In this episode, we will be reviewing what you need to know before your first discussion about infant formula.  We will cover the characteristics and types of formulas, why infants might require different types, the correct way to prepare formula and how much infants need, common concerns from parents, indications for changing formulas, and when to transition away from it.   Reasons for formula feeding  Human milk is first choice for most infants Concern about lactating parent’s milk supply Workplace conditions make it difficult to sustain human milk feeding Parent preference  There are few true contraindications to breastfeeding.  Galactosemia Maternal HIV infection that has not achieved an undetectable viral load Maternal phencyclidine (also known as PCP) or cocaine use Active Herpes Simplex virus lesion Active tuberculosis Types of formula: 3 characteristics Caloric density: calories per ounce. Standard term formula is 20 calories/oz. Infants born preterm or have growth failure may need 22-27 calories/oz. Carbohydrate source: Lactose (galactose + glucose) or non-lactose Protein type:  Cow-milk based formula proteins are whey and casein. Hydrolyzed formulas: proteins are broken down into smaller protein “chunks” or into individual amino acids, which are hypoallergenic and easily digestible.  Other formulas utilize different sources of protein, including soy protein and goat’s milk. Special formulas for infants with specific metabolic conditions: eg. phenylketonuria, maple syrup urine disease, homocystinuria. Forms of formula Powder: most common and least expensive. Usually, 1 scoop of formula powder is mixed with 2 oz water.  Liquid concentrate: mixed 1:1 with water.  Ready to feed: no mixing required, but most expensive. Be sure that the formula is being mixed correctly! Incorrect formula mixing can result in growth failure or electrolyte abnormalities. How much formula should b...

Listen along as we dive into the many causes of sore throat. Learn about the common causes such as allergies and viral illnesses while also what to do when a child with epiglottitis comes in.  We will cover CENTOR criteria as well and when you should think about Group A strep testing. Common Causes Viral Presentation HSV Mononucleosis Allergic Presentation Group A Strep  CENTOR Criteria Emergency Causes Peritonsillar Abscess Retropharyngeal Abscess Epiglottitis Wrap Up & Conclusion   Resources/Links: https://www.chop.edu/conditions-diseases/throat-anatomy-and-physiology  https://www.mdcalc.com/calc/104/centor-score-modified-mcisaac-strep-pharyngitis    References Aluma Chovel-Sella, Amir Ben Tov, Einat Lahav, Orna Mor, Hagit Rudich, Gideon Paret, Shimon Reif; Incidence of Rash After Amoxicillin Treatment in Children With Infectious Mononucleosis. Pediatrics May 2013; 131 (5): e1424–e1427. 10.1542/peds.2012-1575 Becker JA, Smith JA. Return to play after infectious mononucleosis. Sports Health. 2014 May;6(3):232-8. doi: 10.1177/1941738114521984. PMID: 24790693; PMCID: PMC4000473. Chowdhury MDS, Koziatek CA, Rajnik M. Acute Rheumatic Fever. [Updated 2023 Aug 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK594238/ Esposito, S.; De Guido, C.; Pappalardo, M.; Laudisio, S.; Meccariello, G.; Capoferri, G.; Rahman, S.; Vicini, C.; Principi, N. Retropharyngeal, Parapharyngeal and Peritonsillar Abscesses. Children 2022,9,618. https://doi.org/ 10.3390/children9050618  Martin JM. The Mysterie...

Asthma is a common chronic disease of childhood that affects 1 in 12 children in the United States. It can range from mild respiratory symptoms to life threatening respiratory failure, with a range of treatment options in-between from the primary care setting to the pediatric ICU. In this episode, we will discuss the underlying pathophysiology, diagnosis, evaluation, and management of patients with asthma, along with some useful clinical pearls to help you take care of these patients! Cause of asthma Genetics: “Atopic triad” of asthma, atopic dermatitis or eczema, and allergic rhinitis  Prenatal and childhood environmental factors: maternal smoking and allergen exposure  Pathophysiology and diagnosis  AAP definition: “episodic and reversible airway constriction and inflammation in response to infection, environmental allergens, and irritants. It is a complex, multifactorial, and immune-mediated process that presents with various clinical phenotypes.” Airway hyperreactivity leads to inflammation of bronchi, increased mucus production, bronchial smooth muscle contraction Key elements of the history – recurrent episodes of cough, wheeze, difficulty breathing, nighttime symptoms, consistent trigger, atopic personal or family history, improvement with asthma treatment. Identification of triggers is important. Common triggers include respiratory infections, mold or pet dander, pollen, intense crying or laughing, exercise, pollution, and cold air.  Children from minority and lower-income backgrounds experience an increased asthma burden, likely closely tied to a complex interaction of factors such as decreased access to healthcare, increased rates of obesity, and poor air quality in the areas in which they live. Classification of asthma: determined by the frequency and severity of symptoms when they are not receiving preventative treatment. New 2022 guidelines for asthma treatment Albuterol or other beta 2 agonist as needed for symptoms - relaxes bronchial smooth muscles Daily controller medication (usually inhaled steroid) if symptoms more than twice weekly - inhaled steroid decreases inflammation Inhaled steroid + long-acting beta 2 agonist combination inhaler preferred for those >5 years Asthma action plan should be given to every patient Treatment of acute asthma attack Quick assessment and stabilization of patient is important Treat acute symptoms first, then address chronic control of asthma Albuterol or ipratropium-albuterol, systemic steroids are generally first lines of treatment

In this episode, we discuss lead toxicity and lead screening. We will talk about what lead is, what happens when a child is exposed to lead, what to ask parents about if you’re worried about lead exposure, how to screen for lead toxicity, and what to do if your patient has an elevated lead level.  Sources of lead exposure  Ingestion of contaminated food or water Ingestion or breathing in of lead dust Other sources: lead-acid batteries, ammunition, lead-based pigments and paints, stained glass, lead crystal glasses, ceramic glazes, jewelry, toys For families from other cultures, think about ceramic glazes, traditional cosmetics, traditional medicines Government policies to decrease lead exposure Unleaded gasoline Lead-free paint Lead-free solder in food cans Lead-free water pipes Why young children are at risk for lead toxicity Hand-to-mouth behavior Increased absorption of lead Developing nervous system is vulnerable Calcium or iron deficiency increase absorption of lead Effects of lead toxicity in children can be seen at levels as low as 3.5 µg/dL Growth and development delays Lower IQ Learning and behavior problems Hearing and speech problems School underperformance At higher levels, you may see Irritability Loss of appetite, weight loss, fatigue Abdominal pain, vomiting, and/or constipation Anemia Pica Seizures, coma, death Universal lead screening at 1 and 2 years Screening questionnaires are not very sensitive or specific  Blood lead test  Capillary – get results quickly, but can be falsely elevated

In this episode of Clerkship Ready – Pediatrics Dr. Jared Barkes, a Child Neurology resident at The University of Virginia, will be walking you through how to complete the neurologic exam! Throughout the episode he will cover in detail the different parts of a formal neuro exam while also providing useful tips for remembering commonly tested facts, reviewing specific examples of abnormal findings and common neurologic conditions, and offering helpful advice for completing a neuro exam on a pediatric patient. After listening to this podcast you will have all the tools necessary to shine on your first day of your neurology clerkship! Introduction What is the neuro exam? Review of the  “Map” of the neuro system Cortex, Brainstem, Spinal Cord, Motor neuron How to complete a neuro exam and what to look for! General Assessment Mental Status Language Cranial Nerves Strength Sensation Coordination  Reflexes Special consideration for pediatrics  Closing Resources/Links: “NeuroLogic Exam”, A complete in-depth guide of the neuro exam complete with references and videos produced by Dr. Paul D. Larsen, M.D. and Suzanne S. Stensaas, Ph.D. at The University of Utah. (https://neurologicexam.med.utah.edu/adult/html/home_exam.html).  “PediNeurologic Exam” A guide of the neuro exam for children produced by Dr. Paul D. Larsen, M.D. and Suzanne S. Stensaas, Ph.D. at The University of Utah (https://neurologicexam.med.utah.edu/pediatric/html/home_exam.html)  Medical Student Resources from the American Academy of Neurology (https://www.aan.com/tools-resources/medical-student-educational-resources).

Sepsis is a clinical syndrome in which an infection leads to an inflammatory response throughout the body that rapidly progresses to organ dysfunction or even death. Worldwide, neonatal sepsis affects 2,202 infants per 100,000 live births, and has a mortality rate of >11%. In the United States, early onset sepsis affects 50 in 100,000 live births, with a mortality rate of about 3%. So it’s a big problem that we don’t want to miss. In this episode, we will define neonatal sepsis, talk about the presentation of sepsis, what a sepsis workup entails, how to make the diagnosis and treatment of neonatal sepsis. Defining Neonatal Sepsis  Early Onset Sepsis Late Onset Sepsis Neonatal Early Onset Sepsis Calculator - https://neonatalsepsiscalculator.kaiserpermanente.org/ Presentation of Illness and Physical Exam  Pathogenesis Group B Strep Screening and prophylaxis  E coli Strep viridans Klebsiella Enterococcus Listeria  HSV  Screening and prophylaxis  Types of Infection Bacteremia  Pneumonia Meningitis  Work up  CBC with differential  Blood Culture Urinalysis and Urine Culture Cerebrospinal Fluid culture  Chest X-Ray  Surface swabs of mucous membranes  Antimicrobial coverage Evaluation and Treatment of a Well Appearing Febrile Infant 8-60 days old https://doi.org/10.1542/peds.2021-052228 8-21 days <...

Iron deficiency is the most common nutritional deficiency that occurs in children in United States. Iron plays a vital role in cellular function in all organ systems. Today, we will be reviewing what you need to know before you first see a patient with possible iron deficiency. We will discuss why iron is so important, when and why iron deficiency occurs, screening, diagnosis, and treatment for iron deficiency. Importance of Iron  Iron and Hemoglobin  Iron and Neurodevelopment Iron and the Immune System What happens in iron deficiency Reasons that children are at high risk for iron deficiency  Rapid Growth .  Insufficient dietary intake and limited absorption  Increased losses  Peaks of Incidence Other risk factors for iron deficiency. Preterm infants  Children who suffer from neuro-motor disorders as they often have nutritional deficiency related to swallowing impairment G.I. diseases that cause malabsorption,  Diseases predisposing them to bleeding. Lead toxicity.  Screening for IDA History: Asking about prematurity, low birth weight, exclusive breastfeeding beyond 4 months of age, weaning to whole milk without addition of iron rich foods, feeding problems, and any past medical conditions.  Exposure to lead (i.e. age/ condition of home, recent renovations, a parent who has occupational exposure, concerns about drinking water).  Any possible symptoms of anemia, such as fatigue, breath holding spells, pica Physical exam: pallor.  Lab testing. Treatment for iron deficiency  Oral iron: daily dose of 3 to 6 mg per kilogram of elemental iron divided into three doses is adequate. Give iron supplements with juice - increases iron absorption through the action of ascorbic acid! Juices that are high in ascorbic acid include orange and apple juice. Supplements should be continued for a minimum of three months to reestablish iron stores. After completion of treatment, reassessment of iron status  In addition to iron supplementation, the other aspect...

Ear pain is one of the most common chief complaints pediatricians encounter in the outpatient setting and there are quite a few things you need to consider to make a thoughtful diagnosis, assessment, and plan. In this episode, we will discuss the differential diagnosis of ear pain in children, physical exam findings that will help you make a diagnosis, and treatment for the most common causes of ear pain.  Ear anatomy Outer ear, tympanic membrane (TM), middle ear, inner ear Eustacian tube in children is smaller in diameter and angled more horizontally than in adults.  This makes it more difficult to drain fluid behind the middle ear and why kids are more prone to get ear infections when they get a cold than adults are.  The adenoids also are thought to play a role in fluid collection and buildup.  Taking a history for patient with chief complaint of ear pain How old is this child?  Have they had a fever?  Are there any other viral symptoms such as cough, runny nose, or  sore throat?  Has the child been swimming recently?  Has the child put anything in their ears?  Has there been any ear drainage or changes in hearing?  Ear examination Make sure that the child’s head is as still as possible  How to use the otoscope What to look for:  Color of the TM.  Fluid behind the TM  Is the TM bulging or not bulging Light reflex of the TM Ear canal Acute otitis media Infectious causes - bacteria (especially Strep pneumonia, H influenzae, and Moraxella catarrhalis), viruses Treatment Antibiotics vs. “watch and wait approach” Criteria for using antibiotics Antibiotic options Indications for tympanostomy tubes Acute otitis externa (“Swimmer’s ear”)

Child abuse, which is sometimes called non-accidental trauma, is a public health problem with life-long health consequences for survivors and their families. In this episode, we will review what you need to know before you encounter your first patient who may have or has been abused. We will focus on physical and sexual abuse of children.  Long term health consequences of child abuse Why identification of child abuse is difficult It is often difficult to distinguish an accidental injury from a non-accidental injury A caregiver who has abused a child rarely confesses to harming the child Child may be brought to medical care by unsuspecting parent It is emotionally difficult for us to confront parents when there are concerns for abuse Mandated reporting of child abuse Potential clues that a child may have been physically abused Medical record review History Physical exam Differential diagnosis of physical abuse Labs and other tests that you may get The role of the child protection team and child protective services Potential clues that a child may have been sexually abused History Physical exam Lab testing Medical documentation Resources/Links: Christian CW; Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse. Pediatrics. 2015 May;135(5):e1337-54. doi: 10.1542/peds.2015-0356. Pierce MC, Kaczor K, Lorenz DJ, Bertocci G, Fingarson AK, Makorof K, Berger RP, Bennett B, Magana J, Staley S, Ramaiah V, Fortin K, Currie M, Herman BE, Herr S, Hymel KP, Jenny C, Sheehan K, Zuckerbraun N, Hickey S, Meyers G, Leventhal JM (2021) Validation of a clinical decision rule to predict abuse in young children based on bruising characteristics. JAMA Netw Open 4(4):e215832. https://doi.org/10.1001/jamanetworkopen.2021. 5832. Erratum in: JAMA Netw Open. 2021 Sep 1;4(9):e2130136. PMID: 33852003; PMCID: PMC8047759 Smith T, Chauvin-Kimoff L, Baird B, Ornstein A. The medical evaluation of prepubertal children with s...

Discussing menses and pregnancy prevention is an important part of preventative care and reproductive health. Patients and parents come in with a wide range of preconceptions and understanding. It can be daunting to counsel about the many types of contraception to come to a shared decision about what is best for the patient. This podcast will review the following about contraception: Medical contraindications Physiology of hormonal options Efficacy of pregnancy prevention Patient considerations and concerns Emergency contraception Myths   Resources/links: CDC MEC: https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf ACOG contraception chart: https://www.acog.org/womens-health/infographics/effectiveness-of-birth-control-methods https://www.reproductiveaccess.org/ https://www.bedsider.org/

In today’s episode, we are talking about normal child development. We will talk about why this is important and how you will be evaluating children’s development. We will go over major milestones in the 4 developmental domains: movement/physical development – or gross and fine motor, language/communication, cognitive, and social/emotional. We will go over some common cases. Finally, we will briefly discuss what you should do if you suspect developmental delay. Why it is important to learn about developmental delay. Why it is important to learn about development Developmental surveillance versus developmental screening versus diagnosis of developmental issues Developmental domains/categories: Expressive language Receptive language Gross motor: this is how you use all of your big muscles  Fine motor: hand/eye coordination  Social/emotional: how children interact with others and show emotion.  Language/Communication: how children express their needs and share what they are thinking, as well as understand what is said to them. Hearing is important for language/communication development. Cognitive:  how children learn new things and solve problems Movement/Physical Development:  how children use their bodies.  Learning milestones Learn the schedule for well child visits Watch children at different ages to see what they can do.  Gross motor milestones: 1 year goal is to be able to walk independently. Fine motor milestones: 1 year goal is to be able to put food into one’s mouth Language and communication milestones: 1 year goal is to be able to say a few words Social and emotional milestones: 1 year goal is to recognize that people are individuals that they can interact withOK, so those are some of the major milestones. Now, let’s go through a few common case scenarios that have some specific teaching points.  Cases What if there is developmental delay Resources/Links: CDC’s Developmental Milestones: https://www.cdc.gov/ncbddd/actearly/milestones/index.html Ages and Stages developmental screening tool: https://agesandstag...

Neonatal hypoglycemia is a common and often transient issue for newborns during a period of transition from intrauterine to extrauterine life. Many infants with hypoglycemia are screened for it and treated for it in the nursery, and a handful will require NICU admissions. This podcast will help you understand these things about neonatal hypoglycemia: Why we worry  What causes it Which infants are most at risk How to treat it and who needs the NICU Resources/Links: https://downloads.aap.org/AAP/PDF/Seminars_in_Fetal_Neonatal_Medicine.pdf https://publications.aap.org/hospitalpediatrics/article/11/6/595/180015/Practice-Variations-in-Diagnosis-and-Treatment-of https://publications.aap.org/aapnews/news/25073/Myriad-unknowns-regarding-neonatal-hypoglycemia?autologincheck=redirected

Attention deficit-hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children. In this episode, we will discuss ADHD, including the different types, evaluation, management, and follow up. General definition of ADHD and its types Preparing for your first visit Initial evaluation of ADHD vs. med check Reviewing prior visits During an initial visit: Evaluating historical features  Behaviors at home, behaviors at school Common misconceptions about ADHD Surrounding factors and comorbidities/misdiagnosis Physical Exam Important features of the exam Observing the child’s behavior Role of the Vanderbilt Scoring a Vanderbilt Treatment Medication vs. non-pharmacologic interventions Overview of different medications Stimulants Nonstimulants Choosing a medication Family history Comorbidities Titrating medications Follow-up visits Symptoms to look for Resources/Links: Vanderbilt Scoring: https://www.uwmedicine.org/sites/stevie/files/2019-11/sodbp_vanderbilt_scoringinstructions.pdf Parent Training in Behavior Management for ADHD: https://www.cdc.gov/ncbddd/adhd/behavior-therapy.html Dosing guidelines when switching from one stimulant to another in the treatment of attention deficit hyperactivity disorder in children and adolescents: https://www.uptodate.com/contents/image?imageKey=PEDS%2F61007

In this episode, we discuss things you’ll need to know and think about before seeing an infant with jaundice. We will focus on infants from birth to 2 months of age. We will discuss the pathophysiology of hyperbilirubinemia, the difference between unconjugated and conjugated hyperbilirubinemia, the differential diagnosis, key elements of the history and physical exam, laboratory and imaging workup, and management. Introduction to jaundice and hyperbilirubinemia Jaundice is the yellowing of skin, sclerae, and mucous membranes caused by hyperbilirubinemia Hyperbilirubinemia can be further separated into unconjugated or conjugated forms, which allows us to further differentiate etiology Review of bilirubin breakdown pathway, to include enterohepatic circulation Unconjugated hyperbilirubinemia etiologies: Excessive or increased production of bilirubin Cephalohematomas Hemolysis: ABO and Rh incompatibilities; Red Blood Cell (RBC) membrane or enzyme defects, RBC oxidative stress (secondary to sepsis, asphyxia, and acidosis) Decreased clearance of bilirubin Breast milk jaundice Prematurity Hypothyroidism Gilbert Syndrome Crigler-Najjar Syndrome Suboptimal Intake Jaundice Medications Combination of both Physiologic jaundice Conjugated hyperbilirubinemia etiologies: Always pathologic Biliary atresia Briefly mentioned the vast range of other etiologies: infectious, genetic, metabolic, and anatomic Key elements of history and physical examination for a jaundiced infant History: Onset Feeding patterns (what, how much/often, quality of feeding) Urine and stool diapers Prenatal history Delivery history Family history Physical exam:<...

Many of the pediatric inpatients you care for will need intravenous fluids and electrolytes. This episode describes what you need to know before you order fluids or electrolyte replacement for your patient. We will discuss maintenance fluid needs and talk more in depth about what fluids to order and at what rate. We will also talk about managing patients with dehydration and how to replete fluids. Then we will discuss a few cases where we will work through some more common electrolyte derangements and discuss how to manage them. We will end with additional clinical pearls that will be helpful during your time on the inpatient pediatric service. Introduction Definition of maintenance fluid needs Important considerations about maintenance fluids Discussion regarding which fluids to order for different patient populations and at what rate to administer Role of ADH in hospitalized patients How to order a fluid bolus—amount, composition, and rate administered Assessing your patient with dehydration utilizing physical exam findings, vital signs, and other objective data such as weight Case scenarios: Identification and management of hyperkalemia and hypokalemia Case #1- 12-year old with hyperkalemia following infection with influenza Case #2- 2-year old child with history of neglect and malnutrition Additional clinical pearls including the association between albumin and calcium, acidosis/alkalosis and potassium levels Resources/Links:  Clinical Practice Guideline: Maintenance Intravenous Fluids in Children | Pediatrics | American Academy of Pediatrics (aap.org)

This episode is a follow-up to “Before Your First Time Working with a Breastfeeding Mother”. We’ll be reviewing additional details about breastfeeding that can help you to answer some of the most common questions that come up for families. We will discuss strategies to improve milk production, newborn stomach volumes, how to know if baby is getting enough milk, what to do if baby isn’t getting enough milk, and breastfeeding complications. Strategies to improve milk production Latching Newborn stomach volumes How to know if baby is getting enough milk What to do if baby isn’t getting enough milk Manual expression and pumping Breastfeeding complications Resources/Links:  Bella Breastfeeding Curriculum on Open Pediatrics (free): www.openpediatrics.org Virginia Department of Health/Breastfeeding Education Consortium Online Course (free for those who live or work in Virginia): https://bfconsortium.org American Academy of Pediatrics Residency Breastfeeding Curriculum: https://www.aap.org/en/learning/breastfeeding-curriculum/ ACOG Statement on Optimizing Support for Breastfeeding: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/optimizing-support-for-breastfeeding-as-part-of-obstetric-practice AAP Policy Statement: Breastfeeding and the Use of Human Milk, 2022: https://publications.aap.org/journal-blogs/blog/20699/Welcome-to-the-AAP-s-2022-Policy-on-Breastfeeding?autologincheck=redirected# US Breastfeeding Guidelines for Mothers with HIV: https://clinicalinfo.hiv.gov/en/guidelines/perinatal/infant-feeding-individuals-hiv-united-states NEWT Curve: https://newbornweight.org UpToDate “Initiation of Breastfeeding”: https://www.uptodate.com/contents/initiation-of-breastfeeding

This episode describes what you need to know before your first time working with a breastfeeding parent. This will include topics such as how to ensure families feel comfortable, benefits of and contraindications to breastfeeding, how to approach conversations about breastfeeding, and the science behind lactation or milk production. Making families feel comfortable Benefits of breastfeeding for mom and baby Contraindications to breastfeeding Approaching conversations about breastfeeding with families The process of lactogenesis (milk production) Resources/Links:  Bella Breastfeeding Curriculum on Open Pediatrics (free): www.openpediatrics.org Virginia Department of Health/Breastfeeding Education Consortium Online Course (free for those who live or work in Virginia): https://bfconsortium.org American Academy of Pediatrics Residency Breastfeeding Curriculum: https://www.aap.org/en/learning/breastfeeding-curriculum/ ACOG Statement on Optimizing Support for Breastfeeding: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/optimizing-support-for-breastfeeding-as-part-of-obstetric-practice AAP Policy Statement: Breastfeeding and the Use of Human Milk, 2022: https://publications.aap.org/journal-blogs/blog/20699/Welcome-to-the-AAP-s-2022-Policy-on-Breastfeeding?autologincheck=redirected# US Breastfeeding Guidelines for Mothers with HIV: https://clinicalinfo.hiv.gov/en/guidelines/perinatal/infant-feeding-individuals-hiv-united-states NEWT Curve: https://newbornweight.org UpToDate “Initiation of Breastfeeding”: https://www.uptodate.com/contents/initiation-of-breastfeeding

Today we will talk about what to expect before attending your first delivery as part of the pediatrics team while on the Newborn rotation. Each delivery is different and what is needed for each infant at the delivery can be different depending on the status of the infant at birth. In this episode, we will focus on the lower risk deliveries that you are most likely to attend during your newborn rotation, and what you can expect once the baby is born. Newborn deliveries: Low Risk  Low-risk delivery team members  What constitutes a low-risk delivery page  Differences in Operating Room (OR) versus labor room deliveries  Differences in attending delivery in the delivery room versus the operating room  Operating room attire  Importance of Apgar (timer button) on radiant warmer  Delayed Cord clamping  Delayed cord clamping: When this happens and the importance  Why it matters if umbilical cord is clamped before 1 minute and infant brought to the radiant warmer  Neonatal Resuscitation  NRP guidelines from American Academy of Pediatrics  Pertinent Physical Exam at delivery  Importance of full, efficient exam in delivery room  Need for Higher Level Intervention: Neonatal Intensive Care  Reasons for calling for NICU: high-risk delivery team    Resources/Links:  Neonatal Resuscitation Program (NRP)/American Academy of Pediatrics  Neonatal Resuscitation Program (aap.org)

Today, we’ll be discussing how to evaluate and work up a patient with a suspected eating disorder. We’ll use a general case for an adolescent with an eating disorder to examine the different aspects of care you should be thinking about, from lab work to admission criteria and what to do once the diagnosis is made. How to identify an eating disorder  What to do if you suspect an eating disorder  How to manage eating disorder patients in the outpatient setting or in the hospital  Strategies and tips for talking to teens with eating disorders  Resources/Links:  The American Psychiatric Association Practice Guideline for the Treatment of Patients with Eating Disorders, 2023, https://doi.org/10.1176/appi.books.9780890424865.  Laurie L. Hornberger, Margo A. Lane, THE COMMITTEE ON ADOLESCENCE, Laurie L. Hornberger, Margo Lane, Cora C. Breuner, Elizabeth M. Alderman, Laura K. Grubb, Makia Powers, Krishna Kumari Upadhya, Stephenie B. Wallace, Laurie L. Hornberger, Margo Lane, MD FRCPC, Meredith Loveless, Seema Menon, Lauren Zapata, Liwei Hua, Karen Smith, James Baumberger; Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics January 2021; 147 (1): e2020040279. 10.1542/peds.2020-040279

Antibiotic selection can be complicated. In this episode, we discuss how you should approach choosing the appropriate antibiotic for your pediatric patient. There are multiple considerations, including: What organisms do you want to treat? What does anatomy have to do with antibiotic selection? You also have to think about individual circumstances, such as immunzation status, chronic disease, drug allergies, and environmental exposures. Know what organisms you want to treat Because we often treat empirically, we need to know organisms that typically case this typical infection Narrow-spectrum antibiotics if possible Anatomy of the infection For fever in first 4-6 weeks, think about organisms that infant was exposed to during pregnancy and delivery For respiratory infections, think about organisms that live in the respiratory tract Abnormal anatomy Immunization status of child may change your differential diagnosis Drug allergies Look in medical record and ask patient and family about allergies Consider cross-reactivity of antibiotics Geographic location: resistance patterns Individual circumstances Chronic diseases Environmental exposures   Resources/Links: Up to date: uptodate.com   American Academy of Pediatrics Red Book: https://publications.aap.org/redbook?autologincheck=redirected  Sanford Guide to Antimicrobial therapy: https://www.sanfordguide.com/products/print-guides/?gad=1&gclid=CjwKCAjwtuOlBhBREiwA7agf1oWtsyBrx0OFaHxpG2ZpDTXYukd1JGs5R_ZpRWrECT_v0bqhboN15hoCijIQAvD_BwE American Academy of Pediatrics clinical practice guideline: The Diagnosis and Management of Acute Otitis Media. 2013. https://publications.aap.org/pediatrics/article/131/3/e964/30912/The-Diagnosis-and-Management-of-Acute-Otitis-Media