Pediagogy™

With increasing awareness and diagnosis of autism, there has also been an increase in misinformation regarding autism. The goal of today's episode is to provide a brief overview on autism and provide evidenced based information to better inform listeners!

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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Kathleen Angkustsiri (UC Davis developmental and behavioral pediatric specialist). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation. 

Key Points:

• Autism diagnostic criteria have changed to increase detection of milder cases. Asperger's is included in autism. 
• Per the DSM-5, autism is a condition with impairments in social communication (social and emotional reciprocity, non-verbal communication, and relationships) and restrictive and repetitive behaviors.  
• Autism diagnosis also requires 2 out of 4 restrictive or repetitive behaviors: 1. Restrictive or repetitive patterns of behavior, interests, or activities 2. Insistence of sameness, inflexible adherence to routines, ritualized patterns 3. Highly restricted, fixated interest abnormal in intensity or focus. 4. Hyper or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
• Autism can present as regression of social and/or language skills.
• The Modified Checklist for Autism in Toddlers – Revised with Follow-up (MCHAT-R/F) is the most widely known and validated screening tool for autism for ages 16-30 months. A score of 8 or more is high risk for autism

Sources:

• Pediatrics (2020) 145 (1): e20193447. https://doi.org/10.1542/peds.2019-3447

Ever get caught in a sticky ethical situation regarding genetic testing? You're not alone. Join us as we try to navigate these real life issues.

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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Video Jhaveri (UC Davis neonatology fellow). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation. 

Key points:

• Genetic testing may seem relatively benign and non-invasive but is actually fraught with unforeseen issues such as surprise consanguinity and non-paternity.
• Racial and economic disparities are prevalent with genetic testing and their interpretation. For example most test value interpretations are based on people of European and Asian descent.
• We cannot easily predict outcomes and prognosticate even with genetic testing. Prognosis is often fraught with the issue of promoting "ableism".

Sources:

Katharine P. Callahan, Ellen W. Clayton, Amy A. Lemke, Bimal P. Chaudhari, Tara L. Wenger, Allison N. J. Lyle, Kyle B. Brothers; Ethical and Legal Issues Surrounding Genetic Testing in the NICU. Neoreviews March 2024; 25 (3): e127–e138. https://doi.org/10.1542/neo.25-3-e127 

Osteomyelitis is an infection of the bone and is often a delayed diagnosis given the ambiguity of the signs and symptoms. Listen in on how you might be able to better detect and treat osteomyelitis without delay. 

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This episode was written by pediatric resident Victoria Tran Toft and pediatricians Tammy Yau and Lidia Park with content support from Natasha Nakra (UC Davis pediatric infectious disease). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.  

Key points: 

• Osteomyelitis can present as limp or hesitancy with movement; this can occur with or without fevers and localizing signs.  
• Main diagnostics include CRP, which also aids in assessing treatment response. 
• Treatment is a long course of antibiotics. Typically, starting empiric IV antibiotics in the hospital and then transitioning to oral agents. 

Sources: 

• PIDS/IDSA Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics. Published 8/5/2021. Journal of the Pediatric Infectious Diseases Society. https://doi.org/10.1093/jpids/piab027 

Want to know how to differentiate a normal white patch on the tongue vs a not normal white patch? Learn about thrush in this week’s episode!

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

Key Points:

• Thrush is due to candida yeast infection
• It cannot be wiped off the tongue as compared to milk residue
• Treat with topical nystatin solution

Sources:

• Pediatric in Review, 2007: https://publications.aap.org/pediatricsinreview/article/28/1/15/34605/Oral-Conditions 
• Thrush Pediatric Patient Education (2024) https://doi.org/10.1542/ppe_schmitt_240 

AAP Redbook, 2021, Candidiasis: https://doi.org/10.1542/9781610025782-S3_025

Wondering why your patient’s diaper rash won’t go away? Pay attention to this video to learn if there’s something else going on!

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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Lisa Rasmussen (UC Davis pediatrician). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation. 

Key Points:

• Typical diaper rash is an irritant contact dermatitis due to excess moisture, pH imbalance, and excessive friction. It can be a red patch or red macules and papules in the diaper region that spares the skin folds
• Candidal diaper rashes involve the skin folds and have satellite lesions
• Don’t forget in your differential: perianal strep, hand foot mouth syndrome, psoriasis, eczema, scabies, and Langerhans cell histiocytosis

Sources: 

• Pediatrics in Review, January 2021, Helms and Burrows: https://publications.aap.org/pediatricsinreview/article/42/1/48/35437/Diaper-Dermatitis

Uvula deviation, sore throat, fever? Learn all about peritonsillar abscesses in this episode!

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

Key Points:

• Peritonsillar abscess (PTA) is a suppurative infection of the tissue between the palatine tonsil capsule and the pharyngeal muscles
• Symptoms include fever, sore throat, uvular deviation, trismus, voice changes, drooling, unilateral tonsillar swelling with deviation of the uvula to the contralateral side
• Diagnosis can be clinical but imaging is often obtained 
• Treat with antibiotics (empiric amoxicillin, cephalosporin, or clindamycin but adjust based on cultures) and incision and drainage 

Sources:

• A Clinical Approach to Tonsillitis, Tonsillar Hypertrophy, and Peritonsillar and Retropharyngeal Abscesses. R Bochner, et al. Pediatrics in Review (2017) 38 (2): 81–92. https://doi.org/10.1542/pir.2016-0072

Marijuana, cannabis, THC, and CBD are among the many common words and forms of cannabis that pediatric patients are being exposed to in our current day and age. Keep up to date about the official AAP policy and recommendations with today's episode. 

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This episode was written by pediatricians Tammy Yau and Lidia Park. Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.  

Key Points: 

• At the time of this episode release, marijuana is considered a schedule I drug at the federal level meaning here is high potential for abuse, no medical use, and/or lack of safety with using this drug. The official AAP stance is to avoid cannabinoid use in most children. More studies need to be done to determine the long term effects. 
• Cannabis plants generally have both THC and CBD which are types of cannabinoids. THC can cause intoxication, analgesia, and antiemesis. CBD is less intoxicating and anxiolytic.  
• Cannabis intoxication can cause tachycardia, hypertension, red eyes, dry mouth, orthostatic hypotension, increased appetite and thirst, drowsiness, insomnia, anxiety, short term memory loss, ataxia, stroke, nystagmus, hypothermia, hypotonia, and rarely respiratory depression. Treatment is supportive. 
• THC can be detected in breastmilk. There is not enough information about long term safety and implications of THC exposure in utero or while breastfeeding.  
• In children, epidiolex is the only plant derived cannabinoid FDA approved for use of severe seizures in children. 

Sources: 

• Ammerman S, et al. The impact of marijuana policies on youth: clinical, research, and legal update. Pediatrics. 2015 Mar 1;135(3):e769-85. doi: 10.1542/peds.2014-4146 
• Hale’s Medications & Mothers’ Milk 2023: A Manual of Lactational Pharmacology 
• Fischedick J, Van Der Kooy F, Verpoorte R. Cannabinoid receptor 1 binding activity and quantitative analysis of Cannabis sativa L. smoke and vapor. Chem Pharm Bull (Tokyo). 2010;58(2):201-207. doi:10.1248/cpb.58.201 

Don't miss this cause of anemia in your differential in today’s episode about autoimmune hemolytic anemia! 

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

Key Points: 

• Autoimmune hemolytic anemia is an extravascular hemolysis 
• Symptoms can include pallor, fatigue, lightheadedness, jaundice, tachycardia, acrocyanosis, dark urine, splenomegaly, and gallstones with labs showing anemia with schistocytes, reticulocytosis, hyperbilirubinemia, elevated LDH, elevated AST, and positive Coombs testing. 
• AIHA can be triggered by infections, underlying autoimmune diseases, malignancy, immunosuppression, and medications. 
•  Treatment is steroids or rituximab for warm AIHA and avoiding the cold for cold AIHA. In refractory cases, splenectomy or stem cell transplant may be needed. Transfusions are generally not recommended due to ongoing hemolysis unless anemia is severe. 

Sources:  

• Voulgaridou A, Kalfa TA. Autoimmune Hemolytic Anemia in the Pediatric Setting. J Clin Med. 2021;10(2):216. Published 2021 Jan 9. doi:10.3390/jcm10020216 
• Noronha, Suzie A. "Acquired and congenital hemolytic anemia." Pediatrics in Review 37.6 (2016): 235-246. doi: 10.1542/pir.2015-0053   

Plan ahead for the flu season with our episode today where we talk about how to treat the common flu, also known as influenza.

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

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

Key Points: 

• The influenza vaccine is important every flu season! 
• Anti-viral neuraminidase inhibitors like oseltamivir/Tamiflu (oral), zanamavir (inhaled), and peramavir (IV) prevent the flu virus from fusing with infected cell membranes preventing the release of the virus  
• Baloxivir is a endonuclease inhibitor that inhibits mRNA synthesis that can be given as a one time dose to treat influenza infections. 
• Otitis media, PNA, retropharyngeal abscesses, Pott puffy tumors, empyema, meningitis, encephalitis, GBS, acute cerebella ataxia, transverse myelitis, myositis, pericarditis, and myocarditis are all serious complications that can occur with influenza infections 

Sources: 

• O’Leary ST, et al. Recommendations for Prevention and Control of Influenza in Children, 2024–2025: Technical Report. Pediatrics. 2024 Oct 1;154(4). doi: 10.1542/peds.2024-068508 
• AAP Red Book, 2023. doi:10.1542/9781610025782-S3_068 
• Moscona, A. Neuraminidase Inhibitors for Influenza. N Engl J Med 2005;353:1363-1373. 2025 Sept 9. doi: 10.1056/NEJMra05074 

Have you ever wondered if your patient's snoring is concerning or not? Learn about how we screen for obstructive sleep apnea in pediatric patients in this episode.

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This episode was written by pediatricians Lidia Park, Tammy Yau, and Jessica Ahn with content support from Ambika Chidambaram (UCD pediatric pulmonology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.  

Key Points

• Obstructive sleep apnea (OSA) occurs when there is either complete or partial narrowing of the upper airway during sleep that causes an awakening from sleep and/or results in at least 3% drop in oxygen saturation and lasts 2 breath lengths.
• Symptoms of OSA can include episodes of apnea, gasping, choking, frequent awakenings, sleep enuresis, attention difficulties, behavioral problems, daytime sleepiness.
• On physical exam, watch out for enlarged tonsils and/or adenoids, micrognathia, retrognathia, or hypotonia.
• Untreated OSA is an independent comorbid factor for many conditions such as failure to thrive, obesity, and cardiovascular diseases like insulin resistance, fatty liver disease, and hypertension.
• Disorders associated with OSA include Down syndrome, Duchenne Muscular Dystrophy, Prader Willi, achondroplasia, hypothyroidism, and acromegaly.
• The gold standard for diagnosis of OSA is polysomnography and is based off of AHI scores: 1-5 is mild, 6-10 is moderate, and 11 or greater is severe.
• First line treatment for most children is adenotonsillectomy. If this fails, second line treatment is CPAP or BiPAP.

References

• Krishna J, Kalra M, McQuillan ME. Sleep disorders in childhood. Pediatrics in Review. 2023;44(4):189-202. doi:10.1542/pir.2022-005521
• American Academy of Sleep Medicine. Obstructive Sleep Apnea.; 2008. https://aasm.org/resources/factsheets/sleepapnea.pdf. Accessed October 29, 2024.
• Benedek P, Balakrishnan K, Cunningham MJ, et al. International Pediatric Otolaryngology group (IPOG) consensus on the diagnosis and management of pediatric obstructive sleep apnea (OSA). International Journal of Pediatric Otorhinolaryngology. 2020;138:110276. doi:10.1016/j.ijporl.2020.110276
• Basha S, Bialowas C, Ende K, Szeremeta W. Effectiveness of adenotonsillectomy in the resolution of nocturnal enuresis secondary to obstructive sleep apnea. The Laryngoscope. 2005;115(6):1101-1103. doi:10.1097/01.mlg.0000163762.13870.83