Charting Pediatrics

What if the patient you're least worried about is the one most at risk? In pediatrics, we're trained to look for red flags such as low weight, failing growth curves and visible signs of malnutrition. But atypical anorexia challenges that instinct. These patients may sit comfortably on the growth chart, or even above it, while experiencing the same dangerous behaviors and medical instability as those with classic anorexia. In this episode, we rethink what we've been taught to look for. We explore how atypical anorexia presents, why it's so often missed and what it takes to recognize the warning signs hiding beneath the surface.

To discuss this important topic, we are joined by Kimberly Sheffield, PhD. She is an eating disorders psychologist at Children's Hospital Colorado, as well as the clinical director of PMHI day programs, and the associate training director for psychology training.

Some highlights from this episode include:

• The differences between atypical anorexia and low weight anorexia
• How pediatricians can make sure these kids are properly identified
• The impact of behavior on their actions
• How parents or family members involvement can make a difference

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

Heart murmurs are one of the most common findings in pediatric practice, but determining which ones warrant further evaluation can be challenging. While many murmurs are innocent, others may signal underlying structural heart disease and require timely referral and management.

In this episode, we discuss how pediatricians can approach the evaluation of heart murmurs, including key features of the child's history and physical exam that help distinguish benign murmurs from those that may be pathologic. We also explore how factors can influence what you hear through your stethoscope.

Joining us is Christopher Rausch, MD, pediatric cardiologist and Director of the Cardiac Developmental Outcomes Program at Children's Hospital Colorado. He is also a professor at the University of Colorado School of Medicine. Dr. Rausch shares practical insights to help pediatricians feel more confident in evaluating murmurs, identifying red flags, and knowing when referral is appropriate.

Some highlights from this episode include:

• How to differentiate the sound of a murmur
• The biggest differences between a murmur during the first few days of life and as a teenager
• How common it is for children to experience a murmur during their developmental years
• Counseling families and deciphering fact versus fear

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

Ebola has a way of cutting through the noise of the news cycle. Its name alone can shift conversations in exam rooms and on living room couches. But what's circulating in headlines is not always what's circulating in reality. For pediatricians, that gap matters. In this episode, we break down what's actually happening right now with Ebola, what is known about current risk and how clinicians can respond when families arrive with urgent questions shaped more by media than by medicine.

To guide us through the science, we are joined by Sam Dominguez, MD, PhD. He is the Medical Director of the Clinical Microbiology Laboratory, as well as the Associate Medical Director of Infection Control and Prevention at Children's Hospital Colorado. He is a professor at the University of Colorado School of Medicine.

Some highlights from this episode include:

• The current status of Ebola in Africa
• How difficult it is to contract Ebola
• The role of the pediatrician in screening patients who are traveling from other countries
• How pediatricians can ease minds while also promoting the facts

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

There's a moment in a pediatrician's day that doesn't show up on the schedule. It's the bruise that doesn't quite match the story, or the awkward pause after a parent answers a question just a little too quickly or the child who won't make eye contact or let go of your sleeve. In these moments, pediatricians become more than clinicians. They become interpreters, advocates and sometimes the only line of protection.

To help us understand the latest on child abuse, we are joined by Denise Abdoo, PhD, CPNP. Dr. Abdoo is a pediatric nurse practitioner who specializes in child abuse and neglect. She is also an associate professor at the University of Colorado School of Medicine.

Some highlights from this episode include:

• What's changed in treating child abuse over the last decade
• The impact of social media on child abuse
• The most easily missed signs in a pediatric visit
• Recent changes in laws, reporting and expectations

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

When a rare disease suddenly dominates headlines, questions spread quickly and so does anxiety. Over the past few weeks, hantavirus has re-entered the national conversation, leaving many families wondering how concerned they should be. For pediatricians, moments like this can be challenging as they balance public concern with clinical reality, and help families navigate information that is often incomplete, alarming or misleading. In this episode, we take a closer look at hantavirus through an evidence-based pediatric lens including what it is, how transmission occurs, who is truly at risk and what clinicians should know when these questions inevitably enter the exam room.

To create clarity, we are joined by Samuel Dominguez, MD, PhD and Justin Searns, MD. Dr. Dominguez is the Medical Director of the Clinical Microbiology Laboratory, as well as the Associate Medical Director of Infection Control and Prevention at Children's Hospital Colorado. Dr. Searns specializes in pediatric infectious diseases and hospital medicine. Both of these experts teach at the University of Colorado School of Medicine.

Some highlights from this episode include:

• Differentiating the types of hantaviruses based on rodent and region
• Outlining the current status of the cruise ship outbreak
• Tips and tricks for talking with worried families
• The potential impact on patients

• Hantavirus Pulmonary Syndrome: CDC
• "Super-Spreaders" and Person-to-Person Transmission on Andes Virus in Argentina: The New England Journal of Medicine

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

Pediatric urinary tract infections, or UTIs, don't always follow a script. While they're one of the most common diagnoses, they're also one of the most nuanced. They can be subtle, inconsistent and easy to over — or under — diagnose. Aside from clear urinary symptoms, they can show up as a fever without a source, vague abdominal pain, new incontinence or a child who simply isn't acting like themselves. And in those moments, the decisions pediatricians make such as who to test, how to collect a sample or how to interpret results, carry real clinical weight.

To dive into this topic, we are joined by Kevin Olson, PA, and Meghan Rommel, NP, who practice in the Department of Pediatric Urology at Children's Hospital Colorado.

Some highlights from this episode include:

• The challenges of diagnosis and the importance of getting it right
• How UTIs present differently across ages
• When to use antibiotics versus when more discovery is needed
• Approaching recurrent UTIs in children

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

Genetic testing is no longer a distant, specialized tool reserved for rare disease clinics or academic centers. It's showing up in pediatric practice. For example, pediatricians are increasingly considering genetic diagnoses in children with developmental delays outside the normal range. A NICU graduate may already carry a genetic diagnosis when they see their pediatrician after discharge. What does the practicing pediatric provider need to understand about ordering and interpreting genetic tests? In this episode, we unpack how community pediatricians can make sense of the world of genomics.

Joining us for this robust conversation are Austin Larson, MD, and Margarita Saenz, MD. Dr. Larson is a pediatric medical and biochemical geneticist. He is the Medical Director of Precision Medicine Clinical Informatics, as well as the Director of the Mitochondrial Care Network Clinic at Children's Hospital Colorado. Dr. Saenz specializes in clinical genetics and dysmorphology. She is the Medical Director of Precision Medicine Education and Family Engagement. They both are faculty members at the University of Colorado School of Medicine.

Some highlights from this episode include:

• Recent advances making genetic testing more accessible to patients
• How the rise of exome and genome sequencing has changed the diagnostic approach in pediatrics
• Secondary findings and how they should be discussed in advanced
• Practical advice for a pediatrician who feels overwhelmed to order and interpret these tests

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

It's one of the most common calls you'll get as a pediatrician, and one of the fastest infections to spread through a classroom. A pink eye shows up and suddenly the questions follow: Is it contagious? Do they need drops? Can they go back to school? Pink eye seems like a simple fix until it's not. From bacterial to viral to allergic, knowing what you're looking at can change how it impacts a family.

Rebecca Edwards Mayhew, MD, PhD, specializes in pediatric ophthalmology and adult strabismus, at Children's Hospital Colorado. She is also an assistant professor at the University of Colorado School of Medicine.

Some highlights from this episode include:

• Distinguishing between viral, bacterial and allergic conjunctivitis
• How to consult families about contagion and school policies
• Red flags that should immediately raise concerns for more serious pathology
• When treating with antibiotics makes sense and when to wait and watch

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

"Picky eater" is one of the most common labels in pediatrics and one of the easiest to overlook. But when a child's diet is shrinking instead of expanding, when meals are a source of stress instead of routine, or when growth and nutrition start to feel like a question mark, it's worth taking a second look. In this episode, we're discussing ARFID: what it looks like in clinic, how to spot the difference from typical picky eating, and how to approach these patients with a sharper clinical lens.

In this episode, we are joined by Kimberly Sheffield, PhD. She is an eating disorders psychologist at Children's Hospital Colorado, as well as the Clinical Director of Pediatric Mental Health Institute (PMHI) day programs, and the Associate Training Director for Psychology Training.

Some highlights from this episode include:

• Specific growth or nutrition patterns that should raise suspicion of ARFID
• Treatment options pediatricians can manage in clinic
• Overlap between ARFID and neurodiversity
• Patterns to look for in certain age groups

This episode is underwritten by Ent Credit Union, proud supporter of Charting Pediatrics and Children's Hospital Colorado. Ent is Colorado's largest credit union serving more than 550,000 members at 60 service centers across the Front Range. Ent generously responded to Children's Colorado's State of Emergency for pediatric mental health in 2021 and is pleased to support this episode. Visit ent.com, insured by NCUA.

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

A toddler takes their first bite of peanut butter and breaks out in hives. A parent sits across from you, equal parts frightened and overwhelmed, asking the question you hear every day, "What happens now?" Food allergies have long lived at the intersection of fear and uncertainty, for families and clinicians alike. But that story is changing. A landscape once defined by strict avoidance is rapidly evolving into proactive management, personalized risk assessment, and emerging therapies that are reshaping outcomes. In this episode, we step into that evolving world. From early introduction and updated diagnostic strategies to the expanding role of oral immunotherapy and biologics, we'll unpack what's here, what's coming, and what it means for how you care for patients in real time.

Two allergy experts, David Fleischer, MD, and Allison Hicks, MD, join us for this episode. Dr. Fleischer is the Section Head of Allergy and Immunology, as well as the Director of the Allergy and Immunology Center at Children's Hospital Colorado. Dr. Hicks is the Director of Food Immunotherapies. They both teach at the University of Colorado School of Medicine.

Some highlights from this episode include:

• How food allergy management has evolved
• The biggest misconceptions about food allergies
• The latest guidelines on early, consistent introduction to different foods
• What the current treatment options look like and the role of the pediatrician

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