In this Q&A episode of our Postural Orthostatic Tachycardia Syndrome (POTS) series, host Paul Wirkus, MD, FAAP and guest Kirti Sivakoti, MD, answer listener questions about diagnosing and managing POTS in pediatric patients. The discussion explores how to distinguish POTS from conditions with overlapping symptoms, including Mast Cell Activation Syndrome (MCAS) and other common POTS mimics, and when referral to an immunologist may be appropriate.

We also review commonly used medications for symptom management, including practical considerations for initiating and tapering therapy as patients improve. Additional topics include the effects of caffeine, stimulant medications, ADHD treatments, and vasoconstrictors on orthostatic symptoms, helping clinicians navigate treatment decisions in children and adolescents with complex presentations.

Throughout the episode, Dr. Sivakoti emphasizes the importance of individualized care, careful assessment, and ongoing follow-up to optimize outcomes for patients living with POTS.

Have a question? Email [email protected]. 

For more information about available credit, visit vCurb.com.

ACCME Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians.
 
AMA Credit Designation Statement

Kansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In this episode of our Postural Orthostatic Tachycardia Syndrome (POTS) series, we look beyond diagnosis and treatment to discuss what the future holds for children and adolescents living with POTS. Host Paul Wirkus, MD, FAAP and guest Kirti Sivakoti, MD, review the long-term prognosis, highlighting what is currently known about recovery, symptom progression, and functional outcomes over time.

The conversation also explores the complex relationship between POTS and other conditions, including the impact of COVID-19, eating disorders, chronic pain syndromes, and functional neurologic disorders. We discuss how these overlapping conditions can influence diagnosis, management, and quality of life, and examine where current research is headed as our understanding of POTS continues to evolve.

Finally, our Dr. Sivakoti shares what they believe is the most misunderstood aspect of POTS and identifies one of the most undervalued interventions that can make a meaningful difference for patients. This episode offers practical insights into the evolving science of POTS while reinforcing the importance of a comprehensive, individualized approach to care.

Have a question? Email [email protected]. Listener questions will be answered next week.

For more information about available credit, visit vCurb.com.

ACCME Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians.
 
AMA Credit Designation Statement

Kansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In Episode 2 of our series on Postural Orthostatic Tachycardia Syndrome (POTS), we focus on evidence-based treatment strategies to help children and adolescents manage symptoms and improve daily functioning. Host Paul Wirkus, MD, FAAP and guest Kirti Sivakoti, MD, review the foundation of POTS management, emphasizing lifestyle interventions such as maintaining adequate hydration, increasing salt intake when appropriate, establishing healthy sleep habits, and implementing a gradual, structured exercise program.

The discussion also explores the role of nutrition, compression garments, and heat avoidance in reducing symptom burden, along with practical accommodations that can support patients at school and in everyday activities. Finally, we review pharmacologic treatment options, discussing when medications may be appropriate and how they fit into an individualized care plan. Throughout the episode, the emphasis is on developing a comprehensive, patient-centered approach that helps children and adolescents regain function and improve their quality of life.

Have a question? Email [email protected]. Listener questions will be answered in episode four. 

For more information about available credit, visit vCurb.com.

ACCME Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians.
 
AMA Credit Designation Statement

Kansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This month we begin a new series on Postural Orthostatic Tachycardia Syndrome (POTS), exploring the diagnosis and management of this increasingly recognized condition in pediatric patients. In this episode, host Paul Wirkus, MD, FAAP and guest Kirti Sivakoti, MD, provide an overview of POTS before discussing current approaches to diagnosis and recent updates in the field. We review the diagnostic criteria, including orthostatic symptoms and the degree of functional impairment, and consider how these factors help guide clinical evaluation and management.

The conversation also examines the growing understanding of POTS as a spectrum disorder, with many patients experiencing overlapping symptoms and contributing conditions. Finally, we discuss how to distinguish POTS from vasovagal syncope and review current thinking on the underlying causes and pathophysiology of POTS. This episode provides pediatricians with a practical framework for recognizing and evaluating children and adolescents with orthostatic intolerance.

Have a question? Email [email protected]. Listener questions will be answered in episode four. 

For more information about available credit, visit vCurb.com.

ACCME Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians.
 
AMA Credit Designation Statement

Kansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In months with five weeks, The Virtual Curbside takes a break from clinical topics for a pediatric book club discussion. This month, host Paul Wirkus, MD, FAAP, is joined by regular book club guest Angelo Giardino, MD, FAAP, and a special guest, fifth-grader Harry Thatcher, to discuss The Anxious Generation: A Graphic Novel by Jonathan Haidt.

Together, they explore the book's central themes through the lens of two very different childhoods, comparing the play-based experiences of previous generations with today's phone-based childhoods. Harry offers a unique perspective as a member of the generation at the center of the discussion, while Drs. Wirkus and Giardino reflect on how growing up in a different era shaped their own experiences. The conversation examines the impact of technology, social connection, and unstructured play on child development, mental health, and what these changes mean for pediatricians and the families they serve.

No credit available for this episode. See vcurb.com for additional episodes.

In this Q&A episode of our pediatric neurology series, we answer listener questions about some of the most rapidly evolving areas in neurology and genetics. The discussion begins with the relationship between child abuse evaluations and Brief Resolved Unexplained Events (BRUE), including important considerations when assessing infants with unexplained symptoms.

Host Paul Wirkus, MD, FAAP and guest Josh Bonkowsky, MD then explore the neurologic basis of developmental disorders and the growing role of advanced diagnostics such as genome sequencing and MRI. Our guests discuss how these tools can provide valuable insights into underlying conditions and increasingly influence treatment decisions and long-term care planning.

The conversation also examines the complex relationship between genes, brain development, and the symptoms children experience. As genetic testing becomes more widely available, we consider the promise of gene therapy, the emerging field of precision medicine, and realistic timelines for translating these advances into everyday clinical practice. Finally, we discuss the benefits of obtaining a genetic diagnosis-even when a cure is not yet available-including connecting families with resources, reducing isolation, informing future care decisions, and the potential expansion of newborn screening programs as genetic therapies continue to develop.

Have a question? Email [email protected]. Listener questions will be answered in episode four. 

For more information about available credit, visit vCurb.com.

ACCME Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians.
 
AMA Credit Designation Statement

Kansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In this episode of our pediatric neurology series, host Paul Wirkus, MD, FAAP and guest Josh Bonkowsky, MD explore the rapidly evolving field of gene therapy and its potential to transform the care of children with neurologic disorders. Our guest explains the science behind gene therapy, including how these treatments work to target the underlying causes of genetic disease.

The conversation also examines emerging approaches to gene editing and the exciting possibilities these technologies hold for the future of pediatric medicine. Alongside the promise of these innovations, we discuss the challenges, ethical considerations, and unanswered questions that accompany this new era of precision medicine.

Throughout the episode, our guest emphasizes the importance of helping patients and families understand complex treatment options so they can make informed decisions as the landscape of genetic diagnosis and therapy continues to evolve.

Have a question? Email [email protected]. Listener questions will be answered in episode four. 

For more information about available credit, visit vCurb.com.

ACCME Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians.
 
AMA Credit Designation Statement

Kansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In Episode 2 of our pediatric neurology series, we explore how advances in diagnostic technology have transformed the field of neurology. Our guests discuss the evolution of neurologic evaluation - from early ultrasound imaging to CT and MRI - and how modern imaging has revolutionized the ability to diagnose and understand neurologic disease in children.

Host Paul Wirkus, MD, FAAP and guest Josh Bonkowsky, MD also examine the growing role of genomic testing, which is increasingly available in clinical practice and providing families with greater diagnostic clarity. Alongside these advances come important philosophical and ethical questions: What is the value of diagnosing a condition when no cure exists? How much information do families want, and how should that information be shared?

Our guest discusses a “leveled results” approach to genomic testing, emphasizing shared decision-making and giving families meaningful input into how much information they receive. Throughout the episode, the focus remains on helping patients and families make informed decisions while navigating uncertainty with compassion and transparency.

Have a question? Email [email protected]. Listener questions will be answered in episode four. 

For more information about available credit, visit vCurb.com.

ACCME Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians.
 
AMA Credit Designation Statement

Kansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This month we begin a new series on pediatric neurology issues, starting with a discussion with Josh Bonkowsky, MD, PhD, about his book Dancing Eyes, Dancing Feet. In this episode, our host Paul Wirkus, MD, FAAP and Dr. Bonkowsky trace the evolution of how clinicians understand and approach unexplained events in infants and children - from Sudden Infant Death Syndrome (SIDS) to Apparent Life-Threatening Events (ALTE), and more recently, Brief Resolved Unexplained Events (BRUE) and Functional Neurological Disorder (FND).

The conversation explores how terminology, diagnostic approaches, and clinical thinking have changed over time, as well as the challenges providers face when balancing reassurance, evaluation, and uncertainty. We also discuss the important roles of the child’s pediatrician and pediatric hospitalists in coordinating care, supporting families, and guiding follow-up after these often frightening events.

Have a question? Email [email protected]. Listener questions will be answered in episode four. 

For more information about available credit, visit vCurb.com.

ACCME Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians.
 
AMA Credit Designation Statement

Kansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In this Q&A episode of our infant formula and nutrition series, host Paul Wirkus, MD, FAAP and guest Steve Abrams, MD address common questions pediatricians hear from families during the newborn period. The discussion explores the role of lactose in infant formula, including when lactose-free options may - or may not - be appropriate. We also talk about normal newborn fussiness in the first weeks of life and how clinicians can help families distinguish typical infant behavior from signs that warrant further evaluation.

The episode also reviews formula fortification, with a focus on preterm and NICU infants who may require additional nutritional support for growth and development. Our guests discuss when fortification is indicated, practical considerations for outpatient follow-up, and how pediatricians can guide families through feeding decisions with clear, evidence-based counseling.

Have a question? Email [email protected]. 

For more information about available credit, visit vCurb.com.

ACCME Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians.
 
AMA Credit Designation Statement

Kansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.