Charting Pediatrics

Pediatric hypertension occurs in 2-5% of all pediatric patients and is one of the top five chronic diseases in children and adolescents. According to the National Heart, Lung and Blood Institute, the diagnosis is missed in up to 75% of pediatric patients in primary care settings and appropriate medication initiation occurs much less frequently than is indicated, according to current guidelines. In today's episode we talk with Steve Daniels, MD about the pediatric hypertension clinical practice guideline he helped to co-author, how you can incorporate blood pressure screening at well child visits, replacing the term "prehypertension" with "elevated blood pressure" and treatment recommendations for your patients. Dr. Daniels is a pediatric cardiologist, Pediatrician-in-Chief and the L. Joseph Butterfield Chair of Pediatrics at Children's Hospital Colorado, Professor of Pediatrics at the University of Colorado School of Medicine, Professor of Epidemiology at University of Colorado School of Public Health. Dr. Daniels is a sought-out expert in the field of pediatric hypertension and pediatric nutrition.

Acute flaccid myelitis (AFM) is a rare but serious condition; one that strikes fear into the hearts of parents and providers alike. AFM affects the nervous system, specifically the gray matter of the spinal cord, which results in the presenting symptoms of a flaccid paralysis. This condition is not new. Acute flaccid myelitis appears to be caused most often by viruses, especially EV-D68, which is a member of the polio family. Although poliomyelitis has been mostly eradicated worldwide, in recent years large outbreaks of the related enterovirus 71 has been seen in Asia-Pacific countries. This virus, that some have coined "the new polio" mostly affects children, manifesting as hand, foot, and mouth disease, aseptic meningitis, poliomyelitis-like acute flaccid paralysis, brainstem encephalitis, and other severe systemic disorders. In today's episode we are joined by Kevin Messacar, MD to talk through the most common presentations and treatment of enterovirus infections. Dr. Messacar is both an Infectious Disease Specialist and Hospitalist at Children's Hospital Colorado and is an Assistant Professor of Pediatrics at the University of Colorado School of Medicine. Dr. Messacar's interview in this episode is expressly his own and not on a behalf of the professional organizations he serves. CDC AFM Guidelines and Resources for Providers What did you think of today's episode? Tweet Dr. Brent, @AlisonBrentMD or write to us [email protected].

Today we are fortunate to be joined by a home-grown Denver pediatrician, child health advocate and legislator for the Colorado House of Representatives, Rep. Dr. Yadira Caraveo. Dr. Caraveo was born and raised in Denver and attended medical school at the University of Colorado. She completed her residency in pediatrics in Albuquerque, New Mexico at the University of New Mexico and is currently a pediatrician at Peak Pediatrics in Denver. She has been interested in political and child advocacy since medical school and was elected to the Colorado House of Representatives to represent House District 31 in the November 2018 mid-term election. What did you think of today's episode? Send Dr. Brumbaugh a tweet @DBrumbaughMD or write to us at [email protected].

As we head into a busy travel season increasing numbers of our patients and families are venturing to high altitude to partake in activities such as sight-seeing, hiking and climbing. Children who travel to high altitude are at risk for developing some form of acute altitude illness and will seek advice from their primary care physician before traveling. In today's episode we talk to Christine Ebert-Santos, MD to unpack what we know and what we don't about children residing at or visiting high altitude and how you can provide anticipatory guidance to your patients and families. Dr. Ebert-Santos is a pediatrician at the Ebert Family Clinic in Summit County, Colorado. Summit County is comprised of mountainous elevations ranging from 7,957 feet (2,425 m) at Green Mountain Reservoir to 14,270 feet (4,350 m) at Grays Peak. The elevation of the county seat of Breckenridge is 9,602 feet (2,927 m), making it one the highest cities in the state of Colorado and the United States. High Altitude Health

Acute otitis media (AOM) is one of the most common reasons that patients present to our office. Not surprisingly, ear infections are also the most common reason why children receive a prescription for a course of antibiotics. In today's episode, we are going to talk to Peggy Kelley, MD about the classic symptoms and treatment for acute otitis media, safe antibiotic prescribing practices, and how to approach treatment failure and ear tubes. Dr. Kelley is a pediatric otolaryngologist at Children's Hospital Colorado and Associate Professor of Otolaryngology at the University of Colorado School of Medicine. Send Dr. Nicklas a tweet and let him know what you thought about today's episode, @DanielNicklasMD

In this episode, Daniel Searing, MD, Professor of pediatrics and allergies at Children's Colorado, talks about seasonal allergies and pollen. He discusses the effects of pollen, how to treat and alleviate allergies, and more. In this episode, Dr. Searing discusses: Pollen and how it affects allergies Why cottonwood trees are a big pollinator, especially in the springtime Why rain and humidity shut down pollen levels Why Colorado's climate makes people more susceptible to allergies How allergy symptoms will vary from year to year The importance of monitoring the quantitative level of pollen in the environment How physicians should manage the initial approach to a child with allergy symptoms Key features to look out for Why treating pollen allergies with persistent treatment is more effective What role the prescription drug Montelukast plays in treating allergic rhinitis What you can do to help prevent pollen from spreading Which medicines and therapies can help alleviate allergies When to see a doctor for seasonal allergies The approach of an immunotherapy treatment plan and the two phases of a typical treatment schedule

As providers, the safety of our patients is paramount. In recent years, increased attention has been given to diagnostic error in medicine, specifically those that arise through error in cognitive perception, failed heuristics and biases. In today's episode, we are talking with Joe Grubenhoff, MD about error in diagnosis and strategies for reducing cognitive bias. Dr. Grubenhoff is the Associate Medical Director of Clinical Effectiveness and is a pediatric emergency medicine physician at Children's Colorado. He is also an Associate Professor of Pediatrics at the University of Colorado School of Medicine. Resources mentioned in today's episode: How Doctor's Think by Jerome Groopman, MD Thinking Fast and Slow by Daniel Kahneman What did you think of today's episode? Send Dr. Brumbaugh a tweet @DBrumbaughMD.

Measles is a highly contagious respiratory disease that spreads easily through the air or on infected surfaces; According to the American Academy of Pediatrics, of every 1,000 people who get measles, 1 to 2 will die. And the numbers are even higher in developing countries where the case fatality rate is 4-10%. As providers who care for kids, we urge our parents, schools and communities to protect each other by vaccinating for measles. In today's episode Edwin Asturias, MD joins us to talk through the classic symptoms, treatment and vaccination recommendations for measles. Dr. Asturias is the Director for Latin American Infectious Disease at Children's Hospital Colorado. He is also an Associate Professor or Pediatric Infectious Disease at the University of Colorado School of Medicine. Let Dr. Nicklas know what you thought of today's episode - send him a tweet @DanielNicklasMD

In today's episode we dive in to the topic of toxicity and the most common overdoses in pediatric medicine. Our guest is Sam Wang, MD, returning from earlier this season when we covered the topic of Marijuana as Medicine (S2:E14). Dr. Wang is a Pediatric Emergency Medicine Physician and Medical Toxicologist at Children's Hospital Colorado and the University of Colorado School of Medicine. Let us know what you thought of today's episode: Tweet Dr. Brent (@AlisonBrentMD) or write to us, [email protected].

HPV vaccine rates remain low with only about 16% of U.S. adolescents being fully vaccinated by the time they turn 13 according to the CDC. With about 34,000 cases of HPV-induced cancers annually, we as providers have an opportunity to encourage more parents to vaccinate their children. In this episode we talk with guests Brian Gablehouse, MD, and Sean O'Leary, MD, about HPV vaccination hesitancy, recent updates to the HPV vaccination schedule and how to utilize motivational interviewing techniques when talking with parents. Dr. Gablehouse is a pediatrician at Peak Pediatrics located in Wheat Ridge and Thornton, Colorado. Dr. O'Leary is Director of the Colorado Pediatric Practice-Based Research Network and works on the Infectious Disease team at Children's Hospital Colorado; he is Associate Professor at the University of Colorado School of Medicine. Let us know what you think of today's episode! Drop us an email. Check out S2:E12 for further discussion about the topic of Vaccinations and Motivational Interviewing Techniques.

Historically, there has not been a Food and Drug Administration – approved medical therapy to treat food allergies. This is about to change with emerging research in immune desensitization and clinical trials with food immunotherapy products that will likely soon hit the market. In today's episode, we will talk about these clinical trials, what two products are likely to be FDA-approved by the end of 2019 and what that means for your food-allergic patients. Today's guests are David Fleischer, MD and Matthew Greenhawt, MD. Dr. Fleischer is Director of the Allergy and Immunology Center at Children's Hospital Colorado and Associate Professor in Pediatrics and Allergy at the University of Colorado School of Medicine. Dr. Greenhawt is Director of the Food Challenge and Research Unit at Children's Hospital Colorado Associate Professor of Pediatrics and Allergy at the University of Colorado School of Medicine. Related Research: Effect of Epicutaneous Immunotherapy vs Placebo on Reaction to Peanut Protein Ingestion Among Children With Peanut Allergy: The PEPITES Randomized Clinical Trial, JAMA February 22, 2019 We love hearing from our listeners - email the Charting Pediatrics team to suggest a future topic or tell what you thought of this one.

As a continuation of our discussion of congenital heart disease from Season 2, Episode 21, we are going to look at the primary care provider's ongoing role caring for these patients; signs and symptoms of undiagnosed patients and how to support adolescent patients transitioning to adult care. Today's guest is Joe Kay, MD. Dr. Kay is Program Director of the joint Adult Congenital Heart Disease Program at the University of Colorado Hospital and Children's Hospital Colorado, and Associate Professor of both Pediatrics and Medicine at University of Colorado School of Medicine. We love hearing from our listeners! Reach out and tell us what you would like to hear in a future episode.

How many concussions are too many for a young athlete? When should sport retirement be considered? In today's episode we are going to look at the case of a high school athlete as the basis for exploring these questions with Julie Wilson, MD. Dr. Wilson is Co-Director of the Concussion Program at Children's Hospital Colorado and Assistant Professor at the University of Colorado School of Medicine. Tell us what you thought about today's episode. Charting Pediatrics is now on Spotify!

The practice of pediatric pain management has developed significantly in the last decade with the use and validation of pain assessment tools specific to pediatric patients, yielding evidence-based pain management guidelines in children of all ages. Still, pharmacological intervention options coupled with practicing safe prescribing can be overwhelming in the primary care setting. In today's episode we are joined by Tom Majcher, DO, to discuss a practical approach to outpatient pain management in pediatrics and the prevalence of conditions associated with acute and chronic pain. Dr. Majcher is Chair of Anesthesiology at Children's Hospital Colorado and Professor of Anesthesiology at the University of Colorado School of Medicine.

A real public health problem has snuck up on us as pediatricians - vaping and e-cigarettes use. On today's episode, we will unpack the facts about e-cigarettes and vaping, provide you with practical tools to counsel your patients and families and talk about upcoming advocacy and policy work pertaining to e-cigarettes. Our guests today are Jennifer Woods, MD, Medical Director of the Adolescent Medicine Clinic at Children's Hospital Colorado and associate professor of pediatrics at the University of Colorado School of Medicine; and Heather Hoch, MD pediatric pulmonologist at Children's Hospital Colorado and assistant professor the CU School of Medicine. From today's episode: The 2018 NIH Monitoring the Future Survey Results were released last month. The survey found that 37% of 12th graders and 18% of 8th graders have vaped in the last year and the number of kids who used vaping products in the last month jumped from 11 to 21% in 12th graders and from 9 to 16% in 10th graders — those changes are the biggest jumps in adolescent substance use that has been seen in the 4 decades of conducting the Monitoring the Future Survey. From the AAP: 5 Facts to talk to Teens about Vaping The FDA held a public hearing on January 18, 2019 to discuss efforts to eliminate youth e-cigarette use, with a focus on the potential role of drug therapies to support cessation and the issues impacting the development of such therapies. If this is a topic you are passionate about, we encourage our listeners to visit the FDA website to submit a public comment, those public comment submissions will be available through February 1, 2019 https://www.fda.gov/TobaccoProducts/Labeling/ProductsIngredientsComponents/ucm456610.htm) Pediatricians Push for Laws to Prevent Teen Vaping Colorado Bill Introduced to Combat Skyrocketing Youth E-Cigarette Use, Clean Indoor Air Act, House Bill 19-1076 Feedback on this episode or suggestions for a future topic? Write to us at [email protected] - we love hearing from our listeners!

Integrative health care describes the blending of complementary and conventional therapies by practitioners to include all appropriate therapies in a patient-centered and evidence-based fashion. Today we will offer up some practical tips about how you can incorporate an integrative approach to your care of kids and adolescents with Rachel Workman, MD. Dr. Workman runs the Integrative Medicine Clinic at Children's Hospital Colorado and is Assistant Professor of Pediatrics at the University of Colorado School of Medicine. Resources mentioned in this episode: Nourish Your Tribe by Nicole Magryta, MBA, RDN Finally Focused by James Greenblatt, MD FoundMyFitness Podcast with Rhonda Patrick, PhD The Tim Ferriss Show Health for the Whole Child: An Integrative Approach CME Conference, October 30, 2019 in Aurora, CO (CME Credit)

In this episode we discuss how to respond to abnormal results of the newborn Critical Congenital Heart Disease (CCHD) screening with Chris Rausch, MD. Dr. Rausch is the Director of the Cardiopulmonary Exercise Laboratory at Children's Hospital Colorado and Associate Professor of Pediatric Cardiology at the University of Colorado School of Medicine. In this Episode: Why Critical Congenital Heart Disease (CCHD) requires attention from pediatric provider Reasons why CCHD can be missed in prenatal screenings CCHD screening protocols and toolkits for nurseries The recommended screening window for newborns How to ensure that newborns get the appropriate evaluations Understanding the effect of elevation on CCHD screening results The false-positive rate of CCHD screenings Improvement in outcome rates for newborns with CCHD Occurrences when screenings will be performed by the primary care physician

Today we discuss pediatric trigger thumb (also know as Trigger Finger, Flexor Tenosynovitis, or Stenosing Tenosynovitis) with Sarah Sibbel, MD. Dr. Sibbel is the Director of the Pediatric Hand and Upper Extremity Program and Surgical Director of the Brachial Plexus Center at Children's Hospital Colorado and Assistant Professor of Orthopedics at the University of Colorado School of Medicine. In this episode: Defining pediatric trigger thumb and the path of physiology Hypothesis of why trigger thumb occurs in children and adults Diagnosing trigger thumb in primary care Helpful imaging to obtain Operative and non-operative treatment plans and their associated risks The success rate of surgery as a treatment Time optimal period between observation and surgery for trigger thumb How trigger thumb impacts a child's day-to-day life Role for non-steroidal anti-inflammatory agents in trigger thumb treatment Follow-up plans for the outpatient setting

Happy holidays to you, our Charting Pediatrics listeners. Whether the snow is falling where you are, or your palm trees are wrapped in lights, we hope you will be enjoying these next couple of weeks with family and friends. In this season of celebration and reflection, we wanted to say thank you to you, our Charting Pediatrics listeners. Each week we get the opportunity to interview our pediatric colleagues to bring you meaningful educational content, and we have the best time doing this. Indeed, when we do each of these podcasts, it's the very best part of our day. It's truly humbling to know that there are more than 10,000 of you tuning in each month as part of our amazing Charting Pediatrics community. Like you, we will be taking the next couple of weeks off for friends and family. But don't worry! The show will return on January 8th with new and exciting content that you won't want to miss. Thank you for sharing a piece of your week with us. So until next time, keep on keeping kids safe out there and Happy Holidays!

On this episode we discuss the diagnosis and management of ovarian cysts and torsion risk with Patricia Huguelet, MD. Dr. Huguelet is the Section Chief of Pediatric and Adolescent Gynecology at Children's Hospital Colorado and Associate Professor of Obstetrics and Gynecology at the University of Colorado School of Medicine. In this episode: Most common presentations/symptoms of ovarian cysts reported to a primary care provider. Why many ovarian cysts can be asymptomatic. Differentiating between other abdominal pain versus ovarian cyst pain. Determining whether ovarian cysts are benign or malignant. The differences in symptoms and pain in benign versus malignant cysts. Three mechanisms of ovarian pain: ischemia from torsion, acute rupture and hemorrhage, rapid capsular stretch. The optimal modality for ovarian cyst imaging diagnosis. Symptoms and pain that would lead more towards ovarian torsion diagnosis. When ovarian torsion might occur without the presence of a cyst or mass. Why it is always better to preserve the ovary after torsion; resilience of function. The fertility outlook for women who have had ovarian torsion. Best treatment course for a hemorrhagic cyst; preserving fertility. Laboratory tests to consider when diagnosing ovarian cysts/torsion. Outpatient followup care for patients after treatment/diagnosis for ovarian cysts or torsion. Likelihood of recurrence of ovarian cysts and risk for torsion. The role of non-steroidal use in ovarian cyst pain control.

In this episode, we discuss abnormal pediatric head growth, shape and treatment options with Todd Hankinson, MD. Dr. Hankinson is a Pediatric Neurosurgeon at Children's Hospital Colorado and Associate Professor of Neurosurgery at the University of Colorado School of Medicine.

On today's episode we discuss the most common clinical presentations, causes and treatments of atopic eczema with Lori Prok, MD and Julieann Tibbetts, PNP. Dr. Prok is a Pediatric Dermatologist at Children's Colorado and Associate Professor of Dermatology at the University of Colorado School of Medicine. Julieann is a Pediatric Nurse Practitioner in the Dermatology Department at Children's Colorado and Senior Instructor of Dermatology at the University of Colorado School of Medicine.

Today we discuss the art and science of caring for young mothers in the pediatric practice. Hana Smith, MD and Amy Ehmer, PsyD, join us to discuss the Young Mothers Clinic and the Colorado Adolescent Maternity Program and opportunities to adopt aspects of this care model into the primary care practice. Dr. Smith is the Medical Director of the Young Mother's Clinic at Children's Colorado and assistant professor at the University of Colorado School of Medicine. Dr. Ehmer is a psychologist at the Young Mothers Clinic and Colorado Adolescent Maternity Program, and a Senior Instructor at the University of Colorado School of Medicine. In today's episode: PHQ-9 Screening Tool - Modified for Teens Edinburgh Postnatal Depression Scale (EPDS) Nurse Family Partnership Supporting clinical documentation and tests for young mothers Colorado Adolescent Maternity Program (CAMP) Washington Post article about Children's CO CAMP Program

This episode was recorded live from the 2018 American Academy of Pediatrics (AAP) National Conference and Exhibition in Orlando, Fla. with Leslie Walker-Harding, MD discussing addiction prevention in primary care. Dr. Walker-Harding is the chair of the Department of Pediatrics and the pediatrician-in-chief at Penn State Health Milton S. Hershey Medical Center and the Medical Director of Penn State Children's Hospital.

This episode was recorded live from the 2018 American Academy of Pediatrics (AAP) National Conference and Exhibition in Orlando, Fla. with Elissa Miller, MD and Sam Wang, MD discussing the timely and controversial cultural topic of marijuana as medicine. Dr. Miller is the Chief of the Division of Palliative Medicine at Nemours/Alfred I. duPont Hospital for Children and Clinical Associate Professor of Pediatrics at Thomas Jefferson University in Philadelphia, Pa. Dr. Wang is a Pediatric Emergency Physician and Medical Toxicologist at Children's Hospital Colorado and Assistant Professor at the University of Colorado School of Medicine in Denver. Marijuana Exposure in Kids Rose after Recreational Use Legalized in Colorado: Retrospective Study Finds Significant Increase in Unintentional Exposure Marijuana Safety in the Home Acute Marijuana Intoxication Medical Marijuana Research

This episode was recorded live from the 2018 American Academy of Pediatrics (AAP) National Conference and Exhibition in Orlando, Fla. with Rachel Moon, MD discussing safe infant sleep. Dr. Moon is the Division Head of General Pediatrics and professor of pediatrics at the University of Virginia School of Medicine, and Chair of the AAP SIDS Task Force. SIDS and other Sleep-Related Infant Deaths: Updated 2016 Recommendations for Safe Infant Sleeping Environment

Welcome back Charting Pediatrics listeners! Today we are excited to announce that with Season 2 of Charting Pediatrics, we are taking our show on the road. We are going to be live podcasting from Orlando next month at the American Academy of Pediatrics National Conference and Exhibition, which of course is the big general pediatrics conference of the year! Dr. David Brumbaugh and Dr. Alison Brent are thrilled to have the opportunity to sit down and record with some wonderful pediatric experts from around the US and discuss the timely topics they are covering in their specific conference presentations. Our guests will include Dr. Elissa Miller from Nemours/Alfred I. duPont Hospital for Children, and Dr. Sam Wang from our own Children's Hospital Colorado. In addition, we have Dr. Leslie Walker-Harding from Penn State Children's Hospital, as well as Dr. Rachel Moon from the University of Virginia School of Medicine. We'd love the opportunity to meet you, our listeners. So please stop by the exhibit hall where we will be live podcasting from Booth 1113. Stop in, say hello, and catch some of the live recordings that will be taking place on Saturday, November 3rd with this fantastic panel of guests. Until next time, keep on keeping kids safe out there!

Today we are discussing the diagnosis and treatment of Henoch–Schönlein purpura, HSP with Jens Goebel, MD, and Robert Fuhlbrigge, MD. Dr. Goebel is the Chief of Nephrology at Children's Colorado and professor of pediatrics at the University of Colorado School of Medicine. Dr. Fuhlbrigge is Chief of Rheumatology at Children's Colorado and Professor of Pediatrics also at the University of Colorado School of Medicine. Key Points From This Episode: Effects of systemic corticosteroids on HSP symptoms and potential complications. The incidence of HSP in the community and what ages are most likely to be affected. Classification criteria for the onset of HSP in patients. Understanding the events and drive of HSP at a molecular level. Tests that are helpful to understand risk of progression or to confirm diagnosis of HSP. How often HSP patients who are at risk for nephritis should be screened. Treatment decisions for patients with more severe HSP and complications. The percentage of recurrent flares of HSP symptoms in patients. Unusual presentation of HSP symptoms in pediatric patients.

In today's episode, we're examining a case that started in a primary care pediatrician's office and ended in the Children's Hospital Colorado Aerodigestive Program. Joining us are the three physicians involved in the patient's care examine: Larissa Applegate, MD, a pediatrician at Pediatrics West in Wheat Ridge, Colorado; RyanCaltagirone, MD, a pediatricemergency room physician at Children's Colorado; and Sven Streubel, MD, an otolaryngologist with Children's Colorado. In this episode: Our three guests examine their roles in the patient's care and share their key takeaways to inform other medical professionals The origins of the case and how the patient, baby Rachel, first presented in the hospital Steps taken once Rachel's respiratory struggles were evident and next steps to get her to the Emergency Department Importance of clear communication between departments and with patient families in complex, multidisciplinary cases Approaching a patient who presents with laryngomalacia from an ENT perspective Using a bedside scope to determine the severity of the laryngomalacia The various elements of Rachel's multidisciplinary care, including: admission procedure, observation of feedings, continued oxygen support and plan for next steps Most common medical treatment plan for patients with laryngomalacia Designing a long-term management plan for a child with laryngomalacia that supports the patient as well as their family Accounting for comorbidities that come along with laryngomalacia Update from patient and key takeaways from the case

Welcome back Charting Pediatrics listeners! Today we are excited to announce that with Season 2 of Charting Pediatrics, we are taking our show on the road. We are going to be live podcasting from Orlando next month at the American Academy of Pediatrics National Conference and Exhibition, which of course is the big general pediatrics conference of the year! Dr. David Brumbaugh and Dr. Alison Brent are thrilled to have the opportunity to sit down and record with some wonderful pediatric experts from around the US and discuss the timely topics they are covering in their specific conference presentations. Our guests will include Dr. Elissa Miller from Nemours/Alfred I. duPont Hospital for Children, and Dr. Sam Wang from our own Children's Hospital Colorado. In addition, we have Dr. Leslie Walker-Harding from Penn State Children's Hospital, as well as Dr. Rachel Moon from the University of Virginia School of Medicine. We'd love the opportunity to meet you, our listeners. So please stop by the exhibit hall where we will be live podcasting from Booth 1113. Stop in, say hello, and catch some of the live recordings that will be taking place on Saturday, November 3rd with this fantastic panel of guests. Until next time, keep on keeping kids safe out there!

Navigating the waters of child sexual abuse is difficult. This patient population necessitates a delicate approach. Andy Sirotnak, MD, Director of the Child ProtectionTeam and nurse practitionerDenise Abdoo, PhDdiscuss adolescent and child sexual abuse, its indicators and how to approach and care for these patients. In this episode: How providers can normalize conversations around sexual abuse with patients and families When concerns about child sexual abuse most commonly arise Most common indicators and signs of sexual abuse in children Why it is critical to teach children not to take photos of their bodies or keep secrets and good touch versus bad touch What a pediatrician should do when a parent calls with concerns of possible child sexual abuse Key components of a sexual abuse exam and the focus on external genitalia The bathing suit concept for talking to children about private parts Importance of building the family story and why having the parents' history is crucial for treating patients of childhood sexual abuse The role of mental health issues in the spectrum of child sexual abuse Recommended follow-up care and resources to help families through child sexual abuse Resources for sexual abuse: Sirotnak recommends physicians: Be familiar with local child advocacy center and victim assistance programs Use local experts in their communities Call other pediatricians for insight or resources National Child Traumatic Stress Network International Society for the Prevention of Child Abuse & Neglect Child abuse and neglect resourcesfrom the American Academy of Pediatrics The Resilience Project Council on Child Abuse and Neglect

Scoliosis management will vary according to each patient's unique situation and presentation. Mark Erickson, MD, Rose Brown Chair of Pediatric Orthopedic Surgeryand Medical Director of the Children's Colorado Spine Center, joins us to discuss the diagnosis and treatment of scoliosis. In this episode: The three primary types of scoliosis and their common presentations, symptoms, causes and treatments: Congenital scoliosis Neuromuscular scoliosis Idiopathic scoliosis The key components of a physical examination for scoliosis Recommended imaging to order for aiding a scoliosis diagnosis Red flags that may indicate more serious problems and non-idiopathic scoliosis Scoliosis surgeryand treatment and its evolution Risk factors for disease progression The long-term prognosis for a child with scoliosis

Bart Schmitt, MD, pioneer and father of telephone triage pediatric protocols, discusses the role of telephone triage in the pediatrician's office. Dr. Schmittis the Medical Director of General Pediatric Consultations at Children's Colorado. In this episode: Introduction to telephone triage and pediatric telephone protocols for nurses The benefits and importance of having protocols for a call center and medical practice caring for pediatric patients Why pediatricians offer telephone care and telehealth more often than other specialists Why electronic protocols are better than a book The importance of second-level physician triage for after-hours calls How pediatric telephone triage protocols and resources like the symptom checker support patient-centered care Telephone triage resources: ChildrensMD, the pediatric symptom checker app for parents (iTunes,Google Play) "Pediatric Telephone Protocols" ParentSmart HealthlineTM, Children's Hospital Colorado's 24/7 telephone triage

Treating STDs in adolescent patients can be a challenge for today's busy pediatrician. Eliza Buyers, MD, of the Pediatric and Adolescent Gynecology team at Children's Colorado returns to our pediatric podcast to provide practical tools for preventing and treating sexually transmitted infections in teens. In this episode: Why STD rates are higher in adolescents and young adults How PCPs can address teen reproductive health challenges Why we need to consider age as the primary risk factor for STDs Examining the issue of STD rates as a health disparity Importance of conducting universal screening in sexually active adolescents Expedited partner therapy (EPT) and its importance Recommended STD and HIV screening periods for different populations Screening guidelines for STD examinations in the absence of symptoms. Approaching one-to-one time with teen patients Importance of promoting condom use to prevent STDs in teens When to consider screening for less common STDs Why it's crucial to know confidential screening clinics you can send your patients STD management resources: The CDC STD treatment guidelines mobile app CDC STD treatment guidelines for special populations

Feeding an infant brings about joys and challenges for every family. In this episode, we discuss the identification and treatment of feeding and swallowing problems in infants with Laura Pickler, MD, and Nancy Creskoff Maune. Dr. Pickler is the Chair of Family Medicine and Medical Director of the Feeding and Swallowing Program at Children's Colorado. Nancy is an occupational therapist in the program with an extensive background in the evaluation and treatment of infants and children with feeding and swallowing problems. In this episode: Recognizing the signs of pediatric feeding and swallowing problems The most common presentations of feeding difficulties that primary care pediatricians encounter Differentiating between feeding problems versus swallowing problems The visual and auditory signs of swallowing problems Referral criteria for a videofluoroscopic swallowing study (VFSS) Different approaches to feeding and swallowing issues for breast-fed versus bottle-fed babies Approaching feeding and swallowing problems in a breast-fed baby whose mom is returning to work Questions to ask and what to look for to avoid missing the big problems The importance of observing a feeding to evaluate meal-time behavior, stressors and physical findings A primary care physician's toolbox of questions surrounding feedings Recommended resources on feeding and swallowing for pediatricians

Caring for children with Down syndrome can be complicated. Francis Hickey, MD, Medical Director of the Sie Center for Down Syndrome, joins us to discuss primary care for kids and adolescents with Down syndrome (trisomy 21 syndrome). In this episode: Recommendations for making an initial Down syndrome diagnosis The importance of congratulating parents on the birth of their child Helpful tips for siblings of children with Down syndrome What pediatricians should expect for growth and developmental milestones The importance of early visual stimulation for children with Down syndrome Why it's more important to focus on progress rather than on hitting specific goals Common Down syndrome-related GI, ENT, pulmonary and orthopedic problems to watch for The three most important screenings for Down syndrome patients: thyroid, vision and hearing Endocrine challenges and the autoimmune cluster How to recognize the onset of autism in children with Down syndrome Significant concerns to watch out for when adolescents with Down syndrome move into puberty Practical references available for primary care providers Special accommodations and educational advocacy for children with Down syndrome in the public school system Browse our Down syndrome resources to share with patient families.

HLHS care poses a unique challenge for pediatric primary care providers. Pediatric cardiothoracic surgeon James (Jim) Jaggers, MD joins us today to discuss the primary care, treatment and future for patients with hypoplastic left heart syndrome (HLHS). Dr. Jaggers is Co-Director of the Heart Institute and the Barton-Elliman Chair in Pediatric Cardiothoracic Surgery at Children's Colorado. In this episode: Dr. Jaggers' approach to surgical intervention for HLHS How pediatricians and family doctors can support their patients and families confronting an HLHS diagnosis Ongoing and follow-up care for HLHS patients in the pediatricians' office The long-term prognosis for HLHS patients How the nation's leading pediatric hospitals are collaborating to provide solutions for patients with HLHS in a groundbreaking consortium Future innovation and care for HLHS patients

Dan Hyman, MD, and Heather Howman join us today to discuss the four parts of the American Board of Pediatrics' Maintenance of Certification (MOC) program. Dr. Hyman is the Patient Safety Officer at Children's Colorado and Heather Howman is the MOC Program Manager at CU Medicine. Listen in as they share their expertise on the MOC and quality improvement projects for the pediatric primary care office. In this episode: What is MOC? Four parts of the Maintenance of Certification (MOC) for board-certified pediatricians and pediatric subspecialists Achieving the credits that you need to maintain your certification Choosing a quality improvement project for your office Turning quality improvement into a team effort The length of time to complete quality improvement projects Barriers in a private office setting for these kinds of projects Leveraging your EMR in your practice Resources and tools to use in part four of ABP's MOC program Consensus building strategies to use within your pediatric practice The American Board of Pediatrics

Welcome to season two of Charting Pediatrics. In this episode we address the timely and serious topic of firearm safety with Eric Sigel, MD. Dr. Sigel is the Fellowship Director of Adolescent Medicine at Children's Colorado and professor of pediatrics at CU Medicine. In this episode: The AAP gun safety guidelines Principles that implicate firearms in suicide deaths The risks of having firearms in the home What age to start addressing firearm safety with your patients and families Approaches for addressing gun safety with parents and patients Informing people of the importance of safe storage for firearms Ways to become involved in the advocacy efforts around gun safety American Academy of Pediatrics Gun Violence Policy Recommendations American Academy of Pediatrics Gun Violence Prevention AAP News & Journals: Firearm Related Injuries Affecting the Pediatric Population

Our guest for this episode is Jessica Malmberg, PhD, the Clinical Director of Outpatient Services at the Pediatric Mental Health Institute and assistant professor of child psychiatry at CU School of Medicine. Dr. Malmberg talks us through a common behavioral issues of school-aged children – school refusal – and provides insights, advice and tools to help prevent, manage and understand this behavior. In this episode: Outlining and identifying the underlying symptoms and signs associated with a child refusing to attend school How primary care providers (PCPs) can assist parents who are experiencing guilt Identifying the four most common reasons that children refuse to go to school Exploring the effects of social media on children's behavior when it comes to school refusal How a PCP should approach treatment of school refusal The recommended frequency of follow-up care for kids who are refusing to go to school The importance of connecting parents to community-based resources Preventative practices parents can set up in the home to prevent this behavioral issue What an excellent prognosis looks like for children experiencing school refusal When it's time to refer to a mental health professional PCPs in the Denver Metro Area can refer patients to the Children's Hospital Colorado Outpatient Psychiatry Clinic or to a local community mental health center Resources for dealing with school refusal: School Refusal: Information for Educators (.pdf) from the National Association for School Psychologists School Refusal in Children and Adolescents from American Family Physician The Functional Assessment of School Refusal Behavior Effective Child Therapy Division 53 of the Society of Clinical Child & Adolescent Psychology website School Refusal from the American Academy of Child & Adolescent Psychiatry

Today Robert Fuhlbrigge, MD joins us to discuss the 10 most common pediatric rheumatology diagnoses. Dr. Fuhlbrigge is the Chair of Rheumatology at Children's Colorado and professor of pediatrics and rheumatology at the University of Colorado School of Medicine. In this episode: What swollen joints can indicate when assessing potential diagnoses in the realm of rheumatology The most common identifier in determining a systemic problem The role of morning stiffness in the differential diagnosis The difference between mechanical pain and inflammatory disorders Defining how helpful an elevated ANA is in treating a patient with Lupus Outlining the best tests for inflammation: CSR, CSR and ANA Why rheumatologists find unexpected fevers in children interesting Unexplained weakness and what it means Which rashes may indicate that it's necessary to refer to rheumatology The role fatigue plays in the rheumatology world Usefulness of radiology studies, MRI, CT and other imaging modalities Helpful apps clinicians use for rheumatological diseases today The role of genetics and development in rheumatological diseases

Today on the podcast, Dave Scudamore, MD, joins us to talk about neonatal jaundice. Dr. Scudamore is the Director of Inpatient Medicine for the Network of Care at Children's Colorado, and he is also an assistant professor of pediatrics in hospital medicine at the University of Colorado School of Medicine. In this episode: The major risk factors for severe jaundice that can cause complications with neonates How to assess mom and baby for the risk factors of neonatal jaundice by reviewing patient history and birth data Difference between the risk factors for elevated bilirubin and the risk factors for neurotoxicity The significance of the ratio between albumin and bilirubin Standard protocols for bilirubin workups and monitoring for risk factors How you can provide elevated patient care by using a patient-centered care approach and considering the context of the case The way to utilize the Bhutani curve to assess risk and the AAP guidelines to initiate phototherapy Understanding the importance of follow ups and their role in intervention

With us today is Matthew Greenhawt, MD, associate professor of pediatrics and allergy at the University of Colorado School of Medicine. Dr. Greenhawt discusses hot topics surrounding food-related allergies, including the early introduction of peanuts. In this episode: What initial steps to take before referring patients to an allergist The importance of getting a complete patient history to diagnose food allergies Tools primary care providers can utilize in the diagnostic process Why the presence of IGE may not be an effective marker for a food allergy Understanding the cross-reactivity between different allergies How to implement a food allergy action plan Methods and recommendations for early introduction of the peanut Where providers can find resources for on-going food allergy education Recommendations on prescribing epinephrine Links from today's episode Food allergies Research on how to avoid food allergies UpToDate

The host of this podcast is Dr. David Brumbaugh, pediatric gastroenterologist and Associate Chief Medical Officer at Children's Colorado. In this episode, Joel Friedlander, MD, pediatric gastroenterologist at Children's Colorado, addresses the management of constipation and the effects of leaving it untreated, especially in young children. In this episode, Dr. Friedlander discusses: Addressing constipation and uncomfortable stools early Potential long-term complications associated with constipation Two key components to focus on in the physical examination Miralax, a common used laxative for the treatment of constipation The use of lactulose for young children Categorizing medications for constipation Different medications with different adverse effects Steps to behavioral modification Constipation split between organic and functional Why medication to treat constipation won't work without a change in behavior

In this episode, Johannes von Alvensleben, MD, pediatric cardiologist and electrophysiologist at Children's Hospital Colorado and assistant professor of pediatrics at the University of Colorado School of Medicine, talks about heart arrhythmias. He discusses some of the most common heart arrhythmias in the primary care setting, including identifiable characteristics and treatments. In this episode: Palpitations and syncope (commonly known as fainting) as symptoms for heart arrhythmia Characteristics of common heart arrhythmias Supraventricular tachycardia (SVT) in an infant versus a young child Differences in children with syncope Inherited heart arrhythmia syndromes Importance of obtaining an electrocardiogram (ECG) Co-morbidities in children that can impact diagnosis with arrhythmias Drug-related arrhythmias in older children Treatment options for heart arrhythmias in young children The success rate of ablation for arrhythmia

In this episode we discuss attention-deficit/hyperactive disorder (ADHD) medication management with Marissa Schiel, MD. Dr. Schiel is the Medical Director of the Outpatient Psychiatry Program at Children's Colorado and an assistant professor of child psychiatry at the University of Colorado School of Medicine. Also joining us is Danielle Stutzman, R.Ph., a clinical pharmacist at Children's Colorado with a special interest in psychiatry medication. In this episode: The importance of getting a detailed history when assessing a child for ADHD Understanding the spectrum of ADHD symptoms and how they affect a child's function How to approach the medication management conversation when it comes to ADHD The most common side effects that are associated with stimulants or psychotropic medication Management strategies for dealing with potential medication side effects The importance of screening a child for cardiac concerns before prescribing stimulant medications Understanding the functional benefits of the two different classes of stimulants The ideal target doses for specific ADHD medications A recommended follow-up regime and titration strategy for patients How to counsel families on medication management as the child ages Medication recommendations to consider when trialing the non-stimulant class Techniques to use in therapeutic relationships with ADHD patients

In this episode, Sean O'Leary, MD, discusses vaccine safety and hesitancy from parents. He also suggests motivational interviewing techniques to use when talking with your patients and families. Dr. O'Leary is a pediatric infectious disease specialist at Children's Colorado and associate professor pediatrics and infectious diseases at the University of Colorado School of Medicine. In this episode: How to help families identify the good information from misinformation regarding vaccines The prevalence of vaccine resistance Effectively and efficiently delivering vaccines information to parents Using motivational interviewing techniques when talking with parents about vaccines How to pivot the conversation when a parent is resistant to a care plan Why asking permission is a key component to motivational interviewing Understanding the differences between a recommended and alternate vaccine schedule Techniques for communicating relative risks about vaccines Working with parents who are vaccine resistant Vaccines that receive the most resistance and hesitancy

In this episode, Eliza Buyers, MD, talks about reproductive health in teenagers. Dr. Buyers is a pediatric and adolescent gynecologist at Children's Colorado and a senior instructor of obstetrics and gynecology at the University of Colorado School of Medicine. In this episode: How to talk to teens and their parents about reproductive health Implementing a universal screening approach in your practice Dealing with push back from parents Setting up one-on-one time with adolescent patients Misconceptions about teens and their reproductive health Long-acting reversible contraceptive (LARC) methods Non-contraceptive benefits of LARC Importance of hormonal therapy Reversing long-term hormonal care and contraception Talking to teens about screening for sexually transmitted diseases When to send a patient to a specialist

This episode is the season one wrap up show; thank you to all of our listeners! In light of this celebratory occasion, we're going to take a little departure from our regular clinical episodes to reflect on season one and preview what listeners can look forward to in season 2 starting August 7, 2018. Suggestions or feedback? Write to us at [email protected]

Joining us today are Terry Fry, MD and Mike Verneris, MD to explore cellular therapy for the treatment of pediatric cancers. Dr. Fry is the Robert and Kathleen Clark Endowed Chair in Pediatric Cancer Therapeutics and Dr. Verneris is the Barton Family Endowed Chair of Bone Marrow Transplant at Children's Colorado. In this episode: A new immunotherapy known as cellular therapy, or specifically the chimeric antigen receptor T cell therapy (CAR-T cell), is bringing hope to pediatric patients with blood cancers. Two breakthrough events in the field of immunotherapy made CART-T cell therapy possible: Checkpoint inhibitors: a concept where agents can "take the brakes" off the immune, unleashing a sort of preexisting immune response against the tumor Adult epithelia cancers For cancers like pediatric tumors, mutations aren't present or aren't present at high enough levels for checkpoint inhibitors to work. CAR-T cell therapy is different from checkpoint inhibitors in that the immune system, the T cells, are taken and essentially educated in a different way. The T cells are redirected so they can see the tumors that they weren't naturally developed to see. The FDA labor indication is refractory leukemia at the time of diagnosis, relapse or second relapse. There is a 70 to 90% complete remission induction rate in phase one CAR-T therapy clinical trials in patients who had estimated durations of survival of only weeks to months. The CAR-T cell approach may be considered an alternative to chemotherapy. Side effects of CAR-T cell therapy include: Patients become neutropenic, have low counts and are at risk for bacterial infection (because chemotherapy is given before cells are infused) Cytokine release syndrome Transient neurotoxicity, ranging from subtle neurologic changes to severe side effects like seizures or even coma Because of leukemic resistance, half of patients that go into remission will relapse by year, in spite of a successful CAR-T cell treatment upfront. The pros and cons of a bone marrow transplant (BMT) versus CAR-T cell therapy are: BMT patients get mild oblation, likely face sterility, late complications, secondary malignancies and more. With CAR-T cells, patients get a single infusion and risk about a month of significant toxicity, but side effects are mitigated after that. The only long-term side effect is potentially a lack of b-cells.