Pediatrics in Practice

Dr. Grace Mitchell discusses the latest pediatric radiology trends and technology.

Every summer children and families are drawn to oceans, pools, ponds, lakes, rivers, or streams for entertainment and exercise. As prehospital providers know all too well, fun events and gatherings near bodies of water can turn into an emergency setting in an instant.Although drowning injuries can affect anyone, according to the CDC, children ages 1-4 have the highest drowning rates, with most occurring in swimming pools. Fatal drowning is the 2nd leading cause of unintentional injury death for children ages 1-14 with the 1st leading cause being motor vehicle crashes. The risk for moderate to severe neurological complications and long-term disabilities are concerns for survivors of non-fatal drowning incidents. Whether in the hospital or prehospital setting, management of the pediatric drowning patient should aim to identify and treat complications, as well as prevent further anoxic injury.

The national Asthma Education and Prevention Program (NAEPP) published the first expert panel report on the diagnosis and management of asthma in 1991. A comprehensive revision was published in 1997, and an update in 2002. the EPR 3 was published in 2007. The most recent guidelines, published in 2020, represent a paradigm shift in asthma treatment.

In this episode, Dr, Brandon Newell and NP Rebecca Flynn leads an interactive discussion on some of the more common cases seen in dermatology.

Idiopathic congenital clubfoot occurs in 1 in 1,000 infants in the U.S. and is considered the most prevalent musculoskeletal birth defect in the world. In this podcast, Richard Schwend, MD, FAOA, FAAP, Interim Chair, Department of Orthopedic Surgery and Musculoskeletal Science at Children's Mercy Kansas City, discusses a clinical report published by the American Academy of Pediatrics which covers background on the condition, evaluation and treatment – including the Ponseti technique, which is considered the gold standard of care. Click here to view the clinical report.

Massive transfusion protocols have become vital tools used within trauma centers across the country. Appropriately so, as many emergency providers know that hemorrhage is the most common cause of death within the first hour of arrival to a trauma center. Most recently, a medication called Tranexamic Acid or TXA has been found to assist in life-saving measures for trauma victims in both the pre-hospital setting and the emergency department. But is TXA a recommended medication for kids? This podcast segment highlights the safe use of TXA in pediatric traumas and beyond.

Did you know that more than 1 in 5 children with food allergies also experience food insecurity (FI)? Children whose families struggle to acquire adequate nutrition are at higher risk for a wide range of conditions, including asthma, obesity and mental health issues.  In this podcast, you'll hear more on this topic, including guidance on FI screening in the pediatric care setting, from Jodi Shroba, MSN, APRN, CPNP, Food Allergy Program Coordinator for the Division of Allergy, Immunology, Pulmonary and Sleep Medicine at Children's Mercy Kansas City.

Currently 1 out of every 5 children (18.5%) meets the body mass index criteria for obesity (BMI ≥ 95th percentile). With this in mind, it's important for providers to consider many factors when diagnosing and assessing a child for obesity. Kelsee Halpin, MD, MPH, pediatric endocrinologist at Children's Mercy Kansas City, discusses more on this topic and what to look for in the primary care setting. For more information, visit the Common Endocrinology Conditions page on the Children's Mercy website.

Girls and adolescents with more than 3 months between periods or those that remain otherwise irregular 2 years after menarche, should be evaluated for underlying causes. Emily Paprocki, DO, pediatric endocrinologist at Children's Mercy Kansas City, discusses more on this topic and what to look for in the primary care setting. For more information, visit the Common Endocrinology Conditions page on the Children's Mercy website.

Between 25-50% of the referrals to a pediatric endocrinology clinic are related to abnormal thyroid function tests (TFTs). However, the majority of these abnormal TFTs are not associated with a true thyroid problem, especially when these tests are ordered in the absence of any signs or symptoms suggestive of a thyroid disease. In this podcast, Francesco De Luca, MD, Division Director of Pediatric Endocrinology at Children's Mercy Kansas City, covers tips for evaluating abnormal thyroid in the primary care setting. For more information, visit the Common Endocrinology Conditions page on the Children's Mercy website.

When it comes to growth failure, many factors are involved. How short is the child? Is the child's height velocity impaired? Is the child's height/growth within the range for the family? In this podcast, Francesco De Luca, MD, Division Director of Pediatric Endocrinology at Children's Mercy Kansas City, discusses key considerations for evaluating growth failure in the pediatric population. For more information, visit the Common Endocrinology Conditions page on the Children's Mercy website.

Maternal stress, while natural and common, can lead to adverse health outcomes. Based on her research, Shilpa Babbar, MD, OB/Gyn-Maternal and Fetal Medicine at Children's Mercy Kansas City, describes mind-body therapies and interventions, such as muscle relaxation, biofeedback, tai chi, yoga, meditation, mindfulness and hypnosis, which may be effective during pregnancy and postpartum care.

Prevalence of depression, anxiety and ADHD continues to rise in the pediatric and adolescent population. Effective therapies are available for each of these conditions, although medication management can sometimes be problematic in the primary care setting. In this podcast, Ram Chettiar, DO, Child and Adolescent Psychiatrist at Children's Mercy Kansas City, reviews current data on these conditions, discusses strategies for evaluation, and shares recommendations for treatment.

Whether it's on the practice field or under the lights on Friday night, when kids play sports, injuries can occur. Unlike adults, their brains and bodies are still growing and developing, even when they're playing sports at an elite level. The care that coaches, athletic trainers, and EMS personnel provide at the time of injury is crucial and oftentimes, emergent. Dr. Roberson will highlight ways in which effective collaboration and timely, evidence-based management of sports-related injuries correlates with positive outcomes for athletes and their families.

In this podcast, Dr. Krasaelap explains the brain-gut connection and what can happen when this is dysregulated. Listen as she describes misconceptions about abdominal pain and irritable bowel syndrome (IBS), and treatment options that exist – including the novel, FDA-approved auricular neurostimulator device.

In this podcast, Christopher Oermann, MD, Director of the Cystic Fibrosis Care Center at Children's Mercy Kansas City, discusses the current state of cystic fibrosis, developments and research underway, and how primary care providers can partner in managing the overall health of patients with cystic fibrosis.

Human trafficking often seems like a far-off crime in a movie that couldn't possibly be happening in our communities. However, it's far more common in the United States than people realize. Moreover, many trafficking victims (88%) have sought health care at some point while they were being trafficked, but very few victims are recognized by health care workers. Historically, trafficking victims were misidentified as drug addicts, prostitutes, “bad kids”, homeless patients, victims of domestic violence, mentally ill, etc. and we failed to recognize the exploitation occurring to the person in our care. Rachel and Heidi will touch on what signs of human trafficking to look for in the health care setting, how to report it, and why it's so vital for us to speak up when we see something that seems “off”.

Created by a multidisciplinary team of pediatric experts, the Children's Mercy Ped's Guide App puts evidence-based resources—dose recommendations, drip calculations, resuscitation guides and more—right at your fingertips. Listen as Brandan Kennedy, MD, discusses the app, its features, and the evidenced-based resources behind it.

The Thyroid Nodule and Carcinoma Clinic at Children's Mercy Kansas City is the only pediatric clinic of its kind in the region to provide the comprehensive evaluation, diagnosis, treatment, and long-term management of thyroid nodules and differentiated carcinoma. In this episode, Naim Mitre, MD, Pediatric Endocrinologist and Medical Director of the Thyroid Nodule and Carcinoma Clinic at Children's Mercy, discusses the incidence of thyroid cancer in children, how thyroid nodules are diagnosed, and the importance of treatment.

Endocrine disorders, specifically for pediatric patients, pose complex considerations in care based on the type of disorder and an individual's course of therapy. For this reason, Children's Mercy manages programs across the region, providing endocrinology care from western Kansas to south central Missouri. When a pediatric patient with an endocrine disorder requires emergency assistance in the pre-hospital setting, rapid intervention is necessary. In this segment, Children's Mercy Endocrinologist, Dr. Ryan McDonough, will offer life-saving guidance on treating this population of pediatric patients.

Pamela Nicklaus, MD, FACS, discusses protocols surrounding common ENT cases and referrals, difficulties that may arise, options for families, and therapies/support.

In the adult population, COVID-19 infections appear to affect the heart at a higher rate than other viruses, while in the pediatric population, the virus can cause multi-system inflammatory syndrome (MIS-C) involving the heart. Due to the lack of evidence for cardiac injury from COVID-19 infections in the pediatric population and the low number of pediatric cases, recommendations are made from expert opinion from the sports medicine, infectious disease, and cardiology departments and are subject to change. Algorithm for return to play/activity after COVID-19 infection in pediatric patients.

Pediatrics in Practice: Ann Modrcin, MD, EMBA, discusses the pediatric transition to adult care and best practices to achieve it. She also discusses values and pain points for families, and how providers can provide support through the transition.

Struggling with an abnormal value on a screening complete blood count (CBC)? Frustrated that a toddler refuses to take oral iron? Wondering what to do when the 12 month screening hemoglobin comes back a little low? This podcast is for you! We will discuss common hematologic dilemmas in pediatric primary care and how to address them. From the dreaded hemoglobin Barts, to evaluation and management of iron deficiency anemia, and quick review of all those complete blood count indices, this podcast aims to make the CBC fun again!

Anna Esparham, MD, Director of the Headache Treatment Center at Children's Mercy, discusses primary versus secondary headaches, causes of migraines/headaches, treatment approaches, and differences between prevention and abortive therapies.

Autism is one of the fastest-growing developmental disabilities in the United States, affecting approximately 1 in 54 births. For the safety of emergency medical providers and patients with developmental disabilities, it is important to understand what Autism is and how to care for pediatric patients diagnosed with it. In this segment, Children's Mercy specialists will discuss common misconceptions about Autism Spectrum Disorder, as well as share insight from a memorable EMS encounter involving a child with Autism.

Amanda Deacy PhD discusses comfort promise. She shares the concept of Comfort Promise and a quality improvement (QI) project she's leading in GI to assess gaps in documentation of the pain prevention bundle in order to better measure its uptake and success rate.

While approximately 10% of US adults and children claim a penicillin allergy, only 1/20 with a reported allergy are truly allergic. Additionally, 80% of patients with IgE mediated penicillin allergy lose sensitivity after 10 years.It is important to clarify and de-label patients to ensure they receive standard of care, avoid other adverse drug reactions and have a lowered risk of clinical failure. This practice also results in cost savings.Amol Purandare, MD explains the de-labeling process in place at Children's Mercy and how to gain insight into what to prescribe to a patient with a penicillin allergy.

Dr. Shayla Sullivant shares warning signs of anxiety and depression in teens, how to talk to your teen about their feelings, and when you should seek professional help.

The most common reasons that children are seen by pediatric gastroenterologists relate to their bellyaches, bowels, and barfs. A simple approach to these disorders can guide general practitioners to help families find relief from these distressing symptoms.Dr. John Rosen explains when you might want to take your child to see a pediatric gastroenterologist, what to expect at an appointment, and treatments to common GI issues.

Sports related injuries are on the rise with increasing child and adolescent participation. Many training programs do not cover how to evaluate and treat these patients in the subacute setting.Listen as Donna Pacicca, MD, Orthopedic Surgeon and Sports Medicine specialist with the Sports Medicine Center at Children's Mercy Kansas City, discusses evidence-based best practices for pediatric patients with sports related musculoskeletal injuries. Dr. Pacicca will discuss how to take a good history for sports-related injuries, key parts of the physical examination, how to best use imaging, and basics of treatment for upper and lower extremity injuries.

Female reproductive health is critical in growing girls and young women. Julie Strickland, MD, Section Chief of Pediatric and Adolescent Gynecology, joins us for this episode of Pediatrics in Practice to talk about the need for pediatric and adolescent gynecologists, the conditions they treat and when to refer.

Dysmenorrhea is the most common gyencologic complaint in adolescent females, affecting more than half of this population. Julie Strickland, MD, Section Chief of Pediatric and Adolescent Gynecology at Children's Mercy, discusses causes, diagnoses and treatment of this painful condition.

Enuresis or bedwetting is a common childhood problem, affecting 5 to 7 million children in the United States each year. By age 7, about 5-10 percent of all children are still wet at night. While 15 percent of kids will outgrow bedwetting without intervention every year, waiting and watching to see what happens could delay children getting dry at night. Listen as Judith VanSickle, MD, Pediatric Nephrologist, discusses causes, diagnosis and treatment of enuresis.

So you think rheumatology is all about joint pain? Think again. Rheumatologists treat a wide array of autoimmune conditions affecting nearly every part of the body- even the eyes. Uveitis is an inflammatory eye condition that can be caused by infection, underlying autoimmune diseases such as juvenile arthritis or sarcoidosis, or as an idiopathic disease. Untreated it can lead to cataracts, glaucoma and even blindness. Listen as Ashely Cooper, MD, pediatric rheumatologist, discusses childhood uveitis and how Children's Mercy Kansas City is improving care for kids with chronic uveitis.

Dr. Shayla Sullivant discusses warning signs of suicide in teens, and how address it with patients.

Every year, influenza causes many people to become ill. All children 6 months and age and older should receive a yearly flu vaccine. Vaccination remains the best way to prevent influenza. Symptoms of influenza include abrupt onset of fever, myalgias, headache, nonproductive cough, sore throat and runny nose. Fever and cough are the two most common symptoms. When presented with these symptoms, providers are faced with the question to test and confirm the diagnosis of influenza or to initiate influenza treatment. Jennifer Goldman, MD, Infectious Diseases specialist at Children's Mercy, discusses the role of influenza testing in clinical care and the risks and benefits of oseltamivir use.

The AAP recommends conducting general developmental screening at 9, 18, and 30 months, or whenever a concern is expressed. In addition, autism-specific screening is recommended at ages 18 and 24 months of age. When families arrive for their child's well-visits, how can each pediatrician be sure the right screening is taking place to identify any developmental delays quickly and effectively? Hear from Cy Nadler, Phd, and Sarah Nyp, MD, as they discuss the screening process and how to navigate the world of developmental delays and disabilities.

Enuresis, hematuria and proteinuria are common pediatric kidney disorders, but the when do these problems warrant a referral to a pediatric nephrologist? What red flag symptoms require more urgent consultation and evaluation? New specialty-specific guidelines from the "Choosing Wisely" campaign were just released for pediatric nephrology in an effort to educate about unnecessary medical tests, treatments and procedures. In this podcast, Darcy Weidemann, MD, pediatric nephrologist at Children's Mercy Kansas City, discusses evaluation and management options primary care providers should consider prior to subspecialty referral.

“Positive ANA” is one of the most common reasons for referral to the pediatric rheumatology clinic. The antinuclear antibody (ANA) is often mistakenly considered a good screening test for rheumatic disease. Dr. Ashley Cooper, Interim Division Director of Pediatric Rheumatology, discusses what it means when a child has a positive anti-nuclear antibody test, when ANA should be checked, and how to talk about the test results with the family.

Orthopedic conditions can cause pain and dysfunction, causing aches and pains in bones and joints. Mobility and activity may be limited by these conditions. Polly Wimer, CPNP, APRN discusses common orthopedic conditions and their treatment.

Although there has been less emphasis on responsible prescribing of opioids in children, with newly developed legal and regulatory efforts focused almost exclusively on adults, it remains important for pediatric providers to be aware of the heightened risk for substance misuse in adolescents, and the appropriate use of opioids in a pediatric population. In this podcast, Daniel Millspaugh, MD, anesthesiologist and Director of the Comprehensive Pain Management and Opioid Stewardship programs at Children's Mercy Kansas City, discusses the current opioid-related public health emergency, as well as the evolving regulatory and agency response, and appropriate actions by medical providers.

As pediatric cancer survival rates continue to improve, we are faced with a new set of health challenges in caring for these survivors. Joy Fulbright, MD, Director of the Survive and Thrive program at Children's Mercy Kansas City, discusses health concerns after cancer treatment, what primary care providers need to know, and the need for yearly screenings addressing medical and psychosocial issue.

As regional hemophilia treatment center, Children's Mercy follows more than 900 patients with bleeding disorders. Listen as Shannon Carpenter, MD, pediatric hematologist/oncologist and director of the Hemophilia Treatment Center at Children's Mercy Kansas City, discusses hemophilia A and B in children, current treatments and promising new research studies and options on the horizon, such as the PUPS Matter cohort study.

Kidney stones in children have been on the rise for more than a decade, mostly due to hypercalciuria and hypocitraturia. Join us as Uri Alon, MD, Director of the Bone and Mineral Disorders Clinic at Children's Mercy Kansas City, discusses what is behind the increasing incidence of kidney stones, and medical and non-pharmacological interventions to prevent new stones and inhibit the growth of existing ones.

Obstructive sleep apnea is a common but serious condition that inhibits healthy, restful sleep and may lead to learning, behavior and physical health issues in children. Zarmina Ehsan, MD discusses obstructive sleep apnea in infants and children, why it's necessary to conduct a sleep study to diagnose the condition and how to treat and manage the condition.

The prevalence of gestational diabetes is increasing due to increasing rates of obesity. Gestational diabetes increases the chances of adverse outcomes for both the mother and infant. In this Pediatrics in Practice podcast Jessica Brunkhorst, MD, neonatologist, reviews fetal anomalies and conditions associated with maternal diabetes, describes initial evaluation and management for infants of a diabetic mother, and discusses current recommendations regarding the management of hypoglycemia.

Infants under 90 days old with fever can present a diagnostic dilemma. Join us as Russell McCulloh, MD discusses unresolved issues and common conundrums faced by front-line clinicians in the evaluation of neonatal fever, recent literature on laboratory testing for infants with fever, and potential management strategies for febrile infants.

Numerous states have legalized or are considering legalization of marijuana. The AAP recently published an evidence-based position paper and clinical report on marijuana, including medical use. In this podcast, Dr. William Adelman, chief of Adolescent Medicine at Children's Mercy, discusses why adolescents are uniquely vulnerable to the neurotoxic effects of marijuana, the impact of legalization, and why physicians should unequivocally recommend pediatric and adolescent patients never use marijuana.

Strokes in newborns are as common as in adults. Recognition and early intervention is critical to minimizing the damage. Children's Mercy is one of fewer than 10 pediatric stroke centers nationally, and the region's first and only dedicated pediatric stroke center offering comprehensive, individualized treatment protocols for children. In this podcast Mukta Sharma, MD, pediatric hematologist/oncologists, discusses the warnings signs and causes of stroke and how early intervention affect the rest of a child's life.