The MCG Pediatric Podcast

There has long since been a knowledge gap in medical education regarding care of LGBTQIA+ patients. This has manifested itself in health disparities that detrimentally affect the LGBTQIA+ population. This podcast serves as a way to start bridging the gap on order to mitigate the effects of bias, discrimination, and prejudice that queer patients often face in health care. Research has shown that consistent, early exposure in medical education to patients from the queer community has been beneficial in preparing future practitioners for gender inclusive care. We must also do our parts as pediatricians to make sure our queer youth grow into confident, thriving queer adults. 

Join Dr. Farrah-Amoy Fullerton, a recent graduate of the pediatric residency program at MCG, and Professor of Pediatrics, Dr. Lisa Leggio, as they introduce LGBTQIA+ health care disparities and describe ways to bridge the gap for eager general practitioners who would like to know more.

CME Credit (requires free sign up):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19523 

References:

1. Bonvicini, K. A. (2017). LGBT healthcare disparities: What progress have we made? Patient Education and Counseling, 100(12), 2357–2361. https://doi.org/10.1016/j.pec.2017.06.003

With the rise of social media, there has also been a rise in cyberbullying. Dr. Ruth Osondu, a child and adolescent psychiatry fellow joins Dr. Dale Peeples a child and adolescent psychiatrist and medical student Bailey Allen to discuss what pediatricians, parents, and teens should know about cyberbullying and suicide risks. Specifically, they will:

1. Educate the listener and general community on signs a child/teenager at risk for suicide.

CME Credit (requires free sign up):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19521

References:

Bauman S. Cyberbullying: What Does Research Tell Us? Theory Into Practice, Emerging Issues in School Bullying Research. 2013;52(4): 249-256. DOI: 10.1080/00405841.2013.829727

Chan T, Cheun C, Lee Z. Cyberbullying on Social Networking Sites: A Literature Review and and Future Research Directions. Information and Management. 2021;58(2):103411. https://doi.org/10.1016/j.im.202.103411.

Earls M, Foy J, Green C.  “Mental Health Tools for Pediatrics”, Addressing Mental Health Concerns in Pediatrics: A Practical Resource Toolkit for Clinicians. American Academy of Pediatrics. February 2021. https://doi.org/10.1542/9781610024624-2e_s2_02_MH_tools_for_pediatrics

Englander E, Donnerstein E, Kowalski R, Lin CA, Parti K. Defining Cyberbullying. Pediatrics. 2017 Nov;140(Suppl 2):S148-S151. doi: 10.1542/peds.2016-1758U. PMID: 29093051.

Englander E. Back to the Drawing Board With Cyberbullying. JAMA Pediatr. 2019 Jun 1;173(6):513-514. doi: 10.1001/jamapediatrics.2019.0690. PMID: 31009032.

Hamm MP, Newton AS, Chisholm A, Shulhan J, Milne A, Sundar P, Ennis H, Scott SD, Hartling L. Prevalence and Effect of Cyberbullying on Children and Young People: A Scoping Review of Social Media Studies. JAMA Pediatr. 2015 Aug;169(8):770-7. doi: 10.1001/jamapediatrics.2015.0944. PMID: 26098362.

John A, Glendenning AC, Marchant A, Montgomery P, Stewart A, Wood S, Lloyd K, Hawton K. Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review. J Med Internet Res. 2018 Apr 19;20(4):e129. doi: 10.2196/jmir.9044. PMID: 29674305; PMCID: PMC5934539.

Timmons-Mitchell J, Flannery D; What Pediatricians Should Know and Do about Cyberbullying. Pediatr Rev. July 2020; 41 (7): 373–375. https://doi.org/10.1542/pir.2019-0165

Tozzo P, Cuman O, Moratto E, Caenazzo L. Family and Educational Strategies for Cyberbullying Prevention: A Systematic Review. Int J Environ Res Public Health. 2022 Aug 22;19(16):10452. doi: 10.3390/ijerph191610452. PMID: 36012084; PMCID: PMC9408628.

John A, Glendenning AC, Marchant A, Montgomery P, Stewart A, Wood S, Lloyd K, Hawton K. Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review. J Med Internet Res. 2018 Apr 19;20(4):e129. doi: 10.2196/jmir.9044. PMID: 29674305; PMCID: PMC5934539.

Walrave, Michel, and Wannes Heirman. "Cyberbullying: Predicting victimisation and perpetration." Children & Society 25.1 (2011): 59-72.

Did you know that the treatments used to cure pediatric cancers can potentially cause a life-threatening event known as tumor lysis syndrome (TLS)? Arfa Ul-Haque and Yazmin Reategui, two third-year medical students, are joined by Pediatric intensivist, Dr. Smitha Mathew, to discuss the evaluation and management for TLS so that it is promptly recognized and treated in the inpatient hospital setting.  

Specifically, they will: 

• Review the basic assessment skills and evaluation for a child presenting with potential TLS  

CME Credit (requires free sign up):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19520

References:

1. Tumor lysis syndrome. (2022, October 4). Medscape.com. https://emedicine.medscape.com/article/282171-overview

Did you know that undiagnosed developmental dysplasia of the hip (DDH) is the most common cause of arthritis in women under 40? Dr. Melissa Allen, a Pediatric Orthopedic Surgeon, joins 3rd year Pediatric Resident Erica DeMaagd and 4th year medical student Jacob Weiser to discuss the evaluation and management for DDH.  Specifically, they will teach how to: 

• Recognize common history and physical exam findings associated with hip dysplasia.

Special thanks to Dr. Lisa Leggio and Dr. Rebecca Yang for peer reviewing this episode.

CME Credit (requires free sign up):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19519

References:

Auriemma, J., & Potisek, N. M. (2018). Developmental dysplasia of the hip. Pediatrics In Review, 39(11), 570–572. https://doi.org/10.1542/pir.2017-0239

Barrera, C. A., Cohen, S. A., Sankar, W. N., Ho-Fung, V. M., Sze, R. W., & Nguyen, J. C. (2019). Imaging of Developmental Dysplasia of the hip: Ultrasound, Radiography and Magnetic Resonance Imaging. Pediatric Radiology, 49(12), 1652–1668. https://doi.org/10.1007/s00247-019-04504-3

Centers for Disease Control and Prevention. (2022, December 8). Important Milestones: Your Baby by One Year. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-1yr.html

Imrie, M., Scott, V., Stearns, P., Bastrom, T., & Mubarak, S. J. (2010). Is Ultrasound Screening for DDH in Babies Born Breech Sufficient? Journal of Children’s Orthopaedics, 4(1), 3–8. Larson, J. E., Patel, A. R., Weatherford, B., & Janicki, J. A. (2019). Timing of Pavlik Harness Initiation: Can We wait? Journal of Pediatric Orthopaedics, 39(7), 335–338. https://doi.org/10.1097/bpo.0000000000000930

Mahan, S. T., Katz, J. N., & Kim, Y.-J. (2009). To Screen or Not to Screen? A Decision Analysis of the Utility of Screening for Developmental Dysplasia of the Hip. The Journal of Bone and Joint Surgery-American Volume, 91(7), 1705–1719. https://doi.org/10.2106/jbjs.h.00122

Nemeth, B. A., & Narotam, V. (2012). Developmental Dysplasia of the Hip. Pediatrics in Review, 33(12), 553–561. https://doi.org/10.1542/pir.33-12-553

Novais, E. (2018). Pavlik Harness. Boston, MA; Boston Children’s Hospital Child and Young Adult Hip Preservation Program.

Shaw BA, Segal LS, AAP SECTION ON ORTHOPAEDICS. Evaluation and Referral for                                    Developmental Dysplasia of the Hip in Infants. Pediatrics. 2016;138(6):e20163107

Scott Yang, Natalie Zusman, Elizabeth Lieberman, Rachel Y. Goldstein; Developmental Dysplasia of the Hip. Pediatrics January 2019; 143 (1): e20181147. 10.1542/peds.2018-1147

Community acquired pneumonia is unfortunately a common condition seen in children of all ages. Dr. Jacob Eichenberger, an associate professor of pediatrics at MCG and a pediatric hospitalist at the Children's Hospital of Georgia, joins recently graduated pediatric resident, Dr. Fahim Thawer, and medical student Sara Attari to discuss the evaluation and management of community acquired pneumonia.

Specifically, they will:

• Discuss common history and physical exam findings associated with community acquired pneumonia

CME Link (requires login): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19518

Coughs are one of the most common symptoms of childhood illness. But when should we start to get worried? What is a child’s cough trying to tell you? Dr. Sunil Kapoor, a Pediatric Pulmonology Physician, joins Dr. Rebecca Yang and medical student Aparna Prasad to discuss the evaluation and management of chronic cough in children.  Specifically, they will: 

• Review the history and physical examination for a child presenting with a chronic cough

Special thanks to Dr. Dionne Adair, Dr.Sunil Kapoor, and Dr. Rebecca Yang for peer reviewing this episode.

CME Credit (requires free sign up):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19516 

References:

1. Marchant, J. (2021, September 30). Causes of chronic cough in children. UpToDate. Retrieved June 2, 2022, from https://www.uptodate.com/contents/causes-of-chronic-cough-in-children?search=common+causes+of+chronic+cough+in+young+kids&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1   

Did you know around 15 to 25% of children will have at least one syncopal episode before adulthood? Join medical students Sanya Dudani and Caleb Robertson, along with Pediatric Cardiologist Dr. John Plowden, as they discuss the evaluation and management of syncope in the pediatric patient.  Specifically, they will:

• Discuss the definition of syncope and its underlying pathophysiology

Special thanks to Dr. Rebecca Yang and Dr. Melissa Lefebvre for peer reviewing this episode!

CME Credit (requires free sign up):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19514 

References:

Arthur W, Kaye GC  The pathophysiology of common causes of syncope  Postgraduate Medical Journal 2000;76:750-753.

Cipolla MJ. The Cerebral Circulation. San Rafael (CA): Morgan & Claypool Life Sciences; 2009. Chapter 5, Control of Cerebral Blood Flow. Available from: https://www.ncbi.nlm.nih.gov/books/NBK53082/

Clark, BC, Hayman, JM, Berul, CI, Burns, KM, and Kaltman, JR. Selective use of the electrocardiogram in pediatric preparticipation athletic examinations among pediatric primary care providers. Ann Noninvasive Electrocardiol. 2017; 22:e12446. https://doi.org/10.1111/anec.12446]

De, A. and Davidson Ward, S.L. (2014), Syncope at altitude: An enigmatic case. Pediatr Pulmonol., 49: E144-E146. https://doi.org/10.1002/ppul.23062

Gupta A, Menoch M, Levasseur K, Gonzalez IE. Screening Pediatric Patients in New-Onset Syncope (SPINS) Study. Clinical Pediatrics. 2020;59(2):127-133. doi:10.1177/0009922819885660

Hainsworth, R. Pathophysiology of syncope. Clin Auton Res 14 (Suppl 1), i18–i24 (2004). https://doi.org/10.1007/s10286-004-1004-2

Phillip A. Low, Paola Sandroni, Chapter 106 - Postural Tachycardia Syndrome (POTS), Editor(s): David Robertson, Italo Biaggioni, Geoffrey Burnstock, Phillip A. Low, Julian F.R. Paton, Primer on the Autonomic Nervous System (Third Edition), Academic Press, 2012, Pages 517-519, ISBN 9780123865250, https://doi.org/10.1016/B978-0-12-386525-0.00106-2

Zavala, Rennette MD∗; Metais, Benjamin MD†; Tuckfield, Lynnia BS‡; DelVecchio, Michael MD‡; Aronoff, Stephen MD, MBA‡. Pediatric Syncope: A Systematic Review. Pediatric Emergency Care: September 2020 - Volume 36 - Issue 9 - p 442-445 doi: 10.1097/PEC.0000000000002149 

Did you know that 80% of children with biliary atresia who undergo a Kasai procedure will still require liver transplant at some point in their life? Dr. Bade, a pediatric gastroenterologist, joins medical students Tucker Oliver and Sarah Chappell to discuss evaluation and management of infants with biliary atresia. Specifically, they will:

• Discuss the presentation and diagnosis of biliary atresia

Special thanks to Dr. Rebecca Yang and Dr. Jennifer Tucker for peer reviewing this episode.

FREE CME Credit (requires free sign-up): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19513 

References: 

1]          P. J. Lupo et al., “Population-based birth defects data in the United States, 2010-2014: A focus on gastrointestinal defects.,” Birth Defects Res, vol. 109, no. 18, pp. 1504–1514, Nov. 2017, doi: 10.1002/bdr2.1145.

[2]         J. L. Hartley, M. Davenport, and D. A. Kelly, “Biliary atresia,” The Lancet, vol. 374, no. 9702, pp. 1704–1713, Nov. 2009, doi: 10.1016/S0140-6736(09)60946-6.

[3]         S. S. Sundaram, C. L. Mack, A. G. Feldman, and R. J. Sokol, “Biliary atresia: Indications and timing of liver transplantation and optimization of pretransplant care.,” Liver Transpl, vol. 23, no. 1, pp. 96–109, Jan. 2017, doi: 10.1002/lt.24640.

[4]         D. Volpert, F. White, M. J. Finegold, J. Molleston, M. DeBaun, and D. H. Perlmutter, “Outcome of Early Hepatic Portoenterostomy for Biliary Atresia,” J Pediatr Gastroenterol Nutr, vol. 32, no. 3, pp. 265–269, Mar. 2001, doi: 10.1097/00005176-200103000-00006.

[5]         R. Fawaz et al., “Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.,” J Pediatr Gastroenterol Nutr, vol. 64, no. 1, pp. 154–168, Jan. 2017, doi: 10.1097/MPG.0000000000001334.

[6]         P. H. Y. Chung et al., “Life long follow up and management strategies of patients living with native livers after Kasai portoenterostomy.,” Sci Rep, vol. 11, no. 1, p. 11207, May 2021, doi: 10.1038/s41598-021-90860-w.

[7]         E. H. Gad, Y. Kamel, T. A.-H. Salem, M. A.-H. Ali, and A. N. Sallam, “Short- and long-term outcomes after Kasai operation for type III biliary atresia: Twenty years of experience in a single tertiary Egyptian center-A retrospective cohort study.,” Ann Med Surg (Lond), vol. 62, pp. 302–314, Feb. 2021, doi: 10.1016/j.amsu.2021.01.052.

[8]         A. M. Calinescu et al., “Cholangitis Definition and Treatment after Kasai Hepatoportoenterostomy for Biliary Atresia: A Delphi Process and International Expert Panel.,” J Clin Med, vol. 11, no. 3, Jan. 2022, doi: 10.3390/jcm11030494.

[9]         S. Kiriyama et al., “Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos),” J Hepatobiliary Pancreat Sci, vol. 25, no. 1, pp. 17–30, Jan. 2018, doi: 10.1002/jhbp.512.

[10]      K. Decharun, C. M. Leys, K. W. West, and S. M. E. Finnell, “Prophylactic Antibiotics for Prevention of Cholangitis in Patients With Biliary Atresia Status Post-Kasai Portoenterostomy,” Clin Pediatr (Phila), vol. 55, no. 1, pp. 66–72, Jan. 2016, doi: 10.1177/0009922815594760.

[11]      E. Jung, W.-H. Park, and S.-O. Choi, “Late complications and current status of long-term survivals over 10 years after Kasai portoenterostomy.,” J Korean Surg Soc, vol. 81, no. 4, pp. 271–5, Oct. 2011, doi: 10.4174/jkss.2011.81.4.271.

[12]      S. S. Sundaram et al., “Health related quality of life in patients with biliary atresia surviving with their native liver.,” J Pediatr, vol. 163, no. 4, pp. 1052–7.e2, Oct. 2013, doi: 10.1016/j.jpeds.2013.04.037.

[13]      B. L. Shneider et al., “Efficacy of fat-soluble vitamin supplementation in infants with biliary atresia.,” Pediatrics, vol. 130, no. 3, pp. e607-14, Sep. 2012, doi: 10.1542/peds.2011-1423.

[14]      J. P. Molleston and B. L. Shneider, “Preventing variceal bleeding in infants and children: is less more?,” Gastroenterology, vol. 145, no. 4, pp. 719–22, Oct. 2013, doi: 10.1053/j.gastro.2013.08.026.

[15]      G. Grisotti and R. A. Cowles, “Complications in pediatric hepatobiliary surgery,” Semin Pediatr Surg, vol. 25, no. 6, pp. 388–394, Dec. 2016, doi: 10.1053/j.sempedsurg.2016.10.004.

[16]      F. R. Sinatra, “Consultation with the Specialist: Liver Transplantation for Biliary Atresia,” Pediatr Rev, vol. 22, no. 5, pp. 166–168, May 2001, doi: 10.1542/pir.22-5-166.

[17]      I. Sriram and D. Nicklas, “Biliary Atresia,” Pediatr Rev, vol. 43, no. 11, pp. 659–661, Nov. 2022, doi: 10.1542/pir.2021-005287.

[18]      L. H. Rodijk et al., “Parental wellbeing after diagnosing a child with biliary atresia: A prospective cohort study.,” J Pediatr Surg, vol. 57, no. 4, pp. 649–654, Apr. 2022, doi: 10.1016/j.jpedsurg.2021.05.026.

[19]      A. Sanchez-Valle, N. Kassira, V. C. Varela, S. C. Radu, C. Paidas, and R. S. Kirby, “Biliary Atresia: Epidemiology, Genetics, Clinical Update, and Public Health Perspective.,” Adv Pediatr, vol. 64, no. 1, pp. 285–305, Aug. 2017, doi: 10.1016/j.yapd.2017.03.012.

Did you know that salicylate containing substances alone were responsible for over 6,000 cases of pediatric poison exposures in 2020? Dr. Arden Conway, a Pediatric Critical Care Physician, joins Medical Students Morgan Franklin and Ifrah Waris to discuss the evaluation and management for salicylate overdose in a pediatric patient. Specifically, they will: 

• Review the pathophysiology of salicylate toxicity

Special thanks to Dr. Rebecca Yang and Dr. Jennifer Tucker for peer reviewing this episode.

FREE CME Credit (requires free sign-up): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19512 

References: 

Anderson, M. (2021). Initial management of suspected poisoning in children and young people. Paediatrics and Child Health, 31(10), 382-387.

Chyka PA, Erdman AR, Christianson G, Wax PM, Booze LL, Manoguerra AS, Caravati EM, Nelson LS, Olson KR, Cobaugh DJ, Scharman EJ, Woolf AD, Troutman WG; Americal Association of Poison Control Centers; Healthcare Systems Bureau, Health Resources and Sevices Administration, Department of Health and Human Services. Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(2):95-131. doi: 10.1080/15563650600907140.

Darracq, M. A., & Cantrell, F. L. (20136). Hemodialysis and extracorporeal removal after pediatric and adolescent poisoning reported to a state poison center. The Journal of Emergency Medicine., 44(6), 1101–1107. https://doi.org/10.1016/j.jemermed.2012.12.018

Espírito Santo, R., Vaz, S., Jalles, F., Boto, L., & Abecasis, F. (2017). Salicylate Intoxication in an Infant: A Case Report. Drug safety - case reports, 4(1), 23. https://doi.org/10.1007/s40800-017-0065-9

Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Bronstein AC, Rivers LJ, Pham NPT, Weber J. 2020 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021 Dec;59(12):1282-1501. doi: 10.1080/15563650.2021.1989785.

Mukerji V, Alpert MA, Flaker GC, Beach CL, Weber RD. Cardiac conduction abnormalities and atrial arrhythmias associated with salicylate toxicity. Pharmacotherapy. 1986 Jan-Feb;6(1):41-3. doi: 10.1002/j.1875-9114.1986.tb03449.x.

Palmer, B. F., & Clegg, D. J. (2020). Salicylate toxicity. New England Journal of Medicine, 382(26), 2544-2555.

Runde TJ, Nappe TM. Salicylates Toxicity. [Updated 2021 Jul 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499879/

Immunizations are a critical component of the well child management in pediatric patients, as they are responsible for the prevention of numerous serious diseases with devastating consequences even if adequately treated. While many providers are well versed in the standard immunization schedule for children, the care and management of under-immunized children may present itself a challenge. Join Dr. Shreeti Kapoor, a general pediatrician for over 25 years, and recent Pediatric Resident graduate, Dr. Monique Bailey as they discuss caring for under-immunized children. Specifically, they will:

• Review the recommended vaccination schedule for all children, with a focus on those aged 0-4 years.

FREE CME Credit (requires free sign-up):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19511

References:  

Centers for Disease Control and Prevention. (2022, February 17). Birth-18 years immunization schedule. Centers for Disease Control and Prevention. Retrieved April 5, 2022, from https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

Centers for Disease Control and Prevention. (2022, February 17). Catch-up immunization schedule. Centers for Disease Control and Prevention. Retrieved April 5, 2022, from https://www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html

Finkel, L. , Ospina-Jimenez, C. , Byers, M. & Eilbert, W. (2021). Fever Without Source in Unvaccinated Children Aged 3 to 24 Months. Pediatric Emergency Care, 37 (12), e882-e885. doi: 10.1097/PEC.0000000000002249.

Starr M. (2013). Paediatric travel medicine: vaccines and medications. British journal of clinical pharmacology, 75(6), 1422–1432. https://doi.org/10.1111/bcp.12035

NHS. (2019, April 26). BCG vaccine for tuberculosis (TB) overview. NHS choices. Retrieved April 6, 2022, from https://www.nhs.uk/conditions/vaccinations/bcg-tuberculosis-tb-vaccine/

Centers for Disease Control and Prevention. (2019, October 30). Typhoid vaccine information statement. Centers for Disease Control and Prevention. Retrieved April 6, 2022, from https://www.cdc.gov/vaccines/hcp/vis/vis-statements/typhoid.html#:~:text=There%20are%20two%20vaccines%20to,as%20an%20injection%20(shot)

Lopez, A. L., Gonzales, M. L., Aldaba, J. G., & Nair, G. B. (2014). Killed oral cholera vaccines: history, development and implementation challenges. Therapeutic advances in vaccines, 2(5), 123–136. https://doi.org/10.1177/2051013614537819

Lee DID, Vanderhout S, Aglipay M, Birken CS, Morris SK, Piché-Renaud PP, Keown-Stoneman CDG, Maguire JL. Delay in childhood vaccinations during the COVID-19 pandemic. Can J Public Health. 2022 Feb;113(1):126-134. doi: 10.17269/s41997-021-00601-9

Kroger A, Bahta L, Hunter P. General best practice guidelines for immunization. Best practices guidance of the Advisory Committee on Immunization Practices (ACIP). Special situations. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/special-situations.html