Show Outline:

• Introduction to Eczema
  • Description of dermatologic terms
  • Defining eczema and atopic dermatitis
• Pathogenesis
  • Immune dysfunction
  • Histological differences
  • Involvement of filaggrin
  • Racial disparities
• Who gets eczema?
  • Age of onset
  • Demographics of patients with eczema
  • Atopic disease & “The Atopic March”
• Clinical Presentation / Diagnosis
  • Characterization of eczematous lesions
  • What to look for in people of color
  • Most likely locations of eczema based on patient age
  • Differential diagnoses
  • Sleep disturbances
  • Utilizing the Patient-Oriented Eczema Measure (POEM)
• Treatment
  • AAP recently updated treatment guidelines
  • The basic triad for eczema treatment
    • Skin care maintenance
    • Topical anti-inflammatory medications
      • The 5-10-15 Plan
    • Avoidance of triggers
  • Side-effects of topical steroids (very rare)
    • Skin atrophy
    • Steroid withdrawal 
• Complications
  • Secondary infections
    • Tinea
    • Impetigo
    • Eczema herpeticum
• Closing statements

Resources/Links:

1. POEM Eczema Questionnaire: https://www.rchsd.org/documents/2020/08/madp-poem.pdf/
2. Roduit C, et al. (the PASTURE study group). Phenotypes of Atopic Dermatitis Depending on the Timing of Onset and Progression in Childhood. JAMA Pediatr. 2017 Jul 1;171(7):655-662. doi: 10.1001/jamapediatrics.2017.0556. PMID: 28531273; PMCID: PMC5710337.
3. Schoch JJ, Anderson KR, Jones AE, Tollefson MM; Section on Dermatology. Atopic Dermatitis: Update on Skin-Directed Management: Clinical Report. Pediatrics. 2025 Jun 1;155(6):e2025071812. doi: 10.1542/peds.2025-071812. PMID: 40383540.

Links:

https://www.rchsd.org/documents/2020/08/madp-poem.pdf/

About the Speaker:

Host: Carly Pierson, MD – Carly Pierson, MD is a pediatric resident in the Primary Care Track at UVA Health. She graduated from the University of the Incarnate Word School of Osteopathic Medicine and has interests in allergy and immunology.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

• Definition of food allergies
  • Rates of food allergies
  • Possible pathophysiology of food allergies
• Clinical manifestations of food allergies
  • IgE mediated food allergies 
    • Cutaneous symptoms
    • Ocular symptoms
    • Respiratory symptoms
    • GI symptoms
    • Neurological and cardiovascular symptoms
    • Anaphylaxis = involvement of 2 or more systems
  • Non-IgE mediated food allergies
    • Symptoms after 4 hours after ingestion
    • Eosinophilic esophagitis
    • Alpha-gal
    • Food protein induced enterocolitis syndrome (FPIES)
    • Food protein induced proctocolitis (FPIAP)
• Questions to ask to hone your clinical history
  • Presenting symptoms
  • When did symptoms occur
  • Foods ingested
  • Other symptoms, other exposures
  • Any prior allergy testing
  • Family history?
  • Any food avoidance 
• Testing options for food allergies
  • Clinical history
  • Oral food challenge - gold standard
  • Skin prick/puncture test
  • Serum IgE testing
• Treatment of food allergy
  • Referral to allergy/immunology specialist and avoidance of offending food until appointment
  • Prescription for epinephrine autoinjector
  • Second generation antihistamines

Resources/Links:

1. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management Scott H. Sicherer, MD, and Hugh A. Sampson, MD New York, NY
2. Mendonca CE, Andreae DA. Food Allergy. Prim Care. 2023 Jun;50(2):205-220. doi: 10.1016/j.pop.2023.01.002. Epub 2023 Mar 27. PMID: 37105602.

About the Speaker:

Host: Jenna Zuzolo, MD – Jenna Zuzolo, MD is a pediatric resident at the University of Virginia with a focus on allergy and immunology. She attended Marshall University for her undergraduate education.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

1. Definition of “complementary” foods” - a catch all category for “all solid and liquid foods other than breast milk or infant formula”.  Also referred to as “solid foods”
2. Definition of potentially allergenic foods -  eggs, peanut butters, nut butters, fish, shellfish, etc. 
3. When to Introduce solid foods
   1. We will start recommending the introduction of solid foods in the form of puree, around the time an infant turns 4-6 months old – 
      1. Baby should be able to demonstrate adequate head control in the office with us
      2. An infant’s renal and gastrointestinal systems can only start to metabolize complementary foods around the age of 4 months. 
      3. An infant will usually develop motor and dental development skills to sufficiently chew and swallow foods around 6 months. 
      4. Introducing complementary foods too early can be associated with harmful health side effects, e.g., obesity 
4. Importance of introducing complementary foods
   1. Breastmilk and infant formula do not contain all the nutrients a growing infant will need to continue growing and developing appropriately. 
   2. LEAP study – babies less likely to develop peanut allergy if peanut products were introduced at 4-11 months
      • This study had HUGE implications regarding the introduction of potentially high allergen foods into infant’s diets to reduce the risk of developing a food allergy to them.
5. The introduction of complementary foods
   1. First offer  a variety of single-ingredient foods (such as pureed vegetables, fruits, grains and meats),  in any order that parents desire
   2. Iron-fortified cereal is often a good choice as iron stores from mother become depleted by about 4-6 months of age. 
   3. Recommend only providing 1-2 new foods per day in case the child has an adverse reaction 
   4. The main calorie source for these infants should still be formula or human milkor
   5. Important foods to avoid include: honey (due to the risk of botulism), cow’s milk (we transition to cow’s milk instead of formula / breastfeeding at age 12 months but not prior. This is because it has a low absorbable iron content which can lead to iron deficiency anemia, and doesn’t have all of the nutritional value that infant’s need from breastmilk/formula), choking hazards (such as whole nuts, grapes, popcorn, etc). 
6. Introduction of potentially allergenic foods:
   1. The most common allergenic foods are milk, egg, soy, wheat, fish, shellfish, tree nuts, sesame 
   2. Start to introduce these foods after the infant has tried and tolerated a few of the non-allergenic complementary foods (this is to make sure that the infant can tolerate non-allergenic foods first and foremost)
   3. For children with a history of atopy (or a family hx of atopy) it is recommended to start with a small serving of each of these foods, and then gradually increase the serving size as it is tolerated
   4. Avoid cow’s milk in a bottle but instead introduce other cow’s milk based products such as yogurts and cheese
7. Allergic reactions vs contact dermatitis
8. Bowel movements change in color and consistency when solid foods are introduced
9. Summary

Resources/Links:

1. Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G; LEAP Study Team. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015 Feb 26;372(9):803-13
2. Elissa M. Abrams, Marcus Shaker, David Stukus, Douglas P. Mack, Matthew Greenhawt; Updates in Food Allergy Prevention in Children. Pediatrics November 2023; 152 (5): e2023062836. 10.1542/peds.2023-062836
3. Victoria X. Soriano, Daniela Ciciulla, Grace Gell, Yichao Wang, Rachel L. Peters, Vicki McWilliam, Shyamali C. Dharmage, Jennifer J. Koplin; Complementary and Allergenic Food Introduction in Infants: An Umbrella Review. Pediatrics February 2023; 151 (2): e2022058380. 10.1542/peds.2022-058380

About the Speaker:

Host: Erica Licari, MD – Erica Licari, MD is a board-certified pediatrician who completed her residency at the University of Virginia. She has published research on pediatric health topics.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

1. Reasons for formula feeding 
   1. Human milk is first choice for most infants
   2. Concern about lactating parent’s milk supply
   3. Workplace conditions make it difficult to sustain human milk feeding
   4. Parent preference 
   5. There are few true contraindications to breastfeeding. 
      1. Galactosemia
      2. Maternal HIV infection that has not achieved an undetectable viral load
      3. Maternal phencyclidine (also known as PCP) or cocaine use
      4. Active Herpes Simplex virus lesion
      5. Active tuberculosis
2. Types of formula: 3 characteristics
   1. Caloric density: calories per ounce. Standard term formula is 20 calories/oz. Infants born preterm or have growth failure may need 22-27 calories/oz.
   2. Carbohydrate source: Lactose (galactose + glucose) or non-lactose
   3. Protein type: 
      1. Cow-milk based formula proteins are whey and casein.
      2. Hydrolyzed formulas: proteins are broken down into smaller protein “chunks” or into individual amino acids, which are hypoallergenic and easily digestible. 
      3. Other formulas utilize different sources of protein, including soy protein and goat’s milk.
      4. Special formulas for infants with specific metabolic conditions: eg. phenylketonuria, maple syrup urine disease, homocystinuria.
3. Forms of formula
   1. Powder: most common and least expensive. Usually, 1 scoop of formula powder is mixed with 2 oz water. 
   2. Liquid concentrate: mixed 1:1 with water. 
   3. Ready to feed: no mixing required, but most expensive.
   4. Be sure that the formula is being mixed correctly! Incorrect formula mixing can result in growth failure or electrolyte abnormalities.
4. How much formula should be given?
   1. A good rule of thumb is that infants require between 120-150 calories/kilogram per day. 
5. Common myths about formula
   1. Lactose intolerance. True congenital lactase deficiency is rare disorder and, in infants, it will usually present with very severe diarrhea. 
      1. What adults experience as lactose intolerance occurs later in childhood. 
      2. Developmental lactase deficiency can occur in premature infants, but lasts for a short time after birth and the majority are still able to consume lactose-containing formulas. 
      3. Infants can develop a temporary, self-resolving lactase deficiency after suffering from a gastroenteritis
   2. Increased spit ups (often at around 4 months of age): Generally not a sign of formula intolerance.  
   3. Gassiness and stomach discomfort after feeding: Normal and usually not a reason to switch formulas. 
6. Medical reasons to switch formula type
   1. Galactosemia: most often diagnosed after abnormal newborn metabolic screen.  
   2. Milk protein allergy: usually presents with blood in stool from allergic proctocolitis.  Rarely, more severe milk protein allergies can present as hives or even anaphylaxis. 
   3. Metabolic disorders 
7. Usually stop infant formula at 1 year of age and switch to cow’s milk, usually whole milk. 
   1. Do not switch to cow’s milk before 1 year of age because of solute load on kidneys. 

Resources/Links:

https://www.healthychildren.org/English/ages-stages/baby/formula-feeding/Pages/default.aspx

https://www.aafp.org/pubs/afp/issues/2009/0401/p565.html

https://www.cdc.gov/nutrition/infantandtoddlernutrition/formula-feeding/choosing-an-infant-formula.html

https://kidswithfoodallergies.org/recipes-diet/nutrition-and-health/formula-options-for-kids-with-food-allergies/#:~:text=Extensively%20Hydrolyzed%20Formulas%20(e.g.%2C%20Enfamil,common%20cause%20for%20allergy%20symptoms.

Links:

https://www.healthychildren.org/English/ages-stages/baby/formula-feeding/Pages/default.aspx
https://www.aafp.org/pubs/afp/issues/2009/0401/p565.html
https://www.cdc.gov/nutrition/infantandtoddlernutrition/formula-feeding/choosing-an-infant-formula.html
https://kidswithfoodallergies.org/recipes-diet/nutrition-and-health/formula-options-for-kids-with-food-allergies/#:~:text=Extensively%20Hydrolyzed%20Formulas%20(e.g.%2C%20Enfamil,common%20cause%20for%20allergy%20symptoms

About the Speaker:

Host: Paige Howard – Paige Howard completed her medical education at the University of Virginia School of Medicine. She is now a pediatric resident at Children's Hospital of Philadelphia (CHOP).

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

Common Causes

• Viral Presentation
  • HSV
  • Mononucleosis
• Allergic Presentation
• Group A Strep 
  • CENTOR Criteria

Emergency Causes

• Peritonsillar Abscess
• Retropharyngeal Abscess
• Epiglottitis

Wrap Up & Conclusion

Resources/Links:

https://www.chop.edu/conditions-diseases/throat-anatomy-and-physiology 

https://www.mdcalc.com/calc/104/centor-score-modified-mcisaac-strep-pharyngitis 

References

1. Aluma Chovel-Sella, Amir Ben Tov, Einat Lahav, Orna Mor, Hagit Rudich, Gideon Paret, Shimon Reif; Incidence of Rash After Amoxicillin Treatment in Children With Infectious Mononucleosis. Pediatrics May 2013; 131 (5): e1424–e1427. 10.1542/peds.2012-1575
2. Becker JA, Smith JA. Return to play after infectious mononucleosis. Sports Health. 2014 May;6(3):232-8. doi: 10.1177/1941738114521984. PMID: 24790693; PMCID: PMC4000473.
3. Chowdhury MDS, Koziatek CA, Rajnik M. Acute Rheumatic Fever. [Updated 2023 Aug 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK594238/
4. Esposito, S.; De Guido, C.; Pappalardo, M.; Laudisio, S.; Meccariello, G.; Capoferri, G.; Rahman, S.; Vicini, C.; Principi, N. Retropharyngeal, Parapharyngeal and Peritonsillar Abscesses. Children 2022,9,618. https://doi.org/ 10.3390/children9050618 
5. Martin JM. The Mysteries of Streptococcal Pharyngitis. Curr Treat Options Pediatr. 2015 Jun;1(2):180-189. doi: 10.1007/s40746-015-0013-9. PMID: 26146604; PMCID: PMC4486489.
6. MCMILLAN, J. A. , WEINER, L. B. , HIGGINS, A. M. & LAMPARELLA, V. J. (1993). Pharyngitis associated with herpes simplex virus in college students. The Pediatric Infectious Disease Journal, 12 (4), 280-283.
7. Mohseni M, Boniface MP, Graham C. Mononucleosis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470387/
8. Roggen I, van Berlaer G, Gordts F, et al. Centor criteria in children in a paediatric emergency department: for what it is worth. BMJ Open 2013;3: e002712. doi:10.1136/ bmjopen-2013-002712 

Links:

https://www.chop.edu/conditions-diseases/throat-anatomy-and-physiology
https://www.mdcalc.com/calc/104/centor-score-modified-mcisaac-strep-pharyngitis
https://www.ncbi.nlm.nih.gov/books/NBK594238/
https://doi.org/
https://www.ncbi.nlm.nih.gov/books/NBK470387/

About the Speaker:

Host: Chris Stadnick, MD – Chris Stadnick, MD is a board-certified pediatrician at Metropolitan Pediatrics in Portland, Oregon. He earned his MD from the University of Tennessee Health Science Center and completed his pediatric residency at the University of Virginia.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

1. Cause of asthma
   1. Genetics: “Atopic triad” of asthma, atopic dermatitis or eczema, and allergic rhinitis 
   2. Prenatal and childhood environmental factors: maternal smoking and allergen exposure 
2. Pathophysiology and diagnosis 
   1. AAP definition: “episodic and reversible airway constriction and inflammation in response to infection, environmental allergens, and irritants. It is a complex, multifactorial, and immune-mediated process that presents with various clinical phenotypes.”
   2. Airway hyperreactivity leads to inflammation of bronchi, increased mucus production, bronchial smooth muscle contraction
   3. Key elements of the history – recurrent episodes of cough, wheeze, difficulty breathing, nighttime symptoms, consistent trigger, atopic personal or family history, improvement with asthma treatment.
   4. Identification of triggers is important. Common triggers include respiratory infections, mold or pet dander, pollen, intense crying or laughing, exercise, pollution, and cold air. 
   5. Children from minority and lower-income backgrounds experience an increased asthma burden, likely closely tied to a complex interaction of factors such as decreased access to healthcare, increased rates of obesity, and poor air quality in the areas in which they live.
3. Classification of asthma: determined by the frequency and severity of symptoms when they are not receiving preventative treatment.
4. New 2022 guidelines for asthma treatment
   1. Albuterol or other beta 2 agonist as needed for symptoms - relaxes bronchial smooth muscles
   2. Daily controller medication (usually inhaled steroid) if symptoms more than twice weekly - inhaled steroid decreases inflammation
   3. Inhaled steroid + long-acting beta 2 agonist combination inhaler preferred for those >5 years
   4. Asthma action plan should be given to every patient
5. Treatment of acute asthma attack
   1. Quick assessment and stabilization of patient is important
   2. Treat acute symptoms first, then address chronic control of asthma
   3. Albuterol or ipratropium-albuterol, systemic steroids are generally first lines of treatment
   4. Supplemental oxygen as needed
   5. Other options for medications: magnesium, terbutaline, theophylline, epinephrine
   6. Frequent reassessment is needed

Resources:

Global Initiative for Asthma, Pocket Guide for Asthma Management and Prevention for Adults, Adolescents and Children 6-11 Years. Updated 2023. https://ginasthma.org/wp-content/uploads/2023/07/GINA-2023-Pocket-Guide-WMS.pdf

Links:

https://ginasthma.org/wp-content/uploads/2023/07/GINA-2023-Pocket-Guide-WMS.pdf

About the Speaker:

Host: Rebecca Hu, MD – Rebecca Hu, MD is a pediatrician at Signature Healthcare in Brockton, Massachusetts. She completed her pediatric residency at the University of Virginia, where she served as a chief resident with interests in adolescent health and developmental-behavioral pediatrics.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

1. Sources of lead exposure 
   1. Ingestion of contaminated food or water
   2. Ingestion or breathing in of lead dust
   3. Other sources: lead-acid batteries, ammunition, lead-based pigments and paints, stained glass, lead crystal glasses, ceramic glazes, jewelry, toys
   4. For families from other cultures, think about ceramic glazes, traditional cosmetics, traditional medicines
2. Government policies to decrease lead exposure
   1. Unleaded gasoline
   2. Lead-free paint
   3. Lead-free solder in food cans
   4. Lead-free water pipes
3. Why young children are at risk for lead toxicity
   1. Hand-to-mouth behavior
   2. Increased absorption of lead
   3. Developing nervous system is vulnerable
   4. Calcium or iron deficiency increase absorption of lead
4. Effects of lead toxicity in children can be seen at levels as low as 3.5 µg/dL
   1. Growth and development delays
   2. Lower IQ
   3. Learning and behavior problems
   4. Hearing and speech problems
   5. School underperformance
   6. At higher levels, you may see
      1. Irritability
      2. Loss of appetite, weight loss, fatigue
      3. Abdominal pain, vomiting, and/or constipation
      4. Anemia
      5. Pica
      6. Seizures, coma, death
5. Universal lead screening at 1 and 2 years
   1. Screening questionnaires are not very sensitive or specific 
   2. Blood lead test 
      1. Capillary – get results quickly, but can be falsely elevated
      2. Venous – results more accurate, but may take some time to come back
6. Management of elevated lead level
   1. Repeat it if it was a capillary sample
   2. Review results with family
   3. Ask about potential exposures – may need to contact health department, landlord, or independent certified lead inspector to test home for lead
   4. Assess risk factors for iron or calcium deficiency
   5. Ask about developmental milestones – may need to refer to early intervention services
   6. Consider abdominal xray if history of pica
   7. For levels >45, may need chelation therapy 

Resources/Links:

• CDC, Childhood Lead Poisoning Prevention, https://www.cdc.gov/nceh/lead/default.htm
• AAP policy statement. Prevention of Childhood Lead Toxicity, Pediatrics 2016: 138(1):e20161493. https://publications.aap.org/pediatrics/article/138/1/e20161493/52600/Prevention-of-Childhood-Lead-Toxicity
• Mona Hanna-Attisha, What the Eyes Don't See: A Story of Crisis, Resistance, and Hope in an American City, 2018. https://www.amazon.com/What-Eyes-Dont-See-Resistance/dp/0399590838

Links:

https://www.cdc.gov/nceh/lead/default.htm
https://publications.aap.org/pediatrics/article/138/1/e20161493/52600/Prevention-of-Childhood-Lead-Toxicity
https://www.amazon.com/What-Eyes-Dont-See-Resistance/dp/0399590838

About the Speaker:

Host: Rachel Moon, MD – Rachel Moon, MD is the Harrison Distinguished Professor of Pediatrics at UVA Health Children's. She is an internationally recognized researcher in sudden unexpected infant death and chairs the AAP Task Force on SIDS. She is also the Chief of General Pediatrics at UVA.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

• Introduction
• What is the neuro exam?
• Review of the  “Map” of the neuro system
  • Cortex, Brainstem, Spinal Cord, Motor neuron
• How to complete a neuro exam and what to look for!
  • General Assessment
  • Mental Status
  • Language
  • Cranial Nerves
  • Strength
  • Sensation
  • Coordination 
  • Reflexes
• Special consideration for pediatrics 
• Closing

Resources/Links:

• “NeuroLogic Exam”, A complete in-depth guide of the neuro exam complete with references and videos produced by Dr. Paul D. Larsen, M.D. and Suzanne S. Stensaas, Ph.D. at The University of Utah. (https://neurologicexam.med.utah.edu/adult/html/home_exam.html). 
• “PediNeurologic Exam” A guide of the neuro exam for children produced by Dr. Paul D. Larsen, M.D. and Suzanne S. Stensaas, Ph.D. at The University of Utah (https://neurologicexam.med.utah.edu/pediatric/html/home_exam.html) 
• Medical Student Resources from the American Academy of Neurology (https://www.aan.com/tools-resources/medical-student-educational-resources).

Links:

https://neurologicexam.med.utah.edu/adult/html/home_exam.html
https://neurologicexam.med.utah.edu/pediatric/html/home_exam.html
https://www.aan.com/tools-resources/medical-student-educational-resources

About the Speaker:

Host: Jared Barkes, MD – Jared Barkes, MD is a Child Neurology Resident at the University of Virginia. He graduated from the Brody School of Medicine at East Carolina University and completed his undergraduate studies at UNC Chapel Hill in Mathematics and Biochemistry, with research interests in medical play and reducing patient anxiety.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

1. Defining Neonatal Sepsis 
   1. Early Onset Sepsis
   2. Late Onset Sepsis
2. Neonatal Early Onset Sepsis Calculator - https://neonatalsepsiscalculator.kaiserpermanente.org/
3. Presentation of Illness and Physical Exam 
4. Pathogenesis
   1. Group B Strep
      1. Screening and prophylaxis 
   2. E coli
   3. Strep viridans
   4. Klebsiella
   5. Enterococcus
   6. Listeria 
   7. HSV 
      1. Screening and prophylaxis 
5. Types of Infection
   1. Bacteremia 
   2. Pneumonia
   3. Meningitis 
6. Work up 
   1. CBC with differential 
   2. Blood Culture
   3. Urinalysis and Urine Culture
   4. Cerebrospinal Fluid culture 
   5. Chest X-Ray 
   6. Surface swabs of mucous membranes 
7. Antimicrobial coverage
8. Evaluation and Treatment of a Well Appearing Febrile Infant 8-60 days old
   1. https://doi.org/10.1542/peds.2021-052228
   2. 8-21 days 
   3. 22-28 days 
   4. 29-60 days 

References:

1. Neonatal Early Onset Sepsis Calculator - https://neonatalsepsiscalculator.kaiserpermanente.org/
2. AAP Guidelines for Evaluation and Treatment of a Well Appearing Febrile Infant 8-60 days old: https://doi.org/10.1542/peds.2021-052228

Links:

https://neonatalsepsiscalculator.kaiserpermanente.org/
https://doi.org/10.1542/peds.2021-052228

About the Speaker:

Host: Elizabeth (Blair) Davis, MD – Elizabeth Blair Davis, MD, FAAP graduated from the University of Virginia School of Medicine and completed her pediatric residency at UVA. She received her undergraduate education from Washington and Lee University.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

1. Importance of Iron 
   1. Iron and Hemoglobin 
   2. Iron and Neurodevelopment
   3. Iron and the Immune System
2. What happens in iron deficiency
3. Reasons that children are at high risk for iron deficiency 
   1. Rapid Growth . 
   2. Insufficient dietary intake and limited absorption 
   3. Increased losses 
4. Peaks of Incidence
5. Other risk factors for iron deficiency.
   1. Preterm infants 
   2. Children who suffer from neuro-motor disorders as they often have nutritional deficiency related to swallowing impairment
   3. G.I. diseases that cause malabsorption, 
   4. Diseases predisposing them to bleeding.
   5. Lead toxicity. 
6. Screening for IDA
   1. History: Asking about prematurity, low birth weight, exclusive breastfeeding beyond 4 months of age, weaning to whole milk without addition of iron rich foods, feeding problems, and any past medical conditions. 
   2. Exposure to lead (i.e. age/ condition of home, recent renovations, a parent who has occupational exposure, concerns about drinking water). 
   3. Any possible symptoms of anemia, such as fatigue, breath holding spells, pica
   4. Physical exam: pallor. 
   5. Lab testing.
7. Treatment for iron deficiency 
   1. Oral iron: daily dose of 3 to 6 mg per kilogram of elemental iron divided into three doses is adequate.
   2. Give iron supplements with juice - increases iron absorption through the action of ascorbic acid! Juices that are high in ascorbic acid include orange and apple juice.
   3. Supplements should be continued for a minimum of three months to reestablish iron stores. After completion of treatment, reassessment of iron status 
   4. In addition to iron supplementation, the other aspect of treatment is encouraging dietary intake of iron rich foods (meat and fish, cereals, legumes, vegetables, soy, eggs)
8. Follow up

Resources/Links:

• Baker RD, Greer FR, et al. Clinical Report – Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0-3 years of age). Pediatrics. 2010; 126(5). www.pediatrics.org/cgi/doi/10.1542/peds.2010-2576
• Özdemir N. Iron deficiency anemia from diagnosis to treatment in children. Turk Pediatri Ars. 2015 Mar 1;50(1):11-9. doi: 10.5152/tpa.2015.2337. PMID: 26078692; PMCID: PMC4462328.
• Lozoff B, Beard J, Connor J, Barbara F, Georgieff M, Schallert T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev. 2006 May;64(5 Pt 2):S34-43; discussion S72-91. doi: 10.1301/nr.2006.may.s34-s43. PMID: 16770951; PMCID: PMC1540447.
• Yadav, D., Chandra, J. Iron Deficiency: Beyond Anemia. Indian J Pediatr 78, 65–72 (2011). https://doi.org/10.1007/s12098-010-0129-7

Links:

https://doi.org/10.1007/s12098-010-0129-7

About the Speaker:

Host: Riley Calicchia, MD – Riley Calicchia, MD is a pediatric resident at the University of Rochester Medical Center / Golisano Children's Hospital in Rochester, New York. She completed her medical education and began residency training in 2024.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

1. Ear anatomy
   1. Outer ear, tympanic membrane (TM), middle ear, inner ear
   2. Eustacian tube in children is smaller in diameter and angled more horizontally than in adults.  This makes it more difficult to drain fluid behind the middle ear and why kids are more prone to get ear infections when they get a cold than adults are. 
   3. The adenoids also are thought to play a role in fluid collection and buildup. 
2. Taking a history for patient with chief complaint of ear pain
   1. How old is this child? 
   2. Have they had a fever? 
   3. Are there any other viral symptoms such as cough, runny nose, or  sore throat? 
   4. Has the child been swimming recently? 
   5. Has the child put anything in their ears? 
   6. Has there been any ear drainage or changes in hearing? 
3. Ear examination
   1. Make sure that the child’s head is as still as possible 
   2. How to use the otoscope
   3. What to look for: 
      1. Color of the TM. 
      2. Fluid behind the TM 
      3. Is the TM bulging or not bulging
      4. Light reflex of the TM
      5. Ear canal
4. Acute otitis media
   1. Infectious causes - bacteria (especially Strep pneumonia, H influenzae, and Moraxella catarrhalis), viruses
   2. Treatment
      1. Antibiotics vs. “watch and wait approach”
      2. Criteria for using antibiotics
      3. Antibiotic options
      4. Indications for tympanostomy tubes
   3. Acute otitis externa (“Swimmer’s ear”)
      1. Causes
      2. Clinical presentation
      3. Treatment
   4. Foreign body in ear
   5. Mastoiditis

Resources and Links:

Anatomy and Ear Tubes/Adenoidectomy

https://www.texaschildrens.org/departments/ear-nose-and-throat-otolaryngology/conditions-we-treat/dysfunction-eustachian-tube#:~:text=Eustachian%20tubes%20in%20children%20are,cause%20pain%20for%20the%20child.

https://www.childrensmn.org/educationmaterials/childrensmn/article/18784/adenoidectomy-and-ear-tubes/#:~:text=The%20adenoid%20is%20located%20next,is%20for%20recurrent%20nasal%20infections

https://www.ncbi.nlm.nih.gov/books/NBK570549/#:~:text=The%20middle%20ear%20consists%20of,the%20transmission%20of%20sound%20waves.

https://www.ncbi.nlm.nih.gov/books/NBK551658/#:~:text=The%20inner%20ear%20is%20located,labyrinth%2C%20separated%20only%20by%20perilymph.

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/ear-tube-insertion

https://www.chop.edu/news/health-tip/3-signs-your-child-may-need-ear-tubes

Otitis Externa

https://publications.aap.org/pediatricsinreview/article/34/3/143/34784/Otitis-Externa

https://www.aafp.org/pubs/afp/issues/2001/0301/p927.html 

https://www.aafp.org/pubs/afp/issues/2006/1101/p1510.html

AAP Otitis Media Guidelines:

https://publications.aap.org/pediatrics/article/131/3/e964/30912/The-Diagnosis-and-Management-of-Acute-Otitis-Media

Links:

https://www.texaschildrens.org/departments/ear-nose-and-throat-otolaryngology/conditions-we-treat/dysfunction-eustachian-tube#:~:text=Eustachian%20tubes%20in%20children%20are,cause%20pain%20for%20the%20child
https://www.childrensmn.org/educationmaterials/childrensmn/article/18784/adenoidectomy-and-ear-tubes/#:~:text=The%20adenoid%20is%20located%20next,is%20for%20recurrent%20nasal%20infections
https://mcas-proxyweb.mcas.ms/certificate-checker?login=false&originalUrl=https%3A%2F%2Fwww.ncbi.nlm.nih.gov.mcas.ms%2Fbooks%2FNBK570549%2F%3FMcasTsid%3D20893%23%3A~%3Atext%3DThe%2520middle%2520ear%2520consists%2520of%2Cthe%2520transmission%2520of%2520sound%2520waves&McasCSRF=220c67c67eab8f26471d042cc267986ebda3b3589a306336751c3b7097cd6b5b
https://mcas-proxyweb.mcas.ms/certificate-checker?login=false&originalUrl=https%3A%2F%2Fwww.ncbi.nlm.nih.gov.mcas.ms%2Fbooks%2FNBK551658%2F%3FMcasTsid%3D20893%23%3A~%3Atext%3DThe%2520inner%2520ear%2520is%2520located%2Clabyrinth%252C%2520separated%2520only%2520by%2520perilymph&McasCSRF=220c67c67eab8f26471d042cc267986ebda3b3589a306336751c3b7097cd6b5b
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/ear-tube-insertion
https://www.chop.edu/news/health-tip/3-signs-your-child-may-need-ear-tubes
https://publications.aap.org/pediatricsinreview/article/34/3/143/34784/Otitis-Externa
https://www.aafp.org/pubs/afp/issues/2001/0301/p927.html
https://www.aafp.org/pubs/afp/issues/2006/1101/p1510.html
https://publications.aap.org/pediatrics/article/131/3/e964/30912/The-Diagnosis-and-Management-of-Acute-Otitis-Media
https://www.ncbi.nlm.nih.gov/books/NBK570549/#:~:text=The%20middle%20ear%20consists%20of,the%20transmission%20of%20sound%20waves
https://www.ncbi.nlm.nih.gov/books/NBK551658/#:~:text=The%20inner%20ear%20is%20located,labyrinth%2C%20separated%20only%20by%20perilymph

About the Speaker:

Host: Chris Stadnick, MD – Chris Stadnick, MD is a board-certified pediatrician at Metropolitan Pediatrics in Portland, Oregon. He earned his MD from the University of Tennessee Health Science Center and completed his pediatric residency at the University of Virginia.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

1. Long term health consequences of child abuse
2. Why identification of child abuse is difficult
   1. It is often difficult to distinguish an accidental injury from a non-accidental injury
   2. A caregiver who has abused a child rarely confesses to harming the child
   3. Child may be brought to medical care by unsuspecting parent
   4. It is emotionally difficult for us to confront parents when there are concerns for abuse
3. Mandated reporting of child abuse
4. Potential clues that a child may have been physically abused
   1. Medical record review
   2. History
   3. Physical exam
5. Differential diagnosis of physical abuse
6. Labs and other tests that you may get
7. The role of the child protection team and child protective services
8. Potential clues that a child may have been sexually abused
   1. History
   2. Physical exam
   3. Lab testing
9. Medical documentation

Resources/Links:

1. Christian CW; Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse. Pediatrics. 2015 May;135(5):e1337-54. doi: 10.1542/peds.2015-0356.
2. Pierce MC, Kaczor K, Lorenz DJ, Bertocci G, Fingarson AK, Makorof K, Berger RP, Bennett B, Magana J, Staley S, Ramaiah V, Fortin K, Currie M, Herman BE, Herr S, Hymel KP, Jenny C, Sheehan K, Zuckerbraun N, Hickey S, Meyers G, Leventhal JM (2021) Validation of a clinical decision rule to predict abuse in young children based on bruising characteristics. JAMA Netw Open 4(4):e215832. https://doi.org/10.1001/jamanetworkopen.2021. 5832. Erratum in: JAMA Netw Open. 2021 Sep 1;4(9):e2130136. PMID: 33852003; PMCID: PMC8047759
3. Smith T, Chauvin-Kimoff L, Baird B, Ornstein A. The medical evaluation of prepubertal children with suspected sexual abuse. Paediatr Child Health. 2020 Apr;25(3):180-194. doi: 10.1093/pch/pxaa019. Epub 2020 Apr 10. PMID: 32296280; PMCID: PMC7147698

Links:

https://doi.org/10.1001/jamanetworkopen.2021

About the Speaker:

Host: Cindy Christian, MD – Cindy Christian, MD holds the Anthony A. Latini endowed Chair in the Prevention of Child Abuse and Neglect at Children's Hospital of Philadelphia. She is a Professor of Pediatrics at UPenn's Perelman School of Medicine and an internationally recognized expert in child maltreatment.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

• Medical contraindications
• Physiology of hormonal options
• Efficacy of pregnancy prevention
• Patient considerations and concerns
• Emergency contraception
• Myths

Resources/links:

• CDC MEC: https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf
• ACOG contraception chart: https://www.acog.org/womens-health/infographics/effectiveness-of-birth-control-methods
• https://www.reproductiveaccess.org/
• https://www.bedsider.org/

Links:

https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf
https://www.acog.org/womens-health/infographics/effectiveness-of-birth-control-methods
https://www.reproductiveaccess.org/
https://www.bedsider.org/

About the Speaker:

Host: Rebecca Hu, MD – Rebecca Hu, MD is a pediatrician at Signature Healthcare in Brockton, Massachusetts. She completed her pediatric residency at the University of Virginia, where she served as a chief resident with interests in adolescent health and developmental-behavioral pediatrics.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

1. Why it is important to learn about development
2. Developmental surveillance versus developmental screening versus diagnosis of developmental issues
3. Developmental domains/categories:
   1. Expressive language
   2. Receptive language
   3. Gross motor: this is how you use all of your big muscles 
   4. Fine motor: hand/eye coordination 
   5. Social/emotional: how children interact with others and show emotion. 
   6. Language/Communication: how children express their needs and share what they are thinking, as well as understand what is said to them. Hearing is important for language/communication development.
   7. Cognitive:  how children learn new things and solve problems
   8. Movement/Physical Development:  how children use their bodies. 
4. Learning milestones
   1. Learn the schedule for well child visits
   2. Watch children at different ages to see what they can do. 
5. Gross motor milestones: 1 year goal is to be able to walk independently.
6. Fine motor milestones: 1 year goal is to be able to put food into one’s mouth
7. Language and communication milestones: 1 year goal is to be able to say a few words
8. Social and emotional milestones: 1 year goal is to recognize that people are individuals that they can interact withOK, so those are some of the major milestones. Now, let’s go through a few common case scenarios that have some specific teaching points. 
9. Cases
10. What if there is developmental delay

Resources/Links:

• CDC’s Developmental Milestones: https://www.cdc.gov/ncbddd/actearly/milestones/index.html
• Ages and Stages developmental screening tool: https://agesandstages.com/products-pricing/asq3/
• Modified Checklist for Autism in Toddlers (MCHAT): https://www.mchatscreen.com/

Links:

https://www.cdc.gov/ncbddd/actearly/milestones/index.html
https://agesandstages.com/products-pricing/asq3/
https://www.mchatscreen.com/

About the Speaker:

Host: Rachel Moon, MD – Rachel Moon, MD is the Harrison Distinguished Professor of Pediatrics at UVA Health Children's. She is an internationally recognized researcher in sudden unexpected infant death and chairs the AAP Task Force on SIDS. She is also the Chief of General Pediatrics at UVA.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

• Why we worry 
• What causes it
• Which infants are most at risk
• How to treat it and who needs the NICU

Resources/Links:

• https://downloads.aap.org/AAP/PDF/Seminars_in_Fetal_Neonatal_Medicine.pdf
• https://publications.aap.org/hospitalpediatrics/article/11/6/595/180015/Practice-Variations-in-Diagnosis-and-Treatment-of
• https://publications.aap.org/aapnews/news/25073/Myriad-unknowns-regarding-neonatal-hypoglycemia?autologincheck=redirected

Links:

https://downloads.aap.org/AAP/PDF/Seminars_in_Fetal_Neonatal_Medicine.pdf
https://publications.aap.org/hospitalpediatrics/article/11/6/595/180015/Practice-Variations-in-Diagnosis-and-Treatment-of
https://publications.aap.org/aapnews/news/25073/Myriad-unknowns-regarding-neonatal-hypoglycemia?autologincheck=redirected

About the Speaker:

Host: Joanna Parga-Belinkie, MD – Joanna Parga-Belinkie, MD is an Associate Professor of Clinical Pediatrics in Neonatology at the University of Pennsylvania and Attending Physician at Children's Hospital of Philadelphia (CHOP).

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

• General definition of ADHD and its types
• Preparing for your first visit
  • Initial evaluation of ADHD vs. med check
  • Reviewing prior visits
• During an initial visit:
  • Evaluating historical features 
    • Behaviors at home, behaviors at school
    • Common misconceptions about ADHD
    • Surrounding factors and comorbidities/misdiagnosis
  • Physical Exam
    • Important features of the exam
    • Observing the child’s behavior
  • Role of the Vanderbilt
    • Scoring a Vanderbilt
• Treatment
  • Medication vs. non-pharmacologic interventions
    • Overview of different medications
      • Stimulants
      • Nonstimulants
    • Choosing a medication
      • Family history
      • Comorbidities
  • Titrating medications
• Follow-up visits
  • Symptoms to look for

Resources/Links:

• Vanderbilt Scoring: https://www.uwmedicine.org/sites/stevie/files/2019-11/sodbp_vanderbilt_scoringinstructions.pdf
• Parent Training in Behavior Management for ADHD: https://www.cdc.gov/ncbddd/adhd/behavior-therapy.html

Dosing guidelines when switching from one stimulant to another in the treatment of attention deficit hyperactivity disorder in children and adolescents: https://www.uptodate.com/contents/image?imageKey=PEDS%2F61007

Links:

https://www.uwmedicine.org/sites/stevie/files/2019-11/sodbp_vanderbilt_scoringinstructions.pdf
https://www.cdc.gov/ncbddd/adhd/behavior-therapy.html
https://www.uptodate.com/contents/image?imageKey=PEDS%2F61007

About the Speaker:

Host: Lauren Ferguson, MD – Lauren Ferguson, MD is an Assistant Professor of Pediatrics at the University of Utah. She graduated from Virginia Tech Carilion School of Medicine and completed her residency and chief year at UVA, with clinical interests in newborn medicine, breastfeeding, mental health, and ADHD management.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

• Introduction to jaundice and hyperbilirubinemia
  • Jaundice is the yellowing of skin, sclerae, and mucous membranes caused by hyperbilirubinemia
  • Hyperbilirubinemia can be further separated into unconjugated or conjugated forms, which allows us to further differentiate etiology
• Review of bilirubin breakdown pathway, to include enterohepatic circulation
• Unconjugated hyperbilirubinemia etiologies:
  • Excessive or increased production of bilirubin
    • Cephalohematomas
    • Hemolysis: ABO and Rh incompatibilities; Red Blood Cell (RBC) membrane or enzyme defects, RBC oxidative stress (secondary to sepsis, asphyxia, and acidosis)
  • Decreased clearance of bilirubin
    • Breast milk jaundice
    • Prematurity
    • Hypothyroidism
    • Gilbert Syndrome
    • Crigler-Najjar Syndrome
    • Suboptimal Intake Jaundice
    • Medications
  • Combination of both
    • Physiologic jaundice
• Conjugated hyperbilirubinemia etiologies:
  • Always pathologic
  • Biliary atresia
  • Briefly mentioned the vast range of other etiologies: infectious, genetic, metabolic, and anatomic
• Key elements of history and physical examination for a jaundiced infant
  • History:
    • Onset
    • Feeding patterns (what, how much/often, quality of feeding)
    • Urine and stool diapers
    • Prenatal history
    • Delivery history
    • Family history
  • Physical exam:
    • Growth curves
    • Assessing liver size: percussion vs scratch test
    • Neurologic exam
• Review of laboratory and imaging work up for a jaundiced infant
• Brief discussion on management of unconjugated hyperbilirubinemia etiologies
  • Feeding
  • Phototherapy
  • Review of neurotoxicity risk factors
• Brief discussion on management of conjugated hyperbilirubinemia, specifically biliary atresia
  • Early referral to Pediatric Gastroenterology
  • Kasai portoenterostomy
  • Liver transplant
  • Maximizing nutrition

Resources/Links:

• Kemper, A. R., Newman, T. B., Slaughter, J. L., Maisels, M. J., Watchko, J. F., Downs, S. M., ... & Russell, T. L. (2022). Clinical practice guideline revision: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 150(3).
• Pan, D. H., & Rivas, Y. (2017). Jaundice: newborn to age 2 months. Pediatrics in Review, 38(11), 499-510.
• Chou, J. PediTools. AAP 2022 Hyperbilirubinemia management guidelines. https://peditools.org/bili2022/. Published 2012. Updated 2023. Accessed Aug 18, 2023.

Links:

https://peditools.org/bili2022/

About the Speaker:

Host: Ashlee Commeree, MD – Ashlee Commeree, MD is a pediatric critical care medicine physician at the University of Utah in Salt Lake City. She completed her pediatric residency at the University of Virginia before pursuing fellowship training in pediatric critical care.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

• Introduction
• Definition of maintenance fluid needs
• Important considerations about maintenance fluids
• Discussion regarding which fluids to order for different patient populations and at what rate to administer
• Role of ADH in hospitalized patients
• How to order a fluid bolus—amount, composition, and rate administered
• Assessing your patient with dehydration utilizing physical exam findings, vital signs, and other objective data such as weight
• Case scenarios: Identification and management of hyperkalemia and hypokalemia

1. Case #1- 12-year old with hyperkalemia following infection with influenza
2. Case #2- 2-year old child with history of neglect and malnutrition

• Additional clinical pearls including the association between albumin and calcium, acidosis/alkalosis and potassium levels

Resources/Links:

 Clinical Practice Guideline: Maintenance Intravenous Fluids in Children | Pediatrics | American Academy of Pediatrics (aap.org)

Links:

https://publications.aap.org/pediatrics/article/142/6/e20183083/37529/Clinical-Practice-Guideline-Maintenance?autologincheck=redirected

About the Speaker:

Host: Lisa Hainstock, MD – Lisa Hainstock, MD is an Associate Professor of Pediatrics and Director of the Pediatric Residency Program at UVA Health. She is board-certified in hospital medicine and general pediatrics with interests in children with medical complexity and medical education.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

• Strategies to improve milk production
• Latching
• Newborn stomach volumes
• How to know if baby is getting enough milk
• What to do if baby isn’t getting enough milk
• Manual expression and pumping
• Breastfeeding complications

Resources/Links: 

• Bella Breastfeeding Curriculum on Open Pediatrics (free): www.openpediatrics.org
• Virginia Department of Health/Breastfeeding Education Consortium Online Course (free for those who live or work in Virginia): https://bfconsortium.org
• American Academy of Pediatrics Residency Breastfeeding Curriculum: https://www.aap.org/en/learning/breastfeeding-curriculum/
• ACOG Statement on Optimizing Support for Breastfeeding: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/optimizing-support-for-breastfeeding-as-part-of-obstetric-practice
• AAP Policy Statement: Breastfeeding and the Use of Human Milk, 2022: https://publications.aap.org/journal-blogs/blog/20699/Welcome-to-the-AAP-s-2022-Policy-on-Breastfeeding?autologincheck=redirected#
• US Breastfeeding Guidelines for Mothers with HIV: https://clinicalinfo.hiv.gov/en/guidelines/perinatal/infant-feeding-individuals-hiv-united-states
• NEWT Curve: https://newbornweight.org
• UpToDate “Initiation of Breastfeeding”: https://www.uptodate.com/contents/initiation-of-breastfeeding
  

Links:

https://newbornweight.org/
https://bfconsortium.org
https://www.aap.org/en/learning/breastfeeding-curriculum/
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/optimizing-support-for-breastfeeding-as-part-of-obstetric-practice
https://publications.aap.org/journal-blogs/blog/20699/Welcome-to-the-AAP-s-2022-Policy-on-Breastfeeding?autologincheck=redirected#
https://clinicalinfo.hiv.gov/en/guidelines/perinatal/infant-feeding-individuals-hiv-united-states
https://newbornweight.org
https://www.uptodate.com/contents/initiation-of-breastfeeding

About the Speaker:

Host: Emily Fronk – Emily Fronk is a former UVA School of Medicine student who has published research on virtual reality in pediatrics and pain management in pediatric patients.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

• Making families feel comfortable
• Benefits of breastfeeding for mom and baby
• Contraindications to breastfeeding
• Approaching conversations about breastfeeding with families
• The process of lactogenesis (milk production)

Resources/Links: 

• Bella Breastfeeding Curriculum on Open Pediatrics (free): www.openpediatrics.org
• Virginia Department of Health/Breastfeeding Education Consortium Online Course (free for those who live or work in Virginia): https://bfconsortium.org
• American Academy of Pediatrics Residency Breastfeeding Curriculum: https://www.aap.org/en/learning/breastfeeding-curriculum/
• ACOG Statement on Optimizing Support for Breastfeeding: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/optimizing-support-for-breastfeeding-as-part-of-obstetric-practice
• AAP Policy Statement: Breastfeeding and the Use of Human Milk, 2022: https://publications.aap.org/journal-blogs/blog/20699/Welcome-to-the-AAP-s-2022-Policy-on-Breastfeeding?autologincheck=redirected#
• US Breastfeeding Guidelines for Mothers with HIV: https://clinicalinfo.hiv.gov/en/guidelines/perinatal/infant-feeding-individuals-hiv-united-states
• NEWT Curve: https://newbornweight.org
• UpToDate “Initiation of Breastfeeding”: https://www.uptodate.com/contents/initiation-of-breastfeeding
  

Links:

https://newbornweight.org/
https://bfconsortium.org
https://www.aap.org/en/learning/breastfeeding-curriculum/
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/optimizing-support-for-breastfeeding-as-part-of-obstetric-practice
https://publications.aap.org/journal-blogs/blog/20699/Welcome-to-the-AAP-s-2022-Policy-on-Breastfeeding?autologincheck=redirected#
https://clinicalinfo.hiv.gov/en/guidelines/perinatal/infant-feeding-individuals-hiv-united-states
https://newbornweight.org
https://www.uptodate.com/contents/initiation-of-breastfeeding

About the Speaker:

Host: Emily Fronk – Emily Fronk is a former UVA School of Medicine student who has published research on virtual reality in pediatrics and pain management in pediatric patients.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

Newborn deliveries: Low Risk 

• Low-risk delivery team members 
• What constitutes a low-risk delivery page 

Differences in Operating Room (OR) versus labor room deliveries 

• Differences in attending delivery in the delivery room versus the operating room 
• Operating room attire 
• Importance of Apgar (timer button) on radiant warmer 

Delayed Cord clamping 

• Delayed cord clamping: When this happens and the importance 
• Why it matters if umbilical cord is clamped before 1 minute and infant brought to the radiant warmer 

Neonatal Resuscitation 

• NRP guidelines from American Academy of Pediatrics 

Pertinent Physical Exam at delivery 

• Importance of full, efficient exam in delivery room 

Need for Higher Level Intervention: Neonatal Intensive Care 

• Reasons for calling for NICU: high-risk delivery team 

Resources/Links: 

• Neonatal Resuscitation Program (NRP)/American Academy of Pediatrics 

Neonatal Resuscitation Program (aap.org)

Links:

https://www.aap.org/en/learning/neonatal-resuscitation-program/

About the Speaker:

Host: Jolene "Jody" Carlton, DNP, APRN, CPNP-PC/AC, RNC-NIC, EMT-B – Jolene "Jody" Carlton, DNP, APRN is a Pediatric Nurse Practitioner affiliated with UVA Health University Medical Center in Charlottesville. She holds multiple certifications including CPNP-PC/AC and RNC-NIC.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

• How to identify an eating disorder 
• What to do if you suspect an eating disorder 
• How to manage eating disorder patients in the outpatient setting or in the hospital 
• Strategies and tips for talking to teens with eating disorders 

Resources/Links: 

• The American Psychiatric Association Practice Guideline for the Treatment of Patients with Eating Disorders, 2023, https://doi.org/10.1176/appi.books.9780890424865. 

Laurie L. Hornberger, Margo A. Lane, THE COMMITTEE ON ADOLESCENCE, Laurie L. Hornberger, Margo Lane, Cora C. Breuner, Elizabeth M. Alderman, Laura K. Grubb, Makia Powers, Krishna Kumari Upadhya, Stephenie B. Wallace, Laurie L. Hornberger, Margo Lane, MD FRCPC, Meredith Loveless, Seema Menon, Lauren Zapata, Liwei Hua, Karen Smith, James Baumberger; Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics January 2021; 147 (1): e2020040279. 10.1542/peds.2020-040279

Links:

https://doi.org/10.1176/appi.books.9780890424865

About the Speaker:

Host: Sam Baldazo, MD – Sam Baldazo, MD completed his pediatric residency at UVA, where he was involved with the wellness committee and process improvement initiatives. He is currently a Hospice and Palliative Care Fellow.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

• Know what organisms you want to treat
  • Because we often treat empirically, we need to know organisms that typically case this typical infection
  • Narrow-spectrum antibiotics if possible
• Anatomy of the infection
  • For fever in first 4-6 weeks, think about organisms that infant was exposed to during pregnancy and delivery
  • For respiratory infections, think about organisms that live in the respiratory tract
  • Abnormal anatomy
• Immunization status of child may change your differential diagnosis
• Drug allergies
  • Look in medical record and ask patient and family about allergies
  • Consider cross-reactivity of antibiotics
• Geographic location: resistance patterns
• Individual circumstances
  • Chronic diseases
  • Environmental exposures

Resources/Links:

Up to date: uptodate.com  

American Academy of Pediatrics Red Book: https://publications.aap.org/redbook?autologincheck=redirected 

Sanford Guide to Antimicrobial therapy: https://www.sanfordguide.com/products/print-guides/?gad=1&gclid=CjwKCAjwtuOlBhBREiwA7agf1oWtsyBrx0OFaHxpG2ZpDTXYukd1JGs5R_ZpRWrECT_v0bqhboN15hoCijIQAvD_BwE

American Academy of Pediatrics clinical practice guideline: The Diagnosis and Management of Acute Otitis Media. 2013. https://publications.aap.org/pediatrics/article/131/3/e964/30912/The-Diagnosis-and-Management-of-Acute-Otitis-Media

Links:

https://publications.aap.org/redbook?autologincheck=redirected
https://www.sanfordguide.com/products/print-guides/?gad=1&gclid=CjwKCAjwtuOlBhBREiwA7agf1oWtsyBrx0OFaHxpG2ZpDTXYukd1JGs5R_ZpRWrECT_v0bqhboN15hoCijIQAvD_BwE
https://publications.aap.org/pediatrics/article/131/3/e964/30912/The-Diagnosis-and-Management-of-Acute-Otitis-Media

About the Speaker:

Host: Rachel Moon, MD – Rachel Moon, MD is the Harrison Distinguished Professor of Pediatrics at UVA Health Children's. She is an internationally recognized researcher in sudden unexpected infant death and chairs the AAP Task Force on SIDS. She is also the Chief of General Pediatrics at UVA.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

1)    References to look up pediatric drug doses and frequencies.

2)    Calculating weight-based doses

3)    Maximum daily doses

4)    Different formulations of medications

5)    Prescribing oral medicines

1.   Pills vs Liquid
2.   Consider taste
3.   Use the most concentrated suspension
4.   Use milliliters instead of spoonfuls

6)    What if the medicine is not available in liquid form

7)    Options if oral medications are not easily available in liquid form.

8)    Medicine dosing frequency – use the least frequent option

9)    Acetaminophen and Ibuprofen

Resources/Links:

Up to date: uptodate.com  

Harriet Lane Handbook: https://evolve.elsevier.com/cs/product/9780323876988?role=student

Lexi-Comp: https://apps.apple.com/ca/app/lexicomp/id313401238

Links:

https://evolve.elsevier.com/cs/product/9780323876988?role=student
https://apps.apple.com/ca/app/lexicomp/id313401238

About the Speaker:

Host: Rachel Moon, MD – Rachel Moon, MD is the Harrison Distinguished Professor of Pediatrics at UVA Health Children's. She is an internationally recognized researcher in sudden unexpected infant death and chairs the AAP Task Force on SIDS. She is also the Chief of General Pediatrics at UVA.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

1.   Definitions
2.   Interpretation vs translation
3.   Modes of interpretation
4.   When do I need an interpreter?

III.           Who should not serve as an interpreter?

1.   Non-certified team members
2.   Patient’s non-certified friends or community members
3.   Patient’s family members
4.   Getting started
5.   Verify preferred language
6.   Positions in the room
7.   Introductions, including of the interpreter and recording interpreter’s information
8.   Conducting the visit
9.   How long to speak before awaiting interpretation
10.   During the physical exam
11.   Teach-back method via interpreter
12.   Trouble-shooting
13.   When the patient declines interpreter services
14.   When you think the interpreter is misinterpreting
15.   When you have technical difficulties or ambient noise

VII.         At the end of the encounter

1.   Translating written patient materials
2.   Considering variable written and medical literacies
3.   Next steps and follow-up care

VIII.        After the visit

1.   Documentation of your use of interpreter services
2.   Verification of preferred language

Resources:

–         “Addressing Low Health Literacy and Limited English Proficiency,” American Academy of Pediatrics: https://www.aap.org/en/practice-management/providing-patient--and-family-centered-care/addressing-low-health-literacy-and-limited-english-proficiency/

–         “Guidelines for Use of Medical Interpreter Services,” Association of American Medical Colleges: https://www.aamc.org/media/24801/download

–         “Appropriate Use of Medical Interpreters,” American Academy of Family Physicians: https://www.aafp.org/pubs/afp/issues/2014/1001/p476.html

–         “Working effectively with an interpreter,” U.S. Department of Health and Human Services Office of Minority Health: https://thinkculturalhealth.hhs.gov/assets/pdfs/resource-library/working-effectively-with-interpreter.pdf

Links:

https://www.aap.org/en/practice-management/providing-patient--and-family-centered-care/addressing-low-health-literacy-and-limited-english-proficiency/
https://www.aamc.org/media/24801/download
https://www.aafp.org/pubs/afp/issues/2014/1001/p476.html
https://thinkculturalhealth.hhs.gov/assets/pdfs/resource-library/working-effectively-with-interpreter.pdf

About the Speaker:

Host: Irène Mathieu, MD, MPH, FAAP – Irène Mathieu, MD, MPH, FAAP is an Associate Professor of Pediatrics at UVA and core faculty at the Center for Health Humanities & Ethics. She is a primary care pediatrician, award-winning poet with four published collections, and a Fulbright Fellow who completed her residency at CHOP.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

• Why do we talk about safe sleep for infants?
• What causes infants to die suddenly and unexpectedly?
• Goals of safe sleep recommendations are to increase infant arousability and decrease asphyxiating environments
• Asking about sleep practices
• ABCs of safe sleep: Alone, Back, Crib

Safe sleep recommendations:

• Infants should be on their backs
• Infants should sleep on a firm, flat, noninclined sleep surface
• There should be no bedding, such as pillows, blankets, bumper pads, stuffed toys, or fur-like materials in the infant’s sleep area.
• The infant should be breastfed as much and for as long as possible.
• The infant should sleep in the parents’ room, close to the parent’s bed but on a separate surface designed for infants, ideally for at least the first 6 months of life.
• Couches, sofas, and padded armchairs are extremely dangerous places for infants to sleep.
• Offer a pacifier at sleep time
• Parents should stay smoke-free during pregnancy and after the infant is born.
• Parents should avoid alcohol, marijuana, opioids, and illicit drug use during pregnancy and after birth
• Infants should be fully immunized.
• Commercial sleep products are only safe if they are consistent with safe sleep recommendations
• Tummy time

 References:

1. Moon RY, Carlin RF, Hand I, American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics. 2022 Jul 1; 150(1):e2022057990. https://publications.aap.org/pediatrics/article/150/1/e2022057990/188304/Sleep-Related-Infant-Deaths-Updated-2022?autologincheck=redirected
2. Won’t my baby choke if they spit up when placed on their back to sleep? https://safetosleep.nichd.nih.gov/reduce-risk/back-sleeping

Links:

https://publications.aap.org/pediatrics/article/150/1/e2022057990/188304/Sleep-Related-Infant-Deaths-Updated-2022?autologincheck=redirected
https://safetosleep.nichd.nih.gov/reduce-risk/back-sleeping

About the Speaker:

Host: Rachel Moon, MD – Rachel Moon, MD is the Harrison Distinguished Professor of Pediatrics at UVA Health Children's. She is an internationally recognized researcher in sudden unexpected infant death and chairs the AAP Task Force on SIDS. She is also the Chief of General Pediatrics at UVA.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

• Sexual History - why it is important
• Confidentiality
• 5 Ps Framework 
  • Partners
  • Practices
  • Protection of STIs
  • Past history of STIs
  • Pregnancy Intention
• STI Screening and Treatment
• HIV screening algorithm

References:

5 Ps Framework: 

• https://www.cdc.gov/std/treatment/SexualHistory.htm

STI Screening and Treatment: 

• https://www.cdc.gov/std/treatment-guidelines/provider-resources.htm#MobileApp
• https://www.cdc.gov/std/treatment-guidelines/default.htm

HIV screening algorithm:

• https://stacks.cdc.gov/view/cdc/50872

Links:

https://www.cdc.gov/std/treatment/SexualHistory.htm
https://www.cdc.gov/std/treatment-guidelines/provider-resources.htm#MobileApp
https://www.cdc.gov/std/treatment-guidelines/default.htm
https://stacks.cdc.gov/view/cdc/50872

About the Speaker:

Host: Jennifer Louis-Jacques, MD, MPH – Jennifer Louis-Jacques, MD, MPH is an Associate Professor of Pediatrics specializing in Adolescent Medicine at UVA Health. She trained at Columbia/NYU and completed her fellowship at Boston Children's Hospital, with special interests in eating disorders and menstrual disorders.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

1. How to examine a baby/infant
2. How to examine a toddler/preschool aged child
3. Focused information on the ear exam/otoscopy
4. How to examine a school aged child/teen
5. Engaging older children in your exam
6. Focused information on the genitourinary exam 
7. Presenting your physical exam during oral presentation

Resources/Links:

1. Bates' Guide to Physical Examination and History Taking by Lynn Bickley (your pediatric clinics will generally have a copy)

2. https://batesvisualguide.com

Links:

https://batesvisualguide.com/
https://batesvisualguide.com

About the Speaker:

Host: Shakun Gupta, MD – Shakun Gupta, MD is an Associate Professor of Pediatrics and Associate Clerkship Director at the University of Virginia. She completed her residency at Lurie Children's Hospital/Northwestern and joined UVA in 2014, where she practices general pediatrics and pediatric hospital medicine.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

1. List of pediatric vaccines
2. How vaccines work
   1. Harmless piece of the pathogen that is enough to create immune response
   2. Explaining how vaccines work to parents
      1. Emphasis on protecting the community, not just one person
      2. Analogy of vaccine being like a software update
      3. Analogy of vaccine being like a flame retardant that stops a fire from spreading
      4. Analogy of vaccine being like an insecticide that stops bugs from spreading
3. Types of vaccines
   1. Live, attenuated vaccines – cannot be given to patients with immunocompromise
   2. Vaccines without live, attenuated pathogen – includes mRNA vaccines
   3. RSV vaccines
      1. Vaccine for older adults and pregnant adults
      2. Monoclonal antibody for infants
4. What you need to do before the visit
   1. Review the vaccine record
   2. Review the medical record for vaccine contraindications
5. What you should review with families before ordering the vaccines (including precautions and contraindications)
   1. Current or recent illness
   2. Allergies
   3. Problems with vaccines in the past
   4. Chronic disease
   5. History of intussusception, seizures, neurological problems
   6. History of blood transfusion, immunoglobulin or antiviral medications
   7. Pregnancy
6. Anticipatory guidance about vaccines
   1. Shared decision making
   2. Common side effects are a sign that vaccines are working
   3. Treatment of fever
7. How to handle vaccine hesitancy
   1. Recommend the vaccines
   2. Ask if they have questions that you can answer
   3. Provide reputable resources
   4. Helping older children with their anxiety about being vaccinated

REFERENCES/LINKS:

www.cdc.gov/vaccines

AAP Child and Adolescent Immunization Schedule by Age: https://publications.aap.org/redbook/pages/Immunization-Schedules?autologincheck=redirected

O’Shea P, John J, et al. Reframing the Conversation about Child and Adolescent Vaccines, January 2023, Frameworks Institute. https://www.frameworksinstitute.org/wp-content/uploads/2023/01/reframing-the-conversation-about-child-and-adolescent-vaccinations_Jan272023.pdf

Links:

http://www.cdc.gov/vaccines
https://publications.aap.org/redbook/pages/Immunization-Schedules?autologincheck=redirected
https://www.frameworksinstitute.org/wp-content/uploads/2023/01/reframing-the-conversation-about-child-and-adolescent-vaccinations_Jan272023.pdf

About the Speaker:

Host: Rachel Moon, MD – Rachel Moon, MD is the Harrison Distinguished Professor of Pediatrics at UVA Health Children's. She is an internationally recognized researcher in sudden unexpected infant death and chairs the AAP Task Force on SIDS. She is also the Chief of General Pediatrics at UVA.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

1. Before the Rotation
   1.  Reach out to your team..
   2. Understand what first day expectations are. 
   3. Peruse the patient list.
   4. Identify what study materials and resources will help you excel.
   5. Come ready to learn and have fun! 
2. How to Pre-round

1. Collect information on previous day and overnight events - includes talking with resident or night team, reading all notes from day prior
2. Review all vitals from past day
3. Review and calculate “Ins and Outs”
4. Review all labs
5. Check to see what medications, including PRN meds, your patient got
6. Introduce yourself to patient and family - get their input on how patient is doing 
7. Collect your thoughts, interpret your data, and formulate your assessment and plan for your presentation and note

1. How to Present a Patient on the inpatient wards service
   1. Begin with one liner
   2. Subjective: interval and overnight events
   3. Any patient or caregiver concern or question noted when you prerounded
   4. Ins and Outs
   5. Vital signs
   6. Head-to-toe physical exam
   7. Labs, microbiology, and radiology
   8. Assessment one-liner
   9. Plan
2. How to be an effective team member
   1. Touch base with a resident to run through your assessment and plan. 
   2. Show initiative
   3. Be honest and direct
   4. On rounds, listen to all patient presentations, not just your own
   5. Follow up on tasks for your patients (and other patients on the team) and make sure they are carried through
   6. Revisit your patients to keep them updated
   7. Write notes and ask for feedback on your notes

About the Speaker:

Host: Krista Roncone, MD – Krista Roncone, MD, FAAP completed her pediatric residency at the University of Virginia. She is a board-certified pediatrician with interests in humanitarian assistance, global health, and medical education.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

Before visit:

1. Review normal psychosocial development of adolescence
2. Review sexual maturity rating (SMR) (previously referred to as Tanner Staging) of adolescence 
3. Review past medical history, medications, vaccines, labs, prior concerns from previous visits, and their last well visit if available. 
4. Vital signs (including BP), height weight, BMI.
5. Any screening questionnaires (e.g., PHQ-9A)

During visit:

1. Introduce yourself; ask how they would like to be addressed
2. Review structure of visit, including genital exam and interviewing adolescent alone; importance of confidentiality
3. Direct questions to adolescent as much as possible
4. Concerns from adolescent/parent or from prior visits that require follow up or updates
5. Psychosocial screening: HEADSS (home, education/employment, activities, drugs, sexuality, suicide/depression/self-image, and safety) or SSHADESS (strength, school, home, activities, drugs/substance use, emotions/eating/depression, sexuality, and safety). NOTE: Some of this will be done during confidential interview. 
6. Nutrition: number of meals/snacks, dairy intake 
7. Sleep: nighttime and naps
8. Screen time: duration, type(s)
9. Dental: frequency of brushing, last seen by dentist
10. Menstrual history: Age of menarche, frequency, length of periods, heaviness of flow, symptoms associated with menses
11. Review medications, allergies, growth chart, vaccines
12. Confidential interview: any additional questions or concerns; Home, Drugs and substance use; Emotions, eating, and depression; Sexuality; Safety

Physical exam

1. Head to toe
2. Discuss acne
3. Need chaperone for breast and genital exam

Preparation for oral presentation 

About the Speaker:

Host: Serwa Ertl, MD – Serwa Ertl, MD is an Assistant Professor of Pediatrics specializing in Adolescent Medicine at UVA Health. She completed her residency at Connecticut Children's Medical Center and fellowship in adolescent medicine at Children's National Medical Center.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

Introduction

Socio-emotional state of parents

Before the visit, you should review

• Prenatal history
• Delivery history, gestational age
• Physical exam at time of birth
• Preventative treatments
• Course in newborn nursery or NICU
• Type of feeding
• Concerns for infection
• Bilirubin
• Screening tests

Newborn visit

• Parental questions and concerns
• Feeding history and any problems with feeding
• Elimination 
• Sleep and safe sleep
• Social history and parental support system
• Review of systems – irritability, fever, rashes. 

Normal newborn vital signs

Infant growth parameters and weight trajectory

Physical exam

• General
• Head size and shape
• Eyes – pupil shape, red light reflex, scleral icterus
• Cardiovascular – murmurs, capillary refill
• Respiratory
• Abdominal
• Genitourinary – testicles, hernias/hydroceles, circumcision, vaginal discharge
• Musculoskeletal-  clavicles, hip 
• Skin – jaundice, birthmarks, sacral dimples
• Neurological: tone, reflexes

Anticipatory guidance

• Fever
• Safe sleep
• Prevention of shaken baby syndrome
• Postpartum depression
• Appropriate feeding

Next follow up appointment depends on weight, bilirubin level

Resources/Links:

https://peditools.org/bili2022/ - resource for management of hyperbilirubinemia

Links:

https://peditools.org/bili2022/

About the Speaker:

Host: Augustin Casals, MD – Augustin Casals, MD completed his pediatric residency at the University of Virginia. He is now a practicing pediatrician in Los Angeles, California.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

Peds GI clinic covers a host of gastrointestinal, pancreatic, liver and nutrition issues

-3yr fellowship after peds residency 

Before Clinic 

• Review what types of patients you will be seeing. It may be a mix of lots of issues, or just a liver transplant clinic. This will tell you what type of prep you should do (conditions to read up on, medications to review, etc) before the day of clinic.
• On the day of clinic, review expectations with the attending, fellow or resident physician. Do they want you to see patient independently and write notes, just shadow or somewhere inbetween. Review what questions they always want asked, what exams you should do alone vs with your whole team. Setting expectations before you start will set you up for success! 
• Questions: Pain, the PQRST mnemonic is helpful to better understand the pain
  • Provoked the pain
  • Quality of the pain
  • Radiating
  • Severity 
• Specific questions to ask in Peds GI: 
  • Does pain wakes the patient at night? 
  • how much school or other activities the Patient has missed because of symptoms? 
  • Does defecation or passage of gas alleviates pain? 
  • Any specific dietary changes already tried?
• Poop! understand the:
  • Quality of the stool
  • Size and caliber of the bowel movement (Use Bristol stool scale)
• GERD vs EoE  
• A complete GI exam– a lot more than the abdomen!

About the Speakers:

Host: Rachel Moon, MD – Rachel Moon, MD is the Harrison Distinguished Professor of Pediatrics at UVA Health Children's. She is an internationally recognized researcher in sudden unexpected infant death and chairs the AAP Task Force on SIDS. She is also the Chief of General Pediatrics at UVA.

Host: Jeremy Middleton, MD – Jeremy Middleton, MD is an Associate Professor of Pediatrics and Pediatric Gastroenterologist at UVA Health. He serves as the Pediatrics Clerkship Director and has expertise in children with intestinal failure and aerodigestive disorders.

Host: Shakun Gupta, MD – Shakun Gupta, MD is an Associate Professor of Pediatrics and Associate Clerkship Director at the University of Virginia. She completed her residency at Lurie Children's Hospital/Northwestern and joined UVA in 2014, where she practices general pediatrics and pediatric hospital medicine.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

About the Speakers:

Host: Rachel Moon, MD – Rachel Moon, MD is the Harrison Distinguished Professor of Pediatrics at UVA Health Children's. She is an internationally recognized researcher in sudden unexpected infant death and chairs the AAP Task Force on SIDS. She is also the Chief of General Pediatrics at UVA.

Host: Jeremy Middleton, MD – Jeremy Middleton, MD is an Associate Professor of Pediatrics and Pediatric Gastroenterologist at UVA Health. He serves as the Pediatrics Clerkship Director and has expertise in children with intestinal failure and aerodigestive disorders.

Host: Shakun Gupta, MD – Shakun Gupta, MD is an Associate Professor of Pediatrics and Associate Clerkship Director at the University of Virginia. She completed her residency at Lurie Children's Hospital/Northwestern and joined UVA in 2014, where she practices general pediatrics and pediatric hospital medicine.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

• Nursery orientation: family expectations and goals of the healthcare team, expected length of stay
• History 
  • Maternal History:
    • Gs and Ps
    • Prenatal Care: prenatal labs and ultrasounds
    • Past Medical History & medications
    • Social situation/support
  • Baby History:
    • Gestational Age
    • Delivery type and why, resuscitation efforts and complications
    • Growth parameters
• The complete newborn exam: head to toe
• During the newborn stay:
  • Ins and Outs
  • Medications and vaccines
  • Routine screening labs and tests
  • Parental discharge education 
  • Discharge criteria and follow up

About the Speaker:

Host: Shakun Gupta, MD – Shakun Gupta, MD is an Associate Professor of Pediatrics and Associate Clerkship Director at the University of Virginia. She completed her residency at Lurie Children's Hospital/Northwestern and joined UVA in 2014, where she practices general pediatrics and pediatric hospital medicine.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

Essential Resources

 Podcasts:

• Clerkship Ready-Pediatrics
• Charting Pediatrics - Weekly podcast with lots of bread-and-butter pediatrics discussed. 
• Pediatrics on Call - The most recent research and the newest policy updates from the American Academy of Pediatrics. 

Books:

• Red Book (also an app for AAP members) - the definitive source for pediatric infectious diseases. 
• Harriet Lane Handbook (also an app) - has drug doses, commonly used charts, and algorithms.  

Websites:

• Peditools for bilirubin 
• Uptodate
• CDC website is a great source for vaccine guidelines

Apps:

• PedsScripts App: specifically to work on illness scripts

General Tips and Tricks:

• Be Proactive
• Know what the expectations are. 
• Become familiar with the electronic medical record system. 
• Be Self-sufficient, but ask for help when appropriate. 
• Know when you should come in to round, who to pre-round on, and where to meet.  Pair up with an intern to pre-round.
• Ask for feedback.  

Pediatric-specific Tips and Tricks:

• Pediatrics is different from any other rotation. 
• Huge range of ages and developmental stages.
  • At every age, children act differently - and you need to adjust appropriately.
  • If you can, get as much of the history from the child, but you will likely need to supplement that with history from the parent or guardian. 
  • When you do your physical exam on younger children, have to adjust the order of exam  
  • Vital signs change with age. Look up or ask about what is a normal vital sign in the age you are seeing. 
  • Check weight, length/height and/or head circumference and report both percentiles and trends.
  • If an infant has been born prematurely, correct growth and development for gestational age. 
  • Fluids and medication are dosed per kilogram. 
• Family-centered rounds are a unique, important part of pediatrics. The goal is to get both the team and family up to date on the patient’s diagnosis and overall course, and to formulate a plan for the day together with the family.  
  • Brief summary and plan outside of the patient room. 
  • Invite family to participate. 
  • Conversational language with no medical jargon. 
  • Be concise and clear. 

About the Speakers:

Host: Rachel Moon, MD – Rachel Moon, MD is the Harrison Distinguished Professor of Pediatrics at UVA Health Children's. She is an internationally recognized researcher in sudden unexpected infant death and chairs the AAP Task Force on SIDS. She is also the Chief of General Pediatrics at UVA.

Host: Jeremy Middleton, MD – Jeremy Middleton, MD is an Associate Professor of Pediatrics and Pediatric Gastroenterologist at UVA Health. He serves as the Pediatrics Clerkship Director and has expertise in children with intestinal failure and aerodigestive disorders.

Host: Shakun Gupta, MD – Shakun Gupta, MD is an Associate Professor of Pediatrics and Associate Clerkship Director at the University of Virginia. She completed her residency at Lurie Children's Hospital/Northwestern and joined UVA in 2014, where she practices general pediatrics and pediatric hospital medicine.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.