado School of Medicine. Some highlights from this episode include: An orthopedic surgeon's approach to spinal surgery and how it's evolved over time How surgery can improve a patient's quality of life A look at new, customized patient approaches How the use of robotics is advancing treatment What's on the horizon in spine surgery innovation For more information on Children's Colorado, visit: childrenscolorado.org.

When babies enter the world, there's a plethora of diagnoses providers need to look out for. Some are simple fixes, while others are a bit more complicated. When parents take their kids home, how should they know what to keep an eye out for? In this episode, we explore one potential diagnosis for an infant: tongue ties. How can you tell if a baby has one, and if they do, when should it be fixed? Looking at the concerns and consequences of tongue ties is important in making a decision on how to treat it. To provide guidance in making these decisions, Soham Roy, MD, is our guest for this episode. Dr. Roy specializes in pediatric otolaryngology at Children's Hospital Colorado, and he's a visiting professor of otolaryngology at the University of Colorado School of Medicine. Some highlights from this episode include: How to identify a tongue tie and variability in diagnoses Why tongue ties are controversial Identifying fact versus fiction in understanding tongue ties The upsides and downsides of the tongue tie procedure How providers can learn more For more information on Children's Colorado, visit: childrenscolorado.org.

The care of children with cleft lip and palate spans an entire lifetime. It requires methodical care with a multidisciplinary team, and a special emphasis on the family. Integration with a child's pediatrician, medical home and their loved ones is key. While the oral cleft is the most common craniofacial malformation in a newborn, the three main types differ vastly. We are in for a treat with the guest for this episode. We are joined by a gifted plastic surgeon who has traveled the world to perform these life-changing surgeries and bring smiles to everyone involved. Phuong Nguyen, MD, specializes in plastic and reconstructive surgery here at Children's Hospital Colorado. In addition, he is the associate vice chair of global surgery, chief of plastic surgery, co-director of the cleft lip and palate program and a professor of surgery at the University of Colorado School of Medicine. Some highlights from this episode include: Prevalence and diagnosis of cleft lip and palate The role of the pediatrician or PCP throughout the lifespan of these patients Understanding if treatment is unique per patient Global impact of specialists, like Dr. Nguyen, traveling to treat patients For more information on Children's Colorado, visit: childrenscolorado.org

You've likely heard of CRISPR, the comprehensive gene editing technology that emerged in the 2010s and has since revolutionized biological research. Additionally, the medical community has long been using the concept of gene therapy. What's new is that both approaches have now successfully been harnessed for the treatment of human disease. In December 2023, the FDA approved two therapies for the treatment of sickle cell disease; one utilizing CRISPR technology and the other using a gene transfer therapy approach. These therapies now have the opportunity to change the life course of this terrible disease. Our guest for this episode is Christopher McKinney, MD, who specializes in pediatric hematology here at Children's Hospital Colorado. Dr. McKinney has been the hospital's site principal investigator in some of the clinical trials that are contributing to these new sickle cell therapies, and he is an assistant professor of pediatrics at the University of Colorado School of Medicine. Some highlights from this episode include: How these treatments work for diseases like sickle cell What we know about the effectiveness of these therapies thus far Important side effects and risks to take into consideration Regardless of FDA approval, what barriers are in place Powerful patient examples For more information on Children's Colorado, visit: childrenscolorado.org

In its 7th season, Charting Pediatrics has hit 2 million lifetime downloads! What an accomplishment. Our podcast team wants to thank each of you, our listeners, for tuning in each week to learn about the latest and greatest in pediatric healthcare. This accomplishment would not be possible without each of you, and we are thrilled to have you on this journey. 2024 has a lot of unique opportunities in store. Get ready for more content, new ideas, and further educational opportunities. In this special episode, our hosts, David Brumbaugh, MD, Alison Brent, MD, and Dan Nicklas, MD, reflect on the growth of this podcast and the advancements that have happened since its inception. "And I am 100% convinced that we are, right now, in what will eventually be referred to as a golden era of pediatric medicine in terms of developing new treatments," Dr. Brumbaugh says. Here's to 2 million more lifetime downloads, with listeners who are changing the realm of pediatric medicine every day. Thank you for all that you do! For more information on Children's Colorado, visit: childrenscolorado.org

Children and their families need a healthcare system that serves them wholeheartedly. Having their unique needs prioritized creates an important opportunity for lifelong health and wellbeing. However, the current health system in our country and globally has massive gaps to fill, especially as it pertains to children of color. The medical community is focusing on preventative measures and connections between children, families, communities and the systems they interact with regularly. While large efforts are being made across the child healthcare field, there is strong agreement that child health transformation, with a focus on family -centered pediatric care, needs to be accelerated. At the forefront of this work is Hala Durrah, MTA, a patient-family engagement consultant and advocate. Joining us virtually from San Marcos California, she discusses her role on the advisory group of national experts in the pediatric field of accelerating child health transformation initiative. She also has professional experience as a national speaker who has served on a number of national committees. Beyond her professional accomplishments, this topic resonates with her much more personally. Her current work in patient-family-centered care stems from her experiences as a mother of a child who has undergone two liver transplants and a bone marrow transplant. "What I realized when I first knew my daughter was sick, was that this was going to be a journey that required me to be as fully knowledgeable and as fully engaged as possible to advocate for her," Durrah says. Some highlights from this episode include: How providers and practices can partake in this work The importance of acknowledging patient-family engagement to best care for kids What gaps exist and how this method helps to fill them This episode is underwritten by Aegon Transamerica Foundation, a proud supporter of Charting Pediatrics and Children's Hospital Colorado. The Aegon Transamerica Foundation helps build a better world by committing to the improvement of wellness throughout their communities. Their partnership with Children's Colorado addresses the youth mental health crisis to help create a better mental health future for children. Thank you to Aegon Transamerica Foundation for investing in Children's Colorado. For more information on Children's Colorado, visit: childrenscolorado.org

Facts and fiction can overlap in movies and television. That's especially prevalent in medical dramas where the details seem so real but often don't portray the full picture. While the intention may be to create powerful entertainment, sometimes a storyline can misinform the viewer. Unrealistic circumstances, overexaggerated outcomes and the bending of scientific truth, create confusion. When it comes to food allergies, how a situation is handled can be the difference between a routine medical occurrence and a lifesaving episode. "This is where we see some really dramatic portrayals because you generate that emotional kind of connection and we see it both from how reactions are portrayed inappropriately or very severe consequences or frankly people make fun of food allergies a lot," David Stukus, MD, says. In this episode, we dig into how portrayals in the media landscape can impact patient families in the medical community. We are joined by Dr. Stukus, who is otherwise known as the allergy kids doc on social media. Dr. Stukus is the director of the Food Allergy Treatment Center at Nationwide Children's Hospital, as well as a professor of clinical pediatrics in the division of allergy and immunology. In addition, we have Vivian Hernandez-Trujillo, MD, with us. Dr. Hernandez-Trujillo is the director of the Division of Allergy and Immunology at Nicklaus Children's Hospital, as well as a clinical professor of pediatrics at Florida International University Herbert Wertheim College of Medicine. These two doctors are at the forefront of important conversations for change. "I honestly think education is just important. Once we're armed with accurate information, that's powerful. I can speak as a patient, as a mom of two girls with food allergies, and as someone who is a physician for patients with food allergies, my cup is always half full," Dr. Hernandez-Trujillo says. This episode was recorded at the 2023 American Academy of Pediatrics National Conference and Exhibition. Some highlights from this episode include: Common examples of allergy inaccuracies within media The narrative around nut allergies How we remove the stigma around allergies and change how they are portrayed Undoing outdated practices and updating our information For more information on Children's Colorado, visit: childrenscolorado.org

As doctors, curiosity can be the driving factor to a long, successful, and fulfilling career. It can be the difference between daily repetition and years of practicing evolved education. For Barton Schmitt, MD, curiosity has been a transformative force for over 50 years, influencing his approach to teaching residents, patient encounters and career development. Otherwise known as a true icon of pediatrics, Dr. Schmitt's humble, down-to-earth nature helped create one of the most prestigious pediatric guidelines in our industry. "Feedback from a variety of sources is really the life blood of all of this. At least 100 to 150 of the protocols are updated every year," Dr. Schmitt says. For more than five decades, Dr. Schmitt has elevated the Children's Hospital Colorado name while creating an honorable legacy of his own. Many of you know him as the author of the 'Pediatric Telephone Triage Guidelines' used in our Pediatric Call Center. Those decision-support tools are now used worldwide and have been translated into multiple languages. Throughout his career he's had numerous other titles such as the Faculty Attending for the Child Health Clinic and the medical director of the Child Protection Team. Now on the brink of his next chapter, we reflect on his incredible legacy and find out what's next. "I'm hoping to retire when I'm 90. I've got to because I have other things I want to do, including some books I want to write about teaching residents," Dr. Schmitt says. Some highlights from this episode include: Details about the creation and expansion of the Pediatric Telephone Triage Guidelines The impact that curiosity has had on his career His hopes for the future Advice for doctors, nurses and medical professionals "Continual quality improvement is a team sport," Dr. Schmitt says. Dr. Schmitt wants to thank the many health care professionals who help him keep the pediatric telehealth guidelines, parent handouts and symptom checker up-to-date. Most of all, his dedicated pediatric editorial team: Medical editors: Sam Wang, MD, and Julia Bruckner, MD. Nurse editors: Kelli Massaro, RN and Lisa Swerczek, RN. Specialists at Children's Colorado, who provide expert reviews of new topics. The many triage nurses who have worked in the Children's Colorado call center since 1988 and made observations that led to change. David Thompson, MD FACEP and the Adult Editorial Team The nurse leadership at over 40 other U.S. and Canadian call centers who provide the annual user feedback that keep the guidelines reality-based and evolving. For more information on Children's Colorado, visit: childrenscolorado.org

Digital content is at the center of our society and its prevalence continues to grow. Storytelling on digital platforms allows the medical community to showcase groundbreaking research and connect with audiences, who otherwise may not be privy to this information. Experts like Joshua Williams, MD, are at the forefront of some of this innovation. In October 2023, he received the Advancement in Research Award at the American Academy of Pediatrics National Conference. Dr. Williams is an assistant professor of pediatrics at the University of Colorado School of Medicine, as well as a practicing primary care pediatrician with Denver Health. He is the principal investigator on a National Institutes of Health grant to examine the impact of digital storytelling on influenza vaccination equity. In addition, he is a co-investigator at the Denver Health for the Centers for Disease Control and Prevention Vaccine Safety DataLink Project. "And what I hope comes from it is improvement in equity, improvement in the rate of influenza vaccination uptake in groups that historically haven't had high uptake," says Dr. Williams Some highlights from the episode include: The larger goals of these data- and digital-based projects How to merge medicine and storytelling Advice for young doctors and medical professionals Finding success from rejection Dr. Williams will be presenting on this very topic at the PAS 2024 meeting in Toronto, Canda. For more information on Children's Colorado, visit: childrenscolorado.org

Pediatricians, families, and pharmacists are faced with increasing drug costs and a vast array of complex biologic therapies. Up-to-date knowledge on prescribing practice is constantly a need, specifically regarding generics and the availability of biosimilar and interchangeable biosimilar agents. According to a report from the Association for Accessible Medicines, the U.S. healthcare system saved $408 billion from using generic and biosimilar drugs in 2022, a huge jump from the $195 billion in savings accumulated in 2013. In today's episode, we have a rare opportunity to learn critical knowledge about this topic from renowned experts in the field. We are joined by John Routt Reigart, MD, and Dr. Siu. Dr. Reigart is professor emeritus at the Medical University of South Carolina as well as the chairperson for the American Academy of Pediatrics' (AAP) Committee on Drugs. "I have been recognized in my state, and to some extent nationally, as being an advocate for improved health for children. I feel that it's very important that pediatricians be advocates for effective regulations for their patients," Dr. Reigart says. Dr. Siu is a clinical professor, the vice chair for teaching and learning, and the director of faculty mentoring at the Ernest Mario School of Pharmacy at Rutgers University. She is a pediatric pharmacy clinical coordinator and practices at the K. Hovnanian Children's Hospital and Jersey Shore University Medical Center. She has also been appointed to the board of directors of the Board of Pharmacy Specialties and the Pediatric Pharmacy Association liaison for the AAP Section on Clinical Pharmacology and Therapeutics executive committee. "We want to make sure that medications are easily accessible to families and we also want to make sure that they are also cost effective," Anita Sui, PharmD, says. This episode was recorded at the 2023 American Academy of Pediatrics National Conference and Exhibition. Some highlights from this episode include: The difference between biologics and generics What the orange and purple books are and their roles in the industry What an interchangeable product is Patents and exclusivity What savings could look like with an uptick of biologics and generics For more information on Children's Colorado, visit: childrenscolorado.org

For the second time in Charting Pediatrics history, we brought a live audience together to watch the taping of an episode with a guest who has made an everlasting impression on our hospital system. This time, the show was for our colleagues here at Children's Hospital Colorado. Our guest is one of the top healthcare executives within pediatric hospitals in North America. Don't just take our word for it; she was recently selected to be the chair of the board of trustees for the entire Children's Hospital Association. Under her leadership, Children's Colorado has been routinely identified as one of the country's top 10 pediatric healthcare systems. In recent years, her advocacy for greater pediatric behavioral healthcare is a notable example of her dedication to research and innovation. In today's episode, we welcome Jena Hausmann, the CEO and president of Children's Colorado. "I think leaders really should be authentic and should role model, always, their true leadership self and impact. I do think it is important for any of us to see ourselves reflected in whether it's gender or race or ethnicity or age or you name it," says Hausmann. Some highlights from this episode include: Jena's career evolution and how she landed in her current role How to make an impression in healthcare administration The role that mentors play in career growth The example she aims to set for women in leadership How Jena's authenticity and vulnerability enhance her leadership The trends in U.S. healthcare that will impact how we care for kids For more information on Children's Colorado, visit: childrenscolorado.org

Every day, we see patients whose medical hurdles land them at hospitals like Children's Hospital Colorado. There are many answers our providers and specialists can provide when giving patient families a medical diagnosis, but many of those same children are facing gaps and inequities socially. Often, they fall into different minority groups facing disparities in healthcare equality. Medical insurance may cover labs and procedures, but it doesn't cover the need for food or housing. Those are just two examples of social barriers that greatly affect one's health. While many questions remain on best practices for social care programs and how we bring them to fruition, experts, like our guests today, are working hard to use them effectively. "We can't meet family's needs if we don't know what they are. So, the first step is assessing what those needs are," says Lisa DeCamp, MD. In today's episode we are joined by Lisa DeCamp, MD, a practicing general pediatrician at Children's Colorado and an associate professor at the University of Colorado School of Medicine. Her research focuses on increasing healthcare engagement of Spanish -speaking Latino families and reducing disparities in healthcare equality and safety for patients and families with limited English proficiency. Julie Beaubian is an operations manager here at Children's Colorado within the community health department. She manages community benefits for the hospital. "So we're constantly trying to balance what is reasonable, what does the family need and how can we continue to support that family," Beaubian says. Read the paper mentioned in this episode. Some highlights from this episode include: Outlining this Children's Colorado social care program How this program can influence other communities and hospitals Social barriers and how that impacts healthcare How we can bridge gaps for communities facing inequities For more information on Children's Colorado, visit: childrenscolorado.org

While considerable progress has been made in reducing cigarette smoking among our nation's youth, the tobacco product landscape continues to evolve. It includes a variety of tobacco products, including smokeless and electronic products such as e-cigarettes. E-cigarettes entered the U.S. marketplace around 2007, and since 2014 they have been the most used tobacco product among youth. E-cigarette use, among middle and high school students, remains unacceptably high and sets youth up for lifelong nicotine addiction and the effects of toxin exposure. In today's episode, we are joined by Brian Williams, MD, a pediatric and adult hospitalist. He is an assistant professor of pediatrics and internal medicine at the University of Wisconsin School of Medicine and Public Health. Dr. Williams has a research interest in how we promote vaping cessation in young people. "As a resident at UC San Diego, I grew sort of tired and frustrated by seeing patients suffering complications from secondhand smoke exposure," Dr. Williams says. In San Diego, he founded a program that trained nurses to screen for tobacco exposure among the parents of pediatric patients. It worked, increasing screenings from 66% to nearly 100%. "The popularity of e-cigarettes is concerning, and we are seeing rising rates in both middle schoolers and high schoolers," says Williams. This episode was recorded at the 2023 American Academy of Pediatrics National Conference and Exhibition. Some highlights from this episode include: Why are e-cigarettes so appealing to youth Harmful ingredients in e-cigarettes Potential impacts on brain development How advertising impacts behavior For more information on Children's Colorado, visit: childrenscolorado.org

In a busy outpatient practice, timely access to up-to-date clinical resources is crucial to delivering evidence-based care. In the olden days, books and journal articles were the go-to method. Today, technology creates a more user-friendly method of receiving the most recent information. Say goodbye to having to order the latest edition of a book and hello to automatic updates. Our Children's Hospital Colorado antimicrobial stewardship team, clinical effectiveness and pathways teams, along with other local and state partners have partnered with Firstline, a health technology company, to design a mobile version of our infectious disease guidance. "It is another way to bring clinical decision support directly into somebody's hand if they are not sitting at a computer, which a lot of times you are not," Leigh Anne Bakel, MD, says. A technology like this can change the future of treating patients. With new information comes new treatment choices, and this app is a way to put all of that content in the palm of a provider's hand. "It's really about judicious use, so using the right antibiotic for the right length of time but also only in the right patient and then the right dose; I think we understand overtime that antibiotics have a lot more side effects than we previously appreciated," Sarah Parker, MD, says. Joining us to talk about this innovative technology are Drs. Sarah Parker and Leigh Anne Bakel. Dr. Parker is the Medical Director of the Antimicrobial Stewardship Program here at Children's Colorado, as well as a professor of pediatrics in the Division of Infectious Diseases at the University of Colorado School of Medicine. Dr. Bakel is the Medical Director of Clinical Effectiveness here at Children's Colorado, as well as a practicing pediatric hospitalist. She is also an associate professor of pediatrics. Some highlights from this episode include: How the Firstline app works Why Firstline is beneficial for providers everywhere How Firstline will enhance rural healthcare The future of technology for treating patients For more information on how to download the app visit https://firstline.org/colorado/. Drs. Parker and Bakel would like to acknowledge the brains behind this operation. With Children's Colorado: Sarah Parker, MD Leigh Anne Bakel, MD, MSc Michael J Bozzella, DO, MS Joana Dimo, DO Matthew Weber, Research Assistant, MPH Christine MacBrayne, PharmD, MSCS Matt Miller, PharmD With Denver Health: Tim Jenkins, MD Katie Shihadeh, PharmD Maggie Cooper, PharmD With CDPHE: Chris Czaja, MD, DrPH Lauren Biehle, PharmD Rachel Schaefer, MPH Other: Local and regional providers, infection preventionists and pharmacists who gave feedback Firstline Pfizer Global Bridges Grant Daniel Dodson, MD, MS For more information on Children's Colorado, visit: childrenscolorado.org

In today's fast-paced work environment, it can be easy to feel overwhelmed. Due to that intense pace, it's important for employees and employers alike, to promote healthy working behaviors and surroundings. Healthy employees are more productive, have fewer absences, are less prone to work-related injury and are less likely to burn out. "Leading others is how you support them when they show up to work. Showing thanks, giving appreciation, valuing your staff," Jennifer Shaer, MD, says. A 2021 survey tells us that 79% of employees believe their company's wellbeing programs help them be productive employees, but a lot of work still needs to be done. In today's episode, Jennifer Shaer, MD, joins us to discuss wellness in the workplace and how to nurture a positive culture. Dr. Shaer is the Chief Wellness Officer of Allied Physicians Group in Melville, New York, as well as a board-certified pediatrician, an International Board-Certified Lactation Consultant and a certified executive and life coach. "Sometimes you just need a change in your working environment, physically. Sometimes you need a change in your internal world. I've worked with lots of people who have been able to change their mindset around their work and suddenly enjoy their work and extend their working years," Dr. Shaer says. Dr. Shaer has her own podcast called 'Reinventing the White Coat' which you can find here. This episode was recorded at the 2023 American Academy of Pediatrics National Conference and Exhibition. Some highlights from this episode include: How to nurture a positive workplace culture Implementing discipline appropriately Identifying a toxic situation How to advocate for yourself This episode is underwritten by Aegon Transamerica Foundation, a proud supporter of Charting Pediatrics and Children's Hospital Colorado. The Aegon Transamerica Foundation helps build a better world by committing to the improvement of wellness throughout their communities. Their partnership with Children's Colorado addresses the youth mental health crisis to help create a better mental health future for children. Thank you to Aegon Transamerica Foundation for investing in Children's Colorado. For more information on Children's Colorado, visit: childrenscolorado.org

Suicide is the second leading cause of death for children, adolescents and young adults ages 10 to 24. Roughly 7% to 8% of adolescents attempt suicide each year and 17% report significant suicidal ideation. However, while so many kids are affected, diagnosing them isn't so simple. "We know the numbers have climbed significantly. If you look at the trends, we're probably nearly double what we were 20 years ago," Eric Sigel, MD, says. In this episode, we shine a light on how to clinically identify youth at risk for suicide and determine if they have access to lethal means, such as firearms or medications. In addition, we will discuss evidence-based approaches to reduce or eliminate access to lethal means. That includes counseling and safe storage device distribution. Our guest, Dr. Sigel, specializes in adolescent medicine at Children's Hospital Colorado. He is the lead for firearm injury prevention, as well as a professor of pediatrics at the University of Colorado School of Medicine. In addition, he serves as co-chair of the American Academy of Pediatrics firearm injury prevention special interest group. "I think it's an incredible privilege to sit down with a teenager, hear their story and understand a little bit what they may be going through, while being able to help them figure out a better direction to avoid harm," Dr. Sigel says. This episode was recorded at the 2023 American Academy of Pediatrics National Conference and Exhibition. Some highlights from this episode include: The prominence of adolescent suicide in today's society Approaches to suicidal identification in a clinical setting How a change in easy firearm access can prevent suicide Evidence on counseling and safe storage of firearms For more information on Children's Colorado, visit: childrenscolorado.org

One goal in our healthcare improvement is to achieve equitable access to high quality emergency care for kids, regardless of where that child is physically located. Children have unique characteristics and needs, especially in the emergency setting, and the reality is that not all kids have access to specific pediatric care. In fact, 80% of children receive emergency care in general emergency departments, most of which see less than 15 pediatric patients a day. However, care in those adult settings is not specifically geared towards children. Research shows that pediatric readiness results in lower mortality rates among sick and injured kids. Fortunately, ongoing state and national initiatives are making strides in enhancing pediatric readiness. "The first piece of this is that the focus is on system design. This is not about the failings of a single provider, or the knowledge or skill set of healthcare providers. We are only as good as the system in which we work," Katherine Remick, MD, says. In today's episode we are joined by Dr. Remick as well as Kathleen Adelgais, MD. Dr. Remick joins us from Austin Texas, where she is a pediatric emergency medicine provider and an associate professor of pediatrics at the University of Texas at Austin Dell Medical School. She is also the Associate Chair for Quality, Innovation, and Outreach within the Department of Pediatrics. In addition, she is co-director of both the National EMS for Children Innovation and Improvement Center, as well as the National Pediatric Readiness Project. Dr. Adelgais is an emergency medicine physician here at Children's Hospital Colorado and the project director of the Colorado EMS for Children Program. "There are a series of research studies coming out left and right, right now that show the real dramatic impact of pediatric readiness, Dr. Adelgais says. "The research we are getting from the rich data set of the pediatric readiness scores across hospitals, you're hard pressed to find any treatment anywhere for anything that reduces mortality that dramatically." Some highlights from this episode include: What pediatric readiness is and how we achieve it The importance of system-level improvements What COPPER is and how it aligns with national efforts What the pediatric readiness score measures Success through the data For more information on Children's Colorado, visit: childrenscolorado.org

2023 has been an impactful year. We kicked it off by continuing to cover topics under our mental health series. The rise of teen substance abuse and addiction, the intersection between physical and mental health, as well as depression and other mood disorders are just a few of the topics we dove into. Season 6 wrapped up by discussing the trauma and care around gun violence and highlighting some incredible women in medicine. Season 7 launched in August and if you haven't noticed, we've started to make some prominent changes. Our audio is sharper, our show notes are more robust, and our attention to detail is more precise. We are taking all of these positive changes into 2024 and are excited to show you what else we have in store. This episode was an opportunity to get all our hosts together, Drs. David Brumbaugh, Alison Brent and Dan Nicklas, and end 2023 the right way! From all of us at Charting Pediatrics and Children's Hospital Colorado, we wish you and your families a happy and healthy holiday season and New Year. Thanks for listening, we will see you next year!

In 2021, federal rules from the 21st Century Cures Act mandated that most clinical notes be made available in real-time, online and free of charge to patients. This practice, commonly known as "open notes," was a significant step towards enhancing medical information transparency–– a vital step in reinforcing trust in the provider-patient relationship. However, it also introduced complexities, raising questions as to what to include in the notes. "The ethical analysis does not always align with the legal analysis, and these are conversations that ethicists are aware of," Steven Bondi, MD, JD, says. Dr. Bondi, a lawyer turned doctor, is renowned for his expertise on the Cures Act, Open Notes and Electronic Medical Records. He specializes in pediatric medicine at Golisano Children's Hospital and is an associate professor within the Department of Pediatrics at the University of Rochester Medical Center. "I think that knowledge is important, and we need to know what the law says and what its parameters are and when we can use the exceptions," Dr. Bondi says. Dr. Bondi recommends multiple resources on this topic. He suggests visiting healthit.gov and navigating to their information blocking section for informative FAQs and webinars. He also recommends the Guttmacher Institute as a source for general knowledge around adolescent health and privacy. Lastly, he explains that he was recently a part of the American Academy of Pediatrics' committee on medical liability and risk management where he helped produce a monthly column called 'Pediatricians in Law.' This episode was recorded at the 2023 American Academy of Pediatrics National Conference and Exhibition. Some highlights from this episode include: How to navigate difficult situations and avoid labels The role that ethics play in this discussion Confidentiality in adolescents by state Biggest pitfalls and gray areas Disclaimer: Please note that Dr. Steven Bondi is not an attorney for Children's Hospital Colorado and the information presented in this podcast does not constitute legal advice. Regarding interpretation or application of any of the laws and regulations referenced in this episode, it is recommended that you consult with legal counsel familiar with the laws and regulations applicable to your particular jurisdiction and/or service area. For more information on Children's Colorado, visit: childrenscolorado.org

Vaccines are so successful that many people have never seen the diseases they prevent, resulting in misperceptions that vaccines are not needed. While anti-vaccination sentiment and misinformation increased during the COVID-19 pandemic, about 88% of Americans still say they feel the overall benefits of childhood vaccines outweigh the risks. Communicating vaccine science to the public is even more crucial than in times past. It's up to our doctors and medical experts to relay factual information that is backed by science and supported by research. Without receiving proper vaccinations, preventable diseases will keep recurring. In today's episode, we are joined by Paul Offit, MD, whose path toward infectious disease prevention started at the young age of 5 when a failed foot operation landed him in a hospital in suburban Baltimore for nearly six weeks. "If you're in a chronic care facility in the mid 1950s, because I was born in 1951, you're in a polio ward. So, I remember that," Dr. Offit says. Now Dr. Offit is a professor of vaccinology at the Perelman School of Medicine at the University of Pennsylvania. He is an attending physician in the division of infectious diseases at Children's Hospital of Philadelphia, as well as the director of the Vaccine Education Center. "I think the scars of our childhood invariably become the passions of our adulthood. I think it's the reason I became a doctor, I think it's the reason my first book was about polio and the polio vaccine, I think it's why I went into infectious diseases," Dr. Offit says. This episode was recorded at the 2023 American Academy of Pediatrics National Conference and Exhibition in Washington, DC. Some highlights from the episode include: Reasons why people have become so hesitant about vaccines Some of the biggest misconceptions and stigmas around vaccine science Why we need more societal trust in vaccines The role of mRNA How we can use communication to better our future For more information on Children's Colorado, visit: childrenscolorado.org

For most of our careers, our treatments for genetic -based diseases have been supportive, not curative. Our medication recommendations for patients have been based on the expected response of the average individual, but as experts explain, these practices are going to change fast. We are on the cusp of a revolution for two main reasons. First, the ability to understand one's unique genetic profile through genetic sequencing has become more accessible to clinical teams. Second, there are now mechanisms for manipulating one's genetic code to overcome diseases. So what does this mean we can expect over the next decade? Scott Demarest, MD, shares his experience in precision medicine and what that foreshadows for treatments to come. "This is sort of the most extreme version of personalized care that you can imagine and it was something that redefined what we think of as possible within medicine," Dr. Demarest says. Dr. Demarest is an associate professor of pediatric neurology at the University of Colorado School of Medicine and the clinical director of the Precision Medicine Program at Children's Hospital Colorado. He's a perfect expert for this topic, as his research has focused on the characterization of clinical features and clinical trial design for disease -modifying treatments, as well as the development of novel precision therapies for epilepsy and neurogenetic conditions. "I think it's really important that we embrace the genomic era but that we do it very carefully and responsibly," Demarest says. Some highlights from this episode include: Explanation of precision medicine What types of treatments have evolved over time that allow us to manipulate someone's genetic code Current barriers to more regular use of precision medicine How ethics play a role in this specified type of medicine Experience designing a treatment for one individual patient For more information on Children's Colorado, visit: childrenscolorado.org

Our medical community stretches far and wide, with experts that wear many hats. One prevalent group making an impact on the future of childhood medicine is our pediatric trainees. In 1989, the American Academy of Pediatrics (AAP) founded the Section on Pediatric Trainees with a goal to empower and enable pediatric trainees to be strong leaders and advocates for the health and well-being of children. This group aims to be the central source of information, education, and networking for their peers. With over 16,000 members to date, medical students, residents, and fellowship trainees are learning to make a difference in the lives of each child they work with. We recorded this episode at the 2023 AAP National Conference and Exhibition, which couldn't have served as a more perfect place to discuss this topic. "For the medical students listening out there, if you have any interest or if you think you know what specialty you're interested in, just going to these conferences and getting plugged in with these organizations really opens your eyes to a lot of networking opportunities," Amundam Mancho, MD, MPH, says. Today we are joined by Dr. Mancho, a resident physician at Boston Children's Hospital and Boston Medical Center. She also leads the Section on Pediatric Trainees as the executive coordinator on equity, diversity, and inclusion, or DEI. DEI work is central to her advocacy, and she hopes to expand opportunities for other students making their way through their medical education. "We want trainees to feel like even though that representative isn't necessarily there, that people feel empowered they feel culturally competent and also have that understanding to recognize differences that our patients bring to the space," Dr. Mancho says. Some highlights from this episode include: How DEI plays a role within the Section on Pediatric Trainees Exposing medical students and residents to advocacy opportunities within pediatrics The benefits organizations like AAP can provide for medical students For more information on Children's Colorado, visit: childrenscolorado.org

Respiratory Syncytial Virus (RSV) is one of the most common causes of childhood respiratory illness, resulting in annual outbreaks among all age groups. In the United States, an estimated 60,000 to 80,000 children, the majority of whom are under 6 months of age, are hospitalized each year. Approximately 100 to 300 kids die from this infection each year. RSV is the single most common cause of death from respiratory illness, after the newborn period, in developing countries. This year, the medical community has made history with the first RSV vaccine approvals for pregnant individuals, infants and the elderly. In this episode, we are taking a deep dive into RSVpref, which is the first RSV vaccine for use in pregnant individuals to protect newborns and infants from severe RSV in the first six months. We are also discussing nirsevimab, a monoclonal antibody, which protects infants and some children against RSV. That includes children 8 –19 at increased risk for severe disease. This is a significant milestone for the scientific community and for public health. "I think now, in another two or three years, we will decrease ER visits, we will decrease hospital visits and I hope we decrease ICU visits. And the next phase of course, hopefully in my lifetime, we get it into developing countries and see impacts on mortality," Eric Simoes, MD, says. Dr. Simoes has been a part of the creation of these vaccines since the beginning and is our guest for this highly requested topic. He is a clinical professor of pediatrics and infectious disease at the University of Colorado School of Medicine, as well as a professor of epidemiology at the Colorado School of Public Health. He is currently an active clinical infectious disease physician at Children's Hospital Colorado. Of important note, Dr. Simoes served as the global primary investigator for the RSVpreF and lead investigator for the development of nirsevimab. Some highlights from this episode include: How these vaccines received approval and became available on market Indications to delivering this vaccine to a pregnant person Benefits of receiving these vaccines The future of this vaccine and its impact on people of different ages For more information on Children's Colorado, visit: childrenscolorado.org

The preteen and teenage years are taxing and have become increasingly difficult for a multitude of reasons. This is a part of the patient population that pediatricians really worry about. Part of the angst of this time of life has always been the changes that occur to kids' bodies as they grow – particularly for young girls. This experience is different as they experience menarche, the onset of menstruation, which can be both psychologically and physically challenging. Menstrual irregularities are very common, occurring in an estimated 14% to 25% of all women of childbearing age. Many gynecologic conditions diagnosed during childhood require treatment that extends into adulthood and it's hard to stay abreast of all the new therapies and hormonal management strategies of menstruation. "When you can really connect with a teen who is so vulnerable so has just been struggling that recognizes that this is normal, that they are not alone, and that we can help, that's pretty great," Tricia Huguelet, MD, says. Today we are joined Dr. Huguelet, a pediatric and adolescent gynecologist at Children's Hospital Colorado. While she didn't always plan for this career route, she developed a love for pediatrics from an early age. She fondly reflects on her memories going on rounds with her father who was a pediatrician focusing on pediatric infectious disease. Combining her love for children with her passion for surgery, she has become the section chief of pediatric and adolescent gynecology at Children's Colorado, as well as a faculty member in the OBGYN department at the University of Colorado School of Medicine. "When I discovered that not only could I do reproductive care for women but then specifically focus in kids and teens it was a no brainer that that was where I was going to focus my time," Dr. Huguelet says. Dr. Huguelet explains how menstrual abnormalities are not just physically demanding, but can create a strain on mental health. "I mean I've had patients with bleeding disorders who we send letters to school and they still aren't excused. So just the embarrassment over that and day to day life when you don't want to talk about it, you certainly don't want to show it, has a tremendously negative impact," Dr. Huguelet says. Some highlights from this episode include: Most common menstrual abnormalities in children How to normalize these conversations between kids and parents Management and treatment of these abnormalities Mental health impacts from menstruation abnormalities For more information on Children's Colorado, visit: childrenscolorado.org

We live in a country where medical experts are breaking barriers and changing outcomes on a daily basis, so it's always exciting when we get to celebrate one of our own. Recorded at the 2023 American Academy of Pediatrics (AAP) National Conference and Exhibition in Washington, D.C., this episode honors David Keller, MD, who was recently named the recipient of the 2023 AAP Job Lewis Smith Award. "I want to be a part of the solution to problems," Dr. Keller says. The award recognizes lifelong outstanding career achievement in community pediatrics and is the highest award bestowed by the council. Dr. Keller has dedicated more than 40 years to advancing child health and he currently serves as the Department of Pediatrics Vice Chair of Clinical Strategy and Transformation at Children's Hospital Colorado. "We as pediatricians need to remember that children always live in context. There is no such thing as an isolated child. They live in the context of their families, but they also live in the context of their communities. If we don't understand the communities that our kids live in, then it's really challenging to understand how illness interacts with that community and how you can intervene," Dr. Keller says. Some highlights from this episode include: Dr. Keller's early career influences How he earned this prestigious award How we learn more about the context of our patients Advice for young doctors and medical professionals trying to make their own imprint For more information on Children's Colorado, visit: childrenscolorado.org

In the United States, 77% of vector-borne diseases are transmitted by ticks and numbers have increased dramatically in recent decades. While Lyme disease may be the most common in the country, with an estimated 475,000 new cases each year, there are many other vector-borne diseases affecting people every day. Information is constantly shifting related to current and predicted changes in the epidemiology of tick-borne diseases, age -specific clinical and laboratory manifestations, as well as treatment. In addition, there are many public misconceptions regarding vector-borne infections and approaches to infection. What is the risk of labeling someone as having Lyme disease and possibly missing the true diagnosis? We answer that question and many more on today's episode. "When we think about tick-borne infections, I always like to focus on the tick, the organism that it transmits to and then on the disease process," Lourdes Eguiguren, MD says. This episode was recoded at the 2023 American Academy of Pediatrics National Conference and Exhibition in Washington, D.C., which provided us an opportunity to speak with experts in- person from across the country. As an infectious disease expert with a focus on tick-borne infection at Children's Nebraska, Dr. Eguiguren is here to share her knowledge. She is an assistant professor in the division of infectious diseases at the University of Nebraska Medical Center. She has a passion for teaching trainees and connecting with her patients on a personal level. "Many times, we actually come up with a differential diagnosis or even the final diagnosis by talking to parents", Dr. Eguiguren says. Some highlights from this episode include: Key details about Lyme disease How disease is transmitted from tick to organism The impact of climate change on the prevalence of ticks Breaking down misconceptions about vector-borne infections What treatment options look like For more information on Children's Colorado, visit: childrenscolorado.org

For parents expecting a newborn, their top priority is bringing a healthy baby into this world. But it's not just their responsibility while their baby is in the womb. As newborns, important screenings are changing health outcomes. Over 98% of U.S. newborns are screened for hearing loss and about 6,000 U.S. infants born are identified early with a permanent hearing loss. In all 50 states and Washington D.C., there are newborn screening laws to make sure these tests happen. Experts say they are crucial to keep at the forefront of newborn care. It's doctors like Owen Darr, MD, whose passion is helping these kids live the best life possible. "Working with families, helping them through a difficult time, finding interventions –– sometimes small, sometimes big –– that can really make a positive impact on a child's life," Dr. Darr says. In today's episode, we are joined by Dr. Darr and Kristin Uhler, PhD. Dr. Darr specializes in otolaryngology at Children's Hospital Colorado. He is also an assistant professor of otolaryngology, head and neck surgery. Dr. Uhler is an audiologist at Children's Colorado, as well as an associate professor of physical medicine and rehabilitation. Dr. Uhler explains that 1998 was the year experts provided the efficacy for newborn screening. "Where they realized if you screen a baby by 1 month of age, you then rescreen them at and diagnose them with either hearing loss or normal hearing by 3 months of age, and then enroll them in early intervention by 6 months of age, that they have language on par with their typical hearing peers by preschool," Dr. Uhler Says. Some highlights from this episode include: Why we screen newborns and what we are screening for Sensitivity and specificity of the hearing test Intervention options to help children with hearing loss When physicians should refer kids for a hearing test Today's episode is underwritten by the Daniels Fund, in recognition of their longstanding commitment to the Bill Daniels Center for Children's Hearing at Children's Hospital Colorado. Cable television pioneer Bill Daniels suffered hearing loss traced to his service as a decorated fighter pilot in World War II. His experience formed a strong catalyst for the Daniels Fund's gifts to support Children's Colorado, since 2005. Thank you to the Daniels Fund for continued investment in Children's Colorado to help children who are deaf or hard-of-hearing receive the care that they need to grow into healthy and dynamic citizens. For more information on Children's Colorado, visit: childrenscolorado.org

We have listeners all over the world, many of whom are Spanish-speaking. Did you know we have a sister podcast, Pediatras en Línea? It stands out as one of the only podcasts in Spanish that focuses on medical education. About two and a half years ago, Pediatras en Línea launched and became a critical resource for pediatricians all throughout the U.S. and Latin America. Fast forward to today, they are growing 277% per month and have audience members in 90 countries. In 20 of those countries, Spanish is the official language. In this episode, we are joined by the host of Pediatras en Línea, Carla Torres-Zegarra, MD. Dr. Torres-Zegarra is a pediatric dermatologist at Children's Hospital Colorado and assistant professor of dermatology and pediatrics at the University of Colorado School of Medicine. Born and raised in Lima, Peru, Dr. Torres-Zegarra moved to the U.S. in 2009 to pursue medical school and has been practicing at Children's Colorado since 2013. She says being able to work here at Children's Colorado is a dream. "Now I feel the need to give back to the people that have allowed me to have this opportunity by being a resource and even an inspiration for those who are listening outside of the states," Dr. Torres-Zegarra says. About 42.5 million people in the U.S. speak Spanish, and that number increases to more than 457 million worldwide. However, when we specifically look at the medical profession, only 6% of physicians identify as Hispanic and just 2% of non-Hispanic physicians are Spanish-speaking. Of that 6%, Dr. Torres-Zegarra highlights that only 2.4% are female. Through her podcast, she hopes to inspire other Spanish-speaking women to become physicians. "I am just one of them, and I am very happy to be one of them," Dr. Torres Zegarra says. Some highlights from today's episode include: An overview of Pediatras en Línea The power of social media Challenges faced by overseas-trained doctors when relocating to the U.S. How these podcast episodes allow pediatricians to always learn something new For more information on Children's Colorado, visit: childrenscolorado.org

Miracles happen every day and it's an honor when we can celebrate them. This year marks the 60th anniversary of the start of newborn screening in the United States. The program identifies infants with specific genetic conditions that are asymptomatic at birth and ensures they can receive prompt, lifesaving medical interventions. Over its lifespan, the program has saved countless lives. New research and technological advancements have allowed for innovation and enhanced abilities to screen for certain disorders. Today, newborn screening has evolved into one of the most effective public health programs in the country and its impact won't stop anytime soon. On this 60th anniversary, experts are celebrating successes while still trying to improve current processes. "False positives are the Achilles' heel of newborn screening. I know we always think about not missing a case, but the harms are almost all associated with telling a parent their child is positive when they aren't. Some of these treatments are time critical," says Ned Calonge, MD, one of our guests on today's episode and the Chief Medical Officer for the Colorado Department of Public Health and Environment. Dr. Calonge is joined by Stacey Martiniano, MD, a physician here at Children's Hospital Colorado and Gregory Bonn, the Colorado newborn screening program manager. They are three experts behind some of the early intervention that ensures every child can live the healthiest life possible. "My favorite part is helping them stay as healthy as possible, live full lives and keeping that relationship with them throughout their childhood and young adulthood," Dr. Martiniano says. Some highlights from today's episode include: Variations of newborn screening programs in different states and countries How technology has advanced what's possible to identify and treat The history of how the program was created What's on the horizon for newborn screening For more information on Children's Hospital Colorado, visit: childrenscolorado.org

During the 2022-2023 admission cycle, about 22,700 students enrolled in medical school in the United States. In this country alone, we have 154 medical schools offering an MD program. Many of these schools are actively working to incorporate modern learning principles into their structure. It's all a part of a larger goal to align the forces affecting the delivery of care with educational priorities. Over time, comprehensive care has become a widely accepted standard for modern medicine; it puts positive patient outcomes at the forefront. That's why creating those environmental opportunities are crucial to medical students as they prepare for a long career at the bedside. A Longitudinal Integrated Clerkship, or LIC, is a clinical curriculum in which students participate in the comprehensive care of patients over time. "LIC students have been found to experience lasting improvements in their patient centeredness, in their empathy, and also student satisfaction is higher," says Amy Grover, MD, an assistant professor of pediatrics and pediatric hospital medicine. Patient-student relationships are at the heart of LICs. We see these across the scope of medical education worldwide, but there is something unique about the LIC model here at Children's Hospital Colorado. Dr. Grover is a guest on today's episode, along with Meghan Treitz, MD, an associate professor of pediatrics and general pediatrics, and Margie Rodgers, an LIC coordinator. "One of the advantages of this model is students get exposure to the clinical world earlier and also at the end of their second year have had exposure to all of the core disciplines so planning for residency and career is actually made a little bit easier," Dr. Treitz says. Some highlights from this episode include: What an LIC is and how it works The advantages of an LIC curriculum compared to other medical education practices How students learn every discipline through an LIC in a pediatric hospital setting Stories about unique patient care experiences from students Articles referenced in the podcast: Hirsh DA, Ogur B, Thibault GE, Cox M. "Continuity" as an organizing principle for clinical education reform. N Engl J Med. 2007 Feb 22;356(8):858-66 Hirsh et al. Better learning, better doctors, better delivery system: possibilities from a case study of longitudinal integrated clerkships. Med Teach 2012;34(7):548-54. Walters, et al. Outcomes of longitudinal integrated clinical placements for students, clinicians and society. Med Educ 2012; 46: 1028-1041 Poncelet, et al. Development of a longitudinal integrated clerkship at an academic medical center. Med Educ Online 2011; 16: 5939. Hirsh D, Gauberg E, Ogur B, et al. Educational outcomes of the Harvard Medical School—Cambridge integrated clerkship: a way forward for medical education. Acad Med. 2012;87:643-50 Teherani, et al. Outcomes of Different Clerkship Models: Longitudinal Integrated, Hybrid and Block. Acad Med 2013; 88: 1-9 Gaufberg E, Hirsh D, Krupat E, et al. Into the future: patient-centeredness endures in longitudinal integrated clerkship graduates. Med Educ. 2014;48:572-82. Flick RJ, Adams JE. Alliance, trust, and loss: experiences of patients cared for by students in a longitudinal integrated clerkship. Acad Med. 2019 Beard AS, Candy AE, Anderson TJ, Derrico NP, Ishani KA, Gravely AA, Englander R, Ercan-Fang NG. Patient satisfaction with medical student participation in a longitudinal integrated clerkship: a controlled trial. Acad Med. 2020. 95(3):417-424. McKenna et al. The missing link: connection is the key to resilience in medical education. Acad Med 2016 Wald, Hedy S. PhD Professional Identity (Trans)Formation in Medical Education, Academic Medicine, 2015 For more information on Children's Colorado, visit: childrenscolorado.org

The relationship between a child and their furry friend is a very special one, especially when that relationship benefits their physical and mental health. A growing body of evidence demonstrates that animal-assisted therapy helps children cope with and heal from health problems. In addition, we know that interacting with a gentle, friendly pet can decrease pain, reduce anxiety, and encourage communication. A new randomized, controlled study is shining a light on the powerful child-canine connection, telling us that twice weekly sessions with a dog and its handler significantly lowers children's cortisol levels. Here at Children's Hospital Colorado, we've seen that progress happen in real-time with our Medical Dog Program, and the success of this work is just getting started. "There are those things that you can measure, but then there are the pieces about just knowing for families or hearing from them they couldn't have coped with the hospitalization if it wasn't that Halo was a part of their journey," says Devin Devlin, a medical dog handler and child life specialist at Children's Colorado. Devlin, along with Brianne Newman, another medical dog handler and child life specialist, are our guests on today's episode. However, for the first time in our Charting Pediatrics' history, they are joined by two special guests, facility dogs Halo, MD, and Galaxy, MD. You may be wondering: Dogs can become medical doctors?! While that would be awesome, the MD for these two stands for medical dog. Devin is the primary handler for Halo, MD and Brianne is the secondary handler for Galaxy, MD. These two beautiful, fluffy golden retrievers turn 6 on October 1st, 2023. Devin and Brianne are constantly in awe at the impact these dogs make and are so excited to help share their story with our listeners. One patient even named their newborn baby after Halo! They say being on the end of their leashes as they change kids' lives is a sheer privilege. "I'm going to get a little choked up when I say this because the kids here are so brave, and so getting to watch them, what they go through and what they're able to accomplish is just incredibly rewarding," Brianne says. Some highlights from today's episode include: A day in the life of a medical dog handler and their facility animal Examples of positive health outcomes for patients The training that goes into the work of a medical dog How these canines get their creative names! For more information on Children's Hospital Colorado, visit: childrenscolorado.org

In the United States, nearly 68 million people speak a language other than English at home. That number has virtually tripled over the last three decades. As our country continues to experience this soaring growth, qualified medical interpreters are becoming more essential to improving health outcomes and achieving health equity goals. Patients with hearing loss or limited health literacy may also require interpretation services. "Effective communication through interpreter utilization is one of the most important things we can do to help our patients with that," Anna Ruman, MD, says. Dr. Ruman is one of our guests on today's episode. She is an assistant professor of pediatrics at the University of Colorado School of Medicine and a hospitalist at Children's Hospital Colorado. Her passion for this work started before attending medical school. After minoring in Spanish in college, she lived and worked in Mexico. From there, she made her way to Chicago to work as an English-Spanish health educator. She is joined by Nancy Casillas, a medical interpreter and program coordinator for the Medical Interpretation and Translation Department here at Children's Colorado. Casillas, a first-generation Mexican American, has been with Children's Colorado for 16 years and understands the challenges of having English as a second language. "I feel that through this work, I'm helping those families who may be newly arrived immigrants to the country, and they may feel a little lost, and with my skills I'm helping them feel not so lost in this country," Casillas says. These experts explain how the Centers for Medicare & Medicaid Services has specifically identified language access as one of the five priority areas for the next year, aligning with the shared goal to reduce or eliminate healthcare disparities. Some highlights from this episode include: How medical interpreters enhance health equity Advantages and disadvantages of different types of interpreting Qualifications for interpretation practice versus being bilingual Advancements happening at Children's Colorado For more information on Children's Colorado, visit: childrenscolorado.org

Our pediatricians hear it time and time again: "My child is a picky eater." Many times, it starts when kids are young, which naturally creates worry for parents. "It's so innate in us that parents want to feed their children," Dr. Dan Nicklas, our host, says. Researchers looked at the habits of children between 4 and 9 years old and found that because picky eaters don't tend to grow out of it, parents need to intervene before their child turns 2. When children reach the age of 1, the transition from formula or breast milk to whole milk and table food becomes a pivotal time, as children start forming opinions about food. In this episode, Stephanie Gilley, MD, and Rebecca McNab join us to provide strategies for navigating conversations with patients about their children and how they approach meals with their family. Dr. Gilley is a pediatric Clinical Nutrition Physician at Children's Hospital Colorado, as well as an assistant professor at the University of Colorado School of Medicine. Rebecca is an occupational therapist and certified lactation education counselor. They explain this is a journey many parents find themselves on without a single path, but there are ways to create healthy, intuitive relationships with food for their kids. There are many resources out there for parents to rely on but it's important to know what you're looking for. "Parents should not be following any account that makes them feel bad about what they are doing," Dr. Gilley says. She suggests two resources in particular: Kids Eat in Color and Feeding Littles. Some highlights from this episode include: • Parent's responsibility versus child's responsibility • Importance of fostering a child's independence • Creative ways to make food exciting • How feeding disorders are different than picky eating Today's episode is underwritten by Aegon Transamerica Foundation, a proud supporter of Charting Pediatrics and Children's Hospital Colorado. The Aegon Transamerica Foundation helps build a better world by committing to the improvement of wellness throughout their communities. Their partnership with Children's Colorado addresses the youth mental health crisis to help create a better mental health future for children. Thank you to Aegon Transamerica Foundation for investing in Children's Hospital Colorado. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

For many practicing doctors today, advancements in science currently unfolding seemed futuristic during their years of training. Fetal care and in utero surgery are at the forefront of these advancements. Specifically, over the last 50 years, growth of maternal-fetal medicine and the importance of fetal care centers have grown exponentially. Medical evolutions have paved the way for specialists to treat an unborn child as a separate patient, offering life-saving care before birth. Our team at Children's Hospital Colorado has performed more than 1,600 surgeries, making us one of the most experienced fetal centers in the country. That's why this week we are thrilled to welcome Sarkis (Chris) Derderian, MD, as our guest on Charting Pediatrics. As an expert in this field, he is currently an assistant professor of surgery and a pediatric surgeon at Children's Colorado, but his passion for fetal care began during his medical school years. "It was actually trauma that looped me into pediatric surgery and that I remember a 3-month-old baby that was in a car accident, terribly sick at the time, but at the time I left that rotation that baby was up moving around and it was just really a reflection of how resilient this population is," Dr. Derderian says. Throughout this episode we dive into what fetal surgery currently looks like and how its progression gives as a look inside what the next 50 years could look like. "I think it's going to be revolutionary what we can do," Dr. Derderian says. It's a space that's pushing the envelope to provide a new quality of life. Some highlights of today's episode include: · Conditions being intervened by fetal surgery · Diagnosing disease processes early in gestation · How concepts like animation help make information digestible for families · The future potential of fetal surgery For more information on Children's Hospital Colorado, visit: childrenscolorado.org

Welcome back to another exciting season of Charting Pediatrics! For our long-time listeners, we are thrilled to have you back, and for anyone new to our audience, we couldn't be more excited that you've joined us. In this first episode of Season 7, we dive into the world of Type 1 diabetes (T1D). Did you know that one in 300 individuals under the age of 20 is affected by this condition? Our guest on today's episode, Kimber Simmons, MD, isn't just an expert in her field; she was a part of that statistic after getting diagnosed at just 8 –years old. Now, as an associate professor of pediatrics and pediatric endocrinology, as well as a pediatric endocrinologist at Children's Hospital Colorado and the Barbara Davis Center for Diabetes, she's shedding light on some of the latest research. Dr. Simmons and other experts explain alternative approaches that modify the natural course of T1D, rather than solely treating hyperglycemia, could dramatically improve both the quality of life and health outcomes for patients. In this episode, we review strategies for early diagnosis of T1D that predict, as well as prevent or delay, the onset of clinical T1D during preclinical stages of the disease. We also discuss an exciting new medication, Tzield (teplizumab-mzwv), with the promise of delaying the onset of clinical disease in T1D. "It is going to shift how we manage Type 1 diabetes in the future," Dr. Simmons says. Some highlights from today's episode include: How the predictability of T1D has changed over the years Expansion of screening programs worldwide New breakthrough medication, Tzield (teplizumab-mzwv), approved in the U.S. to delay the onset of clinical T1D Children's Colorado program to help providers identify the disease and follow up For more information on Children's Hospital Colorado, visit: childrenscolorado.org

It's time to jump back into the ever evolving world of pediatrics. On this new season of Charting Pediatrics, one of the top 5 pediatric podcasts in the world, we expand our horizons, discuss cutting edge research and cover hot topics among the medical community. Season 7 will push new boundaries, answer lingering questions and take us on the road for in person interactions. Get ready for August 29th, it's a season you won't want to miss. For more information on Children's Hospital Colorado, visit: childrenscolorado.org .

In this episode, we discuss food allergy, a very important topic for the general pediatrics community. Matthew Greenhawt, MD, joins us for this discussion as an expert in pediatric allergy and a leader of pioneering international studies looking at how we treat life- threatening food allergies in kids. Guest: Dr. Matthew Greenhawt specializes in pediatric allergy and immunology and is the director of the Food Challenge and Research Unit at Children's Hospital Colorado. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

Imagine you have a new 13-year-old patient in your practice. When you perform a return-to-school physical examination, you notice healed linear cutting marks on both of their wrists. The remainder of your exam is normal. In light of this finding, what are your next steps? What questions should you be asking the family and the patient, and what should you be concerned about today? As part of our mental health series, in this episode we discuss nonsuicidal self-injury (NSSI). This is a common problem in teenagers and young adults, with some studies estimating a prevalence of up to 18% in high school students. Considered a developmental-timed problem, NSSI becomes much less common with age. Which begs the question, what's happening inside that teenage brain? Two Children's Hospital Colorado experts join us to help decode what is going on. Guests: Evadine Codd, PhD, is a licensed psychologist at Children's Colorado within the Pediatric Mental Health Institute. Luke Miller, MD, is a child and adolescent psychiatrist at Children's Colorado. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

The important but ever-elusive goal of work-life balance is still more out of reach for women than men. Studies of home workloads for physicians indicate that the bulk of the nonprofessional work at home still falls to women. As a result, female physicians experience more work-family conflict than their male counterparts. This dynamic can lead to decreased job satisfaction, fewer women seeking professional advancement and increased burnout. In this episode, we talk with Children's Hospital Colorado experts about their research in the area of work-life balance for female interventional radiologists. Guests: Jenny Zablah Alabi, MD, an associate professor of pediatrics and interventional cardiology at the University of Colorado School of Medicine, and a pediatric cardiologist at Children's Colorado. Natalie Soszyn, MD, a second-year fellow in interventional cardiology at Children's Colorado. This episode is underwritten by Aegon Transamerica Foundation, a proud supporter of Charting Pediatrics and Children's Hospital Colorado. The Aegon Transamerica Foundation helps build a better world by committing to the improvement of wellness throughout their communities. Their partnership with Children's Colorado addresses the youth mental health crisis to help create a better mental health future for children. Thank you to Aegon Transamerica Foundation for investing in Children's Colorado. For more information on Children's Hospital Colorado, visit: childrenscolorado Resource: Work-Life Balance: The Expectations and Perspectives as a Female Interventional Cardiologist

The gut microbiome is a fascinating area of human health that we just started to better understand in the last two decades. With the arrival of PCR sequencing and advanced PCR techniques, we've been able to characterize the microbiome by looking at what organisms live there and how they vary by location and diet, as well as how the microbiome is influenced by things like exposure to antibiotics. We're beginning to understand the relationship between the microbiome and health, from how these bacteria influence human metabolism and immune system development to their association with autoimmune diseases. Although we've learned a great deal, there's still a lot for us to understand about our microbiome, including the relationship between our nervous system and the bacteria in our gut. In this episode, we'll explore what we know and what we have left to discover with our guest Jaime Belkind-Gerson, MD. Guest: Jaime Belkind-Gerson, MD, is a pediatric gastroenterologist at Children's Hospital Colorado. Dr. Belkind-Gerson is an expert in neurogastroenterology and gastrointestinal motility, and he's an associate professor of pediatrics at the University of Colorado School of Medicine. For more information on Children's Hospital Colorado, visit: childrenscolorado.org