Pediagogy™

Join us for part 2 of our 2 part series on sickle cell disease. In this episode, we’ll go over the acute complications related to sickle cell disease and their management.

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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:

• Consider acute chest syndrome in a patient with cough, fever, hypoxemia, and new infiltrate on CXR 
• Acute pain episodes should be treated with IV hydration, oxygen as needed, and adequate pain management. 
• Chronic complications often result from chronic vascular blockage and inadequate oxygenation such as splenomegaly, avascular necrosis, retinopathy, nephropathy, and ulcers. 

Sources:

• Pediatrics 2024, A. Yates. https://doi.org/10.1542/peds.2024-066842 

In part 1 of this 2 part series on sickle cell disease, we’re going to discuss the general pediatric management of a patient with sickle cell disease including what special precautions and additional routine health maintenance they need. 

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 Anjali Pawar (UC Davis pediatric hematologist). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation. 

Key Points:

• Patients with sickle cell disease should receive penicillin prophylaxis from 2 months old til 5 years old or until pneumococcal vaccine series is completed 
• For patients with HbSS or sickle beta zero thalassemia, offer hydroxyurea at 9 months of age, even if they don’t have clinical symptoms. They should also receive stroke risk screening with an annual transcranial doppler
• Patients with sickle cell disease should receive annual screening for retinopathy and nephropathy around age 10
• Patients with sickle cell disease should receive an additional pneumococcal (20 or 23) vaccine and the meningococcal ACWY vaccine at age 10 and men B after age 10 if they have functional asplenia or a splenectomy

Sources:

Pediatrics 2024, A. Yates. https://doi.org/10.1542/peds.2024-066842

Wondering how to get pesky eczema under control? Listen up in today’s episode.

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 Smita Awasthi (UC Davis pediatric dermatology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

●  Daily moisturization, cotton clothing, avoiding allergens and irritants like dust mites help prevent eczema flares

●  For eczema flares, treat with a topical steroid, lower potency on the face and higher potency elsewhere on the body

●  Look out for superimposed bacterial infections from Staphloccocus aureus or group A streptococcus and treat with topical or oral antibiotics depending on the spread (local vs extensive)

●  Eczema herpeticum is due to HSV and should be treated with acyclovir, sometimes requiring hospitalization if severe or close to the eyes



Sources:

-   AAP Patient Care Atopic Dermatitis: https://www.aap.org/en/patient-care/atopic-dermatitis/treatment-of-atopic-dermatitis/

-   Pediatrics in Review, April 2018, Waldman et al, https://doi.org/10.1542/pir.2016-0169

What does it mean for a child to “fail to thrive”? No, it’s not a performance evaluation. Learn when and how to evaluate an infant for faltering growth in this episode! 

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 Lidia Park and Tammy Yau as well as pediatrics resident Megan Branson, with content support from Kelly Haas, pediatric gastroenterologist. Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.



Key Points:

• To diagnose with Faltering Growth (aka Failure to thrive): the infant must fall below weight-for-age or weight-for-length percentile or have rate of weight gain decline across 2 major percentiles.  
• There are three categories to think about when evaluating the etiology of faltering growth:  
• insufficient calories in
• malabsorption or increased calories out
• increased metabolic requirement 

Sources:

• AAP. (2022, May 31). https://www.aap.org/en/patient-care/newborn-and-infant- nutrition/growth-faltering-in-newborns-and-infants/?srsltid=AfmBOopMEVV0n6cZIAM4QHQ02RDREPeELIC107ONgdtSRS8bnrfZs4tP
• Pediatrics in Review 2017, https://doi.org/10.1542/9781610021159-86
• AAP Books: Caring for the Hospitalized Child 2018, https://doi.org/10.1542/9781610021159-86
• Pediatrics in Review 2016, https://doi.org/10.1542/pir.2014-0122

Ever wonder why babies receive erythromycin eye ointment at birth and if it’s really necessary? We’re going to answer that and many other EYE-opening questions in today’s episode! 

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 Lidia Park and Tammy Yau 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: 

• Erythromycin eye ointment is given to newborn babies to prevent against gonococcal infection, it does not cover chlamydia infections. 10% of babies who are exposed to gonococcus can still get eye infections even when given erythromycin 
• Gonococcal eye infections (ophthalmia neonatorum) can cause ulcers, rupture, and blindness. Disseminated infections can cause arthritis, bacteremia, and meningitis 

Sources: 

• Red book “Gonococcal infections”, “Chlamydia”, “Neonatal ophthalmia prevention” chapters 
• Kapoor VS, Evans JR, Vedula SS. Interventions for preventing ophthalmia neonatorum. Cochrane Database Syst Rev. 2020 Sep 21;9(9):CD001862. doi: 10.1002/14651858.CD001862.pub4. PMID: 32959365; PMCID: PMC8524318. 
• Neoreviews (2022) 23 (9): e603–e612. https://doi.org/10.1542/neo.23-9-e603 
• Commentary From the AAP Section on Ophthalmology: Century of Changes | Pediatrics | American Academy of Pediatrics 

What do petting zoos, river swimming, and hamburgers have in common? All have been linked with the spread of Shiga-toxin producing E. coli or STEC O157:H7, which is a strain linked with hemolytic uremic syndrome (HUS).  

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

Key Points: 

• Hemolytic uremic syndrome is a microangiopathic hemolytic anemia caused by Shiga toxin producing E. coli. 
• Symptoms include anemia, thrombocytopenia, and uremia 
• Treat HUS with hydration (but not too much as that can lead to fluid overload), blood transfusion if needed for severe anemia, and close monitoring as some patients progress to needing dialysis 

Sources: 

• Peds in Review, 2020. Pediatr Rev (2020) 41 (4): 213–215. https://doi.org/10.1542/pir.2018-0346 
• AAP Grand Rounds (2023) 49 (5): 55. https://doi.org/10.1542/gr.49-5-55 
• AAP Grand Rounds (2024) 52 (1): 6.https://doi.org/10.1542/gr.52-1-06 
• Ho, Erin.  “Factors associated with Actionable Gastrointestinal Panel Results in Hospitalized Children”.  Hospital Pediatrics Nov 2023 

Unequal blood pressures in the extremities and unequal brachial vs femoral pulses? Consider coarctation of the aorta. What’s that? Learn more in today's episode! 

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

Key Points: 

• Coarctation of the aorta is narrowing of the aorta near the ductus arteriosus (which closes and becomes the ligamentum arteriosum). Most cases occur in the first month of life.  
• Symptoms of coarctation of the aorta are tachypnea, poor feeding, fussiness, and sweating with feeds. Blood pressure is elevated in the right upper extremity compared to the lower extremity. Babies can develop congestive heart failure which can lead to shock.  
• CCHD does not always catch coarctations of the aorta!  

Sources: 

• Raza S, Aggarwal S, Jenkins P, et al. Coarctation of the Aorta: Diagnosis and Management. Diagnostics (Basel). 2023;13(13):2189. Published 2023 Jun 27. doi:10.3390/diagnostics13132189 
• Salciccioli KB, Zachariah JP. Coarctation of the Aorta: Modern Paradigms Across the Lifespan. Hypertension. 2023;80(10):1970-1979. doi:10.1161/HYPERTENSIONAHA.123.19454 
• Parker LE, Landstrom AP. Genetic Etiology of Left-Sided Obstructive Heart Lesions: A Story in Development. J Am Heart Assoc. 2021;10(2):e019006. doi:10.1161/JAHA.120.019006 

Does your child have a barking seal like cough? You better be thinking of croup! Join us on this resident-led episode today.  

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

Key points:  

• Croup, acute laryngotracheitis, a viral infection causing respiratory inflammation, bark like cough, and inspiratory stridor 
• Westley score can be used to determine severity of croup 
• Treatment for mild symptoms is humidified air and supportive care 
• Treatment for moderate/severe symptoms is racemic epinephrine breathing treatment and IV dexamethasone 
• Imaging can be considered to rule out bacterial tracheitis or epiglottitis if history and physical exam cannot narrow down the differential to croup 
• Antibacterials not normally given unless concurrent infection 



Reference: 

• AAP Point of Care Quick Reference, Retzke, 2021. https://doi.org/10.1542/aap.ppcqr.396247 
• Russell KF, Liang Y, O'Gorman K, Johnson DW, Klassen TP. Glucocorticoids for croup. Cochrane Database Syst Rev. 2011;(1):CD001955. Published 2011 Jan 19. doi:10.1002/14651858.CD001955.pub3 
• Cochrane Database Syst Rev. 2018;10:CD006822. Epub 2018 Oct 29.   
• Juliette Anderson. “Baby with Croup Stridor Barking Cough Visual & Audio Sound - When to Hospitalize.” YouTube, 14 Apr. 2011, www.youtube.com/watch?v=Qbn1Zw5CTbA. Accessed 3 Oct. 2024. 

Don’t miss this “ear”-resistible episode on outer ear infections, also known as otitis externa or swimmer’s ear!

This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Lena van Der List. Drs. Tammy and Lidia take full responsibility for any errors or misinformation. 

Key Points:

• Think otitis externa when your patient has ear pain, ear drainage, decreased hearing, and swelling or debris in the ear canal. 
• Treat otitis externa with otic aminoglycosides (neomycin, polymyxin B, trimethoprim-sulfate) when you have an intact tympanic membrane or fluoroquinolone (ciprofloxacin, ofloxacin) if you can’t visualize the tympanic membrane or there is a perforation

Sources:

Pediatrics in Review 2013, https://doi.org/10.1542/pir.34-3-143

Get a real ear-full of information today when we talk about the 2nd most common diagnosis in the pediatric emergency department, acute otitis media (AOM)!

This episode was written by Dr. Tammy Yau and Dr. Lidia Park with content support from Dr. Lena Van der list. Drs. Tammy and Lidia take full responsibility for any errors or misinformation. 

Key Points:

• Ear pain with a red bulging tympanic membrane and decreased tympanic membrane mobility is our diagnosis for acute otitis media. 
• AOM can be due to bacteria (S. pneumoniae, H. influenza, and Moraxella) and viruses (influenza, adenovirus, human metapneumovirus)
• Treat AOM with high dose amoxicillin (cephalexin or azithromycin if penicillin allergy) or amoxicillin-clavulanate. Avoid complications like mastoiditis or tympanic membrane perforation

Sources:

• Pediatrics 2013, https://doi.org/10.1542/peds.2012-3488
• Stat Pearls 2023, https://www.ncbi.nlm.nih.gov/books/NBK470332/ 
• World Journal of Pediatrics 2024, https://doi.org/10.1007/s12519-023-00716-8 
• University of Illinois Chicago: https://dig.pharmacy.uic.edu/faqs/2022-2/december-2022-faqs/what-evidence-supports-the-recommendation-for-high-dose-amoxicillin-in-children-with-acute-otitis-media/