Charting Pediatrics

We all know what it feels like to have a headache, but each person can experience that intensity for dozens of different reasons. Globally, headache disorders affect approximately 40% of the population, which is about 3.1 billion people. Headaches are also among the three most common neurological conditions for most age groups starting at age 5.

As such a ubiquitous issue, it's important for providers to understand, diagnose and treat headaches. What are the most common reasons for headaches in children? How should pediatricians know when a headache is more than surface-level discomfort?

To learn about the latest in pediatric headaches, we are joined by two headache experts, Marcy Yonker, MD, and Angelina Koehler, NP. Dr. Yonker is the Director of the Headache Program at Children's Colorado and the Dale, Cindy and Kristin Francescon Endowed Chair for Headache Treatment with the University of Colorado Department of Pediatrics. Angelina Koehler is a certified pediatric nurse practitioner in the Neuroscience Institute at Children's Colorado.

Some highlights from this episode include:

• What PCPs should take into account about migraines
• How to approach headache treatment options
• What to consider with hesitation around certain medications
• When to look for signs of a more serious illness

For more information on Children's Colorado, visit: childrenscolorado.org.

For almost 50 years, Dr. Fritz Karrer has been wearing a surgeon's cap, growing as a surgeon alongside the evolution of his specialty. For 40 of those 50 years, he's been at Children's Hospital Colorado, making an everlasting impact on kids and their families. On the brink of retirement, we look at his exemplary career and discuss how he's watched firsthand the progression of pediatric surgery. His half century of perspective makes him the perfect expert to dive into the growth of pediatric surgery.

Dr. Karrer specializes in pediatric surgery and surgical critical care at Children's Colorado and is a Professor of Pediatric Surgery at the University of Colorado School of Medicine. He's also a colonel in the U.S. Army Reserve, he was recognized as a top doctor in 2023 by 5280 Magazine and he's been awarded the James Strain Award and the Military Medical Merit from the U.S. Army.

Some highlights from this episode include:

• The incredible journey of Dr. Karrer's career
• The ways pediatric surgery has evolved over the last 50 years
• The influence of technology on pediatric surgery
• Advice for young doctors wanting to follow a similar path

For more information on Children's Colorado, visit: childrenscolorado.org.

More than 50% of rural counties in the United States do not have a pediatrician, and more than 80% of counties lack access to healthcare services that are simply needed to maintain the health of their population. The medical experts in those areas are lifelines to their communities. They are providing essential care, approaching resource and access challenges with creativity and innovation, and connecting kids to specialists when needed. Area codes can determine as much about health and life expectancy as issues like genetic predisposition and lifestyle.

Our two guests are doing this work in rural communities every day. Kelly Miller, MD, is a general pediatrician with Pediatric Partners of the Southwest in Durango, CO. Anna Mack, DNP, FNP, is a family nurse practitioner with Peak Vista Community Health Centers in Colorado Springs. She is also faculty at a post-graduate training advanced practice registered nurse fellowship program.

Some highlights from this episode include:

• What are the primary challenges for providers in rural pediatrics
• How experts are overcoming rural mental health hurdles for kids
• Ways providers are using innovative solutions for issues they face in rural areas
• How more urban and rural organizations can work toward stronger partnerships

For more information on Children's Colorado, visit: childrenscolorado.org.

Running is an increasingly popular sport, with high school track and field programs seeing booming participation rates. With rising interest comes more cases of injury, however, incredible sports medicine advancements and programs are helping young runners manage and prevent injuries.

To break down the most common running-related injuries in youth and discuss comprehensive approaches to prevention and recovery, we are joined by three Children's Hospital Colorado experts. Aubrey Armento, MD is a sports medicine physician, Medical Director of the Runners Clinic for Young Athletes, and an assistant professor of Orthopedics at the University of Colorado School of Medicine. Amanda McCarthy is a program coordinator of sports nutrition and a registered sports dietician. Cameron (Cody) Yeaman, DPT, is a sports physical therapist and a certified specialist in orthopedic sports and strength and conditioning.

Some highlights from this episode include:

• What to know about new diagnoses in young runners
• What there is to be learned from dissecting a case study
• How patients and families benefit from a variety of specialists at the Runners Clinic
• How pediatricians can understand and tap into an athlete mentality to gain buy-in from their patients.

For more information on Children's Colorado, visit: childrenscolorado.org.

For some, COVID-19 may seem like a thing of the past, but for medical professionals, the data regarding post-acute sequalae of COVID infection is only just emerging. Four years ago, the start of the pandemic left doctors puzzled by certain symptoms. Today, we are learning more about the long-term impacts of SARS-CoV-2 in children, often called long COVID or PASC. As the population continues to struggle with persistent and debilitating after-effects and symptoms, we are looking for answers.

To provide insight into this important diagnosis, we are joined by Suchitra Rao, MD. She is an infectious disease specialist at Children's Hospital Colorado, as well as the Associate Medical Director of Infection Prevention and Control. She is also an associate professor of Pediatrics within the sections of Infectious Diseases, Epidemiology, and Hospital Medicine at the University of Colorado School of Medicine.

Some highlights from this episode include:

• The epidemiology of long COVID in kids
• The difference between the data in adults and children
• A discussion of how to diagnose asymptomatic patients
• A closer look at Dr. Rao's groundbreaking research

For more information on Children's Colorado, visit: childrenscolorado.org.

Inflammatory bowel disease, otherwise known as IBD, is an illness pediatric providers need to consider when they see kids with abdominal pain, diarrhea or weight loss. IBD can present in a fairly straightforward way, or it can be incredibly challenging to diagnose. We've seen improvements in IBD diagnosis and care recently, including new screening tools and medications, as well as future treatments currently under investigation. Getting these medications to kids can be a challenge since pharmaceutical companies focus on adult indications and pediatric clinical research can sometimes lag. That delays access to some of the best therapies.

One of our experts in IBD at Children's Hospital Colorado is our guest for this episode, Edwin De Zoeten, MD. He is the director of the Pediatric Inflammatory Bowel Disease Center, and is the Hoover Family Endowed Chair for Digestive Health and Nutrition. He is a professor of Pediatrics at the University of Colorado school of Medicine and has a basic science research lab focused on better understanding the pathophysiology of IBD and looking at new treatment opportunities.

Some highlights from this episode include:

• Understanding what symptoms look like and how early they can begin
• Looking at the underlying pathophysiology that triggers IBD
• Sharing tools pediatricians can use for diagnosing and treating IBD
• Discussing the durability of treatments and benefits over time

For more information on Children's Colorado, visit: childrenscolorado.org.

In simple terms, bioethics is the study of ethical, social and legal issues that arise in biomedicine and biomedical research. It provides guidelines for clinical decision-making and is vital to policy change. Despite standards set by medical entities, significant gaps and variabilities exist within bioethics education for pediatric residents. Every resident will face ethical challenges in their career, so it's important that programs prepare learners to navigate these dilemmas. To address these inconsistencies, a chief resident at the University of Colorado School of Medicine has created a new curriculum that could significantly improve our bioethics education.

Joining us for this episode is Ella Sorscher, MD, Brian Jackson, MD, and Brady Slater. Dr. Sorscher is a pediatrics chief resident at the University of Colorado School of Medicine and is one of the brains behind this new bioethics curriculum. Dr. Jackson is the Medical Director of Clinical Ethics and specializes in critical care as a pediatric intensivist at Children's Hospital Colorado. He is also an associate professor at the University of Colorado School of Medicine. Dr. Slater is a pediatrics and medical genetics resident at the CU School of Medicine.

Some highlights from this episode include:

• Details about this curriculum
• The significance of bioethics in a physician's career
• Information on assessing learners and evaluating the curriculum
• Opportunities for other institutions to learn from this model

For more information on Children's Colorado, visit: childrenscolorado.org.

Earlier this year, new guidelines were released to improve the diagnosis of pediatric sepsis and septic shock. For the first time, the novel Phoenix Sepsis Criteria provides an objective and data-driven approach to aid in the identification of these life-threatening conditions, including prediction of mortality in children with suspected or confirmed infection. Sepsis is one of the leading causes of death among children worldwide, and these guidelines could be a major step in changing outcomes.

To help us understand these guidelines and apply them to your practice, we are joined by two experts who have been at the forefront of this new research. Tell Bennett, MD, specializes in pediatric critical care at Children's Hospital Colorado. He is the Vice Chair of Clinical Informatics, as well as a professor of biomedical informatics and pediatrics at the University of Colorado School of Medicine. Halden Scott, MD, is the Director of Research for the section of emergency medicine at Children's Colorado. She is also an associate professor of pediatrics at the University of Colorado School of Medicine.

Some highlights from this episode include:

• How to diagnosis sepsis under the new guidelines
• How these criteria can be applied to primary care practices
• What treatment options are and why time is of the essence

For more information on Children's Colorado, visit: childrenscolorado.org.

Newborn screening has expanded dramatically over the last decade as our detection methods improved and new treatments became available for rare diseases. One of those rare diseases is adrenoleukodystrophy, otherwise known as ALD. ALD is an example of a rare disease where, thanks to expansions in newborn screenings, we are now able to make a precise genetic diagnosis very early in life and offer therapies far in advance of the onset of symptoms. Early detection and treatment of this can potentially spare a family a lifetime of devastating health impacts. In December 2013, New York became the first state to require newborn screening for ALD. Currently, 43 states and Washington, D.C. are testing babies for ALD.

To help us understand the role of newborn screening, we are joined by Kevin Ess, MD. He is the Ponzio Family Chair of pediatric neurology and is the section head of neurology at Children's Hospital Colorado. He is also a professor of pediatrics at the University of Colorado School of Medicine.

Some highlights from this episode include:

• The pathophysiology of ALD.
• The clinical manifestations of ALD that make it the perfect model for newborn screening.
• The specifics of diagnosing and treating ALD.
• The long-term impact newborn screening can have for the lifetime of children with ALD.

For more information on Children's Colorado, visit: childrenscolorado.org.

Artificial intelligence (AI) has the potential to transform healthcare and disrupt the field of medicine in significant ways. We have already seen remarkable progress in areas such as diagnostics and data analysis, but what could broader use in patient care looks like? A little over a year ago, the arrival of ChatGPT got everyone talking about AI — how realistic it is, how well it understands certain concepts and, specifically in medicine, how it can benefit our care systems. In this episode, we explore the overarching needs for AI in pediatrics and medical education, as well as where we stand in implementing it.

We are joined by two guests from Children's Hospital Colorado who are leading the way in understanding how AI could be incorporated into pediatric care. Jim Barry, MD, specializes in neonatal/perinatal medicine at Children's Colorado and is an associate professor of pediatric neonatology at the University of Colorado School of Medicine. He is also the Medical Director of the UC Health NICU. He co-founded NeoMIND-AI, a learning collaborative for neonatologists and data scientists interested in AI within neonatal and pediatric critical medicine. Sarah Milla, MD, specializes in pediatric radiology and is the John D. Strain Endowed Chair for Radiology, Chief of Pediatric Radiology and Vice Chair of Radiology at Children's Colorado and the University of Colorado School of Medicine. She is also a visiting professor.

Some highlights from this episode include:

• Examples of how AI is currently being used in medicine
• Ways providers can get started with AI
• Ideas on how we can advance care in the future with this tool

For more information on Children's Colorado, visit: childrenscolorado.org.