Clerkship Ready: Pediatrics

In this episode, we will discuss everything you need to know before seeing your first pediatric patient with eczema. We will review its pathogenesis, who gets eczema, what to look for on exam, and potential differential diagnoses. We will also elaborate upon the most recent AAP guidelines for treatment of eczema, which focuses on skin care maintenance, topical steroids, and avoidance of triggers. 

Show Outline:

• Introduction to Eczema
  • Description of dermatologic terms
  • Defining eczema and atopic dermatitis
• Pathogenesis
  • Immune dysfunction
  • Histological differences
  • Involvement of filaggrin
  • Racial disparities
• Who gets eczema?
  • Age of onset
  • Demographics of patients with eczema
  • Atopic disease & “The Atopic March”
• Clinical Presentation / Diagnosis
  • Characterization of eczematous lesions
  • What to look for in people of color
  • Most likely locations of eczema based on patient age
  • Differential diagnoses
  • Sleep disturbances
  • Utilizing the Patient-Oriented Eczema Measure (POEM)
• Treatment
  • AAP recently updated treatment guidelines
  • The basic triad for eczema treatment
    • Skin care maintenance
    • Topical anti-inflammatory medications
      • The 5-10-15 Plan
    • Avoidance of triggers
  • Side-effects of topical steroids (very rare)
    • Skin atrophy
    • Steroid withdrawal 
• Complications
  • Secondary infections
    • Tinea
    • Impetigo
    • Eczema herpeticum
• Closing statements

Resources/Links:

1. POEM Eczema Questionnaire: https://www.rchsd.org/documents/2020/08/madp-poem.pdf/
2. Roduit C, et al. (the PASTURE study group). Phenotypes of Atopic Dermatitis Depending on the Timing of Onset and Progression in Childhood. JAMA Pediatr. 2017 Jul 1;171(7):655-662. doi: 10.1001/jamapediatrics.2017.0556. PMID: 28531273; PMCID: PMC5710337.
3. Schoch JJ, Anderson KR, Jones AE, Tollefson MM; Section on Dermatology. Atopic Dermatitis: Update on Skin-Directed Management: Clinical Report. Pediatrics. 2025 Jun 1;155(6):e2025071812. doi: 10.1542/peds.2025-071812. PMID: 40383540.

Links:

https://www.rchsd.org/documents/2020/08/madp-poem.pdf/

About the Speaker:

Host: Carly Pierson, MD – Carly Pierson, MD is a pediatric resident in the Primary Care Track at UVA Health. She graduated from the University of the Incarnate Word School of Osteopathic Medicine and has interests in allergy and immunology.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

In this episode, we will discuss all things related to food allergies, including the difference between IgE-mediated and non-IgE-mediated allergies, clinical manifestations, the important questions to ask when taking a history, the options for doing allergy testing, and treatment. 

• Definition of food allergies
  • Rates of food allergies
  • Possible pathophysiology of food allergies
• Clinical manifestations of food allergies
  • IgE mediated food allergies 
    • Cutaneous symptoms
    • Ocular symptoms
    • Respiratory symptoms
    • GI symptoms
    • Neurological and cardiovascular symptoms
    • Anaphylaxis = involvement of 2 or more systems
  • Non-IgE mediated food allergies
    • Symptoms after 4 hours after ingestion
    • Eosinophilic esophagitis
    • Alpha-gal
    • Food protein induced enterocolitis syndrome (FPIES)
    • Food protein induced proctocolitis (FPIAP)
• Questions to ask to hone your clinical history
  • Presenting symptoms
  • When did symptoms occur
  • Foods ingested
  • Other symptoms, other exposures
  • Any prior allergy testing
  • Family history?
  • Any food avoidance 
• Testing options for food allergies
  • Clinical history
  • Oral food challenge - gold standard
  • Skin prick/puncture test
  • Serum IgE testing
• Treatment of food allergy
  • Referral to allergy/immunology specialist and avoidance of offending food until appointment
  • Prescription for epinephrine autoinjector
  • Second generation antihistamines

Resources/Links:

1. Food allergy: A review and update on epidemiology, pathogenesis, diagnosis, prevention, and management Scott H. Sicherer, MD, and Hugh A. Sampson, MD New York, NY
2. Mendonca CE, Andreae DA. Food Allergy. Prim Care. 2023 Jun;50(2):205-220. doi: 10.1016/j.pop.2023.01.002. Epub 2023 Mar 27. PMID: 37105602.

About the Speaker:

Host: Jenna Zuzolo, MD – Jenna Zuzolo, MD is a pediatric resident at the University of Virginia with a focus on allergy and immunology. She attended Marshall University for her undergraduate education.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

In this episode, we will discuss when and how to advise parents on introducing complementary foods (aka “solids”), including foods that are potentially allergenic. This is a topic that will invariably come up for you during your rotation. We’ll discuss the timing and sequence of introducing solids, and then talk about the rationale behind early introduction of potentially allergenic foods. 

1. Definition of “complementary” foods” - a catch all category for “all solid and liquid foods other than breast milk or infant formula”.  Also referred to as “solid foods”
2. Definition of potentially allergenic foods -  eggs, peanut butters, nut butters, fish, shellfish, etc. 
3. When to Introduce solid foods
   1. We will start recommending the introduction of solid foods in the form of puree, around the time an infant turns 4-6 months old – 
      1. Baby should be able to demonstrate adequate head control in the office with us
      2. An infant’s renal and gastrointestinal systems can only start to metabolize complementary foods around the age of 4 months. 
      3. An infant will usually develop motor and dental development skills to sufficiently chew and swallow foods around 6 months. 
      4. Introducing complementary foods too early can be associated with harmful health side effects, e.g., obesity 
4. Importance of introducing complementary foods
   1. Breastmilk and infant formula do not contain all the nutrients a growing infant will need to continue growing and developing appropriately. 
   2. LEAP study – babies less likely to develop peanut allergy if peanut products were introduced at 4-11 months
      • This study had HUGE implications regarding the introduction of potentially high allergen foods into infant’s diets to reduce the risk of developing a food allergy to them.
5. The introduction of complementary foods
   1. First offer  a variety of single-ingredient foods (such as pureed vegetables, fruits, grains and meats),  in any order that parents desire
   2. Iron-fortified cereal is often a good choice as iron stores from mother become depleted by about 4-6 months of age. 
   3. Recommend only providing 1-2 new foods per day in case the child has an adverse reaction 
   4. The main calorie source for these infants should still be formula or human milkor
   5. Important foods to avoid include: honey (due to the risk of botulism), cow’s milk (we transition to cow’s milk instead of formula / breastfeeding at age 12 months but not prior. This is because it has a low absorbable iron content which can lead to iron deficiency anemia, and doesn’t have all of the nutritional value that infant’s need from breastmilk/formula), choking hazards (such as whole nuts, grapes, popcorn, etc). 
6. Introduction of potentially allergenic foods:
   1. The most common allergenic foods are milk, egg, soy, wheat, fish, shellfish, tree nuts, sesame 
   2. Start to introduce these foods after the infant has tried and tolerated a few of the non-allergenic complementary foods (this is to make sure that the infant can tolerate non-allergenic foods first and foremost)
   3. For children with a history of atopy (or a family hx of atopy) it is recommended to start with a small serving of each of these foods, and then gradually increase the serving size as it is tolerated
   4. Avoid cow’s milk in a bottle but instead introduce other cow’s milk based products such as yogurts and cheese
7. Allergic reactions vs contact dermatitis
8. Bowel movements change in color and consistency when solid foods are introduced
9. Summary

Resources/Links:

1. Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G; LEAP Study Team. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015 Feb 26;372(9):803-13
2. Elissa M. Abrams, Marcus Shaker, David Stukus, Douglas P. Mack, Matthew Greenhawt; Updates in Food Allergy Prevention in Children. Pediatrics November 2023; 152 (5): e2023062836. 10.1542/peds.2023-062836
3. Victoria X. Soriano, Daniela Ciciulla, Grace Gell, Yichao Wang, Rachel L. Peters, Vicki McWilliam, Shyamali C. Dharmage, Jennifer J. Koplin; Complementary and Allergenic Food Introduction in Infants: An Umbrella Review. Pediatrics February 2023; 151 (2): e2022058380. 10.1542/peds.2022-058380

About the Speaker:

Host: Erica Licari, MD – Erica Licari, MD is a board-certified pediatrician who completed her residency at the University of Virginia. She has published research on pediatric health topics.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

In this episode, we will be reviewing what you need to know before your first discussion about infant formula.  We will cover the characteristics and types of formulas, why infants might require different types, the correct way to prepare formula and how much infants need, common concerns from parents, indications for changing formulas, and when to transition away from it.

1. Reasons for formula feeding 
   1. Human milk is first choice for most infants
   2. Concern about lactating parent’s milk supply
   3. Workplace conditions make it difficult to sustain human milk feeding
   4. Parent preference 
   5. There are few true contraindications to breastfeeding. 
      1. Galactosemia
      2. Maternal HIV infection that has not achieved an undetectable viral load
      3. Maternal phencyclidine (also known as PCP) or cocaine use
      4. Active Herpes Simplex virus lesion
      5. Active tuberculosis
2. Types of formula: 3 characteristics
   1. Caloric density: calories per ounce. Standard term formula is 20 calories/oz. Infants born preterm or have growth failure may need 22-27 calories/oz.
   2. Carbohydrate source: Lactose (galactose + glucose) or non-lactose
   3. Protein type: 
      1. Cow-milk based formula proteins are whey and casein.
      2. Hydrolyzed formulas: proteins are broken down into smaller protein “chunks” or into individual amino acids, which are hypoallergenic and easily digestible. 
      3. Other formulas utilize different sources of protein, including soy protein and goat’s milk.
      4. Special formulas for infants with specific metabolic conditions: eg. phenylketonuria, maple syrup urine disease, homocystinuria.
3. Forms of formula
   1. Powder: most common and least expensive. Usually, 1 scoop of formula powder is mixed with 2 oz water. 
   2. Liquid concentrate: mixed 1:1 with water. 
   3. Ready to feed: no mixing required, but most expensive.
   4. Be sure that the formula is being mixed correctly! Incorrect formula mixing can result in growth failure or electrolyte abnormalities.
4. How much formula should be given?
   1. A good rule of thumb is that infants require between 120-150 calories/kilogram per day. 
5. Common myths about formula
   1. Lactose intolerance. True congenital lactase deficiency is rare disorder and, in infants, it will usually present with very severe diarrhea. 
      1. What adults experience as lactose intolerance occurs later in childhood. 
      2. Developmental lactase deficiency can occur in premature infants, but lasts for a short time after birth and the majority are still able to consume lactose-containing formulas. 
      3. Infants can develop a temporary, self-resolving lactase deficiency after suffering from a gastroenteritis
   2. Increased spit ups (often at around 4 months of age): Generally not a sign of formula intolerance.  
   3. Gassiness and stomach discomfort after feeding: Normal and usually not a reason to switch formulas. 
6. Medical reasons to switch formula type
   1. Galactosemia: most often diagnosed after abnormal newborn metabolic screen.  
   2. Milk protein allergy: usually presents with blood in stool from allergic proctocolitis.  Rarely, more severe milk protein allergies can present as hives or even anaphylaxis. 
   3. Metabolic disorders 
7. Usually stop infant formula at 1 year of age and switch to cow’s milk, usually whole milk. 
   1. Do not switch to cow’s milk before 1 year of age because of solute load on kidneys. 

Resources/Links:

https://www.healthychildren.org/English/ages-stages/baby/formula-feeding/Pages/default.aspx

https://www.aafp.org/pubs/afp/issues/2009/0401/p565.html

https://www.cdc.gov/nutrition/infantandtoddlernutrition/formula-feeding/choosing-an-infant-formula.html

https://kidswithfoodallergies.org/recipes-diet/nutrition-and-health/formula-options-for-kids-with-food-allergies/#:~:text=Extensively%20Hydrolyzed%20Formulas%20(e.g.%2C%20Enfamil,common%20cause%20for%20allergy%20symptoms.

Links:

https://www.healthychildren.org/English/ages-stages/baby/formula-feeding/Pages/default.aspx

About the Speaker:

Host: Paige Howard – Paige Howard completed her medical education at the University of Virginia School of Medicine. She is now a pediatric resident at Children's Hospital of Philadelphia (CHOP).

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

Listen along as we dive into the many causes of sore throat. Learn about the common causes such as allergies and viral illnesses while also what to do when a child with epiglottitis comes in.  We will cover CENTOR criteria as well and when you should think about Group A strep testing.

Common Causes

• Viral Presentation
  • HSV
  • Mononucleosis
• Allergic Presentation
• Group A Strep 
  • CENTOR Criteria

Emergency Causes

• Peritonsillar Abscess
• Retropharyngeal Abscess
• Epiglottitis

Wrap Up & Conclusion

Resources/Links:

https://www.chop.edu/conditions-diseases/throat-anatomy-and-physiology 

https://www.mdcalc.com/calc/104/centor-score-modified-mcisaac-strep-pharyngitis 

References

1. Aluma Chovel-Sella, Amir Ben Tov, Einat Lahav, Orna Mor, Hagit Rudich, Gideon Paret, Shimon Reif; Incidence of Rash After Amoxicillin Treatment in Children With Infectious Mononucleosis. Pediatrics May 2013; 131 (5): e1424–e1427. 10.1542/peds.2012-1575
2. Becker JA, Smith JA. Return to play after infectious mononucleosis. Sports Health. 2014 May;6(3):232-8. doi: 10.1177/1941738114521984. PMID: 24790693; PMCID: PMC4000473.
3. Chowdhury MDS, Koziatek CA, Rajnik M. Acute Rheumatic Fever. [Updated 2023 Aug 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK594238/
4. Esposito, S.; De Guido, C.; Pappalardo, M.; Laudisio, S.; Meccariello, G.; Capoferri, G.; Rahman, S.; Vicini, C.; Principi, N. Retropharyngeal, Parapharyngeal and Peritonsillar Abscesses. Children 2022,9,618. https://doi.org/ 10.3390/children9050618 
5. Martin JM. The Mysteries of Streptococcal Pharyngitis. Curr Treat Options Pediatr. 2015 Jun;1(2):180-189. doi: 10.1007/s40746-015-0013-9. PMID: 26146604; PMCID: PMC4486489.
6. MCMILLAN, J. A. , WEINER, L. B. , HIGGINS, A. M. & LAMPARELLA, V. J. (1993). Pharyngitis associated with herpes simplex virus in college students. The Pediatric Infectious Disease Journal, 12 (4), 280-283.
7. Mohseni M, Boniface MP, Graham C. Mononucleosis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470387/
8. Roggen I, van Berlaer G, Gordts F, et al. Centor criteria in children in a paediatric emergency department: for what it is worth. BMJ Open 2013;3: e002712. doi:10.1136/ bmjopen-2013-002712 

Links:

https://www.chop.edu/conditions-diseases/throat-anatomy-and-physiology

About the Speaker:

Host: Chris Stadnick, MD – Chris Stadnick, MD is a board-certified pediatrician at Metropolitan Pediatrics in Portland, Oregon. He earned his MD from the University of Tennessee Health Science Center and completed his pediatric residency at the University of Virginia.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

Asthma is a common chronic disease of childhood that affects 1 in 12 children in the United States. It can range from mild respiratory symptoms to life threatening respiratory failure, with a range of treatment options in-between from the primary care setting to the pediatric ICU. In this episode, we will discuss the underlying pathophysiology, diagnosis, evaluation, and management of patients with asthma, along with some useful clinical pearls to help you take care of these patients!

1. Cause of asthma
   1. Genetics: “Atopic triad” of asthma, atopic dermatitis or eczema, and allergic rhinitis 
   2. Prenatal and childhood environmental factors: maternal smoking and allergen exposure 
2. Pathophysiology and diagnosis 
   1. AAP definition: “episodic and reversible airway constriction and inflammation in response to infection, environmental allergens, and irritants. It is a complex, multifactorial, and immune-mediated process that presents with various clinical phenotypes.”
   2. Airway hyperreactivity leads to inflammation of bronchi, increased mucus production, bronchial smooth muscle contraction
   3. Key elements of the history – recurrent episodes of cough, wheeze, difficulty breathing, nighttime symptoms, consistent trigger, atopic personal or family history, improvement with asthma treatment.
   4. Identification of triggers is important. Common triggers include respiratory infections, mold or pet dander, pollen, intense crying or laughing, exercise, pollution, and cold air. 
   5. Children from minority and lower-income backgrounds experience an increased asthma burden, likely closely tied to a complex interaction of factors such as decreased access to healthcare, increased rates of obesity, and poor air quality in the areas in which they live.
3. Classification of asthma: determined by the frequency and severity of symptoms when they are not receiving preventative treatment.
4. New 2022 guidelines for asthma treatment
   1. Albuterol or other beta 2 agonist as needed for symptoms - relaxes bronchial smooth muscles
   2. Daily controller medication (usually inhaled steroid) if symptoms more than twice weekly - inhaled steroid decreases inflammation
   3. Inhaled steroid + long-acting beta 2 agonist combination inhaler preferred for those >5 years
   4. Asthma action plan should be given to every patient
5. Treatment of acute asthma attack
   1. Quick assessment and stabilization of patient is important
   2. Treat acute symptoms first, then address chronic control of asthma
   3. Albuterol or ipratropium-albuterol, systemic steroids are generally first lines of treatment
   4. Supplemental oxygen as needed
   5. Other options for medications: magnesium, terbutaline, theophylline, epinephrine
   6. Frequent reassessment is needed

Resources:

Global Initiative for Asthma, Pocket Guide for Asthma Management and Prevention for Adults, Adolescents and Children 6-11 Years. Updated 2023. https://ginasthma.org/wp-content/uploads/2023/07/GINA-2023-Pocket-Guide-WMS.pdf

Links:

https://ginasthma.org/wp-content/uploads/2023/07/GINA-2023-Pocket-Guide-WMS.pdf

About the Speaker:

Host: Rebecca Hu, MD – Rebecca Hu, MD is a pediatrician at Signature Healthcare in Brockton, Massachusetts. She completed her pediatric residency at the University of Virginia, where she served as a chief resident with interests in adolescent health and developmental-behavioral pediatrics.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

In this episode, we discuss lead toxicity and lead screening. We will talk about what lead is, what happens when a child is exposed to lead, what to ask parents about if you’re worried about lead exposure, how to screen for lead toxicity, and what to do if your patient has an elevated lead level. 

1. Sources of lead exposure 
   1. Ingestion of contaminated food or water
   2. Ingestion or breathing in of lead dust
   3. Other sources: lead-acid batteries, ammunition, lead-based pigments and paints, stained glass, lead crystal glasses, ceramic glazes, jewelry, toys
   4. For families from other cultures, think about ceramic glazes, traditional cosmetics, traditional medicines
2. Government policies to decrease lead exposure
   1. Unleaded gasoline
   2. Lead-free paint
   3. Lead-free solder in food cans
   4. Lead-free water pipes
3. Why young children are at risk for lead toxicity
   1. Hand-to-mouth behavior
   2. Increased absorption of lead
   3. Developing nervous system is vulnerable
   4. Calcium or iron deficiency increase absorption of lead
4. Effects of lead toxicity in children can be seen at levels as low as 3.5 µg/dL
   1. Growth and development delays
   2. Lower IQ
   3. Learning and behavior problems
   4. Hearing and speech problems
   5. School underperformance
   6. At higher levels, you may see
      1. Irritability
      2. Loss of appetite, weight loss, fatigue
      3. Abdominal pain, vomiting, and/or constipation
      4. Anemia
      5. Pica
      6. Seizures, coma, death
5. Universal lead screening at 1 and 2 years
   1. Screening questionnaires are not very sensitive or specific 
   2. Blood lead test 
      1. Capillary – get results quickly, but can be falsely elevated
      2. Venous – results more accurate, but may take some time to come back
6. Management of elevated lead level
   1. Repeat it if it was a capillary sample
   2. Review results with family
   3. Ask about potential exposures – may need to contact health department, landlord, or independent certified lead inspector to test home for lead
   4. Assess risk factors for iron or calcium deficiency
   5. Ask about developmental milestones – may need to refer to early intervention services
   6. Consider abdominal xray if history of pica
   7. For levels >45, may need chelation therapy 

Resources/Links:

• CDC, Childhood Lead Poisoning Prevention, https://www.cdc.gov/nceh/lead/default.htm
• AAP policy statement. Prevention of Childhood Lead Toxicity, Pediatrics 2016: 138(1):e20161493. https://publications.aap.org/pediatrics/article/138/1/e20161493/52600/Prevention-of-Childhood-Lead-Toxicity
• Mona Hanna-Attisha, What the Eyes Don't See: A Story of Crisis, Resistance, and Hope in an American City, 2018. https://www.amazon.com/What-Eyes-Dont-See-Resistance/dp/0399590838

Links:

https://www.cdc.gov/nceh/lead/default.htm

About the Speaker:

Host: Rachel Moon, MD – Rachel Moon, MD is the Harrison Distinguished Professor of Pediatrics at UVA Health Children's. She is an internationally recognized researcher in sudden unexpected infant death and chairs the AAP Task Force on SIDS. She is also the Chief of General Pediatrics at UVA.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

In this episode of Clerkship Ready – Pediatrics Dr. Jared Barkes, a Child Neurology resident at The University of Virginia, will be walking you through how to complete the neurologic exam! Throughout the episode he will cover in detail the different parts of a formal neuro exam while also providing useful tips for remembering commonly tested facts, reviewing specific examples of abnormal findings and common neurologic conditions, and offering helpful advice for completing a neuro exam on a pediatric patient. After listening to this podcast you will have all the tools necessary to shine on your first day of your neurology clerkship!

• Introduction
• What is the neuro exam?
• Review of the  “Map” of the neuro system
  • Cortex, Brainstem, Spinal Cord, Motor neuron
• How to complete a neuro exam and what to look for!
  • General Assessment
  • Mental Status
  • Language
  • Cranial Nerves
  • Strength
  • Sensation
  • Coordination 
  • Reflexes
• Special consideration for pediatrics 
• Closing

Resources/Links:

• “NeuroLogic Exam”, A complete in-depth guide of the neuro exam complete with references and videos produced by Dr. Paul D. Larsen, M.D. and Suzanne S. Stensaas, Ph.D. at The University of Utah. (https://neurologicexam.med.utah.edu/adult/html/home_exam.html). 
• “PediNeurologic Exam” A guide of the neuro exam for children produced by Dr. Paul D. Larsen, M.D. and Suzanne S. Stensaas, Ph.D. at The University of Utah (https://neurologicexam.med.utah.edu/pediatric/html/home_exam.html) 
• Medical Student Resources from the American Academy of Neurology (https://www.aan.com/tools-resources/medical-student-educational-resources).

Links:

https://neurologicexam.med.utah.edu/adult/html/home_exam.html

About the Speaker:

Host: Jared Barkes, MD – Jared Barkes, MD is a Child Neurology Resident at the University of Virginia. He graduated from the Brody School of Medicine at East Carolina University and completed his undergraduate studies at UNC Chapel Hill in Mathematics and Biochemistry, with research interests in medical play and reducing patient anxiety.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

Sepsis is a clinical syndrome in which an infection leads to an inflammatory response throughout the body that rapidly progresses to organ dysfunction or even death. Worldwide, neonatal sepsis affects 2,202 infants per 100,000 live births, and has a mortality rate of >11%. In the United States, early onset sepsis affects 50 in 100,000 live births, with a mortality rate of about 3%. So it’s a big problem that we don’t want to miss. In this episode, we will define neonatal sepsis, talk about the presentation of sepsis, what a sepsis workup entails, how to make the diagnosis and treatment of neonatal sepsis.

1. Defining Neonatal Sepsis 
   1. Early Onset Sepsis
   2. Late Onset Sepsis
2. Neonatal Early Onset Sepsis Calculator - https://neonatalsepsiscalculator.kaiserpermanente.org/
3. Presentation of Illness and Physical Exam 
4. Pathogenesis
   1. Group B Strep
      1. Screening and prophylaxis 
   2. E coli
   3. Strep viridans
   4. Klebsiella
   5. Enterococcus
   6. Listeria 
   7. HSV 
      1. Screening and prophylaxis 
5. Types of Infection
   1. Bacteremia 
   2. Pneumonia
   3. Meningitis 
6. Work up 
   1. CBC with differential 
   2. Blood Culture
   3. Urinalysis and Urine Culture
   4. Cerebrospinal Fluid culture 
   5. Chest X-Ray 
   6. Surface swabs of mucous membranes 
7. Antimicrobial coverage
8. Evaluation and Treatment of a Well Appearing Febrile Infant 8-60 days old
   1. https://doi.org/10.1542/peds.2021-052228
   2. 8-21 days 
   3. 22-28 days 
   4. 29-60 days 

References:

1. Neonatal Early Onset Sepsis Calculator - https://neonatalsepsiscalculator.kaiserpermanente.org/
2. AAP Guidelines for Evaluation and Treatment of a Well Appearing Febrile Infant 8-60 days old: https://doi.org/10.1542/peds.2021-052228

Links:

https://neonatalsepsiscalculator.kaiserpermanente.org/

About the Speaker:

Host: Elizabeth (Blair) Davis, MD – Elizabeth Blair Davis, MD, FAAP graduated from the University of Virginia School of Medicine and completed her pediatric residency at UVA. She received her undergraduate education from Washington and Lee University.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.

Iron deficiency is the most common nutritional deficiency that occurs in children in United States. Iron plays a vital role in cellular function in all organ systems. Today, we will be reviewing what you need to know before you first see a patient with possible iron deficiency. We will discuss why iron is so important, when and why iron deficiency occurs, screening, diagnosis, and treatment for iron deficiency.

1. Importance of Iron 
   1. Iron and Hemoglobin 
   2. Iron and Neurodevelopment
   3. Iron and the Immune System
2. What happens in iron deficiency
3. Reasons that children are at high risk for iron deficiency 
   1. Rapid Growth . 
   2. Insufficient dietary intake and limited absorption 
   3. Increased losses 
4. Peaks of Incidence
5. Other risk factors for iron deficiency.
   1. Preterm infants 
   2. Children who suffer from neuro-motor disorders as they often have nutritional deficiency related to swallowing impairment
   3. G.I. diseases that cause malabsorption, 
   4. Diseases predisposing them to bleeding.
   5. Lead toxicity. 
6. Screening for IDA
   1. History: Asking about prematurity, low birth weight, exclusive breastfeeding beyond 4 months of age, weaning to whole milk without addition of iron rich foods, feeding problems, and any past medical conditions. 
   2. Exposure to lead (i.e. age/ condition of home, recent renovations, a parent who has occupational exposure, concerns about drinking water). 
   3. Any possible symptoms of anemia, such as fatigue, breath holding spells, pica
   4. Physical exam: pallor. 
   5. Lab testing.
7. Treatment for iron deficiency 
   1. Oral iron: daily dose of 3 to 6 mg per kilogram of elemental iron divided into three doses is adequate.
   2. Give iron supplements with juice - increases iron absorption through the action of ascorbic acid! Juices that are high in ascorbic acid include orange and apple juice.
   3. Supplements should be continued for a minimum of three months to reestablish iron stores. After completion of treatment, reassessment of iron status 
   4. In addition to iron supplementation, the other aspect of treatment is encouraging dietary intake of iron rich foods (meat and fish, cereals, legumes, vegetables, soy, eggs)
8. Follow up

Resources/Links:

• Baker RD, Greer FR, et al. Clinical Report – Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0-3 years of age). Pediatrics. 2010; 126(5). www.pediatrics.org/cgi/doi/10.1542/peds.2010-2576
• Özdemir N. Iron deficiency anemia from diagnosis to treatment in children. Turk Pediatri Ars. 2015 Mar 1;50(1):11-9. doi: 10.5152/tpa.2015.2337. PMID: 26078692; PMCID: PMC4462328.
• Lozoff B, Beard J, Connor J, Barbara F, Georgieff M, Schallert T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev. 2006 May;64(5 Pt 2):S34-43; discussion S72-91. doi: 10.1301/nr.2006.may.s34-s43. PMID: 16770951; PMCID: PMC1540447.
• Yadav, D., Chandra, J. Iron Deficiency: Beyond Anemia. Indian J Pediatr 78, 65–72 (2011). https://doi.org/10.1007/s12098-010-0129-7

Links:

https://doi.org/10.1007/s12098-010-0129-7

About the Speaker:

Host: Riley Calicchia, MD – Riley Calicchia, MD is a pediatric resident at the University of Rochester Medical Center / Golisano Children's Hospital in Rochester, New York. She completed her medical education and began residency training in 2024.

Clerkship Ready: Pediatrics is a podcast aimed at medical students doing their clinical clerkship in Pediatrics. The views expressed are the speakers' own and do not constitute medical advice.