Pediagogy™

Key points: -Bronchiolitis is seen in kids under the age of 2 and caused by RSV -Treatment is supportive including fluids, oxygen, and suction -Learn about palivizumab and other new preventive therapies against bronchiolitis Supplemental Information: AAP 2014 guidelines: https://pediatrics.aappublications.org/content/134/5/e1474 Day of Illness and Outcomes in Bronchiolitis Hospitalizations: https://publications.aap.org/pediatrics/article/146/5/e20201537/75296/Day-of-Illness-and-Outcomes-in-Bronchiolitis

Key points: -Brief, resolved, unexplained events in patients

Key points: -DKA presents with hyperglycemia, ketosis, and anion gap metabolic acidosis, which if severe can cause cerebral edema and CNS dysfunction -Initial management includes fluid resuscitation and IV insulin -Learn about the 2 bag system for DKA -There is a rule to correct for hyponatremia in hyperglycemia -Learn about how to manage potassium, bicarbonate, and phosphorus in DKA Supplemental information: Pediatrics in Review 2019 DKA: https://publications.aap.org/pediatricsinreview/article-abstract/40/8/412/35321/Diabetic-Ketoacidosis?redirectedFrom=fulltext

Key points: -Remember the 4-2-1 rule for calculating maintenance fluids in children -Use of hypotonic fluids is based on historical data in healthy children -Data now supports use of isotonic fluids like NS or LR to reduce risk of hyponatremia and SIADH -Newer data may support LR over NS Supplemental information AAP 2018 Maintenance Fluid Guidelines: https://publications.aap.org/pediatrics/article/142/6/e20183083/37529/Clinical-Practice-Guideline-Maintenance

Key points: -There are specific clinical criteria for diabetes -There are some differences to help distinguish between type 1 versus type 2 diabetes -Learn about how to manage diabetes on the inpatient floor, including how to calculate total daily insulin dose, correction factors, and carbohydrate ratios. Supplemental information: Pediatrics in Review 2013: https://publications.aap.org/pediatricsinreview/article-abstract/34/5/203/34790/Type-1-Diabetes-Mellitus?redirectedFrom=fulltext American Diabetes Association 2018 Position Statement: https://diabetesjournals.org/care/article/41/9/2026/40739/Type-1-Diabetes-in-Children-and-Adolescents-A

Key points: -First line management is insulin when in DKA -First line management is lifestyle modification and metformin when not in DKA -Consider adding insulin and GLP-1 agonists if still in poor control Supplemental Information AAP guidelines 2013: https://publications.aap.org/pediatrics/article/131/2/364/31847/Management-of-Newly-Diagnosed-Type-2-Diabetes AAFP guidelines 2018: https://www.aafp.org/afp/2018/1101/p590.html ISPAD guidelines 2018: https://www.ispad.org/page/ISPADGuidelines2018

Key points: -New strategies for management of febrile infants depending on age (1-3 weeks, 3-4 weeks, or 4-8 weeks) -Inflammatory markers like CRP and procalcitonin help to determine if LP is needed in older patients. -Learn about common bugs that cause infection in infants and the antibiotics we use to treat them -Observation of febrile infants is now reduced from 48 hours to 24-36 hours Supplemental information: AAP guidelines 2020: https://pediatrics.aappublications.org/content/148/2/e2021052228 Yale Observation Scale Score in febrile infants 60 days and younger: https://publications.aap.org/pediatrics/article/140/1/e20170695/37958/The-Yale-Observation-Scale-Score-and-the-Risk-of

Key points: -Ask about common triggers for asthma like smoke or allergens as well as medication adherence -Asthma is a clinical diagnosis but ancillary tests like PFTs may help -Symptom frequency and severity can help you classify the asthma as intermittent versus persistent -Learn about controller/maintenance therapy, including the new SMART therapy -Learn about steroid use for acute exacerbations as well as next line medications like magnesium, ipratropium, and epinephrine Supplemental information: NIH 2020 guideline updates: https://pediatrics.aappublications.org/content/147/6/e2021050286 Peds in review 2019: https://pedsinreview.aappublications.org/content/40/11/549 Asthma control test: https://www.greenhillspeds.com/wp-content/uploads/2015/12/Asthma-Control-Test-4-to-11-years.pdf GINA 2020 Pocket Guide: https://ginasthma.org/wp-content/uploads/2020/04/Main-pocket-guide_2020_04_03-final-wms.pdf NIH Guidelines 2007: https://www.nhlbi.nih.gov/health-topics/guidelines-for-diagnosis-management-of-asthma JAMA 2021 guideline update summary: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2780356

Ever wonder what if the cafe au lait macule on your patient might be something more than just a benign birth mark? Learn more about neurofibromatosis 1 and other genetic disorders associated with cafe au lait macules in today’s episode. This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Suma Shankar (pediatric genomic medicine). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.comKey Points:Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder with complete penetrance but variable expression.NF1 can be diagnosed clinically if a patient has the following features and meets the specific clinical criteria: cafe au lait macules, neurofibromas, freckling, optic gliomas, iris hamartomas, an osseous lesion, and/or a first degree relative with NF1Sources:Pediatrics, Miller et al (2019) 143 (5): e20190660. https://doi.org/10.1542/peds.2019-0660

Have you ever wondered if your patient pausing to breathe in their sleep is concerning or not? Learn about the signs of central sleep apnea and which medical conditions it is often associated with in pediatric patients in this episode.This episode was written by pediatricians Tammy Yau, Lidia Park, and Jessica Ahn, with content support from Ambika Chidambaram (UCD pediatric pulmonology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.com Key PointsCentral sleep apnea (CSA) occurs when the brain’s central respiratory drive can’t send proper signals to the muscles that are part of breathing.CSA is diagnosed by a polysomnogram if there are apneic episodes that last 20 seconds or longer or if they are associated with oxygen desaturations, arousals, or heart rate changes (specific criteria in footnote).Central apneas are considered normal during certain stages of sleep (onset, during REM, after arousal), in premature infants less than 37 weeks corrected gestational age, and when ascending to altitudes greater than 3500 m above sea level.Common pediatric conditions associated with CSA include congenital central hypoventilation syndrome, achondroplasia, and Arnold-Chiari malformations. Diagnostic Criteria for CSAApneic episodes last 20 seconds or longer ORThe apnea lasts at least the duration of two breaths during baseline breathing and is associated with an arousal or at least a 3% oxygen desaturation ORIf the event occurs in an infant younger than 1 years old, it has to last at least the duration of two breaths during baseline breathing AND be associated with a decrease in heart rate to less than 50 beats per minute for at least 5 seconds OR less than 60 beats per minute for 15 secondsDiagnostic Criteria for Periodic BreathingAt least three episodes of central pauses lasting for at least 3 seconds interspersed by less than 20 seconds of normal breathing. ReferencesGipson K, Lu M, Kinane TB. Sleep-Disordered breathing in children. Pediatrics in Review. 2019;40(1):3-13. doi:10.1542/pir.2018-0142McLaren AT, Bin-Hasan S, Narang I. Diagnosis, management and pathophysiology of central sleep apnea in children. Paediatric Respiratory Reviews. 2018;30:49-57. doi:10.1016/j.prrv.2018.07.005Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Journal of Clinical Sleep Medicine. 2012;08(05):597-619. doi:10.5664/jcsm.2172Javaheri S, Dempsey JA. Central sleep apnea. Comprehensive Physiology. Published online December 10, 2012:141-163. doi:10.1002/cphy.c110057Selim BJ, Somers V, Caples SM. Central sleep apnea, hypoventilation syndrome, and sleep in high altitude. In: Springer eBooks. ; 2017:597-618. doi:10.1007/978-1-4939-6578-6_33Fauroux B, AlSayed M, Ben-Omran T, et al. Management of sleep-disordered breathing in achondroplasia: guiding principles of the European Achondroplasia Forum. Orphanet Journal of Rare Diseases. 2025;20(1). doi:10.1186/s13023-025-03717-0

Wondering how you describe the rash of measles, molluscum contagiosum, hand foot mouth, or chickenpox? Learn how in today’s episode!This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Aruna Venkatesan and Gabriel Molina (dermatologists at Santa Clara Valley Medical Center). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.comKey Points:When describing a rash, include the basic morphology, size, color, location, distribution and configuration, and any secondary morphologyWhen taking photos, try to have natural light and make sure the rash is in focus. If taking a close up photo, make sure to have a photo further away so that the location of the rash is clear.Sources:Stanford Medicine: https://stanfordmedicine25.stanford.edu/the25/dermatology.htmlAllmon A, Deane K, Martin KL. Common skin rashes in children. American family physician. 2015 Aug 1;92(3):211-6. CDC Measles: https://www.cdc.gov/measles/data-research/index.html 

How do you know when a head injury can be observed or if more work-up needs to be done? Find out in this episode!This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Julia Magana (pediatric emergency medicine). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.comKey Points:Low risk head injuries do not need head imaging. The criteria for low risk head injuries are those where the patient’s GCS is 15 without altered mental status and do not have signs of skull fracture. If any of these signs are present, head imaging with a head CT is recommendedIf the head injury includes history of loss of consciousness or vomiting, a non-frontal scalp hematoma (ie parietal, temporal, or occipital), a severe mechanism of injury, or a severe headache, then generally observation is still recommended but a head CT can be obtained based on clinical decision making. Sources:Stat Pearls. Pediatric Head Trauma. Micelle J, et al. February 2024: https://www.ncbi.nlm.nih.gov/books/NBK537029/Pediatrics. Abusive Head Trauma in Infants and Children: Technical Report. Sandeep Narang, et all. February 2025: https://publications.aap.org/pediatrics/article/155/3/e2024070457/201049/Abusive-Head-Trauma-in-Infants-and-Children 

Opioid use disorders affect babies and children in all ways. In newborns, it can present as neonatal opioid withdrawal syndrome (also known as NOWS). Learn how hospital systems are managing infants with NOWS with the Eat, Sleep, Console protocol in our episdoe today!Key Points:Eat Sleep Console (ESC) focuses on non-pharmacological intervention first before initiating medication. This includes limiting excessive stimulation, keeping the room dark and quiet, swaddling, rocking, swaying, and giving babies a pacifier or feeding.Compared to using the Finnegan scoring system, ESC results in shorter or equal length of hospital stay for infants with NOWS. However, some critics of ESC raise the concern for undertreating infants with NOWS.Morphine, clonidine, and phenobarbital are common agents used to treat infant with NOWSSources:Neoreviews (2025) 26 (4): e223–e232. https://doi.org/10.1542/neo.26-4-010Hosp Pediatr (2025) 15 (3): e121–e125. https://doi.org/10.1542/hpeds.2024-008094Hosp Pediatr (2025) 15 (3): e99–e101. https://doi.org/10.1542/hpeds.2025-008332Kaltenbach K, O'Grady KE, Heil SH, et al. Prenatal exposure to methadone or buprenorphine: Early childhood developmental outcomes. Drug Alcohol Depend. 2018;185:40-49.  https://doi.org/10.1016/j.drugalcdep.2017.11.030 Rees P, Stilwell PA, Bolton C, et al. Childhood Health and Educational Outcomes After Neonatal Abstinence Syndrome: A Systematic Review and Meta-analysis. J Pediatr. 2020;226:149-156.e16.  https://doi.org/10.1016/j.jpeds.2020.07.013 

Learn about language and speech development, potential etiologies of speech delay, and early interventions for speech delay.Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.comThis episode was written by pediatricians Lidia Park and Tammy Yau as well as UCD pediatrics resident Elaine Ho, with content support from Anisha Srinivasan (UCD child development and behavioral pediatrician). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation. Key PointsCDC and AAP have created updated 2022 developmental guidelines that includes changes in speech and language milestones for childrens and have added guidelines forage ages 15 months and 30 months Differential for speech delay is broad and includes hearing loss, global developmental delay, autism, and isolated language disorders Interventions include speech therapy services and exercises at homePediatricians play critical role in surveillance, evaluation, and management of speech delays to allow for earlier intervention and improved outcomes Sources  Jennifer M. Zubler, Lisa D. Wiggins, Michelle M. Macias, Toni M. Whitaker, Judith S. Shaw, Jane K. Squires, Julie A. Pajek, Rebecca B. Wolf, Karnesha S. Slaughter, Amber S. Broughton, Krysta L. Gerndt, Bethany J. Mlodoch, Paul H. Lipkin; Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics March 2022; 149 (3): e2021052138. 10.1542/peds.2021-052138Maris Rosenberg, MD, Nancy Tarshis, MA, MS, 2016. "Speech and Language Concerns (Chapter 195)", American Academy of Pediatrics Textbook of Pediatric Care, Thomas K. McInerny, MD, FAAP, Henry M. Adam, MD, FAAP, Deborah E. Campbell, MD, FAAP, Thomas G. DeWitt, MD, FAAP, Jane Meschan Foy, MD, FAAP, Deepak M. Kamat, MD, PhD, FAAP, Rebecca Baum, MD, FAAP, Kelly J. Kelleher, MD, MPH, FAAPHeidi M. Feldman; Evaluation and Management of Language and Speech Disorders in Preschool Children. Pediatr Rev April 2005; 26 (4): 131–142. https://doi.org/10.1542/pir.26-4-131Henry Adam; Speech and Language Concerns. Quick References 2022; 10.1542/aap.ppcqr.396455ASHA Communication Milestones and Age Ranges https://www.asha.org/public/developmental-milestones/communication-milestones/ Audio Clips: From Youtube Channel “Pathways”The 4 to 6 Month Baby Communication Milestones to Look For: https://www.youtube.com/watch?v=d0FGHFrMRXI10-12 month Old Communication Milestones https://www.youtube.com/watch?v=zYHpjZC2qCA19-24 Month Communication Milestones: https://www.youtube.com/watch?v=-2C--4gay2c

Vaccines are life saving medical treatments. Like all medicine, there are benefits and risks to vaccines. Learn how to address common concerns about vaccines and combat misinformation in this episode!Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.comThis episode was written by pediatricians Tammy Yau and Lidia Park with content support from Dean Blumberg (UC Davis pediatric infectious disease). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation. Key Points:Vaccine benefits largely outweigh risks.Vaccines do not cause autism. The frequently cited study that reportedly links vaccines to autism was funded by an anti-vaccine group and only looked at 12 children.Thimerisol is a preservative that is not used in routine vaccinations other than certain influenza vaccines. Anti vaccine groups raise the concern for ethylmercury toxicity from thimerisol but studies looking at mercury levels after vaccination with thimerisol containing vaccines showed the peak mercury levels to still be within the normal EPA range.Oral rotavirus is associated with an increased risk of intussusception. A history of intussusception is a contraindication to the rotavirus vaccineSources:Pediatrics (2016) 138 (3): e20162146. https://doi.org/10.1542/peds.2016-2146Pediatrics (2024) 153 (3): e2023065483. https://doi.org/10.1542/peds.2023-065483Desai R, Cortese MM, Meltzer MI, et al. Potential intussusception risk versus benefits of rotavirus vaccination in the United States. Pediatr Infect Dis J. 2013;32(1):1-7. doi:10.1097/INF.0b013e318270362cWakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children [retracted in: Lancet. 2004 Mar 6;363(9411):750. doi: 10.1016/S0140-6736(04)15715-2. Lancet. 2010 Feb 6;375(9713):445. doi: 10.1016/S0140-6736(10)60175-4.]. Lancet. 1998;351(9103):637-641. doi:10.1016/s0140-6736(97)11096-0Deer B. Secrets of the MMR scare. The Lancet's two days to bury bad news. BMJ. 2011;342:c7001. Published 2011 Jan 18. doi:10.1136/bmj.c7001Pichichero ME, Gentile A, Giglio N, et al. Mercury levels in newborns and infants after receipt of thimerosal-containing vaccines. Pediatrics. 2008;121(2):e208-e214. doi:10.1542/peds.2006-3363Uhlmann V, Martin CM, Sheils O, et al. Potential viral pathogenic mechanism for new variant inflammatory bowel disease. Mol Pathol. 2002;55(2):84-90. doi:10.1136/mp.55.2.84Uptodate “Autism spectrum disorder and chronic disease: no evidence for vaccines or thimerisol as a contributing factor”https://www.aap.org/en/news-room/fact-checked/fact-checked-vaccines-safe-and-effect-no-link-to-autism/?srsltid=AfmBOopWG_rQ1lTaaOvgJLyTk6VdbCN3ypSErxFzhVRjkQ2A4Fet9d

With increasing awareness and diagnosis of autism, there has also been an increase in misinformation regarding autism. The goal of today's episode is to provide a brief overview on autism and provide evidenced based information to better inform listeners!Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.comThis episode was written by pediatricians Tammy Yau and Lidia Park with content support from Kathleen Angkustsiri (UC Davis developmental and behavioral pediatric specialist). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation. Key Points:Autism diagnostic criteria have changed to increase detection of milder cases. Asperger's is included in autism. Per the DSM-5, autism is a condition with impairments in social communication (social and emotional reciprocity, non-verbal communication, and relationships) and restrictive and repetitive behaviors.  Autism diagnosis also requires 2 out of 4 restrictive or repetitive behaviors: 1. Restrictive or repetitive patterns of behavior, interests, or activities 2. Insistence of sameness, inflexible adherence to routines, ritualized patterns 3. Highly restricted, fixated interest abnormal in intensity or focus. 4. Hyper or hyporeactivity to sensory input or unusual interest in sensory aspects of the environmentAutism can present as regression of social and/or language skills.The Modified Checklist for Autism in Toddlers – Revised with Follow-up (MCHAT-R/F) is the most widely known and validated screening tool for autism for ages 16-30 months. A score of 8 or more is high risk for autismSources:Pediatrics (2020) 145 (1): e20193447. https://doi.org/10.1542/peds.2019-3447

Ever get caught in a sticky ethical situation regarding genetic testing? You're not alone. Join us as we try to navigate these real life issues.Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.comThis episode was written by pediatricians Tammy Yau and Lidia Park with content support from Video Jhaveri (UC Davis neonatology fellow). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation. Key points:Genetic testing may seem relatively benign and non-invasive but is actually fraught with unforeseen issues such as surprise consanguinity and non-paternity.Racial and economic disparities are prevalent with genetic testing and their interpretation. For example most test value interpretations are based on people of European and Asian descent.We cannot easily predict outcomes and prognosticate even with genetic testing. Prognosis is often fraught with the issue of promoting "ableism".Sources:Katharine P. Callahan, Ellen W. Clayton, Amy A. Lemke, Bimal P. Chaudhari, Tara L. Wenger, Allison N. J. Lyle, Kyle B. Brothers; Ethical and Legal Issues Surrounding Genetic Testing in the NICU. Neoreviews March 2024; 25 (3): e127–e138. https://doi.org/10.1542/neo.25-3-e127 

Osteomyelitis is an infection of the bone and is often a delayed diagnosis given the ambiguity of the signs and symptoms. Listen in on how you might be able to better detect and treat osteomyelitis without delay.  Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.com  This episode was written by pediatric resident Victoria Tran Toft and pediatricians Tammy Yau and Lidia Park with content support from Natasha Nakra (UC Davis pediatric infectious disease). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.   Key points: Osteomyelitis can present as limp or hesitancy with movement; this can occur with or without fevers and localizing signs.  Main diagnostics include CRP, which also aids in assessing treatment response. Treatment is a long course of antibiotics. Typically, starting empiric IV antibiotics in the hospital and then transitioning to oral agents.  Sources: PIDS/IDSA Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics. Published 8/5/2021. Journal of the Pediatric Infectious Diseases Society. https://doi.org/10.1093/jpids/piab027 

Want to know how to differentiate a normal white patch on the tongue vs a not normal white patch? Learn about thrush in this week’s episode!Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.comThis episode was written by pediatricians Tammy Yau and Lidia Park with content support from Julia Froud (UC Davis pediatrician). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation. Key Points:Thrush is due to candida yeast infectionIt cannot be wiped off the tongue as compared to milk residueTreat with topical nystatin solutionSources:Pediatric in Review, 2007: https://publications.aap.org/pediatricsinreview/article/28/1/15/34605/Oral-Conditions Thrush Pediatric Patient Education (2024) https://doi.org/10.1542/ppe_schmitt_240 AAP Redbook, 2021, Candidiasis: https://doi.org/10.1542/9781610025782-S3_025

Wondering why your patient’s diaper rash won’t go away? Pay attention to this video to learn if there’s something else going on!Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.comThis episode was written by pediatricians Tammy Yau and Lidia Park with content support from Lisa Rasmussen (UC Davis pediatrician). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation. Key Points:Typical diaper rash is an irritant contact dermatitis due to excess moisture, pH imbalance, and excessive friction. It can be a red patch or red macules and papules in the diaper region that spares the skin foldsCandidal diaper rashes involve the skin folds and have satellite lesionsDon’t forget in your differential: perianal strep, hand foot mouth syndrome, psoriasis, eczema, scabies, and Langerhans cell histiocytosisSources: Pediatrics in Review, January 2021, Helms and Burrows: https://publications.aap.org/pediatricsinreview/article/42/1/48/35437/Diaper-Dermatitis