Charting Pediatrics

By Children's Hospital Colorado

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Description

Children's Hospital Colorado faculty examine the latest treatment options for the most common chief complaints in pediatric medicine. We will talk about significant research and advances in pediatric medicine, the nuanced art of practicing pediatrics and everything in between.

Episode Date
Measles (S2:E30)
27:25

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

 

Mar 19, 2019
Toxicity & the Most Common Pediatric Overdoses (S2:E29)
33:26

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, chartingpediatrics@childrenscolorado.org 

Mar 12, 2019
Overcoming HPV Vaccination Hesitency (S2:E28)
24:46

HPV vaccine rates remain low with only about 16 percent 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 & Motivational Interviewing Techniques. 

Mar 05, 2019
Food Allergy Immunotherapy (S2:E27)
59:50

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:

We love hearing from our listeners - email the Charting Pediatrics team to suggest a future topic or tell what you thought of this one.

Feb 26, 2019
Congenital Heart Disease: Ongoing Management (S2:E26)
18:39

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.

 

Feb 19, 2019
Repeat Concussion + Sports Retirement Case Study (S2:E25)
26:56

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!

Feb 12, 2019
Pain Management in Kids (S2:E24)
22:16

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.

Feb 05, 2019
E-Cigarettes and Vaping (S2:E23)
26:56

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:

Feedback on this episode or suggestions for a future topic? Write to us at chartingpediatrics@childrenscolorado.org - we love hearing from our listeners!

Jan 29, 2019
Integrative Approach to Pediatric Medicine (S2:E22)
27:11

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:

Jan 22, 2019
Critical Congenital Heart Disease (CCHD) (S2:E21)
20:42

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
Jan 15, 2019
Pediatric Trigger Thumb (S2:E20)
18:57

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
Jan 08, 2019
Happy Holidays
01:35

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!

Dec 20, 2018
Ovarian Cysts and Torsion Risk (S2:E19)
29:08

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.
Dec 18, 2018
Abnormal Head Growth and Shapes in Pediatrics (S2:E18)
33:36

In this episode we discuss abornormal 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.

 

Dec 11, 2018
Atopic Eczema (S2:E17)
27:56

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.

 

Dec 04, 2018
Care for Young Mothers in Your Pediatric Practice (S2:E16)
20:24

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: 

Nov 27, 2018
Addiction Prevention in Primary Care - Live! From the 2018 AAP Annual Meeting (S2:E15)
24:52

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.

Nov 20, 2018
Marijuana as Medicine - Live! From the 2018 AAP Annual Meeting (S2:E14)
39:12

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.

Nov 13, 2018
Safe Infant Sleep - Live! From the 2018 AAP Annual Meeting (S2:E13)
21:47

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.

Nov 06, 2018
American Academy of Pediatrics Live Recording
01:38

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!

Oct 30, 2018
Henoch–Schönlein purpura, HSP: Diagnosis and Management (S2:E12)
23:43

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 section head of Nephrology at Children’s Colorado and professor of pediatrics at the University of Colorado School of Medicine. Dr. Fuhlbrigge is section head 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.
Oct 23, 2018
Case Study: Laryngomalacia (S2:E11)
31:43

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
Oct 16, 2018
American Academy of Pediatrics Live Recording
01:38

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!

Oct 12, 2018
Child Sexual Abuse (S2:E10)
44:46

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:

Oct 09, 2018
Scoliosis Diagnosis & Management (S2:E9)
23:50

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:
  • 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
Oct 02, 2018
Telephone Triage in Pediatric Primary Care (S2:E8)
22:00

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:

Sep 25, 2018
STDs in Teens: Testing &Treatment (S2:E7)
25:19

Treating STDs in adolescent patients can be a challenge for today’s busy pediatrician. Eliza Buyers, MDof the Pediatric and Adolescent Gynecologyteam 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:

Sep 18, 2018
Infant Feeding & Swallowing Problems (S2:E6)
32:59

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
Sep 11, 2018
Transgender medicine and caring for gender diverse patients (S2:E5)
26:59

Caring for transgender, gender diverse and gender non-conforming patients is complicated, and it’s made even more complex by the dynamic nature of gender itself. In this episode, Natalie Nokoff, MD,from the Children’s Colorado TRUE Center for Gender Diversity, joins us to discusshealthcare for transgender and gender diverse patients.

In this episode:

  • Common gender terminology physicians may encounter when talking with gender diverse patients
  • How to communicate with pediatric patients about their gender identity
  • Proactive strategies pediatricians can use surrounding early gender issues
  • Understanding the relationship between puberty and gender or body distress (gender dysphoria)
  • When to refer young patients experiencing gender dysphoria
  • Why it’s important to ask all teens questions about gender identity
  • Understanding the family dynamic and needs before referring gender diverse patients to a specialist
  • Ensuring a safe environment at school and in the community before gender transition
  • Hormone therapy and puberty blocking protocol and WPATH criteria for starting hormone therapy
  • Most common methods and forms of hormone therapy and the side effects pediatric primary care providers should be aware of
  • The unique mental health, social and emotional support needs of this patient population

 

Resources for transgender healthcare:

 

Sep 04, 2018
Caring for children with Down syndrome (S2:E4)
38:35

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 resourcesto share with patient families.

Aug 28, 2018
A Primary Care Perspective on HLHS (S2:E3)
21:43

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

 

Aug 21, 2018
Maintenance of Certification and Quality Improvement for the Pediatric Primary Care Office (S2:E2)
22:23

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 

Aug 14, 2018
Discussing Firearm Safety in the PCPs Office (S2:E1)
29:40

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

Aug 07, 2018
School Anxiety & School Refusal in Kids (S1:E25 Rebroadcast)
28:44

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:

 

Jul 31, 2018
Top 10 Pediatric Rheumatology Diagnoses (S1:E19 Rebroadcast)
33:30

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
Jul 24, 2018
Neonatal Jaundice & Bilirubin Levels in Newborns (S1:E21 Rebroadcast)
24:01

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
Jul 17, 2018
Food Allergies Diagnosis & Hot Topics (S1:E16 Rebroadcast)
28:39

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

 

Jul 10, 2018
Constipation Treatment & Management (S1:E4 Rebroadcast)
23:49

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
Jul 03, 2018
Heart Arrhythmia in Pediatric Primary Care (S1:E5 Rebroadcast)
23:12

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
Jun 26, 2018
ADHD Med Management (S1:E15 Rebroadcast)
25:46

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

 

Jun 19, 2018
Vaccinations & Motivational Interviewing (S1:E12 Rebroadcast)
21:10

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
Jun 12, 2018
Teen Reproductive Health (S1:E6 Rebroadcast)
27:17

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
Jun 05, 2018
That's a Wrap Season 1 (S1:E34)
10:32

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 chartingpediatrics@childrenscolorado.org 

May 29, 2018
CAR-T Cellular Therapy for Leukemia (S1:E33)
27:40

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.
May 22, 2018
Nocturnal Enuresis & Bedwetting (S1:E32)
20:02

In this episode, we discuss the management of and treatments for nocturnal enuresis, nighttime bedwetting. Joining us is pediatric urology nurse practitioner, Marguerite Korber, NP, who runs many of the enuresis clinics at Children's Colorado.

In this episode:

  • At age 5, the primary care physician should make a formal diagnosis of nighttime wetting and give the family a proactive, therapeutic treatment plan.
  • It's recommended that families come to a urology specialist or enuresis clinic around age 7
  • The reasons for bedwetting may differ according to whether patient has primary or secondary nocturnal enuresis.
  • Before making a referral to urology, primary care physicians can perform an initial workup, evaluating:
    • If the child is ready to become potty-trained and, therefore, dry at night
    • Functional bladder capacity to see if nocturnal enuresis has anything to do with diabetes or UTI concerns
    • If their bladder is releasing earlier than it should and/or doesn't have the appropriate, expected capacity
  • Despite the parents' frustration, until the child is affected by their nighttime bedwetting, initiating them to be responsible for some of their behavioral modifications during the day will be difficult.
  • The important aspects to focus on in a physical exam are the abdominal exam, lumbar spine evaluation, neurologic evaluation and urethral opening evaluation.
  • Constipation plays a large role in nocturnal enuresis.
    • The abdominal exam will tell you whether or not constipation is a contributing factor, specifically in that descending colon. "If you can palpate stool, then you know that it's probably sitting in the rectum as well."
  • The urethral opening tends to be more of an issue for boys specifically.
  • Bedwetting enuresis management options include behavioral therapy, fluid shifting and addressing constipation.
  • How to effectively implement the use of alarm therapy as a bedtime wetting management option – and what parents need to know up front.
  • What criteria allows for using Desmopressin, a DDAVP, as the right option when pursuing pharmacologic therapy
  • Options for managing chronic nocturnal enuresis:
    • By changing any dysfunctional voiding components to their day time habits, patients will be better prepared for the natural progression of the night time to occur.
  • Providers need to provide alternative treatments for patients when cost is a barrier to care, such as with a bed alarm.
    • Pull-ups can be a cost effective solution to involuntary nighttime bed wetting.
  • Oftentimes with nocturnal enuresis, it's necessary to treat the whole family, helping parents to manage their frustration.
May 17, 2018
Neck Mass Diagnosis & Management for Pediatricians (S1:E31)
16:45

On today's episode, we're discussing the diagnosis and management of neck masses in children. Joining us is Melissa Scholes, MD, Director of the Pediatric Balance and Vestibular Disorders Clinic at Children's Colorado.

In this episode:

  • Common presentations of neck masses in children
  • The questions pediatricians should be asking when they encounter a neck mass
  • The various locations and types of neck masses that can be found
  • How to evaluate and address the consistency of a neck mass
  • What information in the child's history is particularly important to look at
  • The increase in head and neck malignancies in children today
  • Possible lab tests and imaging for neck masses in children
  • When pediatricians should send children to an ENT clinic
  • Antibiotics and treatments to consider for infectious neck masses
  • Infectious lymph nodes and the possibilities of them going viral
May 08, 2018
Common Sleep Disorders in Children & Teens (S1:E30)
22:05

Joining us is Ricky Mohon, MD to discuss the most common sleep disorders and sleep issues affecting pediatric and adolescent patients.

Dr. Mohon is Medical Director of Sleep Medicine and Program Director of Pediatric Pulmonology here at Children's Colorado, as well as a professor of pediatrics at CU Medicine.

In this episode:

  • The prevalence of sleep disorders in children and how these issues have evolved
  • Answering "How much sleep should my child be getting?"
  • How to counsel family members on their teenager's sleep needs
  • The disruptive impact electronic devices have on children's sleep patterns
  • The most common sleep disorders Dr. Mohon sees in infants, children and adolescents
  • Whose responsibility is it to change the diaper in the middle of the night?
  • Behavioral changes that parents can make to limit continuous night calls
  • The full extinction technique: How and why parents should let baby learn to self-soothe
  • Managing sleep-related breathing disorders and snoring in children
  • The process of conducting pediatric sleep studies and what sleep specialists monitor
  • The effects of sleep apnea and insomnia on a child’s health and school life
May 01, 2018
Asthma Management (S1:E3 Rebroadcast)
21:11

In this podcast, Bill Anderson, MD, co-director of the multidisciplinary Asthma Program at Children's Colorado and assistant professor of pediatrics at the University of Colorado School of Medicine, talks about asthma. He discusses challenges in the management of asthma, the effect of asthma on pediatric patients and treatment options now available.

In this episode, Dr. Anderson discusses:

  • Common challenges for managing asthma in pediatric patients
  • Factors that come into play when choosing controller medications
  • Why steroids are better suited for atopic patients
  • Teaching patients and families how to use a spacer
  • How co-morbidities affect children with asthma
  • The impact that psychosocial factors have on asthma
  • Working with social workers to help families overcome hurdles
  • Latest treatment options for treating pediatric asthma
  • Overcoming the adherence barrier using technology
  • Natural medications available to pediatric asthma patients
  • Advice for people with dog allergies
Apr 10, 2018
Alleviating Seasonal Allergies (S1:E1 Rebroadcast)
22:53

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
Apr 03, 2018
Celiac Disease Diagnosis & Management with Dr. Edwin Liu (S1:E29)
20:07

Today, we're discussing celiac disease with guest Edwin Liu, MD. Dr. Liu is an international leader in the research and management of celiac disease, the Director of the Colorado Center for Celiac Disease at Children's Colorado and a professor of pediatrics at the CU School of Medicine.

In this episode:

  • How the prevalence of celiac disease has changed over time and what that means
  • The hygiene hypothesis and its role in infectious diseases
  • The ways that the clinical representations of children with celiac disease have changed
  • Untraditional symptoms and signs of celiac disease in children
  • The relationship between type 1 diabetes and celiac disease
  • An outline and definition of the non-genetic, environmental triggers of celiac disease
  • The tests to order if you suspect a child may have celiac disease
  • The populations that should be screened for celiac disease because of their risk factors
  • What distinguishes celiac disease from gluten sensitivity
  • The importance of and how to go about educating families on diet after their child is diagnosed with celiac disease
  • The answer of whether or not there's a chance that children can grow out of having celiac disease
  • Exploring the misconception of celiac disease as an "under dog" condition
Mar 27, 2018
Hip Pain in Children Diagnosis & Management (S1:E28)
23:09

In this episode, Stephanie Mayer, MD, joins us to share her insights on diagnosing hip pain in pediatric patients. We're discussing this issue from its symptoms and causes to how to manage hip pain.

Dr. Mayer is a pediatric orthopedic surgeon at Children's Colorado and an assistant professor of orthopedics at the CU School of Medicine.

In this episode:

  • The common hip pain causes to watch for in adolescents
  • Sports that lend themselves to hip pain
  • Practices for starting an evaluation of the patient and their injury
  • The importance of the patient history when dealing with and considering hip pain
  • The questions to ask, signs to look for and specifics to consider when diagnosing hip pain and differentiating between infection and oncologic hip injuries
  • Signs and factors possibly indicating a patient's hip pain is systemic or rheumatological and when it's time to look for Lyme disease
  • How to determine where hip pain originates from and the conditions to consider
  • The mechanical indicator that the cause of hip pain is slipped capital femoral epiphysis (SCFE)
  • Diagnosing and addressing other causes of hip pain such as Legg-Calvé-Perthes
  • Discussing urgency and when it's time to refer to an orthopedic specialist
  • When and why it's appropriate to order an MRI early on
  • The central role imaging plays in determining a proper hip pain treatment and when it's the right time to order an x-ray for hip pain
  • The benefits of getting images of the entire hip versus radiation exposure
Mar 20, 2018
Autism Spectrum Disorder Diagnosis & Symptoms of Autism in Children (S1:E27)
22:01

In today's episode we discuss autism spectrum disorder with Elizabeth Coan, PsyD. Dr. Coan is a doctor of psychology at the Neuroscience Institute at Children's Colorado and is an instructor of developmental pediatrics at the CU School of Medicine.

In this episode:

  • How a PCP can take the first steps towards diagnosing autism
  • How you can implement autism screening tools in your practice
  • How to sensitively discuss autism spectrum disorder with parents and families
  • Tips for managing screenings and referrals after diagnosing autism
  • The reason why there are things to celebrate once you've made an autism diagnosis
  • Tips PCPs can share with families to help develop the strengths of a child with autism
  • Counseling families on how they use the internet when researching autism

Autism Speaks

ABA Therapy 

M-CHAT Screening Tool

Mar 13, 2018
Physician Burnout (S1:E26)
23:12

In this episode, we explore the stigmatized topic of physician burnout with Jenny Reese, MD, Director of the Resilience Program at CU Anschutz and Inpatient Medicine at Children's Colorado and Sonja O'Leary, MD, Medical Director of Denver Health's School-Based Health Centers Team.

Drs. Reese and O'Leary share their personal experiences with burnout and offer valuable insights on what physician burnout is, its effects and how hospitals can reduce burnout by implementing preventative measures.

In this episode:

  • Defining burnout and the golden measurement of burnout
  • The three main domains of burnout
  • The prevalence of burnout according to the numbers
  • The trends surrounding burnout over time
  • The effects and realities behind compassion fatigue and the second victim phenomenon amongst physicians
  • Outlining if and how burnout differs according to a physician's gender and parental role
  • Why it's important to implement reflective supervision in the workplace
  • Actions to prevent, normalize and reduce the stigma of burnout in medicine
Feb 27, 2018
School Anxiety & School Refusal in Kids (S1:E25)
28:13

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:

 

Feb 20, 2018
Teen Suicide: Risk Factors, Screening & Prevention (S1:E24)
20:10

Today we're discussing the serious topic of teen suicide with Jenna Glover, PhD, MS, BS, of the Pediatric Mental Health Institute at Children's Colorado. Dr. Glover is the Director of Clinical Psychology Training at Children's Colorado and an assistant professor of child psychiatry at the University of Colorado School of Medicine.

Mental health and suicide prevention resources from the episode:

Feb 13, 2018
Bronchiolitis (S1:E23)
26:55

In this episode we're discussing bronchiolitis with Monica Federico, MD, Medical Director of both the Asthma Program and Clinical Alignment at Children's Colorado. Dr. Federico is also an associate professor of pediatrics and pulmonary medicine at the University of Colorado School of Medicine.

In this episode:

  • How to diagnose the classic presentations of bronchiolitis
  • How providers can identify the significant signs of respiratory distress
  • How to utilize the Bronchiolitis Clinical Pathway (.pdf) from Children's Colorado
  • When to use bronchodilators and steroids for treatment
  • Identifying children who are most likely to develop bronchiolitis
Jan 30, 2018
Adolescent Bariatric Surgery with Dr. Thomas Inge (S1:E22)
28:11

Today on the podcast, we're discussing adolescent bariatric surgery with Thomas Inge, MD. Dr. Inge is the division head of Pediatric Surgery and the Director of the Bariatric Surgery Center at Children's Colorado, as well as a professor at the University of Colorado School of Medicine.

In this episode:

  • Where bariatric surgery fits within available options for the morbidly obese adolescent patient
  • Common medical indicators that a patient could be a successful candidate for bariatric surgery, as they indicate general readiness and suitability to a primary care provider
  • Key contraindications for bariatric surgery
  • The impact of patient age and how to assess maturity, both skeletal and psychological
  • The types of bariatric operations that are suitable for adolescents
  • What the Multicenter Teen-LABS study, led by Dr. Inge, means for adolescents
Jan 16, 2018
Neonatal Jaundice & Bilirubin Levels in Newborns (S1:E21)
24:01

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
Dec 26, 2017
Noisy Breathing in Pediatric Patients (S1:E20)
21:15

In this episode, Jeremy Prager, MD, talks us through a common issue in pediatric patients — noisy breathing. He outlines the underlying causes and presentations of, as well as available treatment options for noisy breathing. Dr. Prager is a pediatric otolaryngologist, Director of the Aerodigestive Program at Children's Colorado and associate professor of otolaryngology at the University of Colorado School of Medicine.

In this episode:

  • How an ENT defines noisy breathing
  • Categorizing noisy breathing into age groups
  • The presentations of noisy breathing the infants and toddlers age group
  • The presentations of noisy breathing the school-age children age group
  • Audible examples of a stridor sound versus a stertor sound
  • Questions providers should ask when seeking the cause of noisy breathing
  • The relationship between pediatric obesity and sleep apnea
  • Diagnostic exams and tests that providers can run before a consultation
  • Treatment options available to a child with noisy breathing
  • The effectiveness of natural remedies and oxygen therapies
Dec 19, 2017
Top 10 Pediatric Rheumatology Diagnoses (S1:E19)
33:30

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
Dec 15, 2017
International Adoption Medicine (S1:E18)
22:18

On today's episode, we're diving into the topic of international adoption and international adoption medicine best practices. We explore how primary care providers can support families who are expanding their families through international adoption.

Joining us is Gretchen Domek, MD, Director of the International Adoption Clinic and Senior Investigator for the Center of Global Health at Children's Colorado. Dr. Domek is also the assistant professor of pediatrics at the University of Colorado School of Medicine.

In this episode:

  • Why pre-adoption reviews are critical for families
  • The importance of a post-adoption evaluation
  • Expectations and guidelines for conducting a follow-up consultation
  • Common health issues to look for in internationally adopted children
  • Behavioral problems that are common in internationally adopted children
  • Methods for adapting to culturally different feeding techniques
  • Common questions adoptive families may ask and how to respond
  • How a careful assessment can help you determine a child's age
Dec 08, 2017
Non-IgE Mediated Food Allergies (S1:E17)
20:45

On today's episode, we welcome back Matthew Greenhawt, MD to discuss non-IgE related food allergies, including Food Protein-Induced Enterocolitis Syndrome (FPIES). Dr. Greenhawt is an associate professor of pediatrics and allergy at the University of Colorado School of Medicine.

In this episode:

  • How non-IgE mediated food allergies most commonly presents in children
  • The fact that non-IgE food allergy symptoms appear more slowly
  • Identifying the various presentations and triggers of dietary protein-induced enterocolitis
  • The benefits of using extensively hydrolyzed infant formulas or amino acid-based infant formulas
  • Treating atopic dermatitis with a topical steroid versus allergy screening
  • Creating awareness of eosinophilic esophagitis in the primary care discipline
  • The importance of identifying family history patterns to diagnose allergies
  • How the presentation of FPIES differs between environments globally
Nov 28, 2017
Food Allergies Diagnosis & Hot Topics (S1:E16)
28:39

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

 

Nov 21, 2017
ADHD Med Management (S1:E15)
25:46

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

 

 

Nov 14, 2017
Headaches & Migranes in Children Management (S1:E14)
20:38

Our guest for this episode is Marcy Yonker, MD. We discuss headache and migraine management in primary care, including their prevalence, triggers and treatment options. Dr. Yonker is the Director of the Headache Program at Children's Colorado and visiting professor of pediatrics at the University of Colorado School of Medicine.

In this episode:

  • The prevalence of headaches and migraines in children
  • Creating a differential headache diagnosis
  • When imaging should be used
  • Common medications prescribed for migraine headaches
  • Newer treatments for headaches and migraine
  • Natural remedies for headaches and migraines
  • Triggers for migraines in children and teenagers
  • The influence of family history on migraine prevalence
  • The role of psycho-psychology in migraine diagnosis
  • Other uncommon migraines
  • Using Botox as treatment for migraines
Oct 31, 2017
Vascular Malformations in Pediatric Primary Care (S1:E13)
24:32

In this episode Taizo Nakano, MD, discusses the most common vascular anomalies in the primary care setting. Dr. Nakano is the Medical Director of the Vascular Anomalies Center at Children's Colorado and assistant professor of pediatrics, hematology and oncology and bone marrow transplant at the University of Colorado's School of Medicine.

In this episode:

  • Common presentation of a vascular anomaly
  • The two major categories of a vascular anomaly
  • Defining the genetics lesions
  • Lab testing for vascular anomalies
  • Vascular emergencies and the features of a lesion that can be detrimental
  • Top 10 things to be concerned about with a vascular anomaly
Oct 24, 2017
Vaccinations & Motivational Interviewing (S1:E12)
21:10

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
Oct 17, 2017
Back Pain Management in Pediatrics (S1:E11)
20:48

In this episode Sumeet Garg, MD, discusses back pain management, including identifying characteristics and the relationship between scoliosis and back pain. Dr. Garg is a pediatric orthopedic surgeon at Children’s Colorado and associate professor of orthopedics at the University of Colorado School of Medicine.

In this episode:

  • The incidence of back pain in kids, especially adolescence
  • Identifying what to look for on physical examination
  • When to obtain imagining
  • The challenge with MRI in younger kids
  • Suggestions for talking with patients and families about back pain
  • Tight hamstrings and weak core abdominal muscles as an underlying driver of back pain
  • What type of patients should see an orthopedic surgeon for back pain
  • The relationship between scoliosis and back pain in pediatric and adolescent patients
  • Bad posture as a habit and not a deformity
  • Scoliosis and what families can expect over time
Oct 10, 2017
Breastfeeding Management & Support for Nursing Moms (S1:E10)
19:46

In this episode, Maya Bunik, MD, discusses common challenges and myths surrounding breastfeeding management and how to support new moms in your practice. Dr. Bunik is an executive committee member of the American Academy of Pediatrics (AAP) section on breastfeeding, Medical Director of the Child Health Clinic at Children's Colorado and a professor of pediatrics at the University of Colorado School of Medicine. Dr. Bunik is also the author of the AAP's breastfeeding telephone protocols and advice.

In this episode:

  • Why breast is best
  • Approaches to working with a new mom who is struggling with breastfeeding
  • Identifying reasons why a mom is struggling with breastfeeding
  • Impacts of sleep deprivation on new moms and their milk supply
  • How to know whether a baby is getting enough milk
  • The importance of babies' weight checks
  • Ways to boost milk supply through milk removal
  • Power pumping
  • Indication of needing a lactation professional
  • When a mom should start pumping after delivery
  • Why breastfed babies need Vitamin D
  • Common myths associated with breastfeeding
  • Impact of cleft lip and palate with breastfeeding
Oct 03, 2017
Seizure Management (S1:E9)
20:54

In this episode, Amy Brooks-Kayal, MD, discusses acute seizure management. The conversation includes the importance of gathering a detailed history of a seizure event, identifying provocations of a seizure and options for anti-seizure and rescue medications.

Dr. Brooks-Kayal is the Chief of the Pediatric Neurology, Co-Director of the Translational Epilepsy Research Program and past president of the American Epilepsy Society.

In this episode:

  • Responding to a patient's first seizure
  • Importance of a detailed history of a seizure event
  • Identifying provocations of a seizure
  • Neurological examination
  • Focal onset versus a generalized seizure
  • Chances of seizure reoccurrence
  • Anti-seizure and rescue medications
  • Managing the anxiety of families
  • Basic seizure safety
  • Current research into pediatric epilepsy
Sep 26, 2017
Acute Scrotum Pain Management (S1:E8)
18:41

In this episode, Duncan Wilcox, MD, talks about acute scrotum management. The conversation includes the most common indications of acute scrotum and how to differentiate an incarcerated hernia and a hydroceles scrotal trauma.

Dr. Wilcox is the Chair of Pediatric Urology and Surgeon-in-Chief at Children's Colorado. He is also a professor of surgery at the University of Colorado School of Medicine.

In this episode:

  • The most common indications of acute scrotum
  • The role trauma plays in acute scrotum
  • How to treat testicular torsion and urgent treatment
  • Differentiating an incarcerated hernia and a hydroceles scrotal trauma
  • Why an incarcerated hernia needs to be treated rapidly
  • The three groups of acute scrotum patients
  • Long-term outcome for patients living with one testicle
Sep 19, 2017
Fidget Spinners & Other Ingested Foreign Objects (S1:E7)
18:47

In this episode, Robert Kramer, MD, talks about the dangers of kids and adolescents swallowing common household toys and a recent case involving ingested fidget spinner parts. Dr. Kramer is a pediatric gastroenterologist at Children's Colorado.

In this episode:

  • Recent cases of patients ingesting fidget spinner parts
  • Dangers of ingesting button batteries and other small components
  • Why magnets represent a special threat for kids
  • Age groups impacted by incidental ingestion of objects
  • Batteries ingested into the gastrointestinal tract and how to manage them
  • Types of injuries that can occur beyond damage to the blood vessels
  • The importance of getting the battery out as soon as possible after ingestion
Sep 12, 2017
Teen Reproductive Health (S1:E6)
27:17

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
Sep 05, 2017
Heart Arrhythmia Diagnosis (S1:E5)
23:12

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
Aug 29, 2017
Constipation Treatment & Management (S1:E4)
23:49

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
Aug 22, 2017
Asthma Management (S1:E3)
20:35

In this podcast, Bill Anderson, MD, co-director of the multidisciplinary Asthma Programat Children's Colorado and assistant professor of pediatrics at the University of Colorado School of Medicine, talks about asthma. He discusses challenges in the management of asthma, the effect of asthma on pediatric patients and treatment options now available.

In this episode, Dr. Anderson discusses:

  • Common challenges for managing asthma in pediatric patients
  • Factors that come into play when choosing controller medications
  • Why steroids are better suited for atopic patients
  • Teaching patients and families how to use a spacer
  • How co-morbidities affect children with asthma
  • The impact that psychosocial factors have on asthma
  • Working with social workers to help families overcome hurdles
  • Latest treatment options for treating pediatric asthma
  • Overcoming the adherence barrier using technology
  • Natural medications available to pediatric asthma patients
  • Advice for people with dog allergies
Aug 22, 2017
Approaching Concussions in Primary Care (S1:E2)
20:25

In this episode, Julie Wilson, MD, co-director of the Concussion Program at Children's Colorado and assistant professor of orthopedics at the University of Colorado School of Medicine, discusses pediatric concussions in sports. She also talks about the concussion recovery process, working with parents and coaches to return young athletes to play and the classroom, comorbidities that impact concussion recovery, and more.

In this episode, Dr. Wilson discusses:

  • The signs and symptoms of a concussion in a young or adolescent patient
  • Why grading scales for concussions no longer exist
  • Comorbidities that can impact concussion recovery
  • How long a patient needs to rest after a concussion
  • Current guidelines on concussions in sports
  • "Return to play" concussion protocol is and why it's important
  • How to address parent concerns in a treatment plan
  • The correlation between concussion rates and sports
  • How the primary care provider can address the whole patient as they treat for a concussion
  • Red flags in concussion treatment
  • How many concussions are too many
  • Latest treatment options for concussion management

See our clinical care guidelines from Children's Hospital Colorado - for concussion (.pdf).

Aug 22, 2017
Alleviating Seasonal Allergies (S1:E1)
22:19

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
Aug 11, 2017