Pediagogy™

Is acute appendicitis better than an ugly appendicitis? (Yes that’s supposed to be a joke!) Join us on today’s episode to learn about appendicitis in pediatric patients!

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Julie Fuchs (pediatric surgery). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected]

Key Points:

• Symptoms of appendicitis include abdominal pain (classically right lower quadrant with rebound and guarding), anorexia, vomiting, diarrhea, fatigue, and fever
• Diagnosis can be clinical but imaging with ultrasound or CT is often used to confirm the diagnosis
• Treatment is typically laparoscopic appendectomy but select patients with uncomplicated appendicitis can be treated with IV antibiotics to avoid surgery. However, these patients need close follow up for recurrence or failure of non-operative management 

Sources

-AAP April 2022: https://publications.aap.org/pediatrics/article/149/5/e2021054693/186782/Nonoperative-Management-of-Uncomplicated 

-StatPearls June 2025: https://www.ncbi.nlm.nih.gov/books/NBK441864/

Did you know that platelet transfusion is NOT the treatment for low platelets in immune thrombocytopenic purpura (ITP)? Learn why in this week's episode!

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Anjali Pawar (pediatric hematology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected]

Key Points:

• Immune thrombocytopenic purpura (ITP) causes low platelets, by definition less than 100,000 microL, in the setting of a normal bone marrow and no other cause of thrombocytopenia.
• ITP can be acute or chronic meaning lasting longer than 6 months.
• Acute ITP can be self limiting and not require treatment but treatment can include steroids, IVIG, thrombopoietin receptor agonists (TPO-RA like eltrombopag), or Rhogam.
• Chronic ITP can include rituximab, eltrombopag, and/or splenectomy

Sources

• Pediatric in Review, Chu Y, et al (March 2000): https://doi.org/10.1542/pir.21-3-95
• American Society of Hematology Clinical Practice Guidelines on Immune Thrombocytopenia (2019): https://www.hematology.org/education/clinicians/guidelines-and-quality-care/clinical-
• practice-guidelines/immune-thrombocytopenia-guidelines
• Journal of Pediatrics, Buchanan GR, Adix L (Nov 2002): doi: 10.1067/mpd.2002.128547
• Platelet Disorder Support Association: https://pdsa.org/images/stories/pdf/ITP-in-Children_FAQ.pdf

Purpura, stomach aches, joint pains, maybe blood in the urine? You better be thinking about IgA nephropathy. Learn more 

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Gia Oh (pediatric nephrologist). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected]

Key Points:

• IgA vasculitis (formerly known as Henoch-Schonlein purpura/HSP) is a small vessel vasculitis that causes palpable purpura, abdominal pain, arthritis or arthralgias, IgA deposition on biopsy, and/or renal involvement.
• Management is mainly supportive with hydration and pain management. Steroids can be given for severe GI or renal involvement as well as immunosuppressants, plasmapheresis, or transplant if severe renal symptoms.
• IgA vasculitis symptoms typically resolve within 4-6 weeks but 1/3 of patients will have relapse or recurrence within 1 year. Monitoring for renal involvement is important.

Sources

• Reid-Adam, Jessica. Pediatr Rev (2014) 35 (10): 447–449. https://doi.org/10.1542/pir.35-10-447
• AAP Grand Rounds (2005) 14 (6): 65. https://doi.org/10.1542/gr.14-6-65
• AAP Grand Rounds (2022) 47 (4): 42. https://doi.org/10.1542/gr.47-4-42

You’ve probably seen an infantile hemangiomas before but did you they can be associated with PHACE or LUMBAR syndrome? Learn about this and everything else about infantile hemangiomas in this week’s episode.

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Caitlin Peterman (pediatric dermatology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected]

Key Points:

• Infantile hemangioma which are the most common benign tumor of infancy. Most will involute on their own after 4 months of age and self-resolve
• Hemangiomas can affect nearby organs causing vision impairment, feeding difficulties, or airway compromise. Other complications include ulceration and disfigurement
• First line treatment includes oral propranolol for thicker lesions and topical timolol for superficial/thin lesions. Surgery or laser is reserved for select hemangiomas 

Sources

AAP Jan 2019: https://publications.aap.org/pediatrics/article/143/1/e20183475/37268/Clinical-Practice-Guideline-for-the-Management-of?searchresult=1

Ebstein's anomaly is a congenital heart defect that involves an abnormally developed tricuspid valve. Learn more about its effects on the heart physiology in today's episode.

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Daniel Cortez (pediatric cardiology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected]

Key Points:

• Ebstein's anomaly is characterized by an abnormally placed tricuspid valve causing atrialization of the right ventricle. This can lead to single ventricle physiology.
• Wolff-Parkinson-White (WPW), right bundle branch blocks (RBBB), mitral valve prolapse, mitral valve dysplasia, bicuspid aortic valve, ventricular septal defect, and coarctation of the aorta can all be associated with Ebstein's anomaly
• Treatment of Ebstein's anomaly requires a patient to be stable enough to tolerate surgical correction like aortopulmonary shunting, PDA stenting, tricuspid valvuloplasty, and/or single ventricle palliation. Some patients will require inhaled nitrous oxide, Prostaglandin E, antiarrhythmics, and/or ECMO as well

Sources:

• Truong et al. “Ebstein Anomaly in the Fetus: Preparing for the Perfect Storm”.
• Neoreviews (2011) 12 (5): e260–e269. https://doi.org/10.1542/neo.12-5-e260

If you've been getting a lot more questions about hepatitis B and vaccination from your patients and families and wondering where to find the answers, look no further than our episode today filled with useful information from evidence based sources.

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Dean Blumberg (pediatric infectious disease). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected]

Key Points:

• As of the time of this podcast publishing, the American Academy of Pediatrics still recommends Hepatitis B vaccination at birth, 1-2 months, and 6-18 months.
• Hepatitis B vaccination introduction decreased the lifetime prevalence of hepatitis B from 33% to 5% between 1988-2004.
• 4 in every 1000 people with hepatitis B will go on to develop chronic hepatitis B which can lead to liver failure or hepatocellular carcinoma.
• Hepatitis B has an average incubation of 90 days meaning you might not have symptoms for the first few months of infection. 20-30% of people with hepatitis B do not have a clear source of infection which is why prevention is crucial

Sources:

• “Hepatitis B in Children”. Pediatr Rev (2008) 29 (4): 111–120.
• https://doi.org/10.1542/pir.29-4-111
• “Hepatitis B” Red Book chapter
• https://www.aap.org/en/patient-care/immunizations/vaccination-recommendations-by-
• the-aap/

Have patients asking you about aluminum in vaccines? Listen to this episode to learn about important facts so that you can answer their questions appropriately. 

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Anh Nguyen (allergy and immunology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected]

Key Points: 

• Alumium is an immune adjuvant, it helps the body's innate immune cells recognize vaccine antigen and enhances the ability of the vaccine antigen to activate innate immune cells. Your body has a better response to vaccines with aluminum than without. This is especially important for infants
• Aluminum toxicity is mostly only seen in adult dialysis patients or chronic kidney disease patients due to aluminum in dialysis and total parenteral nutrition. There are no credible reports of aluminum toxicity linked to vaccines
• There are higher levels of serum aluminum after taking over the counter antacids used to treat GERD than after giving an intramuscular vaccine.

Sources:

• “The Role and Safety of Aluminum Adjuvants in Childhood Vaccines”. Pediatrics (2025)
• https://doi.org/10.1542/peds.2025-074874

We're back with journal club to review a study evaluating the PECARN guidelines on febrile infants under 28 days of age and serious bacterial infections like meningitis. 

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Julia Magana (pediatric emergency medicine). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected]

Key Points:

• Urinalysis, absolute neutrophil count, and procalcitonin are useful predictors of serious bacterial infection
• In this study, using urine studies, absolute neutrophil count, and procalcitonin were able to risk stratify patients into risk for meningitis and no cases of meningitis were missed

Sources:

• Burstein B, Waterfield T, Umana E, Xie J, Kuppermann N. Prediction of Bacteremia and
• Bacterial Meningitis Among Febrile Infants Aged 28 Days or Younger. JAMA. Published
• online December 8, 2025. doi:10.1001/jama.2025.21454
• Kuppermann N, Dayan PS, Levine DA, et al. A Clinical Prediction Rule to Identify
• Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA
• Pediatr. 2019;173(4):342-351. doi:10.1001/jamapediatrics.2018.5501

Dealing with a crying and moving child who needs sedation for a laceration repair? Intranasal midazolam is a good sedative option but what dose do you choose? Learn more in this journal club episode where we talk about a recent study that evaluated the most effective dosing of intranasal midazolam.

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Julia Marlow (pediatric hospitalist). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected] Points:

• Intranasal midazolam is a good non-invasive sedative option. It has similar plasma concentrations as intravenous administration because it bypasses first pass metabolism unlike oral administration. Onset of action is 20-30 minutes and can last 30-60 minutes.
• Dosing of intranasal midazalam for children is 0.2 - 0.5 mg/kg
• Based on the results of this study, 0.4 - 0.5 mg/kg of midazolam was found to provide more effective sedation without increased adverse events for the studied patient population (6 months - 7 years old with simple laceration)
• Always critically think through studies! This study had limitations including the narrow patient population (did not include children with autism or developmental delay, did not include children less than 6 months old, and had a small study sample size with n = 101)

Sources:

• Tsze DS, Woodward HA, McLaren SH, et al. Optimal Dose of Intranasal Midazolam for Procedural Sedation in Children: A Randomized Clinical Trial. JAMA Pediatr. Published online July 28, 2025. doi:10.1001/jamapediatrics.2025.2181 
• UpToDate “Pediatric procedural sedation: pharmacological agents”

Sometimes kids are FOS - full of stool! In today's episode, we talk about how to diagnose and treat functional constipation which is a common cause of abdominal pain in pediatrics and can be a pain in the butt, literally!

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Kelly Haas (pediatric gastroenterology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at [email protected]

Key Points:

• Functional constipation is constipation not due to any other underlying conditions such as Hirschsprungs, spinal cord dysphraphism, or other disease. 
• Functional constipation is defined as having at least 1 month of symptoms in kids younger than 4 years old (or) symptoms at least once per week for at least 2 months in kids older than 4 years old who do not meet IBS criteria. Symptoms include 2 or fewer stools per week, at least 1 episode of incontinence per week after toilet training is established, a history of excessive stool retention/retentive posturing/excessive volitional stool retention, a history of hard or painful bowel movements, the presence of large fecal mass in rectum, or a history of large diameter stools that may obstruct the toilet
• Encopresis is liquid stool that goes around large stool balls and is indicative of constipation rather than diarrhea
• Polyethylene glycol (PEG, miralax), lactulose, and enemas are all good treatment options for constipation

Sources:

• Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. Tabbers MM, et al. J Pediatr Gastroenterol Nutr. 2014;58(2):258-274. doi:10.1097/MPG.0000000000000266 
• Constipation. Neal S. LeLeiko, et al. Pediatr Rev (2020) 41 (8): 379–392. https://doi.org/10.1542/pir.2018-033