Harriet Lane Handbook: Pediatric Insights from The Johns Hopkins Hospital

How do you earn the trust of a teenager who won't say aword, a 14-year-old asking about birth control, or a 17-year-old who sees nothing wrong with vaping? In this episode, Dr. Anna Wang, a Johns Hopkins pediatric resident sits down with Dr. Alexander Golec, an adolescent and addiction medicine specialist at Johns Hopkins Hospital, to work through three real clinic cases, sharing candid, hard-won advice from years of practice. You'll hear practical scripts forsetting expectations before the parent leaves the room, how to explain confidentiality in a single breath, and where the gray zones lie. Dr. Golec also shares why the open-ended question isn't always your best tool, and how motivational interviewing can turn a shrug into progress. Whether you're amedical student, intern, or resident, you'll leave with practical ideas for your next adolescent visit. Learn what to say when the room goes quiet.

• Why the first five minutes of a visit can determinewhether a teen opens up later.
• A one-sentence confidentiality script, and the singleexception that changes everything.
• When the textbook rule of open-ended questions may workagainst you.
• What a teen's "I like it" about vaping canreveal about readiness to change, if you know how to listen.
• Why knowing your own state's laws, not assumptions, shouldguide what you promise a teen and a parent.

Get more must-know information in The Harriet Lane Handbook, 24th edition, available now.

A child won't bear weight after a tumble on the playground. Sprain, strain, or fracture? In this episode, join Dr. Eva Seligman, a pediatric emergency medicine and sports medicine specialist at Johns Hopkins Hospital, with host, Dr. Luisa Costa to unpack the evaluation of pediatric ankle and knee injuries. They explore why open growth plates change the game in kids, whether the Ottawa ankle rules really hold up in young patients, and which exam maneuvers separate a stable joint from an unstable one. Dr. Seligman breaks down when imaging is truly warranted, how to decide between sports medicine and orthopedic referral, and what families need to hear about return-to-play timelines. Whether you'refacing a swollen knee in the ED or a worried parent in clinic, this conversation offers a practical framework you'll reach for again and again. Tune in for the pearls every trainee needs before the next limping patient walks in.

• Why the Ottawa ankle rules don't behave quite the sameway in kids — and how that should shift your threshold for ordering an X-ray.       
• The single biomechanical concept (hint: it involves growth plates) that explains almost every injury pattern unique to pediatric patients.
• A rapid rundown of the exam maneuvers for kneeinstability — and the one pitfall that can make them unreliable in kids.
• How to tell when a "simple sprain" is something more, and when to loop in sports medicine versus orthopedics.
• The return-to-play framework Dr. Seligman uses tocounsel families — simpler than you'd think, but easy to get wrong.

Get more must-know information in The Harriet Lane Handbook, 24th edition, available now.

A three-month-old arrives in the ED with irritability,decreased feeding, and a story that doesn't quite add up: he "rolled off the bed." Is this an accident, or something more? In this episode, Dr. Brian Schultz, Dr. Mitchell Goldstein, Dr. Gabrielle Pollack, and Dr. Samantha Waslewski from Johns Hopkins Hospital walk through a real-world case to teach clinicians how to spot the subtle, often non-specific signs of physical child abuse — before it's too late. They cover red flags in history and exam, the sentinel injuries doctors miss, how implicit bias shapes who gets scrutinized, and exactly which imaging and labs to order. Whether you're in the ED or a pediatrician's office, this conversation will change how carefully you listen to every history you take. A must-listen for any provider who cares for children.

• The story doesn't match the injury — why a "three-month-old rolled off the bed" should immediately raise red flags, and how to spot developmental inconsistencies in any history.

• The 2/3 statistic that changes everything — most kids with abusive head trauma have no other physicalfindings. Learn why a normal exam doesn't mean you're in the clear.
• Sentinel injuries you might be missing — subtle signs like a torn frenulum or subconjunctival hemorrhagethat can be the only clue before a fatal injury occurs.
• Bias is invisible until it isn't — how implicit assumptions about "who abuses children" cause providers to miss cases in higher socioeconomic, two-parent households.
• CT vs. MRI — practical, concrete guidance on imaging choices, skeletal surveys, and how to start aworkup even without a trauma center's resources.

When a critically injured child arrives in the emergency department, every second counts — and every decision matters. In this episode of the Harriet Lane Handbook Audio Companion, pediatric residents Dr. Sarah-Thérèse Curtis Welling and Dr. Peyton Russell sit down with Dr. Keith Kleinman, a pediatric emergency medicine physician and researcher at Johns Hopkins, to break down what it really takes to assess and stabilize a child in trauma. From the moment EMS calls ahead to the last step of the secondary survey, Dr. Kleinman walks through the ABCDE framework, the unique physiologic challenges of treating pediatric patients,and the leadership skills that keep a trauma bay from descending into chaos. Whether you're a trainee stepping into the trauma bay for the first time or a seasoned provider looking to sharpen your approach, this episode deliverspractical, expert guidance on one of medicine's highest-stakes scenarios.

• Master the ABCDE primary survey framework andknow exactly when to intervene at each step

• Learn why children are not small adults — andhow their physiology can fool even experienced providers
• Understand the early warning signs of shockin kids before blood pressure tells you it's too late
• Get a step-by-step guide to pediatricintubation, including how to handle a difficult or failed airway
• Discover how to communicate with nonverbaland developmentally delayed patients during high-stakes trauma
• Hear expert advice on leading a trauma teamwith calm, clarity, and control when the pressure is on

Tolulope Fatola, MD and Julia F. Shalen, MD from Johns Hopkins Hospital discuss Rheumatology: A systematic approach to differentiating the various childhood arthritic conditions.

Key takeaways:

• Core diagnostic cues and red flags for common pediatricrheumatic diseases discussed, with quick signs you can check on exam.
• Key physical exam findings and how to differentiateinflammatory vs. noninflammatory presentations in children (joints, skin, mucosal) to guide when to escalate.
• Initial workup steps and criteria for urgent rheumatology referral, including when to order imaging or labs.
• First-line treatment principles in pediatrics: NSAIDs,steroid-sparing approaches, and DMARDs/biologics, with pediatric dosing caveats and vaccine considerations.
• Monitoring and safety considerations for children onimmunomodulatory therapy (growth, infections, lab monitoring, long-term risks).
• Controversies or debated points raised in the episode (e.g., sequencing of DMARDs/biologics, use of steroids, steroid-sparing strategies) with succinct takeaways or guidelines mentioned.
• Practical clinical pearls and common pitfalls for residents(how to simplify complex cases, how to communicate with families, and what to document consistently).

Juliet A. Joseph, MD and Emily Johnson, CRNP from Johns Hopkins Hospital discuss end of life decision makingin the adolescent palliative care patient.

Key takeaways:

• Proactively include PPC in routine care for serious pediatric illnesses.
• Use structured, family-centered conversations to clarify goals, preferences, and trade-offs.
• Leverage a multidisciplinary team to support complex decisions.
• Emphasize clear communication, cultural sensitivity, and ongoing family support.
• Address adolescent autonomy and ethically challenging situations.

Katelyn Williams, MD and Nathaniel J. Silvestri, MD fromJohns Hopkins Hospital discuss the initial presentation and workup of acute lymphoblastic leukemia.

Acute lymphoblastic leukemia (ALL) is the most commonpediatric cancer. Early recognition and prompt workup are critical for improvedoutcomes.

A case-based conversation featuring a 5-year-old withfatigue, bone pain, pallor, and reduced activity, guided by pediatric hematology/oncology expert input. The discussion outlines red flags, initial laboratory tests, imaging, differential diagnoses, and referral pathways.

Key points:

Red flags for ALL in children include persistent bone/backpain, refusal to bear weight, unexplained bruising, pallor, and diminishedactivity.

Comprehensive physical exam should assess forhepatosplenomegaly, lymphadenopathy, and, in boys, testicular involvement.

Initial laboratory workup (if malignancy is suspected) centers on CBC with differential and reticulocyte count, with attention to red cell indices (MCV, iron studies), hemoglobin, platelets, and neutrophils; LDH and uric acid; CMP and coag studies; and peripheral smear.

WBC counts can be normal, low, or high at presentation;imaging (e.g., chest X-ray) is considered to evaluate potential mediastinal mass, particularly with risk for T‑cell leukemia.

Differential includes infectious diseases and rheumatologicconditions; neuroblastoma should be considered in the differential of bone pain.

Referral to pediatric oncology or the emergency departmentis advised when alarm features or concerning labs are present.

Management considerations in the ED/outpatient settinginclude non-emergent procedures planning, NPO status when needed, and cautious use of steroids due to risks such as tumor lysis and diagnostic masking.

Resources and collaboration with oncology, vaccinationconsiderations during therapy, and family education are emphasized.

Implications: The talk reinforces recognizing early ALLsigns, initiating appropriate labs and imaging, timely referrals, and coordinated care to optimize outcomes.

Edward Corty, MD and Melissa Lutz, MD from Johns Hopkins Hospital discuss pediatric food insecurity.

This podcast features a discussion on childhood foodinsecurity, emphasizing its significance as a health and social issue in the United States. Hosted by Edward Corty, MD and Melissa Lutz, MD from Johns Hopkins Hospital, the conversation begins with a case study of a four-year-oldboy, illustrating how food insecurity can affect families even when children appear well.

Key points include:

• Definition and importance: Food insecurity is the lack of consistent access to enough food for an active,healthy life, affecting about 15% of U.S. households with children. It can lead to nutritional deficiencies, physical illnesses, behavioral health issues, developmental delays, and long-term health risks like diabetes and heart disease.
• Screening practices: Pediatricians are recommended to routinely screen for food insecurity using tools like theHunger Vital Signs, which involve simple questions about food access over the past year. Sensitive, private conversations and permission are essential.
• Interventions and resources: Multiple levels of intervention are available, including federal assistance programs (e.g., SNAP, WIC, school meal programs), healthcare-based resources (food vouchers, clinics), and community resources (food banks, churches,community organizations). Follow-up is crucial to ensure families connect with and benefit from these resources.
• Ongoing management: Continuous follow-up within the healthcare setting helps track progress and adapt support.

Maria Molinaro, MD, Molly Himmelrich, MD, Alex Testino, MD, and Eric H. Kossoff, MD from Johns Hopkins Hospital discuss seizure mimics and an age-based approach.

Megan Gates, MD and Kartikeya Makker, MBBS from Johns Hopkins Hospital discuss ventilation strategies in theneonatal ICU.