Charting Pediatrics

Tics are common in childhood, but recognizing when they are part of typical development, and when they may indicate Tourette syndrome or another tic disorder, can be challenging for pediatricians. A child repeatedly blinks during a well visit. A parent mentions a new throat-clearing sound that has been happening for weeks. Soon comes the question pediatricians hear often: "Should I be worried?"

In this episode, we take a closer look at tics and Tourette syndrome, helping pediatricians distinguish common childhood tics from situations that may warrant further evaluation. We'll explore the natural history of tic disorders, common co-occurring conditions, and practical strategies for counseling and supporting families.

Joining us for this conversation is Chelsey Stillman, PA-C, a physician assistant at Children's Colorado and the creator and director of the Integrative Tic Clinic. She is also an Assistant Professor of Pediatrics.

Some highlights from this episode include:

• What tics are and how common they are in children
• The natural history and typical course of tic disorders
• The differences between transient tics, chronic tic disorders, and Tourette syndrome
• Common conditions that can co-occur with tic disorders

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

When adults look back on school, they often remember more than lessons and worksheets. They remember recess — the playground, movement, friendships, laughter and freedom. Yet in many schools today, recess can be one of the most negotiable parts of the school day. It may be shortened, delayed or withheld in favor of academics, structure or behavior management. But research continues to show that recess is far more than a break. Regular opportunities for play and movement support children's physical health, mental well-being, social development, and ability to learn. Pediatricians are uniquely positioned to keep play, movement and recess part of the conversation about child health.

We're joined by two experts from Children's Hospital Colorado: Amanda Lopez, a school health nurse, and Eve Kutchman, a prevention education and outreach manager. Together, they share insights into the role of recess in children's health and development and how pediatricians can advocate for making play a priority.

Some highlights from this episode include:

• The health benefits of recess that go beyond a "break" from learning
• How movement and play support children's physical, emotional and social health
• What children may lose when recess is shortened, delayed or withheld
• How health care professionals can help keep recess visible in conversations about child health

This episode is underwritten by Ovintiv, proud philanthropic supporter of Charting Pediatrics and the Children's Hospital Colorado Foundation. Ovintiv recognizes that their responsibility begins in the communities where they live and work. They are committed to giving back and building safer and more resilient communities. Ovintiv's generous support has made a monumental difference for our patients and families, from enhancing health outcomes to reducing health disparities.

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

Some of the most serious diagnoses in pediatrics begin with common pediatric symptoms. A child comes in looking pale or with a febrile illness. They've been more tired than usual. Maybe they're bruising easily or complaining their legs hurt. Individually, none of these symptoms are unusual. Together, or with persistence, they can tell a different story. Leukemia is the most common childhood cancer, but it's earliest signs often resemble everyday illnesses.

The episode introduces Ashley Rogers, MD, a pediatric oncologist at Children's Hospital Colorado and faculty member at the University of Colorado School of Medicine, as the newest host of Charting Pediatrics. As David Brumbaugh concludes his remarkable nine-year tenure as host, he passes the microphone to Dr. Rogers, ushering in the next chapter of the podcast.

Dr. Rogers joins the conversation to share her expertise on childhood leukemia, including key considerations for diagnosis, treatment and the pediatrician's role in recognizing and managing these patients. This episode offers both valuable clinical insights and a warm welcome to a new voice who will continue bringing evidence-based pediatric education to listeners.

Some highlights from this episode include:

• Earliest signs of leukemia pediatricians can look out for
• How to distinguish between viral illnesses or leukemia
• Red flags that shouldn't be dismissed
• Role of the pediatrician after a leukemia diagnosis

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

Tick bites used to be a seasonal nuisance, something you might mention briefly at a well visit in late spring. But that's no longer the reality. With emergency department visits for tick bites climbing to their highest levels in nearly a decade and tick populations expanding into new regions, pediatricians are now seeing the ripple effects of a changing environment in real time. In this episode, we break down what's driving this surge, how to approach tick bites in clinic, and what's new in our understanding of tick-borne illness — including important updates on alpha-gal syndrome that every clinician should have on their radar.

In this episode, we are joined by tick expert, Justin Searns, MD. He specializes in pediatric infectious diseases and hospital medicine at Children's Hospital Colorado. He is also an associate professor at the University of Colorado School of Medicine.

Some highlights from this episode include:

• Why tick bites are currently at an all-time high
• Best practices for tick removal and immediate post-removal care
• When tick-borne illnesses should be a concern for pediatricians
• Prevention strategies and geographical considerations

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

Puberty doesn't always follow the expected timeline. What happens when it shows up ahead of schedule? For pediatricians, the early appearance of breast development, pubic hair or accelerated growth can trigger a cascade of questions. Is this a normal variant? Should we investigate further? When is it time to refer? In this episode, we unpack the complexities of precocious puberty and explore how timely identification and thoughtful management can make a lasting difference for kids and their families.

To create clarity, we are joined by Stephanie Hsu, MD, PhD, and Clare Parker, MD. Dr. Hsu specializes in endocrinology here at Children's Hospital Colorado and is an associate professor at the University of Colorado School of Medicine. Dr. Parker is a pediatric endocrinology fellow.

Some highlights from this episode include:

• The differences in early puberty between boys and girls
• Environmental impacts that can lead to misleading results
• Signs and symptoms pediatricians can look out for
• Treatment options and their severity

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

A child's future begins long before the first words, first steps or even the first smile. In the span of just 1,000 days, billions of neural connections are formed, and the foundation for lifelong health, learning, and resilience quietly takes shape. Pediatricians understand the critical nature of early development, and they translate that message to parents, helping guide, nurture, recognize risk and shape outcomes that can last decades.

To explore this fascinating time in a child's life, we are joined by two experts. Caroline Dias, MD, PhD, and Annie Helms, MD, both specialize in developmental and behavioral pediatrics here at Children's Hospital Colorado and are assistant professors at the University of Colorado School of Medicine. Dr. Helms also leads the BLOSSOM Clinic at Children's Colorado.

Some highlights from this episode include:

• How small things can have the biggest impact in these 1000 days
• The importance of supportive caregivers
• The balance of nature versus nurture
• Easing parent's minds that they aren't "doing enough"

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

The human spine is designed to support, balance and adapt through a lifetime of growth. But what happens when that growth starts to bend in an unexpected direction? Scoliosis often emerges during periods of rapid development, turning what should be a normal growth spurt into a race against progression. The challenge isn't just finding the curve. It's predicting what that curve will do next.

To explore the latest in scoliosis care, we are joined by Mark Erickson, MD. He specializes in orthopedic surgery and is the Medical Director of the spine center at Children's Hospital Colorado. He is a professor at the University of Colorado School of Medicine as well as the fellowship director of pediatric orthopedic surgery.

Some highlights from this episode include:

• How and when scoliosis most commonly presents in children
• What pediatricians can look for during a routine exam
• Particular red flags in the history or physical exam that should cause concern
• How pediatricians should determine who needs imaging

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

When most people hear the word "discipline", they think consequences, punishments or stopping bad behavior in the moment. But what if we've been thinking about discipline too narrowly? We are reframing discipline in toddlers through a completely different lens. One rooted in connection, development and emotional regulation. Because toddler "misbehavior" isn't usually about manipulation or defiance. More often, it's communication.

To help us create developmentally appropriate expectations, we are joined by two experts. Julia Palozzi, PsyD, specializes in child psychology here at Children's Hospital Colorado and is an instructor at the University of Colorado School of Medicine. Alyson Hatten, MS, is a Licensed Professional Counselor, specializing in child counseling as well as infant and early childhood mental health. She also is an assistant professor.

Some highlights from this episode include:

• Reframing what children can't do into what they can do
• Why allowing emotional dysregulation is critical to a child's development
• Setting developmentally appropriate expectations
• Discipline strategies and how pediatricians can guide families to utilize them

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

It's one of the most unsettling calls a pediatrician can get: a baby who turned blue, stopped breathing or suddenly went limp, only to appear completely normal moments later. Welcome to the clinical gray zone of BRUE (Brief Resolved Unexplained Event). It sits at the intersection of alarm and ambiguity, where the history is often dramatic, but your clinical exam is reassuring. We are going to go beyond the definition and into real-life decisions that you have to make on the phone and in the office. From risk stratification to avoiding unnecessary testing, we break down what actually matters in the moment and what doesn't.

This episode was recorded during a live podcast event in Colorado Springs with Michael DiStefano, MD, and Jamie Hug, DO. Dr. DiStefano is the Chief Medical Officer of Children's Hospital Colorado, Colorado Springs, and a pediatric emergency medicine physician. Dr. Hug is a pediatrician in Southern Colorado at the Children's Clinic of Pueblo.

Some highlights from this episode include:

• What is considered a BRUE
• When to refer to the emergency department
• How pediatricians can reassure families and validate their experiences
• Why history is so critical to the exam

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

For many families, water represents joy, summer afternoons, swimming lessons, beach vacations, backyard pools and time spent together. But in pediatrics, we also know that water can become dangerous in seconds, often quietly and without warning. Drowning remains one of the leading causes of preventable death in children, and recent updates from the American Academy of Pediatrics reinforce that prevention must be layered, proactive and tailored. In this episode, we explore how pediatricians can support drowning prevention, because some of the most important work in pediatrics happens long before an emergency occurs.

We are joined by Jason Woods, MD. He specializes in emergency medicine at Children's Hospital Colorado and is the Associate Program Director of the Pediatric Emergency Medicine Fellowship Program at the University of Colorado School of Medicine. He is also an associate professor.

Some highlights from this episode include:

• The AAP guidelines and toolkit details about drowning prevention
• Why the definition of drowning has changed and why that matters
• How drowning prevention is layered
• The role of the pediatrician in feeling confident to counsel families on this topic

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