Charting Pediatrics

In young children, many of the symptoms of eosinophilic esophagitis resemble those of gastroesophageal reflux disease (GERD)—including feeding disorders and poor weight gain—so the child may be mistakenly diagnosed with GERD. In today's episode we talk to Glenn Furuta, MD about the importance of a proper diagnosis of esophagitis in children, signs/symptoms to look for and effective treatment options.

Dr. Furuta is the La Cache Endowed Chair for GI Allergic and Immunologic Diseases, the Director of Gastrointestinal Eosinophilic Diseases Program at Children's Colorado and a Professor of Pediatrics in Gastroenterology at the University of Colorado School of Medicine.

Do you have a suggestion for a future episode or feedback about this one? Write to us, [email protected]

Biliary atresia is a rare gastrointestinal disorder, occurring approximately 1 in 10,000 to 15,000 births in the United States, and is characterized by a destruction or absence of, all or a portion of the extrahepatic bile duct. Affected infants present with jaundice and fibrosis.

In some cases, additional abnormalities may be present, including cardiac defects and intestinal, spleen and kidney malformations; the exact cause of biliary atresia is unknown. In today's episode we talk with Cara Mack, MD to unpack the clinical presentation, management and ongoing care for patients with biliary atresia.

Dr. Mack is a Professor of Pediatrics at the University of Colorado School of Medicine, a practicing Pediatric Hepatologist and the Director of the Pediatric Liver Center at Children's Hospital Colorado.

Let us know if you have a suggestion for a future topic or thoughts about this episode!

Sepsis remains one of the leading causes of morbidity and mortality in children despite improved understanding of the pathophysiology leading to better clinical management and survival. Recent studies have identified several areas that must be addressed by the clinician in order to continue to impact the morbidity and mortality associated with sepsis. In today's episode we talk with Halden Scott, MD about the presentation, management and follow-up care of pediatric patients with sepsis.

Dr. Scott is an Associate Professor of Pediatrics and Emergency Medicine at the University of Colorado School of Medicine and a Pediatric Emergency Medicine Physician at Children's Hospital Colorado.

Resources mentioned in today's episode:

• The Children's Hospital Association Improving Pediatric Sepsis Outcomes Collaborative
• Children's Hospital Colorado Pathways: Scroll to Emergency Department/Urgent Care Sepsis for the sepsis pathway
• The most recent pediatric sepsis guidelines
• Articles that Dr. Scott referred to in the podcast about the role of lactate in sepsis, and the problems with SIRS criteria for sepsis screening:

https://jamanetwork.com/journals/jamapediatrics/fullarticle/2595569

https://www.ncbi.nlm.nih.gov/pubmed/26711848/

https://www.ncbi.nlm.nih.gov/pubmed/25778743/

Join us as we podcast live from the American Academy of Pediatrics National Conference and Exhibition in New Orleans on October 26 & 27, 2019! Stop by Booth #632 in the Exhibit Hall to say hello – our host team of Dr. Alison Brent, Dr. David Brumbaugh and Dr. Dan Nicklas would love to meet you!

Functional abdominal pain disorders are the most common cause of chronic abdominal pain in children and adolescents. On today's episode we are talk with Jaime Belkind-Gerson, MD to unpack the presentation, diagnosis and management of functional abdominal pain from the primary care perspective.

Dr. Belkind-Gerson is Director of the Neurogastroenterology and Motility Program at Children's Hospital Colorado. He is al an associate professor of pediatric gastroenterology, hepatology and nutrition at the University of Colorado School of Medicine.

Red Flag Symptoms Concerning for an organic cause of GI Pain

• Weight Loss
• Persistent Diarrhea
• Blood in stool
• Waking from a dead sleep with pain
• Persistent vomiting
• Chronic fever

Photo described at the beginning of today's episode:

Photomicrograph of the lining of the intestine of a young female patient who had a biopsy done during a colonoscopy

Things have changed over the last 20 years, with more hospitals using people with expertise in Hospital medicine, known as "Hospitalists," to care for patients who are admitted for an inpatient stay.

In the mid-1990s, as pressures to provide outpatient care to large populations increased for general pediatricians, it became less efficient for them to care for patients in the hospital simultaneously. The field of hospital medicine arose, with physicians who were dedicated to the complexity of inpatient care. Fellowship training followed soon thereafter to prepare doctors further for excellence in the inpatient ward environment. In today's episode, we will talk with Mark Brittan, MD about the history of "Hospitalists," "Hospitalist" training, and where the field is heading in the future.

Dr. Brittan is an Associate Professor of Pediatrics in the Pediatric Hospital Medicine section and the Fellowship Director for Pediatric Hospital Medicine at the University of Colorado School of Medicine.

According to the American Academy of Pediatrics, studies show that up to 9% of teenagers meet criteria for depression at any one time, with as many as 1 in 5 teenagers having a history of depression at some point during adolescence. In primary care settings, point prevalence rates are likely higher, with rates up to 28%. Because adolescents face barriers to receive specialty mental health services, only a small percentage of depressed adolescents are treated by mental health professionals.

As a result, primary care settings have become the de facto mental health clinics for this population, although most primary care clinicians feel inadequately trained, supported, or reimbursed for the management of depression. In today's episode we sit down with Jenna Glover, PhD and clinical pharmacist Dr. Danielle Stutzman to talk through practical approaches to depression screening, anticipatory guidance and medication management.

Dr. Glover is the Director of Clinical Psychology training at Children's Hospital Colorado and Assistant Professor of Child Psychiatry at the University of Colorado School of Medicine. Dr. Stutzman is a Clinical Pharmacist at Children's Hospital Colorado with a special interest in psychiatry medication.

Resources mentioned in today's episode:

• Severity Measure for Depression, child age 11-17
• PROMIS Measure

In today's episode we talk with Nicholas Cost, MD about the diagnosis and management of pediatric urologic cancer in children and adolescents, including initial presentations and ongoing and follow-up management for primary care providers.

Dr. Cost is a Pediatric Urologist at Children's Hospital Colorado and Associate Professor of Pediatrics of Surgery and Urology at the University of Colorado School of Medicine.

Let us know what you think about today's episode or share a suggestion for a future episode by writing to us, [email protected]

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Vision problems are common among school-age kids and there are many eye diseases and conditions that can affect a child's vision. According to Prevent Blindness America, one in four school-age children have vision problems that, if left untreated, can affect learning ability, personality and adjustment in school.

In today's episode we are going to talk with Dr. Emily McCourt to unpack the most common eye issues in pediatrics and front line screening in the primary care office.

Dr. McCourt is an ophthalmologist at Children's Hospital Colorado and is associate professor of pediatric ophthalmology and strabismus at the University of Colorado School of Medicine.

Providers may have seen the reports from around the country of growing associations between vaping and more acute, severe lung injury; this is being called Vaping Associated Pulmonary Injury (VAPI). The CDC is involved and many states are now reporting vaping-associated pulmonary cases. In today's special episode we are discussing VAPI and how to diagnosis, report and treat; our expert guest is Robin Deterding, MD, Chief of Pediatric Pulmonary Medicine at Children's Hospital Colorado and Professor of Pediatrics at the University of Colorado School of Medicine.

Children's Colorado is notifying providers that may see these patients. It is very unclear what is happening, but there is a severe, noninfectious respiratory failure spectrum with an ARDS-like picture. If you know of a past or current patient case that fits the below criteria please contact the Pulmonary Team via OneCall, 720-777-3999.

Additional Resources:

What Parents Need to Know About Teen Vaping

Reporting suspected cases to the CDC

Report suspected cases to CDPHE's Disease Reporting Line, 303-692-2700 or 303-370-9395 (after hours). This includes potential cases who presented since June 1, 2019. CDPHE personnel will conduct a medical record review and contact the patients to administer a thorough investigation questionnaire.

Charting Pediatrics Podcast: Teen E-Cigarette Use and the Vaping Epidemic (S2:E23)