Let’s briefly discuss the new 2023 AAP obesity guidelines in this episode.Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com  This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Sean Munoz. Drs. Tammy and Lidia take full responsibility for any errors or misinformation. Key points:-Obesity is now the most common chronic disease of childhood-Children 10 years of age and older with obesity should have lipid, A1c, and ALT checked.-Children ages 2-9 with obesity should have lipid checked and potentially ALT-Treatment is multimodal and includes lifestyle modification, medications, and surgery.AAP 2023 obesity guidelines:https://publications.aap.org/pediatrics/article/151/2/e2022060640/190443/Clinical-Practice-Guideline-for-the-Evaluation-andNPR: AAP’s new childhood obesity guidance raises worries over the risk of eating disordershttps://www.npr.org/2023/02/15/1155521908/eating-disorder-obesity-guidance-risk-weight-lossUSA Today: Weight loss drugs and surgery- for kids? Why new obesity guidance is drawing scrutinyhttps://www.usatoday.com/story/news/health/2023/01/19/aap-childhood-obesity-guidelines-scrutiny/11039166002/2012 Dyslipidemia Screeninghttps://publications.aap.org/pediatrics/article/146/1_MeetingAbstract/636/4732/Pediatric-dyslipidemia-screening-by-pediatricians

Want to quickly become a pro at family centered rounds? Learn the basics as well as the tips and tricks on how to navigate presenting in a patient-first and family-friendly way.Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com  This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Jessica Witkowski. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.  Key points: -Family centered rounds should involve the patient, family, and all relevant medical team members. Allow space for everyone to be heard and opportunity for questions.-Make sure to include all the same important information as a traditional presentation, but without medical jargon. Direct your presentation at the patient and familySources:2021 AAP Hospital Pediatrics: https://publications.aap.org/hospitalpediatrics/article/11/7/679/179865/Implementing-Family-Centered-Rounds-in-Hospital?autologincheck=redirected 2018 AAP Pediatrics: https://publications.aap.org/pediatrics/article-abstract/141/3/e20171883/37598/Families-Experiences-With-Pediatric-Family?redirectedFrom=fulltext 2022 Michigan Medicine: https://www.ncbi.nlm.nih.gov/books/NBK582289/

Help my kid has a UTI! Does cranberry juice have any benefit for UTIs? Find out with us in today’s episode about urinary tract infections (UTIs)! Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at pediagogypod@gmail.com  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: -A fever may be your only symptom in a young child with a UTI-If you think it’s a UTI, get a clean specimen for culture. A positive culture has more than 50k CFUs/ml on a catheter sample and more than 100k CFUs/ml on a clean catch/void sample.-Most common bacteria causing UTIs are E. coli, Klebsiella, Proteus, Enterococcus, and Enterobacter-Simple cystitis may only need 3-10 days of treatment depending on age, whereas pyelonephritis needs 10-14 days.Sources2021 AAP UTI Management: https://publications.aap.org/pediatrics/article/147/2/e2020012138/36243/Contemporary-Management-of-Urinary-Tract-Infection 2016 AAP Reaffirmation of Clinical Guideline: https://publications.aap.org/pediatrics/article/138/6/e20163026/52686/Reaffirmation-of-AAP-Clinical-Practice-Guideline UTI risk calculator: https://uticalc.pitt.edu/ CDC Urine Culture Stewardship: https://www.cdc.gov/hai/prevent/cauti/index.html 2023 UTI treatment duration: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2806198 2012 Cranberry Juice for UTIs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027998/ 2020 Comparative Effectiveness of Antibiotic Treatment Duration in Children With Pyelonephritis: https://pubmed.ncbi.nlm.nih.gov/32364593/

Seizures can be scary and fevers aren't fun but we'll teach you why simple febrile seizures aren't so bad in this episode!  Follow us on Twitter @Pediagogypod and connect with us at pediagogypod@gmail.com  This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Shannon Liang, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.  Key points: -Simple febrile seizures are generalized, less than 15 minutes, and occur no more than once in a 24-hour period. -No work-up or treatment is recommended for simple febrile seizures  Supplemental information 2011 AAP Pediatrics guidelines: https://publications.aap.org/pediatrics/article/127/2/389/65189/Febrile-Seizures-Guideline-for-the-Neurodiagnostic  2019 AAP Pediatrics - Post Vaccination Febrile Seizure Severity and Outcome https://publications.aap.org/pediatrics/article/143/5/e20182120/37133/Postvaccination-Febrile-Seizure-Severity-and 2010 AAP Pediatrics - MMRV Combination Vaccine and the Risk of Febrile Seizures: https://publications.aap.org/pediatrics/article/126/1/e1/68346/Measles-Mumps-Rubella-Varicella-Combination

Learn about management of newborn jaundice in our 2-part series.   Follow us on Twitter @Pediagogypod and connect with us at pediagogypod@gmail.com  This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Daphne Say, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.  Key points:   -Unconjugated bilirubin is fat soluble so can cross the blood brain barrier and cause kernicterus -Check bilirubin levels at least every 24 hours while a newborn is first hospitalized -New AAP guidelines on hyperbilirubinemia management raised phototherapy and exchange transfusion thresholds -Transcutaneous bilirubin monitoring has a +/- 3 margin of error Supplemental Information 2022 AAP Pediatrics Guidelines: https://publications.aap.org/pediatrics/article/150/3/e2022058859/188726/Clinical-Practice-Guideline-Revision-Management-of?autologincheck=redirected  2012 Journal of Perinatology – Hyperbilirubinemia in Infants https://www.nature.com/articles/jp201271#Tab1  2014 AAP Pediatrics - Transcutaneous Bilirubin After Phototherapy in Term and Preterm Infants https://publications.aap.org/pediatrics/article/134/5/e1324/75870/Transcutaneous-Bilirubin-After-Phototherapy-in?autologincheck=redirected

In the first installment of this 2-part episode, we break down the causes of unconjugated (indirect) and conjugated (direct) hyperbilirubinemia.  Follow us on Twitter @Pediagogypod and connect with us at pediagogypod@gmail.com  This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Daphne Say, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.  Key points: -Unconjugated hyperbilirubinemia causes are due to increased bilirubin production, decreased liver conjugation, or decreased clearance -Conjugated hyperbilirubinemia can be due to outflow or transport problem, infection, metabolic disorders, liver dysfunction, and parenteral nutrition -Always consider biliary atresia in a newborn with pale white stools. The earlier the surgical treatment, the better outcomes Supplemental Information 2017 Pediatrics in Review - Jaundice: Newborn to Age 2 months https://publications.aap.org/pediatricsinreview/article/38/11/499/35001/Jaundice-Newborn-to-Age-2-Months?autologincheck=redirected

Join us today where we discuss one of the most common causes of microcytic anemia in pediatric patients.  Follow us on Twitter @Pediagogypod and connect with us at pediagogypod@gmail.com  This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Anjali Pawar, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.  Key points: -Excessive milk consumption inhibits iron absorption. Limit to 16-24 oz/day  -Iron supplementation dosing depends on gestational age and major food source. Prevention vs treatment dosing also differ. -Mentzer index greater than 13 indicates iron deficiency anemia Supplemental information 2010 AAP Pediatrics guidelines: https://publications.aap.org/pediatrics/article/126/5/1040/65343/Diagnosis-and-Prevention-of-Iron-Deficiency-and?autologincheck=redirected  2020 JAMA Network – vitamin C and irom deficiency anemia: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772395#:~:text=Vitamin%20C%20is%20the%20only,shown%20to%20promote%20iron%20absorption.&text=Iron%20absorption%20occurs%20predominantly%20in,small%20intestine%20mucosal%20epithelial%20cells 2017 AAP Pediatrics in Review – infant nutrition: https://publications.aap.org/pediatricsinreview/article/38/10/449/32000/Updates-in-Infant-Nutrition 2014 Neuropsychiatric Disease and Treatment – iron deficiency anemia and cognitive function: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235202/

In this hot topic summer episode, listeners will learn about the management of infectious gastroenteritis.  Follow us on Twitter @Pediagogypod    This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Christopher Kim, Dr. Lena van der List, and Dr. Su-Ting Li. Drs. Tammy and Lidia take full responsibility for any errors or misinformation.  Key points: -Gastroenteritis is a major cause of pediatric morbidity annually due to dehydration -Learn about oral rehydration with balanced electrolyte solutions vs water or sports drinks -Understand why we avoid testing and antibiotics -Other supportive measures that are available Supplemental information 2012 AAP Pediatrics in Review: https://publications.aap.org/pediatricsinreview/article/33/11/487/34685/Acute-Gastroenteritis?autologincheck=redirected

Key points: -Bronchiolitis is seen in kids under the age of 2 and caused by RSV -Treatment is supportive including fluids, oxygen, and suction -Learn about palivizumab and other new preventive therapies against bronchiolitis Supplemental Information: AAP 2014 guidelines: https://pediatrics.aappublications.org/content/134/5/e1474 Day of Illness and Outcomes in Bronchiolitis Hospitalizations: https://publications.aap.org/pediatrics/article/146/5/e20201537/75296/Day-of-Illness-and-Outcomes-in-Bronchiolitis

Key points: -Remember the 4-2-1 rule for calculating maintenance fluids in children -Use of hypotonic fluids is based on historical data in healthy children -Data now supports use of isotonic fluids like NS or LR to reduce risk of hyponatremia and SIADH -Newer data may support LR over NS Supplemental information AAP 2018 Maintenance Fluid Guidelines: https://publications.aap.org/pediatrics/article/142/6/e20183083/37529/Clinical-Practice-Guideline-Maintenance

Key points: -DKA presents with hyperglycemia, ketosis, and anion gap metabolic acidosis, which if severe can cause cerebral edema and CNS dysfunction -Initial management includes fluid resuscitation and IV insulin -Learn about the 2 bag system for DKA -There is a rule to correct for hyponatremia in hyperglycemia -Learn about how to manage potassium, bicarbonate, and phosphorus in DKA Supplemental information: Pediatrics in Review 2019 DKA: https://publications.aap.org/pediatricsinreview/article-abstract/40/8/412/35321/Diabetic-Ketoacidosis?redirectedFrom=fulltext

Key points: -Brief, resolved, unexplained events in patients

Key points: -New strategies for management of febrile infants depending on age (1-3 weeks, 3-4 weeks, or 4-8 weeks) -Inflammatory markers like CRP and procalcitonin help to determine if LP is needed in older patients. -Learn about common bugs that cause infection in infants and the antibiotics we use to treat them -Observation of febrile infants is now reduced from 48 hours to 24-36 hours Supplemental information: AAP guidelines 2020: https://pediatrics.aappublications.org/content/148/2/e2021052228 Yale Observation Scale Score in febrile infants 60 days and younger: https://publications.aap.org/pediatrics/article/140/1/e20170695/37958/The-Yale-Observation-Scale-Score-and-the-Risk-of

Key points: -First line management is insulin when in DKA -First line management is lifestyle modification and metformin when not in DKA -Consider adding insulin and GLP-1 agonists if still in poor control Supplemental Information AAP guidelines 2013: https://publications.aap.org/pediatrics/article/131/2/364/31847/Management-of-Newly-Diagnosed-Type-2-Diabetes AAFP guidelines 2018: https://www.aafp.org/afp/2018/1101/p590.html ISPAD guidelines 2018: https://www.ispad.org/page/ISPADGuidelines2018

Key points: -There are specific clinical criteria for diabetes -There are some differences to help distinguish between type 1 versus type 2 diabetes -Learn about how to manage diabetes on the inpatient floor, including how to calculate total daily insulin dose, correction factors, and carbohydrate ratios. Supplemental information: Pediatrics in Review 2013: https://publications.aap.org/pediatricsinreview/article-abstract/34/5/203/34790/Type-1-Diabetes-Mellitus?redirectedFrom=fulltext American Diabetes Association 2018 Position Statement: https://diabetesjournals.org/care/article/41/9/2026/40739/Type-1-Diabetes-in-Children-and-Adolescents-A

Key points: -Ask about common triggers for asthma like smoke or allergens as well as medication adherence -Asthma is a clinical diagnosis but ancillary tests like PFTs may help -Symptom frequency and severity can help you classify the asthma as intermittent versus persistent -Learn about controller/maintenance therapy, including the new SMART therapy -Learn about steroid use for acute exacerbations as well as next line medications like magnesium, ipratropium, and epinephrine Supplemental information: NIH 2020 guideline updates: https://pediatrics.aappublications.org/content/147/6/e2021050286 Peds in review 2019: https://pedsinreview.aappublications.org/content/40/11/549 Asthma control test: https://www.greenhillspeds.com/wp-content/uploads/2015/12/Asthma-Control-Test-4-to-11-years.pdf GINA 2020 Pocket Guide: https://ginasthma.org/wp-content/uploads/2020/04/Main-pocket-guide_2020_04_03-final-wms.pdf NIH Guidelines 2007: https://www.nhlbi.nih.gov/health-topics/guidelines-for-diagnosis-management-of-asthma JAMA 2021 guideline update summary: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2780356