Charting Pediatrics

Acute flaccid myelitis (AFM) is a rare but serious condition; one that strikes fear into the hearts of parents and providers alike. AFM affects the nervous system, specifically the gray matter of the spinal cord, which results in the presenting symptoms of a flaccid paralysis.

This condition is not new. Acute flaccid myelitis appears to be caused most often by viruses, especially EV-D68, which is a member of the polio family. Although poliomyelitis has been mostly eradicated worldwide, in recent years large outbreaks of the related enterovirus 71 has been seen in Asia-Pacific countries. This virus, that some have coined "the new polio" mostly affects children, manifesting as hand, foot, and mouth disease, aseptic meningitis, poliomyelitis-like acute flaccid paralysis, brainstem encephalitis, and other severe systemic disorders.

In today's episode we are joined by Kevin Messacar, MD to talk through the most common presentations and treatment of enterovirus infections. Dr. Messacar is both an Infectious Disease Specialist and Hospitalist at Children's Hospital Colorado and is an Assistant Professor of Pediatrics at the University of Colorado School of Medicine. Dr. Messacar's interview in this episode is expressly his own and not on a behalf of the professional organizations he serves.

CDC AFM Guidelines and Resources for Providers

What did you think of today's episode? Tweet Dr. Brent, @AlisonBrentMD or write to us [email protected].

Today we are fortunate to be joined by a home-grown Denver pediatrician, child health advocate and legislator for the Colorado House of Representatives, Rep. Dr. Yadira Caraveo.

Dr. Caraveo was born and raised in Denver and attended medical school at the University of Colorado. She completed her residency in pediatrics in Albuquerque, New Mexico at the University of New Mexico and is currently a pediatrician at Peak Pediatrics in Denver. She has been interested in political and child advocacy since medical school and was elected to the Colorado House of Representatives to represent House District 31 in the November 2018 mid-term election.

What did you think of today's episode? Send Dr. Brumbaugh a tweet @DBrumbaughMD or write to us at [email protected].

As we head into a busy travel season increasing numbers of our patients and families are venturing to high altitude to partake in activities such as sight-seeing, hiking and climbing.

Children who travel to high altitude are at risk for developing some form of acute altitude illness and will seek advice from their primary care physician before traveling.

In today's episode we talk to Christine Ebert-Santos, MD to unpack what we know and what we don't about children residing at or visiting high altitude and how you can provide anticipatory guidance to your patients and families.

Dr. Ebert-Santos is a pediatrician at the Ebert Family Clinic in Summit County, Colorado. Summit County is comprised of mountainous elevations ranging from 7,957 feet (2,425 m) at Green Mountain Reservoir to 14,270 feet (4,350 m) at Grays Peak. The elevation of the county seat of Breckenridge is 9,602 feet (2,927 m), making it one the highest cities in the state of Colorado and the United States.

High Altitude Health

Acute otitis media (AOM) is one of the most common reasons that patients present to our office. Not surprisingly, ear infections are also the most common reason why children receive a prescription for a course of antibiotics.

In today's episode, we are going to talk to Peggy Kelley, MD about the classic symptoms and treatment for acute otitis media, safe antibiotic prescribing practices, and how to approach treatment failure and ear tubes. Dr. Kelley is a pediatric otolaryngologist at Children's Hospital Colorado and Associate Professor of Otolaryngology at the University of Colorado School of Medicine.

Send Dr. Nicklas a tweet and let him know what you thought about today's episode, @DanielNicklasMD

In this episode, Daniel Searing, MD, Professor of pediatrics and allergies at Children's Colorado, talks about seasonal allergies and pollen. He discusses the effects of pollen, how to treat and alleviate allergies, and more.

In this episode, Dr. Searing discusses:

• Pollen and how it affects allergies
• Why cottonwood trees are a big pollinator, especially in the springtime
• Why rain and humidity shut down pollen levels
• Why Colorado's climate makes people more susceptible to allergies
• How allergy symptoms will vary from year to year
• The importance of monitoring the quantitative level of pollen in the environment
• How physicians should manage the initial approach to a child with allergy symptoms
• Key features to look out for
• Why treating pollen allergies with persistent treatment is more effective
• What role the prescription drug Montelukast plays in treating allergic rhinitis
• What you can do to help prevent pollen from spreading
• Which medicines and therapies can help alleviate allergies
• When to see a doctor for seasonal allergies
• The approach of an immunotherapy treatment plan and the two phases of a typical treatment schedule

As providers, the safety of our patients is paramount. In recent years, increased attention has been given to diagnostic error in medicine, specifically those that arise through error in cognitive perception, failed heuristics and biases. In today's episode, we are talking with Joe Grubenhoff, MD about error in diagnosis and strategies for reducing cognitive bias. Dr. Grubenhoff is the Associate Medical Director of Clinical Effectiveness and is a pediatric emergency medicine physician at Children's Colorado. He is also an Associate Professor of Pediatrics at the University of Colorado School of Medicine.

Resources mentioned in today's episode:

• How Doctor's Think by Jerome Groopman, MD
• Thinking Fast and Slow by Daniel Kahneman

What did you think of today's episode? Send Dr. Brumbaugh a tweet @DBrumbaughMD.

Measles is a highly contagious respiratory disease that spreads easily through the air or on infected surfaces; According to the American Academy of Pediatrics, of every 1,000 people who get measles, 1 to 2 will die. And the numbers are even higher in developing countries where the case fatality rate is 4-10%. As providers who care for kids, we urge our parents, schools and communities to protect each other by vaccinating for measles.

In today's episode Edwin Asturias, MD joins us to talk through the classic symptoms, treatment and vaccination recommendations for measles.

Dr. Asturias is the Director for Latin American Infectious Disease at Children's Hospital Colorado. He is also an Associate Professor or Pediatric Infectious Disease at the University of Colorado School of Medicine.

Let Dr. Nicklas know what you thought of today's episode - send him a tweet @DanielNicklasMD

In today's episode we dive in to the topic of toxicity and the most common overdoses in pediatric medicine. Our guest is Sam Wang, MD, returning from earlier this season when we covered the topic of Marijuana as Medicine (S2:E14).

Dr. Wang is a Pediatric Emergency Medicine Physician and Medical Toxicologist at Children's Hospital Colorado and the University of Colorado School of Medicine.

Let us know what you thought of today's episode: Tweet Dr. Brent (@AlisonBrentMD) or write to us, [email protected].

HPV vaccine rates remain low with only about 16% of U.S. adolescents being fully vaccinated by the time they turn 13 according to the CDC. With about 34,000 cases of HPV-induced cancers annually, we as providers have an opportunity to encourage more parents to vaccinate their children.

In this episode we talk with guests Brian Gablehouse, MD, and Sean O'Leary, MD, about HPV vaccination hesitancy, recent updates to the HPV vaccination schedule and how to utilize motivational interviewing techniques when talking with parents.

Dr. Gablehouse is a pediatrician at Peak Pediatrics located in Wheat Ridge and Thornton, Colorado. Dr. O'Leary is Director of the Colorado Pediatric Practice-Based Research Network and works on the Infectious Disease team at Children's Hospital Colorado; he is Associate Professor at the University of Colorado School of Medicine.

Let us know what you think of today's episode! Drop us an email.

Check out S2:E12 for further discussion about the topic of Vaccinations and Motivational Interviewing Techniques.

Historically, there has not been a Food and Drug Administration – approved medical therapy to treat food allergies. This is about to change with emerging research in immune desensitization and clinical trials with food immunotherapy products that will likely soon hit the market. In today's episode, we will talk about these clinical trials, what two products are likely to be FDA-approved by the end of 2019 and what that means for your food-allergic patients.

Today's guests are David Fleischer, MD and Matthew Greenhawt, MD. Dr. Fleischer is Director of the Allergy and Immunology Center at Children's Hospital Colorado and Associate Professor in Pediatrics and Allergy at the University of Colorado School of Medicine. Dr. Greenhawt is Director of the Food Challenge and Research Unit at Children's Hospital Colorado Associate Professor of Pediatrics and Allergy at the University of Colorado School of Medicine.

Related Research:

• Effect of Epicutaneous Immunotherapy vs Placebo on Reaction to Peanut Protein Ingestion Among Children With Peanut Allergy: The PEPITES Randomized Clinical Trial, JAMA February 22, 2019

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