Pediagogy™

In today’s episode, you’ll learn how to recognize and reduce this common pediatric orthopedic injury on your own and even teach parents if needed!

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

Key Points:

• Nursemaid’s elbow, subluxation of the radial head, or annular ligament displacement all refer to the same injury of the elbow that occurs most often when a child’s arm is pronated and pulled.
• Treatment of a nursemaid’s is through reduction - either by supinating and flexing the elbow (or) pronating, hyperextending, and then flexing the elbow
• Imaging is not routinely indicated for highly suspicious nursemaid’s but should be considered if you have concern for fracture

Sources:

• Pediatrics in Review 2013, https://doi.org/10.1542/pir.34-8-366
• Pediatrics 2002, https://doi.org/10.1542/peds.110.1.171 

Eur J Emerg Med 2009, https://doi.org/10.1097/MEJ.0b013e32831d796a

Learn how research continues to change our ability to detect and treat pediatric patients with hepatitis C in today’s episode. 

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

Key Points: 

• Perinatal hepatitis C exposure is the most common cause of pediatric hepatitis C infection 

• NAT testing for hepatitis C RNA can be done as early as 2 months of life to detect hepatitis C infection in pediatric patients rather than waiting until 18 months of life when hepatitis C antibody testing can be done 

• Hepatitis C positive moms can still breastfeed but should halt breastfeeding temporarily if breasts are cracked or bleeding 

Sources: 

• CDC: CDC Recommendations for Hepatitis C Testing Among Perinatally Exposed Infants and Children — United States, 2023 | MMWR 

• AAP Red Book 2024: Hepatitis C  

Ever wonder what CCHD meant on a newborn discharge summary? Learn about how we screen for Critical Congenital Heart Defects in newborns (and which ones we miss!) in this episode. 

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



Key Points: 

• Critical Congenital Heart Defects (CCHD) screening looks for heart defects that can be life threatening in infancy such as coarctation of the aorta, single ventricle defects like hypoplastic left heart syndrome, Tetralogy of Fallot (ToF), pulmonary atresia, total anomalous pulmonary venous return (TAPVR), transposition of the great arteries (TGA), and tricuspid atresia (TA). 

• CCHD screening does not detect atrial septal defects (ASD), ventricular septal defects (VSD), or atrioventricular septal defects (AVSD) 

• CCHD screening is performed by checking the pulse oximeter of the right hand and either foot of a newborn. SpO2 less than 90% is an automatic fail. SpO2 differences of 3% or more or SpO2 91-95% should be repeated twice before counting as a fail. Failed CCHD’s should be followed up with an echocardiogram. 

Sources: 

• CDC: Clinical Screening and Diagnosis for Critical Congenital Heart Defects | Congenital Heart Defects (CHDs) | CDC 
• BMC Pediatric 2021, Jullien S. Newborn pulse oximetry screening for critical congenital heart defects. doi:10.1186/s12887-021-02520-7 

• Pediatrics 2011, Kemper AR, Mahle WT, Martin GR, et al. Strategies for implementing screening for critical congenital heart disease. doi:10.1542/peds.2011-1317 

Did you know that if you exercise while you have a fever, you probably meet SIRS criteria? The new Phoenix sepsis scoring systems aims to better categorize sepsis through specific categories based on the patient’s vitals, labs, and medications. Learn with us as we walk through this new scoring system in today’s episode. 

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



Key Points:  

• The Phoenix sepsis score is based out of 13 points. 2 or more points meets sepsis criteria. The score is based on 4 categories: respiratory, cardiovascular, coagulation, and neurologic. 

• The Phoenix sepsis score is better at predicting mortality than SIRS criteria but does not predict morbidity 

Sources: 

• JAMA 2024, Schlapbach,“International Consensus Criteria for Pediatric Sepsis and Septic Shock”: doi: 10.1001/jama.2024.0179. 

• Hospital Pediatrics 2023, Kusma, “Effect of Viral Illness on Procalcitonin as a Predictor of Bacterial Infection in Febrile Infants”: doi: 10.1542/hpeds.2022-007070 

Learn how to classify and manage pneumonia in today’s episode!

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

Key Points:

• Pneumonia can be due to bacteria or viruses and there is no reliable way to distinguish the two
• Pneumonia can be diagnosed clinically based on exam or with a CXR. Lab work is not always necessary
• Treatment of bacterial pneumonia depends on if you think it is community acquired (first line amoxicillin), atypical (first line azithromycin), or nosocomial/hospital acquired (consider antibiotics for pseudomonal or MRSA coverage)

Sources:

• AAP 2023, Pinto: https://doi.org/10.1542/aap.ppcqr.396216 
• Pediatrics in Review 2017, Messinger: https://doi.org/10.1542/pir.2016-0183 
• Pediatric Care Online 2016, Light: https://publications.aap.org/pediatriccare/book/348/chapter/5785224/Pneumonia-Chapter-315
• IDSA 2013: https://doi.org/10.1093/cid/cir531 

Prolonged viral upper respiratory symptoms or is it actually sinusitis in disguise? Join us as we discuss all things sinusitis in this episode!

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

Key Points:

• Acute bacterial sinusitis can be clinically diagnosed based on persistent respiratory symptoms lasting more than 10 days without improvement, worsening or new respiratory symptoms after initial improvement, or severe symptoms at onset lasting more than 3 days. 
• First line antibiotic treatment for acute bacterial sinusitis is with amoxicillin or amoxicillin-clavulanate
• Complications include orbital or intracranial spread of infection

Sources:

• Pediatrics in Review 2013, Demuri and Wald: https://doi.org/10.1542/pir.34-10-429 
• AAP Pediatrics 2013, Wald et al: https://doi.org/10.1542/peds.2013-1071  
• Pediatrics 2024, Conway et al: https://doi.org/10.1542/peds.2023-064244  

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Lisa Rasmussen. Drs. Tammy and Lidia take full responsibility for any errors or misinformation. 

Key points:

• Vitamin K is important in preventing early and late onset bleeding in newborns (up to 6 months of age), most importantly, intracranial bleeding. 
• Intramuscular vitamin K is most effective but oral vitamin K regimens are used outside of the US and are better than not giving any vitamin K

Sources/Supplemental Information:

• AAP Pediatrics 2022, Hand: https://doi.org/10.1542/peds.2021-056036

CDC Vitamin K Handout: https://www.cdc.gov/ncbddd/vitamink/vitamin-k-fact-sheet-general.html

Can someone with HIV breastfeed their child? You might be surprised at the answer! 

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

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Laura Kair. Drs. Tammy and Lidia take full responsibility for any errors or misinformation. 

Key points: 

• New guidelines from the CDC recommend allowing mothers with HIV on antiretroviral therapy (ART) with an undetectable viral load to breastfeed their child if they desire, whether or not they live in a developed or underdeveloped country. The risk for HIV transmission through breastmilk in these cases is 0.6% 
• In the US, you can call the national perinatal HIV/AIDS hotline at 1-888-448-8765 for advice 
• 

Sources 

• CDC 2023 Infant Feeding for Individuals with HIV in the US: https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/hiv.html     

Stay up to date with new research on shortening antibiotic treatment duration for urinary tract infections (UTIs) with our episode today where we review a recently published randomized control trial (RCT). Learn how to critically analyze study data and what key points we take away. 

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

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Michelle Hamline. Drs. Tammy and Lidia take full responsibility for any errors or misinformation. 



Key points: 

• A single RCT found similar risk of UTI recurrence in children who received a 5 day course vs 10 day course of antibiotics within the first 30 days  

Sources 

• Pediatrics 2024, Montini et al: https://doi.org/10.1542/peds.2023-062598  
• BMJ 2007, Montini et al: https://doi.org/10.1136/bmj.39244.692442.55  
• Cochrane Rev 2012, Altamimi et al: https://doi.org/10.1002/14651858.CD004872.pub3  
• JAMA Ped 2021, Pernica et al: https://doi.org/10.1001/jamapediatrics.2020.6735  
• JAMA Ped, 2022, Williams et al: https://doi.org/10.1001/jamapediatrics.2021.5547  

Ever seen a tuft of hair over the lower back or a sacral dimple? Learn how to recognize and manage normal vs abnormal back and spinal findings in our episode today. 

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

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Laura Kair. Drs. Tammy and Lidia take full responsibility for any errors or misinformation. 

Key points: 

• Spinal dysraphism is the incomplete fusion of the spine during development. 
• Not all spinal dysphraphisms will have abnormal cutaneous manifestations that you can see on exam 
• Diagnose spinal dysphraphisms with spinal ultrasound in young children and MRI in older children 
• Sacral dimples can be normal but should be worked up if they are larger than 5 mm at the base, above 2.5cm from the anus, not midline, or if there are multiple dimples 

Sources 

• Pediatrics in Review 2019, Holmes and Li: https://doi.org/10.1542/pir.2018-0155  
• Peds in Review 2011, Zywicke and Rozzelle: https://doi.org/10.1542/pir.32-3-109  
• Hospital Pediatrics 2020, Aby et al: https://doi.org/10.1542/hpeds.2019-0264