Charting Pediatrics

A real public health problem has snuck up on us as pediatricians - vaping and e-cigarettes use. On today's episode, we will unpack the facts about e-cigarettes and vaping, provide you with practical tools to counsel your patients and families and talk about upcoming advocacy and policy work pertaining to e-cigarettes. Our guests today are Jennifer Woods, MD, Medical Director of the Adolescent Medicine Clinic at Children's Hospital Colorado and associate professor of pediatrics at the University of Colorado School of Medicine; and Heather Hoch, MD pediatric pulmonologist at Children's Hospital Colorado and assistant professor the CU School of Medicine.

From today's episode:

• The 2018 NIH Monitoring the Future Survey Results were released last month. The survey found that 37% of 12th graders and 18% of 8th graders have vaped in the last year and the number of kids who used vaping products in the last month jumped from 11 to 21% in 12th graders and from 9 to 16% in 10th graders — those changes are the biggest jumps in adolescent substance use that has been seen in the 4 decades of conducting the Monitoring the Future Survey.
• From the AAP: 5 Facts to talk to Teens about Vaping
• The FDA held a public hearing on January 18, 2019 to discuss efforts to eliminate youth e-cigarette use, with a focus on the potential role of drug therapies to support cessation and the issues impacting the development of such therapies. If this is a topic you are passionate about, we encourage our listeners to visit the FDA website to submit a public comment, those public comment submissions will be available through February 1, 2019 https://www.fda.gov/TobaccoProducts/Labeling/ProductsIngredientsComponents/ucm456610.htm)
• Pediatricians Push for Laws to Prevent Teen Vaping
• Colorado Bill Introduced to Combat Skyrocketing Youth E-Cigarette Use, Clean Indoor Air Act, House Bill 19-1076

Feedback on this episode or suggestions for a future topic? Write to us at [email protected] - we love hearing from our listeners!

In this episode, we discuss abnormal pediatric head growth, shape and treatment options with Todd Hankinson, MD. Dr. Hankinson is a Pediatric Neurosurgeon at Children's Hospital Colorado and Associate Professor of Neurosurgery at the University of Colorado School of Medicine.

Today's guests are Dr. Lori Prok and Pediatric Nurse Practitioner, Julieann Tibbetts, here to discuss the most common clinical presentations, causes, and treatment of Atopic Eczema. Dr. Prok is a Pediatric Dermatologist at Children's Colorado and Associate Professor of Dermatology at the University of Colorado School of Medicine. Julieann is a Pediatric Nurse Practitioner in the Dermatology Department at Children's Colorado and Senior Instructor of Dermatology at the University of Colorado School of Medicine.

Today's guests are Dr. Jens Goebel and Dr. Robert Fuhlbrigge, here to discuss Henoch-Schönlein purpura (HSP). Dr. Goebel is the Section Head of Nephrology at Children's Colorado and Professor of Pediatrics at the University of Colorado School of Medicine. Dr. Fuhlbrigge is Section Head of Rheumatology at Children's Colorado and Professor of Pediatrics also at the University of Colorado School of Medicine.

In today's episode, we're examining a case that started in a primary care pediatrician's office and ended in the Children's Hospital Colorado Aerodigestive Program.

Joining us are the three physicians involved in the patient's care examine: Larissa Applegate, MD, a pediatrician at Pediatrics West in Wheat Ridge, Colorado; RyanCaltagirone, MD, a pediatricemergency room physician at Children's Colorado; and Sven Streubel, MD, an otolaryngologist with Children's Colorado.

In this episode:

• Our three guests examine their roles in the patient's care and share their key takeaways to inform other medical professionals
• The origins of the case and how the patient, baby Rachel, first presented in the hospital
• Steps taken once Rachel's respiratory struggles were evident and next steps to get her to the Emergency Department
• Importance of clear communication between departments and with patient families in complex, multidisciplinary cases
• Approaching a patient who presents with laryngomalacia from an ENT perspective
• Using a bedside scope to determine the severity of the laryngomalacia
• The various elements of Rachel's multidisciplinary care, including: admission procedure, observation of feedings, continued oxygen support and plan for next steps
• Most common medical treatment plan for patients with laryngomalacia
• Designing a long-term management plan for a child with laryngomalacia that supports the patient as well as their family
• Accounting for comorbidities that come along with laryngomalacia
• Update from patient and key takeaways from the case

Treating STDs in adolescent patients can be a challenge for today's busy pediatrician. Eliza Buyers, MD of the Pediatric and Adolescent Gynecology team at Children's Colorado returns to our pediatric podcast to provide practical tools for preventing and treating sexually transmitted infections in teens.

In this episode:

• Why STD rates are higher in adolescents and young adults
• How PCPs can address teen reproductive health challenges
• Why we need to consider age as the primary risk factor for STDs
• Examining the issue of STD rates as a health disparity
• Importance of conducting universal screening in sexually active adolescents
• Expedited partner therapy (EPT) and its importance
• Recommended STD and HIV screening periods for different populations
• Screening guidelines for STD examinations in the absence of symptoms.
• Approaching one-to-one time with teen patients
• Importance of promoting condom use to prevent STDs in teens
• When to consider screening for less common STDs
• Why it's crucial to know confidential screening clinics you can send your patients

STD management resources:

• The CDC STD treatment guidelines mobile app
• CDC STD treatment guidelines for special populations

In today's episode all three hosts are in the recording studio for a round table discussion about provider self-care and compassion fatigue. The host team shares personal experiences and strategies they utilize for keeping them energized when cases have challenging outcomes.

The host team includes is David Brumbaugh, MD, pediatric gastroenterologist and Associate Chief Medical Officer at Children's Colorado; Alison Brent, MD Pediatric Emergency Medicine Physician and Medical Director of Physician Relations and the Network of Care at Children's Colorado; and Dan Nicklas, MD, pediatrician and Medical Director of the Pediatric Call Center at Children's Colorado.

Thank you to all of our listeners for a fantastic Season 2 of Charting Pediatrics! Season 3 will launch on August 6. If you have suggestions for a future topic email us.

Approximately 6 to 7 percent of children presenting with respiratory symptoms have acute sinusitis. In today's episode we are going to talk to Steven Hamilton, MD about the causes, diagnosis, treatment and safe antibiotic prescribing practices for the management of sinusitis in pediatric patients.

Dr. Hamilton is a pediatric otolaryngologist from our Colorado Springs-based faculty and is an assistant professor of otolaryngology at the University of Colorado School of Medicine.

Let us know what you thought about today's episode or suggest a future topic - Send Dr. Nicklas a tweet, @DanielNicklasMD or send us an email.

Children's Hospital Colorado, Colorado Springs is set to open in late Spring 2019. Read more about our new hospital!

AAP Clinical Practice Guideline for this Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years

Feeding is a primary concern for families of pre-term and low birth weight babies following NICU discharge. Many of these infants have gagging, swallowing, vomiting, aspirating concerns or feeding aversions; they don't seem to experience the sensation of hunger, making feeding each meal an arduous task for their caregivers.

In today's episode, we talk with returning guests Laura Pickler, MD and Nancy Creskoff Maune, OT about approaches to diagnosis and treatment options for infants with severe feeding and swallowing issues, including helpful diagnostic tests and therapies.

Dr. Pickler is the Chair of Family Medicine and Medical Director of the Feeding and Swallowing Program at Children's Colorado. Nancy is an occupational therapist in the program with an extensive background in the evaluation and treatment of infants and children with feeding and swallowing problems.

Tell Dr. Brumbaugh what you thought of today's episode, send him a tweet @DBrumbaughMD.

Pediatric hypertension occurs in 2-5% of all pediatric patients and is one of the top five chronic diseases in children and adolescents. According to the National Heart, Lung and Blood Institute, the diagnosis is missed in up to 75% of pediatric patients in primary care settings and appropriate medication initiation occurs much less frequently than is indicated, according to current guidelines. In today's episode we talk with Steve Daniels, MD about the pediatric hypertension clinical practice guideline he helped to co-author, how you can incorporate blood pressure screening at well child visits, replacing the term "prehypertension" with "elevated blood pressure" and treatment recommendations for your patients.

Dr. Daniels is a pediatric cardiologist, Pediatrician-in-Chief and the L. Joseph Butterfield Chair of Pediatrics at Children's Hospital Colorado, Professor of Pediatrics at the University of Colorado School of Medicine, Professor of Epidemiology at University of Colorado School of Public Health. Dr. Daniels is a sought-out expert in the field of pediatric hypertension and pediatric nutrition.