Charting Pediatrics

One of the most concerning trends in child health is the increase in suicide rates over the last two decades in the United States. Suicide is the second leading cause of death in teenagers and young adults, and we should be alarmed both as pediatricians and citizens. We also need to ask questions about what this says about our society, what kind of promise and opportunity kids see for themselves, whether they are receiving the support they need, and if our healthcare system has the capacity to manage kids before and during a mental health crisis. As part of our ongoing mental health series, in this episode we discuss the alarming increase in suicide rates and some potential solutions to prevent suicide in children. Guests: Lisa Horowitz, PhD, MPH, is a pediatric psychologist and senior associate scientist at the National Institute of Mental Health (NIMH) Intramural Research Program at the National Institutes of Health in Bethesda, Maryland, and is a principal investigator at the NIMH studying detection of suicide risk in the medical setting. Jeff Bridge, PhD, is an epidemiologist and director of the Center for Suicide Prevention and Research in the Abigail Wexner Research Institute at Nationwide Children's Hospital in Columbus, Ohio. He is also the Nationwide Foundation Endowed Chair of Innovation in Behavioral Health Research and professor of pediatrics, psychiatry and behavioral health at The Ohio State University College of Medicine. Today's episode is underwritten by Modivcare Foundation, a proud supporter of Charting Pediatrics and Children's Hospital Colorado. The Modivcare Foundation is committed to improving the health of their members in communities across the country while advocating for the future of care through philanthropic funding. Their partnership allows Children's Colorado to make important changes to our state's mental health system, prevent suicide, and give youth the support and services they need to thrive. Thank you to Modivcare Foundation for your investment in Children's Hospital Colorado. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

It is not uncommon for newborn babies to have slight imperfections in their heads. Most of the time, these imperfections will fix themselves over time, or once they begin to develop. However, sometimes a more serious diagnosis will require medical interventions. Craniosynostosis is a condition where a baby's skull begins to fuse together too early. This occurs at birth or shortly after and if not treated, can affect brain development. Guests: Dr. Brooke French and Dr. Allyson Alexander. Dr Allyson is a Pediatric Neurosurgeon here at Children's Hospital Colorado and is also an Assistant Professor at University of Colorado School of Medicine. Dr. Brooke French is the Co – Director of Cleft and Craniofacial Surgery Programs and is also the Director of Cosmetic Surgery here at Children's Hospital Colorado. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

Sudden unexplained infant death, commonly known SUID, SIDS or crib death, affects approximately 3,400 infants each year. Sudden unexpected infant deaths usually occur when an infant is sleeping, and causes can include suffocation, unknown infection, ingestion and other unknown causes. Not only has there been minimal improvement in rates of sleep-related deaths over the past two decades, but racial and ethnic disparities in SUID persist, including increased mortality rates. These disparities are indicative of the broader landscape of inequities within our healthcare systems. Today, we are talking about how providers and healthcare professionals can educate families and help them catch early signs of SUID. Guests: Sunah Hwang, MD, is a neonatologist at Children's Hospital Colorado and an associate professor of pediatrics at the University of Colorado School of Medicine. Aniekan Udoko, MD is a neonatal-perinatal medicine fellow at Children's Hospital Colorado. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

In 2020, firearm injuries were the leading cause of death in Americans 18 years old and younger. There was a total of 3,230 children's deaths, of which 63% were homicide, 30% were suicide, 4% were unintentional injury, 2% were undetermined and 0.4% were legal intervention. Healthcare providers who interact regularly with parents and children are well-positioned to discuss evidence-based strategies that reduce unauthorized access to firearms and minimize the risk of firearm injury. Guest: Maya Haasz, MD, is a pediatric emergency medicine physician at Children's Hospital Colorado. Resources: The Journal of Pediatrics: Firearms, Physicians, Families, and Kids: Finding Words that Work For more information on Children's Hospital Colorado, visit: childrenscolorado.org

No day is the same as the last when you work in pediatrics. Not only are viruses and public health outbreaks always changing, so are regulatory and administrative factors that impact pediatric healthcare and caring for patients. In this episode, we look at the ever-changing landscape of pediatrics, including the evolving trends in payor mix and common pediatric diseases including RSV, diabetes and obesity. These conditions affect millions of people worldwide and have a significant impact on health systems around the world. Guests: Raphe Schwartz serves as Chief Strategy Officer at Children's Hospital Colorado. Rhae Gamber is a senior consulting director at Sg2 Healthcare Intelligence Services, a healthcare consulting firm. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

Sinusitis is a common viral or bacterial infection that causes swelling in the sinuses. Although some patients need prescription medication, often sinusitis can be triggered by allergies or the common cold. In general, sinusitis is overtreated with antibiotics. In the United States, there are five million antibiotic prescriptions for children and adolescents with acute sinusitis, and around 65% of patients are prescribed either amoxicillin or amoxicillin/clavulanate as first-line treatments. To date, there have been little to no studies to compare the effectiveness and safety of these prescriptions. In today's episode, we discuss a study done by Timothy Savage, MD, and Matthew Kronman, MD, to determine the effectiveness of antibiotics and how to determine who needs antibiotic treatment and who does not. Guest: Matthew Kronman, MD, MSCE, is the fellowship program director for Pediatric Infectious Diseases and the medical director of outpatient antimicrobial stewardship at Seattle Children's Hospital, and an associate professor at University of Washington School of Medicine. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

Necrotizing enterocolitis, or NEC, is a life-threatening illness with a mortality rate as high as 50% that almost exclusively affects neonates. The complex pathophysiology of NEC is based on an immature intestinal system that makes babies more susceptible to injury once they are fed. Ultimately, this can result in a breakdown of the gut, necrosis and then sepsis and death. There's still no known cure for NEC, but we will discuss the potential of probiotics, specifically lactobacillus reuteri, with our guest Gail Besner, MD. As part of our Women in Medicine series, we are pleased to talk to Dr. Besner, whose research at Nationwide Children's Hospital focuses on identifying novel therapeutic strategies to protect the intestines from intestinal injury, including necrotizing enterocolitis. Guest: Gail Besner, MD, is a surgeon-scientist at Nationwide Children's Hospital and The Ohio State University, holds the H. William Clatworthy, Jr. Chair in Surgery, and has been the Chief of Pediatric Surgery at Nationwide Children's Hospital for the past eleven years. She is a member of the Center for Perinatal Research at the Research Institute at Nationwide Children's Hospital. She was the Program Director of the Pediatric Surgery Residency Training Program for many years, and now serves as the Associate Program Director. She's also a scientific Co-Founder of Scioto Biosciences, Inc., a company designed to bring scientific findings from the laboratory to the bedside. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

An article published this spring reported that between 2008 and 2018, there was a 250% increase in suicide rates among 13- and 14-year-old youth in the United States across categories of gender, race and region. There are many factors that contribute to the startling suicide rates in the U.S., including the instability we experienced after the end of this study with the pandemic disrupting our lives. As part of our 12-episode mental health series, host Dr. David Brumbaugh discusses depression and other mood disorders with two mental health providers from Children's Hospital Colorado. Guests: Dr. Melissa Batt specializes in Child and Adolescent Psychiatry at Children's Colorado as part of the Pediatric Mental Health Institute and is an assistant professor at the University of Colorado School of Medicine. Dr. Joel Stoddard specializes in Psychiatry in the Pediatric Mental Health Institute at Children's Colorado and is an associate professor at the University of Colorado School of Medicine. For more information on Children's Hospital Colorado, visit: childrenscolorado.org. This episode is underwritten by Ent Credit Union, a proud supporter of Charting Pediatrics and Children's Hospital Colorado. Ent, Colorado's largest credit union, has a passion for people, not for profit. Ent has more than 45 service centers located up and down the Front Range, including the Denver Metro area and Northern Colorado. Insured by NCUA.

During the COVID-19 pandemic, we couldn't bring folks together to learn about and discuss important concepts in clinical medicine. Nationally, pediatrics board exam passage rates have been falling every year since 2019, hitting its lowest point of just 80% in 2023. For this episode, we talk with a group of residents who saw conference attendance dwindling at their institution and used Kotter's change model to get teachers and learners back together. They share their results, the challenges they faced, and the lessons they learned along the way about pediatric resident education in this new era. Guests: Drs. Sedler, Nguyen and Lion are all chief residents at Stanford University. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

In the emergency department, sepsis is a common problem and often lands patients in the ICU. Although there are many reasons patients may develop sepsis, it's critical to diagnose and treat this condition in a timely manner. In today's episode, we discuss sepsis and the point at which delays in antibiotics delivery increases the risk of mortality. Roni Lane, MD, works in the Division of Pediatric Emergency Medicine at Primary Children's Hospital (PCH) and is the project lead for the PCH Emergency Department Septic Shock Program. Dr. Lane is also an associate professor of pediatrics at the University of Utah. Halden Scott, MD, is an emergency medicine physician at Children's Hospital Colorado and an associate professor at the University of Colorado School of Medicine. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

Pediatricians see an array of patients with unique and individual needs, and each child requires their own specialized and unique care plan. As the rate of children diagnosed with autism continues to increase, it's important that pediatricians adapt and tailor visits to the needs of their patients. In this episode, we discuss some of the simple changes primary care providers can make to ensure patients with autism feel seen, comfortable and understood in their medical home. Guest: Katharine Zuckerman, MD, is a general pediatrician and associate professor at Oregon Health & Science University. Dr. Zuckerman is also a member of the of the AAP Council on Children with Disabilities Executive Committee. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

Today on the podcast, we are going to be doing something a little different. As pediatricians and health care professionals, we dedicate our lives and our careers to helping others. Day in and day out we spend our time making sure our patients receive the best care possible to live life to the fullest. Although this can be one of the most fulfilling careers out there, it can also be physically and mentally demanding. Today, I want to ask each of you, how often do you take the time to check in with yourself? How often do you reflect on your own physical and mental health? If you are struggling physically or emotionally, are you taking the time to get help? Today we are honored to have Dr. Adam B. Hill, a Pediatric oncologist and palliative care physician, join us to share his story from the battle with depression, suicidal thoughts and alcoholism while working in the field of medicine. Guest: Adam B. Hill, MD is the Palliative Medicine Department Chair at Children's Hospital Colorado. He recently wrote and published a book called "Long Walk Out of the woods: A Physicians Story of Addiction, Depression, Hope, and Recovery." For more information on Children's Hospital Colorado, visit: childrenscolorado.org

As primary care providers, it's easy to assess a patient based on the symptoms and circumstances they present with when they walk in the door. However, patients who had adverse childhood experiences (ACEs) may have psychological injuries from that trauma that are more difficult to recognize. These patients also have a lifelong risk for health problems. What if healthcare professionals changed their mindset from "what is wrong with this child?" to "what has happened to this child?" In this episode, we explore childhood trauma with two experts and dive into the concept of trauma-informed pediatric care. Guests: Lyndsay Jensen Gaffey, LPC, is the Director of Patient Care Services for the Pediatric Mental Health Institute at Children's Hospital Colorado. Steven Berkowitz, MD, works in the child and adolescent psychiatry unit at Children's Hospital Colorado and is the Director of the START (Stress, Trauma, Research and Treatment) Center. Dr. Berkowitz is also a professor at the University of Colorado School of Medicine. Today's episode is underwritten by Ent Credit Union, proud supporter of Charting Pediatrics and Children's Hospital Colorado. Ent, Colorado's largest credit union, has a passion for people, not for profit. Ent has more than 45 service centers located up and down the Front Range, including the Denver Metro area and Northern Colorado. Insured by NCUA. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

Children spend the majority of their time either at home or at school. In the state of Colorado, most children spend over 180 days, or 1,080 hours, a year at school. With so much time spent in the school environment, pediatric healthcare workers can collaborate with school health professionals by sharing a child's medical history, allergies, and medications to ensure children are receiving the best care possible. In this episode, we discuss the care children can receive while at school and how pediatricians can communicate effectively with their patient's school health professionals. Guest: Sara Kihn is a pediatric nurse who has been in the profession for over 30 years. She is the associate clinical manager for the school health program at Children's Hospital Colorado. Resources: Children's Hospital Colorado School Health Website (coming soon!) Colorado Department of Education, School Nursing and Health: www.cde.state.co.us/healthandwellness/snh_home National Association of School Nurses: www.nasn.org/home For more information on Children's Hospital Colorado, visit: childrenscolorado.org

The transition from adolescent to adult care can often be a series of challenging obstacles for patients, families, and providers. This time of adjustment can be both overwhelming and difficult, especially for patients with congenital health conditions. Moving from a parent supervised visit to an independent patient model takes time and often takes a lot of discussion. In this episode, we are going unpack and inform primary care providers on how they can play a pivotal role in the transition of care. Dr. Daniel Wood is the newest addition to our Urology department here at Children's Hospital Colorado. Resources: Twitter for pediatric healthcare professionals.

Learning how to read is a pivotal point in childhood development. Incorporating reading into a family's daily routine not only helps with brain development, but it also fosters an emotional relationship between children and their caregivers. Pediatric healthcare workers can help promote healthy reading habits by educating and assisting their patients and families at their pediatric well visits. Michelle Shiffman, MD, joins us on this episode to discuss approaches that help families integrate reading into their home lives. Dr. Shiffman is the Medical Director of Reach Out and Read, a nonprofit organization that helps equip families and pediatric practices with the tools and information they need to make reading aloud a daily routine. Guest: Michelle Shiffman, MD, is a pediatrician at Denver Health and the Medical Director for Reach Out and Read. Resources: Reach Out and Read Colorado: https://reachoutandreadco.org For more information on Children's Hospital Colorado, visit: childrenscolorado.org

There has been an overwhelming amount of change and disruption in the lives of kids over the last few years. Without the foundation of stability and predictability, many children are struggling with an array of anxiety disorders. As part of our ongoing Mental Health Series, Drs. Cassidy McNitt and Benjamin Mullins discuss how to support these kids and make sure they have access to the resources and help they need. Guests: Cassidy McNitt, MD, is an assistant professor of Child and Adolescent Psychiatry for the Children's Hospital Colorado Consultation and Liaison Service and the Colorado Pediatric Psychiatry Consultation and Access Program. Benjamin Mullin, PhD, is an associate professor of Psychiatry at the University of Colorado School of Medicine and a clinical psychologist. Dr. Mullin is the director of the Colorado OCD and Anxiety Program at Children's Colorado. Today's episode is underwritten by Ent Credit Union, proud supporter of Charting Pediatrics and Children's Hospital Colorado. Ent, Colorado's largest credit union, has a passion for people, not for profit. Ent has more than 45 service centers located up and down the Front Range, including the Denver Metro area and Northern Colorado. Insured by NCUA. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

Conjunctivitis, commonly known as pink eye, is a common eye infection that presents at pediatrician offices and often keeps kids out of school or daycare. Although conjunctivitis is commonly caused by viral infections, there are other reasons why a patient might get pink eye. As a pediatric provider, it is essential to understand the signs and symptoms of pink eye and to weigh the risks and benefits of prescribing antibiotics. This episode discusses the treatment of conjunctivitis and the role pediatricians play in antibiotic stewardship. Guest: Nicole Poole, MD, is an assistant professor of pediatrics in the Division of Infectious Diseases at the University of Colorado and the Associate Medical Director of the Antibiotic Stewardship Program at Children's Hospital Colorado. Episode resources: Colorado Department of Public Health and Environment (CDPHE) website: https://cdphe.colorado.gov/child-care-health-regulations How Sick is Too Sick? (CDPHE): https://drive.google.com/file/d/1RcdCmU4SYXwmVhJrA3Pyk0gP0MTDClkF/view AAP Managing Infectious Diseases in Child Care and Schools: https://shop.aap.org/managing-infectious-diseases-in-child-care-and-schools-6th-edition-paperback/ Ophthalmic antibiotic use for acute infectious conjunctivitis in children: https://pubmed.ncbi.nlm.nih.gov/34737083/ Uncomplicated Acute Respiratory Tract Infections (ARTI) Clinical Pathways: https://www.childrenscolorado.org/health-professionals/clinical-resources/clinical-pathways/uncomplicated-acute-respiratory-tract-infections/ For more information on Children's Hospital Colorado, visit: childrenscolorado.org

We're exploring something different in this episode and intentionally not discussing pediatric care. In this episode we share the incredible story of an enduring friendship between two pediatricians — a friendship that's been both generous and life-changing. Guests: Dr. Jennifer England, a pediatrician with Pediatrics at Cherry Creek, and Dr. Sunit Gill, a pediatrician at Greenwood Pediatrics, both located in Colorado. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

As the pandemic continues to shine a light on the mental health crisis in America, the devasting effects of substance abuse and addiction are increasing. Teens across the country continue to use and abuse alcohol, marijuana and nicotine-based vaping, and the rate of deaths linked to fentanyl has hit an all-time high. In the latest episode of our Mental Health series, we are joined by Christian Thurstone, MD, who discusses what's new in adolescent substance use, how it's affecting kids and what providers can do about it. Guest: Christian Thurstone, MD, the Director of Behavioral Health Services at Denver Health and a professor of psychiatry at the University of Colorado School of Medicine. Today's episode is underwritten by Businessolver, who is partnering with Children's Hospital Colorado to create a better mental health future for children. Businessolver is creating a mentally healthy, well-educated workplace where diversity, equity and inclusion matter. Together, we can change the state of pediatric mental health.

How do you know if a sacral dimple needs a closer look? Sacral dimples can be nothing at all, or they may be an indication of something more serious, such as tethered cord syndrome, dermal sinus tract or spina bifida oculate. In this episode, learn how sacral dimples should be evaluated and when providers should run more tests or refer to a specialist. Guest: Dr. Mark Erickson is the Medical Director of the Spine Center and the Pediatric Orthopedics Fellowship Director at Children's Hospital Colorado, and a professor in the Department of Orthopedics at the University of Colorado School of Medicine. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

Implicit bias and systemic racism contribute to health disparities, and they cannot be accounted for only by the social determinants of health (income, education, marital status, employment, etc.). Everyone brings their own biases and lived experiences to the table, and as physicians, it is our responsibility to recognize the role bias plays in our interactions with patients and team members, as well as within our healthcare system. In the latest episode in our Resident Files series, we talk with Kathryn Kalata, MD, about Health Equity Rounds, an initiative to address bias in the care we provide our patients. Guest: Dr. Kathryn Kalata, a current resident at the University of Colorado. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

Effective communication is needed to ensure the public is getting accurate information when it comes to vaccinations. Over the past few years of the COVID-19 pandemic, we've seen an increase of anti-vaccination sentiment and misinformation. In this episode, we discuss the importance of vaccines, the science behind vaccine development, and the impact of effective communication. This episode was recorded live from the 2022 AAP NCE Conference in Anaheim California. Guest: Dr. Hotez is from Texas Children's Hospital where he is the Endowed Chair of Tropical Pediatrics. Dr. Hotez is a professor at Baylor College of Medicine and Texas A&M University. As both a pediatrician and vaccine scientist, he is a passionate advocate for vaccines in the face of the growing anti-vaccine movement and is certainly a hero for all pediatricians. For more information on Children's Hospital Colorado, visit: childrenscolorado.org

When we think about our basic physiological needs, food, water, shelter, and clothing comes to mind yet oxygen is the crucial element for survival. The brain uses about 20% of the body's oxygen supply, which allows it to perform both conscious and autonomic processes and without oxygen brain damage occurs after three to six minutes of anoxia. Since breathing takes little to no effort for most of us, we often neglect to think about how it affects our daily lives. In this episode, we are going to discuss the importance of breathing and the scale at which children are impacted. We are excited to announce that this episode is part of our women in medicine series where we learn from the stories and expertise of amazing women in medicine. Today, I am so fortunate to be joined by an exceptional woman in medicine, my colleague Dr. Robin Deterding. Dr. Deterding is an internationally known pediatric pulmonologist, executive leader of one of the largest academic and clinical pediatric pulmonary practices for children in the country and a serial entrepreneur committed to improved care models for patients. She is a tenured Professor of Pulmonary and Sleep Medicine in the Department of Pediatrics at the University of Colorado School of Medicine and Children's Hospital Colorado.

In this series, we have talked about the importance of family-based therapy and family centered care. Today we are going to discuss what family-based care looks like from the perspective of a psychologist and from a Dad. Today, I am excited to be speaking with Julia Barnes, MD and William Mowle. Dr. Julia Barnes is a licensed clinical psychologist at the pediatric mental health institute here at Children's Hospital Colorado. She is the faculty co-chair for Children's mental health family advisory board council and an assistant professor at the university of Colorado school of medicine. Bill Mowle is the parent co-chair for the mental health family advisory council. Today's podcast is underwritten by Alpine Bank, supporters of Charting Pediatrics and Children's Hospital Colorado. Alpine Bank is proud to call Colorado home and is committed to supporting the community through philanthropic initiatives like their Loyalty Debit Card program, where the bank partners with its customers to raise funds to directly benefit Children's Colorado. Learn how you can get involved at Alpine Bank dot com slash CHCO card. Thank you to Alpine Bank for the continued support of Children's Colorado. Resources: https://www.childrenscolorado.org/community/patient-advocacy/family-advisory-council/

A question that commonly presents to those of us in primary care is what role dairy should play in a child's diet. Rich in nutrients and health benefits, most dairy products are key components for building and maintaining strong bones. Today, we are going to be discussing both the blessings and the challenging implications dairy can have on a child's health. Today, I am happy to be speaking with my colleague, Dr. Stephanie Gilley.

Many children struggle with certain behavior challenges such as aggression, impulsivity, and poor listening skills. Although this is normal for a typically developing child, over 90% of children with Down Syndrome experience one or more behavioral problems on a weekly or daily basis. These behaviors not only impact the child, but also can become major stressors for parents and caregivers. In this episode, we are going to talk about the different strategies and methods primary care providers can use to help persons with down syndrome cope with these challenges in order to live life to the fullest. Today, I am excited to be speaking with Dr. Lina Patel and Dr. Monique Germone. Dr. Lina Patel is the director of the Down Syndrome Behavioral Health Collaborative at Children's Hospital Colorado and is an associate professor in the department of Psychiatry at the Colorado School of Medicine. Dr. Monique Germone is the associate director of the Down Syndrome Behavioral Health Collaborative and an associate professor at the Colorado School of medicine. Resources: Video Understanding Behaviors in Individuals with Down syndrome https://vimeo.com/617189510 password: childrens Books The Guide to Good Health for Teens & Adults With Down Syndrome Paperback by Brian Chicoine and Dennis McGuire (Available on Amazon) Supporting Positive Behavior in Children and Teens with Down Syndrome, Revised Edition: The Respond But Don't React Method by Dr. David Stein Psy.D. (Available on Amazon) Teaching Children with Down Syndrome about Their Bodies: A Guide for Parents and Professionals by Terri Couwenhoven (in the process of being republished) Potty Time for Kids with Down Syndrome: Lose the Diapers, Not Your Patience by Terry Katz, Ph.D., and Lina Patel, Psy.D. (in the process of being republished) Websites https://www.childrenscolorado.org/doctors-and-departments/departments/down-syndrome-behavioral-health/ https://www.globaldownsyndrome.org/ https://www.dsmig-usa.org/ https://www.childrenscolorado.org/doctors-and-departments/departments/down-syndrome/ https://medschool.cuanschutz.edu/linda-crnic-institute

Each year hundreds of children are listed for liver transplants across the United States. Whether these children have chronic liver disease or acute liver failure, too many children spend months or even years waiting for an organ. Historically, deceased organ transplants have been the most common type of organ donation. However, the outcome for many children with chronic liver disease is to experience long wait times with poor quality of life. Too many children die while waiting for a transplant. Living donor transplants have emerged as a new way to care for children with chronic liver disease. Relatives, friends and even strangers serve as living donors to help patients bypass long and uncertain wait times. In this episode, we are joined by two experts from our living donor program to share more about this organ donation option. Today, I am excited to be speaking with Dr. Amy Feldman and Dr. Megan Adams. Dr. Feldman is a pediatric Gastroenterologist and is the Director of the Liver Transplant program here at Children's Hospital Colorado. Dr. Megan Adams is the surgical director of the pediatric living donor transplantation and pediatric transplant clinical reach team here at Children's Hospital Colorado. Resources: https://www.childrenscolorado.org/doctors-and-departments/departments/transplant/liver/

Many people view mental and physical health as two separate and unrelated issues. However, there are many intersections between the two. For example, it is not uncommon for children and adolescents to develop and experience emotions as physical symptoms. Children who experience Somatic Symptoms, or SSRDs, account for 10-15% of medical visits to primary care providers. Today, we are going to be talking about the connection between physical and mental health and how health care professionals can better understand, diagnose, and treat these patients in the medical home. Today, I am excited to be speaking with my colleagues Dr. Lauren Wood and Dr. Beau Carubia. This episode is underwritten by Ent Credit Union, a proud supporter of Charting Pediatrics and Children's Hospital Colorado. Ent, Colorado's largest credit union, has a passion for people, not for profit. Ent has more than 45 service centers located up and down the Front Range, including the Denver Metro area and Northern Colorado. Insured by NCUA.

Children these days face a myriad of social pressures. Kids come from different homes and backgrounds. They grow at different rates. They walk, talk, and act differently. This diversity and individualism can be something to embrace, but often leads to insecurities about being different and not fitting in socially. These insecurities can have detrimental effects on the mental health of kids during their formative years. Today I am speaking with Dr. Daniel Flannery and Dr. Seth Scholer. Dr. Flannery is a professor at the Mandel school at Case Western Reserve University, Director of the Begun Center for Violence Prevention, and Professor of Pediatrics and Psychiatry. Dr. Scholer is a professor of pediatrics in the division of general pediatrics at Vanderbilt University Medical Center.

Happy Holidays from the Charting Pediatrics team!

In past episodes of Charting Pediatrics, we have discussed the health equity challenges that organizations and healthcare systems face and the importance of a diverse workforce. Differences such as race, gender, and socioeconomic status are all associated with the disparities we see in health care systems each day. An important step to help providers close this gap, starts within healthcare professional education. In this episode, we are going to take a deep dive into how health systems can help protect and advocate for the most vulnerable patients of all, the patients in the NICU. Today, I am excited to be speaking with Dr. Paula Dias Maia and Dr. Nicolle Dyess. Dr. Paula Dia Maia is a neonatal-perinatal fellow and was previously one of the leaders of the diversity in pediatrics committee. Dr. Nicolle Dyess works in the Division of Neonatal-Perinatal medicine and is an assistant professor and the University of Colorado. Today's episode is underwritten by Aon, a proud supporter of Charting Pediatrics and Children's Hospital Colorado. Aon believes that businesses thrive when the communities they serve flourish. Thank you to Aon for helping our community flourish through this partnership.

About 14 out of every 1,000 healthy infants born full term develop a fever during the ages 8 days to 60 days old. While most fevers do not lead to severe illness, it can be challenging to immediately identify the cause of a baby's fever and identifying infants who may be at risk for developing serious bacterial infections. In this episode, we will discuss the updated AAP guidelines for well-appearing infants between 8-60 days old who develop a fever at or above 100.4 degrees Fahrenheit (38 degrees Celsius). We will take a deep dive into the changing epidemiology of serious bacterial infection in febrile infants, advances in technology, and evolving research strategies. This episode is being broadcasted live from the AAP NCE in Anaheim California. Today, I am delighted to be speaking with Dr. Samir Shah. Dr. Shah is joining us from Cincinnati Children's hospital where he is the Director of the Division of Hospital Medicine and a professor of pediatrics.

Data from multiple countries have shown an uptick in eating disorder presentations in youth during the pandemic. Here in Colorado, we have certainly seen an increase in medically unstable eating disorder patients admitted to the hospital. As part of our series this year on mental health today we will focus on disordered eating, which encompasses a spectrum of different problems in children. I am joined by two experts between them with many decades of experience caring for children and adolescents with disordered eating so this is going to be a lot of fun. This episode is part of our 12-episode mental health series where we aim to give primary care providers useful tools and relevant clinical information to support them in the care of patients with mental health needs. Today I am happy to be speaking with Dr. Amy Sass and Dr. Jennifer Hagman. Dr. Sass works in the adolescent medicine department at Children's Hospital Colorado and is a professor at the University of Colorado School of Medicine. Dr. Jennifer Hagman works in the child and adolescent psychiatry department here at Children's Colorado and is professor at the University of Colorado school of medicine. Resources: AAP - https://publications.aap.org/pediatrics/article/147/1/e2020040279/33504/Identification-and-Management-of-Eating-Disorders NEDA – National Eating Disorders Association​ www.nationaleatingdisorders.org​ Families Empowered And Supporting Treatment of Eating Disorders (FEAST)​ www.feast-ed.org​ Academy of Eating Disorders​ www.aedweb.org​ NIH - National Institutes of Health​ www.nlm.nih.gov (Search "Eating Disorders")​ Information on Maudsley Method​ www.eatingwithyouranorexic.com, http://www.maudsleyparents.org/, www.aroundthedinnertable.org This episode is underwritten by Ent Credit Union, a proud supporter of Charting Pediatrics and Children's Hospital Colorado. Ent, Colorado's largest credit union, has a passion for people, not for profit. Ent has more than 45 service centers located up and down the Front Range, including the Denver Metro area and Northern Colorado. Insured by NCUA.

In our series, the Resident Files, we feature the thoughts and work of talented pediatric residents here in Colorado and around the country. The section on pediatric trainees has implemented several initiatives into making pediatrics a more diverse and inclusive workforce. This group is working towards achieving child health equity in a global sense. The equity, diversity, and inclusion work group has focused their efforts on increasing visibility of underrepresented in medicine groups highlighting both trainees and faculty members using social media campaigns. This episode was broadcasted live from the AAP conference in Anaheim California. Today I am privileged to be joined by Jeffrey Edwards. Jeffrey is a member of the section on pediatric trainees currently wrapping up his time as the executive coordinator for equity diversity and inclusion with the section on pediatric trainees leadership council.

Although Acute Appendicitis(AA) is the most common acute surgical conditions encountered by children, multiple aspects of the approach to management of AA remain well debated. Despite recent advancements in management, including scoring systems, imaging, antibiotics, the variations in management options, from appendectomy to a laparotomic approach to non-operative management (NOM) remain topics of intense discussion. And with no absolute consensus in the literature, controversy among surgeons and faculty persists. This episode was broadcasted live from the AAP conference in Anaheim California. Today, I am delighted to be speaking with Dr. Lorraine Kelley-Quon. Dr. Kelley-Quon is joining us from Children's Hospital Los Angeles, where she practices as a pediatric surgeon and is an assistant professor of surgery and population and public health sciences at Keck school of Medicine at the University of Southern California.

Today, a vast majority of teenagers and adolescents dedicate their time to athletics. In fact, nearly 8 million students participate in high school sports. With the increasing popularity of club sports, most kids are practicing and playing their dedicated sports year-round. Participating in organized sports allows kids to become a part of a team and improves both physical and mental health. However, an injury to an athlete can impact their ability to perform and practice and can be devastating mentally. On today's episode, we will be discussing common orthopedic injuries among student athletes and how these injuries can be treated and prevented. Welcome to Charting Pediatrics. I'm your host Dan Nicklas. If you are new with us, welcome to our pediatric provider community where we release an episode every Tuesday, and special updates to cover hot topics that impact pediatric providers. Today I am happy to be speaking with Dr. Curtis VandenBerg. Dr. Curt VandenBerg is a Sports medicine surgeon with Children's Hospital Colorado and the University of Colorado school of medicine. Resources: https://www.joinmyhuddle.com/about

It is no surprise that more and more kids are experiencing stress and anxiety. With the recent current events including COVID-19, these last few years have been stressful for everyone. As kids get older and begin to take on more responsibility and experience more changes in life, stress becomes more apparent. Today we are going to talk about strategies that provider can incorporate into clinic, the right questions to ask patients and families, and talk about the post pandemic stress epidemic that we are seeing in kids. This episode is part of our 12-episode mental health series where we aim to give primary care providers useful tools and relevant clinical information to support them in the care of patients with mental health needs. Today I am happy to be speaking with Dr. Jenna Glover and Dr. Jessica Hawks. Today's episode is underwritten by Ent Credit Union, proud supporter of Charting Pediatrics and Children's Hospital Colorado. Ent, Colorado's largest credit union, has a passion for people, not for profit. Ent has more than 45 service centers located up and down the Front Range, including the Denver Metro area and Northern Colorado. Visit Ent.com. Insured by NCUA.

Today's episode is underwritten by Transamerica, a proud supporter of Charting Pediatrics and Children's Hospital Colorado. Transamerica is committed to helping improve the overall wellness within all communities. Their partnership supports the urgent need in our community of pediatric mental health. Thank you Transamerica. When a child is diagnosed with a serious illness, it is important for the whole family to get the support and care that they need. Palliative care not only helps children and families with the pain and symptoms of their illnesses, but it also helps to enhance the child's quality of life. In this episode, we are going to discuss how palliative care teams can partner with Primary care providers to help treat and ease the symptoms, pain, and stress of seriously ill patients. Today I am happy to be speaking with Dr. Adam B. Hill. Dr. Adam B Hill is the Palliative Medicine Department Chair here at Children's Hospital Colorado.

Getting your tonsils out used to mean spending a few days in the hospital and getting ice cream for breakfast, lunch, and dinner. Tonsillectomy and adenoidectomy, or T&A, is the second most common childhood surgery performed. It is important for pediatricians to have a detailed understanding of indication for referral, pre- and post-surgical management, and how this procedure has evolved over time. Today we are joined by an Otolaryngology expert to talk about tonsillectomy and adenoidectomy surgeries, when it is needed, and how this surgery is beneficial to patients. Today I am happy to be speaking with Dr. Soham Roy. Dr. Roy Soham is the chair of Pediatric Otolaryngology at Children's Hospital Colorado and is a professor and vice chair at the university of Colorado school of medicine.

Approximately 35 to 45 million youths, 6 to 18 years of age, participate in some form of athletics. The COVID-19 pandemic has affected many aspects of the lives of children and families, including youth sport activity. As children present for health supervision visits and preparticipation physical evaluations, parents and athletes likely will ask questions about how best to ensure safety when considering a return to sports participation and physical activity. In addition, there are lingering concerns about the risk of myocarditis in this population, from disease and vaccination. In this episode we will evaluate the most current guidance on this topic and discuss the risk of myocarditis, all from a cardiology perspective. Today I am happy to be speaking with Dr. Chris Rausch. Resources: https://www.jacc.org/doi/abs/10.1016/j.jacc.2022.02.003 https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-interim-guidance-return-to-sports/

Recently, the American Academy of Pediatrics (AAP) revised clinical guidelines on hyperbilirubinemia and how to treat infants born at at least 35 weeks. Although it is common for many newborn infants to experience jaundice, it is important for physicians and primary care providers to understand and monitor newborn babies to ensure they don't develop hyperbilirubinemia. In this episode, we are going to discuss what primary care providers should know about these new guidelines and how they are different than the previous guidelines. Today I am happy to be speaking with Dr. Christine Gold. Resources: New 2022 AAP Hyperbilirubinemia guidelines: https://publications.aap.org/pediatrics/article/150/3/e2022058859/188726/Clinical-Practice-Guideline-Revision-Management-of?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000 Old 2004 AAP guidelines: https://publications.aap.org/pediatrics/article/114/1/297/64771/Management-of-Hyperbilirubinemia-in-the-Newborn Bili Tool: https://bilitool.org Pedicalc: https://peditools.org/bili2022/

Primary care providers and Pediatricians play a vital role in the identification, prevention, and management of pediatric mental health. With the increased need for mental health services and limited access to resources, early detection is a crucial first step. On this episode, we are going to discuss the importance of routine mental health screenings and the tools and resources primary care providers can leverage within the medical home. Today I am happy to be speaking with Dr. Robert Hilt and Dr. Sandra Fritsch. Dr. Hilt is a professor at the University of Washington, Department of Psychiatry and Behavioral Sciences and a psychiatrist at Seattle Children's Hospital. Dr. Fritsch is a psychiatrist that works in our Child and Adolescent Psychiatry department here at Children's Colorado. Today's episode is underwritten by Ent Credit Union, proud supporter of Charting Pediatrics and Children's Hospital Colorado.

In the early 1950's, Polio was one of the most unknown and feared disease in the United States. According to the CDC, polio caused hundreds of thousands of cases of paralysis before the development of a vaccine. Since the vaccine, there have been no new cases, until now. In addition, we are seeing the continued spread of another virus that can cause paralysis, Enterovirus D68. Today we will talk about the possible relationships between these two viral diseases and what you our healthcare providers need to be aware of for prompt diagnosis and treatment. Today I am delighted to be speaking with my colleague Dr. Kevin Messacar. Kevin works in the Infectious Disease department at Children's Hospital Colorado and is an Associate professor in the department of pediatrics at the University of Colorado school of Medicine. Resources: Polio MMWR: https://www.cdc.gov/mmwr/volumes/71/wr/mm7133e2.htm EV-D68 MMWR: https://www.cdc.gov/mmwr/volumes/71/wr/mm7140e1.htm AFM Consensus Recommendations: https://www.thelancet.com/article/S0140-6736(20)32723-9/fulltext CDC Job Aid for AFM Reporting: https://www.cdc.gov/acute-flaccid-myelitis/downloads/job-aid-for-clinicians-508.pdf AFM Physician Support Portal: https://wearesrna.org/living-with-myelitis/resources/afm-physician-support-portal/ https://www.cdc.gov/acute-flaccid-myelitis/downloads/examining-proximal-muscle-weakness-508.pdf

Toilet training is a natural milestone that many children master by the age of 3. Although accidents are bound to happen from time to time, consistent day time wetting may be linked to a more serious medical condition. On average, daytime wetting, or Diurnal enuresis, happens in about 3-4% of children and is commonly associated with dysfunctional voiding. Today, we are going to unpack some of the common reasons kids experience daytime wetting and what primary care providers can do to treat this in the medical home. Today I am happy to be speaking with Brian Miller. Brian Miller is PA-C Lead Advanced Practice Provider for Pediatric Urology here at Children's hospital Colorado.

It is not uncommon for newborn babies to have slight imperfections in their heads. Most of the time, these imperfections will fix themselves over time, or once they begin to develop. However, sometimes a more serious diagnosis will require medical interventions. Craniosynostosis is a condition where a baby's skull begins to fuse together too early. This occurs at birth or shortly after and if not treated, can affect brain development. Today, I am excited to be speaking with my colleagues Dr. Brooke French and Dr. Allyson Alexander. Dr Allyson is a Pediatric Neurosurgeon here at Children's Hospital Colorado and is also an Assistant Professor at University of Colorado School of Medicine. Dr. Brooke French is the Co – Director of Cleft and Craniofacial Surgery Programs and is also the Director of Cosmetic Surgery here at Children's Hospital Colorado.

The youth mental health crisis in America is not a new problem. The pandemic drove unprecedented numbers of kids to seek care at all levels and really brought this to the public's attention. In 2021, to highlight the mental health crisis in the United States, the surgeon general's office issued the Youth Mental Health Advisory. Today, as we begin our season 6 focus on mental health with our Charting Pediatrics Mental Health series, we are privileged to talk with our U.S Surgeon General, Dr. Vivek Murthy, and our very own Mental Health In-Chief Ron-Li Liaw. Vivek Murthy serves as the 21st Surgeon General of the United States. Dr. Murthy is a renowned physician, research scientist, and entrepreneur. As the Nation's Doctor, the Surgeon General's mission is to help lay the foundation for a healthier country. Dr. Ron- Li Liaw is the Cannon Y. & Lyndia Harvey Chair in Child and Adolescent Psychiatry, the vice chair of Diversity, Equity, and inclusion and most recently, Ron-Li has been announced as the first ever Mental Health In-Chief for Children's Hospital Colorado. Today's episode is underwritten by Ent Credit Union, proud supporter of Charting Pediatrics and Children's Hospital Colorado.

Since 2020, life as we know it has been turned upside down. Every person has had to deal with the repercussions of the global COVID-19 pandemic in their own individual ways. Pediatrics is no different. Pediatrics has changed immensely over the last few years, and as we emerge from the pandemic, many people are anticipating the "normal" of life to come back. However, it is important to understand that there may be a "new normal". In this episode, we will be discussing what has changed in the landscape of pediatrics, what will stay, and what areas will not recover. Raphe Schwartz serves as Chief Strategy Officer at Children's Hospital Colorado and joining us from health care analytics and intelligence firm Sg2, Rhae Gamber, Senior Consulting Director of Women's Health & Pediatric Intelligence. If any children's hospital leaders or pediatric providers are looking for more info on Sg2 visit https://www.sg2.com/childrens

Sleep is an essential function that is vital to the health and well-being of every individual yet millions of people either neglect or have trouble sleeping. Sleep issues in kids are among the most common problems that parents report when visiting their Primary Care provider. In fact, 20% of all children suffer from some type of sleeping problem. In today's episode, we are going to discuss common sleep disorders and when Primary Care providers should refer patients to a sleep specialist. Today I am happy to be speaking with my colleague Dr. Antoinette Burns. Dr. Burns is a pediatric sleep physician. She is the Associate Medical Director of the Pediatric Sleep Lab in Colorado Springs, Colorado and is also an Associate Professor of Clinical Practice in the Department of Pediatrics at the University of Colorado school of Medicine.

When our pediatric and adolescent patients are diagnosed with cancer or another life-altering conditions, the focus is often on treatment and not the changes chemotherapy, radiation and surgery may have on their body's long-term function. In this episode, we are joined by Leslie Appiah, MD to discuss the innovative topic of fertility preservation for pediatric and adolescent patients -- both at cancer diagnosis and in survivorship. Dr. Appiah is part of the Pediatric and Adolescent Gynecology team at Children's Colorado and is Division Chief, Academic Specialists in Obstetrics and Gynecology and Director of the Fertility Preservation and Reproductive Late Effects Program at the University of Colorado School of Medicine. She is co-founder of the Pediatric Initiative Network of the Oncofertility Consortium where she served as chair for 5 years and is current co-chair of the Adolescent and Young Adult Reproductive Late Effects Committee.