Charting Pediatrics

Join us for our weekly Virtual Town Hall for Providers during COVID-19, Thursdays from 6-7 p.m. MST In this, our 10th COVID-19 podcast, we will have a case discussion around functional and high-yield adult medicine topics that might be useful for pediatricians helping to care for adult patients in the middle of this pandemic. You can go back and listen to our previous coverage on the COVID-19 Pandemic on Season 3 of the podcast. Today we are fortunate to be joined by Dr. Aaron Manning and Dr. Steven Humphrey. Steven is a pediatric hospitalist at Children's Hospital Colorado and Instructor of Pediatrics at the University of Colorado School of Medicine. Aaron is also a pediatric hospitalist at Children's Colorado and is Assistant Professor of Hospital Medicine at the University of Colorado School of Medicine. POPCoRN (Pediatric Overflow Planning Contingency Response Network): https://www.popcornetwork.org/. This site is a multi-institutional collaboration that was created during the COVID-19 pandemic as a vehicle for optimizing adult care in pediatric environments. It contains many "one-pagers" which review the management of a variety of common adult conditions, links to adult protocols shared by various institutions, and recommendations regarding care of patients with COVID-19 among others. Adult medicine guidebooks: Several organizations have made available their adult medicine guidebooks free of charge. UCSF Department of Medicine Hospitalist Handbook (currently free in the Apple and Google App Stores) MGH Resource Guide for Commonly-Encountered Inpatient Topics (available via the POPCoRN website) Society for Hospitalist Medicine: Non-Hospitalist Onboarding. This resource offers a step by step guide to preparing non-hospitalists for the inpatient management of adult care (available via the POPCoRN website) University of Pennsylvania Hospitalists Primer. A resource meant to prepare non-hospitalists for the care of hospitalized adults (http://pennhspprimer.com/) Do you have thoughts about today's episode or suggestions for a future topic? Write to us, [email protected]

One of the bright spots during the COVID-19 pandemic has been the promising and experimental use of convalescent plasma, which was recently approved by the FDA for emergency treatment. The donation of antibody-rich blood from patients who have recovered from the SARS-CoV2 virus has been pioneered by Dr. Kyle Annan and the team at Children's Colorado. I n this, our 9th COVID-19 podcast we will cover the topic of convalescent plasma, discuss the current epidemiology of the pandemic, and talk through the impacts of loosened shelter-in-place orders around the country. You can go back and listen to our previous coverage on the COVID-19 Pandemic on Season 3 of the podcast. Today we are fortunate to be joined once again by un-official Charting Pediatrics co-host, Dr. Sam Dominguez. Sam is a pediatric infectious diseases physician at Children's Hospital Colorado and Associate Professor of Pediatrics and Infectious Diseases at the University of Colorado School of Medicine. Additionally, we are joined by Dr. Kyle Annen who is Director of the Blood Donor Center at Children's Colorado and Assistant Professor of Pathology at the University of Colorado School of Medicine. Join our weekly COVID-19 Virtual Provider Town Hall - Thursday, April 30, 2020 from 6-7 p.m. MST Donate convalescent plasma ABC News Coverage of convalescent plasma for COVID-19 Do you have thoughts about today's episode or suggestions for a future podcast? Write to us, [email protected]

In this episode we will discuss the diagnosis and management of TSS and are privileged to be joined by Jim Todd, MD who first discovered TSS in 1975. Toxic shock syndrome (TSS) is a cluster of symptoms that involves many systems of the body. Certain bacterial infections release toxins into the bloodstream, which then spreads the toxins to body organs and can cause severe damage and illness. Dr. Todd is the previous Section Head of Infectious Diseases, Jules Amer Chair, and Community Pediatrics and Director of Epidemiology at Children's Hospital Colorado. He is also a Professor Emeritus in Pediatrics at the University of Colorado School of Medicine.

In this, our 8th COVID-19 podcast, I talk to two of my pediatric colleagues, Sean O'Leary, MD and Robin Larabee, MD who have had COVID-19 and are now recovered. We will discuss their symptoms and disease course in depth in hopes that it provides greater education and context for how different people have experienced COVID-19. As we move into our second month of the global pandemic most of us know someone who has contracted the SARS-CoV2 virus; this especially probable for you our listeners, as fellow healthcare workers who have many colleagues caring for COVID-positive and exposed patients. You can go back and listen to our previous coverage on the COVID-19 Pandemic on Season 3, Episodes 31, 36 and 38, 41, 42, 43 and 44. Sean has joined us several times on the podcast to discuss vaccines and vaccines hesitancy, he is a pediatric infectious diseases physician at Children's Hospital Colorado and Associate Professor of Pediatrics and Infectious Diseases at the University of Colorado School of Medicine. Sean is also an active spokesperson with the AAP on the topic of vaccines and services as the Director of the Colorado Children's Outcome Network. Additionally, we are pleased to have Dr. Robin Larabee join us today as well. Robin is a pediatrician in Denver and partner with Sapphire Pediatrics.

Today's guest is Dr. Scott Sagel, here to discuss the care of patients with cystic fibrosis (CF) and the clinical research that has led to the advances in access to these breakthrough therapies. Dr. Scott is a Pediatric Pulmonologist at Children's Hospital Colorado and a Professor of Pediatrics at the University of Colorado School of Medicine.

In recent weeks, the podcast has received hundreds of questions from listeners around the topic of PPE. So today, this episode is for you. We are going to cover all things PPE while reviewing the current epidemiology of COVID-19. We are now entering our second month of the global COVID-19 Pandemic. Our world has never experienced anything like this before – some days feel like they have contained an entire month's worth of change and challenges. One of the difficult realities that many healthcare providers have faced is a shortage of necessary PPE. Additionally, what is the truth about the efficacy and use of homemade cloth face coverings? How should providers approach PPE as we move out of the peak of the pandemic? We will cover these topics and more in this episode. You can go back and listen to our previous coverage on the COVID-19 Pandemic on Season 3, Episodes 31, 36 and 38, 41, 42 and 43. Today we are fortunate to be joined once again by un-official Charting Pediatrics co-host, Sam Dominguez, MD, PhD. Sam is a pediatric infectious diseases physician at Children's Hospital Colorado and Associate Professor of Pediatrics and Infectious Diseases at the University of Colorado School of Medicine. Additionally, we are excited to have Pat Givens, DHA, EdM, RN, NEA-BC, as a guest today as we dive in to PPE. Pat is the Chief Nursing Executive for Children's Hospital Colorado and is serving as our PPE Guardian during the COVID-19 Pandemic. Do you have questions about today's episode or suggestions for a future topic? Write to us, [email protected]

In this episode, we are going to discuss practical ways primary care providers can protect their own mental health needs and also deliver meaningful mental health support to their patients and families during the COVID-19 global pandemic. Mental health; never has there been a more crucial time for our primary care providers to talk openly about finding creative and innovative ways to support the mental health needs both of their patients and for themselves. The COVID-19 pandemic has impacted every area of life. Nothing feels normal. Maintaining one's mental health while practicing social distancing, online learning and school, loss of routine and regular social interactions is a challenge! On the podcast we have previously covered a number of topics related to the COVID-19 pandemic – you can go back and listen to those discussions on Season 3, Episodes 31, 36 and 38, 41 and 42. Do you have thoughts about today's episode or suggestions for a future topic? Write to us, [email protected]

In this episode, we are going to talk to the Telehealth team at Children's Hospital Colorado and share how primary care providers could operationalize the delivery of care through telehealth quickly to help navigate the COVID-19 pandemic and looking to the future post-pandemic. For all the reasons that COVID-19 has turned our personal and professional lives upside down, it has positively accelerated the delivery of care through telehealth. Until a few weeks ago, most of our ambulatory providers administered care through telehealth as a secondary, less preferred option in cases where distance between provider and patient was too far to be together in person. In this episode we are joined by Christina Olson, MD; Fred Thomas, PhD and Alison Brent, MD. Christina Olson, MD is Telehealth Medical Director at Children's Colorado and Assistant Professor of Pediatrics at the University of Colorado School of Medicine Fred Thomas, PhD is Director of Telehealth at Children's Colorado and Executive Director of ECHO Colorado; He has academic appointments in the Departments of Psychiatry, Pediatrics and Family Medicine in the Colorado School of Medicine. And finally, we turn the mic on Charting Pediatrics co-host, Alison Brent, MD. Alison is a Pediatric Emergency Medicine Physician at Children's Colorado and Professor of Pediatrics at the University of Colorado School of Medicine. She is currently serving on the Executive Committee of the AAP Section of Telehealth Care. Telehealth Resources Mentioned: email your questions to the AAP: [email protected] From the AAP: Coding During the COVID-19 Pandemic AAP Guidance: Telehealth Payer Policy during the COVID-19 Pandemic State Notices on Telehealth Policy From the AAP: Telehealth and After Hours Care Join the Colorado ECHO online learnings about COVID-19 Do you have questions about today's episode or suggestions for a future topic? Write to us, [email protected]

As the COVID-19 global pandemic has entered its third week, our healthcare providers are realizing the dramatic impact this has had on how we deliver care. Our lives have been touched not only professionally, but certainly personally as well. The uncertainty that this pandemic has driven into our lives is equally matched by the resiliency and ingenuity of our healthcare providers and larger community to come together to face this head on. In this episode, we will cover the current epidemiology of COVID-19, answer listener submitted questions and talk about the creative delivery of primary care that you could consider implementing in your practice as you navigate the pandemic. On the podcast we have previously covered the clinical presentation of the coronavirus in pediatrics, what providers should do if their clinical suspension is high and approaches to pediatric care during the mitigation phase of this pandemic – you can go back and listen to those discussions on Season 3, Episodes 31, 36 and 38. Today we are fortunate to be joined again on the podcast by Sam Dominguez, MD, PhD a pediatric infectious diseases physician at Children's Hospital Colorado and Associate Professor of Pediatrics and Infectious Diseases at the University of Colorado School of Medicine. Maya Bunik, MD is the Medical Director of the Child Health Primary Care Pediatrics Clinic at Children's Hospital Colorado and Professor of Pediatrics at the University of Colorado School of Medicine. Dr. Bunik was previously on the podcast to discuss Breastfeeding Management, you can listen to that on Season 1, Episode 10. Kelly Galloway, RN, is the Director of Patient Care Services for primary care at Children's Hospital Colorado. COVID-19 Resources for Providers COVID-19 Resources for Patients and Families Do you have thoughts about this episode or suggestions for a future topic? Write to us, [email protected]

In this episode we talk with Todd Carpenter, MD and Cameron Gunville, DO about drivers behind general growth in pediatric critical care bed occupancy that has outpaced the general inpatient population; the most important critical care interventions in the last 10 years that has benefited children and the important outcome metrics that define success in pediatric critical care. Dr. Carpenter is the Medical Director of the PICU at Children's Hospital Colorado and is Professor of Pediatrics and Critical Care at the University of Colorado School of Medicine. Dr. Gunville is the Associate Medical Director of the PICU at Children's Hospital Colorado and is Associate Professor of Pediatrics and Critical Care at the University of Colorado School of Medicine. Do you have thoughts about this episode or suggestions for a future topic? Write to us, [email protected]

Kids are notorious for exploring small objects and putting them up their nose, in their ear or swallowing them. Some ingestions like button batteries and small, b-b sized magnets are potentially life-threatening for children and adolescents. Catastrophic and fatal injuries can occur when the object becomes lodged in the esophagus, where injury can extend beyond the esophagus to the trachea or aorta. In this episode, we are going to turn the mic on host, David Brumbaugh, MD, to look at the presentation and treatment of ingested foreign objects and the anticipatory guidance primary care providers can give to their patients and families. What our listeners may not know about Dr. Brumbaugh is that he has a job beyond co-hosting Charting Pediatrics; he is a pediatric gastroenterologist and Associate Chief Medical Officer at Children's Hospital Colorado and is Associate Professor of Pediatrics at the University of Colorado School of Medicine. Ingested Button Battery Clinical Pathway Do you have thoughts about today's episode or suggestions for a future topic? Write to us, [email protected]

Coronavirus. COVID-19. Since we last recorded the podcast the World Health Organization has named COVID-19 a global pandemic. We have previously covered the clinical presentation of the coronavirus in pediatrics and what providers should do if their clinical suspension is high – you can go back and listen to both of those discussions on Season 3, Episodes 31 and 36. Given the rapidly changing nature of this situation and the virus' spread throughout our local Colorado communities we wanted to provide you with an update as we move from a containment to a mitigation strategy. In this episode we will cover the current epidemiology of COVID-19, answer listener submitted questions and provide you with resources of where to find ongoing resources. COVID-19 Provider Resources COVID-19 Telephone Triage Protocols by Bart Schmitt, MD CDC COVID-19 Information for Healthcare Professionals COVID-19 Updates from the American Academy of Pediatrics Do you have thoughts about today's episode or suggestions for a future topic? Write to us, [email protected]

There are many great things about living in rural communities. Across a broad range of healthcare indicators though, our children in rural America are doing more poorly urban areas — higher all-cause mortality rates, higher disability rates, higher rates of obesity and higher risks for suicide and unintentional injury. More than 50% of rural counties in the United States do not have a pediatrician and the number of patients per physician and healthcare professional shortage areas is twice that of a traditional urban area. What is it like to practice and take care of kids in a more rural setting? In this episode we will discuss rural and tertiary care bridges with Bird Gilmartin, MD. Dr. Gilmartin is the Pediatric Medical Director at Uinta Medical Group in Evanston, Wyoming. She is a member of the American Academy of Pediatrics (AAP) Section on Early Career Physicians and was the recipient of the AAP's 2019 Award for Outstanding Service to Maltreated Children. Do you have thoughts about this episode or suggestions for a future topic? Write to us, [email protected]

Coronavirus. COVID-19. It is safe to say that this virus is on the minds of people across the globe and there is increased anxiety among the general public who are seeking guidance from their healthcare providers. And many healthcare providers are looking to their regional healthcare centers and the local/national health authorities for guidance – this is an emerging, rapidly evolving situation. In mid-February we recorded our first episode about COVID-19 where we covered the clinical presentation of the coronavirus in pediatrics and what providers should do if their clinical suspicion is high – you can go back and listen to that on Season 3, Episode 31. Today we are going to examine the current epi of the situation, answer listener submitted questions in follow-up to our previous COVID-19 episode and provide you with resources of where to find ongoing resources. Today we are going to examine the current epi of the situation, answer listener submitted questions in follow-up to our previous COVID-19 episode and provide you with resources of where to find ongoing resources. We are fortunate to be joined again on the podcast by Dr. Sam Dominguez, a pediatric infectious diseases physician at Children's Hospital Colorado and Associate Professor of Pediatrics and Infectious Diseases at the University of Colorado School of Medicine. COVID-19 FAQs for Providers COVID-19 Pediatric Telephone Triage Protocols by Bart Schmitt, MD

In this episode we have the privilege of welcoming Rachel Moon, MD back to the podcast to discuss the importance of social networks, social norms and attitudes in infant care practice decisions. Dr. Moon first joined us on Charting Pediatrics at the 2018 AAP Conference, you can go back and listen to Dr. Brumbaugh's interview with her on Infant Safe Sleep Practices on Season 2, Episode 13. Dr. Moon is the Harrison Distinguished Teaching Professor of Pediatrics and the Division Head of Pediatrics at the University of Virginia School of Medicine. Do you have questions about today's episode or suggestion for a future topic? Write to us, [email protected]

State-level vaccination advocacy is the topic of today's podcast with Zach Zaslow, Director of Government Affairs at Children's Hospital Colorado. Colorado's current vaccination rate for the measles, mumps and rubella vaccine among kindergarteners is 87.4%, one of the lowest in the nation. After more than 15 hours of testimony in committee hearing on February 19, Colorado Senate Bill 163, which aims to standardize and challenge vaccine exemption, passed its first hearing 3-2. Today we are bringing you a special edition of Charting Pediatrics to discuss vaccine legislation and advocacy in our local state of Colorado, specifically Senate Bill 163, which sets a Colorado- statewide immunization goal of 95%. Zach Zaslow, Director of Government Affairs for Children's Hospital Colorado, directs local, state, and federal policy and advocacy efforts with the goal of improving child health by being a voice for kids when and where public policy decisions are being made. Join our 11,000+ advocates who speak up clearly and powerfully for kids' health when public policy decisions are made by signing up today to be a Child Health Champion: https://bit.ly/2uixrab. To learn more about general advocacy efforts at Children's Hospital Colorado visit www.childrenscolorado.org/advocacy. Finally, email [email protected] with questions or if you'd like to get more involved by joining our and the Colorado AAP's statewide pediatricians' advocacy network, penning letters to the editor, attending advocacy events and more. Do you have thoughts about today's episode or suggestions for a future topic? Write to us, [email protected]

There are few things that are more frustrating to parents and young patients than issues involving chronic constipation and involuntary defecation. These issues often have a significant negative impact on the quality of life for the child and the family. In today's episode we are going to talk through the key features, diagnostic evaluation and treatment for fecal incontinence in children with Andrea Bischoff, MD. Dr. Bischoff is an Associate Professor of Pediatric Surgery at the University of Colorado, School of Medicine, she's also the Assistant Director of the International Centre for Colorectal and Urogenital Care at Children's Hospital Colorado. Connect with Doctors Pena Bischoff: Facebook: @DrsPenaBischoff Twitter: https://www.linkedin.com/in/andreabischoff YouTube: https://www.youtube.com/watch?v=FMqLE0sE3zc Instagram: @penabischoff Website for Pena course is: www.penacourse.org Do you have thoughts about today's episode or suggestions for a future topic? Write to us, [email protected]

In this episode we discuss seizures and spells, and the diagnosis and management of events that worry us. This episode was recorded at the 2019 American Academy of Pediatrics NCE in New Orleans with Mered Parnes, MD and Shavonee Massey, MD, MSCE. Dr. Massey is is a pediatric neurologist in the Division of Neurology at Children's Hospital of Philadelphia, specializing in the care of children with epilepsy and a Clinical Instructor in Pediatrics and Neurology. Dr. Parnes is the Director of the Pediatric Movement of Disorders Clinic and an Assistant Professor of Child Neurology at Texas Children's Hospital and Baylor College of Medicine. Do you have thoughts about today's episode or suggestions for a future topic? Write to us, [email protected]

What do you need to know about COVID-19? In this special episode we are joined by Sam Dominguez, MD to discuss the clinical presentation of the coronavirus in pediatrics, what providers should do if their clinical suspicion is high, and updated epidemiology of the situation. Dr. Dominguez is a pediatric infectious disease physician at Children's Hospital Colorado and Associate Professor of Pediatrics and Infectious Diseases at the University of Colorado School of Medicine. This episode was recorded on Tuesday, February 11, 2020. Do you have thoughts about today's episode or suggestions for a future topic? Write to us at [email protected]

In this episode we dive in to the topic of medical missions, specifically surgical and perioperative care in resource-limited settings, with Brian Shaw, MD. Dr. Shaw is a pediatric orthopedic surgeon from Children's Hospital Colorado, Colorado Springs Hospital, Chief of the Section of Pediatric Surgery at Memorial Hospital for Children in Colorado Springs, Associate Professor of Orthopedic Surgery at the University of Colorado School of Medicine and Vice-Chair of the AAP Section on Orthopedics. This episode was recorded live at the 2019 American Academy of Pediatrics NCE in New Orleans, La. Do you have thoughts about today's episode or suggestions for a future topic? Write to us, [email protected]

Pelvic pain most often involves the gastrointestinal or the urinary systems in pre-pubertal girls. However, during late adolescence, gynecologic conditions become more prevalent as etiologies for pelvic pain. Dysmenorrhea and noncyclic pelvic pain are common in adolescents and the management of chronic pelvic pain is often more complex than in adult women. In today's episode we will discuss how to diagnosis and treat possible gynecologic and non-gynecologic conditions of chronic pelvic pain in the adolescent female with Stephen Scott, MD. Dr. Scott is the endowed chair of Perinatal Mental Health and a member of the Pediatric and Adolescent Gynecology team at Children's Hospital Colorado. Dr. Scott is an Associate Professor of Obstetrics and Gynecology and Pediatrics at the University of Colorado School of Medicine. Do you have thoughts about today's episode or suggestions for a future topic? Write to us, [email protected]

Earlier this fall we shared a special episode to update providers about the growing associations between vaping and more acute, severe lung injury called Vaping Associated Pulmonary Injury – you can listen to that content from Season 3, Episode 6. Today we are going to circle back to this topic with Robin Deterding, MD, and discuss its rapid evolution during the recent months. Dr. Deterding is the Chief of Pediatric Pulmonary Medicine at Children's Hospital Colorado and a Professor of Pediatrics at the University of Colorado School of Medicine. Resources Mentioned in this Episode: Update: Interim Guidance for Health Care Professionals Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use, US Department of Health and Human Services/Center for Disease Control and Prevention MMWR - January 3, 2020 Partnership for Drug-Free Kids: What you Need to Know and How to Talk with Your Kids About Vaping CDC: Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products Previous Charting Pediatrics Episodes about Vaping: E-Cigarettes and Vaping (S2:E23) Vaping Associated Pulmonary Injury (S3:E6) Do you have thoughts about today's episode or suggestions for a future topic? Write to us, [email protected]

With Super Bowl season upon us we wanted to use the occasion to examine a common sports injury seen in our pediatric patient population – ACL injury and treatment. An ACL tear was once an injury exclusive to professional or elite athletes, but the growing prevalence of specialization and year-around training in youth sports has contributed to a large rise in ACL tears in pediatric patients. In this episode, Jay Albright, MD joins us as we will look at the ACL tear case of a 16 year-old-female to highlight the diagnosis, treatment and recovery for these patients. Dr. Albright is the Surgical Director of the Sports Medicine Center at Children's Hospital Colorado and Assistant Professor of Orthopedics at the University of Colorado School of Medicine. Do you have thoughts about today's episode or suggestions for a future topic? Write to us, [email protected]

Last season on the podcast we discussed the initial diagnosis and lifestyle management of hypertension in pediatric patients. If you have not had the opportunity to listen to that episode, go back and check out Season 2, Episode 36 as it will set the back drop for today's discussion as we dive more specifically into medication management for pediatric hypertension patients. In this episode we discuss medication management for pediatric hypertension patients with a pediatric cardiologist, Steve Daniels, MD, PhD and a clinical pharmacist, Dr. Megan Greene. Dr. Greene is a pediatric clinical pharmacist at Children's Hospital Colorado with a specialization in critical care and kidney and liver transplant pharmaceutical support, and also works in our pediatric hypertension clinic. Dr. Daniels is the Pediatrician-in-Chief at Children's Hospital Colorado and L. Joseph Butterfield Chair of Pediatrics within the University of Colorado School of Medicine, where he is a professor of pediatrics and epidemiology. He is a cardiologist by training and a sought-out expert in the fields of pediatric hypertension, dyslipidemia, and pediatric nutrition. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents If you have feedback or questions about today's episode or suggestions for a future topic, write to us at [email protected]

In this episode we discuss the history of vaccines and religion with Josh Williams, MD. For a discussion about today's anti-vaccination climate, listen to S3:E17, Peter Hotez, MD, PhD: Physician-Scientist, Pediatrician, Advocate. Dr. Williams is a Pediatrician at Denver Health Medical Center and an Assistant Professor of Pediatrics at the University of Colorado School of Medicine. Do you have thoughts about today's episode or suggestions for a future topic? Write to us, [email protected]

Is social media good or bad? How much or how little screen time should kids and adolescents have each day? What is the impact of screen time? What kind of digital footprint or reputation are parents creating for their children? These questions and more are covered with our guests Jenny Radesky, MD and Michael Rich, MD who discuss social media and its impact on patients and families. Dr. Radesky is a Developmental/Behavioral Pediatrician whose research focuses on family digital media use, child social/emotional development, and parent-child interaction. Dr. Rich is the Director of the Center on Media and Child Health at Boston Children's Hospital. He has developed media-based research methodologies and authored numerous papers and AAP policy statements, testified to the United States Congress, and makes regular national press appearances. Do you have feedback about today's episode or suggestions for a future topic? Write to us, [email protected]

On behalf of the Charting Pediatrics team, we would like to wish you Happy Holidays and a very Happy New Year! 2019 has been a year of explosive growth for the podcast. We went from averaging 8,000 monthly downloads in January to more than 33,000 monthly downloads last month. Thank you to each one of you for listening and sharing the podcast with your colleagues. Connecting with some of you in person at the 2019 AAP Conference was really a highlight for us. We appreciate you coming by the booth and we love reading the emails and tweets that you send our way. We will be taking the next couple of weeks off from releasing new episodes and will look forward to kicking off our first episode of 2020 on Tuesday, January 7th. Happy Holidays!

On behalf of the Charting Pediatrics team, we would like to wish you Happy Holidays and a very Happy New Year! 2019 has been a year of explosive growth for the podcast. We went from averaging 8,000 monthly downloads in January to more than 33,000 monthly downloads last month. Thank you to each one of you for listening and sharing the podcast with your colleagues. Connecting with some of you in person at the 2019 AAP Conference was really a highlight for us. We appreciate you coming by the booth and we love reading the emails and tweets that you send our way. We will be taking the next couple of weeks off from releasing new episodes and will look forward to kicking off our first episode of 2020 on Tuesday, January 7th. Happy Holidays!

In this episode we are fortunate to be talking with Bernard Dreyer, MD from the New York University School of Medicine discussing school and health care provider partnerships that have been successful in addressing effects of childhood poverty. Dr. Dreyer is past president of the American Academy of Pediatrics (AAP) having served as the 2016 AAP president. Dr. Dreyer is a general and development-behavioral pediatrician who has spent his professional lifetime serving poor children and families. He is Professor of Pediatrics at NYU where he leads the Division of Developmental-Behavioral Pediatrics and is Director of Pediatrics at Bellevue Hospital; he also works as a hospitalist. This episode was recorded live from the 2019 AAP NCE in New Orleans, Louisiana. Do you have thoughts about today's episode or suggestions for a future topic? Write to us, [email protected]

In this episode we have the pleasure to talking with Adiaha Spinks-Franklin, MD from Texas Children's Hospital about strategies to help sleepless teens. Dr. Spikes-Franklin is Associate Professor of Pediatrics at Texas Children's Hospital and the Baylor College of Medicine in Houston. Dr. Spinks-Franklin's research interests are in the areas of the cultural aspect of child development. Her previous research experience included studying the development of children in Senegal, West Africa, and studying the mental health impact of the aftermath of Hurricane Katrina on school-aged African American children in Houston. Other research experiences including exploring the racial identity development of school-aged African American and Latino children in the Houston area who are participating in a reading intervention program. She has also studied healthcare disparities among children with Autism Spectrum Disorders. She is currently studying the effect of Adverse Childhood Experience (ACEs) among children and adolescents with developmental disabilities. This episode was recorded live from the 2019 AAP NCE in New Orleans, Louisiana. Topics Discussed in this Episode: Common presentations that primary care providers will see in adolescents with sleep issues. The importance of the patient's history in determining the causes of symptoms. The various factors, including the homeostatic and circadian drive, in regulating sleep. The difference between REM and non-REM sleep and the physiological processes of each. How sleep changes from childhood to adolescence. Considering both the genetic and environmental components of sleep disorders. How social media activity negatively impacts natural sleep rhythms. What parents can do to mitigate some of the environmental hindrances such as electronics. Maintaining a teen's circadian rhythm by not allowing them to sleep in over weekends. Examples of breathing techniques to help calm down hyperactive or anxious kids. The benefits of gratitude journaling and general journaling before bed. Night sports and adrenaline: encouraging parents to prioritize their children's needs. What families' dinner- and bedtime routines reveal about a household. Thoughts on medicating sleep disorders and how melatonin should be approached. Do you have thoughts about this episode or suggestions for a future topic? Write to us, [email protected]

Substance use among adolescents is pervasive and commonly encountered in primary care pediatrics. According to the most recent Monitoring the Future Study published in 2018, opioid misuse among teens and marijuana use remains stable while vaping device use is climbing to record numbers. The general approach to the assessment and treatment of adolescents with substance use disorders is similar in some respects to adults; however, developmental considerations require an approach tailored to the cognitive, social, and legal status of adolescents. In this episode we discuss the epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis of substance use and substance use disorder in adolescents with Christian Thurstone, MD. Dr. Thurstone is the Director of Behavioral and Health Sciences at Denver Health and Professor of Psychiatry at the University of Colorado Denver. Discussed in this episode: HEADSS Screening Tool Motivational Interviewing Apply for a practitioner waiver to prescribe or dispense buprenorphine under the Drug Addiction Treatment Act of 2000 (DATA 2000) - Office-based treatment for opioid use in patients aged 16 years and above How to diffuse tense family situations in the office Show empathy Slow the conversation down Maintain confidentiality Meet with teens and parents separately EPE - Elicit Permission; Provide Advice; Elicit Feedback "What do you think about what I just said?" Another good question to ask teens, "What do you already know about....." Have feedback about today's episode or suggestions for a future topic? Write to us, [email protected]

Each year thousands of babies born neonatal abstinence syndrome and require specialized medical and psycho-social support. In this episode we discuss the care for newborns who have been exposed to substances, specifically how primary care providers can understand the child's needs and support their caregivers. We are joined by Stephen Patrick, MD from the Vanderbilt University School of Medicine and recorded this discussion live from the 2019 American Academy of Pediatrics NCE in New Orleans. Dr. Patrick is a neonatologist and associate professor of pediatrics and is Director at the Vanderbilt Center for Child Health Policy. You can view Dr. Patrick's 2019 AAP NCE plenary session on this topic here. You can reach Dr. Patrick on Twitter @stephenwpatrick and Dr. Brumbaugh on Twitter @DBrumbaughMD Do you have thoughts about today's episode or suggestions for a future topic? Write to us, [email protected]

In this episode we were privileged to sit down with Megan Sandel, MD, at the 2019 American Academy of Pediatrics NCE in New Orleans to discuss the impact of housing on child health. Dr. Sandel is an associate professor of pediatrics at the Boston University School of Medicine as well as an associate professor of environmental health at the Boston University School of Public Health. She has held both of these positions for the last eight years, but has been working with the university since 2002, first as an assistant professor. She is the former pediatric medical director of Boston Healthcare for the Homeless program and the first medical director of the founding site for medical-legal partnerships, Medical-Legal Partnership-Boston. In addition to publishing articles and serving on committees, she is considered an expert in her field on the topic of housing and child health. Resources Mentioned in this Episode: HowHousingMatters.Org The Hunger Vital Sign Screening Tool by Children's HealthWatch Evicted by Mike Desmond PRAPARE Assessment Tool This episode was recorded live from the 2019 AAP NCE in New Orleans, Louisiana. Do you have thoughts about this episode or suggestions for a future topic? Write to us, [email protected]

In this episode we discuss the diagnosis and management of child abuse in primary care pediatrics. We are pleased to be joined by Andy Sirotnak, MD who recently released his new book at the 2019 AAP NCE, Child Abuse Medical Diagnosis and Management. Dr. Sirotnak is a Professor and Vice-Chair for Faculty Affairs in the Department of Pediatrics and the Director of the Child Protection Team at Children's Hospital Colorado. Do you have questions about this episode or suggestions for a future topic? Write to us, [email protected]

The development and deployment of childhood vaccines represents the most important life saving achievement in the last century, but the status of our protection against vaccine-preventable illness is as fragile as ever in the United States. In 2019 we have already seen the most cases of measles since 1992 — over 1200 — this for a disease that was declared eliminated from the U.S. in 2000. Vaccine hesitancy among families has been fueled by an anti-vaccine movement that has steadily organized during the last two decades, represents an existential threat to the health of children and is the subject of today's podcast. Our guest is a physician-scientist, pediatrician and advocate we admire greatly — Peter Hotez, MD, PhD. In today's episode we are going to talk about his new book, Vaccines Did Not Cause Rachel's Autism: My Journey as a Vaccine Scientist, Pediatrician and Autism Dad. Dr. Hotez is Dean of the National School of Tropical Medicine and Professor of Pediatrics and Molecular Virology & Microbiology at Baylor College of Medicine where he is also the Director of the Texas Children's Center for Vaccine Development (CVD) and Texas Children's Hospital Endowed Chair of Tropical Pediatrics. He is also University Professor at Baylor University, and Fellow in Disease and Poverty at the James A Baker III Institute for Public Policy. Thoughts about this episode or suggestions for a future topic? Write to us, [email protected]

Pediatric patients, ages 13 to 18 years, with severe obesity should have greater access to bariatric surgery, according to a new American Academy of Pediatrics (AAP) policy statement. For pediatricians, that means seeking out high-quality multidisciplinary centers for patients who meet criteria; providing timely referrals; and facilitating care before and after surgery for adolescents with severe obesity, defined as a BMI ≥35 or ≥120% of the 95th percentile for age and sex, whichever is lower. The policy statement, and a supporting technical report, were simultaneously published in Pediatrics. Today's guest is Thomas Inge, MD, discussing the new AAP policy statement on bariatric surgery. Dr. Inge is a Professor of Surgery and Pediatrics at the University of Colorado School of Medicine and Associate Surgeon in Chief, Director of Pediatric Surgery and the Director of the Center for Bariatric Surgery at Children's Hospital Colorado. This episode of Charting Pediatrics Podcast was recorded live from the 2019 American Academy of Pediatrics NCE in New Orleans. Do you have questions about this episode or suggestions for a future topic? Write to us, [email protected]

In this episode we talk with Lewis First, MD and Alex Kemper, MD about studies published in the last year that could change the way you practice pediatrics. Dr. First (@lewis_first) is Professor and Chair of the Department of Pediatrics at the Larner College of Medicine at the University of Vermont and Chief of Pediatrics at the University of Vermont Children's Hospital. He serves as the Editor-in-Chief of Pediatrics, the peer-reviewed medical journal of the American Academy of Pediatrics. Dr. Alex Kemper (@AlexRKemper) is the Division Chief of Primary Care Pediatrics at Nationwide Children's Hospital and Professor of Pediatrics at The Ohio State University College of Medicine. He serves as the Deputy-Editor-in-Chief of Pediatrics. Articles Covered that can be found from Pediatrics: Vaccines Updates - What can pediatricians do to increase vaccination rates in their practice? How to evaluate a febrile infant under 2 months of age Issues in Adolescent and Teen Patients — Suicidality and identifying risk Cannabis Concentrate and Cannabinoids — Impact on children and adolescents, including vaping LGBTQ Patient Care, including bullying issues and impact/outcomes based on state legislation (i.e. Proposition 8 from California) Smoking and Vaping - Combustable cigarettes and e-cigarettes CRAFFT instrument - Adapted screening for teens with substance abuse disorders Firearm Safety and Protection of Children from Firearms - Where pediatric firearm mortality has occurred relative to gun laws in the United States; morbidity and mortality of children in homes with firearms Telehealth - Quality of Care, antibiotic prescribing stewardship, patient satisfaction for Telehealth visits Electronic vs Print Books in Kids — Parents interact more with their children when they use a traditional print book than an ebook. Maintenance of Certification - Importance of improving quality of care This episode was recorded live from the 2019 AAP NCE in New Orleans, Louisiana. Do you have a question about this episode or a suggestion for a future topic? Write to us, [email protected]

In young children, many of the symptoms of eosinophilic esophagitis resemble those of gastroesophageal reflux disease (GERD)—including feeding disorders and poor weight gain—so the child may be mistakenly diagnosed with GERD. In today's episode we talk to Glenn Furuta, MD about the importance of a proper diagnosis of esophagitis in children, signs/symptoms to look for and effective treatment options. Dr. Furuta is the La Cache Endowed Chair for GI Allergic and Immunologic Diseases, the Director of Gastrointestinal Eosinophilic Diseases Program at Children's Colorado and a Professor of Pediatrics in Gastroenterology at the University of Colorado School of Medicine. Do you have a suggestion for a future episode or feedback about this one? Write to us, [email protected]

Biliary atresia is a rare gastrointestinal disorder, occurring approximately 1 in 10,000 to 15,000 births in the United States, and is characterized by a destruction or absence of, all or a portion of the extrahepatic bile duct. Affected infants present with jaundice and fibrosis. In some cases, additional abnormalities may be present, including cardiac defects and intestinal, spleen and kidney malformations; the exact cause of biliary atresia is unknown. In today's episode we talk with Cara Mack, MD to unpack the clinical presentation, management and ongoing care for patients with biliary atresia. Dr. Mack is a Professor of Pediatrics at the University of Colorado School of Medicine, a practicing Pediatric Hepatologist and the Director of the Pediatric Liver Center at Children's Hospital Colorado. Let us know if you have a suggestion for a future topic or thoughts about this episode!

Sepsis remains one of the leading causes of morbidity and mortality in children despite improved understanding of the pathophysiology leading to better clinical management and survival. Recent studies have identified several areas that must be addressed by the clinician in order to continue to impact the morbidity and mortality associated with sepsis. In today's episode we talk with Halden Scott, MD about the presentation, management and follow-up care of pediatric patients with sepsis. Dr. Scott is an Associate Professor of Pediatrics and Emergency Medicine at the University of Colorado School of Medicine and a Pediatric Emergency Medicine Physician at Children's Hospital Colorado. Resources mentioned in today's episode: The Children's Hospital Association Improving Pediatric Sepsis Outcomes Collaborative Children's Hospital Colorado Pathways: Scroll to Emergency Department/Urgent Care Sepsis for the sepsis pathway The most recent pediatric sepsis guidelines Articles that Dr. Scott referred to in the podcast about the role of lactate in sepsis, and the problems with SIRS criteria for sepsis screening: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2595569 https://www.ncbi.nlm.nih.gov/pubmed/26711848/ https://www.ncbi.nlm.nih.gov/pubmed/25778743/

Join us as we podcast live from the American Academy of Pediatrics National Conference and Exhibition in New Orleans on October 26 & 27, 2019! Stop by Booth #632 in the Exhibit Hall to say hello – our host team of Dr. Alison Brent, Dr. David Brumbaugh and Dr. Dan Nicklas would love to meet you!

Functional abdominal pain disorders are the most common cause of chronic abdominal pain in children and adolescents. On today's episode we are talk with Jaime Belkind-Gerson, MD to unpack the presentation, diagnosis and management of functional abdominal pain from the primary care perspective. Dr. Belkind-Gerson is Director of the Neurogastroenterology and Motility Program at Children's Hospital Colorado. He is al an associate professor of pediatric gastroenterology, hepatology and nutrition at the University of Colorado School of Medicine. Red Flag Symptoms Concerning for an organic cause of GI Pain Weight Loss Persistent Diarrhea Blood in stool Waking from a dead sleep with pain Persistent vomiting Chronic fever Photo described at the beginning of today's episode: Photomicrograph of the lining of the intestine of a young female patient who had a biopsy done during a colonoscopy

Things have changed over the last 20 years, with more hospitals using people with expertise in Hospital medicine, known as "Hospitalists," to care for patients who are admitted for an inpatient stay. In the mid-1990s, as pressures to provide outpatient care to large populations increased for general pediatricians, it became less efficient for them to care for patients in the hospital simultaneously. The field of hospital medicine arose, with physicians who were dedicated to the complexity of inpatient care. Fellowship training followed soon thereafter to prepare doctors further for excellence in the inpatient ward environment. In today's episode, we will talk with Mark Brittan, MD about the history of "Hospitalists," "Hospitalist" training, and where the field is heading in the future. Dr. Brittan is an Associate Professor of Pediatrics in the Pediatric Hospital Medicine section and the Fellowship Director for Pediatric Hospital Medicine at the University of Colorado School of Medicine.

According to the American Academy of Pediatrics, studies show that up to 9% of teenagers meet criteria for depression at any one time, with as many as 1 in 5 teenagers having a history of depression at some point during adolescence. In primary care settings, point prevalence rates are likely higher, with rates up to 28%. Because adolescents face barriers to receive specialty mental health services, only a small percentage of depressed adolescents are treated by mental health professionals. As a result, primary care settings have become the de facto mental health clinics for this population, although most primary care clinicians feel inadequately trained, supported, or reimbursed for the management of depression. In today's episode we sit down with Jenna Glover, PhD and clinical pharmacist Dr. Danielle Stutzman to talk through practical approaches to depression screening, anticipatory guidance and medication management. Dr. Glover is the Director of Clinical Psychology training at Children's Hospital Colorado and Assistant Professor of Child Psychiatry at the University of Colorado School of Medicine. Dr. Stutzman is a Clinical Pharmacist at Children's Hospital Colorado with a special interest in psychiatry medication. Resources mentioned in today's episode: Severity Measure for Depression, child age 11-17 PROMIS Measure

In today's episode we talk with Nicholas Cost, MD about the diagnosis and management of pediatric urologic cancer in children and adolescents, including initial presentations and ongoing and follow-up management for primary care providers. Dr. Cost is a Pediatric Urologist at Children's Hospital Colorado and Associate Professor of Pediatrics of Surgery and Urology at the University of Colorado School of Medicine. Let us know what you think about today's episode or share a suggestion for a future episode by writing to us, [email protected] Send Dr. Brent a Tweet @AlisonBrentMD

Vision problems are common among school-age kids and there are many eye diseases and conditions that can affect a child's vision. According to Prevent Blindness America, one in four school-age children have vision problems that, if left untreated, can affect learning ability, personality and adjustment in school. In today's episode we are going to talk with Dr. Emily McCourt to unpack the most common eye issues in pediatrics and front line screening in the primary care office. Dr. McCourt is an ophthalmologist at Children's Hospital Colorado and is associate professor of pediatric ophthalmology and strabismus at the University of Colorado School of Medicine.

Providers may have seen the reports from around the country of growing associations between vaping and more acute, severe lung injury; this is being called Vaping Associated Pulmonary Injury (VAPI). The CDC is involved and many states are now reporting vaping-associated pulmonary cases. In today's special episode we are discussing VAPI and how to diagnosis, report and treat; our expert guest is Robin Deterding, MD, Chief of Pediatric Pulmonary Medicine at Children's Hospital Colorado and Professor of Pediatrics at the University of Colorado School of Medicine. Children's Colorado is notifying providers that may see these patients. It is very unclear what is happening, but there is a severe, noninfectious respiratory failure spectrum with an ARDS-like picture. If you know of a past or current patient case that fits the below criteria please contact the Pulmonary Team via OneCall, 720-777-3999. Additional Resources: What Parents Need to Know About Teen Vaping Reporting suspected cases to the CDC Report suspected cases to CDPHE's Disease Reporting Line, 303-692-2700 or 303-370-9395 (after hours). This includes potential cases who presented since June 1, 2019. CDPHE personnel will conduct a medical record review and contact the patients to administer a thorough investigation questionnaire. Charting Pediatrics Podcast: Teen E-Cigarette Use and the Vaping Epidemic (S2:E23)

Nearly 60 percent of children report having headaches; by the age of 18, that number increases to 90 percent. Recurrent, severe headaches also are common in this population. In the United States, one study reported that approximately 20 percent of children aged 4 to 18 years report having had notable recurrent headaches (including migraine) in the past 12 months. In today's episode we are talk with Mario Coleman, MD about the diagnosis and management of reoccurring headaches in children and adolescents. Dr. Coleman is a Pediatric Neurologist and an Assistant Professor of Pediatrics and Neurology at the University of Colorado School of Medicine.

Renal tubular acidosis, or RTA, refers to a group of disorders characterized by defective renal acid-base regulation. The capacity for normal urinary acidification is impaired, resulting in net acid retention and hyperchloremic metabolic acidosis. In this episode, Danielle Soranno, MD reviews basic mechanisms of the disease that are important for diagnosis and management of RTA in your patients. Dr. Soranno is an Associate Professor of Pediatrics, Bioengineering, and Medicine at the University of Colorado School of Medicine and a Pediatric Nephrologist at Children's Hospital Colorado. Tell us what you thought about today's episode or make a suggestion for a future episode! Send a tweet to Dr. Brent, @AlisonBrentMD

Hirschsprung disease occurs in approximately one in 5,000 newborns. Despite advances in the diagnosis and management of the disease, patients remain at risk for long-term gastrointestinal morbidity, including obstructive symptoms, fecal incontinence, and enterocolitis, with negative implications on quality of life. In today's episode we are talking with Luis De la Torre, MD, to unpack the diagnosis and management of Hirschsprung disease and discuss new treatments being explored. Dr. De la Torre is a Visiting Associate Professor of Surgery at the University of Colorado School of Medicine and the newest member of our International Center for Colorectal and Urogenital Care team at Children's Hospital Colorado. We'd love to hear from you! Share your thoughts about today's episode or ideas for a future topic by emailing the Charting Pediatrics host team.